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Wong CSM, Hung IFN, Kwan MYW, Chung MMH, Chan MWM, Cheng AKC, Lau YM, Yeung CK, Chan HHL, Lau CS. Cutaneous manifestations, viral load, and prognosis among hospitalised patients with COVID-19: a cohort study. Hong Kong Med J 2023; 29:421-431. [PMID: 37853787 DOI: 10.12809/hkmj2210199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Various cutaneous manifestations have been reported as symptoms of coronavirus disease 2019 (COVID-19), which may facilitate early clinical diagnosis and management. This study explored the incidence of cutaneous manifestations among hospitalised patients with COVID-19 and investigated its relationships with viral load, co-morbidities, and outcomes. METHODS This retrospective study included adult patients admitted to a tertiary hospital for COVID-19 from July to September 2020. Clinical information, co-morbidities, viral load (cycle threshold [Ct] value), and outcomes were analysed. RESULTS In total, 219 patients with confirmed COVID-19 were included. Twenty patients presented with new onset of rash. The incidence of new rash was 9.1% (95% confidence interval=6.25%-14.4%). The most common manifestations were maculopapular exanthem (n=6, 42.9%, median Ct value: 24.8), followed by livedo reticularis (n=4, 28.6%, median Ct value: 21.3), varicella-like lesions (n=2, 14.3%, median Ct value: 19.3), urticaria (n=1, 7.1%, median Ct value: 14.4), and acral chilblain and petechiae (n=1, 7.1%, median Ct value: 33.1). The median Ct values for patients with and without rash were 22.9 and 24.1, respectively (P=0.58). There were no significant differences in mortality or hospital stay between patients with and without rash. Patients with rash were more likely to display fever on admission (P<0.01). Regardless of cutaneous manifestations, patients with older age, hypertension, and chronic kidney disease stage ≥3 had significantly higher viral load and mortality (P<0.05). CONCLUSION This study revealed no associations between cutaneous manifestation and viral load or clinical outcomes. Older patients with multiple co-morbidities have risks of high viral load and mortality; they should be closely monitored.
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Affiliation(s)
- C S M Wong
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - I F N Hung
- Division of Infectious Diseases, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M Y W Kwan
- Paediatric Infectious Disease Unit, Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, China
| | - M M H Chung
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M W M Chan
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A K C Cheng
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Y M Lau
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C K Yeung
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - H H L Chan
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C S Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Chan LL, Lam KY, Lam DCM, Lau YM, Li L, Ng KKC, Tang RSY, Chan SL. Risks and impacts of thromboembolism in patients with pancreatic cancer. Hong Kong Med J 2023; 29:396-403. [PMID: 37789507 DOI: 10.12809/hkmj219788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Patients with pancreatic cancer have a high risk of thromboembolism (TE), which may increase mortality. Most relevant studies have been conducted in Western populations. We investigated risk factors for TE in a predominantly Chinese population of patients with pancreatic cancer, along with effects of TE on overall survival. METHODS This retrospective cohort study included patients diagnosed with exocrine pancreatic cancer in Prince of Wales Hospital in Hong Kong between 2010 and 2015. Data regarding patient demographics, World Health Organization performance status, stage, treatment, TE-related information, and time of death (if applicable) were retrieved from electronic medical records. Univariate and multivariable logistic regression analyses were performed to identify risk factors for TE. Survival analyses were performed using Kaplan-Meier analysis and Cox proportional hazards regression. RESULTS In total, 365 patients were included in the study. The overall incidence of TE (14.8%) was lower than in Western populations. In univariate logistic regression analysis, stage IV disease and non-head pancreatic cancer were significantly associated with TE (both P=0.01). Multivariable logistic regression analysis showed that stage IV disease was a significant risk factor (odds ratio=1.08, 95% confidence interval [CI]=1.00-1.17; P=0.046). Median overall survival did not significantly differ between patients with and without TE (4.88 months vs 7.80 months, hazard ratio=1.08, 95% CI=0.80-1.49; P=0.58) and between patients with TE who received anticoagulation treatment or not (5.63 months vs 4.77 months, hazard ratio=0.72, 95% CI=0.40-1.29; P=0.27). CONCLUSION The incidence of TE was low in our Chinese cohort. Stage IV disease increased the risk of TE. Overall survival was not affected by TE or its treatment.
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Affiliation(s)
- L L Chan
- Sir Yue-kong Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K Y Lam
- Department of Medicine, United Christian Hospital, Hong Kong SAR, China
| | - D C M Lam
- Sir Yue-kong Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y M Lau
- Sir Yue-kong Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - L Li
- Sir Yue-kong Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K K C Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - R S Y Tang
- Institute of Digestive Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - S L Chan
- Sir Yue-kong Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Nyaw JSF, Cheung KM, Hioe F, Kam MTY, Lau JKS, Lau YM, Leung DKC, Lim FMY. Best practices in epidermal growth factor receptor T790M testing for advanced non-small-cell lung cancer in Hong Kong. Hong Kong Med J 2023; 29:240-246. [PMID: 37349139 DOI: 10.12809/hkmj219632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
The T790M mutation in the epidermal growth factor receptor gene causes most acquired resistance to firstor second-line epidermal growth factor receptor-tyrosine kinase inhibitors in advanced non-small-cell lung cancer. The results of T790M testing can guide subsequent treatment. Despite the availability of guidelines from international organisations, T790M testing practices in Hong Kong must be streamlined and adapted to the Hospital Authority setting. To address this issue, a panel of experts in oncology and pathology met for discussion of key topics regarding T790M testing practices in Hong Kong, including the appropriate timing of testing and re-testing, as well as optimal testing methods. All panel members voted on the results of the discussion to achieve consensus. Items supported by a majority vote were adopted as consensus statements regarding current best practices for T790M testing in Hong Kong. Among the topics discussed, the panel agreed that T790M testing should be initiated upon radiological progression, including symptomatic disease progression or central nervous system-only progression. The experts also preferred initial testing with liquid biopsy, using the widely available digital polymerase chain reaction platform. This document provides the final consensus statements, as well as a testing and treatment workflow, for clinicians in Hong Kong to use as guidance in T790M testing.
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Affiliation(s)
- J S F Nyaw
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China
| | - K M Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - F Hioe
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - M T Y Kam
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - J K S Lau
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - Y M Lau
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong SAR, China
| | - D K C Leung
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - F M Y Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
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Wong CK, Lau YM, Lui HW, Chan A, San WC, HUANG D, ZHOU MI, Siu CW. NOVEL SMARTPHONE APPLICATION FOR OBTAINING ARTIFICIAL INTELLIGENCE DERIVED DIAGNOSIS FROM PHOTOS OF ELECTROCARDIOGRAM. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Wong CK, Un KC, Zhou M, Cheng Y, Lau YM, Shea PC, Lui HW, Zuo ML, Yin LX, Chan EW, Wong ICK, Sin SWC, Yeung PPN, Chen H, Wibowo S, Wei TLN, Lee SM, Chow A, Tong RCF, Hai J, Tam FCC, Siu CW. Daily ambulatory remote monitoring system for drug escalation in chronic heart failure with reduced ejection fraction: pilot phase of DAVID-HF study. Eur Heart J Digit Health 2022; 3:284-295. [PMID: 36713022 PMCID: PMC9708020 DOI: 10.1093/ehjdh/ztac024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/27/2022] [Accepted: 04/11/2022] [Indexed: 05/04/2023]
Abstract
AIMS Underutilization of guideline-directed heart failure with reduced ejection fraction (HFrEF) medications contributes to poor outcomes. METHODS AND RESULTS A pilot study to evaluate the safety and efficacy of a home-based remote monitoring system for HFrEF management was performed. The system included wearable armband monitors paired with the smartphone application. An HFrEF medication titration algorithm was used to adjust medication daily. The primary endpoint was HFrEF medication utilization at 120 days. Twenty patients (60.5 ± 8.2 years, men: 85%) with HFrEF were recruited. All received angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI) at recruitment; 45% received ≥50% maximal targeted dose (MTD) with % MTD of 44.4 ± 31.7%. At baseline, 90 and 70% received beta-adrenergic blocker and mineralocorticoid receptor antagonist (MRA), 35% received ≥50% MTD beta-adrenergic blocker with % MTD of 34.1 ± 29.6%, and 25% received ≥50% MTD MRA with % MTD of 25.0 ± 19.9%. At 120 days, 70% received ≥50% MTD ACEI/ARB/ARNI (P = 0.110) with % MTD increased to 64.4 ± 33.5% (P = 0.060). The proportion receiving ≥50% MTD ARNI increased from 15 to 55% (P = 0.089) with % MTD ARNI increased from 20.6 ± 30.9 to 53.1 ± 39.5% (P = 0.006*). More patients received ≥50% MTD MRA (65 vs. 25%, P = 0.011*) with % MTD MRA increased from 25.0 ± 19.9 to 46.2 ± 28.8% (P = 0.009*). Ninety-five per cent of patients had reduced NT-proBNP with the percentage reduction of 26.7 ± 19.7%. CONCLUSION Heart failure with reduced ejection fraction medication escalation with remote monitoring appeared feasible.
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Affiliation(s)
- Chun Ka Wong
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ka Chun Un
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mi Zhou
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yangyang Cheng
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuk Ming Lau
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Puigi Catherine Shea
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hin Wai Lui
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ming Liang Zuo
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Li Xue Yin
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Simon Wai Ching Sin
- Respiratory Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Pauline Pui Ning Yeung
- Respiratory Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hao Chen
- Biofourmis Singapore Pte Ltd, Singapore, Singapore
| | - Sandi Wibowo
- Biofourmis Singapore Pte Ltd, Singapore, Singapore
| | | | | | | | | | - Jojo Hai
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Frankie Chor Cheung Tam
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chung Wah Siu
- Corresponding author. Tel: +86 (852) 2255 4694, Fax: +86 (852) 2818 6304,
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Zhou M, Chan EW, Hai JJ, Wong CK, Lau YM, Huang D, Lam CC, Tam CCF, Wong YTA, Yung SYA, Chan KWK, Feng Y, Tan N, Chen JY, Yung CY, Lee KL, Choi CW, Lam H, Ng A, Fan K, Jim MH, Yiu KH, Yan BP, Siu CW. Protocol, rationale and design of DAbigatran for Stroke PreVention In Atrial Fibrillation in MoDerate or Severe Mitral Stenosis (DAVID-MS): a randomised, open-label study. BMJ Open 2020; 10:e038194. [PMID: 32978200 PMCID: PMC7520829 DOI: 10.1136/bmjopen-2020-038194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Current international guidelines recommend non-vitamin K oral anticoagulants (NOACs) for stroke prevention among patients with non-valvular atrial fibrillation (AF) at significant ischaemic stroke risk given the superior safety and comparable efficacy of NOACs over warfarin. Nonetheless, the safety and effectiveness of NOACs have not been evaluated in patients with AF with underlying moderate or severe mitral stenosis (MS), hence the recommended stroke prevention strategy remains warfarin therapy. METHOD AND ANALYSIS MS remains disproportionately prevalent in Asian countries compared with the developed countries. This prospective, randomised, open-label trial with blinded endpoint adjudication aims to evaluate the safety and efficacy of dabigatran for stroke prevention in AF patients with moderate or severe MS. Patients with AF aged ≥18 years with moderate or severe MS not planned for valvular intervention in the coming 12 months will be randomised in a 1:1 ratio to receive dabigatran 110 mg or 150 mg two times per day or warfarin with international normalised ratio 2-3 in an open-label design. Patients with estimated creatinine clearance <30 mL/min, or with a concomitant indication for antiplatelet therapy will be excluded. The primary outcome is a composite of stroke and systemic embolism. Secondary outcomes are ischaemic stroke, systemic embolism, haemorrhagic stroke, intracranial haemorrhage, major bleeding and death. The estimated required sample size is approximately 686 participants. ETHICS AND DISSEMINATION The study protocol has been approved by the Institutional Review Board of the University of Hong Kong and Hong Kong West Cluster, Hospital Authority, Hong Kong for Fung Yiu King Hospital, Grantham Hospital, Queen Mary Hospital and Tung Wah Hospital in Hong Kong. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04045093); pre-results.
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Affiliation(s)
- Mi Zhou
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Esther W Chan
- Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jo Jo Hai
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chun Ka Wong
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuk Ming Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Duo Huang
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cheung Chi Lam
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chor Cheung Frankie Tam
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yiu Tung Anthony Wong
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - See Yue Arthur Yung
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ki Wan Kelvin Chan
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yingqing Feng
- Cardiology Division, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Ning Tan
- Cardiology Division, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Ji-Yan Chen
- Cardiology Division, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
- Cardiology Division, South China University of Technology, Guangzhou, Guangdong, China
| | - Chi Yui Yung
- Cardiology Division, Department of Medicine and Geriatrics, Ruttonjee and Tang Siu Kin Hospital, Hong Kong, Hong Kong SAR, China
| | - Kwok Lun Lee
- Cardiology Division, Department of Medicine and Geriatrics, Ruttonjee and Tang Siu Kin Hospital, Hong Kong, Hong Kong SAR, China
| | - Chun Wai Choi
- Cardiology Division, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong SAR, China
| | - Ho Lam
- Cardiology Division, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong SAR, China
| | - Andrew Ng
- Cardiac Medical Unit, Grantham Hospital, Hong Kong, Hong Kong SAR, China
| | - Katherine Fan
- Cardiac Medical Unit, Grantham Hospital, Hong Kong, Hong Kong SAR, China
| | - Man Hong Jim
- Cardiac Medical Unit, Grantham Hospital, Hong Kong, Hong Kong SAR, China
| | - Kai Hang Yiu
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Bryan P Yan
- Cardiology Division, Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chung Wah Siu
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Wong CK, Ho DTY, Tam AR, Zhou M, Lau YM, Tang MOY, Tong RCF, Rajput KS, Chen G, Chan SC, Siu CW, Hung IFN. Artificial intelligence mobile health platform for early detection of COVID-19 in quarantine subjects using a wearable biosensor: protocol for a randomised controlled trial. BMJ Open 2020; 10:e038555. [PMID: 32699167 PMCID: PMC7380847 DOI: 10.1136/bmjopen-2020-038555] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an outbreak of COVID-19 worldwide. As there is no effective therapy or vaccine yet, rigorous implementation of traditional public health measures such as isolation and quarantine remains the most effective tool to control the outbreak. When an asymptomatic individual with COVID-19 exposure is being quarantined, it is necessary to perform temperature and symptom surveillance. As such surveillance is intermittent in nature and highly dependent on self-discipline, it has limited effectiveness. Advances in biosensor technologies made it possible to continuously monitor physiological parameters using wearable biosensors with a variety of form factors. OBJECTIVE To explore the potential of using wearable biosensors to continuously monitor multidimensional physiological parameters for early detection of COVID-19 clinical progression. METHOD This randomised controlled open-labelled trial will involve 200-1000 asymptomatic subjects with close COVID-19 contact under mandatory quarantine at designated facilities in Hong Kong. Subjects will be randomised to receive a remote monitoring strategy (intervention group) or standard strategy (control group) in a 1:1 ratio during the 14 day-quarantine period. In addition to fever and symptom surveillance in the control group, subjects in the intervention group will wear wearable biosensors on their arms to continuously monitor skin temperature, respiratory rate, blood pressure, pulse rate, blood oxygen saturation and daily activities. These physiological parameters will be transferred in real time to a smartphone application called Biovitals Sentinel. These data will then be processed using a cloud-based multivariate physiology analytics engine called Biovitals to detect subtle physiological changes. The results will be displayed on a web-based dashboard for clinicians' review. The primary outcome is the time to diagnosis of COVID-19. ETHICS AND DISSEMINATION Ethical approval has been obtained from institutional review boards at the study sites. Results will be published in peer-reviewed journals.
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Affiliation(s)
- Chun Ka Wong
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Deborah Tip Yin Ho
- Division of Infectious Diseases, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony Raymond Tam
- Division of Infectious Diseases, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mi Zhou
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yuk Ming Lau
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Milky Oi Yan Tang
- Division of Infectious Diseases, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Gengbo Chen
- Research and Development, Biofourmis, Singapore
| | | | - Chung Wah Siu
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Ivan Fan Ngai Hung
- Division of Infectious Diseases, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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Lau YM, Tse HF. A Woman in Her 50s With Dyspnea, Palpitation, and Severely Elevated Pulmonary Artery Pressure. JAMA Cardiol 2020; 5:842. [DOI: 10.1001/jamacardio.2020.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yuk Ming Lau
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Hung Fat Tse
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Cheung JPY, Cheung PWH, Law K, Borse V, Lau YM, Mak LF, Cheng A, Samartzis D, Cheung KMC. Postoperative Rigid Cervical Collar Leads to Less Axial Neck Pain in the Early Stage After Open-Door Laminoplasty-A Single-Blinded Randomized Controlled Trial. Neurosurgery 2020; 85:325-334. [PMID: 30113664 DOI: 10.1093/neuros/nyy359] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cervical collars are used after laminoplasty to protect the hinge opening, reduce risks of hinge fractures, and avoid spring-back phenomena. However, their use may lead to reduced range of motion and worse neck pain. OBJECTIVE To investigate the clinical, radiological, and functional outcomes of patients undergoing single-door laminoplasty with or without collar immobilization. METHODS This was a prospective, parallel, single-blinded randomized controlled trial. Patients underwent standardized single-door laminoplasty with mini-plates for cervical myelopathy and were randomly allocated into 2 groups based on the use of collar postoperatively. Clinical assessments included cervical range of motion, axial neck pain (VAS [visual analogue scale]), and objective scores (short-form 36-item, neck disability index, and modified Japanese Orthopaedic Association). All assessments were performed preoperatively and at postoperative 1, 2, 3, and 6 wk, and 3, 6, and 12 mo. Comparative analysis was performed via analysis of variance adjusted by baseline scores, sex, and age as covariates. RESULTS A total of 35 patients were recruited and randomized to collar use (n = 16) and without (n = 19). There were no dropouts or complications. There were no differences between groups at baseline. Subjects had comparable objective scores and range of motion at postoperative time-points. Patients without collar use had higher VAS at postoperative 1 wk (5.4 vs 3.5; P = .038) and 2 wk (3.5 vs 1.5; P = .028) but subsequently follow-up revealed no differences between the 2 groups. CONCLUSION The use of a rigid collar after laminoplasty leads to less axial neck pain in the first 2 wk after surgery. However, there is no additional benefit with regards to range of motion, quality of life, and complication risk.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Karlen Law
- Department of Occupational Therapy, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR, China
| | - Vishal Borse
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yuk Ming Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ling Fung Mak
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Aldous Cheng
- Department of Physiotherapy, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Lee YK, Lau YM, Ran X, Cai ZJ, Lai WH, Siu CW, Tse HF. P5714Disease modeling of laminopathy-related dilated cardiomyopathy (DCM) - Proarrhythmic effects and electrical-contraction (EC) coupling defeats due to altered mechanosensitivity of lamin A. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y K Lee
- The University of Hong Kong, Department of Medicine, Division of Cardiology, Hong Kong, Hong Kong SAR People's Republic of China
| | - Y M Lau
- The University of Hong Kong, Department of Medicine, Division of Cardiology, Hong Kong, Hong Kong SAR People's Republic of China
| | - X Ran
- The University of Hong Kong, Department of Medicine, Division of Cardiology, Hong Kong, Hong Kong SAR People's Republic of China
| | - Z J Cai
- The University of Hong Kong, Department of Medicine, Division of Cardiology, Hong Kong, Hong Kong SAR People's Republic of China
| | - W H Lai
- The University of Hong Kong, Department of Medicine, Division of Cardiology, Hong Kong, Hong Kong SAR People's Republic of China
| | - C W Siu
- The University of Hong Kong, Department of Medicine, Division of Cardiology, Hong Kong, Hong Kong SAR People's Republic of China
| | - H F Tse
- The University of Hong Kong, Department of Medicine, Division of Cardiology, Hong Kong, Hong Kong SAR People's Republic of China
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11
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Wong MMC, Chan CF, Li SW, Lau YM. Six-month Follow-up of Cognitive Impairment and Depressive Symptoms in Late-onset Depression. East Asian Arch Psychiatry 2015; 25:146-149. [PMID: 26764288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess cognitive performance in elderly depressed patients following treatment for 6 months. Remission rate of depression after 6 months of treatment was calculated. METHODS The study was performed in a consecutive group of patients aged ≥ 65 years with late-onset depression. Severity of depression was assessed by the Hamilton Depression Scale, cognitive performance by the Hong Kong Montreal Cognitive Assessment, and functional level by the Instrumental Activities of Daily Living Scale. RESULTS A total of 52 patients were recruited. In all, 28 (53.8%) were found to have cognitive impairment at baseline and 8 (28.6%) of them had improvement after 6 months. This cognitively impaired group was older and had a lower Instrumental Activities of Daily Living Scale score. The remission rate of depression was 61.5%. CONCLUSIONS Cognitive impairment constituted a stable feature in a considerable number of elderly patients with depression. About two-thirds of patients achieved remission of depression after 6 months of treatment.
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Affiliation(s)
- M M C Wong
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong SAR, China
| | - C F Chan
- Castle Peak Hospital, 1/F, Block F, Tuen Mun, Hong Kong SAR, China
| | - S W Li
- Castle Peak Hospital, 1/F, Block F, Tuen Mun, Hong Kong SAR, China
| | - Y M Lau
- Castle Peak Hospital, 1/F, Block F, Tuen Mun, Hong Kong SAR, China
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12
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Affiliation(s)
- Y M Lau
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
| | - Y K Lam
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
| | - K H Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
| | - S Y Lin
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
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13
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Yang MKW, Lau YM, Lo FH, Lam YK, Lin SY. Hepatosplenic candidiasis complicating acute myeloid leukaemia. Hong Kong Med J 2011; 17:252-253. [PMID: 21636876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Michael K W Yang
- Department of Radiology, United Christian Hospital, Kwun Tong, Hong Kong
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14
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Wong MMC, Tsui CF, Li SW, Chan CF, Lau YM. Patients committing suicide whilst under the care of the elderly suicide prevention programme of a regional hospital in Hong Kong. East Asian Arch Psychiatry 2011; 21:17-21. [PMID: 21837852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine the risk factors for suicide in elderly Hong Kong Chinese. METHODS Case notes, mortality reports and hospital records of all the patients, who committed suicide from 1 July 2002 to 31 March 2010 whilst under the active care of the Elderly Suicide Prevention Programme of the Castle Peak Hospital in Hong Kong, were reviewed. RESULTS A total of 1230 elderly with high risk of suicide were assessed and treated from 1 July 2002 to March 2010. A total of 8 patients in this programme who committed suicide during this period were identified, of whom 63% were male and the most frequent method employed was jumping from a height. All the suicides ensued within the first 6 weeks of treatment under the programme. All these patients were diagnosed to have a depressive illness, and all but 1 had an associated physical illness that possibly precipitated the suicide. They had all been admitted to either a mental or general hospital, about 1 month before committing suicide. CONCLUSIONS The first 2 months of treatment is associated with the highest risk of suicide. Intensive care and support with proper education about effects of antidepressants, and the building-up of a trusted therapeutic alliance with close relatives are particularly important in this vulnerable period.
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Affiliation(s)
- M M C Wong
- Castle Peak Hospital, Tuen Mun, Hong, Kong SAR, China.
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15
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Kotaka M, Lau YM, Cheung KK, Lee SM, Li HY, Chan WY, Fung KP, Lee CY, Waye MM, Tsui SK. Elfin is expressed during early heart development. J Cell Biochem 2001; 83:463-72. [PMID: 11596114 DOI: 10.1002/jcb.1244] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Elfin (previously named CLIM1) is a protein that possesses an N-terminal PDZ domain and a C-terminal LIM domain. It belongs to the family of Enigma proteins. Enigma proteins are a family of cytoplasmic proteins that contain an N-terminal PDZ domain and a series of C-terminal LIM domains. By virtue of these two protein interacting domains, Enigma proteins are capable of protein-protein interactions. It has been proposed that Enigma proteins may act as adapters between kinases and the cytoskeleton. We have previously shown that Elfin is most abundantly expressed in the heart and it colocalizes with alpha-actinin 2 at the Z-disks of the myocardium. In this report, Elfin was shown to localize at the actin stress fibers of myoblasts, as revealed by green fluorescent protein (GFP) tagging. In situ hybridization and immunostaining showed that Elfin expression begins at an early stage in mouse development and is present throughout the developing heart. Taken together, our experimental results suggest that Elfin may play an important role in myofibrillogenesis and heart development.
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Affiliation(s)
- M Kotaka
- Department of Biochemistry, The Chinese University of Hong Kong, Hong Kong
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16
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Chuang MW, Lau YM, Tung JN, Tung JC, Chen PM. [Thymoma with pure red cell aplasia and hemophagocytic syndrome--one case report]. Zhonghua Yi Xue Za Zhi (Taipei) 1991; 47:208-12. [PMID: 1848151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Erythropoietic hypoplasia occurring in the absence of abnormalities in the leukopoietic and thrombocytopoietic series is often defined as "pure red cell aplasia" (PRCA). This condition may appear as an acquired defect of either acute or chronic type, and a congenital form as well. The chronic form of acquired PRCA occurred mostly in adults. It has been reported that a demonstrable thymoma occurred in more than 50% of patients with PRCA. Recent studies suggested that it may contribute to several immune mechanisms. Here we report a case of thymoma with PRCA whose clinical presentations include severe anemia, shock with severe metabolic acidosis, high levels of several organ enzymes (SGOT, SGPT, LDH, CPK, Amylase) and acute renal shutdown with similar manifestations to septic shock. Our explanation to his condition is multi-organ tissue hypoxia caused by severe anemia. Hemophagocytic syndrome was found by the repeated bone marrow smear before death. The clinical course of this patient was so impressive as to be presented here for discussion.
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Affiliation(s)
- M W Chuang
- Section of Hematology-Oncology, Sha-Lu Tung General Hospital
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