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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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Zhou M, Huang D, Cheng Y, Lau YM, Lai WH, Lau YM, Hai J, Lau CP, Chan EW, Yue WS, Zuo ML, Yin LX, Feng Y, Tan N, Chen J, Li XL, Tse HF, Lee CH, Chow WS, Siu CW, Wong CK. Opportunistic screening for asymptomatic left ventricular dysfunction in type 2 diabetes mellitus. Postgrad Med J 2023; 99:476-483. [PMID: 37294724 DOI: 10.1136/postgradmedj-2022-141548] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 01/13/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND International guidelines recommend natriuretic peptide biomarker-based screening for patients at high heart failure (HF) risk to allow early detection. There have been few reports about the incorporation of screening procedure to existing clinical practice. OBJECTIVE To implement screening of left ventricular dysfunction in patients with type 2 diabetes mellitus (DM). METHOD A prospective screening study at the DM complication screening centre was performed. RESULTS Between 2018 and 2019, 1043 patients (age: 63.7±12.4 years; male: 56.3%) with mean glycated haemoglobin of 7.25%±1.34% were recruited. 81.8% patients had concomitant hypertension, 31.1% had coronary artery disease, 8.0% had previous stroke, 5.5% had peripheral artery disease and 30.7% had chronic kidney disease (CKD) stages 3-5. 43 patients (4.1%) had an elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration above the age-specific diagnostic thresholds for HF, and 43 patients (4.1%) had newly detected atrial fibrillation (AF). The prevalence of elevated NT-proBNP increased with age from 0.85% in patients aged <50 years to 7.14% in those aged 70-79 years and worsening kidney function from 0.43% in patients with CKD stage 1 to 42.86% in CKD stage 5. In multivariate logistic regression, male gender (OR: 3.67 (1.47-9.16), p = 0.005*), prior stroke (OR: 3.26 (1.38-7.69), p = 0.007*), CKD (p<0.001*) and newly detected AF (OR: 7.02 (2.65-18.57), p<0.001*) were significantly associated with elevated NT-proBNP. Among patients with elevated NT-proBNP, their mean left ventricular ejection fraction (LVEF) was 51.4%±14.7%, and 45% patients had an LVEF <50%. CONCLUSION NT-proBNP and ECG screening could be implemented with relative ease to facilitate early detection of cardiovascular complication and improve long-term outcomes.
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Affiliation(s)
- Mi Zhou
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Duo Huang
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yangyang Cheng
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yee Man Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Wing Hon Lai
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yuk-Ming Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - JoJo Hai
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Chu Pak Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Esther W Chan
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wen Sheng Yue
- Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ming-Liang Zuo
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Li Xue Yin
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Xin Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Ho Lee
- Endocrinology Division, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wing-Sun Chow
- Endocrinology Division, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chung Wah Siu
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Chun Ka Wong
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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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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5
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Wong CK, Hai JJ, Lau YM, Zhou M, Lui HW, Lau KK, Chan KH, Mok TM, Liu Y, Feng Y, Tan N, Tam WC, Tam KC, Feng X, Zuo ML, Yin LX, Tan J, Zhang WJ, Jiang X, Huang X, Ye J, Liang Y, Jiang W, Lei Z, Huang D, Yue WS, Tan G, Yan BP, Evora MA, Chen JY, Siu CW. Protocol for Home-Based Solution for Remote Atrial Fibrillation Screening to Prevent Recurrence Stroke (HUA-TUO AF Trial): a randomised controlled trial. BMJ Open 2022; 12:e053466. [PMID: 35840293 PMCID: PMC9295642 DOI: 10.1136/bmjopen-2021-053466] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Current international guidelines recommend ECG monitoring after an ischaemic stroke to detect atrial fibrillation (AF) in order to prevent stroke recurrence. However, optimal strategies to detect AF and the downstream management to prevent stroke recurrence remain to be established. The objective of the study was to explore the use of long-term home-based ECG monitoring for AF detection and stroke prevention in patients with a history of stroke. METHODS AND ANALYSIS This prospective, randomised, open-label trial with blinded endpoint adjudication aimed to evaluate the efficacy of long-term home-based ECG monitoring for AF detection and stroke prevention in a 24-month period. Patients aged >18 years with a history of ischaemic stroke will be stratified according to the time from the index ischaemic stroke: <1, 1-3 and >3 years and then randomised in 1:1 to (1) home-based AF screening and (2) control. The home-based AF screening system comprises (1) a handheld single-lead ECG recorder (Comfit Healthcare Devices, Hong Kong SAR, China) and (2) a patient-facing smartphone application specially designed for the study. Patients randomised to the home-based AF group will record a 30 s single-lead ECG using a specially designed handheld ECG device every morning or when symptomatic. All remotely obtained data will be automatically transmitted in real-time through the study smartphone application to a secured cloud hosting and analysed using an artificial intelligence-based diagnostic system. When a diagnosis of AF is made with the system, the patients will be called back for a formal cardiology consultation within 1 week. The primary endpoint is the time to first detection of AF at 24 months of follow-up. Secondary endpoints include recurrent stroke or transient ischaemic attack, initiation of long-term anticoagulation therapy, hospitalisation for heart failure, cardiovascular death and all-cause death. 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 SAR, China. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04523649.
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Affiliation(s)
- Chun Ka Wong
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Jo Jo Hai
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yuk-Ming Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mi Zhou
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Hin-Wai Lui
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Kui Kai Lau
- Neurology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Koon-Ho Chan
- Neurology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Toi Meng Mok
- Department of Medicine, Centro Hospitalar Conde de São Januário, Macau, Macau, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Weng-Chio Tam
- Department of Medicine, Centro Hospitalar Conde de São Januário, Macau, Macau, China
| | - Kun-Chong Tam
- Department of Cardiology, Kiang Wu Hospital, Macau, Macau, China
| | - Xiuhua Feng
- Department of Cardiology, Kiang Wu Hospital, Macau, Macau, China
| | - Ming-Liang Zuo
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
| | - Li-Xue Yin
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
| | - Jing Tan
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliated Wenjiang Hospital, Chengdu, China
| | - Wen-Jun Zhang
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliated Wenjiang Hospital, Chengdu, China
| | - Xiaofei Jiang
- Department of Cardiology, Zhuhai People's Hospital, Zhuhai, China
| | - Xiaoyu Huang
- Department of Cardiology, People's Hospital of Yangjiang, Yangjiang, Guangdong, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Guangdong, China
| | - Wei Jiang
- Department of Cardiology, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Zhen Lei
- Department of Cardiology, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Duo Huang
- Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Wen-Sheng Yue
- Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Guanming Tan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mario Alberto Evora
- Department of Medicine, Centro Hospitalar Conde de São Januário, Macau, Macau, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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Zhou M, Huang D, Cheng Y, Lau YM, Lai WH, Lau YM, Hai J, Lau CP, Chan EW, Yue WS, Zuo ML, Yin LX, Feng Y, Tan N, Chen J, Li XL, Tse HF, Lee CH, Chow WS, Siu CW, Wong CK. Opportunistic screening for asymptomatic left ventricular dysfunction in type 2 diabetes mellitus. Postgrad Med J 2022:7130985. [PMID: 37076445 DOI: 10.1136/postmj/postgradmedj-2022-141548] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/16/2022] [Indexed: 04/21/2023]
Abstract
BACKGROUND International guidelines recommend natriuretic peptide biomarker-based screening for patients at high heart failure (HF) risk to allow early detection. There have been few reports about the incorporation of screening procedure to existing clinical practice. OBJECTIVE To implement screening of left ventricular dysfunction in patients with type 2 diabetes mellitus (DM). METHOD A prospective screening study at the DM complication screening centre was performed. RESULTS Between 2018 and 2019, 1043 patients (age: 63.7±12.4 years; male: 56.3%) with mean glycated haemoglobin of 7.25%±1.34% were recruited. 81.8% patients had concomitant hypertension, 31.1% had coronary artery disease, 8.0% had previous stroke, 5.5% had peripheral artery disease and 30.7% had chronic kidney disease (CKD) stages 3-5. 43 patients (4.1%) had an elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration above the age-specific diagnostic thresholds for HF, and 43 patients (4.1%) had newly detected atrial fibrillation (AF). The prevalence of elevated NT-proBNP increased with age from 0.85% in patients aged <50 years to 7.14% in those aged 70-79 years and worsening kidney function from 0.43% in patients with CKD stage 1 to 42.86% in CKD stage 5. In multivariate logistic regression, male gender (OR: 3.67 (1.47-9.16), p = 0.005*), prior stroke (OR: 3.26 (1.38-7.69), p = 0.007*), CKD (p<0.001*) and newly detected AF (OR: 7.02 (2.65-18.57), p<0.001*) were significantly associated with elevated NT-proBNP. Among patients with elevated NT-proBNP, their mean left ventricular ejection fraction (LVEF) was 51.4%±14.7%, and 45% patients had an LVEF <50%. CONCLUSION NT-proBNP and ECG screening could be implemented with relative ease to facilitate early detection of cardiovascular complication and improve long-term outcomes.
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Affiliation(s)
- Mi Zhou
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Duo Huang
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yangyang Cheng
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yee Man Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Wing Hon Lai
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yuk-Ming Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - JoJo Hai
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Chu Pak Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Esther W Chan
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wen Sheng Yue
- Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ming-Liang Zuo
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Li Xue Yin
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Xin Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Ho Lee
- Endocrinology Division, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wing-Sun Chow
- Endocrinology Division, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chung Wah Siu
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Chun Ka Wong
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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Lau YM, Trendell-Smith NJ, Yeung CK, Wong SM, Chan HLH, Chan WMM. Graft-versus-host-disease-like disease in a patient with thymic lipomatosis. J Dermatol 2021; 48:e458-e459. [PMID: 34265106 DOI: 10.1111/1346-8138.16011] [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] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Yuk-Ming Lau
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | | | - Chi-Keung Yeung
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sze-Man Wong
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hin-Lee Henry Chan
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wai-Man Mandy Chan
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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8
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Un KC, Wong CK, Lau YM, Lee JCY, Tam FCC, Lai WH, Lau YM, Chen H, Wibowo S, Zhang X, Yan M, Wu E, Chan SC, Lee SM, Chow A, Tong RCF, Majmudar MD, Rajput KS, Hung IFN, Siu CW. Observational study on wearable biosensors and machine learning-based remote monitoring of COVID-19 patients. Sci Rep 2021; 11:4388. [PMID: 33623096 PMCID: PMC7902655 DOI: 10.1038/s41598-021-82771-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/21/2021] [Indexed: 01/11/2023] Open
Abstract
Patients infected with SARS-CoV-2 may deteriorate rapidly and therefore continuous monitoring is necessary. We conducted an observational study involving patients with mild COVID-19 to explore the potentials of wearable biosensors and machine learning-based analysis of physiology parameters to detect clinical deterioration. Thirty-four patients (median age: 32 years; male: 52.9%) with mild COVID-19 from Queen Mary Hospital were recruited. The mean National Early Warning Score 2 (NEWS2) were 0.59 ± 0.7. 1231 manual measurement of physiology parameters were performed during hospital stay (median 15 days). Physiology parameters obtained from wearable biosensors correlated well with manual measurement including pulse rate (r = 0.96, p < 0.0001) and oxygen saturation (r = 0.87, p < 0.0001). A machine learning-derived index reflecting overall health status, Biovitals Index (BI), was generated by autonomous analysis of physiology parameters, symptoms, and other medical data. Daily BI was linearly associated with respiratory tract viral load (p < 0.0001) and NEWS2 (r = 0.75, p < 0.001). BI was superior to NEWS2 in predicting clinical worsening events (sensitivity 94.1% and specificity 88.9%) and prolonged hospitalization (sensitivity 66.7% and specificity 72.7%). Wearable biosensors coupled with machine learning-derived health index allowed automated detection of clinical deterioration.
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Affiliation(s)
- Ka-Chun Un
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chun-Ka Wong
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuk-Ming Lau
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jeffrey Chun-Yin Lee
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Frankie Chor-Cheung Tam
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wing-Hon Lai
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yee-Man Lau
- Cardiology Division, Department 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
| | | | - Minghao Yan
- Biofourmis Singapore Pte. Ltd, Singapore, Singapore
| | - Esther Wu
- Biofourmis Singapore Pte. Ltd, Singapore, Singapore
| | | | | | | | | | | | | | - Ivan Fan-Ngai Hung
- Infectious Diseases Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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9
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Zhou M, Wong CK, Un KC, Lau YM, Lee JCY, Tam FCC, Lau YM, Lai WH, Tam AR, Lam YY, Pang P, Tong T, Tang M, Tse HF, Ho D, Ng MY, Chan EW, Wong ICK, Lau CP, Hung IFN, Siu CW. Cardiovascular sequalae in uncomplicated COVID-19 survivors. PLoS One 2021; 16:e0246732. [PMID: 33571321 PMCID: PMC7877588 DOI: 10.1371/journal.pone.0246732] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background A high proportion of COVID-19 patients were reported to have cardiac involvements. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance. Methods We performed a systematic cardiac screening for 97 consecutive COVID-19 survivors including electrocardiogram (ECG), echocardiography, serum troponin and NT-proBNP assay 1–4 weeks after hospital discharge. Treadmill exercise test and cardiac magnetic resonance imaging (CMR) were performed according to initial screening results. Results The mean age was 46.5 ± 18.6 years; 53.6% were men. All were classified with non-severe disease without overt cardiac manifestations and did not require intensive care. Median hospitalization stay was 17 days and median duration from discharge to screening was 11 days. Cardiac abnormalities were detected in 42.3% including sinus bradycardia (29.9%), newly detected T-wave abnormality (8.2%), elevated troponin level (6.2%), newly detected atrial fibrillation (1.0%), and newly detected left ventricular systolic dysfunction with elevated NT-proBNP level (1.0%). Significant sinus bradycardia with heart rate below 50 bpm was detected in 7.2% COVID-19 survivors, which appeared to be self-limiting and recovered over time. For COVID-19 survivors with persistent elevation of troponin level after discharge or newly detected T wave abnormality, echocardiography and CMR did not reveal any evidence of infarct, myocarditis, or left ventricular systolic dysfunction. Conclusion Cardiac abnormality is common amongst COVID-survivors with mild disease, which is mostly self-limiting. Nonetheless, cardiac surveillance in form of ECG and/or serum biomarkers may be advisable to detect more severe cardiac involvement including atrial fibrillation and left ventricular dysfunction.
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Affiliation(s)
- Mi Zhou
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Chun-Ka Wong
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Ka-Chun Un
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Yuk-Ming Lau
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | | | - Frankie Chor-Cheung Tam
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Yee-Man Lau
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Wing-Hon Lai
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Anthony Raymond Tam
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | | | - Polly Pang
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Teresa Tong
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Milky Tang
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Deborah Ho
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, the University of Hong Kong, Hong Kong SAR, China
| | - Esther W. Chan
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, the University of Hong Kong, Hong Kong SAR, China
| | - Ian C. K. Wong
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, the University of Hong Kong, Hong Kong SAR, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Ivan Fan-Ngai Hung
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (IFNH)
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (IFNH)
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10
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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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Lau YM, Lo CH, Lee KLF, Lau CP. Asystole in focal epilepsy complicating a traumatic subdural hematoma. J Arrhythm 2017; 33:330-332. [PMID: 28765766 PMCID: PMC5529326 DOI: 10.1016/j.joa.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/28/2016] [Accepted: 01/12/2017] [Indexed: 11/28/2022] Open
Abstract
Ictal asystole due to sinus node suppression is a cause of sudden unexplained death in epilepsy. Here, for the first time, we describe a complete atrioventricular nodal block in a patient with non-compressive traumatic subdural hematoma, who developed ictal asystole as a delayed presentation. A leadless VVI pacemaker (ventricular paced, ventricular sensed, and pacing inhibited in response to a sensed beat) was implanted as a preventive measure against seizure-related heart block.
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Affiliation(s)
- Yuk-Ming Lau
- Cardiac Health Heart Centre, Room 1303, Pedder Building, Hong Kong
| | - Chi-Hung Lo
- Department of Medicine, St. Paul׳s Hospital, Eastern Hospital Road, Causeway Bay, Hong Kong
| | | | - Chu-Pak Lau
- Cardiac Health Heart Centre, Room 1303, Pedder Building, Hong Kong
- Correspondence to: Cardiac Health Heart Centre, Suite 1303, Central Building, 3 Pedder Street, Central, Hong Kong. Fax: +852 28557610.Cardiac Health Heart Centre, Department of Medicine, University of Hong Kong Room1303, Central Building, 3 Pedder Street, CentralHong Kong
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12
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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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13
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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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14
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Affiliation(s)
- Yuk-Ming Lau
- Department of medicine, The University of Hong Kong, Queen Mary Hospital
| | - Wai-Mo Hui
- Department of medicine, The University of Hong Kong, Queen Mary Hospital
| | - Chu-Pak Lau
- Department of medicine, The University of Hong Kong, Queen Mary Hospital.
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15
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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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16
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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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17
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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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18
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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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