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Mishra SK, Baidya S, Bhattarai A, Shrestha S, Homagain S, Rayamajhee B, Hui A, Willcox M. Bacteriology of endotracheal tube biofilms and antibiotic resistance: a systematic review. J Hosp Infect 2024; 147:146-157. [PMID: 38522561 DOI: 10.1016/j.jhin.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
Bacteria commonly adhere to surfaces and produce polymeric material to encase the attached cells to form communities called biofilms. Within these biofilms, bacteria can appear to be many times more resistant to antibiotics or disinfectants. This systematic review explores the prevalence and microbial profile associated with biofilm production of bacteria isolated from endotracheal tubes and its associations with antimicrobial resistance. A comprehensive search was performed on databases PubMed, Embase, and Google Scholar for relevant articles published between 1st January 2000 and 31st December 2022. The relevant articles were exported to Mendeley Desktop 1.19.8 and screened by title and abstract, followed by full text screening based on the eligibility criteria of the study. Quality assessment of the studies was performed using the Newcastle-Ottawa Scale (NOS) customized for cross-sectional studies. Furthermore, the prevalence of antimicrobial resistance in biofilm-producers isolated from endotracheal tube specimens was investigated. Twenty studies encompassing 981 endotracheal tubes met the eligibility criteria. Pseudomonas spp. and Acinetobacter spp. were predominant isolates among the biofilm producers. These biofilms provided strong resistance against commonly used antibiotics. The highest resistance rate observed in Pseudomonas spp. was against fluoroquinolones whereas the least resistance was seen against piperacillin-tazobactam. A similar trend of susceptibility was observed in Acinetobacter spp. with a very high resistance rate against fluoroquinolones, third-generation cephalosporins and carbapenems. In conclusion, endotracheal tubes were associated with colonization by biofilm forming bacteria with varying levels of antimicrobial resistance. Biofilms may promote the occurrence of recalcitrant infections in endotracheal tubes which need to be managed with appropriate protocols and antimicrobial stewardship. Research focus should shift towards meticulous exploration of biofilm-associated infections to improve detection and management.
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Affiliation(s)
- S K Mishra
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia; Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - S Baidya
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - A Bhattarai
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - S Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - S Homagain
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - B Rayamajhee
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia
| | - A Hui
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia; Center for Ocular Research and Education, School of Optometry &Vision Science, University of Waterloo, Ontario, Canada
| | - M Willcox
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia
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Hui A, Yin J, Liu W, Zheng K. 18P Prolonged in-use stability of reconstituted atezolizumab in commercial intravenous bags. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.171] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Si L, Mao L, Zhou L, Li C, Wang X, Cui C, Sheng X, Chi Z, Lian B, Tang B, Yan X, Li S, Bai X, Dai J, Kong Y, Lin L, Zhang J, Wu Z, Hui A, Guo J. A phase Ia/Ib clinical study to evaluate the safety, pharmacokinetics (PK) and preliminary anti-tumour activity of FCN-159 in patients with advanced melanoma harboring NRAS-aberrant (Ia) and NRAS-mutation (Ib). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.065] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bryant-Stephens T, Kenyon C, Apter AJ, Wolk C, Williams YS, Localio R, Toussaint K, Hui A, West C, Stewart Y, McGinnis S, Gutierrez M, Beidas R. Creating a community-based comprehensive intervention to improve asthma control in a low-income, low-resourced community. J Asthma 2019; 57:820-828. [PMID: 31082287 DOI: 10.1080/02770903.2019.1619083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Asthma evidence-based interventions (EBI) are implemented in the home, school, community or primary care setting. Although families are engaged in one setting, they often have to navigate challenges in another setting.Objective: Our objective is to design and implement a comprehensive plan which integrates EBI's and connects the four sectors in underserved communities such as Philadelphia.Methods: September 2015-April 2016 we implemented a three-pronged strategy to understand needs and resources of the community including 1) focus groups and key informant interviews, 2) secondary data analysis and 3) pilot testing for implementation to determine gaps in care, and opportunities to overcome those gaps.Results: Analysis of the focus group and key informant responses showed themes: diagnosis fear, clinician time, home and school asthma trigger exposures, school personnel training and communication gaps across all four sectors. EBI's were evaluated and selected to address identified themes. Pilot testing of a community health worker (CHW) intervention to connect home, primary care and school resulted in an efficient transfer of asthma medications and medication administration forms to the school nurse office for students with uncontrolled asthma addressing a common delay leading to poor asthma management in school.Conclusion: Thus far there has been limited success in reducing asthma disparities for low-income minority children. This study offers hope that strategically positioning CHWs may work synergistically to close gaps in care and result in improved asthma control and reduced asthma disparities.
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Affiliation(s)
- Tyra Bryant-Stephens
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.,University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - C Kenyon
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.,University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - A J Apter
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - Courtney Wolk
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA.,Department of Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Yolanda S Williams
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA
| | - R Localio
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - K Toussaint
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA
| | - A Hui
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - C West
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | | | - S McGinnis
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - M Gutierrez
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - R Beidas
- Department of Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, PA, USA
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Hui ACF, Man CY, Wong HC. Management of Status Epilepticus. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790200900405] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Status epilepticus is due to a range of insults to the central nervous system and results in significant mortality rates, especially in the elderly. We review the current management of this disorder in light of the latest developments from recent trials and guidelines. Important principles in management includes early recognition of status epilepticus, identification of the underlying cause and prompt treatment to terminate seizures and reduce complications. The differentiation diagnosis, role of electroencephalographic monitoring and different treatment regimes are examined.
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Affiliation(s)
| | - CY Man
- Prince of Wales Hospital, Department of Accident and Emergency Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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De Alba R, Massel F, Storch IR, Abhilash TS, Hui A, McEuen PL, Craighead HG, Parpia JM. Tunable phonon-cavity coupling in graphene membranes. Nat Nanotechnol 2016; 11:741-6. [PMID: 27294504 DOI: 10.1038/nnano.2016.86] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/26/2016] [Indexed: 05/05/2023]
Abstract
A major achievement of the past decade has been the realization of macroscopic quantum systems by exploiting the interactions between optical cavities and mechanical resonators. In these systems, phonons are coherently annihilated or created in exchange for photons. Similar phenomena have recently been observed through phonon-cavity coupling-energy exchange between the modes of a single system mediated by intrinsic material nonlinearity. This has so far been demonstrated primarily for bulk crystalline, high-quality-factor (Q > 10(5)) mechanical systems operated at cryogenic temperatures. Here, we propose graphene as an ideal candidate for the study of such nonlinear mechanics. The large elastic modulus of this material and capability for spatial symmetry breaking via electrostatic forces is expected to generate a wealth of nonlinear phenomena, including tunable intermodal coupling. We have fabricated circular graphene membranes and report strong phonon-cavity effects at room temperature, despite the modest Q factor (∼100) of this system. We observe both amplification into parametric instability (mechanical lasing) and the cooling of Brownian motion in the fundamental mode through excitation of cavity sidebands. Furthermore, we characterize the quenching of these parametric effects at large vibrational amplitudes, offering a window on the all-mechanical analogue of cavity optomechanics, where the observation of such effects has proven elusive.
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Affiliation(s)
- R De Alba
- Department of Physics, Cornell University, Ithaca, New York 14853, USA
| | - F Massel
- Department of Physics, Nanoscience Center, University of Jyväskylä, Jyväskylä FI-40014, Finland
| | - I R Storch
- Department of Physics, Cornell University, Ithaca, New York 14853, USA
| | - T S Abhilash
- Department of Physics, Cornell University, Ithaca, New York 14853, USA
| | - A Hui
- School of Applied &Engineering Physics, Cornell University, Ithaca, New York 14853, USA
| | - P L McEuen
- Department of Physics, Cornell University, Ithaca, New York 14853, USA
- Kavli Institute at Cornell for Nanoscale Science, Ithaca, New York 14853, USA
| | - H G Craighead
- School of Applied &Engineering Physics, Cornell University, Ithaca, New York 14853, USA
| | - J M Parpia
- Department of Physics, Cornell University, Ithaca, New York 14853, USA
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Akhtar MA, Olatunbode O, White L, Hui A. 11 Epidemiology of anterior cruciate ligament (ACL) injuries and functional outcomes following rehabilitation in south tees. Br J Sports Med 2015. [DOI: 10.1136/bjsports-2015-095576.11] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Akhtar MA, Olatunbode O, White L, Hui A. 12 Functional outcomes following primary anterior cruciate ligament (ACL) reconstruction in south tees. Br J Sports Med 2015. [DOI: 10.1136/bjsports-2015-095576.12] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Liu F, Bruce J, Hui A, Shi W, Perez-Ordonez B, Xu W, Boutros P, O'Sullivan B, Waldron J, Huang S. OC-0396: Identification of a microRNA signature associated with risk of distant metastasis in nasopharyngeal carcinoma. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40392-5] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wong P, Hui A, Su J, Xu W, Catton C, Wunder J, Andrulis I, Dickson B, Bell R, Liu F. A Potential Prognostic MicroRNA Signature for Distant Metastasis in Soft-tissue Sarcomas. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.066] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yuan Y, Pan J, Wu Z, Hui A, Zhou A. Validated LC-MS-MS Method for the Determination of Prodrug of Ginkgolide B in Rat Plasma and Brain: Application to Pharmacokinetic Study. J Chromatogr Sci 2012; 51:266-72. [DOI: 10.1093/chromsci/bms137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Stickley T, Hui A. Social prescribing through arts on prescription in a U.K. city: participants' perspectives (part 1). Public Health 2012; 126:574-9. [PMID: 22683358 DOI: 10.1016/j.puhe.2012.04.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 01/04/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES In the U.K., the era of New Labour witnessed a developing connection between the arts (and sport) and 'neighbourhood renewal'. The concept of the usefulness of the arts to health has gained credence largely through community-based arts. Whilst there is an increasing evidence base for the usefulness of community arts delivery, there is little published evidence in the peer-reviewed literature of the effectiveness of delivery of Arts on Prescription. The aim of this study was therefore to explore the experiences of people who have engaged with Arts on Prescription programme of work. STUDY DESIGN This qualitative research study used a narrative inquiry approach amongst participants of Arts on Prescription programme of work. METHODS Sixteen in-depth interviews were conducted in community-based arts venues. Each participant was using or had used mental health services. RESULTS Participants experienced Arts on Prescription as a creative and therapeutic environment. It was considered a safe place where participants can be creative with others who have shared similar experiences. Participants experienced social, psychological and occupational benefits, although these benefits are not easily separated as they are intermingled. By feeling accepted and amongst people who have had similar experiences, participants also gained a sense of social belonging. A number of participants also found new opportunities for the future. CONCLUSIONS Community-based arts groups that are professionally facilitated may provide a therapeutic environment for participants. Participants gained a sense of pride in their work, and experienced psychological, social and occupational benefits.
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Affiliation(s)
- T Stickley
- University of Nottingham, Nottingham, UK.
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Abstract
This article reports upon a research study focusing on a programme of work called Arts In-Reach. The programme was designed to provide a participatory arts programme for the adult mental health inpatient wards in a city in the UK. The aim of the research study was to explore the experiences of people who have engaged with the Arts In-Reach programme of work. Eleven qualitative interviews were conducted among participants of the programme. Consistent with other research, this study reveals how people on the wards often feel powerless and bored. The feelings of boredom are exacerbated as people recover. Participating in the arts groups has alleviated some of those feelings. Furthermore, participation has also increased people's social interactions and given opportunity for self-expression. The arts activities also provide a distraction for people and some appreciated being able to talk about matters other than their 'illness'. The arts activities helped people to think about their future and how they might take their artwork forward. For some people, thinking about the future helped with restoring a sense of hope, a quality imperative for recovery.
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Affiliation(s)
- T Stickley
- School of Nursing, Midwifery and Physiotherapy, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
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Stickley T, Hui A. Social prescribing through arts on prescription in a U.K. city: referrers' perspectives (part 2). Public Health 2012; 126:580-6. [PMID: 22578297 DOI: 10.1016/j.puhe.2012.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 01/04/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study provides some insight into the perceived benefits of an Arts on Prescription service in the U.K. according to referrers. Social prescribing provides a framework for emerging alternative approaches to mental distress. The aim of this study was to investigate the views of referrers to an Arts on Prescription programme regarding the quality and effectiveness of the service. STUDY DESIGN For this study, 10 individuals were recruited from a potential total of 148 referrers who had referred their clients to Arts on Prescription between 2008 and 2011. METHOD Qualitative, in-depth semi-structured interviews were conducted and the findings were thematically analysed. RESULTS It was evident that referrers value Arts on Prescription. It is considered to be a therapeutic, relaxing and safe environment that is professionally led. Referrers reported that their clients take pride in the work they have created at Arts on Prescription. They believe that the programme helps their clients to build confidence, find meaningful occupation, develop skills and express themselves. The social opportunities provided by the programme are considered significant, as well as the peer support that is evident. CONCLUSIONS Social prescribing enables general practitioners to have greater options when helping patients with complex social problems. As such, the programme is clearly valued by referrers for their clients. The programme offers valuable social benefits that are becoming reduced in an era of closure of day service provision. There is concern regarding whether such valuable resources will be commissioned in the future.
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Affiliation(s)
- T Stickley
- University of Nottingham, Nottingham, UK.
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Hui A, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, Sellers E, McGavock J, Morris M, Bruce S, Murray R, Shen GX. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial. BJOG 2011; 119:70-7. [DOI: 10.1111/j.1471-0528.2011.03184.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Hui ACF. Thrombolytic treatment in acute stroke. Hong Kong Med J 2011; 17:82. [PMID: 21282835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Abstract
OBJECTIVE Based on its efficacy in treating neuropathic pain, gabapentin may be effective for the treatment of carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the efficacy of gabapentin for symptom relief in CTS. METHODS We conducted a randomized, double-blinded, placebo-controlled trial recruiting patients with newly diagnosed idiopathic CTS of more than a period of three months. Diagnosis was based on characteristic symptoms with electrophysiological confirmation. Patients were randomly assigned to an active group receiving gabapentin (starting dose 300 mg once daily to a target of 900 mg daily) or a placebo group. Primary end-point was the global symptom score (GSS), which was measured at baseline, two, and eight weeks. RESULTS There was no significant difference in baseline variables between the two treatment groups. Hundred and forty patients were enrolled in the study, of whom 71 were randomly assigned to gabapentin group and 69 assigned to placebo group. Both gabapentin and placebo produced significant improvement in symptoms at two and eight weeks. The GSS at 2 and 8 weeks was 16.4 (SD 9.4) and 13.4 (SD 9.7), respectively, in the active group versus 14.9 (SD 9.0) and 12.5 (SD 8.9) in the control group (P < 0.01). But by eight weeks, the mean reduction in symptom severity of patients on gabapentin [-10.4 (SD 10.8)] was not significant when compared with placebo [-8.7 (SD 8.1), P < 0.39]. Adverse events were not severe and included dizziness, somnolence, and headache. CONCLUSIONS Gabapentin did not produce a significant reduction in symptom severity compared with placebo over an eight-week period.
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Affiliation(s)
- A C F Hui
- Department of Medicine, Electrodiagnostic Unit, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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Shi W, Gerster K, Alajez N, Tsang J, Waldron L, Pintilie M, Hui A, McCready DR, Fyles AW, Miller N, Liu FF. Effect of the novel oncomir MiR-301 on tumor proliferation and invasion in human breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hui A, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, Sellers E, Bruce E, Morris M, Shen G. Effect of a community-based lifestyle intervention on physical activity and diet in pregnant women. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33200-1] [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: 10/27/2022]
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Leung H, Man CY, Hui ACF, Wong KS, Kwan P. Agreement between initial and final diagnosis of first seizures, epilepsy and non-epileptic events: a prospective study. J Neurol Neurosurg Psychiatry 2008; 79:1144-7. [PMID: 18270232 DOI: 10.1136/jnnp.2007.139048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Differentiating between first seizure, epilepsy and a non-epileptic event is a challenging clinical exercise for many physicians as it may lead to different therapeutic implications. This study aims to investigate the agreement between the initial diagnosis at the accident and emergency (A&E) department and the final diagnosis following inpatient neurological evaluation of seizure disorders. METHOD A prospective observational study between April 2004 and June 2005 in a regional hospital in Hong Kong recruited 1701 patients from the A&E to neurology/medical wards with initial diagnoses/labels matching any one of 12 predefined keywords which were categorised as either "seizure specific" or "non-specific". RESULTS Among the 1170 patients with "non-specific" initial diagnoses/labels, 58 (5%) were finally diagnosed as having had a first seizure or epilepsy. Among 531 patients with "seizure specific" initial diagnoses/labels, 27 (5.1%) were subsequently diagnosed as having had non-epileptic events. The kappa value for agreement between the initial and final diagnosis was 0.88. Of the 154 patients with a final diagnosis of first seizure, 34 (22%) had "non-specific" initial labels. Among these patients, components of the evaluation contributing to revision of diagnosis included retrieval of witness accounts (47%), epileptiform discharges on EEG (47%), short term monitoring in patients suspected of acute symptomatic seizures (28%) and panel discussion of cases (22%). CONCLUSION There was generally a high degree of agreement between the initial and final diagnosis, but first seizures were often missed initially. Careful history taking, judicious use of EEG, selective short term monitoring and liaison with specialists are important in reaching an accurate diagnosis.
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Affiliation(s)
- H Leung
- Department of Medicine and Therapeutics, Division of Neurology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
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Simonella L, O’Connell DL, Vinod SK, Delaney GP, Boyer M, Esmaili N, Hensley M, Goldsbury D, Supramaniam R, Hui A, Armstrong B. No improvement in lung cancer care: the management of lung cancer in 1996 and 2002 in New South Wales. Intern Med J 2008; 39:453-8. [DOI: 10.1111/j.1445-5994.2008.01788.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
A narrative-discourse analysis was conducted to study the narratives of mental health service users talking about their engagement with art. The sample was drawn from a group of people who had attended arts workshops organized by a mental health service provider. Eleven people were interviewed and were asked to tell the story of their involvement in art and its significance to their lives. The data were analysed using a discourse analysis approach. Art is constructed as therapeutic within an illness repertoire. Emotions are inseparable from creative expression and identity claims are made in relation to being an artist.
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Affiliation(s)
- T Stickley
- University of Nottingham, School of Nursing, Faculty of Medicine and Health Sciences, Nottingham, UK.
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Affiliation(s)
- A C F Hui
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China.
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Hui ACF, Man BL, Leung WH. Status epilepticus and Hashimotos encephalopathy. Neth J Med 2006; 64:387; author reply 387-8. [PMID: 17122458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Dawson SJ, Michael M, Biagi J, Foo KF, Jefford M, Ngan SY, Leong T, Hui A, Milner AD, Thomas RJS, Zalcberg JR. A phase I/II trial of celecoxib with chemotherapy and radiotherapy in the treatment of patients with locally advanced oesophageal cancer. Invest New Drugs 2006; 25:123-9. [PMID: 17053988 DOI: 10.1007/s10637-006-9016-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 09/25/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND The study's aim was to determine the maximum tolerated dose (MTD) of celecoxib combined with chemoradiotherapy (CRT) for locally advanced oesophageal cancer (OC). METHODS CRT comprised of 5FU (1000 mg/m(2)/day, days 1-4, weeks 1 & 5), cisplatin (75 mg/m(2), days 1 & 29) and radiotherapy (50 Gy in 25 fractions or 50.4 Gy in 28 fractions). Celecoxib was given daily during CRT at one of five doses (200 mg bd to 600 mg bd). Three to six patients were assigned per dose. RESULTS Thirteen patients were recruited before trial closure due to external safety concerns regarding celecoxib. Median follow up was 17 months (95% CI 9 - >39). The highest administered dose was 400 mg bd (n=4) with one dose-limiting toxicity at this level: grade 3 rash. Five (38%) and 8(62%) patients had grade 3 non-haematological and haematological toxicities respectively. No grade 4 toxicities occurred. Radiological response rate was 54% (n=7: all CR). Six patients had resection with one pathological CR. Median progression-free and overall survival were 8.8 (95% CI 5.1 - >24.8) and 19.6 months (95% CI 7.3 - >39) respectively. CONCLUSIONS A MTD was not reached. The regimen was tolerable, indicating that celecoxib can be safely administered with CRT for locally advanced OC.
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Affiliation(s)
- S J Dawson
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Victoria, 8006, Australia.
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Chan H, Wong V, Hui A, Tsang S, Chan J, Wong G, Sung J. P.121 Severe acute exacerbation of HBeAg-negative chronic hepatitis B has good maintained response to lamivudine treatment. J Clin Virol 2006. [DOI: 10.1016/s1386-6532(06)80301-x] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
We investigated the efficacy of a single vs. double steroid injections in the treatment of carpal tunnel syndrome (CTS) in a randomised double-blind controlled trial. Patients with idiopathic CTS were randomised into (i) one group receiving a baseline methylprednisolone acetate injection plus a saline injection 8 weeks later and (ii) a second group receiving methylprednisolone acetate injection at baseline and at 8 weeks. The primary outcome was the Global Symptom Score (GSS). Forty patients were recruited. By 40 weeks, the mean GSS improved from 25.6 to 14.1 in the single-injection group whereas from 26.7 to 12.6 in the reinjection group, but there was no significant difference in GSS between the two groups (p = 0.26). There were also no significant differences in terms of electrophysiological and functional outcomes. The results suggest that an additional steroid injection confers no added benefit to a single injection in terms of symptom relief.
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Affiliation(s)
- S M Wong
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Hui ACF, Ng KC, Tong PY, Mok V, Chow KM, Wu A, Wong LKS. Bacterial meningitis in Hong Kong: 10-years’ experience. Clin Neurol Neurosurg 2005; 107:366-70. [PMID: 16023529 DOI: 10.1016/j.clineuro.2004.10.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 09/29/2004] [Accepted: 10/04/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We studied the etiology, clinical features and outcome of patients with bacterial meningitis from an urban Chinese city over a 10-years period. METHODS We reviewed the files of all persons aged 15-years old or above diagnosed with community-acquired bacterial meningitis from a regional hospital. The clinical findings, relevant laboratory and imaging results as well as outcome were recorded in cases with microbiological evidence of meningitis. Neurosurgical and pediatric patients were excluded. RESULTS Sixty-five patients between the ages of 15 and 86 years of age (mean 52 years) were identified of whom 18 (28%) died. The four most common causes were Mycobacteria tuberculosis (46%), Streptococcus pneumoniae (11%), Streptococcus suis (9%) and Klebsiella pneumoniae (8%). Neisseria meningitidis and Haemophilus influenzae were rare pathogens. The annual incidence of community-acquired bacterial meningitis was 1.27/100,000 adults. Delay in treatment was associated with a poorer prognosis (p<0.001, OR=38.84, CI=7.33-205.80). CONCLUSION The causative organisms found in this region of China differ from that reported from Europe and the US; tuberculous meningitis is the most common cause of bacterial meningitis.
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Affiliation(s)
- A C F Hui
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, New Terriotories, Shatin, Hong Kong SAR.
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Vinod S, Graham P, Hui A. P-642 Outcomes from a patterns of care study for surgery and a high dose concurrent end-phase boost accelerated radiotherapy protocol for treatment of stage 1 non-small cell lung cancer. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81135-3] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hui ACF, Wong S, Leung CH, Tong P, Mok V, Poon D, Li-Tsang CW, Wong LK, Boet R. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology 2005; 64:2074-8. [PMID: 15985575 DOI: 10.1212/01.wnl.0000169017.79374.93] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [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: 11/15/2022] Open
Abstract
BACKGROUND Decompressive surgery and steroid injection are widely used forms of treatment for carpal tunnel syndrome (CTS) but there is no consensus on their effectiveness in comparison to each other. The authors evaluated the efficacy of surgery vs steroid injection in relieving symptoms in patients with CTS. METHODS The authors conducted a randomized, single blind, controlled trial. Fifty patients with electrophysiologically confirmed idiopathic CTS were randomized and assigned to open carpal tunnel release (25 patients) or to a single injection of steroid (25 patients). Patients were followed up at 6 and 20 weeks. The primary outcome was symptom relief in terms of the Global Symptom Score (GSS), which rates symptoms on a scale of 0 (no symptoms) to 50 (most severe). Nerve conduction studies and grip strength measurements were used as secondary outcome assessments. RESULTS At 20 weeks after randomization, patients who underwent surgery had greater symptomatic improvement than those who were injected. The mean improvement in GSS after 20 weeks was 24.2 (SD 11.0) in the surgery group vs 8.7 (SD 13.0) in the injection group (p < 0.001); surgical decompression also resulted in greater improvement in median nerve distal motor latencies and sensory nerve conduction velocity. Mean grip strength in the surgical group was reduced by 1.7 kg (SD 5.1) compared with a gain of 2.4 kg (SD 5.5) in the injection group. CONCLUSION Compared with steroid injection, open carpal tunnel release resulted in better symptomatic and neurophysiologic outcome but not grip strength in patients with idiopathic carpal tunnel syndrome over a 20-week period.
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Affiliation(s)
- A C F Hui
- Division of Neurology, Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Affiliation(s)
- E H Wong
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Hui ACF, Cheung PT, Tang ASY, Fu M, Wong L, Kay R. Clinical and electrophysiological features in Chinese patients with Kennedy’s disease. Clin Neurol Neurosurg 2004; 106:309-12. [PMID: 15297006 DOI: 10.1016/j.clineuro.2004.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2003] [Revised: 01/22/2004] [Accepted: 02/03/2004] [Indexed: 10/26/2022]
Abstract
Kennedy's disease is a X-linked neuromuscular disorder caused by an expanded trinucleotide repeat in the androgen receptor gene. To ascertain the clinical diagnosis of Kennedy's disease in a Chinese population, we used a rapid, accurate PCR-based sizing method for the CAG repeat allelotype. The clinical and electrophysiological features of affected patients are described. The CAG repeats ranged from 43 to 53 and were inversely correlated with the age of onset (r = -0.63; P < 0.005).
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Affiliation(s)
- A C F Hui
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China.
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Leong T, Everitt C, Yuen K, Condron S, Binns D, Pitman A, Lau E, Hui A, Ackerly T, Ngan S. A prospective study to evaluate the impact of coregistered PET/CT images on radiotherapy treatment planning for esophageal cancer. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.06.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hui ACF, Kwan P. Epilepsy in Hong Kong: a literature review. Hong Kong Med J 2004; 10:185-9. [PMID: 15181223] [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: 04/29/2023] Open
Abstract
OBJECTIVE To review data on the causes, clinical features, and management of patients with epilepsy in Hong Kong. DATA SOURCES MEDLINE and Chinese Current Medical Contents were used to search the literature. A manual search of the Hong Kong Medical Journal, Hong Kong Practitioner, and Chinese Medical Journal (1982-2002) was also undertaken. STUDY SELECTION Key words for the literature search were 'epilepsy' and 'Hong Kong'. DATA EXTRACTION All relevant articles in English or in Chinese language were reviewed. DATA SYNTHESIS Overall, disease characteristics and the response to both medical and surgical treatments of epilepsy among local Chinese patients with epilepsy was found to be comparable to that reported for patients in western countries. Knowledge of epilepsy among the general population was more limited than expected from the international literature, and attitudes to epilepsy relatively more negative, adding to the psychosocial burden for people with epilepsy. CONCLUSION Further research in Hong Kong on aspects of epileptology is indicated with a view to developing more innovative and effective therapy.
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Affiliation(s)
- A C F Hui
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Abstract
The purpose of this study was to investigate the long-term prognosis of patients with carpal tunnel syndrome (CTS). We prospectively followed-up patients with CTS for 80 weeks. Thirty cases had been treated with a single injection of methylprednisolone acetate and another 30 with a 10-day course of prednisolone. At the end of the follow-up period, there were no significant differences in symptoms as measured by global symptom score and in the proportion of patients who progressed to decompressive surgery. Few patients who were not operated on (11.4%) remain asymptomatic.
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Affiliation(s)
- A C F Hui
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Mok VCT, Wong A, Lam WWM, Fan YH, Tang WK, Kwok T, Hui ACF, Wong KS. Cognitive impairment and functional outcome after stroke associated with small vessel disease. J Neurol Neurosurg Psychiatry 2004; 75:560-6. [PMID: 15026497 PMCID: PMC1739014 DOI: 10.1136/jnnp.2003.015107] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Although stroke associated with small vessel disease (SSVD) can induce both motor and cognitive impairment, the latter has received less attention. We aimed to evaluate the frequency of the varying severity levels of cognitive impairment, the determinants of severe cognitive impairment, and the association of cognitive impairment with functional outcome after SSVD. METHODS Consecutive patients admitted to hospital because of SSVD were assessed at 3 months after stroke. We performed a semi-structured clinical interview to screen for cognitive symptoms. Severity of cognitive symptoms was graded according to the Clinical Dementia Rating Scale (CDR). Performance on psychometric tests (Mini-Mental State Examination, Alzheimer's Disease Assessment Scale (cognition subscale), Mattis Dementia Rating Scale (initiation/perseverence subscale; MDRS I/P)) of patients of different CDR gradings was compared with that of 42 healthy controls. Basic demographic data, vascular risk factors, stroke severity (National Institute of Health Stroke Scale; NIHSS), pre-stroke cognitive decline (Informant Questionnaire on Cognitive Decline in the Elderly; IQCODE), functional outcome (Barthel index; BI), Instrumental Activities Of Daily Living; IADL), and neuroimaging features (site of recent small infarcts, number of silent small infarcts, white matter changes) were also compared among the groups. Regression analyses were performed to find predictors of severe cognitive impairment and poor functional outcome. RESULTS Among the 75 included patients, 39 (52%) complained of cognitive symptoms. The number of patients in each CDR grading was as follows: 39 (52%) had a CDR of 0, 26 (34.7%) had a CDR of 0.5, 10 (13.3%) had a CDR of > or =1. Pre-stroke IQCODE and previous stroke predicted CDR> or =1. The NIHSS was associated with more impaired BI. The NIHSS and MDRS I/P contributed most to impaired IADL. CONCLUSIONS Half of the patients with SSVD complained of varying severity of cognitive problems 3 months after stroke. Pre-stroke cognitive decline and previous stroke predict severe cognitive impairment post stroke. Stroke severity and executive dysfunction contribute most to a poor functional outcome.
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Affiliation(s)
- V C T Mok
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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38
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Hui ACF, Kwan P. Prevalence of epilepsy in Hong Kong. Hong Kong Med J 2004; 10:70; author reply 70-1. [PMID: 14967862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
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Hui ACF, Wong SM, Griffith JF. An unusual cause of carpal tunnel syndrome. Int J Clin Pract 2003; 57:635-6. [PMID: 14529070] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Tuberculosis is an uncommon cause of carpal tunnel syndrome. We report a patient with systemic lupus erythematosus who developed hand numbness. Ultrasonic, operative and microbiological findings supported the diagnosis of median nerve compression secondary to a tuberculous abscess. The symptoms resolved with surgical excision and antituberculous chemotherapy.
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Affiliation(s)
- A C F Hui
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, China
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Hui ACF, Wong SM. Race and ethnicity in medical research. Hong Kong Med J 2003; 9:312. [PMID: 12904630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Hui ACF, Wong SM. Relation between sulphur dioxide concentration and all-cause mortality. Lancet 2003; 361:787-8. [PMID: 12620771 DOI: 10.1016/s0140-6736(03)12651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hui ACF, Lam JMK, Chan YL, Au-Yeung KM, Wong KS, Kay R, Poon WS. Role of magnetic resonance imaging for preoperative evaluation of patients with refractory epilepsy. Hong Kong Med J 2003; 9:20-4. [PMID: 12547952] [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: 02/28/2023] Open
Abstract
OBJECTIVE To investigate the magnetic resonance imaging characteristics of patients with refractory epilepsy and the relationship to progression to surgery. DESIGN Prospective observational study. SETTING University teaching hospital, Hong Kong. PATIENTS Patients undergoing preoperative evaluation for epilepsy surgery. MAIN OUTCOME MEASURE Cranial magnetic resonance imaging findings, correlation with electroencephalographic results, and percentage of patients who were considered suitable candidates for surgery. RESULTS Structural abnormalities associated with refractory epilepsy in 100 consecutive patients were mesial temporal sclerosis (30%), neocortical sclerosis (23%), vascular malformation (7%), neuronal migration disorders (7%), and tumours (5%). Normal brain scans were found for 28% of patients. Fourteen of 30 (46%) patients with medial temporal lobe lesions at magnetic resonance imaging were suitable candidates for surgery compared with 8/42 (19%) patients with extrahippocampal lesions (odds ratio=3.7; 95% confidence interval, 1.3-10.6; P<0.012). CONCLUSION Mesial temporal sclerosis was the most common pathology in patients with refractory epilepsy. At the Prince of Wales Hospital, for patients who have undergone a basic magnetic resonance imaging protocol and surface electroencephalography, the result of cranial magnetic resonance imaging is an important determinant for whether patients will undergo surgery.
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Affiliation(s)
- A C F Hui
- Division of Neurology, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Affiliation(s)
- A C F Hui
- Department of Medicine, Diagnostic Radiological and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Abstract
A quick HPLC method is reported for the analysis of polysorbate 80 in pharmaceutical suspensions. A typical pharmaceutical suspension was mixed with dilute potassium hydroxide, and heated at 40 degrees C for 6 h. This procedure resulted in quantitative hydrolysis of polysorbate 80 to release oleic acid. A quick HPLC procedure was used to analyze the hydrolyzed samples without further sample treatment. Polysorbate 80 USP, treated in the same way as the pharmaceutical suspensions, was used as standard. Full validation tests were carried out and the validation studies demonstrated that this method is suitable for accurate and reproducible analysis of polysorbate 80 in pharmaceutical suspensions.
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Affiliation(s)
- M Hu
- Novex Pharma, 380 Elgin Mills Road East, Richmond Hill, Ontario, Canada L4C 5H2
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Abstract
BACKGROUND The ability to distinguish between infarct and haemorrhage is essential to the management of acute cerebrovascular disease. In hospitals where emergency neuroimaging is not available, the use of stroke scores has been proposed to distinguish ischaemic from haemorrhagic stroke. AIMS To determine the accuracy of the Siriraj Stroke Score in distinguishing ischaemic from haemorrhagic stroke in a cohort of Chinese patients. METHODS We prospectively assessed and calculated the Siriraj Stroke Score from 253 patients with acute stroke. The sensitivity, specificity, positive and negative predictive values of this score were determined. RESULTS For cerebral haemorrhage, the sensitivity and specificity were both 90% or above, but the positive predictive value was not greater than 70%. For cerebral infarct, the sensitivity and specificity were around 80%, while the positive predictive value exceeded 90%. Analysis by plotting receiver operating characteristic curves failed to find other cut-off points that would improve the performance of the Siriraj Stroke Score. CONCLUSIONS Considering the inconsistent results from this study and previous studies of the Siriraj Stroke Score, we suggest that scoring systems that only require a small number of variables are unlikely to achieve the level of accuracy needed for clinical decision-making.
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Affiliation(s)
- A C F Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR.
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Wong SM, Griffith JF, Hui ACF, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 2002; 46:1914-21. [PMID: 12124876 DOI: 10.1002/art.10385] [Citation(s) in RCA: 180] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Sonographic examination of the median nerve has been suggested as a useful alternative to electrophysiologic study in the diagnosis of carpal tunnel syndrome. To determine its usefulness and the best diagnostic criterion, sonograms of patients with the disease were compared with sonograms of healthy subjects in a case-control study. METHODS Patients with carpal tunnel syndrome and asymptomatic controls who were matched for age and sex were enrolled and underwent sonography of the wrists. Eight separate sonographic criteria were analyzed in each wrist. Data from the patient group and the control group were compared to establish optimal diagnostic criteria for carpal tunnel syndrome, using receiver operating characteristic analytic techniques. RESULTS Thirty-five patients with carpal tunnel syndrome and 35 asymptomatic controls were examined. Increased cross-sectional area of the median nerve was found to be the most predictive measure of carpal tunnel syndrome, proximal to the tunnel inlet, at the tunnel inlet, and at the tunnel outlet, with significant differences between patients and controls. Using a receiver operating characteristic curve, a cut-off value >0.098 cm(2) at the tunnel inlet provided a diagnostic sensitivity of 89% and a specificity of 83%. CONCLUSION Sonographic measurement of the median nerve cross-sectional area is both sensitive and specific for the diagnosis of carpal tunnel syndrome.
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Affiliation(s)
- S M Wong
- Department of Medicine, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Wong SM, Griffith JF, Tang A, Hui ACF. Re: The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology (Oxford) 2002; 41:835-6. [PMID: 12096246 DOI: 10.1093/rheumatology/41.7.835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Hui ACF, Man CY, Tang ASY, Au-Yeung KM. Computed tomography evaluation in acute stroke: retrospective study. Hong Kong Med J 2002; 8:177-80. [PMID: 12055362] [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: 02/25/2023] Open
Abstract
OBJECTIVE To determine the accuracy with which 'frontline' hospital doctors interpret computed tomography brain scans. DESIGN Retrospective study. SETTING University teaching hospital, Hong Kong. PARTICIPANTS Medical and emergency room doctors. MAIN OUTCOME MEASURE Accuracy in correctly identifying features of acute stroke on 18 computed tomography brain scans. RESULTS Computed tomography brain scan images showing easily detectable haemorrhage and infarct were identified in 91% and 90% of scans, respectively; but difficult-to-interpret scans with subtle features of haemorrhage or infarct were only correctly identified in 46% and 45% of readings, respectively. More experienced doctors did not perform better than junior doctors (P=0.69; 95% confidence interval, -1.84 to 2.73) and the mean total score for doctors from the emergency department did not differ significantly from that of doctors from the medical department (P=0.57; 95% confidence interval, -2.98 to 1.67). CONCLUSION Early signs of infarct and small bleeds on computed tomography brain scans are not well recognised by doctors, regardless of clinical exposure or seniority. Ineligible patients may be treated with thrombolytic therapy as a result of such computed tomography scan misinterpretation.
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Affiliation(s)
- A C F Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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