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Chan HS, Ko FWS, Chan JWM, Choo KL, So LKY, Lam DCL, Sin KM, Wong WY, Cheng YL, Wong MML. Hospital Burden of Chronic Obstructive Pulmonary Disease in Hong Kong - The Trend from 2006 to 2014. Int J Chron Obstruct Pulmon Dis 2023; 18:507-519. [PMID: 37056684 PMCID: PMC10086389 DOI: 10.2147/copd.s394698] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/15/2023] [Indexed: 04/15/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common cause for hospital admission. This study aims to review the hospital burden of COPD in Hong Kong (HK) and the trend from year 2006 to 2014. Methods A multi-center, retrospective study of the characteristics of COPD patients discharged from the public hospitals of HK from year 2006 to 2014. Anonymized data retrieval and analysis were performed. The demographic data of the subjects, use of health-care resources, ventilatory support, medications used and mortality of the subjects were analyzed. Results Total patient headcount (HC) and admission number reduced from 10,425 and 23,362 in year 2006 to 9613 and 19,771, respectively, in 2014. There was a progressive reduction of female COPD HC from 2193 (21%) in year 2006 to 1517 (16%) in 2014. The utilization of non-invasive ventilation (NIV) increased rapidly and peaked in 2010 (29%) and decreased thereafter. There was a rapid increase in the prescription of long-acting bronchodilators (from 15% to 64%). COPD and pneumonia were the top causes of death, but death due to pneumonia was rapidly increasing while death due to COPD was progressively decreasing over the period. Conclusion COPD HC and admission number (particularly in female patients) decreased progressively from year 2006 to 2014. There was also a decreasing trend of severity of disease as reflected by lower NIV use (after year 2010) and lower mortality rate due to COPD. Reduced smoking prevalence and tuberculosis (TB) notification rate in the community in the past might have reduced the incidence and severity of COPD and the hospital burden of disease. We observed an increasing trend of mortality due to pneumonia in COPD patients. Appropriate and timely vaccination programs are recommended for COPD patients as in the general elderly population.
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Affiliation(s)
- Hok Sum Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
- Correspondence: Hok Sum Chan, Department of Medicine, 6/F, Block J, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, NT, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China, Email
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Johnny Wai Man Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Kah Lin Choo
- Department of Medicine, North District Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Loletta Kit Ying So
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - David Chi Leung Lam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Kit Man Sin
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Wei Yin Wong
- Department of Medicine, Haven of Hope Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Yuk Lun Cheng
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Maureen Mo Lin Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
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Kwok WC, Ho JCM, Ma TF, Lam DCL, Chan JWM, Ip M, Tam TCC. Risk of hospitalised bronchiectasis exacerbation based on blood eosinophil counts. Int J Tuberc Lung Dis 2023; 27:61-65. [PMID: 36853123 DOI: 10.5588/ijtld.22.0489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
SETTING: There has been growing recognition on the importance of phenotyping of airway diseases. The eosinophilic phenotype was proposed in bronchiectasis; however, there has not been any evidence on its association with the risk of hospitalised bronchiectasis exacerbations.OBJECTIVE: To investigate the association between baseline blood eosinophil count (BEC) and bronchiectasis exacerbations requiring hospitalisation with validation by an independent cohort.DESIGN: This was a retrospective cohort study.RESULTS: Over a 24-month period, 37/318 (11.6%) study participants experienced an exacerbation requiring hospitalisation. The mean baseline serum eosinophil was 135 ± 92 cells/µL in those who had exacerbations, and 188 ± 161 cells/µL in those who did not. A serum eosinophil level of 250 cells/µL at stable state was the most significant cut-off for predicting hospitalised bronchiectasis exacerbation, which was validated by the independent cohort.CONCLUSIONS: Patients with BEC below 250 cells/µL at stable state are at increased risk of having hospitalised bronchiectasis exacerbations.
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Affiliation(s)
- W C Kwok
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - J C M Ho
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - T F Ma
- Department of Statistics, University of South Carolina, Columbia, SC, USA
| | - D C L Lam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - J W M Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - M Ip
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - T C C Tam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
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Kwok WC, Ma TF, Chan JWM, Pang HH, Ho JCM. A multicenter retrospective cohort study on predicting the risk for amiodarone pulmonary toxicity. BMC Pulm Med 2022; 22:128. [PMID: 35382826 PMCID: PMC8981690 DOI: 10.1186/s12890-022-01926-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amiodarone is one of the most commonly used anti-arrhythmic agents. Amiodarone pulmonary toxicity is a potentially fatal adverse effect associated with amiodarone use. Previous studies on the epidemiology and risk factors for amiodarone pulmonary toxicity showed diverse results. METHODS A multicenter retrospective cohort study was conducted to identify clinic-epidemiologic markers associated with amiodarone pulmonary toxicity for development of a prediction rule. Patients taking amiodarone who were managed in 3 centres in Hong Kong from 2005 to 2015 were included in this study. Penalized logistic regression was used to model the outcome as it is rare. RESULTS A total of 34 cases with amiodarone pulmonary toxicity were identified among 1786 patients taking amiodarone for at least 90 days from 2005 to 2015. The incidence of amiodarone pulmonary toxicity was estimated to be 1.9%. The risk factors for amiodarone pulmonary toxicity included advanced age (OR 1.047, 95% CI 1.010-1.085, p = 0.013), ventricular arrhythmia (OR 2.703, 95% CI 1.053-6.935, p = 0.039), underlying lung disease (OR 2.511, 95% CI 1.146-5.501, p = 0.021) and cumulative dose of amiodarone (OR 4.762, 95% CI 1.310-17.309 p = 0.018). CONCLUSIONS The incidence of amiodarone pulmonary toxicity in Chinese patients in Hong Kong is estimated to be 1.9% in this study. Age, underlying lung disease, ventricular arrhythmia and cumulative dose of amiodarone are associated with the development of amiodarone pulmonary toxicity. A prediction rule was developed to inform the risk of developing amiodarone pulmonary toxicity.
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Affiliation(s)
- Wang Chun Kwok
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 4/F, Professorial Block, 102 Pokfulam Road, Hong Kong Special Administrative Region, Pokfulam, China
| | - Ting Fung Ma
- Department of Statistics, University of Wisconsin, Madison, WI, USA
| | - Johnny Wai Man Chan
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Yau Ma Tei, Hong Kong Special Administrative Region, China
| | - Herbert H Pang
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China.,Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, NC, USA
| | - James Chung Man Ho
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 4/F, Professorial Block, 102 Pokfulam Road, Hong Kong Special Administrative Region, Pokfulam, China.
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Wong SCY, Tse H, Siu HK, Kwong TS, Chu MY, Yau FYS, Cheung IYY, Tse CWS, Poon KC, Cheung KC, Wu TC, Chan JWM, Cheuk W, Lung DC. Posterior Oropharyngeal Saliva for the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020; 71:2939-2946. [PMID: 32562544 PMCID: PMC7337706 DOI: 10.1093/cid/ciaa797] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/19/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on the healthcare system worldwide. Diagnostic testing remained one of the limiting factors for early identification and isolation of infected patients. This study aimed to evaluate posterior oropharyngeal saliva (POPS) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection among patients with confirmed or suspected COVID-19. METHODS The laboratory information system was searched retrospectively for all respiratory specimens and POPS requested for SARS-CoV-2 RNA detection between 1 February 2020 and 15 April 2020. The agreement and diagnostic performance of POPS against NPsp were evaluated. RESULTS A total of 13772 specimens were identified during the study period, including 2130 POPS and 8438 nasopharyngeal specimens (NPsp). Two hundred and twenty-nine same-day POPS-NPsp paired were identified with POPS and NPsp positivity of 61.5% (95% confidence interval [CI] 55.1-67.6%) and 53.3% (95% CI 46.8-59.6%). The overall, negative and positive percent agreement were 76.0% (95% CI 70.2-80.9%), 65.4% (95% CI 55.5-74.2%), 85.2% (95% CI 77.4-90.8%). Better positive percent agreement was observed in POPS-NPsp obtained within 7 days (96.6%, 95% CI 87.3-99.4%) compared with after 7 days of symptom onset (75.0%, 95% CI 61.4-85.2%). Among the 104 positive pairs, the mean difference in Cp value was 0.26 (range: 12.63 to -14.74), with an overall higher Cp value in NPsp (Pearson coefficient 0.579). No significant temporal variation was noted between the 2 specimen types. CONCLUSIONS POPS is an acceptable alternative specimen to nasopharyngeal specimen for the detection of SARS-CoV-2.
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Affiliation(s)
- Sally Cheuk Ying Wong
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
- Infection Control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Herman Tse
- Department of Pathology, Hong Kong Children’s Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Hon Kei Siu
- Infection Control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Tsz Shan Kwong
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Man Yee Chu
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Felix Yat Sun Yau
- Department of Pediatrics, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Ingrid Yu Ying Cheung
- Department of Pathology, Kwong Wah Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Cindy Wing Sze Tse
- Department of Pathology, Kwong Wah Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Kin Chiu Poon
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Kwok Chi Cheung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Tak Chiu Wu
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Johnny Wai Man Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
| | - David Christopher Lung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, Hong Kong
- Department of Pathology, Hong Kong Children’s Hospital, Hong Kong Special Administrative Region, Hong Kong
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Ng MY, Wan EYF, Wong HYF, Leung ST, Lee JCY, Chin TWY, Lo CSY, Lui MMS, Chan EHT, Fong AHT, Fung SY, Ching OH, Chiu KWH, Chung TWH, Vardhanbhuti V, Lam HYS, To KKW, Chiu JLF, Lam TPW, Khong PL, Liu RWT, Chan JWM, Wu AKL, Lung KC, Hung IFN, Lau CS, Kuo MD, Ip MSM. Development and validation of risk prediction models for COVID-19 positivity in a hospital setting. Int J Infect Dis 2020; 101:74-82. [PMID: 32947055 PMCID: PMC7491462 DOI: 10.1016/j.ijid.2020.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To develop: (1) two validated risk prediction models for coronavirus disease-2019 (COVID-19) positivity using readily available parameters in a general hospital setting; (2) nomograms and probabilities to allow clinical utilisation. METHODS Patients with and without COVID-19 were included from 4 Hong Kong hospitals. The database was randomly split into 2:1: for model development database (n = 895) and validation database (n = 435). Multivariable logistic regression was utilised for model creation and validated with the Hosmer-Lemeshow (H-L) test and calibration plot. Nomograms and probabilities set at 0.1, 0.2, 0.4 and 0.6 were calculated to determine sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS A total of 1330 patients (mean age 58.2 ± 24.5 years; 50.7% males; 296 COVID-19 positive) were recruited. The first prediction model developed had age, total white blood cell count, chest x-ray appearances and contact history as significant predictors (AUC = 0.911 [CI = 0.880-0.941]). The second model developed has the same variables except contact history (AUC = 0.880 [CI = 0.844-0.916]). Both were externally validated on the H-L test (p = 0.781 and 0.155, respectively) and calibration plot. Models were converted to nomograms. Lower probabilities give higher sensitivity and NPV; higher probabilities give higher specificity and PPV. CONCLUSION Two simple-to-use validated nomograms were developed with excellent AUCs based on readily available parameters and can be considered for clinical utilisation.
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Affiliation(s)
- Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region.
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ho Yuen Frank Wong
- Department of Radiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Siu Ting Leung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region
| | - Jonan Chun Yin Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Thomas Wing-Yan Chin
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | | | - Macy Mei-Sze Lui
- Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Edward Hung Tat Chan
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region
| | - Ambrose Ho-Tung Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Sau Yung Fung
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - On Hang Ching
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Keith Wan-Hang Chiu
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Tom Wai Hin Chung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Varut Vardhanbhuti
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Hiu Yin Sonia Lam
- Department of Radiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Kelvin Kai Wang To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Jeffrey Long Fung Chiu
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Tina Poy Wing Lam
- Department of Radiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Pek Lan Khong
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Raymond Wai To Liu
- Department of Medicine, Ruttonjee Hospital, Hong Kong Special Administrative Region
| | - Johnny Wai Man Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Alan Ka Lun Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region
| | - Kwok-Cheung Lung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region
| | - Ivan Fan Ngai Hung
- Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region; Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Chak Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Michael D Kuo
- Medical Artificial Intelligence Laboratory (MAIL) Program, Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Mary Sau-Man Ip
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; Division of Respiratory & Critical Care Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Ng MY, Ferreira VM, Leung ST, Yin Lee JC, Ho-Tung Fong A, To Liu RW, Man Chan JW, Wu AKL, Lung KC, Crean AM, Fan-Ngai Hung I, Siu CW. Patients Recovered From COVID-19 Show Ongoing Subclinical Myocarditis as Revealed by Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Imaging 2020; 13:2476-2478. [PMID: 33153536 PMCID: PMC7455163 DOI: 10.1016/j.jcmg.2020.08.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
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Wong SCY, Kwong RTS, Wu TC, Chan JWM, Chu MY, Lee SY, Wong HY, Lung DC. Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong. J Hosp Infect 2020; 105:119-127. [PMID: 32259546 PMCID: PMC7128692 DOI: 10.1016/j.jhin.2020.03.036] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and has rapidly spread across different cities within and outside China. Hong Kong started to prepare for COVID-19 on 31st December 2019 and infection control measures in public hospitals were tightened to limit nosocomial transmission within healthcare facilities. However, the recommendations on the transmission-based precautions required for COVID-19 in hospital settings vary from droplet and contact precautions, to contact and airborne precautions with placement of patients in airborne infection isolation rooms. AIM To describe an outbreak investigation of a patient with COVID-19 who was nursed in an open cubicle of a general ward before the diagnosis was made. METHOD Contacts were identified and risk categorized as 'close' or 'casual' for decisions on quarantine and/or medical surveillance. Respiratory specimens were collected from contacts who developed fever, and/or respiratory symptoms during the surveillance period and were tested for SARS-CoV-2. FINDINGS A total of 71 staff and 49 patients were identified from contact tracing, seven staff and 10 patients fulfilled the criteria of 'close contact'. At the end of 28-day surveillance, 76 tests were performed on 52 contacts and all were negative, including all patient close contacts and six of the seven staff close contacts. The remaining contacts were asymptomatic throughout the surveillance period. CONCLUSION Our findings suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions can be prevented through vigilant basic infection control measures, including wearing of surgical masks, hand and environmental hygiene.
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Affiliation(s)
- S C Y Wong
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - R T-S Kwong
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - T C Wu
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - J W M Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - M Y Chu
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - S Y Lee
- Infection control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - H Y Wong
- Infection control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - D C Lung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region; Infection control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region.
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Chan HS, Ko FWS, Chan JWM, So LKY, Lam DCL, Chan VL, Tam CY, Yu WC. Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong - computerized data collection and analysis. Int J Chron Obstruct Pulmon Dis 2018; 13:1913-1925. [PMID: 29942124 PMCID: PMC6005303 DOI: 10.2147/copd.s163659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK). Patients and methods It was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed. Results In total, 9,776 subjects (82.6% men, mean age = 78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies. Conclusion Patients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common.
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Affiliation(s)
- Hok Sum Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | | | | | | | | | - Cheuk Yin Tam
- Department of Medicine and Geriatrics, Tuen Mun Hospital
| | - Wai Cho Yu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
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Tsang DNC, Lai CKC, Yam WC, Chan JWM, Mok YW, Seto WH, Fung SC, Chu CM, Lam BHS, Ng TK. Use of interferon gamma release assay to assess latent tuberculosis infection among healthcare workers in Hong Kong. Hong Kong Med J 2015; 21 Suppl 7:S22-S25. [PMID: 26908269] [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: 06/05/2023] Open
Affiliation(s)
- D N C Tsang
- Department of Pathology, Queen Elizabeth Hospital
| | - C K C Lai
- Department of Pathology, Queen Elizabeth Hospital
| | - W C Yam
- Department of Microbiology, The University of Hong Kong
| | - J W M Chan
- Department of Medicine, Queen Elizabeth Hospital
| | - Y W Mok
- Department of Respiratory Medicine, Kowloon Hospital
| | - W H Seto
- WHO Collaborating Centre for Infection Control, Hospital Authority
| | - S C Fung
- Department of Pathology, United Christian Hospital
| | - C M Chu
- Department of Medicine, United Christian Hospital
| | - B H S Lam
- Department of Pathology, Princess Margaret Hospital
| | - T K Ng
- Department of Pathology, Princess Margaret Hospital
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10
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Affiliation(s)
- Man Po Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
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11
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Mak JCW, Ho SP, Leung HCM, Cheung AHK, Law BKW, So LKY, Chan JWM, Chau CH, Lam WK, Ip MSM, Chan-Yeung M. Relationship between glutathione S-transferase gene polymorphisms and enzyme activity in Hong Kong Chinese asthmatics. Clin Exp Allergy 2007; 37:1150-7. [PMID: 17651144 DOI: 10.1111/j.1365-2222.2007.02704.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 12/22/2022]
Abstract
BACKGROUND Asthma is a disease associated with oxidative stress. The glutathione S-transferases (GST) are a group of enzymes that protect cells from oxidative stress. Functional genetic polymorphisms of GST genes (GSTT1, GSTM1 and GSTP1) have previously been reported. OBJECTIVE To investigate the association of GST gene polymorphisms and its enzyme activity with the risk of asthma in Hong Kong Chinese adults. METHODS An age- and smoking status-matched case-control study was carried out on 315 patients with asthma and 315 healthy controls. Genotyping was carried out on genomic DNA using the PCR and/or restriction fragment length polymorphism (PCR-RFLP). Plasma GST activity was measured by fluorometric assay. RESULTS The distribution of various genotypes or alleles of the GSTT1, GSTM1 and GSTP1 was not significantly different between patients with asthma and healthy controls. The GSTM1 null genotype was found to be protective from the development of asthma in atopic subjects (odds ratios 0.55, 95% confidence interval 0.34-0.90; P=0.017). However, there was no association between GSTT1 and GSTM1 null genotypes and enzyme activity. GSTP1 codon 105 Val variants led to reduced plasma GST activity in healthy controls. Asthma patients had elevated plasma GST activity compared with healthy controls irrespective of their genotypes (P<0.001). CONCLUSION Our data suggest that among atopic subjects, the GSTM1 null genotype is associated with a decreased risk for asthma despite increased level of plasma GST activity in asthma, but it could not distinguish whether this increase is a potentially protective compensatory effect or a pathogenic factor.
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Affiliation(s)
- J C W Mak
- Division of Respiratory Medicine, Department of Medicine, The University of Hong Kong, Hong Kong, China
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Chan-Yeung M, Ho SP, Cheung AHK, So LKY, Wong PC, Chan KK, Chan JWM, Ip MSM, Mak JCW. Polymorphisms of glutathione S-transferase genes and functional activity in smokers with or without COPD. Int J Tuberc Lung Dis 2007; 11:508-14. [PMID: 17439673] [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: 05/14/2023] Open
Abstract
OBJECTIVE To determine the role of polymorphisms of genes regulating glutathione S-transferase (GST) and its plasma GST activity in the pathogenesis of chronic obstructive pulmonary disease (COPD). DESIGN Case-control study. METHODS One hundred and sixty-three patients with stable COPD from several community or regional hospitals were matched for age and pack-years smoked with the same number of health controls from the general population. Each participant underwent an interview-based respiratory and smoking questionnaire, lung function testing and gave a blood sample. Genotyping was carried out using a polymerase chain reaction-based method for polymorphisms of glutathione S-transferase theta 1 (GSTT1), glutathione S-transferase mu 1 (GSTM1) and glutathione S-transferase P 1 (GSTP1) genes. Plasma GST activity was measured using the spectrofluorometric method. RESULTS There were no significant differences in the distribution of various genotypes of polymorphisms of GSTT1, GSTM1 and GSTP1 between COPD patients and healthy controls. GST activity was significantly higher in patients compared with controls, irrespective of their different genotypes, and was not different between patients with different levels of airflow obstruction. CONCLUSION Polymorphisms of GSTT1, GSTM1 and GSTP1 genes are unlikely to be involved in the pathogenesis of COPD in Chinese in Hong Kong and Southern China.
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Affiliation(s)
- M Chan-Yeung
- Respiratory Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
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Chan JWM, Law WL, Cheung SOY, Lee MP, Ng CK, Lee S, Ko KM, Ma CC, Liu JYS, Chan TM, Mok TYW. Benign metastasising leiomyoma: a rare but possible cause of bilateral pulmonary nodules in Chinese patients. Hong Kong Med J 2005; 11:303-6. [PMID: 16085949] [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: 05/03/2023] Open
Abstract
We report three cases of benign metastasising leiomyoma, which is a rare cause of multiple lung nodules, in three Hong Kong Chinese females. One patient presented with pleuritic chest pain, another was asymptomatic, while the last presented with haemoptysis. All three patients had previously undergone surgical resection of uterine leiomyomas. Multiple lung nodules mimicking lung metastases were demonstrated on chest radiographs, and all three diagnoses were obtained from lung biopsies. Hormonal therapy was given to two patients with variable responses. To the best of our knowledge, this is the first report of benign metastasising leiomyoma in Hong Kong Chinese population. It highlights the importance of considering this rare and benign disease in premenopausal females presenting with multiple lung nodules.
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Affiliation(s)
- J W M Chan
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Abstract
Aims: To analyse the lung pathology of severe acute respiratory syndrome (SARS) and correlate the findings with the time sequence of the disease. Methods and results: Ten patients with a clinical diagnosis of SARS, and virological confirmation of SARS coronavirus infection were identified. Histology in most cases showed diffuse alveolar damage, from early to late phases, and the changes corresponded to the time sequence. Other variable features include multinucleated giant cells, pneumocytes with cytomegaly and variable amounts of inflammatory cells and foamy macrophages. One case showed superimposed bronchopneumonia. No viral inclusions were found. Coronavirus particles were identified in pneumocytes by electron microscopy. Conclusions: The predominant pathological process of SARS is diffuse alveolar damage and, in patients who die from the disease, there is evidence of organization and fibrosis. There are apparently no histological features specific for this disease, and the aetiological diagnosis depends on virological and ultrastructural studies.
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Affiliation(s)
- O Y Cheung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
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Lam KW, Cheng F, Chan JWM, Cheung GSY, Lee MWM, Hung CT. Ethical attitudes of non-intensive care unit clinicians upon end-of-life issue: more training is necessary. Hong Kong Med J 2004; 10:438. [PMID: 15591608] [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: 05/01/2023] Open
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Ng CK, Chan JWM, Kwan TL, To TS, Chan YH, Ng FYY, Mok TYW. Six month radiological and physiological outcomes in severe acute respiratory syndrome (SARS) survivors. Thorax 2004; 59:889-91. [PMID: 15454656 PMCID: PMC1746851 DOI: 10.1136/thx.2004.023762] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [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: 12/24/2022]
Abstract
BACKGROUND The long term physiological and radiological outcomes of SARS survivors and their possible determinants are uncertain. METHODS SARS survivors in a follow up clinic in a regional hospital underwent high resolution computed tomography (HRCT) of the thorax and lung function tests 6 months after admission to hospital. The associations between the clinical and demographic data of the patients and the physiological and radiological outcomes were examined. RESULTS Fifty seven patients took part in the study. Lung function abnormalities were detected in 43 patients (75.4%), with restrictive defects (n = 16) being most common (28.1%). Radiological abnormalities of any degree were detected in 43 patients (75.4%). Only the use of pulse corticosteroids was associated with the presence of CT abnormalities (p = 0.043, OR 6.65, 95% CI 1.06 to 41.73). CONCLUSIONS Physiological and radiological abnormalities are still present in a considerable proportion of SARS survivors at 6 months.
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Affiliation(s)
- C K Ng
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Chan JWM, Ng CK, Chan YH, Mok TYW, Lee S, Chu SYY, Law WL, Lee MP, Li PCK. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax 2003; 58:686-9. [PMID: 12885985 PMCID: PMC1746764 DOI: 10.1136/thorax.58.8.686] [Citation(s) in RCA: 261] [Impact Index Per Article: 12.4] [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: 12/11/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) was diagnosed in Hong Kong in over 1700 patients between March and early June 2003. METHODS 115 patients diagnosed with SARS were admitted to Queen Elizabeth Hospital, a large regional hospital in Hong Kong, from March 2003, of whom 100 were either discharged or were dead at 31 May. The patients were prospectively studied after admission to assess their short term outcomes and the risk factors associated with adverse outcomes, defined as death or the need for mechanical ventilation RESULTS At the time of writing 18 patients had died, with a crude mortality rate of 15.7% and a 21 day mortality of 10% (standard error 3%). Thirty nine patients (34%) were admitted to the intensive care unit, 30 of whom (26%) required mechanical ventilation. Multivariate analysis showed that age above 60 (hazards ratio (HR) 3.5, 95% CI 1.2 to 10.2; p=0.02), presence of diabetes mellitus or heart disease (HR 9.1, 95% CI 2.8 to 29.1; p<0.001), and the presence of other comorbid conditions (HR 5.2, 95% CI 1.4 to 19.7; p=0.01) were independently associated with mortality. However, only the presence of diabetes mellitus and/or cardiac disease (HR 7.3, 95% CI 3.1 to 17.4; p<0.001) was associated with adverse outcomes as a whole. CONCLUSION SARS is a new disease entity that carries significant morbidity and mortality. Specific clinical and laboratory parameters predicting unfavourable outcomes have been identified.
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Affiliation(s)
- J W M Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China.
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