Quantifying excess deaths among solid organ transplant recipients in the COVID-19 era

Estimating the total coronavirus disease 2019 (COVID-19) mortality burden of solid organ transplant recipients (SOTRs), both directly through COVID-19 infection and indirectly through other impacts on the healthcare system and society, is critical for understanding the disease's impact on the SOTR population. Using SRTR data, we modeled expected mortality risk per month pre-COVID (January 2015-February 2020) for kidney/liver/heart/lung SOTRs, and compared monthly COVID-era deaths (March 2020-March 2021) to expected rates, overall and among subgroups. Deaths above expected rates were designated "excess deaths." Between March 2020 and March 2021, there were 3739/827/265/252 excess deaths among kidney/liver/heart/lung SOTRs, respectively, representing a 41.2%/27.4%/18.5%/15.0% increase above expected deaths. 93.0% of excess deaths occurred in patients age≥50. The observed:expected ratio was highest among Hispanic SOTRs (1.82) and lowest among White SOTRs (1.20); 56.0% of excess deaths occurred among Black or Hispanic SOTRs. 64.7% of excess deaths occurred among patients who had survived ≥5 years post-transplant. Excess deaths peaked in January 2021; geographic distribution of excess deaths broadly mirrored COVID-19 incidence. COVID-19 likely caused over 5000 excess deaths among SOTRs in the US in a 13-month period, representing 1 in 75 SOTRs and a substantial proportion of all deaths among SOTRs during this time. SOTRs will remain at elevated mortality risk until the COVID-19 pandemic can be controlled.

Telepsychiatry for stable Chinese psychiatric out-patients in custody in Hong Kong: a case-control pilot study

INTRODUCTION

In Hong Kong, persons in custody receive primary medical care within the institutions of the Correctional Services Department (CSD). However, for psychiatric care, persons in custody must attend specialist out-patient clinics (SOPCs), which may cause embarrassment and stigmatisation. The aim of this interventional pilot study was to compare teleconsultations with face-to-face consultations for a group of stable Chinese psychiatric out-patients in custody.

METHODS

A total of 86 stable Chinese male out-patients in custody were recruited for psychiatric teleconsultations. They were compared with 249 age-matched Chinese male out-patients in custody attending standard face-to-face psychiatric consultations at other SOPCs. The two groups had comparable baseline characteristics including age, education level, and 12-item Chinese General Health Questionnaire (C-GHQ-12) score. A satisfaction survey of patients towards the teleconsultation was also carried out.

RESULTS

Compared with the face-to-face consultation group, the teleconsultation group showed a significantly better result in the difference in C-GHQ-12 scores before and after consultations (P=0.023). The correlation between the first and second teleconsultations also showed a moderate positive relationship (r=0.309). The satisfaction survey showed a favourable response to teleconsultations. No significant adverse events were identified for the teleconsultation group.

CONCLUSIONS

The results suggest that teleconsultations are a sustainable and safe alternative to face-to-face consultations for stable Chinese psychiatric out-patients in custody.

Validation of the Chinese Version of the Revised Clinical Interview Schedule: Findings from Hong Kong Mental Morbidity Survey

This study aimed to assess the psychometric properties of the Chinese version of the Revised Clinical Interview Schedule (C-CIS-R), and explore its applicability as a diagnostic instrument for common mental disorders (CMDs) in Hong Kong. Its psychometric properties were evaluated among 140 patients and 161 healthy controls. In comparison to the diagnoses made by the Structured Clinical Interview for the DSM-IV, the C-CIS-R showed good criterion validity in diagnosing CMDs. The correlation of the total score of C-CIS-R with the 12-item General Health Questionnaire and Hospital Anxiety and Depression Scale was satisfactory, indicating favourable convergent validity as well. The inter-rater and test-retest reliability were also satisfactory. Receiver operating characteristic analyses suggested an optimal cut-off point of 11/12 for detecting diagnosable CMDs (sensitivity: 0.69; specificity: 0.93) and 17/18 for identifying a need for treatment (sensitivity: 0.70; specificity: 0.95). In conclusion, C-CIS-R is a valid diagnostic instrument for CMDs in a Chinese community. Its cut-off points for clinically significant symptoms and treatment needs among Chinese are identical to those adopted in the original English version.

Reliability and validity of the Severity of Dependence Scale in a Chinese sample of treatment-seeking ketamine users

OBJECTIVE

Despite growing popularity of ketamine misuse in Asia, there is a lack of a validated instrument to measure the severity of ketamine dependence. Psychometric properties of Chinese Severity of Dependence Scale for ketamine (C-SDS-K) were examined in a sample of treatment-seeking ketamine users in Hong Kong.

METHODS

A total of 80 treatment-seeking ketamine users were recruited from 3 treatment centres. The C-SDS-K was administered to assess their severity of dependence on ketamine in the previous month. The diagnosis of their ketamine misuse as per the DSM-IV criteria, and the count of dependence criteria fulfilled in the previous month were determined by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).

RESULTS

The C-SDS-K showed high internal consistency (α = 0.74) and test-retest reliability (intraclass correlation coefficient = 0.95). Total score of C-SDS-K correlated positively with frequency (rs = 0.73, p < 0.001) and dose (rs = 0.89, p < 0.001) of ketamine use per week in the previous month, duration of regular ketamine use (rs = 0.28, p = 0.01), and the count of DSM-IV ketamine dependence criteria met in the previous month (rs = 0.84, p < 0.001). All items loaded strongly on a single factor (factor loading ≥ 0.60) in principal component analysis.

CONCLUSION

The findings support SDS as a reliable and valid tool for measuring the severity of dependence in the treatment-seeking population of Chinese ketamine users.

The Hong Kong mental morbidity survey: background and study design

Mental disorders are highly prevalent conditions with immense disease burden. To inform health and social services policy formulation, local psychiatric epidemiological data are required. The Hong Kong Mental Morbidity Survey is a 3-year population-based study in which 5700 community-dwelling Chinese adults aged between 16 and 75 years were interviewed with the aim of evaluating the prevalence, co-morbidity, functional impairment, physical morbidity, and social determinants of significant mental disorders in the population. This paper describes the background and design of the survey, and is the first territory-wide psychiatric epidemiological study in Hong Kong.

Acute mental disturbance caused by synthetic cannabinoid: a potential emerging substance of abuse in Hong Kong

Synthetic cannabinoids are hybrid herbal/chemical products which mimic the effects of cannabis. They are usually marketed as incense or 'herbal smoking blend', and best known by the brand names 'K2' and 'Spice'. Their popularity among recreational drug abusers has grown rapidly due to their easy availability, relatively low cost, non-detection by conventional drug tests, and ease of concealing their use from family and authorities. They took Europe and later North America by storm in the late 2000s, yet limited medical literature exists detailing their adverse effects. They began to emerge in the Hong Kong drug scene in 2009. We report on a man who developed acute mental disturbance after 4 weeks of daily K2 abuse. This is the first case report of mental disorder caused by synthetic cannabinoid abuse in a Chinese.

Asymmetry and bifurcations in three-dimensional sudden-contraction channel flows

This study reports the presence of two different stable modes of bifurcation in the near field of a three-dimensional sudden contraction. To be precise, flow downstream of a symmetric sudden contraction undergoes a transition from a symmetric state to an asymmetric state through a symmetry-breaking pitchfork bifurcation following an increase in the channel aspect ratio or the Reynolds number. In addition, the oncoming (upstream) symmetry-plane flow exhibits spanwise bifurcations along the topological core lines of each of the salient roof and floor eddies. Small aspect-ratio (contraction) channels are noted to facilitate interesting splitting of the salient roof and floor eddies into multicore forms with accompanying spanwise flow bifurcations along the respective vortical core lines. Herein extensive three-dimensional simulations performed with various aspect and contraction ratios and Reynolds numbers clearly suggest that flow transition in the sudden-contraction channels should indeed occur primarily through these two generically distinct modes of bifurcation.

Spanwise bifurcation in plane-symmetric sudden-expansion flows

Present computational investigation reports a steady bifurcation phenomenon for three-dimensional flows through a plane-symmetric sudden expansion. When the channel aspect ratio exceeds a critical value, the well-known step height (pitchfork) bifurcation evolves with different symmetry breaking orientations on the left and right sides of the channel and bifurcates in the spanwise direction. For the channel aspect ratio less than the critical value, the originally occurring spanwise bifurcation cannot be stably retained and evolves eventually to a step height bifurcation. Compared to step height bifurcation, the spanwise bifurcation is found to be more difficult to obtain, because the symmetric flow present on the spanwise symmetry plane is unstable in two dimensions. For completeness, an extensive analysis of the observed spanwise bifurcation, covering its transient behavior, dependence on flow Reynolds number, channel aspect ratio, and expansion ratio, is included.

[Pancreatoblastoma: report of one case]

Pancreatoblastoma is an extremely rare pancreatic tumor in childhood, comprising 0.5% of pancreatic non-endocrine tumors. It mostly affects children of under 8 years old without special sexual predilection. Abdominal mass is the dominant clinical feature and abdominal X-ray, sonography, UGI series, CT scan are of assistance in establishing diagnosis. The presence of acinar cells with zymogen granules, squamous metaplasia and endocrine components makes the diagnosis. We report a case of 4-year-old girl, who suffered from abdominal pain for two months. Abdominal mass was found at our OPD and abdominal sonography, UGI series, CT scan all indicated a parapancreatic tumor. AFP was 4700 ng/ml. Laparotomy confirmed a pancreatic tumor and only partial excision was performed due to tumor invasion and adhesion to major vessels. Diagnosis of pancreatoblastoma was made by pathohistology, cytochemical special stains and electronic microscopic examination of the tumor. Neither chemotherapy nor radiotherapy was performed due to family refusal. Then patient followed up at NTUH OPD regularly. Unfortunately patient expired because of the regrowth of residual tumor eight months later.

Serum zinc and copper during long-term total parenteral nutrition

Changes in serum zinc and copper levels were studied in 17 patients who received 18 courses of total parenteral nutrition for 28 to 89 days. Mean serum zinc levels decreased significantly after 4 weeks of therapy in the group without zinc supplementation when compared with pretreatment levels (p less than 0.05) and in a second group who received about 1.5 mg of zinc per day (p less than 0.05). Serum copper levels fell consistently and significantly in patients of both groups. However, no obvious clinical signs or symptoms of zinc or copper deficiencies were observed. Blood transfusions were not able to significantly change the serum levels of zinc or copper. Although serum alkaline phosphatase has been suggested as a functional indicator of zinc deficiency, the concomitant hepatic or skeletal dysfunction of the patients made its interpretation difficult. These findings indicate that a decrease in serum zinc and copper is common during TPN using solutions unsupplemented with these trace elements. Supplementation of TPN solutions with zinc, copper, and other trace elements is recommended.

Adult Hirschsprung's disease

This report presents a series of 17 patients with adult Hirschsprung's disease treated at the National Taiwan University Hospital and its affiliated hospitals from 1965 to 1988. Adults with Hirschsprung's disease may present with symptoms and operative findings different from those of children with Hirschsprung's disease. The symptoms, signs, criteria for diagnosis, operative findings, and operative procedures are presented.