Factors associated with length of hospital stay in children with respiratory disease

ABSTRACT
Hong Kong Med J 2010;16:440–6 | Number 6, December 2010
ORIGINAL ARTICLE
Factors associated with length of hospital stay in children with respiratory disease
LY Tsung, KC Choi, E Anthony S Nelson, Paul KS Chan, Rita YT Sung
Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
OBJECTIVES. To explore factors associated with length of stay, and secondarily to explore the potential of enhanced diagnostics to address respiratory disease burden in children.
 
DESIGN. Prospective study.
 
SETTING. A university teaching hospital in Hong Kong.
 
PATIENTS. Data from 475 children with respiratory tract symptoms or fever admitted to Prince of Wales Hospital, Hong Kong from November 2005 to April 2007.
 
MAIN OUTCOME MEASURES. Aetiological diagnoses based on enhanced diagnostics and their association with clinical information.
 
RESULTS. Data from 469 subjects showed that major presentations were fever (84%), cough (72%), and runny nose (64%). The median length of stay was longest (3 days) for adenovirus, metapneumovirus and mycoplasma infections, while children with negative aetiological results had a median length of stay of 2 days. Fever duration during admission (P<0.001), the highest recorded temperature during admission (P<0.001), use of antibiotics during admission (P<0.001), ear pain before admission (P=0.019), and high white cell counts (P=0.021) were associated with increased length of stay (univariate analysis). Identifying an aetiological agent did not affect length of stay. Comparison of children with a positive immunofluorescence test result (rapidly available) with those in whom the test was negative though a positive multiplex polymerase chain reaction ensued (result not available to clinicians) also showed no association with length of stay.
 
CONCLUSION. Although rapid enhanced diagnostics may not have a major influence on length of stay, these data form an integral part of enhanced sentinel surveillance systems.
 
Key words: Influenza A virus; Length of stay; Nasopharyngeal diseases; Respiratory syncytial virus infections
 
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Amiodarone-induced thyroid dysfunction in the Hong Kong Chinese population

ABSTRACT
Hong Kong Med J 2010;16:434–9 | Number 6, December 2010
ORIGINAL ARTICLE
Amiodarone-induced thyroid dysfunction in the Hong Kong Chinese population
KF Lee, KM Lee, TT Fung
Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
 
 
OBJECTIVE. To determine the frequency, risk factors, clinical features, and management of amiodarone-induced thyroid dysfunctions.
 
DESIGN. Retrospective study.
 
SETTING. A regional hospital in Hong Kong.
 
PATIENTS. Patients who had been prescribed amiodarone for at least 6 months from 1 October 2005 to 30 September 2007.
 
RESULTS. A total of 390 patients (mean age, 70 years; standard deviation, 9 years; 54% male) with a median follow-up of 43 (interquartile range, 25-69) months were studied. Hypothyroidism developed in 87 (22%) of the patients (mean age, 72 years; standard deviation, 7 years; 56% male) and thyrotoxicosis in 24 (6%) of the patients (65 years; 11 years; 54% male). Increased baseline thyrotropin (thyroid-stimulating hormone) level appeared to be predictive of amiodarone-induced hypothyroidism, in which a thyroid-stimulating hormone level of 4 mIU/L or above was associated with a 4.7-fold increase in the risk (95% confidence interval, 1.9-11.7; P<0.001). Compared with those who remained euthyroid on amiodarone, thyrotoxicosis developed in younger patients. In these patients, the classical symptoms of thyroid dysfunction were frequently absent, although worsening of underlying arrhythmias, their cardiac condition, weight loss, and over-warfarinisation were suggestive of amiodarone-induced thyrotoxicosis. In both amiodarone-induced thyrotoxicosis and hypothyroidism, the disease course was benign. Patients with the former showed a good response to anti-thyroid drugs and steroid therapy.
 
CONCLUSIONS. Amiodarone-induced thyroid dysfunction is common among our population. As the clinical presentations are usually vague and atypical, regular biochemical monitoring of thyroid function is warranted, particularly in patients with elevated baseline thyroid-stimulating hormone level. The disease course of amiodarone-induced thyrotoxicosis is usually benign and remits with timely administration of anti-thyroid medications, with or without corticosteroids.
 
Key words: Amiodarone; Anti-arrhythmia agents; Hypothyroidism; Thyroid diseases; Thyrotoxicosis
 
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Rapid aneuploidy screening with fluorescence in-situ hybridisation: is it a sufficiently robust stand-alone test for prenatal diagnosis?

ABSTRACT
Hong Kong Med J 2010;16:427–33 | Number 6, December 2010
ORIGINAL ARTICLE
Rapid aneuploidy screening with fluorescence in-situ hybridisation: is it a sufficiently robust stand-alone test for prenatal diagnosis?
Alvin ST Lim, TH Lim, Michelle M Hess, SK Kee, Yvonne YF Lau, Rebecca Gilbert, Thomas E Hempel, Kirby J Anderson, Dianna H Zaleski, SL Tien, Patrick Chia, Raman Subramaniam, HK Tan, Ann SA Tan, Warren G Sanger
Cytogenetics Laboratory, Department of Pathology, Singapore General Hospital, Singapore
 
 
OBJECTIVES. To assess the clinical utility of fluorescence in-situ hybridisation with chromosomes 13, 18, 21, X and Y as a stand-alone test in detecting chromosomal abnormalities, and the types of chromosomal abnormalities missed.
 
DESIGN. Retrospective analysis.
 
SETTING. A restructured Government hospital in Singapore and an academic hospital in the United States.
 
PARTICIPANTS. Cytogenetic data of prenatal specimens and results of fluorescence in-situ hybridisation of 5883 patients performed between January 2000 and August 2007 were reviewed.
 
RESULTS. Fluorescence in-situ hybridisation detected 558 (9.5%) patients with chromosomal abnormalities. Abnormal ultrasounds (70%) and maternal serum screens (21%) were the most indicative of chromosomal abnormalities. When comparing fluorescence in-situ hybridisation data with karyotype results for the five chromosomes of interest, the sensitivity and specificity were 99.3% and 99.9%, respectively. When comparing fluorescence in-situ hybridisation data with karyotype results for all chromosomes, the sensitivity decreased to 86.8%, whereas the specificity remained at 99.9%. Of 643 cases with karyotype abnormalities, 85 were fluorescence in-situ hybridisation–negative (false negative rate, 13.2%), which included structural rearrangements, chromosome mosaicism, and other trisomies. Despite abnormal ultrasound indications, fluorescence in-situ hybridisation missed 32 cases which included structural rearrangements, mosaicisms, and other trisomies.
 
CONCLUSION. This study does not support fluorescence in-situ hybridisation as a stand-alone test. Institutions supporting fluorescence in-situ hybridisation as a stand-alone test must seriously consider the risks of a missed diagnosis.
 
Key words: Aneuploidy; In situ hybridization, fluorescence; Karyotyping; Prenatal diagnosis
 
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Effect of endorectal coils on staging of rectal cancers by magnetic resonance imaging

ABSTRACT
Hong Kong Med J 2010;16:421–6 | Number 6, December 2010
ORIGINAL ARTICLE
Effect of endorectal coils on staging of rectal cancers by magnetic resonance imaging
Esther MF Wong, John LY Leung, CS Cheng, Jeriel CK Lee, Michael KW Li, Cliff CC Chung
Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
OBJECTIVE. To compare the use of endorectal plus phased-array coils with use of phased-array coil alone with respect to the accuracy of magnetic resonance imaging for detecting mesorectal involvement of rectal cancer.
 
DESIGN. Retrospective study.
 
SETTING. A tertiary referral centre in Hong Kong.
 
PATIENTS. Ethnic Chinese patients with rectal adenocarcinoma who underwent staging magnetic resonance imaging during the years 2003 to 2008 in our centre were selected; those who received preoperative neoadjuvant therapy were excluded. Unless otherwise contra-indicated, endorectal coils have been used since 2006.
 
MAIN OUTCOME MEASURES. Magnetic resonance images were retrieved and reviewed by two radiologists blinded to the pathological results. The radiological findings were then correlated with the pathological reports to determine diagnostic accuracy.
 
RESULTS. A total of 50 patients were studied; 13 of the examinations were in patients having an endorectal coil. The overall accuracy of magnetic resonance imaging in detecting mesorectal tumour involvement was 80%. Subgroup analysis showed higher accuracy in the group with endorectal coils than in those with phased-array coils alone. Over-detection of mesorectal involvement was noted in 12% of the cases, with lower rate being observed in patients with endorectal coils. Underdetection of mesorectal tumour involvement was only noted in the group without endorectal coils. With the use of endorectal coils, the sensitivity reached 100% and the specificity increased to 86%.
 
CONCLUSION. Use of endorectal coil in staging magnetic resonance imaging of the rectum improves diagnostic accuracy. Whenever feasible, endorectal coil use is therefore recommendable to enhance diagnostic accuracy. The study results substantiate the understanding of staging by magnetic resonance imaging of rectal cancer in the local Chinese population.
 
Key words: Adenocarcinoma; Magnetic resonance imaging; Neoplasm staging; Rectal neoplams; Sensitivity and specificity
 
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Impact of delayed graft function on renal function and graft survival in deceased kidney transplantation

ABSTRACT
Hong Kong Med J 2010;16:378–82 | Number 5, October 2010
ORIGINAL ARTICLE
Impact of delayed graft function on renal function and graft survival in deceased kidney transplantation
CY Cheung, HW Chan, YH Chan, KF Chau, CS Li
Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
 
 
OBJECTIVES. To define the risk factors for delayed graft function and study the impact of such delays on renal function and long-term allograft survival in renal transplant recipients.
 
DESIGN. Single-centre retrospective study.
 
SETTING. Regional hospital, Hong Kong.
 
PATIENTS. Records of 118 Chinese renal transplant recipients from 1 July 1997 to 31 July 2005 were reviewed, and categorised into delayed and immediate graft function groups.
 
RESULTS. Delayed graft function was observed in about 19% of patients, for which cold ischaemic time was an important independent predictor. For each additional hour of cold ischaemic time, the odds ratio increased for delayed function by 0.002 (95% confidence interval, 0.001-0.003; P=0.03). Multivariate analysis revealed that neither cold ischaemic time nor delayed graft function was associated with acute rejection. On the other hand, at 1 year both delayed graft function (odds ratio=18.5; 95% confidence interval, 2.6-130.5; P=0.003) and donor age (1.2; 1.1-1.3; P=0.003) were related to a glomerular filtration rate of less than 30 mL/min. When renal function between patients with and without delayed graft function during the first 3 years was compared, it was significantly better in those without delayed graft function. However, there was no significant difference in death-censored graft survival between delayed graft function and immediate graft function groups.
 
CONCLUSIONS. Delayed graft function has a significant adverse effect on graft function at 1 year. Limiting cold ischaemic time is important as it is an independent predictor of delayed graft function.
 
Key words: Cold ischemia; Graft rejection; Graft survival; Kidney transplantation; Treatment outcome
 
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Delayed presentation of symptomatic breast cancers in Hong Kong: experience in a public cancer centre

ABSTRACT
Hong Kong Med J 2010;16:373–7 | Number 5, October 2010
ORIGINAL ARTICLE
Delayed presentation of symptomatic breast cancers in Hong Kong: experience in a public cancer centre
TK Yau, CW Choi, Esther Ng, Rebecca Yeung, Inda S Soong, Anne WM Lee
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
OBJECTIVE. Delayed presentation is an important obstacle to improving cancer treatment outcomes. We aimed to study the magnitude of this problem in Hong Kong and the factors associated with delayed presentation of patients with symptomatic breast cancers.
 
DESIGN. Retrospective study using self-administered questionnaires.
 
SETTING. Clinical Oncology Department in a regional public hospital in Hong Kong.
 
PATIENTS. A total of 158 Chinese women with breast cancer referred to our hospital between October 2006 and December 2007 consented to participate in this study. Among these, 59 (37%) patients were referred after having surgery in private sector.
 
RESULTS. The mean total delay (from first symptom to treatment) was 22 weeks. The mean patient delay (from first symptom to first consultation) was 13 weeks, constituting the largest component (60%) of the total delay. After symptom onset, the delay exceeded 12 weeks for consulting a doctor in 29%, and for receipt of treatment in 52% of them. Low family income (
 
CONCLUSIONS. Delayed presentation and treatment of symptomatic breast cancer remains an important issue in Hong Kong. Apart from socio-economic factors, limited access to public medical care was likely an important contributing factor in delays related to patients as well as to doctor/system.
 
Key words: Breast neoplasms; Socioeconomic factors; Prognosis; Signs and symptoms; Time factors
 
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Localisation of occult breast lesion: a comparative analysis of hookwire and radioguided procedures

ABSTRACT
Hong Kong Med J 2010;16:367–72 | Number 5, October 2010
ORIGINAL ARTICLE
Localisation of occult breast lesion: a comparative analysis of hookwire and radioguided procedures
Tiffany YC Chu, CY Lui, WK Hung, SK Kei, Catherine LY Choi, HS Lam
Department of Radiology, Kwong Wah Hospital, Kowloon, Hong Kong
 
 
OBJECTIVES. For occult breast lesions, to retrospectively compare the performance of radioguided and hookwire methods in terms of ease of localisation and surgical procedures, and the ability to obtain a specimen with a clear margin.
 
DESIGN. Retrospective study.
 
SETTING. Regional hospital, Hong Kong.
 
PATIENTS. All patients who underwent occult breast lesion localisation by either ultrasonography- or stereotactic-guided radioguided occult lesion localisation or hookwire localisation from August 2003 to December 2007 were included.
 
MAIN OUTCOME MEASURES. Demographic data, localisation and operation procedure time, size of specimens and margin clearance.
 
RESULTS. In all, 165 patients (mean age, 52 years) having these procedures were assessed. In 98 instances, the procedure (hookwire=53, radioguided=45) was for diagnostic purposes and in 67 (hookwire=23, radioguided=44) for therapy. Both techniques attained a very high success rate (>95%). For radioguided occult lesion localisation, there was a significantly shorter mean localisation time than for hookwire localisation (18 min versus 31 min; P<0.001), while the mean operating time was similar. Radioguided occult lesion localisation entailed larger specimens and fewer cases with close or involved margins, or recourse to intra-operative re-excision or a second operation, but these differences were not statistically significant. Within the radioguided occult lesion localisation group, there were 42 patients who had a simultaneous sentinel lymph node biopsy (sentinel node and occult lesion localisation), with a 98% success rate although no lymph node metastasis was revealed.
 
CONCLUSION. Radioguided occult lesion localisation excels in yielding a much shorter localisation time and is as good as hookwire localisation in terms of specimen margin clearance and need for re-excision. It also offers the advantage of enabling simultaneous sentinel lymph node biopsy for invasive cancers. Therefore it is a recommended procedure that should be used more widely.
 
Key words: Breast neoplasms/radionuclide imaging; Breast neoplasms/surgery; Breast neoplasms/ultrasonography; Mastectomy
 
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Ten-year review of epidemiology, clinical features, and treatment outcome of achalasia in a regional hospital in Hong Kong

ABSTRACT
Hong Kong Med J 2010;16:362–6 | Number 5, October 2010
ORIGINAL ARTICLE
Ten-year review of epidemiology, clinical features, and treatment outcome of achalasia in a regional hospital in Hong Kong
KY Ng, KF Li, KH Lok, Lawrence Lai, CH Ng, KK Li, ML Szeto
Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
 
 
OBJECTIVE. To describe the epidemiology, clinical features, and treatment outcome of achalasia in Chinese patients.
 
DESIGN. Retrospective study.
 
SETTING. Major regional hospital, Hong Kong.
 
PATIENTS. Clinical records of patients with the diagnosis of achalasia from July 1997 to June 2007 were reviewed.
 
RESULTS. Thirty-two patients were diagnosed with achalasia during the study period. The mean age at diagnosis was 50 years (standard deviation, 20 years). The female-to-male ratio was 1.3:1. The main presenting symptoms were dysphagia (78%) and vomiting (50%). Nine laparoscopic and two open Heller's operations had been performed and 16 patients had undergone endoscopic dilatations. Four patients had botulinum toxin injection and four were taking calcium channel blocker (nifedipine) medications. Botulinum toxin injection and medical therapy had poor shortand long-term responses. Laparoscopic myotomy and pneumatic dilatation had comparable good short- and long-term responses.
 
CONCLUSION. Achalasia affected all age-groups but there was a peak at middle age. Pneumatic dilatation and Heller's myotomy (open or laparoscopic approach) appeared able to maintain longer symptom responses than medical therapy and botulinum toxin injection.
 
Key words: Cardia; Esophageal achalasia; Esophageal sphincter, lower; Laparoscopy; Treatment outcome
 
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Prevalence of allergic rhinitis and its associated morbidity in adults with asthma: a multicentre study

ABSTRACT
Hong Kong Med J 2010;16:354–61 | Number 5, October 2010
ORIGINAL ARTICLE
Prevalence of allergic rhinitis and its associated morbidity in adults with asthma: a multicentre study
Fanny WS Ko, Mary SM Ip, CM Chu, Loletta KY So, David CL Lam, David SC Hui
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
 
 
OBJECTIVES. To assess the prevalence of allergic rhinitis in adult patients with asthma in Hong Kong, and to compare the morbidity endured by asthma patients with and without allergic rhinitis.
 
DESIGN. Cross-sectional study.
 
SETTING. Respiratory clinics of four major public hospitals in Hong Kong.
 
PATIENTS. A total of 600 adults with asthma were recruited from March to May 2007.
 
MAIN OUTCOME MEASURES. Doctors and patients completed separate questionnaires evaluating symptoms, treatment, and health care utilisation. Spirometry data were obtained for a subgroup of patients at the time of survey completion.
 
RESULTS. The patients consisted of 267 males and 333 females, with 251 having spirometry data. The mean pre-bronchodilator 1-second forced expiratory volume predicted among those who had spirometry performed was 88% (standard deviation, 28%). In all, 50% of the patients had intermittent and 50% had persistent asthma. Over three quarters (463/600; 77%) of patients had experienced allergic rhinitis symptoms in the past 12 months, of whom 96% had a previous diagnosis of allergic rhinitis. Asthmatics without allergic rhinitis symptoms had higher rates of visits to doctors, pharmacy visits, emergency department attendances, and hospitalisations for asthma than those with both conditions. Among subjects with asthma and allergic rhinitis, those taking nasal steroid (226/463; 49%) had lower rates of emergency department visits (13 vs 25%, P=0.002) and hospitalisations (7 vs 13%, P=0.045) for asthma than those who were not.
 
CONCLUSION. Allergic rhinitis is a common co-morbid condition of asthma in this hospital clinic cohort. Treatment of allergic rhinitis with intra-nasal steroid was associated with less health care utilisation for asthma.
 
Key words: Asthma; Comorbidity; Rhinitis
 
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Primary percutaneous coronary intervention for ST elevation myocardial infarction: performance with focus on timeliness of treatment

ABSTRACT
Hong Kong Med J 2010;16:347–53 | Number 5, October 2010
ORIGINAL ARTICLE
Primary percutaneous coronary intervention for ST elevation myocardial infarction: performance with focus on timeliness of treatment
Gary SH Cheung, KL Tsui, CC Lau, HL Chan, CH Chau, KL Wu, CY Cheung, MC Choi, TS Tse, KK Chan, SK Li
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
 
 
OBJECTIVE. To review primary percutaneous coronary interventions performed for patients with ST elevation myocardial infarction with a focus on door-to-treatment time, especially after introduction of a new management programme in November 2003.
 
DESIGN. Retrospective study.
 
SETTING. Regional hospital, Hong Kong.
 
PATIENTS. All patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention in our hospital from January 2002 to December 2007.
 
RESULTS. In all, 209 patients with ST elevation myocardial infarction had primary percutaneous coronary interventions between January 2002 and December 2007; 140 of them were admitted within office hours, 125 of whom came directly from Accident and Emergency Department. The mean door-to-balloon time of these patients was 115 minutes, and in 41% the time was less than 90 minutes (as recommended by the American College of Cardiology/American Heart Association guidelines). Since introduction of the new programme, the mean door-to-balloon time has diminished significantly, from 146 to 116 minutes (P=0.047). Delay in diagnosis (28%) and Cardiac Catheterization Laboratory being occupied (20%) were the two most common reasons for prolonged door-to-balloon times.
 
CONCLUSION. We achieved satisfactory performance in our primary percutaneous coronary intervention programme, providing timely reperfusion therapy for patients with ST elevation myocardial infarction. A well-organised and systematic clinical pathway is a prerequisite for a centre that provides a timely and effective primary percutaneous coronary intervention service for patients with ST elevation myocardial infarction. Better public education and greater awareness on the part of medical service providers are needed, so as to facilitate urgent revascularisation and improve outcomes in patients with ST elevation myocardial infarction.
 
Key words: Angioplasty, transluminal, percutaneous coronary; Myocardial infarction; Myocardial reperfusion; Thrombolytic therapy; Time factors
 
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