OBJECTIVE. To examine the side-effect and vital sign profile of nifedipine used as a tocolytic.

DESIGN. Retrospective audit.

SETTING. Tertiary care university hospital, Hong Kong.

PATIENTS. Women presenting with preterm labour (before 34 weeks of gestation) between March 2001 and September 2004.

MAIN OUTCOME MEASURES. Maternal heart rate, blood pressure, and foetal heart rate were monitored regularly. A four-point Likert scale multiple-choice questionnaire was used to assess the perceived degree of flushing, headache, nausea, dizziness, and shortness of breath. All assessments were performed at predefined intervals from the onset of treatment. Repeated measures analysis of variance was performed to identify any time-dependent association with nifedipine treatment.

RESULTS. In all, 212 episodes of preterm labour were treated with nifedipine in 203 women. In 120 episodes, preterm labour was suppressed for more than 48 hours. Treatment was discontinued in three women because of profound hypotension (<90/60 mm Hg), and in one because of severe flushing. Only one patient developed maternal tachycardia (??40 beats per minute), and in two foetal tachycardia (??80 beats per minute) was encountered. Moderate headache was experienced in nine women, flushing in nine, dizziness in four, nausea in three, and shortness of breath in one. Repeated measures analysis of variance with time of measurement revealed a significant reduction in maternal blood pressure and increase in maternal heart rate that plateaued after 1 hour of therapy. The foetal heart rate returned to baseline values 3 hours after commencing therapy.

CONCLUSION. In general, use of nifedipine as the first-line tocolytic was safe. However, severe maternal hypotension can occur and close monitoring of vital signs is warranted.

Key words: Nifedipine; Obstetric labor, Premature; Tocolysis

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OBJECTIVE. To identify predictors of rehabilitation outcomes for the development of a case-mix system to rehabilitate patients suffering from hip fractures.

DESIGN. Prospective cohort study.

SETTING. Two hospitals in Hong Kong.

PATIENTS. A cohort of hip fracture patients in 2005 (n=303) with a mean age of 82 years was studied. Rehabilitation outcomes were defined as: mortality, length of stay, placement, ambulation status, activity of daily living at the time of discharge and at 6-month follow-up. A comparison between groups and multivariate analysis was conducted to validate the best predictors.

MAIN OUTCOME MEASURES. Potential predictors and rehabilitation outcomes.

RESULTS. Two predictors, the Abbreviated Mental Test score of lower than 6 (odds ratio=0.19, P<0.05) and the Functional Independence Measures score of lower than 75 (odds ratio=38.0, P<0.05), at the time of admission to the rehabilitation setting were found to be related to outcomes. Our findings provided further support for a case-mix system based on these two factors, as they could correctly assign patients into three groups with different baseline characteristics and outcomes. A review of the possible limitations of the existing service with respect to each case-mix group was also conducted.

CONCLUSION. A case-mix system utilising the cognition and activity of daily living function is recommended. Revisions of respective care plans are advocated with more realistic outcome expectations and specific actions for the respective case-mix groups. An evaluation study on the usefulness of this case-mix classification could then follow.

Key words: Aged; Geriatric assessment; Hip fractures; Predictive value of tests; Prognosis

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OBJECTIVES. To investigate the proportion of sufferers of benign paroxysmal positional vertigo among hospitalised patients in Hong Kong who complained of dizziness, and to determine the predictive values and likelihood ratios of classical presenting symptoms.

DESIGN. Cross-sectional study.

SETTING. Convalescence/rehabilitation hospital, Hong Kong.

PATIENTS. A cohort of 88 newly admitted patients, who complained of dizziness or complained of having had dizziness in the 2 weeks prior to admission from September 2005 to February 2006.

MAIN OUTCOME MEASURES. Presence of the pathognomonic nystagmus of benign paroxysmal positional vertigo.

RESULTS. Five patients had benign paroxysmal positional vertigo, all with the posterior type. The frequency of its occurrence among patients complaining of dizziness was 6% (95% confidence interval, 1-11%), which was more than double the figure of 3% in our local convalescence/rehabilitation hospitals, though this difference was not statistically significant. Regarding the five identified patients, in two it involved the left ear, in two others the right ear, and in one it was bilateral. All four classical presenting symptoms had low positive predictive values, high negative predictive values, and small likelihood ratios.

CONCLUSION. Benign paroxysmal positional vertigo in the setting of a convalescence/rehabilitation hospital in Hong Kong seems to be underdiagnosed. Small and insignificant likelihood ratios for the classical presenting symptoms preclude their use in making the diagnosis. However, absence of these symptoms in a clinical setting of low occurrence rate can be regarded as against the diagnosis.

Key words: Prevalence; Sensitivity and specificity; Vertigo

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OBJECTIVE. To report a recent clustering of chilblain cases in Hong Kong.

DESIGN. Case series.

SETTING. A regional hospital and a social hygiene clinic in the New Territories West, Hong Kong.

PATIENTS. Patients with a clinical diagnosis of chilblains in February 2008.

RESULTS. Eleven patients with chilblains were identified; seven (64%) gave an antecedent history of prolonged exposure to cold. They all presented with erythematous or dusky erythematous skin lesions affecting the distal extremities, especially fingers and toes. Laboratory tests revealed elevated antinuclear antibodies titres in two, positive rheumatoid factor in two, presence of cold agglutinins in one, and a raised anti-DNA titre (>300 IU/mL) in one. Skin biopsies were performed in six patients, four of them showed typical histopathological features of chilblains. In the patient with systemic lupus erythematosus, features of vasculitis were suspected, and in the one with pre-existing juvenile rheumatoid arthritis, there were features of livedo vasculitis. In 10 (91%) of the patients, the skin lesions had resolved when they were last assessed (at the end of March 2008), but had persisted in the patient who had pre-existing systemic lupus erythematosus.

CONCLUSION. The recent clustering of chilblains was possibly related temporally to the prolonged cold weather at the end of January to mid-February. In our series, most of the patients developed chilblains as an isolated condition and resolved spontaneously within a few weeks. Laboratory tests and skin biopsies for chilblains are not necessary, unless the condition persists, the diagnosis in doubt or an underlying systemic disease is suspected.

Key words: Chilblains; Cold/adverse effects; Fingers; Hypothermia; Toes

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OBJECTIVE. To describe the epidemiology, clinical and laboratory findings, and outcomes of patients presenting locally with dengue.

DESIGN. Retrospective review of case records.

SETTING. Public hospitals, Hong Kong.

PATIENTS. Medical records of all laboratory-confirmed dengue patients admitted to public hospitals during 1998 to 2005 were reviewed retrospectively.

RESULTS. A total of 126 cases were identified, 123 (98%) being dengue fever and three (2%) dengue haemorrhagic fever. One patient who had blood transfusion-acquired dengue fever was highlighted. A total of 116 (92%) cases were 'imported', while 10 (8%) were local. Among the 56 dengue cases confirmed by reverse transcription-polymerase chain reaction, dengue virus type 1 was the most common accounting for 48% of them, followed by type 2, type 3, and type 4 responsible for 23%, 16%, and 13%, respectively. Only type 1 and type 2 were present in locally acquired infections. The median age of the patients was 38 years and the mean duration of hospitalisation was 6 days. There was no mortality, and nearly all patients (98%) presented with fever. Other symptoms at presentation included: myalgia (83%), headache (65%), fatigue (59%), and skin rash (60%). More than one third of patients had gastro-intestinal and upper respiratory complaints. Maculopapular skin rash was the most common physical finding. Thrombocytopenia, neutropenia, and lymphopenia were present in 86%, 78%, and 69% of the patients, respectively. In only 29% of the patients was dengue fever included in the initial differential diagnosis. The demographic, clinical, and laboratory findings as well as outcomes did not differ significantly among the four dengue serotypes, but the lowest lymphocyte counts of type 3 was lower than the other serotypes (P=0.004).

CONCLUSION. When physicians encounter patients with a relevant travel history, presenting with fever and skin rash, and having compatible haematological findings, dengue fever should be included in the differential diagnosis.

Key words: Dengue; Dengue hemorrhagic fever; Serotyping

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