OBJECTIVE. To study the prescribing pattern of proton pump inhibitors with regard to the time of dosing.

DESIGN. Retrospective study.

SETTING. Private hospital, Hong Kong.

PATIENTS. All patients prescribed three specific proton pump inhibitors from 1 January to 31 July 2006 were included.

MAIN OUTCOME MEASURES. For all three proton pump inhibitors, the prescribed dosing instructions were recorded as well as the specialties of the corresponding prescribers.

RESULTS. The ratio of doctors prescribing proton pump inhibitors before meals versus at other times was 1:105. The ratio of patients receiving proton pump inhibitors before meals versus at other times was 1:341. The number of tablets of proton pump inhibitors prescribed before meals versus at other times was 1:409.

CONCLUSIONS. The overwhelming majority of doctors in this study did not prescribe proton pump inhibitors before meals.

Key words: Anti-ulcer agents; Omeprazole; Prescriptions, drug; Proton pumps

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OBJECTIVES. To assess the prevalence of cardiovascular risk factors in men presenting with lower urinary tract symptoms, and their possible correlation with the severity of such symptoms.

DESIGN. Retrospective cohort study.

SETTING. Specialty clinic, Hong Kong.

PATIENTS. A total of 617 men presenting with lower urinary tract symptoms between April 2005 and October 2006.

MAIN OUTCOME MEASURES. Presence of cardiovascular risk factors inferred from the prior and current medical and social history as well as physical examination and investigative findings, among patients with International Prostatic Symptom Scores of different severity.

RESULTS. Of 617 patients, 268 (43%) had known hypertension and 318 (52%) had a history of smoking. According to the World Health Organization criteria for Asian populations, 396 (64%) patients were considered to be overweight (body mass index > or =23 kg/m(2)). A total of 178 (29%) patients were either known to have or were diagnosed to have dysglycaemia during workup. For dyslipidaemia and hyperuricaemia, the corresponding figures were 331 (54%) and 191 (31%). In total, 264 (43%) patients were newly diagnosed as having dysglycaemia, dyslipidaemia, or hyperuricaemia. Logistic regression indicated that only hyperuricaemia and a smoking history were significant predictors of moderate-to-severe lower urinary tract symptoms (International Prostatic Symptom Score > or =8), with respective adjusted odds ratios of 2.20 (95% confidence interval, 1.12-4.31; P=0.022) and 2.11 (1.24-3.57, P=0.006). Patients with moderate-to-severe International Prostatic Symptom Scores had a statistically higher chance of having at least one cardiovascular risk factor during assessment (P=0.001).

CONCLUSIONS. Cardiovascular risk factors were prevalent in male patients who had lower urinary tract symptoms; a large portion of these cardiovascular risk factors were not recognised until their urological consultations. Patients with moderate-to-severe lower urinary tract symptoms (International Prostatic Symptom Score > or =8) had statistically higher chances of having more cardiovascular risk factors.

Key words: Cardiovascular diseases; Hyperuricemia; Smoking; Urinary tract infections

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OBJECTIVE. To describe experience with a chronic pain management programme in Hong Kong Chinese patients.

DESIGN. Prospective study.

SETTING. Regional hospital, Hong Kong.

PARTICIPANTS. Patients with chronic pain who participated in the first six Comprehensive Out-patient Pain Engagement programmes between 2002 and 2005.

INTERVENTION. Comprehensive Out-patient Pain Engagement is a 14-day structured, multidisciplinary out-patient programme conducted over 6 weeks. It includes pain education, cognitive re-conceptualisation, training in communication skills and coping strategies, graded physical exercises and functional activities training. It aims to improve patient function and quality of life, despite persistent pain.

MAIN OUTCOME MEASURES. Changes in scores from baseline values after joining the programme, with respect to several assessment tools. These included the following: visual analogue pain scale, Pain Catastrophizing Scale, Patient Self-efficacy Questionnaire, Canadian Occupational Performance Measure, Medical Outcome Survey-Short Form 36 Questionnaire, and duration of physical tolerances, medication utilisation, and work status records.

RESULTS. Forty-five patients were available for analysis. After the Comprehensive Out-patient Pain Engagement programme, improvements in Medical Outcome Survey-Short Form 36 Questionnaire (role physical and vitality), Pain Catastrophizing Scale, Patient Self-efficacy Questionnaire, and Canadian Occupational Performance Measure were demonstrated (P<0.05). The duration of standing and sitting tolerances increased (P<0.05). An improvement in employment rate was also evident (P=0.01).

CONCLUSION. The initial results of our management programme in Chinese patients with chronic pain are encouraging. This type of programme should be promoted more widely in this group of patients, as it appears to improve physical function, psychological well-being, and productivity.

Key words: Chronic disease; Cognitive therapy; Combined modality therapy; Pain management; Quality of life

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OBJECTIVES. To investigate the problem of drug analogue adulteration in male erectile dysfunction health products.

DESIGN. Survey of over-the-counter male erectile dysfunction health products available in convenience stores and pharmacies in Hong Kong.

SETTING. Tertiary referral centre for clinical toxicology analysis in Hong Kong.

MAIN OUTCOME MEASURES. The pattern and extent of adulteration of male erectile dysfunction health products with sildenafil, tadalafil, and vardenafil as well as their structurally modified analogues.

RESULTS. Of 26 products studied, one (4%) was found to contain undeclared sildenafil, while 14 (54%) contained drug analogues of different kinds. The latter included acetildenafil, hydroxyacetildenafil, hydroxyhomosildenafil, and piperidenafil. The first three were analogues of sildenafil and the last was an analogue of vardenafil. One young patient presented with ataxia after taking an acetildenafil-containing product.

CONCLUSIONS. The positive rate of concealed drug analogues in male erectile dysfunction health products is alarmingly high. Such analogues are difficult to detect by ordinary laboratory methods, and might be used in an attempt to evade regulatory inspection. Without going through the stringent drug testing process, the adverse effects of these chemicals remain largely unknown and unpredictable. Effective surveillance system and control measures are needed urgently. The medical profession and the public should be alerted to this under-recognised threat.

Key words: Designer drugs; Impotence; Sildenafil; Vardenafil

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OBJECTIVE. To report preliminary experience on the Camitz operation for elderly Chinese patients in a Hong Kong public hospital.

DESIGN. Retrospective study.

SETTING. Tertiary referral hospital with hand surgery service in Hong Kong.

PATIENTS. Between January 2000 and January 2004, patients with carpal tunnel syndrome having the Camitz operation were recruited. They were assessed using the measurements of pinch and grip power, sensation, the Kapandji score, and functional grading as well as complications encountered during the subsequent follow-up.

INTERVENTION. The Camitz operation.

RESULTS. A total of 21 patients (8 male and 13 female; mean age, 70 years) were recruited. The mean duration of follow-up was 15 months. There was significant improvement in pinch power, grip power, and hand functions, as well as a positive correlation between the functional score and the Kapandji score. No major complication was recorded. One patient with pre-existing osteoarthritis of the ring finger developed contracture of the proximal interphalangeal joint.

CONCLUSION. The Camitz operation is a simple, effective, and safe means of improving hand function in elderly Chinese patients with long-standing carpal tunnel syndrome and thenar muscle atrophy. Newly acquired strength in antepulsion of thumb resulted in improved pinch, grip, and hand function in this patient group.

Key words: Aged; Carpal tunnel syndrome; Hand/surgery; Thumb

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