OBJECTIVES. To investigate the prevalence and risk factors of malnutrition in geriatric patients admitted to a convalescent and rehabilitation hospital.

DESIGN. Cross-sectional study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. A total of 120 patients (aged 60 years or older) referred to Tung Wah Eastern Hospital.

MAIN OUTCOME MEASURES. Anthropometric, biochemical, and haematological parameters were measured for nutritional assessment. Malnutrition was defined as a body mass index of lower than 18.5 kg/m2 and serum albumin level of lower than 35 g/L. The clinical outcomes of patients were also recorded. The predictive value of the Chinese Mini Nutritional Assessment as a nutritional screening tool was assessed. Potential risk factors associated with malnutrition were evaluated according to established protocols.

RESULTS. The mean age of patients was 80.3 years (standard deviation, 7.4 years), and the mean body mass index was 21.9 kg/m² (standard deviation, 4.4 kg/m²). The prevalence of malnutrition was 16.7%. The age distribution of malnourished patients (mean, 86.2 years; standard deviation, 7.0 years; n=20) was significantly different to those nourished (mean, 79.1 years; standard deviation, 6.9 years; n=100) [P=0.0001]. Mortality was also higher in malnourished patients (25%) than nourished patients (4%) [P=0.001]. Based on the Chinese Mini Nutritional Assessment, 16.9% of patients were classified as malnourished (cut-off value, 18.5). The Chinese Mini Nutritional Assessment was useful as a screening tool to exclude patients who were not malnourished, ie it had a high negative predictive value (95%). Being totally dependent for the performance of activities of daily living, living in a home for the elderly, and being chair- or bed-bound posed a significantly increased risk of malnutrition. The presence of mental depression (geriatric depression scale score of 8 or higher), moderately or severely impaired cognitive function (abbreviated mental test score of lower than 7), or polypharmacy (five medications or more) did not significantly affect risk of malnutrition.

CONCLUSIONS. Malnutrition was common in the geriatric patients studied and was associated with an increased mortality. The Chinese Mini Nutritional Assessment was a useful screening tool to exclude malnutrition. Significant risk factors of malnutrition were total dependence, living in a home for the elderly, and being chair- or bed-bound.

Key words: Aged; Geriatric assessment; Nutrition assessment; Nutritional status; Risk factors

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OBJECTIVES. To describe the characteristics of patients reported with acute flaccid paralysis between 1997 and 2002, and to evaluate the performance of the acute flaccid paralysis surveillance system using indicators recommended by the World Health Organization.

DESIGN. Retrospective study.

SETTING. Department of Health, Hong Kong.

PARTICIPANTS. Children aged younger than 15 years who were reported to the Department of Health between 1997 and 2002 with acute flaccid paralysis.

MAIN OUTCOME MEASURES. The prevalence of urinary symptoms was assessed using telephone interview. The urinary symptoms investigated were as listed in a validated Chinese version of Urogenital Distress Inventory Short Form (UDI-6). The impact on quality of life was quantified using a validated Chinese version of Incontinence Impact Questionnaire Short Form (IIQ-7).

RESULTS. Of 120 children with acute flaccid paralysis reported between 1997 and 2002, 42% were younger than 5 years of age. None of the cases were acute poliomyelitis or polio-compatible. A neurological cause was identified in 67.5% of cases, of which the most common was Guillain- Barré syndrome (42%), followed by transverse myelitis (15%). All except one of the performance indicators consistently met World Health Organization requirements and thus demonstrated the effectiveness of the acute flaccid paralysis surveillance programme. The acute flaccid paralysis notification rate consistently exceeded 1.0 per 100 000 population below 15 years of age. The requirement for adequate stool investigation was the single indicator that did not satisfy World Health Organization requirements. This highlighted the importance of maintaining physicians’ awareness of acute flaccid paralysis surveillance.

CONCLUSION. Hong Kong should remain vigilant for acute flaccid paralysis. The effective surveillance system and its evaluation may serve as a model for surveillance of other infectious diseases.

Key words: Evaluation studies; Guillain-Barre syndrome; Paralysis; Poliomyelitis; Sentinel surveillance

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OBJECTIVE. A review of wire-guided excision of abnormal lesions viewed on screening mammography.

DESIGN. Retrospective review.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Patients who underwent wire-guided excision of abnormalities visualised on screening mammography between 1999 and 2002.

INTERVENTION. Wire-guided excision.

MAIN OUTCOME MEASURES. Biopsy rate and positive biopsy rate.

RESULTS. A total of 65 patients underwent wire-guided excision of an abnormal lesion previously identified by screening mammography. Twenty-one were benign, two were lobular carcinoma in situ, and 42 were malignant. Of the latter, 30 were identified as ductal carcinoma in situ, and 12 as invasive breast cancer. Thirty-eight of the 42 malignant cases required further treatment, and 24 of them underwent further operation. Radiological assessment of the 65 patients suggested that nine lesions were probably benign, 31 indeterminate, 20 suspicious, and five malignant. Malignancy was subsequently confirmed by histological examination in 6, 20, 13, and 3 cases of the respective group of radiological assessment.

CONCLUSION. The biopsy rate was approximately 3.7 per 1000 screened women, with results benign in 1.19 per 1000. The positive biopsy rate was 64.6%, and invasion was evident in 28.6%.

Key words: Biopsy; Breast diseases; Breast neoplasms; Mammography

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OBJECTIVE. To review the outcomes of arthroscopic stabilisation procedures for the treatment of recurrent anterior shoulder dislocation.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Patients receiving arthroscopic stabilisation procedures for recurrent anterior shoulder dislocation between 1999 and 2003.

MAIN OUTCOME MEASURES. Functional outcomes including pain, range of motion, and activity level were assessed using the Constant score. Intra-operative findings were also discussed.

RESULTS. A total of 18 arthroscopic stabilisation procedures were performed for the treatment of recurrent shoulder instability. Two cases converted to open procedures were excluded from this review. The overall outcomes were good and seven patients reported a full recovery. Fourteen out of 16 patients reported minimal or no pain, and the mean Constant score was 80. There were no cases of re-dislocation and no major complication was noted.

CONCLUSION. All the reviewed patients had a satisfactory functional recovery. Therefore, we believe that the use of arthroscopic stabilisation procedure can produce a favourable outcome for appropriate shoulder pathologies.

Key words: Arthroscopy; Joint instability; Recurrence; Shoulder dislocation

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OBJECTIVES. To review the management of primary immunodeficiency and discuss recent advances in genetic analysis.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Children diagnosed with primary immunodeficiency and followed up in the immunology clinic during the period 1988 to 2003.

MAIN OUTCOME MEASURES. Demographic data, co-morbidities and treatment of patients, outcome and complications; identification of disease by genetic mutations.

RESULTS. Medical records of a total of 117 patients (72 male, 45 female) diagnosed with primary immunodeficiency in the Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong during the past 15 years (1988-2003) were reviewed. All patients were followed up in the immunology clinic. Some patients had been referred from the private sector or other hospitals for immunological workup. Six categories of primary immunodeficiency were identified: predominantly humoral defect (n=50), predominantly cellular defect (n=22), combined humoral and cellular defect (n=5), phagocytic defect (n=18), complement disorders (n=4), and others (n=18). Although infection was the underlying cause of most co-morbidities and mortality, autoimmune (n=7) and allergic (n=23) manifestations were common. In addition, three patients developed lymphoma. Recent advances in the genetic diagnosis of several types of primary immunodeficiency were also reviewed: X-linked Wiskott-Aldrich syndrome, X-linked chronic granulomatous disease, X-linked agammaglobulinaemia, X-linked lymphoproliferative syndrome, leukocyte adhesion disease type I, and X-linked hyperimmunoglobulin M syndrome. This provides an invaluable means of understanding the molecular basis of primary immunodeficiency and has important clinical applications.

CONCLUSIONS. Co-morbidities like autoimmune disease and allergic disease are common in patients with primary immunodeficiency and should be carefully evaluated. Likewise, a diagnosis of primary immunodeficiency should be considered when evaluating patients with these conditions. Rapid progress in the field of molecular genetics will enable definite and early diagnosis, and more importantly, potential curative therapy to be administered.

Key words: Allergy and immunology; Autoimmune diseases; Genetic diseases, X-linked; Immunologic deficiency syndromes

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