OBJECTIVES. To determine the prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting, and to study the association between various risk factors and the presence of microalbuminuria.

DESIGN. Cross-sectional community-based study.

SETTING. Four primary care clinics, Hong Kong.

PATIENTS. All patients with type II diabetes mellitus who regularly attended the clinics between May 2002 and March 2003.

MAIN OUTCOME MEASURES. Patients’ demographic data, the proportion with microalbuminuria (measured using a spot urine test), and the association between this condition and risk factors for diabetic nephropathy (via correlation and multivariable logistic regression analysis).

RESULTS. The mean age of the 1161 patients in the sample population was 58.0 years. The mean duration of diabetes mellitus was 5.7 years, and the mean level of glycated haemoglobin was 7.4%. A total of 13.4% of the patients had microalbuminuria. Having the condition was significantly associated with advanced age, female sex, poor glycaemic control, and coexisting hypertension in both correlation and regression analyses. No significant association with ever smoking was found.

CONCLUSION. Early screening for incipient diabetic nephropathy and aggressive management of modifiable risk factors in a primary care setting may be important in optimising the renal outcome of patients with type II diabetes mellitus.

Key words: Diabetes mellitus, type II; Diabetic nephropathies; Hemoglobin A, glycosylated; Neutropenia

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OBJECTIVE. To assess the frequency and clinical features of different types of hereditary spinocerebellar ataxia in Hong Kong.

DESIGN. Cross-sectional study using a questionnaire and clinical examination, with the majority of the information retrospectively collected.

SETTING. Three regional hospitals, Hong Kong.

PARTICIPANTS. All patients with spinocerebellar ataxia that was confirmed by molecular genetic tests between January 2001 and October 2003.

MAIN OUTCOME MEASURES. History, latest physical examination results, clinical investigation results, and genetic profiles.

RESULTS. A total of 16 Chinese patients had received diagnoses of spinocerebellar ataxia. These patients had spinocerebellar ataxia type 1 (n=3), spinocerebellar ataxia type 3 (Machado-Joseph disease; n=12), and dentatorubro-pallidoluysian atrophy (n=1). The most common manifestation was ataxia (15/16), followed by pyramidal signs (12/16). Other features such as bulbar dysfunction, ophthalmoplegia, neuropathy, and cognitive impairment were present but variable.

CONCLUSIONS. The clinical manifestations of different types of spinocerebellar ataxia overlap, and genetic study is necessary to confirm the diagnosis. The frequency of spinocerebellar ataxia type 3 is greater than that of other types among these Chinese patients. The age of onset of this type may correlate inversely with the number of CAG repeats.

Key words: Epidemiology; Friedreich ataxia; Genetic diseases, inborn; Machado-Joseph disease; Spinocerebellar ataxia

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OBJECTIVES. To examine the practice and ethical attitudes of intensive care doctors in Hong Kong and to compare findings with those from European studies.

DESIGN. Structured questionnaire survey, modified from a similar questionnaire used in Europe.

SETTING. Eleven publicly funded intensive care units in Hong Kong.

PARTICIPANTS. Ninety-five doctors practising in intensive care units.

RESULTS. Of the sixty-five respondents, sizeable proportions indicated that the admission of patients to the intensive care unit is often (25%) or sometimes (51%) limited by bed availability. About 69% to 86% of doctors admit patients with limited prognosis or poor quality of life, although all felt that these admissions should be more restricted. ‘Do-not-resuscitate’ orders are applied by almost all respondents, and 52% and 89% of respondents would discuss such orders with the patient or with the family, respectively. The withholding and withdrawal of therapy from patients with no chance of recovery to a meaningful life is common in Hong Kong (99% and 89%, respectively). A total of 83% respondents involved patients or families in the decision to limit therapy, compared with less than half in Europe overall. When the family wanted aggressive life-support despite doctors’ recommendations to limit therapy, 62% of the respondents would still withhold therapy while only 9% would withdraw therapy. More than 60% of doctors feel comfortable talking to patients’ relatives about limitation of therapy. Approximately 75% felt that euthanasia is unacceptable. Most respondents (94%) reported that medical programmes should include more extensive discussion on ethical issues.

CONCLUSION. The ethical attitudes of intensive care doctors in Hong Kong are similar to those of counterparts in Europe. However, Hong Kong doctors tend to involve families more often in the discussion of end-of-life issues.

Key words: Decision making; Ethics, medical; Euthanasia, passive; Intensive care units; Withholding treatment

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OBJECTIVE. To delineate the clinical behaviour of chronic benign neutropenia in Chinese children in Hong Kong.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. All infants and children with absolute neutrophil count of 1.5 x 10⁹ /L or lower for more than 3 months.

MAIN OUTCOME MEASURES. Development of significant infection, and achievement of remission.

RESULTS. Twenty-four children with chronic benign neutropenia were identified between 1992 and 2001. Their median age of diagnosis was 9 months. The mean (standard deviation) initial absolute neutrophil count was 0.28 x 10⁹ /L (0.24 x 10⁹ /L). Twenty-three patients presented with infection. Of the 19 patients tested, four (21%) were positive for anti-neutrophil antibodies. Bone marrow examination was performed in 17 patients: nine had normal results, but six showed evidence of peripheral consumption, one showed late maturation arrest at band stage, and one showed phagocytosis of myeloid cells by histiocytes. The overall hospitalised infection rate was 51.6 episodes per 1000 patient months. Ten percent of cases were considered ‘significant’ infections and required hospital admission with either surgical intervention or intravenous therapy (antibiotics or fluid replacement). In the first year of diagnosis, more than 80% of patients had their lowest absolute neutrophil count (mean, 0.16 x 10⁹ /L; standard deviation, 0.11 x 10⁹ /L). Granulocyte-colony stimulating factor was used to treat three patients and induced transient elevation of absolute neutrophil count in all three. The projected remission rate was 55.4% at 3 years. Even for those with persistent disease, there was significant recovery in absolute neutrophil count to a mean of 0.5 x 10⁹ /L (P<0.01).

CONCLUSIONS. Patients with chronic benign neutropenia experienced a relatively benign clinical course regardless of their remission status. Only a small proportion of patients developed significant infections. A multi-centre prospective study may help identify predictive factors of remission.

Key words: Autoimmune diseases; Chinese; Immunoglobulins; Neutropenia

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OBJECTIVE. To determine the reliability and validity of a dedicated assessment tool for lateral epicondylitis after translation into Hong Kong Chinese.

DESIGN. Cross-sectional study.

SETTING. District hospital, Hong Kong.

PATIENTS. Seventy-four patients, 12 of whom were bilingual, were recruited (total of 82 elbows).

MAIN OUTCOME MEASURES. Translation equivalence and reliability were measured with the test-retest method. Validity was measured against the Roles and Maudsley outcome score and mean maximal grip strength.

RESULT. The Patient-rated Forearm Evaluation Questionnaire had high English-Chinese equivalence (Spearman’s rho correlation coefficient=0.926; P<0.001). It was also very reliable (intraclass correlation coefficient=0.99; P<0.001). Validity according to the Roles and Maudsley outcome score and mean of maximal grip strength was significant (P<0.01).

CONCLUSION. The Hong Kong Chinese version of Patient-rated Forearm Evaluation Questionnaire is a reliable and valid assessment tool for chronic lateral epicondylitis. Its equivalence to the original English version makes outcome assessment across cultural barrier feasible.

Key words: Outcome assessment; Questionnaires; Tennis elbow

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