OBJECTIVES. To investigate the possible benefits and adverse effects of the addition of lopinavir/ritonavir to a standard treatment protocol for the treatment of severe acute respiratory syndrome.

DESIGN. Retrospective matched cohort study. SETTING. Four acute regional hospitals in Hong Kong.

PATIENTS AND METHODS. Seventy-five patients with severe acute respiratory syndrome treated with lopinavir/ritonavir in addition to a standard treatment protocol adopted by the Hospital Authority were matched with controls retrieved from the Hospital Authority severe acute respiratory syndrome central database. Matching was done with respect to age, sex, the presence of co-morbidities, lactate dehydrogenase level and the use of pulse steroid therapy. The 75 patients treated with lopinavir/ritonavir were divided into two subgroups for analysis: lopinavir/ritonavir as initial treatment, and lopinavir/ritonavir as rescue therapy. These groups were compared with matched cohorts of 634 and 343 patients, respectively. Outcomes including overall death rate, oxygen desaturation, intubation rate, and use of pulse methylprednisolone were reviewed.

RESULTS. The addition of lopinavir/ritonavir as initial treatment was associated with a reduction in the overall death rate (2.3%) and intubation rate (0%), when compared with a matched cohort who received standard treatment (15.6% and 11.0% respectively, P<0.05) and a lower rate of use of methylprednisolone at a lower mean dose. The subgroup who had received lopinavir/ritonavir as rescue therapy, showed no difference in overall death rate and rates of oxygen desaturation and intubation compared with the matched cohort, and received a higher mean dose of methylprednisolone.

CONCLUSION. The addition of lopinavir/ritonavir to a standard treatment protocol as an initial treatment for severe acute respiratory syndrome appeared to be associated with improved clinical outcome. A randomised double-blind placebocontrolled trial is recommended during future epidemics to further evaluate this treatment.

Key words: Coronavirus; Protease inhibitors; SARS virus; Treatment outcome

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OBJECTIVES. To assess the clinical significance of a cervical cytological diagnosis of atypical glandular cells of undetermined significance and to formulate the most appropriate management guidelines for patients with such a diagnosis.

DESIGN. Retrospective study. SETTING. Regional hospital, Hong Kong.

PATIENTS. Seventy-two patients with diagnoses of atypical glandular cells of undetermined significance who were managed in a colposcopy clinic between January 1998 and December 1999.

MAIN OUTCOME MEASURES. Age, cytological diagnoses of atypical glandular cells of undetermined significance and its subtypes, method of evaluation, final diagnosis, and outcome after 2 years.

RESULTS. Atypical glandular cells of undetermined significance were diagnosed in 83 (0.4%) of 21 854 cervical smear samples taken during the 2-year study period. Follow-up data were available from 72 patients, whose mean age was 43 years (range, 22-69 years). Forty-three percent of these patients had significant diseases of the genital tract. Patients with the subtype diagnosis of atypical glandular cells of undetermined significance–favour neoplasia had the worst outcome, with 90% of patients having significant disease, followed by patients with atypical glandular cells of undetermined significance 'not otherwise specified' (43%), and atypical glandular cells of undetermined significancefavour reactive (8%).

CONCLUSION. Patients with atypical glandular cells of undetermined significance should be investigated early and thoroughly, because many of them will have premalignant or malignant disease.

Key words: Atypical glandular cell of undetermined significance; Vaginal smears

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OBJECTIVES. To evaluate the outcome of intraventricular thrombolytic therapy for intraventricular haemorrhage and to formulate a safe and effective regimen.

DESIGN. Retrospective study.

SETTING. Regional neurosurgical centre, Hong Kong.

PATIENTS. Twenty-nine consecutive adult patients who presented from November 1995 to November 1998 with non-traumatic intraventricular haemorrhage (Graeb score, >=7) with no active rebleeding risks from vascular abnormalities.

INTERVENTIONS. Fourteen consecutive patients received intraventricular streptokinase via the external ventricular drainage, and 15 consecutive patients received intraventricular urokinase treatment.

MAIN OUTCOME MEASURES. Patient demographics, Glasgow coma scale score, Graeb score, mortality rate, shunt rate, fever response, infection rate, catheter blockage rate, and local and systemic bleeding tendency. RESULT. The mean age of the 16 men and 13 women was 59 years (range, 14-76 years). The median Graeb score for cases of intraventricular haemorrhage was 10 (range, 7-12). There was no significant difference in terms of the Graeb score distribution, total dosage, and duration of treatment between the streptokinase and urokinase groups. More cases of fever were observed in the streptokinase group, which could be due to its antigenicity. The infection rate of the central nervous system was 3%, and the shunt rate was 24%. The overall 1-month postoperative mortality was 10%, which was related to a low preoperative Glasgow coma scale score (<=4). No local rebleeding, systemic coagulopathy, or catheter blockage occurred.

CONCLUSIONS. Intraventricular thrombolytic therapy is a safe and effective method of managing intraventricular haemorrhage. We suggest instilling 20 000 units urokinase intra-operatively, followed by 20 000 units daily for about 3 days, except in cases of vascular abnormality, bleeding tendency, and trauma.

Key words: Cerebral ventricles; Drainage; Intracranial hemorrhages; Thrombolytic therapy; Tomography, X-ray computed

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OBJECTIVES. To evaluate the knowledge of basic life-support and training experience in cardiopulmonary resuscitation among the public in Hong Kong and to identify areas for improvement in public education.

DESIGN. Telephone interview using a structured multiple-choice questionnaire.

SETTING. Random cross-section of the Hong Kong public, from mid-March to May 2002.

PARTICIPANTS. Men and women aged 16 years and older selected using random telephone dialling.

MAIN OUTCOME MEASURE. Overall score in the cardiopulmonary resuscitation knowledge questionnaire.

RESULTS. Of the 357 participants, approximately 12% had received cardiopulmonary resuscitation training. Cardiopulmonary resuscitation knowledge in Hong Kong was poor, even among the previously trained and especially with regard to circulatory maintenance. The most common reason for not taking cardiopulmonary resuscitation training was lack of time.

CONCLUSION. The degree of citizen preparedness in initiating cardiopulmonary resuscitation is very poor in Hong Kong. Intensified educational efforts and exploration of new approaches to improve this first stage in the chain of survival are warranted.

Key words: Cardiopulmonary resuscitation; Heat arrest; Hong Kong; Knowledge; Questionnaires

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OBJECTIVE. To determine the prevalence and risk factors of default from tuberculosis treatment in Hong Kong.

DESIGN. Retrospective study.

SETTING. Data were obtained from programme forms completed by physicians in the Hong Kong Government Tuberculosis and Chest Service and from medical records from Hong Kong chest clinics.

PATIENTS. In all, 5917 patients registered for antituberculous drug therapy in 1996; medical records of 5757 patients were reviewed.

MAIN OUTCOME MEASURES. Patients who defaulted treatment were defined as those who had failed to collect medication for more than 2 consecutive months after the date of the last attendance during the course of treatment. Demographic and clinical characteristics, including history, treatment, and outcome, were compared between defaulters and non-defaulters, both among the whole group and among those with pulmonary disease.

RESULTS. There were 442 (8%) patients who defaulted from treatment. Forty-five percent of those who defaulted did so in the first 2 months of treatment. Key risk factors associated with non-compliance were a history of default, male sex, and a history of concomitant liver disease or lung cancer. Among patients with pulmonary tuberculosis (381 defaulters and 1537 non-defaulters), multiple drug resistance was also associated with default from treatment. Among defaulters with pulmonary disease, 39% were still bacteriologically positive at the time of default.

CONCLUSION. Default from treatment may be partially responsible for the persistent high rates of tuberculosis in Hong Kong in the past decade. Health professionals should ensure that all barriers to treatment be removed and that incentives be used to encourage treatment compliance.

Key words: Hong Kong; Treatment refusal; Tuberculosis

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