OBJECTIVE. To review the current literature on the use of B-type natriuretic peptide in the diagnosis and management of heart failure.

DATA SOURCES. Literature search of PubMed was performed up to September 2007.

STUDY SELECTION. Key words for the literature search were 'heart failure' and 'B-type natriuretic peptide'.

DATA EXTRACTION. Original papers and review articles related to the use of B-type natriuretic peptide in the diagnosis and management of heart failure.

DATA SYNTHESIS. Heart failure is common in Hong Kong, and is associated with significant morbidity and mortality. Heart failure is often misdiagnosed. B-type natriuretic peptide may be regarded as a quantitative marker of heart failure; its levels have good diagnostic accuracy and can be measured with a rapid and simple bed-side assay and are useful in the assessment of patients with acute dyspnoea. Factors, such as obesity and renal impairment, alter B-type natriuretic peptide levels. Measurement of B-type natriuretic peptide facilitates improved medical outcomes, is cost-effective, and constitutes a good prognostic indicator for death and cardiac events.

CONCLUSIONS. Determination of B-type natriuretic peptide levels is useful in the assessment of patients with acute dyspnoea, to exclude or diagnose heart failure, to facilitate improved medical outcomes, and is cost-effective. In addition, it is a good long-term prognostic indicator and can be used to guide heart failure treatment.

Key words: Diagnosis; Heart failure; Natriuretic peptide, brain

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OBJECTIVE. To review the current evidence on the mechanism of actions and clinical applications of maggot debridement therapy.

DATA SOURCES. Literature search of PubMed and Medline was performed up to January 2007.

STUDY SELECTION. Original and major review articles related to maggot debridement therapy were reviewed. Key words used in the literature search were 'maggot debridement therapy', 'wound healing', and 'chronic wound management'.

DATA EXTRACTION. All relevant English and Chinese articles.

DATA SYNTHESIS. The mechanism of such maggot therapy was shown to be due to the debridement, disinfection, and wound healing enhancement actions of maggot excretions/secretions. The efficacy of maggot debridement therapy in chronic wound management has been demonstrated in chronic venous ulcers, pressure ulcers, and diabetic ulcers. There is also a new delivery system for the excretions/secretions, which has been shown to be as effective as using live maggots.

CONCLUSIONS. Maggot debridement therapy has been shown to be a safe and effective means of chronic wound management. However, there are a number of limitations when considering its local applicability. Future development of the delivery system may help to overcome some of these limitations and improve its acceptability.

Key words: Debridement; Diptera; Larva; Wound healing; Wounds and injuries

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OBJECTIVES. To describe the classification, clinical features, and evaluation of diabetic retinopathy and to review its conventional as well as most updated management.

DATA SOURCES. Literature search of Medline up to October 2006.

STUDY SELECTION. Key words for the literature search were 'diabetic' 'retinopathy' 'treatment' 'laser photocoagulation' 'vitrectomy' 'corticosteroid' 'protein kinase C inhibitor' and 'VEGF inhibitor'

DATA EXTRACTION. Original articles, review papers, and book chapters were reviewed.

DATA SYNTHESIS. Diabetic retinopathy remains one of the leading causes of blindness worldwide. The duration of diabetes and severity of hyperglycaemia are the major risk factors. It progresses from non-proliferative diabetic retinopathy to proliferative diabetic retinopathy through various stages, and the accurate diagnosis of its stage is important. Strict metabolic control and tight blood pressure control can significantly reduce the risk of developing retinopathy and its progression, but are difficult to achieve in clinical practice. Laser photocoagulation and vitrectomy are effective in preventing severe visual loss from sight-threatening diabetic retinopathy and its complications, but both modalities have potential side-effects. Results from clinical trials for protein kinase C inhibitors, intravitreal steroid injections, anti-vascular endothelial growth factor agents, angiotensin converting enzyme inhibitors, and growth hormone inhibitors are promising. Evidence from past clinical trials does not support a role for anti-platelet agents, aldose reductase inhibitors, and advanced glycation end-products inhibitors.

CONCLUSION. Strict metabolic control, tight blood pressure control, laser photocoagulation, and vitrectomy remain the conventional management of diabetic retinopathy. Further clinical trials exploring the role of protein kinase C inhibitors, intravitreal steroid, anti-vascular endothelial growth factor agents, angiotensin converting enzyme inhibitors, growth hormone, and other potential therapies for diabetic retinopathy are actively ongoing. In the near future, results from these clinical trials may lead to the introduction of additional treatments and a corresponding reduction in the frequency of visual loss due to diabetic retinopathy.

Key words: Diabetic retinopathy; Laser coagulation; Treatment outcome; Triamcinolone acetonide; Vitrectomy

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OBJECTIVES. To review the types, incidence, pathogenesis, risk factors, and clinical characteristics of hydroxychloroquine ocular toxicity and current views about its screening and management.

DATA SOURCES. Literature search of Medline up to May 2005.

STUDY SELECTION. Key words for the literature search were 'hydroxychloroquine', 'chloroquine', 'ocular', 'toxicity', 'retinopathy', and 'screening'.

DATA EXTRACTION. Original articles and review papers were examined.

DATA SYNTHESIS. Hydroxychloroquine ocular toxicity includes keratopathy, ciliary body involvement, lens opacities, and retinopathy. Retinopathy is the major concern: others are more common but benign. The incidence of true hydroxychloroquine retinopathy is exceedingly low; less than 50 cases have been reported. Although its pathogenesis is unclear, risk factors include: daily dosage of hydroxychloroquine, cumulative dosage, duration of treatment, coexisting renal or liver disease, patient age, and concomitant retinal disease. Patients usually complain of difficulty in reading, decreased vision, missing central vision, glare, blurred vision, light flashes, and metamorphopsia. They can also be asymptomatic. Most patients have a bull's eye fundoscopic appearance. All patients have field defects including paracentral, pericentral, central, and peripheral field loss. Colour vision is usually undisturbed in early retinopathy, but is impaired in the advanced stage. Most patients have visual loss. Some patients with advanced retinopathy may experience deteriorating visual acuity even after cessation of treatment. There is no consensus on the definition of retinopathy, most-effective ophthalmological assessment, or frequency of screening. Regular screening may be necessary to detect reversible premaculopathy. Cessation of the drug is the only effective management of the toxicity.

CONCLUSION. Consensus with regard to various important aspects of hydroxychloroquine ocular toxicity is limited, especially the definition of true hydroxychloroquine retinopathy, the most effective ophthalmological assessment, and frequency of screening. Decisions to stop medication must be made in conjunction with the rheumatologist or physician managing the patient. Management of hydroxychloroquine retinopathy remains a clinical challenge.

Key words: Chloroquine; Hydroxychloroquine; Mass screening; Retinal diseases

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OBJECTIVE. To elucidate the development of human immunodeficiency virus (HIV) clinical care and research in Hong Kong.

DATA SOURCES. Articles on clinical HIV and acquired immunodeficiency syndrome (AIDS) published from 1985 to 2004 were identified through four sources: Red Ribbon Centre, Special Preventive Programme, Secretariat of the Scientific Committee on AIDS, and PubMed search. The first three are operated by the Centre for Health Protection, Department of Health, Hong Kong.

STUDY SELECTION. Key words for the literature search were ‘AIDS’, ‘HIV’, and ‘Hong Kong’.

DATA EXTRACTION. Only papers with original local data were included.

DATA SYNTHESIS. Sixty papers were identified. The contents were catalogued under seven areas: clinical epidemiology, HIV disease course and presentation, specific complications or organ-based manifestations, immunological evaluation and other monitoring, antiretroviral therapy, HIV/AIDS mortality, and HIV in specific groups. Prevalence of HIV has remained low in Hong Kong but new infections continue to occur together with a significant number of late presenters. Three published AIDS patients’ series, up to the first 200 reported cases, identified Pneumocystis carinii pneumonia as the most common AIDS-defining illness in Hong Kong. Penicillium marneffei and Mycobacterium tuberculosis were two important specific infections studied most; uniqueness of the former in patients of South-East Asia was evident. Local studies of Kaposi's sarcoma and HIV-associated lymphoma have also been reported. Research on CD4 counts has revealed that it is lower in healthy and HIV-infected Chinese than their western counterparts. Children, pregnant women, and haemophiliac patients infected with HIV are among the specific groups of patients studied. Survival of patients with advanced disease has greatly improved over the years, particularly after the advent of highly active antiretroviral therapy.

CONCLUSION. The clinical presentation and outcome of HIV/AIDS patients in Hong Kong are a mixture of those of western and developing countries. Research on clinical HIV/AIDS in Hong Kong is not only beneficial to the planning of patient care, but also enables the formulation of treatment guidelines and provides a reference for other countries.

Key words: Acquired immunodeficiency syndrome; Antiretroviral therapy, highly active; Epidemiology; HIV infections; Sexually transmitted diseases

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