2016 Aug - Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

Su HY, Wang MJ, Li YH, Tang CN, Tsai MJ.; Hong Kong Med J. 2016 Aug 12.  [Epub ahead of print]

OBJECTIVES: To investigate the clinical predictors and the aetiologies for surgery in patients with Naja atra (Taiwan or Chinese cobra) envenomation.

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2016 Aug - Extracorporeal blood purification for sepsis

Shum HP, Yan WW, Chan TM.; Hong Kong Med J. 2016 Aug 19. [Epub ahead of print]

It has been speculated that extracorporeal blood purification therapies might improve the clinical outcome for patients with severe sepsis, with or without acute kidney injury, since the removal of inflammatory mediators and/or bacterial toxins from circulation could modulate the inflammatory responses that result in organ damage. Despite initial enthusiasm based on promising preliminary results, subsequent investigations did not show sustainable survival benefit. We review the principles and development of blood purification techniques for sepsis and septic acute kidney injury.

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2016 Apr - Mushroom poisoning in Hong Kong: a ten-year review

Chan CK, Lam HC, Chiu SW, Tse ML, Lau FL.; Hong Kong Med J. 2016 Apr;22(2):124-30.

INTRODUCTION: Mushroom poisoning is a cause of major mortality and morbidity all over the world. Although Hong Kong people consume a lot of mushrooms, there are only a few clinical studies and reviews of local mushroom poisoning. This study aimed to review the clinical characteristics, source, and outcome of mushroom poisoning incidences in Hong Kong.

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2015 Dec - Extrapulmonary involvement associated with Mycoplasma pneumoniae infection

Liong T, Lee KL, Poon YS, Lam SY, Kwok KM, Ng WF, Lam TL, Law KI.; Hong Kong Med J. 2015 Dec;21(6):569-72.

Mycoplasma pneumoniae infection usually presents with upper and lower respiratory tract infection. Extrapulmonary involvement is not uncommon, however. We report two cases of predominantly extrapulmonary manifestations of Mycoplasma pneumoniae infection without significant pulmonary involvement. Both cases were diagnosed by serology. These cases illustrate the diversity of clinical presentations of Mycoplasma pneumoniae infection. Clinicians should maintain a high index of suspicion.

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2016 Jan - Acute carbon monoxide poisoning in a regional hospital in Hong Kong: historical cohort study

Chan MY, Au TT, Leung KS, Yan WW.; Hong Kong Med J. 2016 Jan 15. [Epub ahead of print]

Objectives: This study aimed to describe the clinical profiles of all patients with carbon monoxide poisoning admitted to a regional hospital in order to enhance the vigilance of health care professionals for delayed neurological sequelae associated with carbon monoxide poisoning and to identify the prognostic factors associated with their development. This study also aimed to assess the impact of hyperbaric oxygen therapy on the development of delayed neurological sequelae in these patients.

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2015 Sep - Outcome of elderly patients who receive intensive care at a regional hospital in Hong Kong

Shum HP, Chan KC, Wong HY, Yan WW.; Hong Kong Med J. 2015 Sep 29. [Epub ahead of print]

Objective: To evaluate the clinical outcome (180-day mortality) of very elderly critically ill patients (age ≥80 years) and compare with those aged 60 to 79 years.

2015 Sep - Intensive care unit family satisfaction survey

SM Lam, HM So, SK Fok, SC Li, CP Ng, WK Lui, DK Heyland, WW Yan; HK Medical Journal, 2015 Sep 15 | DOI: 10.12809/hkmj144385

Objectives: To examine the level of family satisfaction in a local intensive care unit and its performance in comparison with international standards, and to determine the factors independently associated with higher family satisfaction.

2015 Jul - Paracetamol overdose in Hong Kong: is the 150-treatment line good enough to cover patients with paracetamol-induced liver injury?

Simon TB Chan, CK Chan, ML Tse; Hong Kong Med J 2015;21:Epub 31 Jul 2015

Objectives: To evaluate the failure rate of the 150-treatment line for paracetamol overdose in Hong Kong, and the impact if the treatment threshold was lowered.

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2015 Jan - Prevention of ventilator-associated pneumonia

Arthur CW Lau, HM So, SL Tang, Alwin Yeung,  SM Lam, WW Yan; for the Hong Kong East Cluster Task Force on Prevention of Ventilator-associated Pneumonia in Critical Care Areas; Hong Kong Med J 2015;21:Epub 16 Jan 2015

Ventilator-associated pneumonia is the commonest, yet mostly preventable, infection in mechanically ventilated patients. Successful control of ventilator-associated pneumonia can save hospitalisation cost, and is possible by using a multidisciplinary clinical and administrative approach. The ventilator-associated pneumonia rate should be expressed as the number of ventilator-associated pneumonia days per 1000 ventilator days to take into account the device-utilisation duration for meaningful comparison. Various strategies address the issue, including general infection control measures, body positioning, intubation and mechanical ventilation, oral and gastro-intestinal tract, endotracheal tube, airway pressure, cuff pressure, selective digestive and/or oropharyngeal decontamination, and probiotic or early antibiotic treatment, as well as overall administration at a policy level..

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2014 Dec - Risks and benefits of citrate anticoagulation for continuous renal replacement therapy

Shum HP, Yan WW, Chan TM.; Hong Kong Med J. 2014 Dec 5

Heparin, despite its significant side-effects, is the most commonly used anticoagulant for continuous renal replacement therapy in critical care setting. In recent years, citrate has gained much popularity by improving continuous renal replacement therapy circuit survival and decreasing blood transfusion requirements. However, its complex metabolic consequences warrant modification in the design of the citrate-based continuous renal replacement therapy protocol. With thorough understanding of the therapeutic mechanism of citrate, a simple and practicable protocol can be devised. Citrate-based continuous renal replacement therapy can be safely and widely used in the clinical setting with appropriate clinical staff training.

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2014 Nov - The benefit of prothrombin complex concentrate in decreasing neurological deterioration in patients with warfarin-associated intracerebral haemorrhage

Fong WC, Lo WT, Ng YW, Cheung YF, Wong GC, Ho HF, Chan JH, Li PC.; Hong Kong Med J. 2014 Nov 7.

OBJECTIVE. To compare the outcomes of patients with warfarin-associated intracerebral haemorrhage given different treatments to reverse the effect of anticoagulation.

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2014 Aug - Use of viscoelastic haemostatic assay in emergency and elective surgery

Yeung MC, Tong SY, Tong PY, Cheung BH, Ng JY, Leung GK.; Hong Kong Med J. 2014 Aug 1. doi: 10.12809/hkmj134147. [Epub ahead of print]

Objectives: To review the current evidence for the use of viscoelastic haemostatic assays in different surgical settings including trauma, cardiac surgery, liver transplantation, as well as the monitoring of antiplatelet agents and anticoagulants prior to surgery.

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2014 Mar - Severe acute pyelonephritis: a review of clinical outcome and risk factors for mortality

Chung VY, Tai CK, Fan CW, Tang CN.; Hong Kong Med J. 2014 Mar 14. doi: 10.12809/hkmj134061.

OBJECTIVE. To review patient demographics and outcome of severe upper urinary tract infection, and to identify risk factors for long hospital stay and mortality.

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2014 Jun - Three-year experience of using venovenous extracorporeal membrane oxygenation for patients with severe respiratory failure

Ng GW, Leung AK, Sin KC, Au SY, Chan SC, Chan OP, Wu HH.; Hong Kong Med J. 2014 Jun 20. doi: 10.12809/hkmj144211. [Epub ahead of print]

OBJECTIVE. To present the 3-year experience of using venovenous extracorporeal membrane oxygenation for patients with severe respiratory failure in a single centre in Hong Kong.

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2014 Feb - Characteristics of patients readmitted to intensive care unit: a nested case-control study

Tam OY, Lam SM, Shum HP, Lau CW, Chan KC, Yan WW.; Hong Kong Med J. 2014 Feb 14.  [Epub ahead of print]

OBJECTIVES. To evaluate the pattern of unplanned readmissions to the intensive care unit and identify patients at risk of readmission.

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2014 Feb - Intensive care unit admission of obstetric cases: a single centre experience with contemporary update

Vivian KS Ng, TK Lo, HH Tsang, WL Lau, WC Leung, Hong Kong Medical J. Feb 2014, 20: 24-31

Objectives: To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007.

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2013 Dec - Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection

HP Shum, KC Chan, MC Kwan, WW Yan  Hong Kong Medical J. Dec, 2013: 491-497

OBJECTIVE. Endotoxins and cytokines play an important role in the pathogenesis of multi-organ failure and mortality in patients suffering from severe Gram-negative bacterial infection. The aim of this study was to determine whether in patients with such infections, use of a haemofilter with enhanced endotoxin haemoadsorption and cytokine removal properties helps to overcome organ dysfunction.

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2013 Jul - Benchtop study of leakages across the Portex, TaperGuard and Microcuff Endotracheal tubes under simulated clinical conditions

Lau AC, Lam SM, Yan WW.; Hong Kong Med J. 2013 Jul 22. [Epub ahead of print]

OBJECTIVES. To compare three endotracheal tubes for leakage across the cuff (microaspiration) under a comprehensive set of simulated clinical situations. These were the Mallinckrodt TaperGuard (Covidien, US) with a tapered polyvinyl chloride cuff; the KimVent Microcuff (Kimberly-Clark Health Care, US) with a cylindrical polyurethane cuff, and a conventional Portex (Smiths Medical International Ltd, UK) with a globular polyvinyl chloride cuff.

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2013 May - Retrospective review of clinical presentations, microbiology, and outcomes of patients with psoas abscess

OF Wong, PL Ho, SK Lam; HKMJ, 6 May 2013

Objective: The clinical features of patients with psoas abscess in a local setting, including the microbiology, incidence and aetiologies, have not been well described. This study aimed to review such clinical features and patient outcomes.

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2013 May - Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection

HP Shum, KC Chan, MC Kwan, WW Yan; HKMJ 6 May 2013

Objective: Endotoxins and cytokines play an important role in the pathogenesis of multi-organ failure and mortality in patients suffering from severe Gram-negative bacterial infection. The aim of this study was to determine whether in patients with such infections, use of a haemofilter with enhanced endotoxin haemoadsorption and cytokine removal properties helps to overcome organ dysfunction.

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