Links between socio-demographic characteristics and body mass index to colorectal cancer in North Borneo, Malaysia: A case-control study.

INTRODUCTION: The fourth leading cause of cancer-related mortality and morbidity worldwide is colorectal cancer (CRC). Numerous reasons have contributed to the massive rise in CRC cases, for which Asian nations differ significantly in terms of risk incidence rates. The objectives of this study were to, first, identify the socio-demographic characteristics of those of North Borneo ethnicity and body mass index (BMI) and, second, determine the association of these factors with CRC. This research will contribute to preventing this form of cancer. MATERIALS AND METHODS: This study is an analysis of a matched case-control study with a ratio of 1:2. The case group contained 206 respondents, and the control group contained 412. All CRC cases were confirmed with the histological results. The control group was matched for links between age, sex and ethnicity with CRC. The Statistical Package for Social Sciences Statistics (SPSS) IBM version 28.0 was used to conduct descriptive analysis using chi-squared testing and simple logistic regression. The statistical significance was P < 0.05. RESULT: Overall, 618 respondents took part in this survey, of which 256 (41.4%) were female and 362 (58.6%) were male. The maximum age was 76, with a mean age ± SD of 53.17 ± 11.4. Those of Bajau ethnicity comprised 24.6% (152) of the population, followed by Dusun with 22.8% (141), Kadazan with 17.6% (109%), other North Borneo ethnic groups with 15.5% (96), Bugis with 9.7% (60), Brunei with 4.4% (27) and other predominant races with 5.3% (33). Regression analyses revealed that the incidence of CRC in North Borneo, Malaysia, was substantially correlated with income, occupation, other linked diseases and BMI. CONCLUSION: Various risk factors are linked to CRC, based on the findings related to socio-demographic characteristics and BMI. Therefore, to lower the nationwide prevalence of CRC, national public health campaigns should include collaboration with the regional authorities to highlight the incidence and risk factors of CRC based on ethnicity.

Development of the rural Palliative Care Services by the Kuala Lipis District Hospital.

In recognising the palliative care (PC) needs globally and in Malaysia, services were developed to serve the rural area of Kuala Lipis, Pahang. This communication describes the initial a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, stages of development towards achieving a successful implementation. PC services were led by Kuala Lipis district hospital include inpatient referrals, outpatient and community care through home visits. These services involve multi-disciplinary team inclusive of representatives from health clinics and allied health. Referrals and opioid usage have demonstrated an increasing trend since its implementation in October 2018. Implementation of rural PC services is feasible; however, long-term sustainability needs to addressed.

Multidrug-resistant organism carriage among residents from residential care homes for the elderly in Hong Kong: a prevalence survey with stratified cluster sampling.

INTRODUCTION: A point prevalence survey was conducted to study the epidemiology of and risk factors associated with multidrug-resistant organism carriage among residents in residential care homes for the elderly (RCHEs). METHODS: A total of 20 RCHEs in Hong Kong were selected by stratified single-stage cluster sampling. All consenting residents aged ≥65 years from the selected RCHEs were surveyed by collection of nasal swab, axillary swab, rectal swab or stool on one single day for each home. Specimens were cultured and analysed for methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Acinetobacter (MDRA, defined as concomitant resistant to fluoroquinolones, carbapenems, aminoglycosides, cephalosporins and beta-lactam with or without beta-lactamase inhibitors), vancomycin-resistant Enterococcus (VRE), and carbapenemase-producing Enterobacteriaceae (CPE). One third of the MRSA-positive samples were selected at random for molecular typing; all positive MDRA, VRE and CPE samples were tested for molecular typing. Demographic and health information of residents including medical history, history of hospitalisation, antimicrobial usage, and use of indwelling catheters were collected to determine any associated risk factors. RESULTS: Samples of 1028 residents from 20 RCHEs were collected. Prevalence of MRSA was estimated as 30.1% (95% confidence interval [CI]=25.1%-35.6%) and MDRA 0.6% (95% CI=0.1%-4.1%). No residents carried VRE nor CPE. Residents living in privately run RCHEs were associated with MRSA carriage. Non-Chinese residents were associated with MRSA carriage with borderline significance. CONCLUSIONS: This survey provided information about multidrug-resistant organism carriage among RCHE residents. This information will enable us to formulate targeted surveillance and control strategies for multidrug-resistant organisms.

Nasopharyngeal non-intestinal-type adenocarcinoma: a case report and updated review of the literature.

BACKGROUND: Non-intestinal-type adenocarcinoma is a malignancy traditionally found in the sinonasal cavity. To our knowledge, this case is the first reported of this rare condition originating in the nasopharynx. CASE PRESENTATION: A 67-year-old woman with nasopharyngeal non-intestinal-type adenocarcinoma, with an accompanying parapharyngeal mass received primary radiation treatment for both lesions. Her tumour subsequently persisted, with a concomitant conversion in pathology from a low- to a high-grade malignancy. RESULTS: Non-intestinal-type and intestinal-type adenocarcinomas of the nasopharynx are extremely rare tumours and do not appear in the World Health Organization classification system. We review the pathophysiologic features of these malignancies and propose modifications to the current classification system. CONCLUSIONS: Non-intestinal-type adenocarcinoma should be included in the differential diagnosis of nasopharyngeal masses. In our experience, this tumour in this location showed a partial response to primary radiation but later converted from a low- to a high-grade adenocarcinoma.

Porcine recombinant factor VIII (Obizur; OBI-1; BAX801): product characteristics and preclinical profile.

INTRODUCTION: Acquired haemophilia A (AHA) is a rare, often severe, auto-immune bleeding disorder caused by the development of inhibitory antibodies (inhibitors) to factor VIII (FVIII). Bypassing agents, recombinant activated FVII or activated prothrombin complex concentrate, are currently recommended as first-line treatments to control bleeding events in patients with AHA. AIM: A plasma-derived porcine FVIII (Hyate:C, Ipsen, UK) was used as a first-line treatment for AHA but was discontinued in 2004 due to viral safety concerns. A recombinant pFVIII (rpFVIII), Obizur (OBI-1; BAX801), which is expected to have a similar efficacy profile to Hyate:C but with a superior safety profile was developed and recently approved by the US Food and Drug Administration for the treatment of AHA. METHODS: Obizur manufacturing begins with the expression of B domain deleted rpFVIII by genetically modified baby hamster kidney-derived cells. The final purified and lyophilized drug product has a negligible risk of viral contamination and contains no animal-derived plasma proteins. Obizur was evaluated for immunogenicity, tolerability, pharmacokinetics and bleeding times in preclinical models including in haemophiliac dogs, cynomolgus monkeys and FVIII-knockout mice. RESULTS: Preclinical animal studies show that the efficacy and immunogenicity of Obizur are similar to that of Hyate:C and that Obizur has a more favourable safety profile. CONCLUSIONS: Obizur is a highly purified recombinant porcine FVIII drug product that has been demonstrated to have a favourable safety and efficacy profile when compared with Hyate:C and can be a valuable treatment option for control of bleeding in AHA patients.

Factors associated with the quality of life of nursing home residents in Hong Kong.

BACKGROUND: The quality of life of nursing home residents has increasingly become an important dimension when evaluating care in a nursing home. Not a lot is known about the quality of life of nursing home residents in Hong Kong. AIM: To investigate factors associated with the quality of life of nursing home residents to inform care management policies and service delivery. METHODS: This study reports data from 125 nursing home residents. The Hong Kong Chinese version of the World Health Organization's Quality of Life-Brief version was used. Other measures used include the Mini-Mental State Examination, the Mini-Nutritional Assessment, the Geriatric Depression Scale, the Modified STRATIFY Falls Prediction Tool and the Modified Barthel Index. A univariate analysis and a multiple regression analysis were then performed to identify the influencing factors. RESULTS: The participants reported a moderate level of quality of life, with the exception in the domain of social relationships. A univariate analysis found some associations between demographic and clinical characteristics and quality of life. A multiple regression analysis indicated that pain, being younger (65-74 years), having son(s) or daughter(s), and cognitive impairment were negatively associated factors. LIMITATIONS: The smallness of the sample from a single study site limits the generalizability of the findings. CONCLUSION: This study provides information that has hitherto been lacking on the quality of life and associated factors among local nursing home residents in Hong Kong. The preliminary findings can help healthcare staff to identify those at risk of suffering from a low quality of life and to design appropriate care interventions to improve the quality of life of such residents. IMPLICATIONS: Adequate pain relief, family connectedness and special attention to the needs of those with cognitive impairment are important considerations in ensuring a better quality of life for older people in long-term residential care.

Hyperornithinaemia-hyperammonaemia-homocitrullinuria syndrome: a treatable genetic liver disease warranting urgent diagnosis.

Hyperornithinaemia-hyperammonaemia-homocitrullinuria syndrome is an autosomal recessive disorder caused by a defect in ornithine translocase. This condition leads to variable clinical presentations, including episodic hyperammonaemia, hepatic derangement, and chronic neurological manifestations. Fewer than 100 affected patients have been reported worldwide. Here we report the first two cases in Hong Kong Chinese, who were compound heterozygous siblings for c.535C>T (p.Arg179*) and c.815C>T (p.Thr272Ile) in the SLC25A15 gene. When the mother refused prenatal diagnosis for the second pregnancy, urgent genetic testing provided the definitive diagnosis within 24 hours to enable specific treatment. Optimal management of these two patients relied on the concerted efforts of a multidisciplinary team and illustrates the importance of an expanded newborn screening service for early detection and treatment of inherited metabolic diseases.

Perspectives on global nursing leadership: international experiences from the field.

AIM: Nursing leaders from six countries engaged in a year-long discussion on global leadership development. The purpose of these dialogues was to strengthen individual and collective capacity as nursing leaders in a global society. Field experiences in practice and education were shared. Perspectives on global leadership can strengthen nurses' contributions to practice, workplace and policy issues worldwide. BACKGROUND: Transformational leadership empowers nurses' increasing confidence. Mentoring is needed to stimulate leadership development but this is lacking in many settings where nurses practice, teach and influence policy. Organizations with global mission provide opportunity for nurses' professional growth in leadership through international dialogues. PROCEDURES: Dialogues among participants were held monthly by conference calls or videoconferences. Example stories from each participant illustrated nursing leadership in action. From these exemplars, concepts were chosen to create a framework. Emerging perspectives and leadership themes represented all contexts of practice, education, research and policy. The cultural context of each country was reflected in the examples. RESULTS: Themes emerged that crossed global regions and countries. Themes were creativity, change, collaboration, community, context and courage. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Relationships initially formed in professional organizations can be extended to intentionally facilitate global nursing leadership development. Exemplars from the dialogues demonstrated nursing leadership in health policy development within each cultural context. Recommendations are given for infrastructure development in organizations to enhance future collaborations.

In search of the diagnosis, and the patient: transient galactosemia demystified after 14 years.

Infantile galactosemia can be caused by inborn errors of galactose metabolism or other rare causes like Fanconi-Bickel syndrome, congenital porto-systemic shunting and multiple hepatic arterio-venous malformations. All these disease entities are however not commonly seen. We report a case of transient infantile galactosemia who first presented in the 1990s, for which no underlying pathology could be identified despite extensive investigations. The diagnosis had not been apparent until after more than a decade, at that time the patient was lost to contact. Considering the potential diagnosis an important and significant one, efforts were made by the case pathologists and clinicians to search for the patient. Ethical dilemmas were encountered during the search of the patient, which involved issues of patient confidentiality and autonomy, and the doctors' duty-to-care. Modern biochemical and molecular testing confirmed the diagnosis after the patient was finally found. The case illustrates the power of molecular testing to retrospectively diagnose an inherited metabolic disease when biochemical abnormalities have subsided, the value of an accurate and precise diagnosis, and the importance of appropriate genetic counselling in an apparently asymptomatic patient in the era of personalized medicine.

Pro-inflammatory high-density lipoproteins and atherosclerosis are induced in lupus-prone mice by a high-fat diet and leptin.

Atherosclerosis is accelerated in people with systemic lupus erythematosus, and the presence of dysfunctional, pro-inflammatory high-density lipoproteins is a marker of increased risk. We developed a mouse model of multigenic lupus exposed to environmental factors known to accelerate atherosclerosis in humans - high-fat diet with or without injections of the adipokine leptin. BWF1 mice were the lupus-prone model; BALB/c were non-autoimmune controls. High-fat diet increased total serum cholesterol in both strains. In BALB/c mice, non-high-density lipoprotein cholesterol levels increased; they did not develop atherosclerosis. In contrast, BWF1 mice on high-fat diets developed increased quantities of high-density lipoproteins as well as elevated high-density lipoprotein scores, indicating pro-inflammatory high-density lipoproteins; they also developed atherosclerosis. In the lupus-prone strain, addition of leptin increased pro-inflammatory high-density lipoprotein scores and atherosclerosis, and accelerated proteinuria. These data suggest that environmental factors associated with obesity and metabolic syndrome can accelerate atherosclerosis and disease in a lupus-prone background.

A novel duplication at the putative DNA polymerase alpha arrest site and a founder mutation in Chinese in the IVD gene underlie isovaleric acidaemia.

Isovaleric acidaemia is a rare inherited organic acidaemia associated with a characteristic odour in affected patients. Fewer than 40 causative mutations have been reported to date. We report a case in a Hong Kong Chinese neonate who presented with respiratory distress and acute encephalopathy requiring aggressive resuscitation and treatment. Residual gross motor developmental delay was still observed at the age of 16 months. The child was subsequently found to harbour a known missense mutation (c.A1199G [p.Y371C]) and a novel 4-bp duplication (c.1148_1151dupGCTA [p.Y355X]) in the IVD gene. We suggest that the former is a founder mutation in the Chinese population and propose an explanation for the duplication event. Strategies that may achieve early diagnosis and prompt treatment include raising awareness of this condition, implementation of a tandem mass spectrometry neonatal screening programme, and local acquisition of appropriate medications for these metabolic diseases.

Are Hong Kong doctors following the Global Initiative for Asthma guidelines: a questionnaire "Survey on Asthma Management"?

OBJECTIVE: To assess the standard of asthma management by doctors in Hong Kong. DESIGN: Cross-sectional postal questionnaire survey. SETTING: Hong Kong. PARTICIPANTS: Practising doctors registered with the Medical Council of Hong Kong were sent a questionnaire between August and December 2007. MAIN OUTCOME MEASURES: Respondents' responses to questions on demographic data, parameters routinely used to assess asthma control, the pattern of asthma medication prescribing, and seven different case scenarios assessing their ability to classify asthma control and management. RESULTS. We received 410 completed questionnaires from general practitioners (55%), internists (22%), paediatricians (11%), and other specialists (12%). The majority (82%) explained the pathology of asthma to at least some of their patients and tried to identify aggravating factors of the asthma (91%). Fewer observed the inhalation technique of their patients (68%) and prescribed a written asthma management plan (33%). The main medications prescribed to adults and children with asthma were inhaled corticosteroids, inhaled short-acting beta-2 agonists, and combinations of an inhaled corticosteroid and a long-acting beta-2 agonist. In adults and children, long-acting beta-2 agonist alone (without inhaled corticosteroid) was being used to treat asthma by 45% and 36% of the doctors, respectively. Also, 94% of the respondents correctly classified the control status in four out of the seven case scenarios and 31% chose the correct medications when responding to seven of the 14 questions asked. CONCLUSIONS: Asthma management practice of Hong Kong doctors falls short of the standards recommended by international guidelines. More effort in improving their knowledge is urgently warranted.

Emergence of new psychoactive substance 2-fluorodeschloroketamine: Toxicology and urinary analysis in a cluster of patients exposed to ketamine and multiple analogues.

New psychoactive substances (NPS) emerge continually, amongst which is a growing class of ketamine analogues with an arylcyclohexylamine backbone. Recently we reported a poisoning outbreak associated with 2-oxo-PCE (deschloro-N-ethyl-ketamine). The present report describes the emergence of another ketamine analogue, 2-fluorodeschloroketamine (2F-DCK). The compound was first detected in a patient's urine, its identity confirmed by accurate mass analysis and comparison with reference standard. Four putative metabolites were identified, including nor-2F-DCK, dehydronor-2F-DCK (major metabolite) and two hydroxylated derivatives of nor-2F-DCK. Between January and July 2019, 20 cases of analytically confirmed 2F-DCK exposure were encountered. In 19 out of 20 cases, at least one more ketamine-type drug was detected concurrently with 2F-DCK, including ketamine (90%), deschloroketamine (DCK, 50%), 2-oxo-PCE (45%) and tiletamine (10%). In particular, six of the cases showed the presence of 4 ketamine-type drugs in the same urine sample. The clinical effects observed in patients exposed to 2F-DCK are predominantly neurological (impaired consciousness, agitation, abnormal behaviour) and cardiovascular (hypertension, tachycardia); five patients had loss of consciousness or convulsion. Management was mainly supportive; all patients recovered uneventfully. This is the first clinical case series involving 2F-DCK and frontline medical personnel are urged to be aware of this rapidly expanding class of NPS, in particular the co-ingestion of multiple ketamine analogues.

Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC).

BACKGROUND: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence and severity of asthma symptoms in children. METHODS: A cross-sectional questionnaire survey of 798 685 children aged 13-14 years from 233 centres in 97 countries, and 388 811 children aged 6-7 years from 144 centres in 61 countries, was conducted between 2000 and 2003 in >90% of the centres. RESULTS: The prevalence of wheeze in the past 12 months (current wheeze) ranged from 0.8% in Tibet (China) to 32.6% in Wellington (New Zealand) in the 13-14 year olds, and from 2.4% in Jodhpur (India) to 37.6% in Costa Rica in the 6-7 year olds. The prevalence of symptoms of severe asthma, defined as >or=4 attacks of wheeze or >or=1 night per week sleep disturbance from wheeze or wheeze affecting speech in the past 12 months, ranged from 0.1% in Pune (India) to 16% in Costa Rica in the 13-14 year olds and from 0% to 20.3% in the same two centres, respectively, in the 6-7 year olds. Ecological economic analyses revealed a significant trend towards a higher prevalence of current wheeze in centres in higher income countries in both age groups, but this trend was reversed for the prevalence of severe symptoms among current wheezers, especially in the older age group. CONCLUSION: Wide variations exist in the symptom prevalence of childhood asthma worldwide. Although asthma symptoms tend to be more prevalent in more affluent countries, they appear to be more severe in less affluent countries.

Identifying uncontrolled asthma in young children: clinical scores or objective variables?

OBJECTIVE: Several international asthma guidelines emphasize the importance of assessing asthma control. However, there is limited data on the usefulness of available assessment tools in indicating disease control in young asthmatics. This study investigated the ability of Chinese version of Childhood Asthma Control Test (C-ACT) and other disease-related factors in identifying uncontrolled asthma (UA) in young children. METHODS: During the same clinic visit, asthma patients 4 to 11 years of age completed C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. RESULTS: The mean (SD) age of 113 recruited patients was 9.1 (2.0) years, and 35% of them had UA. C-ACT, DSS and forced expiratory volume in 1 second (FEV(1)) differed among patients with different control status (p < 0.001 for C-ACT and DSS; p = 0.014 for FEV(1)). Logistic regression confirmed that UA was associated with DSS (p < 0.001), PEF (p = 0.002), C-ACT (p = 0.011), and FEV(1) (p = 0.012). By ROC analysis, C-ACT and DSS were the best predictors for UA (p < 0.001), followed by PEF (p = 0.006) and FEV(1) (p = 0.007). When analyzed by the Classification and Regression Tree (CART) approach, the sequential use of DSS and C-ACT had 77% sensitivity and 84% specificity in identifying UA. CONCLUSIONS: C-ACT is better than objective parameters in identifying young Chinese children with UA.