Successful treatment of spinal cord compression secondary to extramedullary hematopoietic mass by hypertransfusion in a patient with thalassemia major.

A 15-year-old girl with thalassemia major who suffered from paraparesis with a history of progressive lower limb weakness for 2 years immigrated from mainland China to Hong Kong. She had not received regular blood transfusion since the age of 6 years after splenectomy. MRI of the spine showed thoracic spinal cord compression secondary to extramedullary hematopoietic mass. She made significant recovery with hypertransfusion therapy alone. MRI of the spine repeated 3 months later showed nearly complete resolution of the extramedullary hematopoietic mass.

Infectious diseases in children admitted from a residential child care centre.

OBJECTIVES: To describe the pattern of infectious diseases among children admitted from a residential child care centre and to identify any unusual clusters of admissions. DESIGN: Retrospective case review. SETTING: Regional hospital, Hong Kong. PATIENTS: All children from a residential child care centre aged over 28 days who were admitted from the Accident and Emergency Department to paediatric wards for infections from 1 January 1999 to 31 December 2003. MAIN OUTCOME MEASURES: Demographic data, clinical diagnoses, infectious diseases identified, and incidence and seasonal pattern of various infections. RESULTS: Of 267 children admitted to the hospital over the 5-year period, 221 had infectious diseases. Respiratory tract infections, viral exanthema, and gastroenteritis were present in 83.7%, 7.2%, and 5.9%, respectively. Among those with a respiratory tract infection, 22.7%, 9.2%, and 8.6% had respiratory syncytial virus, parainfluenza virus, and influenza A or B viruses, respectively. Two unusual clusters of respiratory syncytial virus and parainfluenza virus were recognised in late 2003. CONCLUSION: Children in this residential child care centre were at risk of infectious diseases. Respiratory tract infection is the most common infectious disease in this centre. An outbreak of respiratory tract infection was recognised. Further efforts may be necessary to improve infection control measures in this setting.

A community-based study of the prevalence of constipation in young children and the role of dietary fibre.

OBJECTIVES: To study the prevalence of constipation in young children, and to explore its association with dietary fibre intake. DESIGN: Cross-sectional community-based study. SETTING: Three kindergartens randomly selected from the eastern district of Hong Kong. PARTICIPANTS: Between October 2003 and January 2004, parents of children aged 3 to 5 years completed a specially designed questionnaire and a 3-day dietary record form, which were used to collect information on bowel function and dietary intake. Children with constipation were identified based on Rome criteria. Children with normal bowel habits served as a comparison group. MAIN OUTCOME MEASURES: Dietary intake of energy, protein, and dietary fibre. RESULTS: Of 778 children recruited, 561 complete sets of data were successfully obtained from the participating kindergartens. One hundred and sixty-six (29.6%) children were found to be constipated. The incidence of a family history of constipation was significantly higher in the constipated group (14%) than in the non-constipated group (7%) [P=0.013]. Mean dietary fibre consumption was 4.1 g/d (standard deviation, 2.3 g/d) in all children corresponding to 45.5% (standard deviation, 24.9%) of the daily recommendation. Constipated children (mean, 40.7%; standard deviation, 20.5%) had a significantly lower dietary fibre intake of the daily recommendation than the non-constipated group (mean, 47.5%; standard deviation, 26.2%) [P=0.017]. CONCLUSION: Up to 30% of preschool children in the eastern district had constipation. A family history of constipation was related to its occurrence in the studied children. Dietary fibre intake was insufficient in all children and even lower in those who were constipated.

Use of an electronic barcode system for patient identification during blood transfusion: 3-year experience in a regional hospital.

OBJECTIVE: To evaluate the use of an electronic barcode system for patient identification during blood transfusion. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: For all patients requiring blood transfusion between May 1999 and April 2002, with the exception of patients in the psychiatric wards and the accident and emergency department, a portable, hand-held scan-and-print electronic device was used to verify and document patients' identity at two critical points of transfusion: blood sampling for the compatibility test and blood administration. MAIN OUTCOME MEASURES: Scope of use of the electronic device, cost, effectiveness, staff compliance, problems and solution for improvement. RESULTS: In the first 3 years of hospital-wide use of the new device, no incidents of blood transfusion to wrong patients, or wrong labelling of blood samples, occurred with 41,00 blood sampling procedures and administration of 27 000 units of blood. Blood sampling took 6 minutes to complete with the use of the electronic device-similar to that taken by the conventional second-checker system. Among hospital staff, the compliance rate of using the new device approached 90%. Battery problems occurred in 12% of episodes of use of the device. CONCLUSIONS: The electronic barcode system was effective in reducing human error related to bedside transfusion procedures. The future goal is to tailor-make a more efficient device with additional functions.

Evaluation of "point of care" devices in the measurement of low blood glucose in neonatal practice.

BACKGROUND: Low blood glucose in newborns is difficult to detect clinically. Hence a reliable "point of care" device (glucometer) for early detection and treatment of low glucose is needed. OBJECTIVE: To evaluate the performance of five readily available glucometers for the detection of low blood glucose in newborn infants. METHOD: Glucostix measurements were taken for newborns with risk factors using a Reflolux S (Boehringer) glucometer. If the initial reading was low (< 2.6 mmol/l), further measurements were taken with two other glucometers (phase I, Advantage and Glucotrend (Roche); phase II, Elite XL (Bayer) and Precision (Abbott)), and plasma glucose was measured in the laboratory (Aeroset; Abbott). RESULTS: Over 10 months, 101 specimens were collected from 71 newborns (57 in phase I; 44 in phase II). The Advantage glucometer usually overestimated blood glucose with a mean difference of 1.07 mmol/l (p < 0.01) at all low glucose ranges. The Glucotrend, Precision, and Elite XL glucometers performed better; the mean differences were not significantly different from the laboratory measured value (0.17 mmol/l (p = 0.37); -0.12 mmol/l (p = 0.13), and 0.24 mmol/l (p = 0.13) respectively). For detection of glucose concentrations < 2.6 mmol/l, the Precision glucometer had the highest sensitivity (96.4%) and negative predictive value (90%). For lower glucose concentrations (< 2.0 mmol/l), the Glucotrend glucometer performed even better (sensitivity 92.3%, negative predictive value 96.3%). CONCLUSION: Point of care devices should have good precision in the low glucose concentration range, sensitivity, and accuracy for early detection of neonatal hypoglycaemia. None of the five glucometers was satisfactory as the sole measuring device. The Glucotrend and Precision glucometers have the greatest sensitivity and negative predictive value. However, confirmation with laboratory measurements of plasma glucose and clinical assessment are still of the utmost importance.

Epidemiology of hepatitis A and hepatitis E infection and their determinants in adult Chinese community in Hong Kong.

Current epidemiology of hepatitis A virus (HAV) and hepatitis E virus (HEV) in Hong Kong was evaluated in 936 adult Chinese subjects recruited through a telephone interview in 2001. Some 15% of the subjects had IgG antibodies to both HAV and HEV while 665 (71.0%) and 176 (18.8%) had anti-HAV and anti-HEV, respectively. Age was the most significant independent factor. Six hundred thirty-eight (79.8%) and 165 (20.7%) subjects aged > or =30 had anti-HAV and anti-HEV, respectively, as compared with 27 (19.7%) and 11 (8.0%) in people aged <30. The corresponding adjusted Odds ratio (OR) was 14.94 (95% CI: 9.13-24.44; P<0.001) for anti-HAV positivity and 2.99 (95% CI: 1.58-5.67; P=0.001) for anti-HEV positivity. Subjects born outside Hong Kong were more likely to have anti-HAV (adjusted OR: 3.41; 95% CI: 2.21-5.26; P<0.001) but not anti-HEV. Non-labour work people were less likely to have anti-HAV-adjusted OR, 0.40 (95% CI: 0.26-0.62; P<0.001). Age-specific HAV prevalence right shifted in the last 20 years. Anti-HAV positivity was less frequent, across all age groups, in subjects >21-years-old in the present study than another study done in 1987-89 (P<0.001). HAV prevalence only increased slightly in every 10-year age groups of people aged 21-50 when compared with their corresponding 10-year-younger age groups (P=0.11), suggesting an ageing cohort effect with no major infections in the last decade. For HEV, both the overall and age-specific prevalence decreased over the last decade (P<0.001). The increasing proportion of susceptible population to enterically transmitted viral hepatitis has implications to future prevention and control programmes, including vaccination strategies.

The long-term efficacy of plasma-derived hepatitis B vaccine in babies born to carrier mothers.

The long-term efficacy of a childhood hepatitis B vaccination programme was evaluated. A total of 112 newborn babies of hepatitis B carrier mothers were given hepatitis B immune globulin (HBIG) and a 10-microg three-dose regimen of plasma-derived vaccine administered at a conventional (0, 1, 6 months), delayed (2, 3, 8 months) or accelerated (0, 1, 2 months) schedule. The vaccinees were followed up to determine their anti-HBs status over a 16-year period. Upon completion of the vaccination schedules, 92.6% developed antibody against surface antigen (anti-HBs) seroconverion, the rate of which fell to 33.3% at year 16. The three schedules were equally effective in preventing chronic infection, with a protective efficacy of 88.9% from hepatitis B surface antigen (HBsAg) carriage, compared with historical control. Vaccinees on the delayed schedule had a slightly higher seroconversion rate over years, and were better able to maintain an anti-HBs level of > or = 100 iu/L. Overall, a quarter demonstrated evidence of exposure to the virus, being positive for antibody against core antigen or HBsAg, or mounting a rise in anti-HBs during the follow-up period. We conclude that a three-dose hepatitis B vaccination regimen is generally effective in protecting newborns of hepatitis B carrier mothers from infection and chronic carriage. Booster is not needed even after 16 years of monitoring.

The implication of a reduced-dose hepatitis B vaccination schedule in low risk newborns.

Five hundred and seventy-four babies born to HBsAg negative mothers in Hong Kong received either a regular (5 micro g) or reduced (2.5 micro g) three-dose regimen of recombinant hepatitis B vaccine. A significantly higher anti-HBs positivity rate (>or=10 mIU/ml), geometric mean titer (GMT) and the maintenance of a high anti-HBs level (>or=100 mIU/ml) were observed with the regular-dose regimen. The differences persisted, however, only up to 1 year post-vaccination. Over an 8-year period, only 1% of the vaccinees demonstrated anti-HBc seroconversion and none had become HBsAg positive. The long-term efficacy of the reduced-dose regimen was confirmed, even in an HBV endemic population.