Renal screening in children after exposure to low dose melamine in Hong Kong: cross sectional study.

OBJECTIVE: To investigate the renal outcomes of children after exposure to low dose melamine in Hong Kong. DESIGN: Cross sectional study. SETTING: Special assessment centres, Hong Kong. PARTICIPANTS: 3170 children (1422 girls and 1748 boys) aged 12 years or less referred from territory-wide primary care clinics after daily consumption for one month or more of milk products tainted with melamine. MAIN OUTCOME MEASURES: Presence of renal stones and haematuria. RESULTS: One child had a confirmed renal stone, seven were suspected of having melamine related renal deposits, and 208 (6.6%) were positive for blood in urine by reagent strip. A proportion of these children were followed up at the special assessment centre, but only 7.4% of those positive for blood on reagent strip were confirmed by microscopy, suggesting an overall estimated prevalence of less than 1% for microscopic haematuria. CONCLUSIONS: No severe adverse renal outcomes, such as acute renal failure or urinary tract obstruction, were detected in children after exposure to low dose melamine. Our results were similar to territory-wide findings in Hong Kong. Even including the seven children with suspected renal deposits, the prevalence of suspected melamine related abnormalities on ultrasonography was only 0.2%. None of these children required specific treatment. The prevalence of microscopic haematuria was probably overestimated by the reagent strip. These data suggest that large scale and urgent screening programmes may not be informative or cost effective for populations who have been exposed to low dose melamine.

The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors.

OBJECTIVE: To examine pulmonary function, exercise capacity, and health-related quality of life (HRQoL) among severe acute respiratory syndrome (SARS) survivors. METHODS: We evaluated survivors with confirmed SARS at the Prince of Wales Hospital, Hong Kong, at 3, 6, and 12 months after symptom onset. Our assessment included: lung volume (total lung capacity [TLC], vital capacity, residual volume, functional residual capacity), spirometry (FVC, FEV1), diffusing capacity of the lung for carbon monoxide (D(LCO)), inspiratory and expiratory respiratory muscle strength, 6-min walk distance (6MWD), chest radiographs (CXRs), and HRQoL by Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire. RESULTS: Ninety-seven patients completed the serial assessments. There were 39 male and 58 female patients, and 63 patients (70%) were health-care workers (mean age, 36.9 years [SD, 9.5 years]; body mass index, 23.7 kg/m2 [SD, 4.0 kg/m2]). At 1 year, 27 patients (27.8%) had abnormal CXR findings. Four patients (4.1%), 5 patients (5.2%), and 23 patients (23.7%) had FVC, TLC, and D(LCO) values < 80% of predicted values, respectively. The 6MWD at 12 months was 511.0 m (SD, 89.8 m), which was higher than at 3 months (mean difference, 47.0 m; 95% confidence interval [CI], 31.8 to 62.1 m; p < 0.01) but not different from 6 months (mean difference, 9.7 m; 95% CI, - 4.4 to 23.8 m; p = 0.18). The 6MWD was lower than that for normal control subjects of the same age groups, and there was impairment of HRQoL at 12 months. Patients who required ICU admission (n = 31) showed higher CXR scores (1.6 [SD, 3.1]; vs 0.4 [SD, 1.1]; p = 0.04) and lower percentage of predicted FVC, TLC, and Dlco than those who did not, but there were no differences in 6MWD and health status. CONCLUSION: Significant impairment in Dlco was noted in 23.7% of survivors 1 year after illness onset. Exercise capacity and health status of SARS survivors were remarkably lower than those of a normal population.

Chest radiograph scores as potential prognostic indicators in severe acute respiratory syndrome (SARS).

OBJECTIVE: We analyzed serial chest radiographic scores for lung opacification in patients with severe acute respiratory syndrome (SARS) for temporal changes and differences between fatal and discharged cases. We sought to establish the earliest radiographic scores sensitive as potential prognostic indicators of fatal outcomes. MATERIALS AND METHODS: Chest radiographs that had been obtained from presentation until the death or discharge of 313 patients with SARS were scored on the basis of the percentage area and location of lung opacification. Profile analysis and univariable logistic regression were performed on these radiographic scores. RESULTS: Despite the increased mortality risks of advanced age and male sex, no significant difference was seen in the percentage area of opacification (AO%) between the sexes in either the group of patients with fatal outcomes or the group of patients who were discharged. No difference existed between age groups (< 65 years vs >/= 65 years), except for the radiograph showing the peak lung opacification in the deceased group in which the lungs of older patients had less opacification than those of younger patients. The radiographic scores obtained by day 7 were the earliest ones with good performance in prognostic prediction. The model showed good discriminatory performance, indicated by high C-indexes for receiver operator characteristic curves (0.86 for AO% and 0.90 for the number of opacified zones). The predicted proportion of patients with fatal outcomes showed high agreement with percentage of patients who died (goodness-of-fit statistic p = 0.18 for AO%, 0.73 for the number of opacified zones). By day 7, crude odds ratio of death was 1.73 per 5% of AO% (p < 0.0001) or 2.93 per lung zone opacified (p < 0.0001). CONCLUSION: Chest radiographic scores (percentage of lung or the number of zones opacified) by day 7 could be used as fatal prognostic indicators.