Acquired localised hypertrichosis in a Chinese child after cast immobilisation.

Hypertrichosis refers to excessive hair growth that is independent of any androgen effect. Hypertrichosis could be congenital or acquired, localised or generalised. The phenomenon of acquired localised hypertrichosis following cast application for a fracture is well known to orthopaedic surgeons, but is rarely encountered by primary care physicians. We describe a 28-month-old Chinese boy who had fracture of right leg as a result of an injury. He had a cast applied by an orthopaedic surgeon as treatment. On removal of the cast 6 weeks later, he was noticed to have significant hair growth on his right leg compared with the left leg. The patient was reassessed 3 months after removal of the cast. The hypertrichosis resolved completely with time. This patient was one of the youngest among the reported cases of acquired localised hypertrichosis after cast application. We illustrate the significance of management of post-cast-acquired localised hypertrichosis in the primary care setting.

Review on the use of insulin in primary care.

Diabetes mellitus is one of the major causes of premature morbidity and mortality. Studies show that intensive glycaemic control could significantly reduce the risk of diabetic complications. With the increasing number of diabetic patients under primary care indicated for insulin, family physicians will play a pivotal role in prescribing it in their setting. The initiation and titration of any insulin regimen is not difficult in most patients. With support from diabetes nurses and training on insulin use, family physicians can provide insulin therapy to diabetic patients in the community and reduce the number of referrals to secondary care. This article reviews the most updated clinical guidelines on insulin use to better equip family physicians on the initiation and titration of insulin in primary care.

Prevalence of diabetic nephropathy among Chinese patients with type 2 diabetes mellitus and different categories of their estimated glomerular filtration rate based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in primary care in Hong Kong: a cross-sectional study.

PURPOSE: To evaluate the prevalence of diabetic nephropathy and different categories of estimated glomerular filtration rate (eGFR) as calculated by the CKD-EPI equation among Chinese patients with type 2 diabetes in primary care in Hong Kong. The associated factors of diabetic nephropathy were also analyzed. METHODS: A cross-sectional study was conducted in 35,109 Chinese patients with type 2 diabetes followed up in all General Outpatient Clinics in a Hospital Authority cluster and had undergone comprehensive diabetic complication assessment from April 2013 to March 2016. The GFR was estimated by the CKD-EPI equation. Logistic regression was used to analyze the associated factors of diabetic nephropathy. RESULTS: The prevalence of diabetic nephropathy (with either or both albuminuria and impaired eGFR), impaired eGFR (with or without albuminuria) and albuminuria (with or without impaired eGFR) was 31.6%, 16.9% and 22.0% respectively. The prevalence of eGFR categories 1, 2, 3, 4 and 5 was 36.0%, 47.1%, 15.7%, 1.1% and 0.1% respectively. The comorbidity with hypertension or presence of other diabetic microvascular or macrovascular complications including diabetic retinopathy, peripheral neuropathy, peripheral vascular disease, history of stroke and history of ischemic heart disease had strong association with diabetic nephropathy. Obesity, smoking, suboptimal control of blood pressure, hemoglobin A1c and non-high density lipoprotein cholesterol were also significantly associated with diabetic nephropathy. CONCLUSIONS: Diabetic nephropathy was common among Chinese patients with type 2 diabetes in primary care in Hong Kong. Early identification and control of the modifiable risk factors are of upmost importance in preventing the complication.