Objective: Psychiatric case management was introduced in inpatient general psychiatry wards in a tertiary psychiatric hospital in late 2003. A brokerage model of case management is used espousing advocacy with case managers acting in their patient’s best interest to encourage and facilitate use of appropriate psychiatric care and reduce fragmentation and costs. Data on patients’ case managed in 2004 and 2005 was analysed to determine the effectiveness of the service in terms of clinical outcomes and service linkages provided. Methods: Psychiatric case managers maintained databases on the patients referred to them. There were 231 patients in 2004 and 375 patients in 2005. Analyses were performed by using SPSS 13.0 with statistical significance set at P <0.05. Descriptive statistics was used and differences between the 2 cohorts in outcome measures were assessed using Chi-square or Fisher’s Exact test. Results: The service developed with a 62.3% increase in the number of cases accepted for case management in the second year. There was improvement in clinical outcomes, such as reductions in unplanned re-admissions within 28 days from 4.8% in the first year to 2.1% in the second year. A reduction in suicide attempts and forensic complications was also found. There were significant reductions in re-hospitalisation in 2004, from 28.1% to just 6.9% after case management was provided (p<0.001). Conclusion: The brokerage model of case management used in this setting was effective in reducing re-hospitalisation, unplanned readmissions, suicide attempts and forensic complications for psychiatric patients

Global public health security is both a collective aspiration and a mutual responsibility that demands cooperative action at all levels. The expansion of the current H5N1 avian influenza enzootic and its incursion into human health presents a real and significant threat of an influenza pandemic. The world has for the first time an unprecedented opportunity for pandemic preparation. Current global efforts to tackle the H5N1 pandemic threat are centred around the framework of the International Health Regulations (2005) that requires countries to openly share disease intelligence including clinical samples, viruses and epidemiological information. Present international initiatives also seek to establish more equitable allocation and sharing mechanisms for developing countries, of therapeutic resources, public health interventions and other broad-based support in the event of a pandemic. To be sustainable, country preparatory efforts need to be integrated within wider national emergency preparedness frameworks and emphasise the strengthening of basic capacities in disease surveillance, outbreak response and health systems that can respond to a range of public health emergencies. Such capacity building represents permanent investments in health that will have enduring benefits beyond a pandemic. Preparations must also go beyond the health sector; greater promotion of intersectoral cooperation and an adoption of a whole-of-society approach to preparation is recommended. Broad collaboration is vital in addressing the complex challenge posed by influenza to our collective security.
Animals ; Birds ; Communicable Disease Control ; methods ; Global Health ; Health Planning ; Humans ; Influenza A Virus, H5N1 Subtype ; isolation & purification ; Influenza in Birds ; epidemiology ; virology ; Public Health

INTRODUCTIONSarcosinaemia is a rare metabolic disorder which has not been reported in Asia.

CLINICAL PICTUREThe urine samples of 2 patients were screened as a routine metabolic screening offered for patients with mental retardation in our hospital. We used gas chromatography-mass spectrometry (GC-MS) which is capable of detecting abnormal pattern in amino acids and organic acids. Plasma sarcosine level was further quantified by GC-MS. The same methods were used in the investigations of asymptomatic family members. Urine examination by GC-MS revealed excessive amount of sarcosine in urine (normally undetectable) and their plasma sarcosine levels were raised. The 2 differential diagnoses of presence of sarcosine in urine--glutaric aciduria type II and folate deficiency--were ruled out by the absence of abnormal organic acids in the initial urine screen and by normal serum folate level respectively. Screening of the 2 families identified excessive sarcosine in urine in 2 siblings, one from each family. However, these 2 siblings of indexed patients thus identified have no neurological or developmental problem.

CONCLUSIONOur finding was consistent with the notion that sarcosinaemia is a benign condition picked up coincidentally during screening for mental retardation.

Amino Acid Metabolism, Inborn Errors ; complications ; diagnosis ; Child ; Child, Preschool ; China ; ethnology ; Family Health ; Female ; Gas Chromatography-Mass Spectrometry ; Hong Kong ; Humans ; India ; ethnology ; Intellectual Disability ; complications ; Sarcosine ; blood ; urine ; Sarcosine Dehydrogenase ; deficiency

Transient cortical blindness (TCB) is a rare but well-known complication of cerebral angiography. Its pathophysiology remains uncertain. We would like to report a case of TCB in a patient during a follow up vertebral angiogram for post-coil embolization of left posterior inferior cerebellar artery aneurysm. Patient's vision was resumed spontaneously within 24 hours after angiography, with no residual neurological deficit in subsequent clinical follow up. Multi-modality imaging evaluation including vertebral angiography, brain CT and MRI performed on same day are presented.
Aneurysm ; Angiography* ; Arteries ; Blindness, Cortical* ; Brain ; Cerebral Angiography ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging

Adult ; Charcot-Marie-Tooth Disease ; etiology ; genetics ; Female ; GTP Phosphohydrolases ; Humans ; Membrane Proteins ; genetics ; Mitochondrial Proteins ; genetics ; Mutation ; Sequence Analysis, DNA

OBJECTIVETo define the prevalence, severity and risk factors for lead poisoning in new immigrant children from the mainland of China to Hong Kong, China.

METHODSNew immigrant children from the mainland of China under 18 years of age were invited to join the study. Their growth parameters and venous blood lead levels (BLL) were measured within 7 days of arrival. Those with elevated BLL i.e. > 10 micrograms/dl (0.48 mumol/L) were assessed for signs, symptoms and risk factors of lead poisoning. Education on the prevention of lead poisoning and follow up BLL measurements were offered until their BLL normalized.

RESULTSFour hundred and fifty-seven children were recruited. Among them, 18.1% and 2.6% had BLL > 0.48 and 0.71 mumol/L, respectively. None had BLL > 0.96 mumol/L. Possible risk factors included contaminated drinking water (19%), herb ingestion (17.5%), pica, playing in dumping grounds, residing near paint factories or highways, habitual inhalation of car exhaust and cooking with petroleum. Symptoms and signs included abdominal pain, headache, short stature, and learning difficulties but did not correlate with BLL. None required treatment except for counseling on the avoidance of risk factors. About 94.7% showed a reduction in BLL 2-3 months after arrival and before counseling. All had normalized BLL by 9 months except 1 who had an X-ray feature of lead line.

CONCLUSIONSLead poisoning is common in new immigrant children from the mainland of China. Environmental factors were most important while behavioral factors like regular herb ingestion might have contributed to the persistence of high BLL in the minority.

Adolescent ; Child ; Child, Preschool ; China ; Emigration and Immigration ; Female ; Hong Kong ; epidemiology ; Humans ; Infant ; Infant, Newborn ; Lead Poisoning ; epidemiology ; etiology ; Male ; Prevalence ; Risk Factors

BACKGROUNDCardiac resynchronization therapy (CRT) is an effective electrical therapy for patients with moderate to severe heart failure and cardiac dyssynchrony. This study aimed to investigate the degree of acute left ventricular (LV) resynchronization with biventricular pacing (BVP) at different LV sites and to examine the feasibility of performing transthoracic echocardiography (TTE) to quantify acute LV resynchronization during CRT procedure.

METHODSFourteen patients with NYHA Class III-IV heart failure, LV ejection fraction < or = 35%, QRS duration > or = 120 ms and septal-lateral delay (SLD) > or = 60 ms on tissue Doppler imaging (TDI), underwent CRT implant. TDI was obtained from three apical views during BVP at each accessible LV site and SLD during BVP was derived. Synchronicity gain index (Sg) by SLD was defined as (1 + (SLD at baseline--SLD at BVP)/SLD at baseline).

RESULTSSeventy-two sites were studied. Positive resynchronization (R+, Sg > 1) was found in 42 (58%) sites. R+ was more likely in posterior or lateral than anterior LV sites (66% vs. 36%, P < 0.001). Concordance of empirical LV lead implantation sites and sites with R+ was 50% (7/14).

CONCLUSIONSThe degree of acute LV resynchronization by BVP depends on LV lead location and empirical implantation of LV lead results in only 50% concordance with R+. Performing TTE during CRT implantation is feasible to identify LV sites with positive resynchronization.

Aged ; Cardiac Resynchronization Therapy ; methods ; Echocardiography ; methods ; Female ; Heart Failure ; therapy ; Humans ; Male ; Middle Aged ; Ventricular Dysfunction, Left ; therapy

Adolescent ; Death, Sudden, Cardiac ; etiology ; Female ; Humans ; Ion Channels ; physiology ; Mutation ; Ryanodine Receptor Calcium Release Channel ; genetics ; Syncope ; etiology ; Tachycardia, Ventricular ; genetics

PURPOSE: The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed. MATERIALS AND METHODS: A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients. RESULTS: No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV₇₀) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm. CONCLUSION: The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.
Clothing ; Cone-Beam Computed Tomography ; Fiducial Markers ; Humans ; New Zealand ; Postoperative Complications ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Radiation Oncology ; Radiotherapy ; Radiotherapy, Image-Guided ; Radiotherapy, Intensity-Modulated ; Rectum ; Retrospective Studies ; Urinary Bladder

Purpose: This study aimed to evaluate the role of gallium-67 single photon emission computed tomography (SPECT) with contrast computed tomography (CT) in the evaluation and monitoring of infected abdominal aortic aneurysms (IAAA). Materials and Methods: A retrospective cohort analysis was performed using prospectively collected data of consecutive patients with IAAA in Princess Margaret Hospital in Hong Kong between January 2010 and December 2020. The patients were identified using the Radiology Information System. Results: All five patients had proven IAAA on CT and/or metabolic imaging.Among them, three were further supported by positive blood culture results. Gallium-67 SPECT with contrast CT was useful in the detection of residual disease, monitoring, and detection of recurrence. Conclusion Gallium-67 SPECT with contrast CT is helpful for evaluating IAAA.It serves an important role in guiding management, especially during long-term follow-up.