Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong

BACKGROUND: Currently there is very limited data in the literature assessing the prevalence of antihistamine prescription, and there is no local prevalence data about the prescription of antihistamine agents among primary practitioner and emergency physicians. The objectives are 1) to report the prevalence of antihistamine prescription for children less than 6 years old with acute upper respiratory infection and 2) to explore the associated factors for the prescription practice.METHODS: This is a cross-sectional study. All consecutive cases of paediatric patients aged 6 or below who presented to the emergency department during a study period of one week from April 1 to July 4, 2009 with diagnosis of acute upper respiratory infection were included. Totally 162 patients were included.RESULTS: Among the 162 cases, 141(87%) patients were prescribed one antihistamine of any group. Sixty(37%) patients were prescribed two or more antihistamines. In multivariate logistic regression model, age was found to be signi? cantly(P<0.001) associated with multiple antihistamine prescription(OR=1.042, 95%CI=1.02 to 1.06). Years of graduation of attending physician for more than 5 years was also a strong predictor of multiple antihistamine prescription(OR=4.654, 95%CI=2.20 to 9.84, P<0.001).CONCLUSION: In the local emergency department, patients' age and the years of graduation from medical school of the attending physician were predictors of multiple antihistamine prescription for acute upper respiratory infections for children aged less than 6.

Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience.Univariate analysis showed that higher endoscopist's experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy.On multivariate analysis, endoscopist's experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for rebleeding and 6.90 for need of transfusion after the endoscopy.CONCLUSION: Endoscopist's experience is an important independent prognostic factor for non-variceal acute upper GI bleeding. Urgent endoscopy should be undertaken preferentially by a skilled endoscopist as less expert staff tends to underestimate some risk lesions with a negative influence on hemostasis.

Simultaneous, Asymmetrical, Comminuted and Bilateral Ballistic Fractures by Multiple Gunshot Wounds and a Review of Its Literature: A Case Report in Chad

Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.

A red herring: An unusual case of pneumothorax

Dear editor,A 67-year-old Chinese man presented to our emergency department (ED) complaining of right-sided chest wall pain.He noticed these symptoms three hours prior to arrival. He denied any shortness of breath or recent injury. Past medical history was significant only for hypertension. Social history was significant for a history of smoking (40 packs per year).

How to secure the connection between thoracostomy tube and drainage system?

BACKGROUND: Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is an important problem with potential complications such as contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction. It is a common practice to tape the connection of the system. This study aimed to evaluate the materials and methods of connection of chest drain system to minimize drainage dislodgement. METHODS: We conducted an experimental study to assess the tightness of the connection with various taping materials and methods. We selected three commonly used adhesive materials(3M^(tm) Transpore^(tm) Medical tape, 3M^(tm) Micropore^(tm) Medical tape, 3M^(tm) Soft Cloth Tape on Liner) and three different methods(cross method, straight method, nylon band) to secure the junction between the thoracostomy tube and the bi-conical adaptor in the drainage system. The measured outcome was the weight causing visible loosening of the junction between thoracotomy tube and the adaptor.RESULTS: For each taping material and taping method, 10 trials were performed. The median weight required to disconnect the junction is 26.22 lb for Transpore^(tm), 31.29 lb for Micropore^(tm) and 32.44 lb for Soft Cloth Tape on Liner. A smaller force was required to disconnect if Transpore^(tm) is used(P<0.001). There was no statistical signifi cant difference between Micropore^(tm) and Soft Cloth Tape on Liner(P=0.98). The median disconnecting force is 32.44 lb for straight taping method, 40.55 lb for cross taping method and 21.15 lb for plastic band. The cross-taping method was the more secure method(P<0.0001 when compared with plastic band)(P=0.033 when compared with straight method).CONCLUSION: Cross-taping is the most secure method among the tested varieties in connecting the thoracostomy tube to the chest drainage system. Transpore^(tm) is not a recommended material for thoracostomy tube taping.

Characterization of available automated external def ibrillators in the market based on the product manuals in 2014

BACKGROUND: To popularize the wide-spread use of automated external defi brillator(AED) to save life in sudden cardiac arrest, we compared the strength and weakness of different types of AEDs to enable a sound selection based on regional requirement.METHODS: This was a retrospective descriptive study. Different types of AEDs were compared according to the information of AEDs from manuals and brochures provided by the manufacturers. Fifteen types of AEDs were divided into 3 groups, basic, intermediate and advanced.RESULTS: Lifeline? AUTO AED had the best performance in price, portability and user-friendly among AEDs of basic level. It required less time for shock charging. Samaritan PAD defi brillator was superior in price, portability, durability and characteristic among AEDs of intermediate level. It had the longest warranty and highest protection against water and dust. Lifeline? PRO AED had the best performance in most of the criteria among AEDs of advanced level and offered CPR video and manual mode for laypersons and clinicians respectively.CONCLUSION: Lifeline? AUTO AED, Samaritan PAD def ibrillator, Lifeline? PRO AED are superior in AEDs of basic, intermediate and advanced levels, respectively. A feasible AED may be chosen by users according to the regional requirement and the current information about the best available products.

Amyotrophic lateral sclerosis: promising therapeutic outcome–not far away?

Dear editors,Amyotrophic lateral sclerosis（ALS）is a neurodegenerative disease.It affects motor neurons in the brain and spinal cord resulting in bulbar palsy and respiratory failure.It also causes weakness of limbs.The disease usually progresses to fatal outcome within 2-4 years.Neural stem cell research for diagnosis and treatment of neurodegenerative disorders is highly promising.

My mother is looking blue

Dear editor,A 76-year-old Chinese female presented by ambulance to the Emergency Department complaining of dizziness,headache and fatigue.Her son claimed that the patient“turned blue”three hours prior to onset of the patient’s symptoms.Paramedics noted the patient’s SpO2 was 83%on room air with no improvement with a nonrebreather mask.Past medical history was signifi cant for diabetes and hypertension.Family,social and medication history were non-contributory.

The Prevalence and Presentation Pattern of Diabetes Mellitus in Patients at Imo State University Teaching Hospital (IMSUTH) Orlu and Imo State Specialist Hospital (IMSSH) Umuguma Owerri (A 10-Year Retrospective Study: 1st November 2004 to 31st October 2013)

Background: The rising prevalence of diabetes mellitus imposes great burden on health worldwide. The burden is enormous in terms of pressure on existing human and material health resources. Diabetes is insidious in onset and has many patterns of presentation which often militates against early detection and diagnosis. Thus most patients present late with the exacerbation of symptoms and complications. Objective: To determine the prevalence and pattern of presentation of diabetes mellitus among patients attending Imo State University Teaching Hospital (IMSUTH) Orlu and Imo State Specialist Hospital (IMSSH) Umuguma Owerri, both in Imo State, Nigeria. Methodology: A retrospective study of the prevalence and pattern of presentation of diabetes mellitus. A total of 2028 patients had diabetes mellitus. Using data collection proforma, information relating to their pattern of presentation such as symptoms and complications, as well as their sociodemography was collected from the case folders. Data were analyzed using SPSS version 17 and results presented in frequency tables and pie charts. Result: A total of 18,912 patients attended the designated hospitals within the period under review, out of which 2028 were diabetic giving a prevalence of 107.2 per 1000 patients (10.7%). Out of these 2028 diabetic patients studied, 75% (1521) had onset of the diseases at the age of 40 years and above, while the remaining 25% (507) had the onset of the diseases before the age of 40 years. The most affected group was in the age range of 51 - 60 years, 585 (28.7%), while the least affected age group was 1 - 10 years, 6 (0.31%). The commonest symptom at presentation was polyuria 2028 (100%), followed closely by polydypsia 1939 (95.6%), while the least presenting symptoms were vaginal discharge and erectile dysfunction 27 (1.35%) respectively. Overall, the symptoms at presentation were polyuria, polydysia, weight loss, fever, blurred vision, paraesthesia, vaginal discharge, erectile dysfunction etc. Conclusion: Diabetes mellitus is a chronic illness with many patterns of presentation ranging from the classical symptoms of polyuria, polydysia, polyphagia and weight loss to the less common ones. The study highlights the need for early detection of the condition through appropriate health information dissemination and institution of prompt and adequate treatment.

Diagnostic accuracy of Focused Abdominal Sonography for Trauma in blunt abdominal trauma patients in a trauma centre of Hong Kong

Objective： Focused Abdominal Sono graphy for Trauma （FAST） is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma （BAT）. This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre. Methods： This was a retrospective study of BAT pa tients over a 6 year period seen in a trauma centre in Hong Kong. FAST findings were compared with laparotomy, ab dominal computed tomography or autopsy findings, which served as the gold standard for presence of intraperi toneal free fluids. The patients who did not have FAST or gold standard confirmatory test performed, had preexisting peritoneal fluid, died at resuscitation or had imcomplete docu mentation of FAST findings were excluded. The performance of FAST was expressed as sensitivity, specificity, predictive values （PV）, likelihood ratios （LR） and accuracy. Results： FAST was performed in 302 patients and 153 of them were included in this analysis. The sensitivity, specificity, positive PV, negative PV, positive LR, negative LR and accuracy for FAST were respectively 50.0%, 97.3%, 87.0%, 84.6%, 18.8, 0.5 and 85.0%. FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients. Conclusion： FAST is a reliable investigation in the initial assessment of BAT patients. The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use.

百草枯中毒致低钾血症临床病例分析

百草枯中毒可引起低钾血症,严重者危及生命。我们总结5例典型病例,经过积极治疗,均取得良好临床效果,临床治愈。