Identify gaps between local and international measures to avoid administration error on 1-year review in United Christian Hospital, Hong Kong

Many medication errors could be avoided if administration was more closely linked with structured monitoring. The contributory factors to administration errors occurred in one recent year were reviewed and identified contributory factors to errors as six domains of administration principles according to the report from the Quality and Safety website. The current measures including guidelines, policy, and practices to prevent the administration errors identified in the previous step were searched from the United Christian Hospital (UCH) homepage. Meanwhile, the international measures suggested in literature were identified to address the administration errors identified. 41 cases were identified as medication errors related to administration error events, with total twenty contributory factors identified according to the incident report which identified five contributory factors as common causes. Measures to prevent interruption of medication round and measures to improve individual knowledge and skills, and personal responsebility were suggested to fill the gaps. The medication administration errors should be avoided through both education reinforcing programme and preventive interventions of distraction or interruption to the procedure after comparing the existing measures to the suggested measures from literature. This study was so important to improve the current measures to prevent medication administration errors.

An unusual cause of myocardial infarction in an elderly man

Cardiac involvement in eosinophilic granulomatosis with polyangiitis (EPGA) is increasingly recognized,but it is unusual to be the initial presentation.We report a case of vasculitic myocardial infarction (MI) and cardiogenic shock in an elderly man caused by EPGA.A 73-year-old man presented with acute chest pain radiating to back for two days.He has a history of asthma and allergic rhinitis for more than ten years well controlled by inhaled corticosteroid.The electrocardiogram showed sinus rhythm,right bundle-branch block and anterolateral ST-segment depression.He had elevated troponin T of 548 ng/L (reference:<14 ng/L),creatine kinase of 454 IU/L (reference:39–308 IU/L)。

Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey

Objective:To scrutinize the definitions of minimal invasive surgical therapy(MIST)and to investigate urologists’knowledge,attitudes,and practices for benign prostatic obstruction surgeries.Methods:A 36-item survey was developed with a Delphi method.Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included.Urologists were invited globally to complete the online survey.Consensus was achieved when more than or equal to 70%responses were“agree or strongly agree”and less than or equal to 15%responses were“disagree or strongly disagree”(consensus agree),or when more than or equal to 70%responses were“disagree or strongly disagree”and less than or equal to 15%responses were“agree or strongly agree”(consensus disagree).Results:The top three qualities for defining MIST were minimal blood loss(n=466,80.3%),fast post-operative recovery(n=431,74.3%),and short hospital stay(n=425,73.3%).The top three surgeries that were regarded as MIST were Urolift®(n=361,62.2%),Rezum®(n=351,60.5%),and endoscopic enucleation of the prostate(EEP)(n=332,57.2%).Consensus in the knowledge section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,day surgery feasibility,and post-operative continence.Consensus in the attitudes section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,and day surgery feasibility.Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement,lower retreatment rate,and better suitable for prostate more than 80 mL.Conclusion:Minimal blood loss,fast post-operative recovery,and short hospital stay were the most important qualities for defining MIST.Urolift®,Rezum®,and EEP were regarded as MIST by most urologists.

A diagnostic and screening strategy with neutrophil counts in patients with suspected aortic dissection in a certain time window

Aortic dissection(AD)is a potentially devastating cardiovascular disease worldwide.However,given the low incidence of AD(2.5 to 3.5 cases per 100,000person-years),the diagnosis of this disease remains relatively difficult in emergency settings.[1,2]Computed tomography aortogram(CTA)is the most commonly used diagnostic tool,which is an invasive investigation with renal impairment and is cost consuming.There are lots of patients at low or moderate risk of AD,which may be no need for CTA screening.As a result,validated clinical strategies beyond clinical judgment are needed to manage patients with suspected AD.

A rare cause of pulmonary hypertension in an elderly woman

Diastolic dysfunction is a common substrate of pulmonary hypertension(PH) in the elderly.A minority of them,however,has another etiology of PH with diastolic dysfunction as a confounder,the alarming echocardiographic features of which are important to recognize.For example,dilated coronary sinus is unusual,as is significantly dilated right atrium.

Comparison of ocular biometry in Chinese patients using two swept-source optical coherence tomography devices

Background:To compare two swept-source optical coherence tomography(SS-OCT)biometers,IOLMaster 700 and ANTERION.Methods:This is a retrospective study.Biometric measurements of cataract patients performed between March and July 2021 in the Department of Ophthalmology,United Christian Hospital,Hong Kong,were reviewed.Patients scheduled for cataract surgery were measured with both SS-OCT devices on the same day.The following biometry parameters were compared:keratometry(K),total keratometry(TK),axial length(AL),central corneal thickness(CCT),anterior chamber depth(ACD),lens thickness(LT),white-to-white(WTW)and the predicted intraocular lens(IOL)power to achieve emmetropia.To assess the agreement between the devices,Bland-Altman analysis with 95%limits of agreement(LoA)were used.Results:In total,92 eyes of 47 subjects were measured with both devices.There were statistically significant differences between the two biometers for most measurements(P<0.05)except for flat K,AL and IOL power when using the right eyes for analysis.For the left eyes,there were statistically significant differences in the measurements from the two biometers in all parameters except for flat and steep K.The ANTERION did not obtain ACD,AL and LT in 2(2.17%),1(1.09%)and 5 cases(5.43%)respectively.Conclusions:The two biometers showed a clinically acceptable agreement in most parameters.Comparisons showed significant differences in most parameters but not clinically relevant except for the TK and WTW,and these two parameters should not be used interchangeably between the devices.

Risk factors and natural history of breast cancer in younger Chinese women

AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients. METHODS: Seven thousand one hundred and fiftytwo women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients' consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger(< 40 years old) vs older patients(≥ 40 years old) for subsequent analyses.RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise(85.4% vs 73.2%, P < 0.001), having high stress in life(46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets(20.2% vs 12.9%, P < 0.001),having alcohol drinking habit(7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity(43.3% vs 17.8%, P < 0.001) and an early age at menarche(20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology(45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion(39.6% vs 33.2%, P = 0.003), and having multifocal disease(15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts.CONCLUSION: Younger patients in Hong Kong are more likely to encounter risk factors associated with breast cancer development and have more aggressive tumours than their older counterparts.

Bevacizumab for neovascular age-related macular degeneration in Chinese patients in a clinical setting

AIM：To determine the outcome of non-investigational treatment with intravitreal bevacizumab（IVB） in neovascular age-related macular degeneration（AMD）patients.· METHODS：Retrospective chart review of 81 eyes with neovascular AMD followed-up for at least 12 mo and received 3-monthly loading IVB injections.Re-treat was based upon the individual clinician＇s judgment.Bestcorrected visual acuity（BCVA） and optical coherence tomography measurements of central foveal thickness outcomes were evaluated at 12,24 mo.· RESULTS：Eighty-one eyes（of 75 patients） completed12 mo of follow-up and 44 eyes（of 41 patients） completed24 mo of follow-up.The mean baseline logMAR BCVA significantly improved from 0.94±0.69 to 0.85±0.68 at12mo（P〈0.001） and from 0.91±0.65 to 0.85±0.60（P=0.004）at 24 mo.The proportion of eyes that lost 〈15 logMAR letters at 12 mo was 90.1%and at 24 mo was 81.8%.IVB was effective in improving visual acuity in both treatment naive and previous photodynamic therapy（PDT）-treated subgroups.Treatment naive patients required significantly fewer injections than patients with prior PDT.Multiple regression analysis identified that poorer baseline visual acuity was associated with greater improvement in visual acuity（P=0.015）.· CONCLUSION：Fewer injections in clinical practice may result in suboptimal visual outcomes compared with clinical trials of IVB in neovascular AMD patients.Poor baseline visual acuity and prior PDT treatment may also improve vision after IVB.The safety and durability of effect was maintained at 24 mo.

Common outcome,different pathways:Social informationprocessing deficits in autism spectrum disorder and attentiondeficit/hyperactivity disorder

Social functioning is a key domain of impairment in both autism spectrum disorder(ASD)and attention-deficit/hyperactivity disorder(ADHD).This review adopts the social information-processing model as the theoretical framework to compare and contrast the deficits of ASD and ADHD at each of the six steps of social information-processing.Both disorders show deficits at each step,but the nature and origins of the deficits are different.Thus,while both disorders exhibit a common outcome of social impairment,the exact pathways that each disorder traverses along the six steps of social information-processing are different.For ASD,there is a social knowledge/behaviour deficit arising from difficulties in social/emotional cue detection,encoding,and interpretation,leading to problems in joining and initiating social interaction.For ADHD,there is a performance deficit incurred by disruption arising from the ADHD symptoms of inattention and hyperactivity/impulsivity,while its acquisition capacity on social knowledge is relatively intact.The inattentive,intrusive,and impulsive behaviours of ADHD unsettle social interaction.Finally,this review proposes training targets for intervention along the six steps of the social information-processing model for ASD and ADHD,as well as areas for future research in further elucidating the social impairment of the two disorders.

Evaluation of the Psychological Impact of COVID-19 Pandemic on Chinese Patients with Common Mental Disorders in Primary Care: A Cross-Sectional Study

Purpose: Our study aimed to evaluate the psychological impact of COVID-19 pandemic on Chinese patients with common mental disorders in primary care in Hong Kong. Method: A cross-sectional study was conducted on 102 Chinese patients with common mental disorders and being followed up in two public integrated mental health clinics in Hong Kong from 1st November 2020 to 31st January 2021. Patients would be evaluated about the impact of COVID-19 pandemic on their mood and daily life by using a questionnaire which assessed social distancing effects, financial impact, relationship with family, anxiety and depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 Questionnaire (GAD-7) would also be used to assess patients’ mood symptoms. Factors which were related to COVID-19 pandemic and associated with anxiety or depressive symptoms would be analysed. Results: The mean age of the subjects was 58.0 years and more patients were female (77.5%). There were 84.3% and 72.5% of patients reported their anxiety and depressive symptoms being affected by COVID-19 pandemic respectively. It was found that 17.6% of patients had their income decreased or were unemployed. About one-third (30.4%) of patients indicated that their relationship with their family was worsened while 8.8% was improved. Social distancing was significantly associated with anxiety (p = 0.006) and depressive symptoms (p 0.001) in patients with common mental disorders. Conclusion: There was considerably more psychological impact including an increase in anxiety and depressive symptoms due to COVID-19 pandemic in Chinese patients with existing common mental disorders in primary care. Primary care physicians should raise their awareness of the psychological impact of COVID-19 pandemic on their patients. Our findings shed light on mental health care planning and preventive measures during the COVID-19 pandemic and potential subsequent pandemics.

Subtalar arthroscopy:When,why and how

Technique of subtalar arthroscopy is rapidly evolving. Increasing number of traditional open procedures for the subtalar joint can now be done arthroscopically. It is hoped that less wound complications, faster rehabilitation and better cosmetic outcomes can be achieved with this minimally invasive technique.

Ventricular tachycardia induced by functional ventricular undersensing and AutoCapture®

The implantable cardioverter-defibrillator(ICD)is a key component in the primary pre-vention of sudden cardiac death in patients with ischemic cardiomyopathy.Appropriate device programming is pivotal in maximizing the benefit as well as minimizing any proarrhythmic effect of dev-ice therapy.It is even more so for patients who require pacing for bradycardia,in which interaction of the de-vice with intrinsic rhythm may generate unexpected consequences.We report a case of pacing induced ven-tricular tachycardia as a result of complex interplay of competitive atrial pacing,atrial and ventricular func-tional undersensing,ventricular functional loss of capture,and the AutoCapture®algorithm specific to Abbott devices.

3D vena contracta area in degenerative mitral regurgitation:cross-platform comparison in a single patient

Quantification of degenerative mitral reg-urgitation(MR)by two-dimensional(2D)transthoracic echocardiography(TTE)and transesophageal echocardiography(TEE)is challen-ging.Eccentric,obliquely oriented regurgitant jets limit inter-observer and intra-observer consistency.In recent years,with increasingly sophisticated three-dimensional(3D)TTE and TEE systems that enable single-beat 3D color acquisition,3D vena contracta area(VCA)has emerged as an attractive indicator of MR severity.It overcomes geometric assumptions in 2D techniques and can be acquired in a single car-diac cycle,which is a major benefit in atrial fibrilla-tion.However,most studies of 3D VCA were perfo-rmed on the Philips TEE platform.[1-3]The perform-ance of the technique on GE systems and on 3D TTE is unexplored.We report 3D VCA measurements in a case of severe degenerative MR on 3D TTE(4V-D transducer,Vivid E95,GE Vingmed Ultrasound,Horten,Norway),and 3D TEE performed on GE(6VT-D transducer,Vivid E95,GE Vingmed Ultraso-und,Horten,Norway)and Philips(X7-2t transdu-cer,EPIC 7C,Philips Medical Systems,Andover,MA,USA).

Acute perimyocarditis following heterologous vaccination of CoronaVac and BNT162b2 SARS-CoV-2 vaccine in an elderly woman

Inactivated and mRNA SARS-CoV-2 vaccines are highly efficacious in preventing severe disease and mortality.As the antibody level wanes over time,^([1])booster vaccination is recommended by the World Health Organization after completion of basic vaccination sequence.^([2])Heterologous compared to homologous boosting is found to be more immunogenic,generate higher antibody levels and may reduce the risk of breakthrough infections.

Updated Gestational Age Specific Birthweight Reference of Hong Kong Chinese Newborns and Comparison with Local and International Growth Charts

Background: Different gestational age specific birthweight reference charts have been produced for different populations and ethnic groups over different time periods, mostly based on birthweight data. This study aims to update birthweight references for Hong Kong (HK) Chinese newborns to provide norms for identification of small and large for gestational age (SGA and LGA) fetuses, and to verify whether there are significant differences compared to previously published local reference charts, as well as to other southern Chinese and international data. Methods: All singleton Chinese livebirths delivered in United Christian Hospital from 2012 to 2017 were retrospectively included. The smoothed birthweight centiles at each gestation were computed. The birthweight centiles were then compared with other reference charts. Results: A total of 25,508 livebirths between 24 and 42 completed weeks of gestation were enrolled in the final analysis. The mean birthweights of our cohort were largely similar to previous studies at each gestation, but the 10th and 90th centile ranges differed significantly, so that the proportion of babies that would be classified as SGA or LGA varied widely using cut-offs from different studies. Older local studies tend to under-estimate, while the international growth charts would over-estimate the proportion of SGA babies. Conclusions: Updating fetal growth curve references based on local data is essential to establish more precise definitions of SGA and LGA babies in clinical management. The use of international growth charts in our population may not be appropriate and requires further validation.

A Registry-Based Observational Study on the Maternal and Fetal Outcomes of COVID-19 Patients in Hong Kong,China

Objective:To report the clinical maternal and fetal outcomes of pregnant women with coronavirus disease 2019(COVID-19),along with any associated pregnancy complications,in Hong Kong,China,and to assess the impact of COVID-19 vaccination on these outcomes.Methods:This prospective registry-based observational study included pregnant women who were recruited through convenient sampling and had a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection with a cycle threshold(Ct)value result available on admission to eight local hospitals in Hong Kong,China.Data on clinical symptoms,laboratory results,medical treatments,delivery timing and mode,and pregnancy complications were extracted from the Hospital Authority’s electronic medical record system.Maternal,fetal,and pregnancy outcomes were compared between unvaccinated pregnant women with COVID-19 and those who had received at least one dose of COVID-19 vaccine before diagnosis.Nonparametric continuous variables and categorical variables were analyzed using the Mann-Whitney U test and the Pearson’s chi-squared test respectively.A P value less than 0.05 was considered statistically significant.Results:A total of 164 pregnant women were included,of whom 78(47.56%)were nulliparous.COVID-19 was diagnosed before 28 weeks’gestation in 30(18.29%),while 134(81.71%)were diagnosed at or after 28 weeks’gestation.Sixty-two(37.80%)women received at least one dose of COVID-19 vaccine.There were no significant differences between vaccinated and unvaccinated groups in the time interval between COVID-19 diagnosis and delivery,the Ct value,and the gestational age at infection onset or delivery(P>0.05).The majority of women were symptomatic at diagnosis regardless of vaccination status 55(88.71%)in vaccinated group vs.78(76.47%)in unvaccinated group(P=0.052).Symptoms did not significantly differ between groups except for cough(62.90%vs.47.06%,P=0.049).The overall rate of severe COVID-19 in pregnant women was low.In total,5(3.05%)patients experienced severe COVID-19,with vaccinated patients more likely to receive low molecular weight heparin(LMWH)as part of their treatment(62.90%vs.42.16%,P=0.010).Ninety-two(56.10%)women had a spontaneous vaginal delivery,7(4.27%)had an instrumental delivery,and 44(26.83%)and 21(12.80%)underwent emergency and elective cesarean sections respectively.For fetal outcomes,14(8.48%)babieswere born preterm and four(2.65%of nonpreterm babies,n=151)had low birthweight.The median birthweight percentile was 52.18th.There were no statistically significant differences in pregnancy complications or fetal outcomes between vaccinated and unvaccinated groups.Conclusion:The overall rate of severe COVID-19 in pregnant women was low.COVID-19 vaccination did not significantly impactmaternal outcomes,except for the use of LMWH.Additionally,the study found no significant differences in fetal outcomes and pregnancy complications between vaccinated and unvaccinated individuals.

The Hong Kong consensus statements on unresectable hepatocellular carcinoma:narrative review and update for 2021

Background and Objective:Hong Kong,like many parts of Asia,faces a high burden of hepatocellular carcinoma(HCC)caused by high endemic rates of hepatitis B virus infection.Hong Kong clinicians have developed a high level of expertise in HCC treatment across surgical,transarterial,ablative,radiotherapeutic and systemic modalities.This publication summarizes the latest evidence-based recommendations on how these modalities should be used.Methods:In two meetings held in 2020,a multidisciplinary panel of surgeons,oncologists and interventional radiologists performed a narrative review of evidence on the management of HCC,with an emphasis on treatment of HCC not amenable to surgical resection.Close attention was paid to new evidence published since the previous version of these statements in 2018.Key Content and Findings:The expert panel has formulated 60 consensus statements to guide the staging and treatment of unresectable HCC.Since the previous version of these statements,considerable additions have been made to the recommendations on use of targeted therapies and immunotherapies because of the large volume of new evidence.Conclusions:Our consensus statements offer guidance on how to select HCC patients for surgical or non-surgical treatment and for choosing among non-surgical modalities for patients who are not candidates for resection.In particular,there is a need for more evidence to aid physicians in the selection of second-line systemic therapies,as currently most data are limited to patients with disease progression on first-line sorafenib.

Cross-Sectional Survey of Views on COVID-19 and Its Vaccines Among Pregnant Women

Objective:The objective of this study is to evaluate the acceptance of pregnant women with regards to coronavirus disease 2019 (COVID-19) vaccination during pregnancy and to identify any significant changes in their anxiety and knowledge on COVID-19 compared to our previous study.Methods:This cross-sectional survey was performed in the antenatal clinics of United Christian Hospital and Tseung Kwan O Hospital of Hong Kong,China.Questionnaires were distributed to pregnant women for self-completion when attending follow-up from August to October 2021.Apart from basic demographic data,the questionnaire comprised of questions including knowledge on COVID-19 and its vaccines in pregnancy as well as attitudes and behaviors of pregnant women and their partners toward COVID-19.Continuous variables were analyzed by Student’s test and Levene’s test was used to confirm normal distribution and homogeneity of variance for continuous variables,whereas categorical variables were analyzed by the Chi-squared test or Fisher’s exact test as appropriate.AP value of <0.05 was considered to be statistically significant.Results:A total of 816 completed questionnaires were included for analysis.Pregnant women were less worried about COVID-19 in the current survey as compared to the last survey (393/816,48.2%vs.518/623,83.1%,P<0.001).Fewer pregnant women believed that pregnancy were more susceptible to contract SARS-CoV-2 as compared to the last survey (265/816,32.5%vs.261/623,41.9%,P<0.001).They have significant knowledge gap and concerns about COVID-19 vaccines.Nearly half of the participants believed that pregnant women cannot have COVID-19 vaccination (402/816,49.3%) and it is unsafe to fetus (365/816,44.7%).Around a third of women perceived that they were more prone to the side effects and complications of COVID-19 vaccines than the general population (312/816,38.2%) and did not recognize that maternal COVID-19 vaccination could effect transferral of antibodies to the fetus to promote postnatal passive immunity (295/816,36.2%).Most of them had not been vaccinated (715/816,87.6%) and only (12/715) 1.7% of them would consider vaccination during pregnancy.Conclusion:Despite the local and international recommendations for pregnant women to be vaccinated,the uptake of COVID-19 vaccines during pregnancy remained extremely low.Efforts should be made to effectively provide information about the safety and benefits of COVID-19 vaccines during pregnancy.There is an urgent need to booster vaccination rates in pregnant women to avoid excessive adverse pregnancy outcomes related to COVID-19.

Reproductive Outcome of Transcervical Uterine Incision in Unicornuate Uterus

Background： The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision （TCUI） in patients with unicornuate uterus. Methods： Thirty-three patients with unicoruuate uterus presented to our tertiary center tbr infertility or miscarriage. All 33 patients underwent TCUI and were followed up for 10-52 months. The pregnancy outcomes （first-trimester miscarriage, second-trimester miscarriage, preterm, term, intrauterine death, ongoing pregnancy, and live birth） before and after TCUI were compared by t-test. Results： Among 31 patients who attempted to conceive alter TCUI, twenty conceived including one terufination of pregnancy, one second-trimester miscarriage, one ectopic pregnancy, five preterm deliveries, 11 term delivery, and one ongoing pregnancy. There were 16 live births in total. There was significant reduction in the first-trimester miscarriage rate （t = 4.890; P 〈 0.001 ）, increase in term delivery （t = -3.288; P =0.002）, and live birth rates （t = -4.073; P 〈 0.001 ） after TCUI. Conclusion： TCUI appeared to improve the pregnancy outcome in women with unicoruuate uterus presenting with infertility or miscarriage.

Clinical characteristics of adult epilepsy patients in the 1997 Hong Kong epilepsy registry

OBJECTIVE: To study the clinical characteristics of 2952 patients with epilepsy who had received drug treatment from the neurology outpatient clinics of eight major hospitals in Hong Kong. METHODS: Retrospective review of outpatient records. RESULTS: 1601 (54.3%) males and 1351 (45.7%) females with a median age of 35.8 years (range, 10-94.8) were studied. Seizure types included generalized tonic-clonic in 80.7% of patients, complex partial in 28.3%, simple partial in 14.4%, atypical absence in 2.6% and myoclonic in 1.4%, and 30.4% of patients had more than one seizure type. EEG, CT brain, MRI brain and neuropsychological evaluation were obtained in 81.2%, 61.7%, 17.0% and 2.2% of patients, respectively. The etiology of epilepsy was cryptogenic in 59.9%, symptomatic in 35.1% and idiopathic in 3.9%; the commonest were intracranial infection, cerebral vascular disease, cranial trauma and perinatal insult. Phenytoin, carbamazepine and valproate were the most frequently used drugs and 25.9% of patients were taking more than two drugs. 48.3% of patients had active seizures in the past six months and 26.4% were considered to have unsatisfactory control of their epilepsy. Medical refractoriness of epilepsy was associated with a history of perinatal insult, intracranial infection, congenital brain malformation, intracranial neoplasm, cerebral vascular disease, hippocampal sclerosis, mental retardation and a history of status epilepticus (P