Factors contributing to the psychological well-being for Hong Kong Chinese children from low-income families: a qualitative study

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Absence of association between angiotensin converting enzyme polymorphism and development of adult respiratory distress syndrome in patients with severe acute respiratory syndrome: a case control study

BACKGROUND: It has been postulated that genetic predisposition may influence the susceptibility to SARS-coronavirus infection and disease outcomes. A recent study has suggested that the deletion allele (D allele) of the angiotensin converting enzyme (ACE) gene is associated with hypoxemia in SARS patients. Moreover, the ACE D allele has been shown to be more prevalent in patients suffering from adult respiratory distress syndrome (ARDS) in a previous study. Thus, we have investigated the association between ACE insertion/deletion (I/D) polymorphism and the progression to ARDS or requirement of intensive care in SARS patients. METHOD: One hundred and forty genetically unrelated Chinese SARS patients and 326 healthy volunteers were recruited. The ACE I/D genotypes were determined by polymerase chain reaction and agarose gel electrophoresis. RESULTS: There is no significant difference in the genotypic distributions and the allelic frequencies of the ACE I/D polymorphism between the SARS patients and the healthy control subjects. Moreover, there is also no evidence that ACE I/D polymorphism is associated with the progression to ARDS or the requirement of intensive care in the SARS patients. In multivariate logistic analysis, age is the only factor associated with the development of ARDS while age and male sex are independent factors associated with the requirement of intensive care. CONCLUSION: The ACE I/D polymorphism is not directly related to increased susceptibility to SARS-coronavirus infection and is not associated with poor outcomes after SARS-coronavirus infection

The antimicrobial susceptibility of Helicobacter pylori in Hong Kong (1997-2001) [1]

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The role of early endoscopic follow up after simple closure of perforated duodenal ulcer: A prospective study

Objective: Eradication of Helicobacter pylori is effective in preventing ulcer relapse after simple repair of perforated duodenal ulcers. However, when and how the H. pylori status should be determined remains unclear. The study investigated the role of early endoscopic follow up in managing patients with simple omentopexy for duodenal ulcer perforation. Patients and Method: Patients below the age of 75 years who had simple repair of perforated duodenal ulcer were recruited. They were given a 4-week course of H 2 receptor antagonist upon discharge and advised to return for a follow-up endoscopy at 8 weeks after operation. During endoscopic examination, ulcer healing and other gastroduodenal pathology were noted. Random biopsies were taken from the antrum and body of the stomach for determination of H. pylori infection. Results: In a 30-month period, 112 patients were admitted with perforated duodenal ulcers. The perforation was repaired by either laparoscopic (n = 41) or open method (n = 71). Eleven patients died during hospitalization. Of the 101 patients who recovered, 16 were lost to follow up. Nine patients were considered unfit for endoscopy as a result of medical comorbidities. Among the 76 patients who attended the follow-up endoscopy, 47 were shown to have H. pylori infection (61.8%). Active duodenal ulcers were found in 15 patients, significant erosions in five patients and severe duodenitis in seven patients. Patients infected by H. pylori had a significantly higher proportion of persistent duodenal pathology compared with the uninfected patients (23/47 vs 4/29; P= 0.003). Multivariate analysis revealed that smoking and H. pylori infection were the two independent factors predicting persistent duodenal lesions. Conclusion: Patients treated with simple-closure for duodenal ulcer perforation are recommended to have their H. pylori status determined by early follow-up endoscopy, and an eradication regimen should be prescribed to those who are positive for the infection.link_to_subscribed_fulltex

Cost-effectiveness analysis of high-dose omeprazole infusion as adjuvant therapy to endoscopic treatment of bleeding peptic ulcer

Background: Intravenous administration of proton pump inhibitors after endoscopic treatment of bleeding peptic ulcers has been shown to decrease the rate of recurrent bleeding and the need for subsequent surgery. Yet there is a relative lack of formal assessment of this practice. The aim of this study was to examine the cost-effectiveness of this therapy by using standard pharmacoeconomic methods. Methods: The present study was performed in conjunction with a randomized controlled clinical trial that included 232 patients who received either omeprazole (80 mg intravenous bolus followed by infusion at 8 mg/hour for 72 hours) or placebo after hemostasis was achieved endoscopically. A cost-effectiveness analysis was performed to evaluate the different outcomes of the trial. All related direct medical costs were identified from patient records. Cost-effectiveness ratios were calculated. Results: Analysis by the Kolmogorov-Smirnov test showed that the direct medical cost in the omeprazole group was lower than that for the placebo group. Cost-effectiveness ratios for omeprazole and placebo groups were, respectively, HK$28,764 (US$ 3688) and HK$36,992 (US$ 4743) in averting one episode of recurrent bleeding in one patient after initial hemostasis was achieved endoscopically. Conclusions: Intravenous administration of high-dose omeprazole appears to be a cost-effective therapy in reducing the recurrence of bleeding and need for surgery in patients with active bleeding ulcer after initial hemostasis is obtained endoscopically.link_to_subscribed_fulltex

Predicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy

Background & Aims: Despite advances in management of patients with bleeding peptic ulcers, mortality is still 10%. This study aimed to identify predictive factors and to develop a prediction model for mortality among patients with bleeding peptic ulcers. Methods: Consecutive patients with endoscopic stigmata of active bleeding, visible vessels, or adherent clots were recruited, and risk factors for mortality were identified in this deprivation cohort by using multiple stepwise logistic regression. A prediction model was then built on the basis of these factors and validated in the evaluation cohort. Results: From 1993 to 2003, 3220 patients with bleeding peptic ulcers were treated. Two hundred eighty-four of the patients developed rebleeding (8.8%); emergency surgery was performed on 47 of these patients, whereas others were managed with endoscopic retreatment. Two hundred twenty-nine of these sustained in-hospital death (7.1%). In patients older than 70 years, presence of comorbidity, more than 1 listed comorbidity, hematemesis on presentation, systolic blood pressure below 100 mm Hg, in-hospital bleeding, rebleeding, and need for surgery were significant predictors for mortality. Helicobacter pylori-related ulcers had lower risk of mortality. The receiver operating characteristic curve comparing the prediction of mortality with actual mortality showed an area under the curve of 0.842. From 2004 to 2006, data were collected prospectively from a second cohort of patients with bleeding peptic ulcers, and mortality was predicted by using the model developed. The receiver operating characteristic curve showed an area under the curve of 0.729. Conclusions: Among patients with bleeding peptic ulcers after endoscopic hemostasis, advanced age, presence of listed comorbidity, multiple comorbidities, hypovolemic shock, in-hospital bleeding, rebleeding, and need for surgery successfully predicted in-hospital mortality. © 2009 AGA Institute.link_to_subscribed_fulltex