The Epidemiology of Household Rodenticides Poisoning in Hong Kong and its Risk Factors for Developing Coagulopathy

Objective To (1) describe the epidemiology of household rodenticides poisoning in Hong Kong, (2) evaluate the proportion of patients who have develop coagulopathy after rodenticide poisoning, (3) identify the risk factors for developing coagulopathy in rodenticide poisoning. Design Case series study. Setting Sixteen accident and emergency departments in Hong Kong. Patients Patients with household rodenticide ingestion who presented to accident and emergency departments during the period from July 2008 to February 2012. Results 110 patients were reported to have rodenticide exposure during the study period. Eighty-seven patients were included in the final analysis. The mean age was 40.1 and the male-to-female ratio was 1.29:1 (49:38). Most patients (91%) took the rodenticide intentionally. Sixty-nine patients (79%) exposed to anticoagulants type of rodenticide based on history or laboratory findings. The ingredient of the rodenticide ingested in 18 patients (21%) was untraceable. The only clinically significant presentation reported after rodenticide exposure was coagulopathy. Thirty-one patients (36%) developed coagulopathy with an international normalised ratio greater or equal to 1.3. Clinical significant bleeding was only observed in one patient. Presence of coagulopathy in rodenticide poisoning was significantly associated with older patient, intentional ingestion, ingestion of warfarin, ingestion of more than one pack and presence of co-ingestion. Multiple logistic regression analysis showed that only two factors were independent predictor of coagulopathy: Ingestion of warfarin rodenticide (p=0.001, odds ratio [OR] = 18.20, 95% confidence interval [CI]=3.44-96.42), and ingestion of more than one pack of rodenticide (p=0.02, OR=10.01, 95% CI=1.43-69.87). Conclusions Clinically significant household rodenticide poisoning in Hong Kong is solely related to ingestion of anticoagulant type of rodenticide. Patients who have ingested warfarin rodenticide and higher ingestion dose are more likely in developing coagulopathy. (Hong Kong j.emerg.med. 2014;21:339-345)

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Prevalence, risk factors and awareness of diabetic retinopathy among admitted diabetic patients at a tertiary level hospital in Kathmandu

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v6i1.10760 ◽

2014 ◽

Vol 6 (1) ◽

pp. 24-30 ◽

Cited By ~ 10

Author(s):

Raba Thapa ◽

Deepak Man Joshi ◽

Aparna Rizyal ◽

Nhukesh Maharjan ◽

Rajesh Dhoj Joshi

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Case Series ◽

Systemic Hypertension ◽

P Value ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Case Series Study ◽

Systemic Problems ◽

Clinically Significant

Introduction: Diabetic retinopathy (DR) is one of the commonest causes of visual impairment and blindness in Nepal. Objectives: The study aims to explore the prevalence, risk factors and awareness of DR among admitted diabetic patients. Materials and methods: A non-interventional case series study was conducted among the inpatient diabetic cases referred for ophthalmic consultation. The patients’ detailed demographics, awareness on DR, concurrent systemic problems, and glycemic control status were recorded. DR was graded using the Early Treatment Diabetic Retinopathy Study Criteria. Main outcome measures: The prevalence, risk factors and awareness of diabetic retinopathy among the study participants was analyzed. Results: A total of 277 diabetic patients were enrolled in the study. The mean age was 62.25 ± 13.26 years. Only one-third (34.6 %) of the cases were admitted for sugar control and newly diagnosed cases comprised of 19.49 %. Nearly half of the cases (46.6 %) were not aware of diabetic retinopathy and dilated fundus evaluation was done for the first time in 44.4 %. DR was found in 38.26 % of the cases and was diagnosed in 13 % of the new cases. Almost four-fifths (78 %) of the diabetics had had the disease for a duration of 16 to 20 years. Clinically significant macular edema was found in 5.78 % and proliferative DR in 2.52 %. DR was significantly associated with the duration of diabetes (P value = 0.001) and concurrent hypertension (P value = 0.004). Conclusion: The prevalence of DR was 38 % among the admitted diabetic cases and the DR was significantly associated with the duration of diabetes and systemic hypertension. Almost half of the cases had been unaware of DR before referral. This emphasizes the importance of the collaboration of the physician and the ophthalmologist for an early DR detection. DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10760 Nepal J Ophthalmol 2014; 6 (2): 24-30

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First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

Foot & Ankle International ◽

10.1177/10711007211034516 ◽

2021 ◽

pp. 107110072110345

Author(s):

Chien-Shun Wang ◽

Yun-Hsuan Tzeng ◽

Tzu-Cheng Yang ◽

Chun-Cheng Lin ◽

Ming-Chau Chang ◽

...

Keyword(s):

Risk Factors ◽

Hallux Valgus ◽

Reconstructive Surgery ◽

Case Series ◽

Deformity Correction ◽

Level Of Evidence ◽

Factors Affecting ◽

Radiographic Parameters ◽

Case Series Study ◽

Adult Acquired Flatfoot Deformity

Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

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Effective Healthcare Worker-Patient Communication in Hong Kong Accident and Emergency Departments

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791502200201 ◽

2015 ◽

Vol 22 (2) ◽

pp. 69-83 ◽

Cited By ~ 10

Author(s):

D Slade ◽

E Chandler ◽

J Pun ◽

M Lam ◽

Cmim Matthiessen ◽

...

Keyword(s):

Hong Kong ◽

Healthcare Worker ◽

Emergency Departments ◽

Patient Communication ◽

Accident And Emergency

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TO DETERMINE THE FREQUENCY OF VISCERAL LEISHMANIASIS IN PERIPHERAL CYTOPENIC PATIENT IN PATHOLOGY DEPARTMENT HAYATABAD MEDICAL COMPLEX.

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2014.4.2.560-566 ◽

1969 ◽

Vol 4 (2) ◽

pp. 560-566

Author(s):

ZARD ALI KHAN ◽

MOHAMMAD SAJJAD ◽

IMRAN UD DIN ◽

MUKAMIL SHAH ◽

SHAH JEHAN

Keyword(s):

Bone Marrow ◽

Visceral Leishmaniasis ◽

Case Series ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Total Leukocyte Count ◽

Full Blood Count ◽

Female Ratio ◽

Pathology Department ◽

Case Series Study

BACKGROUND: Visceral Leishmaniasis is a chronic disease and was first described in 1903, byLIESHMAN and DONOVAN. The disease is common in tropical and sub tropical areas of the worldwith various hematological manifestations. It is characterized by fever, visceromegaly, weight loss,pancytopenia and hypergammaglobulenemia. The disease is silent killer, invariably killing almost alluntreated patients, but curable with hematological improvement within 4-6 weeks of treatment.OBJECTIVE: To determine the frequency of Visceral Leishmaniasis in patints with cytopenias .MATERIAL AND METHODS: A descriptive study conducted in Pathology department, HayatabadMedical Complex, Hayatabad from September 1, 2012 to August 31, 2013. This study comprises of 126patients, subjected to complete blood counts. Diagnosis were confirmed by finding Amastigote( L/Dbody) from bonemarrow aspirate. All the patients who were referred to pathology Department of thehospital for bone marrow examination, with the results of peripheral blood using automatedHaematology analyzer, Sysmex KX 21 showing cytopenia were included in the study. Consent wastaken from the patient for bone-marrow aspiration procedure. After consent detailed history, physicalexamination was done.Laboratory investigations i.e. full blood count, which includes hemoglobin estimation, white blood cell,red blood, and platelet count.Bone marrow cytology (Giemsa stain) was recorded on the designed profroma.Posterior superior iliac spine (PSIS) was used as the site for aspiration in adults and children over 2years of ageRESULT: Descriptive case series study of 126 patients of peripheral cytopenia. In which 77 (61.1%)patients were males and 49 (38.9%) were female with male to female ratio of 1.57: 1 It was also foundin this study that visceral leishmaniasis was present in 29 (23%) of cases and the male: female were 1.6:1. Result of the automated hematology analyzer of peripheral cytopenic patients in visceralleishmaniasis show that all of the patients were having total leukocyte count less than 4000/cmm(100%). The hemoglobin level wass less than lOgm/dl in 26 cases (87.7%) and more than lOgm/dl inthree cases (10.3%). In case of platelets count, 27 cases (93.1%) were having platelets count less than150000/cmm.CONCLUSION: Incidence of visceral leishmaniasis is highier in children age group 1-10 years, alsomales are more prone than females. Leukopenia is recorded in all (100%) of the cases, followed bythrombocytopenia (93.1%) and anemia (Hb <10gm %) 87.7% cases.KEY WORD: Visceral Leishmaniasis, Kala Azar, Amastigote (L/D body)

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CARCINOMA OF URINARY BLADDER;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.11.668 ◽

2017 ◽

Vol 24 (11) ◽

pp. 1691-1696

Author(s):

Khalid Hussain ◽

Manzoor Ahmad Khan ◽

Attiq ur Rahman Khan ◽

Imran Amin ◽

Muhammad Khalid Butt

Keyword(s):

Bladder Tumor ◽

Tnm Classification ◽

Case Series ◽

Female Ratio ◽

Voiding Symptoms ◽

Case Series Study ◽

And Gender ◽

Muscle Invasive ◽

Male To Female ◽

Gross Haematuria

Introduction: The most common presentation of carcinoma of urinarybladder is haematuria. Almost 80-90% of patients with carcinoma of bladder present eitherwith microscopic or gross haematuria and it is mostly intermittent rather than constant. Somepatients also complain of irritative voiding symptoms such as frequency, urgency and dysuria.Study Design: Descriptive, case series study. Setting: Department of Urology, DHQ Hospital,Gujranwala, Pakistan. Period: July 2015 to June 2016. Materials & Methods: Total 30 patientsirrespective of age and gender with diagnosis of bladder tumor based on clinical symptomsand supported by laboratory tools like Urine cytology, Ultrasound and IVU were included. Thealready diagnosed patients of bladder tumor that have been treated with different modalitieswere excluded. All the tumors were staged according to TNM classification after TURBT andgraded on the basis of histopathology. Results: Mean age was 53.17+16.07SD years. Maleswere 25(83.3%) and females were 5(16.7%). Male to female ratio is 5:1. Twenty eight (93.3%)patients out of 30 presented with painless haematuria. 23(73.33%) patients out of 30 patientswere smokers. 09 (30%) patients had Ta, in which G1 was found in 2 patients and G2 in 7patients. T1 was found in 10 (33.3%) patients, in which G2 was 5(17.3%) and G3 was 5(17.3%)cases. Muscle invasive T2a was diagnosed in 04 patients amongst them G2 and G3 wasdetected in 2(6.6%) patients each respectively. T2b was present in 3 patients, which had G1 in1(3.3%) and G3 in 2(10%) patients. T3b G2 was found 01 patient and T3b G3 was detected in1(3.3%) patient, T4M1 G3 was present in 2(6.6%) patients. Conclusion: This study concludedthat the bladder tumor is quite common with muscle invasive TCC is more common. Painlesshematuria is the commonest presentation and also smoking has a definite association with CAbladder.

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Effect of Placenta Previa on fetal & maternal morbidity / mortality

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.997 ◽

2016 ◽

Vol 11 (3) ◽

Author(s):

Bushra Sehr Zaman ◽

Asma Zubair ◽

Sher Zaman Bhatti ◽

Muhammad Zubair Saeed Malik

Keyword(s):

Risk Factors ◽

Early Diagnosis ◽

Maternal Morbidity ◽

Placenta Previa ◽

Case Series ◽

Antenatal Clinic ◽

Case Series Study ◽

Severe Hemorrhage ◽

Year 2000 ◽

Series Study

Objective: To see the effect of placenta previa on fetal and maternal mortality/ morbidity. This was a case series study. Study was conducted in Gynecology unit BV Hospital Bahawalpur during year 2000 to 2003. All the patients presenting with or with out painless bleeding in antenatal clinic & proved to be due placenta previa were included in the study. Patients presenting with pain less bleeding in the antenatal clinic due to other reasons were excluded from the study. In all the patients` history along with the risk factors clinical and sonography finding, any intervention needed and final out come was recorded. SPSS was used for data collection & analysis. Results: Total 50 patients were studied Out of these 84% of patients were symptomatic a t admission the symptoms found were Bleeding, shock & Pain. Strong associations o f risk factors like Age, Parity, ERCP, Smoking and previous C. Section was found in our study. Severe hemorrhage, prematurity, stillbirths and ENND was associated with Placenta Previa. Conclusion: Placenta previa is not an uncommon but underestimated, under reported & preventable condition. Prevention is possible in case of Known risk factors. Early diagnosis is necessary as the delay in some cases may end up in disaster

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Pertussis Vaccination Failure in the New Zealand Pediatric Population: Study Protocol

Vaccines ◽

10.3390/vaccines7030065 ◽

2019 ◽

Vol 7 (3) ◽

pp. 65

Author(s):

Chisholm ◽

Howe ◽

Best ◽

Petousis-Harris

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Pediatric Population ◽

Case Series ◽

Risk Groups ◽

Paediatric Population ◽

Investigate Risk Factor ◽

Case Series Study ◽

Study Results ◽

Series Study

Pertussis vaccines have been effective at reducing pertussis-associated morbidity and mortality. However, they have a complex array of limitations, particularly associated with the duration of protection against clinical disease and imperfect immunity (carriage and transmission). Little is known about risk factors for pertussis vaccination failure. Understanding pertussis vaccination failure risk is most important in the paediatric population. This study aims to investigate risk factors for pertussis vaccination failure in (1) infants between birth and six weeks of age born to mothers who received pertussis booster vaccinations during pregnancy and (2) infants after the completion of the primary series (approximately five months old) to four years old. This will be achieved in a two-step process for each study group. Pertussis vaccination failure cases will first be described using a case series study design, relevant case characteristics will be sourced from six national administrative datasets. The case series study results will help select candidate risk factors (hypothesis generating step) to be tested in the retrospective cohort study (hypothesis testing step. Pattern analysis will be used to investigate risk factor patterns in the cohort study. The identification of higher risk groups enables targeting strategies, such as additional doses, to better prevent pertussis disease.

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Injury patterns of mass casualty incidents involving high-speed passenger ferries presenting to accident and emergency departments in Hong Kong: a retrospective review

Injury ◽

10.1016/j.injury.2019.12.001 ◽

2020 ◽

Vol 51 (2) ◽

pp. 252-259 ◽

Cited By ~ 1

Author(s):

Rex Pui Kin Lam ◽

Ronald Tat Ming Wong ◽

Eric Ho Yin Lau ◽

Kin Wa Wong ◽

Arthur Chi Kin Cheung ◽

...

Keyword(s):

Hong Kong ◽

Retrospective Review ◽

Emergency Departments ◽

High Speed ◽

Mass Casualty ◽

Mass Casualty Incidents ◽

Injury Patterns ◽

Accident And Emergency

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Teenage Attempted Suicide in Hong Kong

Crisis ◽

10.1027/0227-5910.19.2.67 ◽

1998 ◽

Vol 19 (2) ◽

pp. 67-72 ◽

Cited By ~ 7

Author(s):

Paul SF Yip ◽

LH Chiu

Keyword(s):

Hong Kong ◽

Potential Health ◽

Hospital System ◽

Female Ratio ◽

Teenage Girls ◽

Sleeping Pills ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

The Mean ◽

Male To Female

We examined the epidemiological profiles and characteristics of suicide attempters admitted to the Accident and Emergency Department of a regional hospital in Hong Kong (Princess Margaret Hospital) in the period from January to December 1995. These consisted of 101 adolescents (16 males and 85 females) aged between 10 to 24 years. There were significantly more female attempters than males, especially in the group aged 10-19, which had a male-to-female ratio of suicide rates of 1:11. Most of the methods used were nonlethal; the attempters were not serious enough and had no real intention to die. The use of painkillers and sleeping pills was most common. The main precipitating factor was interpersonal problems, for example, relationships, spousal and parental problems, especially among teenage girls. More than 90% of the cases stayed at the hospital for further observation, the mean length of stay in the hospital being 3.3 days. The potential health cost to the hospital system was around HK$ 11.7 million. Underestimating the prevalence of attempted suicides in Hong Kong could be a serious matter.

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Significant Bradycardia in Critically Ill Patients Receiving Dexmedetomidine and Fentanyl

Case Reports in Critical Care ◽

10.1155/2017/4504207 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Channing Hui ◽

Maria Cardinale ◽

Balaji Yegneswaran

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Critically Ill Patients ◽

Infusion Rate ◽

Case Series ◽

Life Threatening ◽

Sedation And Analgesia ◽

Clinically Significant ◽

Dexmedetomidine Infusion ◽

Community Teaching

Purpose. To report a case series of three patients who developed significant bradycardia while receiving the combination of dexmedetomidine and fentanyl for sedation and analgesia. Materials and Methods. This is a case series of patients obtained from a mixed medical, surgical, and cardiac ICU in a community teaching hospital. Three intubated patients receiving fentanyl and dexmedetomidine infusion developed sudden bradycardia requiring intervention. In all three cases, adjustments to therapy were required. Results. All three patients experienced significant bradycardia, with a heart rate less than 50 bpm, and one patient briefly developed asystole. In Case 1, the fentanyl infusion rate was reduced by 67% and the dexmedetomidine infusion rate was reduced by 25%. In Case 2, the sedation was changed to midazolam, and in Case 3, both fentanyl and dexmedetomidine were discontinued. In all three cases, there were no further incidences of significant bradycardia following intervention. Conclusions. Fentanyl used in combination with dexmedetomidine can result in clinically significant bradycardia. Further study is warranted to identify risk factors and elucidate the mechanisms that result in life-threatening bradycardia.

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