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Hong Kong Med J 2009;15:196-200

Sexual enhancement pills and capsules sold by peddlers and pharmacies in Hong Kong and Mainland China were found to contain glibenclamide, a potentially lethal blood-sugar lowering agent, after 68 men developed hypoglycaemia between December 2007 and September 2008. Three of the men died, one remains in a persistent vegetative state and another has permanent brain damage. The others recovered after being treated in hospital.

Outbreak of hypoglycaemia: sexual enhancement products containing oral hypoglycaemic agents published in the June issue of the Hong Kong Medical Journal describes the findings of a study into the 68 cases of hypoglycaemia caused by the use of sexual enhancement products.

The problem was first uncovered when a male patient, who suffered an episode of unexplained hypoglycaemia in January 2008, told his doctors that he had taken a non-prescription erectile dysfunction capsule. The capsule was analysed and found to contain both the erectile dysfunction drug sildenafil and the hypoglycaemic agent glibenclamide.

Other male patients had presented with unexplained hypoglycaemia since December 2007 and glibenclamide had been found in their urine samples, even though they all denied taking any medications.

Although the first cases appeared in December 2007, men are continuing to take these drugs and more cases are occurring say the authors. “Despite repeated public warnings, similar cases have continued to occur in Hong Kong and Singapore. At the time of writing, 61 confirmed and 148 suspected patients in Singapore have been identified, among whom 10 have died. Most worrying of all, as of now, the ultimate source of these products remains unknown.”

"We believe the proliferation of these various erectile dysfunction products poses a severe threat to men worldwide and warrants immediate attention and action from health authorities in different countries."

Hong Kong Med J 2009;15:213-6

Financial abuse of the older people is a well-hidden but serious problem in Hong Kong. A case report published in the June Issue of the Hong Kong Medical Journal highlighted the problem and discussed the actions that frontline medical staff must take to detect and prevent it.

The case involved an 82-year-old retired stockbroker with assets of more than HK$ 70 million who was admitted to hospital for investigation of fainting spells. He confided to the nurses that he believed his domestic helpers were cheating him for his money, but he had no solid evidence.

The nursing staff reported his concerns and a multi-disciplinary team, including a geriatrician, psychiatrist and medical social worker investigated the case. They found the man had Alzheimer’s disease and was incapable of managing his personal and financial affairs. A social inquiry found that the man had no relatives and was living alone with two domestic helpers.

Because the elderly man was at high risk of financial abuse, the medical social worker initiated a guardianship order application, but while the hearing was pending, one of the domestic helpers tried to get the elderly man to sign a cheque for a large sum of money in the hospital. The hospital staff realized that the situation was urgent and an emergency guardianship application was made.

At the Guardianship Board hearing, the Director of Social Welfare was appointed as the guardian and the domestic helpers were ordered to leave the man’s apartment and surrender all his personal items, including his cheque books, bank books, and identity card.

"Early detection of financial abuse and timely intervention are important for safeguarding the welfare of older people" was concluded by the authors of the paper, Financial abuse in a mentally incapacitated old man.

"An unexpected visit to the hospital may be the only opportunity for detecting elder abuse. Hence, doctors and frontline hospital staff should equip themselves with sufficient knowledge to detect, prevent and manage elder abuse cases."