OBJECTIVE. To validate the Hong Kong Chinese translation of the Overactive Bladder Symptom Score questionnaire (OABSS-HKC).

DESIGN. Cross-sectional study.

SETTING. Five urology clinics of different regional hospitals in Hong Kong.

PARTICIPANTS. The Overactive Bladder Symptom Score questionnaire was translated and culturally adapted for Hong Kong Chinese, according to the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures. Chinese-speaking patients with overactive bladder symptoms were recruited from five urology clinics. The patients completed the OABSS-HKC, a 3-day micturition diary, International Prostate Symptom Scores, and the Patient Perception of Bladder Condition questionnaires (visit 1), and again after a 2-week interval (visit 2). Test-retest reliability was evaluated by the intraclass correlation coefficient and weighted Kappa coefficient. The relationship between OABSS-HKC total scores and items in the comparison measures was evaluated using Spearman’s correlation coefficients.

RESULTS. The OABSS-HKC was successfully translated and culturally adapted. Fifty-one patients completed the validation study. A high level of reliability was observed between the OABSS-HKC total score answered at visit 1 and 2 for all subjects (intraclass correlation coefficient, 0.82) and among the four items answered (weighted Kappa coefficients, 0.57-0.75). The OABSS-HKC total score correlated significantly with numbers of micturitions, incontinence and urgency episodes recorded in the 3-day micturition diary, as well as the total International Prostate Symptom Scores and the Patient Perception of Bladder Condition score. However, the OABSS-HKC total score was not significantly associated with nocturia episodes, total voided volume, or number of pads used.

CONCLUSIONS. The OABSS-HKC total scores are reliable and moderately valid for the quantitative evaluation of overactive bladder symptoms in Hong Kong Chinese-speaking adults.

Key words: Reproducibility of results; Severity of illness index; Urinary bladder, overactive; Validation studies

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OBJECTIVE. Endotoxins and cytokines play an important role in the pathogenesis of multi-organ failure and mortality in patients suffering from severe Gram-negative bacterial infection. The aim of this study was to determine whether in patients with such infections, use of a haemofilter with enhanced endotoxin haemoadsorption and cytokine removal properties helps to overcome organ dysfunction.

DESIGN. Prospective case series study with historical controls.

SETTING. A regional hospital in Hong Kong.

PATIENTS. From October 2011 to June 2012, patients with sepsis-induced acute kidney injury due to Gram-negative bacteria were recruited. Continuous venovenous haemofiltration using oXiris haemofilter was performed. The patients’ APACHE (Acute Physiology And Chronic Health Evaluation) II and inclusion criteria matched those of a series of selected historical controls who had been treated with continuous venovenous haemofiltration using polysulfone-based haemofilter from 2009 to 2011. The percentage reduction in the Sequential Organ Failure Assessment score by 24 and 48 hours, the percentage reduction of noradrenaline equivalent usage by 48 hours, as well as intensive care unit and hospital mortality in the two groups were compared.

RESULTS. Pre-treatment biochemical parameters and vasopressor use in the six patients undergoing the intervention and the 24 historical controls were similar. The mean circuit life of oXiris was about 61 hours. The Sequential Organ Failure Assessment score was significantly reduced by 37% at 48 hours post-initiation of oXiris-continuous venovenous haemofiltration versus an increment of 3% in the historical controls. No significant side-effect was detected. Mortality was similar in the two groups.

CONCLUSION. The haemofilter membrane with enhanced endotoxin adsorption and cytokine removal capacity was a safe alternative to traditional polysulfone-based continuous venovenous haemofiltration and expedited improvement in organ dysfunction.

Key words: Acute kidney injury; Cytokines; Endotoxins; Hemadsorption; Sepsis

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OBJECTIVE. To evaluate the optimal timing for initiating antiretroviral therapy in patients with human immunodeficiency virus (HIV)–associated tuberculosis in Hong Kong.

DESIGN. Historical cohort.

SETTING. Tuberculosis and Chest Service and Special Preventive Programme, Public Health Service Branch, Centre for Health Protection, Department of Health, Hong Kong.

PATIENTS. Consecutive patients with HIV-associated tuberculosis in a territory-wide TB-HIV registry encountered from 1996 to 2009.

RESULTS. Of the 260 antiretroviral therapy–naïve patients with HIV-associated tuberculosis, 32 (12%) had antiretroviral therapy initiated within 2 months after starting anti-tuberculosis treatment (early antiretroviral therapy). Early antiretroviral therapy was associated with a more favourable outcome (cure or treatment completion without relapse) at 24 months (91% vs 67%; P=0.007) than those with antiretroviral therapy started later or not initiated, and remained an independent predictor of a favourable outcome after adjustment for potential confounders. Adverse effects from anti-tuberculosis drugs tended to occur more frequently in patients with early antiretroviral therapy (13/32 or 41%) compared with the remainder (59/228 or 26%; P=0.08). A significantly higher proportion of patients in the former group experienced immune reconstitution inflammatory syndrome than in the latter group (7/32 or 22% vs 9/228 or 4%; P<0.001). There was no death attributable to immune reconstitution inflammatory syndrome.

CONCLUSIONS. Early initiation of antiretroviral therapy is associated with more favourable tuberculosis treatment outcomes in patients with HIV-associated tuberculosis with a low CD4 count (<200/μL). Drug co-toxicity and immune reconstitution inflammatory syndrome that may be increased by earlier initiation of antiretroviral therapy does not undermine tuberculosis treatment outcomes to a significant extent.

Key words: Antiretroviral therapy, highly active; HIV; Treatment outcome; Tuberculosis

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OBJECTIVES. To distinguish allergic reactions and anaphylaxis, and to highlight the importance of anaphylaxis.

DESIGN. Case series.

SETTING. Adult emergency department of the medical faculty of Hacettepe University, Ankara, Turkey.

PATIENTS. Adults admitted to the emergency department between 1 May 2005 and 30 April 2010 with allergic diseases considered to be anaphylaxis or anaphylactic reactions.

MAIN OUTCOME MEASURES. Patient age, gender, possible cause(s) of allergy, organ involvement, treatment, and physical examination findings.

RESULTS. Although recorded physical examination findings of patients were consistent with anaphylaxis, 88 patients were not diagnosed as having this condition. All patients in this study group were evaluated in the emergency department facility and did not consult or were not referred to any other department or specialist. In all, 79 (90%) of them were discharged in the first 12 hours, 5 (6%) after 12 to 24 hours, and 4 (5%) after 24 hours. None of these patients died.

CONCLUSION. Emergency physicians should be better able to recognise the clinical features of anaphylaxis, so as to treat the episode promptly and appropriately. Delay in diagnoses could lead to incomplete treatment and even be fatal.

Key words: Anaphylaxis; Diagnosis; Emergency service, hospital

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OBJECTIVE. The clinical features of patients with psoas abscess in a local setting, including the microbiology, incidence and aetiologies, have not been well described. This study aimed to review such clinical features and patient outcomes.

DESIGN. Retrospective case series.

SETTING. Regional hospital, Hong Kong.

PATIENTS Adults (aged ≥18 years) with psoas abscess admitted to Tuen Mun Hospital from 1 January 2006 to 31 December 2010 were included. The clinical presentations, aetiologies, microbiology, treatments, hospital stays, intensive care unit admissions, and outcomes of these patients were reviewed.

RESULTS. The series entailed 42 patients, five of whom developed their psoas abscess after admission and seven were intravenous drug abusers. The most common presenting symptom in community-onset cases was back, hip, or thigh pain (43% [16/37]). Fever was present at presentation in 41% (15/37) of these patients, four of whom presented with fever only. The diagnosis was made by computed tomography in 95% (40/42) of these cases. In all, 23 abscesses were considered secondary; the most common aetiology being infective spondylitis or spondylodiscitis. The commonest causative organism for a primary psoas abscess was methicillin-sensitive Staphylococcus aureus, while for secondary abscesses they were more commonly from the gastro-intestinal and genitourinary tracts. Overall in-hospital mortality rate was 14% (6/42). Secondary psoas abscess patients had longer hospital stays (mean, 62 vs 34 days; P=0.007).

CONCLUSION. Psoas abscess is an uncommon condition. Most patients presented with only non-specific symptoms leading to difficulty in making an early diagnosis. In more than half of these patients, the psoas abscesses were secondary, the aetiology of which differed from reported overseas experience.

Key words: Discitis; Muscles; Psoas abscess; Sepsis; Spondylitis

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