Consensus recommendations for the screening, diagnosis, and management of Helicobacter pylori infection in Hong Kong.

Helicobacter pylori infection causes chronic gastric inflammation that contributes to various gastroduodenal diseases, including peptic ulcer and gastric cancer. Despite broad regional variations, the prevalence of resistance to antibiotics used to manage H pylori infection is increasing worldwide; this trend could hinder the success of eradication therapy. To increase awareness of H pylori and improve the diagnosis and treatment of its infection in Hong Kong, our consensus panel proposed a set of guidance statements for disease management. We conducted a comprehensive review of literature published during 2011 and 2021, with a focus on articles from Hong Kong or other regions of China. We evaluated the evidence using the Oxford Centre for Evidence-Based Medicine's 2011 Levels of Evidence and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system and sought consensus through online voting and a subsequent face-to-face meeting, which enabled us to develop and refine the guidance statements. This report consists of 24 statements regarding the epidemiology and burden, screening and diagnosis, and treatment of H pylori. Key guidance statements include a recommendation to use the test-and-treat approach for high-risk individuals, as well as the confirmation that triple therapy with a proton pump inhibitor, amoxicillin, and clarithromycin remains a valid first-line option for adults and children in Hong Kong.

Antibiotic-resistant Propionibacterium acnes among acne patients in a regional skin centre in Hong Kong.

BACKGROUND: There has been no study on antibiotic-resistant Propionibacterium acnes in Hong Kong. OBJECTIVE: We investigated the prevalence and pattern of antibiotic-resistant P. acnes and to identify any associated factors for harbouring the resistant strains. METHODS: Culture and sensitivity testing of P. acnes to commonly used antibiotics were performed. Resistance to tetracycline was defined at a minimal inhibitory concentration (MIC) of 2 µg/mL or more; erythromycin at an MIC of 0.5 µg/mL or more; clindamycin at an MIC of 0.25 µg/mL or more according to EUCAST. For breakpoints of doxycycline and minocycline, those with an MIC of 1 µg/mL or more were defined as resistant strains. RESULTS: Among the 111 specimens collected from 111 patients, 86 strains of P. acnes were recovered, one from each specimen. Twenty-five specimens had no growth. Forty-seven (54.8%) strains were found to be resistant to one or more antibiotics. Forty-six (53.5%), 18 (20.9%), 14 (16.3%), 14(16.3%) and 14 (16.3%) strains were resistant to clindamycin (CL), erythromycin (EM), tetracycline (TET), doxycycline (DOX) and minocycline (MR) respectively. Ten strains (11.6%) had cross resistance between the MLS antibiotics (erythromycin or clindamycin), one strain (1.2%) had cross resistance among the cyclines and 14 strains (16.4%) had cross resistance between the MLS and cycline antibiotics. Binary logistic regression showed an association between MLS antibiotic resistance with an increased age whereas cycline resistance was associated with the duration of treatment. CONCLUSION: Antibiotic-resistant P. acnes is prevalent in Hong Kong. Dermatologists should be more vigilant in prescribing antibiotics for acne patients.

Study of wrist posture, loading and repetitive motion as risk factors for developing carpal tunnel syndrome.

Occupational risk factors of carpal tunnel syndrome (CTS) are popular current research targets, with main emphasis put on wrist posture and dynamics. In this study, we do not intend to pinpoint individual occupations, but aim to identify high risk wrist postures and actions which may occur across various occupations. It is hoped that prevention can thus be instituted in a general population by directing at the particular causative wrist actions rather than exclusively targeting isolated occupations. We performed a case-control study with 166 cases and 111 controls recruited from different hospitals in Hong Kong in 2004. All cases and controls completed the survey on their general health condition, smoking status, wrist posture and motion as well as psychosocial status at the time of diagnosis of CTS. Frequent flexion OR = 4.436 (95% CI: 1.833-10.734), frequent extension OR = 2.691 (95% CI: 1.106-6.547) of the wrist were found to be associated with CTS. Frequent sustained forceful motion of the wrist OR = 2.588 (95% CI: 1.144-5.851) was also found to be associated with CTS. Neutral wrist position and repetitive wrist motion were not associated with CTS. Adjustment was made for age, sex, BMI, smoking and psychosocial stress. Our study confirms that frequent flexion, extension and sustained force of the wrist increase the risk of developing CTS.

Modified endoscopic dacryocystorhinostomy with posterior lacrimal sac flap for nasolacrimal duct obstruction.

OBJECTIVES: To evaluate a new technique of modified endoscopic dacryocystorhinostomy involving the creation of a large posterior flap at the lacrimal sac and to compare its success rate with that of the conventional endoscopic method of excising the entire medial lacrimal sac wall as a surgical treatment for epiphora caused by nasolacrimal duct obstruction. DESIGN: Retrospective, interventional, and comparative case series. SETTING: University teaching hospital, Hong Kong. PATIENTS AND METHODS: Only adults with primary nasolacrimal duct obstruction were included. Consecutive endoscopic dacryocystorhinostomy was performed using two different techniques from July 1999 to June 2001. The new technique involved the creation of a large posterior flap at the medial lacrimal sac wall, reflecting it posteriorly, followed by removal of the remaining small anterior flap (the LSF group). Other patients had the entire medial lacrimal sac wall excised (the ELS group). MAIN OUTCOME MEASURES: Surgical success was defined by free fluorescein drainage from the conjunctival sac into the rhinostomy site at least 3 months after silicone stent removal. RESULTS: Ninety-nine procedures were performed in 99 patients. The success rate was 89.1% (41/46) in the LSF group and 71.7% (38/53) in the ELS group. The difference between the two groups was statistically significant (Chi squared test, P=0.031). CONCLUSIONS: Our new and modified technique of endonasal dacryocystorhinostomy has a greater success rate than conventional endonasal dacryocystorhinostomy. A large-scale prospective randomised controlled trial to further evaluate the efficacy and safety of this surgical technique is under way.

Solid-state NMR detection, characterization, and quantification of the multiple aluminum environments in US-Y catalysts by (27)Al MAS and MQMAS experiments at very high field.

The detection of all of the aluminum present in steamed zeolite H-Y catalysts by (27)Al MAS NMR at 14.4 T (600 MHz for (1)H) and 18.8T (800 MHz for (1)H) is reported. Further, it is shown that it is possible by (27)Al MAS and MQMAS NMR measurements to clearly identify four separate aluminum environments which are characteristic of these materials and to unambiguously assign their coordinations. Average chemical shift and quadrupolar coupling parameters are used to accurately simulate the (27)Al MAS NMR spectra at 9.4 T (400 MHz for (1)H), 14.4 T (600 MHz for (1)H) and 18.8 T (800 MHz for (1)H) in terms of these four aluminum environments. In addition, these average chemical shift and quadrupolar coupling parameters are used to calculate peak positions in the (27)Al MQMAS isotropic dimension that are in good agreement with the experimental data acquired at 9.4 and 18.8 T.

The laboratory diagnosis of rickettsial diseases in Hong Kong.

Indirect immunoperoxidase (IP) tests against antigens of Rickettsia typhi, R. sibirica and R. tsutsugamushi were carried out on serum samples from 10 patients known to have high titres against one or more Proteus OX antigens in the Weil-Felix (WF) test. The IP test confirmed rickettsial infection in nine of the 10 patients, giving unequivocal indications of the grouping of the infecting Rickettsia species and, in one instance, showing a diagnostic IgM titre in a specimen taken on day 3 of the patient's illness. IP tests confirmed four cases of spotted fever group rickettsial infection, three cases of urban or murine typhus and two of scrub typhus.

Prevalence of antibody to hepatitis C virus in HBsAg-negative chronic liver disease in Hong Kong using different assays.

The prevalence of anti-HCV antibodies in Chinese patients with HBsAg-negative chronic liver diseases was studied retrospectively. Anti-HCV was detected by two different ELISAs. In 97 patients with HBsAg-negative chronic liver disease, 26 (27%) were anti-HCV positive. Of 157 control subjects, only 1 (0.6%) was anti-HCV positive (P less than 0.001). Anti-HCV was detected in 18 of 27 (67%) patients with post-transfusion non-A, non-B (PTNANB) chronic hepatitis or cirrhosis, 5 of 25 (20%) patients with cryptogenic chronic hepatitis or cirrhosis, 2 of 33 (6%) patients with alcoholic liver disease, 1 of 5 (20%) patients with autoimmune chronic active hepatitis (AICAH), none of 4 patients with primary biliary cirrhosis (PBC), and none of 3 patients with fatty liver. The prevalence in this group of patients was lower when compared to reports from other countries. The addition of a urea washing step reduced false-positivity in alcoholic and AICAH groups. The ELISA that employs three recombinant HCV antigens confirmed all positive results by another ELISA with the exception of one weakly positive result in the AICAH group and one in the alcoholic group. One patient in the PTNANB group was detected in addition by the second generation assay. In conclusion, ELISA with a urea wash proved to be useful in reducing false-positivity, and the second generation assay proved to be a sensitive and specific test for anti-HCV antibody.

Vibrio parahaemolyticus and other halophilic vibrios associated with seafood in Hong Kong.

The summer prevalence of Vibrio parahaemolyticus and other halophilic vibrios in seafood from Hong Kong markets was investigated. Halophilic vibrios were isolated from all seven types of seafood examined, and comprised 9.1%, 8% and 6.1% of contaminating aerobic heterotrophic bacteria from mussels, clams and oysters respectively. Sucrose-positive vibrios were more common than sucrose-negative varieties. Vibrio alginolyticus was the most frequently isolated species, followed by V. parahaemolyticus, V. harveyi, V. fluvialis, V. vulnificus, V. pelagius, V. campbellii, V. spendidus and V. marinus. Mussels contained the highest concentration of V. parahaemolyticus (4.6 x 10(4)/g); oysters and clams contained 3.4 x 10(4)/g and 6.5 x 10(3)/g respectively. The ubiquity and relatively high concentrations of V. parahaemolyticus and other pathogenic vibrios in shellfish is a potential public health hazard in Hong Kong and other subtropical Asian countries.