Effectiveness of inactivated COVID-19 vaccine CoronaVac in children aged less than 3 years old during Omicron wave in Hong Kong.

The COVID-19 pandemic has affected people of all ages worldwide. However, there is still no information on the vaccine effectiveness (VE) of inactivated COVID-19 vaccines in children aged less than 3 years old. This study highlighted that 2 doses of CoronaVac were effective in preventing COVID-19, with a VE of 83.1 %.

Dynamics of childhood obesity in Hong Kong throughout the COVID-19 pandemic before and after the school closures: a 3-year longitudinal study.

OBJECTIVE: This study is to evaluate if there is any difference in the balance between incidence of and remission from overweight/obesity in Hong Kong school-age children before and during the COVID-19 pandemic over three years. METHODS: This is a retrospective longitudinal study that involved children aged 6-16 years from a database of the School Physical Fitness Award Scheme. RESULTS: 2765 students were longitudinally followed up for two years. The prevalence of childhood overweight/obesity was increased between the 2019 and 2021 academic years (P < 0.001). During the COVID-19 pandemic, the rate of obesity remission significantly reduced by 7.9 % (P = 0.003), at a background of a plateau of obesity among children and adolescents. CONCLUSIONS: Our study provides evidence on the impact of school closure and home confinement as a standard infection control measure for the prevention of COVID-19, which are likely to break the balance between incidence of and remission from childhood obesity.

Mental health & maltreatment risk of children with special educational needs during COVID-19.

BACKGROUND: Children with special educational needs (SEN) are more vulnerable during the COVID-19 pandemic with risk of poor mental wellbeing and child maltreatment. OBJECTIVE: To examine the impact of COVID-19 on the mental health of children with SEN and their maltreatment risk. PARTICIPANTS AND SETTING: 417 children with SEN studying at special schools and 25,427 children with typical development (TD) studying at mainstream schools completed an online survey in April 2020 in Hong Kong during school closures due to COVID-19. METHOD: Emotional/behavioural difficulties, quality of life and parental stress of children with SEN were compared with typically developed children using mixed effect model. Linear regression analyses were performed to explore factors associated with child emotional/behavioural difficulties and parental stress during the pandemic. Chi-square test was performed to detect the differences in maltreatment risk before and during COVID-19. RESULTS: Children with SEN had significantly poorer overall quality of life (68.05 vs 80.65, p < 0.01). 23.5% of children had at least one episode of severe physical assault and 1.9% experienced very severe physical assault during COVID-19. Rates of physical assault increased significantly (59.8% vs. 71.2% p < 0.001) while children with mental disorders had increased risk of severe physical assault comparing to those without mental disorders (RR = 1.58, ꭓ2 = 5.19 p = 0.023). CONCLUSION: Children with SEN had poorer mental health than typically developed children during the COVID-19 pandemic. Maltreatment risk for children with SEN is higher in comparison to pre-COVID-19 era. Surveillance of child maltreatment, continuity of medical and rehabilitation care to support children with SEN are essential during a disease pandemic.

Subungual squamous cell carcinoma: report of 2 cases.

Subungual squamous cell carcinoma (SCC) is a rare malignant tumor with an indolent course. Its etiology is unknown. It often involves the distal phalanx of the thumb or the index finger, and often presents as a chronic ulcer that is commonly misdiagnosed as chronic paronychia, pyogenic granuloma or verruca vulgaris. Approximately 150 cases of subungual SCC, including one in a Taiwanese patient, have been reported. Here, we report two cases of subungual SCC presenting as a chronic ulcer of the nail bed refractory to antibiotic treatment. One case involved the right thumb, while the other involved the right index finger. Radiographs of both cases showed an osteolytic bone lesion involving the distal phalanx. Excision biopsy revealed SCC in both cases. Both patients received amputation of the involved distal phalanx and showed no signs of reoccurrence during 5 years of follow-up. These findings suggest that all recalcitrant ulcers of the nail bed should be biopsied to facilitate early diagnosis and treatment of subungual SCC.

Articular cartilage lesions of the knee following immobilisation or destabilisation for 6 or 12 weeks in rabbits.

Eighty mature female New Zealand White rabbits were sacrificed 6 or 12 weeks after either section of the medial collateral and the anterior cruciate ligaments with removal of the anterior third of the medial meniscus of one knee, or immobilisation of one knee, using the contralateral non-treated knee as the control. The area of degenerated joint surface of the distal femur, and water and proteoglycan content were measured, and the articular cartilage stained using haematoxylin and eosin and safranin O. Destabilisation resulted in a significantly larger time-dependent degenerated joint surface area. Water content significantly increased after 6 weeks with no significant differences between immobilisation and destabilisation. Destabilisation resulted in a significantly greater decrease in proteoglycan content. At 12 weeks, the control knees of the animals undergoing destabilisation showed significant degenerative changes. There were more extensive lesions in destabilisation, while 6 weeks of immobilisation produced moderate degenerative joint disease.

Regional nerve block for total knee arthroplasty.

Femoral and sciatic nerve blocks have been used occasionally for unilateral total knee arthroplasty (TKA). In order to evaluate the effectiveness of this technique, combined femoral 3-in-1 and sciatic nerve blocks were performed in 20 cases of TKA, by the same surgeon. This surgeon also performed unilateral TKA under spinal anesthesia in another 20 cases. The anesthetic effectiveness of the two types of anesthesia was compared in terms of the time needed to complete the surgery, amount of intraoperative blood loss, and time interval until the first dose of analgesic. The results showed that the two types of anesthesia had comparable anesthetic effects. Ten of the 20 patients who had spinal anesthesia complained of postoperative urinary retention, while none of those who had nerve block had this complaint. Neither group experienced postpunctural headache, neurovascular damage, or drug-over-dose toxicity. We conclude that combined femoral 3-in-1 and sciatic nerve block is an effective anesthetic alternative for unilateral TKA.

Treatment of congenital pseudarthrosis of the tibia with the Ilizarov method.

Congenital pseudarthrosis of the tibia (CPT) is a difficult orthopedic problem. Many modalities of treatment have been used but none provide comprehensive treatment with highly satisfactory results. We reviewed the surgical management and results of eight consecutive patients with CPT treated with the Ilizarov technique for nonunion, angulation, leg length discrepancy and valgus ankle between 1988 and 1992. The median age at the time of Ilizarov treatment was 1.8 years (range, 0.4-20.1 yr). Primary union at the pseudarthrosis site was achieved in five of the eight patients. After a median follow-up period of 5.2 years (range, 3.0-6.2 yr), final union at the pseudarthrosis site was achieved in seven of the eight patients (union rate, 87.5%). However, nonunion persisted at the distraction site in one patient. In the six patients who achieved union and functional recovery, the median number of total surgeries was four; there were two residual deformities. Leg length discrepancy was corrected in these six patients to less than 1.7 cm. Six out of the eight patients were satisfied with the results. In general, the treatment course was lengthy with numerous complications, especially in young children. The Ilizarov technique, with its ring design, simultaneously addresses several problems associated with CPT, and may provide a comprehensive treatment for CPT with promising results. Combination treatment with other methods is necessary.

Subcutaneous ("inverted") verrucous carcinoma with bone invasion.

Verrucous carcinoma (VC) is a low-grade cutaneous squamous carcinoma which often presents on the foot where it is known as carcinoma cuniculatum. Three cases of VC on the buttock have previously been documented. We describe a highly unusual example of VC involving the buttock with extensive iliac bone erosion, and with the apparently unique feature of being totally subcutaneous.

Resurfacing of thumb-pulp loss with a heterodigital neurovascular island flap using a nerve disconnection/reconnection technique.

The problems of late deterioration of sensation and a "double sensibility" phenomenon, either in the thumb or donor finger, are a known deficiency of the conventional heterodigital neurovascular island flap. This is probably related to unsatisfactory cortical reorientation following flap transfer. To obviate this problem, the authors have used a disconnection/reconnection technique for heterodigital island flaps in 17 patients, to resurface defects in the skin of the thumb. All patients were followed-up for 1 year, while 15 were followed-up for 2 years or more. There were no flap complications or failures, and the length of the thumb tip was preserved in all cases. The classic two-point discrimination was less than 6 mm in eight of these patients, and the remaining nine patients had two-point discrimination of between 6 and 8 mm. This technique was found to provide sensitive, supple, and well-vascularized skin with proper cortical representation, to replace the loss of the tactile pump of the thumb tip in one operative stage.

Ender nailing for ipsilateral femoral shaft fractures after Austin-Moore hemiarthroplasty.

BACKGROUND: The management of ipsilateral femoral shaft fractures after hemiarthroplasty is controversial. METHODS: Fifteen patients (average age 82.4 +/- 8 years) with ipsilateral femoral shaft fractures after uncemented hemiarthroplasty were treated by closed reduction and Ender nailing. Under radiographic control, closed reduction was attempted. If not possible, cerclage of the shaft fracture was accomplished through a limited lateral approach. Ender nails were then inserted well past the tip of the stem of the prosthesis. RESULTS: There were a superficial wound infection and a deep vein thrombosis. At 6 months, five patients had died, and backing out of the nails necessitated removal in one patient. At 1 year, nine patients were still alive. Of these, seven were able to walk with aids. At 2 years, seven patients were still alive and were walking with aids. Two patients presented shortening of more than 1.5 cm of the operated femur. After an average of 5 years, 11 patients were dead, two were still walking, and two were bedridden. CONCLUSIONS: The technique described is an option in the treatment of fractures of the ipsilateral femoral shaft after uncemented hemiarthroplasty.

Prevention of potential fracture between two implants using interlocking bipolar cut short GK nail and Enders nail.

A technique to prevent a potential fracture occurring between the distal end of a cementless hip prosthesis and the proximal end of a dynamic compression screw (DCS) is described. The method involves bridging the two implants using a bipolar shortened femoral nail, which is further improved by filling the gap between the stem and the femoral nail with an Enders nail. The distal connection is secured by placing the distal locking screw of the femoral nail through the distal femoral plate of the dynamic compression plate first before locking the nail to the distal femur. Further stabilisation and promotion of healing at the distal femur were achieved using cement and bone graft.

Multiple chop wounds in Hong Kong. An epidemiological study of an unusual injury.

Knife injuries can be classified into stabbing injuries and multiple laceration or multiple chops, the latter being much more common in Chinese communities. It is the mark of criminal gang attacks with their tendency to use long knives and choppers rather than guns. The intention is often to wound rather than kill. A survey of 89 cases revealed that 90% of the victims are men, with a mean age of 27 years; 75% was admitted to the hospital at night, and in 78% of the cases the assailants were persons unknown, or so we were told by the victims. The reasons for the attacks were also not given. Most of the women victims were assaulted by their spouse. Some 74% of the patients suffered three to six lacerations; 62% of the injuries were on the extensor surfaces of the upper limbs, while the hand and the back of the trunk were also common sites. The type of management differs from that for stabbing injuries. There were no fatalities, and less than half of the patients required blood transfusion. The average hospital stay was 6.2 days. The morbidity of these injuries involves damaged tendons and nerves.

False aneurysm with median nerve palsy after iatrogenic brachial artery puncture.

We report on a case in which a patient on oral anticoagulation for her aortic valve replacement, with an International Normalised Ratio of 2.13, developed a false aneurysm of the brachial artery after a routine arterial puncture, despite direct pressure to the aspiration site. The false aneurysm was complicated by the development of median nerve palsy.

Cystic tuberculosis of the bone mimicking osteogenic sarcoma.

Hong Kong has a relatively high incidence of tuberculosis in comparison with other developed cities, possibly due to the influx of mainland Chinese immigrants and Vietnamese boat people. However, primary, solitary cystic tuberculous infection of the bone is rare and few cases have been reported. Radiological appearances of this disease can mimic several bone conditions, including bone cyst, osteoblastoma and even osteosarcoma. We report on a case of a healthy fifteen-year-old who presented with swelling to the left elbow; biopsy confirmed this as cystic tuberculosis of the bone.

The second case of Paget's disease (osteitis deformans) in a Chinese lady.

Paget's disease of the bone is extremely rare in the Chinese population. We report a case of a 91-year-old female patient who presented with a leg ulcer after an injury. On examination, she was incidentally noted to have bowing of the tibia and facial features suggestive of Paget's disease which was later confirmed with plain radiograph. An extensive search of the international literature over the last thirty years, including the use of Medline, has revealed only one other case report of Paget's disease in a Chinese patient in Thailand.

Chondromyxoid fibroma-like osteosarcoma: a distinct variant of low-grade osteosarcoma.

Chondromyxoid fibroma-like osteosarcoma is a recently described, extremely rare subtype of low-grade osteosarcoma. Two such cases were encountered among 102 cases of osteosarcoma seen in the Prince of Wales Hospital, Hong Kong, between 1984 and 1994. The first patient, a 39-year-old woman, presented with a mass in her right maxilla which was resected and mistaken as a myxoma. The tumour recurred locally four years later and she now has extensive local recurrent disease six years after initial presentation and is amenable to support treatment only. The second patient, a 28-year-old man, had a pelvic tumour which recurred in the form of a polypoid left atrial tumour and pulmonary nodules six years after operation. The left atrial tumour recurred one year after operation, and led to sudden death of the patient seven years after initial presentation. Radiologically, the tumours in both cases appeared as expansile osteolytic lesions with erosion of adjacent bone and infiltration into soft tissue. Histologically, they consisted of lobules of spindle, stellate or polygonal tumour cells showing mitotic activity and with moderate nuclear pleomorphism and hyperchromatism, set in a highly myxoid stroma superficially mimicking chondromyxoid fibroma. The histological hallmark was the direct production of osteoid by tumour cells. Chondromyxoid fibroma-like osteosarcoma merits recognition as a distinct variant of low-grade osteosarcoma for which early appropriate surgery is indicated.

Necrotizing fasciitis of the foot caused by an unusual organism, Vibrio vulnificus.

In modern medicine, there are very few infectious disease processes occurring in the foot that can cause death within 48 hr. and have an overall mortality rate of 50% despite appropriate antibiotic and surgical treatment. Such a condition must be regarded as being potentially deadly. The authors report a case of necrotizing fasciitis of the left foot resulting from an unusual organism of Vibrio vulnificus.

Rapid airway access by modified retrograde intubation.

Rapid access to the airway is important to ensure successful resuscitation. However, the establishment of a patent airway by orotracheal intubation is not always easy. This is especially true in patients with upper airway pathology or anatomic variations. A modified retrograde intubation technique was developed using the plastic sheath of the spring guidewire of a central venous pressure (CVP) kit as an introducer. This is considered to be a simple and safe method to provide a secure airway where intubation is difficult or in an emergency. This report presents our clinical experience using this method in 10 patients.