Machine learning model to predict recurrent ulcer bleeding in patients with history of idiopathic gastroduodenal ulcer bleeding.

BACKGROUND: Patients with a history of Helicobacter pylori-negative idiopathic bleeding ulcers have an increased risk of recurring ulcer complications. AIM: To build a machine learning model to identify patients at high risk for recurrent ulcer bleeding. METHODS: Data from a retrospective cohort of 22 854 patients (training cohort) diagnosed with peptic ulcer disease in 2007-2016 were analysed to build a model (IPU-ML) to predict recurrent ulcer bleeding. We tested the IPU-ML in all patients with a diagnosis of gastrointestinal bleeding (n = 1265) in 2008-2015 from a different catchment population (independent validation cohort). Any co-morbid conditions which had occurred in >1% of study population were eligible as predictors. RESULTS: Recurrent ulcer bleeding developed in 4772 patients (19.5%) in the training cohort, during a median follow-up period of 2.7 years. IPU-ML model built on six parameters (age, baseline haemoglobin, and presence of gastric ulcer, gastrointestinal diseases, malignancies, and infections) identified patients with bleeding recurrence within 1 year with an area under the receiver operating characteristic curve (AUROC) of 0.648. When we set the IPU-ML cutoff value at 0.20, 27.5% of patients were classified as high risk for rebleeding with a sensitivity of 41.4%, specificity of 74.6%, and a negative predictive value of 91.1%. In the validation cohort, the IPU-ML identified patients with a recurrence ulcer bleeding within 1 year with an AUROC of 0.775, and 84.3% of overall accuracy. CONCLUSION: We developed a machine-learning model to identify those patients with a history of idiopathic gastroduodenal ulcer bleeding who are not at high risk for recurrent ulcer bleeding.

Territory-wide population-based study of chronic hepatitis C infection and implications for hepatitis elimination in Hong Kong.

BACKGROUND: To study the epidemiology of chronic hepatitis C virus infection in Hong Kong and to estimate the service gap for achieving the WHO hepatitis elimination targets of attaining a diagnosis rate of 90%, treatment rate of 80% and 65% reduction in mortality rate by 2030. METHODS: From January 2005 to March 2017, patients who were tested positive for anti-HCV were retrospectively retrieved from all public hospitals in Hong Kong. The epidemiological data of 15 participating hospitals were analysed. RESULTS: A total of 11 309 anti-HCV+ patients were identified and the estimated diagnosis rate was 50.9%. Our HCV-infected patients were ageing (median age 59). The all-cause mortality rate increased from 26.2 to 54.8 per 1000 person-years over the last decade. Our estimated treatment rate was 12.4%. Among the treated patients, 93.6% had received pegylated interferon/ribavirin (Peg-IFN/RBV) but only 10.8% had received interferon-free direct-acting antivirals (DAAs). In a cohort of 1533 patients, 39% already had advanced liver fibrosis or cirrhosis. The sustained virological response rate for Peg-IFN/RBV and DAAs were 74.8% and 97.2% respectively. However, more than 70% of patients were not subjected to interferon treatment for various reasons. Patients who achieved SVR were associated with a significantly lower risk of HCC (4.7% vs 9.6%, P = 0.005) and death (1.7% vs 23.8%, P < 0.001). CONCLUSION: Our diagnosis rate, treatment rate and mortality rate reduction were still low, particularly the Peg-IFN outcomes, making it difficult to meet the WHO hepatitis elimination targets. A more generalized use of DAAs is urgently needed to improve the situation.

Norovirus as cause of benign convulsion associated with gastro-enteritis.

AIM: Rotavirus and norovirus gastro-enteritis (GE) are common in children. Complications, except severe dehydration, are rare. Rotavirus was known to cause seizures and even GE encephalopathy, but these complications are less described in norovirus infection. The objective of this study is to compare the demographic features, clinical manifestations including the incidence of afebrile seizure, and the outcomes in children with rotavirus and norovirus infections. METHODS: This is a retrospective review of children between age 1 month and 6 years admitted to the paediatric department of a regional hospital in Hong Kong with rotavirus and norovirus infections over a period of 3 years from 1 June 2006 to 31 May 2009. Their demographic data, clinical features, laboratory results and outcomes were compared and analysed. RESULTS: Two hundred and thirty-two children with rotavirus and 173 children with norovirus GE were admitted within the study period. Afebrile seizure commonly occurred in norovirus infection (8.67% vs. 1.29%, P < 0.001). Children with rotavirus infection had higher temperature and more diarrhoea episodes, while more blood-stained stool was noted in the norovirus group. Rotavirus-infected patients stayed longer in hospital. All of them had full recovery without any complication. Among the 18 patients who developed afebrile convulsions, 17 of them had neuroimaging performed, which was normal. Fourteen of them had electroencephalogram (EEG) performed, demonstrating normal or non-specific findings. None of them developed subsequent seizure attack after the GE episode. CONCLUSIONS: Norovirus is more commonly associated with benign convulsion in GE than rotavirus. We need to identify the presence of virus, in particular norovirus, in children with GE and afebrile generalised tonic-clonic seizure. Further neuro-investigations may not be necessary once the aetiology is established. Prognosis is excellent in this group of children and prophylactic anticonvulsant is not needed.

Hyperinsulinism and hyperammonaemia syndrome due to a novel missense mutation in the allosteric domain of the glutamate dehydrogenase 1 gene.

Congenital hyperinsulinism is one of the causes of persistent hypoglycaemia in neonates and infants. We describe a one-month-old boy with a rare form of congenital hyperinsulinism characterised by hypoglycaemia and hyperammonaemia.

Gastrointestinal stromal tumors in a cohort of Chinese patients in Hong Kong.

AIM: To investigate the prevalence and clinical pattern of gastrointestinal stromal tumors (GISTs) in Hong Kong Chinese, and to assess the impact of introduction of CD117 on the disease incidence. METHODS: From the database of the Department of Pathology of Yan Chai Hospital, 47 patients, with GISTs from September 1995 to December 2003 were included in this study. Ten GISTs were diagnosed before the introduction of CD117. The clinical features, tumor characteristics, and treatment were analyzed. Factors predicting tumor related death or recurrence were studied with Cox proportional hazard model. RESULTS: The patients included 26 males and 21 females, with a mean age of 66.6 years (SD 13.1, range 29-87 years). The estimated prevalence of GISTs was 13.4-15.6 per 100,000 people, with an annual incidence of 1.68-1.96 per 100,000 people. The annual incidence of GISTs before and after the introduction of CD117 was 1.1 per 100,000 people and 2.1 per 100,000 people respectively. Stomach (34 patients, 72.3%) was the most common location for the tumor, followed by the small intestine (8 patients, 17.0%), esophagus (2 patients, 4.3%), omentum (2 patients, 4.3%) and colon (1 patient, 2.1%). Thirty-one patients (66%) had complete tumor resection. Eleven out of 16 deaths (23%) were tumor-related. The median survival time was 26 mo. Five-year survival rate was 61.3%. The significant factors associated with tumor-related death or recurrence were incomplete resection, tumor size 5 cm or above, invasion to the adjacent organ or presence of metastasis. CONCLUSION: The incidence of GIST in Hong Kong is comparable to that in the United States but lower than that in Finland. The true incidence of GISTs could be underestimated before the introduction of CD117. Incomplete resection, tumor size 5 cm or above, invasion to the adjacent organ or presence of metastasis are factors predicting tumor-related death or recurrence.

Survival following the development of ascites and/or peripheral oedema in primary biliary cirrhosis: a staged prognostic model.

OBJECTIVE: Current prognostic models in primary biliary cirrhosis (PBC) have low precision, partly due to the restricted inclusion criteria of some cohorts used for modelling but also because of the prolonged natural course of the disease. It is hypothesized that better precision could be achieved with a staged model, using ascites or peripheral oedema as a new starting-point for prediction. MATERIAL AND METHODS: The study was based on an established database of 289 consecutive patients, followed between 1977 and 1998. Stepwise Cox regression was used to construct a staged model based on 143 patients who first developed ascites (n=111) or peripheral oedema (n=32) at entry or during subsequent follow-up. The model was compared with published models using graphical methods and receiver operating characteristics (ROCs). RESULTS: Mean time from clinical diagnosis of ascites or peripheral oedema to death was 3.1 years. The following variables had independent prognostic significance: log10(bilirubin) (p<0.001), albumin (p<0.001), age (p<0.001) and history of encephalopathy (p<0.001). Goodness of fit showed that the survival probabilities predicted by the Ascites Stage Model fitted well with the observed data. The Ascites Stage Model (ROC 0.8324 (SE 0.0348)) was a better predictor of survival than the Mayo long-term model (ROC 0.7833 (SE 0.0397)), the Mayo Repeated Patient Visits Model (ROC 0.7779 (SE 0.0399)) and the Royal Free PBC Prognostic Model (ROC 0.7785 (SE 0.0396)). CONCLUSIONS: The Ascites Stage Model gives a better survival estimate for PBC patients once they have developed ascites or peripheral oedema compared with the current models, and demonstrates an advantage of staged models in diseases with a prolonged natural history.

Osteonecrosis in children with severe acute respiratory syndrome.

Osteonecrosis is a debilitating bone disease affecting adults who have recovered from severe acute respiratory syndrome in Hong Kong and China, but there are no data on its prevalence in children. We report 5 children with magnetic resonance imaging evidence of osteonecrosis. In view of the high prevalence and asymptomatic presentation of osteonecrosis, we suggest magnetic resonance imaging screening for osteonecrosis in children with severe acute respiratory syndrome.

Epstein-Barr virus-associated infectious mononucleosis in Chinese children.

BACKGROUND: According to seroprevalence studies the majority of children in Hong Kong are infected by Epstein-Barr virus (EBV) before 10 years of age, but the characteristics of EBV-associated infectious mononucleosis (IM) in Chinese children are largely unreported. This study aims at defining the clinical presentation and complications of Chinese childhood IM in relation to age of the children. METHODS: A retrospective study was performed on 77 consecutive Chinese childhood IM patients who fulfilled the serologic criteria for the diagnosis of primary EBV infection (viral capsid antigen IgM+ viral capsid antigen IgG+ Epstein-Barr nuclear antigen-). The clinical, hematologic and biochemical findings were evaluated among four age groups of <2 years, 2 to 4 years, 5 to 9 years and 10 to 15 years. RESULTS AND CONCLUSIONS: EBV-associated IM occurred at all age groups with a peak incidence at 2 to 4 years, corresponding to the rapid rise in the seroprevalence of EBV in early childhood in the Hong Kong Chinese. The majority of children presented with fever, tonsillopharyngitis, lymphadenopathy and hepatosplenomegaly, similar to the adult IM patients, and recovered without major complications. Marked lymphocytosis with the presence of atypical lymphocytes was a consistent hematologic finding in all age groups. The occurrence of hepatitis showed a clear association with advancing age (P = 0.003). The age-related increase in IM-associated hepatitis may reflect difference in the host immune response against EBV between the infants and older children.