Pok Oi Hospital (Chinese: 博愛醫院; Cantonese Yale: Bok'oi Yīyún) is a major hospital in Hong Kong, serving the northwest New Territories. Located in Au Tau in Yuen Long, it was founded by residents in 1919 when Yuen Long was a still rural town. The hospital later became a charity organisation, and extended its services to include schools, homes for the elderly, social welfare and other areas. The hospital is now funded and managed by the charity and Hospital Authority..
Background: Post-stroke permanent disability posed a huge socio-economic burden. It was unclear whether adjunctive traditional Chinese medicine (TCM) consisting of acupuncture and herbal therapy in an Integrated Chinese-Western Medicine (ICWM) rehabilitation programme might improve stroke outcomes. Objective: We aimed to evaluate the safety and efficacy of an ICWM Programme implemented in public hospitals in Hong Kong since 2014. Methods: In this retrospective cohort study, we compared the outcome of all patients who received ICWM treatment during acute-to-subacute phase of strokes between September 2014 and December 2022 with that of control patients who underwent conventional stroke rehabilitation in the same period selected by propensity score matching in a 1:1 ratio. We measured and compared 3 functional outcomes between ICWM and control groups by multivariable generalized linear models: 1) Ambulation as measured by the Modified Functional Ambulatory Category (MFAC); 2) Activities of daily living by the Modified Barthel Index (MBI); and 3) Swallowing function by the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS). We conducted a secondary analysis to determine the association between functional recovery and TCM syndromes. Results: Of the 917 patients who received ICWM and the 21,342 patients with conventional stroke rehabilitation, 666 pairs were matched. Baseline characteristics, including MFAC, MBI and RBHOMS scores at stroke onset were balanced. The magnitude of improvement in MFAC (ICWM vs control: 1.3±1.2 vs 0.9±1.3, P <0.001), MBI (16.9±15.3 vs 9.2±14.9, P <0.001) and RHOMBS (1.1±1.4 vs 0.4±1.4, P <0.001) was significantly higher in the ICWM group compared to the control group. On discharge, MFAC (5[4, 6] vs 4[3, 6], P =0.03) and RBHOMS (8 [7, 9] vs 8 [6, 9], P <0.001) were significantly higher in the ICWM group. Among patients participating in the ICWM program, Phlegm-Heat Syndrome and Wind-Phlegm Syndrome were associated with better functional recovery. Conclusion: Compared to conventional stroke rehabilitation, the ICWM program was associated with a greater magnitude of stroke recovery in terms of mobility, activities of daily living, and swallowing function. Furthermore, TCM syndrome categorization may inform stroke prognosis.
Objectives: Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are the two major subtypes of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and are associated with substantial mortality. Geographic variation exists in the epidemiology and clinical manifestations of AAV, with Southeast Asian populations showing a predominance of MPA and higher mortality. However, data on Chinese populations remain limited. This study aimed to investigate the epidemiology, mortality risk, and prognostic factors of GPA or MPA in Chinese patients in Hong Kong. Methods: Newly diagnosed cases of GPA and MPA from 2013 to 2023 were identified using ICD-9 codes from databases across eight public hospitals in Hong Kong. Incidence rates were calculated using population denominators. Patient demographics, clinical features, treatments, and outcomes, including survival, relapse, and dialysis requirement, were analyzed using the Kaplan–Meier method and Cox proportional hazards regression. Results: A total of 35 patients with GPA and 127 patients with MPA were identified. The estimated incidence rates of GPA and MPA were 0.9 and 3.2 per million population, respectively. Renal and pulmonary involvement was common, occurring in 82.1% and 51.2% of patients, respectively. Mortality rates were 22.8% at 1 year and 34.0% at 5 years. The age- and sex-adjusted standardized mortality ratio was 6.51 ± 0.81. Multivariate analysis identified age, renal dysfunction, and pulmonary involvement as independent risk factors for mortality. Subgroup analysis showed better dialysis-free survival among patients treated with rituximab than among those treated with cyclophosphamide. Conclusions: Chinese patients with AAV presented with severe renal–pulmonary disease and markedly elevated mortality. Older age, renal dysfunction, and pulmonary involvement were associated with an increased risk of mortality. Rituximab appeared to be associated with better dialysis-free survival than cyclophosphamide.
Oncocytic adrenocortical neoplasms (OANs) are rare. They are usually asymptomatic, benign and non-functional. Histologically, they display large polygonal cells with granular and eosinophilic cytoplasm. We report a case of left benign cortisol-secreting OAN with initial presentation of hypertension and hypokalaemia. A 46-year-old Asian female with a 10-year history of hypertension and hypokalemia was referred to our clinic for evaluation. She was taking potassium supplement and multiple anti-hypertensives. On physical examination, blood pressure was 141/69 mmHg, BMI 30.9 kg/m². She had facial plethora. There were no abdominal striae, easy bruising, or proximal myopathy. Her serum potassium level was 2.8 mmol/L (3.5-4.5), am cortisol 221 nmol/L (101-536), aldosterone/renin ratio 77 (< 550). Laboratory parameters are summarized in Table 1. A CT urogram was later done during an admission for pyelonephritis, revealing a 2.8 cm left adrenal nodule over lateral limb (Figure 1). The pre-contrast attenuation was 20 Hounsfield units (HU). There were no macroscopic fat or calcifications. Hormonal studies revealed normal 24-hour urine free metanephrines (Table 2). Her ACTH level was 1.7 pmol/L (<10). Both 1mg overnight and low dose dexamethasone suppression tests were non-suppressible, cortisol 126 and 93 nmol/L (<50) respectively. She was diagnosed with left adrenal Cushing’s. Associated metabolic complications included diabetes, hypertension and hyperlipidaemia. Laparoscopic left adrenalectomy resected a 2.5cm left adrenal adenoma. Macroscopically, it was a well-defined and roundish tumour with yellowish cut surface, weighing 52 grams. Microscopically, it was formed by clusters and nests of polygonal cells. Tumour cells exhibited abundant granular eosinophilic nuclei and cytoplasm. There were no coagulate tumour cell necrosis, mitotic figures or evidence of lymphovascular invasion. Immunostaining was positive for Neuron-specific enolase, synaptophysin, alpha-inhibin, SF-1 and S-100; negative for ACTH, EMA, Cam4, Melan-A, HMB45 and chromogranin. The morphology of tumour cells was suggestive of an OAN. There was no morphologic evidence of aggressive clinical behaviour according to the Modified Weiss system. Potassium supplement was weaned off after surgery. An interval CT scan 2 years later showed no recurrence. Cortisol-secreting OANs are uncommon, with less than 40 cases reported in the literature. They can present with hypertension and hypokalaemia. Diagnosis is made after surgical resection by histology, and its malignant potential can be classified by the Modified Weiss system. These tumours should be monitored with serial imaging as they may recur, although there are no guidelines on the surveillance schedule.Figure 1:CT Urogram showing a left 2.8cm adrenal nodule over lateral limb, pre-contrast 20 HU, no macroscopic fat or calcifications Table 1:Patient's blood parameters Table 2:Patient's 24-hour urine free metanephrines
