This study evaluated the resuscitation outcome of adult patients presenting with non-traumatic out-of-hospital cardiac arrest (OHCA) to a regional hospital in Hong Kong. Out of 876 patients of non-traumatic OHCA, 12.7% survived to hospital admission. Only 0.5% of the 876 patients survived to hospital discharge and at one year after discharge. The number needed to treat (NNT) for prehospital asystolic cardiac arrest to have one survival to discharge was 795.
To compare Macintosh laryngoscope with video-optical intubation stylet on rates and time durations of successful tracheal intubation in normal and simulated difficult airway. Design: Crossover experimental study. Setting: Intubation training laboratory. Methods: A group of novices (58 medical students) attempted intubation on manikin under normal and simulated difficult airway (grade 3 larygnoscopic view) settings using both Macintosh laryngoscope and video-optical intubation stylet. The success rate, duration to intubate and occurrence of complications (oesophageal intubation and incisor breakage) when using the two different devices were measured and compared. The time results were analysed by paired t-test and categorical results by chi square test or Fisher's exact test. Results: The success rate to intubate difficult airway using videooptical intubation stylet (0.92) was significantly higher than using Macintosh laryngoscope (0.59) (p=0.002). The mean time taken to intubate difficult airway using video-optical intubation stylet was significantly shorter than using Macintosh laryngoscope by 10.90 seconds (p=0.004). Oesophageal intubation rate was significantly higher when using Macintosh laryngoscope to intubate difficult airway compared to video-optical intubation stylet (p=0.002). There was no significant difference on the rate of incisor breakage between the two instruments. Conclusions: Novice can learn to use both Macintosh laryngoscope and videooptical intubation stylet to intubate successfully after a short training. Video-optical intubation stylet is an effective "Plan B" instrument because it shortens the duration and increases the rate of successful intubation in difficult airway situations.
Acute gastroenteritis represents a frequent cause of morbidity among children in Hong Kong. Despite the large number of potential etiologic agents, principles of management of gastroenteritis are uniform and aim to prevent the two major complications-dehydration and malnutrition. A review of the literature was performed. Selected articles were appraised, graded, and synthesised qualitatively. Statements on recommendations were generated. Current evidence emphasises the use of oral rehydration and the early reintroduction of age-appropriate foods. Apart from these two, important aspects of management reviewed included laboratory investigations, role of anti-diarrhoeal agents, and use of anti-microbial agents. Criteria for admission of high-risk children are also addressed.
IntroductionDiabetic nephropathy is the leading cause of end-stage renal disease in patients undergoing dialysis. Most studies evaluate the association between pre-existing diabetes mellitus, but very few focus on newonset diabetes mellitus after dialysis. Chronic dialysis patients are often older and have multiple comorbidities, including cardiovascular diseases and pancreatic disorder. In addition, these patients have been found to be in a state of chronic inflammation. These characteristics have been associated with the development of insulin resistance and diabetes. Herein, we critically review the epidemiology, risk factors and mortality of new-onset diabetes mellitus after dialysis.
ConclusionThe dialysis population has a higher incidence of new-onset diabetes mellitus and a greater risk of mortality than the general population. In addition, the post-transplant incidence of diabetes mellitus, which always occurs the first year after transplant, is much higher than the pre-transplant incidence. However, dialysis modality does not appear to be associated with new-onset diabetes mellitus after dialysis and post-transplant. The independent predictors of newonset diabetes mellitus are old age, cardiovascular comorbidity and dyslipidemia. Other possible contributing factors are inflammation and use of some commonly prescribed drugs for cardiovascular disease, such as statin. Physicians may need to pay more attention to the possibility of new-onset diabetes mellitus when treating high-risk patients undergoing dialysis.
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