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Introduction: Cycling is associated with a greater risk of traumatic brain injury (TBI) than other recreational activities. This study aimed to investigate the epidemiology of sports-related TBI in Hong Kong and to examine predictors for recreational cycling-induced intracranial haemorrhage., Methods: This retrospective multicentre study included patients diagnosed with sports-related TBI in public hospitals in Hong Kong from 2015 to 2019. Computed tomography scans were reviewed by an independent assessor. The primary endpoint was traumatic intracranial haemorrhage. The secondary endpoint was an unfavourable Glasgow Outcome Scale (GOS) score at discharge from hospital., Results: In total, 720 patients were hospitalised with sports-related TBI. The most common sport was cycling (59.2%). The crude incidence of cycling-related TBI was 1.1 per 100 000 population. Cyclists were more likely to exhibit intracranial haemorrhage and an unfavourable GOS score, compared with patients who had TBI because of other sports. Although 47% of cyclists had intracranial haemorrhage, only 15% wore a helmet. In multivariate analysis, significant predictors for intracranial haemorrhage were age ≥60 years, antiplatelet medication, moderate or severe TBI, and skull fracture. Among 426 cyclists, 375 (88%) had mild TBI, and helmet wearing was protective against intracranial haemorrhage, regardless of age, antiplatelet medication intake, and mechanism of injury. Of 426 cyclists, 31 (7.3%) had unfavourable outcomes on discharge from hospital., Conclusions: The incidence of sports-related TBI is low in Hong Kong. Although cycling-related head injuries carried greater risks of intracranial haemorrhage and unfavourable outcomes compared with other sports, most cyclists experienced good recovery. Helmet wearing among recreational cyclists with mild TBI was protective against intracranial haemorrhage and skull fracture., Competing Interests: All authors have disclosed no conflicts of interest.

Objective: To study the epidemiology, causes, and clinical course of Chinese herbal medicine-induced anticholinergic poisoning in Hong Kong., Design: Case series., Setting: Hong Kong., Patients: All case histories of Chinese herbal medicine-induced anticholinergic poisoning (with laboratory confirmation) recorded by the Hong Kong Poison Information Centre over a 93-month period were accessed for analysis., Results: During the relevant period, 22 clusters of Chinese herbal medicine-induced anticholinergic poisoning involving 32 patients were retrieved. The commonest clinical features were mydriasis (n=32, 100%) and confusion (n=24, 75%). No gastro-intestinal decontamination was performed. None of these patients underwent intubation, defibrillation, cardioversion, pacing, fluid resuscitation, inotropic support or dialysis. Of the 32 patients, 17 (53%) were treated with physostigmine because of confusion, three of whom had previously received intravenous benzodiazepines. No patient could be effectively treated with benzodiazepines alone. There was no mortality, and all the patients were discharged within 3 days. None of them re-attended the emergency department within 1 week of discharge. The commonest cause was the substitution of flos campsis (Campsis grandiflora) by the flower of the Datura species (7 clusters [32%] in 10 patients)., Conclusion: Mydriasis and confusion were the commonest clinical features of Chinese herbal medicine-induced anticholinergic poisoning in Hong Kong. Physostigmine was frequently used in the treatment; benzodiazepines appeared ineffective. The commonest cause was the substitution of flos campsis (Campsis grandiflora) by the flower of the Datura species.

Objectives: To review the characteristics of the consultation about the management of mercury exposure and identify the controversial issues on the clinical management of individuals with a history of mercury exposure., Design: Descriptive case series., Setting: Hong Kong Poison Information Centre, Hong Kong., Participants: Persons consulting the Hong Kong Poison Information Centre about individuals with possible or definitive mercury exposure., Main Outcome Measures: Characteristics of the consultations, including: the demographics of affected individuals, source and reason for the consultation, tissue mercury levels, the source of mercury exposure, specific intervention if any, and clinical outcomes., Results: Forty-one consultations were analysed. Most consultations were from the public sector. Reasons of the consultation were very variable. Individuals with abnormal tissue mercury levels were uncommon. There was only one case of acute mercury poisoning. The majority of identified individuals were not subjected to specific interventions. Chelation therapy was given to three patients, but in one of them it was considered to be contra-indicated., Conclusion: The management of mercury exposure is highly variable. Recommendations were made on the approach to an individual with potential mercury exposure or poisoning.

Objective: To investigate the efficacy and safety of lidocaine nasal spray before nasogastric tube insertion in an emergency department., Design: Double-blind, randomised controlled study., Setting: Emergency department of a major regional hospital in Hong Kong., Patients: A total of 206 adult patients, for whom nasogastric tube insertion was indicated., Main Outcome Measures: Primary outcome was discomfort gauged on a visual analogue scale, and Likert scale addressing difficulty of nasogastric tube insertion., Results: Compared with placebo spray use, lidocaine spray use was associated with less patient discomfort, and less difficulty in nasogastric tube insertion, both difference being statistically significant., Conclusion: Intranasal lidocaine spray before nasogastric tube insertion was safe and effective in reducing patient discomfort related to the procedure.

Objective: To investigate the prevalence and characteristics of abusive drug exposure among non-fatal motor vehicle driver casualties presenting to a designated trauma centre in Hong Kong., Design: Cross-sectional study., Setting: Designated trauma centre/regional accident and emergency department in Hong Kong., Subjects: Non-fatal motor vehicle driver casualties who presented to the trauma centre from 1 January 2007 to 31 December 2007., Main Outcome Measures: Screening of abusive drug exposure using commercial bedside urine immunoassay kits., Results: Drug screening was performed in 395 injured drivers, 10% of whom tested positive for the drugs of interest. Ketamine was the most commonly detected abusive substance (found in 45% of the subjects). A significantly higher proportion of young drivers (aged <25 years) screened positive (odds ratio=2.3; 95% confidence interval, 1.0-5.2; P=0.04), with the rate being 21%. The presence of these drugs in urine was related to the time of occurrence of the crash; those occurring between midnight and dawn revealed a trend towards a higher proportion of casualties testing drug-positive (odds ratio=2.2; 95% confidence interval, 0.9-5.3; P=0.07). There were no significant differences in the frequency of persons testing positive for the screened drugs with respect to gender, class of motor vehicle driven, or the day of the week on which the crash occurred., Conclusions: The prevalence of drugged driving among non-fatal casualties in our series of Hong Kong drivers was 10%. The frequency of such drivers testing positive for drugs was significantly higher in persons aged less than 25 years. These findings indicate a need to amend existing laws and implement on-site drug screening for suspected drugged drivers.

Objectives: To study the acute clinical presentations of ketamine abusers in Hong Kong., Design: Retrospective chart review., Setting: Fifteen accident and emergency departments in Hong Kong., Patients: Consultations associated with recent ketamine use either confirmed by history or urine test were searched for from the database of the Hospital Authority Hong Kong Poison Information Centre from 1 July 2005 to 30 June 2008. Their medical records and investigation results were analysed., Results: A total of 233 records of ketamine use were included for review. Patient ages ranged from 13 to 60, with a median of 22 years, and the male-to-female ratio being 2.1:1. The most common symptoms of ketamine misuse were impaired consciousness (45%), abdominal pain (21%), lower urinary tract symptoms (12%), and dizziness (12%). The most common abnormal physical findings were high blood pressure (40%), followed by tachycardia (39%), abdominal tenderness (18%), and white powder in the nostrils (17%)., Conclusion: Most ketamine abusers presented acutely with transient central nervous system depression, abdominal pain, or lower urinary tract symptoms. Clinicians should be alert to the typical age-group, signs and symptoms of such abusers presenting in an acute medical setting.

Chinese medicine plays an important role in providing medical care for people in countries with large Chinese communities, including Hong Kong. The aconite herb is one of the commonly-prescribed ingredients for various clinical problems. However, due to its narrow therapeutic index, toxicities are not uncommonly encountered, including life-threatening cardiac arrhythmias like ventricular arrhythmias. We report a 57-year-old woman with reversible intraventricular conduction defect attributed to the use of processed Fuzi.

Emergency department (ED) doctors often intubate patients, however no data was available in Hong Kong on this aspect. Our study was to assess the competency of ED doctors in intubating critical patients in a typical ED in Hong Kong. Between March and August 1999, in an urban hospital with an emergency physician training programme, all doctors, after performing any tracheal intubation, were required to fill in a pro forma designed for the study. Data collected included the training status of the intubator, the number of intubation attempts, intubation methods and complications. A total of 214 ED patients required advanced airway management including 87 (41%) patients in cardiopulmonary arrest; 207 (97%) of them were successfully intubated by ED doctors (76 by specialists, 61 by trainees, 70 by residents) and 90% were successful in the first attempt. The remaining seven patients' airway control was eventually managed by anaesthetists who successfully intubated six patients and performed cricothyrotomy for one patient. Rapid sequence intubation was performed in 70 (33%) patients by ED doctors and specialists. There were 30 (14%) patients successfully intubated using sedative agents alone. Twenty-two (10%) patients were found to have a total of 32 complications including 13 patients with oesophageal intubation, seven with soft tissue damage, four with desaturation, three with bronchial intubation, three with hypotension, one with dental trauma, one with dysrhythmia. The majority of ED intubations for critically ill patients were performed by ED doctors with high success rate and few major complications.

The emergency management of poisoning is important in reducing the risk of mortality and morbidity in poisoned patients. This article reviews the Hong Kong system of prehospital and emergency care of poisoning, with reference to recent advances in this field. Administering activated charcoal is recommended for the gastro-intestinal decontamination of most poisons, unless doing so is contra-indicated. Gastric lavage should be considered only in life-threatening cases of poisoning that present within the first hour. Newer antidotes that are available in Hong Kong accident and emergency departments include hydroxocobalamin, stonefish and snake antevenenes, digoxin-specific antibodies, esmolol hydrochloride, and octreotide. The 'golden hour' concept of gastro-intestinal decontamination is advocated and ways to ensure that decontamination is performed within the 'golden hour' are suggested.

Because acute myocardial infarction causes significant morbidity and mortality, a correct diagnosis in the accident and emergency department is important so that early treatment including thrombolytic therapy can be given. The aim of this study was to evaluate the reasons for missed diagnosis of acute myocardial infarction in the accident and emergency department, and the implications. All patients admitted to our coronary care unit in 1995 with the confirmed diagnosis of acute myocardial infarction were analysed retrospectively. The demographic data, clinical profiles, diagnosis made at the accident and emergency department and feasibility of thrombolytic therapy were assessed. Analysis of the electrocardiography by the accident and emergency department doctor and the coronary care unit doctor were also compared. Forty-three out of 159 patients (27.0%) with acute myocardial infarction were missed in the accident and emergency department. The diagnoses made were mostly angina or chest pain. Absence of chest pain (25.6%) [vs. 10.2% in correct diagnosis group, p < 0.05] and lack of ST elevation in electrocardiograph (62.8%) [vs. 18.1% in correct diagnosis group, p < 0.0001] were the main predisposing factors for missed diagnosis. Because of missed diagnosis, only 25.6% (vs. 67.2% in correct diagnosis group, p < 0.01) of patients were admitted to the coronary care unit. About one-third (34.9%) of missed diagnosis patients (vs. 6.0% in correct diagnosis, p < 0.01) did not receive thrombolytic therapy because of delayed diagnosis. In the missed diagnosis group, 34.8% of them might be avoidable, if electrocardiogram interpretation was more accurate. More education and training of the involved medical personnel might improve the overall situation.

The c-kit proto-oncogene encodes a transmembrane tyrosine kinase receptor. It is expressed by the primitive CD34 positive haemopoietic stem cells and interacts with the Kit ligand for signal transduction. It was reported to be expressed in over 80% of acute myelogenous leukaemia (AML) patients in North America and Japan. We analyzed 20 AML patients for c-kit expression using either Northern blot analysis or flow cytometry with the YB5.B8 anti-c-kit antibodies. Only 6 out of 20 AML patients expressed the c-kit mRNA or protein product. However, a previously unreported abnormal sized 1.7-1.9 kb transcript was detected in the blast cells of 1 AML patient, 1 acute mixed lineage leukaemia patient and 1 chronic myelogenous leukaemia (CML) patient in myeloblastic transformation. Our data suggested that in most Hong Kong Chinese AML patients, leukaemia transformation may have occurred at a c-kit negative stage. Alternatively, the abnormal sized c-kit transcript that was detected in some Chinese myeloid leukaemia patients may represent an aberrant c-kit receptor that plays an important role in leukaemogenesis.

Blast cells from a majority of acute myelogenous leukaemia (AML) patients express c-kit mRNA. However, c-kit expression has not been observed in patients with acute lymphoblastic leukaemia (ALL) and lymphoproliferative disease. We report here the detection of an abnormal sized c-kit mRNA in two Hong Kong Chinese patients with pre-B ALL and common ALL.

Seven Vietnamese boat-people in Tai A Chau Detention Centre in Hong Kong caught, barbecued and ate a puffer fish. After 2 h, two of them developed severe symptoms of numbness and vomiting, while the remaining five subjects developed symptoms about 18 h later. They were all transferred to Queen Elizabeth Hospital. One patient died, and the others made an uneventful recovery.