Institution
Kowloon Hospital
Healthcare•Hong Kong, China•
About: Kowloon Hospital is a healthcare organization based out in Hong Kong, China. It is known for research contribution in the topics: Mental health & Randomized controlled trial. The organization has 272 authors who have published 247 publications receiving 5837 citations.
Topics: Mental health, Randomized controlled trial, Psychological intervention, Health care, Population
Papers published on a yearly basis
Papers
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TL;DR: The slower control of viral load and immunodysregulation in severe cases mandate the search for more effective antiviral and immunomodulatory regimens to stop the excessive cytokine activation resulting in ARDS and death.
Abstract: Background Infections caused by the pandemic H1N1 2009 influenza virus range from mild upper respiratory tract syndromes to fatal diseases. However, studies comparing virological and immunological profile of different clinical severity are lacking. Methods We conducted a retrospective cohort study of 74 patients with pandemic H1N1 infection, including 23 patients who either developed acute respiratory distress syndrome (ARDS) or died (ARDS-death group), 14 patients with desaturation requiring oxygen supplementation and who survived without ARDS (survived-without-ARDS group), and 37 patients with mild disease without desaturation (mild-disease group). We compared their pattern of clinical disease, viral load, and immunological profile. Results Patients with severe disease were older, more likely to be obese or having underlying diseases, and had lower respiratory tract symptoms, especially dyspnea at presentation. The ARDS-death group had a slower decline in nasopharyngeal viral loads, had higher plasma levels of proinflammatory cytokines and chemokines, and were more likely to have bacterial coinfections (30.4%), myocarditis (21.7%), or viremia (13.0%) than patients in the survived-without-ARDS or the mild-disease groups. Reactive hemophagocytosis, thrombotic phenomena, lymphoid atrophy, diffuse alveolar damage, and multiorgan dysfunction similar to fatal avian influenza A H5N1 infection were found at postmortem examinations. Conclusions The slower control of viral load and immunodysregulation in severe cases mandate the search for more effective antiviral and immunomodulatory regimens to stop the excessive cytokine activation resulting in ARDS and death.
392 citations
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TL;DR: SARS is a new disease entity that carries significant morbidity and mortality and specific clinical and laboratory parameters predicting unfavourable outcomes have been identified.
Abstract: Background: Severe acute respiratory syndrome (SARS) was diagnosed in Hong Kong in over 1700 patients between March and early June 2003.
Methods: 115 patients diagnosed with SARS were admitted to Queen Elizabeth Hospital, a large regional hospital in Hong Kong, from March 2003, of whom 100 were either discharged or were dead at 31 May. The patients were prospectively studied after admission to assess their short term outcomes and the risk factors associated with adverse outcomes, defined as death or the need for mechanical ventilation
Results: At the time of writing 18 patients had died, with a crude mortality rate of 15.7% and a 21 day mortality of 10% (standard error 3%). Thirty nine patients (34%) were admitted to the intensive care unit, 30 of whom (26%) required mechanical ventilation. Multivariate analysis showed that age above 60 (hazards ratio (HR) 3.5, 95% CI 1.2 to 10.2; p=0.02), presence of diabetes mellitus or heart disease (HR 9.1, 95% CI 2.8 to 29.1; p<0.001), and the presence of other comorbid conditions (HR 5.2, 95% CI 1.4 to 19.7; p=0.01) were independently associated with mortality. However, only the presence of diabetes mellitus and/or cardiac disease (HR 7.3, 95% CI 3.1 to 17.4; p<0.001) was associated with adverse outcomes as a whole.
Conclusion: SARS is a new disease entity that carries significant morbidity and mortality. Specific clinical and laboratory parameters predicting unfavourable outcomes have been identified.
327 citations
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South London and Maudsley NHS Foundation Trust1, World Psychiatric Association2, University of Louisville3, Centre for Mental Health4, Queen Mary University of London5, Beth Israel Deaconess Medical Center6, Columbia University Medical Center7, University of Oxford8, Cayetano Heredia University9, Mayo Clinic10, The Chinese University of Hong Kong11, Wright State University12, Cardiff University13, Prince of Songkla University14, Pan American Health Organization15, Kowloon Hospital16, University of Antwerp17, Wellesley Institute18, University of Toronto19, University of Nottingham20, University of Western Australia21, University of New South Wales22, University of Western Sydney23, Beijing Forestry University24, Harvard University25, Ain Shams University26, Monash University27, Mental Health Services28, Royal College of Psychiatrists29, University of Pittsburgh30, University of Foggia31
TL;DR: The therapeutic relationship remains paramount, and psychiatrists will need to acquire the necessary communication skills and cultural awareness to work optimally as patient demographics change, and psychiatry faces major challenges.
268 citations
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243 citations
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TL;DR: Clinical follow-up of patients who recovered from SARS has demonstrated radiological, functional and psychological abnormalities of varying degrees, and preliminary evidence suggests that these lung function abnormalities will improve over time.
Abstract: Severe acute respiratory syndrome (SARS) is associated with considerable morbidity and mortality in the acute phase. Worldwide case fatality rate is 11% (range 7 to 27%) for the most severely affected regions. Several adverse prognostic factors have been identified, including advanced age, presence of comorbidity, higher lactose dehydrogenase levels and initial neutrophil count, but the impact of viral and other host factors on outcome is unknown. Published data on sequelae of SARS are limited. Clinical follow-up of patients who recovered from SARS has demonstrated radiological, functional and psychological abnormalities of varying degrees. In the early rehabilitation phase, many complained of limitations in physical function from general weakness and/or shortness of breath. In a small series of subjects who underwent CT scan of the chest, over half showed some patchy changes consistent with pulmonary fibrosis. Lung function testing at 6-8 weeks after hospital discharge showed mild or moderate restrictive pattern consistent with muscle weakness in 6-20% of subjects. Mild decrease in carbon monoxide diffusing capacity was detected in a minority of subjects. Preliminary evidence suggests that these lung function abnormalities will improve over time. Psychobehavioural problems of anxiety and/or depression were not uncommon in the early recovery phase, and improved over time in the majority of patients. Avascular necrosis of the hip has been reported as another complication. The long-term sequelae of SARS are still largely unknown. It is important to follow up these patients to detect and appropriately manage any persistent or emerging long-term sequelae in the physical, psychological and social domains.
201 citations
Authors
Showing all 274 results
Name | H-index | Papers | Citations |
---|---|---|---|
Shou-Dong Lee | 75 | 788 | 26066 |
Kenneth N.K. Fong | 20 | 100 | 1226 |
Roger M. K. Ng | 19 | 56 | 1139 |
Thomas Y.W. Mok | 11 | 13 | 845 |
Roger Man Kin Ng | 9 | 16 | 474 |
Xifeng Fei | 9 | 20 | 288 |
Clare Y. L. Chao | 8 | 9 | 416 |
Jizhen Li | 8 | 11 | 225 |
Hobby K Y Cheung | 7 | 8 | 122 |
Zhimin Wang | 7 | 13 | 134 |
Rhonda J. Scudds | 6 | 7 | 282 |
Kathy K.Y. Chow | 5 | 8 | 89 |
Dora Y.L. Chan | 5 | 5 | 120 |
Bobby Hin-Po Ng | 5 | 6 | 74 |
Daisy Saw | 5 | 8 | 315 |