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COVID-19 outbreaks in residential care homes in Hong Kong and effectiveness of vaccine against severe outcomes

Infectious Medicine 2023年第1期2卷 1-10页

作者： Mei Hung Joanna Leung Kin Hang Kung Ian Siu-kiu Yau Yan Yee Fung Kirran Nazesh Mohammad cheong chi andrew lau Ka Wing Albert Au Shuk Kwan Chuang Centre for Health Protection Department of HealthKowloonHong KongChina

Background:COVID-19 outbreaks in residential care homes for the elderly(RCHEs)and for persons with disability(RCHDs)have caused significant morbidity and mortality during 5th epidemic in Hong Kong.This article reviewed COVID-19 outbreaks situation and estimated the effectiveness of receiving at least two-dose of COVID-19 vaccine in preventing severe outcomes.Methods:To estimate attack rates and vaccination coverage,documentation on COVID-19 infection and their vaccination records of residential care homes(RCH)residents reported between December 31,2021 and May 31,2022 were reviewed,and infected cases were follow-up for 4 weeks for severe outcomes or death.Correlation between vaccination coverage against attack rate by types of homes was examined.Infected RCH residents with available information were included in the analysis of vaccine effectiveness against severe outcomes and death.Results:COVID-19 vaccination coverage was low in RCHDs(median 0.46,IQR:0.24-0.76)and very low in RCHEs(median 0.08,IQR:0.00-0.19).Higher attack rates were recorded among RCHE residents(median 0.84,IQR:0.64-0.93)and higher case fatality rate(CFR:28.1%)than in RCHDs(median 0.58,IQR:0.31-0.84;CFR:3.9%).The attack rate decreased when vaccination coverage increased for both RCHEs(ρ=−0.131,p<0.001)and RCHDs(ρ=−0.333,p<0.001).Comparing with infected residents who were unvaccinated/vaccinated with one-dose,receiving at least two-dose was estimated to be effective in reducing severe outcomes in 31%and 36%of infected RCHE and RCHD residents respectively;with greater reduction in mortality among RCHD than RCHE residents(54%and 38%,respectively).Vaccine effectiveness of two-dose of BNT162b2 against severe outcomes and death are higher than that of CoronaVac.Conclusions:Increasing COVID-19 vaccination could have significant impact on reducing the risk of COVID-19 outbreaks in RCHs.At least two-dose of COVID-19 vaccine is still effective in reducing severe outcomes and death among infected residents in RCHs during Omicron epidemic.

关键词： COVID-19 Attack rates Long-term care facilities Vaccine effectiveness Severe outcomes Hong Kong china

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Randomised controlled trial comparing modified Sano's and narrow band imaging international colorectal endoscopic classifications for colorectal lesions

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World Journal of Gastrointestinal Endoscopy 2018年第9期10卷 210-218页

作者： Leonardo Zorrón Cheng Tao Pu Kuan Loong cheong Doreen Siew ching Koay Sze Pheh Yeap Amanda Ovenden Mahima Raju andrew Ruszkiewicz Philip W chiu James Y lau Rajvinder Singh Department of Gastroenterology Lyell McEwin Hospital Medical School University of Adelaide Department of Pathology Lyell McEwin Hospital Department of Surgery the Chinese University of Hong Kong

AIM To assess the utility of modified Sano′s(MS) vs thenarrow band imaging international colorectal endoscopic(NICE) classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial.Based on the MS or the NICE classifications,patients were randomised for real-time endoscopic diagnosis.This was followed by biopsies,endoscopic or surgical resection.The endoscopic diagnosis was then compared to the final(blinded) histopathology.The primary endpoint was the sensitivity(Sn),specificity(Sp),positive predictive value(PPV) and negative predictive value(NPV) of differentiating neoplastic and non-neoplastic polyps(MSⅡ/Ⅱo/Ⅲa/Ⅲb vs I or NICE 1 vs 2/3).The secondary endpoints were "endoscopic resectability"(MSⅡ/Ⅱo/Ⅲa vs Ⅰ/Ⅲb or NICE 2 vs 1/3),NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.RESULTS A total of 348 patients were evaluated.The Sn,Sp,PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were,98.9%,85.7%,98.2% and 90.9% for MS;and 99.1%,57.7%,95.4% and 88.2% for NICE,respectively.The area under the receiver operating characteristic curve(AUC) for MS was 0.92(95%CI:0.86-0.98);and AUC for NICE was 0.78(95%CI:0.69,0.88).The Sn,Sp,PPV and NPV in predicting "endoscopic resectability" were 98.9%,86.1%,97.8% and 92.5% for MS;and 98.6%,66.7%,94.7% and 88.9% for NICE,respectively.The AUC for MS was 0.92(95%CI:0.87-0.98);and the AUC for NICE was 0.83(95%CI:0.75-0.90).The AUC values were statistically different for both comparisons(P = 0.0165 and P = 0.0420,respectively).The accuracy for diagnosis of sessile serrated adenoma/polyp(SSA/P) with high confidence utilizing MS classification was 93.2%.The differentiation of SSA/P from other lesions achieved Sp,Sn,PPV and NPV of 87.2%,91.5%,89.6% and 98.6%,respectively.The NPV for predicting adenomas in diminutive rectosigmoid polyps(n = 150) was 96.6% and 95% with MS and NICE respectively.The calculated accuracy of post-polypectomy surveill

关键词： Colorectal polyps Colorectal adenomas Colorectal neoplasm Colorectal lesions Randomised controlled trial Colonoscopy Magnifying colonoscopy Endoscopic imaging

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全植入式助听器治疗中重度耳聋

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中华耳鼻咽喉头颈外科杂志 2009年第10期44卷 843-847页

作者：唐志辉高晗余家燕王家昌宋家强尹怀信香港中文大学医学院耳鼻咽喉头颈外科学系

目的探讨全植入式助听器（Carina）治疗中重度和重度耳聋的安全性和效果。方法分析随访12个月以上的三例接受全植入式助听器手术的中重度至重度耳聋患者术后康复的效果。比较术前术后纯音测听和言语测听的差异，观察植入体日常使用情况... 详细信息

目的探讨全植入式助听器（Carina）治疗中重度和重度耳聋的安全性和效果。方法分析随访12个月以上的三例接受全植入式助听器手术的中重度至重度耳聋患者术后康复的效果。比较术前术后纯音测听和言语测听的差异，观察植入体日常使用情况及与传统助听器效果的比较。结果手术顺利，无并发症。术后手术侧无助听听阈（听力级，下同）平均升高8．3dB，四个频率（0．5、1、2、4kHz）纯音听阈功能性增益平均为35．4dB，言语听阈平均降低22．5dB，患者主观满意度评分明显高于传统助听器。结论全植入式助听器是治疗中重度和重度耳聋患者的有效方法，其远期疗效需要进一步观察。

关键词：听觉丧失助听器

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