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Kam Lun Ellis Hon,1 Ting Fan Leung,1 Alexander KC Leung21Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; 2Department of Pediatrics, The University of Calgary, Calgary, AB, CanadaAbstract: Asthma is a common childhood atopic disease associated with chronicity and impaired quality of life. As there is no cure for this disease, treatment relies on avoidance of triggers such as food and aeroallergens, the use of inhaled bronchodilators/corticosteroids and antiallergic or immunomodulating therapies. Inhaled corticosteroids (ICSs) and bronchodilators have been the mainstay. However, in Asia, myths and fallacies regarding Western medicine and corticosteroids are prevalent and lead to nonadherence to treatment. Also, use of traditional and proprietary herbal medicines is popular. In the past decades, a novel class of nonsteroidal immunomodulating montelukasts has become available. This article reviews the evidence for the effectiveness and clinical efficacy of these medications. A number of randomized and controlled trials have been performed over the years. The majority of studies confirm the usefulness of montelukast as monotherapy and add-on therapy to ICS in mild to moderate childhood asthma across all age groups. ICSs are generally superior to montelukasts for asthma management. However, montelukast has a place in the treatment of young children with viral-triggered wheezing diseases, exercise-induced asthma, and in children whose parents are steroid-phobic and find ICS unacceptable.Keywords: cysteinyl leukotriene receptor antagonist, inhaled corticosteroid, randomized control trial, meta analysis

Due to increasing worldwide water pollution, fish might be a source of excessive zinc, mercury, arsenic or manganese intake. The aim of this study was to evaluate if fish atopy/sensitization and fish consumption behavior are associated with eczema severity and blood levels of the 4 heavy metals.One-hundred and nineteen patients with eczema and 43 patients with miscellaneous non-eczema skin diseases were studied. There were no differences in average weekly fish consumption and blood levels of the 4 heavy metals between eczema and non-eczema groups. Blood levels of these metals were generally within the upper limits of local reference ranges in all these patients. In eczema patients, freshwater fish consumption behavior in days-per-week was correlated with blood arsenic and mercury levels (rho=0.17, p<0.01 for both metals), but not with zinc or manganese. Levels of arsenic and mercury were also correlated with days of seawater fish consumption per week (arsenic: 0.38, mercury: 0.24, p <0.05).Fish sensitization was present in 25% of patients with eczema. Nevertheless, there was no difference in terms of fish consumption behavior, eczema severity, quality of life, and heavy metal levels between eczema patients with or without fish sensitization. We conclude that without exceeding local normal reference ranges, blood arsenic and mercury levels correlated with fish consumption behavior. There is no evidence to suggest that fish sensitization is associated with more severe eczema (bad for eczema), or that patients have milder eczema with more days of fish consumption (good for eczema). [ABSTRACT FROM AUTHOR]

Objective: To review the pattern of food-associated pediatric intensive care unit (PICU) admissions.Methods: A retrospective chart review was conducted to analyse the pattern of food-associated PICU admissions at a teaching hospital between January 2004 and May 2007.Results: Ten cases (7 boys and 3 girls, aged 9 month to 11.7 year) were identified. One girl developed progressive generalized urticarial rash and anaphylactic shock following consumption of bird nest drink. A boy presented with the classic triads of acute onset altered mental state, respiratory depression and small pupils following consumption of a bottle of presumed "green tea", which was subsequently found to contain methadone. In the remaining 8 cases, dried mango, peanut, peanut-shell, fishmeat ball, pork chop, bread and bone were the culprits, impacting in the airway or oesophagus. All but one patient had short ICU stay (Conclusion: Presentations were generally acute, dramatic and unmistaken. The majority of patients made prompt and uneventful recovery and had short PICU stay. [ABSTRACT FROM AUTHOR]

In this study, we examined Chinese nursing students' attitudes toward and use of traditional Chinese medicine (TCM). Survey questionnaires were distributed to 439 nursing students, 263 of whom (60%) returned them. Of the respondents, 92% had used TCM, while 48% had used TCM at least once during the previous year. Forty-five percent of respondents reported positive attitudes toward TCM use, 52% had neutral attitudes, and only 3% reported negative attitudes. The majority of respondents (76%) reported no change in their attitude toward TCM after studying nursing. Mean scores related to the adequacy of the current curriculum in TCM training and the state of respondents' TCM knowledge were generally low. Of the respondents who had used TCM during the past year, the most common use was for upper respiratory tract infection. The most common type of TCM used by respondents was herbal tea or soup. Final-year nursing students were more likely to have used TCM during the previous year, report they would like more courses on TCM, and consult Western medicine physicians before using TCM; they were also less likely to develop more negative attitudes toward TCM after studying nursing. [ABSTRACT FROM AUTHOR]

Objective: The factors accounting for the low 'ever breastfeeding' rate in Hong Kong remain unclear. The objective of this survey was to study the intention and planned duration of breastfeeding in Chinese women in Hong Kong, and to investigate the sociodemographic and atopic factors affecting the intention to breastfeed.Methods: All Chinese mothers who were Hong Kong residents and who delivered their babies in a University teaching hospital were given a self administered and anonymous Chinese questionnaire within 1 day postpartum. The questionnaire included items on sociodemographic data, the presence of allergic diseases in the families, and the intention and planned duration of breastfeeding for their newborn babies.Results: A total of 1374 eligible questionnaires were collected. About one-third of mothers were born outside Hong Kong and the majority (78%) of them were aged between 25 and 40 years. Logistic regression revealed that only socioeconomic factors, namely older maternal age (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.14-3.89), parity (OR 3.08, 95% CI 1.02-9.27) and higher educational background (OR 2.87, 95% CI 1.92-4.27), significantly affected the intention to breastfeed. In addition, mothers born outside Hong Kong and those with first babies, had a longer intended duration of breastfeeding (P-values < 0.001 and 0.033, respectively). A family history of atopic disorders in parents or siblings did not influence the breastfeeding intention of these Chinese mothers.Conclusion: Several sociodemographic factors, rather than a history of atopic disorders, of Chinese mothers in Hong Kong affected their intention to breastfeed and the planned duration of breastfeeding. [ABSTRACT FROM AUTHOR]

Objective: Severe chronic neutropenia (SCN) is a rare and heterogeneous disorder in children. The epidemiology, clinical features and outcomes of SCN in Chinese children were reviewed.Methodology: A retrospective analysis of case records was undertaken for 18 children with SCN managed during a 12-year period in a university teaching hospital in Hong Kong.Results: The median (range) age of the patients at initial presentation was 6.5 months (4 days-19 months). The initial and lowest median absolute neutrophil counts (ANC) were 0.29 x 109 /L and 0.06 x 109 /L, respectively. Patients with congenital SCN had significantly fewer neutrophils in peripheral blood at diagnosis. Only five subjects received granulocyte colony-stimulating factor (G-CSF) treatment. All children were free from serious infection on follow up for 51 months. Only one child suffered from long-term infection-related morbidity. One patient with chronic neutropenia was subsequently shown to have common variable immunodeficiency.Conclusions: Most children with SCN in our series had favourable clinical outcomes. Our results support the recommendation that G-CSF should be used only in those with recurrent or severe infections. [ABSTRACT FROM AUTHOR]

The clinical, laboratory, and radiological features at presentation of 16 children (<12 years) with severe acute respiratory syndrome (SARS) and pneumonia were compared with 32 age matched patients with community acquired pneumonia for determination of predictive factors that could allow early differentiation of the two conditions. A definitive contact history was the most important predictor for SARS. Raised serum lactate dehydrogenase concentration in the presence of low neutrophil count and serum creatine phosphokinase level at presentation also indicated an increased likelihood of SARS-coronavirus infection in young children. [ABSTRACT FROM AUTHOR]

The Severe Acute Respiratory Syndrome (SARS) is a newly discovered infectious disease caused by a novel coronavirus, which can readily spread in the healthcare setting. A recent community outbreak in Hong Kong infected a significant number of pregnant women who subsequently required emergency caesarean section for deteriorating maternal condition and respiratory failure. As no neonatal clinician has any experience in looking after these high risk infants, stringent infection control measures for prevention of cross infection between patients and staff are important to safeguard the wellbeing of the work force and to avoid nosocomial spread of SARS within the neonatal unit. This article describes the infection control and patient triage policy of the neonatal unit at the Prince of Wales Hospital, Hong Kong. We hope this information is useful in helping other units to formulate their own infection control plans according to their own unit configuration and clinical needs. [ABSTRACT FROM AUTHOR]

Asthma is one of the most common chronic diseases worldwide. Western medications such as glucocorticoids are effective therapeutic agents but may be associated with side effects. Traditional Chinese medicine (TCM) has been used for treating allergic diseases with observable clinical benefits. The present study investigated whether a novel TCM concoction, the wheeze-relief formula (WRF), possesses in vitro anti-allergic activities. We measured the effects of WRF on the release of eosinophil cationic protein (ECP) by human eosinophils using fluorescence enzyme immunoassay, expression of chemokine receptor CCR3 and adhesion molecule CD49d on eosinophils using immunophenotyping, cytokine induction from peripheral blood mononuclear cells (PBMC) using cytometric bead array (CBA), and the gene expression of cytokines and cytokine receptors using cDNA expression array. Results demonstrated that WRF dose-dependently and significantly: (1) suppressed ECP release from eosinophils activated with granulocyte macrophage-colony stimulating factor (GM-CSF) and platelet activating factor (PAF); (2) inhibited the expression of CCR3 and CD49d on PAF-activated eosinophils; and (3) attenuated the production of tumor necrosis factor alpha and gene expression of IL-2 receptor chain alpha (CD25) on house dust mite (Der p 1) activated PBMC. The above results suggest a possible anti-allergic role of WRF and provide a biochemical basis for further clinical trial on human subjects. [ABSTRACT FROM AUTHOR]