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Chronic kidney disease (CKD) imposes a significant burden on healthcare systems worldwide, and diabetes is a major risk factor for CKD. There is currently no consensus in Hong Kong regarding the prioritisation of early identification and intervention for CKD. A comprehensive and Hong Kong-specific diabetes and CKD treatment guideline is also lacking. A multidisciplinary group of experts discussed issues surrounding the current management of CKD and reviewed evidence in the context of local experience to support recommendations. The experts used a modified Delphi approach to finalise recommendations. Consensus was regarded as ≥75% acceptability among all expert panel members. The panel members finalised 14 CKD-focused consensus statements addressing disease definition, screening, disease monitoring, lifestyle management, and treatment strategies. The recommendations provided are relevant to the Hong Kong healthcare setting and can be used as a guide by physicians across various specialties to facilitate the appropriate management of CKD., Competing Interests: RCW Ma has received research funding from AstraZeneca, Bayer, Merck Sharp & Dohme, Novo Nordisk, Pfizer, Roche Diagnostics, and Tricida Inc for carrying out clinical trials or studies, and from AstraZeneca, Bayer, Boehringer Ingelheim, and Merck for speaker honoraria or consultancy on advisory boards. All proceeds have been donated to The Chinese University of Hong Kong to support diabetes research. CC Szeto receives research support from AstraZeneca, Boehringer Ingelheim, and Otsuka Pharmaceutical. KCB Tan has participated in advisory boards and speakers bureaus for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, and Sanofi. MCS Wong is an advisory committee member for Pfizer; an external expert for GlaxoSmithKline Limited, a member of the advisory board of AstraZeneca, and an honorary advisor of GenieBiome Limited. He was paid consultancy fees for providing research advice and delivering talks. Also, as an editor of the journal, he was not involved in the peer review process. Other authors have disclosed no conflicts of interest.

Introduction: Allergic sensitisation to fungi such as Aspergillus are associated to poor clinical outcomes in asthma, bronchiectasis and cystic fibrosis; however, clinical relevance in COPD remains unclear., Methods: Patients with stable COPD (n=446) and nondiseased controls (n=51) were prospectively recruited across three countries (Singapore, Malaysia and Hong Kong) and screened against a comprehensive allergen panel including house dust mites, pollens, cockroach and fungi. For the first time, using a metagenomics approach, we assessed outdoor and indoor environmental allergen exposure in COPD. We identified key fungi in outdoor air and developed specific-IgE assays against the top culturable fungi, linking sensitisation responses to COPD outcomes. Indoor air and surface allergens were prospectively evaluated by metagenomics in the homes of 11 COPD patients and linked to clinical outcome., Results: High frequencies of sensitisation to a broad range of allergens occur in COPD. Fungal sensitisation associates with frequent exacerbations, and unsupervised clustering reveals a "highly sensitised fungal predominant" subgroup demonstrating significant symptomatology, frequent exacerbations and poor lung function. Outdoor and indoor environments serve as important reservoirs of fungal allergen exposure in COPD and promote a sensitisation response to outdoor air fungi. Indoor (home) environments with high fungal allergens associate with greater COPD symptoms and poorer lung function, illustrating the importance of environmental exposures on clinical outcomes in COPD., Conclusion: Fungal sensitisation is prevalent in COPD and associates with frequent exacerbations representing a potential treatable trait. Outdoor and indoor (home) environments represent a key source of fungal allergen exposure, amenable to intervention, in "sensitised" COPD., Competing Interests: Conflict of interest: P.Y. Tiew has nothing to disclose. Conflict of interest: F.W.S. Ko has nothing to disclose. Conflict of interest: S.L. Pang has nothing to disclose. Conflict of interest: S.A. Matta has nothing to disclose. Conflict of interest: Y.Y. Sio has nothing to disclose. Conflict of interest: M.E. Poh has nothing to disclose. Conflict of interest: K.J.X. Lau has nothing to disclose. Conflict of interest: M. Mac Aogain has nothing to disclose. Conflict of interest: T.K. Jaggi has nothing to disclose. Conflict of interest: F.X. Ivan has nothing to disclose. Conflict of interest: N.E. Gaultier has nothing to disclose. Conflict of interest: A. Uchida has nothing to disclose. Conflict of interest: D.I. Drautz-Moses has nothing to disclose. Conflict of interest: H. Xu has nothing to disclose. Conflict of interest: M.S. Koh has nothing to disclose. Conflict of interest: D.S.C. Hui has nothing to disclose. Conflict of interest: A. Tee has nothing to disclose. Conflict of interest: J.A. Abisheganaden has nothing to disclose. Conflict of interest: S.C. Schuster has nothing to disclose. Conflict of interest: F.T. Chew has nothing to disclose. Conflict of interest: S.H. Chotirmall has nothing to disclose., (Copyright ©ERS 2020.)

Background: Many doctors experience psychological ill health. Interns are known to be particularly vulnerable., Aim: To examine the level of depression, anxiety and stress in interns in Hong Kong, as well as the causes and how they cope., Methods: A questionnaire was designed based on the themes identified in three focus groups of medical graduates of Year 2004 of the University of Hong Kong. The 21-item Depression, Anxiety and Stress Scale (DASS 21) was also administered. All 155 graduates of the same year were invited to participate with a response rate of 63%., Results: Percentages of respondents with abnormal levels of depression, anxiety and stress were 35.8%, 35.4% and 29.2%, respectively. Frequent calls during night shift, long working hours and heavy workload constituted the most significant stressors. Factor analysis of the stressors showed that seven factors could explain 68% of the total variance: multidisciplinary team working issues, clinical difficulties, job seeking and employment, workload issues, ethical and interpersonal issues, adjustment to job rotation and performance appraisal. Holidays, peers and sleep offered the most significant relief., Conclusion: Interns experience considerable depression, anxiety and stress. The source of stress is multi-faceted, but workload is the most significant stressor. Peer support groups may relief stress.

Background: Diagnostic stability is one measure of predictive validity for psychiatric syndromes. It is an under-studied area in functional psychosis despite its clinical and research implications. We aimed at evaluating the stability of ICD-10 diagnoses in a sample of young people with first-episode psychosis., Method: One hundred and sixty-six Hong Kong Chinese enrolled in a regional first-episode psychosis treatment program were studied. Subjects' baseline and final 5-year consensus diagnoses were established via systematic medical records' review to determine diagnostic stability and to identify predictors of diagnostic shift towards schizophrenia spectrum., Results: The overall diagnostic consistency was 80.7%. Bipolar affective disorder and schizophrenia were the most stable diagnostic categories over 5 years with prospective consistency of 100% and 95.8% respectively. The least stable baseline diagnoses were unspecified non-organic psychosis, acute and transient psychotic disorders and delusional disorder. Around one-fifth (19.3%) of subjects had diagnostic revision in 5 years. The predominant pattern of diagnostic shift was towards schizophrenia spectrum disorder. Family history of psychosis and longer duration of untreated psychosis were associated with diagnostic transition towards schizophrenia spectrum., Conclusions: Schizophrenia and bipolar affective disorder were diagnostically stable and could be reliably classified at intake in a Chinese first-episode psychosis sample using the ICD-10 criteria. Diagnostic instability in the least prevalent categories of functional psychosis highlights the limitations of current taxonomies and calls for ongoing revision of diagnostic criteria. In the absence of biological marker, longitudinal validation across consecutive episodes is necessary for accurate diagnostic ascertainment.