Biomedical subjects

Kenneth Tsang

Publications and source records attributed to Kenneth Tsang.

3 recordsLinked to original sources

PubMed2004

Severe acute respiratory syndrome: scientific and anecdotal evidence for drug treatment.

Severe acute respiratory syndrome (SARS), caused by a highly infectious novel coronavirus (CoV), predominantly presents with severe pneumonitis leading to respiratory failure and death in approximately 10% of victims. Most cases present, after an incubation of 2 to 11 days, with fever and chills, which are followed by dry cough and dyspnea before the onset of respiratory failure. The management of SARS is controversial, largely due to the lack of data from controlled trials, which were logistically impossible to design or execute at the time of the overwhelming outbreak between March and June 2003. The use of an antiviral is logical although there is no effective agent against SARS-CoV, with the widespread use of ribavirin in 2003 attracting considerable scepticism. The use of ribavirin as a monotherapy in SARS is not recommended. Retrospective data suggest that administration of the anti-HIV drug Kaletra in combination with ribavirin could reduce mortality and incidence of respiratory failure. The use of corticosteroid was based on the similarity between SARS and bronchiolitis obliterans organizing pneumonia. Corticosteroid use is considered important in subsets of patients with SARS. As SARS may still resurge, it is imperative that past experience is analyzed. This review will attempt to address the rationale for pharmacotherapy in SARS using anecdotal and the limited published data.

Adjuvants, Immunologic↗

PubMed2003

SARS: pharmacotherapy.

The pharmacotherapy for severe acute respiratory syndrome (SARS) is controversial and largely anecdotal. Most patients with suspected SARS should initially be treated with potent antibiotics before proceeding to 'anti-SARS' therapy. There is a spectrum of severity and rate of progression in SARS, and the stages of viral replication, inflammatory pneumonitis and residual pulmonary fibrosis are clinically non-distinct. Although now considered lacking in efficacy, ribavirin was used extensively in Hong Kong for treatment of SARS. Retrospective data suggest that the use of Kaletra (ritonavir and lopinavir), an anti-protease, could reduce mortality and improve outcomes, although the adverse reactions are also worrisome. Anecdotal experience strongly supports the use of steroid, at least in a subset of SARS patients, particularly with 'critical SARS' who display continued clinical instability or deterioration and progressive radiographic or HRCT deterioration. A retrospective study carried out of 72 probable SARS patients has shown that cases who received pulse methylprendisolone did not differ in cumulative steroid dosage or adverse reactions, although the former patients had less oxygen requirement, better radiographic outcome, and less likelihood of requiring rescue pulse steroid therapy than their counterparts. Nevertheless, lower dosage of steroid as initial therapy in SARS had also been associated with good clinical outcomes. Poor responders to initial therapy might benefit from rescue steroid therapy or intravenous Pentaglobin. Other drug treatments had also been tried in desperate patients, including the use of convalescence serum and plasmapheresis. Secondary infections could be troublesome, particular for patients with prolonged hospitalization and mechanical ventilation.

Algorithms↗

PubMedDate not supplied

Severe acute respiratory syndrome (SARS) in Hong Kong: patients' experiences.

BACKGROUND: This past year there was an outbreak of Severe Acute Respiratory Syndrome (SARS) in Hong Kong. During that time we investigated the clinical features, treatment, and nursing care of 36 patients and reported on 12 of these patients' perceptions of their illness experience. PURPOSE: The purpose of this article is to describe the clinical features, treatment, nursing care and perceptions of the illness experience of patients with SARS in Hong Kong in order to better inform nurses caring for patients with this highly contagious and potentially lethal disease. METHOD: We abstracted data from the medical and nursing records on the clinical features, treatment and nursing care of 36 patients (21 women, 15 men) in whom SARS was diagnosed and who were admitted to the Queen Mary Hospital in Hong Kong between March 15 and April 15, 2003. A review of the hospital's policy and procedures on infection control was also undertaken. Semi-structured interviews were conducted with 12 of the patients to elicit their perceptions of the illness experience. FINDINGS: The most common symptoms were cough (83%), dyspnea (80.6%), malaise (69.4%) and fever (61%). Less common symptoms included headache (38.9%), diarrhea (38.9%), dizziness (30.6%), myalgia (25%), chills (19.4%), nausea and vomiting (19.4%) and rigor (the occurrence of a sensation of hot-and-cold and shivering in addition to teeth chattering and bed shaking) (8.3%). All 36 patients received a combination of corticosteroids and ribavirin. The patients were at risk of drug-related adverse reactions and deterioration of respiratory function, and nursing vigilance was required. CONCLUSION: Nursing patients with SARS was challenging as the disease was highly contagious and potentially lethal, and not much was known about this disease. In addition to the use of frontline treatment, infection control and sensitivity to individual responses to sudden and catastrophic illness were required to support these patients. From this outbreak of SARS, we have learned the importance of infection control in containing and controlling the disease. Other lessons included the need to strengthen the surge capacity in our hospitals and support health care workers during the crisis.

Adult↗