Biomedical subjects
S W Lam
Publications and source records attributed to S W Lam.
To compare argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure: mid-term results.
PURPOSE: To compare the clinical outcome of argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure (APAC). METHODS: Consecutive patients with APAC were recruited and randomized to receive one of two treatment options: immediate ALPI or systemic acetazolamide +/- mannitol. All eyes were followed up for at least 6 months after laser iridotomy. Main outcome measures were intraocular pressure (IOP) and requirement for glaucoma medications. RESULTS: A total of 41 eyes (39 patients) were randomized into the ALPI group, and 38 eyes (32 patients) into the medical treatment group. There were no significant differences between the two groups in sex, age, presenting IOP, and duration of attack. Mean follow-up duration +/- SD was 15.7 +/- 5.8 months. There were no significant differences between the two groups in mean final IOP and requirement for glaucoma medications. CONCLUSIONS: There were no statistically significant differences in mean IOP and requirement for glaucoma drugs between APAC eyes treated with ALPI and systemic medications.
Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study.
PURPOSE: To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. METHODS: In all, 10 consecutive patients with acute phacomorphic angle-closure and intraocular pressure (IOP) > or =40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment. The IOP at 15, 30, 60, and 120 min, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 h after ALPI. Cataract extraction was subsequently performed as definitive treatment. RESULTS: In total, 10 patients (five male, five female), with a mean age+/-SD of 73.1+/-10.3 years were recruited. Mean duration of symptomatic attack was 128+/-232 h. After ALPI, the mean IOP was reduced from 56.1+/-12.5 to 45.3+/-14.5 mmHg at 15 min, 37.6+/-7.5 mmHg at 30 min, 34.2+/-9.7 mmHg at 60 min, 25.5+/-8.7 mmHg at 120 min, and 13.6+/-4.2 mmHg at 1 day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 h after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered. CONCLUSION: Immediate ALPI, replacing systemic antiglaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure.
A pilot study of the effects of a behavioural intervention on treatment adherence in HIV-infected patients.
A pilot study was carried out in a group of six HIV-infected non-adherent men testing the effects of a behavioural medication management intervention on adherence with antiretroviral drugs. The study was prospective, using a one-group repeated-measures design. Adherence was measured using two self-reports. The intervention was a behaviourally-based programme that lasted for three months and included individualized education about antiretroviral medication and their side effects; positive reinforcement and encouragement; individualized counselling weekly; follow-up calls; and lifestyle assessment and the identification of adherence barriers. Assessments were carried out at recruitment, immediately after the initiation of the intervention, one month, three months and six months later. Results suggested that the intervention enhanced adherence rates from a mean percentage of 80.27 at baseline to a mean of 97.5% at the end of follow-up (six months time point). Similar improvement was observed in the scores of the scale measuring adherence difficulties. Further, CD4+ counts also slightly improved. Interviews with four of the participants at the end of the study highlighted the problems experienced by patients in taking their medication and supported the usefulness of the intervention. Because of the complexity of the factors behind adherence, it is important that patients are supported with individualized medication management programmes.
A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease.
Forty-six Chinese patients with symptomatic human immunodeficiency virus (HIV) participated in a comparative study assessing the effectiveness of cognitive-behavioral group therapy (CBT) and peer support/counseling group therapy (PSC) in relation to improving mood and quality of life and decreasing uncertainty in illness as compared to a group receiving routine treatment with no formal psychosocial intervention. The CBT group consisted of 10 subjects, the PSC group of 10 subjects, and the comparison group of 26 subjects. There was a 24% attrition rate. The intervention groups received 12 weekly sessions of therapy over 3 months. Assessment of mood states was carried out before randomization (baseline data), immediately postintervention (3-month time point) and followed-up 3 months later (6-month time point). Assessment of quality of life and uncertainty in illness was carried out before randomization and at the 6-month follow-up time point. Results indicated that the mood of the participants in the CBT group improved in terms of anger, tension-anxiety, depression, confusion, and overall mood. The quality of life in this group was significantly improved compared to the other two groups, as was uncertainty in illness. In the PSC group a worsening of psychologic functioning was observed immediately postintervention, but this picture dramatically improved at the follow-up assessment with improvements of up to 34%. Quality of life also improved over time in this group by almost 5%, but results did not reach statistical significance. This study demonstrated that psychologic interventions could decrease psychologic distress and improve quality of life in symptomatic HIV patients, indicating their use should be incorporated in the management of care of people living with HIV/AIDS.
Recurrent cerebral lupus heralded by an unusual combination of ocular manifestations.
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Assessment of needs of adult symptomatic HIV patients in Hong Kong.
A cross-sectional survey was designed to assess the physical, psychosocial, health behaviour and informational needs of symptomatic HIV patients in Hong Kong, using both quantitative and qualitative data collection methods. Forty-six consenting adults from an outpatient clinic of a hospital in Hong Kong participated in the study. Results showed that up to 67.3% of the sample had partially or completely unmet needs in one or more areas of functioning. Major needs were related to income, social networking, family processes, money management and financial assistance. Only half the sample was satisfied with the information received related to their HIV infection and its management. Unsafe sexual practices were common, as well as smoking. Meeting these needs through policy making or practice could contribute to the enhancement of the quality of care and support provided to people living with HIV/AIDS in Hong Kong.
Correlates of quality of life in symptomatic HIV patients living in Hong Kong.
This cross-sectional study assessed quality of life (QOL), coping styles, mood and uncertainty in illness in a non-random sample of 46 (out of 91 eligible) symptomatic HIV patients living in Hong Kong. QOL was moderate and the main concerns were related to the environmental aspects of QOL, spirituality and social relationships. Considerable mood disturbance was demonstrated in the sample, especially with regards to depression, fatigue and tension/anxiety. High levels of uncertainty in illness were also reported. A median split of the uncertainty score demonstrated that high uncertainty was related to lower levels of overall QOL (p = 0.04), higher psychological dysfunction (p = 0.05), worse adjustment with the environment (p < 0.001) and higher mood disturbance (p = 0.008). The sample predominantly used internal coping, which also correlated well with higher QOL scores. Through regression analysis it was shown that QOL could be predicted with the combined effects of uncertainty in illness and fatigue (adjusted R2 = 0.51, p < 0.001). Findings indicate that efforts should be directed towards improving QOL issues in the Chinese HIV patients and interventions could be introduced to alleviate those factors that were found to affect QOL. It is suggested that such interventions may include group or individual psychological therapies, management of fatigue and teaching patients more effective coping techniques.
Can vitreous haemorrhage indicate non-accidental injury if mild retinopathy of prematurity is present?
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Labour characteristics and uterine activity: misoprostol compared with oxytocin in women at term with prelabour rupture of the membranes.
OBJECTIVE: To compare the labour pattern and uterine activity of oral misoprostol with oxytocin for labour induction in women presenting with prelabour rupture of membranes at term. DESIGN: Prospective randomised study. SETTING: Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong. PARTICIPANTS: Eighty women presenting with prelabour rupture of membranes at term. METHODS: The women were randomised to receive either 100 microg misoprostol orally every 4 hours to a maximum of three doses, or intravenous oxytocin infusion according to the hospital protocol. Intrauterine pressure transducers were inserted one hour before induction of labour in both groups of women. We compared the pattern of uterine activity, the induction-to-delivery interval, duration of labour, mode of delivery and neonatal outcome between the two groups. RESULTS: Both oxytocin and oral misoprostol caused an increase in uterine activity within one hour of labour induction. Peak uterine activity was reached 6-8 h after oral misoprostol, with persistent effects, and 8-10 h after oxytocin, requiring continuous titration of medication. The duration of labour was significantly reduced in nulliparous women, but not in those who were multiparous in the misoprostol group. The induction-to-delivery interval, the mode of delivery and the perinatal outcome were similar for the two groups. CONCLUSION: Oral misoprostol caused earlier peak uterine activity, compared with oxytocin (6-8 h vs 8-10 h). Oral misoprostol was not only as effective as oxytocin in inducing labour in women at term with prelabour rupture of the membranes, but it reduced significantly the duration of labour in nulliparous women.
Ocular hypertension after a triple procedure: phacoemulsification, intraocular lens implantation, and scleral buckling surgery.
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Endophotocoagulation to retinal pigment epithelium as an adjuvant therapy in the management of retinal detachment caused by a highly myopic macular hole.
Retinal detachment secondary to a highly myopic macular hole remains a particular surgical challenge. Pars plana vitrectomy, endophotocoagulation at the base of a macular hole in conjunction with fluid-gas exchange was performed in 4 consecutive patients with a mean refraction of -13.8D (range, -8D-(-)18D). Mean axial length was 27.5 mm (range, 26.0-29.0 mm). Mild atrophy of the retinal pigment epithelium was present in 3 patients while 1 patient had moderate atrophy. The mean follow-up period was 12 months (range, 6-18 months). The overall primary anatomical success rate was 75%. All 3 eyes with mild retinal pigment epithelium atrophy had retinal reattachment after one operation.
Determination of thimerosal in ophthalmic solutions by radial compression separation HPLC.
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