meningococcal meningitis infectious disease cns cation to excellence in the exchange of information....

August 2007

THE HONG KONGMEDICAL ASSOCIATION

www.hkmacme.org

Management of Chronic Hepatitis B in Children – Part 2

Use of CT and MRI in Coronary Artery Disease

Growth on Palm for 3 Years

Painful Shoulder

Meningococcal Meningitis

Cardiology

Spotlight

Dermatology

CNS Medicine

Infectious Disease

Cardiology

Dermatology

CNS Medicine

Infectious Disease

Spotlight

This month

1HKMA Aug 2007www.hkmacme.org

Elsevier (Singapore) Pte. LtdMichelle Wong Tel: 2965 1300 / Email: [email protected]

Elsevier is a world-leading publisher of scientific, technical and medical information products and services. The world’s premier names in healthcare publishing – Saunders, Mosby, and Churchill Livingstone are all members of the Elsevier team of leading publishers dedicated to meeting the information needs of health science professionals.

For over 125 years, the Elsevier name has represented a dedi-cation to excellence in the exchange of information. Elsevier Health Sciences (HS) publishes over 500 medical journals and 1,000 new medical books each year, across the whole gamut of healthcare: student textbooks in medicine, nursing and most other health professions; review books for exams; comprehensive reference textbooks for specialist practitioners; manuals and handbooks for professionals. In addition, Elsevier HS has a series of revolutionary electronic products, including MD Consult, First Consult, Gold Standard, eJournals, eClinics, iConsult, Nursing Consult, Nursing Skills, etc.

Elsevier is also a world leading medical information service provider. With abundant medical resources and high-profile professional talents, Elsevier is dedicated to building an effective medical communication platform, as well as providing an integrated medical communication service, to medical organizations, associations and R&D-based pharmaceutical communities.

Elsevier service items include:

International Journal/Book ReprintsCME ProgrammesMedical Education WorkshopsMedical Writing Skills WorkshopsAdvanced Medical Communication Meetings

It is our great honor to partner with HKMA for the develop-ment of the new-look CME programme – both print and e-version.

Elsevier – The New Publisher of the HKMA CME Bulletin

CME Bulletin EnhancementsIn addit ion to the famil iar sections, CNS Medicine and Infectious Disease have also been added, and these will be further enhanced in the coming months. If you complete the courses in the CME Bulletin you can attain a total of 3.5 CME points:

Spotlight – 1 CME pointDermatology/Cardiology – 0.5 CME pointCNS Medicine – 1 CME pointInfectious Disease – 1 CME point

For the print courses, you have the option of returning the answers by Fax, but we do encourage you to take a look at the new user-friendly website and make an online submission at CME Online (www.hkmacme.org).

New-look CME Online EnhancementsThe HKMA CME website, CME online (www.hkmacme.org), has been totally revamped and more content has been added, including an enhanced Points Tracker and Learning Center feature, which will roll-out in the coming weeks. This will feature practical clinical information related to your day-to-day practice.

CME Online allows you to complete three additional courses* to attain a further 3 CME points:

Spotlight Current Studies – 1 CME pointCNS Medicine Current Studies – 1 CME pointInfectious Disease Current Studies – 1 CME point

We look forward to enhancing your CME experience in the future and your comments are welcome!!

Elsevier HKMA CME Team

*Exclusive to CME Online only.


17

5

HKMA CME Bulletin 持續醫學進修專訊 August 2007

International Calendar 21

CME Calendar 23

Spotlight: Management of chronic hepatitis B in children – Part 2 6

Cardiology: A 56-year-old male complaining of chest pain and history of CAD 10

Dermatology: A 56-year-old male presenting with growth on his palm for 3 years 11

CNS Medicine: A 54-year-old female with severe shoulder pain of abrupt onset 12

Infectious Disease: A 9-month-old female with high fever and lethargy 14

Answer Sheet 16

EDITORIAL

EVENT INFORMATION

CME COURSES

CME NOTIFICATIONS

CONTENT

The Hong Kong Medical Association is dedicated to providing a coordinated CME programme for all members of the medical profession. Under the HKMA CME Programme, a CME register is installed to document the CME efforts of doctors and special CME avenues are provided. The Association strives to foster a vibrant environment of CME throughout the medical profession. Both members as well as non-members of the Association are welcome to join us. You may contact the HKMA Secretariat for details of the programme.

香港醫學會致力推動持續醫學進修，醫學會體察到業界有必要設立完善的持續進修計劃，為同僚建立有系統的進修記錄機制，以及為全科醫生提供適切的進修課程。藉著這個計劃，我們期望將優良的進修傳統推展至醫學界中每一角落，同時為業界締造一個充滿活力的進修文化。我們誠意邀請你參與醫學會持續進修計劃，不論你是否醫學會的會員，均歡迎你同來與我們一同學習，以及享用醫學會為所有醫生設立的進修記錄機制。如欲了解香港醫學會持續醫學進修計劃的詳情，請聯絡本會秘書處查詢。

HKMA CME Bulletin – MONTHLY SELF-STUDY SERIES to help you grow!Please read the following articles and answer the questions. Participants in the HKMA CME Programme will be awarded credit points under the Programme for returning the completed answer sheet via fax (28650943) or by mail to the HKMA Secretariat on or before 15 September 2007. Answers to questions will be provided in the next issue of the HKMA CME Bulletin. (Questions may also be answered online at www.hkmacme.org)

請細閱本期文章，並利用答題紙完成自我評估測驗，於 2007 年９月 15 日前，將已填妥之答題紙傳真（號碼：2865 0943）或寄回本會秘書處，您將可獲持續醫學進修的積分點 ; 至於是期自我評估測驗之答案，將刊於下一期《持續醫學進修專訊》之中。（您亦可透過網站www.hkmacme.org完成自我評估測驗。）


CME Bulletin & Online Editorial Board 持續醫學進修專訊及網上版編輯委員會

Chief Editor 總編輯：Dr. WONG Bun Lap, Bernard 黃品立醫生

Board Members 委員會成員：Dr. CHAN Man Kam 陳文岩醫生Dr. CHAN Yee Shing, Alvin 陳以誠醫生Dr. CHENG Chi Man 鄭志文醫生Dr. CHEUNG Hon Ming 張漢明醫生Dr. CHU Kin Wah 朱建華醫生Dr. CHIU Shing Ping, James 趙承平醫生Dr. CHOI Kin, Gabriel 蔡　堅醫生Dr. CHOW Pak Chin 周伯展醫生Dr. FONG Chung Yan, Gardian 方頌恩醫生Dr. FUNG Yee Leung, Wilson 馮宜亮醫生Dr. HO Chung Ping, MH 何仲平醫生Dr. HO Hung Kwong, Duncan 何鴻光醫生Dr. KONG Kam Fu, James 江金富醫生Dr. KWOK Ka Ki 郭家麒醫生Dr. LAM Tzit Yuen, David 林哲玄醫生Dr. LEUNG Chi Chiu 梁子超醫生Dr. LI Siu Lung, Steven 李少隆醫生Dr. LI Sum Wo, MH 李深和醫生Dr. POON Tak Lun 潘德鄰醫生Dr. SHIH Tai Cho, Louis 史泰祖醫生Dr. TSE Hung Hing 謝鴻興醫生Dr. WONG Shou Pang, Alexander 王壽鵬醫生Dr. YEUNG Chiu Fat, Henry 楊超發醫生

“To know that we know what we know, and to know that we do not know what we do not know, that is true knowledge.” — Nicolaus Copernicus (1473–1543) Medicine is a rapidly advancing area in the science arena. Every month, there are new guidelines, investigation technologies, imaging modalities, medications, intervention devices and methods popping up with much supporting data and mega trials. It is always a difficult task for family doctors and specialists to chase after all those new advances in various fields, month after month and year after year through their career life.

Every month since September 2004, there has been the honour and excellent educational opportunity for me to join the numerous eminent writers of The Hong Kong Medical Association (HKMA) CME Bulletin as the Editor. Today, it is again my real glory to re-join the new HKMA CME Bulletin as the Chief Editor.

From this issue onwards, we are really happy to have a newly joined, first class team of officials: Mr. Victor Lam, Managing Director, Greater China & Korea, Ms. Jenny Tung, Regional Pharma Director, Greater China & Korea; Mr. Joe Li, Regional E Marketing Director, Greater China & Korea; Ms. Eva Choi, Regional Marketing Director, Greater China & Korea; Ms. Michelle Wong, Account Manager, Hong Kong; and Mr. Richard Henderson, Managing Editor, Greater China, from Elsevier (Singapore) Pte Ltd (the publisher of The Lancet). With their superb professional assistance and experience, we are certainly going to have a more interesting and informative HKMA CME Bulletin.

I owe a huge debt of gratitude to my mentor, President Dr. Choi Kin Gabriel. He was the HKMA CME Bulletin Co-ordinator from May 2001 to August 2004. I would also like to thank Dr. Ko Wing Man and Dr. Shih Tai Cho Louis. They founded the HKMA CME Committee in April 2000 as Co-Chairmen. With their supreme wisdom and insight, Dr. Ko and Dr. Shih published the first issue of the HKMA CME Bulletin in July 2000.

Special thanks to Dr. Li Siu Lung Steven and again, Dr. Shih Tai Cho Louis, as our current HKMA CME Committee Co-Chairmen, for always being extremely insightful. To Miss Kwok Ka Wai, Dorothy, CME Coordinator; Miss Lau Sze Fei, Sophia, Executive Officer; and Mrs. Yvonne Leung Chow Yuet Mei, Chief Executive, HKMA Secretariat, thank you for being time-efficient, responsible and professional. Last but not least, I am deeply grateful to our HKMA CME Committee members and the HKMA CME Bulletin Editorial Board members, for their sage advice, encouragement and support.

The primary aim of HKMA CME Bulletin is to create a handy, quick and updated reference book, for the day in and day out clinical practice of all of our dearest HKMA Members — family practice colleagues, fellow trainees and specialists. Bearing this in mind, our team tried their very best to select simple, straightforward, easy-to-digest articles on complicated new guidelines, new investigation technologies, imaging modalities, medications and interventional devices and methods.

If the HKMA CME Bulletin can help you one day, in some way, with your daily clinical practice, then our aim is fulfilled.

We wish you all a knowledgeable and successful medical career, filled with prosperous, healthy and happy days.

Dr. Wong Bun Lap, BernardChief Editor

EDITORIAL

EDITORIAL

Published by Elsevier (Singapore) Pte Ltd.1102, 11/F Sing Pao Building New Wing, 101 King’s Road, North Point, Hong KongTel: 2965 1300 Fax: 3764 0374

Publishing Editor Richard Henderson

CME Programme Consultant Michelle Gabbe

Senior Production/Design Controller Tommy Wong

Page Layout Ann Fong

Advertising Enquiry Michelle Wong

© Elsevier (Singapore) Pte Ltd. 2007

NOTICEMedical knowledge is constantly changing. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and best treatment for each individual patient. Neither the Publisher nor the Authors assume any liability for any injury and/or damage to persons or property arising from this publication.

Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer.

6 HKMA Aug 2007 www.hkmacme.org

Hepatitis B immunization

Hepatitis B vaccines have been available since 1981, and all are produced with the use of yeast and recombinant techniques [1, 2]. All of the currently licensed hepatitis B vaccines are given intramuscularly and usually administered in three doses, with the second dose given 1 month after the first dose and the third dose given 6 months after the first dose. The current marketed vaccines are highly effective, with 95% of infants, children and adolescents having protective serum anti-hepatitis B surface antigen (HbsAg) antibody concentrations after the vaccine series has been completed [3]. Recently, Lee and co-workers [4] performed a meta-analysis to study the effect of hepatitis B immunization in newborn infants of mothers positive for Hbs, with encouraging results. Hepatitis B vaccination significantly decreased the risk of hepatitis B occurrence (RR 0.28, 95% CI 0.2–0.4). The meta-analysis also found that hepatitis B immunoglobulin alone or when added to hepatitis B vaccine decreased the risk of hepatitis B infection (RR 0.52, CI 0.44–0.63). However, no significant difference in hepatitis B occurrence was found between recombinant vaccine and plasma-derived vaccine (RR1), or between high-dose versus low-dose vaccine (RR 0.97). Furthermore, the study did not show a strong association between timing of injection and magnitude of effects. Moreover, the study found that hepatitis B vaccination is well tolerated and that severe adverse reactions are rare. Concerning the long-term immunogenicity of hepatitis B vaccination, studies in healthcare workers have found that 3 and 13 years after initial immunization, anti-Hbs levels of 10 sample ratio units or greater were present in 52% to 76% of participants, respectively. And, in these studies, administering a booster dose of hepatitis B vaccine resulted in an anamnestic response, indicating that immune memory against HBV infection lasts longer than the persistence of anti-Hbs [5, 6]. A recent 10-year follow-up study from Italy that looked at 1,212 children and 446 Italian air force recruits who were vaccinated clearly showed that strong immunological memory persists more than

10 years after immunization during childhood, and that booster doses of vaccine do not seem necessary to ensure long-term protection [7]. The study found that a protective anti-Hbs concentration was retained in 64% children and 89% of air force recruits after more than 10 years of follow up. Nearly all (97%) of the children and 96% of recruits that had an antibody level less than 10 IU/L and who received a booster dose showed an anamnestic response. Another prospective study from Alaska with a mean follow-up of 15 years also found a similar result: more than 84% of the cohort tested still had anti-Hbs present [8]. From the aforesaid studies, we can comfortably conclude that immunization during childhood or adolescence offers the greatest potential for protection and provides long-term immunity. There are several indicators of a successful vaccination programme for hepatitis B, which include a drop in the incidence of acute hepatitis B, a reduction in deaths due to cirrhosis and/or hepatocellular carcinoma (HCC), and a falling seroprevalence of HbsAg in the vaccinated population. According to a pilot universal immunization project conducted in 1983 in Afragola in southern Italy, a hyperendemic area for HBV [9], after 5 years of the immunization programme, the annual incidence of acute hepatitis B dropped from 63 to 3 per 100,000. The prevalence of HbsAg carriers dropped from 13.4% in 1978 to 3.7% in 1997, while in children and adolescents it decreased from 6.8% to 0.7% during the same period. In Taiwan, similar findings were observed with the average mortality from fulminant hepatitis in infants dropping from 5.36/100.000 in the period 1975–1984 (prior to mass vaccination) to 1.71/100,000 in 1985–1998 [10]. The HbsAg prevalence in the population under 15 years of age changed from 9.8% (1984) to 0.7% (1999) after 15 years following the introduction of the mass vaccination program [11]. In Hong Kong, since the implementation of universal neonatal vaccination against HBV in 1988, the notification rate of HBV infection dropped from 4.44/100,000 in 1988 to 1.99/100,000 in 2001. The mortality rate from HBV infection also changed from 1.95/100,000 to 0.5/100,000 during the same period [12]. Thus, from the implementation of universal

Dr. HUNG Hiu GongSpecialist in Gastroenterology & HepatologyMBChB (CUHK), PDipID (HK), MRCP (UK), FHKCP, FHKAM (Medicine)

Complete this courseand earn

1 CME POINT1 CME POINT

Management of chronic hepatitis B in children – Part 2

SPOTLIGHT


vaccination, there is a rapid decrease in the prevalence of HbsAg carriers and the hard adverse outcomes of chronic HBV infections, such as the incidence of HCC. Chang et al reported that, in Taiwan, after introduction of the mass vaccination programme in July 1984, in children aged 6–14 years, incidence of HCC progressively declined from 0.7/100,000 in the period 1981-1986 to 0.57/10,000 in 1986-1990, to 0.36/100,000 in 1990-1996 [13]. In conclusion, the implementation of universal neonatal vaccination programmes has been associated with a dramatic decrease in the incidence of HBV infection and HCC. We should try our best to achieve universal vaccination of infants and children through the age of 18 years in order to identify and vaccinate persons at risk of infection.

Controversy in the treatment of the immune-tolerant patientRemarkable progress has been made in the treatment of chronic hepatitis B in the past decade. Treatment options have expanded from interferon, which is expensive and has many side effects, to the nucleoside/nucleotide analogs with very few side effects. However, current treatment is still far from satisfactory and sustained off-treatment response is achieved only in small numbers of patients. Maintenance of on-treatment response requires long-term therapy with increased drug costs, and risk of drug resistance and adverse effects. So, the decision to initiate treatment must carefully balance long-term benefits against long-term costs and risk, as well as patient preference, age, co-morbid conditions and severity of liver disease. The goals of treatment of HBV infection are to prevent the long-term adverse outcomes like cirrhosis, liver failure and HCC. The end point of treatment is HbeAg seroconversion with an HBV DNA level of < 100,000 copies/mL and normalization of ALT [14]. Several long-term follow up studies have demonstrated that responders have an im-proved clinical outcome, with maximum benefit achievable when treatment is initiated early and a response is achieved before there is irreversible liver damage. Thus, HBV patients in the so-called ‘immune-tolerant’ phase are ideal candidates for treatment provided effective treatment is available.

What is the efficacy of currently approved treatments?

Four treatments have been approved for chronic hepatitis B: interferon alpha (INFa), lamivudine, adefovir and entecavir.

INFaInterferon impairs HBV replication and up-regulates MHC 1 expression on hepatocytes, likely sensitizing infected cells to virus-specific cytotoxic T-lymphocytes (CTLs) [15]. Clinical trials showed that, compared to untreated controls, a 4-6 month course of INFa treatment results in HbeAg clearance in an additional 24% of patients [16]. The strongest predictor of response is pre-treatment ALT levels [17, 18]. This explains why studies in Asian patients that included patients with normal or minimally elevated ALT levels reported very poor response to INFa treatment (Table 1) [19–22]. Subsequent studies found that Asian patients with elevated ALT had similar response rates as Caucasian patients [22, 23], indicating that host immune response at the time of treatment is initiated and not genetic factors led to the low response rates in early studies of Asian patients. These data showed that INFa have very limited efficacy in HbeAg clearance in HBV patients who are in the immune-tolerant phase. However, a recent phase II trial using pegylated INF2a reported that, among patients with pre-treatment ALT <2x ULN, a combined response in terms of ALT normalization, HBV DNA level <500,000 copies/mL and HBeAg loss was achieved in six of 22 patients (27%) who received pegylated INF and in only one of nine (11%) who received standard INF. These results suggest that pegylated INF may have a role in immune-tolerant phase

Table 1. Efficacy of INFa therapy in controlled trials in HBeAg-positive Chinese patients

Author [ref] Treatment No. of patients Pre-treatment ALT (xULN)

No. (%) patients lost HbeAg

Lai [19]* INFaControl

1212

0.30.3

00

Lai [20]* INFa+-predControl

6030

0.30.3

5 (8)0

Lok [21] INFaControl

5419

1.51.5

9 (17)0

Lok [22]

INFa+-predControl

INFa+-predControl

40203916

0.50.53.53

1 (2.5)0

14 (36) 3 (19)

Liaw [23] INFa+-predControl

7640

66

27 (36)10 (25)

*Studies in children

SPOTLIGHT


baseline with a mean follow-up of 10 years, 85% had spontaneous HbeAg seroconversion and only 5.4% progressed to liver cirrhosis, which indicates the relatively slow deteriora- tion and that a wait-and-see approach can be adopted in this group of patients [31]. Concerning the efficacy of adefovir, because only 2% of patients in the trial had normal pre-treatment ALT levels it is impossible to analyze the impact of adefovir in HBV patients in the immune-tolerant phase [32]. Viral kinetic studies in HBV patients receiving nucleoside/nucleotide analogues or combination therapy showed that the first phase of viral decline is related to the potency

of the antiviral agents, but the second phase of viral decline varies from patient to patient and seems to correlate with pre-treatment ALT, a surrogate marker of host immune response to HBV [33–35]. These data indicate that the likelihood of sustained off-treatment virologic response in HBV patients who are in the immune-tolerant phase will be low even with more potent antiviral therapies unless the immune tolerance can be overcome. Based on the aforesaid information, current evidence does not support the treatment of patients in the immune-tolerant phase because the long-term benefits of currently available treatments do not outweigh the long-term costs, and risk of adverse effects and drug resistance.

Conclusion

Chronic hepatitis B is now preventable by effective vaccination programmes and can be expected to drastically reduce the prevalence of infection in highly endemic areas. However, there are still large numbers of infected children who need our attention and care because of lack of vaccination, infection prior to vaccination programme implementation, or who acquire the virus despite HBV prophylaxis. Taking together the natural history and treatment data discussed above, HBV infection in children is essentially a mild disease but complications can be expected in adults. As a result, the rationale for treating HBV-infected children would be the prevention of long-term complications. Treatment is recommended in children when “immune tolerance” is broken with persistent elevation of ALT as treatment at this stage is more likely to be effective, and to benefit the patient by shortening the period of liver damage. Until then, the “immune tolerant“ patient should be monitored so that treatment can be initiated promptly when the time is ripe.

HBV patients [24]. However, more long-term data are needed to clarify its efficacy.

Nucleoside/Nucleotide analoguesThe current drugs approved by the United States Food and Drug Administration (FDA) are lamivudine, adefovir and, recently, entecavir. The analogues are metabolized by cellular kinases into triphosphate forms that competitively inhibit the viral reverse transcriptase. Lamivudine and adefovir lack a 3-OH moiety for chain elongation, resulting in termination of nascent viral DNA. In clinical trials from adults, a 1-year course of lamivudine results in HbeAg seroconversion in 16-18% of patients compared with 4-6% in those who receive placebo [25, 26]. Lamivudine has been tested in a large randomized controlled trial with 268 HbeAg-positive children [27] in which 23% of those who received lamivudine experienced loss of HbeAg while only 13% of controls had the same change. The conversion rate with respect to pre-treatment ALT levels is charted in Table 2. However, after 52 weeks of treatment, 19% of treated patients developed YMDD mutation. Recently, 18 children with normal pre-treatment ALT were tested with the combination therapy of lamivudine and INF [28]. The results seem promising with an HbeAg seroconversion rate of 22% during a follow-up of 40 months and no patients with detectable YMDD mutation [28]. As with INF, pre-treatment ALT is the strongest predictor of response in lamivudine. This is true for adults as well as children (Table 2) [27, 29]. Even after extending the duration of treatment, only 25% of patients with normal pre-treatment ALT had HbeAg seroconversion after 5 years of lamivudine treatment [30]. The low response rate in relation to a 5-year rate of lamivudine resistance mutation of 69% cannot justify the use of long-term lamivudine treatment for hepatitis B patients who are in the immune-tolerant phase [30]. In a long-term cohort study including 240 HbeAg-positive Taiwanese patients with normal ALT at

Table 2. HbeAg seroconversion rate after 1 year of lamivudine treatment is related to pre-treatment ALT level

Pretreatment ALT x ULN

HbeAg seroconversion Adult29 Children27

Lamivudine Placebo Lamivudine Placebo

<1x 2% 0% 12% 14%

1-2x 7% 5% 12% 7%

2-5x 20% 9% 31% 12%

>5x 42% 15% 50% 24%

SPOTLIGHT


1. Current marketed hepatitis B vaccine is highly effective and safe.

2. The long-term immunogenicity of hepatitis B vaccine is excellent and booster dose is usually not needed.

3. Universal neonatal vaccination programmes against HBV significantly decrease the prevalence of HbsAg carrier and the incidence of HCC.

4. Hepatitis B vaccine programme significantly decrease the incidence of acute hepatitis B infection.

5. A limitation of nucleoside/nucleotide therapy is the development of viral resistance.

Q&A

References1. Valenzuela P, Medina A, Rutter WJ. Synthesis and assembly of hepatitis B virus surface antigen particles in yeast. Nature 1982;298:347–350. 2. McAleer W, Buynak EB, Maigetter RZ, et al. Human hepatitis B vaccine from recombinant yeast. Nature 1984;307:178–180. 3. Mast E, Mahoney F, Kane M, et al. Hepatitis B vaccine. In: Plotkin SA, Orenstein WA, eds. Vaccines. Philadelphia: Saunders 2004:299–337. 4. Lee C, Gong Y, Brok J, et al. Effect of hepatitis B immunization in newborn infants of mothers positive for hepatitis B surface antigen: systemic review and meta-analysis. BMJ 2006;332:328–336. 5. Barash C, Conn MI, DiMarino AJ, et al. Serologic hepatitis B immunity in vaccinated health care workers. Arch Intern Med 1999;159:1481–3. 6. Williams JL, Christensen CJ, McMahoo BJ, et al. Evaluation of the response to a booster dose of hepatitis B vaccine in previously immunized health care workers. Vaccine 2001;19:4081–4085. 7. Alessandro RZ, Andrea M, Lusia R, et al. Long term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet 2005;366:1379–1394. 8. Brain J, Dana L, Bruden MS, et al. Antibody levels and protection after hepatitis B vaccination: Results of a 15 year follow up. Ann Intern Med 2005;142:333–341. 9. Da Villa D, Piccinino F, Scolastico C, et al. Long term epidemiological survey of hepatitis B virus infection in a hyper endemic area (Afragola, southern Italy): results of a pilot vaccination project. Res Virol 1998;263–270. 10. Kao JH, Hsu HM, Shau WY, et al. Universal hepatitis B vaccination and the decreased mortality from fulminant hepatitis in infants in Taiwan. J Pediatr 2001;139:349–352. 11. Ni YH, Chang MH, Huang LM, et al. Hepatitis B virus infection in children and adolescents in hyper endemic area: 15 years after mass hepatitis B vaccination. Ann Intern Med 2001;135:796–800. 12. Topical health report No. 2. Statistic on infectious disease in Hong Kong 1946–2001. Department of Health, HKSAR 2002:63–64. 13. Chang MH, Chen CJ, Lai MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. N Engl J Med 1997;336:1855–1859. 14. Lok AS, Heathcote EJ, Hoofnagle JH. Management of hepatitis B 2000 — summary of a workshop. Gastroenterology 2001;120: 1828–1853. 15. Karayiannis P. Hepatitis B virus: old, new and future approaches to antiviral treatment. J Antimicrob Chemother 2003;51:761–785. 16. Crax A, Di Bona D, Camma C. Interferon-alpha for HbeAg positive chronic hepatitis B. J Hepatol 2003;39:suppl 1:S99–105.17. Lok AS Ghany MG, Watson G, Ayola B. Predictive value of aminotransferase and hepatitis B virus DNA levels on response to interferon therapy for chronic hepatitis B. J Viral Hepat 1998;5(3):171–178. 18. Perrillo RP, Schiff ER, Davis GL, et al. A randomized, controlled trial of interferon alfa-2b alone and after prednisone withdrawal for the treatment of chronic hepatitis B. The Hepatitis Interventional Therapy Group. N Engl J Med 1990;323(5):295–301.

19. Lai CL, Lok AS, Lin HJ, et al. Placebo-controlled trial of recombinant alpha 2 interferon in Chinese HbsAg carrier children. Lancet 1987:2(8564):877–880. 20. Lai CL, Lin HJ, Lau JN, et al. Effect of recombinant alpha 2 interferon with or without prednisone in Chinese HbsAg carrier children. Q J Med 1991;78(286):155–163. 21. Lok AS, Lai CL, Wu PC, Leung EK. Long-term follow-up in a randomized controlled trial of recombinant alpha 2 interferon in Chinese patients with chronic hepatitis B infection. Lancet 1998;2(8606):298–302. 22. Lok AS, Wu PC, Lai CL, et al. A controlled trial of interferon with or without prednisone priming for chronic hepatitis B. Gastroenterology 1992;102(6):2091–2097. 23. Liaw YF, Lin SM, Chen TJ, et al. Beneficial effect of prednisolone withdrawal followed by human lymphoblastoid interferon on the treatment of chronic type B hepatitis in Asians: a randomized controlled trial. J Hepatol 1994;20(2):175–180. 24. Cooksley WG, Piratvisuth T, Lee SD, et al. Peginterferon alpha 2a: an advance in the treatment of hepatitis B e antigen positive chronic hepatitis B. J Viral Hepatol 2003;10(4):298–305. 25. Dienstag JL, Schiff ER, Wright TL, et al. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med 1999;341(17):1256–1263. 26. Lai CL, Chien RN, Leung NW, et al. A one year trial of lamivudine for chronic hepatitis B: Asia Hepatitis lamivudine study group. N Engl J Med 1998;339(2):61–68. 27. Jonas MM, Mizerski J, Badia IB, et al; International Pediatric Lamivudine Investigator Group. Clinical trial of lamivudine in children with chronic hepatitis B. N Engl J Med 2002;36(1):1706–1713. 28. D’Antiga L, Aw M, Atkins M, et al. Combined lamivudine/interferon treatment in ‘immunotolerant children” perinatally infected with hepatitis B: A pilot study. J Pediatr 2006;148:228–233. 29. Perrillo RP, Lai CL, Liaw YF, et al. Predictors of HbeAg loss after lamivudine treatment for chronic hepatitis B. Hepatology 2002;36(1):186–194. 30. Liaw YF. Results of lamivudine trials in Asia. J Hepatol 2003;39(suppl1):S111–S115. 31. Chu CM, Hung SJ, Lin J, et al. Natural history of Hepatitis B e antigen to antibody seroconversion in patients with normal serum aminotransferase levels. Am J Med 2004:16:829–834.32. Marcellin P, Chang TT, Lim SG, et al. Adefovir for the treatment of Hepatitis b e antigen positive chronic hepatitis B. N Engl J Med 2003:348:808–816. 33. Wolters LM, Hansen BE, Niesters HG, et al. The influence of baseline characteristics on viral dynamic parameters in chronic hepatitis B patients treated with lamivudine. J Hepatol 2002;37(2):253–258. 34. Lewin SR, Ribeiro RM, Walters T, et al. Analysis of hepatitis B viral load decline under potent therapy: complex decay profiles observed. Hepatology 2001;34(5):1012–1020. 35. Neumann A, et al. HBV viral dynamics in chronic hepatitis B patients treated with adefovir: effect of dose and pre-treatment on HBV disease characteristics. Hepatology 2002;36(4):375A.

Please indicate true or false to the following statements.

6. Peg-interferon appears to be more active against HBV than standard interferon.

7. Both interferon and lamivudine are effective treatment options for patients who are in the ’immune-tolerant phase’.

8. The strongest predictor of response to antiviral agents is pre-treatment ALT levels.

9. All children who are HbsAg-positive should be treated.

10. Chronic hepatitis B in children is essentially a mild disease and usually treatment is not needed.

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Answer these on page 16 or make an online submission at:

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SPOTLIGHTSPOTLIGHT


JULY ANSWERS

A 56-year-old male complaining of chest pain and history of CAD

CARDIOLOGY

A 56-year-old gentleman presents with a few weeks, history of chest pain, which is sometimes but not always related to exertion. He has a history of coronary artery disease with previous coronary angiogram 3 years ago showing an 80% mid left anterior descending artery (LAD) stenosis and a 50% right coronary artery (RCA) stenosis. He had a coronary angioplasty and stenting to his LAD artery lesion and medical treatment was recommended for his RCA lesion. He wishes to consult you for further evaluation. He also has mild asthma, which does not need maintenance treatment.

There are three types of hypertensive disorders in preg-nancy: chronic hypertension, gestational hypertension and pre-eclampsia. Hypertension in pregnancy may be defined as an absolute increase in blood pressure >140/90 mmHg or a relative rise in blood pressure in either systolic pressure >30 mmHg or diastolic pressure >15 mmHg above blood pressure at pre-natal booking.

Chronic hypertension should be diagnosed in a patient who has a known history of hypertension before pregnancy or if the hypertension occurred before 20 weeks’ gestation.

Gestational hypertension occurs in the second half of pregnancy and resolves by 6 weeks post partum.

Pre-eclampsia is defined as gestational hyperten-sion with >0.3 g proteinuria per 24 hours. Oedema is not essential as it is a non-specific finding.

Most physicians would start treatment if blood pres-sure is >140/90 mmHg. In general, apart from angioten-

sin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB), most conventional anti-hyper-tensive drugs are not fetotoxic or contraindicated in pregnancy. The first-line drug of choice remains to be meth-yldopa, which is a centrally acting agent with a long safety record in pregnancy. Its sedative side effect sometimes limits its application and it may cause increases in liver enzymes or a positive Coomb’s test. It should be avoid-ed in women with a prior history of depression and after delivery, preferably it should be changed to other drugs if possible to decrease the risk of post-partum depression.

Second-line drugs include nifedipine and hydralazine and third-line drugs include beta blockers and thiazide diuretics. Beta blockers have concerns of growth restriction and thiazides might cause plasma volume contraction, thereby limiting their use to third line in general. After delivery, however, a beta blocker is often the drug of first choice for blood pressure control.

A 32-year-old pregnant lady was found to have a blood pressure of 150/100 mmHg for two occasions. She is now at 25 weeks of gestation. She has no prior history of hypertension.

1. How would you further investigate this gentleman? a. Treadmill stress test b. CT coronary angiogram c. Cardiac MRI

2. CT coronary angiogram is contraindicated in patients with asthma. a. True b. False

3. Cardiac MRI is contraindicated in patients with asthma. a. True b. False

4. Cardiac MRI is contraindicated in patients with coronary stents. a. True b. False

Please indicate 1 answer to each question

The content of the Office Cardiology Series is provided by:

Dr. LI Siu Lung, StevenF.H.K.A.M. (Med), F.R.C.P. (Glasg), F.R.C.P. (Edin), F.R.C.P. (Lond), Specialist in Cardiology

Dr. WONG Shou Pang, AlexanderF.R.C.P., F.H.K.A.M.(Med.), F.H.K.C.P., Specialist in Cardiology

臨床心臟科個案研究之內容誠蒙李少隆醫生及王壽鵬醫生提供。

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TRUE OR FALSE ANSWER

1. Urine examination is mandatory. True

2. Anti-hypertensive treatment should be started. True

3. Angiotensin converting enzyme inhibitor is the drug of choice. False

4. Methyldopa is the drug of choice in ante-natal period. True

5. Methyldopa is the drug of choice in post-natal period. False


DERMATOLOGY

A 56-year-old male presenting with growth on his palm for 3 yearsThis 56-year-old gentleman presented with a solitary growth on his left palm for 3 years. There was no history of trauma preceding its appearance. The lesion has remained static in size. Apart from occasional erosion after friction, which normally heals within a few days, the lesion is largely asymptomatic. It measures 0.8 x 0.5 cm in size.

The machine shown on the picture measures about 2 m (height) by 1 m (width) with multiple fluorescent lamps fixed on one side.

JULY ANSWERS

Complete BOTH Dermatology and

Cardiology courses and earn BOTH

0.5 CME POINT0.5 CME POINT

1. What are the likely diagnosis and differential diagnoses?

2. What investigation(s) is/are necessary to establish a diagnosis?

3. Where in the body is this type of lesion found?

4. What treatment will you offer to this patient?

5. What is the prognosis of this condition?

Please answer ALL questions

The content of the Dermatology Series is provided by:

Dr. CHOW Ka Yuen, Dr. TANG Yuk Ming, William, Dr. CHAN Loi Yuen & Dr. MAK Kam Har. Specialists in Dermatology & Venereology

皮膚科病例研究之內容誠蒙周家源醫生、鄧旭明醫生、陳來源醫生及麥錦霞醫生提供。

QUESTION

1. What is the machine called?

2. What is the commonest skin disorder that will benefit from this specific form of therapy?

3. Under what other skin disorders may one utilize this form of therapy?

4. What other forms of therapy with a similar underlying principle do you know of?

5. What are the possible side effects of this form of therapy?

ANSWER

1. It is a phototherapy unit. The lamps of this machine deliver ultraviolet B in the range of 310 to 315 nm and so it is a narrow-band UVB irradiation unit.

2. Psoriasis

3. Other dermatoses that respond to narrow-band UVB include atopic eczema, vitiligo, lichen planus, polymorphic light eruption and some other idiopathic photodermatoses, pityriasis rosea and mycosis fungoides (early stages).

4. These include PUVA (oral psoralen + UVA (320-400 nm)), bath PUVA, topical PUVA, UVA1 (340-400 nm) phototherapy, broad band UVB (290-320 nm), excimer laser therapy and photodynamic therapy.

5. Possible acute side effects include sunburn reaction, corneal burn (if eyes unprotected), freckling and tanning of skin, phototoxic or photoallergic drug eruptions. In the long run, premature ageing of skin and possible increased risk of skin cancers should be considered.

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locating the lesion, thereby confirming the diagnosis. The actual cause of acute brachial plexus neuralgia (also known as neuralgic amyotrophy and Parsonage-Turner syndrome) is not known. Cases have been reported in conjunction with bacterial and viral illnesses and after immunizations. Lymphocyte sensitization to brachial nerve proteins has also been observed, leading to the suggestion that the disease may have an immunologic basis. It has an estimated occurrence rate of 1.64/100,000 and is somewhat more common in men. A hereditary form of brachial plexus neuralgia

has been identified. Patients with this form of the disease have an autosomal-dominant inheritance pa t t e rn fo r a su scep t ib i l i t y to recurrent brachial plexus neuralgia, typically triggered by viral infection or another environmental cause. Mutations in chromosome 17q25 have been identified in six families known to have the hereditary brachial plexus neuralgia.

Most of the information on acute brachial plexus neuralgia is derived from case studies. Many of these patients were treated with corticosteroids, but these have not been proven to be efficacious. Pain medication and physical therapy to maintain mobility in the shoulder girdle are the mainstays of treatment. The condition is self-limited in most patients, with most recovering function within a few months. Although previous smaller series reported up to 90% recovery rates over the course of 1 to 3 years, a retrospective literature review by van Alfen and van Engelen in 2006, covering 246 cases, found that two-thirds of patients still had paresis at 3 years. In one series, 14% of 39 patients had recurrence of the neuritis, but in the retrospective review, 26% had recurrence by 6 years.

CNS MEDICINE

Although shoulder pain can be attributed to numerous causes, the addition of muscle weakness narrows the possibilities considerably. Primary shoulder syndromes such as impingement syndromes might cause pain associated with weakness. Cervical disk disease or spondylosis, thoracic outlet syndrome, spinal cord lesions, and peripheral neuropathies should be considered. Persons with these entities typically present with weakness and pain that occur at the same time. In this patient, the onset of pain followed later by weakness suggests acute brachial plexus neuralgia, which develops with an acute onset of pain that is not associated with an injury. The pain resolves over a period of days to several weeks and is followed by profound muscle weakness. Sensory involvement is variable. Physical findings may be normal initially, but as the condition progresses, the patient experiences muscle atrophy and profound weakness. Associated reflex and sensory abnormalities may or may not exist. Some patients present with bilateral symptoms or have bilateral involvement that is symptomatic on one side only. In a series of 30 patients studied by Gaskin and Helms in 2006, 97% had involvement of the suprascapular nerve on the basis of imaging studies. The MRI usually demonstrates abnormalities in the muscle signal that suggest atrophic changes. Often the MRI is most useful in ruling out other cervical spine pathology. Electromyography can pinpoint the abnormality to the brachial plexus. By 3 to 4 weeks after the initial onset of weakness, muscle denervation is detected in the form of fibrillation potentials, sharp-peak positive waves, and long polyphasic action potentials. Nerve conduction studies are also useful in

A 54-year-old female with severe shoulder pain of abrupt onset



A 54-year-old woman presented to the clinic because of severe pain in her left shoulder. It had begun abruptly the day before presentation. She denied any injury and had not had prior problems with it. She had not had any recent illnesses. On examination, she had persistent pain that was not changed by manipulation, and no focal areas of tenderness were noted. She had no rash. The woman denied numbness, but the pain radiated down her arm to her hand. She was given a prescription for analgesics, and magnetic resonance imaging (MRI) of the cervical spine was ordered. Three days after the initial presentation, she returned to the clinic to follow up on the results of the MRI. At that time, the pain was slightly less severe than before, but she had weakness in the arm, and the weakness prevented her from raising her arm to comb her hair or eat.


CNS MEDICINE

Sheridan MA et al / Orthop Clin N Am / 2006;37:531–539

EXCERPT: Primary adhesive capsulitis, or frozen shoulder, is a condition characterized by gradual loss of active and passive glenohumeral motion. The prevalence of frozen shoulder is slightly greater than 2% in the general population, affecting persons older than 40 years. Approximately 70% of patients presenting with adhesive capsulitis are women, and 20% to 30% of those affected will develop adhesive capsulitis in the opposite shoulder. Despite the female preponderance of patients who have adhesive capsulitis, the role of sex has not been investigated thoroughly and the etiology remains unknown. The lack of consistency in the published literature also reflects a lack of understanding of causation. As a result, management of frozen shoulder is controversial, and many treatment options, both operative and non-operative, are available.

CURRENT STUDIESCOMPLETE THIS COURSE

ONLINE AND RECEIVE 1 CME POINT 1 CME POINT

Upper extremity: emphasis on frozen shoulder

1. Conditions that should be considered when evaluating a patient who presents with severe shoulder pain and muscle weakness include:

a. Spinal cord lesions b. Thoracic outlet syndrome c. Cervical disk disease or spondylosis d. Peripheral neuropathies e. All of the above

2. Acute brachial plexus neuralgia usually develops in association with an injury.

a. True b. False

Q&APlease indicate 1 answer to each question

3. Which statement is true regarding the hereditary form of brachial plexus neuralgia?

a. Inheritance pattern is autosomal-recessive b. Susceptibility is typically triggered by viral infection c. Susceptibility is typically triggered by bacterial

infection d. It is common, with mutations in chromosome

17q25 having been identified in over 1,000 families

4. Acute brachial plexus neuralgia is also called: a. Neuralgic amyotrophy b. Parsonage-Turner syndrome c. Both a and b are correct

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Speaker : Dr. LO Kwok Wing Specialist in Endocrinology, Diabetes & Metabolism

Date : 18 September 2007 (Tuesday)

Time : 7:15 – 8:30 p.m. Dinner 8:30 – 9:30 p.m. Lecture & Q/A

Hong Kong Medical Association

Venue : Miramar Function Room II-III, Basement II, Miramar Hotel, 118-130 Nathan Road, Tsim Sha Tsui

Capacity : 50

Please register for participation. First come, first served. MCHK/HKMA CME Accreditation: 1 point

Please make reservation on or before 14 September 2007 by sending an email with your name, telephone number, EVENT NAME and EVENT DATE to Ms. Anita Wu at [email protected]

Updates on Diabetes Management

Sponsored by : GlaxoSmithKline Ltd.


INFECTIOUS DISEASE

The signs and symptoms of meningococcal meningitis can be very deceptive because fever and headache occur in many illnesses, most of which are benign. In typical cases, fever, myalgias, and abrupt onset of headache occur. In most cases, the infection progresses rapidly; confusion, nuchal rigidity, and progressive decrease in consciousness occur. An infant may have a bulging fontanelle. Rarely, the infection will progress slowly over several days with gradual development of signs of meningeal irritation. Infants and older adults often have an atypical presentation and may not have any signs of meningeal irritation. In addition, mild lethargy may be difficult to distinguish from advanced senility in the elderly or from the sleepiness due to illness in an infant. A purpuric or petechial rash may develop and is an ominous sign. This can occur with other forms of meningitis as well and may be seen in disseminated intravascular coagulation from sepsis. Cranial nerve involvement occurs in 10% to 20% of patients, with sensorineural hearing loss being the most common deficit. Seizures, poorly reactive pupils, and abnormal reflexes develop as a result of swelling in the brain and meninges. The infant described was probably afebrile as a result of advanced sepsis. She began to develop a purpuric rash about 2 hours after presentation, well after the diagnosis was made. Meningococcal meningitis is usually seen in cyclic outbreaks that are most likely to occur in conditions of crowding, such as in dormitories. In the past, military recruits were at increased risk, but immunization has been effective in controlling outbreaks in the USA. Proportionately more young people (aged 2–18 yr) are affected by Neisseria meningitidis than are those in other age groups. In actual total numbers, more cases occur in adults. Patients with deficient complement-mediated immune responses are at the greatest risk. Asplenia, properdin deficiency (results in impaired activation of complements 3 and 5), and immune deficiency due to infection with HIV all predispose a patient to infection with N. meningitidis.

A 9-month-old female with high fever and lethargy

Other risk factors include living in overcrowded conditions, low socioeconomic status, and race (e.g. blacks are at greater risk than whites). Those who are close contacts of an infected person are at much higher risk for infection. In addition, patients who smoke or are exposed passively to cigarette smoke are at higher risk, probably because of impaired mucosal defenses in the nasopharynx. The most helpful diagnostic test is an examination of the spinal fluid. A spinal tap should be done whenever any suspicion of meningitis exists. A Gram stain of the CSF typically shows bacteria and white blood cells (100–10,000 per mm3). Latex agglutination techniques are available to test for the most common N. meningitidis serogroups (A, B, C, Y, W135), though false negatives are not unusual. The CSF usually has a reduced glucose concentration and increased protein levels. Blood cultures are positive in about one-third of patients. N. meningitidis is treated with IV penicillin or ampicillin. In developing countries where the full course of penicillin is not practical, IM chloramphenicol is used. Often, the exact aetiologic agent of meningitis is not known before treatment begins. In those cases, broader coverage is necessary to cover pathogens such as Haemophilus influenzae, which is frequently penicillin resistant. Broad-spectrum cephalosporins, such as ceftriaxone, and vancomycin are often used as a first-line empiric treatment strategy until the organism is identified. Treatment of close contacts with prophylactic antibiotics is strongly recommended. Persons who are exposed to oral secretions or have prolonged contact with the patient (household members, day care workers) are at particularly high risk. Treatment with corticosteroids does not appear to be helpful in treatment or in prevention of long-term neurologic complications. The recommendat ions f rom the Adv i sor y Committee on Immunization Practices are noted in the chart opposite. Rifampin is not recommended for women who are pregnant.



A 9-month-old child was brought to the emergency department by her mother, who was concerned about the infant’s high fever and refusal to take a bottle. The mother first noted the fever about 6 hours before admission. The child had been in good health except for a recent cold. On examination, the child appeared lethargic but was conscious. She had no fever and did not have any signs of meningeal irritation. She had no rash, and the findings of the remainder of the examination were normal.


INFECTIOUS DISEASE

In addition, immunization may prevent further spread of meningococcal meningitis, particularly during outbreaks of infections with serotype C meningococcus. Vaccine is not recommended routinely because it is relatively ineffective in young children and the duration of protection is short. College students may benefit from vaccine, but the only recommendation is that physicians advise students and parents of the potential benefit. The vaccine is recommended for some patients who are at high risk, such as those with asplenia or deficiencies of humoral immunity.

Age group Recommended drug Dosage/route

Adults Rifampin

Ciprofloxacin

Ceftriaxone

600mg po BID 2 days

500mg single dose

250mg IM single dose

Children <1 mo

Children ≥1 mo

Children <15 yr

Rifampin

Rifampin

Ceftriaxone

5mg po BID 2 days

10mg po BID 2 days

125mg IM single dose

Tzanakaki G et al / FEMS Immunol Med Microbiol / 2003;39:31–36

Antibiotic treatment prior to transport or admission to hospital has reduced the proportion of cases of invasive meningococcal disease (IMD) from which Neisseria meningitidis can be isolated by standard microbiological techniques. Identification of meningococci by polymerase chain reaction (PCR) was assessed in relation to microbiological diagnosis for cases over a 4-year period between 1998 and 2001. A screening assay for the IS1106 gene was used to detect meningococcal DNA and five additional assays for siaD and orf-2 genes were performed to determine the serogroup. PCR results were compared with results of bacteriological culture, other laboratory test results and clinical data. Sensitivity of the PCR assay for culture-confirmed cases was 98.5% and specificity 96% based on test results for patients from whom other bacteria were isolated, children with viral meningitis and afebrile negative controls. The siaD B/C/W-135 and Y as well as the orf-2 gene for serogroup A PCR assays were able to determine the serogroup for 75.2% of cases that were positive by PCR screening assay. When isolates from patients with IMD were tested by both agglutination and PCR, the results agreed in all cases. PCR is a useful tool for diagnosis of IMD when Gram stain and culture tests are negative due to antibiotic treatment prior to collection of samples for microbiological analyses.

CURRENT STUDIESCOMPLETE THIS COURSE

ONLINE AND RECEIVE 1 CME POINT 1 CME POINT

Evaluation of non-culture diagnosis of invasive meningococcal disease by polymerase chain reaction (PCR)

1. In most cases of meningococcal meningitis, the infection progresses rapidly and is characterized by:

a. Confusion b. Progressive decrease in consciousness c. Nuchal rigidity d. All of the above

2. Meningococcal immunization has been disappointingly ineffective in controlling outbreaks among US military recruits.

a. True b. False

Q&APlease indicate 1 answer to each question

3. Which of the following is not a recognized risk factor for meningococcal meningitis?

a. Active or passive cigarette smoke exposure b. Alcoholism c. Overcrowded living condition d. Close contact with an infected person

4. In cases where the exact aetiologic agent of meningitis is not known before treatment begins, a broad-spectrum antibiotic (e.g. cephalosporins) is necessary.

a. True b. False

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From: The Centers for Disease Control. Prevention and Control of Meningococcal Disease. MMWR Rec Rep. 1997:46(RR5):1-21.


Please return completed answer sheet to the HKMA Secre-tariat (Fax: 2865 0943) on or before 15 September 2007 for documentation. However, if you choose to do the exercises online, you do not need to return this answer sheet by fax.

請回答所有問題，並於 2007 年 9 月 15 日前將答題紙傳真或寄回至香港醫學會（傳真號碼：2865 0943）。但如果選擇在網上做練習，便不需要把答題紙傳真給秘書處。

答題紙 August 2007

DERMATOLOGY

SPOTLIGHT

ANSWER SHEET

GO ONLINE AND COMPLETE UP TO 3 OTHER MONTHLY COURSES

FOR AN EXTRA

3 CME POINTS3 CME POINTSwww.hkmacme.orgwww.hkmacme.org

1 2 3 4 5

CARDIOLOGY1 2 3 4

CNS MEDICINE1 2 3 4

INFECTIOUS DISEASE1 2 3 4

6 7 8 9 10

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ANSWER BOX

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True False True True False

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True False True True True

Answers to July 2007Management of chronic hepatitis B in children – Part 1

Please answer ALL questions and write the answers in the space provided. Both the Cardiology and Dermatology courses must be completed to earn 0.5 CME point. The other courses attract 1 CME point each.

✂

17HKMA Aug 2007

CME NOTIFICATION

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HKMA CME Programme 香港醫學會持續進修計劃CME Lecture – September 2007 進修講課 – 二零零七年九月

CME EVENT 講課簡介 VENUE & TIME 地點及時間

13 September 2007 (Thursday)

HKMA Structured CME Programme with HKS&H Session IX: Robotic Surgery in Urology

Dr. WONG Wai SangDirector, Urology Centre, HKS&HMBBS (HK), FRCS (Edin), FRACS, FCSHK, FHKAM (Surgery), FRACS(Urology), Specialist in Urology

This symposium is co-organized with Hong Kong Sanatorium & Hospital

The HKMA Dr. Li Shu Pui Professional Education Centre2/F, Chinese Club Building 21-22 Connaught Road Central, Hong KongLecture: 2:00 – 3:00 p.m. (Light lunch will start at 1:15 p.m.)

香港中環干諾道中二十一至二十二號華商會所大廈二樓香港醫學會李樹培醫生專業教育中心講課：下午二時至三時正 (茶點於下午一時十五分開始)

REGISTRATION:Please fill in and return the Registration Form together with a cheque for the correct amount made payable to “The Hong Kong Medical Association” to 5/F Duke of Windsor Social Service Building, 15 Hennessy Road, Hong Kong. Each lecture will carry 1 CME point under the MCHK/HKMA CME Programme (unless otherwise stated). Accreditation from other colleges is pending. (The Secretariat fax no.: 2865 0943)

Please be informed that Confirmation Letter of Registration is required. If you have not received any replies, please do not hesitate to contact us at 2527 8452.

報名方法：請填妥表格連同支票寄交香港灣仔軒尼詩道十五號溫莎公爵社會服務大廈五樓，支票抬頭請書明支付「香港醫學會」。參加者可獲醫務委員會/香港醫學會持續醫學進修計劃積分一分 (除特別註明外)。其他專科學院之學分尚在申請中。(秘書處傳真號碼：2865 0943) 參加者需持有講課確認通知書出席持續醫學進修講課。假若你沒有收到任何通知,請致電2527 8452查詢。

Please register for participation. First come, first served. 名額有限請早登記

I enclose herewith a cheque of 現隨表格附上支票一張作為講課之報名費用：HK$港幣 ______________

Name 姓名：__________________________ Tel No 電話：___________________ Fax No.傳真 : ___________________

HKMA Membership No. 會員編號 or HKMA CME No. 或進修號碼：______________________________ Signature 簽名： ____________________________

Data collected will be used and processed for the purposes related to the MCHK/HKMA CME Programme only. All registration fees are not refundable or transferable.個人資料將用於有關香港醫學會持續醫學進修計劃之事宜。所有報名費用將不給予退還或轉授予其他會員。

Reply Slip 回條

I would like to register for the following CME lecture(s):本人欲報名參加以下講課：

Please“✔”as appropriate. 請在適用處加上 ✔ 號

HKMA Structured CME Programme with HKS&H HKMA Member CME Participants

13 September 2007: HKMA Structured CME Programme with HKS&H Year 2007 – Robotic Surgery in Urology

HK$50 □ HK$80 □

18 HKMA Aug 2007

CME NOTIFICATION

www.hkmacme.org

HKMA Structured CME Programme at Kwong Wah Hospital香港醫學會 ─ 廣華醫院分科進修課程

Hong Kong Medical Association Kwong Wah Hospital

LECTURE DATE TOPIC

V 26 August 2007 Cardiology1. Update in Management of Heart Failure Dr. TAM Li Wah Associate Consultant, Integrated Medical Service, KWH & TWGHs WTSH

2. Exercise Test for Chest Pain Dr. TSANG Chi Yan, Vincent Resident, Integrated Medical Service, KWH & TWGHs WTSH

VI 30 September 2007 Respiratory Medicine1. COPD – An Update Dr. LAM Siu Pui Senior Medical Officer, Integrated Medical Service, KWH & TWGHs WTSH

2. Management of Adult Onset Asthma Dr. YEE Kwok San, Wilson Senior Medical Officer, Integrated Medical Service, KWH & TWGHs WTSH

Venue

地點

Time

時間

Fee

報名費用

Lecture Theatre, 10/F, Yu Chun Keung Memorial Medical Centre, KWH

廣華醫院余振強紀念中心十樓演講廳

2:00–5:00 p.m.

下午二時至五時

HK$50 per lecture for HKMA MembersHK$80 per lecture for CME Participants

醫學會會員 - 每課堂港幣五十元正持續進修參加者 - 每課堂港幣八十元正

REGISTRATION:Please fill in and return the Registration Form on p.19 together with a cheque for the correct amount made payable to “The Hong Kong Medical Association” to 5/F Duke of Windsor Social Service Building, 15 Hennessy Road, Hong Kong. Each lecture will carry 3 CME points under the MCHK/HKMA CME Programme.

報名方法:請填妥第19頁之表格連同支票寄交香港灣仔軒尼詩道十五號溫莎公爵社會服務大廈五樓，支票抬頭請書明支付「香港醫學會」。參加者可獲醫務委員會/香港醫學會持續醫學進修計劃積分三分。

Light snacks and lecture notes will be provided.

敬備茶點及講義

Jointly organized by

Venue will be changed to: 8A, Training Centre,

8/F., Administration Building, Kwong Wah Hospital

19HKMA Aug 2007

CME NOTIFICATION

www.hkmacme.org

HKMA Structured CME Programme at Queen Elizabeth Hospital香港醫學會 ─ 伊利沙伯醫院分科進修課程

Hong Kong Medical Association Queen Elizabeth Hospital

Jointly organized by

LECTURE DATE TOPIC

VI 9 September 2007 Orthopaedics1. Wrist & Hand Pain — Common Conditions & Diagnostic Approach Dr. LO Che Yuen Senior Medical Officer, Dept of Orthopaedics, QEH

2. Approach to Back Pain and Related Conditions Dr. CHIN Ping Hong, Raymond Consultant, Dept of Orthopaedics, QEH

VII 7 October 2007 Neurosurgery1. Neurosurgical Management of Pituitary Diseases Dr. LEUNG Cheong Lun, Samuel Chief of Service, Dept of Neurosurgery, QEH

2. Neurosurgical Treatment of Spinal Diseases Dr. TSE Tat Shing Associate Consultant, Dept of Neurosurgery, QEH

Pathology1. Antibiotics Treatment for Common Infection in General Practice Dr. WONG Yat Ni, Stephenie Resident, Dept of Pathology, QEH

Venue 地點

Time時間

Lecture Theatre, G/F, Block M, QEH伊利沙伯醫院 M 座地下演講廳

2:00–5:00 p.m.下午二時至五時

Please register for participation. First come, first served. 名額有限請早登記

Light snacks and lecture notes will be provided. 敬備茶點及講義

Fee HK$50 per lecture for HKMA Members報名費用 HK$80 per lecture for CME Participants

醫學會會員 - 每課堂港幣五十元正持續進修參加者 - 每課堂港幣八十元正

I enclose herewith a cheque of 現隨表格附上支票一張作為講課之報名費用：HK$港幣 ______________

Name 姓名：______________________________________ Tel No. 電話：________________________ Fax No.傳真 : ________________________

HKMA Membership No. 會員編號： or HKMA CME No. 或進修號碼：_________________________________ Signature 簽名： _________________________________________________

Data collected will be used and processed for the purposes related to the MCHK/HKMA CME Programme only. All registration fees are not refundable or transferable.個人資料將用於有關香港醫學會持續醫學進修計劃之事宜。所有報名費用將不給予退還或轉授予其他會員。

HKMA Member

香港醫學會會員

CME Participants (Non-HKMA member)

持續進修參加者（非香港醫學會會員）

HK$50 HK$80

KWH

26 August 2007 Cardiology

30 September 2007 Respiratory Medicine Venue will be changed to: 8A Training Centre, 8/F Administration Building, KWH

QEH9 September 2007 Orthopaedics

7 October 2007 Neurosurgery & Pathology

Please“✔”as appropriate. 請在適用處加上 ✔ 號

I would like to register for the following lecture(s) 本人欲參加下列講課：

HKMA Structured CME Programme at QEH/KWH — Registration Form 香港醫學會分科進修課程報名表格

20 HKMA Aug 2007

CME NOTIFICATION

www.hkmacme.org

The Hong Kong College of Family Physicians

The Hong KongMedical Association

Our Lady ofMaryknoll Hospital

A certificate will be presented at the end of the course for those achieving > 80% of attendance

CME AccreditationCME accredited by HK College of Family Physicians 2 credit points and HK Medical Association 2 credit points (for MCHK non-specialist)

Please note that NO LUNCH will be provided.

DATE TOPIC SPEAKER

8 September 07 Common ENT Problems in General Practice

Dr. LAU Sai KitSpecialist in ENT in Private Practice

13 October 07 Red Eyes in Primary Care Dr. HO Kai KitSpecialist in Ophthalmology in Private Practice

10 November 07 Approach to Patients with Depression

Dr. CHAN Sai YinSpecialist in Psychiatry in Private Practice

8 December 07 Primary Care Approach to Patientswith Palpitation

Dr. HUNG Yu TakSpecialist in Cardiology, OLMH

12 January 08 Management of Peptic Ulcer Disease and GERD in Primary Care

Dr. TO Hing Ting Specialist in Gastroenterology, OLMH

2 February 08 Dermatological Emergencies Dr. WONG Mon ChingSpecialist in Dermatology in Private Practice

8 March 08 Counselling in Primary Care Dr. Anthony HO Specialist in Family Medicine, Department of Health

12 April 08 Pre-travel Health Service and Update Dr. FAN Pang YungPort Health Officer, Port Health Office, Department of Health

10 May 08 Palliative Care Services in Hong Kong Dr. KWOK Oi Ling Specialist in Palliative Care, OLMH

14 June 08 Management of Febrile Children with Rash

Dr. KO Po WanSpecialist in Paediatrics, OLMH/CMC

12 July 08 Contraception and New Developments

Dr. Grace WONGSenior doctor, Family Planning Association

9 August 08 Handling Demented Patients in Primary Care

Dr. LAU Sze TingSpecialist in Geriatrics, OLMH

Venue: Training Room II, 1/F, OPD Block, Our Lady of Maryknoll Hospital, 118 Shatin Pass Road, Wong Tai Sin, KowloonTime: 14:30 to 16:30

Refresher Course for Health Care Providers 2007/2008Jointly organized by

Hong Kong Medical Association, The Hong Kong College of Family PhysiciansOur Lady of Maryknoll Hospital

Limited car parking can be reserved, on first come first served basis.RSVP: Tel: 2354 2440 (Ms Clara Tsang, OLMH) Fax: 2327 6852

21HKMA Aug 2007

INTERNATIONAL CALENDAR

www.hkmacme.org

OCTOBER 2007

01/10–05/1021st World Congress of DermatologyBuenos Aires, ArgentinaWebsite: www.dermato2007.org

03/10–07/102007 Scientific Assembly of the American Academy of Family PhysiciansChicago, ILWebsite: www.aafp.org

04/10–07/1078th Annual Meeting of the American Thyroid AssociationNew York, NYWebsite: www.thyroid.org

06/10–08/1048th Annual Meeting of the European Society for Paediatric ResearchPrague, Czech RepublicWebsite: www.kenes.com/espr07/index.asp

07/10–11/1093rd Annual Clinical Congress of the American College of SurgeonsNew Orleans, LAWebsite: www.facs.org

08/10–13/1089th Annual Meeting of the American Association of Oral and Maxillofacial SurgeonsHonolulu, HawaiiWebsite: www.aaoms.org

13/10–17/1020th Congress of the European College of NeuropsychopharmacologyVienna, AustriaWebsite: www.ecnp.nl

13/10–17/10Annual Meeting of the American Society of AnesthesiologistsSan Francisco, CAWebsite: www.asahq.org

13/10–17/1063rd Annual Meeting of the American Society of Reproductive MedicineWashington DC, USAWebsite: www.asrm.org

SEPTEMBER 2007

01/09–05/09European Society of Cardiology Congress 2007Vienna, AustriaWebsite: www.escardio.org

02/09–06/0912th World Conference on Lung CancerSeoul, KoreaWebsite: www.2007worldlungcancer.org

02/09–06/0929th Congress of the Societe Internationale d’UrologieParis, FranceWebsite: www.siu-urology.org

05/09–08/0937th Meeting of the European Society for Dermatological ResearchZurich, SwitzerlandWebsite: www.esdr.org

15/09–20/0957th Annual Meeting of the Congress of Neurological SurgeonsSan Diego, CAWebsite: www.neurosurgeon.org

17/09–21/0943rd Annual Meeting of the European Association for the Study of DiabetesAmsterdam, NetherlandsWebsite: www.easd.org

20/09-23/09European Society for Vascular SurgeryMadrid, SpainWebsite: www.esvs.org

21/09–25/0920th Asian and Oceanic Congress of Obstetrics and GynecologyTokyo, JapanWebsite: www.ics-inc.co.jp/aocog2007/

25/09–28/094th World Congress of the World Institute of PainBudapest, HungaryWebsite: www.kenes.com/wip/

22 HKMA Aug 2007

INTERNATIONAL CALENDAR

www.hkmacme.org

20/10–25/10CHEST 2007Chicago, ILWebsite: www.chestnet.org

23/10–28/1054th Annual Meeting of the American Academy of Child & Adolescent Psychiatry Boston, MAWebsite: www.aacap.org

27/10–28/102nd Joint Scientific Meeting of The Royal College of Radiologists & Hong Kong College of Radiologists and 15th Annual Scientific Meeting of Hong Kong College of Radiologists Hong KongWebsite: www.hkcr.org

28/10–01/1115th International Meeting of the European Society of Gynaecological OncologyBerlin, GermanyWebsite: www.esgo.org/esgo15/

NOVEMBER 2007

04/11–07/11American Heart Association Scientific Sessions 2007Orlando, FLWebsite: www.americanheart.org

10/11–13/1115th Asian Congress of AnesthesiologistsPattaya, ThailandWebsite: www.aca2007.org

14/11–16/1114th Hong Kong International Cancer Congress, 4th Annual Meeting of Centre for Cancer Research & International Think Tank ForumHong KongWebsite: www.hkicc.org/f_general.htm

15/11–18/115th World Congress of the World Society for Pediatric Infectious DiseasesBangkok, ThailandWebsite: www.wspid.com

22/11–25/116th Echo Hong KongHong KongWebsite: www.globalevent.hk/echo2007/

28/11–02/12World Psychiatry Association International Congress 2007Melbourne, AustraliaWebsite: www.wpanet.org/home.html

29/11–02/1214th Congress of the ASEAN Federation of Endocrine SocietiesKuala Lumpur, MalaysiaWebsite: www.afes2007.com/program.htm

30/11–04/1212th Congress of the Asia Pacific Society of RespirologyGold Coast, AustraliaWebsite: www.apsresp.org

DECEMBER 2007

02/12–06/12World Allergy Congress 2007Bangkok, ThailandWebsite: www.worldallergy.org, www.congrex.com/wac2007/

08/12–11/1249th Annual Meeting and Exposition of the American Society of HematologyAtlanta, GAWebsite: www.hematology.org

09/12–13/1217th International Congress on Parkinson’s Disease and Related DisordersAmsterdam, NetherlandsWebsite: www.parkinson2007.de

13/12–16/12San Antonio Breast Cancer SymposiumSan Antonio, TXWebsite: www.sabcs.org

13/12–16/12The 16th Asian Pacific Congress of CardiologyTaipei, TaiwanWebsite: www.apcc2007.prg

23HKMA Aug 2007

CME CALENDAR

www.hkmacme.org

Hong Kong Doctors Union ➊Nutrition and Primary Care Making the Connection2:15–3:15 pmRoom 901, Hang Shing Bldg, 363-373, Nathan Road, Kowloon Tel: 2388 2728

HA-PWH-Dept of Clinical Oncology HK College of RadiologistsTopic Review2:30–3:30 pmLecture Room, Dept. of Clinical Oncology, PWH Ms. Diane Lee – Tel: 2871 8830

HA-PWH-Dept of Clinical Oncology ➊HK College of RadiologistsCombined Breast Cancer Meeting1:00–2:00 pmMeeting Room, Dept. of Clinical Oncology, PWH Ms. Diane Lee – Tel: 2871 8830

HKDU-Sheung Shui Study Group ➊Common Shoulder Pain in Elderly1:00–3:00 pm新界上水龍琛路 33 號龍豐花園商場 1 樓囍宴大酒樓 – Tel: 2388 2728

Hong Kong College of Community Medicine ➋Review Meeting in areas related to Public Health Medicine6:00–8:00 pmCentre for Health Protection in Argyle Street/ Wu Chung House Ms. Fanny Kwong – Tel: 2871 8745

HKDU-Shatin Study Group ➊A New Approach in Asthma Management1:00–3:00 pmRoyal Park Chinese Restaurant, Level 2, Royal Park Hotel, 8 Pak Hok Ting Street, Shatin, NT Tel: 2388 2728

HK College of Family Physicians ➌Sports Medicine Course: 1) Common Running Injuries2) Rehabilitation of sports injuries3) Sports Nutrition2:00–5:00 pmDr. Wu Yee Sun Lecture Theatre NAB209 Lam Woo International Conference Centre, Shaw Campus, Hong Kong Baptist University, 34 Renfrew Roa, Kowloon Tong, Kowloon Ms. Carmen Cheng – Tel: 2861 1808

HK College of Family Physicians ➌Assessment Enhancement Course 2007 — Physical Examination Technique & Common Clinic Procedural Skills2:15–5:15 pm8/F, Duke of Windsor Social Service Building, Wanchai Ms. Carmen Cheng – Tel: 2861 1808

HA – United Christian Hospital ➋Refresher Course for Health Personnel 2007 — Drug Treatment for DM-Highlight from recent studies2:15–3:45 pmLecture Theatre, G/F, Block P, UCH Ms. Marina Pun – Tel: 3513 4888

HA – Our Lady of Maryknoll Hospital, Family Medicine ➌Smoking Cessation Counseling Training Program1:45–5:00 pmOur Lady of Maryknoll Hospital Clara Tsang – Tel: 23542440

CUHK – Department of Medicine & Therapeutics CUHK Certificate in Advances in Medicine 2007 – 9A1:30–4:00 pmShaw Auditorium, 1/F., Postgraduate Education Centre, Ms. Carrie Chan – Tel: 2632 3996

CUHK – Department of Medicine & Therapeutics CUHK Diploma in Advances in Medicine 2007/2008 – 9A1:30–4:00 pmShaw Auditorium, 1/F., Postgraduate Education Centre, PWH Ms. Carrie Chan – Tel: 2632 3996

持續進修日程August 2007

CUHK – Department of Medicine & Therapeutics CUHK Certificate in Advances in Medicine 2007 – 9B4:30–7:00 pmShaw Auditorium, 1/F., Postgraduate Education Centre, Prince of Wales Hospital Ms. Carrie Chan – Tel: 2632 3996

CUHK – Department of Medicine & Therapeutics CUHK Diploma in Advances in Medicine 2007/2008 – 9B4:30–7:00 pmShaw Auditorium, 1/F., Postgraduate Education Centre, PWH Ms. Carrie Chan – Tel: 2632 3996

The World Federation for Mental Health; ➓New Life Psychiatric Rehabilitation Association; The Mental Health Association of Hong Kong; The Hong Kong College of PsychiatristsImpact of Culture on Mental Health: East meets WestJockey Club Auditorium, The Hong Kong Polytechnic University Tel: 2778 7173

HA-PWH-Dept of Clinical Oncology ➊HK College of Radiologists10:00–11:00 amCombined Head and Neck MeetingA.K.C.Surgical Library, 4/F, Clinical Sciences Building, PWH Ms. Diane Lee – Tel: 2871 8830

HA – Tuen Mun Hospital ➎Adult In-hosp Cardiac Arrest Management Course (AIHCAM)9:00 am–5:30 pmTraining Centre, 1/F, Block A, NQ, TMH Cookies Kong – Tel: 2468 5777

HK College of Psychiatrists ➌Central Academic Course Term V 1) Head Injury: Psychiatric Sequelae. 2) Head Injury: Legal Aspects. 3) Neuropsychiatric Manifestations of Autoimmune Disease. 4) Seminar II – Recent Topics2:30–5:45 pmClassroom/Seminar Room 52, 1/F, Block J, AHNH Ms. Karen – Tel: 2871 8777

HK College of Psychiatrists ➌Central Academic Course Term II — Risk Factors of Suicide on Psychiatric Patients: 1) Psychiatric in patient Suicide. 2) Psychiatric Discharged Patient Suicide2:30–5:45 pmLecture Theatre, Professional Development and Learning Resources Centre, LG/F, Block B, Kwai Chung Hospital Ms. Karen – Tel: 2871 8777

HA-PWH-Dept of Clinical Oncology ➊HK College of RadiologistsCases Presentation2:30–3:30 pmLecture Room, Dept. of Clinical Oncology, PWH Ms. Diane Lee – Tel: 2871 8830

HKU – Department of Surgery ➓Advanced Trauma Life Support (ATLS) Student CourseSkills Development Centre, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong Medical Centre, Queen Mary Hospital Program Manager, Skills Development Centre, Department of Surgery – Tel: 2855 4885

HK Society of Dermatology & Venereology ➎The Hong Kong Association of Specialists in Dermatology (HKASD)SHMT Dermatology Summit 2007( 二零零七滬港澳臺兩岸四地皮膚科高層學術論壇 )

8:00 am–5:15 pmLecture Theatre of the Li Ka Shing, Faculty of Medicine Building of the University of Hong Kong Ms. Sigourney Liu – Tel: 2290 1717

~

SUN~THU

1923

16THU

17FRI

18SAT

21TUE

Note: For each issue of the CME Bulletin, we shall try our best to include all the CME activities for the month, which are made known to the Association Secretariat. Members interested in any of these functions are encouraged to check with the individual Colleges for credit points awarded by the Colleges and with respective organizers for confirmation of the details.

Pharmaceutical advertisements are welcome. For advertising rates and placement details, please contact Michelle Wong at Tel: 2965 1300, Fax: 3764 0374 or email: [email protected]

Your comments to the HKMA CME Bulletin are most welcome. Please send your opinion to Dr. Wong Bun Lap, Bernard, Editor of HKMA CME Bulletin, by fax at 2865 0943 or via e-mail at [email protected]

15WED

19SUN

22WED

~

FRI~SUN

2426

25SAT

24 HKMA Aug 2007

CME CALENDAR

www.hkmacme.org

26SUN

HA – Our Lady of Maryknoll Hospital, Family Medicine ➌ Smoking Cessation Counseling Training Program1:45–5:00 pmOur Lady of Maryknoll Hospital Clara Tsang – Tel: 23542440

Hong Kong Medical Association ➌HA-Kwong Wah HospitalHKMA Structured CME Programme at KWH 07/08 (V) — Cardiology2:00–5:00 pmLecture Theatre, 10/F, Yu Chun Keung Memorial Medical Centre, KWH Tel: 2861 1979 / Mem: $50, Non-Mem: $80

HKU-Dept of Obstetrics & Gynaecology ➋Research Meeting8:30–10:00 amK509, Seminar Room, Professorial Block, Queen Mary Hospital Ms. Annie Chow – Tel: 2855 3401

HA-PWH-Dept of Clinical Oncology ➊HK College of Radiologists10:00–11:00 amCombined Head and Neck MeetingA.K.C.Surgical Library, 4/F, Clinical Sciences Building, PWH Ms. Diane Lee – Tel: 2871 8830

HK College of Psychiatrists ➌Central Academic Course Term V 1) Assessment of Dangerousness, Predicting Violence. 2) Mental Disorder and Violence.3) Case Conference II or Video Demonstration — Mental Health Ordinance2:30–5:45 pmG073-074, Block D, Lecture Theatre, CPH Ms. Karen – Tel: 2871 8777

HK College of Psychiatrists ➌Central Academic Course Term II1) Disorders of Sexual Preference, Gender Identity & Its Management. 2) Case Conference III or Video Demonstration — Sexual Disorders2:30–5:45 pmSeminar Room, 2/F, Block J, Queen Mary Hospital Ms. Karen – Tel: 2871 8777

HA – Pamela Youde Nethersole Eastern Hospital, ➊Paediatrics Dept co-joint with Comprehensive Paediatric Rehabilitation CentreEducation Programme on Paediatric Rehabilitation — Occupational Therapy for Children with Handwriting Difficulties4:30–5:30 pmChild and Youth Health Link, Ward D6, 6/F Main Block, PYNEH. Lai Pui Shan – Tel: 25956706

HA-PWH-Dept of Clinical Oncology ➊HK College of RadiologistsTopic Review2:30–3:30 pmLecture Room, Dept. of Clinical Oncology, PWH Ms. Diane Lee – Tel: 2871 8830

Caritas Medical Centre & Hong Kong College of ➊Family PhysiciansTopic: Drugs Commonly Used in Psychiatry2:00–3:00 pmSpeaker: Dr. HO Pui Tat Lecture Theatre, G/F., Wai Oi Block, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Kowloon Mr. Dennis Lau at 2785 7871 before 25 August 2007


Hong Kong College of Emergency Medicine ➓American Heart Association Advanced Cardiovascular Life Support (ACLS) Course (2 Days)3/F., A&E Training Centre, Tang Shui Kin Hospital Ms. Juana Ng – Tel: 2871 8877

Hong Kong Medical Association ➋4th Exercise Prescription Certificate Course2:00–4:15 pmLecture Theatre, Ruttonjee Hosptial, 266 Queen’s Road East, HK Ms. Gloria Cheung

St. Teresa’s Hospital; College of Surgeon of HK ➋Minimally Invasive Surgery: Abdomen Eueginics10:00–11:30 amSt. Teresa’s Hospital Dr. Lawrence Chan – Tel: 2771 2312

HKU-Dept of Obstetrics & Gynaecology ➋Journal Club8:30–10:00 amK509, Seminar Room, Professorial Block, Queen Mary Hospita Ms. Annie Chow – Tel: 2855 3401l

HA-PWH-Dept of Clinical Oncology ➊HK College of RadiologistsCombined Head and Neck Meeting10:00–11:00 amA.K.C.Surgical Library, 4/F, Clinical Sciences Building, PWHMs. Diane Lee – Tel: 2871 8830

HK College of Psychiatrists ➌Central Academic Course Term V 1) Management of MI Offenders 1: In Institutions. 2) 1: Management of M1 Offenders 2: In Community 3) Case Conference III or Video Demonstration — Forensic Psychiatry2:30–5:45 pmG073-074, Block D, Lecture Theatre, CPH Ms. Karen – Tel: 2871 8777

HK College of Psychiatrists ➌Central Academic Course Term II 1) Factitious Disorders, Malignering, Manchausen Syndrome. 2) The Role of a Liaison Psychiatrist. 3) Case Conference IV or Video Demonstration – Liaison 2:30–5:45 pmLecture Theatre, Professional Development and Learning Resources Centre, LG/F, Block B, Kwai Chung Hospital Ms. Karen – Tel: 2871 8777

HA – Castle Peak Hospital, Psychiatry Dept ➋Basic Cognitive Behavioural Treatment for Older People withMood Problems11:30 am–1:00 pmLecture Theatre, Blk D, CPH Ms. Cherry Man – Tel: 2456 7855

HA – Pamela Youde Nethersole Eastern Hospital, ➊Paediatrics Dept co-joint with Comprehensive Paediatric Rehabilitation CentreEducation Programme on Paediatric Rehabilitation – Craniosacral Therapy and Its Application in Paediatrics4:30–5:30 pmChild and Youth Health Link, Ward D6, 6/F Main Block, PYNEH. Lai Pui Shan – Tel: 25956706

HA-PWH-Dept of Clinical Oncology ➊HK College of RadiologistsTopic Review2:30–3:30 pmLecture Room, Dept. of Clinical Oncology, PWH Ms. Diane Lee – Tel: 2871 8830

Hong Kong College of Emergency Medicine ➋Joint Clinical Meeting & Didactic Lectures5:00–7:30 pm7/F, Block H, Lecture Theatre, Princess Margaret Hospital Ms. Juana Ng – Tel: 2871 8877


持續進修日程 September 2007

29WED

28TUE

30WED

~

THU~FRI

3031

1SAT

2SUN

3MON

4TUE

5WED

6THU

25HKMA Aug 2007

CME CALENDAR

www.hkmacme.org

HA – Tuen Mun Hospital, Family Medicine ➊Management (Physical Therapy) of Musculoskeletal Pain in Primary Care (knees/elbow/shouder/non-IDD Lap, etc)17:30–18:45 pm3/F, Yan Oi GOPC, Tuen Mun Cowin Tang – Tel: 2468 6601

Hong Kong Doctors Union ➊Diabetes: Managing A 21st Century Lifestyle Disease2:15–3:15 pmRoom 901, Hang Shing Bldg, 363-373, Nathan Road, Kowloon Tel: 2388 2728

Hong Kong College of Community Medicine ➋Review Meeting in areas related to Public Health Medicine6:00–8:00 pmCentre for Health Protection in Argyle Street/Wu Chung House Ms. Fanny Kwong – Tel: 2871 8745

Hong Kong Baptist Hospital Minimal Access therapy for Carcinoma of Rectum8:00–9:30 amThe Chapel, 9/F., Hong Kong Baptist Hospital Ms. Luk – Tel: 2339 8872

Hong Kong College of Emergency Medicine ➌American Heart Association Basic Life Support (BLS) Course for Healthcare Providers 20073/F, A&E Training Centre, Tang Shiu Kin Hospital Ms. Juana Ng – Tel: 2871 8877

HKU – Dept of Surgery ➓Advanced Trauma Life Support (ATLS) Student CourseSkills Development Centre, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong Medical Centre, QMH Tel: 2855 4885

Hong Kong Medical Association ➋4th Exercise Prescription Certificate Course2:00–4:15 pmLecture Theatre, Ruttonjee Hosptial, 266 Queen’s Road East, HK Ms. Gloria Cheung

HKU – Dept of Surgery ➎Pre-Hospital Trauma Life Support (PHTLS) Provider Course – Day 18:45–6:40 pmHong Kong St. John Ambulance Association, 2 Mcdonnell Road, HK Tel: 2530 8015

HK Society of Gastroenterology ➌9th Joint Annual Scientific Meeting1:00–7:20 pmLangham Place Hotel, Mongkok, Kowloon Ms. Celia Tam – Tel: 2869 5933

The Society of Physicians of HK1) PTCA -Update on Advances, Indications and Risks2) Sudden Cardiac Death - Aetiology and Prevention3) Drug Addiction 1/ Case Presentation4) Drug Addiction 211:00 am–4:30 pmHKMA Dr. Li Shu Pui Profession Education Centre, 2/F, Chinese Club Building, 21-22 Connaught Road Central, HK Ms. Becky Chiu – Tel: 2526 2626

HKMA and Queen Elizabeth Hospital ➌HKMA Structured CME Programme at QEH Year 07/08 (VI) – Orthopaedics2:00–5:00 pmLecture Theatre, G/F., Block M, Queen Elizabeth Hospital Tel: 2861 1979 / Mem: $50, Non-Mem: $80

HA-PWH-Dept of Clinical Oncology ➊HK College of RadiologistsCombined Head and Neck Meeting10:00–11:00 amA.K.C.Surgical Library, 4/F, Clinical Sciences Building, PWH Ms. Diane Lee – Tel: 2871 8830

HK College of Psychiatrists ➌Central Academic Course Term V 1) Dementia: Epidemiology and Basic Concepts. 2) Other Dementia: Clinical Features and Diagnosis. 3) Cortical dementia: Clinical Features, Psychopathology & Diagnosis2:30–5:45 pmG073-074, Block D, Lecture Theatre, CPH Ms. Karen – Tel 2871 8777

HA – New Territories West Private Practitioners’ ➊ Network Community Medical Program – Carcinoma of Colon2:00–3:00 pmRoom D1002, 1/F, Main Block, TMH Ms Leung Ho Yan – Tel: 2468 6249

HK College of Psychiatrists ➌Central Academic Course Term II 1) Somatization & Somatoform Disorders, Hypochorndriacal Disorders. 2) Psychogenic Pain & Management. 3) Human Sexuality, Sexual Function Physiology. 4) Sexual Dysfunction & Its Management2:30–5:45 pmSeminar Room, 2/F, Block J, Queen Mary Hospital Ms. Karen – Tel: 2871 8777

Union Hospital ➊X-Ray Meeting8:30–9:30 pmConference Room, 2/F., Medical Centre, Union Hospital, 18 Fu Kin Street, Tai Wai, NT Marketing Department – Tel: 2608 3180

HA-PWH-Dept of Clinical Oncology ➊HK College of RadiologistsJournal Critique2:30–3:30 pmLecture Room, Dept. of Clinical Oncology, PWH Ms. Diane Lee – Tel: 2871 8830

Hong Kong Poison Information Centre; ➋ Hong Kong College of Emergency MedicineMonthly Clinical Meeting4:30–6:30 pmBlock F, Lecture Theatre, United Christian Hospital Ms. Bejyork Wong – Tel: 3513 5089

Hong Kong Society of Clinical Toxicology and ➊Hong Kong College of Emergency MedicineConjoint Toxicology Round6:30–7:30 pmF1 Lecture Theatre, Block F, United Christian Hospital Ms. Bejyork Wong – Tel: 3513 5089

Hong Kong Sanatorium & Hospital – Orthopaedic ➊and Sports Medicine CentreOrthopaedic Clinical Meeting (Every Second Thursday of the Month)8:30–9:30 amRoom 1103, 11/F, Li Shu Pui Block, Hong Kong Sanatorium & Hospital Ms. Eva Wong – Tel: 2835 7890

HKDU-Kwun Tong Study Group ➊What is New in Hepatitis B?1:00–3:00 pm九龍觀塘道 410 號觀點中心 2 樓新馥苑海鮮酒家Tel: 2388 2728

HKMA - Hong Kong Sanatorium & Hospital ➊HKMA Structured CME Programme with HKS&H Session 9: Robotic Surgery in Urology2:00–3:00 pmThe HKMA Dr. Li Shu Pui Professional Education Centre, 2/F, Chinese Club Building, 21-22 Connaught Road Central, HK Tel: 2861 1979 Mem: $50, Non-Mem: $80

HKU-Dept of Medicine ➎Train the Trainer Workshop on Osteoporosis8:30 am–4:00 pmLecture Theatre 2, G/F, Cheung Kung Hai Conference Centre, William MW Mong Block, 21 Sassoon Road, Pokfulam Ms. Chan Wai man – Tei: 2855 4353

HKDU-Tsuen Wan Study Group ➊What is New in Hepatitis B?1:00–3:00 pmSuper Star Restaurant, Shop G02, Ground Floor, CDW Building, 388 Castle Peak Road, Tsuen Wan, NT Tel: 2388 2728

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meningococcal meningitis infectious disease cns cation to excellence in the exchange of information....

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