Kwok Kuen Shing

The Chinese University of Hong Kong, Hong Kong, Hong Kong

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Publications (4)6.67 Total impact

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    ABSTRACT: This study investigated the discriminatory features of severe acute respiratory syndrome (SARS) and severe non-SARS community-acquired viral respiratory infection (requiring hospitalization) in an emergency department in Hong Kong. In a case-control study, clinical, laboratory and radiological data from 322 patients with laboratory-confirmed SARS from the 2003 SARS outbreak were compared with the data of 253 non-SARS adult patients with confirmed viral respiratory tract infection from 2004 in order to identify discriminatory features. Among the non-SARS patients, 235 (93%) were diagnosed as having influenza infections (primarily H3N2 subtype) and 77 (30%) had radiological evidence of pneumonia. In the early phase of the illness and after adjusting for baseline characteristics, SARS patients were less likely to have lower respiratory symptoms (e.g. sputum production, shortness of breath, chest pain) and more likely to have myalgia (p < 0.001). SARS patients had lower mean leukocyte and neutrophil counts (p < 0.0001) and more commonly had "ground-glass" radiological changes with no pleural effusion. Despite having a younger average age, SARS patients had a more aggressive respiratory course requiring admission to the ICU and a higher mortality rate. The area under the receiver operator characteristic curve for predicting SARS when all variables were considered was 0.983. Using a cutoff score of >99, the sensitivity was 89.1% (95%CI 82.0-94.0) and the specificity was 98.0% (95%CI 95.4-99.3). The area under the receiver operator characteristic curve for predicting SARS when all variables except radiological change were considered was 0.933. Using a cutoff score of >8, the sensitivity was 80.7% (95%CI 72.4-87.3) and the specificity was 94.5% (95%CI 90.9-96.9). Certain clinical manifestations and laboratory changes may help to distinguish SARS from other influenza-like illnesses. Scoring systems may help identify patients who should receive more specific tests for influenza or SARS.
    No preview · Article · Feb 2007 · European Journal of Clinical Microbiology
  • K.K. Shing · K.T. Wong · G.E. Antonio · S.J. Lolge · A.T. Ahuja
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    ABSTRACT: Case 1: A 52-year-old woman presented with gross haematuria associated with right loin pain for 3 days. On physical examination, she was tender over the right loin region but was afebrile. Blood tests were essentially normal. Based on these findings, a renal calculus was suspected. A KUB was performed as an initial investigation (Fig. 1a) followed by an IVU a few days later (Fig. 1b). Questions: (1) What radiological abnormality can you see? (2) What is the diagnosis? Case 2: A 45-year-old man, with a known history of left renal calculus, complained of severe left loin pain for one day. The pain was colicky and sharp in nature and radiated to the left groin. Physical examination was essentially normal. Urine examination was positive for RBC and negative for WBC. Blood tests were unremarkable. A clinical diagnosis of ureteric colic was suspected. A KUB (Fig.2a) followed by an IVU (Fig.2b) a few days later was performed. Questions: (1) What radiological abnormality can you see? (2) What is the diagnosis? Case 3: A 49-year-old woman was recently diagnosed with carcinoma of the cervix. She presented with bilateral loin pain and fever for 3 days. Physical examination showed ballotable kidneys with local tenderness. There was no haematuria. Laboratory investigations revealed elevated serum creatinine and white cell count. KUB showed no definite radio-opaque urinary calculus. She was suspected to have a urinary tract obstruction. An urgent ultrasound of the abdomen was performed (Fig. 3a).
    No preview · Chapter · Jan 2006
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    ABSTRACT: The purpose of the study was to evaluate the use of chest radiography for the screening of severe acute respiratory syndrome (SARS). We retrospectively analyzed all patients who attended an Emergency Department SARS screening clinic during the outbreak in Hong Kong, from March 10 to June 5, 2003. Patients with clinical and epidemiologic suspicion of SARS were evaluated by serial chest radiography. All radiographs were reported by consensus from 2 radiologists, blinded to the clinical records. The prevalence of SARS was 13.3% among 1328 patients included. The initial radiograph had sensitivity 50.3%, specificity 95.0%, positive likelihood ratio 10.06, negative likelihood ratio 0.52, positive predictive value 61.5%, and negative predictive value 92.3% for diagnosing SARS. Serial chest radiography had sensitivity 94.4%, specificity 93.9%, positive likelihood ratio 15.48, negative likelihood ratio 0.06, positive predictive value 71.4%, and negative predictive value 99.0%. The initial chest radiograph has poor sensitivity, and serial radiographs are required to rule out SARS.
    No preview · Article · Aug 2005 · American Journal of Emergency Medicine
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    ABSTRACT: We analyzed serial chest radiographic scores for lung opacification in patients with severe acute respiratory syndrome (SARS) for temporal changes and differences between fatal and discharged cases. We sought to establish the earliest radiographic scores sensitive as potential prognostic indicators of fatal outcomes. Chest radiographs that had been obtained from presentation until the death or discharge of 313 patients with SARS were scored on the basis of the percentage area and location of lung opacification. Profile analysis and univariable logistic regression were performed on these radiographic scores. Despite the increased mortality risks of advanced age and male sex, no significant difference was seen in the percentage area of opacification (AO%) between the sexes in either the group of patients with fatal outcomes or the group of patients who were discharged. No difference existed between age groups (< 65 years vs >/= 65 years), except for the radiograph showing the peak lung opacification in the deceased group in which the lungs of older patients had less opacification than those of younger patients. The radiographic scores obtained by day 7 were the earliest ones with good performance in prognostic prediction. The model showed good discriminatory performance, indicated by high C-indexes for receiver operator characteristic curves (0.86 for AO% and 0.90 for the number of opacified zones). The predicted proportion of patients with fatal outcomes showed high agreement with percentage of patients who died (goodness-of-fit statistic p = 0.18 for AO%, 0.73 for the number of opacified zones). By day 7, crude odds ratio of death was 1.73 per 5% of AO% (p < 0.0001) or 2.93 per lung zone opacified (p < 0.0001). Chest radiographic scores (percentage of lung or the number of zones opacified) by day 7 could be used as fatal prognostic indicators.
    No preview · Article · Apr 2005 · American Journal of Roentgenology