For the September issue of the Journal, I am writing this piece in the afternoon of the Mid-Autumn Festival and have a very special feeling of serenity and gratefulness for a few reasons. I am grateful to have been given the opportunity to serve you for the last eight years as President and time indeed flashed by. With the support of you and the council, your Society has grown considerably in her reach to promote the practice of paediatric respirology in Hong Kong and beyond as evidenced by the hosting of the First Asian Paediatric Respirology Forum in Hong Kong from 5th to 7th October. In a month time, I will step down from the Presidency and would like to thank you for the support you have been giving me in the last 8 years.
I am grateful that this Journal has also grown considerably in terms of circulation and quality of papers submitted. Under the able leadership of the Editor and the editorial board, this Journal is now listed in EMBASE. The editorial board has decided to push for SCI indexing in the next 2 years and the format of the Journal will be changed in the next issue so as to match with international standard. This means the President's column will be axed and this is the last President's column published in the Journal. I am feeling relaxed with the end of the column as I no longer need to rush at the last minutes.
I am grateful to have a loving family, good friends, fabulous colleagues and patients and their parents who never fail to support me all these years.
I wish all of you a very happy Mid-Autumn Festival when we should count our blessings and it remains for me to ask you to support the new President and the council who will be duly elected on 6th October 2013.
June 2013 is very hot and wet whilst May 2013 was reported to be the
wettest month in the last 30 years. This hot and wet season sees an
upswing in RSV infection in the community and hospital that of course
keeps our members very busy. Despite your busy schedule, I appeal to
members to prepare the document to support their application as First
Fellow in paediatric respirology. Dr. Alfred Tam, chairman of
accreditation subcommittee of HKSPR, is the person to contact should you
require any information about the application procedure as he has been
dealing with the College of Paediatricians on the matter of paediatric
Your President travelled to Taipei to
attend the 5th Cross-Strait Paediatric Respirology Forum in April and
was impressed by the quality of the forum. The meeting was well attended
with our Society sending 7 members to attend with Dr. SY Lam, Prof.
Ellis Hon and myself giving lectures as well as Dr. Ada Yip presenting a
free paper. Dr. Yip was awarded a prize for her free paper.
Congratulations to her.
We will have our ASM on October 6th in
Sheraton Hotel and it will run concurrent with the 1st Asian Paediatric
Respirology Forum in collaboration with Asian Paediatric Respirology
Interest Group. The topics covered are extensive and speakers, from the
best centres in Asia, Australia and USA, are excellent. Please mark your
diary to stay in Hong Kong for this exciting annual event.
those who are going away for their summer vacation, I wish you a
pleasant trip. For those who are staying in Hong Kong, I wish you summer
fun despite your busy works. See you all in Sheraton in October.
First quarter of 2013 saw the property price in HK hitting another
record height and the announcement of, again, a novel corona virus
identified in the UK that reminds us of course the property price in HK
hitting rock bottom and the SARS epidemic respectively 10 years ago in
The Society has been busy preparing the accreditation of our
subspecialty with meeting the College on April 15th and hosting an
update meeting with all potential first fellows on April 24th. I urge
all members to attend the update meeting to voice your opinions.
This year ASM cum the First Asian Paediatric Respirology Forum will
be held on October 6th in collaboration with the Asian Paediatric
Respirology Interest Group (APRIG) followed by a workshop on
non-invasive ventilation the following day. The program is very well
designed and you can find the details in the current issue announcement.
This meeting provides a unique platform for exchange of ideas between
participants from different countries and speakers. So please mark the
dates in your diary and come join the learning.
March is a special month for your President who was born this month
more than 2 decades ago and I actually wrote this piece on my birthday
by co-incidence. I am most thankful to my family, my friends in Kwong
Wah Hospital who came in with a beautiful birthday cake (photo below) as
I was writing this column and my friends in the Society to make my life
so full of fun. Thank you and I love you all.
I could not believe this is the end of 2012 and I am writing this just past the date for end of the world, December 21, 2012 as suggested by the Mayan calendar. Well the world moves on and we mortals need to keep going with a grateful heart. I wish all members a very Merry Christmas and Happy 2013.
The 15th annual scientific meeting was held on October 7th in Sheraton Hotel with great success. We had over 200 attendees from Hong Kong, Taiwan and China. Please check out the photos posted on our website, hkspr.org. I must thank the organizing committee and the council for making the meeting such a great success. Next year meeting will be held on October 6th in Sheraton Hotel. Please mark your diary.
Your President has been busy in the last 2 months traveling around the region promoting paediatric respirology. An informal group of Asian Paediatric Respirologists have come together to form an interest group, the Asian Paediatric Respirologists Interest Group (APRIG) and your President serves as the convener for the group. APRIG is talking with different groups in this region on the possibility of alliance.
I shall keep you updated on the progress. Our Society sent a delegation to attend the 4th Cross-strait Paediatric Respirology Congress held in Nanchung, China in October and the attendance was over 1,000 and we were impressed by the quality of congress.
Finally, I would like to remind members of the approval of the award of Honorary Fellows of HKSPR in recognition of individuals who have made great contribution to the field of paediatric respirology in Hong Kong in the AGM 2012. Members should forward names of individuals worthy of this award to Dr. TY Miu who heads the panel for this award.
September 2012 sees the beginning of the new school year which is accompanied by the controversy surrounding the "National" education in Hong Kong. Meanwhile, the Society is busy preparing for the coming ASM. This year ASM will be held on October 7th in Sheraton Hotel and the main themes are asthma, neonatology and pneumonia. I encourage members to enroll early to avoid disappointment.
Your President attended the CIPP in Bangkok end of June and was humbled by being presented with the Special CIPP Award by Prof. Andrew Colin for my works in respirology. In fact, the Award belongs to all members of this Society without whose support my works would not have been possible.
I am happy to report that the regular CME meeting of the Society on every last Wednesday of the month has been well at tended and recently we saw attendance from our colleagues from Shenzhen. I hope this participation from outside Hong Kong would become a regular feature and I encourage more members to participate in the CME meeting to make it so much more energetic.
The mid-Autumn Festival is a bit late this year, i.e. last day of September. I wish all of you a happy occasion with your loved ones in the night of full moon.
June 2012 is a special month for Hong Kong as the City is preparing for the arrival of the President of PRC for the July 1st ceremony that sees the new era under Mr. CY Leung. In the last 2 months, your president has travelled twice to Taiwan to talk on different respirology topics. This regional exchange is important to the development of respirology in Hong Kong and Asia. Dr. Alfred Tam has completed the Herculean task of applying for accreditation for respirology and we should hear from College sometime next year.
CIPP XI will be held for the first time in Asia in Bangkok and members are encouraged to attend this superb congress. The Society annual scientific meeting will be held on October 7th in Sheraton Hotel. From the program attached in this issue of the Journal , you will find this to be highly educational with excellent speakers from all over the world. Please mark the diary and I look forward to seeing you there. Meanwhile, enjoy the summer with your loved ones!
March 2012 sees the heat of election for the next CE and we are treated with the spectacular debate between the candidates and their more "inner" issues. The new CE, Mr. CY Leung will lead us for at least 5 years. Meanwhile, your Society also welcomes the new Editor for our journal, JPRCC, Dr. Johnny YC Chan. Dr. Chan is currently the assistant professor in the School of Public Health, Chinese University of Hong Kong and I am sure he will take our journal to a new height with support from all members.
Dr. Alfred Tam has been busy working on the submission to the College of our accredited training program. Hopefully it will be submitted within this year. Your President will travel to Taipei next month to join the annual meeting of our Taiwan brethans. The annual meeting will be held on October 7th in Sheraton Hotel and you will see the announcement in this issue of the journal. So please mark your diary to join the meeting to learn something new as well as meeting some new friends.
December 2011 sees Hong Kong facing a challenging economic outlook with slowdown in European and American markets. However, 2011 has been a very successful year for our Society. We have managed to complete the documents required for the accreditation of paediatric respiratory medicine under the able leadership of Dr. Alfred Tam. We hosted the 3rd Cross-strait paediatric respirology congress in conjunction with the 14th annual scientific meeting of our Society on 8-9 October in the Hong Kong Convention Centre with very good turnout from Hong Kong, Taiwan and China. The readers could access the abstracts of the proceedings in the current issue.
Recurrent preschool wheeze is a very common problem seeking expert opinion from paediatricians. Dr. Chiu and colleagues reviewed the topic in the current issue and the review should provide helpful information to counsel parents. Do also test your radiology skill in the X-ray quiz.
Finally, I would take this opportunity to wish all members a very merry Christmas and a successful 2012.
In this month of Mid-Autumn Festival, I wish all members a happy family gathering as family must be the anchor for life for us all. Welcome back for those who were away during the summer exodus from Hong Kong. This month sees the busy preparation for the hosting of the 3rd Cross-strait Paediatric Respirology Congress in Hong Kong for the first time that will be held concurrent with the 14th Annual Scientific Meeting of our Society. We expect to have more than 200 delegates to attend the meeting from Hong Kong, Taiwan and mainland China. World renowned speakers from this region and beyond will deliver the latest advance in our fields, i.e. pulmonology, sleep medicine and critical care. I urge those who have not signed up for the meeting to send in the application forms. The first paediatric sleep workshop will be held immediately after the ASM in the Hong Kong Sanatorium. As seats are limited, please enroll early to avoid disappointment.
In the current issue, Dr. Soo and colleagues report the preliminary results on the use of probiotics in the prevention of necrotizing enterocolitis and Dr. Chan and Dr. Chow report a case of recurrent pneumothorax in a patient with Dechenne Muscular Dystrophy. Both papers provide useful information for the practicing paediatrician. Do prick your brain with the X-ray quiz provided by Dr. MT Soo.
I look forward to seeing you in the Hong Kong Convention Centre. Do come early.
June sees the start of a real hot season this year. I hope members could stay cool in this hot and challenging environment for medical practitioners in general and paediatricians in particular in view of the tight manpower supply in the public sectors. Paediatricians in the public sector face the double challenge with the surge in demand for NICU and SCBU service with the increased delivery of babies born from parents who are mainland Chinese citizens. Dr. Alfred Tam, convener of the accreditation subcommittee of respirology, is busy working on the submission with inputs from within the subcommittee as well as from our overseas advisors, Prof. Andrew Colin and Prof. Andrew Bush. Members are urged to contact Dr. Tam if they have any opinion about the accreditation.
In the current issue, Dr. Johnny Chan et al. look at the use of a common over-the-counter substance, i.e. xylitol in the prevention of acute otitis media and Dr. Jeff Wong et al. presented a rare case of organising pneumonia. Both papers should be of clinical interest to paediatric respirologist.
This year sees the Third Cross-strait Paediatric Respirology Congress to be held here in Hong Kong to be hosted by this Society. It will be held on October 8th and 9th in the Hong Kong Convention Centre followed by a post-ASM sleep workshop. We have world-class speakers from this region and beyond to talk on respirology, sleep medicine and intensive care. I refer you to the detailed program listed on the flyer enclosed. I look forward to seeing your active participation in the meeting and young investigators are encouraged to submit papers for presentation in the young investigators sessions.
A very warm greeting to all readers after an interlude of 6 months as the December issue 2010 could not be produced due to production delay. I offer my sincerest apology to readers. It has been a busy 6 months as we worked hard to deal with the H1N1 that also infected your president who needed to lay low for a few days and who developed cold intolerance for nearly 2 weeks; manpower crisis in Hospital Authority; overwhelming neonatology demand, etc. Hopefully the $6,000 handout to all Hong Kong permanent residents announced recently could boost our morale.
The Society is busy preparing for the 14th ASM cum 3rd Cross Strait Paediatric Respirology Symposium to be held on October 8th-9th to be followed by the Sleep Workshop 10th-12th. Please refer to the announcement published in this issue of the Journal. Do mark down the event in your diary.
Asthma is the commonest chronic airway disease encountered by members. In the current issue of the Journal, Dr. TW Wong published a case series of severe asthma and discussed extensively on the management of this difficult condition. Chronic cough is another common condition seen by us and not all are asthma. Dr. V Mak published a case report on a child with persistent bacterial bronchitis with excellent response to the prescribed treatment. Do remember to send the sputum culture for those who can and send BAL for those who cannot despite a prominent protracted wet cough.
After the long summer and the associated exodus from Hong Kong, most would by now be back to the busy work schedule. The subspecialty accreditation subcommittee held its third meeting on September 15th in Dr. Alfred Tam's office. Two training networks are formed, i.e. HK / NT network and Kowloon network. Numbers are being gathered to support the application to the College for accreditation of the respirology as a subspecialty in Hong Kong. You would find an open invitation letter from Dr. Tam for all interested FHKCPaed. to express their intentions to become the First Fellows of this subspecialty. I would urge all members to respond to the invitation.
The Lung Function Workshop proves to be very popular with overwhelming response. The following ASM will be held in Eaton Hotel on 17/10/2010. I hope all of you could come and join the exciting program with faculty from Hong Kong, Taiwan, China, Singapore, USA, Canada and Finland.
In the current issue of the Journal, Dr. Dexter Leung reviews an important but oft-neglected topic, i.e. allergic conjunctivitis. Dr. June Chan summarizes the relationship between obesity and OSA. Both topics are highly relevant to the daily practice of paediatricians. Finally, I wish all of you a joyful Mid-Autumn Festival with your family.
A big "Hello" to all members in this very hot summer. The council is busy in the last few months preparing for the coming ASM and the pre-ASM Lung Function. The detailed program could be found in the accompanying flyer with the current issue of the Journal. Dr. Alfred Tam has been pushing forward with the establishment of the accredited training program for paediatric respirology and another meeting is scheduled in September. Coincidentally, a review article (listed in the Journal Watch in the current issue) has been published in Pediatric Pulmonology on the subject of training on paediatric respirology internationally with Prof. Gary Wong as one of the authors. Prof. Wong stresses the importance of the future Children Hospital in Hong Kong as a key component. Your council is contributing to the planning of the Children Hospital by providing inputs to the horizontal group convened by the Hospital Authority and your President made a presentation to the Hospital Authority about the envisaged respirology service in the Children Hospital and other regional hospitals on June 8th.
The Society sent a delegation of 6 to the annual meeting of The Society of Pediatric Pulmonology in Taipei on April 25th. The two abstracts by Dr. TY Miu and Prof. Gary Wong are published in the current issue. In the current issue, Dr. CP Wong reviews the role of long acting bronchodilator (LABA) in the management of childhood asthma, an important subject given the black box warning by FDA. I would also like to welcome Dr. Wong Kin Sun, Chief of Division of Pediatric Pulmonology of Chang Gung Children's Hospital in Taiwan as the international editorial adviser of this Journal.
For those members who are going away for the summer, I wish you a pleasant and safe trip. For those staying in Hong Kong, I look forward to seeing you in the regular monthly meeting held on last Wednesday in Kwong Wah Hospital.
I wish all members a prosperous and happy year of Tiger. We are in Spring with temperature swinging from less than 10°C to near 30°C. This coincides with an upsurge in RSV prevalence that will keep our members busy. The editorial board would like to offer an apology to all members for the failure to publish the December issue last year because of some technical glitches.
I am happy to report that the 12th ASM was held successfully on November 14-15 last year. The second bronchoscopy course was held from January 29-31st this year with Prof. Robert Wood as the lead. The course was well attended with participants from Hong Kong, Macau, Beijing and Singapore. In the current issue, the abstracts of the ASM were published for members. Dr. Lam Ping provides an excellent review of management of bronchiectasis in children. Looking forward, your Society will send a delegation to the second Cross-Strait Symposium of Paediatric Respirology in late April to Taipei. Those members who are interested should contact the secretary for details of sponsorship. The 13th ASM will be organized in October this year under the direction of Prof. Ellis Hon and I ask you for suggestions to be directed to Prof. Hon.
The coming October 1st promised to be a day of joy as we celebrate the 60th anniversary of the founding of the People's Republic of China. Your Society will celebrate our 12th anniversary with the 12th ASM to be held on November 15th. This year ASM promises to be another great success under the very able leadership of Prof. Ellis Hon and Dr. SN Chow who organize an excellent program with speakers from Canada and USA as well as from Hong Kong.
One of the greatest challenges to paediatricians in the field of respirology and critical care is undoubtedly acute respiratory failure. Dr. YS Lui et al from TMH share with us their experience in handling difficult airway whilst Dr. WK Chiu et al share with us their experience with respiratory failure caused by problems with the chest wall. I am sure the readers would benefit from these two excellent case reports. Please also test your skill with the X-ray quiz provided by Prof. Ellis Hon.
I also would like to take this opportunity to wish all members a happy evening with the loved ones in the coming Mid-Autumn Festival.
The rainy summer is now with us and Hong Kong remains as busy and interesting as ever. The financial tsunami appears to have dissipated with the Hang Seng Index surging over 60% from the March trough. The property market is reported to have gained back the loss seen in the tsunami. The novel H1N1 or human swine influenza has established itself in our local population and the Hospital Authority hospitals are on high E2 alert. Paediatricians are as busy as ever. Your Society is busy in a number of fronts.
The First Cross-Strait Symposium on Pediatric Pulmonology was held in Kunming on June 14th successfully. Six of our members, me included, attended the meeting. The proceeding of the meeting is published in the current issue of the Journal. The Symposium proves beyond doubt that collaboration with mainland China and Taiwan would be very beneficial to the Society and more importantly for children with respiratory diseases. The second subspecialty training subcommittee was held on June 18th in Kwong Wah Hospital under the chairmanship of Dr. Alfred Tam. It was agreed that the training program will be divided into different modules and the target of achieving the accreditation by June 2012 was agreed.
In the current issue of the Journal, Dr. June Chan presented a rather difficult case of primary ciliary dyskinesia (PCD). A number of practical issues are addressed. Paediatric respirologists should be well informed for PCD and Dr. Chan's article will help toward this end.
This year's ASM will be held on November 15th. Please make sure you mark it down in your diary as this year's ASM will prove to be of high educational value. I look forward to seeing you in the ASM and do have a nice summer break.
For the first issue of the Journal in 2009, I would like to wish all members a fulfilled year of the Ox. The socalled financial tsunami has been with us for sometimes and there are claims that we are at or near the bottom. Bottom or not, I am confident that the people of Hong Kong will see through this current crisis and emerge stronger as were often the cases in the history of Hong Kong. Your Society has been exceptionally busy in the first quarter of 2009 in the areas of training and regional collaboration.
The training accreditation subcommittee has been expanded to include more representatives from different hospitals. Dr. Alfred Tam was elected chairman of the subcommittee. Two working groups have been created under the subcommittee, i.e. the syllabus working group and the curriculum working group. Dr. TY Miu is the chairman of the syllabus working group that is tasked with preparing the document that outlines the scope of training program. Dr. NS Tsoi is the chairman of the curriculum working group that is tasked with describing how the syllabus should be run in different training centres. Prof. Andrew Bush and Prof. Andrew Colin gave their valuable opinions about the syllabus during their visits to Hong Kong and I would urge members to provide their inputs to ensure the final product is workable for Hong Kong.
The "Snoring Working Group" has completed and published the management guideline for childhood snoring and you should find the booklet accompanying the current issue. Prof. Christian Guilleminault of Stanford University and Prof. YK Wing of the Hong Kong Society of Sleep Medicine have kindly provided the forewords. This booklet is an important first step to standardize the approach to the kids with snoring. Your Council has passed the resolution to fund two scholarships per year to sponsor members to attend international conference. The first recipient is Prof. Ellis Hon who will deliver a talk in the APAPARI meeting held in China.
Dr. TK Wong and myself will attend the annual meeting of the Taiwan Pediatric Pulmonology Society held in Ka-yi on April 12th when we also will discuss the cross-strait symposium for mainland China, Taiwan and Hong Kong. The first meeting will be held in Kunming on June 12th. The theme is infection and members are encouraged to join the meeting.
In the current issue, you would find two hot topics, namely hypothermia and obesity. Dr. Sharon Cherk presents a review of the use of hypothermia in the management of hypoxic-ischaemic encephalopathy and Dr. Almen Lam et al present an obese lady with respiratory failure with a detailed discussion on the various mechanisms of respiratory failure in this particular patient.
I would like to end by wishing you a peaceful Ching Ming Festival and a very Happy Easter.
The 11th Annual Scientific Meeting was held in the Hong Kong Exhibition and Convention Centre on November 2nd. We had over 20 speakers from Hong Kong, China, Taiwan, Greece and USA. The attendance was excellent with over 200 enthusiastic participants. The pre-congress workshops were packed with a good audience in Queen Elizabeth Hospital the day before. The best free paper presentation was won by Dr. Zhifei Xu from Beijing Children Hospital on the subject of obesity and obstructive sleep apnoea. A lunch meeting with representatives from our "brother" organisations from China and Taiwan was held on the day of ASM. The three organisations have agreed to take turn in hosting a "Cross Strait Paediatric Respirology Conference" lasting for half a day annually. It will coincide with the annual meeting of the hosting organisation. Dr. Alfred Tam will represent the Society in liaison with the other parties.
The Society representatives and Prof. Andrew Colin, visiting professor of HKSPR, has met formally with the representative of the College of Paediatricians on the subject of accredited training program in paediatric respirology. As part of the above-mentioned exercise, Prof. Andrew Colin visited a few hospitals and made a number of suggestions to the accreditation subcommittee. The accreditation subcommittee chaired by Dr. TY Miu will draft a program for discussion in an open forum. Please attend the open forum to voice your opinions. With support of the members of the Society, I am sure we will eventually achieve the objective of a formal paediatric respirology training here in Hong Kong.
In the current issue, Dr. Gerber presents a cogent argument in favour of the cuffed endotracheal tube for full term neonates and above. This may well decrease the chance of subglottic stenosis. Dr. YC Chan et al present a review paper on the management of preschool recurrent wheeze that should prove to be helpful in this rather controversial subject.
I would like to wish all members a happy festive season with your loved ones. Count what you've got but not what you've lost. Merry Christmas and Happy New Year to all of you.
More challenges and opportunities......
September 2008 is a remarkable month that sees the near-collapse of the American finance market and the poisoning of tens of thousands of babies and children in mainland China with milk formula tainted with melamine. The repercussion of these two events will certainly reach Hong Kong in the days to come and may last for years. We in Hong Kong should prepare ourselves to face these challenges and offer help to those in need of it.
Infection is a common problem facing paediatricians, especially paediatric respirologist. In the current issue, Dr. Lam Ping of CMC presents a comprehensive review of the problem of aspiration and chest infection. This would be helpful especially for those of us who need to take care of neurological impaired children who aspirate regularly. Meningitis is a not-too-common disease but recurrent meningitis in the absence of risk factors is rare. Dr. CY Chu et al of KWH present a child with this rare picture of recurrent meningitis in the absence of risk factors. To pick your brain, please try out the X-ray Quiz offered by Dr. WT Ko of QEH. Randomised controlled trial is the gold standard of any treatment although the reason behind this is not often mentioned. Mr. CH Chan et al discuss the "KISS Principle" in the statistics corner.
Your society is currently working on the training program for our subspecialty to be submitted to the College for accreditation. Prof. Andrew Colin has been enlisted to help and he will visit different centres in November to help us draft the program. Your suggestions are most welcome and you are invited to send any opinions to me or Dr. TY Miu. The annual scientific meeting is just 2 months away. This year will see over 20 speakers who will cover a wide range of topics. What we need now is your active participation to make it a rewarding experience for everyone. I hope to meet you all in the meeting.
2008: a year of challenges
We are now entering the really hot summer and the year of 2008 is indeed a year of challenges for all of us. We had the biggest downpour in the Hong Kong Observatory record the day before Dragon Boat Festival, the biggest earthquake hitting Sichuan less than a month ago, H5N1 found in chickens sold here in Hong Kong warranting culling all chickens in markets at the time of writing, just to name a few. With these challenges overcome, I am sure the Nation will go from strength to strength. The first Olympic Games to be held in China two months later will showcase this strength and confidence.
Here in the paediatric community of Hong Kong, the College of Paediatricians is organizing a forum on accreditation of subspecialists. This will be in line with our efforts to draw up a workable training program under the able leadership of Dr. TY Miu. I hope all members would support the endeavour.
Your Society sent a delegation, including Drs. Alfred Tam, TY Miu, PY Chow, TK Wong and myself, to Taiwan to attend the annual scientific meeting of The Society of Pediatric Pulmonology, ROC as well as visiting different hospitals in Kaoshiung and Taipei 2 months ago. Drs. PY Chow, TY Miu and TK Wong made some excellent presentation in the annual meeting. The main objective of the Taiwan trip is to learn about their training program that has been accreditating paediatric pulmonologists. I believe we could learn from the Taiwan model and strive for an accreditating program in Hong Kong.
In the current issue of the Journal, Dr. S Koo of Queen Mary Hospital presents a young child with empyema thoracis treated conservatively with fibrinolytics. This case illustrates the importance of involvement of paediatric respirologist in
preventing morbidities and surgery. Nearly everybody is vaccinated with BCG at birth in Hong Kong. Given this large number of vaccinees, it is not uncommon for paediatricians to face with the complications of BCG vaccination. Dr. OY Wong of Tuen Mun Hospital presents two patients with lumps related to BCG vaccination that provide worthwhile readings. Mr. CH Chan gives out tips on calculating sample size, an oft-neglected part in clinical studies. Please also challenge yourselves with the X-ray quiz although there is no prize for the winner.
Spring as the season of sowing
With the arrival of Spring after a Winter that was marked by the longest stretch of temperature below 12 degree Celcius in recent years, I am musing over this paradox in view of the global warming. I hope the readers could enlighten me on this.
In the current issue of the Journal, the colleagues from Kwong Wah Hospital published an original paper on the poor fruit intake in their patients attending the outpatient clinics. As respirologists, we should be interested in the fruit intake in terms of its potential impact on the airway. As paediatricians, we undoubtedly would be interested in promoting a healthy diet in our patients. Do spare a few seconds to ask about fruit intake for your patients. These few seconds may steer them toward a healthy diet because the children look up to their doctors and will follow your advice. I still remember one patient of mine, 6-year-old, who liked to eat luncheon meat every day. Having heard my condemnation of this practice for a host of reasons that I do not want to bore you with, he stopped his father from buying luncheon meat in his next trip to supermarket and he told his father that it was only for the "dumb people". Colleagues from United Christian Hospital reported on an uncommon complication of pulmonary edema after treatment of pneumothorax. I am sure the readers would benefit from the information contained therein.
Your Society is embarking on the process of preparation of a workable training program for paediatric respirologists in Hong Kong. A subcommittee has been convened and chaired by Dr. TY Miu of Queen Elizabeth Hospital. Please provide your inputs to Dr. Miu as the training program will be important for the development of our sub-specialty in Hong Kong. On a separate note, the first guideline initiated by the Society, i.e. guideline on management of childhood obstructive sleep apnoea, is near completion. Please provide your opinions to the working group during the briefing session held in the coming monthly CME meeting. Finally, I, on behalf of the Council, would like to wish you an enjoyable Easter.
Looking forward to the next 10 years
2007 is an exciting year for the Society that celebrates ten years of existence. The 10th ASM is a resounding success that saw over 200 participants enjoying 2 days of excellent talks by speakers from around the world. The pre-congress workshops were oversubscribed with very favourable feedbacks from the participants. The new council was also duly elected in the AGM held during the ASM. A number of new faces join the council and I look to the old and new council members for a fresh impetus to carry the Society to new heights. One of the main focuses is to promote the development of the subspecialty of paediatric respirology. In the coming years, the Society will try to help the College to accredit our subspecialty by preparing a workable training program and encourage our members to be recognized as trainers in respirology.
The current issue of the Journal touches on some practical issues in paediatric respirology. Dr. TK Wong provides a nice review of the use of non-invasive ventilation (NIV) for children with obstructive sleep apnoea (OSA). One needs to remember that NIV is sometimes needed for paediatric OSA. Dr. EYT Chan wrote on the use of an interrupter technique to deduce the airway resistance. This would be helpful in those suspected young asthmatics who cannot blow hard or long enough to do a FEV-1 / FVC. The statistical corner sees new authors to provide practical information for clinicians. I would like to take this opportunity to thank Mr. Wilfred Wong of HKU for his contributions in the last two years. It is my pleasure to end with a THANK YOU for your support this year and wish you a safe and merry Christmas with your loved ones.
October sees the opening of our 10th annual scientific meeting. In recognition of the 10th anniversary of our Society, we organized an enhanced program for 2 days with speakers from Hong Kong, Beijing, Taipei, Singapore, Australia, Sweden and USA. The program, ranging from paediatric intensive care to allergy to sleep-disordered breathing, reflects the diversity and strength of our Society. The annual scientific meeting provides a valuable chance for the Society to raise its profile amongst medical practitioners and allied health professionals in Hong Kong. The event also helps promote interaction between the Society and speakers from this region. I hope all members would participate actively and benefit from the ASM.
In the current issue, Dr. Lettie Leung provides a review of the use of non-invasive ventilation (NIV) in acute respiratory insufficiency, a relatively new area. Judicious use of NIV would help achieve the same outcome without endotracheal intubation, a procedure that is not without complication. The author still remembers vividly a child who developed subglottic stenosis after a short period of intubation. The stenosis was so severe that mandated a tracheostomy. Dr. SC Sit reported an interesting case of necrotizing pneumonia with an extensive review of literature. With more use of CT scan in severe pneumonia, the diagnosis is more often made and appropriate counseling is important with regard of the good prognosis of the condition despite the rather threatening name.
Finally, I would like to wish our members a Happy Mid-Autumn Festival.
Summer is firmly upon us and it looks like Hong Kong will experience another record-breaking hot summer. The tall and broad buildings undoubtedly aggravate the situation. Our members should voice out our opinions especially in issues related to our specialty, like air pollution. So please respond to the call by the government for community opinions about air pollution. Details of the government initiatives could be found in the announcement by Dr. Alfred Tam in this issue of the Journal.
In the current issue, Dr. TY Miu reviews the management of empyema thoracis and Dr. S Fung reviews the use of non-invasive ventilation for children with neuromuscular diseases. Both topics are not uncommon areas in hospital-based practice and it would be educational for community-based paediatricians to know the recent advance in these areas.
In the journal watch section, one could see that there are very active research activities in our specialty here in Hong Kong. I am sure our Society could play an active role to promote it further by facilitating collaboration between different departments. The coming 10th ASM program has been finalized and you could find the updated program in the current issue.
I look forward to welcome you in person on October 6th in the Hong Kong Convention Centre.
After a rather warm Winter, Hong Kong is now in the warm and humid Spring / Summer seasons when we would see more of RSV infection. The ever present pollution will make it worse for those with RSV infection. Hong Kong needs more strong wind to dilute out the pollutants although the ubiquitous waterfront gigantic apartment blocks make it so much harder to those living behind these apartment blocks. The Society should play an active role to inform the public and government of the potential hazards of the environment on respiratory health in children.
The current issue sees a timely review of management of childhood pneumonia by Dr. Lam Ping as pneumonia is the commonest reason for antibiotics in paediatrics, assuming that antibiotics is not prescribed for most upper respiratory tract infection. Apnoea is a common problem in preterm neonates and its occurrence in full term neonates is less well studied. Dr. Sharon Fung reported a case with apnoea caused by documented gastroesophageal reflux (GER) and the extensive review on the relationship between GER and apnoea provides good reference material for paediatric respirologist. The statistical corner by Mr. Chun-Fan Lee et al. tackles a commonly used tool, i.e. logistic regression, in research study and you are encouraged to test out the regression with data found in the Society's website. Don't forget to try out the X-ray Quiz.
An updated programme of the 10th ASM is posted to remind you to stay in Hong Kong during the first weekend of October for the exciting educational activities prepared by the scientific committee.
To end, I wish you a Happy Easter with your family and friends.
Entering the 10th year
This is the second Christmas issue of our Journal, I would like to wish all members a peaceful Christmas and a rewarding 2007. Our society was founded in 1997 and next year will be our tenth year of existence. We will celebrate this with an enhanced education program. In the November CME meeting, the topic was "Childhood pneumonia" and it attracted a large audience. The success of this particular meeting suggests that the way forward for the monthly CME meetings is to target a larger audience in a bigger venue when the topic is believed to be of a more general interest. We could probably host this enhanced CME meeting every three to four months. For the 2007 calendar, the interesting topics would probably include the new guideline for childhood snoring led by the Sleep Focus Group under Dr. PY Chow and the new asthma guideline led by the Asthma Focus Group under Dr. Gary Wong. For the 10th ASM, it will be held from October 6th through 7th in the Hong Kong Convention and Exhibition Centre. It will cover pulmonology, allergy, sleepdisordered breathing and critical care. Please mark your diary and your support would ensure success of the event.
Your Society has established two prizes for the best paediatric respiratory medicine essay for the medical undergraduates from the two universities. This year, Mr. John Li is the winner from the University of Hong Kong and his essay “Neonatal respiratory distress syndrome: a review of current understanding and new concept" is published in the current issue. Dr. Tak-wai Wong shared with us his collection of unusual neck masses. This case report would certainly help decrease the unnecessary investigations often associated with these masses. Our statisticians, Mr. Wilfred Wong et al, have prepared some raw data, available in the society's website, for the readers to analyze after reading their article on regression. I believe this hands-on experience is important for the clinicians to learn more about statistics.
We will also have a new session on X-ray quiz and you are encouraged to tackle it before checking the answers. Do enjoy the current issue in your favourite sofa, helped by a cup of tea. See you all in 2007.
In the current issue, Prof. Gary Wong and Prof. Allan Becker, representing the Asia Pediatric MetaForum, presented a summary of the discussion on management of paediatric asthma. The paper briefly outlined the management of childhood asthma and reiterated a numbers of management goals. It is important for medical practitioners to regularly look for achievement of these various goals in their daily clinical practice.
Dr. HS Wan and Dr. SC Sit reported 3 children with retropharyngeal abscess. These cases highlighted the importance of clinical training that would allow the clinicians, in one hand, not to prescribe antibiotics to all patients with fever and upper respiratory symptoms and, in the other hand, to prescribe when it is required to prevent retropharyngeal abscess. Obviously, one could be wrong in not prescribing antibiotics in the first encounter even with the best training and adequate sleep. The well-trained clinician should than be able to diagnose retropharyngeal abscess and offer appropriate management as in the cases reported.
Paediatric critical care
Most paediatricians working in critical care in Hong Kong are also involved in the respiratory medicine. This is probably accounted for by the fact that pulmonary diseases account for a significant proportion of PICU admission, e.g. the number one diagnosis for PICU admission in Kwong Wah Hospital is respiratory diseases (nearly 40%). In the current issue, three patients were presented with pulmonary diseases that require PICU admission.
The first case was a child with croup that required prolonged intubation. She was successfully managed after a concerted effort by a team of dedicated paediatricians, otorhinolaryngologist, anaesthesiologists. The second childd had intrapulmonary shunt secondary to chronic liver disease and subsequent liver transplant and the third child had pulmonary hypertension associated with portal hypertension. All three cases illustrate the increased complexities faced by paediatric intensivists and these are often brought by advances in other fields, e.g. surgery, immunology, etc. It is important for Hong Kong paediatric intensivists to have a common forum for discussion of case management, division of labour, resources allocation and training program.
To these ends, the Society and this Journal should play an important role in promoting paediatric critical care development here in Hong Kong. Presentation of interesting or difficult cases in the monthly CME meeting would be one step. Organization of workshops in paediatric critical care would be the next step and you are advised to watch out for future workshops organized by the Society and encourage colleagues to join.
Childhood snoring: an ideal area for public-private collaboration
Habitual snoring occurs in around 10% of Hong Kong primary school children and witnessed apnoea was observed in 1.5% of the same group of children. Both are important symptoms of obstructive sleep apnoea syndrome (OSAS). Sleep polysomnography is currently the only investigation that could exclude OSAS in children with snoring. It is important to note that the standards for paediatric sleep polysomnography differ significantly from that of adults, in terms of longer time of preparation because of co-operation problem, smaller nostrils, smaller chest, hypoventilation without apnoea, etc. Ms. MY Cheung, a registered polysomnography technologist and Dr. PY Chow, provides some basic information about the technical requirements for paediatric sleep polysomnography in the current issue. In view of the role of sleep PSG plays in diagnosing OSAS in children, it is not surprising that sleep laboratories in the public hospitals have long waiting time. Dr. KW Chau provides some information on the characteristics of suspected OSAS children in the private sector. OSAS is an ideal area for closer co-operation between public and private paediatricians, otorhinolaryngologists, orthodontists, anaesthesiologists. A guideline for management of childhood snoring would provide a helpful tool to facilitate the co-operation. To this end, the sleep focus group of the Society, led by Dr. PY Chow, is currently working on such a guideline for management of snoring in children. Hopefully, this would help standardise the management here in Hong Kong and help promote the public / private interface in the provision of services.
Respiratory infections form the main bulk of work for paediatricians. Compared with the viruses, Bordetella pertussis is indeed a minority that should always be borne in mind even in the absence of whoop. Dr. TH Fung and Dr. SWW Cherk presented a series of hospitalised infants with pertussis to remind us of this in the current issue.
I am delighted and honoured to be elected the President of the Society in the AGM held on 9th October, 2005. The Society was founded in 1997 to promote the development of paediatric respirology and critical care. Under Dr So Kwan-tong, the founding President, the Society worked hard to arouse the interest in these areas with success. Further development was achieved under Dr Alfred Tam, who led the Society for six years. Alfred was instrumental in establishing the Society its present leading position in Hong Kong and Asia. The successful hosting of the International Pediatric Respiratory, Allergy and Immunology Congress (IPRAIC) by the Society in 2004 would not have been possible without the vision and perseverance of Alfred.
I would like to take this opportunity to thank Dr So and Dr Tam for their contributions. Behind them were a group of dedicated office bearers and council members who have been working hard to promote the works of the Society. I thank them all from the bottom of my heart. I would like to build on the past success and push for further development in the areas of paediatric respirology. I see three main areas that the Society should focus on in the coming years, i.e. research, training, and accreditation. Original clinical research is essential for development of paediatric respirology and it should not be confined to the university units. I hope to encourage more collaborative research projects both in the HA hospitals and the private sector. Collaborative research projects would provide the platform for mutual understanding. This is essential to develop a common training program for the whole of Hong Kong with different hospitals playing different parts in it. It is extremely important for this Society to help train recognized paediatric sub-specialists in the areas of paediatric respirology or it will never occur. Eventually, these "specialist in paediatric respirology" should be formally accredited by the Hong Kong Academy of Medicine. The process of research, training, and accreditation would be an arduous one but its success is assured if we all work toward this goal.