EY1920 Year Book

113 112 Lee Ho Cheung Nicholas Full year cardiac imaging research at Department of Diagnostic Radiology, Queen Mary Hospital Cardiac CT Imaging Prognostic Significance of Coronary Artery Calcium Scoring in Breast Cancer Patients Introduction: The risk of chemotherapy-induced cardiotoxicity is higher in patients with pre-existing cardiovascular disease. The aim of this study is to assess whether coronary artery calcium (CAC) scoring on pre-chemotherapy PET scans predicts future cardiotoxicity and adverse cardiac events. Methods: 139 breast cancer patients undergoing anthracyclines and/or trastuzumab containing chemotherapy between 2009 and 2019, who had at least one pre-chemotherapy non-contrast PET scan and a baseline MUGA or echocardiogram were included. Patients with pre- existing symptomatic heart failure, recent acute coronary syndrome or coronary revascularization were excluded. Male patients were also excluded. CAC was scored and expressed as Agatston scores. Primary end-point was a combined major adverse cardiovascular event (MACE) comprising of chemotherapy cardiotoxicity, heart failure and all cause death. Cardiotoxicity was defined as a decrease in left ventricular ejection fraction >10 percentage points to a value <53% from baseline MUGA or echocardiogram. Association of CAC with cardiotoxicity, adverse cardiac events and mortality was analyzed. Results: Median follow-up time was 5 years(IQR=3-7 years). The cohort had a mean age of 53.9 (SD=10.2). 4 out of 139 patients (2.9%; mean age 50.3, SD=2.50) had chemotherapy-induced cardiotoxicity. 22 patients died (15.8%) and none of the deaths were of cardiac causes. The whole cohort had a mean CAC score of 20.9 (SD=93.4). 111 patients (79.9%) had a score of 0. A receiver operator curve was plotted to determine whether CAC score predicts MACE and the area under the curve was 0.522 (p=0.738) indicating that there is no CAC cut- off point which identifies cardiotoxicity and death. There was no significant difference in CAC score between patients with (median=0; IQR=0-116.25; SD=77.5)and without(median=0; IQR=0-0; SD=94.0) cardiotoxicity (p=0.706) by Mann-Whitney U Test as well. Conclusions: CAC scoring is not predictive of chemotherapy-induced cardiotoxicity in the cohort. There are a low number of cardiac events and there was not significant difference in CAC score between patients with and without MACE. This may be due to our sample being small to detect a difference. Prognostic Value of Morphological Plaque Characteristics on Coronary Computed Tomographic Angiography – A Systematic Review and Meta-Analysis Purpose: To compare the association between CTCA-derived plaque characteristics and MACE before and after adjusting for clinical parameters, through systematic review and meta-analysis. Methods: Studies that included patients undergoing CTCA for suspected or known CAD, and followed up for MACE were identified from electronic databases Medline and Embase. Studies that included patients presenting with acute coronary syndrome (ACS) at CTCA or elective revascularization as outcome, or did not report hazard ratio (HR) were excluded. Primary outcome is MACE, a composite of cardiac death, nonfatal myocardial infarction (MI), all cause death and unstable angina requiring revascularization or hospitalisation. HRs measuring a composite of only cardiac death and nonfatal MI were prioritised when individual studies conducted separate analyses for other outcomes. Data on plaque morphology (calcified, noncalcified, and partially calcified) and high-risk plaque (HRP) features (low- attenuation plaque, positive remodelling, spotty calcification, and napkin-ring sign) were gathered. Effect estimates of univariate and multivariate HRs were generated respectively using the random effects model. Statistical heterogeneity was quantified using the I 2 statistic. Results: Of 3712 citations, 24 studies met the inclusion criteria. 1120 (3.94%) MACE occurred in 28411 patients. The mean or median follow-up ranged between 1.3 and 10.5 years. For univariate analysis, all plaque morphologies and HRP features were associated with MACE. Strongest association was observed in partially calcified plaque (HR, 1.44; 95% CI, 1.20-1.73; p<0.001; I 2 , 89.4%) and napkin-ring sign (HR, 6.32; 95% CI, 2.42-16.5; p<0.001; I 2 , 88.5%) among plaque morphology and HRP features respectively. After adjusting for clinical parameters (age, gender, CACS, stenosis severity, etc. depending on individual study), partially calcified plaque lost significance (HR, 1.17; 95% CI, 0.97-1.42; p=0.103; I 2 , 72.4%) while noncalcified plaque had the strongest association with MACE (HR, 1.22; 95% CI, 1.04- 1.44; p=0.015; I 2 , 64.3%) in multivariate analysis. Napkin ring sign (HR, 3.47; 95% CI, 2.19-5.50; p<0.001; I 2 , 38.2%) was still the most associated with MACE among all HRP features, while all other HRP features remained to be independent predictors of MACE in multivariate analysis. HRP≥1 and HRP≥2 had a multivariate HR of 2.02 (95% CI, 1.32-3.10; p=0.001; I 2 , 44.3%) and 5.63 (95% CI, 1.99- 15.9; p=0.001; I 2 , 70.8%) respectively. Conclusion: Reporting of each and every plaque characteristic may not be indicated in clinical practice. From left to right, a screenshot of me doing calcium scoring; some drawings I did in the year MBBS Enrichment Year 2019/20 Lee Ho Cheung Nicholas Full Year < RA - C ar d ia c i m aging re s ear c h at D e p art m ent of D iagn os ti c R a d i o l o g y, HK U, H o ng K o ng > MBBS Enrichment Year 2019/20 Lee Ho Kwan Sem 1 Children’s Home, Shuifu, Yunnan, China Introduction: Based on the 10-weeks long field observation and volunteer work on Shuifu, Yunnan Children’s Home, comments on the our work contents, operation, living conditions and health conditions can be summarized and problems could be identified, The findings include lack of a public health awareness in children regarding hand hygiene and prevention of disease, lack of effective treatment for community-acquired disease, eg hair lice and foot odor, and insufficient coordination between staffs particularly regarding volunteers visits. Insights to more of the findings will be covered in this report from a primary point of view after having daily interactions with the children and the staff in the Children’s Home and suggestions to improve the conditions in the Children’s Home will also be given below. Discussion: First, there is a general lack of health awareness among children. It can often be seen that children would pick up food there were dropped on the floor and then proceed to eat the contaminated food. This practice poses many threats to the well-being of the children as harmful bacteria and virus could contaminate the food and enter the children’s system orally. This could lead to potentially serious problems such as dysentery which would require medical attention. Moreover, it was observed that children would often touch their hands on the floor in the playground and then proceed to eating snacks with their hands without washing them beforehand. The same theory could also be applied here as harmful bacteria and virus could be transmitted from their hands to the food, which enters their body through their mouths. It was also more prominent among younger children that they would put their toys in their mouths. It is recommended that the staffs educate the children with a stronger awareness on the potential threats and dangers of eating contaminated food and the importance of hand hygiene, starting from a young age. It is also recommended that the staffs put a halt to the poor hygienic behaviors of the children once spotted, imposing punishment such as deducting their stamps. This could act as a deterrent effect to effectively put an end to the unhygienic behaviors of the children. Second, there is often inadequate treatment and prevention for common community-acquired diseases such as hair lice and foot odor. It was observed that the staffs would only treat the affected child infected with hair lice with insecticides without other measures such as wet combing. While insecticides may be effective on their own, wet combing is often required as a secondary measure due to the recurrent nature of the disease in the Children’s Home. It is recommended to teach the staffs regarding the techniques of wet combing and repeating the application of insecticides every 7 days if recurrent cases are found. It is also observed that there was inadequate warning to children to avoid head-to-head contact as it is the major transmission route for hair lice. The children would often play and bump their head against one another accidently transmitting hair lice to the other person. It is recommended to give warning to children not to engage in head-to-head contact during times where hair lice infection in the Children’s Home is high.Regarding the management of foot odor, inadequate treatment can also be seen. The staffs would only resort to using lukewarm water to soak the feet of children without using antibacterial soap. Using water alone is ineffective against killing bacteria residing in the foot. It is recommended that the staffs use antibacterial soap in their regular foot soak and employ rubbing technique to eliminate the foot odor problem. It is also recommended that the children change their shoes every few days and allow their old shoes to air dry out in the sun to prevent the buildup of moisture in the footwear. The foot odor problem has caused distress among the high school children where they always complain about the foul smell during the time when they returned for the weekends. The foot odor problems need to be addressed as it may cause social problem between younger children and older children which may cause a sense of rejection among younger children and affect their social development. Conclusion: To conclude, the Children’s Home is operating with an emphasis with a high level of both physical and emotional care to the children living in the home. The academic life is well balanced with regular playtime which allows children to relax. The discipline of children is also excellent which the children know to respect the staffs and visitors. The children were taught great manners and self-discipline where they know when is the time to play and when is the time to work. The children would also handle the cleaning of bowls and chopsticks after each meal and clean the canteen afterwards which demonstrates their good self-care ability and discipline. While there are some shortcomings when it comes to health awareness and coordination between staffs and volunteers which I believe can be easily resolved by the aforementioned measures. Sem 2 Koc University, Istanbul, Turkey My second semester was an exchange semester which happened during a turbulent time in global history - COVID-19. Duiring the first half of my exchange semester before the global pandemic broke out, I was grateful I had the change to explore all of the Balkans countries before moving into Turkey. Those experience opened my eyes as those countries are relatively less significant players in the global theater and went through civil wars during the 1990s which was only 30 years ago. Traces of war-torn buildings could still be seen dotted across the streets of Belgrade, the capital of Serbia. During my time in Koc University, I took up many classes that are not pertinent to medicine. Among those are archaeology, history, psychology, political science and art. I have always been interested in those fields and this exchange served as a perfect opportunity for me to further explore my interests. Due to Turkey’s location in the Europe, I was able to take courses that taught Mediteranean art and history which is something that could rarely be found in the usual cirriculum of Hong Kong universities. Such a special opporunity could only be realized by studying in Turkey. Moreover, due to Turkey’s history and demographics, I was able to meet people with different cultures and religions in the city of Istanbul, the Crossroad of East and West. With Istanbul situated on both the European and Asian continent, it was evident that the city is very diverse and accepting towards different cultures. I was able to interact with people from various backgrounds and learn from their culture, particularly the Islamic culture, which was origianlly very foreign to me. This was truely a great venture on cultural learning. To everyone’s dismay, COVID-19 broke out in Europe during late Feburary - early March. Turkey was among the countries to be last hit in Europe by this crisis with the first case being reported 11 March. It was a time of great tragedy and turmoil. During SARS outbreak in 2003, I was still a child with little contemplation on what was happening. Now in 2020, as a third- year medical student, this incidence of global pandemic become even more poignant and impactful. I was left contemplating everyday on the trajectory of the outbreak and its potential implication on the history of mankind. Needless to say, the exchange was forced to come to a halt in mid-March where I had to return to Hong Kong from Turkey in fear of the ever-rising cases of confirmed coronavirus cases in Turkey. Sem 1 < SH - Internshi p at Sowers Action, China >; Sem 2 < IC - HKUWW Exchange Programme at Koc University, T urkey > Lee Ho Kwan