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June 2015, Volume 37, No. 2
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Editorial
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Sunny days aheadKathy KL Tsim 詹觀蘭 HK Pract 2015;37:49-50 It is only appropriate that spring, the season for new beginnings, was when the World Family Doctor Day was conceived, among the applause and cheers of the Wonca Executive Committee. May 19th 2010 was its official birth day. Since that beginning, this day, May 19th, continues to highlight the important role of and contribution by the family doctor in the global health-care system. Our own Hong Kong College of Family Physicians has continued to raise the level of recognition and awareness of the important roles of family doctors among the general public as well as within the medical profession. Such activities include the Hong Kong Primary Care Conference, now in its 5th year and the great success of the TV programme “My Family Doctor / 我的家庭醫生”, which has just recently received an award as being one of the 10 most favoured TV programmes in 2014.1 As we ease into the sunny days of summer, just let us revisit a rare but important children springtime illness. As family physicians, we are all familiar with childhood rashes. In fact, it is safe to say that this is one of the many “bread and butter” fields of our profession. Rashes may be important but more importantly, is the ability to discern benign from the potentially more serious vasculitic rashes that is where we earn our keep. In this month's journal, Dr Lau has provided us with valuable information on the management of one such springtime vasculitic rash: the rash of Henoch-Schönlein Purpura (HSP). It is a rare condition but one that must not be missed. It has in its wake the possible serious sequelae of renal damage and intestinal obstruction. In fact, HSP is noted to be the second most prevalent cause of secondary glomerular disease in China.2 Those children with renal involvement will have a higher than 30% chance of recurrence.3 Interestingly, evidence exists which suggests an association between Helicobacter pylori infection and Henoch-Schönlein Purpura in Chinese children. Since H pylori has a high prevalence in China, there is a school of thought which calls for its screening in HSP children in order to reduce its recurrence.4 One of the quoted risk factors for HSP is being Asian.5 It does seem that being Asian, and particularly ethnic minority persons, appears to have a hard time when it comes to medical co-morbidities. As indicated in Dr Chen's article, hypertensive ethnic minority patients tend to be younger, more obese and have a higher prevalence of diabetes. This article highlights the great need for culturally tailored healthcare interventions in Hong Kong. This is of high importance especially when one notes that diabetic patients (irrespective of sex) are more likely to have drug resistant bacteria that cause urinary tract infections; especially if their diabetes is poorly controlled.6 In such a busy city, we are often stressed and overworked. People get ill and too often the tendency is for the request for antibiotics in the hope of getting better quickly. We all have a reason for asking for the “quick fix”; especially parents of children with runny noses who need to get their children better quickly for school entrance interviews. The company executive who has laryngitis but has to attend an important career meeting. Everyone is busy and there seems to be no time for the “wait and see” policy. In a new 2014 report by WHO, its first to look at antibiotic resistance globally reveals that this serious threat is upon us all in every region of the world7; including Hong Kong. This is one of the modern major public health threats. What can we do about it? In his article, Dr Chow addresses this issue. He advocates evidence guided clinical practice with his study on appropriate antibiotic regimes for the less talked about but important issue of male urinary tract infections. Are we treating urinary tract infections with the same effectiveness as female urinary tract infections? Nearly 50% of males in Hong Kong are classified as obese 8 and obesity itself is associated with a higher risk of suffering from urinary tract infections.9 Henceforth obese men have a higher risk of more severe complications from their urinary tract infection if not treated effectively. These include bladder and kidney damage, and in those with poorly controlled diabetes the rare but severe sequelae of eyesight damage.10 Having read this month's journal, I am sure that we would agree it is time for a summer break. However, one last word of warning for summer is from the French philosopher Denis Diderot (1713-1784): “Doctors are always working to preserve our health and cooks to destroy it, but the latter are the more often successful.” Remember that when you tuck into your ice-cream under the red hot sun.
Kathy KL Tsim, MB ChB (Glasgow), DRCOG, FHKCFP,
FRACGP
Resident Department of Family Medicine and Primary Health Care, United Christian Hospital, Kowloon East Cluster, Hospital Authority Correspondence to : Dr Kathy KL Tsim, Department of Family Medicine and Primary Health Care, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR, China. References
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