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Infertility - www.hkma.org
www.hkma.org January 2021
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B   U     L    L     E     T   I   N

持 續 醫 學 進 修 專 訊

          Infertility
Dr. CHUNG Hoi Sze, Cathy

                                                         CME
                                                         LIVE
Infertility - www.hkma.org
Infertility - www.hkma.org
HKMA CME Bulletin                                         CME Bulletin & Online Editorial Board

持續醫學進修專訊                                                  Co-editor
                                                          Dr. CHENG Chi Man                                                                                           鄭志文醫生
                                                          Dr. HO Hung Kwong, Duncan                                                                                   何鴻光醫生
                                                          Dr. LAM Ho                                                                                                   林賀醫生

Contents
                                                          Dr. MAK Siu King                                                                                            麥肇敬醫生
                                                          Dr. WONG Bun Lap, Bernard                                                                                   黃品立醫生

Editorial 2                                               Cardiology
                                                          Dr. CHAN Kit                                  陳杰醫生
                                                                                                                         Neurology
                                                                                                                         Dr. FONG Chung Yan, Gardian                  方頌恩醫生
                                                          Dr. CHEN Wai Hong                            陳偉康醫生             Dr. TSANG Kin Lun, Alan                      曾建倫醫生
Spotlight 3                                               Dr. LEE Pui Yin
                                                          Dr. LI Siu Lung, Steven
                                                                                                       李沛然醫生
                                                                                                       李少隆醫生             Neurosurgery
                                                                                                       譚礎璋醫生                                                          陳秉漢醫生
    Infertility                                           Dr. TAM Chor Cheung
                                                          Dr. WONG Shou Pang, Alexander                王壽鵬醫生
                                                                                                                         Dr. CHAN Ping Hon, Johnny

                                                                                                                         Obstetrics and Gynaecology
Cardiology           7                                    Cardiothoracic Surgery
                                                          Dr. CHENG Lik Cheung                         鄭力翔醫生
                                                                                                                         Dr. CHAN Kit Sheung                          陳潔霜醫生

                                                          Dr. CHIU Shui Wah, Clement                   趙瑞華醫生             Ophthalmology
    A Patient Presenting with                             Dr. CHUI Wing Hung                           崔永雄醫生             Dr. LIANG Chan Chung, Benedict               梁展聰醫生
    Palpitation annd Dizzieness                           Dr. LEUNG Siu Man, John                      梁兆文醫生             Dr. PONG Chiu Fai, Jeffrey                   龐朝輝醫生

                                                          Colorectal Surgery                                             Orthopaedics and Traumatology
Dermatology              11                               Dr. CHAN Cheung Wah                          陳長華醫生             Dr. IP Wing Yuk, Josephine                   葉永玉醫生
                                                          Dr. LEE Yee Man                              李綺雯醫生             Dr. KONG Kam Fu                              江金富醫生
    A Lady With Itchy Skin Rash                           Dr. TSE Tak Yin, Cyrus                       謝得言醫生             Dr. POON Tak Lun
                                                                                                                         Dr. TANG Yiu Kai
                                                                                                                                                                      潘德鄰醫生
                                                                                                                                                                      鄧耀楷醫生
    On Her Legs                                           Dermatology
                                                          Dr. CHAN Hau Ngai, Kingsley                  陳厚毅醫生             Paediatrics
Answer Sheet 12                                           Dr. HAU Kwun Cheung                          侯鈞翔醫生             Dr. CHAN Yee Shing, Alvin
                                                                                                                         Dr. TSE Hung Hing, JP
                                                                                                                                                                      陳以誠醫生
                                                                                                                                                                      謝鴻興醫生
                                                          Endocrinology                                                  Dr. YEUNG Chiu Fat, Henry                    楊超發醫生
CME Notifications 13                                      Dr. LEE Ka Kui                               李家駒醫生
                                                          Dr. LO Kwok Wing, Matthew                    盧國榮醫生             Plastic Surgery
Meeting Highlights 16                                     ENT
                                                                                                                         Dr. NG Wai Man, Raymond                      吳偉民醫生

CME Calendar 17                                           Dr. CHOW Chun Kuen                           周振權醫生             Psychiatry
                                                                                                                         Dr. LAI Tai Sum, Tony                        黎大森醫生
                                                          Family Medicine                                                Dr. LEUNG Wai Ching                          梁偉正醫生
                                                          Dr. LAM King Hei, Stanley                    林敬熹醫生             Dr. WONG Yee Him, John                       黃以謙醫生
                                                          Dr. LI Kwok Tung, Donald, SBS, JP            李國棟醫生
                                                                                                                         Radiology
                                                          Gastroenterology                                               Dr. CHAN Ka Fat, John                        陳家發醫生
                                                          Dr. NG Fook Hong                             吳福康醫生             Dr. CHAN Yip Fai, Ivan                       陳業輝醫生

                                                          General Practice                                               Respiratory Medicine
                                                          Dr. YAM Chun Yin                             任俊彥醫生             Dr. LEUNG Chi Chiu                           梁子超醫生
                                                                                                                         Dr. WONG Ka Chun                             黃家進醫生
                                                          General Surgery                                                Dr. WONG King Ying                           黃琼英醫生
                                                          Dr. LAM Tzit Yuen, David                     林哲玄醫生             Dr. YUNG Wai Ming, Miranda                   容慧明醫生
                                                          Dr. LEUNG Ka Lau                             梁家騮醫生
                                                                                                                         Rheumatology
                                                          Geriatric Medicine                                             Dr. CHAN Tak Hin                             陳德顯醫生
                                                          Dr. KONG Ming Hei, Bernard                   江明熙醫生             Dr. CHEUNG Tak Cheong                        張德昌醫生
                                                          Dr. SHEA Tat Ming, Paul                      佘達明醫生
                                                                                                                         Urology
                                                          Haematology                                                    Dr. CHEUNG Man Chiu                          張文釗醫生
The Hong Kong Medical Association is dedicated to         Dr. AU Wing Yan                              區永仁醫生             Dr. KWOK Ka Ki                               郭家麒醫生
providing a coordinated CME programme for all members     Dr. MAK Yiu Kwong, Vincent                   麥耀光醫生             Dr. KWOK Tin Fook                            郭天福醫生
of the medical profession. Under the HKMA CME                                                                            Dr. YEUNG Hip Wo, Victor                     楊協和醫生
Programme, a CME registration process has been created    Hepatobiliary Surgery
to document the CME efforts of doctors and to provide     Dr. CHIK Hsia Ying, Barbara                  戚夏穎醫生             Vascular Surgery
                                                          Dr. LIU Chi Leung                            廖子良醫生             Dr. TSE Cheuk Wa, Chad                       謝卓華醫生
special CME avenues. The Association strives to foster
a vibrant environment of CME throughout the medical       Medical Oncology                                               HKMA Secretariat
profession. Both members as well as non-members of the    Dr. TSANG Wing Hang, Janice                  曾詠恆醫生             Ms. Jovi LAM                                 林偉珊女士
Association are welcome to join us. You may contact the                                                                  Miss Irene GOT                               葛樂詩小姐
HKMA Secretariat for details of the programme.            Nephrology                                                     Miss Ivy IP                                  葉珈甄小姐
                                                          Dr. CHAN Man Kam                             陳文岩醫生             Mr. Jeff CHENG                               鄭嘉信先生
                                                          Dr. HO Chung Ping, MH, JP                    何仲平醫生
HKMA CME Bulletin –                                       Dr. HO Kai Leung, Kelvin                     何繼良醫生
MONTHLY SELF-STUDY SERIES to help you grow!               Dr. LAM Man Fai                              林萬斐醫生
Please read the articles and answer the questions.        Dr. LEE Hoi Kan, Achillers                   李海根醫生
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Infertility - www.hkma.org
EDITORIAL
Hong Kong has experienced a modified lock down or more appropriate “curfew” in the last one
year and all of us must have suffered from some form of anti-epidemic fatigue. However, we have
to stay optimistic and keep ourselves physically and psychologically sound in order to fight the
virus.

For couples staying home last year without getting pregnant, the spotlight article by Dr. Cathy
CHUNG is definitely the most appropriate one! Itchy legs in this particularly cold winter will be
taken care in the Dermatology series.

Apart from studying the articles in this Bulletin, we have to stay alert about the updates on the
epidemic, active in participating in the screening & vaccination programs. Anyway, cheer up our
Hongkongers!

Dr. HO Hung Kwong, Duncan
Co-editor, Hong Kong Medical Association CME Bulletin

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 HKMA members are entitled to a FREE copy of CME Bulletin.
 Subscription is opended to sponsors and interested individuals.
Infertility - www.hkma.org
Spotlight

Infertility                                                                                        Dr. CHUNG Hoi Sze, Cathy
                                                                                                   MBChB (CUHK), FRCOG, FHKCOG,
                                                                                                   FHKAM (O&G), Cert RCOG (Reprod Med),
                                                                                                   Dip Med (CUHK), PGDipClinDerm (QMUL)
  Introduction                                                                                     Specialist in O&G
                                                                                                   Associate Professor of Practice in
                                                                                                   Reproductive Medicine, Department of O&G,
In general, over 80% couple would get pregnant after 1 year of                                     The Chinese University of Hong Kong
regular unprotected sexual intercourse while the remaining half
(make up to 90-93% in total) would be successful after total 2        sperm concentration, sperm motility and morphology can
years of trying [1]. Infertility is defined as failure to conceive    be examined. WHO 2010 criteria [2] is currently used as a
after 1 year of regular unprotected coitus. Around 1 in 6             reference value for comparison (table 1).
couples suffer from this problem worldwide.
                                                                      Semen parameters                        WHO 2010 reference range

  Causes                                                              Ejaculate volume                        >/= 1.5ml
                                                                      Sperm concentration                     >/= 15 million/ml

In achieving a pregnancy, five important components are               Total sperm count in ejaculate          >/= 39 million
required. They include: normal sperm, normal egg, normal              Total motility (progressive and >/= 40%
fallopian tube for fertilization (egg and sperm) to take place,       non-progressive)
normal uterine cavity for embryo to implant and last but              Normal morphology                       >/= 4%
not least, normal sexual intercourse resulting in successful          Table 1. WHO 2010 criteria
intravaginal ejaculation. Any abnormality in these 5 factors will
reduce the chance of natural conception and may end up with           Female factors
infertility. Broadly speaking, causes of infertility can be divided
into male and female factors. Nevertheless, around 20-25%             Sexual dysfunction
cases can also be unexplained, that is, no abnormality can be
found after basic investigations including semen analysis test,       Vaginismus, referring to spasm of vaginal muscle
ovulation test and tubal patency test.                                during vaginal penetration such as sexual intercourse or
                                                                      gynaecological vaginal examination, will also result in coital
Male factors                                                          problem and failure in intravaginal ejaculation. By referring
                                                                      to psychosexual therapist after excluding any underlying
Sexual dysfunction                                                    structural abnormality / pathology, patients can learn the
                                                                      relevant relaxation skill and vaginal dilatation technique using
Sexual dysfunction, such as erectile dysfunction and                  different size vaginal dilators, which could be very effective.
ejaculatory problem, will lead to failure of intravaginal
ejaculation. Seeking expert advice from urologist or in case          Anovulation
of suspecting any underlying medical disorders like diabetes,
referral to physician is indicated. In some cases, men may            Women with ovulation problem will mostly present with
only have problem during sexual intercourse but no problem in         irregular menstrual cycle or even amenorrhoea, although 5%
ejaculation by masturbation or in producing semen sample for          women with regular monthly cycle may also have anovulation.
semen analysis test. In this scenario, psychological component        Diseases involving any part along the hypothalamic-
needed to be considered and referral to psychosexual                  pituitary-ovarian axis will affect normal ovarian function
therapist would be helpful.                                           and hence ovulation. For example, excessive weight loss,
                                                                      hyperprolactinaemia and thyroid disease will affect normal
Abnormal semen parameters                                             hormonal secretion (GnRH/FSH/LH) from hypothalamus
                                                                      and pituitary gland. Therefore, ovary cannot be stimulated
Depending on the severity of                                          appropriately to have ovulation. On the other hand, women
abnormality, it could be due to various                               who had previous ovarian surgery, chemotherapy or pelvic
pathologies like testicular problems                                  radiotherapy, they are at particular high risk of ovarian
such as testicular failure or varicocele,                             failure. This will lead to not only anovulation, but also early
genetic / chromosomal abnormality,                                    or premature menopause. In addition, polycystic ovarian
hypothalamic / pituitary disease                                      syndrome (PCOS) is a common cause of anovulation. It is due
or mo s t ly com m onl y , i d i o p a t h i c .                      to the disorder of gonadotrophin action and hence ovulation
By performing semen analysis                                          cannot be achieved. Women with PCOS may also have clinical
test, numerous semen parameters                                       hyperandrogenism such as acne or hirsutism and they are at
including ejaculate semen volume,                                     risk of developing metabolic diseases.

www.hkma.org                                                                                  HKMA CME Bulletin 持續醫學進修專訊 January 2021          3
Infertility - www.hkma.org
Spotlight

    Tubo-peritoneal problem                                           be asked for any history of pelvic surgery, sexually transmitted
                                                                      disease, ectopic pregnancy, duration of infertility and any
    Fertilization is one of the important steps in achieving          dysmenorrhea/dyspareunia or history of endometriosis. If
    pregnancy. Women who had history of ectopic pregnancy,            patient has positive answer for one of the above, she is
    pelvic surgery, pelvic inflammatory disease or sexually           considered to be at high risk and this will affect the option
    transmitted disease, they are at risk of having peri-tubal        of subsequent tubal assessment. In addition, woman will be
    adhesion and tubal blockage. This will increase their chance      asked if she has any intermenstrual bleeding or menorrhagia
    of having ectopic pregnancy and infertility. For those with       that may be related to underlying uterine pathology like
    endometriosis who may present with dysmenorrhea or                endometrial polyp or fibroid. If patient has scanty menstrual
    dyspareunia, the ectopic pelvic endometrial tissue will also      flow and history of uterine surgery, intrauterine adhesion
    affect the normal tubo-peritoneal environment and reduce the      needed to be suspected.
    chance of in-vivo fertilization.
                                                                      For male partner, specific questions regarding smoking and
    Uterine factor                                                    drinking habit, any history of genital tract trauma, infection and
                                                                      surgery needed to be asked.
    Embryo implantation is the final step involved in conception
    and a normal uterine cavity is a pre-requisite. Women who         Physical examination
    have endometrial polyps and fibroids protruding into uterine
    cavity (mainly submucosal fibroid) may have reduced chance        Most of investigations will be done on female partner.
    of pregnancy due to the distortion of uterine cavity for          Speculum examination will be performed and endocervical
    implantation. With previous uterine surgery, especially uterine   swab (or urine) will be taken to check for any chlamydial
    curettage involving in surgical termination of pregnancy or       infection. Pelvic ultrasound is used to look for any underlying
    surgical management of miscarriage, women are at risk             uterine (endometrial polyp / fibroid) or ovarian (polycystic ovary
    of having intrauterine adhesion and they may present with         / endometrioma) pathology.
    reduced or scanty menstrual flow after the surgery. This
    adhesion or scarring will adversely affect the endometrium        Investigations
    causing failure of embryo implantation. Some patients with
    history of tuberculosis endometritis will also be at risk of      Endocervical swab (or urine): check for chlamydial infection
    developing intrauterine adhesion.
                                                                      Blood tests:

     Management                                                       Q    CBC to screen for any thalassemia trait and Rubella
                                                                           antibody IgG test to check woman’s immunity status +/-
    History                                                                for vaccination.

    Couple is preferably to be seen together and then interviewed     Q    For ovulation and ovarian function tests, FSH (Follicle
    separately regarding those sensitive issues such as history            stimulating hormone), LH (Luteinizing hormone), E2
    of previous pregnancy and sexually transmitted disease.                (Estrogen) will be checked during early follicular phase
    The frequency of sexual intercourse and whether successful             (Day 2 to 5 of menses) and Progesterone level will be
    intravaginal ejaculation can be achieved will be checked with          check during mid luteal phase (7 days before the first day
    couple in order to screen for any underlying coital problem.           of next period) for women with regular menstrual cycle.
    Besides, any significant medical history and family history of
    genetic disease from couple is also important.                    Q    If anovulation is suspected, additional blood tests
                                                                           including prolactin, thyroid function test and female
    For female partner, questions regarding length of menstrual            androgen profile are indicated in order to screen for any
    cycle and regularity will be asked in order to screen for any          underlying endocrine diseases.
    ovulation problem. If patient had irregular cycle or even
    amenorrhoea, specific questions relating to any underlying        S e m e n a n a l y s i s : M e n n e e d t o h a v e 2-7 d a y s s e x u a l
    endocrine diseases such as any acne or hirsutism (PCOS), any      abstinence before the test. Besides, semen sample needed
    galactorrhoea, visual field defect or taking antipsychotic drug   to be collected by masturbation and delivered to laboratory
    (hyperprolactinaemia), any significant weight loss or excessive   for testing within 1 hour while keeping at room temperature
    exercise (hypothalamic cause) and also any previous ovarian       during delivery. If the first result is abnormal, second sample
    surgery, chemotherapy or menopausal symptoms (ovarian             will be checked 3 months later in order to confirm whether the
    failure) will be checked with her. In order to screen whether     abnormality is persistent.
    woman is at risk of having tubo-peritoneal diseases, she will

4   HKMA CME Bulletin 持續醫學進修專訊 January 2021                                                                                     www.hkma.org
Infertility - www.hkma.org
Spotlight

Tubal patency tests                                              Management options

Q   Hysterosalpingogram HSG: This is a screening test and        Healthy lifestyle: Couple should be advised to have healthy
    is only suitable for women at low risk for tubo-peritoneal   lifestyle such as balanced diet, regular exercise, weight
    disease. It is an outpatient procedure performing by         reduction if obese and smoking cessation. Women should take
    radiologist and no anaesthesia is required.                  folic acid while she is planning for pregnancy in order to reduce
                                                                 the chance of fetus having neural tube defect.

                                                                 Expertise referral: Couple should be referred to relevant
                                                                 experts if in case of any underlying psychosexual, urological or
                                                                 endocrine pathology is suspected.

                                                                 Operation: Surgery is one of the options for managing
                                                                 tubo-peritoneal cause of infertility and it is the mainstay
                                                                 of treatment for uterine pathology. Laparoscopic tubal
                                                                 surgeries such as salpingostomy (for distal tubal blockage)
                                                                 and hysteroscopic proximal tubal cannulation (for proximal
                                                                 tubal blockage) could be performed if in case of mild tubal
Q   Laparoscopy and chromotubation: This is a gold               disease. However, surgery is not effective in moderate to
    standard test for proper tubo-peritoneal assessment and      severe tubal problems and chance of future ectopic pregnancy
    is indicated for high risk women. Therapeutic surgeries      also needs to be considered. For pelvic endometriosis and
    including adhesiolysis and tubal surgery can be done at      adhesion, laparoscopic ablation / excision of endometriosis
    the same time. However, it requires general anaesthesia      and adhesiolysis can also be performed at the same time.
    and laparoscopy.                                             Laparoscopic ovarian drilling could be done for patient
                                                                 with PCOS if she needs to undergo laparoscopy and
                                                                 chromotubation as part of her tubo-peritoneal assessment. For
                                                                 managing intrauterine pathologies, hysteroscopic surgeries
                                                                 such as resection of fibroids, endometrial polypectomy
                                                                 and intrauterine adhesiolysis would be done under general
                                                                 anaesthesia by using resectoscope and scissors.

                                                                 Ovulation induction: After excluding other endocrine
                                                                 diseases, oral ovulation induction drug like clomid is commonly
                                                                 used in patients with PCOS or normogonadotrophic
                                                                 normogonadism. Women need to take it for 5 days starting
                                                                 from day 2 or 3 of their menstrual cycle. During that cycle,
Hysteroscopy: This is a gold standard method to diagnose         they need to monitor the treatment response by having basal
pathology within uterine cavity and at the same time,            body temperature to check for any biphasic change or doing
therapeutic surgery (excision / removal) can be performed if     LH urine kit for any positive LH surge in order to determine
needed.                                                          whether the drug is at ovulatory dose. Women can also
                                                                 have serial ultrasound scans to check for ovulation while
                                                                 minimizing the chance of multiple pregnancy by cancelling
                                                                 the treatment cycle if more than one mature follicle achieved.
                                                                 However, oral ovulation induction drug is not useful in cases
                                                                 of hypergonadotrophic hypogonadism (ovarian failure) which
                                                                 needs to consider egg donation while hypogonadotrophic
                                                                 hypogonadism (hypothalamic / pituitary causes) requires
                                                                 gonadotrophin injection including both FSH and LH hormones
                                                                 for folliculogenesis.

www.hkma.org                                                                         HKMA CME Bulletin 持續醫學進修專訊 January 2021         5
Infertility - www.hkma.org
Spotlight

    Assisted reproductive technology (ART): intrauterine                      age. For younger women, such as 30 years old, their
    insemination and in-vitro-fertilization                                   success rate could be much higher and up to 40-50%. On
                                                                              the other hand, for women older than 40, their success
    Q   Intrauterine insemination with or without ovulation                   rate can be reduced to 10% or even lower with advancing
        induction (IUI +/- OI): During this treatment, women’s                age.
        menstrual cycle and follicular growth will be monitored
        by serial ultrasound scans and hormonal blood tests. For
        women with anovulation, ovulation induction medication           Conclusion
        (oral / injection) is required and will be given since early
        follicular phase. On the day of ovulation, washed semen        Infertility problem affects 1 in 6 couples. Early recognition of
        sample will be inseminated into uterine cavity using a         any underlying problem and timely referral for treatment is
        fine catheter. The whole treatment cycle takes around          important as female fecundity decreases with age especially
        2 weeks and a pregnant test will be done 2 weeks after         for advanced age women.
        the insemination. This treatment option is most suitable
        for couple suffering from coital problem which failed           References
        psychosexual therapy. In addition, IUI can also be used        [1] Fertility problems: assessment and treatment. NICE guideline Feb 2013.
        in cases with mild abnormal semen parameters and               [2] WHO laboratory manual for the examination and processing of human
        unexplained cause. The success rate is around 10-15%.              semen. Fifth edition, January 2010.

    Q   In-vitro-fertilization with or without intracytoplasmic
                                                                                                                  Complete Spotlight, 1 CME Point
        sperm injection (IVF +/- ICSI): This treatment takes

                                                                        Q&A Self-Assessment
                                                                                                                  will be awarded for at least five
        around 2-3 weeks and it consists of (1) controlled                  CME                                   correct answers
        ovarian hyperstimulation using injectable ovulation drugs
                                                                            Questions:
                                                                            QUESTIONS:
        to achieve multi-follicular growth, (2) follicular growth
                                                                         Answer these on page 12 or make an online submission at: www.hkma.org.
        monitoring by means of ultrasound and hormonal blood             Please indicate whether the following statements are true of false.
        tests, (3) transvaginal oocyte retrieval under sedation
        once follicles reaching mature size, (4) fertilization of        1.  Infertility is defined as failure to conceive after 1 year of regular
        oocytes and sperms in laboratory by conventional                     unprotected coitus.
        method or ICSI and (5) embryo transfer into uterine              2. Around 1 in 3 couple will suffer from infertility.
        cavity under ultrasound guided if good quality embryo            3. Over 80% couple can achieve natural conception within first
                                                                             year of trying.
        available. This treatment is suitable for women with tubo-
                                                                         4. Unexplained infertility means only semen analysis test is
        peritoneal problem especially those with moderate and
                                                                             abnormal while ovulation test and tubal patency test are
        severe cases as fertilization of oocyte and sperm taking             normal.
        place in laboratory instead of relying on a normal tubo-         5. Psychosexual therapy is considered as the first line treatment
        peritoneal environment. Besides, it is also indicated in             for couple with coital problem.
        men with moderate to severe abnormal semen parameters            6. Women with irregular menstrual cycle should be suspected
        as an additional laboratory procedure called ICSI                    to have ovulation problem and further investigation should be
                                                                             arranged.
        (intracytoplasmic sperm injection), which means injecting
                                                                         7. Women with previous sexually transmitted disease, pelvic
        a sperm with normal motility and morphology directly                 surgery or dysmenorrhea are considered to be at low risk of
        into an oocyte using a micro-needle by embryologist in               tubo-peritoneal problem.
        laboratory, can be performed during IVF treatment in             8. Women with light menstrual flow and previous uterine surgery
        order to optimize the chance of fertilization. For couple            should be suspected to have intrauterine adhesion.
        with unexplained infertility who failed previous IUI or          9. Assisted reproductive technology consists of intrauterine
                                                                             insemination and in-vitro-fertilization.
        with advancing female age, IVF can also be considered.
                                                                         10. In-vitro-fertilization IVF has the highest successful treatment
        However, IVF is not without risks and its complications              rate while no complication is involved.
        include ovarian hyperstimulation syndrome (ascites,
        pleural effusion, venous thromboembolism etc.) resulting
                                                                       Answer to December 2020
        from ovarian hyperstimulation, internal organs injuries
                                                                       Spotlight 1 – Life-Time Management Of Aortic Stenosis
        (bowel, bladder and pelvic vessels) and infection during
                                                                       1. T 2. T 3. T 4. F 5. T 6. F 7. T 8. F 9. F 10. T
        oocytes retrieval, and multiple pregnancy relating to the
        number of embryos being transfer. Couple should be             Spotlight 2 – Immunotherapy For Urothelial Carcinoma: What’s
        counseled properly before treatment. For the success           The Latest Updates?
        rate, it is around 30-35% and it greatly depends on female     1. T 2. T 3. F 4. T 5. T 6. T 7. F 8. T 9. F 10. F

6   HKMA CME Bulletin 持續醫學進修專訊 January 2021                                                                                       www.hkma.org
Infertility - www.hkma.org
Cardiology
                                                                                                         The content of the January 2021 Cardiology Series is provided by:
                                                                                                                                                 Dr. CHEUNG Ling Ling
                                                                                                      MBBS(HK), MRCP(UK), FHKCP, FHKAM(Med), Specialist in Cardiology
                                                                                                                                                          Dr. Karl CHAN
Complete Cardiology case,                                                                                                                        MBBS (HK), MRCP (UK)
0.5 CME POINT will be awarded for                                                                     一月臨床心臟科個案研究之內容承蒙張玲玲醫生及陳斯畧醫生提供。
at least 2 correct answers in total

                                        A Patient Presenting with Palpitation and Dizziness
                                                                                          A 72 year old lady presented to outpatient clinic
                                                                                          complaining of noticeable palpitations associated with
                                                                                          dizziness for the past 3 months. She was a social smoker
                                                                                          and drinker with a history of myocardial infarction 10 years
                                                                                          ago. She was also diagnosed with hypothyroidism 2 years
                                                                                          ago and now on thyroxine supplement. She had no chest
                                                                                          pain. Physical examination revealed an irregular pulse
                                                                                          and normal apex position, there was no palpable thrill or
                                                                                          heave and no murmur was elicited on auscultation of the
                                                                                          precordium. An ECG was performed (Figure 1).
   Figure 1

     Q&A
                 Please answer ALL questions
                 Answer these on page 12 or make an online submission at: www.hkma.org.

     1) What is the rhythm seen in the ECG (Figure 1)?                                      3) This patient volunteers that she has been
        A. Atrial Fibrillation    C. Atrial Flutter                                            on regular aspirin ever since her episode of
        B. Normal sinus rhythm    D. Junctional rhythm                                         myocardial infarction many years ago. What is
                                                                                               your advice regarding the newly diagnosed AF
     2) Is she indicated for anticoagulation to reduce                                         and prevention of stroke?
        her risk of cardioembolic stroke?                                                      A. Advise her to continue the aspirin alone
        A. Yes, because her CHA2DS2-VASc score is 2                                            B. Advise her to continue the aspirin but add on a
        B. Yes, because her CHA2DS2-VASc score is 3                                               direct oral anticoagulant
        C. Yes, because anticoagulation is indicated in her                                    C. Advise her to discontinue the aspirin and switch
            case regardless of the quantitative stroke risk as                                    to a direct oral anticoagulant
            she has a thyroid disorder                                                         D. Advise her to discontinue the aspirin and switch
        D. No, because her CHADS2 score is 0                                                      to warfarin

 December Answers

   Explanation                                                                                                                  Answers: 1. C             2. D      3. B

   1. In the attached ECG, the absent of p-wave or “saw-tooth” flutter wave in the baseline, together with irregular
      ventricular rate suggest this patient suffering from atrial fibrillation.

   2. This is a 62 year-old lady with known history of diabetes and hypertension. Her CHA2DS2-VASc score is 3, so she
      has high risks of AF related thromboembolic events and oral anti-coagulation is indicated.

        Her symptoms last for more than 48 hours and her haemodynamic condition was stable besides fast AF on
        presentation, so she can be treated with medications for rate control (beta-blocker, calcium channel blocker or
        digoxin) and oral anti-coagulation. Cardioversion (electrical or pharmacological) can be considered 1) after at
        least 3 weeks of adequate anti-coagulation or 2) after performance of transesophageal echocardiogram under
        adequate anti-coagulation, which show the absence of left atrial (including left atrial appendage) thrombus.
        Immediate cardioversion can also be considered in patients with haemodynamic instability. After cardioversion,
        anti-coagulation should be continued for at least 4 weeks irrespective of the CHA2DS2-VASc score. (Fig A)

 www.hkma.org                                                                                                      HKMA CME Bulletin 持續醫學進修專訊 January 2021                   7
Infertility - www.hkma.org
Cardiology

8   HKMA CME Bulletin 持續醫學進修專訊 January 2021
                                              www.hkma.org
www.hkma.org
                                               本診所將於                             至                     休息,

                                                           並於年初                           開診。

                                                  This clinic will be closed from

                                                      to                         for Lunar New Year.

                                                           如有緊急查詢,請致電
                                               In an emergency, please contact

     HKMA CME Bulletin 持續醫學進修專訊 January 2021
                                                                                                             Cardiology

   9
Cardiology

        3. In patients with symptomatic paroxysmal atrial fibrillation or symptomatic persistence atrial fibrillation without
           major risk factors of AF recurrence (significantly enlarged LA volume, advanced age, long AF duration, renal
           dysfunction and other cardiovascular risk factors), both anti-arrhythmic drugs or catheter-based AF ablation
           (Class IIa for symptomatic paroxysmal AF and Class IIb for symptomatic persistence AF without major risk factors)
           can be considered after detailed discussion with patients concerning the pros and cons of each strategies. If the
           patient remained in symptomatic atrial fibrillation despite optimal anti-arrhythmic medications, catheter-based AF
           ablation is indicated. (Fig B)

                                                                                                                      Fig A

                                                                                                                      Fig B

        LAA closure maybe considered for stroke prevention in patients with AF with elevated stroke risks and
        contra-indications for long term anticoagulation.
        In patients with AF and symptomatic bradycardia, which is often related to underlying sick sinus syndrome and
        maybe exacerbated by antiarrhythmic therapy, pacemaker implantation is indicated.
        Reference:                                                                  The content of the December 2020 Cardiology Series is provided by:
        2020 ESC Guidelines for the diagnosis and management of                                                                Dr. CHUI Shing Fung
        atrial fibrillation developed in collaboration with the European   MBChB (CUHK), MRCP (UK), FHKCP, FHKAM (Medicine), Specialist in Cardiology
        Association for Cardio-Thoracic Surgery (EACTS). European                                                               Dr. WONG Chi Yuen
                                                                             MBBS (HK), FHKCP, FHKAM (Medicine), FRCP (Edin), Specialist in Cardiology
        Heart Journal (2020) 00, 1-126.
                                                                                十二月臨床心臟科個案研究之內容承蒙徐城烽醫生及黃志遠醫生提供。

10   HKMA CME Bulletin 持續醫學進修專訊 January 2021
                                                                                                                                       www.hkma.org
Dermatology
                                                                                                                    Dermatology Series for January 2021 is provided by:
                                                                                                                    Dr. LEUNG Wai Yiu, Dr. TANG Yuk Ming, William,
                                                                                             Dr. CHAN Hau Ngai, Kingsley, Dr. KWAN Chi Keung and Dr. NG Shun Chin
                                                                                                                               Specialists in Dermatology & Venereology
Complete Dermatology case,                                                                       一月皮膚科個案研究之內容承蒙梁偉耀醫生、鄧旭明醫生、陳厚毅醫生、
0.5 CME POINT will be awarded for                                                                                                       關志強醫生及吳順展醫生提供。
at least 2 correct answers in total

                                                               A Lady With Itchy Skin Rash On Her Legs
                                                               A 73-year-old female complained of itching on the legs and noticed
                                                               multiple red fissures on her shin for several weeks. The patient has a
                                                               history of diabetes but not any past medical history of autoimmune or
                                                               endocrine diseases. She is not on any medication such as retinoid.
                                                               Physical examination revealed erythematous plaque of polygonal
                                                               fissures with exudate and yellow crust on her shin. She recalled similar
                                                               pruritic rashes on her legs last winter, which resolved when the weather
                                                               was warmer.

    Q&A
                Please answer ALL questions
                Answer these on page 12 or make an online submission at: www.hkma.org.

    1. What is the clinical diagnosis?                                                   3. Are these skin lesions more pronounced in
        A. Cellulitis                             C. Livedo reticularis                     winter? (T/F)
        B. Asteatotic eczema                      D. Contact dermatitis
                                                                                         4. Which of the following is NOT a treatment
    2. Who is more prone to this skin disease?                                              option for this patient?
       A. Female                                                                            A. Patient education and reassurance
       B. Patient with ichthyosis                                                           B. Low potency steroid cream
       C. Patient with autoimmune disease                                                   C. Systemic antibiotics
       D. Elderly                                                                           D. Frequent Emollient/ Moisturizers

        I. A+C                    III. All
        II. B+D                   IV. None of the above

December Answers
 1. E                                                                                    5. E
    The clinical diagnosis is seborrheic dermatitis. It is a                                Medicated shampoo containing ketoconazole. tar,
    common, chronic for of eczema and mainly affecting the                                  selenium sulfide etc can be used to decrease the
    sebaceous gland rich area, like the scalp, face and trunk.                              scales over scalp. Steroid scalp application help to
    It is non infectious and usually worsen in dry weather.                                 decrease itchness and can be stopped once the
                                                                                            symptom subsided. Topical immunosuppressant like
 2. F                                                                                       calcineurin inhibitor can be as used as alternative to
    Infantile seborrhoic dermatitis usually affects babies                                  steroid. Combination treatment is usually needed to treat
    under 3 months of age and usually resolves around 1                                     seborhoic dermatitis.
    year old. Adult seborrhoic dermatitis usually affects late
    adolescence and it is more common in males than in
    females.

 3. E
    Seborrhoic dermatitis usually presents as red scaly rash
    over scalp, but it can also occur over eyebrow, ear, nose,
    upper trunk, etc.

 4. F                                                                                          The content of the December 2020 Dermatology Series is provided by:
    Seborrhoic dermatitis is best to be diagnosed clinically.                                          Dr. CHAN Hau Ngai, Kingsley, Dr. TANG Yuk Ming, William,
                                                                                                 Dr. KWAN Chi Keung, Dr. LEUNG Wai Yiu and Dr. NG Shun Chin,
    No skin biopsy or blood checking is usually needed for                                                                Specialists in Dermatology & Venereology
    most cases                                                                              十二月皮膚科個案研究之內容承蒙陳厚毅醫生、鄧旭明醫生、關志強醫生、
                                                                                                                                   梁偉耀醫生及吳順展醫生提供。

www.hkma.org                                                                                                     HKMA CME Bulletin 持續醫學進修專訊 January 2021                  11
Name                                                                     Signature:

Answer Sheet                       HKMA Membership No.

                                                                                                            Contact Tel No.:

                                   HKID No.             -                xxx(x)

January 2021
                                                                           ANSWER SHEET
        Please answer ALL questions and write the answers in the space provided.                                       Please return the
                                                                                                                       completed answer sheet
        SPOTlight
                                                                                                                       to the HKMA Secretariat
        Complete Spotlight, 1 CME point will be awarded for at least 5 correct answers
                                                                                                                       (Fax: 2865 0943) on or
        1         2         3         4         5           6        7        8           9         10                 before 15 February 2021
                                                                                                                       for documentation.
                                                                                                                       If you complete
        Cardiology                                       Dermatology                                                   the exercise online,
        Complete Cardiology, 0.5 CME point will be          Complete Dermatology, 0.5 CME point will be                you are NOT required to
        awarded for at least two correct answers            awarded for at least two correct answers                   return the answer sheet by fax.
        1         2         3                               1        2         3          4

                                                                                                                         A maximum of 20 points can
                                                                                                                         be awarded for self-study
                                                                                                                         per year and no upper limit of
                                                                                                                         CME points for attending CME
                                                                                                                         lectures

  CME Physical Lecture Policy and Procedure
  Registration                                                                     Online payment available ONLY for attending a single lesson, payment for
  1. Please complete the reply slip and return to HKMA Secretariat in person       package is unavailable currently.
     or by fax/mail/email.                                                         CME Self-Studies Series
  2. Enrollment priorities will be given to doctors who have purchased             You can register the CME Lectures and finish the CME Self-Studies Series
     packages. For Community Network Lectures, priorities will be given to         within the webpage (www.hkma.org).
     doctors from that Community Network with Packages, then doctors               Don’t wait! Please register and create your own account through https://
     from that Community Network.                                                  www.thkma.org/members/register.php (1st time register account is limited
  3. No walk in or on-site payment will be accepted. Attendance without            on desktop ONLY) to experience our new Members Portal.
     registration will not be recognized and CME point will not be accredited.     Information for Participants
  4. Please ensure that your registration is confirmed before attending            Special weather arrangement
     lecture. Only successfully registered doctors who paid could attend the       When Tropical Storm Warning Signal No. 8 (or above) or a Black Rainstorm
     lecture.                                                                      Warning Signal is in force within 3 hours of the commencement time, the
  5. The HKMA Secretariat will notify doctors who have successfully enrolled       relevant CME function will be cancelled. (i.e. CME starting at 2:00 pm will be
     to arrange for payment. If doctors have not arranged for payment within       cancelled if the warning signal is hoisted or in force any time between 11:00
     a specified period after the notification, the seat will be released to       am and 2:00 pm).
     doctors on waiting list without further notice.
                                                                                   The function will proceed as scheduled if the signal is lowered three hours
  Payment                                                                          before the commencement time. (i.e. CME starting at 2:00 pm will proceed
  1. All HKMA CME lectures that involve registration and enrollment through        if the warning signal is lowered at 11:00 am, but will be cancelled even if it is
     the HKMA would require the collection of lecture fee (unless otherwise        lowered at 11:01 am).
     specified).
  2. The lecture fee is $50 for HKMA members and $100 for non-members              When Typhoon No. 8 Signal or a Black Rainstorm signal is in force after
     per lecture.                                                                  CME commencement, announcement will be made depending on the
  3. Online payment is available to doctors who have registered the HKMA           conditions as to whether the CME will be terminated earlier or be conducted
     website online system. One transaction is for one lecture only.               until the end of the session.
  4. Packages could be purchased through cash or cheque only.                      The above are general guidelines only. Individuals should decide on their
  5. Cash payments have to be paid in person at HKMA Secretariat and               CME attendance according to their own transportation and work/home
     cheque payments have to be mailed or paid in person at HKMA                   location considerations to ensure personal safety.
     Secretariat.                                                                  General lecture policy
  6. Fee can be paid together in one cheque for lecture within the same            1. Doctor should sign for own CME.
     month. Only combined cheque payment for not more than 2 packages              2. Registration will cease when Q & A Session starts.
     will be accepted.                                                             3. No recording unless permission is granted by the HKMA.
  7. No refund or transfer will be allowed after payment is made. Payment          4. If doctor has attended CME Lecture and CME Live at the same point of
     cannot be transferred to other lectures or for other specified doctors.            time, only CME Points for the Lecture would be counted.
  CME Online Payment & CME Self-Studies Series                                     5. The HKMA will investigate when non-compliance at CME Session is
  CME Online Payment                                                                    reported, further action will be considered to ensure all CME activities
  The HKMA is excited to introduce online payment for CME Lectures:                     are properly held.
  1. Login to CME Portal to apply for a lecture                                    6. For enquiries, please contact the CME Department of the HKMA
  2. Receive SMS notification                                                           Secretariat at 2527-8452.
  3. Pay online!

                                                                                                                                             (revised in August 2019)
CME Live                                                                CME notifications

                       The HKMA CME Live Lectures in January 2021

                                               All lectures start at 2:00-3:00 p.m.

                                                                                                                   CME
                                                                                                                   Accreditation
                                                                                                           CME     from Colleges
      Date                    Organizer and Topic              Speaker                                    Points   (Pending)#
 1.   20 January       HKMA                                    Dr. NGAI Chi Fung                            1      Pending
      (Wed)            Update on Management of Fatty Liver     Specialist of Gastroenterology and
                       Disease                                 Hepatology
                       Sponsor: Abbott Laboratories Limited
 2.   22 January       HKMA                                    Dr. JIM Man Hong                              1     Pending
      (Fri)            Optimized choice of anticoagulation     Specialist in Cardiology
                       -NOAC in high risk AF patients
                       Sponsor: Daiichi Sankyo Hong Kong
                       Limited
 3.   23 January       HKMA & Hong Kong Elderly                1. Dr. WONG Tai Hung, John                    2     Yes
      (Sat)            Welfare Foundation                      Specialist in Cardiology
      2:00-3:45 p.m.   1. LUTS and Heart Diseases (CHF)        2. Dr. CHU Wing Hong
                       2. LUTS And Mortality (Falls And        Specialist in Urology
                       Fractures)                              3. Dr. CHEON Willy Cecilia
                       3. LUTS And Incontinence                Consultant (O&G) Head, Urogynaecology
                       Sponsor: Hong Kong Elderly Welfare      Team in O&G Dept, QEH
                       Foundation                              Dr. CHAN Yuen Mei, Toby
                                                               Associate Consultant, Urogynaecology
                                                               Team in O&G Dept, QEH
 4.   26 January       HKMA Yau Tsim Mong Community            Dr. CHOW Man Po                               1     Yes
      (Tue)            Network                                 Specialist in General Surgery
                       Lecture Series on Surgery (Session 1)
                       – Colorectal Cancer Prevention and
                       Treatment Updates
 5.   27 January       HKMA                                    Dr. Martin WONG                               1     Yes
      (Wed)            Personalized treatment for              Specialist in Urology
                       management of BPH
                       Sponsor: Synmosa Biopharma (HK)
                       Co Ltd
 6.   28 January       HKMA New Territories West               Dr. CHAN Ki Wan, Kelvin                       1     Yes
      (Thu)            Community Network                       Specialist in Cardiology
                       Diagnosis and Management for
                       Chronic Coronary Syndrome
                       Sponsor: Sanofi Hong Kong Ltd.
 7.   29 January       HKMA                                    Dr. CHAN Pak To                               1     Pending
      (Fri)            Management of Rheumatoid Arthritis.     Specialist in Rheumatology
                       What is the update in 2020?
                       Sponsor: AbbVie Limited
 8.   30 January       HKMA 3D Printing Interest Group         1. Prof. Alex PW LEE                         1.5    Pending
      (Sat)            1. 3D Printing in clinical medicine.    Professor & Honorary Consultant
      3:00-4:30 p.m.   Sharing our knowledge and current       Cardiologist, CUHK
                       methods between different specialties   2. Prof. Richard SU
                       – a series of short lectures and        Clinical Associate Professor in Oral and
                       discussion                              Maxillofacial Surgery, HKU
                       2. Round table discussion               3. Mr. Joseph CHENG
                                                               Senior Occupational Therapist, CMC
                                                               4. Mr. Gabriel CHU
                                                               Prosthetist-Orthotist I, UCH
                                                               5. Dr. Christian FANG
                                                               Clinical Associate Professor, Department
                                                               of Orthopaedics and Traumatology, HKU
                                                               6. Dr. Damian MAK
                                                               Associate Consultant, Department of
                                                               Orthopaedics and Traumatology, North
                                                               District Hospital

www.hkma.org                                                                              HKMA CME Bulletin 持續醫學進修專訊 January 2021   13
CME notifications                                                                           CME Live

                         The HKMA CME Live Lectures in February 2021

                                                     All lectures start at 2:00-3:00 p.m.
     **The final arrangement of the Live sessions might subject to changes, please refer to the RCS and the list post in the
     Facebook Group for the most updated arrangement.**

                                                                                                                                CME
                                                                                                                                Accreditation
                                                                                                                      CME       from Colleges
           Date                      Organizer and Topic                       Speaker                               Points     (Pending) #
      1.   2 February    The Hong Kong Medical Association &                   Dr. LI Chung Ki, Patrick                1        Yes
           (Tue)         Hong Kong Sanatorium & Hospital                       Specialist in Neurology
                         Updates on Acute Stroke Management
                         Sponsor: Hong Kong Sanatorium & Hospital
      2.   4 February    HKMA Kowloon East Community Network                   Dr. CHAN Chi Wing, Timmy                 1       Yes
           (Thu)         Chronic Pain Management                               Consultant,
                         Sponsor: Abbott Laboratories Limited                  Department of Anaesthesiology,
                                                                               Queen Mary Hospital
      3.   9 February    HKMA Kowloon West Community Network                   Dr. WONG King Ying                       1       Yes
           (Tue)         Safety & Efficacy of Corticosteroids for Asthma       Specialist in Respiratory
                         Treatment                                             Medicine and Internal Medicine
                         Sponsor: GlaxoSmithKline Limited
      4.   10 February   HKMA Central, Western & Southern                      Dr. IP Ka Lun                            1       Pending
           (Wed)         Community Network                                     Specialist in
                         Management of Tonsillitis and Carcinoma of            Otorhinolaryngology
                         Larynx
                         Sponsor: Medtronic Hong Kong Medical
                         Limited
      5.   18 February   HKMA New Territories West Community                   Dr. LAU Chun Leung                       1       Yes
           (Thu)         Network                                               Specialist in Cardiology
                         Leading the Shift in Paradigm in T2D
                         Treatments: Cardio-Protection with Glucose-
                         Lowering Drug
                         Sponsor: Boehringer Ingelheim (Hong Kong)
                         Limited
      6.   23 February   The Hong Kong Medical Association & the               Dr. WAN Chi Kin                          1       Yes
           (Tue)         Gleneagles Hong Kong Hospital                         Specialist in Respiratory
                         CA lung /Lung Nodules and Ground Glass                Medicine
                         Opacities: how should we manage them?                 Dr. SIHOE Dart Loon, Alan
                         Sponsor: Gleneagles Hong Kong Hospital                Specialist in Cardio-thoracic
                                                                               Surgery
      7.   25 February   HKMA Hong Kong East Community Network                 Dr. NG Ka Kin                            1       Yes
           (Thu)         Hemorrhoids... A Common Disease and                   Specialist in General Surgery
                         Effective Treatment Options
                         Sponsor: Servier Hong Kong Ltd
      8.   26 February   HKMA Yau Tsim Mong Community Network                  Dr. KAN Mei Yee, Daisy                   1       Yes
           (Fri)         Lecture Series on Surgery (Session 2) - Non-          Consultant,
                         Surgical Treatment of Benign Thyroid Nodule           Department of Surgery,
                                                                               Kwong Wah Hospital

                         Please register through https://forms.gle/fEfbjYihuE81qyni6 or scan the QR code placed on the left if you are interested
                         to attend. For enquiry, please contact the Secretariat at 2527 8285.
                         #
                             Accreditation from various colleges pending, for specialists, please completed the quiz online within two hours after
                             the lecture with at least 50% correct for CME/ CPD points. For lecture without “Yes”, CME Accreditation is for Non-
                             Specialists Only. Non-Specialists doctors must complete lecture quiz (10 Q&A) and answer questions within two hours
                             after the lecture with at least 50% correct.

14   HKMA CME Bulletin 持續醫學進修專訊 January 2021
                                                                                                                                 www.hkma.org
CME Live                                                                  CME notifications

                                         HKMA-HKSH and HKMA-GHK
                                           CME Programme 2021
                                                   All lectures start at 2:00-3:00 p.m.

 Date                            HKSH Programme                                                     Speaker

 02 February 2021 (Tue)          Updates On Acute Stroke Management                                 Dr. LI Chung Ki, Patrick
                                                                                                    Specialist in Neurology

 02 March 2021 (Tue)             The Application & Effectiveness Of Allergen                        Dr. CHAN Wai Ming, Alson
                                 Immunotherapy In Co-Morbid Allergic Diseases                       Specialist in Paediatric Immunology,
                                                                                                    Allergy and Infectious Diseases

 13 April 2021 (Tue)             10 Things That You Need Know About Prostate Cancer                 Dr. POON Ming Chun, Darren
                                                                                                    Specialist in Clinical Oncology

 04 May 2021 (Tue)               Recent Advance In GORD                                             Dr. KWONG Wing Hang
                                                                                                    Specialist in General Surgery

 01 June 2021 (Tue)              Common Upper Limb Fractures And Options Of                         Dr. KOU Sio Kei
                                 Treatment                                                          Specialist in Orthopaedics &
                                                                                                    Traumatology

 06 July 2021 (Tue)              Surgical Management Of Lymphoedema                                 Dr. CHOI Wing Kee
                                                                                                    Specialist in Plastic Surgery

 03 August 2021 (Tue)            Glaucoma - Beyond Intraocular Pressure, The Updates                Dr. BAIG, Nafees Begum
                                 We Should Know                                                     Specialist in Ophthalmology

 Date                            GHK Programme                                                      Speaker

 23 February 2021 (Tue)          CA Lung /Lung Nodules And Ground                                   1.   Dr. WAN Chi Kin
                                 Glass Opacities: How Should We Manage Them?                             Specialist in Respiratory Medicine
                                                                                                    2.   Dr. SIHOE Dart Loon, Alan
                                                                                                         Specialist in Cardio-thoracic
                                                                                                         Surgery

 12 March 2021 (Fri)             Update On Minimally Invasive Spine Surgery                         Dr. LAM Cheung Hing, Eric
                                                                                                    Specialist in Orthopaedics &
                                                                                                    Traumatology

 20 April 2021 (Tue)             Update On Management Of Peritoneal Malignancy                      Dr. Jeremy YIP
                                                                                                    Specialist in General Surgery

 25 May 2021 (Tue)               Update On Renal Stone Management                                   Dr. CHUNG Yeung, Vera
                                                                                                    Specialist in Urology

 22 June 2021 (Tue)              Management On Musculoskeletal Tumor                                Dr. SO Yat Cheong, Timothy
                                                                                                    Specialist in Orthopaedics &
                                                                                                    Traumatology

                       CME Accreditation: 1 CME point per day #
                       Registration: Please scan the QR code or register through https://forms.gle/pHfp3YbkcWSvqbxa9
                       Registration Deadline: Monday, 8 February 2021
                       Enquiry: CME Department, Tel: 2527 8285 / cme@hkma.org

                       #
                           Accreditation from various colleges pending. For Specialists, please completed the quiz online within two hours
                           after the lecture with at least 50% correct for CME/CPD point(s). For Non-Specialists Doctors, please completed the
                           quiz online within two hours after the lecture with at least 50% correct for CME point(s).

www.hkma.org                                                                                  HKMA CME Bulletin 持續醫學進修專訊 January 2021            15
Meeting Highlights

     The Hong Kong Medical Association

                                                                                                                            Dr. MAK Siu King (2nd speaker of the roll), Dr. Jennifer
                                                                                                                            Ma Wai Wai MYINT (3rd speaker of the roll) and
                                                                                                                            Prof. YING Tin-Cheung, Michael (1st speaker of the
     Dr.WONG Y at Hin, Ian presenting a CME Live Lecture on     Dr. LAU Cham Yat,Vincent presenting a CME Live Lecture on   roll) presenting a CME Live LUTS Series Half-Day
     1December 2020                                             18 December 2020                                            Symposium on19 December 2020

     The HKMA Hong Kong East                                    The HKMA Kowloon West
     Community Network (HKECN)                                  Community Network (KWCN)                                    The HKMA Shatin Community
     ~ Dr. CHAN Nim Tak, Douglas                                ~ Dr. TONG Kai Sing                                         Network (SCN)

     Dr. Ray CHAN presenting a CME Live Lecture                  Dr. Gary CHEUNG presenting a CME Live Lecture              Dr. Alfred T AM presenting a CME Live Lecture
     on17 December 2020                                          on 4 December 2020                                         on16 December 2020

                                                                        HKMA CME Bulletin
                                                              Monthly Self-Study Series Call for Articles
         Since its publication, the HKMA CME Bulletin has become one of the most popular CME readings for doctors. This
         monthly publication has been serving more than 10,000 readers each month through practical case studies and picture
         quizzes. To enrich its content, we are inviting articles from experts of different specialties. Interested contributors may
         refer to the General Guidance below. Other formats are also welcome.
         For further information, please contact CME Dept. at 2527 8452 or by email at cme@hkma.org.
         General Guidance for Authors
         Intended Readers : General Practitioners
         Length of Article : Approximately 8-10 A-4 pages in 12-pt fonts in single line spacing, or around 1,500-2,000 words
                               (excluding references).
         Review Questions : Include 10 self-assessment questions in true-or-false format.
         		 (It is recommended that analysis and answers to most questions be covered in the article.)
         Language           : English
         Highlights         : It is preferable that key messages in each paragraph/section be highlighted in bold types.
         Key Lessons        : Recommended to include, if possible, a key message in point-from at the end of the article.
         Others             : List of full name(s) of author(s), with qualifications and current appointment quoted, plus a digital
                               photograph of each author.
         Deadline           : All manuscripts for publication of the month should reach the Editor before the 1st of the previous
                               month.
         All articles submitted for publication are subject to review and editing by the Editorial Board.
         We welcome submissions for consideration which are original and not under consideration for any other
         publication at the same time. Articles submitted will be checked using originality detection software. For details
         please contact CME Bulletin Editorial Office of the HKMA.

16   HKMA CME Bulletin 持續醫學進修專訊 January 2021
                                                                                                                                                                             www.hkma.org
CME Calendar

                               January 2021                                                                   February 2021
20 January       The Hong Kong Medical Association                               2 February       The Hong Kong Medical Association & Hong Kong
(Wed)            Update on Management of Fatty Liver Disease               1     (Tue)            Sanatorium & Hospital                                  1
2:00-3:00 p.m.   HKMA Facebook CME Live Lecture                                  2:00-3:00 p.m.   Updates on Acute Stroke Management
                 HKMA CME Dept. – Tel: 2527 8452                                                  HKMA Facebook & Zoom CME Live Lecture
22 January       The Hong Kong Medical Association                                                HKMA CME Dept. – Tel: 2527 8452
(Fri)            Optimized choice of anticoagulation -NOAC in high risk    1
                                                                                 4 February       HKMA Kowloon East Community Network
2:00-3:00 p.m.   AF patients                                                     (Thu)            Chronic Pain Management                                1
                 HKMA Facebook CME Live Lecture                                  2:00-3:00 p.m.   HKMA Facebook CME Live Lecture
                 HKMA CME Dept. – Tel: 2527 8452                                                  HKMA CME Dept. – Tel: 2527 8452
23 January       HKMA & Hong Kong Elderly Welfare Foundation                     9 February       HKMA Kowloon West Community Network
(Sat)            1. LUTS and Heart Diseases (CHF)                          2                                                                             1
                                                                                 (Tue)            Safety & Efficacy of Corticosteroids for Asthma
2:00-3:45 p.m.   2. LUTS And Mortality (Falls And Fractures)                     2:00-3:00 p.m.   Treatment
                 3. LUTS And Incontinence                                                         HKMA Facebook CME Live Lecture
                 HKMA Facebook & Zoom CME Live Lecture                                            HKMA CME Dept. – Tel: 2527 8452
                 HKMA CME Dept. – Tel: 2527 8452                                 10 February      HKMA Central, Western & Southern Community
26 January       HKMA Yau Tsim Mong Community Network                            (Wed)            Network                                                1
(Tue)            Lecture Series on Surgery (Session 1) – Colorectal        1
                                                                                 2:00-3:00 p.m.   Management of Tonsillitis and Carcinoma of Larynx
2:00-3:00 p.m.   Cancer Prevention and Treatment Updates                                          HKMA Facebook CME Live Lecture
                 HKMA Facebook CME Live Lecture
                                                                                                  HKMA CME Dept. – Tel: 2527 8452
                 HKMA CME Dept. – Tel: 2527 8452
                                                                                 18 February      HKMA New Territories West Community Network
27 January       The Hong Kong Medical Association                                                                                                       1
                                                                           1     (Thu)            Leading the Shift in Paradigm in T2D Treatments:
(Wed)            Personalized treatment for management of BPH
                                                                                 2:00-3:00 p.m.   Cardio-Protection with Glucose-Lowering Drug
2:00-3:00 p.m.   HKMA Facebook CME Live Lecture
                                                                                                  HKMA Facebook CME Live Lecture
                 HKMA CME Dept. – Tel: 2527 8452
                                                                                                  HKMA CME Dept. – Tel: 2527 8452
28 January       HKMA New Territories West Community Network
                                                                           1     23 February      The Hong Kong Medical Association & the
(Thu)            Diagnosis and Management for Chronic Coronary                                                                                           1
                                                                                 (Tue)            Gleneagles Hong Kong Hospital
2:00-3:00 p.m.   Syndrome
                 HKMA Facebook CME Live Lecture                                  2:00-3:00 p.m.   CA lung/Lung Nodules and Ground Glass Opacities:
                 HKMA CME Dept. – Tel: 2527 8452                                                  how should we manage them?
                                                                                                  HKMA Facebook & Zoom CME Live Lecture
29 January       The Hong Kong Medical Association
(Fri)            Management of Rheumatoid Arthritis. What is the           1                      HKMA CME Dept. – Tel: 2527 8452
2:00-3:00 p.m.   update in 2020?                                                 25 February      HKMA Hong Kong East Community Network
                                                                                 (Thu)            Hemorrhoids... A Common Disease and Effective          1
                 HKMA Facebook CME Live Lecture
                 HKMA CME Dept. – Tel: 2527 8452                                 2:00-3:00 p.m.   Treatment Options
30 January       HKMA 3D Printing Interest Group                                                  HKMA Facebook CME Live Lecture
(Sat)            1. 3D Printing in clinical medicine. Sharing our          1.5                    HKMA CME Dept. – Tel: 2527 8452
3:00-4:30 p.m.   knowledge and current methods between different                 26 February      HKMA Yau Tsim Mong Community Network
                                                                                 (Fri)            Lecture Series on Surgery (Session 2) - Non-Surgical   1
                 specialties – a series of short lectures and discussion
                 2. Round table discussion                                       2:00-3:00 p.m.   Treatment of Benign Thyroid Nodule
                 HKMA Facebook & Zoom CME Live Lecture                                            HKMA Facebook CME Live Lecture
                 HKMA CME Dept. – Tel: 2527 8452                                                  HKMA CME Dept. – Tel: 2527 8452

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