Evaluation of Clinical Neuropathy After Living Donor Liver Transplant.

OBJECTIVES: Neurologic complications are more common in liver transplants than in other solid-organ transplants. One such neurologic complication, peripheral neuropathy, may cause functional limitations for recipients and have a negative effect on posttransplant quality of life. We aimed to examine the risk factors associated with the occurrence of clinical neuropathy after liver transplant and to investigate the frequency of sensory deficits. MATERIALS AND METHODS: In this case-control study, we analyzed factors from medical records of 63 recipients who underwent living donor liver transplant during the period from January 2010 to December 2016. A neuropathy symptom score was assigned to identify the patients who had clinical neuropathy (case group) and the patients without clinical neuropathy (control group). Quantitative sensory testing was performed to measure the warm and cold detection thresholds, and the difference between the 2 groups was examined. RESULTS: Compared with controls, patients with clinical neuropathy were older (61.0 vs 55.4 years; P = .028), had higher rates of diabetes (46.2% vs 16.0%; P = .03), and were taking antiviral agents against hepatitis B (100% vs 62%; P = .006). Patients with neuropathic symptoms had significantly increased frequencies of impairment of warm and cold detection thresholds. In addition, the greater severity of symptoms showed higher detection thresholds of warm (control, 40.7℃; mild-to-moderate, 43.8 ℃; severe, 46.0 ℃; P = .007) and cold (control, 28.8℃ ; mild-to-moderate, 27.0 ℃; severe, 21.8 ℃ ; P = .008). CONCLUSIONS: Our findings show that older age, diabetes, and treatment with oral antiviral agents against hepatitis B virus were more likely to be associated with the occurrence of clinical neuropathy after liver transplant. Early awareness and careful monitoring are warranted.

Metoclopramide as a prokinetic agent for diabetic gastroparesis: revisiting the risk of Parkinsonism.

BACKGROUND: Metoclopramide is used to relieve gastrointestinal symptoms, however, it could cause adverse reactions of motor disorders. The aim of this study was to investigate whether metoclopramide treatment has a duration-response or dose-response effect and to estimate the risk of developing Parkinsonism following different and specific durations of treatment. METHODS: A cohort study of newly diagnosed type 2 diabetes mellitus in 45- to 79-year-old patients, between 1999 and 2008, was selected using the Longitudinal Health Insurance Database 2005. A nested case-control study was conducted in the diabetes cohort in which all incident cases of Parkinsonism were identified. We randomly matched each case with up to 10 controls from the risk set. Conditional logistic regression was utilized to estimate odds ratio of Parkinsonism associated with metoclopramide use. RESULTS: A total of 34,685 patients with diabetes were assembled as the cohort, and 541 incident Parkinsonism cases were identified. There were duration-response and dose-response effects on the risk of developing Parkinsonism. Compared with never-use patients, the adjusted odds ratios (ORs) of continuing therapy for 0-1 month, 1-2 months, 2-3 months, 3-5 months, and more than 5 months were 1.17 [95% confidence interval (CI) 0.93-1.45], 1.44 (95% CI 1.04-2.00), 1.74 (95% CI 1.14-2.65), 1.90 (95% CI 1.23-2.93), and 2.17 (95% CI 1.50-3.12), respectively. CONCLUSIONS: With metoclopramide treatment, regardless of less or more than 3 months of use, the risk of developing Parkinsonism in patients with newly diagnosed diabetes escalated with the duration of therapy. Therefore, we recommend close monitoring for the development of Parkinsonism in patients treated with metoclopramide, particularly (but not limited to) those with prolonged exposure.

Type 2 diabetes mellitus and risk of hydrocephalus: A 5 year population-based follow-up study in Taiwan.

AIMS: Type 2 diabetes mellitus (T2DM) involves many organ systems and is associated with a wide range of neurologic complications. However, it is not known whether T2DM is a risk factor of hydrocephalus. METHODS: Research data were retrieved from the National Health Insurance Research Database of Taiwan. A total of 25,903 individuals with T2DM aged 40-80 years diagnosed during 2000-2003 and two times-number (n=51,806) age- and sex-matched comparisons during the same period were included. We tracked all individuals from their defined index visits for up to 5 years to detect a new diagnosis of hydrocephalus. RESULTS: Among the 25,903 patients, 9227 cases were newly diagnosed T2DM and 16,676 were pre-existing T2DM patients. During the follow-up period, 27 (0.3%) of the newly diagnosed T2DM patients, 97 (0.6%) of the pre-existing T2DM patients and 149 (0.3%) of the comparison group developed hydrocephalus. The risk of hydrocephalus was significantly increased in patients with pre-existing diabetes but not in patients with newly diagnosed diabetes. CONCLUSIONS: Longer duration of type 2 diabetes is associated with an increased risk of the development of hydrocephalus. Further studies to confirm such association and to investigate the causality and mechanism are needed.

Significantly increased medical expenditure on breast cancer failing to bring down its mortality and incidence rate.

BACKGROUND: The direct impact of medical expenses on breast cancer incidence and mortality rate has not been sufficiently addressed. The purpose of this study is to investigate the potential correlation between the incidence and mortality rate of breast cancer and the medical expenses in Taiwan. MATERIALS AND METHODS: Breast cancer cases were identified from the National Health Insurance Research Database (NHIRD) with corresponding to International Classification of Diseases, and the Ninth Revision (ICD-9) code 174, 1740-1749, 175, 1750 and 1759 from January 1999 to December 2006. Age-specific incidences were estimated by population data obtained from the Department of Statistics, Ministry of the Interior. Medical expenses, including outpatient and inpatient services, were also retrieved from the NHIRD. RESULTS: The incidence increased from 20.06 per 100,000 in 1999 to 30.34 per 100,000 in 2006; the total expenses increased from 1,449,333,521 in 1999 to 4,350,400,592 Taiwan dollars in 2006. The age-standardized mortality rate for female breast cancer remained essentially unchanged, while the age-standardized incidence increased steadily (except 2002-2003). Among the top 20 coexisting ICD-9 codes for expenses, four are directly on cancers, while 16 are on other diseases or symptoms, which are not necessarily caused by breast cancer. CONCLUSIONS: Significantly increased medical expenditure on breast cancer failed to bring down its mortality and incidence rate. The finding has implications for healthcare policy planners in proposing strategies for breast cancer control and allocating the resources.

Nationwide population-based epidemiologic study of childhood and adulthood intussusception in Taiwan.

BACKGROUND: Most studies have evaluated the epidemiology of intussusception only in children. This was the first nationwide population-based study conducted to investigate the epidemiology and associated medical expenses of intussusception for all age groups in Taiwan. METHODS: Cases of intussusception were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database with corresponding International Classification of Diseases, Ninth Revision (ICD-9) code 560.0, from January 2000 to December 2007. RESULTS: In total, 7255 incident cases of intussusception were detected. The majority of cases were children younger than 4 years of age. Significant male predominance was observed in the under-10-, 55-59-, and older-than-80-year age groups. The incidence peaked in the 1-2-year age group, reaching as high as 112.84 and 81.96 per 100,000 person-years for males and females, respectively. The incidence of intussusception was very low in adults. However, the medical expenses, number of coexisting neoplasms and malignancies, and hospitalization days were substantially higher in adults than in children. Although coexisting neoplasms developed in 40.8% of adult patients with intussusception, it occurred in only 0.4% of those younger than 3 years. CONCLUSION: This study is the first to describe detailed age- and sex-specific incidence rates and medical expenses of intussusception for both pediatric and adult groups in Taiwan. There were significant differences between the two groups, with a much higher incidence in young children, but more coexisting neoplasms and malignancies and average medical expenses in adult patients.

The incidence rate of post-stroke epilepsy: a 5-year follow-up study in Taiwan.

PURPOSE: The impact of epilepsy following different subtypes of stroke is unclear. The aim of this study was to evaluate the risk of post-stroke epilepsy with different stroke subtypes. METHODS: A total of 4126 stroke patients and 24,756 age- and sex-matched controls were retrieved from the Longitudinal Health Insurance Database 2005, a major dataset of the National Health Insurance Research Database, from 2000 to 2003. All were then individually tracked to their last medical visit up to five years from 30 days after their first-ever stroke incident to identify those who developed epilepsy. RESULTS: Among the 4126 stroke patients, 72.2% had ischemic stroke, 14.7% had intracerebral hemorrhage (ICH), 2.3% had subarachnoid hemorrhage (SAH), 2.0% had other and unspecified intracranial hemorrhage (OIH), including subdural hemorrhage and epidural hemorrhage, and 8.9% had multiple stroke subtypes. The adjusted hazard ratio for the development of epilepsy was 11.5 (95% CI 8.2-16.2) for the patients with stroke compared to the controls. 2.6% of the patients with stroke developed epilepsy during the 5-year follow-up period. The rate of post-stroke epilepsy was highest in patients with multiple subtypes (7.7%), followed by ICH (4.3%), SAH (4.2%), OIH (2.5%) and ischemic stroke (1.6%). CONCLUSION: Stroke patients had a significantly higher risk of developing epilepsy than the controls. The risk of post-stroke epilepsy was higher in patients with hemorrhagic stroke than ischemic stroke.

Parkinson's disease and risk of hip fracture: an 8-year follow-up study in Taiwan.

BACKGROUND: Patients with Parkinson's disease (PD) are subject to posture instability and falling. However, PD was not included as one of the risk factors in commonly used fracture risk calculation tools and the fracture rate in patients with PD was rarely reported. The aim of this study was to evaluate the risk of hip fracture in patients with PD. METHODS: Data were collected from the National Health Insurance Research Database of Taiwan. The study group included 394 patients with PD diagnosed in 1999-2000. The comparison cohort was comprised of 3940 age- and sex-matched patients from the same enrollment period. All patients were tracked from their index visits for eight years. RESULTS: Hip fracture developed in 10.4% of patients with PD and 4.1% of patients in the comparison cohort during the follow-up period. Log-rank test analysis showed a significantly higher rate of hip fracture in PD. The Cox proportional regression model showed an adjusted hazard ratio of 2.71 (95% confidence interval = 1.92-3.83, P < 0.001) for patients with PD. CONCLUSION: The hip fracture rate was as high as 10.4% in PD patients during 8 years follow-up period. While assessing the risk of hip fracture, PD should be taken into consideration. For those very high risk patients (elderly women with PD, osteoporosis, diabetes and diabetic neuropathy), many efforts should be made to prevent fracture.

Nationwide population-based epidemiologic study on cerebellar ataxia in Taiwan.

AIMS: To conduct the first nationwide population-based epidemiologic study on cerebellar ataxia in Taiwan. METHODS: Cerebellar ataxia cases were identified from the National Health Insurance Research Database by using the corresponding International Classification of Diseases, Ninth Revision (ICD-9) codes, from January 2005 to December 2007. Age- and sex-specific incidences were estimated by dividing the number of new cases by the population data. RESULTS: During the study, 934 cases were identified (average annual incidence: 0.91/100,000). No significant difference was noted in the incidence in men and women. The majority of the patients were middle-aged or elderly. CONCLUSION: The average annual incidence rate of cerebellar ataxia in Taiwan was 0.91/100,000, without a significant difference between the genders.

Liver cirrhosis and risk of intracerebral hemorrhage: a 9-year follow-up study.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the risk of future intracerebral hemorrhage development in patients with liver cirrhosis. METHODS: Data were collected from the National Health Insurance Research Database of Taiwan. The study cohort included 948 patients with liver cirrhosis diagnosed in 1999 and 9480 age- and sex-matched patients of the same year. All patients were tracked from their index visits for 9 years. RESULTS: Intracerebral hemorrhage developed in 1.3% of patients with liver cirrhosis and 1.0% of patients in the comparison cohort during the follow-up period. Log-rank test analysis showed no significant difference between the 2 cohorts (P=0.39). A stratified Cox proportional regression model showed an adjusted hazard ratio of 1.62 (95% CI, 0.85 to 3.10) for patients with liver cirrhosis to develop intracerebral hemorrhage compared with patients without liver cirrhosis. CONCLUSIONS: Patients with liver cirrhosis had a similar intracerebral hemorrhage incidence rate but a trend of increased risk for intracerebral hemorrhage compared with the comparison cohort during the 9-year follow-up period.

Nationwide population-based epidemiologic study of cryptococcal meningitis in Taiwan.

BACKGROUND: Little is known about the epidemiology of cryptococcal meningitis in Taiwan. The aim of this study was to conduct the first nationwide population-based epidemiologic study of cryptococcal meningitis in Taiwan. METHODS: Cases of cryptococcal meningitis were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database with the corresponding ICD-9 code 321.0 from January 2000 to December 2007. RESULTS: A total of 845 incident cases of cryptococcal meningitis were detected. Among them, 109 patients (12.9%) had human immunodeficiency virus (HIV) infection. The average incidence was 4.7 per million person-years. The incidence remarkably increased in the age group of 60-69 years, peaked in the age group of 70-79 years, and fell after the age of 80 years. The average incidence for men was 2.2-fold higher than that for women. The most common complication was obstructive hydrocephalus in 15.3% of the patients, followed by acute respiratory failure in 12.0% of the patients. CONCLUSION: This is the first population-based epidemiologic study of cryptococcal meningitis in Taiwan. The incidence was stable during the study period, and most cases were non-HIV related.

Nationwide population-based epidemiologic study of Huntington's Disease in Taiwan.

BACKGROUND: The purpose of this study is to investigate the epidemiology and medical expenses of Huntington's disease (HD) in Taiwan. METHODS: Cases of HD were identified from the National Health Insurance Research Database with corresponding International Classification of Diseases, Ninth Revision (ICD-9) code 333.4 from January 2000 to December 2007. Age- and sex-specific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. RESULTS: During the study period, 182 cases were identified, including 81 males and 101 females. The average annual incidence rate was 0.1 per 100,000. The age-specific incidence peaked in the 40-49 age group in men (0.23 per 100,000 per year) and in the 50-59 age group in women (0.24 per 100,000 per year). The incidence rate was only 0.01 per 100,000 per year in those under 20 years of age. The prevalence was 0.42 per 100,000 in 2007. CONCLUSIONS: This is the first population-based epidemiologic study on HD in Taiwan. The incidence rates and prevalence were much lower than those of Caucasians although the age distribution was similar.

Nationwide population-based epidemiological study of myasthenia gravis in taiwan.

BACKGROUND: The purpose of this study is to investigate the epidemiology and medical expenses of myasthenia gravis (MG) in Taiwan. METHODS: Cases of MG were identified from the National Health Insurance Research Database with corresponding codes of the International Classification of Diseases, ninth revision (ICD-9), from January 2000 to December 2007. Age- and sex-specific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. RESULTS: During the study period, 5,211 cases were identified. The incidence ratio of males to females was 0.68. The average annual incidence rate was 2.1/100,000. MG occurred in all age groups with a higher incidence in older individuals and the lowest incidence in the 10- to 14-year-olds for both sexes. Among the 5,211 cases, 615 (12%) had a neoplasm of the thymus. The prevalence increased steadily during the study period from 8.4/100,000 in 2000 to 14.0/ 100,000 in 2007. CONCLUSIONS: This is the first population-based epidemiological study of MG in Taiwan. The incidence rate and prevalence were higher than in most published studies, especially in old age groups.

Population-based epidemiological study of neurological diseases in Taiwan: I. Creutzfeldt-Jakob disease and multiple sclerosis.

BACKGROUND: The purpose of the study is to investigate the epidemiology of Creutzfeldt-Jakob disease (CJD) and multiple sclerosis (MS) in Taiwan. METHODS: Cases of CJD and MS were identified from the National Health Insurance Research Database from January 2000 to December 2005. Age- and sex-specific incidences of these diseases were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. RESULTS: During the study period, 79 cases of CJD, 41 women and 38 men, were identified. The average annual incidence rate was 0.63/million. Most cases were older than 60 years. There were 1,262 cases of MS. The male-to-female ratio was 0.4. The average annual incidence rate was 0.79/100,000. The incidence reached a peak at the age group of 40-60 years for females and at the age group of over 55 years for males. The prevalence of MS was 2.96/100,000 in 2005, which is higher than those of previous studies in Taiwan. CONCLUSIONS: The annual incidence rate of CJD in Taiwan is lower than in western countries. The annual incidence rate and prevalence of MS in Taiwan are low. The prevalence of MS in Taiwan increased in recent decades.

Epidemiology and medical expenses of motor neuron diseases in Taiwan.

BACKGROUND: The purpose of the study is to investigate the epidemiology and associated medical expenses of motor neuron diseases (MND) in Taiwan. METHODS: Data from the National Health Insurance Research Database, involving diagnoses of MND and Certificates of Serious Accidents and Diseases, were retrieved from January 2000 to December 2005. Age- and sex-specific incidences of MND were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. RESULTS: In total, 1,554 patients with MND were identified. The average yearly incidence was 1.05 per 100,000 people. The male to female ratio was 1.51. The incidence rate, which was 1.25 in men and 0.84 in women, tended to increase with age, and peaked in the ranges of 65-69 years in men and 70-74 years in women. The expenses of the medical services associated with MND increased year by year, except for a sudden drop in inpatient expenses in 2005. CONCLUSIONS: The incidence of MND in Taiwan was 1.05 per 100,000/year, which was lower than that of Caucasians. The incidence had moderate male predominance and increased with age. With an aging population, case numbers and medical expenses associated with these diseases are expected to rise in future decades.