Rapid establishment of a COVID-19 biobank in NHRI by National Biobank Consortium of Taiwan.

By the request of the Minister of Health and Welfare, NHRI Biobank was assigned to establish a COVID-19 biobank in early Feb, 2020 to collect COVID-19 patients' blood samples for Taiwan researchers and industries in an emergent way. It was set up in less than 3 weeks and quickly opened for application. By August 5, 2020, this COVID-19 biobank has collected 165 blood samples of 110 patients from more than 10 hospitals across north, middle and south part of Taiwan, including both COVID-19 (+) and (-) pneumonia patients. This biobank can provide applicants with biosamples, such as serum, DNA and RNA, and also the clinical and genomic data, so as to accelerate the COVID-19 treatment and prevention research in Taiwan. This COID-19 biobank already received 15 applications. It has become the most important research resource for the COVID-19 pandemic in Taiwan, including new screening reagents, disease mechanism, the variable human responses and epidemic preventions. Since it is publicly available for both academic and industrial applicants.

Bacterial colonization with balloon uterine stent placement in the uterus for 30 days: a randomized controlled clinical trial.

OBJECTIVE: To assess bacterial colonization following balloon uterine stent placement in the uterus for 30 days. DESIGN: Prospective randomized controlled study. SETTING: Tertiary medical center. PATIENT(S): Sixty-eight women scheduled for hysteroscopy. INTERVENTION(S): Women who were undergoing hysteroscopic surgery were randomly assigned to receive a balloon uterine stent or not. Before starting surgery, the uterine cavity was swabbed for bacterial culture. The device was placed in the uterus after surgery in the stent group. After 30 days, the stent was removed and sent for culture and the uterine cavity also swabbed and cultured. The uterine cavities of the control patients were swabbed before and 30 days after surgery. MAIN OUTCOME MEASURE(S): The primary outcome was the incidence of bacterial colonization of the uterus. Secondary outcomes were pain intensity and species of colonizing bacteria. RESULT(S): Excluding eight women, 30 women in each group were included in this analysis. In the stent group, three women (10.0%) demonstrated bacterial colonization before surgery compared with nine women (30.0%) after 30 days. In the control group, four (13.3%) and ten (33.3%) women had microorganisms detected in the uterus before and after 30 days after surgery, respectively. In neither group did the percentage of women with uterine microorganisms increase significantly after 30 days. The percentages of women with uterine bacterial colonization before and 30 days after surgery were similar between both groups. CONCLUSION(S): Balloon uterine stents may be placed after surgery for up to 30 days without increasing bacterial colonization. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (www.clinicaltrials.gov) NCT01167296.

Endovascular stent graft repair for a Salmonella-infected aneurysm of thoracic aorta.

Thoracic endovascular aneurysm repair using stent graft has been reported as a feasible and effective treatment for aortic aneurysm. However, its application for treating infected aortic aneurysms is still controversial and less reported. We report a 74-year-old male diabetic patient diagnosed with Salmonella-infected aortic aneurysm, who was successfully treated with endovascular stent graft repair followed by a 2-month course of intravenous antibiotics and long-term oral antibiotic therapy. Sequential computed tomography scans demonstrated the shrinkage of the aneurysm and no evidence of relapse 11 months later.

Necrotizing fasciitis after acupuncture in a patient with aplastic anemia.

OBJECTIVES: The objective of this study was to describe a serious complication of acupuncture treatment in a high-risk patient with aplastic anemia. DESIGN: A 44-year-old woman with aplastic anemia experienced right calf pain after running. After poor results with physical therapy, she received needle acupuncture for pain relief. However, aggravated pain with swelling of the right calf developed 2 days later. RESULTS: On admission, she had a temperature of 38.8°C, a white blood cell count of 500/µL, and hemoglobin of 5.7 g/dL. Ultrasound and computed tomography scans showed swelling of the right calf muscle fascia, and aspiration drew out Staphylococcus infection. The symptoms improved after treatment with parenteral antibiotics. CONCLUSIONS: This case illustrates that necrotizing fasciitis must be considered as a possible complication of acupuncture in high-risk patients, and that early recognition and treatment of this life-threatening soft-tissue infection must be emphasized. Extreme caution should be employed when using acupuncture for high-risk patients, such as those with aplastic anemia.

In vitro susceptibilities of aerobic and facultative anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections at a medical center in Taiwan: results of the Study for Monitoring Antimicrobial Resistance Trends (SMART) 2002-2006.

BACKGROUND AND PURPOSE: The Study for Monitoring Antimicrobial Resistance Trends (SMART) was initiated to monitor the in vitro antimicrobial susceptibility of aerobic and facultative anaerobic Gram-negative bacilli (GNB) isolated from patients with intra-abdominal infections (IAI). This report summarizes the SMART data from 1 of the study centers from 2002 to 2006. METHODS: 492 Gram-negative isolates were collected from 482 patients with IAI. Susceptibilities of these isolates to 12 antimicrobial agents were determined using the broth microdilution method. RESULTS: Enterobacteriaceae comprised 68.3% of the isolates (n = 336). The 4 main species were Klebsiella spp. (n = 129; 26.2%), Escherichia coli (n = 122; 24.8%), Enterobacter spp. (n = 36; 7.3%), and Aeromonas hydrophila (n = 35; 7.1%). The commonest glucose non-fermentative GNB were Acinetobacter baumannii (n = 46; 9.3%) and Pseudomonas aeruginosa (n = 35; 7.1%). Extended-spectrum beta-lactamase (ESBL) production was detected in 70 Enterobacteriaceae isolates (70/336; 21%). The ESBL phenotype was exhibited by 23% of Klebsiella pneumoniae, 26% of E. coli, and 19% of Enterobacter spp. The highest rate of ESBL production was found in 2005 for E. coli (38%) and in 2003 for Klebsiella spp. (38%) and Enterobacter spp. (40%). The incidence of ESBL-producing isolates declined in 2005 and 2006. Low susceptibility rates of E. coli isolates to ciprofloxacin (58%) and levofloxacin (64%) were noted. Ertapenem (99%), imipenem (99%), and amikacin (94%) were the most potent agents against Enterobacteriaceae spp. CONCLUSIONS: Continuous surveillance is crucial to monitor the trend of antimicrobial resistance patterns among GNB isolated from IAI.

AIDS with acute cerebral infarct: a case report.

A 38 year-old male presented with an acute onset of left hemiplegia. Brain magnetic resonance imaging (MRI) revealed a bright lesion by diffusion-weighted imaging with low apparent diffusion coefficient value in the right subcortical region, a finding compatible with an acute cerebral infarct. An old infarct was also noted in the same imaging. Both enzyme-linked immunosorbent assay and Western blot method were positive for human immunodeficiency virus infection. The white blood cell count was 2930 cells / mm3, and the subpopulation study for lymphocyte revealed a decreased cluster of differentiation 4+ count of 149 cells/mm3. Studies for prothrombotic states showed decreased protein S and increased anticardiolipin antibodies. We concluded that this was a case of acquired immunodeficiency syndrome (AIDS) with acute and old cerebral infarcts. This patient might be the first reported case in Taiwan. AIDS might be related with stroke in young patients, a condition probably under-recognized in Taiwan.

Establishing a clinical decision rule of severe acute respiratory syndrome at the emergency department.

STUDY OBJECTIVE: In the absence of reliable rapid confirmatory tests during severe acute respiratory syndrome (SARS) endemics, we designed a 2-phase cohort study to establish a scoring system for SARS and to evaluate whether it could improve the sensitivity and specificity of the World Health Organization (WHO) criteria. METHODS: According to the clinical characteristics and initial laboratory findings of 175 suspected cases defined by the WHO criteria (20 confirmed as cases of SARS) in 3 university teaching hospitals in Taipei between March 1 and April 20, 2003, the scoring system for SARS was designed by multivariate analysis and stepwise logistic regression as the simple arithmetic sum of point values assigned to 7 parameters. We thereafter applied the scoring system for SARS to the consecutive 232 patients (the validation group) who met the WHO criteria of suspected cases from April 21 to May 22, 2003. Final diagnosis of SARS was determined by the results of real-time polymerase chain reaction and paired serum. RESULTS: The scoring system for SARS was defined as radiographic findings of multilobar or bilateral infiltrates (3 points), sputum monocyte predominance (3 points), lymphocytopenia (2 points), history of exposure (1 point), lactate dehydrogenase more than 450 U/L (1 point), C-reactive protein more than 5.0 mg/dL (1 point), and activated partial prothrombin time more than 40 seconds (1 point). Of the validation group, 60 patients (group A) were confirmed as having cases of SARS, and the other 172 (group B) patients tested negative for SARS. The total points of the scoring system for SARS at initial presentation were significantly higher in the SARS group (median 9; range 6 to 11) than in the non-SARS group (median 4; range 3 to 7; P<.001). At the cutoff value of 6 points, the sensitivity and specificity of the scoring system for SARS in diagnosing SARS were 100% and 93%, respectively. The positive and negative predictive values of the scoring system for SARS were 83% and 100%, respectively. CONCLUSION: The scoring system for SARS can provide a rapid and reliable clinical decision to help emergency physicians detect cases of SARS more accurately in the endemic area.