Hepatitis C viral infection and the risk of dementia.

BACKGROUND AND PURPOSE: Hepatitis C virus (HCV) infection may cause cognitive impairment, but no studies have focused specifically on cognitive impairment stemming from HCV. The purpose of this study was to investigate the potential increased risk for dementia in HCV-infected patients. METHODS: A population-based cohort study based on the Taiwan National Health Insurance Research Database was conducted. From all potential participants aged 50 years or more, a total of 58,570 matched (1:1) pairs of HCV-infected patients and non-HCV-infected patients were included. Each subject was individually tracked from 1997 to 2009 to identify incident cases of dementia (onset in 1999 or later). Cox proportional hazards regressions were employed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HCV infection and dementia. RESULTS: There were 2989 dementia cases from the HCV-infected cohort during the follow-up period of 533,861.1 person-years; the overall incidence rates of dementia differed from the non-HCV cohort (56.0 vs. 47.7 cases per 10,000 person-years, P < 0.05). The adjusted HR for dementia was 1.36 (95% CI 1.27-1.42) for HCV-infected patients after adjusting for alcohol-related disease, liver cirrhosis, hepatic encephalopathy and hepatocellular carcinoma. CONCLUSIONS: HCV infection may increase the risk for dementia. Further mechanistic research is needed.

Bromism caused by mix-formulated analgesic injectables.

Bromism, chronic bromide intoxication, can be caused by a variety of medicines, but bromism due to pain-relieving injectable medications has not been reported. In this study, the methods used were internet searching on bromide-containing injectables available in Taiwan and the first case report of bromism due to mixed-formulated injectable medication. Many analgesic/antipyretic and antihistamine injections containing bromides are still being used in Taiwan. They contain sodium bromide up to 1000 mg/ampoule or calcium bromide up to 800 mg/amp. A 25-year-old female suffered from forgetfulness and unstable gait after long-term frequent injections of a preparation to relieve head and neck pain. Blood tests showed hyperchloremia (171 mEq/L) and a negative anion gap (-48.7 mEq/L). Serum bromide measured 2150 mg/L. She recovered completely in 3 days with saline treatment. Many bromide-containing injections are still being used in Taiwan. Clinicians should keep alert on this issue to avoid iatrogenic bromism or making misdiagnoses.

Venomous snakebites and antivenom treatment according to a protocol for pediatric patients in taiwan

Children bitten by venomous snakes comprise emergency cases that present high morbidity and mortality, especially in some regions of Asia and Africa. Reports on clinical features and management of envenomated children are scarce. This observational study implemented a protocol for antivenom use in pediatric snakebite victims in Taiwan, between 1994 and 2007. The present work investigated demographics, clinical features and effects of antivenom therapy and the complications and prognosis for snakebites. A total of 55 children and adolescents, with a median age of 9.9 years (ranging from 2 to 18 years), was identified. Forty-five patients (82 percent) were bitten between May and September. Thirty-five patients (64 percent) received antivenom therapy, 28 of them (80 percent) within two hours after being bitten. No fatalities occurred and only five of 35 patients (14 percent) had major morbidity when treated according to the protocol. Thirty-one snakes (56 percent) were identified and 12 of them (38 percent) were Naja atra. This study indicates that a protocol for children affected by snakebites is valuable for guiding emergency physicians to treat these patients immediately. Further strategies are required to reduce the morbidity rate that occurs as a result of Naja atra bite.(AU)