Chondromalacia patella increases the risk of herpes zoster: a population-based study.

BACKGROUND: The reactivation of herpes zoster (HZ) is associated with disease stress. However, the relationship between chondromalacia patella (CMP) and HZ remains poorly understood. This study investigated the relationship between CMP and the risk of developing HZ. METHODS: Data were collected from the Taiwan's National Health Insurance Research Database. Patients with CMP diagnosed between 2000 and 2017 were assigned to the case group; patients without CMP were randomly selected from the same database and paired with controls matched by age and sex. The primary outcome was a diagnosis of HZ. All patients were followed until their diagnosis of HZ, their withdrawal from the NHI program, their death, or the end of 2017, whichever was earliest. The risk of developing HZ was compared between the case and control groups. RESULTS: In total, 22,710 patients with CMP and 90,840 matched controls were enrolled. The overall incidence rates of HZ in the CMP and control cohorts were 7.94 and 7.35 per 1,000 person-years, respectively. After potential confounders were controlled for, the case group exhibited a higher risk of HZ than did the control group [adjusted hazard ratio (aHR) = 1.06, p < 0.05]. In a stratification analysis by age, patients over 65 years old in the CMP group exhibited a higher risk of HZ than did those in the control group (aHR = 1.22, p < 0.01). In a stratification analysis by sex, women with CMP were at greater risk of developing HZ than women without CMP (aHR = 1.18, p < 0.01). CONCLUSION: Patients with CMP, especially elder adults and women, exhibited a higher risk of HZ. The HZ risk of patients with CMP should thus be assessed, and the necessity of HZ vaccination should be informed.

Herpes zoster in patients with sciatica.

BACKGROUND: Several diseases are associated with herpes zoster (HZ). However, whether sciatica is a stressor leading to HZ development remains unclear. Here, we evaluated the occurrence of HZ in patients with sciatica. METHODS: The sciatica cohort consisted of patients first diagnosed as having sciatica between 2000 and 2012. All patients with sciatica were randomly age, sex and index year matched with control individuals without sciatica. The primary outcome was diagnosis of HZ. All individuals were followed until HZ diagnosis, withdrawal from the insurance, death, or December 31, 2013, whichever occurred first. HZ risk in the two cohorts was further analyzed with age, sex and comorbidity stratification. RESULTS: In total, 49,023 patients with sciatica and 49,023 matched controls were included. Female patients were more likely to have HZ development than were male patients [adjusted hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02-1.12]. After adjustments for all the covariates, HZ risk was significantly higher in the sciatica cohort than in the control cohort (adjusted HR = 1.19; 95% CI = 1.12-1.25). CONCLUSION: Sciatica increased HZ risk. Thus, HZ risk should be addressed whenever physicians encounter patients with sciatica, HZ vaccination should be considered especially those aged over 50.

State differences in the reporting of 'unspecified stroke' on death certificates: implications for improvement.

BACKGROUND AND PURPOSE: Little is known about the comparability of stroke subtype mortality across states. We conducted a cross-sectional descriptive study to examine state differences in the reporting of "unspecified stroke" on death certificates in the United States. METHODS: The number of deaths from different subtypes of stroke in each state for the years 2007 to 2009 were obtained from the CDC WONDER online databases. We calculated the percentage of stroke deaths classified as unspecified stroke (International Classification of Diseases, 10th Revision [ICD-10] code I64) among all stroke deaths (ICD-10 codes I60-I69) for each state. RESULTS: Of 398 942 people who died from stoke in the United States between 2007 and 2009, in 209 933 (53%) cases, the medical certifier did not specify whether the stroke was hemorrhage or infarction on the death certificate. There were 44 states in which the percentage of unspecified stroke among all strokes was ≥50 and 20 states in which the percentage was ≥55%. The percentage was lowest in the District of Columbia (46%) and highest in Oklahoma (64%). The state variation in the proportion of unspecified stroke decreased with age of the deceased. The state percentage of unspecified stroke correlated most with the state percentage of cerebral infarction and other and sequelae of cerebrovascular disease. CONCLUSIONS: Owing to the high percentage and state variation in the reporting of unspecified stroke on death certificates, the comparability of stroke subtype mortality is threatened. Querying of medical certifiers for more specific information for better coding is needed.

Overwork, stroke, and karoshi-death from overwork.

Karoshi, death from over-work, is usually the extreme result of acute cardiovascular events including stroke. Among 203 karoshi cases received worker compensation in Japan, sixty percent died of stroke. Karoshi is a term for social medicine originated form Japan. Literature reviews on karoshi found that long overtime at work, on duty in holidays, attending a new job with no family members around, and working at night shift are risk factors. Work stress increases secretion of catecholamines (epinephrine and norepinephrine) and cortisol which is associated with progression of atherosclerosis and increased risk of cardiovascular diseases and stroke. To avoid long working hours, stress management and treatment of hypertension, diabetes, and hyperlipidemia are key issues in preventing karoshi caused by stroke.

The Risk of Herpes Zoster in Women with Polycystic Ovary Syndrome: A Retrospective Population-Based Study.

Background: The association between polycystic ovary syndrome (PCOS) and the risk of herpes zoster (HZ) remains unclear. This study investigated the risk of HZ in women with PCOS. Methods: This study used data from the Longitudinal Generation Tracking Database (LGTD 2005) which contains the information of 2 million randomly selected from National Health Insurance beneficiaries. Patients who received a diagnosis of PCOS between 2000 and 2017 were included in the PCOS cohort. Patients who were not diagnosed as having PCOS were randomly selected from the LGTD 2005 and included in the control cohort. Patients who were aged <20 years and had a history of HZ before the index date were excluded. Patients who were in both the cohorts were matched at a ratio of 1:1 through propensity score matching based on age, comorbidities, and medication. The primary outcome was the diagnosis of HZ. Results: A total of 20,142 patients were included in each case and control cohorts. The incidence rates of HZ in the PCOS and control cohorts were 3.92 and 3.17 per 1000 person-years, respectively. The PCOS cohort had a significantly higher risk of HZ than did the control cohort (adjusted hazard ratios [aHR] = 1.26). Among the patients aged 30−39 years, those with PCOS had a significantly higher risk of HZ than did those without PCOS (aHR = 1.31). Among the patients without any comorbidities, those with PCOS had a significantly higher risk of HZ (aHR = 1.26) than did those without PCOS. Conclusion: PCOS is associated with the risk of HZ, especially in young women. The risk of HZ should be addressed while treating patients with PCOS. An HZ vaccine is recommended for these patients.

RETRACTED: Perceived health consequences, memory impairments, and subjective memory complaints of elderly individuals exposed to polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs) in Taiwan.

The Publisher regrets that this article was an accidental duplication of an article in Computers and Geotechnics. The duplicate article has therefore been withdrawn.

To Investigate the Risk of Herpes Zoster in Women With Endometriosis: A Taiwan National Population-Based Cohort Study.

Background: The objective of this study is to investigate the occurrence of herpes zoster (HZ) in patients with endometriosis. Methods: This retrospective population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. Between 2000 and 2012, women aged ≥20 years with newly diagnosed endometriosis were enrolled into the endometriosis group. Each patient with endometriosis was randomly matched to 4 controls according to age and index year. All the patients were traced from the index date to HZ diagnosis, loss to follow-up, death, or the end of December 2013. Results: In total, 19,147 patients with newly diagnosed endometriosis and 76,588 participants without endometriosis were enrolled. The incidence of HZ was higher in endometriosis persons (5.36 per 1,000 person-years) than in matched controls (4.43 per 1,000 person-years) (p < 0.001). After adjustment for age and comorbidities, patients with endometriosis age ≤ 49 years (adjusted hazard ratio [aHR] = 1.17) (p < 0.001) and 50-64 years (aHR = 1.27) (p < 0.05) showed significantly higher risk of HZ than the corresponding controls. Among women without any comorbidities, patients with endometriosis were 1.22 times (p < 0.001) more likely to have HZ than those without endometriosis. Conclusion: Taiwanese women with endometriosis may have a higher rate of HZ occurrence. Endometriosis seems to be a high burden for affected women. Therefore, we suggest that clinicians should be aware of HZ among women with endometriosis, although there may be ethnic differences.

Association between lateral epicondylitis and the risk of herpes zoster development.

BACKGROUND: Diseases burden is associated with herpes zoster (HZ) development. However, the relationship between lateral epicondylitis (LE) and HZ remains unknown. AIM: This study investigated the association between LE and the risk of HZ development. METHODS: In this study, we collected data from the National Health Insurance Research Database of Taiwan. Patients who were diagnosed as having LE for the first time between 2000 and 2012 were included in the LE cohort. Patients without LE were randomly selected from the same database for inclusion in the control cohort. The outcome of interest was the first diagnosis of HZ during the follow-up period. RESULTS: The overall incidence rates of HZ in the LE and control cohort were 8.95 and 7.14 per 1,000 person-years, respectively. After adjustments were made, the LE cohort had a higher hazard ratio of HZ than the control cohort [adjusted hazard ratio (aHR) = 1.23]. The risk of HZ was significantly higher in those aged 50 to 64 years (aHR = 2.05) and in those over the age of 65 years (aHR = 2.50), compared with those aged ≤49 years. The risk of HZ was significantly higher in women (aHR = 1.17). The female patients with LE had a higher risk of HZ development than controls (aHR = 1.27). CONCLUSION: Women with LE had a higher risk of HZ development. HZ vaccination may be needed for the female patients with LE.

Association between de Quervain syndrome and herpes zoster: a population-based cohort study.

OBJECTIVE: Both physical diseases such as infection and chronic pain and psychological disorders such as depression have been associated with herpes zoster (HZ) reactivation. However, the relationship between de Quervain syndrome (DQS), a painful tenosynovitis and HZ remains unclear. We investigated whether DQS increases the risk of HZ reactivation. DESIGN: A retrospective population-based cohort study. SETTING: Taiwan. PARTICIPANTS: We used a subset of Taiwan's National Health Insurance Research Database, the Longitudinal Health Insurance Database which contains the registration files and original claims data of 1 million randomly selected individuals from the National Health Insurance programme. The case group in this study comprised patients newly diagnosed with DQS between 2000 and 2012. Individuals without DQS comprised the control group. Cases and controls were 1:1 matched by age, sex and index year (defined as the year of DQS diagnosis). RESULTS: Approximately 55% of the participants were ≤49 years. Most participants were women (77%). The incidence rate of HZ in the DQS group was 8.39 per 1000 person years. After adjustments for age, sex and comorbidities, patients with DQS had a 1.30 times higher risk of HZ reactivation than the control group. Stratification analysis revealed taht DQS increases the HZ risk in individuals ≤64 years, women, and patients without comorbidities. CONCLUSION: DQS is associated with an increased risk of HZ. Clinicians should be aware of this risk when dealing with patients with DQS, particularly in young adults.

Plantar fascial fibromatosis and herpes zoster.

PURPOSE: Infection, chronic pain and depression are considered risk factors for herpes zoster (HZ). However, the correlation between plantar fascial fibromatosis (PFF) and HZ remains unknown. This study investigated HZ risk in patients with PFF. METHODS: Data was extracted from the Longitudinal Health Insurance Database 2000, which is a subsample of the Taiwan National Health Insurance (NHI) Research Database and contains 1 million NHI beneficiaries. Between 2000 and 2012, patients diagnosed as having PFF were included in the case cohort. Every case was age and sex-matched with individuals without PFF through 1:4 frequency matching (control cohort). The end of the follow-up was defined as December 31, 2013, the date of HZ diagnosis, death, emigration, or withdrawal from the NHI program. RESULTS: In total, 4,729 patients were diagnosed as having PFF and were matched with 18,916 individuals without PFF. Patients with PFF were 1.23 times more likely to develop HZ than were those without PFF. Among those aged ≥65 years, patients with PFF had a higher HZ risk than did those without PFF (adjusted hazard ratio [aHR] = 1.48). Men with PFF had a significantly higher risk of HZ than did men without PFF (aHR = 1.44). CONCLUSION: Patients with PFF, particularly older and male patients, having a high HZ risk and may thus be vaccinated for HZ.

Risk of herpes zoster infection in men with varicocele.

PURPOSE: Several diseases have been identified as stressful factors for herpes zoster (HZ) infection. In this study, we investigated the risk of HZ infection in men with varicocele. METHODS: We enlisted the data of patients with newly diagnosed varicocele between 2000 and 2012 from the Taiwanese National Health Insurance Research Database as case cohort. Four control patients were matched as per age and index year to a case patient. HZ diagnosis was the primary end point, and the follow-up period was considered as the time interval from the index date to the main outcome, withdrawal from the National Health Insurance program, or end of the study (31 December 2013). RESULTS: In total, 8720 patients were recruited (1744 with varicocele and 6976 controls); the overall mean age was 36 years. Majority (85%) of the participants were 20-49 years old. HZ incidence was higher in patients with varicocele (5.60 per 1,000 person-years) than in the control group (4.01 per 1,000 person years). Patients with varicocele were 1.37 times more likely to develop HZ than the controls after adjustment. Compared with the control cohort, the adjusted hazards ratio (HR) of the varicocele cohort was higher in patients younger than 49 years old (adjusted HR = 1.60). CONCLUSION: Men with varicocele had a higher risk of HZ development than those without varicocele, particularly those aged ≤49 years. Thus, stress from varicocele cannot be ignored in young men.

Lateral medullary infarction presenting as Brown-Séquard syndrome-like manifestation: a case report and literature review.

PURPOSE: Lateral medullary infarction is not uncommon in clinical practice of neurology. This report describes a patient who initially presented with Brown-Séquard syndrome-like manifestation but was later diagnosed with acute infarction in the left lower lateral medulla. CASE REPORT: A 65-year-old woman presented with acute onset of unsteadiness, left side hemiparesis, left limb dysmetria, left side partial Horner syndrome, and paresthesia in the right lower limb and trunk with a sensory level at T5 on the right. No bulbar symptoms nor facial paresthesia was noted. Brown- Séquard syndrome was suspected initially, but cervical spine magnetic resonance imaging showed only mild spinal stenosis. Brain magnetic resonance imaging revealed acute infarction in the left lower lateral medulla. The mechanism of this unusual presentation is discussed. CONCLUSION: Brown-Séquard syndrome-like manifestation can be a rare presentation of lower lateral medullary infarction.

Comparing Mini-Mental State Examination and Attention and Digit Span in elderly exposed to polychlorinated biphenyls and polychlorinated dibenzofurans.

BACKGROUND: Polychlorinated biphenyls (PCB)/polychlorinated dibenzofurans (PCDF) are known to affect central nervous functioning. In recent studies, elderly patients who have been exposed to these have been noted to have psychological deficits. There is little known about which test is sensitive to neurotoxins in cognitive evaluation. The objective of the present study was to compare the significance between selective psychological tests in cognitive assessment in PCB-laden elderly. METHODS: A retrospective PCB/PCDF exposed cohort was observed. Exposed elderly aged ≥ 60 years and registered in Central Health Administration were enrolled, and similar age- and sex-matched subjects served as non-exposed controls. The Mini-Mental State Examination (MMSE) and Attention and Digit Span (ADS) were tested in both groups. Student's t-test, χ(2) -test and linear regression models were used for statistical analysis. RESULTS: A total of 165 exposed patients and 151 controls were analyzed. The exposed group included 49% men, a mean age of 69.3 ± 6.4 years and an education level of 4.0 ± 3.9 years. The controls included 52% men, a mean age of 69.9 ± 5.5 years and an education level of 4.5 ± 3.2 years. There was no statistical difference in MMSE before and after adjusting for the confounding variables of age, sex and education (P= 0.16 vs P= 0.12). However, ADS-forward and ADS-total scores showed a significant decline in the exposed subjects (P= 0.0001 vs P= 0.001). Using a linear regression among stratified PCB and cognitive functioning (≤30 ppb; 31-89; ≥90), a dose effect was found at the medium (31-89 ppb) and high exposure (≧90 ppb) levels. CONCLUSION: Our observations showed attention and short-term memory were impaired in PCB-laden elderly patients. Higher exposure level showed lower cognitive functioning in ADS. The MMSE was insensitive to neurotoxins. The present study shows that the selective test has a decisive role in toxic-related cognitive assessments.

Risk of Herpes Zoster in Patients with Adhesive Capsulitis of the Shoulder.

BACKGROUND: Physical diseases, such as infection, and emotional distress are associated with herpes zoster (HZ). However, the relationship between adhesive capsulitis of the shoulder (ACoS) and HZ remains unknown. OBJECTIVE: This study investigated the risk of HZ development in patients with ACoS. METHODS: We analyzed the Longitudinal Health Insurance Database, a subset of 1 million beneficiaries from the National Health Insurance Research Database. Patients newly diagnosed with ACoS during the 2000-2012 period were the case group. Each patient with ACoS was matched to a control, according to age and index year, through frequency matching. HZ was the primary event in this study. RESULTS: A total of 60,478 patients were included and each group contained 30,239 patients. The risk of HZ infection in the case cohort was 1.28 times that of the control cohort. ACoS increased the risk of HZ infection in each age group, particularly among patients aged younger than 50 [adjusted hazard ratio (aHR) = 1.52, 95% confidence interval (CI): 1.31-1.75]. Relative to the control group, the hazard ratio of HZ for male patients (aHR = 1.40, 95% CI: 1.26-1.55) in the case group was higher than that for female patients (aHR = 1.22, 95% CI: 1.13-1.32). Conclusion: Patients with ACoS have a higher risk of HZ development, particularly among those aged younger than 50 years. The effect of ACoS on HZ development among young adults requires attention.

Essential fatty acids and human brain.

The human brain is nearly 60 percent fat. We've learned in recent years that fatty acids are among the most crucial molecules that determine your brain's integrity and ability to perform. Essential fatty acids (EFAs) are required for maintenance of optimal health but they can not synthesized by the body and must be obtained from dietary sources. Clinical observation studies has related imbalance dietary intake of fatty acids to impaired brain performance and diseases. Most of the brain growth is completed by 5-6 years of age. The EFAs, particularly the omega-3 fatty acids, are important for brain development during both the fetal and postnatal period. Dietary decosahexaenoic acid (DHA) is needed for the optimum functional maturation of the retina and visual cortex, with visual acuity and mental development seemingly improved by extra DHA. Beyond their important role in building the brain structure, EFAs, as messengers, are involved in the synthesis and functions of brain neurotransmitters, and in the molecules of the immune system. Neuronal membranes contain phospholipid pools that are the reservoirs for the synthesis of specific lipid messengers on neuronal stimulation or injury. These messengers in turn participate in signaling cascades that can either promote neuronal injury or neuroprotection. The goal of this review is to give a new understanding of how EFAs determine our brain's integrity and performance, and to recall the neuropsychiatric disorders that may be influenced by them. As we further unlock the mystery of how fatty acids affect the brain and better understand the brain's critical dependence on specific EFAs, correct intake of the appropriate diet or supplements becomes one of the tasks we undertake in pursuit of optimal wellness.

Exon 33 T/T genotype of the thyroglobulin gene is a susceptibility gene for Graves' disease in Taiwanese and exon 12 C/C genotype protects against it.

This study investigates whether Tg gene polymorphisms can be associated with Graves' disease (GD) in a Taiwanese population and identifies potential polygenic susceptive genes for GD. The findings of such a study may have important implications for prognostic prediction and treatment of GD. We performed case control association studies for the 3 discovered Tg single nucleotide polymorphisms (SNPs) (E10, E12, E33) in 215 GD patients and 141 controls. The three SNPs were identified within the Tg gene. These SNPs were analysed by a fluorescent-based restriction fragment length polymorphism method (RFLP) and PCR. The genotype and allele frequencies at E10SNP158, E12SNP and E33SNP in GD patients were compared with those of the controls. In addition, we analysed the interactions between these SNPs and the clinical and laboratory variables. We found a significant difference in the T/T genotype of E33SNP and G/G genotype of E12SNP compared with the control group (p<0.001). We also found the E33SNP T/T genotype to be positively associated with development of GD, whereas the E12SNP G/G genotype protected it.

The early response of mannitol infusion in traumatic brain injury.

INTRODUCTION: Mannitol was used in traumatic brain injury but controversy about the onset and duration. SETTING: Clinical observational study. METHODS: Fourteen traumatic brain injured patients with a Glasgow Coma Scale (GCS) score < or = 8 were enrolled. Group I patients (n = 8) with intracranial pressure (ICP) < 20 mmHg, and group II patients (n = 6) with ICP > or = 20 mmHg underwent transcranial Doppler (TCD) monitoring and blood samples were drawn every 5 minutes during the post-operation period. Several parameters were compared with statistical analysis between both groups. RESULTS: The ICP declined during a 30-minute recording in both groups and the decline of ICP was significant (p < 0.05) at the 10-minute interval in group II. The decline of hemoglobin (Hb) and oxygen content (CaO2), increase of venous pressure (CVP) and 02-transport ability (CeDO2) at 10-minute were also statistically significant (p < 0.05) in group II as compared to the group I. Using a regression model between both comparisons, several parameters were statistically different at the 10-minute interval after mannitol infusion. CONCLUSIONS: The dynamic responses can happen as early as 5-10 minutes after mannitol infusion, and had a greater effect on traumatic brain injury patients with ICP > or = 20 mmHg. It demonstrated a significant dynamic difference between both groups. All these changes can be monitored by TCD and peripheral blood tests.

Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan.

BACKGROUND: The association of the magA gene with the hypermucoviscosity phenotype relevant to the pathogenesis of Klebsiella pneumoniae liver abscess has been reported in Taiwan. Similarly, the rmpA gene, known as a positive regulator of extracapsular polysaccharide synthesis that confers a mucoid phenotype, may be another candidate gene causing hypermucoviscosity. However, the association of rmpA with K. pneumoniae clinical syndromes is unreported. We aimed to investigate the clinical correlation between rmpA and primary Klebsiella abscess, focusing on sites other than the liver. METHODS: From July 2003 through December 2004, a total of 151 K. pneumoniae isolates recovered from 151 patients with bacteremia were collected from 2 large medical centers in southern Taiwan. Clinical data were collected from medical records. The genes rmpA and magA were amplified by polymerase chain reaction using specific primers. RESULTS: The prevalences of hypermucoviscosity, rmpA, and magA were 38%, 48%, and 17%, respectively. As determined by statistical multivariate analysis, strains carrying rmpA were significantly associated with the hypermucoviscosity phenotype, and there was a significant correlation with purulent tissue infections, such as liver abscess and lung, neck, psoas muscle, or other focal abscess. CONCLUSION: Our data support a statistical correlation between the rmpA gene and virulence in terms of abscess formation for these hypermucoviscous K. pneumoniae strains. Hypermucoviscosity associated with rmpA, together with a thorough physical examination, may be helpful as a guide to carry out appropriate diagnostic tests on patients with an initially unknown source of K. pneumoniae bacteremia, particularly when looking for the occurrence of an underlying abscess.

[Using "number needed to treat" to interpret treatment effect].

Evidence-based medicine (EBM) has rapidly emerged as a new paradigm in medicine worldwide. The clinical medicine in twenty-first century could be the era of EBM. Randomized controlled trial has been regarded as the gold standard for evaluating the treatment effect of a new drug or a new therapy. The effect of a treatment versus controls may be expressed in relative or absolute measures. Relative measures include relative risk, relative risk reduction, and odds ratio. Absolute risk reduction and number needed to treat are absolute measures. For rational decision-making, absolute measures are more meaningful because they have taken baseline risk and the amount of clinical benefit into account. The number needed to treat (NNT), the reciprocal of the absolute risk reduction, is a useful estimate of treatment effect. Interpreting a NNT should be very cautious accompanied by information about the experimental treatment (including drugs and surgical procedures), the control treatment for comparison, the baseline risk of the study population, the length of the follow-up period, and an exact definition of the endpoint.