Degree of exposure to psychotropic medications and mortality in people with bipolar disorder.

OBJECTIVES: To investigate the associations between psychotropic medication dosage and mortality in patients with bipolar disorder. METHODS: A nationwide cohort of individuals aged ≥15 years who had received a diagnosis of bipolar disorder in 2010 was identified from the Taiwanese national health-care database linked with the mortality registry and followed up for 5 years. The mean defined daily dose (DDD) of mood stabilizers, antipsychotics, antidepressants, and sedative-hypnotics was estimated, and survival analyses were conducted to assess the effects of degree of exposure to psychotropic medications on mortality. RESULTS: A total of 49,298 individuals (29,048 female individuals, 58.92%) with bipolar disorder were included. Compared with individuals without exposure to mood stabilizers, those prescribed mood stabilizers had a decreased overall mortality risk, regardless of exposure dosage. By contrast, compared with a reference group with no exposure to antipsychotics, individuals using antipsychotics had dose-dependent, increased mortality in both overall causes of deaths and deaths due to cardiovascular diseases, with hazard ratios of 1.13 (95% CI: 1.21-1.42) in the low-dose (<0.5 DDD) group, 1.69 (1.51-1.90) in the moderate-dose (0.5-1.5 DDD) group, and 2.08 (1.69-2.57) in the high-dose (>1.5 DDD) group for overall mortality. CONCLUSIONS: In sum, mood stabilizers were associated with decreased overall mortality in individuals with bipolar disorder, regardless of the dosage. However, the use of antipsychotics appeared to be associated with a dose-dependent increased mortality risk. Owing to study limitations, precise information on prior use of psychotropic medications, and patient's adherence to medication are not available. Potential adverse effects and benefits should be carefully considered when prescribing psychotropic medications for long-term use in patients with bipolar disorder.

Evaluating the "holiday season effect" of hospital care on the risk of mortality from pulmonary embolism: a nationwide analysis in Taiwan.

We aimed to determine whether hospital admissions during an extended holiday period (Chinese New Year) and weekends were associated with increased mortality risk from pulmonary embolism (PE), compared to admissions on weekdays. We conducted a nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database. Data of newly diagnosed PEs during the months of January and February from 2001 to 2017 were obtained from patient records and classified into three admission groups: Chinese New Year (≥ 4 consecutive holiday days), weekends, and weekdays. The adjusted odds ratios (aORs) (95% confidence intervals [CIs]) for 7-day and in-hospital mortality were calculated using multivariable logistic regression models. The 7-day and in-hospital mortality risks were higher for patients admitted during the Chinese New Year holiday (10.6% and 18.7%) compared to those admitted on weekends (8.4% and 16.1%) and weekdays (6.6% and 13.8%). These higher mortality risks for holiday admissions compared to weekday admissions were confirmed by multivariable analysis (7-day mortality: aOR = 1.68, 95% CI 1.15-2.44, P = 0.007; in-hospital mortality: aOR = 1.41, 95% CI 1.05-1.90, P = 0.022), with no subgroup effects by sex or age. Hospital admission for PE over an extended holiday period, namely Chinese New Year, was associated with an increased risk of mortality.

Comparison of the Incidence of Urinary Tract Infection by Replacement Time of the Urinary Drainage System.

BACKGROUND: Urinary catheters (UCs) with a closed urinary drainage system have been widely used in patients for many years. However, the frequency of replacing and operating these devices may be associated with catheter-associated urinary tract infection (CAUTI). PURPOSE: This study was designed to compare the incidence of CAUTI by replacement time (every 14 or ≥ 15 days) of the urinary drainage system. METHODS: This 1-year prospective, nonrandomized controlled study was conducted in a major teaching hospital. The Transparent Reporting of Evaluations with Nonrandomized Designs Statement checklist was used. All of the patients with UCs were divided into two groups based on each patient's preference with regard to replacement time of the urinary drainage system. RESULTS: Five hundred sixty-two patients were evaluated, and 341 patients with UCs were enrolled as participants in the study. In the per-protocol analysis, 16 patients (22.2%; 9.3 episodes/1,000 catheter-days) in the 14-day group and 15 patients (17.9%; relative risk = 1.24, 95% confidence interval [0.66, 2.34]) in the ≥ 15-day group (7.7 episodes/1,000 catheter-days; incidence density ratio 1.20, 95% confidence interval [0.60, 2.43]) had CAUTIs. A comparison of cleanliness within urinary bags showed no significant intergroup difference (p > .05). In the intention-to-treat analysis, the incidence of CAUTI between the two groups was also not significantly different (p > .05). CONCLUSIONS: No statistically significant difference in the incidence of CAUTI was identified between patients who used the 14-day replacement interval and those who used the ≥ 15-day replacement interval for their urinary drainage system.

Impact of Extended-spectrum ß-lactamase-producing Escherichia coli and Klebsiella pneumoniae on the outcome of community-onset bacteremic urinary tract infections.

BACKGROUND/PURPOSE: The number of community-onset bacteremic urinary tract infections (UTIs) caused by Escherichia coli and Klebsiella pneumoniae is increasing. However, the impact of extended-spectrum ß-lactamase (ESBL)-producing E. coli and K. pneumoniae (ESBL-EK) on bacteremic UTI outcomes is unknown. The aim of this study was to retrospectively analyze the impact of ESBL-EK on community-onset bacteremic UTIs. METHODS: Of the 58 patients enrolled, 12 suffered from ESBL-EK-caused community-onset bacteremic UTIs. Patients were categorized into ESBL (n=12) and non-ESBL (n=46) groups. Diagnosis was based on findings of concurrent bacteremia and bacteriuria caused by the same pathogen on admission. RESULTS: The ESBL group had significantly more male patients (66.7%vs. 23.9%; p=0.005), indwelling urinary catheters (41.7%vs. 6.5%; p=0.002), patients admitted from other healthcare facilities (50.0%vs. 8.7%; p=0.001), and patients with higher Acute Physiology and Chronic Health Evaluation II scores (23.3±7.1 vs. 15.9±6.3; p=0.001) and intensive care unit admissions (41.7%vs. 4.4%; p=0.003) than the non-ESBL group. Multiple logistic regression analysis revealed that male gender (odds ratio=9.2; 95%, confidence interval=1.7-50.6) and healthcare facility residency (odds ratio=15.5; 95% confidence interval=2.4-98.9) were independent risk factors for ESBL-producer infections among bacteremic UTIs. Although the mortality rate of both groups was similar (8.3%vs. 4.4%; p=0.403), the ESBL group had longer hospital stays (16.3±9.3 days vs. 7.9±5.2 days; p=0.010) and higher antibiotic costs (615.1±423.5 USD vs. 252.8±269.2 USD, p=0.014). CONCLUSION: Male gender and healthcare facility residency are risk factors for ESBL-producer infections among patients with community-onset bacteremic UTIs. Patients with bacteremic UTIs caused by ESBL-EK also have prolonged hospital stays and higher antibiotic costs. Early detection of ESBLs and appropriate antibiotic coverage are likely to shorten hospital stays and reduce medical costs.

Comparison of 0.052-inch coils vs amplatzer duct occluder for transcatheter closure of moderate to large patent ductus arteriosus.

BACKGROUND: Percutaneous device closure is now the widely accepted management technique for patent ductus arteriosus (PDA). In the present study, current practice of closing moderate to large PDA using the Amplatzer duct occluder (ADO) was compared with the previous experience using 0.052-inch coils. METHODS AND RESULTS: From August 1997 to September 2006, 76 patients were selected for either 0.052-inch coils or ADO implantation. Selection criteria were a minimal diameter of > or =2.5 mm and angiographic type A, C, D or E. In group I, 21 patients received 0.052-inch coils in a multiple coil strategy for PDA closure. In group II, 55 patients underwent ADO device implantation. The age, weight, hemodynamics, minimal PDA diameter and shunt size were insignificantly different between groups. However, group I had a higher rate of failed implantation and device embolization, and the immediate and 24-h closure rates (38.9% vs 81.8%, P<0.05; 72.3% vs 96.4%, P<0.05) favored group II. CONCLUSIONS: ADO implantation is safer and more effective than the 0.052-inch coil strategy for transcatheter closure of moderate to large PDA.

Clinical results of percutaneous closure of large secundum atrial septal defects in children using the Amplatzer septal occluder.

We reviewed our experience using the Amplatzer septal occluder (AGA Medical, Golden Valley, MN, USA) to close large, secundum-type atrial septal defects (ASDs) in children. Between June 2002 and December 2005, 52 patients (mean age 13.5 +/- 8.7 years) underwent transcatheter closure of large (> or =25 mm), secundum ASDs with the use of the Amplatzer septal occluder (ASO). Groups 1 and 2 included patients with a retroaortic rim of <5 mm (n = 39) or > or =5 mm (n = 13), respectively. All procedures were performed with general anesthesia and transesophageal echocardiographic guidance except for 10 patients, which involved local anesthesia and three-dimensional transthoracic echocardiography. Successful device implantations, device sizes, approaches, complications, and closure rates were assessed. Device implantation was successful in 50 patients (96.1%), with no difference between groups (95% vs 100%, P>0.05). In 2 patients, implantation failed because of embolism or deployment failure. Device were larger in group 1 than in group 2 (29.7 +/- 4.2 vs 26.7 +/- 3.8 mm, P = 0.04). The right upper pulmonary-vein approach was more common in group 1 than in group 2 (P = 0.0001). Complications and closure rates did not differ between the groups (P > 0.05). Transcatheter closure of large, secundum ASD by using the ASO device was feasible, and complication rates were low. A deficient retroaortic rim did not preclude successful device implantation; however, a large device may be needed to close large ASD. Close long-term follow-up is necessary to determine the safety of transcatheter closure of large ASDs in children.

In situ generation of the silica shell layer--key factor to the simple high yield synthesis of silver nanowires.

a-Silica encapsulated silver nanowires (diameter of 25 +/- 5 nm, average length of 10 mum) have been synthesized by reacting (Me3Si)4Si with AgNO3 in nearly quantitative yield. Formation of the a-silica shell layer (1-3 nm) in situ appears to be one of the most important factors in this simple process.

Use of Inoue balloon dilatation method for treatment of Cor triatriatum stenosis in a child.

An 8-year-old girl was referred for evaluation of a heart murmur and progressive dyspnea with exertion. Transthoracic echocardiogram revealed Cor triatriatum with severe stenosis at its orifice. The resting transmembrane CW Doppler velocity was 2.3 m/sec. Cardiac catheterization and hemodynamic assessment were performed and demonstrated a marked increase in pulmonary capillary wedge and pulmonary artery pressures. The stenosis was successfully dilated with an Inoue balloon using a transseptal technique. This is the first description of dilation of a Cor triatriatum using the Inoue technique. Only one previous case report of balloon dilatation for Cor triatriatum sinister has appeared in the English literature using a different technique (double balloon method).

Safety and efficacy of using 0.052-inch Gianturco coil for closure of large ( > or = 4mm) patent ductus arteriosus.

Transcatheter closure of patent ductus arteriosus (PDA) is now a well-established treatment alternative to surgery in many cardiology centers. Of all the methods used, transcatheter coil occlusion is the preferred therapy. For small PDA, the method using 0.038" Gianturco coils has proven safe and effective. However, this therapeutic strategy has encountered some difficulties with large PDA. This study provides an alternative strategy, using 0.052" Gianturco coil and complete closure of residual shunt with multiple coils to close large PDA. Fifteen patients underwent transcatheter coil occlusion of large ( > or = 4mm) patent ductus arteriosus. The intermediate success rate was 86.7%. There were four complications and only two patients had to be referred for surgery.