Prenatal heavy metal exposure, total immunoglobulin E, trajectory, and atopic diseases: A 15-year follow-up study of a Taiwanese birth cohort.

Prenatal exposure to heavy metals may cause atopic diseases. Little association between cord blood total immunoglobulin E (CB-tIgE) levels and the occurrence of atopic diseases has been found. This study investigated the atopic status and tIgE trajectory trend in a Taiwanese birth cohort over 15 years. We also assessed the effect of maternal heavy metal exposure on maternal serum cytokine and CB-tIgE levels. We recruited 430 pregnant women during their third trimester in 2000-2001. Maternal urinary heavy metal concentrations and serum cytokine levels were measured. The CB-tIgE and serum tIgE levels of the women's children when they were aged 5, 8, 11, and 14 years were measured. The upper quartile of the maternal urinary arsenic concentration was associated with an increased risk of a CB-tIgE level higher than 1 IU/mL (odds ratio, 1.845; 95% confidence interval, 1.003-3.395). Serum tIgE trajectory levels were the highest in children with asthma, followed by those with atopic dermatitis and allergic rhinitis at the age of 5-14 years. Serum tIgE levels tended to peak at the age of 11 years in the atopic children but were stable from the age of 8 years in the non-atopic children. We first demonstrated that serum tIgE levels reached a trajectory peak in the atopic children aged 11 years. Prenatal exposure to arsenic may increase the risk of elevated CB-tIgE levels. Further investigation is warranted to elucidate the mechanism through which maternal serum cytokines affect the occurrence of atopic diseases in children.

Statin use and the risk of chronic kidney disease in patients with psoriasis: A nationwide cohort study in Taiwan.

BACKGROUND: Psoriasis is associated with hyperlipidemia. Few studies have examined the association among psoriasis, hyperlipidemia, and chronic kidney disease (CKD). It remains a topic of debate whether statin treatment for hyperlipidemia prevents the development of CKD in patients with psoriasis. OBJECTIVE: We investigated whether there is an association among psoriasis, hyperlipidemia and CKD. If so, we asked whether statin treatment for hyperlipidemia reduces the risk of CKD in patients with psoriasis. METHODS: A Taiwan nationwide population-based cohort study between 1997 and 2010 included 2,912 patients with psoriasis and 8,736 matched patients without psoriasis (1:3 propensity score matched according to age, sex, and region); 104,609 patients without psoriasis but with hyperlipidemia and 104,609 matched patients without psoriasis or hyperlipidemia (1:1). The hazard ratios, relative risks, and 95% confidence intervals were calculated using Cox proportional hazards model. RESULTS: Psoriasis significantly increased the risk of CKD (adjusted hazard ratio 2.48, 95% confidence interval 1.81-3.40), and so did hyperlipidemia (adjusted hazard ratio 2.93, 95% confidence interval 2.79-3.08). Compared to treatment without statins, statin treatment for hyperlipidemia reduced the risk of CKD in patients with psoriasis (adjusted relative risk 0.58, 95% confidence interval 0.55-0.62). CONCLUSION: As well as hyperlipidemia, psoriasis significantly increased the risk of CKD. Statin treatment for hyperlipidemia reduced the risk of CKD in patients with psoriasis.

Non-mycosis fungoides cutaneous lymphomas in a referral center in Taiwan: A retrospective case series and literature review.

BACKGROUND: While mycosis fungoides (MF) and Sézary syndrome (SS) are the most common cutaneous lymphomas (CLs), there is limited data about non-MF/SS CLs. OBJECTIVE: We aimed to evaluate clinical characteristics of non-MF/SS CLs. METHODS: A retrospective analysis evaluated patients with non-MF/SS CLs covering a period of 17 years. The records of 59 patients with non-MF/SS CLs were reviewed for demographic profiles, clinical features, and survival outcomes. RESULTS: Our series consisted of 38 non-MF/SS cutaneous T-cell lymphomas (CTCLs) and 21 cutaneous B-cell lymphomas (CBCLs). In the group of non-MF/SS CTCLs including 33 primary and five secondary cases, there were cases of anaplastic large cell lymphoma (15.3% of non-MF/SS CLs), extranodal natural killer/ T-cell lymphoma (13.5%), peripheral T-cell lymphoma, not otherwise specified (13,5%), adult T-cell leukemia/lymphoma (8.5%), subcutaneous panniculitis-like T-cell lymphoma (6.8%) and angioimmunoblastic T-cell lymphoma (6.8%). In the group of CBCLs including nine primary and 12 secondary cases, there were cases of diffuse large B-cell lymphoma (22.0%), mantle cell lymphoma (5.1%), extranodal marginal lymphoma of mucosa associated lymphoid tissue (3.4%), follicle center lymphoma (3.4%) and intravascular large B-cell lymphoma (1.7%). The overall survivals were 57 months for non-MF/SS CTCLs and 41.5 months for CBCLs. Elevated serum lactate dehydrogenase level, thrombocytopenia, multiple anatomical sites of skin involvement and lower albumin level may be associated with poor prognosis in non-MF/SS CTCLs, but the latter two were not in CBCLs. CONCLUSION: With this series, we hope to provide indigenous data and outcome of non-MF/SS CLs. The overall survival of non-MF/SS CTCLs was better than CBCLs.

Factors of missed appointments at an academic medical center in Taiwan.

BACKGROUND: Missed appointments mean appointments neither attended nor canceled by patients. Missed appointments belong to one of the important subjects of hospital management because they would incur the inactivity of medical professionals and devices, occupy the health resources for other patients, and thus impair the quality of healthcare services. The aim of this study was to explore the factors of missed appointments at the outpatient department of an academic medical center in Taiwan. METHODS: This was a cross-sectional study based on registration records of an academic medical center in Northern Taiwan in 2015. Fifteen variables of patients, appointments, and weathers were taken into analysis. Logistic regression was used to calculate the adjusted odds ratio of each variable. For nonfirst visits, we further built a logistic regression model with the five most influential variables and the personal attendance pattern of the previous three appointments. RESULTS: Of 2 132 577 eligible appointments in 2015, the overall no-show rate was 16.9%. The influential factors included the following: (1) patient characteristics: younger than 40 years, ≤6 visits, and a no-show rate between 50% and 75% in the previous year; (2) appointment characteristics: Saturdays, evenings, on the last third of the waiting list, only one appointment on the same day, online appointments, appointment-to-visit intervals (wait time) in 7 to 14 days, appointments to obstetrics/gynecology or pediatrics, first-time appointments, and the interval between the appointed visit and the previous visit in <7 days; and (3) weather characteristics: warm weathers and heavy rains. For nonfirst appointments, the influences in decreasing order were heavy rain, shorter interval between the appointed visit and the previous visit to the same department, higher no-show rate in the previous year, total absence in the personal attendance pattern of the previous three appointments, longer wait time, and children. CONCLUSION: The factors of missed appointments were multifaceted. Further measures could be undertaken accordingly to enhance healthcare efficiency.

Cutaneous sarcoidosis: A retrospective case series and a hospital-based case-control study in Taiwan.

Sarcoidosis is a systemic granulomatous disorder of unknown etiology often involving skin. Studies on cutaneous sarcoidosis and comorbidities are limited. This study is aimed to describe the clinical features of cutaneous sarcoidosis diagnosed in our hospital and to determine the relationships between cutaneous sarcoidosis and comorbidities.This retrospective study evaluates patients with cutaneous sarcoidosis in a tertiary center in Taiwan from 1996 to 2015. The records of 38 patients with cutaneous sarcoidosis were reviewed for clinical characteristics and evaluated by analysis of variance. A 1:4 case-control analysis was conducted with 152 age- and sex-matched controls who underwent biopsy for other benign skin tumors.The male to female ratio was 1:4.4. The average age at diagnosis was 51.7 years. Female patients were on average 13.9 years older than male patients. The correlation of age with gender was statistically significant (P = .037). The most common cutaneous lesions were plaques (47.4%) and confined to the face (71.1%). Of the 38 patients, 26.3% had diabetes mellitus. Age over 40 (P = .014) and female (P = .014) were associated with facial involvement. In the case-control study, a higher percentage of patients with cutaneous sarcoidosis than of control subjects had diabetes mellitus (P = .001), hearing loss (P = .031) and eye diseases (P = .047).The present study demonstrates a striking female predominance and high proportions of facial involvement. Diabetes mellitus, hearing loss, and eye diseases may be associated with Taiwanese patients with cutaneous sarcoidosis.

Cutaneous manifestations of subcutaneous and systemic fungal infections in tropical regions: a retrospective study from a referral center in southern Taiwan.

BACKGROUND: Deep cutaneous fungal infections, including subcutaneous mycoses and systemic fungal infection with cutaneous involvement, cause significant morbidity and mortality in light of increasing immunocompromised patients and global warming. Although a few studies reviewed deep fungal infections in temperate regions, a relevant study in tropical regions is lacking. We evaluated features of deep cutaneous fungal infections in southern Taiwan among the tropical regions. METHODS: We retrospectively reviewed all histopathological specimens with deep cutaneous fungal infections in a single referral center from 2001 to 2014 and successfully identified 23 cases. Medical chart review revealed patient demographic data, clinical presentation, underlying disease, microbiological culture reports, and treatment outcomes. RESULTS: The average patient age was 52 years. Fourteen cases had primary subcutaneous mycoses, and nine had systemic mycoses. Fifteen patients were immunocompromised, including hematological malignancies. Acquired immune deficiency syndrome (AIDS) and long-term steroid use were most commonly associated with deep fungal infections. The positive culture growth rate was 63%. Fonsecaea sp. was most frequently identified by tissue culture. Aspergillosis, mucormycosis, and disseminated cryptococcosis were particularly fatal. CONCLUSIONS: Diabetes and long-term steroid use appear as major risk factors for advanced mycoses in this region. Rapid diagnosis with skin biopsy and tissue culture along with appropriate treatment of deep cutaneous fungal infection are necessary.

Progression of Idiopathic Eruptive Macular Pigmentation in a Girl from Childhood to Adolescence: Case Report and Literature Review.

A 14-year-old girl developed brownish round macules and patches over the face, trunk, and proximal limbs with extensive progression since she was 7 years old. Electron microscopy examination revealed an increase in the number and maturity of melanosomes in basal and suprabasal keratinocytes, although the number of melanocytes was within the normal range. A diagnosis of idiopathic eruptive macular pigmentation was made. We describe the unusual disease progression of this case of idiopathic eruptive macular pigmentation, which was thought to be self-limited.

Bull's eye dermatoscopy pattern at bacillus Calmette-Guérin inoculation site correlates with systemic involvements in patients with Kawasaki disease.

For the past decades, although the rash at the bacillus Calmette-Guérin (BCG) inoculation site has been recognized as a diagnostic clue in Kawasaki disease, the present study is the first known one attempting to characterize BCG inoculation by dermatoscopy in Kawasaki disease and correlate the grade of BCG reaction with systemic involvement. Thirty-four patients diagnosed with Kawasaki disease by pediatric specialists were enrolled. We performed detailed history taking, laboratory examination, physical examination and dermatoscopy examinations. Based on the BCG reaction pattern by dermatoscopy, we were able to characterize three patterns: (A) Bull's eye pattern in 18 patients; (B) faint homogenous erythema in nine; and (C) central white patch in seven. Patients from group A exhibited the highest elevation of blood aspartate aminotransferase levels (P < 0.05). Notably, three patients from group A had a significantly dilated coronary artery despite i.v. immunoglobulin injection. We concluded that the bull's eye dermatoscopy sign is not only a useful diagnostic clue but also a severity biomarker in patients with Kawasaki disease.