Double lung transplantation is better than single lung transplantation for end-stage chronic obstructive pulmonary disease: a meta-analysis.

BACKGROUND: Lung transplantation is one of the most common treatment options for patients with end-stage chronic obstructive pulmonary disease. However, the choice between single and double lung transplantation for these patients remains a matter of debate. Therefore, we performed a systematic search of medical databases for studies on single lung transplantation, double lung transplantation, and chronic obstructive pulmonary disease. METHODS: The rate ratio and hazard ratio of survival were analyzed. The meta-analysis included 15 case-control and retrospective registry studies. RESULTS: The rate ratios of the 3-year survival (0.937 and P = 0.041) and 5-year survival (0.775 and P = 0.000) were lower for single lung transplantation than for double lung transplantation. However, the hazard ratio did not differ significantly between the two. CONCLUSIONS: Double lung transplantation was found to provide better benefits than single lung transplantation in terms of the long-term survival in patients with chronic obstructive pulmonary disease.

A case report of drug interaction between co-packaged nirmatrelvir-ritonavir and tacrolimus causing hyponatremia in a lung transplant recipient.

BACKGROUND: Coronavirus disease 2019 (COVID-19) infection in lung transplant recipients can be lethal owing to the use of immunosuppressants. Antiviral agents may be administered to these patients. Co-packaged nirmatrelvir-ritonavir is a new agent currently being used in combination. CASE PRESENTATION: In this report, we present a case of a 64-year-old woman, a lung transplant recipient, who experienced hyponatremia and showed a high serum tacrolimus concentration following the administration of the co-packaged nirmatrelvir-ritonavir combination. CONCLUSION: Although the nirmatrelvir-ritonavir and tacrolimus combination is not contraindicated, other treatment strategies should be considered first, if available, and the dose of tacrolimus should be reduced when using the nirmatrelvir-ritonavir combination. In cases where combination therapy is necessary, serum tacrolimus levels should be closely monitored in lung transplant recipients. Documentation of more such reports is important to identify drug interactions between nirmatrelvir-ritonavir and other agents, with the aim of preventing severe adverse effects.

Enhancing Spiritual Well-Being, Physical Activity, and Happiness in Hospitalized Older Adult Patients with Swallowing Difficulties: A Comparative Study of Thickeners and Swallowing Exercises.

Swallowing difficulties often occur in older adult patients during acute hospitalization, leading to reduced nutritional intake, increased frailty, and various psychosocial challenges. This randomized controlled study aimed to assess the effects of two interventions, thickeners and swallowing exercises, on the spiritual well-being, physical activity, and happiness of older adult patients with swallowing difficulties during acute hospitalization from October 2019 to August 2020. Sample size calculation was performed using a conservative estimate approach, resulting in an estimate-required sample size of 42 participants. The sampling method was a random cluster sampling approach, with three ward rooms assigned to the thickeners group, swallowing exercises group and control group, respectively. Seventy-two participants were assigned to the intervention groups (thickeners or swallowing exercises) or the control group using a 1:1:1 stratified random assignment. Data were collected before and after the intervention, and matched samples were analyzed using t-tests, ANOVA, and generalized estimating equations for statistical analysis. Both intervention groups showed significant improvements in spiritual well-being (p < 0.001), physical activity (p < 0.001), and happiness (p < 0.001) compared to the control group. However, there were no significant differences between the intervention groups. Our findings suggest that interventions involving thickeners and swallowing exercises have positive effects on the spiritual well-being, physical activity, and happiness of older adult patients with swallowing difficulties during acute hospitalization and emphasize the importance of implementing these interventions to enhance the overall well-being and quality of life of this vulnerable patient population.

Association of Hypernatremia with Immune Profiles and Clinical Outcomes in Adult Intensive Care Unit Patients with Sepsis.

Both hypernatremia and an abnormal immune response may increase hospital mortality in patients with sepsis. This study examined the association of hypernatremia with abnormal immune response and mortality in 520 adult patients with sepsis in an intensive care unit (ICU). We compared the mortality and ex vivo lipopolysaccharide (LPS)-induced inflammatory response differences among patients with hyponatremia, eunatremia, and hypernatremia, as well as between patients with acquired hypernatremia on ICU day 3 and those with sustained eunatremia over first three ICU days. Compared with eunatremia or hyponatremia, hypernatremia led to higher 7 day, 14 day, 28 day, and hospital mortality rates (p = 0.030, 0.009, 0.010, and 0.033, respectively). Compared with sustained eunatremia, acquired hypernatremia led to higher 7, 14, and 28 day mortality rates (p = 0.019, 0.042, and 0.028, respectively). The acquired hypernatremia group nonsignificantly trended toward increased hospital mortality (p = 0.056). Day 1 granulocyte colony-stimulating factor (G-CSF) and tumor necrosis factor (TNF) α levels were relatively low in patients with hypernatremia (p = 0.020 and 0.010, respectively) but relatively high in patients with acquired hypernatremia (p = 0.049 and 0.009, respectively). Thus, in ICU-admitted septic patients, hypernatremia on admission and in ICU-acquired hypernatremia were both associated with higher mortality. The higher mortality in patients with hypernatremia on admission was possibly related to the downregulation of G-CSF and TNF-α secretion after endotoxin stimulation. Compared to sustained eunatremia, acquired hypernatremia showed immunoparalysis at first and then hyperinflammation on day 3.

Dilemmas in managing acute myocardial infarction during Covid-19 pandemic.

A 38-year-old man presented to emergency department with dizziness, dyspnea and diarrhea for 5 days. Serum lab data revealed lymphopenia and computed tomography imaging of the chest exhibited multiple ground-glass patches in bilateral lung fields. COVID-19 was suspected and further examination was done. But patient's dyspnea progressed while waiting for the result of COVID-19 examination and respiratory failure with cardiac arrest occurred eventually, acute myocardial infarction was diagnosed then. This article is aimed to discuss the dilemmas in managing acute myocardial infarction during COVID-19 pandemic.

Impact of metformin use on the recurrence of hepatocellular carcinoma after initial liver resection in diabetic patients.

BACKGROUND: Metformin is proposed to have chemopreventive effect of various cancer currently. However, the anti-cancer effect of metformin for diabetic patients with hepatocellular carcinoma (HCC) undergoing liver resection remains unclear. The aim of our cohort study was to assess whether metformin influence the recurrence of HCC. METHODS: We retrospectively enrolled 857 HCC patients who received primary resection from April 2001 to June 2016. 222 patients were diagnosed with diabetes mellitus (DM) from medical record. Factors influence the overall survival (OS) and recurrence-free survival (RFS) were analyzed by multivariate analysis. RESULTS: During the follow-up period (mean, 75 months), 471 (54.9%) patients experienced recurrence, and 158 (18.4%) patients died. Multivariate analysis revealed that DM (p = 0.015), elevated AST (p = 0.006), hypoalbuminemia (p = 0.003), tumor number (p = 0.001), tumor size (p < 0.001), vascular invasion (p <0.001), high Ishak fibrosis score (p <0.001), hepatitis B (p = 0.014), hepatitis C (p = 0.001) were independent predictors for RFS. In diabetic patients, only HbA1c>9% (p = 0.033), hypoalbuminemia (p = 0.030) and vascular invasion (p = 0.001) were independent risk factors for HCC recurrence; but the metformin use revealed no significance on recurrence. DM is a risk factor of HCC recurrence after resection. Adequate DM control can reduce the recurrence of HCC. However, the use of metformin does not reduce the risk of HCC recurrence in diabetic patient after initial resection. Hence, metformin may not have protective influences on HCC recurrence in diabetic patients who undergo initial liver resection.

Attention-Deficit/Hyperactivity Disorder, Its Pharmacotherapy, and Adrenal Gland Dysfunction: A Nationwide Population-Based Study in Taiwan.

This study aims to examine the co-occurrence rate of attention deficit hyperactivity disorder (ADHD) and adrenal gland disorders, as well as whether pharmacotherapy may affect ADHD patients' risk of developing adrenal gland disorder. One group of patients newly diagnosed with ADHD (n = 75,247) and one group of age- and gender-matching controls (n = 75,247) were chosen from Taiwan's National Health Insurance database during the period of January 1999 to December 2011. Both patients and controls were monitored through December 31, 2011, in order to identify the occurrence of adrenal gland disorders (ICD-9-CM code 255.X). We also explored the potential effect of methylphenidate (MPH) and atomoxetine (ATX) treatments on the risk of developing adrenal gland disorders. We found that ADHD patients showed a significantly increased probability of developing an adrenal gland disorder compared to the control group (0.2% of ADHD vs. 0.1% of controls). However, neither MPH nor ATX treatment significantly influenced the patients' risk of developing adrenal gland dysfunction. We propose that patients with ADHD had greater comorbid rates with adrenal gland dysfunction than the control subjects. Nevertheless, undergoing treatment with MPH or ATX did not significantly influence the risk of developing adrenal gland dysfunction among ADHD patients.

The Pre- and Postoperative FIB-4 Indexes Are Good Predictors to the Outcomes of HBV-Related HCC Patients after Resection.

BACKGROUND AND AIM: Liver fibrosis is associated with the prognosis of patients with hepatocellular carcinoma (HCC) after resection. The fibrosis-4 (FIB-4) index is an accurate and noninvasive marker to determine the degree of liver fibrosis. Here, we evaluated the effect of pre- and postoperative FIB-4 index in predicting the outcomes after resection of HCC in patients who have chronic hepatitis B (CHB) infection. METHODS: A total of 534 CHB patients with HCC who received curative hepatectomy between 2001 and 2016 at Kaohsiung Chang Gung Memorial Hospital, Taiwan, were enrolled in this study. The impact of the FIB-4 index (preoperative and the 1st year after operation) on overall survival (OS) and recurrence-free survival (RFS) was evaluated. RESULTS: There was a significant association between the preoperative FIB-4 index and Metavir fibrosis stage (p < 0.01). The multivariate analysis showed that preoperative FIB-4 > 2 is an independent risk factor for RFS and OS after HCC curative resection [hazard ratio (HR), 1.902; 95% CI, 1.491-2.460; p < 0.001, and HR, 2.207; 95% CI, 1.420-3.429; p < 0.001, respectively]. Notably, preoperative FIB-4 is also an independent risk factor for RFS (HR, 1.219; p = 0.035) in noncirrhotic patients. Furthermore, patients had deteriorated FIB-4 1 year after operation [definition: the value (the 1st year FIB-4 after operation minus preoperative FIB-4) > 1] and had an adverse outcome in RFS and OS (p < 0.001, both). CONCLUSION: The pre and postoperative FIB-4 indexes are useful clinical markers to predict the prognosis in HBV-HCC patients after curative hepatectomy.

Correlation between attention-deficit/hyperactivity disorder, its pharmacotherapy and thyroid dysfunction: A nationwide population-based study in Taiwan.

OBJECTIVE: The aim of this study was to examine the comorbid rates of thyroid dysfunction among patients with attention-deficit/hyperactivity disorder (ADHD) and the general population. We further examined whether pharmacotherapy affects ADHD patients' risk of developing thyroid dysfunction. DESIGN AND MEASUREMENT: We recruited 75 247 newly diagnosed ADHD patient and 75 247 healthy controls between January 1999 and December 2011 from the National Health Insurance database in Taiwan. We compared hyperthyroidism, hypothyroidism and other common paediatric psychiatric diseases between ADHD patients and controls. We carried out logistic regression analysis to identify an independent factor for predicting thyroid dysfunction. Furthermore, we analysed the time sequence of the diagnosis and the risk of developing a thyroid disorder after receiving pharmacotherapy. RESULTS: Compared to the control group, the ADHD group had higher comorbidity rates of both hyperthyroidism (1.1% of ADHD vs 0.7% of controls, aOR: 1.72, P < 0.001) and hypothyroidism (0.6% of ADHD vs 0.2% of controls, aOR: 2.23, P < 0.001). Of the ADHD patients with comorbid thyroid dysfunction, about two-thirds and half of patients were diagnosed with ADHD prior to their diagnosis of hyperthyroidism and hypothyroidism, respectively. Furthermore, pharmacotherapy had no significant influence on the risk of developing hyperthyroidism (aHR: 1.09, P = 0.363) or hypothyroidism (aHR: 0.95, P = 0.719) among ADHD patients. CONCLUSION: Patients with ADHD had greater comorbid rates with thyroid dysfunction than the control subjects, but pharmacotherapy for treating ADHD did not affect thyroid dysfunction later in life. However, these findings should be further verified using a clinical cohort with comprehensive laboratory assessment in future.