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1.
Emerg Med J ; 38(9): 679-684, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34261763

RESUMO

BACKGROUND: Emergency medical service (EMS) personnel have high COVID-19 risk during resuscitation. The resuscitation protocol for patients with out-of-hospital cardiac arrest (OHCA) was modified in response to the COVID-19 pandemic. However, how the adjustments in the EMS system affected patients with OHCA remains unclear. METHODS: We analysed data from the Taichung OHCA registry system. We compared OHCA outcomes and rescue records for 622 cases during the COVID-19 outbreak period (1 February to 30 April 2020) with those recorded for 570 cases during the same period in 2019. RESULTS: The two periods did not differ significantly with respect to patient age, patient sex, the presence of witnesses or OHCA location. Bystander cardiopulmonary resuscitation and defibrillation with automated external defibrillators were more common in 2020 (52.81% vs 65.76%, p<0.001%, and 23.51% vs 31.67%, p=0.001, respectively). The EMS response time was longer during the COVID-19 pandemic (445.8±210.2 s in 2020 vs 389.7±201.8 s in 2019, p<0.001). The rate of prehospital return of spontaneous circulation was lower in 2020 (6.49% vs 2.57%, p=0.001); 2019 and 2020 had similar rates of survival discharge (5.96% vs 4.98%). However, significantly fewer cases had favourable neurological function in 2020 (4.21% vs 2.09%, p=0.035). CONCLUSION: EMS response time for patients with OHCA was prolonged during the COVID-19 pandemic. Early advanced life support by EMS personnel remains crucial for patients with OHCA.


Assuntos
COVID-19/transmissão , Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/virologia , Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/normas , Auxiliares de Emergência/normas , Auxiliares de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/epidemiologia , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2/patogenicidade , Taiwan/epidemiologia , Tempo para o Tratamento/normas , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
2.
Medicine (Baltimore) ; 100(17): e25724, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907164

RESUMO

ABSTRACT: Metabolic acidosis is observed in 98% of patients with out-of-hospital cardiac arrest (OHCA). The longer the no-flow or low-flow duration, the more severe is the acidosis in these patients. This study explored whether blood pH in early stages of advanced life support (ALS) was an independent predictor of neurological prognosis in patients with OHCA.We retrospectively enrolled patients with OHCA from January 2012 to June 2018 in a single-medical tertiary hospital in Taiwan. Patients with OHCA whose blood gas analyses within 5 minutes after receiving ALS at the emergency department (ED) were enrolled. Patients younger than 20 years old, with cardiac arrest resulting from traumatic or circumstantial causes, with return of spontaneous circulation (ROSC) before ED arrival, lacking record of initial blood gas analysis, and with do-not-resuscitate orders were excluded. The primary outcome of this study was neurological status at hospital discharge.In total, 2034 patients with OHCA were enrolled. The majority were male (61.89%), and the average age was 67.8 ±â€Š17.0 years. Witnessed OHCA was noted in 571 cases, cardiopulmonary resuscitation was performed before paramedic arrival in 512 (25.2%) cases, and a shockable rhythm was observed in 269 (13.2%). Blood pH from initial blood gas analysis remained an independent predictor of neurological outcome after multivariate regression.Blood pH at early stages of ALS was an independent prognostic factor of post-OHCA neurological outcome. Blood gas analysis on arrival at the ED may provide additional information about the prognosis of patients with OHCA.


Assuntos
Acidose , Gasometria , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência , Doenças do Sistema Nervoso , Parada Cardíaca Extra-Hospitalar , Acidose/diagnóstico , Acidose/etiologia , Idoso , Gasometria/métodos , Gasometria/estatística & dados numéricos , Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Exame Neurológico/métodos , Exame Neurológico/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/sangue , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Taiwan/epidemiologia , Centros de Atenção Terciária , Tempo para o Tratamento/estatística & dados numéricos
3.
Wound Repair Regen ; 29(1): 87-96, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33047411

RESUMO

Acute and minor skin wounds are common in daily life. However, in clinical practice, after initial management in the acute phase, the wounds are managed mainly through observation, and the patients are usually lost to follow-up. Considering a multicomponent hydrolipidic dressing (MAS063DP) long-known for its safe application in eczema and recently in laser-induced wounds, we aimed to evaluate its ability in functional recovery of impaired skin integrity during wound healing. Sixteen patients (N = 16) were enrolled and completed (n = 8 vs n = 8) this prospective, open-label, vehicle-controlled clinical trial with 12-week follow-up. Transepidermal water, skin viscoelasticity and bioimpedance analysis were measured initially, at the 1st, 4th, 8th, and 12th weeks. Improvements in these parameters were greater in the MAS063DP group (from 31.4 ± 9.0 to 16.4 ± 4.3 g/m2 h, P < .001; from 77 ± 16% to 88 ± 9%, P < .05; from 4182 ± 3823 to 2644 ± 1772 Ω) than in the white petrolatum group. No significant adverse events occurred, and all participants were more satisfied with the intervention. In this study, MAS063DP can restore skin integrity and reinstitute physiologic function as a feasible and safe intervention more markedly than management through observation during the healing process by providing protective hydrolipidic layer on the skin with simultaneous anti-inflammatory and antioxidant activities from its key ingredients such as glycyrrhetinic acid, Vitis vinifera, telmesteine, and vitamins C and E.


Assuntos
Bandagens , Gorduras na Dieta/administração & dosagem , Ácido Glicirretínico/administração & dosagem , Extratos Vegetais/administração & dosagem , Recuperação de Função Fisiológica/fisiologia , Pele/patologia , Lesões dos Tecidos Moles/terapia , Cicatrização , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pele/fisiopatologia , Lesões dos Tecidos Moles/patologia , Adulto Jovem
4.
J Emerg Med ; 60(1): 115-116, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33011042
6.
Medicine (Baltimore) ; 99(3): e18840, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011498

RESUMO

Alcohol consumption has been suggested as a potential risk factor for diverticular diseases. This study investigated the association between alcohol intoxication or abuse and colonic diverticular disease (CDD).Using the National Health Insurance Research Database of Taiwan from January 1, 2000, to December 31, 2008, 51, 866 subjects newly diagnosed with alcohol intoxication were enrolled in this study as the alcohol intoxication cohort. The control (nonalcohol intoxication) cohort was frequency-matched 1:4 by age, sex and index year. Data were analyzed using a Cox proportional hazards model.The overall incidence of CDD (per 10,000 person-years) for the alcohol intoxication and control cohorts was 16.4 and 3.46, respectively. Compared with patients in the control cohort (95% confidence interval [CI] = 2.76-3.74), those with alcohol intoxication exhibited a 3.21-fold risk of CDD; the risk was particularly higher in male patients (adjusted hazard ratio [aHR] = 3.19, 95% CI = 2.72-3.74) and in those aged <45 years (aHR = 4.95, 95% CI = 3.91-6.27). The alcohol intoxication still had higher risk of CDD than nonalcohol intoxication, regardless of subjects without comorbidity (aHR = 3.38, 95% CI = 2.77-4.11) or with (aHR = 2.85, 95% CI = 2.25-3.61).There was a significant relationship between alcohol intoxication or abuse and CDD.


Assuntos
Intoxicação Alcoólica/complicações , Alcoolismo/complicações , Diverticulose Cólica/etiologia , Adulto , Idoso , Comorbidade , Diverticulose Cólica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Taiwan/epidemiologia
7.
PLoS One ; 15(2): e0229202, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32092086

RESUMO

BACKGROUND: Insufficient sleep is a common health and safety risk factor in high-impact workplaces where workers are required to take rotating shifts. However, studies on sleepiness-related risks and incidents, particularly among emergency medical services (EMS) workers are limited. OBJECTIVE: This study sought to investigate the prevalence of sleepiness and related workplace incidents among EMS workers. METHODS: This study utilized a cross-sectional survey design on a convenient sample of 500 EMS workers from 41 EMS squads across Taiwan. Data were collected using structured online questionnaires on workplace sleepiness and related safety incidents based on the Epworth Sleepiness Scale (ESS) and a modified 25-item EMS Safety Inventory respectively. RESULTS: With a response rate of 79.8% (n = 399), 36.9% of the respondents were identified as having mild daytime sleepiness, while 39.2% of the respondents were identified as having excessive daytime sleepiness. Multivariate analysis indicated that not only was working on rotating shifts the main cause of the high ESS scores among EMS workers, but also that higher ESS scores increased their risk of sustaining a workplace injury. Furthermore, ill-at-work incidents were associated with an increased risk of workplace-related injuries. CONCLUSION: Overall, the findings indicated a correlation among working on rotation shifts, the prevalence of sleepiness, and a higher risk of workplace injury among EMS workers.


Assuntos
Distúrbios do Sono por Sonolência Excessiva/complicações , Serviços Médicos de Emergência , Sonolência , Ferimentos e Lesões/etiologia , Adulto , Estudos Transversais , Distúrbios do Sono por Sonolência Excessiva/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/etiologia , Risco , Jornada de Trabalho em Turnos/efeitos adversos , Inquéritos e Questionários , Taiwan , Vigília
8.
Medicine (Baltimore) ; 99(2): e18765, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914100

RESUMO

RATIONALE: Acute chest pain remains one of the most challenging complaints of patients presenting to emergency departments (EDs). The diverse etiologies of chest pain frequently lead to diagnostic and therapeutic challenges. Esophageal perforation is a rare but potentially life-threatening disease. It results in delayed diagnosis and an estimated mortality risk of 20% to 40%. Prompt diagnosis and immediate therapeutic interventions are key factors for a good prognosis. PATIENT CONCERNS: Case 1 involved a 66-year-old man who presented to the ED with acute chest pain radiating to the back and hematemesis. Emergent contrast thoracic computerized tomography (CT) indicated the presence of a massive pneumothorax with pleural effusion. The continuous drainage of a dark-red bloody fluid following emergent thoracic intubation led to the discovery that the patient had experienced severe vomiting after whiskey consumption before admission to the hospital. Re-evaluation of the CT indicated spontaneous pneumomediastinum, whereas barium esophagography confirmed the presence of an esophageal perforation. Case 2 involved an 18-year-old Vietnamese man admitted to our ED with acute chest pain and swelling of the neck after vomiting due to beer consumption. A chest x-ray indicated diffuse subcutaneous emphysema of the neck and upper thorax. Contrast CT indicated pneumomediastinum with extensive emphysema and air in the paraspinal region and spinal canal. DIAGNOSES: Both of the 2 cases were diagnosed as spontaneous perforation of the esophagus (Boerhaave syndrome [BS]). INTERVENTIONS: Case 1 received surgical interventions, whereas case 2 decided not to avail our medical services. OUTCOMES: Case 1 was discharged after a good recovery. Case 2 lost to follow-up. LESSONS: We recommend all physicians in the ED to raise their index of suspicion for BS when dealing with patients having acute chest pain, dyspnea, confirmed pneumothorax, or newly-developed pleural effusion.


Assuntos
Dor no Peito/etiologia , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico , Doenças do Mediastino/complicações , Doenças do Mediastino/diagnóstico , Idoso , Hematemese/etiologia , Humanos , Masculino
9.
Gastroenterol Res Pract ; 2020: 3261542, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33456459

RESUMO

Background: Preeclampsia is a multiple organ dysfunction during pregnancy, including hepatic, renal, and neurological dysfunction, and is defined as hypertension and proteinuria occurring after 20 weeks of pregnancy. Clinical features seen in preeclampsia are due to relatively poorly perfused placenta and maternal endothelial dysfunction. Some studies have found that preeclampsia may cause acute pancreatitis due to microvascular abnormalities and visceral ischemia. This retrospective cohort study used the Taiwanese National Health Insurance Research Databases (NHIRD) to study the relationship between preeclampsia and the risk of pancreatitis. Methods: In total, 606,538 pregnant women were selected from the NHIRD between January 1, 1998 and December 31, 2010. They were divided into a preeclampsia cohort (n = 485,211) and a nonpreeclampsia cohort (n = 121,327). After adjusting for comorbidities that may induce pancreatitis, we analyzed and compared the incidence of pancreatitis in the two cohorts. Results: The overall incidence of pancreatitis in the preeclampsia cohort was significantly higher than that in the control cohort (4.29 vs. 2.33 per 10,000 person-years). The adjusted HR of developing pancreatitis increased 1.68-fold (95% CI: 1.19-2.36) in the preeclampsia cohort. In addition, pregnant women with preeclampsia without comorbidities had a significantly high risk of pancreatitis (aHR = 1.83, 95% CI 1.27-2.63). The combined effect of preeclampsia and alcohol-related diseases resulted in the highest risk of pancreatitis (aHR = 43.4, 95% CI: 6.06-311.3). Conclusion: Compared with patients without preeclampsia, the risk of pancreatitis in patients with preeclampsia is significantly increased after adjusting for demographics and comorbidities. The risk of pancreatitis is greatly increased when preeclampsia is accompanied by alcohol-related diseases, hepatitis C, gallstones, diabetes, or age of 26-35 years. Early identification and effective control of preeclampsia and the associated comorbidities can reduce the risk of pancreatitis and the associated morbidity and mortality.

10.
BMJ Open ; 9(11): e030939, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31753874

RESUMO

OBJECTIVE: Studies on the association between clinical vertebral fractures (CVFs) and the subsequent risk of cardiopulmonary diseases, including aortic dissection (AD), congestive heart failure (CHF), pneumonia and acute respiratory distress syndrome (ARDS) are scarce. Therefore, we used the National Health Insurance Research Database to investigate whether patients with CVF have a heightened risk of subsequent AD, CHF, pneumonia and ARDS. DESIGN: The National Health Insurance Research Database was used to investigate whether patients with CVFs have an increased risk of subsequent AD, CHF, pneumonia and ARDS. PARTICIPANTS: This cohort study comprised patients aged ≥18 years with a diagnosis of CVF and were hospitalised at any point during 2000-2010 (n=1 08 935). Each CVF patient was frequency-matched to a no-CVF hospitalised patients based on age, sex, index year and comorbidities (n=1 08 935). The Cox proportional hazard regressions model was used to estimate the adjusted effect of CVF on AD, CHF, pneumonia and ARDS risk. RESULTS: The overall incidence of AD, CHF, pneumonia and ARDS was higher in the CVF group than in the no-CVF group (4.85 vs 3.99, 119.1 vs 89.6, 283.3 vs 183.5 and 9.18 vs 4.18/10 000 person-years, respectively). After adjustment for age, sex, comorbidities and Charlson comorbidity index score, patients with CVF had a 1.23-fold higher risk of AD (95% CI=1.03-1.45), 1.35-fold higher risk of CHF (95% CI=1.30-1.40), 1.57-fold higher risk of pneumonia (95% CI=1.54-1.61) and 2.21-fold higher risk of ARDS (95% CI=1.91-2.57) than did those without CVF. Patients with cervical CVF and SCI were more likely to develop pneumonia and ARDS. CONCLUSIONS: Our study demonstrates that CVFs are associated with an increased risk of subsequent cardiopulmonary diseases. Future investigations are encouraged to delineate the mechanisms underlying this association.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma Aórtico/etiologia , Insuficiência Cardíaca/etiologia , Pneumonia/etiologia , Síndrome do Desconforto Respiratório/etiologia , Fraturas da Coluna Vertebral/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Bases de Dados Factuais , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Modelos de Riscos Proporcionais , Síndrome do Desconforto Respiratório/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan , Adulto Jovem
11.
Medicine (Baltimore) ; 98(15): e15166, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985697

RESUMO

The relationship of hypothyroidism and Menière's disease (MD) has been discussed before, yet not well documented. Our study aims to investigate the correlation of both diseases.This is a retrospective cohort study based on data from the LHID2000 (Longitudinal Health Insurance Database 2000), a subset of the Taiwan National Research Health Insurance Database that contains claims data for the 2000 to 2011 period. A total of 27,050 patients were included in this study, 5410 of whom had received a hypothyroidism diagnosis. The prevalence of MD was high in patients with hypothyroidism (95% confidence interval [CI]: 1.14-1.51), especially in those older than 50 years old (P < .001). Although comorbidities such as hypertension or cirrhosis are significant risk factors for Menière's disease (P < .001, P < .05), the incidence rate of Menière's disease in patients with hypothyroidism differs significantly between groups without these comorbidities (95% CI: 1.14-1.95). Regarding the timing for the occurrence of Menière's disease in patients with hypothyroidism, there was a significant time interval of <5 years (P < .05). The risk of MD decreased after treatment with thyroxine and did not differ from that of the nonhypothyroidism cohort (adjusted HR [aHR] = 0.85, 95% CI: 0.66-1.11).The study demonstrates a significant association between hypothyroidism and Menière's disease, especially in elderly female patients. Physicians should consider verifying the thyroid function when encountering these patients.


Assuntos
Hipotireoidismo/epidemiologia , Doença de Meniere/epidemiologia , Adulto , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taiwan , Adulto Jovem
12.
Resuscitation ; 138: 106-109, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30862425

RESUMO

BACKGROUND: In Taiwan, emergency department (ED) crowding is inevitable; many studies have investigated the various negative effects of ER crowding on patients. In general, ED crowding reduces patient satisfaction, delays treatment, and increases mortality. However, most studies have focused on the relationship between ED crowding and delay mortality rather than sudden mortality. This study investigates the association of ED crowding with sudden unexpected in-hospital cardiac arrest (IHCA). METHODS: The retrospective observational study recruited patients with sudden IHCA in an ED from February 2016 to September 2017. Exclusion criteria included (1) out-of-hospital cardiac arrest, (2) patient with signed do-not-resuscitate consent, (3) pediatric patient, and (4) trauma patient. ED crowding parameters, including ED bed occupancy rates (EDBORs), number of boarding patients, and patients with boarding time to general ward or intensive care unit of >24 and >48 h, all were recorded every 2 h. RESULTS: Significant increments were noted in IHCA incidence when EDBOR was >260%, with a rate ratio of 1.50 (95% confidence interval [CI], 1.03-2.17). However, the number of boarding patients was not associated with IHCA incidence (P > 0.05). Prolonged boarding time to general ward and ICU of >24 and >48 h both increased the IHCA incidence. CONCLUSION: This first study investigating the relationship between ED crowding and sudden IHCA found EDBORs and prolonged boarding to general wards or ICUs were associated with increased sudden IHCA incidence.


Assuntos
Aglomeração , Morte Súbita Cardíaca , Serviço Hospitalar de Emergência , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Admissão do Paciente/estatística & dados numéricos , Melhoria de Qualidade , Estudos Retrospectivos , Taiwan/epidemiologia , Tempo para o Tratamento/organização & administração , Tempo para o Tratamento/normas
13.
Medicine (Baltimore) ; 98(10): e14791, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855493

RESUMO

Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST-segment elevation myocardial infarction (STEMI). Many efforts had been made to reduce door-to-balloon (DTB) time in patients with STEMI. The objective of this study is to demonstrate how intrahospital social media communication reduced DTB times in STEMI patients requiring an interhospital transfer.We retrospectively enrolled patients with STEMI who had been transferred from other hospitals during 2016 and 2017. Patients were divided into 2 groups. The previewed group had an electrocardiogram (ECG) done at the first hospital that was previewed by the cardiologist via social media. The control group was treated using the conventional clinical approach. We compared DTB time and outcome between 2 groups.The 2 groups shared some similar clinical characteristics. However, the previewed group had significantly shorter DTB times than the control group (n = 51, DTB 52.61 ±â€Š42.20 vs n = 89, DTB time 78.40 ±â€Š50.64, P = .003). The time elapsed between ECG and the call to the laboratory decreased most apparently in the previewed group (-11.24 ±â€Š48.81 vs 16.96 ±â€Š33.08, P < .001). The previewed group also tended to have less in-hospital major adverse cardiovascular events (P = .091).When the patients with STEMI required transfer to the PCI-capable hospital, using social media to preview ECG reduced DTB time, mainly because the cardiologists activated the catheter laboratories much earlier, sometimes even before the patients arrived at the PCI-capable hospital.


Assuntos
Angioplastia Coronária com Balão , Comunicação em Saúde , Transferência de Pacientes , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Mídias Sociais , Tempo para o Tratamento , Cardiologistas , Eletrocardiografia , Serviços Médicos de Emergência , Feminino , Comunicação em Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
14.
Medicine (Baltimore) ; 98(10): e14814, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855503

RESUMO

Periodontal disease is a chronic inflammation of periodontium and has a high prevalence. Periodontal disease has been discovered to be a possible risk factor for cerebrovascular diseases. The available evidence are not enough to set up a causal relationship between periodontal disease and cerebrovascular diseases. Patients with spontaneous intracerebral hemorrhage have high mortality rates. The present study investigated whether intensive periodontal treatment is a protective factor of spontaneous intracerebral hemorrhage and can reduce the risk of spontaneous intracerebral hemorrhage.In total, 64,960 patients with a history of periodontal disease were picked out from the National Health Insurance Research Databases as a case-cohort from January 01, 2000 to December 31, 2010. They were divided on the basis of whether periodontal disease patients received intensive surgical treatment (treatment cohort) or not (control cohort). The periodontal disease patients in treatment and control cohorts were selected by propensity score matching at a ratio of 1:1. Incidences of spontaneous intracerebral hemorrhage in both cohorts were analyzed and compared.The total hazard of spontaneous intracerebral hemorrhage was significantly decreased in the treatment cohorts compared with the control cohorts (adjusted hazard ratio = 0.60, 95% confidence interval = 0.45-0.79).Compared with the control cohort, intensive periodontal treatment may reduce the overall incidence of spontaneous intracerebral hemorrhage, particularly in elderly patients, males, and those who received more than 2 intensive treatments.


Assuntos
Hemorragia Cerebral/epidemiologia , Doenças Periodontais/epidemiologia , Doenças Periodontais/cirurgia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Fatores de Risco , Taiwan
15.
Ann Emerg Med ; 73(6): 578-588, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30819521

RESUMO

STUDY OBJECTIVE: For patients with out-of-hospital cardiac arrest who receive cardiopulmonary resuscitation in an emergency department (ED), the early evaluation of their neurologic prognosis is essential for emergency physicians. The aim of this study is to establish a simple and useful assessment tool for rapidly estimating the prognosis of patients with out-of-hospital cardiac arrest after their arrival at an ED. METHODS: A total of 852 patients admitted from January 1, 2015, to June 30, 2017, were prospectively registered and enrolled in the derivation cohort. Multivariate logistic regression on this cohort identified 4 independent factors associated with unfavorable outcomes: initial nonshockable rhythm (odds ratio [OR] 3.40; 95% confidence interval [CI] 1.58 to 7.32), no witness of collapse (OR 3.19; 95% CI 1.51 to 6.75), older than 60 years (OR 3.65; 95% CI 1.64 to 8.09), and pH less than or equal to 7.00 (OR 3.27; 95% CI 1.42 to 7.54). The shockable rhythm-witness-age-pH (SWAP) score was developed and 1 point was assigned to each predictor. RESULTS: For a SWAP score of 4, the specificity was 97.14% (95% CI 91.62% to 100%) for unfavorable outcomes in the derivation cohort. For validation, we retrospectively collected data for 859 patients with out-of-hospital cardiac arrest from January 1, 2012, to December 31, 2014. A SWAP score of 4 was 100% specific (95% CI 99.9% to 100%) for unfavorable outcomes in the validation cohort. CONCLUSION: The SWAP score is a simple and useful predictive model that may provide information for the very early estimation of prognosis for patients with out-of-hospital cardiac arrest. Further research is required to integrate ultrasonographic findings and validate the SWAP score's application in other populations.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Doenças Neurodegenerativas/diagnóstico , Parada Cardíaca Extra-Hospitalar/complicações , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/fisiopatologia , Doenças Neurodegenerativas/terapia , Exame Neurológico , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Parada Cardíaca Extra-Hospitalar/terapia , Valor Preditivo dos Testes , Estudos Prospectivos
16.
Aging (Albany NY) ; 10(12): 4166-4174, 2018 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-30582744

RESUMO

Exercise is known to be beneficial in controlling aging associated disorders however, the consequence of long-term exercise on cardiac health among aging population is not much clear. In this study the protective effect of exercise on aging associated cardiac disorders was determined using a D-galactose-induced aging model. Eight weeks old Sprague Dawley rats were given intraperitoneal injection of 150 mL/kg D-galactose. Swimming exercise was provided in warm water for 60 min/day for five days per week. Hematoxylin and eosin staining of cardiac tissue sections revealed cardiomyocyte disarrangements in the aging rat hearts but long-term exercise training showed improvements in the cardiac histology. Exercise training also enhanced the expression levels of proteins such as SIRT1, PGC-1α and AMPKα1 that are associated with energy homeostasis and further suppressed aging associated inflammatory cytokines. Our results show that long-term exercise training potentially enhances SIRT1 associated anti-aging signaling and provide cardio-protection against aging.


Assuntos
Envelhecimento/efeitos dos fármacos , Galactose/toxicidade , Cardiopatias/prevenção & controle , Inflamação/etiologia , Condicionamento Físico Animal , Sirtuína 1/metabolismo , Animais , Regulação da Expressão Gênica/efeitos dos fármacos , Masculino , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/fisiologia , Sirtuína 1/genética , Natação
17.
PLoS One ; 13(9): e0203410, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30188943

RESUMO

INTRODUCTION: Alcohol use disorder (AUD) is a spectrum of high risk behaviors including alcohol abuse and dependence. Chronic kidney disease (CKD) is progressive loss of renal function for more or equal to 3 months or presence of any irreversible kidney damage. Common risk factors of CKD have been identified, but the impact of alcohol consumption on kidney function is controversial. The study aims to investigate the relationship between alcohol use disorder and CKD on a national scale. METHODS: This retrospective cohort study was conducted using Taiwan's National Health Insurance research database. Patients aged 20 years or older, without CKD and with the diagnosis of AUD (ICD-9-CM codes 303.X; 305.0, V113) from years 2000 to 2013 were enrolled. Control cohort was selected to match the demographics of the target population. Patients were followed until the end of 2013 or earlier if they developed CKD, died, or lost follow up. Baseline characteristics and comorbidities were identified for risk stratification. RESULTS: We identified 11639 patients in the AUD cohort and 46556 patients in the control cohort. Compared to patients in the control cohort, those in the AUD group were more likely to have multiple comorbidities (p < 0.001 for all comorbidities). After adjustment of age, gender, baseline comorbidities, and nonsteroidal anti-inflammatory drug use, the diagnosis of AUD was associated with an increased risk of CKD development (aHR = 1.62, 95% CI, 1.46-1.81). During the mean follow up periods of 6.47 (standard deviation (SD) = 3.80) years for the AUD cohort and 7.23 (SD = 3.75) years for the control cohort, the overall incidence density of CKD was significantly higher in patients with AUD than those in the control cohort (3.48 vs 6.51 per 1000 person-years, aHR = 1.68, 95% CI, 1.50-1.87). Kaplan-Meier analysis showed that the AUD cohort had a higher cumulative incidence of CKD than the control cohort (log-rank test, p value < 0.001). Patients with AUD had higher risks of CKD in all the stratified groups, except for the subgroup with age over 65 years old. CONCLUSION: Our study suggested that AUD was associated with an increased incidence of newly diagnosed CKD by nearly two folds. Young age, in particular, had a higher association between AUD and CKD. Considering the preventable nature of AUD, establishing effective health policies is imperative to reduce high-risk alcohol behaviors and thereby prevent alcohol-related kidney disease. Further prospective studies are warranted to further elucidate the causation of AUD on kidney function.


Assuntos
Alcoolismo/complicações , Alcoolismo/epidemiologia , Bases de Dados Factuais , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Adulto , Idoso , Alcoolismo/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Taiwan/epidemiologia
18.
Medicine (Baltimore) ; 97(36): e12223, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200143

RESUMO

Extracorporeal membrane oxygenation (ECMO) has been increasingly applied for the treatment of patients with trauma. Because a common complication of ECMO is bleeding, the use of ECMO support for patients with trauma was limited in the past. Studies have demonstrated a survival benefit from ECMO support in cases of traumatic lung injury, and it is likely that patients with other types of trauma would also benefit from ECMO support. However, the effect of ECMO in patients with other types of trauma is unknown.Using the national insurance data of Taiwan, we identified 810 patients with trauma who received ECMO support from 2000 to 2010. Patients who died or who withdrew from the program within 7 days after discharge were defined as deceased. Logistic regression was used to estimate the odds ratio (OR) of death and 95% confidence intervals (CIs).The overall mortality was 32.8% (266/810). A total of 417 patients received surgery during hospitalization, with an overall mortality of 39.0% (163/417). Patients who underwent thoracic surgery had an OR of 2.23 (95% CI: 1.49-3.34) compared with those who did not. Patients who underwent brain surgery had an OR of 2.86 (95% CI: 1.37-5.98) compared with patients who did not. Patients who received abdominal surgery had an OR of 4.47 (95% CI: 2.63-7.61) compared with patients who did not. All types of surgery had odds of mortality except orthopedic surgery; the use of ECMO with orthopedic surgery had an OR of 1.06 (95% CI: 0.69-1.62) compared with patients who did not receive orthopedic surgery.Except for orthopedic surgery, patients with trauma who received ECMO support and required further surgery during hospitalization exhibited a relatively high mortality rate.


Assuntos
Oxigenação por Membrana Extracorpórea , Ferimentos e Lesões/terapia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Procedimentos Cirúrgicos Operatórios , Taiwan/epidemiologia , Ferimentos e Lesões/mortalidade
19.
Hu Li Za Zhi ; 65(4): 18-23, 2018 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-30066319

RESUMO

Acute pain is the main cause for patient visits to the emergency department. An important issue faced in emergency medical care is to resolve patient pain. Moreover, limb traumatic pain is noted in 58-66% of emergency trauma patients. This paper explored the effectiveness of using non-pharmacological complementary interventions, including body operation therapies that used trauma limb care and therapeutic touch and mind-body interventions, in order to strengthen the support system and create a healing environment. The experience described herein is hoped to facilitate the provision of multifaceted emergency care for patients with limb trauma pain in the emergency department in order to improve the comfort and return rate of patients.


Assuntos
Terapias Complementares , Serviço Hospitalar de Emergência , Extremidades/lesões , Manejo da Dor/métodos , Humanos
20.
Exp Cell Res ; 363(2): 227-234, 2018 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-29331388

RESUMO

The bZIP transcription factor E4BP4 is a survival factor that is known to be elevated in diseased heart and promote cell survival. In this study the role of E4BP4 on angiotensin-II (AngII)-induced apoptosis has been examined in in vitro cell model. H9c2 cardiomyoblast cells that overexpressed E4BP4 were exposed to AngII to observe the cardio-protective effects of E4BP4 on hypertension related apoptosis. The results from TUNEL assays revealed that E4BP4 significantly attenuated AngII-induced apoptosis. Further analysis by Western blot and RT-PCR showed that E4BP4 inhibited AngII-induced IGF-II mRNA expression and cleavage of caspase-3 through the PI3K-Akt pathway. In addition, E4BP4 enhanced calcium reuptake into the sacroplasmic reticulum by down-regulating PP2A and by up-regulating the phosphorylation of PKA and PLB proteins. Our findings indicate that E4BP4 functions as a survival factor in cardiomyoblasts by inhibiting IGF-II transcription and by regulating calcium cycling.


Assuntos
Apoptose/efeitos dos fármacos , Fatores de Transcrição de Zíper de Leucina Básica/metabolismo , Cálcio/metabolismo , Miócitos Cardíacos/efeitos dos fármacos , Angiotensina II/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Miócitos Cardíacos/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo
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