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1.
Medicine (Baltimore) ; 98(49): e18167, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804331

RESUMO

RATIONALE: Renal actinomycosis is a rare clinical infection, subacute to chronic presentation caused by the Actinomyces bacteria. Actinomyces israelii is diagnosed in the overpowering majority of reported cases. Abdominopelvic manifestation forms 10% to 20% of all actinomycosis, and may be misdiagnosed as either a malignancy or chronic inflammation due to the lower correct preoperative diagnostic rate (<10%). PATIENT CONCERNS: A 38-year-old man with alcoholic liver cirrhosis experienced right flank pain, abdominal pain, and fever for 3 days. Leukocytosis, acute kidney injury, and impaired liver function were found. A computed tomographic scan demonstrated multiple renal cystic lesions, along with fluid accumulation at the right subphrenic and retroperitoneal spaces. DIAGNOSES: Renal actinomycosis was confirmed via cultures of both the abscess and nephrectomy specimen which grew A israelii and the pathological findings of multiple renal abscesses of actinomycosis with the characteristics of sulfur granules. INTERVENTIONS: A nephrectomy was performed for an inadequate percutaneous drainage of renal abscess. OUTCOMES: A full course of antibiotics with intravenous penicillin G (3 million units every 4 hours) was prescribed for 2 weeks, followed by oral penicillin V given at a dose of 2 grams per day for 6 months at our out-patient facility. LESSONS: A precise diagnosis of primary renal actinomycosis depends on any histopathological findings and/or cultures of specimens. A high dose of intravenous penicillin G is the first choice, followed by oral penicillin V, with the duration of each being dependent upon the individual condition.


Assuntos
Abscesso Abdominal/complicações , Actinomicose/complicações , Nefropatias/complicações , Cirrose Hepática Alcoólica/complicações , Espaço Retroperitoneal/patologia , Abscesso Abdominal/tratamento farmacológico , Actinomicose/tratamento farmacológico , Actinomicose/cirurgia , Adulto , Antibacterianos/uso terapêutico , Humanos , Nefropatias/tratamento farmacológico , Nefropatias/cirurgia , Masculino , Nefrectomia
2.
Medicine (Baltimore) ; 98(48): e18159, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770260

RESUMO

RATIONALE: Toothpick puncture (TPP) is a penetrating injury that can result in bringing pathogens to the deep space. Such penetrating wounds are typically of pinpoint size with initial symptoms appearing subtle. Consequently, the injury itself is often neglected by patients, or is not detected during physical examinations by medical doctors. Reported complications from such injuries include osteomyelitis and septic arthritis, mostly due to delayed treatment. PATIENT CONCERNS: A diabetic patient aged 83-year-old presented a 2-day history of skin redness, swelling, and tenderness over his forearm following a TPP a week earlier. Laboratory investigations showed leukocytosis with neutrophilic predominance and a high level of C-reactive protein. Before his operation, cultures of aspirated fluid from the injured site revealed the presence of Streptococcus anginosus, Streptococci viridans, Prevotella intermedia, and Pavimonas (Peptostreptococcus) micra. DIAGNOSIS: Intramuscular abscess associated with toothpick injury. INTERVENTIONS: Surgical irrigation with debridement and adjunctive antibiotics of ceftriaxone and clindamycin were given with a satisfactory response. Cultures of debrided tissue showed the presence of P intermedia and P (Peptostreptococcus) micra. OUTCOMES: A split-thickness skin graft was done. Patient was discharged on the 30th postoperative day. LESSONS: Toothpick injury, initial symptoms of which are subtle, can in some cases, lead to serious complications especially when managements are delayed. In such situations (including the present case), surgical irrigation and debridement are administrated for the eradication of infections, removal of potentially retained toothpick, and tissue cultures analyzed. Adjunctive antibiotics is recommended to combat both the aerobic and anaerobic microorganisms of the gastrointestinal tract, skin surface, and oral cavity.


Assuntos
Abscesso , Antibacterianos/administração & dosagem , Desbridamento/métodos , Dispositivos para o Cuidado Bucal Domiciliar/efeitos adversos , Traumatismos do Antebraço , Ferimentos Penetrantes , Abscesso/etiologia , Abscesso/terapia , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus/epidemiologia , Traumatismos do Antebraço/diagnóstico , Traumatismos do Antebraço/etiologia , Traumatismos do Antebraço/terapia , Humanos , Masculino , Peptostreptococcus/isolamento & purificação , Prevotella intermedia/isolamento & purificação , Streptococcus anginosus/isolamento & purificação , Resultado do Tratamento , Estreptococos Viridans/isolamento & purificação , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/microbiologia , Ferimentos Penetrantes/terapia
3.
BMJ Open ; 9(11): e032779, 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31740474

RESUMO

OBJECTIVES: To detect the combined effects of lifestyle factors on work-related burnout (WB) and to analyse the impact of the number of weekend catch-up sleep hours on burnout risk in a medical workplace. DESIGN: Cross-sectional study. SETTING: Hospital-based survey in Taiwan. PARTICIPANTS: In total, 2746 participants completed the hospital's Overload Health Control System questionnaire for the period from the first day of January 2016 to the end of December 2016, with a response rate of 70.5%. The voluntary participants included 358 physicians, 1406 nurses, 367 medical technicians and 615 administrative staff. PRIMARY AND SECONDARY OUTCOME MEASURES: All factors that correlated significantly with WB were entered into a multinomial logistic regression after adjustment for other factors. The dose-response relationship of combined lifestyle factors and catch-up sleep hours associated with WB was explored by logistic regression. RESULTS: Abnormal meal time (adjusted OR 2.41, 95% CI 1.85 to 3.15), frequently eating out (adjusted OR 1.49, 95% CI 1.12 to 1.97), lack of sleep (adjusted OR 5.13, 95% CI 3.94 to 6.69), no exercise (adjusted OR 1.41, 95% CI 1.10 to 1.81) and >40 work hours (adjusted OR 2.72, 95% CI 2.08-3.57) were independently associated with WB (for high level compared with low level). As the number of risk factors increased (1-5), so did the proportion of high severity of WB (adjusted OR 1.39, 95% CI 0.45 to 4.27, to adjusted OR 32.98, 95% CI 10.78 to 100.87). For those with more than 7 hours' sleep on workdays, weekend catch-up sleep (≤0/>0 and ≤2/>2 hours) was found to be related to an increase of burnout risk (adjusted OR 4.91, 95% CI 2.24 to 10.75/adjusted OR 4.94, 95% CI 2.54 to 9.63/adjusted OR 6.74, 95% CI 2.94 to 15.46). CONCLUSION: WB in the medical workplace was affected by five unhealthy lifestyle factors, and combinations of these factors were associated with greater severity of WB. Weekend catch-up sleep was correlated with lower burnout risk in those with a short workday sleep duration (less than 7 hours). Clinicians should pay particular attention to medical staff with short sleep duration without weekend catch-up sleep.

4.
Medicine (Baltimore) ; 98(45): e17885, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702663

RESUMO

RATIONALE: Endograft infection following endovascular stent for aortic aneurysm is rare (0.6%-3%), but it results in high mortality rate of 25% to 88%. PATIENT CONCERNS: A 66-year-old hypertensive man underwent an endovascular stent graft for abdominal aortic aneurysm 18 months ago. Recurrent episodes of fever, chills, and abdominal fullness occurred 6 months ago before this admission. Laboratory data showed 20 mg/dL of C-reactive protein and abdominal computed tomography (CT) revealed an aortic endoleak at an urban hospital, so 4-day course of intravenous (IV) amoxicillin/clavulanic acid was given and he was discharged after fever subsided. He was admitted to our hospital due to fever, chills, and watery diarrhea for 1 day. Abdominal CT showed left psoas abscess associated with endograft infection. Blood culture grew Listeria monocytogenes. DIAGNOSIS: Left psoas abscess associated with endograft infection caused by bacteremia of Listeria monocytogenes. INTERVENTIONS: IV ampicillin with 8 days of synergistic gentamicin was prescribed and it created satisfactory response. Ampicillin was continued for 30 days and then shifted to IV co-trimoxazole for 12 days. OUTCOMES: He remained asymptomatic with a decline of CRP to 0.36 mg/dL and ESR to 39 mm/h. He was discharged on the 44th hospital day. Orally SMX/TMP was prescribed for 13.5 months. LESSONS: Only few cases of aortic endograft infection caused by Listeria monocytogenes had been reported. In selected cases, particularly with smoldering presentations and high operative risk, endograft retention with a prolonged antimicrobial therapy seem plausible as an initial therapeutic option, complemented with percutaneous drainage or surgical debridement if necessary.


Assuntos
Listeria monocytogenes/isolamento & purificação , Infecções Relacionadas à Prótese/diagnóstico , Abscesso do Psoas/diagnóstico , Idoso , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Gentamicinas/uso terapêutico , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/etiologia , Tomografia Computadorizada por Raios X
5.
Ther Adv Endocrinol Metab ; 10: 2042018819875406, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31598211

RESUMO

Background: The association between type 2 diabetes and hospital outcomes of sepsis remains controversial when severity of diabetes is not taken into consideration. We examined this association using nationwide and hospital-based databases. Methods: The first part of this study was mainly conducted using a nationwide database, which included 1.6 million type 2 diabetic patients. The diabetic complication burden was evaluated using the adapted Diabetes Complications Severity Index score (aDCSI score). In the second part, we used laboratory data from a distinct hospital-based database to make comparisons using regression analyses. Results: The nationwide study included 19,719 type 2 diabetic sepsis patients and an equal number of nondiabetic sepsis patients. The diabetic sepsis patients had an increased odds ratio (OR) of 1.14 (95% confidence interval 1.1-1.19) for hospital mortality. The OR for mortality increased as the complication burden increased [aDCSI scores of 0, 1, 2, 3, 4, and ⩾5 with ORs of 0.91, 0.87, 1.14, 1.25, 1.56, and 1.77 for mortality, respectively (all p < 0.001)].The hospital-based database included 1054 diabetic sepsis patients. Initial blood glucose levels did not differ significantly between the surviving and deceased diabetic sepsis patients: 273.9 ± 180.3 versus 266.1 ± 200.2 mg/dl (p = 0.095). Moreover, the surviving diabetic sepsis patients did not have lower glycated hemoglobin (HbA1c; %) values than the deceased patients: 8.4 ± 2.6 versus 8.0 ± 2.5 (p = 0.078). Conclusions: For type 2 diabetic sepsis patients, the diabetes-related complication burden was the major determinant of hospital mortality rather than diabetes per se, HbA1c level, or initial blood glucose level.

6.
BMC Musculoskelet Disord ; 20(1): 474, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653245

RESUMO

BACKGROUND: Iliopsoas abscess (IPA) is a rare clinical entity and is difficult to diagnose due to its insidious onset and nonspecific symptoms. The association between IPA and cardiovascular disorders (CVD) has been rarely reported. Computed tomographic (CT) scan can provide a definitive diagnosis of IPA and associated foci of adjacent structures. IPA is a life-threatening condition, especially when associated with CVD. MATERIALS AND METHODS: We conducted a hospital-based observational study of IPA associated with CVD. Data were collected from the electronic clinical database of Taichung Veterans General Hospital (1520-bed tertiary referral hospital in central Taiwan) between July 2007 and December 2017. The diagnosis of IPA associated with CVD was confirmed by classical findings on CT and transesophageal echocardiography with compatible clinical presentation and cultures from pus/tissue and blood. RESULTS: Fifteen patients of IPA associated with CVD were studied. They included 12 males (80%) and 3 females (20%), with a mean age 63.2 ± 16.9 years (31-85 years). CVD included stent-graft/endograft infection of abdominal aortic aneurysm (AAA) (40%), primary mycotic AAA (33.3%), and infective endocarditis (26.7%). Staphylococcus aureus is the most common microorganism in pus/tissue cultures (n = 3, 37.5%) and in blood cultures (n = 6, 40%). The average length of hospital stay was 33.1 ± 20.5 days (range, 3-81 days; median, 33 days). Hospital stay lasted 42.6 ± 19.2 days in the survival group and 19.0 ± 14.1 days (P = 0.018) in the non-survival group. Incidence of patients staying in the intensive care unit (ICU) with intubation > 3 days was 33% in the survival group and 100% (P = 0.028) in the non-survival group. Intra-hospital mortality rate was 40%. Poor prognostic factors in the non-survival group were hypoalbuminemia, hyponatremia, involved disc/vertebral body and/or epidural abscess, and ICU stay with intubation > 3 days. Cumulative survival rate was 25% under conservative treatments and 66.3% under aggressive treatments (P = 0.038). CONCLUSION: Due to high mortality rates, clinicians should keep a high suspicion index for IPA associated with CVD through clinical presentation, physical examination, and imaging study. Timely empiric antibiotics for common bacteria, drainage for IPA, endovascular repair, or vascular reconstruction by graft replacement or bypass with intensive care should be mandatory to shorten the hospital stay, reduce medical costs, and lower mortality rate.

8.
Medicine (Baltimore) ; 98(17): e15253, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027074

RESUMO

Most patients diagnosed with sepsis died during their first episode, with the long-term survival rate upon post-sepsis discharge being low. Major adverse cardiovascular events and recurrent infections were regarded as the major causes of death. No definite medications had proven to be effective in improving the long-term prognosis. We aimed to examine the benefits of statins on the long-term prognosis of patients who had survived sepsis.Between 1999 and 2013, a total of 220,082 patients who had been hospitalized due to the first episode of sepsis were included, with 134,448 (61.09%) of them surviving to discharge. The surviving patients who were subsequently prescribed statins at a concentration of more than 30 cumulative Defined Daily Doses (cDDDs) during post-sepsis discharge were defined as the users of statin.After a propensity score matching ratio of 1:5, a total of 7356 and 36,780 surviving patients were retrieved for the study (statin users) and comparison cohort (nonstatin users), respectively. The main outcome was to determine the long-term survival rate during post-sepsis discharge.HR with 95% CI was calculated using the Cox regression model to evaluate the effectiveness of statins, with further stratification analyses according to cDDDs.The users of statins had an adjusted HR of 0.29 (95% CI, 0.27-0.31) in their long-term mortality rate when compared with the comparison cohort. For the users of statins with cDDDs of 30-180, 180-365, and >365, the adjusted HRs were 0.32, 0.22, and 0.16, respectively, (95% CI, 0.30-0.34, 0.19-0.26, and 0.12-0.23, respectively), as compared with the nonstatins users (defined as the use of statins <30 cDDDs during post-sepsis discharge), with the P for trend <.0001. In the sensitivity analysis, after excluding the surviving patients who had died between 3 and 6 months after post-sepsis discharge, the adjusted HR for the users of statins remained significant (0.35, 95% CI 0.32-0.37 and 0.42, 95% CI 0.39-0.45, respectively).Statins may have the potential to decrease the long-term mortality of patients who have survived sepsis. However, more evidence, including clinical and laboratory data, is necessary in order to confirm the results of this observational cohort study.Trial registration: CMUH104-REC2-115.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Sepse/tratamento farmacológico , Sepse/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Relação Dose-Resposta a Droga , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão , Análise de Regressão , Características de Residência , Fatores de Risco , Fatores Socioeconômicos , Taiwan , Adulto Jovem
10.
BMJ Open ; 8(7): e021382, 2018 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-30002011

RESUMO

OBJECTIVE: The Diabetes Shared Care Program (DSCP) is an integrated care model in Taiwan that has been proven to improve the care quality of patients with diabetes. We aimed to evaluate the efficacy of DSCP in decreasing the hospital mortality of infectious diseases. METHODS: From 1 662 929 patients with type 2 diabetes newly diagnosed between 1999 and 2013, we retrieved a total of 919 patients who participated in the DSCP with the first hospitalisation for an infectious disease as the study cohort and 9190 propensity score-matched patients with type 2 diabetes who did not participate as the comparison.The efficacy of DSCP was evaluated via the following comparisons between the DSCP and non-DSCP cohorts: hospital mortality, 1-year medical cost prior to and during the hospitalisation, and complications, such as receiving mechanical ventilation and intensive care unit admission. The ratio (OR) for hospital mortality of the DSCP participants was calculated by logistical regression. Further stratification analyses were conducted to examine which group of patients with type 2 diabetes benefited the most from the DSCP during hospitalisation for infectious diseases. RESULTS: The DSCP cohort had a lower hospital mortality rate than the non-DSCP participants (2.18% vs 4.82%, p<0.001). The total medical cost during the hospitalisation was lower in the DSCP cohort than in the non-DSCP cohort (NT$72 454±30 429 vs NT$86 385±29 350) (p=0.006). In the logistical regression model, the DSCP participants exhibited a significantly decreased adjusted OR for hospital mortality (adjusted OR=0.42, 95% CI 0.26 to 0.66, p=0.0002). The efficacy of the DSCP was much more prominent in male patients with type 2 diabetes and in patients with lower incomes. CONCLUSION: Participation in the DSCP was associated with a lower risk of hospital mortality for infectious diseases.


Assuntos
Infecções Bacterianas/complicações , Infecções Bacterianas/mortalidade , Prestação Integrada de Cuidados de Saúde , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/mortalidade , Adulto , Idoso , Infecções Bacterianas/imunologia , Diabetes Mellitus Tipo 2/imunologia , Diabetes Mellitus Tipo 2/microbiologia , Angiopatias Diabéticas/imunologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Taiwan/epidemiologia , Adulto Jovem
11.
BMC Cardiovasc Disord ; 18(1): 113, 2018 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-29879911

RESUMO

BACKGROUND: Primary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate. CASE PRESENTATION: We report a rare case of AAA complicating ADF with massive GI bleeding in a 73-year-old Taiwanese man. He presented with abdominal pain and tarry stool for 5 days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. He was referred to our hospital for EVAR and primary closure of fistula defect due to massive GI bleeding with shock from ADF caused by AAA. Diagnosis was made by CTA of aorta. CONCLUSIONS: A timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Doenças da Aorta/etiologia , Duodenopatias/etiologia , Hemorragia Gastrointestinal/etiologia , Fístula Intestinal/etiologia , Fístula Vascular/etiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Doenças da Aorta/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Duodenopatias/diagnóstico por imagem , Duodenopatias/fisiopatologia , Duodenopatias/cirurgia , Procedimentos Endovasculares , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/fisiopatologia , Hemorragia Gastrointestinal/cirurgia , Hemodinâmica , Técnicas Hemostáticas , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/fisiopatologia , Fístula Intestinal/cirurgia , Masculino , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/fisiopatologia , Fístula Vascular/cirurgia
13.
Medicine (Baltimore) ; 97(6): e9803, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29419677

RESUMO

Multiple comorbidities, especially musculoskeletal dysfunction and cerebrovascular disease, remain barriers to normal social participation among persons with hemophilia (PWH). However, the relative health effects of such comorbidities on workers with hemophilia have seldom been explored. In this study, we investigated the incidence of comorbidities and their risk factors among workers with hemophilia.The study compared the incidence and risk factors of the major comorbidities of 411 workers with hemophilia enrolled in Taiwan's National Health Insurance Research Database between 1997 and 2010 with an age- and sex-matched general population.Compared with the general population, workers with hemophilia had higher risks for hemorrhagic stroke, arthritis/arthropathy, and knee/hip replacement among workers with hemophilia after multivariate adjustment, with hazard ratios (95% CI) of 4.60 (2.81-7.53), 4.03 (3.34-4.87), and 1.29 (1.10-1.41), respectively.Disorder of joints, hemophilia-related arthritis/arthropathy, hemorrhagic stroke, and knee/hip replacement remain significant comorbidities among workers with hemophilia, which will result in increased social burden. Policymakers and employers should apply appropriate interventions to help prevent productivity losses, reduced workforce participation, sick leave, and work disability among hemophilia workers.


Assuntos
Transtornos Cerebrovasculares/epidemiologia , Hemofilia A/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Adulto , Comorbidade , Efeitos Psicossociais da Doença , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Política Pública , Fatores de Risco , Taiwan/epidemiologia
14.
Cancer Manag Res ; 9: 709-720, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29238221

RESUMO

Background: This study aimed to investigate the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection. Methods: We conducted a population-based cohort study by using claims data from the Taiwan National Health Insurance Research Database (NHIRD). The study cohort comprised 1380 newly diagnosed HBV-infected patients with SSRI use who were frequency matched by age, sex, liver cirrhosis, and index year with HBV-infected patients without SSRI use in the comparison cohort. Each patient case was followed from 2000 to 2012 to identify incident HCC cases. Cox proportional hazards regression was performed to evaluate the association between SSRI use and HCC risk. The further sensitivity analysis used case-control study design. A total of 9070 HCC subjects retrieved from NHIRD, and equal non-HCC subjects were analyzed after matching for age and sex. Results: We identified 9 and 24 HCC cases in the study and comparison cohorts during the follow-up period of 7056 and 6845 person-years, respectively. The incidence rate of HCC was 1.28 and 3.51 per 1000 person-years for SSRI and non-SSRI users, respectively. After adjusting for potential confounders, the adjusted hazard ratio (HR) for SSRI use was 0.28 (95% confidence interval [CI], 0.12-0.64; p = 0.0027). For SSRI users with a cumulative defined daily dose (cDDD) of 28-89, 90-364, and ≥365, the adjusted HRs were 0.51, 0.22, and 0.12, respectively, (95% CI, 0.21-1.25, 0.05-0.94, and 0.02-0.90, respectively) compared with non-SSRI users (<28 cDDD). The sensitivity analysis showed that the SSRI presented with a dose-response protective effect for HCC in the multivariate analysis. Conclusion: SSRIs use may possibly reduce the risk of HCC in HBV-infected patients in a dose-responsive manner.

15.
J Cardiothorac Surg ; 12(1): 109, 2017 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-29197388

RESUMO

BACKGROUND: Mycotic aortic aneurysm (MAA) is a rare clinical entity with an incidence of 1-3%, but it is a life-threatening infection of aorta characterized by dilatation of aorta with false lumen. Multiple MAAs have been reported rarely with an incidence of 0.03% and associated with a high mortality rate of 80% if ruptured. CASE PRESENTATION: A hypertensive and diabetic 78-year-old man visited our emergency department complaining intermittent dull and tingled pain over the left flank region for 1 week. Chest X-ray showed left pleural effusion and hemothorax was confirmed by thoracocentesis. Computed tomography (CT) of chest demonstrated multiple thoracic aortic aneurysms and the pathological findings disclosed the diagnosis of multiple MAAs. He was discharged under an uneventful condition post-surgical aortic repair with adequate intravenous antibiotics for 4 weeks. CONCLUSIONS: CT scan may make a definite diagnosis of multiple MAAs and management with surgical debridement, aortic repair and full-course antibiotics for Gram-positive coccus and/or Gram-negative bacillus is recommended.


Assuntos
Aneurisma Infectado/complicações , Aneurisma da Aorta Torácica/complicações , Ruptura Aórtica/complicações , Hemotórax/etiologia , Micoses/complicações , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/cirurgia , Hemotórax/diagnóstico , Humanos , Masculino , Micoses/diagnóstico , Micoses/terapia , Tomografia Computadorizada por Raios X
16.
Asian Pac J Trop Med ; 10(1): 102-105, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28107857

RESUMO

Prostatic abscess is a rare entity with an incidence of 0.5%-2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status. Prostatic abscess might be a process of evolution from acute prostatitis. Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan. A 60-year-old diabetic man, with a one-week history of acute bacterial prostatitis was reported in this study, presenting to the emergency department with sudden altered mental status. The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses. Analysis of cerebrospinal fluid showed white blood cells of 10771 counts/mm3 with segmented neutrophils of 99%. Cultures of blood, cerebrospinal fluid and sputum yielded Klebsiella pneumoniae. We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.

17.
Artigo em Inglês | MEDLINE | ID: mdl-27803727

RESUMO

Objectives. To evaluate the effectiveness of acupressure on the Taichong acupoint in lowering systolic and diastolic blood pressure (BP) in hypertensive patients. Methods. Eighty patients with hypertension attending a cardiology outpatient department in central Taiwan were included in this randomized clinical trial. Acupressure was applied to the Taichong acupoint in the experimental group (n = 40) and to the first metatarsal (sham acupoint) in the control group (n = 40). Blood pressure was measured by electronic monitoring before and immediately 15 min and 30 min after acupressure. Results. The average age of the experimental and control participants was 59.3 ± 9.2 years and 62.7 ± 8.4 years, respectively. The two groups were similar for demographics and antihypertensive drug use. Mean systolic and diastolic BP in the experimental group decreased at 0, 15, and 30 min after acupressure (165.0/96.3, 150.4/92.7, 145.7/90.8, and 142.9/88.6 mmHg); no significant changes occurred in the control group. There was a significant difference in systolic and diastolic BP between the experimental and control groups immediately and 15 and 30 min after acupressure (p < 0.05). Conclusion. Acupressure on the Taichong acupoint can lower BP in hypertensive patients and may be included in the nursing care plan for hypertension. However, additional studies are needed to determine the optimal dosage, frequency, and long-term effects of this therapy.

20.
BMJ Open ; 6(8): e012233, 2016 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-27554106

RESUMO

OBJECTIVE: Hyperglycaemic crisis was associated with significant intrahospital morbidity and mortality. However, the association between hyperglycaemic crisis and long-term cardiovascular outcomes remained unknown. This study aimed to investigate the association between hyperglycaemic crisis and subsequent long-term major adverse cardiovascular events (MACEs). PARTICIPANTS AND METHODS: This population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database for the period of 1996-2012. A total of 2171 diabetic patients with hyperglycaemic crisis fit the inclusion criteria. Propensity score matching was used to match the baseline characteristics of the study cohort to construct a comparison cohort which comprised 8684 diabetic patients without hyperglycaemic crisis. The risk of long-term MACEs was compared between the two cohorts. RESULTS: Six hundred and seventy-six MACEs occurred in the study cohort and the event rate was higher than that in the comparison cohort (31.1% vs 24.1%, p<0.001). Patients with hyperglycaemic crisis were associated with a higher risk of long-term MACEs even after adjusting for all baseline characteristics and medications (adjusted HR=1.76, 95% CI 1.62 to 1.92, p<0.001). Acute myocardial infarction had the highest adjusted HR (adjusted HR=2.19, 95% CI 1.75 to 2.75, p<0.001) in the four types of MACEs, followed by congestive heart failure (adjusted HR=1.97, 95% CI 1.70 to 2.28, p<0.001). Younger patients with hyperglycaemic crisis had a higher risk of MACEs than older patients (adjusted HR=2.69 for patients aged 20-39 years vs adjusted HR=1.58 for patients aged >65 years). CONCLUSIONS: Hyperglycaemic crisis was significantly associated with long-term MACEs, especially in the young population. Further prospective longitudinal study should be conducted for validation.


Assuntos
Doenças Cardiovasculares/epidemiologia , Hiperglicemia/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Hiperglicemia/mortalidade , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Fatores de Risco , Adulto Jovem
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