Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Burkholderia pseudomallei ; drug effects ; isolation & purification ; Ceftazidime ; pharmacology ; therapeutic use ; Comorbidity ; Drug Resistance, Bacterial ; Humans ; Lymphadenitis ; physiopathology ; Male ; Mediastinal Diseases ; physiopathology ; Melioidosis ; etiology ; physiopathology ; Middle Aged

The hemorrhage in hemorrhagic fever with renal syndrome (HFRS) varies from transient petechial lesions to fulminant and massive bleeding. Also in vital organ such as lung, kidney, spleen, brain and pituitary, hemorrhage occasionally occurs spontaneously or by minor trauma. We report a case of retroperitoneal hematoma by spontaneous rupture of renal capsule in HFRS presented with anuria and right flank pain. A 34-year-old male was admitted to our hospital presenting anuria and right flank pain for 3 days. He also had suffered from fever and myalgia since 5 days ago. Sonography and computed tomography were performed at the day of hospitalization and showed massive perirenal hematoma with ruptured renal capsule and spurtting subcapsular renal artery on the right kidney. He was diagnosed as HFRS and treated with hemodialysis, fluid infusion and transfusion. After conservative treatment, he recovered from HFRS without further blood loss.
Adult ; Anuria* ; Brain ; Fever ; Flank Pain* ; Hematoma* ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome* ; Hospitalization ; Humans ; Kidney ; Lung ; Male ; Myalgia ; Renal Artery ; Renal Dialysis ; Rupture ; Rupture, Spontaneous* ; Spleen

No abstract available.
Head and Neck Neoplasms* ; Head* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Ischemic Attack, Transient* ; Radiotherapy* ; Stroke*

The impact the metabolic syndrome (MetS) components on the severity of insulin resistance (IR) has not been reported. We enrolled 564 subjects with MetS and they were divided into quartiles according to the level of each component; and an insulin suppression test was performed to measure IR. In males, steady state plasma glucose (SSPG) levels in the highest quartiles, corresponding to body mass index (BMI) and fasting plasma glucose (FPG), were higher than the other three quartiles and the highest quartiles, corresponding to the diastolic blood pressure and triglycerides, were higher than in the lowest two quartiles. In females, SSPG levels in the highest quartiles, corresponding to the BMI and triglycerides, were higher than in all other quartiles. No significant differences existed between genders, other than the mean SSPG levels in males were greater in the highest quartile corresponding to BMI than that in the highest quartile corresponding to HDL-cholesterol levels. The factor analysis identified two underlying factors (IR and blood pressure factors) among the MetS variables. The clustering of the SSPG, BMI, triglyceride and HDLcholesterol was noted. Our data suggest that adiposity, higher FPG and triglyceride levels have stronger correlation with IR and subjects with the highest BMI have the highest IR.
Waist-Hip Ratio ; Triglycerides/blood ; Middle Aged ; Metabolic Syndrome X/*metabolism ; Male ; *Insulin Resistance ; Humans ; Female ; Fasting/blood ; Cholesterol, HDL/blood ; Body Mass Index ; Blood Glucose/analysis ; Aged ; Adult

Background/Aims:  Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate in hepatitis B surface antigen (HBsAg)-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort. Methods:  From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcome and factors associated with HBVr were analyzed. Results: After a median follow-up period of 3.3 years, 21 patients developed HBVr, among whom 17 patients were positive for hepatitis B core antibody (anti-HBc) and four were negative. Thirteen patients had clinical hepatitis flare, while eight patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, undetectable serum hepatitis B surface antibody level at rituximab initiation and a higher average rituximab dose were associated with a higher HBVr rate. There was no significant difference in the HBVr risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBVr (4/368, 1.1%) compared with those who received vaccination (0/126, 0%). Conclusions In HBV endemic areas where occult HBV is prevalent, anti-HBc-negative patients, may still be at risk for HBVr after rituximab exposure. HBVr may still be considered in HBsAgnegative patients developing abnormal liver function after rituximab exposure, even in patients with negative anti-HBc.

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection which usually develops in immunosuppressant patients, especially in patients with AIDS, organ transplantation, diabetic mellitus, administration of steroid, chronic illness, severe malnutrition. It is classified into four groups as clinical forms and one of its, gastrointestinal type is an unusual form, believed that infection of the gastrointestinal tract is acquired through ingestion of the ubiquitous fungal spores, the stomach being the most frequently involved site. Especially, gastric mucormycosis, vascular invasive type is frequently fatal. Recently we experienced a case of gastric mucormycosis, vascular invasive type found in a 74-year old male undergoing hemodialysis for chronic renal failure and he was in severe malnutrition. In the course of the admission, unexpectedly, hematemesis was developed. Upper gastrointestinal fiberoscopy was done and we found a ulcerative lesion, geographic in body of stomach and on histologic examination, characteristic findings of nonseptate hyphae with right angle branchings was observed in the ulcer debris with vessel invasion. The patient was treated with systemic antifungal agent, amphotericin B but expired due to massive hematemesis.
Aged ; Amphotericin B ; Chronic Disease ; Eating ; Gastrointestinal Tract ; Hematemesis ; Humans ; Hyphae ; Kidney Failure, Chronic ; Male ; Malnutrition* ; Mucormycosis* ; Organ Transplantation ; Renal Dialysis* ; Spores, Fungal ; Stomach ; Transplants ; Ulcer

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection which usually develops in immunosuppressant patients, especially in patients with AIDS, organ transplantation, diabetic mellitus, administration of steroid, chronic illness, severe malnutrition. It is classified into four groups as clinical forms and one of its, gastrointestinal type is an unusual form, believed that infection of the gastrointestinal tract is acquired through ingestion of the ubiquitous fungal spores, the stomach being the most frequently involved site. Especially, gastric mucormycosis, vascular invasive type is frequently fatal. Recently we experienced a case of gastric mucormycosis, vascular invasive type found in a 74-year old male undergoing hemodialysis for chronic renal failure and he was in severe malnutrition. In the course of the admission, unexpectedly, hematemesis was developed. Upper gastrointestinal fiberoscopy was done and we found a ulcerative lesion, geographic in body of stomach and on histologic examination, characteristic findings of nonseptate hyphae with right angle branchings was observed in the ulcer debris with vessel invasion. The patient was treated with systemic antifungal agent, amphotericin B but expired due to massive hematemesis.
Aged ; Amphotericin B ; Chronic Disease ; Eating ; Gastrointestinal Tract ; Hematemesis ; Humans ; Hyphae ; Kidney Failure, Chronic ; Male ; Malnutrition* ; Mucormycosis* ; Organ Transplantation ; Renal Dialysis* ; Spores, Fungal ; Stomach ; Transplants ; Ulcer

Background: and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking. Methods: This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance. Results: Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal. Conclusions The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.

Background: and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking. Methods: This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance. Results: Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal. Conclusions The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.

Background: and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking. Methods: This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance. Results: Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal. Conclusions The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.