Ci ji yi xue za zhi = Tzu-chi medical journal最新文献

Objective: The prevalence of anemia during pregnancy is as high as 80% in some sections of the Indian population. Iron therapy in different forms has been found to alleviate anemia and yield good fetomaternal outcome. This study aims to evaluate the efficacy of intravenous iron sucrose (IVIS) versus oral iron in treating anemia among the antenatal mothers attending a tertiary care center of Northeast India.

Materials and methods: One hundred women between 18 and 28 weeks of gestation with diagnosed iron-deficiency anemia and hemoglobin (Hb) of 7-10.9 g/dL were enrolled to be administered either oral ferrous sulfate 200 mg twice daily or requisite dose of IVIS 100 mg in 100 ml normal saline on alternate days. Hb and hematocrit were measured at the time of enrollment, 4^th week, and 8^th week of therapy. Acceptability of both the drugs based on like and dislike after interviewing the study participants was recorded. Adverse drug reactions, gestational age at delivery, and neonatal birth weight were also noted in both the groups. The results were analyzed by Student's t-test and Chi-square test.

Results: Hb and hematocrit values were found to be increased in both the groups at 4^th and 8^th weeks. When both the groups were compared, the rise in the values was higher in the iron sucrose group (at 4^th week P = 0.01 and at 8^th week P = 0.00). The number of participants who reached target Hb levels at 4 weeks was 41 (82%) with oral iron and 48 (96%) with iron sucrose. In the iron sucrose group, no adverse effects were observed, suggesting its safety, and the acceptability and newborn birth weight were noted to be higher.

Conclusion: IVIS was found to be more effective than oral iron therapy in treating antenatal anemia with no serious adverse drug reactions.

Objective: Previous Western studies reported that older (≥50 years) breast cancer survivors with tamoxifen treatment had higher risk of endometrial cancer. This study aims to disclose whether younger (<50 years) tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and to examine whether sequenced aromatase inhibitor (AI) use could reduce the risk.

Materials and methods: A population-based cohort of 39,216 newly diagnosed breast cancer patients was identified from Taiwan National Health Insurance Database from 1999 to 2012. The risk of endometrial cancer in nonusers (n = 14,588), tamoxifen-only (n = 19,302), and sequenced AI (n = 5326) users was compared with Cox regression analysis and was adjusted with age, diabetes, hypertension, and chemotherapy.

Results: During the 14-year study period, 133 patients were diagnosed with subsequent endometrial cancers. Compared with nonusers, tamoxifen-only users had higher risk of endometrial cancer (14-year incidence 1.7% vs. 0.3%; adjusted hazard ratio [HR] 3.90; 95% confidence interval [CI], 2.37-6.42). This was observed in both older (≥50 years) and younger (40-50 years) age groups. Adjusted HR (95% CI) for the latter was 3.74 (1.65-8.48). This risk persisted after cessation of tamoxifen use. The risk of endometrial cancer was lower in sequenced AI when compared with tamoxifen-only users (adjusted HR 0.43; 95% CI, 0.25-0.72).

Conclusions: Not only patients ≥50 years but also younger (40-49 years) patients with tamoxifen treatment had higher risk of subsequent endometrial cancer in this nation-wide cohort. We suggest regular gynecologic monitoring not only during active use but also during follow-up phase. Sequenced AI use may reduce the risk of endometrial cancer in tamoxifen-treated breast cancer patients.

Objective: The incidence of gastroesophageal reflux disease (GERD) is increasing, and the disease has a close association with dietary habits. This study aims to investigate the role of tea and coffee drinking in the development of GERD.

Materials and methods: This study prospectively enrolled individuals who underwent an upper gastrointestinal endoscopy during a health checkup. Each participant completed the reflux disease questionnaire (RDQ). Coffee or tea drinking was defined as drinking the beverage at least 4 days/week for 3 months. Heavy coffee or tea consumption was defined as drinking at least two cups every day.

Results: A total of 1837 participants (970 men; age 51.57 ± 10.21 years), who had data on clinical characteristics and consumption of coffee and tea with or without additives such as milk or sugar were included for final analysis. Among them, 467 (25.4%) were diagnosed as having symptomatic GERD based on the RDQ score, and 427 (23.2%) had erosive esophagitis (EE) on endoscopy. Drinking coffee or tea was not associated with reflux symptoms or EE in univariate and multivariate analyses. In contrast, drinking coffee with milk was associated with reflux symptoms and drinking "tea and coffee" was associated with EE in univariate analysis. However, these associations became insignificant after multivariate analysis.

Conclusion: Drinking coffee or tea and adding milk or sugar was not associated with reflux symptoms or EE.

Objective: Improving clinical teachers' ability to teach interprofessional collaborative practice warrants development in current faculty training programs; in particular, current education training emphasizes experiential learning and multiple teaching strategies. The purpose of this study was to establish a teaching model to apply interdisciplinary collaborative care and to improve clinical teachers' execution of interprofessional practices.

Materials and methods: Health-care faculty members were studied; this study assessed a teacher education curriculum for interprofessional education (IPE) and applied an objective structured teaching exercise (OSTE) to evaluate IPE execution by clinical teachers.

Results: The OSTE improved clinical teachers' IPE execution, verifying the necessity for multistrategy teaching in faculty training programs.

Conclusions: This study provides different types of interprofessional faculty training and assessments. Development of an OSTE requires long-term planning, and IPE should also be incorporated into formal programs.

Objectives: The objectives of this study are to explore medical care utilization associated with promoting the central venous catheter (CVC) care bundle plan using Taiwan's National Health Insurance Research Database (NHIRD).

Materials and methods: We performed a cross-sectional, secondary analysis of the data from patients who were admitted to a medical center for the first time between July 1, 2010, and June 30, 2012, in the NHIRD. The control group was patients who were admitted at nine medical center hospitals that participated in the pilot plan, and the study group was patients who were admitted at other ten medical center hospitals that did not participate in the pilot plan, and the differences between groups were analyzed.

Results: After implementing the CVC care bundle, the average hospital stay decreased significantly (18.43 ± 12.96 vs. 15.49 ± 10.16, P < 0.05). In addition, the study group patients were clinically less likely to require antibiotics than the control group (odds ratio = 0.33, 95% confidence interval [CI] = [0.07, 1.71] vs. 0.62, 95% CI = [0.40, 0.96], P = 3768), and their medical expenses were lower (220, 618 ± 226, 419 vs. 208, 079 ± 193, 610, P > 05). Furthermore, the incidence rate of CVC-associated sepsis decreased from 12.59% to 5.66%.

Conclusions: By implementing the CVC care bundle in clinical practice in accordance with national policies, medical utilization decreased, thereby considerably improving medical resource usage. These results confirmed that implementing the CVC care bundle possibly decreased medical utilization in clinical practice.

The bladder urothelium plays an important role of barrier function to prevent influx of urinary toxic substance and bacteria. When there is insult to the urinary bladder, the urothelium will start to regenerate on injury. However, several factors might affect the regenerative function of bladder urothelium, including aging, chronic inflammation, and system diseases such as diabetes and chronic kidney diseases (CKDs). Impairment of bladder mucosal regenerative function might result in defective urothelial cell differentiation as well as barrier function, which might be the underlying pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) and recurrent bacterial cystitis. Our previous immunohistochemistry (IHC) study and electron microscopic study revealed that the loss of normal umbrella cells and defective junction proteins in IC/BPS and recurrent cystitis. Platelet-rich plasma (PRP) has been previously used in many medical aspects as regenerative medicine therapy. PRP is rich in many growth factors and cytokines which modulate the process of inflammation and regeneration in the wound healing process. Recent pilot studies have shown that intravesical PRP injections improve IC symptoms and yield a success rate of 70% at 3 months after treatment. The results highly suggest that PRP injection could improve urothelial regenerative function and reduce chronic inflammation in IC patients. This article reviews recently published researches on the urothelial dysfunction biomarkers, urothelial cell differentiation, and urinary regenerative and inflammatory proteins in patients with IC/BPS or recurrent bacterial cystitis. The pathophysiology of the insufficient urothelial regeneration and differentiation; and chronic inflammation may induce urothelial dysfunction and further affect the regenerative ability of the diseased bladder urothelium in IC/BPS and recurrent bacterial cystitis are discussed.

In the era of enhanced recovery after surgery, clinicians are encouraged to develop optimized programs for patients who require surgery. Minimal intervention with laparoscopic surgery and multimodal pain management mostly with peripheral nerve block are key components. We are developing a departmental program for enhanced recovery after surgery for single-port laparoscopic surgery. We applied an erector spinae plane block, a novel, newly recognized block, bilaterally at the T10 transverse process with a small dose (10 mL) of local anesthetic. This method was effective and safe and resulted in successful analgesia in a patient who received single-port surgery. This surgery requires a 3-5 cm horizontal or longitudinal periumbilical incision, which was performed in this case, and our results were promising and encouraging.

Objective: Active management of the third stage of labor (AMTSL) is a critical intervention for the prevention of postpartum hemorrhage (PPH), which is still the most common cause of maternal morbidity and mortality worldwide. The objective of the study is to compare the effect of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in the AMTSL in terms of amount of blood loss and duration of the third stage of labor, cost-effectiveness, and side effect profile.

Materials and methods: Seventy-five pregnant patients admitted in the maternity ward for vaginal delivery from February 2017 to February 2018 received either intramuscular methylergometrine (0.2 mg) or rectal misoprostol (400 mcg) or low-dose intravenous oxytocin (5 units oxytocin in 100 mL normal saline) for AMTSL. Data were recorded in three groups: Group A (methylergometrine), Group B (misoprostol), and Group C (oxytocin) consisting of 25 cases each.

Results: Mean blood loss was found to be least in methylergometrine group (246.87 ± 65.44 mL) as compared to misoprostol (346.13 ± 58.35 mL) and oxytocin (334.5 ± 69.20 mL) (P = 0.000) Mean duration of the third stage of labor was also least in methylergometrine group (6.21 ± 1.58 min) (P = 0.0008).

Conclusion: Although methylergometrine was found to have higher incidence of side effects such as nausea, vomiting, headache, and raised blood pressure, it was found to be the most effective drug for minimizing blood loss in the third stage of labor. In remote places where healthcare facilities are limited and drugs cannot be administered by parenteral route, rectal misoprostol remains an alternative.

Patients with cancer-associated ischemic stroke pose similar clinical manifestations and image characteristics, mainly embolic infarction, as patients with atrial fibrillation do. D-dimer, a degraded product of fibrin polymer, is a useful indicator of hypercoagulability, which frequently increases in cancer-associated stroke, but not in stroke resulted from atrial fibrillation. The level of serum D-dimer is associated with mortality, prognosis, and recurrence of systemic thromboembolism in these patients. Theoretically, drugs block coagulation cascade, such as heparin and low-molecular-weight-heparin (LMWH), oral direct anticoagulants, could attenuate the status of hypercoagulation and decrease the amount of D-dimer. These drugs may be helpful to prevent thromboembolic events in patients with cancer-associated hypercoagulability. Vitamin K antagonist, warfarin, decreases the production of coagulation factors, but not interrupts coagulation cascade may not be helpful to decrease hypercoagulability, but increase the risk of bleeding. However, the treatment of cancer-associated embolic stroke is still controversial. This article reviews relevant clinical studies and proposes the applicability of direct oral anticoagulants from the pathophysiological mechanism.

Objective: Despite the known association of perioperative stroke with perioperative mortality, the prevalence of stroke following neck dissection in elderly patients remains unclear. This study compared the incidence of neck dissection-associated perioperative stroke in elderly and younger patients.

Materials and methods: Totally, 1057 patients receiving neck dissection for head and neck cancers between June 2012 and July 2016 were reviewed at a single center. The patients were divided into elderly (age ≥65 years, n = 177) and younger (age <65 years, n = 880) groups (mean age: 72.3 ± 6.1 and 53.3 ± 7.6, respectively). Patient, anthropometric, and clinical characteristics including diagnoses, comorbidities, length of hospitalization, and incidence of perioperative stroke were compared.

Results: Younger patients were more likely to be male (P = 0.001) and to have received radiotherapy (P = 0.013). The prevalence of predisposing factors was higher in the elderly, including history of cerebral vascular accident (P = 0.002), hypertension (P < 0.001), diabetes (P < 0.001), and coronary artery disease (P < 0.001). Elderly patients also had longer hospitalizations (P < 0.001) for which previous radiotherapy was identified as a risk factor (adjusted odds ratio = 3.79, P = 0.0078). Postoperative ischemic stroke was diagnosed in two elderly patients (1.1%), whereas no ischemic strokes occurred in the younger group (P = 0.028). The overall incidence of perioperative stroke was 0.19%.

Conclusion: The incidence of perioperative stroke was higher in the elderly than in the younger group. Furthermore, the prevalence of ischemic stroke in elderly patients associated with neck dissection was higher than that previously reported in the aged population after general head and neck operations, highlighting an increased risk of stroke in elderly patients receiving extensive neck surgery.