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Ma-kung, Taiwan

Liaw J.-J.,National Defense Medical Center | Zeng W.-P.,Tri Service General Hospital | Yang L.,Hsuan Chuang University | Yuh Y.-S.,National Defense Medical Center | And 3 more authors.
Journal of Pain and Symptom Management | Year: 2011

Context: Newborns are subject to pain during routine invasive procedures. Pain caused by immunization injections is preventable, but remains untreated in neonates. Objectives: The purpose of the study was to compare the effectiveness of three nonpharmacological pain relief strategies on newborns' pain, physiological parameters, and cry duration before, during, and after hepatitis B intramuscular (IM) injection. Methods: In this prospective, randomized clinical trial, we enrolled 165 newborns (gestational age, ≥36 weeks). The infants received IM injections and were randomized to three treatment groups: nonnutritive sucking (NNS), 20% oral sucrose, or routine care. Pain was measured by the Neonatal Facial Coding System, physiological signals by electrocardiogram monitors, and cry duration using a stopwatch. Results: Pain was significantly lower among infants in the NNS (B = -11.27, P < 0.001) and sucrose (B = -11.75, P < 0.001) groups than that in controls after adjusting for time effects, infant sleep/wake state, number of prior painful experiences, and baseline pain scores. Infants in the NNS and sucrose groups also had significantly lower mean heart and respiratory rates than the controls. Cry duration of infants receiving sucrose was significantly shorter than those in the NNS (Z = -3.36, P < 0.001) and control groups (Z = -7.80, P < 0.001). Conclusion: NNS and oral sucrose can provide analgesic effects and need to be given before painful procedures as brief as a one-minute IM injection. Sucrose orally administered two minutes before injection more effectively reduced newborns' pain during injection than NNS. Both nonpharmacological methods more effectively relieved newborns' pain, stabilized physiological parameters, and shortened cry duration during IM hepatitis injection than routine care. © 2011 U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All rights reserved. Source

Ng Y.Y.,Taipei Veterans General Hospital | Wu S.C.,Taipei Veterans General Hospital | Lin H.D.,Taipei Veterans General Hospital | Hu F.H.,Wei Gong Memorial Hospital | And 6 more authors.
Peritoneal Dialysis International | Year: 2012

Aims: We investigated dialysis duration, dose of erythropoietin (EPO), and clinical manifestations in peritoneal dialysis (PD) patients with subclinical hypothyroidism. Methods: This cross-sectional study, performed in 3 centers, assessed 122 adult patients on PD for more than 6 months with regard to demographic data, dialysis duration, thyroid function, biochemical data, EPO dose, and clinical manifestations. Thyroid dysfunction was determined by serum thyroid-stimulating hormone, free thyroxine, total thyroxine, total triiodothyronine, antithyroid peroxidase antibodies, and auto-antibodies against thyroglobulin. Results: Of the 122 study patients, 98 (80.3%) were assessed as having euthyroidism; 19 (15.6%), subclinical hypothyroidism; and 5 (4.1%), subclinical hyperthyroidism. The proportion of women (74.2% vs. 57.1%, p = 0.038), the mean duration of PD (58.1 months vs. 37.9 months, p = 0.032), and the weighted mean monthly EPO dose (1.22 μg/kg vs. 1.64 μg/kg, p = 0.009) were significantly higher in the subclinical hypothyroidism group than in the euthyroidism group, but the prevalences of coronary artery disease and cerebrovascular disease were not. From the multivariate model, PD duration was more significant than sex as a risk factor for subclinical hypothyroidism (p = 0.0132). Conclusions: Subclinical hypothyroidism is frequent in PD patients, especially female patients and patients with a longer PD duration. Compared with euthyroid patients, patients with subclinical hyperthyroidism need a higher dose of EPO to maintain a stable hemoglobin level. © 2012 International Society for Peritoneal Dialysis. Source

Hung S.-C.,Tzu Chi University | Kuo K.-L.,Tzu Chi University | Tarng D.-C.,National Yang Ming University | Tarng D.-C.,Taipei Veterans General Hospital | And 3 more authors.
Nephrology | Year: 2014

The introduction of erythropoiesis-stimulating agents (ESAs) markedly improved the lives of many anaemic patients with chronic kidney disease (CKD). In Taiwan, the strategy of management of anaemia in patients with CKD was different from many other parts of the world. In 1996, the National Health Insurance Administration of Taiwan applied a more restrictive reimbursement criteria for ESA use in patients with CKD. ESA is to be initiated when non-dialysis CKD patients have a serum creatinine >6 mg/dL and a hematocrit <28% to maintain a hematocrit level not exceeding 30%. The maximal dose of epoetin-α or β was 20 000 U per month. The target haemoglobin range and dose limitation for ESAs were the same for dialysis CKD patients. Thus, long before randomized controlled trials showing an increased risk for cardiovascular events at nearly normal haemoglobin concentrations and higher ESA doses in CKD, nephrologists in Taiwan had avoided the use of disproportionately high dosages of ESAs to achieve a haemoglobin level of 10-11 g/dL. Moreover, intravenous iron supplementation was encouraged earlier in Taiwan in 1996, when we reached consensus on the diagnostic criteria for iron deficiency (serum ferritin <300 ng/mL and/or transferrin saturation <30%). The experience of CKD anaemia management in Taiwan demonstrated that a reasonable haemoglobin target can be achieved by using the lowest possible ESA dose and intravenous iron supplementation. © 2014 Asian Pacific Society of Nephrology. Source

Tang M.-B.,Wei Gong Memorial Hospital | Yu C.-P.,Tatung University | Chen S.-C.,Tatung University | Chen C.-H.,Tatung University
Southeast Asian Journal of Tropical Medicine and Public Health | Year: 2014

Up to now, there has been no report of co-infection of torque teno virus (TTV) with other enteric viruses playing a role in the pathogenesis of viral acute gastroenteritis (AGE). We investigated the proportion, epidemiological and clinical features of concurrent infections of adenovirus (ADV), norovirus (NV) and TTV in stools of 155 patients with AGE attending Wei-Gong Memorial Hospital, Miaoli City, Taiwan. The presence of the three viruses were determined using PCR-based assays. Some 55% of the patients were infected with at least 1 enteric virus, among whom 18% were co-infected, NV and TTV being the most common (62%). Rate of co-infectious in AGE patients is correlated statistically significantly (p < 0.05) with age, fever and drinking of spring water. Furthermore, AGE children with co-infection have a higher hospitalization rate (69%). To the best of our knowledge, this is the first report of ADV, NV and TTV triple co-infection in children (2) with AGE. This study also revealed that TTV co-infection promoted the pathogenicity of other infectious agents. © SEAMEO TROPMED Network. All Rights Reserved. Source

Tang M.-B.,Wei Gong Memorial Hospital | Chen C.-H.,Tatung University | Chen S.-C.,Tatung University | Chou Y.-C.,National Defense Medical Center | Yu C.-P.,Tatung University
BMC Infectious Diseases | Year: 2013

Background: The human norovirus (NV) circulates worldwide and is a major cause of epidemics, which have increased in Taiwan since 2002. NV in acute gastroenteritis (AGE) and non-acute gastroenteritis (asymptomatic) patients, including children and adults, have not been previously examined in Taiwan; therefore, we examined the epidemiology and phylogeny of NV in AGE and asymptomatic patients of all ages.Methods: 253 stool samples were collected from August 2011 to July 2012 (including 155 AGE and 98 asymptomatic samples in Taiwan) and analyzed using reverse transcription-polymerase chain reaction (RT-PCR) for NV. Primers targeting the RNA-polymerase gene were used for RT-PCR to allow DNA sequencing of Taiwan NV strains and phylogenetic analyses.Results: NV was detected in 24 (9.5%) of 253 stool specimens using RT-PCR. NV was isolated from all age groups (1 to 86 y) and those NV-positive samples were major identified from inpatients (79.2%, 19/24). Statistical analysis showed that the NV infectious rate of AGE patients was statistically significant (P < 0.05) for age, season and water type, respectively. Phylogenetic analyses of the RdRp region sequence showed that 24 NV isolates belonged to Genogroup II Genotype 4 (GII.4). They were closely related to the epidemic strain in Taiwan in 2006, the GII.4-2006b pandemic strain in 2006, and the GII.4-New Orleans strain in 2010.Conclusion: This study is the first to examine NV in sporadic AGE and asymptomatic patients in Taiwan. Furthermore, epidemic strains of isolated GII.4 were predominant in Taiwan during 2011 and 2012. © 2013 Tang et al.; licensee BioMed Central Ltd. Source

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