Browsing by Author "Chen, Tun-Chieh"

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Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity
(2019-02-01)
Chang, Ko
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Lee, Nan-Yao
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Ko, Wen-Chien
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Lin, Wei-Ru
;
Chen, Yen-Hsu
Background/purpose: The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear. Methods: We conducted a retrospective study to identify the characteristics of the elderly aged >= 65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011. Results: Among 441 cases, including 187 cases of scrub typhus, 166 acute Qfever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99). Conclusion: The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications. Copyright (C) 2017, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.
Differences in Mortality and Clinical Manifestations of Dengue Hemorrhagic Fever in Taiwan in Different Years: A Comparison for Cases in 2014 and 2015 Epidemics
(2017-01-01)
Chang, Ko
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Huang, Chung-Hao
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Lee, Ing-Kit
;
Lu, Po-Liang
;
Lin, Chun-Yu
People in southern Taiwan experienced two major dengue outbreaks in 2014 and 2015. The mortality and clinical features were very different between these 2 years. Dengue virus serotype 1 (DENV-1) caused epidemic outbreak in 2014 and DENV-2 was predominant in 2015. The characteristics of dengue hemorrhagic fever (DHF) cases in the 2 years was analyzed. We conducted a retrospective chart review to analyze the clinical and laboratory features of 206 adult patients with DHF in southern Taiwan in 2014 and 2015. The mortality rate of DHF cases in 2015 was higher than that of cases in 2014 (38.7% versus 12.4%, P < 0.0001). Compared with cases in 2014, DHF cases in 2015 had more complications, such as gastrointestinal bleeding (78.5% versus 61.9%, P = 0.01), severe hepatitis (30.1% versus 8%, P < 0.0001), and myocarditis (14% versus 0.9%, P < 0.0001). Among the mortality cases, diabetes, chronic renal failure, proton-pump inhibitors using, platelet transfusion, and Charlson comorbidity index score (Charlson score) were also higher in 2015. Multivariate analysis for the mortality cases revealed that the risk factors were Charlson score (3) 5 (P = 0.02, odds ratio [OR] = 4.07, 95% confidence interval [CI] = 1.244-13.307), severe hepatitis (P < 0.0001, OR = 11.97, 95% CI = 3.831-37.396), and acute renal failure (P < 0.0001, OR = 98.76, 95% CI = 10.847-899.22). DHF cases in 2015 had higher mortality and more complications, such as gastrointestinal bleeding, severe hepatitis, and myocarditis, than in 2014 in southern Taiwan. In the 2-year DHF case series, Charlson score >= 5, severe hepatitis, and acute renal failure were independent significant variables for mortality.
How to prevent outbreak of a hospital-affiliated dementia day-care facility in the pandemic COVID-19 infection in Taiwan
(2020-06-01)
Huang, Hsuan-Ti
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Chen, Tun-Chieh
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Liu, Tzu-Yin
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Chiu, Chun-Feng
;
Hsieh, Wen-Chien
Incidence rates of tuberculosis in chronic hepatitis C infected patients with or without interferon based therapy: a population-based cohort study in Taiwan
(2014-12-19)
Lin, Shang-Yi
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Chen, Tun-Chieh
;
Lu, Po-Liang
;
Lin, Chun-Yu
;
Lin, Wei-Ru
Background: It is debated whether interferon-based therapy (IBT) would affect the incidence of active tuberculosis (TB) among hepatitis C virus (HCV) infected patients. Although some case reports have demonstrated a possible association, the results are currently inconclusive. Therefore, we conducted a nation-wide population study to investigate the incidence of active TB in HCV infected patients receiving IBT in Taiwan. Methods: This 9-year cohort study was based on the Longitudinal Health Insurance Database 2000 (LHID 2000) consisting of 1,000,000 beneficiaries randomly selected from all Taiwan National Health Insurance enrollees in 2000 (>23.7 million). This insurance program covers all citizens in Taiwan. We conducted a retrospective cohort study that identified subjects with HCV infection. IBTs were defined as regimens that included interferon alpha, peginterferon alpha 2a and peginterferon alpha 2b for at least 2 months. Among them, 621 subjects received IBT, and 2,460 age-and gender-matched subjects were enrolled for analysis. The Cox proportional hazards models were used to estimate the hazard ratio (HR) for active TB, and associated confidence intervals (CIs), comparing IBT cohort and untreated cohort. The endpoint in this study was whether an enrolled subject had a new diagnosis of active TB. Results: During the 9-year enrollment period, the treated and untreated cohorts were followed for a mean (+/- SD) duration of 6.97 +/- 0.02 years and 8.21 +/- 0.01 years, respectively. The cumulative incidence rate of active TB during this study period was 0.150 and 0.151 per 100 person-years in the IBT treated and untreated cohorts, respectively. There was no significant difference in the incidence of active TB in either cohort during a 1-year follow-up (Adjusted Hazard Ratio (AHR): 2.81, 95% Confidence Interval (95% CI): 0.61 - 12.98) or the long-term follow-up (AHR: 1.02, 95% CI: 0.28 - 3.78). The Cox proportional hazards model demonstrated that IBT was not a risk factor for active TB. The only risk factor for active TB was the occurrence of hepatic encephalopathy. Conclusion: Our results showed that IBT is associated with increased hazard of active TB in HCV infected patients in 1-year follow-up; however, the effect sizes were not statistically significant.
Metformin is associated with a lower risk of active tuberculosis in patients with type 2 diabetes
(2018-11-01)
Lin, Shang-Yi
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Tu, Hung-Pin
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Lu, Po-Liang
;
Chen, Tun-Chieh
;
Wang, Wen-Hung
Background and objective Metformin is an oral anti-diabetic therapy (ADT) to manage type 2 diabetes mellitus (T2DM), and has been reported to have potential anti-tuberculosis (TB) effects. This study investigates the risk of active TB among persons with T2DM who were treated with various ADT and insulin therapies. MethodsResultsWe conducted a nationwide population-based cohort study using the Taiwan Longitudinal Health Insurance Database, including 49028 T2DM patients who were metformin users (n=44002) or non-users (n=5026). A total of 5026 propensity score-matched pairs of metformin users and non-users with T2DM were evaluated from 1998 to 2010. The data were analysed using Cox proportional hazard models. Patients with T2DM had a significantly higher rate of incident TB than did the control subjects (adjusted hazard ratio: 2.01; 95% confidence interval (95% CI): 1.80-2.25). After adjusting for comorbidities, diabetes complications, ADT type and statin use, metformin use was an independent factor for predicting a reduced risk of active TB (adjusted relative risk (aRR): 0.24; 95% CI: 0.18-0.32). The association between metformin use and active TB risk was also consistent in most subgroup analyses, except for patients with metabolic disorders (aRR: 0.46; 95% CI: 0.11-1.87). This protective effect of metformin was dose-dependent but diminished gradually in the elderly population. ConclusionAmong all types of ADT and insulin therapies, metformin is the only agent with a decreased risk of active TB in the T2DM population. However, this effect was diminished in the elderly population and was not observed in patients with metabolic disorders. See This retrospective, propensity score-matched cohort study demonstrated that the risk of active tuberculosis (TB) is higher in the type 2 diabetes mellitus population. However, the use of metformin is associated with a decreased risk of active TB in this population.
The preventive strategies of community hospital in the battle of fighting pandemic COVID-19 in Taiwan
(2020-06-01)
Yang, Chih-Jen
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Chen, Tun-Chieh
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Chen, Yen-Hsu
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生物科技學系
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Department of Biological Science and Technology
Three months of rifapentine and isoniazid for latent tuberculosis infection in hemodialysis patients: High rates of adverse events
(2019-02-01)
Lin, Shang-Yi
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Chiu, Yi-Wen
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Lu, Po-Liang
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Hwang, Shang-Jyh
;
Chen, Tun-Chieh
The consequences of once-weekly rifapentine plus isoniazid for 3 months (3HP) against latent tuberculosis infections in hemodialysis patients have not been studied before. This is the first study to evaluate the safety and tolerability of 3HP in this population and revealed a completion rate of 65.4%. The therapy was not associated with hepatotoxicity, but with high rates of adverse events (69.2%). Copyright (C) 2018, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.