Acute immune thrombocytopenic purpura in an adolescent with 2009 novel H1N1 influenza A virus infection

AbstractAlthough both leukopenia and thrombocytopenia are not uncommon hematological findings among patients with novel 2009 H1N1 influenza virus infection, immune thrombocytopenic purpura has rarely been shown to be associated with this novel influenza A infection. Here, we describe a previously healthy adolescent who presented with fever, influenza-like symptoms and acute onset of generalized petechiae and active oral mucosa bleeding on the third day of his illness. Severe leukopenia and thrombocytopenia were found. There was neither malignancy nor blast cells found by bone marrow aspiration. Real-time reverse transcriptase polymerase chain reaction was positive for novel 2009 H1N1 influenza infection. Novel influenza-associated atypical immune thrombocytopenic purpura was diagnosed. The patient recovered uneventfully after oseltamivir and methylprednisolone therapy

Associated clinical characteristics of patients with candidemia among different Candida species

BackgroundThe rising incidence of non-albicans Candida (NAC) infection has been associated with a potentially adverse outcome for patients with candidemia. However, categorizing various species causing candidemia into a single NAC group might lead to inappropriate conclusions due to heterogeneity in species. Thus we examined the associated factors among patients with candidemia caused by different species.MethodsThis retrospective study was conducted at a tertiary medical center in Taiwan from 2006 to 2009. Mortality rate, demographic and clinical characteristics, albumin levels, and severity scores of acute illness of patients at the onset of candidemia were analyzed.ResultsA total of 447 episodes among 418 patients were included for analysis. The overall 30-day crude mortality was 48.2%, with no significant difference between C. albicans and NAC candidemia, but apparently C. parapsilosis candidemia was associated with a lower mortality rate. Time to positivity for yeast was significantly different between species. Compared with infection involving C. albicans, more frequent use of total parenteral nutrition, lower Sequential Organ Failure Assessment score and higher albumin levels were observed for C. parapsilosis candidemia.ConclusionIdentifying associated factors for each species may be a more effective approach than single NAC grouping. Time to positivity may be a hint for treatment guidance in candidemia. More frequent use of total parenteral nutrition and less virulent nature were noted for C. parapsilosis candidemia

Clinical significance of time to positivity for yeast in candidemia

PurposeCandidemia is an important issue of nosocomial bloodstream infections, and is associated with a high mortality rate. However, little information is available before final species identification, which takes days after the episode of candidemia. This study tried to determine whether time to positivity (TTP) for yeast helps in predicting the species of candidemia.MethodsA retrospective cohort study was conducted in Taiwan, which included 434 episodes of nonduplicated candidemia during the period between 2006 and 2009. The demographic features, clinical characteristics, TTP for yeast, and acute illness scores were included for analysis.ResultsThe mean age of patients with candidemia was 70.4 ± 15.2 years, and the 30-day crude mortality rate was 48.2%. Forty-five percent of patients suffered from shock status with a mean Acute Physiological and Chronic Health Evaluation II score of 27.0 ± 8.7 and a mean Sequential Organ Failure Assessment score of 9.7 ± 4.5, whereas 50% were admitted to the intensive care units. Candida albicans was still the most commonly identified pathogen (58.1%), followed by C. tropicalis (14.7%), C. parapsilosis (13.1%), and C. glabrata (8.3%). Results of multivariate logistic regression showed that TTP for yeast within 48 hours would more favor C. tropicalis (p = 0.044), and less favor C. glabrata (p = 0.025) and C. parapsilosis (p < 0.001). Patients with parenteral nutrition usage were more frequently associated with a TTP for yeast within 48 hours, whereas those with previous exposure to an antifungal agent had a longer TTP for yeast.ConclusionThe TTP for yeast might provide a hint of the responsible Candida species before final identification among critical patients with candidemia. The association between antifungal agents and TTP would need more evidence for elucidation

Virological investigation of four outbreaks of influenza B reassortants in the northern region of Taiwan from October 2006 to February 2007

<p>Abstract</p> <p>Background</p> <p>From October 2006 to February 2007, clinical specimens from 452 patients with symptoms related to respiratory tract infection in the northern region of Taiwan were collected. Real-time PCR and direct immunofluorescent antibody tests showed that 145 (32%) patients had influenza B virus infections. Subsequently, nucleotide sequence analyses of both hemagglutinin (HA) and neuraminidase (NA) genes of 39 isolates were performed. Isolated viruses were antigenically characterized using hemagglutinin inhibition (HI) test.</p> <p>Findings</p> <p>Phylogenetic tree analysis showed that all the isolates belonged to the B reassortant lineage with HA gene belonged to the B/Victoria/2/87 lineage and the NA gene belonged to the B/Yamagata/16/88 lineage. In addition, a group of children aged between 6 to 8 years old resided in Yilan county were infected with a variant strain. Hemagglutinin inhibition (HI) tests confirmed that all the reassortant influenza B viruses were B/Malaysia/2506/04-like viruses. Pre- and post-immunized serum samples from 4 normal volunteers inoculated with 2007 influenza vaccine were evaluated for their HI activity on 6 reassortant B isolates including two variants that we found in the Yilan county. The results demonstrated that after vaccination, all four vaccinees had at least 4-fold increases of their HI titers.</p> <p>Conclusion</p> <p>The results indicate that the 2006–2007 seasonal influenza vaccine was effective in stimulating protective immunity against the influenza B variants identified in Yilan county. Continuous surveillance of emerging influenza B variants in the northern region of Taiwan is important for the selection of proper vaccine candidate in the future.</p

The relationship between gallbladder status and recurrent biliary complications in patients with choledocholithiasis following endoscopic treatment

AbstractBackgroundEndoscopic methods are currently the treatment of choice for patients with common bile duct (CBD) stones, but subsequent management of the intact gallbladder for patients following endoscopic treatment is still controversial. The primary aim of this study was to discover the association between gallbladder status and recurrent biliary complications for patients with CBD stones after endoscopic treatment. Additionally, we also sought to determine risk factors for recurrent biliary complications in these patients.MethodsThe records of 1625 patients with CBD stones following endoscopic treatment were reviewed. A total of 681 patients were enrolled and subsequently categorized into four groups: Group 1 (n = 201), calculous gallbladder; Group 2 (n = 140), acalculous gallbladder; Group 3 (n = 175), elective cholecystectomy after endoscopic treatment; and Group 4 (n = 165), prior cholecystectomy. The basic demographics and recurrent biliary complications during follow-up among these four groups were analyzed by Chi-square test, ANOVA, Kaplan-Meier analysis, and log-rank test.ResultsDuring the median follow-up period of 34 months, 133 patients (20%) with recurrent biliary complications were identified. The recurrence rates of Groups 1, 2, 3, and 4 were 29%, 11%, 15%, and 19%, respectively. Kaplan-Meier analysis showed that patients with calculous gallbladder had a significantly higher rate of recurrent biliary complication. In multivariate analysis, patients with a history of cirrhosis, juxta-papillary diverticulum, calculous gallbladder, CBD size ≥1.5 cm, and endoscopic management with endoscopic sphincterotomy were at a higher risk for developing biliary complications (p = 0.029, p = 0.039, p < 0.001, p = 0.002, p = 0.021, respectively.)ConclusionPatients with cholecystolithiasis and CBD stones had a higher incidence of recurrent biliary complications. For some of these patients, elective cholecystectomy following endoscopic treatment may be considered. However, routine elective cholecystectomy in patients with normal gallbladder is not appropriate because of the low recurrence of biliary complications. Whether gallbladder function affects the biliary clearance and biliary complications requires further research

Factors Influencing the Competency of Head Nurses When Assisting With Inhospital Cardiopulmonary Resuscitation

AbstractObjectiveHead nurses in a hospital setting work to maintain the quality of nursing care and ensure that staff nursing skills are up-to-date. Although cardiopulmonary resuscitation (CFR) is most often performed by physicians in a hospital, nurses play crucial assistance roles, including the administration of medication, record-keeping, obtaining intravenous access, and helping with intubation. Patient outcome is therefore related to nurses' skill level in CFR. We hypothesized that the more senior head nurses would be more skillful at assisting with CFR.Materials and MethodsWe conducted an observational study of 55 head nurses, who were asked to perform a 4-minute simulation in which they assisted with CFR using a resuscitation manikin. We collected demographic data, including age and years since becoming a nurse and becoming a head nurse, together with a stress score, which assessed the stress felt by the nurses while taking the test. These measures were analyzed along with the accuracy of the nurses' skills while performing CFR.ResultsTwenty-two skills were evaluated, with each skill graded as either a pass or fail. Only 30/55 (54.5%) of the head nurses passed all 22 skills. There was a significant difference in the numbers of skills with a pass rating (p = 0.043) in relation to the units where the head nurses were employed. Their performance also showed a strong negative correlation with age (p = 0.001), work experience (p = 0.028), and time since becoming head nurse (p<0.001). However, there was no significant difference between the numbers of skills with a pass rating and pre-test stress score (p = 0.129).ConclusionIn our study, the head nurses of surgical wards, medical wards, and intensive care units had better scores than the head nurses of pediatric, obstetrics-gynecology, and other units. In contrast with our original hypothesis, we found that the more senior head nurses' skills when assisting with CFR were poorer than those of their more junior colleagues. This suggests that senior head nurses should undergo frequent refresher courses, not only to help maintain their life-saving abilities, but also so that they can better mentor less experienced nurses in situations requiring CFR

Differentiating impacts of non‐pharmaceutical interventions on non‐coronavirus disease‐2019 respiratory viral infections: Hospital‐based retrospective observational study in Taiwan

Background Physical distancing and facemask use are worldwide recognized as effective non-pharmaceutical interventions (NPIs) against the coronavirus disease-2019 (COVID-19). Since January 2020, Taiwan has introduced both NPIs but their effectiveness on non-COVID-19 respiratory viruses (NCRVs) remain underexplored. Methods This retrospective observational study examined electronic records at a tertiary hospital in northern Taiwan from pre-COVID (January–December 2019) to post-COVID period (January–May 2020). Patients with respiratory syndromes were tested for both enveloped (eg, influenza virus and seasonal coronavirus) and non-enveloped RVs (eg, enterovirus and rhinovirus) using multiplex reverse transcription polymerase chain reaction assays. Monthly positivity rates of NCRVs among adult and pediatric patients were analyzed with comparison between pre- and post-COVID periods. Results A total of 9693 patients underwent 12 127 multiplex RT-PCR tests. The average positivity rate of NCRVs reduced by 11.2% (25.6% to 14.4%) after nationwide PHIs. Despite the COVID-19 pandemic, the most commonly identified enveloped and non-enveloped viruses were influenza virus and enterovirus/rhinovirus, respectively. Observed reduction in NCRV incidence was predominantly contributed by enveloped NCRVs including influenza viruses. We did not observe epidemiological impacts of NPIs on non-enveloped viruses but an increasing trend in enterovirus/rhinovirus test positivity rate among pediatric patients. Our data were validated using Taiwan's national notification database. Conclusions Our frontline investigation suggests that the current NPIs in Taiwan might not effectively control the transmission of non-enveloped respiratory viruses, despite their protective effects against influenza and seasonal coronavirus. Health authorities may consider using hydrogen peroxide or chloride-based disinfectants as additional preventative strategies against non-enveloped respiratory viruses in the post-COVID-19 era

The Yuan-Tseh Lee Array for Microwave Background Anisotropy

The Yuan-Tseh Lee Array for Microwave Background Anisotropy (AMiBA) is the first interferometer dedicated to studying the cosmic microwave background (CMB) radiation at 3mm wavelength. The choice of 3mm was made to minimize the contributions from foreground synchrotron radiation and Galactic dust emission. The initial configuration of seven 0.6m telescopes mounted on a 6-m hexapod platform was dedicated in October 2006 on Mauna Loa, Hawaii. Scientific operations began with the detection of a number of clusters of galaxies via the thermal Sunyaev-Zel'dovich effect. We compare our data with Subaru weak lensing data in order to study the structure of dark matter. We also compare our data with X-ray data in order to derive the Hubble constant.Comment: accepted for publication in ApJ (13 pages, 7 figures); a version with high resolution figures available at http://www.asiaa.sinica.edu.tw/~keiichi/upfiles/AMiBA7/pho_highreso.pd

High Photoelectric Conversion Efficiency of Metal Phthalocyanine/Fullerene Heterojunction Photovoltaic Device

This paper introduces the fundamental physical characteristics of organic photovoltaic (OPV) devices. Photoelectric conversion efficiency is crucial to the evaluation of quality in OPV devices, and enhancing efficiency has been spurring on researchers to seek alternatives to this problem. In this paper, we focus on organic photovoltaic (OPV) devices and review several approaches to enhance the energy conversion efficiency of small molecular heterojunction OPV devices based on an optimal metal-phthalocyanine/fullerene (C60) planar heterojunction thin film structure. For the sake of discussion, these mechanisms have been divided into electrical and optical sections: (1) Electrical: Modification on electrodes or active regions to benefit carrier injection, charge transport and exciton dissociation; (2) Optical: Optional architectures or infilling to promote photon confinement and enhance absorption