Case Report: The Clinical Toxicity of Dimethylamine Borane

Context: Dimethylamine borane (DMAB) is a reducing agent used in nonelectric plating of semiconductors. Exposures are usually through occupational contact. We report here four cases of people who suffered from work-related exposure to DMAB. Case presentation: Three patients exposed to DMAB decontaminated immediately by drinking a lot of water; they reported dizziness, nausea, diarrhea 6–8 hr later. The other patient did not decontaminate at once, and he suffered from more severe symptoms, including dizziness, nausea, limb numbness, slurred speech, irritable mood, and ataxia 13 hr later. Magnetic resonance imaging showed symmetric lesions with hyperintensity on T2WI and FLAIR in bilateral cerebellar dantate nuclei. This patient was readmitted to the hospital due to difficulty in walking and climbing 18 days after exposure. Lower leg weakness and drop foot were found bilaterally. A nerve conduction study revealed polyneuropathy with motor-predominant axonal degeneration. This patient receives regular outpatient followups and still walks with a clumsy gait and has difficulty with hand-grasping activity. Discussion: This case study demonstrates that DMAB is highly toxic to humans through any route of exposure, and dermal absorption is the major route of neurotoxicity. DMAB induces acute cortical and cerebellar injuries and delayed peripheral neuropathy. Relevance: Further investigation of the toxic mechanism of DMAB is warranted. Early decontamination with copious water is the best current treatment for exposure to DMAB

A model for predicting physical function upon discharge of hospitalized older adults in Taiwan—a machine learning approach based on both electronic health records and comprehensive geriatric assessment

BackgroundPredicting physical function upon discharge among hospitalized older adults is important. This study has aimed to develop a prediction model of physical function upon discharge through use of a machine learning algorithm using electronic health records (EHRs) and comprehensive geriatrics assessments (CGAs) among hospitalized older adults in Taiwan.MethodsData was retrieved from the clinical database of a tertiary medical center in central Taiwan. Older adults admitted to the acute geriatric unit during the period from January 2012 to December 2018 were included for analysis, while those with missing data were excluded. From data of the EHRs and CGAs, a total of 52 clinical features were input for model building. We used 3 different machine learning algorithms, XGBoost, random forest and logistic regression.ResultsIn total, 1,755 older adults were included in final analysis, with a mean age of 80.68 years. For linear models on physical function upon discharge, the accuracy of prediction was 87% for XGBoost, 85% for random forest, and 32% for logistic regression. For classification models on physical function upon discharge, the accuracy for random forest, logistic regression and XGBoost were 94, 92 and 92%, respectively. The auROC reached 98% for XGBoost and random forest, while logistic regression had an auROC of 97%. The top 3 features of importance were activity of daily living (ADL) at baseline, ADL during admission, and mini nutritional status (MNA) during admission.ConclusionThe results showed that physical function upon discharge among hospitalized older adults can be predicted accurately during admission through use of a machine learning model with data taken from EHRs and CGAs

Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

<p>Abstract</p> <p>Background</p> <p>Scrub typhus, a mite-transmitted zoonosis caused by <it>Orientia tsutsugamushi</it>, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed.</p> <p>Case presentations</p> <p>We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days.</p> <p>Conclusion</p> <p>Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.</p

Risk of hospitalization for acute hepatitis in patients treated with non-benzodiazepine hypnosedatives: case-crossover study from the National Health Insurance in Taiwan

簡介：隨著安眠藥於全世界廣泛使用，其安全性備受重視，除常見中樞神經副作用外，安眠藥引起的肝毒性亦不容忽視。大部分安眠藥需經過肝臟代謝，而安眠藥引起之肝毒性均為病例報告，沒有大型流行病學研究。因此，我們研究目的試圖驗證苯二酚和新一代安眠藥與急性肝炎住院間的關聯。法：從1997年至2004年的健保資料庫連結，依研究定義找出個案與前後各兩組對照組，然後去分析不同暴露時段，同時將個案分成乙型、丙型、酒精、非病毒非酒精性肝炎等組別，接著利用個案交叉研究方法算出因急性肝炎住院的勝算比。果：45,626個案因急性肝炎住院，連結門診檔分析後發現於急性肝炎住院前一週接受Zolpidem處方之勝算比為2.4 (95％信賴區間 1.9, 3.0)。而Zopiclone位第一週暴露時間，其勝算比為1.5 (95％信賴區間 1.0, 2.4)。對於傳統苯二酚，亦以住院前一週勝算比最明顯。此外，根據調整過之勝算比趨勢，另一高峰呈現於前三至六週。論：Zolpidem、zopiclone還有傳統苯二酚安眠藥處方時，會增加急性肝炎住院的風險應特別注意，且常見反應為非特異性與非線性劑量。臨床醫師使用這類潛在風險之安眠藥時，需定期監測肝功能。Introduction: With extensive use of hypnosedatives worldwide, in addition to the most commonly reported side effects of sedation, liver injury induced by benzodiazepines (BZDs) has been reported and should be monitored. BZDs, zolpidem and zopiclone all undergo hepatic metabolism. Hepatoxicity has been suspected so the aim of this study was to determine the association between the use of BZDs, zolpidem, zopiclone and the risk of hospitalization related to acute hepatitis.ethods: The study cohort dataset was obtained from the National Health Insurance (NHI) research database in Taiwan from 1997-2004. We separated the groups of patients diagnosed before selected admission of outpatient visits or hospitalization as viral hepatitis B, C, non-viral, non-alcoholic hepatitis, alcoholic hepatitis. Since there were so many determinants, or potential confounders for acute hepatitis, we applied case-crossover design as a means of controlling factors within subjects.esults: 45,626 cases of hospitalization relating to acute hepatitis were obtained. The odds ratio for the first week was the largest and most significant for these medicines. Conditional logistic regression analysis showed a significant adjusted odds ratio of 2.4 (95% confidence interval 1.9, 3.0) for zolpidem during the 7-day risk period. The adjusted odds ratio of zopiclone was 1.5 (95% confidence interval 1.0, 2.4) during the 7-day exposure period. In BZDs, the results were similar to the previous two drugs. In addition, based on the trend of the adjusted odds ratios, another peak was found during the 3 to 6-week period.iscussion: There is an increased risk of hospitalization for acute hepatitis in patients treated with zolpidem, zopiclone and benzodiazepines, and most severe drug induced liver injuries can be idiosyncratic and dose-independent. Thus, physicians and clinical pharmacists should take such potential into consideration and monitor the liver function of patients taking hypnosedatives suspected to be hepatotoxic.Table of Contents要 5bstract 6ntroduction 8ntroduction of benzodiazepines, zolpidem and zopiclone 8iver injury induced by zolpidem, zopiclone and BZDs 8ith and without pre-existing liver diseases 9ethods 11ata Sources 11tudy Subjects 11ase-crossover Design 13ase and Control Exposure Windows and Washout Periods 14ovariates for Adjustment 16tatistical Analysis 16esults 18emographic results 18ncreased risk of hospitalization for acute hepatitis in patients treated with zolpidem, zopiclone, BZDs 18he risks of hospitalization for acute hepatitis in patients treated with zolpidem, zopiclone, BZDs between different hepatitis groups 19he risks of hospitalization for acute hepatitis treated with zolpidem, zopiclone, BZDs by age, sex and dose 20iscussion 21ncreased risk of hospitalization for acute hepatitis in patients treated with zolpidem, zopiclone, BZDs 21he advantage of National Health Insurance in Taiwan 22ncreased risk of hospitalization for acute hepatitis in an individual hypnosedative 22he risks of hospitalization for acute hepatitis in patients treated with zolpidem, zopiclone, BZDs between different hepatitis groups 23he risks of hospitalization for acute hepatitis treated with zolpidem, zopiclone, BZDs by age, sex and dose 25otential limitations 26onclusion 28eference 29igure 1. Subjects selection process. 32igure 2. Timeline of the risk and four control periods 33able 1. Characteristics of study subjects with initial admission diagnosis of acute hepatitis, 1997-2004 34able 2. Odds ratios between hospitalizations and zolpidem, zopiclone, BZDs, by first week and 3 to 6-week risk periods in hepatitis groups 35able 3. Odds ratios between hospitalizations and zolpidem, zopiclone, BZDs, by risk period, age, sex and dose in hepatitis groups. 36ppendix 1. Comparison the latency time and dosage between sedative hypnotics induced liver injury in Micromedex&reg; and NHI databases 37ppendix 2 Comparison between case reports of sedative hypnotics induced liver injury 39ppendix 3. Hepatoxic Drugs (Generic Name) Identified in the Micromedex&reg; Database 54ppendix 4. The trend of adjusted odds ratio between hospitalizations and zolpidem, zopiclone, BZDs by the 1,2,3,4,5,6,7,8,9,10,11,12,13-weeks weekly exposure periods, and acute hepatitis groups. 56ppendix 5. Categories of acute hepatitis according to the International Classification of Diseases, 9th Revision (ICD-9) code. 66ppendix 6. Odds ratios of symmetrical bi-directional versus uni-directional cross-over design between hospitalizations and zolpidem, zopiclone, BZDs, by 3 to 6-week risk period in hepatitis groups 6

In the Seeking of Association between Air Pollutant and COVID-19 Confirmed Cases Using Deep Learning

The COVID-19 pandemic raises awareness of how the fatal spreading of infectious disease impacts economic, political, and cultural sectors, which causes social implications. Across the world, strategies aimed at quickly recognizing risk factors have also helped shape public health guidelines and direct resources; however, they are challenging to analyze and predict since those events still happen. This paper intends to invesitgate the association between air pollutants and COVID-19 confirmed cases using Deep Learning. We used Delhi, India, for daily confirmed cases and air pollutant data for the dataset. We used LSTM deep learning for training the combination of COVID-19 Confirmed Case and AQI parameters over the four different lag times of 1, 3, 7, and 14 days. The finding indicates that CO is the most excellent model compared with the others, having on average, 13 RMSE values. This was followed by pressure at 15, PM2.5 at 20, NO2 at 20, and O3 at 22 error rates

A Hydrogel-Based Epirubicin Delivery System for Intravesical Chemotherapy

This study aimed to examine the efficacy of epirubicin-loaded gelatin hydrogel (EPI-H) in the treatment of superficial urothelium carcinoma. Hydrogel was prepared by Schiff base-crosslinking of gelatin with glutaraldehyde. EPI-H exhibited high entrapment efficiency (59.87% ± 0.51%). EPI-H also increased epirubicin accumulation in AY-27 cells when compared with the effect of aqueous solutions of epirubicin (EPI-AQ); respective epirubicin-positive cell counts were 69.0% ± 7.6% and 38.3% ± 5.8%. EPI-H also exhibited greater cytotoxicity against AY-27 cells than that of EPI-AQ; IC50 values were 13.1 ± 1.1 and 7.5 ± 0.3 μg/mL, respectively. Cystometrograms showed that EPI-H reduced peak micturition, threshold pressures, and micturition duration, and that it increased bladder compliance more so than EPI-AQ. EPI-H enhanced epirubicin penetration into basal cells of urothelium in vivo, whereas EPI-AQ did so only to the umbrella cells. EPI-H inhibited tumor growth upon intravesical instillation to tumor-bearing bladder of F344 rats, inducing higher levels of caspase-3 expression than that observed with EPI-AQ treatment; the number of caspase-3 positive cells in treated urothelium carcinoma was 13.9% ± 4.0% (EPI-AQ) and 34.1% ± 1.0%, (EPI-H). EPI-H has value as an improved means to administer epirubicin in intravesical instillation treatments for bladder cancer