Pingtung Hospital

Unhealthy alcohol use (UAU) screening facilitates identification of patients with alcohol use problems for intervention. This study evaluates the usefulness of gamma-glutamyl transferase (GGT) and sequential percentage of carbohydrate-deficient transferrin (%CDT) in community screening for UAU. In two indigenous communities (A and B), liver disease screening data including GGT, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alcohol use disorders identification test (AUDIT) were reviewed. In Community B, residents with high GGT were invited for sequential evaluation including %CDT, AUDIT, ultrasonography, and liver stiffness measurement. With AUDIT score ≥ 8 and ≥ 4 as UAU criteria for male and female genders, we determined the diagnostic performances and validities of GGT and sequential %CDT in detecting UAU. A total of 1755 residents with available GGT, AST, ALT, and AUDIT were reviewed. UAU prevalence ranged from 7.4% to 44% between communities. For sequential evaluation, 79 residents were enrolled in which 57 (72.2%) were classified as UAU. The performances of GGT, AST, ALT, and AST/ALT ratios in detecting UAU were 0.767, 0.66, 0.597, and 0.549, respectively. With a cutoff of GGT ≥ upper normal limit in detecting UAU, the sensitivity, specificity, accuracy, positive (PPV), and negative predictive value (NPV) were 62.5%, 75.5%, 72.1%, 47.4%, and 85.0%. In Community B, among residents with high GGT, %CDT had a performance of 0.684. With a cutoff of 1.72, the sensitivity, specificity, accuracy, PPV, and NPV were 59.6%, 81.8%, 65.8%, 89.5%, and 43.9%, respectively. GGT and sequential %CDT are useful for screening UAU in indigenous communities with high negative and positive predictive values, respectively.

Traditional Chinese Medicine (TCM) interventions have shown efficacy in aiding the outpatient treatment of patients with ischemic stroke, particularly in functional recovery and mortality reduction. Despite being covered by Taiwan National Health Insurance (NHI), TCM utilization among inpatients remains low. This study investigated the use of acupuncture, a key TCM modality, among hospitalized patients with ischemic stroke in a medical center in southern Taiwan from 2017 to 2020. Newly hospitalized ischemic stroke patients diagnosed between January 1, 2017, and December 31, 2020, were enrolled. This study assessed acupuncture interventions in hospitalized patients with stroke and evaluated whether acupuncture reduced patient mortality. Differences in demographic and clinical variables between the acupuncture and non-acupuncture groups were analyzed using independent sample t-tests or chi-square tests. Hazard ratios (HR) were used to compare the mortality risk between the acupuncture and non-acupuncture groups using Cox proportional hazards models employed for univariate and multivariate regressions. Between 2017 and 2020, 23.9% of the 1,455 inpatients with ischemic stroke at Kaohsiung Veterans General Hospital received acupuncture interventions. The demographic characteristics were similar between the two groups, except for age and renal failure. The acupuncture group showed a higher proportion of patients receiving recombinant tissue plasminogen activator, lipid-modifying agents, and endovascular thrombectomy, as well as a higher proportion of patients with baseline modified Rankin Scale scores of 3–6. Adjusted HRs for 12-month mortality in the acupuncture group were 0.45 (0.22–0.93, 95% CI) compared to the control group. This study provides real-world data on inpatients with ischemic stroke receiving acupuncture treatment during hospitalization. Patients with ischemic stroke who received acupuncture during hospitalization exhibited a lower 12-month mortality risk, even among those who were older or had severe physical disabilities at admission. This study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital (IRB No. KSVGH23-CT8-12).

Mycobacterium kansasii (M. kansasii) pulmonary disease is an emerging global health concern, and the pathogen's resistance to antimicrobial agents is challenging. Understanding the epidemiology of drug resistance rates and the associated risk factors is useful for guiding antimicrobial agent selection for M. kansasii treatment. This retrospective cohort study analysed 361 pathogenic M. kansasii isolates collected from patients with M. kansasii pulmonary disease in two tertiary medical centres in Taiwan between 2011 and 2022. Antimicrobial susceptibility testing was performed using Sensititre™ SLOMYCO1 or SLOMYCO2, and MIC breakpoints were according to CLSI 2018. We applied multivariate logistic regression and Cochran-Mantel-Haenszel test to assess the factors associated with drug resistance. Most M. kansasii isolates in Taiwan remained susceptible to the first-line agents, including rifampin (92.2%) and clarithromycin (98.6%). High resistance rates were observed in ciprofloxacin (42.7%), doxycycline (56.2%), and trimethoprim/sulfamethoxazole (87.8%). The drug resistance rates of tested antibiotics for M. kansasii increased notably in 2018-2022 compared to those between 2015-2017. M. kansasii isolates from central Taiwan exhibited significantly higher resistance rates in all drugs compared to those in southern Taiwan. Pulmonary fibrocavitary lesion was an independent risk factor for resistance to rifampin and ciprofloxacin. The study reveals increasing resistance to the first- and second-line agents in M. kansasii isolates across Taiwan. Resistance epidemiology differed between regions. Fibrocavitary lung lesion was significantly associated with drug resistance. These findings underscore the importance of region-specific surveillance to undergo individualized treatment strategies for M. kansasii pulmonary disease.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

IntroductionBronchiectasis exhibits substantial heterogeneity across geographic locations and includes a diverse range of aetiologies. Limited large-scale data are available for Southeast Asian countries.MethodsThis was a multicentre, retrospective, observational cohort study. Between January 2017 and June 2020, comprehensive clinical data were collected on enrolment, and 1-year follow-ups were conducted using an electronic case report form.ResultsA total of 2753 patients were enrolled. The mean age of the patients was 67 years. Forty-two per cent (1150/2753) of patients were male. The mean modified Reiff score was 5.0±3.3. The proportions of bacteria, tuberculosis and nontuberculous mycobacteria cultured from sputum within 1 year of follow-up were 46% (381/829), 1% (10/829) and 24% (202/829), respectively. The most prevalent bacterial isolate was Pseudomonas aeruginosa (22%), followed by Klebsiella pneumoniae (11%). Airflow obstruction was observed in 32% of patients, and 39% used inhaled bronchodilators. A substantial proportion (57%) of the patients were prescribed mucolytics. Seventeen per cent of the patients experienced severe exacerbations within a year. One-year all-cause mortality rate was 2% (52 of 2563 patients). Female patients demonstrated more severe imaging findings than male patients (modified Reiff score, 5.2 vs 4.6, p<0.001). However, they exhibited less obstructive lung function impairment (26% vs 40%, p<0.001), experienced fewer severe exacerbations (15% vs 20%, p=0.002) and had lower mortality rates (2% vs 5%, p<0.001). The risk of severe exacerbation and mortality increased significantly among patients older than 80 years.ConclusionAlthough female patients with bronchiectasis exhibited more severe imaging findings, their prognoses were better in Taiwan. Elderly patients older than 80 years had worse prognosis.