Yee-Hsuan Chiou

Significant Relationship Between Serum High-sensitivity C-Reactive Protein, High-density Lipoprotein Cholesterol Levels and Children With Kawasaki Disease and Coronary Artery Lesions

BACKGROUND/PURPOSE The aim of this study was to understand the association between Kawasaki disease (KD) in children and serum high-sensitivity C-reactive protein (hs-CRP), which is a sensitive indicator of inflammation, lipid profiles and coronary artery lesions. METHODS Between July 2005 and December 2007, 119 children with KD at least 1 year after diagnosis were recruited. The children were classified into one of two groups: Group I comprised 55 children with KD and coronary aneurysms; Group 2 comprised 64 children with KD and normal coronary arteries. The relationship between hs-CRP concentration and high-density lipoprotein cholesterol (HDL-C) and the size of arterial lesions was investigated in Group I 1 year after onset of KD. RESULTS Serum hs-CRP levels in Group I (mean, 0.251 mg/dL) were significantly greater than those in Group II (mean, 0.162 mg/dL; p = 0.011). However, plasma HDL-C levels in Group I (mean 42.51 mg/dL) were significantly lower than those in Group II (mean, 44.34 mg/dL; p = 0.037). In Group I, there was a positive association between hs-CRP and the size of coronary artery lesions (r = 0.672, p = 0.035), but no association between lipid profiles, including HDL-C, and coronary artery lesions (all p > 0.05). CONCLUSION Our results support the possibility of ongoing low-grade inflammation late after the acute phase of KD in children with coronary aneurysms. Serum hs-CRP and HDL-C levels are associated with coronary artery lesions in children with KD.

The role of Mycoplasma pneumoniae in acute exacerbation of asthma in children.

BACKGROUND The aim of this retrospective study was to test the connection between acute M. pneumoniae infection and the exacerbation of asthma. The clinical characteristics of Mycoplasma infection seen during emergent visits in asthmatic children were reviewed. METHODS We examined the cases of 316 asthma exacerbation patients aged from two to fourteen-years-old. They were divided into two groups according to their asthma history. One hundred and eighty-eight cases had evidence of a history of asthma (group 1) and 128 had only had their first asthma attack (group 2). The control group (group 3) was made up of 151 asthmatic children who had no acute exacerbation during the previous six months. In all three groups, we looked whether those children had acute M. pneumoniae infection or not. Acute M. pneumoniae infection was defined by positive results in serologic testing, with specific immunoglobulin M (IgM) antibody or with a > or = fourfold increase in IgG titer by the third week in the same children. RESULTS In group 1, acute M. pneumionae infection was found in 42 (23%) of the 188 children. In group 2, acute M. pneumoniae infection was proven in 57 (45%) of the 128 children. In the control group, 10 (7%) of the 151 children had M. pneumoniae infection. Twenty-three (54%) asthmatic children that presented with fever as the chief complaint were infected with M. pneumoniae, compared with 18 (12%) children without infection (p = 0.014). Twenty-nine (50%) children having their first asthma attack with fever were infected with M. pneumoniae, compared with 22 (32%) without infection (p = 0.009). In group 1, 17 (41%) children with M. pneumoniae infections and 28 (19%) children without M. pneumoniae infections presented with rale breathing sounds of the physical examination (p = 0.027). In group 2, 26 (46%) children with M. pneumoniae infections and 17 (24%) children without M. pneumoniae infections presented with rale breathing sounds (p = 0.019). CONCLUSIONS We found that M. pneumoniae may play a role in asthmatic exacerbation among children, especially in those experiencing their first asthma attack. Moreover, among children with acute M. pneumoniae infection, the number was significantly increased of children having fever as the chief complaint and rales in auscultations compared with those without M. pneumoniae infection.

Pulmonary hemorrhage in very low‐birthweight infants: Risk factors and management

Background:  Beginning 2007, the intratracheal route of epinephrine to end massive pulmonary hemorrhage (MPH) in very low‐birthweight (VLBW) infants was modified at Kaohsiung Veterans General Hospital. The aim of the present study was to assess the change in outcomes for these infants, and to evaluate the risk factors of MPH.

Urinary tract infection in infants: a single-center clinical analysis in southern Taiwan.

BACKGROUND This study summarized the epidemiology, etiology, and susceptibility of pathogens to antibiotics, and specific characteristics in infants aged less than 4 months diagnosed with urinary tract infection in the past decade in Taiwan. METHODS The medical charts of patients aged less than 4 months admitted for urinary tract infection to Kaohsiung Veterans General Hospital between January 2001 and December 2009 were retrospectively reviewed. RESULTS A total of 132 patients, with male predominance (68.9%), were enrolled. The top three pathogens were similar to those identified in previous studies in Taiwan. The most common pathogen, Escherichia coli (85.3%), was resistant to ampicillin (75.9%), followed by sulfamethoxazole/trimethoprim (31.7%), and cefazolin (28.5%). Dimercaptosuccinic acid (DMSA) renal scan revealed 34.5% positive findings, while the vesicoureteral reflux (VUR) rate was 37.8% by direct radionuclide voiding cystography and/or voiding cysto-urethrography. Positive DMSA findings significantly correlated with VUR (p<0.001) and higher C-reactive protein level (p<0.05). CONCLUSIONS E coli was the most common pathogen in the present cohort, and the top three pathogens were similar to those found in general pediatric population in Taiwan. VUR was the most common genitourinary tract anomaly in this age group. Positive DMSA was well correlated with VUR and higher C-reactive protein level.

Perinatal factors in patent ductus arteriosus in very low-birthweight infants

The relationship between hemoglobin and patent ductus arteriosus (PDA) has not been discussed before. The aim of this study was to assess the influence of hemoglobin and perinatal factors on PDA in very low‐birthweight (VLBW) infants.

Hemolytic Uremic Syndrome Associated with Invasive Streptococcus Pneumoniae Infection: Report of One Case

Hemolytic uremic syndrome (HUS) most commonly follows an episode of gastroenteritis associated with Escherichia coli (O157:H7). S. pneumoniae-associated HUS is rare and has been reported having a high morbidity and mortality rate. We present a 1-year-5-month-old girl who developed S. pneumoniae-associated HUS and positive T-activation testing. She received antibiotics, washed red blood cell transfusion and early continuous venovenous hemodiafiltration treatment. She had chronic renal failure but was without other sequelae after 8 months, follow-up. Early dialysis intervention in S. pneumoiae-induced HUS patients decreasing the morbidity and mortality rate is discussed, and the literature is reviewed.

Incidence, clinical characteristics, and associated diseases in patients with immune thrombocytopenia: A nationwide population-based study in Taiwan

INTRODUCTION Immune thrombocytopenia (ITP) is an immune-mediated disease; it has been reported to be associated with several diseases. The data on ITP in patients with hepatitis B, tuberculosis, or thyroid diseases are relatively scarce. In addition, these diseases are not rare in Taiwan, together with hepatitis C and Helicobacter pylori which are also related to ITP. METHODS AND MATERIALS We identified 1223 ITP patients and characterized these patients between 2000 and 2013 from the National Health Insurance Research Database. The adult ITP patients were matched with non-ITP patients. RESULTS The overall incidence of ITP was 2.59/100,000 person-years. The frequencies of hepatitis B and C in adult ITP patients were much higher than those indicated in previous studies. The frequencies of non-traumatic intracerebral hemorrhage and gastrointestinal bleeding during hospitalization among ITP patients were low. The diseases associated with increased risks of ITP included hepatitis B (OR = 18.70, 95% CI = 9.71-36.03), hepatitis C (OR = 54.43, 95% CI = 15.94-185.88), hepatitis B and hepatitis C (OR = 7.02, 95% CI = 1.47-33.56), tuberculosis (OR = 5.37, 95% CI = 2.72-10.61), Helicobacter pylori infection (OR = 5.93, 95% CI = 3.16-11.10), hyperthyroidism (OR = 3.43, 95% CI = 2.09-5.64), hypothyroidism (OR = 6.70, 95% CI = 2.35-19.13), and simple and unspecified goiter (OR = 2.68, 95% CI = 1.43-5.03). CONCLUSIONS Surveying for the diseases which are frequent and related to increased risks of ITP among patients with newly diagnosed ITP should be considered.