Yung-Feng Huang

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.

Three-Combination Probiotics Therapy in Children With Salmonella and Rotavirus Gastroenteritis

Goals: Quantitative Vesikari scales and qualitative severe diarrhea (Vesikari scale ≥11) assessments were used to grade the Salmonella-induced and rotavirus-induced gastroenteritis severity. A significant reduction in severe diarrhea (Vesikari score ≥11) was used to evaluate the efficacy of three-combination probiotics (BIO-THREE). Background: Several studies have shown that rotavirus and Salmonella infections are the leading causes of infectious gastroenteritis. Although probiotics have been effective in some studies, the use of 3-combination formulation probiotics is rare. Study: This single-center, open-label, randomized, controlled trial included 159 patients (age range, 3 mo to 14 y) hospitalized with infectious gastroenteritis between February 2009 and October 2010. Results: Patients were grouped according to the pathogen identified (48, Salmonella; 42, rotavirus; and 69, unknown origin). The total diarrhea duration was significantly shorter for children who received BIO-THREE (P<0.0001). After BIO-THREE administration, there were significantly less intervention group patients with severe diarrhea at intervention day 3. Vesikari scale or diarrhea frequency results did not reveal significant differences between groups (except for day 5 in patients with rotavirus), and there were no significant changes in other clinical parameters or the length of hospital stay. Conclusions: Seven-day BIO-THREE administration demonstrated high efficacy and safety in infants and children with severe gastroenteritis. The incidence of severe gastroenteritis was significantly reduced in the rotavirus origin and BIO-THREE intervention groups.

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.

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.

A Comparison of Clinical Use of Fluticasone Propionate and Beclomethasone Dipropionate in Pediatric Asthma

Inhaled steroids play a very important role in the prevention and treatment of asthma. Previous studies indicated that fluticasone propionate (FP) had low bioavailability and high local potency. However, the laboratory data in these studies were not obtained among Taiwan population. It is very important that native data should be established. Thus a 12-week research program was designed, involving 77 patients, 51 for FP group and 26 for beclomethasone dipropionate (BD) group. The objects were victims of moderate to severe asthma and their age ranged from 4 to 14 years old. An open, comparative and randomized method was adopted. Except for the 4-week-later daytime symptom score(P = 0.033, BD group was better), no other significant differences were found between the two groups in the symptom score improvement(P > 0.05). All the P-values for the daytime & night-time scores were lower than 0.001, which means obvious improvement after treatment in both groups. P-value for PEF improvement was 0.003 after 4 weeks (BD group was better) and 0.943 after 8 weeks; for FEV1 improvement, it was 0.005 after 4 weeks(BD group was better) and 0.252 after 8 weeks; and for FEV1/FVC improvements, it was 0.067 after 4 weeks and 0.097 after 8 weeks. There was no statistic significance in total eosinophil count (TEC), IgE, eosinophil cationic protein (ECP) serum level changes after 4 or 8 weeks. Adverse effects were all anticipated and no statistic significance showed up, either, between the two groups or in the cortisol levels (P > 0.05). In conclusion, native data indicated that the potency of 100 micrograms of FP was equal to that of 200 micrograms of BD and that few side effects were noted in FP group. It is recommended that this drug be introduced for clinical use.

Comparisons of etiology and diagnostic tools of lower respiratory tract infections in hospitalized young children in Southern Taiwan in two seasons.

BACKGROUND Lower respiratory tract infections (LRTIs) play an important role in pediatric diseases; however, there are limited data about LRTIs in Southern Taiwan. This study aimed to investigate the clinical and epidemiological data of LRTIs in this area. METHODS Children aged under 5 years who were hospitalized at a medical center in Southern Taiwan with acute LRTIs from July 2010 to October 2010 (summer) and from March 2011 to May 2011 (spring) were prospectively enrolled. Nasopharyngeal aspirates were obtained and sent for viral cultures, multiplex polymerase chain reaction (PCR), and traditional quick tests. The clinical features, laboratory data, and imaging findings were recorded and analyzed. RESULTS A total of 90 children were enrolled, 70 of whom had detectable pathogens. The positive rate of conventional viral and bacterial cultures was 25.6%, which increased to 77.77% after combining with the two multiplex PCR methods. Adenovirus and enterovirus were the most common viral etiologies identified (26.5% of cases) and Streptococcus pneumoniae was the leading bacterial etiology (46.4%). The seasonal trend of viral infections in Southern Taiwan was different from Northern Taiwan. There were no differences in demographic data, severity of disease, or hospital stay between single and mixed infections. A similar result was found between nonpneumococcal and pneumococcal infections. CONCLUSION Viral infections were the main etiologies of LRTIs in young children. Multiplex PCR methods are rapid assays that can increase the diagnostic yield rate. Mixed infections do not seem to affect the severity of disease. Early detection may aid clinicians in appropriate decision-making and treatment.

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.