Search PubMed⌕ Search

Biomedical subjects

S C Chang

Publications and source records attributed to S C Chang.

At least 109 records · Page 6Linked to original sources

Antibiotic usage in primary care units in Taiwan.

To understand the situation of antibiotic usage in primary care units in Taiwan, we collected all prescriptions over a 1 week period during March 2 to March 7, 1992, December 2 to December 7, 1992, and January 14 to January 19, 1994 from out-patient clinics of public health stations located in various parts of Taiwan. In the first time period 60 health stations were sampled, 18,350 patient-visits made and 23,674 diagnoses recorded. In the second time period 168 health stations were sampled, 84,143 patient-visits made and 96,528 diagnoses recorded. In the third time period 173 health stations were sampled with 85,623 patient-visits and 105,132 diagnoses recorded. The percentages of total patient-visits that resulted in antibiotic treatment were 16.7, 13.5 and 12.4% in the three time periods, respectively. The patient group under the age of 11 received the highest percentage of antibiotic treatment. The percentage of patient-visits that resulted in treatment with two or more types of antibiotics decreased from 25.4% in March, 1992 to 13.2% in January, 1994. Common cold was the most frequent diagnosis in patients receiving antibiotic therapy during the three time periods and accounted for 36.9% of total antibiotic prescriptions. Of the patients with the diagnosis of common cold, 29.7% received antibiotic treatment, of whom the largest group were paediatric patients (< 16 years). Penicillins, macrolides and cephalosporins were the most commonly prescribed antibiotics and accounted for 34.0, 21.8 and 21.3% of all prescribed antibiotics in the three study periods.

Adolescent↗

[Supra-fascial elevated free forearm flap--indications, surgical technique and follow-up examination of the donor site defect].

From March 1995 to May 1997, 66 free radial forearm flaps were used for orofacial reconstructions. All flaps were elevated following the suprafascial technique. Donor-site closure was performed with split-thickness skin grafts in 54 cases, and with full-thickness skin grafts in 12 patients. Investigations after six months included grip strength, pulp-to-pulp pinch strength, range of motion as compared to preoperative values, aesthetical self-assessment, cold intolerance, and dysesthesias. The latter evaluation could be performed in 42 patients, whereas the complete follow-up protocol included 36 patients. Primary wound healing with immediate complete take of skin grafts was achieved in 93.9%. Grip strength and pulp-to-pulp pinch strength showed no decrease postoperatively. An impairment of range of motion of the wrist was observed in 2.8%. There was no cold intolerance. Aesthetical outcome was rated as good or fair in 97.3%. Slight numbness distally to the donor-site was found in 59.5%. The results of this prospective study show a superiority of suprafascial elevation of the radial foream flap as compared to the classic elevation technique, particularly in a higher rate of primary wound healing, thus avoiding impairment of range of motion and strength of the donor hand.

Adult↗

Emergence of vancomycin-resistant enterococci at a university hospital in Taiwan: persistence of multiple species and multiple clones.

OBJECTIVES: To describe the epidemiology of vancomycin-resistant enterococci (VRE) in a university hospital in Taipei, Taiwan. DESIGN: Retrospective review over a 27-month period, from March 1996 to May 1998. SETTING: A tertiary-care teaching hospital in Taiwan. PARTICIPANTS: Patients with VRE isolated from any body site. METHODS: Patients were identified through hospital microbiology and infection control records. Patient charts were reviewed for clinical and epidemiology data, including age, gender, previous hospital admissions, underlying diseases, types of infection, and recent antibiotic use. VRE isolates were characterized by their typical biochemical reactions, cellular fatty acid profiles, and the presence of van genes. Antibiotypes using the E-test and randomly amplified polymorphic DNA (RAPD) patterns of these isolates were used to determine the clonality. RESULTS: Twenty-five isolates of VRE recovered from 12 patients were identified. One patient with a perianal abscess had 12 isolates of VRE (4 Enterococcus faecalis, 7 Enterococcus faecium, and 1 Enterococcus casseliflavus) recovered from perianal lesions. Among 3 patients who were hospitalized in the same room, 1 had a community-acquired cellulitis over the left leg caused by E. faecalis, and the other 2 patients both had anal colonization with 2 isolates of E. faecalis. The other 8 patients had 1 E. faecalis isolate each from various clinical specimens. All isolates possessed vanA resistance phenotype and vanA genes. Different antibiotypes and RAPD patterns of the isolates from different patients excluded the possibility of nosocomial spread at the hospital. CONCLUSIONS: Multiple species of VRE (E. faecalis, E. faecium, and E. casseliflavus) and multiple clones of E. faecium could colonize or infect hospitalized patients. In addition, clones of VRE can persist long-term in patients' lower gastrointestinal tracts. These results extend our knowledge of the coexistence and the persistence of multiple species and multiple clones of VRE in hospitalized patients.

Cross Infection↗

Antithyroid-drug-induced agranulocytosis complicated by life-threatening infections.

Agranulocytosis is a rare complication of antithyroid drugs, and the aetiologies of community-acquired, life-threatening infections in patients taking these drugs have not previously been systematically described. Of 5653 hyperthyroid patients treated with antithyroid drugs at National Taiwan University Hospital between January 1987 and December 1997, 13 (0.23%) developed agranulocytosis with life-threatening infections. The most common presentations were fever (92%) and sore throat (85%). Initial clinical diagnoses were acute pharyngitis (46%), acute tonsillitis (38%), pneumonia (15%) and urinary tract infection (8%). Positive blood cultures from six patients yielded Pseudomonas aeruginosa (3), Escherichia coli (1), Staphylococcus aureus (1), Capnocytophaga species (1). Two patients died of uncontrolled infection, thyroid storm and multiple organ failure. Cases of antithyroid-drug-induced agranulocytosis in the English language literature are reviewed; Gram-negative bacilli, including Klebsiella pneumoniae (4 patients) and P. aeruginosa (3), were the most common pathogens in clinical isolates. Our observation and review suggest that broad-spectrum antibiotics with anti-pseudomonal activity should be given to patients with antithyroid drug-induced agranulocytosis who present with severe infection.

Adolescent↗

Donor site morbidity after suprafascial elevation of the radial forearm flap: a prospective study in 95 consecutive cases.

From March of 1995 to November of 1997, 95 free radial forearm flaps for orofacial reconstructions were performed and included in this prospective study of donor site morbidity. All flaps were elevated using the suprafascial dissection technique. Donor site closure was performed with either split-thickness skin grafts (64 cases) or full-thickness skin grafts (31 cases). Among the 95 flaps, there were two complete flap losses and one partial flap loss because of arterial thrombosis. One orocutaneus fistula was successfully treated with a pedicled pectoralis major flap. At the donor site, the rate of complete take of skin graft was 94 percent in 95 patients. Functional and aesthetic results evaluated at least 6 months postoperatively in 50 patients revealed no significant change in grip power, pulp-to-pulp pinch power, or wrist movement in the complete skin graft take group (45 cases), whereas in the partial skin graft failure group (5 cases), both grip power and movement were significantly decreased. There was no remarkable cold intolerance in any of the 50 patients. Critical evaluations of sensory change revealed numbness distal to the donor site in 54 percent of the patients. However, dysesthesia was usually mild and improved spontaneously as time passed. Aesthetic outcome was rated as good or fair in 98 percent of the cases. The results of this prospective study show that suprafascial elevation of the radial forearm flap is superior to the classic elevation technique, particularly with regard to a higher rate of immediate complete take of skin grafts, thus avoiding impairment of range of motion and strength of the donor hand.

Adult↗

Bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric oncology ward: clinical features and identification of different plasmids carrying both SHV-5 and TEM-1 genes.

Thirteen patients who had 16 episodes of bacteremia were observed between 1993 and 1997 in a pediatric oncology ward with a high background isolation rate of cefotaxime- or aztreonam-resistant gram-negative bacteria. Four blood isolates were Escherichia coli and 12 were Klebsiella pneumoniae, and these isolates harbored extended-spectrum beta-lactamases (ESBLs). All episodes of bacteremia were nosocomial, all except one of the episodes occurred in neutropenic patients, and all patients were treated with piperacillin or ceftazidime with amikacin and cefazolin prior to the onset of bacteremia. Nine of 13 patients were receiving extended-spectrum beta-lactam treatment when the bacteremias caused by ESBL producers occurred. Molecular studies revealed that four K. pneumoniae SHV-2-producing isolates from 1994 were of the same clone. Other ESBL producers, including six that carried both TEM-1 and SHV-5, five that carried SHV-5, and one that carried SHV-2 alone, were unrelated. In conclusion, SHV-5 was present in 11 of the 16 isolates and coexisted with TEM-1 in 6 isolates. Acquisition of resistance genes probably occurred under antibiotic selection pressure. This study highlights the importance of routine checks for and detection of ESBL producers. Effective therapy against ESBL producers should be considered early for children who have malignancies and neutropenia and who are septic, despite treatment with a regimen that includes an extended-spectrum beta-lactam, in a clinical setting of an increased incidence of ESBL-producing bacteria.

Adolescent↗

Specific interaction between the hepatitis C virus NS5B RNA polymerase and the 3' end of the viral RNA.

Hepatitis C virus (HCV) NS5B protein is the viral RNA-dependent RNA polymerase capable of directing RNA synthesis. In this study, an electrophoretic mobility shift assay demonstrated the interaction between a partially purified recombinant NS5B protein and a 3' viral genomic RNA with or without the conserved 98-nucleotide tail. The NS5B-RNA complexes were specifically competed away by the unlabeled homologous RNA but not by the viral 5' noncoding region and very poorly by the 3' conserved 98-nucleotide tail. A 3' coding region with conserved stem-loop structures rather than the 3' noncoding region of the HCV genome is critical for the specific binding of NS5B. Nevertheless, no direct interaction between the 3' coding region and the HCV NS5A protein was detected. Furthermore, two independent RNA-binding domains (RBDs) of NS5B were identified, RBD1, from amino acid residues 83 to 194, and RBD2, from residues 196 to 298. Interestingly, the conserved motifs of RNA-dependent RNA polymerase for putative RNA binding (220-DxxxxD-225) and template/primer position (282-S/TGxxxTxxxNS/T-292) are present in the RBD2. Nevertheless, the RNA-binding activity of RBD2 was abolished when it was linked to the carboxy-terminal half of the NS5B. These results provide some clues to understanding the initiation of HCV replication.

Amino Acid Sequence↗

Evaluation of pre- and postdilutional on-line hemodiafiltration adequacy by partial dialysate quantification and on-line urea monitor.

On-line highflux hemodiafiltration (HDF) is a clinically interesting and effective mode of renal replacement therapy, which offers the possibility to obtain an increased removal of both small and large solutes. The fundamental role of urea kinetic monitoring to assess dialysis adequacy in conventional hemodialysis has been widely studied. Both direct measurement of the urea removed by the modified direct dialysate quantitation (mDDQ) based on partial dialysate collection (PDC) and dialysate-based urea kinetic modeling (DUKM) using urea monitor have been advocated. The validity of this assessment tool in the patients with on-line HDF remained unclear. The aims of this investigation were (1) to compare the delivered Kt/V, urea mass removal (UMR), solute removal index (SRI) and normalized protein catabolic rate (nPCR) between pre- and postdilutional high-flux HDF; (2) to verify and compare the efficiency of pre- and postdilutional HDF using DUKM with on-line dialysate urea sensor, and mDDQ with partial dialysate collection. During both mode of HDF, the paired analysis urea removed and Kt/V showed no significant difference. Using mDDQ, mean values for predilutional mode were as follows: Kt/V 1.53 +/- 0.01 UMR, 16.8 +/- 0.3 g/session; urea clearance 178 +/- 18 ml/min; SRI 75.5 +/- 7.7%; urea distribution volume (V) 28.3 +/- 1.2 liters; nPCR 1.34 +/- 0.18 g/kg/day; on the other hand, mean values for postdilutional mode were Kt/V 1.58 +/- 0.01; UMR 17.10 +/- 0.28 g/session; urea clearance 184 +/- 21 ml/min; SRI 77.2 +/- 3.5%; urea distribution volume, 27.8 +/- 1.5 liters; nPCR 1.34 +/- 0.19 g/kg/day. The mean value of urea generation rate was 5.82 +/- 1.12 mg/min during HDF. Our results showed that dialysis adequacy was achieved with both high-volume predilutional HDF and postdilutional HDF. These two modes of HDF provided similar and adequate small solute clearance. In addition, we found that on-line analysis of urea kinetics is a reliable tool for quantifying and assuring delivery of adequate dialysis.

Adult↗

Argyrophilic nucleolar organizer regions in cells of thymoma and thymic carcinoma: correlation with DNA ploidy and clinicopathologic characteristics.

STUDY OBJECTIVES: To evaluate the usefulness of argyrophilic nucleolar organizer region (AgNOR) counting and flow cytometric DNA analysis in the differential diagnosis of thymoma and thymic carcinoma, as well as in the differences among various stages and histologic subtypes of these tumors. DESIGN AND INTERVENTIONS: Paraffin-embedded blocks of 64 thymic epithelial tumors (20 noninvasive thymomas, 34 invasive thymomas, and 10 thymic carcinomas) were studied by AgNOR counting and flow cytometric DNA analysis. The thymomas were histologically classified as medullary, cortical, or mixed subtype. MEASUREMENTS AND RESULTS: Invasive thymomas had more AgNORs (-/+ SD) than noninvasive thymomas (7.93+/-2.90 vs 5.97+/-1.77; p < 0.01). The number of AgNORs of thymoma increased progressively with advances in stage (p < 0.01). Cortical thymomas had the highest number of AgNORs among the three subtypes (p < 0.05). Patients with thymoma who presented with myasthenia gravis also had a higher number of AgNORs (8.30+/-3.12 vs 6.50+/-2.03; p < 0.01). The AgNOR number did not correlate with the DNA ploidy of all specimens. CONCLUSIONS: AgNOR counting is useful in differentiating between invasive and noninvasive thymomas, and in predicting the stage of thymomas. A greater number of AgNORs was observed in patients with cortical thymoma and in those who presented with myasthenia gravis.

Adult↗

Proinflammatory cytokines and fibrinolytic enzymes in tuberculous and malignant pleural effusions.

OBJECTIVES: To measure tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) in pleural effusions caused by tuberculosis (TB) and malignancy and their relationship with plasminogen activator inhibitor type I (PAI-1) and tissue type plasminogen activator (tPA), and to compare the differences between tuberculous and malignant pleural effusions. In addition, the relationship between the effusion levels of these parameters and the development of residual pleural thickening was evaluated in the patients with tuberculous pleurisy. DESIGN: Prospective study. MATERIALS AND METHODS: TNF-alpha, IL-1beta, PAI-1, and tPA were measured simultaneously in blood and pleural fluid using an enzyme-linked immunosorbent assay in 33 patients with tuberculous and in 30 patients with malignant pleural effusions. Residual pleural thickening was measured and defined as a pleural thickness of >/= 10 mm found on chest radiographs at the completion of anti-TB chemotherapy in tuberculous pleurisy patients. RESULTS: In both groups, the levels of proinflammatory cytokines and fibrinolytic enzymes were significantly higher in pleural fluid than in blood. The levels of TNF-alpha and PAI-1 were significantly higher in tuberculous than in malignant effusions. In contrast, malignant pleural fluid had significantly higher values of tPA than did tuberculous pleural fluid. In tuberculous effusions, the values of PAI-1 and the PAI-1/tPA ratio correlated positively and the levels of tPA correlated negatively with those of TNF-alpha and IL-1beta. In malignant pleural fluid, positive correlations were found between the values of proinflammatory cytokines (TNF-alpha and IL-1beta) and PAI-1. Residual pleural thickening was found in 9 of 33 patients (27. 3%) with tuberculous pleurisy. The pleural fluid values of TNF-alpha, IL-1beta, and PAI-1 were significantly higher and the concentrations of tPA were significantly lower in tuberculous pleurisy patients with residual pleural thickening. CONCLUSIONS: Compared to malignant pleural effusion, fibrinolytic activity in pleural fluid was reduced in tuberculous effusion. Pleural inflammation caused by TB may enhance the release of proinflammatory cytokines, particularly TNF-alpha, which subsequently may increase PAI-1 and decrease tPA in pleural fluid. The imbalance of PAI-1 and tPA in pleural space may lead to fibrin deposition and pleural thickening.

Antitubercular Agents↗

Body position, membrane diffusing capacity and pulmonary capillary blood volume in chronic bronchitis and pulmonary emphysema.

BACKGROUND: The effect of body position on diffusing capacity and its components, membrane diffusing capacity (Dm) and pulmonary capillary blood volume (Vc), in patients with chronic obstructive pulmonary disease (COPD) has remained elusive. This study was designed to evaluate the effect of body position on diffusing capacity for carbon monoxide (DLco), Dm and Vc in male patients with chronic bronchitis and pulmonary emphysema. METHODS: Pulmonary function tests including spirometry and lung volume were assessed in the erect position, and DLco, Dm and Vc were measured in the erect and supine positions in a random order in 17 men with chronic bronchitis and 19 men with pulmonary emphysema. RESULTS: Spirometry results and lung volumes were comparable between both groups of patients; however, significantly lower values of DLco and Kco (DLco corrected by alveolar volume, VA) were observed in the emphysema than in the bronchitis group. In the bronchitis group, Kco and Vc were significantly higher in the supine than in the erect position, but Dm was significantly lower in the supine position. Alternation of body position did not significantly affect DLco and its components in the emphysema group. DLco, Kco and Vc in both the erect and supine positions were significantly higher in the bronchitis than in the emphysema group. Vc-SE (SE, the data in the supine minus those in the erect position) was also significantly higher in the bronchitis group. In the bronchitis group, DLco-SE was significantly correlated with Dm-SE and Vc-SE. However, Kco-SE was highly correlated with Dm-SE. In the emphysema group, DLco-SE and Kco-SE were highly correlated with Vc-SE only. CONCLUSIONS: An increase in Vc in the supine position may account for the postural effect on Kco in bronchitis patients. In patients with pulmonary emphysema, decreased DLco and an absence of postural effect on DLco and its components may be due to a widespread abnormality of the pulmonary capillary bed. These findings may be of value in elucidating the difference in mechanisms of impaired gas exchange between patients with chronic bronchitis and pulmonary emphysema.

Aged↗

The role of tissue studies in facilitating early initiation of antimycobacterial treatment in AIDS patients with disseminated mycobacterial disease.

SETTING: The question of whether aggressive investigations are useful in diagnosis and initiation of treatment in AIDS patients with disseminated mycobacterial disease (DMD) is still under debate. OBJECTIVE: To define the role of tissue studies in facilitating early initiation of antimycobacterial treatment and in establishing diagnosis in AIDS patients with DMD. DESIGN: From July 1994 through June 1997, 167 AIDS cases with fever were evaluated by stepwise investigation using a standardized protocol. Data of DMD cases were analyzed to define the role of tissue studies. RESULTS: A total of 40 cases of culture-proven DMD were identified. Antimycobacterial treatment was initiated due to positive acid-fast bacilli smears of sputum in only five cases. In the remaining cases, positive pathologic findings from tissue biopsies (lymph node, bone marrow or liver) facilitated early initiation of treatment in 60% (21/35). In 50% of all cases (20/40), the diagnosis could not have been established if cultures of tissue biopsies had not been performed. Both the pathologic examinations and mycobacterial cultures from liver biopsies had positivity rates of more than 50% (53.8% and 69.2%, respectively). CONCLUSIONS: Tissue studies were useful in facilitating early initiation of treatment and establishing diagnosis at least in half of the AIDS cases with DMD. Liver biopsy is worthwhile if the cause of fever is not discovered using less invasive investigations.

AIDS-Related Opportunistic Infections↗

Clones of Lactobacillus casei and Torulopsis glabrata associated with recurrent abdominal wall abscess.

Infectious disease caused by Lactobacillus sp has not been previously reported in Taiwan. We present a case of recurrent abdominal wall abscess in a chronically ill 36-year-old woman, and review the literature on Lactobacillus infection. Five isolates of L. casei were recovered from blood and pus samples, and two isolates of Torulopsis glabrata were isolated from two blood specimens 3 months apart. Two clones of L. casei and T. glabrata were identified by means of antibiotyping with the E test and molecular methods. The abscess was surgically removed because of poor response to 7 months of antimicrobial therapy for the second infectious episode. Recurrent Lactobacillus infection can occur in chronically ill or immunosuppressed patients. Treatment of these infections may require a longer duration of antibiotic therapy, or surgical intervention.

Abdominal Abscess↗

Longitudinal analysis of methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan.

In Taiwan, the frequency of nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has increased rapidly during the past 10 years. To investigate the epidemiology of MRSA infections, a total of 140 MRSA isolates collected at National Taiwan University Hospital from 1992 to 1996 were characterized by pulsed-field gel electrophoresis (PFGE) profiles and antibiotypes, as determined with the disk diffusion method. Among these isolates, six PFGE types (with 20 subtypes) and six antibiotypes were identified. Antibiotyping proved to be a poor method of epidemiologic analysis, because almost all of the MRSA isolates analyzed shared a very similar multidrug-resistant antibiotype. Most MRSA infections and colonizations in this hospital were due to the spread of strains belonging to three major PFGE types (A, B, and C). However, the major type changed in different years with types A, B, and C being predominant in 1992 through 1993, 1994 through 1995, and 1996, respectively. The three major PFGE types spread easily throughout the hospital wards, presumably carried by health care workers and environmental contamination. Our results demonstrate that there was a dominant strain spreading in our hospital each year and the dominant strain may shift in different years.

Bacterial Typing Techniques↗

Pattern of defervescence in response to anti-tuberculosis therapy in patients with extrapulmonary tuberculosis and advanced human immunodeficiency virus infection.

The pattern of fever response to empiric anti-tuberculosis therapy in patients with tuberculosis (TB) and human immunodeficiency virus (HIV) infection, and the relationship between fever response patterns and anti-TB drug susceptibility profiles of Mycobacterium tuberculosis isolates are rarely described. In this study, we evaluated the fever responses to a four-drug anti-TB regimen in 26 HIV-infected patients with culture-proven extrapulmonary TB, and compared the results with those in 12 patients with disseminated Mycobacterium avium complex (DMAC) infection treated with a clarithromycin-containing regimen. The CD4 lymphocyte counts did not differ significantly between TB and DMAC patients (26 x 10(6)/L in TB patients vs 5 x 10(6)/L in DMAC patients). Drug susceptibility data were available for 22 patients with TB. Most TB patients had rapid defervescence after initiation of anti-TB therapy. Fever resolved within 1 week in 85% (22/26) of patients, including three of six (50%) with multidrug-resistant (MDR) TB. The median duration of fever in patients with drug-susceptible TB was similar to that in patients with drug-resistant TB (3 vs 4 days, p = 0.33). However, patients with MDR-TB were more likely than those with non-MDR TB to have fevers lasting longer than 1 week after initiating anti-TB therapy (3/6 vs 1/16, p = 0.046). Only 17% (2/12) of the patients with DMAC infection became afebrile within 1 week of beginning anti-MAC therapy (p < 0.001 vs those with TB). Our observations suggest that in HIV-infected patients with advanced immunosuppression, anti-TB regimens achieve significantly faster defervescence in TB patients than do anti-MAC regimens in DMAC patients. Rapid defervescence in patients with TB does not necessarily indicate that TB isolates are not MDR strains.

AIDS-Related Opportunistic Infections↗