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Background/objectivesLittle is known about the role of allopurinol use on the risk of hepatocellular carcinoma (HCC). The study aimed to examine the association between allopurinol use and HCC in Taiwan.MethodsUsing the database from the Taiwan National Health Insurance Program, we designed a case–control study that consisted of 4901 subjects aged 20–84 years with newly diagnosed HCC as the case group, and 4901 subjects aged 20–84 years without HCC as the control group, from 2000 to 2013. Ever use of allopurinol was defined as a subject who had at least a prescription for allopurinol before the index date. Never use was defined as a subject who never had a prescription for allopurinol before the index date. The OR and 95% CI for HCC associated with allopurinol use was measured by the multivariable logistic regression model.ResultsAfter adjustment for confounding factors, the adjusted OR of HCC was 0.93 (95% CI 0.81 to 1.07) for subjects with ever use of allopurinol, compared with never use. The adjusted OR of HCC was 1.01 for subjects with increasing cumulative duration of allopurinol use for every 1 year (95% CI 0.92 to 1.12), compared with never use. The adjusted OR of HCC was 0.99 for subjects with increasing cumulative dosage of allopurinol use for every 50 mg (95% CI 0.94 to 1.05), compared with never use.ConclusionsNo statistical association can be detected between allopurinol use and HCC risk in Taiwan. There are no duration-dependent and dosage-dependent effects of allopurinol use on the risk of HCC.

Few studies focus on the relationship between allopurinol and ischemic cerebrovascular disease. The goal of the study was to investigate the association of long-term therapy of allopurinol with the first-time attack of ischemic cerebrovascular disease in Taiwan. We performed a case–control study using the database of the Taiwan National Health Insurance Program. The case group included 14,937 subjects aged 20–84 years with the first-time attack of ischemic cerebrovascular disease from 2000 to 2013. The control group included 14,937 sex-matched and age-matched subjects aged 20–84 years without any type of cerebrovascular disease. Ever use of allopurinol was defined as subjects who had at least a prescription for allopurinol before the index date. The OR and the 95% CI for ischemic cerebrovascular disease associated with allopurinol use were measured by the multivariable logistic regression model. The adjusted OR of ischemic cerebrovascular disease was 0.992 (95% CI 0.989 to 0.996) for subjects with increasing cumulative duration of allopurinol use for every 1 month, compared with never use. In a further analysis, the adjusted OR of ischemic cerebrovascular disease was 0.74 (95% CI 0.57 to 0.96) for cumulative duration of allopurinol use >3 years, compared with never use. Our findings suggest that lone-term therapy of allopurinol >3 years is associated with decreased risk of the first-time attack of ischemic cerebrovascular disease, compared with no allopurinol therapy.

Few studies focus on the relationship between allopurinol and ischemic cerebrovascular disease. The goal of the study was to investigate the association of long-term therapy of allopurinol with the first-time attack of ischemic cerebrovascular disease in Taiwan. We performed a case–control study using the database of the Taiwan National Health Insurance Program. The case group included 14,937 subjects aged 20–84 years with the first-time attack of ischemic cerebrovascular disease from 2000 to 2013. The control group included 14,937 sex-matched and age-matched subjects aged 20–84 years without any type of cerebrovascular disease. Ever use of allopurinol was defined as subjects who had at least a prescription for allopurinol before the index date. The OR and the 95% CI for ischemic cerebrovascular disease associated with allopurinol use were measured by the multivariable logistic regression model. The adjusted OR of ischemic cerebrovascular disease was 0.992 (95% CI 0.989 to 0.996) for subjects with increasing cumulative duration of allopurinol use for every 1 month, compared with never use. In a further analysis, the adjusted OR of ischemic cerebrovascular disease was 0.74 (95% CI 0.57 to 0.96) for cumulative duration of allopurinol use >3 years, compared with never use. Our findings suggest that lone-term therapy of allopurinol >3 years is associated with decreased risk of the first-time attack of ischemic cerebrovascular disease, compared with no allopurinol therapy.

The aim of the study was to compare the treatment efficacy of peginterferon plus ribavirin on vegetarian vs omnivorous (nonvegetarian) patients with chronic hepatitis C infection. Two hundred and fifty-four hepatitis C virus (HCV) viremic patients with elevated alanine aminotransferase (ALT) levels, who received peginterferon plus ribavirin therapy were included in this study. Sixty-one patients (24.0%) were vegetarians and 193 patients (76.0%) were omnivores. We analyzed the sustained virological response (SVR) and compared the data between the two treatment groups using a logistic-regression model. Other possible confounding factors such as age, gender, body mass index, HCV genotype, pretreatment ALT levels and HCV viral count, type of peginterferon used, and status of cirrhosis, coronary heart disease, hypertension, and diabetes mellitus were also included in the analysis. SVR was demonstrated in 77% of the vegetarian cohort (47 out of 61 patients) and 76.2% of the omnivorous cohort (147 out of 193 patients). In the multivariate logistic-regression analysis, we found that a vegetarian diet was not associated with an increased protection against an SVR (odds ratio [OR] 1.35; 95% confidence interval [CI] 0.61-2.99). HCV genotype 1b (OR 0.51; 95% CI 0.27-0.98), ALT level (OR 1.01; 95% CI 1.00-1.01), cirrhotic (OR 0.20; 95% CI 0.08-0.49), and diabetic (OR 0.22; 95% CI 0.08-0.64) at pretreatment baseline were significantly associated with a clinical SVR. A vegetarian diet exerts no influence on the treatment efficacy of peginterferon plus ribavirin cotherapy among patients with chronic hepatitis C infection.

Background This study was conducted to evaluate the risk of developing acute pancreatitis (AP) and the fatality from AP in hemodialysis (HD) and peritoneal dialysis (PD) patients, using the claims data of Taiwan National Health Insurance.Methods From patients with newly diagnosed end-stage renal disease (ESRD) in 2000–2010, we identified a PD cohort (N= 9,766), a HD cohort (N= 18,841), and a control cohort (N= 114,386) matched by sex, age, and the diagnosis year of the PD cohort. We also established another 2 cohorts with 9,744 PD patients and 9,744 propensity score-matched HD patients. The incident AP and fatality from AP were evaluated for all cohorts by the end of 2011.Results The adjusted hazard ratios (HRs) of acute pancreatitis were 5.68 (95% confidence interval [CI] = 5.05 – 6.39), 4.91 (95% CI = 4.32 – 5.59), and 7.47 (95% CI = 6.48 – 8.62) in the all dialysis, HD, and PD patients, compared with the controls, respectively. Peritoneal dialysis patients had an adjusted HR of 1.41 (95% CI = 1.21 – 1.65) for AP, compared with propensity score-matched HD patients. Peritoneal dialysis patients under icodextrin treatment had a lower incidence of AP than those without the treatment, with an adjusted HR of 0.59 (95% CI = 0.47 – 0.73). There was no significant difference in the 30-day mortality from AP between HD and PD patients.Conclusions Peritoneal dialysis patients were at a higher risk of developing AP than HD patients. Icodextrin solution could reduce the risk of developing AP in PD patients.

IntroductionMaintaining the standard two-handed chest compression is difficult in high-speed ambulances in rural areas.MethodsA retrospective, video-based, observational study was conducted from June to September 2013 in Nantou, a rural county of central Taiwan, to evaluate the chest compression fraction in an ambulance carriage during the travel from the scene to the hospital. The chest compression fraction was calculated as the chest compression time period divided by the ambulance travelling time period; the one-handed and two-handed chest compression fractions were also calculated.ResultsDuring the 4-month study period, a total of 102 videos that were recorded in an ambulance carriage were reviewed, including 97 cases of manual chest compressions. When there was only one emergency medical technician (EMT) in the carriage, the combined chest compression fraction was 50.6±20.7%; when there were two EMTs, the fraction was 58.3±16.0% and the fraction was 58.3±21.0% in a three-EMT scenario (p=0.221). Moreover, in the carriage, EMTs usually performed one-handed chest compressions.ConclusionsThe chest compression fraction was low for patients with out-of-hospital cardiac arrest in a moving ambulance, irrespective of the number of providers. Reasons for this observation, as well as the effectiveness of the one-handed chest compression require further evaluation.

Background and objectiveClinical evidence is scarce about the relationship between losartan use and acute pancreatitis. We therefore conducted a population-based case–control study using the database from the Taiwan National Health Insurance Program to investigate this question.MethodsThe study consisted of 1449 hypertensive subjects aged 20–84 years with a first episode of acute pancreatitis during the period 2000–2011 as the case group and 2479 hypertensive subjects without acute pancreatitis as the control group. Both the case and control groups were matched for sex, age, comorbidities and index year of acute pancreatitis diagnosis. According to the history of losartan prescription before the date of diagnosis of acute pancreatitis, subjects who had never received a prescription for losartan were defined as ‘never use of losartan’, those whose last remaining losartan tablet was detected within 7 days before the date of diagnosis of acute pancreatitis were defined as ‘current use of losartan’ and those whose last remaining tablet of losartan was detected ≥8 days before the date of diagnosis of acute pancreatitis were defined as ‘late use of losartan’. ORs and 95% CIs were measured to investigate the risk of acute pancreatitis associated with losartan use by the multivariable unconditional logistic regression model.ResultsAfter adjustment for potentially confounding factors, the adjusted OR of acute pancreatitis was 0.96 (95% CI 0.68 to 1.37) for subjects with current use of losartan compared with those with never use of losartan, but the difference was not statistically significant. For subjects with late use of losartan the adjusted OR of acute pancreatitis was 1.05 (95% CI 0.80 to 1.37), which also was not statistically significant.ConclusionsNo significant association can be detected between losartan use and acute pancreatitis in hypertensive patients. More research is required to determine the potential role of losartan in the risk of acute pancreatitis.

Epidemiological studies have shown that people having hyperuricemia are at increased risk of ischemic cerebrovascular disease. This research aimed to study the relation of ischemic cerebrovascular disease with benzbromarone use among persons with gout-related disorders. This was a retrospective cohort design utilizing a 2003 to 2015 national health insurance database in Taiwan. Subjects aged 20 to 99 years who already had suffered from gout-related disorders were included as eligible subjects. Eligible persons who had the benzbromarone prescription alone were selected into the benzbromarone group. Sex-matched and age-matched eligible persons who never used any urate-lowering agents were selected into the control group. An index date was set as a date of benzbromarone being prescribed. The end-point was defined as ischemic cerebrovascular disease being newly diagnosed. A hazard ratio was applied to measure the association strength between benzbromarone use and ischemic cerebrovascular disease. Totally, there were 13,398 persons in the benzbromarone group and 13,398 persons in the control group. The incidence rate of ischemic cerebrovascular disease seemed to be modestly higher in the benzbromarone group than the control group, but it did not achieve statistical significance (0.78 vs 0.75 every 100 person-years, incidence rate ratio = 1.05, 95% confidence interval = 0.94–1.16). A crude hazard ratio of ischemic cerebrovascular disease showed 1.05 in the benzbromarone group (95% confidence interval = 0.94–1.17, P= .373) comparing with the control group. No significant association can be detected between benzbromarone use and the probability of ischemic cerebrovascular disease among persons with gout-related disorders. We think that reduction of the serum uric acid by use of benzbromarone could not be related to the probability of ischemic cerebrovascular disease. Further research is suggested to clarify this issue.

Few studies have addressed the association between polypharmacy and hip fracture using population data. We conducted a population-based case-control study to investigate whether polypharmacy increases the risk for hip fracture in the elderly. We used insurance claims data from the Taiwan Bureau of National Health Insurance, a universal insurance program with a coverage rate of more than 98% of the population in Taiwan. We identified 2328 elderly patients with newly diagnosed hip fracture during the period 2005-2007. We randomly selected 9312 individuals without hip fracture to serve as the control group. Patient characteristics, drugs prescribed by physicians, and all types of hip fracture were ascertained. The odds ratio (OR) of hip fracture in association with the number of medications used per day in previous years was assessed.

The pathogenesis of gallstone disease is multifactorial. Few studies have focused on gallbladder stones in the chronic kidney disease population in Taiwan. We conducted the current study to determine the prevalence of gallbladder stones in populations with and without chronic kidney disease.

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Background/Aim: No published nation-based study has examined the relationship between weight loss and cancer in Taiwan. The aim of this study was to investigate whether weight loss is an early clinical manifestation of cancer in Taiwan.

Background/Objective: Little research is available on the relationship between weight loss and human immunodeficiency virus (HIV) infection in Taiwan. We hope to evaluate whether weight loss could be an early clinical feature of undiagnosed HIV infection in Taiwan.

Background/Purpose: Little research is currently available on the relationship between weight loss and pulmonary tuberculosis in Taiwan. This study aimed to evaluate whether weight loss is an early clinical feature of pulmonary tuberculosis in Taiwan.

Background and aim: There are no epidemiological studies focusing on the association between oral corticosteroid use and pyogenic liver abscesses. The aim of the study was to assess whether oral corticosteroid use is associated with increased odds of pyogenic liver abscesses in adults in Taiwan.