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Background and purpose Stroke is a rare complication of snakebites, but may lead to serious sequelae. We aimed to explore the relationship between venomous snakebite and the risk for acute stroke, in a nationwide population-based cohort study. Methods This retrospective cohort study used claims data between 1 January 2000 and 31 December 2012, from the Taiwan National Health Insurance Research Database. The study included data of patients aged 18 years or older with venomous snakebite (n  = 535), matched for propensity score with controls without venomous snakebite (n  = 2140). The follow-up period was the duration from the initial diagnosis of venomous snakebite and administration of antivenom to the date of an acute stroke, or until 31 December 2013. The competing risk model was used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of stroke, ischemic stroke and hemorrhagic stroke, after adjusting for demographic and other possible stroke risk factors. Results The adjusted HR for the venomous snakebite group compared with the control group was 2.68 for hemorrhagic stroke (95% CI = 1.35-5.33). Stratified analysis showed that the older age group (>65 years old) had a higher risk of hemorrhagic stroke. A 2.72-fold significant increase in the risk for hemorrhagic stroke was observed following venomous snakebite with antivenom usage (95% CI = 1.41–5.26). Conclusion Venomous snakebite is associated with an increased risk of hemorrhagic stroke after the use of antivenom. Further study of the underlying mechanism is warranted. [ABSTRACT FROM AUTHOR]

Background Many patients with atopic diseases, including asthma, have sought complementary and alternative medicine and traditional Chinese medicine (TCM) treatments. But, limited clinical studies have yet examined TCM effects on medical utility in asthma patients. Aim To assess the medical utility of TCM in patients with asthma. Design Population-based retrospective cohort study. Methods We performed a 13-year population-based retrospective cohort study. A total of 5235 asthma patients who were TCM users and 5235 propensity-score matched asthma patients who never used TCM were sampled from the Taiwan National Health Insurance Research Database from 2000 to 2012. We compared these two groups of patients to calculate their medical utility, including numbers of emergency visits and hospitalizations until 2013. Univariate analyses were performed using Chi-square tests for dichotomous variables and t-tests for continuous variables. Cox proportional hazard models were conducted to investigate the medical utility of asthma after TCM use. Results Compared with non-TCM patients, TCM patients had a significantly decreased medical utility of asthma admission [adjusted odds ratio (OR) = 0.63; 95% confidence interval (CI): 0.46–0.85; P  < 0.05], especially in patients who used TCM for >60 days. Asthma medical utility in asthma emergencies was significantly higher for male than for female patients (adjusted OR = 1.45; 95% CI: 1.08–1.96). The most frequently used TCMs for asthma control or cough treatment were antitussive agents. Conclusion This population-based retrospective cohort study showed a significantly decreased medical utility of emergency visits and admissions in TCM patients, especially using TCM for >60 days. [ABSTRACT FROM AUTHOR]

Background The relationship between gout medication use and cataract development is controversial. Moreover, limited clinical studies have evaluated this relationship. Aim To assess the effects of colchicine, allopurinol and benzbromarone on the risk of cataract in patients with gout. Design Population-based nested case–control study. Methods We enrolled 7900 patients who had received a new diagnosis of cataract >3 years after gout diagnosis into the study group and 33 475 patients who did not receive a diagnosis of cataract into the control group by matching for age, sex and the year of gout diagnosis at a ratio of 1:1. We used World Health Organization's defined daily dose (DDD) as a measure to assess the dosage of colchicine, allopurinol and benzbromarone exposure. Logistic regression was used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of cataract. Results The risk of cataract significantly increased in patients who received colchicine at a cumulative DDD of ≥66.5 (OR = 1.17, 95% CI = 1.01–1.36, P  = 0.041). In the age-stratified analysis, patients with gout aged >60 years had a higher risk of cataract (OR = 1.27, 95% CI = 1.06–1.53, P  = 0.011) than did patients aged <60 years. Allopurinol and benzbromarone had no association with cataract. Conclusions In this population-based nested case–control study, we observed that colchicine use increased the risk of cataract in patients with gout, especially in those aged >60 years who received colchicine at a cumulative DDD of >66.5. [ABSTRACT FROM AUTHOR]

Objectives To determine whether taking hydroxychloroquine (HCQ) could prevent the development of new-onset diabetes mellitus (DM) among patients with Sjögren syndrome (SS). Methods This is a nationwide, population-based, retrospective cohort study utilizing the Taiwan National Health Insurance Research Database (NHIRD). Data were collected from 1 January 1999, through 31 December 2013, using the International Classification of Diseases , Ninth Revision , Clinical Modification codes. In total, 7774 patients newly diagnosed with SS by at least three outpatient visits or one inpatient admission were selected from the NHIRD as participants. Patients who had previously been diagnosed with DM and whose follow-up durations shorter than 90 days were excluded. HCQ exposure group includes patients who had been diagnosed with SS no longer than 180 days previously, and had been prescribed HCQ for the first time for at least 90 days. The diagnosis of DM was defined as at least two outpatient visits or one inpatient admission with anti-diabetic medication prescription. Results Patients with SS treated with HCQ had a significantly lower cumulative incidence of new-onset DM than those not treated with HCQ (adjusted hazard ratio: 0.51, 95% confidence interval: 0.28–0.96, P < 0.05). HCQ use for 3 years or more had favorable protective effects (adjusted hazard ratio: 0.22, CI: 0.05–0.92). Conclusions HCQ reduced the incidence of DM in a time and dose-dependent manner. Patients with SS who had taken HCQ for 3 years or more exhibited significant protective effects against developing new-onset DM. [ABSTRACT FROM AUTHOR]

The correspondents call attention to unmeasured confounders such as anticoagulants and occupations that might have a moderating or mediating effect on the association between venomous snakebite and subsequent risk of hemorrhagic stroke in our study.[1] However, the limited availability of up-to-date data in the National Health Insurance Research Database (NHIRD) impedes a complete answer to the question pose. We searched for traumatic ICH using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 800-804 and found that the patients with hemorrhagic stroke in our study did not have a traumatic ICH as the cause. First, non-vitamin K antagonist oral anticoagulants (NOACs) are covered by Taiwan national health insurance since 2012, less data we could get about the correlation between NOACs and hemorrhagic stroke. [Extracted from the article]

We thank you for the opportunity to answer about the letter from Prof. Jou I et al. i , and we thank Prof. Jou I et al. i for their comments. Traditional Chinese medicine use may reduce medical utility in patients with asthma: a nationwide population-based retrospective cohort study. [Extracted from the article]

Background: Viral infection contributing to systemic lupus erythematosus (SLE) development has been largely reported. However, the SLE risk in patients with human papillomavirus (HPV) infection is unknown. Methods: Data were retrieved from the Longitudinal Health Insurance Database (2000) in Taiwan. We identified 43,567 patients with HPV infection and 174,268 age- and sex-matched uninfected controls from 2002 to 2012. Individuals were followed up from index date (first date of diagnosis with HPV) until the occurrence of SLE, at the end of the study (December 2013), or when they were withdrawn from the insurance program. The incidence rate ratio (IRR) was calculated using the univariate Poisson regression. The adjusted hazard ratios (aHRs) were calculated, and sensitive and subgroups analyses were also conducted. Results: Compared with the non-HPV controls, the IRR of SLE in HPV patients was 1.52 (95% confidence interval (CI): 1.09–2.12). The risk of SLE in HPV-infected individuals was significantly high (aHR: 1.48, 95% CI: 1.06–2.06) after adjusting for age, sex, and comorbidities. Men aged between 16 and 45 years were more susceptible to developing SLE (aHR: 21.57, 95% CI: 2.52–184.60, p = 0.0051). Conclusion: Our study showed a significantly higher risk of SLE among HPV-infected patients, especially in men aged between 16 and 45 years. [ABSTRACT FROM AUTHOR]

Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort. Dear Editor, We read with great interest the article by Zhan I et al. i [1] reporting that the poor glycemic control would lead to short-term dismal outcome among coronavirus disease 2019 (COVID-19) patients with type 2 diabetes. [Extracted from the article]

Perhaps dual-energy X-ray absorptiometry based bone mineral density (BMD) can act as a predictor for fracture risk to avoid interindividual differences in drug response, especially signs such as BMD changes that are strongly associated with vertebral fractures [4]. Keywords: anti-osteoporosis medication; bisphosphonates; denosumab; NHIRD EN anti-osteoporosis medication bisphosphonates denosumab NHIRD 384 385 2 02/22/22 20220301 NES 220301 We have carefully read the cohort study by Fu et al. on anti-osteoporosis medication (AOM) [1]. Regarding: Increased fracture risk after discontinuation of anti-osteoporosis medications among hip fracture patients. [Extracted from the article]

Systemic lupus erythematosus (SLE) can affect all heart structures including the conduction system, with either reversible or permanent derangement. However, only a few cases of adult SLE and complete atrioventricular (AV) block have been reported. We describe a young pregnant woman who initially presented with complete AV block on electrocardiography before the diagnosis of SLE. Syncope subsequently developed during the postpartum period due to frequent nonsustained polymorphic ventricular tachycardia, suggesting lupus myocarditis. The ventricular arrhythmia was successfully treated by intravenous corticosteroids, lidocaine and implantation of a permanent pacemaker. This may represent the first report of complete AV block with polymorphic ventricular tachycardia, which was identified before the other clinical features of SLE fully manifested. SLE should be considered if a patient presents with complete AV block without other clinical features. It may warn for early diagnosis and appropriate treatment of SLE including lupus-related heart disease. [ABSTRACT FROM AUTHOR]

Background/Objectives:The purpose of this study was to investigate whether vitamin B6 supplementation had a beneficial effect on inflammatory and immune responses in patients with rheumatoid arthritis (RA).Subjects/Methods:This was a single-blind co-intervention study performed at the Division of Allergy, Immunology and Rheumatology of Chung Shan Medical University Hospital, Taiwan. Patients were diagnosed with RA according to the 1991 American College of Rheumatology criteria for RA. Patients were randomly allocated into two groups: control (5 mg/day folic acid only; n=15) or vitamin B6 (5 mg/day folic acid plus 100 mg/day vitamin B6; n=20) for 12 weeks. Plasma pyridoxal 5′-phosphate (PLP), serum folate, inflammatory parameters (that is, high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)) and immune parameters (that is, white blood cell, total lymphocyte, T-cell (CD3), B-cell (CD19), T-helper cell (CD4), T-suppressor (CD8)) were measured on day 1 (week 0) and after 12 weeks (week 12) of the intervention.Results:In the group receiving vitamin B6, plasma IL-6 and TNF-α levels significantly decreased at week 12. There were no significant changes with respect to immune responses in both groups except for the percentage of total lymphocytes in the vitamin B6 group when compared with week 0 and week 12. Plasma IL-6 level remained significantly inversely related to plasma PLP after adjusting for confounders (β=−0.01, P=0.01).Conclusions:A large dose of vitamin B6 supplementation (100 mg/day) suppressed pro-inflammatory cytokines (that is, IL-6 and TNF-α) in patients with RA. [ABSTRACT FROM AUTHOR]