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Background: Medical students' white coats were found to harbor harmful organisms. This could be due to non-compliance to white coat hygiene measures. Therefore, we aim to develop and validate a questionnaire to assess the of knowledge, attitude, and practice (LAUNDERKAP) of white coat use among medical students in Malaysia., Methods: This study was conducted in 4 local medical schools. LAUNDERKAP was developed via literature review and had 3 domains: attitude, knowledge, practice. An expert panel assessed the content validity and clarity of wording. LAUNDERKAP was then piloted among 32 medical students. To test construct validity and internal consistency, 362 medical students were approached. Construct validity was assessed using exploratory factor analysis. Internal consistency was evaluated using Cronbach alpha for attitude and practice, while Kuder-Richardson 20 (KR-20) was used for knowledge., Results: A total of 319 of 362 students responded. Exploratory factor analysis extracted 1 factor each for attitude and knowledge respectively, and 3 factors for practice. Cronbach alpha for attitude was 0.843 while KR-20 for knowledge was 0.457. Cronbach alpha for practice ranged from 0.375 to 0.689. The final LAUNDERKAP contained 32-items (13 attitude, 9 knowledge, 10 practice)., Conclusions: LAUNDERKAP had adequate psychometric properties and can be used to assess KAP of medical students towards white coat use., (Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: The spread of the coronavirus disease 2019 (COVID-19) has increasingly agonized daily lives worldwide. As an archipelagic country, Indonesia has various physical and social environments, which implies that each region has a different response to the pandemic. This study aims to analyze the spatial differentiation of COVID-19 in Indonesia and its interactions with socioenvironmental factors., Methods: The socioenvironmental factors include seven variables, namely, the internet development index, literacy index, average temperature, urban index, poverty rate, population density (PD) and commuter worker (CW) rate. The multiple linear regression (MLR) and geographically weighted regression (GWR) models are used to analyze the impact of the socioenvironmental factors on COVID-19 cases. COVID-19 data is obtained from the Indonesian Ministry of Health until November 30th 2020., Results: Results show that the COVID-19 cases in Indonesia are concentrated in Java, which is a densely populated area with high urbanization and industrialization. The other provinces with numerous confirmed COVID-19 cases include South Sulawesi, Bali, and North Sumatra. This study shows that the socioenvironmental factors, simultaneously, influence the increasing of confirmed COVID-19 cases in the 34 provinces of Indonesia. Spatial interactions between the variables in the GWR model are relatively better than those between the variables in the MLR model. The highest spatial tendency is observed outside Java, such as in East Nusa Tenggara, West Nusa Tenggara, and Bali., Conclusion: Priority for mitigation and outbreak management should be high in areas with high PD, urbanized spaces, and CW., (© 2022. The Author(s).)

Rice is an important cereal and a staple food in many countries in the world. Climate change is a significant challenge that affects paddy production and threatens food security. However, research and development in this area continue to work to ensure the supply of rice fulfils the demands of the population. The study aims to analyse the transformation of international research power in trends in climate change that threaten food security (rice) worldwide. This study evaluates existing publications, especially research works from the period 1970 to 2020. The Web of Science database and the VOSviewer software were used together to generate a systematic analysis. A total of 1181 publications on climate change and paddy production were identified, written by 2249 authors from 56 countries. The highest number of publications was from China with 240 publications with 4609 citations, followed by India, with 225 publications and 2070 citations. Yield and adaptation are the most frequently used keywords that reflect this field's current significant research direction. Besides that, developing countries have received greater attention from researchers to focus on science, agriculture, climatology, and agriculture engineering as their domains. Therefore, socio-economic aspects should also be highlighted to raise awareness of the dangers of climate change and improve the farmers' economy by increasing paddy production. Attention was given by all countries globally, especially by researchers and stakeholders who need to plan holistic policies and strategies to encourage sustainable rice production and at the same time reduce the impact of climate change worldwide., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The purpose of this study was to develop an automatic deep learning-based approach and corresponding free, open-source software to perform segmentation of the Schlemm's canal (SC) lumen in optical coherence tomography (OCT) scans of living mouse eyes. A novel convolutional neural network (CNN) for semantic segmentation grounded in a U-Net architecture was developed by incorporating a late fusion scheme, multi-scale input image pyramid, dilated residual convolution blocks, and attention-gating. 163 pairs of intensity and speckle variance (SV) OCT B-scans acquired from 32 living mouse eyes were used for training, validation, and testing of this CNN model for segmentation of the SC lumen. The proposed model achieved a mean Dice Similarity Coefficient (DSC) of 0.694 ± 0.256 and median DSC of 0.791, while manual segmentation performed by a second expert grader achieved a mean and median DSC of 0.713 ± 0.209 and 0.763, respectively. This work presents the first automatic method for segmentation of the SC lumen in OCT images of living mouse eyes. The performance of the proposed model is comparable to the performance of a second human grader. Open-source automatic software for segmentation of the SC lumen is expected to accelerate experiments for studying treatment efficacy of new drugs affecting intraocular pressure and related diseases such as glaucoma, which present as changes in the SC area., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Although COVID-19 is predominantly a respiratory disease, it is known to affect multiple organ systems. In this article, we highlight the impact of SARS-CoV-2 (the coronavirus causing COVID-19) on the central nervous system as there is an urgent need to understand the longitudinal impacts of COVID-19 on brain function, behaviour and cognition. Furthermore, we address the possibility of intergenerational impacts of COVID-19 on the brain, potentially via both maternal and paternal routes. Evidence from preclinical models of earlier coronaviruses has shown direct viral infiltration across the blood-brain barrier and indirect secondary effects due to other organ pathology and inflammation. In the most severely ill patients with pneumonia requiring intensive care, there appears to be additional severe inflammatory response and associated thrombophilia with widespread organ damage, including the brain. Maternal viral (and other) infections during pregnancy can affect the offspring, with greater incidence of neurodevelopmental disorders, such as autism, schizophrenia and epilepsy. Available reports suggest possible vertical transmission of SARS-CoV-2, although longitudinal cohort studies of such offspring are needed. The impact of paternal infection on the offspring and intergenerational effects should also be considered. Research targeted at mechanistic insights into all aspects of pathogenesis, including neurological, neuropsychiatric and haematological systems alongside pulmonary pathology, will be critical in informing future therapeutic approaches. With these future challenges in mind, we highlight the importance of national and international collaborative efforts to gather the required clinical and preclinical data to effectively address the possible long-term sequelae of this global pandemic, particularly with respect to the brain and mental health.

Background: Safety, environmental and economic setbacks are driving industries to find greener approaches to extract bioactive compounds from natural resources. Pressurized hot water extraction (PHWE) is among the solvent free and efficient methods for extracting bioactive compounds., Experimental: In this study, the suitability of PHWE for extracting bioactive compounds such as phenolics, hydrolysable tannins and flavonoids from Phyllanthus tenellus was investigated by UPLC-qTOF-MS., Results: Solvent properties of water are significantly increased through imposing temperature at 121 °C and pressure at 15 p.s.i. Pressurized hot water extraction obtained 991-folds higher hydrolysable tannins than methanol extraction., Conclusion: The extraction yields of hydrolysable tannins with PHWE was almost double of absolute methanol extraction., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2019.)

Water constitutes a major environmental and public health concerns worldwide. A large proportion of global water consumption is sourced from surface water. The dependency level on surface water is higher in developing countries, especially in rural-to-semi-urban areas, where subsurface water is not accessible. Presented in this paper is a spatiotemporal and hydrochemical quality assessment of the spring-originated Landzun Stream in Bida, Nigeria; which is usually consumed in its untreated state. Water samples were systematically collected in eighteen locations along the stream channel in both rainy and dry seasons at an equidistance interval of 500m. On-site and laboratory measurement of important physical and hydrochemical parameters were carried out using standard procedures. Water temperature in the rainy season (34-37 °C) slightly exceeds measured values in the dry season (29-33 °C). 72.22% (rainy) and 83.33% (dry) of collected samples did not meet the odourless requirement for drinking water. Similarly, estimated percentages of 66.67 and 94.44 of collected samples in rainy and dry seasons respectively have a taste. Contrary to data in the rainy season, 89%, 11%, 67% and 56% of the dry season's samples were enriched in magnesium (Mg), lead (Pb), potassium (K) and iron (Fe) respectively above the 2018 World Health Organisation guidelines for drinking water. This study further established that seasonal variation plays a major role in altering the aesthetic surface water quality. The intake of untreated surface water is a vehicle for potential water-borne diseases and allergies, hence alternative sources of drinking water for the populace dependent on the Landzun Stream is recommended to reduce risks and possible dangers of consuming the stream water.

Context: The Palliative Care Outcome Scale (POS) is an easy-to-use assessment tool to evaluate the effectiveness of palliative care. There is no published literature on the use of POS as an assessment tool in Malaysia., Aim: To define the concordance in the assessment of quality of life between patients with advanced cancers and their palliative care nurses using a Malay version of the POS., Settings and Design: This study was conducted in the palliative care unit of the Hospital Tuanku Ja'afar Seremban, Malaysia, from February 2014 to June 2014., Subjects and Methods: We adapted and validated the English version of the 3-day recall POS into Malay and used it to define the concordance in the assessment of quality of life between patients and palliative care nurses. Forty patients with advanced stage cancers and forty palliative care nurses completed the Malay POS questionnaire., Statistical Analysis Used: The kappa statistical test was used to assess the agreement between patients and their palliative care nurses., Results: Slight to fair concordance was found in all items, except for one item (family anxiety) where there was no agreement., Conclusions: The Malay version of the POS was well accepted and reliable as an assessment tool for evaluation of the effectiveness of palliative care in Malaysia. Slight to fair concordance was shown between the patients and their palliative care nurses, suggesting the needs for more training of the nurses., Competing Interests: There are no conflicts of interest.

An efficient and rapid method for the analysis of pesticide residues in cocoa beans using gas and liquid chromatography-tandem mass spectrometry was developed, validated and applied to imported and domestic cocoa beans samples collected over 2 years from smallholders and Malaysian ports. The method was based on solvent extraction method and covers 26 pesticides (insecticides, fungicides, and herbicides) of different chemical classes. The recoveries for all pesticides at 10 and 50 μg/kg were in the range of 70-120% with relative standard deviations of less than 20%. Good selectivity and sensitivity were obtained with method limit of quantification of 10 μg/kg. The expanded uncertainty measurements were in the range of 4-25%. Finally, the proposed method was successfully applied for the routine analysis of pesticide residues in cocoa beans via a monitoring study where 10% of them was found positive for chlorpyrifos, ametryn and metalaxyl., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: The perioperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for T1-T2 renal cell carcinoma (RCC) are well established. We aim to determine whether LRN is a comparable alternative to open radical nephrectomy (ORN) in the treatment of T3 RCC using a matched pair analysis study design., Methods: A review of a prospectively collected database at the Western General Hospital, Edinburgh, between 2000 and 2011 was conducted. Patient pairs were matched based on age at operation, gender, histological subgroup, maximal tumour diameter, TNM stage and grade. Patient demographics, operative and post-operative outcomes were compared. Overall, cancer-specific and progression-free survival [overall survival, cancer-specific survival (CSS) and progression-free survival (PFS)] were estimated using the Kaplan-Meier method., Results: From 252 patients with T3 disease, 25 pairs were matched. Patients were of median age 66.2 years, 64 % male. Tumours were all clear cell RCC, were stage pT3a (32 %) or pT3b and had maximal tumour diameters of 8.7 cm for LRN and 10.0 cm for ORN. Estimated blood loss (100 ml LRN; 650 ml ORN, p < 0.001) and length of post-operative hospital stay (4 days LRN: 9 days ORN, p < 0.001) were lower in the LRN group. Operation time and post-operative complication rates were comparable. CSS and PFS were comparable with a mean CSS of 91.3 months for LRN and 88.7 months for ORN., Conclusion: This study reports the longest median follow-up in a T3 LRN cohort. In matched patients, LRN has been shown to have a superior perioperative profile to ORN for the treatment of pT3a/b RCC, with no adverse effect on midterm oncological outcomes.

Previous studies on the nutritional and nutraceutical properties of Lignosus rhinocerotis focused mainly on the sclerotium; however, the supply of wild sclerotium is limited. In this investigation, the antioxidant capacity and cytotoxic effect of L. rhinocerotis cultured under different conditions of liquid fermentation (shaken and static) were compared to the sclerotium produced by solid-substrate fermentation. Aqueous methanol extracts of the mycelium (LR-MH, LR-MT) and culture broth (LR-BH, LR-BT) demonstrated either higher or comparable antioxidant capacities to the sclerotium extract (LR-SC) based on their radical scavenging abilities, reducing properties, metal chelating activities, and inhibitory effects on lipid peroxidation. All extracts exerted low cytotoxicity (IC50>200 µg/ml, 72 h) against selected mammalian cell lines. Several low-molecular-weight compounds, including sugars, fatty acids, methyl esters, sterols, amides, amino acids, phenolics, and triterpenoids, were identified using GC-MS and UHPLC-ESI-MS/MS. The presence of proteins (<40 kDa) in the extracts was confirmed by SDS-PAGE and SELDI-TOF-MS. Principal component analysis revealed that the chemical profiles of the mycelial extracts under shaken and static conditions were distinct from those of the sclerotium. Results from bioactivity evaluation and chemical profiling showed that L. rhinocerotis from liquid fermentation merits consideration as an alternative source of functional ingredients and potential substitute for the sclerotium.

We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM) clients who received voluntary counseling and testing (VCT) services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9%) clients rated themselves as low risk, 118 (27.9%) as medium risk, 36 (8.5%) as high risk, and 168 (39.7%) were unsure of their risk. Twenty-four (9.4%) clients tested HIV positive (4 (4%) low risk, 9 (7.6%) medium risk, 11 (30.6%) high risk, and 13 (7.7%) unsure risk). We found a positive correlation between risk perception and HIV infection in this study. Clients with high HIV risk perception have 17x the odds of testing HIV positive compared to low risk clients. High HIV risk perception was significantly associated with multiple sex partners, multiple types of sex partners, alcohol use before intercourse, unprotected sex beyond 6 months, and inconsistent condom use during anal sex compared to low risk clients. There were no statistically significant differences between medium risk and unsure risk clients compared to low risk clients. Strategies should be targeted towards change in sexual practices among those who are perceived to be at high risk.

The total phenolic content and radical scavenging activity of Andrographis paniculata has been investigated to estimate the amount of phenolic compounds and diterpene lactones, respectively in the plant extracts. The stem extracts exhibited higher total phenolic content and scavenging activity than those of the leaf extracts from both young and mature plants. A range of 19.6-47.8 mg extract of A. paniculata from different parts of the plant is equivalent to the scavenging activity exhibited by one mg of standard Trolox. HPLC-ESI-MS/MS was also used to identify simultaneously the phytochemicals from the leaves and stems of both young and mature plant samples. Of the identified compounds, seven of the sixteen diterpene lactones, three of the six flavonoids, five of the six phenolic acids and two cyclic acids are reported here for the first time for this species. Multivariate statistical approaches such as Hierarchiral Component Analysis (HCA) and Principle Component Analysis (PCA) have clustered the plant extracts into the leaf and stem groups, regardless of plant age. Further classification based on the phytochemical profiles revealed that mostly phenolic acids and flavonoids were from the young leaf extracts, and diterpenoids and their glycosides from the mature leaf extracts. However, the phytochemical profiles for the stems of both young and mature plants were not significantly different as presented in the dendrogram of HCA and the score plot of PCA. The marker for mature plants might be the m/z 557 ion (dihydroxyl dimethyl 19-[(beta-D-glucopyranosyl)oxy]-19-oxo-ent-labda-8(17),13-dien-16,15-olide), whereas the m/z 521 ion (propyl neoandrographolide) could be the marker for leaf extracts.

Objective: The aim of this study was to compare cognition following coronary artery bypass grafting (CABG) surgery with or without cardiopulmonary bypass (CPB) (on- or off-pump)., Design: Systematic review and meta-analysis of randomized control trials comparing cognitive outcome in patients undergoing CABG surgery on- or off-pump as assessed by continuous measures from a battery of 7 psychometric tests., Setting: Multi-institutional centers performing CABG surgery., Participants: Patients with coronary artery disease requiring CABG surgery., Interventions: CABG surgery with or without CPB., Measurements and Main Results: A structured literature search identified 13 randomized control trials that included a total of 2,405 patients. Results from 7 psychometric tests were grouped into early (≤3 months) and late (6-12 months) postoperative periods. No significant differences were found between on- and off-pump groups in any of the 7 psychometric tests in either the early (p range 0.21-0.78) or late (p range 0.09-0.93) postoperative period., Conclusion: The results suggested that CPB may not be associated with cognitive decline that is associated with CABG surgery., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Early and targeted antimicrobial therapy improves outcomes in patients with febrile neutropenia (FN). We evaluated the impact of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) on antimicrobial utilization in the management of FN. A cohort of patients with FN and hematological malignancy was identified. Cases (in whom FDG-PET was performed, n = 37) were compared with controls (in whom conventional investigations excluding FDG-PET were performed, n = 76). An underlying cause for FN was determined in 94.6% of cases, compared to 69.7% of controls. FDG-PET had a significant impact on antimicrobial utilization compared to conventional imaging (35.1% vs. 11.8%; p = 0.003), and was associated with shorter duration of liposomal amphotericin-B therapy for systemic fungal infection (median 4.0 days cases vs. 10.0 days controls; p = 0.001). Cases had a longer length of hospitalization (p = 0.016). In the management of patients with high-risk FN, FDG-PET improves diagnostic yield and allows rationalization of antifungal therapy. The impact upon healthcare costs associated with antimicrobial therapy for FN requires further evaluation.

When irradiated under near-ultraviolet (UV) light, TiO(2) exhibits strong bactericidal activity. The TiO(2) photocatalyst would be effective on orthodontic appliances after its antibacterial effect on the carcinogenic microorganism Lactobacillus acidophilus is evaluated. To compare the antibacterial effect of two crystalline forms of TiO(2), rutile and anatase, thermal oxidation and anodic oxidation were employed to form each structure, respectively. The antibacterial effect of TiO(2) film on TiAg was also compared with that on Ti. Bacterial solutions were pipetted onto the TiO(2)-coated specimen and illuminated with UVA (2 x 15 W, black light, 356 nm) up to 100 min and the reaction solutions were incubated to count the colony-forming units. The antibacterial activity of the coated specimens was similar to that of the uncoated group. The antibacterial activity of the coated specimens of TiAg was not different from that of Ti. TiO(2) coatings formed on both Ti and TiAg specimens did not exhibit cytotoxicity on the L-929 cells of mice., ((c) 2006 Wiley Periodicals, Inc.)

Blunt injury to the carotid artery is rare but may produce a devastating outcome with longterm morbidity. Initial recognition by clinicians is often difficult because of the diverse clinical manifestations, the delay in presentation of symptoms, and the associated multi-organ system injuries that accompany carotid injury. Early diagnosis and successful management of traumatic carotid artery injury require a high index of clinical suspicion. We report herein a 20-year-old male victim of internal carotid artery injury induced by a motorcycle accident, who initially presented with a clear consciousness and had normal computed tomogram (CT) of brain. Two days after injury, the patient suffered from left hemiplegia and coma. The follow-up brain CT showed acute infarction of right cerebrum and severe cerebral edema. Emergency craniotomy for brain decompression and anticoagulation therapy was carried out. After a three-month treatment, he was discharged and underwent regular follow-up in the outpatient department. Six months later, the patient had intact awareness but remained in a left-sided hemiparetic state.

Objectives: The aim of this survey was to assess the association between the three simple anthropometric indices (body mass index [BMI], waist-to-hip ratio (WHR), and waist circumference [WC]) and various metabolic disorders, and to identify which indices can best predict metabolic disorders in Taiwan., Methods: A cross-sectional hospital-based survey was carried out from January to December 2000. We retrospectively analyzed the medical records of all the patients receiving periodic health examination with scheduled items at China Medical University Hospital. Anthropometric indices, metabolic profiles, and abdominal sonography were performed. A total of 746 people aged 19 to 87 were recruited as subjects for this study. The t test, chi2 test, and stepwise multivariate logistic regression were used., Results: The subjects included 44.5% women and 55.5% men, with a mean age of 50.74 +/- 12.68 years. After controlling for the other covariables, stepwise multivariate logistic regression showed considerable statistical significance between overall obesity and hypertension, hypertriglyceridemia, hyperuricemia, and fatty liver. There is also statistical significance between abdominal obesity and abnormal ratio of total cholesterol HDL (high-density lipoprotein), hyperuricemia, and fatty liver. None of the indices revealed any association with hyperglycemia, hypercholesterolemia, abnormal low-density lipoprotein, or abnormal HDL., Conclusions: BMI and WC can best predict some metabolic disorders. For practical reasons, the combined measurement of BMI and WC is the simple and inexpensive anthropometric index for primary health care settings in the routine physical examinations of adults. We hope this study can establish the background data for further investigation on the epidemiology of anthropometric indices in Taiwan.

Objectives: The purpose of this study was to determine which anthropometric index can best predict childhood obesity and to investigate the interrelationship between these anthropometric indices and metabolic abnormalities., Methods: This was a cross-sectional study. In March 2000, 2005 children aged 7 to 8 from the first grade of primary schools in Taichung City in Taiwan were enrolled in this study. Data were obtained on the children's anthropometry, blood pressure, and serum lipid profiles. Body mass index (cutoff points by international age- and sex-specific body mass index [BMI]) and weight-length index (WLI) were measured. The t test, the chi2 test, and stepwise multivariate logistic regression were used. All subjects were divided into four groups: Group 1, nonobese by BMI definition, WLI < 1.2; group 2, obese by BMI definition, WLI < 1.2; group 3, nonobese by BMI definition, WLI > or = 1.2; and group 4, obese by BMI definition, WLI > or = 1.2., Results: There were 951 girls (47.43%) and 1,054 boys (52.57%). The mean age was 7.3 +/- 0.4 years. The prevalence of obesity was 4.21% in girls and 7.87% in boys using BMI definition, and 12.83% in girls and 14.14% in boys using WLI definition. The prevalence of obesity revealed an increased trend with age in both sexes, whether by BMI or WLI definition. Group 4 had the highest prevalence rate of all metabolic abnormalities, except hypertriglyceridemia. After controlling for age and sex, and with group 1 as a reference, odds ratios were considerably higher in group 3 for the risk of hypertension (2.73; 95% confidence interval [CI], 1.67-4.44) and hypertriglyceridemia (5.83; 95% CI, 1.42-23.95). Odds ratios were considerably higher in group 4 for the risk of hypertension (3.75; 95% CI, 2.31-6.07) and high level of low-density lipoprotein cholesterol (1.93; 95% CI, 1.32-2.82)., Conclusions: The prevalence of obesity apparently differs depending on the definition of estimation. Childhood obesity exhibits significant correlation with some metabolic abnormalities. We hypothesize that, at present, both indices, BMI and WLI, should be used together to define childhood obesity in clinical practice until a more appropriate and excellent index can be established.

Acute dissection of the aorta can be one of the most dramatic of cardiovascular emergencies. Its symptoms can occur abruptly and progress rapidly. Prompt recognition and appropriate intervention is crucial. However, not all aortic dissections present with classic symptoms of abrupt chest, back, or abdominal pain, and the diagnosis may be missed. Aortic dissection presenting as a sore throat is quite unusual. A 53-year-old man presented with sore throat as the early symptom of an acute thoracic aortic dissection. Unfortunately, the diagnosis was delayed, and the patient died. Given the high morbidity and mortality after delayed recognition or misdiagnosis, aortic dissection should be considered in the differential diagnosis of a patient presenting with sore throat and normal findings of neck and throat, even when there is no classic symptoms.

Objective: Different parameters were compared in children with acute pyelonephritis in order to facilitate the early detection of vesicoureteral reflux (VUR) in primary healthcare settings., Material and Methods: This was a cross-sectional, hospital-based study. A total of 149 children with confirmed acute pyelonephritis were retrospectively analyzed between January 1999 and December 2000. The primary factors studied were body temperature, C-reactive protein level, white blood cell count and neutrophil ratio., Results: The study population comprised 82 males (55.0%) and 67 females (45.0%). The mean age of the patients was 2.7 +/- 3.9 years (age range 1 day to 18 years; 75% <3 years old). Of 123 patients who underwent voiding cystourethrography, 34 (27.6%) had VUR. When raised C-reactive protein, leukocytosis and raised neutrophil ratio occurred together, the specificity and positive predictive value for predicting VUR were obviously increased, but sensitivity was radically decreased. After controlling for the other covariates, multivariate logistic regression analysis showed that factors significantly related to VUR were age (odds ratio = 1.3, 95% confidence interval 1.02-1.67; p < 0.05) and raised neutrophil ratio (odds ratio = 4.2, 95% confidence interval 1.1-16.5; p < 0.05)., Conclusions: Our findings emphasize that the prevalence of VUR in children with acute pyelonephritis is extremely high. If a raised neutrophil ratio is observed, the potential risk of VUR is significantly increased in patients with clinically suspected acute pyelonephritis. Hence, the neutrophil ratio is recommended as an excellent parameter for predicting VUR.

Background: We investigated the risk factors for gallstone disease in Taiwan., Methods: We retrospectively analyzed medical records of patients receiving periodic health examination at China Medical College Hospital from January to December 2000. A detailed history, physical examination, biochemical measurements, and abdominal ultrasonography were done., Results: The 602 men (58.6%) and 426 women (41.4%) had a mean age of 49.2 +/- 12.8 years (range, 18 to 87). The prevalence of gallstone disease was 7.8% in women and 6.5% in men. After controlling for other covariates, multivariate logistic regression analysis showed that with a reference group aged less than 40 years as a comparison, both men and women aged 65 or older were more likely to have gallstone disease., Conclusions: Age in both sexes and hepatitis C virus infection in women were found to be risk factors for gallstone disease in our study population.

Background: The aim of this study was to assess the epidemiology of fatty liver in Taiwan., Methods: We retrospectively analyzed the medical records of all patients receiving health examinations at China Medical College Hospital from January through December 2000. A total of 1,012 subjects were included for analysis. Data were analyzed using the t test, chi-square analysis, and multivariate logistic regression., Results: Our cohort was comprised of 41.8% women and 58.2% men; mean age was 49.2 years. The prevalence of fatty liver was 36.9% in all subjects, and prevalence was higher in men than in women. After controlling for other covariates, the multivariate logistic regression analysis showed that the significant factors related to fatty liver were male sex, obesity, hyperglycemia, hypertriglyceridemia, elevated glutamate pyruvate transaminase level, and hyperuricemia. Elevated glutamate oxaloacetate transaminase level was negatively associated with fatty liver., Conclusions: The prevalence of fatty liver is high in Taiwan. This study establishes background data for further investigation.

Although not common, acute leg ischemia is an important element in the clinical presentation of a patient with aortic dissection. This report describes a case of aortic dissection in which the main feature at presentation was acute right leg ischemia. The angiography showed right common iliac artery and external iliac artery occlusion. Diagnosis was made by clinical evaluation and angiography. Embolectomy was then attempted immediately but failed. Aortic dissection was highly suspected and confirmed by emergency computed tomography. Fortunately, the patient had good recovery. Aortic dissection is potentially lethal if misdiagnosed or if recognition is delayed. As such, aortic dissection should be considered in the differential diagnosis.

This study used data collected in Chung-Hsing Village to evaluate the relationship between hyperuricaemia and cardiovascular risk factors inTaiwanese middle-aged adults in May 1998. All of the government employees working at theTaiwan Provincial Government in Chung-Hsing Village aged 40-64 years were candidates for this study. Only 708 volunteers underwent blood tests. To study the significant related factors of hyperuricaemia, the t-test, chi2 analysis and multivariate logistic regression were used. The results showed that the significant related factors of hyperuricaemia are sex, obesity, hypertriglyceridaemia and renal function impairment. Hyperuricaemia is more common in middle-aged men than in middle-aged women. It is important to determine serum uric acid values if obesity, hypertriglyceridaemia or renal function impairment are apparent.

Background: In order to determine reliable clues for early diagnosis of acute appendicitis, this study was conducted to examine the related factors in patients with clinically suspected acute appendicitis., Methods: We retrospectively analyzed 282 patients with the clinical diagnosis of acute appendicitis at China Medical College Hospital in Taiwan from January to December 2000. To study the significant related factors of acute appendicitis, the t-test, chi-square analysis, and multivariate logistic regression analysis were used., Results: There were 153 males (54.3 percent) and 129 females (45.7 percent). The mean age was 30.3+/-17.4 years (range 1 to 81). The diagnostic rate of acute appendicitis was 86.2 percent. If the combination of elevated C-reactive protein, leukocytosis and elevated neutrophil ratio was used, satisfactory specificity and positive predictive value were achieved in diagnosing acute appendicitis. After controlling for the other covariates, the multivariate logistic regression analysis showed that the significant related factors of acute appendicitis were male sex (odds ratio = 3.4; 95 percent confidence interval = 1.6 to 7.3; p <0.01) and elevated neutrophil ratio (odds ratio = 4.6; 95 percent confidence interval = 2.0 to 10.6; p <0.001)., Conclusions: If an elevated neutrophil ratio was observed, the probability of acute appendicitis was increased in patients with clinically suspected acute appendicitis. Thus, neutrophil ratio appears to be a good parameter for diagnosis of acute appendicitis in primary healthcare settings.