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Background: Several studies have identified correlations between cancer and increased risks of ischemic stroke (IS), particularly following radiotherapy (RT) or chemotherapy (CT). However, data regarding relative risks of IS in oral cancer are limited. The aim of this study was to compare hazard ratios (HR) of IS among oral cancer patients treated with and without RT, CT, or both (CCRT).Methods: We analyzed data collected by the Taiwan National Health Insurance Research Database (NHIRD) from 1996 to 2009, which covered approximately 99.5% of the medical claims submitted nationally. A total of 21,853 patients diagnosed with oral cancer from 2000 to 2008 were included. The Cox proportional hazard model was used to estimate the HRs of IS among different treatment modalities and a matched cohort.Results: The overall risk of IS was1.24-fold greater in patients treated with RT/CT/CCRT than those treated with surgery alone and 1.08-fold greater for surgery with adjuvant therapy (radiotherapy or chemotherapy after surgery) after adjusting for confounding factors. The incidence of IS was 0.23-fold lower in matched control group than in the oral cancer cohort. In subgroup analysis, patients who received RT/CT/CCRT and aged <40 years old were at a 2.77-fold greater risk for IS than age-matched patients who underwent surgery alone, although this difference decreased with patient age.Conclusions: Oral cancer patients, particularly those aged <40 years, who underwent RT or CT are at increased risks for IS. Other significant risk factors for IS included Charlson comorbidity index (CCI) >1, hypertension, coronary artery disease, and atrial fibrillation. [ABSTRACT FROM PUBLISHER]

An alarm system of carbamazepine-induced toxic effects highly associated with HLA-B*1502 allele Carbamazepine is widely used in epilepsy, trigeminal neuralgia, and bipolar disorder, but if it causes severe cutaneous adverse reactions including Steven-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), and the mortality rate is as high as 30%.1 Because of the death of patient taking carbamazepine due to this serious adverse drug reaction in our hospital, we read the article "Carbamazepine-induced Toxic Effects and HLA-B1502* Screening in Taiwan" by Chen et al, and learned that this toxic reaction was strongly correlated with the HLA-B*1502 allele, and compared with other ethnic groups, this genotype is the highest proportion in Asian population.2 Therefore, this article recommended that Asian patients should undergo HLA-B*1502 genetic screening before taking carbamazepine to avoid serious adverse drug reactions caused by this drug. Therefore, we, located in Southeast Asia-Taiwan, are motivated to get actively involved in building a computer-based alarm system for carbamazepine and HLA-B*1502 allele cross matching. [Extracted from the article]

Objective: β-Blockers are safe and improve survival in patients with both congestive heart failure (CHF) and COPD. However, the superiority of different types of β-blockers is still unclear among patients with CHF and COPD. The association between β-blockers and CHF exacerbation as well as COPD exacerbation remains unclear. The objective of this study was to compare the outcome of different β-blockers in patients with concurrent CHF and COPD., Patients and Methods: We used the National Health Insurance Research Database in Taiwan to conduct a retrospective cohort study. The inclusion criteria for CHF were patients who were >20 years old and were diagnosed with CHF between January 1, 2005 and December 31, 2012. COPD patients included those who had outpatient visit claims ≥2 times within 365 days or 1 claim for hospitalization with a COPD diagnosis. A time-dependent Cox proportional hazards regression model was applied to evaluate the effectiveness of β-blockers in the study population., Results: We identified 1,872 patients with concurrent CHF and COPD. Only high-dose bisoprolol significantly reduced the risk of death and slightly decreased the hospitalization rate due to CHF exacerbation (death: adjusted hazard ratio [aHR] =0.51, 95% confidence interval [CI] =0.29-0.89; hospitalization rate due to CHF exacerbation: aHR =0.48, 95% CI =0.23-1.00). No association was observed between β-blocker use and COPD exacerbation., Conclusion: In patients with concurrent CHF and COPD, β-blockers reduced mortality, CHF exacerbation, and the need for hospitalization. Bisoprolol was found to reduce mortality and CHF exacerbation compared to carvedilol and metoprolol., Competing Interests: Disclosure The authors report no conflicts of interests in this work.