Background and Objectives: Aspiration pneumonia is a major cause of death in patients on nasogastric tube (NGT) feeding. This study aimed to evaluate the oropharyngeal dysphagia and stratify risk of pneumonia in patients undergoing NGT feeding. Methods and Study Design: The study included patients on NGT feeding who underwent UGI endoscopy at Tri- Service General Hospital, Taiwan. Endoscopy was performed to examine the pharyngolaryngeal region. The severity of oropharyngeal dysphagia was evaluated according to the visualized amount and location of pooling of secretions in the pharyngolaryngeal region; 60 patients showed absent or minimal amount of secretions (control group), 14 patients showed moderate-to-large amounts of secretions filling the pyriform sinus (pharyngeal group), and 27 patients showed secretions entering the laryngeal vestibule (laryngeal group). Demographic data and occurrence of pneumonia were analyzed. Results: The incidence of pneumonia was highest in the pharyngeal group (4.2±3.6 episodes/person-years), followed by the laryngeal (2.6±2.2 episodes/person-years) and control groups (1.7±3.8 episodes/person-years) (p=0.042). Multivariable regression showed significantly higher risk of pneumonia in the pharyngeal (adjusted odds ratio=2.7, 95% CI, 2.4-2.8, p＜0.001) and laryngeal (adjusted odds ratio=2.0, 95% CI, 1.7-2.4, p＜0.001) groups. The cumulative incidence rate of pneumonia was significantly higher in the laryngeal and pharyngeal groups than in the control group (log rank test, p＜0.001). Conclusions: Endoscopic pharyngolaryngeal observation can evaluate the oropharyngeal dysphagia. Visual evidence of oropharyngeal dysphagia increase the risk of pneumonia in patients on NGT feeding.
Investigations regarding the chemistry and mechanism of action of 2‐methyl‐1,4‐naphthoquinone (or menadione) derivatives revealed 3‐phenoxymethyl menadiones as a novel anti‐schistosomal chemical series. These newly synthesized compounds ( 1 – 7 ) and their difluoromethylmenadione counterparts ( 8 , 9 ) were found to be potent and specific inhibitors of Schistosoma mansoni thioredoxin‐glutathione reductase ( Sm TGR ), which has been identified as a potential target for anti‐schistosomal drugs. The compounds were also tested in enzymic assays using both human flavoenzymes, i.e. glutathione reductase ( h GR ) and selenium‐dependent human thioredoxin reductase ( h T rxR), to evaluate the specificity of the inhibition. Structure–activity relationships as well as physico‐ and electro‐chemical studies showed a high potential for the 3‐phenoxymethyl menadiones to inhibit Sm TGR selectively compared to h GR and h T rxR enzymes, in particular those bearing an α‐fluorophenol methyl ether moiety, which improves anti‐schistosomal action. Furthermore, the (substituted phenoxy)methyl menadione derivative ( 7 ) displayed time‐dependent Sm TGR inactivation, correlating with unproductive NADPH ‐dependent redox cycling of Sm TGR , and potent anti‐schistosomal action in worms cultured ex vivo . In contrast, the difluoromethylmenadione analog 9 , which inactivates Sm TGR through an irreversible non‐consuming NADPH ‐dependent process, has little killing effect in worms cultured ex vivo . Despite ex vivo activity, none of the compounds tested was active in vivo , suggesting that the limited bioavailability may compromise compound activity. Therefore, future studies will be directed toward improving pharmacokinetic properties and bioavailability.
Background and Aim: Eosinophilic gastroenteritis (EG), a rare gastrointestinal (GI) tract disease, usually involves vague abdominal symptoms. Owing to the difficulty of diagnosis, the prevalence of EG is still unclear. Herein, we aim to identify the clinical features of EG in Taiwanese patients. Methods: The medical records of 19 patients with definitive EG in a medical center over a 20-year period were reviewed. Results: Nineteen patients, 12 males and 7 females aged 42 ± 18 years, had been diagnosed with EG. The most common symptoms were diarrhea (74%) and abdominal pain (53%). Laboratory examinations revealed abnormalities of peripheral hypereosinophilia (84%), hypoalbuminemia (39%), and anemia (37%). Seventeen patients were diagnosed by histiology of endoscopic biopsies and 2 by operation. EG patients with ascites more frequently had symptoms of abdominal fullness and radiological abnormalities. Excellent therapeutic responses to steroid therapy (92%) and a high recurrent rate (47%) were observed. Conclusion: Vague GI symptoms, peripheral hypereosinophilia, and ascites of unknown origin are clues for diagnosing EG. Repeated, multiple, and random biopsies with adequate depth, even over areas of normal mucosa are necessary for accurate diagnosis. A timely diagnosis could initiate effective steroid therapy and even prevent unnecessary operations.
Not all endoscopic clips are compatible with magnetic resonance imaging (MRI). The aim of this study is to investigate the safety of MRI-incompatible endoscopic clips in patients undergoing MRI scans.We retrospectively reviewed the medical records of patients who had received endoscopic clip placement of Olympus Long Clip MRI-incompatible clips and then had undergone MRI scans within two weeks in our hospital between 2014 and 2019.A total of 44,292 patients had undergone an MRI examination at our hospital. Only 15 patients had MRI scans within two weeks after the endoscopic clip placement. Their median age was 65.5 years, and 12 of the 15 patients were men. At the time of the clip placement and MRI scan, four patients were taking anti-coagulation or anti-platelet agents. The indication for endoscopic clip placement of the 15 patients was mucosal/submucosal defect or hemorrhage and colonic perforation. Endoscopic clips were placed in the colon of 14 patients and in the stomach of only one patient for gastric hemorrhage. One patient experienced clip migration and three displayed artifacts in abdominal images. No patient complications of mortality, hemorrhage, or organ perforation occurred.No serious adverse event occurred during MRI scans of patients with MRI-incompatible clips in this study, suggesting that MRI-incompatible clips may be safe to use in MRI scans. However, this does not guarantee the safety of the Long Clip for MRI scans, as further tests are needed to verify that this clip is safe for use during MRI.
The aim of this study is to evaluate the role of hepatitis C virus (HCV) infection in patients with primary biliary cirrhosis (PBC).On the basis of a retrospective review of medical records, all patients consecutively diagnosed with PBC or HCV infection between 1999 and 2011 and who had a regular follow-up of at least 3 years were included in the study. Clinical characteristics, especially the severity of cirrhosis, were analyzed in PBC patients with HCV infection (PBC-HCV), PBC patients without HCV infection (PBC-only), and patients with only HCV infection (HCV-only).A total of 76 patients with PBC, including 9 patients with HCV infection, were analyzed. Of the PBC-HCV patients, 7 (7/9, 77.8%) were women with a mean age of 55.11 ± 14.29 years. Age- and sex-matched PBC-only patients (n = 36) and HCV-only patients (n = 36) were used as control groups. In comparison to the PBC-only controls, PBC-HCV patients had a greater severity of cirrhosis based on Child-Pugh (p = 0.019) and Model for End-Stage Liver Disease (MELD) (p = 0.01) scores. However, no significant difference in the severity of cirrhosis was found between the PBC-HCV and HCV-only control patients (p = 0.94 in Child-Pugh scores; p = 0.64 in MELD scores).In PBC patients with concomitant HCV infection, aggressive management may be warranted in view of the associated more severe liver cirrhosis.
We describe telehealth data-derived visual analytics (VA) approaches aiming to deliver better healthcare outcomes to our telehealth service users with multiple comorbidities through enhanced real-time and real-world clinical decisions. Our telehealth center provides telehealth services and integrates telehealth datasets with electronic medical record (EMR)-derived information. In addition to the continuous vital sign data acquired from years of telemonitoring, the telehealth datasets also contain large amounts of unstructured service data including intervention notes and lifestyle-related information. These data are analyzed by our natural language processing (NLP) program for extracting coded data and subsequent machine learning. We develop a Gantt chart-based approach to interactively visualizing these complex analytics results in order to perform insightful examinations of users' health status. The interactive Gantt chart presentations provide clear and quick comprehension of users' disease status and progression, medication management, and treatment outcomes. Our VA approach potentially can optimize clinical decision making, facilitate efficient care coordination, ensure care continuum, and provide cognitive supports for reducing workload burdens. To our knowledge, this is the first case of using Gantt chart model for analyzing telehealth datasets and the integrated health information of both providers- and users-generated sources.
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