ObjectivesIsolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas.DesignNationwide population-based cohort study.SettingPatients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database.ParticipantsNon-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included.Main outcome measureThe primary end point was the occurrence of pneumonia within 30 days.ResultsThe incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, p<0.001). Furthermore, old age (≥65 years; aHR=5.60, 95% CI 1.97 to 15.89, p<0.001) and COPD (aHR=5.41, 95% CI 1.02 to 3.59, p<0.001) were risk factors for pneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, p<0.001) and 17.13 (95% CI 6.66 to 44.04, p<0.001), respectively.ConclusionsAlthough the incidence of pneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD.

Background The association between asthma (AS), allergic rhinitis (AR) and oral diseases remains inconclusive in adults. AS and AR often coexist. However, studies that investigate AS, AR together and their association with oral diseases are scarce. Methods Data from 22,898 men and 28,541 women, aged 21 to 25 years, were collected from a national database in Taiwan. Five common oral diseases: dental caries, periodontitis, pulpitis, gingivitis, and stomatitis/aphthae were studied. Differences in the incidence of the five oral diseases in AR vs. non-AR, and AS vs. non-AS groups were compared. The incidence of the five oral diseases in men/ women, urban/country citizen, and high/low income groups was studied. The frequencies of clinical visits and impact of topical steroid use between the groups were also studied. The confounding factors included sex, socioeconomic status, urbanization, dentofacial anomalies, disease of salivary flow, diabetes mellitus, and esophageal reflux. Results The incidence and the frequencies of clinical visits for all five oral diseases were higher in those with AR than in the non-AR group after adjusting for confounding factors and AS. Similar observation was made for the AS group, without adjusting for AR. However, if AR was included for adjustment, no relationship was found between AS and oral diseases. In the AR group, those with higher incomes, and country residents had a high risk of developing oral disease. Intranasal steroids, rather than inhaled steroids, were also associated with oral diseases. Conclusion AR, rather than AS, may be associated with oral diseases in young adults.

Acid-suppressive drugs, including histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), are common medications used for treating upper gastrointestinal tract disorders. However, acid-suppressive drugs have been reported to increase the risk of pneumonia in numerous disease populations. However, the relationship between acid-suppressive drugs and stroke-associated pneumonia (SAP) remains controversial.The purpose of this study was to investigate the association between acid-suppressive drug usage and pneumonia among patients with stroke by using a nationwide data set.A population-based cohort study was conducted using a data set from the Taiwanese National Health Insurance Research Database. Data on patients with new-onset stroke from 2010 to 2011 were collected. Patients with and without acid-suppressive drug usage were followed up to identify the occurrence of any type of pneumonia. We estimated the adjusted hazard ratios (HRs) by using the Cox proportional hazards model.The study cohort comprised 7965 patients with new-onset stroke. The incidence of pneumonia was 6.9% (552/7965) and more than 40% (225/552) of patients developed pneumonia within 3 months after an acute stroke. Acid-suppressive drug usage was an independent risk factor of pneumonia. The adjusted HR for the risk of pneumonia in patients with new-onset stroke using acid-suppressive drugs was 1.44 (95% confidence interval [CI] = 1.18–1.75, P < .01). Only PPI usage increased risk of chronic SAP (adjusted HR = 1.46, 95% CI = 1.04–2.05).Acid-suppressive drug usage was associated with a slightly increased risk of SAP. Physicians should exercise caution when prescribing acid-suppressive drugs to patients with stroke, particularly at the chronic stage.

ObjectivesThis nationwide cohort study investigated the association between proton pump inhibitor (PPI) usage and the risk of pneumonia in patients with non-traumatic intracranial haemorrhage (ICH).DesignNationwide population-based cohort study.SettingLongitudinal Health Insurance Database 2010 (LHID2010) sampled from the Taiwan National Health Insurance Research Database.Participants4644 patients with non-traumatic ICH from 2010 to 2011 were identified. Patients aged <18 years and newly diagnosed with non-traumatic ICH complicated with pneumonia during the same admission period were excluded. A total of 2170 participants were eligible for the final analysis.Main outcome measurePatients using PPIs or not during the study period were tracked to identify the occurrence of any type of pneumonia.ResultsThe adjusted HR of the risk of pneumonia for ICH patients who used PPIs was 1.61 (95% CI 1.32 to 1.97, p<0.001). The risk of pneumonia was positively associated with the administration of PPIs. We observed a greater risk of pneumonia in patients who used PPIs than in those who did not. Moreover, we observed that the risk of pneumonia in patients who used PPIs was 2.60 and 2.04 (95% CI 2.01 to 3.38, p<0.001; 95% CI 1.34 to 3.10, p<0.001) greater than that in patients who did not use PPIs when the defined daily dose was <30 and 30−60, respectively.ConclusionsThe results of this study indicate that the use of PPIs in patients with non-traumatic ICH is associated with an increased risk of pneumonia, and the severity of this risk depends on the defined daily dose. Physicians should exercise caution when prescribing PPIs for patients with non-traumatic ICH.

PPI usage in dementia patients is associated with an 89% increased risk of pneumonia.

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Background: An association between allergic rhinitis (AR) and digestive diseases (DDs) has been reported; however, studies have only focused on the prevalence of DDs in populations of patients with AR. In individuals with specific DDs, the impact of AR on the frequency of clinical visits for each DD has not been studied. Moreover, the association between topical steroid usage for AR and DDs has not been investigated.Methods: Data from 16 526 men and 18 438 women, aged 21 to 30 years, were collected from a national database. Individuals were separated into the AR and non-AR groups. Eight common DDs were studied: (1) gastroesophageal reflux disease (GERD), (2) gastritis and duodenitis, (3) peptic ulcers, (4) irritable bowel syndrome, (5) gastric functional disease, (6) intestinal functional disease, (7) gastroenteritis and colitis, and (8) constipation. The rate of each DD was compared between groups. In individuals with specific DDs, the frequency of clinical visits for each DD was also compared between groups. Between users and nonusers of topical steroids in the AR group, the rate of DDs was compared.Results: Significant associations were observed between all eight DDs and AR in both sexes. In comparison to the non-AR group, women with AR visited clinics more frequently for gastritis/duodenitis, gastric and intestinal functional disease, gastroenteritis/colitis, and constipation, while men with AR visited clinics more frequently for gastritis/duodenitis, gastric functional disease, gastroenteritis/colitis, and constipation. Female topical-steroid users with AR had higher rates of GERD, irritable bowel syndrome, gastric or intestinal functional disease, and gastritis/colitis. Male topical-steroid users with AR had higher rates of GERD and peptic ulcers.Conclusion: AR was associated with DDs in both sexes. However, the influence of AR on clinical visit frequency varied among specific DD groups. Topical steroid usage for AR was associated with some DDs, but the association requires future evaluation.

Acute pancreatitis is difficult to diagnose during pregnancy. It presents as a systemic inflammatory response syndrome resulting in hemodynamic changes and may lead to abruptio placentae. Nonsurgical conservative treatment may be useful in such patients.