BackgroundThis study was aimed at determining the outcome and examining the association between comorbidities and mortality after intracerebral hemorrhage in chronic dialysis patients.MethodsWe used the Taiwan National Health Insurance Research Database and enrolled patients who underwent maintenance dialysis between 2000 and 2007. Annual incidence of intracerebral hemorrhage in patients receiving dialysis from 2000 to 2007 was determined. To identify predictors of hemorrhagic stroke, we used logistic regression model to estimate the relative ratio of factors for intracerebral hemorrhage in the most recent cohort (2007). The cumulative survival rate and comorbid conditions associated with mortality after intracerebral hemorrhage among all dialysis patients between 2000 and 2007 was calculated using the Kaplan-Meier method and Cox regression analysis.ResultsWe identified 57,261 patients on maintenance dialysis in the cohort of 2007, and 340 patients had history of intracerebral hemorrhage among them. Hypertension was the most common comorbidity of dialysis patients. The incidence rate of intracerebral hemorrhage among dialysis patients was about 0.6%. Adjusted logistic regression model showed that male gender, middle age (45–64 years), hypertension, and previous history of stroke were the independent predictors for the occurrence of intracerebral hemorrhage among chronic dialysis patients. 1,939 dialysis patients with development of intracerebral hemorrhage in the analysis period from 2000 to 2007 were identified. In-hospital mortality was high (36.15%) following intracerebral hemorrhage. They were followed up after intracerebral hemorrhage for a mean time of 41.56 months. Adjusted Cox regression analyses demonstrated that the factors independently associated with mortality after intracerebral hemorrhage among dialysis patients included diabetes mellitus, malignancy and a history of prior stroke.ConclusionsDialysis patients who have history of prior stroke, diabetes and malignancy have worse survival than patients without these comorbidities. Attention must focus on providing optimal medical care after hemorrhagic stroke for these target groups to reduce mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-186) contains supplementary material, which is available to authorized users.

Yokenella regensburgei belongs to the Enterobacteriaceae and shares some biochemical characteristics with Hafnia alvei. A few case reports have suggested that it is an opportunistic pathogen, but there is no strong evidence to support its clinical importance. Until recently, it was difficult to accurately differentiate between Y. regensburgei and H. alvei by use of routine identification techniques. Here, we present a case of soft tissue infection and bacteremia caused by Y. regensburgei, which was successfully treated by intravenous administration of ceftriaxone for three weeks, and review the previous literature.

Background: Rheumatoid arthritis (RA)-related comorbidities, including cardiovascular disease (CVD), osteoporosis (OP), and interstitial lung disease (ILD), are sub-optimally managed. RA-related comorbidities affect disease control and lead to impairment in quality of life. We aimed to develop consensus recommendations for managing RA-related comorbidities. Methods: The consensus statements were formulated based on emerging evidence during a face-to-face meeting of Taiwan rheumatology experts and modified through three-round Delphi exercises. The quality of evidence and strength of recommendation of each statement were graded after a literature review, followed by voting for agreement. Through a review of English-language literature, we focused on the existing evidence of management of RA-related comorbidities. Results: Based on experts’ consensus, eleven recommendations were developed. CVD risk should be assessed in patients at RA diagnosis, once every 5 years, and at changes in DMARDs therapy. Considering the detrimental effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids on CVD risks, we recommend using the lowest possible dose of corticosteroids and prescribing NSAIDs cautiously. The OP/fragility fracture risk assessment includes dual-energy X-ray absorptiometry and fracture risk assessment (FRAX) in RA. The FRAX-based approach with intervention threshold is a useful strategy for managing OP. RA-ILD assessment includes risk factors, pulmonary function tests, HRCT imaging and a multidisciplinary decision approach to determine RA-ILD severity. A treat-to-target strategy would limit RA-related comorbidities. Conclusions: These consensus statements emphasize that adequate control of disease activity and the risk factors are needed for managing RA-related comorbidities, and may provide useful recommendations for rheumatologists on managing RA-related comorbidities.

Objective This national cohort study investigated the incidence, site-specific mortality and prognostic factors of native septic arthritis (SA). Methods Tapping Taiwan’s National Health Insurance Research Database, we identified inpatients with newly diagnosed SA between 1998 and 2012. They were categorized by site of infection and followed to calculate 30-day, 90-day and 1-year mortality. Predictors of mortality were calculated using Cox models. Results A total of 31 491 patients were identified as having SA, the most common site of infection being the knee (50.1%), followed by the hip (14.4%), other sites (26.8%), the shoulder (5.5%) and multiple sites (1.2%). Knee joint involvement was the most common site for all subgroups. Incidence increased from 9.8/105 in 1998 to 13.3/105 in 2012. The 30-day, 90-day and 1-year mortality rates were 4.3, 8.6 and 16.4% respectively. Predictors for mortality were hip infection, shoulder infection, multiple-site infection, being male, age ≥65 years old and comorbidities. We derived a mortality scoring model over age/SA site/comorbidity, and age ≥65 years old had the greatest risk contribution to mortality. No matter whether 1-month, 3-month or 1-year mortality was being considered, patients with the higher risk scores had the higher mortality rates (P < 0.0001). Conclusion SA is an emerging infectious disease with a rising incidence, long duration of hospital stay and high mortality rate. The most common affected joint was knee for all subgroups. Patients aged ≥65 years old had a high SA incidence and the greatest risk contribution.

The mitral valve areas determined by Doppler pressure half-time and by cardiac catheterization with use of the Gorlin formula were compared in 18 adult patients who underwent percutaneous mitral balloon valvuloplasty. Doppler measurements and catheterization were performed simultaneously before, immediately after and 24 to 48 h after valvuloplasty. A high correlation between Doppler- and catheterization-derived mitral valve areas was found before mitral valvuloplasty (r = 0.81, Y = 0.88X + 0.1, SEE = 0.11 cm2) and 24 to 48 h after valvuloplasty (r = 0.84, Y = 0.70X + 0.67, SEE = 0.20 cm2). In contrast, the correlation immediately after valvuloplasty was only moderate (r = 0.72, Y = 0.43X + 1.1, SEE = 0.49 cm2). The Doppler-derived mitral valve area (2.41 +/- 0.61 cm2) immediately after valvuloplasty was significantly larger than the catheterization-derived area (2.08 +/- 0.39 cm2, p less than 0.05). In conclusion, the Doppler echocardiographic measurement performed with the pressure half-time method may lead to significant error immediately after mitral balloon valvuloplasty, but clinically accurate measurement can be obtained 24 to 48 h after valvuloplasty.