Current status of gastroesophageal reflux disease : diagnosis and treatment.

AIMS: The aim of this study was to explore the recent advances in diagnosis and treatment of gastroesophageal reflux disease (GERD). METHODS: Previous studies were searched using the terms "gastroesophageal reflux disease" and "diagnosis" or "treatment" in Medline and Pubmed. Articles that were not published in the English language, manuscripts without an abstract, reviews, meta-analysis, and opinion articles were excluded from the review. After a preliminary screening, all of the articles were reviewed and synthesized to provide an overview of the contemporary approaches to GERD. RESULTS: GERD has a variety of symptomatic manifestations, which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of other alarming symptoms, these symptoms allow one to make a presumptive diagnosis of GERD and initiate empiric therapy. GERD-associated complications include erosive esophagitis, peptic stricture, Barrett's esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modifications, medical and surgical therapy. Medical therapy involves acid suppression, which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. CONCLUSION: The management of this disease requires a complex approach. Maintenance therapy of GERD after using anti-secretory drugs should be continuously monitored.

The Current Status of the Disease Caused by Enterovirus 71 Infections: Epidemiology, Pathogenesis, Molecular Epidemiology, and Vaccine Development.

Enterovirus 71 (EV71) infections have a major public health impact in the Asia-Pacific region. We reviewed the epidemiology, pathogenesis, and molecular epidemiology of EV71 infection as well as EV71 vaccine development. Previous studies were found using the search terms "enterovirus 71" and "epidemiology" or "pathogenesis" or "molecular epidemiology" or "vaccine" in Medline and PubMed. Articles that were not published in the English language, manuscripts without an abstract, and opinion articles were excluded from the review. The reported epidemiology of cases caused by EV71 infection varied from country to country; seasonal variations in incidence were observed. Most cases of EV71 infection that resulted in hospitalization for complications occurred in children less than five years old. The brainstem was the most likely major target of EV71 infection. The emergence of the EV71 epidemic in the Asia-Pacific region has been associated with the circulation of different genetic lineages (genotypes B3, B4, C1, C2, and C4) that appear to be undergoing rapid evolutionary changes. The relationship between the gene structure of the EV71 virus and the factors that ensure its survival, circulation, and evasion of immunity is still unknown. EV71 infection has emerged as an important global public health problem. Vaccine development, including the development of inactivated whole-virus live attenuated, subviral particles, and DNA vaccines, has been progressing.

Current status of rotavirus vaccines.

BACKGROUND: Rotaviruses remain the major cause of childhood diarrheal disease worldwide and of diarrheal deaths of infants and children in developing countries. The huge burden of childhood rotavirus-related diarrhea in the world continues to drive the remarkable pace of vaccine development. DATA SOURCES: Research articles were searched using terms "rotavirus" and "rotavirus vaccine" in MEDLINE and PubMed. Articles not published in the English language, articles without abstracts, and opinion articles were excluded from the review. After preliminary screening, all articles were reviewed and synthesized to provide an overview of current vaccines and vaccination programs. RESULTS: In this review of the global rotavirus vaccines and vaccination programs, the principles of rotavirus vaccine development and the efficacy of the currently licensed vaccines from both developed and developing countries were summarized. CONCLUSIONS: Rotavirus is a common cause of diarrhea in children in both developed and developing countries. Rotavirus vaccination is a cost-effective measure to prevent rotavirus diarrhea.

The epidemiology of imported malaria in Taiwan between 2002-2013: the importance of sensitive surveillance and implications for pre-travel medical advice.

The purpose of this study was to assess the epidemiology of imported malaria in Taiwan between 2002 and 2013. We analyzed the national data recorded by the Taiwan Centers for Disease Control (Taiwan CDC). Malaria cases were diagnosed by blood films, polymerase chain reaction, or rapid diagnostic tests. The risk of re-establishment of malarial transmission in Taiwan was assessed. A total of 229 malaria cases were included in our analysis. All of the cases were imported. One hundred and ninety-two cases (84%) were diagnosed within 13 days of the start of symptoms/signs; 43% of these cases were acquired in Africa and 44% were acquired in Asia. Plasmodium falciparum was responsible for the majority (56%) of these cases. Travel to an endemic area was associated with the acquisition of malaria. The malaria importation rate was 2.36 per 1,000,000 travelers (range 1.20-5.74). The reproductive number under control (Rc) was 0. No endemic transmission of malaria in Taiwan was identified. This study suggests that a vigilant surveillance system, vector-control efforts, case management, and an educational approach focused on travelers and immigrants who visit malaria endemic countries are needed to prevent outbreaks and sustain the elimination of malaria in Taiwan.

CO-INFECTION OF ADENOVIRUS, NOROVIRUS AND TORQUE TENO VIRUS IN STOOLS OF PATIENTS WITH ACUTE GASTROENTERITIS.

Up to now, there has been no report of co-infection of torque teno virus (TTV) with other enteric viruses playing a role in the pathogenesis of viral acute gastroenteritis (AGE). We investigated the proportion, epidemiological and clinical features of concurrent infections of adenovirus (ADV), norovirus (NV) and TTV in stools of 155 patients with AGE attending Wei-Gong Memorial Hospital, Miaoli City, Taiwan. The presence of the three viruses were determined using PCR-based assays. Some 55% of the patients were infected with at least 1 enteric virus, among whom 18% were co-infected, NV and TTV being the most common (62%). Rate of co-infectious in AGE patients is correlated statistically significantly (p < 0.05) with age, fever and drinking of spring water. Furthermore, AGE children with co- infection have a higher hospitalization rate (69%). To the best of our knowledge, this is the first report of ADV, NV and TTV triple co-infection in children (2) with AGE. This study also revealed that TTV co-infection promoted the pathogenicity of other infectious agents.

Disease caused by rotavirus infection.

Although rotavirus vaccines are available, rotaviruses remain the major cause of childhood diarrheal disease worldwide. The Rotarix (GlaxoSmithKline Biologicals Rixensart, Belgium) and RotaTeq (Merck and Co., Inc. Whitehouse Station, New Jersey, USA) vaccines are effective for reducing the morbidity and mortality of rotavirus infection. This article aims to assess the epidemiology of rotaviral gastroenteritis and the efficacy and effectiveness of licensed rotavirus vaccines. This review concludes by presenting challenges in the field that require further exploration by and perspectives from basic and translational research in the future.

Epidemiological and molecular analysis of human norovirus infections in Taiwan during 2011 and 2012.

BACKGROUND: The human norovirus (NV) circulates worldwide and is a major cause of epidemics, which have increased in Taiwan since 2002. NV in acute gastroenteritis (AGE) and non-acute gastroenteritis (asymptomatic) patients, including children and adults, have not been previously examined in Taiwan; therefore, we examined the epidemiology and phylogeny of NV in AGE and asymptomatic patients of all ages. METHODS: 253 stool samples were collected from August 2011 to July 2012 (including 155 AGE and 98 asymptomatic samples in Taiwan) and analyzed using reverse transcription-polymerase chain reaction (RT-PCR) for NV. Primers targeting the RNA-polymerase gene were used for RT-PCR to allow DNA sequencing of Taiwan NV strains and phylogenetic analyses. RESULTS: NV was detected in 24 (9.5%) of 253 stool specimens using RT-PCR. NV was isolated from all age groups (1 to 86 y) and those NV-positive samples were major identified from inpatients (79.2%, 19/24). Statistical analysis showed that the NV infectious rate of AGE patients was statistically significant (P < 0.05) for age, season and water type, respectively. Phylogenetic analyses of the RdRp region sequence showed that 24 NV isolates belonged to Genogroup II Genotype 4 (GII.4). They were closely related to the epidemic strain in Taiwan in 2006, the GII.4-2006b pandemic strain in 2006, and the GII.4-New Orleans strain in 2010. CONCLUSION: This study is the first to examine NV in sporadic AGE and asymptomatic patients in Taiwan. Furthermore, epidemic strains of isolated GII.4 were predominant in Taiwan during 2011 and 2012.

Updated diagnosis and treatment of childhood tuberculosis.

BACKGROUND: Childhood tuberculosis (TB) accounts for a significant proportion of the global tuberculosis disease burden. However, current and previous efforts to develop better diagnostic, therapeutic, and preventive interventions have focused on TB in adults, and childhood TB has been relatively neglected. The purpose of this review is to provide an update on the diagnostic and therapeutic recommendations for childhood TB with an emphasis on intrathoracic disease. DATA SOURCES: The literature from a range of sources was reviewed and synthesized to provide an overview of the contemporary approaches for the diagnosis and treatment of childhood TB. RESULTS: This review summarizes the clinical, radiological, bacteriological, and immunological approaches to diagnose TB infection and disease in children. In addition, we summarize the updated guidelines for the treatment of TB in children. CONCLUSIONS: The development of better diagnostic and therapeutic methods for childhood TB remains a significant challenge. As the strategies for diagnosis and treatment of childhood TB continue to improve and the knowledge base increases, the implementation of these strategies will be crucial.

Rotavirus infection and the current status of rotavirus vaccines.

Among children, rotaviruses are the most common cause of severe gastroenteritis worldwide and of diarrheal deaths in developing countries. Current vaccines (e.g., Rotarix, GlaxoSmithKline Biologicals; RotaTeq, Merck and Company) effectively reduce rotaviral gastroenteritis, emergency department visits, and hospitalizations. The tremendous burden of rotavirus-related diarrhea in children across the world continues to drive the remarkable pace of vaccine development. This review assesses the global epidemiological and economic burden of rotavirus diseases, summarizes the relevant principles of the development of rotavirus vaccines, and presents data on the efficacy and effectiveness of currently licensed vaccines in both developed and developing countries.

Psychoactive substance use and the risk of motor vehicle crash injuries in southern Taiwan.

The purpose of this study was to examine the association between psychoactive drug use and motor vehicle crash (MVC) injuries requiring hospitalization in southern Taiwan. A case-control study was conducted in southern Taiwan from January 2009 to December 2009. The cases included car or van drivers who were involved in MVCs and required hospitalization. Demographic and trauma-related data were collected from questionnaires and hospital and ambulance records. Urine and/or blood samples were collected on admission. The controls consisted of drivers who were randomly recruited while driving on public roads. Study subjects were interviewed and asked to provide urine samples. All blood and urine samples were tested for alcohol and a number of other legal and illegal drugs. Only those subjects who provided urine and/or blood specimens were included in the study. During the study period, 254 case patients and 254 control drivers were enrolled. The analysis showed an odds ratio (OR) of 3.41 (95% confidence intervals (95% CI), 1.76-6.70; p < 0.001) for persons taking benzodiazepines, and an OR of 3.50 (95% CI, 1.81-6.85; p < 0.001) for those taking alcohol (blood alcohol concentrations (BAC) ≥ 0.8 g/l) with regard to hospitalizations due to MVCs. For persons taking combinations of benzodiazepines and alcohol, the OR increased to 5.12 (95% CI: 1.77-15.91, p < 0.001). This study concluded that drug use among motor vehicle drivers increases the risk of MVCs that require hospitalization. From a public health perspective, the high risk ratios are concerning, and preventive measures are warranted.

An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan.

In 1998, an epidemic of enterovirus 71 (EV 71) infection occurred in Taiwan. The purpose of this study was to assess the epidemiology of EV 71 infection in Taiwan. Between March 1998 and December 2005, a total of 1,548 severe cases of hand-foot-mouth disease and herpangina (HFMD/HA) was reported to the Center for Disease Control in Taiwan. A seasonal variation in number of severe cases was observed, with the annual peak in second quarter. Deaths from severe HFMD/HA varied from year to year (chi(2) for trend = 6.781, P = 0.009). Most (92%) cases occurred in children

Chlamydial infection among patients attending STD and genitourinary clinics in Taiwan.

BACKGROUND: The main objective of this study is to examine the epidemiology of Chlamydia trachomatis (CT) infection amongst patients (473 men, 180 women) seen two hospitals in Taiwan. METHODS: Between July 2004 and June 2005, a total of 653 patients provided first-void urine samples for examination of CT using PCR assay. RESULTS: The overall prevalence of CT infection was 18.4% (95% confidence interval [CI] 17.3-19.5). Prevalence for men and women were 16.7 % (95% CI 15.3-18.0%) and 22.8% (95% CI 17.5-28.1%), respectively. Age group-specific prevalence was 25.7% (95% CI 22.5-28.9%) in < 20 year olds, 23.5% (95% CI 20.3-26.7%) in 20-24 year olds, 22.3% (95% CI 18.9-25.7%) in 25-30 year olds, and 11.5% (95% CI 10.3-12.7%) in > 30 year olds. Independent risk factors for chlamydial infection included younger age (aged < or = 30 years) (adjusted odds ratio [AOR] = 2.44; 95% CI 1.52-3.84; p < 0.001), inconsistent condom use (AOR = 2.01; 95% CI 1.32-3.06; p < 0.001), being symptomatic (dysuria, urethral discharge) at the time of testing (AOR = 1.84; 95% CI 1.21-2.80; p < 0.001), and having N. gonorrhoeae infection (AOR = 3.82; 95% CI 2.20-6.58; p < 0.001). CONCLUSION: Genital chlamydial infection is an important sexually transmitted disease in Taiwan. Young Taiwanese persons attending a STD clinic should be screened for CT infection and counselled on condom use.