ABSTRACT
BACKGROUND: The association between betel quid (BQ) chewing and oral cancer is well established. However, evidence regarding the relationship between BQ chewing and cardiovascular disease (CVD) is still insufficient. METHODS: This cross-sectional study included 2002 men and 1175 women aged 50 and older in a city-level health examination survey of an agricultural and fishing population in 2013. In addition to anthropometric parameters, CVD risks were estimated using high-sensitivity C-reactive protein (hs-CRP), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index. Age, gender, smoking and alcohol drinking status were all incorporated into the multivariate logistic regression model to delineate the effect of BQ chewing on CVD risks. RESULTS: Two hundred forty-one (12%) males and eight (0.7%) females were ever chewers. BQ chewing was an independent risk factor for general obesity (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.07-1.91, p=0.017), central obesity (OR 2.27, 95% CI 1.53-3.37, p<0.001) and an elevated hs-CRP level (OR 1.38, 95% CI 1.03-1.85, p=0.029). Subjects who chewed more frequently had a higher systolic blood pressure (p=0.025) and baPWV (p=0.006). The waist circumference (p=0.015) and waist-to-height ratio (p=0.022) were greater in current chewers than in former chewers. CONCLUSION: These findings suggest that BQ chewing is associated with obesity and a higher CVD risk as estimated by hs-CRP. Furthermore, potential beneficial effects of BQ chewing cessation on central obesity were also found.
Subject(s)
Areca/adverse effects , Cardiovascular Diseases/etiology , Obesity/epidemiology , Smoking/epidemiology , Aged , Aged, 80 and over , Ankle Brachial Index , Cardiovascular Diseases/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Mastication , Middle Aged , Risk , Taiwan/epidemiologySubject(s)
Klebsiella Infections/diagnosis , Klebsiella Infections/pathology , Klebsiella pneumoniae/isolation & purification , Pyomyositis/diagnosis , Pyomyositis/pathology , Quadriceps Muscle/pathology , Anti-Bacterial Agents/therapeutic use , Hip/diagnostic imaging , Humans , Klebsiella Infections/drug therapy , Klebsiella Infections/microbiology , Male , Middle Aged , Pyomyositis/drug therapy , Pyomyositis/microbiology , Quadriceps Muscle/microbiology , Thigh/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Aortic Aneurysm, Thoracic/etiology , Aortic Dissection/etiology , Calcinosis/complications , Aortic Dissection/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , Aortic Diseases/complications , Aortic Diseases/diagnosis , Calcinosis/diagnosis , Diagnosis, Differential , Electrocardiography , Fatal Outcome , Humans , Male , Middle Aged , Radiography, ThoracicSubject(s)
Hernia, Obturator/diagnostic imaging , Intestinal Obstruction/diagnostic imaging , Intestine, Small/diagnostic imaging , Tomography, X-Ray Computed , Aged, 80 and over , Contrast Media , Female , Hernia, Obturator/complications , Hernia, Obturator/surgery , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestine, Small/surgery , Tomography, X-Ray Computed/methods , Treatment OutcomeSubject(s)
Anti-Bacterial Agents/therapeutic use , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/drug therapy , Teicoplanin/therapeutic use , Vancomycin/therapeutic use , Aged , Aged, 80 and over , Female , Humans , Male , Staphylococcal Infections/microbiology , Treatment OutcomeABSTRACT
OBJECTIVES: To investigate the determinants of outcome in patients with persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. METHODS: All patients >or=18 years old with MRSA bacteraemia for >or=7 days from 2000 to 2008 treated at National Taiwan University Hospital were investigated. The associations of mortality with clinical characteristics, management and vancomycin MICs for serial MRSA isolates were analysed. RESULTS: Persistent MRSA bacteraemia occurred in 227 patients. Decreasing trends in the incidence of MRSA bacteraemia (P < 0.001) and persistent MRSA bacteraemia (P = 0.031) were found. Elevated vancomycin MICs for subsequent MRSA isolates were found in 49 (24.6%) of 199 patients, especially those with infective endocarditis (41.9% versus 21.4%; P = 0.027). Metastatic infection [odds ratio (OR) 5.23; 95% confidence interval (CI) 2.17-12.59; P < 0.001], congestive heart failure (OR 4.78; 95% CI 2.19-10.42; P < 0.001) and elevated vancomycin MICs for subsequent MRSA isolates (OR 3.21; 95% CI 1.46-7.07; P = 0.004) were independent predictors of MRSA-related mortality, while metastatic infection (OR 3.01; 95% CI 1.45-6.28, P = 0.003) and congestive heart failure (OR 2.85; 95% CI 1.44-5.56, P = 0.003) were predictors of 30 day mortality. No significant impact of empirical glycopeptide therapy on MRSA-related (P = 0.89) or 30 day mortality (P = 0.26) was found. The 30 day mortality rate was lower in patients who received complete foci eradication (35.6% versus 51.1%; P = 0.03). CONCLUSIONS: Congestive heart failure and metastatic infections were predictors of mortality. Isolates with decreased susceptibility to vancomycin that emerged during persistent MRSA bacteraemia were associated with mortality. Aggressive attempts to completely eradicate foci should be encouraged.
Subject(s)
Bacteremia/microbiology , Bacteremia/mortality , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/microbiology , Staphylococcal Infections/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Female , Hospitals , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Prognosis , Risk Factors , Taiwan , Vancomycin/pharmacology , Young AdultABSTRACT
Hospital-associated invasive pneumococcal disease (HA-IPD) is infrequently reported. A retrospective surveillance of IPD in a medical centre in Taiwan was conducted from 2000 to 2008 to compare the clinical and microbiological characteristics of HA-IPD and community-associated IPD (CA-IPD). HA-IPD was identified in 37 patients, comprising 12.3% of the 302 hospitalised patients with IPD. Patients with HA-IPD were more likely to have solid-organ cancer (40.5% vs. 16.6%; P=0.001) or to have received immunosuppressive therapy (56.8% vs. 26.8%; P<0.001). The 30-day mortality rate of HA-IPD was significantly higher than that of CA-IPD (40.5% vs. 16.2%; P=0.001). Age >or=65 years [odds ratio (OR)=2.10; P=0.033], HA-IPD (OR=2.90; P=0.009) and liver cirrhosis (OR=3.19; P=0.009) were independent predictors of 30-day mortality. No significant differences in serotype distribution or in susceptible rates to penicillin (18.2% vs. 32.6%; P=0.14) and cefotaxime (60.6% vs. 67.8%; P=0.53) were found between HA-IPD and CA-IPD isolates. Similar prevalences of the serotypes included in the pneumococcal vaccines were found in isolates from patients with HA-IPD and CA-IPD. Among patients with HA-IPD and CA-IPD, 26 (78.8%) and 172 (73.2%) (P=0.45) had isolates of serotypes included in the 7-valent pneumococcal conjugate vaccine, and 30 (90.9%) and 224 (95.3%) (P=0.96) had isolates of serotypes included in the 23-valent pneumococcal polysaccharide vaccine, respectively. In summary, this study found that HA-IPD and CA-IPD were not significantly different with regard to serotype distribution and antimicrobial susceptibility in Taiwan. Patients with HA-IPD have a higher mortality rate, and pneumococcal vaccination for patients at increased risk for HA-IPD should be encouraged.
Subject(s)
Anti-Bacterial Agents/pharmacology , Community-Acquired Infections , Cross Infection , Pneumococcal Infections , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Adult , Age Factors , Aged , Cefotaxime/pharmacology , Community-Acquired Infections/complications , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Cross Infection/complications , Cross Infection/drug therapy , Cross Infection/microbiology , Cross Infection/mortality , Female , Humans , Immunosuppressive Agents/adverse effects , Liver Cirrhosis/complications , Male , Neoplasms/complications , Penicillins/pharmacology , Pneumococcal Infections/complications , Pneumococcal Infections/drug therapy , Pneumococcal Infections/microbiology , Pneumococcal Infections/mortality , Pneumococcal Vaccines/immunology , Retrospective Studies , Risk Factors , Serotyping , Taiwan/epidemiology , Treatment Outcome , Vaccines, Conjugate/immunologySubject(s)
Buttocks/diagnostic imaging , Fat Necrosis/diagnostic imaging , Lithiasis/diagnostic imaging , Aged , Female , Humans , RadiographyABSTRACT
BACKGROUND: Bony metastases were occasionally the initial presentations of malignancy. Overlooking of bony changes on radiographs in cancer patients with non-specific clinical symptoms may lead to delayed diagnosis. CASE PRESENTATION: We presented a 70-year-old male having hypercalcemia and diffuse osteoblastic bone metastases on routine plain films. Finally, prostate cancer was diagnosed with a prostate needle biopsy. CONCLUSION: Although the modern radionuclide bone scanning is useful in diagnosis, osteoblastic bone changes are occasionally seen in plain films, which are frequently overlooked. To avoid delayed diagnosis, bony structures should be carefully examined in all plain-film radiographs.
