Twenty years' experience of midgut malrotation and volvulus in a tertiary center in northern Taiwan: A retrospective study.

BACKGROUND: Early diagnosis and surgical intervention for midgut malrotation with bowel obstruction are crucial. We aimed to identify risk factors for adverse outcomes in infants with midgut malrotation and to develop a prediction model. METHODS: We reviewed the operation records of infants surgically diagnosed with midgut malrotation at Chang Gung Children's Medical Center between January 2000 and December 2020. Patients were classified into the poor-outcome group (PO) if they underwent bowel resection or experienced mortality; all others were categorized as the favorable-outcome group (FO). Data on demographics, initial presentations, laboratory results, radiographic or sonographic findings, maternal conditions, and outcomes were collected and analyzed. Fisher's exact test, the independent sample t-test, and the Mann-Whitney test were utilized for comparative analysis when suitable. RESULTS: The study included 103 infants. Eleven were in the PO group, and 92 were in the FO group. Initial presentations such as respiratory distress, poor activity, and shock status were notably more prevalent in the PO group. The INR, hemoglobin, HCO3, base excess, and aspartate transaminase values showed significant variation between the two groups. Multivariate analysis identified that lower hemoglobin (OR 0.677, p = 0.043) and higher AST (OR 1.036, p = 0.044) were independent predictors of adverse outcomes. An AST/Hb ratio of <3.78 demonstrated a high negative predictive value (98.6%) for an adverse outcome in midgut malrotation. CONCLUSIONS: Prompt diagnosis and surgical treatment of midgut malrotation are vital to prevent bowel resection or mortality. The independent predicting factors for poor outcomes include low hemoglobin and elevated AST levels.

Association between different systemic therapies and the risk of tuberculosis in psoriasis patients: A population-based study.

BACKGROUND: Despite the evolution of biologic agents, the use of traditional systemic immunosuppressants still account for a considerable proportion of systemic anti-psoriasis therapy. The risk of tuberculosis among psoriasis patients receiving such conventional immunosuppressants is not clearly understood. METHODS AND MATERIALS: We used the retrospectively-collected data from the Taiwan National Health Insurance Research Database to perform this prospective cohort study. We included 94,585 adult patients with newly diagnosed psoriasis between January 1, 2001 and December 31, 2013. We documented the exposure of systemic anti-psoriasis therapies. The outcome is incident mycobacterium tuberculosis infection. RESULTS: During a mean 6.8 years follow-up, 703 (0.74%) incident tuberculosis was diagnosed and treated. The crude incidence of tuberculosis was 1.11 (95% confidence interval [CI] 1.03-1.19) events per 1000 person-years. The result demonstrated that MTX (Hazard ratio [HR] 2.16, 95% CI 1.47-3.16) and tacrolimus (HR 5.31, 95% CI 1.66-17.01) were significantly associated with increased risks of tuberculosis. Noticeably, azathioprine was a borderline significant risk factor of tacrolimus (HR 2.63, 95% 0.96-7.21, P = 0.059). The risk of TB in patients receiving adalimumab was twofold (HR 2.07) though not significant because of only one TB event was detected. The steroid was also associated with a dose-dependent increase of tuberculosis risk (HR 1.09, 95% CI 1.09-1.12, for every 1 mg of prednisolone equivalent dose per day). CONCLUSION: The study found that among systemic anti-psoriasis therapy, methotrexate, tacrolimus, azathioprine and steroid may be associated with an increased risk of tuberculosis.

Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study.

The incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the "on-treatment" effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51-15.17), adalimumab (HR 5.52, 95% CI 1.72-17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78-9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60-0.96) and acitretin (HR 0.39, 95% CI 0.24-0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.