Risk of severe dengue during secondary infection: A population-based cohort study in Taiwan.

BACKGROUND: Dengue poses a significant public health concern. Secondary dengue infections with different dengue virus (DENV) serotypes have been linked to an increased risk of severe dengue. This study aimed to assess the risk of severe dengue during secondary infection in Taiwan. METHODS: A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to identify dengue cases with secondary dengue infection born after 1944 from 2014 to 2015. Ten matched patients with primary infection were selected as controls using propensity score matching for each secondary dengue infection case. The odds ratio (OR) for severe dengue in secondary versus primary infections was calculated using conditional logistic regression. RESULTS: This study included 357 cases with secondary dengue infection and 3570 matched controls. The risk of severe dengue was found to be 7.8% in individuals with secondary infection, compared to 3.8% in those with primary dengue infection. Secondary infection significantly increased the risk of severe dengue (OR 2.13, 95% CI: 1.40-3.25, P = 0.0004). Notably, a significant association between secondary infection and severe dengue was observed only when the interval between the first and secondary infection was greater than two years (OR 3.19, 95% CI 2.04-5.00, P < 0.0001). CONCLUSION: Secondary dengue infection significantly increases the risk of severe disease in Taiwan, particularly when the interval between infections is over two years. Healthcare professionals should maintain heightened vigilance for individuals with a history of previous dengue infection, particularly if their initial diagnosis was more than two years prior.

Prediction of white-coat hypertension and white-coat uncontrolled hypertension using machine learning algorithm.

Aims: The detection of white-coat hypertension/white-coat uncontrolled hypertension (WCH/WUCH) with out-of-office blood pressure (BP) monitoring is time- and resource-consuming. We aim to develop a machine learning (ML)-derived prediction model based on the characteristics of patients from a single outpatient visit. Methods and results: Data from two cohorts in Taiwan were used. Cohort one (970 patients) was used for development and internal validation, and cohort two (464 patients) was used for external validation. WCH/WUCH was defined as an office BP of ≥140/90 mmHg and daytime ambulatory BP of <135/85 mmHg in treatment-naïve or treated individuals. Logistic regression, random forest (RF), eXtreme Gradient Boosting, and artificial neural network models were trained using 26 patient parameters. We used SHapley Additive exPlanations values to provide explanations for the risk factors. All models achieved great area under the receiver operating characteristic curve (AUROC), specificity, and negative predictive value in both validations (AUROC = 0.754-0.891; specificity = 0.682-0.910; negative predictive value = 0.831-0.968). The RF model was the best performing (AUROC = 0.884; sensitivity = 0.619; specificity = 0.887; negative predictive value = 0.872; accuracy = 0.819). The five most influential features of the RF model were office diastolic BP, office systolic BP, current smoker, estimated glomerular filtration rate, and fasting glucose level. Conclusion: Our prediction models achieved good performance, underlining the feasibility of applying ML models to outpatient populations for the diagnosis of WCH and WUCH. Further validation with other prospective data sets should be considered in the future.

Prediction of Masked Hypertension and Masked Uncontrolled Hypertension Using Machine Learning.

Objective: This study aimed to develop machine learning-based prediction models to predict masked hypertension and masked uncontrolled hypertension using the clinical characteristics of patients at a single outpatient visit. Methods: Data were derived from two cohorts in Taiwan. The first cohort included 970 hypertensive patients recruited from six medical centers between 2004 and 2005, which were split into a training set (n = 679), a validation set (n = 146), and a test set (n = 145) for model development and internal validation. The second cohort included 416 hypertensive patients recruited from a single medical center between 2012 and 2020, which was used for external validation. We used 33 clinical characteristics as candidate variables to develop models based on logistic regression (LR), random forest (RF), eXtreme Gradient Boosting (XGboost), and artificial neural network (ANN). Results: The four models featured high sensitivity and high negative predictive value (NPV) in internal validation (sensitivity = 0.914-1.000; NPV = 0.853-1.000) and external validation (sensitivity = 0.950-1.000; NPV = 0.875-1.000). The RF, XGboost, and ANN models showed much higher area under the receiver operating characteristic curve (AUC) (0.799-0.851 in internal validation, 0.672-0.837 in external validation) than the LR model. Among the models, the RF model, composed of 6 predictor variables, had the best overall performance in both internal and external validation (AUC = 0.851 and 0.837; sensitivity = 1.000 and 1.000; specificity = 0.609 and 0.580; NPV = 1.000 and 1.000; accuracy = 0.766 and 0.721, respectively). Conclusion: An effective machine learning-based predictive model that requires data from a single clinic visit may help to identify masked hypertension and masked uncontrolled hypertension.

Mab_3083c Is a Homologue of RNase J and Plays a Role in Colony Morphotype, Aggregation, and Sliding Motility of Mycobacterium abscessus.

Mycobacterium abscessus is an opportunistic pathogen causing human diseases, especially in immunocompromised patients. M. abscessus strains with a rough morphotype are more virulent than those with a smooth morphotype. Morphotype switch may occur during a clinical infection. To investigate the genes involved in colony morphotype switching, we performed transposon mutagenesis in a rough clinical strain of M. abscessus. A morphotype switching mutant (smooth) named mab_3083c::Tn was obtained. This mutant was found to have a lower aggregative ability and a higher sliding motility than the wild type strain. However, its glycopeptidolipid (GPL) content remained the same as those of the wild type. Complementation of the mutant with a functional mab_3083c gene reverted its morphotype back to rough, indicating that mab_3083c is associated with colony morphology of M. abscessus. Bioinformatic analyses showed that mab_3083c has a 75.4% identity in amino acid sequence with the well-characterized ribonuclease J (RNase J) of M. smegmatis (RNase JMsmeg). Complementation of the mutant with the RNase J gene of M. smegmatis also switched its colony morphology from smooth back to rough. These results suggest that Mab_3083c is a homologue of RNase J and involved in regulating M. abscessus colony morphotype switching.

Effects of childhood adversity and resilience on Taiwanese youth health behaviors.

BACKGROUND: Adverse childhood experiences (ACEs) can leave negative impacts on one's health behaviors or social functioning later in life. Resilient characteristics have been shown to mitigate effects against risk behaviors in developing adolescents. However, clinical and research attention has rarely been given to jointly consider the effects of ACEs and resilient characteristics on health behaviors in Taiwanese youth. METHOD: A total of 200 individuals aged 15-22 years were recruited from primary care settings, communities, and schools. Participants completed questionnaires assessing their ACEs, resilient characteristics, and health behaviors. Univariate analysis was firstly used to describe the correlates of ACEs and resilient characteristics. Further multivariate logistic regression analysis was used to examine the association of both factors with health behaviors. RESULTS: More than half (61.5%) of those surveyed had been exposed to at least one category of ACE. Verbal (37%) and physical (21%) abuses were the most common types of ACEs. The counts in the ACE categories were associated with being involved in physical fights (odds ratio 1.28 [confidence interval 1.01-1.63]), property damage (1.29 [1.03-1.61]), running away from home (1.30 [1.05-1.60]), bullying victimization (1.37 [1.16-1.61]), and sleep problems/tiredness (1.25 [1.03-1.52]). Meanwhile, resilience scores were associated with decreased odds of infrequent seatbelt use (0.47 [0.23-0.97]), low fruit and vegetable intake (0.42 [0.21-0.86]) unsatisfied body image (0.46 [0.22-0.97]), and sleep problems/tiredness (0.37 [0.18-0.79]). CONCLUSIONS: ACEs and resilience characteristics play a significant role in shaping youth health behaviors. Further research should be undertaken to identify ways to build resilience against health risks in youth with prior ACE exposure.

Cost-effectiveness Analysis for Genotyping before Allopurinol Treatment to Prevent Severe Cutaneous Adverse Drug Reactions.

OBJECTIVE: Patients with an HLA-B*58:01 allele have an increased risk of developing severe cutaneous adverse drug reactions (SCAR) when treated with allopurinol. Although one-off pharmacogenetic testing may prevent life-threatening adverse drug reactions, testing prior to allopurinol initiation incurs additional costs. The study objective was to evaluate the cost-effectiveness of HLA-B*58:01 screening compared with using other available urate-lowering agents (ULA). METHODS: A decision-analytical model was used to compare direct medical costs and effectiveness [including lifetime saved, quality-adjusted life-yrs (QALY) gained] in treating new patients with the following options: (1) genetic screening followed by allopurinol prescribing for noncarriers of HLA-B*58:01, (2) prescribing benzbromarone without screening, (3) prescribing febuxostat without screening, and (4) prescribing allopurinol without screening. A 1-year time frame and third-party payer perspective were modeled for both the entire cohort (base-case) and for the subgroup of patients with chronic kidney disease (CKD). RESULTS: The incremental cost-effectiveness ratio of genetic screening prior to ULA therapy was estimated as New Taiwan (NT) $234,610 (US$7508) per QALY gained in the base-case cohort. For patients with CKD, it was estimated as NT$230,925 (US$7390) per QALY. The study results were sensitive to the probability of benzbromarone/febuxostat-related hypersensitivity, and a negative predicted value of genotyping. CONCLUSION: HLA-B*58:01 screening gave good value for money in preventing allopurinol-induced SCAR in patients indicated for ULA therapy. In addition to the costs of genotyping, it is important to monitor ULA safety closely in adopting HLA-B*58:01 screening in practice.

Orthognathic Surgery with Simultaneous Autologous Fat Transfer for Correction of Facial Asymmetry.

BACKGROUND: Most patients treated with orthognathic surgery for facial asymmetry would value improvement in residual soft-tissue asymmetry. Autologous fat transfer is widely used to augment facial soft tissue. The authors assessed the effect of combining orthognathic surgery with autologous fat transfer for treating patients with facial asymmetry. METHODS: In this retrospective study, 15 consecutive adults underwent combined orthognathic surgery and autologous fat transfer between January of 2013 and December of 2015. Lower facial profile symmetry was assessed using postoperative standard frontal photographs. RESULTS: Lower facial symmetry was much improved by combining orthognathic surgery and autologous fat injection. CONCLUSION: The combined use of orthognathic surgery and autologous fat transfer is a promising technique for improving facial symmetry in patients with facial asymmetry. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury: A Retrospective Cohort Study.

The disease burden and outcomes of community-acquired (CA-) and hospital-acquired acute kidney injury (HA-AKI) are not well understood. The aim of the study was to investigate the incidence, outcomes, and risk factors of AKI in a large Taiwanese adult cohort.This retrospective cohort study examined 734,340 hospital admissions from a group of hospitals within an organization in Taiwan between January 1, 2010 and December 31, 2014. Patients with AKI at discharge were classified as either CA- or HA-AKI based on the RIFLE (risk, injury, failure, loss of function, end stage of kidney disease) classification criteria. Outcomes were in-hospital mortality, dialysis, recovery of renal function, and length of stay. Risks of developing AKI were determined using multivariate logistic regression based on demographic and baseline clinical characteristics and nephrotoxin use before admission.AKI occurred in 1.68% to 2% hospital discharges among adults without and with preexisting chronic kidney disease (CKD), respectively. The incidence of CA-AKI was 17.25 and HA-AKI was 8.14 per 1000 admissions. The annual rate of CA-AKI increased from 12.43 to 19.96 per 1000 people, but the change in HA-AKI was insignificant. Comparing to CA-AKI, those with HA-AKI had higher levels of in-hospital mortality (26.07% vs 51.58%), mean length of stay (21.25 ±â€Š22.35 vs 35.84 ±â€Š34.62 days), and dialysis during hospitalization (1.45% vs 2.06%). Preexisting systemic diseases, including CKD were associated with increased risks of CA-AKI, and nephrotoxic polypharmacy increased risk of both CA- and HA-AKI.Patients with HA-AKI had more severe outcomes than patients with CA-AKI, and demonstrated different spectrum of risk factors. Although patients with CA-AKI with better outcomes, the incidence increased over time. It is also clear that optimal preventive and management strategies of HA- and CA-AKI are urgently needed to limit the risks in susceptible individuals.

Compliance with risk management plan recommendations on laboratory monitoring of antitumor necrosis factor-α therapy in clinical practice.

BACKGROUND/PURPOSE: A risk management plan (RMP) was introduced to monitor the association between initiation of antitumor necrosis factor-α (anti-TNF-α) therapy and tuberculosis (TB) and viral hepatitis infections. The aim of this study was to assess adherence and predictors of laboratory-testing rates among patients treated with anti-TNF-α therapy. METHODS: Data on patients receiving anti-TNF-α therapy between January 1, 2005, and November 31, 2013, were retrieved from a large medical organization in Taiwan. Newly-treated patients were categorized into pre- and post-RMP groups. Laboratory testing for TB and hepatitis B and C was ascertained and the proportion of new users receiving the test was compared between the pre- and post-RMP groups. Patient characteristics and concomitant medications used were investigated using multivariate logistic regression to determine the impact of each factor on laboratory testing. RESULTS: Among 1128 new users, the initial testing rate of chest X-ray (CXR) for latent TB infection increased from 60.26% before RMP to 76.38% after RMP implementation; hepatitis B surface antigen (HBsAg) increased from 31.13% to 51.42%; and hepatitis C virus antibody (HCVAb) increased from 32.2% to 54.10%. CXR was significantly associated with age >60 years, higher Quan-Charlson comorbidity index score, psoriasis, and use of prednisolone (≥7.5 mg/d). Patients aged 40-60 years and with prednisolone doses of ≥7.5 mg/d and history of cancer were more likely to receive HBsAg or HCVAb tests than their counterparts. CONCLUSION: The rate of laboratory test monitoring for anti-TNF-α therapy increased after RMP implementation. A strategy that integrates efforts from patient's education, health profession, and regulatory agencies is needed to improve safety screening and access to laboratory resources for the at-risk group of patients.

Correction of skeletal Class III malocclusion with clockwise rotation of the maxillomandibular complex.

A 19-year-old woman with skeletal Class III malocclusion, paranasal depression, and a low mandibular plane angle was treated with orthodontics and orthognathic surgery. Dental decompensation and protraction of maxillary right third molar to replace maxillary right second molar were performed before surgery. Clockwise rotation of maxillo-mandibular complex was applied by Le Fort I osteotomy and bilateral sagittal split osteotomies to achieve facial balance. The active treatment period was 12 months. The stable occlusion and skeletal relationship were observed after a 10-month follow-up period.