Case of Pulmonary Cryptococcosis Mimicking Hematogeneous Metastases in an Immuocompetent Patient: Value of Absent 18F-Fluorodeoxylucose Uptake on Positron Emission Tomography/CT Scan

Chiao-Hua Lee,Ching Tzao,Tsun-Hou Chang,Wei-Chou Chang,Guo-Shu Huang,Chih-Kung Lin,Hsin-Chung Lin,Hsian-He Hsu 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.3

The radiologic appearance of multiple discrete pulmonary nodules in immunocompetent patients, with cryptococcal infection, has been rarely described. We describe a case of pulmonary cryptococcosis, presenting with bilaterally and randomly distributed nodules on a computed tomography, mimicking hematogeneous metastases. Positron emission tomography does not demonstrate 18F-fluorodeoxyglucose (FDG) uptake, suggesting a low probability for malignancy, which is a crucial piece of information for clinicians when making a management decision. We find the absence of FDG uptake correlates with the pathologic finding of an infectious nodule, composed of fibrosis and necrosis.

Haloperidol and Other Antipsychotics Exposure before Endometrial Cancer Diagnosis: A Population-based Case-control Study

Wei-Ling Chen,Srinivasan Nithiyanantham,Yan-Chiao Mao,Chih-Hsin Muo,Chih-Pin Chuu,Shih-Ping Liu,Min-Wei Huang,Kuan-Pin Su 대한정신약물학회 2022 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.20 No.3

Objective: Endometrial cancer is the most common malignancy of the female genital tract worldwide, and the associated relationship between endometrial cancer formation and various antipsychotics need to be confirmed. Methods: We conducted a case-control study by using data from Taiwan National Health Insurance Research Database to compare individual antipsychotic exposure between females with and without endometrial cancer. Among 14,079,089 females in the 12-year population-based national dataset, 9,502 females with endometrial cancer were identified. Their medical records of exposure to antipsychotics, including quetiapine, haloperidol, risperidone, olanzapine, amisulpride, clozapine, and aripiprazole, for up to 3 years before endometrial cancer diagnosis were reviewed. Daily dosage and cumulative exposure days were analyzed in the risky antipsychotic users. Additionally, the subsequent 5-year mortality rate of endometrial cancer among users of the risky antipsychotic were also analyzed. Results: Among endometrial cancer patients, the proportion of those who have used haloperidol before being diagnosed with endometrial cancer is significantly higher than other antipsychotic users. The significant odds ratio (OR) and a 95% confidence interval of 1.75 (1.31−2.34) were noted. Furthermore, haloperidol users were associated with a significantly higher 5-year mortality rate after getting endometrial cancer than non-users. Conclusion: There is a high correlation between the use of haloperidol and endometrial cancer formation. However, the underlying pathological biomechanisms require additional investigations.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

( Shu-Chen Wei ),( Ting-An Chang ),( Te-Hsin Chao ),( Jinn-Shiun Chen ),( Jen-Wei Chou ),( Yenn-Hwei Chou ),( Chiao-Hsiung Chuang ),( Wen-Hung Hsu ),( Tien-Yu Huang ),( Tzu-Chi Hsu ),( Chun-Chi Lin ) 대한장연구학회 2017 Intestinal Research Vol.15 No.3

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan. (Intest Res 2017;15:266-284)

Management of Crohn`s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

( Shu-Chen Wei ),( Ting-An Chang ),( Te-Hsin Chao ),( Jinn-Shiun Chen ),( Jen-Wei Chou ),( Yenn-Hwei Chou ),( Chiao-Hsiung Chuang ),( Wen-Hung Hsu ),( Tien-Yu Huang ),( Tzu-Chi Hsu ),( Chun-Chi Lin ) 대한장연구학회 2017 Intestinal Research Vol.15 No.3

Crohn`s disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan. (Intest Res 2017;15:285-310)

Experience in Professional Resilience for Nurses Caring for Patients with COVID-19: A Qualitative Descriptive Study

Chiu Pai-En,Lin Shu-Chuan A.,Li Ya-Ping,Huang Chiao-Hsin,Shu Ying-Mei,Chen Chi-Wen 한국간호과학회 2024 Asian Nursing Research Vol.18 No.1

Purpose During the COVID-19 pandemic, nurses have faced many professional and ethical dilemmas and challenges along with bearing physical, mental, and emotional stress resulting from worrying about themselves or their family being infected and stigmatized. This stress can potentially lead to burnout and resignation. Professional resilience is crucial for nurses to cope with these adverse situations. This study aimed to investigate the process by which nurses adapt, change, and overcome challenges during the COVID-19 pandemic and ultimately demonstrate professional resilience. Methods Descriptive phenomenology was applied. Semi-structured interviews were conducted with 11 nurses working in COVID-19 wards and intensive care units to collect data. Giorgi's phenomenological analysis method was employed. Results Based on the interview responses, four major themes were identified: 1) balancing patient care, self-protection, and passing on experience; 2) providing timely pandemic team resources and social support; 3) nurses' perseverance amid social discourse and constrained lives; and 4) selfless dedication shaping nursing's pinnacle experiences. Conclusions In the face of a sudden pandemic, frontline nurses play a critical role in maintaining medical capacity. Consequently, they must balance their families, lives, and work while adapting to the impact of the pandemic and changing practices and procedures based on the development of the pandemic and policy demands. The study findings provide insights into the challenges and emotional experiences encountered by nurses during a sudden pandemic outbreak and can serve as a reference for developing strategies to help nurses overcome these challenges and enhance their professional resilience.

Outcomes of limited period of adalimumab treatment in moderate to severe Crohn’s disease patients: Taiwan Society of Inflammatory Bowel Disease Study

( Wei-chen Lin ),( Jen-wei Chou ),( Hsu-heng Yen ),( Wen-hung Hsu ),( Hung-hsin Lin ),( Jen-kou Lin ),( Chiao-hsiung Chuang ),( Tien-yu Huang ),( Horng-yuan Wang ),( Shu-chen Wei ),( Jau-min Wong ) 대한장연구학회 2017 Intestinal Research Vol.15 No.4

Background/Aims: In Taiwan, due to budget limitations, the National Health Insurance only allows for a limited period of biologics use in treating moderate to severe Crohn’s disease (CD). We aimed to access the outcomes of CD patients following a limited period use of biologics, specifically focusing on the relapse rate and remission duration; also the response rate to second use when applicable. Methods: This was a multicenter, retrospective, observational study and we enrolled CD patients who had been treated with adalimumab (ADA) according to the insurance guidelines from 2009 to 2015. Results: A total of 54 CD patients, with follow-up of more than 6 months after the withdrawal of ADA, were enrolled. The average period of treatment with ADA was 16.7±9.7 months. After discontinuing ADA, 59.3% patients suffered a clinical relapse. In the univariate analysis, the reason for withdrawal was a risk factor for relapse (P=0.042). In the multivariate analysis, current smoker became an important risk factor for relapse (OR, 3.9; 95% CI, 1.2-14.8; P=0.044) and male sex was another risk factor (OR, 2.9; 95% CI, 1.1-8.6; P=0.049). For those 48 patients who received a second round of biologics, the clinical response was seen in 60.4%, and 1 anaphylaxis occurred. Conclusions: Fifty-nine percent of patients experienced a relapse after discontinuing the limited period of ADA treatment, and most of them occurred within 1 year following cessation. Male sex and current smoker were risk factors for relapse. Though 60.4% of the relapse patients responded to ADA again. (Intest Res 2017;15:487-494)