Epidemiology of pandemic influenza A/H1N1 virus during 2009–2010 in Taiwan

Outbreak of swine-origin influenza A/H1N1 virus (pdmH1N1) occurred in 2009. Taiwanese authorities implemented nationwide vaccinations with pdmH1N1-specific inactivated vaccine as of November 2009. This study evaluates prevalence, HA phylogenetic relationship, and transmission dynamic of influenza A and B viruses in Taiwan in 2009–2010. Respiratory tract specimens were analyzed for influenza A and B viruses. The pdmH1N1 peaked in November 2009, was predominant from August 2009 to January 2010, then sharply dropped in February 2010. Significant prevalence peaks of influenza B in April–June of 2010 and H3N2 virus in July and August were observed. Highest percentage of pdmH1N1- and H3N2-positive cases appeared among 11–15-year-olds; influenza B-positive cases were dominant among those 6–10 years old. Maximum likelihood phylogenetic trees showed 11 unique clusters of pdmH1N1, seasonal H3N2 influenza A and B viruses, as well as transmission clusters and mixed infections of influenza strains in Taiwan. The 2009 pdmH1N1 virus was predominant in Taiwan from August 2009 to January 2010; seasonal H3N2 influenza A and B viruses exhibited small prevalence peaks after nationwide vaccinations. Phylogenetic evidence indicated transmission clusters and multiple independent clades of co-circulating influenza A and B strains in Taiwan.     

Expression of Krűppel-like factor 5 in gastric cancer and its clinical correlation in Taiwan

Krűppel-like factors (KLFs), highly conserved zinc-finger proteins, play either anti- or pro-proliferation roles in different human cancers through regulating a wide range of genes’ expression. Here, we investigated the expression of KLF5 in gastric cancers and its correlation with clinicopathological parameters and overall survival rates. In this study, KLF5 expression was measured by an immunohistochemical microarray assay of tissue taken from 76 surgical specimens. Higher KLF5 expression was significantly associated with lower tumor grade (P < 0.001). Nuclear staining of the KLF5 expression was significantly associated with a higher tumor grade (P = 0.000), higher clinical stage (P = 0.019), lymph node status (P = 0.016), and 2-year survival (P = 0.017). Patients with nuclear staining of KLF5 had a significantly lower disease-free survival rate compared to patients with negative nuclear staining, as defined by a log-rank test (P = 0.041). Our results revealed that KLF5 may play an oncogenetic role in gastric carcinogenesis.     

Sleeping in? The impact of age and depressive sub-type on hypersomnia

BACKGROUND: While early morning wakening is held to be a classic feature of melancholia, we investigate the clinical observation that young patients with melancholia and bipolar depression tend to be more likely to report hypersomnia. METHODS: We examine age-related rates of those two sleep disturbance patterns in a consecutive set of out-patients with differing depressive sub-types assessed over a 20-year period. RESULTS: Hypersomnia was more likely to be reported than early morning wakening across all age bands by those with non-melancholic depression. Hypersomnia was also more likely than early morning wakening in younger patients with melancholia and bipolar disorder but, with age, early morning wakening became the dominant pattern. LIMITATIONS: The study was retrospective, undertaken in a sample attending a tertiary referral unit and artefactual determinants of the associations were not pursued. CONCLUSIONS: We speculate that hypersomnia may be a non-specific homeostatic coping response to stress and thus to the non-melancholic depressive disorders, but that this pattern is overruled by an early morning wakening pattern in the more biological depressive sub-types as the individual ages, perhaps reflecting a noradrenergic contribution.     

Culture-positive invasive aspergillosis in a medical center in Taiwan, 2000–2009

We reviewed 776 patients who were culture positive for Aspergillus species at the hospital from 2000 to 2009. The isolates were collected for species identification by oligonucleotide hybridization and sequence analysis. A total of 96 cases of proven or probable IA were identified according to published criteria. The incidence of IA has increased significantly during the study period. Aspergillus fumigatus and A. flavus (41.7% each) were equally prevalent causative species. IA due to unusual species including A. nidulans (n=2), A. versicolor (n=2), and A. tubingensis (n=1) were also found. Among patients with IA, 55.2% had hematological disorder, 19.8% had underlying lung disorder, and 10.4% had autoimmune disease. The isolates species (P<0.001) and underlying disease (P<0.001) significantly affect the association of a positive culture with invasive disease. The overall mortality at three months was 62.5%, which remained stable throughout the study period. Multivariate analysis identified prior steroid use (P=0.007) as a significant risk factor for death, while surgery (P=0.030) and voriconazole (P=0.012) had protective effects. In conclusion, autoimmune disorders and underlying pulmonary diseases should also be considered as important predisposing factors of IA. Further emphasis on surgery and voriconazole in the management of IA might be beneficial.     

Role of α-glucan-induced oxygen species in dendritic cells and its impact in immune response against tuberculosis

With 10 million new cases and three million deaths estimated to occur yearly ? more than any time in history ? tuberculosis (TB) remains the single most widespread and deadly infectious disease. Until recently, it was thought that both latent and active TB was primarily related to host factors. Nonetheless, the participation of bacterial factors is becoming increasingly evident. Minimal variations in genes related to Mycobacterium tuberculosis (Mtb) virulence and pathogenesis can lead to marked differences in immunogenicity. Dendritic cells (DC) are professional antigen presenting cells whose maturation can vary depending on the cell wall composition of each particular Mtb strain being critical for the onset of the immune response against Mtb. Here we evaluated the role played by α-glucan, in the endogenous production of reactive oxygen species, ROS, and the impact on DC maturation and function. Results showed that α-glucans on Mtb induce ROS production leading to DC maturation and lymphocyte proliferation. Even more, α-glucans induced Syk activation but were not essential in non-opsonized phagocytosis. In summary, α-glucans of Mtb participates in ROS production and the subsequent DC maturation and antigen presentation, suggesting a relevant role of α-glucans for the onset of the protective immune response against TB.     

Associations of age and sex with brain volumes and asymmetry in 2–5-week-old infants

Brain Structure and Function - Information on normal brain structure and development facilitates the recognition of abnormal developmental trajectories and thus needs to be studied in more detail....     

A comparison of the impact of CPOE implementation and organizational determinants on doctor–nurse communications and cooperation

ObjectiveTo compare the impact of CPOE implementation and of the workplace organizational determinants on the doctor–nurse cooperation and communication processes.MethodA first study was undertaken in eight different wards aimed to identify the different workplace organizations that support doctor–nurse communications’. A second study compared the impact of these organizations and of a CPOE on medication-related doctor–nurse communications.ResultsThe doctor–nurse communications could be structured into three typical workplace organizations: the common round, the briefing and the opportunistic exchange organizations. The results (i) confirmed the impact of the organizational determinants on the cooperative activities and (ii) demonstrated the CPOE system has no significant impact within a given workplace organization.ConclusionThe success of the implementation of HIT applications relies partly on the identification of the actual (and sometimes hidden) structuring variables of teamwork and ultimately on their control at the time of implementation to ensure the quality and safety of the patient care provided.     

Surveillance of multidrug-resistant tuberculosis in Taiwan, 2008–2019

BackgroundDrug-resistant tuberculosis (DR-TB) is a major contributor to global cases of antimicrobial resistance and remains a public health challenge. To understand the extent and trend of DR-TB under an enhanced multidrug-resistant TB (MDR-TB) management program, we conducted a population-based retrospective study of 1511 Taiwanese MDR-TB cases reported from 2008 to 2019.MethodsWe obtained patient demographics and clinical and bacteriological information from the National TB Registry and the Infectious Disease Notification System.ResultsOf the 1511 MDR-TB patients, 941 were new cases, 485 were previously treated, and 85 had an unknown history of treatment. The male to female ratio was 2.75, and the median age of the patients was 57 years (IQR: 45–72). We observed a significant decline in MDR-TB cases, with annual percentage change (APC) of ?4.17%. However, new and previously treated MDR-TB cases had APCs of ?1.41% and ?9.18%, respectively. The rates of MDR-TB resistance to ethambutol, streptomycin and pyrazinamide were 47.2%, 42.4% and 28.9%, respectively, whereas the rates of resistance to fluoroquinolones and second-line injectable drugs (SLIDs) were 4.1–7.1%, 9.0–14.1%; and the rate of extensively drug-resistant TB was 1.9%, respectively. Furthermore, we observed a decreasing trend of resistance to SLIDs (APCs ?7.0% to ?8.2%) in new cases and a significant decreasing trend of resistance to moxifloxacin (?24.6%) and levofloxacin (?23.3%) in previously treated cases.ConclusionThe decreasing trend of MDR-TB and resistance to second-line drugs suggested that our programmatic management of TB was effective and that the impact on TB control was profound.     

Changes in epidemiology and antimicrobial susceptibility of nontyphoid Salmonella in children in southern Taiwan, 1997–2016

BackgroundThis study aimed to investigate the changing trends in serogroup distribution and antimicrobial susceptibility of nontyphoid Salmonella (NTS) isolated from children in the past two decades in Taiwan.MethodsThis retrospective study enrolled patients aged younger than 18 years with culture-proven NTS infection in a tertiary medical center from 1997 to 2016. Data on age, Salmonella serogroup, culture sample, and antimicrobial susceptibility were obtained from medical records. The rates of Salmonella serogroups and antimicrobial resistance were compared between period 1 (1997–2006) and period 2 (2007–2016).ResultsA total of 2075 NTS isolates were identified from 1997 to 2016 (1036 in period 1, 1039 in period 2). The major isolates were from feces (89.1%) and blood (10.4%). The most common serogroup was serogroup B (54.8%), followed by serogroup D (18.8%). There was a significant decline in the proportion of serogroup B with a concomitant rise in serogroup D in the past two decades. In period 2, resistance to cefotaxime and cefixime increased remarkably among serogroup B, whereas resistance to ampicillin increased notably among serogroup D. Furthermore, the incidence of multidrug-resistant (≥3 antibiotics) NTS significantly decreased in both serogroup B and serogroup D in period 2.ConclusionThis study revealed a significant rise in serogroup D with a concomitant decline in serogroup B NTS infection in Taiwanese children. Moreover, antimicrobial resistance to third-generation cephalosporins increased in serogroup B. Continuous surveillance of NTS serogroup distribution and antimicrobial susceptibility is mandatory to formulate therapeutic strategies for NTS infections.     

The clinical implication of serotype distribution and drug resistance of invasive pneumococcal disease in children: A single center study in southern Taiwan during 2010–2016

BackgroundThe regional study of pediatric invasive pneumococcal disease (IPD) is still limited in Taiwan. The aim of this study is to update the epidemiologic data of pediatric IPD in Taiwan, focusing on the trend of non-13-valent pneumococcal conjugate vaccines (PCV13)-specific serotypes and antimicrobial susceptibility.MethodsThis was a single-center retrospective study by chart reviewing and recruited patients aged <18 years who were reported having IPD between January 2010 and December 2016. Clinical manifestations, serotypes of pneumococcus and antimicrobial susceptibility were compared and analyzed.ResultsA total of 46 patients were enrolled in this study. Serotype 19 A was the most common serotype (32.6%) in pediatric IPD and significantly correlated with empyema. Non-PCV13-specific serotypes such as serotype 15, 15B, 15C and 22 were reported during this period. There was no mortality or significant morbidity associated with these emerging strains. Using the meningitis breakpoint of minimum inhibitory concentration (MIC), although it showed no significant linear trend of the prevalence of ceftriaxone non-susceptible pneumococcus (CNSP) (p = 0.392), the prevalence of CNSP increased from 50% (11 over 22) before 2013 to 83% (20 over 24) after 2013 with statistical significance (p = 0.027).ConclusionThe increase in the prevalence of CNSP using meningitis breakpoint was observed since 2013. For treating pneumococcal meningitis, empirical therapy with vancomycin and ceftriaxone is warranted. Although the non-PCV13-specific serotypes reported in our study caused no morbidity and mortality, further monitoring and surveillance are still recommended.     

Clinical manifestations and outcome of nocardiosis and antimicrobial susceptibility of Nocardia species in southern Taiwan, 2011–2021

Background/PurposeNocardiosis is an uncommon infectious disease. This study aimed to assess the clinical outcome of patients with nocardiosis and examine the antimicrobial susceptibility profiles of Nocardia spp. isolated.MethodsWe retrospectively reviewed the medical records of all inpatients diagnosed with nocardiosis between 2011 and 2021. The identification of Nocardia spp. at the species level was performed with the use of MALDI-TOF and 16S rRNA assays. The antimicrobial susceptibility of Nocardia spp. was performed using the microbroth dilution method. Factors associated with 90-day all-cause mortality were identified in multivariate logistic regression analysis.ResultsOf 60 patients with nocardiosis in the 11-year study period, the lungs (55.0%) were the most common site of involvement, followed by the skin and soft tissue (45.0%). Twenty-two patients (36.7%) died within 90 days following the diagnosis. All of the Nocardia isolates were susceptible to trimethoprim-sulfamethoxazole, linezolid, and amikacin, whereas more than 70% of the isolates were not susceptible to ciprofloxacin, imipenem-cilastatin, moxifloxacin, cefepime, and clarithromycin. Nocardiosis involving the lungs (relative risk [RR], 9.99; 95% confidence interval [CI], 1.52–65.50; p = 0.02), nocardiosis involving the skin and soft tissue (RR, 0.15; 95% CI, 0.02–0.92; p = 0.04), and treatment with trimethoprim-sulfamethoxazole (RR, 0.14; 95% CI, 0.03–0.67; p = 0.01) were independently associated with 90-day all-cause mortality.ConclusionsNocardia spp. identified between 2011 and 2021 remained fully susceptible to trimethoprim-sulfamethoxazole, linezolid, and amikacin. Nocardiosis of the lungs, skin and soft tissue infection, and treatment with trimethoprim-sulfamethoxazole were independently associated with 90-day all-cause mortality.     

Molecular epidemiology of respiratory syncytial virus during the 2009–2010 season in Latvia

For the first time, we studied molecular epidemiology of respiratory syncytial virus in hospitalized children in Latvia. During the study period, ten unique group A and three group B strains were identified and assigned to a single genotype within each group—GA2 for group A and BA-IV for group B.     

The impact of maternal psychopathology on child–mother attachment

This review aims to consider evidence for the impact of maternal psychopathology on the child’s attachment to the mother, and the role of this in mediating the known transmission of developmental and clinical risk to children. The studies reviewed focus on mothers with depression and psychotic disorder. A number of studies (mainly of mothers with depression) demonstrate an association between insecure/disorganised infant attachments and severe maternal psychopathology, whether chronic or current, in the presence of comorbid disorder, maternal insecure or unresolved attachment state of mind, trauma/loss, or low parenting sensitivity. Whether such effects last into middle childhood, however, is unclear. Our understanding of the role of attachment in determining developmental trajectories in this group is at an early stage. Some evidence suggests that attachment may have a role in mediating the intergenerational transmission of internalising and other problems in this group, although the presence of co-occurring contextual risk factors may account for the variability in findings. A multifactorial longitudinal approach is needed to elucidate such factors. However, the current literature highlights which subgroups are likely to be vulnerable and provides an evidence-based rationale for taking an attachment-based approach to intervention in this group.