J Formos Med Assoc
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Kidney transplant recipients have an increased risk of cytomegalovirus (CMV) infection and disease. A strategy for mitigating the risk of CMV infection in kidney transplant recipients has not yet been established in Taiwan. The Transplantation Society of Taiwan aimed to develop a consensus by expert opinion on the prevention and management of CMV infection. ⋯ Letermovir and marabavir are emerging CMV agents used for prophylaxis and refractory CMV disease. CMV immunoglobulins have been used to treat refractory CMV disease in Taiwan. We hope this consensus will help professionals manage patients with CMV in Taiwan to improve the quality of care.
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Review
Small airways dysfunction in severe asthma: Current treatment approaches and future directions.
Severe asthma is a significant health concern due to its association with higher mortality rates, reduced quality of life, and increased healthcare costs. These challenges make it a persistent issue for both clinicians and researchers. ⋯ Recent studies demonstrated that small airways dysfunction is found in all asthma severity levels, but it is most pronounced in severe asthma, and greater small airways dysfunction severity correlates with poorer asthma control and a higher frequency of exacerbations. Therefore, therapies aimed at targeting small airways dysfunction are essential for effective asthma management, especially in severe asthma.
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Contrast media are essential agents that enhance the diagnostic capabilities of imaging studies, such as computed tomography and magnetic resonance imaging. However, concerns regarding the risk of adverse events have led to cautious use in patients with chronic kidney disease. A multidisciplinary review by nephrologists, cardiologists, and radiologists at National Taiwan University Hospital examined evidence linking iodinated contrast media and gadolinium-based contrast agents with acute kidney injury and nephrogenic systemic fibrosis. ⋯ Preventive strategies, including hydration with 0.9% saline and limiting contrast volume, may further reduce acute kidney injury risk in susceptible individuals. For nephrogenic systemic fibrosis, the risk is negligible with group II gadolinium-based contrast agents, even in patients with advanced chronic kidney disease or those on dialysis. The panel concludes that the use of iodinated contrast media or group II gadolinium-based contrast agents should not be postponed in chronic kidney disease patients when clinically significant imaging studies are required.
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Controlling hypertension has become an important issue in the elderly population in whom neurological comorbidities are highly prevalent. Most of the large-scale trials focusing on hypertension management in older populations have excluded patients with comorbid neurological disorders. However, this population requires special considerations, as the benefits of antihypertensive agents are mostly uncertain and there is a higher risk of adverse events. ⋯ For patients with neurodegenerative disorders such as cognitive dysfunction and Parkinson's disease, achieving adequate blood pressure control may be beneficial in reducing cardiovascular risks, although the higher risk of adverse events from antihypertensive treatment may offset some of these benefits. Special considerations for factors such as orthostatic hypotension, risk of falls, polypharmacy, and significant drug-drug interactions are required but frequently neglected in clinical practice. More efforts are warranted to determine the optimal treatment strategy for elderly populations with neurological disorders.
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The coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted long-term care facilities (LTCFs), revealing vulnerabilities due to residents' advanced age, comorbidities, and facility infrastructures. In Taiwan, the Central Epidemic Control Center implemented a range of strategies to protect LTCF residents. These included early containment measures to allow time for preparing pharmaceutical intervention, the establishment of infection prevention and control guidelines, the implementation of comprehensive screening and testing protocols, the prioritization of vaccination for both residents and staff, and the expansion of the national stockpile of oral antiviral agents. ⋯ All measures were made and adjusted based on community prevalence, evolving knowledge about the virus, and balancing the negative impacts on LTCF residents. These multifaceted efforts effectively mitigated transmission, maintained essential healthcare services, and supported LTCF staff, demonstrating the critical importance of coordinated, adaptive strategies in managing the impact of COVID-19 on vulnerable populations in LTCFs. By learning from the COVID-19 pandemic, we can develop more effective and resilient responses for managing future epidemics in LTCFs in Taiwan.