Chang Gung medical journal
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The effect of epidural analgesia on nulliparous labor and delivery remains controversial. In addition, pregnancy and delivery have long been considered risk factors in the genesis of stress urinary incontinence (SUI). We sought to determine the effect of epidural analgesia and timing of administration on labor course and postpartum SUI. ⋯ Our findings showed that epidural analgesia is associated with an increased risk of prolonged labor, and instrumental and cesarean delivery but is not related to increased postpartum SUI. Regarding the impact of the timing of epidural analgesia given in the labor course, the first stage of labor appeared to last longer when analgesia was administered early rather than late.
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Leptospirosis is a re-emerging infectious disease affecting both animals and humans worldwide. This infection is associated with occupational contact with animals, recreational exposure and contact with leptospires as a consequence of flooding. Multiple organ involvement may be encountered in acute severe leptospirosis and early renal involvement is commonly characterized by tubulo-interstitial nephritis and tubular dysfunction. ⋯ The rapid IgM assay may aid screening of Leptospirosis, thus allowing effective treatment to be initiated early. Leptospirosis appears to be underestimated in Taiwan and affects at least 10% of patients with multiple organ dysfunction. Therefore, a high level of clinical suspicion may help in identifying underestimated leptospirosis in Taiwan.
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The mortality rate after discharge from the intensive care unit (ICU) (so called post-ICU mortality) has remained high (8.6-23.6%) during the past 15 years. The object of this study was to examine the effects of the severity of illness at ICU discharge assessed using the Acute Physiology and Chronic Health Evaluation (APACHE) on the post-ICU mortality rate. ⋯ In our study, a higher APACHE II score calculated at ICU discharge and male gender were independent risk factors for post-ICU death. Identifying patients with discharge APACHE II scores of 17 or greater helps to predict post-ICU death.