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DOĞAN M. Examination of patients admitted to a university hospital with methanol intoxication. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1107285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: The aim of this study is to evaluate the demographic data, clinical features and laboratory findings of patients followed up with methanol poisoning in our internal medicine clinic. In addition, to examine the data of the patients followed in our intensive care unit and to contribute to the literature in this direction.
Material and Method: In this study, 21 patients diagnosed with methanol intoxication who were hospitalized in the internal medicine clinic of our hospital between 01.01.2019 and 01.04.2022 were included. Demographic information of the patients, initial complaints, accompanying symptoms, laboratory results, blood gas values, intensive care unit requirements, mechanical ventilation needs, length of hospital stay and whether they received hemodialysis treatment were recorded from the hospital automation system.
Results: 21 patients were included in the study. The mean time for patients to apply to the hospital after drinking alcohol was calculated as 31.42±4.27 hours. The mean hospital stay was 3.0±1.02 days. While 12 patients were followed up in the intensive care unit, it was found that 6 patients needed mechanical ventilation and 9 patients needed hemodialysis. Glucose, creatinine, acetyl aminotransferase (AST), partial carbon dioxide pressure (PaCO2), lactate, anion gap and base gap were found to be statistically significantly higher in the group treated in the intensive care unit (p
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Affiliation(s)
- Murat DOĞAN
- Çorum Hitit Üniversitesi EAH İç Hastalıkları
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2
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Zamani N, Gheshlaghi F, Haghighi-Morad M, Bahrami-Motlagh H, Alavi Darazam I, Hadeiy SK, McDonald R, Hassanian-Moghaddam H. Prevalence of clinical and radiologic features in methanol-poisoned patients with and without COVID-19 infection. Acute Med Surg 2021; 8:e715. [PMID: 34925862 PMCID: PMC8647202 DOI: 10.1002/ams2.715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
Aim The aim of the current study was to evaluate the prevalence of coronavirus disease (COVID‐19) in methanol‐poisoned patients admitted to two toxicology academic centers during the COVID‐19 outbreak and determine their clinical features and chest/brain computed tomography (CT) findings. Methods Methanol‐poisoned patients who had been referred during the COVID‐19 pandemic were evaluated for signs and symptoms of COVID‐19 by chest CT scans and/or polymerase chain reaction test. Results A total of 62 patients with confirmed methanol poisoning were enrolled in the study, with a median (interquartile range) age of 35 (28–44) years. Thirty‐nine (62.9%) survived. Nine (14.5%) were diagnosed to have COVID‐19, of whom four survived. There was a significant correlation between COVID‐19 disease and a history of alcohol consumption (p = 0.036; odds ratio 1.7; 95% confidence interval, 1.3–2.2). Univariate analysis showed significant differences between infected and noninfected patients regarding their urea and time for first and second hemodialysis sessions, as well as the duration of ethanol administration. Conclusions In conclusion, during the pandemic, specific attention should be paid to patients with a history of alcohol ingestion and elevated creatinine, loss of consciousness, and severe acidosis as these signs/symptoms could be present in both COVID‐19 and methanol poisoning, making differentiation between the two challenging.
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Affiliation(s)
- Nasim Zamani
- Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran.,Department of Clinical Toxicology Loghman-Hakim Hospital School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Farzad Gheshlaghi
- Department of Clinical Toxicology Isfahan Clinical Toxicology Research Center School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Maryam Haghighi-Morad
- Department of Radiology Loghman-Hakim Hospital School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Hooman Bahrami-Motlagh
- Department of Radiology Loghman-Hakim Hospital School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Ilad Alavi Darazam
- Department of Infectious Diseases Loghman-Hakim Hospital School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Seyed Kaveh Hadeiy
- Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Rebecca McDonald
- Institute of Psychiatry, Psychology and Neuroscience National Addiction Centre King's College London London UK
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran.,Department of Clinical Toxicology Loghman-Hakim Hospital School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
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Sharif AF, AlAmeer MR, AlSubaie DS, Alarfaj NH, AlDawsari MK, AlAslai KM, BuSaleh MJ, AlSabr AI, Al-Mulhim KA. Predictors of poor outcomes among patients of acute methanol intoxication with particular reference to Sequential Organ Failure Assessment (SOFA) score. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:60511-60525. [PMID: 34156622 DOI: 10.1007/s11356-021-14998-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Methanol intoxication is a global problem with serious morbidities and mortalities. Apart from the lifelong disabilities experienced by methanol intoxication survivors, mortality rates of up to 44% of exposed patients have been reported. The aim of the current study was to outline the early findings that could be utilized as effective in-hospital outcome predictors among cases of methanol exposure. Furthermore, the role of the Sequential Organ Failure Assessment (SOFA) score was evaluated as an early in-hospital outcome indicator among patients presented with acute methanol intoxication. A multicenter study including 37 patients diagnosed with acute methanol intoxication and referred to three major poison control centers in Saudi Arabia during the past 3 years (January 1, 2018-January 1, 2021) was conducted. Data including demographics, exposure history, presenting complaints, clinical findings, and laboratory investigation were collected. The patients were scored on Glasgow Coma Scale (GCS), Poison Severity Score (PSS), and SOFA score on admission. Out of the presented patients, 83.8% were alcoholic men. No deaths have been reported, and 51.4% were discharged with unfavorable outcomes, including 29.7% suffered optic neuropathy and blindness, 18.9% showed acute renal impairment, and 10.8% were complicated with respiratory failure. The diastolic blood pressure, anion gap, visual acuity, number of hemodialysis sessions, PSS, duration of Intensive Care Unit (ICU) stay, and SOFA score were all significant organ failure predictors (P < 0.05). However, only the SOFA score showed the best significant prediction on multivariate analysis, with an odds ratio (95% confidence interval) of 0.10 (0.04-0.17) and P = 0.003. At a cutoff of greater than 4.5, the SOFA score could significantly predict unfavorable outcomes with area under curve (AUC) = 0.955, accuracy 89.2%, specificity 94.4%, and sensitivity 84.2%. Early identification of methanol exposed patients at risk is critical and lifesaving. The SOFA score is a substantially useful and early inclusive unfavorable outcome predictor.
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Affiliation(s)
- Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, El Geish Street, Tanta, Gharbia, 31527, Egypt.
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia.
| | - Mahdi Riyadh AlAmeer
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Respiratory Care Department, Riyadh Care Hospital, Riyadh, Saudi Arabia
| | - Duhaim Saad AlSubaie
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Emergency Medicine Department, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Naser Husam Alarfaj
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Administartion of Radiology Department, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | - Mubarak Khalifah AlDawsari
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Diagnostic Radiology Department, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Khalid Mansour AlAslai
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Emergency Medicine Department, Prince Mohammed Bin Abdulaziz Hospital (PMAH), Riyadh, Saudi Arabia
| | - Mahmoud Jawad BuSaleh
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Abdulaziz Ibrahim AlSabr
- Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
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Hadipourzadeh M, Ebrahimi S, Ziaeefar P, Zamani N, Falahaty H, Robert D, Hassanian-Moghaddam H. Comparing the Clinical Characteristics, Laboratory Findings, and Outcomes between Epidemic and Episodic Methanol Poisoning Referrals; a Cross-sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e46. [PMID: 34223191 PMCID: PMC8221550 DOI: 10.22037/aaem.v9i1.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: Due to illegal manufacturing and sales of alcoholic beverages, epidemic outbreaks of methanol poisoning may occur. The aim of this study was to determine if there were differences in the severity, course of poisoning, and outcomes between methanol-poisoned patients admitted during an outbreak versus those who were admitted following episodic exposures. Methods: The present retrospective study was performed in a single referral poisoning center between March 2018 and March 2019 in patients with confirmed methanol poisoning. During this time, in addition to episodic cases of methanol intoxication, there were three methanol poisoning outbreaks. Outbreaks were characterized by an unexpected increase in the number of methanol-poisoned patients in a short period of time, which impacted resources and decision-making. The two groups were compared regarding their severity of poisoning, sessions of hemodialysis, and clinical outcomes. Results: Outbreak cases had a higher level of methanol than episodic cases. Odds of being dialyzed more than once was 5.4 times higher in the cases presenting during an outbreak (95% CI 2.1-14.0; p=0.001). Mean hospital stay, intubation/mechanical ventilation, and death were similar between the two groups. An evaluation of the alcoholic beverage samples available in the Iranian black market during the outbreak showed a 7-percent methanol concentration with no ethanol content. Conclusions: Poisoning risk may be higher during methanol outbreaks due to the higher methanol concentrations, requiring more hemodialysis sessions for persistent metabolic acidosis. In addition to alcohol dehydrogenase blockade, careful risk assessment of all methanol poisonings can assist with stratifying the priority for, and duration of, hemodialysis to optimize outcomes.
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Affiliation(s)
- Mehdi Hadipourzadeh
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Falahaty
- Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Darren Robert
- Departments of Clinical Pharmacology and Toxicology, and Renal Medicine and Transplantation, St Vincent's Hospital, Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Hossein Hassanian-Moghaddam
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nikoo MH, Arjangzadeh A, Pakfetrat M, Boogar SS, Mohammadkarimi V, Ostovan VR, Khodamoradi Z, Roozbeh J, Khalili M, Shirazi FKH, Kouhi P, Heydari ST. Electrocardiographic findings of methanol toxicity: a cross-sectional study of 356 cases in Iran. BMC Cardiovasc Disord 2020; 20:415. [PMID: 32928149 PMCID: PMC7488223 DOI: 10.1186/s12872-020-01691-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/27/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Methanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature. METHOD A total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. RESULTS The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings. In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC > 500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P < 0.05 for all), respectively. CONCLUSION Electrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.
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Affiliation(s)
- Mohammad Hossein Nikoo
- Non-communicable Disease Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Pakfetrat
- Department of Internal Medicine, Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Sadeghi Boogar
- Department of Internal Medicine, School Of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Mohammadkarimi
- Department of Internal Medicine, School Of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Reza Ostovan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Poostchi Eye Research Centre, Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohre Khodamoradi
- Department of Internal Medicine, School Of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Roozbeh
- Department of Internal Medicine, Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Khalili
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Poostchi Eye Research Centre, Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Paryia Kouhi
- Department of Internal Medicine, School Of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Building No.2.8th Floor School of Medicine Zand Avenue, P.O.Box:71345-1877, Shiraz, Iran
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Md Noor J, Hawari R, Mokhtar MF, Yussof SJ, Chew N, Norzan NA, Rahimi R, Ismail Z, Singh S, Baladas J, Hashim NH, Mohamad MIK, Pathmanathan MD. Methanol outbreak: a Malaysian tertiary hospital experience. Int J Emerg Med 2020; 13:6. [PMID: 32028888 PMCID: PMC7006424 DOI: 10.1186/s12245-020-0264-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/21/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Methanol poisoning usually occurs in a cluster and initial diagnosis can be challenging. Mortality is high without immediate interventions. This paper describes a methanol poisoning outbreak and difficulties in managing a large number of patients with limited resources. Methodology A retrospective analysis of a methanol poisoning outbreak in September 2018 was performed, describing patients who presented to a major tertiary referral centre. Result A total of 31 patients were received over the period of 9 days. Thirty of them were males with a mean age of 32 years old. They were mostly foreigners. From the 31 patients, 19.3% were dead on arrival, 3.2% died in the emergency department and 38.7% survived and discharged. The overall mortality rate was 61.3%. Out of the 12 patients who survived, two patients had toxic optic neuropathy, and one patient had uveitis. The rest of the survivors did not have any long-term complications. Osmolar gap and lactate had strong correlations with patient’s mortality. Serum pH, bicarbonate, lactate, potassium, anion gap, osmolar gap and measured serum osmolarity between the alive and dead patients were significant. Post-mortem findings of the brain were unremarkable. Conclusion The mortality rate was higher, and the morbidity includes permanent visual impairment and severe neurological sequelae. Language barrier, severity of illness, late presentation, unavailability of intravenous ethanol and fomipezole and delayed dialysis may have been the contributing factors. Patient was managed based on clinical presentation. Laboratory parameters showed difference in median between group that survived and succumbed for pH, serum bicarbonate, lactate, potassium and osmolar and anion gap. Management of methanol toxicity outbreak in resource-limited area will benefit from a well-designed guideline that is adaptable to the locality.
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Affiliation(s)
- J Md Noor
- Emergency Department, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
| | - R Hawari
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - M F Mokhtar
- Emergency Department, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - S J Yussof
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - N Chew
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - N A Norzan
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - R Rahimi
- Department of Pathology, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Z Ismail
- Department of Public Health & Preventative Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - S Singh
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - J Baladas
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - N H Hashim
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - M I K Mohamad
- Emergency Department, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
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Chang ST, Wang YT, Hou YC, Wang IK, Hong HH, Weng CH, Huang WH, Hsu CW, Yen TH. Acute kidney injury and the risk of mortality in patients with methanol intoxication. BMC Nephrol 2019; 20:205. [PMID: 31170938 PMCID: PMC6554873 DOI: 10.1186/s12882-019-1404-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/30/2019] [Indexed: 12/19/2022] Open
Abstract
Background Methanol poisoning is a serious public health issue in developing countries, but few data are available in the literature on acute kidney injury (AKI) after methanol intoxication. Methods This study examined the clinical features, spectrum and outcomes of AKI in patients with methanol intoxication and evaluated the predictors of mortality after methanol intoxication. A total of 50 patients with methanol intoxication were seen at Chang Gung Memorial Hospital between 2000 and 2013. Patients were grouped according to the status of renal damage as AKI (n = 33) or non-AKI (n = 19). Demographic, clinical, laboratory, and mortality data were obtained for analysis. Results Most patients were middle-aged (47.8 ± 14.9 years), predominantly male (74.0%), and habitual alcohol consumers (70.0%). Most incidents were oral exposures (96.0%) and unintentional (66.0%). Two (4.0%) patients attempted suicide by intravenous injection of methanol. Five (10.0%) patients suffered methanol intoxication after ingestion of methomyl pesticide that contained methanol as a solvent. Compared to non-AKI patients, the AKI patients were older (50.9 ± 13.7 versus 41.6 ± 15.6 years, P = 0.034), predominantly male (90.9% versus 42.8%, P = 0.000), more habitual alcohol users (84.8% versus 41.2%, P = 0.001) and had more unintentional exposures (82.8% versus 35.3%, P = 0.001). Furthermore, there was a higher incidence of respiratory failure (63.6% versus 29.4%, P = 0.022) in the AKI group than in the non-AKI group, respectively. The laboratory studies revealed that the AKI patients suffered from more severe metabolic acidosis than the non-AKI patients. By the end of this study, 13 (39.5%) AKI patients and 1 (5.9%) non-AKI patient had died. The overall in-hospital hospital mortality rate was 28%. In a multivariate binary logistic regression model, it was demonstrated that AKI (odds ratio 19.670, confidence interval 1.026–377.008, P = 0.048) and Glasgow coma scale score (odds ratio 1.370, confidence interval 1.079–1.739, P = 0.010) were significant factors associated with mortality. The Kaplan-Meier analysis disclosed that AKI patients suffered lower cumulative survival than non-AKI patients (log-rank test, chi-square = 5.115, P = 0.024). Conclusions AKI was common (66.0%) after methanol intoxication and was predictive of in-hospital hospital mortality. The development of AKI was associated with a 19.670-fold higher risk of in-hospital mortality.
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Affiliation(s)
- Shu-Ting Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Ting Wang
- Department of Pediatrics, Taipei Municipal Wan Fang Hospital, Taipei, Taiwan
| | - Yi-Chou Hou
- Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiang-Hsi Hong
- Department of Periodontics, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan. .,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Nephrology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, 105, Taiwan.
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Ou TH, Wang Y, Fang D, Narayanan SR, Wu W. Detection of Fake Alcoholic Beverages Using Electrolyte-Free Nanogap Electrochemical Cells. ACS APPLIED MATERIALS & INTERFACES 2019; 11:6217-6223. [PMID: 30663304 DOI: 10.1021/acsami.8b18729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Because of the similarity of odor, appearance, and chemical structure of methanol and ethanol, measuring the low concentration of methanol in an alcoholic beverage is difficult to perform in a quick, quantitative, and repeatable fashion. However, it is important for people to monitor the content of methanol in a liquor because a high amount of methanol absorbed will result in blindness, coma, and death. In response to this need, we have developed electrolyte-free methanol electrolysis and ethanol electrolysis based on the nanogap electrochemical cells for the methanol and ethanol sensing. Upon applying a voltage, a high electric field across the nanogap cell enhances the solution ionization and the ion transport rate. Moreover, the nanoscale distance between the electrodes provides a shorter path for electrolysis to easily occur. The nanogap electrochemical cells not only make the direct electrolyte-free organic solvent electrolysis possible but also enhance the sensitivity of the chemical of interest in low-concentration solutions without the influence of the added electrolyte. The nanogap electrochemical cells have been demonstrated having high sensitivity to detect 0.15% methanol volume concentration in deionized water solutions without adding any electrolyte, and its ability for the fake alcoholic beverages' detection has successfully demonstrated.
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Yang WS, Yen TH, Juang YY, Lee SH, Wang BH, Lee CP. Psychiatric comorbidities in patients with intentional methanol intoxication. Neuropsychiatr Dis Treat 2019; 15:397-402. [PMID: 30774350 PMCID: PMC6362913 DOI: 10.2147/ndt.s192943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Intentional methanol intoxication (IMI) is an emerging public health issue in Asian countries, but few data are available in the literature on underlying psychiatric comorbidities in these suicide attempters. PATIENTS AND METHODS We conducted a retrospective chart review on patients with methanol intoxication (MI) treated at Chang-Gung Memorial Hospital, Linkou, Taiwan during 2000-2016. Of the 56 cases of documented MI, 16 were IMI. Baseline demographic, clinical, laboratory, psychiatric diagnoses, and mortality data were collected and analyzed. RESULTS Patient group with IMI had more females (62.5% vs 7.5%, P=0.000), less alcohol consumption (33.3% vs 92.5%, P=0.000), and less smoking (40.0% vs 79.5%, P=0.009), but higher past psychiatric disease (73.3% vs 10.0%, P=0.000) and past suicide attempts (81.1% vs 2.5%, P=0.000) than patient group with unintentional MI (UMI). Pesticides (50.0%) comprised the most common source used for suicide, followed by industrial methanol (37.5%). There was no significant difference in mortality rates between these two group (25.0% vs 22.5%, P=0.548). Twelve (75.0%) survivors of IMI were referred to a psychiatric consultation-liaison team, and depressive disorder (58.3%) and adjustment disorder (25.0%) were common. CONCLUSION There is a female predominance and a high prevalence of psychiatric comorbidities, namely depression and adjustment disorder in patients with IMI. Besides, alcohol consumption is a prevalent but not adequately treated condition in UMI group.
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Affiliation(s)
- Wei-Sheng Yang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Tzung-Hai Yen
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, .,Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Bi-Hwa Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Pang Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
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Chung JY, Ho CH, Chen YC, Chen JH, Lin HJ, Wang JJ, Hsu CC, Huang CC. Association between acute methanol poisoning and subsequent mortality: a nationwide study in Taiwan. BMC Public Health 2018; 18:985. [PMID: 30086726 PMCID: PMC6081913 DOI: 10.1186/s12889-018-5918-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methanol poisoning (MP) often causes acute mortality and morbidities; however, the association between MP and subsequent mortality has not been well studied. METHODS We conducted a nationwide population-based cohort study by identifying 621 participants with MP from the Nationwide Poisoning Database and 6210 participants without MP from the Longitudinal Health Insurance Database 2000 by matching the index date at a 1:10 ratio between 1999 and 2012. Comparison of the mortality rate between the two cohorts was performed by following up until 2013. RESULTS A total of 249 (40%) participants with MP and 154 (2.5%) participants without MP died during the follow-up (p < 0.001). Statistic analysis showed that participants with MP had a higher risk for mortality than did the participants without MP (adjusted hazard ratio [AHR]: 13.48; 95% confidence interval [CI]: 10.76-16.88). The risk of mortality was highest in the first 6 months after MP (AHR: 480.34; 95% CI: 117.55-1962.75). Hypertension, chronic obstructive pulmonary disease, liver disease, malignancy, drug abuse, and lower monthly income also predicted mortality. CONCLUSIONS MP was associated with increased subsequent mortality. Close follow-up for comorbidity control and socioeconomic assistance are suggested for patients with MP.
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Affiliation(s)
- Jui-Yuan Chung
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.,Fu Jen Catholic University School of Medicine, Taipei, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan. .,Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan. .,Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
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11
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Chen YC, Tseng YC, Huang WH, Hsu CW, Weng CH, Liu SH, Yang HY, Chen KH, Chen HL, Fu JF, Lin WR, Wang IK, Yen TH. Acute Kidney Injury Predicts Mortality after Charcoal Burning Suicide. Sci Rep 2016; 6:29656. [PMID: 27430168 PMCID: PMC4949594 DOI: 10.1038/srep29656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
A paucity of literature exists on risk factors for mortality in charcoal burning suicide. In this observational study, we analyzed the data of 126 patients with charcoal burning suicide that seen between 2002 and 2013. Patients were grouped according to status of renal damage as acute kidney injury (N = 49) or non-acute kidney injury (N = 77). It was found that patients with acute kidney injury suffered severer complications such as respiratory failure (P = 0.002), myocardial injury (P = 0.049), hepatic injury (P < 0.001), rhabdomyolysis (P = 0.045) and out-of-hospital cardiac arrest (P = 0.028) than patients without acute kidney injury. Moreover, patients with acute kidney injury suffered longer hospitalization duration (16.9 ± 18.3 versus 10.7 ± 10.9, P = 0.002) and had higher mortality rate (8.2% versus 0%, P = 0.011) than patients without injury. In a multivariate Cox regression model, it was demonstrated that serum creatinine level (P = 0.019) and heart rate (P = 0.022) were significant risk factors for mortality. Finally, Kaplan-Meier analysis revealed that patients with acute kidney injury suffered lower cumulative survival than without injury (P = 0.016). In summary, the overall mortality rate of charcoal burning suicide population was 3.2%, and acute kidney injury was a powerful predictor of mortality. Further studies are warranted.
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Affiliation(s)
- Yu-Chin Chen
- Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chia Tseng
- Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shou-Hsuan Liu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Huang-Yu Yang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Hsin Chen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hui-Ling Chen
- Department of Dentistry and Craniofacial Orthodontics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jen-Fen Fu
- Department of Medical Research, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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12
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Prediction and validation of hemodialysis duration in acute methanol poisoning. Kidney Int 2015; 88:1170-7. [PMID: 26244924 PMCID: PMC4653586 DOI: 10.1038/ki.2015.232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/29/2015] [Accepted: 06/04/2015] [Indexed: 11/17/2022]
Abstract
The duration of hemodialysis (HD) in methanol poisoning (MP) is dependent on the methanol concentration, the operational parameters used during HD, and the presence and severity of metabolic acidosis. However, methanol assays are not easily available, potentially leading to undue extension or premature termination of treatment. Here we provide a prediction model for the duration of high-efficiency HD in MP. In a retrospective cohort study, we identified 71 episodes of MP in 55 individuals who were treated with alcohol dehydrogenase inhibition and HD. Four patients had residual visual abnormality at discharge and only one patient died. In 46 unique episodes of MP with high-efficiency HD the mean methanol elimination half-life (T1/2) during HD was 108 min in women, significantly different from the 129 min in men. In a training set of 28 patients with MP, using the 90th percentile of gender-specific elimination T1/2 (147 min in men and 141 min in women) and a target methanol concentration of 4 mmol/l allowed all cases to reach a safe methanol of under 6 mmol/l. The prediction model was confirmed in a validation set of 18 patients with MP. High-efficiency HD time in hours can be estimated using 3.390 × (Ln (MCi/4)) for women and 3.534 × (Ln (MCi/4)) for men, where MCi is the initial methanol concentration in mmol/l, provided that metabolic acidosis is corrected.
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13
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Ku CH, Hung HM, Leong WC, Chen HH, Lin JL, Huang WH, Yang HY, Weng CH, Lin CM, Lee SH, Wang IK, Liang CC, Chang CT, Lin WR, Yen TH. Outcome of patients with carbon monoxide poisoning at a far-east poison center. PLoS One 2015; 10:e0118995. [PMID: 25745854 PMCID: PMC4352004 DOI: 10.1371/journal.pone.0118995] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 01/27/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Many cases of carbon monoxide poisoning in Taiwan are due to burning charcoal. Nevertheless, few reports have analyzed the mortality rate of these patients who survive to reach a hospital and die despite intensive treatment. Therefore, this study examined the clinical features, physiological markers, and outcomes after carbon monoxide poisoning and the associations between these findings. METHODS We analyzed the records of 261 patients who were referred for management of carbon monoxide intoxication between 2000 and 2010. Patients were grouped according to status at discharge as alive (survivor, n = 242) or dead (non-survivor, n = 19). Demographic, clinical, laboratory, and mortality data were obtained for analysis. RESULTS Approximately half of the cases (49.4%) attempted suicide by burning charcoal. Most of the patients were middle-aged adults (33±19 years), and were referred to our hospital in a relatively short period of time (6±10 hours). Carbon monoxide produced many serious complications after exposure: fever (26.1%), hypothermia (9.6%), respiratory failure (34.1%), shock (8.4%), myocardial infarction (8.0%), gastrointestinal upset (34.9%), hepatitis (18.4%), renal failure (25.3%), coma (18.0%) and rhabdomyolysis (21.8%). Furthermore, the non-survivors suffered greater incidences of hypothermia (P<0.001), respiratory failure (P<0.001), shock (P<0.001), hepatitis ((P=0.016), renal failure (P=0.003), coma (P<0.001) than survivors. All patients were treated with high concentration of oxygen therapy using non-rebreather mask. However, hyperbaric oxygen therapy was only used in 18.8% of the patients. In a multivariate-Cox-regression model, it was revealed that shock status was a significant predictor for mortality after carbon monoxide poisoning (OR 8.696, 95% CI 2.053-37.370, P=0.003). Finally, Kaplan-Meier analysis confirmed that patients with shock suffered greater cumulative mortality than without shock (Log-rank test, Chi-square 147.404, P<0.001). CONCLUSION The mortality rate for medically treated carbon monoxide-poisoned patients at our center was 7.3%. Furthermore, the analysis indicates that shock was most strongly associated with higher risk of mortality.
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Affiliation(s)
- Chung-Hsuan Ku
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Huei-Min Hung
- Department of Pediatrics, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wa Cheong Leong
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Hsiao-Hui Chen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Huang-Yu Yang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Che-Min Lin
- Department of Psychiatry, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Chia Liang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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