Journal of the Formosan Medical Association RSS feed: Current Issue. The Journal of the Formosan Medical Association is the peer-reviewed publication of the Formosan Medical Association , based in Taipei, Taiwan. The JFMA invites original contributions relating to all fields of medicine and related disciplines that are of interest to the medical profession. http://www.jfma-online.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Journal of the Formosan Medical Association0929-664611012December 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jfma-online.com/article/PIIS0929664611001264/abstract?rss=yesIn 2008, Taiwan started a national tuberculosis (TB) program to implement latent tuberculosis infection (LTBI) treatment for TB contacts. Child contacts aged younger than 13 years were the first priority group to receive treatment. Countries in West-Pacific and South-Eastern Asia, such as Japan, Hong Kong, and South Korea have scaled up their LTBI strategies in recent years in order to reach the long-term goal of stopping TB. Incidence of TB in Taiwan decreased gradually from 73/100,000 in 2005 to 57/100,000 in 2010. With decreasing TB case number, and decreasing mortality rate under the directly observed treatment (DOT) strategy, diagnosis and treatment of LTBI in high-risk populations has become the most important strategy for case management.Scaling up of latent tuberculosis infection treatment for close contacts of tuberculosis in TaiwanPei-Chun Chan, Chin-Hui Yang, Feng-Yee Chang10.1016/j.jfma.2011.11.001Journal of the Formosan Medical Association 110, 12 (2011)2011-12-23Journal of the Formosan Medical Association2011-12-2311012S0929-6646(11)X0013-XPerspectives733736http://www.jfma-online.com/article/PIIS0929664611001276/abstract?rss=yesTuberculosis (TB) is an important public health issue in Taiwan and worldwide. Taiwan has made major progress in combating TB in the past 40 years. However, childhood TB still constitutes a significant challenge in disease control. From January to mid December 2011, 369 new cases of pediatric TB were confirmed. The relatively low case number and variable clinical presentations made it difficult for early detection. Latent TB infections in children also pose further complexity in clinical management. Knowledge of the clinical features of active and latent TB infection is crucial for efficient TB control.Clinical perspectives of childhood tuberculosis in TaiwanTzong-Shiann Ho, Shih-Min Wang, Ching-Fen Shen, Kuan-Hsien Lee, Ching-Chuan Liu10.1016/j.jfma.2011.11.002Journal of the Formosan Medical Association 110, 12 (2011)2011-12-29Journal of the Formosan Medical Association2011-12-2911012S0929-6646(11)X0013-XReview Articles737743http://www.jfma-online.com/article/PIIS0929664611001288/abstract?rss=yesSurveillance and control of tuberculous infection in pediatric patients, especially in those with a contact history, is important to prevent tuberculous infection in the general population. Totally 26 patients, younger than 14 years of age, who had a diagnosis of pulmonary Mycobacterium tuberculosis (TB), underwent both chest radiographs and computed tomography (CT), which were retrospectively reviewed and compared with those of 20 patients with community-acquired bacterial pneumonia (CABP). TB patients were commonly afebrile and had less cavitating lesions or pleural fluid than CABP patients had. Focal or sub-segmental lung opacities suggested the diagnosis of TB than of CABP. Chest CT could also help to identify enlarged, calcified, necrotic mediastinal lymph nodes, which are less frequently found in CABP and frequently obscured by thymic shadows on chest radiographs of children. Low-dose CT for children or infants suspected to have pulmonary TB infection could help to make the decision of further antibiotic treatment.Computed tomography of children with pulmonary Mycobacterium tuberculosis infectionSteven Shinn-Forng Peng, Pei-Chun Chan, Yeun-Chung Chang, Tiffany Ting-Fang Shih10.1016/j.jfma.2011.11.003Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XReview Articles744749http://www.jfma-online.com/article/PIIS092966461100129X/abstract?rss=yesNatural human immunity to the mycobacteria group, including Mycobacterium tuberculosis, Bacille Calmette-Guérin (BCG) or nontuberculous mycobacteria (NTM), and/or Salmonella species, relies on the functional IL-12/23-IFN-γ integrity of macrophages (monocyte/dendritic cell) connecting to T lymphocyte/NK cells. Patients with severe forms of primary immunodeficiency diseases (PIDs) have more profound immune defects involving this impaired circuit in patients with severe combined immunodeficiencies (SCID) including complete DiGeorge syndrome, X-linked hyper IgM syndrome (HIGM) (CD40L mutation), CD40 deficiency, immunodeficiency with or without anhidrotic ectodermal dysplasia (NEMO and IKBA mutations), chronic granulomatous disease (CGD) and hyper IgE recurrent infection syndromes (HIES). The patients with severe PIDs have broader diverse infections rather than mycobacterial infections. In contrast, patients with an isolated inborn error of the IL-12/23-IFN-γ pathway are exclusively prone to low-virulence mycobacterial infections and nontyphoid salmonella infections, known as Mendelian susceptibility to the mycobacterial disease (MSMD) phenotype. Restricted defective molecules in the circuit, including IFN-γR1, IFN-γR2, IL-12p40, IL-12R-β1, STAT-1, NEMO, IKBA and the recently discovered CYBB responsible for autophagocytic vacuole and proteolysis, and interferon regulatory factor 8 (IRF8) for dendritic cell immunodeficiency, have been identified in around 60% of patients with the MSMD phenotype. Among all of the patients with PIDs referred for investigation since 1985, we have identified four cases with the specific defect (IFNRG1 for three and IL12RB for one), presenting as both BCG-induced diseases and NTM infections, in addition to some patients with SCID, HIGM, CGD and HIES. Furthermore, manifestations in patients with autoantibodies to IFN-γ (autoAbs-IFN-γ), which is categorized as an anticytokine autoantibody syndrome, can resemble the relatively persistent MSMD phenotype lacking BCG-induced diseases.Immune defects in active mycobacterial diseases in patients with primary immunodeficiency diseases (PIDs)Wen-I Lee, Jing-Long Huang, Kuo-Wei Yeh, Tang-Her Jaing, Tzou-Yien Lin, Yhu-Chering Huang, Cheng-Hsun Chiu10.1016/j.jfma.2011.11.004Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XReview Articles750758http://www.jfma-online.com/article/PIIS0929664611001306/abstract?rss=yesMolecular techniques along with clinical evaluation have been demonstrated to be effective for differentiating childhood tuberculosis (TB), and for establishing an enhanced survey of adverse reactions of Bacilli Calmette-Guerin vaccination in Taiwan. Future development and evaluation of new diagnostics should be prioritized in strengthening the management of childhood TB.Molecular diagnosis of childhood tuberculosis and infection with Bacilli Calmette-Guerin in TaiwanRuwen Jou, Wei-Lun Huang10.1016/j.jfma.2011.11.005Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XMini-Review759761http://www.jfma-online.com/article/PIIS0929664611001318/abstract?rss=yesBackground/Purpose: In the past few years, many new subtypes in hepatitis C virus (HCV) genotype 6 have been identified. The aim of this study was to modify the multiplex real-time polymerase chain reaction (RT-PCR) protocol and use it to determine the HCV subtypes of a group of Taiwanese injection drug users (IDUs).Methods: We used 76 serum specimens collected in northern Taiwan in 2008. Multiplex RT-PCR was used for HCV subtyping among those serum samples having anti-HCV antibodies. Twenty cases were randomly selected for comparison with subtyping results from Inno-LiPa II tests and phylogenetic tree analysis using NS5B sequences.Results: Multiplex RT-PCR assays showed that 60.5% (46/76) of IDUs had single HCV infection. Three out of 76 (3.9%) had double HCV infection (1b/6a, 2a/2b and 2b/6a). Besides this, 27.6% (21/76) had no HCV signal. One IDU had subtype 6n and two had subtype 6w infection. Inno-LiPa II tests misclassified all 6n and 6w cases as 1b subtype.Conclusion: Our modified multiplex RT-PCR protocol can be used to support molecular epidemiological studies and laboratory diagnoses of different HCV subtypes including genotype 6.Detection of hepatitis C virus subtypes 6a, 6n, 6w and mixed infections using a modified multiplex real-time polymerase chain reaction protocolYuan-Ming Lee, Yen-Ju Chen, Cheng-Ming Lee, Lou-Hui Kuo, Wing-Wai Wong, Yi-Ming Arthur Chen10.1016/j.jfma.2011.11.006Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XOriginal Articles762767http://www.jfma-online.com/article/PIIS092966461100132X/abstract?rss=yesBackground/Purpose: Despite availability of effective antihypertensives, blood pressure (BP) control is usually inadequate. The Reasons for not Intensifying Antihypertensive Treatment (RIAT) registry evaluated the reasons behind not modifying treatment in an international, cross-sectional study in 16 countries.Methods and results: The Taiwanese cohort of RIAT consisted of 8922 patients with untreated/uncontrolled essential hypertension recruited from 22 centers in the country. At the first visit, physicians selected target BP and antihypertensive treatment, and at the next three visits they measured BP and modified treatment/provided justification for not modifying treatment. Mean target BP selected by physicians was 134.6/84.6 ± 5.1/5.0 mmHg, respectively. Patients’ individual risk stratification determined the BP goals. More patients achieved targets according to the physicians’ opinion than based on actual BP measurements: visit 2–50.6% vs. 48.6%; visit 3–58.4% vs. 55.2%; and visit 4–61.2% vs. 57.0%. At each visit, treatment remained unchanged for >60% patients not reaching target; the most common reason for this at visit 2 was the assumption that the time was too short to assess new drug therapy and at visits 3 and 4 was the assumption that target was reached/had almost been reached.Conclusion: About 40% Taiwanese hypertensive patients in RIAT did not reach BP targets after an average of 4 months’ follow-up. The most common reason for not modifying treatment was the assumption that the target had been reached or had almost been reached.Assessment of reasons for not intensifying antihypertensive treatment in the Taiwanese populationChiung-Jen Wu, Kwo-Chuan Lin, Sien-Tsong Chen, Wen-Ter Lai, Chun-Peng Liu, Shou-Shan Chiang, Yu-Yao Huang, Paolo Ferrari10.1016/j.jfma.2011.11.007Journal of the Formosan Medical Association 110, 12 (2011)2011-12-01Journal of the Formosan Medical Association2011-12-0111012S0929-6646(11)X0013-XOriginal Articles768774http://www.jfma-online.com/article/PIIS0929664611001331/abstract?rss=yesBackground/Purpose: Occupational dermatitis among cement workers is a major occupational health concern. The two most important occupational hazards for cement workers are irritant and allergic cement contact dermatitis. The objective of this study was to investigate the severity of occupational cement contact dermatitis and the common allergens among cement workers in Taiwan.Methods: A total of 97 cement workers from the Cement Workers’ Association of Tainan City and County participated in this study. A structured questionnaire was used to evaluate the demographic data and work-related activities of these cement workers. A complete skin examination was conducted, and skin manifestations were assessed by a dermatologist. Allergens from European Standard Tray (Chemotechnique Diagnostic AB, Sweden) with a total of 25 substances were used for patch testing.Results: Our results showed that 65 out of 97 cement workers were suffering from occupational cement hand contact dermatitis. The most affected skin area was the hand. Thickening of the dorsal surface of the hand, especially around the metacarpophalangeal joint area, and hyperkeratosis of the palm were the major skin manifestations. The results of the patch test showed that 24 out of 97 were allergic to potassium dichromate, nine were allergic to thiuram mix, nine were allergic to fragrance mix and seven were allergic to cobalt chloride. The final diagnosis, based on the results of the skin examination and the patch test, showed that 43 of 97 cement workers had irritant cement contact dermatitis and 22 had allergic cement contact dermatitis.Conclusion: We conclude that occupational cement hand dermatitis among cement workers is an important and severe issue in Taiwan, and the most common allergens among cement workers are potassium dichromate, thiuram mix, fragrance mix and cobalt chloride. The high positive rate of chromium hypersensitivity among cement workers reflects the urgency to regulate the addition of ferrous sulfate to cement in Taiwan.Occupational hand dermatitis among cement workers in TaiwanBour-Jr Wang, Jyun-De Wu, Shiann-Cherng Sheu, Tung-Sheng Shih, Ho-Yuan Chang, Yue-Liang Guo, Ying-Jan Wang, Tzu-Chieh Chou10.1016/j.jfma.2011.11.008Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XOriginal Articles775779http://www.jfma-online.com/article/PIIS0929664611001343/abstract?rss=yesBackground/Purpose: A multicenter study (NCT00449670) conducted across Taiwan, Singapore, Hong Kong and Thailand evaluated the safety and manufacturing consistency of four formulations of an AS03A-adjuvanted H5N1 vaccine in terms of immune response against the vaccine-homologous strain (A/Vietnam/1194/2004). This manuscript presents data from the Taiwanese population.Methods: A total of 400 individuals, aged 18–60 years, were randomized into six groups (2:2:2:2:1:1 ratio) to receive two doses (21 days apart) of one of the four adjuvanted formulations (H5N1-AS03A-groups) or one of the two nonadjuvanted formulations (H5N1-DIL-groups). Blood samples collected before vaccination (Day 0) and 21 days after each vaccine dose were analyzed using hemagglutination inhibition (HI) assay. Adverse events were recorded.Results: All four AS03A-adjuvanted formulations induced comparable immune responses against the A/Vietnam/1194/2004 strain; following the second dose, immune response in terms of HI antibodies was higher in the H5N1-AS03A-groups {seroprotection rate=91.6% [95% confidence interval (CI): 87.9–94.4]; geometric mean titer (GMT)=177.6 (95% CI: 153.2–206.0)} compared with the H5N1-DIL-groups [seroprotection rates=5.0% (95% CI: 1.4–12.3); GMT=6.3 (95% CI: 5.4–7.4)]. Immune response against the heterologous A/Indonesia/05/2005 strain was also stronger in the H5N1-AS03A-groups [seroprotection rate=45.6% (95% CI: 40.0–51.4); GMT=20.5 (95% CI: 17.8–23.7)] compared with the H5N1-DIL groups [seroprotection rate=0.0% (95% CI: 0.0–4.5); GMT=5.0 (95% CI: 5.0–5.0)]. The overall reactogenicity profile of the adjuvanted formulations was clinically acceptable.Conclusion: The AS03A-adjuvanted H5N1 influenza vaccine formulations induced stronger immune response against the vaccine-homologous and heterologous strains than the nonadjuvanted formulations. The AS03A-adjuvanted H5N1 vaccine demonstrated a good immunogenicity and an acceptable safety profile in the Taiwanese population.Immunogenicity and safety of an AS03A-adjuvanted H5N1 influenza vaccine in a Taiwanese populationShinn-Jang Hwang, Shan-Chwen Chang, Chong-Jen Yu, Yu-Jiun Chan, Tzeng-Ji Chen, Shie-Liang Hsieh, Hsiu-Yun Lai, Ming-Hsien Lin, Jui-Yao Liu, Gary Ong, Francois Roman, Mamadou Dramé, Hans L. Bock, Pan-Chyr Yang10.1016/j.jfma.2011.11.009Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XOriginal Articles780786http://www.jfma-online.com/article/PIIS0929664611001355/abstract?rss=yesKetamine hydrochloride, commonly used as a pediatric anesthetic agent, is an N-methyl-d-aspartic (NMDA) acid receptor antagonist with rapid onset and short duration of action. It produces a cataleptic-like state where the patient is dissociated from the surrounding environment by direct action on the cortex and limbic system. It has emerged as an increasingly popular choice among young drug users, especially within dance club venues. Cases of bladder dysfunction among recreational ketamine users were reported since Shahani et al first reported nine cases of ketamine-associated ulcerative cystitis in 2007. We report on four patients who had history of ketamine abuse, presenting with dysuria, fluctuating lower urinary tract symptoms (LUTS), lower abdominal or perineal pain, and impaired functional bladder capacities. Urinalysis showed pyuria and microhematuria. Urine culture was sterile. Bladder ulceration with severe diffuse hemorrhage and low bladder capacity were noted under anesthetized cystoscopic examination. Transurethral bladder mucosa biopsy was consistent with chronic cystitis. Cessation of ketamine abuse was the milestone of treatment, followed by the administration of mucosal protective agents, such as pentosan polysulphate or hyaluronic acid. Suprapubic pain was improved in three patients during follow-up. However, the outcome of treatment depends on the severity of the disease process, similar to that of interstitial cystitis (IC).Ketamine-snorting associated cystitisChung-Hsien Chen, Ming-Huei Lee, Yi-Chang Chen, Ming-Fong Lin10.1016/j.jfma.2011.11.010Journal of the Formosan Medical Association 110, 12 (2011)2011-12-29Journal of the Formosan Medical Association2011-12-2911012S0929-6646(11)X0013-XCase Report787791http://www.jfma-online.com/article/PIIS0929664611001367/abstract?rss=yesA 43-year-old female presented with a 3-week history of hoarseness. She denied cough, fever, weight loss, chills, night sweats, hemoptysis, or any other chest symptoms. Indirect laryngoscopy revealed irregular thickening of right vocal cord (). A specimen was obtained from the right vocal cord under general anesthesia, and histopathological examination confirmed Mycobacterium tuberculosis infection by showing discrete epithelioid cell granulomas with Langhans giant cell and acid-fast stain bacilli. A chest X-ray showed normal over bilateral lung fields. The patient was placed on antituberculous therapy (Isoniazid, Rifampin, Pyrazinamide, and Ethambutol). Regression of right vocal cord lesion was observed after the initial 4 weeks of treatment.Primary laryngeal tuberculosisLeh-Kiong Huon, Te-Yung Fang10.1016/j.jfma.2011.11.011Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XCorrespondence792793http://www.jfma-online.com/article/PIIS0929664611001379/abstract?rss=yesWe compliment Professor Wang on the study of “Medical leaders in Taiwan during Japanese colonization.” However, because some data were not available in the study, we would like to add additional data in the field of ophthalmology to make the study more complete. The data we would like to add are in the following:Response to “Medical leaders in Taiwan during Japanese colonization”Tzyy-Chang Ho, Fung-Rong Hu, Ping-Kang Hou, Muh-Shy Chen10.1016/j.jfma.2011.11.012Journal of the Formosan Medical Association 110, 12 (2011)2011-12-19Journal of the Formosan Medical Association2011-12-1911012S0929-6646(11)X0013-XLetters to the Editor794795http://www.jfma-online.com/article/PIIS0929664611001380/abstract?rss=yesAdiponectin is an adipose tissue-derived plasma protein that has been implicated to play a role in obesity-induced insulin resistance and related metabolic disorders. Many human studies also suggest its role in various cardiovascular diseases in addition to metabolic disorders. Recently, our group has extended the clinical implication of blood adiponectin beyond the cardiometabolic disorders to age-related hearing impairment (ARHI). ARHI is characterized by progressive deterioration of auditory sensitivity associated with aging. It is a common sensory disorder in adults. Dyslipidemia, type 2 diabetes mellitus, and hypertension (HTN) have been reported to be independently associated with ARHI. Since obesity-related cardiometabolic disorders were associated with ARHI, we speculated that obesity might also contribute to ARHI. However, it was still unclear whether obesity per se could lead to ARHI until two recent independent studies were conduted. In an European population-based multicenter study, occupational noise, smoking, and a high body mass index were risk factors for ARHI, whereas moderate alcohol consumption was found to be protective. We were the first to report that waist circumference, a measurement of visceral or central obesity, even adjusting for body mass index and the other variables, was an independent risk factor for ARHI in Taiwanese. Furthermore, we showed that plasma adiponectin concentration was significantly associated with auditory thresholds of high frequencies in a negative manner after adjusting for weight circumference and other variables.Adiponectin beyond cardiometabolic disordersJuen-Haur Hwang, Chuan-Jen Hsu, Tien-Chen Liu, Wei-Shiung Yang10.1016/j.jfma.2011.11.013Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XLetters to the Editor796797http://www.jfma-online.com/article/PIIS0929664611001392/abstract?rss=yesWe read with great interest the article by Shifflet and colleagues. Although this interesting review article summarized the pathogenic mechanisms, advances in diagnosis and current treatments for nonalcoholic fatty liver disease (NAFLD), several issues are worthy of discussion.Uncovered issues in the overview of nonalcoholic steatohepatitisChia-Chi Wang, Jia-Horng Kao10.1016/j.jfma.2011.11.014Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XLetters to the Editor798798http://www.jfma-online.com/article/PIIS0929664611001409/abstract?rss=yesTwo papers published recently in Journal of the Formosan Medical Association highlight the increased recognition of the importance of end-of-life care for cancer patients in Taiwan. According to a population-based study, aggressive end-of-life care was associated with male sex, younger age, hematologic malignancies, co-morbid diseases, admission to hospitals with abundant health care resources, and primary care by oncologists. While these studies may help improve the quality of end-of-life care and rational allocation of health resources, several issues should be addressed to apply the results of these studies in clinical practice.End-of-life care for cancer patients in TaiwanChiun Hsu10.1016/j.jfma.2011.11.015Journal of the Formosan Medical Association 110, 12 (2011)2011-12-22Journal of the Formosan Medical Association2011-12-2211012S0929-6646(11)X0013-XLetters to the Editor799799http://www.jfma-online.com/article/PIIS0929664611001410/abstract?rss=yesWe are interested in a randomized trial of oxytocin antagonist atosiban versus β-adrenergic agonists in the treatment of spontaneous preterm labor in Taiwanese women reported by Lin et al in the June 2009 issue of the Journal of the Formosan Medical Association. In that study, atosiban was showed to be an effective tocolytic drug without the conventional cardiovascular side-effects. They enrolled the cases from gestational age of 24–33 weeks. In Taiwan, 8354 assisted reproductive technology (ART) cycles were performed in 2008, leading to 36.5% clinical pregnancies, but only 27.1% live births. We noticed that the first- and second-trimester bleeding was more prevalent in ART than in spontaneous pregnancies. In a large series study in Belgium, of 2450 clinical pregnancies (not biochemical or ectopic), 772 presented with first-trimester bleeding (31.5%), and ultimately 436 miscarried (56.5% of patients with first-trimester bleeding). It is not uncommon to find regular uterine contractions before 20 weeks. In a recent meta-analysis, nifedipine is superior to β2-adrenergic-receptor agonists and magnesium sulfate for tocolysis in women with preterm labor (20–36 weeks), but it has been assigned to pregnancy category C by the Food and Drug Administration (FDA) so is not recommended before 20 weeks, or even in the first trimester. A recent report showed, even at very early pregnancy, atosiban can be used to decrease the frequency of uterine contractions to enhance success of pregnancy. For cases of early pregnancy with vaginal bleeding, if uterine contractions are noted either by ultrasound (in the first trimester) or on tocometer (in the second trimester), what can we do in addition to traditional bed rest and progesterone supplements? From 2004 to 2010, we treated 33 first-trimester pregnancies with vaginal bleeding after ART with evident uterine contractions using ritodrine and/or atosiban, and there was no preterm delivery before 30 weeks. This seems to be much better than was reported in the Belgian study, in which abortion rates were 56.5%2. However, we may need a larger, prospective randomized study to prove the effectiveness of tocolysis in such high-risk cases of threatened abortion.Using atosiban in uterine contractions of early pregnancies after assisted reproductionMing-Yih Wu, Shee-Uan Chen, Yu-Shih Yang10.1016/j.jfma.2011.11.016Journal of the Formosan Medical Association 110, 12 (2011)2011-12-22Journal of the Formosan Medical Association2011-12-2211012S0929-6646(11)X0013-XLetters to the Editor800800http://www.jfma-online.com/article/PIIS0929664611001422/abstract?rss=yesWe read with great interest the article by Sun et al. They prospectively investigated 261 adult patients who underwent antituberculosis treatment with different co-morbidities. By using multivariate analysis, the authors identified that abnormal baseline liver function tests and liver cirrhosis were independent factors associated with development of hepatitis. Because of the inclusion criteria adopted, the patient characteristics in this study mimicked real-world practice and hence their findings provide novel information to the practicing physician. However, some issues are worthy of further discussion.Hepatitis during antituberculosis treatmentLi-Wei Wu, Jia-Horng Kao10.1016/j.jfma.2011.11.017Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XLetters to the Editor801801http://www.jfma-online.com/article/PIIS0929664611001434/abstract?rss=yesThroughout history, socioeconomic development has always been accompanied by inevitable environmental and health risks. Evaluating voluntarily risk behaviors in patients from the viewpoint of disease prevention is critical in daily clinical practice. Chung and others have addressed this issue, especially considering the scenario of the current budget limitations of the National Health Insurance in Taiwan. However, in the case of certain populations, exposure to environmental hazards cannot be controlled or prevented; such populations should receive attention in the current health care system. It is also evident from the perspective of the integrated health management that the balance between environmental health maintenance and socioeconomic development is an urgent and challenging concern, even at the government level.The unaffordable cost of socioeconomic growth in disease preventionChin-Chi Kuo10.1016/j.jfma.2011.11.018Journal of the Formosan Medical Association 110, 12 (2011)2011-12-26Journal of the Formosan Medical Association2011-12-2611012S0929-6646(11)X0013-XLetters to the Editor802803