Endophthalmitis is a severe eye infection leading to disabling outcome. Because there were only a few case report illustrating endophthalmitis in chronic dialysis patient, we would like to investigate the epidemiology and clinical features of endophthalmitis in chronic dialysis patient in a tertiary referral center. We searched the health information system in the study hospital with ICD9 encoding endophthalmitis during Jan. 2002 to Dec. 2015. A total of 32 episodes of endophthalmitis occurred in chronic dialysis patients. We performed an 1:2 case-control match on propensity score. The demographic features, clinical manifestation, infection focus and visual outcome were recorded. Of the total of 32 patients, 25 were classified as endogenous endophthalmitis and another seven were exogenous. Most patients presented with ophthalmalgia (n = 32, 100%) and periocular swelling (n = 31, 96.8%), whereas half of the patients suffered blurred vision (n = 16, 50%). Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most frequent causative pathogens. Dialysis vascular infection was also a possible unique focus for bacteremia. The visual acuity of the endogenous groups were less likely to improve in the chronic dialysis patients compared with control group. This is the first and the largest case series focusing on endophthalmitis in chronic dialysis patients. Our study showed different pathogen spectrum, an unique bacterial origin and worse visual outcome in these group of patients. Prompt referral to ophthalmologists when the patients present with suspicious symptoms (blurred vision, ophthalmalgia and periocular swelling) is crucial.

Background: Either sodium-glucose cotransporter-2 (SGLT-2) inhibitors or pioglitazone (Pio) has doubtful issues of bladder cancer, especially for the combination therapy with these two drugs. Our study aimed to investigate the risk of bladder cancer under combination therapy of SGLT-2 inhibitors and Pio. Materials and Methods: We included 97,024 patients with type 2 diabetes mellitus (T2DM) in the Chang Gung Research Database in Taiwan from 1 January 2016 to 31 December 2019. The primary outcome was newly diagnosed bladder cancer after combination therapy with SGLT-2 inhibitors and Pio. Group 1 received both study drugs, group 2 received SGLT-2 inhibitors, group 3 received Pio, and group 4 received non-study drugs (the reference group). The secondary outcome in each group was all-cause mortality. Results: In group 1, no newly diagnosed bladder cancer was detected after a mean 2.8-year follow-up and all-cause mortality decreased significantly (adjusted hazard ratio (AHR), 0.70; 95% confidence interval (CI), 0.54–0.92) in comparison to the reference group (group 4). In group 2 and group 3, no trend of increased bladder cancer was observed (group 2: AHR 0.49, 95% CI 0.05–4.94; group 3: AHR 0.48, 95% CI 0.15–1.58) and it still reduced all-cause mortality (group 2: AHR 0.83, 95% CI 0.70–0.99; group 3: AHR 0.90, 95% CI 0.83–0.99). Conclusions: In T2DM patients without previous or active bladder cancer, the combination therapy of SGLT-2 inhibitors and Pio was not associated with newly diagnosed bladder cancer and had lower all-cause mortality.

Background: Telmisartan, a widely used angiotensin II receptor blocker (ARB) with partial peroxisome proliferator-activated receptor-gamma (PPAR-γ) activity, may confer additional cardiovascular and metabolic benefits. However, evidence comparing telmisartan with other ARBs in terms of major cardiovascular outcomes and risk of new-onset diabetes remains limited Method: 59767 patients with hypertension and ARB use between January 1, 2007 to December 31, 2017 were identified from the Chang Gung Research Database (CGRD), a multi-institutional electronic medical record database in Taiwan. Patients prescribed telmisartan or other ARBs for at least six months were included. Propensity score matching (1:4) was applied to balance baseline characteristics. Primary outcomes were new-onset diabetes mellitus(DM), major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, non-fatal stroke and CV death) and all cause mortality.Secondary outcomes include hospitalization for heart failure and malignancy.The risks of new-onset DM, MACE, and mortality were compared between two groups using Cox proportional hazards models. In addition, we performed analyzes using Fine and Gray sub-distribution hazard models that considered death a competing risk. Result: A total of 15,160 patients (telmisartan: 3,032; other ARBs: 12,128) were included after matching. Telmisartan users had a significantly lower risk of 3P-MACE (aHR 0.88, 95% CI 0.80–0.97, p = 0.0074) and non-fatal MI (aHR 0.68, 95% CI 0.52–0.90, p = 0.006) compared to other ARB users. No significant differences were observed for new-onset DM (aHR 1.06, 95% CI 0.88–1.28, p = 0.54), cardiovascular death (aHR 0.86, 95% CI 0.62–1.18, p = 0.35), or other outcomes such as stroke or hospitalization for heart failure. Conclusion: Telmisartan is associated with superior cardiovascular protection which mainly attributed to reducing risks of non-fatal MI compared to other ARBs, while exhibiting a neutral effect on risk of new-onset DM. These findings suggest telmisartan may be a preferred ARB for hypertensive patients at high cardiovascular risk. Further prospective studies are warranted to validate these results and explore the underlying mechanisms.