Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey

ObjectivesThe aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey.MethodsThe study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing.ResultsThe prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR = 2.5, 95% CI: 1.3–4.7, p = 0.004), dampness at home (OR = 2.4, 95% CI: 1.2–4.8, p = 0.008), a history of intestinal parasites (OR = 4.3, 95% CI: 1.7–10.9, p = 0.002), previous history of pneumonia (OR = 6.9, 95% CI: 1.9–25.9, p = 0.004), initiation of complementary foods before the age of three months (OR = 6.1, 95%CI: 1.4–26.9, p = 0.02) and presence of food allergy (OR = 3.1, 95% CI: 1.1–9.2, p = 0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR = 5.2, 95% CI: 0.9–28.7, p = 0.05) and high serum IgE levels (OR = 2.9, 95% CI: 0.9–9.0, p = 0.05) at borderline significance.ConclusionOur study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors.     

Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

PurposeThis study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria.MethodsAn observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed.Results672 patients [median age (Q1–Q3) 82 (79–86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1–Q3 7–13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p < 0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p < 0.001) was observed. Polypharmacy (≥ 10 medicines) was the strongest predictor of IP [OR = 11.34 95% confidence interval (CI) 4.96–25.94], PIMs [OR = 14.16, 95% CI 6.44–31.12], Beers-listed PIMs [OR = 8.19, 95% CI 3.01–22.28] and STOPP-listed PIMs [OR = 8.21, 95% CI 3.47–19.44]. PIMs was the strongest predictor of PPOs [OR = 2.79, 95% CI 1.81–4.28].ConclusionsA high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.     

Alarming incidence of reinfections after treatment for Chlamydia trachomatis and gonorrhoea: Can we predict and prevent them?

BackgroundChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are a public health problem, worsened by frequent reinfections, whose incidence rate is not known in Spain. The objective of this study is to estimate in patients diagnosed with NG, CT or mixed infection (NG and CT): (1) the incidence of reinfections by the same microorganism, (2) the total incidence of Sexually Transmitted Infections (STI), both by the same microorganism and by infections other than the initial one, and (3) to identify predictors of reinfection.MethodsObservational prospective case series involving 986 patients with CT and/or NG at specialized STI clinics in Biscay (Spain) between 2016 and 2019.ResultsThe six month cumulative incidence of reinfection by the same microorganism was 17.24% (CI95%: 14.9–19.7) and 24.65% (CI95%: 21.9–27.4) for any STI (reinfection or other). Being an immigrant (OR = 1.8; CI95%: 1.3–2.6), men who have sex with men (OR = 1.8; CI95%: 1.3–2.6), number of sexual partners (OR = 4.3; CI95%: 2.7–6.8 for more than 5 partners), having a new partner (OR = 1.7; CI95%: 1.08–2.6), not always using a condom (OR = 1.4; CI95%: 1.02–1.9) and consumption of alcohol prior to sex (OR = 3.8; CI95%: 1.5–9.5) were associated with reinfection by any STI.ConclusionThese characteristics allow doctors to identify patients in whom to prioritize short-term rescreening for repeated infections with any STIs after initial treatment for NG or CT.     

Reduced risk of metabolic syndrome due to regular intake of vegetables rich in antioxidants among African type 2 diabetics

BackgroundAntioxidant nutrients found in vegetables are thought to prevent chronic diseases including type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS).ObjectiveWe evaluated the prevalence of MetS and the association of antioxidants and cardiovascular risk factors with risk of MetS among patients with T2DM from General hospital of Kinshasa, DRC.MethodsThis cross-sectional study using a validated semiquantitative food frequency questionnaire. MetS was defined using criteria of IDF/Europids, IDF modified for Africa and NCEP-ATP III. Risk factors of MetS (OR and 95% CI) was estimated using logistic regression, adjusting for confounding factors.ResultsOut of 244 T2 DM patients (56.6% of females) and 48 ± 16 years, 0%, 13%, 34.4%, 20.9%, and 11.9% were defined by never consuming fruits, never consuming vegetables, MetS/IDF Europids, MetS/IDF modified for Africa, and MetS/NCEP-ATP III. Females (OR = 5 95% CI 2–10; P < 0.01), High socioeconomic status (HSES, OR = 3.5, 95% CI 1.5–8.3; P = 0.005), and regular Cassava leaves intake (OR= 0.4, 95% CI 0.2–0.9; P = 0.027) were the independent determinants of MetS/IDF Europids. HSES (OR= 2.9, 95% CI 1.2–6.9; P = 0.015), physical inactivity (OR = 2.6, 95% CI 1.6–6; P = 0.03) and regular dry red beans intake (OR = 0.4, 95% CI 0.2–0.8; P = 0.016) were the independent determinants of MetS/IDF modified for Africa. Females (OR = 5, 95% CI 2–20; P < 0.001), HSES (OR = 3.5, 95% CI 1.5–8.3; P = 0.005) and regular Cassava leaves intake (OR = 0.4, 95% CI 0.2–0.9; P < 0.0001) were the independent determinants of MetS/NCEP-ATP III.ConclusionCassava leaves and dried red beans intake, rich in antioxidants, are protective factors against MetS presence, while females, HSES, and physical inactivity are independent risk factors of MetS.     

Clinical diagnostic accuracy of suspected sources of bacteremia and its effect on mortality

BackgroundAlthough much has been written about bacteremia, evidence of the clinical diagnostic accuracy of bacteremia sources in the absence of microbiological results and the impact of diagnostic accuracy on mortality is scarce.MethodsThis is a retrospective study of bacteremia episodes over a 2-year period at a general hospital in Madrid. Congruence analyses between clinically presumed and definite sources, acquisition, causative organism, empirical treatment and progression to death were performed.ResultsThe study included 323 bacteremia episodes. Clinicians' diagnostic accuracy was higher for gastrointestinal (88.8%; 95% CI: 79%–84%), respiratory (93.9%; 95% CI: 79%–99%) and urinary tract sources (83.6%; 95% CI: 75%–89%) and lower for skin and soft tissues (77.2%; 95% CI: 54%–92%) and, notably, intravascular sources (56%; 95% CI: 39%–71%).Overall, a non-significant (3.45%; 95% CI: ? 0.6%–13.5%, p = 0.47) increase in mortality was observed in the incorrectly suspected bacteremia source group.Mortality related to a definitive source was significantly higher when an intravascular origin was not suspected, resulting in a 26% increase in mortality (95% CI: 1%–52%, p = 0.03). Differences in mortality related to inaccurate source assumptions were non-significant when the definitive bacteremia sources were gastrointestinal, urinary, respiratory, skin and soft tissues or unknown.Mortality in the group receiving appropriate empirical antimicrobial treatment was 10.6% compared with 19.7% mortality in the group receiving inappropriate empirical antimicrobial treatment (OR 2; 95% CI: 1.01–4.25).ConclusionsThe diagnostic accuracy of bacteremia sources is high in all but intravascular sources. A non-suspected intravascular source and inappropriate empirical treatment are related to a higher mortality.     

Predictive model of persistent choledocholithiasis in patients with acute biliary pancreatitis

BackgroundCholedocholithiasis causing acute biliary pancreatitis (ABP) may migrate to the duodenum or persist in the common bile duct (CBD). We developed a model for predicting persistent choledocholithiasis (PC) in patients with ABP.MethodsThis retrospective cohort study included 204 patients, age ≥18 years (mean age: 73 years, 65.7% women), admitted for ABP in 2013–2018, with at least a magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and/or endoscopic retrograde cholangiopancreatography (ERCP). Epidemiological, analytical, imaging, and endoscopic variables were compared between patients with and without PC. Multivariate logistic regression analyses were performed to develop a predictive model of PC.ResultsPatients underwent MRCP (n = 145, 71.1), MRCP and ERCP (n = 44, 21.56%), EUS and ERCP (n = 1, 0.49%), or ERCP (n = 14, 6.86%). PC was detected in 49 patients (24%). PC was strongly associated with CBD dilation, detected in the emergency ultrasound (p < 0.001; OR = 27; 95% CI: 5.8–185.5), increased blood levels of gamma glutamyl transpeptidase, detected at 72 h (p = 0.008; OR = 3.4; 95% CI: 1.5–8.9); and biliary sludge in the gallbladder (p = 0.008; OR = 0.03; 95% CI: 0.001–0.3).ConclusionsThe predictive model showed a validated area under the curve (AUC) of 0.858 for detecting PC in patients with ABP. A nomogram was developed based on model results.ConclusionsThe predictive model was highly effective in detecting PC in patients with ABP. Therefore, this model could be useful in clinical practice.     

Prevalence of asthma and associated factors in adolescents living in Belem (Amazon region), Para,Brazil

BackgroundThe prevalence of asthma in the Brazilian Amazon region is unknown. We studied the prevalence of asthma and associated factors in adolescents (13–14 years old) living in Belem, a large urban centre in this region.Methods3725 adolescents were evaluated according to the International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a random sample of them (126 asthmatics and 254 non-asthmatics) were assessed for possible risk factors by a supplementary questionnaire (ISAAC Phase II) and skin prick tests with aeroallergens. The association between asthma and associated factors was determined by logistic regression analysis.Results3708 adolescents were enrolled, 48% were male. The prevalence of asthma in the last 12 months (identified as asthmatics) and the medical diagnosis of asthma were 20.7% and 29.3%, respectively. Risk factors significantly associated with asthma were: previous diagnosis of tuberculosis (odds ratio [OR] = 38.9; 95% confidence interval [95% CI]: 4.6–328.0) and measles (OR = 4.7; 95% CI: 2.3–9.8), breastfeeding for any length of time (OR = 4.2; 95% CI: 1.1–15.2), current rhinitis (OR = 3.2; 95% CI: 1.8–5.9), exposure to smokers (OR = 2.4; 95% CI: 1.2–4.5), moisture in home (OR = 1.8; 95% CI: 1.1–3.2) and rhinitis diagnosed by physician (OR = 1.7; 95% CI: 1.2–2.9). Sensitisation to at least one aeroallergen was significantly higher among asthmatic adolescents (86.5% vs. 32.4%; p < 0.0001).ConclusionsThe prevalence of asthma was similar to that observed in other Brazilian centres. Physician-diagnosed asthma was more frequent than the presence of symptoms suggestive of asthma. Infectious diseases, nutritional and environmental factors, as well as concomitant allergic rhinitis, were the main risk factors associated with the development of asthma in these adolescents.     

Cardiothyreosis: Prevalence and risk factors

Cardiothyreosis (CT) or thyrotoxic heart disease is associated with higher morbidity and mortality than the other forms of hyperthyroidism. Its risk factors have been analyzed in a limited number of studies. The aims of our study were to investigate the prevalence of CT and its risk factors in patients with hyperthyroidism.MethodsWe identified 538 patients with a hospital discharge diagnosis of hyperthyroidism from January 2000 to December 2015. Among them, 35 patients were diagnosed as having CT. Their demographic, clinical and biological characteristics were studied and compared with those of 72 controls (patients admitted for hyperthyroidism without CT) randomly selected using univariate and multivariate analysis.ResultsThe prevalence of CT in patients hospitalized with overt hyperthyroidism was 6.5%. The cardiac complications seen were atrial fibrillation (AF) in 33 cases (6.1%) and cardiac heart failure (CHF) in 11 cases (2%). The risk factors of CT were age greater than 50 years (OR = 13.1; 95% CI [4.9–34.4]), low socioeconomic status (OR = 2.8; 95% CI [1.2–6.7]), low educational level (OR = 3.1; 95% CI [1.2–8.3]), personal history of hypertension (OR = 3.5; 95% CI [1.1–11.2]) and a multinodular toxic goiter as the etiology of hyperthyroidism (OR = 4.6; 95% CI [1.6–13.9]). After multivariate analysis, age greater than 50 years was the only independent risk factor of CT (adjusted OR = 11.6; 95% CI [2.7–49.5]). Severe biological hyperthyroidism (FT4 > 3 times normal) was associated with a lower risk of CT (adjusted OR = 0.2; 95% CI [0.1–0.9]).ConclusionsThe prevalence of CT in patients with overt hyperthyroidism was relatively low. Cardiac complications were AF and CHF with a clear predominance of AF. Advanced age was the only independent risk factor of CT. Cardiac complications may be seen even if hyperthyroidism is not biologically severe.     

Recours à l’automédication chez l’hypertendu noir africain : ses facteurs et ses conséquences

IntroductionSelf-medication practice is under-evaluated among black African hypertensive patients.AimTo assess the level of self-medication among black African hypertensive patients and to determine the factors favoring this practice and their consequences.MethodsProspective study during a 3-month period including 612 hypertensive patients followed in Abidjan cardiology institute.ResultsMean age was 55.1. The patients had a self-medication use in 60.1% of cases. Medicinal plants and derived products were commonly involved. Self-medication use reasons were: influence of relatives (89.8%) and the fear of antihypertensive drugs adverses effects (54.9%). Multivariate analysis shows that factors of self-medication were age (56.6 years vs. 50.3 years, P < 0.001), income less than 762 euros/month (88% vs. 75.4%; OR = 2.73; 95% CI: 1.62–4.6; P < 0,0001), obesity (70.4% vs. 35.6%; OR = 1.24; 95% CI: 0.75–1.15; P = 0.037), dyslipidemia (40.8% vs. 27.9%; OR = 6.72; 95% CI: 0.57–2.13; P = 0.043), antihypertensive association therapy (61.7% vs. 51.4%; OR = 2.27; 95% CI: 0.25–0.97; P = 0.037). Poor control of high blood pressure (HBP) was a consequence of self-medication (6.5% vs. 47.1%; OR = 10.27; 95% CI: 4.65–56.4; P = 0.034), repercussions of HBP on major organ (75% vs. 17.2%; OR = 12.9; 95% CI: 8.5–19.6; P = 0.0001).ConclusionSelf-medication is a common practice in African hypertensive patients. It has many consequences.     

Body composition and frailty profiles in Brazilian older people: Frailty in Brazilian Older People Study-FIBRA-BR

ObjectiveTo determine the association between body composition and frailty in older Brazilian subjects.Material and methodsThis is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n = 5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio.ResultsThe lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9 kg/m². Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR) = 3.10; 95% CI: 2.06–4.67) and (OR = 1.15; 95% CI: 1.03–1.27), respectively. Being overweight was protective for pre-frailty (OR = 0.48; 95% CI: 0.4–0.58) and frailty (OR = 0.77; 95% CI: 0.67–0.9). Obese older people presented a higher risk of pre-frailty only (OR = 1.29; 95% CI: 1.09–1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range.ConclusionUndernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI.     

Prior history of sexually transmitted diseases in women living with AIDS in São Paulo,Brazil

ObjectivesTo describe the epidemiological profile, risk behaviors, and the prior history of sexually transmitted diseases (STDs) in women living with acquired immunodeficiency syndrome (AIDS).MethodsCross-sectional study, performed at the Centro de Referência e Treinamento em DST/AIDS of São Paulo. The social, demographic, behavioral, and clinical data such as age, schooling, marital status, age at first sexual intercourse, number of sexual partners, parity, use of drugs, time of HIV diagnosis, CD4 count, and viral load determination were abstracted from the medical records of women living with AIDS who had gynecological consultation scheduled in the period from June 2008 to May 2009.ResultsOut of 710 women who were scheduled to a gynecological consultation during the period of the study, 598 were included. Previous STD was documented for 364 (60.9%; 95% CI: 56.9%–64.8%) women. The associated factors with previous STDs and their respective risks were: human development index (HDI) < 0.50 (ORaj = 5.5; 95% CI: 2.8–11.0); non-white race (OR_aj = 5.2; 95% CI: 2.5–11.0); first sexual intercourse at or before 15 years of age (OR_aj = 4.4; 95% CI: 2.3–18.3); HIV infection follow-up time of nine years or more (OR_aj = 4.2; 95% CI: 2.3–7.8)]; number of sexual partners during the entire life between three and five partners (OR_aj = 2.2; 95% CI: 1.1–4.6), and six or more sexual partners (OR_aj = 3.9; 95% CI: 1.9–8.0%); being a sex worker (OR_aj = 1.9; 95% CI: 1.1–3.1).ConclusionsA high prevalence of a prior history of STDs in the studied population was found. It is essential to find better ways to access HIV infection prevention, so that effective interventions can be more widely implemented.     

The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy

BackgroundSuboptimal colon preparation is a significant barrier to quality colonoscopy. The impact of pharmacologic agents associated with gastrointestinal dysmotility on quality of colon preparation has not been well characterized.AimsEvaluate impact of opiate pain medication and psychoactive medications on colon preparation quality in outpatients undergoing colonoscopy.MethodsOutpatients undergoing colonoscopy at a single medical centre during a 6-month period were retrospectively identified. Demographics, clinical characteristics and pharmacy records were extracted from electronic medical records. Colon preparation adequacy was evaluated using a validated composite colon preparation score.Results2600 patients (57.3 ± 12.9 years, 57% female) met the inclusion and exclusion criteria. 223 (8.6%) patients were regularly using opioids, 92 antipsychotics, 83 tricyclic antidepressants and 421 non-tricyclic antidepressants. Opioid use was associated with inadequate colon preparation both with low dose (OR = 1.4, 95%CI 1.0–2.1, p = 0.05) and high dose opioid users (OR = 1.7, 95%CI 1.1–2.9, p = 0.039) in a dose dependent manner. Other significant predictors of inadequate colon preparation included use of tricyclics (OR = 1.9, 95%CI 1.1–3.0, p = 0.012), non-tricyclic antidepressants (OR = 1.5, 95%CI 1.1–2.0, p = 0.013), and antipsychotic medications (OR = 2.2, 95%CI 1.4–3.4, p = 0.001).ConclusionsOpiate pain medication use independently predicts inadequate quality colon preparation in a dose dependent fashion; furthermore psychoactive medications have even more prominent effects and further potentiates the negative impact of opiates with concurrent use.     

The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapy

BackgroundPreventive strategies developed to avoid the complications of antiplatelet therapies recommend the evaluation of risk factors for gastrointestinal events and indicated gastroprotective strategies.AimWe aimed to assess the impact of predisposing factors - histological findings, concomitant drug consumption, comorbidities, symptoms, social habits, Helicobacter pylori infection - on severe gastro-duodenal lesions in patients with low-dose aspirin and concomitant protective therapy with proton pump inhibitors (PPI).MethodWe enrolled 237 patients with LDA and PPI therapy, referred for upper digestive endoscopy, divided into two groups according to the severity of their endoscopic lesions (172 patients with no or mild endoscopic lesions and 65 patients with severe endoscopic lesions).ResultsIn the univariate logistic regression model, the factors associated with severe gastro-duodenal lesions were gender (OR = 1.87, 95% CI: 1.04–3.41), anticoagulants (OR = 2.40, 95% CI: 1.26–4.53), gastric atrophy and/or intestinal metaplasia (OR = 1.85, 95% CI: 1.04–3.32), congestive heart failure (OR = 2.59, 95% CI: 1.16–6.62), anaemia (OR = 3.01, 95% CI: 1.67–5.47) and smoking (OR = 4.29, 95% CI: 1.57–12.32). In the final model, anticoagulants (p = 0.041 < 0.05) and anaemia (p = 0.019 < 0.05) were risk factors for severe lesions via multivariate regression analysis, while for active/inactive chronic gastritis and smoking a positive dependency with a tendency towards statistical significance (p < 0.10) was noticed for severe gastric lesions.ConclusionsIn patients treated with low-dose aspirin and gastroprotective therapy with proton pump inhibitors we have enough evidence to consider co-treatment with anticoagulants and anaemia important predictors for severe endoscopic lesions, while other factors such as inflammation in gastric biopsies, congestive heart failure, co-treatment with clopidogrel and smoking tended to have a positive influence on risk for severe gastro-duodenal lesions.     

Comparison of clinical and laboratory characteristics between children and adults with dengue

Over the past several years, the epidemiological profile of dengue has been changing progressively and is currently characterized by an increase in the number of cases in children under 15 years of age. This study was aimed at comparing the clinical and laboratory features between adults and children with dengue; therefore, we performed a cross-sectional analysis of 5686 individuals with laboratory-confirmed dengue who sought treatment at a healthcare facility in Rio de Janeiro, Brazil from 2010 to 2011. A multivariate analysis indicated that myalgia (OR = 2.58; CI 95% = 2.08–3.18), retro-orbital pain (OR = 1.36; CI 95% = 1.15–1.62), nausea (OR = 1.92; CI 95% = 1.60–2.30), and arthralgia (OR = 3.64; CI 95% = 2.72–4.89) were the most frequent clinical symptoms in adults, whereas vomiting (OR = 0.52; CI 95% = 0.43–0.61) and skin rash (OR = 0.46; CI 95% = 0.25–0.85) were the most prevalent symptoms in children. Adults exhibited a higher hemoconcentration (OR = 3.04; CI 95% = 2.53–3.65), thrombocytopenia (OR = 2.17; CI 95% = 1.80–2.60), increased erythrocyte sedimentation rate (OR = 1.81; CI 95% = 1.53–2.14), and increased ALT (OR = 3.13; CI 95% = 2.44–4.02) than did children. In addition, adults exhibited a higher frequency of the severe forms of the disease (OR = 1.74; CI 95% = 1.12–2.72) and hospitalization (OR = 2.21; CI 95% = 1.59–3.06) relative to children. Based on these results, this study demonstrated significant differences in the clinical and laboratory presentations and disease severity between adults and children affected by dengue.     

Factores de riesgo asociados con morbilidad y mortalidad postoperatoria en gastrectomía radical D2 por cáncer gástrico

Introduction and aimsSurgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer.Materials and methodsA retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days.ResultsThe percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥ 70 years (OR = 1.85, 95% CI: 1.25-2.76), ASA III-IV (OR = 2.06, 95% CI: 1.28-3.34), total gastrectomy (OR = 1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR = 5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age ≥ 70 years (OR = 4.92, 95% CI:1.78-13.65), lower BMI (OR = 0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR = 0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy.ConclusionsD2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age ≥ 70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age ≥ 70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.     

Predictors of functional disability with focus on activities of daily living: A community based follow-up study in older adults in India

BackgroundDisability in activities of daily living is a growing concern among older populations all over the world. India has one of the rapidly ageing populations and predicted burden of functional disability is higher for Indian older adults as compared to other ageing Asian countries.MethodsTotal 1140 aged 60 years and over participated in a baseline study. 560 of them participated in the prospective cohort study conducted in the city of Pune, India. An interview and functional assessment using a questionnaire and Pune-FAAT tool was carried out in 2013–14. Binary logistic regression was used to obtain the factors that increased the odds of having ADL disability at follow-up.ResultsThe mean age of the study population was 69.73 ± 5.48 years. Squatting, walking and climbing functions were affected significantly. Total 376 participants (67.1%) reported difficulties and/or disability in performing activities of daily living (ADL) at follow-up. Hospitalization (OR = 3.6; 95% CI: 1.9–6.7), being female (OR = 2.3; 95% CI: 1.5–3.5), presence of two or more chronic diseases (OR = 1.7; 95% CI: 1.1–2.7), experience of memory loss (OR = 1.9; 95% CI: 1.2–3.0) and feeling of loneliness (OR = 2.3; 95% CI: 1.0–5.3) increased the odds of being in the “With disability” group at follow-up. Apart from this, self-rated health and self-reported depression were associated with limitations in ADL.ConclusionHospitalization and being female appeared to be the most significant risk factors for disability in urban older adults in India. Rehabilitation services after hospitalization, physical exercise, effective control on chronic illness, and social participation to reduce loneliness is recommended.     

The impact of angiotensin converting enzyme insertion/deletion gene polymorphism on diabetic kidney disease: A debatable issue

ObjectiveThe objective of this study was to evaluate the influence of ACE I/D gene polymorphisms on diabetic kidney disease (DKD) risk.MethodsAll eligible investigations were identified, the number of various genotype in the case and control group were reviewed. The pooled analysis was performed using Stata software.ResultsIn overall subjects, 24,321 participants with 12,961 cases and 11,360 controls were included. the pooled analysis showed a significant link between D allele, DD or II genotype and DKD risk (D versus I: OR = 1.316, 95% CI: 1.213–1.427, P = 0.000; DD versus ID + II: OR = 1.414, 95% CI: 1.253–1.595, P = 0.000; II versus DD + ID: OR = 0.750, 95% CI: 0.647–0.869, P = 0.000). The subgroup pooled analysis showed that ACE I/D gene polymorphism was correlated with DKD both in Asian and in Chinese population. In addition, ACE I/D gene polymorphism was correlated with type 2 DKD (D versus I: OR = 1.361, 95% CI: 1.243–1.490, P = 0.000; DD versus ID + II: OR = 1.503, 95% CI: 1.310–1.726, P = 0.000; II versus DD + ID: OR = 0.738, 95% CI: 0.626 –0.870, P = 0.000). However, there was no obvious correlation in Caucasian subjects and type 1 diabetic patients.ConclusionACE I/D polymorphisms were correlated with DKD in Asian and type 2 diabetic populations. ACE D allele/DD genotype might be a risk factor, while ACE II genotype might be a protective factor for DKD.     

Functional polymorphisms of Toll-like receptors 2 and 4 alter the risk for colorectal carcinoma in Europeans

BackgroundColon carcinogenesis is associated with increased expression levels of Toll-like receptor 2 and Toll-like receptor 4.AimTo determine in a Caucasian population the role of Toll-like receptor 2 and Toll-like receptor 4 polymorphisms in colorectal cancer development.MethodsHospital based multicentre case control study involving 193 colorectal cancer patients and 278 healthy individuals. DNA samples were extracted from blood cells and genotyping of TLR2+597T>C, TLR2?4760T>C, TLR4?3745A>G, TLR2Arg753Gln, TLR4Asp299Gly was performed. Functionality of risk polymorphisms was evaluated through production of TNF-α in cell culture and Toll-like receptors levels quantified by real-time RT-PCR.ResultsTLR2+597CC homozygous had 5-fold decreased risk (odds ratio (OR) = 0.21, 95% CI: 0.09–0.50, p < 0.001) and TLR4 299Gly homozygous 3-fold increased risk of colorectal cancer (OR = 3.30, 95% CI: 1.18–9.28, p = 0.015). In stratified analysis, TLR2+597CC genotype protective effect was even higher in overweight individuals (OR = 0.17, 95% CI: 0.06–0.53, p < 0.001) and in never smokers (OR = 0.11, 95% CI: 0.02–0.51, p = 0.001). Also, the increased risk effect for TLR4 299Gly homozygous genotype was higher in overweight individuals (OR = 8.67, 95% CI: 1.11–87.85, p = 0.011). TLR2+597T>C polymorphism conferred 41% less (p = 0.03) and TLR4Asp299Gly 65% more TNF-α production (p = 0.02) with no differences in Toll-like receptors levels.ConclusionFunctional Toll-like receptor 2 and Toll-like receptor 4 polymorphisms significantly alter the risk to have colorectal cancer. Obesity and smoking may influence the risk for colorectal cancer in individuals presenting these genetic profiles.     

Influence of the CYP2J2 Gene Polymorphisms on Chronic Obstructive Pulmonary Disease Risk in the Chinese Han Population

IntroductionCytochrome P450 (CYP) 2J2 is a major enzyme that controls epoxyeicosatrienoic acids biosynthesis, which may play a role in chronic obstructive pulmonary disease (COPD) development. In this study, we aimed to assess the influence of CYP2J2 polymorphisms with COPD susceptibility.Material and methodsA case–control study enrolled 313 COPD cases and 508 controls was to investigate the association between CYP2J2 polymorphisms and COPD risk. Agena MassARRAY platform was used to genotype CYP2J2 polymorphisms. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the association between CYP2J2 polymorphisms and COPD risk.ResultsWe observed rs11207535 (homozygote: OR = 0.08, 95%CI = 0.01–0.96, p = 0.047; recessive: OR = 0.08, 95%CI = 0.01–0.94, p = 0.044), rs10889159 (homozygote: OR = 0.08, 95%CI = 0.01–0.92, p = 0.043; recessive: OR = 0.08, 95%CI = 0.01–0.90, p = 0.040) and rs1155002 (heterozygote: OR = 1.63, 95%CI = 1.13–2.36, p = 0.009; dominant: OR = 1.64, 95%CI = 1.15–2.35, p = 0.006; additive: OR = 1.45, 95%CI = 1.09–1.92, p = 0.011) were significantly associated with COPD risk. Allelic tests showed T allele of rs2280274 was related to a decreased risk of COPD and T allele of rs1155002 was associated with an increased COPD risk. Stratified analyses indicated the effects of CYP2J2 polymorphisms and COPD risk were dependent on gender and smoking status (p < 0.05). Additionally, two haplotypes (A_rs11207535C_rs10889159T_rs1155002 and A_rs11207535C_rs10889159C_rs1155002) significantly decreased COPD risk.ConclusionIt suggested CYP2J2 polymorphisms were associated with COPD susceptibility in the Chinese Han population.