Patients with rheumatoid arthritis have an increased risk of incident chronic kidney disease: a systematic review and meta-analysis of cohort studies

International Urology and Nephrology - Patients with rheumatoid arthritis (RA) may have a higher risk of developing chronic kidney (CKD) compared with general population, but the data on this risk...     

Psoriasis and risk of incident chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis

Objectives

Patients with psoriasis may have a higher risk of developing chronic kidney (CKD) and end-stage renal disease (ESRD) compared with general population. This systematic review and meta-analysis aimed to comprehensively investigate this association by reviewing all available evidence.

Methods

A systematic review was performed using MEDLINE and EMBASE database from inception to January 2018 to identify all cohort studies that compared the risk of incident CKD and/or ESRD in patients with psoriasis versus individuals without psoriasis. Pooled risk ratio and 95% confidence interval were calculated using random-effect, generic inverse variance method.

Results

A total of four retrospective cohort studies with 199,808 patients with psoriasis were included. The risk of incident CKD and ESRD was significantly increased among patients with psoriasis with the pooled risk ratio of 1.34 (95% CI, 1.14–1.57) and 1.29 (95% CI, 1.05–1.60), respectively.

Conclusion

A significantly increased risk of incident CKD and ESRD among patients with psoriasis compared with individuals without psoriasis was demonstrated in this study.

     

Clinical Factors Predictive of Pneumonia Caused by Pandemic 2009 H1N1 Influenza Virus

Pneumonia was the most common cause of death during the 2009 pandemic H1N1 influenza virus infection. Clinical risk factors for pneumonia caused by this virus are limited. We enrolled consecutive patients treated at the H1N1 Clinic in Thungsong Hospital in Nakhon Si Thammarat, Thailand, during June–December 2009 who had positive polymerase chain reaction results for H1N1 virus. Clinical features for patients given a diagnosis with and without pneumonia were studied. There were 441 patients with positive polymerase chain reaction results for H1N1 virus. Of these patients, 51 (11.56%) had pneumonia. Three independent clinical factors for H1N1 pneumonia were myalgia, dyspnea, and an absolute neutrophil count > 7,700 cells/μL. Adjusted odds ratios (95% confidence intervals) for these three variables were 0.413 (0.173–0.988), 2.625 (1.230–5.604), and 4.475 (1.882–10.644), respectively. Clinical features may be a useful tool for predicting risk for pneumonia caused by H1N1 virus.     

A risk score for predicting incident diabetes in the Thai population

OBJECTIVE: The objective of this study was to develop and evaluate a risk score to predict people at high risk of diabetes in Thailand. RESEARCH DESIGN AND METHODS: A Thai cohort of 2,677 individuals, aged 35-55 years, without diabetes at baseline, was resurveyed after 12 years. Logistic regression models were used to identify baseline risk factors that predicted the incidence of diabetes; a simple model that included only those risk factors as significant (P < 0.05) when adjusted for each other was developed. The coefficients from this model were transformed into components of a diabetes score. This score was tested in a Thai validation cohort of a different 2,420 individuals. RESULTS: A total of 361 individuals developed type 2 diabetes in the exploratory cohort during the follow-up period. The significant predictive variables in the simple model were age, BMI, waist circumference, hypertension, and history of diabetes in parents or siblings A cutoff score of 6 of 17 produced the optimal sum of sensitivity (77%) and specificity (60%). The area under the receiver-operating characteristic curve (AUC) was 0.74. Adding impaired fasting glucose or impaired glucose tolerance status to the model slightly increased the AUC to 0.78; adding low HDL cholesterol and/or high triglycerides barely improved the model. The validation cohort demonstrated similar results. CONCLUSIONS: A simple diabetes risk score, based on a set of variables not requiring laboratory tests, can be used for early intervention to delay or prevent the disease in Thailand. Adding impaired fasting glucose or impaired glucose tolerance or triglyceride and HDL cholesterol status to this model only modestly improves the predictive ability.     

Predicting Treatment Cost for Bacterial Diarrhoeaat a Regional Hospital in Thailand

The aim of this study was to estimate the treatment cost and formulate a cost-function for bacterial diarrhoea among patients in a Thai regional hospital. This study was an incidence-based cost-of-illness analysis from a hospital perspective, employing a micro-costing approach. It covered new episodes of both outpatients and inpatients who were diagnosed to have bacterial diarrhoea (ICD-10 code A00-A05) and who received treatment during 1 October 2000–31 July 2003. Retrospective data were collected from medical records of the hospital. The study covered 384 episodes, and the mean age of patients was 24 years. The average treatment costs (at 2002 prices; US$ 1=approximately 40 Thai baht) were US$ 11.29, 76.78, and 44.72 per outpatient episode, inpatient episode, and outpatient/inpatient combined episode respectively. Furthermore, the positive significant predictor variables were: inpatient care, other Salmonella-associated infections, shigellosis, other bacterial intestinal infections, and the health insurance scheme. The fitted model was able to predict greater than 80% of the treatment cost. The estimation of simulated patients demonstrated a wide range of costs, from US$ 10 per episode to US$ 163 per episode. Overall, hospital administrators can apply these results in cost-containment interventions.Key words: Bacteria, Cost-function analysis, Cost and cost analysis, Diarrhoea, Health expenditure, Healthcare cost, Retrospective studies, Thailand     

Validity of the Thai EQ-5D in an occupational population in Thailand

Purpose

To assess the construct validity of the Thai EuroQoL (EQ-5D) among an occupational population in Thailand.

Methods

Data were derived from a large cohort study among employees of the Electricity Generating Authority of Thailand. In 2008 and 2009, 4,850 participants completed the Thai EQ-5D and Short-Form 36 version 2 (SF-36v2). Thai preferences weights were used to convert EQ-5D health states into EQ-5D index scores. Construct validity of the Thai EQ-5D was examined by specifying and testing hypotheses about the relationships between the EQ-5D, SF-36v2, and participants’ demographic and medical characteristics.

Results

Construct validity of the Thai EQ-5D was supported by expected relationships with SF-36v2 scale and summary scores. For example, SF-36v2 scores on the mental health scale were much lower for participants who reported having problems on the EQ-5D anxiety/depression dimension compared to those reporting no problems (mean norm-based SF-36v2 scores: 52.9 vs. 41.8, p < 0.001). Additionally, reporting a problem in a given EQ-5D dimension was generally associated with lower SF-36v2 summary scores. The EQ-5D index score distinguished between groups of participants in the expected manner, on the basis of sex, age, education and self-reported health, thus providing evidence of known-groups validity.

Conclusion

The study demonstrated good construct validity of the Thai EQ-5D in a large occupational population in Thailand.     

Oncologic safety of colonic stenting as a bridge to surgery in left-sided malignant colonic obstruction: Current evidence and prospects

Approximately 7%-29% of patients with colorectal cancer present with colonic obstruction. The concept of self-expandable metal stent (SEMS) insertion as a bridge to surgery (BTS) is appealing. However, concerns on colonic stenting possibly impairing oncologic outcomes have been raised. This study aimed to review current evidence on the short- and long-term oncologic outcomes of SEMS insertion as BTS for left-sided malignant colonic obstruction. For short-term outcomes, colonic stenting facilitates a laparoscopic approach, increases the likelihood of primary anastomosis without a stoma, and may decrease postoperative morbidity. However, SEMS-related perforation also increases local recurrence and impairs overall survival. Moreover, colonic stenting may cause negative oncologic outcomes even without perforation. SEMS can induce shear forces on the tumor, leading to increased circulating cancer cells and aggressive pathological characteristics, including perineural and lymphovascular invasion. The conflicting evidence has led to discordant guidelines. Well-designed collaborative studies that integrate both oncologic outcomes and data on basic research (e.g., alteration of circulating tumors) are needed to clarify the actual benefit of colonic stenting as BTS.     

In vivo analysis of bacterial biofilm formation on facial plastic bioimplants

Objectives: This study examines the formation of biofilm on biomaterials commonly used in facial plastics and reconstruction including titanium, silicone, ionbombarded silicone (Ultrasil), e-PTFE (Gore-Tex), e-PTFE with silver/chlorhexidine (Gore-Tex Plus), and PHDPE (Medpor). Methods: These biomaterials were implanted subcutaneously in the dorsum of 11 guinea pigs after contamination with Staphylococcus aureus and examined with scanning electron microscopy after 7 days. Wounds were also inspected for infection and extrusion rates. Results: Results show biofilm formation on titanium, silicone, ion-bombarded silicone, e-PTFE, and PHDPE associated with high rates of extrusion and infection. Implants of e-PTFE with silver/chlorhexidine, on the other hand, appeared resistant to biofilm formation and demonstrated significantly lower rates of extrusion and infection. Conclusions: Contamination of bioimplants in vivo leads to formation of bacterial biofilm on the surface of the biomaterial, causing infection, pus formation, and extrusion. The authors hypothesize that the antiseptic agents impregnated in the biomaterial form a protective coat of silver, chlorhexidine, and inflammatory cells that inhibits initial bacterial adhesion to the biomaterial surface. Laryngoscope, 108:1733–1738, 1998