Clinical distinction and evaluation of leptospirosis in Taiwan--a case-control study

BACKGROUND: Leptospirosis is the most widespread zoonosis. Leptospirosis remains underreported in Taiwan because of ignorance and the broad spectrum of clinical manifestations. Acute renal failure (ARF) is a prominent feature of leptospirosis. This investigation conducted a case-control study to obtain information to distinguish leptospirosis from other conditions with similar presentations. METHODS: Leptospirosis surveillance was performed at Chang Gung Memorial Hospital, Taiwan, between September 2000 and December 2001. Suspected clinical cases were included in the sample and investigated. Diagnosis was confirmed with four-fold or greater increase of microscopic agglutination test (MAT) titer in paired sera; positive immunoglobulin M (IgM) dipstick with single MAT > or =400; or isolation of leptospira. Cases were classified as excluded based on confirmed etiology other than leptospirosis or negative paired serologic test. RESULTS: Twenty-two confirmed cases and 21 excluded cases of leptospirosis were identified from among 169 suspected cases. An outbreak was observed during the flooding from Typhoon Nali. L. shermani, the most common serovar in Taiwan, was identified in 78.5% of confirmed cases. In the confirmed group, mean age was 44 +/- 14.5 (21-66) yrs similar to that of the excluded group, with male predominance (86.4 vs. 57.1%, p<0.05). The most common presentations in the confirmed group were fever (95.5%), ARF (86.4%), myalgia (72.7%) and jaundice (63.6%). Ten patients were infected through occupational or recreational exposure, and in six patients, the infection was associated with flooding. The most distinct presentations of leptospirosis cases compared with excluded cases were increased incidence of hemorrhagic diathesis (odds ratio (OR): 10, p=0.04), myalgia (OR: 8.0, p=0.02), bilateral enlarged kidneys (OR: 7.5, p=0.0004), risk factor exposure (OR: 6.9, p=0.005), sterile pyuria (OR: 6.3, p=0.017), hypokalemia (OR: 5.0, p=0.035) and thrombocytopenia (OR: 4.8, p=0.04). Hospitalization days correlated well with levels of peak creatinine (Cr) (p=0.0362) and platelet nadir (p=0.0039) reached. Penicillin treatment was followed by rapid symptoms and renal function improvement. CONCLUSIONS: Prompt recognition of the characteristic presentations of leptospirosis, followed by timely antibiotic treatment, can dramatically save the patients even with severe multiple organ damage.     

Minimally invasive total knee arthroplasty using the contralateral knee as a control group: a case-control study

The primary purpose of this study was to compare clinical and functional results of bilateral total knee arthroplasties in which a conventional total knee replacement was initially performed on one knee and a minimally invasive total knee replacement was later performed on the contralateral side. Operative factors, clinical and radiographic outcomes, and quadriceps muscle strength were evaluated in twenty-five patients (50 total knee arthroplasties). Twenty-one of the 25 patients preferred the minimally invasive approach. Knee society objective scores and range-of-motion were significantly greater in the minimally invasive group. Isokinetic testing demonstrated statistically improved quadriceps muscle strength in the minimally invasive technique group compared to the standard approach at both 12 weeks and one year postoperatively. Radiographic analysis did not reveal differences in alignment variables between the two approaches. The results of this study suggest that minimally invasive total knee arthroplasty offers superior short-term as well as possible long-term results.     

ABO血型与深静脉血栓发生风险关系的病例对照研究及Meta分析

背景与目的:深静脉血栓(DVT)是住院患者常见的并发症,其病因复杂,如何预防DVT的发生是临床工作的重点。本研究通过病例对照研究及Meta分析探讨ABO血型与DVT发生风险的关系,以期为DVT的个体化预防及精准治疗提供依据。方法:选择2012年10月—2018年12月苏北人民医院血管外科的500例住院DVT患者(多次住院患者只统计首次住院),并按诱因(无明显诱因、妊娠、外伤、手术、癌症、长期卧床)及性别1:1配对选择同期500例非DVT住院患者行病例-对照研究。检索多个国内外数据库收集相关病例-对照研究,检索时间从建库至2019年10月1日,根据纳入标准和排除标准筛选文献,经质量评价及提取数据后,采用Review Manager 5.3软件进行Meta分析。结果:病例-对照研究中,整体分析结果显示,非O型血较O型血个体DVT发生风险升高(RR=2.859,95% CI=2.142～3.817,P0.01);按诱因进行亚组分析,结果显示,在无明显诱因(RR=2.845,95% CI=1.819～4.282,P0.05)、外伤(RR=3.11,95% CI=1.477～6.552,P0.05)、手术(RR=2.613,95% CI=1.271～5.373,P0.05)及癌症(RR=2.962,95% CI=1.436～6.106,P0.05)患者中,非O型血是DVT发生的可能危险因素,而在妊娠(RR=1,95%CI=0.034～29.807,P0.05)及卧床(RR=5.714,95% CI=0.528～30.325,P0.05)患者未表现出明显关系。Meta分析结果显示,O型血个体发生DVT风险低于非O血型人群(RR=0.62,95% CI=0.56～0.69,P0.05)。结论:对无明显诱因组、外伤组、手术组及癌症组患者,将ABO血型纳入DVT危险因素的综合分析中,对于血栓的个体化干预和精准治疗有一定临床价值。对于妊娠组及长期卧床组患者,ABO血型的不一定能表现出足够临床价值,仍需进一步验证。     

The comparative study of serum iron,copper, and zinc levels between bladder cancer patients and a control group

Objective  

A relatively wide range of trace elements are known to play important roles in biological processes, including the oxidative processes. Oxidative processes are one of the mechanisms involved in both incidence and recurrence of bladder cancer. In the present study, the concentration of iron (Fe), copper (Cu) and zinc (Zn) were determined in the serum of patients with bladder cancer in comparison to healthy subjects.     

Cannabis use and cancer of the head and neck: case-control study

OBJECTIVE: To investigate whether cannabis smoking increases the risk of head and neck cancer. DESIGN: Case-control study. SUBJECTS AND METHODS: Cases of head and neck cancer < or =55 years identified from hospital databases and the Cancer Registry, and controls randomly selected from the electoral roll completed interviewer-administered questionnaires. Logistic regression was used to estimate the relative risk of head and neck cancer. RESULTS: There were 75 cases and 319 controls. An increased risk of cancer was found with increasing tobacco use, alcohol consumption, and decreased income but not increasing cannabis use. The highest tertile of cannabis use (>8.3 joint years) was associated with a nonsignificant increased risk of cancer (relative risk = 1.6, 95% confidence interval, 0.5-5.2) after adjustment for confounding variables. CONCLUSIONS: Cannabis use did not increase the risk of head and neck cancer; however, because of the limited power and duration of use studied, a small or longer-term effect cannot be excluded.     

Correlation between nutritional biomarkers and breast cancer: a case-control study

A case-control study to explore associations between retinoids, tocopherols, total and beta-carotenes and breast cancer was conducted by analysing concentrations of these biomarkers in adipose tissue, cheek cells and plasma. A total of 414 French-Canadians in Montreal with new diagnoses of breast cancer were age-matched to 429 population-based controls. Subjects were interviewed using a questionnaire, and biological samples from 287 cases and 112 controls were collected within 3 months of the diagnosis. Mean beta carotene concentrations in cheek cells were significantly lower among controls. Odds ratios (ORs) from logistic regression analysis were used to compare higher and lower tercile concentrations. Significant positive associations were observed in adipose tissue for retinoid [OR=2.11; 95% CI (1.09-4.08)] and beta carotene [OR=3.18; 95% CI (1.70-5.93)]; in cheek cells for beta carotene [OR=2.22; 95% CI (1.21-4.50)] and for total carotenes [OR=2.94; 95% CI (1.59-5.42)] and in plasma for beta carotene [OR=1.53; 95% CI (0.80-2.93)] and total carotenes [OR=1.04; 95% CI (0.53-2.05)]. Among the control groups, significant Pearson correlations were observed between cheek cells and adipose tissue for total carotenes (r=0.27; p=0.01) and cheek cells and plasma (r=0.22; p=0.04). In contrast to previous works, this study shows that high concentrations of retinoids and carotenes in adipose tissue and cheek cells are associated with increased risk of breast cancer. However, all these studies are limited by small sample size. Although our study tested a limited number of controls, important associations were observed. These results suggest that the effect of disease on biomarkers is fundamental to the interpretation of epidemiological data. We suggest either that the high levels of these biomarkers found in cancer patients in this study may be due to the disease process that affects the pharmacokinetics of the biomarker or that the disease causes a change in dietary habits. In addition, in studies involving the application of biomarkers to cancer epidemiology it is imperative that a typical biomarker concentration is not associated with breast cancer risk before further examination of the methodological limitations of epidemiological studies investigating this relationship. Therefore, sample size, selection bias, information bias, and confounding should be considered in the design of studies investigating the aetiological relationship between biomarkers and breast cancer.     

Association between smoking and chronic renal failure in a nationwide population-based case-control study

For determining whether smoking is associated with an increased risk for chronic renal failure (CRF) overall and by type of renal disease, smoking data were analyzed from a nationwide population-based case-control study. Eligible as cases were native 18- to 74-yr-old Swedes whose serum creatinine for the first time and permanently exceeded 3.4 mg/dl (men) or 2.8 mg/dl (women). A total of 926 cases (78% of all eligible) and 998 control subjects (75% of 1330 randomly selected subjects from the source population), frequency matched to the cases by gender and age within 10 yr, were included. A face-to-face interview and a self-administered questionnaire provided information about smoking habits and other lifestyle factors. Logistic regression models estimated odds ratios (OR) as measures of relative risk for disease-specific types of CRF among smokers compared with never-smokers. Despite a modest and nonsignificant overall association, the risk increased with high daily doses (OR among smokers of >20 cigarettes/d, 1.51; 95% confidence interval [CI], 1.06 to 2.15), long duration (OR among smokers for >40 yr, 1.45; 95% CI, 1.00 to 2.09), and a high cumulative dose (OR among smokers with >30 pack-years, 1.52; 95% CI, 1.08 to 2.14). Smoking increased risk most strongly for CRF classified as nephrosclerosis (OR among smokers with >20 pack-years, 2.2; 95% CI, 1.3 to 3.8), but significant positive associations were also noted with glomerulonephritis. This study thus suggests that heavy cigarette smoking increases the risk of CRF for both men and women, at least CRF classified as nephrosclerosis and glomerulonephritis.     

Relationship between body size and prostate cancer in a sibling based case-control study

PURPOSE: Body size has been hypothesized to affect the risk of prostate cancer (PCa). However, previous studies have provided conflicting results, in that some show positive associations, whereas others indicate inverse associations or null findings. To further understand this we examined the effects of weight, height, body mass index and lean body mass (LBM) on PCa risk and aggressiveness in a sibling based case-control study. MATERIALS AND METHODS:A total of 439 cases were recruited at major medical institutions in Cleveland, Ohio and Detroit, Michigan, and 479 unaffected brothers were recruited as controls. Conditional logistic regression with robust variance estimation was used to evaluate the association between body size and PCa. RESULTS: Higher LBM was inversely associated with PCa, especially in men with more aggressive disease or a later age at onset. Comparing those above and below the 25th percentile showed an OR of 0.49 (95% CI 0.28 to 0.84) and 0.28 (95% CI 0.14, 0.56), respectively. Similar inverse patterns were observed for weight. No noteworthy associations were observed between PCa and height or body mass index. CONCLUSIONS: These observations suggest that PCa may be affected by LBM.     

Deaths certified as asthma and use of medical services: a national case-control study

BACKGROUND: Studies have linked asthma death to either increased or decreased use of medical services. METHODS: A population based case-control study of asthma deaths in 1994-8 was performed in 22 English, six Scottish, and five Welsh health authorities/boards. All 681 subjects who died were under the age of 65 years with asthma in Part I on the death certificates. After exclusions, 532 hospital controls were matched to 532 cases for age, district, and date of asthma admission/death. Data were extracted blind from primary care records. RESULTS: The median age of the subjects who died was 53 years; 60% of cases and 64% of controls were female. There was little difference in outpatient attendance (55% and 55%), hospital admission for asthma (51% and 54%), and median inpatient days (20 days and 15 days) in the previous 5 years. After mutual adjustment and adjustment for sex, using conditional logistic regression, three variables were independently associated with asthma death: fewer general practice contacts (odds ratio 0.82 (95% confidence interval (CI) 0.74 to 0.91) per 5 contacts) in the previous year, more home visits (1.14 (95% CI 1.08 to 1.21) per visit) in the previous year, and fewer peak expiratory flow recordings (0.83 (95% CI 0.74 to 0.92) per occasion) in the previous 3 months. These associations were similar after adjustment for markers of severity, psychosocial factors, systemic steroids, short acting bronchodilators and antibiotics, although the association with peak flow was weakened and just lost significance. CONCLUSION: Asthma death is associated with less use of primary care services. Both practice and patient factors may be involved and a better understanding of these may offer possibilities for reducing asthma death.     

Association between psoas abscess and prosthetic hip infection: a case-control study

Background and purpose The relationship between prosthetic hip infection and a psoas abscess is poorly documented. We determined the frequency of prosthetic hip infections associated with psoas abscesses and identified their determinants.Methods We conducted a 2-year observational study. Data from patients with psoas abscesses that were associated with prosthetic hip infections were examined in a case-control study.Results Of 106 patients admitted to the Infectious Diseases Department with prosthetic hip infection, 13 also had a psoas abscess (12%; 95% CI: 6–19). By conditional logistic regression analysis, psoas abscesses were observed more frequently in cases of hematogenous prosthetic infections (OR = 93, p = 0.06) and in patients with a history of neoplasm (OR = 20, p = 0.03).Interpretation Our results suggest that the presence of psoas abscesses is a frequent but under-diagnosed complication of prosthetic hip infection. We recommend that an abdominal CT scan be performed on patients with hematogenous prosthetic hip infection or with a history of neoplasm.The risk of infectious complications after hip replacement is 1–2%, even despite the use of standard operating procedures including laminar airflow and routine antimicrobial prophylaxis (Widmer 2001). Most authors recommend removal of the device to eradicate chronic infections.A prosthetic hip infection can give rise to a psoas abscess, which can occur hematogenously or by microbial inoculation (Ricci et al. 1986). Primary psoas abscesses are caused by a hematogenous agent from another, distant infection. Secondary infections are caused by contiguous infections. The iliopsoas bursa is the largest synovial bursa in the body and is connected to the hip joint in 14% of subjects (Chandler 1950). In addition, the new capsule formed after prosthetic implantation can interact with the iliopsoas bursa (Steinbach et al. 1985). There have been few reports on psoas abscess associated with an infected prosthetic hip (for review, see Buttaro et al. 2002).Because of the limited information on the association between psoas abscesses and prosthetic hip infection, we assessed its frequency and tried to identify its causes.     

The association between hip fracture and hip osteoarthritis: A case-control study

Background  

There have been reports both supporting and refuting an inverse relationship between hip fracture and hip osteoarthritis (OA). We explore this relationship using a case-control study design.     

Gout drugs use and risk of cancer: A case-control study

Objective

Firm conclusion about whether short and long-term gout medications use has an impact on cancer risk remain inconclusive. The aim of this study was to investigate the association between gout drugs use and risk of cancer.

人口及社会经济因素与髋骨骨折风险的病例对照研究

目的 探讨老年人社会经济因素与髋骨骨折的关系.方法 采用1∶1配对的病例对照研究方法,收集2009年6月-2012年6月在广东省4所医院就诊的581名55～80岁新发髋骨骨折患者作为病例,同期招募性别、年龄(+/-3岁)匹配的广州市社区居民或非骨科相关疾病的病人作为对照.通过面对面访问调查其人口学特征及社会经济学情况.结果 单因素条件logistic回归分析显示,已婚、文化程度高、职业体力活动低、收入和社会地位高、城镇居民及近5年经济状况好可降低髋骨骨折风险.在年龄、家族史及社会经济因素间相互校正后,婚姻状况、当前家庭人均收入及近5年经济状况的影响仍具有统计学意义.已婚者髋骨骨折风险是未婚、离异或丧偶者的0.44(95％CI:0.29 ～0.64)倍;家庭月收入最高组是最低组的0.26(95％CI:0.09 ～ 0.77)倍;近5年经济状况较好者风险是较差者的0.32(0.15～0.70)倍.分层和交互作用分析发现,近5年经济状况的影响在男性中更为明显(交互作用P=0.053).结论 社会经济状况较差及无配偶易增加髋骨骨折风险.