SNOT-22: psychometric properties and cross-cultural adaptation into the portuguese language spoken in Brazil

Rhinosinusitis is a highly prevalent disease and a major cause of high medical costs. It has been proven to have an impact on the quality of life through generic health-related quality of life assessments. However, generic instruments may not be able to factor in the effects of interventions and treatments. SNOT-22 is a major disease-specific instrument to assess quality of life for patients with rhinosinusitis. Nevertheless, there is still no validated SNOT-22 version in our country.ObjectiveCross-cultural adaptation of the SNOT-22 into Brazilian Portuguese and assessment of its psychometric properties.MethodThe Brazilian version of the SNOT-22 was developed according to international guidelines and was broken down into nine stages: 1) Preparation 2) Translation 3) Reconciliation 4) Backtranslation 5) Comparison 6) Evaluation by the author of the SNOT-22 7) Revision by committee of experts 8) Cognitive debriefing 9) Final version. Second phase: prospective study consisting of a verification of the psychometric properties, by analyzing internal consistency and test-retest reliability.ResultsCultural adaptation showed adequate understanding, acceptability and psychometric properties.ConclusionWe followed the recommended steps for the cultural adaptation of the SNOT-22 into Portuguese language, producing a tool for the assessment of patients with sinonasal disorders of clinical importance and for scientific studies.     

Single nucleotide polymorphisms in the matrix metalloproteinase gene family and the frequency and duration of gastroesophageal reflux disease influence the risk of esophageal adenocarcinoma

The matrix metalloproteinase (MMP) family of proteins mediates various cellular pathways, including apoptosis and angiogenesis. Polymorphisms of MMP genes are associated with increased esophageal adenocarcinoma (EAC) risk. Gastroesophageal reflux disease (GERD) is an established EAC risk factor. We examined whether MMP polymorphism-EAC risk is modified by GERD. In total, 309 EAC patients and 279 frequency-matched healthy controls underwent MMP1 1G/2G, MMP3 6A/5A, MMP12 -82A/G and MMP12 1082A/G genotyping. Questionnaires collected GERD history. EAC risk was analyzed using logistic regression, adjusted for key covariates and stratified by GERD. Joint effects models explored GERD severity and duration, whereas additional models explored genotype-GERD interactions in EAC risk. We determined that each MMP1 and MMP3 minor (variant) allele was independently associated with increased EAC risk (adjusted odds ratio (AOR) 3.2, 95% confidence interval (CI) 2.0-5.1, p < 0.001 and AOR 1.8, 95% CI 1.1-2.7, p = 0.01, respectively) only among those with GERD but not in GERD-free individuals (all p = nonsignificant). There were significant interactions between the MMP1 variants and the presence of GERD (p = 0.002) and between MMP3 variants and GERD (p = 0.04). There was an equally strong interaction between cumulative GERD severity and MMP1 (p = 0.002). The AOR of each variant allele was 14.9 (95% CI 1.6-136) for individuals with severe GERD, 1.7 (95% CI 1.0-2.7) for mild-moderate GERD and 0.98 (95% CI 0.7-1.4) for those without GERD. This was further reflected in separate analyses of frequency and duration of GERD. In conclusion, MMP1 1G/2G (and possibly MMP3 6A/5A) polymorphisms alter EAC risk differentially for GERD and GERD-free individuals.     

Association of the melanocortin-4 receptor V103I polymorphism with dietary intake in severely obese persons

BACKGROUND: Several studies have reported that carriers of the 103I allele of the melanocortin-4 receptor (MC4R) gene had lower body weight than did persons with the wild-type genotype. A recent study found an association of the MC4R 103I variant with carbohydrate intake, which may mediate some of the association of this variant with leanness. OBJECTIVE: The purpose of the study was to investigate the association between the MC4R V103I polymorphism and the dietary intake of persons with severe obesity, which was derived by using the Willett food-frequency questionnaire. DESIGN: The MC4R V103I polymorphism was genotyped in a group of 1029 severely obese white subjects with an average body mass index (BMI; in kg/m(2)) of 46.0 (range: 33-92). RESULTS: Carriers of the 103I allele had significantly higher daily energy (364 kcal/d or 19%; P = 0.03) and carbohydrate (57 g/d or 27%; P = 0.01) intakes than did noncarriers, but there was no relation with BMI. No notable association of this polymorphism with lipid and glucose variables of the metabolic syndrome was observed. CONCLUSIONS: The higher dietary intake of carbohydrates in severely obese persons with the MC4R 103I variant is in line with previous findings. It may indicate a differential effect on body size measures in extremely obese subjects as compared with the general population.     

First report of Ancylostoma tubaeforme in Persian Leopard (Panthera pardus saxicolor)

Ancylostoma tubaeforme was originally described as a separate species parasitizing the cat. The adults of A. tubaeforme are 7 to 12 mm long. A. tubaeforme can be differentiated from the adults of A. braziliense and A. ceylanicum by the presence of three teeth. Here we describe the first report of A. tubaeforme in a Persian young female leopard, 2–3 years old, with head and trunk length 120 centimeters, length of tail 98 centimeters and body weight 35 kilograms.     

Effects of study design and trends for EVAR versus OSR

Purpose:

To investigate if study design factors such as randomization, multi-center versus single center evidence, institutional surgical volume, and patient selection affect the outcomes for endovascular repair (EVAR) versus open surgical repair (OSR). Finally, we investigate trends over time in EVAR versus OSR outcomes.

Methods:

Search strategies for comparative studies were performed individually for: OVID’s MEDLINE, EMBASE, CINAHL, HAPI, and Evidence Based Medicine (EBM) Reviews (including Cochrane DSR, ACP Journal Club, DARE and CCTR), limited to 1990 and November 2006.

Results:

Identified literature: 84 comparative studies pertaining to 57,645 patients. These include 4 randomized controlled trials (RCTs), plus 2 RCTs with long-term follow-up. The other 78 comparative studies were nonrandomized with 75 reporting perioperative outcomes, of which 16 were multi-center, and 59 single-center studies. Of the single-center studies 31 were low-volume and 28 were high-volume centers. In addition, 5 studies had all patients anatomically eligible for EVAR, and 8 studies included high-risk patients only. Finally, 25 long term observational studies reported outcomes up to 3 years.

Outcomes:

Lower perioperative mortality and rates of complications for EVAR versus OSR varied across study designs and patient populations. EVAR adverse outcomes have decreased in recent times.

Conclusion:

EVAR highlights the problem of performing meta-analysis when the experience evolves over time.