Analysis of matched case-control data with multiple ordered disease states: possible choices and comparisons

In an individually matched case-control study, effects of potential risk factors are ascertained through conditional logistic regression (CLR). Extension of CLR to situations with multiple disease or reference categories has been made through polychotomous CLR and is shown to be more efficient than carrying out separate CLRs for each subgroup. In this paper, we consider matched case-control studies where there is one control group, but there are multiple disease states with a natural ordering among themselves. This scenario can be observed when the cases can be further classified in terms of the seriousness or progression of the disease, for example, according to different stages of cancer. We explore several popular models for ordered categorical data in this context. We first adopt a cumulative logit or equivalently, a proportional-odds model to account for the ordinal nature of the data. The important distinction of this model from a stratified dichotomous and polychotomous logistic regression model is that the stratum-specific nuisance parameters cannot be eliminated in this model via the conditional-likelihood approach. We discuss a Mantel-Haenszel approach for analysing such data. We point out possible difficulties with standard likelihood-based approaches with the cumulative logit model when applied to case-control data. We then consider an alternative conditional adjacent-category logit model. We illustrate the methods by analysing data from a matched case-control study on low birthweight in newborns where infants are classified according to low and very low birthweight and a child with normal birthweight serves as a control. A simulation study compares the different ordinal methods with methods ignoring sub-classification of the ordered disease states.     

Ampullary Carcinoma in a Patient with Agenesis of the Dorsal Pancreas: A Case Report

The most common congenital anomaly of the pancreas is pancreatic divisum (Tadokoro et al. in Anat Res Int 2011:1–7, 2011). Agenesis of the dorsal pancreas is extremely rare (Schnedl et al. in World J Gastroenterol 15(3):376–377, 2009). We are reporting a case of agenesis of dorsal pancreas presented with ampullary carcinoma.     

Functional outcome and quality of life following restorative proctocolectomy for ulcerative colitis in Indians

Background  

The functional outcome and quality of life after sphincter-saving operations for ulcerative colitis have not been previously assessed in Indian patients whose dietary habits and socio-cultural practices differ considerably from those in western countries.     

Prevalence of Thinness among Rural Bengalee Pre-school Children in Chapra, Nadia District, West Bengal, India

This-cross sectional study investigated the age and sex variations in thinness among 2016 (930 boys and 1086 girls) 3-5 years old rural children of Bengalee ethnicity. The children were randomly recruited from 66 Integrated Child Development Service (ICDS) centres of Chapra Block, Nadia District, West Bengal, India. The area is remote and mostly inhabited by Bengalee Muslims. All preschool children (3-5 years old) living in Chapra Block are enrolled at these centres. Anthropometric measures taken included height and weight using standard techniques and then body mass index (BMI) was computed. Age and sex specific cut-off values of body mass index (BMI) were utilised to identify thinness. Overall prevalence of thinness was 49.68% and 51.57% among boys and girls, respectively. There were significant (p< 0.05) sex differences in height, weight and BMI. In general, the frequency of thinness increased with increasing age in both sexes. The rates of Grade-III and Grade-II thinness were higher among girls (Grade-III = 7.46%, Grade-II = 13.44%) compared with boys (Grade-III = 5.48%, Grade-II = 11.72%). In contrast, Grade-I thinness was higher among boys. The results from this study indicate that the nutritional status of rural Bengalee pre-school children is unsatisfactory. These children are experiencing marked nutritional stress. There is scope for much improvement in the form of enhanced supplementary nutrition.     

Two hundred and forty-one consecutive liver resections: an experience from India

Background: Although liver resection has become an established procedure in western countries and South-east Asia it is still not performed frequently in most centres in India. In the last 10 years newly created specialized units have been performing more liver resections but no major series have been reported. Patients and methods: We analysed the results of 241 hepatic resections in the Gyan Burman Liver Unit, Sir Ganga Ram Hospital to compare our results with those published from established centres and to identify the factors relating to morbidity and mortality. To examine the effect of a greater experience with the procedure we compared the outcome of our operations from 1996–2000 (first period) and those from 2001–2005 (second period). Results: The overall mortality and morbidity rates were 6.6% and 44.8%, respectively, which are comparable with those of most recently published Western series. Life-threatening complications occurred in 12.4% patients. Multivariate analysis showed that the presence of comorbid conditions, intraoperative blood transfusions of >3 units, hepatocellular carcinoma with underlying cirrhosis and gall bladder carcinoma with jaundice were the independent risk factors for morbidity, whereas the presence of comorbid illness and underlying liver cirrhosis were the risk factors for mortality. During the second period there was an increase in the number of operations performed (66 vs 175; first vs second period), but the mortality rates remained essentially unchanged (6.1% vs 6.8%). Discussion: Hepatic resections can be performed safely in India with results comparable to those achieved in the West. Increasing experience did not reduce overall mortality. Perhaps more careful patient selection and better perioperative management of comorbid illnesses may reduce the morbidity and mortality further.     

Functional outcomes at PICU discharge in hemato-oncology children at a tertiary oncology center in Hong Kong

International Journal of Clinical Oncology - Advancements in cancer treatment have resulted in longer survival but often at the expense of new therapy-associated morbidities. The aim of this study...     

Transabdominal gastroesophageal devascularization without transection for bleeding varices: results and indicators of prognosis

BACKGROUND: Esophagogastric devascularization is an operation that can be performed for endoscopically uncontrolled variceal bleeding in hospitals having only basic surgical instruments and is therefore an appropriate procedure for small hospitals in developing countries. The aim of this study was to analyze one hospital's experience of this operation in consecutive patients with variceal bleeding. METHODS: Between 1996 and 2003, 45 patients (30 male, 15 female) who had a mean age of 40 years (range 7-78 years) underwent devascularization procedures. Of the 45, 23 had cirrhosis and 22 had non-cirrhotic portal hypertension (11 extrahepatic portal venous obstruction, 11 non-cirrhotic portal fibrosis), and 18 patients had emergency procedures and 27 were elective. Mortality, morbidity, rebleeding rates and the prognostic factors for death were assessed. RESULTS: Elective and emergency mortality was one (3.7%) and 11 (61%) patients, respectively. There was no rebleeding in hospital. At follow up (mean 48 months, range 3-92 months) overall survival in patients with cirrhosis was 7 out of 20 and in patients with non-cirrhotic portal hypertension was 19 of 21. Five (17%) had recurrent variceal hemorrhage, of whom three, all cirrhotic patients, died. Preoperative prognostic indicators for death were emergency surgery, a Child-Pugh score >or=10, preoperative blood transfusion >or=20 units and renal failure. CONCLUSIONS: Gastroesophageal devascularization effectively controls variceal bleeding especially in non-cirrhotic patients with portal hypertension. In the elective situation it carries a low mortality and rebleed rate. In emergencies the prognosis is poor with advanced cirrhosis, following large quantities of blood transfusion and deranged renal function. It is suggested that this operation be offered especially to non-cirrhotic patients in hospitals in developing countries where facilities for more sophisticated procedures are not available.