Incidence of Abdominal Aortic Aneurysm Casually Detected by Ultrasonography in Elderly Patients

Cardiovascular diseases are the most common pathologies in the elderly. The aim of our study was to assess the incidence of asymptomatic abdominal aortic aneurysms in the elderly casually detected during ultrasonographic examination. We performed a blind prospective study on 493 outpatients between 65 and 92 years who had been referred for abdominal ultrasonography for other symptoms. Blood pressure, serum creatinine and creatinine clearance, fasting glucose; -carotid intima-media thickness, and standard echo color Doppler of the abdominal aorta were performed. Ultrasonography detected 25 patients with an asymptomatic aorta aneurysm. Moreover, our investigation revealed a significant correlation between hypertension, atherosclerosis, and diabetes with abdominal aortic aneurysm. Ultrasonography is a widely used, low-cost, noninvasive, diagnostic method without negative side effects that can be used to detect an aortic aneurysm in the asymptomatic stage in all elderly subjects during diagnostic investigation for other diseases or symptoms.     

An Improved Method of Assessing Esophageal Emptying Using the Timed Barium Study Following Surgical Myotomy for Achalasia

Introduction  The timed barium study (TBS) is used to assess esophageal emptying in patients with achalasia. Improvement in emptying correlates with outcome after endoscopic therapy, but the results of the TBS have been variable after myotomy. Our aim was to evaluate a new method for assessing improvement in emptying after myotomy. Methods  A TBS was performed before and 3–6 months after myotomy in 30 patients. Emptying was assessed by measuring the percent difference in area of the barium column on films obtained 1 and 5 min after ingesting 150 ml of barium. Initial esophageal clearance was also assessed by comparing the area of the barium column on 1-min images obtained before and after therapy. Both measures were compared to clinical outcome. Results  After myotomy, 21 patients (70%) had no symptoms, four (13%) had mild, and five (17%) had moderate/severe symptoms. Using the standard method, esophageal emptying before and after surgery were not significantly different (25% vs. 37%; p = 0.22) and did not correlate with clinical outcome. In contrast, initial esophageal clearance improved significantly (median 81%) and correlated with clinical outcome. Conclusion  Esophageal emptying measured by the standard method is not useful to assess outcome after myotomy. However, initial esophageal clearance correlates well with clinical outcome. Previous presentations: 49th SSAT Annual Meeting at Digestive Disease Week, San Diego, 2008 and 23rd Annual SSAT Residents and Fellows Research Conference, San Diego, 2008     

Nuclear factor-kappaB activation in neonatal mouse lung protects against lipopolysaccharide-induced inflammation

RATIONALE: Injurious agents often cause less severe injury in neonates as compared with adults. OBJECTIVE: We hypothesized that maturational differences in lung inflammation induced by lipopolysaccharide (LPS) may be related to the nature of the nuclear factor (NF)-kappaB complex activated, and the profile of target genes expressed. METHODS: Neonatal and adult mice were injected with intraperitoneal LPS. Lung inflammation was assessed by histology, and apoptosis was determined by TUNEL (terminal deoxynucleotidyl transferase UTP nick-end labeling). The expression of candidate inflammatory and apoptotic mediators was evaluated by quantitative real-time polymerase chain reaction and Western immunoblot. RESULTS: Neonates demonstrated reduced inflammation and apoptosis, 24 hours after LPS exposure, as compared with adults. This difference was associated with persistent activation of NF-kappaB p65p50 heterodimers in the neonates in contrast to early, transient activation of p65p50 followed by sustained activation of p50p50 in the adults. Adults had increased expression of a panel of inflammatory and proapoptotic genes, and repression of antiapoptotic targets, whereas no significant changes in these mediators were observed in the neonates. Inhibition of NF-kappaB activity in the neonates decreased apoptosis, but heightened inflammation, with increased expression of the same inflammatory genes elevated in the adults. In contrast, inhibition of NF-kappaB in the adults resulted in partial suppression of the inflammatory response. CONCLUSIONS: NF-kappaB activation in the neonatal lung is antiinflammatory, protecting against LPS-mediated lung inflammation by repressing similar inflammatory genes induced in the adult.     

A cost-utility analysis of cervical cancer vaccination in preadolescent Canadian females

Background  

Despite the fact that approximately 70% of Canadian women undergo cervical cancer screening at least once every 3 years, approximately 1,300 women were diagnosed with cervical cancer and approximately 380 died from it in 2008. This study estimates the effectiveness and cost-effectiveness of vaccinating 12-year old Canadian females with an AS04-adjuvanted cervical cancer vaccine. The indirect effect of vaccination, via herd immunity, is also estimated.     

Comparison of the safety and immunogenicity of ACAM1000, ACAM2000 and Dryvax in healthy vaccinia-naive adults

Currently, more than half of the world's population has no immunity against smallpox variola major virus. This phase I double-blind, randomized trial was conducted to compare the safety and immunogenicity of two clonally derived, cell-culture manufactured vaccinia strains, ACAM1000 and ACAM2000, to the parent vaccine, Dryvax^®. Thirty vaccinia-naïve subjects were enrolled into each of three groups and vaccines were administered percutaneously using a bifurcated needle at a dose of 1.0 × 10⁸ PFU/mL. All subjects had a primary skin reaction indicating a successful vaccination. The adverse events, 4-fold neutralizing antibody rise and T cell immune responses were similar between the groups.     

Cost of hospitalization of diabetic patients admitted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

OBJECTIVE: In Ethiopia the problems passed by diabetes is increasing for the last two to three decades. This indicates that diabetes is becoming a major economic factor in drug use and bed occupancy. So far there has been no study conducted to evaluate the cost of care among Ethiopian diabetic patients. This study aimed at assessing the cost of hospitalization of diabetic patients. METHODS: A case control study was conducted on consecutive 146 diabetic patients and 142 non diabetic controls admitted to the medical wards of Tikur Anbessa Specialized Hospital. Every first non-diabetic patient who was admitted to the same ward on the same day or in the subsequent days was taken as a control group. RESULTS: The average total cost of hospitalization of cases was significantly higher than the controls with mean cost of 1109.7 +/- 1026.4 for cases and 872.9 +/- 828.3 Birr for controls respectively, (p < 0.03). A large proportion (57%) of the total cost was utilized for treatment of acute and chronic complications of diabetes. The average treatment and laboratory cost were significantly higher among cases compared to controls (p = 0.013 and p = < 0.001 respectively). However, when adjusted by age, sex, address and history of hypertension and renal diseases, the average cost of laboratory investigation remained significantly higher for cases. CONCLUSION: The current study demonstrated that the direct cost of hospitalization of diabetic patient is significantly higher than non diabetics. The study showed that substantial proportion of the total cost of admission is utilized for treating acute and long term complications. This study warrants further research, attention of the health policy makers and health providers for future planning of prevention, diagnosis and treatment of diabetes.     

The SH2B1 obesity locus and abnormal glucose homeostasis: Lack of evidence for association from a meta-analysis in individuals of European ancestry

Background/AimsThe development of type 2 diabetes (T2D) is influenced both by environmental and by genetic determinants. Obesity is an important risk factor for T2D, mostly mediated by obesity-related insulin resistance. Obesity and insulin resistance are also modulated by the genetic milieu; thus, genes affecting risk of obesity and insulin resistance might also modulate risk of T2D.Recently, 32 loci have been associated with body mass index (BMI) by genome-wide studies, including one locus on chromosome 16p11 containing the SH2B1 gene. Animal studies have suggested that SH2B1 is a physiological enhancer of the insulin receptor and humans with rare deletions or mutations at SH2B1 are obese with a disproportionately high insulin resistance. Thus, the role of SH2B1 in both obesity and insulin resistance makes it a strong candidate for T2D. However, published data on the role of SH2B1 variability on the risk for T2D are conflicting, ranging from no effect at all to a robust association.MethodsThe SH2B1 tag SNP rs4788102 (SNP, single nucleotide polymorphism) was genotyped in 6978 individuals from six studies for abnormal glucose homeostasis (AGH), including impaired fasting glucose, impaired glucose tolerance or T2D, from the GENetics of Type 2 Diabetes in Italy and the United States (GENIUS T2D) consortium. Data from these studies were then meta-analyzed, in a Bayesian fashion, with those from DIAGRAM+ (n = 47,117) and four other published studies (n = 39,448).ResultsVariability at the SH2B1 obesity locus was not associated with AGH either in the GENIUS consortium (overall odds ratio (OR) = 0.96; 0.89–1.04) or in the meta-analysis (OR = 1.01; 0.98–1.05).ConclusionOur data exclude a role for the SH2B1 obesity locus in the modulation of AGH.