Evaluation of Signs and Symptoms Post Recovery in COVID Patients: A Questionn...DrHeena tiwari
This document describes a questionnaire survey of 287 individuals who recovered from COVID-19. The survey found that only 10.8% reported no ongoing symptoms, while most reported fatigue (72.8%), anxiety (38%), joint pain (31.4%), or other symptoms. Symptom severity was related to severity of initial COVID-19 infection and presence of pre-existing conditions. The study aims to evaluate ongoing signs and symptoms in post-recovery COVID patients.
CLINICAL FEATURES, DIFFERENCES IN COVID FIRST, SECOND, THIRD WAVES- A DATA BA...DrHeena tiwari
This study compared the clinical features of COVID-19 in children and youth across the first three waves in multiple countries. A total of 397 patients aged 18 or younger were included. More patients were asymptomatic in the second and third waves compared to the first wave. Most illnesses were mild in all waves. A few patients presented with unusual manifestations like chilblains or multisystem inflammatory syndrome. The study found differences in symptoms and hospital length of stay across the three waves.
This document summarizes the challenges encountered during a West Nile virus outbreak at a hospital in 2012. It found 55 cases of West Nile infection, including 12 cases of West Nile fever and 43 cases of West Nile neuroinvasive disease. Many patients presented without a documented fever, which challenged the application of diagnostic criteria. Neurological symptoms like altered mental status, headache and seizures were common in neuroinvasive disease cases. The outbreak resulted in a high mortality rate of 21% among neuroinvasive disease patients. Diagnosing and classifying West Nile virus infections proved difficult, highlighting challenges in outbreak response.
Factors associated with development of vitiligo in patients with halo nevustloanphan
This study aimed to identify factors associated with the development of vitiligo in patients with halo nevus (HN). The researchers performed a retrospective study of 212 patients with HN, 101 of whom also had vitiligo (HNV group). Univariate analysis found that a personal history of thyroid disease and younger age of HN onset were associated with vitiligo. Multivariate analysis identified the Koebner phenomenon (skin depigmentation in areas of friction or trauma), multiple HN lesions, and a familial history of vitiligo as independent risk factors for vitiligo in HN patients. The study suggests HN patients with these risk factors should be monitored more closely for signs of vitiligo.
Capstone thesis submitted for undergraduate studies on the utility of genomic surveying tools in improving sudden cardiac arrest risk stratification and prediction of sudden cardiac death.
Clinical and epidemiological characteristics of childhoodtloanphan
This study analyzed clinical and epidemiological data from 701 children with vitiligo who were seen at a dermatology clinic in Brazil between 2006-2014. The main findings were:
1) Most patients were female (62%) and the average age of onset was 5.9 years. The most common subtype was generalized vitiligo (53.8%).
2) The most affected initial site was the head/neck region (44.2%). Emotional stressors were reported as triggering factors in 67% of patients.
3) Segmental and nonsegmental vitiligo differed significantly in characteristics like age of onset, presence of the Koebner phenomenon, associations with autoimmune diseases, and family
Clinical and epidemiological characteristics of childhood vitiligo a study of...tloanphan
This study analyzed clinical and epidemiological data from 701 children with vitiligo who were seen at a dermatology clinic in Brazil between 2006-2014. The main findings were:
1) Vitiligo was more common in females (62% of cases) and the average age of onset was 5.9 years.
2) The most common subtype was generalized vitiligo (53.8% of cases) and the most common initial site was the head/neck region (44.2% of cases).
3) Associated autoimmune diseases, family history of vitiligo, and the Koebner phenomenon were present in 6.5%, 16.9%, and 38.2% of
Evaluation of Signs and Symptoms Post Recovery in COVID Patients: A Questionn...DrHeena tiwari
This document describes a questionnaire survey of 287 individuals who recovered from COVID-19. The survey found that only 10.8% reported no ongoing symptoms, while most reported fatigue (72.8%), anxiety (38%), joint pain (31.4%), or other symptoms. Symptom severity was related to severity of initial COVID-19 infection and presence of pre-existing conditions. The study aims to evaluate ongoing signs and symptoms in post-recovery COVID patients.
CLINICAL FEATURES, DIFFERENCES IN COVID FIRST, SECOND, THIRD WAVES- A DATA BA...DrHeena tiwari
This study compared the clinical features of COVID-19 in children and youth across the first three waves in multiple countries. A total of 397 patients aged 18 or younger were included. More patients were asymptomatic in the second and third waves compared to the first wave. Most illnesses were mild in all waves. A few patients presented with unusual manifestations like chilblains or multisystem inflammatory syndrome. The study found differences in symptoms and hospital length of stay across the three waves.
This document summarizes the challenges encountered during a West Nile virus outbreak at a hospital in 2012. It found 55 cases of West Nile infection, including 12 cases of West Nile fever and 43 cases of West Nile neuroinvasive disease. Many patients presented without a documented fever, which challenged the application of diagnostic criteria. Neurological symptoms like altered mental status, headache and seizures were common in neuroinvasive disease cases. The outbreak resulted in a high mortality rate of 21% among neuroinvasive disease patients. Diagnosing and classifying West Nile virus infections proved difficult, highlighting challenges in outbreak response.
Factors associated with development of vitiligo in patients with halo nevustloanphan
This study aimed to identify factors associated with the development of vitiligo in patients with halo nevus (HN). The researchers performed a retrospective study of 212 patients with HN, 101 of whom also had vitiligo (HNV group). Univariate analysis found that a personal history of thyroid disease and younger age of HN onset were associated with vitiligo. Multivariate analysis identified the Koebner phenomenon (skin depigmentation in areas of friction or trauma), multiple HN lesions, and a familial history of vitiligo as independent risk factors for vitiligo in HN patients. The study suggests HN patients with these risk factors should be monitored more closely for signs of vitiligo.
Capstone thesis submitted for undergraduate studies on the utility of genomic surveying tools in improving sudden cardiac arrest risk stratification and prediction of sudden cardiac death.
Clinical and epidemiological characteristics of childhoodtloanphan
This study analyzed clinical and epidemiological data from 701 children with vitiligo who were seen at a dermatology clinic in Brazil between 2006-2014. The main findings were:
1) Most patients were female (62%) and the average age of onset was 5.9 years. The most common subtype was generalized vitiligo (53.8%).
2) The most affected initial site was the head/neck region (44.2%). Emotional stressors were reported as triggering factors in 67% of patients.
3) Segmental and nonsegmental vitiligo differed significantly in characteristics like age of onset, presence of the Koebner phenomenon, associations with autoimmune diseases, and family
Clinical and epidemiological characteristics of childhood vitiligo a study of...tloanphan
This study analyzed clinical and epidemiological data from 701 children with vitiligo who were seen at a dermatology clinic in Brazil between 2006-2014. The main findings were:
1) Vitiligo was more common in females (62% of cases) and the average age of onset was 5.9 years.
2) The most common subtype was generalized vitiligo (53.8% of cases) and the most common initial site was the head/neck region (44.2% of cases).
3) Associated autoimmune diseases, family history of vitiligo, and the Koebner phenomenon were present in 6.5%, 16.9%, and 38.2% of
This study analyzed data from 2,668 patients in Denmark who underwent surgery for perforated peptic ulcer between 2003-2009 to evaluate the association between hourly surgical delay and 30-day survival. The results showed that for every hour of delay between admission and surgery, there was an average 2.4% decreased probability of survival. Overall, 26.5% of patients died within 30 days of surgery. Limiting surgical delay seems critically important for patients with perforated peptic ulcers.
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has been used as a treatment for infectious diseases for over a century. It involves transfusing plasma from patients who have recovered from an infection into patients who are currently ill with that same infection. Clinical trials are now investigating its use for COVID-19. While some early studies showed promising results, larger randomized controlled trials found no significant benefit of convalescent plasma for severe COVID-19. Further research is still needed to determine whether certain patient populations or plasma dosages may be more effective.
Who 2019-n cov-corticosteroids-2020.1-engCIkumparan
This document provides recommendations from the WHO on the use of corticosteroids for the treatment of COVID-19. It recommends the use of systemic corticosteroids for patients with severe or critical COVID-19 based on moderate certainty evidence showing benefits. It conditionally recommends against the use of corticosteroids for non-severe COVID-19 based on low certainty evidence. The document was developed in collaboration with experts and reviews evidence on corticosteroid use from multiple clinical trials. It provides the background, methods, evidence and practical considerations regarding the recommendations.
This document describes a study that derived and validated a new severity assessment model called CURB-65 for stratifying patients with community acquired pneumonia (CAP) into different risk groups upon hospital admission. The study combined data from previous CAP studies involving over 1000 patients. Using logistic regression, factors independently associated with 30-day mortality were identified as age over 65, albumin level under 30 g/dl, and CURB score over 2 (which evaluates confusion, urea, respiratory rate, blood pressure). These factors were used to create the CURB-65 score, which stratifies patients into risk groups from 0.7% to 57% 30-day mortality risk based on their score. The validation cohort confirmed similar mortality risks based on
This study analyzed 107 cases of acute pancreatitis treated at a hospital in Islamabad, Pakistan over one year. Gallstones were found to be the most common cause, accounting for 36.5% of cases. Alcohol was a factor in 11.2% of cases. In 46.7% of cases, no clear cause was identified. Based on the Ranson score, 35.5% of cases were considered severe. The average hospital stay was 8.9 days and mortality rate was 8.4%, with all deaths occurring in severe cases. The authors conclude that while the causes and severity of acute pancreatitis in Pakistan are generally similar to other countries, gallstones are a relatively more common cause than alcohol compared to Western
Comparison of Infection Episodes in CKD Patients with or without Hemodialysis...ijtsrd
This study compared infection episodes in chronic kidney disease (CKD) patients with and without hemodialysis. A cross-sectional study of 56 CKD patients found that those undergoing hemodialysis had higher rates of chills, increased white blood cell count, and elevated erythrocyte sedimentation rate compared to non-hemodialysis patients. The study concluded that CKD patients on long-term hemodialysis were more prone to developing infections than those not on hemodialysis, likely due to factors such as catheter insertion for hemodialysis. Better infection prevention strategies are needed for CKD patients undergoing hemodialysis.
Etiologia de la celulitis y Predicción clínica de la enfermedad Estreptocócic...Alex Castañeda-Sabogal
Etiologia de la celulitis. Estudio prospectivo y predicción clínica de la infeccion por Estreptococcus basado en la frecuencia encontrada de las especies de estreptococo
Factors associated with developing esophageal adenocarcinoma in Barett's esop...Dr Sayan Das
Based on the study “Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett’s esophagus cohort” by Krishnamoorthi R et al published in “HHS Public Access” on 2016 July
Childhood and later-onset vitiligo have diversetloanphan
1. The study compared the characteristics of 126 patients with childhood-onset vitiligo (before age 12) to 107 patients with later-onset vitiligo.
2. Childhood-onset vitiligo more often involved the eyelids and lower extremities initially and was more commonly segmental. It had a higher prevalence of allergic diseases and lower prevalence of thyroid disease.
3. In childhood-onset vitiligo, longer disease duration and a family history of thyroid disease were associated with thyroid disease, whereas female sex was the only predictor for later-onset vitiligo.
This study examined 186 treated leprosy patients in the Diamer district of Gilgit-Baltistan, Pakistan to document their clinical status and disabilities. The majority of patients were male (75.8%) with a mean age of 53 years. Borderline tuberculoid leprosy was the most common subtype (43.54%). Many patients still had disabilities after treatment, including claw hand (11.82%), foot drop (10.21%), and visual impairment (11.29-6.9%). The results suggest leprosy remains prevalent in the area and a significant number of treated patients still have disabling effects of the disease. Addressing disabilities through an integrated healthcare approach is recommended.
Management of Fournier’s Gangrene in a Low Resource Settingasclepiuspdfs
external genitalia and perineum. Although the condition is rare in absolute terms, over 1726 cases have been reported in English literature, with a male/female ratio of 10:1. There have been 502 cases from Africa, which ranks second to the USA/Canada. At present, there is only one published literature on the management of FG in Liberia. Objective: This study highlig hts the late presentation and the challenges in the management of FG at the John F. Kennedy Medical Center. Methodology: This is a retrospective study of 30 patients with FG who were admitted and managed by our division of urology, from January 2018 to May 2019. The patient’s records were retrieved and reviewed for age, sex, onset of disease, sites of the disease, management, duration of stay, and outcome. The frequency and percentage of various parameters were displayed in tables.
Vitiligo clinical findings in 1436 patientstloanphan
This study analyzed clinical findings from 1436 patients with vitiligo seen between 1989-1993. The key findings were:
1) Vitiligo vulgaris was the most common type (69.8% of patients), followed by focal (14.9%) and segmental (5.0%) vitiligo.
2) The most common sites of onset were the face (22.9%), trunk (22.3%), and legs (18.6%). Less than 20% body area was involved in 94.4% of patients.
3) Associated conditions included atopic/nummular eczema (1.4%), bronchial asthma (0.7%), diabetes (0.
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
This study examines risk factors for multiple treatments and recurrence of anal condyloma in HIV-negative men who have sex with men. The study retrospectively analyzed 231 patients treated at a private surgical practice between 2008-2012. Most patients (79.2%) were treated with electrocautery ablation and achieved primary clearance after one treatment. However, having moderate disease severity, intra-anal and perianal lesions, and receiving imiquimod adjuvant therapy were associated with requiring multiple treatments. No single factor predicted recurrence, but those with moderate disease experienced recurrences sooner. The study aims to better understand effective treatment of anal condyloma in this high-risk population.
EPC_June-15_pp.52-55 (EPC Industry Advisor) (1)shelley bowers
The document discusses the challenges surrounding diagnosing and predicting the future of patients with variant Creutzfelt-Jakob disease (vCJD). Current diagnostic tools can only confirm the disease post-mortem and late in progression, providing little useful information for patients. New diagnostic techniques including nasal sampling and blood tests show promise but are still only effective for symptomatic patients. Wide-scale population testing raises ethical issues as many carriers may never develop symptoms but would suffer psychologically from a positive diagnosis. There are no treatments for vCJD, so early diagnosis remains a priority but challenges remain due to the properties of prions and low levels in the body.
Stigmatisation, avoidance behaviour and difficulties in coping are common amo...tloanphan
This study explored quality of life, coping, depression, and experiences of stigmatization among 96 patients with vitiligo compared to 23 controls. Key findings include:
1) Stigmatization was common among patients, with 90% reporting questions/approaches about their skin and 24% experiencing nasty comments. 66.7% avoided social situations or concealed white spots due to vitiligo.
2) Patients scored higher than controls on all quality of life and coping questionnaires, indicating more impairment and difficulties. However, depression scores were similar.
3) Treatment with pro-pseudocatalase reduced social anxiety/avoidance, depressed mood, and depression scores.
4) Patients who
This study compared outcomes for head and neck cancer patients based on age. Younger patients (≤40 years old) had significantly better 5-year survival rates (65%) than middle-aged (41-64 years old, 52%) or older patients (≥65 years old, 38%). Younger patients also developed fewer recurrent tumors or new primary tumors. However, the reasons for the differences in outcomes based on age are unclear. The study aimed to analyze outcomes while controlling for other factors like smoking history, tumor stage, and treatment received to better understand the independent impact of age.
1. This study examined outcomes of 2541 hospitalized COVID-19 patients treated with hydroxychloroquine alone, hydroxychloroquine plus azithromycin, azithromycin alone, or neither drug.
2. Overall in-hospital mortality was 18.1%. Mortality was lowest in the hydroxychloroquine alone group (13.5%) and highest in the neither drug group (26.4%).
3. After controlling for risk factors, treatment with hydroxychloroquine alone or with azithromycin was associated with reduced COVID-19 mortality compared to no treatment. Prospective randomized trials are still needed.
Early initiation of antiretroviral therapy (ART) within 6 months of HIV infection contributes to the normalization of CD8 T-cell counts. The study found that:
1) CD8 counts decreased significantly from 797 to 588 cells/μL over 24 months in individuals who started ART early, reaching lower levels than those without ART or with delayed ART.
2) CD4 T-cell recovery was more prominent in individuals who started ART early compared to those with delayed ART.
3) ART initiated early in HIV infection is associated with improved resolution of elevated CD8 T-cell counts compared to long-term ART initiated in chronic infection, which may help reduce non-AIDS related events.
—India constitutes about one fourth of the Global TB burden. Cutaneous TB is less common clinical form of tuberculosis accounting for 1-2 % of the total extra-pulmonary cases. Objective of this study was to describe the clinical and epidemiological pattern of Cutaneous TB presenting in the Skin Outpatient Department (OPD). Patients presenting with clinically suspected skin lesions of Cutaneous TB from January 2015 to August 2016 were included in the study. Dermatological and systemic examination was carried out and histopathogical examination of skin punch biopsy was done. It was observed that out of a total of sixty patients, 45 (75%) patients were found to have features of Cutaneous TB on histopathology. Lupus vulgaris (42.2%) was the most common form of Cutaneous TB. Most patients were in age group of 11-30 years. Male to female ratio was 1.6:1. Most common sites of involvement were lower limbs and neck. Mantoux test was positive(≥15 mm induration) in 66.7% cases. Typical tuberculoid histology was found in 91.1% cases. No cases of tuberculids were seen and non-specific chronic inflammation was seen in six cases. It was concluded that Cutaneous TB may present with different morphological patterns resembling other inflammatory, infective and neoplastic conditions. Proper and thorough investigations are necessary for detection of Cutaneous TB as the annual incidence of total TB cases in India is high.
Antibiotic exposure and the development of coeliac disease: a nationwide case...Enrique Moreno Gonzalez
The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce.
Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kamp...PUBLISHERJOURNAL
Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kampala International University Teaching Hospital, Bushenyi District
Okello, Andrew
School of Allied Health Sciences Kampala International University-Western Campus
________________________________________
ABSTRACT
This study on the prevalence of TB among HIV sero-positive was carried at the HIV CLINIC of Kampala International University Teaching Hospital (KIUTH), Ishaka Bushenyi district. A retrospective cross-sectional study design was used to conduct this research. The study targeted all patients attending KIUTH HIV/TB clinic. A standard structured and semi-structured questionnaires were designed and pre-tested for validity and reliability at Kampala International University Teaching Hospital HIV/Tuberculosis clinic before being used for data collection. Data collection started by recruitment of qualified research assistants, appropriate training and orientation of the interviewers before the survey for example when reading the questions. Quantitative methods of data analysis was used in which data was presented in form of bar charts, graphs and tables. The prevalence of TB among HIV sero-positive patients attending HIV clinic at KIUTH stands at 8.06 per 100 participants. The study found that generally, people are aware about the modes of transmission of TB but there is still need for more awareness. Many patients are still not certain whether TB is curable in HIV patients. As seen from the above study, most of the people are not yet aware whether HIV goes hand in hand with tuberculosis. The prevalence of TB in HIV sero-positive attending HIV clinic at KIUTH is high. Generally, TB is affecting patients of all ages and most patients are still not aware if TB in HIV is curable. Most patients have a perception that all TB patients have HIV. Health workers in HIV clinic of KIU-TH should teach patients the modes of transmission and prevention of TB. KIUTH also need to provide easy access to TB screening services to patients. There is need for financial support by the government to the unemployed patients and low-income earners in order to curb TB infections.
Keywords: Tuberculosis, HIV, Sero-positive, Bushenyi District
________________________________________
This study analyzed data from 2,668 patients in Denmark who underwent surgery for perforated peptic ulcer between 2003-2009 to evaluate the association between hourly surgical delay and 30-day survival. The results showed that for every hour of delay between admission and surgery, there was an average 2.4% decreased probability of survival. Overall, 26.5% of patients died within 30 days of surgery. Limiting surgical delay seems critically important for patients with perforated peptic ulcers.
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has been used as a treatment for infectious diseases for over a century. It involves transfusing plasma from patients who have recovered from an infection into patients who are currently ill with that same infection. Clinical trials are now investigating its use for COVID-19. While some early studies showed promising results, larger randomized controlled trials found no significant benefit of convalescent plasma for severe COVID-19. Further research is still needed to determine whether certain patient populations or plasma dosages may be more effective.
Who 2019-n cov-corticosteroids-2020.1-engCIkumparan
This document provides recommendations from the WHO on the use of corticosteroids for the treatment of COVID-19. It recommends the use of systemic corticosteroids for patients with severe or critical COVID-19 based on moderate certainty evidence showing benefits. It conditionally recommends against the use of corticosteroids for non-severe COVID-19 based on low certainty evidence. The document was developed in collaboration with experts and reviews evidence on corticosteroid use from multiple clinical trials. It provides the background, methods, evidence and practical considerations regarding the recommendations.
This document describes a study that derived and validated a new severity assessment model called CURB-65 for stratifying patients with community acquired pneumonia (CAP) into different risk groups upon hospital admission. The study combined data from previous CAP studies involving over 1000 patients. Using logistic regression, factors independently associated with 30-day mortality were identified as age over 65, albumin level under 30 g/dl, and CURB score over 2 (which evaluates confusion, urea, respiratory rate, blood pressure). These factors were used to create the CURB-65 score, which stratifies patients into risk groups from 0.7% to 57% 30-day mortality risk based on their score. The validation cohort confirmed similar mortality risks based on
This study analyzed 107 cases of acute pancreatitis treated at a hospital in Islamabad, Pakistan over one year. Gallstones were found to be the most common cause, accounting for 36.5% of cases. Alcohol was a factor in 11.2% of cases. In 46.7% of cases, no clear cause was identified. Based on the Ranson score, 35.5% of cases were considered severe. The average hospital stay was 8.9 days and mortality rate was 8.4%, with all deaths occurring in severe cases. The authors conclude that while the causes and severity of acute pancreatitis in Pakistan are generally similar to other countries, gallstones are a relatively more common cause than alcohol compared to Western
Comparison of Infection Episodes in CKD Patients with or without Hemodialysis...ijtsrd
This study compared infection episodes in chronic kidney disease (CKD) patients with and without hemodialysis. A cross-sectional study of 56 CKD patients found that those undergoing hemodialysis had higher rates of chills, increased white blood cell count, and elevated erythrocyte sedimentation rate compared to non-hemodialysis patients. The study concluded that CKD patients on long-term hemodialysis were more prone to developing infections than those not on hemodialysis, likely due to factors such as catheter insertion for hemodialysis. Better infection prevention strategies are needed for CKD patients undergoing hemodialysis.
Etiologia de la celulitis y Predicción clínica de la enfermedad Estreptocócic...Alex Castañeda-Sabogal
Etiologia de la celulitis. Estudio prospectivo y predicción clínica de la infeccion por Estreptococcus basado en la frecuencia encontrada de las especies de estreptococo
Factors associated with developing esophageal adenocarcinoma in Barett's esop...Dr Sayan Das
Based on the study “Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett’s esophagus cohort” by Krishnamoorthi R et al published in “HHS Public Access” on 2016 July
Childhood and later-onset vitiligo have diversetloanphan
1. The study compared the characteristics of 126 patients with childhood-onset vitiligo (before age 12) to 107 patients with later-onset vitiligo.
2. Childhood-onset vitiligo more often involved the eyelids and lower extremities initially and was more commonly segmental. It had a higher prevalence of allergic diseases and lower prevalence of thyroid disease.
3. In childhood-onset vitiligo, longer disease duration and a family history of thyroid disease were associated with thyroid disease, whereas female sex was the only predictor for later-onset vitiligo.
This study examined 186 treated leprosy patients in the Diamer district of Gilgit-Baltistan, Pakistan to document their clinical status and disabilities. The majority of patients were male (75.8%) with a mean age of 53 years. Borderline tuberculoid leprosy was the most common subtype (43.54%). Many patients still had disabilities after treatment, including claw hand (11.82%), foot drop (10.21%), and visual impairment (11.29-6.9%). The results suggest leprosy remains prevalent in the area and a significant number of treated patients still have disabling effects of the disease. Addressing disabilities through an integrated healthcare approach is recommended.
Management of Fournier’s Gangrene in a Low Resource Settingasclepiuspdfs
external genitalia and perineum. Although the condition is rare in absolute terms, over 1726 cases have been reported in English literature, with a male/female ratio of 10:1. There have been 502 cases from Africa, which ranks second to the USA/Canada. At present, there is only one published literature on the management of FG in Liberia. Objective: This study highlig hts the late presentation and the challenges in the management of FG at the John F. Kennedy Medical Center. Methodology: This is a retrospective study of 30 patients with FG who were admitted and managed by our division of urology, from January 2018 to May 2019. The patient’s records were retrieved and reviewed for age, sex, onset of disease, sites of the disease, management, duration of stay, and outcome. The frequency and percentage of various parameters were displayed in tables.
Vitiligo clinical findings in 1436 patientstloanphan
This study analyzed clinical findings from 1436 patients with vitiligo seen between 1989-1993. The key findings were:
1) Vitiligo vulgaris was the most common type (69.8% of patients), followed by focal (14.9%) and segmental (5.0%) vitiligo.
2) The most common sites of onset were the face (22.9%), trunk (22.3%), and legs (18.6%). Less than 20% body area was involved in 94.4% of patients.
3) Associated conditions included atopic/nummular eczema (1.4%), bronchial asthma (0.7%), diabetes (0.
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
This study examines risk factors for multiple treatments and recurrence of anal condyloma in HIV-negative men who have sex with men. The study retrospectively analyzed 231 patients treated at a private surgical practice between 2008-2012. Most patients (79.2%) were treated with electrocautery ablation and achieved primary clearance after one treatment. However, having moderate disease severity, intra-anal and perianal lesions, and receiving imiquimod adjuvant therapy were associated with requiring multiple treatments. No single factor predicted recurrence, but those with moderate disease experienced recurrences sooner. The study aims to better understand effective treatment of anal condyloma in this high-risk population.
EPC_June-15_pp.52-55 (EPC Industry Advisor) (1)shelley bowers
The document discusses the challenges surrounding diagnosing and predicting the future of patients with variant Creutzfelt-Jakob disease (vCJD). Current diagnostic tools can only confirm the disease post-mortem and late in progression, providing little useful information for patients. New diagnostic techniques including nasal sampling and blood tests show promise but are still only effective for symptomatic patients. Wide-scale population testing raises ethical issues as many carriers may never develop symptoms but would suffer psychologically from a positive diagnosis. There are no treatments for vCJD, so early diagnosis remains a priority but challenges remain due to the properties of prions and low levels in the body.
Stigmatisation, avoidance behaviour and difficulties in coping are common amo...tloanphan
This study explored quality of life, coping, depression, and experiences of stigmatization among 96 patients with vitiligo compared to 23 controls. Key findings include:
1) Stigmatization was common among patients, with 90% reporting questions/approaches about their skin and 24% experiencing nasty comments. 66.7% avoided social situations or concealed white spots due to vitiligo.
2) Patients scored higher than controls on all quality of life and coping questionnaires, indicating more impairment and difficulties. However, depression scores were similar.
3) Treatment with pro-pseudocatalase reduced social anxiety/avoidance, depressed mood, and depression scores.
4) Patients who
This study compared outcomes for head and neck cancer patients based on age. Younger patients (≤40 years old) had significantly better 5-year survival rates (65%) than middle-aged (41-64 years old, 52%) or older patients (≥65 years old, 38%). Younger patients also developed fewer recurrent tumors or new primary tumors. However, the reasons for the differences in outcomes based on age are unclear. The study aimed to analyze outcomes while controlling for other factors like smoking history, tumor stage, and treatment received to better understand the independent impact of age.
1. This study examined outcomes of 2541 hospitalized COVID-19 patients treated with hydroxychloroquine alone, hydroxychloroquine plus azithromycin, azithromycin alone, or neither drug.
2. Overall in-hospital mortality was 18.1%. Mortality was lowest in the hydroxychloroquine alone group (13.5%) and highest in the neither drug group (26.4%).
3. After controlling for risk factors, treatment with hydroxychloroquine alone or with azithromycin was associated with reduced COVID-19 mortality compared to no treatment. Prospective randomized trials are still needed.
Early initiation of antiretroviral therapy (ART) within 6 months of HIV infection contributes to the normalization of CD8 T-cell counts. The study found that:
1) CD8 counts decreased significantly from 797 to 588 cells/μL over 24 months in individuals who started ART early, reaching lower levels than those without ART or with delayed ART.
2) CD4 T-cell recovery was more prominent in individuals who started ART early compared to those with delayed ART.
3) ART initiated early in HIV infection is associated with improved resolution of elevated CD8 T-cell counts compared to long-term ART initiated in chronic infection, which may help reduce non-AIDS related events.
—India constitutes about one fourth of the Global TB burden. Cutaneous TB is less common clinical form of tuberculosis accounting for 1-2 % of the total extra-pulmonary cases. Objective of this study was to describe the clinical and epidemiological pattern of Cutaneous TB presenting in the Skin Outpatient Department (OPD). Patients presenting with clinically suspected skin lesions of Cutaneous TB from January 2015 to August 2016 were included in the study. Dermatological and systemic examination was carried out and histopathogical examination of skin punch biopsy was done. It was observed that out of a total of sixty patients, 45 (75%) patients were found to have features of Cutaneous TB on histopathology. Lupus vulgaris (42.2%) was the most common form of Cutaneous TB. Most patients were in age group of 11-30 years. Male to female ratio was 1.6:1. Most common sites of involvement were lower limbs and neck. Mantoux test was positive(≥15 mm induration) in 66.7% cases. Typical tuberculoid histology was found in 91.1% cases. No cases of tuberculids were seen and non-specific chronic inflammation was seen in six cases. It was concluded that Cutaneous TB may present with different morphological patterns resembling other inflammatory, infective and neoplastic conditions. Proper and thorough investigations are necessary for detection of Cutaneous TB as the annual incidence of total TB cases in India is high.
Antibiotic exposure and the development of coeliac disease: a nationwide case...Enrique Moreno Gonzalez
The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce.
Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kamp...PUBLISHERJOURNAL
Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kampala International University Teaching Hospital, Bushenyi District
Okello, Andrew
School of Allied Health Sciences Kampala International University-Western Campus
________________________________________
ABSTRACT
This study on the prevalence of TB among HIV sero-positive was carried at the HIV CLINIC of Kampala International University Teaching Hospital (KIUTH), Ishaka Bushenyi district. A retrospective cross-sectional study design was used to conduct this research. The study targeted all patients attending KIUTH HIV/TB clinic. A standard structured and semi-structured questionnaires were designed and pre-tested for validity and reliability at Kampala International University Teaching Hospital HIV/Tuberculosis clinic before being used for data collection. Data collection started by recruitment of qualified research assistants, appropriate training and orientation of the interviewers before the survey for example when reading the questions. Quantitative methods of data analysis was used in which data was presented in form of bar charts, graphs and tables. The prevalence of TB among HIV sero-positive patients attending HIV clinic at KIUTH stands at 8.06 per 100 participants. The study found that generally, people are aware about the modes of transmission of TB but there is still need for more awareness. Many patients are still not certain whether TB is curable in HIV patients. As seen from the above study, most of the people are not yet aware whether HIV goes hand in hand with tuberculosis. The prevalence of TB in HIV sero-positive attending HIV clinic at KIUTH is high. Generally, TB is affecting patients of all ages and most patients are still not aware if TB in HIV is curable. Most patients have a perception that all TB patients have HIV. Health workers in HIV clinic of KIU-TH should teach patients the modes of transmission and prevention of TB. KIUTH also need to provide easy access to TB screening services to patients. There is need for financial support by the government to the unemployed patients and low-income earners in order to curb TB infections.
Keywords: Tuberculosis, HIV, Sero-positive, Bushenyi District
________________________________________
This document discusses support vector machines (SVM), a machine learning technique used for classification and regression analysis. SVM works by finding optimal hyperplanes in a multidimensional space that maximize the margin between examples of different classes. It can handle both continuous and categorical variables. The algorithm finds this optimal hyperplane by minimizing an error function during training. Depending on the type of error function used, there are four main types of SVM models: C-SVM classification, nu-SVM classification, epsilon-SVM regression, and nu-SVM regression.
This study evaluated the diagnostic accuracy of a Trypanosoma cruzi Loop-mediated isothermal amplification (Tc LAMP) kit for detection of T. cruzi infection in congenital, acute, and reactivated Chagas disease. Clinical samples from 46 patients were tested including those with confirmed congenital Chagas disease, recipients of organs from infected donors, cases of oral transmission, and coinfected HIV/T. cruzi patients. The Tc LAMP kit showed high sensitivity (93%) and specificity (100%) compared to quantitative PCR used as the reference standard. The agreement between Tc LAMP and qPCR was almost perfect. The Tc LAMP kit accurately detected T. cruzi infection
This document summarizes a study of 233 cases of abdominal tuberculosis treated at a hospital in Pakistan from 2003-2008. Some key findings include:
- The average age was 28 years and most patients were from poor families.
- The most common presentation was acute abdomen (67%), requiring emergency surgery. Common surgical findings included intestinal strictures (69%).
- Most cases involved the ileocecal region and presented as intestinal obstructions.
- The majority of cases were considered primary abdominal tuberculosis, though some had a history of pulmonary TB.
- Most patients required hospitalization, with an average stay of 19.5 days. The in-hospital mortality rate was 2.1%.
This document discusses sepsis case studies and the importance of timely diagnosis and treatment of sepsis. It defines sepsis and its criteria according to SIRS (Systemic Inflammatory Response Syndrome). Early diagnosis is important as each hour of delayed treatment can increase mortality rates by 5-10%. While microbiological cultures are traditionally used for definitive diagnosis, they can take 48-72 hours for results. Biomarkers like PCT and CRP can provide faster results and guide early empiric therapy.
This study evaluated the validity of procalcitonin (PCT) for diagnosing bacterial infections in elderly patients aged 75 years or older. 161 patients were included in the study and divided into two groups: 95 patients with probable bacterial infections and 66 patients without infections. PCT levels above 0.5 ng/mL were found in 72% of patients with probable bacterial infections and 8% of patients without infections. The study found that PCT has a sensitivity of 72% and specificity of 92% for diagnosing bacterial infections in elderly patients using a cutoff of 0.5 ng/mL. The researchers concluded that PCT can be reliably used to diagnose bacterial infections in elderly patients due to its good sensitivity and high specificity.
Risk factors of chronic liver disease amongst patients receiving care in a Ga...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study aimed to determine the epidemiology of candidemia and evaluate risk factors for mortality in patients with candidemia admitted to an Indian medical ICU. The incidence of candidemia was found to be 17.8 per 1,000 ICU admissions. Non-albican species accounted for 78.6% of candidemia. Previous antifungal use and a Candida score greater than 3 were found to independently predict increased ICU mortality. The Candida score integrates several risk factors and may provide a useful bedside tool for predicting mortality in patients with candidemia.
This study analyzed serious non-AIDS events (SNAs) among HIV-infected adults in Latin America. The researchers identified 130 patients with SNA events out of 6007 patients in the cohort, representing an incidence rate of 0.86 events per 100 person-years. Risk factors like hepatitis B/C coinfection, diabetes, and alcohol abuse were associated with SNA events. Lower CD4 cell counts prior to and at the index date were significantly associated with SNA events occurring, even in patients receiving antiretroviral treatment. The study found HIV-associated immune deficiency increased the risk of SNA events.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontal Disease Indices and Colorectal Cancer Risk in Greek Adults: A Cas...asclepiuspdfs
Introduction: The previous researches have recorded positive associations between periodontal disease (PD) and risk of cancer at various locations. The aim of the present case–control study was to investigate the possible associations between PD indices and the risk of colorectal cancer (CRC) development in a sample of Greek outpatients referred to a medical and dental private practice. Materials and Methods: A total of 342 individuals were interviewed and underwent an oral clinical examination, and 85 of them were suffered from CRC at various anatomic locations. The evaluation of the possible associations between CRC and PD indices was performed using a regression analysis model. Results: Clinical attachment loss (CAL) (P = 0.042, odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.02–3.11) was significantly associated with the risk of developing CRC. CRC family history (P = 0.002, OR = 2.33, 95% CI = 1.35–4.03) and smoking (P = 0.019, OR = 1.96, 95% CI = 1.12–3.45) were also significantly associated with the mentioned risk, whereas smoking was found to be nota confounder regarding the estimated association between moderate/severe CAL with the risk of developing CRC. Conclusion: CAL as an index for PD severity was statistically significantly associated with the risk of developing CRC.
This document provides an introduction to the field of epidemiology. It defines epidemiology as the study of disease occurrence and distribution in human populations and the factors that influence these. Key points made include that epidemiological studies examine disease outcomes in relation to the population at risk, draw conclusions by making comparisons between groups, and aim to identify risk factors and monitor disease trends over time. However, the text stresses the importance of ensuring comparisons are not biased by unequal ascertainment of cases or exposures.
3TC-DTG Dual Therapy and Its Implications in Hepatic Steatosis in People Livi...semualkaira
Hepatic disease is one of the major comorbidities
in people living with HIV. We intended to define the incidence of
NAFLD and to identify any factors which may be associated with
such a condition.
paper 2 seroprevalencia en individuos sin sintomas.pdfssuser5aa5ba
This study aimed to estimate the seroprevalence of COVID-19 among individuals in Daegu, South Korea who had never been diagnosed with COVID-19. The study tested 198 patients and guardians for COVID-19 antibodies. It found an estimated seroprevalence of 7.6%, with 15 positive cases. Most positive cases did not experience COVID-19 symptoms. Based on this rate, the estimated number of undiagnosed COVID-19 cases in Daegu was about 12 times the number of confirmed cases. Seroprevalence was higher among smokers and diabetics. This suggests the number of undiagnosed cases was substantial even with South Korea's aggressive testing and contact tracing strategy.
This meta-analysis evaluated the performance of the Bacterial Meningitis Score by aggregating data from 8 validation studies including over 5000 children. The Bacterial Meningitis Score had a high sensitivity of 99.3% for identifying bacterial meningitis. It also had moderate specificity of 62.1% for ruling out bacterial meningitis. This clinical prediction rule could assist clinicians in managing children with cerebrospinal fluid pleocytosis by accurately identifying those at very low risk of bacterial meningitis.
632 0713 - ferreyro bl - predictive score for estimating cancer after venou...Debourdeau Phil
This study developed a clinical predictive score to estimate cancer risk after venous thromboembolism (VTE). Researchers analyzed data from 540 patients diagnosed with new VTE. During the 1-year follow up, 26.4% developed cancer or died. Multivariable models were used to identify predictors of cancer alone and cancer/death. The final scores included previous VTE, recent surgery, comorbidities for cancer risk, and age, albumin, comorbidities, previous VTE, recent surgery for cancer/death risk. The scores had good discrimination for risk stratification with areas under the curve of 0.75-0.79 for cancer and 0.71-0.72 for cancer/death.
long-term colorrectal-cancer mortality after adenoma removalPascual Marrero
This study evaluated long-term colorectal cancer mortality among over 40,000 patients in Norway who had colorectal adenomas removed between 1993 and 2007. Patients were followed through 2011 to assess mortality. The study found that after a median follow-up of 7.7 years, colorectal cancer mortality was lower among patients who had low-risk adenomas removed and moderately higher among those who had high-risk adenomas removed, compared to the general population. High-risk adenomas were defined as multiple adenomas or adenomas with villous growth patterns or high-grade dysplasia.
Colorectal cancer screening and subsequent incidence of colorectal cancer: re...Cancer Council NSW
Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up Study
Annika Steffen, Marianne F Weber, David M Roder and Emily Banks
This study prospectively collected data on 10,745 patients from 357 centers in 58 countries who underwent emergency abdominal surgery. Overall mortality was 1.6% at 24 hours and 5.4% at 30 days. Mortality was highest in low HDI countries (3.4% at 24 hours and 8.6% at 30 days) and lowest in high HDI countries (1.1% at 24 hours and 4.5% at 30 days). After adjustment, 30-day mortality remained 2-3 times higher in middle- and low-income countries compared to high-income countries. Surgical safety checklist use was less frequent in low- and middle-income countries but associated with reduced mortality when used.
Similar to A large nationwide population-based case-control study of the association between intussusception and later celiac disease (20)
Incidence of pneumonia and risk factors among patients with head and neck can...Enrique Moreno Gonzalez
This study investigated the incidence and patient- and treatment-related risk factors related to pneumonia acquired during radiotherapy (PNRT) in head and neck cancer (HNC) patients.
Gene expression analysis of a Helicobacter pyloriinfected and high-salt diet-...Enrique Moreno Gonzalez
Helicobacter pylori (H. pylori) infection and excessive salt intake are known as important risk factors for stomach cancer in humans. However, interactions of these two factors with gene expression profiles during gastric carcinogenesis remain unclear. In the present study, we investigated the global gene expression associated with stomach carcinogenesis and prognosis of human gastric cancer using a mouse model.
Acute myeloid leukemia (AML) is a hematopoietic malignancy with a dismal outcome in the majority of cases. A detailed understanding of the genetic alterations and gene expression changes that contribute to its pathogenesis is important to improve prognostication, disease monitoring, and therapy. In this context, leukemia-associated misexpression of microRNAs (miRNAs) has been studied, but no coherent picture has emerged yet, thus warranting further investigations.
Recently, a phase II clinical trial in hepatocellular carcinoma (HCC) has suggested that the combination of sorafenib and 5-fluorouracil (5-FU) is feasible and side effects are manageable. However, preclinical experimental data explaining the interaction mechanism(s) are lacking. Our objective is to investigate the anticancer efficacy and mechanism of combined sorafenib and 5-FU therapy in vitro in HCC cell lines MHCC97H and SMMC-7721.
Differences in microRNA expression during tumor development in the transition...Enrique Moreno Gonzalez
The prostate is divided into three glandular zones, the peripheral zone (PZ), the transition zone (TZ), and the central zone. Most prostate tumors arise in the peripheral zone (70-75%) and in the transition zone (20-25%) while only 10% arise in the central zone. The aim of this study was to investigate if differences in miRNA expression could be a possible explanation for the difference in propensity of tumors in the zones of the prostate.
Multicentric and multifocal versus unifocal breast cancer: differences in the...Enrique Moreno Gonzalez
This study compared the expression of E-cadherin, β-catenin, and MUC1 in multicentric/multifocal breast cancers versus unifocal breast cancers of identical tumor size and grade. The study found significantly downregulated expression of E-cadherin in multicentric/multifocal cancers compared to unifocal cancers. In contrast, no significant differences were seen in β-catenin expression between the two groups. Within the unifocal group, E-cadherin and β-catenin expression were positively correlated, but this was not seen in the multicentric/multifocal group. The results suggest multicentric/multifocal and unifocal breast cancers differ in E-
The life in sight application study (LISA): design of a randomized controlled...Enrique Moreno Gonzalez
It is widely recognized that spiritual care plays an important role in physical and psychosocial well-being of cancer patients, but there is little evidence based research on the effects of spiritual care. We will conduct a randomized controlled trial on spiritual care using a brief structured interview scheme supported by an e-application. The aim is to examine whether an assisted reflection on life events and ultimate life goals can improve quality of life of cancer patients.
Clinical and experimental studies regarding the expression and diagnostic val...Enrique Moreno Gonzalez
Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a multifunctional Ig-like cell adhesion molecule that has a wide range of biological functions. According to previous reports, serum CEACAM1 is dysregulated in different malignant tumours and associated with tumour progression. However, the serum CEACAM1 expression in nonsmall-cell lung carcinomas (NSCLC) is unclear. The different expression ratio of CEACAM1-S and CEACAM1-L isoform has seldom been investigated in NSCLC. This research is intended to study the serum CEACAM1 and the ratio of CEACAM1-S/L isoforms in NSCLC.
Assessment of preoperative exercise capacity in hepatocellular carcinoma pati...Enrique Moreno Gonzalez
Cardiopulmonary exercise testing measures oxygen uptake at increasing levels of work and predicts cardiopulmonary performance under conditions of stress, such as after abdominal surgery. Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. This study examined the relationship between preoperative exercise capacity and event-free survival in hepatocellular carcinoma (HCC) patients with chronic liver injury who underwent hepatectomy.
Overexpression of YAP 1 contributes to progressive features and poor prognosi...Enrique Moreno Gonzalez
Yes-associated protein 1 (YAP 1), the nuclear effector of the Hippo pathway, is a key regulator of organ size and a candidate human oncogene in multiple tumors. However, the expression dynamics of YAP 1 in urothelial carcinoma of the bladder (UCB) and its clinical/prognostic significance are unclear.
CXCR7 is induced by hypoxia and mediates glioma cell migration towards SDF-1a...Enrique Moreno Gonzalez
Glioblastomas, the most common and malignant brain tumors of the central nervous system, exhibit high invasive capacity, which hinders effective therapy. Therefore, intense efforts aimed at improved therapeutics are ongoing to delineate the molecular mechanisms governing glioma cell migration and invasion.
Abnormal expression of Pygopus 2 correlates with a malignant phenotype in hum...Enrique Moreno Gonzalez
Pygopus 2 (Pygo2) is a Pygo family member and an important component of the Wnt signaling transcriptional complex. Despite this data, no clinical studies investigating Pygo2 expression in lung cancer have yet been reported.
Differentiation of irradiation and cetuximab induced skin reactions in patien...Enrique Moreno Gonzalez
In order to improve the clinical outcome of patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) not being capable to receive platinum-based chemoradiation, radiotherapy can be intensified by addition of cetuximab, a monoclonal antibody that blocks the epidermal growth factor receptor (EGFR). The radioimmunotherapy with cetuximab is a feasible treatment option showing a favourable toxicity profile. The most frequent side effect of radiotherapy is radiation dermatitis, the most common side effect of treatment with cetuximab is acneiform rash. Incidence and severity of these frequent, often overlapping and sometimes limiting skin reactions, however, are not well explored. A clinical and molecular differentiation between radiogenic skin reactions and skin reactions caused by cetuximab which may correlate with outcome, have never been described before.
Cholestasis induces reversible accumulation of periplakin in mouse liverEnrique Moreno Gonzalez
Periplakin (PPL) is a rod-shaped cytolinker protein thought to connect cellular adhesion junctional complexes to cytoskeletal filaments. PPL serves as a structural component of the cornified envelope in the skin and interacts with various types of proteins in cultured cells; its level decreases dramatically during tumorigenic progression in human epithelial tissues. Despite these intriguing observations, the physiological roles of PPL, especially in noncutaneous tissues, are still largely unknown. Because we observed a marked fluctuation of PPL expression in mouse liver in association with the bile acid receptor farnesoid X receptor (FXR) and cholestasis, we sought to characterize the role of PPL in the liver and determine its contributions to the etiology and pathogenesis of cholestasis.
Functional p53 is required for rapid restoration of daunorubicin-induced lesi...Enrique Moreno Gonzalez
This document summarizes a research article that studied the role of p53 in daunorubicin (DNR)-induced lesions in the spleen. The key findings were:
1) DNR treatment caused more rapid cell death and weight loss in the spleens of wild type mice compared to p53-null mice.
2) While wild type mouse spleens recovered normal morphology 8 days after DNR treatment, p53-null mouse spleens still had large necrotic lesions.
3) DNR treatment increased p21 levels in wild type mice but not p53-null mice, indicating p53 is required for p21 induction.
4) The results suggest p53
Post-diagnosis hemoglobin change associates with overall survival of multiple...Enrique Moreno Gonzalez
Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation car...Enrique Moreno Gonzalez
Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting.
Impaired mitochondrial beta-oxidation in patients with chronic hepatitis C: r...Enrique Moreno Gonzalez
Hepatic steatosis is often seen in patients with chronic hepatitis C (CH-C). It is still unclear whether these patients have an impaired mitochondrial β-oxidation. In this study we assessed mitochondrial β-oxidation in CH-C patients by investigating ketogenesis during fasting.
Intraepithelial lymphocyte distribution differs between the bulb and the seco...Enrique Moreno Gonzalez
Evaluation of intraepithelial duodenal lymphocytosis (IDL) is important in celiac disease (CD). There is no established cut-off value for increased number of IELs in the bulb. We therefore investigated the relation between IEL counts in the bulb and duodenal specimens in non-celiac subjects.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
2. A large nationwide population-based case–control
study of the association between intussusception and
later celiac disease
Jonas F Ludvigsson1,2,3*
*
Corresponding author
Email: jonasludvigsson@yahoo.com
Agneta Nordenskjöld4
Email: Agneta.Nordenskjold@ki.se
Joseph A Murray3
Email: Murray.Joseph@mayo.edu
Ola Olén1,5
Email: Ola.Olen@ki.se
1
Clinical Epidemiology Unit, Department of Medicine, Karolinska University
Hospital and Karolinska Institutet, Karolinska, Sweden
2
Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
3
Division of Gastroenterology and Hepatology, Departments of Medicine and
Immunology, Mayo Clinic College of Medicine, Rochester, NY, USA
4
Department of Women’s and Children’s Health, Karolinska Institutet and
Department of Pediatric Surgery, Karolinska University Hospital, Karolinska,
Sweden
5
Sachs’ Children’s Hospital, Stockholm South General Hospital, Stockholm,
Sweden
Abstract
Background
Case reports and case series studies suggest a positive association between intussusception
and celiac disease (CD).
Methods
We contacted Sweden’s 28 pathology departments and obtained data on 29,096 patients with
biopsy-verified CD (equal to Marsh stage 3) through biopsy reports. Patients with CD were
matched for age, sex, calendar period and county of residence with up to five reference
individuals from the general population (n = 144,522). Cases of intussusception were
identified from nationwide inpatient, hospital-based outpatient and day-surgery data from the
Swedish Patient Register.
3. Odds ratios (ORs) for future CD in patients with intussusception were estimated using
conditional logistic regression.
Results
34 (0.12%) individuals with CD had a diagnosis of intussusception vs. 143 (0.10%) reference
individuals, suggesting that intussusception was not a risk factor for later CD (OR = 1.17;
95% confidence interval (CI) = 0.82–1.67). The OR for CD in patients with at least two
records of intussusception was 0.40 (95% CI = 0.06–2.99).
In contrast, a post-hoc analysis showed that CD was associated with a statistically
significantly increased risk of intussusception after CD diagnosis (hazard ratio = 1.95; 95%
CI = 1.01–3.77); however, this analysis was based on only 12 cases with both CD and
intussusception.
Conclusion
We found no association between intussusception and future CD; and a mostly modest
increased risk of intussusception after a diagnosis of CD.
Keywords
Celiac, Coeliac, Gluten, Inflammation, Intussusception, Population-based
Background
Intussusception is a condition in which a segment of intestine invaginates into another section
of intestine. Signs and symptoms of intussusception include acute pain, nausea, lethargy,
vomiting and sometimes bleeding from the rectum (“red currant jelly”) [1]. Although
intussusception generally remits spontaneously, in a number of cases either contrast enema or
surgery is needed to treat the disorder [2]. The causes of intussusception include infections
and vaccination with rotavirus vaccine, but organic disorders such as malignancy tend to
predominate in adults.
Celiac disease (CD) is a chronic inflammatory small intestinal disorder that occurs in about
1–2% of the general population [3,4]. Undiagnosed CD is characterized by small bowel
inflammation [5] and will sometimes cause small bowel wall edema [6], intestinal lymph
node swelling [7] and dysmotility [7] but also ulcers and strictures [8]. It has therefore been
suggested that untreated CD may be linked to intussusception; a number of case-reports and
case series substantiate this hypothesishesis [9-14]. In a recent paper from a tertiary
institution in the US [14], 3/252 (1.2%) of children with newly diagnosed CD had a history of
intussusception compared with 0.07% of the child population attending this center. This
suggests intussusception may be associated with CD, however, due to small numbers or lack
of controls, none of these studies have estimated relative risks or odds ratios (ORs) [9-14].
The main objective of this study was therefore to examine the association between
intussusception and later biopsy-verified CD in a large nationwide population-based case–
4. control study. In a post-hoc analysis we examined the risk of intussusception in patients who
already had a diagnosis of CD.
Methods
We identified patients with intussusception through the Swedish Patient Register [15] (data
on inpatient care, hospital-based outpatient care and day-care surgery). Intussusception data
were linked to data on CD obtained from biopsy reports at Sweden’s 28 pathology registers
[16]. Linkages were performed using the Swedish personal identity number (PIN) [17].
Intussusception
Cases with intussusception were identified from the Swedish Patient Register [15] by
reference to relevant International Classification of Disease (ICD) codes ICD-7: 570.0; ICD-
8: 560.0; ICD-9: 560A; and ICD-10: K56.1. In subanalyses we restricted intussusception to
cases with surgery or to those who had radiological intervention (code TJG30 or 4780) for
intussusception. In a separate analysis we examined the risk of CD in patients with at least
two recorded health care contacts that were due to intussusception.
The Swedish Patient Register started in 1964 and since 1987 the register has nationwide
coverage. Day-surgery data were added from 1997 and hospital-based outpatient data since
2001 [15].
Celiac disease
In 2006–2008 we collected small intestinal biopsy report data from all pathology departments
(n = 28) in Sweden. The biopsies were performed between 1969 and 2008. IT personnel
carried out computerized searches for arrival date of biopsies, PIN [17], morphology and
topography (duodenum and jejunum). CD was defined as having a biopsy with villous
atrophy (VA, equals Marsh stage 3) [18] according to the Swedish SnoMed classification.
We did not require patients to have a positive antibodies against tissue transglutaminase
(TTG), endomysium (EMA), or gliadin for a CD diagnosis, but in a random subset of patients
with VA and available data on CD serology about 88% were positive for either of these
antibodies at the time of biopsy [16]. An earlier validation of 114 patients with VA found that
108 (95%) had CD [16]. Approximately 79% of individuals with CD had gastrointestinal
symptoms before biopsy and 35% had anemia.
Controls
Each individual undergoing biopsy was matched with up to five controls for age, sex,
calendar period and county of residence. Controls were identified from the Total Population
Register by the Swedish government agency, Statistics Sweden and had no previous
duodenal/jejunal biopsy.
We then excluded individuals whose biopsy may have originated from the ileum, CD
individuals lacking a serial number from Statistics Sweden or having no matched controls
since all analyses were carried out per stratum. The remaining individuals were identical to
those in our study on mortality in CD [19]. Thus, the final sample on which this study is
based was 29,096 individuals with CD and 144,522 matched controls.
5. Statistics
We used conditional logistic regression to estimate ORs for CD and earlier intussusception.
The conditional approach entails that each individual with CD is only compared with his or
her controls within the same stratum. We also present percentages of CD patients and
controls with a previous diagnosis of intussusception.
In pre-defined subanalyses we examined intussusception and CD in relation to sex, age (0–
19, 20–39, 40–59 and ≥60 years at age of diagnosis) and calendar period (1989, 1990–1999
and 2000-) at CD diagnosis.
In another pre-defined subanalysis we examined the association between intussusception and
CD in children aged <2 years (CD: n = 4,589). We did so for two reasons. First, in Sweden,
CD is often diagnosed in this age group [20], and second, as opposed to adults in which
intussusception may be caused by cancers [11], underlying cancers are unusual in childhood
when most intussusception is idiopathic. We therefore hypothesized that the association with
CD would be strongest with idiopathic intussusception in infancy and childhood. For
consistency, we also examined the risk of intussusception in individuals diagnosed with CD
≥2 years of age (CD: n = 24,507). In a post-hoc analysis we excluded all intussusception
occurring before the age of 2 years (not equal to the previous analysis in which we examined
risk of CD after the age of 2 years but included intussusceptions occurring before age 2) and
calculated OR for future CD.
We also examined the risk of future CD in patients with at least 2 health care contacts for
intussusception (repeated intussusceptions) of which at least one intussusception had to occur
before CD diagnosis. Having at least 2 records of intussusception will increase the likelihood
that the patient really had intussusception.
Cancer is sometimes the underlying cause of intussusception [11] and CD has been linked to
both lymphoproliferative [21] and gastrointestinal cancer [22] (at least about the time of CD
diagnosis [23]). To rule out that a positive association between CD and intussusception would
be due to cancer we performed a separate analysis in which we excluded all individuals (CD
patients and controls) who ever had a diagnosis of cancer according to the Swedish Cancer
Registry (CD: n = 25,869). The Swedish Cancer Registry began in 1958. About 99% of all
cancers are morphologically verified [24] and almost 100% of all cancers are reported to this
register each year [24].
Post-hoc analysis: CD and risk of future intussusception
In a post-hoc analysis we examined the risk of future intussusception in patients with CD.
This analysis was done to explore whether the null relationship that we found between
intussusception and later CD was independent of temporal sequence. In the prospective
analysis we used a cohort study design. Individuals with CD were compared with matched
reference individuals and followed from biopsy (or matching date) until first event of
intussusception, emigration, death or end of follow-up (Dec 31, 2009), whichever occurred
first. We used Cox regression models to calculate hazard ratios (HRs) for the risk of future
intussusception in CD. All analyses were internally stratified, i.e. one individual with CD was
only compared with his or her matched reference individuals (within a stratum) before a
summary estimate for the whole CD population was calculated. This approach eliminates the
influence of matching variables, such as sex, age, county of residence and calendar year at
6. CD diagnosis. The prospective cohort analysis was based on 29,060 individuals with no
earlier record of intussusception and 144,304 matched reference individuals.
SPSS version 20.0 (SPSS Inc, Chicago, IL, USA) was used for all analyses. Statistical
significance was defined as 95% confidence intervals (CIs) for risk estimates (ORs and HRs)
not including 1.0.
Ethics
The study was approved by the regional ethical review board in Stockholm, Sweden. Since
none of the participants was contacted and individual information was “anonymized” before
the analyses, informed consent was not required by the board.
Results
The median age at CD diagnosis was 30 years (range 0–95) (Table 1). Most patients with CD
were diagnosed after 1990 since this study was based on computerized biopsy reports and
computerized registers were usually introduced in this decade. Data on the sub-cohort of
children diagnosed with CD <2 years of age are presented in Additional file 1. Slightly more
than 6 of 10 study participants (all ages) were women.
Table 1 Characteristics of study participants
Matched controls Patients with celiac disease
Total, n 144,522 29,096
Age at celiac diagnosis, years (median, range) * 30; 0–95
Age 0–19, n (%) 58,852 (40.7) 11,802 (40.6)
Age 20–39, n (%) 26,385 (18.3) 5,312 (18.3)
Age 40–59, n (%) 32,254 (22.3) 6,477 (22.3)
Age ≥60, n (%) 27,031 (18.7) 5,505 (18.9)
Entry year (median, range) 1998, 1969–2008 1998, 1969–2008
Females, n (%) 89,544 (62.0) 18,005 (61.9)
Males, n (%) 54,978 (38.0) 11,091 (38.1)
Calendar year
−1989, n (%) 20,378 (14.1) 4,105 (14.1)
1990–99, n (%) 59,874 (41.4) 12,059 (41.4)
2000, n (%) 64,270 (44.5) 12,932 (44.4)
Country of birth
Nordic# 136,279 (94.3) 28,139 (96.7)
Data on intussusception
Intussusception n (%) 143 (0.10) 34 (0.12)
Age at first intussusception, years (median, range) 1 (0–60) 3 (0–68)
Intussusception with surgery/radiology, n (%) 31 (0.02) 8 (0.03)
* Reference individuals were matched for age. The median age at matching was 30 years
(range 0–95 years).
# Sweden, Denmark, Finland, Norway and Iceland.
7. Intussusception and risk of CD
Of 29,096 individuals with CD, 34 (0.12%) had a diagnosis of intussusception vs.
143/144,522 of the controls (0.10%). Hence, we found no association between
intussusception and later CD (OR = 1.17; 95%CI = 0.82–1.67). The OR for having a
diagnosis of CD was 1.31 (95%CI = 0.64–2.68) within 1 year after intussusception, 0.56
(95%CI = 0.17–1.78) 1–< 5 years after intussusception and 1.31 (95%CI = 0.84–2.05) ≥5
years after intussusception.
The risk of future CD was similar in females (OR = 0.97; 95%CI = 0.57–1.66) and males
(OR = 1.40; 95%CI = 0.86–2.28)(Table 2), and there were no significant differences in ORs
according to age at CD diagnosis or calendar year (Table 2). Adjustment for education and
country of birth (Nordic vs. Non-Nordic) did not affect our ORs (data not shown).
Table 2 Intussusception and risk of later celiac disease.
Subgroup Intussusceptions, N OR; 95% CI P-value P for interaction
Celiac disease Controls
Sex
Males 19 66 1.40; 0.86–2.28 0.176 0.323
Females 15 77 0.97; 0.57–1.66 0.922
Age*
<20 yrs 20 103 0.97; 0.61–1.54 0.902 0.256
20–39 yrs 8 23 1.67; 0.78–3.66 0.186
40–59 yrs 3 6 2.34; 0.64–8.62 0.201
60+ yrs 3 11 1.34; 0.39–4.66 0.645
Calendar period*
−1989 7 21 1.59; 0.71–3.56 0.258 0.292
1990–1999 14 54 1.27; 0.72–2.22 0.407
2000–2008 13 68 0.96; 0.54–1.70 0.881
*At time of celiac disease diagnosis.
Subanalyses
When we restricted our dataset to children <2 years of age (at diagnosis of CD or at date of
matching), 6 individuals with CD had a previous intussusception vs. 32 controls.
Intussusception was no risk factor for CD in this subset of young children (OR = 0.94;
95%CI = 0.42–2.14)(Table 3). Table 3 shows additional data.
8. Table 3 Subanalyses: Intussusception and risk of later celiac disease.
Subgroup Celiac disease <2 years Intussusception with radiology#/surgery
OR; 95% CI OR; 95% CI
Overall 0.94; 0.42–2.14 1.27; 0.60–2.69
Sex
Males 1.55; 0.56–4.31 1.07; 0.31–3.63
Females 0.53; 0.13–2.16 1.42; 0.55–3.67
Age*
<20 yrs Not estimated 0.80; 0.24–2.62
20–39 yrs Not estimated 2.88; 0.93–8.91
40–59 yrs Not estimated 2.50; 0.23–27.57
≥60 yrs Not estimated Not estimated§
Calendar period*
−1989 1.41; 0.44–4.54 2.31; 0.48–11.30
1990–1999 0.59; 0.14–2.39 0.94; 0.28–3.14
2000–2008 1.23; 0.15–9.82 1.33; 0.39–4.52
*At time of celiac disease diagnosis. #Radiological intervention for intussusception.
§ No cases of previous intussusception in the CD group vs. four cases in the control group.
Similarly, intussusception was no risk factor for having a diagnosis of CD after 2 years of age
(OR = 1.24; 95%CI = 0.83–1.86). However, we did find a statistically significant association
(OR = 2.11; 95%CI = 1.26–3.53) in a post-hoc analysis that only examined intussusceptions
occurring after the age of 2 years and risk of future CD.
Restricting our exposure to intussusception with either radiological intervention or surgery,
the OR for future CD was 1.27 (95%CI = 0.60–2.69).
One patient with CD vs. 13 controls had ≥2 records of intussusception (out of which at least
one intussusception occurred before CD diagnosis and study entry). This outcome
corresponded to a non-significant OR of 0.40 for future CD (95%CI = 0.06–2.99). In eleven
of the fourteen (1 + 13) patients with ≥2 records of intussusception, did the two records
correspond to the same intussusception (e.g. follow-up visit shortly after first diagnosis). All
three patients with ≥30 days between the two intussusceptions (our definition of different
episodes), were controls.
Excluding study participants who had a diagnosis of cancer at some stage in life, the OR for
future CD in patients with intussusception was 1.10 (95%CI = 0.76–1.59)(31/25,869 CD
patients vs. 140/130,041 controls had an earlier diagnosis of intussusception).
Celiac disease and risk of future intussusception
Using a prospective cohort approach, a post-hoc analysis found that 12 of 29,060 individuals
with CD had a diagnosis of intussusception after CD onset (expected n = 6), corresponding to
a hazard ratio and relative risk of 1.95 (95%CI = 1.01–3.77, p = 0.046).
9. Discussion
To our knowledge this is the first case–control study examining intussusception and risk of
future CD. It found no association between intussusception and CD (overall OR = 1.17). In a
post-hoc analysis intended to confirm the null relationship between prior intussusception and
CD before diagnosis we instead found that patients with diagnosed CD were at an almost
twofold increased risk of later intussusception.
Most literature on CD and intussusception has been limited to case reports or case series [9-
13,25]. Germann et al. suggest that intussusception in CD has a mild clinical course [25].
Intussusception may take place in the duodenum or jejunum but may occur in other parts of
the intestine. In our study we were unable to differentiate between intussusceptions in the
small intestine and the colon. If intussusception is associated with CD, it is most likely
associated with small intestinal intussusception and thus the inclusion of colonic
intussusception may have diluted a positive relationship. Still, the overall OR for future CD
was very close to 1.0, and if there had been a significant association between previous
intussusception and CD, this would have appeared in our data. Reilly et al. reported that 1.2%
of their celiac children had experienced a known intussusception [14] but since the authors do
not present any statistical comparison with the general population this may or may not
represent an increase. Our study differs from that of Reilly et al. [14] by different source
populations (nationwide approach vs. tertiary institution), and larger number of celiac
patients (29,096 vs. 254).
In a recent paper we studied the role of surgery in adult intussusception [11]. In that case
series 8/196 (4%) patients with intussusception had CD [11]. In a paper looking at the risk of
intussusception in patients with a diagnosis of CD 14/880 (1.6%) developed intussusception
during follow-up [13]. In both these series, with strong associations between CD and
intussusception, participants were recruited from single tertiary centers, making it is possible
that this procedure selected cases with more severe CD and intussusception [11,13], or that
these patients were at higher risk of undergoing investigation or contacting health care for a
number of disorders. We have previously shown that the relative risk of another disorder in
CD (tuberculosis) is twice as high in CD patients identified through hospital records [26] as
in patients identified through biopsy reports [27]. Further, the risk of mortality in CD seems
higher in patients with a hospital record of CD [28] than in patients diagnosed through biopsy
reports [19]. More than 96% of pediatricians and gastroenterologists in Sweden perform a
biopsy in at least 90% of patients with suspected CD before diagnosis [29]. Other strengths of
our paper include the high specificity of VA for CD. When two independent reviewers
manually scrutinized more than 1500 biopsy reports, very few individuals had other
comorbidities than CD (0.3% of patients with VA had inflammatory bowel disease and 0.2%
had Helicobacter pylori). The nationwide ascertainment of CD yielded a large number of CD
cases, which contributed to high statistical power. We were therefore able to stratify for age,
sex and calendar period at CD diagnosis.
Restricting our analyses to intussusception with radiological intervention and surgery did not
affect the OR (1.27). Only after we restricted our analyses to individuals with intussusception
after the age of 2 years, did we find a positive association between intussusception and future
CD. We urge caution when interpreting these data since they made up a post-hoc finding and
could be due to chance. Still, these data may reflect a true association between inflammation
from undiagnosed CD in older children and adults and secondary intussusception.
10. This study has some limitations. We used a case–control design to examine the association
between previous intussusception and future CD. This design means that we did not screen
individuals with intussusception for serological markers. Still, if any, patients with
intussusception would have been more likely to undergo investigation for CD and this would
have driven up the OR for CD. The lack of serological data can therefore not explain our null
findings for later CD risk.
We did not have access to radiological data such as computed tomography and thus could not
confirm the intussusception diagnosis. However, in several analyses we increased the
specificity of intussusception through various restrictions of the dataset and this had only
marginal effects on the ORs. Nor did we screen CD patients for intussusception with MRI,
CT or ultrasound [7]. Thus, we have no information on the association between CD and
intussusception that did not require health care.
We know of no earlier incidence study of intussusception in Sweden but a study from nearby
Germany found an incidence of 60/100,000 person-years in children <1 year of age [30].
When we examined control children who were born in 1987 or later (when the Swedish
Patient Registry was complete) in our dataset, there were 37 intussusceptions in the first year
of life corresponding to an incidence of 83/100,000 (37/44,759 person-years). This incidence
suggests that the low OR of our study is unlikely to be due to underreporting of
intussusceptions.
Finally, despite the large number of patients, we cannot rule out a weak association between
intussusception and later CD since the upper 95% CI reached 1.67.
Early versions of Rotavirus immunizations have been linked to intussusception [31], and we
lacked immunization data. However a recent study from Sweden [32] found no association
between childhood immunizations and CD, and rotavirus immunizations have not yet been
included in the general childhood immunization program in Sweden. Hence, biased
immunization coverage in CD children is unlikely to explain our results.
Conclusion
In conclusion, this study found no association between intussusception and CD before CD
diagnosis (undiagnosed CD), but did find a twofold increased risk of intussusception after CD
diagnosis. However, because only 12/29,060 (0.04%) individuals with CD developed
intussusception during follow-up, intussusception is probably a rare complication in CD. This
study does not support CD screening in patients with intussusception.
Abbreviations
CD, Celiac disease; CI, Confidence interval; OR, Odds ratio; VA, Villous atrophy
Competing interests
The authors declared that they have no competing interest.
11. Authors’ contributions
ICMJE criteria for authorship read and met: JFL, AN, JAM, OO. Agree with the manuscript’s
results and conclusions: JFL, AN, JAM, OO. Designed the experiments/the study: JFL and
OS. Collected data: JFL. Analyzed the data: JFL. Wrote the first draft of the paper: JFL.
Contributed to the writing of the paper: AN, JAM, OO. Contributed to the study design and
interpretation of the data analyses: JFL, AN, JAM, OO. Approved the final version of the
manuscript: JFL, AN, JAM, OO. Responsible for data integrity: JFL. Obtained funding: JFL.
Guarantor: JFL had full access to all the data in the study and takes responsibility for the
integrity of the data. JFL takes responsibility for the accuracy of the data analyses. All
authors read and approved the final manuscript.
Acknowledgement
Details of ethics approval: This project (2006/633-31/4) was approved by the regional
ethical review board in Stockholm on June 14, 2006.
Funding
JFL was supported by grants from the Swedish Society of Medicine, the Swedish Research
Council, the Swedish Celiac Society, and the Fulbright Commission.
JAM: The National Institutes of Health –DK057892.
AN was supported by the Swedish Research Council, The Foundation Frimurarna in
Stockholm and Stockholm City Council (ALF)
OO was supported by grants from the Magnus Bergvall Foundation, the Mjölkdroppen
Foundation, the Samariten Foundation and Stockholm County.
None of the funders had any influence on this study.
References
1. Samad L, Marven S, El Bashir H, Sutcliffe AG, Cameron JC, Lynn R, Taylor B:
Prospective surveillance study of the management of intussusception in UK and Irish
infants. Br J Surg 2012, 99:411–415.
2. Loukas M, Pellerin M, Kimball Z, de la Garza-Jordan J, Tubbs RS, Jordan R:
Intussusception: an anatomical perspective with review of the literature. Clin Anat 2011,
24:552–561.
3. Dube C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, Sampson M, Zhang L, Yazdi
F, Mamaladze V, et al: The prevalence of celiac disease in average-risk and at-risk
Western European populations: a systematic review. Gastroenterology 2005, 128:S57–
S67.
12. 4. Walker MM, Murray JA, Ronkainen J, Aro P, Storskrubb T, D'Amato M, Lahr B, Talley
NJ, Agreus L: Detection of Celiac Disease and Lymphocytic Enteropathy by Parallel
Serology and Histopathology in a Population-Based Study. Gastroenterology 2010,
139:112–119.
5. Walker MM: Murray. An update in the diagnosis of coeliac disease. Histopathology: JA;
2010.
6. Tomei E, Semelka RC, Braga L, Laghi A, Paolantonio P, Marini M, Passariello R, Di Tola
M, Sabbatella L, Picarelli A: Adult celiac disease: what is the role of MRI? J Magn Reson
Imaging 2006, 24:625–629.
7. Bartusek D, Valek V, Husty J, Uteseny J: Small bowel ultrasound in patients with celiac
disease. Retrospective study. Eur J Radiol 2007, 63:302–306.
8. Schweiger GD, Murray JA: Postbulbar duodenal ulceration and stenosis associated
with celiac disease. Abdom Imaging 1998, 23:347–349.
9. Fishman DS, Chumpitazi BP, Ngo PD, Kim HB, Lightdale JR: Small bowel
intussusception in celiac disease: revisiting a classic association. J Pediatr Gastroenterol
Nutr 2010, 50:237.
10. Mushtaq N, Marven S, Walker J, Puntis JW, Rudolf M, Stringer MD: Small bowel
intussusception in celiac disease. J Pediatr Surg 1999, 34:1833–1835.
11. Onkendi EO, Grotz TE, Murray JA, Donohue JH: Adult intussusception in the last 25
years of modern imaging: is surgery still indicated? J Gastrointest Surg 2011, 15:1699–
1705.
12. Cohen MD, Lintott DJ: Transient small bowel intussusception in adult coeliac disease.
Clin Radiol 1978, 29:529–534.
13. Gonda TA, Khan SU, Cheng J, Lewis SK, Rubin M, Green PH: Association of
intussusception and celiac disease in adults. Dig Dis Sci 2010, 55:2899–2903.
14. Reilly NR, Aguilar KM, Green PH: Should intussusception in children prompt
screening for celiac disease? J Pediatr Gastroenterol Nutr 2013, 56:56–59.
15. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren
M, Otterblad Olausson P: External review and validation of the Swedish national
inpatient register. BMC Public Health 2011, 11:450.
16. Ludvigsson JF, Brandt L, Montgomery SM, Granath F, Ekbom A: Validation study of
villous atrophy and small intestinal inflammation in Swedish biopsy registers. BMC
Gastroenterol 2009, 9:19.
17. Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A: The Swedish personal
identity number: possibilities and pitfalls in healthcare and medical research. Eur J
Epidemiol 2009, 24:659–667.
13. 18. Marsh MN: Gluten, major histocompatibility complex, and the small intestine. A
molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac
sprue’). Gastroenterology 1992, 102:330–354.
19. Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F: Small-intestinal
histopathology and mortality risk in celiac disease. JAMA 2009, 302:1171–1178.
20. Ivarsson A, Persson LA, Nystrom L, Ascher H, Cavell B, Danielsson L, Dannaeus A,
Lindberg T, Lindquist B, Stenhammar L, Hernell O: Epidemic of coeliac disease in Swedish
children [see comments]. Acta Paediatr 2000, 89:165–171.
21. Elfstrom P, Granath F, Ekstrom Smedby K, Montgomery SM, Askling J, Ekbom A,
Ludvigsson JF: Risk of Lymphoproliferative Malignancy in Relation to Small Intestinal
Histopathology Among Patients With Celiac Disease. J Natl Cancer Inst 2011, 103:436–
444.
22. Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI: Risk of malignancy
in patients with celiac disease. Am J Med 2003, 115:191–195.
23. Elfstrom P, Granath F, Ye W: Ludvigsson. Low Risk of Gastrointestinal Cancer Among
Patients With Celiac Disease, Inflammation, or Latent Celiac Disease. Clin Gastroenterol
Hepatol: JF; 2011.
24. Socialstyrelsen: Cancer incidence in Sweden 2005. In Book Cancer incidence in Sweden
2005. City; 2007.
25. Germann R, Kuch M, Prinz K, Ebbing A, Schindera F: Celiac disease: an uncommon
cause of recurrent intussusception. J Pediatr Gastroenterol Nutr 1997, 25:415–416.
26. Ludvigsson JF, Wahlstrom J, Grunewald J, Ekbom A, Montgomery SM: Coeliac disease
and risk of tuberculosis: a population based cohort study. Thorax 2007, 62:23–28.
27. Ludvigsson JF, Sanders DS, Maeurer M, Jonsson J, Grunewald J, Wahlstrom J: Risk of
tuberculosis in a large sample of patients with coeliac disease–a nationwide cohort
study. Aliment Pharmacol Ther 2011, 33:689–696.
28. Peters U, Askling J, Gridley G, Ekbom A, Linet M: Causes of death in patients with
celiac disease in a population-based Swedish cohort. Arch Intern Med 2003, 163:1566–
1572.
29. Ludvigsson JF, Brandt L, Montgomery SM: Symptoms and signs in individuals with
serology positive for celiac disease but normal mucosa. BMC Gastroenterol 2009, 9:57.
30. Jenke AC, Klaassen-Mielke R, Zilbauer M, Heininger U, Trampisch H, Wirth S:
Intussusception: incidence and treatment-insights from the nationwide German
surveillance. J Pediatr Gastroenterol Nutr 2011, 52:446–451.
31. MMWR Morb Mortal Wkly RepIntussusception among recipients of rotavirus vaccine-
-United States, 1998–1999. 1999, 48:577–581.
14. 32. Myleus A, Stenlund H, Hernell O, Gothefors L, Hammarstrom ML, Persson LA, Ivarsson
A: Early vaccinations are not risk factors for celiac disease. Pediatrics 2012, 130:e63–
e70.
Additional file
Additional_file_1 as DOC
Additional file 1. Characteristics of study participants with diagnosis of CD <2 years of age.
15. Additional files provided with this submission:
Additional file 1: 5760799898178468_add1.doc, 41K
http://www.biomedcentral.com/imedia/1327376134996265/supp1.doc