BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and outcomes in patients with or without type 2 diabetes mellitus (T2DM) in Spain from 2003 to 2013. METHODS: We collected ...BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and outcomes in patients with or without type 2 diabetes mellitus (T2DM) in Spain from 2003 to 2013. METHODS: We collected all cases of open and laparoscopic cholecystectomies using national hospital discharge data and evaluated the annual cholecystectomy rates stratiifed by T2DM status. We analyzed tendency for in-hospital mortality (IHM). We also analyzed the impact of T2DM on IHM in patients who underwent cholecystectomies. RESULTS: We identiifed 611 533 cholecystectomies (71.3%laparoscopic) in the patients, in whom 78 227 (12.8%) patients had T2DM. The rates of open cholecystectomies were 3-fold higher (130.0/105 vs 41.1/105) in patients with T2DM than in those without T2DM, and the rate of laparoscopic cholecys-tectomies was almost 2-fold higher (195.2/105 vs 111.8/105) in patients with T2DM. The annual rate of laparoscopic pro-cedures showed an 11-year relative increase of 88.3% (from 117.0/105 to 220.3/105) in T2DM and 49.2% (from 79.2/105 to 118.2/105) in patients without T2DM (P<0.001), whereas the rate of open procedures showed an 11-year relative decrease of 27.6% in patients with T2DM and 37.9% in those without T2DM (P<0.001). The rate of emergency laparoscopic cho-lecystectomy was increased in the 11 years, whereas the rate of emergency open cholecystectomies was decreased (both P<0.001). Multivariate analysis revealed that older age, higher comorbidity and emergency cholecystectomy were associated with a higher IHM. Compared with patients without T2DM, patients with T2DM demonstrated a lower IHM after open cholecystectomy [OR=0.82 (0.78-0.87)], but a higher IHM after laparoscopic cholecystectomy (OR=1.18 (1.03-1.35))Time-trend analyses showed a signiifcant reduction in IHM in patients with or without T2DM after the two procedures. CONCLUSION: The rate of cholecystectomy was higher in patients with T2DM, and laparoscopic cholecystectomy was popularized in the past 11 years both in selective and emer-gency cholecystectomies.展开更多
Background::The burden of human immunodeficiency virus(HIV)infection in people who use drugs(PWUD)is significant.We aimed to screen HIV infection among PWUD and describe their retention in HIV care.Besides,we also scr...Background::The burden of human immunodeficiency virus(HIV)infection in people who use drugs(PWUD)is significant.We aimed to screen HIV infection among PWUD and describe their retention in HIV care.Besides,we also screen for hepatitis C virus(HCV)infection among HIV-seropositive PWUD and describe their linkage to care.Methods::We conducted a prospective study in 529 PWUD who visited the"Ca?ada Real Galiana"(Madrid,Spain).The study period was from June 1,2017,to May 31,2018.HIV diagnosis was performed with a rapid antibody screening test at the point-of-care(POC)and HCV diagnosis with immunoassay and PCR tests on dried blood spot(DBS)in a central laboratory.Positive PWUD were referred to the hospital.We used the Chi-square or Fisher’s exact tests,as appropriate,to compare rates between groups.Results::Thirty-five(6.6%)participants were positive HIV antibodies,but 34 reported previous HIV diagnoses,and 27(76%)had prior antiretroviral therapy.Among patients with a positive HIV antibody test,we also found a higher prevalence of homeless(P<0.001)and injection drug use(PWID)(P<0.001),and more decades of drug use(P=0.002).All participants received HIV test results at the POC.Of the 35 HIV positives,28(80%)were retained in HIV medical care at the end of the HIV screening study(2018),and only 22(62.9%)at the end of 2020.Moreover,12/35(34.3%)were positive for the HCV RNA test.Of the latter,10/12(83.3%)were contacted to deliver the HCV results test(delivery time of 19 days),5/12(41.7%)had an appointment and were attended at the hospital and started HCV therapy,and only 4/12(33.3%)cleared HCV.Conclusions::We found almost no new HIV-infected PWUD,but their cascade of HIV care was low and remains a challenge in this population at risk.The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for HCV screening and reinforcing the link to care.展开更多
基金Funding:Dr.Ana López-de-Andrés is the recipient of a Fondo de Investigaciones Sanitarias on behalf of the Spanish Ministry of Health,Social Policy and Equality,2013(PI13/00118)
文摘BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and outcomes in patients with or without type 2 diabetes mellitus (T2DM) in Spain from 2003 to 2013. METHODS: We collected all cases of open and laparoscopic cholecystectomies using national hospital discharge data and evaluated the annual cholecystectomy rates stratiifed by T2DM status. We analyzed tendency for in-hospital mortality (IHM). We also analyzed the impact of T2DM on IHM in patients who underwent cholecystectomies. RESULTS: We identiifed 611 533 cholecystectomies (71.3%laparoscopic) in the patients, in whom 78 227 (12.8%) patients had T2DM. The rates of open cholecystectomies were 3-fold higher (130.0/105 vs 41.1/105) in patients with T2DM than in those without T2DM, and the rate of laparoscopic cholecys-tectomies was almost 2-fold higher (195.2/105 vs 111.8/105) in patients with T2DM. The annual rate of laparoscopic pro-cedures showed an 11-year relative increase of 88.3% (from 117.0/105 to 220.3/105) in T2DM and 49.2% (from 79.2/105 to 118.2/105) in patients without T2DM (P<0.001), whereas the rate of open procedures showed an 11-year relative decrease of 27.6% in patients with T2DM and 37.9% in those without T2DM (P<0.001). The rate of emergency laparoscopic cho-lecystectomy was increased in the 11 years, whereas the rate of emergency open cholecystectomies was decreased (both P<0.001). Multivariate analysis revealed that older age, higher comorbidity and emergency cholecystectomy were associated with a higher IHM. Compared with patients without T2DM, patients with T2DM demonstrated a lower IHM after open cholecystectomy [OR=0.82 (0.78-0.87)], but a higher IHM after laparoscopic cholecystectomy (OR=1.18 (1.03-1.35))Time-trend analyses showed a signiifcant reduction in IHM in patients with or without T2DM after the two procedures. CONCLUSION: The rate of cholecystectomy was higher in patients with T2DM, and laparoscopic cholecystectomy was popularized in the past 11 years both in selective and emer-gency cholecystectomies.
基金This work was funded by a research grant from Merck Sharpe&Dohme(Grant Number MISP ⅡS#54846)Instituto de Salud Carlos Ⅲ(ISCⅡGrant Numbers PI20CⅢ/00004,and RD16CⅢ/0002/0002 to SR).
文摘Background::The burden of human immunodeficiency virus(HIV)infection in people who use drugs(PWUD)is significant.We aimed to screen HIV infection among PWUD and describe their retention in HIV care.Besides,we also screen for hepatitis C virus(HCV)infection among HIV-seropositive PWUD and describe their linkage to care.Methods::We conducted a prospective study in 529 PWUD who visited the"Ca?ada Real Galiana"(Madrid,Spain).The study period was from June 1,2017,to May 31,2018.HIV diagnosis was performed with a rapid antibody screening test at the point-of-care(POC)and HCV diagnosis with immunoassay and PCR tests on dried blood spot(DBS)in a central laboratory.Positive PWUD were referred to the hospital.We used the Chi-square or Fisher’s exact tests,as appropriate,to compare rates between groups.Results::Thirty-five(6.6%)participants were positive HIV antibodies,but 34 reported previous HIV diagnoses,and 27(76%)had prior antiretroviral therapy.Among patients with a positive HIV antibody test,we also found a higher prevalence of homeless(P<0.001)and injection drug use(PWID)(P<0.001),and more decades of drug use(P=0.002).All participants received HIV test results at the POC.Of the 35 HIV positives,28(80%)were retained in HIV medical care at the end of the HIV screening study(2018),and only 22(62.9%)at the end of 2020.Moreover,12/35(34.3%)were positive for the HCV RNA test.Of the latter,10/12(83.3%)were contacted to deliver the HCV results test(delivery time of 19 days),5/12(41.7%)had an appointment and were attended at the hospital and started HCV therapy,and only 4/12(33.3%)cleared HCV.Conclusions::We found almost no new HIV-infected PWUD,but their cascade of HIV care was low and remains a challenge in this population at risk.The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for HCV screening and reinforcing the link to care.
