BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care....BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.展开更多
AIM:To review our outcomes and compare the results of the Less Invasive Stabilization System(LISS)to other implants for distal femur fracture management at a regional Australian hospital.METHODS:The LISS is a novel im...AIM:To review our outcomes and compare the results of the Less Invasive Stabilization System(LISS)to other implants for distal femur fracture management at a regional Australian hospital.METHODS:The LISS is a novel implant for the management of distal femur fractures.It is,however,technically demanding and treatment results have not yet been assessed outside tertiary centres.Twenty-seven patients with 28 distal femur fractures who had been managed surgically at the Mackay Base Hospital from January 2004 to December 2010 were retrospectively enrolled and assessed clinically and radiologically.Outcomes were union,pain,Lysholm score,knee range of motion,and complication rates.RESULTS:Twenty fractures were managed with the LISS and eight fractures were managed with alternative implants.Analysis of the surgical techniques re-vealed that 11 fractures managed with the LISS were performed according to the recommended principles(LISS-R)and 9 were not(LISS-N).Union occurred in67.9%of fractures overall:9/11(82%)in the LISS-R group vs 5/9(56%)in the LISS-N group and 5/8(62.5%)in the alternative implant group.There was no statistically significant difference between pain,Lysholm score,and complication rates between the groups.However,there was a trend towards the LISS-R group having superior outcomes which were clinically significant.There was a statistically significant greater range of median knee flexion in the LISS-R group with compared to the LISS-N group(P=0.0143)and compared with the alternative implant group(P=0.0454).CONCLUSION:The trends towards the benefits of the LISS procedure when correctly applied would suggest that not only should the LISS procedure be performed for distal femur fractures,but the correct principle of insertion is important in improving the patient’s outcome.展开更多
AIM:To determine the incidence,clinical characteristics and outcomes of patients with metformin associated lactic acidosis(MALA).METHODS:Auckland City Hospital drains a population of just over 400000 people.All cases ...AIM:To determine the incidence,clinical characteristics and outcomes of patients with metformin associated lactic acidosis(MALA).METHODS:Auckland City Hospital drains a population of just over 400000 people.All cases presenting with metabolic acidosis between July 2005 and July 2009 were identifed using clinical coding.A retrospective case notes review identifed patients with MALA.Prescribing data for metformin was obtained from the national pharmaceutical prescribing scheme.RESULTS:There were 42 cases of metabolic lactic acidosis over 1718000 patient years.There were 51000 patient years of metformin prescribed to patients over the study period.There were thirty two cases of lactic acidosis due to sepsis,seven in patients treated with metformin.Ten cases of MALA were identified.The incidence of MALA was estimated at 19.46 per 100000 patient year exposure to metformin.The relative risk of lactic acidosis in patients on metformin was 13.53(95%CI:7.88-21.66)compared to the general population.The mean age of patients with MALA was 63 years,range 40-83 years.A baseline estimated glomerular fltration rate was obtained in all patients and ranged from 23-130 mL/min per 1.73 m^(2).Only two patients had chronic kidney disease G4.Three patients required treatment with haemodialysis.Two patients died.展开更多
BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,...BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,as it would elucidate the compre-hensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.AIM To compare the levels of burden,stress and depression among family caregivers of cirrhotic and liver transplant patients.METHODS This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital.Instruments included identification cards,interview scripts,the caregiver burden scale Inventory,Lipp’s Stress Symptom Inventory,and the Beck Depression Inventory-Second Edition.Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability.Factor scores were compared with the Mann-Whitney U test,with effect size as the rank-biserial correlation coefficient(r).Statistical analysis was performed with R software(P<0.05).RESULTS Seventy-seven CP caregivers and 65 LT recipient caregivers were included.Most were female(CP:85.7%vs LT:84.6%)and the patients’spouses(76.6%vs 63.1%).The median age and caregiving duration were 55.4(23.3-76.3)vs 54.6(25.7-82.1)and 3.9(1-20)vs 8(1.5-24)years,respectively(P=0.001).LT caregivers were less likely to be at risk of overload(21.5%vs 49.4%),to be under stress(33.8%vs 36.4%)and to show symptoms of depression(15.4%vs 35.1%).Compared with LT caregivers,CP caregivers had greater median factor scores for burden(general tension,P=0.012;isolation,P=0.014;disappointment,P=0.004),depression(P=0.008),and stress(P=0.047),with small to moderate effect sizes.The disappointment(r=0.240)and depression(r=0.225)dimensions had the largest effect sizes.CONCLUSION Family caregivers of LT recipients are less likely to exhibit symptoms of burden,stress,and depression,suggesting that the benefits of LT extend to the patients’family members.展开更多
The term subepithelial lesions encompasses a wide array of pathology of which numerous benign and malignant pathologies are grouped.A subset of these lesions are termed gastric mesenchymal tumours of which some have i...The term subepithelial lesions encompasses a wide array of pathology of which numerous benign and malignant pathologies are grouped.A subset of these lesions are termed gastric mesenchymal tumours of which some have innate malignant potential.Currently there is various guidance on the recommended approach to the investigation and management of these lesions and there exists multiple methods of resection.Lin et al have developed and proposed a new method of resection of these gastric mesenchymal tumours within the field of endoscopy,a procedure they have termed endoscopic calabash ligation and resection.This editorial aims to outlay the current landscape for gastric mesenchymal tumours with regards to the various guidelines and resection techniques while comparing Lin et al’s new technique to those that are already established in the field of endoscopy.Advancements in endoscopy that maintain or improve patient outcomes compared to the gold standard approach are exciting developments.Lin et al’s study suggests that their technique is comparable in regard to patient outcomes while simultaneously being more efficient in its use of hospital resources including procedural time.Whilst the data and analysis proposed in the study is promising,there are areas that need to be addressed before advocating the procedure for widespread use.However,with further studies and analysis this may be foreseeable in the future.展开更多
Autoimmune hepatitis(AIH)is a rare cause of chronic liver disease.The exact pa-thophysiology of AIH is unknown.Breakdown of self-tolerance against hepatic antigens and molecular mimicry are often implicated in the pat...Autoimmune hepatitis(AIH)is a rare cause of chronic liver disease.The exact pa-thophysiology of AIH is unknown.Breakdown of self-tolerance against hepatic antigens and molecular mimicry are often implicated in the pathogenesis of AIH.Immunosuppressive therapy is the mainstay of treatment;however,10%–25%of patients with AIH may not respond to primary therapy.Those patients are often salvaged with second-and third-line immunosuppressive therapy.Workup for other concomitant diseases should be done for patients who fail to respond to primary immunosuppressive therapy.Concurrent metabolic dysfunction-asso-ciated steatotic liver disease,alcohol-related liver disease,overlap syndrome(AIH with primary biliary cholangitis or sclerosing cholangitis),chronic hepatitis B virus,hepatitis C virus,and human immunodeficiency virus infection should be ruled out in such cases.Targeting the concomitant etiology may lead to resolution of the clinical symptoms and induce biochemical and histological remission.Isolated AIH without other etiologies for liver injury should be managed with a higher dose of steroids,azathioprine,or other immunosuppressive agents.Second-and third-line immunosuppressive agents include mycophenolate mofetil,cyclosporine,tacrolimus,infliximab,and rituximab.Patients with AIH may present with acute severe AIH(AS-AIH)and AIH-related acute on chronic liver failure,and they often require liver transplantation.The terms refractory or difficult-to-treat AIH have been used interchangeably and have no distinct definition.Difficult-to-treat AIH includes patients with intolerable side effects,fulminant disease(AIH with acute on chronic liver failure and AS-AIH),AIH in pregnancy,and HIV infection.Patients who fail to respond to standard first-line immunosuppressive therapy should be classified as refractory AIH.This review addresses the issues in the management of difficult-to-treat AIH with recent advances in pharmacological management.展开更多
AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necess...AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.METHODS A prospective,randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate(n=29),or another treatment modality(n=27;cast immobilisation with or without wires or external fixator).Outcomes were measured at 12 wk.Functional outcome scores measured were the Patient-Rated Wrist Evaluation(PRWE)Score;Disabilities of the Arm,Shoulder and Hand and activities of daily living(ADLs).Clinical outcomes were wrist range of motion and grip strength.Radiographic parameters were volar inclination and ulnar variance.RESULTS Patients in the volar locking plate group had significantly better PRWE scores,ADL scores,grip strength and range of extension at three months compared with the control group.All radiological parameters were significantly better in the volar locking plate group at 3 mo.CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities.Anatomical reduction was significantly more likely to be preserved in the plating group.Level of evidence:Ⅱ.展开更多
Objective: To investigate the therapeutic potential of adipose-derived stern cells (ADSCs) for limited cutaneous scleroderma (LS) in mouse models. Methods: ADSCs were isolated from pathogen-free female C57BL/6 mice an...Objective: To investigate the therapeutic potential of adipose-derived stern cells (ADSCs) for limited cutaneous scleroderma (LS) in mouse models. Methods: ADSCs were isolated from pathogen-free female C57BL/6 mice and LS was induced in wild type (WT) C57BL/6 mice via daily injection of bleomycin (0.1 mL x 300 mu g/mL) for 4 weeks; then the ADSCs were subcutaneously injected into the dorsal area in the model treatment group, and 100 mu L of phosphate buffered saline (PBS) solution was injected into the same site in the model control group. Green fluorescent protein (GFP) was used to track the cells using an in vivo imaging system on days 7, 14, 21 and 28 after transplantation. All mice were sacrificed and histologic analyses were performed after 4 weeks, and the skin thickness, collagen deposition and the total content of hydroxyproline were evaluated. Additionally, immunohistochemistry were performed to compare the tissue expression and distribution of TGF-beta 1 and VEGF between the ADSCs treatment group and the treatment control group. Results: WT C57BL/6 LS mouse model were successfully established and GFP in vivo fluorescence imaging showed that the translated ADSCs survived at the local for at least 4 weeks. Compared with the control group, the ADSCs treatment group significantly attenuated bleomycin-induced dermal fibrosis, reduced the skin thickness and the total content of hydroxyproline (P<0.05). The ADSCs treatment group displayed significantly lower levels of TGF-beta 1 and higher levels of VEGF than the control group (P<0.05). Conclusions: ADSCs may provide a feasible and practical treatment for autoimmune diseases such as LS and ameliorate dermal fibrosis.展开更多
Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objec...Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objective:We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same.Methods:In a cadaveric study comprising of 47 human temporal bones,canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact.The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone.The data analysis was performed using statistical software Stata version 12.0.Results:The mean ISJ angle for the 47 bones was 90.5^0(SD-15^0;range:54^0-122^0).The mean angle in well pneumatized bones was 93.7^0(SD-16.5;Range:54°-122^0)and in sclerotic mastoids was 88.7^0(SD-14;Range:68°-118^0).The difference in the ISJ angle in these two conditions was not statistically significant(p=0.27).The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ(111.4^0{SD-8.8;range:100.3^0-221.9^0};p=0.0001)and in the cases with an‘adherent/tilted morphology’of the stapes suprastructure with the promontory(mean-95.8^0(SD-13.8;range:70.7^0-120.4^0);p-<0.00001).Conclusion:The ISJ angle shows considerable variations.This variability needs to be taken into account when undertaking middle ear reconstructive procedures,specifically the ones involving the stapes footplate.The mastoid pneumatization does not appear to have an impact on the ISJ angle.展开更多
Colonic polyps may arise from BRAF inhibitor treatment of melanoma, possibly due to paradoxical activation of the mitogen-activated protein (MAP)-kinase pathway. In an alternative evidence based scenario, tubular colo...Colonic polyps may arise from BRAF inhibitor treatment of melanoma, possibly due to paradoxical activation of the mitogen-activated protein (MAP)-kinase pathway. In an alternative evidence based scenario, tubular colonic adenomas with APC gene mutations have also been identified in the context of BRAF inhibitor treatment, in the absence of mutations of MAPK genes. A minority of colorectal cancers develop by an alternative “serrated polyp pathway”. This article postulates a novel hypothesis, that the established phenotypic and molecular characteristics of serrated colonic polyps/CRC offer an intriguing insight into the pathobiology of BRAF inhibitor induced colonic polyps. Serrated polyps are characterized by a CpG island methylation phenotype, MLH1 silencing and cellular senescence. They also have BRAF mutations. The contention is that BRAF inhibitor induced polyps mimic the afore-described histology and molecular features of serrated polyps with the exception that instead of the presence of BRAF mutations they induce C-RAF homodimers and B-RAF: C-RAF heterodimers.展开更多
Background To document the pharmacotherapy of chronic heart failure （CHF） and to evaluate the adherence to treatment guidelines in Australian population. Methods The pharmacological management of 677 patients （fema...Background To document the pharmacotherapy of chronic heart failure （CHF） and to evaluate the adherence to treatment guidelines in Australian population. Methods The pharmacological management of 677 patients （female 46.7%, 75.5 ±11.6 years） with CHF was retrospectively analyzed. Results The use of angiotensin converting enzyme （ACE） inhibitors/angiotensin receptor blockers （ARB） and β-blockers were 58.2 % and 34.7 %, respectively. Major reasons for non-use of ACE inhibitors/ARBs were hyperkalemia and elevated serum creatinine level. For patients who did not receive β-blockers, asthma and chronic obstructive pulmonary disease were the main contraindications. Treatment at or above target dosages for ACE inhibitors/ARBs and β-blockers was low for each medication （40.3% and 28.9%, respectively）. Conclusions Evidenced-based medical therapies for heart failure were under used in a rural patient population. Further studies are required to develop processes to improve the optimal use of heart failure medications.展开更多
Objective:To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka,during outbreaks reported between 2013 and 2017.Metho...Objective:To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka,during outbreaks reported between 2013 and 2017.Methods:The retrospective multi-center study was carried out during 2013-2017 in 5 selected hospitals representing 3 high endemic districts in Sri Lanka.Clinically suspected leptospirosis patients were recruited according to the Communicable Disease Epidemiology Profile Sri Lanka,WHO.Leptospirosis was confirmed by either single microscopic agglutination test titre 1:400 or by positive polymerase chain reaction(PCR)test result.Results:Out of 372 clinically suspected cases,29.00%were confirmed as leptospirosis cases by either microscopic agglutination test(50.00%)or positive polymerase chain reaction(52.77%)and 12.90%were presumptively identified as leptospirosis.Clinical symptoms(headache,vomiting,jaundice and dyspnoea)and variations in haematological parameters(haemoglobin,platelet count)and biochemical parameters(serum creatinine,serum urea,serum bilirubin and C-reactive protein)were associated with confirmed leptospirosis(P<0.05).Acute kidney injury,meningitis,myocarditis,pulmonary haemorrhage and acute liver failure was seen among 21.30%,12.04%,6.48%,6.48%,5.56%,respectively with 4.63%fatality among the leptospirosis confirmed patients.The sensitivity,specificity,positive predictive value and negative predictive value of the case definition of Ministry of Health,Sri Lanka were 96.29%,9.09%,31.13%and 85.71%,respectively,when benchmarked against either positive polymerase chain reaction or microscopic agglutination test as the gold standard.Conclusions:Acute kidney injury is the predominant complication observed among the leptospirosis confirmed patients.However,pulmonary haemorrhage is predominantly associated with mortality.The case definition of Ministry of Health,Sri Lanka is found to have higher sensitivity and enabled the screening of all probable cases of leptospirosis.展开更多
Combined liver-kidney transplantation(CLKT)is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual(usually a...Combined liver-kidney transplantation(CLKT)is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual(usually a cadaver)to the same recipient during a single surgical procedure.Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1.Atypical haemolytic uremic syndrome,methylmalonic academia,and conditions where liver and renal failure co-exists may be indications for CLKT.CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft;however,liver survival has no significant impact.Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries,acute complications are not uncommon.Bleeding,thrombosis,haemodynamic instability,infections,acute cellular rejections,renal and liver dysfunction are acute complications.The long-term outlook is promising with over 80%5-year survival rates among those children who survive the initial six-month postoperative period.展开更多
AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.METHODS A total of 250 patients with a distal radius fr...AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.METHODS A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study.We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.RESULTS Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening.No other patient,injury,or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.CONCLUSION Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.展开更多
Dear editor,Peripheral venous blood gas(VBG)analysis is increasingly used as an alternative to arterial sampling in Emergency Departments throughout the world.[1]There are multiple advantages using peripheral venous s...Dear editor,Peripheral venous blood gas(VBG)analysis is increasingly used as an alternative to arterial sampling in Emergency Departments throughout the world.[1]There are multiple advantages using peripheral venous samples for blood gas analysis-technical ease,reduced pain and fewer complications.The difference in sample site chosen for blood gas analysis between European and Australian centres has been notable for members of our author group,prompting discussion and review of the literature.展开更多
Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments causing malabsorption. The cachexia-anorexia syndrome is a compl...Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments causing malabsorption. The cachexia-anorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions characterized by involuntary weight loss involving fat and muscle, anorexia, early satiety, fatigue and weakness due to shifts in metabolism caused by tumour by-products and cytokines. Cachexia is a distressing and debilitating condition, affecting significant numbers of patients with advanced disease and is the primary cause of death in about 20% of all patients with cancer. Though cachexia is most commonly associated with particular tumours, such as head and neck, gastrointestinal tract, pancreas, central nervous system and lung, it may affect any patient with any tumour at any site;no patient and no tumour are excluded. Current treatment for principally depends on its prevention rather than reversing the present disease state, and the clinical results are far from being satisfactory. A careful decision based on good clinical judgement is necessary before deciding to start either enteral or parenteral nutrition, to avoid a useless, costly and difficult treatment. Treatment should be directed toward improvement in the quality of life of the patient and should often include nutritional counseling. It should take into consideration both disease and treatment related factors as well as the cachexia syndrome itself.展开更多
BACKGROUND The etiology of inflammatory bowel disease(IBD)is unknown,but it is believed to be multifactorial.The hygiene hypothesis proposes that better hygiene conditions would lead to less infectious disease during ...BACKGROUND The etiology of inflammatory bowel disease(IBD)is unknown,but it is believed to be multifactorial.The hygiene hypothesis proposes that better hygiene conditions would lead to less infectious disease during childhood and favor the development of immune-mediated diseases.AIM To test the hygiene hypothesis in IBD by assessing the environmental risk factors associated with IBD development in different regions of Brazil with diverse socioeconomic development indices.METHODS A multicenter case-control study was carried out with 548 Crohn’s disease(CD)and 492 ulcerative colitis(UC)outpatients and 416 healthy controls,from six IBD centers within different Brazilian states at diverse socioeconomic development stages.A semi-structured questionnaire with 87 socioeconomic and environmental questions was applied.Logistic regression model was created to assess the odds ratio(OR)with P value and 95%confidence intervals(CI).RESULTS Predictive variables for both diseases(CD and UC)were women[odd ratios(OR)=1.31;OR=1.69],low monthly family income(OR=1.78;OR=1.57),lower number of cohabitants(OR=1.70;OR=1.60),absence of vaccination(OR=3.11;OR=2.51),previous history of bowel infections(OR=1.78;OR=1.49),and family history of IBD(OR=5.26;OR=3.33).Associated risk factors for CD were age(18-39 years)(OR=1.73),higher educational level(OR=2.22),absence of infectious childhood diseases(OR=1.99).The UC predictive variables were living in an urban area(OR=1.62),inadequate living conditions(OR=1.48)and former smokers(OR=3.36).Appendectomy was a risk factor for CD(OR=1.58)with inverse association with UC(OR=4.79).Consumption of treated and untreated water was associated with risk of CD(OR=1.38)and UC(OR=1.53),respectively.CONCLUSION This is the first examining environmental exposures as risk factors for inflammatory bowel disease in Brazil.Most of the variables associated with disease risk support the role of the hygiene hypothesis in IBD development.展开更多
Objective:To determine whether blood nitrite levels are elevated in patients with leptospirosis. Methods:Male patients Fulfilling clinical and epidemiological criteria for a diagnosis of leptospirosis were recruited.T...Objective:To determine whether blood nitrite levels are elevated in patients with leptospirosis. Methods:Male patients Fulfilling clinical and epidemiological criteria for a diagnosis of leptospirosis were recruited.Those with MAT title of≥400 together with those seroconverting to a titer of≥200 were included in the analysis.Serum nitrite levels were measured in these patients and age.sex matched healthy controls.Results:Patients from 3 hospitals(n=75) were screened during a 3 month period from 28th June to 3rd September 2009,of whom 20 were eligible for the study.Serum nilrile levels were found to be significantly higher in patients with acute leptospirosis[n=20.(0.359±0.229)μM]compared to controls[(n= 13.(0.216±0.051)μM] (P=0.014).A significant correlation was also observed between the MAT titre and the day of illness (r = 0.547;P【0.0001).Conclusions:Serum nitrite levels are higher in patients with acute leptospirosis compared to age and sex matched controls.No correlation could be assessed with severity of illness,as sample size was inadequate to determine this.展开更多
AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Prog...AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures.Participating physicians were invited to contribute data from their patients:baseline characteristics,ontreatment responses,sustained virological response at week 12(SVR12),and safety were collected and analysed.Multivariate analysis was performed to determine predictors of response.RESULTS:150 patients were enrolled from Australia,Malaysia,Singapore and Thailand(Asians = 86,Caucasians = 63).Overall SVR12 was 61%(Asians= 59.3%,Caucasians = 63.5%).SVR12 was higher in relapsers(78%) compared with non-responders(34%).On-treatment responses predicted SVR,with undetectable HCVRNA at week 4,8 and 12 leading to SVR12 s of 100%,87%,and 82%respectively,and detectable HCVRNA at week 4,8 and 12,leading to SVR12 s of 58%,22%and 6%respectively.Asian patients were similar to Caucasian patients with regards to on-treatment responses.Patients with cirrhosis(n= 69) also behaved in the same manner with regards to on-treatment responses.Those with the IL28 B CC genotype(80%) had higher SVRs than those with the CT/TT(56%) genotype(P = 0.010).Multivariate analysis showed that TW8 and TW12 responses were independent predictors of SVR.Serious adverse events occurred in 18.6%:sepsis(2%),decompensation(2.7%) and blood transfusion(14%).Discontinuations occurred in 30.7%,with 18.6%fulfilling stopping rules.CONCLUSION:Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80%if they have good on-treatment responses;however,discontinuations occurred in 30%because of virological failure or adverse events.展开更多
文摘BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.
文摘AIM:To review our outcomes and compare the results of the Less Invasive Stabilization System(LISS)to other implants for distal femur fracture management at a regional Australian hospital.METHODS:The LISS is a novel implant for the management of distal femur fractures.It is,however,technically demanding and treatment results have not yet been assessed outside tertiary centres.Twenty-seven patients with 28 distal femur fractures who had been managed surgically at the Mackay Base Hospital from January 2004 to December 2010 were retrospectively enrolled and assessed clinically and radiologically.Outcomes were union,pain,Lysholm score,knee range of motion,and complication rates.RESULTS:Twenty fractures were managed with the LISS and eight fractures were managed with alternative implants.Analysis of the surgical techniques re-vealed that 11 fractures managed with the LISS were performed according to the recommended principles(LISS-R)and 9 were not(LISS-N).Union occurred in67.9%of fractures overall:9/11(82%)in the LISS-R group vs 5/9(56%)in the LISS-N group and 5/8(62.5%)in the alternative implant group.There was no statistically significant difference between pain,Lysholm score,and complication rates between the groups.However,there was a trend towards the LISS-R group having superior outcomes which were clinically significant.There was a statistically significant greater range of median knee flexion in the LISS-R group with compared to the LISS-N group(P=0.0143)and compared with the alternative implant group(P=0.0454).CONCLUSION:The trends towards the benefits of the LISS procedure when correctly applied would suggest that not only should the LISS procedure be performed for distal femur fractures,but the correct principle of insertion is important in improving the patient’s outcome.
文摘AIM:To determine the incidence,clinical characteristics and outcomes of patients with metformin associated lactic acidosis(MALA).METHODS:Auckland City Hospital drains a population of just over 400000 people.All cases presenting with metabolic acidosis between July 2005 and July 2009 were identifed using clinical coding.A retrospective case notes review identifed patients with MALA.Prescribing data for metformin was obtained from the national pharmaceutical prescribing scheme.RESULTS:There were 42 cases of metabolic lactic acidosis over 1718000 patient years.There were 51000 patient years of metformin prescribed to patients over the study period.There were thirty two cases of lactic acidosis due to sepsis,seven in patients treated with metformin.Ten cases of MALA were identified.The incidence of MALA was estimated at 19.46 per 100000 patient year exposure to metformin.The relative risk of lactic acidosis in patients on metformin was 13.53(95%CI:7.88-21.66)compared to the general population.The mean age of patients with MALA was 63 years,range 40-83 years.A baseline estimated glomerular fltration rate was obtained in all patients and ranged from 23-130 mL/min per 1.73 m^(2).Only two patients had chronic kidney disease G4.Three patients required treatment with haemodialysis.Two patients died.
文摘BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,as it would elucidate the compre-hensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.AIM To compare the levels of burden,stress and depression among family caregivers of cirrhotic and liver transplant patients.METHODS This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital.Instruments included identification cards,interview scripts,the caregiver burden scale Inventory,Lipp’s Stress Symptom Inventory,and the Beck Depression Inventory-Second Edition.Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability.Factor scores were compared with the Mann-Whitney U test,with effect size as the rank-biserial correlation coefficient(r).Statistical analysis was performed with R software(P<0.05).RESULTS Seventy-seven CP caregivers and 65 LT recipient caregivers were included.Most were female(CP:85.7%vs LT:84.6%)and the patients’spouses(76.6%vs 63.1%).The median age and caregiving duration were 55.4(23.3-76.3)vs 54.6(25.7-82.1)and 3.9(1-20)vs 8(1.5-24)years,respectively(P=0.001).LT caregivers were less likely to be at risk of overload(21.5%vs 49.4%),to be under stress(33.8%vs 36.4%)and to show symptoms of depression(15.4%vs 35.1%).Compared with LT caregivers,CP caregivers had greater median factor scores for burden(general tension,P=0.012;isolation,P=0.014;disappointment,P=0.004),depression(P=0.008),and stress(P=0.047),with small to moderate effect sizes.The disappointment(r=0.240)and depression(r=0.225)dimensions had the largest effect sizes.CONCLUSION Family caregivers of LT recipients are less likely to exhibit symptoms of burden,stress,and depression,suggesting that the benefits of LT extend to the patients’family members.
文摘The term subepithelial lesions encompasses a wide array of pathology of which numerous benign and malignant pathologies are grouped.A subset of these lesions are termed gastric mesenchymal tumours of which some have innate malignant potential.Currently there is various guidance on the recommended approach to the investigation and management of these lesions and there exists multiple methods of resection.Lin et al have developed and proposed a new method of resection of these gastric mesenchymal tumours within the field of endoscopy,a procedure they have termed endoscopic calabash ligation and resection.This editorial aims to outlay the current landscape for gastric mesenchymal tumours with regards to the various guidelines and resection techniques while comparing Lin et al’s new technique to those that are already established in the field of endoscopy.Advancements in endoscopy that maintain or improve patient outcomes compared to the gold standard approach are exciting developments.Lin et al’s study suggests that their technique is comparable in regard to patient outcomes while simultaneously being more efficient in its use of hospital resources including procedural time.Whilst the data and analysis proposed in the study is promising,there are areas that need to be addressed before advocating the procedure for widespread use.However,with further studies and analysis this may be foreseeable in the future.
文摘Autoimmune hepatitis(AIH)is a rare cause of chronic liver disease.The exact pa-thophysiology of AIH is unknown.Breakdown of self-tolerance against hepatic antigens and molecular mimicry are often implicated in the pathogenesis of AIH.Immunosuppressive therapy is the mainstay of treatment;however,10%–25%of patients with AIH may not respond to primary therapy.Those patients are often salvaged with second-and third-line immunosuppressive therapy.Workup for other concomitant diseases should be done for patients who fail to respond to primary immunosuppressive therapy.Concurrent metabolic dysfunction-asso-ciated steatotic liver disease,alcohol-related liver disease,overlap syndrome(AIH with primary biliary cholangitis or sclerosing cholangitis),chronic hepatitis B virus,hepatitis C virus,and human immunodeficiency virus infection should be ruled out in such cases.Targeting the concomitant etiology may lead to resolution of the clinical symptoms and induce biochemical and histological remission.Isolated AIH without other etiologies for liver injury should be managed with a higher dose of steroids,azathioprine,or other immunosuppressive agents.Second-and third-line immunosuppressive agents include mycophenolate mofetil,cyclosporine,tacrolimus,infliximab,and rituximab.Patients with AIH may present with acute severe AIH(AS-AIH)and AIH-related acute on chronic liver failure,and they often require liver transplantation.The terms refractory or difficult-to-treat AIH have been used interchangeably and have no distinct definition.Difficult-to-treat AIH includes patients with intolerable side effects,fulminant disease(AIH with acute on chronic liver failure and AS-AIH),AIH in pregnancy,and HIV infection.Patients who fail to respond to standard first-line immunosuppressive therapy should be classified as refractory AIH.This review addresses the issues in the management of difficult-to-treat AIH with recent advances in pharmacological management.
文摘AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.METHODS A prospective,randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate(n=29),or another treatment modality(n=27;cast immobilisation with or without wires or external fixator).Outcomes were measured at 12 wk.Functional outcome scores measured were the Patient-Rated Wrist Evaluation(PRWE)Score;Disabilities of the Arm,Shoulder and Hand and activities of daily living(ADLs).Clinical outcomes were wrist range of motion and grip strength.Radiographic parameters were volar inclination and ulnar variance.RESULTS Patients in the volar locking plate group had significantly better PRWE scores,ADL scores,grip strength and range of extension at three months compared with the control group.All radiological parameters were significantly better in the volar locking plate group at 3 mo.CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities.Anatomical reduction was significantly more likely to be preserved in the plating group.Level of evidence:Ⅱ.
文摘Objective: To investigate the therapeutic potential of adipose-derived stern cells (ADSCs) for limited cutaneous scleroderma (LS) in mouse models. Methods: ADSCs were isolated from pathogen-free female C57BL/6 mice and LS was induced in wild type (WT) C57BL/6 mice via daily injection of bleomycin (0.1 mL x 300 mu g/mL) for 4 weeks; then the ADSCs were subcutaneously injected into the dorsal area in the model treatment group, and 100 mu L of phosphate buffered saline (PBS) solution was injected into the same site in the model control group. Green fluorescent protein (GFP) was used to track the cells using an in vivo imaging system on days 7, 14, 21 and 28 after transplantation. All mice were sacrificed and histologic analyses were performed after 4 weeks, and the skin thickness, collagen deposition and the total content of hydroxyproline were evaluated. Additionally, immunohistochemistry were performed to compare the tissue expression and distribution of TGF-beta 1 and VEGF between the ADSCs treatment group and the treatment control group. Results: WT C57BL/6 LS mouse model were successfully established and GFP in vivo fluorescence imaging showed that the translated ADSCs survived at the local for at least 4 weeks. Compared with the control group, the ADSCs treatment group significantly attenuated bleomycin-induced dermal fibrosis, reduced the skin thickness and the total content of hydroxyproline (P<0.05). The ADSCs treatment group displayed significantly lower levels of TGF-beta 1 and higher levels of VEGF than the control group (P<0.05). Conclusions: ADSCs may provide a feasible and practical treatment for autoimmune diseases such as LS and ameliorate dermal fibrosis.
基金Funded by Research Section,All India Institute of Medical Sciences,New Delhi,India,File No.F.8-522/A-522/2017/RS(Project code No:A-522)Dated 19th September 2017
文摘Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objective:We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same.Methods:In a cadaveric study comprising of 47 human temporal bones,canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact.The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone.The data analysis was performed using statistical software Stata version 12.0.Results:The mean ISJ angle for the 47 bones was 90.5^0(SD-15^0;range:54^0-122^0).The mean angle in well pneumatized bones was 93.7^0(SD-16.5;Range:54°-122^0)and in sclerotic mastoids was 88.7^0(SD-14;Range:68°-118^0).The difference in the ISJ angle in these two conditions was not statistically significant(p=0.27).The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ(111.4^0{SD-8.8;range:100.3^0-221.9^0};p=0.0001)and in the cases with an‘adherent/tilted morphology’of the stapes suprastructure with the promontory(mean-95.8^0(SD-13.8;range:70.7^0-120.4^0);p-<0.00001).Conclusion:The ISJ angle shows considerable variations.This variability needs to be taken into account when undertaking middle ear reconstructive procedures,specifically the ones involving the stapes footplate.The mastoid pneumatization does not appear to have an impact on the ISJ angle.
文摘Colonic polyps may arise from BRAF inhibitor treatment of melanoma, possibly due to paradoxical activation of the mitogen-activated protein (MAP)-kinase pathway. In an alternative evidence based scenario, tubular colonic adenomas with APC gene mutations have also been identified in the context of BRAF inhibitor treatment, in the absence of mutations of MAPK genes. A minority of colorectal cancers develop by an alternative “serrated polyp pathway”. This article postulates a novel hypothesis, that the established phenotypic and molecular characteristics of serrated colonic polyps/CRC offer an intriguing insight into the pathobiology of BRAF inhibitor induced colonic polyps. Serrated polyps are characterized by a CpG island methylation phenotype, MLH1 silencing and cellular senescence. They also have BRAF mutations. The contention is that BRAF inhibitor induced polyps mimic the afore-described histology and molecular features of serrated polyps with the exception that instead of the presence of BRAF mutations they induce C-RAF homodimers and B-RAF: C-RAF heterodimers.
文摘Background To document the pharmacotherapy of chronic heart failure （CHF） and to evaluate the adherence to treatment guidelines in Australian population. Methods The pharmacological management of 677 patients （female 46.7%, 75.5 ±11.6 years） with CHF was retrospectively analyzed. Results The use of angiotensin converting enzyme （ACE） inhibitors/angiotensin receptor blockers （ARB） and β-blockers were 58.2 % and 34.7 %, respectively. Major reasons for non-use of ACE inhibitors/ARBs were hyperkalemia and elevated serum creatinine level. For patients who did not receive β-blockers, asthma and chronic obstructive pulmonary disease were the main contraindications. Treatment at or above target dosages for ACE inhibitors/ARBs and β-blockers was low for each medication （40.3% and 28.9%, respectively）. Conclusions Evidenced-based medical therapies for heart failure were under used in a rural patient population. Further studies are required to develop processes to improve the optimal use of heart failure medications.
基金funded by grants awarded by University of Sri Jayewardenepura,Sri Lanka(No.ASP/01/RE/MED/2015/37,ASP/01/RE/MED/2016/48 and ASP/01/RE/MED/2017/29).
文摘Objective:To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka,during outbreaks reported between 2013 and 2017.Methods:The retrospective multi-center study was carried out during 2013-2017 in 5 selected hospitals representing 3 high endemic districts in Sri Lanka.Clinically suspected leptospirosis patients were recruited according to the Communicable Disease Epidemiology Profile Sri Lanka,WHO.Leptospirosis was confirmed by either single microscopic agglutination test titre 1:400 or by positive polymerase chain reaction(PCR)test result.Results:Out of 372 clinically suspected cases,29.00%were confirmed as leptospirosis cases by either microscopic agglutination test(50.00%)or positive polymerase chain reaction(52.77%)and 12.90%were presumptively identified as leptospirosis.Clinical symptoms(headache,vomiting,jaundice and dyspnoea)and variations in haematological parameters(haemoglobin,platelet count)and biochemical parameters(serum creatinine,serum urea,serum bilirubin and C-reactive protein)were associated with confirmed leptospirosis(P<0.05).Acute kidney injury,meningitis,myocarditis,pulmonary haemorrhage and acute liver failure was seen among 21.30%,12.04%,6.48%,6.48%,5.56%,respectively with 4.63%fatality among the leptospirosis confirmed patients.The sensitivity,specificity,positive predictive value and negative predictive value of the case definition of Ministry of Health,Sri Lanka were 96.29%,9.09%,31.13%and 85.71%,respectively,when benchmarked against either positive polymerase chain reaction or microscopic agglutination test as the gold standard.Conclusions:Acute kidney injury is the predominant complication observed among the leptospirosis confirmed patients.However,pulmonary haemorrhage is predominantly associated with mortality.The case definition of Ministry of Health,Sri Lanka is found to have higher sensitivity and enabled the screening of all probable cases of leptospirosis.
文摘Combined liver-kidney transplantation(CLKT)is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual(usually a cadaver)to the same recipient during a single surgical procedure.Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1.Atypical haemolytic uremic syndrome,methylmalonic academia,and conditions where liver and renal failure co-exists may be indications for CLKT.CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft;however,liver survival has no significant impact.Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries,acute complications are not uncommon.Bleeding,thrombosis,haemodynamic instability,infections,acute cellular rejections,renal and liver dysfunction are acute complications.The long-term outlook is promising with over 80%5-year survival rates among those children who survive the initial six-month postoperative period.
文摘AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.METHODS A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study.We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.RESULTS Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening.No other patient,injury,or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.CONCLUSION Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.
文摘Dear editor,Peripheral venous blood gas(VBG)analysis is increasingly used as an alternative to arterial sampling in Emergency Departments throughout the world.[1]There are multiple advantages using peripheral venous samples for blood gas analysis-technical ease,reduced pain and fewer complications.The difference in sample site chosen for blood gas analysis between European and Australian centres has been notable for members of our author group,prompting discussion and review of the literature.
文摘Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments causing malabsorption. The cachexia-anorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions characterized by involuntary weight loss involving fat and muscle, anorexia, early satiety, fatigue and weakness due to shifts in metabolism caused by tumour by-products and cytokines. Cachexia is a distressing and debilitating condition, affecting significant numbers of patients with advanced disease and is the primary cause of death in about 20% of all patients with cancer. Though cachexia is most commonly associated with particular tumours, such as head and neck, gastrointestinal tract, pancreas, central nervous system and lung, it may affect any patient with any tumour at any site;no patient and no tumour are excluded. Current treatment for principally depends on its prevention rather than reversing the present disease state, and the clinical results are far from being satisfactory. A careful decision based on good clinical judgement is necessary before deciding to start either enteral or parenteral nutrition, to avoid a useless, costly and difficult treatment. Treatment should be directed toward improvement in the quality of life of the patient and should often include nutritional counseling. It should take into consideration both disease and treatment related factors as well as the cachexia syndrome itself.
基金Supported by Carlos Chagas Filho Rio de Janeiro State Research Foundation(Faperj),No.100.044/2011.
文摘BACKGROUND The etiology of inflammatory bowel disease(IBD)is unknown,but it is believed to be multifactorial.The hygiene hypothesis proposes that better hygiene conditions would lead to less infectious disease during childhood and favor the development of immune-mediated diseases.AIM To test the hygiene hypothesis in IBD by assessing the environmental risk factors associated with IBD development in different regions of Brazil with diverse socioeconomic development indices.METHODS A multicenter case-control study was carried out with 548 Crohn’s disease(CD)and 492 ulcerative colitis(UC)outpatients and 416 healthy controls,from six IBD centers within different Brazilian states at diverse socioeconomic development stages.A semi-structured questionnaire with 87 socioeconomic and environmental questions was applied.Logistic regression model was created to assess the odds ratio(OR)with P value and 95%confidence intervals(CI).RESULTS Predictive variables for both diseases(CD and UC)were women[odd ratios(OR)=1.31;OR=1.69],low monthly family income(OR=1.78;OR=1.57),lower number of cohabitants(OR=1.70;OR=1.60),absence of vaccination(OR=3.11;OR=2.51),previous history of bowel infections(OR=1.78;OR=1.49),and family history of IBD(OR=5.26;OR=3.33).Associated risk factors for CD were age(18-39 years)(OR=1.73),higher educational level(OR=2.22),absence of infectious childhood diseases(OR=1.99).The UC predictive variables were living in an urban area(OR=1.62),inadequate living conditions(OR=1.48)and former smokers(OR=3.36).Appendectomy was a risk factor for CD(OR=1.58)with inverse association with UC(OR=4.79).Consumption of treated and untreated water was associated with risk of CD(OR=1.38)and UC(OR=1.53),respectively.CONCLUSION This is the first examining environmental exposures as risk factors for inflammatory bowel disease in Brazil.Most of the variables associated with disease risk support the role of the hygiene hypothesis in IBD development.
文摘Objective:To determine whether blood nitrite levels are elevated in patients with leptospirosis. Methods:Male patients Fulfilling clinical and epidemiological criteria for a diagnosis of leptospirosis were recruited.Those with MAT title of≥400 together with those seroconverting to a titer of≥200 were included in the analysis.Serum nitrite levels were measured in these patients and age.sex matched healthy controls.Results:Patients from 3 hospitals(n=75) were screened during a 3 month period from 28th June to 3rd September 2009,of whom 20 were eligible for the study.Serum nilrile levels were found to be significantly higher in patients with acute leptospirosis[n=20.(0.359±0.229)μM]compared to controls[(n= 13.(0.216±0.051)μM] (P=0.014).A significant correlation was also observed between the MAT titre and the day of illness (r = 0.547;P【0.0001).Conclusions:Serum nitrite levels are higher in patients with acute leptospirosis compared to age and sex matched controls.No correlation could be assessed with severity of illness,as sample size was inadequate to determine this.
文摘AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures.Participating physicians were invited to contribute data from their patients:baseline characteristics,ontreatment responses,sustained virological response at week 12(SVR12),and safety were collected and analysed.Multivariate analysis was performed to determine predictors of response.RESULTS:150 patients were enrolled from Australia,Malaysia,Singapore and Thailand(Asians = 86,Caucasians = 63).Overall SVR12 was 61%(Asians= 59.3%,Caucasians = 63.5%).SVR12 was higher in relapsers(78%) compared with non-responders(34%).On-treatment responses predicted SVR,with undetectable HCVRNA at week 4,8 and 12 leading to SVR12 s of 100%,87%,and 82%respectively,and detectable HCVRNA at week 4,8 and 12,leading to SVR12 s of 58%,22%and 6%respectively.Asian patients were similar to Caucasian patients with regards to on-treatment responses.Patients with cirrhosis(n= 69) also behaved in the same manner with regards to on-treatment responses.Those with the IL28 B CC genotype(80%) had higher SVRs than those with the CT/TT(56%) genotype(P = 0.010).Multivariate analysis showed that TW8 and TW12 responses were independent predictors of SVR.Serious adverse events occurred in 18.6%:sepsis(2%),decompensation(2.7%) and blood transfusion(14%).Discontinuations occurred in 30.7%,with 18.6%fulfilling stopping rules.CONCLUSION:Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80%if they have good on-treatment responses;however,discontinuations occurred in 30%because of virological failure or adverse events.
