The Worldwide Epidemiology of Acute Appendicitis: An Analysis of the Global Health Data Exchange Dataset

BACKGROUND

This study aims to describe the worldwide epidemiology and changing disease trends of acute appendicitis (AA).

METHODS

Epidemiological data on the incidence of AA and deaths were collected from the Global Health Data Exchange repository from 1990 to 2019. Data were stratified by age, sex and Socio-Demographic Index (SDI).

RESULTS

In 2019, there were an estimated 17.7 million cases (incidence 228/100,000) with over 33,400 deaths (0.43/100,000). Both the absolute number and the incidence had increased from 1990 to 2019 (+ 38.8% and + 11.4%, respectively). The number of deaths and deaths per 100,000 declined during this period (- 21.8% and - 46.2%, respectively). These trends were largely similar in all 5 SDI groups. There was a significant difference in the incidence of AA between the SDI groups, with low SDI group having the lowest and high SDI group having the highest. The high SDI group had the lowest mortality rate (Kruskall-Wallis test, p < 0.001). The peak incidence was in the 15-19-year age group. The mortality rate increased exponentially from the third decade of life.

CONCLUSIONS

The mortality rate of AA is declining worldwide, while the incidence is increasing. The peak incidence is in the 15-19-year group.

Translation and Validation of the Sinhala Version of the EORTC-QLQ-CR29 Questionnaire

Purpose:

To validate the Sinhalese version of the EORTC QLQ-CR29 quality of life questionnaire for colorectal cancer.

Method:

We translated and pilot-tested (n=10) the questionnaire in Sri Lanka. We then assessed the reliability, factor structure and construct validity according to the EORTC guidelines. The testing was done in two tertiary care hospitals in Sri Lanka.

Results:

Of 110 participants, 103 (93%) returned the questionnaire, and 15 out of 20 (75%) returned the repeat-test questionnaire within a period of two weeks. Out of the original four scales three had better reliability than the original scales: urinary frequency (Cronbach α - 0.82), blood and mucus in stools (α-0.85), defaecation problems (α-0.76). The body image scale showed low reliability (α – 0.33). However, when one of the 3 items in the scale was omitted, it showed sufficient reliability (α – 0.74). Factor analysis showed good reliability for overall assessment of the two item scale for stool frequency (α – 0.82) and six item scale for defaecation problems (α – 0.76). Correlations between the subscales of CR29 and C30 questionnaires were below 0.40, except for body image, which correlated moderately (r-0.44) with emotional functioning. This confirmed satisfactory overall construct validity

Conclusion:

The scales for urinary frequency, blood and mucus in stools and defaecation problems which were reliable and had good validity. Body image scale failed to show sufficient reliability with the three-item scale and we suggest omitting one of the items to improve the overall reliability of the questionnaire. Construct validity was comparable to published data.

Incidence of esophageal cancer in Sri Lanka: Analysis of cancer registry data and comparison with other South Asian populations

INTRODUCTION

The objectives of this study were to report the incidence of Carcinoma of Esophagus (CaE) in Sri Lanka and to compare these values with other cancer registry data of the region and with migrant populations.

MATERIALS AND METHODS

We compared the data published by the National Cancer Control Program over the last two decades with data from the National Cancer Registry Programme of the Indian Council of Medical Research and Karachi Cancer Registry. SEERstat was used to analyze the surveillance, epidemiology and end results database to analyze data on Indian migrant population.

RESULTS

CaE was the fourth most common cancer overall and among females and third most common cancer among males. The incidence of CaE rises with age in both sexes, with a peak in the 70-74 year age group. There was a disproportionately higher number of CaE in the Tamil population (chi-square test, P < 0.00001). The commonest type of CaE in Sri Lanka was squamous cell carcinoma, Not otherwise specified (NOS) (n = 750, 70.5%), followed by adenocarcinoma, NOS (n = 83, 7.8%). India, Pakistan and Sri Lanka have comparable age-adjusted incidence and age distribution of CaE. All migrant populations had lower incidence of CaE than original population or population in their present country. Both cigarette smoking and alcohol consumption are more prevalent in Sri Lankan males than females.

DISCUSSION AND CONCLUSIONS

The incidence of CaE and its distribution among age groups in Sri Lanka was comparable to other countries of the region. Persons of Tamil ethnicity have a higher risk of developing CaE.

Three-Dimensional Anorectal Manometry Findings in Primigravida

BACKGROUND

Vaginal delivery is an identified risk factor for anal sphincter injury. Therefore, to identify postpartum injury, an antepartum value or a normal range is required. However, at present, the normal values of 3D manometry are not available for primigravida or pregnant mothers.

AIMS

Our study aims at describing normal values of 3D manometry in primigravida.

METHODS

We analyzed 3DARM data of 101 consecutive primigravid mothers in the third trimester. 3DARM was performed using the Given Imaging(®) ManoScan system.

RESULTS

The mean age was 24.7 (SD 5.1) years. All patients had a normal Cleveland Clinic Incontinence Score. The mean resting pressure (RP) was 87.02 (SD 18.43) mmHg and the maximum squeeze pressure (SP) was 179.21 (SD 52.96) mmHg. The mean length of the high-pressure zone (HPZ) was 3.67 (SD 0.52) cm. Mean volumes for initial rectal sensation, urge, and discomfort were 50.36 (± 25.57), 76.70 (± 35.17), and 143.40 (± 66.26) ml, respectively. The pressure asymmetry was highest in the lower anal sphincter and lowest in the mid-sphincter. There was a statistically significant relationship between the HPZ and RP (Pearson ρ -0.23, p = 0.01), height (Pearson ρ 0.22, p = 0.028), and weight (Pearson ρ 0.25, p = 0.012). There were no statistically significant correlations between age, height, or weight with RP, SP, or balloon fill volumes. The characteristic appearance of the normal RP and SP was clearly visualized in all patients.

CONCLUSIONS

Normal 3DARM values for Sri Lankan primigravid mothers have been established. These may be used as reference values by other investigators.

Predictors in breast cancer screening behaviors of South Asian women

AIM

Screening is important in minimizing breast cancer-related morbidity. It is prudent to identify the factors that affect women's choice in participation in mammographic screening. Our objective was to identify the factors that influence the breast screening behaviors in Sri Lankan women.

METHODS

Data on referral, sociodemographic factors and relevant personal history of all the women visiting a single mammography center were prospectively collected during a 4-year period.

RESULTS

Of the 2695 participants, 1580 had sought mammographic services for screening purposes while 1115 were due to symptoms. A majority had Advanced Level (AL) or higher education (n = 1570, 58.3%) and were parous. Only a minority had past history (n = 221, 8.2%) or family history (n = 357, 13.3%) of breast cancer. Majority has normal mammographic findings with detection of 289 (10.7%) benign lesions. The mean age was 50.2 years in screening participants, 45.9 years in symptomatic women. Use of hormone replacement therapy, age >50 years, AL or higher education, having had undergone hysterectomy, past history of breast cancer, family history of breast cancer, family history of other cancer and self-referral were statistically significant contributors to mammography participation. In the logistic regression analysis age >50 years, AL or higher education, premenopausal status, having undergone hysterectomy and self-referral were significantly associated with screening participation and the model predicted 72.1% of the cases accurately.

CONCLUSION

Five statistically significant predictors of mammographic screening among Sri Lankan women were identified. These suggest that higher health awareness and exposure to health care providers are important predictors.

Factors influencing the approaches to studying of preclinical and clinical students and postgraduate trainees

BACKGROUND

Students can be classified into three categories depending on their approaches to studying; namely, deep approach (DA), strategic approach (SA) and surface apathetic or superficial approach (SAA). The aim of this study was to identify factors affecting the approaches to studying among Sri Lankan medical undergraduates and post graduate trainees and to analyze the change in the pattern of study skills with time and experience.

METHOD

Pre-clinical and clinical students of the Faculty of Medicine, University of Colombo and postgraduate trainees in Surgery at the National Hospital of Sri Lanka were invited to complete the Approaches and Study Skills Inventory for Students (ASSIST) questionnaire.

RESULTS

A total of 187 pre clinical (M: F = 96:91), 124 clinical (M: F = 61:63) and 53 post graduate trainees (M: F = 50:3) participated in the study. Approaches of male and female students were similar. SA was significantly affected by age among the preclinical students (p = 0.01), but not in other groups. Among pre-clinical students, males preferred a teacher who supported understanding (p = 0.04) but females preferred a passive transmission of information (p < 0.001). This, too, was not visible among other groups. A linear regression performed on group (batch), gender, island rank at GCE Advance Level (AL) examination, self appraisal score and the preference scores of type of teacher only managed to explain 35% or less of variance observed for each approach in individual groups.

CONCLUSION

Different factors affect the approach to studying in different groups but these explain only a small fraction of the variance observed.