Anorectal malformation and Hirschsprung's disease: a cross-sectional multicentre comparison of quality of life and bowel function to a healthy population

PURPOSE

Children with anorectal malformation (ARM) and Hirschsprung's disease (HD) often experience bowel symptoms into adulthood, despite definitive surgery. This study evaluates the quality of life (QOL) and bowel functional outcome of children treated for ARM and HD in comparison to healthy controls.

METHODS

Between December 2020 and February 2023, we recruited patients with ARM and HD aged 3-17 years at four tertiary referral centres, who had primary corrective surgery done >12 months prior. Healthy controls were age-matched and sex-matched. All participants completed the Pediatric Quality of Life Inventory Generic Core Scales 4.0, General Well-Being (GWB) Scale 3.0 and Family Impact (FI) Module 2.0 Questionnaires. Bowel Function Score (BFS) Questionnaires were also administered. We also performed subgroup analysis according to age categories. Appropriate statistical analysis was performed with p<0.05 significance. Ethical approval was obtained.

RESULTS

There were 306 participants: 101 ARM, 87 HD, 118 controls. Patients with ARM and HD had significantly worse Core and FI Scores compared with controls overall and in all age categories. In the GWB Scale, only ARM and HD adolescents (13-17 years) had worse scores than controls. ARM and HD had significantly worse BFSs compared with controls overall and in all age categories. There was significant positive correlation between BFS and Core Scores, GWB Scores and FI Scores.

CONCLUSION

Patients with ARM and HD had worse QOL than controls. Lower GWB Scores in adolescents suggests targeted interventions are necessary. Bowel function influences QOL, indicating the need for continuous support into adulthood.

Trends in cardiovascular mortality of cancer patients in the US over two decades 1999–2019

Background

Cancer is the second most common cause of death globally after cardiovascular (CV) disease. The present study sought to compare the trends in CV mortality between patients with and without cancer in the US over two decades (1999 to 2019), stratified by sociodemographic factors such as age, sex and geographical location.

Methods

In this retrospective study, the number of deaths, crude- and age-adjusted mortality rates between January 1, 1999, and December 31, 2019, were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data set

Results

We examined a total of 53,422,612 deaths between 1999 and 2019; of which 33.4% were defined as CV mortality and 25.6% had malignancy. During this period, among patients with cancer, the age-adjusted mortality rate dropped by 52%. (Vs, 38% in patients with no malignancy). CV mortality was highest in patients with gastrointestinal and prostate malignancy where CV mortality accounts together for over 40% of all CV mortality in patients with cancer in 1999 and 33.6% in 2019. The age-adjusted CV mortality rate (per 100,000 people) of patients with GI and prostate cancer nearly halved over twenty years from 2.7 to 1.0 and 2.5 to 1.0.

The CV age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with hematological malignancy (59–63% vs. 41%. We observed that crude CV mortality rates amongst patients with cancer declined over the study period in all age groups but was more prominent among patients over 65 years old than those aged 55–64 and under 55 (51%-55% Vs. 41%, 25%, respectively).Similar reductions in mortality in men and women (54% and 53% reduction) were observed

During the study period the decline in cardiovascular mortality was more prominent in metro areas which led to lower age adjusted CV mortality in Metro compared to non-Metro areas (5.7–6.3 vs 7.2). The decline in age adjusted CV mortality in patients with cancer differed significantly in different states

Conclusions

In our temporal analysis we show a 50% decline in CV mortality in the US over two decades in both male and female patients with cancer, that has exceeded the reduction in CV mortality seen in the non-cancer population. The greatest reductions in CV mortality were observed in patients with GI, breast and prostate malignancies, those residing in metro areas and in patients aged 65 and over.

Funding Acknowledgement

Type of funding sources: None. CV death among cancer patients

Successful therapeutic regimens for treating Brucella melitensis and Brucella abortus infections in cows

Three therapeutic regimens were evaluated in 121 cows naturally infected with Brucella melitensis or Brucella abortus, using a combination of long-acting oxytetracycline (LA-OTC), streptomycin (ST) and OTC-intramammary infusion (IMI). Cessation of shedding of Brucella in udder secretions and absence of Brucella in selected tissues were considered criteria for successful treatment. Regimen A (tested on 35 cows) consisted of LA-OTC 25 mg/kg administered intramuscularly (i.m.) every 3 days for 42 days, ST 25 mg/kg i.m. daily for 8 days, and OTC-IMI 20 ml/teat daily for 4 days. Regimen B (tested on 53 cows) was similar to regimen A, except that ST was administered every 2 days for 16 days and OTC-IMI every 2 days for 8 days. Both regimens were equally effective in eliminating Brucella organisms from all cows involved in the tests and no relapses were recorded. However, regimen C, which was similar to regimen A, except that ST was administered every 3 days for 24 days and OTC-IMI every 3 days for 12 days, resulted in the elimination of Brucella organisms from only 30 (91%) of 33 cows. Before commencement of the therapeutic regimens, B. melitensis biovar 1 or 2 had been repeatedly isolated from udder secretions of 103 cows and B. abortus biovar 1 from mammary secretions of 18 cows.

[The circulation of the hepatitis A and B viruses in the Somali population]

We report the results of a study carried out to evaluate the extent of hepatitis A virus (HAV) and hepatitis B virus (HBV) circulation in Somalia. Serum samples were collected from 593 subjects (age range 0-83 years) and tested for anti-hepatitis A (HAV) and anti-HAV IgM. Serum samples taken from 1272 individuals (age range 0-83 years) were tested for HBsAg, anti-HBsAg, anti-HBcAg, HBeAg and anti-HBeAg. We confirmed a very high rate of HAV exposure (about 90% of the subjects tested had circulating anti-HAV) as is typical of fecal-orally transmitted infectious agents. The age-specific anti-HAV IgM prevalence suggests that HAV infection is acquired very early in life. Our data also indicate a high rate of HBsAg carriers (range: 10.5%-27.4%) in the Somalian population. When all markers are considered, 60% of the adult population showed evidence of HBV exposure. HBV spreads very subtly: in fact, it is generally transmitted via non-overtly percutaneous routes. In Somalia, hepatitis A virus infection is highly endemic and occurs very early in life. Hepatitis B virus infection is also widespread in this country.

High prevalence of anti-hepatitis delta virus antibody in chronic liver disease in Somalia

We have assessed the prevalence of hepatitis delta virus (HDV) infection in people with histologically proven chronic liver disease living in Somalia. Among 104 patients studied (14 with chronic persistent hepatitis, 74 with chronic active hepatitis, and 16 with active cirrhosis), 52 were positive for hepatitis B surface antigen; of these, 26 (50%) carried anti-delta antibodies. HDV infection was detected more frequently in sera from hepatitis B e antigen (HBeAg) negative patients (60.9%) than in HBeAg positive patients (9.1%). Using the dot-blot hybridization technique, serum hepatitis B virus deoxyribonucleic acid was revealed in 73.1% of patients without HDV infection, while it was detected in only 7.7% of anti-delta positive patients. It is concluded that HDV is strongly associated with chronic liver disease in Somalia.