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A Review of Preoperative Embolization Effectiveness in Patients With Arteriovenous Malformations. Neurosurgery 2024; 94:129-139. [PMID: 37522732 DOI: 10.1227/neu.0000000000002629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/01/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Preoperative embolization of arteriovenous malformations (AVMs) remains controversial. This study sought to analyze the cost-effectiveness of preoperative embolization of AVMs. METHODS Patients who underwent AVM resection at a single institute (January 1, 2015-December 31, 2020) were analyzed. Patients with preoperative embolization (embolization cohort) were compared with those without preoperative embolization (nonembolization cohort). Cost-effectiveness score (CE) was the primary outcome of interest and was determined by dividing the total 1-year cost by effectiveness, which was derived from a validated preoperative to last follow-up change in the modified Rankin Scale utility score. A lower CE signifies a more cost-effective treatment strategy. RESULTS Of 188 patients, 88 (47%) underwent preoperative embolization. The mean (SD) total cost was higher in the embolization group than in the nonembolization group ($117 594 [$102 295] vs $84 348 [$82 326]; P < .001). The mean (SD) CE was higher in the embolization cohort ($336 476 [$1 303 842]) than in the nonembolization cohort ($100 237 [$246 255]; P < .001). Among patients with Spetzler-Martin (SM) grade I and II AVMs, the mean (SD) CE was higher in the embolization (n = 40) than in the nonembolization (n = 72) cohort ($164 950 [$348 286] vs $69 021 [$114 938]; P = .004). Among patients with SM grade III AVMs, the mean (SD) CE was lower in the embolization (n = 33) than in the nonembolization (n = 25) cohort ($151 577 [$219 130] vs $189 195 [$446 335]; P = .006). The mean (SD) CE was not significantly different between cohorts among patients with higher-grade AVMs (embolization cohort [n = 3] vs nonembolization cohort [n = 15]: $503 639 [$776 492] vs $2 048 419 [$4 794 758]; P = .49). The mean CE for embolized SM grade III aneurysms was nonsignificant in the ruptured group; however, for the unruptured group, CE was significantly higher in the embolization cohort (n = 26; $160 871 [$240 535]) relative to the nonembolization cohort (n = 15; $108 152 [$166 446]) ( P = .006). CONCLUSION Preoperative embolization was cost-effective for patients with SM grade III AVMs but not for patients with lower-grade AVMs.
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Changing epidemiology and trends in incidence of thyroid cancer in England, 1985-2019. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Thyroid cancer is 2-3 times more common in females and is currently the fastest growing cancer worldwide. Exposure to ionizing radiation is the only established risk factor for thyroid cancer. Other factors include obesity, history of benign thyroid conditions, and family history. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of thyroid cancer in England during the past four decades.
Methods
Individual level data for patients diagnosed with thyroid cancer in England during 1985-2019 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates were calculated by two age categories (0-49, 50+ years) and all ages combined during the seven five-year time periods (1985-89 to 2015-19). The percentage change in incidence was calculated as change in the average annual incidence rate from the first (1985-89) to the last time period (2015-19).
Results
During the 35-year study period, a total of 58,710 new cases of thyroid cancer were registered in England (27.3% males, 72.7% females). In young people aged 0-49 years, the average annual incidence rates increased by 375% in males and 438% in females (from 0.4/100,000 in 1985-89 to 1.9/100,000 in 2015-19 in males and from 1.3/100,000 in 1985-89 to 7.0/100,000 in 2015-19 in females). In older people aged 50+ years, the rates increased by 146% in males and 171% in females (from 2.4/100,000 in 1985-89 to 5.9/100,000 in 2015-19 in males and from 4.1/100,000 in 1985-89 to 11.1/100,000 in 2015-19 in females).
Conclusions
There has been a steady and substantial increase in the incidence of thyroid cancer in England over the past four decades. The largest increase in incidence was observed in young people aged 0-49 years. Some of this increase is due to enhanced surveillance and sensitive diagnostic methods, but other factors (e.g., obesity and history of benign thyroid conditions) need to be considered.
Key messages
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Changing epidemiology and trends in incidence of kidney cancer in England, 1985-2019. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Kidney cancer is the 7th most common cancer in the UK, accounting for 4% of all new cancer cases. The risk factors for kidney cancer include obesity, smoking, hypertension, and exposure to certain environmental and occupational carcinogens. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of kidney cancer in England during the past four decades.
Methods
Individual level data for patients diagnosed with kidney cancer in England during 1985-2019 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates were calculated by two age categories (0-49, 50+ years) and all ages combined during the seven five-year time periods (1985-89 to 2015-19). The percentage change in incidence was calculated as change in the average annual incidence rate from the first (1985-89) to the last time period (2015-19).
Results
During the 35-year study period, a total of 197,819 new cases of kidney cancer were registered in England (62.4% males, 37.6% females). In young people aged 0-49 years, the average annual incidence rates increased by 164% in males and 144% in females (from 1.4/100,000 in 1985-89 to 3.7/100,000 in 2015-19 in males and from 0.9/100,000 in 1985-89 to 2.2/100,000 in 2015-19 in females). In older people aged 50+ years, the rates increased by 129% in males and 147% in females (from 24.5/100,000 in 1985-89 to 56.0/100,000 in 2015-19 in males and from 11.9/100,000 in 1985-89 to 29.4/100,000 in 2015-19 in females).
Conclusions
There has been a steady and significant increase in the incidence of kidney cancer in England over the past four decades. The largest increase (164%) was observed in young males aged 0-49 years, which was unexpected. Considering the risk factors for kidney cancer, further research is needed to understand the role of environmental/occupational exposures in causing kidney cancer.
Key messages
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Trends in incidence of cervical cancer in England, 1985-2019. Eur J Public Health 2022. [PMCID: PMC9594791 DOI: 10.1093/eurpub/ckac131.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Worldwide, cervical cancer is the 4th most common cancer in women. The highest incidence is observed in Africa (25.6/100,000) and the lowest in North America (6.1/100,000). Over 99% of cases are caused by human papillomavirus (HPV). In the UK, HPV vaccination has been offered to school children aged 12-13 years since 2008. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of cervical cancer in England during the past four decades. Methods Individual level data for women diagnosed with cervical cancer in England during 1985-2019 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates were calculated by two age categories (0-49, 50+ years) and all ages combined during the seven five-year time periods (1985-89 to 2015-19). The percentage change in incidence was calculated as change in the average annual incidence rate from the first (1985-89) to the last time period (2015-19). Index of Multiple Deprivation (IMD) quintiles (2015-19) were examined to determine the social gradient of the disease. Results During the 35-year study period, a total of 100,303 women with cervical cancer were registered in England. In women aged 0-49 years, the average annual incidence rates declined by about 20% (from 11.6/100,000 in 1985-89 to 9.3/100,000 in 2015-19), and in women aged 50+ years, the rates declined by about 64% (from 26.1/100,000 in 1985-89 to 9.5/100,000 in 2015-19). At all ages combined, the rate declined by 43%. With regard to the social gradient, about half of the cases occurred in women in the most deprived quintiles. Conclusions There has been a steady decline in the incidence of cervical cancer in England over the past four decades. These findings are consistent with reports from other Western countries. The finding of relatively increased risk of cervical cancer among women from most deprived communities needs further investigation. Key messages • Considering that over 99% of cervical cancers are potentially preventable, there is an urgent need to support low- and middle-income countries to roll out HPV vaccination programme. • The difference in risk of cervical cancer by social gradient highlights the importance of reducing health and social inequalities.
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Changing epidemiology and trends in incidence of oesophageal cancer in England, 1985-2017. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The incidence of oesophageal cancer has been steadily increasing over the past 30 years in many countries. The UK has the highest incidence of oesophageal adenocarcinoma in the world which is associated with obesity and gastro-oesophageal reflux disease. The study aimed to determine trends in the incidence of oesophageal cancer in England between 1985-2017.
Methods
Individual-level data for patients diagnosed with oesophageal cancer in England were obtained from the Office for National Statistics/Public Health England. The national population-based cancer registry data were analysed to determine changes in oesophageal cancer incidence (ICD-10 code: C15) by sex, age (0-49, 50+) and histological subtype. Percentage change in incidence rates was calculated using the change in average annual incidence rate from the first (1985-89) to the last time period (2015-17).
Results
During the 33-year study period, 199,489 cases of oesophageal cancer were registered in England (63.5% males, 36.5% females) with adenocarcinoma accounting for 50.9% of cases. The average annual number of cases increased from 4595/year in 1985-89 to 7612/year in 2015-17. The average annual incidence rates increased by 42%, from 9.7/100,000 in 1985-89 to 13.8/100,000 in 2015-17. The incidence of adenocarcinoma increased by 77%, from 4.6/100,000 in 1985-89 to 8.1/100,000 in 2015-17. The incidence of squamous-cell carcinoma was unchanged. The steepest increase in adenocarcinoma was observed in males (more than two-folds as compared to females).
Conclusions
Over the study period, there was an increase in the incidence of oesophageal cancer in England. The largest increase was seen in rates of adenocarcinoma. Considering obesity has a strong temporal association with oesophageal adenocarcinoma, further research is needed to understand the biological mechanisms of this association to inform public health efforts to reduce the prevalence of obesity.
Key messages
Further research and analysis of routinely collected data on histological subtypes of oesophageal cancer can provide insight into the increasing trend in incidence. Considering the strong association between obesity and oesophageal adenocarcinoma, this research highlights the benefits of reducing the prevalence of obesity.
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Trends in incidence of uterine cancer in England, 1985-2017. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cancer of the corpus uteri (hereafter, uterine cancer) is the fourth most common cancer in women in the UK, accounting for 5% of all cancers in women. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of uterine cancer in England during the past four decades.
Methods
Individual level data for women diagnosed with uterine cancer in England during 1985-2017 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates were calculated by two age categories (0-49, 50+ years) and all ages combined during the six five-year time periods (1985-89 to 2010-14) and the recent three-year period (2015-17). The percentage change in incidence was calculated as change in the average annual incidence rate from the first (1985-89) to the last time period (2015-17). Index of Multiple Deprivation (IMD) quintiles (2015-17) were examined to determine the social gradient of the disease.
Results
During the 33-year study period, a total of 169,768 women with uterine cancer were registered in England. In women aged 0-49 years, the average annual incidence rates increased by about 51% (from 1.8/100,000 in 1985-89 to 2.8/100,000 in 2015-17), and in women aged 50+ years, the rates increased by about 74% (from 39.0/100,000 in 1985-89 to 67.7/100,000 in 2015-17.). At all ages combined, the rates increased by 88%. With regard to the social gradient, in the young age group the highest proportion (46%) of cases occurred in women from the most deprived areas, whereas in the older age-group the highest proportion (43%) occurred in women from the least deprived areas.
Conclusions
There has been a steady and substantial increase in the incidence of uterine cancer in England over the last four decades. The observed dichotomy in risk between the young and older women by social gradient needs further investigation.
Key messages
Considering that 34% of the cases of uterine cancer in the UK are associated with obesity, the study informs formulation of public health programmes to reduce the prevalence of obesity. The difference in risk between the young and older women by social gradient highlights the importance of reducing health and social inequalities.
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COVID-19 infection in ethnic minorities: A systematic review of age and gender distribution. Eur J Public Health 2021. [PMCID: PMC8574885 DOI: 10.1093/eurpub/ckab164.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Currently, there have been 135,646,617 cases of COVID-19 infection and 2,930,732 deaths in the world. Compared with the White populations, members of the ethnic minorities living in Europe and North America are disproportionately diagnosed, hospitalized and dying from COVID-19. The reasons for this relatively increased risk of infection and adverse outcome are poorly understood. The aim of this review is to summarise current epidemiological evidence on age and gender distribution in ethnic minority patients hospitalized with COVID-19 infection.
Methods
Multiple electronic databases were searched. Data from studies, published in any language, reporting the risk factors, incidence and outcomes of COVID-19 infection in hospitalized White and ethnic minorities patients were extracted, reviewed and compiled.
Results
36 studies reporting data on age and 26 on gender were included in the review. Ethnic minority patients hospitalized with COVID-19 were relatively younger than White patients. Within the different minority groups, a greater proportion of Black patients were female, whereas a greater proportion of Asian patients were male.
Conclusions
This review confirms findings from individual studies that with regard to age, the ethnic minority patients hospitalized with COVID-19 infection are relatively younger than the White patients. There is also a disparity with regard to gender within the different minority groups.
Key messages
There is a disparity with regard to age and gender between the different ethnic groups affected with COVID-19 infection in Europe and North America. Potential factors for disparities are genetics, vitamin D deficiency, BCG vaccine, comorbidities, occupation, social gradient, housing, PPE access and understanding/compliance to protection measures.
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Prevalence of autism in Europe, North America and Oceania, 2000-2020: A systematic review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Since the first study of the prevalence of autism spectrum disorder (ASD) in 1966, several studies from across the world have reported increasing prevalence of ASD in children. This has led to a debate whether childhood ASD cases are increasing in real time or the increase is essentially due to improved accessibility/referral to health services or changes in diagnostic criteria and accuracy.
Methods
MEDLINE and PSYCINFO databases were searched for studies of ASD prevalence estimates in Europe, North America and Oceania published during 2000-2020 (including prevalence data for 1993-2019). Data including age at diagnosis, gender, ethnicity, diagnostic criteria/tools, method(s) of case detection and prevalence per 10,000 population were extracted.
Results
75 studies, reporting a wide range of prevalence estimates, were included in the review. Overall, there was a steady and substantial increase in the prevalence of ASD in Europe, North America and Oceania during the last three decades. For Europe, the median prevalence was 59 per 10,000 population (range, 8 to 420; mean, 80). For North America, the median prevalence was 86 per 10,000 population (range, 11 to 247; mean, 95). For Oceania, the median prevalence was 47 per 10,000 population (range, 10 to 390; mean, 112). Overall, the prevalence was higher in White children compared to other ethnic groups.
Conclusions
It appears that several factors can be attributed to increasing prevalence of ASD in Europe, North America and Oceania. Some of the increase is likely due to increased case ascertainment, but other factors need further investigation to determine the reason(s) for increasing prevalence of ASD.
Key messages
There is a wide variation in the prevalence of ASD in populations of Europe, North America and Oceania. This is partly explained by differences in case ascertainment and sociodemographic factors. The differences in prevalence between ethnic groups need further investigation.
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Relationship Between Mobile Digital Sensor Monitoring and Perioperative Outcomes: Systematic Review. JMIR Perioper Med 2021; 4:e21571. [PMID: 33629966 PMCID: PMC7952235 DOI: 10.2196/21571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/07/2021] [Accepted: 01/29/2021] [Indexed: 12/26/2022] Open
Abstract
Background Monitoring surgical recovery has traditionally been confined to metrics measurable within the hospital and clinic setting. However, commercially available mobile sensors are now capable of extending measurements into a patient’s home. As these sensors were developed for nonmedical applications, their clinical role has yet to be established. The aim of this systematic review is to evaluate the relationship between data generated by mobile sensors and postoperative outcomes. Objective The objective of this study is to describe the current use of mobile sensors in the perioperative setting and the correlation between their data and clinical outcomes. Methods A systematic search of EMBASE, MEDLINE, and Cochrane Library from inception until April 2019 was performed to identify studies of surgical patients monitored with mobile sensors. Sensors were considered if they collected patient metrics such as step count, temperature, or heart rate. Studies were included if patients underwent major surgery (≥1 inpatient postoperative day), patients were monitored using mobile sensors in the perioperative period, and the study reported postoperative outcomes (ie, complications and hospital readmission). For studies including step count, a pooled analysis of the step count per postoperative day was calculated for the complication and noncomplication cohorts using mean and a random-effects linear model. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess study quality. Results From 2209 abstracts, we identified 11 studies for review. Reviewed studies consisted of either prospective observational cohorts (n=10) or randomized controlled trials (n=1). Activity monitors were the most widely used sensors (n=10), with an additional study measuring temperature, respiratory rate, and heart rate (n=1). Low step count was associated with worse postoperative outcomes. A median step count of around 1000 steps per postoperative day was associated with adverse surgical outcomes. Within the studies, there was heterogeneity between the type of surgery and type of reported postoperative outcome. Conclusions Despite significant heterogeneity in the type of surgery and sensors, low step count was associated with worse postoperative outcomes across surgical specialties. Further studies and standardization are needed to assess the role of mobile sensors in postoperative care, but a threshold of approximately 1000 steps per postoperative day warrants further investigation.
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Antiseizure drug efficacy and tolerability in established and novel drug discovery seizure models in outbred vs inbred mice. Epilepsia 2020; 61:2022-2034. [PMID: 32757210 PMCID: PMC7722177 DOI: 10.1111/epi.16624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Initial identification of new investigational drugs for the treatment of epilepsy is commonly conducted in well-established mouse acute and chronic seizure models: for example, maximal electroshock (MES), 6 Hz, and corneal kindling. Comparison of the median effective dose (ED50) of approved antiseizure drugs (ASDs) vs investigational agents in these models provides evidence of their potential for clinical efficacy. Inbred and outbred mouse strains exhibit differential seizure susceptibility. However, few comparisons exist of the ED50 or median behaviorally impairing dose (TD50) of prototype ASDs in these models in inbred C57Bl/6 vs outbred CF-1 mice, both of which are often used for ASD discovery. METHODS We defined the strain-related ED50s and TD50s of several mechanistically distinct ASDs across established acute seizure models (MES, 6 Hz, and corneal-kindled mouse). We further quantified the strain-related effect of the MES ED50 of each ASD on gross behavior in a locomotor activity assay. Finally, we describe a novel pharmacoresistant corneal-kindling protocol that is suitable for moderate-throughput ASD screening and demonstrates highly differentiated ASD sensitivity. RESULTS We report significant strain-related differences in the MES ED50 of valproic acid (CF-1 ED50: 90 mg/kg [95% confidence interval (CI) 165-214] vs C57Bl/6: 276 mg/kg [226-366]), as well as significant differences in the ED50 of levetiracetam in the pharmacoresistant 6 Hz test (CF-1: 22.5 mg/kg [14.7-30.2] vs C57Bl/6: >500 mg/kg [CI not defined]). There were no differences in the calculated TD50 of these ASDs between strains. Furthermore, the MES ED50 of phenobarbital significantly enhanced locomotor activity of outbred CF-1, but not C57Bl/6, mice. SIGNIFICANCE Altogether, this study provides strain-related information to differentiate investigational agents from ASD standards-of-care in commonly employed preclinical discovery models and describes a novel kindled seizure model to further explore the mechanisms of drug-resistant epilepsy.
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How do people perceive their everyday wellbeing? Relevance for public health research and policy. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Factors associated with obesity in children in Brighton & Hove: An analysis of cross-sectional data. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Trends in Incidence of Primary Liver Cancer in the Elderly (Aged 65+ Years) in England, 1971-2010. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.69000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: About 45% of the cases of liver cancer in England are diagnosed in the elderly. Since the 1990s, there has been a substantial increase in the incidence of liver cancer, and it has been projected that the incidence of rates will continue to increase to 15/100,000 by 2035. Aim: To determine the trends of incidence of liver cancer in the elderly in England during the period 1971-2010. Methods: Population-based national cancer registration data (obtained from the Office for National Statistics) were analyzed to determine the incidence of liver cancer (ICD-9 code: 155, ICD-10 code: C22) by age, gender, morphologic subtype and level of deprivation. Microsoft Excel and SPSS software were used for the analysis. Results: During the 40-year period, a total of 42,800 cases of liver cancer in the elderly were registered in England (58% male, 42% female). The number of cases increased by 462% - from 2,019 in 1971-75 (404 cases/year) to 11,345 in 2006-10 (2269 cases/year). The incidence rate (per 100,000) increased from 9.0 in 1971-75 to 37.4 in 2006-10 in males (316% increase); and from 4.6 to 19.6 in females (326% increase). In males, the incidence rates of liver cell carcinoma (ICD-10 code: C22.0) increased by 140% and the intrahepatic bile duct carcinoma (ICD-10 code: C22.1) by 2467%; whereas in females the incidence rates increased by 22% and 2260%, respectively. As for level of deprivation, the largest increase in incidence was observed in the least deprived population (721% in males, 690% in females). Conclusion: During the past four decades, there has been a remarkable increase in the incidence of liver cancer in the elderly in England. The relatively large increase in liver cell carcinoma in males, those in the least deprived category, and substantial increase in intrahepatic bile duct carcinoma in both genders warrant further investigation. These findings are also relevant for the planning of oncology services, resource allocation, screening for early diagnosis and public health education for primary prevention of liver cancer.
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Is subjective wellbeing associated with depression? A cross-sectional survey in southeast England. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Parent's use of the Internet in the search for healthcare information and subsequent impact on the doctor-patient relationship. Ir J Med Sci 2017; 186:821-826. [PMID: 28130665 DOI: 10.1007/s11845-017-1555-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Internet is an unavoidable source of healthcare information. This information, both reliable and unreliable, has previously been shown to influence carer's decisions. AIMS Our aim was to evaluate this information seeking behavior among parents and its subsequent potential impact on the doctor-patient relationship. METHOD We undertook a cross-sectional questionnaire-based survey of paediatric outpatients. Enrollment took place over 4 weeks in March 2015. There were no inclusion or exclusion criteria and enrollment was voluntary. In total 100 questionnaires were completed. RESULTS General Practitioners were the most common source of healthcare information. The Internet ranked third as a reliable source of healthcare information. The Internet was commonly used as an educational resource to learn about causes, treatment, and medications. A significant percentage of our population expressed concern regarding Internet information reliability. A small percentage of parents were concerned that disclosing Internet usage may worsen the relationship with their doctor. CONCLUSIONS Parents showed a willingness to learn about diseases and treatments, and felt that the Internet was a good resource to do so. This study shows that open discussion about Internet usage between parents and doctors is not common and carers feel at risk of judgment should they admit to Internet usage. The Internet should be seen as a positive adjunct to patient education which can improve understanding, thus strengthening the doctor-patient relationship. The Internet will never replace the role of healthcare professionals but must be seen as an integral part of a multi-disciplinary approach.
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Factors associated with clustering of multiple health-risk behaviours in young people in England. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw175.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Prevalence and pattern of performance-enhancing drugs use in a sample of British medical students. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv172.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Minority Status as a Determinant of Tobacco-Caused Health Inequalities: A Global Perspective. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Alcohol-related hospital admissions in England by age, sex, local authority and socioeconomic status. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clustering of unhealthy behaviours over time: An analysis of health and wellbeing surveys in Southeast England, 2003 and 2012. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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PP11 Association between atopic disorders and childhood type 1 diabetes: A population-based case control study in the Middle East. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Anaplastic Thyroid Cancer: a Retrospective analysis of 120 cases. Gulf J Oncolog 2014; 1:32-37. [PMID: 24610286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Anaplastic Thyroid Cancer (ATC) is one of the most lethal malignancies with very short survival and extremely poor treatment outcome. ATC accounts for 2-5% of all thyroid cancers worldwide with an annual incidence of about 2 million. OBJECTIVE To review the natural history and treatment outcome of ATC patients treated at King Faisal Specialist Hospital and Research Centre (KFSH and RC) located at Riyadh, Saudi Arabia. MATERIAL AND METHODS Retrospective review of 120 Saudi cancer patients collected from registry data at KFSH & RC from 1976-2008. Search key words included: thyroid cancer, anaplastic, undifferentiated and not otherwise specified. Search was not restricted to particular age, gender, treatment or tumor size. Demographic information, baseline patient characteristics including date of diagnosis, type of treatment and date of death were obtained from KFSH & RC registry data and Saudi death registry. RESULTS A total of 120 cases were identified at our cancer centre from 1976 to 2008. Of these total, 73 were females (60.8%) and 47 were males (39.2%). The average age at diagnosis was 63.34 +/- 12.8 years. Thirty-four patients underwent surgery (28.3%), 52 had a palliative radiation treatment (43.3%) and only 5 had chemotherapy (4.2%). The median survival was 53 days (0-457). CONCLUSION Our review proves that ATC is rapidly fatal cancer and is unresponsive to currently available therapeutic options. More research is needed to understand the tumor biology and novel treatment options. KEYWORDS thyroid cancer, anaplastic, undifferentiated, radiation treatment, chemotherapy, median survival, Riyadh and Saudi Arabia.
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OP02 Women’s Views on Smoking Cessation Services and National Tobacco Control Measures. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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PP53 Predictive Risk Modelling of Childhood Overweight or Obesity at age 10-11 years: An Epidemiological Analysis of National Child Measurement Programme and Birth Notification Data. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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PP75 What Factors are Important in Smoking Cessation and Relapse in Women from Deprived Communities? – A Qualitative Study. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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THE SIGNIFICANCE OF EPIDERMAL GROWTH FACTOR RECEPTOR AND SURVIVIN EXPRESSION IN BLADDER CANCER TISSUE AND URINE CYTOLOGY OF PATIENTS WITH TRANSITIONAL CELL CARCINOMA OF THE URINARY BLADDER. EAST AFRICAN MEDICAL JOURNAL 2013; 90:19-27. [PMID: 26862626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess whether epidermal growth factor receptor (EGFR) and survivin immunostaining of tumour cells in urinary cytology and tissue of patients with bladder cancer has a prognostic significance. DESIGN Prospective study SETTING Department of Surgery (Division of Urology), Mubarak Al-Kabeer Teaching Hospital and Faculty of Medicine, Kuwait University, Kuwait SUBJECTS Urine cytology smears obtainedpriorto cystoscopy in patients with transitional cell carcinoma (TCC) of the bladder were immunostained for EGFR and survivin. Bladder cancer tissue resected at surgery was also immunostained for EGFR and survivin expression. Tissue expression of EGFR and survivin in TCC of the bladder was compared to their expression in urine cytology and relationship to tumour grade and stage. RESULTS 178 patients were studied (43 newly diagnosed bladder cancer, 58 with recurrent TCC and 77 in disease remission). Twenty five patients with normal urothelium served as controls. The mean sensitivity of urine cytology, tissue survivin immunohistochemistry (IHC) and tissue EGFR IHC was 30.5%, 62% and 59% respectively. The corresponding mean specificity was 95%, 79% and 38% respectively. For grades 1, 2 and 3 bladder tumors, tissue expression positivity for EGFR was 47.8%, 92.9%, 100% and for tissue survivin it was 27.8%, 18.2% and 33.3% respectively. For grades 1, 2 and 3 bladder tumors, urine expression positivity for EGFR was 35.7%, 40% and 67.7% and for urine survivin it was 8.3%, 42.9% and 33.3% respectively. CONCLUSION Positive EGFR immunostaining of urine cytology specimen or tumour tissue increases with histological grade of TCC of the bladder. Survivin expression is less consistent in both urine cytology specimen and tissue samples. EGFR immunostaining may provide a useful tool in the grading of bladder TCC and aid in the selection of patients that may benefit from administration of EGFR inhibitors.
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Factors Associated With Smoking Relapse in the Postpartum Period: An Analysis of the Child Health Surveillance System Data in Southeast England. Nicotine Tob Res 2012; 15:904-9. [DOI: 10.1093/ntr/nts221] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sonographic fetal biometry charts for a Pakistani cohort. EASTERN MEDITERRANEAN HEALTH JOURNAL 2012; 17:969-75. [PMID: 22355951 DOI: 10.26719/2011.17.12.969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study aimed to develop growth centiles at different gestational weeks for fetal biparietal diameter, abdominal circumference, femur length and head circumference in a Pakistani cohort. Data were collected at a tertiary referral hospital from pregnant women at gestational ages 13-40 weeks referred for obstetric ultrasound as a part of routine antenatal care. A total of 1599 fetal sonographic biometric measurements were collected after screening for the inclusion criteria. For each measurement, separate regression models were derived to estimate the mean, standard deviation and reference percentiles at each week of gestational age for this cohort. The best fitting model for each variable was selected. These charts will help radiologists and clinicians in predicting dates of delivery, assessing fetal growth and identifying intrauterine fetal insufficiency in the Pakistani population.
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P2-186 Maternal use of vitamins during pregnancy and the risk of type 1 diabetes in offspring. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P1-326 100 Years of suicide in Brighton and Hove, England. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976f.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Staging of prostatic adenocarcinoma with radical prostatectomy specimens in Pakistan. Asian Pac J Cancer Prev 2009; 10:551-554. [PMID: 19827867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES Data for pathological staging of radical prostatectomy specimens reported in the Section of Histopathology of a large tertiary care hospital in Pakistan were compared with sextant biopsy findings to determine whether clinically localized disease is actually localized pathologically. DESIGN A study was conducted of radical prostatectomy specimens reported in the Section of Histopathology from Jan 2001 to July 2008, with cases staged according to the pathologic TNM staging system. Other variables such as amount of tumor in prostatectomy specimens and lobes affected were also determined. RESULTS Out of 65 cases, 83.3% were clinical stage TIc. 29.2% were pT3a, 24.6% were pT3b and 3.1% were pT4. Therefore, in the majority of cases, disease was not localized to the prostate and perineurial invasion was seen in all. Comparison with biopsy results showed Gleason's grade to be altered in 20% cases. CONCLUSIONS The large majority of prostatic carcinomas in Pakistan are advanced cancers with pathologic stage more advanced than evident on clinical staging. On average, tumors involved 35-40% of the prostate with a particular preponderance in posterior lobes.
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High-risk behaviours among juvenile prison inmates in Pakistan. Public Health 2009; 123:470-475. [PMID: 19615706 DOI: 10.1016/j.puhe.2009.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 05/04/2009] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the sexual- and drug-use-related risk behaviours of male juvenile detainees in Karachi, Pakistan. DESIGN Cross-sectional study. METHODS A cross-sectional study was conducted of prison inmates aged 15-21 years in Karachi Juvenile Prison in 2002. In total, 321 inmates were interviewed about sexual orientation and behaviours, and knowledge about human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). Urine specimens were collected and tested for Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction. RESULTS A substantial proportion (n=111, 34.6%) of the participants were sexually active. Sixty-two (19%) and 67 (21%) had had sex with a male or female before incarceration, respectively. Twenty-seven (8.4%) participants had an STI, and 50% of the 109 sexually active participants had had multiple sexual partners. Use of addictive substances was associated with sexual activity. The mean knowledge score computed from the sum of 16 items was 4.7, with a median of 2.9. A large proportion (40%) of participants knew about condoms, but very few (3.4%) had ever used one. The mean+/-standard deviation risk score from nine items was 2.4+/-1.7. On the basis of behavioural and biological markers, 117 (36.4%) participants had high-risk behaviour. In multivariate logistic regression analysis, knowledge, risk perception and age were predictive of higher risk. CONCLUSIONS HIV risk behaviours are common among adolescent inmates. Although inmates do have knowledge about modes of transmission and condom use, the use of condoms is significantly low. Interventions are needed for behavioural change among this group.
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Severe acute maternal morbidity and intensive care in a public sector university hospital of Pakistan. J Ayub Med Coll Abbottabad 2008; 20:109-112. [PMID: 19024201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The study was planned to review the case series of pregnant women requiring intensive care due to severe acute maternal morbidity in the public sector university hospital, in order to identify failures and priorities in maternal health care provision in Pakistan. METHODS A retrospective case series study was performed of critically ill obstetrics patients admitted to general intensive care unit of Liaquat University Hospital Hyderabad, Pakistan, from January 1st to 31st December 2006. Data included demographics, disease responsible for critical illness, complications that prompted ICU admissions, intervention required, length of ICU stay and the resulting foeto-maternal mortality and morbidity. RESULTS Over the study period, 30 obstetric patients were transferred to general ICU, representing 1.34% of 2224 deliveries. Seventy three % of women belonged to rural areas, 96% were un-booked while history of surgical intervention was present in 87% of cases. Hypertensive disorders of pregnancy (50%) and sepsis (17%) were the two main obstetrical conditions responsible for maternal illness. Respiratory failure (57%) and haemodynamic instability (40%) were the major indications for ICU transfer. Mechanical ventilatory support was the commonest intervention required in the ICU followed by the ionotropic support (33%). The foetal mortality rate was 43%, while maternal mortality rate was 33%. CONCLUSION Maternal morbidity and mortality can be reduced by meticulous adaptation of safe motherhood initiative, provision of separate ICU services for critically ill obstetrical patients and early assessment and aggressive intervention through a team approach involving obstetricians, intensivists and anaesthetists.
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Authors' reply. J Minim Access Surg 2007; 3:178-9. [PMID: 19789681 PMCID: PMC2749203 DOI: 10.4103/0972-9941.38914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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MP-03.08: Predictors of blood transfusion in percutaneous nephrolithotomy (PCNL). Urology 2007. [DOI: 10.1016/j.urology.2007.06.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Renal lymphangiectasia is a benign disorder of renal lymphatics. Seldom observed, the pathophysiology is unclear. The clinical course may vary, and management alternatives range from percutaneous drainage in symptomatic cases to pharmacological substitutes in the form of anti-hypertensives and diuretics. We present a case of bilateral perinephric collections on imaging, which presented with gross ascites, abdominal pain and reversible hypertension. Ultrasound examination indicated ascites. Computerized tomography revealed bilateral symmetrical large perinephric collections. This is consistent with the appearance of renal lymphangiectasis (enlarged kidneys with fluid collections seen to be abutting the surrounding structures) reported in the literature. Needle aspiration of the perinephric fluid was undertaken, and laboratory analysis was carried out, which revealed a protein level of 643 mg dl(-1) and a total leucocyte count of 50, of which 80% were lymphocytes. Thereafter, a diagnosis of renal lymphangiectasia was made, and conservative treatment with diuretics and anti-hypertensives was initiated. Reassessment at subsequent follow up visits showed improvement in the patient's clinical condition.
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Prostate Cancer Risk: The Significance of Differences in Age Related Changes in Serum Conjugated and Unconjugated Steroid Hormone Concentrations Between Arab and Caucasian Men. Int Urol Nephrol 2006; 38:33-44. [PMID: 16502050 DOI: 10.1007/s11255-005-3619-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Factors responsible for the low incidence of clinical prostate cancer (3-8/100,000 men/year) in the Arab population remain unclear, but may be related to changes in steroid hormone metabolism. We compared the levels of serum conjugated and unconjugated steroids between Arab and Caucasian populations, to determine if these can provide a rational explanation for differences in incidence of prostate cancer between the two populations. PATIENTS/METHOD Venous blood samples were obtained from 329 unselected apparently healthy indigenous Arab men (Kuwaitis and Omanis) aged 15-80 years. Samples were also obtained from similar Arab men with newly diagnosed prostate cancer or benign prostatic hyperplasia (BPH). The samples were taken between 8:00 am and 12:00 noon. Serum levels of total testosterone, (TT), sex hormone binding globulin (SHBG), free androgen index (FAI); adrenal C19-steroids, dehydroepiandrosterone sulphate (DHEAS) and androstenedione (ADT) were determined using Immulite kits (Diagnostic Systems Laboratories Inc, Webster Texas, USA). The results obtained in Arab men were compared with those reported for similarly aged Chinese, German and White USA men. RESULTS In all four ethnic groups, median TT and FAI declined with age, while SHBG increased with age. However, the mean TT and SHBG was significantly lower (p < 0.01) and the FAI significantly higher in Arab men (p < 0.01) compared to German men only in 21-30 years age group. In the other age groups the levels of TT and SHBG were higher in the Germans but the differences were not statistically significant. In all the racial groups serum levels of DHEAS and ADT reached a peak by about 20 years of life, and then declined progressively. The mean DHEAS in American Caucasians aged 20-29 years was 11.4 micromol/l compared to 6.22 micromol/l in the Arabs (p < 0.001). The mean DHEAS in USA Caucasians aged 70-79 years was 2.5 micromol/l compared to 1.8 micromol/l (p < 0.03) in the Arabs. There was no significant difference in mean serum levels of DHEAS between German and USA men. Similarly, there was no significant difference in the level of the hormones between Arab and Chinese men. Arab men with newly diagnosed prostate cancer had high serum TT, SHBG and DHEAS compared to those without the disease. CONCLUSIONS The mean TT and SHBG was significantly lower in Arab men compared to Caucasian men especially in early adulthood. Caucasians have significantly higher serum levels of the precursor androgens DHEAS and ADT especially in early adulthood compared to Arab men. These observations of low circulating androgens and their adrenal precursors in Arab men may partially account for the decreased risk for prostate cancer among Arab men.
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Prevalence of HIV, hepatitis B and C amongst health workers of Civil Hospital Karachi. J PAK MED ASSOC 2006; 56:S48-50. [PMID: 16689485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To determine the prevalence of HIV, Hepatitis B (HBV) and Hepatitis C (HCV) amongst the health workers of Civil Hospital Karachi (CHK). MATERIAL AND METHODS Prospective study. A precoded Proforma was filled out which included questions regarding the knowledge, attitude and practices (KAP) of HIV, HBV and HCV. SETTING Departments of a tertiary health care facility at CHK. Antibodies to HIV, HCV and Hepatitis B surface antigen (HBsAg) were done using enzymes linked immunosorbent assay [ELISA]. RESULTS Uptake of screening was 98% to those offered. The prevalence was 5.6% for antibodies to HCV, 2.4% for HBsAg, while none of those studied had antibodies to HIV. CONCLUSION Our results show the prevalence of antibodies to HCV in health workers are 20 folds higher than health workers in the developed countries. Similarly, the prevalence of HBV although not as high as HCV is significant. Seroprevalence of HIV does not exist in this group. We need to ensure better training; regulations regarding preventive and safety measures also need to be enforced (JPMA 52:92; 2002).
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Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis. JAMA 2005; 294:1799-809. [PMID: 16219884 DOI: 10.1001/jama.294.14.1799] [Citation(s) in RCA: 460] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Plasma fibrinogen levels may be associated with the risk of coronary heart disease (CHD) and stroke. OBJECTIVE To assess the relationships of fibrinogen levels with risk of major vascular and with risk of nonvascular outcomes based on individual participant data. DATA SOURCES Relevant studies were identified by computer-assisted searches, hand searches of reference lists, and personal communication with relevant investigators. STUDY SELECTION All identified prospective studies were included with information available on baseline fibrinogen levels and details of subsequent major vascular morbidity and/or cause-specific mortality during at least 1 year of follow-up. Studies were excluded if they recruited participants on the basis of having had a previous history of cardiovascular disease; participants with known preexisting CHD or stroke were excluded. DATA EXTRACTION Individual records were provided on each of 154,211 participants in 31 prospective studies. During 1.38 million person-years of follow-up, there were 6944 first nonfatal myocardial infarctions or stroke events and 13,210 deaths. Cause-specific mortality was generally available. Analyses involved proportional hazards modeling with adjustment for confounding by known cardiovascular risk factors and for regression dilution bias. DATA SYNTHESIS Within each age group considered (40-59, 60-69, and > or =70 years), there was an approximately log-linear association with usual fibrinogen level for the risk of any CHD, any stroke, other vascular (eg, non-CHD, nonstroke) mortality, and nonvascular mortality. There was no evidence of a threshold within the range of usual fibrinogen level studied at any age. The age- and sex- adjusted hazard ratio per 1-g/L increase in usual fibrinogen level for CHD was 2.42 (95% confidence interval [CI], 2.24-2.60); stroke, 2.06 (95% CI, 1.83-2.33); other vascular mortality, 2.76 (95% CI, 2.28-3.35); and nonvascular mortality, 2.03 (95% CI, 1.90-2.18). The hazard ratios for CHD and stroke were reduced to about 1.8 after further adjustment for measured values of several established vascular risk factors. In a subset of 7011 participants with available C-reactive protein values, the findings for CHD were essentially unchanged following additional adjustment for C-reactive protein. The associations of fibrinogen level with CHD or stroke did not differ substantially according to sex, smoking, blood pressure, blood lipid levels, or several features of study design. CONCLUSIONS In this large individual participant meta-analysis, moderately strong associations were found between usual plasma fibrinogen level and the risks of CHD, stroke, other vascular mortality, and nonvascular mortality in a wide range of circumstances in healthy middle-aged adults. Assessment of any causal relevance of elevated fibrinogen levels to disease requires additional research.
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Abstract
We conducted a clinical study to assess the pattern of dyslipidaemia in type 2 diabetic patients and to examine the demographic and clinical factors associated with dyslipidaemia. The study population comprised 206 consecutive type 2 diabetic patients attending the out-patient clinic at a major hospital in Kuwait. Clinical history and physical examination were done and fasting blood samples were taken to determine HbA1c and lipid levels. American Diabetes Association criteria were applied to define clinical targets for lipid levels and coronary heart disease risk categories. Stepwise multiple linear regression was conducted to identify the demographic and clinical factors associated with lipid levels outside of the clinical target. The large majority of the patients were either over-weight (32%) or obese (57%); the mean BMI was 32.6 kg/m2. Serum total cholesterol, LDL-cholesterol, and triglycerides were above optimal levels in 67%, 86%, and 25% of patients, respectively. For HDL-cholesterol, 63% of men and 71% of women had values below the corresponding optimal level. Only 14 patients (6.8%) had all three lipid values within the respective target level. The percentages of patients with one, two, or all three lipid values outside of target were 31%, 46%, and 16%, respectively. The most frequent (41%) pattern of dyslipidaemia was a combination of LDL-cholesterol level above target with HDL-cholesterol level below target; the second most common pattern was an isolated increase in LDL-cholesterol, observed in 21% of the patients. In the stepwise regression analyses, glycaemic control was strongly associated with dyslipidaemia (i.e. high total- and LDL-cholesterol and triglycerides); female gender were associated with low HDL-cholesterol. Kuwaiti type 2 DM patients have a high prevalence of dyslipidaemia and obesity. Weight reduction, increased physical activity, improved glycaemic control, and increased HDL-cholesterol levels, along with reduced LDL-cholesterol, should be important goals of therapy in these patients to reduce the risk of coronary heart disease.
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Incidental intrarenal-pelvic hydatid cyst discovered during percutaneous Nephrolithotomy (PCNL). J PAK MED ASSOC 2004; 54:436-8. [PMID: 15461215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Changes in blood levels of eosinophil cationic protein and tryptase after exercise challenge in adolescents with exercise-induced asthma. ACTA ACUST UNITED AC 2004; 81:27-33. [PMID: 15080512 DOI: 10.4314/eamj.v81i1.8791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise-induced asthma (EIA) is increasingly encountered among school children in Kuwait. Available evidence has shown that inflammatory mediators may be involved in the pathogenesis of EIA. Studies on release of inflammatory mediators have been carried out in adult patients with asthma in Kuwait, but no study on EIA involving children has taken place in this region. OBJECTIVE To investigate changes in the concentration of some of the mediators involved in EIA in adolescent school children, using exercise challenge. DESIGN Prospective, case control study. SETTING Respiratory and Cardiology units Mubarak Hospital, Kuwait, between January and June 2001. SUBJECTS Nine EIA and 14 non-EIA and 10 normal control subjects, designated as groups one, two and three aged between 13 and 17 years, who were non-smokers, were enrolled for the study. MAIN OUTCOME MEASURES Blood eosinophils (EOS), eosinophil cationic protein (ECP) and tryptase were estimated pre-exercise, 5 and 30 minutes after exercise. Spirometry was measured at the same period. RESULTS In group one, ECP and tryptase levels fell after exercise, but significant difference in the levels were obtained only in tryptase between pre-exercise and 30 minutes after exercise (4.1 microg/L Vs 3.8 microg/L) P <0.05, while the difference for ECP was not significant (P=0.09). In group two, both tryptase (6.0 microg/L Vs 5.7 microg/L) P < 0.05, and ECP (21.8 microg/L Vs 12.1 microg/L) P<0.01, fell after exercise. However, in group three, no appreciable difference was observed between pre and post exercise. Correlation between tryptase and EOS (r=0.770; P<0.05) and between tryptase and ECP (r=0.850; p<0.05) was observed pre-exercise and after exercise in groups one and two. CONCLUSION A fall in the level of the mediators was observed after exercise challenge, but the relevance of this finding in the pathogenesis of EIA remains unclear. Further studies are required to verify this finding.
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Family history of benign thyroid disease and cancer and risk of thyroid cancer. Eur J Cancer 2004; 40:754-60. [PMID: 15010077 DOI: 10.1016/j.ejca.2003.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2003] [Revised: 11/21/2003] [Accepted: 12/20/2003] [Indexed: 11/21/2022]
Abstract
In a population-based study of 313 case-control pairs in Kuwait, we evaluated whether a family history of benign thyroid disease (BTD) and thyroid or other cancers was associated with an increased risk of thyroid cancer, the second most common neoplasm among women in this and several other Arab countries in the Gulf region. Family history of BTD was reported by 78 (24.9%) cases and 40 (12.8%) controls in 132 and 57 relatives, respectively. There was an approximately 2-fold increased risk of thyroid cancer in individuals who had a mother (Odds Ratio (OR)=2.3; 95% Confidence Intervals (95% CI): 1.1-5.1), sister(s) (OR=2.6; 95% CI: 1.3-5.3) or aunt(s) (OR=2.1; 95% CI: 0.9-5.3) with BTD; there was also a significant trend in increasing risk with an increasing number of affected female relatives (P<0.0001). Stratification by age at diagnosis of the case showed that individuals aged </= 35 years, who had an affected first- or second/third-degree relative(s), had an approximately 3-fold increased risk of the cancer. Family history of thyroid cancer was reported by 9 (2.9%) cases in 13 relatives (11 females, 2 males) and by 3 controls in 3 relatives (all females) (OR=3.0; 95% CI: 0.8-11.1). The OR for all hormone-related cancers combined was 1.5 (95% CI: 0.8-2.6). There was no clear association with family history of breast or any other common cancer. Our data suggest that a family history of BTD is associated with an increased risk of thyroid cancer, and point to the role of familial susceptibility to BTD and thyroid cancer in the Kuwaiti population.
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Dental health knowledge, attitudes and behaviour among students at the Kuwait University Health Sciences Centre. Med Princ Pract 2003; 12:260-5. [PMID: 12966201 DOI: 10.1159/000072295] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2002] [Accepted: 10/15/2002] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine the extent of dental health knowledge among students at the Kuwait University Health Sciences Centre (HSC), as well as their attitudes toward dental health and their oral hygiene habits. METHODS A structured questionnaire was distributed to 450 of the 800 students enrolled in 3 faculties of the HSC from March to April 2000. The questionnaire was completed anonymously by the students. RESULTS Four hundred and ten students (91.1%) completed the questionnaire. Of these, 64.6% believed that the main cause of tooth decay was 'not brushing properly'. Only 19.3% of the students believed that sugar could cause dental decay. Half of the students did not know if sugar-free drinks are harmful to their teeth, and 29.5% did not know about any measures to prevent gums from bleeding. Self-assessment questions showed that 84.5% of the students were satisfied with their dental health. A large majority of the students (94.8%) brushed their teeth at least once a day. Female students brushed their teeth more frequently than male students, as did those students who had visited a dentist in the past 6-12 months and those who rated their dental health to be very good. The main reason given for a dental visit was toothache (70.0%). Coffee was consumed daily by 68.9% of students, 76.6% of whom added sugar to their coffee. CONCLUSIONS The findings indicate that although most of the students at the HSC seem to be satisfied with their dental health, they did not have correct knowledge about the causes and prevention of dental diseases. In general, female students were more aware and concerned about dental health issues and more engaged in dental behaviour than male students.
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Three-dimensional visualization of the craniofacial patient: volume segmentation, data integration and animation. Orthod Craniofac Res 2003; 6 Suppl 1:66-71; discussion 179-82. [PMID: 14606537 DOI: 10.1034/j.1600-0544.2003.237.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The research goal at the Craniofacial Virtual Reality Laboratory of the School of Dentistry in conjunction with the Integrated Media Systems Center, School of Engineering, University of Southern California, is to develop computer methods to accurately visualize patients in three dimensions using advanced imaging and data acquisition devices such as cone-beam computerized tomography (CT) and mandibular motion capture. Data from these devices were integrated for three-dimensional (3D) patient-specific visualization, modeling and animation. Generic methods are in development that can be used with common CT image format (DICOM), mesh format (STL) and motion data (3D position over time). This paper presents preliminary descriptive studies on: 1) segmentation of the lower and upper jaws with two types of CT data--(a) traditional whole head CT data and (b) the new dental Newtom CT; 2) manual integration of accurate 3D tooth crowns with the segmented lower jaw 3D model; 3) realistic patient-specific 3D animation of the lower jaw.
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Abstract
BACKGROUND Sampling variability on liver biopsy has been demonstrated in a variety of liver diseases. The objective of this study was to determine whether sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection. METHODS Two separate tissue samples were obtained from the right lobe of the liver, through a single skin puncture, in 29 patients (22 M, mean age 43.4 +/- 8.1 years) with chronic HCV infection. The biopsies were assessed using a descriptive histological reporting system and Knodell's Histological Activity Index (HAI) and compared for differences in necroinflammatory activity (grade) and fibrosis (stage). RESULTS Thirteen (44.8%) patients had a difference of > or = 1 grade between the 2 biopsies on the descriptive system and 13 differed by > or = 1 stage. On the HAI, 20 (69.0%) patients had a difference of > or = 2 in the necroinflammatory activity score and 10 (34.5%) had a difference of > or = 4; whereas, 11 (38.0%) patients had a difference of > or = 1 in the fibrosis score and 6 (20.7%) had a difference of > or = 2. The mean difference between the two sets of biopsies was 2.4 +/- 2.1 (range 0-7) for the necroinflammatory activity and 0.6 +/- 0.9 (range 0-3) for fibrosis. Spearman's correlation coefficient (r) was moderate for both necroinflammatory activity (r = 0.53, P < 0.01) and fibrosis (r = 0.62, P < 0.0001). CONCLUSIONS Sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection and should be taken into consideration when decisions regarding prognosis and therapy are made based on biopsy, and when defining histological response to antiviral regimens.
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Abstract
OBJECTIVES The biotransformation of acetyl salicylic acid (ASA) differs within species, and gender differences have been documented and attributed to the effect of sex hormones. Castration remains a standard therapy for men with advanced prostate cancer. We studied the effect of castration on the metabolism of ASA in rabbits to find out whether the metabolism of ASA is adversely affected after castration. METHODS ASA in doses of 12.5, 25, and 50 mg/kg body weight was given intravenously to male and female prepubertal and adult rabbits, castrated adult male rabbits, and castrated male rabbits given testosterone (3 animals per group). Blood samples were collected at 0, 10, 30, 60, 120, and 180 minutes. The high-performance liquid chromatography method was used for the quantitation of salicylic acid (SA) in serum. The percentage of SA not metabolized was determined by comparing the serum level at 10 and 180 minutes for each group. RESULTS At a dose of 50 mg/kg in the adult rabbits, the mean +/- SD of SA in serum at 10 and 180 minutes was 146.54 +/- 29.54 microg/mL and 19.12 +/- 5.93 microg/mL for males, 158.25 +/- 6.70 microg/mL and 33.24 +/- 2.78 microg/mL for females, 229.72 +/- 47.85 microg/mL and 44.33 +/- 5.64 microg/mL for castrated male rabbits, and 170.88 +/- 12.03 microg/mL and 68.1 +/- 37.54 microg/mL for castrated male rabbits given testosterone, respectively. Also, at 180 minutes, the percentage of SA not metabolized in adult male rabbits was 12.82% +/- 1.65% compared with 21.04% +/- 2.14% (P <0.01) in adult females, 19.53% +/- 1.73% (P <0.01) in castrated adult male rabbits, and 38.95% +/- 19.48% (P <0.001) in castrated male rabbits given testosterone. At all doses of ASA, the serum SA concentration in male and female prepubertal rabbits was not significantly different for each time point. CONCLUSIONS These results indicate that male rabbits are able to metabolize ASA faster than are females. After castration, this ability is significantly decreased. If these experimental results are confirmed in humans, men who are undergoing hormonal manipulation for advanced prostate cancer and who require high-dose ASA, such as in the treatment of stroke or rheumatoid arthritis or as an antioxidant, may need lower doses to reduce the possible toxic effects of ASA.
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Benign thyroid disease and dietary factors in thyroid cancer: a case-control study in Kuwait. Br J Cancer 2002; 86:1745-50. [PMID: 12087461 PMCID: PMC2375394 DOI: 10.1038/sj.bjc.6600303] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2002] [Revised: 03/14/2002] [Accepted: 03/15/2002] [Indexed: 11/08/2022] Open
Abstract
We conducted a population-based study of 313 case-control pairs in Kuwait to examine the aetiology of thyroid cancer, the second most common neoplasm among women in this and several other countries in the Gulf region. Among the demographic variables, individuals with 12+ years of education had a significantly reduced risk of thyroid cancer (OR=0.6; 95% CI: 0.3-0.9). The average age at diagnosis (+/-s.d.) of thyroid cancer was 34.7+/-11 years in women and 39+/-13.4 years in men. History of thyroid nodule was reported only by cases (n=34; 10.9%; lower 95% CI: 12.0); and goitre by 21 cases and four controls (OR=5.3; 95% CI: 1.8-15.3). There was no significant increase in risk with history of hypothyroidism (OR=1.8) or hyperthyroidism (OR=1.7). For any benign thyroid disease, the OR was 6.4 (95% CI: 3.4-12.0); and the population attributable risk was about 26% (95% CI: 21.1-30.9). Stepwise regression analysis showed that high consumption of processed fish products (OR=2.2; 95% CI: 1.6-3.0) fresh fish (OR=0.5; 95% CI: 0.4-0.7) and chicken (OR=1.7; 95% CI: 1.2-2.3) were independently associated with thyroid cancer with significant dose-response relationships. Among the thyroid cancer patients who reported high consumption of fish products, a large majority also reported high consumption of fresh fish (98%) and shellfish (68%). No clear association emerged with consumption of cruciferous vegetables. These data support the hypothesis that hyperplastic thyroid disease is strongly related to thyroid cancer; and that habitual high consumption of various seafoods may be relevant to the aetiology of thyroid cancer. The association with chicken consumption requires further study.
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