The risks of infective endocarditis (IE) associated with various conditions and procedures are poorly defined.
This was a population-based case-control study conducted in 54 Philadelphia, Pa-area ...hospitals from 1988 to 1990. Community-acquired IE cases unassociated with intravenous drug use were compared with matched community residents. Subjects were interviewed for risk factors. Diagnoses were confirmed by expert review of medical record abstracts with risk factor data removed. Cases were more likely than controls to suffer from prior severe kidney disease (adjusted OR 95% CI=16.9 1.5 to 193, P:=0.02) and diabetes mellitus (adjusted OR 95% CI=2.7 1.4 to 5.2, P:=0.004). Cases infected with skin flora had received intravenous fluids more often (adjusted OR 95% CI=6.7 1.1 to 41, P:=0.04) and had more often had a previous skin infection (adjusted OR 95% CI=3.5 0.7 to 17, P:=0.11). No association was seen with pulmonary, gastrointestinal, cardiac, or genitourinary procedures or with surgery. Edentulous patients had a lower risk of IE from dental flora than patients who had teeth but did not floss. Daily flossing was associated with a borderline decreased IE risk.
Within the limits of the available sample size, the data showed that IE patients differ from people without IE with regard to certain important risk factors but not regarding recent procedures.
Although antibiotic prophylaxis against infective endocarditis is recommended, the true risk factors for infective endocarditis are unclear.
To quantitate the risk for endocarditis from dental ...treatment and cardiac abnormalities.
Population-based, case-control study.
54 hospitals in the Philadelphia area.
Persons with community-acquired infective endocarditis not associated with intravenous drug use were compared with community residents, matched by age, sex, and neighborhood of residence.
Information on demographic characteristics, host risk factors, and dental treatment was obtained from structured telephone interviews, dental records, and medical records.
During the preceding 3 months, dental treatment was no more frequent among case-patients than controls (adjusted odds ratio, 0.8 95% CI, 0.4 to 1.5). Of 273 case-patients, 104 (38%) knew of previous cardiac lesions compared with 17 controls (6%) (adjusted odds ratio, 16.7 CI, 7.4 to 37.4). Case-patients more often had a history of mitral valve prolapse (adjusted odds ratio, 19.4 CI, 6.4 to 58.4), congenital heart disease (adjusted odds ratio, 6.7 CI, 2.3 to 19.4), cardiac valvular surgery (adjusted odds ratio, 74.6 CI, 12.5 to 447), rheumatic fever (adjusted odds ratio, 13.4 CI, 4.5 to 39.5), and heart murmur without other known cardiac abnormalities (adjusted odds ratio, 4.2 CI, 2.0 to 8.9). Among case-patients with known cardiac lesions--the target of prophylaxis--dental therapy was significantly (P = 0.03) less common than among controls (adjusted odds ratio, 0.2 CI, 0.04 to 0.7 over 3 months). Few participants received prophylactic antibiotics.
Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but cardiac valvular abnormalities are strong risk factors. Few cases of infective endocarditis would be preventable with antibiotic prophylaxis, even with 100% effectiveness assumed. Current policies for prophylaxis should be reconsidered.
Guillain–BarrÉ syndrome is characterized by loss of reflexes and symmetric paralysis, usually beginning in the legs, with eventual nearly complete or complete clinical recovery in most cases.
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...It is mediated by an immune response that results in the direct destruction of either the myelin sheath surrounding the peripheral nerves or the axon itself, and it may or may not follow triggering events, including vaccinations.
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Among the vaccines reported to be associated with the onset of Guillain–Barré syndrome are the swine influenza (A/ New Jersey) vaccine in 1976–1977, oral poliovirus vaccine, and tetanus toxoid.
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The association with the A/ . . .
Regular continuing nonsteroidal anti-inflammatory drug (NSAID) use has
been associated with a reduction in risk of large bowel cancer in many
studies, including our Case-Control Surveillance Study of ...medication
use and cancer risk. We assessed the relation of NSAID use to the risk
of digestive cancers at sites other than the large bowel in this
database. Nurse-interviewers administered questionnaires to patients
admitted to hospitals in four centers from 1977 to 1998. Cases
comprised 1149 patients with cancers of the pancreas
( n = 504), stomach ( n = 254),
esophagus ( n = 215), gallbladder
( n = 125), or liver ( n = 51).
Controls were 5952 patients admitted for trauma or acute infection.
History of NSAID use was elicited by questions about indications for
use. Multiple logistic regression models were used to calculate odds
ratios (ORs) for categories of regular NSAID use (at least 4 days/week
for at least 3 months) relative to never use. The OR for regular use
initiated at least 1 year before admission and continuing into that
year was reduced for stomach cancer (OR = 0.3; 95% confidence
interval, 0.1–0.6) and was compatible with 1.0 for other sites. The
ORs for regular continuing use of at least 5 years duration were <1.0
for cancers of the stomach, pancreas, esophagus, and gallbladder but
were statistically significant only for stomach cancer. These data
suggest that regular continuing NSAID use may be associated with
reduced risk of stomach cancer. For the other sites, the data are
consistent with no effect of NSAID use.
Effectiveness of hysterectomy Kjerulff, Kristen H; Langenberg, Patricia W; Rhodes, Julia C ...
Obstetrics and gynecology (New York. 1953),
2000-March, Letnik:
95, Številka:
3
Journal Article
Recenzirano
Objective: To measure the effectiveness of hysterectomy in relieving adverse symptoms and to identify factors associated with lack of symptom relief.
Methods: In a 2-year prospective study, data were ...collected before and at 3, 6, 12, 18, and 24 months after hysterectomy in 1299 women who had hysterectomies for benign conditions at 28 hospitals across Maryland. Effectiveness was measured in terms of relief of symptoms such as problematic vaginal bleeding, pelvic pain, and urinary incontinence. Psychologic function and quality of life before and after surgery also were assessed.
Results: Symptom severity, depression, and anxiety levels decreased significantly after hysterectomy and quality of life improved, particularly in the area of social function. However, 8% of women had at least as many symptoms at problematic-severe levels 1 and 2 years after hysterectomy as before. In multiple logistic regression, several presurgical patient characteristics predicted lack of symptom relief, including therapy for emotional or psychologic problems, depression, and household income of $35,000 or less. Bilateral oophorectomy predicted lack of symptom relief at 24 months but not at 12 months after hysterectomy.
Conclusion: Significant improvements were seen after hysterectomy for all three aspects of health status (symptoms, psychologic function, and quality of life), which persisted or continued to improve throughout the 2 years of follow-up. However, hysterectomy did not relieve symptoms for some women, particularly those who had low incomes or were in therapy at the time of hysterectomy.
A recent case-control study raised the hypothesis that acetaminophen use
1 day or more per week for at least 6 months reduces the risk of
epithelial ovarian cancer. We assessed analgesic use in ...relation to
epithelial ovarian cancer risk using data from our case-control
surveillance study of medication use and cancer. Patients were
interviewed in hospitals in Baltimore, Boston, New York, and
Philadelphia during 1976–1998. We compared 780 women with epithelial
ovarian cancer to 2053 cancer controls and 2570 noncancer controls. For
acetaminophen use 1 day or more per week for at least 6 months, the
odds ratio estimate was 0.9 (95% confidence interval, 0.6–1.4)
derived with cancer controls and 1.0 (0.6–1.5) with noncancer
controls. Estimates for more frequent and longer term use were also
compatible with 1.0. The odds ratios among patients with metastatic
ovarian cancer were reduced but not statistically significant. The odds
ratio for use of nonsteroidal anti-inflammatory drugs 4 or more days
per week for at least 5 years, 0.5, was statistically significant. The
present results provide only weak support for a reduction in the risk
of epithelial ovarian cancer among acetaminophen users. They raise the
possibility of an inverse association with long-term nonsteroidal
anti-inflammatory drug use.
CONTEXT.— Recent epidemiologic studies have raised the concern that calcium channel
blocker use may increase the risk of cancer overall and of several specific
cancers. OBJECTIVE.— To assess whether ...calcium channel blocker use increases the risk of
cancer overall and of specific cancers. DESIGN.— Case-control drug surveillance study based on data collected from 1983
to 1996. SETTING.— Hospitals in Baltimore, Md, New York, NY, and Philadelphia, Pa. PATIENTS.— A total of 9513 patients aged 40 to 69 years with incident cancer of
various sites and 6492 controls aged 40 to 69 years admitted for nonmalignant
conditions. MAIN OUTCOME MEASURES.— Incident cancer overall and 23 specific cancers. RESULTS.— Calcium channel blocker use was unrelated to the risk of cancer overall
(relative risk RR, 1.1; 95% confidence interval CI, 0.9-1.3). Use was
not significantly associated with increased risks of individual cancers, including
those previously implicated, except cancer of the kidney (RR, 1.8; 95% CI,
1.1-2.7). Recent use, use for 5 or more years, and use of individual calcium
channel blocker drugs were also not associated with cancer incidence. Use
of β-blockers and angiotensin-converting enzyme inhibitors was generally
unrelated to cancer overall or individual cancers, but both were associated
with kidney cancer (RR, 1.8; 95% CI, 1.3-2.5; and RR, 1.9; 95% CI, 1.2-3.0,
respectively). CONCLUSIONS.— The present study suggests that the use of calcium channel blockers
is unrelated to an increase in the overall risk of cancer or of individual
cancers, except kidney cancer, which has been associated with hypertension
or drugs to treat hypertension in previous studies.
To investigate racial differences in the presence of leiomyomas, condition severity, associated symptoms and age at diagnosis between black and white hysterectomy patients.
This study included 409 ...black women and 836 white women aged 18 or older who underwent hysterectomy for noncancerous conditions at 28 hospitals in Maryland. Patients were interviewed shortly before surgery, and hospital records were abstracted after discharge.
Overall, 89% of the black women and 59% of the white women were found to have leiomyomas. Among those with a confirmed presurgical diagnosis of leiomyomas, the average age at diagnosis was 37.5 years for black women and 41.6 for white women, and the average age at hysterectomy was 41.7 for black women and 44.6 for white women. The average uterine weight for black women with leiomyomas was 420.8 g and for white women was 319.1 g. Black women were more likely to have seven or more leiomyomas (57%) in comparison to white women (36%). Black women with leiomyomas were more likely to be anemic (56%) than white women (38%) and more likely to report having very severe or severe pelvic pain (59%) than white women (41%).
Black women having hysterectomy had larger and more numerous leiomyomas, and the leiomyomas were more symptomatic than in white women despite a younger age at diagnosis and hysterectomy.
Concepts of Fever: Recent Advances and Lingering Dogma Mackowiak, Philip A.; Borden, Ernest C.; Goldblum, Simeon E. ...
Clinical infectious diseases,
07/1997, Letnik:
25, Številka:
1
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
Fever has been a preoccupation of clinicians since medicine's beginning. One might therefore expect that basic concepts relating to this physiological response would be well delineated and that such ...concepts would be widely known. In fact, only in the past several decades has the febrile response been subjected to scientific scrutiny. As a result of recent scientific investigation, modern concepts have evolved from a perception of fever as nothing more than a rise in core temperature to one in which fever is recognized as a complex physiological response characterized by a cytokinemediated rise in temperature, as well as by generation of acute-phase reactants and activation of a panoply of physiological, endocrinologic, and immunologic systems. The average clinician appears to have little more than a regrettably rudimentary knowledge of these modern concepts of fever. This symposium summary considers many such concepts that have immediate relevance to the practice of medicine.
In laboratory studies, some antidepressants caused increased growth of mammary tumors. The relation of use of these drugs to the development of breast cancer was examined in a hospital-based ...case-control study. Information, including lifetime medication history, was collected by interview from 5,814 women with primary breast cancer diagnosed within the previous year, 5,095 women with primary malignancies of other sites, and 5,814 women with other conditions. Relative risks were estimated by using unconditional multiple logistic regression for regular use (> or =4 days per week for > or =4 weeks beginning > or =1 year before admission) of antidepressants and structurally similar drugs. With reference to never use of each drug, relative risks were statistically compatible with 1.0 for selective serotonin reuptake inhibitors (SSRI), tricyclics, other antidepressants, phenothiazines, and antihistamines; results were very similar using both control groups. There were no significant increases in risk for any category of regular use, stratified according to cumulative duration of use or time interval since the most recent use or for any individual drug within the broader classes. However, the estimate for regular SSRI use in the previous year, 1.8, was of borderline statistical significance (95% confidence interval: 1.0, 3.3). The findings do not support an overall association between the use of antidepressants, phenothiazines, or antihistamines and breast cancer. However, the results for SSRIs are not entirely reassuring.
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