Age-matched Case-control Study Research Articles

Lean Muscle Mass in Classic or Ovulatory PCOS: Association with Central Obesity and Insulin Resistance

This age-matched case-control study assessed total and segmental lean muscle mass in classic or ovulatory polycystic ovary syndrome (PCOS) patients and investigated whether lean mass is associated with hormone and metabolic features. Participants underwent anthropometric and clinical evaluation. Habitual physical activity was assessed with a digital pedometer, and body composition by dual-energy X-ray absorptiometry. Laboratory measurements included total cholesterol, cholesterol fractions, triglycerides, glucose, total serum testosterone, serum insulin, estradiol, luteinizing hormone, and SHBG. Energy intake was calculated using a food frequency questionnaire. Classic PCOS patients had higher body mass index (BMI), waist circumference, testosterone and lipid accumulation product values than ovulatory PCOS and controls. Energy consumption, homeostasis model assessment index, SHBG, free androgen index and triglycerides, total and trunk lean mass were higher only in classic PCOS women vs. controls. Arm, leg, trunk, total or limb lean masses were not correlated with hormone levels in any of the groups. However, in PCOS women lipid accumulation product was positively correlated with total (r=0.56, p=0.001), trunk (r=0.59, p=0.001), arm (r=0.54, p=0.001), leg (r=0.44, p=0.03) and limb (r=0.48, p=0.001) lean masses. BMI was positively correlated with all lean mass segments and independently associated with total lean mass. Lipid accumulation product and BMI were independently associated with trunk lean mass variation. The increase in lean mass in classic PCOS appears to be associated with insulin resistance and central obesity rather than with energy intake, physical activity or androgens.

Congenital heart defects and parental occupational exposure to chemicals

Congenital heart defects (CHDs) are the most common major malformations in newborns. In this study we examined the associations between the occurrence of CHDs in children and periconceptional occupational parental exposures to chemicals. In an age-matched case-control study with standardized data collection at c. 15 months after birth, 424 mothers and 421 fathers of a child with CHD and 480 mothers and 477 fathers of a non-malformed child, filled out questionnaires on periconceptional general and job characteristics. A job exposure matrix, which links the information on job title and a description of work tasks to an expert judgement on exposure to chemicals in the workplace, was used. The overall prevalence of occupational exposure to chemicals was 5.0 in cases and 6.2% in controls for mothers [odds ratio (OR) adjusted = 0.92; 95% confidence interval (CI): 0.26-3.25], while 22.3 and 15.9% for fathers, respectively (OR adjusted = 1.23; 95% CI: 0.39-3.91). No association of maternal occupational exposure to chemicals with risk of CHDs was found. Paternal exposure to phthalates was associated with a higher incidence of CHDs in general (OR adjusted = 2.08; 95% CI: 1.27-3.40). Paternal exposure to phthalates was associated with perimembranous ventricular septal defect (OR adjusted = 2.84; 95% CI: 1.37-5.92), to polychlorinated compounds with atrioventricular septal defect (OR adjusted = 4.22; 95% CI: 1.23-14.42) and to alkylphenolic compounds with coarctation of the aorta (OR adjusted = 3.85; 95% CI: 1.17-12.67). Periconceptional paternal (but not maternal) occupational exposure to certain chemicals is associated with an increased risk of CHDs in children. The results, however, must be interpreted cautiously as exposure probabilities are a crude measure of exposure.

Association of genetic polymorphisms of key molecules in JAK/STAT signaling pathway with susceptibility of hepatocellular carcinoma

To elucidate the association of genetic polymorphisms of key molecules in JAK/STAT signaling pathway with susceptibility of hepatocellular carcinoma (HCC). A total of 367 HCC patients and 367 healthy controls were recruited in this sex- and age-matched case-control study. Genetic polymorphisms of IL-6 (rs1800796, -572C > G), STAT3 (rs744166, +26312T > C; rs3816769, +42240T > C; rs6503695, +40980T > C), EGFR (rs11543848, +142530A > G), and mTOR (rs7211818, +170278A > G; rs9674559, +196983A > G; rs11653499, +65678G > A) were genotyped using a mass spectrometry method. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Genotype frequency of the 8 polymorphisms of IL-6, STAT3, EGFR, and mTOR were not significantly different between the patients with HCC and the controls. When stratified by sex, the female subjects who carried STAT3 +26312CC, +42240CC, or +40980CC had a decreased risk of HCC when compared to those who carried TT allele (OR = 0.192, 95%CI: 0.047 - 0.784; OR = 0.180, 95%CI: 0.045 - 0.725; OR = 0.198, 95%CI: 0.049 - 0.806, respectively). When compared with AA genotype on the site of EGFR +142530, the (AG + GG) genotype reduced the risk of HCC in women (OR = 0.422, 95%CI: 0.179 - 0.994). The polymorphisms of IL-6 (rs1800796) and mTOR (rs7211818, rs9674559, and rs11653499) were not associated with the HCC susceptibility. Those carrying CC allele in three loci (rs744166, rs3816769, and rs6503695) of STAT3 and (AG + GG) in rs11543848 of EGFR had a decreased risk of HCC in women. However, these results need to be validated using larger sample size.

The comparison of clinicopathological characteristics in primary malignant mixed műllerian tumour with epithelial endometrial carcinoma

We performed an age-matched case-control study to compare the clinical and pathology outcomes between histologically diagnosed primary malignant mixed műllerian tumour (MMMT) of the uterus and endometrial carcinoma. Thirty-two women were treated for primary MMMT at seven tertiary medical centres in Korea from 2000 to 2006. For each woman with MMMT, four women with endometrioid and two with non-endometrioid endometrial carcinoma were selected as age-matched controls for analysis. Medical records were retrospectively reviewed to obtain outcome data. The incidence of MMMT was 2.57% (32/1244). In comparison with women with endometrioid endometrial cancer, those with MMMT were characterised by large tumour size, higher incidence of adnexal involvement and lymph node metastases, leading to advanced disease stage. Despite the frequent use of adjuvant treatment, the 5-year survival rate of women with MMMT was significantly poorer than those with endometrioid endometrial cancer. However, women with MMMT were not significantly different from those with non-endometrioid endometrial cancer in terms of important pathologic variables, apart from larger tumour size. In addition, the 5-year survival rate of women MMMT was poorer than that those with non-endometrioid endometrial cancer, but the difference was not statistically significant. Malignant mixed műllerian tumour is characterised by a high incidence of lymph node metastases and advanced stage at diagnosis, leading to poorer overall survival than other subtypes of endometrial carcinoma. Clinical trials for MMMT are critical for improving treatment strategies.

B-006 DECREASE OF AUTOANTIBODIES AGAINST OXIDIZED LDL IN CYTOMEGALOVIRUS - RELATED CAROTID ATHEROSCLEROSIS

Background Autoantibodies against Oxidized low-density lipoproteins (oxLDL) were found to be protective at an early stage of atherosclerosis in our previous study.[Chen et al. Cardiology 2008;110:252–259.]Howerer, we suspected that latent human cytomegalovirus (HCMV) infection may modulate the protection of immune response in subclinical atherosclerosis. Methods An age-matched case-control study was constructed including 72 HCMV latent infection subjects and 41 non-HCMV latent infection healthy controls recruited from 2009 to 2010. HCMV latent infection is defined as presence of HCMV DNA, detected by nested PCR, in leucocytes but absence in plasma of subjects. Carotid atherosclerosis, lipid profile, oxLDL and autoantibody were also measured. Results Increase of intima-media thickness of common carotid artery (p = 0.018) indicated subclinical atherosclerosis in the HCMV latent infection subjects compared with non-HCMV latent infection healthy controls. Lower autoantibodies against oxLDL (p = 0.018), relatively higher level of oxLDL (p = 0.058), higher triglyceride (p = 0.014) and higher ratio of cholesterol to HDL (p = 0.009) were noted in the HCMV latent infection subjects. Conclusions We concluded HCMV latent infection may play a crucial role in the lessened production of protective autoantibodies against oxLDL. Based on the differences in lipid panel, interference with lipid metabolism may be one possible pathway for HCMV to precipitate the process of carotid atherosclerosis.

Open-Angle Glaucoma and the Risk of Erectile Dysfunction: A Population-based Case-control Study

Open-angle glaucoma (OAG) is associated with systemic metabolic and cardiovascular disorders, and both share common risk factors with erectile dysfunction (ED). However, few studies have investigated the association of ED with OAG. This study aimed to estimate the association of ED with prior OAG by using a nationwide, population-based data with a retrospective case-control cohort design in Taiwan. Age-matched case-control study. We identified 4605 patients with ED as the cases and randomly selected 23 025 subjects as the controls (5 controls to 1 case). We used conditional logistic regression analysis to estimate the odds ratio and 95% confidence interval of having previously been diagnosed with OAG according to the presence/absence of ED after adjusting for patient's monthly income, geographical location, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse. We identified OAG cases not only based on an International Classification of Diseases, Ninth Revision, Clinical Modification code, but also by the prescription of topical antiglaucoma medication. In total, prior OAG was found among 137 subjects (0.5 %); 53 individuals (1.1% of the ED patients) from the cases and 84 individuals (0.4% of patients without ED) from the controls. Conditional logistic regression analysis demonstrated that, after adjusting for potential confounders, patients with ED were more likely to have prior OAG than controls (odds ratio, 2.85; 95% confidence interval, 2.10-4.07). This study identifies a novel association between ED and prior OAG.

Effect of Low and Chronic Radiation Exposure: A Case-Control Study of Mental Retardation and Cleft Lip/Palate in the Monazite-Bearing Coastal Areas of Southern Kerala

A population-based 1:3 age-matched case-control study was conducted during 2006-2009 to assess the role of high-level natural radiation (>1 mSv/year) on congenital mental retardation and cleft lip/palate in the southwest coastal area of Kerala. Dosimetry was carried out in the house where parents resided during conception and the subsequent two trimesters of pregnancy of the study subject. Conditional logistic regression did not suggest any statistically significant association of either mental retardation (n = 445) or cleft lip/palate (n = 116) with high-level natural radiation. The odds of mental retardation and cleft lip/palate among those exposed to high-level natural radiation relative to normal levels of natural background radiation (≤1 mSv/year) were 1.26 (95% CI: 0.91-1.73) and 0.56 (95% CI: 0.31-1.02), respectively, after controlling for gender and maternal age at birth of the study subject. The data did not suggest any dose-related trend in the risk of either mental retardation (P = 0.113) or cleft lip/palate (P = 0.908). Notwithstanding the use of a single dose estimate to reconstruct past radiation exposure and the complex etiology of congenital malformations, it may reasonably be concluded that the prevailing high-level natural radiation in the study area does not appear to increase the risk of either mental retardation or cleft lip/palate among offspring of parents staying in the area.

Sleep problems in children with autism, attention-deficit hyperactivity disorder, and epilepsy

This study aimed to examine sleep problems in children with autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD), and epilepsy in clinical settings. We assessed 64 children with ASD, 64 with ADHD, 64 with epilepsy, and 64 typically developing children without any neuropsychiatric disorders by using a sex-and age-matched case–control study design. The parents reported their children's sleep problems. Parents of children with ASD and ADHD reported more current and lifetime sleep problems of their children than parents of children with epilepsy, especially in snoring and restless legs syndrome. Current or lifetime sleep problems did not differ between children with ASD and children with ADHD, or between children with epilepsy and typically developing children. Demographic characteristics and medication status could not fully explain the increased risk of sleep problems in children with ASD and ADHD. Our findings lend evidence to support more sleep problems in children with ASD and ADHD than typically developing children. Our study adds that children with epilepsy do not. These findings emphasize the importance to assess sleep problems in children with neurodevelopmental disorders highly comorbid with ASD or ADHD in clinical practice.

Haptoglobin Polymorphism as a Risk Factor for Chronic Kidney Disease: A Case-Control Study

Aims: Taiwan has the highest incidence and prevalence of end-stage renal disease worldwide. Haptoglobin (Hp) has a role in renal protection, and there are known differences in the function of different Hp alleles. We aim to study the association between Hp genotype and chronic kidney disease (CKD) in Taiwan. Methods: We performed one hospital-based, age-matched case-control study of 213 patients with CKD and 213 controls to evaluate the association between Hp polymorphism and CKD. Three major Hp genotypes were determined using polymerase chain reaction and electrophoresis. An unconditional logistic regression model was used to identify the associated risk factors for the development of CKD. Results: The frequency of Hp2-2 genotype and Hp² allele was significantly higher in the CKD group than in controls (p = 0.032 and 0.024, respectively). After adjustment for covariates, the Hp2-2 genotype (vs. Hp1-1; OR 3.841) remained significantly associated with the development of CKD, together with diabetes (OR 3.131), hypertension (OR 1.748) and dyslipidemia (OR 1.646). Conclusion: This present study shows that Hp2-2 genotype is an independent risk factor for CKD. Determination of the Hp genotype may be of potential value to the prediction of genetic risk for CKD.

Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury

ObjectiveTo verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator. DesignRetrospective study of a prospective database and age-matched case control study. SettingIntensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain). PatientsWe collected data on all patients discharged from the Hospital with permanent respiratory support by volumetric respirator or diaphragmatic pacemaker during a follow-up period of 25 years. Personal interviews were conducted to evaluate health-related qualify of life. Comparison and survival tests were used for statistical comparisons. InterventionsQuality of life questionnaire. Main variablesThe main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life. ResultsWe evaluated the clinical records of 101 patients, 37 in the pacemaker-group and 64 in the volumetric respirator-group. Our results show that ICU admission duration and hospitalization as well as family reintegration, without significant differences, with a tendency to greater survival in pacemaker patients (18.18 versus 9.67 years by the Kaplan-Meier method, p<0.001). However, this difference becomes non-significant (p=0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in the same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients. ConclusionsDiaphragmatic pacemaker ventilation is an effective alternative to mechanical ventilation with similar efficacy that improve quality of life in patients with severe respiratory failure due to cervical spinal cord injury.

Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical

Objective To verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator. Design Retrospective study of a prospective database and age-matched case-control study. Setting Intensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain). Patients We collected data on all patients discharged from the Hospital with permanent respiratory support by volumetric respirator or diaphragmatic pacemaker during a follow-up period of 25 years. Personal interviews were conducted to evaluate health-related quality of life. Comparison and survival tests were used for statistical comparisons. Interventions Quality of life questionnaire. Main variables The main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life. Results We evaluated the clinical records of 101 patients, 37 in the pacemaker-group and 64 in the volumetric respirator-group. Our results show that ICU admission duration and hospitalization as well as family reintegration, without significant differences, with a tendency to greater survival in pacemaker patients (18.18 versus 9.67 years by the Kaplan-Meier method, p < 0.001). However, this difference becomes non-significant (p = 0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in these same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients. Conclusions Diaphragmatic pacemaker ventilation is an effective alternative to mechanical ventilation with similar efficacy that improve quality of life in patients with severe respiratory failure due to cervical spinal cord injury.

Pseudoexfoliation as a risk factor for peripheral vascular disease: a case-control study

To determine the association between pseudoexfoliation (PEX) and peripheral vascular disease (PVD) among age-related cataract. Iladevi Cataract and IOL Research Center, Ahmedabad, India. An observational age-matched case-control study of 160 patients over 60 years of age with age-related cataract. A total of 40 subjects with PEX (cases) were compared with 120 subjects with cataract but without PEX (controls). A detailed medical history, including hypertension, diabetes mellitus, cerebrovascular stroke and ischaemic heart disease, was recorded. Ankle brachial index (ABI) was used to determine the risk of PVD among age-related cataract patients. Color Doppler imaging was performed on the brachial and dorsalis pedis artery to measure ABI and detect PVD. Least mean ABI was the main outcome measure, as low ABI indicates higher risk for PVD. The lowest mean ABI was measured for each subject. An ABI ratio of <0.90 was considered abnormal. The Mann-Whitney U-test and logistic regression were used for analysis. The lowest mean ABI in the controls was 0.98 ± 0.03 (SD; a range of 0.86-1.08) as compared with 0.88 ± 0.02 (SD) among the cases (a range of 0.79-0.92; P < 0.001). When compared with controls, cases had a lower ABI (P < 0.001) irrespective of the presence or absence of systemic illness. On multiple regression analysis adjusting for systemic illness, the presence of PEX increased the odds of a low ABI group 150 times (P < 0.001). Subjects with cataract and PEX had a significantly lower ABI as compared with controls (cataracts without PEX). PEX is associated with and may be a risk factor for PVD.

Outcomes of cataract surgery and intraocular lens implantation with and without intracameral triamcinolone in pediatric eyes

To evaluate whether intracameral triamcinolone has an effect on anterior segment inflammation and visual axis obscuration after pediatric cataract surgery with intraocular (IOL) implantation. Iladevi Cataract and IOL Research Institute, Ahmedabad, India. This retrospective age-matched case-control study comprised consecutive eyes of children having phacoaspiration, posterior capsulectomy, vitrectomy, and IOL implantation. In the study group, eyes received a standardized application of an intracameral preservative-free triamcinolone acetonide suspension intraoperatively. In the control group, age-matched consecutive eyes had surgery with a similar technique but without intracameral preservative-free triamcinolone acetonide. Cell deposits, posterior synechias, visual axis obscuration, and intraocular pressure (IOP) were evaluated 1 month and 12 months postoperatively. The mean patient age at surgery was 9.15 months +/- 5.04 (SD) in the study group (41 eyes) and 9.34 +/- 5.10 months in the control group (83 eyes) (P = .91). The visual axis was not obscured in any eye in the study group, while 9 eyes (10.8%) in the control group had an obscured axis; the difference between groups was statistically significant (P<.029). Six eyes (7.2%) in the control group required secondary membranectomy with pars plana vitrectomy. There was a statistically significant difference between the 2 groups in posterior synechias and cell deposits (both P<.033) and no significant difference in preoperative or postoperative IOP (P = .29 and P = .50, respectively). Pediatric eyes receiving intracameral triamcinolone intraoperatively had significantly less anterior segment inflammation and no visual axis obscuration after cataract surgery with IOL implantation.

Association between obesity and the risk of malignant lymphoma in Japanese: a case–control study

Although marked differences in anthropometric characteristics and malignant lymphoma (ML) incidence suggest that the association between obesity and ML risk in Asian and non-Asian populations may differ, few studies have investigated this association in Asian populations. Here, we conducted a sex- and age-matched case-control study in a Japanese population using 782 cases and 3,910 noncancer controls in the hospital-based Epidemiological Research Program at Aichi Cancer Center Hospital. Odds ratios (ORs) and 95% confidence intervals (CIs) for anthropometric characteristics were estimated using a conditional logistic regression model that incorporated smoking and alcohol intake. Recent body weight and body mass index (BMI) showed marginally significant association with ML risk (ORs [95% CIs] per 5-unit increase in recent weight and BMI; 1.04 [0.99-1.09] and 1.11 [0.98-1.27], respectively). On the other hand, weight and BMI in early adulthood exhibited a strong association with ML risk (ORs [95% CIs] per 5-unit increase in early adulthood weight and BMI; 1.11 [1.05-1.18] and 1.33 [1.13-1.55], respectively). Further, in women, a BMI of 25.0-29.9 kg/m(2), defined as obesity in Asian populations, during early adulthood was significantly associated with ML risk compared to the normal range of 18.5-22.9 kg/m(2). By histological ML subtype, the point estimates of ORs for obesity relative to normal weight in early adulthood were over unity for non-Hodgkin lymphoma (NHL) as a whole and significant for diffuse large B-cell lymphoma (DLBCL). In conclusion, our study in Japanese subjects suggested that early adulthood obesity is associated with the risk of NHL, particularly DLBCL.

Case-Control Study of Risk Factors Associated with Feline and Canine Chronic Kidney Disease

An age-matched case-control study was initiated to determine the major risk factors associated with CKD in cats and dogs and to determine what clinical signs cat and dog owners observed before their veterinarian diagnosed their pet with CKD. When compared to controls, the feline cases were more likely to have had polydipsia and polyuria in the year before the owners' cats were diagnosed with CKD. In the dogs, increased water intake, increased urination, small size and a recent history of weight loss and bad breath were noticed by the dog owners before veterinary CKD diagnosis. Dog owners recognized abnormal drinking and urination behavior over half a year before their pet's veterinary diagnosis with CKD, and they recognized weight loss almost 4 months before CKD diagnosis. Bad breath was noticed 1.2 years before recognition of CKD by a veterinarian. Given that earlier CKD diagnosis should have been possible in most cases, clinical trials should proceed to measure the efficacy of early interventions.

Case-control study of risk factors for sporadic Campylobacter infections in northeastern Spain

An age-matched case-control study was conducted in northeastern Spain to identify major risk factors for sporadic Campylobacter infections and their relative importance. Cases were aged >6 months, residents of Sector Sanitario Huesca with diarrhea and confirmed culture of Campylobacter not related to outbreak. For each case <15 years of age, the patient closest in age to the case was selected from the medical records of the case's pediatrician to serve as a control. If the case was >or=15 years of age, the control was nominated by the case. Eighty one cases (median age 2.3 years, 79% <15 years) and 81 controls were enrolled. Three exposures, in the 7 days prior to symptom onset, were independent predictors for illness after multivariate conditional logistic regression analysis: consuming three or more times chicken [odds ratio (OR)(adjusted) = 6.1; confidence interval (CI): 2.0-18.5; population attributable fraction (PAF) = 36.1%], consuming sliced deli meat unhygienically handled at retail stores (OR(adjusted) = 4.1; CI: 1.2-13.2; PAF = 24.5%) and contact with animals (OR(adjusted) = 2.8; CI: 1.1-7.3; PAF = 19. 0%). Among cases <15 years of age, only consuming chicken >or=3 times (OR(adjusted) = 7.8; CI: 2.2-26.7; PAF = 43.6%) and contact with animals (OR(adjusted) = 3.7; CI: 1.2-11.0; PAF = 25.1%) were independent predictors for disease. Consuming sliced deli meat unhygienically handled at retail stores was significantly more frequent among <15-year age group (56.3% versus 26.6.0%, P = 0.04). A control programme for Campylobacter in the food chain and targeted food-safety education to prevent cross-contamination seem warranted to decrease the opportunity of human exposure to the pathogen in northeastern Spain.

Association of Alcohol Intake and Smoking with Malignant Lymphoma Risk in Japanese: A Hospital-Based Case-Control Study at Aichi Cancer Center

Given the lower incidence and differences in distribution of malignant lymphoma in Asian than western populations, the association of alcohol intake and smoking with malignant lymphoma risk in Asian populations merits investigation. Here, we conducted a sex- and age-matched case-control study of a Japanese population using two data sets, the first and second versions of the Hospital-based Epidemiological Research Program at Aichi Cancer Center Hospital (HERPACC-I and HERPACC-II, respectively), in 452 and 330 cases of histologically diagnosed malignant lymphoma and 2,260 and 1,650 noncancer controls, respectively. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a conditional logistic regression model that incorporated smoking exposure and alcohol intake. Compared with nondrinking, consumption of >or=50 g/d by frequent drinkers was associated with significantly decreased risk in both data sets [OR (95% CI), 0.70 (0.53-0.93) for HERPACC-I and 0.40 (0.23-0.68) for HERPACC-II]. Given similar findings among groups, we used pooled data sets in subsequent analyses. For any alcohol intake versus nondrinking, point estimates of OR were less than unity for all four malignant lymphoma subtypes. In contrast, pack-years of smoking were associated with increased malignant lymphoma risk: relative to the reference (0-4 pack-years), OR (95% CI) were 1.32 (1.02-1.71), 1.39 (1.07-1.80), and 1.48 (1.12-1.95) for 5 to 19, 20 to 39, and >or=40 pack-years, respectively. This association with smoking was less apparent for all subtypes, except Hodgkin's lymphoma. In conclusion, we found that alcohol had an inverse association with malignant lymphoma risk across all malignant lymphoma subtypes in our Japanese subjects. Smoking appeared to be positively associated with malignant lymphoma risk, but this finding may vary by subtype.

Cholera outbreak secondary to contaminated pipe water in an urban area, West Bengal, India, 2006

Outbreaks of cholera are common in West Bengal. In April 2006, Garulia municipality reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures. We defined a case of diarrhea as occurrence of > or =3 loose/watery stools a day among the residents of Garulia since April 2006. We searched for cases of diarrhea in health care facilities and health camp. We conducted a gender- and age-matched case-control study to identify risk factors. We inspected the sanitation and water supply system. We collected rectal swabs from diarrhea patients and water specimens from the affected areas for laboratory investigation. Two hundred and ninety-eight cases of diarrhea were reported to various health care facilities (attack rate: 3.5/1000, no deaths). The attack rate was highest among children (6.4/1000). Vibrio cholerae El Tor O1 Inaba was isolated from two of 7 rectal swabs. The outbreak started on 10 April 2006, peaked on 26 April and lasted till 6 May. Cases clustered in an area distal to leaking water pipelines. Drinking municipal water exclusively was significantly associated with the illness (OR 13, 95% CI=6.5-27). Eight of the 12 water specimens from the affected area had fecal contamination and poor chlorine content. This outbreak was due to a contaminated municipal piped water supply and V. cholera 01 Inaba was possibly the causative organism.

Predictors of Mortality in Patients with Delirium Tremens

The objectives were to identify factors that may help predict mortality for patients with delirium tremens (DT). The authors conducted a 1:1 gender- and age-matched case-control study of patients hospitalized for DT. Using McNemar chi-square tests and conditional logistic regression (CLR), risk factors for death, including demographics, location of diagnosis, vital sign derangements, treatment methods, and comorbid conditions, were evaluated. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported. Thirty-five patients with DT died between January 2000 and June 2006. The majority (31; 88.6%) were male with a mean (+/-standard deviation [SD]) age of 51.7 (+/-7.6) years. Hyperthermia in the first 24 hours of DT diagnosis (OR = 10.0, 95% CI = 2.3 to 42.7), persistent tachycardia (OR = 24.0, 95% CI = 3.3 to 177.4), and use of restraints (OR = 7.50, 95% CI = 1.7 to 32.8) were associated with increased mortality by univariate analysis, while an emergency department (ED) diagnosis of DT (OR = 0.18, 95% CI = 0.05 to 0.6) and use of clonidine (OR = 0.10, 95% CI = 0.01 to 0.78) were associated with decreased mortality. In the CLR model, restraint use and hyperthermia were the only variables that remained significant (OR = 5.8, 95% CI = 1.0 to 32.2; and OR = 6.1, 95% CI = 1.2 to 30.4, respectively). The use of restraints and hyperthermia is associated with increased odds of death for patients with DT. This study highlights the need for further research into modifiable factors influencing mortality from DT.

Lack of Association of Endothelial Nitric Oxide Synthase Polymorphisms and Migraine

The aim of this study was to evaluate if 2 functional endothelial nitric oxide synthase (eNOS) gene polymorphisms might be risk factors for migraine. Nitric oxide synthase promotes the synthesis of nitric oxide (NO). NO is a potent vasodilator and mediates several processes involved in migraine pathophysiology. Only one study has suggested an association with migraine with aura. We performed a sex- and age-matched case-control study using 2 eNOS polymorphisms (rs1800779 and rs1799983), which are in linkage disequilibrium. Genotypes were obtained with allele-specific probes in a real-time polymerase chain reaction assay. Genotypic and allelic distributions were compared with chi(2) method. We also estimated the reconstructed haplotypes and calculated ORs for individual haplotypes. A total of 337 migraine patients (188 with aura) and 341 healthy controls were recruited. We found no significant differences in the distribution of genotypes and alleles for either polymorphism among clinical subgroups. Neither rs1800779 nor rs1799983 polymorphisms increased the risk for suffering from migraine aura. As others have previously reported, we failed to demonstrate genetic association of the eNOS gene with migraine.