Current Smoking Habits Research Articles

Relative and absolute lung function change in a general population aged60-102 years.

Data on longitudinal lung function change in the elderly are scarce. Uncertainty remains about whether to use absolute or relative change and how it relates to subject demographics.We studied absolute and relative forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) change in a population-based geriatric sample using a repeated measurements model adjusted for age, sex, smoking habits, heart failure, hypertension, diabetes, coronary heart disease, educational level, occupation, alcohol consumption, C-reactive protein (CRP) and body mass index. 3736 participants aged 60–102 years completed between one and five spirometries during 13.5 years of follow-up. Lung volumes, FEV1 quotient (Q) and Global Lung Initiative (GLI)-2012 and National Health and Nutrition Examination Survey (NHANES) III z-scores were presented from 6932 spirometries.Adjusted absolute change per year (95% CI) was −51.7 (−63.7–−39.9) mL for FEV1 and −56.2 (−73.6–−38.8) mL for FVC. Adjusted relative change per year was −2.97 (−3.53–−2.40)% for FEV1 and −2.46 (−3.07–−1.85)% for FVC. Risk factors for increased relative FVC and FEV1 decline were female sex, higher age, current smoking habits, elevated CRP (nonsignificant for FEV1, p=0.057) and low educational level. For increased absolute decline the risk factors were male sex and being a current smoker for FEV1 and low education for FVC.Relative but not absolute change correlated significantly with clinically relevant markers of functional status and may be superior to absolute change in risk factor analysis. Cross-sectional reduction in terms of FEV1Q was ∼1 unit per 10 years for both sexes. Proportions of subjects with results below lower limit of normal using NHANES III were close to anticipated, but were two to four times higher than expected using GLI-2012.

Comparison of Nasal Colonization of Methicillin-Resistant Staphylococcus aureus in HIV-Infected and Non-HIV Patients Attending the National Public Health Laboratory of Central Nepal.

Background Staphylococcus aureus is a cardinal source of community- and hospital-acquired infection. HIV infection is a well-recognized risk factor for methicillin-resistant S. aureus (MRSA) carriage and infection. Intrinsically developed antibiotic resistance has sharply increased the burden of MRSA which is often associated with morbidity and mortality of the patients. Moreover, nasal carriage of S. aureus plays a significant role in spread of community-associated (CA) S. aureus infections. Methods This study was conducted from June 2016 to December 2016 at National Public Health Laboratory (NPHL), Kathmandu, with an aim to assess the rate of S. aureus nasal carriage and MRSA carriage among HIV-infected and non-HIV patients. A total of 600 nonrepeated nasal swabs were analyzed following standard microbiological procedures, where 300 swabs were from HIV-infected patients while remaining 300 were from non-HIV patients. The isolates were identified on the basis of colony characteristics and a series of biochemical tests. The antibiotic susceptibility test (AST) was performed by the modified Kirby–Bauer disc diffusion method. Inducible clindamycin resistance in isolates was confirmed by the D-test method. Results Overall, out of 600 nasal swabs of patients tested, 125 (20.8%) were S. aureus nasal carriers which included 80 out of 300 (26.66%) among HIV-infected patients and 45 (15%) out of 300 among non-HIV patients, and the result was statistically significant (p=0.0043). Among the isolated S. aureus, 11 (13.8%) MRSA were confirmed in HIV-infected while 3 (6.7%) MRSA were detected from non-HIV patients. A higher number of S. aureus carriers was detected among HIV-infected males 40 (26.49%), whereas MRSA carriage was more prevalent among HIV-infected females 7 (5.1%). Among the HIV-infected, patients of age group 31–40 years were the ones with highest carriage rate 36 (45%), while in non-HIV patients, the highest rate 13 (28.9%) of carriage was detected among the patients of age group 21–30 years. Statistically significant difference was found between S. aureus carriage and HIV infection in patients (p < 0.05). Higher rate 2/3 (66.7%) of inducible clindamycin resistance in MRSA was detected from non-HIV patients in comparison to HIV-infected patients 7/11 (63.63%) while the result was statistically insignificant (p > 0.05). All the MRSA isolates (100%) were resistant against co-trimoxazole while ciprofloxacin showed high rate of sensitivity towards both MSSA and MRSA. None of the isolates were detected as VRSA. The major factors associated with nasal colonization of S. aureus were close personal contact, current smoking habit, and working or living in a farm (p < 0.05). Conclusion Regular surveillance and monitoring of MRSA nasal carriage and antibiotic susceptibility pattern are of prime importance in controlling S. aureus infections especially in high risk groups like HIV-infected patients.

Patient-reported Outcomes in Facial Reconstruction: Assessment of FACE-Q Scales and Predictors of Satisfaction.

Background:There is a paucity of patient-reported outcome measures for facial trauma reconstruction. To measure satisfaction and health-related quality of life (HRQOL), following repair of traumatic facial fractures, we used the FACE-Q, a set of patient-reported outcome instruments designed for aesthetic facial surgery. As a step toward validating the scales for facial trauma, we evaluated their reliability.Methods:This is a prospective study of patients following primary repair of traumatic facial fractures at a level 1 trauma center from 2016 to 2018. Six FACE-Q scales with relevance to the facial trauma population were completed by patients at their 1-month postoperative visits. Predictors of satisfaction were examined using multiple linear regression models. Reliability of the scales in this population was evaluated using psychometric methods.Results:One hundred eighty-five participants fulfilled inclusion criteria. Mean scores for the 6 scales ranged from 59 (SD = 15) for Recovery-Early Life Impact to 94 (SD = 13) for Satisfaction with Medical Team. Predictors of lower satisfaction and/or HRQOL include current tobacco smoking status, mandibulomaxillary fixation, and Le Fort pattern fractures. All scales were found to have good to excellent reliability (Cronbach’s alpha = 0.824–0.969).Conclusions:Following repair of facial fractures, patient-reported outcomes can be reliably measured using FACE-Q scales. On average, patients report poor health-related quality of life in the early postoperative period. Predictors of low satisfaction and/or poor HRQOL include current smoking habit, mandibulomaxillary fixation, and Le Fort fractures.

Smoking, alcohol consumption and mental health: Data from the Brazilian study of Cardiovascular Risks in Adolescents (ERICA)

IntroductionPrevious researches have indicated a strong association of alcohol and tobacco use with psychiatric disorders, but the relationship with depression and anxiety symptoms is still uncertain. We investigated the association of psychological distress and alcohol consumption, tobacco use and exposure to secondhand smoke (SHS) among adolescents in a developing country. MethodsThe authors evaluated 73,399 individuals (12–17 years) who participated in the Cardiovascular Risks Study in Adolescents (ERICA), a cross-sectional, national and school-based study, carried out in 124 Brazilian municipalities. The variables considered were alcoholic beverages (experimentation, consumption in the previous month and frequency of use) and smoking (experimentation, current smoking habits, frequent smoking and SHS exposure). Psychological distress was defined as a score ≥ 3 points in GHQ-12. Analyses included multiple logistic regression modeling. ResultsThe frequency of individuals with psychological distress was higher in the group who smoked for at least 7 consecutive days (53.3% vs 31.2%; OR: 2.17; 95%CI: 1.65–2.86), were exposed to SHS indoors (37.8% vs 29.8%; OR:1.30; 95%CI: 1.14–1.48), and outdoors (37.7% vs 26.6%; OR: 1.49; 95%CI: 1.28–1.74), and among young people who consumed at least 1 drink of alcohol in the previous 30 days (42.4% vs 28.6%; OR: 1.70; 95%CI: 1.46–1.97), when compared to adolescents not exposed. ConclusionsSmoking (passively and actively) and the consumption of alcoholic beverages are associated to psychological distress in the adolescent population. Avoiding smoking and the use of alcohol may have beneficial effects on the mental health. Our data reinforce the urgent necessity to prevent effectively underage access to legal drugs in Brazil.

Correlation Between Anti-TNF Serum Levels and Endoscopic Inflammation in Inflammatory Bowel Disease Patients

(a) To evaluate the diagnostic accuracy of anti-TNF trough levels to predict mucosal healing in inflammatory bowel disease (IBD); (b) to determine the best cut-off point to predict mucosal healing in IBD patients treated with anti-TNF. This is a multicenter, prospective study. IBD patients under anti-TNF treatment for at least 6months that had to undergo an endoscopy were included. Mucosal healing was defined as: Simple endoscopic score for Crohn's Disease < 3 for Crohn's disease (CD), Rutgeerts score < i2 for CD in postoperative setting, or Mayo endoscopic score ≤ 1 for ulcerative colitis (UC). Anti-TNF concentrations were measured using SMART ELISAs at trough. A total of 182 patients were included. Anti-TNF trough levels were significantly higher among patients that had mucosal healing than among those who did not. The area under the curve of infliximab for mucosal healing was 0.63 (best cutoff value 3.4μg/mL), and for adalimumab 0.60 (best cutoff value 7.2μg/mL). In the multivariate analysis, having anti-TNF drug levels above the cutoff values [odds ratio (OR) 3.1]) and having UC instead of CD (OR 4) were associated with a higher probability of having mucosal healing. Additionally, the need for an escalated dosage (OR 0.2) and current smoking habit (OR 0.2) were also associated with a lower probability of mucosal healing. There was an association between anti-TNF trough levels and mucosal healing in IBD patients; however, the accuracy of the determination of infliximab and adalimumab concentrations able to predict mucosal healing was suboptimal.

Long and Short Sleep Duration and Physical Frailty in Community-Dwelling Older Adults.

The objective of this study was to investigate whether older adults who have a particularly long sleep duration are likely to exhibit physical frailty, similar to those with a particularly short sleep duration. Cross-sectional study. The National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. A total of 9,824 older adults (mean age: 73.6 ± 5.5 years, 4,812 men and 5,012 women) met the entry criteria for this study. We divided the participants into three groups according to self-reported sleep duration (Short: ≤6 h, Mid: 6.1-8.9 h (control), Long: ≥ 9 h). Physical frailty was characterized based on the criteria from the Cardiovascular Health Study. Multinomial logistic regression analysis was performed to evaluate the effect of sleep duration on physical frailty by sex. Among all participants, the prevalence of physical frailty was higher in the Short (10.5%) and Long (17.9%) groups than in the Mid (7.4%) group (p < 0.001). Multinomial logistic regression analysis showed that both Short and Long groups had a significantly higher odds ratio (OR) for physical frailty than the Mid group [Short: OR 1.53, 95% confidence interval (CI) 1.26-1.87; Long: OR 2.39, 95% CI 1.90-3.00], even after adjusting for age, educational level, number of medications, body mass index, Mini Mental State Examination score, current smoking and alcohol habits, self-perceived health, and medical history. Both long and short sleep durations were associated with physical frailty. Further studies are required to confirm the effect of sleep duration on the incidence or worsening of physical frailty in older adults.

Colorectal Advanced Neoplasia Are Associated with Aging, Current Smoking, and Metabolic Factors in Japan: Analyses of Comprehensive Health Checkup Data

Introduction: For the past decades, the incidence and mortality rate of colorectal cancer (CRC) have increased in Japan and CRC is the third leading cause of cancer death in Japan. The association of metabolic syndrome (MetS) and CRC has been reported in several studies, however, individual factors contributing to CRC occurrence have been obscure, especially in Japan. In the present study, we investigated the risk factors such as metabolic and lifestyle factors for colorectal advanced neoplasia (AN) using comprehensive health checkup data. Methods: We conducted a retrospective analysis in clinical practice at a single center. Among 10138 subjects who took comprehensive health checkup at our hospital between in August 2012 and December 2016, 2769 subjects who underwent screening colonoscopy were enrolled. In the present study, AN was defined as cancer or adenoma that was at least 10 mm in diameter, had high-grade dysplasia, had villous or tubulovillous histologic characteristics, or any combination thereof. A diagnosis of MetS was made by Metabolic Syndrome Diagnostic Criteria Exploratory Committee in Japan. We evaluated demographic characteristics, anthropometric measurements, visceral fat area (VFA) measured by CT, hematological metabolic parameters, degree of liver fat evaluated by ultrasonography, and current smoking and drinking habits as variables. Association between variables and AN was evaluated by univariate analysis using t-test, ?2 test, Mann-Whitney test, and then by multivariate analysis using multiple logistic regression model. A pvalue < 0.05 was considered statistically significant. Results: Of 2769 subjects (men: 1843, women: 926) analyzed, 676 subjects were diagnosed as MetS (24.4%; 31.3 % in men, 10.8 % in women) and 99 subjects had AN (3.6%). Subjects with MetS had significantly more AN (37 subjects, 5.5%) compared with those without MetS (62 subjects, 3.0%) (p = 0.004). Univariate analysis identified significant association of age, body mass index (BMI), VFA, systolic blood pressure, fatty liver, current smoking habits and ≥ 10 kg weight gain compared with the body weight at the age of twenty with AN prevalence. Logistic regression analysis revealed that age, current smoking, low-density lipoprotein (LDL)-cholesterol and triglycerides were independent factors associated with AN prevalence (Table). Conclusion: The present study demonstrated that colorectal AN was associated with MetS and aging, current smoking and dyslipidemia might be risk factors for CRC in Japan.210 Figure 1. OR; odds ratio, CI; confidence interval, N.S.; not significant

Exposure to Metal Fume Particulate Matter and NO in Exhaled Breath in Shipyard Welders

Exposure to metal fume particulate matter has been linked to numerous adverse health endpoints. Clinical researches have been clarifying the relation of Fractional nitric oxide (FeNO) with airway inflammation in asthma. Despite this, limited data examining the relation of metal fume particulate matter exposure and NO in exhaled breath in welders.We conducted a cross-sectional study. Study participants consisted of 52 welders and 29 office workers. Exposure assessment was based on eight-hour measurement with a personal PM2.5 sampler of exposure to metal fume fine particle matter on Monday. On Tuesday morning, participants were instructed to fast for at least 10 hours prior to urine sampling. The concentration of NO in exhaled breath, an indicator of acute bronchial inflammation and oxidative stress, was measured first, using the portable analyzer. Then a portable spirometer was used to perform the forced expiratory measurements.PM2.5 exposure concentrations were 379.9&amp;#177;4.7 &amp;#956;g/m3 and 154.5&amp;#177;3.6 &amp;#956;g/m3 in welders and office workers, respectively. Welders had lower levels of NO in exhaled breath than that of office workers after adjusting for confounds, though the difference was not significant. Participants with current smoking habit had significant lower NO levels compared to non-smokers. Individual urinary metal such as Mn, Co, Ni, and Fe was associated with NO in exhaled breath in all workers after adjusting for confounds. However, only individual urinary Ni, or Fe metal was associated with NO in exhaled breath in welders. No association between any lung function indicators and NO level in exhaled breath was found.We concluded that some particular metals from metal fume particulate matter exposure may be associated with decreasing NO level in exhaled breath in welders.

Magnetic resonance imaging using ultrasmall superparamagnetic particles of iron oxide for abdominal aortic aneurysm: a risk prediction study

Background Abdominal aortic aneurysm (AAA) rupture is a common cause of sudden death. Pre-emptive elective surgical repair can prevent aneurysm rupture and be life-saving. Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation using magnetic resonance imaging (MRI) in patients with AAAs. For this reason, USPIO-enhanced MRI represents a promising new technique that could improve risk prediction and better guide surgical intervention. Objectives To assess whether or not USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes in patients with AAAs. Design A prospective multicentre open-label observational cohort study. Setting Three secondary and tertiary care hospitals in Scotland. Participants Patients (n = 342) aged &gt; 40 years with a maximum anteroposterior AAA diameter of ≥ 40 mm confirmed by abdominal ultrasonography, and under ultrasonographic surveillance as part of routine clinical care. Interventions USPIO-enhanced MRI of AAA. Main outcome measures The primary end point was the composite of aneurysm rupture or repair. Secondary outcomes included rate of aneurysm growth, all-cause mortality and aneurysm-related mortality. Results Participants (85% male, aged 73.1 ± 7.2 years) had a baseline aneurysm diameter of 49.6 ± 7.7 mm, and USPIO enhancement was identified in 146 participants (42.7%), absent in 191 participants (55.8%) and indeterminate in 5 participants (1.5%). During follow-up (1005 ± 280 days), there were 17 AAA ruptures (5.0%), 126 AAA repairs (36.8%) and 48 deaths (14.0%). Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1 ± 2.5 vs. 2.5 ± 2.4 mm/year; p = 0.0424), although this was not independent of current smoking habits (p = 0.1993). The primary end point (aneurysm rupture or repair) occurred more frequently in participants with USPIO enhancement [69/146 (47.3%) vs. 68/191 (35.6%), difference 11.7%, 95% confidence interval 1.1% to 22.2%; p = 0.0308]: this was similar for each component of rupture (6.8% vs. 3.7%; p = 0.1857) or repair (41.8% vs. 32.5%; p = 0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair (p = 0.0275). Baseline AAA diameter (p &lt; 0.0001) and current smoking habits (p = 0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic 0.7935 to 0.7936). Conclusions USPIO-enhanced MRI is a novel approach to the identification of aortic wall cellular inflammation in patients with AAAs, and predicts the rate of aneurysm growth and clinical outcome. USPIO-enhanced MRI does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors. Larger trials are now needed to explore the prediction of emergent aneurysm events to establish the added benefit of USPIO-enhanced MRI. Comparative outcome studies should determine whether or not using other imaging biomarkers that track alternative disease processes have better predictive capability than USPIO-enhanced MRI. Trial registration Current Controlled Trials ISRCTN76413758. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.

Risk factors and clinical courses of concomitant primary sclerosing cholangitis and ulcerative colitis: a Korean multicenter study.

Primary sclerosing cholangitis (PSC) is a rare progressive cholestatic liver disease of unknown causes, but is strongly associated with inflammatory bowel diseases (IBDs), particularly ulcerative colitis (UC). However, studies comparing risk factors and clinical courses of patients with concomitant UC and PSC with those of patients with PSC alone are lacking. We retrospectively reviewed patients with PSC diagnosed between 2005 and 2017 in four tertiary hospitals in Korea. We compared the risk factors and outcomes of concomitant UC and PSC (UC-PSC) and those of PSC alone. PSC was diagnosed in 50 patients in four different tertiary hospitals in Korea. Of them, 18 patients (36.0%) had UC-PSC and 32 patients (64.0%) had PSC alone. The median age at PSC diagnosis was younger in the UC-PSC group than that in the PSC alone group (37 vs. 54years, P = 0.002). In multivariate analysis, older age at PSC diagnosis (P = 0.007; odds ratio [OR], 0.884; 95% confidence interval [CI], 0.808-0.966) and current smoking habit (P = 0.033; OR, 0.026; 95% CI, 0.001-0.748) were determined to be independent factors for reducing the possibility of developing concomitant UC after PSC. Additionally, UC-PSC was shown to be an independent risk factor for the development of colorectal dysplasia (P = 0.044; OR, 10.829; 95% CI, 1.065-110.127). Our analysis showed that UC-PSC is more likely to be negatively associated with current smoking and older age at the time of PSC diagnosis. Moreover, UC-PSC increased the risk of colorectal dysplasia.

Abstract 5266: Current smoking habit is a risk factor for poor surgical outcome of non-B, non-C hepatocellular carcinoma

Abstract Background: Many factors are recognized as risks for the development of hepatocellular carcinoma (HCC) in non-B non-C (NBNC) patients. Although cigarette smoking has been recognized as one of the risk factors for HCC, the surgical outcomes and clinicopathological characteristics according to smoking habits of NBNC-HCC patients are unclear. Methods: Consecutive cases of 83 NBNC-HCC patients who underwent curative surgical treatment for the primary lesion at Saga University Hospital were enrolled the study. The information about possibly carcinogenic factors such as alcohol abuse, diabetes mellitus, obesity and smoking habit were collected from medical records. Smoking habits were subcategorized as never, ex- and current smoker at the time of surgery. The diagnosis of non-alcoholic steatohepatitis (NASH) was based on both clinical information and pathological confirmation. Results: Alcohol abuse, diabetes mellitus, obesity and NASH had no significant effect on the surgical outcomes. Current smoking status was strongly correlated with both overall survival (p=0.0058) and disease-specific survival (p=0.0105) by multivariate analyses. Subset analyses revealed that current smokers were significantly younger at the time of surgery (p=0.0002) and more likely to abuse alcohol (p=0.0188) and to have multiple tumors (p=0.023). Conclusion: Current smoking habit at the time of surgery is a risk factor for poor long-term survival in NBNC-HCC patients. Current smokers tend to have multiple HCCs at a younger age than other patients. Citation Format: Keita Kai, Hiroki Koga, Shinichi Aishima, Atsushi Kawaguchi, Koutaro Yamaji, Takao Ide, Junji Ueda, Hirokazu Noshiro. Current smoking habit is a risk factor for poor surgical outcome of non-B, non-C hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5266.

Skipping Breakfast and Eating Fast Could Be Associated with Metabolic Syndrome—Clinical Cohort Study in Japan

Metabolic syndrome (MetS) has been reported to promote the development of atherosclerotic diseases and lower quality of life. Recently, it has also been reported that MetS could be a risk factor for some types of cancer, such as colon and pancreatic cancer. Several studies have reported that lifestyle, especially eating habits, was closely associated with metabolic diseases. However, the evidence among Japanese subjects is limited. We therefore conducted the present study to perform a cross-sectional evaluation of the relationship between eating habits and the prevalence of MetS among Japanese subjects. The present study included 6,925 Japanese subject (3,532 men and 3,393 women) who had undergone annual health checkups and received a questionnaire that included items on lifestyles such as frequency of skipping breakfast, pace of eating, usual physical activity, sleeping hours, alcohol consumption, and current smoking habits. MetS was diagnosed according to the criteria of the Japanese Society of Internal Medicine. To investigate the association between eating habits and MetS, we used multiple logistic regression analysis. Adjustments were made for age, sex, usual physical activity, sleeping hours, alcohol consumption, and current smoking habits. The results showed that skipping breakfast was positively associated with MetS; the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for MetS in relation to skipping breakfast on the items “eating every day,” “skipping about 3 days per week,” and “skipping almost every day” were 1.00 (reference), 1.22 (0.93-1.60), and 1.41 (1.12-1.79), respectively. Eating fast was also associated with the prevalence of MetS; the adjusted ORs and 95% CIs in relation to an eating pace of “more than 20 min,” “10-20 min,” and “ less than 10 min” were 1.00 (reference), 1.27 (1.02-159), and 1.61 (1.26 2-2.06), respectively. These results suggest that eating breakfast every day and eating slowly would be beneficial to prevent MetS. Disclosure H. Senba: None. T. Miyake: None. W. Kurihara: None. Y. Sakiko: None. S. Yamamoto: None. S. Furukawa: None. M. Abe: None. B. Matsuura: None. Y. Hiasa: None.

IS IT RESISTANT HYPERTENSION?

Objective: Characterization of patients referred by their general practice physician to our hypertension (HTN) clinic with the diagnosis of resistant HTN. Design and method: Retrospective study of patients with the diagnosis of resistant HTN referred to the HTN clinic from primary care between 2012 and 2017. Data was obtained from electronic medical records and analyzed with SPSS software. Results: From a total of 213 patients presently followed in our HTN clinic, 37 were referred due to resistant HTN. Female sex was slightly more prevalent (51,4%) and the average age was 64 years (with a minimum of 18 and a maximum of 84 years). Patients had a mean duration of HTN of 20 years (ranging from 2 months to 50 years). At the time of referral 41% had grade 1, 27% grade 2 and 22% grade 3 HTN. Other contributing factors to global vascular risk were sedentary lifestyle (68%), excess weight (68%), dyslipidemia (46%), diabetes (38%) and past or current smoking habits (32%). With regard to therapy only 43.2% could formally be deemed resistant HTN according to the current definition (high blood pressure values despite treatment with a diuretic and two other antihypertensive drugs of different classes at adequate dose) and 8% had no diuretic in their prescription. The most prescribed class was angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (67%) followed by diuretics (49%), calcium channel antagonists (43%) and beta-blockers (27%). There was a strong suspicion of noncompliance to the prescribed regimen in 11% of patients. Secondary causes of HTN were found in 24,3% of cases: hyperaldosteronism in 4 patients, hyperthyroidism in 1 and sleep apnea in 4. Conclusions: Defining resistant hypertension remains a clinical problem and an update on its definition should be considered. Patients’ education is of foremost importance in promoting compliance to prescribed therapy and reducing concomitant risk factors. Regarding therapy, clinical inertia should be avoided, promoting optimization of anti-hypertension drugs dosages and implementing diuretics as third class, when indicated, in the primary care setting.

Interaction of smoking and metabolic syndrome in increasing the recurrence risk of colorectal cancer in a Chinese male cohort: a retrospective study

Whether smoking and metabolic syndrome (MetS) can affect colorectal carcinoma (CRC) prognosis remains debatable. Therefore, the present study aimed to examine the individual and combined effects of smoking and MetS on the prognosis of patients with localized CRC, including stage I to III disease. The relationship among smoking status, MetS, and CRC was assessed in 838 Chinese male patients. Cox proportional hazards regression analysis was used to evaluate CRC prognosis adjusted for clinicopathological variables. Relative excess risk of interaction (RERI), attributable proportion (AP), and synergy index (SI) were used to evaluate additive interactions between smoking and MetS. The presence of MetS was an independent risk factor for low rates of recurrence-free survival (RFS) but not for overall survival (OS). However, smoking was independently associated with both poor RFS and OS. Furthermore, the recurrence risk for current smokers with MetS was 1.62 times as high as the sum of risks in patients exposed to each risk factor alone. In conclusion, current smoking habit is a risk factor for both recurrence and cancer-specific mortality in CRC patients, while MetS is an independent predictor for CRC recurrence. Furthermore, these two factors have an additive effect on the recurrence risk of CRC.

Prevalence and associated factors of sarcopenia, dynapenia, and sarcodynapenia in community-dwelling elderly in São Paulo - SABE Study.

To estimate the prevalence of sarcopenia, dynapenia, and sarcodynapenia and associated factors in older adults in the city of São Paulo, Brazil. A population-based, cross-sectional study was conducted with 1,168 older adults who participated in the third wave of the Health, Well-being, and Aging study in 2010 (SABE study). Men and women with skeletal muscle mass ≤ 8.90 and ≤ 6.37 kg/m2, respectively, were considered sarcopenic. Men and women with grip strength < 30 and < 20 kg, respectively, were considered dynapenic. Those with both conditions were considered sarcodynapenic. Sociodemographic, behavioral, clinical, nutritional, and biochemical characteristics were investigated as factors associated with each of the three conditions using multinomial logistic regression. Theprevalence of sarcopenia, dynapenia, and sarcodynapenia was 4.8% (95%CI 3.6 - 6.3), 30.9% (95%CI 27.5 - 34.6) and 9.0% (95%CI 7.2-11.3), respectively. An increase in age and malnutrition was associated with all the three conditions. Cognitive impairment was associated with both dynapenia and sarcodynapenia. Schooling, current smoking habit, and not having a marital life were associated with sarcopenia. Osteoarthritis, schooling, being an ex-smoker, and low hemoglobin were associated with dynapenia. Smoking habit and the risk of malnutrition were associated with sarcodynapenia. Dynapenia is more prevalent among older adults, followed by sarcodynapenia, and sarcopenia. With the exception of age, schooling, and malnutrition, the factors associated with sarcopenia and dynapenia are different. However, there are similarities in some associations regarding the presence of sarcodynapenia.

Analysis of the Skin Basocellular Carcinoma (BCC) Among the Smokers in Bosnia and Herzegovina.

Aim:The aim of this article is to determine the possible correlation between the smoking habit and the incidence of basocellular skin cancer (BCC).Patients and methods:The prospective study, which lasted from June 2012 to June 2018, included subjects diagnosed with basocellular skin cancer (BCC). Respondents were divided into 3 groups. The first, group A (21 respondents), are respondents who smoke 20-35 cigarettes a day. The second, group B (19 respondents), consists of respondents who smoke 35-50 cigarettes a day. The third, group C (91 respondents), consist of non-smokers. Observed parameters are sex, age, current and previous smoking habits, including duration (total smoking year) and intensity (average number of cigarettes smoked per day), age at the start of smoking, and prolonged exposure to the sun. Results:No statistically significant relationship was found between smoking and BCC frequency. It was shown that with BCC of the skin was more affected those who did not smoke. There is no clear relationship between the duration of smoking and/or the amount of smoking and the development of BCC, and it follows that this relationship is not likely to be causative. A suggestive, but not significant, evidence of relationship between smoking and skin cancer is found at this time.Conclusion:Since it is a conglomerate of possible etiological factors, further research is needed to definitively clarify the effect of tobacco consumption on the development of BCC by monitoring a larger number of respondents over a longer period of time in large prospective studies. In any case, a possible association with skin cancer is a reason to avoid smoking.

Impact of obstructive sleep apnea on blood pressure and cardiovascular risk factors in Japanese men: A cross-sectional study in work-site group

ABSTRACTIt has been shown that obstructive sleep apnea (OSA) is related to hypertension and cardiovascular disease; however, the prevalence of OSA in general population and the impact of it on blood pressure especially in Japan has not been well determined. We have conducted a screening test for OSA from 2003 to 2011. In addition, a cross-sectional analysis was performed in 2012 to determine the association of OSA and cardiovascular risk factors in Japanese men (18–69 years of age; mean age, 44.4 ± 0.2). The study group consisted of 2208 male employees, and OSA was evaluated by using the 4% oxygen desaturation index and apnea-hypopnea index (AHI). The prevalence of mild-to-moderate (5≤AHI<30) and severe (AHI≥30) OSA in the studied subjects were 7.1%, and 6.1%, respectively. Among the 135 severe OSA subjects, 105 (77.8%) had been treated with continuous positive airway pressure. Both systolic and diastolic blood pressures (DBP) were significantly increased in the subjects with severe OSA compared with those without OSA. These associations in DBP remained observed after adjustment for age, body mass index (BMI), estimated glomerular filtration rate, HbA1c, current alcohol intake, current smoking habits, and OSA treatment. DBP in severe OSA subjects were significantly increased in 1807 subjects who were not treated for hypertension or OSA. However, the levels of blood pressures were not decreased by OSA treatment. These results suggest that the prevalence of OSA is relatively high in middle-aged Japanese men and that blood pressures were elevated in the subjects with severe OSA.

Management of atherosclerosis risk factors for patients at high cardiovascular risk in real-world practice: a multicentre study.

Atherosclerotic cardiovascular disease is a global health burden. However, there are heterogeneities among countries or regions in the risk factors and clinical manifestations of atherosclerotic diseases as well as management patterns. We collected data from 25 centres in Thailand. Patients with documented coronary artery disease, cerebrovascular disease or peripheral arterial disease, or with at least three atherosclerosis risk factors were enrolled between April 2011 and March 2014. Data on demographics, atherosclerosis risk factors and the management pattern of risk factors, including laboratory findings, were recorded. In total, 9,390 patients, including 4,861 patients with established atherosclerotic disease and 4,529 patients with multiple risk factors, were enrolled. The modifiable risk factors, other than current smoking habit (5.3%), were common: hypertension (83.8%), dyslipidaemia (85.9%) and diabetes mellitus (57.4%). A majority of patients with hypertension (96.3%), dyslipidaemia (93.8%) and diabetes mellitus (78.5%) received medications for their conditions. Antiplatelet agents were given to 73.9% of patients. The undertreatment rate of cardiovascular risk factors, such as blood pressure, low-density lipoprotein cholesterol, haemoglobin A1c and smoking status, was 35.8%, 59.0%, 45.3% and 5.3%, respectively. Conventional atherosclerosis risk factors were common among Thai patients with established atherosclerotic disease. Even though most of the patients received recommended treatments according to established guidelines, a significant proportion of them were undertreated for atherosclerosis risk factors.

Conversion of Minimally Invasive Distal Pancreatectomy: Predictors and Outcomes.

Data on the risk factors for conversion during minimally invasive distal pancreatectomy (MIDP) and its effect on postoperative outcomes are limited. This retrospective study used the pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program database to compare MIDP requiring unplanned conversion with completed MIDP and open distal pancreatectomy (ODP). Of the 2926 cases identified in this study, 48.8% had ODP, 42.8% had MIDP, and 7.9% had conversion to MIDP. The conversion rate was 15.3% overall, 17.3% for laparoscopic surgery, and 8.5% for robotic surgery (p<0.001). The risk factors associated with conversion were higher body mass index (BMI), low preoperative albumin level, a current smoking habit, and malignant T3/T4 disease or chronic pancreatitis compared with benign tumor smaller than 5cm. A robotic approach was associated with a lower adjusted conversion rate than laparoscopy (odds ratio [OR] 0.32; 95% confidence interval [CI] 0.19-0.52). After adjustment, conversion was associated with a higher overall complication rate than MIDP (OR 1.89; 95% CI 1.35-2.66) or ODP (OR 1.41; 95% CI 1.00-1.98). Chronic pancreatitis, large malignant tumors, higher BMI, lower serum albumin, and a current smoking habit were shown to be independent risk factors for conversion during MIDP. A robotic approach was associated with a lower conversion rate than laparoscopic MIDP. Conversion of MIDP was associated with a higher overall complication rate than completed MIDP or ODP. Adequate patient selection for MIDP may prevent conversion and associated increased morbidity.

Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair.

Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation on magnetic resonance imaging (MRI). In patients with abdominal aortic aneurysm, we assessed whether USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes. In a prospective multicenter open-label cohort study, 342 patients with abdominal aortic aneurysm (diameter ≥40 mm) were classified by the presence of USPIO enhancement and were monitored with serial ultrasound and clinical follow-up for ≥2 years. The primary end point was the composite of aneurysm rupture or repair. Participants (85% male, 73.1±7.2 years) had a baseline aneurysm diameter of 49.6±7.7 mm, and USPIO enhancement was identified in 146 (42.7%) participants, absent in 191 (55.8%), and indeterminant in 5 (1.5%). During follow-up (1005±280 days), 17 (5.0%) abdominal aortic aneurysm ruptures, 126 (36.8%) abdominal aortic aneurysm repairs, and 48 (14.0%) deaths occurred. Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1±2.5 versus 2.5±2.4 mm/year, P=0.0424), although this was not independent of current smoking habit (P=0.1993). Patients with USPIO enhancement had higher rates of aneurysm rupture or repair (47.3% versus 35.6%; 95% confidence intervals, 1.1-22.2; P=0.0308). This finding was similar for each component of rupture (6.8% versus 3.7%, P=0.1857) or repair (41.8% versus 32.5%, P=0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair (P=0.0275), all-cause mortality (P=0.0635), and aneurysm-related mortality (P=0.0590). Baseline abdominal aortic aneurysm diameter (P<0.0001) and current smoking habit (P=0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic, 0.7935-0.7936). USPIO-enhanced MRI is a novel approach to the identification of aortic wall cellular inflammation in patients with abdominal aortic aneurysms and predicts the rate of aneurysm growth and clinical outcome. However, it does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors. URL: http://www.isrctn.com. Unique identifier: ISRCTN76413758.