Fourfold Increase In Incidence Research Articles

Cumulative incidence of type 1 diabetes in two cohorts of children with different national gluten recommendations in infancy

AimsBetween 1985 and 1996, Sweden experienced an “epidemic” of celiac disease with a fourfold increase in incidence in young children. Timing and amount of gluten introduced during infancy have been thought to explain this “epidemic”. We aimed to study whether the cumulative incidence of type 1 diabetes differs between children born during the “epidemic” compared to children born after.MethodsThis is a national register study in Sweden comparing the cumulative incidence of type 1 diabetes in two birth cohorts of 240 844 children 0–17 years old born 1992–1993, during the “epidemic”, and 179 530 children born 1997–1998, after the “epidemic”. Children diagnosed with type 1 diabetes were identified using three national registers.ResultsThe cumulative incidence of type 1 diabetes by the age of 17 was statistically significantly higher in those born after the “epidemic” 0.77% than in those born during the “epidemic” 0.68% (p < 0.001).ConclusionThe incidence of type 1 diabetes is higher in those born after the epidemic compared to those born during the epidemic, which does not support the hypothesis that gluten introduction increases the incidence of T1D. Changes in gluten introduction did not halt the increased incidence of type 1 diabetes in Sweden.

Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study

ObjectiveThe objective of this study was to determine the incidence in Eastern Finland of the different stages of status epilepticus (SE): 1) at the early stage of SE (a prolonged seizure lasting over 5 min);, 2) refractory SE (RSE), and 3) super-refractory SE (SRSE). MethodsFirstly, we conducted a retrospective study on the incidence and outcome of intensive care unit (ICU)-treated RSE and SRSE in the adult population (≥16 years) in Kuopio University Hospital (KUH)'s special care responsibility area (840,000 inhabitants). Secondly, we conducted a prospective study using the International League Against Epilepsy (ILAE)'s new definition for SE (prolonged seizures lasting over 5 min), in adult (≥16 years) patients in the KUH municipality district (North Savo, 248,000 inhabitants). ResultsThe retrospective study on ICU-treated RSE and SRSE from 2010 to 2012 identified 75 patients with RSE, of whom 21% were treated as SRSE, resulting in an annual age-adjusted incidence of ICU-treated RSE of 3.0/100,000 (95% confidence interval [CI]: 2.4–3.8) and 0.6/100,000 (95% CI: 0.4–1.0) for SRSE. In the prospective study of early stage SE (seizures lasting over 5 min), we identified 151 consecutive episodes during the 9-month study period in 2015, corresponding to an annual age-adjusted incidence of 81.1/100,000 (95% CI: 75.8–87.0). In this study, 11 seizure episodes became refractory, resulting in an age-adjusted incidence of RSE of 6.0/100,000 (95% CI: 3.4–10.4), of which seven were treated in the ICU [3.8/100,000 (95% CI: 1.8–7.8)], four were treated palliatively [2.2/100,000 (95% CI: 0.82–5.7)], and two evolved to SRSE [1.1/100,000 (95% CI: 0.3–4.3)]. ConclusionsThe new ILAE 2015 definition of SE resulted in a four-fold increase in incidence of SE compared to the earlier 30-min definition reported earlier in Europe. In the epidemiology of RSE, the incidence of ICU-treated RSE, palliatively treated RSE, and SRSE needs to be separated.This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.

National trends in incidence and survival of chronic lymphocytic leukemia in Norway for 1953-2012: a systematic analysis of population-based data.

Chronic lymphocytic leukemia is a disease of the elderly, and despite major advances in treatment, remains incurable. The Cancer Registry of Norway has registered data on patients with chronic lymphocytic leukemia since 1953. We aimed to analyze trends in incidence and survival of chronic lymphocytic leukemia in Norway. We identified 7664 patients reported with chronic lymphocytic leukemia to the registry between 1953 and 2012. We gathered information on sex, age at diagnosis, date of death and basis for diagnosis. The age‐standardized incidence increased from 0.6/100.000 person‐years in 1953 to 3.1/100,000 person‐years in 2012. We found a significant decrease in median age between 1993–2002 and 2003–2012 (75 vs. 72 years, 95%CI: 2.52–3.98, P < 0.001). Men were diagnosed at a significantly younger age than women. Immunophenotyping has become the most important diagnostic method after 2002. Median observed survival increased from 3 years in 1952–1963 to 8.5 years in 2003–2012. Five‐ and 10‐year age‐standardized net survival increased throughout the whole period across age groups and reached 79% and 57%, respectively. Median observed survival was significantly shorter in men than in women in 1993–2002 (4.9 vs. 6.1 years, P < 0.001). The gap between survival rates for men and women was diminishing in 2003–2012 in patients younger than 60 years while it remained considerable in older patients. Despite an aging Norwegian population, chronic lymphocytic leukemia (CLL) patients become younger at diagnosis. A fourfold increase in incidence, a prolonged survival, and major changes in diagnostic methods in Norway were observed.

Hemorrhagic Fundic Gland Polyps Associated with Proton Pump Inhibitor Use and Anticoagulation

Introduction: Fundic gland polyps (FGP) are the most commonly found gastric polyps in Western countries and are often incidental findings on upper endoscopic examinations. FGPs have a known association with chronic proton pump inhibitor (PPI) use, however they are rarely associated with iron deficiency anemia and GI bleeding. We present a case of hemorrhagic FGPs that resolved with discontinuation of PPI therapy. Case: A 72 year-old female underwent upper endoscopy and colonoscopy after being hospitalized with severe iron deficiency anemia. Her past medical history included insulin-dependent diabetes mellitus and coronary artery disease with coronary artery bypass graft, for which she was on c lopidogrel. The upper endoscopy showed multiple, large bleeding gastric polyps. The largest polyps were removed by snare polypectomy and endoclips were placed to achieve hemostasis. Pathology revealed fundic gland polyps with focal ulceration and without dysplasia. Her colonoscopy revealed no additional polyps. The PPI and clopidogrel were stopped, and the patient was discharged home. Healing and incomplete resolution of the fundic gland polyps was noted during three month followup EGD. Upper endoscopy revealed normal appearing gastric mucosa three years after the initial presentation. Discussion: Fundic gland polyps are the most commonly found gastric polyps in Western countries where Helicobacter pylori prevalence is low and PPI use is common. They are generally categorized as non-neoplastic and are found in up to 2% of all upper gastrointestinal endoscopy examinations performed. Unlike hyperplastic polyps, FGPs are often asymptomatic and rarely associated with gastrointestinal bleeding. While sporadic FGPs have been theorized to be the result of activating mutations of beta catenin genes, there has been a noticeable increase in FGPs associated with long-term proton pump inhibitor use in developed countries worldwide; in some studies PPI use of greater than 12 months incurs a fourfold increase in incidence of FGPs. We describe a rare case of bleeding fundic gland polyps that resolved completely with the discontinuation of proton pump inhibitors and antiplatelet medication.Figure 1Figure 2Figure 3

Comprehensive geriatric assessment (CGA) in men age 70 or over with localized prostate cancer.

184 Background: There has been a four-fold increase in incidence of prostate cancer (PC) in men age 70 or older in England in the last 30 years. Which treatment (surgery, radiotherapy, or surveillance) is right for which patient depends on a number of factors including the risk of death from competing causes and fitness for the proposed treatment. Objective assessments such as those included in a Comprehensive Geriatric Assessment (CGA) might be helpful in this regard. The primary objective of this study is to describe CGA scores of a cohort of older men with PC. The secondary objectives are to examine if a single score (the Vulnerable Elders Survey [VES-13]), is a suitable screening test for a full CGA and to assess whether scores predict radiotherapy toxicity. Methods: Patients age 70 and older with localised PC completed a CGA prior to commencement of radical radiotherapy. The CGA assessed WHO performance status (PS), activities of daily living (ADL), instrumental activities of daily living (IADL), Charlson co-morbidity index, number of medications, mini-nutritional assessment (MNA), social network index (SNI), G8 score, and VES-13. Participants had acute radiotherapy toxicity assessed 12 weeks post-treatment completion. Results: As of September 2013, 100 patients had been recruited. Median age was 74.5 (range 70 to 82). Ninety five percent of patients had a PS less than two. Using the VES-13 tool, 5.2% scored greater than two. 22.6% scored less than 14 on G8 scoring. Additionally, 13.5% were not fully independent on ADLs, 4.2% were not fully independent on IADLs, 32.3% scored greater than one on the Charlson Index, 12.3% had a history of depression or dementia, and 52.9% were on more than three prescription medications. Fourteen percent were at risk of malnutrition and 2.3% were malnourished according to MNA scores, 25.0% had SNI scores less than three and 9.3% of patients had fallen at least once in the preceding three months. Twelve week follow-up data regarding acute radiotherapy toxicity is currently being collected; these will be correlated with the CGA components and presented at the 2014 ASCO Genitourinary Cancers Symposium. Conclusions: These data demonstrate that many older men with localised prostate cancer are vulnerable according to a CGA. Correlations observed between radiotherapy toxicity and CGA scores would have important implications for therapeutic decisions.

Surgical and Dysmorphological Aspects of Abdominal Wall Defects

ABSTRACT

Imaging of metastatic melanoma

Cutaneous cancer is now the most common human malignancy and in the UK malignant melanoma comprises 11% of all skin cancers. Eighty percent of malignant melanoma is thought to be related to excessive exposure to sunlight, particularly in childhood. Although the least common skin cancer, malignant melanoma is the most deadly. In 1999 it killed over 1600 individuals in the UK and by 2004, in the USA, 55,100 new cases were anticipated. The incidence of this disease is increasing more rapidly than any other malignancy and in males there was a four-fold increase in incidence between 1971 and 1997 whilst there was a three-fold increase in women. Cutaneous melanoma is arguably the most widely metastasising neoplastic disease and it has a particularly unpredictable pattern of spread. Imaging has an important role in the management of this disease as the demonstration and delineation of metastases influences management and prognosis.

Gunshot injuries to the extremities: experience of a U.K. trauma centre

The Metropolitan Police figures suggest an increase in the incidence of injuries related to gun crime. We conducted a retrospective analysis of extremity gunshot injuries over a five-year period. Our aim is to report on our (1) incidence, (2) complications and (3) experience in treating these injuries. Over a five-year period (1998-2002), 70 extremity gunshot injuries in 61 patients were identified from a trauma register and case notes reviewed retrospectively. The following were identified and analysed: type of injury (low or high-energy transfer), treatment (early/late), complications, patient demographics and compliance. There was a four-fold increase in incidence. Our incidence correlated well with The Metropolitan Police figures (r = 0.93). One-third of our injuries were managed non-operatively and on an outpatient basis. Complications were as follows: eight wound infections, one fracture non-union, one compartment syndrome, one vascular injury and five nerve injuries. Compliance was excellent for high-energy transfer injuries. Extremity gunshot injuries are on an increase in the United Kingdom highlighting the need for trauma surgeons' knowledge of the management of these injuries. Complications can be reduced to a minimum if the basic principles of management are strictly adhered to.

A phenotypically distinct subset of immature B cells exhibits partial activation, increased survival, and preferential expression of VhS107.

We have observed that immature B cells (IgM(low)IgD(-)) in the bone marrow of adult BALB/c mice exhibit heterogeneity, with a distinct subpopulation ( approximately 4-10%) expressing the CD43/S7 surface protein. These CD43/S7(+) immature B cells often express other surface antigens associated with B cell activation (CD5, CD11b, PD-1). Generation of optimal numbers of CD43/S7(+) immature B cells requires expression of a functional Btk protein, consistent with activation as a requisite for the CD43/S7(+) immature B cell phenotype. Like typical CD43/S7(-) immature B cells, the CD43/S7(+) immature B cells are predominantly resting cells, which are derived from cycling bone marrow B cell precursors. The CD43/S7(+) immature B cell population exhibits enhanced survival in vivo upon administration of the apoptosis-inducing corticosteroid, dexamethasone. Finally, CD43/S7(+) immature B cells show a fourfold increase in incidence of VhS107 micro heavy chain expression compared to the CD43/S7(-) immature B cells. Therefore, in adult murine bone marrow, the presence of a phenotypically distinct immature B cell population can be demonstrated which has undergone partial activation leading to increased survival and BCR-dependent Vh repertoire selection.

Epidemiology of type I diabetes mellitus in Switzerland: steep rise in incidence in under 5 year old children in the past decade.

In this nationwide prospective study we wanted to verify the trend of increasing diabetes incidence data from our earlier retrospective analysis of the military registry of Swiss men. The data collection of newly diagnosed children in Switzerland at an age younger than 15 years started in 1991. The countrywide survey used a small questionnaire which was sent back to the study centre. The questionnaire was anonymous and contained: hospital of diagnosis, initials, sex, birth date, date of diagnosis, residence, country of citizenship, and responsible physician. General data on the population were taken from publications of the Swiss Federal Statistical Office. A total of 941 children below the age of 15 years with newly diagnosed Type I (insulin-dependent) diabetes mellitus were collected (434 girls, 507 boys). The incidence in children aged 0 to 14 years rose significantly between 1991 and 1999 with a yearly average increase of 5.1%. In the age group 0 to 4 years a more than four-fold increase in incidence from 2.4/100,000 per year to 10.5/100,000 per year (p = 0.0002) was recorded, whereas the age-specific incidence in the 5 to 9-year-old and 10 to 14-year-old children did not change during the data collection period. The incidence was significantly higher in boys than in girls, whereas no difference was found between rural and urban populations. The incidence of Type I diabetes is rising in children living in Switzerland but only the youngest age group of under 5 years of age is affected showing a large annual average increase of 23.8%.

Does ethnic origin influence the incidence or severity of keratoconus?

Keratoconus affects all races, yet very little information exists as to the relative frequency in patients of different ethnic origin. We aimed to establish the incidence and severity of keratoconus in Asian and white patients. The hospital records of the ophthalmology department of a large Midlands hospital with a catchment population of approximately 900,000 (87% white, 11% Asian, 2% other) were examined retrospectively for the 10 year period from 1989 to 1998. For the age group 10-44 years the prevalence of keratoconus in Asians and whites was 229 and 57 per 100,000 respectively, a relative prevalence of 4 to 1. The incidence of keratoconus in the same age group was 19.6 and 4.5 per 100,000 per year respectively, a relative incidence of 4.4 to 1. Asians were significantly younger at presentation compared with whites (mean 22.3 +/- 6.5 vs 26.5 +/- 8.5 years, p < 0.0001). A first corneal graft was carried out on 14% of the Asian and 15% of the white patients. Of those having grafts, Asians were significantly younger than white patients at the time of diagnosis (mean 19.1 +/- 4.8 vs 25.7 +/- 7.3 years, p = 0.005) and at operation (mean 21.4 +/- 5.0 vs 28.7 +/- 7.7 years, p = 0.004). The interval from diagnosis to operation, though shorter for Asians, was not significantly different (mean 1.8 +/- 1.4 vs 2.5 +/- 1.7 years, p = 0.2). The results show previously unrecognised racial differences in the hospital presentation of keratoconus in the UK. Compared with white patients, Asians have a fourfold increase in incidence, are younger at presentation and require corneal grafting at an earlier age.

Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study.

To analyse the association between use of antihypertensive treatment, diastolic blood pressure, and long term incidence of ischaemic cardiac events in elderly men. Population based cohort study. Baseline examination in 1982-3 and follow up for up to 10 years. Malmŏ, Sweden. 484 randomly selected men born in 1914 and living in Malmŏ during 1982. Observational comparisons of incidence rates and rate and hazard ratios of ischaemic cardiac events (myocardial infarction or death due to chronic ischaemic cardiac disease). The crude incidence rate of ischaemic cardiac events was higher in those subjects who were taking antihypertensive drugs than in those who were not (rate ratio 2.6 (95% confidence interval 1.7 to 3.9)). After adjustment for potential confounders (differences in baseline smoking habits, blood pressure, time since diagnosis of hypertension, ischaemic or other cardiovascular disease, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus, obesity, and raised serum creatinine concentration) this rate was reduced but still raised (hazard ratio 1.9 (1.0 to 3.7)). In men with diastolic blood pressure > 90 mm Hg, antihypertensive treatment was associated with a twofold increase in the incidence of ischaemic cardiac events (rate ratio 2.0 (1.1 to 3.6)), which vanished after adjustment for potential confounders (hazard ratio 1.1 (0.5 to 2.6)). In those subjects with diastolic blood pressure < or = 90 mm Hg, antihypertensive treatment was associated with fourfold increase in incidence (rate ratio 3.9 (2.1 to 7.1)), which remained after adjustment for potential confounders (hazard ratio 3.8 (1.3 to 11.0)). Antihypertensive treatment may increase the risk of myocardial infarction in elderly men with treated diastolic blood pressures < or = 90 mm Hg.

Reduction in Pulmonary Function and Increased Frequency of Cough Associated With Passive Smoking in Teenage Athletes

Previous studies have suggested that passive smoking (involuntary inhalation of tobacco smoke by nonsmokers) reduces small airways function. We evaluated the exposure to passive smoking and its effects on pulmonary function and symptoms in a group of 12- to 17-year-old high school athletes (N = 209; 119 boys and 90 girls) at their annual presport participation physical examinations. A structured interview was used to assess pulmonary symptoms, personal smoking habits, and passive cigarette smoke exposure. All athletes performed forced expiratory maneuvers on a portable spirometer. We measured forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow 25% to 75% (FEF25-75). The best of three FEF25-75 measured was used. Less than 70% of predicted FEF25-75 was considered abnormal. Of the 209 athletes, 7.7% were active smokers and were excluded. Of the remaining 193 athletes, 68.4% were currently exposed to passive smoking. We found a fourfold increase in incidence of low FEF25-75 and/or cough in athletes exposed to passive smoking compared with athletes not exposed: 18 of 132 exposed athletes (13.6%) had low FEF25-75 and/or cough compared with two of 61 unexposed athletes (3.3%) who had low FEF25-75 and cough (P = .02). Boys were more frequently exposed to passive smoking than girls (74% of boys [80/108] v 61% of girls [52/85] ), but the effects were more pronounced in girls. These data show a relationship between exposure to passive smoking and early pulmonary dysfunction in young athletes. The frequent exposure to passive smoke and the high prevalence of dysfunction in this population, generally considered to be healthy, is of particular concern.

Diverging trends in incidence and mortality of testicular cancer in Denmark, 1943-1982.

Between 1943 and 1982, 5,140 new cases of testicular cancer were diagnosed in Denmark. The age-standardized incidence rate more than doubled in the period. Striking variations is seen in the age-relationship over time with a four-fold increase in incidence for men aged 15-24 years while no increment was observed for those above 65 years of age. The increase with time in the risk could be accounted for by a cohort effect. The mortality rate did not parallel the incidence rate and a 50% decrease in mortality rate appeared in the period 1978-1982. Introduction of combination chemotherapy including cis-platinum is one of the main factors responsible for this beneficial development. The observed pattern of diverging trends in incidence and mortality of testicular cancer implies that mortality rates do not reflect the incidence and will accordingly be unsuited as a basis for aetiological considerations based on trends. The brisk increase in the risk of testicular cancer, especially among young men is in accordance with trends in other western countries, and prompts an enforced search for suspected or new risk factors.