Morbidity Ratio Research Articles

Environmental health surveillance in the areas near large electoronic industrial complex in Korea

(Introduction)There have been constant civil complaints about the health influences caused by air pollution from Industrial Complexes in Korea. The environmental health surveillance system was implemented to identify pollution and consequent health damage in these areas and conduct risk communication with local communities. (Method)Regional air pollution was evaluated through data assessment of pollutant release/transfer register and air pollution monitoring, 130 hazardous air pollutants were also measured in the residential areas. The study areas (exposed(E)/non-exposed(NE)) were selected by the CALPUFF modeling with stack emmission(PM10, NO2) data. The questionnaires on health situation and characteristics of exposure were done from 2,500 subjects(purposive and propotionate quota sampling). The concentration of 18 pollutants were analyzed in blood and urine of 850 people. Regional health issues were examined with the standardized ratio of morbidity and hospital visit by disease from the 10-year data of National Health Insurance Service. (Results)Methylethylketon and lead were released 380, 2.4 tons per year respectively. The atmospheric concs of methylethylketon and lead were 6.71-2.6ppb, 62-53 ng/m3 in E area, which were relatively higher than those in NE areas and other complexes. The urinary lead and ethylbenzene metabolites were 1.96ug/dl, 232ug/g-creatinine. The residents had relatively more experiences of sinusitis(3%), allergic rhinitis(7%). Their standardized morbidity ratio of cardiovascular disease and cancer in E areas were 1.19, 3.19 compared to NE area. The ratio of hospital visits due to conjunctivitis and respiratory diseases were 1.02, 1.05. The lead in blood were attributed to age, residence regions and smoking habits and had significant relations with blood pressure and cerebrovascular diseases in E areas. (Conclusion) The people have lived in areas near industrial complex would be influenced from polutants emission in their exposure and health.

Spatial mapping of acute diarrheal disease using GIS and estimation of relative risk using empirical Bayes approach

Background/objectivesDiarrheal disease is one among the top five causes of death in low- and middle-income countries. It is the second leading cause of death in children under five years of age. Diarrheal disease contributes to the mortality of nearly 1.5 million children and globally there are about two billion cases of diarrheal diseases every year. In the present study, we studied the spatio-temporal pattern of acute diarrheal disease (ADD) ward-wise and to estimate and compare two widely used Bayesian models in the study of measuring relative risk of ADD in Chennai Corporation, Tamilnadu, India. Materials and methodsData on ADD were obtained from Communicable disease hospital, Chennai, Tamilnadu, India from 2009–11. Geographical Information System (GIS) technique was used to map ADD data ward- wise and relative risk was estimated using empirical Bayes approach using Poisson gamma and Poisson log normal models. ResultsOver a period of three years from 2009–11, nearly 7661 cases of ADD were reported in Chennai Corporation. The cumulative incidence rate of diarrhea was 142.6 cases per 100,000 population ranging from minimum of 0 to maximum of 1699.7 cases per year. Males had higher average incidence 147.4 cases than females with 137.7 cases per 100,000 population per year. Also, the cumulative incidence was higher in the age group of 0–4 years (306.8 cases) than that in any other category. Higher incidence was observed during the months of Apr–Jun (55.2 cases) than that in any other seasons. Choropleth map indicates that higher incidence of ADD was more prevailed in northern part of Chennai near coastal area which includes the wards from Tondiarpet, Basin bridge, and Pulianthope zones. The posterior relative risk estimate obtained using empirical Bayes approach identified 23, 30, and 19 wards having relative risk significantly greater than 1 for years 2009, 2010, and 2011, respectively. Fitting standardized morbidity ratio (SMR) and the other two models showed that, consistently Tondiarpet ward had the highest relative risk of ADD in all the three years (relative risk (95% credible interval) based on SMR, Poisson gamma and Poisson log normal models were 13.3 (11.6, 15.2), 13.0 (11.3, 14.8), 13.3 (11.5, 15.1) in 2009 and 8.0 (6.9, 9.2), 7.8 (6.7, 8.9), 8.0 (6.9, 9.1) in 2010 and 19.6 (17.0, 22.3), 19.0 (16.5, 21.7), 19.5 (16.9, 22.1) in 2011, respectively. ConclusionGIS mapping of ADD during the years from 2009–11 identified wards having higher incidence near northern part of Chennai near coastal area. Thus estimation of relative risk using empirical Bayes approach and mapping of disease would help us to estimate accurate incidence despite small observations and to take precautionary measure to prevent and control the spread of the disease.

Fine-Scale Mapping by Spatial Risk Distribution Modeling for Regional Malaria Endemicity and Its Implications under the Low-to-Moderate Transmission Setting in Western Cambodia.

The disease burden of malaria has decreased as malaria elimination efforts progress. The mapping approach that uses spatial risk distribution modeling needs some adjustment and reinvestigation in accordance with situational changes. Here we applied a mathematical modeling approach for standardized morbidity ratio (SMR) calculated by annual parasite incidence using routinely aggregated surveillance reports, environmental data such as remote sensing data, and non-environmental anthropogenic data to create fine-scale spatial risk distribution maps of western Cambodia. Furthermore, we incorporated a combination of containment status indicators into the model to demonstrate spatial heterogeneities of the relationship between containment status and risks. The explanatory model was fitted to estimate the SMR of each area (adjusted Pearson correlation coefficient R2 = 0.774; Akaike information criterion AIC = 149.423). A Bayesian modeling framework was applied to estimate the uncertainty of the model and cross-scale predictions. Fine-scale maps were created by the spatial interpolation of estimated SMRs at each village. Compared with geocoded case data, corresponding predicted values showed conformity [Spearman’s rank correlation r = 0.662 in the inverse distance weighed interpolation and 0.645 in ordinal kriging (95% confidence intervals of 0.414–0.827 and 0.368–0.813, respectively), Welch’s t-test; Not significant]. The proposed approach successfully explained regional malaria risks and fine-scale risk maps were created under low-to-moderate malaria transmission settings where reinvestigations of existing risk modeling approaches were needed. Moreover, different representations of simulated outcomes of containment status indicators for respective areas provided useful insights for tailored interventional planning, considering regional malaria endemicity.

Estatística Espacial Aplicada aos Estudos de Incidência de Câncer

O Sistema de Informação Geográfica (SIG) como ferramenta em estudos epidemiológicos tem se tornado algo frequente na área da Saúde Coletiva. Em estudos sobre incidência de câncer, o uso da análise espacial ainda é incipiente no país, entretanto possuí grande potencial para auxílio nos modelos de planejamento em saúde. O objetivo deste trabalho é apresentar um método empírico de análise de padrões espaciais para os casos de incidência de cânceres considerados raros que acometem a população com idades entre 0 e 19 anos, discutindo a aplicabilidade da estatística espacial e as possíveis utilizações da interpretação da disposição espacial dos eventos. Utilizou-se o SIG para georreferenciar as taxas de incidências de casos de cânceres de alguns grupos da Classificação Internacional de Câncer Infantil (CICI), ajustadas por idade e sexo, segundo os Centros de Saúde de suas residências. Foram estimadas as razões padronizadas de incidência (Standardized Morbidity Ratio-SMR). Para controlar a instabilidade das taxas devido ao pequeno número de casos, foi feita uma suavização pelo método Empirical Bayes. Comparando as taxas anuais, suavizadas pelo referido método Bayesiano, constatou-se diferenças entre elas quanto à distribuição espacial, com concentração destas nas regiões Sudoeste e Noroeste do município de Campinas. Conclui-se que o uso de estatística espacial como ferramenta de apoio à decisão, permite identificar a distribuição de casos de cânceres do grupo da CICI, contribuindo para o planejamento em saúde.

Improving public health intervention for mosquito-borne disease: the value of geovisualization using source of infection and LandScan data.

Epidemiological studies use georeferenced health data to identify disease clusters but the accuracy of this georeferencing is obfuscated by incorrectly assigning the source of infection and by aggregating case data to larger geographical areas. Often, place of residence (residence) is used as a proxy for the source of infection (source) which may not be accurate. Using a 21-year dataset from South Australia of human infections with the mosquito-borne Ross River virus, we found that 37% of cases were believed to have been acquired away from home. We constructed two risk maps using age-standardized morbidity ratios (SMRs) calculated using residence and patient-reported source. Both maps confirm significant inter-suburb variation in SMRs. Areas frequently named as the source (but not residence) and the highest-risk suburbs both tend to be tourist locations with vector mosquito habitat, and camping or outdoor recreational opportunities. We suggest the highest-risk suburbs as places to focus on for disease control measures. We also use a novel application of ambient population data (LandScan) to improve the interpretation of these risk maps and propose how this approach can aid in implementing disease abatement measures on a smaller scale than for which disease data are available.

Immunosuppressive therapy in the posttransplant period and skin cancer.

To determine the incidence of malignancies in renal transplant recipients (RTRs) and to analyze the association between the risk of skin cancer and immunosuppressive regiments used in the posttransplant period. A cohort study was performed on 797 RTRs. Standardized morbidity ratio (SMR) was calculated for the most common types of cancer developed in the posttransplant period and different types of immunosuppressive therapy used in the cohort. 192 cases of malignancies were diagnosed in 86 RTRs (10.8%). Nonmelanoma skin cancer (NMSC) was the most frequent type of cancer (SMR = 6.42, p = 0.000), followed by renal cancer (SMR = 5.9, p = 0.000), malignant melanoma (SMR = 2.59, p = 0.080), and prostate cancer (SMR = 1.21, p = 0.593). The risk to develop NMSC was significantly higher in the group where cyclosporine has been used besides tacrolimus, mycophenolatemophetil and steroids as well as in the group treated with the combination without cyclosporine (SMR = 9.62, p = 0.001 and SMR = 5.18, p = 0.000). Furthermore, the risk was significantly higher in RTRs receiving anti-thymocyte globulin within induction therapy (SMR = 4.14, p = 0.000). The preliminary results indicate that the risk of NMSC in RTRs is significantly higher than in the general population and thus emphasize the need to improve preventive strategies in the Czech transplant population.

Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropaenia: a developing country perspective

ObjectivesThe prevalence of malnourishment among paediatric cancer patients undergoing chemotherapy in developing countries is poorly documented despite greater potential for malnourishment in such settings. We aimed to estimate the prevalence...

Cardiovascular Disease Risk Associated With Familial Hypercholesterolemia: A Systematic Review of the Literature

PurposeThe goal of this study was to determine cardiovascular disease (CVD) risk associated with familial hypercholesterolemia (FH). MethodsA systematic review of the published literature was conducted. All publications describing FH risk from PubMed (“cardiovascular disease risk + familial hypercholesterolaemia,” 2004–2015), Internet and Medline search of FH registries, and associated references were screened for FH-related CVD risk in titles, abstracts, and study methods. CVD risk expressed as rates, odds, or ratios of mortality and morbidity were extracted. Each article was reviewed for bias by 2 reviewers within 17 items in 7 categories; a modified Newcastle-Ottawa assessment scale was used for nonrandomized studies. FindingsThe complete literature search identified 712 potential publications: 549 from PubMed (Medline), 150 from registries, and 13 from references. Fourteen articles met the inclusion criteria: 8 from registries in the United Kingdom, the Netherlands, Norway, and Spain; 5 from single hospitals or families in Japan, Denmark, the Netherlands, and the United Kingdom; and a population survey in Denmark. Across studies, attrition bias was low in 22 (80%) of 28 items. Risk of selection bias was high in 35 (63%) of 56 items. Selection bias risk was due to low representativeness and lack of a non-FH comparator group within the same study; detection bias risk was due to variable definitions of CVD outcomes/measurement; and performance bias risk was due to long-term, intensive treatment, the most common limitations for registries. Studies from single hospitals and families lacked generalizability. In contrast, the Danish study revealed a low bias in each of the 4 selection bias criteria and 2 attrition risk criteria. Fatal and nonfatal CVD events were collected in the study. Comparing patients with FH versus non-FH patients, the odds ratios for coronary artery disease were 10.3 (95% CI, 7.8–13.8) and 13.2 (95% CI, 10.0–17.4) in subjects treated and not treated with lipid-lowering therapy, respectively. These ratios fall within the ranges of ratios reported in other studies but are generally higher than the ratios from registries and clinics, in which intensive specialized management is available. ImplicationsThere is a lack of available data describing CVD risk in patients with FH, and many of the existing studies have biases in their design that could affect their risk estimates. A Danish study had the highest quality based on a predefined quality check list, providing the most credible estimates of the increase in CVD risk in patients with FH. The CVD risk due to FH is high and represents unmet medical need for patients with FH. Further research is warranted to validate the magnitude of risk.

L’état de santé des populations des départements d’outre-mer en 2012, comparativement à la métropole : une analyse de la base nationale de l’Assurance maladie

BackgroundThis study uses healthcare consumption to compare the health status of beneficiaries of the French national health insurance general scheme between individuals living in French overseas territories (FOT) and those living in metropolitan France. MethodsData were extracted from the French national health insurance database (Sniiram) for 2012, using algorithms, 56 groups of diseases and 27 groups of hospital activity were isolated. Standardized morbidity ratio for age and sex (SMR) were used to compare FOT to mainland France. ResultsCompared with mainland France, people living in the four FOT had high SMR for diabetes care (Guadeloupe 1.9; Martinique 1.7; Guyane 1.9; La Réunion 2.3), dialysis (2.7; 2.4; 3.8; 4.4), stroke (1.2; 1.1; 2.0; 1.5), and hospitalization for infectious diseases (1.9; 2.5; 2.4; 1.4) and obstetrics (1.4; 1.2; 1.9; 1.2). Care for inflammatory bowel disease or cancer were less frequent except for prostate in Martinique and Guadeloupe (2.3). People living in Martinique, Guadeloupe and la Reunion had more frequently care for psychotic disorders (2.0; 1.7; 1.2), dementia (1.1; 1.3; 11), epileptic seizures (1.4; 1.4; 16) and hospitalizations for burns (2.6; 1.7; 2.9). In la Reunion, people had more frequently coronary syndrome (1.3), cardiac heart failure (1.6), chronic respiratory diseases except cystic fibrosis (1.5), drug addiction (1.4) and hospitalizations for cardiovascular catheterization (1.4) and toxicology, poisoning, alcohol (1.7). Other differences were observed by gender: HIV infection, peripheral arterial disease, some chronic inflammatory disease (lupus) were more frequent in women living in Martinique or Guadeloupe, compared to women from mainland France and psychotic disorders for men. From la Reunion, men had more frequently liver and pancreatic diseases and hospitalisation for toxicology, poisoning, alcohol than men from mainland France. ConclusionThis study highlights the utility of administrative database to compare and follow population health status considering healthcare use. Specific Public Health policies are justified for FOT, taking into account the specific context of each FOT, the necessity of prevention initiatives and screening to reduce the frequency of the chronic diseases.

Cerebrovascular Safety of Sulfonylureas: The Role of KATP Channels in Neuroprotection and the Risk of Stroke in Patients With Type 2 Diabetes.

Sulfonylureas are ATP-sensitive potassium (KATP) channel blockers commonly used in the treatment of type 2 diabetes mellitus (T2DM). Activation of KATP channels plays a neuroprotective role in ischemia; thus, whether sulfonylureas affect the outcomes of stroke in patients with T2DM needs to be further studied. In our study, streptozotocin (STZ)-induced diabetic mice subjected to transient middle cerebral artery occlusion (MCAO) showed larger areas of brain damage and poorer behavioral outcomes. Blocking the KATP channel by tolbutamide increased neuronal injury induced by oxygen-glucose deprivation (OGD) in vitro and permanent MCAO (pMCAO) in vivo. Activating the KATP channel by diazoxide reduced the effects of both the OGD and pMCAO. Western blot analysis in STZ mouse brains indicated an early increase in protein levels of N-methyl-d-aspartate receptor 2B and postsynaptic density protein-95, followed by a decrease in phosphorylation of glycogen synthase kinase 3β. Our systematic meta-analysis indicated that patients with T2DM treated with sulfonylureas had a higher odds ratio for stroke morbidity than those who received comparator drugs. Taken together, these results suggest that sulfonylurea treatment in patients with T2DM may inhibit the neuroprotective effects of KATP channels and increase the risk of stroke.

Transitioning toward Sustainable Development Goals: The Role of Household Environment in Influencing Child Health in Sub-Saharan Africa and South Asia Using Recent Demographic Health Surveys.

The Millennium Development Goals are now replaced by 17 sustainable development goals. The emphasis of old goals was on improving water, sanitation, and child mortality conditions in developing countries. The study explored the major question about the association between different household environment conditions with child survival and health in Sub-Saharan African and South Asian countries in the current scenario. This paper estimated the risk of death, morbidity, and undernutrition among children living in households with the improved sources of water, sanitation, and non-solid cooking fuel. Two sources of information are explored in this study. First, data from World Health Statistics (WHS)-2014 for all of the Sub-Saharan African and South Asian countries were used. Second, available standard Demographic and Health Survey (DHS) performed in the countries of Sub-Saharan Africa and South Asia after 2010 was included in the study. It resulted in the inclusion of 15 countries which were Bangladesh (2011), Congo Republic (2013–2014), Cote d’Ivoire (2011–2012), Ethiopia (2011), Gambia (2013), Mali (2012–2013), Mozambique (2011), Namibia (2013), Nepal (2011), Niger (2012), Nigeria (2013), Pakistan (2012–2013), Sierra Leone (2013), Uganda (2011), and Zambia (2013). The scatter plot diagram was plotted, and the curve was fitted using the WHS-2014. Cox regression and logistic regression were used to estimate adjusted risks (odds ratio) of child mortality and health outcomes using DHSs. The use of non-solid cooking fuel was very high in most of the Sub-Saharan African and South Asian countries. There was a positive correlation between improving access to safe drinking water and sanitation. The exponential curve fitted well with child mortality and household environmental indicators. The use of improved source of water and sanitation significantly related with the lower odds ratio of death, morbidity, and undernutrition among children aged 12–59 months. The risks were not significant for children aged less than 12 months. The study provides evidence that these environmental conditions hold importance for improving child health, especially in Sub-Saharan African countries.

Trends in pertussis mortality and morbidity in Colombia, 2002-2012

Whooping cough is a public health problem that mainly affects children under one year of age with highly lethal outcomes. It is a re-emerging disease, which is preventable by immunization.Objective: To analyze mortality and morbidity trends of whooping cough in Colombia between 2002 and 2012.Materials and methods: We conducted a quantitative descriptive study of deaths by pertussis between 2002 and 2012 using data from death certificates registered by the Departamento Administrativo Nacional de Estadística, and cases reported to the Sistema Nacional de Vigilancia en Salud Pública, 2005-2012. Frequency measurements, morbidity and mortality ratios and female increased mortality were calculated.Results: Fifty one point two percent of the deaths occurred in women; the year with more deaths was 2012; 67.3% occurred in urban areas, and 43.5% of the subjects were affiliated to the subsidized health regime. The risk of illness was 1.88 per 1,000 live births with increased risk in Vaupés and Vichada. The risk of death was 0.02 per 1,000 live births; there was a decrease in the lethality trend.Conclusions: Pertussis has reemerged with increasing mortality and morbidity. Since this is a preventable disease through vaccination, it is advisable to increase control and enhance vaccination coverage in both children and adults, who are an important reservoir of the disease. The effective control of pertussisdemands continued work aimed at early identification. It is also necessary to carry out actions to improve data quality in order to facilitate its analysis and the generation of more valid information.

Mouth breathing, another risk factor for asthma: the Nagahama Study.

Allergic rhinitis, a known risk factor for asthma onset, often accompanies mouth breathing. Mouth breathing may bypass the protective function of the nose and is anecdotally considered to increase asthma morbidity. However, there is no epidemiological evidence that mouth breathing is independently associated with asthma morbidity and sensitization to allergens. In this study, we aimed to clarify the association between mouth breathing and asthma morbidity and allergic/eosinophilic inflammation, while considering the effect of allergic rhinitis. This community-based cohort study, the Nagahama Study, contained a self-reporting questionnaire on mouth breathing and medical history, blood tests, and pulmonary function testing. We enrolled 9804 general citizens of Nagahama City in the Shiga Prefecture, Japan. Mouth breathing was reported by 17% of the population and was independently associated with asthma morbidity. The odds ratio for asthma morbidity was 1.85 (95% CI, 1.27-2.62) and 2.20 (95% CI, 1.72-2.80) in subjects with mouth breathing alone and allergic rhinitis alone, which additively increased to 4.09 (95% CI, 3.01-5.52) when mouth breathing and allergic rhinitis coexisted. Mouth breathing in nonasthmatics was a risk for house dust mite sensitization, higher blood eosinophil counts, and lower pulmonary function after adjusting for allergic rhinitis. Mouth breathing may increase asthma morbidity, potentially through increased sensitization to inhaled allergens, which highlights the risk of mouth-bypass breathing in the 'one airway, one disease' concept. The risk of mouth breathing should be well recognized in subjects with allergic rhinitis and in the general population.

The Impact of Radical Cystectomy and Urinary Diversion on Suicidal Death in Patients With Bladder Cancer.

Compared to the general population, suicide is more common in the elderly and in patients with cancer. We sought to examine the incidence of suicide in patients with bladder cancer and evaluate the impact of radical cystectomy in this high-risk population. Patients diagnosed with urothelial carcinoma from 1988 to 2010 were identified in the Survey, Epidemiology, and End Results (SEER) database. Contingency tables of suicide rates and standardized mortality ratios (SMRs) and 95% confidence intervals were calculated. Multivariable logistic regression models were performed to generate odds ratios (ORs) for the identification of factors associated with suicide in this population. There were 439 suicides among patients with bladder cancer observed for 1,178,000 person-years (Standard Morbidity Ratio [SMR] = 2.71). All demographic variables analyzed had a higher SMR for suicide compared to the general population, in particular age ≥80 years (SMR = 3.12), unmarried status (SMR = 3.41), and white race (SMR = 2.60). The incidence of suicide was higher in the general population for patients who underwent radical cystectomy compared to those who did not (SMR = 3.54 vs SMR = 2.66). On multivariate analysis, the strongest predictors of suicide were male gender (vs female; OR = 6.63) and distant disease (vs localized; OR = 5.43). Clinicians should be aware of risk factors for suicide in patients diagnosed with bladder cancer, particularly older, white, unmarried patients with distant disease, and/or those who have undergone radical cystectomy. A multidisciplinary team-based approach, including wound ostomy care trained nursing staff and mental health care providers, may be essential to provide care required to decrease suicide rates in this at-risk population.

Evaluation of POSSUM scoring system in patients with perforation peritonitis

Background: Continuous audit of clinical practice is an essential part of making improvements in medicine and enhancing patient care. Recently, physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scores has been developed, which would help to identify those patients who are at increased risk of developing complications and deaths. This scoring system is based on 12 physiological characteristics of patient and 6 characteristics of the surgery performed. Methods: This study was done in Department of surgery at Patna medical college, Patna, Bihar, India from April 2014 to October 2015 on 100 patients. Physiological variables were collected prior to induction of anesthesia and operative variable collected during operation chi-square test was used for expected and actual mortality differences. Results: In present study 100 patients of peritonitis due to different cause of intestinal perforation were studied. Comparison of observed and POSSUM predicted mortality and morbidity rates were done. Observed to expect mortality and morbidity ratio was 1.005 and 1.001 respectively and there was no statistically significant difference between the predicted and observed values. Conclusions: This study confirms and validates the findings of previous work that POSSUM is an accurate and reliable tool for estimating in-hospital mortality.

A Rare Etiology of Intestinal Obstruction: Paraduodenal Hernia

Internal hernias are a rare cause of intestinal obstructions and responsible for 1% of all obstructions. Paraduodenal hernia is the most common form of congenital internal hernia and constitutes a protrusion of bowel into the retroperitoneal space through peritoneal defects near the third and fourth portion of the duodenum. The clinical symptoms are non-specific and it depends on the degree of obstruction. Preoperative diagnosis is very difficult. If diagnosis is delayed, the course of this disease may lead to high mortality and morbidity ratio. J Med Cases. 2016;7(6):223-225 doi: http://dx.doi.org/10.14740/jmc2491w

Geographic variations of multiple sclerosis prevalence in France: The latitude gradient is not uniform depending on the socioeconomic status of the studied population.

BackgroundIn France, two studies analysed multiple sclerosis prevalence nationwide: one was carried out in farmers, and the other one in employees. A south-north gradient of prevalence was found solely in farmers.ObjectiveIn order to better describe the latitude gradient in France, which is not uniform depending on the studied population, we assessed whether a gradient exists in another population than farmers and employees: independent workers. The same methods of case ascertainment have been used.MethodsAltogether 4,165,903 persons insured by the French health insurance scheme for independent workers were included. We searched the database for (a) long term disease status ‘multiple sclerosis’, (b) domicile, (c) gender and (d) age.ResultsA total of 4182 cases of multiple sclerosis were registered giving a prevalence of 100.39/100,000. Adjustment by age and sex and spatial smoothing with a Bayesian analysis showed a gradual increase of prevalence from the southwest to the northeast of France. Standardised morbidity ratio was correlated with latitude and longitude (p<0.0001; p = 0.0031; adjusted R2 = 0.3038).ConclusionA discrepancy of geographic distribution between farmers and independent workers on the one hand and employees on the other cannot be attributable to environment. Assuming that socioeconomic status by itself is not associated with multiple sclerosis risk, employees’ geographic mobility at adulthood for professional reasons could have interfered with the gradient effect.

Clinical Outcomes of Surgically Managed Spontaneous Tumors in 114 Client-owned Dogs

Medical records of 139 tumors from 114 dogs that underwent surgery from May 2010 through March 2015 were retrospectively reviewed. Among 114 dogs, females (64.9%) were significantly more common than males (35.1%) (p<0.05). Dogs aged 6 to 10 years were more presented than non-tumor patients, however, there was no significant difference. The mean age (±SD) was 10.3±3.0 years. Although we found no significant difference of breed predisposition, the most common breed was Maltese (19.3%), followed by Shih-Tzu (14.0%), and Yorkshire terrier (13.2%). Proportional morbidity ratios (PMRs) of mammary gland, oral cavity, and skin tumors were high in Poodles, Yorkshire terriers, and Golden retrievers, respectively. Mammary gland (36.0%) was the most common site, followed by skin and soft tissues (12.2%), oral cavity (10.8%), and digestive organs (8.6%), but there was no significant difference. The objectives of surgery were curative surgery (86.2%), biopsy (4.9%), and palliative surgery (6.5%). In this study, 123 of 139 tumors had histopathological diagnoses. Adenocarcinoma was the most common type (n=24), followed by adenoma (n=17), soft tissue sarcoma (n=13), benign mixed tumor (n=5), and others (n=64). Recurrence or suspected metastasis was identified in 26 dogs. Median survival times of malignant mammary gland tumors, skin and subcutaneous tumors, and splenic tumors were 1,563.0±1,201.7, 469, and 128 days, respectively.

Bile duct surgery in the treatment of hepatobiliary and gallbladder malignancies: effects of hepatic and vascular resection on outcomes

BackgroundResection of the bile duct is required for the treatment of cholangiocarcinoma and is sometimes indicated in resections of liver and gallbladder malignancies. The goal of this retrospective review was to characterize surgical outcomes in patients submitted to bile duct resection for malignancy when additional procedures, specifically hepatic or vascular resections, were performed. MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was searched to identify a total of 747 patients who underwent: (i) biliary‐enteric anastomosis (BEA) only (Group 1, n= 266); (ii) BEA with hepatic resection (Group 2, n= 439), or (iii) BEA with hepatic and vascular resection (Group 3, n = 42). Postoperative outcomes were compared and regression‐adjusted risk factors were analysed to produce observed and expected (O/E) morbidity and mortality ratios. ResultsThe performance of hepatic and vascular resections significantly increased rates of overall morbidity (P < 0.001) and mortality (P = 0.021). Risk‐adjusted O/E mortality ratios in Groups 1, 2 and 3 were 1.44 [95% confidence interval (CI) 0.84–2.30], 2.16 (95% CI 1.51–2.98) and 5.92 (95% CI 2.54–11.66), respectively. Multivariate analysis identified Group 2 (P < 0.001) and Group 3 (P= 0.001) status as independent predictors of morbidity, and Group 3 status (P= 0.008) as independently associated with mortality. More than 30% of deaths were associated with pulmonary complications and septic shock. ConclusionsThe addition of hepatic and vascular resections to bile duct resection significantly increased morbidity and mortality. The high O/E mortality ratios for patients in Groups 2 and 3 suggest these outcomes can be improved.

Granulomatous Mastitis: A Ten-Year Experience at a University Hospital.

In this study we aimed to define clinical, radiologic and pathological specialties of patients who applied to General Surgery Department of Atatürk University Medical Faculty with granulomatous mastitis and show medical and surgical treatment results. With the help of this study we will be able to make our own clinical algorithm for diagnosis and treatment. We searched retrospectively addresses, phone numbers and clinical files of 93 patients whom diagnosed granulomatous mastitis between a decade of January 2001 - December 2010. We noted demographic specialties, ages, gender, medical family history, main complaints, physical findings, radiological and laboratory findings, medical treatments, postoperative complications and surgical procedures if they were operated; morbidity, recurrence and success ratios, complications after treatment for patients discussed above. In this study we evaluated 93 patients, 91 females and 2 males, with granulomatous mastitis retrospectively who applied to General Surgery Department of Atatürk University Medical Faculty between January 2001 and December 2010. Mean age was 34.4 years. The diagnosis was confirmed by histopathologic examination of the lesions. Seventy three patients had idiopathic granulomatous lobular mastitis and 20 patients had specific granulomatous mastitis IGM (18 tuberculosis mastitis, 1 alveolar echinococcosis and 1 silk reaction). All the patients had surgical debridement or antibiotic, and anti-inflammatory treatment with results bad clinical response before applied our clinic. Empiric antibiotic therapy and drainage of the breast lesions are not enough for complete remission of idiopathic granulomatous mastitis. The lesion must be excised completely. In selected patients, corticosteroid therapy can be useful. In the patients with tuberculous mastitis, abscess drainage and antituberculous therapy can be useful, but wide excision must be chosen for the patients with recurrent disease.