Significant Higher Incidence Rate Research Articles

Idiopathic granulomatous mastitis: Risk factors and management.

IGM has a diagnostic and treatment dilemma. The etiology of IGM is unknown but some conditions have been discussed as predisposing factors including Oral Contraceptive Pills, pregnancy, breast feeding, reproductive age, hyperprolactinemia, infectious and autoimmune diseases. The current study aimed to determine possible risk factors for IGM and to evaluate our experience in its management. The study included forty patients with IGM and forty females with normal breasts as a control group. CST treatment was initiated for all patients; patients who responded completely were followed up without surgical intervention. Failure to respond to medical therapy or incidence of corticosteroid-related complications were considered indications for surgical treatment. All patients were followed up for 6 months to detect recurrence. IGM had a significant higher incidence rate in young females within 5 years from the last lactation, smokers, those with hypperprolactinaemia, who had a history of breast feeding and those who received OCP (P =<0.001, <0.001, 0.006, 0.001, 0.023 and 0.027 respectively). The central part of the breast was more affected (9 cases (22.5%)). Multicenteric disease affected 8 cases (20%). Breast Mass was the most common presenting sign. After CST; the mass disappeared in 5 cases (12.5%), mass size reduced in 26 cases (65%) and mass size not affected in 9 cases (22.5%). Surgery was done in whom the mass size was reduced or not affected (35 cases (87.5%)). Disease recurrence was reported in 2 cases (5.7%). IGM usually affects females in their childbearing period with multiple risk factors mainly parity, smoking, OCP and breast feeding with wide variation regarding the presenting manifestations. We should start with CST as there is always a chance to avoid unnecessary surgery and combination of both modalities can reduce the incidence of recurrence.

Primary Prevention of Strokes in Nigerian Children with Sickle Cell Disease (SPIN Trial): Final Results

Introduction: In children with sickle cell anemia (SCA) living in high-income settings, the routine use of transcranial Doppler (TCD) measurements, coupled with regular blood transfusion therapy for those with abnormal velocities (&amp;gt; 200 cm/sec) dramatically decreased the rate of strokes. Despite evidence of its beneficial effects in preventing strokes, regular blood transfusion therapy is not feasible for 99% of the children that are born with SCA living in low- and middle-income countries. To address this gap in care, we tested the hypothesis that moderate fixed dose of hydroxyurea (20 mg/kg/day) for primary stroke prevention was feasible in a low-income setting, Kano, Nigeria. Specifically, we previously demonstrated that families were willing to enroll at a 92% recruitment rate and were adherent to the study protocol with no missed monthly research visits (603 of 603 visits). We have extended the trial for approximately five years to test the hypotheses that moderate fixed dose hydroxyurea will: 1) not result in excess incidence rate of severe adverse events (death or stroke) when compared to a group of children with SCA and TCD measurements less than 200 cm/sec; 2) decrease the incidence rate of strokes to the level of children receiving regular blood transfusion for primary stroke prevention in the STOP Trial. We report the final results of the primary Stroke Prevention Feasibility Trial in Nigeria (SPIN Trial (NCT01801423). Methods: At trial entry, all eligible participants were screened with non imaging TCD to determine increased stroke risk; defined as two independent measurements of time-averaged maximum velocity (TAMV) ≥ 200cm/sec in the middle cerebral artery (MCA) or one measurement &amp;gt;219cm/sec. Families were offered moderate fixed dose hydroxyurea (~20mg/kg/day). The comparison group included individuals with SCA that have a TCD measurement less than 200 cm/sec and agreed to be followed as routine medical care. Serious adverse events including death or stroke in the treatment and comparison groups were defined based on WHO criteria. Results: A total of 29 children treated with hydroxyurea for primary stroke prevention, and 206 children in the comparison group, were included. The median age for the treatment and comparison groups were 7.0 and 8.2 years, respectively. No statistically significant difference was observed in age, sex, ethnicity, height and weight of the treatment and comparison groups. Table 1 The median time on therapy (follow up time) was 4.9years (IQR- 4.60, 5.2). After 3 months of starting hydroxyurea therapy, 65.5% of the participants had a drop in TCD measurement to below 200cm/sec, which was sustained through 12months of therapy (61.5% had a TCD measurement below 200cm/sec at 12 months). Figure 1 The stroke incidence rate among the participants on hydroxyurea was 0.76 per 100 person-years (95% confidence interval 0.11 to 5.24), which was not significantly different from the incidence rate of 0.32 per 100 person-years (95% confidence interval 0.10 to 0.99) for participants in the comparison arm (P = 0.489), and significantly lower than the reported rate of stroke in the standard care group for the STOP study (10.7 per 100 person-years, total of 102 patient years). A total of 20 deaths occurred, with no death in the treatment group. One death occurred in a child that was originally in the treatment group, but after the patient was withdrawn from the trial due to progressive renal disease unrelated to treatment. The death rate in the comparison group was 2.05 per 100 patient-years. There was no statistically significant difference in the death rate between treatment and comparison group (p = 0.082). The leading cause of death was suspected malaria occurring in 79% (15 of 19). As expected, we found a statistically significant higher incidence rate of pain in the comparison group (30.04 per 100 person-years) compared to the treatment group (15.28 per 100 person-years) (P &amp;lt;0.001). No difference in incidence rates of anemia, infection, malaria and transfusion rates between the two groups. Conclusion: The extended results of the SPIN trial provide clear evidence that initial treatment with fixed moderate dose hydroxyurea (20 mg/kg/day) will prevent strokes in children with abnormal TCD measurements in a low-resource setting. The results of the extended SPIN trial have established the first evidence based stand care strategy for primary stroke prevention for children with SCA in Africa. Disclosures No relevant conflicts of interest to declare.

Effects of Geographic and Economic Variations on Global Cancer Burden

Background: Previous studies have stated that high-income countries tend to have the highest incidence and mortality for all types of cancer, while geographical factors are also linked to the prevalence of cancer. Only a few studies have explored the relevance of economic/geographical factors to the cancer epidemic integrally. Aim: This study aims to explore the diversities of the overall cancer epidemic rates made by geographic and economic variations respectively and their interaction effects, after adjusting gender, population structure. Methods: We collected 170 countries' epidemic data from WHO's 2012 GLOBOCAN project and economic classifications data from the World Bank in 2012. We applied generalized linear model to make 2-way ANOVA and to analyze the variations of 3 epidemic rates (age-standardized incidence, age-standardized mortality and prevalence) between 6 regions (Asia, Africa, Europe, North America, South America, and Oceania) and 4 income levels (high income, upper-middle income, lower-middle income and low income). We identified extreme rates and discuss their reasons and implications, and make suggestions regarding the situations. Results: Both geographic variation and economic variation were key factors for incidence and prevalence of global cancer burden, and the interaction between geographic and economic variations on incidence and prevalence was very strong. However, there was no significant association between income and mortality, and the interaction between geographic and economic variations on mortality was not obvious either. Using South America as the reference, only North America had significant higher incidence rate of cancer; no significant variation of mortality rates between regions was observed; North America and Europe had significant higher prevalence rates. Using low income as the reference, only high and upper-middle income had significant higher incidence rates; no significant variation of mortality rates between regions was observed; only high income had significant higher prevalence rates. Among high-income countries, incidence, mortality and prevalence rates in Europe were significantly higher than them in South America, Asia and Africa. Among countries in Europe, high-income country had significantly higher incidence rate than that in upper-middle cancer, and it also had significant higher prevalence rates than them in upper-middle and lower-middle countries. Conclusion: Overall, the cancer incidence and prevalence are significantly different due to the country's geographical location and economic level, but the mortality rate is not. Understanding the differences in geographical location and economic levels between countries and their interactions on the cancer epidemic would benefit the future global cancer prevention and treatment policy planning.

Prevalence and incidence of clinically diagnosed knee, hip and hand osteoarthritis in women with polycystic ovary syndrome: a National Register-Based Study

Purpose: Osteoarthritis (OA) is the most common form of arthritis associated with high morbidity and increased risk of early cardiovascular mortality. Obesity is associated with metabolic dysregulation and an increased risk of developing OA even in non-weight bearing joints. Polycystic ovary syndrome (PCOS) is a very common endocrinology problem among women associated with reproductive and metabolic features, and as a result, these women have increased risk of stroke and thrombosis when compared with a general population. Assessing incidence and prevalence of OA in this group represent a great natural experiment for testing association between metabolic dysregulation and risk of OA. The main objective of this study was to investigate the prevalence and incidence risk of clinically diagnosed OA affecting different site(s) (knee, hip and hand) in PCOS compared to a control population. Methods: A PCOS cohort based on a Danish national register (NPR) study was compared with matched controls. All incident PCOS cases were defined according to the Rotterdam criteria and/or diagnosis of hirsutism, and were based on the International Classification of Diseases (ICD) 10 codes from the Danish NPR available between 1995 and 2012. Women in the control cohort were randomly selected, matched 1:3 to PCOS cases on age and index date. The outcome was clinically diagnosed knee, hip and hand OA according to the ICD-10 codes. Incidence rates of clinical OA were estimated in women with and without PCOS, both overall and per age categories. Person-time at risk for each woman was estimated as the time each woman remains free of OA during the follow-up period (up to 17 years). Hazard ratio (HR) and 95% confidence of intervals (CIs) were assessed to estimate the risk of OA at the three different joints in PCOS cohort compared to the control group. Cox proportional hazard regression was used. Results: Data was available for 75,089 patients: 18,923 women with PCOS and 56,166 controls, with a median age of 29 years (24–36). During the observation period (median follow-up of 11.1 years (range: 6.9–16.0)), 2253 women were identified with OA, 4.3% and 2.6% in the PCOS and control cohorts, respectively. A high prevalence at index date for Charlson comorbidity and cardiometabolic diseases were observed in the PCOS cohort, including obesity, diabetes, dyslipidaemia and hypertension. In 2012, the most prevalent joint OA was knee OA (4.9%), followed by hip OA (1.6%) and then hand OA (0.5%). Significant higher incidence rates were observed in PCOS cohort compared with the control cohort (2.8 vs. 1.5, 0.8 vs. 0.6 and 0.3 vs. 0.1 cases per 1000 person years, for knee, hip and hand, respectively) (Table 1). The hazards of developing OA was 90% higher (HR 1.9, 95% CI: 1.7 to 2.1) for knee, 30% (HR 1.3, 95% CI: 1.1 to 1.6) for hip and 80% (HR: 1.8, 95% CI: 1.3-2.4) for hand (Table 1) in PCOS cohort compared to the control cohort. There was a trend between higher incidence rates of knee, hip and hand OA and greater age. Women at the age of 50–60 were more likely to develop OA that those younger than 45 years old. Conclusions: Women with PCOS have a greater risk of OA when compared to the control population. Given the high risk of metabolic syndrome (MetS) in PCOS population, understanding their metabolic profile, including metabolomics, might provide us with a better understanding of the shared pathogenesis of MetS and OA. Furthermore, this population might also benefit more from targeted secondary prevention for both OA and MetS. Weight loss and exercise interventions are already recommended as first line treatment for PCOS. Further investigations into the effects of modifiable risk factors on OA are needed.

Impact of type 2 diabetes mellitus in hospitalizations for atrial fibrillation in Spain (2004–2013)

BackgroundTo describe trends in the incidence and outcomes for atrial fibrillation (AF) in patients with and without type 2 diabetes (T2DM) in Spain between 2004 and 2013. MethodsWe used national hospital discharge data to select all patients discharged from hospital after AF. We focused our analysis on patients with AF in the primary diagnosis field. Discharges were grouped by diabetes status (diabetic or non-diabetic). Incidence was calculated overall and stratified by diabetes status. We analyzed diagnostic and therapeutic procedures, patient comorbidities, CHA2DS2-VASc score, length of hospital stay and in-hospital mortality (IHM). ResultsWe identified a total of 214,457 admissions for AF (21.1% with T2DM). The incidence was higher among people with T2DM. Women with T2DM have significant higher incidence than men in all years studied. T2DM was positively associated with AF hospitalization (IRR 3.76, 95%CI 3.72–3.80). T2DM patients were significantly older than patients without diabetes, had more comorbidity and had higher values of CHA2DS2-VASc score. Prevalence of dyslipidemia and hypertension were almost 50% higher and prevalence of obesity was two times higher (all p values<0.05). Diabetes was not associated with a higher IHM (OR: 0.99, 95%CI 0.93–1.06). For the entire sample, time trend analyses showed a significant decrease in mortality in patients admitted for AF (OR: 0.98, 95%CI 0.97–0.99). ConclusionsIncidence rates were higher in T2DM patients. Women with T2DM have significant higher incidence rates than men. The presence of diabetes is not associated with a higher IHM during admission for AF.

Abstract 3706: Risk of bladder and kidney cancers in end-stage renal disease patients: a nationwide, population-based study in Taiwan

Abstract Chronic kidney disease (CKD) was the tenth leading cause of death in Taiwan. as the fifth stage of progressive CKD. Various therapeutic modalities including hemodialysis (HD),peritoneal dialysis (PD) and renal transplantation (RT) modify the risks of systemic chronic diseases in end-stage renal disease (ESRD) patients remains unclear. A total of 18,081 newly diagnosed ESRD patients and 54,243 controls matched for age, gender and index date were recruited from the National Health Insurance Research Database in Taiwan. The ESRD status was confirmed by the registry of catastrophic illness. The incidence of cancer was identified through cross-referencing with the National Cancer Registry Database. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox proportional hazards model. Kaplan-Meier method were used for all analyses. Significant higher incidence rate ratios (IRRs) of bladder cancer of 7.0, 9.5 and 14.4 were found for ESRD patients undergoing HD, PD and RT, respectively. The IRRs of kidney cancer also represent a similar risk pattern. We observed that significant bladder cancer risks were observed among ESRD patients undergoing HD (HR = 10.0), PD (HR = 12.8) and RT (17.7) after the adjustment for age, gender and co-morbidities. In addition, significant kidney cancer risks of 11.2, 17.1 and 33.7 were also found for ESRD patients undergoing HD, PD and RT, respectively. In conclusion, different therapeutic modalities could modify the risks of bladder and kidney cancers in ESRD patients in Taiwan. Citation Format: Wei-Tang Kao, Cheng-Huang Shen, Kee-Thai Kiu, Hsin-An Chen, Chia-Chang Wu, Yuan-Hung Wang. Risk of bladder and kidney cancers in end-stage renal disease patients: a nationwide, population-based study in Taiwan. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3706. doi:10.1158/1538-7445.AM2015-3706

Características epidemiológicas y clínicas de la tos ferina en los lactantes hospitalizados en Sevilla durante el periodo 2007-2011

IntroductionDespite routine pertussis immunization, pertussis burden remains high, especially among infants. The aim of this study was to describe epidemiologic, clinical and outcome features in pediatric patients admitted to a tertiary hospital in Andalusia (Southern Spain) with confirmed Bordetella pertussis infection. MethodsRetrospective descriptive study based on a review of medical records for all pediatric patients admitted to Hospital Universitario Virgen del Rocío (Sevilla) between January 1, 2007 and December 31, 2011. ResultsOverall, 39 patients were diagnosed with pertussis during the study period with significant higher incidence rate in 2011 compared to 2007 (p=0.0003). Eleven children were admitted to the pediatric intensive care unit (ICU) in 2010 and 2011 and two of them died. Patients who were admitted to ICU presented with more atypical disease compared to controls in a conventional ward. They were less likely to have pertussoid cough and clinical diagnosis at admission and had a smaller percentage of lymphocytes. Creactive protein values were higher and they had a longer duration of hospital stay. ConclusionThe pertussis incidence rate increased significantly among hospitalized infants during the study period, and was associated with severe morbidity, including unusual complications, and mortality. A higher awareness of the clinical diagnosis of pertussis among infants admitted to ICU is required due to more atypical manifestations, and the risk of sudden deterioration associated to fatal outcome.

Anal Cancer: Focus on HIV-Positive Patients in the HAART Era

Anal cancer represents an increasing health problem, especially in immune-compromised patients, as HIV-positive patients. Notably, a significant higher incidence rate is reported among HIV infected patients with the advent of highly active antiretroviral therapy (HAART). To date, no randomised trial supports the correlation between existing screening strategies and reduced progression of anal intraepithelial neoplasia (AIN) to anal cancer or improved survival. Nevertheless, screening and treatment of AIN by topical agents should be implemented in high risk population. Data on invasive anal cancer treatment show that combined modality treatment (CMT) is the treatment of choice. Early reports on HIV-positive patients describe higher treatment toxicity and a relation with lower CD4 count and higher HIV viral load. More recently, reported outcomes seem to be similar in HIV-positive population and general population. Reports on a rise in local recurrence rates and in acute side effects along with a correlation with pre-treatment CD4 counts in HIV-positive patients, are not confirmed by all authors. The development of the first approved vaccine is a milestone in the field of anogenital cancers. However, many questions are still unresolved especially as concerns immunization in the setting of HIV infection.