A case-control study and meta-analysis of the association of eNOS rs1799983 SNP with stroke risk

The endothelial nitric oxide synthase (eNOS) rs1799983 polymorphism is known to increase the risk towards stroke, but data is under-reported in Malaysian population. Therefore, this study sought to investigate this association in a Malaysian population and in a comprehensive meta-analysis. Genotyping of the eNOS rs1799983 polymorphism was performed for 241 Malaysians using a hydrolysis probe. Odd ratio with 95% confidence interval was calculated. Meta-analysis was conducted using the Comprehensive Meta-Analysis software ver. 2.2.064. A p-value less than 0.05 was considered statistically significant. Overall, our results showed that the presence of eNOS rs1799983-T allele increases the risk towards stroke, particularly in males, fast-food goers and Malaysian Chinese. The meta-analysis showed that the rs1799983 polymorphism is significantly associated with an increase ischemic stroke risk in the recessive and allelic models. After stratified with population, these associations remain significant in the Asian population but not in the Caucasian population. In summary, this study establishes a significant relationship between the eNOS rs1799983 polymorphism with gender, lifestyle and ethnicity differences towards stroke risk in the Malaysian population. In addition, our meta-analysis suggests that the eNOS rs1799983 polymorphism is associated with an increase risk of ischemic stroke

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients