Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings

BACKGROUND AND AIMS: There a shortage of robust information about profiles of gastrointestinal disease in sub-Saharan Africa. The endoscopy unit of the University Teaching Hospital in Lusaka has been running without interruption since 1977 and this 38-year record is largely intact. We report an analysis of endoscopic findings over this period. METHODS: Written endoscopy records from 29th September 1977 to 16th December 2014 were recovered, computerised, coded by two experienced endoscopists and analysed. Temporal trends were analysed using tables, graphs, and unconditional logistic regression, with age, sex of patient, decade, and endoscopist as independent variables to adjust for inter-observer variation. RESULTS: Sixteen thousand nine hundred fifty-three records were identified and analysed. Diagnosis of gastric ulcer rose by 22 %, and that of duodenal ulcer fell by 14 % per decade. Endoscopically diagnosed oesophageal cancer increased by 32 % per decade, but gastric cancer rose only in patients under 60 years of age (21 % per decade). Oesophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group. Two HIV-related diagnoses, oesophageal candidiasis and Kaposi’s sarcoma, rose from almost zero to very high levels in the 1990s but fell substantially after 2005 when anti-retroviral therapy became widely available. CONCLUSIONS: This useful dataset suggests that there are important trends in some endoscopic findings over four decades. These trends are not explained by inter-observer variation. Reasons for the divergent trends in incidence of peptic ulceration and apparent trends in diagnosis of upper gastrointestinal cancers merit further exploration

Seasonality of MRSA Infections

Using MRSA isolates submitted to our hospital microbiology laboratory January 2001–March 2010 and the number of our emergency department (ED) visits, quarterly community-associated (CA) and hospital-associated (HA) MRSA infections were modeled using Poisson regressions. For pediatric patients, approximately 1.85x (95% CI 1.45x–2.36x, adj. p<0.0001) as many CA-MRSA infections per ED visit occurred in the second two quarters as occurred in the first two quarters. For adult patients, 1.14x (95% CI 1.01x–1.29x, adj.p = 0.03) as many infections per ED visit occurred in the second two quarters as in the first two quarters. Approximately 2.94x (95% CI 1.39x–6.21x, adj.p = 0.015) as many HA-MRSA infections per hospital admission occurred in the second two quarters as occurred in the first two quarters for pediatric patients. No seasonal variation was observed among adult HA-MRSA infections per hospital admission. We demonstrated seasonality of MRSA infections and provide a summary table of similar observations in other studies

Consensus review of best practice of transanal irrigation in adults

Study design: Review article. Objectives: To provide a consensus expert review of the treatment modality for transanal irrigation (TAI). Methods: A consensus group of specialists from a range of nations and disciplines who have experience in prescribing and monitoring patients using TAI worked together assimilating both the emerging literature and rapidly accruing clinical expertise. Consensus was reached by a round table discussion process, with individual members leading the article write-up in the sections where they had particular expertise. Results: Detailed trouble-shooting tips and an algorithm of care to assist professionals with patient selection, management and follow-up was developed. Conclusion: This expert review provides a practical adjunct to training for the emerging therapeutic area of TAI. Careful patient selection, directly supervised training and sustained follow-up are key to optimise outcomes with the technique. Adopting a tailored, stepped approach to care is important in the heterogeneous patient groups to whom TAI may be applied. Sponsorship: The review was financially supported by Coloplast A/S. Spinal Cord (2013) 51, 732–738; doi:10.1038/sc.2013.86; published online 20 August 201

Genetic ancestry is associated with colorectal adenomas and adenocarcinomas in Latino populations

Colorectal cancer rates in Latin American countries are less than half of those observed in the United States. Latin Americans are the resultant of generations of an admixture of Native American, European, and African individuals. The potential role of genetic admixture in colorectal carcinogenesis has not been examined. We evaluate the association of genetic ancestry with colorectal neoplasms in 190 adenocarcinomas, 113 sporadic adenomas and 243 age- and sex-matched controls enrolled in a multicentric case–control study in Colombia. Individual ancestral genetic fractions were estimated using the STRUCTURE software, based on allele frequencies and assuming three distinct population origins. We used the Illumina Cancer Panel to genotype 1,421 sparse single-nucleotide polymorphisms (SNPs), and Northern and Western European ancestry, LWJ and Han Chinese in Beijing, China populations from the HapMap project as references. A total of 678 autosomal SNPs overlapped with the HapMap data set SNPs and were used for ancestry estimations. African mean ancestry fraction was higher in adenomas (0.13, 95% confidence interval (95% CI)=0.11–0.15) and cancer cases (0.14, 95% CI=0.12–0.16) compared with controls (0.11, 95% CI=0.10–0.12). Conditional logistic regression analysis, controlling for known risk factors, showed a positive association of African ancestry per 10% increase with both colorectal adenoma (odds ratio (OR)=1.12, 95% CI=0.97–1.30) and adenocarcinoma (OR=1.19, 95% CI=1.05–1.35). In conclusion, increased African ancestry (or variants linked to it) contributes to the increased susceptibility of colorectal cancer in admixed Latin American population

Estudo de alterações na cavidade oral em pacientes com doença do refluxo gastroesofágico Study in oral cavity alterations in patients with gastroesophageal reflux disease

RACIONAL: A doença do refluxo gastroesofágico, afecção de elevada e crescente incidência, pode se manifestar através de sintomas típicos (pirose e regurgitação) e atípicos (pulmonares, otorrinolaringológicos e bucais). OBJETIVO:Analisar as alterações na cavidade oral de pacientes com a doença do refluxo gastroesofágico. MÉTODOS: Foram estudados 100 pacientes, sendo 50 acometidos por doença do refluxo gastroesofágico (grupo 1) e 50 controles (grupo 2). Todos os pacientes foram submetidos a exame clínico oral e questionário específico, e naqueles do grupo 1, foram realizadas endoscopia digestiva alta e manometria e pHmetria esofágicas. RESULTADOS: A endoscopia digestiva alta demonstrou esofagite em todos os pacientes, sendo erosiva em 20, não-erosiva em 30 e hérnia hiatal em 38. A pressão média no esfíncter inferior do esôfago foi de 11 ± 4,8 mm Hg e no superior de 75 ± 26,5 mm Hg. Em 42 pacientes do grupo 1 (84%) foi observado refluxo gastroesofágico patológico. O exame clínico oral mostrou: erosões dentárias no grupo 1: 273 faces e no grupo 2: 5; dentes cariados no grupo 1: 23 e 115 no grupo 2; abrasão no grupo 1: 58 e no grupo 2: 95; desgaste por atrito: 408 no grupo 1 e 224 no grupo 2. A face dental mais acometida foi a palatina. No grupo 1, 21 pacientes referiam queixas de aftas freqüentes, 35 sensibilidade dentária, 26 ardência bucal e 42 gosto azedo na boca. Naqueles do grupo 2 estas queixas foram observadas em menor número de pacientes. CONCLUSÕES: Os doentes com doença do refluxo gastroesofágico apresentam maior incidência de erosões dentárias, aftas, ardência bucal, sensibilidade dentária e gosto azedo que os controles e menor incidência de lesões cariosas em relação aos controles.<br>BACKGROUND: The gastroesophageal reflux disease, which has become highly and increasingly incident, may be manifested by typical (pyrosis and regurgitation) and atypical (pulmonary, otorhinolaryngological and buccal) symptoms. AIM: To analyze alterations in the oral cavity patients with gastroesophageal reflux disease. METHODS: One hundred patients were studied being 50 gastroesophageal reflux disease patients (group 1) and 50 controls (group 2). All patients were submitted to an oral clinical exam and specific survey. Patients in group 1 were submitted to upper endoscopy, manometry and esophageal pH monitoring. RESULTS: The upper endoscopy revealed esophagitis in all patients, 20 erosive esophagitis, 30 no-erosive esophagitis and 38 hiatal hernia. Average pressure of the lower esophageal sphincter was 11 ± 4,8 mm Hg and of the upper esophageal sphincter 75 ± 26,5 mm Hg. In 42 patients of group 1 (84%) pathological gastroesophageal reflux was observed. Clinical exams revealed: dental erosions in group 1: 273 faces and in group 2: 5 tooth decays in group 1: 23 and 115 in group 2; abrasion in group 1: 58 and in group 2: 95; attrition wear: 408 in group 1 and 224 in group 2. The most damages was the palatine face. In group 1, 21 patients complained about frequent episodes of cankers sores, 35 of tooth sensibility, 26 of burning mouth and 42 of sour taste in the mouth. In group 2 the complaints were observed in lower number of patients. CONCLUSIONS: Patients with gastroesophageal reflux disease present higher incidence of dental erosion, cankers sores, mouth burning sensation, sensitivity and sour taste than controls. Patients with gastroesophageal reflux disease show lower incidence of tooth decays as compared to controls