high body mass index is associated with increased risk of implant dislocation following primary total hip replacement 2 106 patients followed for up to 8 years

Background and purpose Implant dislocation is one of the commonest complications following primary total hip replacement (THR). We investigated the effect of body mass index (BMI) and tobacco use on the risk of this complication.Subjects and methods Through linkage between the Swedish Construction Workers' cohort and the Swedish Inpatient Register, 2,106 male patients who had undergone primary THR between 1997 and 2004 were identified. We used Cox multivariable regression analysis to study the association between BMI and tobacco use and the risk of implant dislocation.Results 53 patients (2.5%) developed implant dislocation during a mean of 2 (0–3) years of follow-up. We found overweight and obesity to be associated with increased risk of implant dislocation (HR = 2.5,95% CI: 1.1–5.5 and HR = 3.7, 95% CI: 1.5–9.3, respectively as compared to those of normal weight). There was no statistically significant association between tobacco use and the risk of dislocation.Interpretation Greater attention should be..

Head injury triage in a sub Saharan African urban population

AbstractBackgroundInjuries are the ninth leading cause of death in the world and disproportionately affect low- and middle-income countries. Head injury is the leading cause of trauma death. This study examines the epidemiology and outcomes of traumatic head injury presenting to a tertiary hospital in Malawi, in order to determine effective triage in a resource limited setting.MethodsThe study was conducted at Kamuzu Central Hospital (KCH) in Lilongwe Malawi during a three-month period. Vital signs and Glasgow Coma Score (GCS) were prospectively collected for all patients that presented to the casualty department secondary to head injury. All head injury admissions were followed until death or discharge.ResultsDuring the three-month study period, 4411 patients presented to KCH secondary to trauma and 841 (19%) had a head injury. A multivariate logistic regression model revealed that GCS and heart rate changes correlated strongly with mortality. There is a four-fold increase in the odds of mortality in moderate versus mild head injury based on GCS.ConclusionIn a resource limited setting, basic trauma tools such as GCS and heart rate can effectively triage head injury patients, who comprise the most critically ill trauma patients. Improvements in head injury outcome require multifaceted efforts including the development of a trauma system to improve pre-hospital care

Patients With Celiac Disease Have an Increased Risk for Pancreatitis

Background & Aims Patients with celiac disease have been reported to be at increased risk for pancreatitis and pancreatic insufficiency, but the risk might have been overestimated because of patient selection and limited numbers of patients for analysis. Furthermore, no distinction has been made between patients with gallstone-related and non–gallstone-related pancreatitis. We performed a nationwide study to determine the risk for any pancreatitis or subtype of pancreatitis among patients with biopsy-verified celiac disease. Methods We analyzed data from patients in Sweden with celiac disease (n = 28,908) who were identified on the basis of small intestinal biopsy records from 28 pathology departments (those with villous atrophy, Marsh 3). Biopsies were performed from 1969 to 2008, and biopsy report data were collected from 2006 to 2008. Patients with pancreatitis were identified on the basis of diagnostic codes in the Swedish Patient Register and records of pancreatic enzyme use in the Swedish Prescribed Drug Register. Data were matched with those from 143,746 individuals in the general population; Cox regression was used to estimate hazard ratios (HRs) for pancreatitis. Results We identified 406 patients with celiac disease who were later diagnosed with pancreatitis (and 143 with expected pancreatitis) (HR, 2.85; 95% confidence interval [CI], 2.53–3.21). The absolute risk of any pancreatitis among patients with celiac disease was 126/100,000 person-years, with an excess risk of 81/100,000 person-years. The HR for gallstone-related acute pancreatitis was 1.59 (95% CI, 1.06–2.40), for non–gallstone-related acute pancreatitis HR was 1.86 (95% CI, 1.52–2.26), for chronic pancreatitis HR was 3.33 (95% CI, 2.33–4.76), and for supplementation with pancreatic enzymes HR was 5.34 (95% CI, 2.99–9.53). The risk of any pancreatitis within 5 years of diagnosis was 2.76 (95% CI, 2.36–3.22). Conclusions Based on an analysis of medical records from Sweden, patients with celiac disease have an almost 3-fold increase in risk of developing pancreatitis, compared with the general population

Acute Pancreatitis – Beyond Gallstones and Alcohol

Acute pancreatitis is the most common disorder of the pancreas. The incidence of the disease has increased markedly during the past decades. Whilst alcohol abuse and gallstone disease might explain a large proportion of the disease etiology, in one quarter of the patients, the cause remains unknown. Life-style and pharmaceutical drug use are potential risk factors for the disease. This brief review highlights the recent research on the role of these factors in the etiology of acute pancreatitis

Association between proton pump inhibitor use and biliary tract cancer risk : a Swedish population-based cohort study

Background and Aims Biliary tract cancer is a group of highly aggressive malignant disorders, yet risk factors are poorly understood. In this study, we aim to assess whether prolonged use of proton pump inhibitors (PPIs) increases the risk of incident biliary tract carcinoma in a nation-wide population-based cohort in Sweden. Approach and Results Using nation-wide registries, we identified all adults who received maintenance PPIs (>= 180 days) according to the Swedish Prescribed Drug Register from 2005 through 2012. Data on incident biliary tract cancer were retrieved from the Swedish Cancer, Death and Outpatient Registers. Risk of biliary tract cancer in persons who received PPI treatment was compared with the general population of the corresponding age, sex, and calendar year yielding standardized incidence ratios (SIRs) with 95% CIs. Of 738,881 PPI users (median follow-up of 5.3 years), 206 (0.03%) developed gallbladder cancer and 265 (0.04%) extrahepatic and 131 (0.02%) intrahepatic bile duct cancer corresponding to SIRs of 1.58 (95% CI, 1.37-1.81), 1.77 (95% CI, 1.56-2.00), and 1.88 (95% CI, 1.57-2.23), respectively. In sensitivity analyses restricted to persons without a history of gallstones or chronic liver or pancreatic diseases, SIRs were 1.36 (95% CI, 1.17-1.57) and 1.47 (95% CI, 1.19-1.80) for extra- and intrahepatic duct cancer, respectively. The risk remained higher than the corresponding general population with >= 5 years of PPIs use, ruling out confounding by indication. Conclusions In this study, long-term use of PPIs was associated with an increased risk of gallbladder, intrahepatic, and extrahepatic bile duct cancer compared with the general population

Cholecystectomy in Patients with Liver Cirrhosis

Background. The aim of this population-based study was to describe characteristics of patients with liver cirrhosis undergoing cholecystectomy and evaluate the risk for perioperative and postoperative complications during the 30-day postoperative period. Results. Of 62,488 patients undergoing cholecystectomy, 77 (0.12%) had cirrhosis, of which 29 patients (37.7%) had decompensated cirrhosis. Patients with cirrhosis were older and had more often gallstone complications at the time for surgery. Postoperative complications were registered in 13 (16.9%) patients with liver cirrhosis and in 5,738 (9.2%) patients in the noncirrhotic group ( < 0.05). Univariable analysis showed that patients with liver cirrhosis are more likely to receive postoperative blood transfusion (OR = 4.4, CI 1.08-18.0, < 0.05) and antibiotic treatment >1 day (OR = 2.3, CI 1.11-4.84, < 0.05) than noncirrhotic patients. Conclusion. Patients with cirrhosis undergoing cholecystectomy have a higher incidence of postoperative complications than patients without cirrhosis. However, cholecystectomy is safe and if presented with adequate indication, surgery should not be delayed due to fears of surgical complications