Trans fatty acid intake and its association with adenomas and cancers of the colon and rectum

Recently, there has been increasing concern about the health effects of trans fatty acid consumption, however, little is known about its role in digestive tract neoplasia. The goal of this dissertation was to investigate this relationship. The association between trans fatty acid consumption and colorectal adenomas (present throughout the entire colon and rectum) was investigated using the Diet and Health Study IV, a cross-sectional study conducted between 2001 and 2002. The highest quartile of consumption was associated with an increased prevalence of colorectal adenomas, with an adjusted prevalence odds ratio comparing the highest to the lowest quartile of consumption of 1.86 (95%CI 1.04, 3.33). The North Carolina Colon Cancer Study I, a case-control study taking place between 1996 and 2000, was utilized to examine the association for colon cancer (located between the cecum and sigmoid colon). No association was seen between trans fatty acid consumption and colon cancer among Whites or African Americans. Those in the highest quartile of consumption had an adjusted odds ratio of 1.01 (95%CI 0.69, 1.49) for Whites and 0.99 (95%CI 0.61, 1.62) for African Americans when compared to participants in the lowest quartile. The North Carolina Colon Cancer Study II was similar to the above study except cases of distal colorectal cancer (present in the sigmoid colon, rectosigmoid, and rectum) were recruited from 2001-2006. An association was seen between trans fatty acid consumption and distal colorectal cancer in Whites, giving an adjusted odds ratio of 1.34 (95%CI 0.99, 1.83) for the comparison of the highest quartile of consumption to the lowest. For African Americans this adjusted odds ratio was 0.54 (95%CI 0.28, 1.02). In sum, the research presented in this dissertation demonstrated that high trans fatty acid consumption was positively associated with colorectal adenomas and cancers of the sigmoid colon, rectosigmoid, and rectum (in Whites). No association was present between consumption and cancers of the colon (cecum through sigmoid colon). Although further research needs to be done investigating the relationship for distal colorectal cancer in African Americans, as trans fatty acid consumption declines in the United States, rates of colorectal cancer may fall as well

Hepatitis B therapy as HIV prevention in Africa: a case series from Zambia.

In East and Southern Africa, where 5-10% have chronic hepatitis B virus (HBV) infection, incidence of human immunodeficiency virus (HIV) infection remains unacceptably high. This introduces challenges and opportunities for implementation of HBV care and treatment. We now describe new HIV diagnoses made within an HBV monoinfection cohort in Zambia and their relevance to broader HBV policy implementation. This article is protected by copyright. All rights reserved

Investigation into Levels of Pain, Quality of Life, and Depression by Stage of Endometriosis

Objective: Despite the high prevalence of endometriosis, controversy exists surrounding the association between the stage of endometriosis and long-term treatment outcomes. The objective of the present study was to investigate the postsurgical long-term pain, quality-of-life, and psychological distress among women with differing stages of endometriosis. Methods: This cross-sectional study was conducted between 2008 and 2009. Women who had undergone surgery for pelvic pain at UNC Hospitals from 2003 to 2006 were mailed questionnaires to collect information on demographics, pain, sexual dysfunction, quality of life, and depression. Descriptive statistics and ANOVAs were used to examine the distribution of these variables by stage of endometriosis. Results: The study population included women aged 22 to 50 years old (mean age 36 years). Of the 82 women, 38 (46%) were classified as having stage 1 endometriosis, 26 (32%) having stage 2 endometriosis, 13 (16%) having stage 3 endometriosis, and 5 (6%) having stage 4 endometriosis. Across the four stages, there was no pattern of increased overall pain, pelvic pain, quality-of-life, or depression with increasing stage of endometriosis. The mean scores (standard deviation) on an adapted version of the McGill Pain Questionnaire for total pain were 8.0 (7.8), 10.4 (10.8), 4.6 (7.5), and 9.4 (13.4) for stages 1, 2, 3, and 4, respectively (ANOVA p-value 0.34). The mean scores for intensity of pelvic pain (possible score range of 0-5) were 1.5 (1.4), 1.7 (1.4), 1.0 (1.6), and 1.6 (0.9), respectively (ANOVA p-value 0.56). Using the SF12 quality-of-life measure the mean (standard deviation) mental and physical component standardized scores were 43.2 (10.3) and 45.6 (11.7) for stage 1, 45.5 (11.4) and 44.1 (10.2) for stage 2, 47.3 (12.8) and 50.4 (9.4) for stage 3, and 36.0 (14.8) and 43.3 (8.7) for stage 4 (ANOVA p-values 0.30 and 0.39 for the mental and physical components, respectively). Finally, scores on the Beck Depression Inventory were also similar by stage, although women with stage 4 endometriosis did score higher than the other three stages [stage 1: 9.2 (7.9), stage 2: 10.9 (7.5), stage 3: 8.3 (8.4) and stage 4: 16.2 (12.3)] (ANOVA p-value 0.26). Conclusions: These results indicate that long-term treatment outcomes in women undergoing laparoscopic surgery for pelvic pain may not be related to the stage of endometriosis. Regardless of endometriosis stage, most women were found to have residual pain symptoms. Further research to understand chronic pain, quality-of-life, and psychological distress and endometriosis is warranted. Summary: This study has shown that among women who underwent surgery for pelvic pain at UNC Hospitals, level of pain, quality-of-life, and depression do not increase with increasing stage of endometriosis

Chronic Hepatitis B Virus Coinfection Is Associated With Renal Impairment Among Zambian HIV-Infected Adults

Among 6789 HIV-infected Zambian adults screened for hepatitis B virus (HBV) coinfection, estimated glomerular filtration rate (eGFR) was 50-90 mL/minute/1.73 m2 in 17.6% and <50 mL/minute/1.73 m2 in 2.5%. Human immunodeficiency virus/HBV coinfection was associated with eGFR <50 mL/minute/1.73 m2 (adjusted odds ratio, 1.96 [95% confidence interval, 1.34-2.86]), adjusted for age, sex, CD4+ count, and World Health Organization disease stag

Burden of illness of trigeminal neuralgia among patients managed in a specialist center in England

BACKGROUND: Trigeminal neuralgia (TN) causes severe episodic, unilateral facial pain and is initially treated with antiepileptic medications. For patients not responding or intolerant to medications, surgery is an option. METHODS: In order to expand understanding of the pain-related burden of illness associated with TN, a cross-sectional survey was conducted of patients at a specialist center that utilizes a multidisciplinary care pathway. Participants provided information regarding their pain experience and treatment history, and completed several patient-reported outcome (PRO) measures. RESULTS: Of 129 respondents, 69/128 (54%; 1 missing) reported no pain in the past 4 weeks. However, 84 (65%) respondents were on medications, including 49 (38%) on monotherapy and 35 (27%) on polytherapy. A proportion of patients had discontinued at least one medication in the past, mostly due to lack of efficacy (n = 62, 48%) and side effects (n = 51, 40%). A total of 52 (40%) patients had undergone surgery, of whom 30 had microvascular decompression (MVD). Although surgery, especially MVD, provided satisfactory pain control in many patients, 29% of post-surgical patients reported complications, 19% had pain worsen or stay the same, 48% were still taking pain medications for TN, and 33% reported new and different facial pain. CONCLUSIONS: In most PRO measures, respondents with current pain interference had poorer scores than those without pain interference. In the Patient Global Impression of Change, 79% expressed improvement since beginning of treatment at this clinic. These results indicate that while the multidisciplinary approach can substantially alleviate the impact of TN, there remains an unmet medical need for additional treatment options

Neighborhood conditions are associated with maternal health behaviors and pregnancy outcomes

Women residing in neighborhoods of low socioeconomic status are more likely to experience adverse reproductive outcomes; however, few studies explore which specific neighborhood features are associated with poor maternal health behaviors and pregnancy outcomes. Based upon our conceptual model, directly observed street-level data from four North Carolina US counties were used to create five neighborhood indices: physical incivilities (neighborhood degradation), social spaces (public space for socializing), walkability (walkable neighborhoods), borders (property boundaries), and arterial features (traffic safety). Singleton birth records (2001–2005) were obtained from the North Carolina State Center for Vital Statistics and maternal health behavior information (smoking, inadequate or excessive weight gain) and pregnancy outcomes (pregnancy-induced hypertension/pre-eclampsia, low birthweight, preterm birth) were abstracted. Race-stratified random effect models were used to estimate associations between neighborhood indices and women’s reproductive behaviors and outcomes. In adjusted models, higher amounts of physical incivilities were positively associated with maternal smoking and inadequate weight gain, while walkability was associated with lower odds of these maternal health behaviors. Social spaces were also associated with inadequate weight gain during pregnancy. Among pregnancy outcomes, high levels of physical incivilities were consistently associated with all adverse pregnancy outcomes, and high levels of walkability were inversely associated with pregnancy-induced hypertension and preterm birth for Non-Hispanic white women only. None of the indices were associated with adverse birth outcomes for Non-Hispanic black women. In conclusion, certain neighborhood conditions were associated with maternal health behaviors and pregnancy outcomes

An Ecologic Analysis of County-Level PM2.5 Concentrations and Lung Cancer Incidence and Mortality

Few studies have explored the relationship between PM2.5 and lung cancer incidence. Although results are mixed, some studies have demonstrated a positive relationship between PM2.5 and lung cancer mortality. Using an ecologic study design, we examined the county-level associations between PM2.5 concentrations (2002–2005) and lung cancer incidence and mortality in North Carolina (2002–2006). Positive trends were observed between PM2.5 concentrations and lung cancer incidence and mortality; however, the R2 for both were <0.10. The slopes for the relationship between PM2.5 and lung cancer incidence and mortality were 1.26 (95% CI 0.31, 2.21, p-value 0.01) and 0.73 (95% CI 0.09, 1.36, p-value 0.03) per 1 μg/m3 PM2.5, respectively. These associations were slightly strengthened with the inclusion of variables representing socioeconomic status and smoking. Although variability is high, thus reflecting the importance of tobacco smoking and other etiologic agents that influence lung cancer incidence and mortality besides PM2.5, a positive trend is observed between PM2.5 and lung cancer incidence and mortality. This suggests the possibility of an association between PM2.5 concentrations and lung cancer incidence and mortality

Cholecystectomy and the Risk of Colorectal Adenomas

Cholecystectomy has been identified as a risk factor for colorectal cancer, yet little attention has been given to the association between cholecystectomy and colorectal adenomas

Do all candidemic patients need an ophthalmic examination?

Intraocular candidiasis is a potentially sight-threatening complication of candidemia. While the incidence of candidemia in North America has increased, the prevalence of intraocular candidiasis appears to be decreasing. In the USA and Europe, an ophthalmic examination is recommended for all candidemic patients to rule out intraocular involvement. However, improvements in management, clarification of the diagnosis, and trends in the epidemiology of intraocular candidiasis suggest that some candidemia patients might be safely managed without the recommended dilated ophthalmic examination