Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study

Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients.A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact.Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37), pneumonia (odds ratio 2.01, 1.61 to 2.49), postoperative bleeding (odds ratio 1.35, 1.09 to 1.68) and septicemia (odds ratio 2.43, 1.85 to 3.21) without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability.Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients

Serological Diagnosis of Helicobacter pylori Infection in Patients With a Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in 4%-6% of women in the reproductive age and is a common cause of infertility. Even though the number of investigations is scarce, studies show that Helicobacter pylori infection may influence reproduction. Objectives: The purpose of this study was to determine and compare the levels of H. pylori specific antibodies IgA, IgG and anti-CagA at both PCOS and non-PCOS women with their spouses using the serological test. Patients and Methods: In this cross-sectional study, 127 women with their spouses (age range, 30 - 60 years) were selected. These patient were referred to infertility center of Shariati Hospital in Tehran, Iran, with a diagnostic criteria of PCOS based on Androgen Excess Society (AES). The specific antibodies of IgA, IgG and anti-CagA were measured using the commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit. Results: The positive titers of H. pylori antibodies IgA, IgG and anti-CagA in the PCOS group were 45 (35%), 79 (62%) and 77 (60.5%), respectively, while in non-PCOS group were 38 (30%), 76 (60%) and 50 (39.5%), respectively. The sera positive for IgA, IgG and anti-CagA antibodies in spouses of the non-PCOS group were 38 (30%), 84 (66%) and 79 (62%) respectively, but in spouses of the PCOS group were 51 (40%), 83 (66%) and 48 (38%), respectively. The results showed that H. pylori infection probably did not affect infertility or reproduction. Conclusions: Findings of this study demonstrate no significant difference between levels of H. pylori specific antibodies of IgA, IgG, anti-CagA and the presence of PCOS disorders, and also indicate that serologic testing is a sensitive method for the detection of H. pylori antibodies. The high prevalence of H. pylori positive antibody levels in both PCOS and non-PCOS patients can be probably associated with the high frequency of H. pylori infection