Incidence and prevalence of hepatitis B in patients with diabetes mellitus in the UK: A population-based cohort study using the UK Clinical Practice Research Datalink.

We assessed the incidence and prevalence of hepatitis B (Hep B) in patients with or without diabetes mellitus (DM) using the UK Clinical Practice Research Datalink (CPRD). This was a retrospective, observational study of diabetic and nondiabetic cohorts aged 0-80 years using CPRD (NCT02324218). Incidence rates (IR) for each cohort were calculated. Crude and adjusted (Poisson regression) IR ratios (IRR) were estimated with 95% confidence intervals (CI) to compare the cohorts. Hep B prevalence stratified by age, and hospitalization related to Hep B was also calculated. Of 7 712 043 subjects identified, 4 839 770 were included (DM: 160 760; non-DM: 4 679 010). Mean ages were 54.4 and 32.0 years, and 57.20% and 50.14% were male in the diabetic and nondiabetic cohorts, respectively. Hep B was identified in 29 diabetic and 845 nondiabetic subjects; IR was 4.03 per 100 000 person-years and 2.88 per 100 000 person-years, respectively. The adjusted IRR was 1.00 (95% CI: 0.70-1.50) between diabetic and nondiabetic cohorts. Hep B prevalence was higher in the diabetic cohort (0.01%-0.26%) than in the nondiabetic cohort (0.00%-0.03%) across the different age groups. Hep B-associated hospitalization IR was higher in the diabetic cohort (4.98-10.91) than the nondiabetic cohort (0.26-2.44). The Hep B IR, hospitalization and prevalence were higher in males in both cohorts. In conclusion, the risk of incident Hep B diagnosis in the diabetic cohort was not different from that in the nondiabetic cohort. However, prevalence of Hep B and Hep B-associated hospitalization rate was higher in the diabetic than in the nondiabetic cohort.

Risk of herpes zoster among diabetics: a matched cohort study in a US insurance claim database before introduction of vaccination, 1997-2006.

PURPOSE: To assess whether diabetes is a risk factor for herpes zoster (HZ). METHODS: We conducted a retrospective cohort study using the Integrated Health Care Information Services database, during the period 1997-2006. A type I diabetes cohort, a type II diabetes cohort and two non-diabetic cohorts matched for date of enrolment and duration of follow-up were defined. HZ and diabetes were defined using a combination of ICD-9 and prescription drug codes. Individuals with immunosuppressive conditions or treatments were excluded. Cox Proportional Hazards regression analysis using a stepwise method with backward elimination was applied to estimate the hazard ratios (HR) of HZ, including age, gender and co-morbidities as covariates. RESULTS: The study population comprised 380,401 and 20,397 type II and type I diabetic subjects respectively, as well as 1,521,604 and 81,588 matched controls. The median ages were 55, 35, 33 and 29 years, respectively. HZ incidence was 4.59, 2.13, 1.97, and 1.82 per 1,000 person-years, respectively. There was no evidence of an impact of type I diabetes on the risk of HZ. Type II diabetes was associated with an increased risk for HZ in subjects ≥ 65 (HR 3.12; 95 % CI 2.77-3.52, adjusted for gender) and in subjects between 40 and 64 (HR 1.51; 95 % CI 1.42-1.61) years of age. Cardiac disease and chronic pulmonary disease were also risk factors (HR 1.92; 95 % CI 1.73-2.13 and HR 1.52; 95 % CI 1.38-1.67) in non-diabetic subjects. CONCLUSIONS: This study suggests that type II diabetes is associated with an increased risk of developing HZ, which was particularly high in adults 65 years and older and moderately increased in adults under 65 years of age.

Radiofrequency ablation of bone tumours.

The indications for radiofrequency bone ablation in the case of benign tumours (osteoid osteoma, osteoblastoma) are curative, whereas for bone metastases, the prime aim is palliative analgesia. The failure rate for osteoid osteomas is low (<15%), and 70 to 90% of patients with metastases experience considerable relief, but if the treatment fails, it can be offered again. In the spine, heating can damage neighboring nerve structures, which means they need to be protected (CO(2) dissection). Radiofrequency ablation may be combined with an injection of cement. The osteonecrosis resulting from heating is painful and justifies performing the procedure under general anesthesia.

A risk-based sampling plan for monitoring of histamine in fish products.

In 2008, the French Institute for Public Health Surveillance reported an increase in the number of histamine food poisoning outbreaks and cases in France. The aim of this study was to propose a new monitoring plan for characterizing consumers' exposure to histamine through fishery products. As fish products of concern are numerous, we proposed that the number of samples allocated for a fish category be chosen based on the risk associated with the category. Point risk estimates of histamine poisoning were assessed with the Risk Ranger tool. Fresh fish with high histidine content was found to contribute most to the number of cases. The (estimated) risks associated with the consumption of canned and deep-frozen fish appear marginal as compared with the risk associated with fresh fish with high histidine concentrations. Accordingly, we recommend excluding canned and deep-frozen fish from the monitoring plan, although these risk estimates can be biased. Within a category, samples were proportional to the relative food consumption of the different fishes. The spatial and seasonal consumption patterns were also taken into account for the design of the new monitoring plan. By testing appropriate numbers of samples from categories of fish products of concern, this plan will permit investigation of trends or comparison of product categories presenting risks of histamine poisoning.