The association of genetic susceptibility to smoking with cardiovascular disease mortality and the benefits of adhering to a DASH diet: The Singapore Chinese Health Study.

BACKGROUND: Understanding the genetic predisposition to cardiovascular disease (CVD) may help to improve clinical intervention strategies. Lifestyle factors, such as diet, may differ among ethnic groups and may, in turn, modify individuals' risks to diseases. OBJECTIVES: We examined the genetic predisposition to ever smoking in relation to CVD mortality and assessed whether such an association could be modified by dietary intake. METHODS: A total of 23,760 Chinese adults from the Singapore Chinese Heath Study who were free of cancer and CVD at recruitment (1993-1998) were included in the study. A weighted genetic risk score (wGRS) was calculated to define the genetically determined regular smoking behavior (never or ever). Multivariable-adjusted Cox regression models were used to assess the association between the wGRS and CVD mortality. We also conducted a 1-sample Mendelian randomization analysis for ever smoking and CVD mortality. RESULTS: Over a mean of 22.6 years of follow-up, 2301 CVD deaths were identified. A genetic predisposition to ever smoking was significantly associated with CVD mortality; the multivariable-adjusted HR of CVD mortality was 1.07 (95% CI: 1.03-1.12), with a per-SD increment in the wGRS. However, the Mendelian randomization analysis did not support a causal relationship between ever smoking and CVD mortality (OR, 1.13; 95% CI: 0.87-1.45). Additionally, the Dietary Approaches to Stop Hypertension (DASH) score significantly modified the association between the smoking wGRS and CVD mortality; the association between a genetic predisposition to smoking and CVD mortality was only observed among individuals with a low DASH score (P-interaction = 0.004). CONCLUSIONS: A genetic predisposition to smoking was associated with CVD mortality in the Chinese population. In addition, we detected a significant interaction showing higher CVD mortality related to genetically determined smoking among those with lower DASH scores.

Quality Diet Index and Risk of Pancreatic Cancer: Findings from the Singapore Chinese Health Study.

BACKGROUND: Limited research has been conducted on the effect of quality diet index (QDI), which represents a comprehensive assessment of healthy diet quality and quantity, on pancreatic cancer risk in Asian populations. METHODS: Using data from the Singapore Chinese Health Study, a prospective cohort of 63,257 middle-aged or older Chinese men and women, four QDI scores: the Alternative Health Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH), and the Heathy Diet Indicator (HDI), at baseline were calculated. After 25 years of follow-up, 311 cohort participants developed pancreatic cancer. Cox proportional hazard regression method was used to estimate HR and 95% confidence interval (CI) for pancreatic cancer associated with higher QDI scores. RESULTS: Higher scores of AHEI-2010, aMED, and DASH were significantly associated with lower pancreatic cancer risk (all P trend < 0.05). Compared with the lowest quartile, HRs (95% CIs) of pancreatic cancer for the highest quartiles of AHEI-2010, aMED, and DASH scores were 0.65 (0.46-0.90), 0.57 (0.38-0.85), and 0.66 (0.46-0.95), respectively. These associations were more apparent among men. Overall, there was no statistically significant difference in the QDI-pancreatic cancer risk association between subgroups stratified by levels of body mass index, history of diabetes, and smoking status. CONCLUSIONS: Higher QDI scores were significantly associated with reduced risk of pancreatic cancer. IMPACT: The consistent results across multiple QDIs shows that adherence to a healthy diet may lower pancreatic cancer risk, suggesting that dietary modification may be a promising approach for primary prevention of pancreatic cancer.

Healthful dietary patterns and risk of end-stage kidney disease: the Singapore Chinese Health Study.

BACKGROUND: Although adherence to healthful dietary patterns has been associated with a lower risk of kidney function decline in Western populations, evidence in Asian populations remains scanty. OBJECTIVES: We examined predefined dietary patterns, namely, the Alternate Healthy Eating Index-2010 (AHEI-2010), the Dietary Approaches to Stop Hypertension (DASH), and the alternate Mediterranean diet (aMED), in relation to risk of end-stage kidney disease (ESKD). METHODS: We included 56,985 Chinese adults (aged 45-74 y) in the Singapore Chinese Health Study who were free of cancer, stroke, coronary artery disease, and ESKD at recruitment (1993-1998). Dietary pattern scores were calculated based on a validated 165-item FFQ. AHEI-2010 and aMED scores were modified by excluding the alcohol intake component because daily drinking has been associated with a higher risk of ESKD in our study population. We identified 1026 ESKD cases over a median follow-up of 17.5 y via linkage with the nationwide Singapore Renal Registry. Multivariable Cox regression models were used to compute HRs and their 95% CIs. RESULTS: Higher scores of all 3 dietary patterns were associated with lower ESKD risk in a dose-dependent manner. Compared with the lowest quintiles, the multivariable-adjusted HRs (95% CIs) of ESKD were 0.75 (0.61, 0.92) for the highest quintile of AHEI-2010, 0.67 (0.54, 0.84) for DASH, and 0.73 (0.59, 0.91) for aMED (all P-trend ≤ 0.004). These inverse associations were stronger with increasing BMI (in kg/m2), and the HRs for the diet-ESKD association were lowest in the obese (BMI ≥ 27.5), followed by the overweight (BMI = 25 to <27.5) participants, compared with those in lower BMI categories; the P-interaction values between BMI and diet scores were 0.03 for AHEI-2010, 0.004 for aMED, and 0.06 for DASH. CONCLUSIONS: Adherence to healthful dietary patterns was associated with a lower ESKD risk in an Asian population, especially in overweight or obese individuals.

Association Between Dietary Patterns in Midlife and Healthy Ageing in Chinese Adults: The Singapore Chinese Health Study.

OBJECTIVE: To examine the associations between dietary patterns in midlife and likelihood of future healthy ageing in Chinese older adults. DESIGN: Prospective population-based study. SETTING AND PARTICIPANTS: We included 14,159 participants aged 45-74 years who were free from cancer, cardiovascular disease, or diabetes at baseline (1993-1998) from the Singapore Chinese Health Study. METHODS: Dietary intakes in midlife were assessed by a validated food frequency questionnaire at baseline. Diet quality was scored according to the alternate Mediterranean diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) diet, the alternative Healthy Eating Index (AHEI)-2010, overall plant-based diet index (PDI), and healthful plant-based diet index (hPDI). Healthy ageing was assessed at the third follow-up visit (2014-2016), which occurred about 20 years after the baseline visit, and was defined as the absence of 10 chronic diseases, no impairment of cognitive function, no limitations in instrumental activities of daily living, no clinical depression at screening, good overall self-perceived health, good physical functioning, and no function-limiting pain among participants who had survival to at least 65 years of age. Multivariable-adjusted logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between each dietary pattern score and healthy ageing. RESULTS: About 20.0% of participants met the healthy ageing criteria. The OR (95% CI) for healthy ageing comparing the highest with the lowest quartile of diet quality scores was 1.52 (1.31-1.77) for aMED, 1.53 (1.35-1.73) for DASH, 1.39 (1.23-1.57) for AHEI-2010, 1.34 (1.18-1.53) for PDI, and 1.45 (1.27-1.65) for hPDI (all P-trend < .001). Each standard deviation increment in different diet quality scores was associated with 12% to 18% higher likelihood of healthy ageing. CONCLUSIONS AND IMPLICATIONS: In this Chinese population, adherence to various healthy dietary patterns at midlife is associated with higher likelihood of healthy ageing at later life.

Quality diet indexes and risk of hepatocellular carcinoma: Findings from the Singapore Chinese Health Study.

There is limited research on the effect of dietary quality on hepatocellular carcinoma (HCC) risk in populations with relatively high risk of HCC. Using data from Singapore Chinese Health Study, a prospective cohort study, of 63 257 Chinese aged 45 to 74, we assessed four diet-quality index (DQI) scores: the Alternative Health Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH) and Heathy Diet Indicator (HDI). We identified 561 incident HCC cases among the cohort participants after a mean of 17.6 years of follow-up. Cox proportional hazard regression model was used to estimate hazard ratio (HR) and 95% confidence interval (CI) for HCC in relation to these DQI scores. Unconditional logistic regression method was used to evaluate the associations between DQIs and HCC risk among a subset of individuals who tested negative for hepatitis B surface antigen (HBsAg). High scores of AHEI-2010, aMED and DASH, representing higher dietary quality, were associated with lower risk of HCC (all Ptrend < .05). Compared with the lowest quartile, HRs (95% CIs) of HCC for the highest quartile of AHEI-2010, aMED and DASH were 0.69 (0.53-0.89), 0.70 (0.52-0.95) and 0.67 (0.51-0.87), respectively. No significant association between HDI and HCC risk was observed. Among HBsAg-negative individuals, similar inverse associations were observed, and the strongest inverse association was for aMED (HRQ4vsQ1 = 0.46, 95% CI: 0.23-0.94, Ptrend = .10). These findings support the notion that adherence to a healthier diet may lower the risk of HCC, suggesting that dietary modification may be an effective approach for primary prevention of HCC.

Systematic review of effectiveness and cost-effectiveness of lifestyle interventions to improve clinical diabetes outcome measures in women with a history of GDM.

OBJECTIVE: Lifestyle interventions have been shown to be both effective and cost-effective in reducing diabetes and metabolic risk in high-risk populations. We systematically reviewed the effectiveness and cost-effectiveness of lifestyle interventions on anthropometric, glycemic and cardiovascular outcomes in women with previous gestational diabetes mellitus (GDM). METHOD: Relevant randomized control trials (RCT) were identified by searching multiple electronic databases through 20th June 2018. Data were pooled using random-effects models. The review protocol was registered on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42018108870). RESULTS: Twenty-one studies met the inclusion criteria and 16 studies with outcome data were analyzed in the meta-analysis. No RCT studies included cost-effectiveness data on lifestyle interventions. The pooled estimate for postpartum weight showed a significant mean reduction in the intervention arm (-1.8 kg [95% CI: -2.9, -0.6; p = 0.002; I2 = 92.2%; p < 0.05]). Further, the effect of lifestyle intervention on weight change was significantly greater in studies of longer duration. Most of the other endpoints had modest improvements but only anthropometric endpoints were statistically significant. However, there was high heterogeneity between the studies. CONCLUSIONS: Lifestyle interventions showed statistically and clinically significant improvements in anthropometric outcomes. However, more research is needed to explore lifestyle effects on glycemic and cardiovascular risk factors and to establish cost-effectiveness. Methodologically sound, large scale studies on diverse ethnicities and with longer follow-up would establish the real effect of lifestyle interventions to reduce diabetes risk in women with previous GDM.

The Effect of Coconut Oil Consumption on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Clinical Trials.

BACKGROUND: Coconut oil is high in saturated fat and may, therefore, raise serum cholesterol concentrations, but beneficial effects on other cardiovascular risk factors have also been suggested. Therefore, we conducted a systematic review of the effect of coconut oil consumption on blood lipids and other cardiovascular risk factors compared with other cooking oils using data from clinical trials. METHODS: We searched PubMed, SCOPUS, Cochrane Registry, and Web of Science through June 2019. We selected trials that compared the effects of coconut oil consumption with other fats that lasted at least 2 weeks. Two reviewers independently screened articles, extracted data, and assessed the study quality according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The main outcomes included low-density lipoprotein cholesterol (LDL-cholesterol), high-density lipoprotein cholesterol (HDL-cholesterol), total cholesterol, triglycerides, measures of body fatness, markers of inflammation, and glycemia. Data were pooled using random-effects meta-analysis. RESULTS: 16 articles were included in the meta-analysis. Results were available from all trials on blood lipids, 8 trials on body weight, 5 trials on percentage body fat, 4 trials on waist circumference, 4 trials on fasting plasma glucose, and 5 trials on C-reactive protein. Coconut oil consumption significantly increased LDL-cholesterol by 10.47 mg/dL (95% CI: 3.01, 17.94; I2 = 84%, N=16) and HDL-cholesterol by 4.00 mg/dL (95% CI: 2.26, 5.73; I2 = 72%, N=16) as compared with nontropical vegetable oils. These effects remained significant after excluding nonrandomized trials, or trials of poor quality (Jadad score <3). Coconut oil consumption did not significantly affect markers of glycemia, inflammation, and adiposity as compared with nontropical vegetable oils. CONCLUSIONS: Coconut oil consumption results in significantly higher LDL-cholesterol than nontropical vegetable oils. This should inform choices about coconut oil consumption.

Diet Quality Indices and Risk of Type 2 Diabetes Mellitus: The Singapore Chinese Health Study.

We aimed to test whether predefined dietary patterns that are inversely related to risk of type 2 diabetes (T2D) in Western populations were similarly associated with lower T2D risk in an Asian population. We included 45,411 middle-aged and older participants (ages 45-74 years) in the Singapore Chinese Health Study who were free of diabetes, cancer, and cardiovascular disease at baseline (1993-1998). Participants were followed up for T2D diagnosis through 2010. Dietary information was collected using a validated food frequency questionnaire. Dietary pattern scores were calculated for the alternate Mediterranean diet (aMED), Alternate Healthy Eating Index 2010 (AHEI-2010), the Dietary Approaches to Stop Hypertension (DASH) diet, an overall plant-based diet index, and a healthful plant-based diet index. During a median of 11.1 years of follow-up, 5,207 incident cases of T2D occurred. After adjustment for multiple potential confounders, the 5 dietary pattern scores were significantly associated with 16% (for aMED) to 29% (for DASH) lower risks of T2D when comparing the highest score quintiles with the lowest (all P-for-trend values < 0.001). These associations did not vary substantially by baseline age, sex, body mass index, or hypertension status but were limited to nonsmokers (aMED: P for interaction < 0.001; AHEI-2010: P for interaction = 0.03). Adherence to a high-quality diet, as reflected by several predefined diet quality indices derived in Western populations, was significantly associated with lower T2D risk in an Asian population.

Diet-Quality Indexes Are Associated with a Lower Risk of Cardiovascular, Respiratory, and All-Cause Mortality among Chinese Adults.

Background: Diet-quality indexes have been associated with a lower risk of chronic disease mortality in Western populations, but it is unclear whether these indexes reflect protective dietary patterns in Asian populations. Objective: We examined the association between Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Healthy Diet Indicator (HDI) scores and the risk of all-cause cardiovascular disease (CVD), cancer, and respiratory disease mortality. Methods: We used data from a prospective cohort of 57,078 Singapore Chinese men and women (aged 45-74 y) who were free of cancer and CVD at baseline (1993-1998) and who were followed up through 2014. The diet-quality index scores were calculated on the basis of data from a validated 165-item food-frequency questionnaire. Cox regression models with adjustment for potential confounders including sociodemographic and lifestyle variables, body mass index, and medical history were used to estimate HRs and 95% CIs. Results: During a total of 981,980 person-years of follow-up, 15,262 deaths (CVD: 4871; respiratory: 2690; and cancer: 5306) occurred. Comparing the highest with the lowest quintiles, the multivariable adjusted HRs (95% CIs) for all-cause mortality were 0.82 (0.78, 0.86) for AHEI-2010, 0.80 (0.76, 0.85) for aMED, 0.80 (0.75, 0.84) for DASH, and 0.88 (0.83, 0.92) for HDI scores (all P-trend < 0.001). Higher diet index scores were associated with a 14-28% lower risk of CVD and respiratory mortality, but only a 5-12% lower risk of cancer mortality. Higher consumption of vegetables, fruit, nuts, and long-chain n-3 (ω-3) fatty acids, lower consumption of red meat, and avoidance of high alcohol consumption were the diet index components associated with a lower risk of mortality. Conclusion: Adherence to several recommended dietary patterns that emphasize healthy plant-based foods was associated with a substantially lower risk of chronic disease mortality in an Asian population. The Singapore Chinese Health Study was registered at www.clinicaltrials.gov as NCT03356340.

Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies.

OBJECTIVE: To assess the association between maternal caffeine intake and risk of pregnancy loss using a systematic review and meta-analysis. DESIGN: Categorical and dose-response meta-analysis of prospective studies. SETTING: Relevant articles were identified by searching MEDLINE and SCOPUS databases through 30 January 2015. Two authors independently extracted information from eligible studies. Random-effects models were used to derive the summary relative risks (RR) and corresponding 95% CI for specific categories of caffeine consumption and for a continuous association using generalized least-squares trend estimation. SUBJECTS: A total of 130 456 participants and 3429 cases in fourteen included studies. RESULTS: Compared with the reference category with no or very low caffeine intake, the RR (95% CI) of pregnancy loss was 1·02 (0·85, 1·24; I(2)=28·3%) for low intake (50-149 mg/d), 1·16 (0·94, 1·41; I 2=49·6%) for moderate intake (150-349 mg/d), 1·40 (1·16, 1·68; I(2)=18·6%) for high intake (350-699 mg/d) and 1·72 (1·40, 2·13; I(2)=0·0%) for very high intake (≥ 700 mg/d). In the dose-response analysis, each 100 mg/d increment in maternal caffeine intake (~1 cup of coffee) was associated with 7% (95% CI 3%, 12%) higher risk of pregnancy loss. Our results may have been affected by publication bias, but the association remained significant for the subset of larger studies. Furthermore, adjustment for smoking and pregnancy symptoms may have been incomplete, potentially resulting in residual confounding. CONCLUSIONS: Albeit inconclusive, higher maternal caffeine intake was associated with a higher risk of pregnancy loss and adherence to guidelines to avoid high caffeine intake during pregnancy appears prudent.

Palm Oil Consumption Increases LDL Cholesterol Compared with Vegetable Oils Low in Saturated Fat in a Meta-Analysis of Clinical Trials.

BACKGROUND: Palm oil contains a high amount of saturated fat compared with most other vegetable oils, but studies have reported inconsistent effects of palm oil on blood lipids. OBJECTIVE: We systematically reviewed the effect of palm oil consumption on blood lipids compared with other cooking oils using data from clinical trials. METHODS: We searched PubMed and the Cochrane Library for trials of at least 2 wk duration that compared the effects of palm oil consumption with any of the predefined comparison oils: vegetable oils low in saturated fat, trans fat-containing partially hydrogenated vegetable oils, and animal fats. Data were pooled by using random-effects meta-analysis. RESULTS: Palm oil significantly increased LDL cholesterol by 0.24 mmol/L (95% CI: 0.13, 0.35 mmol/L; I(2) = 83.2%) compared with vegetable oils low in saturated fat. This effect was observed in randomized trials (0.31 mmol/L; 95% CI: 0.20, 0.42 mmol/L) but not in nonrandomized trials (0.03 mmol/L; 95% CI: -0.15, 0.20 mmol/L; P-difference = 0.02). Among randomized trials, only modest heterogeneity in study results remained after considering the test oil dose and the comparison oil type (I(2) = 27.5%). Palm oil increased HDL cholesterol by 0.02 mmol/L (95% CI: 0.01, 0.04 mmol/L; I(2) = 49.8%) compared with vegetable oils low in saturated fat and by 0.09 mmol/L (95% CI: 0.06, 0.11 mmol/L; I(2) = 47.8%) compared with trans fat-containing oils. CONCLUSIONS: Palm oil consumption results in higher LDL cholesterol than do vegetable oils low in saturated fat and higher HDL cholesterol than do trans fat-containing oils in humans. The effects of palm oil on blood lipids are as expected on the basis of its high saturated fat content, which supports the reduction in palm oil use by replacement with vegetable oils low in saturated and trans fat. This systematic review was registered with the PROSPERO registry at http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012002601#.VU3wvSGeDRZ as CRD42012002601.

A comparison of brilliant blue G, trypan blue, and indocyanine green dyes to assist internal limiting membrane peeling during macular hole surgery.

PURPOSE: To compare surgical outcomes with three dyes, brilliant blue G (BBG), trypan blue (TB) and indocyanine green (ICG), used to facilitate internal limiting membrane peeling during macular hole surgery. METHODS: This comparative, interventional cases series consisted of 50 eyes of 50 patients with senile idiopathic macular holes, who underwent vitrectomy with internal limiting membrane peeling using BBG (n = 15), TB (n = 20), or ICG (n = 15). The cases involving use of BBG and TB were enrolled prospectively and concurrently, and the cases using ICG were selected through chart reviews. We compared the intraoperative surgical facilitation with the 3 dyes and the surgical outcomes in terms of macular hole closure and visual improvement at 6 months. RESULTS: The 3 groups were similar in mean age, sex distribution, preoperative best-corrected visual acuity, and duration of follow-up (P = 0.957, 0.974, 0.939, and 0.5524, respectively). Of the 3 dyes, BBG appeared to provide greatest intraoperative facilitation: most convenient to use and remove, and similar to ICG in terms of internal limiting membrane staining. Six months postoperatively, macular hole closed in 100%, 95%, and 86% eyes (P = 0.48) and visual improvement occurred in 80%, 85%, and 33% eyes (P = 0.005) in BBG, TB, and ICG groups, respectively. The BBG and TB groups also had a better final best-corrected visual acuity than ICG group (P = 0.05) and smaller percentage of visual decline (5% and 6.7% vs. 40% respectively; P = 0.049). CONCLUSION: Brilliant blue G was comparable with TB in optimizing visual and functional outcomes, while it was similar to ICG in ease of internal limiting membrane peeling.

Localized Serous Retinal Detachment of Macula as a Marker of Malignant Hypertension.

The association between serous retinal detachment of macula (SRD) in hypertensive retinopathy (HTR) and malignant hypertension has been reported. This cross-sectional study included 14 consecutive patients on treatment for hypertension, who were referred for ophthalmic evaluation and were found to have macular SRD, documented by optical coherence tomography. All underwent systemic evaluation for hypertensive status and to rule out other associated/similar diseases such as diabetes, coagulopathies, lupus etc. The mean age of the patients was 44.35 +/- 15.5 years; the mean best-corrected visual acuity was 6/12. All had grade 3-4 HTR; 10 patients had bilaterally symmetrical retinopathy (grade 3 or 4); 4 had asymmetric fundus changes. Systemically, every patient was found to have malignant hypertension. The mean systolic and diastolic pressures were 208.57 +/- 32.78 and 117.86 +/- 14.2 mm Hg, respectively. SRD predicted malignant hypertension more consistently than papilledema (P = .0132). The presence of macular SRD in a hypertensive patient may serve as an indicator of malignant hypertension.

Inhibitory effect of nicorandil on the contraction of isolated human urinary bladder detrusor muscle.

This study was performed to determine whether the antianginal drug nicorandil relaxes isolated human detrusor muscle. Ten strips of detrusor muscle obtained from 10 pediatric patients who underwent surgery on the urinary bladder were contracted with 80 mM potassium chloride (KCl) before and after incubation with four concentrations of nicorandil (100, 200, 400 and 800 microM). The percent inhibition by nicorandil of the height and area under the curve (AUC) of KCl-induced contractions of the detrusor strips was calculated. The effect of glibenclamide (10 microM) on nicorandil (800 microM)-induced inhibition of KCl-induced detrusor contractions was also studied. Nicorandil caused a concentration-dependent inhibition of KCl-induced contractions of the detrusor strips. The percent inhibition of the height of KCl-induced contractions of the detrusor by nicorandil was significant at concentrations of 200, 400 and 800 microM. The percent inhibition of the AUC for KCl-induced detrusor contractions was significant at all four concentrations of nicorandil used. Glibenclamide reversed the inhibitory effect of 800 microM nicorandil on KCl-induced detrusor contractions. These results suggest that nicorandil inhibits KCl-induced contractions of isolated human detrusor muscle and may therefore be useful in clinical conditions requiring detrusor muscle relaxation.

Surgical results in bronchiectasis: analysis of 149 patients.

Bronchiectasis remains a serious problem in developing countries. We reviewed the morbidity, mortality, and functional outcome of surgical treatment for bronchiectasis in our institution. Between 1992 and 2003, 149 patients (105 males, 44 females) underwent pulmonary resection for bronchiectasis. Their mean age was 33.7 years (range, 5-66 years). The indications for surgery were failure of conservative treatment in 59 (40%) patients, recurrent hemoptysis in 53 (36%), bronchial obstruction by a tumor in 9 (6%), and destroyed lung in 28 (19%). Bilateral disease was seen in 24 (16%) patients. Surgical treatment included pneumonectomy in 55 (37%) patients, lobectomy in 55 (37%), bilobectomy in 37 (25%), and lobectomy and/or segmentectomy in 2 (1%). There was one operative death (mortality, 0.67%) and morbidity occurred in 22 (14.8%) patients. Follow-up was complete in 94 patients, for a mean of 4.8 years (range, 3 months to 12 years). After surgery, 51 (34%) patients were asymptomatic. Surgical treatment for bronchiectasis can achieve good results with acceptable morbidity and mortality, not only in localized disease but also in extensive disease, if complete resection can be achieved.

Presentation, prognosis and outcome of IgA nephropathy in Indian adults.

BACKGROUND: IgA nephropathy (IgAN) is not well characterized in India. This retrospective study of 478 patients with IgAN was performed to clarify the presenting features, prognostic factors and the renal survival rates of the disease. METHODS: Three hundred and forty-seven patients who had been followed on average for 27 months after diagnosis were divided into two groups based on renal function at diagnosis. In group 1 (229 patients), the creatinine clearance estimated by the Modification of Diet in Renal Disease formula was <85 mL/min and in group 2 (118 patients) it was >/=85 mL/min. RESULTS: The predominant modes of presentation were nephrotic syndrome, hypertension and renal failure. Twenty-nine percent of patients had more than a 20% decline in renal function at the last follow up. Multivariate analyses with stepwise logistic regression identified hypertension (odds ratio (OR) 3.5), nephrotic range proteinuria (OR 3.4) and sclerosed glomeruli on biopsy (OR 4.1) to be independently associated with progression in group 1 and hypertension (OR 2.3) in group 2. Seventeen percent of patients progressed to end-stage renal disease (ESRD). Using multivariate analysis by the Cox model, four risk factors for developing ESRD were identified: hypertension (hazard ratio (HR) 3.1); nephrotic proteinuria (HR 1.9); interstitial fibrosis (HR 2.5); and sclerosed glomeruli (HR 1.8). The renal survival rates at 1, 5 and 10 years were 84, 55 and 33%, respectively, with a median renal survival of 61 months from the time of biopsy. CONCLUSION: The relatively rapid rate of progression of IgAN in India is suggestive towards a 'malignant' nature of the disease in this country.