Forgotten fatalities: British military, mining and maritime accidents since 1900.

BACKGROUND: Comparative long-term trends in fatal accident rates in the UK's most hazardous occupations have not been reported. AIMS: To compare trends in fatal accident rates in six of the most hazardous occupations (the three armed forces, merchant shipping, sea fishing and coal mining) and the general British workforce during peacetime years since 1900. METHODS: Examinations of annual mortality reports, returns, inquiry files and statistics. The main outcome measure was the fatal accident rate per 100 000 population employed. RESULTS: These six occupations accounted for ~40% of all fatal accidents in the British workforce. Fatal accident rates were highest in merchant shipping to 1914 (400-600 per 100 000) and in the Royal Air Force and sea fishing by the early 1920s (around 300 per 100 000). Since the 1950s sea fishing has remained the most hazardous occupation (50-200). Widespread reductions in fatal accident rates for each occupation have been greatest in recent years in the three armed forces and merchant shipping. Compared with the general workforce, relative risks of fatalities have increased in recent decades in all these occupations except shipping. CONCLUSIONS: All six occupations still have high fatal accident rates. The greatly increased fatalities in sea fishing generally and in the Royal Air Force during its early years reflect, for different reasons, cultures of extreme risk-taking in these two sectors. Reductions in fatality rates in the armed forces over the last 20 years are due largely to decreases in land transport accidents.

A Systematic Review and Meta-analysis of Paediatric Inflammatory Bowel Disease Incidence and Prevalence Across Europe.

BACKGROUND AND AIMS: Inflammatory bowel disease [IBD] is often one of the most devastating and debilitating chronic gastrointestinal disorders in children and adolescents. The main objectives here were to systematically review the incidence and prevalence of paediatric IBD across all 51 European states. METHODS: We undertook a systematic review and meta-analysis based on PubMed, CINAHL, the Cochrane Library, searches of reference lists, grey literature and websites, covering the period from 1970 to 2018. RESULTS: Incidence rates for both paediatric Crohn's disease [CD] and ulcerative colitis [UC] were higher in northern Europe than in other European regions. There have been large increases in the incidence of both paediatric CD and UC over the last 50 years, which appear widespread across Europe. The largest increases for CD have been reported from Sweden, Wales, England, the Czech Republic, Denmark and Hungary, and for UC from the Czech Republic, Ireland, Sweden and Hungary. Incidence rates for paediatric CD have increased up to 9 or 10 per 100 000 population in parts of Europe, including Scandinavia, while rates for paediatric UC are often slightly lower than for CD. Prevalence reported for CD ranged from 8.2 per 100 000 to approximately 60 and, for UC, from 8.3 to approximately 30. CONCLUSIONS: The incidence of paediatric IBD continues to increase throughout Europe. There is stronger evidence of a north-south than an east-west gradient in incidence across Europe. Further prospective studies are needed, preferably multinational and based on IBD registries, using standardized definitions, methodology and timescales.

Pursing a career in academic surgery among African American medical students.

BACKGROUND: There are few African American students in medical school, and even fewer are choosing academic surgical careers. The objective of this study is to provide insight into what barriers URM students perceive when considering a career in academic surgery. METHODS: This qualitative, descriptive study was conducted at the University of Pennsylvania. Sixteen African American students with an interest in surgery were recruited to participate in the study. The outcomes reported are themes of how participants perceive the challenges of pursuing an academic surgical career. RESULTS: Barriers to pursuing a career in academic surgery cited by students included lifestyle concerns, financial pressures, having to work in a predominantly white environment, lack of mentorship, feelings of having to prove oneself, stressful environments and concerns of being a minority female in surgery. CONCLUSIONS: These study findings indicate that the persistent dearth of African-Americans in academic surgery is likely multi-factorial. Some ways surgical leadership can begin addressing these issues is through establishment of formal mentorship programs, ensuring non-discriminatory recruiting processes, having explicit goals of improving diversity and supporting pipeline programs.

Suicide following acute admissions for physical illnesses across England and Wales.

BACKGROUND: The study aim was to establish and quantify suicide risk following acute admissions for all major physical illnesses, for confirmatory purposes, from two independent information sources from different countries. METHODS: Record linkage of inpatient and death certificate data for 11 004 389 acute admissions for physical illnesses in England and 713 496 in Wales. The main outcome measure was standardised mortality ratios (SMRs) for suicide at 1 year following discharge from hospital. RESULTS: There were 1781 suicides within 1 year of discharge in England (SMR = 1.7; 95% = 1.6-1.8) and 131 in Wales (SMR = 2.0; 1.7-2.3). Of 48 major physical illnesses that were associated with at least eight suicides in either country, there was high consistent suicide mortality (significant SMR >3) in both countries for constipation (SMR = 4.1 in England, 7.5 in Wales), gastritis (4.4 and 4.9) and upper gastrointestinal bleeding (3.4 and 4.5). There was high suicide mortality in one country for alcoholic liver disease, other liver disease and chronic pancreatitis; for epilepsy and Parkinson's disease; for diabetes, hypoglycaemia and hypo-osmolality & hyponatraemia; and for pneumonia, back pain and urinary tract infections. CONCLUSIONS: There is little or no increased suicide mortality following acute admissions for most physical illnesses. Much of the increased suicide mortality relates to gastrointestinal disorders that are often alcohol related or specific chronic conditions, which may be linked to side effects from certain therapeutic medications. Acute hospital admissions for physical illnesses may therefore provide an opportunity for targeted suicide prevention among people with certain conditions, particularly alcohol related disorders.

Weekend admission and mortality for gastrointestinal disorders across England and Wales.

BACKGROUND: Little has been reported on mortality following admissions at weekends for many gastrointestinal (GI) disorders. The aim was to establish whether GI disorders are susceptible to increased mortality following unscheduled admission on weekends compared with weekdays. METHODS: Record linkage was undertaken of national administrative inpatient and mortality data for people in England and Wales who were hospitalized as an emergency for one of 19 major GI disorders. RESULTS: The study included 2 254 701 people in England and 155 464 in Wales. For 11 general surgical and medical GI disorders there were little, or no, significant weekend effects on mortality at 30 days in either country. There were large consistent weekend effects in both countries for severe liver disease (England: 26·2 (95 per cent c.i. 21·1 to 31·6) per cent; Wales: 32·0 (12·4 to 55·1 per cent) and GI cancer (England: 21·8 (19·1 to 24·5) per cent; Wales: 25·0 (15·0 to 35·9) per cent), which were lower in patients managed by surgeons. Admission rates were lower at weekends than on weekdays, most strongly for severe liver disease (by 43·3 per cent in England and 51·4 per cent in Wales) and GI cancer (by 44·6 and 52·8 per cent respectively). Both mortality and the weekend mortality effect for GI cancer were lower for patients managed by surgeons. DISCUSSION: There is little, or no, evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Lower admission rates at weekends indicate more severe cases. The findings for severe liver disease may suggest a lack of specialist hepatological resources. For cancers, reduced availability of end-of-life care in the community at weekends may be the cause.

Osteoid Osteoma of the Trapezium: Case Report of an Unusual Tumor Location Presenting a Diagnostic Challenge.

Osteoid osteoma is a benign bone tumor, which represents approximately 10% of all benign bone tumors. When localized to the carpus, osteoid osteomas are most often seen in the scaphoid and capitate. Rarely, these tumors can also be observed in the trapezium. Given the infrequency with which osteomas are located in the trapezium and often nonspecific presenting symptoms, diagnosis of this tumor can be challenging and requires a high index of suspicion.

Do COPD patients taught pursed lips breathing (PLB) for dyspnoea management continue to use the technique long-term? A mixed methodological study.

OBJECTIVE: To investigate whether COPD patients taught pursed lips breathing (PLB) for dyspnoea management continue to use the technique long-term and, if so, their experience of this. DESIGN: A mixed methodological approach using semi-structured telephone interviews, a focus group and observation of current PLB technique was used. Qualitative analysis was based on grounded theory. SETTING: Participants were recruited from the two inner city London (UK) boroughs. PARTICIPANTS: A purposive sample of 13 patients with COPD taught PLB 6 to 24 months previously. 11 participants took part in the telephone interviews; focus group participation and observed PLB was 5/11 and 6/11 respectively. MAIN OUTCOME MEASURES: A thematic analysis of interviews and focus group; observation of PLB technique. RESULTS: Nine reported on-going use of PLB with 8 reporting definite benefit. Observed technique showed ongoing ability for PLB to reduce RR and increase SpO2. Four distinct themes emerged from the data: use of PLB when short of breath due to physical activity (8/9), increased confidence and reduced panic (4/9), use as an exercise (3/9), use at night (3/9). Those that had discontinued PLB had done so because it didn't help (2) and they had forgotten/were too busy to continue. CONCLUSION: This study found 9 of 13 of patients taught PLB continued with long-term use and 8 of 13 reporting definite benefit from PLB. The role of PLB in increasing patients' confidence in their ability to manage their breathlessness and, use at night, were novel findings.

To reverse or not to reverse? A systematic review of autograft polarity on functional outcomes following peripheral nerve repair surgery.

BACKGROUND: The literature describing the best clinical practice for proximal-distal autograft orientation, otherwise known as nerve graft polarity, is inconsistent. With existing disparities in the peripheral nerve literature, the clinical question remains whether reversing nerve autograft polarity bears an advantage for nerve regeneration. METHODS: A comprehensive review of the literature using Embase and PubMed databases (1940-June 2015) was performed to retrieve all original articles on the effects of nerve autograft polarity on nerve regeneration and functional recovery following primary repair of peripheral nerve defects. RESULTS: The initial database search yielded 318 titles. Duplicate exclusion, title review and full text review yielded six articles which directly compared nerve autograft polarity. Histological, morphometric, electrophysiological, and behavioral outcomes were reviewed. All retained articles were animal studies, of which none demonstrated significant differences in outcomes between the normal and reversed polarity groups. A reversed graft may ensure that regenerating nerve fibers are not lost at branching points, however this may not translate into improved function. CONCLUSION: There is insufficient data to suggest that nerve autograft polarity has an impact on nerve regeneration and functional outcomes.

The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study.

UNLABELLED: We used routine hospital data to investigate whether socially deprived patients had an increased risk of dying following hip fracture compared with affluent patients. We found that the most deprived patients had a significantly increased risk of dying at 30, 90 and 365 days compared with the most affluent patients. INTRODUCTION: To identify whether social deprivation has any effect on mortality risk after emergency admission with hip fracture and to determine whether any increased mortality observed among deprived groups was associated with patient and hospital-related factors. METHODS: We used routine, linked hospital inpatient and mortality data for emergency admissions with a hip fracture in both England and Wales between 2004 and 2011. Mortality rates at 30, 90 and 365 days were reported. Logistic regression was used to identify any significant increases in mortality with higher levels of social deprivation and the influence of other risk factors on any increased mortality among the most deprived group. RESULTS: Mortality rates at 30, 90 and 365 days were 9.3, 17.4 and 29.0 % in England and 8.3, 16.1 and 27.9 % in Wales. Social deprivation was significantly associated with increased mortality in the most deprived quintile compared with the least deprived quintile at 30, 90 and 365 days in England (OR = 1.187, 1.185 and 1.154, respectively) and at 90 and 365 days in Wales (1.135 and 1.203). There was a little interaction between deprivation and other risk factors influencing 30- and 365-day mortality except for patient age, pre-fracture residence and hospital size. CONCLUSIONS: We demonstrated a positive association between social deprivation and increased mortality at 30 days post-admission for hip fracture in both England and Wales that was still evident at 90 and 365 days. We found little influence of other factors on social inequalities in mortality risk at 30 and 365 days post-admission.

Review article: the prevalence of Helicobacter pylori and the incidence of gastric cancer across Europe.

BACKGROUND: There is little up-to-date review evidence on the prevalence of Helicobacter pylori across Europe. AIM: To establish regional and national patterns in H. pylori prevalence across Europe. Secondly, to establish trends over time in H. pylori prevalence and gastric cancer incidence and, thirdly, to report on the relationship between H. pylori prevalence and age group across Europe. METHODS: A review of H. pylori prevalence from unselected surveys of adult or general populations across 35 European countries and four European regions since 1990. Secondly, an analysis of trends over time in H. pylori prevalence and in gastric cancer incidence from cancer registry data. RESULTS: Helicobacter pylori prevalence was lower in northern and western Europe than in eastern and southern Europe (P < 0.001). In 11 of 12 European studies that reported on trends, there were sharp reductions in H. pylori prevalence (mean annual reduction = 3.1%). The mean annual reduction in the incidence of gastric cancer across Europe from 1993 to 2007 was 2.1% with little variation regionally across Europe (north 2.2%, west 2.3%, east 1.9% and south 2.0%). Sharp increases in age-related prevalence of H. pylori often levelled off for middle age groups of about 50 years onwards, especially in areas with high prevalence. CONCLUSIONS: This review shows that H. pylori prevalence is much higher in less affluent regions of Europe and that age-related increases in prevalence are confined to younger age groups in some areas. There were sharp reductions in both H. pylori prevalence and gastric cancer incidence throughout Europe.

Fatal accidents and injuries among merchant seafarers worldwide.

BACKGROUND: The British merchant fleet has expanded in recent years but it is not known whether this expansion has led to proportionate changes in mortality. AIMS: To investigate mortality from accidents and injuries in British merchant shipping, to determine whether this has increased in recent years, to compare fatal accident rates across British industries and to review fatal accident rates in merchant shipping worldwide over the last 70 years. METHODS: Examinations of marine accident investigation files, death registers and death inquiry files, national mortality statistics, worldwide surveys and review methodology. The main outcome measure was the fatal accident rate per 100 000 worker-years. RESULTS: Of 66 deaths in British shipping from 2003 to 2012, 49 were caused by accidents, which largely affected deck ratings. The fatal accident rate in British shipping increased by 4.7% per annum from 2003, although this was not significant (95% confidence interval: -5.1 to 15.6%). During 2003-12, the fatal accident rate in shipping (14.5 per 100 000) was 21 times that in the general British workforce, 4.7 times that in the construction industry and 13 times that in manufacturing. Of 20 merchant fleets worldwide with population-based fatal accident rates, most have shown large reductions over time. CONCLUSIONS: The expansion of the British merchant fleet in recent years does not appear to have had a major impact on fatal accidents. Further preventive measures should target fatalities during mooring and towing operations. Internationally, most shipping fleets have over time experienced large decreases in fatal accident rates.

The incidence of acute pancreatitis: impact of social deprivation, alcohol consumption, seasonal and demographic factors.

BACKGROUND: The incidence of acute pancreatitis has increased sharply in many European countries and the USA in recent years. AIM: To establish trends in incidence and mortality for acute pancreatitis in Wales, UK, and to assess how incidence may be linked to factors including social deprivation, seasonal effects and alcohol consumption. METHODS: Use of record linked inpatient, mortality and primary care data for 10,589 hospitalised cases of acute pancreatitis between 1999 and 2010. RESULTS: The incidence of acute pancreatitis was 30.0 per 100,000 population overall, mortality was 6.4% at 60 days. Incidence increased significantly from 27.6 per 100,000 in 1999 to 36.4 in 2010 (average annual increase = 2.7% per year), there was little trend in mortality (0.2% average annual reduction). The largest increases in incidence were among women aged <35 years (7.9% per year) and men aged 35-44 (5.7%) and 45-54 (5.3%). Incidence was 1.9 times higher among the most deprived quintile of patients compared with the most affluent (3.9 times higher for alcoholic acute pancreatitis and 1.5 for gallstone acute pancreatitis). Acute pancreatitis was increased significantly during the Christmas and New Year weeks by 48% (95% CI = 24-77%) for alcoholic aetiology, but not for gallstone aetiology (9%). Alcoholic admissions were increased with higher consumption of spirits and beer, but not wine. CONCLUSIONS: The study shows an elevated rate of alcoholic acute pancreatitis during the Christmas and New Year period. Acute pancreatitis continues to rise, most rapidly for young women, while alcoholic acute pancreatitis is linked strongly with social deprivation.

High-risk occupations for suicide.

BACKGROUND: High occupational suicide rates are often linked to easy occupational access to a method of suicide. This study aimed to compare suicide rates across all occupations in Britain, how they have changed over the past 30 years, and how they may vary by occupational socio-economic group. Method We used national occupational mortality statistics, census-based occupational populations and death inquiry files (for the years 1979-1980, 1982-1983 and 2001-2005). The main outcome measures were suicide rates per 100 000 population, percentage changes over time in suicide rates, standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs). RESULTS: Several occupations with the highest suicide rates (per 100 000 population) during 1979-1980 and 1982-1983, including veterinarians (ranked first), pharmacists (fourth), dentists (sixth), doctors (tenth) and farmers (thirteenth), have easy occupational access to a method of suicide (pharmaceuticals or guns). By 2001-2005, there had been large significant reductions in suicide rates for each of these occupations, so that none ranked in the top 30 occupations. Occupations with significant increases over time in suicide rates were all manual occupations whereas occupations with suicide rates that decreased were mainly professional or non-manual. Variation in suicide rates that was explained by socio-economic group almost doubled over time from 11.4% in 1979-1980 and 1982-1983 to 20.7% in 2001-2005. CONCLUSIONS: Socio-economic forces now seem to be a major determinant of high occupational suicide rates in Britain. As the increases in suicide rates among manual occupations occurred during a period of economic prosperity, carefully targeted suicide prevention initiatives could be beneficial.

Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study.

BACKGROUND: Upper gastrointestinal (GI) bleeding is the most common emergency managed by gastroenterologists. AIM: To establish the hospitalized incidence and case fatality for upper GI bleeding, and to determine how they are associated with factors including day of admission, hospital size, social deprivation and distance from hospital. METHODS: Systematic record linkage of hospital in-patient and mortality data for 24 421 admissions for upper GI bleeding among 22 299 people in Wales from 1999 to 2007. RESULTS: The hospitalized incidence of upper GI bleeding was 134 per 100 000. Case fatality was 10.0%. Incidence was stable from 1999 to 2007; case fatality fell from 11.4% in 1999-2000 to 8.6% in 2006-7. Incidence was associated significantly with social deprivation. Compared with weekday admissions, case fatality was 13% higher for weekend admissions and 41% higher for admissions on public holidays. There was little variation in case fatality according to social deprivation, hospital size or distance from hospital. CONCLUSIONS: Incidence, but not case fatality, was associated significantly with social deprivation. The higher mortality for weekend and public holiday admissions could not be explained by measures of case mix and may indicate a possible impact of reduced staffing levels and delays to endoscopy at weekends in some hospitals.

Perinatal risk factors and coeliac disease in children and young adults: a record linkage study.

BACKGROUND: Little is known about perinatal risk factors and coeliac disease. AIM: To investigate the relationship between perinatal risk factors and subsequent coeliac disease among offspring. METHODS: Record linked abstracts of birth registrations, maternity, in-patient and day case records in a defined population of southern England. RESULTS: Using univariate analysis, coeliac disease in the child was associated with maternal coeliac disease (odds ratio = 20.6; 95% CI = 5.04-84.0; based on two cases in both mother and child) and with social class, year of birth, maternal smoking and parity. Multivariate analysis confirmed an increased risk of coeliac disease of 3.79 (95% CI = 1.85-7.79) for classes IV and V compared with I and II, an increased risk of 1.92 (1.06-3.49) for births during 1975-1979 compared with 1970-1974 and an increased risk of 1.80 (1.05-3.09) for 'subsequent' compared with 'first' births. Smoking during pregnancy was no longer associated with coeliac disease. Because numbers were small, maternal coeliac disease was excluded from the multivariate analysis. CONCLUSIONS: This study shows increased risks of coeliac disease for manual social classes, births during the late 1970s and 'subsequent' births. Overall, perinatal risk factors seem to have a limited role in the aetiology of coeliac disease in children and young adults.

Incidence and case fatality for acute pancreatitis in England: geographical variation, social deprivation, alcohol consumption and aetiology--a record linkage study.

BACKGROUND: Regional studies in the UK indicate that the incidence of acute pancreatitis increased from the 1940s to the 1990s, while case fatality fell until the 1970s but has levelled-off since. AIMS: To establish incidence and case fatality for acute pancreatitis in England from 1998 to 2003, to study geographical variation and recent trends in incidence and to study associations with social deprivation and alcohol consumption. METHODS: Use of national record linkage of in-patient and mortality data for 52 096 people. RESULTS: Overall incidence was 22.4 per 100 000 population, increasing by 3.1% annually, with largest increases for women aged under 35 years (11% per year) and for men aged 35 to 45 (5.6%). Incidence was higher in northern regions than in southern regions and in areas with high social deprivation and binge drinking. Case fatality was 6.7% at 60 days, higher for alcoholic than gallstones aetiology and was associated with social deprivation and geography. CONCLUSIONS: Acute pancreatitis is a growing problem in England, particularly among younger women. The findings indicate strongly that alcohol consumption is the main reason for recent increases in incidence, the higher incidence in socially-deprived areas and for the lack of recent improvement in prognosis.

Perinatal factors associated with subsequent diabetes mellitus in the child: record linkage study.

AIMS: To report on associations between perinatal factors and the subsequent development of diabetes mellitus under the age of 30 years in the offspring. METHODS: Analysis of linked hospital statistical records, comparing perinatal factors relating to the birth of 518 people admitted to hospital for diabetes with the same factors in 292 845 others, in a defined population in southern England from 1963 to 1999. RESULTS: Diabetes mellitus was much more common in children of mothers with diabetes than in others (odds ratio 6.42; 95% confidence interval 4.18-9.86). There was no significant association with birthweight or gestational age separately. Diabetes was more common in those in the highest quintile of 'birthweight for gestational age' compared with the lowest four quintiles combined (odds ratio 1.33; 95% confidence interval 1.08-1.64), but there was no consistent gradient of increasing frequency of diabetes across the lowest four quintiles. There were no significant associations between diabetes and mothers' age, parity, social class, or smoking during pregnancy, or between babies' mode of delivery or any other perinatal factors investigated. All results were similar when the analysis was confined to diabetes in people aged < 15 years. CONCLUSIONS: We found a strong association between diabetes in the child-mainly, if not entirely Type 1 diabetes-and maternal diabetes. Diabetes was slightly more common in the heaviest quintile of birthweight for gestational age than in other quintiles. There were no significant associations between diabetes and the other perinatal factors studied.

Coccygectomy for coccydynia: case series and review of literature.

STUDY DESIGN: This is a case series in which case notes review and telephone interview update were used to assess the outcome following coccygectomy. OBJECTIVE: To correlate the clinical results of coccygectomy with histology and discography of the sacrococcygeal and intercoccygeal segments. SUMMARY OF BACKGROUND DATA: Clinicians regard chronic disabling pain in the sacrococcygeal region with much dismay because of the reputed unpredictability of the treatment outcome. METHODS: A total of 38 patients had coccygectomy for intractable coccydynia, and 31 were available for follow-up. The excised specimen with intact sacrococcygeal joint was sent for histologic examination in 22 patients. There were 6 patients investigated using sacrococcygeal and intercoccygeal discography. RESULTS: Mean postoperative follow-up was 6.75 years (range 2-16). There were 16 patients who benefited highly from the surgery, and 6 benefited to some extent, giving an overall beneficial result of 71%. Of all specimens, 86.3% had histologic changes of degeneration. Moderate-to-severe degenerate changes in sacrococcygeal and intercoccygeal joints on histology were found in 54.5% of patients. Of these patients, 83.3% did well with surgery. Only 57.1% of those patients with mild changes did well. There were 2 patients who had positive discography, and both did well with surgery. Three patients had negative diskographies, and 2 of them had a poor result, and 1 had only some relief. CONCLUSIONS: It is possible that degenerate changes in sacrococcygeal discs and/or intercoccygeal discs are associated with pain. Surgical results are better in those with a severe degree of degenerative change. Coccygectomy remains a successful treatment for a majority of severely disabled patients with coccydynia.

The effect of low-dose ritonavir monotherapy on fasting serum lipid concentrations.

OBJECTIVES: Ritonavir (RTV) at doses of 400 mg twice a day (bid) or higher adversely affects serum lipids. However, the effect of RTV 100 mg bid on serum lipids is unknown. We conducted a study to evaluate the effect of RTV 100 mg bid on fasting serum lipid profiles in HIV-negative healthy volunteers. METHODS: Ritonavir 100 mg bid was administered for 14 days to 20 healthy HIV-seronegative adults with normal serum lipids. After a 7-day washout, lopinavir/ritonavir (LPV/RTV) 400/100 mg bid was administered for 14 days. Fasting serum lipid parameters were measured twice at baseline, after 14 days of RTV, and after 14 days of LPV/RTV, and comparisons were made at each time-point for levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, the total/HDL cholesterol ratio and triglycerides. RESULTS: After 14 days of RTV 100 mg bid, total cholesterol level increased by 10.2% (P<0.001), LDL cholesterol level increased by 16.2% (P<0.001), triglyceride levels increased by 26.5% (P<0.001), HDL cholesterol level decreased by 5.4% (P<0.01) and the total/HDL cholesterol ratio increased by 17.3% (P<0.001). The addition of LPV 400 mg bid to RTV 100 mg bid resulted in no significant further changes in LDL cholesterol or triglyceride level or total/HDL cholesterol ratio, but there were significant increases in both total cholesterol (8.0% increase; P=0.007) and HDL cholesterol levels (6.7% increase; P=0.008). CONCLUSIONS: Ritonavir dosed at 100 mg bid significantly increased the concentration of total cholesterol, LDL cholesterol, total/HDL cholesterol ratio and triglycerides and reduced HDL cholesterol concentration. The addition of LPV 400 mg bid to RTV 100 mg bid further increased both total and HDL cholesterol levels without affecting the total/HDL ratio.