Association between Helicobacter pylori and Barrett's esophagus: a case-control study.

OBJECTIVES: The estimated association between Helicobacter pylori and Barrett's esophagus (BE) has been heterogenous across previous studies. In this study, we aimed to examine the association between H. pylori and BE and to identify factors that may explain or modify this association. METHODS: We conducted a case-control study in which we used screening colonoscopy controls recruited from primary care clinics as our primary control group in order to minimize selection bias. All participants underwent an esophagogastroduodenoscopy with gastric mapping biopsies. We used logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the association between H. pylori and BE while controlling for confounders. RESULTS: We identified 218 cases and 439 controls. The overall OR for the association between H. pylori and BE after controlling for age and white race was 0.55 (95% CI: 0.35-0.84). We observed an even stronger inverse association (OR: 0.28; 95% CI: 0.15, 0.50) among participants with corpus atrophy or antisecretory drug use ≥ 1 time per week (factors thought to lower gastric acidity), and no inverse association in patients without these factors (OR: 1.32; 95% CI: 0.66, 2.63). CONCLUSIONS: The association between H. pylori and a decreased risk for BE appears to occur in patients with factors that would likely lower gastric acidity (corpus atrophy or taking antisecretory drugs at least once a week).

Fears and anxiety in children with long-QT syndrome compared to children with asthma.

OBJECTIVE: To compare children with asthma to children with long-QT syndrome (LQTS) in terms of anxiety and medical fears. METHOD: Forty children (25 males/15 females) with asthma and their mothers participated, along with seven children with LQTS (four males/three females) and their mothers. RESULTS: Children with asthma had significantly more medical fears, fear of danger/death, and fear of minor injury and small animals compared to children with LQTS. Children with LQTS tended to have more fear of failure and criticism, and tended to keep their feelings to themselves and minimize their real feelings of anxiety. Children with LQTS had significantly more internalizing problems, and their mothers had significantly higher anxiety. CONCLUSION: Fear and uncertainty can be overwhelming in LQTS. Children with LQTS do not seem to be able to share their feelings openly. Examining the psychosocial adjustment of affected children may assist professionals to help families to cope more effectively.

Postpartum spontaneous coronary dissection presenting with ventricular fibrillation.

BACKGROUND: Spontaneous coronary artery dissection is a rare cause of acute coronary syndromes; and one quarter of these patients present during the post-partum period. Furthermore, ventricular fibrillation is a rare presentation of this disease entity. CASE: A 32-year-old woman presented 3 days post Cesarean-section delivery with chest pain, ischemic electrocardiogram changes, and ventricular fibrillation arrest. The patient was taken for cardiac catheterization and found to have a left anterior coronary artery dissection necessitating 6 stents to restore flow to the vessel. CONCLUSION: We report the first case of survival after ventricular fibrillation arrest of a woman presenting with spontaneous coronary dissection in the post-partum period. Our case underscores the importance of recognizing ventricular fibrillation as a first presenting sign of spontaneous coronary artery dissection in the post-partum period.