Dysphagia and Satisfaction Following Anterior Cervical Spine Surgery: A Prospective Observation Trial.

STUDY DESIGN: Prospective observation. OBJECTIVE: To assess the effect of dysphagia on patient satisfaction following anterior cervical discectomy and fusion. BACKGROUND: Difficulty with swallowing is a common complaint following anterior cervical spine surgery. The exact impact of this issue on the patient's overall satisfaction is unknown because of its often-transient nature. MATERIALS AND METHODS: A prospective evaluation of all patients from a single surgeon undergoing an anterior cervical spine surgery. Dysphagia was evaluated both preoperatively and postoperatively at set intervals via a combination of 3 validated scoring systems. Mean satisfaction scores at 6 months was evaluated at 6 months via modified CSRS survey. Comparative analysis was performed to determine if there was any relationship between the 2 outcomes. RESULTS: A total of 96.77% (68/71) of enrolled patients completed all of their follow-up surveys. The prevalence of dysphagia was 32.4% at 2 weeks after surgery, 20.6% at 6 weeks, 13.2% at 3 months, and 13.2% at 6 months. In total, 82.35% (56/68) of patients were satisfied with their surgical outcome and only 5.88% (4/68) were dissatisfied with their outcome. There was no relationship between a patient's overall satisfaction level and the presence of dysphagia at any postoperative interval. The absence of neck pain at 6 months was the only significant predictor of patient satisfaction (P=0.003). CONCLUSION: Dysphagia is a common but often transient complaint following anterior cervical spine surgery. Fortunately, its presence does not seem to correlate with a patient's overall satisfaction level following surgery. LEVEL OF EVIDENCE: Level I.

Is living in a region with high groundwater arsenic contamination associated with adverse reproductive health outcomes? An analysis using nationally representative data from India.

BACKGROUND: Exposure to groundwater arsenic via drinking water is common in certain geographies, such as parts of India, and causes a range of negative health effects, potentially including adverse reproductive health outcomes. METHODS: We conducted an ecological analysis of self-reported rates of stillbirth, recurrent pregnancy loss, and infertility in relation to groundwater arsenic levels in India. We used a gridded, modeled dataset of the probability of groundwater arsenic exceeding 10 µg/L (World Health Organization drinking water limit) to calculate mean probabilities at the district level (n = 599 districts). A spatial integration approach was used to merge these estimates with the third India District-Level Health Survey (DLHS-3) conducted in 2007-08 (n = 643,944 women of reproductive age). Maps of district level arsenic levels and rates of each of the three outcomes were created to visualize the patterns across India. To adjust for significant spatial autocorrelation, spatial error models were fit. FINDINGS: District-level analysis showed that the average level of stillbirth was 4.3%, recurrent pregnancy loss was 3.3%, and infertility was 8.1%. The average district-level probability of groundwater arsenic levels exceeding 10 µg/L was 42%. After adjustment for sociodemographic factors, and accounting for spatial dependence, at the district level, for each percentage point increase in predicted arsenic levels exceeding 10 µg/L increased, the rates of stillbirths was 4.5% higher (95% confidence interval (CI) 2.4-6.6, p < 0.0001), the rates of RPL are 4.2% higher (95% CI 2.5-5.9, p < 0.0001), and the rates of infertility are 4.4% higher (95% CI 1.2-7.7, p=<0.0001).). CONCLUSIONS: While arsenic exposure has been implicated with a range of adverse health outcomes, this is one of the first population-level studies to document an association between arsenic and three adverse reproductive pregnancy outcomes. The high levels of spatial correlation suggest that further and targeted efforts to mitigate arsenic in groundwater are needed.

Symptoms of gluten ingestion in patients with non-celiac gluten sensitivity: A randomized clinical trial.

OBJECTIVES: Non-celiac gluten sensitivity (NCGS) is the presence of symptoms induced by gluten and relieved by a gluten-free diet (GFD) in patients without celiac disease or wheat allergy. Studies are mixed as to whether gluten is the main symptom trigger in patients with NCGS. Gluten immunogenic peptides (GIPs) in stool and urine are novel methods to monitor GFD compliance. Few studies have investigated their use in patients with NCGS. The aim of this study was to assess whether patients with NCGS have increased symptoms with gluten ingestion and to assess compliance with the GFD using stool and urine GIPs. METHOD: This was a prospective, randomized, double-blinded crossover trial evaluating symptoms in patients with NCGS. Thirty patients with NCGS and 43 healthy controls were placed on a GFD. Patients received 0.5 or 2 g/d of gluten for 7 d each. The remaining weeks, they received placebo for a total of 4 wk. Symptoms were evaluated weekly using the Celiac Symptom Index (CSI). Urine and stool samples were collected weekly and measured for the detection of GIPs to detect exposure to gluten. RESULTS: There was no difference in symptom severity within the NCGS group whether receiving placebo or gluten (32.69 versus 31.54, P = 0.64). Patients with NCGS had significantly higher CSI scores at baseline than healthy controls. Patients with NCGS were less likely to have stool and urine GIPs than healthy patients. CONCLUSION: Patients with NCGS were more adherent to the GFD based on stool and urine GIP results. Patients with NCGS had increased symptom severity at baseline compared with healthy controls. Neither group had significantly increased symptoms after ingestion of gluten.