Stage of colorectal cancer diagnosis for immigrants: a population-based retrospective cohort study in Ontario, Canada.

BACKGROUND: Colorectal cancer (CRC) is the second most common cause of cancer death in Canada. Immigrants in Ontario, Canada's most populous province, are known to have lower rates of CRC screening, but differences in stage of CRC diagnosis are not known. METHODS: We utilized linked administrative databases to compare early (stage I-II) versus late (stage III-IV) stage of CRC diagnosis for immigrants versus long-term residents among patients diagnosed in Ontario between 2012 and 2017 (n = 37,717) and examined the association of immigration-related, sociodemographic, and healthcare-related factors with stage. RESULTS: Almost 45% of those with CRC were diagnosed at a late stage. Immigrants were slightly more likely to be diagnosed at a late stage than their long-term resident counterparts [Adjusted relative risks (ARRs) 1.06 (95% CI 1.02-1.10)], but after adjusting for age and sex, this difference was no longer significant. In fully adjusted models, we observed a higher likelihood of late-stage diagnosis for people with the fewest co-morbidities (ARR 0.86 [95% CI 0.83-0.89]) and those with no visits to primary care (versus a high level of continuity of care) [ARR 1.07 (95% CI 1.03-1.12)]. CONCLUSION: Immigrants were not more likely to have a late-stage CRC diagnosis after adjusting for relevant factors, but access to primary care and healthcare contact was significantly associated with diagnostic stage. IMPACT: Attachment to a primary care provider who provides regular preventive care may play a role in more favorable stage at diagnosis for CRC and thus should be a healthcare system priority.

HPV sampling options for cervical cancer screening: preferences of urban-dwelling Canadians in a changing paradigm.

Introduction: Of women in Canada diagnosed with invasive cervical cancer, 50% have not been screened according to guidelines. Interventions involving self-collected samples for human papillomavirus (hpv) screening could be an avenue to increase uptake. To guide the development of cervical cancer screening interventions, we assessed ■ preferred sample collection options,■ sampling preferences according to previous screening behaviours, and■ preference for self-sampling among women not screened according to guidelines, as a function of their reasons for not being screened. Methods: Data were collected in an online survey (Montreal, Quebec; 2016) and included information from female participants between the ages of 21 and 65 years who had not undergone hysterectomy and who had provided answers to survey questions about screening history, screening interval, and screening preferences (n = 526, weighted n = 574,392). Results: In weighted analyses, 68% of all women surveyed and 82% of women not recently screened preferred screening by self-sampling. Among women born outside of Canada, the United States, or Europe, preference ranged from 47% to 60%. Nearly all women (95%-100%) who reported fear or embarrassment, dislike of undergoing a Pap test, or lack of time or geography-related availability of screening as one of their reasons for not being screened stated a preference for undergoing screening by self-sampling. Conclusions: The results demonstrate a strong preference for self-sampling among never-screened and not-recently-screened women, and provides initial evidence for policymakers and researchers to address how best to integrate self-sampling hpv screening into both organized and opportunistic screening contexts.

Visual Outcomes Following Intravitreal Ranibizumab for Diabetic Macular Edema in a Pro Re Nata Protocol from Baseline: A Real-World Experience.

PURPOSE: To investigate long-term outcomes of pro re nata (PRN) treatment protocol of ranibizumab for diabetic macular edema (DME) adopted from the first month of therapy without 3 loading doses. DESIGN: Retrospective interventional study. METHODS: We analyzed 180 eyes of 144 patients treated with ranibizumab for DME with a minimum follow-up of 1 year during December 2013 to December 2017. Data of all patients with treatment-naive center-involving DME who received at least 1 intravitreal injection of ranibizumab during the study period were drawn from a locally adapted electronic form for DME. The primary outcome measure was change in best-corrected visual acuity (BCVA) from baseline at 1-year follow-up, with intergroup comparisons in BCVA between eyes receiving 1, 2, and 3 injections in the first 3 months of treatment. RESULTS: The mean baseline BCVA was 0.47 ± 0.30 logMAR, which improved to 0.38 ± 0.3 logMAR (P = 0.003) at 3 months and stabilized at 0.35 ± 0.27 logMAR at 1 year (P = 0.46 vs BCVA at 3 months) and 0.34 ± 0.26 logMAR at 2 years of follow-up (P = 0.44 vs BCVA at 3 months). At 3 months, 24 eyes (13%) underwent 1 intravitreal injection, 52 eyes (29%) had 2 injections, and the majority (n = 104 eyes, 58%) had 3 injections on a monthly basis. During the first year, the group that received only 1 injection in the first 3 months also required fewer injections and fewer follow-up visits compared with those receiving 2 or 3 injections in the first 3 months. CONCLUSIONS: One-third of eyes with DME responded well to PRN treatment strategy from the first month without 3 loading doses of ranibizumab. Baseline visual acuity is the best predictor of vision at 1 and 2 years of follow-up.

Area-level income disparities in colorectal screening in Canada: evidence to inform future surveillance.

Background: Participation in colorectal screening remains low even in countries with universal health coverage. Area-level determinants of low screening participation in Canada remain poorly understood. Methods: We assessed the association between area-level income and two indicators of colorectal screening (having never been screened, having not been screened recently) by linking census-derived local area-level income data with self-reported screening data from urban-dwelling respondents to the Canadian Community Health Survey (50-75 years of age, cycles 2005 and 2007, n = 18,362) who reported no known risk factors for colorectal cancer. Generalized estimating equation Poisson models estimated the prevalence ratios and differences for having never been screened and having not been screened recently, adjusting for individual-level income, education, marital status, having a regular physician, age, and sex. Results: About 53% of the study population had never been screened. Among individuals who had ever been screened, 35% had been screened recently. Adjusting for covariates, lower area-level income was associated with having never been screened [covariate-adjusted prevalence ratios: 1.24 for quartile 1; 95% confidence limits (cl): 1.16, 1.34; 1.25 for quartile 2; 95% cl: 1.15, 1.33; 1.15 for quartile 3; 95% cl: 1.08, 1.23]. Among individuals who had been screened in their lifetime, area-level income was not associated with having not been screened recently. Conclusions: Lower area-level income is associated with having never been screened for colorectal cancer even after adjusting for individual socioeconomic factors. Those findings highlight the potential importance of socioeconomic contexts for colorectal screening initiation and merit attention in both future research and surveillance efforts.

School food environments associated with adiposity in Canadian children.

BACKGROUND/OBJECTIVES: Targeting obesogenic features of children's environment that are amenable to change represents a promising strategy for health promotion. The school food environment, defined as the services and policies regarding nutrition and the availability of food in the school and surrounding neighborhood, is particularly important given that students travel through the school neighborhood almost daily and that they consume a substantial proportion of their calories at school. SUBJECTS/METHODS: As part of the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) cohort study, we assessed features of school indoor dietary environment and the surrounding school neighborhoods, when children were aged 8-10 years (2005-2008). School principals reported on food practices and policies within the schools. The density of convenience stores and fast-food outlets surrounding the school was computed using a Geographical Information System. Indicators of school neighborhood deprivation were derived from census data. Adiposity outcomes were measured in a clinical setting 2 years later, when participants were aged 10-12 years (2008-2011). We conducted cluster analyses to identify school food environment types. Associations between school types and adiposity were estimated in linear regression models. RESULTS: Cluster analysis identified three school types with distinct food environments. Schools were characterized as: overall healthful (45%); a healthful food environment in the surrounding neighborhood, but an unhealthful indoor food environment (22%); or overall unhealthful (33%). Less healthful schools were located in more deprived neighborhoods and were associated with greater child adiposity. CONCLUSIONS: Despite regulatory efforts to improve school food environments, there is substantial inequity in dietary environments across schools. Ensuring healthful indoor and outdoor food environments across schools should be included in comprehensive efforts to reduce obesity-related health disparities.

Disruption of cellular homeostasis induces organelle stress and triggers apoptosis like cell-death pathways in malaria parasite.

A regulated protein turnover machinery in the cell is essential for effective cellular homeostasis; any interference with this system induces cellular stress and alters the normal functioning of proteins important for cell survival. In this study, we show that persistent cellular stress and organelle dysfunction because of disruption of cellular homeostasis in human malaria parasite Plasmodium falciparum, leads to apoptosis-like cell death. Quantitative global proteomic analysis of the stressed parasites before onset of cell death, showed upregulation of a number of proteins involved in cellular homeostasis; protein network analyses identified upregulated metabolic pathways that may be associated with stress tolerance and pro-survival mechanism. However, persistent stress on parasites cause structural abnormalities in endoplasmic reticulum and mitochondria, subsequently a cascade of reactions are initiated in parasites including rise in cytosolic calcium levels, loss of mitochondrial membrane potential and activation of VAD-FMK-binding proteases. We further show that activation of VAD-FMK-binding proteases in the parasites leads to degradation of phylogenetically conserved protein, TSN (Tudor staphylococcal nuclease), a known target of metacaspases, as well as degradation of other components of spliceosomal complex. Loss of spliceosomal machinery impairs the mRNA splicing, leading to accumulation of unprocessed RNAs in the parasite and thus dysregulate vital cellular functions, which in turn leads to execution of apoptosis-like cell death. Our results establish one of the possible mechanisms of instigation of cell death by organelle stress in Plasmodium.

Custom-made rotating hinge total knee replacement in a patient with congenital tibial deficiency avoids the need for amputation.

We report a unique case of a patient with type 2 congenital tibial deficiency and disabling knee osteoarthritis in whom a custom-made rotating hinge knee replacement was successfully performed, allowing continued mobilisation with a below-knee prosthesis, thereby avoiding the need for an above-knee amputation. Level of evidence Therapeutic study, Level IV.

Nine years' review on preseptal and orbital cellulitis and emergence of community-acquired methicillin-resistant Staphylococus aureus in a tertiary hospital in India.

CONTEXT: Preseptal cellulitis is the commonest orbital disease which frequently needs to be differentiated from orbital cellulitis. Prompt diagnosis and treatment with appropriate antibiotics can prevent vision loss and life-threatening complications of orbital cellulitis. AIMS: To describe the clinical profile of cases with preseptal and orbital cellulitis admitted to a tertiary care hospital during a period of nine years. The causative organisms and the clinical outcome were analyzed. SETTINGS AND DESIGN: Retrospective descriptive case study done in a tertiary care hospital in South India. MATERIAL AND METHODS: The in-patient records of patients with preseptal and orbital cellulitis were reviewed from 1998 to 2006. The factors reviewed included ocular findings aiding in the distinction of the two clinical conditions, the duration of symptoms, the duration of hospital stay, microbiological culture report of pus or wound swab, blood culture, drugs used for treatment, the response to therapy and complications. STATISTICAL ANALYSIS USED: Descriptive analysis. RESULTS: One hundred and ten cases, 77 patients with preseptal cellulitis and 33 patients with orbital cellulitis were reviewed. Five percent of children and 21% of adults presented with cutaneous anthrax contributing to preseptal cellulitis. Thirty-nine percent cases with orbital cellulitis were caused by methicillin-resistant Staphylococcus aureus (MRSA). CONCLUSIONS: This study has helped in identifying organisms which cause orbital infections, especially community-acquired MRSA. It indicates the need for modifying our empirical antimicrobial therapy, especially in orbital cellulitis.

Bilateral versus unilateral cochlear implantation in young children.

OBJECTIVES: To compare the preverbal communication skills of two groups of young implanted children: those with unilateral implantation and those with bilateral implantation. MATERIAL AND METHODS: The study assessed 69 children: 42 unilaterally and 27 bilaterally implanted with age at implantation less than 3 years. The preverbal skills of these children were measured before and 1 year after implantation, using Tait Video Analysis that has been found able to predict later speech outcomes in young implanted children. RESULTS: Before implantation there was no significant difference between the unilateral group and the bilateral group. There was still no difference at 12 months following implantation where vocal autonomy is concerned, but a strongly significant difference between the groups for vocal turn-taking and non-looking vocal turns, the bilateral group outperforming the unilateral group. Regarding gestural turn-taking and gestural autonomy, there was a strongly significant difference between the two groups at the 12 month interval, and also a difference before implantation for gestural autonomy, the unilateral group having the higher scores. Multiple regression of non-looking vocal turns revealed that 1 year following implantation, bilateral implantation contributed to 51% of the variance (p<0.0001), after controlling for the influence of age at implantation and length of deafness which did not reach statistical significance. CONCLUSIONS: Profoundly deaf bilaterally implanted children are significantly more likely to use vocalisation to communicate, and to use audition when interacting vocally with an adult, compared with unilaterally implanted children. These results are independent of age at implantation and length of deafness.

Surgical site infection rate is lower in laparoscopic than open colorectal surgery.

OBJECTIVE: Few studies have investigated whether surgical site infection (SSI) incidence differs between laparoscopic colorectal surgery (LCS) and open colorectal surgery (OCS). This study investigated the SSI incidence using the validated UK SSI Surveillance Service (SSISS) criteria for diagnosing wound infections. METHOD: Prospective data collection recorded patients' demographics, operative details, antibiotic use, wound evaluation and microbiological wound culture results, for consecutive patients undergoing elective resectional LCS and OCS. Postdischarge surveillance consisted of patient questionnaires sent out at 30 days and the primary care communication. RESULTS: A total of 122 patients underwent colorectal resections over 1 year (LCS 43; OCS 79). Patients' demographics and operative case-mix were similar for both groups, including body mass index (BMI), diabetic and smoking status. Operative duration was longer in the LCS group compared with OCS group (P = 0.012, Mann-Whitney U-test), but hospital stay was shorter for LCS (P = 0.0001, Mann-Whitney U-test). The SSI rate was significantly lower in the LCS than OCS group (7%vs 25% respectively; P = 0.015, two-tailed Fisher's exact test). BMI > 30 and operation length > 4 h influenced the risk of SSI formation (P < 0.05, chi-squared test). One LCS patient required conversion to a limited laparotomy. CONCLUSIONS: Surgical site infection incidence is significantly lower following LCS when compared with OCS. Confounding factors in this study include patient selection for LCS and nonrandomization.

Janibacter hoylei sp. nov., Bacillus isronensis sp. nov. and Bacillus aryabhattai sp. nov., isolated from cryotubes used for collecting air from the upper atmosphere.

Three novel bacterial strains, PVAS-1(T), B3W22(T) and B8W22(T), were isolated from cryotubes used to collect air samples at altitudes of between 27 and 41 km. Based on phenotypic characteristics, chemotaxonomic features, DNA-DNA hybridization with the nearest phylogenetic neighbours and phylogenetic analysis based on partial 16S rRNA gene sequences (PVAS-1(T), 1196 nt; B3W22(T), 1541 nt; B8W22(T), 1533 nt), the three strains were identified as representing novel species, and the names proposed are Janibacter hoylei sp. nov. (type strain PVAS-1(T) =MTCC 8307(T) =DSM 21601(T) =CCUG 56714(T)), Bacillus isronensis sp. nov. (type strain B3W22(T) =MTCC 7902(T) =JCM 13838(T)) and Bacillus aryabhattai sp. nov. (type strain B8W22(T) =MTCC 7755(T) =JCM 13839(T)).

Marital status and survival following bladder cancer.

BACKGROUND: Marital status has been implicated as a prognostic factor in bladder cancer survival. However, few studies have explored potential mechanisms through which this might occur. METHODS: The study identified 19,982 bladder cancer patients from the SEER-Medicare database (1992-8) and constructed sex-specific Cox proportional hazard models to assess the relation between marital status and 5-year survival, while sequentially adding covariates to test possible mechanisms. RESULTS: Multivariable Cox analyses suggest that at every stage, married men had better survival than unmarried men independent of age, race, ecologic socioeconomic status, comorbidities, any or aggressive treatment (assessed separately), and accessing a teaching hospital (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.74 to 0.87). Among women with stages II-IV bladder cancer, age and the presence of comorbid conditions explained the association between marital status and survival. However, among those diagnosed with stage I bladder cancer, none of the covariates explained the association between marital status and decreased mortality (fully adjusted HR 0.72; 95% CI 0.62 to 0.84). CONCLUSION: The lack of evidence of mediation through treatment, overall health, SES, or quality of healthcare institution among married men and women with stage I disease suggests they may be benefiting from something other than these factors, perhaps practical or social support.

Using self-rated health for analysing social inequalities in health: a risk for underestimating the gap between socioeconomic groups?

BACKGROUND: The use of self-rated health (SRH) for measuring health inequalities could present some limits. The impact of the same disease on SRH could be different according to health expectations people have which are associated with social characteristics. The aim of this study was to analyse the link between physical health status and SRH, according to level of education. METHOD: Data from the National Health and Nutrition Examination Survey for the years 2001-4 were used. Multivariate logistic regression analyses were performed for assessing the relation between health status and SRH according to educational level. RESULTS: The sample consisted of 4661 men and 4593 women. Reporting functional limitation was associated more strongly with poor SRH in higher educated women than in lower educated women (OR, 8.73, 95% CI 5.87 to 12.98 vs OR, 3.97, 95% CI 2.93 to 5.38 respectively), as was reporting respiratory disease (OR, 5.17, 95% CI 3.67 to 7.30 vs OR, 2.60, 95% CI 1.72 to 3.95 respectively), cardiovascular disease (OR, 9.79, 95% CI 6.22 to 15.40 vs OR, 3.34, 95% CI 2.29 to 4.87 respectively) and dental problems (OR, 4.37, 95% CI 3.22 to 5.92 vs OR, 2.58, 95% CI 1.97 to 3.39 respectively). Reporting functional limitation was associated more strongly with poor SRH in higher educated men than in lower educated men (OR, 7.71, 95% CI 5.04 to 11.79 vs OR, 4.87, 95% CI 3.30 to 7.18 respectively), as reporting oral problems (OR, 2.62, 95% CI 1.84 to 3.74 vs OR, 3.63, 95% CI 2.81 to 4.68 respectively). CONCLUSIONS: The impact of health problems on SRH is stronger among better educated individuals. This phenomenon could lead to an underestimate of the health inequalities across socioeconomic groups.

Limb contouring after massive weight loss: functional rather than aesthetic improvement.

BACKGROUND: After massive weight loss, both upper and lower limbs show a similar deformity which consists of redundancy and ptosis of the cutaneous mantle. Many disturbances are associated with this abnormality, which can be treated surgically. A retrospective review of limb-contouring procedures after massive weight loss is presented. METHODS: Thigh lift and arm lift procedures are described. All surgeries of upper and lower limbs contouring performed between 2003 and 2006 are reviewed with regard to quantity of tissue removed, comorbidities, complications and patients' satisfaction, which was surveyed through a questionnaire exploring functional and esthetic results (maximum score 3). RESULTS: Among 48 bilateral limb-contouring procedures, medial thigh lifts were 35 (73%) and brachioplasties were 13 (27%). Mean age was 46 and average body mass index variation was 20 kg/m(2). The most frequent comorbidity was gallstones (28%). In 46% of the whole group of patients, there was no complication to mention. The most frequent complication was acute anaemia in both procedures (43% in thigh lift and 54% in arm lift). Mean quantity of adipose-dermoid tissue removed was 766 g in thigh lift and 463 g in arm lift. In case of surgery combined with liposuction, the average aspirated volume was 1,933 ml (thighs) and 1,117 ml (arms). Patients' satisfaction was 2.7 for thighs and 2.6 for arms, as average. CONCLUSION: The rate of complications in limb contouring after weight loss is higher than the analogue esthetic procedures. Nevertheless, due to the rehabilitative significance of limb surgery after weight loss, this step is to be included as fundamental in obese patients' surgical therapy.

Chest wall and hemidiaphragm reconstruction with Gore-Tex mesh and omolateral latissimus dorsi flap. A case report.

There are various method of reconstruction when chest wall resection is performed for the treatment of tumors of the chest wall. In this case a chest wall resection and reconstruction was performed using an omolateral latissimus dorsi flap, together with Gore-Tex mesh. A 42-year-old woman was diagnosed as having a huge low grade chondrosarcoma and underwent surgical resection which interested the anterior chest wall from the level of the IV to X rib and the right hemidiaphragm. Gore-Tex mesh was fixed to the residual chest wall and an ipsilateral pedicled latissimus dorsi muscle flap was placed on the alloplastic mesh. The patient was discharged from the hospital 17 days postoperatively. The postoperative course was uneventful and the wound was fine.