RESUMO
BACKGROUND: Fundoplication provides excellent control of gastro-oesophageal reflux disease (GORD), but there remain a number of unsatisfied patients who have proven difficult to identify pre-operatively. We hypothesised that pre-operative symptom patterns can predict of the risk of post-operative dissatisfaction. METHODS: Pre-operative symptoms and post-operative satisfaction were measured using standardised questionnaires along with routine investigations. These data were used to calculate our novel pre-operative risk of dissatisfaction (PROD) score. Potential pre-operative prognostic markers were tested against the post-operative satisfaction data, including the objective investigations and the PROD score. The prognostic utility of the PROD score and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline was tested using receiver operating characteristic analysis to determine the area under the curve (AUC). RESULTS: An association was found between our PROD score and each of the satisfaction measures (n = 225, p < 0.001) which is likely to be of prognostic utility (AUC = 0.67-0.79). No such association was found between the routine investigations and post-operative satisfaction. The PROD score was found to be of greater prognostic utility than the SAGES guideline (n = 166, p < 0.001). CONCLUSIONS: The PROD score is a novel, easy-to-use test that can predict individual patient satisfaction with fundoplication.
Assuntos
Fundoplicatura/estatística & dados numéricos , Refluxo Gastroesofágico/cirurgia , Modelos Estatísticos , Satisfação do Paciente/estatística & dados numéricos , Avaliação de Sintomas , Área Sob a Curva , Feminino , Humanos , Masculino , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Curva ROC , Fatores de Risco , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Epidemiological studies and case reports provide evidence for an association between Parkinson's disease and past exposure to pesticides. Susceptibility to the effects of pesticides and other putative neurotoxins depends on variability in xenobiotic metabolism possibly generated by genetic polymorphisms, aging and variation in exposure to environmental agents including pesticides. The simplest mechanistic hypothesis for the association of pesticides with Parkinson's disease is that pesticides or their metabolites are directly toxic to mitochondria, although modulation of xenobiotic metabolism by pesticides provides an adjunct or alternative hypothesis.