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1.
Ann Hematol ; 100(4): 921-931, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33586016

RESUMO

Alpha thalassemia and beta-globin haplotype are considered classical genetic disease modifiers in sickle cell anemia (SCA) causing clinical heterogeneity. Nevertheless, their functional impact on SCA disease emergence and progression remains elusive. To better understand the role of alpha thalassemia and beta-globin haplotype in SCA, we performed a retrospective study evaluating the clinical manifestations of 614 patients. The univariate analysis showed that the presence of alpha-thalassemia -3.7-kb mutation (αα/-α and -α/-α) decreased the risk of stroke development (p = 0.046), priapism (p = 0.033), and cholelithiasis (p = 0.021). Furthermore, the cumulative incidence of stroke (p = 0.023) and cholelithiasis (p = 0.006) was also significantly lower for patients carrying the alpha thalassemia -3.7-kb mutation. No clinical effects were associated with the beta-globin haplotype analysis, which could be explained by the relatively homogeneous haplotype composition in our cohort. Our results reinforce that alpha thalassemia can provide protective functions against hemolysis-related symptoms in SCA. Although, several genetic modifiers can impact the inflammatory state of SCA patients, the alpha thalassemia mutation remains one of the most recurrent genetic aberration and should therefore always be considered first.


Assuntos
Anemia Falciforme/complicações , Talassemia alfa/complicações , Globinas beta/genética , Adolescente , Adulto , Idoso , Anemia Falciforme/sangue , Anemia Falciforme/genética , Arteriopatias Oclusivas/epidemiologia , Arteriopatias Oclusivas/etiologia , Brasil/epidemiologia , Criança , Colelitíase/epidemiologia , Colelitíase/etiologia , Feminino , Hemoglobina Fetal/análise , Seguimentos , Haplótipos/genética , Hemólise , Humanos , Úlcera da Perna/epidemiologia , Úlcera da Perna/etiologia , Masculino , Mutação , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Adulto Jovem , Talassemia alfa/sangue , Talassemia alfa/genética
2.
Postgrad Med ; 133(3): 357-361, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33337258

RESUMO

Objectives: Despite the high prevalence of gallstone disease (GSD), the shared risk factors of GSD and osteoporosis, and the known association between hip fracture and hepatobiliary diseases, the association between hip fracture and GSD is not currently clear. Therefore, we performed a nationwide population-based study to investigate the association between GSD and hip fracture to determine the impact of cholecystectomy on the risk of fracture.Methods: In this study, we assessed all subjects in the longitudinal health insurance database (LHID) between 2000 and 2011, excluding those subjects aged >20 years old and those with a previous history of hip fracture (ICD-9-CM 820). Among those that were included, subjects with at least two or more outpatient visits or with one record of hospitalization under the coding of GSD (ICD-9-CM code: 574) were allocated to the GSD cohort. The remaining subjects were designated to the control cohort. All participants were followed till the onset of hip fracture, withdrawal from the NHI, or the end of 2013.Results: We found that the cumulative incidence of hip fracture was higher in the GSD cohort than in the control cohort (log-rank test: p-value < 0.01). After adjustment, the GSD patients had a 1.21-fold risk of hip fracture compared to control subjects (aHR = 1.21, 95% CI = 1.21-1.30). Comparison between those subjects without GSD and those without cholecystectomy revealed that the risk of hip fracture was higher among GSD patients that had not undergone cholecystectomy (aHR = 1.17, 95% CI = 1.06-1.29) or those that had undergone cholecystectomy (aHR = 1.22, 95% CI = 1.06-1.41).Conclusion: Based upon these results, we concluded that GSD was associated with an increased risk of hip fracture regardless of whether the patient had undergone cholecystectomy.


Assuntos
Colecistectomia/estatística & dados numéricos , Colelitíase/epidemiologia , Colelitíase/cirurgia , Fraturas do Quadril/epidemiologia , Adolescente , Corticosteroides/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Inibidores da Bomba de Prótons/administração & dosagem , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
3.
Magy Seb ; 73(2): 49-56, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32609630

RESUMO

Biliary injury is a rare but a very serious complication of laparoscopic cholecystectomy (LC). Our aim was to analyse the incidence of the biliary injuries and its therapeutic outcome on patients who underwent LC or converted LC. Our research was conducted at the 1st Department of Surgery, Semmelweis University, Budapest between 2006 and 2016, retrospectively. We analysed the LCs and converted LCs performed at our Department and as well as cases where the primary operations were conducted at other institutions but they were unable to provide the adequate therapy for the injury, thus the patients were transferred to our institution. At the 1st Department of Surgery complications occurred in 0,66% (30/4885) of all LCs. 327 converted LCs were done, complications occurred in 26 (7.95%) times. 22 patients were transferred to the 1st Department of Surgery from other institutions. Bilio-vascular injuries occurred in 61% (41/78). ERCP was performed in 25 cases with a 92% success rate. Reoperation was needed in 41% (28/41). Biliary reconstruction during the reoperation was performed via hepaticojejunostomy in 82% of all reoperations. The therapeutic solutions of LC's complications are complex. Therefore, the treatment is recommended only in institutions with appropriate experience.


Assuntos
Ductos Biliares/lesões , Sistema Biliar/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colelitíase/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Adulto , Colecistectomia Laparoscópica/estatística & dados numéricos , Colelitíase/epidemiologia , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
4.
Ann Hematol ; 99(9): 2019-2026, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32676731

RESUMO

Hyperbilirubinemia and pigment gallstones are frequent complications in transfusion-dependent ß-thalassemia (TDßT) patients. Bilirubin production and clearance are determined by genetic as well as environmental variables like ineffective erythropoiesis, hemolysis, infection-induced hepatic injury, and drug- or iron-related toxicities. We studied the frequency of the Gilbert syndrome (GS), a common hereditary cause of hyperbilirubinemia in 102 TDßT patients aged 13-43 years (median 26 years). Total and unconjugated hyperbilirubinemia were frequent (81.4% and 84.3% patients respectively). Twenty (19.6%) patients showed total bilirubin > 3.0 mg/dL; 53 (51.9%) had an elevation of either alanine or aspartate aminotransferase, or alkaline phosphatase liver enzymes. Nineteen (18.6% of the 92 tested) were positive for hepatitis B or C, or HIV. The mean total and unconjugated bilirubin levels and AST, ALT, and ALP levels in patients positive for hepatitis B or C were not significantly different from negative cases. Eighteen patients (17.7%) had GS: homozygous (TA)7/7 UGT1A1 promoter motif (the *28/*28 genotype), 48 (47.1%) were heterozygous (TA)6/7. Total + unconjugated bilirubin rose significantly with the (TA)7 allele dose. Fourteen (13.7%) patients had gallstones. There was no significant difference in total/unconjugated bilirubin in patients with/without gallstones and no significant differences in frequencies of gallstones within the three UGT1A1 genotypes. This largest study in Indian TDßT patients suggests that GS should be excluded in TDßT cases where jaundice remains unexplained after treatable causes like infections, chelator toxicity, or transfusion-related hemolysis are excluded. GS was not associated with gallstones, possibly due to a lower incidence of cholelithiasis overall, a younger age cohort, or other environmental factors.


Assuntos
Grupo com Ancestrais do Continente Asiático , Colelitíase/epidemiologia , Doença de Gilbert/epidemiologia , Glucuronosiltransferase , Hiperbilirrubinemia/epidemiologia , Talassemia beta/epidemiologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Transfusão de Sangue/tendências , Colelitíase/genética , Feminino , Doença de Gilbert/genética , Glucuronosiltransferase/genética , Humanos , Hiperbilirrubinemia/genética , Índia/epidemiologia , Masculino , Estudos Prospectivos , Adulto Jovem , Talassemia beta/genética , Talassemia beta/terapia
5.
Curr Gastroenterol Rep ; 22(6): 30, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32383039

RESUMO

PURPOSE OF REVIEW: Hepatolithiasis is a disease characterized by intrahepatic stone formation. In this article, we review the features of this disease and explore the established and emerging treatment modalities. RECENT FINDINGS: Recent reports show an increasing prevalence of hepatolithiasis, likely owed to increased immigration and shifts in the Western diet. New pharmacotherapy options are limited and are often only supportive. Endoscopic intervention still cruxes on removal of impacted stones, though new techniques such as bile duct exploratory lithotomy and lithotripsy continue to advance management. Although hepatectomy of the effected portion of the liver offers definitive therapy, alternative less invasive modalities such as combined endoscopic/interventional radiology modalities have been utilized in select patients. Additionally, liver transplant serves as an option for otherwise incurable hepatolithiasis with coexisting liver dysfunction. Multiple emerging pharmacologic and procedural interventions may provide novel treatment for hepatolithiasis. While definitive therapy remains resection of affected liver segments, these modalities offer hope for less invasive approaches in the future.


Assuntos
Colelitíase/terapia , Hepatopatias/terapia , Ductos Biliares Intra-Hepáticos , Colelitíase/epidemiologia , Colelitíase/etiologia , Humanos , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Prognóstico , Resultado do Tratamento
6.
Acta Chir Belg ; 120(1): 35-41, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30618322

RESUMO

Background: Prophylactic cholecystectomy has been proposed as a concomitant procedure during upper gastrointestinal surgery. This study evaluates the safety and the need of concurrent cholecystectomy during esophagectomy for cancer.Methods: All consecutive esophagectomies for esophageal cancer at the Center for Esophageal Diseases in Padova (Italy) between 1992 and 2011 were included. The safety of concurrent cholecystectomy was evaluated by surgical outcomes (length of stay, postoperative mortality and perioperative complications). The need for concurrent cholecystectomy was evaluated by occurrence of biliary duct stones and of cholelithiasis/cholecystitis after esophagectomy.Results: Cholecystectomy was performed during 67 out of 1087 esophagectomies (6.2%). Cirrhosis or chronic liver disease was associated with receiving cholecystectomy during esophagectomy (OR: 1.99, 95%C.I. 1.10-3.56). Patients receiving and those not receiving cholecystectomy showed similar length of stay (median 14 days, p = .87), postoperative mortality (3.0% vs. 2.5%, p = .68), intraoperative complication (4.5% vs. 7.1%, p = .62), early complications (52.2% vs. 44.6%, p = .25) and late complications (20.9% vs. 24.8%, p = .56). Cholelithiasis/cholecystitis after esophagectomy occurred in 61 (6.1%) patients, with only four requiring cholecystectomy during follow-up. The biliary stone occurrence was nil. Only pathologic stage III-IV (OR: 2.17, 95%C.I. 1.19-3.96) was associated with cholelithiasis/cholecystitis after esophagectomy.Conclusion: Routine prophylactic cholecystectomy during esophagectomy could be safe but unnecessary.


Assuntos
Carcinoma/cirurgia , Colecistectomia , Colelitíase/epidemiologia , Colelitíase/prevenção & controle , Neoplasias Esofágicas/cirurgia , Esofagectomia , Idoso , Carcinoma/complicações , Carcinoma/patologia , Colelitíase/diagnóstico , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Feminino , Humanos , Itália , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Rev Med Chil ; 148(10): 1398-1405, 2020 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-33844709

RESUMO

BACKGROUND: The prevalence of cholelithiasis and gallbladder cancer may be different across ethnic groups. AIM: To study the prevalence of cholelithiasis and gallbladder cancer among Aymara individuals. MATERIAL AND METHODS: An abdominal ultrasound was carried out in a sample of 182 Aymara women aged 46 ± 16 years and 76 Aymara men aged 55 ± 16 years. In addition, the histopathological reports of both patients with a history of previous cholecystectomy and those operated after the study were reviewed. RESULTS: Ultrasound was normal in 150 participants (58%), 76 had cholelithiasis (30%) and 32 (12%) had a history of cholecystectomy. Pathological reports of the excised gallbladder were available for 106 cases and showed a chronic cholecystitis in 98% of cases. Gallbladder cancer was not reported. CONCLUSIONS: There is a 42% prevalence of cholelithiasis and no gallbladder cancer in this sample of Aymara population.


Assuntos
Colecistite , Colelitíase , Neoplasias da Vesícula Biliar , Adulto , Idoso , Colecistectomia , Colecistite/cirurgia , Colelitíase/diagnóstico por imagem , Colelitíase/epidemiologia , Colelitíase/cirurgia , Feminino , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
8.
Physiol Res ; 68(Suppl 2): S173-S182, 2019 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-31842581

RESUMO

Cholelithiasis is more common in patients with Crohn's disease (CD) than in the healthy population. The aim here was to examine risk factors for cholelithiasis in a cohort of CD patients and to compare the prevalence of cholelithiasis in a cohort of CD patients with that in a control group. This was a single-center retrospective case-control study. The cohort comprised all consecutive CD patients who underwent abdominal ultrasound from January 2007 to January 2018. The control group comprised age- and gender-matched non-CD patients referred for upper gastrointestinal tract dyspepsia. The study included 238 CD patients and 238 controls. The prevalence of cholelithiasis in the CD and control groups was 12.6 % and 9.2 %, respectively (risk ratio (RR), 1.36; p=0.24). Univariate analysis revealed that cholelithiasis was associated with multiple risk factors. Multivariate analysis identified age (OR, 1.077; 95 % CI, 1.043-1.112; p<0.001) and receipt of parenteral nutrition (OR, 1.812; 95 % CI, 1.131-2.903; p=0.013) as independent risk factors for cholelithiasis in CD patients. The prevalence of cholelithiasis in CD patients was higher than that in the control group; however, the difference was not statistically significant. Age and receipt of parenteral nutrition were independent risk factors for cholelithiasis in CD patients.


Assuntos
Colelitíase/epidemiologia , Doença de Crohn/complicações , Adulto , Colelitíase/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Eslováquia/epidemiologia
9.
J Helminthol ; 94: e107, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31779732

RESUMO

The association between eosinophil count and cholelithiasis among people with Clonorchis sinensis infection is still uncertain. We conducted a cross-sectional study to investigate the associations among Clonorchis sinensis infection, eosinophil count and cholelithiasis. The study included 4628 participants from January to December 2018. The levels of eosinophil count were divided into four groups according to the quartiles of eosinophil count. Spearman's rank correlation was performed to assess the association between eosinophil counts and Clonorchis sinensis egg counts. Multiple regression analysis was performed to evaluate the relationships among C. sinensis infection, eosinophil count and cholelithiasis after adjusting for three models. The prevalence of C. sinensis infection was 38.72% (1792/4628), and the prevalence of cholelithiasis was 6.03% (279/4628). The infection rate of C. sinensis was higher in the cholelithiasis group than in the non-cholelithiasis group (63.08% vs. 37.16%, P < 0.001). Significant differences were found among various eosinophil count quartiles for C. sinensis infection, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltranspeptidase (γ-GT), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine (CRE), blood urea nitrogen (BUN), uric acid (UA) and non-alcoholic fatty liver disease (NAFLD) (all P < 0.001). A significant positive correlation was found between eosinophil count and log-transformed C. sinensis egg count (r = 0.9477, P < 0.001). Multiple logistic regression analysis revealed that light and moderate intensities of C. sinensis infection were associated with cholelithiasis (P < 0.01 and P < 0.001, respectively), and C. sinensis infection with eosinophil count ranging from 0.05 to 0.5 × 109/l were associated with cholelithiasis (P < 0.05). In conclusion, our findings suggest that the light and moderate infections of C. sinensis with eosinophil count ranging from 0.05 to 0.5 × 109/l may be associated with a higher risk of cholelithiasis.


Assuntos
Colelitíase/diagnóstico , Clonorquíase/diagnóstico , Eosinófilos/citologia , Adulto , Animais , China/epidemiologia , Colelitíase/epidemiologia , Colelitíase/parasitologia , Clonorquíase/epidemiologia , Clonorchis sinensis , Estudos Transversais , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Contagem de Ovos de Parasitas , Prevalência , Fatores de Risco , Estatísticas não Paramétricas
10.
BMC Emerg Med ; 19(1): 71, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752694

RESUMO

BACKGROUND: The diagnosis of pediatric pancreatitis has been increasing over the last 15 years but the etiology of this is uncertain. The population of pre-adolescent patients with pancreatitis in the emergency department has not been specifically described. Our objective was to determine the characteristics of these patients to illuminate this population and disease in order to better identify them and avoid a delay in diagnosis and treatment. METHODS: This was a retrospective descriptive study of consecutive pediatric patients under the age of 13 years between 2006 and 2016 who presented to our pediatric emergency department with a diagnosis of atraumatic pancreatitis. Patient characteristics, lab and imaging results, identified etiology of pancreatitis, and recurrence rates were recorded and evaluated. RESULTS: There were 139 visits, of which 85 were for a first episode of acute pancreatitis, and 54 were patients with an episode of recurrent pancreatitis. The median age for all visits was 8 years (IQ range 5-11). Of the acute cases, 26% had uncertain or undetermined etiologies of which half were thought to likely be viral related; 20% had systemic inflammatory or autoimmune diseases; 19% were associated with medications, with the most common being valproic acid; 16% were cholelithiasis-related; and 15% were found to have a genetic, congenital or structural etiology. No patients had elevated triglycerides. Those with cholelithiasis and genetic or structural defects were found to have a higher recurrence rate than those with other etiologies. There were only four patients diagnosed with chronic pancreatitis. CONCLUSIONS: The etiology of pancreatitis in pre-adolescent children has a different distribution than in adolescents and adults, with gallstone disease less frequent and concurrent contributing illness more common. Patients on pancreatitis-causing medications or with known genetic risk or structural pancreatic problems should be tested for pancreatitis if presenting with concerning symptoms. Hypertriglyceridemia and chronic pancreatitis with evidence of pancreatic exocrine insufficiency is uncommon in this population.


Assuntos
Pancreatite/etnologia , Pancreatite/fisiopatologia , Doença Aguda , Adolescente , Criança , Pré-Escolar , Colelitíase/epidemiologia , Doença Crônica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Serviço Hospitalar de Emergência , Predisposição Genética para Doença , Humanos , Inflamação/epidemiologia , Pancreatite/epidemiologia , Estudos Retrospectivos , Fatores de Risco
11.
Surg Obes Relat Dis ; 15(10): 1822-1828, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466873

RESUMO

BACKGROUND: Reproductive-aged women constitute a substantial proportion of patients who undergo weight loss procedures. While the risk of gallstone disease after such procedures has been addressed extensively, the impact of pregnancy on gallstone disease after bariatric procedures has not been reported. OBJECTIVES: To explore the effects of pregnancy on cholecystectomy rates after laparoscopic sleeve gastrectomy (LSG). SETTING: A university hospital. METHODS: A cross-sectional cohort study of reproductive aged women (18-45 yr) who underwent LSG. The association between pregnancy and cholecystectomy was evaluated with Cox regression analysis. RESULTS: Of 1056 women of childbearing age who underwent LSG during 2006-2017, 128 (12.1%) subsequently experienced a pregnancy. Median follow-up durations were 3.9 and 4.9 years for women who did and did not conceive, respectively (P < .001). The median time from procedure to conception was 509 (374-1031) days. Overall, 117 (11.1%) women underwent cholecystectomy after LSG. The rate of cholecystectomy among those who conceived was higher than among those who did not (18.8% versus 10.0%, P = .005). In an unadjusted analysis, pregnancy was associated with an increased risk of cholecystectomy (hazard ratio [95% confidence interval]: 3.97 [2.58, 6.09], P < .0001). The association between pregnancy and cholecystectomy persisted after controlling for confounding factors (hazard ratio [95% confidence interval]: 3.82 [2.47, 5.92], P < .0001). Among those who experienced pregnancy, lower gestational weight gain was the only factor found to be associated with cholecystectomy after surgery (P = .05). CONCLUSIONS: Pregnancy is associated with a 4-fold increased risk of cholecystectomy after LSG. Thus, the desire for future pregnancy should be considered before LSG.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Colecistectomia/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Adulto , Colelitíase/epidemiologia , Feminino , Humanos , Obesidade/cirurgia , Estudos Retrospectivos , Fatores de Risco
12.
Acta Obstet Gynecol Scand ; 98(12): 1534-1539, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31355915

RESUMO

INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver disorder occurring during pregnancy. It has a typical genetic background with known genetic mutations and can be considered an expression of this genetic predisposition. The objective of this study was to determine whether ICP is associated with specific long-term comorbidity. MATERIAL AND METHODS: The study population comprised 571 women with ICP in at least one pregnancy who were compared with 1333 pregnant women without ICP during 1969-1988 at Tampere University Hospital, Finland. The cohort's follow-up time was 44 years. All ICD-10 classification discharge diagnoses were examined for the women in the ICP group from 1998 to 2013 and ICD-10 diagnoses from outpatient care from 1969 to 2013. RESULTS: At least one disease of the digestive system had been diagnosed in 50.4% (288/571) of the ICP mothers compared with 34.4% (459/1333) of the reference group (P < 0.001). In a more detailed analysis, women with a history of ICP had an increased risk for cholelithiasis and/or cholecystitis (odds ratio [OR] 2.88, 95% confidence interval [CI] 2.17 to 3.84), diseases of the pancreas (OR 2.26, 95% CI 1.20 to 4.27) and hypothyroidism (OR 2.38, 95% CI 1.27 to 4.46) compared with the reference group. Arterial diseases were less common in the ICP mothers than in the reference group (OR 0.38, 95% CI .15 to .99). Regarding other diseases, there were no statistically significant differences between the ICP mothers and reference group. CONCLUSIONS: Half of the women with a history of ICP were diagnosed with at least one disease of the digestive system compared with a third in the reference group. The risk of cholelithiasis, cholecystitis, diseases of the pancreas and hypothyroidism was increased compared with the reference group. These are important facts when counseling women after a pregnancy with ICP. Also, this is of importance for the general practitioners and other physicians who take care of these women.


Assuntos
Colecistite/epidemiologia , Colelitíase/epidemiologia , Colestase Intra-Hepática/epidemiologia , Hipotireoidismo/epidemiologia , Pancreatopatias/epidemiologia , Complicações na Gravidez/epidemiologia , Doenças Vasculares/epidemiologia , Adulto , Idoso , Artérias , Estudos de Casos e Controles , Comorbidade , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Gravidez
13.
J Microbiol Immunol Infect ; 52(5): 720-727, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31358463

RESUMO

BACKGROUND: To determine the prevalence of chronic comorbidities and associated medication costs in Taiwanese HIV patients in order to increase awareness of the disease burden among healthcare providers and patients. METHODS: HIV-diagnosed patients receiving highly active antiretroviral therapy (HAART; 2010-2013) were identified from the Taiwan National Health Insurance Research Database with the corresponding International Classification of Diseases, ninth revision (ICD-9) code. Comorbidities (type II diabetes mellitus, hypertension, dyslipidemia, major depressive disorder, acute coronary syndrome, and cholelithiasis/nephrolithiasis) were identified according to ICD-9 or relevant medication use. Comorbidity medication and associated costs were identified using the drug classification code from the Anatomical Therapeutic Chemical classification system code series and series outpatient prescriptions. RESULTS: Of 20,726 HIV-diagnosed Taiwanese patients (2010-2013), 13,142 receiving HAART were analyzed. Prevalence of all chronic comorbidities was significantly greater (p < 0.0001) in patients aged ≥40 years versus <40 years (diabetes mellitus, 14.95% vs. 3.30%; hypertension, 46.73% vs. 26.83%; dyslipidemia, 34.93% vs. 18.37%; depression, 23.75% vs. 19.88%; acute coronary syndrome, 1.16% vs. 0.21%; nephrolithiasis/cholelithiasis, 7.26% vs. 4.56%; >2 comorbidities, 24.80% vs. 7.21%). An increase in comorbidity medication spending (2010 vs. 2013 medication costs) was observed (antidyslipidemia, $88,878 vs. $168,180; antihyperglycemia, $32,372 vs. $73,518; antidepressants, $78,220 vs. $125,971; sedatives, $60,009 vs. $85,055; antihypertension, $47,115 vs. $95,134), contributing to overall treatment costs increasing almost two-fold from 2010 to 2013. CONCLUSIONS: Among HIV-infected Taiwanese patients receiving HAART, significant increases in comorbidity prevalence with age, along with rising comorbidity medication costs, suggest the need for preventative as well as chronic care.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Diabetes Mellitus Tipo 2/epidemiologia , Custos de Medicamentos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Síndrome Coronariana Aguda/epidemiologia , Adulto , Colelitíase/epidemiologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Dislipidemias/epidemiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Nefrolitíase/epidemiologia , Prevalência , Taiwan/epidemiologia , Adulto Jovem
14.
Medicine (Baltimore) ; 98(27): e16018, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277096

RESUMO

There have been reports linking nonalcoholic fatty liver disease (NAFLD) with gallstone disease (GD) owing to shared risk factors. However, there are no reported associations between the different NAFLD grades and GD. This study aimed to determine whether NAFLD grade is an independent risk factor for GD in a Korean population.This study enrolled 7886 participants who completed a questionnaire and underwent medical examination and ultrasound scanning at the Health Promotion Center of Jeju National University Hospital in Korea, from January 2009 to December 2017. Fatty liver grading and presence of gallstones were investigated using abdominal ultrasound. Body mass index and biochemical parameters were measured, and age, sex, and metabolic syndrome status were collected from medical records. Univariate and multivariate analyses were performed to identify risk factors for GD.The estimated prevalences of NAFLD and GD were 40.6% and 4.5%, respectively. In the univariate analysis, factors associated with GD were age; NAFLD; presence of metabolic syndrome; and levels of fasting blood glucose, high-density lipoproteins, aspartate aminotransferase, and alanine aminotransferase. Multivariate logistic regression analysis revealed older age and higher NAFLD grade as independent risk factors for GD.Older age and higher grade of NAFLD were independent risk factors for GD in our cohort. There was a strong correlation between grade of NAFLD on abdominal ultrasonography and GD.


Assuntos
Colelitíase/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Índice de Gravidade de Doença , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Colelitíase/diagnóstico por imagem , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/classificação , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Razão de Chances , República da Coreia/epidemiologia , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
15.
Medicine (Baltimore) ; 98(25): e16153, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232971

RESUMO

This study aimed to evaluate the association between cholelithiasis and sialolithiasis using a national sample cohort in Korea.The Korean National Health Insurance Service-National Sample Cohort (patients ≥20 years old) was collected from 2002 to 2013. In study I, we extracted cholelithiasis patients (n = 21,170) and 1:4 matched control I subjects (n = 84,680) and analyzed the occurrence of sialolithiasis. In study II, we extracted sialolithiasis patients (n = 761) and 1:4 matched control II subjects (n = 3044) and analyzed the occurrence of cholelithiasis. Hazard ratios (HRs) were determined using the stratified Cox proportional hazard model.The HR for sialolithiasis was 1.49 (95% CI = 0.88-2.52) in the cholelithiasis group (P = .14), and the HR for cholelithiasis was 1.18 (95% CI = 0.53-2.59) in the sialolithiasis group (P = .69).We did not find an association between cholelithiasis and sialolithiasis.


Assuntos
Colelitíase/fisiopatologia , Cálculos das Glândulas Salivares/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colelitíase/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Cálculos das Glândulas Salivares/epidemiologia
16.
Hernia ; 23(6): 1205-1213, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31073959

RESUMO

BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) is a feasible technique that provides comparable results to standard laparoscopic cholecystectomy (LC). However, despite the theoretical advantages of minor wound complications and cosmetic results, SILC usually requires a larger incision, which may increase the incidence of incisional hernias. This study evaluated SILC and standard multiport cholecystectomy with respect to perioperative outcomes, hospital stay, cosmetic results, and postoperative complications, including the 5-year incisional hernia rate. METHODS: A cohort study was performed with patients who underwent elective laparoscopic surgery for noncomplicated cholelithiasis at our hospital between July 2009 and June 2011. During the study period, there were 45 nonselected patients who underwent SILC, and these patients were compared with a control group of 140 patients who underwent LC using the standard three-trocar technique during the same period. Both patient groups were comparable in age, gender, BMI and ASA classification. RESULTS: The mean follow-up was 58.7 ± 10.9 (range 3-80) months. There were no differences between groups in terms of hospital stay, rate and severity of complications, wound infection, and patient cosmetic satisfaction. However, the operating time (57.8 versus 35.2 min) and long-term incisional hernia rate (13.3% versus 4.7%) were significantly higher in the SILC group. CONCLUSION: SILC is associated with a statistically significantly higher long-term incisional hernia rate at the umbilical port site than the standard multiport laparoscopic cholecystectomy. Our data show there was no relevant advantage regarding the postoperative course, hospital stay or cosmetic satisfaction. To date, widespread use of SILC cannot be recommended. Registration number: NCT03768661 (https://www.clinicaltrials.gov). TRIAL REGISTRATION: This study has been registered at www.clinicaltrials.gov. The clinicaltrials.gov ID number is: NCT03768661.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Hérnia Incisional/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/estatística & dados numéricos , Colelitíase/epidemiologia , Feminino , Humanos , Incidência , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Espanha/epidemiologia , Fatores de Tempo
17.
Obes Surg ; 29(7): 2110-2114, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31001756

RESUMO

BACKGROUND: Obesity and rapid weight loss after bariatric surgery (BS) are independent risk factors for development of cholelithiasis (CL), a prevalent disease in the Chilean population. This study aimed to determine the incidence of CL in obese Chilean patients 12 months after BS and identify risk factors for development of gallstones. METHODS: Retrospective study of patients who underwent BS in 2014. Patients with preoperative negative abdominal ultrasound (US) for CL and follow-up for at least than 12 months were included. Patients underwent US at 6 months and 12 months. We analyzed sex, age, hypertension, dyslipidemia, type 2 diabetes mellitus, body mass index (BMI), surgical procedure, percentage of excess BMI loss (%EBMIL) at 6 months, and BMI at 6 months. RESULTS: Of 279 patients who underwent bariatric surgery during 2014, 66 had previous gallbladder disease and 176 met the inclusion criteria (82.6%), while 54.6% were female. The mean age was 37.8 ± 10.5 years and preoperative BMI was 37.5 kg/m2. BMI and %EBMIL at 6 months were 27.8 ± 3.3 kg/m2 and 77.9 ± 33.6%, respectively. At 12 months after BS, CL was found in 65 patients (36.9%). Hypertension turned out to be protective against occurrence of gallstones at 1 year with an OR 0.241. CONCLUSIONS: Incidence of CL was up to one-third of the patients followed up for 12 months after BS. Excessive weight loss and other variables studied did not increase risk. Hypertension seems to be protective against gallstone formation, but this result needs further analysis.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Colelitíase/epidemiologia , Colelitíase/etiologia , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Chile/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Cálculos Biliares/epidemiologia , Cálculos Biliares/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Perda de Peso/fisiologia
18.
Reumatol. clín. (Barc.) ; 15(2): 84-89, mar.-abr. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184354

RESUMO

Objective: To assess the prevalence of gallstone disease and identify associated risk factors in rheumatoid arthritis (RA) patients compared to the general population. Methods: Eighty-four women with rheumatoid arthritis were included in the study. Each patient was assessed via a structured interview, physical examination, abdominal ultrasound and blood test including lipid profile. The prevalence of gallstone disease in rheumatoid arthritis was compared with data from a study of the Spanish population matched by age groups. Results: Twenty-eight of the 84 women had gallstone disease (33.3%). RA women with and without gallstone disease were similar in most of the variables assessed, except for older age and menopausal status in the former. A greater prevalence of gallstone disease was seen in rheumatoid arthritis patients compared to the general population of the same age; however, the differences were significant only in women aged 60 or older (45.5% versus 23.1% respectively, P-value .008). The age-adjusted OR of developing gallstone disease in RA women compared with general population women was 2,3 (95% CI: 1.3-4.1). A significantly higher HDL3-c subfraction and higher apoA-I/HDL and HDL3-c/TC ratios were observed in patients with gallstone disease. Conclusion: Women with rheumatoid arthritis may have a predisposition to gallstones that can manifest in middle or older age compared with women in the general population. This situation could be related to chronic inflammation and HDL metabolism


Objetivo: Evaluar la prevalencia de litiasis biliar e identificar los factores de riesgo asociados en pacientes con artritis reumatoide (AR) en comparación con la población general. Métodos: Ochenta y cuatro mujeres con AR fueron incluidas en el estudio. Cada paciente fue evaluada a través de una entrevista estructurada, un examen físico, una ecografía abdominal y un análisis de sangre que incluía el perfil lipídico. La prevalencia de litiasis biliar en AR se comparó con los datos de un estudio de la población española emparejada por grupos de edad. Resultados: Veintiocho de las 84 mujeres tenían litiasis biliar (33,3%). Las pacientes con y sin colelitiasis fueron similares en la mayoría de las variables evaluadas, a excepción de la edad más avanzada y mayor prevalencia de estado menopáusico en las pacientes con AR. Las pacientes con AR presentaban una mayor prevalencia de litiasis biliar en comparación con la población general de la misma edad; sin embargo, estas diferencias solo fueron significativas en mujeres de 60 años o más (45,5% vs. 23,1% respectivamente, p-valor 0,008). La OR ajustada por edad de presentar litiasis biliar en mujeres con AR respecto a mujeres de la población general fue de 2,3 (IC del 95%: 1,3-4,1). Se observó una subfracción de c-HDL3 significativamente más alta y una relación mayor de apoA-I/HDL y c-HDL3/TC en las pacientes con litiasis biliar. Conclusión: Las mujeres con AR pueden tener una mayor predisposición a la presencia de litiasis biliar en comparación con las mujeres en la población general, sobre todo en edades más avanzadas. Esta situación podría estar relacionada con la inflamación crónica y el metabolismo de las HDL


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Artrite Reumatoide/complicações , Colelitíase/epidemiologia , Dislipidemias/epidemiologia , Artrite Reumatoide/epidemiologia , Dislipidemias/complicações , Lipídeos/sangue , Colecistectomia/estatística & dados numéricos , Comorbidade , Fatores de Risco
19.
Expert Rev Gastroenterol Hepatol ; 13(2): 157-171, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30791781

RESUMO

INTRODUCTION: Cholesterol gallstone disease have relationships with various conditions linked with insulin resistance, but also with heart disease, atherosclerosis, and cancer. These associations derive from mechanisms active at a local (i.e. gallbladder, bile) and a systemic level and are involved in inflammation, hormones, nuclear receptors, signaling molecules, epigenetic modulation of gene expression, and gut microbiota. Despite advanced knowledge of these pathways, the available therapeutic options for symptomatic gallstone patients remain limited. Therapy includes oral litholysis by the bile acid ursodeoxycholic acid (UDCA) in a small subgroup of patients at high risk of postdissolution recurrence, or laparoscopic cholecystectomy, which is the therapeutic radical gold standard treatment. Cholecystectomy, however, may not be a neutral event, and potentially generates health problems, including the metabolic syndrome. Areas covered: Several studies on risk factors and pathogenesis of cholesterol gallstone disease, acting at a systemic level have been reviewed through a PubMed search. Authors have focused on primary prevention and novel potential therapeutic strategies. Expert commentary: The ultimate goal appears to target the manageable systemic mechanisms responsible for gallstone occurrence, pointing to primary prevention measures. Changes must target lifestyles, as well as experimenting innovative pharmacological tools in subgroups of patients at high risk of developing gallstones.


Assuntos
Bile/metabolismo , Colelitíase/prevenção & controle , Colesterol/metabolismo , Fármacos Gastrointestinais/uso terapêutico , Prevenção Primária/métodos , Comportamento de Redução do Risco , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Animais , Colelitíase/diagnóstico , Colelitíase/epidemiologia , Colelitíase/metabolismo , Dieta Saudável , Exercício Físico , Fármacos Gastrointestinais/efeitos adversos , Humanos , Fatores de Proteção , Fatores de Risco , Resultado do Tratamento
20.
Am J Surg ; 218(3): 567-570, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30728100

RESUMO

BACKGROUND: Recent rapid increases in the aging population have created an impending "Silver Tsunami" in advanced countries. The overall prevalence of gallstone disease and its related complications will soon increase, and there will be a larger demand for gallbladder surgery. METHODS: We examined the outcomes of cholecystectomy according to age among patients with cholelithiasis to determine how a patient's age influences the outcome of cholecystectomy. All patients with gallstone disease who presented for cholecystectomy at our institute from January 2006 to December 2018 were analyzed. RESULTS: All perioperative outcomes (operation length, length of hospital stay, rate of open surgery, urgent surgery, postoperative complications, incidental gallbladder cancer, postoperative hospital death, concomitant bile duct stones, and total medical costs per patient) increased as patients aged. CONCLUSIONS: To prevent the progression of biliary disease, elective laparoscopic cholecystectomy is recommended before patients with cholelithiasis advance in age.


Assuntos
Colecistectomia , Colelitíase/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Colelitíase/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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