RESUMEN
OBJECTIVES: This study of young black men who have sex with men (YBMSM) assessed the prevalence of extragenital chlamydia and gonorrhea among those testing negative for urethral infections, and compared prevalence of both by human immunodeficiency virus (HIV) status. METHODS: A convenience sample of 609 YBMSM was recruited for a cross-sectional study from 2 sexual health clinics located in Jackson, MS. To detect Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), nucleic acid amplification testing was performed on urine, rectal swabs, and oral swabs. OraSure was used to detect HIV. RESULTS: Seventy-three percent of all chlamydia infections and 77% of gonorrhea infections were found from anal and oral swabs in the absence of urethral positivity. Compared with HIV-uninfected men, HIV-infected men were significantly more likely to have pharyngeal chlamydia (P = 0.03), multiple CT infections (P = 0.02), rectal NG (P < 0.001), multiple NG infections (P = 0.04), both CT/NG rectal infections (P = 0.001). CONCLUSIONS: As much as three quarters of all chlamydia and gonorrhea infections may be missed when only urine-based nucleic acid amplification testing is used to screen YBMSM for bacterial sexually transmitted infections. These missed opportunities for diagnosis may be particularly likely among HIV-infected YBMSM.
Asunto(s)
Negro o Afroamericano , Infecciones por Chlamydia/diagnóstico , Gonorrea/diagnóstico , Infecciones por VIH/etnología , Homosexualidad Masculina , Enfermedades Bacterianas de Transmisión Sexual/etnología , Adulto , Infecciones por Chlamydia/etnología , Chlamydia trachomatis , Estudios Transversales , Gonorrea/etnología , VIH , Infecciones por VIH/microbiología , Humanos , Masculino , Tamizaje Masivo , Neisseria gonorrhoeae , Técnicas de Amplificación de Ácido Nucleico , Enfermedades del Recto/etnología , Enfermedades del Recto/microbiología , Conducta Sexual , Minorías Sexuales y de GéneroRESUMEN
BACKGROUND & AIMS: Despite the availability of endoscopic therapy, many patients in the United States undergo surgical resection for nonmalignant colorectal polyps. We aimed to quantify and examine trends in the use of surgery for nonmalignant colorectal polyps in a nationally representative sample. METHODS: We analyzed data from the Healthcare Cost and Utilization Project National Inpatient Sample for 2000 through 2014. We included all adult patients who underwent elective colectomy or proctectomy and had a diagnosis of either nonmalignant colorectal polyp or colorectal cancer. We compared trends in surgery for nonmalignant colorectal polyps with surgery for colorectal cancer and calculated age, sex, race, region, and teaching status/bed-size-specific incidence rates of surgery for nonmalignant colorectal polyps. RESULTS: From 2000 through 2014, there were 1,230,458 surgeries for nonmalignant colorectal polyps and colorectal cancer in the United States. Among those surgeries, 25% were performed for nonmalignant colorectal polyps. The incidence of surgery for nonmalignant colorectal polyps has increased significantly, from 5.9 in 2000 to 9.4 in 2014 per 100,000 adults (incidence rate difference, 3.56; 95% confidence interval 3.40-3.72), while the incidence of surgery for colorectal cancer has significantly decreased, from 31.5 to 24.7 surgeries per 100,000 adults (incidence rate difference, -6.80; 95% confidence interval -7.11 to -6.49). The incidence of surgery for nonmalignant colorectal polyps has been increasing among individuals age 20 to 79, in men and women and including all races and ethnicities. CONCLUSIONS: In an analysis of a large, nationally representative sample, we found that surgery for nonmalignant colorectal polyps is common and has significantly increased over the past 14 years.
Asunto(s)
Colectomía/tendencias , Pólipos del Colon/cirugía , Neoplasias Colorrectales/cirugía , Pólipos Intestinales/cirugía , Pautas de la Práctica en Medicina/tendencias , Enfermedades del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/estadística & datos numéricos , Pólipos del Colon/etnología , Pólipos del Colon/patología , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Pólipos Intestinales/etnología , Pólipos Intestinales/patología , Masculino , Persona de Mediana Edad , Enfermedades del Recto/etnología , Enfermedades del Recto/patología , Factores de Tiempo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Racial disparities in outcomes are well described among surgical patients. OBJECTIVE: The purpose of this work was to identify any racial disparities in the receipt of a minimally invasive approach for colorectal surgery. DESIGN: Adults undergoing colorectal surgery were studied using the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify predictors for the receipt of a minimally invasive approach. SETTINGS: The study was conducted at academic hospitals and their affiliates. PATIENTS: Adults ≥18 years of age who underwent surgery for colorectal cancer, diverticular disease, IBD, or benign colorectal tumor between 2008 and 2011 were included. MAIN OUTCOME MEASURES: The receipt of a minimally invasive surgical approach was the main measured outcome. RESULTS: A total of 82,474 adult patients met the study inclusion criteria. Of these, 69,664 (84%) were white, 10,874 (13%) were black, and 1936 (2%) were Asian. Blacks were younger, with higher rates of public insurance and higher comorbidity burden and baseline severity of illness compared with white and Asian patients. Black patients were less likely (adjusted OR = 0.83 (95% CI, 0.79-0.87)) and Asian patients more likely (adjusted OR = 1.34 (95% CI, 1.21-1.49)) than whites to receive minimally invasive surgery. This association did not change with stratification by insurance type (public or private). Black patients had higher rates of intensive care unit admission and nonhome discharge, as well as an increased length of stay compared with white and Asian patients. No differences in complications, readmission, or mortality rates were observed with minimally invasive surgery, but black patients were more likely to be readmitted or to die with open surgery. LIMITATIONS: The study was limited by the retrospective nature of its data. CONCLUSIONS: We identified racial differences in the receipt of a minimally invasive approach for colorectal surgery, regardless of insurance status, as well as improved outcomes for minority races who underwent a minimally invasive technique compared with open surgery. The improved outcomes associated with minimally invasive surgery should prompt efforts to increase rates of its use among black patients.
Asunto(s)
Colectomía , Enfermedades del Colon , Cirugía Colorrectal , Disparidades en Atención de Salud , Procedimientos Quirúrgicos Mínimamente Invasivos , Enfermedades del Recto , Adulto , Anciano , Colectomía/estadística & datos numéricos , Enfermedades del Colon/etnología , Enfermedades del Colon/cirugía , Cirugía Colorrectal/métodos , Cirugía Colorrectal/estadística & datos numéricos , Etnicidad , Femenino , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Cobertura del Seguro , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Mejoramiento de la Calidad , Enfermedades del Recto/etnología , Enfermedades del Recto/cirugía , Estudios Retrospectivos , Estados UnidosRESUMEN
BACKGROUND: Racial disparities in care and outcomes contribute to mortality and morbidity in children; however, the role in pediatric Crohn's disease is unclear. In this study, we compared cohorts of black and white children with Crohn's disease to determine the extent race is associated with differences in readmissions, complications, and procedures among hospitalizations in the United States. METHODS: Data were extracted from the Pediatric Health Information System (January 1, 2004-June 30, 2012) for patients with 21 years or younger hospitalized with a diagnosis of Crohn's disease. White and black cohorts were randomly selected in a 2:1 ratio by hospital. The primary outcome was time from index hospital discharge to readmission. The most frequent complications and procedures were evaluated by race. RESULTS: There were 4377 patients. Black children had a shorter time to first readmission and higher probability of readmission (P = 0.009) and a 16% increase in risk of readmission compared with white children (P = 0.01). Black children had longer length of stay and higher frequency of overall and late (30-d to 12-mo postdischarge) readmissions (P < 0.001). During index hospitalization, more black children had perianal disease and anemia (P < 0.001). During any hospitalization, black children had higher incidence of perianal disease, anemia, and vitamin D deficiency, and greater number of perianal procedures, endoscopies, and blood product transfusion (P < 0.001). CONCLUSIONS: There are differences in hospital readmissions, complications, and procedures among hospitalized children related to race. It is unclear whether these differences are due to genetic differences, worse intrinsic disease, adherence, access to treatment, or treatment disparities.
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Negro o Afroamericano/estadística & datos numéricos , Enfermedad de Crohn/epidemiología , Disparidades en Atención de Salud/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Adolescente , Anemia/epidemiología , Anemia/etnología , Anemia/etiología , Transfusión Sanguínea/estadística & datos numéricos , Niño , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/etnología , Enfermedad de Crohn/terapia , Procedimientos Quirúrgicos del Sistema Digestivo/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Humanos , Tiempo de Internación/estadística & datos numéricos , Enfermedades del Recto/epidemiología , Enfermedades del Recto/etnología , Enfermedades del Recto/etiología , Estados Unidos , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/etnología , Deficiencia de Vitamina D/etiología , Adulto JovenRESUMEN
Abundant recent data suggest that sessile serrated adenoma/polyp (SSA/P) is an early precursor lesion in the serrated pathway of carcinogenesis. It is believed that SSA/Ps develop cancer by an SSA/P-dysplasia-carcinoma sequence. Hyperplastic polyps (HPs) share some histologic and molecular characteristics with SSA/P, but it is unclear whether SSA/Ps are derived from HPs or whether they develop by a different pathogenetic pathway. Previous studies have shown that serrated polyps from Korean patients show different prevalence rates of certain molecular abnormalities compared with similar lesions from American patients, and this suggests that lifestyle and dietary factors may influence the serrated neoplasia pathway. The purpose of this study was to evaluate the molecular features of HPs and SSA/Ps, the latter both with and without dysplasia, from Korean patients and to compare the findings with similar lesions from American patients. One hundred and eleven serrated polyps, consisting of 45 HPs (30 microvesicular, 11 goblet cell, 4 mucin depleted) and 56 SSA/Ps (36 with dysplasia, 20 without dysplasia), were retrieved from the pathology files of a large medical center in Korea and 38 SSA/P from American patients were evaluated for BRAF and KRAS mutations, microsatellite instability, and hypermethylation of O6-methylguanine-DNA methyltransferase (MGMT), hMLH1, adenomatous polyposis coli (APC), p16, methylated in tumor-1 (MINT-1), MINT2, and MINT31. Methylation of hMLH1 was performed using 2 different sets of primers. Twenty-three conventional adenomas from Korean patients were included as controls. The data were compared between polyp subtypes and between polyps in the right versus the left colon. With regard to HP, KRAS mutations were present in 31.1% of polyps and BRAF mutations in 46.7% of polyps. KRAS mutations were significantly more common in goblet cell HP and BRAF in microvesicular HP (MVHP). Methylation of MGMT, hMLH1, APC, p16, MINT1, MINT2, and MINT31 were present in 42.2%, 64.4% (and 24.4%), 37.8%, 60%, 68.9%, 51.1%, and 60% of HPs. CpG island methylator phenotype high was noted in 60% of HPs. Methylation of hMLH1, p16, MINT2, and MINT31 were more frequent in MVHPs compared with other types of HPs. In contrast, SSA/Ps showed KRAS and BRAF mutations in 12.5% and 60.7% of cases, respectively. Methylation of all tumor-related genes, except hMLH1 (23.2% using 1 type of primers) and APC (37.5%), occurred in >50% of lesions, and CpG island methylator phenotype (CIMP) high was noted in 76.8% of cases. None of the molecular findings were significantly more common in SSA/P with, versus those without, dysplasia, but only 2 of the 36 polyps with dysplasia were of the conventional adenomatous type; the remainder (34 of 36) was of the serrated type. Nevertheless, both SSA/P with conventional adenomatous dysplasia showed methylation of MGMT, APC, MINT1, and MINT31 and were CIMP high. BRAF mutations, methylation of most tumor related genes, and CIMP high occurred more frequently in HPs and SSA/Ps in the right colon, compared with the left colon. In fact, no significant differences were observed between HPs and SSPs of the right colon and HPs and SSA/Ps from the left colon. Furthermore, compared with American patients, Korean male individuals were affected more frequently than female individuals, and both BRAF mutations and hMLH1 methylation were less frequent in the latter compared with the former. We conclude that HPs and SSA/Ps in Korean patients share some, but not all, clinical and molecular characteristics to those that occur in Americans. The data support the theory that the right and left colon are biologically different with regard to susceptibility to serrated cancer, and that anatomic location (right vs. left) may be a more significant risk factor of progression than the histologic type of polyp. Our data also support the theory that right-sided MVHPs may be a precursor to SSA/P.
Asunto(s)
Adenoma/genética , Pólipos del Colon/genética , Neoplasias Colorrectales/genética , Pólipos Intestinales/genética , Proteínas Adaptadoras Transductoras de Señales/genética , Adenoma/etnología , Adenoma/patología , Adulto , Anciano , Pueblo Asiatico/genética , Cadherinas/genética , Proteínas Portadoras/genética , Distribución de Chi-Cuadrado , Inmunoprecipitación de Cromatina , Pólipos del Colon/etnología , Pólipos del Colon/patología , Neoplasias Colorrectales/etnología , Neoplasias Colorrectales/patología , Metilación de ADN , Metilasas de Modificación del ADN/genética , Enzimas Reparadoras del ADN/genética , Femenino , Regulación Neoplásica de la Expresión Génica , Genes APC , Genes p16 , Humanos , Hiperplasia , Pólipos Intestinales/etnología , Pólipos Intestinales/patología , Modelos Lineales , Masculino , Inestabilidad de Microsatélites , Persona de Mediana Edad , Homólogo 1 de la Proteína MutL , Mutación , Proteínas del Tejido Nervioso/genética , Proteínas Nucleares/genética , Reacción en Cadena de la Polimerasa , Proteínas Proto-Oncogénicas/genética , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas p21(ras) , Enfermedades del Recto/etnología , Enfermedades del Recto/genética , Enfermedades del Recto/patología , República de Corea/epidemiología , Proteínas Supresoras de Tumor/genética , Estados Unidos/epidemiología , Adulto Joven , Proteínas ras/genéticaRESUMEN
We evaluated cervical and rectal Chlamydia trachomatis OmpA genotypes isolated from 22 women in Birmingham, AL, who were infected at both sites. Two women had mixed infection at one site. Of 20 women infected with a single OmpA genotype at each site, four (20%) had discordant genotypes at these sites.
Asunto(s)
Proteínas de la Membrana Bacteriana Externa/genética , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/clasificación , Enfermedades del Recto/epidemiología , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Alabama/epidemiología , Infecciones por Chlamydia/etnología , Femenino , Genotipo , Humanos , Prevalencia , Enfermedades del Recto/etnología , Enfermedades del Recto/microbiología , Estudios Retrospectivos , Vaginosis Bacteriana/etnología , Vaginosis Bacteriana/microbiologíaRESUMEN
PURPOSE: We sought to translate the Bowel Function in the Community instrument into the Portuguese language and to culturally adapt it to Brazilian society. We also aimed to test the validity and reliability (content validity, and interrater and test-retest reliability) of this adapted version. INSTRUMENT: The original instrument comprised 70 items grouped into 6 principal areas: general bowel habits, fecal incontinence, lower urinary tract symptoms, anorectal diseases and surgical history, medical care utilization, and potential contributing medical disorders. METHODS: The instrument was translated into Portuguese, and assessed by a committee of specialists. Content validity of the translated version was verified by testing and via feedback from a focus group. The adapted version incorporated both semantic and idiomatic alterations. The instrument then underwent testing for interrater and test-retest reliability. RESULTS: Interrater reliability testing revealed a 94% level of agreement between interviewers and researchers. Test-retest reliability testing revealed a slightly higher than 60% level of agreement when the same subjects completed the instrument twice, during a baseline measurement and a second time following a 1-week interval. CONCLUSIONS: The adapted version of the Bowel Function in the Community instrument demonstrates adequate validity and reliability for use in research in the Brazilian population.
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Actitud Frente a la Salud/etnología , Defecación , Evaluación en Enfermería/métodos , Enfermedades del Recto/etnología , Encuestas y Cuestionarios/normas , Traducción , Adulto , Anciano , Brasil , Comparación Transcultural , Incontinencia Fecal/etnología , Femenino , Grupos Focales , Hábitos , Humanos , Masculino , Persona de Mediana Edad , Evaluación en Enfermería/normas , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Variaciones Dependientes del Observador , Psicometría , Sensibilidad y Especificidad , Trastornos Urinarios/etnologíaRESUMEN
We sought to assess the significance of an incidental finding of colorectal wall thickening (CRWT) on computed tomography (CT) scan in African-American and Hispanic patients. We retrospectively reviewed charts of African-American and Hispanic patients from January 1994 to December 2005. Those patients were included in whom the colonoscopy was performed due to incidental CRWT on CT scan. Patients with a history or a family history of colorectal malignancy, inflammatory bowel disease, or colorectal surgery, with an incomplete colonoscopic examination, or <18 years of age were excluded. Endoscopic and pathological findings were abstracted. Thirty-two patients met the criteria. Endoscopic examination was abnormal in 21 (65.6%). The positive predictive value of CRWT for abnormal endoscopic examination was 65.6%. Abnormal endoscopic examination revealed diverticulosis in 9 (43%), erythematous mucosa in 8 (38%), polyps in 6 (29%), mass in 2 (9%), thickened folds in 1 (5%), and diverticulitis in 1 (5%). Histopathological findings revealed colitis in 7 (33%), adenoma in 4 (19%), hyperplastic polyps in 4 (19%), adenocarcinoma in 2 (9%), lymphoid aggregates in 2 (9%), melanosis coli in 1 (5%), and normal in 1 (5%) in the abnormal examination group. Abnormal endoscopic examination was found in 65.6% of patients. The prevalence of colitis, adenomas, and malignancy was high, therefore abnormal CRWT warrants further endoscopic evaluation.
Asunto(s)
Negro o Afroamericano , Colon/diagnóstico por imagen , Enfermedades del Colon/diagnóstico por imagen , Hispánicos o Latinos , Enfermedades del Recto/diagnóstico por imagen , Recto/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Colon/patología , Enfermedades del Colon/etnología , Enfermedades del Colon/patología , Colonoscopía , Diagnóstico Diferencial , Femenino , Humanos , Hipertrofia/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Enfermedades del Recto/etnología , Enfermedades del Recto/patología , Recto/patología , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The aim of this prospective study was to describe the clinical characteristics of colorectal polyp in Thai children. METHODS: From December 2002 to February 2005, children under 15 years of age presenting with rectal bleeding were prospectively enrolled. Demographic, clinical, and laboratory information was recorded. Location, number, characteristics, and histopathology of the polyps were noted. RESULTS: There were 32 patients with a mean age of 6.5 years. The most common presenting symptom was hematochezia, followed by prolapsing rectal mass and diarrhea. In 20 patients there was a single polyp, 6 had 2-4 polyps, and 6 were diagnosed with polyposis coli. Most of the polyps were located exclusively at the rectum and sigmoid colon. In only 7 cases were the polyps proximal to the rectosigmoid region. This included 6 patients who had polyps beyond the splenic flexure. All were juvenile polyps without evidence of adenomatous changes. Compared to those with isolated polyps, the patients with polyposis coli had a statistically significant incidence of right-sided polyps (P <0.001) and a history of prolapse of the rectal mass (P = 0.006). CONCLUSIONS: Because of the high prevalence of right-sided polyps and the concern about malignant transformation, colonoscopy should be considered as the initial evaluation in children with rectal bleeding.