ABSTRACT
INTRODUCTION: The US Centers for Disease Control recommends hepatitis C virus (HCV) screening for baby boomers. Spain presents a similar distribution of infected patients. We performed a cross sectional prospective study to evaluate the prevalence of undiagnosed HCV infection in subjects born between 1949 and 1974. METHODS: All out-patients within the age range, both symptomatic and screening procedures, undergoing colonoscopy between December 2014 and June 2015 were offered a HCV antibody blood test and a survey including risk factors for HCV infection and attitude toward HCV screening. Patients with chronic HCV or with a previous negative HCV antibody test were excluded. RESULTS: A total of 570 subjects, 50% screening procedures, were analyzed. The median age was 55.7, 94.6% were born in Spain and 54.6% were women. Antibodies against HCV were found in 1.6% (95% CI: 0.8-3%) and HCV-RNA in 0.4% (0.1-1.3%). We found no statistically significant differences regarding HCV prevalence, risk factors or socioeconomic characteristics between subjects undergoing colorectal cancer screening and symptomatic subjects. CONCLUSION: Symptomatic and screening subjects undergoing colonoscopy support HCV screening and present a similar HCV risk profile. Results suggest linking colorectal and HCV screening would yield good results.
Subject(s)
Attitude to Health , Colorectal Neoplasms/diagnosis , Hepatitis C Antibodies/blood , Hepatitis C/diagnosis , Mass Screening/methods , Colonoscopy/methods , Cross-Sectional Studies , Early Detection of Cancer/methods , Female , Hepacivirus , Humans , Logistic Models , Male , Middle Aged , Outpatients/statistics & numerical data , Prospective Studies , RNA, Viral/isolation & purification , Risk Factors , Seroepidemiologic Studies , Spain , Surveys and QuestionnairesSubject(s)
Abdominal Pain/etiology , Intervertebral Disc Displacement/complications , Intervertebral Disc , Nerve Compression Syndromes/etiology , Thoracic Vertebrae , Abdominal Pain/diagnosis , Abdominal Pain/drug therapy , Aged , Amines/administration & dosage , Analgesics/administration & dosage , Cyclohexanecarboxylic Acids/administration & dosage , Gabapentin , Humans , Intervertebral Disc/diagnostic imaging , Intervertebral Disc Displacement/diagnostic imaging , Magnetic Resonance Imaging , Male , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/drug therapy , Pain Measurement , Thoracic Vertebrae/diagnostic imaging , Treatment Outcome , gamma-Aminobutyric Acid/administration & dosageSubject(s)
Chlamydia Infections/microbiology , Chlamydia trachomatis/isolation & purification , Proctitis/microbiology , Anti-Bacterial Agents/therapeutic use , Biopsy , Chlamydia Infections/diagnosis , Chlamydia Infections/drug therapy , Chlamydia Infections/transmission , Chlamydia trachomatis/drug effects , Gastrointestinal Hemorrhage/microbiology , Humans , Male , Middle Aged , Proctitis/diagnosis , Proctitis/drug therapy , Rectum , Risk Factors , Sigmoidoscopy , Treatment Outcome , Unsafe SexABSTRACT
BACKGROUND AND AIM: Elderly patients are frequently affected by gallstone-related disease. Current guidelines support cholecystectomy after a first acute biliary complication. In the aging, these recommendations are irregularly followed. METHODS: We analyzed data from patients 65 or older admitted between June 30, 2004 and June 30, 2013 with a diagnosis of acute pancreatitis, cholangitis, or cholecystitis. Diagnosis and severity assessment were defined according to current guidelines. Harms, mortality, and cholecystectomy rates were evaluated. Baseline factors independently predicting cholecystectomy were identified. RESULTS: A total of 491 patients were included. The median age was 78.8 years, and 51.7 % were women. Acute cholecystitis was present in 51.7 %, acute pancreatitis in 36.5 %, and acute cholangitis in 11.8 %. Cholecystectomy was performed in 47.1 %. Age, myocardial infarct, dementia, diabetes, nonmetastatic tumor, and severe liver disease were risk factors for not undergoing surgery. Complications related to hospital stay appeared in 33 % of patients. Surgery, cholecystostomy, and ERCP presented harms in 21-25 %. Overall mortality rate was 5.4 %: 10.4 % in acute cholangitis, 6.8 % in acute cholecystitis, and 2.2 % in acute pancreatitis. Mild cases presented a 1.3 % mortality, while 28.6 % of severe cases died. After discharge, 24.7 % of patients presented a new biliary complication, 9.7 % of them severe. Relapse was more frequent in patients managed without invasive procedures, 42.3 % than in cholecystectomy patients, 9.9 % (p < 0.001) and than in ERCP patients, 19.4 % (p = 0.01). CONCLUSIONS: Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused.
