Risks associated with colonoscopy in a population-based colon screening program: an observational cohort study.

BACKGROUND: The risks associated with colonoscopy performed through the British Columbia Colon Screening Program (BCCSP) are not known. We aimed to determine the rate of colonoscopy-related serious adverse events within this program. METHODS: For this prospective observational study, we used the BCCSP database to identify participants 50 to 74 years of age who had a positive result on fecal immunochemical testing (FIT) between Nov. 15, 2013, and Dec. 31, 2017, followed by colonoscopy. Unplanned medical events were recorded at the time of colonoscopy and 14 days later. We reviewed the unplanned events and defined them as serious adverse events if they resulted in death, hospital admission or intervention; we also classified them as probably, possibly or unlikely related to the colonoscopy. The primary outcome was the overall rate of serious adverse events; the secondary outcomes were 14-day post-colonoscopy rates of perforation, bleeding and death. RESULTS: During the study period, a total of 96 192 colonoscopies were performed by 308 physicians at 50 sites. The median age of patients was 62 (10th-90th percentile 52-71) years, and 56% were male. Of these, 78 831 patients were contacted after the colonoscopy. Serious adverse events were deemed to have occurred in 350 colonoscopies (44 per 10 000, 95% confidence interval [CI] 39-50 per 10 000), with a number needed to harm of 225. Of the 332 (94.9%) serious adverse events that were probably or possibly related to colonoscopy, perforation occurred in 6 (95% CI 5-8) per 10 000 colonoscopies, bleeding in 26 (95% CI 22-30) per 10 000 colonoscopies and death in 3 (95% CI 1-10) per 100 000 colonoscopies. INTERPRETATION: The rate of serious adverse events associated with colonoscopy in the BCCSP was in keeping with previous publications and met accepted benchmarks. The findings of this study inform stakeholders of the risks associated with colonoscopy in an FIT-based colon screening program.

Nosocomial MRSA infection in vascular surgery patients: impact on patient outcome.

Although methicillin-resistant Staphylococcus aureus (MRSA) infection is a worldwide problem, data on its significance among vascular surgery patients remain scant and conflicting. This study was designed to evaluate the association between nosocomial MRSA infection and patient outcome following vascular surgery procedures. Outcomes among patients with MRSA infection were also compared to those infected with methicillin-sensitive Staphylococcus aureus (MSSA). All patients admitted to a tertiary care Vascular Surgery ward during the year 2002 were included in this retrospective review. In addition to information on demographic and comorbid conditions, data on surgical interventions, nosocomial infection incidence rates as defined by the Center for Disease Control guidelines, and MRSA screening results were collected. Primary outcome was in-hospital death. Secondary outcomes measures included length of hospital stay, readmissions, or repeat surgeries, and ICU admissions. Of a total of 408 subjects, 110 were documented with a nosocomial infection (27.0%). Of these, 16 patients (3.9%) were colonized with MRSA on screening at time of admission, 22 (5.4%) had acquired MRSA infection during hospitalization, and 15 (3.7%) had MSSA infection. Patients with MRSA, MSSA, and non-MRSA infection had similar baseline characteristics except for hypertension and tobacco use. Age and MRSA infection were significant risk factors for in-hospital deaths (OR 1.07, 95% CI 1.01-1.13, p = 0.01 and OR 7.44, 95% CI 1.63-33.9, p = 0.01, respectively). Adjusted for the effects of age, MRSA infection remained a significant independent risk factor associated with in-hospital deaths (OR 4.38, 95% CI 1.09-17.7, p = 0.04). After adjustment for baseline risk factors, MRSA infection was also independently associated with secondary outcome measures. Although risks of non-MRSA infections were also associated with adverse outcomes in the multivariate analyses, MRSA posed higher risks, as reflected by higher odds ratio in all instances. The 22 patients with documented MRSA infection had significantly longer hospital stays than those with MSSA infection (median 24 days vs 8 days, p = 0.02). However, no significant differences were noted between the 2 groups in terms of secondary outcome. These results show that MRSA infection is a significant risk factor for adverse clinical outcomes among patients undergoing vascular surgery procedures. Infection with MRSA results in a greater risk of these outcomes when compared with non-MRSA infection. However, despite concerns regarding the virulence of this strain of staphylococcus, patients infected with MRSA had no higher rates of morbidity or mortality except for increased length of hospital stay when compared to patients with MSSA.

Palmitate increases nitric oxide synthase activity that is involved in palmitate-induced cell death in cardiomyocytes.

The objective of this study was to test the hypothesis that nitric oxide synthase (NOS) is subjected to regulatory control by palmitate, and that nitric oxide (NO) is operative in palmitate-induced cell death. Palmitate induced a significant ( p<0.05 ) concentration-dependent increase in NOS activity measured by the conversion of [(3)H]arginine to [3H]citrulline in embryonic chick cardiomyocytes. Cellular eNOS and iNOS, determined by immunocytochemistry, were increased by palmitate. Western blotting also showed that palmitate, 500 microM for 4h, significantly increased the amount of cellular of eNOS and iNOS by 36.2+/-6.5% ( p<0.001 ) and 38.4+/-14.4% ( p<0.05 ), respectively. The NOS inhibitor L-NAME significantly ( p<0.05 ) accentuated palmitate-induced cell death These data suggest that palmitate has a bifunctional effect on cell viability--in addition to loss of cell viability, palmitate stimulates NOS activity by inducing an increase in cellular eNOS and iNOS with the resultant NO production serving to protect cardiomyocytes from palmitate-induced cell death.