ABSTRACT
BACKGROUND: To evaluate the risks of esophageal and stomach carcinomas in people living with HIV (PLWH) compared with the general population and risk factors for these cancers in PLWH. SETTING: Retrospective cohort study in the Veterans Health Administration. METHODS: We compared incidence rates for esophageal and stomach cancers in 44,075 HIV-infected male veterans with those in a matched HIV-uninfected cohort (N = 157,705; 4:1 matched on age and HIV-index date). We used Cox regression models to estimate Hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with HIV infection and for cancer risk factors in PLWH. RESULTS: In unadjusted models, HIV infection was associated with increased risks of esophageal squamous cell carcinoma (ESCC; HR, 2.21; 95% CI: 1.47 to 3.13) and gastric cardia cancer (HR, 1.69; 95% CI: 1.00 to 2.85) but associated with lower risk of esophageal adenocarcinoma (EAC; HR, 0.48; 95% CI: 0.31 to 0.74). After adjusting for age, race/ethnicity, smoking and alcohol use, HIV infection remained statistically significantly associated with elevated risk for ESCC [adjusted hazard ratio (aHR), 1.58; 95% CI: 1.02 to 2.47], especially among HIV-infected patients with CD4 count ≤200 (aHR, 2.20; 95% CI: 1.35 to 3.60). HIV infection was not associated with risks of EAC (aHR, 0.82; 95% CI: 0.53 to 1.26), gastric cardia (aHR, 0.80; 95% CI: 0.33 to 1.94), or noncardia (aHR, 1.06; 95% CI: 0.61 to 1.84) cancers. Risk factors for these cancers in HIV-infected patients were otherwise similar to those in general population (eg, Helicobacter pylori for gastric noncardia cancer). CONCLUSION: HIV-infected individuals with low CD4 count are at highest risk for ESCC, but HIV infection was not independently associated with EAC or gastric cancer after adjusting for confounders.
Subject(s)
Esophageal Neoplasms/complications , Esophageal Neoplasms/epidemiology , HIV Infections/complications , HIV Infections/epidemiology , Stomach Neoplasms/complications , Stomach Neoplasms/epidemiology , Adenocarcinoma/complications , Adenocarcinoma/epidemiology , Adult , Alcohol Drinking/adverse effects , CD4 Lymphocyte Count , Cohort Studies , Esophageal Squamous Cell Carcinoma/complications , Esophageal Squamous Cell Carcinoma/epidemiology , Ethnicity , Female , Helicobacter pylori , Humans , Male , Middle Aged , Proportional Hazards Models , Race Factors , Regression Analysis , Retrospective Studies , Risk Assessment , Risk Factors , Smoking/adverse effects , VeteransABSTRACT
Introducción: La detección temprana de hipoacusia ha sido ampliamente estudiada en recién nacidos gracias a las nuevas tecnologías en pruebas diagnósticas y tratamiento; existen protocolos bien establecidos de despistaje universal en esta población. Sin embargo, en adultos, el despistaje auditivo es un tema que también cobra importancia debido al aumento en la esperanza de vida, al cambio en la pirámide poblacional mexicana, que se estima que en los siguientes 50 años se transformará hacia una forma rectangular (con un aumento en la prevalencia de presbiacusia), y al establecimiento de programas de protección social en salud como el Seguro Popular. No se cuenta con investigaciones mexicanas sobre despistaje auditivo en adultos. El objetivo de este trabajo es evaluar una prueba de emisión tonal y un cuestionario como estrategias de despistaje en adultos. Métodos: Se tomó una muestra de 500 personas sin antecedente de patología otológica en la consulta externa de un hospital general. Se realizó otoscopia, 2 pruebas de despistaje auditivo (emisión tonal y cuestionario) y audiometría a todos los sujetos. Resultados: El cuestionario es una prueba sensible pero poco específica, mientras que la prueba de emisión de tono fue menos sensible pero más específica con tasa mayor de exactitud. La mejor estrategia resultó la combinación de ambas pruebas que alcanzó una exactitud del 90%. Conclusiones: Se propone como la mejor estrategia de despistaje en adultos un cuestionario y una prueba de emisión tonal que garantiza de forma rápida, sin necesidad de entrenamiento especial, una evaluación completa del estado de audición en lo objetivo y subjetivo (AU)
Introduction: The early detection of hearing loss has been studied widely in newborns due to the emerging technologies for diagnosis and treatment. There are detailed protocols for this goal. Nonetheless, hearing loss screening in adults has become more important lately with the increase of the life expectancy, an expected change in the Mexican population pyramid towards a rectangular shape in the next 50 years (with increased hearing loss prevalence) and the creation of public policies for social security such as the «Seguro Popular». There are no Mexican studies about hearing loss screening in adults. The aim of this work was to assess a tone emission and a questionnaire as screening tools for hearing loss in adults. Methods: A sample size of 500 individuals without otology pathology from the outpatient clinics at a general hospital. An otoscopy, 2 screening tests (tone emission and questionnaire) and tonal audiometry were performed on all subjects. Results: The questionnaire turned out to be a sensitive test but with low specificity, while the tone emission was less sensitive but more specific with a higher rate of precision. In this study, the best result was achieved by a combined strategy using the two tests above, with a precision of 90%. Conclusions: The best screening strategy proposed by this study for hearing loss in adults is a questionnaire and tone emission test, which guarantees complete hearing assessment in objective and subjective manners, performed quickly and without special training (AU)
Subject(s)
Humans , Male , Female , Adult , Mass Screening/methods , Hearing Disorders/epidemiology , Hearing Tests/methods , Surveys and Questionnaires , Aging , Presbycusis/epidemiology , Hearing Loss/epidemiologyABSTRACT
INTRODUCTION: The early detection of hearing loss has been studied widely in newborns due to the emerging technologies for diagnosis and treatment. There are detailed protocols for this goal. Nonetheless, hearing loss screening in adults has become more important lately with the increase of the life expectancy, an expected change in the Mexican population pyramid towards a rectangular shape in the next 50 years (with increased hearing loss prevalence) and the creation of public policies for social security such as the "Seguro Popular". There are no Mexican studies about hearing loss screening in adults. The aim of this work was to assess a tone emission and a questionnaire as screening tools for hearing loss in adults. METHODS: A sample size of 500 individuals without otology pathology from the outpatient clinics at a general hospital. An otoscopy, 2 screening tests (tone emission and questionnaire) and tonal audiometry were performed on all subjects. RESULTS: The questionnaire turned out to be a sensitive test but with low specificity, while the tone emission was less sensitive but more specific with a higher rate of precision. In this study, the best result was achieved by a combined strategy using the two tests above, with a precision of 90%. CONCLUSIONS: The best screening strategy proposed by this study for hearing loss in adults is a questionnaire and tone emission test, which guarantees complete hearing assessment in objective and subjective manners, performed quickly and without special training.
Subject(s)
Hearing Loss/diagnosis , Adult , Aged , Cross-Sectional Studies , Female , Hearing Tests , Humans , Male , Middle Aged , Prospective Studies , Surveys and QuestionnairesABSTRACT
Propósito : El objetivo del estudio fue valorar si el uso de esteroides tópicos nasales en el postoperatorio de polipectomia por vía endoscopica aumentaba la incidencia de infección postoperatoria. Material y métodos: Cuarenta y cinco pacientes con indicación de polipectomía fueron divididos de manera aleatoria en 3 grupos de 15 pacientes cada uno. A los pacientes del primer grupo se les realizó curación con lavados nasales exclusivamente. A los pacientes del segundo grupo se les aplicaron además 400 mcg de propionato de fluticasona al día. A los pacientes del tercer grupo se les administraron 600 mcg de dipropionato de beclometasona al día. Se comparó la prevalencia de infección y de recidiva de poliposis en el postoperatorio de los tres grupos de pacientes. Resultados : En ninguno de los 45 pacientes se presento infección en los primeros 3 meses del postoperatorio. Hubo recidiva en 46 por ciento de los pacientes sin esteroide tópico en comparación de 7 por ciento en el grupo de Fluticasona y de 13 por ciento en el grupo de Beclometasona. Conclusión : En la polipectomia endoscópica, los esteroides tópicos nasales disminuyen el porcentaje de recidivas tempranas sin provocar infección postoperatoria
