Appendectomy and Non-Typhoidal Salmonella Infection: A Population-Based Matched Cohort Study.

The potential association between appendectomy and non-typhoidal Salmonella (NTS) infection has not been elucidated. We hypothesized that appendectomy may be associated with gut vulnerability to NTS. The data were retrospectively collected from the Taiwan National Health Insurance Research Database to describe the incidence rates of NTS infection requiring hospital admission among patients with and without an appendectomy. A total of 208,585 individuals aged ≥18 years with an appendectomy were enrolled from January 2000 to December 2012, and compared with a control group of 208,585 individuals who had never received an appendectomy matched by propensity score (1:1) by index year, age, sex, occupation, and comorbidities. An appendectomy was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification Procedure Codes. The main outcome was patients who were hospitalized for NTS. Cox proportional hazards models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Two sensitivity analyses were conducted for cross-validation. Of the 417,170 participants (215,221 (51.6%) male), 208,585 individuals (50.0%) had an appendectomy, and 112 individuals developed NTS infection requiring hospitalization. In the fully adjusted multivariable Cox proportional hazards regression model, the appendectomy group had an increased risk of NTS infection (adjusted HR (aHR), 1.61; 95% CI, 1.20-2.17). Females and individuals aged 18 to 30 years with a history of appendectomy had a statistically higher risk of NTS than the control group (aHR, 1.92; 95% CI, 1.26-2.93 and aHR, 2.67; 95% CI, 1.41-5.07). In this study, appendectomy was positively associated with subsequent hospitalization for NTS. The mechanism behind this association remains uncertain and needs further studies to clarify the interactions between appendectomy and NTS.

The Risk of Subsequent Deep Vein Thrombosis and Pulmonary Embolism in Patients with Nontyphoidal Salmonellosis: A Nationwide Cohort Study.

The purpose of this study was to evaluate the deep vein thrombosis (DVT) and pulmonary embolism (PE) risk among patients with a diagnosis of nontyphoidal salmonellosis (NTS) in an Asian population. The risk was analyzed in a cohort of 17,855 patients newly diagnosed with NTS and 71,420 individuals without NTS using a hospitalization claim dataset. Both groups were matched by age, sex, and index date as an original analysis. A Cox proportional-hazards regression model was applied to estimate the risk of DVT and PE, accounting for any competing event (death). With a follow-up of 4.94 (±3.93) years in the NTS group and 6.30 (±3.67) years in the non-NTS group, the adjusted subhazard ratios (SHRs) of DVT and PE were 1.83 (95% CI 1.44-2.31) and 1.84 (95% CI 1.30-2.60). The NTS group had an increased risk of DVT and PE compared with the control group in all of the age subgroups. Stratified analyses showed that patients aged 18-39 years in the NTS group had significantly higher DVT and PE risks compared with patients of the same age in the non-NTS group (aHR, 5.95; 95% CI, 2.22-15.91 for DVT; aHR 6.72; 95% CI, 2.23-20.30 for PE). The P-value for interaction between age and exposure of NTS is <0.001 for DVT and 0.004 for PE in our sub-group analyses. The findings were cross-validated by a re-analysis with propensity score matching (PSM), and that revealed consistent results. Despite of low absolute risk, clinicians should be aware that patients with an NTS hospitalization history is at increased risk for VTE especially when assessing patients coincident with other VTE risk factors.

Main pulmonary arterial distensibility: different presentation between chronic pulmonary hypertension and acute pulmonary embolism.

BACKGROUND: The main pulmonary arterial (PA) distensibility in patients with pulmonary hypertension (PH) and pulmonary embolism (PE) is uncertain. METHODS AND RESULTS: We enrolled 45 patients with echocardiographic signs of PH and without imaging evidence of PE, and another 45 who were found by multidetector-row computed tomography to have PE. Fifty normal patients served as a control group. The PA distensibility was calculated from the change in main PA diameter between diastole and systole, as the maximal systolic diameter minus the minimal diastolic diameter divided by the minimal diastolic diameter. The PA distensibility is lowest in PH (6.0+/-2.7%), followed by PE (12.9+/-3.4%) and then the normal controls (25.9+/-5.7%). Statistical analysis of data obtained from patients with PE or PH reveals that a PA distensibility of >8.3% could be used to identify PE with a sensitivity of 83% and a specificity of 82%. After a 3-month anticoagulation, 22 of 45 PE patients had complete resolution of thrombus; 23 had residual thrombus. The PE patients, regardless of residual thrombus presence, had significant improvement of PA distensibility after a 3-month anticoagulation, although the diameters of main PA did not shrink. CONCLUSION: PA distensibility is a method to distinguish acute PE from chronic PH.