Anjum Memon

Sampling variability on percutaneous liver biopsy in patients with chronic hepatitis C virus infection.

Background: Sampling variability on liver biopsy has been demonstrated in a variety of liver diseases. The objective of this study was to determine whether sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection. Methods: Two separate tissue samples were obtained from the right lobe of the liver, through a single skin puncture, in 29 patients (22 M, mean age 43.4 ± 8.1 years) with chronic HCV infection. The biopsies were assessed using a descriptive histological reporting system and Knodells Histological Activity Index (HAI) and compared for differences in necroinflammatory activity (grade) and fibrosis (stage). Results: Thirteen (44.8%) patients had a difference of ≥1 grade between the 2 biopsies on the descriptive system and 13 differed by ≥1 stage. On the HAI, 20 (69.0%) patients had a difference of ≥2 in the necroinflammatory activity score and 10 (34.5%) had a difference of ≥4; whereas, 11 (38.0%) patients had a difference of ≥1 in the fibrosis score and 6 (20.7%) had a difference of ≥2. The mean difference between the two sets of biopsies was 2.4 ±2.1 (range 0–7) for the necroinflammatory activity and 0.6 ±0.9 (range 0–3) for fibrosis. Spearmans correlation coefficient (r) was moderate for both necroinflammatory activity (r = 0.53, P < 0.01) and fibrosis (r = 0.62, P < 0.0001). Conclusions: Sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection and should be taken into consideration when decisions regarding prognosis and therapy are made based on biopsy, and when defining histological response to antiviral regimens.

Dental x-rays and the risk of thyroid cancer: A case-control study

Abstract The thyroid gland is highly susceptible to radiation carcinogenesis and exposure to high-dose ionising radiation is the only established cause of thyroid cancer. Dental radiography, a common source of low-dose diagnostic radiation exposure in the general population, is often overlooked as a radiation hazard to the gland and may be associated with the risk of thyroid cancer. An increased risk of thyroid cancer has been reported in dentists, dental assistants, and x-ray workers; and exposure to dental x-rays has been associated with an increased risk of meningiomas and salivary tumours. Methods. To examine whether exposure to dental x-rays was associated with the risk of thyroid cancer, we conducted a population-based case-control interview study among 313 patients with thyroid cancer and a similar number of individually matched (year of birth ± three years, gender, nationality, district of residence) control subjects in Kuwait. Results. Conditional logistic regression analysis, adjusted for other upper-body x-rays, showed that exposure to dental x-rays was significantly associated with an increased risk of thyroid cancer (odds ratio = 2.1, 95% confidence interval: 1.4, 3.1) (p=0.001) with a dose-response pattern (p for trend <0.0001). The association did not vary appreciably by age, gender, nationality, level of education, or parity. Discussion. These findings, based on self-report by cases/controls, provide some support to the hypothesis that exposure to dental x-rays, particularly multiple exposures, may be associated with an increased risk of thyroid cancer; and warrant further study in settings where historical dental x-ray records may be available.

Epidemiology of reproductive and hormonal factors in thyroid cancer: Evidence from a case‐control study in the Middle East

Thyroid cancer is the second most common neoplasm among women in Kuwait and several other countries in the Middle East. Most of these countries also have relatively high birth and total fertility rates. To examine potential relationships between reproductive and hormonal factors and thyroid cancer, we conducted a population‐based case‐control interview study among 238 women diagnosed with thyroid cancer and a similar number of individually matched controls in Kuwait. Among the demographic variables, women with 12+ years of education had a significantly reduced risk of thyroid cancer (OR = 0.4; 95% CI: 0.2–0.8; p‐trend <0.05). The average age at diagnosis (±SD) of thyroid cancer was 34.7 ± 11 years. Events such as age at menarche, pregnancy, menopausal status and age at menopause were not associated with thyroid cancer. There was an association with age at last pregnancy and parity. Women who had their last pregnancy at ages ≥30 years were at a significantly increased risk (OR = 2.1; 95% CI: 1.2–3.8); there was also a significant trend in risk with increasing age at last pregnancy. There was a modest increase in risk among women who had borne ≥5 children (OR = 1.5; 95% CI: 0.9–2.5). A joint analysis of these factors showed that childbearing during the latter half of reproductive life had a substantial effect on the incidence of thyroid cancer; for any given level of parity, there was about a 2‐fold increased risk if the age at last pregnancy was ≥30 years. A substantial recent‐birth effect, in relation to subsequent diagnosis of thyroid cancer, was observed during the second and third year after a birth (OR = 2.0; 95% CI: 1.0–4.1). In contrast, spontaneous abortion seemed to have a protective effect. There was a significant decrease in risk among women who had a miscarriage as outcome of first pregnancy (OR = 0.1; 95% CI: 0.03–0.4) and those who had experienced ≥3 miscarriages (OR = 0.3; 95% CI: 0.1–0.8; p‐trend <0.05). Overall, any female hormone use was not associated with thyroid cancer risk. New association is suggested for a history of post‐partum thyroiditis (OR = 10.2; 95% CI: 2.3–44.8). These data support the hypothesis that reproductive factors and patterns may influence, or contribute to, the risk of thyroid cancer among women.

Benign thyroid disease and dietary factors in thyroid cancer: a case-control study in Kuwait

We conducted a population-based study of 313 case–control pairs in Kuwait to examine the aetiology of thyroid cancer, the second most common neoplasm among women in this and several other countries in the Gulf region. Among the demographic variables, individuals with 12+ years of education had a significantly reduced risk of thyroid cancer (OR=0.6; 95% CI: 0.3–0.9). The average age at diagnosis (±s.d.) of thyroid cancer was 34.7±11 years in women and 39±13.4 years in men. History of thyroid nodule was reported only by cases (n=34; 10.9%; lower 95% CI: 12.0); and goitre by 21 cases and four controls (OR=5.3; 95% CI: 1.8–15.3). There was no significant increase in risk with history of hypothyroidism (OR=1.8) or hyperthyroidism (OR=1.7). For any benign thyroid disease, the OR was 6.4 (95% CI: 3.4–12.0); and the population attributable risk was about 26% (95% CI: 21.1–30.9). Stepwise regression analysis showed that high consumption of processed fish products (OR=2.2; 95% CI: 1.6–3.0) fresh fish (OR=0.5; 95% CI: 0.4–0.7) and chicken (OR=1.7; 95% CI: 1.2–2.3) were independently associated with thyroid cancer with significant dose-response relationships. Among the thyroid cancer patients who reported high consumption of fish products, a large majority also reported high consumption of fresh fish (98%) and shellfish (68%). No clear association emerged with consumption of cruciferous vegetables. These data support the hypothesis that hyperplastic thyroid disease is strongly related to thyroid cancer; and that habitual high consumption of various seafoods may be relevant to the aetiology of thyroid cancer. The association with chicken consumption requires further study.

Breast-Feeding and Childhood-Onset Type 1 Diabetes: A pooled analysis of individual participant data from 43 observational studies

OBJECTIVE To investigate if there is a reduced risk of type 1 diabetes in children breastfed or exclusively breastfed by performing a pooled analysis with adjustment for recognized confounders. RESEARCH DESIGN AND METHODS Relevant studies were identified from literature searches using MEDLINE, Web of Science, and EMBASE. Authors of relevant studies were asked to provide individual participant data or conduct prespecified analyses. Meta-analysis techniques were used to combine odds ratios (ORs) and investigate heterogeneity between studies. RESULTS Data were available from 43 studies including 9,874 patients with type 1 diabetes. Overall, there was a reduction in the risk of diabetes after exclusive breast-feeding for >2 weeks (20 studies; OR = 0.75, 95% CI 0.64–0.88), the association after exclusive breast-feeding for >3 months was weaker (30 studies; OR = 0.87, 95% CI 0.75–1.00), and no association was observed after (nonexclusive) breast-feeding for >2 weeks (28 studies; OR = 0.93, 95% CI 0.81–1.07) or >3 months (29 studies; OR = 0.88, 95% CI 0.78–1.00). These associations were all subject to marked heterogeneity (I2 = 58, 76, 54, and 68%, respectively). In studies with lower risk of bias, the reduced risk after exclusive breast-feeding for >2 weeks remained (12 studies; OR = 0.86, 95% CI 0.75–0.99), and heterogeneity was reduced (I2 = 0%). Adjustments for potential confounders altered these estimates very little. CONCLUSIONS The pooled analysis suggests weak protective associations between exclusive breast-feeding and type 1 diabetes risk. However, these findings are difficult to interpret because of the marked variation in effect and possible biases (particularly recall bias) inherent in the included studies.

Lithium in drinking water and suicide rates across the East of England

Lithium can be found naturally in drinking water. In clinical practice, it is widely used in pharmacological doses for the treatment of bipolar disorder; and may also prevent suicidal behaviour in people with mood disorders. In two studies, lithium levels in tap water have been significantly and negatively correlated with suicide. We measured lithium levels in tap water in the 47 subdivisions of the East of England and correlated these with the respective suicide standardised mortality ratio in each subdivision. We found no association between lithium in drinking water and suicide rates across the East of England from 2006 to 2008.

Diagnosis of Helicobacter pylori: improving the sensitivity of CLOtest by increasing the number of gastric antral biopsies.

Background and Goal The rapid urease CLOtest is commonly used during endoscopy to diagnose the presence of Helicobacter pylori. The aim of this study was to determine whether the sensitivity of the CLOtest can be improved by increasing the number of gastric antral biopsies from 1 to 4. Methods The study included 100 adult patients who were referred for upper gastrointestinal endoscopy and tested positive for H. pylori infection on 13C urea breath test (“gold standard”). These 100 patients were then randomly divided into 4 equal groups (groups 1 to 4), and underwent an upper gastrointestinal endoscopy. Patients in group 1 had 1 gastric antral biopsy during endoscopy, whereas those in groups 2, 3, and 4 had 2, 3, and 4 biopsies, respectively. The biopsies were placed in the rapid urease CLOtests, which were incubated at room temperature for up to 24 hours, and read for positive results at 1, 6, and 24 hours. Results About half of the patients (52%) had a positive CLOtest in group 1, compared to 68% in group 2, 76% in group 3, and 96% in group 4 (group 1 vs. 4 P<0.01). After 1 hour of incubation 96% of the patients in group 4 had a positive CLOtest, compared to 40% in group 3, 12% in group 2, and 4% in group 1. Conclusions Increasing the number of gastric antral biopsies from 1 to 4 significantly improves the sensitivity of the CLOtest, eliminates sampling error, and hastens the time needed by the test to become positive for the diagnosis of H. pylori infection.

Factors Associated with the Initiation of Smoking by Kuwaiti Males

PURPOSE To estimate the age patterns in cumulative probability of smoking initiation among Kuwaiti adult males and to study the differentials in smoking initiation in relation to factors such as age-cohort, marital status, educational level, income, type of residence, and history of smoking among family members and friends. METHODS A stratified three stage cluster sampling design was implemented for the selection of the sample. A self-administered questionnaire was completed by 1798 Kuwaiti adult males working in different ministries. RESULTS AND IMPLICATIONS Of the 1798 respondents, 34.4% were classified as current smokers, 17.7% as former smokers and 47.9% as non-smokers. The highest probability of smoking initiation (among current and former smokers) was found for the age group 15-20 years, where almost 29% of the respondents initiated smoking. In the univariate analysis, marital status, education, income, type of residence, and history of smoking among family members and friends showed significant variation in the age-patterns of initiation. In the Cox proportional hazard regression model, education, type of residence, and history of smoking among family members and friends were found to be independently associated with the risk of initiation. The highest risk of initiation (Relative Risk (RR) = 1.85; 95% CI: 1.62-2.10) was found among those who had a history of smoking in family and friends. Individuals in the lowest education category (RR = 1.64; 95% CI: 1.32-2.04) and those residing in apartments (RR = 1.65; 95% CI: 1.43-1.92) were at a higher risk of initiation compared with those who had university education or those who resided in villas. The results of the study should prompt further efforts to develop tobacco control policies in Kuwait and the other Arabian Gulf countries to help establish norms for not initiating smoking through persistent messages to not start or to stop smoking. There is also a need to enhance awareness about the influence of smokers in family or friends on other people to initiate smoking.

Factors Associated With Smoking Relapse in the Postpartum Period: An Analysis of the Child Health Surveillance System Data in Southeast England

INTRODUCTION There is increasing evidence that a high proportion (47%-63%) of women who quit smoking during pregnancy relapse during the postpartum period. The purpose of this population-based study was to examine the association between selected sociodemographic factors and smoking relapse in the early postpartum period (within the first 6 weeks) in women who had successfully quit smoking during the pregnancy. METHODS The study included 512 women resident in East Sussex, United Kingdom, who had quit smoking during the pregnancy. Information on the prevalence of smoking and selected sociodemographic factors and breast feeding at the 6-weeks postpartum review by health visitor was obtained from the Child Health Surveillance System, which records and monitors the health and development of children from birth until school entry. RESULTS Of the 512 women who had quit smoking during the pregnancy, 238 (46.5%) relapsed in the early postpartum period. In the bivariate analysis, there was an association between deprivation and smoking relapse in the early postpartum period (OR = 5.3, 95% CI: 2.5-11.4), with a significant trend in increasing risk of relapse with increasing level of deprivation (p < .01). Stepwise logistic regression analysis showed that women who lived in deprived urban areas (OR = 2.3, 95% CI: 1.2-4.2), had ≥3 children (OR = 3.8, 95% CI: 2.2-6.4), and had other smokers in the household (OR = 5.6, 95% CI: 3.6-8.8) were significantly more likely to relapse in the early postpartum period. On the other hand, women who were breast feeding were significantly less likely to relapse (OR = 0.6, 95% CI: 0.4-0.9). CONCLUSIONS Factors associated with early postpartum smoking relapse identified in this study, particularly breast feeding, high parity, and concurrent smoking by partner/other household member(s), may contribute to the development of effective and targeted interventions to maintain smoking cessation in women and their household.

Comparison Between Young and Old Patients with Bronchogenic Carcinoma

The aim of this study was to compare the clinical characteristics, histological type, stage at diagnosis, treatment and survival of young (< or = 45 years) and older patients with bronchogenic carcinoma. The study was designed as a retrospective review of all lung cancer patients referred to the Kuwait Cancer Control Center over a 10-year period from 1985 to 1994. The study comprised 590 patients with primary bronchogenic carcinoma, of whom 72 (12%) were < or = 45 years of age at the time of diagnosis. Median (range) duration of symptoms, percentage of smokers and male to female ratios for the younger and older patients were 8 (2-48) weeks vs. 8 (1-52) weeks (p = 0.9), 74% vs. 83% (p = 0.06) and 5.5 vs. 5.3, respectively. The majority of patients had advanced stage disease at presentation; 91% of the younger patients had stage III or IV compared with 88% of the older patients (p = 0.1). The histological types for the younger and older patients were 32% vs. 20% for adenocarcinoma (p = 0.01) and 33% vs. 45% for squamous cell carcinoma (p = 0.1). There were more patients in the younger group who had surgery (21% vs. 7.5%) than in the older group (p = 0.001). Follow-up data were available for 177 patients out of 190 Kuwaiti national patients (93%). The median (range) survival rates for young and old patients were 8 (3-62) months and 7 (1-174) months, respectively (p = 0.09). Only 6 patients survived for more than 5 years, one (7.6%) from the younger group and 5 (3%) from the older group. Our study shows a relatively high percentage of young patients in our population of lung cancer patients. Apart from the higher incidence of adenocarcinoma in the young group and the fact that these patients had more surgery than the older group, there were no other significant differences between the two groups.