Bhuma Krishnamachari

Association between Glioma and History of Allergies, Asthma, and Eczema: A Case-Control Study with Three Groups of Controls

Because glioma etiology is largely unknown, the inverse association of glioma risk with atopic conditions is promising and deserves close scrutiny. We examined the association between a history of allergies, asthma, and eczema, and glioma risk using sibling, friend, and clinic-based controls. This analysis included 388 incident glioma cases and 80 sibling, 191 friend, and 177 clinic-based controls. Each subjects medical history was assessed via a Web-based or telephone survey. Odds ratios (OR) and their 95% confidence intervals (CI) for the associations with allergies, asthma, eczema, and the overall number of these conditions were calculated from conditional (for sibling and friend controls) and unconditional (for clinic-based controls) logistic models. Allergies were consistently inversely associated with the glioma: ORs were 0.53 (95% CI, 0.15-1.84), 0.54 (95% CI, 0.28-1.07), and 0.34 (95% CI, 0.23-0.50) with sibling, friend, and clinic-based controls, respectively. Asthma showed an inverse association only in the comparison with sibling controls (OR, 0.43; 95% CI, 0.19-1.00). Eczema showed an inverse association only in the comparison with friend controls (OR, 0.42; 95% CI, 0.15-1.18). The overall number of these conditions (ordinal score 0, 1, 2, 3) was inversely associated with glioma: The risk decreased 31% to 45% with each addition of an atopic condition. These estimates were the most stable when different control groups were considered. Comparing the prevalence of these conditions in the three control groups with published data, we note that clinic-based controls generally better approximate the prevalence data for population-based groups. These controls seem to present a reasonable choice for clinic-centered case-control studies. (Cancer Epidemiol Biomarkers Prev 2009;18(4):1232–8)

The association of H. pylori and colorectal adenoma: does it exist in the US Hispanic population?

BACKGROUND Although data on the association between colorectal adenomas and Helicobacter pylori (H. pylori) exists in White and Black patients, there is no data on this association in a US Hispanic population. Our aim was to study the association of adenoma detection and biopsy proven H. pylori infection in a cohort of US Hispanics. METHODS Data were collected from Nassau University Medical Center, a 530-bed tertiary care teaching hospital in East Meadow, New York. Patients who underwent both an esophagogastroduodenoscopy (EGD) and colonoscopy from July 2009 to March 2011 were pulled from an electronic database. A total of 1,737 patients completed colonoscopies during this time with 95 excluded: 17 inflammatory bowel disease, 12 malignancy, 22 prior history of colorectal adenoma, and 44 incomplete. Among the colonoscopies, 799 patients had EGDs performed prior to colonoscopies that were eligible for our study. RESULTS H. pylori prevalence was highest in Hispanics 40.9%, followed by Blacks 29.1% (OR 0.59, 95% CI: 0.42-0.84), then Whites 7.9% (OR 0.12, 95% CI: 0.06-0.24). The adenoma detection rate was significantly higher in Whites 23.2% and Blacks 21.8% compared to Hispanics 14.5%, P=0.0002 respectively. Smoking and alcohol were lower in the H. pylori group, 18.6% (n=44) vs. 26.1% (n=147) for smoking (P=0.02) and 14.4% (n=34) vs. 19% (n=107) for alcohol (P=0.12), respectively. There was no evidence in the Hispanics for an association between adenoma detection and H. pylori infection. Furthermore size, location, and multiple polyps did not differ between the two groups. CONCLUSIONS While data has shown an association between H. pylori and colorectal adenomas, we did not find this in our Hispanic population. With the growing population of Hispanics in the U.S, large scale studies are needed to conclusively characterize the role of H. pylori infection in colorectal adenoma and adenocarcinoma in this group of patients.

A pooled multisite analysis of the effects of atopic medical conditions in glioma risk in different ethnic groups

PURPOSE The incidences of atopic conditions (allergies, asthma, or eczema) and glioma vary by ethnicity. Atopic conditions are inversely associated with gliomas. We conducted a pooled multisite study investigating the associations of atopic conditions with glioma in different race/ethnicity groups. METHODS Using glioma cases and healthy controls, unconditional logistic regression was conducted to assess the associations of atopic conditions with glioma separately in white, black, Asian, and Hispanic subpopulations. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS Glioblastoma multiforme cases were less likely than controls to report a history of atopic conditions in whites (OR = 0.46, [95% CI, 0.38-0.54]) and Asians (OR = 0.27, [95% CI, 0.10-0.73]). The same trend was seen when looking at glioma cases of all histologies. An inverse association was not seen in blacks for glioblastoma multiforme or all histologies combined. CONCLUSIONS The inverse association between glioma and atopic conditions may vary by ethnicity due to a difference in the biology of atopic conditions in different ethnicities but may be due to chance because of the limitations of small nonwhite sample sizes.

Erosive Esophagitis in the Obese: The Effect of Ethnicity and Gender on Its Association

Background. Data examining the association between obesity and erosive esophagitis (ErE) have been inconsistent, with very little known about interracial variation. Goals. To examine the association between obesity and ErE among patients of different ethnic/racial backgrounds. Methods. The study sample included 2251 patients who underwent esophagogastroduodenoscopy (EGD). The effects of body mass index (BMI) on ErE were assessed by gender and in different ethnic groups. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariate logistic regression analysis. Results. The prevalence of ErE was 29.4% (661/2251). Overweight and obese subjects were significantly more likely to have ErE than individuals with a normal BMI, with the highest risk seen in the morbidly obese (OR 6.26; 95% CI 3.82–10.28; p < 0.0001). Normal weight Black patients were less likely to have ErE as compared to Caucasians (OR 0.46; 95% CI 0.27–0.79; p = 0.005), while the odds ratio comparing normal weight Hispanics to normal weight Whites was not statistically significant. No effect modification was seen between BMI and race/ethnicity or BMI and gender. Significant trends were seen in each gender and ethnicity. Conclusions. The effect of BMI on ErE does not appear to vary by race/ethnicity or gender.

Ethnic disparities in the risk of colorectal adenomas associated with aspirin and statin use: a retrospective multiethnic study.

BACKGROUND Although data on the inverse association between colorectal adenomas (CRA) and daily aspirin or statin therapy exists in white and black patients, scarce data exists on these associations in the Hispanic population. With a rapidly increasing Hispanic population in the United States, defining the association in Hispanics is crucial. METHODS The study sample included 1,843 consecutive patients who underwent a colonoscopy (screening or diagnostic) from 2009 to 2011 at a community hospital in East Meadow, New York. Data was then extracted from patient charts regarding aspirin and/or statin use. Adjusted odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association between colonoscopy findings and aspirin, statin, or aspirin/statin use. RESULTS In our total population including all races, aspirin user had an increased risk for having two or more adenomas (OR =1.73, 95% CI: 1.00, 2.99, P=0.05) and presence of an adenoma in the proximal colon (OR =1.66, 95% CI: 1.07, 2.58, P=0.02). In the total study population, those who used both statin and aspirin had an increased risk for having two or more adenomas (OR =2.56, 95% CI: 1.21, 5.39, P=0.01). In the Hispanic population, users of both medications had an increased risk for having two or more adenomas (OR =19.04, 95% CI: 1.30, 280.09, P=0.03), adenoma present in the distal colon (OR =5.75, 95% CI: 1.64, 20.21, P=0.01) and largest adenoma in distal colon (OR =5.75, 95% CI: 1.64, 20.21, P=0.01). CONCLUSIONS Aspirin use and aspirin/statin use was associated with abnormal colonoscopy findings, particularly in the Hispanic population. These findings may be due to environmental factors such as dietary, colonic flora, or genetic susceptibility. The findings warrant further investigational research, particularly in Hispanics.

Physician Knowledge of Ethnicity Specific Differences in BRCA Genetic Testing

To the Editor: Breast Cancer is the most common cancer and the second leading cause of cancer death in American women (1). Approximately 5–15% of all breast cancers are hereditary and the most commonly described cause is germline BRCA mutations. The lifetime risk of breast cancer in females with a BRCA mutation is up to 90%, while the lifetime risk of ovarian cancer is up to 40% (2,3). Ethnicity can be associated with determining the overall likelihood for an individual to harbor a specific hereditary mutation as well as specific mutation type. When ordering BRCA testing, physicians must choose between different types of genetic testing technologies that can each detect specific types of mutations. It was recently determined that Latino/Hispanic individuals who carry a BRCA mutation are more likely to carry a distinct BRCA1 rearrangement than individuals of other ethnicities. BRCA gene sequencing will not detect large rearrangements and deletions, including the mutation seen in Latinos/Hispanics. Detection of this mutation requires a specific rearrangement test (4,5). The rearrangement test does not hold equal importance for all ethnic groups. For example, the contribution of BRCA rearrangements in the Jewish population is significantly lower (6). Once ordered predominantly by specialists in academic settings, genetic testing is now frequently ordered by primary care physicians (PCPs) (7). A minority of PCPs appear to recognize the current risk assessment guidelines for identifying a BRCA mutation. Specifically, PCPs may not be familiar with recommendations by the National Comprehensive Cancer Network (NCCN), which is considered the gold standard in cancer risk assessment, screening and treatment (7,8). In addition, they may not be aware of more recent details about BRCA testing that are not yet reflected in NCCN guidelines. A survey of 55 questions was administered to 116 PCPs evaluating their knowledge and practice patterns regarding hereditary breast and ovarian cancer (HBOC). Survey questions were designed by using NCCN guidelines for HBOC (8). The survey addressed demographic variables, frequency of genetics assessment in clinical practice and knowledge about HBOC. Physicians were posed with a variety of knowledge statements relating to BRCA testing and were asked to indicate whether the items were true, false, or whether they did not know the answer. The mean age of all physicians in our study was 47.2 (SD 13.6), 52.6% (n = 61) were female and 83.6% (n = 97) were white. For questions pertaining to ethnicity specific issues in BRCA genetic testing, physicians were most aware that an Ashkenazi Jewish woman with a diagnosis of ovarian cancer is at high risk for carrying a BRCA mutation (n = 85, 73.3%). More than half of the physicians were aware that all ethnicities are not equally at risk for carrying a BRCA mutation (n = 70, 60.3%), 45.7% (n = 53) of physicians correctly answered that the genetic tests ordered for a given hereditary condition would not be the same regardless of the patient’s ethnicity, 29.6% (n = 34) knew that the BRCA mutations found in Ashkenazi Jewish individuals are generally one of three specific mutations, and only 12.2% (n = 14) correctly identified that Latino/Hispanic individuals have a higher chance of having a deletion in the BRCA gene that cannot be detected by gene sequencing. With regard to knowledge about molecular genetics, most physicians correctly identified that there are different types of mutations that can exist in the same gene (n = 102, 89.5%). Over half of the physicians knew that that genetic sequencing will not detect all types of genetic mutations (n = 77, 68.1%). About a third of the physicians knew that standard BRCA sequencing Address correspondence and reprint requests to: Bhuma Krishnamachari, Division of Research, Department of Medicine, NYIT College of Osteopathic Medicine, PO Box 8000, Old Westbury, NY 11568, USA, or e-mail: bkrishna@nyit.edu

Acceptance of technology-based tools in a sample of Parkinson’s patients:

Objectives Parkinson’s disease is the second most common neurodegenerative movement disorder in the United States. Patients’ opinions of technology-based tools for education and communication as related to Parkinson’s disease are unclear with little documented research addressing the issue. The goal of this research was to investigate patient opinions about technology-based tools with a focus on differences between patients of different age groups. Methods A cross-sectional survey was used to assess views on using multiple different electronic methods for receiving instructions and communicating with healthcare providers in 109 Parkinson’s disease patients. Results Approximately 28% (n = 28) of the subjects reported having unmet needs related to Parkinson’s disease. Those 65 and over were less likely to believe that using technology to communicate with the healthcare center would result in themselves having a better understanding of their care (odds ratio = 0.36, 95% confidence interval: 0.14, 0.95). Those over 75 had a lower odds of being willing to use electronic methods (odds ratio = 0.33, 95% confidence interval: 0.14, 0.79), a lower odds of believing that technology would result in better self-understanding of medical needs (odds ratio = 0.27, 95% confidence interval: 0.12, 0.63) and a lower odds of believing that technology would result in their healthcare providers better understanding their needs (odds ratio = 0.32, 95% confidence interval: 0.14, 0.73). Discussion The results of this study indicate that older Parkinson’s disease patients report a less favorable view regarding the role of technology in communicating with healthcare providers and for understanding their care.

Physician and medical student knowledge of hereditary cancer genetics in pediatrics

Introduction: The deficit in knowledge regarding pediatric cancer genetics along the medical training spectrum is unknown. Methods: 35 survey items were presented to 95 physicians and 145 students to evaluate their pediatric cancer syndrome knowledge. Results: There were several questions which the majority of students and physicians did not answer correctly. Physicians were less likely than students to know some aspects of pediatric hereditary cancer. Physicians with genetics training were more likely to answer some items correctly. Conclusions: Pediatric cancer genetics should be thoroughly addressed in medical school education and in CME training, as current knowledge may be limited. This may be an issue as the practicing physicians are the ones who are ultimately responsible for their patients. Correspondence to: Bhuma Krishnamachari, Department of Medicine, Department of Educational Development & Assessment, NYIT College of Osteopathic Medicine, Old Westbury, NY 11568, USA, Tel: 516-686-7564; Fax: 516-686-3834; E-mail: bkrishna@nyit.edu