Zuber D. Mulla

Malignant tumors of the orbit: Analysis of the Florida cancer registry

PURPOSE The purpose of the study is to determine the relative frequency and incidence of primary malignant tumors of the orbit occurring in Florida. METHODS Cases of primary orbital malignancy were identified in the Florida Cancer Data System registry from 1981 through 1993. Analysis was restricted to persons who reside within the state. RESULTS Three hundred fourteen primary orbital malignancies were reported; 55% of malignant orbital tumors were lymphoma. The average annual incidence for all malignancies was 2 cases per million. There was a steady increase in the annual incidence of orbital malignancy during the 13 years of the study. Lymphoma showed the greatest rise in annual incidence. The average annual incidence of lymphoma increased 166% the last 6 years of the study compared to the first 6 years. CONCLUSIONS A large increase in orbital lymphoma was documented in the Florida cancer registry from 1981 through 1993. The increase in incidence cannot be explained by improved compliance in reporting or by the small increase in incidence of systemic lymphoma during the survey period. Additional studies are needed to determine whether the observed increase in incidence in orbital lymphoma is genuine or spurious.

Invasive group A streptococcal infections in Florida.

Background Several previous studies of invasive Group A streptococcal (GAS) disease have been hindered by small sample sizes (≤ 100 patients) and limited generalizability. Methods We conducted a population-based study of invasive GAS disease. The objectives of the study were to describe the clinical features of individuals who were hospitalized for invasive GAS disease and to identify risk factors for hospital mortality. The cases were 257 patients who were hospitalized throughout Florida during a 4-year period and reported to the Florida Department of Health. Logistic regression was used to calculate adjusted odds ratios (OR) for mortality and 95% confidence intervals (CI). Results The overall mortality was 18% (41 of 228). Admission into an intensive care unit was a strong predictor of mortality (OR, 20.41; 95% CI, 6.41–64.96). Treatment with clindamycin reduced mortality in patients who had necrotizing fasciitis (OR, 0.11; 95% CI, 0.01–0.89) but not in patients who did not have necrotizing fasciitis (OR, 1.01; 95% CI, 0.31–3.33). Conclusion Clindamycin reduces mortality in patients with invasive GAS disease who have necrotizing fasciitis.

Elevated antiphospholipid antibody titers and adverse pregnancy outcomes: analysis of a population-based hospital dataset.

BackgroundThe primary objective of this study was to determine if elevated antiphospholipid antibody titers were correlated with the presence of preeclampsia/eclampsia, systemic lupus erythematosus (SLE), placental insufficiency, and a prolonged length of stay (PLOS), in women who delivered throughout Florida, USA.MethodsCross-sectional analyses were conducted using a statewide hospital database. Prevalence odds ratios (OR) were calculated to quantify the association between elevated antiphospholipid antibody titers and four outcomes in 141,286 women who delivered in Florida in 2001. The possibility that the relationship between elevated antiphospholipid antibody titers and the outcomes of preeclampsia/eclampsia, placental insufficiency, and PLOS, may have been modified by the presence of SLE was evaluated in a multiple logistic regression model by creating a composite interaction term.ResultsWomen with elevated antiphospholipid antibody titers (n = 88) were older, more likely to be of white race and not on Medicaid than women who did not have elevated antiphospholipid antibody titers. Women who had elevated antiphospholipid antibody titers had an increased adjusted odds ratio for preeclampsia and eclampsia, (OR = 2.93 p = 0.0015), SLE (OR = 61.24 p < 0.0001), placental insufficiency (OR = 4.58 p = 0.0003), and PLOS (OR = 3.93 p < 0.0001). Patients who had both an elevated antiphospholipid antibody titer and SLE were significantly more likely than the comparison group (women without an elevated titer who did not have SLE) to have the outcomes of preeclampsia, placental insufficiency and PLOS.ConclusionThis exploratory epidemiologic investigation found moderate to very strong associations between elevated antiphospholipid antibody titers and four important outcomes in a large sample of women.

Incidence of surgically treated uveal melanoma by race and ethnicity

OBJECTIVE The purpose of the study was to determine the race- and ethnicity-specific incidence of histologically confirmed uveal melanoma. DESIGN The study design was a retrospective study of histologically confirmed cases of primary uveal melanoma submitted to the Florida Cancer Data System (FCDS). MAIN OUTCOME MEASURES Race-, gender-, and Hispanic-specific incidence rates of uveal melanoma were measured. Calculations are based on Florida census data and Hispanic population estimates from the University of Florida Bureau of Economic and Business Research. RESULTS From 1981 through 1993, 873 histologically confirmed uveal melanomas were reported to the FCDS. Four melanomas occurred in black non-Hispanics, 47 in white Hispanics, and none in black Hispanics. The relative risk of uveal melanoma for blacks compared to non-Hispanic whites was 0.03 (95% confidence interval, 0.01-0.08). Non-Hispanic white men had 72 times the risk of uveal melanoma compared to black men; non-Hispanic white women experienced a 22-fold risk compared to black women. White Hispanics were less likely to develop uveal melanoma than white non-Hispanics (relative risk, 0.36; 95% confidence interval, 0.27-0.48). CONCLUSION The risk of uveal melanoma in blacks is exceptionally low. The reason for lower risk of uveal melanoma in white Hispanics than in white non-Hispanics is not known but could be related to the protective effects associated with dark skin pigmentation or may be because of unknown cultural-environmental exposures or socioeconomic factors.

Primary Malignancies of the Thyroid: Epidemiologic Analysis of the Florida Cancer Data System Registry

PURPOSE Descriptive epidemiology of thyroid cancer in Florida. METHODS The Florida Cancer Data System (FCDS) registry was used to identify patients with the different histologic subtypes of thyroid cancer occurring in Florida from 1981 through 1993. RESULTS The FCDS recorded 5746 primary malignancies of the thyroid. The average annual incidence of all types of thyroid cancer was 37.0 cases/1,000,000 population. One type of thyroid cancer (papillary carcinoma) accounted for the overall increase during the 13 years of this study. There was no difference in incidence based on Hispanic ethnicity, but the incidence in Blacks was half that of Whites, and Blacks showed less advanced disease at the time of diagnosis. CONCLUSIONS The increase in incidence of only one histologic type of thyroid cancer suggests that the increasing rate is not an artifact related to the utilization of new diagnostic technologies. The lower incidence and tendency to have less advanced thyroid cancer in Blacks would indicate that racial differences in thyroid cancer are not likely explained by socioeconomic factors such as access to medical care. A substantial amount of the difference in incidence between Whites and Blacks is explained by differences in age distribution.

Correlates of length of stay, cost of care, and mortality among patients hospitalized for necrotizing fasciitis

Several previous studies of necrotizing fasciitis (NF) have been single-institution investigations suffering from small samples sizes. This study of 216 NF patients hospitalized in Florida, USA, during 2001 was designed to identify risk factors for length of stay (LOS), total patient charges (TC), and mortality, using a statewide database. Robust gamma mixed regression was used to determine the predictors of LOS and TC while simultaneously accounting for outliers and the clustering of patients in 87 hospitals. Relative risks (RR) for hospital mortality were calculated using binomial regression. The NF hospitalization rate in Florida was 1.3/100,000. The median TC was US

Perspectives on Anaphylaxis Epidemiology in the United States with New Data and Analyses

54,533 and cumulative charges for all 216 patients were nearly US

Therapies for necrotising fasciitis

20 million. Patients aged > or =44 years at the time of admission were five times as likely to expire in the hospital than patients who were aged < or =43 years (adjusted RR 5.08, P=0.03). Unexpectedly, diabetes was associated with a 61% reduction in the risk of hospital mortality (adjusted RR 0.39, P=0.04). Age > or =44 years was the most powerful predictor of prolonged LOS, elevated TC, and an increased risk of hospital mortality in patients suffering from NF.

Anaphylaxis in the obstetric patient: analysis of a statewide hospital discharge database

Anaphylaxis incidence rates and time trends in the United States have been reported using different data sources and selection methods. Larger studies using diagnostic coding have inherent limitations in sensitivity and specificity. In contrast, smaller studies using chart reviews, including reports from single institutions, have better case characterization but suffer from reduced external validity due to their restricted nature. Increasing anaphylaxis hospitalization rates since the 1990s have been reported abroad. However, we report no significant overall increase in the United States. There have been several reports of increasing anaphylaxis rates in northern populations in the United States, especially in younger people, lending support to the suggestion that higher anaphylaxis rates occur at higher latitudes. We analyzed anaphylaxis hospitalization rates in comparably sized northern (New York) and southern (Florida) states and found significant time trend differences based on age. This suggests that the relationship of latitude to anaphylaxis incidence is complex.

The Reliability of Clinical Methods in Ophthalmology

Necrotising fasciitis is a rare but life-threatening infectious disease emergency. Delays in diagnosis and treatment are common, and mortality rates often exceed 30%. Successful management of this disease requires high clinical suspicion and aggressive action. The mainstays of therapy include early and wide surgical debridement, antibiotics and supportive care, with prompt surgical intervention. Adjunctive modalities, such as protein synthesis inhibitors, hyperbaric oxygen and intravenous immunoglobulin, may have a role, but their effectiveness remains unproven. New rapid diagnostic tools are emerging that promise to revolutionise early detection of necrotising fasciitis. Research into the molecular microbiology, especially regarding group A streptococcus, are providing novel insights into the pathogenesis of necrotising soft tissue infections and identifying future targets for rationally designed interventions.