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Association Between the Most Frequent Complications After Surgery for Stage I–III Colon Cancer and Short-Term Survival, Long-Term Survival, and Recurrences
Background
The purpose of this study was to identify the ten most frequent complications after surgery for stage I–III colon cancer and to assess the association between these complications and overall survival, conditional overall survival, and recurrences.
Methods
All patients who underwent surgery for stage I–III colon cancer in five hospitals in the Western region of the Netherlands were identified. Crude and adjusted Cox proportional hazards models were used to study the association between complications and 1-year overall survival, 5-year overall survival, 5-year conditional overall survival, and 5-year disease-free period.
Results
Data from 761 patients were used for the analyses. Complications were associated with decreased 1-year overall survival (hazard ratio (HR) 2.87, 95 % confidence interval (CI) 1.82–4.51;
p
< 0.001), 5-year overall survival (HR 1.59, 95 % CI 1.25–2.04;
p
< 0.001), and 5-year conditional overall survival (HR 1.34, 95 % CI 1.06–1.69;
p
= 0.016), whereas an increasing number of complications had no additional impact. Anastomotic leakage, excessive blood loss, and (abdominal) sepsis were associated with reduced 1-year overall survival, anastomotic leakage, delirium, abscess, and (abdominal) sepsis with reduced 5-year overall survival, and anastomotic leakage, delirium, and abscess with reduced 5-year conditional overall survival. Anastomotic leakage, electrolyte disorders, and abscess were risk factors for recurrence within five years.
Conclusions
Our results demonstrate the serious impact of the most frequent complications after surgery for colon cancer on short-term and long-term outcomes. This study confirms the prolonged impact of surgery and demonstrates that complications result not only in reduced 1-year survival, but also in reduced long-term outcomes.
Journal Article
The origins of health and disease
\"Some phenomena in medicine and psychology remain unexplained by current theory. Chronic fatigue syndrome, repetitive strain injury and irritable bowel syndrome, for example, are all diseases or syndromes that cannot be explained in terms of a physiological abnormality. In this intriguing book, Michael Hyland proposes that there is a currently unrecognised type of illness which he calls 'dysregulatory disease'. Hyland shows how such diseases develop and how the communication and art of medicine, good nursing care, complementary medicine and psychotherapy can all act to reduce the dysregulation that leads to dysregulatory disease. The Origins of Health and Disease develops a novel theory for understanding health and disease, demonstrates how this theory is supported by existing data and how it explains currently unexplained phenomena. Hyland also shows how his theory leads to new testable predictions that, in turn, will lead to further scientific advancement and development\"--Provided by publisher.
Book
Glycemia Reduction in Type 2 Diabetes — Microvascular and Cardiovascular Outcomes
In a secondary analysis comparing the effect of insulin glargine, glimepiride, liraglutide, and sitagliptin, added to metformin, on the incidences of microvascular complications and death, no material between-group differences were seen.
Journal Article
Frailty as Tested by Gait Speed is an Independent Risk Factor for Cirrhosis Complications that Require Hospitalization
Frailty is a known risk factor for major life-threatening liver transplant complications, deaths, and waitlist attrition. Whether frailty indicates risk for adverse outcomes in cirrhosis short of lethality is not well defined. We hypothesized that clinical measurements of frailty using gait speed and grip strength would indicate the risk of subsequent hospitalization for the complications of cirrhosis.
We assessed frailty as gait speed and grip strength in a 1-year prospective study of 373 cirrhotic patients evaluated for or awaiting liver transplantation. We determined its association with the outcome of subsequent hospital days/100 days at risk for 7 major complications of cirrhosis. We tested potential covariate influences of Model for Endstage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores, age, sex, height, depression, narcotic use, vitamin D deficiency, and hepatocellular carcinoma using multivariable modeling.
Patients experienced 2.14 hospital days/100 days at risk, or 7.81 days/year. Frailty measured by gait speed was a strong risk factor for hospitalization for all cirrhosis complications. Each 0.1 m/s gait speed decrease was associated with 22% greater hospital days (P<0.001). Grip strength showed a similar but nonsignificant association. Gait speed remained independently significant when adjusted for MELD, CTP, and other covariates. At hospital costs of $4,000/day, patients with normal 1 m/s gait speed spent 6.2 days and $24,800/year; patients with 0.5 m/s speed spent 21.2 days and $84,800/year; and patients with 0.25 m/s speed spent 40.2 days and $160,800/year.
Frailty as measured by gait speed is an independent and potentially modifiable risk factor for cirrhosis complications requiring hospitalization. The potential clinical value of frailty measurements to help define such risk merits broader evaluation.
Journal Article
Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic
Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological, neuropsychiatric and psychological effects. This review aims to analyze them with a discussion of evolving therapeutic recommendations.
PubMed and Google Scholar were searched from 1 January 2020 to 30 May 2020 with the following key terms: \"COVID-19\", \"SARS-CoV-2\", \"pandemic\", \"neuro-COVID\", \"stroke-COVID\", \"epilepsy-COVID\", \"COVID-encephalopathy\", \"SARS-CoV-2-encephalitis\", \"SARS-CoV-2-rhabdomyolysis\", \"COVID-demyelinating disease\", \"neurological manifestations\", \"psychosocial manifestations\", \"treatment recommendations\", \"COVID-19 and therapeutic changes\", \"psychiatry\", \"marginalised\", \"telemedicine\", \"mental health\", \"quarantine\", \"infodemic\" and \"social media\". A few newspaper reports related to COVID-19 and psychosocial impacts have also been added as per context.
Neurological and neuropsychiatric manifestations of COVID-19 are abundant. Clinical features of both central and peripheral nervous system involvement are evident. These have been categorically analyzed briefly with literature support. Most of the psychological effects are secondary to pandemic-associated regulatory, socioeconomic and psychosocial changes.
Neurological and neuropsychiatric manifestations of this disease are only beginning to unravel. This demands a wide index of suspicion for prompt diagnosis of SARS-CoV-2 to prevent further complications and mortality.
Journal Article
The biology of desire : why addiction is not a disease
\"Neuroscientist Lewis (Memoirs of an Addicted Brain) presents a strong argument against the disease model of addiction, which is currently predominant in medicine and popular culture alike, and bolsters it with informative and engaging narratives of addicts' lives ... Even when presenting more technical information, Lewis shows a keen ability to put a human face on the most groundbreaking research into addiction. Likewise, he manages to make complex findings and theories both comprehensible and interesting...This book, written with hopeful sincerity, will intrigue both those who accept its thesis and those who do not.\"-- Publishers Weekly.
Book
Oral complications of cancer and cancer therapy: From cancer treatment to survivorship
Oral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long-term oral health and general well-being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long-term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long-term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. [PUBLICATION ABSTRACT]
Journal Article