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Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids

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World Journal of Gastroenterology 2017年第11期23卷 2052-2059页

作者： Ashwin D Dhanda Ashish Sinha Vicky Hunt sarah saleem Matthew E Cramp Peter L Collins Institute of Translational and Stratified Medicine Plymouth University Peninsula Schools of Medicine and Dentistry South West Liver Unit Plymouth Hospitals NHS Trust Department of Liver Medicine University Hospitals Bristol NHS Foundation Trust

AIM To determine whether infection in patients with acute severe alcoholic hepatitis(AAH) treated with corticosteroids is associated with increased *** Consecutive patients with AAH were treated with steroids and recruited to the study. Clinically relevant infections(body temperature > 38 ℃ or 0.25 ×109/L, consolidation on chest radiograph or clinically relevant positive microbiological culture of bodily fluid) were recorded prospectively. Clinical and laboratory parameters were recorded and survival at 90 d and 6 mo was determined. Univariate analysis of factors associated with 90-d mortality was performed and significant variables included in a multivariate *** Seventy-two patients were included in the final analysis(mean age 47.9 years, 26% female, mean discriminant function 53.0). Overall mortality in the group occurred in 15(21%), 23(32%) and 31(43%) at day 28, day 90 and 1 year respectively. 36(50%) had a clinically relevant infection during their hospitalisation(23 after initiation of steroids). The median time to development of incident infection after commencement of steroids was 10 d. The commonest site of infection was ascites(31%) and bacteraemia(31%) followed by urinary tract(19%) and respiratory tract(8%). Forty-one separate organisms were isolated in 33 patients; the most frequent genus was Escherichia(22%) and Enterococcus(20%). Infection was not associated with 90-d or 1 year mortality but was associated with higher creatinine, model for end-stage liver disease and Lille score. Baseline urea was the only independent predictor of 90-d *** Clinically relevant infections are common in patients with AAH but are not associated with increased 90-d or 1 year mortality.

关键词： Alcoholic hepatitis Escherichia Infection Lille score Corticosteroids

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Association of Obesity with Infertility among Pakistani Men: A Case Control Study

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Open Journal of Epidemiology 2015年第3期5卷 204-215页

作者： Nida Zahid sarah saleem Iqbal Azam Tariq Moatter Department of Community Health Sciences Aga Khan University Karachi Pakistan Department of Pathology Aga Khan University Karachi Pakistan

Background: The reported prevalence of infertility in Pakistan is 21% of which 35% is contributed by male factor. Male infertility has multifactorial etiologies ranging from modifiable to genetic risk factors. Among all the risk factors that may account for male infertility, obesity is one of the emerging public health problems. Therefore, the aim of the study was to determine the association of obesity with infertility in Pakistani men. Methods: We conducted a case control study. Cases were men with impaired semen parameters and controls did not have impaired semen parameters. Results: The final multivariable logistic regression model after adjusting for the effect of other variables revealed that with every 1 kg/m2 increase in BMI the odds of being infertile was 6% higher as compared to being fertile (aOR = 1.06;95% CI = 1.01, 1.11). Moreover the odds of having education of higher secondary or above was 3 times greater among cases as compared with the controls (OR = 3.10;95% CI = 1.66, 5.77). Furthermore the odds of having previous medical conditions increasing the risk of infertility was higher among cases as compared with the controls (OR = 3.07;95% CI = 1.63, 5.79). Conclusion & recommendations: This study indicates that obesity is an important risk factor for male infertility. Moreover our findings also indicate that higher educational status and previous medical conditions are also associated with male infertility. Thus awareness can be raised through treating physicians and public health messages.

关键词： Male Infertility Obesity

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Geographic Access to Working Family Planning Centers and Unintended Pregnancies among Married Women: A Community Based Nested Case Control Study

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Open Journal of Epidemiology 2016年第1期6卷 95-108页

作者： Sumera Aziz Ali sarah saleem Neelofar Sami Mir Shabbar Muhammad Ahmed Shafquat Rozi Robert L. Goldenberg Margo S. Harrison Omrana Pasha Department of Community Health Sciences Aga Khan University Karachi Pakistan Willows Foundation Karachi Pakistan Department of Urban and Infrastructure Engineering NED University Karachi Pakistan Department of OB/GYN Columbia University Medical Center New York USA

Background: Unintended pregnancies pose substantial risk to mothers and children. In Pakistan, unintended pregnancies account for 46% of all pregnancies. Lack of geographic access to open and well-supplied family planning (FP) centers may be related to the occurrence of such pregnancies, particularly in rural areas. Objective: The objective of this analysis is to determine if geographic access to family planning centers in the Thatta district of Pakistan is related to unintended pregnancy rates among married women. Methods: We conducted a community-based, nested case-control study of 800 pregnant women identified from the database of an active surveillance system, which registers and follows all pregnant women in the catchment area of Thatta district. Women were enrolled during the first trimester;those that reported their pregnancy to be unintended were selected as cases (n = 200), and those whose pregnancies were intended served as controls (n = 600). We defined geographic access as including both the distance of a family planning center from the woman’s home, and availability of personal transportation. Logistic regression was used for analysis. Results: In the multivariate model, neither distance [OR = 1.0;95% CI (0.95 - 1.05)] nor availability of transportation [OR = 1.14;95% CI (0.78 - 1.67)] were significantly associated with unintended pregnancy. In fact, women with unintended pregnancies were more likely to be aware of family planning [OR = 2.21;95% CI (1.23 - 3.97)] and more likely to have been using a contraceptive method before conceiving their index pregnancy [OR = 3.59;95% CI (1.83 - 7.06)]. Other factors related to unintended pregnancy were older maternal age [OR = 1.13;95% CI (1.08 - 1.17)], having already had at least one son [OR = 3.13;95% CI (1.93 - 5.07)];spousal opposition to contraceptive use, [OR = 3.24;95% CI (1.89 - 5.56)] and low spousal education level [OR = 1.85;95% CI (1.08 - 3.18)] as compared to women with intended pregnancy. Conclusio

关键词： Unintended Pregnancy Geographic Access Family Planning

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