Increased risk of many early-life diseases after surgical removal of adenoids and tonsils in childhood

2017 ◽  
Author(s):  
Sean G. Byars ◽  
Stephen C. Stearns ◽  
Jacobus J. Boomsma
Keyword(s):  
Absolute Risk ◽  
Surgical Removal ◽  
Adult Health ◽  
Immune Development ◽  
Relative Risks ◽  
Increased Risk ◽  
Disease Risks ◽  
Perioperative Risks ◽  
Lymphatic Organs

AbstractBACKGROUNDSurgical removal of the adenoids and tonsils are common pediatric procedures, with conventional wisdom suggesting their absence has little impact on health or disease. However, little is known about long-term health consequences beyond the perioperative risks. Such ignorance is significant, for these lymphatic organs play important roles in both the development and the function of the immune system.METHODSWe tested the long-term consequences of surgery in the population of Denmark by examining risk for 28 diseases with ̴1 million individuals followed from birth up to 30 years of age depending on whether any of three common surgeries (adenoidectomy, tonsillectomy, adenotonsillectomy) occurred in the first 9 years of life. To weigh costs and benefits, we also compared the absolute risks for these diseases to the risks for the conditions that these surgeries aimed to treat. We obtained robust results by using stratified Cox regressions with statistically well-powered samples of cases (with surgery) and controls (without surgery) whose general health was no different prior to surgery. We adjusted our estimates of risk for diseases occurring before surgery, stratified for sex (and other effects) and for 18 covariates, including parental disease history and birth metrics.RESULTSWe found significantly elevated relative risks for many diseases, with effects on respiratory, allergic and infectious disorders after removal of adenoids and tonsils being most pronounced. For some of these diseases, absolute risk increases were considerable. In comparison, many risks for conditions that surgeries aimed to treat were either not significantly different or significantly higher following surgery up to 30 years of age. This suggests that any immediate benefits of these surgeries may not continue longer-term, while resulting in slightly compromised early adult health due to significantly increased risk of many non-target diseases.CONCLUSIONSOur results indicate that surgical removal of tonsils and adenoids early in life are associated with longer-term health risks. They underline the importance of these organs and tissues for normal immune functioning and early immune development, and suggest that these longer-term disease risks may outweigh the short-term benefits of these surgeries.

scholarly journals Preeclampsia and the risk of chronic kidney disease: a national registry-based cohort study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P M Barrett ◽  
F P McCarthy ◽  
M Evans ◽  
M Kublickas ◽  
I J Perry ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Absolute Risk ◽  
Population Based ◽  
National Registry ◽  
Medical Birth Register ◽  
Increased Risk ◽  
History Of

Abstract Background Preeclampsia is associated with increased risk of future cardiovascular disease, but evidence for associations with chronic kidney disease (CKD) has been inconsistent to date. We aimed to measure associations between preeclampsia and long-term CKD in a population-based sample of parous women, and to identify whether the risk differs by CKD subtype. Methods Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used for analysis. Women with pre-pregnancy comorbidities were excluded. Results The dataset included 1,924,591 unique women who had 3,726,819 singleton pregnancies. The median follow-up was 20.7 (interquartile range 9.9-30.0) years. Overall, 90,964 women (4.7%) experienced preeclampsia and 18,146 (0.9%) developed CKD. Women who had preeclampsia had higher risk of developing any CKD during follow-up (aHR 1.88, 95% CI 1.79-1.98). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.76, aHR 3.09-4.57), diabetic CKD (aHR 3.45, 95% CI 2.83-4.21) and glomerular/proteinuric CKD (aHR 2.08, 95% CI 1.90-2.29). Women who had preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity were also at greater risk of any CKD. Conclusions Women with a history of preeclampsia are at increased risk of long-term CKD. The risk is most marked for hypertensive CKD, diabetic CKD, and glomerular/proteinuric CKD. The absolute risk of CKD related to preeclampsia is substantial, and these women may warrant systematic renal monitoring in the years following delivery. Key messages Preeclampsia is an independent predictor of long-term risk of chronic kidney disease in otherwise healthy parous women. Women with a history of preeclampsia may warrant systematic renal monitoring through additional blood pressure, blood glucose, and proteinuria checks.

scholarly journals Long-Term Follow-Up of Patients with Malignant Pedunculated Colon Polyps after Colonoscopic Polypectomy

2013 ◽  
Vol 27 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Hugh James Freeman
Keyword(s):  
Colon Cancer ◽  
Early Stage ◽  
Surgical Removal ◽  
Neoplastic Disease ◽  
Colon Polyps ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Malignant Polyps

BACKGROUND: Previously published studies have suggested that patients with resected colon cancer have an increased risk for early metachronous colon cancer. Current screening guidelines recommend intense surveillance by colonoscopy for the initial five years after the initial colon cancer has been resected. Information regarding endoscopically removed malignant polyps is limited.METHODS: In the present study, 25 consecutive patients (14 male, 11 female) with malignant pedunculated colon polyps treated with snare cautery polypectomy were followed for more than one decade up to 20 years. Five patients required an additional resection to ensure that removal of the original cancer was complete. Annual colonoscopies were planned for five years. If an adenoma was detected in the fifth year, colonoscopy was performed annually until no adenomas were detected. Otherwise, colonoscopy was planned every three years after five years.RESULTS: In the present study, there was no mortality from colon cancer and no patient developed either recurrent colon cancer or an early metachronous colon cancer during the initial five-year period of surveillance. Two patients (one male, one female) ultimately developed late cecal cancers almost one decade after the original colon cancers were resected. One had an early stage cancer that was resected, while the other had an infiltrating mucinous carcinoma complicating a small tubulovillous adenoma with extension to a single lymph node. After surgical removal and adjuvant chemotherapy, no further neoplastic disease has been detected.CONCLUSIONS: Overall, patients with malignant pedunculated polyps do extremely well if appropriately managed at the time of the initial polypectomy. Short-term outcomes after removal of a malignant polyp(s) appear to be similar to those with a nonmalignant polyp. However, late metachronous colon cancer may still occur. Long-term follow-up should be considered in each patient, assuming reasonable life expectancy, because risk of additional adenomas and metachronous colon cancer persists even after the initial five years of currently recommended surveillance. Patients with resected malignant polyps may represent a special patient subgroup that requires surveillance for more extended periods than current guidelines have recommended.

scholarly journals Splenectomy and the Incidence of Venous Thromboembolism and Sepsis In Patients with Immune Thrombocytopenia,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3284-3284 ◽  
Author(s):  
Ted Wun ◽  
Soames F. Boyle ◽  
Ann Brunson ◽  
Richard H. White
Keyword(s):  
Venous Thromboembolism ◽  
Research Funding ◽  
Immune Thrombocytopenia ◽  
Absolute Risk ◽  
Health Planning ◽  
Patient Discharge ◽  
Primary Prophylaxis ◽  
Therapeutic Decisions ◽  
Increased Risk

Abstract Abstract 3284 Introduction: Splenectomy is efficacious for many patients with chronic immune thrombocytopenia (ITP) refractory to initial corticosteroid therapy. However, there are concerns about short and long term complications, especially venous thromboembolism (VTE) and sepsis. Information regarding the incidence and risk factors for these complications might inform therapeutic decisions. Methods: Using the California Office of Statewide Health Planning and Development Patient Discharge Dataset, we identified all the records of Californians discharged with a diagnosis of ITP from 1991–2009. Similarly, all records with a procedure code for splenectomy, or principal or secondary diagnosis of VTE or sepsis were identified. The resultant datasets were then merged with the ITP dataset so that incident splenectomy, VTE, and sepsis could be determined for the ITP cohort. Results: A total of 37,780 unique patients were initially identified with an ITP code, of which 13,798 were in the principal position. Records where the first ITP code was on the same date as a splenectomy were then excluded as we wished to study a cohort of ITP cases that warranted admission but may or may not have undergone splenectomy later. This resulted in 10,752 cases that constitute the ITP analysis cohort. This cohort was 60% female, 57% White, 23% Hispanic, 9% Asian, and 8% African-American with a median age of 54 years. One thousand nine hundred fifty-five ITP patients underwent splenectomy subsequent to their first ITP hospitalization; 8,797 did not. The cumulative incidences of VTE were 4.4% and 1.8%, and for sepsis were 7.9% and 6.7%, for patients who did and did not undergo splenectomy, respectively. Cox proportional hazard models for VTE and sepsis are given in the tables. Discussion: In this large cohort of cases with ITP, splenectomy was associated with hazard ratios (HR) of 2.6 to 4.8 for VTE and a HR of 8.2 in older patients for sepsis, confirming the results of smaller studies. Age and diagnosis of lupus also increased the risk of VTE. Asians had a lower risk of VTE, consistent with previous findings. The absolute risk of VTE was < 5% and would not seem to warrant long-term primary prophylaxis. Age, lupus, and co-morbidities also increased the risk of sepsis in patients with ITP. The increased risk of sepsis in Asians is unexplained. Of note, the cumulative incidence of sepsis in patients that did not undergo splenectomy was still considerable and may have reflected the use of immunosuppressive therapy. Disclosures: Wun: Glycomimetics, Inc.: Research Funding; Eli Lilly, Inc.: Research Funding.

Long-term outcomes and secondary prevention after acute coronary events in patients with rheumatoid arthritis

2017 ◽  
Vol 76 (12) ◽  
pp. 2017-2024 ◽  
Author(s):  
Ängla Mantel ◽  
Marie Holmqvist ◽  
Tomas Jernberg ◽  
Solveig Wållberg-Jonsson ◽  
Johan Askling
Keyword(s):  
Rheumatoid Arthritis ◽  
Standard Of Care ◽  
Long Term Outcomes ◽  
Short Term ◽  
Coronary Syndrome ◽  
Relative Risks ◽  
Increased Risk ◽  
Coronary Events

ObjectivesPatients with rheumatoid arthritis (RA) are at increased risk of acute coronary syndrome (ACS) and suffer from poorer short-term outcomes after ACS. The aims of this study were to assess long-term outcomes in patients with RA with ACS compared with non-RA patients with ACS, and to investigate whether the use of secondary preventive drugs could explain any differences in ACS outcome.MethodsWe performed a cohort study based on 1135 patients with RA and 3184 non-RA patients who all developed an incident ACS between 2007 and 2010. We assessed 1-year and overall relative risks for ACS recurrence and mortality, as well as prescriptions of standard of care secondary preventive drugs.ResultsThe risk of ACS recurrence, and of mortality, was increased in RA, both at 1 year after adjusting for baseline comorbidities (HR=1.30(95% CI 1.04 to 1.62) and 1.38(95% CI 1.20 to 1.59), respectively) and throughout the complete (mean 2 years) follow-up (HR=1.27(95% CI 1.06 to 1.52) and 1.50(95% CI 1.34 to 1.68), respectively). Among certain subgroups of ACS, there was a tendency of lower usage of statins, whereas there were no apparent differences in others. The increased rates of ACS recurrence and mortality remained in subgroup analyses of individuals whose prescription pattern indicated both adequate initiation and persistence to secondary preventive treatments.ConclusionsPatients with RA suffer from an increased risk of ACS recurrence and of death following ACS compared with general population, which in the present study could not readily be explained by differences in usage of secondary preventive drugs.

Prenatal exposure to hyperemesis gravidarum linked to increased risk of psychological and behavioral disorders in adulthood

2011 ◽  
Vol 2 (4) ◽  
pp. 200-204 ◽  
Author(s):  
P. M. Mullin ◽  
A. Bray ◽  
F. Schoenberg ◽  
K. W. MacGibbon ◽  
R. Romero ◽  
...  
Keyword(s):  
Behavioral Disorders ◽  
Maternal Stress ◽  
Hyperemesis Gravidarum ◽  
In Utero ◽  
Behavioral Disorder ◽  
Adult Health ◽  
Fetal Exposure ◽  
Long Term Outcome ◽  
Increased Risk

Hyperemesis gravidarum (HG), severe nausea and vomiting of pregnancy, is characterized by long-term maternal stress, undernutrition and dehydration. While maternal stress and malnutrition of pregnancy are linked to poor neonatal outcome and associated with poor adult health, long-term outcome of fetal exposure to HG has never been explored. The purpose of this study is to determine whether long-term emotional and behavioral diagnoses may be associated with fetal exposure to HG. Emotional and behavioral diagnoses of adults born of a pregnancy complicated by HG were compared to diagnoses from non-exposed controls. Offspring exposed to HG in utero were significantly more likely to have a psychological and behavioral disorder (OR = 3.6, P < 0.0001) with diagnoses primarily of depression, bipolar disorder and anxiety. In utero exposure to HG may lead to increased risks of psychological and behavioral disorders in the offspring.

Long-Term Outcomes of Small for Gestational Age Twins Born at 34 Weeks or Later

2017 ◽  
Vol 35 (03) ◽  
pp. 254-261 ◽  
Author(s):  
Nola Herlihy ◽  
Elizabeth Odom ◽  
Natalie Cohen ◽  
Annemarie Stroustrup ◽  
Andrei Rebarber ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Cardiac Disease ◽  
Speech Therapy ◽  
Absolute Risk ◽  
Adverse Outcomes ◽  
Long Term Outcomes ◽  
Increased Risk

Objective This article aims to compare long-term neurodevelopmental and health outcomes of twins born at 34 weeks or later, based on the presence of small for gestational age (SGA). Study Design This study is a mail-based survey of twin gestations delivered by a single practice. We compared twins with and without SGA delivered at ≥34 weeks. There were two primary outcomes for this study: a composite of major adverse outcomes (death; cerebral palsy; necrotizing enterocolitis; chronic renal, heart, or lung disease) and a composite of minor adverse outcomes (learning disability, speech therapy, occupational therapy, physical therapy). Regression analysis was performed to control for clustering of outcomes within twin pairs. Results A total of 712 children were included. Comparing twins with birthweights <10% to ≥10%, there were no significant differences in rates of composite major morbidities (3.2 vs. 1.4%, p = 0.109) or composite minor morbidities (43.6 vs. 39.3%, p = 0.279). Comparing twins with birthweights <5% to ≥5%, the rates of major morbidities were low in both groups, but significantly higher in the group with birthweights <5% (4.4 vs. 1.6%, p = 0.046). There were no significant differences seen in the composite minor morbidities (46.7 vs. 39.7%, p = 0.134). Twins with birthweights <5% were significantly more likely to have childhood cardiac disease (2.9 vs. 0.7%, p = 0.041). Conclusion Twins with SGA <10% born at ≥34 weeks have similar long-term neurodevelopmental and health outcomes compared with twins with normal birthweights. Birthweight less than 5th percentile is associated with an increased risk of major morbidity, specifically cardiac disease, but the absolute risk is low.

scholarly journals Familial risk of urinary incontinence in women: population based cross sectional study

BMJ ◽  
2004 ◽  
Vol 329 (7471) ◽  
pp. 889-891 ◽  
Author(s):  
Yngvild S Hannestad ◽  
Rolv Terje Lie ◽  
Guri Rortveit ◽  
Steinar Hunskaar
Keyword(s):  
Urinary Incontinence ◽  
Stress Incontinence ◽  
Absolute Risk ◽  
Population Based ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mixed Incontinence ◽  
Relative Risks ◽  
Increased Risk

Abstract Objective To determine whether there is an increased risk of urinary incontinence in daughters and sisters of incontinent women. Design Population based cross sectional study. Setting EPINCONT (the epidemiology of incontinence in the county of Nord-Trøndelag study), a substudy of HUNT 2 (the Norwegian Nord-Trøndelag health survey 2), 1995-7. Participants 6021 mothers, 7629 daughters, 332 granddaughters, and 2104 older sisters of 2426 sisters. Main outcome measures Adjusted relative risks for urinary incontinence. Results The daughters of mothers with urinary incontinence had an increased risk for urinary incontinence (1.3, 95% confidence interval 1.2 to 1.4; absolute risk 23.3%), stress incontinence (1.5, 1.3 to 1.8; 14.6%), mixed incontinence (1.6, 1.2 to 2.0; 8.3%), and urge incontinence (1.8, 0.8 to 3.9; 2.6%). If mothers had severe symptoms then their daughters were likely to have such symptoms (1.9, 1.3 to 3.0; 4.0%). The younger sisters of female siblings with urinary incontinence, stress incontinence, or mixed incontinence had increased relative risks of, respectively, 1.6 (1.3 to 1.9; absolute risk 29.6%), 1.8 (1.3 to 2.3; 18.3%), and 1.7 (1.1 to 2.8; 10.8%). Conclusion Women are more likely to develop urinary incontinence if their mother or older sisters are incontinent.

scholarly journals Body Mass Index and Risk of Hypertension: 8-Year Prospective Findings From a Nationwide Thai Cohort Study

2019 ◽  
Vol 11 (3) ◽  
pp. 91
Author(s):  
Prasutr Thawornchaisit ◽  
Ferdinandus de Looze ◽  
Christopher M Reid ◽  
Sam-ang Seubsman ◽  
Adrian Sleigh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Thai Population ◽  
Relative Risks ◽  
Health Gains ◽  
Increased Risk ◽  
Multivariable Regression ◽  
Thai People ◽  
Expected Benefits ◽  
Questionnaire Surveys

OBJECTIVE: As Thailand modernizes an ensuing health risk transition associates with rising chronic non-communicable diseases, especially hypertension. This is a driving force for emerging vascular disease, especially stroke and hypertension. Studies in other countries have shown hypertension is associated with obesity. Longitudinal information is needed forthailand and here we present our cohort data collected over 8 years And recording incidence of hypertension and exposure to elevated abnormal BMI. DESIGN &amp; METHODS: BMI effects on incident hypertension were investigated prospectively in a nationwide Thai Cohort Study (TCS) from 2005 to 2013. Data were derived from 42 785 off-campus Sukhothai Thammathirat Open University students returning mail-based questionnaire surveys in both 2005 and 2013. Participants analysed were normotensive at the start (40 548). Multivariable regression estimated adjusted relative risks estimate linking obesity (measured by BMI) and hypertension (self-reported) among Thai men and women. RESULTS: In Thailand from 2005 to 2013 the TCS 8-Year Incidence of hypertension was 5.1% (men 7.1%, women 3.6%), which meant 1958 participants developed hypertension. BMI was directly associated with an increased risk of hypertension. Compared to participants with a normal BMI (18.5-22.9 Kg/M2), The relative risks (95% confidence interval) of developing hypertension with a BMI of &le; 18.5.23.0&ndash;24.9, 25-29.9 and &gt;30 Kg/m2 were 0.54 (0.3-0.97), 1.8(1.49-2.18), 3.27 (2.73-3.91) and 6.73 (5.1-8.97) for men and 0.65 (0.45-0.95), 2.28 (1.81-2.88), 3.71 (2.96-4.64) and 9.72 (7.09-13.32) for women respectively (p-trend &lt;0.0001). CONCLUSION: Our data confirmed the adverse effects of long-term high bmi on an increased risk of hypertension in Thai people. Therefore, Ministry of Public Health should develop a national program to encourage people to remain healthy with a normal BMI. There are many health gains from such a program and the information presented here shows clearly that decreased hypertension would be one of the expected benefits for the Thai population.

scholarly journals Nutritional Surveillance for the Best Start in Life, Promoting Health for Neonates, Infants and Children

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3386
Author(s):  
Valeria Calcaterra ◽  
Hellas Cena ◽  
Elvira Verduci ◽  
Alessandra Bosetti ◽  
Gloria Pelizzo ◽  
...  
Keyword(s):  
Early Life ◽  
Maternal Nutrition ◽  
Noncommunicable Diseases ◽  
Life Cycle Approach ◽  
Adult Health ◽  
Disease Manifestation ◽  
Increased Risk ◽  
Nutritional Surveillance

This Special Issue aims to examine the crucial role of nutritional status starting from pregnancy in modulating fetal, neonatal and infant growth and metabolic pathways, with potential long-term impacts on adult health. Poor maternal nutritional conditions in the earliest stages of life during fetal development and early life may induce both short-term and longer lasting effects; in particular, an increased risk of noncommunicable diseases (NCDs) and other chronic diseases such as obesity, which itself is a major risk factor for NCDs, is observed over the lifespan. Poor maternal nutrition affects the fetal developmental schedule, leading to irreversible changes and slowdown in growth. The fetus limits its size to conserve the little energy available for cardiac functions and neuronal development. The organism will retain memory of the early insult, and the adaptive response will result in pathology later on. Epigenetics may contribute to disease manifestation affecting developmental programming. After birth, even though there is a limited evidence base suggesting a relationship between breastfeeding, timing and type of foods used in weaning with disease later in life, nutritional surveillance is also mandatory in infants in the first year of life. We will explore the latest findings on nutrition in early life and term and preterm babies, as well as the role of malnutrition in the short- and long-term impact over the lifespan. Focusing on nutritional interventions represents part of an integrated life-cycle approach to prevent communicable and non-communicable diseases.

scholarly journals The health outcomes of human offspring conceived by assisted reproductive technologies (ART)

2017 ◽  
Vol 8 (4) ◽  
pp. 388-402 ◽  
Author(s):  
M. Chen ◽  
L. K. Heilbronn
Keyword(s):  
Health Outcomes ◽  
Assisted Reproductive Technologies ◽  
Perinatal Outcomes ◽  
Reproductive Technologies ◽  
Adult Health ◽  
Increased Risk ◽  
Increase Risk ◽  
Potential Factors ◽  
Underlying Mechanisms

Concerns have been raised about the health and development of children conceived by assisted reproductive technologies (ART) since 1978. Controversially, ART has been linked with adverse obstetric and perinatal outcomes, an increased risk of birth defects, cancers, and growth and development disorders. Emerging evidence suggests that ART treatment may also predispose individuals to an increased risk of chronic ageing related diseases such as obesity, type 2 diabetes and cardiovascular disease. This review will summarize the available evidence on the short-term and long-term health outcomes of ART singletons, as multiple pregnancies after multiple embryos transfer, are associated with low birth weight and preterm delivery, which can separately increase risk of adverse postnatal outcomes, and impact long-term health. We will also examine the potential factors that may contribute to these health risks, and discuss underlying mechanisms, including epigenetic changes that may occur during the preimplantation period and reprogram development in utero, and adult health, later in life. Lastly, this review will consider the future directions with the view to optimize the long-term health of ART children.

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