Impact of vitamin D on the hospitalization rate of Crohn's disease patients seen at a tertiary care center

AIM To study the association between vitamin D level and hospitalization rate in Crohn's disease(CD) patients.METHODS We designed a retrospective cohort study using adult patients(> 19 years) with CD followed for at least one year at our inflammatory bowel disease center. Vitamin D levels were divided into: low mean vitamin D level(< 30 ng/m L) vs appropriate mean vitamin D level(30-100 ng/m L). Generalized Poisson Regression Models(GPR) for Rate Data were used to estimate partially adjusted and fully adjusted incidence rate ratios(IRR) of hospitalization among CD patients. We also examined IRRs for vitamin D level as a continuous variable.RESULTS Of the 880 CD patients, 196 patients with vitamin D level during the observation period were included. Partially adjusted model demonstrated that CD patients with a low mean vitamin D level were almost twice more likely to be admitted(IRR = 1.76, 95%CI: 1.38-2.24) compared to those with an appropriate vitamin D level. The fully adjusted model confirmed this association(IRR = 1.44, 95%CI: 1.11-1.87). Partially adjusted model with vitamin D level as a continuous variable demonstrated,higher mean vitamin D level was associated with a 3% lower likelihood of admission with every unit(ng/m L) rise in mean vitamin D level(IRR = 0.97, 95%CI: 0.96-0.98). The fully adjusted model confirmed this association(IRR = 0.98, 95%CI: 0.97-0.99). CONCLUSION Normal or adequate vitamin D stores may be protective in the clinical course of CD. However, this role needs to be further characterized and understood.

Increasing pancreatic cancer is not paralleled by pancreaticoduodenectomy volumes in Brazil:A time trend analysis

Background: Currently, surgical resection represents the only curative treatment for pancreatic cancer(PC), however, the majority of tumors are no longer resectable by the time of diagnosis. The aim of this study was to describe time trends and distribution of pancreaticoduodenectomies(PDs) performed for treating PC in Brazil in recent years. Methods: Data were retrospectively obtained from Brazilian Health Public System(namely DATASUS) regarding hospitalizations for PC and PD in Brazil from January 2008 to December 2015. PC and PD rates and their mortalities were estimated from DATASUS hospitalizations and analyzed for age, gender and demographic characteristics. Results: A total of 2364 PDs were retrieved. Albeit PC incidence more than doubled, the number of PDs increased only 37%. Most PDs were performed in men(52.2%) and patients between 50 and 69 years old(59.5%). Patients not surgically treated and those 70 years or older had the highest in-hospital mortality rates. The most developed regions(Southeast and South) as well as large metropolitan integrated municipalities registered 76.2% and 54.8% of the procedures, respectively. LMIM PD mortality fluctuated, ranging from 13.6% in 2008 to 11.8% in 2015. Conclusions: This study suggests a trend towards regionalization and volume-outcome relationships for PD due to PC, as large metropolitan integrated municipalities registered most of the PDs and more stable mortality rates. The substantial differences between PD and PC increasing rates reveals a limiting step on the health system resoluteness. Reduction in the number of hospital beds and late access to hospitalization, despite improvement in diagnostic methods, could at least in part explain these findings.