Prevalence and clinical risk factors for esophageal candidiasis in non-human immunodeficiency virus patients:A multicenter retrospective case-control study

BACKGROUND Although esophageal candidiasis(EC)may manifest in immunocompetent individuals,there is a lack of consensus in the current literature about predisposing conditions that increase the risk of infection.AIM To determine the prevalence of EC in patients without human immunodeficiency virus(HIV)and identify risk factors for infection.METHODS We retrospectively reviewed inpatient and outpatient encounters from 5 regional hospitals within the United States(US)from 2015 to 2020.International Classification of Diseases,Ninth and Tenth Revisions were used to identify patients with endoscopic biopsies of the esophagus and EC.Patients with HIV were excluded.Adults with EC were compared to age,gender,and encounter-matched controls without EC.Patient demographics,symptoms,diagnoses,medications,and laboratory data were obtained from chart extraction.Differences in medians for continuous variables were compared using the Kruskal-Wallis test and categorical variables using chi-square analyses.Multivariable logistic regression was used to identify independent risk factors for EC,after adjusting for potential confounding factors.RESULTS Of the 1969 patients who had endoscopic biopsies of the esophagus performed from 2015 to 2020,295 patients had the diagnosis of EC.177 of 1969 patients(8.99%)had pathology confirming the diagnosis of EC and were included in the study for data collection and further analysis.In comparison to controls,patients with EC had significantly higher rates of gastroesophageal reflux disease(40.10%vs 27.50%;P=0.006),prior organ transplant(10.70%vs 2%;P<0.001),immunosuppressive medication(18.10%vs 8.10%;P=0.002),proton pump inhibitor(48%vs 30%;P<0.001),corticosteroid(35%vs 17%;P<0.001),Tylenol(25.40%vs 16.20%;P=0.019),and aspirin use(39%vs 27.50%;P=0.013).On multivariable logistic regression analysis,patients with a prior organ transplant had increased odds of EC(OR=5.81;P=0.009),as did patients taking a proton pump inhibitor(OR=1.66;P=0.03)or corticosteroids(OR=2.05;P=0.007).Patients with gastroesophageal reflux disease or medication use,including immunosuppressive medications,Tylenol,and aspirin,did not have a significantly increased odds of EC.CONCLUSION Prevalence of EC in non-HIV patients was approximately 9%in the US from 2015-2020.Prior organ transplant,proton pump inhibitors,and corticosteroids were identified as independent risk factors for EC.

Prospective study evaluating the value of subjective global assessment and national risk score 2002 for post-operative risk detection in living related donor liver transplant recipients

Background: Chronic liver disease may be associated with protein energy malnutrition. Those malnourished patients undergoing liver transplantation suffer great morbidities and even mortalities. Estimating the degree of malnutrition in patients with end stage liver disease is a difficult job, Subjective Global Assessment (SGA) and Nutritional Risk Score-2002 (NRS-2002) are among many tools that can give an overview for the nutritional status of the patients. Aim: To detect the efficacy and the predictive validity of SGA and NRS 2002 for post-operative risk detection for liver transplant patients. Patients & Methods: 30 recipients of end stage liver disease had undergone a nutritional assessment by SGA score & NRS-2002 score, to be compared with the parameters of outcome of post-operative liver transplantation (ALT, AST, INR, Bilirubin, time spent in ICU, hospital infective episodes & number of antibiotic courses). Results: Patients declared as malnourished by SGA and NRS-2002 had higher post operative ALT & AST value, more prolonged INR, spent more time at ICU and hospital, suffered from more infective episodes and had more antibiotic courses in a significant statistical manner. Conclusion: SGA and NRS-2002 could be useful, simple and dependable tools to be used for risk detection of post-operative morbidities after liver transplantation.

The distribution of parotid gland neoplasms in a veteran population

Objective:Salivary gland tumors account for 6%-8%of head and neck neoplasms with the parotid gland as the most common primary site.Pleomorphic adenomas(PA)are considered the most common benign parotid gland neoplasms,followed by Warthin tumors(WT).The goal of this study was to investigate the distribution of parotid gland neoplasms among a United States veteran population.Design:Retrospective chart review.Setting:Washington DC Veterans Affairs Medical Center.Participants:Veterans who underwent fine needle aspiration(FNA)for a parotid gland mass from 2000 to 2018 were included.Medical records were reviewed for gender,age,tobacco use,surgery date,and pathology results.Main outcome measures:Changes in the distribution of parotid neoplasms and tobacco use over an 18-year period.Results:Of 141 patients with parotid gland masses,86.5%(n=122)were benign,9.9%(n=14)were malignant,and 3.5%(n=5)were indeterminate.Of benign tumors,WT accounted for the majority at 51.6%,followed by PA at 40.2%.When stratified by decade(2000-2009 and 2010-2018),the proportion of WT compared to all other benign and malignant neoplasms increased from 31.6%to 53.6%,whereas the proportion of PA decreased from 36.8%to 33.3%.The rate of tobacco use was unchanged at approximately 32.0%among our cohort from 2000 to 2018.Conclusion:Among our cohort of veteran patients,WT was the most common benign parotid tumor and has increased in incidence over the last two decades despite an unchanged smoking rate.