Publications

PURPOSE OF REVIEW

Despite the progress toward understanding the molecular pathogenesis of rheumatoid arthritis (RA), its cause remains elusive. Genes are important but rather insufficient to explain the majority of RA cases. This review describes the novel data supporting the microbiome and its interactions with the human host as potential en('in')vironmental factors in RA pathogenesis.

RECENT FINDINGS

Animal models of inflammatory arthritis have shown that the presence of bacteria in mucosal surfaces is sufficient to alter local and systemic host immune responses and elicit joint inflammation. Human RA studies have focused on three mucosal sites: the gut, the gingiva, and the respiratory tree. The oral microbiome, and specifically Porphyromonas gingivalis, has long been implicated. Novel sequencing technologies have allowed investigations into the role of the gut microbiome in the development of autoimmune arthritis. Most recently, the pulmonary parenchyma has also been described as yet another possible mucosal site of initiation of autoimmunity in RA.

SUMMARY

Emerging data implicate the microbiome in RA pathogenesis. Mucosal sites exposed to a high load of bacterial antigens--such as the periodontium, lung, and gut--may represent the initial site of autoimmune generation. If validated, these findings could lead to the discovery of potential biomarkers and therapeutic approaches in the preclinical and clinical phases of RA.

BACKGROUND

Hospital readmissions have become a topic of focus for quality care measures and cost-reduction efforts. However, no comparative multi-institutional data on plastic surgery outpatient readmission rates currently exist. The authors endeavored to investigate hospital readmission rates and predictors of readmission following outpatient plastic surgery.

METHODS

The 2011 National Surgical Quality Improvement Program database was reviewed for all outpatient procedures. Unplanned readmission rates were calculated for all 10 tracked surgical specialties (i.e., general, thoracic, vascular, cardiac, orthopedics, otolaryngology, plastics, gynecology, urology, and neurosurgery). Multivariate logistic regression models were used to determine predictors of readmission for plastic surgery.

RESULTS

A total of 7005 outpatient plastic surgery procedures were isolated. Outpatient plastic surgery had a low associated readmission rate (1.94 percent) compared with other specialties. Seventy-five patients were readmitted with a complication. Multivariate regression analysis revealed obesity (body mass index ≥ 30), wound infection within 30 days of the index surgery, and American Society of Anesthesiologists class 3 or 4 physical status as significant predictors for unplanned readmission.

CONCLUSIONS

Unplanned readmission after outpatient plastic surgery is infrequent and compares favorably to rates of readmission among other specialties. Obesity, wound infection within 30 days of the index operation, and American Society of Anesthesiologists class 3 or 4 physical status are independent predictors of readmission. As procedures continue to transition into outpatient settings and the drive to improve patient care persists, these findings will serve to optimize outpatient surgery use.

OBJECTIVE

Hypertension is an important risk factor for cardiovascular disease throughout the world. Little is known about the prevalence of hypertension in rural Haiti. Our study aims to estimate prevalence and knowledge of hypertension in Northern Haiti.

DESIGN

Cross-sectional.

SETTING

Four rural communities surrounding Milot, Haiti.

PARTICIPANTS

Participants (69 males, 106 females, 175 total) were eligible to take part if they were aged > 18 years and not pregnant. Enrollment was voluntary.

METHODS

Two initial blood pressure measurements were taken for each participant. Participants who had an average systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg were instructed to return in 1 week for two additional confirmatory measurements. Based on these measures, participants were classified as either hypertensive or not. All participants were surveyed to assess their knowledge of hypertension.

RESULTS

The prevalence of hypertension among the study sample was 36.6%. Overall, 47% of women and 21% of men were hypertensive. Approximately 30% of women of reproductive age (18-39 years) were hypertensive. Participants showed little knowledge of the asymptomatic nature of hypertension and the need for lifelong treatment.

CONCLUSIONS

Hypertension is prevalent in Haiti. The high prevalence of hypertension among women of reproductive age is a concern since it is a risk factor for cardiovascular disease. Lack of knowledge surrounding hypertension indicates low awareness of the condition and is a possible target for future educational interventions.