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- Thomas, HS, et al.
(författare)
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- 2019
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swepub:Mat__t
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| 2. |
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| 3. |
- Bläckberg, Anna, et al.
(författare)
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A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess
- 2023
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Ingår i: Open Forum Infectious Diseases. - 2328-8957. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPyogenic liver abscess (PLA) is a rare entity that is associated with substantial mortality and morbidity. Our objective was to investigate variables associated with mortality and subsequent PLA in patients diagnosed with PLA in southern Sweden.MethodsWe conducted a population-based observational study comprising all episodes of PLA that occurred between 2011 and 2020 in the county of Skåne, southern Sweden. The primary outcome was defined as all-cause 90-day mortality and the secondary outcome was defined as the occurrence of a subsequent PLA.ResultsA total of 452 episodes of PLA occurred in 360 patients during the study period. The 90-day mortality rate was 16% (n = 58) and the subsequent PLA rate was 20% (n = 92). In a multivariable logistic regression model, female sex (odds ratio [OR], 2.0 [95% confidence interval {CI}, 1.1–3.9]), malignancy (OR, 3.7 [95% CI, 1.9–7.1]), liver failure (OR, 6.3 [95% CI, 2.7–14.5]), and polymicrobial findings (OR, 3.8 [95% CI, 2.2–6.9]) were associated with death within 90 days (P < .05). Male sex (OR, 2.1 [95% CI, 1.2–3.6]), malignancy (OR, 2.1 [95% CI, 1.3–3.6]), age (64–74 years: OR, 2.5 [95% CI, 1.3–4.8]), and chronic liver disease (OR, 3.0 [95% CI, 1.4–6.5]) were associated with the risk of subsequent PLA (P ≤ .01).ConclusionsIdentifying different clinical variables associated with an unfavorable outcome may improve the management and treatment of patients with PLA and thus prevent the risk of death and subsequent PLA.
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| 4. |
- Kiasat, Ali
(författare)
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Inflammatory bowel disease : determinants related to gut microbiota
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Inflammatory bowel disease (IBD) is a chronic and idiopathic disorder that causes inflammation in the gastrointestinal tract. Overall, it can be classified into two types: ulcerative colitis (UC) and Crohn's disease (CD). The causes of IBD have been extensively studied, with heredity, lifestyle, and environmental factors being identified as possible contributors. These factors can trigger an imbalance in the bacterial flora in the colon, which is increasingly thought to play a crucial role in the development of IBD. As dysbiosis in the gut microbiota has been frequently reported in inflammatory bowel disease, it has been proposed that both UC and CD may be caused by an auto-immune response to gut bacteria in genetically susceptible individuals. However, the exact aetiology of these diseases is still largely unknown. The aim of this thesis was to investigate epidemiological aspects of surgical abdominal procedures and possible biochemical markers associated with gut microbiota, in relation to IBD. In Paper I, we investigated the association between juvenile appendicitis, treated with appendectomy or conservatively treated without surgery, and adult risk of IBD. This, nation-wide, population-based retrospective cohort study, based on Swedish national registers, included all individuals with a diagnosed appendicitis before the age of 16, during the time-period 1973-1996, and matched controls. The study population was followed until 2017 for any development of UC and CD. We found that childhood appendicitis with appendectomy was associated with lower risk of UC (aHR 0.30 95% CI 0.25-0.36) and CD (aHR 0.82 95% CI 0.68-0.97), whereas conservative treatment was associated with lower risk of adult UC (aHR 0.29 95% CI 0.12-0.69), only, compared to unexposed individuals. Our findings warrant further research of the appendix in relation to gut microbiota and IBD pathogenesis. In Paper II, we investigated the association between bariatric surgery and new onset of IBD. This population-based retrospective cohort study included Swedish individuals registered in the Scandinavian Obesity Surgery Registry who underwent primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) during 2007 – 2018 and matched controls. The study population was followed up until 2019 to determine the development of CD and UC. We found that individuals operated on with RYGB had an increased risk of later development of CD (HR 1.8 95% CI 1.5 - 2.2) whereas individuals who underwent SG had an increased risk of UC (HR 1.8 95% CI 1.1-3.1). The findings should encourage further studies on surgical procedures for obesity and their effect on gut microbiota and development of IBD. In Paper III, the aim was to analyse plasma concentrations of short chain fatty acids (SCFA) in relation to CD and UC and to evaluate SCFA as a potential biomarker for IBD. This cross-sectional study included 132 and 119 individuals with CD and UC respectively and 205 controls. Although we found lower plasma concentrations of succinic acid among individuals with CD and UC in comparison to controls in univariate analysis, the difference did not remain after adjusting for sex, age and dietary factors. For all other SCFA, no differences could be found between the groups. In conclusion, CD and UC were not associated with alterations in plasma SCFA concentration. In Paper IV, we aimed to assess alterations of plasma bile acid (BA) profiles in association to CD. This cross-sectional study included 88 individuals with CD and 88 controls. CD was found to be associated with lower concentrations of most secondary BA, particularly derivatives of deoxycholic acid and lithocholic acid. Moreover, plasma concentration of secondary BA among participants with active CD was lower in comparison to participants with CD in remission. We concluded that the immune dysfunction in CD may be associated with altered bile acid composition in blood plasma.
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| 5. |
- Kiasat, Ali, et al.
(författare)
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Plasma bile acids in association with Crohn’s disease
- 2024
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor and Francis Ltd.. - 0036-5521 .- 1502-7708.
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Tidskriftsartikel (refereegranskat)abstract
- Background: In addition to facilitating lipid digestions, bile acids (BA) are signalling molecules acting on receptors on immune cells and along the gastrointestinal (GI) tract. The aim of this study was to assess if altered bile acid profiles in plasma are associated with Crohn’s disease (CD). Method: This cross-sectional study included individuals (aged ≥18 years) referred for colonoscopy at a tertiary centre in Stockholm between 2016 and 2019. All participants received bowel preparation, completed a lifestyle questionnaire and provided blood samples for analysis. During colonoscopy, severity of disease was graded, and biopsies were taken from colonic mucosa. In the current substudy, 88 individuals with CD and 88 age-matched controls were selected for analysis of BA in plasma with ultra performance liquid chromatography (UPLC). Linear regression models were then used to compare mean bile acid concentrations and concentration ratios between CD and controls. Results: Individuals with CD had lower plasma concentrations of the majority of secondary BA compared to controls, in total CD/CC ratio 0.60 (SE 0.12), p = 0.001. The most prominent observations were lower levels of deoxycolic acid derivates and lithocolic acid derivates among participants with CD. Moreover, plasma concentration for secondary BA among participants with active CD was significantly lower compared to those with CD in remission, CD active/CD remission ratio 0.65 (SE 0.11), p < 0.002. Conclusion: Crohn’s disease may be associated with altered plasma bile acid composition. The significance of colonic bacterial diversity in this context needs to be investigated in further studies.
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| 6. |
- Kiasat, Ali, et al.
(författare)
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The risk of inflammatory bowel disease after bariatric surgery
- 2022
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 18:3, s. 343-350
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The association between bariatric surgery and new onset of inflammatory bowel disease has so far only been sparsely studied and with conflicting results.OBJECTIVES: To investigate the association between bariatric surgery and inflammatory bowel disease in a large population-based cohort.SETTING: Nationwide in Sweden.METHODS: This population-based retrospective cohort study included Swedish individuals registered in the Scandinavian Obesity Surgery Registry who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy during 2007-2018. Ten control individuals from the general population were matched according to age, sex, and region of residence at time of exposure. The study population was followed until 2019 with regard to the development of inflammatory bowel disease. Cox proportional hazards models were used to compare disease-free survival time between subgroups and control individuals for each outcome.RESULTS: The final cohort consisted of 64,188 exposed individuals with a total follow-up of 346,860 person-years and 634,530 controls with total follow-up of 3,444,186 person-years. Individuals who underwent Roux-en-Y-gastric bypass had an increased risk of later development of Crohn's disease (hazard ratio [HR] 1.8, 95% CI 1.5-2.2) and unclassified inflammatory bowel disease (HR 2.7, 95% CI 2.0-3.7) but not ulcerative colitis (HR .9, 95% CI .8-1.1) compared with control individuals, whereas individuals who underwent sleeve gastrectomy had an increased risk of ulcerative colitis (HR 1.8, 95% CI 1.1-3.1) but not Crohn's disease (HR .8, 95% CI .3-2.1) and unclassified inflammatory bowel disease (HR 2.5, 95% CI .8-7.8).CONCLUSIONS: Roux-en-Y gastric bypass was associated with increased risk of Crohn's disease and unclassified inflammatory bowel disease, whereas sleeve gastrectomy was associated with increased risk of ulcerative colitis only.
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| 7. |
- Svensson, Emma, et al.
(författare)
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Increasing incidence of pyogenic liver abscess in Southern Sweden : a population-based study from 2011 to 2020
- 2023
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Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 55:6, s. 375-383
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pyogenic liver abscess (PLA) is a rare but potentially life-threatening disease, and estimates suggest a gradual increase in the incidence during the last decades. The primary aim of this study was to report the incidence, trend and aetiology of PLA during a decade in Southern Sweden.METHODS: This was a population-based observational cohort study between 2011 and 2020 in Skåne, Southern Sweden. Data were retrieved from the Swedish National Board of Health and Welfare for all individuals diagnosed with liver abscess (K750) according to ICD-10 (International Statistical Classification of Diseases, 10th revision).RESULTS: A total of 456 episodes of PLA occurred in 364 patients during the study period. The median age of the first PLA episode was 71 years (range 3-97) and 57% (n = 206) were men. The mean incidence of all patients was 3.4/100,000 person-years (range 1.8-5.2). The incidence increased almost three times, from 1.8/100,000 person-years in 2011 to 5.2/100,000 person-years in 2020. Streptococcus species, Escherichia coli and Klebsiella species accounted for the vast majority of both mono- and polymicrobial findings in both blood and local abscess cultures. 16s rDNA added information about aetiology in 37% of episodes.CONCLUSION: The incidence of PLA increased during the study period, and Streptococcus spp., Klebsiella spp. and E. coli dominated both blood and local cultures. Despite antimicrobial therapy, pathogens could be found in local abscess cultures several weeks into treatment. Increased use of 16s rDNA in the management of PLA could be beneficial.
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