Background Antibiotics use may increase colorectal cancer (CRC) risk by altering the gut microbiota, with suggestive evidence reported. Our study aims to investigate antibiotics use in relation to subsequent CRC risk. Methods This is a nationwide, population-based study with a matched case-control design (first primary CRC cases and 5 matched, cancer-free controls). Complete-population data, extracted from Swedish national registers for the period 2005-2016, were used to calculate odds ratios and 95% confidence intervals. Results We included 40 545 CRC cases and 202 720 controls. Using the full dataset, we found a positive association between more frequent antibiotics use and CRC, excluding antibiotics prescribed within 2 years of diagnosis attenuated results toward the null. In site-specific analyses, excluding the 2-year washout, the positive association was confined to the proximal colon (adjusted odds ratio for very high use vs no use = 1.17, 95% confidence interval = 1.05 to 1.31). For rectal cancer, an inverse association, which appears to be driven by women, was observed. Quinolones and sulfonamides and/or trimethoprims were positively associated with proximal colon cancer, whereas a more general inverse association, across antibiotics classes, was observed for rectal cancer. We found no association between methenamine hippurate, a urinary tract antiseptic not affecting the gut microbiota, and CRC risk. Conclusions This register-based study covering the entire population of Sweden found a robust association between antibiotics use and higher risk of proximal colon cancer and an inverse association with rectal cancer in women. This study strengthens the evidence from previous investigations and adds important insight into site-specific colorectal carcinogenesis.
Background: Antibiotic use has been hypothesized to modify colorectal cancer (CRC) risk by altering the composition of gut microbiota, with some suggestive evidence reported. The aim of the current study was to investigate the possible association between antibiotic use and CRC risk, taking into consideration daily dose, antibiotic type, and tumor location. Methods: This is a nation-wide, registry-based study with a matched case-control design. All primary CRC cases diagnosed during 2010 to 2016 were selected from the Swedish Colorectal Cancer Register to ensure availability of antibiotic prescription data and a minimum of 5 years of follow-up. Five cancer-free controls were matched to each case for age, sex, and county using the Register of the Total Population. Defined daily doses of antibiotics were extracted from the Swedish Prescribed Drug Register (with complete data from 2005), antibiotic prophylaxis use was estimated using surgical procedural codes from the Swedish National Patient Register, and potential confounders related to socioeconomic status (level of education, country of birth and marital status) were obtained from the LISA database. Multivariable conditional logistic regression was performed to investigate associations between antibiotic use (divided into 5 categories ranging from non-use to very high use (>6months)) and CRC risk. Results: Our study included 40,545 cases and 202,720 matched controls. We identified a positive, linear association between antibiotic use and CRC risk (adjusted OR for very high users vs non-users = 1.11 (95% CI: 1.03-1.19), p-trend=0.014), which was pronounced for proximal colon cancer (OR = 1.42 (95% CI: 1.28-1.58), p-trend = 1.20 × 10−15), less robust for distal colon and null for rectal cancer. The association was strongest for broad-spectrum beta lactams (adjusted OR =1.50 (95% CI, 1.01-2.23), p-trend=3.12 × 10−6). In contrast, Hiprex, an antibiotic used for treatment and prevention of urinary tract infections, with no known effect on gut microbiota, was not associated with CRC risk (OR = 0.92 (95% CI, 0.81-1.05), p-trend=0.217). Conclusion: In this registry-based study covering the entire population of Sweden, we identified a robust association between antibiotic use, particularly broad-spectrum beta-lactams, and an increased risk of colon cancer, particularly proximal colon cancer, and a null relationship for rectal cancer. The null findings for Hiprex, which does not affect gut microbiota, lend support to the microbiota hypothesis for the putative influence of antibiotic use in colonic carcinogenesis. Citation Format: Sai San Moon Lu, Zahraa Mohammed, Christel Häggström, Robin Myte, Elisabeth Lindquist, Åsa Gylfe, Bethany Van Guelpen, Sophia Harlid. Antibiotic use and risk of colorectal cancer: A Swedish population-based registry study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1055.
Hyperparathyroidism is a common endocrine disorder characterized by hypersecretion of parathyroid hormones due to abnormal activity of one or more parathyroid glands. Several cardiac abnormalities have been reported due to hyperparathyroidism. In this case report, a case of cardiac arrest due to hyperparathyroidism and hypercalcemia is presented and discussed. A female patient, 73 years old, was admitted to surgical ward (SICU) with malignant goiter extending to the retrosternum. She was a known case of hyperparathyroidism and hypercalcemia. After the operation, the patient was shifted to SICU for further management. Suddenly, the patient had sudden cardiac arrest and was successfully resuscitated within 2 minutes. The ECG showed a new Right Bundle Branch Block (RBBB) changes. Patient remained on ventilator, not obeying commands, and opened her eyes spontaneously with cough reflex. A week after, percutaneous tracheostomy was performed, and patient became hemodynamically stable, weaned from ventilator and allowed to breathe spontaneously. Although cardiac arrest is a rare complication, it should be expected by health care providers when dealing with patients with hyperparathyroidism and hypercalcemia.
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