Smoking Tobacco Doubles Risk of Recurrent Tuberculosis

Patients who continue tobacco smoking after successful treatment of TB often develop TB again called recurrent TB.

In a study published in April 2014 issue of the International Journal of Tuberculosis and Lung Disease theresearchers followed a large sample of fully treated 5,567 bacteriologically confirmed TB patients in Taiwan.  Of those patients, 1.5% developed a recurrent TB.Regular tobacco smokers were twice as likely to develop recurrent TB compared with former smokers or people who had never smoked tobacco.

Regular tobacco smokers were defined as individuals who smoked 10 or more cigarettes a day.

Another study published in the Bulletin of the World Health Organization (2015; 93:390-399) concluded that smoking is an independent risk factor for poor TB treatment outcomes. The study reported that Georgian patients whose sputum samples had been found culture-positive for MDR tuberculosis were less likely to become culture-negative after treatment if they currently smoked, (adjusted hazard ratio: 0.82; 95% CI: 0.71–0.95).

In a 2005 study published in Int J Tuberc Lung Dis. (May;9(5):556–61) among patients with pulmonary tuberculosis in India, smokers were found to have a threefold greater risk of recurrent tuberculosis than non-smokers.

There are no studies who have tested the effect of switching to nicotine vaping and the recurrence of TB.

Asymptomatic gall bladder stones

Majority of patients with gallstones are asymptomatic and will remain so throughout their lives.

Of those with incidental (asymptomatic) gallstones, 15 to 25 percent will become symptomatic after 10 to 15 years of follow-up.

Patients who develop symptoms initially report biliary colic rather than symptoms associated with the complications of gallstone disease (such as cholecystitis, pancreatitis, and choledocholithiasis).

Once patients have biliary pain from uncomplicated disease, the risk of developing complications is approximately 2 to 3 percent per year.  Once a complication develops, the risk of additional, often more severe, complications is approximately 30 percent per year

Patients with asymptomatic gallstones appear to have a lower risk of complications than those with symptomatic gallstones.

Microlithiasis (biliary sludge) can produce biliary colic and lead to complications such as acute cholangitis and acute pancreatitis.

Microlithiasis may also progress to macroscopic gallstones.

Answer: wait for the first biliary pain and then opt for surgery

Can’t it cause cancer?

The overall incidence of gall bladder cancer in patients with cholelithiasis is only 0.5 percent. The risk is higher with larger gallstones (in one study, patients with stones larger than 3 cm had a 10-fold higher risk of GBC compared with those with stones <1 cm and longer duration of cholelithiasis (particularly over the age of 40 years.

Risk of surgery: Lap chole vs open

Pneumonia 0.2% ( open 1.7%); heart attack or cardiac arrest  0.1% ( open 0.7%); wound infection 1% ( open 7.6%); UTI 0.5% ( open 1.5%); lung embolism 0.2% ( open 1%); kidney failure 0.1% ( open 0.9%); bile leakage 0.8% ( open 3.3%); death 0.8% ( open 3.3%), discharge to nursing facility 0.6% ( open 5.4%); bile duct injury 0.5%; retained GB stone 4-40%; foetal los in pregnancy 4% [ Based on ACS surgical risk calculator]

Respect the nature: Breast Implants Linked to a Rare Cancer

Eight years back US FDA first reported a suspicious link between breast implants and a rare cancer of the immune system. Evidence of that connection is now stronger than ever, with 457 confirmed cases of anaplastic large cell lymphoma (ALCL) reported in women who have received implants in recent years.

FDA is advising patients and medical care providers to remain aware of the potential risks involved with breast implant surgery.

"After a thorough data analysis, we are reporting that, as of September 2018, the agency has received a total of 660 total medical device reports (MDRs) regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) cases in the US since 2010," the FDA reports. "Of the 660 MDRs, our in-depth analysis suggests that there are 457 unique cases of BIA-ALCL, including 9 patient deaths."

The exact nature of the link between implants and ALCL, or even if the relationship is strictly causative, is yet to be convincingly established.

Though the number of identified cases of BIA-ALCL is small compared to the estimated 1.5 million patients who receive breast implants worldwide every year, confirmed data and published information reviewed to date suggests that patients with breast implants have an increased risk of BIA-ALCL.

"Choosing to obtain a breast implant is a very personal decision that patients and their providers should make based on individual needs and with the most complete information about products."

Update: On Friday, French regulatory authorities recommended a ban on Allergan textured breast implants, citing concerns about breast implant-associated anaplastic large cell lymphoma. (NBC News)