Archive for March, 2012

So What Happens To Lottery Winners?

Well, I bought a lottery ticket for the Mega Millions Lottery.  Yes, it’s a gimmick, but it’s a gimmick that just got all of us to collectively fork out 1.5 billion overnight.  And, before you flood me with requests, I didn’t win.  But I thought about what it would be like to win.

Sorry, all you lump summers, I’d go for the annuity.  It takes time to learn how to deal with your wealth, and I’d want to make sure I couldn’t blow it all in a rapper-style frenzy.

ABC covered two winners, one who bought NASCAR teams and the other who still works as a waitress.  So clearly there is no “lottery life change.”  Winning the lottery only reflects back to you in grand style who you already are.

Which brings me to think of my favorite TV stars’ and what they would do with the lottery.  Right now I want Sheldon from The Big Bang Theory to win the lottery.  He’d use his millions and his genius to build an actual Starship (and then go after Will Wheaton)

The Big Bang Theory

The Big Bang Theory (Photo credit: Wikipedia). Or how about the Office staff? Where would they go and what would they do if none of them had to work?

See, this is free.  So I got a lot for my $1 investment.  What did you get?



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Do-It-Yourself Gastric Bypass: For The Desperate Dieter.

Diagram of a Roux-en-Y gastric bypass.

Image via Wikipedia

Warning: The following is meant to be humorous.Fat?  No health insurance?  Then Roca Labs has a cure for you!  The do-it-yourself gastric bypass!

Don’t worry, you don’t have to open up your own belly.  Sewing that back together can be tricky, especially if you can’t see over the top.

Instead, you get to drink something that halves your stomach size!  That’s right, we’ve got something so caustic your belly will basically shrivel up.  Side effects?  Well, we’re bypassing studies because it’s a diet supplement.

As you can imagine, I was pretty interested in what they were going to put in a drink to make the stomach shrivel up.  It wasn’t nitric acid (you’d need to put that in capsules) or cayenne (that would just burn, period.  If you wanted that it’s called the Malaysian diet.)  It turns out to be relatively boring, really.

What Roca Labs is selling is basically non-digestable gum that fills your stomach and makes you less hungry.  This will work as long as you keep filling your stomach and don’t force more food in.  If you did, your stomach would expand.  Then you’d eat MORE food without being hungry as soon as you stopped the gum.

So, the only really shocking thing about this diet is the price.  $480 for some gum.  Yikes!

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Blowing Out Your Bowel: The Truth About Nuts, Seeds, and Diverticulitis.

English: Diverticulitis in the left lower quadrant

Image via Wikipedia

Warning:  only mildly funny, quite educational, and gross.

Ok, the following will be graphic.  Leave now if you don’t want to change the way you view your poo.

Right, all you coprophiles, here goes.

We like to think of ourselves as a single entity.  In fact, we are a hotel, and not a very upscale hotel at that.  The number of bacteria in our gut outnumber the number of cells in our bodies by about ten to one.  These bacteria provide, on average, about a third of our daily protein.  They manufacture a number of our essential vitamins.  And they change the color and consistency of our poo.

If you don’t go poo very often, this is a problem.  It means the type, nature, and aggression of your bacteria changes.  Sometimes they get downright mean and nasty.  If they do, the body flushes them out (diarrhea) and sometimes empties both ends (vomiting).  Barring things like cholera and parasites, the body does a pretty good job of cleaning things out.  But sometimes bacteria manage to swell up the inside of the colon and cause outpouching or diverticula.  They can be helped by years of not going poo enough (how much is enough?  Let’s try for once a day, not once a week).

When the diverticular outpouchings occur, we have preliminary studies than show switching around bacteria makes a difference in how much pain and outpouching occurs.

Given the effect of bacteria on poo, what about the diet?  What diet would be best for, say, people recovering from having diverticulitis surgery?  Would, say, nuts and seeds be a problem for someone recovering from this surgery?  Do you know?

Of course you do.  Nuts and seeds would be a big no-no.  They tear up the bowel like big boulders, absolutely not.  And better keep it low on the roughage as well.

So, what do the surgeons think?  They all gave antibiotics, but all different ones.  Most of them recommended a low fiber diet, some said the regular diet is fine, and ten percent recommended a high fiber diet.  In terms of nuts and seeds, half of them said they weren’t a problem.

Horrendous, right?  How could half the surgeons not know nuts and seed are a problem?

Because they’re not.

In a free article by JAMA, 47 thousand men were followed from 1986 to 2004.  Those eating the most nuts and seeds had less risk of getting diverticulitis.   That’s right, more nuts and seeds, less problems.

In an article on how to prevent the return of diverticulitis, the author states that fiber is the only proven effective solution.  A recent UNC study found the opposite, that too many bowel movements and too much fiber also caused problems.  The UNC study surveyed 2,000 people, so we would still use the 47 thousand person study above to say that nuts and seeds aren’t a problem.

As late as April of 2011, a review was still trying to bury the dinosaur of a low-fiber diet: “Historically, low-residue diets have been recommended for diverticulosis because of a concern that indigestible nuts, seeds, corn, and popcorn could enter, block, or irritate a diverticulum and result in diverticulitis and possibly increase the risk of perforation. To date, there is no evidence supporting such a practice. In contrast, dietary fiber supplementation has been advocated to prevent diverticula formation and recurrence of symptomatic diverticulosis, although this is based mostly on low-quality observational studies.” (Nutr Clin Pract. 2011 Apr;26(2):137-42.)

So, despite the “common wisdom,” we should all enjoy our nuts and seeds.  The real question is why half the surgeons treating diverticulitis still believe the myth?

Oh, but don’t believe me.  Here are the studies.

Nutr Clin Pract. 2011 Apr;26(2):137-42.

Low-residue diet in diverticular disease: putting an end to a myth.

Tarleton S, DiBaise JK.


Division of Gastroenterology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259, USA.


Residue refers to any indigestible food substance that remains in the intestinal tract and contributes to stool bulk. Historically, low-residue diets have been recommended for diverticulosis because of a concern that indigestible nuts, seeds, corn, and popcorn could enter, block, or irritate a diverticulum and result in diverticulitis and possibly increase the risk of perforation. To date, there is no evidence supporting such a practice. In contrast, dietary fiber supplementation has been advocated to prevent diverticula formation and recurrence of symptomatic diverticulosis, although this is based mostly on low-quality observational studies. This report focuses on the evidence that fiber intake may be beneficial in the prevention and recurrence of symptomatic and complicated diverticular disease and provides recommendations regarding fiber supplementation in individuals with diverticulosis.

PMID: 21447765

JAMA. 2008 Aug 27;300(8):907-14.  Free Full Article

Nut, corn, and popcorn consumption and the incidence of diverticular disease.

Strate LL, Liu YL, Syngal S, Aldoori WH, Giovannucci EL.


University of Washington School of Medicine, Seattle, USA.



Patients with diverticular disease are frequently advised to avoid eating nuts, corn, popcorn, and seeds to reduce the risk of complications. However, there is little evidence to support this recommendation.


To determine whether nut, corn, or popcorn consumption is associated with diverticulitis and diverticular bleeding.


The Health Professionals Follow-up Study is a cohort of US men followed up prospectively from 1986 to 2004 via self-administered questionnaires about medical (biennial) and dietary (every 4 years) information. Men reporting newly diagnosed diverticulosis or diverticulitis were mailed supplemental questionnaires.


The study included 47,228 men aged 40 to 75 years who at baseline were free of diverticulosis or its complications, cancer, and inflammatory bowel disease and returned a food-frequency questionnaire.


Incident diverticulitis and diverticular bleeding.


During 18 years of follow-up, there were 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding. We found inverse associations between nut and popcorn consumption and the risk of diverticulitis. The multivariate hazard ratios for men with the highest intake of each food (at least twice per week) compared with men with the lowest intake (less than once per month) were 0.80 (95% confidence interval, 0.63-1.01; P for trend = .04) for nuts and 0.72 (95% confidence interval, 0.56-0.92; P for trend = .007) for popcorn. No associations were seen between corn consumption and diverticulitis or between nut, corn, or popcorn consumption and diverticular bleeding or uncomplicated diverticulosis.


In this large, prospective study of men without known diverticular disease, nut, corn, and popcorn consumption did not increase the risk of diverticulosis or diverticular complications. The recommendation to avoid these foods to prevent diverticular complications should be reconsidered.

Comment in

J Fam Pract. 2009 Feb;58(2):82-4.

PMID: 18728264

Dig Dis. 2007;25(2):151-9.

Diverticular disease in the elderly.

Comparato G, Pilotto A, Franzè A, Franceschi M, Di Mario F.


University of Parma, Parma, Italy.


There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those > or =65 years of age. Of patients with diverticula, 80-85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15-20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10-25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15-30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.

Copyright 2007 S. Karger AG, Basel.

PMID: 17468551

Drugs Aging. 2004;21(4):211-28.

Epidemiology and management of diverticular disease of the colon.

Kang JY, Melville D, Maxwell JD.


Department of Gastroenterology, St George’s Hospital and Medical School, London, England.


Colonic diverticula are protrusions of the mucosa through the outer muscular layers, which are usually abnormally thickened, to form narrow necked pouches. Diverticular disease of the colon covers a wide clinical spectrum: from an incidental finding to symptomatic uncomplicated disease to diverticulitis. A quarter of patients with diverticulitis will develop potentially life-threatening complications including perforation, fistulae, obstruction or stricture. In Western countries diverticular disease predominantly affects the left colon, its prevalence increases with age and its causation has been linked to a low dietary fibre intake. Right-sided diverticular disease is more commonly seen in Asian populations and affects younger patients. Its pathogenesis and relationship to left-sided diverticular disease remains unclear. Diverticular disease of the colon is a significant cause of morbidity and mortality in the Western world and its frequency has increased throughout the whole of the 20th century. Since it is a disease of the elderly, and with an aging population, it can be expected to occupy an increasing portion of the surgical and gastroenterological workload. It is uncertain what symptoms uncomplicated diverticular disease gives rise to: there is an overlap with irritable bowel syndrome. Diagnosis is primarily by barium enema and colonoscopy, but more sophisticated imaging procedures such as computed tomography (CT) are increasingly being used to assess and treat complications such as abscess or fistula, or to provide alternative diagnoses if diverticulosis is not confirmed. Initial therapy for uncomplicated diverticulitis is supportive, including monitoring, bowel rest and antibacterials. CT is used to guide percutaneous drainage of abscesses to avoid surgery or allow it to be performed as an elective procedure. Surgery is indicated for complications of acute diverticulitis, including failure of medical treatment, gross perforation, and abscess formation that cannot be resolved by percutaneous drainage. Complications of chronic diverticulitis (fistula formation, stricture and obstruction) are also usually treated surgically. However, the indications for, and the timing and staging of operations for diverticular disease are often difficult decisions requiring sound clinical judgement. Factors such as the number of episodes of inflammation, the age of the patient, and his/her overall medical condition play a role in determining whether or not a patient should undergo surgical resection. Laparoscopic surgery may be associated with less pain, less morbidity and shorter hospital stays, but its exact role is yet to be defined. Diverticular disease of the colon is the most common cause of acute lower gastrointestinal haemorrhage, which can be massive. Although the majority of patients stop bleeding spontaneously, angiographic and surgical treatment may be required, while the place of endoscopic haemostasis remains to be established.

PMID: 15012168

J Fam Pract. 2009 Jul;58(7):381-2.

Clinical inquiries: How can you help prevent a recurrence of diverticulitis?

Weisberger L, Jamieson B.


University of Illinois/Advocate Illinois Masonic Hospital, Chicago, IL, USA.


EVIDENCE-BASED ANSWER: A high-fiber diet may help; available evidence does not support other interventions. A high-fiber diet is often prescribed after recovery from acute diverticulitis, based on extrapolation from epidemiologic data showing an association between low-fiber diets and diverticulosis. No direct evidence establishes a role for fiber in preventing recurrent diverticulitis, however. No evidence supports the common advice to avoid nuts and seeds to prevent diverticulitis. Eating nuts, corn, and popcorn does not increase the risk; in fact, nuts and popcorn may have a protective effect. There is not enough evidence to recommend the anti-inflammatory drug mesalamine or a polybacterial lysate for immunostimulation. Retrospective data do not support routine prophylactic colectomy after 1 or 2 episodes of acute diverticulitis.

PMID: 19607778

Dis Colon Rectum. 1999 Apr;42(4):470-5; discussion 475-6.

Management of uncomplicated acute diverticulitis: results of a survey.

Schechter S, Mulvey J, Eisenstat TE.


Department of Surgery, The Miriam Hospital/Brown University, Providence, Rhode Island, USA.



A survey was conducted to document current medical treatment of patients with uncomplicated acute diverticulitis.


A survey was mailed to 667 fellows of The American Society of Colon and Rectal Surgeons certified by the American Board of Colon and Rectal Surgery. Queries were based on a clinical scenario of a patient with uncomplicated diverticulitis.


Three hundred seventy-three surveys (56 percent) were returned completed. The majority (66 percent) chose an abdominal computed tomographic scan as the initial diagnostic test. One-half used a single intravenous antibiotic with second-generation cephalosporins (27 percent) and ampicillin/sulbactam (16 percent) being the most common. Oral antibiotics given at discharge were ciprofloxacin (18 percent), amoxicillin/clavulanate (14 percent), metronidazole (7 percent), and doxycycline (6 percent). Combinations chosen were ciprofloxacin/metronidazole (28 percent) and metronidazole/trimethoprim sulfamethoxazole (6 percent), whereas 21 percent chose a variety of other antibiotics. The majority (74 percent) prescribed oral antibiotics for 7 to 10 days. Dietary recommendations at discharge were low residue (68 percent), regular (21 percent), and high residue (10 percent). Half of those surveyed believed avoidance of seeds and nuts were of no value. Follow-up examinations chosen included sigmoidoscopy and barium enema (29 percent), colonoscopy (25 percent), sigmoidoscopy (17 percent), barium enema (13 percent), and other (16 percent). Sixty-five percent of colon and rectal surgeons claim to handle more than half of their patients with uncomplicated diverticulitis on an outpatient basis.


Variations in the management of uncomplicated sigmoid diverticulitis are noted among colon and rectal surgeons, especially in terms of antibiotic choice, discharge instructions, and follow-up outpatient studies. The survey results are compared with the conclusions reached in The American Society of Colon and Rectal Surgeons practice parameters. Documentation of practice pattern variation may serve as an educational tool for physicians to improve their quality and cost of medical care. Consideration should be given to better publicize already existing American Society of Colon and Rectal Surgeons practice parameters for this common entity.

PMID: 10215046

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NASA – NASAS Spitzer Finds Solid Buckyballs in Space

I love buckyballs.  Not the ones that tore up some kid’s intestine – those are magnets and hello?  Yucky parenting.  Where were you when she was eating the twelfth one, much less 37?

No, I’m talking about awe inspiring sixty carbon balls in space.  Microscopic giant soccer balls that probably will be useful for something great.

NASA – NASAS Spitzer Finds Solid Buckyballs in Space.

If you can’t wait for manned spaceflight to see them, just burn a candle.  They exist in the smoke.


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Valley Fever: Like, So Totally Serious, Dude.

Geographic distribution of Coccidioidomycosis....

Image via Wikipedia

Ike Davis may or may not have Valley Fever.  But for those of us not part of Valley culture, Valley Fever sounds like something one would get from drinking someone else’s wine cooler.  Maybe Ike borrowed someone else’s unwashed leg warmers for aerobics.  (Are those back yet?  When will retro cool encompass leg warmers?  About the same time the giant airplane-wing size collars come back.)

Being a medical type, I was interested in this Valley Fever.  Was this some new disease striking yuppies, making them retro before their time?  Symptoms include the unnecessary use of the word like, addiction to pastels, and a slight fever – dance fever, that is.

Turns out that Valley Fever is a real disease.  The NIH website first lists it as “Valey Fever” in a rare typo.  I had a momentary image of Valet Fever, an infection caught from exclusively luxury model car keys.  Not to be mistaken for Ballet Fever, the urge to leap up and applaud mediocre ballet performances.

So the REAL name of Valley Fever is coccidioidomycosis.  If you went, oh, of course, you definitely spent time in medical school.  Or taking NPLEX exams for fun (sicko!).  Actually, I kind of liked taking practice NPLEX exams.  It’s Trivial Pursuit for the really intense hypochondriac within all of us.

Coccidiodomycosis is a fungal infection.  If you want to hear the way it is pronounced, Webster’s now has a wonderful audio feature.  Hearing it pronounced makes it sound like something so truly filthy that you could get slapped unless the people you are talking to are intense hypochondriacs.  It sounds like something Barney from How I Met Your Mother would be into.  It might be what J. Lo whispered in Barney’s ear before he had to tell her no and then went and jumped into the river.

But regardless of how it sounds, having it is no fun.  Ike made it sound like no big deal, but having a fungal infection in your lungs at his age is a serious no-no.  That’s the kind of thing you get after you get transplants of other organs and your body is shutting down.

So, either the NY specialists are making an error, or Ike doesn’t want to believe them.  It’s true that a huge number of people have antibodies to the fungus, but very few of them get the disease.  The fungus can go system wide and affect any body organ.  Time to really think about prevention if he did have this pneumonia.  If he developed symptoms, it is likely his body isn’t working at full capacity.

Semin Respir Crit Care Med. 2011 Dec;32(6):754-63. Epub  2011 Dec 13.

Pulmonary coccidioidomycosis.


Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis, Davis, California 95616, USA.


Coccidioidomycosis refers to the spectrum of disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. Clinical manifestations vary depending upon both the extent of infection and the immune status of the host. Coccidioidomycosis has been reported to involve almost all organ systems; however, pulmonary disease is the most common clinical manifestation. The incidence of coccidioidomycosis continues to rise, and primary coccidioidal pneumonia accounts for 17 to 29% of all cases of community-acquired pneumonia in endemic regions. The majority of patients with coccidioidomycosis resolve their initial infection without sequelae; however, several patients develop complications of disease ranging in severity from complicated pulmonary coccidioidomycosis to widely disseminated disease with immediately life-threatening manifestations. This review focuses on complications of pulmonary coccidioidomycosis with an emphasis on the management of primary coccidioidal infection, solitary pulmonary nodules, pleural effusions, cavitary disease, acute respiratory distress syndrome (ARDS), miliary disease, and sepsis.

© Thieme Medical Publishers.

PMID: 22167403
Pol Arch Med Wewn. 2008 Jun;118(6):387-90.

Coccidioidomycosis in a 38-year-old man: a case report.


Department of Pulmonary Diseases, Medical University, Poznań, Poland.


The present article describes a case of acute pulmonary coccidioidomycosis in a 38-year-old man, a research worker. The disease started during the patient stay in Arizona, USA, and clinical symptoms persisted after his return to Poland. Acute coccidioidomycosis is one the clinical manifestations of Coccidioides immitis strain endemic infections occurring in the south-western regions of USA including California (mainly San Joaquin Valley), Western Texas, New Mexico and the desert areas of Arizona, and Central and South America. The native environment of Coccidioides immitis is soil penetrated by rodents. People, domestic and wild animals suffer from coccidioidomycosis. The infection rate in endemic areas is about 2-4% a year in the healthy population. Coccidioidomycosis can be observed in non-endemic areas due to population mobility and in immunocompromised patients. The Coccidioides immitis infection is caused by inhaled airborne fungal spores and it may occur as primary pulmonary (acute or chronic) asymptomatic form, meningitis, or disseminated disease. The clinical symptoms of coccidioidomycotis like acute pulmonary manifestations may resemble typical, resistant to empiric antibiotic treatment of bacterial pneumonia. In healthy subjects, pulmonary coccidioidomycosis may occur as asymptomatic infection, which resolves spontaneously without medication. Sometimes, slight shadows like local fibrosis and cavities may be visible on the chest X-ray. The Coccidioides immitis infection in people with immunological deficiency syndromes, e.g. HIV/AIDS, manifests itself as disseminated disease and may lead to severe complications including death.



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Nick Cannon Diagnosed With “Lupus Type of Thing.” The Medical Mystery Continues.

Nick Cannon

Image via Wikipedia

A little while ago Nick Cannon almost died from “mild kidney failure,” which is sort of like “mild gunshot wound,” it doesn’t really exist.

Nick Cannon continues to be a medical mystery.  Soon after recovering from “mild kidney failure” he now has a “Lupus type of thing.”  Is this Lupus, or another autoimmune illness?  It’s going to be hard for Nick to be a spokesperson for his foundation to find a cure for a Lupus type of thing.  It doesn’t even look good on a T-shirt. “Cure Lupus type of thing.”  Heck, it doesn’t even fit on a baseball cap.  His wife can’t find a rhyme for it to work it into a song.

So here’s one celebrity I wish would have a medical doctor announce his illnesses from now on.  No more of these weird un-diseases that sound more ominous than the real thing.  If it truly is unknown, I want a medical profession to state that.  “It’s a Lupus-type thingy,” would be at least worth a laugh.

If Nick has Lupus bad enough to have had kidney failure from it, this is what we’d call a “way bad sick” case.  Not only is his Lupus advanced, as an African-American his risk of failure after kidney transplant is not good.  (unfunny abstract below).

I think it’s time for Nick to re-evaluate his public presentation about what’s going on.  Here in Maine we’d say:  “He’s wicked sick, and we’re holding a bean supper to help him and the missus out.”  There’s a time for cool, and there’s a time to avoid the “death type of thing.”

Lupus. 2012 Jan;21(1):3-12. Epub  2011 Oct 5.

Kidney transplantation outcomes in African-, Hispanic- and Caucasian-Americans with lupus.


Division of Nephrology, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 360E, Miami, FL 33136, USA.


African-American recipients of kidney transplants with lupus have high allograft failure risk. We studied their risk adjusting for: (1) socio-demographic factors: donor age, gender and race-ethnicity; recipient age, gender, education and insurance; donor-recipient race-ethnicity match; (2) immunologic factors: donor type, panel reactive antibodies, HLA mismatch, ABO blood type compatibility, pre-transplant dialysis, cytomegalovirus risk and delayed graft function (DGF); (3) rejection and recurrent lupus nephritis (RLN). Two thousand four hundred and six African-, 1132 Hispanic-, and 2878 Caucasian-Americans were followed for 12 years after transplantation. African- versus Hispanic- and Caucasian-Americans received more kidneys from deceased donors (71.6%, 57.3% and 55.1%) with higher two HLA loci mismatches for HLA-A (50%, 39.6% and 32.4%), HLA-B (52%, 42.8% and 35.6%) and HLA-DR (30%, 24.5% and 21.1%). They developed more DGF (19.5%, 13.6% and 13.4%). More African- versus Hispanic- and Caucasian-Americans developed rejection (41.7%, 27.6% and 35.9%) and RLN (3.2, 1.8 and 1.8%). 852 African-, 265 Hispanic-, and 747 Caucasian-Americans had allograft failure (p < 0.0001). After adjusting for transplant era, socio-demographic-immunologic differences, rejection and RLN, the increased hazard ratio for allograft failure of African- compared with Caucasian-Americans became non-significant (1.26 [95% confidence interval 0.78-2.04]). African-Americans with lupus have high prevalence of risk factors for allograft failure that can explain poor outcomes.

PMID: 21976401

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