Background
Thiazide diuretics are very common and are hence used very often for medication. These drugs are metabolized in the liver eliminated through the kidneys or biliary route, their metabolism, therefore, has an effect on the gallbladder as well. There is at least a 12% rate of Americans suffering from the effects of kidney metabolism and have developed gall stones. There are several factors that affect this including bodyweight where its found to be greater in obese people, fast weight loss, parturition, some medication, estrogen hormones after menopause, ethnicity, inheritance and diseases of the illume. Nonetheless, Rosenberg et al studied these relationships and they discovered that there was a relationship between the occurrence of acute Cholecystitis and the thiazide medication. Cholecystitis described the condition where the gallbladder is inflamed because of gallstones. These stones block the flow of bile and it results in pain in the abdomens, fever and nausea. The inflammation can b detected by ultrasonography. The result is usually the removal of the gallbladder through a process of laparoscopy. Cholecystitis can either be acute or chronic. The acute one is highly associated with gallstones whereby 95% of the patients are usually found to have both conditions when Cholecystitis is diagnosed.
Comparing the Rosenberg et al Article with Ovarian Cancer Paper
Sir Bradford Hill was very instrumental in research comparisons and established the casual criteria. This is used to determine whether a causal factor an indeed resulted in the impact or outcome B. there are nine factors that will be used to evaluate ovarian cancer paper and the Thiazide and acute Cholecystitis paper.
Strength
For the Thiazide use and occurrence of Cholecystitis, the effect is not substantially. It is been found in that the use of thiazide diuretic can exacerbated gallstones but does not necessarily cause them. Furthermore in some cases, the duration of use did not increase the risk of developing the problem. For the ovarian cancer paper, using a combination of contraceptives greatly reduced the risk of developing cancer. The paper can hence be said to be having a stronger relationship that can be assessed statistically. Mantel Haenzel Process was used in analyses.
Temporal relationships
Based on this factor, the thiazide paper does not compare well with other researches in that there have been studies which show that use of thiazide diuretics does not cause Cholecystitis rather aggravate the condition. However, ovarian cancer is more consistent with other findings. Combinations of contraceptives reduce the risk of cancer and many other researchers have found similar outcomes. Basically if a factor causes a disease then it has to precede the outcome.
Consistency
The results of the ovarian paper are consistent as they have been replicated in other researches. However the thiazides impact on Cholecystitis cannot be explained by confounding. Past use of the thiazide was not associated with risk of Cholecystitis.
Specificity
This factor has to ensure that alter the cause only would change the outcomes. This is true for the case of ovarian cancer but thiazide use brings some complication. Basically the duration of use in obese women did not affect the risk according to Kakar et al. However the Rosenberg et al generally conclude that the there was significant relationship between use and the risk. Other factors like hypertension and age are not clearly confounded.
Dose response
There is a biological gradient for the OC and ovarian cancer since the risk reduces when one stops using the drugs. The risk increases with increased use as well. For the thiazide and Cholecystitis this is not clearly explained. The only relationship found was confined to the participants who used the drug for high blood pressure.
Biological Plausibility
The two papers are in line with the current accepted knowledge of disease processes. Combined contraceptive reduce the risk of cancer and gallstones cause Cholecystitis.
Coherence
The outcomes of the results in ovarian cancer paper is compatible with the current understanding of biology. However for the thiazide use, the conclusion states that5 the researchers are unaware of any other information that links Cholecystitis with use of the thiazide diuretics hence the conclusions are hypotheses and should be used with caution.
Experiment
There are clinical studies that have been conducted and others are being run today to help women to reduce epithelial ovarian cancer by using combination of contraceptives. There are pills that have two active ingredients to help achieve this purpose. This is because the oral contraceptive showed higher risk
Analogy
There are several hypotheses that need to be considered for an experiment to proceed. This means that there could be other alternative for a certain outcome. For instance, the occurrence of cholecystitis is not necessarily because of thiazide use. However, still there is a relationship in that gallstones and thiazide aggravate the condition. Researchers have proposed that Rosenberg findings be used as a strong stone for future research to establish the facts.
Comparison between Rosenberg et al and Kakar et al Findings
During the routine screening of the drugs used in hospital, for dieresis, thiazide diuretics were found to have an association with the prevalence of Cholecystitis. The data collected for the case-control plans of inspection. Rosenberg et al then carried out a test to verify these findings. They evaluated 419 participants who had suffered acute inflammation of the gallbladder. This experiment had a control of 1676 participants who posed a relative risk of developing the condition by a rate of 2.0 for those patients who had previously used thiazides at least one month before joining the study. They were compared to patients who had never used thiazides before. The experiment was analyzed at a confidence interval of 95% 1-4-2.7. According to the research, the risk of developing the Cholecystitis increased proportionally to the length or duration of using the thiazides. Those patients who used the drugs for at least five years more that others had a risk of 2.9. This correlation was not however clarified by confounding data due to the interactions as well as other factors like high blood pressure, other related medicine or body weight. Basically, the findings of the study are shielded by the fact that there can not be any epidemiologic study that can totally get rid of chance or biasness.
With increasing need to get proper understanding of the connection between gallstones and use of thiazide diuretics, Kakar et al carried out a case control study about this relationship. The study involved a group of women from Puget Sound health Cooperathe. The investigation was about finding the possible etiologic duty of previous encounter with thiazides. The study involved 150 women who had previously undergone surgery were selected to participate in the study. Eligibility for participation was that the patient should have undergone the surgery between the beginning of 1979 and before the last quarter of 1980, that is September. There was also a control group set for checking extraneous variables. 156 participants were selected for the control group. The names were from the hospitals membership files. They were then interviewed concerning their health history if they had used certain medications, their reproductive past and physical health. The risk of developing gallstones was that the women must have used thiazides. Thos gallstone disease evaluated from the fact that it required surgery for management. This was related to those who had not been exposed to the drug before. After managing extraneous factors like race, age and pregnancy as well as the body weight in terms of BMI. The risk was found to be 1.9 at a confidence interval of 95%. Nonetheless, the relationship was only established in the women with low weight. Basically overweight women were classified from equal or more than 36. This study showed that those with lower weight were at higher risk of 1.0. In this category of women, there was no increase in risk with time of using thiazides. These findings failed to conform to the results from the previous studies which indicate that there could be a possibility of thiazide use causing or exacerbating gallstones. The outcomes of the recent studies show that if thiazide use was to have any effect on the occurrence of the disease then it could be specifically among the people who are not overweight. Still it was ascertained that it’s still premature to make decisive conclusion since there are several reasons that still need clarification. For instance the risk did not increase with prolonged use of the thiazides and that only those not overweight were affects by this. Furthermore, besides thiazides, those women who had undergone surgery due to gallstone disease had used other drugs like propranolol and frusermide.
Subgroup Association among Women Who Are Not Overweight
Basically, weight altered the impact of thiazide diuretic on the users. This is the reason why there is modi8fication of disease appearance between women who are overweight and those who are not. In another research by Blum Arnon found that women who were not overweight presented a very high risk of developing the disease at 5.0 while the overweight women only had a risk of 1.0. This difference is quite large and therefore significant in the research. Furthermore just like Kakar et al, Blum did not find any associated increase in the risk as the duration of the thiazide use increased. Also, note that the other factors like race, age, pregnancy and presence of a disease like hypertension were standardized for the test. Therefore only weight must have brought the alteration.