Trichomonas vaginalis infection among young pregnant women in Brazil

Our goal was to determine the prevalence of Trichomonas vaginalis and its associated risk factors in parturient women aged 15–24 years attending Brazilian public maternity units. Participants answered a demographic, behavioral, and clinical data questionnaire. A sample of urine was screened for T. vaginalis. A total 299 women participated in this study. The prevalence rate of T. vaginalis was 7.7% (95% CI: 4.7–10.7%). The factors associated with T. vaginalis were use of illicit drugs [OR = 4.70 (95% CI: 1.63–13.56, p = 0.004)] and not attending antenatal care [OR = 5.15 (95% CI: 1.15–23.25, p = 0.032)]. These data demonstrate that it is important to discuss how to include routine screening for T. vaginalis during antenatal care in Brazil.     

Prior history of sexually transmitted diseases in women living with AIDS in São Paulo,Brazil

ObjectivesTo describe the epidemiological profile, risk behaviors, and the prior history of sexually transmitted diseases (STDs) in women living with acquired immunodeficiency syndrome (AIDS).MethodsCross-sectional study, performed at the Centro de Referência e Treinamento em DST/AIDS of São Paulo. The social, demographic, behavioral, and clinical data such as age, schooling, marital status, age at first sexual intercourse, number of sexual partners, parity, use of drugs, time of HIV diagnosis, CD4 count, and viral load determination were abstracted from the medical records of women living with AIDS who had gynecological consultation scheduled in the period from June 2008 to May 2009.ResultsOut of 710 women who were scheduled to a gynecological consultation during the period of the study, 598 were included. Previous STD was documented for 364 (60.9%; 95% CI: 56.9%–64.8%) women. The associated factors with previous STDs and their respective risks were: human development index (HDI) < 0.50 (ORaj = 5.5; 95% CI: 2.8–11.0); non-white race (OR_aj = 5.2; 95% CI: 2.5–11.0); first sexual intercourse at or before 15 years of age (OR_aj = 4.4; 95% CI: 2.3–18.3); HIV infection follow-up time of nine years or more (OR_aj = 4.2; 95% CI: 2.3–7.8)]; number of sexual partners during the entire life between three and five partners (OR_aj = 2.2; 95% CI: 1.1–4.6), and six or more sexual partners (OR_aj = 3.9; 95% CI: 1.9–8.0%); being a sex worker (OR_aj = 1.9; 95% CI: 1.1–3.1).ConclusionsA high prevalence of a prior history of STDs in the studied population was found. It is essential to find better ways to access HIV infection prevention, so that effective interventions can be more widely implemented.     

Dyslipidemia and fasting glucose impairment among HIV patients three years after the first antiretroviral regimen in a Brazilian AIDS outpatient clinic

ObjectiveTo evaluate the cumulative incidence of dyslipidemia and fasting glucose impairment three years after initiating the first antiretroviral (ART) regimen and the association with the type of ART regimen in an AIDS outpatient clinic in Brazil.MethodsRetrospective cohort of HIV-1 infected patients attending an outpatient HIV clinic in Vitoria, Brazil, between January/2010 and May/2011. Data, including blood pressure, dyslipidemia (high total cholesterol and low HDL-C), fasting glucose, and cardiovascular risk by Framingham Risk Score were abstracted from medical records from clinic visits six months prior and three years after starting ART. We assessed independent associated factors for dyslipidemia using multiple logistic regression.ResultsFour hundred and ninety-eight patients on ART were studied. Median age was 45 years (interquartile range (IQR): 37–52), and median time since HIV diagnosis was 7.7 years (IQR: 3.8–10.0). The proportion of patients with dyslipidemia was 22.3% (95% CI: 18.6–25.9%) 36 months after ART initiation. Triglycerides levels >150 mg/dL (55.2% vs. 25.4%, p = 0.021) and high fasting glucose (5.8% vs. 2.3%, p = 0.034) were diagnosed more frequently after ART use when compared to baseline values. Multiple logistic regression analysis has shown dyslipidemia to be associated with lopinavir/r use [OR = 1.74 (95% CI: 1.12–2.86)].ConclusionThese data show high chance of dyslipidemia after initiation of ART. Long-term follow-up will help identify the impact of ART on cardiovascular risk.     

Aspirin for primary prevention of cardiovascular events in patients with diabetes: A meta-analysis

BackgroundTo systematically review trials concerning the benefit and risk of aspirin therapy for primary prevention of cardiovascular events in patients with diabetes mellitus.MethodsWe searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Eligible studies were prospective, randomized controlled trials of aspirin therapy for primary cardiovascular prevention in patients with diabetes with follow-up duration at least 12 months.Results7 trials included 11,618 individuals with diabetes. Aspirin therapy was not associated with a statistically significant reduction in major cardiovascular events (relative risk [RR] 0.92, 95% confidence interval [CI] 0.83–1.02, p = 0.11). Aspirin use also did not significantly reduce all-cause mortality (0.95, 95% CI 0.85–1.06; p = 0.33), cardiovascular mortality (0.95, 95% CI 0.71–1.27; p = 0.71), stroke (0.83, 95% CI 0.63–1.10; p = 0.20), or myocardial infarction (MI) (0.85, 95% CI 0.65–1.11; p = 0.24). There was no significant increased risk of major bleeding in aspirin group (2.46, 95% CI 0.70–8.61; p = 0.16). Meta-regression suggested that aspirin agent could reduce the risk of stroke in women and MI in men.ConclusionsIn patients with diabetes, aspirin therapy did not significantly reduce the risk of cardiovascular events without an increased risk of major bleeding, and showed sex-specific effects on MI and stroke.     

Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey

ObjectivesThe aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey.MethodsThe study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing.ResultsThe prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR = 2.5, 95% CI: 1.3–4.7, p = 0.004), dampness at home (OR = 2.4, 95% CI: 1.2–4.8, p = 0.008), a history of intestinal parasites (OR = 4.3, 95% CI: 1.7–10.9, p = 0.002), previous history of pneumonia (OR = 6.9, 95% CI: 1.9–25.9, p = 0.004), initiation of complementary foods before the age of three months (OR = 6.1, 95%CI: 1.4–26.9, p = 0.02) and presence of food allergy (OR = 3.1, 95% CI: 1.1–9.2, p = 0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR = 5.2, 95% CI: 0.9–28.7, p = 0.05) and high serum IgE levels (OR = 2.9, 95% CI: 0.9–9.0, p = 0.05) at borderline significance.ConclusionOur study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors.     

Gender differences in the impact of diabetes on mortality in patients with established coronary artery disease: A report from the Eastern Taiwan integrated health care delivery system of Coronary Heart Disease (ET-CHD) registry, 1997–2006

ObjectivesThe effect of type 2 diabetes mellitus (DM) on mortality was more pronounced in women than men with coronary artery disease (CAD) in the pre-stent era before 1996. However this relationship is controversial in the post-stent era.MethodsWe studied a cohort of 1073 patients with angiographically defined CAD from the Eastern Taiwan integrated health care delivery system of Coronary Heart Disease (ET-CHD) registry during 1997–2003 in Tzu-Chi General Hospital, Hualien, Taiwan. To evaluate gender-specific DM effect on mortality, the subjects were divided into 4 groups: diabetic women (n = 147), non-diabetic women (n = 127), diabetic men (n = 239), and non-diabetic men (n = 560). At a mean follow-up of 5.4 years, cardiac and all-cause mortality were the primary end points.ResultsAnnual total mortality rates were 10.2%, 5.1%, 7.2%, and 4.8%; annual cardiac mortality rates were 8.2%, 3.0%, 4.3%, and 2.6% for diabetic women, non-diabetic women, diabetic men, and non-diabetic men, respectively. Multivariate Cox regression models, adjusted for possible confounders showed that gender-specific hazard ratios (HRs) of DM for total mortality were 2.02 (95% CI: 1.32–3.09), and 1.72 (95% CI: 1.32–2.25) for women and men, respectively. The HRs for total mortality associated with diabetes were not different between women and men (p = 0.53). Similarly, adjusted gender-specific HRs of DM for cardiac mortality were 2.46 (95% CI: 1.45–4.19) for women, and 1.83 (95% CI: 1.28–2.62) for men, which were also not significantly different (p = 0.36).ConclusionsAmong patients with CAD, the impact of DM on mortality was consistently higher in women than in men, but the differences across sexes were not statistically significant after 1996 in Taiwan.     

Prolongation of the heart rate-corrected QT interval is associated with cardiovascular diseases: Systematic review and meta-analysis

BackgroundConflicting findings have described the association between prolonged heart rate-corrected QT interval (QTc) and cardiovascular disease.AimsTo identify articles investigating the association between QTc and cardiovascular disease morbidity and mortality, and to summarize the available evidence for the general and type 2 diabetes populations.MethodsA systematic search was performed in PubMed and Embase in May 2022 to identify studies that investigated the association between QTc prolongation and cardiovascular disease in both the general and type 2 diabetes populations. Screening, full-text assessment, data extraction and risk of bias assessment were performed independently by two reviewers. Effect estimates were pooled across studies using random-effect models.ResultsOf the 59 studies included, 36 qualified for meta-analysis. Meta-analysis of the general population studies showed a significant association for: overall cardiovascular disease (fatal and non-fatal) (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.33–2.12; I² = 69%); coronary heart disease (fatal and non-fatal) in women (HR 1.27, 95% CI 1.08–1.50; I² = 38%; coronary heart disease (fatal and non-fatal) in men (HR 2.07, 95% CI 1.26–3.39; I² = 78%); stroke (HR 1.59, 95% CI 1.29–1.96; I² = 45%); sudden cardiac death (HR 1.60, 95% CI 1.14–2.25; I² = 68%); and atrial fibrillation (HR 1.55, 95% CI 1.31–1.83; I² = 0.0%). No significant association was found for cardiovascular disease in the type 2 diabetes population.ConclusionQTc prolongation was associated with risk of cardiovascular disease in the general population, but not in the type 2 diabetes population.     

Risk factors for foot ulcers—A cross sectional survey from a primary care setting in Brazil

AimsTo identify the prevalence of higher risk of foot ulceration and associated factors among patients with diabetes mellitus (DM) at primary health care services.MethodsIndividuals with DM, registered at primary health care services in a municipality in southern Brazil, were interviewed and underwent foot examinations. Their risk of ulceration was classified in accordance with the recommendations of the International Working Group on the Diabetic Foot. Poisson bivariate and multivariate analyses were performed and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated.ResultsThe prevalence of higher risk of foot ulceration among the 337 interviewees was 27.9% (95% CI 23.1–32.9). The following factors were associated with this risk: having been diagnosed with DM for more than 10 years (Adjusted-PR 1.669; 95% CI 1.175–2.373; p = 0.004); having had previous diagnoses of acute myocardial infarction (Adjusted-PR 1.873; 95% CI 1.330–2.638; p < 0.001) and stroke (Adjusted-PR 1.684; 95% CI 1.089–2.604; p = 0.019); presenting interdigital mycosis (Adjusted-PR 1.539; 95% CI 1.030–2.300; p = 0.035) and calluses (Adjusted-PR 1.654; 95% CI 1.117–2.451; p = 0.012).ConclusionsThe prevalence of higher risk of ulceration was high, which reinforces the importance of continued education for health care professionals in order to prevent complications in the feet of these patients.     

Recours à l’automédication chez l’hypertendu noir africain : ses facteurs et ses conséquences

IntroductionSelf-medication practice is under-evaluated among black African hypertensive patients.AimTo assess the level of self-medication among black African hypertensive patients and to determine the factors favoring this practice and their consequences.MethodsProspective study during a 3-month period including 612 hypertensive patients followed in Abidjan cardiology institute.ResultsMean age was 55.1. The patients had a self-medication use in 60.1% of cases. Medicinal plants and derived products were commonly involved. Self-medication use reasons were: influence of relatives (89.8%) and the fear of antihypertensive drugs adverses effects (54.9%). Multivariate analysis shows that factors of self-medication were age (56.6 years vs. 50.3 years, P < 0.001), income less than 762 euros/month (88% vs. 75.4%; OR = 2.73; 95% CI: 1.62–4.6; P < 0,0001), obesity (70.4% vs. 35.6%; OR = 1.24; 95% CI: 0.75–1.15; P = 0.037), dyslipidemia (40.8% vs. 27.9%; OR = 6.72; 95% CI: 0.57–2.13; P = 0.043), antihypertensive association therapy (61.7% vs. 51.4%; OR = 2.27; 95% CI: 0.25–0.97; P = 0.037). Poor control of high blood pressure (HBP) was a consequence of self-medication (6.5% vs. 47.1%; OR = 10.27; 95% CI: 4.65–56.4; P = 0.034), repercussions of HBP on major organ (75% vs. 17.2%; OR = 12.9; 95% CI: 8.5–19.6; P = 0.0001).ConclusionSelf-medication is a common practice in African hypertensive patients. It has many consequences.     

Asthma prevalence,but not allergic rhinitis nor atopic dermatitis,is associated to exposure to dogs in adolescents

BackgroundExposure to pets can be a predisposing factor in the development of certain diseases, including allergic diseases.ObjectiveWe analyzed the role that exposure to indoor dogs and cats plays in the prevalence of allergic diseases.MethodsWe examined the cross-sectional data of 1056 women and 936 men aged 15 to 18 years; these individuals were selected through stratified and cluster random sampling. We asked all participants about their exposure to indoor dogs and cats during the year that preceded our study. The prevalence of allergic diseases was determined through core questions taken from The International Study of Asthma and Allergies in Childhood questionnaire.ResultsThe prevalence was 12.7% (95% CI: 11.3%–14.2%) for asthma, 9.0% (95% CI: 7.8%–10.4%) for allergic rhinitis, and 5.2% (95% CI: 4.3%–6.2%) for atopic dermatitis. The multivariate analyses showed that exposure to indoor dogs, but not indoor cats, was associated with asthma prevalence (aOR 1.37; 95% CI: 1.03–1.83), as was male sex (aOR = 1.42; 95% CI: 1.08–1.86), a personal history of allergic rhinitis (aOR = 3.24; 95% CI: 2.25–4.66), and a maternal history of asthma (aOR = 3.06; 95% CI: 1.89–4.98). The population attributable risk for exposure to indoor dogs was 18%. Notably, neither allergic rhinitis nor atopic dermatitis was found to be associated with dog or cat exposure (p >  0.05).ConclusionExposure to dogs in late adolescence is a factor associated with asthma, although its contribution to the development of asthma should be investigated in new studies.     

What are the sociodemographic and health determinants for older adults continue to participate in work?

ObjectiveThis study aimed to determine the sociodemographic and health factors that influence older adults who continue to participate in the workforce.MethodsData were collected and evaluated for 1762 older adults aged 65 years and older who were living in the community and were enrolled in a population-based study (FIBRA Network Study). Older adults who participated in the workforce were compared with those who did not in terms of sociodemographic characteristics, physical and mental health, and physical functioning and performance in advanced and instrumental activities characteristic of daily living. A multivariate hierarchical logistic regression analysis was performed.ResultsFactors associated with not participating in the workforce were aged (OR: 1.71, [95% CI: 1.26–2.30], p < 0.001), female gender (OR: 1.70, [95% CI: 1.22–2.37], p = 0.002), poor visual perception (OR: 1.31, [95% CI: 1.00–1.72], p = 0.046), using 4 or more medications regularly (OR: 1.41, [95% CI: 1.489–2.247], p = 0.034), having 3 or more comorbidities (OR: 1.44, [95% CI: 1.01–2.04], p = 0.040), and a handgrip strength below 24.6 kg/f (18.1–24.6 kg/f (2nd tertile): OR: 1.52, [95% CI: 1.06–2.18], p = 0.022; 0–18 kg/f (1st tertile): OR: 1.60, [95% CI: 1.08–2.38], p = 0.019). The probability estimates of the final model explained 67.9% of the events related to not participating in the workforce, as observed by the area under the ROC curve.ConclusionOur results highlight that work in later life is influenced by sociodemographic characteristics, intrinsic capacity, and multimorbidity. We suggest that strategies for optimizing healthy and active aging may help older people to continue participating in the workforce and contributing toward their communities.     

Comparison of non-invasive models for predicting liver damage in chronic hepatitis B patients

IntroductionInexpensive blood tests have been well established as alternatives to liver biopsies to evaluate liver fibrosis in CHB patients. Here, we aim to compare their diagnostic accuracy in assessing liver fibrosis and necroinflammation.Patients and methodsA retrospective study was performed to evaluate the predictive value of non-invasive models in chronic hepatitis B patients with liver fibrosis by the area under receiver operating characteristic curve (AUROC). The clinical data of 160 patients were collected from medical records.ResultsOf the 160 consecutive treatment-naïve CHB patients, 29 (16%) had significant fibrosis and 34 (21%) had severe necroinflammation. The AUROC of the gamma-glutamyl transpeptidase to platelet ratio (GPR) (0.761, 95% CI 0.671–0.850) for predicting significant fibrosis was significantly higher than that of the aspartate transaminase-to-platelet ratio index (APRI) (0.680, 95% CI 0.585–0.774, p = 0.034), but comparable with the fibrosis index based on four factors (Fib-4) (0.746, 95% CI 0.656–0.836, p = 0.703), while for predicting severe necroinflammation, the performance of the GPR (AUROC = 0.869, 95% CI 0.800–0.937) was better than the APRI (AUROC = 0.816, 95% CI 0.740–0.892, p = 0.085) and Fib-4 (0.792, 95% CI 0.711–0.873, p = 0.023).DiscussionGPR is a satisfactory model to stage liver fibrosis and to grade necroinflammation activity, representing a convenient non-invasive alternative to liver biopsy in China.     

Effect modification of hyperlipidemia and hypertension on the association between type 2 diabetes and gout

AimsWe evaluated the association between type 2 diabetes and gout by a retrospective cohort study.MethodsData of 17,259 male and 18,318 female patients with type 2 diabetes were retrieved for the 1998–2010 period. These patients were matched to a comparison group (n = 34,518 and n = 36,636, respectively) in a 1:2 ratio by age and region.ResultsWe found that patients with type 2 diabetes after adjustment for hyperlipidemia and hypertension had a lower risk of incident gout than the matched population (incidence rate ratio, men: 0.39 [95% CI: 0.36–0.42]; women: 0.78 [0.72–0.84]). Specifically, type 2 diabetes alone without hyperlipidemia and hypertension was associated with a reduced risk of incident gout in men (adjusted relative risk [RR]: 0.29, 95% CI: 0.22–0.39), but not in women (0.86, 95% CI: 0.55–1.36). We found that insulin users with hyperlipidemia and hypertension associated with risk of incident gout and no sex-specific differences were noted (adjusted RR, men: 1.28 [95% CI: 1.11–1.48]; women: 1.32 [95% CI: 1.14–1.53]). Specifically, insulin users alone without hyperlipidemia and hypertension were not statistically significantly associated with gout risk (P ≥ .0954).ConclusionsThe results of this study indicated that hyperlipidemia and hypertension modified the association between type 2 diabetes and gout.     

The metabolic syndrome in early pregnancy and risk of gestational diabetes mellitus

AimThe objective of the present study was to determine whether or not maternal metabolic syndrome in early pregnancy in women without previous diabetes is associated with the development of gestational diabetes mellitus (GDM).MethodsA total of 508 women from the Rhea study—involving a pregnant cohort in Crete, Greece (2007–2009)—with singleton pregnancies were included in the present analysis. Maternal fasting serum samples were collected and blood pressure measured before gestational week 15. The metabolic syndrome in early pregnancy was defined according to NHLBI/AHA criteria. Pregnant women were screened for GDM between weeks 24 and 28 of gestation, as defined by Carpenter and Coustan criteria. Multivariable log-binomial regression models were used to estimate the effect of the metabolic syndrome in early pregnancy on the risk of GDM, after adjusting for confounding factors.ResultsWomen with the metabolic syndrome were at high risk of GDM (RR = 3.17; 95% CI: 1.06–9.50). Among the components of the metabolic syndrome, the most significant risk factors were impaired fasting glucose (RR = 4.92; 95% CI: 1.41–17.23) and pre-pregnancy obesity (RR = 2.65; 95% CI: 1.23–5.70). A 10-mmHg rise in systolic and diastolic blood pressure increased the relative risk of GDM by 49% (RR = 1.49; 95% CI: 1.10–2.02) and 34% (RR = 1.34; 95% CI: 1.04–1.73), respectively, whereas a 1-unit increase in pre-pregnancy BMI increased the relative risk of GDM by 6% (RR = 1.06; 95% CI: 1.01–1.12).ConclusionThese findings suggest that women with the metabolic syndrome in early pregnancy have a greater risk of developing GDM.     

Prospective comparative study between two first-line regimens for Helicobacter pylori eradication: Non-bismuth quadruple versus bismuth quadruple therapy

BackgroundThe Maastricht V Consensus recommends quadruple therapies as first-line Helicobacter pylori treatment in high clarithromycin (CLA) resistance areas.AimsTo compare efficacy, side effects and compliance between quadruple concomitant non-bismuth vs bismuth quadruple therapy.MethodProspective study enrolling H. pylori-positive patients. Omeprazol and a three-in-one formulation of bismuth–metronidazol–tetracycline (OBMT-3/1) for 10 days, or combination of omeprazol–clarithromycin–amoxicillin–metronidazol (OCAM) for 14 days, were prescribed. Eradication outcome was assessed by urea breath test or histology. Side effects and compliance were recorded during the treatment period with specific questionnaires.Results404 patients were recruited (median age 53 years; 62.87% women). In 382 (183 with OCAM, 199 with OBMT-3/1) the post-treatment test result was available. The eradication rates were 85.94% (CI95%: 80.20–90.52) with OCAM and 88.21% (CI95%: 83.09–92.22) with OBMT-3/1 (p = 0.595) in intention-to-treat analysis, whilst in per protocol analysis they were 91.12% (CI95%: 85.78–94.95) and 96.17% (CI95%: 92.28–98.45) respectively (p = 0.083). Compliance over 90% was 91.35% with OCAM and 92.04% with OBMT-3/1 (p = 0.951). Some side effect was present in 94.02% with OCAM and in 88.89% with OBMT-3/1 (p = 0.109), being longer (12 vs 7 days, p < 0.0001) and more severe (p < 0.0001) with OCAM.ConclusionsIn a high CLA-resistance area, there are no differences between OBMT-3/1 and OCAM in H. pylori eradication and compliance rates, but OBMT-3/1 achieves a higher safety profile.     

Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Findings from the 5-year follow-up of the MADIABETES cohort

PurposeTo analyse the association between body mass index (BMI) and all-cause mortality in a 5-year follow-up study with Spanish type 2 diabetes mellitus (T2DM) patients, seeking gender differences.Methods3443 T2DM outpatients were studied. At baseline and annually, patients were subjected to anamnesis, a physical examination, and biochemical tests. Data about demographic and clinical characteristics was also recorded, as was the treatment each patient had been prescribed. Mortality records were obtained from the Spanish National Institute of Statistics. Survival curves for BMI categories (Gehan-Wilcoxon test) and a multivariate Cox proportional hazard analysis were performed to identify adjusted Hazard Ratios (HRs) of mortality.ResultsMortality rate was 26.38 cases per 1000 patient-years (95% CI, 23.92–29.01), with higher rates in men (28.43 per 1000 patient-years; 95% CI, 24.87–32.36) than in women (24.31 per 1000 patient-years; 95% CI, 21.02–27.98) (p = 0.079). Mortality rates according to BMI categories were: 56.7 (95% CI, 40.8–76.6), 28.4 (95% CI, 22.9–34.9), 24.8 (95% CI, 21.5–28.5), 21 (95% CI, 16.3–26.6) and 23.7 (95% CI, 14.3–37) per 1000 person-years for participants with a BMI of < 23, 23–26.8, 26.9–33.1, 33.2–39.4, and > 39.4 kg/m², respectively. The BMI values associated with the highest all-cause mortality were < 23 kg/m², but only in males [HR: 2.78 (95% CI, 1.72–4.49; p < 0.001)], since in females this association was not significant [HR: 1.14 (95% CI, 0.64–2.04; p = 0.666)] (reference category for BMI: 23.0–26.8 kg/m²). Higher BMIs were not associated with higher mortality rates.ConclusionsIn an outpatient T2DM Mediterranean population sample, low BMI predicted all-cause mortality only in males.     

Chlamydia trachomatis infection among HIV-infected women attending an AIDS clinic in the city of Manaus,Brazil

This was a cross-sectional study aimed to determine the prevalence of and to identify risk factors for Chlamydia trachomatis (CT) among human immunodeficiency virus (HIV)-infected women attending the acquired immunodeficiency syndrome (AIDS) clinic in the city of Manaus, Brazil, in 2009-2010. Participants answered a questionnaire containing demographic, epidemiological, and clinical data. A genital specimen was collected during examination to detect CT-DNA by hybrid capture, and blood samples were taken to determine CD4⁺T and HIV viral load. There were 329 women included in the study. Median age was 32 years (IQR = 27-38) and median schooling was nine years (IQR = 4-11). The prevalence of CT was 4.3% (95%CI: 2.1-6.5). Logistic regression analysis showed that age between 18-29 years [OR = 4.1(95%CI: 1.2-13.4)] and complaint of pelvic pain [OR = 3.7 (95%CI: 1.2-12.8)] were independently associated with CT. The use of condom was inversely associated with CT [OR = 0.39 (95%CI: 0.1-0.9)]. The results showed that younger women who did not use condoms are at a higher risk for CT. Screening for sexually transmitted infections must be done routinely and safe sexual practices should be promoted among this population.     

Adiponectin Levels and Risk of Coronary Heart Disease: A Meta-analysis of Prospective Studies

BackgroundAdiponectin is the most abundant circulating protein secreted by adipocytes. There is uncertainty about the association between adiponectin levels and risk of coronary heart disease (CHD). We conducted this meta-analysis to summarize the effect of adiponectin on the risk of CHD.MethodsA comprehensive search was performed to identify all prospective studies on the association of adiponectin levels and risk of CHD. The quality of the eligible studies was evaluated by the Newcastle-Ottawa Scale. The fixed- or random-effects model was selected to pool the relative risk (RR) and 95% confidence interval (CI). Heterogeneity among studies was evaluated using Q test and the I² statistic. Publication bias was estimated using modified Egger’s linear regression test.ResultsTwelve prospective studies comprising 8 nested case-control studies and 4 cohort studies were included in the meta-analysis. A total of 14,960 participants were enrolled and 4,132 incident CHD events were observed. The pooled RR for CHD was 0.83 (95% CI, 0.69–0.98, P = 0.031). Subgroup analyses showed that the pooled RRs (95% CIs) for CHD risk were 0.78 (0.66–0.92) and 0.75 (0.59–0.94) for men and women, respectively. For studies with mean age less than 65 years, the pooled RR (95% CI) for CHD risk was 0.72 (0.59–0.87). For studies with 100 or more CHD cases, the pooled RR was marginally significant (RR = 0.83, 95% CI, 0.69–1.00; P = 0.051). No publication bias was found in our study (P = 0.911).ConclusionsThis meta-analysis showed that higher levels of adiponectin were associated with a low risk of CHD. The protective effect was consistently existed in men and women and in the middle-aged populations.     

Fitness Fatness Index and Alzheimer-specific mortality

ObjectiveWe evaluated the specific association between a Fitness Fat Index (FFI) and Alzheimer's-specific mortality among a national sample of the broader U.S. adult population.MethodsFFI was calculated as cardiorespiratory fitness (CRF) divided by waist-to-height ratio (WHR). Data from the 1999–2006 National Health and Nutrition Examination Survey (NHANES) were used to identify 16,146 participants, ages 20–85. Data from participants in these cycles were linked to death certificate data from the National Death Index. Person-months of follow-up were calculated from the date of the interview until date of death or censoring on December 31, 2011, whichever came first.ResultsIn a Cox proportional hazard model, for every 1 FFI unit increase, participants had a 14% reduced hazard of Alzheimer-specific death (HR = 0.86; 95% CI: 0.83–0.90; P < 0.001). When including diabetes and hypertension (via physician-diagnosis) as covariates, results were unchanged (HR = 0.87; 95% CI: 0.82–0.91; P < 0.001). Results were also unchanged when restricting the sample to those 50 + years (HR = 0.92; 95% CI: 0.88–0.97; P = 0.005) or stratifying by men (HR = 0.85; 95% CI: 0.81–0.91; P < 0.001) or women (HR = 0.86; 95% CI: 0.79–0.94; P = 0.002).ConclusionIn this national sample of individuals at risk for Alzheimer's disease, increased FFI was associated with reduced risk of Alzheimer's-specific death. Thus, a more favorable fitness-to-fatness ratio is associated with reduced risk of Alzheimer's-specific mortality, underscoring the importance of fitness promoting and fatness reducing strategies.     

Predictive model of persistent choledocholithiasis in patients with acute biliary pancreatitis

BackgroundCholedocholithiasis causing acute biliary pancreatitis (ABP) may migrate to the duodenum or persist in the common bile duct (CBD). We developed a model for predicting persistent choledocholithiasis (PC) in patients with ABP.MethodsThis retrospective cohort study included 204 patients, age ≥18 years (mean age: 73 years, 65.7% women), admitted for ABP in 2013–2018, with at least a magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and/or endoscopic retrograde cholangiopancreatography (ERCP). Epidemiological, analytical, imaging, and endoscopic variables were compared between patients with and without PC. Multivariate logistic regression analyses were performed to develop a predictive model of PC.ResultsPatients underwent MRCP (n = 145, 71.1), MRCP and ERCP (n = 44, 21.56%), EUS and ERCP (n = 1, 0.49%), or ERCP (n = 14, 6.86%). PC was detected in 49 patients (24%). PC was strongly associated with CBD dilation, detected in the emergency ultrasound (p < 0.001; OR = 27; 95% CI: 5.8–185.5), increased blood levels of gamma glutamyl transpeptidase, detected at 72 h (p = 0.008; OR = 3.4; 95% CI: 1.5–8.9); and biliary sludge in the gallbladder (p = 0.008; OR = 0.03; 95% CI: 0.001–0.3).ConclusionsThe predictive model showed a validated area under the curve (AUC) of 0.858 for detecting PC in patients with ABP. A nomogram was developed based on model results.ConclusionsThe predictive model was highly effective in detecting PC in patients with ABP. Therefore, this model could be useful in clinical practice.