Prevalence and Predictors of Left Ventricular Diastolic Dysfunction in a Hispanic Patient Population

Minimal data exist on attributes of diastolic dysfunction in the Hispanic population. The purpose of this study was to evaluate the prevalence and predictors of diastolic dysfunction in a Hispanic patient population. We performed a retrospective review of 166 consecutive echocardiograms in a southwestern Texas Hospital that caters to a large Hispanic patient population. We identified all echocardiograms that met criteria for diastolic dysfunction and assessed baseline demographics and comorbidities in the cohort of Hispanic patients. A multivariate analysis was performed to identify the independent predictors of diastolic dysfunction. A total of 129 out of 166 patients (77.8%) were of Hispanic origin. Out of the 129 patients, 87 (67.4%) had some degree of diastolic dysfunction in this population suggesting a high prevalence in the study cohort. In the diastolic dysfunction group, the mean age was 64.5 ± 13.9, 37% were male and 63% female, 78% had diabetes, 85% had hypertension, and 49% had some degree of renal insufficiency (stages 3–5). A logistic multivariate analysis showed that diabetes was an independent predictor of diastolic dysfunction with odds ratio of 2.69 (95% confidence interval [CI], 1.06–6.28; p = 0.038). Similarly age (per year increase) and chronic kidney disease were independent predictors of diastolic dysfunction. We demonstrated that older age, presence of diabetes, and renal dysfunction are independent predictors of diastolic dysfunction in the Hispanic patient population. Strategies geared toward reducing diabetes and preventing renal dysfunction are likely to decrease prevalence of diastolic dysfunction and heart failure in this community.     

Different Fish-Eating Habits and Cytokine Production in Chronic Urticaria with and without Sensitization against the Fish-Parasite Anisakis simplex

BackgroundAnisakis simplex sensitization has been associated with acute, but also with chronic urticaria. The objective of this study is to characterize chronic urticaria with (CU +) and without sensitization (CU-) against the ubiquitous fish parasite A. simplex in a transversal and longitudinal evaluation.Methods16 CU + and 22 CU- patients were included and assessed for Urticaria activity score (UAS), fish-eating habits by standardized questionnaire and cytokine production (assessed by flow cytometric bead-based array) of peripheral blood mononuclear cells after stimulation with A. simplex extract or Concanavalin A (Con A). Patients were randomly put on a fish-free diet for three months and UAS, as well as cytokine production were again assessed. A difference of ≥ 1 in UAS was defined as improvement.ResultsThere was no difference in UAS in both groups. Anisakis induced IL-2, IL-4 and IFN-γ production was higher in CU +. Con A induced IL-6 and IL-10 production was higher in CU +. CU + was associated with higher total fish intake, whereas CU- was associated with oily fish intake. The correlation of UAS was positive with oily fish, but negative with total fish intake.There was a better UAS-based prognosis in CU + without diet. Improvement was associated with higher Con A induced IL-10/IFN-γ as well as IL-10/IL-6 ratios. Further, previous higher oily fish intake was associated with improvement.ConclusionsOur data confirm the different clinical and immunological phenotype of CU +. Our results show a complex relationship between fish-eating habits, cytokine production and prognosis, which could have important consequences in dietary advice in patients with CU. When encountering A. simplex sensitization, patients should not be automatically put on a diet without fish in order to reduce contact with A. simplex products.     

Pulmonary embolism,part II: Management

Acute pulmonary embolism (PE) bears a significant burden on health and survival. Rapid and accurate risk stratification and management are of paramount importance to ensure the highest quality of care. This present article summarizes currently available and emerging management strategies for the disease. The authors not only review current evidence regarding early therapy of acute PE, including supportive care, anticoagulation, thrombolysis, surgical and catheter-based treatment, but also the possible role of mechanical circulatory support in PE. The authors also discuss complications related to PE and its management.     

Social Factors Associated with the Knowledge About HIV of the Immigrants from China, Latin America, the Maghreb and Senegal in the Basque Country (Spain)

The objective of this study was to identify the social factors that explain the differences in knowledge with regards to HIV/AIDS among immigrants in the Basque Country (Spain). We conducted a cross-sectional study based on information obtained in the Basque Health Survey for 754 immigrants from: 86 China, 368 Latin America, 237 the Maghreb and 74 Senegal. Odds ratios (95% CI) were calculated from logistic regression models to measure the degree of association between inadequate knowledge regarding transmission, prevention and places where HIV testing is offered, and the independent variables. We found that this inadequate knowledge is associated with place of birth, sex, a lower level of education, immigration status, difficulties in understanding Spanish, and not receiving advice about AIDS in primary care. These findings indicate that initiatives must be developed to promote equity in the provision of healthcare through clinical guidelines, including details of the specific needs of different groups of immigrants and considering gender issues.     

Antioxidant and Anticlastogenic Capacity of Prickly Pear Juice

Plants belonging to the genus Opuntia spp. are the most abundant of the Cactaceae family, grown throughout America and the Mediterranean central area. Its fruit, known as cactus pear or prickly pear, is an oval berry grouped in different colors. Some studies have shown its antioxidant activities which may help in preventing chronic pathologies such as diabetes. The purpose of the study was to evaluate the antioxidant capacity of three varieties of prickly pear juice (red-purple, white-green and yellow-orange) in five different concentrations (100, 250, 500, 750, and 1000 mg/mL) by DPPH (1,1-diphenyl-2-picrylhydrazyl radical) colorimetric method, selecting the best variety to determine its anticlastogenic potential against methyl methanesulfonate (MMS). The results indicate that the highest antioxidant was found in the juice of the prickly pear red-purple variety (PPRP), in all concentrations. Its anticlastogenic potential was therefore evaluated with a micronucleus assay. The experiment was run over two weeks. A negative control was included along with a positive control with MMS (40 mg/kg), a group of mice treated with PPRP (25 mL/kg), and three groups with PPRP (in doses of 25, 16.5 and 8.3 mL/kg) plus the mutagen. The PPRP was administered daily by oral gavage and the MMS was injected intraperitoneally five days prior to the end of the experiment. Blood samples were obtained at 0, 24, 48, 72 and 96 h in order to determine the frequency of micronucleated polychromatic erythrocytes (MNPE). The results indicated that PPRP is not a genotoxic agent, on the contrary, it may reduce the number of MNPE. In this regard, the PPRP showed an anticlastogenic effect directly proportional to its concentrations. Thus, the highest protection was obtained with a concentration of 25 mL/kg after 48 h of treatment.