Impact of traditional risk factors for the outcomes of atrial fibrillation across race and ethnicity and sex groups.

BACKGROUND: Although traditional risk factors for atrial fibrillation (AF) and its outcomes are established in whites, their role in the pathogenesis of AF across race-ethnicity and both sexes remain unclear. Cohort studies have consistently shown worse AF-related outcomes in these groups. The objective of this study was to determine the role played by race- and sex-specific risk factors in AF outcomes in non-Hispanic blacks (NHBs), Hispanics/Latinos (H/Ls), and non-Hispanic whites (NHWs). METHODS: Using electronic health records (EHR), 3607 patients with an ICD-9 code for AF were identified over a 7-year period. Risk factors were identified from ICD to 9 CM claims data: hypertension (HTN), type 2 diabetes mellitus (T2DM), stroke/transient ischemic attack (TIA), smoking, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), peripheral arterial disease (PAD) and obstructive sleep apnea (OSA). Multivariate analysis of variance was used to compare the incidence of AF risk factors. RESULTS: NHBs and H/Ls with AF experienced more stroke than NHWs (27% and 24% vs. 19% P < 0.01). Females had less HTN (48.4% vs 51.6% [males], P = 0.0002), CAD (47.4% vs 55.7% [males], P = 0.02), and smoking rates (38.2% vs 61.8% [males], P < 0.0001) but higher stroke rates (25.9% [female] vs 21.8% [males], P < 0.0001). Age-adjusted risk factors for stroke varied markedly across race-ethnicity and sex. CONCLUSIONS: We identified differences in risk factors for AF and stroke across race-ethnicity and sex. The findings of our study are hypothesis generating and should be used to direct future studies.

Place of birth,age of immigration,and disability in Hispanics with multiple sclerosis.

BACKGROUND: Hispanics in the US are a diverse community where their knowledge and risk for developing disability in multiple sclerosis (MS) may relate to their level of acculturation. OBJECTIVE: To compare the risk of disability in Hispanics with MS in the US by place of birth and age of immigration. METHODS: We conducted a cross-sectional study of 304 Hispanics with MS residing in Southern California. Place of birth and age of immigration were used as proxies to acculturation. Individuals were classified as US-born, early and late-immigrant (<15 and ≥15 years at immigration to the US, respectively). Risk of disability (expanded disability status scale ≥6) was adjusted for age at symptom onset, sex, socioeconomic status, and disease duration, using logistic regression. RESULTS: Late-immigrants were older at symptom onset (34.2±11.9 vs. 31.9±12.9 vs. 28.5±9.7 years, p<0.001) and had more disability (28% vs. 9% vs. 18%, p=0.04) compared to early-immigrant and US-born respectively. There was no difference between groups by female sex, type of MS, ethnicity, chronic medical conditions, and disease duration while differences were noted by socioeconomic status. Being late-immigrant was independently associated with increased disability (adjusted OR 2.3 95% CIs 1.07­4.82; p=0.03) compared to US-born. CONCLUSION: Later immigration to the US in Hispanics with MS is associated with greater disability. These findings may reflect differences in social, environmental and cultural factors that may act as barriers for accessibility and utilization of health services. An in-depth assessment of the perceptions and attitudes about MS are warranted in this population.

Ultimos tratamientos antivirales contra el SIDA / x

Los últimos tratamientos encierran muchos significados como el fin del SIDA, pero hasta nuestros días no hay una cura segura sino más bien medicamentos para sobrellevar el virus convirtiendose de esta manera de condena a muerte, a enfermedad crónica controlada. Esto se ha logrado gracias a los muchos medicamentos que se han encontrado como ser: Los inhibidores de proteasa: Indinavir, ritonavir y el saquinavir; Los inhibidores de la transcriptasa: AZT, DDC, D4T, DDI, 3TC...