Prevalence of Integrase Strand Inhibitor Resistance (INSTI)in New Orleans, Louisiana, 2012-2013.

Integrase strand inhibitors (INSTI) are the newest class of antiretroviral (ARV) therapies available to patients. There is little surveillance data on INSTI resistance, particularly in the South. A retrospective review on all patients who underwent PhenoSense Integrase testing between January 1, 2012 and June 30, 2013 was performed to better identify who should be screened for integrase strand transfer inhibitor (INSTI) resistance at the Interim Louisiana State University Hospital (ILH). Fifty-three patients underwent PhenoSense testing for elvitegravir/raltegravir resistance during this time period. Resistance was significantly associated with INSTI experience but not with other characteristics including sex, age, race, CD4 cell count, or concurrent reverse transcriptase inhibitor or protease inhibitor mutations. The frequency of reduced elvitegravir/ raltegravir susceptibility among INSTI experienced patients with virologic failure at ILH was 14/41 (34%). Future surveillance monitoring will be useful for determining if baseline INSTI resistance testing needs to be performed for INSTI naïve patients in the future at ILH.

An analysis of chronic kidney disease risk factors in a Louisiana nursing home population: a cross-sectional study.

BACKGROUND: Chronic Kidney Disease (CKD) and its progression are associated with multiple risk factors. CKD is prevalent in nursing homes residents, but factors related to CKD in this setting have not been defined. METHODS: A cross-sectional study was conducted (n=103). Data was abstracted using standardized forms and analyzed (SAS 9.2). Chi square and t-test statistics were used to compare proportions and means; correlation coefficients were used to describe associations. Logistic models were fit to the data to determine multivariate associations. Modification of Diet in Renal Disease (MDRD) formula was used to estimate GFR. CKD was defined according to established standards. A cutoff point of 60 was chosen for further analysis. RESULTS: Twenty-three percent of subjects had CKD. Mean age for eGFR <60 was 70.8 +/- 13 and for eGFR >60 was 61.7 +/-14. Frequent co-morbidities were hypertension (75%), GERD (40%), obesity (39%), dyslipidemia (35%), depression (34%), anemia (32%), and diabetes (32%). CONCLUSIONS: Our population is unique in terms of its age and reasons for nursing home admission. Factors associated with CKD in our study include age >65 years old, being male, having a positive history of cardiovascular disease (including congestive heart failure and coronary artery disease,) anemia, polypharmacy, and being obese (BMI >30). Further analysis showed that age and anemia are the strongest factors associated with CKD in our population. Management targeted at CKD risk factor reduction may play a vital role in controlling the magnitude of this disease. Prospective studies to investigate the relationship between gender, a BMI greater than 30, cardiovascular disease, and CKD and its complications are warranted.

Sex and race effects on risk for selected outcomes among elderly HIV-infected patients.

The HIV-infected population in the United States is aging. A retrospective study of 132 patients (26 women, 106 men) ≥59 years of age was undertaken to evaluate the effect of race and sex on selected outcomes. With the exception of women being more likely to have diagnosis of depression compared with men, sex had little influence on risk for other conditions among elderly patients with HIV. In contrast, African American race was significantly associated with the risk for several selected disorders and outcomes. These results can assist in future prevention efforts among senior individuals with HIV infection.

Risk factors for suboptimal vitamin D levels among adults with HIV attending an inner-city clinic of New Orleans, Louisiana.

BACKGROUND: Vitamin D insufficiency and deficiency are highly prevalent in populations with HIV, but there is limited data on predictors for suboptimal levels. METHODS: To determine risk factors for Vitamin D insufficiency/deficiency, 185 charts were retrospectively reviewed. RESULTS: Proportions with Vitamin D levels < 10 ng/ml, 10 - 20 ng/ml, 20 - 30 ng/ml and > 30 ng/ml were 14.6%, 44.8%, 24.9%, and 15.7%, respectively. Bivariate analysis showed that Vitamin D levels < 20 ng/ml were associated with a lower albumin level (p =.02), female gender (p = .0003), and African-American (AA) race (p = .0001). Tenofovir exposure showed borderline significance (p = .09). AA race was the only significant factor in multivariate modeling. CONCLUSIONS: Vitamin D insufficiency/deficiency was high. AA race was an independent risk factor. Although not significant, obese persons with a poorer nutritional status and possibly those on tenofovir may also be at higher risk.

Evaluating Factors Contributing to Dropout in a Large Peritoneal Dialysis Program.

BACKGROUND: The low prevalence of peritoneal dialysis (PD) (9%) vs. hemodialysis (HD) (88.2%) is partly due to patient dropout from therapy. METHODS: This retrospective study identified patients who withdrew from PD between 2016 and 2018 in our program. We evaluated all other factors as controllable losses. Analysis included time on therapy at dropout (very early, early or late) and method of initiation (HD to PD conversion, unplanned PD, or planned start). RESULTS: Eighty-three patients enrolled into our PD program. 27 dropped out; 24 were due to controllable factors, 3 due to death, with a median age at dropout of 52 years old. We determined psychosocial factors (PF) to be the largest controllable factor influencing dropout; contributing a 63% rate among all controllable factors. When considering time until dropout, 100% of very early dropout patients and 50% of late dropout patients did so due to PF. Among early dropout patients 67% dropped out due to other medical reasons. The mean time to dropout for PF, other, and infection (INF) were 13, 26, and 33 months, respectively. When considering type of initiation, we found PF to be the largest attributable factor with 50% of unplanned, 100% of planned, and 50% of conversions stopping therapy. CONCLUSIONS: Our study indicates that the primary reason for controllable loss from therapy was secondary to PF regardless of the time on therapy or the method of initiation to therapy.

[U.S.-Mexico cross-border cooperation in research on diabetes mellitus type 2]. / Cooperación transfronteriza en investigación sobre diabetes mellitus tipo 2: México-Estados Unidos.

OBJECTIVE: To describe and analyze, utilizing a case study approach, the U.S.- Mexico Border Diabetes Prevention and Control Project, a health research cooperation initiative incorporating the participation of federal, state, and local institutions of both countries. METHODS: A model of equal representation, participation, consensus, and shared leadership was used, with the participation of more than 130 institutions. A sample of 4 020 people over 18 years of age was obtained by a random, multistage, stratified, clustered design. A questionnaire about diabetes mellitus type 2 (DM2) and health was applied. The statistical analysis took into account the design effect. RESULTS: The prevalence of diagnosed DM2 was 14.9% (95% confidence interval [95% CI]: 12.5-17.6) and the prevalence of diagnosed DM2 adjusted by age was 19.5% (95% CI: 16.8-22.6) on the Mexican side of the border and 16.1% (IC95%: 13.5-19.2) on the U.S. border side. There were differences between the DM2 prevalence and risk factors along the border. CONCLUSIONS: The U.S.-Mexico Border Diabetes Prevention and Control Project allowed the border zone between the two countries to be considered, for the first time ever, as a unit for epidemiological research. A shared understanding among all participating institutions and entities of sociopolitical structures and procedures is required for effective border health cooperation initiatives.

Access to health care and undiagnosed diabetes along the United States-Mexico border.

OBJECTIVE: To examine the relationship between access to health care and undiagnosed diabetes among the high-risk, vulnerable population in the border region between the United States of America and Mexico. METHODS: Using survey and fasting plasma glucose data from Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project (February 2001 to October 2002), this epidemiological study identified 178 adults 18-64 years old with undiagnosed diabetes, 326 with diagnosed diabetes, and 2 966 without diabetes. Access to health care among that sample (n = 3,470), was assessed by type of health insurance coverage (including "none"), number of health care visits over the past year, routine pattern of health care utilization, and country of residence. RESULTS: People with diabetes who had no insurance and no place to go for routine health care were more likely to be undiagnosed than those with insurance and a place for routine health care (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0-6.6, and OR 4.5, 95% CI 1.4-14.1, respectively). When stratified by country, the survey data showed that on the U.S. side of the border there were more people with undiagnosed diabetes if they were 1) uninsured versus the insured (28.9%, 95% CI 11.5%-46.3%, versus 9.1%, 95% CI 1.5%-16.7%, respectively) and if they 2) had made no visits or 1-3 visits to a health care facility in the past year versus had made ≥ 4 visits (40.8%, 95% CI 19.6%-62.0%, and 23.4%, 95% CI 9.9%-36.9%, respectively, versus 2.4%, 95% CI -0.9%-5.7%) (all, P < 0.05). No similar pattern was found in Mexico. CONCLUSIONS: Limited access to health care--especially not having health insurance and/or not having a place to receive routine health services--was significantly associated with undiagnosed diabetes in the U.S.-Mexico border region.

Tasas de suicidio y concentración de litio en agua corriente en Rocha y Montevideo: primer estudio en Uruguay, período 2019-2020 / Suicide rates and lithium concentration in tap water in Rocha and Montevideo: first study in Uruguay, period 2019-2020 / Taxas de suicídio e concentração de lítio na água encanada em Rocha e Montevidéu: primeiro estudo no Uruguai, período 2019-2020

El suicidio es un fenómeno que además de las pérdidas humanas que involucra, repercute negativamente en familiares y allegados, produciendo a su vez enormes gastos en el sistema sanitario. En Uruguay, la tasa de suicidio no solo ha experimentado un aumento sostenido, representando una preocupación constante para las autoridades, sino que suele ser una de la más altas de Latinoamérica, en 2022 fue de 23,08 cada 100.000 habitantes. Reconociendo que el suicidio es un fenómeno multifactorial grave, diversos estudios han indagado sobre la posible correlación entre la presencia de litio en agua corriente y tasas de suicidio, habiéndose observado una relación inversa, lo que permitiría considerar el litio como eventualmente protector de la conducta suicida. El presente estudio pretende abordar dicha correlación en los departamentos de Rocha y Montevideo, de Uruguay. Los resultados obtenidos no son concluyentes. En cuanto a las concentraciones de litio presentes en agua corriente, en general son menores a las señaladas en otros estudios como protectoras (30 µ/L). Es necesario profundizar en este eje de discusión, como en otros, para obtener un diagnóstico más detallado de este complejo y sentido fenómeno.

Suicide is a phenomenon that, in addition to the human losses it involves, has a negative impact on family members and acquaintances, leading to enormous costs in the healthcare system. In Uruguay, the suicide rate has not only experienced a sustained increase, representing a constant concern for authorities, but it also tends to be one of the highest in Latin America, reaching 23.08 per 100,000 inhabitants in 2022. Recognizing that suicide is a serious multifactorial phenomenon, several studies have investigated the possible correlation between the presence of lithium in tap water and suicide rates, noting an inverse relationship. This suggests that lithium could potentially be considered protective against suicidal behavior. This study aims to address this correlation in the departments of Rocha and Montevideo, Uruguay. The results obtained are inconclusive. Regarding the concentrations of lithium present in tap water, they are generally lower than those indicated in other studies as protective (30 µg/L). It is necessary to delve deeper into this axis of discussion, as in others, to obtain a more detailed diagnosis of this complex and profound phenomenon.

O suicídio é um fenómeno que, além das perdas humanas que envolve, tem um impacto negativo nos familiares e amigos, produzindo enormes gastos no sistema de saúde. No Uruguai, a taxa de suicídio não só tem registado um aumento sustentado, representando uma preocupação constante para as autoridades, mas geralmente é uma das mais altas da América Latina, sendo de 23,08 por 100.000 habitantes em 2022. Reconhecendo que o suicídio é um fenómeno multifatorial grave, vários estudos têm investigado a possível correlação entre a presença de lítio na água encanada e as taxas de suicídio; observa-se uma relação inversa, o que permitiria considerá-lo como um possível protetor do comportamento suicida. O presente estudo visa abordar esta correlação nos departamentos de Rocha e Montevidéu no Uruguai. Os resultados obtidos não são conclusivos. Quanto às concentrações de litio presentes na água corrente, são geralmente inferiores às indicadas em outros estudos como protetoras (30 µ/L). É necessário aprofundar esta área de discussão como em outras linhas de pesquisa, e obter um diagnóstico mais detalhado deste fenômeno complexo e significativo.

Utility of non-high-density lipoprotein cholesterol versus other lipoprotein measures in detecting subclinical atherosclerosis in young adults (The Bogalusa Heart Study).

Direct comparative data on the utility of non-high-density lipoprotein (HDL) cholesterol versus low-density lipoprotein cholesterol, HDL cholesterol, triglycerides, apolipoprotein (apo) B, apo A-I, ratio to total cholesterol to HDL cholesterol, and ratio of apo B to apo A-I in detecting increased carotid intima-media thickness (IMT), a validated measurement of subclinical atherosclerosis, in asymptomatic younger adults are scant. This aspect was examined in 1,203 black and white subjects (71% white, 43% men) 24 to 43 years of age. In multivariate logistic regression analysis of each lipoprotein measurement (top quartile vs lower 3 quartiles specific for age, race, and gender) for detecting increased carotid IMT (top decile vs lower 9 deciles specific for age, race, and gender), only non-HDL cholesterol, total cholesterol/HDL cholesterol, and apo B emerged as significant correlates with respective odds ratios of 1.75 (95% confidence interval [CI] 1.10 to 2.78), 2.02 (95% CI 1.27 to 3.19), and 2.13 (95% CI 1.38 3.29), after adjusting for body mass index, systolic blood pressure, and other lipoprotein measurements. Regarding discriminating values of different lipoprotein measurements in detecting increased carotid IMT, area (c-value) under the receiver operating characteristic curve analysis for each lipoprotein measurement adjusted for age, race, gender, body mass index, and systolic blood pressure indicated that the c-value for non-HDL cholesterol (0.73) was similar to those for low-density lipoprotein cholesterol (0.76), total cholesterol/HDL cholesterol (0.72), apo B/apo A-I (0.71), and HDL cholesterol (0.70), but significantly (p <0.001) higher than that for apo A-I (0.69), triglycerides (0.64), and apo B (0.64). In conclusion, non-HDL cholesterol is as good as or better than other widely recommended lipoprotein measurements in the identification of subclinical atherosclerosis in young adults.

Characteristics and genotype profiles of antiretroviral-naïve patients entering a Southern US HIV outpatient clinic 2009-2012.

The US city of New Orleans was ranked second in the nation for estimated HIV case rates in 2011. Opt-out testing was established at the Interim Louisiana Hospital in New Orleans in 2013. The majority of new diagnoses were referred to the HIV outpatient program. We conducted a retrospective chart review of newly referred antiretroviral-naïve patients establishing HIV care between January 2009 and June 2013 to characterise demographic and genotype profiles to assist in clinical management and needed services. Of the eligible 226 patients, 68% were men, and 88% were African American. Nearly half of the study patients were younger than 35 years of age. Forty-six percent had an initial CD4 count <200 cells/mm(3), and 39% had a HIV viral load >100,000 copies/mL. The antiretroviral class with the most common major mutation was the non-nucleoside reverse transcriptase inhibitors (NNRTIs) where K103N was the most common major NNRTI mutation at presentation. We observed that male patients showed more advanced disease with later presentation to care, confirming the need for earlier HIV diagnosis. When considering initial antiretroviral therapy, baseline genotype information is encouraged, particularly if considering a NNRTI-based regimen.

Longitudinal changes in risk variables of insulin resistance syndrome from childhood to young adulthood in offspring of parents with type 2 diabetes: the Bogalusa Heart Study.

The occurrence of metabolic abnormalities related to insulin resistance syndrome in nondiabetic offspring of type 2 diabetic parents is known. However, information is lacking on the timing and the course of development of the components of this syndrome from childhood to adulthood in the offspring of parents with diabetes. This aspect was examined in a community-based cohort with (n = 303) and without (n = 1,136) a parental history of type 2 diabetes followed longitudinally since childhood (ages 4 to 17 years; mean follow-up period, 15 years) by repeated surveys. Offspring with parental diabetes versus those without such history had significantly excess generalized and truncal adiposity as measured by body mass index (BMI) and subscapular skinfold beginning in childhood, higher levels of fasting insulin and glucose and homeostasis model assessment index of insulin resistance (HOMA-IR) from adolescence, and higher levels of low-density lipoprotein (LDL) cholesterol and triglycerides and lower levels of high-density lipoprotein (HDL) cholesterol in adulthood. Many of these risk variables changed adversely at an increased rate in offspring of diabetic parents. In a multivariate analysis, parental diabetes was an independent predictor of longitudinal changes in adiposity, glucose, insulin, HOM-IR, systolic and diastolic blood pressure, and LDL cholesterol in the offspring, regardless of race and gender. As young adults, the offspring of diabetic parents had a higher prevalence of generalized (BMI > 30, 36% v 16%, P =.0001) and visceral (waist > 100 cm, 15% v 6%, P =.0001) obesity, hyperinsulinemia indicative of insulin resistance (insulin > 18 microU/mL, 15% v 8%, P =.0001), hyperglycemia (>or=110 mg/dL, 2% v 0.5%, P =.02), high LDL cholesterol (>or=160 mg/dL, 11% v 7%, P =.02), low HDL cholesterol (<40 mg/dL for males and <50 mg/dL for females, 40% v 31%, P =.004), high triglycerides (>or=150 mg/dL, 23% v 15%, P =.0001), and hypertension (>140/90 mm Hg, 11% v 6%, P =.004). Thus, the offspring of diabetic parents displayed excess body fatness beginning in childhood and accelerated progression of adverse risk profile characteristics of insulin resistance syndrome from childhood to young adulthood. These observations have important implications for early prevention and intervention.

Low birth weight and longitudinal trends of cardiovascular risk factor variables from childhood to adolescence: the bogalusa heart study.

BACKGROUND: Several studies have linked low birth weight to adverse levels of cardiovascular risk factors and related diseases. However, information is sparse at a community level in the U.S. general population regarding the effects of low birth weight on the longitudinal trends in cardiovascular risk factor variables measured concurrently from childhood to adolescence. METHODS: Longitudinal analysis was performed retrospectively on data collected from the Bogalusa Heart Study cohort (n = 1141; 57% white, 43% black) followed from childhood to adolescence by repeated surveys between 1973 and 1996. Subjects were categorized into low birth weight (below the race-specific 10th percentile; n = 123) and control (between race-specific 50-75th percentile; n = 296) groups. RESULTS: Low birth weight group vs control group had lower mean HDL cholesterol (p = 0.05) and higher LDL cholesterol (p = 0.05) during childhood (ages 4-11 years); higher glucose (p = 0.02) during adolescence. Yearly rates of change from childhood to adolescence in systolic blood pressure (p = 0.02), LDL cholesterol (p = 0.05), and glucose (p = 0.07) were faster, and body mass index (p = 0.03) slower among the low birth weight group. In a multivariate analysis, low birth weight was related independently and adversely to longitudinal trends in systolic blood pressure (p = 0.004), triglycerides (p = 0.03), and glucose (p = 0.07), regardless of race or gender. These adverse associations became amplified with age. CONCLUSIONS: Low birth weight is characterized by adverse developmental trends in metabolic and hemodynamic variables during childhood and adolescence; and thus, it may be an early risk factor in this regard.

Experiencia de cambio de marcas comerciales de lamotrigina en una paciente ambulatoria del Hospital Vilardebó / Experience of changing commercial brands of lamotrigine in an outpatient of the Vilardebó Hospital

Se desarrolló una experiencia en una pacientede cambio entre dos marcas comerciales de lamotrigina: Lamictal (referencia) y Epilepax (test). Esto fue motivado por notificaciones sobre sospecha de falta de eficacia de una de las citadas presentaciones farmacéuticas utilizada en el Hospital Vilardebó. Se realizó la comparación de las curvas salivales de lamotrigina versus tiempo para las dos marcas, determinándose parámetros clínicos, farmacocinéticos y de seguridad. La experiencia de cambio entre las dos marcas en la paciente no evidenció diferencias en ninguno de los parámetros mencionados.

An experience was developed in a patient of change between two commercial brands of lamotrigine: Lamictal (reference) and Epilepax (test). This was motivated by notifications on suspicion of lack of efficacy of one of the aforementioned pharmaceutical presentations used in the Vilardebó Hospital. The comparison of salivary curves of lamotrigine versus time for the two brands was made, determining clinical, pharmacokinetic and safety parameters. The experience of change between the two brands in the patient did not show any differences in any of the mentioned parameters.

Gender differences in HIV drug resistance mutations and virological outcome.

BACKGROUND: Previous studies have shown that female gender has higher odds of developing HIV drug resistance mutations. We aimed to evaluate the gender differences in HIV drug resistance mutation patterns and outcomes in a cohort of an HIV-infected population who underwent genotype resistance testing (GRT). METHODS: We conducted a retrospective study from January 2004 to April 2007 of patients >12 years of age who underwent GRT in the HIV Outpatient Program Clinic (HOP) at the Medical Center of Louisiana at New Orleans. RESULTS: Among 391 patients included in the analysis, 130 were females and 261 were males. There were no major statistically significant differences in the baseline demographic, clinical, or genotypic characteristics between males and females before GRT except for race, presence of coexisting hepatitis B and C infection, prior diagnosis of tuberculosis, presence of thymidine analogue mutations (TAMs), and protease inhibitor (PI) mutations L90M and I84V (p < 0.05). Females showed a 1.6 fold probability of carrying nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.02-2.6), whereas males showed a 2-fold probability of carrying PI mutations (OR 2, 95% CI 1.12-3.8). Sixty-seven percent of males achieved virological suppression compared with 57% of females at 1 year (±6 months). Independent of history of optimal treatment and race, females showed 2-fold odds of having virological failure compared with males at 1 year (±6 months) after GRT (OR 2.0, 95% CI 1.04-3.8). CONCLUSIONS: Females did worse than males in regard to viral load suppression at the end of 1 year if they had documented HIV drug resistance at baseline. Further longitudinal studies are needed to confirm our findings.

Prescripción de antipsicóticos al egreso hospitalario durante el período abril-setiembre de 2012 en el Hospital Vilardebó de Montevideo, Uruguay / Prescribing antipsychotics to hospital discharge during the period April-September 2012 Vilardebó Hospital in Montevideo, Uruguay

Las guías clínicas recomiendan la monoterapia antipsicótica (mta). La polifarmacia antipsicótica (pfa, uso concomitante de dos o más antipsicóticos) es una práctica clínica frecuente. El objetivo del trabajo fue determinar el perfil de prescripción antipsicótica y su uso en mta o pfa, al egreso hospitalario durante el período abril setiembre de 2012 en el Hospital Vilardebó. Se realizó un estudio descriptivo, observacional y retrospectivo. Las variables estudiadas fueron sexo, edad, medicación y diagnóstico. Se definió mta para los que egresaron con un antipsicótico y pfa para aquellos que egresaron con dos o más antipsicóticos. El 52 % egresó con mta, de los cuales el 42% recibió un antipsicótico atípico y el 10%, uno típico. El 48 % restante egresó con dos o más antipsicóticos (pfa). El 19 % de los pacientes con pfa egresó con tres o más antipsicóticos. Es elevado el uso de pfa al egreso hospitalario.