Spatial distribution and risk factors for sheep toxoplasmosis in Goiás, Brazilian Cerrado Region.

The present study aimed to evaluate the spatial distribution and risk factors for infection by Toxoplasma gondii in sheep in the state of Goiás, located in the central-western region of Brazil. Through the immunofluorescence antibody test (IFAT), the seroprevalence of anti-T. gondii antibodies was analyzed in 1000 blood serum samples obtained from sheep in all macro and micro regions of the state of Goiás. Data related to sex, age of the animals, size of the farm, type of farm, water source, veterinary assistance, replacement of the herd, presence of domestic cats, presence of wild cats and presence of other wild animals were obtained at the sampling time. The differences between the seroprevalences obtained in relation to the variables analyzed were estimated using Pearson's chi-square test (χ2). The odds ratio (OR) values for each risk factor evaluated were statistically analyzed with a confidence interval of 95%. Positivity for IgG anti-T. gondii was observed (titer ≥64) in 34.3% (343/1000) of the samples, which ranged from 26.9% (31/115) to 44.2% (53/120) and from 21.8 (12/55) to 55.2% (16 / 29), respectively in the analyzed mesoregions and microregions. In all investigated regions of the State of Goiás, serum-reactive animals were detected with the age of the animals, the source of water, the form of replacement of the herd and the presence of domestic cats and wild animals risk factors statistically associated with the occurrence of T. gondii in animals.

Spatial distribution of Toxoplasma gondii in cows and associated risk factors.

The aim of the present study was to evaluate the spatial distribution of the prevalence of T. gondii in cows using the indirect immunofluorescence assay and determine associated risk factors. Serum samples were collected from 2970 cows on 263 rural farms in 223 municipalities. A questionnaire was administered to herd owners to collect data for the evaluation of risk factors associated with this disease. Mean seroprevalence of T. gondii in cows was 8.48% (95% CI: 7.48 to 9.49). The microregions with the greatest likelihood (p ≤ 0.05) of having infected animals were Anápolis, Ceres, São Miguel do Araguaia, the Federal District, Anicuns, and Vão do Paraná. The purchase of females or males for reproductive/breeding purposes was significantly associated (p ≤ 0.05) with the prevalence of T. gondii in these regions. A positive correlation (0.7618; p = 0.047) was found between the prevalence of T. gondii and total area in hectares of forests in these regions, suggesting that wild cats may be disseminating T. gondii at these sites. The present results highlight the importance of considering the meat from these animals to be an important infection route for humans who eat raw or undercooked food.

Identification of Biomarkers for Diagnosis and Prognosis of Congenital and Acute Toxoplasmosis.

BACKGROUND: The diagnosis of congenital toxoplasmosis can be inconclusive in many cases. Despite the several serological tests developed, the literature on biomarkers that can assist in the diagnosis of congenital an acute toxoplasmosis is limited. The objective of this study was to analyze the immunoreactive profile of Toxoplasma gondii protein bands with the potential to be biomarkers for diagnosis and prognosis of congenital and acute toxoplasmosis. METHODS: Peripheral blood samples from women of childbearing age and/or pregnant women diagnosed with acquired toxoplasmosis as well as from congenitally infected children were selected and submitted to immunoblotting for analysis of the immunoreactive bands profile by immunoglobulin G (IgG) antibodies. RESULTS: When comparing the immunoreactive bands profile for antibodies present in samples from different groups and subgroups, the 150, 18.5, and 16.96-kDa bands were more immunoreactive with the antibodies present in serum samples from the acquired infection group. The 343, 189, 150, 75, and 42-kDa bands showed more chance to be detected by the symptomatic congenital infection subgroup samples, while the 61, 50, and 16.96-kDa bands were significantly immunoreactive with the acute infection subgroup samples. CONCLUSIONS: The identification of these potential biomarkers can assist in early diagnosis and treatment of congenital toxoplasmosis.

Efecto de la vulnerabilidad urbana en la prevalencia de obesidad infantil en Sevilla / Effect of urban vulnerability on the prevalence of infant obesity in Seville

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Evaluation of toxoplasmosis risk factors and seroprevalence rates in the elderly

Toxoplasmosis is an infection caused by the protozoan Toxoplasma gondii, whose definitive hosts are cats and whose intermediate hosts include humans.This research aims to evaluate aspects related to seroprevalence rates of anti-T. gondii antibodies among elderly users of the Primary Health Care Service in the municipality of Aparecida de Goiânia, State of Goiás, Brazil. A total of 101 elderly people participated in the study, and a questionnaire was applied to examine sociodemographic factors related to risk factors for toxoplasmosis. Five mL of peripheral blood were collected from all the participants for serological tests. IgM and IgG antibody screening was performed using ELISA. The average age of the participants was 69.5 years, the seroprevalence rate was 75.2% (76/101) of reactive IgG, and 24.8% (25/101) were non-reactive. IgM and IgG antibodies were found in 2.9% (3/101) of the participants. An IgG avidity test was performed, which revealed that the antibodies in the three samples were of low avidity, thus indicating that these individuals were in the acute phase of the infection. It was suggested that, in terms of socioeconomic conditions, an income of one to three monthly minimum salaries is the predominant risk factor for toxoplasmosis in this group.

Anaerobic Metabolism in T4 Acanthamoeba Genotype.

Members of the genus Acanthamoeba are of the most common protozoa that has been isolated from a variety of environment and affect immunocompromised individuals, causing granulomatous amoebic encephalitis and skin lesions. Acanthamoeba, in immunocompetent patients, may cause a keratitis related to corneal microtrauma. These free-living amoebas easily adapt to the host environment and wield metabolic pathways such as the energetic and respiratory ones in order to maintain viability for long periods. The energetic metabolism of cysts and trophozoites remains mostly unknown. There are a few reports on the energetic metabolism of these organisms as they are mitochondriate eukaryotes and some studies under aerobic conditions showing that Acanthamoeba hydrolyzes glucose into pyruvate via glycolysis. The aim of this study was to detect the energetic metabolic pathways with emphasis on anaerobic metabolism in trophozoites of three isolates of Acanthamoeba sp belonging to the T4 genotype. Two samples were collected in the environment and one was a clinical sample. The evaluation of these microorganisms proceeded as follows: rupture of trophozoites (7.5 × 103 parasites/ml) and biochemical analysis with high performance liquid chromatography and spectrophotometry. The anaerobic glycolysis was identified through the detection of glucose, pyruvate, and lactate. The protein catabolism was identified through the detection of fumarate, urea, and creatinine. The fatty acid oxidation was identified through the detection of acetate, beta-hydroxybutyrate, and propionate. The detected substances are the result of the consumption of energy reserves such as glycogen and lipids. The anaerobic glycolysis and protein catabolism pathways were observed in all three isolates: one clinical and two environmental. This study represents the first report of energetic pathways used by trophozoites from different isolates of the T4 genotype Acanthamoeba.

A benzimidazole derivative (RCB20) in vitro induces an activation of energetic pathways on Taenia crassiceps (ORF strain) cysticerci.

Human cysticercosis caused by Taenia crassiceps is unusual; however, it is an useful experimental model for cysticercosis studies. Benzimidazole derivatives are important antihelminthic drugs widely used against helminths. A novel compound 6-chloro-5-(1-naphthyloxy) -2-(trifluoromethyl)-1H-benzimidazole (RCB20) is a benzimidazole derivative less polar and more lipophilic. The aim of this study was to detect the effect of the RCB20 on the in vitro energetic metabolism of T. crassiceps cysticerci. For this, products of the metabolism both produced and secreted/excreted (S/E) by the parasite were detected through spectrophotometry and high performance liquid chromatography after exposure to 6.5 and 13 µM of RCB20 and albendazole sulfoxide (ABZSO). There was a gradual increase in the concentrations of glucose not uptaken by parasites exposed to both concentrations RCB20 and ABZSO. There was a higher concentration of all the organic acids related to the tricarboxilic acid cycle int the parasites exposed to RCB20. The structural differences between RCB20 and ABZSO result in different targets within the parasite and in a greater induction of the energetic pathways, such as the glycolysis and the TCA cycle. RCB20 is a good candidate as a substitute for anthelminthic benzimidazoles due to a differentiated site of action with similar outcome.

Alternative energy production pathways in Taenia crassiceps cysticerci in vitro exposed to a benzimidazole derivative (RCB20).

Biochemical studies of benzimidazole derivatives are important to determine their mode of action and activity against parasites. The lack of antihelminthic alternatives to treat parasitic infections and albendazole resistance cases make the search for new antiparasitary drugs of utmost importance. The 6-chloro-5-(1-naphthyloxy)-2-(trifluoromethyl)-1H-benzimidazole (RCB20) is a benzimidazole derivative with promising effect. This study evaluated the effect of different concentrations of RCB20 in the alternative energetic pathway of in vitro Taenia crassiceps cysticerci. The parasites were in vitro exposed to 6.5 and 13 µM of RCB20 and albendazole sulfoxide (ABZSO). The quantification of acetate, acetoacetate, ß-hydroxybutyrate, fumarate and propionate was performed by high-performance liquid chromatography. The quantification of urea, creatinine and total proteins was performed by spectrophotometry. The increase in ß-hydroxybutyrate reflects the enhancement of the fatty acid oxidation in the treated groups. Volatile fatty acids secretion, acetate and propionate, was increased in the treated groups. The secretion mechanisms of the treated parasites were impaired due to organic acids increased concentrations in the cysticerci. It is possible to conclude that the metabolic effect on alternative energetic pathways is slightly increased in the parasites treated with RCB20 than the ones treated with ABZSO.

Evaluation of the accuracy of parasitological techniques for the diagnosis of intestinal parasites in cats.

The accuracy of the parasitological techniques of Willis, Hoffman-Pons-Janer or Lutz (HPLJ), Sheather and Faust was evaluated in fecal samples from stray cats caught by the Zoonosis Control Center in Goiânia, Goiás, Brazil. These four techniques were applied separately to analyze 154 fecal samples, and their accuracy was analyzed based on an evaluation of their sensitivity, specificity, positive and negative predictive values, and Kappa index, resulting in the selection of the Willis technique as the nominal gold standard. Of the 154 samples, 115 (74.68%) tested positive for intestinal parasites. The analysis of the frequency of positivity indicated that the HPLJ technique detected 86.1% of the positive samples and was the closest to the gold standard. The analysis of the accuracy of the techniques was evaluated using the most prevalent parasites. The Sheather technique showed the highest accuracy in the detection of Ancylostomatidae, while the Sheather and HPLJ techniques showed similar accuracies in the detection of Cystoisospora spp. when compared to the gold standard. Lastly, the Faust technique showed the highest accuracy in the detection of Toxoplasma gondii when compared to the gold standard. This study underscores the importance of combining parasitological techniques in the diagnosis of intestinal parasites in cats.

Prevalence of toxoplasmosis in pregnant women and vertical transmission of Toxoplasma gondii in patients from basic units of health from Gurupi, Tocantins, Brazil, from 2012 to 2014.

INTRODUCTION: Toxoplasmosis is a parasitary disease that presents high rates of gestational and congenital infection worldwide being therefore considered a public health problem and a neglected disease. OBJECTIVE: To determine the prevalence of toxoplasmosis amongst pregnant women and vertical transmission of Toxoplasma gondii in their newborns attended in the Basic Units of Health (BUH) from the city of Gurupi, state of Tocantins, Brazil. METHODS: A prevalence study was performed, including 487 pregnant women and their newborns attended in the BUH of the urban zone of the city of Gurupi, state of Tocantins, Brazil, during the period from February 2012 to February 2014. The selection of the pregnant women occurred by convenience. In the antenatal admission they were invited to participate in this study. Three samples of peripheral blood were collected for the detection of specific anti-T. gondii IgG, IgM and IgA through ELISA, for the polimerase chain reaction (PCR) and IgG avidity during pregnancy. When IgM antibodies were detected the fetal and newborn infection investigation took place. The newborn was investigated right after birth and after one year of age through serology and PCR to confirm/exclude the vertical transmission. The analyses were performed in the Studies of the Host-Parasite Relationship Laboratory (LAERPH, IPTSP-UFG), Goiania, state of Goias, Brazil. The results were inserted in a data bank in Epi-Info 3.3.2 statistic software in which the analysis was performed with p≤5%. RESULTS: The toxoplasmosis infection was detected in 68.37% (333/487, CI95%: 64.62-72.86). The toxoplasmosis chronic infection prevalence was of 63.03% (307/487, CI95%: 58.74-67.32). The prevalence of maternal acute infection was of 5.33% (26/487; CI95%: 3.3-7.3) suspected by IgM antibodies detection in the peripheral blood. The prevalence of confirmed vertical transmission was of 28% (7/25; CI95%: 10.4-45.6). CONCLUSIONS: These results show an elevated prevalence of toxoplasmosis in pregnant women and vertical transmission of T. gondii in the city of Gurupi, state of Tocantins, Brazil.

Epidemiological factors associated with seropositivity for toxoplasmosis in pregnant women from Gurupi, State of Tocantins, Brazil

Introduction Knowledge of the prevalence and risk factors for Toxoplasma gondii dissemination among pregnant women is relevant because the parasite can be spread from mother to infant. The objective of this study was to assess the epidemiology and risk factors of toxoplasmosis in pregnant women from Gurupi, State of Tocantins, Brazil, from February 2012 to June 2013. Methods The study population included 487 pregnant women. Sociodemographic, dietary and cultural data were collected using a standardized and validated form. Peripheral blood was collected for serologic testing using the ELISA test (IgM/IgG antibodies). The data were analyzed by comparing seropositivity with risk factors using crude and adjusted odds ratios. Results The prevalence rate for IgG and IgM antibodies was 68.7% and 5.7%, respectively. Sociodemographic characteristics associated with toxoplasmosis risk included the following: education level ≤ 8 years (OR: 6.612; CI: 1.450-30.144), age ≥ 30 years (OR: 5.273; CI: 1.166-23.844), working outside the home (OR: 1.604; CI: 1.015-2.536), and family income of two minimum wages or lower (OR: 2.700; CI: 1.891-8.182). Regarding dietary habits, there was a significant association of seropositivity with meat intake (OR: 1.78; CI: 1.149-4.080), cutting vegetables without washing the cutting board beforehand (OR: 2.051; CI: 1.165-3.614), frequent intake of vegetables (OR: 2.051; CI: 1.368-3.006) and in natura milk intake (OR: 2.422; CI: 1.014-5.785). Conclusions The high prevalence rates of toxoplasmosis in Gurupi are related to age, raw meat and in natura milk intake, as well as education level, working outside the home, and poor hygienic habits during meal preparation. .

Evaluación del citómetro UF-1000i como método de cribado en el diagnóstico de infecciones del tracto urinario / Evaluation of the Sysmex UF-1000i flow cytometer for screening of urinary tract infection

INTRODUCCIÓN: El cultivo de orina supone una enorme carga de trabajo en el Laboratorio de Microbiología y sigue siendo técnica de referencia para el diagnóstico de las infecciones urinarias. Considerando la elevada prevalencia de resultados negativos, la implementación de un método de cribado fiable y rápido podría suponer un ahorro en costes de carga de trabajo y adelantar los resultados negativos. MÉTODO: Evaluamos la utilidad del citómetro de flujo UF-1000i® (bioMérieux, España) para cribado de muestras negativas que se pueden excluir del cultivo. Dividimos las muestras en 2 grupos: grupo 1, hombres y mujeres en edad fértil, que se consideran positivas con un crecimiento ≥ 104 UFC/ml, y grupo 2, consideradas positivas con crecimiento ≥ 105 UFC/ml. RESULTADOS: Enfrentando los datos del cultivo y del cribado en curva ROC, los puntos de mejor sensibilidad y especificidad fueron de 53,1 bacterias/μl para el grupo 1, y de 128,35 bacterias/μl para el grupo 2. En el grupo 1 la sensibilidad fue del 92,2%, la especificidad del 60%, la reducción de cultivos de orina del 46%, con el 2,1% de falsos negativos (42 muestras). En el grupo 2, la sensibilidad fue del 86%, la especificidad del 87,7%, la reducción de cultivos del 57,5%, con el 5,1% de falsos negativos (74 muestras). CONCLUSIÓN: La incorporación del citómetro UF-1000i al cribado de las muestras de orina depende mucho de las características de los pacientes y de la definición de cultivo de orina positivo. En nuestro caso, con el estudio exclusivo de la bacteriuria, los datos de reducción de carga de trabajo y de falsos negativos cuestionan seriamente esta incorporación

INTRODUCTION: The urine culture is a huge workload in the Microbiology Laboratory and remains the gold standard for the diagnosis of urinary tract infections. Considering the high prevalence of negative results, the implementation of a reliable screening method could lead to cost saving in the workload, and speedup reporting of negative results. METHODS: We evaluated the usefulness of the flow cytometer UF-1000i in the screening for negative samples than could be excluded from culture. We divided the samples into two groups, Group 1, males and women of childbearing age who were considered positive with a growth ≥ 104 CFU/ml, and Group 2,considered positive with ≥ 105 CFU/ml growth. RESULTS: On comparing the culture and screening data in the ROC curve, the best sensitivity and specificity points were 53.1 bact/l for Group 1, and 128.3 bact/l for Group 2. In Group 1, the sensitivity was 92.2%and a specificity of 60%, a reduction in urine cultures of 46%, with 2.1% false negative (42 samples). In Group 2, the sensitivity was 86%, with a specificity of 87.7%, a culture reduction of 57.5%, and 5.1% false negatives (74 samples). CONCLUSION: The incorporating of the UF-1000i cytometer to the screening of urine samples depends on the characteristics of the patients and the definition of positive urine culture. In our case, with only studying bacteriuria, the data on the reduction of workload and the false negatives seriously question this incorporation

[Vertical transmission from abortive material and blood with emphasis on Toxoplasma gondii]. / Infecções de transmissão vertical em material abortivo e sangue com ênfase em Toxoplasmose gondii.

PURPOSE: To analyze the serological, anatomopathological and parasitological results obtained from abortive material in order to detect infections with the risk of vertical transmission, with emphasis on toxoplasmosis. METHODS: A cross-sectional cohort study was conducted in order to determine the prevalence of infectoparasitic diseases. A total of 105 women who suffered spontaneous complete or incomplete abortion participated in the study. The women were interviewed, answered a questionnaire and had their blood and abortive material collected. Immunological tests were carried out in order to detect toxoplasmosis, Chagas disease, rubeola, cytomegalovirus and syphilis, and anatomopathological analysis of the ovular remains was performed. RESULTS: 55% of the women studied were 20 to 30 years old. Most of them (68%) presented a gestational age between the 7th and 14th week. 54.3% of the women had complete or incomplete high school education. Serological analysis showed cytomegalovirus (CMV) as the most common vertically transmitted infection with 97.1% positivity, followed by rubeola with 95.2%. Toxoplasmosis showed 54.3% positivity, Chagas disease 1.9% and syphilis 0.95%. Anatomopathological analysis showed inflammation in 63.1% of the cases and absence of inflammation in 34%. The results of the serological, anatomopathological and parasitological analysis of the 105 participants showed that 57 women were T. gondii positive. However, none showed positivity in the polymerase chain reaction (PCR) or in mouse inoculation. CONCLUSIONS: The prevalence of diseases with the risk of vertical transmission is important in women with spontaneous abortion, indicating the need for more research in order to investigate the etiology of abortion.

[Evaluation of the Sysmex UF-1000i flow cytometer for screening of urinary tract infection]. / Evaluación del citómetro UF-1000i como método de cribado en el diagnóstico de infecciones del tracto urinario.

INTRODUCTION: The urine culture is a huge workload in the Microbiology Laboratory and remains the gold standard for the diagnosis of urinary tract infections. Considering the high prevalence of negative results, the implementation of a reliable screening method could lead to cost saving in the workload, and speed up reporting of negative results. METHODS: We evaluated the usefulness of the flow cytometer UF-1000i in the screening for negative samples than could be excluded from culture. We divided the samples into two groups, Group 1, males and women of childbearing age who were considered positive with a growth ≥ 104 CFU/ml, and Group 2, considered positive with ≥ 105 CFU/ml growth. RESULTS: On comparing the culture and screening data in the ROC curve, the best sensitivity and specificity points were 53.1 bact/µl for Group 1, and 128.3 bact/µl for Group 2. In Group 1, the sensitivity was 92.2% and a specificity of 60%, a reduction in urine cultures of 46%, with 2.1% false negative (42 samples). In Group 2, the sensitivity was 86%, with a specificity of 87.7%, a culture reduction of 57.5%, and 5.1% false negatives (74 samples). CONCLUSION: The incorporating of the UF-1000i cytometer to the screening of urine samples depends on the characteristics of the patients and the definition of positive urine culture. In our case, with only studying bacteriuria, the data on the reduction of workload and the false negatives seriously question this incorporation.

Chagas disease: increased parasitemia during pregnancy detected by hemoculture.

One hundred fifty-two Trypanosoma cruzi seropositive women were submitted to a single hemoculture; 101 were pregnant, and 51 were not pregnant. Seven tubes from each individual were harvested with liver infusion tryptose (LIT) medium and observed monthly until the fifth month. Hemocultures were positive in 50% (76 of 152) of the women. Results showed that the positivity was 29.4% (15 of 51) among non-pregnant women and 60.4% (61 of 101) in pregnant women (P < 0.05). In relation to gestational age, there were significant differences in positivity, with a higher proportion of women with positive hemocultures (20 of 25) before 21 weeks and lower after 30 weeks (10 of 21; P = 0.02). We conclude that pregnancy enhances the parasitemia in Chagas disease, with a higher effect early in pregnancy.

Probing population dynamics of Trypanosoma cruzi during progression of the chronic phase in chagasic patients.

Our research aimed to characterize the genetic profiles of 102 Trypanosoma cruzi isolates recently obtained from 44 chronic chagasic patients from different regions of the states of Minas Gerais and Goiás in Brazil. At least two isolates were obtained from each patient at different times in order to study the parasite population dynamics during disease progression in the chronic phase. The isolates were characterized molecularly by genotyping the 3' region of the 24S alpha rRNA, the mitochondrial cytochrome oxidase subunit 2 (COII) gene, and the intergenic region of the spliced leader intergenic region (SL-IR) gene. Seventy-seven isolates were analyzed for nine microsatellite loci. The data presented here show a strong correlation between the T. cruzi lineage II (T. cruzi II) and human infection in these regions of Brazil. Interestingly, isolates from two patients were initially characterized (by rRNA genotyping) as T. cruzi I and hybrid strains, but subsequent analyses of the COII and SL-IR genes confirmed that those isolates belonged to T. cruzi III and a hybrid group, respectively. Our results confirm the risk of misclassifying T. cruzi isolates on the basis of analysis of a single molecular marker. The microsatellite profiles showed that different isolates obtained from the same patient were genetically identical and monoclonal. Exceptions were observed for T. cruzi isolates from two patients who presented differences for the SCLE11 locus and also from two other patients who showed amplification of three peaks for a microsatellite locus (TcAAAT6), implying that they were multiclonal. On the basis of the findings of the studies described here, we were not able to establish a correlation between the clinical forms of Chagas' disease and the genetic profiles of the T. cruzi isolates.

Anatomopathological study in BALB/c mice brains experimentally infected with Toxoplasma gondii.

Toxoplasmosis is one of the most important diseases of the nervous central system, leading to severe symptoms and, many times, irreversible sequelae. This work demonstrated the main anatomopathological lesions caused by Toxoplasma gondii in brains from experimentally infected BALB/c mice. We analyzed 51 cases of mice that developed toxoplasmosis after experimental infection by intraperitoneal inoculation of blood, amniotic liquid and cerebrospinal fluid from fetuses, newly born children and pregnant women with clinical and laboratory signals of toxoplasmosis. In all experiments where we detected the parasite in mice we also detected pathological lesions in the animal brains with great polymorphism between experiments. Edema was the most found lesion in all cases. Besides, it was possible to demonstrate the inflammatory process in 82.4% of cases and necrosis in 64.7% of cases, in agreement with the literature that describes severe neurological damage in its hosts.

Non-steroidal anti-inflammatory drug-related hepatic damage in France and Spain: analysis from national spontaneous reporting systems.

Several non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with liver damage. The aim of this study was to compare proportions of hepatic adverse drug reaction reports associated with NSAIDs in France and Spain. Information from the Spanish and French pharmacovigilance databases were used from 1982 to 2001. To assess the risk of liver injury, the case/non-case methodology was applied, 'cases' being reports of liver damage and 'non-cases' or controls, all other reports. Exposure was considered as the presence of at least one NSAID. Liver injury risk was estimated for each drug in the two databases by calculation of reporting odds ratio in cases and non-cases, with its 95% confidence interval. Out of 62 456 reports from the Spanish database, 2114 (3.38%) were identified as liver injuries, whereas there were 27 372 liver injuries out of 200 046 (13.68%) in the French database. In Spain, there was a significant association between liver injuries and droxicam, sulindac, and nimesulide. The risk was also slightly above 1 for aceclofenac. In France, the risk was very high with clometacin, followed by sulindac, and was slightly above 1 for naproxen, diclofenac, piroxicam, and tenoxicam. This study shows that some NSAIDs are associated with reports of hepatic injuries when compared with other drugs, and most of those have been withdrawn from the market for this reason. However, the frequency of drug-related hepatic injuries reported differed in the French and Spanish databases, and some drugs did not show the same risk level in the two countries. These discrepancies could be explained in part not only by reporting rates, but also by difference in drug use patterns and/or by genetic or environmental factors.

Prevalence of glucose metabolism abnormalities and cardiovascular co-morbidity in the US elderly adult population.

PURPOSE: To estimate the prevalence of glucose metabolism abnormalities, including diabetes, and its associated cardiovascular risk factors and co-morbidity in the US elderly population. METHODS: Cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) in adults aged 65 years and more. The 1997 American Diabetes Association (ADA) and the 1998 World Health Organization (WHO) criteria were used to classify the subject's glucose metabolism status. The 2-hour oral glucose tolerance test (OGTT) was performed only among those participants aged 40 to 74 years. RESULTS: The age-adjusted prevalence of diagnosed diabetes was 12.5% (95% CI: 11.4%-13.6%) among US adults aged 65 years or more. According to the ADA definition 40% of men and 28% of women were affected by some degree of glucose metabolism impairment. According to the WHO definition, 55% of men and 50% of women aged 65 to 74 years were affected by glucose metabolism abnormalities. Mexican-Americans were the most affected under both definitions (51% and 77%, respectively). Overall, 72% of elderly diagnosed diabetics had hypertension, 28% had coronary heart disease (CHD), 47% suffered from cardiovascular disease and 80% of them presented known CHD or multiple coronary risk factors, other than age, level of LDL-cholesterol and diabetes. Under both definitions, a trend towards a worsening coronary risk profile with increased glucose metabolism impairment was observed. CONCLUSION: A notable proportion of elderly people is affected by some degree of glucose metabolism impairment which in turn is associated with cardiovascular co-morbidity.