Cadmium (Cd) distribution and soil-plant relationship in cacao farms in Costa Rica.

The current cadmium (Cd) regulations in chocolate threaten the cacao supply chain in several Latin American countries. The factors contributing to Cd accumulation in cacao beans have been poorly studied in Central America. The objective of this research was to identify the location of Cd hotspots as well as soil properties and management practices influencing the Cd concentration in cacao beans. A survey was carried out and soil, leaf, and beans were sampled from 150 farms in the three principal cacao-producing regions in Costa Rica. Total soil Cd concentration ranged from <0.1 to 1.05 (average 0.22 mg kg-1) which is typical of uncontaminated soils. Bean Cd concentration ranged from 0.12 to 3.23 (average 0.56 mg kg-1) and 22% of the samples exceeded the selected threshold of 0.80 mg kg-1, located mostly in the Huetar Caribe and Huetar Norte regions. Variability in bean Cd concentration was better explained by total soil Cd and soil organic carbon (SOC) (R2 = 0.62, p < 0.05). In addition, bean Cd concentration was affected by leaf nutrient content and management practices. Leaf Zn and P were positively correlated with bean Cd while K and Mn were negatively correlated (p < 0.05). Farm altitude and orchard age were also negatively correlated with bean Cd. Overall, this study shows that bean Cd contamination does not reach the extent observed in other Latin American countries such as Ecuador, Colombia, or Honduras. Nevertheless, research is needed in hotspot areas to assess the feasibility of potential mitigation strategies, particularly the use of mineral or organic soil amendments, which may allow better for planning in existing plantations or the expansion into new cacao-growing areas in the country.

Multiscale environmental determinants of Leishmania vectors in the urban-rural context.

BACKGROUND: In South America, cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) are emerging diseases, expanding in the border area of Argentina, Brazil and Paraguay. Outbreaks of CL were reported since the 1990s, with Nyssomyia whitmani as the main vector in this region. Regarding VL, urban reports started in 2010 with Lutzomyia longipalpis as the main vector. The aim of this study was to evaluate environmental determinants related to the main vectors of leishmaniasis, to contribute to the prevention and control response to the emergence of VL and CL in the Argentina-Brazil-Paraguay border region. METHODS: The cross-sectional survey includes two cities and two close rural areas in the Argentinean Northeast Region, between November 2014 and January 2015, with a total of 95 sampling sites. REDILA-BL traps were set for three consecutive nights, and a total of 68 meso- and microscale environmental and landscape characteristics were surveyed. The association between vector abundance with different variables was evaluated using a generalized linear model with zero-inflated negative binomial distribution. We analyzed females for detection of Leishmania DNA. RESULTS: The analysis for Lu. longipalpis indicates an excess of absences when the mean NDWI around the sites were higher. The abundance of Lu. longipalpis at mesoscale level was higher when more urban services were present, and when blood sources such as chickens or dogs at the microscale level were present. For Ny. whitmani, no variable was found to be associated with the absences, while its abundance increased in association with the following variables: percentage of tree cover, presence of garbage collection service, hosted people and, at microscale, the presence of poultry. Leshmania infantum DNA was detected in 2/49 (4%) Lu. longipalpis. CONCLUSIONS: The abundance of both species is influenced by variables at different scales, their influence probably has a hierarchy and they are acting on different aspects of the biology of these vectors. The urban spatial segregation of Lu. longipalpis and the peri-urban and rural segregation of N. whitmani increase the risk of VL and CL. The selection of the better variables for each scale will allow the design of appropriate control strategies depending on species.

Molecular identification of Leishmania in free-ranging black and gold howler monkeys (Alouatta caraya) in northeastern Argentina.

Parasitological surveys of non-human primates provides an important opportunity to better understand the epidemiology, transmission dynamics and emergence risk of anthropozoonoses such as leishmaniasis, which affect human populations in several regions accross South America. Our study area, in northeastern Argentina, can be considered a southern marginal region for the presence of leishmaniases and includes the habitat of black and gold howler monkeys, Alouatta caraya. To evaluate if A. caraya serve as potential hosts in the Leishmania cycle, we used molecular methods to examine infection by Leishmania spp. in 109 howler monkeys of different ages captured between July and August 2010. External ear tissue samples were subjected to PCR amplification for the Leishmania ribosomal internal transcribed spacer (ITS-1) and a RFLP assay with the Hae III restriction enzyme, and finally confirmed by sequencing. Nine howler monkeys (8.3%) were infected with Le. braziliensis (2.8%), Le. amazonensis (2.8%) and/or Le. infantum (3.7%). The results also suggest a case of co-infection between Le. braziliensis and Le. amazonensis. Further, we report the first observation of Le. amazonensis in the northeastern region of Argentina. The detection of Leishmania spp. in free-ranging howler monkeys gives rise to questions about the actual prevalence of the parasite in the wild, as well as if the number of infected wild monkeys detected may present a risk of leishmaniasis emergence in surronding human populations. Anyway, the presence of Leishmania spp. in A. caraya suggests the possible importance of these monkeys in the sylvatic and periurban transmission.

Twice upon a time: The progression of canine visceral leishmaniasis in an Argentinean city.

Canine Visceral Leishmaniasis (CVL) prevalence, spatial distribution and associated factors were assessed in four locations in Iguazú department in 2014 and in Puerto Iguazú city again in 2018. The city areas were divided into a grid of 400x400m cells. All cells were sampled in 2014 and a random subsampling was developed in 2018. In each cell, five dogs clustered in a 'critical scenario' (prone to have vectors) were sampled. A rapid immunochromatographic dipstick was used to detect antibodies against Leishmania infantum, confirming by lymph node smears observation and PCR. For Puerto Iguazú, Generalized Linear Models (GLMs) were constructed considering environmental, dog and clinical variables. Pearson's Chi square and Fisher's exact tests were employed to evaluate the association between CVL, dog clinical signs and infestation with other parasites. Cartographic outputs were made and Moran's I indices were calculated as spatial autocorrelation indicators. CVL prevalence rates were 26.18% in 2014 and 17.50% in 2018. No associations were established in environmental models, but dog age and repellent use were significant when running 2014 dog models. Clinical models showed significant associations between seropositive dogs and ophthalmological, dermal signs and onychogryphosis in 2014. In 2018, only adenomegaly was associated. The results of global Moran´s I were not significant but regarding local analysis, six sites in 2014 and one in 2018 presented autocorrelation with neighboring sites. The decrease in CVL prevalence may be associated to transmission stabilization, which could explain the lack of associations with dog-related variables. Further, spatial distribution of CVL is a poor evidence for design of transmission control measures but could be important in case of intensive parasite circulation or when the first autochthonous cases appear. For control success, sensitivity of diagnostic methods, political will and adequate material resources remain critical. Modeling of multiple variables will be required to identify factors that drive disease stabilization/destabilization.

Mutational analysis of CFTR in the Ecuadorian population using next-generation sequencing.

The frequency distributions of cystic fibrosis variants are heterogeneous in Ecuador because of the genetic admixture of its population. The aim of this study was to identify disease-causing variants among Ecuadorian cystic fibrosis (CF) patients by next-generation sequencing (NGS) of the entire cystic fibrosis transmembrane conductance regulator (CFTR) gene. The results showed an approximation of the frequencies of pathogenic variants in the population under study and an optimal mutation panel for routine first-line CF molecular diagnosis. One hundred and forty-one patients with suspected CF from the 3 largest Ecuadorian cities (Guayaquil, Quito, and Cuenca) were studied. One hundred and seventy mutated alleles were detected in eighty-five individuals. Twenty-eight disease-causing variants were identified, with p.Phe508del and p.His609Arg being the most frequent (both 24.7%) followed by p.Gly85Glu (11.1%), p.Leu15Pro (9.4%), p.Asn1303Lys (4.1%), and p.Gly542* (2.3%). Together, these variants constituted 76.44% of the detected disease-causing variants. The following six novel potentially disease-associated variants were detected: 3 deletions (CFTR_dele10, CFTR_dele12, and c.2672delA), 1 nonsense variant (p.Cys491*), 1 missense variant (p.Trp496Arg), and 1 complex allele (p.[Gly253Arg;Gly451Val]). The remaining mutations occurred in isolation and were present in the databases.

Prevalencia de hipertrigliceridemia y factores de riesgo cardiovascular en estudiantes de la Universidad de Ciencias Médicas. Holguín, 2014-2015 / Prevalence of hypertriglyceridemia and cardiovascular risk factors in students from the University of Medical Sciences. Holguin, 2014-2015

Fundamento: La detección de altas concentraciones de triglicéridos en plasma en niños, adolescentes y jóvenes, es de capital importancia para prevenir futuros eventos cardiovasculares.Objetivo: determinar la prevalencia de hipertrigliceridemia y factores de riesgo cardiovascular asociados en estudiantes de medicina.Métodos: estudio transversal, con periodo de muestreo aleatorio simple de 776 estudiantes matriculados durante el curso 2014-2015, en primer año de Medicina, en la Universidad de Ciencias Médicas de Holguín, Cuba. En la muestra, de 242 estudiantes, fue analizada la presencia de hipertrigliceridemia en relación a las variables: edad, sexo, presión arterial, mediciones antropométricas, determinaciones de laboratorio y factores de riesgo asociados. Se determinaron las Odds Ratio y sus intervalos de confianza para los factores de riesgo. El análisis de regresión logística se realizó en EPIDAT 4,1 con un nivel de significación de 5 %.Resultados: la prevalencia de hipertrigliceridemia fue 30,58 %, sin diferencias entre sexos. Las prevalencias de sobrepeso, obesidad, exceso de peso, obesidad abdominal, prehipertensión arterial, hipertensión arterial, lipoproteínas de alta densidad-colesterol bajo, lipoproteínas de baja densidad-colesterol alto y síndrome metabólico, fueron 15,70 %, 4,13 %, 19,83 %, 22,31 %, 10,74 %, 3,31 %, 23,14 %, 8,26 % y 8,26 %, respectivamente. Los factores de riesgo significativos asociados a la entidad, fueron síndrome metabólico, pliegue suprailiaco, lipoproteínas de alta densidad-colesterol bajo y glucemia.Conclusión: las tasas de prevalencia de hipertrigliceridemia y factores de riesgo asociados, son relativamente altas en estudiantes universitarios aparentemente sanos.

Foundation: Detecting high plasma triglyceride concentrations in children, teenagers and young people is of great importance to prevent future cardiovascular events.Objective: To determine the prevalence of hypertriglyceridemia and cardivascular risk factors associated to medical students.Methods: cross study, with a period of random sampling of 776 students registered during the academic course 2014-2015, in first year medical studies at the University of Medical Sciences Holguin, Cuba. In the sample of 242 students it was analyzed the presence of hypertriglyceridemia related to the variables: age, sex, arterial pressure, anthropometric measurements, laboratory measurements and associated risk factors. The Odd Ratios and the confidence intervals for risk factors were determined. The logistic regression analysis was done with EPIDAT 4,1 with a level of significance of 5 %.Results: The prevalence of hypertriglyceridemia was 30.58%, without differences between sexes. The prevalence of overweight, obesity, weight excess, abdominal obesity, arterial hypertension, high density lipoproteines- low cholesterol, and metabolic syndrome were  15,70 %, 4,13 %, 19,83 %, 22,31 %, 10,74 %, 3,31 %, 23,14 %, 8,26 % y 8,26 %, respectively. The associated significant risk factors metabolic syndrome, supraileac fold, high density lipoproteins- low cholesterol and glucemia.Conclusion: The prevalence rate of hypertriglyceridemia and associated risk factors were relatively high in university students apparently healthy.

Factores de riesgo en pacientes con lupus eritematoso sistémico y obesidad abdominal en Holguín, Cuba / Risk factors in patients suffering from systemic lupus erythematosus and abdominal obesity in Holguín, Cuba

Introducción: los pacientes con lupus eritematoso sistémico y obesidad abdominal representan un problema de salud no estudiado en Holguín. Objetivo: identificar factores de riesgo asociados a la obesidad abdominal en pacientes con lupus eritematoso sistémico. Métodos: estudio transversal con una muestra de 81 pacientes, de un universo de 193 pacientes con lupus, atendidos en la consulta de Reumatología del Hospital Clínico-Quirúrgico de Holguín desde 3 febrero 2014 hasta 1 diciembre 2015. Se realizó un muestreo aleatorio simple, según nivel de confianza de 95%, tamaño poblacional de 193, prevalencia estimada de obesidad abdominal de 20%, precisión de 7% y efecto de diseño de 1. Para el diagnóstico de lupus eritematoso se siguieron las recomendaciones de American College of Rheumatology y la obesidad abdominal según National Cholesterol Education Program. Se determinaron Odds Ratio (OR) y sus intervalos de confianza de 95% (IC95%) de los factores de riesgo en EPIDAT 4,1 y un nivel de significación de 5%. Resultados: los factores de riesgo asociados a obesidad abdominal en pacientes con lupus fueron edad (OR=1,06; IC95%=1,02-1,11), tiempo de evolución del lupus (OR=1,06; IC95%=1,01-1,13), síndrome metabólico (OR=7,75; IC95%=2,35-25,49), índice cintura/estatura alto (OR=27,47; IC95%=7,03-107), pliegue bicipital (OR=1,37;IC95%=1,14-1,65), pliegue tricipital (OR=1,34; IC95%=1,12-1,62), pliegue subescapular (OR=1,36; IC95%=1,13-1,63), pliegue suprailiaco (OR=1,55;IC95%=1,26-1,90) y % de grasa(OR=1,34; IC95%=1,15-1,57). Conclusiones: los pacientes con lupus eritematoso sistémico y obesidad abdominal presentaron factores de riesgo cardiovascular, lo que amerita un pesquisaje poblacional de estas enfermedades en la atención primaria de salud.

Introduction: patients with abdominal obesity and systematic lupus erythematosus represent a not inquired health problem in Holguín. Objective: to identify risk factors associated with abdominal obesity in patients with systemic lupus erythematosus. Methods: a cross-sectional study of a universe of 193 patients with lupus treated at the Rheumatology Clinic of the Clinic Surgery Hospital of Holguín from February 2, 2014 to December 1, 2015. The sample of 81 patients selected by simple random sampling according to the 95% confidence level, population size of 193, estimated proportion of abdominal obesity of 0.20, accuracy of 7% and design effect of 1. For the diagnosis of lupus erythematosus, the recommendations of the American College of Rheumatology were followed, and the National Cholesterol Education Program was taken into account for abdominal obesity. Odds Ratio (OR) and its confidence intervals of 95% (IC95%) for risk factors were determined in EPIDAT 4.1 and a significance level of 5%. Results: the risk factors associated with abdominal obesity in patients with lupus were age (OR=1.06, IC95%=1.02-1.11), time of lupus progress (OR=1.06, IC95%=1.01-1.13), metabolic syndrome (OR=7.75, IC95%=2.35-25.49), waist/height index high (OR=27.47, IC95%=7.03-107), bicipital fold (OR=1.37,IC95%=1.14-1.65), tricipital fold (OR=1.34, IC95%=1.12-1.62), subscapular fold (OR=1.36, IC95%=1.13-1.63), suprailiac fold (OR=1.55, IC95%=1.26-1.90), and % fat (OR=1.34, IC95%=1.15-1.57). Conclusions: patients with systemic lupus erythematosus and abdominal obesity showed cardiovascular risk factors, which require a screening of these diseases in primary health care.

Factores de riesgo asociados a hipertensión arterial en pacientes con lupus eritematoso sistémico. Holguín, Cuba / Risk factors associated with arterial hypertension in patients with Systemic lupus erythematous. Holguín, Cuba

Introducción: La presencia de hipertensión arterial en pacientes con lupus eritematoso sistémico constituye un problema de salud no estudiado en Holguín. Objetivo: Determinar factores de riesgo cardiovascular asociados a la hipertensión arterial en pacientes con lupus eritematoso sistémico. Material y Métodos: Estudio transversal de un universo de 193 pacientes con lupus atendidos en la consulta de Reumatología del Hospital Clínico Quirúrgico de Holguín desde el 3 de marzo de 2014 al 1 de enero de 2015. La muestra de 81 pacientes seleccionados por muestreo aleatorio simple según nivel de confianza de 95 por ciento, tamaño poblacional de 193, proporción estimada de hipertensión arterial de 0,20, precisión de 7 por ciento y efecto de diseño de 1. Para el diagnóstico de lupus eritematoso se siguieron las recomendaciones de American College of Rheumatology y de la hipertensión arterial por las guías nacionales. Se determinaron variables clínicas, antropométricas y de laboratorio. Se determinaron Odds Ratio (OR) e intervalos de confianza de 95 por ciento(IC95 por ciento) de los factores de riesgo. Resultados: Los factores de riesgo asociados a la hipertensión en pacientes con lupus son edad (OR=1,04; IC95 por ciento:1,01-1,08), edad de debut del lupus (OR=1,04; IC95 por ciento:1,01-1,08), diabetes mellitus (OR=8,50; IC95 por ciento:1,63-44,33), síndrome metabólico (OR=5,09; IC95 por ciento:1,87-13,84), hiperuricemia (OR=4,08; IC95 por ciento:1,07-15,44) y microalbuminuria (OR=19,81; IC95 por ciento:4,24-92,39). Conclusiones: Los pacientes con lupus eritematoso sistémico presentaron factores de riesgo cardiovascular asociados a la hipertensión arterial, identificables en la atención primaria de salud con variables de relativa fácil realización(AU)

Introduction: The presence of hypertension in patients with systemic lupus erythematous is a health problem that has not been studied in Holguín. Objective:To determine the cardiovascular risk factors associated with hypertension in patients with systemic lupus erythematous. Material and Methods: A cross-sectional study was conducted. The universe was composed of 193 patients with lupus who were treated in the Rheumatology consultation of the Clinical-Surgical Hospital of Holguín from March 3, 2014 to January 1, 2015. The sample was made up of 81 patients who were randomly selected according to a 95 percent confidence interval, a population size of 193, an estimated proportion of arterial hypertension of 0,20, a precision of a 7 percent, and a design effect of 1. The recommendations of the American College of Rheumatology were followed for the diagnosis of lupus erythematous, and national guidelines were used for the diagnosis of hypertension. Clinical, anthropometric, and laboratory variables were determined. Odds Ratio (OR), and 95 percent (IC95 percent) confidence intervals for risk factors were determined. Results: The risk factors associated with hypertension in patients with lupus erythematous are: age (OR=1,04; IC95 percent:1,01-1,08), age of the lupus onset (OR=1,04; IC95 percent:1,01-1,08), diabetes mellitus (OR=8,50; IC95 percent:1,63-44,33), metabolic syndrome (OR=5,09; IC95 percent:1,87-13,84), hyperuricemia (OR=4,08; IC95 percent:1,07-15,44), and microalbuminuria (OR=19,81; IC95 percent:4,24-92,39). Conclusions:The patients with systemic lupus erythematous presented cardiovascular risk factors associated with hypertension, which are identifiable in the primary health care with variables of relatively easy realization(AU)

Complicaciones durante el soporte enteral en adultos mayores en un hospital de referencia / Complications during enteral support of elderly adults in a referral hospital

Los adultos mayores corresponden una población vulnerable a presentar complicaciones durante su hospitalización, pudiendo aparecer una de estas complicaciones durante el soporte enteral, por ello el objetivo de este trabajo fue identificar las complicaciones gastrointestinales, infecciosas y mecánicas durante el soporte enteral en adultos mayores institucionalizados. El diseño fue transversal, en el cual se analizaron fichas de adultos de 60 o más años de edad, de ambos sexos, con indicación de soporte nutricional enteral, internados en el Hospital Geriátrico Dr. Gerardo Buongermini del IPS. Se realizó la revisión retrospectiva de 48 historias clínicas, analizándose los datos demográficos, clínicos, de soporte y las complicaciones mediante estadística descriptiva La mediana de la edad fue 82,5 años y el 54,2% era del sexo femenino. El 72,9% de los pacientes estaba internado en clínica médica, el 52,1% presentó algún tipo de complicación durante al soporte enteral, siendo estas en orden decreciente: gastrointestinales (60%), infecciosas (44%) y mecánicas (20%). Se encontró que la diarrea (10/11) fue la principal complicación gastrointestinal. Dentro de las infecciosas, la broncoaspiración (8/11), y la única complicación mecánica fue el autoretiro de la sonda. Todos los pacientes (4/4) con formula artesanal o mixta presentaron complicaciones y estas fueron más frecuentes en pacientes con forma de administración tipo bolo y por método de infusión continua. En conclusión alrededor de la mitad de los adultos mayores presentaron algún tipo de complicación durante el soporte enteral.

The elderly correspond to a population that is vulnerable to complications during hospitalization, and complications may appear during enteral support. The objective was to identify gastrointestinal, infectious and mechanical complications during enteral support in hospitalized older adults. A crossed-sectional descriptive study was carried out using the medical records of adults aged 60 and above who had indication of enteral nutritional support and hospitalized for any pathology at the Dr. Gerardo Buongermini Geriatric Hospital from IPS. Complying with the estimated sample about size, 48 medical records were analyzed and information aboutdemographic and clinical data, support and complications, was collected. The median age was 82.5 years, 54.2% were women, 72.9% of the patients were hospitalized in the medical clinic area. Fifty two point one percent presented some type of complication during enteral support, the frequency of complications was as follows: gastrointestinal (60%), infectious (44%) and mechanical complications (20%). Diarrhea (10/11) was the main gastrointestinal complication, the broncoaspiration (8/11) among complications infectious, and the only mechanical complication was the removal of the catheter. All patients (4/4) with craft formula or mixed formula had complications and these were more frequent in patients with bolus administration and y continuous infusion. In conclusion about half of older adults presented some type of complications during enteral support.

Prevalencia de obesidad abdominal y factores de riesgo cardiovascular asociados en adultos jóvenes / Prevalence of abdominal obesity and associated cardiovascular risk factors in young adults

Introducción: Los factores de riesgo cardiovascular relacionados con la obesidad abdominal en jóvenes constituyen un problema de salud no bien estudiado en Cuba. Objetivo: Determinar la prevalencia de obesidad abdominal y factores de riesgo cardiovascular asociados en adultos jóvenes. Métodos: Estudio transversal analítico. De un universo de 776 estudiantes de primer año de medicina enHolguín se seleccionó una muestra aleatoria simple de 242 alumnos prácticamente sanos según examen médico e historia clínica. El periodo de muestreo, desde octubre 2014 hasta enero 2015. Las variables expresadas en porcentajes se compararon con la prueba Ji-Cuadrada y las medias de las características clínicas, antropométricas y de laboratorio, con el test t o U de Mann-Whitney. Para los factores de riesgo independientes asociados a la obesidad abdominal se calcularon los Odds Ratio y sus intervalos de confianza del 95 por ciento por regresión logística simple y múltiple. Resultados: La prevalencia de obesidad abdominal fue 22,31 por ciento, con predominio del sexo femenino (77,77 por ciento). Tasas de prevalencia de exceso de peso (19,83 por ciento), hipertensión arterial (14,05 porciento), hipertrigliceridemia (30,58 por ciento), HDL-colesterol bajo (23,14 por ciento) y síndrome metabólico(8,26 por ciento).Los factores independientes de riesgo cardiovascular fueron antecedentes familiares de hipertensión, presión arterial sistólica y masa corporal grasa. El sexo masculino se comportó como factor protector. Conclusiones: Son altas las tasas de prevalencia de obesidad abdominal y variados los factores de riesgo asociados en adultos jóvenes prácticamente sanos(AU)

Introduction: Cardiovascular risk factors associated with abdominal obesity in young people represent a barely studied health problem in Cuba. Objective: To determine the prevalence of abdominal obesity and its associated cardiovascular risk factors in young adults. Methods: A cross-sectional analytical study was conducted. According to their medical check-up and medical histories, a simple random sample of 242 apparently healthy students was selected from a universe of 776 first-year students in Holguin province. The sampling period ranged from October 2014 to January 2015. The percentage variables were compared by using the Chi-square test whereas the means of the clinical, anthropometric and laboratory variables, with t test or Mann-Whitney U test. For the abdominal obesity-associated independent risk factors, the odds ratios and 95 percent confidence intervals were then calculated by using the single and multiple logistic regression. Results: Prevalence of abdominal obesity was 22.31 percent, mainly in females (77.77 percent). The prevalence rates of overweight (19.83 percent), hypertension (14.05 percent), hypertriglyceridemia (30.58 percent), low HDL-cholesterol (23.14) and metabolic syndrome (8.26 percent) were observed. The independent risk factors associated with abdominal obesity were family history of hypertension, systolic blood pressure and body fat mass. Conclusions: High prevalence rates of abdominal obesity and different associated cardiovascular risk factors are observed in apparently healthy young adults. Being a male functions as a protective factor(AU)

Factores de riesgo en pacientes con lupus eritematoso sistémico y obesidad abdominal en Holguín, Cuba / Risk factors in patients suffering from systemic lupus erythematosus and abdominal obesity in Holguín, Cuba

Introducción: los pacientes con lupus eritematoso sistémico y obesidad abdominal representan un problema de salud no estudiado en Holguín.Objetivo: identificar factores de riesgo asociados a la obesidad abdominal en pacientes con lupus eritematoso sistémico. Métodos: estudio transversal con una muestra de 81 pacientes, de un universo de 193 pacientes con lupus, atendidos en la consulta de Reumatología del Hospital Clínico-Quirúrgico de Holguín desde 3 febrero 2014 hasta 1 diciembre 2015. Se realizó un muestreo aleatorio simple, según nivel de confianza de 95 por ciento, tamaño poblacional de 193, prevalencia estimada de obesidad abdominal de 20 por ciento, precisión de 7 por ciento y efecto de diseño de 1. Para el diagnóstico de lupus eritematoso se siguieron las recomendaciones de American College of Rheumatology y la obesidad abdominal según National Cholesterol Education Program. Se determinaron Odds Ratio (OR) y sus intervalos de confianza de 95 por ciento (IC95 por ciento) de los factores de riesgo en EPIDAT 4,1 y un nivel de significación de 5 por ciento. Resultados: los factores de riesgo asociados a obesidad abdominal en pacientes con lupus fueron edad (OR=1,06; IC95 por ciento=1,02-1,11), tiempo de evolución del lupus (OR=1,06; IC95 por ciento=1,01-1,13), síndrome metabólico (OR=7,75; IC95 por ciento=2,35-25,49), índice cintura/estatura alto (OR=27,47; IC95 por ciento=7,03-107), pliegue bicipital (OR=1,37;IC95 por ciento=1,14-1,65), pliegue tricipital (OR=1,34; IC95 por ciento=1,12-1,62), pliegue subescapular (OR=1,36; IC95 por ciento=1,13-1,63), pliegue suprailiaco (OR=1,55;IC95 por ciento=1,26-1,90) y por ciento de grasa(OR=1,34; IC95 por ciento=1,15-1,57).Conclusiones: los pacientes con lupus eritematoso sistémico y obesidad abdominal presentaron factores de riesgo cardiovascular, lo que amerita un pesquisaje poblacional de estas enfermedades en la atención primaria de salud.(AU)

Introduction: patients with abdominal obesity and systematic lupus erythematosus represent a not inquired health problem in Holguín.Objective: to identify risk factors associated with abdominal obesity in patients with systemic lupus erythematosus.Methods: a cross-sectional study of a universe of 193 patients with lupus treated at the Rheumatology Clinic of the Clinic Surgery Hospital of Holguín from February 2, 2014 to December 1, 2015. The sample of 81 patients selected by simple random sampling according to the 95 percent confidence level, population size of 193, estimated proportion of abdominal obesity of 0.20, accuracy of 7 percent and design effect of 1. For the diagnosis of lupus erythematosus, the recommendations of the American College of Rheumatology were followed, and the National Cholesterol Education Program was taken into account for abdominal obesity. Odds Ratio (OR) and its confidence intervals of 95 percent (IC95 percent) for risk factors were determined in EPIDAT 4.1 and a significance level of 5 percent. Results: the risk factors associated with abdominal obesity in patients with lupus were age (OR=1.06, IC95 percent=1.02-1.11), time of lupus progress (OR=1.06, IC95 percent=1.01-1.13), metabolic syndrome (OR=7.75, IC95 percent=2.35-25.49), waist/height index high (OR=27.47, IC95 percent=7.03-107), bicipital fold (OR=1.37,IC95 percent=1.14-1.65), tricipital fold (OR=1.34, IC95 percent=1.12-1.62), subscapular fold (OR=1.36, IC95 percent=1.13-1.63), suprailiac fold (OR=1.55, IC95 percent=1.26-1.90), and percent fat (OR=1.34, IC95 percent=1.15-1.57).Conclusions: patients with systemic lupus erythematosus and abdominal obesity showed cardiovascular risk factors, which require a screening of these diseases in primary health care.(AU)

Caracterización clínico epidemiológica de la hipertensión arterial en pacientes con diabetes mellitus tipo 2 / Clinical-epidemiological characterization of high blood pressure in patients with diabetes mellitus type 2

Introducción: la diabetes mellitus y la hipertensión arterial constituyen enfermedades de elevada morbilidad y mortalidad. Objetivo: caracterizar clínica y epidemiológicamente la hipertensión arterial en pacientes diabéticos. Métodos: estudio transversal en el Centro de Atención al Paciente Diabético de Holguín con una muestra de 109 pacientes con diabetes tipo 2, seleccionadas aleatoriamente de un universo de 452 pacientes atendidos desde enero a julio del 2016, seleccionados por muestreo aleatorio simple según tamaño poblacional de 452, precisión 7 por ciento, nivel de confianza 95 por ciento, prevalencia esperada de hipertensión en diabéticos de 25 por ciento y efecto de diseño de 1. El análisis estadístico comprendió la comparación de medias con el test t o de Mann-Whitney y la regresión logística múltiple con la hipertensión arterial como variable dependiente. Los datos se procesaron en EPIDAT 4,1 con un nivel de significación de 5 por ciento. Resultados: media de edad de 57,58 con desviación estándar de 11,90 años, rango 31-85 años. El índice cintura/estatura, los pliegues cutáneos y el por ciento de grasa fueron significativamente superiores en los pacientes hipertensos. El ácido úrico sérico y la proteína C reactiva también fueron superiores en los pacientes con hipertensión. Los factores de riesgo independientes relacionados con la hipertensión fueron por ciento de grasa, cardiopatía isquémica, síndrome metabólico e hiperuricemia. La proteína C reactiva alta no resultó un factor de riesgo independiente. Conclusiones: existen diferencias entre variables clínicas y antropométricas entre los pacientes diabéticos hipertensos y no hipertensos que permiten valorar el riesgo. Se necesita un seguimiento de estos pacientes para estimar las consecuencias a largo plazo(AU)

Introduction: Diabetes mellitus and high blood pressure are diseases with high morbidity and mortality rates. Objective: To characterize clinically and epidemiologically high blood pressure in diabetic patients. Methods: A cross-sectional study at the Care Center for the Diabetic Patient in Holguín, with a sample of 109 patients with type 2 diabetes, randomly selected from a universe of 452 patients given attention from January to July 2016, selected by simple random sampling according to the population size of 452, precision 7 percent, confidence level 95 percent, expected prevalence of hypertension in diabetics of 25 percent, and design effect of 1. The statistical analysis consisted of the mean values comparison with the Mann-Whitney test and multiple logistic regression with arterial hypertension as a dependent variable. The data were processed in EPIDAT 4.1 with a significance level of 5 percent. Results: Mean age of 57.58 with standard deviation of 11.90 years, range 31-85 years. Waist/height index, skin folds and fat percentage were significantly higher in hypertensive patients. Serum uric acid and C-reactive protein were also higher in patients with hypertension. The independent risk factors associated with hypertension were fat percentage, ischemic heart disease, metabolic syndrome and hyperuricemia. High C-reactive protein was not an independent risk factor. Conclusions: There are differences between clinical and anthropometric variables between hypertensive and non-hypertensive diabetic patients that allow risk assessment. The follow-up of these patients is needed to estimate long-term consequences(AU)

Caracterización clínico epidemiológica de la hipertensión arterial en pacientes con diabetes mellitus tipo 2 / Clinical-epidemiological characterization of high blood pressure in patients with diabetes mellitus type 2

Introducción: la diabetes mellitus y la hipertensión arterial constituyen enfermedades de elevada morbilidad y mortalidad. Objetivo: caracterizar clínica y epidemiológicamente la hipertensión arterial en pacientes diabéticos. Métodos: estudio transversal en el Centro de Atención al Paciente Diabético de Holguín con una muestra de 109 pacientes con diabetes tipo 2, seleccionadas aleatoriamente de un universo de 452 pacientes atendidos desde enero a julio del 2016, seleccionados por muestreo aleatorio simple según tamaño poblacional de 452, precisión 7 por ciento, nivel de confianza 95 por ciento, prevalencia esperada de hipertensión en diabéticos de 25 por ciento y efecto de diseño de 1. El análisis estadístico comprendió la comparación de medias con el test t o de Mann-Whitney y la regresión logística múltiple con la hipertensión arterial como variable dependiente. Los datos se procesaron en EPIDAT 4,1 con un nivel de significación de 5 por ciento. Resultados: media de edad de 57,58 con desviación estándar de 11,90 años, rango 31-85 años. El índice cintura/estatura, los pliegues cutáneos y el por ciento de grasa fueron significativamente superiores en los pacientes hipertensos. El ácido úrico sérico y la proteína C reactiva también fueron superiores en los pacientes con hipertensión. Los factores de riesgo independientes relacionados con la hipertensión fueron por ciento de grasa, cardiopatía isquémica, síndrome metabólico e hiperuricemia. La proteína C reactiva alta no resultó un factor de riesgo independiente. Conclusiones: existen diferencias entre variables clínicas y antropométricas entre los pacientes diabéticos hipertensos y no hipertensos que permiten valorar el riesgo. Se necesita un seguimiento de estos pacientes para estimar las consecuencias a largo plazo(AU)

Introduction: Diabetes mellitus and high blood pressure are diseases with high morbidity and mortality rates. Objective: To characterize clinically and epidemiologically high blood pressure in diabetic patients. Methods: A cross-sectional study at the Care Center for the Diabetic Patient in Holguín, with a sample of 109 patients with type 2 diabetes, randomly selected from a universe of 452 patients given attention from January to July 2016, selected by simple random sampling according to the population size of 452, precision 7 percent, confidence level 95 percent, expected prevalence of hypertension in diabetics of 25 percent, and design effect of 1. The statistical analysis consisted of the mean values comparison with the Mann-Whitney test and multiple logistic regression with arterial hypertension as a dependent variable. The data were processed in EPIDAT 4.1 with a significance level of 5 percent. Results: Mean age of 57.58 with standard deviation of 11.90 years, range 31-85 years. Waist/height index, skin folds and fat percentage were significantly higher in hypertensive patients. Serum uric acid and C-reactive protein were also higher in patients with hypertension. The independent risk factors associated with hypertension were fat percentage, ischemic heart disease, metabolic syndrome and hyperuricemia. High C-reactive protein was not an independent risk factor. Conclusions: There are differences between clinical and anthropometric variables between hypertensive and non-hypertensive diabetic patients that allow risk assessment. The follow-up of these patients is needed to estimate long-term consequences(AU)

Molecular characterization of trypanosomatid infections in wild howler monkeys (Alouatta caraya) in northeastern Argentina.

The transmission of Trypanosoma cruzi by vectors is confined to the Americas, and the infection circulates in at least two broadly defined transmission cycles occurring in domestic and sylvatic habitats. This study sought to detect and characterize infection by T. cruzi and other trypanosomes using PCR strategies in blood samples from free-ranging howler monkeys, Alouatta caraya, in the northeastern Argentina. Blood samples were collected at four sites with variable levels of habitat modification by human activity. PCR was conducted using primers for kinetoplast DNA, satellite DNA and ribosomal DNA of the trypanosomatid parasites. Ribosomal and satellite DNA fragments were sequenced to identify the trypanosomatid species and to characterize the discrete typing units (DTUs) of T. cruzi. Overall, 46% (50/109) of the howlers were positive according to the kDNA-PCR assay, but only 7 of the howlers were positive according to the SatDNA-PCR protocol. We sequenced the amplicons of the satellite DNA obtained from five specimens, and the sequences were 99% and 100% similar to T. cruzi. A sequence typical of DTU T. cruzi I was found in one howler monkey from the "remote" site, while sequences compatible with DTUs II, V, and VI were found in howlers from the "remote", "rural" and "village" sites. We detected 96% positive samples for RibDNA-PCR, 9 of which were sequenced and displayed 99% identity with Trypanosoma minasense, while none showed identity with T. cruzi. The results demonstrated the presence of T. cruzi and a species closely related to T. minasense in blood samples from free-ranging A. caraya, belonging to different T. cruzi DTUs circulating in these howler monkey populations. The results obtained in this study could help evaluate the role of A. caraya as a reservoir of T. cruzi in regions where Chagas disease is hyper-endemic and where the human-wildlife interface is increasing.

Performance of light-emitting diode traps for collecting sand flies in entomological surveys in Argentina.

The performance of two light-emitting diode traps with white and black light for capturing phlebotomine sand flies, developed by the Argentinean Leishmaniasis Research Network (REDILA-WL and REDILA-BL traps), were compared with the traditional CDC incandescent light trap. Entomological data were obtained from six sand fly surveys conducted in Argentina in different environments. Data analyses were conducted for the presence and the abundance of Lutzomyia longipalpis, Migonemyia migonei, and Nyssomyia whitmani (106 sites). No differences were found in presence/absence among the three types of traps for all sand fly species (p>0.05). The collection mean of Lu. longipalpis from the REDILA-BL didn´t differ from the CDC trap means, nor were differences seen between the REDILA-WL and the CDC trap collection means (p>0.05), but collections were larger from the REDILA-BL trap compared to the REDILA-WL trap (p<0.05). For Mg. migonei and Ny. whitmani, no differences were found among the three types of traps in the number of individuals captured (p>0.05). These results suggest that both REDILA traps could be used as an alternative capture tool to the original CDC trap for surveillance of these species, and that the REDILA-BL will also allow a comparable estimation of the abundance of these flies to the CDC light trap captures. In addition, the REDILA-BL has better performance than the REDILA-WL, at least for Lu. longipalpis.

Yellow fever impact on brown howler monkeys (Alouatta guariba clamitans) in Argentina: a metamodelling approach based on population viability analysis and epidemiological dynamics

In South America, yellow fever (YF) is an established infectious disease that has been identified outside of its traditional endemic areas, affecting human and nonhuman primate (NHP) populations. In the epidemics that occurred in Argentina between 2007-2009, several outbreaks affecting humans and howler monkeys (Alouatta spp) were reported, highlighting the importance of this disease in the context of conservation medicine and public health policies. Considering the lack of information about YF dynamics in New World NHP, our main goal was to apply modelling tools to better understand YF transmission dynamics among endangered brown howler monkey (Alouatta guariba clamitans) populations in northeastern Argentina. Two complementary modelling tools were used to evaluate brown howler population dynamics in the presence of the disease: Vortex, a stochastic demographic simulation model, and Outbreak, a stochastic disease epidemiology simulation. The baseline model of YF disease epidemiology predicted a very high probability of population decline over the next 100 years. We believe the modelling approach discussed here is a reasonable description of the disease and its effects on the howler monkey population and can be useful to support evidence-based decision-making to guide actions at a regional level.

Yellow fever impact on brown howler monkeys (Alouatta guariba clamitans) in Argentina: a metamodelling approach based on population viability analysis and epidemiological dynamics.

In South America, yellow fever (YF) is an established infectious disease that has been identified outside of its traditional endemic areas, affecting human and nonhuman primate (NHP) populations. In the epidemics that occurred in Argentina between 2007-2009, several outbreaks affecting humans and howler monkeys (Alouatta spp) were reported, highlighting the importance of this disease in the context of conservation medicine and public health policies. Considering the lack of information about YF dynamics in New World NHP, our main goal was to apply modelling tools to better understand YF transmission dynamics among endangered brown howler monkey (Alouatta guariba clamitans) populations in northeastern Argentina. Two complementary modelling tools were used to evaluate brown howler population dynamics in the presence of the disease: Vortex, a stochastic demographic simulation model, and Outbreak, a stochastic disease epidemiology simulation. The baseline model of YF disease epidemiology predicted a very high probability of population decline over the next 100 years. We believe the modelling approach discussed here is a reasonable description of the disease and its effects on the howler monkey population and can be useful to support evidence-based decision-making to guide actions at a regional level.