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1.
Am Surg ; 86(6): 591-595, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32683969

RESUMEN

An informal workgroup of 9 hepatopancreaticobiliary (HPB) surgeons from 6 different countries on 4 continents shifted the focus of their quarterly tumor board discussions to their responses to the current COVID-19 pandemic. Just as they had discussing HPB cases, they share their experiences and ideas in dealing with the outbreak that faced their hospitals and communities. Their efforts to improve care proved that professionalism in surgery, like the global pandemic, has no boundaries.


Asunto(s)
Infecciones por Coronavirus/terapia , Pandemias , Rol del Médico , Neumonía Viral/terapia , Cirujanos , Australia/epidemiología , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Cuidados Críticos , Procedimientos Quirúrgicos Electivos , Inglaterra/epidemiología , Gastroenterología , Humanos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Mianmar/epidemiología , Nepal/epidemiología , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Aislamiento Social , Sri Lanka/epidemiología , Texas/epidemiología
2.
Tex Med ; 116(6): 22-26, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32645176

RESUMEN

The early days of the COVID-19 pandemic threw the market for personal protective equipment (PPE) into chaos. So physicians and county medical societies across Texas found they had to go big or go home when it came to obtaining those critical supplies.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/prevención & control , Asignación de Recursos/tendencias , Humanos , Texas/epidemiología
3.
Tex Med ; 116(6): 47-48, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32645181

RESUMEN

Despite the suspension of the Texas Medical Association House of Delegates due to the COVID-19 pandemic, special provisions in TMA's bylaws allowed for limited elections to take place on May 2, including that of Edinburg internist E. Linda Villarreal, MD, as president-elect. And Diana L. Fite, MD, took office as planned as TMA's 155th president.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Sociedades Médicas/organización & administración , Humanos , Liderazgo , Texas/epidemiología
4.
Tex Med ; 116(6): 27-28, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32645182

RESUMEN

Umair Shah, MD, Harris County Public Health executive director, on how COVID-19 has exposed gaps in the public health system.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Administración en Salud Pública/métodos , Salud Pública/métodos , Humanos , Pandemias , Texas/epidemiología
5.
MMWR Morb Mortal Wkly Rep ; 69(26): 830-835, 2020 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-32614814

RESUMEN

On March 27, 2020, a University of Texas at Austin student with cough, sore throat, and shortness of breath had a positive test result for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). On March 28, two more symptomatic students had positive test results, alerting the COVID-19 Center at the University of Texas Health Austin (UTHA) to a potential outbreak; the center initiated an outbreak investigation the same day. UTHA conducted contact tracing, which linked the students' infections to a spring break trip to Cabo San Lucas, Mexico, during March 14-19. Among 231 persons tested for SARS-CoV-2 in this investigation, 64 (28%) had positive test results, including 60 (33%) of 183 Cabo San Lucas travelers, one of 13 (8%) household contacts of Cabo San Lucas travelers, and three (9%) of 35 community contacts of Cabo San Lucas travelers. Approximately one fifth of persons with positive test results were asymptomatic; no persons needed hospitalization, and none died. This COVID-19 outbreak among a young, healthy population with no or mild symptoms was controlled with a coordinated public health response that included rapid contact tracing and testing of all exposed persons. A coordinated response with contact tracing and testing of all contacts, including those who are asymptomatic, is important in controlling future COVID-19 outbreaks that might occur as schools and universities consider reopening.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Neumonía Viral/epidemiología , Estudiantes/estadística & datos numéricos , Enfermedad Relacionada con los Viajes , Adulto , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Pandemias , Texas/epidemiología , Universidades , Adulto Joven
6.
J Community Health ; 45(4): 696-701, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32500438

RESUMEN

The pandemic of novel Coronavirus (SARS-CoV-2) is currently spreading rapidly across the United States. We provide a comprehensive overview of COVID-19 epidemiology across the state of Texas, which includes vast rural & vulnerable communities that may be disproportionately impacted by the spread of this new disease. All 254 Texas counties were included in this study. We examined the geographic variation of COVID-19 from March 1 through April 8, 2020 by extracting data on incidence and case fatality from various national and state datasets. We contrasted incidence and case fatality rates by county-level demographic and healthcare resource factors. Counties which are part of metropolitan regions, such as Harris and Dallas, experienced the highest total number of confirmed cases. However, the highest incidence rates per 100,000 population were in found in counties of Donley (353.5), Castro (136.4), Matagorda (114.4) and Galveston (93.4). Among counties with greater than 10 cases, the highest CFR were observed in counties of Comal (10.3%), Hockley (10%), Hood (10%), and Castro (9.1%). Counties with the highest CFR (> 10%) had a higher proportion of non-Hispanic Black residents, adults aged 65 and older, and adults smoking, but lower number of ICU beds per 100,000 population, and number of primary care physicians per 1000 population. Although the urban areas of Texas account for the majority of COVID-19 cases, the higher case-fatality rates and low health care capacity in rural areas need attention.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Humanos , Incidencia , Mortalidad , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Población Rural/estadística & datos numéricos , Texas/epidemiología , Población Urbana/estadística & datos numéricos
7.
J Aging Soc Policy ; 32(4-5): 439-449, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32501753

RESUMEN

As the coronavirus crisis spreads swiftly through the population, it takes a particularly heavy toll on minority individuals and older adults, with older minority adults at especially high risk. Given the shockingly high rates of infections and deaths in nursing homes, staying in the community appears to be a good option for older adults in this crisis, but in order for some older adults to do so much assistance is required. This situation draws attention to the need for benevolent intervention on the part of the state should older adults become ill or lose their sources of income and support during the crisis. This essay provides a brief overview of public support and the financial and health benefits for older individuals who remain in the community during the pandemic. It reports the case example of Austin, Texas, a city with a rapidly aging and diverse population of almost a million residents, to ask how we can assess the success of municipalities in responding to the changing needs of older adults in the community due to COVID-19. It concludes with a discussion of what governmental and non-governmental leadership can accomplish in situations such as that brought about by the current crisis.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Vida Independiente , Gobierno Local , Neumonía Viral/epidemiología , Servicio Social/organización & administración , Anciano , Anciano de 80 o más Años , Betacoronavirus , Abastecimiento de Alimentos , Humanos , Persona de Mediana Edad , Pandemias , Texas/epidemiología
8.
MMWR Morb Mortal Wkly Rep ; 69(22): 685-688, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32497031

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic has resulted in substantial morbidity and mortality since it was first described in December 2019 (1). Based on epidemiologic data showing spread in congregate settings (2-4), national, state, and local governments instituted significant restrictions on large gatherings to prevent transmission of disease in early March 2020. This and other nonpharmaceutical interventions (NPIs) have shown initial success in slowing the pandemic across the country (5). This report examines the first 7 weeks (March 1-April 18) of implementation of NPIs in Basic Military Training (BMT) at a U.S. Air Force base. In a population of 10,579 trainees, COVID-19 incidence was limited to five cases (47 per 100,000 persons), three of which were in persons who were contacts of the first patient. Transmission of symptomatic COVID-19 was successfully limited using strategies of quarantine, social distancing, early screening of trainees, rapid isolation of persons with suspected cases, and monitored reentry into training for trainees with positive test results after resolution of symptoms.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Personal Militar/educación , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Humanos , Masculino , Aislamiento de Pacientes , Neumonía Viral/transmisión , Texas/epidemiología
9.
J Comput Assist Tomogr ; 44(4): 479-484, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32433251

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid response plans to minimize risks of infection in the workforce while ensuring maintenance of essential functions of radiology departments. Plan adoption is, however, challenged by the need to coordinate with institutional efforts, a rapidly expanding number of patients, and the diversity of clinical and administrative functions in the department. Here, we describe the implementation of a response plan in an academic radiology department, challenges encountered, and tactics used to address these challenges.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Control de Infecciones/organización & administración , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición Profesional/prevención & control , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Servicio de Radiología en Hospital/organización & administración , Administración de la Seguridad , Betacoronavirus , Humanos , Factores de Riesgo , Texas/epidemiología
11.
South Med J ; 113(4): 168-175, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32239229

RESUMEN

OBJECTIVE: Research suggests a high prevalence of obesity in children with autism spectrum disorders (ASDs), but the prevalence of severe obesity and its association with risk factors unique to this population remain undetermined. This study sought to compare the prevalence of severe obesity in children with ASDs to that of the general population and investigated associated risk factors for obesity in this population. METHODS: A chart review was done on 592 patients with ASDs seen between 2013 and 2017 at a center in Houston, Texas. The prevalence of obesity in the study population was compared with 2013-2016 national data. Univariable, multivariable, and stratified analyses were performed to determine the association between risk factors and body mass index. RESULTS: The prevalence of obesity and severe obesity in our study population was similar to those reported in the general population. When stratified by age, children with ASDs ages 6 to 11 years had a significantly higher prevalence of severe obesity than the general population. CONCLUSIONS: The prevalence of severe obesity in children with ASDs was higher with increasing age, and in the 6- to 11-year-old age group, was significantly higher than in the general population. Healthcare providers should address diet and exercise early as part of a comprehensive management plan for children with ASDs.


Asunto(s)
Trastorno del Espectro Autista/etiología , Obesidad/complicaciones , Prevalencia , Trastorno del Espectro Autista/epidemiología , Índice de Masa Corporal , Niño , Preescolar , Femenino , Humanos , Masculino , Obesidad/epidemiología , Vigilancia de la Población/métodos , Factores de Riesgo , Texas/epidemiología
12.
South Med J ; 113(4): 183-190, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32239231

RESUMEN

OBJECTIVE: Although substantial research has explored the Hispanic health paradox (HHP) and suggests that Latinx immigrants experience positive health outcomes relative to those born in the United States, less research has assessed the role of immigration status. Our aim was to examine this role in Latinx health. METHODS: Using survey data collected at two free/reduced-cost clinics in southernmost Texas, we examined differences in the mental and self-rated health, substance, alcohol, and tobacco use of low-income patients by undocumented/documented immigrant and US-born/naturalized citizen status (N = 588). RESULTS: Based on ordinary least squares regression results, undocumented Latinx immigrants report lower negative self-rated health (coefficient -0.27, 95% confidence interval -0.50 to -0.01) and lower depressive symptoms (coefficient -0.34, 95% confidence interval -0.67 to -0.02]) compared with their US citizen peers (P < 0.05). Logistic regression results suggest that undocumented and documented Latinx immigrants do not differ in alcohol, tobacco, or substance use relative to their citizen peers. CONCLUSIONS: Despite facing potentially adverse social environments, undocumented Latinx immigrants experience positive health outcomes relative to US-born/naturalized citizen peers.


Asunto(s)
Emigrantes e Inmigrantes/psicología , Hispanoamericanos/estadística & datos numéricos , Trastornos Relacionados con Sustancias/psicología , Adulto , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y Cuestionarios , Texas/epidemiología , Uso de Tabaco/epidemiología , Uso de Tabaco/psicología
13.
Fertil Steril ; 113(2): 392-399, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32106992

RESUMEN

OBJECTIVE: To examine the association between prior cancer treatments, medical comorbidities, and voluntary childlessness in reproductive-age women who are survivors of cancers diagnosed as adolescents and young adults (AYA survivors). DESIGN: Cross-sectional analysis. SETTING: Participants were recruited from California and Texas cancer registries, fertility preservation programs, and cancer advocacy groups. PATIENT(S): Women (n = 413) ages 18-40 who were diagnosed with cancer between ages 15 and 35, completed primary cancer treatments, had at least one ovary, and were nulliparous. INTERVENTION(S): Cancer treatment gonadotoxicity and medical comorbidities. MAIN OUTCOME MEASURE(S): Voluntary childlessness. RESULT(S): The mean age of survivors was 31.8 years (SD, 4.9) with a mean of 6.5 years (SD, 4.4) since cancer diagnosis. Breast (26%), thyroid (19%), and Hodgkin lymphoma (18%) were the most common cancers. Twenty-two percent of the cohort was voluntarily childless. Medical comorbidities, cancer diagnosis, prior surgery, prior chemotherapy, and prior gonadotoxic treatments were not significantly associated with voluntary childlessness. In adjusted analysis, survivors of older reproductive age (adjusted odds ratio = 2.97 [1.71-5.18]) and nonheterosexual participants (adjusted odds ratio = 4.71 [2.15-10.32]) were more likely to report voluntary childlessness. CONCLUSION(S): A moderate proportion of AYA cancer survivors are voluntarily childless, but reproductive intentions were not related to cancer type or cancer treatments. AYA survivors of older age and nonheterosexual identification were more likely to be voluntarily childless. These data support assessing reproductive intentions and tailoring reproductive care such as fertility and contraception counseling that is appropriate for a survivor's intentions.


Asunto(s)
Supervivientes de Cáncer/psicología , Conocimientos, Actitudes y Práctica en Salud , Neoplasias/terapia , Reproducción , Conducta Reproductiva/psicología , Adolescente , Adulto , Factores de Edad , California/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiología , Sistema de Registros , Factores Sexuales , Sexualidad , Factores Socioeconómicos , Texas/epidemiología , Adulto Joven
14.
Otolaryngol Head Neck Surg ; 162(6): 888-896, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32093532

RESUMEN

OBJECTIVE: Advanced laryngeal squamous cell carcinoma remains associated with approximately 50% mortality at 5 years. Delivery of multimodality treatment remains critical to maximizing survival for this disease, but achieving this at a national level remains a difficult undertaking, particularly in under- and uninsured patients as well as minority patients. We sought to evaluate laryngeal cancer treatment delivery and clinical outcomes in a predominantly minority and underserved cohort of largely under- and uninsured patients in a county hospital. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care county hospital in Houston, Texas. SUBJECTS AND METHODS: Patients (N = 210) with a new diagnosis of laryngeal squamous cell carcinoma treated between 2005 and 2015 were included in a retrospective analysis of patient demographics, tumor and treatment characteristics, and oncologic outcomes. RESULTS: The majority of patients presented with advanced disease (T4 = 43%, N>0 = 45%). Treatment selection was compliant with National Comprehensive Cancer Network guidelines in 81% of cases, but 76% of patients who required adjuvant radiotherapy were unable to start it within 6 weeks postsurgery. Overall survival and disease-free survival were 52% and 63% for the entire cohort, respectively. Supraglottic subsite and nodal metastases were significantly associated with decreased overall survival and disease-free survival. Race/ethnicity and insurance status were not associated with worse oncologic outcomes. CONCLUSION: Under- and uninsured patients often present with advanced laryngeal cancer. Oncologic outcomes in this cohort of patients is similar to that of other published series. Moreover, tumor characteristics rather than demographic variables drive oncologic outcomes for the predominantly minority and underserved patients seeking care in our tertiary care county hospital.


Asunto(s)
Carcinoma de Células Escamosas/epidemiología , Neoplasias Laríngeas/epidemiología , Grupos Minoritarios , Estadificación de Neoplasias , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Supervivencia sin Enfermedad , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/terapia , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Texas/epidemiología
15.
Am J Pathol ; 190(2): 306-322, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31955791

RESUMEN

Mediterranean spotted fever is a reemerging acute tick-borne infection produced by the α-proteobacterium, Rickettsia conorii. Rickettsia conorii infects vascular endothelial cells producing disseminated plasma leakage, manifesting as nonspecific fever, headache, and maculopapular rash. Because there are no available tests of early infection, Mediterranean spotted fever is often undiagnosed and untreated, resulting in significant mortality. To address this critical need, we have applied a quantitative proteomics pipeline for analyzing the secretome of primary human umbilical vein endothelial cells. Of the 104 proteins whose abundance changed significantly in the R. conorii-infected human umbilical vein endothelial cells' secretome, 46 proteins were up-regulated: 45 were host secreted proteins (including cytokines), and 1 was a rickettsial protein, the putative N-acetylmuramoyl-l-alanine amidase RC0497. Proteins with sequence highly homologous to RC0497 were found to be shared by many species of the spotted fever group rickettsiae, but not typhus group rickettsiae. Quantitative targeted proteomics studies of plasma from a mouse model of sublethal and lethal R. conorii identified RC0497 in the blood, and its circulating levels were proportionally associated with infection outcome. Finally, the presence of RC0497 in the serum samples from a cohort of humans presenting with acute rickettsioses was confirmed. The detection of RC0497 has the potential to be a sensitive and specific marker for acute rickettsial spotted rickettsioses.


Asunto(s)
Biomarcadores/sangre , Fiebre Botonosa/diagnóstico , Células Endoteliales de la Vena Umbilical Humana/metabolismo , N-Acetil Muramoil-L-Alanina Amidasa/sangre , Proteoma/análisis , Infecciones por Rickettsia/complicaciones , Rickettsia/patogenicidad , Animales , Fiebre Botonosa/epidemiología , Fiebre Botonosa/microbiología , Estudios de Cohortes , Femenino , Interacciones Huésped-Patógeno , Células Endoteliales de la Vena Umbilical Humana/microbiología , Humanos , Masculino , Ratones , Ratones Endogámicos C3H , Proteómica , Rickettsia/aislamiento & purificación , Infecciones por Rickettsia/microbiología , Infecciones por Rickettsia/transmisión , Texas/epidemiología
16.
Ann Surg ; 271(6): 996-1002, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31895709

RESUMEN

OBJECTIVE: We sought to determine whether postoperative chemotherapy after preoperative therapy and pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) prolongs survival. BACKGROUND: Data to support administering postoperative chemotherapy to patients who received preoperative therapy are lacking. METHODS: All patients with PDAC who underwent pancreatectomy after preoperative therapy between 2010 and July 2017 at The University of Texas MD Anderson Cancer Center were identified. To control for selection bias, patients who received postoperative therapy and patients who did not were matched by propensity scores based on factors associated with the use of postoperative chemotherapy. RESULTS: Among 245 patients treated with a median of 4 cycles of preoperative treatment and pancreatectomy, 155 (63%) initiated postoperative chemotherapy and 90 (37%) did not. Patients who received postoperative therapy had a higher median cancer antigen 19-9 level before surgery, larger median tumor diameter, higher rate of extrapancreatic invasion, and lower rate of pathologic major response. The propensity-matched cohort comprised 122 patients: 61 who received postoperative chemotherapy and 61 who did not. The median overall survival (OS) and recurrence free survival (RFS) for patients who received postoperative therapy were 42 and 17 months, respectively, versus 32 and 12 months for patients who did not (OS: P = 0.06; RFS: P = 0.04). Postoperative therapy was marginally associated with a longer OS (hazard ratio 0.55, 95% confidence interval 0.29-1.01; P = 0.05) and significantly associated with a longer RFS (hazard ratio 0.55, 95% confidence interval 0.29-0.96; P = 0.04). CONCLUSIONS: Despite being administered more frequently to patients with poor prognostic factors, postoperative chemotherapy after preoperative therapy and pancreatectomy for PDAC was of clinical benefit.


Asunto(s)
Adenocarcinoma/terapia , Antineoplásicos/uso terapéutico , Estadificación de Neoplasias , Pancreatectomía/métodos , Neoplasias Pancreáticas/terapia , Cuidados Posoperatorios/métodos , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidad , Periodo Preoperatorio , Pronóstico , Estudios Retrospectivos , Texas/epidemiología
17.
Ann Epidemiol ; 41: 21-27, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31928895

RESUMEN

PURPOSE: Maternal body mass index (BMI) is inversely associated with gastroschisis, but a causal relationship has not been established. As data demonstrating that a change in exposure status is related to a change in the frequency of the outcome can add to the evidence for causality, we conducted a case-control study of change in maternal BMI, assessed using interpregnancy change in BMI (IPC-BMI), and gastroschisis. METHODS: Data for 258 gastroschisis cases and 2561 controls were obtained from the Texas Birth Defects Registry and vital records (2006-2012). Logistic regression was used to estimate the adjusted association between IPC-BMI and gastroschisis. RESULTS: The continuous IPC-BMI variable was inversely associated with gastroschisis (adjusted odds ratio [aOR] = 0.90, 95% confidence interval [CI]: 0.86, 0.95). When assessed as a six-level categorical variable, with weight stable women as the referent, the odds of gastroschisis were higher following a BMI decrease of greater than 1 unit (aOR = 1.37, 95% CI: 0.91, 2.06) and lower after a BMI increase of ≥3 units (aOR = 0.62, 95% CI: 0.42, 0.94). CONCLUSIONS: Our findings suggest that maternal change in BMI is associated with gastroschisis and, thus, add to the epidemiological evidence that can be used to inform our understanding of the relationship between BMI and gastroschisis.


Asunto(s)
Índice de Masa Corporal , Gastrosquisis/epidemiología , Obesidad/epidemiología , Complicaciones del Embarazo/epidemiología , Aumento de Peso/fisiología , Pérdida de Peso/fisiología , Adulto , Estudios de Casos y Controles , Femenino , Gastrosquisis/patología , Humanos , Obesidad/complicaciones , Embarazo , Complicaciones del Embarazo/patología , Factores de Riesgo , Texas/epidemiología , Estados Unidos/epidemiología , Adulto Joven
18.
Vet Parasitol ; 278: 109014, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31972512

RESUMEN

Trypanosoma cruzi is a zoonotic protozoan parasite transmitted by triatomines that infects a wide range of mammals. South Texas is a hotspot for triatomines, T. cruzi-infected dogs and wildlife, and local transmission to humans also occurs. However, little is known about the infection of domestic cats (Felis catus) in the United States. Given the role cats play in the ecology of T. cruzi in Mexico and South America, we hypothesized that T. cruzi infection occurs in cats from south Texas, sometimes associated with cardiac pathology. In 2017, 167 euthanized cats from a south Texas shelter were sampled across winter, spring, and summer. We collected whole blood and hearts from all cats, with additional tissues from a subset. Serum samples were screened for T. cruzi antibodies using two independent rapid immunochromatographic tests and an indirect fluorescent antibody test. Cats were considered seropositive if they were positive on at least two independent serological tests. Blood clot, heart tissue and other tissues were subjected to qPCR for parasite detection and discrete typing unit (DTU) determination. Tissues from selected seropositive or PCR-positive animals and a subset of negative animals were processed routinely for histopathology and examined by a board-certified pathologist. A total of 19 cats (11.4%) were seropositive and three cats (1.8%) - one of which was seropositive - had one or more PCR-positive tissues. Infected tissues included heart, bicep femoris muscle, sciatic nerve, esophagus, and mesentery. Genotyping of the parastite to the level of DTU showed that exclusively DTU TcI was present, despite past studies showing both TcI and TcIV in vectors of the region. Eight of 19 (42.1%) seropositive cats exhibited lymphoplasmacytic inflammation, sometimes with fibrosis, in cardiac tissue compared to 28.6% of 28 seronegative cats (P = 0.10). Domestic cats are affected hosts in the eco-epidemiology of Chagas disease. Future prospective studies are needed to understand disease progression. Veterinarians in the southern United States should consider T. cruzi in their index of suspicion in cats with exposure to vectors and undetermined cardiac abnormalities.


Asunto(s)
Enfermedades de los Gatos/epidemiología , Enfermedad de Chagas/veterinaria , Miocardio/patología , Animales , Enfermedades de los Gatos/parasitología , Gatos , Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/parasitología , Femenino , Técnica del Anticuerpo Fluorescente Indirecta/veterinaria , Corazón/parasitología , Inmunoensayo/veterinaria , Masculino , Prevalencia , Texas/epidemiología
19.
Disasters ; 44(2): 408-432, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31231850

RESUMEN

Most disaster studies rely on convenience sampling and 'after-only' designs to assess impacts. This paper, focusing on Hurricane Harvey (2017) and leveraging a pre-/post-event sample of Greater Houston households (n=71) in the United States, establishes baselines for disaster preparedness and home structure flood hazard mitigation, explores household-level ramifications, and examines how preparedness and mitigation relate to health effects, event exposures, and recovery. Between 70 and 80 per cent of participants instituted preparedness measures. Mitigation actions varied: six per cent had interior drainage systems and 83 per cent had elevated indoor heating/cooling components. Sixty per cent reported home damage. One-half highlighted allergies and two-thirds indicated some level of post-traumatic stress (PTS). Three-quarters worried about family members/friends. The results of generalised linear models revealed that greater pre- event mitigation was associated with fewer physical health problems and adverse experiences, lower PTS, and faster recovery. The study design exposed the broad benefits of home structure flood hazard mitigation for households after Harvey.


Asunto(s)
Tormentas Ciclónicas , Desastres , Inundaciones , Adulto , Anciano , Planificación en Desastres/estadística & datos numéricos , Composición Familiar , Estado de Salud , Vivienda/normas , Vivienda/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Factores Socioeconómicos , Trastornos por Estrés Postraumático/epidemiología , Encuestas y Cuestionarios , Texas/epidemiología
20.
Surgery ; 167(2): 442-447, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31727324

RESUMEN

BACKGROUND: First postoperative day drain fluid amylase (DFA1) <5000 U/L is commonly used for early drain removal. We manage patients with risk-stratified pancreatectomy care pathways determined preoperatively by risk for postoperative pancreatic fistula. We hypothesized that preoperative risk stratification would yield unique DFA1/DFA3 cutoffs for safe early drain removal. METHODS: Patients with DFA1/DFA3 values after pancreaticoduodenectomy or distal pancreatectomy were identified. Patients were risk stratified as "low-risk pancreaticoduodenectomy," "high-risk pancreaticoduodenectomy," or "distal pancreatectomy." Receiver operator characteristic analyses yielded clinically relevant sensitivity thresholds for International Study Group on Pancreatic Surgery grade B/C postoperative pancreatic fistulas. RESULTS: From October 2016 to April 2018, 174 patients were preoperatively stratified as low-risk pancreaticoduodenectomy (n = 78, 45%), high-risk pancreaticoduodenectomy (n = 51, 29%), and distal pancreatectomy (n = 45, 26%). B/C postoperative pancreatic fistulas developed in 3% (n = 2) of low-risk pancreaticoduodenectomies, 37% (n = 19) of high-risk pancreaticoduodenectomies, and 24% (n = 11) of distal pancreatectomies (low- vs high-risk pancreaticoduodenectomy P < .001, low-risk pancreaticoduodenectomy versus distal pancreatectomy P = .004, high-risk pancreaticoduodenectomy versus distal pancreatectomy P = .25). B/C postoperative pancreatic fistulas occurred in 16% (n = 21) pancreaticoduodenectomy patients (high- + low-risk pancreaticoduodenectomy), and B/C postoperative pancreatic fistulas were excluded in pancreaticoduodenectomy with 100% sensitivity if DFA1 ≤ 136 or DFA3 ≤ 93. DFA1 < 5000 excluded B/C postoperative pancreatic fistulas with only 57% sensitivity after pancreaticoduodenectomy. Exclusion of B/C postoperative pancreatic fistulas occurred with 100% sensitivity if DFA1 ≤ 661 or DFA3 ≤ 141 in low-risk pancreaticoduodenectomy patients, DFA1 ≤ 136 or DFA3 ≤ 93 in high-risk pancreaticoduodenectomy patients, and DFA1 < 49 or DFA3 < 26 in distal pancreatectomy patients. CONCLUSION: Preoperative risk stratification results in unique DFA1/DFA3 thresholds to exclude B/C postoperative pancreatic fistulas, thus allowing for safe drain removal and potential for accelerated discharge. Rather than applying generic DFA cutoffs based on national databases, we propose institution-specific DFA1 and DFA3 values tailored to 3 replicable postoperative pancreatic fistula-risk pathways.


Asunto(s)
Amilasas/análisis , Fístula Pancreática/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pancreatectomía , Fístula Pancreática/epidemiología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Texas/epidemiología , Adulto Joven
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