Race Adjustment of Pulmonary Function Tests in the Diagnosis and Management of COPD: A Scoping Review.

Aim: Increasing evidence suggests that the inclusion of self-identified race in clinical decision algorithms may perpetuate longstanding inequities. Until recently, most pulmonary function tests utilized separate reference equations that are race/ethnicity based. Purpose: We assess the magnitude and scope of the available literature on the negative impact of race-based pulmonary function prediction equations on relevant outcomes in African Americans with COPD. Methods: We performed a scoping review utilizing an English language search on PubMed/Medline, Embase, Scopus, and Web of Science in September 2022 and updated it in December 2023. We searched for publications regarding the effect of race-specific vs race-neutral, race-free, or race-reversed lung function testing algorithms on the diagnosis of COPD and COPD-related physiologic and functional measures. Joanna Briggs Institute (JBI) guidelines were utilized for this scoping review. Eligibility criteria: The search was restricted to adults with COPD. We excluded publications on other lung disorders, non-English language publications, or studies that did not include African Americans. The search identified publications. Ultimately, six peer-reviewed publications and four conference abstracts were selected for this review. Results: Removal of race from lung function prediction equations often had opposite effects in African Americans and Whites, specifically regarding the severity of lung function impairment. Symptoms and objective findings were better aligned when race-specific reference values were not used. Race-neutral prediction algorithms uniformly resulted in reclassifying severity in the African Americans studied. Conclusion: The limited literature does not support the use of race-based lung function prediction equations. However, this assertion does not provide guidance for every specific clinical situation. For African Americans with COPD, the use of race-based prediction equations appears to fall short in enhancing diagnostic accuracy, classifying severity of impairment, or predicting subsequent clinical events. We do not have information comparing race-neutral vs race-based algorithms on prediction of progression of COPD. We conclude that the elimination of race-based reference values potentially reduces underestimation of disease severity in African Americans with COPD.

Potentially toxic elements fluxes in 210Pb-dated sediment cores from a large coastal lagoon (southern Gulf of Mexico) under environmental stress.

Terminos Lagoon (TL), in the southern Gulf of Mexico, has been under intensive anthropogenic pressure (e.g., oil-industry development) since the 1970s. Historical changes in flux ratios of potentially toxic elements (PTEs; As, Cd, Cr, Cu, Ni, Pb, V, Zn) were, for the first time, assessed inside TL by using 210Pb-dated sediment cores. Sediments showed minor enrichments for Cd, Ni, Pb, and V. However, according to international benchmarks, the As, Cr, Cu, and Ni concentrations could pose a risk for benthic biota. Sedimentary processes involved in the accumulation of PTEs were identified through a chemometric approach. Increments in PTEs flux ratios concur with the recent (⁓50 years) and extensive land-use changes, particularly the transport and deposit of materials delivered by rivers. These findings are expected to be used in managing this crucial natural resource, the larger Mexican coastal lagoon ecosystem, to mitigate the effects of global change.

Why are cell populations maintained via multiple compartments?

We consider the maintenance of 'product' cell populations from 'progenitor' cells via a sequence of one or more cell types, or compartments, where each cell's fate is chosen stochastically. If there is only one compartment then large amplification, that is, a large ratio of product cells to progenitors comes with disadvantages. The product cell population is dominated by large families (cells descended from the same progenitor) and many generations separate, on average, product cells from progenitors. These disadvantages are avoided using suitably constructed sequences of compartments: the amplification factor of a sequence is the product of the amplification factors of each compartment, while the average number of generations is a sum over contributions from each compartment. Passing through multiple compartments is, in fact, an efficient way to maintain a product cell population from a small flux of progenitors, avoiding excessive clonality and minimizing the number of rounds of division en route. We use division, exit and death rates, estimated from measurements of single-positive thymocytes, to choose illustrative parameter values in the single-compartment case. We also consider a five-compartment model of thymocyte differentiation, from double-negative precursors to single-positive product cells.

Ecological traits influence the bioaccumulation of microplastics in commercially important estuarine crabs from the southeastern Gulf of Mexico.

We assessed microplastics (MPs) contamination in water, sediments, and tissues (gills, digestive tract, and muscle) of two intertidal crab species with different ecological traits and commercial importance (Menippe mercenaria and Callinectes sapidus), from a coastal lagoon in the southeastern Gulf of Mexico. There were significant differences between MP abundances in the abiotic matrices and between crab species. The burrower, sedentary and carnivorous M. mercenaria bioaccumulates 50 % more MPs than the free-swimming, omnivorous C. sapidus. However, no differences were observed between species' tissues. Fragments were the predominant shape in the tissues of both species, with the exception in the digestive tract of M. mercenaria. We identified polyethylene, and polyethylene terephthalate in water samples and Silopren® in sediment. In both crab species, Silopren and polyethylene predominated. Differences in ecological traits resulted in different bioaccumulation patterns in intertidal crabs.

Contrasting nutrient distributions during dry and rainy seasons in coastal waters of the southern Gulf of Mexico driven by the Grijalva-Usumacinta River discharges.

Globally, nutrient river discharges drive water quality of coastal ecosystems, and excess nutrients can cause eutrophication impacts. The Grijalva-Usumacinta River System (GURS) discharges in the southern Gulf of Mexico (SGoM) and it is the second largest riverine input to the Gulf. To study how contrasting GURS freshwater flow between rainy and dry seasons affects nutrients concentrations in the receiving coastal ecosystem, we evaluated nutrient variability in the water column during both seasons. High inorganic nutrients and total phosphate outline the rivers discharge plumes during rainy season, and were significantly higher than during the dry season throughout the study area, suggesting contrasting seasonal nutrient discharge of the GURS to coastal waters. On average the GURS discharged 141,123 t N yr-1 6893 t P yr-1 and 928,904 t Si yr-1 to SGoM. These results contribute with a nutrient baseline in the SGoM that could be useful for GURS decision-makers.

Can tolerances of multiple stressors and calculated safety margins in fiddler crabs predict responses to extreme environmental conditions resulting from climate change?

To comprehend mangrove crab responses to predicted global climate changes, we assessed submersion and desiccation survival durations and salinity tolerances and upper thermal limits in fiddler crabs from Isla del Carmen, Yucatán Peninsula. Based on their tolerances of extreme ambient conditions, we also calculated safety margins using abiotic monitoring data. The two most terrestrial species, Minuca rapax and Leptuca panacea, exhibited submersion tolerances of from 22 to 40 h, and desiccation tolerances of from 30 to 55 h; LC50's were ≈45‰S and UT50's were ≈40 °C. The two least terrestrial species, M. vocator and L. speciosa, were less tolerant of all experimental challenges, showing submersion and desiccation tolerances of <6 h, and LC50's of 36‰S and UT50's of 38 °C. While these fiddler crabs inhabit niches closer to their salinity and desiccation/submersion tolerances than to their temperature limits, all are clearly vulnerable to the multiple stressors that accompany anticipated global climate change.

Amyloid A amyloidosis with subcutaneous drug abuse.

INTRODUCTION: Amyloid A (AA) amyloidosis is a systemic form of amyloidosis secondary to chronic infections and inflammatory disorders. An acute-phase protein produced by the liver, serum amyloid A (SAA) is the precursor of AA amyloid fibrils. AA amyloid deposition occurs predominantly in the kidneys, spleen, adrenal glands, liver and gastrointestinal tract. The manifestations of AA amyloidosis involving the kidneys include proteinuria, tubular dysfunction and progressive loss of renal function. CASE: We report a 47-year-old drug addict who developed AA amyloidosis as a result of recurrent suppurative skin infections secondary to subcutaneous drug injection. Elevated C-reactive protein concentrations attested to the presence of a chronic systemic inflammatory state. He suffered from the nephrotic syndrome and insidious loss of renal function. Isosthenuria and glycosuria were indicative of renal tubular dysfunction. Renal biopsy demonstrated AA amyloidosis involving the glomeruli, tubular basement membranes and blood vessel walls. CONCLUSION: Superimposed acute tubular necrosis due to concomitant endocarditis and cocaine use accelerated his renal disease. CASE presentation is followed by a brief discussion of clinical features, natural history and outcome of AA amyloidosis with a particular emphasis on AA amyloidosis as a complication of subcutaneous drug abuse.

Knowledge about HIV prevention and transmission among recently diagnosed tuberculosis patients: a cross sectional study.

BACKGROUND: Patients with Tuberculosis (TB) are a vulnerable group for acquiring HIV infection. Therefore, countries with a concentrated HIV epidemic and high prevalence of TB should provide adequate information about HIV prevention to TB patients. METHODS: We conducted a cross-sectional study to evaluate the level of knowledge on HIV prevention and transmission among newly diagnosed TB patients in Lima, Peru. The survey evaluated knowledge about HIV infection and prevention and was administered before HIV counseling and blood sampling for HIV testing were performed. RESULTS: A total of 171 TB patients were enrolled; mean age was 31.1 years, 101 (59%) were male. The overall mean level of knowledge of HIV was 59%; but the specific mean level of knowledge on HIV transmission and prevention was only 33.3% and 41.5%, respectively. Age and level of education correlated with overall level of knowledge in the multivariate model (P-value: 0.02 and <0.001 respectively). CONCLUSIONS: The study shows inadequate levels of knowledge about HIV transmission and prevention among newly-diagnosed TB patients in this setting, and underscores the need for implementing educational interventions in this population.

Additional evidence to support the phasing-out of treatment category II regimen for pulmonary tuberculosis in Peru.

The effectiveness of the World Health Organization's (WHO) treatment category II regimen for tuberculosis in 124 patients was compared to that of 1147 patients receiving treatment category I in Lima, Peru following WHO's guidelines. Drug susceptibility test was available for 85% of patients. Prevalence of multi drug resistance and streptomycin resistance were 5.1% and 20.7%, respectively. Overall cure rate for regimen II was lower than that of regimen I: 67.8% (95% CI: 58.9-75.6.) vs 77.8% (95% CI: 75.3-80.2), p=0.014. Multi-drug resistance exerted a profound effect on cure rates in both regimens. Our results support the phasing-out of treatment category II regimen in Peru.

Colecistectomía laparoscópica con trócar umbilical único de 12 mm y óptica con canal operatorio: asistido con agujas percutaneas y dispositivos magneticos: reporte de 80 casos / Laparoscopic cholecystectomy with single umbilical trocar of 12mm and an optical device with a working cannel: assisted with percutaneous needles and magnetic devices: report of 80 cases

Presentar nuestra experiencia en la técnica de colecistectomia laparoscópica con trócar umbilical único. Sede: Departamento de Cirugía General de dos hospitales privados. Diseño: estudio prospectivo, observacional. 80 pacientes intervenidos quirúrgicamente con la técnica de colecistectomía laparoscópica con trócar umbilical único de 12mm y óptica con canal operatorio, 74 asistidos con agujas, percutáneas y 6 añadiendo dispositivos magnéticos, desde octubre 2008 al 31 de agosto del 2010. Se excluyeron casos de coledocolitiasis, cáncer y pacientes con cirugías abdominales previas. Se analizó edad, sexo, índice de masa corporal (IMC), tiempo quirúrgico, estancia hospitalaria, complicaciones, índice de conversión y resultado estético. Predomino el sexo femenino (5 a 1). La edad promedio fue de 41 años. El tiempo quirúrgico promedio fue de 63 minutos. IMC promedio 29. Adición de trócar en 7 pacientes (9%), no hubo conversiones a técnicas abiertas. El tiempo de hospitalización fue de 24 horas. Sin cicatriz abdominal visible en 73 pacientes en los que se completó el procedimiento por un trócar (91%). Morbilidad=3,75%, mortalidad=0%. La colecistectomía con trócar umbilical único y óptica con canal de trabajo asistida con agujas percutaneas es aplicable en el 91% de los pacientes con enfermedad vasicular. Con los imanes se logró tracción satisfactoria de la vesícula, siendo de mucha utilidad al realizar la técnica "cirugía sin huella".

To present our experience in the technique of laparoscopic cholecystectomy with single umbilical trocar. Headquarters: Departament of General Surgery of two private hospitals Design: Prospective, observational study. 80 patients operated with the techniqué of laparoscopic cholecystectomy with single umbilical trocar of 12mm and an optical device with a working channel: 74 attended with percutaneous needles and 6 adding magnetic devices, from Octuber 2008 to August 31, 2010. Cases of choledocholithiasis, cancer and patients with previous abdominal surgery were excluded. Age, sex, body mass index (BMI), surgical time, hospital stay, complications, index of conversión and cosmetic result were analyzed. Feminine sex predominated (5 to 1). The average age was 41 years. The surgical time average was 70 minutes. IMC average 29. Addition of trocars was need in 7 patients (9%), there were no conversion to open surgery. The hospitalization time was 24 hours. Abdominal scar was not visible in 73 patients in whom the precedure with one trocar was completed (91%). Morbidity=3.75%, mortality=0%. The laparoscopic cholecystectomy with single umbilical trocar of 12mm and an optical device with a working cannel attended with percutaneous needles is applicable in 91% of patients with gallbladder disease. With magnets satisfactory traction of the gallbladder was obtained, being very useful to per-form the technique "surgery without trace".

Accounting for autocorrelation in multi-drug resistant tuberculosis predictors using a set of parsimonious orthogonal eigenvectors aggregated in geographic space.

Spatial autocorrelation is problematic for classical hierarchical cluster detection tests commonly used in multi-drug resistant tuberculosis (MDR-TB) analyses as considerable random error can occur. Therefore, when MDRTB clusters are spatially autocorrelated the assumption that the clusters are independently random is invalid. In this research, a product moment correlation coefficient (i.e., the Moran's coefficient) was used to quantify local spatial variation in multiple clinical and environmental predictor variables sampled in San Juan de Lurigancho, Lima, Peru. Initially, QuickBird 0.61 m data, encompassing visible bands and the near infra-red bands, were selected to synthesize images of land cover attributes of the study site. Data of residential addresses of individual patients with smear-positive MDR-TB were geocoded, prevalence rates calculated and then digitally overlaid onto the satellite data within a 2 km buffer of 31 georeferenced health centers, using a 10 m2 grid-based algorithm. Geographical information system (GIS)-gridded measurements of each health center were generated based on preliminary base maps of the georeferenced data aggregated to block groups and census tracts within each buffered area. A three-dimensional model of the study site was constructed based on a digital elevation model (DEM) to determine terrain covariates associated with the sampled MDR-TB covariates. Pearson's correlation was used to evaluate the linear relationship between the DEM and the sampled MDR-TB data. A SAS/GIS(R) module was then used to calculate univariate statistics and to perform linear and non-linear regression analyses using the sampled predictor variables. The estimates generated from a global autocorrelation analyses were then spatially decomposed into empirical orthogonal bases using a negative binomial regression with a non-homogeneous mean. Results of the DEM analyses indicated a statistically non-significant, linear relationship between georeferenced health centers and the sampled covariate elevation. The data exhibited positive spatial autocorrelation and the decomposition of Moran's coefficient into uncorrelated, orthogonal map pattern components revealed global spatial heterogeneities necessary to capture latent autocorrelation in the MDR-TB model. It was thus shown that Poisson regression analyses and spatial eigenvector mapping can elucidate the mechanics of MDR-TB transmission by prioritizing clinical and environmental-sampled predictor variables for identifying high risk populations.

Colecistectomía laparoscópica con un sólo puerto umbilical: sin huella: reporte de 3 casos en Venezuela / Laparoscopic cholecystectomy with only one port cord: without mark: report of 3 cases in Venezuela

Reproducir en nuestro país, la técnica de colecistectomía laparoscópica con un sólo puerto umbilical, sin huella, con el fin de añadir a la laparoscopia tradicional resultados estéticos óptimos, libre de cicatriz abdominal. Trabajo realizado en el Departamento de Cirugía General de dos hospitales privados. Estudio prospectivo observacional en 3 pacientes intervenidos quirúrgicamente con la técnica de colecistectomía laparoscópica con un sólo puerto umbilical asistido con agujas percutáneas, en un período de tiempo del 1 al 30 del octubre del 2008. Se excluyeron casos de colecistitis aguda, colédoco litiasis y cáncer. Se analizó edad, sexo, tiempo quirúrgico, estancia hospitalaria, complicaciones, índice de conversión y efectos estéticos. Predominó el sexo femenino (100 por ciento). La edad promedio fue de 30 años. El tiempo quirúrgico promedio fue de 107 minutos. El tiempo de hospitalización fue de 24 horas. No se evidenció cicatriz abdominal, en contraste con la técnica laparoscópica habitual, con 3 cicatrices visibles. No hubo conversiones. Morbilidad = 0 por ciento, mortalidad = 0 por ciento. La técnica es perfectamente reproducible en nuestro medio, aportando beneficios estéticos óptimos a la colecistectomía laparoscópica tradicional, quedando ausente la pared abdominal de cicatrices visibles.

Colecistectomía laparoscópica con un sólo puerto visible subxifoideo de 5 mm: experiencia en Venezuela / Laparoscopic cholecystectomy with a single subxyphoid port of 5 mm: our experience in Venezuela

Presentar nuestra experiencia en 18 colecistectomías laparoscópicas con un sólo puerto visible subxifoideo de 5 mm, obtenida en el Departamento de Cirugía de dos hospitales privados, con el fin de introducir en nuestro país las técnicas que disminuyan aún más el trauma de la laparoscopia tradicional. Estudio prospectivo, observacional. Fueron intervenidos 18 pacientes con la técnica de colecistectomía laparoscópica con un sólo puerto visible subxifoideo, en el período de enero a abril de 2008. Se excluyeron casos de colecistitis aguda, coledocolitiasis y cáncer. Se analizaron la edad, sexo, el tiempo quirúrgico, la estancia hospitalaria, las complicaciones, el índice de conversión y los efectos estéticos. Predominó el sexo femenino (17 a 1). La edad promedio fue de 41 años. El tiempo quirúrgico promedio fue de 67 minutos (58 minutos promedio con el uso del ligasure y 98 minutos sin este equipo). El tiempo de hospitalización fue de 24 horas. Se evidenció una sola cicatriz a nivel subxifoideo, en contraste con la técnica laparoscópica habitual, con 3 cicatrices visibles. No hubo conversiones. No hubo morbilidad ni mortalidad. La técnica es perfectamente reproducible en nuestro medio, aportando beneficios adicionales estéticos a la colecistectomía laparoscópica tradicional.

Tratamiento ambulatorio de la enfermedad y seno pilonidal / Ambulatory treatment of disease and pilonidad sinus

Fueron operados un total de 43 pacientes portadores de enfermedad pilonidal recidivante, no complicada, en un lapso comprendido entre Noviembre de 1984 y Noviembre de 1986. Hubo un 10% de complicaciones, una infección, dos seromas y un hematoma. 29 pacientes han tenido un seguimiento de más de un año sin evidencias clínicas de recidiva. Esta forma de tratamiento para la enfermedad pilonidal es un procedimiento sencillo, bien tolerado por el enfermo, que ha permitido reducir notablemente los costos hospitalarios con la recuperación del enfermo en su domicilio, permitiendose la incorporación temprana a sus actividades (15-20 días) con un riesgo minimo de complicaciones