Clinical inertia in newly diagnosed type 2 diabetes mellitus among patients attending selected healthcare institutions in Colombia.

BACKGROUND: The burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed. OBJECTIVE: To measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines. METHODS: An observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest. RESULTS: A total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41-3.86). CONCLUSIONS: In this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.

Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus living in Puerto Rico.

This is a descriptive study using healthcare claims data from patients with T2DM from public and private healthcare insurance companies providing services in Puerto Rico in 2013, aimed to estimate the prevalence of comorbidities in this population. Descriptive analyses were performed by sociodemographic, and type of service variables using frequency and percent for categorical data or means (+/-SD) or median (IQR) for continuous variables. Chi-square, Fisher exact or two-sample t-tests were used for comparisons. A total of 3,100,636 claims were identified from 485,866 adult patients with T2DM. Patients older than 65 years represented 48% of the study population. Most patients were women (57%) and had private health insurance (77%). The regions of Metro Area (17%) and Caguas (16%) had the higher number of persons living with T2DM. The overall estimated prevalence of T2DM was 17.4%. The number of claims per patient ranged from 1 to 339. A mean of 6.3 claims (SD±9.99) and a median of 3 claims (Q1 1- Q3 8) per subject were identified. Of the 3,100,636 claims most (74%) were related to the diagnosis of diabetes (59%) and associated to outpatient services (88%). The most prevalent comorbidities were hypertension (48%), hyperlipidemia (41%), neuropathy (21%); renal disease (15%), and retinopathy (13%). A high prevalence and co-prevalence of comorbidities and use of healthcare services were identified in patients with T2DM, especially in older adults. Since most comorbidities were due to diabetes-related conditions, this analysis highlights the importance of early diagnosis and adequate management of T2DM patients to avoid preventable burden to the patient and to the healthcare system.

Is Oral Vaccination against Escherichia coli Influenced by Zinc Oxide?

BACKGROUND: Although zinc oxide has been banned at therapeutic doses in the EU, its use is still legal in most countries with industrial pig farming. This compound has been shown to be very effective in preventing E. coli-related diseases. However, another strategy used to control this pathogen is vaccination, administered parenterally or orally. Oral vaccines contain live strains, with F4 and F18 binding factors. Since zinc oxide prevents E. coli adhesion, it is hypothesised that its presence at therapeutic doses (2500 ppm) may alter the immune response and the protection of intestinal integrity derived from the vaccination of animals. METHODS: A group of piglets were orally vaccinated at weaning and divided into two subgroups; one group was fed a feed containing 2500 ppm zinc oxide (V + ZnO) for the first 15 days post-vaccination (dpv) and the other was not (V). Faeces were sampled from the animals at 6, 8, 11, 13, and 15 dpv. Unvaccinated animals without ZnO in their feed (Neg) were sampled simultaneously and, on day 15 post-vaccination, were also compared with a group of unvaccinated animals with ZnO in their feed (ZnO). RESULTS: Differences were found in E. coli excretion, with less quantification in the V + ZnO group, and a significant increase in secretory IgA in the V group at 8 dpv, which later equalised with that of the V + ZnO group. There was also some difference in IFNα, IFNγ, IL1α, ILß, and TNFα gene expression when comparing both vaccinated groups (p < 0.05). However, there was no difference in gene expression for the tight junction (TJ) proteins responsible for intestinal integrity. CONCLUSIONS: Although some differences in the excretion of the vaccine strain were found when comparing both vaccinated groups, there are no remarkable differences in immune stimulation or soluble IgA production when comparing animals orally vaccinated against E. coli in combination with the presence or absence of ZnO in their feed. We can conclude that the immune response produced is very similar in both groups.

Trends in Pneumococcal and Bacterial Meningitis in Brazil from 2007 to 2019.

The pneumococcal conjugate vaccination (PCV) was introduced into the Brazilian Childhood National Immunization Program in 2010; however, universal pneumococcal vaccination for older adults has not been implemented yet. Our aim is to evaluate the trends in pneumococcal meningitis incidence and case fatality rate (CFR) across all age groups from 2007 to 2019 using data from the National Surveillance System. The pre-PCV (2007-2009) and post-PCV (2011-2019) periods were compared; changes in incidence and CFR were assessed by joinpoint regression. Additional analyses of bacterial meningitis were performed to compare the patterns and trends. Over the 13-year period, 81,203 and 13,837 cases were classified as bacterial and pneumococcal meningitis, respectively. S. pneumoniae was the main etiological agent of bacterial meningitis in adults aged ≥50 years and the most lethal in all age groups. In the post-PCV period, a 56.5% reduction in the average incidence was seen in pneumococcal meningitis in the pediatric population. In contrast, there was an increasing trend among adults. The CFR for pneumococcal and bacterial meningitis remained stable in most age groups during the study period. These findings highlight the value of expanding pneumococcal vaccination policies, including vaccines that provide better indirect protection from children to adults and broadening vaccination to older adults.

Logro de control metabólico temprano en adultos con diabetes mellitus tipo 2 en Perú

Objetivo: Estimar la proporción de sujetos con diabetes mellitus tipo 2 (DMT2) que alcanzan la meta terapéutica para HbA1C un año después del diagnóstico (control metabólico temprano). Métodos: Revisión retrospectiva de historias clínicas de adultos atendidos en 16 centros médicos distribuidos en nueve ciudades peruanas. Se incluyeron pacientes que recibieron un diagnóstico inicial de DMT2 y tuvieron al menos un año de seguimiento. Se consideraron las metas metabólicas definidas en los estándares ADA 2018. Resultados: Se incluyeron 457 sujetos (53,03% mujeres). Cuando fueron diagnosticados, la edad media fue de 55,75 años (DE ± 12,92), la media de HbA1C fue de 9,10% (DE ± 2,28). Hubo diagnóstico concomitante de hipertensión arterial o de dislipidemia en 27,13% y 52,40%, respectivamente. Al año de seguimiento, 57,76% de los sujetos alcanzó la meta de HbA1C ( 40 mg / dL), 24,31% para HDL-c en mujeres (>50 mg/dL), 48,24% para triglicéridos (<150 mg/dL), y 89,23% para presión arterial (<140/90 mmHg). Conclusiones: En este estudio en condiciones de la vida real, en adultos con DMT2 con un año de seguimiento, el logro de la meta de HbA1C (<7%) se alcanzó en el 58% de los pacientes. Si bien estos resultados son compatibles con los reportados en otros estudios de la región, se evidencia la oportunidad de mejorar el logro temprano de metas con el objetivo de optimizar los resultados a largo plazo.

Aim: To estimate the proportion of subjects with type 2 diabetes mellitus (T2DM) who attain therapeutic goal for HbA1C one year after diagnosis (early metabolic control). Methods: Retrospective review of medical records of adults cared for at 16 centers in nine Peruvian cities. Patients who received an initial diagnosis of T2DM and had at least one year of follow up were included. Metabolic goals were as defined by ADA 2018 standards. Results: 457 subjects were included (53,03% female). At diagnosis, mean age was 55,75 years (SD ± 12.92), mean HbA1C was 9,10% (SD ± 2,28). Concomitant hypertension or dyslipidemia were present in 27,13% and 52,40%, respectively. At one year follow up, 57,76% of subjects attained the goal for HbA1C ( 40 mg/dL), 24,31% for HDL-c in women (>50 mg/dL), 48,24% for triglycerides (<150 mg/dL), and 89,23% for blood pressure (<140/90 mmHg). Conclusions: In this real-life study of adults with T2DM with one year of follow up, metabolic control for HbA1C (<7%) was attained in 58% of subjects. While the results are compatible with those reported in other studies in the region, there is opportunity to further improve early treatment goal attainment to optimize long-term outcomes.

Effect of Sow Body Weight at First Service on Body Status and Performance during First Parity and Lifetime.

In this retrospective study, we aimed to assess the effect of body weight (BW) at first service on body status development and sow performance during first parity and lifetime efficiency. A total of 360 DanBred gilts were used, which we categorized into three groups according to their BW: (1) Small sows (<135 kg BW; n = 108); (2) Medium sows (135−150 kg BW; n = 155); (3) Large sows (>150 kg BW; n = 63). We studied the gilts from first insemination to first weaning, and then monitored until culling. Sow body status, litter size and weight, farrowing rate, weaning-to-conception interval, lifetime performance, and hormones linked to metabolism were recorded. Sows in the Small group had the lowest body weight, backfat thickness, and loin depth during gestation. Moreover, they had the smallest number of total piglets born and longest weaning-to-conception interval at first parity. The Small sows also had, on average, one less piglet born during their productive life, and they tended to have a higher culling rate over three parities. For immunoglobulins, insulin, cortisol, and IGF-I levels, no differences were found. In conclusion, achieving optimal body weight at first service is essential for maximizing the sow's lifetime performance.

Use of Mediterranean By-Products to Produce Entire Male Large White Pig: Meat and Fat Quality.

A total of 70 male growing non-castrated pigs (Large White), with a 23.07 ± 2.87 kg average body weight (BW), were randomly allocated to three treatments in a 103 day trial: a CONTROL diet and two experimental diets, ALLIUM (5 g/kg of Allium spp. extract) and OLIVE (100 g/kg of olive pulp). Animals were slaughtered at 115 kg live body weight. Meat and fat quality were analyzed. Animals fed ALLIUM and OLIVE had higher water holding capacity (WHC) than those fed the control diet. No significant differences were observed between groups for cooking loss, drip losses and color CIELab. No antioxidant effect was observed on an oxygen radical absorbance capacity (ORAC) test. Animals fed OLIVE presented a more unsaturated fatty acid profile than CONTROL and ALLIUM. Meat from ALLIUM group and OLIVE showed her values of brightness and meat odor than CONTROL. Mean scores of sensory analyses (color, odor, flavor and juiciness) of cooked samples were similar for the three treatments, with the meat samples from the ALLIUM and OLIVE treatments being less hard. Consumers did not reflect a preference for any of the treatments. Both by-products could be used for pork production.

Feeding Crude Glycerin to Finishing Iberian Crossbred Pigs: Effects on Growth Performance, Nutrient Digestibility, and Blood Parameters.

A total of 192 Iberian × Duroc pigs kept under intensive conditions were used to investigate the effects of feeding crude glycerin on growth performance, nutrient digestibility, and blood parameters. Animals were blocked by initial body weight (96.0 ± 11.3 kg) and allotted to pens (16 pigs per pen). Pens were assigned randomly to one of three dietary treatments (four pens per treatment). Dietary treatments contained 0, 5, or 10% of crude glycerin proportionally substituting for wheat (G0, G5, and G10, respectively). Diets were formulated to be isoenergetic and isoaminoacidic. No significant effect of crude glycerin was observed on average daily gain, average feed intake, or feed conversion ratio. The apparent total tract digestibility of dry matter, organic matter, and crude protein was no different between treatments. Total serum protein, albumin, glucose, insulin, and IGF-1 were not affected by glycerin inclusion. In conclusion, crude glycerin up to 100 g/kg can be included in the diets of finishing Iberian crossbred pigs without any negative effect on growth performance, digestibility, or serum metabolic parameters.

The Effect of the Dietary Inclusion of Crude Glycerin in Pre-Starter and Starter Diets for Piglets.

The aim of this study was to evaluate the effect of the inclusion of crude glycerin in post-weaning diets for piglets on growth performance and digestibility. The study was carried out with a total of 360 piglets over a 39 day period. Animals were blocked by body weight (7.7 ± 0.86 kg) and allotted randomly to one of three dietary treatments containing 0, 2.5 or 5% glycerin (G0, G2.5 and G5, respectively). Considering the whole period, glycerin did not affect the average daily gain. However, the average daily feed intake (ADFI) and the feed conversion ratio (FCR) tended to decrease or decreased linearly as the amount of glycerin increased, respectively (p = 0.060 and p = 0.039). The apparent total tract digestibility (ATTD) of dry and organic matter (DM, OM) increased linearly with increasing glycerin in both periods (p ≤ 0.05). At the end of the study, there were no differences between treatments for any of the hormones measured. In conclusion, the FCR and digestibility of DM and OM were improved although the ADFI tended to be lower when glycerin was included at 5%. Consequently, crude glycerin could be used as an alternative ingredient to partially replace sweet whey and wheat in post-weaning diets.

Effects of Commercial Antioxidants in Feed on Growth Performance and Oxidative Stress Status of Weaned Piglets.

This work aimed to evaluate the effect of adding two different commercial antioxidants (AOX) products to pre-starter and starter diets using low vitamin E (Vit E as DL-α-tocopheryl acetate) levels on the growth performance and oxidative stress of piglets for the first six weeks post-weaning (PW). They were sorted by initial body weight (BW: 6.175 ± 0.931 kg) and randomly allotted to four dietary treatments (with six replicates per treatment): a positive control (PC) and a negative control (NC) diet, with normal and low dose of vitamin E (80 and 15 mg kg-1, respectively), both without AOX; the other two experimental diets with a low dose of vitamin E (LVE) plus LOXIDAN VD100 (LVE + AOX1) or LOXIDAN E Ros (LVE + AOX2). Growth data were recorded, and blood samples were taken, at the beginning (day 0) and at the end of each feeding period: pre-starter and starter (at days 14 and 42, respectively). No differences among dietary treatments were found with respect to growth performance in the pre-starter period (p ≥ 0.05). However, at the end of the starter period, a lower BW was found in piglets fed the NC diet compared to the other dietary treatments. Differences in daily gain and feed conversion ratio were also found either for the starter period or when the whole period was considered (p < 0.05), whereby piglets fed PC or LVE diets supplemented with AOX showed better growth performance compared to piglets fed the NC diet. Regarding Vit E (α-tocopherol) serum levels, there were no differences among treatments at day 0; but the serum values of this vitamin decreased in LVE diets at 14 and 42 days, but not in the PC. On day 42, the highest levels of α-tocopherol in liver were also found in piglets fed PC (p < 0.05). Nevertheless, in general, from a metabolic point of view and after checking the serum biochemical profile of piglets, there were no differences in other oxidative stress markers (p ≥ 0.05). The results showed that the AOX products used were able to compensate for the lower Vit E supply with respect to growth performance in the starter phase. The use of AOXs or usual levels of Vit E in feed constitutes a key factor in achieving optimal growth performance of piglets in the PW period.

Evaluation of the Pink Luminous Breast LED-Based Technology Device as a Screening Tool for the Early Detection of Breast Abnormalities.

Breast cancer is the leading cause of sex-specific female cancer deaths in the United States. Detection at earlier stages contributes to decreasing the mortality rate. The mammogram is the "Gold Standard" for breast cancer screening with an estimated sensitivity of 86.9% and a specificity of 88.9%. However, these values are negatively affected by the breast density considered a risk factor for developing breast cancer. Herein, we validate the novel LED-based medical device Pink Luminous Breast (PLB) by comparison with the mammogram using a double blinded approach. The PLB works by emitting a LED red light with a harmless spectrum of 640-800 nanometers. This allows the observation of abnormalities represented by dark or shadow areas. In this study, we evaluated the sensitivity and specificity of the PLB device as a screening tool for the early detection of breast abnormalities. Our results show that the PLB device has a high sensitivity (89.6%) and specificity (96.4%) for detecting breast abnormalities comparable to the adjusted mammogram values: 86.3 and 68.9%, respectively. The percentage of presence of breast density was 78.2% using PLB vs. 72.9% with the mammogram. Even with higher findings of breast density, the PLB is still capable of detecting 9.4% of calcifications compared to 6.2% in mammogram results and the reported findings for cysts, masses, or tumor-like abnormalities was higher using the PLB (6.5%) than the mammogram (5.6%). A 100% of the participants felt comfortable using the device without feeling pain or discomfort during the examination with 100% acceptability. The PLB positive validation shows its potential for routine breast screening at non-clinical settings. The PLB provides a rapid, non-invasive, portable, and easy-to-use tool for breast screening that can complement the home-based breast self-examination technique or the clinical breast examination. In addition, the PLB can be conveniently used for screening breasts with surgical implants. PLB provides an accessible and painless breast cancer screening tool. The PLB use is not intended to replace the mammogram for breast screening but rather to use it as an adjunct or complemental tool as part of more efficient earlier detection strategies contributing to decrease mortality rates.

Price Fluctuation, Protected Geographical Indications and Employment in the Spanish Small Ruminant Sector during the COVID-19 Crisis.

Official milk prices in the Spanish small ruminant sector were used for 5 years (2015-2019) to analyze the effect caused by the coronavirus disease (COVID-19) crisis in 2020. Meat price fluctuations were also studied using the weekly prices officially provided by some of the main agrarian markets of the country (n = 6) in 2019 and 2020. Moreover, the sales and prices of three protected geographical indications (PGI) of lamb meat served to study the marketability when the products are sold or not under these quality labels in a crisis context. According to Spanish Government's official communications, 2020 was divided in three periods of study (pre-COVID-19, total confinement and post-confinement). The evolution of employment in this subsector in 2020, as a direct consequence of this crisis, was also analyzed considering data provided by producers. Results showed an intra-annual seasonal effect for milk prices in 2020 for both livestock species, as observed in previous years. However, a negative economic impact on goat milk prices due to the pandemic was checked during the confinement and post-confinement months. Sheep milk prices remained stable. Lamb and goat kid meat prices showed a similar trend in comparison with 2019 during the pre-COVID-19 period. The total confinement period recorded a short interval of 1-2 weeks in which the prices declined, before the suspension of quotations in many markets. In contrast, once confinement was completed, meat prices for both ruminant species rapidly reached levels that existed before the coronavirus crisis. Overall data suggested the protective effect of the PGI marks on lamb meat. Lambs with a PGI had better 2020 prices than non-PGI lambs (+8%), regardless of the period analyzed. Moreover, with fewer lambs sold in 2020, there was a relevant drop in sales of non-PGI lambs vs. PGI (-19% vs. -2%) during the first 7 months. Finally, there was little or no readjustment of the workforce in the small ruminant flocks.

Effect of Alliaceae Extract Supplementation on Performance and Intestinal Microbiota of Growing-Finishing Pig.

The aim of the present study was to ascertain whether an Allium spp. extract rich in organosulfur compounds, such as propyl thiosulfonate (PTSO), added to the feed of growing-finishing pigs at 5 g/kg enhances growth performance or affects the fecal microbiome, the levels of short-chain fatty acids, or the antioxidant capacity of the animals. Fifty male growing pigs (large white) of 23.07 ± 2.87 kg average body weight were randomly allotted to two treatments in a 103-day trial. The trial was divided into two periods, an initial growing phase (56-days) and a finishing phase (47-days). Two dietary treatments for each phase (growing and finishing) were used: a control diet (CON) and an experimental diet consisting of the control diet to which 5 g/kg of Allium spp. extract was added to substitute sepiolite (GAR). Throughout the study, body weight, average daily gain (kg/day, ADG), feed intake (kg/day), and feed conversion ratio (kg/kg) were measured, while the backfat thickness and muscle depth were determined at the end of the study. Besides, feces samples were taken for bacterial counts by means of real-time PCR and short-chain fatty acid (SCFA) profile determination, and the antioxidant capacity was assessed in serum and saliva. In the animals receiving Allium spp. extract (5 g/kg) in the feed, ADG increased (p < 0.05) throughout the trial, Salmonella spp. and Clostridium spp. counts in feces had decreased (p < 0.05) when measured on day 56, and, by day 103, Salmonella spp., Clostridium spp., and Enterobacteriaceae counts had decreased (p < 0.05) and Lactobacillus spp. counts had increased (p < 0.01) in feces. Regarding the SCFA profile in feces and antioxidant capacity measured in serum and saliva, supplementation with Allium spp. extract significantly increased the levels of propionic, isobutyric, and isovaleric acids and the percentage of total branched fatty acids, while the c2/c3 and (c2 + c4)/c3 ratios were lower (p < 0.05) in feces; the Trolox equivalent antioxidant capacity and the cupric reducing antioxidant capacity levels in serum were significantly higher in the same pigs on day 103 than on day 0. Consequently, based on the current results, Allium spp. extract rich in organosulfur compounds, added to the diet at 5 g/kg, had a beneficial effect on the microbiota and would seem to be a possible alternative for increasing the growth performance of growing-finishing pigs. However, further studies on the effects of Allium spp. supplementation on carcass quality are necessary.

Short-Term Economic Impact of COVID-19 on Spanish Small Ruminant Flocks.

The human pandemic COVID-19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) started in China in 2019 and has rapidly spread around the world, leading to extreme control measures such as population confinement and industry activity closure. Although small ruminants are not sanitary affected by this virus, the short-term economic impact derived by COVID-19 on Spanish flocks is estimated in this study, using data provided by producers and two major slaughterhouses. Milk prices of dairy goat flocks suffered a substantial drop in April 2020, close to 4.5 cts EUR/liter compared to the previous month. In contrast, the monthly milk prices in sheep remained almost stable during this period, and even increases of more than EUR 6 cts were reported in comparison with the previous year. Nevertheless, economical differences are reported by areas where producers could receive a higher income, close to EUR 0.3 per liter of milk. Global data provided by feedlots affecting 2750 Spanish flocks evidenced a lamb price drop ranging from 16.8% to 26.9% after the pandemic arrival; in line with the data directly reported by a limited sample of producers (ranging from 11.0% to 23.7%). The goat kid meat market also suffered a reduction in prices per kg, near 12.5%; although, for some flocks, losses reached up to 40%. In the same line, 2 slaughterhouses reported a sudden sacrifice drop around 27% for lambs and goat kids sacrifices in April, in contrast with the usual sacrifice figures from the beginning of 2020. Moreover, our study showed a temporary and unexpected retention of lambs and goat kids at farms due to a reduction in animals slaughtered during this period. In conclusion, data evidenced a considerable negative economic impact on Spanish small ruminant flocks, throughout the first 60 days after COVID-19's pandemic declaration. Further studies are needed to evaluate the long-term economic consequences, in order to establish contingency plans and avoid the collapse of small ruminant industries when a crisis of these characteristics occurs.

Inflammatory Biomarkers, Microbiome, Depression, and Executive Dysfunction in Alcohol Users.

Alcohol-related disorders (ARD) are highly prevalent among Latin American-Caribbean countries. Mental disorders are common comorbidities in individuals with ARD. However, the etiology of the association between ARD and mental disorders remains unclear. We examined the association of inflammatory cytokines, microbiome, and other biomakers with measures of depression, social anxiety, and executive functions. We observed a significant increase in cytokine and chemokine expression levels in saliva and plasma in the alcohol group (AG) samples. Also, the salivary bacterial composition in the AG revealed an abundance of Prevotella. Depression symptomatology was markedly higher in the AG, but social anxiety levels were negligible. AG also exhibited executive dysfunctions, which negatively correlated with increased plasma levels of pro-inflammatory cytokines and increased salivary concentrations of Prevotella bacteria. Our study suggests that chronic alcohol use correlates with executive dysfunction, immune system dysregulation, and dysbiosis of the salivary microbiota. Additional studies are needed to understand the role of the microbiome and inflammation in alcohol use and mental comorbidities.

Comorbidities in a sample of adults with HIV in Puerto Rico: an exploratory study.

BACKGROUND: Puerto Rico is among the areas with the highest estimated rates of people living with HIV in the United States. Despite the epidemiologic data available, there is limited real-world information that can help understand the comorbidities of people with HIV. In this study, we describe common comorbidities among adults with HIV attending treatment clinics in Puerto Rico. METHODS: An exploratory, retrospective, cross-sectional study was conducted at five HIV clinics in Puerto Rico. A random sample of medical records was reviewed. Descriptive statistics were used to summarize patient demographics, morbidity, and clinical characteristics. Multivariate analyses were conducted to explore comorbidities by age and sex. RESULTS: A total of 250 (179 men; 71 women) medical records were reviewed. Participants' mean age was 47.9 years and on average they had been living with HIV for 9 years. Most (97.6%) had at least one comorbidity. The most common comorbidities were dyslipidemia and hypertension. Men were more likely to have been diagnosed with alcohol misuse while women were more likely to have been diagnosed with obesity, human papillomavirus (HPV), hypothyroidism, and osteoporosis. Participants younger than 50 years of age were more likely to have history of alcohol misuse while older individuals (50 years and old) were more likely to have been diagnosed with dyslipidemia, hypertension, and diabetes. Adjusting by sex and age, women were more likely to have been diagnosed with obesity and depression and those older than 50 years were more likely to have had a diagnosis of dyslipidemia, hypertension, HPV, and diabetes. CONCLUSIONS: This is one of the few studies assessing comorbidities among adults with HIV in Puerto Rico, among Latino/Hispanics within the United States, and Latin America. Consistent with other studies, cardiovascular diseases are common among adults with HIV in Puerto Rico. Findings support the need for awareness and real-world evidence about comorbidities among people with HIV when implementing screenings and prescribing drugs.

Effect of Feeding Glycerin on Ruminal Environment and In Situ Degradability of Feedstuffs in Young Bulls.

This work studied the effect of feeding glycerin in bulls that were fed high levels of concentrate on the ruminal environment and in situ degradability of feedstuffs. Four ruminally cannulated young bulls were assigned to a 4 × 4 Latin square arrangement of treatments. The diets consisted of 15% barley straw and 85% concentrate in dry matter (DM). There were four different concentrates: without glycerin, and with 20, 40 or 80 g of glycerin per kg of DM. Each diet was offered for 24 days, the ruminal fluid was sampled to evaluate the ruminal metabolism and to determine the ruminal bacterial population by quantitative real-time polymerase chain reaction analysis, and the in situ degradability of six different feedstuffs was measured. The treatment with the highest level of glycerin provided the lower pH (p < 0.001), and the acetic/propionic molar ratio decreased (p < 0.001) as glycerin increased. The incorporation of glycerin in the diet did not affect the DNA copies/µL of the total bacteria, Butyrivibrio fibrisolvens and Butyrivibrio proteoclasticus (p > 0.05) in the DNA extract of rumen fluid, but at high levels increased Selenomonas ruminantium (p < 0.01). Very few effects of glycerin incorporation were found for the in situ degradability. In young bulls that were fed high levels of concentrate, glycerin at 20 or 40 g/kg of feed could be included without affecting the ruminal pH and raising the propionic acid, but at 80 g/kg the ruminal pH dropped, despite the increase of Selenomonas ruminantium.

Vitamin D levels and fracture risk among Hispanic children.

PURPOSE: There is a lack of knowledge about whether low vitamin D levels increase the risk of pediatric low-energy fractures among Hispanic population. The objective of this study is to determine whether there is a direct relationship between low vitamin D levels and the incidence of low-energy fractures in Hispanic children. METHOD: Cases included all consecutive patients evaluated with low-energy fractures in the pediatric orthopedic clinic. The control group consisted of all pediatric patients evaluated, without fractures, who had bone and joint pain complaints in the general pediatric clinic. The main focus was to compare cases and controls in relation to their vitamin D levels. Cases and controls were compared using t tests for means of quantitative variables and Chi-square tests. RESULTS: A total of 201 subjects, distributed as cases (n = 107) and controls (n = 94), were included in this study. One hundred twelve (55.7%) of the total study population were males. The mean age for the study population was 8.6 years old ranging from 1 year to 18 years, and standard deviation = 4.0 years. The median age for the study population was 9 years. The mean vitamin D level for the cases was 32.6 ng/dl (SD = 10.9); the mean vitamin D level for controls was 32.3 ng/dl (SD = 13.4). This difference was not statistically significant (t = 0.18, 95% CI - 3.2 to 3.9; p = 0.854). CONCLUSION: A direct relationship between low vitamin D levels and fracture risk in a Hispanic pediatric population was not established. LEVELS OF EVIDENCE: III.

Causes, consequences and biomarkers of stress in swine: an update.

BACKGROUND: In recent decades there has been a growing concern about animal stress on intensive pig farms due to the undesirable consequences that stress produces in the normal physiology of pigs and its effects on their welfare and general productive performance. This review analyses the most important types of stress (social, environmental, metabolic, immunological and due to human handling), and their biological consequences for pigs. The physio-pathological changes associated with stress are described, as well as the negative effects of stress on pig production. In addition an update of the different biomarkers used for the evaluation of stress is provided. These biomarkers can be classified into four groups according to the physiological system or axis evaluated: sympathetic nervous system, hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-gonadal axis and immune system. CONCLUSIONS: Stress it is a process with multifactorial causes and produces an organic response that generates negative effects on animal health and production. Ideally, a panel of various biomarkers should be used to assess and evaluate the stress resulting from diverse causes and the different physiological systems involved in the stress response. We hope that this review will increase the understanding of the stress process, contribute to a better control and reduction of potential stressful stimuli in pigs and, finally, encourage future studies and developments to better monitor, detect and manage stress on pig farms.