Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy

Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.Revisión por pare

Acute pulmonary histoplasmosis related to occupational roofing: A case report of two brothers

Background and Purpose: Histoplasma capsulatum is the cause of a prevalent fungal disease in certain regions in the United States of America, like Ohio and the Mississippi River. Its clinical manifestations range from asymptomatic to life-threatening diseases,according to the immune system. A definitive diagnosis is made by biopsy.Case report: Two middle-aged brothers presented with a nine-day history of severe progressive dyspnea. Both were living in Cincinnati, Ohio, and encountered bird droppings 7 days prior to symptoms while working on a roofing project. It should be mentioned that they were not wearing masks. After extensive testing, they were diagnosed with acute pulmonary histoplasmosis. Both were successfully treated with azole-derivative fungal therapy.Conclusion: This is the first case of histoplasmosis acquired through occupational exposure related to roofing and is unique given the two patients were sibling

Prevalence of small intestinal bacterial overgrowth in patients with gastroparesis: a systematic review and meta-analysis

Aim: We performed a systematic review and meta-analysis to identify the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with gastroparesis. Background: Several studies have suggested an association between SIBO and gastroparesis, which is characterized by delayed gastric emptying in the absence of mechanical obstruction. Methods: A comprehensive search was performed using MEDLINE, EMBASE, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) through January, 2022 for randomized controlled trials and observational studies reporting the prevalence of SIBO in gastroparesis. Pooled prevalence was estimated using a random effects model. Heterogeneity was assessed by using the inconsistency index (I2). Results: Among the 976 articles identified, 43 studies were selected for full text review. Six studies, with 385 patients, were deemed eligible for inclusion, with a perfect agreement between investigators (kappa=1.0). Overall, 379 patients were diagnosed with gastroparesis by gastric emptying scintigraphy and six were diagnosed with a wireless motility capsule. The pooled prevalence of SIBO was 41% (95% confidence interval 0.23-0.58). SIBO was diagnosed using jejunal aspirate cultures (N=15, 8.4%), lactulose breath test (N=80, 44.7%), glucose breath test (N=30, 16.8%), D-xylose breath test (N=52, 29.1%), and hydrogen breath test (N=2, 1.1%). Heterogeneity was significant and noted to be high at 91%. Only one study reported SIBO diagnosis in controls, therefore no pooled odds ratio was calculated. Conclusion: SIBO was present in almost half of the patients with gastroparesis. Future studies should examine and identify the association between SIBO and gastroparesis.Revisión por pare

High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg (p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension (p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan–Meier analysis regarding the survival (log-rank p-value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.Revisión por pare

Factors associated with nutritional deficiencies in adults undergoing bariatric surgery: a cross-sectional study in a Peruvian high-resolution clinic

Introducción: Estudios previos han descrito múltiples deficiencias nutricionales tras la cirugía bariátrica (CB). Sin embargo, pocos estudios han evaluado estas deficiencias antes de la CB, específicamente en América Latina. Este estudio tuvo como objetivo determinar los factores asociados a los biomarcadores de deficiencia nutricional en adultos sometidos a CB en Perú. Métodos: Se incluyeron adultos de ambos sexos de 18 a 59 años, ingresados ​​en una clínica peruana con índice de masa corporal (IMC) ≥30 kg /m2, candidatos a CB de 2017 a 2020. Se consideraron los niveles séricos de hemoglobina y albúmina (en terciles) como los biomarcadores de deficiencia nutricional. Realizamos modelos lineales generalizados de la familia de Poisson con función log-link y varianzas robustas. Resultados: Analizamos 255 paciente, el 63,1% eran varones, con una edad media de 37,1 ± 10,3 años y valores medios de hemoglobina y albúmina de 14,0 ± 1,5 g / dL y 4,6 ± 0,4 g / dL, respectivamente. Encontramos que los hombres, los participantes entre 30 y 49 o 50 años o más, con un IMC ≥40 kg / m2, niveles alterados de HDL y los individuos en el tercil alto de PCR tenían una mayor probabilidad de estar en el tercil inferior de la albúmina. Además, encontramos que el sexo masculino y los niveles elevados de colesterol se asociaron con la terciles de hemoglobina más bajos. Discusión: En nuestro medio, los biomarcadores de deficiencia nutricional se asociaron con marcadores sociodemográficos, antropométricos y de laboratorio.Background: Previous studies have shown multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated the micronutrient deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with micronutrient deficiencies in adults undergoing bariatric surgery in Peru. Methods: We included adults of both sexes aged 18 to 59 years, with a body mass index (BMI)≥30 kg/m2, and candidates for bariatric surgery from 2017 to 2020 admitted to a Peruvian clinic. We considered the serum levels of hemoglobin and albumin (in tertiles) as the micronutrient deficit markers. We performed generalized linear models of the Poisson family with log-link function and robust variances to estimate the factors associated with micronutrient deficiencies. Results: We analyzed 255 patients, 63.1% were males, with a mean age of 37.1 ± 10.3 years and a mean of hemoglobin and albumin of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males, participants between 30 and 49 years, 50 or more, with a BMI ≥40 kg/m2, impaired HDL levels and being in the high tertile of CRP had a higher probability of being in the lower tertile of albumin. In addition, we found that male sex and elevated cholesterol were associated with the lowest tertile of hemoglobin. Conclusion: In our setting, micronutrient deficiencies were associated with sociodemographic, anthropometric and laboratory markers. Pre-bariatric correction of micronutrient deficiencies is essential and could prevent major complications after surgery.Tesi

Association between nonalcoholic steatohepatitis (NASH) and pulmonary function in adult candidates for bariatric surgery during the years 2016-2020 in a clinic in Lima, Peru

Introducción: La presencia de NAFLD es una de las morbilidades que ha ganado peso a nivel mundial con una prevalencia de 25% de la población total. Dentro de la evolución de esta comorbilidad los pacientes pueden desarrollar NASH y cirrosis hepática. La presencia de NAFLD y NASH se ha asociado al hallazgo de parámetros de la función pulmonar alterados. El objetivo de este estudio es evaluar la asociación entre NAFLD y NASH y los parámetros de la función pulmonar. Métodos: Estudio observacional, transversal analítico con uso de base de datos secundaria de una clínica privada Lima, Perú. Se calcularon los coeficientes β crudos (βc) y ajustados (βa) con sus respectivos intervalos de confianza al 95% (IC95%), a través de modelos de regresión lineal bivariables y multivariables, respectivamente. Resultados: Se evidenció que los pacientes con obesidad mórbida y que tenían NASH (β=0.58; IC95%: 0.02-1.14; p=0,042), tuvieron 0.58 L más de FEV1 en comparación con la población que no tenía NASH. Conclusión: En los pacientes con obesidad mórbida candidatos a cirugía bariátrica en el Perú se halló una asociación significativa entre la presencia de NASH y los valores de FEV1. Sin embargo, este hallazgo carece de implicancia clínicamente relevante.Introduction: The presence of NAFLD is one of the morbidities that has gained weight worldwide with a prevalence of 25% of the total population. Within the evolution of this comorbidity, patients may develop NASH and liver cirrhosis. The presence of NAFLD and NASH has been associated with the finding of altered pulmonary function parameters. The aim of this study is to evaluate the association between NAFLD and NASH and lung function parameters. Methods: Observational, analytical cross-sectional study using secondary database from a private clinic Lima, Peru. Crude (βc) and adjusted (βa) β-coefficients with their respective 95% confidence intervals (95%CI) were calculated through bivariate and multivariable linear regression models, respectively. Results: It was evidenced that patients with morbid obesity and who had NASH (β=0.58; 95%CI: 0.02-1.14; p=0.042), had 0.58 L more FEV1 compared to the population without NASH. Conclusion: In morbidly obese patients candidates for bariatric surgery in Peru, a significant association was found between the presence of NASH and FEV1 values. However, this finding lacks clinically relevant implication.Tesi

Factors Associated with Nutritional Deficiency Biomarkers in Candidates for Bariatric Surgery: A Cross-Sectional Study in a Peruvian High-Resolution Clinic

Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26–2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24–3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35–4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09–2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01–2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52–0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery

Prevalence of depression among patients with chronic pancreatitis: A systematic review and meta-analysis

Introduction: Chronic Pancreatitis (CP) is a fibroinflammatory condition with debilitating symptoms. Quality of life is severely affected in patients with CP and they are likely to suffer from mental health disorders, including depression. We conducted a systematic review and meta-analysis assessing the prevalence of depressive symptoms and depression in patients with CP. Methods: MEDLINE (OVID), PsycINFO, Cochrane Library, Embase, CINAHL Complete, Scopus and Web of Science were searched until July 2022 to identify manuscripts reporting the prevalence of depressive symptoms and depression (diagnosed clinically or with a validated scale without language restriction) in patients with Chronic Pancreatitis. The pooled prevalence was calculated using a random effects model. Heterogeneity was assessed by the inconsistency index (I2). Results: Among 3647 articles identified, 58 studies were identified for full text review, and ultimately nine studies were included. A total of 87,136 patients were included in the studies. Depression was diagnosed clinically or symptoms were identified using validated scales including Center for Epidemiological Studies 10-item Depression Scale (CESD), Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). The overall prevalence of depression in patients with chronic pancreatitis was 36.2% (95%CI: 18.8–55.7). In the stratified analysis, depression prevalence according to the clinical diagnosis, BDI and HADS was 30.10%, 48.17% and 36.61%, respectively. Conclusion: The high prevalence of depression among patients with CP deserves a call-to-action due to its medical implications and worsening quality of life. Our findings raise awareness of the importance of screening patients with CP for mental health disorders. Further well-designed studies are needed to further characterize these findings.Revisión por pare

How Good Is Online Information for Patients on the Treatment for Luminal Gastrointestinal Cancers? A Comprehensive Evaluation in English and Spanish

The internet has become a necessary communication platform for health information. The quality of online material for patients varies significantly, and this is not different for material on gastrointestinal cancers. We aimed to assess English and Spanish online patient information addressing esophageal, gastric, and colorectal cancer treatment. Six independent Google searches were conducted using the terms: esophageal cancer treatment, gastric cancer treatment, colorectal cancer treatment, and their translations in Spanish. Websites were included in the top 50 results for each search. Readability was assessed using two validated tests for each language. Understandability/actionability, quality, and cultural sensitivity were assessed using Patient Education Materials Assessment Tool (PEMAT), DISCERN, and Cultural Sensitivity Assessment Tool (CSAT), respectively. Pearson’s chi-squared was used for categorical variables and Wilcoxon rank-sum (2 groups) or Kruskal–Wallis (> 2 groups) for continuous. One hundred twelve websites were analyzed. Readability levels were high in both languages (between 11th grade and university level) and significantly higher in English. Mean quality scores for English and Spanish were consistent with good quality. CSAT scores met the cultural acceptability with lower CSAT scores for gastric cancer treatment in English. Higher actionability scores were found in English for colorectal cancer. Also, there was a clear trend for higher cultural sensitivity and quality of Spanish material for gastric cancer treatment. Online patient information on esophageal, gastric, and colorectal cancer treatment, in English and Spanish, were at a readability level above the average literacy level and even significantly higher in English. Initiatives to improve online information on gastrointestinal cancer treatments are warranted.Revisión por pare

Prevalence of celiac disease in systemic lupus erythematosus, sjogren syndrome and systemic sclerosis: A systematic review and meta-analysis

Background: Celiac disease (CeD) is an immune-mediated disorder affecting the small bowel, associated with genetic factors and increasing global prevalence. Aim: This study explores the association between CeD, Systemic Lupus Erythematosus (SLE), primary Sjogren syndrome (pSS), and Systemic Sclerosis (SSc). Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches across multiple databases yielded 2728 articles, with 15 studies selected. Data extraction included study characteristics, prevalence of CeD and CeD antibodies in SLE, pSS, and SSc. Quality assessment utilized the Newcastle-Ottawa Scale. Results: The meta-analysis revealed a pooled prevalence of biopsy-proven CeD in SLE, pSS, and SSc of approximately 3%. Seroprevalence of any CeD antibody in SLE, pSS, and SSc ranged from 3% to 10%. Notably, pSS exhibited the highest prevalence at 5.59%. High heterogeneity was observed in seroprevalence across autoimmune conditions. Quality assessment indicated robust methodological quality in the selected studies. Conclusion: This study highlights a significantly higher prevalence of CeD, especially pSS, compared to the general population. The findings underscore the importance of recognizing elevated CeD antibodies in patients with SLE, pSS and SSc emphasizing the need for early detection and comprehensive care for gastrointestinal symptoms in these conditions.Revisión por pare