Chagas Disease among the Latin American Adult population attending in a primary care center in Barcelona, Spain

Background/Aims: The epidemiology of Chagas disease, until recently confined to areas of continental Latin America, has undergone considerable changes in recent decades due to migration to other parts of the world, including Spain. We studied the prevalence of Chagas disease in Latin American patients treated at a health center in Barcelona and evaluated its clinical phase. We make some recommendations for screening for the disease. Methodology/Principal Findings: We performed an observational, cross-sectional prevalence study by means of an immunochromatographic test screening of all continental Latin American patients over the age of 14 years visiting the health centre from October 2007 to October 2009. The diagnosis was confirmed by serological methods: conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA). Of 766 patients studied, 22 were diagnosed with T. cruzi infection, showing a prevalence of 2.87% (95% CI, 1.6-4.12%). Of the infected patients, 45.45% men and 54.55% women, 21 were from Bolivia, showing a prevalence in the Bolivian subgroup (n = 127) of 16.53% (95% CI, 9.6-23.39%). All the infected patients were in a chronic phase of Chagas disease: 81% with the indeterminate form, 9.5% with the cardiac form and 9.5% with the cardiodigestive form. All patients infected with T. cruzi had heard of Chagas disease in their country of origin, 82% knew someone affected, and 77% had a significant history of living in adobe houses in rural areas. Conclusions: We found a high prevalence of T. cruzi infection in immigrants from Bolivia. Detection of T. cruzi¿infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems

Does Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome

Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI (β 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values < 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight/obesity and MetS

Validesa de l'automesura de la pressió arterial domiciliària en el diagnòstic de la hipertensió clínica aïllada a l'Atenció Primària

[cat] OBJECTIU: Determinar el rendiment diagnòstic de l'automesura de la pressió arterial domiciliària (AMPAd) en el diagnòstic de la hipertensió clínica aïllada (HCA) utilitzant un programa de tres dies de lectures.MATERIAL I MÈTODES: Es va incloure a cent noranta pacients diagnosticats recentment d'hipertensió lleugera-moderada no tractats, seleccionats consecutivament a 4 centres d'atenció primària de la ciutat de Barcelona. Cada pacient va realitzar lectures de AMPAd per triplicat pel matí i per la nit durant 3 dies consecutius, seguidament se'ls practicà una monitorització ambulatòria de la pressió arterial (MAPA) de 24 hores. El punt de tall de normalitat per a l'AMPAd i la MAPA diurna era de 135/85 mmHg.RESULTATS: Seixanta-tres pacients van ser diagnosticats d'HCA amb AMPAd (34.8 %; IC95%: 27.9-42.2) i 74 amb MAPA (41.6%; IC95%: 33.7-48.4). No es varen observar diferències estadísticament significatives entre els valors d'AMPAd i els de la MAPA diurna (137.4 [14.3]/82.1[8.3] mmHg vs 134.8 [11.3]/81.3[9.5] mmHg). Els paràmetres de rendiment diagnòstic de l'AMPAd van ser: S 50.0% (IC95%: 38.3-61.7), E 75.7% (IC95%: 66.3-83.2), VPP i VPN 58.7%(IC95%: 45.6-70.8) i 68.6% (IC95%: 59.4-76.7), respectivament, i CPP i CPN 2.05 i 0.66 respectivament.L'anàlisi mitjançant una corba ROC (receiver operating characteristic) dels diferents punts de tall de normalitat no va suposar l'obtenció de millores significatives en el rendiment diagnòstic de l'AMPAd.CONCLUSIONS: Un programa de 3 dies de lectures d'AMPAd en el diagnòstic de l'HCA ha obtingut una escasa precisió diagnòstica. La MAPA continúa sent la prova d'elecció en aquesta indicació.[eng] OBJECTIVE: To determine the diagnostic performance of home blood pressure self-monitoring (hBPSM) in white-coat hypertension (WCH) using a 3-day reading program.MATERIAL and METHODS: One hundred and ninety non-treated patients recently diagnosed of mild-moderate hypertension, selected consecutively at 4 primary health-care centers in the city of Barcelona, were included. Each patient underwent morning and night hBPSM with readings in triplicate for 3 consecutive days, followed by 24-hour ambulatory blood pressure monitoring (ABPM). The normality cut-off point value for hBPSM and daytime ABPM was 135/85 mmHg.RESULTS: Sixty-three patients were diagnosed of WCH with hBPSM (34.8 %; CI95%: 27.9-42.2) and 74 with ABPM (41.6%; CI95%: 33.7-48.4). No statistically-significant differences were observed between hBPSM values and those of diurnal ABPM (137.4 [14.3]/82.1[8.3] mmHg vs 134.8 [11.3]/81.3[9.5] mmHg). hBPSM diagnostic performance parameters were: sensitivity 50.0% (CI95%: 38.3-61.7), specificity 75.7% (CI95%: 66.3-83.2), positive and negative predictive values 58.7%(CI95%: 45.6-70.8) and 68.6% (CI95%: 59.4-76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66 respectively. Analysis of different normality cut-off points using a ROC curve (receiver operating characteristic) failed to produce significant improvement in the diagnostic performance of hBPSM.CONCLUSIONS: The diagnostic accuracy of a 3-day hBPSM reading program in WCH was poor. ABPM continues to be the test of choice for this indication

Chagas Disease among the Latin American Adult population attending in a primary care center in Barcelona, Spain

Background/Aims: The epidemiology of Chagas disease, until recently confined to areas of continental Latin America, has undergone considerable changes in recent decades due to migration to other parts of the world, including Spain. We studied the prevalence of Chagas disease in Latin American patients treated at a health center in Barcelona and evaluated its clinical phase. We make some recommendations for screening for the disease. Methodology/Principal Findings: We performed an observational, cross-sectional prevalence study by means of an immunochromatographic test screening of all continental Latin American patients over the age of 14 years visiting the health centre from October 2007 to October 2009. The diagnosis was confirmed by serological methods: conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA). Of 766 patients studied, 22 were diagnosed with T. cruzi infection, showing a prevalence of 2.87% (95% CI, 1.6-4.12%). Of the infected patients, 45.45% men and 54.55% women, 21 were from Bolivia, showing a prevalence in the Bolivian subgroup (n = 127) of 16.53% (95% CI, 9.6-23.39%). All the infected patients were in a chronic phase of Chagas disease: 81% with the indeterminate form, 9.5% with the cardiac form and 9.5% with the cardiodigestive form. All patients infected with T. cruzi had heard of Chagas disease in their country of origin, 82% knew someone affected, and 77% had a significant history of living in adobe houses in rural areas. Conclusions: We found a high prevalence of T. cruzi infection in immigrants from Bolivia. Detection of T. cruzi¿infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems