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

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

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

"HIV therapy adherence and outcomes in Peruvian military personnel over a 30-year period"

"Objectives: We aimed to describe the sociodemographic, clinical, and therapeutic characteristics of Peruvian military personnel diagnosed with HIV. Furthermore, we determined the frequency of highly active antiretroviral therapy (HAART) adherence, the complications and mortality. Methods: We retrospectively reviewed the medical records of patients diagnosed with HIV, confirmed by Western blot at a single institution from 1989-2020. Descriptive analyses were performed for all the variables using mean and standard deviation (SD) in the case of quantitative variables, and frequency and percentage for qualitative variables. Results:Ofthe 161 patients included, 95.7% were males and the mean age was 39.59 years (SD= 16.45 years). Most had college or higher education (67.7%) and were on active duty at diagnosis (77%). 35.4% had AIDS at diagnosis; 28.6% opportunistic infections; and 8.1% tuberculosis. The median follow-up was five years. 94.4% of the patients received HAART as the principal treatment; of these, 88.8% was adherent to treatment, and death was reported in 6.8%. There were no factors associated with adherence. Conclusions: Although the sociodemographic characteristics of Peruvian military personnel are similar to those of other countries, our findings suggest that Peruvian military personnel present higher adherence to HAART compared to previous studies in other military populations from South American countries. Further studies are recommended to assess specific factors attributed to these successful outcomes in the military personnelthat can be applied in other hospitals.

"HIV therapy adherence and outcomes in Peruvian military personnel over a 30-year period"

"Objectives: We aimed to describe the sociodemographic, clinical, and therapeutic characteristics of Peruvian military personnel diagnosed with HIV. Furthermore, we determined the frequency of highly active antiretroviral therapy (HAART) adherence, the complications and mortality. Methods: We retrospectively reviewed the medical records of patients diagnosed with HIV, confirmed by Western blot at a single institution from 1989-2020. Descriptive analyses were performed for all the variables using mean and standard deviation (SD) in the case of quantitative variables, and frequency and percentage for qualitative variables. Results:Ofthe 161 patients included, 95.7% were males and the mean age was 39.59 years (SD= 16.45 years). Most had college or higher education (67.7%) and were on active duty at diagnosis (77%). 35.4% had AIDS at diagnosis; 28.6% opportunistic infections; and 8.1% tuberculosis. The median follow-up was five years. 94.4% of the patients received HAART as the principal treatment; of these, 88.8% was adherent to treatment, and death was reported in 6.8%. There were no factors associated with adherence. Conclusions: Although the sociodemographic characteristics of Peruvian military personnel are similar to those of other countries, our findings suggest that Peruvian military personnel present higher adherence to HAART compared to previous studies in other military populations from South American countries. Further studies are recommended to assess specific factors attributed to these successful outcomes in the military personnelthat can be applied in other hospitals

Prevalencia de ansiedad y depresión utilizando la escala de ansiedad y depresión (HADS) en pacientes con Síndrome de Intestino Irritable

Introducción: en ausencia de una anormalidad estructural. Es una de las enfermedades que se ha asociado frecuentemente con enfermedades psiquiátricas como ansiedad y depresión. El objetivo del estudio fue determinar la prevalencia de depresión y ansiedad en pacientes con SII empleando la encuesta Hospital Anxiety and Depression Scale (HADS) en pacientes que acuden a consultorio de gastroenterología en la Clínica Internacional Sede Lima (CILM). Materiales y Métodos: Estudio descriptivo no comparativo en el cual se utilizaron encuestas autoaplicadas en consultorio externo de la CILM. Se utilizó Microsoft Excel para tabular y STATA versión 17 para calcular las frecuencias absolutas y relativas. Resultados: Se incluyó a 67 pacientes: sexo: femenino (77.61%), rango de edad: 36-45 años (56.72%) y variedad de sintomas en SII: estreñimiento (55.22%). La prevalencia de ansiedad fue de 71.64% mientras que la de depresión fue de 26.87%. Conclusiones: Los p cientes con SII tuvieron mayor prevalencia de síntomas compatibles con ansiedad en comparación con depresión.Introduction: Irritable bowel syndrome (IBS) is characterized by the presence of intestinal disturbances in the absence of structural abnormalities. IBS is one of the diseases that has been frequently associated with psychiatric diseases such as anxiety and depression. The aim of this study was to determine the prevalence of depression and anxiety in patients with IBS using the Hospital Anxiety and Depression Scale (HADS) survey in patients attending the gastroenterology clinic of the International Clinic of Lima (CILM). Materials and Methods: Descriptive non- comparative study where self-administered surveys were used in the outpatient clinic of the CILM. Microsoft Excel was used for tabulation and STATA version 17 for calculation of absolute and relative frequencies. Results: Sixty-seven patients were included. Sex: female (77.61%), age range 36-45 (56.72%) and variety of IBS symptoms: constipation (55.22%). The prevalence of anxiety was 71.64% while that of depression was 26.87%. Conclusions: Patients with IBS presented a higher prevalence of symptoms compatible with anxiety compared to depression

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

Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients

Background: There have been conflicting studies reporting on survival advantages between breast-conserving surgery with radiotherapy (BCS) in comparison with mastectomy. Our aim was to compare the efficacy of BCS and mastectomy in terms of overall survival (OS) comparing all past published studies. Methods: We performed a comprehensive review of literature through October 2021 in PubMed, Scopus, and EMBASE. The studies included were randomized controlled trials (RCTs) and cohorts that compare BCS versus mastectomy. We excluded studies that included male sex, stage 0, distant metastasis at diagnosis, bilateral synchronous cancer, neoadjuvant radiation/chemotherapy, and articles with incomplete data. We performed a meta-analysis following the random-effect model with the inverse variance method. Results: From 18,997 publications, a total of 30 studies were included in the final analysis: 6 studies were randomized trials, and 24 were retrospective cohorts. A total of 1,802,128 patients with a follow-up ranging from 4 to 20 years were included, and 1,075,563 and 744,565 underwent BCS and mastectomy, respectively. Among the population, BCS is associated with improved OS compared with mastectomy [relative risk (RR) 0.64, 95% confidence interval (CI) 0.55–0.74]. This effect was similar when analysis was performed in cohorts and multi-institutional databases (RR 0.57, 95% CI 0.49–0.67). Furthermore, the benefit of BCS was stronger in patients who had less than 10 years of follow-up (RR 0.54, 95% CI 0.46–0.64). Conclusions: Patients who underwent BCS had better OS compared with mastectomy. Such results depicting survival advantage, especially using such a large sample of patients, may need to be included in the shared surgical decision making when discussing breast cancer treatment with patients.Revisión por pare

ASO Visual Abstract: Does Breast-Conserving Surgery with Radiotherapy Have a Better Survival Than Mastectomy? A Meta-Analysis of More Than 1,500,000 Patients

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