Incretin treatment and risk of pancreatitis in patients with type 2 diabetes mellitus : systematic review and meta-analysis of randomised and non-randomised studies

Objective To investigate the risk of pancreatitis associated with the use of incretin-based treatments in patients with type 2 diabetes mellitus. Design Systematic review and meta-analysis. Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. Eligibility criteria Randomised and non-randomised controlled clinical trials, prospective or retrospective cohort studies, and case-control studies of treatment with glucagon-like peptide-1 (GLP-1) receptor agonists or dipeptidyl peptidase-4 (DPP-4) inhibitors in adults with type 2 diabetes mellitus compared with placebo, lifestyle modification, or active anti-diabetic drugs. Data collection and analysis Pairs of trained reviewers independently screened for eligible studies, assessed risk of bias, and extracted data. A modified Cochrane tool for randomised controlled trials and a modified version of the Newcastle-Ottawa scale for observational studies were used to assess bias. We pooled data from randomised controlled trials using Peto odds ratios, and conducted four prespecified subgroup analyses and a post hoc subgroup analysis. Because of variation in outcome measures and forms of data, we describe the results of observational studies without a pooled analysis. Results 60 studies (n=353 639), consisting of 55 randomised controlled trials (n=33 350) and five observational studies (three retrospective cohort studies, and two case-control studies; n=320 289) were included. Pooled estimates of 55 randomised controlled trials (at low or moderate risk of bias involving 37 pancreatitis events, raw event rate 0.11%) did not suggest an increased risk of pancreatitis with incretins versus control (odds ratio 1.11, 95% confidence interval 0.57 to 2.17). Estimates by type of incretin suggested similar results (1.05 (0.37 to 2.94) for GLP-1 agonists v control; 1.06 (0.46 to 2.45) for DPP-4 inhibitors v control). Analyses according to the type of control, mode, duration of treatment, and individual incretin agents suggested no differential effect by subgroups, and sensitivity analyses by alternative statistical modelling and effect measures did not show important differences in effect estimates. Three retrospective cohort studies (moderate to high risk of bias, involving 1466 pancreatitis events, raw event rate 0.47%) also did not suggest an increased risk of pancreatitis associated with either exenatide (adjusted odds ratios 0.93 (0.63 to 1.36) in one study and 0.9 (0.6 to 1.5) in another) or sitagliptin (adjusted hazard ratio 1.0, 0.7 to 1.3); a case-control study at moderate risk of bias (1003 cases, 4012 controls) also suggested no significant association (adjusted odds ratio 0.98, 0.69 to 1.38). Another case-control study (1269 cases, 1269 controls) at moderate risk of bias, however, suggested that the use of either exenatide or sitagliptin was associated with significantly increased odds of acute pancreatitis (use within two years v no use, adjusted odds ratio 2.07, 1.36 to 3.13). Conclusions The available evidence suggests that the incidence of pancreatitis among patients using incretins is low and that the drugs do not increase the risk of pancreatitis. Current evidence, however, is not definitive, and more carefully designed and conducted observational studies are warranted to definitively establish the extent, if any, of increased risk

Bed net use and associated factors in a rice farming community in Central Kenya

<p>Abstract</p> <p>Background</p> <p>Use of insecticide-treated nets (ITNs) continues to offer potential strategy for malaria prevention in endemic areas. However their effectiveness, sustainability and massive scale up remain a factor of socio-economic and cultural variables of the local community which are indispensable during design and implementation stages.</p> <p>Methods</p> <p>An ethnographic household survey was conducted in four study villages which were purposefully selected to represent socio-economic and geographical diversity. In total, 400 households were randomly selected from the four study villages. Quantitative and qualitative information of the respondents were collected by use of semi-structured questionnaires and focus group discussions.</p> <p>Results</p> <p>Malaria was reported the most frequently occurring disease in the area (93%) and its aetiology was attributed to other non-biomedical causes like stagnant water (16%), and long rains (13%). Factors which significantly caused variation in bed net use were occupant relationship to household head (χ²= 105.705; df 14; P = 0.000), Age (χ²= 74.483; df 14; P = 0.000), village (χ²= 150.325; df 6; P = 0.000), occupation (χ²= 7.955; df 3; P = 0.047), gender (χ²= 4.254; df 1; P = 0.039) and education levels of the household head or spouse (χ²= 33.622; df 6; P = 0.000). The same variables determined access and conditions of bed nets at household level. Protection against mosquito bite (95%) was the main reason cited for using bed nets in most households while protection against malaria came second (54%). Colour, shape and affordability were some of the key potential factors which determined choice, use and acceptance of bed nets in the study area.</p> <p>Conclusion</p> <p>The study highlights potential social and economic variables important for effective and sustainable implementation of bed nets-related programmes in Sub-Saharan Africa.</p

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Manifestaciones psicológicas frente a la situación epidemiológica causada por la COVID-19

Introduction: In the context of the COVID-19 pandemic and due to its high contagiousness and the increasing number of confirmed cases and deaths worldwide, negative thoughts and emotions spread as a threat to mental health.Objective: To identify the psychological manifestations against the epidemiological situation caused by COVID-19.Material and Methods: An observational descriptive cross-sectional study was carried out in the 16-A family medicine office belonging to the "Jimmy Hirtzel" Teaching Polyclinic in Bayamo on April 2020. The variables of anxiety, depression, stress and suicidal ideation were studied to which psychological tests were applied.Results: Anxiety as a state predominated in the majority of patients with high (30.96%) and medium (26.90%) levels; depression manifested as a state in the medium (36.54%) and high (13.70%) and medium (12.20%) levels as a trait; 66.49% of the patients presented altered stress levels; 98.47% of the patients did not show a suicidal idea. There was no association between stress and anxiety (p= 0,90) and depression as a trait and state (p= 0,97).Conclusions: Coping with the epidemiological situation caused by COVID-19, the people studied presented psychological alterations of anxiety and depression as a state and high levels of stress, without suicidal ideation in most cases.Introducción: en el contexto de la pandemia por la COVID-19 y debido a su alta contagiosidad y al número cada vez mayor de casos confirmados y muertes en el mundo, las emociones y los pensamientos negativos se extienden como amenaza hacia la salud mental.Objetivo: identificar las manifestaciones psicológicas frente a la situación epidemiológica causada por la COVID-19. Material y Métodos: se realizó un estudio observacional descriptivo transversal, en el consultorio médico de la familia 16-A perteneciente al Policlínico docente “Jimmy Hirtzel” de Bayamo durante el mes de abril de 2020. Se estudiaron las variables ansiedad, depresión, estrés e idea suicida, para lo cual se aplicaron pruebas psicológicas.Resultados: predominó la ansiedad como estado con niveles alto (30,96 %) y medio (26,90 %); la depresión se manifestó como estado en los niveles medio (36,54 %) y alto (13,70 %) y medio (12,20 %) como rasgo; el 66,49 % de las personas presentaron niveles de estrés alterado; el 98,47 % no mostró idea suicida. No se reveló asociación entre el estrés, la ansiedad (p= 0,90) y la depresión como rasgo y estado (p= 0,97).Conclusiones: frente a la situación epidemiológica causada por la COVID-19, las personas estudiadas presentaron alteraciones psicológicas de ansiedad y depresión como estado, altos niveles de estrés y sin idea suicida en la mayoría de los casos

Etnobotánica: Empleo de plantas para uso medicinal.

The use of plants to relieve illnesses is considered a millennial science, in the last years investigators, Scientifics, technicians and specialists have been devoted to deepen in the topic. The objective of this work is to contribute to the recovery of the popular wisdom in the use of vegetable species in medicine, so that it contributes to recognize the most used plants for the population. The investigation was carried out at random by means of surveys semi structured to traders and consumers of plants or parts of these with medicinal aims. The study was accomplished in the provinces of Havana, Pinar del Rio and Matanzas. It was emphasized in defining the arboreal species used with these purposes; information was also collected on other plants. 69 individuals were interviewed, 57 women and 18 men, 34 are salespersons, 30 consumers of plants in establishments and five suppliers. There were defined 47 forest and fruit-bearing species and 79 bushes, grasses and plants cultivated in gardens or wild. The most recommended species are Bursera simaruba (L.) Sarg. And Psidium guajava L. The scientific names, the recommended use are presented from ten of the most represented species in the group of the arboreal and not arboreal and other characteristics of the informers.El empleo de plantas para aliviar dolencias se considera una ciencia milenaria. En los últimos años muchos investigadores, científicos, técnicos y especialistas se han dedicado a profundizar en el tema. El objetivo de este trabajo es contribuir a la recuperación de la sabiduría popular respecto al uso de especies vegetales en la medicina, de manera que se pudiera conocer también las plantas más aprovechadas por un sector de la población. La investigación se realizó en Pinar del Río, La Habana y Matanzas mediante encuestas semidirigidas al azar a expendedores y consumidores de plantas o partes de estas con fines medicinales. Se entrevistaron en total 69 individuos, de ellos 34 son vendedores, 30 consumidores y cinco suministradores de plantas presentes en los establecimientos. La técnica empleada permitió definir las especies arbóreas aprovechadas con estos propósitos y recoger información sobre otras plantas. De esta forma se precisaron 47 especies forestales o frutales y 79 arbustos, hierbas y plantas cultivadas en jardines o silvestres, de ellas Bursera simaruba (L.) Sarg. y Psidium guajava L fueron las más recomendadas. Asimismo, se presentan los nombres científicos, posible uso, partes y formas de empleo de las diez especies más representadas en el grupo de las plantas arbóreas y no arbóreas y otras características de los informantes

Ethnobotany: Use of plants for therapeutic use

The use of plants to relieve illnesses is considered a millennial science, in the last year's investigators, Scientifics, technicians and specialists have been devoted to deepen in the topic. The objective of this work is to contribute to the recovery of the popular wisdom in the use of vegetable species in medicine, so that it contributes to recognize the most used plants for the population. The investigation was carried out at random by means of surveys semi structured to traders and consumers of plants or parts of these with medicinal aims. The study was accomplished in the provinces of Havana, Pinar del Rio and Matanzas. It was emphasized in defining the arboreal species used with these purposes; information was also collected on other plants. 69 individuals were interviewed, 57 women and 18 men, 34 are salespersons, 30 consumers of plants in establishments and five suppliers. There were defined 47 forest and fruit-bearing species and 79 bushes, grasses and plants cultivated in gardens or wild. The most recommended species are Bursera simaruba (L.) Sarg. And Psidium guajava L. The scientific names, the recommended use are presented from ten of the most represented species in the group of the arboreal and not arboreal and other characteristics of the informers