37 research outputs found
Estudio clínico-epidemiológico de leptospirosis en humanos y reservorios en Yucatán, México
A leptospirosis clinical-epidemiological study was made in humans and reservoirs in the state of Yucatán, México. Interviews and serological analyses were made on 400 persons from an open population, 439 probable cases of leptospirosis and 1060 animal reservoirs (cows, pigs, dogs, rats and opossums). IgM Leptospira DipstickTM and Microscopic Agglutination Test (MAT) was used to detect human antibodies to leptospiras and serovar respectively. Leptospirosis incidence in humans was 2.2/100,000 inhab. in 1998, 0.7/100,000 in 1999 and 0.9/100,000 in 2000. Overall seroprevalence was 14.2%, relatively unchanged from seroprevalences observed 20 years ago. Highest seropositivity was found in people over 56 years of age, predominating males over females. Predominant serovars in the open population were tarassovi, hardjo, pomona and panama. Leptospirosis cases were most frequent in rural areas, and the anicteric course predominated over the icteric. The panama, icterohaemorrhagiae and pomona serovars predominated in both anicteric and icteric courses. Dogs, pigs and rodents had the highest seropositivity among the reservoirs. Contact with rodents and natural water sources were significant factors (p ;£; 0.05). Human cases (74%) occurred during the rainy season. It is concluded that leptospirosis is still a serious illness with important clinical and epidemiological implications in the state of Yucatán, Mexico.Un estudio clínico-epidemiológico de leptospirosis fue realizado en humanos y reservorios en el estado de Yucatán, México. Se entrevistaron y analizaron mediante serología 400 personas en población abierta, 439 pacientes sospechosos y 1060 reservorios (bovinos, cerdos, perros, roedores y zarigüeyas). En humanos para la detección de anticuerpos se utilizó IgM Dipstick LeptospiraTM y la prueba de aglutinación microscópica (MAT) para detectar serovar. La incidencia en humanos fue de 2.2/100,000, 0.7/100,000 y 0.9/100,000 habitantes para los años 1998, 1999 y 2000 respectivamente y la seroprevalencia de 14.2%. La frecuencia más alta de seropositivos se encontró en mayores de 56 años, predominando el sexo masculino sobre el femenino. Predominó en población abierta el serovar tarassovi siguiendo en importancia hardjo, pomona y panamá. Los casos fueron más frecuentes en el área rural y el curso anictérico predominó sobre el ictérico. Panamá, icterohaemorrhagiae y pomona predominaron en ambos cursos de la enfermedad. Los perros cerdos y roedores tuvieron mayor positividad. El contacto con roedores y depósitos naturales de agua fue significativo (p ;£; 0.05). El 74.3% de los casos se presentaron en época de lluvia. En conclusión la leptospirosis en Yucatán, México, sigue siendo una entidad patológica de importancia tanto clínica como epidemiológica
Fatal Human Infection with Rickettsia rickettsii, Yucatán, Mexico
The first fatal Rickettsia rickettsii infection was diagnosed in the southwest of Mexico. The patient had fever, erythematous rash, abdominal pain, and severe central nervous system involvement with convulsive crisis. The diagnosis of R. rickettsii infection was established by immunohistochemistry and specific polymerase chain reaction
Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study
Interactions between macrophages and adipocytes are early molecular factors influencing adipose tissue (AT) dysfunction, resulting in high leptin, low adiponectin circulating levels and low-grade metaflammation, leading to insulin resistance (IR) with increased cardiovascular risk. We report the characterization of AT dysfunction through measurements of the adiponectin/leptin ratio (ALR), the adipo-insulin resistance index (Adipo-IRi), fasting/postprandial (F/P) immunometabolic phenotyping and direct F/P differential gene expression in AT biopsies obtained from symptom-free adults from the GEMM family study. AT dysfunction was evaluated through associations of the ALR with F/P insulin-glucose axis, lipid-lipoprotein metabolism, and inflammatory markers. A relevant pattern of negative associations between decreased ALR and markers of systemic lowgrade metaflammation, HOMA, and postprandial cardiovascular risk hyperinsulinemic, triglyceride and GLP-1 curves was found. We also analysed their plasma non-coding microRNAs and shotgun lipidomics profiles finding trends that may reflect a pattern of adipose tissue dysfunction in the fed and fasted state. Direct gene differential expression data showed initial patterns of AT molecular signatures of key immunometabolic genes involved in AT expansion, angiogenic remodelling and immune cell migration. These data reinforce the central, early role of AT dysfunction at the molecular and systemic level in the pathogenesis of IR and immunometabolic disorders
Expert consensus on low-calorie sweeteners:facts, research gaps and suggested actions
A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation
Transcriptoma en mexicanos: metodología para analizar el perfil de expresión genética de gran escala en muestras simultáneas de tejido muscular, adiposo y linfocitos obtenidas en un mismo individuo
Describir la metodología de análisis de múltiples trasncritos con técnicas de microarreglo en biopsisas simultáneas de tejido muscular, adiposo y sangre en un mismo individuo, como parte de la estandarización del estudio GEMM (Genética de las enfermedades Metabólicas en México
Replication of obesity and diabetes-related SNP associations in individuals from Yucatán, México
The prevalence of type 2 diabetes (T2D) is rising rapidly and in Mexicans is ∼19%. T2D is affected by both environmental and genetic factors. Although specific genes have been implicated in T2D risk few of these findings are confirmed in studies of Mexican subjects.
Our aim was to replicate associations of 39 single nucleotide polymorphisms (SNPs) from 10 genes with T2D-related phenotypes in a community-based Mexican cohort. Unrelated individuals (n = 259) living in southeastern Mexico were enrolled in the study based at the University of Yucatan School of Medicine in Merida. Phenotypes measured included anthropometric measurements, circulating levels of adipose tissue endocrine factors
(leptin, adiponectin, pro-inflammatory cytokines), and insulin, glucose, and blood pressure. Association analyses were conducted by measured genotype analysis implemented in SOLAR, adapted for unrelated individuals. SNP Minor allele frequencies ranged from 2.2 to 48.6%. Nominal associations were found for CNR1, SLC30A8, GCK, and PCSK1 SNPs with systolic blood pressure, insulin and glucose, and for CNR1, SLC30A8, KCNJ11, and PCSK1 SNPs with adiponectin and leptin (p < 0.05). P-values greater than 0.0014 were considered significant. Association of SNPs rs10485170 of CNR1 and rs5215 of KCNJ11 with adiponectin and leptin, respectively, reached near significance (p = 0.002). Significant association (p = 0.001) was observed between plasma leptin and rs5219 of KCNJ11
Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study
Interactions between macrophages and adipocytes are early molecular factors influencing adipose tissue (AT) dysfunction, resulting in high leptin, low adiponectin circulating levels and low-grade metaflammation, leading to insulin resistance (IR) with increased cardiovascular risk. We report the characterization of AT dysfunction through measurements of the adiponectin/leptin ratio (ALR), the adipo-insulin resistance index (Adipo-IRi), fasting/postprandial (F/P) immunometabolic phenotyping and direct F/P differential gene expression in AT biopsies obtained from symptom-free adults from the GEMM family study. AT dysfunction was evaluated through associations of the ALR with F/P insulin-glucose axis, lipid-lipoprotein metabolism, and inflammatory markers. A relevant pattern of negative associations between decreased ALR and markers of systemic low-grade metaflammation, HOMA, and postprandial cardiovascular risk hyperinsulinemic, triglyceride and GLP-1 curves was found. We also analysed their plasma non-coding microRNAs and shotgun lipidomics profiles finding trends that may reflect a pattern of adipose tissue dysfunction in the fed and fasted state. Direct gene differential expression data showed initial patterns of AT molecular signatures of key immunometabolic genes involved in AT expansion, angiogenic remodelling and immune cell migration. These data reinforce the central, early role of AT dysfunction at the molecular and systemic level in the pathogenesis of IR and immunometabolic disorders
Canagliflozin and renal outcomes in type 2 diabetes and nephropathy
BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years
Agentes comunitarios de salud para el autocontrol en diabetes
Community health agents are individuals trained to assist the health professional during the provision of community service. They also receive the name of support couple: they live with the same illness as the person they support and know what it means to live and deal with the disease. The purpose of this paper is to present scientific evidence on the extent and benefit of peer contribution in various education programs for the self-management of diabetes mellitus type 2 (DT2). For this, a bibliographic review of controlled clinical trials published in the years of 2010 to 2015 was carried out. Data sources were compiled from national and international databases, such as MEDLINE, Pubmed, Web of Science (Science, Index). The descriptors were three concepts "diabetes" AND "peer support" AND "results". Full text articles were included in English and Spanish.
The search results provided strong evidence of peer support in self-management of diabetes. The intervention of the support pairs proved to be an excellent collaborator with the health professionals in the self-management of the DT2. In addition, it has viability in its implementation, sustainability by retaining a high proportion of the participating population, clinical effectiveness and improvement in the quality of life at evidencing a significant reduction in glycosylated hemoglobin (HbA1C), efficacy —especially in people with low adherence to medication and self-management, and low health literacy—, cost reduction for hospitalizations, and has proved to be a humanizing practice. The implementation of programs for the self-management of diabetes with the support of peers is widespread in several parts of the world. The study findings showed that support pairs are an excellent strategy for self-management and to address present and future health challenges in caring for the person living with DT2.Os agentes comunitários de saúde são pessoas treinadas para auxiliar o profissional da saúde durante a prestação de serviços na comunidade. Eles também recebem o nome do par de suporte: eles vivem com a mesma doença que a pessoa que eles apoiam e sabem o que significa viver e lidar com a doença. O objetivo deste trabalho é apresentar evidências científicas sobre o escopo e benefício da contribuição de pares em vários programas de educação para a autogestão do diabetes mellitus tipo 2 (DT2). Para isso, foi realizada uma revisão bibliográfica de ensaios clínicos controlados publicados nos anos de 2010 a 2015. As fontes foram compiladas a partir de bases de dados nacionais e internacionais, como MEDLINE, Pubmed, Web of Science (Science, Index). Os descritores foram três conceitos de "diabetes" e "suporte de pares" e "resultados". Os artigos de texto completo foram incluídos em inglês e espanhol. Os resultados da pesquisa forneceram fortes evidências de apoio aos pares na autogestão da diabetes. A intervenção dos pares de apoio resultou ser um excelente colaborador com os profissionais de saúde na autogestão do DT2. Possui viabilidade na sua implementação, sustentabilidade, mantendo a alta proporção da população participada, a eficácia clínica e a melhoria da qualidade de vida, evidenciando uma redução significativa da hemoglobina glicosilada (HbA1C), a eficácia - principalmente em pessoas com baixa adesão à medicação e autogestão, e com baixo nível de alfabetização na saúde -, redução de custos para hospitalizações e, além disso, provou ser uma prática humanizadora. A implementação de programas para a autogestão de diabetes com o apoio de colegas é generalizada em várias partes do mundo. As descobertas do estudo demonstraram que o apoio aos pares é uma excelente estratégia para o autocontrole e para enfrentar os desafios de saúde presentes e futuros no cuidado da pessoa que vive com DM2.Los agentes comunitarios de salud son personas capacitadas para asistir al profesional de salud durante la prestación de servicio en la comunidad. También reciben el nombre de par de apoyo: viven con la misma enfermedad que la persona a la cual apoyan y saben lo que significa vivir y lidiar con la enfermedad. El propósito de este trabajo es presentar evidencia científica sobre el alcance y beneficio de la contribución de los pares en diversos programas de educación para el automanejo de la diabetes mellitus tipo 2 (DT2). Para esto, se realizó una revisión bibliográfica de ensayos clínicos controlados publicados en los años de 2010 a 2015. Las fuentes fueron recopiladas de bases de datos nacionales e internacionales, tales como MEDLINE, Pubmed, Web of Science (Science, Index). Los descriptores fueron tres conceptos “diabetes” AND “apoyo de los pares” AND “resultados”. Se incluyeron artículos de texto completo en inglés y español. Los resultados de la búsqueda proporcionaron una fuerte evidencia de apoyo entre iguales en el automanejo de la diabetes. La intervención de los pares de apoyo demostró ser una excelente colaboradora con los profesionales de salud en el automanejo de la DT2. Tiene viabilidad en su implementación, sustentabilidad al retener la alta proporción de población participante, efectividad clínica y mejora en la calidad de vida al evidenciar una reducción signifcativa de hemoglobina glucosilada (HbA1C), eficacia —especialmente en personas con baja adherencia al medicamento y autogestión, y con bajo nivel de alfabetización en salud—, reducción de costos por hospitalizaciones, y,además, ha demostrado ser una práctica humanizadora. La implementación de programas para el automanejo de la diabetes con el apoyo de pares está altamente difundida en varias partes del mundo. Los hallazgos del estudio demostraron que los pares de apoyo son una excelente estrategia para el autocontrol y para hacer frente a los retos de salud presentes y futuros en el cuidado de la persona que vive con DT2