2,043 research outputs found
Trajectories of body mass index and waist circumference in four Peruvian settings at different level of urbanisation: the CRONICAS Cohort Study
BACKGROUND: Studies have reported the incidence/risk of becoming obese, but few have described the trajectories of body mass index (BMI) and waist circumference (WC) over time, especially in low/middle-income countries. We assessed the trajectories of BMI and WC according to sex in four sites in Peru. METHODS: Data from the population-based CRONICAS Cohort Study were analysed. We fitted a population-averaged model by using generalised estimating equations. The outcomes of interest, with three data points over time, were BMI and WC. The exposure variable was the factorial interaction between time and study site. RESULTS: At baseline mean age was 55.7 years (SD: 12.7) and 51.6% were women. Mean follow-up time was 2.5 years (SD: 0.4). Over time and across sites, BMI and WC increased linearly. The less urbanised sites showed a faster increase than more urbanised sites, and this was also observed after sex stratification. Overall, the fastest increase was found for WC compared with BMI. Compared with Lima, the fastest increase in WC was in rural Puno (coefficient=0.73, P<0.001), followed by urban Puno (coefficient=0.59, P=0.001) and Tumbes (coefficient=0.22, P=0.088). CONCLUSIONS: There was a linear increase in BMI and WC across study sites, with the greatest increase in less urbanised areas. The ongoing urbanisation process, common to Peru and other low/middle-income countries, is accompanied by different trajectories of increasing obesity-related markers
Left Atrial Volume: an Old Echocardiographic Measure with Renewed Prognostic Significance: a Study in Patients with Dilated Cardiomyopathy
Recentemente, surgiram alguns trabalhos que
ressaltaram a importância do cálculo do
volume da aurÃcula esquerda (VAE) como um
marcador de eventos cardÃacos adversos. Foi
objectivo deste estudo avaliar a importância
prognóstica deste parâmetro em doentes (dts)
com deficiente função ventricular esquerda e
correlacioná-lo com outros parâmetros
clássicos de prognóstico – consumo de O2
(VO2 max) e pro-BNP (pBNP).
Métodos: Analisou-se o volume da aurÃcula
esquerda (VAE) por método de Simpson, numa população de 35 dts com cardiopatia dilatada (idiopática e isquémica) com fracção de ejecção (FE) 31±9,6% doentes (dts) eram de sexo masculino e a média de idades foi de
50,5±10,5 anos. Toda a população efectuou
estudos de ecocardiografia convencional
(incluindo avaliação por M-mode, bidimensional e Doppler), prova cardiorespiratória (VO2max) e doseamento de
pro-BNP. O tempo médio de seguimento foi de
24 ± 4 meses, tendo-se considerado como
eventos cardÃacos (EC): internamento por
insuficiência cardÃaca, transplante e morte.
Resultados: Dos parâmetros da ecocardiografia
- o diâmetro da AE foi de 46,6±5,7mm, as dimensões do VE em diástole – 73,5±10mm e
em sÃstole -58,9±11mm, a média da fracção
de ejecção foi de 31±9,6%, o VAE foi de
78,6±33 ml, os volumes do VE foram de
214±82ml em diástole e de 153±75ml em
sÃstole, 15 dts tinham padrão restritivo de
enchimento ventricular (E/A>2), a média da
área (Doppler cor) da insuficiência mitral foi de 4±3,3cm2, 14 dts tinham E/E’>15. O VO2
max médio foi de 20±5,8ml/kg/min e o pro-BNP de 3146±4629pg/mL. Para além da correlação de outros parâmetros clássicos ecocardiográficos com o prognóstico (volumes
VE, FE e E/E’), o VAE e o volume indexado
da AE (VAE/SC) mostraram uma correlação
com o prognóstico (EC) com r=0,4 (p=0,02)
que não se verificou para o diâmetro da AE
(p=ns). Em relação à tolerância ao esforço,
houve uma correlação inversa entre o diâmetro, o volume e o volume indexado da
AE e o VO2max, com maior significado
estatÃstico para o VAE e VAE/SC com
r=-0,48, p=0,008. Quanto ao pro-BNP, quer o
diâmetro, quer o VAE (ou volume indexado)
tiverem o mesmo nÃvel de significado
estatÃstico (r=0,43; p=0,02). O valor predictivo de eventos (curvas ROC) para o VAE foi de 70ml e de 37ml/m2 para o VAE/m2.
Conclusão: O volume da aurÃcula esquerda/volume indexado é um parâmetro
ecocardiográfico com significado prognóstico
em dts com deficiente função ventricular
esquerda, correlacionando-se com a tolerância
ao esforço e pro-BNP
Correlation Between NT-proBNP Values and Changes in Functional Capacity in Patients with Chronic Heart Failure
OBJECTIVE: We set out to evaluate whether changes in N-terminal pro-brain natriuretic peptide (proBNP) can predict changes in functional capacity, as determined by cardiopulmonary exercise testing (CPET), in patients with chronic heart failure (CHF) due to dilated cardiomyopathy (DCM).
METHODS: We studied 37 patients with CHF due to DCM, 81% non-ischemic, 28 male, who performed symptom-limited treadmill CPET, with the modified Bruce protocol, in two consecutive evaluations, with determination of proBNP after 10 minutes rest prior to CPET. The time between evaluations was 9.6+/-5.5 months, and age at first evaluation was 41.1+/-13.9 years (21 to 67). RESULTS IN THE FIRST AND SECOND EVALUATIONS RESPECTIVELY WERE: NYHA functional class >II 51% and 16% (p<0.001), sinus rhythm 89% and 86.5% (NS), left ventricular ejection fraction 24.9+/-8.9% and 26.6+/-8.6% (NS), creatinine 1.03+/-0.25 and 1.09+/-0.42 mg/dl (NS), taking ACE inhibitors or ARBs 94.5% and 100% (NS), beta-blockers 73% and 97.3% (p<0.001), and spironolactone 89% and 89% (NS). We analyzed the absolute and percentage variation (AV and PV) in peak oxygen uptake (pVO2--ml/kg/min) and proBNP (pg/ml) between the two evaluations.
RESULTS: (1) pVO2 AV: -17.4 to 15.2 (1.9+/-5.7); pVO2 PV: -56.1 to 84% (11.0+/-25.2); proBNP AV: -12850 to 5983 (-778.4+/-3332.5); proBNP PV: -99.0 to 379.5% (-8.8+/-86.3); (2) The correlations obtained--r value and p value [r (p)]--are shown in the table below; (3) We considered that a coefficient of variation of pVO2 PV of >10% represented a significant change in functional capacity. On ROC curve analysis, a proBNP PV value of 28% showed 80% sensitivity and 79% specificity for pVO2 PV of >10% (AUC=0.876, p=0.01, 95% CI 0.75 to 0.99).
CONCLUSIONS: In patients with CHF due to DCM, changes in proBNP values correlate with variations in pVO2, as assessed by CPET. However, our results suggest that only a proBNP PV of >28% predicts a significant change in functional capacity
Wormhole Cosmic Censorship
We analyze the properties of a Kerr-like wormhole supported by phantom
matter, which is an exact solution of the Einstein-phantom field equations. It
is shown that the solution has a naked ring singularity which is unreachable to
null geodesics falling freely from the outside. Similarly to Roger Penrose's
cosmic censorship, that states that all naked singularities in the Universe
must be protected by event horizons, here we conjecture from our results that a
naked singularity can also be fully protected by the intrinsic properties of a
wormhole's throat
Training opportunities for noncommunicable diseases research in Latin America: A scoping review.
Objective: To identify gaps in postgraduate training and options for building capacity in noncommunicable disease (NCDs) research in Latin America. Methods: This was a scoping review of postgraduate opportunities in NCDs at top universities in Latin America and of training grants awarded by international funding bodies. Three global university rankings were considered-the QS Ranking, the Shanghai Ranking, and the Times Ranking. Latin American universities appearing in at least two of these were selected. University websites were searched for current graduate programs in biostatistics, epidemiology, global health, health economics, and public health. Information was extracted, summarized, and evaluated to identify any programs focused on NCDs. In addition, seven international funding bodies' websites were searched for training grants. Results: In all, 33 universities offering 72 postgraduate programs met the inclusion criteria. One of these programs was exclusively devoted to NCD, and 12 offered NCDs as a dissertation research topic. Only two training grants were awarded to a Latin American institution for NCD capacity building. There are few NCD research training programs in Latin America and only one program exclusively focused on NCDs. Conclusion: There seem to be few NCD-specific research training programs in Latin America. Leveraging existing programs and expanding those with a focus on NCDs could help enhance NCD research capacity in the region. These initiatives should be supported by international funding agencies through more funding opportunities
Analysis of dietary patterns and cross-sectional and longitudinal associations with hypertension, high BMI and type 2 diabetes in Peru
OBJECTIVE: To determine if specific dietary patterns are associated with risk of hypertension, type 2 diabetes mellitus (T2DM) and high BMI in four sites in Peru. DESIGN: We analysed dietary patterns from a cohort of Peruvian adults in four geographical settings using latent class analysis. Associations with prevalence and incidence of hypertension, T2DM and high BMI were assessed using Poisson regression and generalised linear models, adjusted for potential confounders. SETTING: Four sites in Peru varying in degree of urbanisation. PARTICIPANTS: Adults aged ≥35 years (n 3280). RESULTS: We identified four distinct dietary patterns corresponding to different stages of the Peruvian nutrition transition, reflected by the foods frequently consumed in each pattern. Participants consuming the 'stage 3' diet, characterised by high proportional consumption of processed foods, animal products and low consumption of vegetables, mostly consumed in the semi-urban setting, showed the highest prevalence of all health outcomes (hypertension 32·1 %; T2DM 10·7 %; high BMI 75·1 %). Those with a more traditional 'stage 1' diet characterised by potato and vegetables, mostly consumed in the rural setting, had lower prevalence of hypertension (prevalence ratio; 95 CI: 0·57; 0·43, 0·75), T2DM (0·36; 0·16, 0·86) and high BMI (0·55; 0·48, 0·63) compared with the 'stage 3' diet. Incidence of hypertension was highest among individuals consuming the 'stage 3' diet (63·75 per 1000 person-years; 95 % CI 52·40, 77·55). CONCLUSIONS: The study found more traditional diets were associated with a lower prevalence of three common chronic diseases, while prevalence of these diseases was higher with a diet high in processed foods and low in vegetables
Cohort Profile: The PERU MIGRANT Study-A prospective cohort study of rural dwellers, urban dwellers and rural-to-urban migrants in Peru.
Enzymatic hydrolysis of esters from 2-carboxy-6- methoxy-2,3-dihydrobenzofuran acid
In this work we describe the results of the enzymatic hydrolysis of esters from 2-carboxy-6-methoxy-2,3-dihydrobenzofuran acid using Candida antarctica lipase supported on acrylic resin, with enantiomeric excesses ranging between 80 to 99%
Use of diffusion spectrum imaging in preliminary longitudinal evaluation of amyotrophic lateral sclerosis: Development of an imaging biomarker
Previous diffusion tensor imaging (DTI) studies have shown white matter pathology in amyotrophic lateral sclerosis (ALS), predominantly in the motor pathways. Further these studies have shown that DTI can be used longitudinally to track pathology over time, making white matter pathology a candidate as an outcome measure in future trials. DTI has demonstrated application in group studies, however its derived indices, for example fractional anisotropy, are susceptible to partial volume effects, making its role questionable in examining individual progression. We hypothesize that changes in the white matter are present in ALS beyond the motor tracts, and that the affected pathways and associated pattern of disease progression can be tracked longitudinally using automated diffusion connectometry analysis. Connectometry analysis is based on diffusion spectrum imaging and overcomes the limitations of a conventional tractography approach and DTI. The identified affected white matter tracts can then be assessed in a targeted fashion using High definition fiber tractography (a novel white matter MR imaging technique). Changes in quantitative and qualitative markers over time could then be correlated with clinical progression. We illustrate these principles toward developing an imaging biomarker for demonstrating individual progression, by presenting results for five ALS patients, including with longitudinal data in two. Preliminary analysis demonstrated a number of changes bilaterally and asymmetrically in motoric and extramotoric white matter pathways. Further the limbic system was also affected possibly explaining the cognitive symptoms in ALS. In the two longitudinal subjects, the white matter changes were less extensive at baseline, although there was evidence of disease progression in a frontal pattern with a relatively spared postcentral gyrus, consistent with the known pathology in ALS. © 2014 Abhinav, Yeh, El-Dokla, Ferrando, Chang, Lacomis, Friedlander and Fernandez-Miranda
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