Analysis of nucleotide diversity of NAT2 coding region reveals homogeneity across Native American populations and high intra-population diversity.

N-acetyltransferase 2 (NAT2), an important enzyme in clinical pharmacology, metabolizes antibiotics such as isoniazid and sulfamethoxazole, and catalyzes the transformation of aromatic and heterocyclic amines from the environment and diet into carcinogenic intermediates. Polymorphisms in NAT2 account for variability in the acetylator phenotype and the pharmacokinetics of metabolized drugs. Native Americans, settled in rural areas and large cities of Latin America, are under-represented in pharmacogenetics studies; therefore, we sequenced the coding region of NAT2 in 456 chromosomes from 13 populations from the Americas, and two from Siberia, detecting nine substitutions and 11 haplotypes. Variants *4 (37%), *5B (23%) and *7B (24%) showed high frequencies. Average frequencies of fast, intermediate and slow acetylators across Native Americans were 18, 56 and 25%, respectively. NAT2 intra-population genetic diversity for Native Americans is higher than East Asians and similar to the rest of the world, and NAT2 variants are homogeneously distributed across native populations of the continent

A Community Program of Integrated Care for Frail Older Adults : +AGIL Barcelona

Objectives: To assess the 3-month impact on physical function of a program for community-dwelling frail older adults, based on the integration of primary care, geriatric medicine, and community resources, implemented in \u201creal life\u201d. Design: Interventional cohort study. Setting: Primary care in Barcelona, Spain. Participants: Individuals aged 6580 years (n=134), presenting at least one sign of frailty (i.e., slow gait speed, weakness, memory complaints, involuntary weight loss, poor social support). Intervention: After frailty screening by the primary care team, candidates were referred to a geriatric team (geriatrician + physical therapist), who performed a comprehensive geriatric assessment and designed a tailored multidisciplinary intervention in the community, including a) multi-modal physical activity (PA) sessions, b) promotion of adherence to a Mediterranean diet c) health education and d) medication review. Measurements: Participants were assessed based on a comprehensive geriatric assessment including physical performance (Short Physical Performance Battery -SPPB- and gait speed), at baseline and at a three month follow-up. Results: A total of 112 (83.6%) participants (mean age=80.8 years, 67.9% women) were included in this research. Despite being independent in daily life, participants\u2019 physical performance was impaired (SPPB=7.5, SD=2.1, gait speed=0.71, SD=0.20 m/sec). After three months, 90.2% of participants completed 657.5 physical activity sessions. The mean improvements were +1.47 (SD 1.64) points (p<0.001) for SPPB, +0.08 (SD 0.13) m/sec (p<0.001) for gait speed, 125.5 (SD 12.10) sec (p<0.001) for chair stand test, and 53% (p<0.001) improved their balance. Results remained substantially unchanged after stratifying the analyses according to the severity of frailty. Conclusions: Our results suggested that a \u201creal-world\u201d multidisciplinary intervention, integrating primary care, geriatric care, and community services may improve physical function, a marker of frailty, within 3 months. Further studies are needed to address the long-term impact and scalability of this implementation program

A Community Program of Integrated Care for Frail Older Adults: +AGIL Barcelona

Objectives: To assess the 3-month impact on physical function of a program for community-dwelling frail older adults, based on the integration of primary care, geriatric medicine, and community resources, implemented in 'real life'. Design: Interventional cohort study. Setting: Primary care in Barcelona, Spain. Participants: Individuals aged ≥80 years (n=134), presenting at least one sign of frailty (i.e., slow gait speed, weakness, memory complaints, involuntary weight loss, poor social support). Intervention: After frailty screening by the primary care team, candidates were referred to a geriatric team (geriatrician + physical therapist), who performed a comprehensive geriatric assessment and designed a tailored multidisciplinary intervention in the community, including a) multi-modal physical activity (PA) sessions, b) promotion of adherence to a Mediterranean diet c) health education and d) medication review. Measurements: Participants were assessed based on a comprehensive geriatric assessment including physical performance (Short Physical Performance Battery -SPPB- and gait speed), at baseline and at a three month follow-up. Results: A total of 112 (83.6%) participants (mean age=80.8 years, 67.9% women) were included in this research. Despite being independent in daily life, participants' physical performance was impaired (SPPB=7.5, SD=2.1, gait speed=0.71, SD=0.20 m/sec). After three months, 90.2% of participants completed ≥7.5 physical activity sessions. The mean improvements were +1.47 (SD 1.64) points (p<0.001) for SPPB, +0.08 (SD 0.13) m/sec (p<0.001) for gait speed, -5.5 (SD 12.10) sec (p<0.001) for chair stand test, and 53% (p<0.001) improved their balance. Results remained substantially unchanged after stratifying the analyses according to the severity of frailty. Conclusions: Our results suggested that a 'real-world' multidisciplinary intervention, integrating primary care, geriatric care, and community services may improve physical function, a marker of frailty, within 3 months. Further studies are needed to address the long-term impact and scalability of this implementation program

Coinfección por patógenos respiratorios virales y bacterianos detectados por métodos moleculares en pacientes hospitalizados por COVID-19 y su impacto en la mortalidad y desenlaces desfavorables

Resumen del Proyecto: Antecedentes y Justificación La mortalidad de los pacientes infectados con COVID-19 suele estar alrededor del 5%, dependiendo de las poblaciones reportadas y los métodos diagnósticos usados. Sin embargo, en pacientes hospitalizados, la mortalidad puede llegar al 30%. La variabilidad de este y otros indicadores pueden estar supeditados a la presencia de otras condiciones como las coinfecciones respiratorias. Se han reportado la presencia de coinfecciones en alrededor del 10 a 12,5% de pacientes hospitalizados por COVID19 siendo estos mayormente detectados con métodos de baja sensibilidad, por lo que su prevalencia es probablemente mayor. Aunque en otras infecciones respiratorias el rol de la coinfección con patógenos respiratorios como neumococo o estafilococo es alta, su rol en el pronóstico de la enfermedad por COVID-19 no está claro aún. Objetivo principal Evaluar la frecuencia de coinfección con patógenos respiratorios bacterianos y virales detectados mediante métodos moleculares y su asociación con desenlaces desfavorables incluyendo la necesidad de ventilación mecánica y muerte en pacientes hospitalizados por COVID-19. Metodología Estudio longitudinal analítico de cohorte prospectiva que analizará muestras de esputo o lavado bronquial obtenidas de pacientes hospitalizados con sospecha de COVID-19 en el Hospital Nacional Hipólito Unanue entre abril y octubre 2020, para evaluar la coinfección de patógenos respiratorios bacterianos y virales y su asociación con mortalidad y desenlaces desfavorables. El tamaño muestral requerido es de 196 participantes Las muestras de esputo y lavado bronco alveolar evaluadas para la identificación de agentes etiológicos virales y bacterianos mediante la plataforma molecular FilmArray. Se analizarán 33 patógenos respiratorios incluyendo 18 bacterias, 9 virus y 7 genes asociados a resistencia antimicrobiana. Se considerará como desenlace primario la mortalidad. Como desenlaces secundarios se incluirán la necesidad de ventilación mecánica, ingreso a unidad de cuidados intensivos, estancia hospitalaria y el indicador combinado de mortalidad e ingreso a cuidados intensivos. Resultados esperados (corto y mediano plazo) Nuestros datos serán útiles para establecer recomendaciones basadas en evidencia nacional para determinar la necesidad y posible beneficio de terapia antimicrobiana. De encontrarse asociación entre la coinfección bacteriana o viral y la mortalidad o complicaciones se justificaría la implementación de diagnóstico molecular en estas muestras a fin de intervenir tempranamente y evitar desenlaces desfavorables.Trabajo academic

Mitochondrial DNA diversity in south America and the genetic history of Andean highlanders

We analyzed mtDNA sequence variation in 590 individuals from 18 south Amerindian populations. The spatial pattern of mtDNA diversity in these populations fits well the model proposed on the basis of Y-chromosome data. We found evidence of a differential action of genetic drift and gene flow in western and eastern populations, which has led to genetic divergence in the latter but not in the former. Although it is not possible to identify a pattern of genetic variation common to all South America, when western and eastern populations are analyzed separately, the mtDNA diversity in both regions fits the isolation-by-distance model, suggesting independent evolutionary dynamics. Maximum-likelihood estimates of divergence times between central and south Amerindian populations fall between 13,000 and 19,000 years, which is consistent with a Pleistocenic peopling of South America. Moreover, comparison of among-population variability of mtDNA and Y-chromosome DNA seems to indicate that South America is the only continent where the levels of differentiation are similar for maternal and paternal lineages

Correlación entre mortalidad por COVID-19, índices de riqueza y desarrollo humano y densidad poblacional en distritos de Lima Metropolitana durante el 2020: Correlation between mortality due to COVID-19, wealth index, human development and population density in districts of Metropolitan Lima during 2020

OBJECTIVE:&nbsp;To determine the correlation between mortality due to COVID-19 and incidence of poverty and district human development index (HDI) in the department of Lima.&nbsp;METHODOLOGY:&nbsp;An observational, ecological, correlational study. The population were patients who died from COVID-19 in Lima Metropolitana. We included all patients reported dead in the open data base of the Ministerio de Salud. The dependent variable was mortality due to COVID-19, calculated by dividing the number of deaths by the total district population, and the independent variables were the incidence of poverty and HDI. We carried out a secondary analysis evaluating the fatality by COVID-19. The correlation was calculated through Spearman’s non-parametric method.&nbsp;RESULTS:&nbsp;13 154 people died of COVID-19 during the period between March and September, the majority was of masculine gender with an average age of 66 years. We did not find a significant correlation between mortality and incidence of poverty (rho=-0,2230; p=0,15). We found a significant correlation between mortality due to COVID-19 and HDI (rho= 0,4466; p=0,002). Mortality was correlated with population density (rho=0,7616; p=&lt;0,001). We found a positive (rho=0,32) and significant (p=0,037) correlation between fatality and incidence of poverty. We found a significant correlation between fatality due to COVID-19 and population density (rho=0,7616; p=&lt;0,001). We did not find a significant correlation between fatality and HDI.&nbsp;CONCLUSIONS:&nbsp;Population density was a factor associated in the most consistent manner with mortality and fatality due to COVID. Poverty was associated to greater fatality, but not to greater mortality.OBJETIVO:&nbsp;Determinar la correlación entre la mortalidad por COVID-19 y el porcentaje de pobreza e Índice de desarrollo Humano (IDH) distrital en el departamento de Lima.&nbsp;METODOLOGÍA:&nbsp;Estudio observacional ecológico de correlación. La población fueron pacientes fallecidos por COVID-19 en Lima metropolitana. Se incluyeron a todos los pacientes fallecidos reportados en la base de datos abiertos del Ministerio de Salud. La variable dependiente fue la mortalidad por COVID-19 calculada dividiendo el número de muertes entre la población total de los distritos y las variables independientes fueron el porcentaje de pobreza e IDH. Se realizó un análisis secundario evaluando la letalidad por COVID-19. La correlación se calculó mediante el método no paramétrico de Spearman.&nbsp;RESULTADOS:&nbsp;13154 personas fallecieron por COVID-19 durante el periodo de marzo a setiembre, la mayoría fue del sexo masculino con un promedio de edad de 66 años. No se encontró una correlación significativa entre mortalidad y porcentaje de pobreza (rho=-0,2230; p=0,15). Se encontró una correlación significativa entre mortalidad por COVID-19 e IDH (rho= 0,4466; p=0,002). La mortalidad se correlacionó con la densidad poblacional (rho=0,7616; p=&lt;0,001). Se encontró una correlación positiva (rho=0,32) y significativa (p=0,037) entre la letalidad y el porcentaje de pobreza. Se encontró una correlación significativa entre letalidad por COVID-19 y densidad poblacional (rho=0,7616; p=&lt;0,001). No se encontró correlación significativa entre letalidad y el IDH.&nbsp;CONCLUSIONES:&nbsp;La densidad poblacional fue el factor asociado de manera más consistente a mortalidad y letalidad por COVID. La pobreza se asoció a mayor letalidad, pero no a mayor mortalidad

Distribución regional de mortalidad COVID-19 en Perú: Regional distribution of COVID-19 mortality in Peru

Objectives:&nbsp;Compare the death rate from COVID-19 at the national level by regions and departments from March to September 2020.&nbsp;Methods:&nbsp;Quantitative, observational, cross-sectional, ecological and retrospective study. The data was extracted from the National Death System (SINADEF) in Microsoft Excel 2016 and imported into Stata. The variables were described as frequencies and percentages. Mortality was obtained by dividing the total deaths over the total population according to the last census. An adjusted exploratory analysis was performed using robust regression methods to evaluate the association between mortality by department and regions adjusted for age and sex of the deceased. P &lt;0.05 was considered significant.&nbsp;Results:&nbsp;32535 deaths were reported, 69.84% were male and the median was 67. The mortality rate in the Costa region 145 deaths were calculated (n = 24,276), followed by Sierra with 51 (n = 4434) and Selva with 63 (n = 2545). There were significant differences in mortality according to the region, in the comparison of the coast with the Sierra region a beta coefficient of -96.28 was found (p &lt;0.001 IC -123.76 -68.77), while in the comparison with the Selva it was determined a coefficient of -50.38 (p 0.01 95% CI -91.47 -9.29). No significant association was found between the mortality rate and the average age or sex of the deceased by department.&nbsp;Conclusion:&nbsp;The death rate from COVID-19 at the national level was 101 per 100 000 inhabitants. The mortality rate found was higher on the Costa region than in the Sierra and Selva, regardless of the proportion of men, women or age.Objetivos:&nbsp;Comparar la tasa de mortalidad por COVID-19 a nivel nacional por regiones y departamentos desde marzo a septiembre del 2020.&nbsp;Métodos:&nbsp;Estudio cuantitativo, observacional, transversal, ecológico y retrospectivo. La data fue extraída del Sistema Nacional de Defunciones (SINADEF) en Microsoft Excel 2016 y se importó a Stata. Se obtuvo la mortalidad dividiendo el total de muertes sobre la población total de acuerdo al último censo. Se utilizó frecuencias y porcentajes, se realizó un análisis exploratorio ajustado con métodos de regresión robusta para evaluar la asociación entre mortalidad por departamento y regiones ajustado a edad y sexo. Se consideró significativo p&lt; 0.05.&nbsp;Resultados:&nbsp;Se reportaron 32535 fallecidos, el 69.84% fueron varones y la mediana de edad fue 67. La mortalidad por mil habitantes, en la región Costa se calculó en 145 muertes (n=24276), seguido de Sierra con 51 (n=4434) y Selva con 63 (n=2545). Existieron diferencias significativas de mortalidad de acuerdo a la región, en la comparación de la costa con la sierra se halló un coeficiente beta de -96.28 (p &lt;0.001 IC -123.76 -68.77), mientras que en la comparación con la selva se determinó un coeficiente de -50.38 (p 0.01 IC 95% -91.47 -9.29). No se encontró asociación significativa entre la mortalidad y la edad o el sexo de los fallecidos por departamento.&nbsp;Conclusión:&nbsp;La tasa de mortalidad por COVID-19 en Perú fue de 101 por 100000 habitantes, fue mayor en la costa que en la sierra y la selva independientemente de la proporción de varones, mujeres o la edad

Concordance between the Mini-Mental State Examination, Short Portable Mental Status Questionnaire and Montreal Cognitive Assessment Tests for Screening for Cognitive Impairment in Older Adults

Abstract: Determine the level of concordance between the Mini-Mental State Examination (MMSE), Short Portable Mental State Examination (SPMSQ), and Montreal Cognitive Assessment (MoCA) screening test for cognitive impairment in older adults. A cross-sectional study based on an original cohort study. 1683 patients over 60 years-old were included between 2010 and 2015. Demographic information was collected and the MMSE, MoCA, and SPMSQ scores were obtained. Categorical variables were presented as frequencies and percentages, while numerical ones as median and interquartile range. The agreement was measured and adjusted by the number of years of education by Cohen’s Kappa index (k) with a 95% confidence interval (CI). The agreement was considered as good if k > 0.80. MMSE classified 43.32% of the patients as having cognitive impairment, MoCA 43.14%, and SPMSQ 24.84%. MMSE and MoCA showed an agreement (k) of 0.99 with a 95% CI of 0.99–1.00; MoCA and SPMSQ showed a k of 0.43 (95% CI: 0.38–0.46). Finally, MMSE and SPMSQ showed a k of 0.42 (95% CI: 0.37–0.46). The results did not change when performing the analysis by education subgroups. There was a strong concordance between MoCA and MMSE tests. Nevertheless, the SPMSQ was discordant with the other tests.Revisión por pare