Multiple cardiovascular risk factor care in 55 low- and middle-income countries:A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults

The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009–2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40–69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8–66.4]) than those with hypertension only (47.4% [45.3–49.6]) or diabetes only (46.7% [44.1–49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8–41.8] using antihypertensive and 42.3% [95% CI: 39.4–45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1–27.2]).The percentage of individuals achieving appropriate management was highest in the hypertension group (17.6% [16.4–18.8]), followed by diabetes (13.3% [10.7–15.8]) and hypertension-diabetes (6.6% [5.4–7.8]) groups. Although health systems in LMICs are reaching a larger share of individuals living with both hypertension and diabetes than those living with just one of these conditions, only seven percent achieved both BP and blood glucose treatment targets. Implementation of cost-effective population-level interventions that shift clinical care paradigm from disease-specific to comprehensive CVD care are urgently needed for all three groups, especially for those with multiple CVD risk factors

Enzymatic Reaction Mechanisms, pp ranca

ABSTRACT: The mechanism of the argininosuccinate lyase reaction has been probed by the measurement of the effects of isotopic substitution a t the reaction centers. A primary deuterium isotope effect of 1.0 on both Vand V / K is obtained with (2S,3R)-argininosuccinate-3-d, while a primary 15N isotope effect on V / K of 0.9964 f 0.0003 is observed. The 15N isotope effect on the equilibrium constant is 1.018 f 0.001. The proton that is abstracted from C-3 of argininosuccinate is unable to exchange with the solvent from the enzyme-intermediate complex but is rapidly exchanged with solvent from the enzyme-fumaratearginine complex. A deuterium solvent isotope effect of 2.0 is observed on the V,,, of the forward reaction. These and other data have been interpreted to suggest that argininosuccinate lyase catalyzes the cleavage of argininosuccinate via a carbanion intermediate. The proton abstraction step is not rate limiting, but the inverse 15N primary isotope effect and the solvent deuterium isotope effect suggest that protonation of the guanidino group and carbon-nitrogen bond cleavage of argininosuccinate are kinetically significant. Argininsuccinate lyase catalyzes the cleavage of argininosuccinate to arginine and fumarate. The enzyme is found in the liver where it functions in the biosynthesis of urea. The enzyme from bovine liver has been shown by Lusty and Ratner (1972) to be a tetramer of four identical subunits. No external cofactor is involved, and the enzyme apparently does not require metal ions for catalytic activity. The details of the catalytic events leading to the chemical transformation of argininosuccinate to fumarate and arginine are largely unknown. Ratner and co-workers have shown that the reaction involves the trans elimination of arginine and the pro-R hydrogen at C-3 of argininosuccinate (Hoberman et al., 1965). The kinetic mechanism of the reaction is random In this paper we report on our efforts to determine the magnitude and the timing of the bond-breaking steps in the conversion of argininosuccinate to arginine and fumarate. Th

Multiple cardiovascular risk factor care in 55 low- and middle-income countries: A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults

The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009–2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40–69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8–66.4]) than those with hypertension only (47.4% [45.3–49.6]) or diabetes only (46.7% [44.1–49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8–41.8] using antihypertensive and 42.3% [95% CI: 39.4–45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1–27.2]).The percentage of individuals achieving appropriate management was highest in the hypertension group (17.6% [16.4–18.8]), followed by diabetes (13.3% [10.7–15.8]) and hypertension-diabetes (6.6% [5.4–7.8]) groups. Although health systems in LMICs are reaching a larger share of individuals living with both hypertension and diabetes than those living with just one of these conditions, only seven percent achieved both BP and blood glucose treatment targets. Implementation of cost-effective population-level interventions that shift clinical care paradigm from disease-specific to comprehensive CVD care are urgently needed for all three groups, especially for those with multiple CVD risk factors

Preliminary Survey on Foraminiferal Responses to Pollutants in Torrecillas Lagoon Puerto Rico

Torrecilla Lagoon, part of the San Juan Bay Estuary system, is a moderately-polluted estuary on the northern coast of Puerto Rico. Foraminiferal assemblages from two 30 cm cores were dominated by Ammonia spp. and Quinqueloculina rhodiensis. The latter taxon exhibits a relatively high occurrence of deformed tests (up to 18%). Analyses for potentially toxic-element in bulk sediment samples of one core show concentrations below recognized toxicity levels except for copper. Copper concentrations (50–138 ppm) fall between previously established Effect Range Low and Effect Range Median values, representing potential for occasional detrimental effects to the aquatic environment. Organic matter content (loss-on-ignition) ranging from 10–23%, coupled with the presence of framboidal pyrite, indicate low oxygen conditions. Ammonia spp. showed no significant variation in size with depth in core. Ammonia-Elphidium index values, a previously established indicator of hypoxia, are 69–100, reflecting relative few Elphidium. Species diversity indices indicate temporal variability in abundance and distribution of foraminifers. Foraminiferal assemblages and organic matter in sediments indicate that Torrecilla Lagoon has undergone episodes of hypoxia

The costs of organized violence: a review of the evidence

Conflict, Property rights, Governance, D74, H56, I31, O57,