Pre-evaluation assessment of serological-based COVID-19 point-of-care lateral flow assays in Kenya

Background: Timely testing is a key determinant of management outcomes of coronavirus disease 2019 (COVID-19). Real-time reverse transcription polymerase chain reaction tests are currently the mainstay for COVID-19 testing. However, serological point-of-care tests (PoCTs) can be useful in identifying asymptomatic and recovered cases, as well as herd immunity. Objective: The aim of this study was to assess COVID-19 PoCTs in Kenya to support the emergency use authorisation of these tests. Methods: Between March 2020 and May 2020, 18 firms, of which 13 were from China, submitted their PoCTs to the national regulatory authority, the Pharmacy and Poison Board, who in turn forwarded them to the Kenya Medical Research Institute for pre-evaluation assessment. The tests were run with real-time reverse transcription polymerase chain reaction COVID-19-positive samples. Pre-COVID-19 plasma samples that were collected in June 2019were used as negative samples. The shelf lives of the PoCTs ranged from 6 to 24 months. Results: Only nine (50%) tests had sensitivities ≥ 40% (range: 40% ­ 60%) and the ability of these tests to detect IgM ranged from 0% to 50%. Many (7/18; 38.9%) of the kits had very weak IgM and IgG band intensities (range: 2­3). Conclusion: Serological-based PoCTs available in Kenya can only detect COVID-19 in up to 60% of the infected population.

Early Cardiac Dysfunction in Biopsy-proven Nonalcoholic Fatty Liver Disease / 대한소화기학회지

Background/Aims@#Nonalcoholic fatty liver disease (NAFLD) encompasses a range of diseases from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) and has been linked to cardiovascular disease and sub-clinical cardiac remodeling. This paper presents a retrospective study of biopsy-proven NAFL and NASH to examine the differences in subclinical cardiac remodeling. @*Methods@#Patients were recruited from an institutional repository of patients with liver-biopsy-confirmed NAFLD. Patients with a transthoracic echocardiogram (TTE) within 12 months of the liver biopsy were included. The parameters of the diastolic dysfunction were reviewed for the differences between NAFL and NASH as well as between the stages and grades of NASH. @*Results@#Thirty-three patients were included in the study, 17 with NAFL and 16 with NASH. The NASH patients were more likely to have lower platelets, higher AST, higher ALT, and higher rates of type 2 diabetes mellitus, coronary artery disease, and hypertension than the NAFL patients. The E/e’ ratio on transthoracic echocardiogram was significantly higher in NASH compared to NAFL, advanced-stage NASH compared to early stage, and high-grade NASH compared to low-grade. The E/e’ ratio was also significantly higher in NASH than NAFL in patients without diabetes mellitus. The presence of diastolic dysfunction trended toward significance. The other markers of diastolic dysfunction were similar. Logistic regression revealed a statistical association with E/e' and NASH. @*Conclusions@#NASH patients had evidence of a higher E/e’ ratio than NAFL, and there was a trend towards a significant diastolic dysfunction. Patients with NASH compared to NAFL should be closely monitored for signs and symptoms of cardiac dysfunction.

Early Cardiac Dysfunction in Biopsy-proven Nonalcoholic Fatty Liver Disease / 대한소화기학회지

Background/Aims@#Nonalcoholic fatty liver disease (NAFLD) encompasses a range of diseases from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) and has been linked to cardiovascular disease and sub-clinical cardiac remodeling. This paper presents a retrospective study of biopsy-proven NAFL and NASH to examine the differences in subclinical cardiac remodeling. @*Methods@#Patients were recruited from an institutional repository of patients with liver-biopsy-confirmed NAFLD. Patients with a transthoracic echocardiogram (TTE) within 12 months of the liver biopsy were included. The parameters of the diastolic dysfunction were reviewed for the differences between NAFL and NASH as well as between the stages and grades of NASH. @*Results@#Thirty-three patients were included in the study, 17 with NAFL and 16 with NASH. The NASH patients were more likely to have lower platelets, higher AST, higher ALT, and higher rates of type 2 diabetes mellitus, coronary artery disease, and hypertension than the NAFL patients. The E/e’ ratio on transthoracic echocardiogram was significantly higher in NASH compared to NAFL, advanced-stage NASH compared to early stage, and high-grade NASH compared to low-grade. The E/e’ ratio was also significantly higher in NASH than NAFL in patients without diabetes mellitus. The presence of diastolic dysfunction trended toward significance. The other markers of diastolic dysfunction were similar. Logistic regression revealed a statistical association with E/e' and NASH. @*Conclusions@#NASH patients had evidence of a higher E/e’ ratio than NAFL, and there was a trend towards a significant diastolic dysfunction. Patients with NASH compared to NAFL should be closely monitored for signs and symptoms of cardiac dysfunction.

Development and External Validation of a Deep Learning Algorithm for Prognostication of Cardiovascular Outcomes

BACKGROUND AND OBJECTIVES@#We aim to explore the additional discriminative accuracy of a deep learning (DL) algorithm using repeated-measures data for identifying people at high risk for cardiovascular disease (CVD), compared to Cox hazard regression.@*METHODS@#Two CVD prediction models were developed from National Health Insurance Service-Health Screening Cohort (NHIS-HEALS): a Cox regression model and a DL model. Performance of each model was assessed in the internal and 2 external validation cohorts in Koreans (National Health Insurance Service-National Sample Cohort; NHIS-NSC) and in Europeans (Rotterdam Study). A total of 412,030 adults in the NHIS-HEALS; 178,875 adults in the NHIS-NSC; and the 4,296 adults in Rotterdam Study were included.@*RESULTS@#Mean ages was 52 years (46% women) and there were 25,777 events (6.3%) in NHIS-HEALS during the follow-up. In internal validation, the DL approach demonstrated a C-statistic of 0.896 (95% confidence interval, 0.886–0.907) in men and 0.921 (0.908–0.934) in women and improved reclassification compared with Cox regression (net reclassification index [NRI], 24.8% in men, 29.0% in women). In external validation with NHIS-NSC, DL demonstrated a C-statistic of 0.868 (0.860–0.876) in men and 0.889 (0.876–0.898) in women, and improved reclassification compared with Cox regression (NRI, 24.9% in men, 26.2% in women). In external validation applied to the Rotterdam Study, DL demonstrated a C-statistic of 0.860 (0.824–0.897) in men and 0.867 (0.830–0.903) in women, and improved reclassification compared with Cox regression (NRI, 36.9% in men, 31.8% in women).@*CONCLUSIONS@#A DL algorithm exhibited greater discriminative accuracy than Cox model approaches.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02931500

Development and External Validation of a Deep Learning Algorithm for Prognostication of Cardiovascular Outcomes

BACKGROUND AND OBJECTIVES: We aim to explore the additional discriminative accuracy of a deep learning (DL) algorithm using repeated-measures data for identifying people at high risk for cardiovascular disease (CVD), compared to Cox hazard regression.METHODS: Two CVD prediction models were developed from National Health Insurance Service-Health Screening Cohort (NHIS-HEALS): a Cox regression model and a DL model. Performance of each model was assessed in the internal and 2 external validation cohorts in Koreans (National Health Insurance Service-National Sample Cohort; NHIS-NSC) and in Europeans (Rotterdam Study). A total of 412,030 adults in the NHIS-HEALS; 178,875 adults in the NHIS-NSC; and the 4,296 adults in Rotterdam Study were included.RESULTS: Mean ages was 52 years (46% women) and there were 25,777 events (6.3%) in NHIS-HEALS during the follow-up. In internal validation, the DL approach demonstrated a C-statistic of 0.896 (95% confidence interval, 0.886–0.907) in men and 0.921 (0.908–0.934) in women and improved reclassification compared with Cox regression (net reclassification index [NRI], 24.8% in men, 29.0% in women). In external validation with NHIS-NSC, DL demonstrated a C-statistic of 0.868 (0.860–0.876) in men and 0.889 (0.876–0.898) in women, and improved reclassification compared with Cox regression (NRI, 24.9% in men, 26.2% in women). In external validation applied to the Rotterdam Study, DL demonstrated a C-statistic of 0.860 (0.824–0.897) in men and 0.867 (0.830–0.903) in women, and improved reclassification compared with Cox regression (NRI, 36.9% in men, 31.8% in women).CONCLUSIONS: A DL algorithm exhibited greater discriminative accuracy than Cox model approaches.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02931500

The world database for pediatric and congenital heart surgery: A collaboration with the Registro Nacional de Cirugía Cardiaca Pediátrica / La base de datos mundial de cirugía cardíaca pediátrica y congénita: una colaboración con el Registro Nacional de Cirugía Cardiaca Pediátrica (RENACCAPE)

Abstract Objective: Following the notable work accomplished by the Mexican Association of Specialists in Congenital Heart Disease (Asociación Mexicana de Especialistas en Cardiopatías Congénitas) with the development of a national registry for congenital cardiac surgery, the World Society for Pediatric and Congenital Heart Surgery has implemented an international platform to collect data and analyze outcomes of children with congenital heart disease. Methodology: This manuscript proposes a possible collaboration between Mexico's national congenital cardiac database (Registro Nacional de Cirugía Cardíaca Pediátrica) and the World Database for Pediatric and Congenital Heart Surgery. Conclusion: Such a partnership would advance the countries' desire for the ongoing development of quality improvement processes and improve the overall treatment of children with congenital heart disease.

Resumen Objetivo: Siguiendo el notable trabajo realizado por la Asociación Mexicana de Especialistas en Cardiopatías Congénitas (Asociación Mexicana de Especialistas en Cardiopatías Congénitas: AMECC) con el desarrollo de un registro nacional para la cirugía cardíaca congénita, la Sociedad Mundial de Pediatría y Cirugía Cardíaca Congénita ha implementado una plataforma internacional para recopilar datos y analizar los resultados de los niños con cardiopatía congénita. Metodología: Este manuscrito propone una posible colaboración entre la base nacional de datos cardiacos congénitos de México (RENACCAPE) y la Base de Datos Mundial para la Cirugía Cardíaca Pediátrica y Congénita (WDPCHS). Conclusión: Esta asociación promovería el deseo de los países de seguir desarrollando procesos de mejora de la calidad y mejorar el tratamiento general de los niños con cardiopatía congénita.

Cutaneous Patches to Monitor Myoelectric Activity of the Gastrointestinal Tract in Postoperative Pediatric Patients / 대한소아소화기영양학회지

PURPOSE: Limited means exist to assess gastrointestinal activity in pediatric patients postoperatively. Recently, myoelectric gastrointestinal activity recorded by cutaneous patches has been shown in adult patients to be predictive of clinical return of gastrointestinal function postoperatively. The aim of this case series is to demonstrate the feasibility of this system in pediatric patients and to correlate myoelectric signals with return of bowel function clinically. METHODS: Pediatric patients undergoing abdominal surgery were recruited to have wireless patches placed on the abdomen within two hours postoperatively. Myoelectric data were transmitted wirelessly to a mobile device with a user-interface and forwarded to a cloud server where processing algorithms identified episodes of motor activity, quantified their parameters and nominally assigned them to specific gastrointestinal organs based on their frequencies. RESULTS: Three patients (ages 5 months, 4 year, 16 year) were recruited for this study. Multiple patches were placed on the older subjects, while the youngest had a single patch due to space limitations. Rhythmic signals of the stomach, small intestine, and colon could be identified in all three subjects. Patients showed gradual increase in myoelectric intestinal and colonic activity leading up to the first recorded bowel movement. CONCLUSION: Measuring myoelectric intestinal activity continuously using a wireless patch system is feasible in a wide age range of pediatric patients. The increase in activity over time correlated well with the patients' return of bowel function. More studies are planned to determine if this technology can predict return of bowel function or differentiate between physiologic ileus and pathologic conditions.

Dementia among Older Persons in Jamaica: Prevalence and Policy Implications / La demencia entre las personas de edad en Jamaica: prevalencia e implicaciones para la implementación de políticas

ABSTRACT Objective: To determine the prevalence of dementia and dementia types in Jamaica. Methods: An embedded case-control design was used to investigate dementia within the ageing population. Cases (Mini-Mental State Examination [MMSE] scores of < 20) and controls (MMSE scores of > 20) were evaluated using DSM-IVprotocol and magnetic resonance imaging. Prevalences (crude and age-adjusted) were calculated and distribution of dementia by type described. Results: Dementia prevalence was 5.9%. Alzheimer's pattern dementia accounted for 61.8% and vascular dementia 32.4%. However, vascular disease was prominent in 45.5% of the Alzheimer's cases. Female gender and increasing age were associated with higher rates of dementia. Dementia was 38 times more likely in participants with MMSE scores below 20. Conclusion: This first nationally representative study indicated that dementia rates in Jamaica were comparable with regional and global estimates. Regardless of the dementia type, vascular change was pervasive and suggested that synergistic efforts should be made to address underlying contributory factors. Cardiovascular and cerebrovascular risk reduction should be deliberately pursued as integral adjuncts to dementia risk reduction.

RESUMEN Objetivo: Determinar la prevalencia de los tipos de demencia y demencia en Jamaica. Métodos: Se utilizó un diseño de caso-control incrustado para investigar la demencia dentro de la población en proceso de envejecimiento. Los casos (puntuación < 20 en el Mini Examen del Estado Mental [MEEM]) y los controles (puntuación > 20 en el MEEM) fueron evaluados usando el protocolo DSM-IVy la imagen por resonancia magnética. Se calcularon prevalencias (crudas y ajustadas por edad) y se describió la distribución de la demencia por tipo. Resultados: La prevalencia de demencia fue de 5.9%. El Alzheimer representó el 61.8% y la demencia vascular 32.4%. Sin embargo, la enfermedad vascular fue prominente en el 45.5% de los casos de Alzheimer. El género femenino y la edad creciente se asociaron con tasas más altas de demencia. La demencia fue 38 veces más probable en los participantes con puntuaciones de MEEM por debajo de 20. Conclusión: Este primer estudio nacionalmente representativo indicó que las tasas de demencia en Jamaica eran comparables con los estimados regionales y globales. Independientemente del tipo de demencia, el cambio vascular fue generalizado y sugirió que se hicieran esfuerzos sinérgicos para abordar los factores contribuyentes subyacentes. Debe buscarse deliberadamente la reducción del riesgo cardiovascular y cerebrovascular como adjuntos integrantes de la reducción del riesgo de demencia.

Resistance to sliding in orthodontics: misconception or method error? A systematic review and a proposal of a test protocol / 대한치과교정학회지

Resistance to sliding (RS) between the bracket, wire, and ligature has been largely debated in orthodontics. Despite the extensive number of published studies, the lack of discussion of the methods used has led to little understanding of this phenomenon. The aim of this study was to discuss variables affecting RS in orthodontics and to suggest an operative protocol. The search included PubMed©, Medline©, and the Cochrane Library©. References of full-text articles were manually analyzed. English-language articles published between January 2007 and January 2017 that performed an in vitro analysis of RS between the bracket, wire, and ligature were included. Study methods were analyzed based on the study design, description of materials, and experimental setup, and a protocol to standardize the testing methods was proposed. From 404 articles identified from the database search and 242 records selected from published references, 101 were eligible for the qualitative analysis, and six for the quantitative synthesis. One or more experimental parameters were incompatible and a meta-analysis was not performed. Major factors regarding the study design, materials, and experimental setup were not clearly described by most studies. The normal force, that is the force perpendicular to the sliding of the wire and one of the most relevant variable in RS, was not considered by most studies. Different variables were introduced, often acting as confounding factors. A protocol was suggested to standardize testing procedures and enhance the understanding of in vitro findings.

Evaluation of Atherosclerotic Plaque in Non-invasive Coronary Imaging

Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Over the last decade coronary computed tomography angiography (CCTA) has gained wide acceptance as a reliable, cost-effective and non-invasive modality for diagnosis and prognostication of CAD. Use of CCTA is now expanding to characterization of plaque morphology and identification of vulnerable plaque. Additionally, CCTA is developing as a non-invasive modality to monitor plaque progression, which holds future potential in individualizing treatment. In this review, we discuss the role of CCTA in diagnosis and management of CAD. Additionally, we discuss the recent advancements and the potential clinical applications of CCTA in management of CAD.

The World Database for Pediatric and Congenital Heart Surgery: Use of an International Congenital Database in South Korea / 대한흉부외과학회지

No abstract available.

Who Cares? Sociodemographic and Health Characteristics of Carers of Older Persons in Jamaica / ¿Quién cuida? Características Sociodemográficas y de Salud de los Cuidadores de Personas Mayores en Jamaica

ABSTRACT Objective: To describe the sociodemographic and health characteristics and implied needs of caregivers to older persons in Jamaica. Method: This was a community-based, nationally representative study in which a sample of 180 caregivers to older persons was interviewed. Findings: Caregivers were aged between 18 and 88 years (mean 50.5; s = 14.7) and most (77%) were informal compared to 23% who were paid to care. There were no differences between urban and rural caregivers with respect to gender, union status, residing with care recipients and holding a regular job while giving care. Urban caregivers were significantly more likely to report attaining secondary education than those in rural communities (χ2 (2) = 7.40, p < 0.05). Over 90% reported they had not received any formal training in caregiving and those ≤ 45 years were more likely than those in age groups ≥ 46 years to say they want to get caregiver training (χ2 (4) = 27.1, p < 0.001). Male caregivers were significantly more likely to report being the 'child/grandchild/in-law' of care recipients than female caregivers, among whom almost one in four reported their relationship as employee (Fisher's Exact test: p = 0.002). Most caregivers (51.7%) reported being diagnosed with one or more medical condition and 89% of those diagnosed reported being prescribed medications for their illnesses. Forty-five per cent of caregivers reported that they performed one or more activity of daily living (ADL) for their care recipients daily. Conclusion: Carers of older persons in Jamaica are predominantly family members, most have not received caregiving training and most have been diagnosed with a medical condition.

RESUMEN Objetivo: Describir las características sociodemográficas y de salud, así como las necesidades implícitas de los cuidadores de las personas mayores en Jamaica. Método: Se trata de un estudio comunitario representativo a nivel nacional, en el que se entrevista una muestra de 180 cuidadores de personas de edad. Resultados: Los cuidadores tenían entre 18 y 88 años (media 50.5; s.d. = 14.7) y la mayoría (77%) eran informales en comparación con el 23% que recibían pago por el cuidado. No hubo diferencias entre los cuidadores urbanos y rurales con respecto a género, estado civil, residir con las personas objeto del cuidado, y mantener un trabajo regular a la par con la atención a los ancianos. Los cuidadores urbanos presentaban una probabilidad significativamente mayor de haber alcanzado educación secundaria en comparación con aquellos de las comunidades rurales (χ2 (2) = 7.40, p < 0.05). Más del 90% reportó no haber recibido ninguna capacitación formal en cuidados, y aquellos con ≤ 45 años eran más propensos que los de los grupos de edad ≥ 46 años a decir que deseaban recibir entrenamiento como cuidadores (χ2 (4) = 27.1, p < 0.001). Los cuidadores hombres presentaban una probabilidad significativamente mayor de ser "hijo/nieto/yerno" de personas receptoras de cuidados, que las mujeres cuidadoras, entre las cuales casi una de cada cuatro reportó su relación como empleado (Prueba exacta de Fisher: p = 0.002). La mayoría de los cuidadores (51.7%) reportaron estar diagnosticados con una o más condiciones médicas, y el 89% de los diagnosticados reportaron recibir prescripciones de medicamentos para sus enfermedades. Cuarenta y cinco por ciento de los cuidadores informó realizar una o más actividades de la vida diaria (AVD) para las personas bajo su cuidado diariamente. Conclusión: Los cuidadores de personas mayores en Jamaica son en su mayoría miembros de la familia; la mayor parte de ellos no ha recibido capacitación como cuidadores; y la mayoría han sido diagnosticados con alguna condición médica.

Adult Obesity: Management Practices of General Practitioners/Family Physicians in Kingston and St Andrew, Jamaica / Obesidad en Adultos: Prácticas de su Tratamiento por Parte de los Médicos Generales/médicos de Familia en Kingston y Saint Andrew, Jamaica

ABSTRACT Objective: To determine the practices of Family Physicians/General Practitioners in Kingston and St Andrew regarding the management of adult obesity and compare their management to the 2013 American College of Cardiology/American Heart Association/Task Force on Practice Guidelines and The Obesity Society (AHA/ACC/TOS) Guidelines for the Management of Overweight and Obesity in Adults. Methods: A cross-sectional study was done of Family Physicians/General Practitioners in the Kingston and St Andrew area. A Census approach was used with the aid of a self-administered questionnaire and practices compared to the American Guidelines for Obesity Management. Results: There were 117 respondents out of the 155 Family physicians/General practitioners. While most physicians were found to have medium to high level practice scores, 23% had low practice scores. Diagnosis of obesity using body mass index (BMI) was high (99%), but only 64% employed hormonal assays. Almost 36% did not refer patients with BMI > 40 kg/m2 for bariatric surgery. Conclusion: Assessed against existing guidelines, physicians were found generally to have medium to high practice levels regarding management of obesity, however, gaps remain to be closed.

RESUMEN Objetivo: Determinar las prácticas de los médicos de familia/médicos generales en Kingston y Saint Andrew en relación con el tratamiento de la obesidad en adultos y comparar su tratamiento con las Pautas para el Tratamiento del Sobrepeso y la Obesidad en Adultos del Colegio Americano de Cardiología/Sociedad Americana del Corazón/Grupo de Trabajo para las Guías Prácticas y la Sociedad de la Obesidad (AHA/ACC/TOS) de 2013. Métodos: Se realizó un estudio transversal de médicos de familia/ médicos generales en el área de Kingston y Saint Andrew. Se usó un enfoque de censo con la ayuda de un cuestionario autoadministrado y prácticas comparadas a las pautas americanas para el tratamiento de la obesidad. Resultados: Hubo 117 encuestados provenientes de los 155 médicos de familia/médicos generales. Si bien se halló que la mayor parte de los médicos tenían niveles de medio a alto en las puntuaciones de la práctica, el 23% tenía puntuaciones bajas de la práctica. El diagnóstico de la obesidad usando el índice de masa corporal (IMC) fue alto (99%), pero solamente el 64% empleó ensayos hormonales. Casi el 36% no remitió pacientes con IMC > 40 kg/m2 para cirugía bariátrica. Conclusión: Evaluados frente a las pautas existentes, los médicos generalmente mostraron niveles de práctica medios a altos con respecto al tratamiento de la obesidad. Sin embargo, quedan aún vacíos por llenar.

Hypertension in Older Adults in Jamaica: Prevalence, Treatment and Control / La Hipertensión en los Adultos Mayores en Jamaica: Prevalencia, Tratamiento y Control

ABSTRACT Objective: To examine the prevalence, treatment and control and associated risk factors for hypertension among older adults in Jamaica. Methods: Four parishes in Jamaica were surveyed using a cross-sectional study design involving 2943 participants. The survey used a cluster sampling methodology with probability-proportional-to-size. A sub sample of 373 persons was randomly selected for assessment with regard to hypertension prevalence, treatment and control. Results: The sample consisted of 373 older adults with the majority (56.6%) being female. The age of the participants ranged from 60 to 100 years, with the median age being 70 (interquartile range = 13) years. Reported prevalence of hypertension was 61.7% and significantly (p < 0.001) more females than males (71.4% vs 49.1%, respectively) reported having hypertension. There was no significant difference in being diagnosed with hypertension by age groups, area of residence, highest level of education and union status. Among older adults who reported having hypertension, the majority (90.0%) were being treated while one in ten (10%) reported not being treated. "Based on the Eighth Joint National Committee (JNC-8) definition of control, among older adults who reported having hypertension, only slightly more than a third (34.8%) were controlled; the majority (65.2%) were uncontrolled. Conclusion: The low level of hypertension control documented is of concern given the availability of medication subsidies and the priority attention being given to chronic disease. Further research is needed regarding facilitators and barriers to hypertension control to identify the best interventions to increase control levels.

RESUMEN Objetivo: Examinar la prevalencia, tratamiento y control, así como los factores de riesgo asociados con la hipertensión entre los adultos mayores en Jamaica. Métodos: Cuatro parroquias en Jamaica fueron encuestadas usando un diseño de estudio transversal que abarcó 2943 participantes. La encuesta utilizó una metodología de muestreo por conglomerados con probabilidad proporcional al tamaño. Una submuestra de 373 personas fue seleccionada aleatoriamente para su evaluación con respecto a la prevalencia, tratamiento y control de la hipertensión. Resultados: La muestra constó de 373 adultos mayores, de los cuales la mayor parte (56. 6%) eran mujeres. La edad de los participantes fluctúo de 60 a 100 años, siendo la edad mediana 70 años (rango intercuartil = 13). La prevalencia de hipertensión reportada fue 61.7%, y significativamente (p < 0.001) más hembras que varones (71.4% vs 49.1%, respectivamente) reportaron tener hipertensión. No hubo diferencia significativa alguna en ser diagnosticado con hipertensión por grupos de edad, área de residencia, nivel más alto de educación, y estado de la unión. Entre los adultos mayores que reportaron tener hipertensión, la mayoría (90.0%) estaban siendo tratados, mientras que uno de cada diez (el 10%) reportaron no tener tratamiento. Basándose en la definición de control ocho del Comité Nacional Conjunto (JNC, siglas en inglés) entre los adultos mayores que reportaron tener hipertensión, sólo poco más de un tercio (34.8%) eran controlados. La mayoría (65.2%) no eran controlados. Conclusión: El bajo nivel de control de la hipertensión documentado es asunto de preocupación, dada la disponibilidad de subsidios para medicamentos y la atención prioritaria que se da a las enfermedades crónicas. Se necesitan investigaciones adicionales sobre facilitadores y barreras al control de la hipertensión para identificar mejores intervenciones para aumentar los niveles de control.

Sinking Teeth into Dental Health of Older Adults in Jamaica / Compromiso Entusiasta con la Salud Dental de los Adultos Mayores en Jamaica

ABSTRACT Objectives: To describe the prevalence of tooth loss, denture use and dental care utilization among older persons by age, gender, union, residence, education, chronic illness and health insurance status and to identify independent predictors of dental service use and tooth loss. Methods: A cross-sectional survey utilizing a nationally representative sample of 2943 older persons in Jamaica was conducted. Data related to tooth loss, dental care use and sociodemographic data were obtained. Relationships between variables were assessed in bivariate analyses and logistic regression models subsequently developed to identify predictors of tooth loss and dental care use. Results: Tooth loss (any) prevalence was 94% and among those who reported tooth loss, 61.1% had dentures: the majority of those with dentures reported using them. Non-use was mainly related to damaged denture or discomfort. Only 35% of persons reported a dental visit within the last 12 months. Age, union status and educational level were significant predictors of both tooth loss and dental visit within the past year. Additionally, gender, residence and having health insurance predicted dental care utilization. Conclusion: Dental health issues are important in the care of older persons and assume increasing relevance given rapid ageing of the population. Jamaica must craft strategies to address emergent needs in its response to the challenges of oral healthcare for older persons.

RESUMEN Objetivos: Describir la prevalencia de la pérdida de dientes, el uso de prótesis dentales, y la utilización de la atención dental entre las personas mayores por edad, género, estado civil, residencia, educación, enfermedad crónica, y posesión de seguro médico, e identificar predictores independientes de la utilización de la atención dental, así como de la pérdida de dientes. Métodos: Se realizó una encuesta transversal utilizando una muestra representativa de 2943 personas de edad a nivel nacional en Jamaica. Se obtuvo datos sobre la pérdida de dientes, el uso de los servicios dentales, y la demografía. Las relaciones entre las variables se evaluaron en análisis bivariados y modelos de regresión logística desarrollados posteriormente para identificar los predictores de la pérdida de dientes y la utilización de la atención dental. Resultados: La prevalencia de la pérdida de dientes (cualesquiera) fue 94%, y entre los que informaron pérdida de dientes, un 61.1% utilizaban prótesis dentales: la mayoría de los que utilizaban prótesis dentales reportaron su uso. El no uso se relacionó principalmente con prótesis dentales dañadas o molestias. Sólo el 35% de las personas reportaron una visita dental en los últimos 12 meses. La edad, el estado civil, y el nivel educacional fueron predictores significativos de la pérdida de dientes y la visita dental el año anterior. Además, el género, la residencia y la posesión del seguro médico fueron predictores de la utilización de la atención dental. Conclusión: Los problemas de salud dental son importantes en el cuidado de las personas de edad y adquieren una relevancia creciente dado el rápido envejecimiento de la población. Jamaica debe elaborar estrategias para abordar las necesidades emergentes en su respuesta a los desafíos de la salud oral de las personas mayores.

Evaluation of Atherosclerotic Plaque in Non-invasive Coronary Imaging

Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Over the last decade coronary computed tomography angiography (CCTA) has gained wide acceptance as a reliable, cost-effective and non-invasive modality for diagnosis and prognostication of CAD. Use of CCTA is now expanding to characterization of plaque morphology and identification of vulnerable plaque. Additionally, CCTA is developing as a non-invasive modality to monitor plaque progression, which holds future potential in individualizing treatment. In this review, we discuss the role of CCTA in diagnosis and management of CAD. Additionally, we discuss the recent advancements and the potential clinical applications of CCTA in management of CAD.

Atomic force microscopy correlates antimetastatic potentials of HepG2 cell line with its redox/energy status: effects of curcumin and Khaya senegalensis / 中西医结合学报

<p><b>OBJECTIVE</b>The fatality of cancer is mostly dependent on the possibility of occurrence of metastasis. Thus, if the development of metastasis can be prevented through novel therapeutic strategies targeted against this process, then the success of cancer treatment will drastically increase. In this study, therefore, we evaluated the antimetastatic potentials of an extract of Khaya senegalensis and curcumin on the metastatic liver cell line HepG2, and also assessed the anticancer property of the extract.</p><p><b>METHODS</b>Cells were cultured and treated with graded concentrations of test substances for 24, 48, or 72 h with provisions made for negative controls. Treated cells were assessed as follows: nanotechnologically - atomic force microscopy (AFM) was used to determine cell stiffness; biochemically - cell cytotoxicity, glutathione level and adenosine triphosphate status, caspase activation and mitochondrial toxicity were considered; and microbiologically - a carrot disk assay was used to assess the anticancer property of the extract of K. senegalensis.</p><p><b>RESULTS</b>Curcumin and K. senegalensis increased the cell stiffness by 2.6- and 4.0-fold respectively, indicating their antimetastatic effects. Corresponding changes in redox (glutathione level) and energy (adenosine triphosphate) status of the cells were also demonstrated. Further mechanistic studies indicated that curcumin was not mitotoxic in HepG2 cells unlike the K. senegalensis extract. In addition, the extract potently inhibited the Agrobacterium tumefaciens-induced genetic transformation based on carrot disk assay.</p><p><b>CONCLUSION</b>Cell elasticity measurement data, using AFM, strongly suggested, for the first time, that both curcumin and the extract of K. senegalensis exhibited antimetastatic properties on HepG2 cells.</p>

Cholesterol-loaded cyclodextrin in fresh goat sperm improves cryosurvival rates / Colesterol em sêmen caprino melhora a criopreservação

Este estudo teve como objetivo avaliar o efeito da adição do colesterol carreado com a ciclodextrina (CCC) sobre a melhoria da qualidade espermática após a descongelação. Trinta ejaculados foram diluídos, centrifugados e ressuspendidos com Tris para concentração de 120 x 106 células/mL. O sêmen foi tratado com 0, 0,75, 1,5, 3,0, 4,5, 6,0 ou 7,5 mg de CCC. Em seguida, as amostras foram resfriadas a 4°C durante 2 horas, diluídas com Tris-Gema de ovo e 2% de glicerol, envasadas e colocadas sobre o vapor do nitrogênio líquido (N2 ) por 20 min e depois mergulhadas no N2 . As amostras foram descongeladas a 37°C por 30s, e avaliadas quanto: o teste de termorresistência (TRT); motilidade progressiva utilizando CASA; teste hiposmótico e a capacidade de ligação dos espermatozoides à membrana perivitelina (MP). As variáveis foram analisadas por meio da ANOVA e os tratamentos comparados a 5% de probabilidade. A motilidade dos espermatozoides (50,4; 33,8 e 22,5%) foi maior nas amostras tratadas com 0,75 mg de CCC após 0, 60 e 120 min de incubação quando comparado com demais tratamentos (P<0,05). As amostras tratadas com 6,0 e 7,0 mg de CCC apresentaram maior dobramento de cauda que os demais tratamentos (P<0,05). A capacidade de ligação dos espermatozoides a MP foi maior no tratamento com 0,75 mg CCC comparado ao controle (166 vs 65; P <0,05). No entanto, quando o potencial de ligação dos espermatozoides foi determinado dividindo o número médio de espermatozoides ligados a MP sobre o percentual de espermatozoides móveis, o tratamento com CCC proporcionou maior eficiência (1,52) do que o controle (1,00; P < 0,05). A adição de 0,75 mg de CCC no sêmen fresco de caprino antes da criopreservação melhorou a motilidade espermática após a criopreservação até 2 horas.

Multimodality Imaging in Coronary Artery Disease: Focus on Computed Tomography

Coronary artery disease (CAD) is the leading cause of mortality worldwide, and various cardiovascular imaging modalities have been introduced for the purpose of diagnosing and determining the severity of CAD. More recently, advances in computed tomography (CT) technology have contributed to the widespread clinical application of cardiac CT for accurate and noninvasive evaluation of CAD. In this review, we focus on imaging assessment of CAD based upon CT, which includes coronary artery calcium screening, coronary CT angiography, myocardial CT perfusion, and fractional flow reserve CT. Further, we provide a discussion regarding the potential implications, benefits and limitations, as well as the possible future directions according to each modality.