O Impacto da COVID-19 no Diagnóstico de Doenças Cardíacas na América Latina Uma Subanálise do INCAPS COVID / The Impact of COVID-19 on Diagnosis of Heart Disease in Latin America an INCAPS COVID Sub-analysis

Resumo Fundamento A pandemia de COVID-19 interferiu na prestação de atendimento a doenças cardiovasculares na América Latina. No entanto, o efeito da pandemia nos volumes de procedimentos cardíacos diagnósticos ainda não foi quantificado. Objetivo Avaliar (1) o impacto de COVID-19 nos volumes de diagnóstico cardíaco na América Latina e (2) determinar sua relação com a incidência de casos de COVID-19 e as medidas de distanciamento social. Métodos A International Atomic Energy Agency realizou uma pesquisa mundial avaliando mudanças nos volumes diagnósticos cardíacos decorrentes da COVID-19. Foram obtidos os volumes diagnósticos cardíacos dos locais participantes para março e abril de 2020 e comparados com março de 2019. Foram coletados dados de distanciamento social a partir dos Relatórios de mobilidade da comunidade de Google e a incidência de COVID-19 por país a partir de Our World in Data. Resultados Foram realizadas pesquisas em 194 centros que realizam procedimentos diagnósticos cardíacos, em 19 países da América Latina. Em comparação com o mês de março de 2019, os volumes dos procedimentos diagnósticos cardíacos diminuíram 36% em março de 2020 e 82% em abril de 2020.As maiores reduções ocorreram em relação aos testes de estresse ecocardiográfico (91%), testes ergométricos de esteira (88%) e escore de cálcio por tomografia computadorizada (87%), com pequenas variações entre as sub-regiões da América Latina. As mudanças em padrões de distanciamento social (p < 0,001) estavam mais fortemente associadas com a redução do volume do que a incidência de COVID-19 (p = 0,003). Conclusões A COVID-19 foi associada a uma redução significativa de procedimentos diagnósticos cardíacos na América Latina, a qual foi mais relacionada ao distanciamento social do que ao aumento da incidência da COVID-19. São necessários melhor equilíbrio e timing de medidas de distanciamento social e planejamento para manter o acesso ao atendimento médico durante um surto pandêmico, especialmente em regiões com alta mortalidade cardiovascular.

Abstract Background The COVID-19 pandemic has disrupted the delivery of care for cardiovascular diseases in Latin America. However, the effect of the pandemic on the cardiac diagnostic procedure volumes has not been quantified. Objective To assess (1) the impact of COVID-19 on cardiac diagnostic volumes in Latin America and (2) determine its relationship with COVID-19 case incidence and social distancing measures. Methods The International Atomic Energy Agency conducted a worldwide survey assessing changes in cardiac diagnostic volumes resulting from COVID-19. Cardiac diagnostic volumes were obtained from participating sites for March and April 2020 and compared to March 2019. Social distancing data were collected from Google COVID-19 community mobility reports and COVID-19 incidence per country from the Our World in Data. Results Surveys were conducted in 194 centers performing cardiac diagnostic procedures, in 19 countries in Latin America. Procedure volumes decreased 36% from March 2019 to March 2020, and 82% from March 2019 to April 2020. The greatest decreases occurred in echocardiogram stress tests (91%), exercise treadmill tests (88%), and computed tomography calcium scores (87%), with slight variations between sub-regions of Latin America. Changes in social distancing patterns (p < 0.001) were more strongly associated with volume reduction than COVID-19 incidence (p = 0.003). Conclusions COVID-19 was associated with a significant reduction in cardiac diagnostic procedures in Latin America, which was more related to social distancing than to the COVID-19 incidence. Better balance and timing of social distancing measures and planning to maintain access to medical care is warranted during a pandemic surge, especially in regions with high cardiovascular mortality.

Early Pregnancy Maternal Hepatocyte Growth Factor and Risk of Gestational Diabetes.

Aims: We investigated associations of serum hepatocyte growth factor (HGF) with risk of gestational diabetes mellitus (GDM). We also examined whether pre-pregnancy overweight/obesity status or leisure-time physical activity (LTPA) modify these associations. Methods: In a nested case-control study (173 GDM cases and 187 controls) among participants of a pregnancy cohort, early pregnancy (16 weeks of gestation, on average) serum HGF was measured using enzyme-linked immunoassay. GDM was diagnosed using American Diabetes Association guidelines. Logistic regression was used to calculate odd ratios (ORs) and 95% confidence intervals (CI). Effect modifications by pre-pregnancy overweight/obesity status or LTPA during pregnancy were examined using stratified analyses and interaction terms. Results: Overall, we did not find significant associations of serum HGF with GDM risk (pvalue> 0.05). However, compared with women who had low serum HGF concentrations (<2.29 ng/ml), women with high serum HGF concentrations (≥ 2.29 ng/ml) had 3.8-fold (95%CI: 1.30- 10.98) and 4.5-fold (95%CI: 1.28-15.80) higher GDM risk among women who were overweight/obese, pre-pregnancy (body mass index≥25 kg/m2), or did not report LTPA, respectively. These associations were not present among women who were not overweight/obese (interaction p=0.05) or reported LTPA (interaction p=0.05). Conclusion: Overweight/obesity status and LTPA may modify associations of early pregnancy serum HGF with subsequent GDM risk.

Inactivation of Tor proteins affects the dynamics of endocytic proteins in early stage of endocytosis.

Tor2 is an activator of the Rom2/Rho1 pathway that regulates α-factor internalization. Since the recruitment of endocytic proteins such as actin-binding proteins and the amphiphysins precedes the internalization of α-factor, we hypothesized that loss of Tor function leads to an alteration in the dynamics of the endocytic proteins. We report here that endocytic proteins, Abp1 and Rvs167, are less recruited to endocytic sites not only in tor2 but also tor1 mutants. Furthermore, we found that the endocytic proteins Rvs167 and Sjl2 are completely mistargeted to the cytoplasm in tor1Δtor2ts double mutant cells. We also demonstrate here that the efficiency of endocytic internalization or scission in all tor mutants was drastically decreased. In agreement with the Sjl2 mislocalization, we found that in tor1Δtor2ts double mutant cells, as well as other tor mutant cells, the overall PIP2 level was dramatically increased. Finally, the cell wall chitin content in tor2ts and tor1Δtor2ts mutant cells was also significantly increased. Taken together, both functional Tor proteins, Tor1 and Tor2, are essentially required for proper endocytic protein dynamics at the early stage of endocytosis.

Vps1 in the late endosome-to-vacuole traffic.

Vacuolar protein sorting 1 (Vps1), the yeast homolog to human dynamin, is a GTP hydrolyzing protein, which plays an important role in protein sorting and targeting between the Golgi and late endosomal compartments. In this study, we assessed the functional significance of Vps1 in the membrane traffic towards the vacuole. We show here that vps1Δ cells accumulated FM4-64 to a greater extent than wild-type (WT) cells, suggesting slower endocytic degradation traffic toward the vacuole. In addition, we observed that two endosome-to-vacuole traffic markers, DsRed-FYVE and Ste2-GFP, were highly accumulated in Vps1-deficient cells, further supporting Vps1’s implication in efficient trafficking of endocytosed materials to the vacuole. Noteworthy, a simultaneous imaging analysis in conjunction with FM4-64 pulse-chase experiment further revealed that Vps1 plays a role in late endosome to the vacuole transport. Consistently, our subcellular localization analysis showed that Vps1 is present at the late endosome. The hyperaccumulation of endosomal intermediates in the vps1 mutant cells appears to be caused by the disruption of integrity of HOPS tethering complexes, manifested by mislocalization of Vps39 to the cytoplasm. Finally, we postulate that Vps1 functions together with the Endosomal Sorting Complex Required for Transport (ESCRT) complex at the late endosomal compartments, based on the observation that the double mutants, in which VPS1 along with singular ESCRT I, II and III genes have been disrupted, exhibited synthetic lethality. Together, we propose that Vps1 is required for correct and efficient trafficking from the late endosomal compartments to the vacuole.

Association of high sensitivity C-reactive protein concentrations and metabolic syndrome among Thai adults.

Background: Limited information is available regarding associations of metabolic syndrome with C-reactive protein (CRP) concentrations among Asian populations. Objective: Investigate the association of high sensitivity CRP (hsCRP) concentrations and metabolic syndrome among Thai adults. Methods: This cross-sectional study was comprised of 467 Thai participants (209 men and 258 women) receiving annual health check-up. Spearman’s rank correlation coefficients were used to assess the associations between metabolic parameters (age, waist circumference, blood pressure, triglycerides, HDL-C, fasting plasma glucose, fasting insulin and uric acid) with hsCRP concentrations for men and women, respectively. Multivariable logistic regression procedures were used to estimate the risk (odds ratios (OR), and 95% confidence intervals (CI) of metabolic syndrome according to low, moderate, and high hsCRP concentrations (<1.0, 1.0-3.0, and >3.0 mg/L, respectively). Results: Measures of adiposity and fasting insulin were positively and significantly correlated with hsCRP concentrations among women with and without metabolic syndrome. Similar associations were observed among men without metabolic syndrome. After controlling for confounders, moderately elevated hsCRP concentrations were associated with a 2.38-fold increased risk of metabolic syndrome (OR=2.38, 95%CI=1.20-4.72) among men. Men with high hsCRP concentrations had a 5.45-fold increased risk of metabolic syndrome (OR=5.45, 95%CI=2.24- 13.27) when compared with those who had low hsCRP concentrations. The corresponding OR for women with moderately elevated and high hsCRP concentrations were 4.92 (OR=4.92, 95%CI=2.34-10.35) and 11.93 (OR=11.93, 95%CI=5.54-25.72), respectively. Conclusions: These findings are consistent with the literature suggesting a role of hsCRP as a biomarker for metabolic syndrome.

Risk of dyslipidemia in relation to level of physical activity among Thai professional and office workers.

We completed a cross-sectional study of 1,608 Thai participants (536 men and 1,072 women) receiving annual health check-ups to evaluate the relation between physical activity levels and fasting serum concentrations of total cholesterol (TCH), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), and the total cholesterol: high density lipoprotein-cholesterol (TCH:HDL-C) ratio. Physical activity levels were assessed using a self-administered questionnaire administered at the time of blood collection. After controlling for confounders, men who reported high physical activity levels had on average a 3.42 mg/dl higher (p = 0.020) in HDL-C concentrations, when compared to men who reported low physical activity levels. Higher mean HDL-C concentrations were also observed for women who reported high physical activity levels, when compared with their less active counterparts (4.24 mg/dl, p = 0.004). TG concentrations were 30.92 mg/dl lower in men (p = 0.029) and 12.83 mg/dl lower in women (p = 0.003) who had high physical activity levels when compared with less active individuals. Men who reported high physical activity levels, compared with those who reported low physical activity levels, had a 59% reduction in risk for hypertriglyceridemia (OR = 0.41, 95% CI: 0.24-0.70). The corresponding OR for women was 0.43 (95% CI: 0.21-0.88). No association was found between physical activity levels and TCH concentrations. Overall, these data suggest that habitually active men and women are less likely to have hypertriglyceridemia and low HDL-C concentrations. The favorable effects of physical activity on lipid and lipoprotein concentrations are consistent with the evidence documenting the cardiovascular health benefits of physically active lifestyles.

Prevalence of metabolic syndrome among professional and office workers in Bangkok, Thailand.

OBJECTIVE: To estimate the prevalence of metabolic syndrome (MetS) among Thai professional and office workers and to compare the prevalence with other populations. MATERIAL AND METHOD: The authors conducted a cross-sectional study of 1,339 professional and office workers (535 men and 804 women) who participated in the annual health examinations at the Mobile Health Checkup Unit of King Chulalongkorn Memorial Hospital in Bangkok, Thailand during the period of August through December 2001. MetS was defined using the modified NCEP ATP III criteria. Chi-square tests were used to evaluate differences in distribution of covariates for affected and unaffected patients. RESULTS: The prevalence of MetS among Thai professional and office workers was 15.2% and approximately 3 times more common among men than women (25.8% vs. 8.2%). Men and women with MetS were older (p < 0.05) and were less well-educated (p < 0.05) than those without MetS. The three most common metabolic abnormalities in men were high blood pressure (45.0%), BMI > or = 25 kg/m2 (40.7%) and hypertriglyceridemia (38.7%). Among women, high blood pressure (22.8%), BMI > or = 25 kg/m2 (20.9%) and low HDL-Cholesterol (18.4%) were the most common metabolic abnormalities noted. CONCLUSION: The prevalence of MetS in this cohort of Thai professional and office workers was as high as those observed in developed countries. These findings emphasize the urgent need to develop strategies for the detection, treatment, and prevention of MetS. Such efforts will contribute to attenuating the incidence of cardiovascular disease and diabetes.

Prevalence and risk factors of hypercholesterolemia among Thai men and women receiving health examinations.

The purpose of our study was to evaluate risk factors for hypercholesterolemia and correlates of serum lipid concentrations in Thai men and women. A cross-sectional study was conducted in 1392 patients (380 men and 1012 women) who received health examinations during July 1999 - February 2000 at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Serum total cholesterol (TC), triglyceride (TG) and high density lipoprotein- cholesterol (HDL-C) concentrations were determined using standard procedures. Logistic and linear regression procedures were used to assess the association of several covariates with risk for hypercholesterolemia. The results reveal that the prevalences of hypercholesterolemia (TC > or =200 mg/dl) among men and women were 66.8% and 66.0%, respectively. Among men, hypercholesterolemia was associated with older adults (OR = 3.26), and previous alcohol consumption (OR = 2.05). Risk factors for women included advanced age (OR = 3.19), and a family history of dyslipidemia (OR = 1.59). Serum TC and TG were positively associated with age and previous alcohol consumption among men. Among women, TC and TG were strongly associated with age, body mass index (BMI) and family history of dyslipidemia. In men and women, HDL-C was inversely associated with BMI. More emphasis should be placed on understanding the epidemiology of hypercholesterolemia and other dyslipidemias in Thai men and women. More information regarding risk factors will aid in the development of effective health promotion and disease prevention efforts.

Risk factors of hypertension and correlates of blood pressure and mean arterial pressure among patients receiving health exams at the Preventive Medicine Clinic, King Chulalongkorn Memorial Hospital, Thailand.

OBJECTIVE: The purpose of the present cross-sectional study was to determine the relevance of several risk factors for hypertension in a Thai population. MATERIAL AND METHOD: The authors used multiple linear regression to identify factors that influenced systolic blood pressure(SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) in a study of 1,398 patients. RESULTS: Hypertensive risk factors were similar among men and women. Increased age, body mass index (BMI), and low educational attainment, were statistically significant risk factors for hypertension in men. For example, overweight men (BMI = 25.0-29.9 kg/m2) were 1.88 times more likely to be hypertensive (OR = 1.88, 95%CI = 1.02-3.47) as compared with men who had a normal BMI (20.0-24.9 kg/m2). Obese men (> or = 30.0 kg/m2) had an increased risk, but this association was not significant (OR = 1.40, 95%CI = 0.34-5.69). Similar risk factors were identified among women. Overweight women had a 1.74-increased risk for hypertension (OR = 1.74, 95%CI = 1.13-2.69). The corresponding risk was increased 3-fold among obese women (OR = 3.05, 95%CI = 1.76-5.29). Among men, age and BMI were positively associated with increased SBP, DBP and MAP Men > or = 60 years of age had an increase in SBP (beta = 18.89, p < 0.001), DBP (beta = 5.53, p < 0.001), and MAP (beta = 9.89, p < 0.001) values as compared with the referent group (< 40 years). Similar associations were noted among women. CONCLUSION: Hypertension risk factors observed in this Thai population are similar to those found in Western populations. Prospective studies are needed to evaluate rigorously causal relationships between risk factors and hypertension.

Nivel de conocimiento sobre el cáncer cervical y el papanicolaou en relación al temor, estrés o verguenza al tamizaje: estudio transversal en una comunidad pobre / Level of knowledge on the cervical neoplasms and the papanicolaou in relation to the dread, stress or shame to the straining: transverse study in a poor community

Objetivo: Evaluar la asociación entre el nivel de conocimientos sobre cáncer cervical y Papanicolaou (Pap) con el miedo, estrés o verguenza asociados a este tamizaje. Diseño: Estudio descriptivo transversal, prospectivo basado en comunidad. Material y Métodos: Usando muestreo aleatorio por conglomerados, se entrevistó mujeres de una comunidad pobre de Lima, evaluando su nivel de conocimientos sobre cáncer cervical y Papanicolaou y su percepción sobre este tamizaje. Se usó chi cuadrado, Odds ratios, intervalos de confianza al 95 por ciento y regresión logística para evaluar la asociación en estudio. Resultados: De 300 mujeres entre 18 y 50 años, 20 por ciento habia tenido su último Pap hacía más de dos años y 20 por ciento nunca se lo había realizado; 57 (19 por ciento) mujeres refirieron tener mucho miedo, estrés o verguenza al tamizaje, lo cual estuvo asociado a ser adolescente (OR 5,5 IC95 por ciento 1,8-16,9), tener cinco o menos años de vivir en Lima desde haber llegado del interior del país (OR 2,6,IC95 por ciento 1,3-5,2), no haber tenido pareja sexual durante el último año (OR 2,1,IC 95 por ciento 1,1-7,6), no embarazos previos (OR 3,1, IC 95 por ciento 1,2-8,0), no tener Pap previo (OR 4,7,IC 95 por ciento 1,9-8,7) y el bajo o regular conocimiento sobre el Papanicolaou o el cáncer de cérvix (OR 4,1,IC 95 por ciento 2,2-7,9). Durante el análisis multivariado, persistieron asociados el ser adolescente y el bajo o regular nivel de conocimiento sobre el Pap y el cáncer de cérvix. Conclusión: Se recomienda informar a la comunidad sobre la prueba de Pap y cáncer cervical para mejorar las actitudes negativas asociadas al tamizaje.