Prevalence and factors associated with latent autoimmune diabetes in adults (LADA): a cross-sectional study.

BACKGROUND: The Latent Autoimmune Diabetes in Adults (LADA) is a slowly progressive Type 1 diabetes subgroup with onset during middle age. Studies report that about 10% of adults initially diagnosed with clinical Type 2 diabetes (T2D) have LADA. Inappropriate diagnosis and mismanagement of the LADA can increase the risk of diabetic complications, which affect the quality of life and is the cause of increased mortality. In low-income countries setting, data regarding the magnitude of LADA is limited. We carried out this study to estimate the burden of misdiagnosed LADA among T2D patients in selected health facilities in Dar es Salaam and to bring awareness to the use of Glutamic Acid Decarboxylase (GAD) autoantibody in screening for LADA. METHODOLOGY: We enrolled 186 phenotypically T2D patients in this cross-sectional study, through a standardized data collection tool we obtained participants' demographic and clinical information. For testing GAD levels, we used a double-antibody Enzyme-Linked Immunosorbent Assay (ELISA). The Fisher's Exact and student t-tests were used to test the significance of the statistical associations of the glycaemic control and diabetes complications between T2D and LADA. RESULTS: Out of 186 patients, 156 gave conclusive GAD Ab ELISA reading with LADA accounting for 5.1% (95% CI: 2.5 - 10.0). The mean age of subjects was 54.3 years (Range: 33-85 years). The parameters such as mean age, family history of diabetes mellitus status, Fasting Blood Glucose, clinical characteristics, and complications did not show significant statistical differences between patients with LADA and Type 2 diabetes. However, all LADA- Human Immunodeficiency Virus (HIV) comorbid patients had retinopathy, which was statistically insignificant in 20 (87%) T2D-HIV comorbid patients (p = 0.669). Neither neuropathy, nephropathy, nor Diabetic Mellitus (D.M.) foot syndrome was observed among LADA-HIV comorbid patients. Nevertheless, 22 (95.7%), 3 (13%), and 2 (8.7%) of T2D-HIV comorbidity had neuropathy, nephropathy, or D.M. foot syndrome, respectively. CONCLUSIONS: The study established a LADA prevalence of 5.1% among T2D patients and has shown the role of GAD autoantibody in the screening for LADA. The study calls for a well- designed larger longitudinal study to generate strong evidence on the association of risk factors and complications associated with the LADA. This will develop robust evidence on the association of risk factors and complications associated with the LADA and T2D.

Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them.

INTRODUCTION AND AIMS: Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. MATERIALS AND METHODS: A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. RESULTS: The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2 months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. CONCLUSIONS: A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.

Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them. / Evaluación de fibrosis en pacientes con enfermedad por hígado graso no alcohólico: adherencia a los algoritmos propuestos y barreras para cumplir con ellos.

INTRODUCTION AND AIMS: Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. MATERIALS AND METHODS: A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. RESULTS: The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. CONCLUSIONS: A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.

Access to direct-acting antivirals for the treatment of hepatitis C in a country with limited resources. / Evaluación del acceso a antivirales para el tratamiento de la hepatitis C en un país con recursos limitados.

AIMS: To estimate the number of patients that have access to treatment of hepatitis C with direct-acting antivirals in Argentina and evaluate the factors associated with the lack of access. MATERIALS AND METHODS: A cross-sectional cohort study was conducted that included all the consecutive prescriptions of direct-acting antivirals issued at health centers that participated in the ECHOTM telemedicine project directed by the Hospital Italiano de Buenos Aires, within the time frame of January 2016 and February 2017. RESULTS: A total of 143 treatment prescriptions were included and overall access was 70% (95% CI 62-77%). The only independent factor associated with a lack of treatment access was coverage by a public healthcare system (OR 4.98 [95% CI 2.05- 12.09]). CONCLUSION: Patients with hepatitis C that were covered by a public healthcare system had a 4 times higher chance of not having access to treatment with direct-acting antivirals than patients covered by other healthcare systems (private insurance or the social welfare system).

Risk factors for severe complications of the novel influenza A (H1N1): analysis of patients hospitalized in Italy.

Eighty-one patients affected by the novel influenza A (H1N1), hospitalized in North-western Italy, were studied. The median age was 32 years (range 1-81 years). Fifty-six (69%) had an underlying medical condition, including lung disorders (asthma or chronic obstructive pulmonary disease) in 34% and obesity in 25%. Fifty percent of them had pneumonia, 12% were admitted to the intensive care unit and 3% died. Antiviral treatment was initiated in 75% of patients started within 48 h. Older age and lung and neurocognitive disorders were associated with severe disease and death.

Late occurrence of pleural and peritoneal effusion due to Mycobacterium tuberculosis infection (TB) in a patient with posttransplantation recurrent HCV chronic hepatitis: safety of peginterferon and ribavirin treatment after recovery of TB:- a case report.

The late occurrence of a large and often long-lasting effusion in the pleural and peritoneal cavities after liver transplantation is an uncommon and poorly understood complication. Even rarer (<1%) is the incidence of Mycobacterium tuberculosis (MT) in Western world series. Herein we have described a case of massive pleural effusion and ascites due to MT occurring 22 months after liver transplantation for hepatitis C virus (HCV) cirrhosis. The infection was successfully treated with no hepatotoxicity or rejection, so that it was possible to start antiviral treatment with peginterferon and ribavirin for recurrent HCV without reactivation of MT infection.

[Substance use and risk behaviors of out-of-treatment cocaine base paste and cocaine hydrochloride users]. / Consumo de sustancias y conductas de riesgo en consumidores de pasta base de cacaína no consultantes a servicios de rehabilitación.

BACKGROUND: In Chile, cocaine base paste (CBP) is the illegal substance that produces the highest rate of addiction. Nonetheless, a marginal number of users receive treatment each year. AIM: To compare the consumption patterns and risk behavior of CBP and cocaine hydrochloride (CH) users who do not attend rehabilitation services. MATERIAL AND METHODS: In a prospective research design, through a study methodology called Privileged Access Interview of hidden populations, 28 surveyors recruited 231 CBP users (group 1) and 236 CH users (group 2). The Risk Behavior Questionnaire was applied in four communities of Metropolitan Santiago, that have the highest prevalence of PBC and CH use. RESULTS: CBP users showed higher schools drop-out and unemployment rates. Subjects of both groups were predominantly polysubstance and polyaddicted users. The severity of addiction to CBP of group 1 was significantly higher than the severity of addiction to CH of group 2 (5.5 versus 5.1: p<0.001). CBP users showed significantly higher rates of sexual risk behaviors, antisocial behavior, self infliction of injuries, suicide attempt and child neglect. CONCLUSIONS: A higher vulnerability was shown for users of CBP than those of CH. Attention is drawn to the need for developing community interventions in order to alter substance abuse and the risk behavior of these vulnerable groups.

Consumo de sustancias y conductas de riesgo en consumidores de pasta base de cacaína no consultantes a servicios de rehabilitación / Substance use and risk behaviors of out-of-treatment cocaine base paste and cocaine hydrochloride users

Background: In Chile, cocaine base paste (CBP) is the illegal substance that produces the highest rate of addiction. Nonetheless, a marginal number of users receive treatment each year. Aim: To compare the consumption patterns and risk behavior of CBP and cocaine hydrochloride (CH) users who do not attend rehabilitation services. Material and Methods: In a prospective research design, through a study methodology called Privileged Access Interview of hidden populations, 28 surveyors recruited 231 CBP users (group 1) and 236 CH users (group 2). The Risk Behavior Questionnaire was applied in four communities of Metropolitan Santiago, that have the highest prevalence of PBC and CH use. Results: CBP users showed higher schools drop-out and unemployment rates. Subjects of both groups were predominantly polysubstance and polyaddicted users. The severity of addiction to CBP of group 1 was significantly higher than the severity of addiction to CH of group 2 (5.5 versus 5.1: p<0.001). CBP users showed significantly higher rates of sexual risk behaviors, antisocial behavior, self infliction of injuries, suicide attempt and child neglect. Conclusions: A higher vulnerability was shown for users of CBP than those of CH. Attention is drawn to the need for developing community interventions in order to alter substance abuse and the risk behavior of these vulnerable groups.

A randomized trial of pegylated-interferon-alpha2a plus ribavirin with or without amantadine in the re-treatment of patients with chronic hepatitis C not responding to standard interferon and ribavirin.

BACKGROUND: There is yet no established treatment for chronic hepatitis C patients non-responder to standard interferon and ribavirin. AIM: To evaluate efficacy and safety of pegylated-interferon-alpha2a plus ribavirin with or without amantadine in such patients. METHODS: 161 non-responders to standard interferon and ribavirin were randomized into two groups: 81 patients (Group 1) were given weekly Peg-IFN-alpha2a 180 microg plus ribavirin 1,000-1,200 mg/daily for 12 months, 80 patients (Group 2) received weekly Peg-IFN-alpha2a 180 microg plus ribavirin 1,000-1,200 mg/daily and amantadine 200 mg/daily for 12 months. RESULTS: At the end of follow-up, HCV-RNA was negative in 29.6% of Group 1 and in 21.2% of Group 2 patients (P = 0.22). Patients with genotypes 1 and 4 responded better to bi-therapy (21.7%) than to triple therapy (17.3%, P = 0.5) while among patients with genotypes 2 and 3 there was a trend towards a higher sustained virological response rate when retreated with triple treatment (80% vs. 75%, P = 0.82). On multivariate analysis, genotype 1 or 4, high body mass index and >20% reduction of Peg-interferon were associated with the treatment failure. CONCLUSIONS: The addition of amantadine does not improve the overall SVR rate in non-responder patients retreated with Peg-IFN and ribavirin; however, about 30% of non-responders may achieve a sustained response, in particular patients with genotypes 2 and 3 show a high SVR (75%).

Patrones de consumo de sustancias de una muestra no consultante de consumidores de pasta base de cocaína / Patterns of substance use of out-of-treatment cocaine base paste users

Introducción: En Chile, el consumo de Pasta Base de Cocaína (PBC) se ha asociado a marginalidad y micronarcotráfico. Es posible que en nuestro país exista una población de consumidores de PBC oculta a los estudios de población general y a los servicios sanitarios. El objetivo fue caracterizar una muestra de consumidores de PBC que no han recibido tratamiento reciente por abuso de sustancias utilizando la Entrevista de Acceso Privilegiado. Método: Se entrenaron 9 entrevistadores, con acceso a consumidores de PBC en las comunas de San Joaquín y La Pintana, en la administración de una encuesta sobre patrones de consumo y conductas de riesgo. Resultados: se reclutaron 160 sujetos con una mediana de edad de 21 años (mín: 12; máx: 46) de los cuales 99 fueron hombres (61,9 por ciento). La PBC fue la sustancia primaria de consumo en 136 sujetos (85 por ciento) con una mediana de días de consumo en el último mes de 23 (mín: 1; máx: 30) y una cantidad mediana de consumo de 4,2 gr/día (mín: 1; máx: 75). La edad mediana de inicio de consumo de PBC fue de 16 años (mín: 8; máx: 37). Conclusiones: el patrón de consumo de sustancias de esta muestra no consultante parece ser de mayor severidad que el patrón de consumo de una muestra de población general reportada en el Estudio Nacional de consumo de Sustancias (CONACE 2000) en las mismas comunas. La muestra descrita, o parte de ella, pudiera constituir una población oculta de consumidores de PBC.

Background: In Chile, crack or free-base Cocaine (FBC) use is associated with social isolation and drug traffic. This fact might be conditioning a hidden population of CBP users. The aim of the study was to characterize a sample of out-of-treatment CBP users by means of Privileged Access Interviewing in two districts of Santiago. Methods: Nine privileged access interviewers were trained to administer a questionnaire about substance use patterns and related risk behaviors. Results: 160 CBP users were recruited. The median age of the sample was 21 years (min: 12; max: 46). Gender distribution was 61,9 percent male. CBP was the primary abused substance in 85 percent of the sample. The median days of use in the last month was 23 days (min: 0; max: 30) and the median daily dose in the last month was 4,2 gr/day (min:0; max:75). The median age of onset of CBP use was 16 years (min: 8; max: 37). Conclusions: The pattern of substance use of this out-of-treatment sample seems to be more serious than the pattern of a general population sample reported by a National Survey in the same territorial areas. This sample, or part of it, might be a hidden population of CBP users.

Bioecology and vectorial capacity of Aedes albopictus (Diptera: Culicidae) in Macao, China, in relation to dengue virus transmission.

Until 2001, the Chinese Territory of Macao had not registered any autochthonous dengue cases, despite the abundance of Aedes albopictus (Skuse), a known vector. This work describes a bioecological characterization of the local Ae. albopictus adult population, with the purpose of estimating the receptivity of Macao to dengue introduction. In the wet seasons of 1997 and 1998 and the dry season of 1998, Ae. albopictus was the most abundant human-biting mosquito. Daily biting rates of 314 mosquitoes per person were recorded in the wet season with a reduction to 94 in the dry season. Ae. albopictus was mainly exophagic and exophilic and had a human blood index of 44%. The parity rate of field-collected mosquitoes was 57%. Daily survival rate ranged from 91 to 97%. Estimates of vectorial capacity ranged from 144 to 880, depending on what parameter values were used. These estimates indicated a great receptivity for the introduction of dengue viruses, as the 2001 outbreak came to prove.

Implementación de la entrevista de acceso privilegiado para caracterizar consumidores de pasta base de cocaína / Using privileged access interviewing to identify crack cocaine users

Introducción. En Chile, es posible que parte de los consumidores de pasta base de cocaína (PBC) estén ocultos dada la asociación del consumo de esta sustancia con pobreza y micronarcotráfico. La entrevista de acceso privilegiado es un método utilizado en la exploración de poblaciones ocultas. Objetivo. Implementar en Chile la entrevista de acceso privilegiado para contactar consumidores de PBC sin tratamiento en el último año. Método. Se seleccionaron y entrenaron potenciales entrevistadores de acceso privilegiado (EAPs) en las comunas La Pintana y San Joaquín para la realización de una encuesta de conductas de riesgo a consumidores crónicos de PBC en su medio natural. Resultados. Se contactaron 27 sujetos de los cuales se seleccionaron 17 entrevistadores. Participaron efectivamente en el estudio 9 sujetos (52,9 por ciento) con una edad mediana de 21 años (mín: 20, máx: 28). Un total de 160 encuestas cumplieron los mecanismos de control de confiabilidad en un plazo de 7 meses. Los EAPs de sexo femenino reclutaron el 59,2 por ciento de la muestra. Los EAPs hombres reclutaron sujetos con mayor frecuencia de conductas antisociales y conductas sexuales de riesgo que las entrevistadoras mujeres. Discusión. La utilización de la entrevista de acceso privilegiado fue un método rápido, seguro y confiable para la obtención de información de consumidores de PBC que no han consultado a servicios de rehabilitación, pudiendo constituirse como un método de estudio sistemático de poblaciones ocultas en Chile. Un adecuado proceso de selección de los EAPs puede mejorar el acceso a consumidores de sustancias difíciles de contactar.

Two brothers with severe developmental delay, growth retardation and unusual appearance.

We report on two brothers with short stature, severe developmental delay and unusual appearance. Several conditions including the Russell-Silver, Dubowitz, Floating-Harbour and Cockayne syndromes were considered in the differential diagnosis, but subsequently rejected. These two cases are likely to represent a new autosomal recessive or X-linked recessive syndrome.

Transient detection of plasma HIV-1 RNA during postexposure prophylaxis.

Transient plasma human immunodeficiency virus (HIV) copies were detected by nucleic-acid sequence-based amplification during combination antiretroviral prophylaxis in a healthcare worker who reported a percutaneous injury from a stylet and who remained HIV-antibody-negative. An HIV-specific T-helper response, assessed by interleukin-2 production, was observed when tested at 13 months following the exposure.

On Coquilleitidia crassipes, a new record for Macau, with a key to adults of the subgenera and species groups of the genus.

Coquillettidia (Coquillettidia) crassipes is recorded for the 1st time in the Territory of Macau, southern China. The systematics of the genus is examined, new species groups are proposed, and a key to subgenera and species groups of Coquillettidia is provided.

Utility of kindergarten teacher judgments in identifying early learning problems.

Most existing research on early identification of learning difficulties has examined the validity of methods for predicting future academic problems. The present study focused instead on the sensitivity of kindergarten teachers to learning problems in their students and on the continuity of teacher-identified problems over time. To identify early learning problems, kindergarten teachers in a suburban school district rated student progress toward six academic objectives as satisfactory or unsatisfactory. Twenty percent of the district's 303 kindergarten children received unsatisfactory ratings in at least one area. Thirty-eight of these children (identified group) were matched to 34 children with satisfactory ratings in all areas (nonidentified group). Results of testing conducted during kindergarten revealed poorer academic achievement in identified children than in nonidentified children. Children from the identified group also performed more poorly than children from the nonidentified group on tests of phonological processing and working memory/executive function and were rated by teachers as having more behavior and attention problems and lower social competence. Follow-up of the sample to first grade documented continued learning problems in the identified group. These findings support the use of teacher judgements in early detection of learning problems and argue against reliance on discrepancy criteria.

[Ceftazidime in the treatment of Weil's disease] / Ceftazidime nel trattamento del morbo di Weil.

We present a case report of leptospirosis with acute renal failure and hepatic dysfunction. Aspecific clinical presentation and serologic tests do not help therapeutic choices. The patient received 18 sessions of hemodialysis and early treatment with intravenous ceftazidime 1 g tid (under the impression of Gram- sepsis). Third generation cephalosporins, ceftriaxone and cefotaxime, are highly active against Leptospira [10] while clinical experience with ceftazidime is lacking.

[Staff meetings as a fundamental element in work organization]. / As reuniões de equipe como elemento fundamental na organização do trabalho.

The present study was developed as part of the Integrated Research Project "New Forms of Health Work Organization: emphasis on nursing work", carried out at the University Hospital of the Rio Grande Federal University. A series of studies were carried out with the objective of identifying the occurrence, content, periodicity and vision of nursing personnel about staff meetings in order to understand the importance of holding periodic meetings. Interviews were carried out with 21 nursing professionals. Data analysis revealed two main categories: differences in vision about staff meetings among nursing personnel and dichotomy between what theory dictates and what truly happens in staff meetings.

Anti-V3 loop spectrotype in HIV-infected individuals during zidovudine therapy.

In order to investigate the role played by zidovudine (ZDV) as immune modulator, particularly on B-cell response, the anti-V3 loop spectrotype in 115 sera from 26 HIV-infected individuals was evaluated, prior to and during treatment with ZDV, by isoelectric focusing and reverse blotting (IEF-RB), a technique useful for indirectly measuring the activity and the number of B-cell clones. All 18 patients showing seroreactivity by IEFRB displayed a clear oligoclonal banding pattern, with no change in the spectrotype (i.e. new bands), in sequential analysis over the course of therapy. Only minor changes in band intensity were found, without any correlation with ZDV treatment or CD4+ cell count. In addition, among the sera reactive in spectrotypic analysis, the percentage of those with p24 antigen positivity was significantly lower than those with no detectable p24 antigen (19.8% vs 80.2%, respectively, p = < 0.0001, Fisher's exact test). In conclusion, it could not be demonstrated by IEFRB that there was any effect of ZDV on the activity and the number of anti-V3 specific B-cell clones. This data is in line with previous studies showing the constancy of anti-gp120 antibody spectrotype over the long course of the disease.

[Port malaria caused by Plasmodium falciparum a case report]. / Malaria portuale da Plasmodium falciparum: descrizione di un caso clinico.

A case of unusual transmission by Plasmodium falciparum malaria is reported. The patient, had not been travelling outside North-West of Italy for the previous 6 months, he was not drug abuser. He had spent the last two months prior his admission, partly in his home town, an urban area in the region of Piemonte, and partly in a resort area on the Ligurian sea. Neither place has ever been associated with unusual malaria transmission. The possible transmission way is through a live vector imported from endemic area in a port terminal near a resort area.