Food Insecurity and Peripheral Arterial Disease in Older Adult Populations.

OBJECTIVES: Food insecurity, defined as the limited or uncertain availability of nutritious and safe foods, is a complex phenomenon and is linked to poor nutrition and diet-sensitive chronic diseases. Dietary patterns that include saturated fats and meat products are potential risk factors for the progression of peripheral arterial disease (PAD). This study explored whether there is a relationship between food insecurity and PAD among a national sample of older adults. DESIGN: We conducted a cross-sectional data analysis using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Food security was assessed using the US Household Food Security Survey Module. Bivariate analyses were conducted using the Rao-Scott Chi-square test to examine associations between PAD and sociodemographic variables. Multivariable generalized logistic regression was employed to assess the effect of food security on the presence of PAD, with adjustment for respondent's socio demographic characteristics. PARTICIPANTS: A total of 2,027 adults with PAD were included (Ankle Brachial Index (ABI) score ≤ 0.90).We excluded participants less than 60 years of age. RESULTS: Compared to older adults who are food secure, those who are food insecure have an increased risk for PAD. Food insecurity is associated with peripheral arterial disease among older adults (adults adjusted odds ratio, 1.50 [95% CI 1.11-2.03). CONCLUSION: Older adults with peripheral arterial disease are experiencing food insecurity. While nutrition and PAD are not well-defined, previous literature indicates there is a connection between food insecurity and diet-sensitive chronic diseases (diabetes and hypertension) which are risk factors for PAD. Food insecurity should be taken into consideration when treating older adults with PAD to help decrease poor health outcomes that are linked to an insufficient amount of nutritious foods.

Three men, a paint brush and a coronavirus.

Coronaviruses cause respiratory tract infection and a coryzal syndrome. Although described as a cause of gastroenteritis in HIV patients, with the exception of the severe acute respiratory syndrome (SARS), there is little in the literature about respiratory infection in HIV patients. We describe two patients with HIV, exacerbations of chronic obstructive pulmonary disease and proven coronavirus infection. A third patient presented with an upper respiratory tract infection but coronavirus was not isolated. All three men had spent a day decorating the first patient's flat four days prior to presentation. This is the first description of respiratory tract infection with coronavirus in HIV patients. Both patients with coronavirus required prolonged admission to hospital and extensive investigations because they were HIV infected. Coronavirus is often associated with less severe upper respiratory tract infection but can cause more severe disease and should be considered in patients with HIV and respiratory tract infection.

Practical experience of high throughput real time PCR in the routine diagnostic virology setting.

The advent of PCR has transformed the utility of the virus diagnostic laboratory. In comparison to traditional gel based PCR assays, real time PCR offers increased sensitivity and specificity in a rapid format. Over the past 4 years, we have introduced a number of qualitative and quantitative real time PCR assays into our routine testing service. During this period, we have gained substantial experience relating to the development and implementation of real-time assays. Furthermore, we have developed strategies that have allowed us to increase our sample throughput while maintaining or even reducing turn around times. The issues resulting from this experience (some of it bad) are discussed in detail with the aim of informing laboratories that are only just beginning to investigate the potential of this technology.

Preoperative risk factors for 30-day mortality after elective surgery for vascular disease in Department of Veterans Affairs hospitals: is race important?

PURPOSE: Racial variation in health care outcomes is an important topic. Risk-adjustment models have not been developed for elective abdominal aortic aneurysm repair (AAA), lower extremity bypass revascularization (LEB), or lower extremity amputation (AMP). Earlier studies examining racial variation in mortality and morbidity from AAA, LEB, or AMP were limited to administrative data. This study determined risk factors for mortality after surgery for vascular disease and determined whether race is an important risk factor. METHODS: Data in this prospective observational study were obtained from the Department of Veterans Affairs (VA) National Surgical Quality Improvement Program. Detailed demographic and clinical data were collected prospectively from patients' medical records by trained nurse reviewers. Eligible patients were those 18 years and older who underwent elective AAA, LEB, or AMP at one of 44 VA medical centers performing both vascular and cardiac surgery (phase I; October 1991 to December 1993) and at one of these 44 or 79 additional VA medical centers performing vascular but not cardiac surgery (phase II; January 1994 to August 1995). The independent association of several preoperative factors with the 30-day postoperative mortality rate was examined with stepwise logistic regression analysis for AAA, LEB, and AMP. Models were developed in the combined 44 VA medical centers and validated in the 79 VA medical centers. The independent association of race with the 30-day postoperative mortality rate was examined after controlling for important preoperative risk factors for each operation. RESULTS: More than 10,000 surgical operations were examined, and 5, 3, and 10 independent preoperative predictors of 30-day mortality rate were identified for AAA, LEB, and AMP, respectively. The observed mortality rate for patients undergoing AAA was higher (7.2% vs 3.2%; P =.02) in African American patients than in white patients in the 44 VA medical centers, although the differences were not significant in LEB and AMP or at the additional 79 hospitals. After important preoperative risk factors were controlled, there was no difference in 30-day mortality rates between African American patients and white patients. CONCLUSION: We identified several important preoperative risk factors for 30-day mortality rate in three vascular operations. From the results of this study, race was determined not to be an independent predictor of mortality.

Risk factors for prolonged length of stay after major elective surgery.

OBJECTIVE: Length of stay (LOS) is an important outcome as a marker of resource consumption. Determining which factors increase LOS may provide information on reducing costs and improving the delivery of care. The purpose of this study was to determine the independent association of intraoperative process of care and postoperative events with prolonged LOS after adjusting for preoperative severity of illness in patients undergoing major elective surgery. METHODS: Cases representing 11 elective operations from the National VA Surgical Quality Improvement Program were analyzed using multivariate logistic regression analysis. The outcome, prolonged LOS, was defined as an LOS greater than or equal to the 75th percentile (in days) for each operation. Hierarchical modeling was used to assess the independent association of groups of variables (preoperative patient characteristics, intraoperative process of care, and postoperative adverse events) with prolonged LOS. RESULTS: For the 11 operations explored, there were 23,919 cases. Common preoperative variables associated with prolonged LOS were functional status, American Society of Anesthesiology class, and age. The most predictive intraoperative and postoperative variables included intraoperative blood transfusion, operative time, return to the operating room, and the number of complications after surgery. CONCLUSIONS: Prolonged LOS is associated with preoperative, intraoperative, and postoperative factors. Although preoperative factors were independently associated with a prolonged LOS, the factors generating the highest risks for a prolonged LOS were the intraoperative process of care and postoperative adverse events. To reduce costs, efforts should be made to improve the intraoperative process of care and to minimize postoperative complications.

Presence of severe intimal thickening by intravascular ultrasonography predicts cardiac events in cardiac allograft vasculopathy.

BACKGROUND: The clinical utility of intimal hyperplasia detected by intravascular ultrasonography in predicting cardiac events in heart transplant recipients with cardiac allograft vasculopathy has not been previously investigated. METHODS: Intravascular ultrasonographic examination of 74 consecutive heart transplant recipients, including 62 men and 12 women with a mean age of 51 +/- 10 years (range 22 to 68 years), was performed at the time of annual angiography. Two groups of study patients were identified: group I consisted of patients with minimal, mild, or moderate intimal thickness by intravascular ultrasonography, whereas group II patients had severe intimal thickness. RESULTS: Patient characteristics were similar in both groups except for higher serum triglycerides (220 +/- 95 versus 165 +/- 79 mg/dl), more advanced donor age (28 +/- 11 versus 23 +/- 6 years) and greater duration of follow-up after transplantation (3.3 +/- 1.4 versus 1.8 +/- 1.2 years) in group II patients with severe intimal thickening (p < 0.01). Cardiac events were defined as the occurrence of sudden death, myocardial infarction, or the need for coronary revascularization via percutaneous or surgical intervention. One cardiac event occurred in group I patients (sudden death), whereas seven events were noted in the group II patients (p = 0.006). Cardiac events in the group of patients with severe intimal thickening included four patients with sudden cardiac death and three patients who underwent percutaneous revascularization procedures involving directional coronary atherectomy. Angiograms were normal in 62% of patients who had cardiac events. CONCLUSIONS: This study represents one of the first reports that provides evidence that severe intimal hyperplasia predicts the development of cardiac events even in the presence of a normal coronary angiogram.

HSV-2 increases the mitochondrial aspartate amino transaminase characteristic of tumor cells.

A set of polypeptides has previously been described as being immunoprecipitated from tumor cell lysates by the sera of tumor-bearing animals (TBS) or by antisera raised to herpes simplex virus type 2 (HSV-2)-infected cells. These polypeptides were not immunoprecipitated from control cells. The principal polypeptides detected of MW 200, 90 (U90 and L90), 40, and 32 kDa were increased by HSV-2 infection. This communication describes the purification of the 40-kDa protein and its identification by amino acid sequence analysis as being homologous to the mature form of mitochondrial aspartate amino transaminase (mAAT). Two different forms of mAAT were purified and sequenced. One form, of low abundance, was immunoprecipitated by TBS and corresponded to the 40-kDa protein immunoprecipitated from tumor, but not control, cell lysates. Western blotting of the 40-kDa protein immunoprecipitated by TBS showed that it was a form of mAAT found only in tumor cells. The other abundant form reacted in Western blots with antibody to mAAT and was clearly the constitutive enzyme, present in all cells. In general, mAAT was increased up to fourfold after infection with HSV-2, HSV-2 infection also increased mAAT enzyme activity. Northern blotting and quantitative PCR showed that mAAT was induced by HSV-2 at the level of transcription. The specific form of mAAT immunoprecipitated from tumor, but not control, cell lysates could have a role in tumorigenesis, could be a putative tumor cell marker, or could be a target for antitumor drugs. HSV-2 probably induces enzymes of glutamine metabolism because HSV-2 requires glutamine for growth, thus revealing potential new antiviral targets.

Abortion and early neonatal death of kids attributed to intrauterine Yersinia pseudotuberculosis infection.

Yersinia pseudotuberculosis was isolated from placenta and abomasal contents of triplet goat kids, two of which were aborted and one of which died shortly after birth. Necropsy findings in the kids were suppurative placentitis and suppurative pneumonia. The public health implications in intrauterine Yersinia infection in goats are discussed.