Trends in ischemic heart disease among females in low-and middle-income countries from 1990 to 2019.

BACKGROUND: Ischemic heart disease (IHD) is a major contributor to mortality in low-and middle-income-countries (LMICs). However, trends in IHD in females in LMICs are not well described. METHODS: We analyzed the Global Burden of Disease (GBD) Study from 1990 to 2019 for males and females with IHD from the ten most-populous LMICs (India, Indonesia, Pakistan, Nigeria, Ethiopia, Philippines, Egypt, Vietnam, Iran, and Afghanistan). RESULTS: In females, IHD incidence increased from 950,000 cases/year to 1.6 million/year, IHD prevalence increased from 8 million to 22.5 million (181% increase) and IHD mortality from 428,320 to 1,040,817 (143% increase). IHD accounted for 6.2% of all deaths among females in 1990, doubling to 13.2% in 2019. IHD mortality for each country increased with the greatest shift in AAPC seen in the Philippines (5.8%, 95% CI 5.4-6.1) and India (3.7%, 95% CI 3.0-4.4). Notably, reductions in ASMR were greater for males than females in Afghanistan, Iran, Egypt, Ethiopia and Nigeria. (all p < 0.001). CONCLUSIONS: The burden of IHD among females in LMIC has increased considerably in LMICs from 1990 to 2019. While the ASMR from IHD across most countries is declining, this was not uniformly noted. Furthermore, several countries noted lesser improvement in ASMR among females compared to males.

Impact of Oral-Cecal Transit Time on the Interpretation of Lactulose Breath Tests After RYGB: a Personalized Approach to the Diagnosis of SIBO.

BACKGROUND: Traditionally, small intestinal bacterial overgrowth (SIBO) is diagnosed when there is an early peak in breath hydrogen or methane. Given unclear intestinal transit time in Roux-en-Y gastric bypass (RYGB) patients, it is unknown if the traditional approach at diagnosing SIBO is adequate in this patient population. AIM: To assess oral-cecal transit time (OCTT) and its impact on the interpretation of breath tests in the diagnosis of SIBO in patients with RYGB. METHODS: This study was a retrospective review of prospectively collected data on RYGB patients who underwent testing for SIBO using lactulose breath test (LBT) with or without small bowel follow-through (SBFT) to assess OCTT. Outcomes of SIBO test based on LBT alone versus LBT with OCTT were compared using a chi-squared test. RESULTS: Sixty-two of the 151 RYGB patients who underwent LBT underwent an additional SBFT to assess OCTT. Median OCTT was 60 min. Of these, 59.7% had OCTT shorter than 90 min. Based on LBT alone, 36/62 patients (58.1%) were classified as positive SIBO. When LBT results were combined with OCTT, 26/36 patients (72.2%) had hydrogen or methane rise within OCTT, suggesting 27.8% false positive rate. Patients with true positive SIBO based on LBT and OCTT had a higher response rate to antibiotics compared to those with false positive SIBO (78.3% vs. 33.3%, p = 0.03). CONCLUSION: A personalized approach of combining LBT with SBFT to assess OCTT may improve the accuracy of SIBO testing and enhance clinical outcomes in patients with RYGB.