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Roberts NL, Pierre JL, Rouzier V, Sufra R, St-Preux S, Yan LD, Metz M, Clermont A, Apollon A, Sabwa S, Deschamps MM, Kingery JR, Peck R, Fitzgerald D, Pape JW, Tummalapalli SL, McNairy ML. Prevalence and Severity of Chronic Kidney Disease in Haiti. Clin J Am Soc Nephrol 2023; 18:739-747. [PMID: 37081617 PMCID: PMC10278829 DOI: 10.2215/cjn.0000000000000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND CKD is a major cause of morbidity and mortality in lower-income countries. However, population-based studies characterizing the epidemiology of CKD in these settings are lacking. The study objective was to describe the epidemiology of CKD in a population-based cohort in urban Haiti, including estimates of the prevalence by CKD stage, the magnitude of associated factors with CKD, and the proportion on guideline-recommended treatment. METHODS We assessed the prevalence of CKD and associated risk factors in the population-based Haiti Cardiovascular Disease Cohort. We analyzed cross-sectional data from 2424 adults who completed a clinical examination, risk factor surveys, and laboratory measurements for serum creatinine, urinary albumin, and urinary creatinine. We compared our results with US estimates from the National Health and Nutrition Examination Survey. CKD was defined as either a reduced eGFR <60 ml/min per 1.73 m 2 or urinary albumin-to-creatinine ratio ≥30 mg/g according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable logistic regression identified associated factors with CKD. RESULTS The mean age was 42 years, 57% of participants were female, and 69% lived in extreme poverty on ≤1 US dollar per day. The age-standardized prevalence of CKD was 14% (95% confidence interval [CI], 12% to 15%). The age-standardized prevalence of reduced eGFR and elevated urinary albumin-to-creatinine ratio was 3% (95% CI, 2% to 4%) and 11% (95% CI, 10% to 13%), respectively. Diabetes (adjusted odds ratio, 4.1; 95% CI, 2.7 to 6.2) and hypertension (adjusted odds ratio, 2.9; 95% CI, 2.0 to 4.2) were significantly associated with CKD. Only 12% of participants with CKD and albuminuria were on guideline-recommended agents, such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. CONCLUSIONS In a large population-based cohort of Haitian adults, CKD was highly associated with both diabetes and hypertension. The proportion of participants with CKD on treatment was low, underscoring the need for strengthening clinical management and nephrology care health infrastructure in Haiti. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER A Longitudinal Cohort Study to Evaluate Cardiovascular Risk Factors and Disease in Haiti, NCT03892265 .
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Affiliation(s)
- Nicholas L.S. Roberts
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jean L. Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Stefano St-Preux
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Lily D. Yan
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Miranda Metz
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Adrienne Clermont
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Shalom Sabwa
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Marie M. Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Justin R. Kingery
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Robert Peck
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Daniel Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jean W. Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
| | - Margaret L. McNairy
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Nordvig AS, Rajan M, Lau JD, Kingery JR, Mahmud M, Chiang GC, De Leon MJ, Goyal P. Brain fog in long COVID limits function and health status, independently of hospital severity and preexisting conditions. Front Neurol 2023; 14:1150096. [PMID: 37251229 PMCID: PMC10213727 DOI: 10.3389/fneur.2023.1150096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Importance The U.S. government has named post-acute sequelae of COVID-19 (longCOVID) as influential on disability rates. We previously showed that COVID-19 carries a medical/functional burden at 1 year, and that age and other risk factors of severe COVID-19 were not associated with increased longCOVID risk. Long-term longCOVID brain fog (BF) prevalence, risk factors and associated medical/functional factors are poorly understood, especially after mild SARS-CoV-2 infection. Methods A retrospective observational cohort study was conducted at an urban tertiary-care hospital. Of 1,032 acute COVID-19 survivors from March 3-May 15, 2020, 633 were called, 530 responded (59.2 ± 16.3 years, 44.5% female, 51.5% non-White) about BF prevalence, other longCOVID, post-acute ED/hospital utilization, perceived health/social network, effort tolerance, disability. Results At approximately 1-year, 31.9% (n = 169) experienced BF. Acute COVID-19 severity, age, and premorbid cardiopulmonary comorbidities did not differ between those with/without BF at 1 year. Patients with respiratory longCOVID had 54% higher risk of BF than those without respiratory longCOVID. BF associated with sleep disturbance (63% with BF vs.29% without BF, p < 0.0001), shortness of breath (46% vs.18%, p < 0.0001), weakness (49% vs.22%, p < 0.0001), dysosmia/dysgeusia (12% vs.5%, p < 0.004), activity limitations (p < 0.001), disability/leave (11% vs.3%, p < 0.0001), worsened perceived health since acute COVID-19 (66% vs.30%, p < 0.001) and social isolation (40% vs.29%, p < 0.02), despite no differences in premorbid comorbidities and age. Conclusions and relevance A year after COVID-19 infection, BF persists in a third of patients. COVID-19 severity is not a predictive risk factor. BF associates with other longCOVID and independently associates with persistent debility.
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Affiliation(s)
- Anna S. Nordvig
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Jennifer D. Lau
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Justin R. Kingery
- Division of General Internal Medicine, University of Louisville School of Medicine, Louisville, KY, United States
| | - Meem Mahmud
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Gloria C. Chiang
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Mony J. De Leon
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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Goyal P, Zhu A, Clarkson SA, Brown TM, Durant R, Kingery JR, Shen MJ, Khodneva Y, Jackson EA, Safford MM, Levitan EB. Patient Awareness of Their Heart Failure Diagnosis and Its Implications for Epidemiologic Studies and Clinical Care. Am J Cardiol 2023; 195:27-27.c3. [PMID: 37003081 DOI: 10.1016/j.amjcard.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York.
| | | | | | - Todd M Brown
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raegan Durant
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Justin R Kingery
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Yulia Khodneva
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York
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Kingery JR, Roberts NL, Lookens Pierre J, Sufra R, Dade E, Rouzier V, Malebranche R, Theard M, Goyal P, Pirmohamed A, Yan LD, Hee Lee M, Nash D, Metz M, Peck RN, Safford MM, Fitzgerald D, Deschamps MM, Pape JW, McNairy M. Population-Based Epidemiology of Heart Failure in a Low-Income Country: The Haiti Cardiovascular Disease Cohort. Circ Cardiovasc Qual Outcomes 2023; 16:e009093. [PMID: 36472189 PMCID: PMC9974582 DOI: 10.1161/circoutcomes.122.009093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/19/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiovascular disease disproportionately affects persons living in low- and middle-income countries and heart failure (HF) is thought to be a leading cause. Population-based studies characterizing the epidemiology of HF in these settings are lacking. We describe the age-standardized prevalence, survival, subtypes, risk factors, and 1-year mortality of HF in the population-based Haiti Cardiovascular Disease Cohort. METHODS Participants were recruited using multistage cluster-area random sampling in Port-au-Prince, Haiti. A total of 2981 completed standardized history and exam, laboratory measures, and cardiac imaging. Clinical HF was defined by Framingham criteria. Kaplan-Meier and Cox proportional hazard regression assessed mortality among participants with and without HF; logistic regression identified associated factors. RESULTS Among all participants, the median age was 40 years (interquartile range, 27-55), and 58.2% were female. Median follow-up was 15.4 months (interquartile range, 9-22). The age-standardized HF prevalence was 3.2% (93/2981 [95% CI, 2.6-3.9]). The average age of participants with HF was 57 years (interquartile range, 45-65), and 67.7% were female. The first significant increase in HF prevalence occurred between 30 to 39 and 40 to 49 years (1.1% versus 3.7%, P=0.003). HF with preserved ejection fraction was the most common HF subtype (71.0%). Age (adjusted odds ratio, 1.36 [1.12-1.66] per 10-year increase), hypertension (2.14 [1.26-3.66]), obesity (3.35 [95% CI, 1.99-5.62]), poverty (2.10 [1.18-3.72]), and renal dysfunction (5.42 [2.94-9.98]) were associated with HF. One-year HF mortality was 6.6% versus 0.8% (hazard ratio, 7.7 [95% CI, 2.9-20.6]; P<0.0001). CONCLUSIONS The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%-5-fold higher than modeling estimates for low- and middle-income countries. Adults with HF were two decades younger and 7.7× more likely to die at 1 year compared with those in the community without HF. Further research characterizing the population burden of HF in low- and middle-income countries can guide resource allocation and development of pragmatic HF prevention and treatment interventions, ultimately reducing global cardiovascular disease health disparities. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03892265.
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Affiliation(s)
- Justin R Kingery
- Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy)
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
- University of Louisville School of Medicine, KY (J.R.K.)
| | - Nicholas L Roberts
- Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy)
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti (J.L.P., R.S., E.D., V.R., M.M.D., J.W.P., M. McNairy)
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti (J.L.P., R.S., E.D., V.R., M.M.D., J.W.P., M. McNairy)
| | - Eliezer Dade
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti (J.L.P., R.S., E.D., V.R., M.M.D., J.W.P., M. McNairy)
| | - Vanessa Rouzier
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti (J.L.P., R.S., E.D., V.R., M.M.D., J.W.P., M. McNairy)
| | | | - Michel Theard
- Haitian College of Cardiology, Port-au-Prince, Haiti (R.M., M.T.)
| | - Parag Goyal
- Division of Cardiology (P.G., A.P.), Weill Medical College of Cornell University, New York, NY
| | - Altaf Pirmohamed
- Division of Cardiology (P.G., A.P.), Weill Medical College of Cornell University, New York, NY
| | - Lily D Yan
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
| | - Myung Hee Lee
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
- Department of Statistics and Data Science, Cornell University, Ithaca, NY (M.H.L.)
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY (D.N.)
| | - Miranda Metz
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
| | - Robert N Peck
- Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy)
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
| | - Monika M Safford
- Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy)
| | - Daniel Fitzgerald
- Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy)
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
| | - Marie M Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti (J.L.P., R.S., E.D., V.R., M.M.D., J.W.P., M. McNairy)
| | - Jean W Pape
- Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy)
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti (J.L.P., R.S., E.D., V.R., M.M.D., J.W.P., M. McNairy)
| | - Margaret McNairy
- Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy)
- Center for Global Health (J.R.K., N.L.R., V.R., L.Y., M.H.L., M. Metz, R.P., D.F., J.W.P., M. McNairy), Weill Medical College of Cornell University, New York, NY
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti (J.L.P., R.S., E.D., V.R., M.M.D., J.W.P., M. McNairy)
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Pham K, Mertelsmann A, Mages K, Kingery JR, Mazigo HD, Jaka H, Kalokola F, Changalucha JM, Kapiga S, Peck RN, Downs JA. Effects of helminths and anthelmintic treatment on cardiometabolic diseases and risk factors: A systematic review. PLoS Negl Trop Dis 2023; 17:e0011022. [PMID: 36827239 PMCID: PMC9956023 DOI: 10.1371/journal.pntd.0011022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/12/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Globally, helminth infections and cardiometabolic diseases often overlap in populations and individuals. Neither the causal relationship between helminth infections and cardiometabolic diseases nor the effect of helminth eradication on cardiometabolic risk have been reviewed systematically in a large number of human and animal studies. METHODS We conducted a systematic review assessing the reported effects of helminth infections and anthelmintic treatment on the development and/or severity of cardiometabolic diseases and risk factors. The search was limited to the most prevalent human helminths worldwide. This study followed PRISMA guidelines and was registered prospectively in PROSPERO (CRD42021228610). Searches were performed on December 10, 2020 and rerun on March 2, 2022 using Ovid MEDLINE ALL (1946 to March 2, 2022), Web of Science, Cochrane Library, Global Index Medicus, and Ovid Embase (1974 to March 2, 2022). Randomized clinical trials, cohort, cross-sectional, case-control, and animal studies were included. Two reviewers performed screening independently. RESULTS Eighty-four animal and human studies were included in the final analysis. Most studies reported on lipids (45), metabolic syndrome (38), and diabetes (30), with fewer on blood pressure (18), atherosclerotic cardiovascular disease (11), high-sensitivity C-reactive protein (hsCRP, 5), and non-atherosclerotic cardiovascular disease (4). Fifteen different helminth infections were represented. On average, helminth-infected participants had less dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. Eleven studies examined anthelmintic treatment, of which 9 (82%) reported post-treatment increases in dyslipidemia, metabolic syndrome, and diabetes or glucose levels. Results from animal and human studies were generally consistent. No consistent effects of helminth infections on blood pressure, hsCRP, or cardiac function were reported except some trends towards association of schistosome infection with lower blood pressure. The vast majority of evidence linking helminth infections to lower cardiometabolic diseases was reported in those with schistosome infections. CONCLUSIONS Helminth infections may offer protection against dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. This protection may lessen after anthelmintic treatment. Our findings highlight the need for mechanistic trials to determine the pathways linking helminth infections with cardiometabolic diseases. Such studies could have implications for helminth eradication campaigns and could generate new strategies to address the global challenge of cardiometabolic diseases.
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Affiliation(s)
- Khanh Pham
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Anna Mertelsmann
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, United States of America
| | - Keith Mages
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York, United States of America
| | - Justin R. Kingery
- Department of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Humphrey D. Mazigo
- Department of Parasitology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Mwanza College of Health and Allied Sciences, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | | | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Robert N. Peck
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Jennifer A. Downs
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
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Kingery JR, Chalem A, Mukerebe C, Shigella PS, Miyaye D, Magawa RG, Ward M, Kalluvya SE, McCormick J, Maganga JK, Colombe S, Aristide C, Corstjens PLAM, Lee MH, Changalucha JM, Downs JA. Schistosoma mansoni Infection Is Associated With Increased Monocytes and Fewer Natural Killer T Cells in the Female Genital Tract. Open Forum Infect Dis 2022; 9:ofac657. [PMID: 36601557 PMCID: PMC9801228 DOI: 10.1093/ofid/ofac657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Schistosoma mansoni infection may impair genital mucosal antiviral immunity, but immune cell populations have not been well characterized. We characterized mononuclear cells from cervical brushings of women with and without S mansoni infection. We observed lower frequencies of natural killer T cells and higher frequencies of CD14+ monocytes in infected women.
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Affiliation(s)
| | | | | | | | - Donald Miyaye
- National Institute for Medical Research, Mwanza, Tanzania
| | - Ruth G Magawa
- National Institute for Medical Research, Mwanza, Tanzania
| | - Maureen Ward
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Samuel E Kalluvya
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Jason McCormick
- Flow Cytometry Core Laboratory, Weill Cornell Medicine, New York, New York, USA
| | - Jane K Maganga
- National Institute for Medical Research, Mwanza, Tanzania,Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Soledad Colombe
- Outbreak Research Team, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christine Aristide
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, TheNetherlands
| | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - Jennifer A Downs
- Correspondence: Jennifer A. Downs, MD, MSc, PhD, Center for Global Health, Weill Cornell Medicine, 402 E 67th St, Second Floor, New York, NY, 10065, USA ()
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Yan LD, Lookens Pierre J, Rouzier V, Théard M, Apollon A, St Preux S, Kingery JR, Jamerson KA, Deschamps M, Pape JW, Safford MM, McNairy ML. Comparing six cardiovascular risk prediction models in Haiti: implications for identifying high-risk individuals for primary prevention. BMC Public Health 2022; 22:549. [PMID: 35305599 PMCID: PMC8933947 DOI: 10.1186/s12889-022-12963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian risk profiles from high-income country populations, and have not been evaluated in LMIC populations. We aimed to compare six existing models for predicted 10-year risk of CVD and identify high-risk groups for targeted prevention and treatment in Haiti. METHODS We used cross-sectional data within the Haiti CVD Cohort Study, including 1345 adults ≥ 40 years without known history of CVD and with complete data. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility. RESULTS Sixty percent were female, 66.8% lived on a daily income of ≤ 1 USD, 52.9% had hypertension, 14.9% had hypercholesterolemia, 7.8% had diabetes mellitus, 4.0% were current smokers, and 2.5% had HIV. Predicted 10-year CVD risk ranged from 3.6% in adjusted PCE (IQR 1.7-8.2) to 9.6% in Framingham-BMI (IQR 4.9-18.0), and Spearman rank correlation coefficients ranged from 0.86 to 0.98. The percent of the cohort categorized as high risk using model specific thresholds ranged from 1.8% using the WHO-BMI model to 41.4% in the PCE model (χ2 = 1416, p value < 0.001). Statin eligibility also varied widely. CONCLUSIONS In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on which prediction model is chosen. There is a need to design and validate CVD risk prediction tools for low-middle income countries that include locally relevant risk factors. TRIAL REGISTRATION clinicaltrials.gov NCT03892265 .
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Affiliation(s)
- Lily D Yan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Michel Théard
- Collège Haïtien de Cardiologie, Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Stephano St Preux
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Justin R Kingery
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Kenneth A Jamerson
- Division of Cardiovascular Disease, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marie Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean W Pape
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Margaret L McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
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Chen Y, Alphonce E, Mujuni E, Kisigo GA, Kingery JR, Makubi A, Peck RN, Kalokola F. Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study. BMJ Open 2022; 12:e058200. [PMID: 35046009 PMCID: PMC8772409 DOI: 10.1136/bmjopen-2021-058200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA. DESIGN A prospective cohort study using data collected between October 2018 and May 2020. SETTING Outpatient clinic at a tertiary hospital in Mwanza, Tanzania. PARTICIPANTS 303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of <3 months (ie, advance solid tumours, advance haematological malignancies) were excluded. METHODS Participants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors. RESULTS We enrolled 403 participants with HF (mean age 60±19 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality. CONCLUSION AF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95% CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (>110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p<0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF.
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Affiliation(s)
- Yunchan Chen
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Emmanuel Alphonce
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Eva Mujuni
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Godfrey A Kisigo
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Justin R Kingery
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Abel Makubi
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Dar es Salaam, Tanzania, United Republic of
| | - R N Peck
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
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Kingery JR, Bf Martin P, Baer BR, Pinheiro LC, Rajan M, Clermont A, Pan S, Nguyen K, Fahoum K, Wehmeyer GT, Alshak MN, Li HA, Choi JJ, Shapiro MF, McNairy ML, Safford MM, Goyal P. Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection. J Gen Intern Med 2021; 36:2378-2385. [PMID: 34100231 PMCID: PMC8183585 DOI: 10.1007/s11606-021-06924-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of outcomes. OBJECTIVE To determine 30-day post-hospitalization outcomes following COVID-19 infection. DESIGN Retrospective cohort study SETTING: Quaternary referral hospital and community hospital in New York City. PARTICIPANTS COVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020. MEASUREMENT Outcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge. RESULTS Thirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00-1.02]), diabetes (1.54 [1.06-2.23]), and the need for inpatient dialysis (3.78 [2.23-6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05-1.11]) and Asian race (2.89 [1.27-6.61]) were significantly associated with mortality. CONCLUSIONS Among patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.
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Affiliation(s)
- Justin R Kingery
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Paul Bf Martin
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Ben R Baer
- Department of Statistics and Data Science, Cornell University, Ithaca, NY, USA
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | | | - Sabrina Pan
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Khoi Nguyen
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Khalid Fahoum
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Mark N Alshak
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Han A Li
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Justin J Choi
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Martin F Shapiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Margaret L McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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10
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Nolan C, Reis K, Fadhil S, Etyang A, Ezeomah C, Kingery JR, Desderius B, Lee MH, Kapiga S, Peck RN. Nocturnal dipping of heart rate and blood pressure in people with HIV in Tanzania. J Clin Hypertens (Greenwich) 2021; 23:1452-1456. [PMID: 34080288 PMCID: PMC8678662 DOI: 10.1111/jch.14300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 01/10/2023]
Abstract
People with HIV (PWH) have a >2-fold greater risk for development of cardiovascular disease (CVD), which may be associated with abnormalities in 24-h ambulatory blood pressure measurement (ABPM) profile. We conducted a nested case-control study of ABPM in 137 PWH and HIV-uninfected controls with normal and high clinic blood pressure (BP) in Tanzania. Nocturnal non-dipping of heart rate (HR) was significantly more common among PWH than HIV-uninfected controls (p = .01). Nocturnal non-dipping of BP was significantly more common in PWH with normal clinic BP (p = .048). Clinical correlates of nocturnal non-dipping were similar in PWH and HIV-uninfected adults and included higher BMI, higher CD4+ cell count, and high C-reactive protein for HR and markers of renal disease for BP. In conclusion, nocturnal non-dipping of both BP and HR was more common in PWH but further research is needed to determine causes and consequences of this difference.
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Affiliation(s)
- Cody Nolan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Karl Reis
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.,Mwanza Interventional Trials Unit (MITU), Mwanza, Tanzania.,Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Salama Fadhil
- Mwanza Interventional Trials Unit (MITU), Mwanza, Tanzania.,Weill Bugando School of Medicine, Mwanza, Tanzania
| | | | - Chiomah Ezeomah
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.,Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Justin R Kingery
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.,Mwanza Interventional Trials Unit (MITU), Mwanza, Tanzania.,Weill Bugando School of Medicine, Mwanza, Tanzania.,Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Myung-Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Saidi Kapiga
- Mwanza Interventional Trials Unit (MITU), Mwanza, Tanzania
| | - Robert N Peck
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.,Mwanza Interventional Trials Unit (MITU), Mwanza, Tanzania.,Weill Bugando School of Medicine, Mwanza, Tanzania
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11
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Choi JJ, Contractor JH, Shaw AL, Abdelghany Y, Frye J, Renzetti M, Smith E, Soiefer LR, Lu S, Kingery JR, Krishnan JK, Levine WJ, Safford MM, Shapiro MF. COVID-19-Related Circumstances for Hospital Readmissions: A Case Series From 2 New York City Hospitals. J Patient Saf 2021; 17:264-269. [PMID: 33852540 PMCID: PMC8131259 DOI: 10.1097/pts.0000000000000870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of the study was to determine the main factors contributing to hospital readmissions and their potential preventability after a coronavirus disease 2019 (COVID-19) hospitalization at 2 New York City hospitals. METHODS This was a retrospective study at 2 affiliated New York City hospitals located in the Upper East Side and Lower Manhattan neighborhoods. We performed case reviews using the Hospital Medicine Reengineering Network framework to determine potentially preventable readmissions among patients hospitalized for COVID-19 between March 3, 2020 (date of first case) and April 27, 2020, and readmitted to either of the 2 hospitals within 30 days of discharge. RESULTS Among 53 readmissions after hospitalization for COVID-19, 44 (83%) were deemed not preventable and 9 (17%) were potentially preventable. Nonpreventable readmissions were mostly due to disease progression or complications of COVID-19 (37/44, 84%). Main factors contributing to potentially preventable readmissions were issues with initial disposition (5/9, 56%), premature discharge (3/9, 33%), and inappropriate readmission (1/9, 11%) for someone who likely did not require rehospitalization. CONCLUSIONS Most readmissions after a COVID-19 hospitalization were not preventable and a consequence of the natural progression of the disease, specifically worsening dyspnea or hypoxemia. Some readmissions were potentially preventable, mostly because of issues with disposition that were directly related to challenges posed by the ongoing COVID-19 pandemic. Clinicians should be aware of challenges with disposition related to circumstances of the COVID-19 pandemic.
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Affiliation(s)
- Justin J. Choi
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Amy L. Shaw
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Jesse Frye
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Emily Smith
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Shuting Lu
- MD Program, Weill Cornell Medicine, New York, NY
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12
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Kapiga S, Hansen CH, Downs JA, Sichalwe S, Hashim R, Mngara J, van Dam GJ, Corstjens PLAM, Kingery JR, Peck RN, Grosskurth H. The burden of HIV, syphilis and schistosome infection and associated factors among adults in the fishing communities in northwestern Tanzania. Trop Med Int Health 2021; 26:204-213. [PMID: 33159819 DOI: 10.1111/tmi.13520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To quantify the burden of HIV, syphilis and schistosome infection and associated risk factors among adults living in seven fishing communities of Lake Victoria in northwest Tanzania. METHODS Cross-sectional study conducted between 2015 and 2016 in the selected communities. In each community, we randomly selected a sample of adults from the general population and from three putative risk groups including the following: (i) fishermen, (ii) fish processors and traders, and (iii) women working in the recreational facilities. Participants were interviewed to obtain information about potential risk factors, and venous blood was collected for detection of HIV, syphilis and schistosome infections. We used logistic regression models to quantify the associations between potential risk factors and HIV, and also between schistosome infection and HIV. RESULTS We enrolled 1128 people from selected fishing communities. The overall prevalence of HIV, syphilis and schistosome infection was 14.2%, 15.6% and 83.1%, respectively. Female recreational facility workers had the highest prevalence of HIV (30.4%) and syphilis (24%). The odds of being HIV infected were generally higher in all age categories. Transactional sex was commonly reported and especially receiving gifts for sex was found to be strongly associated with HIV (adjusted OR = 2.50; 95% CI: 1.44-4.34, P = 0.008). Confirmed serological syphilis was associated with increased odds of having HIV infection. HIV was not associated with schistosome infection in a combined dataset and when we examined this separately for men and women alone. CONCLUSIONS We observed a high burden of HIV, syphilis and schistosome infections in the fishing communities. Targeted efforts to treat and control infections have the potential to improve health among their residents.
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Affiliation(s)
- Saidi Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Christian H Hansen
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer A Downs
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Simon Sichalwe
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Julius Mngara
- National Institute for Medical Research, Mwanza, Tanzania
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Justin R Kingery
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Robert N Peck
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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13
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Kingery JR, Goyal P, Hosalli R, Lee MH, Desderius B, Kalokola F, Makubi A, Fadhil S, Kapiga S, Karmali D, Kaminstein D, Devereux R, McNairy M, Johnson W, Fitzgerald D, Peck R. Human Immunodeficiency Virus-Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study. J Infect Dis 2021; 223:83-93. [PMID: 32526008 PMCID: PMC7781450 DOI: 10.1093/infdis/jiaa328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aims of this study were (1) to compare the prevalence of myocardial diastolic dysfunction (DD) in antiretroviral therapy (ART)-naive people living with human immunodeficiency virus (PLWH) to human immunodeficiency virus (HIV)-uninfected adults in East Africa and (2) to determine the association between serum concentration of the cardiac biomarkers ST2 and DD. METHODS In this cross-sectional study, we enrolled PLWH and uninfected adults at a referral HIV clinic in Mwanza, Tanzania. Standardized history, echocardiography, and serum were obtained. Regression models were used to quantify associations. RESULTS We enrolled 388 ART-naive PLWH and 461 HIV-uninfected adults with an average age of 36.0 ± 10.2 years. Of PLWH in the third, fourth, and fifth decades of life, 5.0%, 12.5%, and 32.7%, respectively, had DD. PLWH had a higher prevalence of DD (adjusted odds ratio, 2.71 [95% confidence interval, 1.62-4.55]; P < .0001). PLWH also had a higher probability of dysfunction with one or fewer traditional risk factors present. Serum ST2 concentration was associated with dysfunction in PLWH but not uninfected participants (P = .04 and P = .90, respectively). CONCLUSIONS In a large population of young adults in sub-Saharan Africa, DD prevalence increased starting in the third decade of life. HIV was independently associated with dysfunction. Serum ST2 concentration was associated with DD in PLWH but not HIV-uninfected participants. This pathway may provide insight into the mechanisms of HIV-associated dysfunction.
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Affiliation(s)
- Justin R Kingery
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Division of Cardiovascular Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Rahul Hosalli
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Myung Hee Lee
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Bernard Desderius
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Abel Makubi
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Salama Fadhil
- Mwanza Intervention Trials Unit, London School of Hygiene and Tropical Medicine, Mwanza, Tanzania
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, London School of Hygiene and Tropical Medicine, Mwanza, Tanzania
| | - Dipan Karmali
- Division of General Internal Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Daniel Kaminstein
- Center for Ultrasound Education, Department of Emergency Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Richard Devereux
- Division of Cardiovascular Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Margaret McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Warren Johnson
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Daniel Fitzgerald
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert Peck
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, New York, USA
- Mwanza Intervention Trials Unit, London School of Hygiene and Tropical Medicine, Mwanza, Tanzania
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14
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Affiliation(s)
- Robert N Peck
- Center for Global Health Weill Cornell Medical College New York NY.,Department of Medicine Weill Bugando School of Medicine Mwanza Tanzania.,Mwanza Interventional Trials Unit Mwanza Tanzania
| | - Justin R Kingery
- Center for Global Health Weill Cornell Medical College New York NY.,Department of Medicine Weill Bugando School of Medicine Mwanza Tanzania.,Mwanza Interventional Trials Unit Mwanza Tanzania
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15
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Cricco-Lizza E, Tavakkoli M, Kingery JR. Abdominal Distension in an Elderly Man after Presumed Vertical Transmission of Chagas Disease. Am J Trop Med Hyg 2019; 100:773-774. [PMID: 31971127 PMCID: PMC6447105 DOI: 10.4269/ajtmh.18-0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eliza Cricco-Lizza
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York
| | - Montreh Tavakkoli
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York
| | - Justin R. Kingery
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York
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Kingery JR, Yango M, Wajanga B, Kalokola F, Brejt J, Kataraihya J, Peck R. Heart failure, post-hospital mortality and renal function in Tanzania: A prospective cohort study. Int J Cardiol 2017; 243:311-317. [PMID: 28522164 DOI: 10.1016/j.ijcard.2017.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine one-year, post-hospital mortality and the predictors of mortality in Tanzanian adults with heart failure (HF) compared to other admitted adults. METHODS In this prospective cohort study we consecutively enrolled medical inpatients admitted during a 3-month period, screened for HF and followed until 12 months after hospital discharge. Standardized history, physical examination, echocardiography and laboratory investigations were obtained during hospital presentation. The primary outcome was one-year post-discharge mortality. The secondary outcome was in-hospital mortality. Cox regression adjusted for age and sex was used. RESULTS During the study period, we enrolled 558 adults; 145 had HF and 107 of these survived until discharge. Patients with HF had a higher one-year post-hospital discharge mortality than all other diagnoses (62/107 (57.9%) vs 150/343 (43.7%), respectively, HR=1.57[1.13-2.18]). In-hospital mortality was similar. Markers of renal disease were more common in adults with HF (40/107 (37.4%) and were the strongest independent predictors of post-hospital mortality: low eGFR (HR=2.94[1.62-5.31]) and proteinuria (HR=2.03, [95%CI 1.13-3.66]). No patients discharged with the combination of low eGFR/proteinuria survived to the one-year endpoint. Of note, 79/145 (54.5%) of adults admitted with HF were newly diagnosed during hospital admission. CONCLUSIONS Over half of adults discharged with HF died within 12months after discharge. Adults with HF had higher post-hospital mortality compared to other medical inpatients. Markers of renal disease were the strongest predictor of this mortality. Innovative interventions are needed to reduce post-hospital mortality in adults with HF and should focus on those with renal disease.
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Affiliation(s)
- Justin R Kingery
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania; Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA; Center for Global Health, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA.
| | - Missana Yango
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
| | - Bahati Wajanga
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
| | - Josef Brejt
- Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA
| | - Johannes Kataraihya
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
| | - Robert Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania; Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA; Center for Global Health, Department of Internal Medicine, Weill Cornell Medical College, New York City, USA
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Kingery JR, Hamid T, Lewis RK, Ismahil MA, Bansal SS, Rokosh G, Townes TM, Ildstad ST, Jones SP, Prabhu SD. Leukocyte iNOS is required for inflammation and pathological remodeling in ischemic heart failure. Basic Res Cardiol 2017; 112:19. [PMID: 28238121 DOI: 10.1007/s00395-017-0609-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/23/2017] [Indexed: 12/18/2022]
Abstract
In the failing heart, iNOS is expressed by both macrophages and cardiomyocytes. We hypothesized that inflammatory cell-localized iNOS exacerbates left ventricular (LV) remodeling. Wild-type (WT) C57BL/6 mice underwent total body irradiation and reconstitution with bone marrow from iNOS-/- mice (iNOS-/-c) or WT mice (WTc). Chimeric mice underwent coronary ligation to induce large infarction and ischemic heart failure (HF), or sham surgery. After 28 days, as compared with WTc sham mice, WTc HF mice exhibited significant (p < 0.05) mortality, LV dysfunction, hypertrophy, fibrosis, oxidative/nitrative stress, inflammatory activation, and iNOS upregulation. These mice also exhibited a ~twofold increase in circulating Ly6Chi pro-inflammatory monocytes, and ~sevenfold higher cardiac M1 macrophages, which were primarily CCR2- cells. In contrast, as compared with WTc HF mice, iNOS-/-c HF mice exhibited significantly improved survival, LV function, hypertrophy, fibrosis, oxidative/nitrative stress, and inflammatory activation, without differences in overall cardiac iNOS expression. Moreover, iNOS-/-c HF mice exhibited lower circulating Ly6Chi monocytes, and augmented cardiac M2 macrophages, but with greater infiltrating monocyte-derived CCR2+ macrophages vs. WTc HF mice. Lastly, upon cell-to-cell contact with naïve cardiomyocytes, peritoneal macrophages from WT HF mice depressed contraction, and augmented cardiomyocyte oxygen free radicals and peroxynitrite. These effects were not observed upon contact with macrophages from iNOS-/- HF mice. We conclude that leukocyte iNOS is obligatory for local and systemic inflammatory activation and cardiac remodeling in ischemic HF. Activated macrophages in HF may directly induce cardiomyocyte contractile dysfunction and oxidant stress upon cell-to-cell contact; this juxtacrine response requires macrophage-localized iNOS.
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Affiliation(s)
- Justin R Kingery
- Department of Medicine, University of Louisville, Louisville, KY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tariq Hamid
- Department of Medicine, University of Louisville, Louisville, KY, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, and Birmingham VAMC, Birmingham, AL, USA
| | - Robert K Lewis
- Department of Medicine, University of Louisville, Louisville, KY, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Mohamed Ameen Ismahil
- Department of Medicine, University of Louisville, Louisville, KY, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, and Birmingham VAMC, Birmingham, AL, USA
| | - Shyam S Bansal
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, and Birmingham VAMC, Birmingham, AL, USA
| | - Gregg Rokosh
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, and Birmingham VAMC, Birmingham, AL, USA
| | - Tim M Townes
- Department of Biochemistry & Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne T Ildstad
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Steven P Jones
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Sumanth D Prabhu
- Department of Medicine, University of Louisville, Louisville, KY, USA. .,Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, and Birmingham VAMC, Birmingham, AL, USA.
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Kingery JR, Alfred Y, Smart LR, Nash E, Todd J, Naguib MR, Downs JA, Kalluvya S, Kataraihya JB, Peck RN. Short-term and long-term cardiovascular risk, metabolic syndrome and HIV in Tanzania. Heart 2016; 102:1200-5. [PMID: 27105648 DOI: 10.1136/heartjnl-2015-309026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/03/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare short-term and long-term cardiovascular disease (CVD) risk scores and prevalence of metabolic syndrome in HIV-infected adults receiving and not receiving antiretroviral therapy (ART) to HIV-negative controls. METHODS A cross-sectional study including 151 HIV-infected, ART-naive, 150 HIV-infected on ART and 153 HIV-negative adults. Traditional cardiovascular risk factors were determined by standard investigations. The primary outcome was American College of Cardiology/American Heart Association Atherosclerotic CVD (ASCVD) Risk Estimator lifetime CVD risk score. Secondary outcomes were ASCVD 10-year risk, Framingham risk scores, statin indication and metabolic syndrome. RESULTS Compared with HIV-negative controls, more HIV-infected adults on ART were classified as high lifetime CVD risk (34.7% vs 17.0%, p<0.001) although 10-year risk scores were similar, a trend which was similar across multiple CVD risk models. In addition, HIV-infected adults on ART had a higher prevalence of metabolic syndrome versus HIV-negative controls (21.3% vs 7.8%, p=0.008), with two common clusters of risk factors. More than one-quarter (28.7%) of HIV-infected Tanzanian adults on ART meet criteria for statin initiation. CONCLUSIONS HIV-infected ART-treated individuals have high lifetime cardiovascular risk, and this risk seems to develop rapidly in the first 3-4 years of ART as does the development of clusters of metabolic syndrome criteria. These data identify a new subgroup of low short-term/high-lifetime risk HIV-infected individuals on ART who do not currently meet criteria for CVD risk factor modification but require further study.
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Affiliation(s)
- Justin R Kingery
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, New York, USA Department of Internal Medicine, Center for Global Health, Weill Cornell Medical College, New York City, New York, USA
| | - Yona Alfred
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Luke R Smart
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania Department of Internal Medicine, Center for Global Health, Weill Cornell Medical College, New York City, New York, USA
| | - Emily Nash
- Department of Internal Medicine, Center for Global Health, Weill Cornell Medical College, New York City, New York, USA
| | - Jim Todd
- Population Health Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Mostafa R Naguib
- Department of Medicine, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Jennifer A Downs
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania Department of Internal Medicine, Center for Global Health, Weill Cornell Medical College, New York City, New York, USA
| | - Samuel Kalluvya
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Johannes B Kataraihya
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Robert N Peck
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, New York, USA Department of Internal Medicine, Center for Global Health, Weill Cornell Medical College, New York City, New York, USA
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Ismahil MA, Hamid T, Bansal SS, Patel B, Kingery JR, Prabhu SD. Remodeling of the mononuclear phagocyte network underlies chronic inflammation and disease progression in heart failure: critical importance of the cardiosplenic axis. Circ Res 2013; 114:266-82. [PMID: 24186967 DOI: 10.1161/circresaha.113.301720] [Citation(s) in RCA: 255] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
RATIONALE The role of mononuclear phagocytes in chronic heart failure (HF) is unknown. OBJECTIVE Our aim was to delineate monocyte, macrophage, and dendritic cell trafficking in HF and define the contribution of the spleen to cardiac remodeling. METHODS AND RESULTS We evaluated C57Bl/6 mice with chronic HF 8 weeks after coronary ligation. As compared with sham-operated controls, HF mice exhibited: (1) increased proinflammatory CD11b+ F4/80+ CD206- macrophages and CD11b+ F4/80+ Gr-1(hi) monocytes in the heart and peripheral blood, respectively, and reduced CD11b+ F4/80+ Gr-1(hi) monocytes in the spleen; (2) significantly increased CD11c+ B220- classical dendritic cells and CD11c+ low)B220+ plasmacytoid dendritic cells in both the heart and spleen, and increased classic dendritic cells and plasmacytoid dendritic cells in peripheral blood and bone marrow, respectively; (3) increased CD4+ helper and CD8+ cytotoxic T-cells in the spleen; and (4) profound splenic remodeling with abundant white pulp follicles, markedly increased size of the marginal zone and germinal centers, and increased expression of alarmins. Splenectomy in mice with established HF reversed pathological cardiac remodeling and inflammation. Splenocytes adoptively transferred from mice with HF, but not from sham-operated mice, homed to the heart and induced long-term left ventricular dilatation, dysfunction, and fibrosis in naive recipients. Recipient mice also exhibited monocyte activation and splenic remodeling similar to HF mice. CONCLUSIONS Activation of mononuclear phagocytes is central to the progression of cardiac remodeling in HF, and heightened antigen processing in the spleen plays a critical role in this process. Splenocytes (presumably splenic monocytes and dendritic cells) promote immune-mediated injurious responses in the failing heart and retain this memory on adoptive transfer.
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Affiliation(s)
- Mohamed Ameen Ismahil
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham and Birmingham VAMC, Birmingham, AL (M.A.I., T.H., S.S.S., B.P., S.D.P.); and Department of Medicine, University of Louisville, KY (J.R.K.)
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Ismahil MA, Kingery JR, Hamid T, Zhou G, Guo S, Prabhu SD. Abstract 221: Chronic Alterations of the Tissue Dendritic Cell and Macrophage Network Underlies the Th1 Response in the Failing Heart. Circ Res 2012. [DOI: 10.1161/res.111.suppl_1.a221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about changes in the immune cell network that underlie pro-inflammatory cytokine elaboration in chronic heart failure (HF). Dendritic cells (DCs) and macrophages are antigen-presenting cells that play a central role in inflammation and immune tolerance. We investigated the pattern of infiltrating cardiac DCs and macrophages in chronic post-ischemic HF. Myocardial infarction (MI) was induced by left coronary ligation in male C57BL/6 mice. Pathological remodeling and HF were confirmed by hemodynamics, gravimetry, and echocardiography at 8 weeks post-MI. Sham-operated mice served as controls. At 8 weeks, cardiac infiltrating immune cells were isolated by collagenase digestion followed by density gradient centrifugation. Trypan blue-negative viable cells were quantified using flow cytometry. DCs were characterized using specific markers for classical (cDC) (CD11C+B220-), plasmacytoid (pDC) (CD11C+B220+), and immunogenic (CD11c+B220+CD86hi) and tolerogenic (CD11c+B220+CD86low) DCs. Macrophages were classified as activated (CD11b+F480+), pro- or anti-inflammatory (CD11b+F480+Gr1hi or low), and M1 (CD11b+F480+CD206-) or M2 (CD11b+F480+CD206+). Significant increases in cDCs (1.4 fold; p=0.016) and pDCs (4.3 fold; p=0.0016) were observed in failing myocardium. Surface expression of the maturation marker CD86 was increased 8.6 fold (p=0.009), whereas immature DCs exhibited a robust 24.4 fold (p=0.0005) increase. Activated macrophages were also significantly elevated in the failing heart as compared with sham-operated hearts (19.2 ± 1.9 vs 10.9 ± 2.9%; p=0.033), with marked infiltration of pro-inflammatory and M1 macrophages (6.2 ± 0.6 vs 3.8 ± 0.7%; p=0.019). In contrast, levels of anti-inflammatory and M2 macrophages were unchanged. We conclude that in chronic HF, there is marked upregulation of cDC and pDC subsets and pro-inflammatory/M1 macrophages that alter immune homeostasis, contribute to the recruitment and activation of immune cells, and underlie the chronic Th1 response in failing myocardium that promotes pathological remodeling. This suggests that targeting or altering immune cell subsets in the failing heart, rather than specific cytokines, may be a better approach to modulating inflammation in HF.
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Affiliation(s)
| | | | - Tariq Hamid
- Univ of Alabama at Birmingham, Birmingham, AL,
| | - Guihua Zhou
- Univ of Alabama at Birmingham, Birmingham, AL,
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Ismahil MA, Hamid T, Kingery JR, Prabhu SD. Abstract 90: The Spleen Is an Essential Regulator of Systemic Neovascularization In Vivo. Circ Res 2012. [DOI: 10.1161/res.111.suppl_1.a90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myocardial neovascularization play key role in the structural remodeling that occurs in heart failure. Prior studies have suggested an important role for splenic monocytes in tissue healing after myocardial infarction; however, the role of macrophages in regulating angiogenesis at the site of tissue injury is complex and not well defined. Moreover, it is unclear how the spleen regulates macrophage-mediated neovascularization. We hypothesized that the spleen plays a critical role in determining macrophage polarity that in turn influences tissue neovascularization. In 7 naïve and 7 splenectomized C57BL/6 mice (splenectomy performed 28 d prior), we performed in vivo Matrigel plug assays. Matrigel (0.6 mL/plug) was injected subcutaneously, either alone or together with peritoneal macrophages (∼20,000 cells/plug) isolated from syngeneic mice, and Matrigel plug neovascularization was assessed after 10 d. Masson trichrome staining and CD31 immunostaining was used to index vascularization. Circulating activated monocytes (CD11b+F480+) and endothelial progenitor cells (EPCs, CD34+Flk-1+) were assessed by flow cytometry. Flow cytometry of peripheral blood revealed significant reductions in circulating activated monocytes (2.20 ± 0.32 vs. 3.95 ± 0.49 %; p=0.002) and EPCs (0.0076 ± 0.0013 vs. 0.018 ± 0.0023; p=0.0002) in splenectomized mice as compared with naïve mice. Splenectomized mice also exhibited markedly reduced neovessel formation in Matrigel plugs indexed by morphometric and immunohistological analyses. The addition of peritoneal macrophages to the Matrigel plug restored vessel formation in splenectomized mice, but did not change neovascularization in naïve mice. Moreover, this restoration of neovascularization occurred with the addition of peritoneal macrophages polarized to an M2 phenotype (using interleukin [IL]-4 or IL-10) but not to an M1 phenotype. We conclude that the spleen is a key determinant of macrophage polarization and function that subsequently impacts the efficiency of tissue neovascularization. Hence, the spleen provides an anti-inflammatory and pro-angiogenic regulatory function in vivo that may be of central importance to the adequacy of myocardial repair and remodeling following tissue injury.
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Affiliation(s)
| | - Tariq Hamid
- Univ of Alabama at Birmingham, Birmingham, AL,
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Hamid T, Guo SZ, Kingery JR, Xiang X, Dawn B, Prabhu SD. Cardiomyocyte NF-κB p65 promotes adverse remodelling, apoptosis, and endoplasmic reticulum stress in heart failure. Cardiovasc Res 2010; 89:129-38. [PMID: 20797985 DOI: 10.1093/cvr/cvq274] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS the role of nuclear factor (NF)-κB in heart failure (HF) is not well defined. We sought to determine whether myocyte-localized NF-κB p65 activation in HF exacerbates post-infarction remodelling and promotes maladaptive endoplasmic reticulum (ER) stress. METHODS AND RESULTS non-transgenic (NTg) and transgenic (Tg) mice with myocyte-restricted overexpression of a phosphorylation-resistant inhibitor of κBα (IκBα(S32A,S36A)) underwent coronary ligation (to induce HF) or sham operation. Over 4 weeks, the remote myocardium of ligated hearts exhibited robust NF-κB activation that was almost exclusively p65 beyond 24 h. Compared with sham at 4 weeks, NTg HF hearts were dilated and dysfunctional, and exhibited hypertrophy, fibrosis, up-regulation of inflammatory cytokines, increased apoptosis, down-regulation of ER protein chaperones, and up-regulation of the ER stress-activated pro-apoptotic factor CHOP. Compared with NTg HF, Tg-IκBα(S32A,S36A) HF mice exhibited: (i) improved survival, chamber remodelling, systolic function, and pulmonary congestion, (ii) markedly diminished NF-κB p65 activation, cytokine expression, and fibrosis, and (iii) a three-fold reduction in apoptosis. Moreover, Tg-IκBα(S32A,S36A) HF hearts exhibited maintained expression of ER chaperones and CHOP when compared with sham. In cardiomyocytes, NF-κB activation was required for ER stress-mediated apoptosis, whereas abrogation of myocyte NF-κB shifted the ER stress response to one of adaptation and survival. CONCLUSION persistent myocyte NF-κB p65 activation in HF exacerbates cardiac remodelling by imparting pro-inflammatory, pro-fibrotic, and pro-apoptotic effects. p65 modulation of cell death in HF may occur in part from NF-κB-mediated transformation of the ER stress response from one of adaptation to one of apoptosis.
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Affiliation(s)
- Tariq Hamid
- Department of Medicine, Louisville VAMC and Institute of Molecular Cardiology, University of Louisville, ACB, 3rd Floor, 550 South Jackson Street, Louisville, Louisville, KY 40202, USA
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Wang G, Hamid T, Keith RJ, Zhou G, Partridge CR, Xiang X, Kingery JR, Lewis RK, Li Q, Rokosh DG, Ford R, Spinale FG, Riggs DW, Srivastava S, Bhatnagar A, Bolli R, Prabhu SD. Cardioprotective and antiapoptotic effects of heme oxygenase-1 in the failing heart. Circulation 2010; 121:1912-25. [PMID: 20404253 DOI: 10.1161/circulationaha.109.905471] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Heme oxygenase-1 (HO-1) is an inducible stress-response protein that imparts antioxidant and antiapoptotic effects. However, its pathophysiological role in cardiac remodeling and chronic heart failure (HF) is unknown. We hypothesized that induction of HO-1 in HF alleviates pathological remodeling. METHODS AND RESULTS Adult male nontransgenic and myocyte-restricted HO-1 transgenic mice underwent either sham operation or coronary ligation to induce HF. Four weeks after ligation, nontransgenic HF mice exhibited postinfarction left ventricular (LV) remodeling and dysfunction, hypertrophy, fibrosis, oxidative stress, apoptosis, and reduced capillary density, associated with a 2-fold increase in HO-1 expression in noninfarcted myocardium. Compared with nontransgenic mice, HO-1 transgenic HF mice exhibited significantly (P<0.05) improved postinfarction survival (94% versus 57%) and less LV dilatation (end-diastolic volume, 46+/-8 versus 85+/-32 microL), mechanical dysfunction (ejection fraction, 65+/-9% versus 49+/-16%), hypertrophy (LV/tibia length 4.4+/-0.4 versus 5.2+/-0.6 mg/mm), interstitial fibrosis (11.2+/-3.1% versus 18.5+/-3.5%), and oxidative stress (3-fold reduction in tissue malondialdehyde). Moreover, myocyte-specific HO-1 overexpression in HF promoted tissue neovascularization and ameliorated myocardial p53 expression (2-fold reduction) and apoptosis. In isolated mitochondria, mitochondrial permeability transition was inhibited by HO-1 in a carbon monoxide (CO)-dependent manner and was recapitulated by the CO donor tricarbonylchloro(glycinato)ruthenium(II) (CORM-3). HO-1-derived CO also prevented H2O2-induced cardiomyocyte apoptosis and cell death. Finally, in vivo treatment with CORM-3 alleviated postinfarction LV remodeling, p53 expression, and apoptosis. CONCLUSIONS HO-1 induction in the failing heart is an important cardioprotective adaptation that opposes pathological LV remodeling, and this effect is mediated, at least in part, by CO-dependent inhibition of mitochondrial permeability transition and apoptosis. Augmentation of HO-1 or its product, CO, may represent a novel therapeutic strategy for ameliorating HF.
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Affiliation(s)
- Guangwu Wang
- Division of Cardiovascular Medicine, Institute of Molecular Cardiology, Department of Medicine, University of Louisville, ACB, Third Floor, 550 S Jackson St, Louisville, KY 40202, USA
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Kingery JR, Sowinski KM, Kraus MA, Klaunig JE, Mueller BA. Vancomycin assay performance in patients with end-stage renal disease receiving hemodialysis. Pharmacotherapy 2000; 20:653-6. [PMID: 10853620 DOI: 10.1592/phco.20.7.653.35177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To compare the performance of polyclonal fluorescence polarization immunoassay (pFPIA) with that of enzyme-multiplied immunoassay technique (EMIT) in patients receiving vancomycin and hemodialysis. SETTING Outpatient hemodialysis center. PATIENTS Seven subjects with end-stage renal disease treated with hemodialysis 3 times/week with a cellulose triacetate hemodialyzer. INTERVENTION Subjects received vancomycin 1000 mg intradialytically during the first study session and 750 mg every other hemodialysis session thereafter for 4 weeks. MEASUREMENTS AND MAIN RESULTS Blood samples were obtained throughout the study, and vancomycin serum concentrations were determined by pFPIA and EMIT. The mean +/- SD difference (estimate of bias) between assays was -1.10 +/- 1.35 mg/L. The limits of agreement (mean difference +/- 1.96 x SD) between them were -3.80-1.60 mg/L. CONCLUSION Our data suggest that the manufacturer's changes in the vancomycin pFPIA eliminated overestimation of drug concentrations in patients undergoing high-permeability hemodialysis.
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Affiliation(s)
- J R Kingery
- Department of Pharmacy, Clarian Health Partners, Inc., Indiana University Hospital, Indianapolis, USA
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