BackgroundAnemia occurs frequently in HIV-infected patients and has been associated with an increased risk of death in this population. For Hispanic subjects, information describing this blood disorder during HIV is scarce. Therefore, the present study examined data from a cohort of HIV-positive Hispanics to determine the prevalence of anemia, identify its associated factors, and evaluate its relationship with one-year mortality.MethodsThis study included 1,486 patients who enrolled between January, 2000 and December, 2010 in an HIV-cohort in Bayamón, Puerto Rico. Data were collected through personal interviews and medical record abstractions. To determine the factors independently associated with anemia, a multivariable logistic regression model was used. Kaplan-Meier and Cox proportional hazards models were also performed to estimate survival time and to predict death risk.ResultsThe prevalence of anemia at enrollment was 41.5%. Factors independently associated with increased odds of anemia were: unemployment (OR = 2.02; 95% CI 1.45-2.79), CD4 count <200 cells/μL (OR = 2.66; 95% CI 1.94-3.66), HIV viral load ≥100,000 copies/mL (OR = 1.94; 95% CI 1.36-2.78), white blood cell count <4,000 cells/μL (OR = 2.42; 95% CI 1.78-3.28) and having clinical AIDS (OR = 2.39; 95% CI 1.39-4.09). Overweight (OR = 0.43; 95% CI 0.32-0.59) and obese (OR = 0.44; 95% CI 0.29-0.67) BMI’s were independently associated with reduced odds of anemia. Survival differed significantly by anemia status (log-rank test: p < 0.001). One-year mortality estimates were: 30.8%, 23.3%, 8.4% and 2.5%, for patients with severe, moderate, mild and no anemia, respectively. Having anemia at baseline was independently associated with an increased one-year mortality risk (severe anemia: HR = 9.06; 95% CI: 4.16-19.72; moderate anemia: HR = 6.51; 95% CI: 3.25-13.06; mild anemia: HR = 2.53; 95% CI: 1.35-4.74).ConclusionsA high prevalence of anemia at enrollment was observed in this cohort of HIV-infected Hispanics. Unemployment and several adverse prognostic features of HIV infection were independently associated with this blood disorder. Anemia resulted to be the strongest predictor of one-year mortality, evidencing a dose–response effect. Further investigations are needed to evaluate whether recovering from anemia is associated with longer survival, and to identify the types of anemia affecting this particular group of HIV patients.

Background There are limited validated FFQs for infants and toddlers, most of which were evaluated in Europe or Oceania and the available ones for use in the US have important limitations. Objective To assess the validity of a food frequency questionnaire (FFQ) developed for infants and toddlers. Design A semi-quantitative FFQ was developed including 52 food items, their source and portion sizes. It enquired about diets over the previous 7 days. Its validity was assessed in a cross-sectional study. Participants completed the FFQ followed by a 24-hour recall on two occasions with one week between data collection. Participants/setting A total of 296 caregivers of infants and toddlers aged 0–24 months enrolled in WIC-Puerto Rico. Main outcome measures Intake of nutrients and food groups were averaged for the two FFQs and the two 24-h food recalls and adjusted for energy intake. Statistical analyses performed Spearman correlations were performed for intakes of energy, nutrients, and foods between administrations and between instruments. Correlation coefficients were de-attenuated to account for variation in the 24 hour recalls. Results A total of 241 participants completed the study. Intake of all nutrients and foods were significantly correlated between FFQs, 24-h recalls and between the average of FFQs and 24-h food recalls. The de-attenuated correlation for nutrients between the FFQs and 24-h recalls ranged from 0.26 (folate) to 0.77 (energy), with an average correlation of 0.53. The de-attenuated correlation for food groups between the FFQs and 24-h recalls ranged from 0.28 (sweets) to 0.80 (breast-milk) with an average correlation of 0.55. When analyses were restricted to those consuming foods other than breast milk or formula (N=186), results were similar. Conclusions This semi-quantitative FFQ is a tool that offers reasonably valid rankings for intake of energy, nutrients, foods and food groups in this sample of infants and toddlers.

Background: Colorectal cancer incidence and mortality have declined with increased screening and scientific advances in treatment. However, improvement in colorectal cancer outcomes has not been equal for all groups and disparities have persisted over time.Methods: Data from the California Cancer Registry were used to estimate changes in 5-year colorectal cancer-specific survival over three diagnostic time periods:

BackgroundThe clinical impact of arrhythmias on the continuum of critical illness is unclear, and data in medical intensive care units (ICU) is lacking. In this study, we distinguish between different types of arrhythmias and evaluate if their distinction is of clinical importance based on ICU length of stay and mortality outcomes.MethodsWe performed a retrospective analysis of 215 patients in a community-based teaching hospital medical ICU. Variables gathered include sociodemographic data, arrhythmias identified and interpreted by the study team, and admission diagnoses coded into clinical mediator categories based on theorized common risk pathways. Univariable and multivariable Poisson regression models were used to identify risk factors for developing arrhythmias by type, prolonged length of stay, and hospital mortality.ResultsSignificant arrhythmia was detected in 28.8 % of subjects with most new arrhythmia events developing within the first 3 days of ICU stay. Acute myocardial ischemia and acute kidney injury at the time of ICU admission were associated with an increased risk of developing supraventricular arrhythmias (SVA) (RR = 2.02; 95 % CI 1.08–3.78 and RR = 1.93; 95 %CI 1.09–3.37, respectively). SVA in the first 3 days of ICU stay was associated with an increased risk of prolonged ICU stay (RR = 1.47; 95 % CI 1.09–1.97). After controlling for clinical mediators, development of SVA was not independently associated with in-hospital mortality. No mediators significantly increased the risk of developing ventricular arrhythmias (VA). VA were not associated to prolonged ICU stay but were associated with increased risk of hospital mortality (RR = 1.93; 95 % CI 1.18–3.15).ConclusionsIt is important to distinguish between supraventricular and ventricular arrhythmias for outcomes in the medical ICU setting. Developing a new VA increases the risk of in-hospital mortality independently. Developing a new SVA increases the risk of having a prolonged ICU stay but does not appear to increase in-hospital mortality independently. These findings suggest that the development of a VA should be considered an independent morbid event and not necessarily the end result of a complicated clinical course, while a new SVA may be considered a cardiac complication of the disease continuum which may add complexity to an ICU stay.

Pancytopenia is seen in late HIV infection; it is associated with medical complications and with decreased survival. We determined the prevalence of pancytopenia at baseline in a cohort of HIV-positive Hispanics living in Puerto Rico, and compared their socio-demographic, immunological and clinical characteristics. A total of 1202 patients enrolled between 2000 and 2010 were included. They were grouped according to pancytopenia status, defined by having: platelets <150,000 μL, white cell count <4000 μL, and hemoglobin <12 g/dL (women) or <13 g/dL (men). Differences were evaluated using Student’s t-test, Chi-square test and Kaplan-Meier method. The prevalence of pancytopenia was 8.7%. Patients with pancytopenia had lower BMI and lower CD4 count, as well as higher HIV viral load and higher proportions of unemployment, clinical AIDS and antiretroviral treatment (ART) use (p < 0.05). One-year mortality rate was significantly higher in patients with pancytopenia (18.1% vs. 5.1%, p < 0.001). When stratifying for ART this association persisted for patients who did not receive ART (41.4% vs. 5.2%, p < 0.001), but it was not seen in patients who received treatment (9.2% vs. 5.6%, p = 0.196). Pancytopenia was associated with elements of advanced stages of HIV. ART could reduce the mortality of HIV-patients with pancytopenia to levels comparable to patients without the disorders.