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Imaging with late gadolinium enhancement (LGE) magnetic resonance (MR) and 18F-fluorodeoxyglucose (18F-FDG) PET allows complementary assessment of myocardial injury and disease activity and has shown promise for improved characterization of active cardiac sarcoidosis (CS) based on the combined positive imaging outcome, MR(+)PET(+). This study aims to evaluate qualitative and quantitative assessments of hybrid MR/PET imaging in CS and to evaluate its association with cardiac-related outcomes. A total of 148 patients with suspected CS underwent hybrid MR/PET imaging. Patients were classified based on the presence/absence of LGE (MR+/MR−), presence/absence of 18F-FDG (PET+/PET−), and pattern of 18F-FDG uptake (focal/diffuse) into the following categories: MR(+)PET(+) FOCAL , MR(+)PET(+) DIFFUSE , MR(+)PET(−), MR(−)PET(+) FOCAL , MR(−)PET(+) DIFFUSE , MR(−)PET(−). Further analysis classified MR positivity based on %LGE exceeding 5.7% as MR(+/−) 5.7%. Quantitative values of standard uptake value, target-to-background ratio, target-to-normal-myocardium ratio (TNMRmax), and T2 were measured. The primary clinical endpoint was met by the occurrence of cardiac arrest, ventricular tachycardia, or secondary prevention implantable cardioverter-defibrillator (ICD) before the end of the study. The secondary endpoint was met by any of the primary endpoint criteria plus heart failure or heart block. MR/PET imaging results were compared between those meeting or not meeting the clinical endpoints. Patients designated MR(+) 5.7% PET(+) FOCAL had increased odds of meeting the primary clinical endpoint compared to those with all other imaging classifications (unadjusted OR: 9.2 [95% CI: 3.0-28.7]; P = 0.0001), which was higher than the odds based on MR or PET alone. TNMRmax achieved an area under the receiver-operating characteristic curve of 0.90 for separating MR(+)PET(+) FOCAL from non-MR(+)PET(+) FOCAL , and 0.77 for separating those reaching the clinical endpoint from those not reaching the clinical endpoint. Hybrid MR/PET image–based classification of CS was statistically associated with clinical outcomes in CS. TNMRmax had modest sensitivity and specificity for quantifying the imaging-based classification MR(+)PET(+) FOCAL and was associated with outcomes. Use of combined MR and PET image–based classification may have use in prognostication and treatment management in CS. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Mitral valve (MV) prolapse (MVP) is a primary valvular abnormality. We hypothesized that additionally there are concomitant abnormalities of the left ventricle (LV) and MV apparatus in this entity even in the absence of significant mitral regurgitation (MR). Objective: To characterize MV and LV anatomic and functional features in MVP with preserved LV ejection fraction, with and without significant MR, using cardiovascular magnetic resonance (CMR). Methods: Consecutive MVP patients (n = 80, mean 52 years, 37% males) with preserved LV ejection fraction, and 44 controls (46 years, 52% males) by CMR were included, as well as 13 additional patients with "borderline" MVP. From cine images we quantified LV volumes, MV and LV anatomic measurements (including angle between diastolic and systolic annular planes, annular displacement, and basal inferolateral hypertrophy) and, using feature tracking, longitudinal and circumferential peak systolic strains. Results: Significant MR was found in 46 (56%) MVP patients. Compared with controls, MVP patients had LV enlargement, basal inferolateral hypertrophy, higher posterior annular excursion, and reduced shortening of the papillary muscles. LV basal strains were significantly increased, particularly in several basal segments. These differences remained significant in patients without significant MR, and many persisted in "borderline" MVP. Conclusions: In patients with MVP and preserved LV ejection fraction there is LV dilatation, basal inferolateral hypertrophy, exaggerated posterior annular displacement and increased basal deformation, even in the absence of significant MR or overt MVP. These findings suggest that MVP is a disease not only of the MV but also of the adjacent myocardium. [ABSTRACT FROM AUTHOR]

Syndemic Theory (ST) provides a framework to examine mutually enhancing diseases/health issues under conditions of social inequality and inequity. ST has been used in multiple disciplines to address interacting infectious diseases, noncommunicable diseases, and mental health conditions. The theory has been critiqued for its inability to measure disease interactions and their individual and combined health outcomes. This article reviews literature that strongly suggests a syndemic between food insecurity (FI) and diet-related chronic diseases (DRCDs), and proposes a model to measure the extent of such interaction. The article seeks to: (1) examine the potential syndemic between FI and DRCDs; (2) illustrate how the incorporation of Life History Theory (LHT), into a syndemic framework can help to highlight critical lifeperiods when FI-DRCD interactions result in adverse health outcomes; (3) discuss the use of mixed methods to identify and measure syndemics to enhance the precision and predictive power of ST; and (4) propose an analytical model for the examination of the FI-DRCD syndemic through the life course. The proposed model is more relevant now given the significant increase in FI globally as a result of the ongoing COVID-19 pandemic. The differential impact that the pandemic appears to have among various age groups and by other demographic factors (e.g., race, gender, income) offers an opportunity to examine the potential FI-DRCD syndemic under the lens of LHT. • Systematic review of literature on Food Insecurity and Diet Related Chronic Diseases. • New conceptual model of Food Insecurity and Diet Related Chronic Disease Syndemic. • Use of qualitative and quantitative methods and Life History Theory. • Use of Structural Equation Modeling to identify and measure syndemics. [ABSTRACT FROM AUTHOR]

Drawing on a review of the existing literature and on the knowledge derived from many years of direct work with sex workers in the inner city, we conceptualize the mutually reinforcing relation that exists among violence, drug use, and risk for HIV/AIDS among women involved in street-level prostitution. While recognizing the centrality of violence victimization, we call attention to the need to examine exposure to indirect (or witnessed) violence (when the person is the witness rather than the direct victim of violence) as a factor that increases drug- and sex-related HIV risk in this population. Specifically, we hypothesize that the emotional sequela that results from continued exposure to indirect violence has a direct effect on patterns of drug use (including drug use initiation, relapses, and changes in quantity, frequency, and mode of ingestion), and increases women''s vulnerability to sexual transmission of HIV by making them more vulnerable to sexual attacks, and less able to demand use of condoms. The impact of indirect violence is especially detrimental when the woman witnesses serious violent acts against other sex workers. [Copyright &y& Elsevier]

Background Beta-blockers (BBs) remain underused in elderly patients with reduced ejection fraction (REF). Our aim was to determine the prognostic impact of different doses of BB in this setting. Methods and results A single-center observational study was conducted. Inclusion criteria were age ≥ 75 and EF ≤ 0.35. Six months after diagnosis, patients were divided into 3 groups depending on BB dose: no BB (NBB), low dose (< 50% of the target dose) (LD), and high dose (≥ 50%) (HD). Two different analytical approaches were employed: multivariate Cox model and propensity-score (PS) matching. Outcomes were all-cause death and heart failure (HF) admission. We included 559 patients (134 NBB, 259 LD, and 166 HD) with median follow-up of 29.9 months. There were 212 deaths (NBB: 70 (52.2%); LD: 94 (36.3%); and HD: 48 (28.9%)) and 171 HF admissions (NBB: 42 (31.3%); LD: 85 (32.8%); and HD: 44 (26.5%)). On multivariate analysis, both LD and HD were associated with improved survival, with no differences between them (HD vs. NBB = 0.67, 95% CI = [0.46–0.98], p = 0.037; HD vs. LD = 1.03, 95% CI = [0.72–1.46], p = 0.894; and LD vs. NBB = 0.65, 95% CI = [0.48–0.90], p = 0.009). However, BB therapy failed to show benefits in HF admissions ( p = NS, for each comparison). PS-matched analysis included 198 patients, with similar results to those mentioned above. Conclusions BB therapy was associated with a significant reduction in mortality among elderly patients with REF, regardless of dose. Nevertheless, it was not associated with a decrease in HF admissions. Further studies are needed to determine the optimal BB dose in these patients. [ABSTRACT FROM AUTHOR]

The aim of this paper is to examine the role and impact that globalization and migration (e.g., intra-/intercontinental, urban/rural, and circular) have had on diet patterns, diet quality, and energy balance as reported on in the literature during the last 20 years. Published literature from the fields of anthropology, public health, nutrition, and other disciplines (e.g., economics) was collected and reviewed. In addition, case studies from the authors' own research are presented in order to elaborate on key points and dietary trends identified in the literature. While this review is not intended to be comprehensive, the findings suggest that the effects of migration and globalization on diet quality and energy balance are neither lineal nor direct, and that the role of social and physical environments, culture, social organization, and technology must be taken into account to better understand this relationship. Moreover, concepts such as acculturation and the nutrition transition do not necessarily explain or adequately describe all of the global processes that shape diet quality and energy balance. Theories from nutritional anthropology and critical bio-cultural medical anthropology are used to tease out some of these complex interrelationships. [ABSTRACT FROM AUTHOR]