Browsing by Author "Beas, Renato"

Now showing 1 - 9 of 9
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    Cognitive Impairment and Insomnia in Celiac Disease: A Systematic Review and Meta-Analysis
    (Korean Society of Gastroenterology, 2024) Beas, Renato; Godoy, Ambar; Norwood, Dalton A.; Ascencio, Ysaith Orellana; Izquierdo-Veraza, Diego; Montalvan-Sanchez, Eleazar E.; Ramirez, Mirian; Kurada, Satya; Medicine, School of Medicine
    Emerging evidence suggests a broader spectrum of celiac disease (CeD) system involvement, including neurological manifestations. We aimed to conduct a systematic review and meta-analysis of the available evidence from studies assessing the association of cognitive impairment and insomnia with CeD. A total of 259 participants with CeD were included in the studies investigating insomnia and 179 were included in studies investigating cognitive impairment. The overall pooled odds ratio for insomnia in patients with CeD was 1.83 (95% confidence interval, 1.38 to 2.42; I2=0.00%). The present study provides valuable insights into the available evidence from studies investigating cognitive impairment in patients with CeD and our systematic review and meta-analysis revealed a significant association between CeD and insomnia.
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    Colorectal Cancer Screening Programs in Latin America: A Systematic Review and Meta-Analysis
    (American Medical Association, 2024-02-05) Montalvan-Sanchez, Eleazar E.; Norwood, Dalton A.; Dougherty, Michael; Beas, Renato; Guranizo-Ortiz, Maria; Ramirez-Rojas, Miriam; Morgan, Douglas R.; Imperiale, Thomas F.; Medicine, School of Medicine
    Importance: Colorectal cancer (CRC) is a leading cause of cancer-related mortality globally, with increasing incidence and mortality in Latin America. CRC screening programs can reduce disease burden, but information on screening programs in Latin America is limited. Objective: To describe characteristics (eg, type of program, uptake, neoplastic yield) of CRC screening programs in Latin America. Data sources: PubMed, Ovid MEDLINE, EMBASE, Cochrane, PsycINFO, Web of Science Core Collection, LILACS, and SciELO were searched from inception to February 2023. Relevant references from bibliographies, conference proceedings, and gray literature were considered. The search strategy included English, Spanish, and Portuguese terms. Study selection: Included were studies of CRC screening programs in Latin America using fecal immunochemical test (FIT) or colonoscopy as the primary screening method. Four reviewers independently assessed study eligibility based on titles, with review of abstracts and full texts as needed. Data extraction and synthesis: Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed for data abstraction and quality assessment. Descriptive information was extracted, and data were pooled using a random-effects model. Main outcomes and measures: Program performance indicators included rates of participation and FIT positivity, adenoma detection rate (ADR), advanced adenoma detection rate (AADR), CRC detection rate, and colonoscopy quality indicators. Results: There were 17 studies included from upper middle-income and high-income countries in Latin America with a total of 123 929 participants. Thirteen studies used FIT as the initial screening method, whereas 4 used screening colonoscopy. The participation rate in FIT-based programs was 85.8% (95% CI, 78.5%-91.4%). FIT positivity rates were 15.2% (95% CI, 9.6%-21.8%) for the 50-ng/mL threshold and 9.7% (95% CI, 6.8%-13.0%) for the 100-ng/mL threshold. For FIT-based studies, the pooled ADR was 39.0% (95% CI, 29.3%-49.2%) and CRC detection rate was 4.9% (95% CI, 2.6%-7.9%); for screening colonoscopy-based studies, the pooled ADR was 19.9% (95% CI, 15.5%-24.8%) and CRC detection rate was 0.4% (95% CI, 0.1%-0.8%). Conclusions and relevance: This systematic review and meta-analysis suggests that CRC screening in upper middle-income countries in Latin America is feasible, detecting rates of neoplasia comparable with those of high-income regions. Population-based screening programs should be developed or enhanced in these settings. There is a knowledge gap regarding feasibility and yield of screening programs in lower middle-income countries.
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    Delays in Colorectal Cancer Screening for Latino Patients: The Role of Immigrant Healthcare in Stemming the Rising Global Incidence of Colorectal Cancer
    (Elmer Press, 2024) Montalvan-Sanchez, Eleazar E.; Beas, Renato; Karkash, Ahmad; Godoy, Ambar; Norwood, Dalton Argean; Dougherty, Michael; Medicine, School of Medicine
    The significant global burden of colorectal cancer accentuates disparities in access to preventive healthcare in most low- and middle-income countries (LMICs) as well as large sections of underserved populations within high-income countries. The barriers to colorectal cancer screening in economically transitioning Latin America are multiple. At the same time, immigration from these countries to the USA continues to increase. This case highlights the delays in diagnosis experienced by a recent immigrant from a country with no established colorectal cancer screening program, to an immigrant population in the USA with similar poor screening coverage. We discuss common challenges faced by Latinos in their home countries and the USA, as well as strategies that could be implemented to improve screening coverage in US immigrant populations.
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    Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy
    (Baishideng Publishing Group, 2021-11-20) Gnoni, Martin; Beas, Renato; Raghuram, Anupama; Díaz-Pardavé, Celeste; Riva-Moscoso, Adrian; Príncipe-Meneses, Fortunato S.; Vásquez-Garagatti, Raúl; Medicine, School of Medicine
    Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.
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    Prevalence of Obesity and Metabolic Syndrome in the High Cardiovascular Risk Setting of Rural Western Honduras
    (Ethnicity & Disease, 2024-04-10) Montalvan-Sanchez, Eleazar E.; Rodriguez-Murillo, Aida; Carrasco-Stoval, Tiffani; Carrera, Keila; Beas, Renato; Giron, Roberto; Jerez-Moreno, Valeria; Soriano-Turcios, Roque Antonio; Reyes-Guerra, Orlando; Torres, Karla; Izquierdo-Veraza, Diego; Torres, Tatiana; Beran, Azizullah A.; Montalvan-Sanchez, Daniela; Norwood, Dalton A.; Medicine, School of Medicine
    Objective: To determine the prevalence of obesity and metabolic syndrome (MS) in the population older than 45 years in rural Western Honduras and contribute to the limited literature on MS in Central America. Methods: Descriptive cross-sectional study conducted in the District of Copan. The study includes 382 men and women aged 45 to 75 years. With proper consent, anthropometric parameters, blood pressure, blood sugar, and lipid profile were evaluated. MS was diagnosed by using the National Cholesterol Education Program Criteria - Adult Panel Treatment III (NCEP-ATP III). Data were stored in REDCap (Research Electronic Data Capture) and analyzed with STATA14. Results: Data were collected on 382 patients; of these, 38% were male and 62% female. The prevalence of obesity was 24.1% for both sexes. The prevalence of MS was 64.9%. Prevalence in males and females was 54% and 71%, respectively. Notable parameters were elevated triglycerides (71%), low High-density lipoprotein cholesterol (HDL-C) (63.4%), and abdominal obesity (56.8%). In men, the distribution of MS was more homogeneous, with a mean result of 80% amongst all ages. Conclusions: The overall prevalence of obesity and MS is severely underestimated in rural Honduras. The most remarkable parameter for MS was high triglycerides (71%). Sixty-nine percent of the population has above-normal Body Mass Index (BMI). Public health efforts to control comorbidities and tackle risk factors in this population should take utmost priority.
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    Prevalence of small intestinal bacterial overgrowth in patients with gastroparesis: a systematic review and meta-analysis
    (Research Institute for Gastroenterology and Liver Diseases, 2023) Beas, Renato; Riva-Moscoso, Adrian; Montalvan-Sanchez, Eleazar; Príncipe-Meneses, Fortunato S.; Aljaras, Rawan; Ramirez, Mirian; Izquierdo-Veraza, Diego; Calderon, Gerardo; Medicine, School of Medicine
    Aim: We performed a systematic review and meta-analysis to identify the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with gastroparesis. Background: Several studies have suggested an association between SIBO and gastroparesis, which is characterized by delayed gastric emptying in the absence of mechanical obstruction. Methods: A comprehensive search was performed using MEDLINE, EMBASE, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) through January, 2022 for randomized controlled trials and observational studies reporting the prevalence of SIBO in gastroparesis. Pooled prevalence was estimated using a random effects model. Heterogeneity was assessed by using the inconsistency index (I2). Results: Among the 976 articles identified, 43 studies were selected for full text review. Six studies, with 385 patients, were deemed eligible for inclusion, with a perfect agreement between investigators (kappa=1.0). Overall, 379 patients were diagnosed with gastroparesis by gastric emptying scintigraphy and six were diagnosed with a wireless motility capsule. The pooled prevalence of SIBO was 41% (95% confidence interval 0.23-0.58). SIBO was diagnosed using jejunal aspirate cultures (N=15, 8.4%), lactulose breath test (N=80, 44.7%), glucose breath test (N=30, 16.8%), D-xylose breath test (N=52, 29.1%), and hydrogen breath test (N=2, 1.1%). Heterogeneity was significant and noted to be high at 91%. Only one study reported SIBO diagnosis in controls, therefore no pooled odds ratio was calculated. Conclusion: SIBO was present in almost half of the patients with gastroparesis. Future studies should examine and identify the association between SIBO and gastroparesis.
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    Primary Sclerosing Cholangitis-Autoimmune Hepatitis Overlap Syndrome: Significant Barriers in Liver Disease Diagnosis and Treatment Experienced by the Latino Community
    (Springer, 2023-03-14) Guifarro, Daniel A.; De Oliveira-Gomes, Diana; Beas, Renato; Yibirin-Wakim, Marcel J.; Montalvan-Sanchez, Eleazar E.; Medicine, School of Medicine
    Overlap syndrome (OS) is a term that comprises the presentation of multiple hepatic disease characteristics in the same patient, such as the presence of autoimmune hepatitis (AIH) features in addition to primary sclerosing cholangitis (PSC) or primary biliary cholangitis (PBC). Standard therapy for AIH is immunosuppression, while ursodeoxycholic acid is the preferred treatment for PBC. Additionally, liver transplantation (LT) may be considered in severe cases. Hispanics have been found to have a higher prevalence of chronic liver disease and develop more complications associated with portal hypertension at the time of listing for LT. Despite being the fastest-growing population in the USA, Hispanics have a higher probability of not receiving an LT due to issues with social determinants of health (SDOH). It has been reported that Hispanics are more likely to be removed from the transplant list. We report a case of a 25-year-old female immigrant from a Latin American developing country who presented with symptoms consistent with worsening liver disease after years of inappropriate workup and late diagnosis due to barriers within the healthcare system. The patient had a history of unresolved jaundice and pruritus and presented with worsening of her previous symptoms and new onset abdominal distention, bilateral leg edema, and telangiectasias. Laboratory and imaging studies confirmed the diagnosis of AIH and primary sclerosing cholangitis (PSC-AIH syndrome). The patient was started on steroids, azathioprine, and ursodeoxycholic acid, showing improvement. Due to her migratory status, she could not receive an appropriate diagnosis and follow up with a single provider or healthcare institution, putting her at increased risk for life-threatening complications. Although medical management is the first step, the probability of future liver transplants exists. The patient is still undergoing liver transplant evaluation and completing a workup since she was found to have an elevated model for end-stage liver disease (MELD) score. Even with the introduction of new scores and policies that aim to reduce disparities in LT, Hispanic patients are still at higher risk of being removed from the waitlist because of death or clinical deterioration compared to non-Hispanics. To this day, Hispanics have the highest percentage of waitlist deaths (20.8%) of all ethnicities and the lowest overall rate for undergoing LT. Understanding and addressing the causes that could contribute to and explain this phenomenon is essential. Increasing awareness of this problem is vital to promote more research on LT disparities.
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    Therapies for patients with coexisting heart failure with reduced ejection fraction and non-alcoholic fatty liver disease
    (Baishideng, 2023) Arriola-Montenegro, Jose; Beas, Renato; Cerna-Viacava, Renato; Chaponan-Lavalle, Andres; Hernandez Randich, Karla; Chambergo-Michilot, Diego; Flores Sanga, Herson; Mutirangura, Pornthira; Medicine, School of Medicine
    Heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD) are two common comorbidities that share similar pathophysiological mechanisms. There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD. This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD. Pharmacological therapies, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoids receptor antagonist, and sodium-glucose cotransporter-2 inhibitors, have been shown to reduce fibrosis and fat deposits in the liver. However, there are currently no data showing the beneficial effects of sacubitril/valsartan, ivabradine, hydralazine, isosorbide nitrates, digoxin, or beta blockers on NAFLD in patients with HFrEF. This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities. Further research is needed in patients with coexisting HFrEF and NAFLD, with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities.
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    Upper Gastrointestinal Cancer: Delays in Diagnosis and Treatment Caused by Barriers to Healthcare in the Latino Community
    (Elmer Press, 2022) Montalvan-Sanchez, Eleazar E.; Beas, Renato; Norwood, Dalton Argean; Alkashash, Ahmad Mahmoud; Rodriguez Murillo, Aida A.; Calderon, Gerardo; Medicine, School of Medicine
    We report a case of an 81-year-old male immigrant from a Latin American developing country with a high burden of upper gastrointestinal neoplasms, who presented with a small bowel gastrointestinal stromal tumor (GIST) after 2 years of delay in the diagnosis due to multiple barriers to healthcare. The patient presented with a partial intestinal obstruction in an abdominal computed tomography (CT) scan suggestive of a GIST. Surgical resection was performed, and adjuvant therapy was initiated with imatinib (a tyrosine kinase inhibitor) after the diagnosis was confirmed. The patient had a successful outcome. Due to his migratory status, the patient planned to follow up with different health providers in two different countries, which constitutes a common challenge in the immigrant population.