Browsing by Author "Norwood, Dalton A."
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Item 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 MedicineEmerging 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.Item 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 MedicineImportance: 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.Item High Gastric Cancer Mortality and Years of Life Lost in Nicaragua: A Population-Based Study 1997 – 2012(American Association for Cancer Research, 2024) Peña-Galo, Edgar M.; Palacios-Navarro, Guillermo; Pastora-Membreño, Javier; Torres-Herman, Tatiana; Norwood, Dalton A.; Montalvan-Sanchez, Eleazar E.; Beasley, Timothy; Bravo, Luis Eduardo; Morgan, Douglas R.; Medicine, School of MedicineBackground: Gastric adenocarcinoma is the fourth leading cause of cancer-related mortality and leading infection-associated cancer. Gastric adenocarcinoma has striking geographic variability, with high incidence in East Asia and mountainous Latin America. Reliable cancer data and population-based cancer registries are lacking for the majority of low- and middle-income countries, including the Central American Four region (CA-4, Nicaragua, El Salvador, Honduras, and Guatemala). Methods: Mortality data for Nicaragua were obtained from the highly rated Ministry of Health death registry. All the patients were diagnosed with gastric cancer between 1997 and 2012 (ICD-10 codes, C16.0-C16.9) and death due to any cause were included in the study. Data on variables such as sex, age (stratified by 5-year age groups), municipality, urban/rural, altitude, and year of death were analyzed. Results: A total of 3,886 stomach cancer deaths were reported in Nicaragua between 1997 and 2012, of which 2,214 (56.9%) were male. The age-standardized mortality rates were 13.1 and 8.7 per 100,000 habitants for males and females, respectively, and without significant change during the study period (annual percentage change = -0.7, P = 0.2). An average of 17.9 years were lost per death, accounting for 67,964 years of life lost (YLL). Conclusions: The burden of gastric cancer mortality is high in Nicaragua with a significantly elevated age-standardized mortality rate, YYL, and average YLL. Impact: The projected increase in mortality portends the double cancer burden in northern Central America, with persistent infection-associated cancers and growing transition cancers (e.g., breast and colon cancers), which has implications for cancer control in Mesoamerica and US Latino populations. See related commentary by Riquelme and Abnet, p. 1550.Item High Incidence of Gastric Cancer in El Salvador: A National Multisectorial Study 2000–2014(American Association for Cancer Research, 2024) Ruiz de Campos, Lisseth; Valdez de Cuellar, Marisabel; Norwood, Dalton A.; Carrasco, Tiffany Y.; Montalvan-Sanchez, Eleazar E.; Rodriguez Funes, Maria-Virginia; Beasley, Timothy; Dominguez, Ricardo L.; Bravo, Luis Eduardo; Morgan, Douglas R.; Medicine, School of MedicineBackground: Gastric adenocarcinoma is the fourth leading cause of global cancer mortality and leading infection-associated cancer. Gastric cancer has significant geographic variability, with a high incidence in East Asia and mountainous regions of Latin America. In the United States, gastric cancer represents a marked disparity with incidence rates that are two to three times higher in Hispanics compared to non-Hispanic Whites. Methods: We conducted a national retrospective study of incident gastric cancer in El Salvador from to 2000 to 2014 to estimate the age-standardized incidence rate (ASIR) by using a combination of pathology and endoscopy databases. A unique multisectorial coalition was formed between the Ministry of Health (MINSAL) and ES Gastroenterology Society (AGEDES), representing public hospitals (n = 5), governmental employee hospitals (ISSS, n = 5), and private facilities (n = 6), accounting for >95% of national endoscopy capacity. HER2 and EBV tumor status was ascertained in a representative sample during 2014 to 2016. Results: A total of 10,039 unique cases of gastric cancer were identified, 45.5% female, and mean age of 65. 21% and 9.4% were <55 and <45 years old, respectively. ASIRs (M, F) were 18.9 (95% CI, 14.4-20.7) and 12.2 per 100,000 persons (95% CI, 10.9-13.5), respectively, in the period 2010 to 2014 with all centers operational. Intestinal gastric cancer was 2.8 times more common than diffuse gastric cancer; 23.2% had partial or complete pyloric obstruction. The HER2 2+/3+ status was 16.7% and EBV-encoded RNA positivity was 10.2%. Conclusions: A high incidence of gastric cancer was confirmed in El Salvador and nearly half of the patients were female. Impact: The findings have implications for cancer control in the Central America LMICs and for US Latino populations. See related commentary by Riquelme and Abnet, p. 1550.Item High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America(Ainosco Press, 2023) Montalvan-Sanchez, Eleazar; Chambergo-Michilot, Diego; Rodriguez-Murillo, Aida A.; Brooks, Alexandra E.; Palacios-Argenal, Dairy; Rivera-Pineda, Shery; Ordonez-Montes, Jose; Estevez-Ramirez, Rosa; Riva-Moscoso, Adrian; Norwood, Dalton A.; Calderon-Rodriguez, Alex; Pineda-SanMartin, Elizabeth; Giron, Roberto; Rivera-Corrales, Luis; Carcamo-Murillo, Balduino; Garner, Orlando; Medicine, School of MedicineTo compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan–Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.Item Population-Based Study of Gastric Cancer Survival and Associations in Rural Western Honduras(American Association for Cancer Research, 2024) Dominguez, Ricardo L.; Montalvan-Sanchez, Eleazar E.; Norwood, Dalton A.; Rodriguez-Murillo, Aida; Dominguez, Lucia; Estevez Ordoñez, Dagoberto; Beasley, Timothy; Bravo, Luis Eduardo; Morgan, Douglas R.; Medicine, School of MedicineBackground: Two-thirds of global cancers occur in low/middle income countries (LMIC). Northern Central America is the largest LMIC region in the Western Hemisphere and lack cancer registries to guide cancer control. We conducted a gastric cancer survival study in rural Western Honduras, characterized as having among the highest gastric cancer incidence rates in Latin America. Methods: The cohort of incident gastric cancer diagnosed between 2002 and 2015 was studied with active follow-up with household visits. The regional gastric cancer registry was primary for case identification, with completeness examination with hospital data and national death certificates. Cox regression models were used for survival calculations. Results: Survival follow-up was achieved in 741/774 patients (95.7%). Household interviews were conducted in 74.1% (n = 549); 65.7% were male, median age at diagnosis was 64 years, 24.5% were <55 years; 43.9% of tumors had pyloric obstruction; 45.2%, 43.2%, and 7.3% of histology was intestinal, diffuse, and mixed, respectively. A total of 24.7% patients received treatment. The 5-year survival rates were 9.9% for both males and females, 7.7% for age <45, and 7.9% for diffuse gastric cancer. Median survival time was 4.8 months [95% confidence interval (CI), 4.2-5.6]. In the final Cox regression model including age, sex, Lauren subtype, and poverty index, only treatment was significantly associated with survival (hazard ratio = 2.43, 95% CI, 1.8-3.2). Conclusions: Markedly low gastric cancer 5-year survival rates are observed in rural Central America. The majority of patients present with advanced disease and a minority have access to therapy. Impact: The findings have implications for cancer control in the Central America LMICs and for US Latino populations. See related commentary by Riquelme and Abnet, p. 1550.Item 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 MedicineObjective: 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.Item Wood cookstove use is associated with gastric cancer in Central America and mediated by host genetics(Springer Nature, 2023-10) Rifkin, Samara B.; Miller, Anna K.; Montalvan‑Sanchez, Eleazar E.; Norwood, Dalton A.; Martinez, Enrique; Waterboer, Tim; Beasley, T. Mark; Dominguez, Ricardo L.; Williams, Scott M.; Morgan, Douglas R.; Medicine, School of MedicineBiomass cookstove food preparation is linked to aero-digestive cancers, mediated by ingested and inhaled carcinogens (e.g., heterocyclic amines, and polycyclic aromatic hydrocarbons). We investigated the association between gastric adenocarcinoma, wood cookstove use, H. pylori CagA infection and risk modification by variants in genes that metabolize and affect the internal dose of carcinogens. We conducted a population-based, case–control study (814 incident cases, 1049 controls) in rural Honduras, a high-incidence region with a homogeneous diet and endemic H. pylori infection, primarily with the high-risk CagA genotype. We investigated factors including wood cookstove use, H. pylori CagA serostatus, and 15 variants from 7 metabolizing genes, and the interactions between wood stove use and the genetic variants. Male sex (OR 2.0, 1.6–2.6), age (OR 1.04, 1.03–1.05), wood cookstove use (OR 2.3, 1.6–3.3), and CagA serostatus (OR 3.5, 2.4–5.1) and two SNPs in CYP1B1 (rs1800440 and rs1056836) were independently associated with gastric cancer in multivariate analysis. In the final multivariate model, a highly significant interaction (OR 3.1, 1.2–7.8) was noted between wood cookstove use and the rs1800440 metabolizing genotype, highlighting an important gene-environment interaction. Lifetime wood cookstove use associates with gastric cancer risk in the high-incidence regions of Central America, and the association is dependent on the rs1800440 genotype in CYP1B1. H. pylori CagA infection, wood cookstove use and the rs1800440 genotype, all of which are highly prevalent, informs who is at greatest risk from biomass cookstove use.