Background Strongyloides stercoralis is a soil‐transmitted helminth, endemic in remote Aboriginal and Torres Strait Islander communities in northern Australia with estimates of prevalences up to 60%. Hyperinfection in the setting of immunosuppression is a rare, but well recognised cause of significant morbidity and mortality. However, the morbidity associated with chronic uncomplicated infection is less well characterised. Aims To measure the prevalence of symptoms potentially attributable to S. stercoralis infection and their association with seropositivity. Methods This retrospective matched case‐control study reviewed records of primary healthcare presentations for symptoms in the 12 months before and after an ivermectin mass drug administration (MDA) in a remote Aboriginal community. Results One hundred and seventy‐five S. stercoralis seropositive cases were matched with 175 seronegative controls. The most frequently reported symptom overall in the 12 months prior to the MDA was cough followed by abdominal pain, weight loss/malnutrition, diarrhoea and pruritis. Seropositive cases were not more likely than matched controls to have symptoms typically attributed to strongyloidiasis. In the seropositive cohort, we found no difference in symptoms in the 12 months before and after an ivermectin MDA despite a reduction in seroprevalence. Conclusion We found no evidence to suggest that S. stercoralis seropositivity was associated with increased symptoms when compared to matched seronegative controls. Treatment with ivermectin did not reduce symptoms in seropositive cases. Without evidence to support that population‐based screening or treatment programmes reduce symptoms, the emphasis must remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life‐threatening hyperinfection.
Aim: We compared the anthropometric and metabolic parameters before and after six months of bariatric surgery (BS) between a group of patients aged ≥65 and <65 years old (y/o) with or without comorbidities. Materials and Methods: We did a prospective study with patients who had undergone BS and followed them for six months from July, 2015 to May, 2018 at Milstein hospital, Argentina and divided them into two cohorts: older and younger than 65 y/o. Outcomes were compared (lost weight [LW], excess weight loss percentage [EWLP], BMI, A1c hemoglobin [HbA1c], HDL, Triglycerides [Tg] and Tg/HDL ratio) and we considered a p <0.05 as statistically significant. Results: We included 36 patients, 15 were ≥65 y/o and 21 <65 y/o. There were more patients with type 2 diabetes mellitus (DM2) in the oldest group. We found no statistical difference between groups in WL and the EWLP but observed a statistical rise in the levels of HDL (43, RIQ 95% CI: 39-48 vs. 51, RIQ 95% CI: 44-55, p=0.026) and the decrease of the Tg/HDL ratio (1.6 RIQ 95% CI: 1.4-2.1 vs. 3.1 RIQ 95% CI: 2.2-4.6, p=0.02) in the group of ≥65 y/o. The HbA1c levels were significantly higher in the > 65 y/o with DM2 and the decrease was statistically greater after the follow-up. When we compared initial treatment for DM2 after 3 and 6 months of BS, there was a statistically significant decrease in the use of oral antidiabetic drugs and insulin (chi2= 19%, p=0.004 at 3 months, chi2: 27%, p<0.001 at 6 months after surgery). If we analyzed this result by age, there was no difference between both cohorts (chi2=3.73, p=0.15 and chi2=1.46, p=0.4 at 3 and 6 months after surgery respectively). Conclusion: We found a significant benefit in metabolic effects of BS in the ≥65 y/o cohort, especially by decreasing insulin resistance, even in those patients without diagnosis of DM2. We need more studies and a greater sample size to generalize these results. Disclosure C. Musso: None. F.A. Di Fermo Gomez: None. J. Rosenfarb: None. L. Bosio: None. J. Santamaria: None. M. Hansen: None. C. Gimenez: None. A.G. Errasti: None. D. Caruso: Other Relationship; Self; Novartis Pharmaceuticals Corporation. M.C. Faingold: None.
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