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  1. Article ; Online: Point-of-Care Testing in Chronic Kidney Disease of Non-Traditional Origin

    Miranda Dally / Juan José Amador / Jaime Butler-Dawson / Damaris Lopez-Pilarte / Alexandra Gero / Lyndsay Krisher / Alex Cruz / Daniel Pilloni / Joseph Kupferman / David J. Friedman / Benjamin R. Griffin / Lee S. Newman / Daniel R. Brooks

    Annals of Global Health, Vol 89, Iss

    Considerations for Clinical, Epidemiological, and Health Surveillance Research and Practice

    2023  Volume 1

    Abstract: Purpose: As the prevalence of chronic kidney disease of non-traditional origin (CKDnt) rises in low-resource settings, there is a need for reliable point-of-care creatinine testing. The purpose of this analysis was to assess the accuracy of two commonly ... ...

    Abstract Purpose: As the prevalence of chronic kidney disease of non-traditional origin (CKDnt) rises in low-resource settings, there is a need for reliable point-of-care creatinine testing. The purpose of this analysis was to assess the accuracy of two commonly used point-of-care creatinine devices, the i-STAT handheld (Abbott, Princeton, NJ, USA) and the StatSensor Creatinine (Nova Biomedical, Waltham, MA, USA) in comparison to venipuncture serum creatinine measures. The affordability, sensitivity, specificity, ease of use, and other considerations for each device are also presented. Methods: Three paired data sets were compared. We collected 213 paired i-STAT and venipuncture samples from a community study in Nicaragua in 2015–2016. We also collected 267 paired StatSensor Creatinine and venipuncture samples, including 158 from a community setting in Nicaragua in 2014–2015 and 109 from a Guatemala sugarcane worker cohort in 2017–2018. Pearson correlation coefficients, Bland-Altman plots, and no intercept linear regression models were used to assess agreement between point-of-care devices and blood samples. Results: The i-STAT performed the most accurately, overestimating creatinine by 0.07 mg/dL (95% CI: 0.02, 0.12) with no evidence of proportional bias. The StatSensor Creatinine performed well at low levels of creatinine (Mean (SD): 0.87 (0.19)). Due to proportional bias, the StatSensor Creatinine performed worse in the Nicaragua community setting where creatinine values ranged from 0.31 to 7.04 mg/dL. Discussion: Both devices provide acceptable sensitivity and specificity. Although adequate for routine surveillance, StatSensor Creatinine is less accurate as the values of measured creatinine increase, a consideration when using the point-of-care device for screening individuals at risk for CKDnt. Research, clinical, and screening objectives, cost, ease of use, and background prevalence of disease must all be carefully considered when selecting a point-of-care creatinine device. Conclusion: POC testing can be more ...
    Keywords chronic kidney disease ; pointof- care ; health surveillance ; epidemiology ; clinical services ; Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270
    Subject code 630
    Language English
    Publishing date 2023-02-01T00:00:00Z
    Publisher Ubiquity Press
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Climate Trends at a Hotspot of Chronic Kidney Disease of Unknown Causes in Nicaragua, 1973–2014

    Zoe E. Petropoulos / Oriana Ramirez-Rubio / Madeleine K. Scammell / Rebecca L. Laws / Damaris Lopez-Pilarte / Juan José Amador / Joan Ballester / Cristina O’Callaghan-Gordo / Daniel R. Brooks

    International Journal of Environmental Research and Public Health, Vol 18, Iss 5418, p

    2021  Volume 5418

    Abstract: An ongoing epidemic of chronic kidney disease of uncertain etiology (CKDu) afflicts large parts of Central America and is hypothesized to be linked to heat stress at work. Mortality rates from CKDu appear to have increased dramatically since the 1970s. ... ...

    Abstract An ongoing epidemic of chronic kidney disease of uncertain etiology (CKDu) afflicts large parts of Central America and is hypothesized to be linked to heat stress at work. Mortality rates from CKDu appear to have increased dramatically since the 1970s. To explore this relationship, we assessed trends in maximum and minimum temperatures during harvest months between 1973 and 2014 as well as in the number of days during the harvest season for which the maximum temperature surpassed 35 °C. Data were collected at a weather station at a Nicaraguan sugar company where large numbers of workers have been affected by CKDu. Monthly averages of the daily maximum temperatures between 1996 and 2014 were also compared to concurrent weather data from eight Automated Surface Observing System Network weather stations across Nicaragua. Our objectives were to assess changes in temperature across harvest seasons, estimate the number of days that workers were at risk of heat-related illness and compare daily maximum temperatures across various sites in Nicaragua. The monthly average daily maximum temperature during the harvest season increased by 0.7 °C per decade between 1973 and 1990. The number of days per harvest season with a maximum temperature over 35 °C increased by approximately five days per year between 1974 and 1990, from 32 days to 114 days. Between 1991 and 2013, the number of harvest days with a maximum temperature over 35 °C decreased by two days per year, and the monthly average daily maximum temperature decreased by 0.3 °C per decade. Comparisons with weather stations across Nicaragua demonstrate that this company is located in one of the consistently hottest regions of the country.
    Keywords heat stress ; occupational heat exposure ; historical weather trends ; Central America ; Medicine ; R
    Subject code 333
    Language English
    Publishing date 2021-05-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Urinary Metals Concentrations and Biomarkers of Autoimmunity among Navajo and Nicaraguan Men

    Madeleine K. Scammell / Caryn Sennett / Rebecca L. Laws / Robert L. Rubin / Daniel R. Brooks / Juan José Amador / Damaris López-Pilarte / Oriana Ramirez-Rubio / David J. Friedman / Michael D. McClean / Navajo Birth Cohort Study Team / Johnnye Lewis / Esther Erdei

    International Journal of Environmental Research and Public Health, Vol 17, Iss 5263, p

    2020  Volume 5263

    Abstract: Metals are suspected contributors of autoimmune disease among indigenous Americans. However, the association between metals exposure and biomarkers of autoimmunity is under-studied. In Nicaragua, environmental exposure to metals is also largely ... ...

    Abstract Metals are suspected contributors of autoimmune disease among indigenous Americans. However, the association between metals exposure and biomarkers of autoimmunity is under-studied. In Nicaragua, environmental exposure to metals is also largely unexamined with regard to autoimmunity. We analyzed pooled and stratified exposure and outcome data from Navajo ( n = 68) and Nicaraguan ( n = 47) men of similar age and health status in order to characterize urinary concentrations of metals, compare concentrations with the US National Health and Nutrition Examination Survey (NHANES) male population, and examine the associations with biomarkers of autoimmunity. Urine samples were analyzed for metals via inductively coupled plasma mass spectrometry (ICP-MS) at the US Centers for Disease Control and Prevention. Serum samples were examined for antinuclear antibodies (ANA) at 1:160 and 1:40 dilutions, using an indirect immunofluorescence assay and for specific autoantibodies using enzyme-linked immunosorbent assay (ELISA). Logistic regression analyses evaluated associations of urinary metals with autoimmune biomarkers, adjusted for group (Navajo or Nicaraguan), age, and seafood consumption. The Nicaraguan men had higher urinary metal concentrations compared with both NHANES and the Navajo for most metals; however, tin was highest among the Navajo, and uranium was much higher in both populations compared with NHANES. Upper tertile associations with ANA positivity at the 1:160 dilution were observed for barium, cesium, lead, strontium and tungsten.
    Keywords autoimmunity ; antinuclear antibodies ; specific autoantibodies ; metals ; Medicine ; R
    Language English
    Publishing date 2020-07-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Dysuria, heat stress, and muscle injury among Nicaraguan sugarcane workers at risk for Mesoamerican nephropathy

    Tiffany L Stallings / Alejandro Riefkohl Lisci / Nathan L McCray / Daniel E Weiner / James S Kaufman / Ann Aschengrau / Yan Ma / Michael P LaValley / Oriana Ramírez-Rubio / Juan Jose Amador / Damaris López-Pilarte / Rebecca L Laws / Michael Winter / V Eloesa McSorley / Daniel R Brooks / Katie M Applebaum

    Scandinavian Journal of Work, Environment & Health, Vol 47, Iss 5, Pp 377-

    2021  Volume 386

    Abstract: OBJECTIVES: Nicaraguan sugarcane workers, particularly cane cutters, have an elevated prevalence of chronic kidney disease of unknown origin, also referred to as Mesoamerican nephropathy (MeN). The pathogenesis of MeN may include recurrent heat stress, ... ...

    Abstract OBJECTIVES: Nicaraguan sugarcane workers, particularly cane cutters, have an elevated prevalence of chronic kidney disease of unknown origin, also referred to as Mesoamerican nephropathy (MeN). The pathogenesis of MeN may include recurrent heat stress, crystalluria, and muscle injury with subsequent kidney injury. Yet, studies examining the frequency of such events in long-term, longitudinal studies are limited. METHODS: Using employment and medical data for male workers at a Nicaraguan sugarcane company, we classified months of active work as either work as a cane cutter or other sugarcane job and determined occurrence of dysuria, heat events and muscle events. Work months and events occurred January 1997 to June 2010. Associations between cane cutting and each outcome were analyzed using logistic regression based on generalized estimating equations for repeated events, controlling for age. RESULTS: Among 242 workers with 7257 active work months, 19.5% of person-months were as a cane cutter. There were 160, 21, and 16 episodes of dysuria, heat events, and muscle events, respectively. Compared with work months in other jobs, cane cutting was associated with an elevated odds of dysuria [odds ratio 2.40 (95% confidence interval 1.56–3.68)]. The number of heat and muscle events by cane cutter and other job were limited. CONCLUSIONS: Working as a cane cutter compared with other jobs in the sugarcane industry was associated with increased dysuria, supporting the hypothesis that cane cutters are at increased risk of events suspected of inducing or presaging clinically evident kidney injury.
    Keywords dysuria ; nicaragua ; chronic kidney disease of unknown origin ; ckdu ; crystalluria ; rhabdomyolysis ; heat stress ; muscle injury ; sugarcane worker ; mesoamerican nephropathy ; chronic kidney disease ; Public aspects of medicine ; RA1-1270
    Subject code 610
    Language English
    Publishing date 2021-07-01T00:00:00Z
    Publisher Nordic Association of Occupational Safety and Health (NOROSH)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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