Hemoglobin sickle cell disease in Brazil

Universidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

TB-HIV co-infection: spatial and temporal distribution in the largest Brazilian metropolis

OBJECTIVE: To describe the spatial and temporal distribution of TB-HIV co-infection, as well as the profile of the characteristics of the co-infected population in the municipality of São Paulo. METHODS: This is an ecological and time series study with data from the Tuberculosis Patient Control System (TBWeb), including all new cases of tuberculosis co-infected individuals with HIV living in the municipality from 2007 to 2015. Time trends of the disease were analyzed using Prais-Winsten regression. The cases were geocoded by the address of residence for the elaboration of maps with the incidence rates smoothed by the local empirical Bayesian method. The global and local Moran indexes evaluated spatial autocorrelation. Individuals’ profiles were described and the characteristics of the cases with and without fixed residence were compared by Pearson’s chi-square or Fisher’s exact tests. RESULTS: We analyzed 6,092 new cases of TB-HIV co-infection (5,609 with fixed residence and 483 without fixed residence). The proportion of TB-HIV co-infection ranged from 10.5% to 13.7%, with a drop of 3.0% per year (95%CI -3.4 – -2.6) and was higher in individuals without fixed residence. Incidence rates decreased by 3.6% per year (95%CI -4.4% – -2.7%), declining from 7.0 to 5.3 per 100,000 inhabitants/year. Co-infection showed positive and significant spatial autocorrelation, with heterogeneous spatial pattern and a high-risk cluster in the central region of the municipality. Cure was achieved in 55.5% of cases with fixed residence and in 32.7% of those without a fixed residence. CONCLUSIONS: The data indicate an important advance in the control of TB-HIV co-infection in the period analyzed. However, we identified areas and populations that were unequally affected by the disease and that should be prioritized in the improvement of actions to prevent and control co-infection.OBJETIVO: Descrever a distribuição espacial e temporal da coinfecção TB-HIV, assim como o perfil das características da população coinfectada no município de São Paulo. MÉTODOS: E studo e cológico e d e s érie t emporal c om d ados d o S istema d e C ontrole d e Pacientes com Tuberculose (TBWeb), incluindo todos os casos novos de tuberculose coinfectados pelo HIV residentes no município no período de 2007 a 2015. Tendências temporais do agravo foram analisadas por regressão de Prais-Winsten. Os casos foram geocodificados pelo endereço de residência para a elaboração de mapas com as taxas de incidência suavizadas pelo método bayesiano empírico local. Os índices de Moran global e local avaliaram a autocorrelação espacial. O perfil dos indivíduos foi descrito e as características dos casos com e sem residência fixa foram comparadas pelos testes de qui-quadrado ou exato de Fisher. RESULTADOS: Foram analisados 6.092 casos novos de coinfecção TB-HIV (5.609 com residência fixa e 483 sem residência fixa). A proporção de coinfecção TB-HIV variou de 10,5% a 13,7%, com queda de 3,0% ao ano (IC95% -3,4 – -2,6), e foi maior nos indivíduos sem residência fixa em todo o período. As taxas de incidência apresentaram diminuição de 3,6% ao ano (IC95% -4,4% – -2,7%), declinando de 7,0 para 5,3 por 100 mil habitantes/ano. A coinfecção apresentou autocorrelação espacial positiva e significativa, com padrão espacial heterogêneo e um aglomerado de alto risco na região central do município. A cura foi alcançada em 55,5% dos casos com residência fixa e em 32,7% daqueles sem residência. CONCLUSÕES: Os dados indicam um importante avanço no controle da coinfecção TB-HIV no período analisado. Todavia, foram identificadas áreas e populações que se apresentaram desigualmente afetadas pelo agravo, e que devem ser priorizadas no aprimoramento das ações de prevenção e controle da coinfecção

Accuracy of yellow fever case definition of epidemiologic surveillance, São Paulo, 2018

OBJECTIVE: To evaluate the accuracy of yellow fever (YF) suspected case definitions from the Brazilian Ministry of Health (BMH) and World Health Organization (WHO), as well as propose and evaluate new definitions of suspected cases, considering confirmed and discarded cases. METHODS: The retrospective study was conducted at the Instituto de Infectologia Emílio Ribas (IIER), using the Epidemiologic Surveillance Form of YF cases. From the confirmed and discarded cases of YF, a logistic regression model was developed. The independent variables were used in a proposed definition of a suspected case of YF and its accuracy was evaluated. RESULTS: In total, 113 YF suspect cases were reported, with 78 confirmed (69.0%). The definitions by BMH and WHO presented low sensitivity, 59% and 53.8%, and reduced accuracy, 53.1% and 47.8%, respectively. Predictive factors for YF were thrombocytopenia, leukopenia, and elevation of transaminases greater than twice normal. The definition including individual with acute onset of fever, followed by elevation of ALT or AST greater than twice the reference value AND leukopenia OR thrombocytopenia presented high sensitivity (88.3%), specificity (62.9%), and the best accuracy (80.4%), as proposed in the model. CONCLUSION: The YF suspected case definitions of the BMH and the WHO have low sensitivity. The inclusion of nonspecific laboratory tests increases the accuracy of YF definition

Molecular analysis and association with clinical and laboratory manifestations in children with sickle cell anemia

Objectives: To analyze the frequency of βS-globin haplotypes and alpha-thalassemia, and their influence on clinical manifestations and the hematological profile of children with sickle cell anemia.Method: The frequency of βS-globin haplotypes and alpha-thalassemia and any association with clinical and laboratorial manifestations were determined in 117 sickle cell anemia children aged 3–71 months. The confirmation of hemoglobin SS and determination of the haplotypes were achieved by polymerase chain reaction-restriction fragment length polymorphism, and alpha-thalassemia genotyping was by multiplex polymerase chain reaction (single-tube multiplex-polymerase chain reaction).Results: The genotype distribution of haplotypes was 43 (36.7%) Central African Republic/Benin, 41 (35.0%) Central African Republic/Central African Republic, 20 (17.0%) Rare/atypical, and 13 (11.1%) Benin/Benin. The frequency of the α3.7 deletion was 1.71% as homozygous (−α3.7/−α3.7) and 11.9% as heterozygous (−α3.7/αα). The only significant association in respect to haplotypes was related to the mean corpuscular volume. The presence of alpha-thalassemia was significantly associated to decreases in mean corpuscular volume, mean corpuscular hemoglobin and reticulocyte count and to an increase in the red blood cell count. There were no significant associations of βS-globin haplotypes and alpha-thalassemia with clinical manifestations.Conclusions: In the study population, the frequency of alpha-thalassemia was similar to published data in Brazil with the Central African Republic haplotype being the most common, followed by the Benin haplotype. βS-globin haplotypes and interaction between alpha-thalassemia and sickle cell anemia did not influence fetal hemoglobin concentrations or the number of clinical manifestations.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Prevalência do diabetes melito na comunidade nipo-brasileira de Mombuca, Guatapará, SP

OBJECTIVE: To estimate the prevalence of type 2 diabetes mellitus (DM2) and impaired glucose tolerance (IGT) in the Japanese-Brazilian community of Mombuca in relation to risk factors (FR) for diabetes and cardiovascular disease. SUBJECTS AND METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69% first generation), aged 20 years or more, submitted to socio-cultural, anthropometric, and biochemistry evaluation. RESULTS: Of the individuals studied (n = 131, age = 55.1 ± 15.9 years), 58.8% were women. The prevalence of DM2 and IGT were 13.7% and 14.5%, respectively. Regarding RF, 76.3% presented dyslipidemia, 52.7% abdominal obesity, 48.1% arterial hypertension, and 42.3% whole body obesity. CONCLUSIONS: The prevalence of DM2, IGT, and RF in this Japanese-Brazilian community was higher than in the adult population of the city of Ribeirão Preto-SP, Brazil, suggesting an increase in risk conditions for these morbidities.OBJETIVO: Estimar prevalências de diabetes melito tipo 2 (DM2) e tolerância à glicose diminuída (TGD) na comunidade de Mombuca, Guatapará, SP, relacionando-as com fatores de risco (FR) para diabetes e doenças cardiovasculares. SUJEITOS E MÉTODOS: Estudo transversal com 131 nipo-brasileiros (69% de 1ª geração), idade > 20 anos, ambos os sexos, com avaliação sociocultural, antropométrica e bioquímica. RESULTADOS: Dos 131 participantes (idade média = 55,1 ± 15,9 anos), a maioria (58,8%) era do sexo feminino. As prevalências de DM2 e TGD foram 13,7% e 14,5%, respectivamente. Em relação aos FR, 76,3% apresentaram dislipidemia, 52,7%, obesidade abdominal (OA), 48,1%, hipertensão arterial (HA) e 42,3%, obesidade geral. CONCLUSÕES: As prevalências de DM2, TGD e FR observadas nos nipo-brasileiros foram superiores aos valores da população adulta de Ribeirão Preto, SP, sugerindo acentuação de situações predisponentes dessas morbidades

Reliability of the intra and inter-test measures with universal goniometer and podalic arthrometer of the active range of ankle inversion and eversion

O objetivo deste estudo foi avaliar a confiabilidade das medidas intra- e interavaliadores e interinstrumentos da amplitude de movimento ativa de eversão e inversão do tornozelo. Participaram deste estudo 100 indivíduos saudáveis (71 mulheres e 29 homens; idade: 21,32±2,83 anos; massa corporal: 60,40±4,95 kg; estatura: 1,66±0,04 m; e índice de massa corporal de 21,89±2,83 kg/m2), os quais foram submetidos à mensuração de inversão e eversão do tornozelo com goniômetro universal e artrômetro podálico. Foram utilizados o coeficiente de correlação intraclasse (CCI) e o teste de Pearson, considerando-se um nível de significância de 5%. Os resultados deste estudo demonstraram um CCI intra-avaliador muito forte (0,91≥0,99; pEl objetivo del estudio fue evaluar la fiabilidad de las medidas intra e inter-evaluadores e inter-instrumentos de la amplitud del movimiento activa de eversión e inversión del tobillo. Participaron de este estudio 100 sujetos sanos (71 mujeres y 29 hombres; edad: 21,32±2,83 años; masa corporal: 60,40±4,95 kg; estatura: 1,66±0,04 m e índice de masa corporal: 21,89±2,83 kg/m2), que fueron sometidos a la medición de inversión y eversión del tobillo con goniómetro universal y artrómetro podálico. Se utilizó el coeficiente de correlación intraclase (CCI) y la prueba de Pearson, teniendo en cuenta un nivel de significancia del 5%. Los resultados del estudio demostraron un CCI intra-evaluador muy fuerte (0,91≥0,99; pThe objective this study was to evaluate intra and inter-rater and inter-instruments reliability of ankle inversion and eversion active range of motion. The study included 100 healthy individuals (71 women and 29 men; ages: 21.32±2.83 years old; body mass: 60.40±4.95 kg; height: 1.66±0.04 m; and body mass index: 21.89±2.83 kg/m2), who were submitted to measurement of ankle inversion and eversion using the universal goniometer and podalic arthrometer. We used the intra-class correlation coefficient (ICC) and Pearson's test, considering a 5% significance level. The results of this study demonstrated one very strong intra-rater ICC (0.91≥0.99;

Health benefits of green banana consumption : a systematic review

Despite the growing demand for green banana (GB) products, there is no review study regarding their potential health benefits. We aimed to compare the health benefits among different GB products by a systematic review. We researched six electronic databases (PubMed, EMBASE, Scopus, Science Direct, Web of Science, and Google Scholar) from inception to March 2019. We found 1009 articles in these databases. After duplicate removal, we screened 732 articles’ titles and abstracts, and selected 18 potentially relevant studies for full-text reading. We added five records from the reference list of the fully-read articles and seven suggested by the expert. Twelve articles were excluded. In the end, 18 studies were considered for this systematic review. Ten studies were conducted with green banana flour and eight with the green banana pulp/biomass. Most of the GB health benefits studied were related to the gastrointestinal symptoms/diseases, followed by the glycemic/insulin metabolism, weight control, and renal and liver complications associated to diabetes. Only one study did not confirm the health benefit proposed. It is necessary to standardize the GB dose/effect to different age groups and different health effects considering the GB variety and ripeness level. Further studies are necessary to present better detailing of GB product and their health effects considering all the raw-material characteristics

ANÁLISIS DE LA ETAPA DE GARANTÍA DE PREPARACIÓN DEL TEAM BASED LEARNING EN LA ENSEÑANZA DE ENFERMERÍA

Objetivo: analizar la etapa de garantía de preparación del Team-Based Learning a través del desempeño de los estudiantes de Enfermería en el Individual Readiness Assurance Test – iRAT y Team Readiness Assurance Test – tRAT. Método: estudio descriptivo con enfoque cuantitativo. Veintiséis estudiantes en el quinto semestre de una universidad del Norte de Brasil. La recopilación de datos se realizó en octubre y noviembre de 2018 con cuestionarios aplicados en cinco unidades. El análisis fue descriptivo, por cuestionario, pregunta, equipo y alumno. Resultados: el desempeño en equipo fue superior, pero no en todas las unidades. Hay cuestiones en las que los estudiantes, individualmente y en equipo, presentaron dificultades, sugiriendo variables que intervienen de origen pedagógico. Conclusión: el análisispor el desempeño de los estudiantes sugiere fallos en la garantía de preparación. El estudio contribuye indicando las posibles variables pedagógicas que pueden influir en el éxito de esta etapa del Team-Based Learning.Objetivo: analisar a etapa de garantia de preparo do Team-Based Learning por meio do desempenho de estudantes de Enfermagem no Individual Readiness Assurance Test – iRAT e Team Readiness Assurance Test – tRAT.Método: estudo descritivo de abordagem quantitativa. Participaram 26 estudantes do quinto semestre de uma faculdade do Norte do Brasil. A coleta de dados ocorreu nos meses de outubro e novembro de 2018 com questionários aplicados em cinco unidades. A análise foi descritiva, por questionário, questão, equipe e aluno.Resultados: o desempenho em equipe foi superior, porém não em todas as unidades. Há questões em que os estudantes individualmente e em equipe apresentaram dificuldades, sugerindo variáveis intervenientes de origem pedagógica.Conclusão: a análise por desempenho dos estudantes sugere falhas na garantia de preparo. O estudo contribui ao indicar possíveis variáveis pedagógicas que podem influenciar no sucesso desta etapa do Team-Based Learning.Objective: to analyze the readiness assurance step of the Team-Based Learning through the performance of Nursing students in the Individual Readiness Assurance Test – iRAT and Team Readiness Assurance Test – tRAT.Method: descriptive study of quantitative nature. Twenty-six fifth semester students of a university of northern Brazil participated. Data collection took place in October and November 2018 with questionnaires applied in five units. The analysis was descriptive, by questionnaire, question, team and student.Results: the team performance was superior, but not in all units. There are issues where students individually and in teams presented difficulties, suggesting intervening variables of pedagogical origin.Conclusion: the analysis by performance of students suggests failures in the readiness assurance. The study contributes by indicating possible pedagogical variables that can influence the success of this step of the Team-Based Learning

Prevalência do diabetes melito na comunidade nipo-brasileira de Mombuca, Guatapará, SP

OBJECTIVE: To estimate the prevalence of type 2 diabetes mellitus (DM2) and impaired glucose tolerance (IGT) in the Japanese-Brazilian community of Mombuca in relation to risk factors (FR) for diabetes and cardiovascular disease. SUBJECTS AND METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69% first generation), aged 20 years or more, submitted to socio-cultural, anthropometric, and biochemistry evaluation. RESULTS: Of the individuals studied (n = 131, age = 55.1 ± 15.9 years), 58.8% were women. The prevalence of DM2 and IGT were 13.7% and 14.5%, respectively. Regarding RF, 76.3% presented dyslipidemia, 52.7% abdominal obesity, 48.1% arterial hypertension, and 42.3% whole body obesity. CONCLUSIONS: The prevalence of DM2, IGT, and RF in this Japanese-Brazilian community was higher than in the adult population of the city of Ribeirão Preto-SP, Brazil, suggesting an increase in risk conditions for these morbidities.OBJETIVO: Estimar prevalências de diabetes melito tipo 2 (DM2) e tolerância à glicose diminuída (TGD) na comunidade de Mombuca, Guatapará, SP, relacionando-as com fatores de risco (FR) para diabetes e doenças cardiovasculares. SUJEITOS E MÉTODOS: Estudo transversal com 131 nipo-brasileiros (69% de 1ª geração), idade > 20 anos, ambos os sexos, com avaliação sociocultural, antropométrica e bioquímica. RESULTADOS: Dos 131 participantes (idade média = 55,1 ± 15,9 anos), a maioria (58,8%) era do sexo feminino. As prevalências de DM2 e TGD foram 13,7% e 14,5%, respectivamente. Em relação aos FR, 76,3% apresentaram dislipidemia, 52,7%, obesidade abdominal (OA), 48,1%, hipertensão arterial (HA) e 42,3%, obesidade geral. CONCLUSÕES: As prevalências de DM2, TGD e FR observadas nos nipo-brasileiros foram superiores aos valores da população adulta de Ribeirão Preto, SP, sugerindo acentuação de situações predisponentes dessas morbidades

Obesity and its relationship with cardiovascular risk factors in a Japanese-Brazilian population

OBJETIVO: Descrever associações entre excesso de peso e obesidade abdominal com fatores de risco cardiovascular na população nipo-brasileira de Mombuca, Guatapará, SP. MÉTODOS: Participaram do estudo 131 indivíduos com descendência japonesa (69,2% da primeira e 30,8% da segunda geração), com idade > 20 anos, correspondendo a 66,8% da população residente dessa faixa etária. Os dados foram coletados por meio de questionários padronizados e foram realizados exames clínicos e laboratoriais. RESULTADOS: A prevalência de sobrepeso foi de 29,6% entre os homens e de 25,6% entre as mulheres e a de obesidade foi de 46,3% entre os homens e de 39,0% entre as mulheres. Entre os homens a prevalência de obesidade abdominal foi de 55,6% e entre as mulheres de 20,8%. O índice de massa corpórea foi associado independentemente com triglicérides, circunferência abdominal e idade; a pressão arterial sistólica com a circunferência abdominal. CONCLUSÃO: O presente estudo enfatiza a necessidade de medidas de intervenção para a prevenção da obesidade na população nipo-brasileira de Mombuca.OBJECTIVE: To describe associations of weight excess and abdominal obesity with cardiovascular risk factors in a Japanese-Brazilian population from Mombuca, Guatapará, SP. METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69.2% first and 30.8% second generation), aged 20 years or more, corresponding to 66.8% of the resident population from this age group. Data were collected through standardized questionnaires and laboratory and physical examinations were performed. RESULTS: Prevalence of overweight and obesity was 29.6% and 46.3% in men and 25.6% and 39.0% in women, respectively. The prevalence of abdominal obesity was 55.6% in men and 20.8% in women. Body mass index was independently associated with triglycerides, waist circumference and age; systolic blood pressure with waist circumference. CONCLUSIONS: Data from the present survey highlight the necessity of interventions to prevent obesity in the Japanese-Brazilian population from Mombuca