Anthropometric risk factors for metabolic syndrome in HIV patients.

OBJECTIVE: Metabolic syndrome, which affects the general population in epidemic proportions, is associated with a set of cardiovascular disease risk factors. The aims of this cross-sectional study were to determine the prevalence and investigate the risk factors associated with metabolic syndrome in outpatients living with HIV/AIDS using anthropometric and clinical evaluations. METHOD: The study was carried out on 253 HIV infected outpatients. Metabolic syndrome was classified according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) and the International Diabetes Federation (IDF) criteria. Logistic regression was used to identify factors associated with the metabolic syndrome. RESULTS: The prevalence of metabolic syndrome varied from 19.4% to 26.4%, according to the criterion used. The factors associated with it in the two classifications used, when adjusted by sex and BMI, were age (? 40years) and subscapular skinfold (> 12 mm). In the final model, using the NCEP/ATPIII criterion the risk factors associated with metabolic syndrome were age ? 40 years (OR = 3.18; CI95% = 1.42; 7.14) and subscapular skinfold > 12 mm (OR = 2.85, CI95% = 1.13; 7.17). In the final model, using the IDF criterion the risk factors associated with metabolic syndrome were age (OR = 3.38, CI95% = 1.61; 7.10) and subscapular skinfold > 12 mm (OR = 4.37, CI95% = 1.84; 10.39). CONCLUSION: In clinical practice, the regular monitoring of subscapular skinfold can help in the identification of HIV infected individuals in risk of MS

Spatial and temporal trends of visceral leishmaniasis by mesoregion in a southeastern state of Brazil, 2002-2013.

This article presents the spatial and temporal distribution of visceral leishmaniasis (VL) in Minas Gerais State and identifies the greater risk areas of transmission. This study is both timely and substantive because Minas Gerais is an important Brazilian state in the number of cases of visceral leishmaniasis. The results showed that during the 12-year time series the VL had a heterogeneous spatial and temporal distribution in the state of Minas Gerais. Among the 12 existing mesoregions, six (Central Mineira, Jequitinhonha, Metropolitan area of Belo Horizonte, Northwest of Minas, North of Minas, and Vale do Rio Doce) were responsible for the expansion and maintenance of VL in the state. Among them, the Vale do Rio Doce and Jequitinhonha mesoregions presented a considerable increase in the incidence rates of the disease in the last period. In the other six mesoregions only sporadic cases of the disease were reported during the study period. The results of in this study may contribute to a better understanding the dynamic of the disease in Minas Gerais. Also these findings can provide subsidies to assist the actions of the control program of VL

Effectiveness of the Brazilian Visceral Leishmaniasis Surveillance and Control Programme in reducing the prevalence and incidence of Leishmania infantum infection.

Background Control strategies adopted by the Brazilian Visceral Leishmaniasis Surveillance and Control Programme (VLSCP) include identifying and culling seropositive infected dogs, early diagnosis and treatment of human cases, chemical control of the vector and population awareness. This study evaluated the effectiveness of the VLSCP on the prevalence and incidence rates of Leishmania infantum in children residing in areas under different VLSCP intervention times. Methods A quasi-experimental epidemiological study with a panel (two cross-sectional) and a concurrent cohort was performed in three areas of Belo Horizonte, southeast Brazil. The first cross-sectional study (I) was carried out with 1875 children, 478 of which were enrolled in the cohort study. In the second cross-sectional study (II), 413 additional children were included, totalizing 891 children. Laboratory diagnosis was performed by ELISA-rK39. Analyses included multilevel logistic and Poisson regression models. Results The incidence rates of L. infantum infection were: 14.4% in the area where VLSCP intervention was initiated in 2006 (AI2006); 21.1% in the area where intervention was initiated in 2008 (AI2008); and 11.6% in the area where intervention was initiated in 2010 (AI2010 - control area). A follow-up period of 24 months showed that the persons-time incidence rates in AI2006, AI2008, and AI2010 were: 6.2/100, 10/100, and 5.6/100 persons/24 months, respectively. The final prevalence rates of infection (cross-sectional II - in 2012), compared to the initial rates (cross-sectional I - in 2010), increased 83.7% in AI2006, 74.1% in AI2008, and decreased 5% in AI2010. Analysis of the effectiveness revealed that children residing in AI2008 are more likely to be infected (OR = 1.84; 95% CI: 1.06-3.23) and present a higher risk of infection (IRR = 1.76; 95% CI: 1.05-2.95) compared to those in AI2010. No statistically significant differences were observed in asymptomatic infection (OR and IRR) in AI2006 compared to AI2010. Conclusions The VLSCP was not effective at controlling L. infantum infection in areas where interventions had respectively been carried out for six and four years. However, it is unclear what the consequences in terms of human infection and diseases would be in the absence of the VLSCP. Efforts to improve the effectiveness of control measures remain a necessary priority

The prevalence of malnutrition and its risk factors in children attending outpatient clinics in the city of Manaus, Amazonas, Brazil.

O objetivo do estudo foi determinar a preval?ncia de desnutri??o e fatores de risco em crian?as de 0-10 anos, atendidas em ambulat?rios em Manaus, Amazonas, Brasil. Foi conduzido um estudo epidemiol?gico transversal em uma amostra de 347 crian?as. As entrevistas foram realizadas com os pais ou respons?veis, foram coletados dados socioecon?mico e de consumo alimentar de cada crian?a. Para avalia??o diet?tica utilizou-se um question?rio semiquantitativo de freq??ncia alimentar. Amostras de fezes foram examinas por microsc?pio ?tico. Medidas antropom?tricas foram transformadas em percentis e z-escore e o estado nutricional foi avaliado pelos indicadores do National Center for Health Statistics (NCHS) e do Centers for Disease Control (CDC). Fatores de risco associados ? desnutri??o foram analisados usando modelo de regress?o log?stica com efeito aleat?rio. As preval?ncias de baixo peso, d?ficit de estatura e d?ficit de peso foram 18,1, 15,5 e 10,7% pela refer?ncia do CDC e 14,3, 17,3 e 4,4% do NCHS. A preval?ncia de d?ficit de peso foi maior quando estimada pelo CDC em compara??o ao NCHS (p=0,02). A preval?ncia de parasitoses intestinais foi de 58,8%. Os fatores de risco associados a desnutri??o foram: baixo n?vel educacional dos respondentes (OR=4.55), ingest?o cal?rica <54.5 kcal/kg (OR=4.55), crian?as na faixa et?ria de 6-10 anos (OR=3.54), e consulta pedi?trica como motivo de visita ao ambulat?rio (OR=2.71). Na popula??o estudada, desnutri??o (baixo peso, d?ficit de estatura e d?ficit de peso) e infec??o parasit?ria ainda representam um problema de sa?de p?blica. Os fatores de risco confirmam a influ?ncia dos fatores s?cio econ?micos no estado nutricional das crian?as.The objective of this study was to determine the prevalence of malnutrition and its risk factors in children aged 0-10 years attending outpatient clinics in Manaus, Amazonas, Brazil. A cross-sectional epidemiological study of a population of 347 children was conducted. Data concerning socio-economic levels and food consumption were obtained by interviewing the accompanying guardian of each child. Dietetic evaluation was conducted using a semi-quantitative food frequency questionnaire, and faecal samples were examined by optical microscopy. Anthropometric measurements were transformed into percentiles and z-scores, and nutritional status was evaluated by reference to National Center for Health Statistics (NCHS) and Centers for Disease Control (CDC) indicators. Factors associated with undernutrition were analysed using a random-effects logistic regression model. The overall prevalences of underweight, stunting and wasting were 18.1, 15.5 and 10.7%, respectively, with reference to CDC growth curves, and 14.3, 17.3 and 4.4%, respectively, with reference to NCHS growth curves. The overall prevalence of wasting was statistical higher according to the CDC reference than that estimated using the NCHS reference (P=0.02). The prevalence rate of intestinal parasites was 58.8%. Risk factors associated with malnutrition were: low educational level of guardian respondent (OR=4.55), energy intake <54.5 kcal/kg (OR=4.55), children in age group 6-10 years (OR=3.54), and attendance at outpatient clinic for paediatric visit (OR=2.71). In the studied population, malnutrition (stunting, underweight and wasting) and parasite infection still represent serious public health problems. The risk factors identified in the present study confirm the influence of socio-economic factors on the nutritional status of children

Retinol and fat from breast milk of Brazilian mothers at high risk for food unsafe.

Promotion and protection of breastfeeding is an important strategy in prevention of Vitamin A (Retinol) deficiency in childhood. Breast milk retinol?s allows us the chance to reach the maternal nutritional status and go over infant status. This study aimed to know the retinol and fat content in mature breast milk from Novo Cruzeiro?s population, Brazil. It was analyzes 63 samples of breast milk that belonged to 81 children. The fat content was reached by crematocrit procedure and Retinol content by HPLC. Others datas had gotten through semi-structured pre-coded questionnaires. Statistics analyses were performed nonparametric for paired samples. The median of Retinol was 0,62 ?g/100mL and 1,7?g/100mL from breast milk before and after the infant had breastfed. The samples were considered statistically different (p<0,001) for Retinol contents and for fat contents (p<0,001). The results shows that Vitamin A?s content after the suck one , in each class of alimentary security, are strongly bigger than the content before suck (The Alimentary Security p=0,005; Light Unreliability p < 0,001; Moderate Unreliability p < 0,001; Deep Unreliability p< 0,001). The results suggest that the breast milk from the end of the suck provides greater retinol ingestion; breast milk before feed allows to reach The Brazilian Scale of Unreliability Alimentary. Although it is important to guide mothers to not interrupt the suck one and not to limit the manual expression only to initial breast milk

Risk profile for Leishmania infection in dogs coming from an area of visceral leishmaniasis reemergence.

Until the 1980s, visceral leishmaniasis was concentrated in poor rural areas of Brazil. The Vale do Rio Doce, located in the Southeastern Brazilian state of Minas Gerais, was an endemic area with high numbers of human and canine cases. Prophylactic measures adopted since the 1960s reduced the number of cases and the region became a ?controlled endemic? area. In the early 1990s, however, the program was interrupted, and the human disease reemerged in 2008. This cross-sectional study evaluated the prevalence and the risk profile of infection of dogs with Leishmania spp in this reemergence area of visceral leishmaniasis. Among a population of approximately 280,000 people, a total of 3835 dog owners were interviewed about socioeconomic conditions, housing, peridomicile features, and their dogs? characteristics and behavior. Blood samples were collected from 5822 dogs of an estimated canine population of 20,000 and anti-Leishmaniasis antibodies were identified using Dual-Path Platform and ELISA. We observed that 1282 of the 5822 dogs were seropositive for the protozoan indicating a seroprevalence of 22%. The risk factors associated with Leishmania infection in dogs were: non-paved backyard (OR 1.4; 95%CI 1.2?1.7); the presence of dry leaves and decaying fruit in the backyard (OR 1.3; 95%CI 1.1?1.5); medium-sized (OR 1.3; 95% 1.1?1.5) or big-sized dogs (OR 1.8; 95%CI 1.5?2.3); short-haired dogs (OR 1.8; 95%CI 1.5?2.1); dogs that slept in the backyard (OR 2.6; 95%CI 1.8?3.6) or in the balcony (OR 1.6; 95%CI 1.1?2.3); and history of canine visceral leishmaniasis in the household (OR 1.3; 95%CI 1.1?1.5). Our results suggest a strong reemergence of canine visceral leishmaniasis after the discontinuation of the control programs. Also, the observed risk factors reinforce the role of health education and environmental management measures to the effective control of the disease

Comparison of serological assays for the diagnosis of canine visceral leishmaniasis in animals presenting different clinical manifestations.

Three serological methods, indirect fluorescent immunoassay (IFI), enzyme-linked immunosorbent assay (ELISA) and direct agglutination test (DAT) that are commonly employed in the diagnosis of canine visceral leishmaniasis (CVL), have been assessed. A total of 234 domestic dogs, drawn from an area in the municipality of Belo Horizonte, Minas Gerais, Brazil, endemic for visceral leishmaniasis, were submitted to clinical and parasitological examinations and serological assay. Sera collected from confirmed non-infected dogs (n = 20), and from dogs with other parasitic diseases including Trypanosoma cruzi ( n = 7), Leishmania braziliensis ( n = 5), Toxoplasma gondii ( n = 5) and Ehrlichia canis ( n = 3), were also included in the study. IFI presented a lower sensitivity (72%) than ELISA (95%), although the specificities of these assays were low (52 and 64%, respectively) and both exhibited cross-reactivity with sera from dogs infected with T. cruzi , L. braziliensis and E. canis. In contrast, DAT exhibited a high sensitivity (93%) and a high specificity (95%) and cross-reacted with only one serum sample derived from anE. canis-infected dog. The reproducibilities of the ELISA and DAT assays were excellent, whilst that of IFI was considered to be acceptable. The results produced by ELISA and DAT were in complete agreement, those between ELISA and IFI were at an acceptable level of agreement, whilst the concurrence between the IFI and DAT results were either acceptable or poor depending on the clinical conditions of the group of dogs examined. Since there is no readily accessible method for the diagnosis of CVL that offers 100% specificity and sensitivity, the choice of technique employed must depend on the aim of the investigation

Seroprevalence and risk factors for human toxoplasmosis in northeastern Brazil.

Toxoplasmosis is one of the most prevalent parasitic infections in humans, causing severe clinical complications in immunocompromised patients or in foetuses. Estimates on the toxoplasmosis seroprevalence in human populations vary widely, even within the same region. This study aimed to estimate the prevalence of Toxoplasma gondii infection in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, and identify the risk factors for toxoplasmosis. T. gondii IgG antibodies were measured in 66.2% of the studied population. The factors associated with infection were as follows: age above 45 years (OR = 7.4; 95% CI = 3.7-14.8); illiteracy (OR = 2.8; 95% CI = 1.6-5.0); the presence of more than three cats in the home (OR 2.0; 95% CI = 1.2-3.5); no water tank (OR = 2.0; 95% CI = 1.4-3.1); and consumption of raw or unpasteurized milk (OR = 2.0; 95% CI = 1.3-3.0). The risk factors identified were predominantly related to the ingestion of oocysts. This study may contribute to public health knowledge of toxoplasmosis and the definition of control programs, particularly for pregnant women from regions similar to the area studied

Determinants of iron deficiency anemia in a cohort of children aged 6-71 months living in the northeast of Minas Gerais, Brazil.

Iron deficiency anemia is one of the most common nutritional disorders worldwide. The aim was to identify the prevalence and incidence of anemia in children and to identify predictors of this condition, including intestinal parasites, social, nutritional and environmental factors, and comorbidities. A population-based cohort study was conducted in a sample of 414 children aged 6?71 months living in Novo Cruzeiro in the Minas Gerais State. Data were collected in 2008 and 2009 by interview and included socio-economic and demographic information about the children and their families. Blood samples were collected for testing of hemoglobin, ferritin and C-reactive protein. Anthropometric measurements and parasitological analyses of fecal samples were performed. To identify risk factors associated with anemia multivariate analyses were performed using the generalized estimating equations (GEE). In 2008 and 2009, respectively, the prevalence rates of anemia were 35.9% (95%CI 31.2?40.8) and 9.8% (95%CI 7.2?12.9), the prevalence rates of iron deficiency were 18.4% (95%CI 14.7?22.6) and 21.8%(95%CI 17.8?26.2), and the incidence rates of anemia and iron deficiency were 3.2% and 21.8%. The following risk factors associated with anemia were: iron deficiency (OR = 3.2; 95%CI 2.0-.5.3), parasitic infections (OR = 1.9; 95%CI 1.2? 2.8), being of risk of or being a low length/height-for-age (OR = 2.1; 95%CI 1.4?3.2), and lower retinol intake (OR = 1.7; 95%CI 1.1?2.7), adjusted over time. Nutritional factors, parasitic infections and chronic malnutrition were identified as risk factors for anemia. These factors can be verified in a chronic process and have been classically described as risk factors for these conditions