Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium.

Background: Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies. Methods: We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks. Findings: Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association. Interpretation: This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%.

Neurological disease caused by Oropouche virus in northern Brazil: should it be included in the scope of clinical neurological diseases?

We describe two neurological cases of Oropouche virus infection in northern Brazil, where the virus is endemic but neglected as a pathogen. This study reiterates the necessity of developing protocols for diagnosing infections and training medical personnel to recognize the pathogenicity of Oropouche virus in neurological infections.

Risk of Zika virus-associated birth defects in congenital confirmed cases in the Brazilian Amazon.

OBJECTIVE: To establish the risk of microcephaly in neonates born to women infected with ZIKV during pregnancy. METHODS: A cohort of laboratory-confirmed ZIKV cases of congenital infections (109 mothers infected during pregnancy and 101 newborns) among 308 suspect cases was followed in Belem, Pará, Brazil, from October 2015 to December 2017. RESULTS: A microcephaly risk of 1.98% (95% CI 0.54-6.93%) was found, or 2 cases among the 101 neonates infected with ZIKV during pregnancy. 72% of the pregnant women had ZIKV infection confirmed by RT-qPCR during gestation. CONCLUSIONS: Results showed a low incidence of ZIKV-associated birth defects, stillbirth, and miscarriage, which contrasts with previous studies in other Brazilian regions. Previous exposure to yellow fever vaccine and/or multiserotype DENV infection could be implicated in the protection from ZIKV congenital infection.

OBJETIVO: Establecer el riesgo de microcefalia en los recién nacidos de mujeres infectadas con ZIKV durante el embarazo. MÉTODOS: Se siguió a una cohorte de casos con infección congénita por ZIKV confirmada por laboratorio (109 madres infectadas durante el embarazo, 101 recién nacidos) conformada a partir de 308 casos sospechosos en Belem, Pará, Brasil, de octubre de 2015 a diciembre de 2017. RESULTADOS: Se encontró un riesgo de microcefalia de 1,98% (IC95% 0,54-6,93%), o 2 casos entre los 101 neonatos infectados con ZIKV durante el embarazo. En el 72% de las mujeres embarazadas se confirmó mediante RT-qPCR la infección por ZIKV durante la gestación. CONCLUSIONES: Los resultados mostraron una baja incidencia de malformaciones congénitas, mortinatos y abortos asociados al ZIKV, lo que contrasta con estudios anteriores de otras regiones de Brasil. La exposición previa a la vacuna contra la fiebre amarilla o la infección previa por varios serotipos de virus del dengue podrían estar implicados en la protección contra la infección congénita por ZIKV.

Formação e atuação profissional de médicos egressos de uma instituição privada do Pará: perfil e conformidade com as diretrizes curriculares nacionais / Training and professional activities of medical graduates from a private institution of Pará: profile and compliance with the national curricular guidelines

O estudo objetivou conhecer o perfil sociodemográfico, de formação e atuação profissional de médicos egressos de uma instituição privada, observar a conformidade deste perfil com o preconizado pelas Diretrizes Curriculares Nacionais (DCN) e contribuir para o Programa de Acompanhamento de Egressos. O instrumento de coleta de dados foi um questionário validado, adaptado e enviado online aos egressos das primeiras quatro turmas. A maioria era composta por mulheres, jovens, solteiras, com renda mensal de até dez salários mínimos. O curso contribuiu totalmente ou em grande parte para a formação na atenção básica e uma formação humanista, generalista, crítico-reflexiva e ética. Os egressos são atuantes no SUS, como generalistas, alocados na Região Norte, sentindo-se razoavelmente preparados para o mercado de trabalho e competentes. Houve tendência de conformidade deste perfil com o preconizado pelas DCN, e a contribuição para o Programa de Acompanhamento de Egressos se deu por meio da elaboração da Revista do Egresso.(AU)

The objectives of this study were to know the socio-demographic profile, training and professional performance of physicians graduates of a private institution, to observe the compliance of this profile with the one advocated by the DCN and to contribute to the Program of Accompaniment of Graduates. The instrument of data collection was a questionnaire validated, adapted and sent online to the graduates of the first four classes. Most were women, young, single, with monthly income up to 10 minimum wages. The course contributed wholly or largely to training in basic Attention and humanistic training, generalist, critical-reflexive and ethical. The graduates are active in the SUS, as generalists, allocated in the North region, feeling reasonably prepared for the job market and competent. There was a tendency of compliance of this profile with the one recommended by the DCN and the contribution to the Program of Accompaniment of Graduates was given through the elaboration of Revista do Egresso.(AU)

Pregnant women co-infected with HIV and Zika: Outcomes and birth defects in infants according to maternal symptomatology.

BACKGROUND: Zika virus (ZIKV) was first isolated in Uganda in 1947. In Brazil, the first reported case of ZIKV infection was in May 2015. Additionally, dengue (DENV) is endemic and there has been a recent outbreak of chikungunya (CHIKV). Since the clinical manifestations of different arboviral infections (AI) can be similar, definitive diagnosis requires laboratory testing. OBJECTIVES: To determine the prevalence of ZIKV, DENV, and CHIKV infections in a Brazilian cohort of HIV-infected pregnant women, to assess clinical/immunological characteristics and pregnancy outcomes of women with evidence of recent AI. STUDY DESIGN: Laboratory diagnosis of ZIKV, DENV and CHIKV infections utilized serological assays, RT-PCR and PRNT. The tests were performed at the first visit, 34-36 weeks of gestation and at any time if a woman had symptoms suggestive of AI. Mann-Whitney tests were used for comparison of medians, Chi-square or Fisher's to compare proportions; p< 0.05 was considered statistically significant. Poisson regression was used to analyze risk factors for central nervous system (CNS) malformations in the infant according to maternal symptomatology. RESULTS: Of 219 HIV-infected pregnant women enrolled, 92% were DENV IgG+; 47(22%) had laboratory evidence of recent AI. Of these, 34 (72%) were ZIKV+, nine (19%) CHIKV+, and two (4%) DENV+. Symptoms consistent with AI were observed in 23 (10%) women, of whom 10 (43%) were ZIKV+, eight (35%) CHIKV+. No CNS abnormalities were observed among infants of DENV+ or CHIKV+ women; four infants with CNS abnormalities were born to ZIKV+ women (three symptomatic). Infants born to ZIKV+ women had a higher risk of CNS malformations if the mother was symptomatic (RR = 7.20), albeit not statistically significant (p = 0.066). CONCLUSIONS: Among HIV-infected pregnant women with laboratory evidence of a recent AI, 72% were ZIKV-infected. In this cohort, CNS malformations occurred among infants born to both symptomatic and asymptomatic pregnant women with Zika infection.

Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units.

INTRODUCTION: The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units. Given the lack of information regarding the dynamics of multidrug resistance in northern Brazil, we analyzed the clinical and microbiological features of nosocomial infections caused by P. aeruginosa. METHODS: Between January 2010 and March 2012, we conducted a retrospective cohort study of P. aeruginosa isolates from 54 patients who were hospitalized in intensive care units. The clinical and epidemiologic variables were analyzed, including the patients' demographic data and comorbidities, and the lengths of the intensive care unit stays, the classification of the infections as nosocomial, the use of invasive procedures, antimicrobial therapy, and the patients' outcomes. We undertook susceptibility tests, molecular detection of the metallo-ß-lactamase genes, and genotypic analyses of the isolates using the repetitive element-polymerase chain reaction. RESULTS: Multidrug resistance occurred most frequently among isolates from adults who had been hospitalized for an average of 87.1 days. The use of mechanical ventilation and urinary catheters were risk factors for infection. The four isolates that harbored the blaSPM-1-like gene showed >95% genetic similarity. CONCLUSIONS: This study's findings show that P. aeruginosa has a high death rate, and that inadequate treatment and invasive procedures are risk factors for infection. This is the first report describing the detection of the blaSPM-1-like gene in northern Brazil. These results highlight the need for better monitoring and a greater understanding of nosocomial infections and their public health impacts.

Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units

Abstract: INTRODUCTION: The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units. Given the lack of information regarding the dynamics of multidrug resistance in northern Brazil, we analyzed the clinical and microbiological features of nosocomial infections caused by P. aeruginosa. METHODS Between January 2010 and March 2012, we conducted a retrospective cohort study of P. aeruginosa isolates from 54 patients who were hospitalized in intensive care units. The clinical and epidemiologic variables were analyzed, including the patients' demographic data and comorbidities, and the lengths of the intensive care unit stays, the classification of the infections as nosocomial, the use of invasive procedures, antimicrobial therapy, and the patients' outcomes. We undertook susceptibility tests, molecular detection of the metallo-β-lactamase genes, and genotypic analyses of the isolates using the repetitive element-polymerase chain reaction. RESULTS: Multidrug resistance occurred most frequently among isolates from adults who had been hospitalized for an average of 87.1 days. The use of mechanical ventilation and urinary catheters were risk factors for infection. The four isolates that harbored the blaSPM-1-like gene showed >95% genetic similarity. CONCLUSIONS This study's findings show that P. aeruginosa has a high death rate, and that inadequate treatment and invasive procedures are risk factors for infection. This is the first report describing the detection of the blaSPM-1-like gene in northern Brazil. These results highlight the need for better monitoring and a greater understanding of nosocomial infections and their public health impacts.

Leprosy New Case Detection Trends and the Future Effect of Preventive Interventions in Pará State, Brazil: A Modelling Study.

BACKGROUND: Leprosy remains a public health problem in Brazil. Although the overall number of new cases is declining, there are still areas with a high disease burden, such as Pará State in the north of the country. We aim to predict future trends in new case detection rate (NCDR) and explore the potential impact of contact tracing and chemoprophylaxis on NCDR in Pará State. METHODS: We used SIMCOLEP, an existing individual-based model for the transmission and control of M. leprae, in a population structured by households. The model was quantified to simulate the population and observed NCDR of leprosy in Pará State for the period 1990 to 2014. The baseline scenario was the current control program, consisting of multidrug therapy, passive case detection, and active case detection from 2003 onwards. Future projections of the NCDR were made until 2050 given the continuation of the current control program (i.e. baseline). We further investigated the potential impact of two scenarios for future control of leprosy: 1) discontinuation of contact tracing; and 2) continuation of current control in combination with chemoprophylaxis. Both scenarios started in 2015 and were projected until 2050. RESULTS: The modelled NCDR in Pará State after 2014 shows a continuous downward trend, reaching the official elimination target of 10 cases per 100,000 population by 2030. The cessation of systematic contact tracing would not result in a higher NCDR in the long run. Systematic contact tracing in combination with chemoprophylaxis for contacts would reduce the NCDR by 40% and bring attainment of the elimination target two years forward to 2028. CONCLUSION: The NCDR of leprosy continues to decrease in Pará State. Elimination of leprosy as a public health problem could possibly be achieved around 2030, if the current control program is maintained. Providing chemoprophylaxis would decrease the NCDR further and would bring elimination forward by two years.

Basic sanitation, socioeconomic conditions, and degree of risk for the presence and maintenance of malaria in a low-transmission area in the Brazilian Amazon.

INTRODUCTION: This study aimed to evaluate basic sanitation and socioeconomic indicators, reported cases of malaria, and risk of contracting malaria in the Ananindeua municipality, State of Pará. METHODS: Data on basic sanitation and socioeconomic dimensions were taken from the Brazilian Institute of Geography and Statistics [ Instituto Brasileiro de Geografia e Estatística (IBGE)] 2010 census. Epidemiological malaria information was taken from the Epidemiological Malaria Surveillance Information System [ Sistema de Informação de Vigilância Epidemiológica de Malária (SIVEP/Malaria)], between 2003 and 2013 of the Ministry of Health and from the SIVEP/Malaria forms of the municipality's Endemic Diseases Unit for 2,013 cases. RESULTS: Our data do not confirm the correlation among indicators of basic sanitation, socioeconomic conditions, and water supply with malaria cases. Of the 1,557 cases evaluated, most were caused by Plasmodium vivax , with rare cases of Plasmodium falciparum and mixed infections. There were 756 notifications in 2003. The number of reported cases was sharply reduced between 2006 and 2012, but a 142-case outbreak occurred in 2013. Ananindeua municipality's Annual Parasite Index indicated low risk in 2003 and no risk in other years, and the 2,013 cases were predominantly male individuals aged ≥40 years. CONCLUSIONS: Our data confirm the non-endemicity of malaria in the Ananindeua municipality, as the Annual Parasite Indices described for the years 2004-2013 classify it as a risk-free area. However, the 2013 outbreak indicates the need to strengthen prevention, surveillance, and control activities to reduce the risk of new outbreaks and consequent economic and social impacts on the population.

Basic sanitation, socioeconomic conditions, and degree of risk for the presence and maintenance of malaria in a low-transmission area in the Brazilian Amazon

ABSTRACTINTRODUCTION:This study aimed to evaluate basic sanitation and socioeconomic indicators, reported cases of malaria, and risk of contracting malaria in the Ananindeua municipality, State of Pará.METHODS:Data on basic sanitation and socioeconomic dimensions were taken from the Brazilian Institute of Geography and Statistics [ Instituto Brasileiro de Geografia e Estatística (IBGE)] 2010 census. Epidemiological malaria information was taken from the Epidemiological Malaria Surveillance Information System [ Sistema de Informação de Vigilância Epidemiológica de Malária (SIVEP/Malaria)], between 2003 and 2013 of the Ministry of Health and from the SIVEP/Malaria forms of the municipality's Endemic Diseases Unit for 2,013 cases.RESULTS:Our data do not confirm the correlation among indicators of basic sanitation, socioeconomic conditions, and water supply with malaria cases. Of the 1,557 cases evaluated, most were caused by Plasmodium vivax , with rare cases of Plasmodium falciparum and mixed infections. There were 756 notifications in 2003. The number of reported cases was sharply reduced between 2006 and 2012, but a 142-case outbreak occurred in 2013. Ananindeua municipality's Annual Parasite Index indicated low risk in 2003 and no risk in other years, and the 2,013 cases were predominantly male individuals aged ≥40 years.CONCLUSIONS:Our data confirm the non-endemicity of malaria in the Ananindeua municipality, as the Annual Parasite Indices described for the years 2004-2013 classify it as a risk-free area. However, the 2013 outbreak indicates the need to strengthen prevention, surveillance, and control activities to reduce the risk of new outbreaks and consequent economic and social impacts on the population.

Royal sun medicinal mushroom Agaricus brasiliensis (higher Basidiomycetes) and the attenuation of pulmonary inflammation induced by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK).

Agaricus brasiliensis currently is one of the most studied fungi because of its nutritional and therapeutic properties as an anti-inflammatory agent and an adjuvant in cancer chemotherapy. The effects of orally administered aqueous A. brasiliensis extract (14.3- and 42.9-mg doses) on parenchymal lung damage induced by carcinogenic 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) were observed in Wistar rats. NNK treatment induced pulmonary inflammation, but not lung cancer, in the rats. The lungs of animals treated with NNK showed a higher level of inflammation than those of the control group according to histopathologic examinations (P < 0.01) and kurtosis analysis (P < 0.001) of a global histogram generated from thoracic computed tomography scans. There was no significant difference in the alveolar and bronchial exudates between animals treated with a 14.3-mg dose of A. brasiliensis extract and the control without NNK. However, a significant difference was found between animals treated with NNK, received a 42.9-mg dose of A. brasiliensis (P < 0.05), and the controls not treated with NNK. We did not observe a significant difference between the kurtoses of the A. brasiliensis (14.3 mg) and control groups. However, a 42.9-mg dose of A. brasiliensis resulted in lower kurtosis values than those observed in the control group (P < 0.001). In conclusion, a low dose of A. brasiliensis was more effective in attenuating pulmonary inflammation. Similar to the histopathological results, the computed tomography scans also showed a protective effect of A. brasiliensis at the lower dose, which prevented gross pulmonary consolidation.

Sobrevida de pacientes com Síndrome da Imunodeficiência Adquirida em hospital geral no Rio de Janeiro, a partir de dados da vigilância epidemiológica / Survival of patients with Acquired Immunodeficiency Syndrome in a general hospital at Rio de Janeiro city, using epidemiologic surveillance data

OBJETIVO: Estimar a sobrevida de pacientes com Síndrome da Imunodeficiência Adquirida (SIDA) notificados e acompanhados no Hospital Federal dos Servidores do Estado (HFSE) no período de 1986 a 2006. METODOLOGIA: Utilizou-se o modelo de riscos proporcionais de Cox estendido, considerando a data de diagnóstico como variável tempo-dependente, dividindo a análise em dois períodos: <1996 e ≥1996 (após a introdução de antirretrovirais no HFSE). RESULTADOS: Dos 1.300 casos analisados, 62% eram homens. As seguintes variáveis apresentaram razões de risco (HR) significativas: critério de notificação baseado na quantificação sérica de CD4<350 (HR=0,187); grupo diagnosticado a partir de 1996 (HR=0,355); faixa etária >50 anos (HR=1,386); disfunção do sistema nervoso central (HR=1,570); caquexia (HR=1,526); sarcoma de Kaposi (HR=1,376); candidíase (HR=1,295). A taxa de sobrevida geral em 5 anos foi 35,7% e, em 10 anos, 6,3%. Para os casos notificados através do critério CD4, a sobrevida em 5 e 10 anos foi 89,6%. CONCLUSÃO: Este trabalho agrega evidência ao aumento de sobrevida dos pacientes de SIDA, e aponta o critério CD4 e o grupo tratado a partir de 1996 como as variáveis com maior associação a esse aumento.

OBJECTIVE: To estimate the survival of AIDS patients reported in HFSE from 1986 to 2006. METHODS: We used the extended proportional hazards model of Cox considering the diagnosis date as a time-dependent variable, which divided the analysis in two periods: <1996 and ≥1996 (after the introduction of antiretrovirals in HFSE). RESULTS: Among the 1.300 cases analyzed, 62% were males. The following variables showed significant hazard ratios (HR): criteria for notification based on the quantification of serum CD4<350 (HR=0.187); group diagnosed after 1996 (HR=0.355); age >50 years (HR=1.386); dysfunction of the central nervous system (HR=1.570), cachexia (HR=1.526); Kaposi's sarcoma (HR=1.376); candidiasis (HR=1.295). The overall survival rate at 5 years was 35.7% and at 10 years, 6.3%. For cases reported through the CD4 criteria, survival at 5 and 10 years was 89.6%. CONCLUSION: This study adds evidence to the increased survival of AIDS patients and points the CD4 notification criteria and group diagnosed after 1996 as the variables with the greatest association with this increase.

Leprosy exposure, infection and disease: a 25-year surveillance study of leprosy patient contacts

Contact surveillance is a valuable strategy for controlling leprosy. A dynamic cohort study of leprosy contacts was initiated in 1987 at Oswaldo Cruz Foundation. The objective of this work was to review the data on the major risk factors leading up to the infectious stage of the disease, estimate incidence rates of leprosy in the cohort and characterise the risk factors for the disease among the contacts under surveillance. The incidence rate of leprosy among contacts of leprosy patients was estimated at 0.01694 cases per person-year in the first five years of follow-up. The following factors were associated with acquiring the disease: (i) not receiving the BCG vaccine, (ii) a negative Mitsuda reaction and (iii) contact with a patient with a multibacillary clinical form of leprosy. The contacts of index patients who had high bacilloscopic index scores > 1 were at especially high risk of infection. The following factors were associated with infection, which was defined as a seropositive reaction for anti-phenolic glicolipid-1 IgM: (i) young age (< 20 years), (ii) a low measured Mitsuda reaction (< 5 mm) and (iii) contact with an index patient who had a high bacilloscopic index. BCG vaccination and re-vaccination were shown to be protective among household contacts. The main conclusions of this study indicate an urgent need for additional leprosy control strategies in areas with a high incidence of the disease.

[Epidemiological aspects of leprosy: a spatial approach]. / Aspectos epidemiológicos da hanseníase: uma abordagem espacial.

The objective of this study was to identify spatial patterns in the occurrence of leprosy in Duque de Caxias, a municipality (county) with high endemicity for the disease in the State of Rio de Janeiro, Brazil. The authors selected all new leprosy cases reported to the Brazilian National Database on Diseases of Notification (SINAN) from 1998 to 2006. The analysis was performed according to three-year periods, followed by spatial analysis according to the local empirical Bayesian method and calculation of global (Moran) and local (LISA) spatial autocorrelation. The analysis showed marked improvement in the epidemiological situation associated with earlier diagnosis. There was a reduction in the proportion of cases with grade II leprosy, from 13.6% to 8.6% (p = 0.04), and increased detection of cases with the indeterminate form, from 10.3% to 18% (p = 0.00). Spatial analysis identified a cluster in the South-Northwest of the municipality, not directly related to the actions or decentralization campaign, proving to be an important tool for identifying critical areas for the endemic and assessing the impact of strategic measures to combat the disease.

Aspectos epidemiológicos da hanseníase: uma abordagem espacial / Epidemiological aspects of leprosy: a spatial approach

O objetivo foi identificar o padrão espacial da ocorrência da hanseníase em Duque de Caxias, município de alta endemicidade da doença no Estado do Rio de Janeiro, Brasil. Foram selecionados todos os casos novos de hanseníase registrados no banco do Sistema de Informação de Agravos de Notificação (SINAN), entre 1998 e 2006. Realizou-se análise por período subdividido a cada três anos, seguido de análise espacial por meio da estimativa bayesiana empírica local e do cálculo da autocorrelação espacial global (Moran) e local (LISA). A análise mostrou melhora acentuada do quadro epidemiológico, com o diagnóstico mais precoce. Houve redução da proporção de casos com grau II de 13,6% para 8,6% (p = 0,04). Verificou-se aumento da detecção de casos com forma indeterminada, de 10,3% para 18% (p = 0,00). A análise espacial identificou cluster na faixa sul-noroeste, não relacionado diretamente às ações de campanhas ou descentralização, mostrando ser uma ferramenta importante para identificação de áreas críticas da endemia e para avaliação do impacto das ações estratégias de combate à doença.

The objective of this study was to identify spatial patterns in the occurrence of leprosy in Duque de Caxias, a municipality (county) with high endemicity for the disease in the State of Rio de Janeiro, Brazil. The authors selected all new leprosy cases reported to the Brazilian National Database on Diseases of Notification (SINAN) from 1998 to 2006. The analysis was performed according to three-year periods, followed by spatial analysis according to the local empirical Bayesian method and calculation of global (Moran) and local (LISA) spatial autocorrelation. The analysis showed marked improvement in the epidemiological situation associated with earlier diagnosis. There was a reduction in the proportion of cases with grade II leprosy, from 13.6% to 8.6% (p = 0.04), and increased detection of cases with the indeterminate form, from 10.3% to 18% (p = 0.00). Spatial analysis identified a cluster in the South-Northwest of the municipality, not directly related to the actions or decentralization campaign, proving to be an important tool for identifying critical areas for the endemic and assessing the impact of strategic measures to combat the disease.

Determination of insulin-like growth factor-I reference values using an immunoradiometric assay in a Brazilian adult population.

BACKGROUND: Serum levels of total insulin-like growth factor I (IGF-I) reflect endogenous growth hormone (GH) secretion in healthy adults, which makes it a good diagnostic marker for screening of GH-related disorders. Studies also have supported a possible relation between IGF-I levels and the risk and prognostic for some malignancies, besides a relation between IGF-I levels and mortality. OBJECTIVE: As the determination of the IGF-I normal values for local populations is strongly desired, the aim of this investigation was to determine reference values for IGF-I using an immunoradiometric assay (IRMA) in an adult Brazilian population of Rio de Janeiro city, since there is no other study using this methodology in Brazilian population, and that this method is widely used in Brazil and worldwide. MATERIALS AND METHODS: The study included samples of blood taken from 484 healthy subjects (251 men and 233 women) aged 18-70. The subjects agreed with this study, approved by the Ethical Committee of the Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti, Rio de Janeiro, Brazil. The samples were analyzed using a Diagnostic System Laboratories kit. For data analysis, age- and sex-specific figures were fitted after transformation of IGF-I values. RESULTS: In adulthood, a slow age-dependent decrease was found. There was no significant difference in IGF-I values between men and women. CONCLUSION: This study established age-specific IGF-I reference values, for a healthy Brazilian adult population, determined by a widely IGF-I, IRMA used currently in Brazil.

Leprosy exposure, infection and disease: a 25-year surveillance study of leprosy patient contacts.

Contact surveillance is a valuable strategy for controlling leprosy. A dynamic cohort study of leprosy contacts was initiated in 1987 at Oswaldo Cruz Foundation. The objective of this work was to review the data on the major risk factors leading up to the infectious stage of the disease, estimate incidence rates of leprosy in the cohort and characterise the risk factors for the disease among the contacts under surveillance. The incidence rate of leprosy among contacts of leprosy patients was estimated at 0.01694 cases per person-year in the first five years of follow-up. The following factors were associated with acquiring the disease: (i) not receiving the BCG vaccine, (ii) a negative Mitsuda reaction and (iii) contact with a patient with a multibacillary clinical form of leprosy. The contacts of index patients who had high bacilloscopic index scores > 1 were at especially high risk of infection. The following factors were associated with infection, which was defined as a seropositive reaction for anti-phenolic glicolipid-1 IgM: (i) young age (< 20 years), (ii) a low measured Mitsuda reaction (< 5 mm) and (iii) contact with an index patient who had a high bacilloscopic index. BCG vaccination and re-vaccination were shown to be protective among household contacts. The main conclusions of this study indicate an urgent need for additional leprosy control strategies in areas with a high incidence of the disease.

The role of metabolic syndrome components and adipokines in insulin resistance in prepubertal children.

OBJECTIVE: Insulin resistance has a central role in the pathophysiology of cardiovascular atherosclerotic disease. Adipose tissue is of capital importance in view of its production of adipokines. The present study aims to determine the association of metabolic syndrome components, which constitute risk factors for cardiovascular atherosclerotic disease, and leptin and adiponectin with insulin resistance in prepubertal children. METHODS: We conducted a cross-sectional study involving 197 children. Of these, 112 children were obese, 36 were overweight and 49 had normal weight. The association of sex, waist circumference, Acanthosis nigricans, age, BMI Z-score, serum lipids, leptin and adipocytokines with insulin resistance [defined as the homeostatic model assessment for insulin resistance (HOMA-IR) index higher than or equal to 2.5] was investigated using logistic regression. RESULTS: There was positive association of sex (female), age, BMI Z-score, triglycerides and leptin with insulin resistance (p<0.05). CONCLUSION: Among the conventional components of metabolic syndrome, the role of BMI Z-score and triglycerides stands out in insulin resistance of prepubertal children. Sex (female), age and leptin also showed to be of major importance.

[The AIDS epidemic in adolescents between the ages of 13 and 19 in the City of Rio de Janeiro, Brazil: space-time description]. / A epidemia de AIDS em adolescentes de 13 a 19 anos, no município do Rio de Janeiro: descrição espaço-temporal.

INTRODUCTION: The purpose of this study was to analyze the dynamics of the AIDS epidemic affecting adolescents in Rio de Janeiro to establish healthy prevention strategies. The incidence of AIDS in Brazil is declining among men who have sex with men (MSM) except in individuals between 13 and 19 years of age, and the feminization phenomenon is more pronounced among adolescents. METHODS: We evaluated data from Sistema de Informações de Agravos de Notificação (SINAN) regarding cases of AIDS in patients aged between 13 and 19 years through November 2009. RESULTS: This study includes 656 cases. The incidence of AIDS increased until 1998, and, since 1996, more cases have been diagnosed in girls than in boys. The homo/bisexual exposure category predominantly consisted of boys (50.8%), and the heterosexual category predominantly consisted of girls (88.9%). The geographic distribution of the cases by year of diagnosis revealed that the increase was proportionally larger in the poorest area and that there was a large decrease in the wealthiest area. A decreasing linear tendency was observed in the relationship between the year of diagnosis and the human development index (HDI). CONCLUSIONS: This study demonstrates the need for greater investment in sexual health and reproductive services in the poorest areas of the city and in the promotion of healthy sexual practices directed to MSM and female adolescents.

A epidemia de AIDS em adolescentes de 13 a 19 anos, no município do Rio de Janeiro: descrição espaço-temporal / The AIDS epidemic in adolescents between the ages of 13 and 19 in the City of Rio de Janeiro, Brazil: space-time description

INTRODUÇÃO: o objetivo do estudo foi analisar a epidemia de AIDS em adolescentes no município do Rio de Janeiro para subsidiar políticas públicas de prevenção. A incidência de AIDS no Brasil está diminuindo entre homens que fazem sexo com homens (HSH), exceto entre 13 e 19 anos e a feminização é mais intensa entre adolescentes. MÉTODOS: Estudo de dados do Sistema de Informações de Agravos de Notificação (SINAN) de casos diagnosticados, entre 13 e 19 anos até novembro de 2009. RESULTADOS: Foram analisados 656 casos, com incidência crescente até 1998 e verificou-se que, desde 1996, ocorrem mais casos no sexo feminino do que no masculino. A categoria de exposição homo/bissexual é predominante nos rapazes (50,8%) e a heterossexual nas moças (88,9%). A distribuição geográfica dos casos no município por ano de diagnóstico revelou que houve proporcionalmente grande aumento da incidência na Área de Planejamento mais pobre da cidade e redução acentuada na mais rica. Observou-se uma tendência linear decrescente entre o ano de diagnóstico e o índice de desenvolvimento humano (IDH). CONCLUSÕES: O estudo aponta a necessidade de investimento em serviços de saúde sexual e reprodutiva nas áreas mais pobres da cidade e ações de promoção de saúde direcionadas aos rapazes HSH e às adolescentes.

INTRODUCTION: The purpose of this study was to analyze the dynamics of the AIDS epidemic affecting adolescents in Rio de Janeiro to establish healthy prevention strategies. The incidence of AIDS in Brazil is declining among men who have sex with men (MSM) except in individuals between 13 and 19 years of age, and the feminization phenomenon is more pronounced among adolescents. METHODS: We evaluated data from Sistema de Informações de Agravos de Notificação (SINAN) regarding cases of AIDS in patients aged between 13 and 19 years through November 2009. RESULTS: This study includes 656 cases. The incidence of AIDS increased until 1998, and, since 1996, more cases have been diagnosed in girls than in boys. The homo/bisexual exposure category predominantly consisted of boys (50.8%), and the heterosexual category predominantly consisted of girls (88.9%). The geographic distribution of the cases by year of diagnosis revealed that the increase was proportionally larger in the poorest area and that there was a large decrease in the wealthiest area. A decreasing linear tendency was observed in the relationship between the year of diagnosis and the human development index (HDI). CONCLUSIONS: This study demonstrates the need for greater investment in sexual health and reproductive services in the poorest areas of the city and in the promotion of healthy sexual practices directed to MSM and female adolescents.