Pediatric neurodevelopment by prenatal Zika virus exposure: a cross-sectional study of the Microcephaly Epidemic Research Group Cohort.

BACKGROUND: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly. METHODS: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC. RESULTS: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were 'at risk of development delay' according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were 'at risk of development delay'. For children without microcephaly, the percentages found to be 'at risk of developmental delay' were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N = 94), 13.8%; Group 4 (N = 46), 21.7%. CONCLUSIONS: Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.

Food Consumption as a Modifier of the Association between LEPR Gene Variants and Excess Body Weight in Children and Adolescents: A Study of the SCAALA Cohort.

No studies showing that food consumption is a modifier of the association of variants of the leptin receptor gene (LEPR) with body weight have involved a Brazilian population. The aim of this study was to evaluate the modifying effect of dietary intake on the association between the LEPR gene and excess weight. In this study, 1211 children and adolescents aged 4⁻11 years were assessed. Participants were genotyped for 112 single-nucleotide variants of the LEPR gene. Anthropometric measurements were performed, and dietary data were obtained. Logistic regressions were used to study the associations of interest. Of the participants, 13.4% were overweight/obese. The risk allele (G) of the rs1137100 variant was associated with excess weight in individuals with fat consumption below the median (odds ratio OR = 1.92; 95% confidence interval CI = 1.18⁻3.14), with daily frequency of consumption of drink/artificial juice (OR = 2.15; 95% CI = 1.26⁻3.68) and refined cereals (OR = 2.17; 95% CI = 1.31⁻3.62) above the median. The risk allele (G) of variant rs1177681 was also associated with excess weight (OR = 2.74; 95% CI = 1.65⁻4.57) in subjects with a daily frequency of refined cereal consumption above the median. The association between LEPR and excess weight can be modulated by the type and distribution of dietary fatty acids, sugary drinks, and refined cereals.

Economic burden of HIV and TB/HIV coinfection in a middle-income country: a costing analysis alongside a pragmatic clinical trial in Brazil.

OBJECTIVE: The objective of this study was to measure the costs of people living with HIV (PLHIV) as well as active tuberculosis (TB/HIV), latent tuberculosis infection (LTBI/HIV) or without TB (HIV/AIDS). METHODS: We analysed the costs through the entire pathway of care during the prediagnosis and treatment periods from the Brazilian public health system perspective. We applied a combination of bottom-up and top-down approaches to capture and estimate direct medical and non-medical costs. We measured the mean cost per patient per type of care (inpatient, outpatient and emergency care) and disease category (HIV/AIDS, HIV/AIDS death, TB/HIV, TB/HIV death and LTBI/HIV). RESULTS: Between March 2014 and March 2016 we recruited 239 PLHIV. During the follow-up 26 patients were diagnosed and treated for TB and 5 received chemoprophylaxis for LTBI. During the prediagnosis and treatment period, the mean total costs for HIV or AIDS and AIDS death categories were US$1558 and US$2828, respectively. The mean total costs for TB/HIV and TB/HIV death categories were US$5289.0 and US$8281, respectively. The mean total cost for the LTBI/HIV category was US$882. CONCLUSIONS: Patients with TB/HIV impose a higher economic burden on the health system than HIV/AIDS and LTBI/HIV. Patients with LTBI/HIV were the lowest cost group among all disease categories, indicating that preventive TB treatment can avoid the further costs treating active TB. TRIAL REGISTRATION NUMBER: RBR-22t943, Results.

Effect of dietary consumption as a modifier on the association between FTO gene variants and excess body weight in children from an admixed population in Brazil: the Social Changes, Asthma and Allergy in Latin America (SCAALA) cohort study.

Previous studies have shown associations of variants of the FTO gene with body weight, but none of these have involved Latin American populations with a high level of miscegenation, as is seen in the north-eastern Brazilian population. This study evaluated the association between SNP in the FTO gene and excess weight in Salvador, Bahia, Brazil. In addition, the effect of diet as a modifier on this association was also investigated. This cross-sectional study included 1191 participants aged 4-11 years, who were genotyped for 400 variants of the FTO gene. Direct anthropometric measures were made and dietary data were obtained by 24-h food recall. Multivariate logistic regression analyses were used to assess the associations of interest. Overall, 11·2 % of the individuals included in the study were overweight/obese. Interactions were identified between the percentage energy intake from proteins and obesity risk linked to the rs62048379 SNP (P interaction=0·01) and also between fat intake (PUFA:SFA ratio) and obesity risk linked to the rs62048379 SNP (P interaction=0·01). The T allele for the variant rs62048379 was positively associated with overweight/obesity in individuals whose percentage energy intake from protein was above the median (OR 2·00; 95 % CI 1·05, 3·82). The rs62048379 SNP was also associated with overweight/obesity in individuals whose PUFA:SFA ratio was below the median (OR 1·63; 95 % CI 1·05, 2·55). The association between FTO gene variants and excess body weight can be modulated by dietary characteristics, particularly by fatty acid distribution and dietary protein intake in children.

Minor psychiatric disorders in mothers and asthma in children.

OBJECTIVE: Recent studies have shown that asthma represents a major health issue not only in children of developed countries but also in urban centers in some middle-income countries. Brazil has one of the highest prevalences of asthma worldwide. Recently, interest has grown in the relationship between psychosocial factors and asthma. This article examines the relationship between maternal mental disorders and the prevalence of asthma in low-income children from an inner city area of Salvador in the state of Bahia, Brazil, and is part of the SCAALA program (Social Change, Allergy and Asthma in Latin America). PATIENTS AND METHODS: A total of 1,087 children between the ages of 5 and 12 were investigated, together with their mothers. The mothers' mental health was evaluated using the SRQ-20, an instrument for the psychiatric screening of minor psychiatric disorders (depression, anxiety and somatic complaints). The prevalence of asthma was investigated using the ISAAC survey, a standardized, validated questionnaire for asthma and other allergic diseases. Cases were defined as asthma if the patient reported having had wheezing in the previous 12 months in addition to at least one of the following: having asthma, wheezing while exercising, waking during the night because of wheezing, or having had at least four episodes of wheezing in the previous 12 months. Atopy was defined as a positive skin prick test to allergens. RESULTS AND CONCLUSION: The presence of minor psychiatric disorders in the mothers was significantly associated with the presence of asthma in the children, and this association was consistent with all forms of asthma, irrespective of whether it was atopic or nonatopic. Future studies should be carried out to further investigate this association and the potential biological mechanisms involved. Programs for asthma control should include strategies for stress reduction and psychological support for the families of asthmatic children.