Occurrence of bisphosphonate-associated osteonecrosis of the jaws in individuals with rheumatoid arthritis - a systematic review.

BACKGROUND: To access the occurrence of bisphosphonate-associated osteonecrosis of the jaw (BAONJ) in individuals with rheumatoid arthritis (RA). MATERIAL AND METHODS: Observational studies that evaluated the occurrence of BAONJ in individuals with RA (BAONJ-RA) were considered for inclusion. Electronic searches were performed up to December 2022 in six databases and in the grey literature. The study selection, data extraction, and quality assessment of the included studies according to the Joanna Briggs Institute Critical Appraisal Checklists was performed. The certainty of evidence was evaluated using the GRADE approach. RESULTS: Five studies were included three cohort and two cross-sectional. The sample size of subjects with RA ranged from 16 to 3201. Together, the studies presented 36 cases of BAONJ-RA. Prevalence of BAONJ-RA ranged from 0.094% to 56.25%. The incidence ranged from 0.4% to 2.21. Women between the 6th and 8th decade of life were the most affected. Alendronate (n=5) and zoledronic acid (n=9), orally and intravenously, respectively, were the most used bisphosphonates. The duration of bisphosphonates use ranged from 2.7 to 8 years. The certainty of evidence was very low. CONCLUSIONS: The occurrence of BAONJ-RA is low. However, the certainty of the evidence was very low for this outcome.

Physical activity and long COVID: findings from the Prospective Study About Mental and Physical Health in Adults cohort.

OBJECTIVES: The study investigated the longitudinal association between physical activity and the risk of long COVID in patients who recovered from COVID-19 infection. STUDY DESIGN: We analyzed longitudinal data of the Prospective Study About Mental and Physical Health cohort, a prospective cohort study with adults living in Southern Brazil. METHODS: Participants responded to an online, self-administered questionnaire in June 2020 (wave 1) and June 2022 (wave 4). Only participants who self-reported a positive test for COVID-19 were included. Physical activity was assessed before (wave 1, retrospectively) and during the pandemic (wave 1). Long COVID was assessed in wave 4 and defined as any post-COVID-19 symptoms that persisted for at least 3 months after infection. RESULTS: A total of 237 participants (75.1% women; mean age [standard deviation]: 37.1 [12.3]) were included in this study. The prevalence of physical inactivity in baseline was 71.7%, whereas 76.4% were classified with long COVID in wave 4. In the multivariate analysis, physical activity during the pandemic was associated with a reduced likelihood of long COVID (prevalence ratio [PR]: 0.83; 95% confidence interval [CI]: 0.69-0.99) and a reduced duration of long COVID symptoms (odds ratio: 0.44; 95% CI: 0.26-0.75). Participants who remained physically active from before to during the pandemic were less likely to report long COVID (PR: 0.74; 95% CI: 0.58-0.95), fatigue (PR: 0.49; 95% CI: 0.32-0.76), neurological complications (PR: 0.47; 95% CI: 0.27-0.80), cough (PR: 0.40; 95% CI: 0.22-0.71), and loss of sense of smell or taste (PR: 0.43; 95% CI: 0.21-0.87) as symptom-specific long COVID. CONCLUSION: Physical activity practice was associated with reduced risk of long COVID in adults.

Lactobacillus plantarum Lp62 exerts probiotic effects against Gardnerella vaginalis ATCC 49154 in bacterial vaginosis.

The severe side-effects elicited by conventional antibiotic therapy and the recurrence of Bacterial vaginosis-associated bacteria and bacterial resistance have led to the development of novel alternative therapies, among which genital probiotics are widely used. In this study, we aimed to evaluate the antimicrobial activities of Lactobacillus plantarum Lp62 and its supernatant against Gardnerella vaginalis, using both in vitro and in vivo approaches. In vitro assays were used to evaluate the viability of the strain and the antimicrobial activities of the supernatant in different pH ranges. An in vivo assay was performed on female BALB/c mice, wherein the animals were divided into eight groups: four control groups and four treated groups (for curative and preventive therapies). After infecting and treating the mice, the animals were killed to quantify the bacterial load using qPCR, evaluate leucocyte cellular response, determine vaginal cytokine levels and perform cytokine tissue gene expression. Our analyses revealed significant activity of the strain and its supernatant against G. vaginalis. Preliminary in vitro tests showed that the strain grew with equal efficiency in different pH ranges. Meanwhile, the presence of halo and inhibition of pathogen growth established the significant activity of the supernatant against G. vaginalis. We observed that both micro-organisms are resident bacteria of mouse microbiota and that the lactobacilli population growth was affected by G. vaginalis and vice versa. We also observed that the treated groups, with their low bacterial load, absence of leucocyte recruitment, reduced cytokine levels in the vaginal lavage and normalized cytokine gene expression, successfully controlled the infection.

Organic copper, iron, manganese and zinc: digestibility, production parameters and egg quality of layers / [Cobre, ferro, manganês e zinco orgânico: digestibilidade, parâmetros zootécnicos e qualidade dos ovos de poedeiras]

This study examined the replacement of the inorganic minerals (IM) Cu, Fe, Mn and Zn with their organic form (OM) in the diet of 67-week-old Dekalb White laying hens by comparing digestibility, production and egg quality. The experiment involved 240 birds, with 48 birds used per treatment and 12 per replicate. Isoenergetic and isonutrient diets were supplemented with 8mg Cu, 50mg Fe, 70mg Mn and 50mg Zn per kilogram of diet from an inorganic premix (IM100), from an organic premix (OM100), or the latter at the decreasing inclusion levels of 65% (OM65), 45% (OM45) and 35% (OM35). The following variables were evaluated: production, eggs per housed bird (EHB), viability, egg weight and mass, cracked and lost eggs, digestibility and egg physicochemical traits. Birds fed OM35 and OM45 showed lower production rates, and organic minerals provided the highest egg weights, regardless of their inclusion level. Accordingly, egg mass was similar between IM100, OM45 and OM35, and highest values were obtained with OM100 and OM65. Source or level had no influence on digestibility or egg quality. Supplementation with 2.8mg Cu, 17.5mg Fe, 24.5m g Mn and 17.5mg Zn per kilogram of diet (OM35) in the last third of the laying cycle provided relevant economic production indices (EHB, viability, egg weight or mass).(AU)

Estudou-se a substituição dos minerais inorgânicos (MI) Cu, Fe, Mn e Zn por minerais orgânicos (MO) na dieta de poedeiras Dekalb White com 67 semanas, comparando-se índices de produção, digestibilidade e qualidade dos ovos. Utilizaram-se 240 aves, 48 aves por tratamento e 12 por repetição. Dietas isoenergéticas e isonutrientes foram suplementadas com 8mg Cu, 50mg Fe, 70mg Mn e 50mg Zn por kg de ração MI100 e MO100 ou suplementações decrescentes MO65, MO45 e MO35. Avaliou-se produção, ovo por ave alojada (OAA), viabilidade, peso e massa dos ovos, trincados e perdidos, digestibilidade dos nutrientes e características físico-químicas dos ovos. Observaram-se menores índices de produção nas aves dos tratamentos MO35 e MO45 e maiores pesos dos ovos nos tratamentos com minerais orgânicos, independentemente da inclusão. Assim, massas de ovos foram semelhantes para os tratamentos MI100, MO45 e MO35 e maiores para MO100 e MO65. Fontes ou níveis de inclusões não influenciaram a digestibilidade e a qualidade dos ovos. Índices zootécnicos economicamente relevantes (OAA, viabilidade, peso e massa do ovo) foram obtidos com suplementação de 2,8mg Cu, 17,5mg Fe, 24,5mg Mn e 17,5mg Zn por kg de ração (MO35) em poedeiras brancas no último terço do ciclo de postura.(AU)

Recombinogenic, genotoxic, and cytotoxic effects of azathioprine using in vivo assays.

Azathioprine (Aza) is a purine antimetabolite immunosuppressant that is widely employed for immunosuppressive therapy in post-transplant recipients or patients with autoimmune diseases. Chronic use of immunosuppressants might produce several side effects, including a high rate of neoplasms in these patients. Considering that genotoxic effects are associated with an increased risk of developing cancer, the aim of this study was to examine the recombinogenic, genotoxic, and cytotoxic effects of Aza using Somatic Mutation and Recombination Test (SMART) in Drosophila melanogaster, as well as comet and micronucleus assays in mouse bone marrow cells. Further, the adverse effects of Aza were determined in mouse hepatic and renal tissues using histopathological analysis. Data demonstrated that Aza induced significant increased genotoxicity in D. melanogaster and mouse bone marrow cells at all concentrations tested. Homologous recombination was the predominant genotoxic event noted for the first time to be initiated by Aza in SMART. In histopathological analysis, Aza did not show any marked toxic activity in mouse hepatic and renal tissues. Therefore, the high rate of neoplasms reported in patients with long-term use of Aza may be attributed, at least partially, to the genotoxic action of this drug.

Perineurioma versus meningioma. A multi-institutional immunohistochemical and ultrastructural studY.

The differential diagnosis between perineurioma (PN) and meningioma (MEN) can be difficult by histology and immunohistochemistry (IHC) because the perineurium and arachnoid have the same embryological origin. However, there are no comparative studies determining conclusive parameters for the differential diagnosis. The aim of this study is to compare IHC of PN and MEN and their ultra-structural characteristics to elucidate which are the useful data that allow differentiate both entities. Thirty-five MEN were analyzed, and 15 PN, (11 skin and soft tissues and four oral cavity). IHC for epithelial membrane antigen (EMA), Claudin-1, GLUT-1, somatostatin-2 receptor (SSTR-2), and progesterone receptor (RP) was performed. Ultrastructural studies were performed on 8 MEN and 15 PN. Only in PN Claudin-1 was positive in 9/11 (90%) cases and GLUT-1 in 7/11 (63%) cases. In MEN, the progesterone receptor was expressed in 21/35 (60%) cases and no case expressed Claudin-1 and GLUT-1; EMA was expressed in all MEN cases and 93% of PN. SSTR-2 was expressed weakly in six cases of MEN (17%), and it was not considered useful for differential diagnosis. On ultrastructure, PN showed thin and parallel processes, some caveolae, and lacked cell junctions. The cellular processes were surrounded by a collagenous stroma in 94% of the cases. MEN were characterized by curved cytoplasmic cell processes showing desmosomes in 75% of cases. Ultrastructural findings aid in the differential diagnosis between PN and MEN, especially if molecular studies are not available.

[Mirror writing in epilepsy]. / Escritura en espejo en epilepsia.

TITLE: Escritura en espejo en epilepsia.

Association of spontaneous abortion and Ureaplasma parvum detected in placental tissue.

Spontaneous abortion is considered a public health problem having several causes, including infections. Among the infectious agents, bacteria of the vaginal microbiota and Ureaplasma parvum have been associated with abortion, but their participation needs to be further elucidated. This study aims to evaluate the influence of Mollicutes on the development of spontaneous abortion. Women who underwent spontaneous abortion and those with normal birth (control) were studied. Samples of cervical mucus (CM) and placental tissue were collected to identify Mollicutes using the quantitative polymerase chain reaction methodology. Eighty-nine women who had a miscarriage and 20 women with normal pregnancies were studied. The presence of Mollicutes in placental tissue increased the chance of developing miscarriage sevenfold. The prevalence of U. parvum in women who experienced spontaneous abortion was 66.3% in placental tissue. A positive association was observed between the detection of U. parvum in samples of placental tissue and abortion. There was a significant increase in microbial load in placental tissue for M. hominis, U. urealyticum and U. parvum compared to the control group. Detection of U. parvum in CM in pregnant women can ascend to the region of the placental tissue and trigger a spontaneous abortion.

Metallic sample preparation for phase transformation analysis.

Metallic materials characterization is a important part of phase transformation studies, and the sample preparation plays a crucial role in the measured properties. The methodologies available are not fully described and refer in its majority only to iron-based and aluminum-based alloys focusing in industrial analysis. In this paper the authors fully described the preparation methodology for metallic samples used by their research group. This method aims to attend different characterization techniques, producing samples of complex metallic systems from pure base materials by arc melting. •The melting of metallic ingots from pure base materials was fully described.•The correct sample cutting, sanding and polishing procedures were described.•A full detailed procedure is described to prepare the samples for different analyses.

Construct validity and reliability of EQ-5D-3L for stroke survivors in a lower middle income setting

Introduction: Stroke is a leading disease accounting for burden of chronic NCDs especially in lower and lower-middle income (LMI) settings. Quality of Life (QOL) is considered as an important facet of determination of success of patient management. EQ-5D-3L is a generic QOL tool. It provides an index score amalgamating responses for five descriptive questions and a visual analogue scale (VAS) value. Objectives: To assess the validity and reliability of EQ-5D-3L for stroke patients in Sri Lanka, which is a LMI setting. Methods: A descriptive cross sectional study was done among 100 stroke survivors among whom 50 each were managed at an ambulatory setting and an in-ward setting. A second wave of data collection was done for reliability analysis among one half of participants. The validity of EQ-5D-3L was assesses with five a-priori hypotheses. Reliability was assessed with test-retest method and with internal consistency. Non parametric Mann Whitney U test and Spearman correlation coefficients were used in the analysis. Results: The EQ-5D index scores had significant positive correlation with SF-36 domain scores (p<0.001). The EQ-5D VAS scores had significant positive correlation with SF-36 domain scores (p<0.01). Index and VAS values of the EQ-5D were proved to be valid in known-group comparison (p<0.001). Participants reporting some kind of impairment for EQ-5D-3L dimensions had lower SF-36 domain scores. All the kappa values in the analysis of test-retest method were significant (p<0.001). For the VAS score, the Spearman correlation coefficient in test-reter analysis was 0.993 (p<0.001). Cronbach's alpha value was 0.928. Conclusions: and Recommendations EQ-5D-3L questionnaire demonstrates construct validity and a is a reliable toolin measuring QOL among stoke survivors in Sri Lanka.

Bone marrow mononuclear cells versus mesenchymal stem cells from adipose tissue on bone healing in an Old World primate: can this be extrapolated to humans? / Células mononucleares de medula óssea versus células-tronco mesenquimais de tecido adiposo em cicatrização de lesão óssea em primata: pode ser extrapolado para humanos?

In veterinary medicine, the cell therapy is still unexplored and there are many unanswered questions that researchers tend to extrapolate to humans in an attempt to treat certain injuries. Investigating this subject in nonhuman primates turns out to be an unparalleled opportunity to better understand the dynamics of stem cells against some diseases. Thus, we aimed to compare the efficiency of bone marrow mononuclear cells (BMMCs) and mesenchymal stem cells (MSCs) from adipose tissue of Chlorocebus aethiops in induced bone injury. Ten animals were used, male adults subjected, to bone injury the iliac crests. The MSCs were isolated by and cultured. In an autologous manner, the BMMCs were infused in the right iliac crest, and MSCs from adipose tissue in the left iliac crest. After 4.8 months, the right iliac crests fully reconstructed, while left iliac crest continued to have obvious bone defects for up to 5.8 months after cell infusion. The best option for treatment of injuries with bone tissue loss in old world primates is to use autologous MSCs from adipose tissue, suggesting we can extrapolate the results to humans, since there is phylogenetic proximity between species.(AU)

Na medicina veterinária, a terapia celular ainda é inexplorada e há muitas perguntas não respondidas, o que leva os pesquisadores a uma tendência a estender a terapia para os seres humanos, na tentativa de tratar certas lesões. Investigar esse assunto em primatas não humanos revela-se uma oportunidade sem precedentes para compreender melhor a dinâmica das células-tronco contra algumas doenças. Assim, objetivou-se comparar a eficiência das células mononucleares de medula óssea (BMMCs) e das células-tronco mesenquimais (MSCs) do tecido adiposo de Chlorocebus aetiops na lesão óssea induzida. Foram utilizados 10 animais, adultos do sexo masculino, submetidos à lesão óssea nas cristas ilíacas. As MSCs foram isoladas e cultivadas; de forma autóloga, as BMMCs foram infundidas na crista ilíaca direita e as MSCs de tecido adiposo na crista ilíaca esquerda. Após 4,8 meses, a crista ilíaca direita foi totalmente reconstruída, enquanto a crista ilíaca esquerda continuou apresentando defeito ósseo evidente por até 5,8 meses após a infusão. A melhor opção para o tratamento de lesões com perda de tecido ósseo em primatas do Velho Mundo é a utilização de MSCs autólogas de tecido adiposo, sugerindo que se podem estender os resultados para seres humanos, uma vez que há proximidade filogenética entre as espécies.(AU)

Mantle cell lymphoma with involvement of the digestive tract. / Linfoma del manto con afección del tubo digestivo.

INTRODUCTION AND AIM: Mantle cell lymphoma is an aggressive subtype of B-cell non-Hodgkin lymphoma and its incidence is 0.5/100,000 inhabitants. Gastrointestinal involvement at diagnosis is 15-30%. The aim of our study was to analyze the clinical and endoscopic characteristics of mantle cell lymphoma affecting the digestive tract. MATERIAL AND METHODS: A retrospective study was conducted, based on a case series of patients with mantle cell lymphoma affecting the gastrointestinal tract that were diagnosed over a 10-year period. RESULTS: Ten patients (11.7%) had gastrointestinal tract involvement. The upper endoscopic findings were polypoid lesions (66%), thickened folds (44%), and nonspecific changes in the mucosa (33%). At colonoscopy, polypoid lesions were viewed in 100% of the patients and ulcerated lesions in 40%. CONCLUSION: Polypoid lesions are the most common endoscopic characteristics in patients with mantle cell lymphoma of the gastrointestinal tract. Upper endoscopy and colonoscopy should be carried out on patients with mantle cell lymphoma, even those with nonspecific symptoms, to check their gastrointestinal status. Gastrointestinal involvement has an impact on disease staging.

Microbiological, chemical, physical, and proteolytic activities of raw milk after thermal processing / Atividade microbiológica, física, química e proteolítica do leite cru após o processamento térmico

The aim was to evaluate the microbiological, chemical- physical, and shelf-life quality of milk samples after pasteurization (HTST) for 10 days or ultra-high temperature (UHT) treatment for 120 days. Raw milk counts of mesophilic aerobic microorganisms, Staphylococcus spp. and thermotolerant coliforms before HTST and UHT processing were 6.73 and 7.77; 2.84 and 4.30, and 4.68 and 4.37log10, respectively. Pseudomonas spp. were found in raw milk samples. No presence of any other microorganisms studied was detected and no microbial inhibitor was found. Processed samples met microbiological legal requirements. However, aerobic mesophilic counts for HTST pasteurized milk samples stored for 5 and 10 days increased to values comparable to those in raw milk. Composition chemical- physical of all samples were within legal limits. These results demonstrate that, although HTST and UHT processed milk comply with the microbiological standards required by Brazilian law, high microbial counts in raw milk are an issue, possibly due to failures in the early stages of the production chain. Increase in casein macropeptide (CMP), probably because of proteases psychrotrophic bacteria. It is concluded that the quality of raw milk directly influences the progressive increase of the CMP values.(AU)

O objetivo da presente pesquisa foi avaliar a qualidade microbiológica, fisco-química e a vida de prateleira de amostras de leite, após o processo de pasteurização rápida (HTST) ou de ultra-alta temperatura (UHT) durante 10 dias, ou de ultra-alta temperatura (UHT) por 120 dias. As contagens de micro-organismos aeróbios mesófilos, Staphylococcus spp. e de coliformes termotolerantes do leite cru utilizado para tratamentos HTST e UHT foram, respectivamente (log10): 6,73 e 7,77; 2,84 e 4,30 e 4,68 e 4,37. Foi constatada a presença de Pseudomonas spp. no leite cru. Não foi detectada a presença de nenhum outro micro-organismo estudado, e as amostras estavam isentas de inibidores microbianos. Após a pasteurização, todas as amostras apresentaram contagens microbianas compatíveis com os limites legais. No entanto, as amostras de leite pasteurizado apresentaram contagens de aeróbios mesófilos semelhantes ao leite cru após cinco e 10 dias de armazenamento. A composição físico-química de todas as amostras estava de acordo com os limites legais. Observou-se acréscimo dos níveis de caseinomacropeptídeo (CMP) no leite UHT, provavelmente em função das proteases de bactérias psicrotróficas. Conclui-se que a qualidade do leite cru influencia diretamente os valores de CMP.(AU)

Hidden prevalence of chronic kidney disease in hypertensive patients: the strategic role of primary health care.

OBJECTIVE: To identify the hidden prevalence of chronic kidney disease (CKD) in hypertensive patients. STUDY DESIGN: Cross-sectional study of individuals with systemic arterial hypertension (SAH) who were registered for primary health care (PHC). METHODS: In total, 293 individuals participated. Data were collected through interviews, as well as biochemical and anthropometric assessments. The CKD-EPI formula was used to identify the occurrence of CKD. Pearson's chi-squared test or Fisher's exact test were used to compare proportions. Prevalence ratios were estimated with a confidence interval of 95% for associations between the explanatory variables and CKD. RESULTS: Most of the individuals assessed were female (74%), elderly (69%), with a low income (90%), low education levels (84%) and overweight (66.9%). A CKD prevalence of 38.6% (95% CI: 33.0-44.2) was found and approximately 14% were at an advanced stage of the disease. Upon comparison of the variables in the different stages of CKD, statistically significant association could be suggested between CKD and age, education, alcohol intake, overweight individuals, cardiovascular risk, abnormal creatinine and abnormal microalbuminuria. When the prevalence ratio was assessed, association could be suggested between CKD and age, and CKD and creatinine. CONCLUSION: The high hidden prevalence of CKD confirms the need to train health professionals involved in the treatment of SAH through PHC, enabling the prevention and diagnosis of CKD in its early stages.

Structural Insights into Substrate Binding of Brown Spider Venom Class II Phospholipases D.

Phospholipases D (PLDs), the major dermonecrotic factors from brown spider venoms, trigger a range of biological reactions both in vitro and in vivo. Despite their clinical relevance in loxoscelism, structural data is restricted to the apo-form of these enzymes, which has been instrumental in understanding the functional differences between the class I and II spider PLDs. The crystal structures of the native class II PLD from Loxosceles intermedia complexed with myo-inositol 1-phosphate and the inactive mutant H12A complexed with fatty acids indicate the existence of a strong ligand-dependent conformation change of the highly conserved aromatic residues, Tyr 223 and Trp225 indicating their roles in substrate binding. These results provided insights into the structural determinants for substrate recognition and binding by class II PLDs.

Técnica de Doyle na correção de fratura completa em úmero de tucano (Ramphastos toco): relato de caso / Doyle technique in the repair of complete fracture in the humerus of toucan (Ramphastos toco): a case report

O objetivo deste trabalho foi relatar a realização de osteossíntese no úmero esquerdo de uma ave silvestre utilizando-se a técnica de Doyle. Um tucano (Ramphastos toco) sofreu uma fratura transversa completa no terço proximal do úmero esquerdo. Após avaliação clínica e procedimentos pré-operatórios, a ave foi submetida à osteossíntese. A técnica cirúrgica utilizada permitiu uma perfeita coaptação dos fragmentos ósseos, ocasionando a formação de calo ósseo e recuperação do membro afetado em um período curto de tempo, apresentando-se como opção eficaz na correção de fraturas do úmero em aves de médio porte...

The aim of this study was to report the realization of the left humerus osteosynthesis of a wild bird using the Doyle technique. A toucan (Ramphastos toco) suffered a complete transverse fracture of the proximal third of the left humerus. After clinical evaluation and pre-operative procedures, the bird was submitted to osteosynthesis. The surgical technique used allowed a perfect coaptation of the bone fragments, resulting in the formation of a bone callus and recovery of the affected limb in a short period of time presenting this as an effective option for the correction of fractures of the humerus in medium size birds...

The effectiveness of a physical activity and nutrition education program in the prevention of overweight in schoolchildren in Criciúma, Brazil.

BACKGROUND/OBJECTIVES: The objectives of this study were to evaluate nutritional status, aptitude and physical activity at the beginning and end of the nutrition education and physical activity intervention program as compared with a control group. METHODS: We conducted a 28-week quasi-experimental study involving 238 students (108 in the intervention group (IG) and 130 in the control group (CG)). The IG participated in curricular and extracurricular activities for nutrition education (50 min once a week) and physical activity (50 min twice a week), and the CG participated only in curricular activities. Nutritional status was determined using body mass index, according to the WHO 2007 curve. The effect of the intervention program was evaluated using a model of generalized estimating equations. RESULTS: Among overweight students, a greater reduction in percentile of BMI was observed in the IG (64.6%) compared with CG (36.4%), P=0.001. Improvement in nutritional status occurred in 26.2% of IG versus 10.4% of CG (P=0.014). The IG showed a significant increase in the amount of moderate or vigorous physical activity (P=0.012), whereas in the control group the increase was not significant (P=0.810). In three physical fitness tests, the IG showed significant improvements in performance (P<0.001), whereas the control group's performance was worse in the final evaluation. CONCLUSIONS: The intervention program had a positive effect on overweight, with significant improvements in nutritional status and physical fitness.

The risk factors for and effects of visceral leishmaniasis in graft and renal transplant recipients.

BACKGROUND: The aim of this study was to identify the risk factors for visceral leishmaniasis (VL) in renal transplant recipients and to analyze the impacts of this disease on graft success and patient health. METHODS: This retrospective, case-control study examined 120 renal transplant patients in a VL endemic area. The treatment group included patients (n=20) who developed VL after transplantation, and the control group (n=100) was composed of renal transplant recipients without VL. This study evaluated socioeconomic, demographic, clinical, and laboratory variables. Bivariate analysis and multiple logistic regressions were performed to identify potential risk factors. RESULTS: The average time between transplantation and Leishmania infection in the treatment group was 29.4 months. Seventeen (85%) patients were cured and 3 (15%) died. In 95% of the cases, a myelogram was used for initial identification of Leishmania forms. The significant risk factors for VL in renal transplant recipients were cytomegalovirus infection after transplantation (odds ratio [OR], 5.29; 95% confidence interval [CI], 1.27-21.97) and living with cats (OR, 5.74; 95% CI, 1.15-28.76). Bacterial infection after transplantation (OR, 3.00; 95% CI, 0.96-9.37) and unpaved streets in the neighborhood (OR, 2.14; 95% CI, 0.71-6.43) tended to increase the risk of VL, whereas a negative Rh factor tended to protect against VL (OR, 0.26; 95% CI, 0.06-1.02). CONCLUSION: Cytomegalovirus infection after transplantation and living with cats increased the risk of VL in renal transplant recipients living in VL endemic areas.