Relapses in canine leishmaniosis: risk factors identified through mixed-effects logistic regression.

BACKGROUND: Canine leishmaniosis (CanL), caused by Leishmania infantum, is an important vector-borne parasitic disease in dogs with implications for human health. Despite advancements, managing CanL remains challenging due to its complexity, especially in chronic, relapsing cases. Mathematical modeling has emerged as a powerful tool in various medical fields, but its application in understanding CanL relapses remains unexplored. METHODS: This retrospective study aimed to investigate risk factors associated with disease relapse in a cohort of dogs naturally infected with L. infantum. Data from 291 repeated measures of 54 dogs meeting the inclusion criteria were included. Two logistic mixed-effects models were created to identify clinicopathological variables associated with an increased risk of clinical relapses requiring a leishmanicidal treatment in CanL. A backward elimination approach was employed, starting with a full model comprising all potential predictors. Variables were iteratively eliminated on the basis of their impact on the model, considering both statistical significance and model complexity. All analyses were conducted using R software, primarily employing the lme4 package, and applying a significance level of 5% (P < 0.05). RESULTS: This study identified clinicopathological variables associated with an increased risk of relapses requiring a leishmanicidal treatment. Model 1 revealed that for each 0.1 increase in the albumin/globulin ratio (A/G) ratio, the odds of requiring treatment decreased by 45%. Conversely, for each unit increase in the total clinical score (CS), the odds of requiring treatment increase by 22-30%. Indirect immunofluorescence antibody test (IFAT) was not a significant risk factor in model 1. Model 2, incorporating individual albumin and globulins values, showed that dogs with high IFAT titers, hyper beta-globulinemia, hypoalbuminemia, anemia, and high CS were at increased risk of relapse. Both models demonstrated a good fit and explained a substantial amount of variability in treatment decisions. CONCLUSIONS: Dogs exhibiting higher CS, dysproteinemia, anemia, and high IFAT titers are at increased risk of requiring leishmanicidal treatment upon clinical relapse in CanL. Regular monitoring and assessment of risk factors prove essential for early detection of relapses and effective intervention in CanL cases. The contrasting findings between the two models highlight the complexity of aspects influencing treatment decisions in this disease and the importance of tailored management strategies to improve outcomes for affected dogs.

Diet quality and nutritional status in children with human immunodeficiency virus.

Background: Poor diet quality in children and adolescents may contribute to decreased immunity and lead to an increased risk of opportunistic diseases. Aim: To investigate diet quality and its relationship to nutritional status in human immunodeficiency virus (HIV)-infected pediatric patients (HIV-PIHIV). Methods: We conducted a cross-sectional study with 87 patients aged between 6 and 19 years carried out in two University Hospitals. Diet quality was analyzed by an adapted Healthy Eating Index (HEI) and nutritional status. The association between HEI with body mass index-for-age (BMI-for-age) and height-for-age was performed using a linear regression model. Clinical, maternal, anthropometric, and dietary data were collected through a semi-structured questionnaire, based on nutrition service protocols. Results: Diet quality was intermediate (median IAS = 54.8 interquartile range: 47.5 to 65.9 points), due to low consumption of fruits, vegetables, and dairy products and high empty calories and sodium by the PPIHIV. The multivariate regression model indicated that HEI was not significant for explaining BMI-for-age [ß = -0.01; 95% CI = (-0.03; 0.01); p 0.40] nor height-for-age [ß = 0.01; 95% CI = (-0.02; 0.03); p 0.51]. However, it was observed that adolescents showed 1 Z-score [95% CI = (-1.6; -0.44); p 0.001] a reduction in BMI-for-age compared with children, and those black patients showed an increase in BMI-for-age Z-score of 0.57 [95% CI = (0.7; 1.1); p 0.03] compared with non-blacks. Conclusion: The diet quality of the HIV-infected children and adolescents was below desired. No association was found between diet quality and inadequate nutritional status of HIV-PIHIV.

Symptom-based clusters of hospitalized patients with severe acute respiratory illness by SARS-CoV-2 in Brazil.

BACKGROUND: COVID-19 has shown a broad clinical spectrum, ranging from asymptomatic to mild, moderate, and severe infections. Many symptoms have already been identified as typical of COVID-19, but few studies show how they can be useful in identifying clusters of patients with different severity of illness. This interpretation may help to recognize the different profiles of symptoms of COVID-19 expressed in a population at certain time. The aim of this study was to identify symptom-based clusters of hospitalized patients with severe acute respiratory illness by SARS-CoV-2 in Brazil. The clusters were evaluated based on sociodemographic characteristics, admission to the Intensive Care Unit (ICU), use of respiratory support, and outcome. METHODS: The Multiple Correspondence Analysis (MCA)-based cluster analysis was applied to symptoms presented before admission. Pearson's chi-square test was used to compare the proportions of symptoms between the clusters and to examine differences in the calculated rates for the following variables: sex, age group, race, Brazilian region, use of respiratory support, admission to the ICU and outcome. RESULTS: Three COVID-19 clusters with distinct symptom profiles were identified by MCA-based cluster analysis. Cluster 1 had the mildest severity profile, with the lowest frequencies for most symptoms investigated. Cluster 2 had a severe respiratory profile, with the highest frequencies of patients with dyspnea, respiratory discomfort and O2 saturation< 95%. Cluster 2 was also the most prevalent in all Brazilian regions and had the highest percentages of patients who used invasive respiratory support (27.4%) (p-value<0.001), were admitted to the ICU (42.6%) (p -value<0.001) and died (39.0%) (p-value<0.001). Cluster 3 had a prominent profile of gastrointestinal symptoms. CONCLUSIONS: The study identified three distinct COVID-19 clusters based on the symptoms presented by patients with severe acute respiratory illness by SARS-CoV-2, but without distinction in their prevalence in the Brazilian regions.

Eating habits of children and adolescents during the COVID-19 pandemic: The impact of social isolation.

BACKGROUND: The social isolation enforced as a result of the new coronavirus (COVID-19) pandemic may impact families' lifestyle and eating habits. The present study aimed to assess the behaviour and dietary patterns of Brazilian children and adolescents during the social isolation imposed by the COVID-19 pandemic. METHODS: The present study was conducted using an online, anonymous cross-sectional survey with 589 children and 720 adolescents from Brazil during a nationwide social isolation policy. The Mann-Whitney U-test or the Kruskal-Wallis with the Dunn post-hoc method and a radar chart were used to compare the weekly consumption of each food by age group and isolation status. p < 0.05 was considered statistically significant. Analyses were conducted using R statistical software, version 4.0.2 (R Foundation for Statisitical Computing). RESULTS: We found that isolated families showed breakfast eating habits and the consumption of raw salad, vegetables, beans and soft drinks. Lower-class isolated families and those from the Northeast region consumed fruits, juices, vegetables and beans less frequently. Compared to children, adolescents were less isolated (p = 0.016), less active (p < 0.001), exposed to longer screen time (p < 0.001), showed an inadequate sleeping pattern (p = 0.002) and were from lower-class families (p < 0.001). CONCLUSIONS: Social isolation affected the eating habits of children and adolescents. Non-isolated families presented a lower consumption of healthy food, especially those among the lower class, from Northeast Brazil, as well as adolescents.

Risk Factors for Hospitalization and Mortality due to COVID-19 in Espírito Santo State, Brazil.

Brazil is, at the time of writing, the global epicenter of COVID-19, but information on risk factors for hospitalization and mortality in the country is still limited. Demographic and clinical data of COVID-19 patients until June 11th, 2020 were retrieved from the State Health Secretariat of Espírito Santo, Brazil. Potential risk factors for COVID-19 hospitalization and death were analyzed by univariate and multivariable logistic regression models. A total of 10,713 COVID-19 patients were included in this study; 81.0% were younger than 60 years, 55.2% were female, 89.2% were not hospitalized, 32.9% had at least one comorbidity, and 7.7% died. The most common symptoms on admission were cough (67.7%) and fever (62.6%); 7.1% of the patients were asymptomatic. Cardiovascular diseases (23.7%) and diabetes (10.3%) were the two most common chronic diseases. Multivariate logistic regression analysis identified an association of all explanatory variables, except for cough and diarrhea, with hospitalization. Older age (odds ratio [OR] = 3.95, P < 0.001) and shortness of breath (OR = 3.55, P < 0.001) were associated with increase of odds to COVID-19 death in hospitalized patients. Our study provided evidence that older age, male gender, Asian, indigenous or unknown race, comorbidities (smoking, kidney disease, obesity, pulmonary disease, diabetes, and cardiovascular disease), as well as fever and shortness of breath increased the risk of hospitalization. For death outcome in hospitalized patients, only older age and shortness of breath increased the risk.

The use of intervention analysis of the mortality rates from breast cancer in assessing the Brazilian screening programme

Abstract Introduction There is a need to develop methods to evaluate public health interventions. Therefore, this work proposed an intervention analysis on time series of breast cancer mortality rates to assess the effects of an action of the Brazilian Screening Programme. Methods The analysed series was the monthly female breast cancer mortality rates from January 1996 to March 2016. The intervention was the establishment of the National Information System on Breast Cancer in June 2009. The Box-Tiao approach was used to build a Global Intervention Model (GIM) composed of a component that fits the series without the intervention, and a component that fits the effect with the intervention. The intervention's response time was estimated and used to define the length of the residual series to assess the predictive accuracy of the GIM, which was compared to a one-step-ahead forecasting approach. Results The pre-intervention period was fitted to a SARIMA (0,1,2) (1,1,1)12 model and the intervention's effect to an ARIMA (1,1,0) model. The intervention led to an increase in the mortality rates, and its response time was 24 months. The forecast error (MAPE) for the GIM was 3.14%, and for the one-step-ahead forecast it was 2.15%. Conclusion This work goes one step further in relation to the studies carried out to evaluate the Breast Cancer Screening Programme in Brazil, considering that it was possible to quantify the effects and the response time of the intervention, demonstrating the potential of the proposed method to be used to evaluate health interventions.

[Performance by cytology and hybrid capture II in screening for high-grade squamous intraepithelial lesions in women with HIV]. / Desempenho do exame citológico e da captura híbrida II no rastreamento de lesões intraepiteliais escamosas de alto grau em mulheres HIV+

HIV-infected women are at increased risk of developing high-grade squamous intraepithelial lesions (HSIL), the precursor lesions for cervical cancer. This study estimated and compared the performance of cytology and hybrid capture II in screening for precursor lesions of cervical cancer among HIV-infected women. The study population consisted of women from the open prospective cohort at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/Fiocruz). Colposcopy and histology were considered jointly in defining the gold standard. Cytology showed 31.8% sensitivity and 95.5% specificity, while hybrid capture II showed higher sensitivity (100%) and lower specificity (52%). The positive likelihood ratio was 7.1 for cytology and 2.1 for hybrid capture II, while the negative likelihood ratio was 0.7 for cytology and 0.0 for hybrid capture II.

Desempenho do exame citológico e da captura híbrida II no rastreamento de lesões intraepiteliais escamosas de alto grau em mulheres HIV+ / Performance by cytology and hybrid capture II in screening for high-grade squamous intraepithelial lesions in women with HIV

As lesões intraepiteliais escamosas de alto grau (HSIL) são precursoras do câncer do colo do útero, com maior risco de ocorrência e desenvolvimento em mulheres HIV+. Neste trabalho, estimamos e comparamos o desempenho do exame citológico e da captura híbrida II no rastreamento das lesões precursoras em mulheres HIV+. A população de estudo compreendeu mulheres acompanhadas na coorte prospectiva aberta do Instituto de Pesquisa Clínica Evandro Chagas da Fundação Oswaldo Cruz (IPEC/Fiocruz). A colposcopia e histologia foram consideradas conjuntamente na definição do teste de referência. O exame citológico apresentou sensibilidade de 31,8 por cento e especificidade de 95,5 por cento, enquanto a captura híbrida II apresentou maior sensibilidade (100 por cento) e menor especificidade (52 por cento). As razões de verossimilhança para o teste positivo e negativo foram estimadas em 7,1 e 0,7 para o exame citológico e em 2,1 e 0,0 para a captura híbrida II, respectivamente.

HIV-infected women are at increased risk of developing high-grade squamous intraepithelial lesions (HSIL), the precursor lesions for cervical cancer. This study estimated and compared the performance of cytology and hybrid capture II in screening for precursor lesions of cervical cancer among HIV-infected women. The study population consisted of women from the open prospective cohort at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/Fiocruz). Colposcopy and histology were considered jointly in defining the gold standard. Cytology showed 31.8 percent sensitivity and 95.5 percent specificity, while hybrid capture II showed higher sensitivity (100 percent) and lower specificity (52 percent). The positive likelihood ratio was 7.1 for cytology and 2.1 for hybrid capture II, while the negative likelihood ratio was 0.7 for cytology and 0.0 for hybrid capture II.