Intestinal parasites, growth and physical fitness of schoolchildren in poor neighbourhoods of Port Elizabeth, South Africa: a cross-sectional survey.

BACKGROUND: As traditional lifestyle and diets change with social and economic development, disadvantaged communities in low- and middle-income countries increasingly face a double burden of communicable and non-communicable diseases. We studied the relationship between physical fitness and infections with soil-transmitted helminths (STHs), intestinal protozoa and Helicobacter pylori among schoolchildren in Port Elizabeth, South Africa. METHODS: We conducted a cross-sectional survey among 1009 children, aged 9 to 12 years, from eight primary schools in socioeconomically disadvantaged neighbourhoods of Port Elizabeth. Physical fitness was determined using field-deployable tests of the Eurofit fitness test battery. Stool samples were analysed with the Kato-Katz thick smear technique to diagnose STHs and with rapid diagnostic tests (RDTs) to detect intestinal protozoa and H. pylori infections. Haemoglobin (Hb) levels were assessed and anthropometric indicators determined. RESULTS: Complete data were available for 934 children (92 %). In two schools, high STH prevalences were found (Ascaris lumbricoides 60 and 72 %; Trichuris trichiura 65 % each). For boys and girls co-infected with A. lumbricoides and T. trichiura (n = 155) the maximal oxygen uptake (VO2 max) was estimated to be 50.1 and 47.2 ml kg(-1) min(-1), compared to 51.5 and 47.4 ml kg(-1) min(-1) for their non-infected peers (n = 278), respectively. On average, children without helminth infections had greater body mass (P = 0.011), height (P = 0.009) and a higher body mass index (P = 0.024) and were less often stunted (P = 0.006), but not significantly less wasted compared to their peers with a single or dual species infection. Among 9-year-old boys, a negative correlation between helminth infections and VO2 max, grip strength and standing broad jump distance was observed (P = 0.038). The overall mean Hb level was 122.2 g l(-1). In the two schools with the highest prevalence of STHs the Hb means were 119.7 and 120.5 g l(-1), respectively. CONCLUSIONS: Intestinal parasite infections appear to have a small but significant negative effect on the physical fitness of infected children, as expressed by their maximal oxygen uptake. We observed a clear impact on anthropometric indicators.

Coronavirus and Other Respiratory Illnesses Comparing Older with Young Adults.

BACKGROUND: Study of human coronavirus and other virus-associated respiratory illnesses is needed to describe their clinical effects on chronically ill, older adults. METHODS: A prospective study during 2009 to 2013 clinically assessed acute respiratory illnesses soon after onset and 3 to 4 weeks later in patients aged ≥60 years with chronic lung and heart diseases (group 1, 100 subjects) and healthy adults aged 18 to 40 years (group 2, 101 subjects). Respiratory secretions were tested for nucleic acids of a panel of respiratory viruses. An increase in antibody titer was assessed for 4 coronavirus strains. RESULTS: Virus-associated illnesses (29 [39.1%] of 74 illnesses in group 1 and 59 [48.7%] of 121 illnesses in group 2) occurred in all calendar quarters, most commonly in the first and fourth quarters. Coronaviruses (group 1: 14 [18.9%] illnesses; group 2: 26 [21.5%] illnesses) and enteroviruses/rhinoviruses (group 1: 14 [18.9%] illnesses; group 2: 37 [30.6%] illnesses) were most common. Virus co-infections occurred in 10 illnesses. Illnesses with 9 to 11 symptoms were more common in group 1 (17 [23.0%]) than in group 2 (15 [12.4%]) (P < .05). Compared with group 2, more group 1 subjects reported dyspnea, more severe disease of longer duration, and treatment for acute illness with prednisone and antibiotics. Coronavirus-associated illnesses (percent of illnesses, group 1 vs group 2) were characterized by myalgias (21% vs 68%, P < .01), chills (50% vs 52%), dyspnea (71% vs 24%, P < .01), headache (64% vs 72%), malaise (64% vs 84%), cough (86% vs 68%), sputum production (86% vs 60%), sore throat (64% vs 80%), and nasal congestion (93% vs 96%). CONCLUSIONS: Respiratory illnesses were commonly associated with coronaviruses and enteroviruses/rhinoviruses affecting chronically ill, older patients more than healthy, young adults.

The burden of comorbidity is associated with symptomatic polymicrobial urinary tract infection among institutionalized elderly.

BACKGROUND: Urinary tract infections (UTIs), often sustained by polymicrobial flora (p-UTIs), are a common finding among nursing home patients, and associated with adverse outcomes and increased healthcare costs. P-UTIs have been extensively studied with regard to microbiological aspects. However, little is known about the characteristics of the host. AIMS: The aim of this study is to verify to which extent comorbidity characterizes elderly nursing home patients with p-UTIs. METHODS: We enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the "Fondazione San Raffaele Cittadella della Carità", Taranto, Italy. P-UTI was diagnosed when two uropathogens were simultaneously isolated. The burden of comorbidity was quantified using the Charlson comorbidity score index. Logistic regression analysis was used to assess the adjusted association of the variables of interest with the presence of p-UTI. RESULTS: P-UTIs were detected in 118/299 (39%) patients. According to logistic regression, the presence of p-UTIs was independently associated with the Charlson index (OR 1.70; 95% CI 1.06-2.72; P = .026). This association remained also after excluding participants without urinary catheter (OR 1.88; 95% CI 1.13-3.11; P = .015). DISCUSSION: The presence of P-UTIs is associated with the burden of comorbidity, but not with individual diseases. CONCLUSIONS: Older nursing home patients with comorbidity should be screened for the presence of p-UTIs; further studies are needed to evaluate the impact of early detection and treatment of p-UTIs on the development of comorbidity.

Co-infected HIV/hepatitis patients compared with chronic liver patients and healthy individuals: respiratory assessment through surface electromyography and spirometry.

INTRODUCTION: Co-infected HIV and hepatitis subjects are candidates for a liver transplantation because of progressive liver disease. Chronic liver disease, co-infected or not, requires assessment of respiratory function before liver transplantation. The respiratory evaluation of these 2 groups compared with healthy individuals can define deficits, and this can impair a full recovery after transplant surgery. OBJECTIVE: This study sought to compare the respiratory profile in co-infected patients with chronic liver disease who are candidates for liver transplantation with that of healthy subjects. METHODS: Through respiratory evaluation of flows and lung volumes (spirometry), muscle activity (surface electromyography), and maximum pressure (manovacuometer), 250 people were distributed into 3 groups: 14 patients with HIV and liver disease, 65 healthy subjects, and 171 patients with chronic liver disease. The mean age (years) was respectively 47.5 ± 6.2, 48.3 ± 14.1, and 52.9 ± 8.5. The average body mass index (kg/m(2)) of the groups was 24.6 ± 4.5, 26.0 ± 3.2, and 28.5 ± 5.3, respectively. RESULTS: There was a statistical difference among the groups in the root means square (RMS) rectus abdominis (µV) (P = .0016), RMS diaphragm (µV) (P = .0001), maximal inspiratory pressure (cmH2O) (P = .001), forced exhaled volume at the end of first second (%) (P = .002), and maximal mid expiratory flow 25% to 75% (%) (P = .0001) for the Kruskal-Wallis test. The multivariate analysis among the groups showed that the RMS diaphragm had a tendency to discriminate the co-infected subjects. CONCLUSIONS: The co-infected HIV group showed a muscle deficit of diaphragm and rectus abdominis activity, and the liver disease group showed lower indexes in volumes and respiratory flows.