Macrodetermined racial inequalities in diagnostic testing among tuberculosis patients in Brazil.

OBJECTIVES: To estimate the association between tuberculosis (TB) patients' race and patients' access to diagnostic testing in Brazil. In addition, we evaluated if the associations could be explained by a geographic codistribution between racial groups and diagnostic testing. STUDY DESIGN: It is a cross-sectional study based on secondary data from a national surveillance system of new TB cases diagnosed in 2015. METHODS: We evaluated the association between TB patients' race (independent variable) and the HIV testing and TB mycobacterial culture providing (dependent variables) with logistic regression models. We used multilevel models to consider different geopolitical levels (region, state and municipality). In addition, we used conditional logistic regressions matched by health-care unit. All models were adjusted by individual covariates associated with the outcomes. RESULTS: Compared with non-Afro-Brazilian patients, Afro-Brazilian patients had significantly lower odds to have had HIV testing [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.69-0.75] and mycobacterial culture performed (OR: 0.74; 95% CI: 0.71-0.77). However, these statistically significant negative associations between Afro-Brazilian racial category and testing disappeared when patients were considered as nested in geopolitical contexts or matched for health-care unit. CONCLUSIONS: Afro-Brazilian TB patients had lower probability to have HIV test and mycobacterial culture performed. However, these associations seem to be macrodeterminated by the geographic distribution of both racial groups and diagnostic testing. Our findings can support the formulation of public policies aiming to mitigate regional disparities as a strategy to improve racial equity in access to healthcare. The approach presented can be applied in a range of scenarios to identify disparities, localize its source and support decision-making.

Risk of dengue virus infection according to serostatus in individuals from dengue endemic areas of Mexico.

The variability in the host immune response directed against dengue virus (DENV) has demonstrated the need to understand the immune response associated with protection in incident infection. The objective was to estimate the association between serostatus and the risk of incident DENV infection. We used a prospective study from 2014 to 2016 in the localities of Axochiapan and Tepalcingo, Morelos, Mexico. We recruited 966 participants, of which, according to their infection history registered were categorized in four groups. To accomplish the objectives of this study, we selected to 400 participants older than 5 years of age were followed for 2.5 years. Blood samples were taken every 6 months to measure serological status and infection by ELISA. In individuals with at least two previous infections the risk of new infection was lower compared to a seronegative group (hazard ratio adjusted 0.49, 95% CI 0.24-0.98), adjusted for age and locality. Therefore, individuals who have been exposed two times or more to a DENV infection have a lower risk of re-infection, thus showing the role of cross-immunity and its association with protection.

[Early indicators of dengue infection in children]. / Indicadores tempranos de infección por dengue en niños.

OBJECTIVE: To identify clinical manifestations and laboratory findings useful for the early diagnosis of dengue in children. MATERIALS AND METHODS: We prospectively evaluated 125 children (aged 5 to 12 years old) with acute febrile syndrome with no apparent etiology. Paired serologic tests and/or viral culture were performed and dengue infection was confirmed in 40 patients and ruled out in 68 (17 indefinite cases). Early clinical manifestations (within the first 4 days of the disease) in the groups with dengue and other causes of febrile syndrome were compared. Independent indicators of dengue were determined in a multivariate logistic regression analysis. RESULTS: When clinical manifestations and complete blood count were considered, the independent indicators of dengue were: absence of nasal discharge, facial flushing, and leukocyte count < or = 4,500/.l. With at least two of these findings, a sensitivity of 67 % and a specificity of 72 % for the diagnosis of dengue were obtained. When coagulation tests were considered, a model for diagnosis was composed of: absence of nasal discharge, leukocyte count < or = 4500/.l, prothrombin time > 14 seconds, and partial thromboplastin time > 29 seconds. Two of these findings suggested a diagnosis of dengue with a sensitivity of 90 % and a specificity of 52.9 %. With at least 3 findings, specificity increased to 89.7 % and sensitivity decreased to 50 %. The presence of the four components of this latter model shows a specificity of 100 %. CONCLUSIONS: Some clinical manifestations and simple laboratory tests could aid the early detection of dengue infection in children.

Value of routine postextubation chest X-ray on prognosis for neonates.

AIM: The postextubation chest X-ray (CXR) is frequently taken in neonates who have undergone mechanical ventilation (MV); however, this is not an evidence-based practice. The aim of this paper was to assess the utility of routine post-extubation CXR on the prognosis for neonates who have undergone MV. METHODS: This is a retrospective cohort study comparing two periods of time. During the first period, the routine postextubation CXR was performed in neonates; during the second period, postextubation CXR was performed only in infants with any sign of clinical deterioration. Patients were continuously followed up to identify complications such as need for reintubation, length of hospital stay, and death. RESULTS: Twenty-nine vs. 33 patients were compared in the first and second periods, respectively. Throughout follow-up one patient died (in the routine CXR period) and there were 17 reintubations: 8 in the routine CXR group and 9 in the selective CXR group (P=1). However, in a multivariate Cox model (adjusted for birth weight, nasal continuous positive airway pressure [CPAP], bronchopulmonary dysplasia and duration of MV), the routine CXR was associated with an acceleration of discharge after extubation (Hazard Ratio: 1.86, 95% CI: 1.02-3.38). On the other hand, birthweight, nasal-CPAP and duration of MV were strong predictors of hospital stay after extubation. CONCLUSION: Although it may help accelerate hospital discharge, the utility of routine CXR on prognosis is uncertain. Consequently, it is required to conduct studies of greater magnitude in order to assess the relevance of this procedure.

Sex differences in cardiac autonomic function of depressed young adults.

BACKGROUND: Cardiac autonomic dysfunction has been proposed as an important contributing factor to the increased cardiovascular risk observed in major depression (MDD). However, the evidence regarding alterations in heart rate variability (HRV) in otherwise healthy depressed subjects has been inconclusive. METHODS: A case-control study in 50 treatment-naïve young adults with a first MDD episode without comorbid psychiatric disorders and 50 healthy control subjects was conducted. Time- and frequency-domain indexes of HRV were determined at baseline supine and after 5-min of orthostatic stress at 60°. RESULTS: There were no significant differences in the time- or frequency-domain variables of HRV between depressed patients and controls. However, a random-effect ANOVA model showed that during orthostatic stress depressed men had a reduced HRV and decreased parasympathetic activity compared to control subjects, while no differences were found between depressed women and controls. CONCLUSION: These results suggest a sex-dependent relationship between major depression and cardiac autonomic dysfunction and provide one potential explanation for sex differences in the association of depressive symptoms with cardiovascular morbidity.

Early predictors of haemorrhage in acute febrile syndrome patients from Bucaramanga, Colombia: a dengue endemic area.

INTRODUCTION: Spontaneous haemorrhage is an important cause of hospitalisation in dengue patients. Early predictors of these complications could help to make opportune decisions. METHODS: We prospectively evaluated 51 febrile patients (without previous spontaneous haemorrhage), including 32 cases of dengue fever. Initial evaluation was performed during the first 96 hours after the onset of fever and included complete blood cell count and coagulation tests. Participants were followed-up daily until the seventh day of the disease. RESULTS: Overall, 15 patients developed spontaneous haemorrhage during the follow-up. Tourniquet test and dengue infection were not associated with haemorrhage (p-value is greater than 0.2). In a logistic regression analysis, platelet count (odds-ratio [OR] 0.78; 95 percent confidence interval [CI] 0.65-0.94) and partial thromboplastin time (OR 1.78; 95 percent CI 1.06-2.99) were independently associated with spontaneous haemorrhage. CONCLUSION: Early alterations in platelet count and coagulation test could predict spontaneous bleeding in the acute febrile syndrome.

Aplasia Cutis Congénita: tratamiento con hidrocoloides / Aplasia Cutis Congenita: treatment with hydrocoiloids

La Aplasia Cutis Congénita es un defecto caracterizado por la ausencia localizada de la piel en una o más áreas corporales. Las lesiones pequeñas cicatrizan espontáneamente, mientras que las lesiones de gran tamaño requerirán manejo médico y/o quirúrgico. El pronóstico está determinado por el tamaño, localización del defecto y malformaciones asociadas. Presentamos un recién nacido de sexo femenino con Aplasia Cutis Congénita aislada y su evolución posterior al tratamiento con hidrocoloides (AU)

Aplasia Cutis Congenita is a defect characterized by localized absence of skin in one or more body areas. Small lesions health spontaneously, whereas larger lesions require medical management and/or surgery. The prognosis depends on the size, location of the defect and associated malformations. We present a case of a female newborn with isolated Aplasia Cutis Congenita and its posterior evolution to management with hydrocolloids (AU)

Trastornos neurológicos en la convalecencia de un síndrome febril agudo / Neurological disorders in convalescence from an acute febrile syndrome

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