Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study.

INTRODUCTION: The HIV epidemic continues to disproportionately impact Latin-American transgender women (TGW). We assessed factors associated with long-term pre-exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. METHODS: HIV-negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow-up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long-term PrEP engagement (3+ follow-up visits in 52 weeks) and complete self-reported adherence (no missed pills in the past 30 days) during follow-up. For both outcomes, we constructed multivariable models controlling for country, socio-demographics, sexual behaviour, substance use, STIs and self-reported adherence at 4 weeks (long-term engagement outcome only). RESULTS: From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18-24 years, 67.8% were mixed-race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person-years (95% confidence interval [CI]: 0.76-4.38). Almost half of TGW (48.6%) had long-term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88-4.63]) and was inversely associated with reporting CAS with unknown-HIV partner (aOR:0.52 [95%CI:0.34-0.81]), migration (aOR:0.54 [95%CI:0.34-0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14-0.53]). Self-reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10-2.34]) compared to those aged 25-34 and those with >secondary education (aOR:1.55 [95%CI:1.10-2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21-0.41]) or reporting PrEP-related adverse effects (aOR:0.63 [95%CI:0.42-0.92]). CONCLUSIONS: Although TGW were willing to enrol in ImPrEP, long-term PrEP engagement and complete self-reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans-specific interventions supporting oral PrEP and exploring long-acting PrEP strategies for TGW.

Essential Oil Composition and DNA Barcode and Identification of Aniba species (Lauraceae) Growing in the Amazon Region.

Lauraceae species are widely represented in the Amazon, presenting a significant essential oil yield, large chemical variability, various biological applications, and high economic potential. Its taxonomic classification is difficult due to the accentuated morphological uniformity, even among taxa from a different genus. For this reason, the present work aimed to find chemical and molecular markers to discriminate Aniba species collected in the Pará State (Brazil). The chemical composition of the essential oils from Aniba canelilla, A. parviflora, A. rosaeodora, and A. terminalis were grouped by multivariate statistical analysis. The major compounds were rich in benzenoids and terpenoids such as 1-nitro-2-phenylethane (88.34-70.85%), linalool (15.2-75.3%), α-phellandrene (36.0-51.8%), and ß-phellandrene (11.6-25.6%). DNA barcodes were developed using the internal transcribed spacer (ITS) nuclear region, and the matK, psbA-trnH, rbcL, and ycf1 plastid regions. The markers psbA-trnH and ITS showed the best discrimination for the species, and the phylogenic analysis in the three- (rbcL + matK + trnH - psbA and rbcL + matK + ITS) and four-locus (rbcL + matK + trnH - psbA + ITS) combination formed clades with groups strongly supported by the Bayesian inference (BI) (PP:1.00) and maximum likelihood (ML) (BS ≥ 97%). Therefore, based on statistical multivariate and phylogenetic analysis, the results showed a significant correlation between volatile chemical classes and genetic characteristics of Aniba species.

Influence on Secondary Metabolism of Piper nigrum L. by Co-Inoculation with Arbuscular Mycorrhizal Fungi and Fusarium solani f. sp. piperis.

To elucidate defense mechanisms of Piper nigrum against fusariosis, an experiment based on co-inoculation of arbuscular mycorrhizal fungi (AMF) and Fusarium solani f. sp. piperis was performed. Variations in secondary metabolism in plants infected with F. solani f. sp. piperis (FUS) and co-inoculated with AMFs and F. solani (AMF + FUS) were monitored at 7- and 21-days post inoculations (dpi). The pathogen induced a decrease in oxygenated sesquiterpenes (82.0-77.4%), and changes in the concentrations of the main compounds, α-muurolene, α-muurolol, and 2E-hexenal in the leaves. It was observed that the concentration of 2E-hexenal decreased at 7 dpi, α-muurolene decreased at 21 dpi, and α-muurolol increased at 21 dpi. There was a prevalence of sesquiterpene and monoterpene hydrocarbons in the roots, such as ß-caryophyllene, δ-elemene, and limonene. The infection and co-inoculation induced greater production of phenolics in the roots at 7 dpi. The enzymatic activity of phenylalanine ammonia-lyase decreased in the leaves at 21 dpi and in the roots on both days, while the lipoxygenase activity decreased only in the roots at 21 dpi. The results demonstrated that co-inoculation with AMFs and F. solani induces changes in the defense metabolism of P. nigrum, but it is not efficient in the biocontrol of fusariosis during the evaluated period.

Secondary Metabolic Profile as a Tool for Distinction and Characterization of Cultivars of Black Pepper (Piper nigrum L.) Cultivated in Pará State, Brazil.

This study evaluated the chemical compositions of the leaves and fruits of eight black pepper cultivars cultivated in Pará State (Amazon, Brazil). Hydrodistillation and gas chromatography-mass spectrometry were employed to extract and analyze the volatile compounds, respectively. Sesquiterpene hydrocarbons were predominant (58.5-90.9%) in the cultivars "Cingapura", "Equador", "Guajarina", "Iaçará", and "Kottanadan", and "Bragantina", "Clonada", and "Uthirankota" displayed oxygenated sesquiterpenoids (50.6-75.0%). The multivariate statistical analysis applied using volatile composition grouped the samples into four groups: γ-Elemene, curzerene, and δ-elemene ("Equador"/"Guajarina", I); δ-elemene ("Iaçará"/"Kottanadan"/"Cingapura", II); elemol ("Clonada"/"Uthirankota", III) and α-muurolol, bicyclogermacrene, and cubebol ("Bragantina", IV). The major compounds in all fruit samples were monoterpene hydrocarbons such as α-pinene, ß-pinene, and limonene. Among the cultivar leaves, phenolics content (44.75-140.53 mg GAE·g-1 FW), the enzymatic activity of phenylalanine-ammonia lyase (20.19-57.22 µU·mL-1), and carotenoids (0.21-2.31 µg·mL-1) displayed significant variations. Due to black pepper's susceptibility to Fusarium infection, a molecular docking analysis was carried out on Fusarium protein targets using each cultivar's volatile components. F. oxysporum endoglucanase was identified as the preferential protein target of the compounds. These results can be used to identify chemical markers related to the susceptibility degree of black pepper cultivars to plant diseases prevalent in Pará State.

Reduced-dose intensity therapy for pediatric lymphoblastic leukemia: long-term results of the Recife RELLA05 pilot study.

Treatment-related mortality is common among children with acute lymphoblastic leukemia (ALL) treated in poor-resource settings. We applied a simplified flow cytometric assay to identify patients with precursor B-cell ALL (B-ALL) at very low risk (VLR) of relapse and treated them with a reduced-intensity treatment plan (RELLA05). VLR criteria include favorable presenting features (age ≥ 1 and < 10 years), white blood cell count of <50 ×109/L, lack of extramedullary leukemia, and minimal residual disease level of <0.01% on remission induction day 19. Except for 2 doses of daunorubicin, treatment of patients with VLR B-ALL consisted of a combination of agents with relatively low myelotoxicity profiles, including corticosteroids, vincristine, L-asparaginase, methotrexate, and 6-mercaptopurine. Cyclophosphamide, systemic cytarabine, and central nervous system radiotherapy were not used. Of 454 patients with ALL treated at the Instituto de Medicina Integral Professor Fernando Figueira in Recife, Brazil, between December 2005 and June 2015, 101 were classified as having VLR B-ALL. There were no cases of death resulting from toxicity or treatment abandonment during remission induction. At a median follow-up of 6.6 years, there were 8 major adverse events: 6 relapses, 1 treatment-related death (from septicemia) during remission, and 1 secondary myeloid leukemia. The estimated 5-year event-free and overall survival rates were 92.0% ± 3.9% and 96.0% ± 2.8%, respectively. The 5-year cumulative risk of relapse was 4.24% ± 2.0%. The treatment was well tolerated. Episodes of neutropenia were of short duration. Patients with B-ALL selected by a combination of presenting features and degree of early response can be successfully treated with a mildly myelosuppressive chemotherapy regimen.

Arbuscular Mycorrhizal Fungi Colonization Promotes Changes in the Volatile Compounds and Enzymatic Activity of Lipoxygenase and Phenylalanine Ammonia Lyase in Piper nigrum L. 'Bragantina'.

Arbuscular mycorrhizal fungi (AMF) have been used to promote numerous benefits to plants. In this study, we evaluated the symbiosis between AMF species (Rhizophagus clarus, Claroideoglomus etunicatum) and Piper nigrum L. 'Bragantina'. Volatile compounds, lipoxygenase (LOX) and phenylalanine ammonia-lyase (PAL) activities, and total phenolic content were monitored from 1 to 60 days post-inoculation (dpi). Hyphae, arbuscles, and vesicles were observed during the root colonization. In the leaves, AMF induced an increase of sesquiterpene hydrocarbons (54.0%-79.0%) and a decrease of oxygenated sesquiterpenes (41.3%-14.5%) at 7 dpi and 60 dpi (41.8%-21.5%), respectively. Cubenol, the main volatile compound of leaves, showed a significant decrease at 7 dpi (21.5%-0.28%) and 45 dpi (20.4%-18.42%). ß-caryophyllene, the major volatile compound of the roots, displayed a significant reduction at 45 dpi (30.0%-20.0%). LOX increased in the roots at 21, 30, and 60 dpi. PAL was higher in leaves during all periods, except at 60 dpi, and increased at 21 and 45 dpi in the roots. The total phenolic content showed a significant increase only in the roots at 30 dpi. The results suggested that AMF provided changes in the secondary metabolism of P. nigrum, inducing its resistance.

Effects of inoculation by arbuscular mycorrhizal fungi on the composition of the essential oil, plant growth, and lipoxygenase activity of Piper aduncum L.

The aim of this study was to evaluate the changes in the production of secondary metabolites Piper aduncum seedlings were inoculated by spores of the arbuscular mycorrhizal fungi (AMF) Rhizophagus clarus and Claroideoglomus etunicatum. P. aduncum seedlings were inoculated by spores of R. clarus and C. etunicatum and then, development parameters, root colonization, lipoxygenase (LOX) activity, and essential oil (OE) chemical composition were monitored at 30, 60 and 90 days' post-inoculation (dpi). The inoculation had influenced the plant height and root length at 30 and 90 dpi and microscopic analysis of roots showed the presence of hyphae, arbuscules and vesicles in the inoculated plants. Phenylpropanoids and sesquiterpene hydrocarbons were the main compounds in the EO. In the leaves, the concentration of phenylpropanoids showed a decrease, mainly at 60 dpi, with increased sesquiterpene hydrocarbon production. The main compounds were dillapiole, myristicin, and germacrene D; the dillapiole concentration decreased in all treatments. LOX activity had an increase in the leaves and roots at 90 dpi. These results suggest that alterations in the secondary metabolites of P. aduncum can be induced by its mechanisms of resistance during AMF interaction.

Cytokines and soluble HLA-G levels in bone marrow stroma and their association with the survival rate of patients exhibiting childhood T-cell acute lymphoblastic leukemia.

Leukemic cells can induce defective expression of soluble factors and change marrow cytokine profile, leading to aberrant cell signaling, cell fixation and cell proliferation in bone marrow. T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive disorder which accounts for 15% of pediatric ALL. To evaluate the contribution of immunological factors on T-ALL survival, we measured Th1, Th2, Th17 cytokines and soluble HLA-G (sHLA-G) levels in bone marrow from 32 Brazilian children at diagnosis (D0), after induction (D19) and after consolidation (D49) of the chemotherapy phase. Data were analyzed using non-parametric tests, and survival rates were evaluated by Kaplan-Meier method (log-rank test). TNF, IL-10 and IL-6 levels were increased at diagnosis compared to D19 and D49. IL-10 levels<4.57pg/mL at diagnosis were associated with increased survival rate, in presence of positive correlation between IL-2 and IL-17 levels. Increased survival rate was also associated with IFN-γ levels<1.17pg/mL at D49, with a positive correlation observed between IL-4 and IL-2 as well IL-4 and IL-17 levels. In contrast, worse survival rate was associated with IL-2, IL-4 and IL-10 levels imbalance. In addition, increased sHLA-G levels at diagnosis were associated with increased leukocyte count, a well-known factor for poor prognosis. In conclusion, cytokines and sHLA-G play an essential role in marrow T-ALL microenvironment during chemotherapy, especially the immunosuppressive cytokine IL-10 which can be used as biomarker of disease outcome, being also a potential target for novel T-ALL treatments.

Secondary Metabolic Profiles of Two Cultivars of Piper nigrum (Black Pepper) Resulting from Infection by Fusarium solani f. sp. piperis.

Bragantina and Cingapura are the main black pepper (Piper nigrum L.) cultivars and the Pará state is the largest producer in Brazil with about 90% of national production, representing the third largest production in the world. The infection of Fusarium solani f. sp. piperis, the causal agent of Fusarium disease in black pepper, was monitored on the cultivars Bragantina (susceptible) and Cingapura (tolerant), during 45 days' post infection (dpi). Gas Chromatography-Mass spectrometry (GC-MS) analysis of the volatile concentrates of both cultivars showed that the Bragantina responded with the production of higher contents of α-bisabolol at 21 dpi and a decrease of elemol, mostly at 30 dpi; while Cingapura displayed an decrease of δ-elemene production, except at 15 dpi. The phenolic content determined by the Folin Ciocalteu method showed an increase in the leaves of plants inoculated at 7 dpi (Bragantina) and 7-15 dpi (Cingapura); in the roots, the infection caused a phenolic content decrease in Bragantina cultivar at 45 dpi and an increase in the Cingapura cultivar at 15, 30 and 45 dpi. High Performance Liquid Chromatography-Mass spectrometry (HPLC-MS) analysis of the root extracts showed a qualitative variation of alkamides during infection. The results indicated that there is a possible relationship between secondary metabolites and tolerance against phytopathogens.

Celiac Disease and Cystic Fibrosis: Challenges to Differential Diagnosis.

Cystic fibrosis and celiac disease were considered a single clinical entity for many years. Differentiation between the diseases occurred some time in the 1930s of the 20th Century. Both diseases may present the intestinal malabsorption syndrome and similar clinical manifestations that contribute to difficulties with clinical distinction. We describe a report of two patients with initial diagnosis of cystic fibrosis, who were subsequently diagnosed with celiac disease. These case reports emphasize the possibility of false positivity being shown in the sweat test in CD, which may result in delayed diagnosis and inadequate management of this disease.

Antimicrobial properties of two novel peptides derived from Theobroma cacao osmotin.

The osmotin proteins of several plants display antifungal activity, which can play an important role in plant defense against diseases. Thus, this protein can be useful as a source for biotechnological strategies aiming to combat fungal diseases. In this work, we analyzed the antifungal activity of a cacao osmotin-like protein (TcOsm1) and of two osmotin-derived synthetic peptides with antimicrobial features, differing by five amino acids residues at the N-terminus. Antimicrobial tests showed that TcOsm1 expressed in Escherichia coli inhibits the growth of Moniliophthora perniciosa mycelium and Pichia pastoris X-33 in vitro. The TcOsm1-derived peptides, named Osm-pepA (H-RRLDRGGVWNLNVNPGTTGARVWARTK-NH2), located at R23-K49, and Osm-pepB (H-GGVWNLNVNPGTTGARVWARTK-NH2), located at G28-K49, inhibited growth of yeasts (Saccharomyces cerevisiae S288C and Pichia pastoris X-33) and spore germination of the phytopathogenic fungi Fusarium f. sp. glycines and Colletotrichum gossypi. Osm-pepA was more efficient than Osm-pepB for S. cerevisiae (MIC=40µM and MIC=127µM, respectively), as well as for P. pastoris (MIC=20µM and MIC=127µM, respectively). Furthermore, the peptides presented a biphasic performance, promoting S. cerevisiae growth in doses around 5µM and inhibiting it at higher doses. The structural model for these peptides showed that the five amino acids residues, RRLDR at Osm-pepA N-terminus, significantly affect the tertiary structure, indicating that this structure is important for the peptide antimicrobial potency. This is the first report of development of antimicrobial peptides from T. cacao. Taken together, the results indicate that the cacao osmotin and its derived peptides, herein studied, are good candidates for developing biotechnological tools aiming to control phytopathogenic fungi.

Antifungal activity and computational study of constituents from Piper divaricatum essential oil against Fusarium infection in black pepper.

Fusarium disease causes considerable losses in the cultivation of Piper nigrum, the black pepper used in the culinary world. Brazil was the largest producer of black pepper, but in recent years has lost this hegemony, with a significant reduction in its production, due to the ravages produced by the Fusarium solani f. sp. piperis, the fungus which causes this disease. Scientific research seeks new alternatives for the control and the existence of other Piper species in the Brazilian Amazon, resistant to disease, are being considered in this context. The main constituents of the oil of Piper divaricatum are methyleugenol (75.0%) and eugenol (10.0%). The oil and these two main constituents were tested individually at concentrations of 0.25 to 2.5 mg/mL against F. solani f. sp. piperis, exhibiting strong antifungal index, from 18.0% to 100.0%. The 3D structure of the ß-glucosidase from Fusarium solani f. sp. piperis, obtained by homology modeling, was used for molecular docking and molecular electrostatic potential calculations in order to determine the binding energy of the natural substrates glucose, methyleugenol and eugenol. The results showed that ß-glucosidase (Asp45, Arg113, Lys146, Tyr193, Asp225, Trp226 and Leu99) residues play an important role in the interactions that occur between the protein-substrate and the engenol and methyleugenol inhibitors, justifying the antifungal action of these two phenylpropenes against Fusarium solani f. sp. piperis.

Homocysteine: cardiovascular risk factor in children and adolescents? / Homocisteína: fator de risco cardiovascular em crianças e adolescentes?

The aim of this study was to identify publications in literature that investigated Homocysteine (He) as a risk factor for CVD among children and adolescents. An active search for information in LILACS, IBECS, Science Direct, Medline and Cochrane Library databases was conducted using the following combination of keywords "homocysteine", "cardiovascular diseases", "child" and "adolescent". Fifteen articles were analyzed showing direct relationship with increasing age (8 studies) and male gender (10 studies), and an inverse relationship with serum vitamins B6, B12 and folate levels. Thus, the results suggest that more research must be carried through in order to determine in a more coherent way the causes of the hiperhomocisteinemia in the pediatric population, guiding for an adequate diet, rich in nutrients necessary to favor the metabolism of the He.

O objetivo do estudo foi identificar na literatura publicações que investigaram a Homocisteína (He) como um fator de risco para doenças cardiovasculares na faixa etária de crianças e adolescentes. Realizou-se uma busca ativa de informações nas bases de dados LILACS e IBECS, Science Direct, Medline e Biblioteca Cochrane, utilizando-se a combinação dos descritores "homocysteine", "cardiovascular diseases", "child" e "adolescent". Foram analisados 15 artigos, os quais apontaram relação direta dos níveis de He com o sexo masculino (10 estudos) e com o aumento da idade (8 estudos), e uma relação inversa com os níveis séricos das vitaminas B6, B12 e folatos (10 estudos). Sugere-se que sejam realizadas mais pesquisas a fim de determinar de maneira mais coerente as causas da hiperhomocisteinemia na população pediátrica, orientando para uma dieta adequada e rica em nutrientes necessários para favorecer o metabolismo da He.

Homocysteine: cardiovascular risk factor in children and adolescents?

The aim of this study was to identify publications in literature that investigated Homocysteine (He) as a risk factor for CVD among children and adolescents. An active search for information in LILACS, IBECS, Science Direct, Medline and Cochrane Library databases was conducted using the following combination of keywords "homocysteine", "cardiovascular diseases", "child" and "adolescent". Fifteen articles were analyzed showing direct relationship with increasing age (8 studies) and male gender (10 studies), and an inverse relationship with serum vitamins B6, B12 and folate levels. Thus, the results suggest that more research must be carried through in order to determine in a more coherent way the causes of the hiperhomocisteinemia in the pediatric population, guiding for an adequate diet, rich in nutrients necessary to favor the metabolism of the He.

C-reactive protein and its relation to high blood pressure in overweight or obese children and adolescents.

OBJECTIVE To investigate the association between C-reactive protein (CRP) and high blood pressure (BP) in overweight or obese children and adolescents. METHODS Cross-sectional study with 184 overweight or obese children and adolescents aged from two to 18 years old, from April, 2009 to April, 2010. The classification of nutritional status used the body mass index (BMI). Based on the Centers for Disease Control and Prevention curve, individuals were classified as: overweight (BMI between the 85th-95th percentiles), obesity (BMI between 95th-97th percentiles) and severe obesity (BMI >97th percentile). Abnormal values were considered for systolic BP (SBP) and/or diastolic (DBP) if ≥ 90th percentile of the BP curve recommended for children and adolescents in the V Brazilian Guidelines on Hypertension, for waist circumference (WC) if ≥ 90th percentile of the curve established by the National Cholesterol Education Program, and for high sensitive CRP (hs-CRP) if >3mg/dL. To evaluate the association of inadequate values of CRP and the studied groups, chi-square test and analysis of variance were applied, using the Statistical Package for the Social Sciences version 17.0 and adopting a significance level of 5%. RESULTS Among the evaluated sample, 66.3% were female, 63.5%, non-white, 64.1% had severe obesity, 78.3% had altered WC and 70.6% presented high BP. There was a significant association of CRP high levels with altered WC and BMI ≥ 97 th percentile. In adolescents, high CRP was related to high SBP. CRP mean values were higher in individuals with elevated SBP. CONCLUSIONS Inadequate values of hs-CRP were associated with severe obesity and high SBP in the studied population. These markers can be used to identify children and adolescents at higher risk for developing atherosclerosis.

C-reactive protein and its relation to high blood pressure in overweight or obese children and adolescents / Proteina C-reactiva y su relacion con la presion arterial elevada en ninos y adolescentes con sobrepeso u obesidad / Proteina C-reativa e sua relacao com pressao arterial elevada em criancas e adolescentes com sobrepeso ou obesidade

OBJECTIVE To investigate the association between C-reactive protein (CRP) and high blood pressure (BP) in overweight or obese children and adolescents. METHODS Cross-sectional study with 184 overweight or obese children and adolescents aged from two to 18 years old, from April, 2009 to April, 2010. The classification of nutritional status used the body mass index (BMI). Based on the Centers for Disease Control and Prevention curve, individuals were classified as: overweight (BMI between the 85th-95th percentiles), obesity (BMI between 95th-97th percentiles) and severe obesity (BMI >97th percentile). Abnormal values were considered for systolic BP (SBP) and/or diastolic (DBP) if ≥90th percentile of the BP curve recommended for children and adolescents in the V Brazilian Guidelines on Hypertension, for waist circumference (WC) if ≥90th percentile of the curve established by the National Cholesterol Education Program, and for high sensitive CRP (hs-CRP) if >3mg/dL. To evaluate the association of inadequate values of CRP and the studied groups, chi-square test and analysis of variance were applied, using the Statistical Package for the Social Sciences version 17.0 and adopting a significance level of 5%. RESULTS Among the evaluated sample, 66.3% were female, 63.5%, non-white, 64.1% had severe obesity, 78.3% had altered WC and 70.6% presented high BP. There was a significant association of CRP high levels with altered WC and BMI ≥97th percentile. In adolescents, high CRP was related to high SBP. CRP mean values were higher in individuals with elevated SBP. CONCLUSIONS Inadequate values of hs-CRP were associated with severe obesity and high SBP in the studied population. These markers can be used to identify children and adolescents at higher risk for developing atherosclerosis. .

OBJETIVO Verificar la asociación entre proteína C-reactiva (PCR) y presión arterial (PA) elevada en niños y adolescentes con sobrepeso u obesidad. MÉTODOS Estudio transversal, realizado de abril de 2009 a abril de 2010, con 184 niños y adolescentes de 2 a 18 años, obesos o con sobrepeso, atendidos en el Centro de Obesidad Infantil. Se realizó la clasificación del estado nutricional por medio del índice de masa corporal (IMC). Se adoptó la curva del Centers for Disease Control and Prevention, clasificándose a los individuos en: sobrepeso (IMC entre percentil 85-95), obesidad (IMC entre percentil 95-97) y obesidad grave (IMC >percentil 97). Se consideraron alterados los valores de PA sistólica (PAS) y/o diastólica (PAD) ≥percentil 90 - conforme curva de clasificación de la PA para niños y adolescentes recomendada en las V Directrices Brasileñas de Hipertensión Arterial, circunferencia abdominal (CA) ≥percentil 90 - conforme a la curva establecida por el National Cholesterol Education Program, y PCR ultrasensible (PCR-us) >3mg/dL. Para evaluar la asociación de valores inadecuados de PCR entre los grupos, se utilizaron la prueba del chi-cuadrado y análisis de variancia. Los análisis fueron realizados en la versión 17.0 del programa Statistical Package for the Social Sciences, adoptándose nivel de significancia de 5%. RESULTADOS De los evaluados, el 66,3% eran del sexo femenino, el 63,5% no blancos, el 64,1% tenían obesidad grave, el 78,3% presentaban CA alterada y el 70,6%, PA elevada. Se verificó la asociación significante de los niveles aumentados de PCR con CA alterada e IMC ≥percentil 97. En los adolescentes, la PCR aumentada se asoció a la PAS elevada. Los valores medianos de la PCR fueron superiores en los individuos que presentaron PAS elevada. CONCLUSIONES Valores ...

OBJETIVO Verificar a associação entre proteína C-reativa (PCR) e pressão arterial (PA) elevada em crianças e adolescentes com sobrepeso ou obesidade. MÉTODOS Estudo transversal, realizado de abril de 2009 a abril de 2010, com 184 crianças e adolescentes de dois a 18 anos, obesos ou com sobrepeso. Realizou-se a classificação do estado nutricional por meio do índice da massa corpórea (IMC). Adotou-se a curva do Centers for Disease Control and Prevention, classificando-se os indivíduos em: sobrepeso (IMC entre percentil 85-95), obesidade (IMC entre percentil 95-97) e obesidade grave (IMC>percentil 97). Consideraram-se alterados valores de: PA sistólica (PAS) e/ou diastótica (PAD) ≥percentil 90, conforme curva de classificação da PA para crianças e adolescentes nas V Diretrizes Brasileiras de Hipertensão Arterial; circunferência abdominal (CA) ≥percentil 90 de acordo com a curva do National Cholesterol Education Program; e PCR ultrassensível (PCR-us) >3mg/dL. Para avaliar a associação de valores inadequados de PCR entre os grupos, utilizaram-se o teste do qui-quadrado e a análise de variância. As análises foram realizadas na versão 17.0 do programa Statistical Package for the Social Sciences, adotando-se nível de significância de 5%. RESULTADOS Dos avaliados, 66,3% eram do sexo feminino, 63,5%, não brancos, 64,1% tinham obesidade grave, 78,3% apresentavam CA alterada e 70,6%, PA elevada. Verificou-se associação significante dos níveis aumentados de PCR com CA alterada e IMC ≥percentil 97. Nos adolescentes, a PCR aumentada associou-se à PAS elevada. Os valores médios da PCR foram superiores nos indivíduos que apresentaram PAS elevada. CONCLUSÕES Valores inadequados da PCR-us associaram-se à obesidade grave e à PAS elevada ...

Pressão arterial elevada em crianças e adolescentes com excesso de peso / High blood pressure in overweight children and adolescents

OBJETIVO: verificar a prevalência de pressão arterial elevada em crianças e adolescentes obesos ou com sobrepeso, bem como os fatores associados. MÉTODO: estudo transversal com 200 crianças e adolescentes, entre dois e 18 anos. Foram aferidos circunferência abdominal, pressão arterial, peso e estatura. Tanto a pressão arterial sistólica quanto a diastólica foram consideradas elevadas quando iguais ou superiores ao percentil 90. O valor da pressão arterial nos percentis 25, 50 e 75 foi descrito de acordo com faixa etária, sexo, estado nutricional e circunferência abdominal. Para avaliar a associação da pressão arterial elevada com as variáveis clínicas foi utilizado o teste do qui-quadrado e adotado nível de significância de 5 por cento. RESULTADOS: a maioria das crianças e adolescentes (70,5 por cento) apresentava pressão arterial elevada: 6 por cento mostravam elevação apenas na pressão arterial sistólica, 33 por cento na diastólica e 31,5 por cento em ambas. Valores pressóricos sistólicos mais elevados foram observados nos indivíduos com obesidade grave e circunferência abdominal aumentada, assim como naqueles do sexo masculino e no grupo dos adolescentes. Entre os que tinham pressão arterial elevada, o limite máximo da normalidade da pressão sistólica foi observado no percentil 50 e, da diastólica, no 75. A pressão arterial sistólica elevada esteve associada aos adolescentes com obesidade grave. CONCLUSÃO: a alta prevalência de pressão arterial elevada observada neste estudo mostra a necessidade da implantação de políticas e ações voltadas à prevenção e controle da obesidade e suas co-morbidades, a exemplo da hipertensão arterial sistêmica.

High blood pressure in overweight children and adolescents / Pressão arterial elevada em crianças e adolescentes com excesso de peso

OBJECTIVE: to evaluate the prevalence of high blood pressure in fat or overweight children and adolescents and its associated factors. METHODS: Cross-sectional study including 200 children and adolescents between two and 18 years old. It was measured the abdominal circumference, blood pressure, weight and height. The systolic and diastolic blood pressure were considered high when equal or higher than 90th percentile. The value of the blood pressure in the 25th, 50th and 75th percentiles were described according to age groups, sex, nutritional state and abdominal circumference. To check the association between high blood pressure and clinical variables it was used qui-square tests and a significant level of 5 percent. RESULTS: The majority of children and adolescents (70.5 percent) had high blood pressure: 6 percent showed an increase only in the systolic blood pressure, 33 percent in diastolic blood pressure and 31.5 percent in both. Systolic blood pressure values were higher observed in individuals with severe obesity and increased waist circumference, as well as those of the male sex and in the group of adolescents. Among those who had high blood pressure, the normal maximum limit of the systolic blood pressure was observed in the 50th percentile and for the diastolic in the 75th percentile. The high systolic blood pressure was associated with adolescents with severe obesity. CONCLUSION: The high prevalence of high blood pressure observed in this study indicates the need to implement policies and actions oriented towards the prevention and control of obesity and its co-morbidities, as the case of high blood pressure.(AU)

OBJETIVO: verificar a prevalência de pressão arterial elevada em crianças e adolescentes obesos ou com sobrepeso, bem como os fatores associados. MÉTODO: estudo transversal com 200 crianças e adolescentes, entre dois e 18 anos. Foram aferidos circunferência abdominal, pressão arterial, peso e estatura. Tanto a pressão arterial sistólica quanto a diastólica foram consideradas elevadas quando iguais ou superiores ao percentil 90. O valor da pressão arterial nos percentis 25, 50 e 75 foi descrito de acordo com faixa etária, sexo, estado nutricional e circunferência abdominal. Para avaliar a associação da pressão arterial elevada com as variáveis clínicas foi utilizado o teste do qui-quadrado e adotado nível de significância de 5 por cento. RESULTADOS: a maioria das crianças e adolescentes (70,5 por cento) apresentava pressão arterial elevada: 6 por cento mostravam elevação apenas na pressão arterial sistólica, 33 por cento na diastólica e 31,5 por cento em ambas. Valores pressóricos sistólicos mais elevados foram observados nos indivíduos com obesidade grave e circunferência abdominal aumentada, assim como naqueles do sexo masculino e no grupo dos adolescentes. Entre os que tinham pressão arterial elevada, o limite máximo da normalidade da pressão sistólica foi observado no percentil 50 e, da diastólica, no 75. A pressão arterial sistólica elevada esteve associada aos adolescentes com obesidade grave. CONCLUSÃO: a alta prevalência de pressão arterial elevada observada neste estudo mostra a necessidade da implantação de políticas e ações voltadas à prevenção e controle da obesidade e suas co-morbidades, a exemplo da hipertensão arterial sistêmica.(AU)

Resistência insulínica e sua relação com os componentes da síndrome metabólica / Insulin resistance and its association with metabolic syndrome components

FUNDAMENTO: Os portadores de resistência à insulina apresentam maior predisposição para desenvolver posteriormente Síndrome Metabólica (SM), Diabetes Mellitus tipo 2 e Doença Cardiovascular (DCV). OBJETIVO: Avaliar a associação entre resistência insulínica (RI) e os componentes da síndrome metabólica. MÉTODOS: Estudo transversal envolvendo 196 indivíduos entre 2 e 18 anos, usuários do sistema único de saúde. A associação da RI com os componentes da SM foi avaliada pelo teste do qui-quadrado, adotando-se o valor do índice da homeostase glicêmica (HOMA-RI) > 2,5, e pelo teste de variância (ANOVA) e Tukey, por meio da comparação das médias dos componentes nos quartis do HOMA-RI. A análise estatística foi realizada através do SPSS 17.0, com a adoção do nível de significância de 5 por cento. RESULTADOS: RI foi observada em 41,3 por cento da população estudada e esteve associada à faixa etária entre 10-18 anos (p = 0,002 RP = 3,2), à SM em ambos os sexos [Masculino (p = 0,022 RP = 3,7) e Feminino (p = 0,007 RP = 2,7)] e ao triglicerídeo alterado (p = 0,005 RP = 2,9) no sexo feminino. Os valores médios dos componentes da SM diferiram significativamente entre os quartis do HOMA-RI (p < 0,01), com exceção do HDL-colesterol. CONCLUSÃO: A resistência insulínica pode ser considerada um marcador de risco cardiovascular.

BACKGROUND: Individuals with insulin resistance are more prone to the development of metabolic syndrome (MS), Type 2 Diabetes Mellitus and Cardiovascular Disease (CVD) OBJECTIVE: To evaluate the association between insulin resistance (IR) and metabolic syndrome components. METHODS: Cross-sectional study of 196 individuals between 2 and 18 years, treated at the Brazilian Public Healthcare system. The association of IR with the MS components was evaluated by Chi-square test, adopting the Homeostasis model assessment-insulin resistance (HOMA-IR) value > 2.5, and by analysis of variance (ANOVA) and Tukey's test, by comparing the means of the components in the HOMA-IR quartiles. Statistical analysis was performed using SPSS 17.0 software and significance level was set at 5 percent. RESULTS: IR was observed in 41.3 percent of the studied population and was associated with age between 10-18 years (p = 0.002 PR = 3.2), to MS in both sexes [Male (p = 0.022 PR = 3.7) and female (p = 0.007 PR = 2.7)] and altered triglycerides (p = 0.005 PR = 2.9) in females. The mean values of the MS components differed significantly between HOMA-IR quartiles (p <0.01), except for HDL-cholesterol. CONCLUSION: Insulin resistance can be considered a marker of cardiovascular risk.