Vitamin D status and risk of incident tuberculosis disease: A nested case-control study, systematic review, and individual-participant data meta-analysis.

BACKGROUND: Few studies have evaluated the association between preexisting vitamin D deficiency and incident tuberculosis (TB). We assessed the impact of baseline vitamins D levels on TB disease risk. METHODS AND FINDINGS: We assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6,751 HIV-negative household contacts of TB patients enrolled between September 1, 2009, and August 29, 2012, in Lima, Peru. We screened for TB disease at 2, 6, and 12 months after enrollment. We defined cases as household contacts who developed TB disease at least 15 days after enrollment of the index patient. For each case, we randomly selected four controls from among contacts who did not develop TB disease, matching on gender and year of age. We also conducted a one-stage individual-participant data (IPD) meta-analysis searching PubMed and Embase to identify prospective studies of vitamin D and TB disease until June 8, 2019. We included studies that assessed vitamin D before TB diagnosis. In the primary analysis, we defined vitamin D deficiency as 25-(OH)D < 50 nmol/L, insufficiency as 50-75 nmol/L, and sufficiency as >75nmol/L. We estimated the association between baseline vitamin D status and incident TB using conditional logistic regression in the Lima cohort and generalized linear mixed models in the meta-analysis. We further defined severe vitamin D deficiency as 25-(OH)D < 25 nmol/L and performed stratified analyses by HIV status in the IPD meta-analysis. In the Lima cohort, we analyzed 180 cases and 709 matched controls. The adjusted odds ratio (aOR) for TB risk among participants with baseline vitamin D deficiency compared to sufficient vitamin D was 1.63 (95% CI 0.75-3.52; p = 0.22). We included seven published studies in the meta-analysis and analyzed 3,544 participants. In the pooled analysis, the aOR was 1.48 (95% CI 1.04-2.10; p = 0.03). The aOR for severe vitamin D deficiency was 2.05 (95% CI 0.87-4.87; p trend for decreasing 25-(OH)D levels from sufficient vitamin D to severe deficiency = 0.02). Among 1,576 HIV-positive patients, vitamin D deficiency conferred a 2-fold (aOR 2.18, 95% CI 1.22-3.90; p = 0.01) increased risk of TB, and the aOR for severe vitamin D deficiency compared to sufficient vitamin D was 4.28 (95% CI 0.85-21.45; p = 0.08). Our Lima cohort study is limited by the short duration of follow-up, and the IPD meta-analysis is limited by the number of possible confounding covariates available across all studies. CONCLUSION: Our findings suggest vitamin D predicts TB disease risk in a dose-dependent manner and that the risk of TB disease is highest among HIV-positive individuals with severe vitamin D deficiency. Randomized control trials are needed to evaluate the possible role of vitamin D supplementation on reducing TB disease risk.

Percepción de riesgo respecto al consumo de tabaco en jóvenes universitarios cubanos / Risk perception about tobacco consumption in Cuban university students

Introducción: el consumo de tabaco constituye un serio problema de salud a nivel mundial y en Cuba, especialmente en la población joven. La percepción de riesgo ha sido identificada como una importante variable que influye en el inicio y mantenimiento del consumo de tabaco en esta etapa. Objetivo: explorar las características de la percepción de riesgo respecto al consumo de tabaco en jóvenes universitarios cubanos. Métodos: investigación con enfoque cuantitativo, diseño descriptivo ex post facto. La muestra quedó conformada por 1 377 estudiantes universitarios. Se aplicó un cuestionario para explorar la percepción de riesgo respecto al consumo de tabaco. Se utilizó el análisis descriptivo univariante, el análisis de conglomerados en dos etapas, el análisis categórico de componentes principales y los árboles de decisión. Resultados: se identificaron niveles adecuados de información sobre las consecuencias de este comportamiento de riesgo. Las variaciones más altas fueron en la dimensión conductual-motivacional y fue el mejor predictor en el proceso de agrupación de acuerdo a los niveles de percepción de riesgo. Hay más mujeres que hombres en el grupo con los mejores resultados. Conclusiones: los resultados permitieron una compresión multidimensional de la percepción del riesgo en estudiantes universitarios cubanos(AU)

Introduction: Tobacco consumption is a serious problem in a worldwide and in Cuba, especially in young people. Risk perception has been identified as an important variable that influences the initiation and maintenance of tobacco consumption in this stage. Objetive: To explore the characteristics of risk perception of the tobacco consumption in Cuban university students. Methods: The research was conceived from a quantitative approach with a descriptive ex post facto design. The sample was composed by 1377 university students. It was used the questionnaire of risk perception of tobacco consumption. In the data analysis the authors used univariate descriptive analysis, two step cluster analysis, categorical principal components analysis and the decision trees. Results: It was identified as tendency, adequate levels of information about consequences of this risk behavior. The higher variations were in the behavioral-motivational dimension and it was the best predictor in the grouping process according to levels of risk perception. There are more females than males in the cluster with the best results Conclusions: The results allowed a multidimensional understanding of risk perception of tobacco consumption in Cuban university students(AU)

Impact of the Bowel Management Program on the quality of life in children with fecal incontinence.

PURPOSE: Evaluate the impact of implementing Bowel Management Program (BMP) on quality of life (QoL) in children with fecal incontinence (FI). METHODS: Children 3-12 years referred to the Children's Treatment Center of FI were included and categorized accordingto the tendency to constipation (dilated colon; group 1) or diarrhea (non-dilated colon; group 2). Evaluations were performed before and after 3 months of BMP implementation. Perceptions from parents and children about QoL were assessed by the instrument PedsQL4.0 and the severity of FI by the fecal incontinence index (FII) of Wexner scale. RESULTS: 43 children (mean age of 7.7 ± 3.1) were studied. 32 (74.4 %) belonged to group 1 and 11 (25.6 %) to group 2. After 3 months of BMP, it was noticed a significant improvement of the FII (14.5 ± 3.7 versus 2.8 ± 2.5; p < 0.001) in both groups. QoL perception by the parents and children increased on PedsQL4.0 evaluation (p < 0.001). There was a medium inverse statistically significant correlation of the FII and the total PedsQL4.0 score among children and parents (r = -0.47, p = 0.009 and r = -0, 39, p = 0.03, respectively). CONCLUSION: The BMP applied by a multidisciplinary dedicated team significantly improves the QoL of children with FI in the short-term period.

Epididymitis in patients with anorectal malformations: a cause for urologic concern.

INTRODUCTION: Epididymitis in patients with anorectal malformation (ARM) represents a unique problem because unlike the general population, an underlying urinary tract problem is frequently identified. We review our experience with epididymitis in ARM population with an emphasis on examining urologic outcomes. MATERIALS AND METHODS: We performed a retrospective review of male patients with ARM cared for from 1980 to 2010. Clinical and pathologic variables recorded included age at presentation, recurrence, associated urologic anomalies, incidence of ureteral fusion with mesonephric ductal structures, glomerular filtration rate and urodynamic parameters. RESULTS: Twenty-six patients were identified with documented episodes of epididymitis. Renal injury was noted in five patients (19%), all of whom were diagnosed with neurogenic bladder (NGB) several years after anorectoplasty. NGB was found in ten patients (38%) in our series. Ectopic insertion of ureter into a mesonephric ductal structure was discovered in five patients (19%). Twelve patients (46%) had recurrent episodes of epididymitis, with seven of these patients (58%) being diagnosed with NGB. Two patients in the pubertal group presented with a history of epididymitis and complained of ejaculatory pain. CONCLUSION: Epididymitis in a patient with ARM warrants a comprehensive urologic investigation, particularly in recurrent episodes. Attempts at surgical intervention (e.g. vasectomy) should be avoided until functional assessment of the urinary tract has occurred. Failure to recognize this association may lead to potentially avoidable complications and morbidity. Long term urological follow up of these patients is warranted to identify at risk patients and minimize renal deterioration.

Epididymitis in Patients with Anorectal Malformations: A Cause for Urologic Concern

Introduction Epididymitis in patients with anorectal malformation (ARM) represents a unique problem because unlike the general population, an underlying urinary tract problem is frequently identified. We review our experience with epididymitis in ARM population with an emphasis on examining urologic outcomes. Materials and Methods We performed a retrospective review of male patients with ARM cared for from 1980 to 2010. Clinical and pathologic variables recorded included age at presentation, recurrence, associated urologic anomalies, incidence of ureteral fusion with mesonephric ductal structures, glomerular filtration rate and urodynamic parameters. Results Twenty-six patients were identified with documented episodes of epididymitis. Renal injury was noted in five patients (19%), all of whom were diagnosed with neurogenic bladder (NGB) several years after anorectoplasty. NGB was found in ten patients (38%) in our series. Ectopic insertion of ureter into a mesonephric ductal structure was discovered in five patients (19%). Twelve patients (46%) had recurrent episodes of epididymitis, with seven of these patients (58%) being diagnosed with NGB. Two patients in the pubertal group presented with a history of epididymitis and complained of ejaculatory pain. Conclusion Epididymitis in a patient with ARM warrants a comprehensive urologic investigation, particularly in recurrent episodes. Attempts at surgical intervention (e.g. vasectomy) should be avoided until functional assessment of the urinary tract has occurred. Failure to recognize this association may lead to potentially avoidable complications and morbidity. Long term urological follow up of these patients is warranted to identify at risk patients and minimize renal deterioration .

Update on the management of anorectal malformations.

Thirty-three years ago, on 10 August 1980, in Mexico City, the first patient with an anorectal malformation was operated on using the posterior sagittal approach. At that time it was not obvious that we were actually opening a "Pandora's box" that continues to give many positive surprises, a few disappointments, and the constant hope that each day we can learn more about how to improve the quality of life of children born with all different types of anorectal malformations. In November 2012, patient number 3000 in our database was operated in the city of Cochabamba, Bolivia; during one of our International Courses of Anorectal Malformations and Colorectal Problems in Children. The goal of this article is to give a brief update on the current management of patients with anorectal malformation, based on the multiple lessons learned during this period.

Factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España / Risk factors for symptoms of allergic rhinitis in adolescents in Castellón, Spain

OBJETIVOS: Estimar factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España. MÉTODOS: Estudio transversal de base poblacional a partir de la fase III del ISAAC (International Study of Asthma and Allergies in Childhood) llevado a cabo en 2002 entre adolescentes de 13 a 14 años. Se utilizó el cuestionario ISAAC para definir los casos de rinitis alérgica. Se estimaron razones de posibilidades (RP) y sus intervalos de confianza de 95 por ciento (IC95 por ciento) mediante modelos de regresión logística. RESULTADOS: La participación fue de 66,8 por ciento (3 995 adolescentes de un total de 5 981). La prevalencia de síntomas de rinoconjuntivitis en los últimos 12 meses fue de 16,5 por ciento, y la prevalencia de alergia nasal alguna vez, de 7,4 por ciento. Con la regresión logística, la rinoconjuntivitis se asoció a la mujer (RP=1,63; IC95 por ciento:1,33-2,00); fumar la madre en casa (RP=1,32; IC95 por ciento:1,08-1,63); historia de sinusitis (RP=2,02; IC95 por ciento:1,51-2,70), y circulación constante de camiones por la calle de residencia (RP=1,58; IC95 por ciento:1,02-2,44). De igual manera, la alergia nasal se asoció con la historia familiar de rinitis alérgica (RP=2,62; IC95 por ciento:1,90-3,63); historia de sinusitis (RP=2,65; IC95 por ciento:1,77-3,96), historia de bronquitis (RP=1,68; IC95 por ciento:1,19-2,36), y clase social, con descensos progresivos al comparar las clases superiores e inferiores. CONCLUSIONES: Diferentes factores de riesgo medioambientales se asociaron con el hecho de sufrir síntomas de alergia nasal; se sugiere la importancia de adecuar medidas preventivas específicas.

OBJECTIVES: To estimate the risk factor for symptoms of allergic rhinitis in adolescents in Castellón, Spain. METHODS: A cross-sectional population based study of Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC) conducted in 2002 among adolescents from 13-14 years of age. The ISAAC questionnaire was used to define cases of allergic rhinitis. Logistic regression models were used to estimate odds ratio (OR) and their 95 percent confidence intervals (95 percentCI). RESULTS: Participation was 66.8 percent (3 995 adolescents of the 5 981 total). The prevalence of rhinoconjunctivitis symptoms in the last 12 months was 16.5 percent and the prevalence of nasal allergy at some point was 7.4 percent. Logistic regression showed that rhinoconjunctivitis was associated with being female (OR = 1.63; 95 percentCI: 1.33-2.00); a mother who smokes in the home (OR = 1.32; 95 percentCI: 1.08-1.63); a history of sinusitis (OR = 2.02; 95 percentCI: 1.51-2.70); and living on a street with heavy truck traffic (OR = 1.58; 95 percentCI: 1.02-2.44). Likewise, nasal allergy was associated with a family history of allergic rhinitis (OR = 2.62; 95 percentCI: 1.90-3.63); a history of sinusitis (OR = 2.65; 95 percent CI: 1.77-3.96); a history of bronchitis (OR = 1.68; 95 percentCI: 1.19-2.36); and social class, with a steady decline when comparing higher classes to lower classes. CONCLUSIONS: Various environmental risk factors were associated with the symptoms of nasal allergies, which points to the importance of implementing specific preventive measures.

[Domestic water hardness and prevalence of atopic eczema in Castellon (Spain) school children]. / Dureza del agua de consumo doméstico y prevalencia de eczema atópico en escolares de Castellón, España.

UNLABELLED: Water hardness has been associated with atopic eczema (AE) prevalence in two epidemiologic studies carried out on schoolchildren in England and Japan. OBJECTIVE: To estimate the association between the prevalence of AE and domestic water hardness. METHODS: The prevalence of AE was obtained from The International Study of Asthma and Allergies in Childhood, carried out in six towns in the province of Castellón on schoolchildren 6-7 and 13-14 years of age, using a standard questionnaire in 2002. Three zones were defined according to domestic water hardness of the six study localities: <200 mg/l, 200-250 mg/l, and >300 mg/l. A logistic regression analysis was performed. RESULTS: The lifetime prevalence of AE in schoolchildren 6-7 years of age was higher with the increment of water hardness, 28.6, 30.5 and 36.5% respectively for each zone; between zone 1 and zone 3, the adjusted odds ratios (ORa) were 1.58 (95% Confidence Intervals [CI] 1.04-2.39) (adjusted tendency test p=0.034). Prevalence of symptoms of AE within the past year were 4.7, 4.5, and 10.4%, respectively by zone; between zone 1 and zone 3, the ORa was 2.29 (95% CI 1.19-4.42) (adjusted tendency test p=0,163). For 13-14 year-old schoolchildren, tendencies to lifetime prevalence of AE at any time or in the past year were not significant. CONCLUSIONS: This study suggests that in 6-7 year-old schoolchildren, water hardness in the area where they live has some relevance to the development of the disease.

Dureza del agua de consumo doméstico y prevalencia de eczema atópico en escolares de Castellón, España / Domestic water hardness and prevalence of atopic eczema in Castellon (Spain) schoolchildren

OBJETIVO: Estudiar la asociación entre la prevalencia de eczema atópico (EA) y la dureza del agua de uso doméstico. MATERIAL Y MÉTODOS: El estudio ISAAC (International Study of Asthma and Allergies in Childhood) estimó la prevalencia de EA en seis localidades de Castellón, España, en escolares de 6-7 y 13-14 años durante 2002. Se establecieron tres zonas de <200 mg/l, 200-250 mg/l, y >300 mg/l según la dureza del agua doméstica de esas localidades. Se empleo regresión logística en el análisis. RESULTADOS: En escolares de 6-7 años, las prevalencias acumuladas de EA en las tres zonas fueron de 28.6, 30.5 y 36.5 por ciento. Entre la zona 1 y la zona 3, la razón de momios ajustada (RMa) fue 1.58 (IC 95 por ciento 1.04-2.39) (prueba de tendencia ajustada p=0.034). La prevalencias de síntomas de EA en el último año fueron de 4.7, 4.5, y 10.4 por ciento, respectivamente. Entre la zona 1 y la zona 3, la (RMa) fue 2.29 (IC95 por ciento 1.19-4.42) (prueba de tendencia ajustada p=0.163). En escolares de 13-14 años no se apreciaron tendencias significativas. CONCLUSIONES: Se sugiere que la dureza del agua podría tener alguna importancia en el desarrollo de la enfermedad en los escolares de 6-7 años.

Water hardness has been associated with atopic eczema (AE) prevalence in two epidemiologic studies carried out on schoolchildren in England and Japan. OBJECTIVE: To estimate the association between the prevalence of AE and domestic water hardness. METHODS: The prevalence of AE was obtained from The International Study of Asthma and Allergies in Childhood, carried out in six towns in the province of Castellón on schoolchildren 6-7 and 13-14 years of age, using a standard questionnaire in 2002. Three zones were defined according to domestic water hardness of the six study localities: <200 mg/l, 200-250 mg/l, and >300 mg/l. A logistic regression analysis was performed. RESULTS: The lifetime prevalence of AE in schoolchildren 6-7 years of age was higher with the increment of water hardness, 28.6, 30.5 and 36.5 percent respectively for each zone; between zone 1 and zone 3, the adjusted odds ratios (ORa) were 1.58 (95 percent Confidence Intervals [CI] 1.04-2.39) (adjusted tendency test p=0.034). Prevalence of symptoms of AE within the past year were 4.7, 4.5, and 10.4 percent, respectively by zone; between zone 1 and zone 3, the ORa was 2.29 (95 percent CI 1.19-4.42) (adjusted tendency test p=0,163). For 13-14 year-old schoolchildren, tendencies to lifetime prevalence of AE at any time or in the past year were not significant. CONCLUSIONS: This study suggests that in 6-7 year-old schoolchildren, water hardness in the area where they live has some relevance to the development of the disease.

Síndrome metabólico en adolescentes con sobrepeso y obesidad / Metabolic syndrome in overweight and obese adolescents

Objetivo: Conocer y cuantificar la presencia de síndrome metabólico en una población adolescente que presenta sobrepeso y obesidad. Diseño: Estudio clínico. Lugar: Servicio de Endocrinología. Hospital Nacional Dos de Mayo. Participantes: Adolescentes. Intervenciones: Se estudió una muestra de 195 adolescentes comprendidos entre los 10 a 19 años. El criterio de inclusión fue que presentasen sobrepeso u obesidad, de acuerdo al índice de masa corporal (IMC). Para ello, se hizo uso de la población de referencia de Must y col, con los siguientes criterios diagnósticos: de 85 a 95 percentil, sobrepeso; y mayor del 95 percentil, obesos. El peso, la talla y la circunferencia de la cintura (CC) fueron tomados siguiendo las recomendaciones internacionales. El síndrome metabólico fue definido mediante la recomendación de Cook (triglicéridos mayor que 110, colesterol HDL menor que 40 mg/dL, glicemia mayor que 110 mg/dL y CC menor que 90 percentil), la presencia de tres o más de estos criterios indicó síndrome metabólico. Principales medidas de resultados: Síndrome metabólico, sobrepeso, obesidad. Resultados: En 8,8 por ciento de la muestra estudiada existió la presencia de síndrome metabólico. Los obesos presentaron mayor prevalencia de síndrome metabólico que los con sobrepeso (22,9 y 3 por ciento, respectivamente); el género masculino (24,1 por ciento) más que el femenino (2,9 por ciento). Los de 15 años y más tuvieron un 9,7 por ciento, con relación a los menores, 7,4 por ciento. Conforme se incrementaba la CC, la presencia de síndrome metabólico fue mayor. Conclusiones: El síndrome metabólico se encuentra presente en la población adolescente, si bien con prevalencias bajas, pero que están íntimamente relacionadas al estado nutricional (sobrepeso y obesidad). La tendencia de estas alteraciones nutricionales es a incrementarse y como consecuencia mucho más adolescentes presentaran el síndrome metabólico, lo que lleva implícito un riesgo para su salud.

Objective: To determine the presence of metabolic syndrome in overweight and obese adolescent population. Design: Clinical study. Setting: Endocrinology service. Hospital Nacional Dos de Mayo. Participants: Adolescents. Interventions: We studied 195 adolescents between 10 to 19 year-old. Inclusion criteria was that they should be overweight or obese. We used the reference population of Must et al. with the following diagnosis criteria: 85 to 95 percentile, overweight; higher than 95 percentile, obese. Weight, height and waist circumference (WC) were taken following international recommendations. Metabolic syndrome determination followed Cook recommendations (TG major 110, cholesterol HDL minor 40 mg/dL, glycemia mayor 110 mg/dL y WC major 90 percentile), the presence of three or more of these criteria indicated metabolic syndrome. Main outcome measures: Setabolic syndrome, overweight, obesity. Results: Metabolic syndrome was present in 8,8 por cent of the studied population. Those with obesity presented a higher prevalence of metabolic syndrome than those overweight (22,9 and 3 por cent, respectively). It occurred more in the male gender (24,1 por cent) than in the female (2,9 por cent) and in those 15 year-old and over, 9,7 por cent compared with the other younger group, 7,4 por cent. As WC increased, metabolic syndrome also increased. Conclusions: Metabolic syndrome is present in the adolescent population, although with low prevalence, but intimately related to nutritional status (overweight and obesity). Tendency of these nutritional alterations is to increase and as a consequence more and more adolescents will have metabolic syndrome that implies health risk.

[Seroprevalence of brucellosis in agricultural workers in the coastal zones of Castellón, Spain]. / Seroprevalencia de brucelosis en trabajadores agrícolas de las comarcas costeras de Castellón, España.

OBJECTIVE: To estimate the seroprevalence of brucellosis in agricultural workers. MATERIAL AND METHODS: This cross-sectional study was conducted between 1996 and 1997 at Unidad de Salud Laboral del Centro de Salud Pública (CSP) in Castellón, España (Public Health Center Occupational Health Unit), among 482 subjects applying for certification to handle pesticides for agricultural use. Serologic testing consisted of rose Bengal staining, Wright's agglutination, and antibrucella Coombs tests: Statistical analysis consisted in estimation of prevalence figures and logistic regression modelling. RESULTS: Fifteen subjects (3.1%, 95% CI 1.8%-5.1%) had titers of 1/40 or higher to Wright and/or Coombs tests; all were negative to rose Bengal staining. No high occupational risk was observed. CONCLUSIONS: A low prevalence of brucellosis was found. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Seroprevalencia de brucelosis en trabajadores agrícolas de las comarcas costeras de Castellón, España / Seroprevalence of brucellosis in agricultural workers in the coastal zones of Castellón, Spain

OBJECTIVE: To estimate the seroprevalence of brucellosis in agricultural workers. MATERIAL AND METHODS: This cross-sectional study was conducted between 1996 and 1997 at Unidad de Salud Laboral del Centro de Salud Pública (CSP) in Castellón, España (Public Health Center Occupational Health Unit), among 482 subjects applying for certification to handle pesticides for agricultural use. Serologic testing consisted of rose Bengal staining, Wright's agglutination, and antibrucella Coombs tests: Statistical analysis consisted in estimation of prevalence figures and logistic regression modelling. RESULTS: Fifteen subjects (3.1, 95 CI 1.8-5.1) had titers of 1/40 or higher to Wright and/or Coombs tests; all were negative to rose Bengal staining. No high occupational risk was observed. CONCLUSIONS: A low prevalence of brucellosis was found.

Comparación de parámetros cefalométricos en pacientes ortodónticos con respiración nasal y oral / Comparison of cephalometric parameters in orthodontic patients with oral and nasal respiartion

La influencia de la función naso-respiratoria en el crecimiento craneofacial ha despertado interés por más de un siglo. Esta posible relación permanece controvertida a pesar del gran interés clínico de ortodoncistas, otorrinolaringológos, pediatras y cirujanos orales y maxilofaciales. Este estudio se realizó para comprobar si la respiración oral cambia los patrones morfológicos craneofaciales que pueden ser detectados en la radiografía cefalométrica lateral de cráneo.