Prognostic factors associated with death from visceral leishmaniasis: a case-control study in Brazil.

BACKGROUND: The aim of this study was to identify the prognostic factors associated with death from visceral leishmaniasis (VL) considering the clinical evolution of patients through a case-control study. METHODS: We randomly selected 180 cases (death caused by VL) and 180 controls (cured) from Belo Horizonte's hospitals in Brazil, according to data found in the patients' medical records. Five models of multivariate logistic regression were performed following the chronological order of the variables between the onset of the symptoms and evolution of the VL cases. RESULTS: Considering the multivariate models and the stages of clinical evolution of VL, the prognostic factors associated with death are: age >60 y, minor hemorrhagic phenomena, increased abdominal volume, jaundice, dyspnea, malnutrition, TB, billirubin >2 mg/dL, Aspartate Aminotransferase (AST) or Alanine Aminotransferase (ALT) >100 U/L, leukocytes >7000/mm3, hemoglobin <7 g/dL, platelets <50 000/mm3 and infection without defined focus and bleeding. CONCLUSIONS: Knowledge regarding the prognostic factors associated with death from VL in different stages of the disease in large Brazilian urban centers such as Belo Horizonte may help optimize patient management strategies and contribute to reduce the high fatality rates in these cities.

Anemia and the frailty syndrome amongst the elderly living in the community: a systematic review / Anemia e síndrome da fragilidade em idosos da comunidade: revisão sistemática

Objective: To evaluate the association between anemia and the onset of the frailty syndrome amongst the elderly living in the community. Method: A systematic literature review of articles from the MEDLINE and LILACS databases published in English, Spanish and Portuguese over the last ten years was carried out. Articles were included in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The search identified 193 studies. After deleting duplicated articles and applying the exclusion criteria only seven articles remained. Three articles used standardized criteria to define frailty, whereas four evaluated functional capacity as a synonym for the frailty syndrome. Conclusion: Anemia was related to a worsening of functional capacity and to the presence of the frailty syndrome in elderly persons living in the community. However, the risk of bias in the studies was high in relation to the selection of the criteria and instruments used to assess and define frailty.

Objetivo: Avaliar a associação entre anemia e síndrome de fragilidade em idosos da comunidade. Método: Trata-se de uma revisão sistemática da literatura nos idiomas inglês, espanhol e português, nas bases de dados MEDLINE e LILACS no período de 2007 a 2016. A inclusão dos artigos foi guiada pelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Essa revisão identificou 193 artigos e após eliminação dos artigos duplicados e dos critérios de exclusão, foram incluídos sete artigos. Três artigos utilizaram critérios padronizados para definição de fragilidade e quatro estudos avaliaram a capacidade funcional como sinônimo de síndrome de fragilidade. Conclusão: A anemia mostrou-se relacionada à piora da capacidade funcional e à presença da síndrome de fragilidade em idosos da comunidade. Entretanto, o risco de viés dos estudos foi alto durante a seleção dos critérios e dos instrumentos utilizados para avaliação e definição da fragilidade.

Anemia and functional capacity in elderly Brazilian hospitalized patients.

This study evaluated the association between anemia and physical functional capacity in a cross-sectional population-based sample of 709 hospitalized elderly patients aged 60 years and over admitted to the Madre Teresa Hospital, Belo Horizonte, State of Minas Gerais, Brazil. The Mann-Whitney or "t" test, and chi-square or Fisher exact test were used for quantitative and categorical variables, respectively, and hierarchical binary logistic regression was used to identify significant predictors. The presence of anemia was found in 30% of participants and was significantly associated with decreased functionality according to the two measures which were used - ADL (activities of daily living) and IADL (instrumental activities of daily living). Anemia was also independently associated with older age. The results of this study demonstrate a strong association between the presence of anemia and lower levels of functional capacity. Further investigations are needed to assess the impact of anemia treatment on the functionality and independence of older people.

Anemia and functional capacity in elderly Brazilian hospitalized patients / Anemia e capacidade funcional em idosos brasileiros hospitalizados / La anemia y la capacidad funcional de los ancianos brasileños hospitalizados

O presente estudo avaliou a associação entre anemia e a capacidade física funcional em idosos hospitalizados. Estudo transversal, com amostra de 709 participantes com idades ≥ 60 anos, internados no Hospital Madre Teresa, em Belo Horizonte, Minas Gerais, Brasil. Foram utilizados os testes de Mann-Whitney ou "t" e qui-quadrado ou teste exato de Fisher para as variáveis quantitativas e categóricas, respectivamente, e um modelo hierárquico de regressão logística foi usado para identificar as variáveis preditoras associadas. A presença de anemia foi encontrada em 30% dos participantes e associada a uma diminuição significativa da funcionalidade em ambos os índices utilizados - AVD (atividades da vida diária) e AIVD (atividades instrumentais da vida diária). A idade avançada também foi independentemente associada com anemia. Os resultados deste estudo demonstraram uma forte associação entre a redução da capacidade funcional e a presença de anemia. Investigações adicionais são necessárias para avaliar o impacto do tratamento da anemia na melhora da funcionalidade e independência em pessoas idosas.

This study evaluated the association between anemia and physical functional capacity in a cross-sectional population-based sample of 709 hospitalized elderly patients aged 60 years and over admitted to the Madre Teresa Hospital, Belo Horizonte, State of Minas Gerais, Brazil. The Mann-Whitney or "t" test, and chi-square or Fisher exact test were used for quantitative and categorical variables, respectively, and hierarchical binary logistic regression was used to identify significant predictors. The presence of anemia was found in 30% of participants and was significantly associated with decreased functionality according to the two measures which were used - ADL (activities of daily living) and IADL (instrumental activities of daily living). Anemia was also independently associated with older age. The results of this study demonstrate a strong association between the presence of anemia and lower levels of functional capacity. Further investigations are needed to assess the impact of anemia treatment on the functionality and independence of older people.

Este estudio evaluó la asociación entre la anemia y la capacidad física funcional en ancianos hospitalizados. Se trató de un estudio transversal con una muestra de 709 participantes con edad ≥ 60 años, ingresados en el hospital Madre Teresa, Belo Horizonte, Minas Gerais, Brasil. Se aplicó el Mann-Whitney o "t" y chi-cuadrado o la prueba exacta de Fisher para las variables cuantitativas y categóricas, respectivamente, así como un modelo jerárquico binario de regresión logística para identificar predictores significativos. La presencia de anemia se encontró en un 30% de los participantes y se asoció con una disminución significativa de la funcionalidad en ambos índices utilizados - AVD (actividades de la vida diaria) y de AIVD (actividades instrumentales de la vida diaria). La edad avanzada también se asocia de forma independiente con la anemia. Los resultados de este estudio demostraron una fuerte asociación entre una menor capacidad funcional y la presencia de anemia. Se necesitan más investigaciones para evaluar los efectos del tratamiento de la anemia en la mejora de la funcionalidad y la independencia de los ancianos.

Ultrasound and magnetic resonance imaging findings in Schistosomiasis mansoni: expanded gallbladder fossa and fatty hilum signs / Achados da ultrassonografia e da ressonância magnética na esquistossomose mansônica: sinais da expansão da fossa da vesícula e do hilo gorduroso

INTRODUCTION: There is no study relating magnetic resonance imaging (MRI) to ultrasound (US) findings in patients with Schistosomiasis mansoni. Our aim was to describe MRI findings inpatients with schistosomal liver disease identified by US. METHODS: Fifty-four patients (mean age 41.6±13.5years) from an area endemic for Schistosomiasis mansoni were selected for this study.All had US indicating liver schistosomal fibrosis and were evaluated with MRI performed witha 1.5-T superconducting magnet unit (Sigma). RESULTS: Forty-seven (87%) of the 54 patientsshowing signs of periportal fibrosis identified through US investigation had confirmed diagnosesby MRI. In the seven discordant cases (13%), MRI revealed fat tissue filling in the hilar periportalspace where US indicated isolated thickening around the main portal vein at its point of entryto the liver. We named this the fatty hilum sign. One of the 47 patients with MRI evidence ofperiportal fibrosis had had his gallbladder removed previously. Thirty-five (76.1%) of the other46 patients had an expanded gallbladder fossa filled with fat tissue, whereas MRI of the remainingeleven showed pericholecystic signs of fibrosis. CONCLUSIONS: Echogenic thickening of thegallbladder wall and of the main portal vein wall heretofore attributed to fibrosis were frequentlyidentified as fat tissue in MRI. However, the gallbladder wall thickening shown in US (expandedgallbladder fossa in MRI) is probably secondary to combined hepatic morphologic changes inschistosomiasis, representing severe liver involvement.

INTRODUÇÃO: Não existem estudos que correlacionam os achados da ressonância magnética (RM) aos da ultrassonografia (US) em pacientes com esquistossomose mansônica. O objetivodeste estudo foi descrever os achados da imagem por RM em pacientes com doença hepática esquistossomótica identificada por US. MÉTODOS: Selecionaram-se 54 pacientes com idade média de 41,6±13,5 anos, provenientes de área endêmica para a esquistossomose mansônica. Todos apresentavam US indicativa de fibrose hepática esquistossomótica, e foram avaliados com imagens por RM, realizadas com uma unidade magnética supercondutora de 1,5-T(Sigma). RESULTADOS: Quarenta e sete (87%) entre 54 pacientes com sinais ultrassonográficosde fibrose periportal esquistossomótica tiveram este diagnóstico confirmado pela RM. Nos sete(13%) casos discordantes, a RM revelou tecido adiposo preenchendo o espaço periportal hilaronde a US indicava espessamento isolado da parede da veia porta em seu ponto de entrada no fígado. Este achado foi nomeado sinal do hilo gorduroso. Um dos 47 pacientes com evidência de fibrose periportal RM era colecistectomizado. Trinta e quatro (76,1%) dos 46 pacientes restantes apresentavam expansão da fossa da vesícula, que se encontrava preenchida portecido adiposo. Nos outros sete, a RM revelou sinais de fibrose pericolecística. CONCLUSÕES: Os espessamentos ecogênicos central da parede da veia porta, e da parede da vesícula biliar, até o momento, atribuídos à fibrose, foram frequentemente identificados como tecido adiposopela RM. Entretanto, o espessamento da parede da vesícula identificado pela US (expansão da fossa da vesícula na RM) é provavelmente secundário a alterações morfológicas hepáticas na esquistossomose, e representa comprometimento grave do fígado.

Ultrasound and magnetic resonance imaging findings in Schistosomiasis mansoni: expanded gallbladder fossa and fatty hilum signs.

INTRODUCTION: There is no study relating magnetic resonance imaging (MRI) to ultrasound (US) findings in patients with Schistosomiasis mansoni. Our aim was to describe MRI findings inpatients with schistosomal liver disease identified by US. METHODS: Fifty-four patients (mean age 41.6±13.5years) from an area endemic for Schistosomiasis mansoni were selected for this study.All had US indicating liver schistosomal fibrosis and were evaluated with MRI performed witha 1.5-T superconducting magnet unit (Sigma). RESULTS: Forty-seven (87%) of the 54 patientsshowing signs of periportal fibrosis identified through US investigation had confirmed diagnosesby MRI. In the seven discordant cases (13%), MRI revealed fat tissue filling in the hilar periportalspace where US indicated isolated thickening around the main portal vein at its point of entryto the liver. We named this the fatty hilum sign. One of the 47 patients with MRI evidence ofperiportal fibrosis had had his gallbladder removed previously. Thirty-five (76.1%) of the other46 patients had an expanded gallbladder fossa filled with fat tissue, whereas MRI of the remainingeleven showed pericholecystic signs of fibrosis. CONCLUSIONS: Echogenic thickening of thegallbladder wall and of the main portal vein wall heretofore attributed to fibrosis were frequentlyidentified as fat tissue in MRI. However, the gallbladder wall thickening shown in US (expandedgallbladder fossa in MRI) is probably secondary to combined hepatic morphologic changes inschistosomiasis, representing severe liver involvement.

Prognosis for patients diagnosed with pregnancy-associated breast cancer: a paired case-control study.

CONTEXT AND OBJECTIVE: Previous studies have suggested that the occurrence of pregnancy concomitantly with a diagnosis of breast cancer may affect the evolution of the neoplasia. The present study aimed to compare pregnancy-associated breast cancer (PABC) patients with non-pregnant cancer patients (controls) in relation to the time taken to diagnose the disease, tumor characteristics and mortality. DESIGN AND SETTING: A retrospective, paired case-control study was conducted at the Hospital da Santa Casa de Misericórdia and Centro de Quimioterapia Antiblástica e Imunoterapia in Belo Horizonte, Brazil. METHODS: The study involved 87 PABC and 252 control patients. The influence of covariables (interval between first symptoms and diagnosis, tumor histology, size of primary tumor, distant metastasis, grade of malignancy, hormone receptor status and axillary lymph node involvement) and the pregnancy variable on overall survival was investigated using univariate and multivariate analyses. RESULTS: The median overall survival for PABC patients of 30.1 months (95% confidence interval, CI: 19.4-40.9 months) was significantly different (P = 0.005) from that of the control group (53.1 months; 95% CI: 35.1-71.0 months). The cumulative overall survivals after five and ten years were, respectively, 29.7 and 19.2% for PABC patients, and 47.3 and 34.8% for control patients (P = 0.005). Tumor size, grade of malignancy, distant metastasis and pregnancy were independent factors that significantly modified disease prognosis. CONCLUSIONS: Pregnancy was an independent prognostic factor. The overall survival of PABC patients was shorter than that of non-pregnant patients.

Prognosis for patients diagnosed with pregnancy-associated breast cancer: a paired case-control study / Prognóstico para pacientes grávidas portadoras de câncer de mama: estudo caso-controle pareado

CONTEXT AND OBJECTIVE: Previous studies have suggested that the occurrence of pregnancy concomitantly with a diagnosis of breast cancer may affect the evolution of the neoplasia. The present study aimed to compare pregnancy-associated breast cancer (PABC) patients with non-pregnant cancer patients (controls) in relation to the time taken to diagnose the disease, tumor characteristics and mortality. DESIGN AND SETTING: A retrospective, paired case-control study was conducted at the Hospital da Santa Casa de Misericórdia and Centro de Quimioterapia Antiblástica e Imunoterapia in Belo Horizonte, Brazil. METHODS: The study involved 87 PABC and 252 control patients. The influence of covariables (interval between first symptoms and diagnosis, tumor histology, size of primary tumor, distant metastasis, grade of malignancy, hormone receptor status and axillary lymph node involvement) and the pregnancy variable on overall survival was investigated using univariate and multivariate analyses. RESULTS: The median overall survival for PABC patients of 30.1 months (95 percent confidence interval, CI: 19.4-40.9 months) was significantly different (P = 0.005) from that of the control group (53.1 months; 95 percent CI: 35.1-71.0 months). The cumulative overall survivals after five and ten years were, respectively, 29.7 and 19.2 percent for PABC patients, and 47.3 and 34.8 percent for control patients (P = 0.005). Tumor size, grade of malignancy, distant metastasis and pregnancy were independent factors that significantly modified disease prognosis. CONCLUSIONS: Pregnancy was an independent prognostic factor. The overall survival of PABC patients was shorter than that of non-pregnant patients.

CONTEXTO E OBJETIVO: Estudos prévios sugerem que a ocorrência de gravidez simultaneamente com o diagnóstico de câncer de mama pode afetar a evolução da neoplasia. O presente estudo objetivou comparar pacientes com câncer de mama associado à gravidez (PABC) e pacientes com câncer não grávidas (controles) com relação ao tempo decorrido até o diagnóstico de câncer, características tumorais e mortalidade. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, tipo caso-controle pareado, foi conduzido no Hospital da Santa Casa de Misericórdia e Centro de Quimioterapia Antiblástica e Imunoterapia em Belo Horizonte, Brasil. MÉTODOS: O estudo envolveu 87 pacientes PABC e 252 controles. A influência das covariáveis (intervalo entre os primeiros sintomas e diagnóstico, histologia do tumor, tamanho do tumor primário, metástase a distância, grau de malignidade, dosagem de receptor hormonal e acometimento dos linfonodos axilares) e da variável gravidez sobre a sobrevida global foram avaliados através de análises univariada e multivariada. RESULTADOS: A mediana da sobrevida global para as pacientes PABC de 30,1 meses (intervalo de confiança, IC 95 por cento: 19,4-40,9 meses) foi significativamente (P = 0,005) diferente daquela dos controles (53,1 meses; IC 95 por cento: 35,1-71,0 meses). A sobrevida global acumulada após 5 e 10 anos foi 29,7 e 19,2 por cento no grupo PABC e 47,3 e 34,8 por cento nos controles. Tamanho do tumor, grau de malignidade, metástase a distância e gravidez foram fatores independentes e significativamente condicionantes do prognóstico da doença. CONCLUSÕES: A gravidez foi um fator independente para o prognóstico da doença. A sobrevida global das pacientes PABC foi mais curta do que aquela dos controles.

Aspectos ultrassonográficos e hemodinâmicos da esquistossomose mansônica: avaliação pela ultrassonografia Doppler em áreas endêmicas / Sonographic and hemodynamic findings of schistosomiasis mansoni: doppler sonography assessment in endemic areas

OBJETIVO: Este estudo de campo objetivou identificar as alterações ultrassonográficas e hemodinâmicas indicativas da morbidade da esquistossomose mansônica em áreas endêmicas. MATERIAIS E MÉTODOS: Foram examinados pela ultrassonografia Doppler 554 pacientes esquistossomóticos em três áreas com níveis distintos de endemicidade: baixa endemicidade (n = 109); média endemicidade (n = 255) e alta endemicidade (n = 190). Para o estudo ultrassonográfico foi utilizado o protocolo da Organização Mundial da Saúde (Niamey Working Group, 2000). Pelo Doppler foram avaliados: vasos portais, artérias hepática e esplênica, veias hepáticas e vasos colaterais. RESULTADOS: Houve correlação significativa entre a frequência das alterações ultrassonográficas e o nível de endemicidade das áreas, exceto a hipertrofia do lobo esquerdo. As veias hepáticas apresentaram padrão de fluxo alterado em 23,7 por cento dos casos, alteração esta relacionada à presença e à intensidade de espessamento periportal. A artéria hepática não apresentou alterações nos parâmetros avaliados. Os vasos colaterais foram identificados apenas na área de alta endemicidade. A artéria esplênica apresentou alterações (aumento do calibre, da velocidade e do índice de resistência) mais frequentes na área de alta endemicidade, com diferença significativa entre os grupos. CONCLUSÃO: A ultrassonografia Doppler mostrou-se ferramenta auxiliar importante no estudo da morbidade relacionada à esquistossomose mansônica, contribuindo para definição mais precisa do perfil da doença nas áreas endêmicas.

OBJECTIVE: The present field research was aimed at identifying sonographic and hemodynamic findings indicative of the presence of schistosomiasis mansoni in endemic areas. MATERIALS AND METHODS: Doppler sonography was performed in 554 patients with schistosomiasis in three areas with different endemicity levels: low (n = 109), medium (n = 255) and high endemicity (n = 190). The World Health Organization (Niamey Working Group, 2000) protocol was adopted for sonographic evaluation. Doppler study included portal vessels, hepatic and splenic arteries, hepatic veins and collateral vessels. RESULTS: A significant correlation was observed between the frequency of sonographic findings, except for left lobe hypertrophy, and the areas endemicity levels. Altered hepatic veins flow pattern was observed in 23.7 percent of cases, such abnormality being related to the presence and intensity of periportal thickening. Hepatic arteries did not present any alteration as related to the evaluated parameters. Collateral vessels were identified only in the patients from the high-endemicity area. The splenic artery presented alterations (increase in caliber, flow velocity and resistive index), most frequently in the high-endemicity area, with significant difference between groups. CONCLUSION: Doppler sonography has shown to be a relevant auxiliary tool in the study of the morbidity related to schistosomiasis mansoni, contributing for a more accurate description of the disease profile in endemic areas.

Seroprevalence of ML Flow test in leprosy contacts from State of Minas Gerais, Brazil.

Leprosy is a public health problem in Brazil. Epidemiological control actions are based on the diagnosis and treatment of leprosy patients and household contact surveillance. Serological tests for leprosy could identify from among the contacts those at greater risk of developing leprosy in the future. ML Flow was administered to 2,840 household contacts of new leprosy cases diagnosed from October 2002 to March 2004, in State of Minas Gerais. ML Flow was positive in 20.5% of leprosy contacts, with high seropositivity among males (22.4%), individuals aged over 15 years-old (21.7%) and individuals in contact with multibacillary cases (23.9%). The chances of a household contact presenting a seropositive test was related to household contact with a multibacillary index case (OR=1.75), age over 15 years-old (OR=1.38) and male gender (OR=1.25). Follow-up of these contacts is necessary to evaluate the real role of seropositivity in the development of leprosy disease.

Soroprevalência do teste ML Flow em contatos de hanseníase de Minas Gerais / Seroprevalence of ML Flow test in leprosy contacts from State of Minas Gerais, Brazil

A hanseníase é um problema de saúde pública no Brasil. As ações de controle estão baseadas no diagnóstico e tratamento dos indivíduos doentes e na vigilância de seus contatos. Os testes sorológicos permitem identificar, entre os contatos, aqueles com maior risco de desenvolver hanseníase. O ML Flow foi utilizado em 2.840 contatos intradomiciliares de casos novos de hanseníase, diagnosticados entre outubro de 2002 e março de 2004, em Minas Gerais. O ML Flow foi positivo em 20,5% dos contatos de hanseníase, sendo maior nos contatos do sexo masculino (22,4%), nos maiores de 15 anos (21,7%), nos contatos de doentes multibacilares (23,9%). A chance de um contato ser soropositivo foi maior se convivia com caso multibacilar (OR=1,75), idade superior a 15 anos (OR=1,38) e sexo masculino (OR=1,25). O acompanhamento desses contatos permitirá, no futuro, avaliar o risco que a soropositividade representa no desenvolvimento de hanseníase.

Leprosy is a public health problem in Brazil. Epidemiological control actions are based on the diagnosis and treatment of leprosy patients and household contact surveillance. Serological tests for leprosy could identify from among the contacts those at greater risk of developing leprosy in the future. ML Flow was administered to 2,840 household contacts of new leprosy cases diagnosed from October 2002 to March 2004, in State of Minas Gerais. ML Flow was positive in 20.5% of leprosy contacts, with high seropositivity among males (22.4%), individuals aged over 15 years-old (21.7%) and individuals in contact with multibacillary cases (23.9%). The chances of a household contact presenting a seropositive test was related to household contact with a multibacillary index case (OR=1.75), age over 15 years-old (OR=1.38) and male gender (OR=1.25). Follow-up of these contacts is necessary to evaluate the real role of seropositivity in the development of leprosy disease.

Ultrasound and clinical investigation of hepatosplenic schistosomiasis: evaluation of splenomegaly and liver fibrosis four years after mass chemotherapy with oxamniquine.

The course of hepatosplenic schistosomiasis after mass chemotherapy with oxamniquine has been rarely reported. We report the effect of treatment in patients with advanced schistosomiasis mansoni living in area of Brazil highly endemic for this disease. A total of 739 inhabitants of a village were subjected to clinical and abdominal ultrasound examinations and were treated with oxamniquine. We have identified 84 individuals with hepatosplenic schistosomiasis. Alcohol abuse was associated with periportal thickening. Four years after treatment, 42 of the 84 individuals were re-examined and regression of splenomegaly was observed in 59% and of periportal thickening in 32%. Our data indicate that mass chemotherapy can lead to reduction of schistosomiasis morbidity but a significant group of patients (68%) will not improve. The association with alcohol abuse should be further evaluated. Thickening of the gallbladder wall can be a useful predictor of no involution of liver fibrosis after treatment.

Risk factors for Leishmania chagasi infection in an urban area of Minas Gerais State

Com o objetivo de identificar os determinantes da infeccão humana por Leishmania chagasi em uma área urbana, foi realizado um estudo seccional de base populacional utilizando-se métodos moleculares e sorológicos para identificar a infeccão. Os participantes foram entrevistados utilizando-se questionário pré-codificado. Dois critérios foram testados para identificar os fatores de risco: Modelo 1- incluindo todos os participantes positivos na hibridizacão com sonda para o complexo Leishmania donovani; Modelo 2- incluindo todos os participantes positivos na hibridizacão e em pelo menos um teste sorológico. No Modelo 1, as variáveis associadas à infeccão foram: criar pássaros, encontrar-se fora de casa entre 18:00-22:00h e não ter o lixo coletado. No Modelo 2, as variáveis associadas à infeccão foram: família conhecer o vetor, não ter o lixo coletado, lixo não removido ou queimado, criar pássaros, proximidade de áreas erodidas. Os fatores de risco identificados foram associados às condicões das moradias, presenca de animais e probabilidade de contato com flebotomíneos.

Risk factors for Leishmania chagasi infection in an urban area of Minas Gerais State.

In order to understand the determinants of human infection by Leishmania chagasi in an urban area, a cross-sectional population based study was conducted using molecular and serologic methods to identify infection. Participants were interviewed using a pre-coded questionnaire. Two criteria were tested to identify risk factors: Model 1--including all participants positive in hybridization by Leishmania donovani complex probe; Model 2--including all participants positive for hybridization and at least one serologic test. In Model 1, the variables associated with infection were: ownership of birds, time spent outside house between 6:00-10:00 PM and garbage not collected. In Model 2, the variables associated with infection were: family with knowledge of the vector, garbage not collected, garbage not removed or buried, ownership of birds and eroded areas in the neighborhood. The risk factors identified were associated with household conditions, presence of animals and the likelihood of contact with phlebotomine sandflies.

Alteration in the endogenous intestinal flora of swiss webster mice by experimental Angiostrongylus costaricensis infection

The association between worm infections and bacterial diseases has only recently been emphasized. This study examined the effect of experimental Angiostrongylus costaricensis infection on endogenous intestinal flora of Swiss Webster mice. Eight mice aging six weeks were selected for this experiment. Four were infected with A. costaricensis and the other four were used as controls. Twenty eight days after the worm infection, all mice in both groups were sacrificed and samples of the contents of the ileum and colon were obtained and cultured for aerobic and anaerobic bacteria. In the mice infected with A. costaricensis there was a significant increase in the number of bacteria of the endogenous intestinal flora, accompanied by a decrease in the number of Peptostreptococcus spp. This alteration in the intestinal flora of mice infected by the nematode may help to understand some bacterial infections described in humans.

Alteration in the endogenous intestinal flora of Swiss Webster mice by experimental Angiostrongylus costaricensis infection.

The association between worm infections and bacterial diseases has only recently been emphasized. This study examined the effect of experimental Angiostrongylus costaricensis infection on endogenous intestinal flora of Swiss Webster mice. Eight mice aging six weeks were selected for this experiment. Four were infected with A. costaricensis and the other four were used as controls. Twenty eight days after the worm infection, all mice in both groups were sacrificed and samples of the contents of the ileum and colon were obtained and cultured for aerobic and anaerobic bacteria. In the mice infected with A. costaricensis there was a significant increase in the number of bacteria of the endogenous intestinal flora, accompanied by a decrease in the number of Peptostreptococcus spp. This alteration in the intestinal flora of mice infected by the nematode may help to understand some bacterial infections described in humans.

Risk Factors for tuberculosis among human immunodeficiency virus-infected persons. A case-control study in Belo Horizonte, Minas Gerais, Brazil (1985-1996)

The objective of this study was to identify tuberculosis risk factors and possible surrogate markers among human immunodeficiency virus (HIV)-infected persons. A retrospective case-control study was carried out at the HIV outpatient clinic of the Universidade Federal de Minas Gerais in Belo Horizonte. We reviewed the demographic, social-economical and medical data of 477 HIV-infected individuals evaluated from 1985 to 1996. The variables were submitted to an univariate and stratified analysis. Aids related complex (ARC), past history of pneumonia, past history of hospitalization, CD4 count and no antiretroviral use were identified as possible effect modifiers and confounding variables, and were submitted to logistic regression analysis by the stepwise method. ARC had an odds ratio (OR) of 3.5 (CI 95 per cent - 1.2-10.8) for tuberculosis development. Past history of pneumonia (OR 1.7 - CI 95 0.6-5.2) and the CD4 count (OR 0.4 - CI 0.2-1.2) had no statistical significance. These results show that ARC is an important clinical surrogate for tuberculosis in HIV-infected patients. Despite the need of confirmation in future studies, these results suggest that the ideal moment for tuberculosis chemoprophylaxis could be previous to the introduction of antiretroviral treatment or even just after the diagnosis of HIV infection.

Diagnostic electrocardiography in epidemiological studies of Chagas' disease: Multicenter evaluation of a standardized method

An electrocardiographic recording method with an associated reading guide, designed for epidemiological studies on Chagas' disease, was tested to assess its diagnostic reproducibility. Six cardiologists from five countries each read 100 electrocardiographic (ECG) tracings, icluding 30 from chronic chagasic patients, then reread them after an interval of 6 months. The readings were blind, with the tracings numbered randomly for the first reading and renumbered randomly for the second reading. The physicians, all experienced in interpreting ECGs from chagasic patients, followed printed instructions for reading the tracings. Reproducibility of the readins was evaluated using the Kappa (k) index for concordance. The results showed a high degree of interobserver concordance with respect to the diagnosis of normal vs. abnormal tracings (k= 0.66; SE 0.02). While the interpretations of some categories of ECG abnormalities were highly reproducible, others, especially those having a low prevalence, showed lower levels of concordance. Intraobserver concordance was uniformly higher than interobserver concordance. The findings of this study justify the use by specialists of the recording of readings method proposed for epidemiological studios on Chagas' disease, but warrant caution in the interpretation of some categories of electrocardiographic alterations

Diagnostic electrocardiography in epidemiological studies of Chagas' disease: Multicenter evaluation of a standardized method

An electrocardiographic recording method with an associated reading guide, designed for epidemiological studies on Chagas' disease, was tested to assess its diagnostic reproducibility. Six cardiologists from five countries each read 100 electrocardiographic (ECG) tracings, icluding 30 from chronic chagasic patients, then reread them after an interval of 6 months. The readings were blind, with the tracings numbered randomly for the first reading and renumbered randomly for the second reading. The physicians, all experienced in interpreting ECGs from chagasic patients, followed printed instructions for reading the tracings. Reproducibility of the readins was evaluated using the Kappa (k) index for concordance. The results showed a high degree of interobserver concordance with respect to the diagnosis of normal vs. abnormal tracings (k= 0.66; SE 0.02). While the interpretations of some categories of ECG abnormalities were highly reproducible, others, especially those having a low prevalence, showed lower levels of concordance. Intraobserver concordance was uniformly higher than interobserver concordance. The findings of this study justify the use by specialists of the recording of readings method proposed for epidemiological studios on Chagas' disease, but warrant caution in the interpretation of some categories of electrocardiographic alterations