Accuracy of the tuberculosis point-of-care Alere determine lipoarabinomannan antigen diagnostic test using α-mannosidase treated and untreated urine in a cohort of people living with HIV in Guatemala.

BACKGROUND: Improved point-of-care diagnostic tests for tuberculosis (TB) in severe immune suppressed people living with HIV (PLWH) are needed to decrease morbidity and mortality outcomes. The aim of the study is to evaluate the performance of the lipoarabinomannan antigen test (LAM-test) with and without α-mannosidase pre-treated urine in a cohort of PLWH in primary care clinics in Guatemala. We further determined TB incidence, and mortality rates and its risk factors in PLWH with TB symptoms. METHODS: Prospective longitudinal study of PLWH with TB symptoms. Urine samples were collected at 2 HIV sites to test the sensitivity of the LAM-test in urine with and without α-mannosidase pre-treatment. A composite reference standard of either a positive Mycobacterium tuberculosis complex culture and/or GeneXpert® MTB/RIF (Xpert, Cepheid, Sunnyvale, CA, USA) results was used in the LAM-test diagnostic accuracy studies. Cox proportional hazards regression was used to study mortality predictors. RESULTS: The overall sensitivity of the LAM-test was of 56.1% with 95% CI of (43.3-68.3). There were no differences in the LAM-test sensitivity neither by hospital nor by CD4 T cell values. LAM-test sensitivity in PLWH with < 200 CD4 T cells/µl was of 62.2% (95% CI 46.5-76.2). There were no significant differences in sensitivity when comparing LAM-test results obtained from untreated vs. α-mannosidase treated urine [55.2% (95% CI 42.6-67.4) vs. 56.9% (95% CI 44-69.2), respectively]. TB incidence in our cohort was of 21.4/100 person years (PYs) (95% CI 16.6-27.6), and mortality rate was of 11.1/100 PYs (95% CI 8.2-15.0). Importantly, PLWH with a positive LAM-test result had an adjusted hazard ratio (aHR) of death of 1.98 (1.0-3.8) with a significant p value of 0.044 when compared to PLWH with a negative LAM-test result. CONCLUSIONS: In this study, α-mannosidase treatment of urine did not significantly increase the LAM-test performance, however; this needs to be further evaluated in a large-scale study due to our study limitations. Importantly, high rates of TB incidence and mortality were found, and a positive LAM-test result predicted mortality in PLWH with TB clinical symptoms.

Sugar Content and Nutritional Quality of Child Orientated Ready to Eat Cereals and Yoghurts in the UK and Latin America; Does Food Policy Matter?

Ready to eat breakfast cereals (REBCs) and yoghurts provide important nutrients to children's diets, but concerns about their high sugar content exist. Food reformulation could contribute to sugar reduction, but policies across countries are not uniform. We aimed to compare the sugar content and nutritional quality of child-orientated REBCs and yoghurts in Latin American countries with the UK. In a cross-sectional study, nutritional information, marketing strategies, and claims were collected from the food labels and packaging of products available in Guatemala, Mexico, Ecuador and the UK. Nutritional quality was assessed using the UK Ofcom Nutrient Profiling System. In total, 262 products were analysed (59% REBCs/41% yoghurts). REBCs in the UK had a lower sugar content (mean ± SD) (24.6 ± 6.4) than products in Ecuador (34.6 ± 10.8; p < 0.001), Mexico (32.6 ± 7.6; p = 0.001) and Guatemala (31.5 ± 8.3; p = 0.001). Across countries, there were no differences in the sugar content of yoghurts. A large proportion (83%) of REBCs and 33% of yoghurts were classified as "less healthy". In conclusion, the sugar content of REBCs in Latin America is higher than those of the UK, which could be attributed to the UK voluntary sugar reduction programme. Sugar reformulation policies are required in Guatemala, Mexico and Ecuador.

Effect of a Group Behavioural Management Program on Emotional Regulation of Food Choices: A Pilot Randomized Controlled Trial.

PURPOSE: In Ontario, group programs to increase mindfulness of food choices are provided in Family Health Teams (FHTs), but evaluation is limited. We targeted patients with chronic conditions that could benefit from intensified management and evaluated an existing program. METHODS: We included 3 FHTs. Patients were randomized to immediate participation in the intervention (n = 16) or to wait-list control (n = 14). Eligible participants were between 40 and 70 years old, living with diabetes and/or hypertension and had at least 2 of: elevated cholesterol (LDL >4 if hypertension or LDL >2 mmol/L if diabetes), blood sugar (A1c >7.5%), or blood pressure (systolic BP >140). The intervention was a 6-week group program of 2-hour weekly sessions addressing mindfulness of food choices facilitated by a trained dietitian and social worker. We used the Emotional Eating Questionnaire (EEQ) a validated 10-item questionnaire measuring the degree of interaction between food intake and emotion. The primary outcome was change in the EEQ over 6 weeks. RESULTS: There was no difference in the change in EEQ in either unadjusted (P = 0.4) or adjusted (P = 0.3) analysis. CONCLUSIONS: We found no effect for this intervention, although the small sample size limits interpretation. The results were contrary to what was expected.

Abceso esplénico, rara presentación de salmonela typhi / Splenic abscess, rare presentation of salmonella typhi

Absceso esplénico es una rara complicación de fiebre tifoidea. La incidencia es de 0.2 a 0.7 por ciento en estudios basados en autopsias. Existen menos de 500 casos reportados en la literatura mundial. La presentación clínica es inespecífica y es potencialmente un problema quirúrgico asociado a alta mortalidad. El tratamiento se basa en una combinación de esplenectomía total o drenaje percutáneo mas una terapia antibiótica adecuada (1,2) El absceso esplénico puede ocurrir secundario a infección del tracto urinario, apendicitis, trauma, endocarditis, neoplasia, fiebre tifoidea, embolias sépticas. Entre los microorganismos causantes más frecuentes encontramos Streptococcus, Staphylococcus, Enterobacterias. Nosotros reportamos un caso de absceso esplénico con documentación microbiológica de Salmonella typhi como agente causal.