Accuracy, acceptability, and feasibility of diagnostic tests for the screening of Strongyloides stercoralis in the field (ESTRELLA): a cross-sectional study in Ecuador.

BACKGROUND: WHO recommends the implementation of control programmes for strongyloidiasis, a neglected tropical disease caused by Strongyloides stercoralis. Specific recommendations on the diagnostic test or tests to be used for such programmes have yet to be defined. The primary objective of this study was to estimate the accuracy of five tests for strongyloidiasis. Secondary objectives were to evaluate acceptability and feasibility of use in an endemic area. METHODS: The ESTRELLA study was a cross-sectional study for which we enrolled school-age children living in remote villages of Ecuador. Recruitment took place in two periods (Sept 9-19, 2021, and April 18-June 11, 2022). Children supplied one fresh stool sample and underwent blood collection via finger prick. Faecal tests were a modified Baermann method and an in-house real-time PCR test. Antibody assays were a recombinant antigen rapid diagnostic test; a crude antigen-based ELISA (Bordier ELISA); and an ELISA based on two recombinant antigens (Strongy Detect ELISA). A Bayesian latent class model was used to analyse the data. FINDINGS: 778 children were enrolled in the study and provided the required samples. Strongy Detect ELISA had the highest sensitivity at 83·5% (95% credible interval 73·8-91·8), while Bordier ELISA had the highest specificity (100%, 99·8-100). Bordier ELISA plus either PCR or Baermann had the best performance in terms of positive and negative predictive values. The procedures were well accepted by the target population. However, study staff found the Baermann method cumbersome and time-consuming and were concerned about the amount of plastic waste produced. INTERPRETATION: The combination of Bordier ELISA with either faecal test performed best in this study. Practical aspects (including costs, logistics, and local expertise) should, however, also be taken into consideration when selecting tests in different contexts. Acceptability might differ in other settings. FUNDING: Italian Ministry of Health. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Predictores de riesgo cardiometabólico en adolescentes de Quito / Predictors of cardiometabolic risk in adolescents in Quito

Introducción: Obesidad en la adolescencia se asocia con trastornos cardiometabólicos en la edad adulta. Es necesario contar con un índice de obesidad fácilmente aplicable para predecir riesgo cardiometabólico en adolescentes. Objetivo: Comparar la utilidad de los índices radio Cintura/Talla (r-CT), circunferencia de cintura (CC) y el índice de masa corporal (IMC) para determinar obesidad y predecir riesgos cardiometabólicos en adolescentes. Métodos: En este estudio trasversal, bajo criterios de la International Diabetes Federation (IDF) se determinó obesidad mediante tres índices, hipertensión arterial, hiperglicemia, hipertrigliceridemia y bajo HDL en 931 adolescentes mestizos ecuatorianos. La asociación de los índices de obesidad (r-CT, IMC y CC) con los factores de riesgo cardiometabólico se determinaron mediante radios de Odds ajustados y áreas bajo la curva (AUC, siglas en inglés) ROC (Característica Operativa del Receptor, siglas en inglés). Resultados: El r-CT ≥0.5 determinó mayor porcentaje de obesidad (36.6%) respecto a CC (17.4%) e IMC (6.7%). IMC ≥95 percentil se asoció significativamente con los cuatro factores de riesgo cardiometabólico, mientras que CC y r-CT se asociaron con tres de los cuatro factores. Los tres índices de obesidad determinan la concurrencia de tres o más factores de riesgo cardiometabólico con alta sensibilidad y especificidad con un AUC mayor de 0.80. Conclusiones: El IMC ≥ al percentil 95 es mejor predictor de riesgo cardiometabólico, pero no determina bien obesidad. El r-CT parece ser el indicador antropométrico más adecuado para detectar obesidad y predecir riesgo cardiometabólico en adolescentes mestizos debido a su fácil determinación y uso.

Background: Obesity in adolescence is associated with cardiometabolic problems in adulthood. It is necessary to have an easily applicable obesity index to predict cardiometabolic risk in adolescents. Objective: To compare the usefulness of waist to-height ratio (WHtR), waist circumference (WC), and body mass index (BMI) to determine obesity and predict cardiometabolic risks in adolescents. Methods: In this cross-sectional study, under the criteria of the International Diabetes Federation (IDF), obesity, hypertension, hyperglycemia, hypertriglyceridemia and low HDL rates were determined in 931 Ecuadorian mestizo adolescents. The association of the three obesity indices with the cardiometabolic risk factors was determined by means of adjusted Odds radios and area under the Receiver Operating Characteristic curve (AUC-ROC). Results: WHtR ≥0.5 determined the highest percentage of obesity (36.6%) with respect to WC (17.4%) and BMI (6.7%). BMI ≥95 percentile was significantly associated with the four cardiometabolic risk factors, while WC and WHtR were associated with three out of four factors. The three obesity indices determine the concurrence of three or more cardiometabolic risk factors with high sensitivity and specificity with an AUC greater than 0.80. Conclusions: BMI ≥95th percentile is a better predictor of cardiometabolic risk, but it is not a good determinant of obesity. The WHtR seems to be the most suitable anthropometric indicator to detect obesity and predict cardiome- tabolic risk in mestizo adolescents due to its easy determination and use.

Anthropometric variables as cardiovascular risk predictors in a cohort of adult subjects with Turner syndrome.

BACKGROUND AND PURPOSE: Excessive adiposity is associated with cardiometabolic complications in Turner syndrome (TS) subjects. Reference data for predictive anthropometric indices of overweight/obesity and metabolic syndrome (MetS) are lacking for subjects with TS. The purpose of this study was to identify the best anthropometric predictor of cardiometabolic risk in a Latin-American cohort of TS subjects. PATIENTS AND METHODS: This was a cross-sectional correlational study conducted in adult TS subjects (n=88) over the past seven years. Anthropometric parameters, body composition and biochemical variables were evaluated in a study and in a reference (n=57) group. Overweight/obesity and MetS were diagnosed using international consensus. The area under the ROC curve (AUC-ROC) was then used to determine the value of each anthropometric variable in predicting MetS or overweight/obesity. RESULTS: The prevalence of MetS and overweight/obesity in TS subjects was 40% and 48%, respectively. All anthropometric and cardiometabolic variables were significantly increased in TS subjects when compared to the reference group, except for body mass index (BMI) and HDL-c. To detect MetS and overweight/obesity, waist to height ratio (WHtR) was found to have a higher correlation with cardiometabolic variables (TC, LDL-c, HDL-c levels and the LDL-c/HDL-c ratio), and to have a higher AUC-ROC and odds ratio than BMI, waist circumference (WC) and the waist to hip ratio (WHR). CONCLUSION: The prevalence of MetS and overweight/obesity is elevated in TS subjects. WHtR was the most useful variable in predicting the presence of MetS and overweight and obesity in this TS cohort. A combination of WHtR with BMI or with WC could have the best clinical utility in identifying adult TS subjects with overweight/obesity and MetS, respectively.

Evaluation of Sources and Patterns of Elemental Composition of PM2.5 at Three Low-Income Neighborhood Schools and Residences in Quito, Ecuador.

Elemental characterization of fine particulate matter was undertaken at schools and residences in three low income neighborhoods in Quito, Ecuador. The three zones were located in the northern (Cotocollao), south central (El Camal), and south east (Los Chillos) neighborhoods and were classified as zones 1-3, respectively. Forty elements were quantified via ICP-MS analysis. Amongst the geogenic elements, the concentration of Si was the most abundant followed by S, Al, and Ca. Elements with predominantly anthropogenic sources such as Zn, V, and Ni were higher in zone 3 school followed by zone 2 and zone 1 schools. Enrichment factors were calculated to study the role of crustal sources in the elemental concentrations. Geogenic elements, except K, all had values <10 and anthropogenic elements such as Ni, V, Zn, Pb, As, Cr had >10. Principal Component Analysis suggested that Ni and V concentrations were strongly attributable to pet coke and heavy oil combustion. Strong associations between As and Pb could be attributed to traffic and other industrial emissions. Resuspended dust, soil erosion, vehicular emissions (tailpipe, brake and tire wear, and engine abrasion), pet coke, heavy oil combustion, and heavy industrial operations were major contributors to air pollution.

Association of Household Food Insecurity with the Mental and Physical Health of Low-Income Urban Ecuadorian Women with Children.

Chronic physical and mental health conditions account for a rising proportion of morbidity, mortality, and disability in the Americas region. Household food insecurity (HFI) has been linked to chronic disease in US and Canadian women but it is uncertain if the same is true for low- and middle-income Latin American countries in epidemiologic transition. We conducted a survey to investigate the association of HFI with the physical and mental health of 794 women with children living in low-income Quito, Ecuador, neighborhoods. Data were collected on HFI and health indicators including self-reported health (SF-1), mental health (MHI-5), blood pressure, and self-reported mental and physical health complaints. Fasting blood glucose and lipids were measured in a subsample. The multivariate analyses revealed that HFI was associated with poorer self-rated health, low MHI-5 scores, and mental health complaints including stress, depression, and ethnospecific illnesses. It was also associated with chest tightness/discomfort/pain, dental disease, and gastrointestinal illness but not other conditions. The findings suggest that improving food security in low-income households may help reduce the burden of mental distress in women with children. The hypothesized link with diabetes and hypertension may become more apparent as Ecuador moves further along in the epidemiologic transition.

Assessment of indoor and outdoor PM species at schools and residences in a high-altitude Ecuadorian urban center.

An air monitoring campaign to assess children's environmental exposures in schools and residences, both indoors and outdoors, was conducted in 2010 in three low-income neighborhoods in Z1 (north), Z2 (central), and Z3 (southeast) zones of Quito, Ecuador - a major urban center of 2.2 million inhabitants situated 2850 m above sea level in a narrow mountainous basin. Z1 zone, located in northern Quito, historically experienced emissions from quarries and moderate traffic. Z2 zone was influenced by heavy traffic in contrast to Z3 zone which experienced low traffic densities. Weekly averages of PM samples were collected at schools (one in each zone) and residences (Z1 = 47, Z2 = 45, and Z3 = 41) every month, over a twelve-month period at the three zones. Indoor PM2.5 concentrations ranged from 10.6 ± 4.9 µg/m(3) (Z1 school) to 29.0 ± 30.5 µg/m(3) (Z1 residences) and outdoor PM2.5 concentrations varied from 10.9 ± 3.2 µg/m(3) (Z1 school) to 14.3 ± 10.1 µg/m(3) (Z2 residences), across the three zones. The lowest values for PM10-2.5 for indoor and outdoor microenvironments were recorded at Z2 school, 5.7 ± 2.8 µg/m(3) and 7.9 ± 2.2 µg/m(3), respectively. Outdoor school PM concentrations exhibited stronger associations with corresponding indoor values making them robust proxies for indoor exposures in naturally ventilated Quito public schools. Correlation analysis between the school and residential PM size fractions and the various pollutant and meteorological parameters from central ambient monitoring (CAM) sites suggested varying degrees of temporal relationship. Strong positive correlation was observed for outdoor PM2.5 at Z2 school and its corresponding CAM site (r = 0.77) suggesting common traffic related emissions. Spatial heterogeneity in PM2.5 concentrations between CAM network and sampled sites was assessed using Coefficient of Divergence (COD) analysis. COD values were lower when CAM sites were paired with outdoor measurements (<0.2) and higher when CAM and indoor values were compared (>0.2), suggesting that CAM network in Quito may not represent actual indoor exposures.

Food Insecurity Is Associated with Undernutrition but Not Overnutrition in Ecuadorian Women from Low-Income Urban Neighborhoods.

Household food insecurity (HFI) is becoming an increasingly important issue in Latin America and other regions undergoing rapid urbanization and nutrition transition. The survey investigated the association of HFI with the nutritional status of 794 adult women living in households with children in low-income neighborhoods in Quito, Ecuador. Data were collected on sociodemographic characteristics, household food security status, and nutritional status indicators (dietary intake, anthropometry, and blood hemoglobin). Data were analyzed using multivariate methods. The findings identified revealed a high HFI prevalence (81%) among the urban households that was associated with lower per capita income and maternal education; long-term neighborhood residency appeared protective. HFI was associated with lower dietary quality and diversity and an increased likelihood of anemia and short stature but not increased high-calorie food intake or generalized or abdominal obesity. Although significant progress has been made in recent years, low dietary diversity, anemia, and growth stunting/short stature in the Ecuadorian maternal-child population continue to be major public health challenges. The study findings suggest that improving urban food security may help to improve these nutritional outcomes. They also underscore the need for food security policies and targeted interventions for urban households and systematic surveillance to assess their impact.

Residential exposure to urban traffic is associated with increased carotid intima-media thickness in children.

Chronic exposure to urban traffic pollution is documented to promote atherosclerosis in adults but little is known about its potential effects in children. Our study examined the association of long-term exposure to traffic with carotid intima-media thickness (cIMT) in 287 healthy children. Residential proximity and distance-weighted traffic density (DWTD) were used as proximity markers for traffic-related air pollution exposure. The multivariable analyses revealed that children residing <100 meters from the nearest heavily trafficked road had cIMT mean and maximum measurements that were increased by 15% and 11% compared to those living ≥ 200 meters away (P = 0.0001). Similar increases in cIMT were identified for children in the highest versus lowest DWTD tertile. Children who resided 100-199 meters from traffic or in the middle DWTD tertile also exhibited increased cIMT but these differences were not statistically significant. No statistically significant differences were identified between residential distance to traffic or DWTD and systemic inflammation indicators (CRP, IL-6). The study results suggest that exposure to urban traffic promotes arterial remodeling in children. This finding is important since even small increases in cIMT over time can potentially lead to earlier progression to atherosclerosis. It is also important because traffic-related pollution is potentially modifiable.

First description of Trypanosoma cruzi human infection in Esmeraldas province, Ecuador.

Chagas disease was described in Ecuador in 1930 in the province of Guayas and thereafter in various provinces. Triatomine were reported in the province of Esmeraldas but no human infection has been described. Here we report the first evidence that the disease does exist in the province of Esmeraldas. In indigenous Awá communities located in the northwest jungle of the Esmeraldas province, 144 individuals were tested using ELISA and PCR for T.cruzi of which 5 (3.47%) were positive. Twenty eight triatomine were collected, 27 were Triatoma dispar and 1 Pastrongylus rufotuberculatus, T.cruzi was detected in 11 (42.3%) of 26 insects.