Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010

INTRODUCTION: Human immunodeficiency virus (HIV) coinfection with Leishmania infantum or Leishmania donovani, the agents of visceral leishmaniasis (or kala-azar), has become a fatal public health problem in the tropics where kala-azar is endemic. METHODS: The clinical presentation of patients with HIV and L. infantum coinfection is described using two unique databases that together produce the largest case series of patients with kala-azar infected with HIV in South America. First, a retrospective study paired the list of all patients with kala-azar from 1994 to 2004 with another of all patients with HIV/AIDS from the reference hospital for both diseases in the City of Teresina, State of Piauí, Brazil. Beginning in 2005 through to 2010 this information was prospectively collected at the moment of hospitalization. RESULTS: During the study, 256 admissions related to 224 patients with HIV/L. infantum coinfection were registered and most of them were males between 20-40 years of age. Most of the 224 patients were males between 20-40 years of age. HIV contraction was principally sexual. The most common symptoms and signs were pallor, fever, asthenia and hepatosplenomegaly. 16.8% of the cohort died. The primary risk factors associated to death were kidney or respiratory failure, somnolence, hemorrhagic manifestations and a syndrome of systemic inflammation. The diagnosis of HIV and kala-azar was made simultaneously in 124 patients. CONCLUSIONS: The urban association between HIV and kala-azar coinfection in South America is worrisome due to difficulty in establishing the diagnosis and higher mortality among the coinfected then those with either disease independently. HIV/L. infantum coinfection exhibits some singular characteristics and due to its higher mortality it requires immediate assistance to patients and greater research on appropriate combination therapy. .

Uso de drogas antiobesidade entre estudantes universitários / Use of anti-obesity drugs among college students

OBJETIVO: Avaliar o uso de drogas antiobesidade entre estudantes de uma universidade pública. MÉTODOS: Estudo transversal com amostra probabilística constituída por 664 universitários. Foram observadas variáveis socioeconômicas, antropométricas e uso das drogas. O índice de massa corpórea (IMC) e circunferência da cintura (CC) foram classificados segundo critérios da Organização Mundial de Saúde. RESULTADOS: Uso atual ou anterior de agentes antiobesidade foi referido por 6,8 por cento dos estudantes. As anfetaminas e as aminas simpaticomiméticas (40,5 por cento) foram as drogas mais usadas. Entre aqueles que referiram uso de agentes antiobesidade, 62,2 por cento eram do sexo feminino. Apenas 31,1 por cento das prescrições foram indicadas por médicos. As médias de IMC e CC foram maiores entre estudantes que referiram uso de tais drogas, mas 47 por cento deles foram classificados como eutróficos pelo IMC, e 76,5 por cento apresentavam medida de CC normal. CONCLUSÃO: O uso de drogas antiobesidade se mostrou preocupante, principalmente pela elevada proporção de uso sem indicação ou prescrição médica.

OBJECTIVE: To evaluate the use of anti-obesity drugs among students attending a public university. METHODS: This was a cross sectional random study of 664 college students. Drug use, socioeconomic, and anthropometric variables were observed. Body mass index (BMI) and waist circumference (WC) were classified according to World Health Organization criteria. RESULTS: Current or previous use of anti-obesity drugs was reported by 6.8 percent of students. Amphetamine and sympathomimetic amines (40.5 percent) were the most commonly used drugs. Among those who reported use of anti-obesity agents, 62.2 percent were female. Only 31.1 percent of medications were prescribed by doctors. Mean BMI and WC were higher among students reporting the use of such drugs, but 47 percent of them were classified as eutrophic by BMI, and 76.5 percent had normal WC measure. CONCLUSION: The use of anti-obesity drugs among college students is of concern, particularly due to the high proportion of drug use without indication or prescription.