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The Amazonian indigenous peoples depend on natural resources to live, but human activities’ growing impacts threaten their health and livelihoods. Our objectives were to present the principal results of an integrated and multidisciplinary analysis of the health parameters and assess the mercury (Hg) exposure levels in indigenous populations in the Brazilian Amazon. We carried out a cross-sectional study based on a census of three Munduruku indigenous villages (Sawré Muybu, Poxo Muybu, and Sawré Aboy), located in the Sawré Muybu Indigenous Land, between 29 October and 9 November 2019. The investigation included: (i) sociodemographic characterization of the participants, (ii) health assessment, (iii) genetic polymorphism analysis, (iv) hair mercury determination, and (v) fish mercury determination. We used the logistic regression model with conditional Prevalence Ratio (PR), with the respective 95% confidence intervals (CI95%) to explore factors associated with mercury exposure levels ≥6.0 µg/g. A total of 200 participants were interviewed. Mercury levels (197 hair samples) ranged from 1.4 to 23.9 μg/g, with significant differences between the villages (Kruskal–Wallis test: 19.9, p-value &lt, 0.001). On average, the general prevalence of Hg exposure ≥ 6.0 µg/g was 57.9%. For participants ≥12 years old, the Hg exposure ≥6.0 µg/g showed associated with no regular income (PR: 1.3, CI95%: 1.0–1.8), high blood pressure (PR: 1.6, CI95%: 1.3–2.1) and was more prominent in Sawré Aboy village (PR: 1.8, CI95%: 1.3–2.3). For women of childbearing age, the Hg exposure ≥6.0 µg/g was associated with high blood pressure (PR: 1.9, CI95%: 1.2–2.3), with pregnancy (PR: 1.5, CI95%: 1.0–2.1) and was more prominent among residents in Poxo Muybu (PR: 1.9, CI95%: 1.0–3.4) and Sawré Aboy (PR: 2.5, CI95%: 1.4–4.4) villages. Our findings suggest that chronic mercury exposure causes harmful effects to the studied indigenous communities, especially considering vulnerable groups of the population, such as women of childbearing age. Lastly, we propose to stop the illegal mining in these areas and develop a risk management plan that aims to ensure the health, livelihoods, and human rights of the indigenous people from Amazon Basin.

Background Toxoplasmosis is one of the main preventable congenital infections in Brazil. This manuscript aims to describe antenatal factors possibly associated with congenital toxoplasmosis (CT). Methods This is a case-control study, with data collected from medical records, from infants admitted under one year of age at the Infectious Diseases Clinic of Instituto de Puericultura e Pediatria Martagao Gesteira, reference center from Rio de Janeiro, exposed to toxoplasmosis during their antenatal period. Patients diagnosed with CT were classified as cases and those exposed without infection as controls. Results A total of 289 patients were followed up in 10 years. CT was confirmed in 43 (14.9%) of which six (14%) were asymptomatic, five (12%) had the classic triad (retinochoroiditis, hydrocephalus and intracranial calcifications), 27/42 (64.3%) had reactive IgM. Even after adjusted for prematurity, cases were born with lower weight (OR 0.49 - IC95% 0.33-0.73). There was a 13% increase in chance of CT per gestational week of the maternal diagnosis. Maternal fever, consumption of poorly washed vegetables during pregnancy, and diagnosis in the third trimester were associated with CT (OR: 6.43, 6.55, and 2.16, respectively). Conclusion Fever during pregnancy, consumption of poorly washed vegetables and diagnosis in the third trimester were associated with CT. Infants with diagnosis of CT were born with lower weight than the controls.

Background We aim to investigate possible maternal- and pregnancy-related factors associated with the development of Congenital Zika Syndrome (CZS) in children of mothers with probable gestational infection. Methods This case-control study, we recruited mother-infant pairs between May 2015 and October 2017 in a pediatric infectious disease clinic in Rio de Janeiro. Inclusion criteria required either that the mother reported Zika infection symptoms during pregnancy or that the infant presented with clinical or imaging features of the CZS. Exclusion criteria included detection of an alternative cause for the patient’s presentation or negative polymerase chain reaction assays for Zika in all specimens tested within 12 days from the beginning of maternal symptoms. Infants with CZS (CDC definition) were selected as cases and infants without CZS, but with probable maternal Zika virus infection during pregnancy, were selected as controls. Maternal and pregnancy-related informations were collected and their relationship to the presence of congenital anomalies due to CZS was assessed by Fisher exact or Mann-Whitney test. Results Out of the 42 included neonates, 24 (57.1%) were diagnosed with CZS (cases). The mean maternal age at the birth was 21 years old. The early occurrence of maternal symptoms during pregnancy was the only variable associated with CZS (odds ratio = 0.87, 95% CI: 0.78–0.97). Case’s mothers presented symptoms until the 25th week of gestational age (GA), while control’s mothers presented until 36th weeks of GA. Income; illicit drug, alcohol, or tobacco use during pregnancy; other infections during pregnancy (including previous dengue infection) were not associated with CZS. Conclusions Our study corroborates the hypothesis that Zika virus infection earlier in pregnancy is a risk factor to the occurrence of congenital anomalies in their fetuses.

This text presents complementary data corresponding to schistosomiasis mansoni׳s vector control and toxicity on Schistosoma mansoni cercariae using potassium usnate. This information support our research article “Potassium Usnate Toxicity Against Embryonic Stages of the Snail Biomphalaria glabrata and Schistosoma mansoni Cercariae” [1] , and focuses on the analysis of the detailed data regarding the different concentrations of potassium usnate and their efficiency to B. glabrata mortality and non-viability and S. mansoni cercariae mortality etiologic agent of the disease.

To describe the mean time of decrease of T. gondii IgG titers in uninfected infants exposed in utero to toxoplasmosis. A retrospective cohort study was conducted between 2008–2017, among infants under 12 months and exposed in utero to toxoplasmosis. Serial monthly monitoring of serum IgG titers were done till undetectable levels. Results: 240 infants with mean gestational age at diagnosis of 19.2 weeks were included in the study. The mean (range) time for IgG level to become undetectable was 7.9 (0.8–25.0) months. 14 infants became negative between 13–24 months. Majority of asymptomatic infants exposed in utero to T. gondii become seronegative before 12 months of age.

OBJECTIVE: The aim of this study is to describe the prevalence of Listeria spp. in feces of HIV-infected and -uninfected pregnant women in Brazil. METHODS: Cross-sectional study. Women on their second or third trimester of pregnancy were submitted to a clinical questionnaire and feces collection. The feces were inoculated on selective media and identification by biochemical tests combined with PCR. RESULTS: A total of 213 pregnant women were enrolled: 73 (34%) HIV-infected and 140 (66%) -non-infected. The prevalence of Listeria spp. and L. monocytogenes in feces of HIV-infected women were 8.2% and 2.7%. In the HIV-uninfected were 8.6% and 2.9% (p-values = 0.98 and 0.66, respectively). CONCLUSION: The prevalence of fecal carriers of Listeria spp. and L. monocytogenes was not associated with HIV infection during pregnancy.

Congenital Zika syndrome is a consequence of maternofetal transmission of the Zika virus. Newborns whose mothers have infection during pregnancy may develop this syndrome. The severity of the syndrome varies from asymptomatic to severe microcephaly, with several malformations. The factors that could possibly contribute to the severity variation are not well understood. At the moment, there is no evidence to support other factors that would contribute to the development of this syndrome. Zika virus infection is a mosquito-borne infection that affects more intensely the population of areas without minimum sanitary conditions such as clean water suply and sewage. Mothers of Zika virus in utero exposed children live in situation of very high social vulnerability. The influence of these factors in the maternofetal transmission is not well studied yet. The socioeconomic condition and the access to health care and health education may also present important factors that differentiate the chance of a newborn to be affected by the syndrome.

ObjectivesIdentify missed opportunities for the prevention and early diagnosis of congenital toxoplasmosis (CT) in infants followed up in a reference center for pediatric infectious diseases (PID) in Rio de Janeiro between January 2007 and December 2016.MethodsDescriptive study including infants with CT, diagnosis established based on Brazil’s Ministry of Health’s criteria. All data regarding the infants and their mother’s prenatal care were collected from the medical records of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG)—a tertiary public pediatric university hospital. The study enrolled infants aged between 0 and 12 months followed up in the PID department of IPPMG and with confirmed infection by Toxoplasma gondii in the period between January 2007 and December 2016. All patients with diagnosis of CT registered in the PID database of the IPPMG and admitted in the above-mentioned period were included in the study. Patients whose records were not available, or who went to just one clinic appointment were excluded.ResultsThe obstetric history of all 44 women, whose infants (45) were diagnosed with CT, was analyzed. Their median age was 22 years. None had undergone preconception serological testing for toxoplasmosis. Only 20 (45%) of them started antenatal care during the first trimester of gestation, a total of 24 (55%) had more than six antenatal care visits, and 16% of those did not undergo serological testing for toxoplasmosis. None were adequately informed of preventive measures. The diagnosis of acute toxoplasmosis was made in 50% of these pregnancies but 32% of the women were not treated. Only 10 children of these mothers were adequately screened and treated at birth.ConclusionDespite the existence of national recommendations, several opportunities were missed to prevent CT during the antenatal period and to diagnose and treat this condition in the neonatal period.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) colonization in Atopic Dermatitis (AD) patients can contribute to worsening their clinical condition.OBJECTIVE: A cohort study was carried out to determine the incidence of MRSA acquisition and its risk factors in AD children.METHODS: Patients with AD (2 months-14 years old) were followed up for about 1 year at a reference center for AD treatment in Rio de Janeiro, Brazil, from September 2011 to February 2014. Nasal swabs from patients and contacts were collected every 2 months. The SCORAD system assessed the severity of the AD. S. aureus isolates were evaluated to determine the methicillin resistance and the clonal lineages.RESULTS: Among 117 AD patients, 97 (82.9%) were already colonized with S. aureus and 26 (22.2%) had MRSA at the first evaluation. The incidence of MRSA acquisition in the cohort study was 27.47% (n = 25). The SCORAD assessments were: mild (46.15%), moderate (37.36%) or severe (16.48%). Risk factors were: colonized MRSA contacts (HR = 2.27; 95% CI: 1.16-7.54), use of cyclosporine (HR = 5.84; 95% CI: 1.70-19.98), moderate or severe AD (HR = 3.26; 95% CI: 1.13-9.37). Protective factors were: availability of running water (HR = 0.21; 95% CI: 0.049-0.96) and use of antihistamines (HR = 0.21; 95% IC: 0.64-0.75). MRSA isolates carried the SCCmec type IV and most of them were typed as USA800/ST5.CONCLUSIONS: The high incidence of MRSA acquisition found among AD patients and the risk factors associated show that an effective surveillance of MRSA colonization in these patients is needed.

This study aimed to assess the effectiveness of a structured intervention on the frequency of self-care behaviors with arteriovenous fistula (AVF) by patients on hemodialysis. This is a quasi-experimental study with pre- and post-measurements. Participants were assigned to an intervention group (IG) (n=48) or to a control group (CG) (n=41). IG patients were subject to a structured intervention on self-care with AVF (SISC-AVF) consisting of both a theoretical and a practical part. After SISC-AVF application, patients in the IG showed better overall self-care behaviors with AVF than patients in the CG (79.2% and 91.4%, respectively, p

Mother-to-child transmission (MTCT) is the main route of transmission for HIV among under 5 children in Brazil. National data indicate that missed opportunities for HIV prevention of MTCT are still common in antenatal care (ANC). We studied variables related to target process indicators in a cohort of HIV exposed children. We used data from 1996 to 2013 related to HIV exposed uninfected and HIV-infected children attended in an HIV reference hospital in Rio de Janeiro, Brazil. Data were collected from baseline questionnaires applied to all children followed-up in the hospital. Gestational and perinatal history were extracted from the mother's ANC card. Infants were categorized according to dates of first HIV care at the unit (1996-2000, 2001-2006 and 2007-2013). Distances between recorded addresses and the nearest maternity/hospital were measured by Euclidean distance, the shortest car route calculated in Google Maps and the route of the available bus line. Of the 599 children who fulfilled the inclusion criteria, 178 (29.7%) were HIV-infected. Approximately 70% of infants exposed to the virus from 1996-2000 were infected, dropping to 15.2% from 2001-2006 and rebounding to 30.1% from 2007-2013. Birth cohort was associated with ANC, and mothers from 2007-2013 had a lower chance of attending ANC (OR = 0.16; 95%CI 0.08-0.30). In addition, when the distance home-birthplace was higher than 9.5 km, there was a lower chance that the mother had attended ANC (OR = 0.35; 95%CI 0.18-0.68). Birth cohort was associated to HIV and ANC, and our data showed that a reduction of ANC might be related to rebound in HIV cases. There seems to have an association between larger distances from home to the birthplace and absence of ANC, which suggests that ANC was being performed in the tertiary units instead of in the primary care facilities as recommended.

This text presents complementary data corresponding to schistosomiasis mansoni's vector control and enviromental toxicity using usnic acid. These informations support our research article “Toxicity of Usnic Acid from Cladonia substellata (Lichen) to embryos and adults of Biomphalaria glabrata ” by Araujo et al. [1] , and focuses on the analysis of the detailed data regarding the different concentrations of Usnic Acid and their efficiency to B. glabrata mortality and non-viability, as also to environmental toxicity, evaluated by A. salina mortality.

Objective: To describe the prevalence and factors associated with serologic response to Listeria monocytogenes in HIV infected and uninfected pregnant women in Brazil. Methods: Cross-sectional study, pregnant women after 14 weeks of gestational age were enrolled. Positive serologic test for L. monocytogenes was defined as titers >1:80 (agglutination test). Comparisons were performed using logistic regression. Results: A total of 213 women were enrolled, 73 (34%) were HIV infected. 55 women were seroreactive for L. monocytogenes, 27 (37%) HIV-infected and 28 (20%) HIV-uninfected (p

Anti-diphtheria antibody levels decrease with aging, and frequent booster vaccinations are required to maintain herd immunity. We analyzed the diphtheria toxin neutralizing antibody (DT-Nab) response induced by a conjugate vaccine (meningococcal C polysaccharide-CRM197) in HIV-vertically infected (HI) children and adolescents and healthy controls (HC) with matched age. We report the association of DT-Nab with the bactericidal antibodies to serogroup C meningococcus (MenC). Before vaccination, 21 HI patients (50%) had no protection against diphtheria (≤0.01IU/ml of antibody) and only 8 (19%) showed complete protection (≥0.1IU/ml). About half of the HC (56%) had complete protection before immunization and 6 subjects (12%) had no protection against diphtheria. After one and two vaccine injections, 96% of HC and 64% of HI vaccinees, respectively, showed full protection against diphtheria. These data indicate that CRM197 was able to induce primary and/or booster response in both groups of individuals.

IntroductionZika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes.Methods and analysisWe will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty.Ethics and disseminationThe IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals.Trial registration numberPROSPERO International prospective register of systematic reviews (CRD42017068915).

The human cervical microbiome is complex, and its role in health and disease has just begun to be elucidated. In this study, 57 cervical swab samples from 19 HIV/HPV co-infected women were analyzed for both virome and bacteriome composition. Virome analysis focused on circular DNA viruses through rolling circle amplification followed by next-generation sequencing (NGS). Data were assigned to virus families and genera, and HPV types were identified. NGS data of bacterial 16S from a subset of 24 samples were assigned to operational taxonomic units and classified according to vaginal microbiome community state types (CSTs). Four viral families were found: Papillomaviridae, Anelloviridae, Genomoviridae, and Herpesviridae. Papillomavirus reads were more abundant in women with premalignant cervical lesions, which were also strongly associated with multiple (&ge, 3) high-risk HPV infection. Anellovirus read abundance was negatively correlated with host CD4+ T-cell counts. The bacteriome revealed the presence of CST III and CST IV, and women with &ge, 1% frequency of genomovirus or herpesvirus reads displayed an increased risk of carrying CST IV. By characterizing the composition of the cervical circular DNA viruses and the bacteriome of HIV/HPV co-infected women, we identified putative interactions between these two microorganism communities and their associations with patients&rsquo, clinical characteristics, notably immunodeficiency status.

National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico? CNPq) (grant number 404861/2018-0); Wellcome Trust and the United Kingdom?s Department for International Development (grant numbers: 205377/Z/16/Z; 201870/Z/16/Z). European Union?s Horizon 2020 research and innovation programme under ZikaPLAN (grant number 734584). Wellcome Trust - Research Enrichment in Epidemic Situation (grant number 107779/Z/15/Z; with ER1505 & ER1601). Medical Research Council on behalf of the Newton Fund and Wellcome Trust (grant number MC_PC_15088). National Institutes of Health/National Institute of Allergy and Infectious Diseases (grant number RO1/AI140718). Fondation Christophe et Rodolphe M?rieux. National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico?CNPq) (grant numbers 443875/2018-9; 440573/2016-5; 441098/2016-9; 305090/2016-0; 307282/2017-1; 304476/2018- 8; 465549/2014-4; 440763/2016-9; 309722/2017-9; 306708/2014-0; 440577/2016-0). Coordination for the improvement of Higher Education Personnel (Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior-Capes) (grant numbers 88881.130813/2016-01; 88887.116627/2016-01; 88887.136366/2017-00). Ministry of Health of Brazil-Emergency Response in Public Health-Zika virus and Microcephaly (Minist?rio da Sa?de de Brasil-Resposta ? Emerg?ncia em Sa?de P?blica?Zika v?rus e Microcefalia) (grant number 837058/2016). Department of Science and Technology (Departamento de Ci?ncia e TecnologiaDECIT) (grant numbers 25000.072811/2016-19; 440839/2016-5). Foundation of Research Support of the State of S?o Paulo (Funda??o de Amparo ? Pesquisa do Estado de S?o Paulo?FAPESP) (grant numbers 2016/08578-0; 2017/21688-1; 2013/21719-3; 2016/15021-1; 2015/12295-0; 2016/05115-9). Foundation of Research Support of the State of Rio de Janeiro (Funda??o de Amparo ? Pesquisa do Estado do Rio de Janeiro ?FAPERJ) (grant numbers E-26/201.351/2016; E-18/2015TXB; E-26/202.862/2018; E-26/010.002477/2016). Foundation of Support for Research and Scientific and Technological Development of Maranh?o (Funda??o de Amparo ? Pesquisa e ao Desenvolvimento Cient?fico e Tecnol?gico do Maranh?o?FAPEMA) (grant number 008/2016). Brazilian Ministry of Health (Minist?rio da Sa?de?MS) (grant number 929698560001160-02). Evandro Chagas Institute/Brazilian Ministry of Health (Instituto Evandro Chagas/Minist?rio da Sa?de). Foundation of Research Support of the State of Goi?s (Funda??o de Amparo ? Pesquisa do Estado de Goi?s?FAPEG) (number grant 2017/10267000531). Foundation of Research Support of the State of Rio Grande do Sul (Funda??o de Amparo ? Pesquisa do Estado do Rio Grande do Sul?FAPERGS) (grant number 17/2551-0000521-0). Foundation to Support Teaching, Research and Assistance at Hospital das Cl?nicas, Faculty of Medicine of Ribeir?o Preto (Funda??o de Apoio ao Ensino, Pesquisa e Assist?ncia do Hospital das Cl?nicas da Faculdade de Medicina de Ribeir?o Preto) and S?o Paulo State Department of Health (Secretaria de Sa?de do Estado de S?o Paulo). Support Foundation of Pernambuco Science and Technology (Funda??o de Amparo ? Ci?ncia e Tecnologia de Pernambuco?FACEPE) (grant numbers APQ-0172-4.01/16; APQ-0192-4.01/17; APQ-0793-4.01/17). Funda??o de Medicina Tropical Doutor Heitor Vieira Dourado. Manaus, AM, Brasil. Universidade Federal de Campina Grande. Campina Grande, PB, Brasil / Instituto de Medicina Integral Professor Fernando Figueira. Recife, PE, Brazil. Universidade Federal de Pernambuco. Departamento de Medicina Social. Recife, PE, Brazil. Funda??o Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil. London School of Hygiene & Tropical Medicine. London, UK. Funda??o de Medicina Tropical Doutor Heitor Vieira Dourado. Manaus, AM, Brasil. Universidade Federal de Pernambuco. Centro de Ci?ncias da Sa?de. Recife, PE, Brazil. Universidade Federal do Rio de Janeiro. Departamento de Pediatria. Rio de Janeiro, RJ, Brazil. Universidade de S?o Paulo, Ribeir?o Preto. Faculdade de Medicina de Ribeir?o Preto. Ribeir?o Preto, SP, Brasil. Universidade Federal de Sergipe. Aracaju, SE, Brazil. Secretaria Municipal de Tangar? da Serra. Tangar? da Serra, MT, Brazil. Universidade Federal do Rio de Janeiro. Departamento de Pediatria. Rio de Janeiro, RJ, Brazil. Universidade Federal de Sergipe. Aracaju, SE, Brazil. Funda??o Oswaldo Cruz. Instituto Aggeu Magalh?es. Recife, PE, Brazil. Universidade Federal de Campina Grande. Campina Grande, PB, Brasil / Instituto Paraibano de Diagn?stico. Campina Grande, PB, Brazil. Universidade de Pernambuco. Faculdade de Ci?ncias M?dicas. Recife, PE, Brazil. Universidade de Pernambuco. Instituto de Ci?ncias Biol?gicas. Recife, PE, Brazil. Funda??o Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil. Universidade de S?o Paulo. Faculdade de Medicina de Ribeir?o Preto. Ribeir?o Preto, SP, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil Faculdade de Medicina de Jundia?. Jundia?, SP, Brasil. Instituto D?Or de Pesquisa e Ensino. Rio de Janeiro, RJ, Brazil. Universidade Federal da Bahia. Instituto Sa?de Coletiva. Salvador, BA, Brazil. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil. Universidade Federal do Maranh?o. Departamento de Sa?de P?blica. S?o Lu?s, MA, Brazil. Centro de Pesquisas Gon?alo Moniz. Salvador, BA, Brazil. Secretaria de Sa?de do Estado do Maranh?o. Assist?ncia e Reabilita??o de Crian?as. Centro de Refer?ncia em Neurodesenvolvimento. S?o Lu?s, MA, Brazil. Universidade Federal de Goi?s. Departamento de Saude Coletiva. Goi?nia, GO, Brazil. Faculdade de Medicina de S?o Jos? do Rio Preto. S?o Jos? do Rio Preto, SP, Brasil. Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions.

The metabolic syndrome (MS) is a set of metabolic disturbances, represented by various cardiovascular risk factors which are generally associated with the central accumulation of fat and the resistance to insulin. Inadequate changes in eating behaviours and weight loss, which are associated to taking part in regular physical activity, are considered to be primary and first choice therapies for the treatment of MS, as they assist in the reduction of the abdominal girth and visceral fat, improve the sensibility to insulin and reduce the plasmatic concentrations of glucose and triglycerides, raise the values of high density lipoproteins and, consequently decrease the risk factors which contribute to the development of type 2 diabetes. The MS is a current discussion theme in the health field as it is related to illnesses/diseases, which not only cause a worldwide high mortality rate but show increasing incidence. Type 2 diabetes is characterised by a deregulation of the carbohydrates, lipids and proteins found in the metabolism and result in diminished secretion of insulin, resistance to insulin or a combination of both. Type 2 diabetes is the most form of diabetes of the first 3 types of diabetes, representing 90% of all cases. Diabetes is a chronic and complex disease which requires a strict medical follow-up so as to reduce the risks and obtain strategies for its control. The fast-epidemiological global evolution which has been registered in the last few years, leads to it being considered one of the pandemics of the 21st century. In this non-systematic and advanced review of the MS in type 2 diabetic patients, several articles were consulted, and some recently published studies were analysed. info:eu-repo/semantics/publishedVersion

In this study, the molluscicidal activities against Biomphalaria glabrata and cercaricidal activities against Schistosoma mansoni of the ether extract of Ramalina aspera were evaluated. Additionally, toxicity parameters were evaluated at sublethal doses in terms of the influence of the extract on the fertility and fecundity of snails, as well as morphological alterations and quantification of their immunological cells. A test with Artemia salina was also carried out, in order to verify the environmental toxicity of the compound. The ether extract of R. aspera, in which divaricatic acid was identified as the major compound, demonstrated molluscicidal activity at low concentrations against both embryos (LC90 of 22.78, 24.23, 16.63 and 16.03 μg mL−1 for the gastrula, blastula, trochophore and veliger, respectively) and against adult snails (LC90 of 8.66 μg mL−1), after 24 h of exposure. At the sublethal doses, it was possible to observe a decrease in fecundity and quantitative and morphological changes in the defense cells of the exposed snails. In addition, the extract of R. aspera showed a cercaricidal effect on S. mansoni from the concentration of 5.0 μg mL−1, while showing low toxicity to Artemia salina. The ether extract of R. aspera demonstrated effective molluscicidal activity on embryos and adult snails of the species B. glabrata, cercariae of S. mansoni, and presenting low toxicity on Artemia salina. In this way, it could be considered a promising compound in the development of future molluscicidal and cercaricidal agents, thus helping to combat schistosomiasis.

The snail Biomphalaria glabrata is the most important vector for Schistosoma mansoni. Control of this vector to prevent the spread of schistosomiasis is currently performed with the application of a niclosamide molluscicide, which is highly toxic to the environment. Screening of substances that show embryotoxic molluscicidal potential as well as have detrimental effects on cercariae is very relevant for the control of schistosomiasis, as the efficacy of prevention of the disease is increased if it acts as a molluscicide as well as on the cercariae of S. mansoni. The aim of this work was to evaluate the effect of potassium usnate derived from usnic acid on different stages of embryonic development of B. glabrata and on S. mansoni cercariae. After 24 h of exposure, potassium usnate showed embryotoxic activity across all embryonic stages. The values obtained from the LC50 for the embryonic stages were the following: blastula 5.22 μg/mL, gastrula 3.21 μg/mL, trochophore 3.58 μg/mL, veliger 2.79, and hippo stage 2.52 μg/mL. Against S. mansoni cercariae, it had LC90 and 100% mortality at concentrations of 2.5 and 5 μg/mL in 2 h of exposure. In conclusion, this is the first report of potassium usnate toxicity on the embryonic stages of B. glabrata and cercariae of S. mansoni, and this study shows the potassium usnate as a promising agent for the control of mansoni schistosomiasis.

Antiretroviral adherence in the postpartum period is crucial for maternal health and decreasing the risk of mother-to-child HIV transmission and transmission to sexual partners. Self-reported antiretroviral adherence was examined between 6- to 12-weeks and 30 months postpartum among 270 HIV-infected women enrolled in a prospective cohort study from 2008 to 2010 at multiple sites in Latin America. Adherence data were collected at each study visit to quantify the proportion of prescribed antiretrovirals taken during the previous three days, assess the timing of the last missed dose, and identify predictors of adherence. Mean adherence rates were 89.5% at 6–12 weeks and 92.4% at 30 months; the proportions with perfect adherence were 80.3% and 83.6%, respectively. The overall trend for perfect adherence was not significant ( p = 0.71). In adjusted regression modelling, younger age was associated with an increased probability of non-perfect adherence at 18 and 24 months postpartum. Other factors associated with increased probability of non-perfect adherence were higher parity, current use of alcohol and tobacco, and more advanced HIV disease. Women with perfect adherence had lower viral loads. Interventions for alcohol and tobacco use cessation, and support for young women and those with advanced HIV disease should be considered to improve postpartum adherence.

This study evaluated the biological activity of an ether extract and barbatic acid (BAR) from Cladia aggregata on embryos and adult mollusks of Biomphalaria glabrata, cercariae of Schistosoma mansoni and the microcrustacean Artemia salina. The ether extract and BAR were obtained by successive extractions with diethyl ether. The obtained extracts were analyzed using thin-layer chromatography (TLC), high-performance liquid chromatography (HPLC), proton nuclear magnetic resonance (1H-NMR) and infrared (IR) spectroscopy. The results demonstrated that the ether extract exerted embryotoxic effects at 50 and 100 µg/mL and molluscicidal effects at 20 and 25 µg/mL. BAR exhibited no embryotoxicity, and its molluscicidal concentration was equal to that of the ether extract. However, after 60 min of exposure, 1 µg/mL BAR presented cercaricidal activity against the parasite S. mansoni at the second larval stage. Neither substance induced toxicity against A. salina. These results indicate the potential molluscicidal activities of the ether extract and BAR against B. glabrata and S. mansoni cercariae. In addition to these effects, there was a lack of toxicity against the aquatic environment and no damage to the biota, indicating the potential of these products for large-scale control and/or eradication of schistosomiasis.

Objective To describe the cascade of care to HIV mother-to-child-transmission (PMTCT) in a Rio de Janeiro reference pediatric clinic, and evaluate the main factors possibly associated with HIV transmission. Methods Data on antenatal care, perinatal and neonatal assistance to HIV-infected and HIV-exposed but uninfected children assisted in the clinic from 1996-2013 were collected. The cascade of care was graphically demonstrated, and possible factors associated with HIV infection were described using regression models for bivariate and multivariate analysis. We imputed missing values of explanatory variables for the final model. Results 989 children were included in the analysis: 211were HIV and 778 HEU. Graphically the HIV PMTCT cascade of care improved from 1996/2000 to the later periods, but not from 2001/2006 to 2007/2013. The main factor independently associated with the HIV infection over time was breastfeeding. In the period 1996/2000 the lack of antiretroviral use during labor was associated HIV transmission. While in 2001/2007, other modes of delivery but elective cesarean section, and lack of maternal antiretroviral use during antenatal care were associated with HIV transmssion. In the last period, the main factor associated with transmission was the lack of maternal antenatal care. Conclusions The HIV PMTCT cascade improved over time, but HIV vertical transmission remains a problem, and better access to antenatal care is needed. This article is protected by copyright. All rights reserved.

Studies about toxicological potential of usnic acid are limited. This way, the vast majority of data available in the literature are related only to biological activities. This is the first study that aimed to evaluate the oral toxicity of usnic acid during the period of organogenesis. Females rats were distributed in the control groups, treated I and II, at doses of 15 and 25 mg/kg, administered by gavage during the 6° to 15° days of pregnancy. After 20 days the fetuses were removed and analyzed. A reduction in weight gain during pregnancy, increased resorption, reduction in the number of viable fetuses, and their body weight were observed. Morphological changes in the litter were visualized as exposure of the eye and atrophy of the limbs at the dose of 25 mg/kg. Histological analysis of the liver of the fetus showed reduction in the number of megakaryocytes between experimental groups and increase in the number of hepatocytes in a dose of 25 mg/kg. The experimental model used in this study reveals teratogenic effect of usnic acid in the period of organogenesis. Since this achievement, the importance of evaluating the toxic effects of natural substances is imperative, in order to elucidate the care in their indication as drug.

Introduction: Calcium has several physiological functions and when it registers abnormal serum levels those functions may be impacted with potentially severe consequences. There is much research on hypercalcemia in cancer patients, but there are no recent studies on the prevalence of hypocalcemia in those patients. However, there has been an evolution in oncology, namely, new drugs that may directly or indirectly result in hypocalcemia. The primary aim was to explore the association of hypocalcemia with the diverse types of cancer. The secondary aim was to study the influence that hypocalcemia might have on survival. Methods: Review of the records of patients ≥18 years old, with total calcium

The aim of this study is to evaluate the characteristics of pregnant women whether they are HIV infected or not and their prenatal care. It is a cross-sectional study. HIV-infected women were derived from a cohort study of all HIV-infected pregnant women followed from 1995 to 2005, at the Instituto de Puericultura e Pediatria Martagão Gesteira - Rio de Janeiro. HIV-non-infected women were derived from a random sample of all pregnant women who gave birth at Rio de Janeiro municipality between 1999 and 2001. All relevant sociodemographic, clinical, and pregnancy outcomes data were retrieved from both studies. To evaluate the prenatal care, we calculated the Kotelchuck Modified Index (KMI). The index is based on the months of initiation of prenatal care and the proportion of visits observed in each trimester, according to gestational age at birth. Comparisons were performed using Student t- and chi-square tests. Variables with p-value0.25 were included in an unconditional logistic regression model. There were 713 HIV-infected women and 2145 HIV-non-infected women. Variables independently associated with HIV status were: inadequate KMI (OR=4.08, 95% CI=3.17-5.24); lower educational level (OR=1.32, 95% CI=1.04-1.68); does not live with a partner (OR=3.54, 95% CI=2.66-4.64); lower family income (OR=4.71, 95% CI=3.62-6.14); tobacco use (OR=2.17, 95% CI=1.63-2.88); and hypertension (OR=1.47, 95% CI=1.01-2.17). Prematurity was not independently associated with HIV status. Although in Brazil, the HIV care is free of charge, pregnant women are still having difficulty to reach the specialized care. Better access to care must be offered to this population and studies of prematurity in the HIV-infected women must evaluate their prenatal care.

Objective HIV + pregnant women are at a higher risk of HPV infection and development of cervical cancer. Our objectives were to assess the prevalence and HPV types in HIV + pregnant women and to identify risk factors for HPV infection and cytological abnormalities. Methods Cervicovaginal smears were collected during pregnancy from 140 women. Partial HPV L1 gene and the exon 4 of the human TP53 gene (containing codon 72) were PCR-amplified and sequenced. Amplified products indicating multiple HPV infection were further cloned and sequenced. The association of demographic, obstetric and HIV-related clinical variables with HPV infection and cervical lesions was tested by univariate analyses, and significant factors were subsequently tested by logistic regression multivariate analysis. Results HPV DNA tested positive for 118 patients and HPV types were identified in 104 samples. Twenty-eight different types were found, HPV-16 and HPV-58 being the most prevalent. High-risk types were present in 79.8% of samples and multiple infections in 16.3%. Abnormal cervical smears were found in 44 patients (31.4%). Absolute CD4 + T-cell counts below 350 were associated with HPV infection. Younger age was associated with cervical abnormalities and higher CD4 + T-cell count was an apparent protective factor. Conclusions We found a high prevalence of HPV infection and high-risk types in this cohort. Our results highlighted the relevance of immune system integrity rather than TP53 variants for protecting this highly vulnerable population to HPV infection and carcinogenesis.

Neisseria meningitidis serogroup C (MenC) is the main causative agent of meningitis in Brazil. HIV infection affects the quality of the immune system. HIV+ children have an increased risk of infection to encapsulated bacteria such as N. meningitidis. We evaluated the opsonic antibody (OPA) levels and its correlation with serum bactericidal antibody (SBA) levels induced by one and two doses of a MenC conjugate vaccine in children and adolescents HIV+ and HIV-exposed but uninfected children (HEU) group. Overall the data show the importance of two doses of vaccine for HIV+ individuals. About 79% and 58% of HIV+ patients showed SBA and OPA positive response after two doses of vaccine, respectively. For HEU group, 62% and 41% of patients showed SBA and OPA positive response after one dose of vaccine, respectively. A positive and significant association between SBA and OPA levels was seen after two doses of vaccine in HIV+ patients.

This study investigated the rate of human papillomavirus (HPV) persistence, associated risk factors, and predictors of cytological alteration outcomes in a cohort of human immunodeficiency virus-infected pregnant women over an 18-month period. HPV was typed through L1 gene sequencing in cervical smears collected during gestation and at 12 months after delivery. Outcomes were defined as nonpersistence (clearance of the HPV in the 2nd sample), re-infection (detection of different types of HPV in the 2 samples), and type-specific HPV persistence (the same HPV type found in both samples). An unfavourable cytological outcome was considered when the second exam showed progression to squamous intraepithelial lesion or high squamous intraepithelial lesion. Ninety patients were studied. HPV DNA persistence occurred in 50% of the cases composed of type-specific persistence (30%) or re-infection (20%). A low CD4+T-cell count at entry was a risk factor for type-specific, re-infection, or HPV DNA persistence. The odds ratio (OR) was almost three times higher in the type-specific group when compared with the re-infection group (OR = 2.8; 95% confidence interval: 0.43-22.79). Our findings show that bonafide (type-specific) HPV persistence is a stronger predictor for the development of cytological abnormalities, highlighting the need for HPV typing as opposed to HPV DNA testing in the clinical setting.

BACKGROUND There are concerns about the effects of in utero exposure to antiretroviral drugs (ARVs) on the development of HIV-exposed but uninfected (HEU) children. The aim of this study was to evaluate whether in utero exposure to ARVs is associated with lower birth weight/height and reduced growth during the first 2 years of life. METHODS This cohort study was conducted among HEU infants born between 1996 and 2010 in Tertiary children's hospital in Rio de Janeiro, Brazil. Weight was measured by mechanical scale, and height was measured by measuring board. Z-scores for weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length were calculated. We modeled trajectories by mixed-effects models and adjusted for mother's age, CD4 cell count, viral load, year of birth and family income. RESULTS A total of 588 HEU infants were included of whom 155 (26%) were not exposed to ARVs, 114 (19%) were exposed early (first trimester) and 319 (54%) later. WAZ were lower among infants exposed early compared with infants exposed later: adjusted differences were -0.52 (95% confidence interval [CI]: -0.99 to -0.04, P = 0.02) at birth and -0.22 (95% CI: -0.47 to 0.04, P = 0.10) during follow-up. LAZ were lower during follow-up: -0.35 (95% CI: -0.63 to -0.08, P = 0.01). There were no differences in weight-for-length scores. Z-scores of infants exposed late during pregnancy were similar to unexposed infants. CONCLUSIONS In HEU children, early exposure to ARVs was associated with lower WAZ at birth and lower LAZ up to 2 years of life. Growth of HEU children needs to be monitored closely.

Background: Lichen compounds exhibit remarkable biological activity. Several of them are potent anticancer agent and some with low or none toxicity. The aim of this study was perform in vitro and in vivo assessments of the antineoplastic activity of organic extract and barbatic acid (BAR) isolated from the lichen Cladia aggregata (Sw.) Nyl. Methods: In vitro assays were performed with both extract and BAR against HEp-2 (Adenocarcinoma of the Larynx), NCI-H292 (Squamous Cell Lung Carcinoma) and KB (Nasopharyngeal Squamous Cell Carcinoma) cells. The tests were carried out on the Sarcoma-180 BAR, tumor and organs were analyzed histopatologically after 7 days of chemotherapy. Results: Cytotoxic tests with BAR revealed 50% inhibitory concentration (IC 50 ) of 19.06 µg mL -1 for NCI-H292 and 12.0 µg mL -1 for KB and 6.25 µg mL -1 for HEp-2 cells. Tests with Sarcoma-180 demonstrated 46.3% inhibitory activity against the tumor by BAR. This substance showed no significant effect on the expression of argyrophilic nucleolar organizer regions proteins (AgNORs). The histopathology study of neoplastic tissue, demonstrated that cell proliferation was not affected by the antineoplastic action of the compound tested. Conclusions: The results indicate that barbatic acid exhibits significant antineoplastic activity and low toxicity rate.

The potential adverse effects of antiretroviral drugs during pregnancy are discrepant and few studies, mostly from Europe, have provided information about pregnancy outcomes of those already on treatment at conception. The aim of this study was to investigate the impact of antiretrovirals (ARVs) on pregnancy outcome according to the timing of treatment initiation in a cohort of pregnant women from Brazil infected with HIV.A prospective cohort of 696 pregnant women followed up in one single centre between 1996 and 2006 was studied. Patients who had ARV treatment before pregnancy were compared with those treated after the first trimester. The outcomes evaluated were preterm delivery (PTD) (37 weeks), severe PTD (34 weeks), low birth weight (LBW) (2500 g) and very LBW (1500 g).Patients who were using ARVs pre-conception had higher rates of LBW (33.3% vs 16.5%; p0.001) and a similar trend for PTD (26.3% vs 17.7%; p = 0.09). Stratification by type of therapy (dual vs highly active antiretroviral therapy (HAART)) according to timing of initiation of ARVs showed that patients who use HAART pre-conception have a higher rate of PTD (20.2% vs 10.2%; p = 0.03) and LBW (24.2% vs 10.2%; p = 0.002). After adjusting for several factors, HAART used pre-conception was associated with an increased risk for PTD (AOR 5.0; 95% CI 1.5 to 17.0; p = 0.009) and LBW (OR 3.6; 95% CI 1.7 to 7.7; p = 0.001).We identified an increased risk for LBW and PTD in patients who had HAART prior to pregnancy.

Growth failure in HIV-infected children is an important factor in either initiating or changing antiretroviral therapy (ART). This study assesses the impact of HIV infection on growth parameters of adolescents who acquired HIV vertically.This retrospective, longitudinal study involved adolescents aged 10-20 years with vertically-acquired HIV infection who were followed up in one of the three main referral centres for paediatric HIV/AIDS in Rio de Janeiro, Brazil. Length, weight and variables related to demographic, clinical and laboratory issues were analysed.108 subjects were enrolled. Median age was 12.7 years, median duration of follow-up was 97.2 months and 61 (56.5%) were female. The difference between the baseline and final weight Z-scores was -0.31 (p=0.02). Patients with final weight Z-scoresor = -2 used more ART regimens (average 4.13) than those with Z-scores-2 (average 2.90, p0.01) and also had a lower final CD4+ cell percentage--average 19% vs 24% (p0.01), respectively. The difference between baseline and final-height Z-scores was -0.27 (p0.01). Several factors were associated with a final-height Z-scoreor = -2: clinical stage C during follow-up (RR 1.60, 95% CI 1.11-2.31), chronic diarrhoea during follow-up (RR 2.02, 95% CI 1.04-3.90), HAART use (RR 1.41, 95% CI 1.16-1.71), number of ART regimens (p0.01) and final CD4+ cell percentage (p0.01). In multivariate analysis, presentation in clinical stage C during follow-up was the only significant variable (OR 4.04, 95% CI 1.23-13.28).Even on HAART, HIV-infected adolescents have lower growth parameters than the normal population and this is associated with a worse prognosis.

Leishmaniasis is considered by the World Health Organization as one of the infectious parasitic diseases endemic of great relevance and a global public health problem. Pentavalent antimonials used for treatment of this disease are limited and new phytochemicals emerge as an alternative to existing treatments, due to the low toxicity and cost reduction. Usnic acid is uniquely found in lichens and is especially abundant in genera such asAlectoria,Cladonia,Evernia,Lecanora,Ramalina,andUsnea. Usnic acid has been shown to exhibit antiviral, antiprotozoal, antiproliferative, anti-inflammatory, and analgesic activity. The aim of this study was to evaluate the antileishmanial activity of usnic acid onLeishmania infantum chagasipromastigotes and the occurrence of drug-induced ultrastructural damage in the parasite. Usnic acid was effective against the promastigote forms (IC50= 18.30 ± 2.00 µg/mL). Structural and ultrastructural aspects of parasite were analyzed. Morphological alterations were observed as blebs in cell membrane and shapes given off, increasing the number of cytoplasmic vacuoles, and cellular and mitochondrial swelling, with loss of cell polarity. We concluded that the usnic acid presented antileishmanial activity against promastigote forms ofLeishmania infantum chagasiand structural and ultrastructural analysis reinforces its cytotoxicity. Further,in vitrostudies are warranted to further evaluate this potential.

A análise fenotípica de 255 amostras do gênero Listeria isoladas de material clínico humano, tanto de indivíduos doentes (220-86,3%), como de aparentemente normais (35-13,7%) de várias regiões do país e colecionadas no período de 1969 a 2000, permitiu caracterizar a distribuição de sorovares de Listeria monocytogenes. Nas faixas etárias de 0 a 10 e de 41 a 60 anos, predominaram os isolamentos de líquido cefalorraquidiano sobre os de sangue, incluindo dos transplantados renais. Somente dos hemocultivos foi possível detectar os sete sorovares de Listeria monocytogenes. No cômputo geral, o sorovar 4b foi o mais incidente (154-60,3%) secundado por ¹/2 a (74-29%) nos três decênios considerados, além de ocorrerem em quase todas as regiões do país. Os dados deste estudo evidenciaram a circulação de L. monocytogenes na espécie humana, provocando quadros graves de meningite e septicemia, bem como, revelando a figura do portador assintomático, razão pela qual são recomendadas novas investigações bacteriológicas, subsidiadas por análises clínico-patológicas e epidemiológicas.

Meningococcal disease is endemic in Brazil, with periodic outbreaks and case fatality rates reach as high as 18 to 20% of cases. Conjugate vaccines against meningococci are immunogenic in healthy children. However, we have previously shown a poor bactericidal antibody response to a Men C conjugate vaccine in Brazilian HIV-infected children and adolescents after a single vaccine administration. The goal of the present work was to investigate associations between bactericidal antibody response induced by MenC vaccine and the frequency and activation profile (expression of CD38, HLA-DR and CCR5 molecules) of total CD4+ memory T cell sub-populations in HIV-1-infected children and adolescents. Responders to vaccination against MenC had a predominance (about 44%) of CD4+ TINTERMEDIATE subset followed by TTRANSITIONAL memory subset (23 to 26%). Importantly, CD4+ TINT frequency was positively associated with bactericidal antibody response induced by vaccination. The positive correlation persisted despite the observation that the frequency TINT CD38+HLA-DR+ was higher in responders. In contrast, CD4+ TCENTRAL MEMORY (TCM) subset negatively correlated with bactericidal antibodies. In conclusion, these data indicate that less differentiated CD+ T cells, like TCM may be constantly differentiating into intermediate and later differentiated CD4+ T cell subsets. These include CD4 TINT subset which showed a positive association with bactericidal antibodies.

BACKGROUND: Symptoms associated with HIV infection are common among HIV seroconverters, but the acute retroviral syndrome (ARS) is a diagnostic challenge because of the absence of a sensitive and specific case definition. We conducted an analysis of HIV seroconverters in Projeto Praca Onze, a HIVNET HIV seroincidence study among homosexual men in Rio de Janeiro. METHODS: Information from study subjects enrolled in Projeto Praca Onze who were documented HIV seroconverters were compared with nonseroconverters. At each semiannual study visit, participants were asked about HIV seroconversion symptoms and sexually transmitted diseases (STDs) during the preceding 6 months. All information was collected before the laboratory evaluation. A classification tree analysis was used to identify an ARS case definition, first using clinical information and then after including risk factor data for seroconversion in our cohort. RESULTS: As of July 1998, 674 volunteers were enrolled and 34 of these seroconverted; information was available for 33 of these. Among the seroconverters, 11 (34%) denied any symptoms, and 22 (66%) reported one or more symptoms, the most common of which were fever (25% of seroconverters versus 7% of nonseroconverters; p /=3 days (27% versus 7%, respectively; p /=2 kg (21% versus 9%, respectively; p =.05). STDs were more common in seroconverters (gonorrhea: 9% versus 1%, respectively; p 3 days, fever, pharyngitis, and myalgia (seroconverters, 3 of 32, versus nonseroconverters, 2 of 640). The second case definition was was ID for >3 days, anti-core hepatitis b-positive, and age

O objetivo deste estudo foi avaliar a influência da altura de um step na atividade elétrica dos músculos vasto medial oblíquo (VMO), vasto lateral longo (VLL) e vasto lateral oblíquo (VLO) no exercício de subida posterior. Participaram do estudo 27 indivíduos do sexo feminino, sendo 15 sadios (21,13 ± 2,17 anos) e 12 portadores da Síndrome da Dor Femoropatelar-SDFP (21,08 ± 2,31 anos). A atividade elétrica foi captada por eletrodos de superfície. Os indivíduos subiram o step em duas alturas diferentes (45º e 75º de flexão do joelho) no sentido posterior. A integral do sinal elétrico normalizado pela média das repetições foi utilizada para o estudo da relação de ativação VMO:VLO e VMO:VLL. A ANOVA two-way e o post hoc de Duncan (p < 0,05) mostraram que no grupo SDFP, os valores da relação VMO:VLO e VMO:VLL foram maiores no ângulo de 45º do que a 75º. No grupo Controle, a relação VMO:VLO foi maior a 45º que a 75º enquanto que a relação VMO:VLL foi maior no ângulo de 75º. Os resultados deste estudo sugerem que o exercício de subida posterior no step a 45º está indicado no tratamento da SDFP, pois ativou mais seletivamente o músculo VMO.

The aim of present study was to describe the frequency of lipodystrophy syndrome associated with HIV (LSHIV) and factors associated with dyslipidemia in Brazilian HIV infected children.HIV infected children on antiretroviral treatment were evaluated (nutritional assessment, physical examination, and laboratory tests) in this cross-sectional study. Univariate analysis was performed using Mann–Whitney test or Fisher's exact test followed by logistic regression analysis. Presence of dyslipidemia (fasting cholesterol >200 mg/dl or triglycerides >130 mg/dl) was the dependent variable.90 children were enrolled. The mean age was 10.6 years (3–16 years), and 52 (58%) were female. LSHIV was detected in 46 children (51%). Factors independently associated with dyslipidemia were: low intake of vegetables/fruits (OR = 3.47, 95%CI = 1.04–11.55), current use of lopinavir/ritonavir (OR = 2.91, 95%CI = 1.11–7.67). In conclusion, LSHIV was frequently observed; inadequate dietary intake of sugars and fats, as well as current use of lopinavir/ritonavir was associated with dyslipidemia. Keywords: HIV, Lipodystrophy, Dyslipidemia, Children

HIV infection epidemiology in adolescents is divided into two groups: vertical and sexual transmission. When both groups have access to antiretroviral therapy, and HIV becomes a chronic disease, several nutritional issues are observed and must be better studied in South American population. In HIV vertically infected adolescents, who were exposed to several antiretroviral practices, including antiretroviral regimens of lower potency used in the past, the main problem is related to lower stature when compared to the same-age population, but not necessarily lower weight. As a consequence, a cohort with higher body mass index has been created. Adolescents with HIV who had been sexually infected are probably those who are recently infected, and they reflect the epidemiology of HIV in South America: more prevalent among young and poor females. The study of the nutritional aspects of this population demonstrates a fiber poor, fat rich diet in a population without the right nutritional knowledge with higher tendency to be overweight. In the population that is using antiretrovirals, the frequency of lipodystrophy syndrome, i.e., fat redistribution (mainly lipohypertrophy) and metabolic alterations, such as dyslipidemia, insulin resistance, or lactic acidosis, is higher than in the population without medication, and factors associated with this syndrome and several consequences are discussed in this chapter.

Summary During a dengue epidemic in Rio de Janeiro in 2007–2008 the Instituto de Puericultura e Pediatria Martagao Gesteira Hospital was a reference for admitted children. The World Health Organization (WHO) considered several manifestations as warning signs of severe dengue This is a retrospective cohort study of all children admitted with dengue fever. Clinical variables considered warning signs by WHO were evaluated in the multivariate analysis, to investigate if they were independently associated with severe dengue. One hundred and eighty one children were admitted, aged from 4 months to 15 years; 30 were classified as severe dengue. Abdominal pain (OR = 2.63, 95% CI1.06–6.53) and lethargy (OR = 3.40, 95% CI 1.45–7.99) were independently associated with severe dengue.

The objective of this study was to describe the adherence to antiretroviral therapy (ART) among adolescents followed-up in Rio de Janeiro. This cross-sectional study included all adolescents (aged 10–19 years) followed at Instituto de Puericultura e Pediatria Martagão Gesteira and Hospital Universitário Clementino Fraga Filho. Adherence was determined by self-report (number of missed ART doses in three days prior to the interview). Adherence was categorized as taking ≥95% of the ARTs (adherent), or

Immediate prevention of meningococcal disease relies in part on the prompt treatment with antibiotics of household and other close contacts of cases; however intervention with effective vaccination relies on identification of serogroup-causing strains. Parenteral antibiotic for patient with suspected meningococcal disease before hospital admission is currently recommended. Laboratory standard methods are hindered by failure to detect bacteria by this medical approach to improve patient prognosis. We assessed two polymerase chain reaction (PCR) assays to detect (crgA) and define the serogroups (siaD, orf-2, and ctrA) of Neisseria meningitidis in 120 cerebrospinal fluid (CSF) samples from positive cases (culture or antigen detection or direct smear). The PCR sensitivity for the identification of N. meningitidis was 100% (95% confidence interval, CI, 96-100%) compared to a sensitivity of 46% for culture (95% CI 37-55%), 61% for latex agglutination test (95% CI 52-70%), and 68% for Gram stain (95% CI 59-76%); PCR specificity was 97% (95% CI 82-100%). PCR correctly identified the serogroups A, B, C, W135, Y, and X in CSF samples with a sensitivity of 88% (95% CI 80-93%); the primer sets were 100% specific. The introduction of PCR-based assays shall increase laboratory confirmed cases, consequently enhancing surveillance of meningococcal disease.

Diagnosis of bacterial meningitis has long been based on classical methods of Gram stain, serological tests, and culture of cerebrospinal fluid (CSF). The performance of these methods, especially culture and direct smear, is thwarted by failure to detect bacteria following administration of antimicrobial agents and reluctance to performance lumbar punctures at admission. Indeed, patients with meningitis frequently receive antibiotics orally or by injection before the diagnosis is suspected or established. Thus an alternative method has become necessary to help clinicians and epidemiologists to management and control of bacterial meningitis. We evaluate the application of a polymerase chain reaction-based (PCR) assay for amplification of pneumolysin gene (ply) to diagnosis of Streptococcus pneumoniae meningitis. The PCR assay sensitivity for CSF was 96% (95% confidence interval, CI, 90-99%) compared to a sensitivity of 59% for culture (95% CI 49-69%), 66% for Gram stain (95% CI 56-74%), and 78% for latex agglutination test (95% CI 69-86%); PCR specificity was 100% (95% CI 83-100%). PCR results were available within 4 h of the start of the assay. This molecular approach proved to be reliable and useful to identify this bacterium compared with other classical laboratory methods for identification of bacterial meningitis pathogens.

Brazil provides antiretroviral therapy (ART) to HIV-infected persons free of charge. The objective of this study was to investigate factors associated with ART failure in patients receiving free ART in public clinics in Brazil.This is a cross-sectional study of adults taking ART for 6 to 24 months in 5 public clinics in Rio de Janeiro. Patients were interviewed and their charts were reviewed. The following definitions of response to therapy at 6 months were used: virologic responders (VR),or =1 log reduction in plasma viral load (VL); immunologic responders (IR), increase ofor = 50 CD4 cells/mL; complete responders (CR), both VR and IR; and nonresponders (NR), neither VR nor IR.Of 211 patients enrolled, 173 (82%) were VR, IR, or CR and 38 (18%) were NR. Of the responders, 28 (13%) were IR, 32 (15%) were VR, and 113 (53%) were CR. In multivariate analysis, factors associated with NR were less than 80% adherence (OR = 8.6; 95% CI, 2.9-25.7), baseline CD4 count (OR = 0.5 per 50 cells/mL; 95% CI, 0.2-1.1), interval between starting ART and first VL/CD4 testing (OR = 1.4 for each month; 95% CI, 1.1-1.8), opportunistic disease after starting ART (OR = 6.8; 95% CI, 1.4-34.0), inability to read prescription (OR = 3.9; 95% CI, 1.4-10.9), not believing physician is knowledgeable about HIV (OR = 4.0; 95% CI, 1.1-15.0), not having a friend with HIV (OR = 6.1; 95% CI, 1.7-21.8), believing ART will make him/her ill (OR = 5.6; 95% CI, 1.7-18.8), and believing ART will delay HIV progression (OR = 0.001; 95% CI, 0.0-0.2).The proportion of patients responding to ART in Brazil was similar to reports from developed countries, suggesting that ART can be used successfully in developing countries. Variables related to adherence, knowledge, and perceptions about ART were associated with a lack of response to ART. These findings have important implications for developing nations that are considering increased access to ART.

Summary This study was designed to estimate the frequency of p24 antigenaemia in HIV-1 infected Brazilians and to relate it to epidemiological, clinical and immunological parameters.

Purpose. This study examined breast and cervical cancer knowledge, attitudes, and screening behaviors among different Hispanic populations in the United States. Design. Data were collected from a random digit dial telephone survey of 8903 Hispanic adults from eight U.S. sites. Across sites, the average response rate was 83%. Setting. Data were collected as part of the baseline assessment in a national Hispanic cancer control and prevention intervention study. Subjects. Analysis was restricted to 2239 Hispanic women age 40 and older who were self-identified as either Central American (n = 174), Cuban (n = 279), Mexican American (n = 1550), or Puerto Rican (n = 236). Measures. A bilingual survey instrument was used to solicit information on age, education, income, health insurance coverage, language use, U.S.-born status, knowledge of screening guidelines, attitudes toward cancer, and screening participation. Differences in knowledge and attitudes across Hispanic groups were assessed by either chi-square tests or analysis of variance. Logistic regression models assessed the influence of knowledge and attitudes on screening participation. Results. The level of knowledge of guidelines ranged from 58.3% (Mexican Americans) to 71.8% (Cubans) for mammography, and from 41.1% (Puerto Ricans) to 55.6% (Cubans) for Pap smear among the different Hispanic populations. Attitudes also varied, with Mexican Americans and Puerto Ricans having more negative or fatalistic views of cancer than Cuban or Central Americans. Knowledge was significantly related to age, education, income, language preference, and recent screening history. Overall, attitudes were not predictive of mammography and Pap smear behavior. Conclusions. Factors related to mammography and Pap smear screening vary among the different Hispanic populations. Limitations include the cross-sectional nature of the study, self-reported measures of screening, and the limited assessment of attitudes. The data and diversity of Hispanic groups reinforce the position that ethno-regional characteristics should be clarified and addressed in cancer screening promotion efforts. The practical relationships among knowledge, attitudes, and cancer screening are not altogether clear and require further research.

Isolates of Mycobacterium tuberculosis from 120 tuberculosis patients seen in the 12 months ending September 1994 at 2 tertiary-care centres in Rio de Janeiro were characterized by IS6110 restriction fragment length polymorphism (RFLP) analysis. Ninety-seven patients (81%) had isolates with unique RFLP patterns, while 23 patients (19%) had isolates that belonged to 11 different RFLP cluster patterns. The strains from the latter patients were distributed among 1 group of 3 patients and 10 groups of 2 patients each. The cluster-pattern strains were not associated with gender, age, HIV infection, type of residence, living in shelter, homelessness or previous history of tuberculosis. However, clustering was strongly associated with multidrug resistance (P = 0.006). These data suggest that recent exogenous transmission may be important for the development of new cases of multidrug-resistant disease in patients attending tertiary-care centres in Rio de Janeiro, Brazil.