Impact of cash transfer programs on birth and child growth outcomes: systematic review / Impacto dos programas de transferência de renda nos desfechos de nascimento e crescimento infantil: revisão sistemática

Abstract To investigate the impact of cash transfer (CTs) on birth outcomes, including birth weight, low birth weight and prematurity, as well as child physical growth were included, as assessed by anthropometric indices in children under five years of age. Searching was performed using the PubMed/Medline, Embase, LILACS, Cochrane Library, Scopus and Web of Science databases. Quantitative observational, experimental and quasi-experimental. Eleven studies were included in the review. The majority (81.8%) were carried out in low-and middle-income countries and most involved conditional CTs (63.6%). Four were clinical trials and seven were observational studies. Conditional CTs were found to be associated with a reduction in height-for-age (-0.14; 95%CI -0.27, -0.02); (OR 0.85; 95%CI 0.77-0.94); (OR = 0.44; 95%CI 0.19-0.98), a significantly reduced chance of low weight-for-age (OR = 0.16; 95%CI -0.11-0.43), low weight-for-height (OR = -0.68; 95%CI -1.14, -0.21), and low weight-for-age (OR = 0.27; 95%CI 0.10; 0.71). Unconditional CTs were associated with reduced birth weight (RR = 0.71; 95%CI 0.63-0.81; p < 0.0001) and preterm births (RR = 0.76; 95%CI 0.69-0.84; p < 0.0001). Conditional CTs can positively influence birth outcomes and child growth.

Resumo Investigar o impacto dos programas de tranferência de renda (CTs) nos desfechos ao nascer, incluindo peso ao nascer, baixo peso ao nascer e prematuridade, e crescimento físico infantil, avaliado pelos índices antropométricos de crianças menores de cinco anos. Revisão sistemática realizada nas bases de dados PubMed/Medline, Embase, LILACS, Cochrane Library, Scopus e Web of Science. Foram incluídos estudos quantitativos observacionais, experimentais e quasi-experimentais, com um total de 11 estudos na revisão. A maioria (81,8%) foi realizada em países de baixa e média rendas. Também na modalidade CT condicionais (63,6%). Quatro eram ensaios clínicos, e sete observacionais. Os CT condicionais estiveram associados a uma redução nos índices de altura-para-idade (-0,14; IC95% -0,27, -0,02); (OR 0,85; IC95% 0,77-0,94); (OR = 0,44; IC95% 0,19-0,98), redução significativa na chance de baixo peso-para-idade (OR = 0,16; IC95% -0,11-0,43), baixo peso-para-altura (OR = -0,68; IC95% -1,14, -0,21), e redução de peso para idade (OR = 0,27; IC95% 0,10; 0,71). CTs não condicionais foram associados à redução do baixo peso as nascer (RR = 0,71; IC95% 0,63-0,81; p < 0,0001), e de prematuros (RR = 0,76; IC95% 0,69-0,84; p < 0,0001). Os CTs condicionais podem influenciar positivamente os desfechos ao nascer e o crescimento infantil.

RT-qPCR-based pool testing for the diagnosis of COVID-19

ABSTRACT This study proposes a strategy for large-scale testing among a large number of people for the early diagnosis of COVID-19 to elucidate the epidemiological situation. Pool testing involves the analysis of pooled samples. This study aimed to discuss a reverse transcription technique followed by quantitative real-time polymerase chain reaction using pool testing to detect SARS-CoV-2 in nasopharyngeal swab samples. The study proposes an innovative diagnostic strategy that contributes to resource optimization, cost reduction, and improved agility of feedback from results.

Factors associated with the development of leprosy in Brazilian contacts: a systematic review

ABSTRACT People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review investigated the risk and protective factors associated with the development of leprosy in Brazilian contacts. The studies were found in Cochrane Library, PubMed (MEDLINE), Embase, Virtual Health Library, grey literature and hand search until July 2021. The study selection, data extraction and quality assessment were independently performed by two investigators. The quality assessment was performed using the Newcastle-Ottawa Scale (NOS). This review was registered in PROSPERO (CRD42020160680). Seventeen articles fulfilled the inclusion criteria (n=544). The immunological and molecular factors, such as Anti-phenolic Glycolipid Antibodies (Anti-PGL-1) seropositivity, negative Mitsuda test, absence of Bacillus Calmette-Guérin (BCG) scar, positive Polymerase Chain Reaction (PCR) in blood; age and race; conviviality, education, contact time and type of contact, as well as elements related to the index case (bacilloscopic index; genetic conditions, family relationships), and some combined factors were shown to be relevant risk factors associated with the development of the disease in Brazilian leprosy contacts. The protective factors reported were the presence of one or more BCG scars, positive Mitsuda test, and education level. All selected studies were considered of high quality according to NOS. The knowledge of disease-related risk and protective factors provides the scientific basis for decision-making in the management of the disease in leprosy contacts.

Effect of biological disease-modifying antirheumatic drugs on body composition in patients with rheumatoid arthritis: a systematic review and meta-analysis

Abstract Background: Rheumatoid arthritis (RA) generates an inflammatory profile that predisposes to total and visceral fatty accumulation and reduced fat free mass (FFM). This metabolic disorder contributes to poor functionality, increased cardiovascular risk and higher mortality. This study aimed to address a systematic review with meta-analysis to determine the effect of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) on body composition (BC) of patients with RA. Methods: The search was conducted at the electronic databases PubMed, Cochrane Library, Embase, Lilacs and grey literature. This investigation was carried until July 2021. Outcomes of interest were total weight, body mass index (BMI), fat mass (FM) and FFM. A meta-analysis comparing these outcomes in RA patients under bDMARD treatment versus controls was performed. Results: Out of 137 studies reviewed, 18 were selected: fifteen prospective cohorts, two retrospective cohorts, and one cross-sectional study. The studies comprised 1221 patients, 778 on bDMARD treatment and 443 controls, which included RA patients under conventional synthetic DMARD (csDMARD). No study addressing BC analysis in patients using tsDMARD was found. The mean age and duration of the disease was 56.7 years and 6.77 years, respectively. Ten studies demonstrated a significant increase of total weight in 88.2% of patients and 42.3% for BMI. In studies that analyzed BC by double X-ray absorptiometry (DXA), the increase in total weight and BMI correlated positively to the increase in FFM. The meta-analysis carried out in five studies showed no significant difference of the mean difference for total weight 0.12 kg (95% CI − 5.58, 5.82), BMI 0.08 kg/m2 (95% CI − 1.76, 1.92), FM − 0.08 kg (95% IC − 5.31, 5.14), and FFM − 2.08 kg (95% CI − 7.37, 3.21). Conclusion: This systematic review suggests a possible impact of bDMARDs on BC of RA patients, even though, the meta-analysis carried out in a small part of these studies was not able to confirm significant variation in BC components. Trial registration: PROSPERO code: CRD42020206949.

Autocoleta de swab nasofaríngeo e teste molecular em pool testing como estratégias para detecção de coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2): viabilidade em estudantes de medicina da Universidade Federal de Minas Gerais, 2021 / Autocolección de hiopados nasofaríngeos y pruebas moleculares en pool testing como estrategias para la detección del Coronavirus Síndrome Respiratorio Agudo Severo 2 (SARS-CoV-2): viabilidad en estudiantes de medicina de la Universidad Federal de Minas Gerais, Brasil, 2021 / Self-collected nasopharyngeal swab and molecular test using pool testing as strategies to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): feasibility in medical students at the Universidade Federal de Minas Gerais, Brazil, 2021

Objetivo: Demonstrar a viabilidade da utilização combinada da autocoleta de swab nasofaríngeo e pool testing para detecção do SARS-CoV-2 em inquéritos epidemiológicos. Métodos: A experiência envolveu amostra de 154 estudantes da Universidade Federal de Minas Gerais, que realizaram a autocoleta do swab nasofaríngeo em cabines individuais e sem supervisão. O teste molecular foi realizado utilizando-se a técnica de pool testing. Resultados: A obtenção de amostras durou cerca de 5 minutos por pessoa. Realizou-se análise para detecção de RNA endógeno em 40 amostras e os resultados indicaram que não houve falhas decorrentes da autocoleta. Nenhum dos pools detectou presença de RNA viral. O custo da realização do teste molecular (RT-PCR) por pool testing com amostras obtidas por autocoleta foi cerca de dez vezes menor do que nos métodos habituais. Conclusão: As estratégias investigadas mostraram-se economicamente viáveis e válidas para a pesquisa de SARS-CoV-2 em inquéritos epidemiológicos.

Objetivo: Demostrar la viabilidad del uso combinado de la auto recolección de swabs nasofaríngeos y tests por agrupamiento (pool testing) para la detección del SARS-CoV-2 en encuestas epidemiológicas. Métodos: La prueba involucró a una muestra de 154 estudiantes de la Universidade Federal de Minas Gerais, quienes realizaron e autorecolectado del hisopo nasofaríngeo en cabinas individuales sin supervisión. La prueba molecular se realizó utilizando la técnica de prueba de grupo. Resultados: La obtención de muestras duró unos 5 minutos por persona. Se realizó un análisis para detectar ARN endógeno en 40 muestras y los resultados indicaron que no hubo fallas derivadas de la autorecolección. Ninguno de los grupos detectó la presencia de ARN viral. El costo de realizar una prueba molecular (RT-PCR) por pool con muestras obtenidas por auto-recolección fue aproximadamente 10 veces menor que con los métodos habituales. Conclusión: Las estrategias investigadas demostraron ser económicamente viables y válidas para la investigación del SARS-CoV-2 en encuestas epidemiológicas.

Objective: To show the feasibility of the combined use of self-collected nasopharyngeal swab and pool testing to detect SARS-CoV-2 in epidemiological surveys. Methods: This experience included a sample of 154 students at the Universidade Federal de Minas Gerais, who performed self-collected nasopharyngeal swab in individual cabins and without supervision. The molecular test was performed using the pool testing technique. Results: It took each person 5 minutes to collect the sample. An analysis was performed to detect endogenous RNA in 40 samples. The results showed that there were no failures resulting from self-collection. None of the pools detected the presence of viral RNA. The cost of molecular testing (RT-PCR), by pool testing, with samples obtained by self-collection was about ten times lower than the usual methods. Conclusion: The strategies that were investigated proved to be economically feasible and valid for the research on SARS-CoV-2 in epidemiological surveys.

Abdominal obesity-related risk factors in children from public schools of Barbacena, Minas Gerais, Brazil / Fatores associados à obesidade abdominal em crianças matriculadas na rede pública de ensino, Barbacena, Minas Gerais

ABSTRACT Objective: To evaluate the sociodemographic and lifestyle factors associated with abdominal obesity in children from public schools in Barbacena, state of Minas Gerais, Brazil. Methods: This is a cross-sectional study conducted on 326 students aged 7 to 9 years from public schools in the urban area of the city. Anthropometric data included body weight, height, body mass index according to age, waist circumference, and waist-to-height ratio. Food consumption was evaluated using the Previous Day Food Questionnaire. Abdominal obesity was assessed based on waist circumference and waist-to-height ratio. The bivariate and multivariate analyses were performed by logistic regression, estimating the crude and adjusted odds ratio (OR), with 95% confidence interval. Results: The prevalence of overweight was 30.7%; whereas the prevalence of abdominal obesity was 9.2 and 12.6% according to waist circumference and waist-to-height ratio, respectively. Boys (OR 2.76; 95%CI 1.22-6.25) and children from central schools (OR 2.73; 95%CI 1.08-6.80) presented an increased chance of abdominal obesity according to waist circumference. Abdominal obesity according to waist-to-height ratio was associated with the central location of the schools (OR 2.18; 95%CI 1.02-4.63) and the habit of skipping supper (OR 2.01; 95%CI 1.00-4.09). Conclusions: The findings showed that being a boy, studying in a central school, and skipping supper were the main risk factors associated with abdominal obesity.

RESUMO Objetivo: Avaliar os fatores sociodemográficos e de estilo de vida associados à obesidade abdominal em crianças de escolas públicas de Barbacena, Minas Gerais. Métodos: Trata-se de estudo transversal realizado com 326 escolares de sete a nove anos, matriculados em escolas da zona urbana da cidade. As variáveis antropométricas avaliadas foram peso, estatura, índice de massa corpórea por idade, circunferência da cintura e relação cintura-estatura. O consumo alimentar foi registrado pelo Questionário Alimentar do Dia Anterior. A obesidade abdominal foi avaliada com base na circunferência da cintura e relação cintura-estatura. As análises bivariada e multivariada foram realizadas por meio de regressão logística, estimando-se a Odds Ratio (OR) bruta e ajustada, com os intervalos de confiança de 95% (IC95%). Resultados: A prevalência de excesso de peso foi de 30,7%, enquanto a prevalência de obesidade abdominal foi de 9,2 e 12,6%, de acordo com circunferência da cintura e relação cintura-estatura, respectivamente. Crianças do sexo masculino (OR 2,76; IC95% 1,22-6,25) e de escolas centrais (OR 2,73; IC95% 1,08-6,80) tiveram maior chance de apresentar obesidade abdominal segundo a circunferência da cintura. A obesidade abdominal, de acordo com a relação cintura-estatura, associou-se à localização central das escolas (OR 2,18; IC95% 1,02-4,63) e à omissão da ceia (OR 2,01; IC95% 1,00-4,09). Conclusões: Os achados mostraram que ser do sexo masculino, estudar em escola central e omitir a ceia foram os principais fatores de risco associados à obesidade abdominal.

Galectin-3 and fibrosis intensity in Chronic Chagas Cardiomyopathy: a systematic review

ABSTRACT Chronic Chagas Cardiomyopathy (CCC) is the most prevalent type of myocarditis and the main clinical form of the Chagas disease, which has peculiarities such as focal inflammation, structural derangement, hypertrophy, dilation, and intense reparative fibrosis. Many cellular compounds contribute to CCC development. Galectin-3 is a partaker in inflammation and contributes to myocardial fibrosis formation. Some studies showed the connection between Galectin-3 and fibrosis in Chagas disease but are still inconclusive on the guidance for the early implementation of pharmacological therapy. This systematic review evaluated Galectin-3 as a biomarker for fibrosis intensity in CCC. Two independent reviewers have searched five databases (PubMed, EMBASE, Cochrane Library, Scopus, and Lilacs), using the following search terms: galectin-3, biomarkers, fibrosis, Chagas cardiomyopathy, and Chagas disease. Overall, seven studies met the inclusion criteria and made up this review. There were four trials conducted through animal model experiments and three trials with humans. Experimental data in mice indicate an association between Galectin-3 expression and fibrosis in CCC (75% of studies). Data from human studies showed no direct connection between myocardial fibrosis and Galectin-3 expression (80% of studies). Thus, human findings do not provide significant evidence indicating that Galectin-3 is related to fibrosis formation in Chagas disease. Based on the analyzed studies, it is suggested that Galectin-3 might not be a good fibrosis marker in CCC.

Polyphenols for improvement of inflammation and symptoms in rheumatic diseases: systematic review

ABSTRACT BACKGROUND: Rheumatic diseases (RDs) are a group of pathological conditions characterized by inflammation and functional disability. There is evidence suggesting that regular consumption of polyphenols has therapeutic effects capable of relieving RD symptoms. OBJECTIVE: To synthesize data from randomized controlled trials on administration of polyphenols and their effects on RD activity. DESIGN AND SETTING: Systematic review conducted at Universidade Federal de Ouro Preto, Minas Gerais, Brazil. METHODS: A systematic search was conducted in the databases PubMed (Medline), LILACS (BVS), IBECS (BVS), CUMED (BVS), BINACIS (BVS), EMBASE, Web of Science and Cochrane Library and in the grey literature. The present study followed a PRISMA-P checklist. RESULTS: In total, 646 articles were considered potentially eligible, of which 33 were then subjected to complete reading. Out of these, 17 randomized controlled trials articles were selected to form the final sample. Among these 17 articles, 64.71% assessed osteoarthritis (n = 11), 23.53% rheumatoid arthritis (n = 4), 5.88% rheumatoid arthritis and fibromyalgia (n = 1) and 5.88% osteoarthritis and rheumatoid (n = 1). Intake of polyphenol showed positive effects in most of the studies assessed (94.12%): it improved pain (64.70%) and inflammation (58.82%). CONCLUSION: Polyphenols are potential allies for treating RD activity. However, the range of polyphenol sources administered was a limitation of this review, as also was the lack of information about the methodological characteristics of the studies evaluated. Thus, further primary studies are needed in order to evaluate the effects of polyphenol consumption for reducing RD activity. SYSTEMATIC REVIEW REGISTER: PROSPERO - CRD42020145349.

Aumento de Óbitos Domiciliares devido a Parada Cardiorrespiratória em Tempos de Pandemia de COVID-19 / Increased Home Death Due to Cardiopulmonary Arrest in Times of COVID-19 Pandemic

Resumo Fundamento As doenças cardiovasculares constituem um grupo importante de causas de morte no Brasil. As doenças isquêmicas do coração são as principais causas de parada cardiorrespiratória, levando a um impacto na mortalidade devido às doenças cardiovasculares no sistema de saúde. Objetivo Avaliar o número de óbitos domiciliares por parada cardiorrespiratória notificados pelo Serviço de Atendimento Móvel de Urgência (SAMU) em março de 2018, 2019 e 2020. Métodos Trata-se de um estudo observacional realizado a partir da análise de dados de mortalidade por parada cardiorrespiratória de cidadãos atendidos pelo SAMU em Belo Horizonte, Minas Gerais, Brasil. Foram analisadas as características sociais e clínicas e as informações de ocorrência. Foi avaliada a taxa de mortalidade por parada cardiorrespiratória em relação ao número total de atendimentos. Foi considerado um nível de significância de 95%. Resultados Houve um aumento nos óbitos domiciliares por parada cardiorrespiratória em março de 2020, em comparação com março de 2018 (p < 0,001) e março de 2019 (p = 0,050). Dos óbitos relatados em 2020, 63,8% dos pacientes tinham 60 anos ou mais; 63,7% das ocorrências foram à tarde e aproximadamente 87% dos casos de parada cardiorrespiratória notificados apresentavam comorbidades clínicas, com hipertensão arterial sistêmicas e parada cardíaca correspondendo a 22,87% e 13,03% dos casos relatados, respectivamente. A maioria da amostra avaliada deste estudo não teve acompanhamento médico (88,7%). Conclusão Considerando o aumento do número de óbitos, sugerimos reflexões e reajustes quanto ao monitoramento das doenças crônicas não transmissíveis durante a pandemia, bem como melhorias na vigilância dos óbitos. (Arq Bras Cardiol. 2021; 116(2):266-271)

Abstract Background Cardiovascular diseases constitute an important group of causes of death in the country. Ischemic heart diseases that are the main causes of cardiopulmonary arrest, leading to an impact on the mortality of the cardiovascular diseases in the health system. Objective Assess the number of home deaths by cardiopulmonary arrest notified by the Mobile Emergency Medical Service (SAMU) in March 2018, 2019 and 2020. Methods Observational study carried out from the analysis of cardiopulmonary arrest mortality data of citizens assisted by SAMU in Belo Horizonte, Minas Gerais, Brazil. Social and clinical characteristics and occurrence information of the patients were analyzed. The mortality rate due to cardiopulmonary arrest in relation to the total number of attendances was assessed. A significance level of 95% was considered. Results There was increase of home deaths due to cardiopulmonary arrest in March 2020 compared to March 2018 (p<0.001) and March 2019 (p=0.050). Of the deaths reported in 2020, 63.8% of the patients were aged 60 years or older, 63.7% of the occurrences were performed in the afternoon and approximately 87% of the cardiopulmonary arrest notified had associated clinical comorbidities, with systemic arterial hypertension and heart failure represented by 22.87% and 13.03% of the reported cases, respectively. The majority of the evaluated sample of this study did not have any medical care follow-up (88.7%). Conclusion Considering the increase in the number of the deaths, we suggest reflections and readjustments regarding the monitoring of chronic non-transmissible diseases during a pandemic, as well as improvements in death surveillance. (Arq Bras Cardiol. 2021; 116(2):266-271)

Comparação de rótulos de doces diet e convencionais disponíveis aos consumidores: estudo exploratório descritivo com base na legislação federal vigente / Comparison of labels of twelve diets and conventional ones available to consumers: descriptive exploratory study based on current federal legislation

Este estudo tem como objetivo avaliar o custo e as conformidades das informações nutricionais nos rótulos dos doces diet e convencionais de acordo com as legislações vigentes. Trata-se de estudo exploratório descritivo em que foram avaliados 22 rótulos de doces diet e 22 correspondentes convencionais, da mesma marca de supermercados em Barbacena, Minas Gerais. Verificou-se a conformidade dos dados obtidos nos rótulos com as Resoluções RDC nº 360/2003; nº 359/2003; nº 259/2002, Portaria nº 29/1998 e Lei Federal nº 10.674/2003. Em relação às RDC nº 360/2003 e nº 259/2002, os produtos avaliados não apresentaram irregularidades. Entretanto, segundo a RDC nº 359/2003 observou-se que 9% nos doces diet e 9% dos doces convencionais estavam irregulares. De acordo com a Portaria nº 29/1998 houve 4,5% de irregularidades nos doces diet. As irregularidades apontadas por este estudo demonstram a necessidade de maior fiscalização dos órgãos competentes, pois a ausência de informações pode interferir na saúde dos consumidores, especialmente o público com necessidades específicas. As ausências de conformidades nos rótulos podem estar relacionadas a interpretação errônea da sociedade durante a escolha e a aquisição dos alimentos. (AU)

The aim of this study is to evaluate the cost and nutritional information of the labels of diet sweet and conventional sweet according to current legislation. It is an exploratory descriptive study evaluating 22 labels of diet sweets and 22 labels of their conventional correspondents, in supermarkets of Barbacena, Minas Gerais. It was verified the compliance of the data obtained on the labels with the RDC resolutions No.360/2003; No.359/2003; No. 259/2002, Ordinance No. 29/1998 and Federal Law No.10 674/2003. In relation to RDC No.360/2003 and No.259/2002, the evaluated products did not show irregularities. However, according to RDC No.359/2003, it was observed that 9% of diet sweets and 9% of conventional sweets were irregular and, according to Ordinance No. 29/1998, there were 4.5% irregularities in the diet sweets.The irregularities found by this study highlight the need for a greater control by the competent bodies since the lack of information can interfere with the health of consumers, especially the public with specific needs. The absence of conformities may be related to the misinterpretation of society during the choice and purchase of food. (AU)

Correlations among neck circumference and anthropometric indicators to estimate body adiposity in people living with HIV

Abstract INTRODUCTION: Neck circumference (NC) and anthropometric data of people living with HIV (PLWH) are correlated. METHODS: Socioeconomic, NC, body mass index (BMI), tricipital skinfold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), waist-hip ratio (WHR), waist-to-height ratio (WHtR), waist circumference (WC), and hip circumference (HC) data of 72 PLWH were correlated. RESULTS Higher adiposity was observed in NC (40.3% [n=29]) and WC (31.9% [n=23]). Correlations between NC/BMI, NC/WC, NC/HC, NC/MAC, NC/MAMC, and NC/WHtR were significant. Increased NC (40.3%[n=29]) and WC (31.9 [n=23]) were associated with higher cardiometabolic risk. CONCLUSIONS: NC correlations are adequate for estimating cardiometabolic risk.

Efetividade do tratamento antirretroviral após 12 e 66 meses em centro de referência para pessoas vivendo com HIV, Belo Horizonte, Minas Gerais - 2012 a 2018 / Effectiveness of antiretroviral treatment after 12 and 66 months at a reference centre for people living with HIV, Belo Horizonte, Minas Gerais; 2012-2018

A terapia antirretroviral (TARV) promoveu reduções drásticas na morbidade e mortalidade de pessoas vivendo com HIV (PVH). A utilização adequada da TARV requer monitoramento contínuo para avaliar a resposta terapêutica e identificar eventos adversos relacionados à administração a longo prazo. Trata-se de um estudo de coorte, realizado em centro de referência em doenças infecciosas, Belo Horizonte, Minas Gerais, com o objetivo de avaliar a efetividade da TARV entre 2012 e 2018. A população do estudo foi composta por 82 PVH que tiveram indicação para início da TARV entre janeiro a dezembro de 2012. A efetividade da TARV, definida como carga viral < 50 cópias/mL, foi de 75,6% e 80,5% após 12 e 66 meses de seu início, respectivamente. Os casos de falha terapêutica continham em prontuário informações sobre má-adesão e/ou abandono. Apesar da introdução tardia da TARV, a resposta terapêutica foi melhor às estimadas pelo Ministério da Saúde e semelhante a estudos de eficácia, demonstrando efetividade da TARV nos períodos analisados. Estes dados ratificam que a política brasileira de enfrentamento da epidemia de HIV/ Aids, de distribuição universal, é exitosa e deve ser mantida e aprimorada para evitar eventuais falhas terapêuticas.

The antiretroviral therapy (ART) has caused a significant reduction in morbidity and mortality in people living with HIV (PLH). The appropriate use of the ART demands continuous monitoring in order to assess the therapeutic response and identify adverse events related to medium and long-term ART exposure. The aim of this study is to evaluate the effectiveness of ART between 2012 and 2018. It is a prospective cohort study carried out at a reference centre of infectious diseases in Belo Horizonte, Minas Gerais - Brazil. The population of this study was composed of 82 PLH who had indication for the beginning of ART between January and December 2012. The effectiveness of ART, defined as viral load < 50 copies/mL, was of 75.6% and 80.5% after 12 and 66 months, respectively. The cases of treatment failure registered in medical records had information of poor adhesion and abandonment of treatment. In spite of the late introduction of ART in this population, the therapeutic response was better than the values described by Ministry of Health and similar to efficacy studies. These data ratify that the Brazilian public policies of combating HIV/AIDS epidemic, of universal distribution, have been successful and must be kept and improved to avoid possible treatment failures.

Detection of SARS-CoV-2 through pool testing for COVID-19: an integrative review

Abstract INTRODUCTION: The pool testing technique optimizes the number of tests performed and reduces the delivery time of results, which is an interesting strategy for the health crisis caused by the COVID-19 pandemic. This integrative review investigated studies in which pool testing was carried out for epidemiological or screening purposes to analyze its clinical or cost effectiveness and assessed the applicability of this method in high-, middle-, and low-income countries. METHODS: This integrative review used primary studies published in the MEDLINE, EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Cochrane Library databases. RESULTS: A total of 435 studies were identified: 35.3% were carried out in Asia, 29.4% in Europe, 29.4% in North America, and 5.9% in Oceania. CONCLUSIONS: This review suggests that pool testing in the general population may be a useful surveillance strategy to detect new variants of SARS-CoV-2 and to evaluate the period of immunogenicity and global immunity from vaccines.

Profile of drug-drug interactions and impact on the effectiveness of antiretroviral therapy among patients living with HIV followed at an Infectious Diseases Referral Center in Belo Horizonte, Brazil

ABSTRACT HIV infection may be considered a chronic condition for people living with HIV with access to antiretrovirals and this has effectively increased survival. Moreover, this has also facilitated the emergence of other comorbidities increasing the risk for drug-drug interactions and polypharmacy. The profile of these interactions as well as their consequences for people living with HIV are still not completely elucidated. The objectives of this study were to describe the profile of these interactions, their prevalence and their classification according to the potential for significant or non-significant drug-drug interactions. From June 2015 to July 2016, people living with HIV on follow-up at an Infectious Diseases Referral Center in Belo Horizonte, Brazil have been investigated for the presence of drug-drug interactions. A total of 304 patients were included and the majority (75%) had less than 50 years of age, male (66.4%), and 37.8% self-defined as brown skinned. Approximately 24% were on five or more medications and half of them presented with drug-drug interactions. Patients older than 50 years had a higher frequency of antiretrovirals drug-drug interactions with other drugs compared to younger patients (p = 0.002). No relationship was found between the number of drug-drug interactions and the effectiveness of antiretrovirals. As expected, the higher the number of non-HIV medications used (OR = 1.129; 95%CI 1.004-1.209; p = 0.04) was associated with an increase in drug-drug interactions. The high prevalence of drug-drug interactions found and the data collected should be useful to establish measures of quaternary prevention and to increase the medication security for people living with HIV.

Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review / Fatores de risco associados aos desfechos da meningite bacteriana pediátrica: uma revisão sistemática

Abstract Objective: The aim of this study was to systematically review the literature and answer the following central question: "What are the risk factors associated with worse clinical outcomes of pediatric bacterial meningitis patients?" Methods: The articles were obtained through literary search using electronic bibliographic databases: Web of Science, Scopus, MEDLINE, and LILACS; they were selected using the international guideline outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. Results: The literature search identified 1,244 articles. After methodological screening, 17 studies were eligible for this systematic review. A total of 9,581 patients aged between 0 days and 18 years were evaluated in the included studies, and several plausible and important prognostic factors are proposed for prediction of poor outcomes after bacterial meningitis in childhood. Late diagnosis reduces the chances for a better evolution and reinforces the importance of a high diagnostic suspicion of meningitis, especially in febrile pictures with nonspecific symptomatology. S. pneumoniae as a causative pathogen was demonstrated to be related to clinical severity. Conclusions: Early prediction of an adverse outcome may help determine which children require more intensive or longer follow-up and may provide the physician with rationale for parental counseling about their child's prognosis in an early phase of the disease.

Resumo Objetivo O objetivo deste estudo é revisar sistematicamente a literatura e responder à seguinte questão central: "Quais são os fatores de risco associados a piores desfechos clínicos de pacientes pediátricos com meningite bacteriana?". Métodos Os artigos foram obtidos através de pesquisa bibliográfica, nas bases de dados eletrônicas Web of Science, Scopus, Medline e Lilacs, e selecionados com diretriz internacional delineada pela abordagem Prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Resultados A pesquisa bibliográfica identificou 1.244 artigos. Após a triagem metodológica, 17 estudos foram considerados elegíveis para esta revisão sistemática. Foram avaliados 9.581 pacientes até 18 anos nos estudos incluídos e vários fatores prognósticos plausíveis e importantes são propostos para a previsão de desfechos piores após meningite bacteriana na infância. O diagnóstico tardio reduz as chances de uma melhor evolução e reforça a importância de uma alta suspeita diagnóstica de meningite, especialmente em quadros febris com sintomatologia inespecífica. S. pneumoniae como patógeno causador demonstrou estar relacionado à gravidade clínica. Conclusões A previsão precoce de um desfecho clínico desfavorável pode ajudar a determinar quais crianças necessitam de uma abordagem mais invasiva ou seguimento mais prolongado e pode fornecer ao médico a justificativa para o aconselhamento dos pais sobre o prognóstico de seu filho em uma fase inicial da doença.

Avaliação da adequação nutricional de cardápios escolares em uma instituição da rede pública de ensino na região Sudeste de Minas Gerais / Evaluation of the nutritional adequacy of school menus in a public school in the Southeast region of Minas Gerais

Este estudo teve como objetivo verificar a adequação dos cardápios da alimentação escolar com a legislação do Programa Nacional de Alimentação Escolar (PNAE), quanto ao valor calórico, quantidade de macronutrientes, vitaminas A e C, cálcio, ferro, magnésio, zinco e fibras dietéticas. Foram avaliados 20 cardápios destinados a uma escola da rede pública que atende às faixas etárias de 6 a 10 anos e 11 a 15 anos, localizada no sudeste de Minas Gerais. Os cardápios analisados não contemplaram todas as recomendações de nutrientes e de energia para ambas faixas etárias, sendo a maior inadequação para o cálcio. Foi verificado que os mesmos cardápios e per capita eram utilizados para ambas faixas etárias, apesar do PNAE determinar necessidades nutricionais diferentes. Desta forma, as necessidades da faixa etária de 6 a 10 anos foi melhor atendida, com maior percentual de cardápios adequados em relação a carboidrato, proteína, lipídios, vitamina C, ferro, magnésio e zinco, quando comparado aos escolares de idade igual ou maior a 11 anos (p<0,05). Com os resultados obtidos, concluímos que ações corretivas em relação ao planejamento de refeições do cardápio da escola avaliada precisam ser realizadas respeitando a diferença entre as faixas etárias. (AU)

This study aimed to verify the adequacy of school feeding menus with the legislation of the National School Feeding Program (PNAE), regarding caloric value, quantity of macronutrients, vitamins A and C, calcium, iron, magnesium, zinc and dietary fibers. We evaluated 20 menus destined to a public school that serves the age groups of 6 to 10 years and 11 to 15 years at Southeast of Minas Gerais. The menus analyzed did not contemplate all the nutrient and energy recommendations for both age groups being the greatest inadequacy for calcium. It was verified that the same menus and per capita were used for both age groups although the PNAE determined different nutritional needs. Thus, the needs of the 6 to 10 years old age group were better met, with a higher percentage of adequate menus in relation to carbohydrates, protein, lipids, vitamin C, iron, magnesium and zinc, when compared to children with aged 11 years or older (p<0.05). We conclude that corrective actions in relation to the meal planning of the menu of the school evaluated must be carried out respecting the difference between age groups. (AU)

Avaliação da adequação nutricional de cardápios escolares em uma instituição da rede pública de ensino na região Sudeste de Minas Gerais / Evaluation of the nutritional adequacy of school menus in a public school in the Southeast region of Minas Gerais

Este estudo teve como objetivo verificar a adequação dos cardápios da alimentação escolar com a legislação do Programa Nacional de Alimentação Escolar (PNAE), quanto ao valor calórico, quantidade de macronutrientes, vitaminas A e C, cálcio, ferro, magnésio, zinco e fibras dietéticas. Foram avaliados 20 cardápios destinados a uma escola da rede pública que atende às faixas etárias de 6 a 10 anos e 11 a 15 anos, localizada no sudeste de Minas Gerais. Os cardápios analisados não contemplaram todas as recomendações de nutrientes e de energia para ambas faixas etárias, sendo a maior inadequação para o cálcio. Foi verificado que os mesmos cardápios e per capita eram utilizados para ambas faixas etárias, apesar do PNAE determinar necessidades nutricionais diferentes. Desta forma, as necessidades da faixa etária de 6 a 10 anos foi melhor atendida, com maior percentual de cardápios adequados em relação a carboidrato, proteína, lipídios, vitamina C, ferro, magnésio e zinco, quando comparado aos escolares de idade igual ou maior a 11 anos (p<0,05). Com os resultados obtidos, concluímos que ações corretivas em relação ao planejamento de refeições do cardápio da escola avaliada precisam ser realizadas respeitando a diferença entre as faixas etárias.

This study aimed to verify the adequacy of school feeding menus with the legislation of the National School Feeding Program (PNAE), regarding caloric value, quantity of macronutrients, vitamins A and C, calcium, iron, magnesium, zinc and dietary fibers. We evaluated 20 menus destined to a public school that serves the age groups of 6 to 10 years and 11 to 15 years at Southeast of Minas Gerais. The menus analyzed did not contemplate all the nutrient and energy recommendations for both age groups being the greatest inadequacy for calcium. It was verified that the same menus and per capita were used for both age groups although the PNAE determined different nutritional needs. Thus, the needs of the 6 to 10 years old age group were better met, with a higher percentage of adequate menus in relation to carbohydrates, protein, lipids, vitamin C, iron, magnesium and zinc, when compared to children with aged 11 years or older (p<0.05). We conclude that corrective actions in relation to the meal planning of the menu of the school evaluated must be carried out respecting the difference between age groups.

Práticas alimentares de estudantes universitários da área da saúde, de acordo com as recomendações do Guia Alimentar para a População Brasileira / Food practices of health university students according to the recommendations of the Dietary Guidelines for the Brazilian Population

Introdução: As práticas alimentares dos indivíduos são influenciadas pelo ambiente em que eles estão inseridos. Estudantes universitários, ao ingressarem no ensino superior, podem modificar seus hábitos alimentares em função de novos comportamentos e relações sociais que se estabelecem nesta nova fase da vida. Objetivo: Avaliar as práticas alimentares de estudantes universitários ingressantes no 1º semestre dos cursos da área da saúde de uma instituição federal de ensino superior, de acordo com as recomendações do Guia Alimentar para a População Brasileira. Métodos: Estudo transversal com estudantes universitários dos cursos de graduação da área da saúde de uma instituição pública do ensino superior. As práticas alimentares foram obtidas através da escala desenvolvida e validada por Gabe e Jaime (2019). Foram avaliadas as características sociodemográficas, hábitos de vida e condições de saúde. A análise dos dados compreendeu distribuição de frequência e análise bivariada. Resultados: Foram entrevistados 148 estudantes, dos quais 58,1% eram mulheres, 61,5% tinham 20 anos ou menos, com idade variando de 18 a 31 anos. Práticas alimentares inadequadas foram observadas em 23,7% dos estudantes, 52,0% mostraram práticas de risco e 24,3%, adequadas. O somatório das categorias de risco e inadequação foi representado por 75,7% dos estudantes. Homens apresentaram maior frequência de práticas alimentares de risco (64,5%) e mulheres, maior frequência de práticas alimentares inadequadas (29,1%) (p=0,033). Conclusão: Observou-se alta frequência (75,7%) de práticas alimentares inadequadas no público estudado. Ao comparar as variáveis explicativas com as práticas alimentares, observou-se associação positiva entre o sexo e as práticas alimentares dos estudantes. (AU)

Introduction: Dietary practices are influenced by the environment. When entering higher education, university students may change their eating habits by developing new behaviors and social relationships in this new phase of life. Objective: To evaluate the dietary practices of first-semester university students enrolled health sciences courses at a federal institution of higher education, according to the recommendations of the Guia Alimentar para a População Brasileira [Dietary Guidelines for the Brazilian population]. Methods: Cross-sectional study with university students from health sciences courses of a public institution of higher education. Dietary practices were assessed using the scale developed and validated by Gabe and Jaime (2019). Sociodemographic characteristics, lifestyle and health status were assessed. Data analysis comprised frequency distribution and bivariate analysis. Results: In total, 148 students were interviewed, of whom 58.1% were women, and 61.5% were 20 years of age or younger, with ages ranging from 18 to 31 years. Inadequate dietary practices were observed in 23.7% students, 52.0% showed risky practices and 24.3% adequate practices. The sum of the risk and inadequacy categories was represented by 75.7% students. Men had a higher frequency of risky dietary practices (64.5%), and women had a higher frequency of inadequate dietary practices (29.1%) (p = 0.033). Conclusion: A high frequency (75.7%) of inadequate dietary practices was observed in the university students. The comparison between explanatory variables and dietary practices showed a positive association between the sex and dietary practices of the students. (AU)

Biscoitos sem glúten versus com glúten: composição nutricional, ingredientes e custo / Cookies gluten-free versus gluten-containing cookies: nutritional composition, ingredients and cost

O objetivo deste estudo foi comparar ingredientes, informação nutricional e valor financeiro de biscoitos isentos e com glúten. A amostra foi composta por 25 unidades de biscoitos sem glúten e 25 unidades com este componente, disponíveis em lojas de produtos naturais e em hipermercados do município de Barbacena/MG. As informações nutricionais foram obtidas por meio dos rótulos. Não houve diferença estatística entre os valores calóricos de biscoitos com e sem glúten ou acerca dos valores de carboidratos, gorduras totais e saturadas, fibras ou sódio. A quantidade de proteínas foi estatisticamente menor nos biscoitos sem glúten (p < 0,001) e os substitutos da farinha de trigo mais utilizados foram as fontes amiláceas: amido de milho e farinha de arroz. O preço dos biscoitos isentos de glúten foi significativamente maior comparado aos biscoitos com glúten (p < 0,001). Então, os biscoitos isentos de glúten avaliados possuem menor valor nutricional devido ao teor proteico reduzido, e maior custo, comparado ao biscoito com glúten.

The aim of this study was to compare ingredients, nutritional information and financial support of gluten-free and cookies with gluten. The sample consisted of 25 gluten-free cookies units and 25 with cookies with gluten units, available at health products stores and hypermarkets at the Barbacena city. Nutritional information was obtained through labels. There was not statistical difference between the caloric values of cookies with and without gluten or about the values of carbohydrates, total and saturated fats, fiber or sodium. The amount of protein was statistically lower in gluten-free cookies (p < 0.001) and the most used wheat flour substitutes were starchy sources: corn starch and rice flour. The price of gluten-free cookies was significantly higher compared to gluten-free cookies (p < 0.001). So, the gluten-free cookies evaluated have less nutritional value due to the reduced protein content and higher cost compared to the cookies with gluten