Tuberculosis/HIV co-infection in Northeastern Brazil: Prevalence trends, spatial distribution, and associated factors.

INTRODUCTION: The objective was to analyze the prevalence trend, spatial distribution, and TB-HIV co-infection-associated factors in an endemic scenario for TB in Northeastern Brazil. METHODS: An ecological and temporal series study was conducted based on secondary data obtained from the Brazilian Notifiable Diseases Information System between January 2008 and December 2019. The prevalence rates were determined for each year and the average for the period. Prais-Winsten regressions were used for temporal variation analysis, scanning techniques were used to detect spatial clusters, and the Poisson regression model was used to explore the factors associated with the outcome. RESULTS: A total of 947 TB cases were reported, of which 501 (52.9%) underwent HIV testing, and of these, 73 were positive. The average prevalence was 20.0%, ranging from 1.5% in 2018 to 44.4% in 2009. A decreasing trend was found. Sixty-seven cases (92%) were geocoded, and two statistically significant (p < 0.005) high relative risk (RR) spatial clusters were detected. Statistically significant associations (p < 0.05) between the co-infection and variables such as male gender, living in the urban area, entry due to relapse, and case closure due to loss to follow-up were evidenced, and these variables constituted risk factors. CONCLUSIONS: A decreasing prevalence of TB-HIV co-infection has been found, as well as a heterogeneous spatial distribution with the formation of spatial clusters in urban areas characterized by socio-spatial inequalities associated with clinical-epidemiological factors. Such findings provide subsidies for rethinking health care activities and improving public policies for vulnerable populations.

Vulnerable territories to tuberculosis-diabetes mellitus comorbidity in a northeastern Brazilian scenario.

INTRODUCTION: Epidemiological investigations on tuberculosis-diabetes comorbidity using spatial analysis should be encouraged towards a more comprehensive view of the health of individuals affected by such comorbidity in different contexts. This study analyzes the territories vulnerable to tuberculosis-diabetes comorbidity in a municipality in northeastern Brazil using spatial analysis techniques. METHODS: An ecological study was carried out in Imperatriz, Maranhão, Brazil. Tuberculosis-diabetes cases reported in the Brazilian Notifiable Diseases Information System between 2009 and 2018 were analyzed. Kernel density estimation and spatial scanning techniques were used to identify the areas with the greatest occurrence of spatial clusters. RESULTS: A heterogeneous spatial distribution was found, ranging from 0.00 to 4.12 cases/km2. The spatial scanning analysis revealed three high-risk spatial clusters with statistical significance (p < 0.05), involving eleven strictly urban sectors with a relative risk of 4.00 (95% CI: 2.60-6.80), 5.10 (95% CI: 2.75-7.30), and 6.10 (95% CI: 3.21-8.92), indicating that the population living in these areas had a high risk of tuberculosis-diabetes comorbidity. CONCLUSIONS: The highest concentration of cases/km2, as well as risk clusters, were found in areas with high circulation of people and socio-economic and environmental vulnerabilities. Such findings reinforce the need for public health interventions to reduce social inequalities.

Consumption of caffeinated and decaffeinated coffee enriched with cocoa and fructo-oligosaccharides among non-diabetic persons: Double blind randomized clinical trial.

Food industry has been investing in bringing to the market coffee-based drinks enriched in compounds that promise weight loss, which consequently influences diabetes risk. However, there are no clinical trials showing the effects of brewed coffee (with or without caffeine) enriched with bioactive compounds on body fat and glycemic control in healthy individuals. Therefore, we have evaluated the effect of consuming two coffee formulas enriched with cocoa and fructo-oligosaccharides (FOS) on glycemic and anthropometric biomarkers and blood pressure in non-diabetic adults for 10 weeks. In general, we observed that the values of fasting plasma glucose (FPG) (p = .006) and fasting capillary blood glucose (FCBG) (p < .001) had lower values with a tendency to decrease in FCG (p = .003) and FBG (p < .005) in both formulas. We observed statistically significant reductions in waist circumference (WC) (p = .012), arm circumference (AC) (p = .015), and percentage of fat (<0.0001) for all participants. However, we noticed a greater reduction in the caffeinated formula group (-2.92%, p = .005) compared to the decaffeinated formula (-1.62%, p = .008). Consumers of both cocoa and FOS-enriched coffee formulas benefited from reduced FBG, FCG, WC, and body fat percentage. The consumption of caffeinated formula was more effective in reducing the percentage of fat, while the decaffeinated formula was more effective in reducing diastolic blood pressure. PRACTICAL APPLICATIONS: This study provides robust evidence that effects of fortified coffee on non-diabetic people is positive for reduction in blood glucose, body fat and diastolic blood pressure. This study proposes a practical and safe coffee formulation for the consumption of caffeinated and decaffeinated coffee for non-diabetic people.

Helicobacter Pylori cagA+ Genotype is Associated With Consumption of Untreated Drinking Water in North-Eastern Brazil.

INTRODUCTION: This study aimed to identify the Helicobacter pylori cagA+ genotype prevalent in a region of north-eastern Brazil and find possible associations between this genotype and socioeconomic variables. METHODS: This cross-sectional study included 751 patients with dyspepsia from a public endoscopy clinic. Genotyping was carried out on 98 samples from gastric tissue with positive urease test for H. pylori using polymerase chain reaction (PCR). Socioeconomic variables were collected via forms. Pearson's χ2 test was used to analyze associations between variables and odds ratios were obtained to compare effects. Statistical significance was defined as p < 0.05 for univariate and multivariate analyses. RESULTS: H. pylori infection was present in 52.7% of the patients and associated with low income and consumption of untreated drinking water. The prevalence of the cagA+ genotype was 25.5%. Low income was inversely related to the presence of cagA+ genotype, even after adjustment. Untreated drinking water consumption was associated with the presence of the cagA+ genotype in both the univariate (p = 0.03; OR = 2.55; 95% CI: 1.008-6.48) and multivariate (p = 0.03; OR = 2.89; 95% CI: 1.08-7.67) analyses. CONCLUSION: The findings of this study suggest that water can be an important vehicle for the transmission of pathogenic H. pylori strains and may be a public health challenge, especially in less developed regions with precarious water and sanitary conditions.

Effects of Cashew Nut (Anacardium occidentale L.) Seed Flour in Moderately Malnourished Children: Randomized Clinical Trial.

The monitoring and combined use of dietary supplements to restore adequate growth are paramount and highly recommended in child malnutrition, an important public health problem. The objective of this study was to analyze the effects of cashew nut seed flour in children with moderate malnutrition, treated at primary healthcare services. This is a randomized clinical trial conducted from April to October 2017 in the city of Imperatriz, Brazil. The sample comprised 30 children born at term, aged between 2 and 5 years, and newly diagnosed with malnutrition (60 days or less), randomized into experimental and control groups. The intervention consisted of daily intake of cashew nut seed flour. There was intragroup statistically significant difference in the glucose levels of children who were assigned to the control group (p=0.02) and in the glycated hemoglobin in the experimental group (p < 0.01). Intergroup analysis of glycated hemoglobin levels showed statistically significant differences in favor of the experimental group (p=0.01). HDL and LDL had, respectively, increased and decreased in the experimental group. The use of cashew nut seed flour in a 24-week period had positive effects on glycated hemoglobin, HDL, and LDL parameters in moderately malnourished children.

Comparison between Two Decades of Prevalence of Intestinal Parasitic Diseases and Risk Factors in a Brazilian Urban Centre.

Objectives. This study's objective was to compare the prevalence of intestinal parasites and associated risk factors in children in urban communities, in the Brazilian Northeast, between two decades. Methods. This quantitative transversal study consisted of a comparative analysis of two different samples: the first viewing the years 1992-1996 and the other through a coproepidemiological data survey undertaken in 2010-2011. Results. It was evidenced that there was a reduction of intestinal parasites and that there were improvements in the socioenvironmental conditions between the two decades evaluated. It was observed that, in the period 1992-1996, playing out in the streets was associated with a higher risk for acquiring intestinal parasites. Over the 2010-2011 period, the characteristics of more than five residents per household, houses with dirt floors, children who live in homes without piped water, and children who play out in the streets were associated with a higher risk of intestinal parasitic infection. Conclusion. The study showed a reduction of intestinal parasitic diseases to 23.8% in 2010-2011 from 81.3% in 1992-1996 and improvement of the social-sanitary conditions of the population between the decades analyzed.