Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil / Avaliação antropométrica longitudinal de lactentes nascidos de mães infectadas pelo HIV-1 / Evaluación antropométrica longitudinal de lactantes nacidos de madres infectadas por VIH-1

OBJECTIVE: To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS: The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fitted using a restricted maximum likelihood. RESULTS: There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS: The precocious and increasing deterioration of the HIV-infected infants' anthropometric indicators demonstrates the importance of the early identification of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.

OBJETIVO: Avaliar os parâmetros de crescimento em lactentes nascidos de mães infectadas com o HIV-1. MÉTODOS: Avaliação longitudinal dos z-escores peso-idade (PI), estatura-idade (EI), peso-estatura (PE) foi realizada em uma coorte. Foram estudados 97 lactentes não-infectados e 33 lactentes infectados nascidos de mães infectadas com o HIV-1 em Belo Horizonte, MG, de 1995 a 2003. O tempo mediano de seguimento para os lactentes infectados e não-infectados foi de 15,8 meses (variação: 6,8 a 18,0 meses) e 14,3 meses (variação: 6,3 a 18,6 meses), respectivamente. Utilizou-se o modelo de regressão linear de efeitos mistos ajustado por máxima verossimilhança restrita para construir as curvas de crescimento. RESULTADOS: Os z-escores PI, EI e PE dos lactentes infectados com o HIV-1 apresentaram decréscimo. Aos seis meses, a diferença média nos z-escores PI, EI e PE entre lactentes infectados e não-infectados com o HIV era, respectivamente, 1,02, 0,59 e 0,63 desvios-padrão. Aos 12 meses, a diferença média nos z-escores PI, EI e PE entre lactentes infectados e não-infectados era, respectivamente, 1,15, 1,01 e 0,87 desvios-padrão. CONCLUSÕES: O comprometimento precoce e crescente dos indicadores antropométricos de crianças infectadas com o HIV-1 mostra a importância de identificar precocemente crianças infectadas com o HIV que estão em risco nutricional e a necessidade de se avaliarem continuamente as intervenções nutricionais adotadas.

OBJETIVO: Evaluar los parámetros de crecimiento en lactantes nacidos de madres infectadas con el VIH-1. MÉTODOS: Evaluación longitudinal de los z-escores peso-edad (PI), estatura-edad (EI), peso-estatura (PE) fue realizada en una cohorte. Fueran estudiados 97 lactantes no infectados y 33 lactantes infectados nacidos de madres infectadas con el VIH-1 en Belo Horizonte, Sureste de Brasil, de 1995 a 2003. El tiempo medio de seguimiento para los lactantes infectados y no infectados fue de 15,8 meses (variación: 6,8 a 18,0 meses) y 14,3 meses (variación: 6,3 a 18,6 meses), respectivamente. Se utilizó el modelo de regresión linear de efectos mixtos ajustado por máxima verosimilitud restringida para construir las curvas de crecimiento. RESULTADOS: Los z-escores PI, EI y PE de los lactantes infectados con el VIH-1 presentaron decrecimiento. A los seis meses, la diferencia promedio en los z-escores PI, EI y PE entre lactantes infectados y no infectados con el VIH era, respectivamente, 1,02, 0,59 y 0,63 desviaciones-estándares. A los 12 meses, la diferencia promedio en los z-escores PI, EI y PE entre lactantes infectados y no infectados era, respectivamente, 1,15, 1,01 y 0,87 desviaciones-estándares. CONCLUSIONES: El comprometimiento precoz y creciente de los indicadores antropométricos de niños infectados con el VIH-1 muestra la importancia de identificar precozmente niños infectados con el VIH que están en riesgo nutricional y la necesidad de evaluarse continuamente las intervenciones nutricionales adoptadas.

Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil.

OBJECTIVE: To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS: The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fitted using a restricted maximum likelihood. RESULTS: There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS: The precocious and increasing deterioration of the HIV-infected infants' anthropometric indicators demonstrates the importance of the early identification of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.

Early right cardiac dysfunction in patients with schistosomiasis mansoni.

BACKGROUND: Pulmonary hypertension (PH) is a complication of schistosomiasis mansoni (SM), mainly in the hepatosplenic form. However, its prevalence is not well established. We evaluated the usefulness of Doppler echocardiographic indexes to detect right heart dysfunction in SM. METHODS: A total of 83 patients divided into two groups were studied: Group 1: 44 patients with hepatosplenic SM, and Group 2: 39 patients with hepatointestinal SM who served as controls. All patients underwent a Doppler echocardiogram. Right ventricular end-diastolic area (RVEDA), the peak systolic tricuspid annular tissue velocity (S'), right ventricular index of myocardial performance (RVIMP) and right atrial area (RAA) were measured in all patients. Tricuspid regurgitation peak velocity (TR) was measured and the pressure gradient (TG) was obtained. RESULTS: The prevalence of patients with elevated systolic pulmonary artery pressure at echocardiography was 31% in hepatosplenic patients, while no patient with the hepatointestinal form presented PH. Patients with hepatosplenic SM had larger RVEDA (10.0 ± 2.8 vs. 8.5 ± 1.8 cm(2) /m, P = 0.006) and RAA (9.39 [8.3-11.0] vs. 7.7 [6.9-8.4 cm(2) /m], P < 0.001). There was correlation between TG and RVIMP (r = 0.58; P < 0.001) and between TG and RAA (r = 0.36; P = 0.03) in Group 1. CONCLUSION: Larger RAA and RVEDA were found in patients with hepatosplenic SM, when compared to patients with the hepatointestinal form, which may suggest early impairment of RV function in patients with hepatosplenic SM.

Longitudinal growth of infants born to HIV-1-infected mothers in Belo Horizonte, Brazil.

OBJECTIVE: To prospectively evaluate growth parameters assessed by weight and length in infected and uninfected infants born to HIV-1-infected mothers and followed from birth to 18 months. METHODS: A cohort consisting of ninety-seven uninfected and forty-two infected infants born to HIV-infected mothers enrolled from 1995 to 2004, and admitted during their first 3 months of life at a referral Pediatric AIDS Clinic in Belo Horizonte, Brazil. Infants were followed until 18 months of age. Data were analysed using mixed-effects linear regression models for weight and length fitted by restricted maximum likelihood. RESULTS: Infected infants contributed to 466 weight and 411 recumbent length measurements. Uninfected infants provided 924 weight and 907 length measurements. Mean birth weight and length were similar in both groups, 3.1 (sd 0.4) and 3.0 (sd 0.5) kg, and 48.7 (sd 1.4) and 48.8 (sd 2.9) cm for uninfected and infected infants, respectively. However, HIV-1 infection had an early impact in growth impairment: at 6 months of age, HIV-infected children were 1 kg lighter and 2 cm shorter than the uninfected. CONCLUSIONS: Growth faltering in weight, but not length, in HIV-infected children in Brazil is more marked than that reported in a European cohort, probably reflecting background nutritional deficiencies and concomitant infections. In these settings, early and aggressive nutritional management in HIV-1-infected infants should be a priority intervention associated with the antiretroviral therapy.

Impaired warm and cold perception thresholds in leprosy skin lesions.

The aim of the present study was to determine the frequency of alteration in warm perception thresholds (WPT), cold perception thresholds (CPT) and the warm and cold perception interval (WCPI) in leprosy-suspected skin lesions, and to determine if these tests could assist in the diagnosis of leprosy. Tests were conducted using a thermal sensory analyser TSA-2001 (Medoc Ltd, Israel) and the method of levels. A cross-sectional study of 112 patients presenting leprosy-suspected skin lesions ('patch'), with no clinical evidence of peripheral nerve damage, was conducted. Leprosy diagnosis was based on clinical dermato-neurological examinations and complementary tests. One hundred and eight subjects (45 males, 63 females; average age 37.7 years) completed the tests: 82 were positively diagnosed with leprosy and 26 with diseases of different etiologies. The mean values of WPT (45-63 +/- 5.59), CPT (9.64 +/- 11.34) and WCPI 36.01 +/- 15.58) registered in leprosy-skin lesions were significantly different (P < 0.001) from lesions of diverse aetiologies and skin area without lesions. The cut-off point for WPT as determined from the ROC curve (receiver operating characteristic) was 35-10 degrees C, with a sensitivity of 90.2% and a specificity of 100%, and the corresponding cut-off point for CPT was 28.95 degrees C, with a sensitivity of 92.7% and a specificity of 100%. Nevertheless, all patients with leprosy presented a WCPI greater than 6.10 degrees C (ROC curve) in skin lesions. Increase in the thermal thresholds indicated warm hypoaesthesia, cold hypoaesthesia or both. The WCPI, which embraces both warm and cold perception thresholds, was the best indicator of thermal sensation, a term used in literature as a non-specific expression that does not describe warm and cold stimuli explicitly in terms of units of temperature.

Diagnosing human asymptomatic visceral leishmaniasis in an urban area of the State of Minas Gerais, using serological and molecular biology techniques.

A population-based cross-sectional study was set up in Sabará country, Southeastern Brazil, to identify asymptomatic human visceral leishmaniasis in an urban area of low disease prevalence. Blood was collected on filter paper (n=1,604 inhabitants) and examined by indirect immunofluorescent test, enzyme-linked immunosorbent assay and immunochromatographic strip test. The prevalence rates of infection ranged from 2.4 to 5.6% depending on the test used. One year later, venous blood was collected in a subset of 226 participants (102 seropositive and 124 seronegative). The tests performed were IFAT, ELISA, rk39-ELISA, polymerase chain reaction and hybridization with Leishmania donovani complex probe. No clinical signs or symptoms of leishmaniasis were observed. Using hybridization as a reference test, the sensitivity and specificity of serology were respectively: 24.8 and 71% (ELISA); 26.3 and 76.3% (rk-39); 30.1 and 63.4% (IFAT). Due to disagreements, different criteria were tested to define the infection and hybridization should be considered in epidemiological studies.

Diagnosing human asymptomatic visceral leishmaniasis in an urban area of the State of Minas Gerais, using serological and molecular biology techniques

A population-based cross-sectional study was set up in Sabará country, Southeastern Brazil, to identify asymptomatic human visceral leishmaniasis in an urban area of low disease prevalence. Blood was collected on filter paper (n=1,604 inhabitants) and examined by indirect immunofluorescent test, enzyme-linked immunosorbent assay and immunochromatographic strip test. The prevalence rates of infection ranged from 2.4 to 5.6 percent depending on the test used. One year later, venous blood was collected in a subset of 226 participants (102 seropositive and 124 seronegative). The tests performed were IFAT, ELISA, rk39-ELISA, polymerase chain reaction and hybridization with Leishmania donovani complex probe. No clinical signs or symptoms of leishmaniasis were observed. Using hybridization as a reference test, the sensitivity and specificity of serology were respectively: 24.8 and 71 percent (ELISA); 26.3 and 76.3 percent (rk-39); 30.1 and 63.4 percent (IFAT). Due to disagreements, different criteria were tested to define the infection and hybridization should be considered in epidemiological studies.

Um estudo seccional de base populacional foi desenvolvido no município de Sabará, região sudeste do Brasil, para identificar a leishmaniose visceral humana assintomática em uma área urbana de baixa prevalência da doença. Foi coletado sangue em papel filtro (n=1.604 moradores), sendo examinados pela reação de imunofluoresência indireta, ensaio imunoenzimático e teste imunocromatográfico (strip test). As taxas de prevalência da infecção variaram de 2,4 a 5,6 por cento, dependendo do teste utilizado. Um ano depois foi coletado sangue venoso de um subgrupo de 226 participantes (102 soropositivos e 124 soronegativos). Os testes realizados foram IFAT, ELISA, rk39-ELISA, reação em cadeia da polimerase e hibridização com sonda específica para o complexo Leishmania donovani. Não foi observado nenhum sinal clínico ou sintoma de leishmaniose. Usando a hibridização como teste de referência, a sensibilidade e especificidade dos testes sorológicos foram, respectivamente: 24.8 e 71 por cento (ELISA); 26,3 e 76,3 por cento (rk39-ELISA); 30,1 e 63,4 por cento (IFAT). Devido a discordâncias, diferentes critérios foram testados para definir a presença da infecção e a hibridização deveria ser considerada em estudos epidemiológicos.

Epidemiologia da leishmaniose visceral humana assintomática em área urbana, Sabará, Minas Gerais, 1998-1999: (Nota Prévia) / Epidemiology of asymptomatic human visceral leishmaniasis in an urban area of Sabará, Minas Gerais State, 1998-1999

BACKGROUND: Most of the studies conducted to determine the occurrence of human visceral leishmaniasis are based on clinical cases. One of the problems in detecting asymptomatic infections is the lack of adequate diagnosis methods. This investigation´s objectives were: to estimate the prevalence of asymptomatic Leishmania chagasi infection in an urban population exposed to risk due to the high prevalence of canine visceral leishmaniasis, and to identify risk factors for infection. MATERIAL AND METHODS: A cross sectional population-based study was conducted in Sabara county, Metropolitan Region of Belo Horizonte/MG during 1998-1999. The investigation was approved by the Ethical Committee. Screening interviews were conducted using a pre-coded questionnaire, and blood was collected on filter paper from 1604 randomly selected household inhabitants. Samples were tested using immunofluorescence-IF, enzyme immunoassay-ELISA (crude antigen) and rapid test L. donovani-TRALd. In the confirmatory phase 102 seropositive and 124 seronegative participants were examined and venous blood was collected for serological tests (IF, ELISA and rk39-ELISA), PCR and hybridization for L. chagasi. Analyses of data were performed using logistic regression. RESULTS: None of the participants developed visceral leishmaniasis during the study period. Due to the discordant results between the diagnostic techniques, four criteria of infection were defined. Prevalence estimates ranged form 1.1 to 11.9% according to the criteria used. The criterion which included participants with positive hybridization (L. chagasi) and at least one serological positive test was considered to yield the most realistic prevalence estimate (4.6%). The variables independently associated with infection for this criterion were: garbage not been collected (OR:6.0; 95%CI: 2.4-15.0), owing birds (OR:2.9; 95%CI: 1.5-5.6), garbage not being buried or deposited outside the household (OR: 4.8; CI95%: 1.7-13.4), family reporting knowing the vector (OR:6.0; 95%CI: 1.8-20.1), eroded areas in the neighborhood (OR:0.3; 95%CI: 0.1-0.8). Other identified risks factors were: to be outside of the house between 6-10 p.m., to own a short-haired dog or a house with plaster walls. CONCLUSIONS: The occurrence of asymptomatic human visceral leishmaniasis by L. chagasi in an urban population of Minas Gerais State was demostrated in this study. The estimated prevalence and the risk factors identified depend on the infection criteria used and were related to household conditions, the presence of domesticated animals and environmental conditions that allows contact with the vector.

DELINEAMENTO DO PROBLEMA: Estudos sobre a ocorrência da leishmaniose visceral humana baseiam-se, geralmente, em casos clínicos. Um dos problemas atuais é a falta de métodos de diagnóstico adequados para detecção da infecção. Os objetivos da investigação foram: determinar a prevalência da infecção assintomática por Leishmania chagasi em população urbana exposta ao risco em virtude das altas prevalências da leishmaniose visceral canina; e identificar fatores de risco. MATERIAL E MÉTODOS: Realizou-se estudo seccional populacional no Município de Sabará, Região Metropolitana de Belo Horizonte-Minas Gerais, entre 1998 e 1999. A investigação foi aprovada por comitê de ética. Na triagem, foram realizadas entrevistas pré-codificadas, coletando-se sangue em papel-filtro de 1.604 moradores, selecionados aleatoriamente, para realização do ensaio imunoenzimático (ELISA), reação de imunofluorescência indireta (RIFI) e teste rápido L. donovani (TRALd). Na etapa de confirmação dos resultados, foram reavaliados 102 participantes soropositivos e 124 soronegativos. Realizaram-se exames clínicos e coleta de sangue venoso para sorologia (RIFI, ELISA com antígenos bruto e recombinante-rk39), reação em cadeia da polimerase (PCR) e hibridização para L. chagasi. Foi utilizada, na análise, regressão logística multivariada. RESULTADOS: Nenhum participante desenvolveu a doença no período estudado. Devido às discordâncias entre as técnicas de diagnóstico, foram definidos quatro critérios de infecção. As estimativas de prevalência variaram entre 1,1 a 11,9%, dependendo do critério adotado. A estimativa que, provavelmente, mais se aproximou da real prevalência da infecção na população foi de 4,6% e incluiu todos os participantes com hibridização positiva e pelo menos uma sorologia reativa. As variáveis independentemente associadas à infecção para este critério foram: não ter o lixo recolhido pela prefeitura (OR:6,0; IC95%: 2,4-15,0), ter pássaros (OR:2,9; IC95%: 1,5-5,6), não ter o lixo enterrado ou não dispensado fora de casa (OR:4,8; IC95%: 1,7-13,4), família conhecer o vetor (OR:6,0; IC95%: 1,8-20,1) e presença de áreas erodidas na vizinhança (OR:0,3; IC95%: 0,1-0,8). Os demais fatores de risco identificados foram: encontrar-se fora de casa entre 18 e 22 horas, ter cão de pelo curto e casa com paredes rebocadas. CONCLUSÕES: Demonstrou-se a ocorrência da infecção humana assintomática por L. chagasi em amostra populacional urbana de Minas Gerais. As estimativas de prevalência e os fatores de risco dependeram do critério utilizado para definição da infecção e relacionaram-se às condições da moradia, à presença de animais e às condições do meio ambiente, que favorecem contato com o vetor.

Frequência das manifestaçöes oculares nos pacientes com sorologia positiva para o HIV ou de risco para a infecçäo na cidade de Belo Horizonte de 1990 a 1992: parte I / Frequency of ocular manifestations in patients with or at risk of HIV infection in Belo Horizonte city; 1990 a 1992: part I

Uma série de 332 pacientes ambulatoriais com sorologia positiva para o HIV ou de risco para a infecçäo, subdivididos em classes (AIDS, ARC, LGP, soropositivos assintomáticos e soronegativos), foram examinados para determinar a frequência das manifestaçöes oftalmológicas. As alteraçöes oculares foram observadas em 26,5 por cento dos pacientes e houve um aumento significativo destas quando o paciente se encontrava naas fases de ARC (13,6 por cento) e AIDS (73,8 por cento) (p<0,05). A microangiopatia retiniana foi a alteraçäo ocular mais frequente (42,0 por cento), seguida pela retinite por citomegalovírus (18,2 por cento), retinocoroidite toxoplásmica (7,9 por cento) e a coroidite tuberculosa (4,5 por cento). A proporçäo das alteraçöes oftalmológicas foi 7 vezes maior nos pacientes imunodeficientes que nos imunocompetentes (p=0)

Correlaçäo entre a infecçäo pelo HIV, anergia cutânea e alteraçöes oculares observadas entre pacientes com sorologia positiva para o HIV ou de risco para a infecçäo: parte II / Correlation of HIV infection, anergy and ocular manifestations observed in patients with or at risk of HIV infection: part II

Uma série de 203 pacientes ambulatoriais com sorologia positiva para o HIV ou de risco para a infecçäo foram examinados para determinar a frequência das manifestaçöes oftalmológicas e correlacioná-las com a imunodeficiência. O estado imunológico foi pesquisado através de testes cutâneos utilizando os antígenos: PPD, candidina, tricofitina e estreptoquinase. Observou-se que existe uma forte associaçäo entre a infecçäo pelo HIV, a energia cutânea e as alteraçöes oculares. O paciente infectado e anérgico apresenta um risco 22 vezes maior de desenvolver alteraçöes oculares (p=0)

Quatro casos de presumível coroidite tuberculosa em pacientes infectados pelo HIV / Four cases of probable tuberculous choroiditis in patients HIV infected

Desde o início dos anos 80 tem-se observado um aumento da associaçäo da infecçäo pelo Mycobacterium tuberculosis e o paciente infectado pelo HIV ou com AIDS. Quatro pacientes portadores de AIDS, tuberculose e manifestaçöes oculares säo descritos pelos autores. Dois pacientes eram portadores de tuberculose miliar, um com tuberculose pulmonar com padräo radiológico atípico e um paciente com tuberculose ganglionar. Até a presente data, este é o primeiro relato de presumível coroidite tuberculosa em pacientes com AIDS, apesar da alta prevalência da tuberculose no Brasil

Estudo dacriocistográfico em pacientes portadores de hanseníase / Dacriocystographic study in patients bearing Hansen's disease

Com a finalidade de se pesquisar a possibilidade de um comprometimento precoce do nervo facial e uma consequente reduçäo da funçäo da bomba lacrimal, em pacientes portadores de hanseníase, foi realizado um estudo dacriocistográfico em 2 grupos de pacientes: portadores e näo portadores desta moléstia. Após análise estatística dos resultados, concluiu-se que o referido exame näo é válido na comprovaçäo do comprometimento nervoso - nervo facial - e que o tempo pré-determinado de 10 minutos para a realizaçäo da última chapa do exame de dacriocistografia, realizado com o contraste Hypaque a 75%, deve ser novamente avaliado em estudos futuros