Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study.

BACKGROUND: Despite the global decline in the detection of leprosy cases, its incidence has remained unchanged in certain settings and requires the determination of the factors linked to its persistence. We examined the spatial and space-time distribution of leprosy and the influence of social vulnerability on the occurrence of the disease in an endemic area of Northeast Brazil. METHODS: We performed an ecological study of all leprosy cases reported by Sergipe state, Northeast Brazil from 2001 to 2015, to examine the association of the Social Vulnerability Index and the prevalence and persistence of leprosy among the State's municipalities. Socio-economic and leprosy surveillance information was collected from the Brazilian information systems, and a Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial and space-time clusters were identified using scan spatial statistic tests and to measure the municipalities' relative risk of leprosy. RESULTS: Leprosy clusters and burden of disease had a strong statistical association with the municipalities' Social Vulnerability Index. Municipalities with a high social vulnerability had higher leprosy incidence, multibacillary leprosy and newly diagnosed cases with grade 2 disability than areas with low social vulnerability. CONCLUSION: Social vulnerability is strongly associated with leprosy transmission and maintenance of disease incidence. Leprosy control programmes should be targeted to the populations with high social vulnerability.

Avaliação dos níveis plasmáticos do peptídeo natriurético NT-proBNP em cães da raça Poodle em diferentes estágios da doença valvar crônica mitral / Evaluation of plasma levels of NT-proBNP natriuretic peptide in Poodle dogs at different stages of chronic mitral valve disease

A doença valvar crônica mitral (DVCM) é comum em cães e pode não causar sintomas clínicos da insuficiência cardíaca (IC) durante anos. O peptídeo natriurético tipo B (BNP) é armazenado nos miócitos ventriculares e secretado para circulação com seu fragmento NT-proBNP, quando ocorre aumento. Este estudo avaliou os níveis plasmáticos do peptídeo natriurético NT-proBNP em cães da raça Poodle em diferentes estágios da DVCM, seguindo as diretrizes do American College of Veterinary Internal Medicine (ACVIM, 2009). Amostras de sangue foram coletadas para determinação do biomarcador NT-proBNP para comparação entre grupos. As medianas do NT-proBNP nos grupos estudados foram: 551pmol/L (controle), 302pmol/L (grupo B1), 1.033pmol/L (grupo B2), 954pmol/L (grupo C) e 5.541pmol/L (grupo D). Mediante o uso de um ponto de corte ideal de >709pmol/L, foi possível identificar os cães com aumento cardíaco verdadeiro daqueles sem aumento cardíaco, com sensibilidade de 75% e especificidade de 100%. O NT-proBNP aumentou de acordo com o avanço dos estágios da DVCM, sendo os estágios B2, C e D aqueles com valores mais elevados desse biomarcador. Para o estágio B2, a mensuração do NT-proBNP mostrou ser uma excelente ferramenta para diagnosticar precocemente o aumento cardíaco em cães da raça Poodle.(AU)

Chronic mitral valve disease (CMVD) is common in dogs, it may not cause clinical symptoms of heart failure (HF) for years. The type B natriuretic peptide (BNP) is stored in the ventricular myocytes and secreted for circulation with its NT-proBNP fragment, when an increase occurs. This study evaluated the plasma levels of the NT-proBNP natriuretic peptide in Poodles at different stages of CMVD, following the guidelines of the American College of Veterinary Internal Medicine (ACVIM, 2009). Blood samples were collected for determination of NT-proBNP biomarker for comparison between groups. This median NT-proBNP in the studied groups were: 551pmol/L (Control), 302pmol/L (Group B1), 1,033pmol/L (Group B2), 954pmol/L (Group C) and 5,541pmol/L (Group D). Using an ideal cutoff of > 709pmol/L it was possible to identify dogs with true heart enlargement of those without a cardiac increase with sensitivity of 75% and specificity of 100%. NT-proBNP increased according to the progress of the stages of CMVD, being that stages B2, C and D, with the highest values of the biomarker. To stage B2, the NT-proBNP measurement proved to be an excellent tool for early diagnosis of cardiac enlargement in Poodles.(AU)