Invasive Pneumococcal Disease in People Living with HIV: A Retrospective Case-Control Study in Brazil

HIV-infected patients are at particular risk for invasive pneumococcal disease (IPD). We describe cases of IPD in people living with HIV/AIDS (PLWHA) and find associated risk factors for infection and death.

METHODS

A retrospective case-control study, nested in a cohort, including PLWHA with and without IPD, conducted in Brazil, 2005-2020. Controls were of the same gender/age and seen at the same time/place as cases.

RESULTS

We identified 55 episodes of IPD (cases) in 45 patients and 108 controls. The incidence of IPD was 964/100,000 person-years. A total of 42 of 55 (76.4%) IPD episodes presented with pneumonia and 11 (20%) with bacteremia without a focus and 38/45 (84.4%) were hospitalized. Blood cultures were positive in 54/55 (98.2%). Liver cirrhosis and COPD were the only factors associated with IPD in PLWHA in univariate analysis, although no associated factors were found in multivariate analysis. Penicillin resistance was found in 4/45 (8.9%). Regarding antiretroviral therapy (ART), 40/45 (88.9%) cases vs. 80/102 controls (74.1%) were in use (p = 0.07). Patients with HIV and IPD had a higher CD4 count of 267 cells/mm³ compared with the control group, in which it was 140 cells/mm³ (p = 0.027). Pneumococcal vaccination was documented in 19%. Alcoholism (p = 0.018), hepatic cirrhosis (p = 0.003), and lower nadir CD4 count (p = 0.033) were associated with the risk of death in patients with IPD. In-hospital mortality among PLWHA and IPD was 21.1%, and it was associated with thrombocytopenia and hypoalbuminemia, elevated band forms, creatinine, and aspartate aminotransferase (AST).

CONCLUSIONS

The incidence of IPD in PLWHA remained high despite ART. The vaccination rate was low. Liver cirrhosis was associated with IPD and death.

Hypocaloric diet with lower meal frequency did not affect weight loss, body composition and insulin responsiveness, but improved lipid profile: a randomized clinical trial

Dietary approaches are essential to control obesity, but the effectiveness of changes in meal frequency (MF) as a strategy for body weight loss or maintenance remain unclear. This study aimed to evaluate the influence of MF of a hypocaloric diet on weight loss, body composition, active ghrelin levels and metabolic indicators of obese women. This is a randomized, parallel clinical trial, including 40 women divided into two groups that received a hypocaloric diet with different MFs: MF6: six meals per day, and MF3: three meals per day. Dietary, laboratory, anthropometric and body composition indicators were assessed, as well as energy expenditure (EE), before and after the 90 days of the intervention. Dietary consumption did not differ between groups, before or after intervention. The two groups reduced their energy intake after intervention, but there were no differences between the groups. Waist circumference (WC) was reduced and resting metabolic rate had increased in the MF3 group at the end compared to baseline. Moreover, there was a significant difference in the triglyceride levels between groups after intervention, with an important reduction in the MF3 group, although changes in body composition, blood glucose, plasma ghrelin levels and EE variables did not differ between the groups at the end. It is concluded that, the hypocaloric diet with different MF each day did not change weight loss, body composition or insulin responsiveness, but there was an improvement of triglyceridemia in the MF3 group. The present study suggests that eating snacks between meals is not an important factor for weight loss and improvement of metabolic health in women with obesity.

Characterization of death from colorectal cancer in Mato Grosso State/Legal Amazon/Brazil, 2000-2016

Background

Colorectal cancer has been one of the cancers that most contributed to mortality, in both sexes in the world. In Brazil, cancer is among the top five causes of death and colorectal cancer is ranked on the fifth position. Of the Federative Units belonging to the Legal Amazon, Mato Grosso stands out for the higher adjusted incidence of colorectal cancer for both sexes. Thus, the objective is to characterize deaths from colorectal cancer, according to sociodemographic variables in Mato Grosso from 2000 to 2016.

Methods

A descriptive study was carried out, using data from the Mortality Information System, made available by the Department of Health of the Mato Grosso State. Deaths of all ages were selected, whose basic cause was identified by the codes from the International Classification of Diseases: (C.18) colon cancer, (C.19) rectosigmoid junction cancer, (C.20) rectal cancer or (C.21) anus cancer.

Results

Between 2000 and 2016, 31,607 deaths from cancer were registered. Of these, 1,750 (5.6%) were due to colorectal cancer. An increased number of deaths was observed at the end of the period, with a variation from 46 deaths in 2000 from 173 in 2016. Highest frequency was verified in men (51.3%), people aged 60 years or older (59.7%), black (54.6%), married (52.3%) and those with primary education (55.2%). According to Brazilian occupation classification options or those answers filled out on the death certificate, highest frequency were for “Retired” (26.2%), “Housewife” (23.1%), Agricultural/Forestry and Fisheries” (11.3%) and “Production of Industrial Goods and Services” (10.3%).

Conclusions

This study evidenced the increased number of deaths due to colorectal cancer in Mato Grosso State, and identified priority groups for interventions through public health policies which should include screening and early diagnosis to cope with the disease.

Key messages

Evidenced the increased number of deaths due to colorectal cancer in Mato Grosso State. Identified priority groups for interventions through public health policies.

Overview of HOMEChem: House Observations of Microbial and Environmental Chemistry

The House Observations of Microbial and Environmental Chemistry (HOMEChem) study is a collaborative field investigation designed to probe how everyday activities influence the emissions, chemical transformations and removal of trace gases and particles in indoor air. Sequential and layered experiments in a research house included cooking, cleaning, variable occupancy, and window-opening. This paper describes the overall design of HOMEChem and presents preliminary case studies investigating the concentrations of reactive trace gases, aerosol particles, and surface films. Cooking was a large source of VOCs, CO2, NOx, and particles. By number, cooking particles were predominantly in the ultrafine mode. Organic aerosol dominated the submicron mass, and, while variable between meals and throughout the cooking process, was dominated by components of hydrocarbon character and low oxygen content, similar to cooking oil. Air exchange in the house ensured that cooking particles were present for only short periods. During unoccupied background intervals, particle concentrations were lower indoors than outdoors. The cooling coils of the house ventilation system induced cyclic changes in water soluble gases. Even during unoccupied periods, concentrations of many organic trace gases were higher indoors than outdoors, consistent with housing materials being potential sources of these compounds to the outdoor environment. Organic material accumulated on indoor surfaces, and exhibited chemical signatures similar to indoor organic aerosol.

Predictors of early menopause in HIV-infected women: a prospective cohort study

OBJECTIVE

This study sought to investigate the age at natural menopause and its predictors in a cohort of human immunodeficiency virus (HIV)-infected women in Rio de Janeiro, Brazil.

STUDY DESIGN

HIV-infected women ≥30 years of age were included. Menopause was defined as having ≥1 year since the last menstrual period. Early age at natural menopause was defined as the onset of menopause at ≤45 years of age. Multivariate Cox proportional hazards analysis was applied.

RESULTS

A total of 667 women were included, and the median age at baseline was 34.9 years (interquartile range, 30.9-40.5 years). In all, 507 (76%) women were premenopausal, and 160 (24%) reached menopause during the observational period; of these, 36 of 160 (27%) had early menopause. The median age at natural menopause was 48 years (interquartile range, 45-50 years). Menarche at <11 years of age (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.23-3.37), cigarette smoking during the observational period (HR, 1.59; 95% CI, 1.08-2.33), chronic hepatitis C virus (HCV) infection (HR, 2.53; 95% CI, 1.27-5.07), and CD4 count <50 cells/mm(3) (HR, 3.07; 95% CI, 1.07-8.80) were significantly associated with an earlier age at natural menopause. The magnitudes of the effects of menarche at <11 years of age (HR, 2.7; 95% CI, 1.23-5.94), cigarette smoking during the observational period (HR, 3.00; 95% CI, 1.39-6.45), chronic HCV infection (HR, 6.26; 95% CI, 2.12-18.52), and CD4 count <50 cells/mm(3) (HR, 6.64; 95% CI, 1.91-23.20) were much higher and significantly associated with early natural menopause.

CONCLUSION

Early natural menopause was frequent among the HIV-infected women. In addition to menarche and cigarette smoking, which are menopausal factors among women in general, HIV-related immunodeficiency and chronic HCV were additional predictors for an earlier age at natural menopause. Adequate management of HIV in women is critical, as early onset of menopause has been associated with increased morbidity and mortality.

Fat-soluble vitamin (A, D, E, and β-carotene) contents from a Portuguese autochthonous cow breed--Minhota

In Portugal, commercial milk is obtained almost entirely from cows of the Holstein breed. However, other breeds may also show dairy aptitude, and produce milk of good quality. The aim of this study was to investigate the effect of the breed factor in the vitamin contents of milks from Holstein and the autochthonous Portuguese breed Minhota, as well as possible variations due to season. Milk samples were collected from 15 cows of each breed. Milk from Minhota cows showed higher contents of retinol, retinyl palmitate, α-tocopherol, and β-carotene. No differences were verified between breeds regarding vitamin D(3) content, but Holstein cows presented higher amounts of provitamin D(3). Seasonal variations were not observed for milk samples from Holsteins, and only a very small variation was observed for milk samples from Minhota cows, mainly in retinol, α-tocopherol, and provitamin D(3) levels. This study revealed that breed has a pronounced effect on milk fat-soluble vitamins, which is an important observation regarding future genetic selection plans. Also, the increased vitamin amounts found in milk from Minhota cows can be regarded as an important nutritional parameter that can potentiate the economical value of this breed.

Determinants of ochratoxin A exposure--a one year follow-up study of urine levels

Dietary exposure to the ochratoxin A (OTA) occurring in Portugal is characterized by a high frequency of contamination of the consumed foodstuffs, although at low levels. The exposure bears significance for the total food consumed, and not for a particular one. Biomonitoring studies are thus fundamental in simplifying the evaluation of exposure, with no need to examine the entire range of consumed foodstuffs. Biomonitoring studies further allow the identification of host factors as predictors of OTA exposure in epidemiologic studies, the results of which are merited for targeting intervention strategies by public health authorities and advising official regulatory decisions. Using a longitudinal approach, this study examined factors related to OTA exposure in the adult population over a one-year period. Anthropometric measures, season of the year and region were the selected factors correlated with OTA exposure biomarker. Urine samples from 95 inhabitants from six Portuguese main geographical areas were assayed through spectrofluorimetric detection. Exposure to OTA proved to markedly increase in winter, and gender differences were observed only in summer, which might be related to different dietary patterns not only between seasons, but also between genders. The same rationale may also serve the observed statistically significant differences between some regions. No other strong association upon the remaining determinants under testing was observed. These observations reinforce the need for OTA exposure evaluation, possibly specifically targeting the staple foods or dietary habits that sustain potential predictors or determinants of exposure.

Monitoring of ochratoxin A exposure of the Portuguese population through a nationwide urine survey--Winter 2007

Ochratoxin A (OTA) is a mycotoxin produced by a variety of fungi, such as Penicillium verrucosum and Aspergillium spp., which has been found to have a wide number of potentially deadly toxic effects, and can enter the human organism through a variety of means. It then finds its way into the bloodstream and, after a lengthy process, is eventually excreted through the urine. It can thus be detected in its original form not only in blood samples but also in this biological medium. As such, and in an attempt to evaluate the exposure of the Portuguese population to this mycotoxin, morning urine samples were collected during the Winter of 2007, from each of five geographically distinct Portuguese locations--Bragança, Porto, Coimbra, Alentejo, and Algarve--and subjected to extraction by immunoaffinity columns and to OTA quantification through liquid chromatography coupled with fluorescence detection. Prevalent incidence was higher than 95% with Coimbra being the exception (incidence of 73.3%). In nearly all locations, the OTA content of most samples was found to be above the limit of quantification (LOQ) of 0.008 ng/ml. Indeed, excluding Coimbra, with an OTA content level of 0.014 ng/ml, all regions featured content values over 0.021 ng/ml.

Sorption and desorption of the herbicide alachlor on humic acid fractions from two vermicomposts

The present study focuses on the analysis of two vermicomposts, that have been used as alternative sources of restitution of soil organic matter, as well as sources of nutrient replacements. For this purpose, two samples of vermicomposts from different Brazilian regions (São Carlos-SP and Londrina-PR) were characterized according to their humic acid content. Both samples had a pH value near 7.0, and the humic acids present showed high cationic exchange capacities and low values for the C/N ratios. The infrared spectra showed bands that suggested the presence of aliphatic and aromatic components bound to phenolic, carboxylic and amide groups. The effect of vermicompost added to soil on the application of alachlor was evaluated. Alachlor sorption, Freundlich isotherms and alachlor desorption curves in the soil matrix and the vermicompost/soil mixture matrix were determined.

Discriminate analysis of roasted coffee varieties for trigonelline, nicotinic acid, and caffeine content

Arabica and robusta roasted coffees from several geographical origins, in a total of 29 samples, were characterized for their contents in caffeine, trigonelline, and nicotinic acid by a recently developed HPLC/diode-array detector method. All samples were subjected to the same roasting procedure in order to eliminate the variations due to this process. Characterization was achieved by applying multivariate and nonparametric analysis to the chromatographic results. The two coffee varieties were clearly separated by their trigonelline and caffeine contents. Nicotinic acid could not be used as a variety discriminate factor. There was no association with the geographical origin of the samples.

Role of reinsertion of the lower eyelid retractor on involutional entropion

AIMS

To verify and evaluate the effect of reinsertion of the lower eyelid retractor aponeurosis to correct involutional entropion.

METHODS

The involutional entropion is one affection that occurs mainly in the lower eyelid of patients over 60 years old. The surgical techniques proposed to correct this condition are based on correction of horizontal laxity-the preseptal orbicularis muscle overrides the pretarsal muscle, and the reinsertion of the lower eyelid retractor aponeurosis. 30 patients clinically diagnosed with involutional entropion and randomly selected underwent reinsertion of the lower eyelid retractor aponeurosis to the tarsal plate, without horizontal shortening or resection of the skin or orbicularis muscle.

RESULTS

Good anatomical and functional correction was achieved in 96.6% of the patients and no recurrence was observed on 29 month follow up examination. The surgical result was very satisfactory.

CONCLUSIONS

It was concluded that this procedure is effective and has low recurrence rate, showing the important role of the reinsertion of the lower eyelid retractor aponeurosis in this surgical correction.

An improved surgical technique for pterygium excision with intraoperative application of mitomycin-C

A surgical technique was designed to improve safety after pterygium excision with intraoperative application of mitomycin-C (MMC). A limbic incision was performed in 40 eyes. The body of the pterygium was dissected from the episclera to allow its excision. Care was taken to avoid excessive delamination and cauterization of tissues. A 0.02% MMC solution was then applied. Only at the end of the surgery was the head of the pterygium dissected from the cornea. The 8-0 absorbable sutures were used to place both edges of the conjunctiva together to completely cover the area of bare sclera. After a mean follow-up time of 12 months, a recurrence rate of 5% was observed. No complications of therapy were observed. This is a logical alternative to other surgical techniques. However, randomized studies with more patients and longer follow-up are necessary to determine the potential of this procedure in improving the safety of pterygium excision with intraoperative MMC.

[Senile cataract: patient's characteristics and perceptions on a sight restoration communitary project]

A survey was conducted to identify some patient's characteristics and perceptions related to senile cataract and delivery of cataract care. The patients were diagnosed by means of ophthalmic examination carried out on a Rehabilitation of the Aged Campaign at the Hospital das Clínicas of the University of São Paulo Medical School. A questionnaire was administered by interviewing 70 subjects, who presented the following characteristics: 32.86% were males and 67.14% were females; 42.86% with ages varying between 50 and 70 years; 67.14% took notice of campaign through TV; 60.00% underwent SUS previous ophthalmic evaluation; 72.86% presented low vision acuity on both eyes for a year or longer, (27.14% for 5 years or longer); 40.00% had previous surgery indication for a year or longer and 80.00% of the patients claimed declared financial reasons to explain their non-previous cataract surgery. We recommend eye health educational programs for prevention of blindness and sigh restoration.

[Perforating eye injuries caused by motor vehicle accidents: cases assisted during the year 1994]

A prospective study of 32 patients with perforating eye injuries caused by motor vehicle accidents, 24.32% of the 131 cases of perforating injuries admitted at the University of São Paulo Medical School Hospital from January to december, 1994 was performed. Most of the accidents occurred at night (68.75%), and in urban areas (65.63%). There were more male victims (65.63%), mostly under 25 years of age (53.13%). None of the victims were using seat belts and those in the front seats were more vulnerable. Safety precautions should be effectively in use in order to reduce frequency and morbidity of these injuries.

[Perforating eye injuries in children]

The author studied 140 cases of perforating eye injury in children up to 15 years old admitted at the Clinic Hospital of the Medical College of the University of São Paulo (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo) from January 1989 to December 1993. These cases represent 24.71% of the total of the perforating eye injuries seen during this period, showing a ratio of 76.42% of males, a ratio of 2/1 in the group from 0 to 6 years old, 7/1 in the group from 7 to 11 years old and a ratio of 3/1 in the group from 12 to 15 years old. The most common perforating eye injuries were due to sharp objects (54.71%), contusion (20%), explosions (7.85%) and flying objects (5.71%). The relation between the severity of the injury and the prognosis is emphasized. Safety precautions should be effective in order to reduce frequence and morbidity of these perforating ocular injuries.

Single intraoperative application versus postoperative mitomycin C eye drops in pterygium surgery

PURPOSE

To determine the minimum effective dosage, most effective route of administration and long-term effects of mitomycin C for prevention of recurrence after pterygium surgery.

METHODS

In a prospective, masked study, 227 patients undergoing surgery for primary pterygia were assigned randomly to five groups: group 1 received a single intraoperative application of 0.2 mg/ml mitomycin C for 3 minutes; group 2 received a single intraoperative application of 0.4 mg/ml mitomycin C for 3 minutes; group 3 received mitomycin C eye drops 0.2 mg/ml three times daily for 7 days; group 4 received mitomycin C eye drops 0.4 mg/ml three times daily for 14 days; group 5 acted as a control (surgery alone).

RESULTS

After a mean follow-up time of 28 months, recurrence rates of 6.66%, 4.08%, 4.26%, 4.44%, and 29.27%, respectively, were observed. Statistical analysis showed significant differences between groups receiving mitomycin C and the control (P < or = 0.001). There was no statistical difference among treated groups (P > or = 0.0681). No complications of therapy were observed.

CONCLUSION

These results support the efficacy and relative safety of a single, low-concentration, intraoperative application of mitomycin C in pterygium surgery together with the use of a conjunctival flap, avoiding excessive cauterization of the sclera and leaving bare sclera.

[Noninfectious bilateral corneal ulceration associated with Sjögren's syndrome: report of a case]

A case of noninfectious bilateral corneal ulceration in a 46 year old patient with Sjögren's syndrome is reported. The clinical evolution is commented and the available therapeutic measures for this complication are discussed.

[Pneumonia caused by Legionella pneumophila. Report of the 2d Brazilian case]

Os autores relatam um caso de pneumonia por Legionella pneumophila, diagnosticado pela primeira vez em Porto Alegre, Rio Grande do Sul. A hipótese diagnóstica foi confirmada por imunofluorescência indireta nas amostras de soro do paciente enviadas ao C.D.C. (Atlanta — E.U.A.), com títulos de 1:128 na amostra da fase aguda e 1:512 na amostra da fase de convalescença.