RESUMO

While incidence of tuberculosis (TB) has decreased globally, in Paraguay, considered a medium-incidence country by the WHO, TB incidence has increased slightly from 42 per 100,000 in 2010 to 46 per 100,000 in 2022. We conducted a retrospective study of TB cases notified to the Paraguay National Program for Tuberculosis Control (NPTC) from 2018 to 2022 and quantified trends in specific populations identified as vulnerable. Of the 13,725 TB cases notified in Paraguay from 2018 to 2022, 2,331 (17%) occurred among incarcerated individuals and 1,743 (12.7%) occurred among self-identified Indigenous individuals. In 2022, the relative risk of TB was 87 and 6.4 among the incarcerated and Indigenous populations, compared with the non-incarcerated and non-Indigenous populations respectively. We found significant heterogeneity in TB incidence across Paraguay's 17 departments. Our findings highlight the urgency of expanding access to TB diagnosis, treatment, and prevention in populations at heightened risk of TB in Paraguay.

RESUMO

It has recently been shown that the administration of probiotics can modulate the microbiota-gut-brain axis and may have favorable effects in models of Parkinson's disease. In this study, we used a hemiparkinsonism model induced by the neurotoxin 6-OHDA to evaluate the efficacy of the administration of a four-week administration of a mixture containing the microorganisms Lactobacillus fermentum LH01, Lactobacillus reuteri LH03, and Lactobacillus plantarum LH05. The hemiparkinsonism model induced an increase in rotations in the apomorphine test, along with a decrease in the latency time to fall in the rotarod test on days 14 and 21 after surgery, respectively. The administration of probiotics was sufficient to improve this condition. The model also showed a decrease in tyrosine hydroxylase immunoreactivity in the striatum and the number of labeled cells in the substantia nigra, both of which were counteracted by the administration of probiotics. The permeability of the blood-brain barrier was increased in the model, but this effect was reversed by the probiotics for both brain regions. The gut barrier was permeated with the model, and this effect was reversed and dropped to lower levels than the control group after the administration of probiotics. Finally, lipid peroxidation showed a pattern of differences similar to that of permeabilities. The inhibition of the permeability of the blood-brain and gut barriers mediated by the administration of probiotics will likely provide protection by downregulating oxidative stress, thus affecting the rotarod test performance.

Assuntos

RESUMO

La COVID-19 ha provocado una emergencia sanitaria mundial sin precedentes, afectando también negativamente a la prestación de atención a la tuberculosis (TB) en casi todos los países. Por tanto, esta investigación analiza el impacto de la COVID-19 en el control de la TB en Paraguay. Estudio descriptivo, retrospectivo, con enfoque mixto y de corte transversal. Resultados: siete de los 10 indicadores priorizados de la Estrategia "Fin de la TB" registraron resultados por debajo a lo notificado en los últimos tres años, siendo el 2020 el más afectado. Existe una brecha de 1.037 personas que no han sido diagnosticadas y tratadas por TB en Paraguay, de acuerdo a lo estimado por la Organización Mundial de la Salud (OMS) en 2020. Se analizaron 2.598 casos de TB en 2020, frente a 3.083 en el 2019, lo que representa una disminución del 15,7% en la notificación de casos; las notificaciones disminuyeron en un 24% en mujeres, 40,5% en niños y en un 19,6% de éxito de tratamiento. Se presentó una tasa de letalidad de 12%, la mayor en los últimos cuatro años. Las expertas encuestadas, opinan que la situación de la TB empeoró tras la llegada de la COVID-19 en el país, principalmente en la notificación de casos e investigación de contactos. La COVID-19 ha impactado negativamente en el control de la TB en Paraguay, esto representa un riesgo significativo en el control de la enfermedad y el avance a lo largo de los años se ve seriamente comprometido y amenaza con revertir los logros alcanzados.

COVID-19 has caused an unprecedented global health emergency, also negatively affecting the delivery of tuberculosis (TB) care in almost all countries. This research therefore analyses the impact of COVID-19 on TB control in Paraguay. Descriptive, retrospective, mixed-approach, cross-sectional study. Results: seven of the 10 prioritized indicators of the "End TB Strategy" registered results below what was reported in the last three years, with 2020 being the most affected. There is a gap of 1,037 people who have not been diagnosed and treated for TB in Paraguay, as estimated by the World Health Organisation (WHO) in 2020. There were 2,598 TB cases analysed in 2020, compared to 3,083 in 2019, representing a 15.7% decrease in case notification; notifications decreased by 24% in women, 40.5% in children and 19.6% treatment success. There was a case fatality rate of 12%, the highest in the last four years. The experts surveyed were of the opinion that the TB situation worsened after the advent of COVID-19 in the country, mainly in case notification and contact investigation. COVID-19 has had a negative impact on TB control in Paraguay, which represents a significant risk for the control of the disease, and progress over the years is seriously compromised and threatens to reverse the achievements made.

RESUMO

RESUMEN Introducción: La búsqueda activa de casos de Tuberculosis (TB) pretende garantizar la detección temprana para reducir el riesgo de malos resultados de la enfermedad y las consecuencias sociales propias de la misma, así como cortar oportunamente la cadena de transmisión en la comunidad. Objetivo: Determinar el estado actual, retos y soluciones operacionales a las Búsquedas activas en las 18 Regiones Sanitarias del Paraguay. Métodos: Estudio descriptivo retrospectivo de corte transversal, fuente de datos: registros de búsqueda activa disponibles de las regiones sanitarias, sociedad civil y Programa Nacional de Control de Tuberculosis (PNCT) del Paraguay 2019-2020 y Sistema Experto del PNCT (SEPNCT) Para el análisis estadístico se utilizaron medidas de resumen como frecuencias absolutas, relativas y proporciones. Resultados: se analizaron las visitas de campo para búsquedas activas, en tres tipos de intervenciones, 5089 personas investigadas, 26.5% fueron identificadas como SR. La positividad general fue de 5%. Se necesita en promedio de 76 personas para encontrar un caso de TB. Las búsquedas activas que tuvieron mayor impacto fueron las realizadas por el nivel nacional con 49.3% de casos de TB aportados. Conclusiones: Las intervenciones basadas en la comunidad, como el establecimiento de redes de derivación y otras actividades que acercan la información y los servicios sobre la tuberculosis a las personas con síntomas, pueden contribuir a mejorar la notificación de casos de tuberculosis, cortar la cadena de transmisión y reducir la mortalidad por tuberculosis.

SUMMARY Introduction: The active search for cases of Tuberculosis (TB) aims to ensure early detection to reduce the risk of poor outcomes of the disease and the social consequences of the disease, as well as to cut the chain of transmission in the community in a timely manner. Objective . To determine the current status, challenges and operational solutions to the Active Searches in the 18 Health Regions of Paraguay. Methods: Retrospective descriptive cross-sectional study, data source: active search records available from the health regions, civil society and National Tuberculosis Control Program (PNCT) of Paraguay 2019-2020 and Expert System of the PNCT (SEPNCT) For the statistical analysis summary measures such as absolute and relative frequencies and proportions were used. Results: field visits were analyzed for active searches, in three types of interventions, 5089 people investigated, 26.5% were identified as RH. The overall positivity was 5%. It takes an average of 76 persons to find a TB case. The active searches that had the greatest impact were those conducted by the national level with 49.3% of TB cases contributed. Conclusions: Community-based interventions, such as the establishment of referral networks and other activities that bring TB information and services closer to people with symptoms, can help improve TB case notification, cut the chain of transmission, and reduce TB mortality.

RESUMO

This study was undertaken to explore how the use of pigmented corn as brewing ingredient influences the sensory profile of craft beers, by using both sensory and chemical analyses. Six pigmented corn and barley beers were brewed and then analysed to obtain their sensory characteristics, volatile composition and non-volatile (alcohol, bitterness, anthocyanins and polyphenol content) composition. ANOVAs, Principal Component Analysis (PCA) and Multiple Factor Analysis (MFA) were used to visualise these data for exploring the differences between beers based on the type of malt and to characterise corn beers considering the relationships between their sensory characteristics and their chemical parameters. The sensory attributes such as fermented fruits, cooked vegetables, tortillas, bread, dried fruits and dried chili characterised beers made 100% with pigmented corn. Over 100 volatiles were identified by head space-solid phase micro-extraction coupled with gas chromatography-mass spectrometry (HS-SPME/GC-MS). Among them, phenols and terpenes were the groups of volatiles that better characterised beers containing corn. The content of anthocyanins in corn beers provide the 'amber-red-cooper' colours in beers and may prevent the development of off-aromas and tastes. The use of pigmented corn seems to be a good option to renew the traditional 'Sendechó' while preserving some of its sensory attributes.

RESUMO

[RESUMEN]. Objetivo. Describir las características sociodemográficas y clínico-epidemiológicas y determinar los factores asociados a la mortalidad de personas con diagnóstico de tuberculosis en Paraguay. Métodos. Investigación operativa con un diseño de cohortes retrospectivo de los casos diagnosticados con TB en Paraguay entre 2015-2016. Se utilizó la base datos del Programa Nacional de Control de Tuberculosis. Para determinar los factores asociados con mortalidad se utilizaron pruebas chi cuadrado y riesgo relativo (RR) con un intervalo de confianza de 95% (IC95%); además, se ajustó un modelo de regresión múltiple de Poisson robusto. Se utilizó un nivel de significación de 5%. Resultados. Se estudiaron 5 141 casos de TB, de los cuales 11,5% fallecieron, los factores que aumentan el riesgo de muerte fueron: sexo masculino (RR: 1,26 IC; 95%: 1,1-1,50), infección con virus de la inmunodeficiencia humana (VIH) (RR: 4,78; IC 95%: 4,04-5,65) y enfermedad pulmonar obstructiva crónica (RR: 1,70; IC 95%: 1,19-2,42). Como factor protector se identificó ser persona privada de la libertad (RR: 0,37 IC 95%: 0,24-0,61). Conclusiones. El mayor riesgo de muerte lo presentan los hombres y las personas con coinfección TB/VIH y el menor riesgo, las personas privadas de la libertad. Es necesario mejorar el diagnóstico y seguimiento a los casos de TB, con la efectiva implementación del tratamiento directamente observado (TDO) así como el manejo oportuno de enfermedades asociadas como VIH y enfermedad pulmonar obstructica crónica (EPOC).

[ABSTRACT]. Objective. To describe the socio-demographic and clinical-epidemiological characteristics and to determine the factors associated with the mortality of people diagnosed with tuberculosis (TB) in Paraguay. Methods. Operational research with a retrospective cohort design of cases diagnosed with TB in Paraguay between 2015-2016. The database of the National Tuberculosis Control Program was used. Chi-square and relative risk (RR) tests with a 95% confidence interval (95% CI) were used to determine the factors associated with mortality; in addition, a robust Poisson multiple regression model was adjusted. A significance level of 5% was used. Results. Five hundred and forty-one cases of TB were studied, of which 11.5% died. The factors increasing the risk of death were male sex (RR 1.26; 95% CI 1.1-1.50), infection with human immunodeficiency virus (RR 4.78; 95% CI 4.04-5.65) and chronic obstructive pulmonary disease (RR 1.70; 95% CI 1.19-2.42). Being deprived of one’s liberty was a protective factor (RR 0.37; 95% CI 0.24-0.61). Conclusions. The highest risk of death is presented by men and people with TB/HIV coinfection and the lowest risk is presented by people deprived of liberty. There is a need to improve diagnosis and follow-up of TB cases, with effective implementation of directly observed treatment (DOTS) and timely management of associated diseases such as HIV and chronic obstructive pulmonary disease.

[RESUMO]. Objetivo. Descrever as características sociodemográficas e clínico-epidemiológicas e determinar os fatores associados à mortalidade de pessoas diagnosticadas com tuberculose (TB) no Paraguai. Métodos. Pesquisa operacional com desenho de coorte retrospectivo de casos diagnosticados com TB no Paraguai entre 2015-2016. Foi utilizada a base de dados do Programa Nacional de Controle da Tuberculose. Testes de qui-quadrado e risco relativo (RR) com intervalo de confiança de 95% (IC95%) foram utilizados para determinar os fatores associados à mortalidade; além disso, um robusto modelo de regressão múltipla de Poisson foi ajustado. Foi utilizado nível de significância de 5%. Resultados. Foram estudados quinhentos e quarenta e um casos de TB, dos quais 11,5% morreram. Os fatores que aumentaram o risco de morte foram sexo masculino (RR 1,26; IC95% 1,1-1,50), infecção por vírus da imunodeficiência humana (RR 4,78; IC95% 4,04-5,65) e doença pulmonar obstrutiva crônica (RR 1,70; 95 % CI 1,19-2,42). Ser privado de liberdade foi um fator protetor (RR 0,37; IC 95% 0,24-0,61). Conclusões O maior risco de morte é apresentado por homens e pessoas com co-infecção TB / HIV e o menor risco é apresentado por pessoas privadas de liberdade. É necessário melhorar o diagnóstico e o acompanhamento dos casos de TB, com a implementação efetiva do tratamento diretamente observado (DOTS) e o gerenciamento oportuno de doenças associadas, como o HIV e a doença pulmonar obstrutiva crônica.

Assuntos

RESUMO

OBJECTIVE: To describe the socio-demographic and clinical-epidemiological characteristics and to determine the factors associated with the mortality of people diagnosed with tuberculosis (TB) in Paraguay. METHODS: Operational research with a retrospective cohort design of cases diagnosed with TB in Paraguay between 2015-2016. The database of the National Tuberculosis Control Program was used. Chi-square and relative risk (RR) tests with a 95% confidence interval (95% CI) were used to determine the factors associated with mortality; in addition, a robust Poisson multiple regression model was adjusted. A significance level of 5% was used. RESULTS: Five hundred and forty-one cases of TB were studied, of which 11.5% died. The factors increasing the risk of death were male sex (RR 1.26; 95% CI 1.1-1.50), infection with human immunodeficiency virus (RR 4.78; 95% CI 4.04-5.65) and chronic obstructive pulmonary disease (RR 1.70; 95% CI 1.19-2.42). Being deprived of one's liberty was a protective factor (RR 0.37; 95% CI 0.24-0.61). CONCLUSIONS: The highest risk of death is presented by men and people with TB/HIV coinfection and the lowest risk is presented by people deprived of liberty. There is a need to improve diagnosis and follow-up of TB cases, with effective implementation of directly observed treatment (DOTS) and timely management of associated diseases such as HIV and chronic obstructive pulmonary disease.

OBJETIVO: Descrever as características sociodemográficas e clínico-epidemiológicas e determinar os fatores associados à mortalidade de pessoas diagnosticadas com tuberculose (TB) no Paraguai. MÉTODOS: Pesquisa operacional com desenho de coorte retrospectivo de casos diagnosticados com TB no Paraguai entre 2015-2016. Foi utilizada a base de dados do Programa Nacional de Controle da Tuberculose. Testes de qui-quadrado e risco relativo (RR) com intervalo de confiança de 95% (IC95%) foram utilizados para determinar os fatores associados à mortalidade; além disso, um robusto modelo de regressão múltipla de Poisson foi ajustado. Foi utilizado nível de significância de 5%. RESULTADOS: Foram estudados quinhentos e quarenta e um casos de TB, dos quais 11,5% morreram. Os fatores que aumentaram o risco de morte foram sexo masculino (RR 1,26; IC95% 1,1-1,50), infecção por vírus da imunodeficiência humana (RR 4,78; IC95% 4,04-5,65) e doença pulmonar obstrutiva crônica (RR 1,70; 95 % CI 1,19-2,42). Ser privado de liberdade foi um fator protetor (RR 0,37; IC 95% 0,24-0,61). CONCLUSÕES: O maior risco de morte é apresentado por homens e pessoas com co-infecção TB / HIV e o menor risco é apresentado por pessoas privadas de liberdade. É necessário melhorar o diagnóstico e o acompanhamento dos casos de TB, com a implementação efetiva do tratamento diretamente observado (DOTS) e o gerenciamento oportuno de doenças associadas, como o HIV e a doença pulmonar obstrutiva crônica.

RESUMO

OBJECTIVES: This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated. METHODS/PRINCIPAL FINDINGS: A cross-sectional study enrolling women aged 18-25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%-49.3%), and 17.4% (95%CI: 13.1%- 21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81-3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14-3.30) after controlling for confounders. CONCLUSIONS: There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed.

Assuntos