RESUMO
OBJECTIVE: To describe independent factors related to the interaction of FTO rs9939609, TMEM18 rs6548238, leptin, and adiponectin in children/adolescents with asthma, under the influence of obesity. METHODS: The authors performed a cross-sectional study with 57 children/adolescents, ages 8-19 years, at a tertiary hospital, from 2017 to 2018. Participants were classified by nutritional status, performed spirometry with a bronchodilator test and completed an asthma questionnaire, higher scores indicated more asthma symptoms. Two asthma groups were formed: Group 1(G1)-normal-weight; Group 2(G2)-overweight/obese. Serum was collected for adipokines (n = 32) and genetic polymorphisms (n = 53) dosages. RESULTS: Age and body mass index (BMI) correlated directly in normal-weight (p = 0.009) and obese participants (p = 0.004). Girls reported more asthma complaints (p = 0.044). Participants with negative bronchodilator responses presented lower BMI (14.55-17.16) than responders (19.4-26.84) (p = 0.049). Leptin dosages are related directly to BMI (5,34-40 ng/ml in obese × 0,54-42 ng/ml in nonobese) (p = 0.003). Levels were high in girls (4.78-17.55 µg/ml) (p = 0.029) and low in nonobese boys (0.54-6.92 µg/ml) (p = 0.006). In obese, low leptin levels (< 10 ng/ml) were found in small airway dysfunction carriers (p = 0.025); elevated adiponectin (> 5 µg/ml) correlated with FEV1/FVC > 80 % (p = 0.035) and positive bronchodilator tests (8.84-13 µg/ml) (p = 0.039); and FTO A allele correlated with low adiponectin 0-8.84 µg/ml (p = 0.021) and low FEV1/FVC (46 %-88 %) (p = 0.023). CONCLUSION: BMI correlated directly with age and leptin levels. Obese participants presented high serum levels of leptin and FTO A allele correlated with low FEV1/FVC. Larger cohorts are necessary for better elucidation of the role of adipokines and polymorphisms in the pathophysiology of asthma and obesity.
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Since 2018, adolescents have been included as a target group for tuberculosis (TB) surveillance by the WHO. However, they are considered a neglected population, as there are considerable gaps in information about them. We aimed to analyze the risk factors for unfavorable TB treatment outcomes among adolescents in Rio de Janeiro, a Brazilian city with a high burden of TB. This is a retrospective study of adolescents (10-18 years) with TB notified in Rio de Janeiro, from four national database systems, covering 2014-2016. "Extreme vulnerability" was defined as adolescents who presented one of the following characteristics: homelessness, incarceration, tobacco use, illicit drug use, or alcohol abuse. Logistic regression analysis was used to identify factors associated with favorable (cure/completed treatment) and unfavorable outcomes (lost to follow-up, death, and treatment failure). A total of 725 adolescents with TB were included: 610 (84.1%) were cured, 94 (13%) were lost to follow-up, six (0.8%) died because of TB, 13 (1.8%) died because of other causes, and two (0.3%) failed treatment. Unfavorable outcomes were associated with retreatment (adjusted odds ratio [aOR]: 4.51; 95% CI: 2.23-9.17), TB-HIV coinfection (aOR: 10.15; 95% CI: 4.15-25.34), extreme vulnerability (aOR: 3.01; 95% CI: 1.70-5.33), and living in the two districts (3.1 and 3.3) with worst conditions: large population and rates of homicides and shantytowns (aOR: 4.11; 95% CI: 1.79-9.46 and aOR: 5.35; 95% CI: 2.20-13.03, respectively). Our findings underscore the need for strengthening early identification and interventions for adolescents at high risk of unfavorable outcomes, especially those living in shantytowns.
Assuntos
Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/patologia , Adolescente , Antituberculosos/uso terapêutico , Brasil/epidemiologia , Criança , Coinfecção/epidemiologia , Coinfecção/patologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Resultado do TratamentoAssuntos
Anticorpos Antibacterianos/sangue , Proteínas de Bactérias/imunologia , Imunoglobulina G/sangue , Tuberculose Latente/diagnóstico , Mycobacterium tuberculosis/imunologia , Testes Sorológicos , Tuberculose Pulmonar/diagnóstico , Adolescente , Fatores Etários , Biomarcadores/sangue , Brasil , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Imunoglobulina M/sangue , Lactente , Recém-Nascido , Tuberculose Latente/sangue , Tuberculose Latente/imunologia , Tuberculose Latente/microbiologia , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/microbiologiaRESUMO
OBJECTIVES: The diagnosis of pediatric tuberculosis (TB) presents many challenges, and is further complicated in HIV-infected patients. While many diagnostic systems have been proposed, there is no pediatric TB diagnosis gold standard. The outcomes of four TB diagnostic systems in HIV-infected children were compared in this study. METHODS: A retrospective cohort study was conducted at a TB/HIV reference hospital in Rio de Janeiro. HIV-infected pediatric patients evaluated for TB from 1998 to 2010 were reassessed using four diagnostic systems: Kenneth Jones, 1969; Tidjani, 1986; Ben Marais, 2006; Brazilian Ministry of Health, 2010. Results were compared to standardized diagnoses made by an expert panel of physicians. RESULTS: Of the 121 patients in the study cohort, the expert panel diagnosed 64 as TB and 57 as not TB cases. The Tidjani system showed the highest diagnostic accuracy, with and without the inclusion of microbiological data. The Tidjani and Kenneth Jones systems produced fewer false-positives, and the Ben Marais and Ministry of Health fewer false-negatives. Across systems, there was little agreement between TB diagnoses. CONCLUSIONS: In HIV-infected pediatric patients, the Ben Marais and Ministry of Health systems are useful for TB diagnostic screening, whereas the Tidjani and Kenneth Jones systems are best used in a reference center setting.
Assuntos
Testes Diagnósticos de Rotina/métodos , Infecções por HIV/complicações , Tuberculose Pulmonar/diagnóstico , Adolescente , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tuberculose Pulmonar/complicaçõesRESUMO
BACKGROUND: There are controversies regarding the accuracy of the tuberculin skin test (TST) and methods based on the production of interferon gamma by sensitized T cells for the diagnosis of latent tuberculosis infection (LTBI) in pediatrics and immunosuppressed patients. Our objectives are to study TST and ELISPOT/T. SPOT.TB in the diagnosis of LTBI in children and adolescents with JIA undergoing methotrexate, the correlation between both and the sensitivity and specificity of T. SPOT.TB. METHODS: This is an observational prospective longitudinal study in which children and adolescents with JIA undergoing methotrexate therapy were assessed for clinical and epidemiological data for LTBI, in addition to performing TST and T. SPOT.TB at baseline and after 3 and 12months. RESULTS: There were 24 patients. The prevalence of LTBI at inclusion was 20.8%, the incidence after initiation of immunosuppressions 26.3% and the prevalence at the end of the study 41.6%. Epidemiological history positive for TB showed a relative risk of 2.0 for the development of LTBI. Only 2 patients had positive T. SPOT.TB but only in one it was useful for detecting early LTBI. T. SPOT.TB presented a sensitivity of 10%, specificity of 92.8%, and low correlation with TST. No patient developed TB disease at a mean follow-up of 47months. CONCLUSIONS: We found a high prevalence of ILTB that doubled with immunosuppression and that epidemiological history was an important relative risk. T. SPOT.TB showed low sensitivity and high specificity, and no superiority over TST. There was low agreement and little influence of immunosuppression on the results of both tests.
Assuntos
Artrite Juvenil , ELISPOT/métodos , Tuberculose Latente , Metotrexato , Mycobacterium tuberculosis/isolamento & purificação , Teste Tuberculínico/métodos , Adolescente , Artrite Juvenil/tratamento farmacológico , Artrite Juvenil/epidemiologia , Artrite Juvenil/imunologia , Brasil/epidemiologia , Criança , Feminino , Humanos , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Tuberculose Latente/etiologia , Estudos Longitudinais , Masculino , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Se presenta una revisión no sistemática sobre el control de los contactos de tuberculosis (TB) y la terapia preventiva con isoniazida (TPI) para niños y adolescentes, basada en la literatura oficial de entidades internacionales, artículos relevantes y pautas de países latinoamericanos. La Organización Mundial dela Salud recomienda las dos estrategias presentadas como muy importantes en la prevención de la TB en áreas endémicas. El artículo destaca las indicaciones de control de contactos de TB y enfatiza la interpretación del test tuberculínico en algunos de los países de Latinoamérica. Las barreras actuales y las perspectivas de la TPI frente a la TB multirresistente también se analizan. El tratamiento de la infección latente por tuberculosis (ILTB) se hace en la mayoría de los países con isoniazida (H), de ahí la denominación de quimioprofilaxis o TPI. Hay consenso en la comunidad científica en relación con que los niños, adolescentes y adultos jóvenes con test de tuberculina positivo constituyen un grupo prioritario para la TPI. Las principales acciones de control de la TB acorde con las estrategias a nivel de las unidades básicas son: registrar el tratamiento de los casos de ILTB, mantener actualizado el sistema de información, verificar el stock de medicamentos y realizar el seguimiento mensual de las consultas y eventuales reacciones adversas a la isoniazida...
Assuntos
Criança , Adulto Jovem , Isoniazida , Mycobacterium tuberculosis , Tuberculose , América Latina , Infecções , Organização Mundial da Saúde , Quimioprevenção , TuberculinaRESUMO
OBJECTIVE: To describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital. METHOD: A longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic andclinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression. RESULTS: A total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02). CONCLUSION: When the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric in patients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR. .
OBJETIVO: Descrever a taxa de letalidade (TL) e os fatores de risco de óbito em crianças com pneumonia grave adquirida na comunidade (CAP) em um hospital universitário pediátrico. MÉTODO: Foi desenvolvido um estudo longitudinal com dados prospectivos coletados de 1996 a2011. Foram incluídos no estudo pacientes com idade entre 1 mês e 12 anos de idade. Foram excluídos aqueles que deixaram o hospital desconsiderando as recomendações médicas e aqueles transferidos para UTI ou outras unidades. Foram estudadas as características demográficas, clínicas e etiológicas e o tratamento inicial. As variáveis associadas a óbito foram determinadas por análise bivariada e multivariada utilizando regressão logística. RESULTADOS: Foi selecionado um total de 871 pacientes, dos quais 11 foram excluídos; assim, foram incluídas no estudo 860 crianças. Houve 26 óbitos, com uma TL de 3%; em 58,7% desses, penicilina G foi o tratamento inicial. Pneumococo foi o patógeno mais comum (50,4%). De 1996 a 2000, houve 24 óbitos (93%), com uma TL de 5,8% (24/413). De 2001 a 2011, a faixa etária de pacientes internados foi mais velha (p = 0,03) e o número de óbitos (p = 0,02) e o percentual de gravidade das doenças foram menores (p = 0,06). Apenas a gravidade das doenças continuou associada a óbito na análise multivariada (RC = 3,2; IC de 95%: 1,2-8,9; p = 0,02). CONCLUSÃO: Quando os períodos de 1996-2000 e 2001-2011 foram comparados, foi observada uma redução significativa na TL no último período, bem como uma alteração no perfil clínico dos pacientes hospitalizados no instituto. Esses achados podem estar relacionados à melhora na situação socioeconômica da população. O uso de penicilina não influenciou a TL. .
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mortalidade Hospitalar , Pneumonia/mortalidade , Brasil/epidemiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Hospitalização/estatística & dados numéricos , Modelos Logísticos , Estudos Longitudinais , Análise Multivariada , Estudos Prospectivos , Penicilina G/uso terapêutico , Pneumonia/tratamento farmacológico , Pneumonia/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVE: To describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital. METHOD: A longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic and clinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression. RESULTS: A total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02). CONCLUSION: When the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric inpatients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR.
Assuntos
Mortalidade Hospitalar , Pneumonia/mortalidade , Brasil/epidemiologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Estudos Longitudinais , Masculino , Análise Multivariada , Penicilina G/uso terapêutico , Pneumonia/tratamento farmacológico , Pneumonia/epidemiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
Esta é uma revisão não sistemática da literatura sobre aspectos do diagnóstico da tuberculose pulmonar e extrapulmonar na infância e na adolescência. Para o diagnóstico da tuberculose pulmonar, deve-se separar os pacientes em duas faixas etárias: em crianças (<10 anos), emprega-se na prática o sistema de pontuação recomendado pelas normas do Ministério da Saúde; em adolescentes (≥10 anos), recomenda-se a realização de baciloscopia de escarro, além de dados clinico-radiológicos. Os aspectos radiológico sem ambos os grupos são diferentes e podem auxiliar no diagnóstico. As formas de tuberculose extrapulmonar necessitam, em geral, de diferentes recursos para o diagnóstico, como punções, biópsias, exames histopatológicos e outros testes, além de prova tuberculínica e radiografias. Discute-se também o diagnóstico de tuberculose em situações especiais: nos infectados por HIV, há a necessidade deamplo diagnóstico diferencial com outras pneumopatias (que podem mascarar ou estar associadas à tuberculose); e no período neonatal, necessita-se de alto grau de suspeição, principalmente quando a mãe está com tuberculose à época do parto. Na suspeita de tuberculose multirresistente, buscar associar a doença da criança com a da fonte de contágio
This was a non-systematic review of the literature on the diagnosis of pulmonary and extrapulmonary tuberculosis in children and adolescents. For the diagnosis of pulmonary tuberculosis, patients should be separated by age group: in children (< 10 years of age), the scoring system recommended by the Brazilian National Ministry of Health should be used; in adolescents (≥ 10 years of age), sputum smear microscopy is recommended in addition to clinic-radiologic features.. Radiological indings difer between the groups and can be useful in making the diagnosis. In general, diagnosing extrapulmonary tuberculosis requires diferent resources for the diagnosis, such as taps and biopsies, as well as histopathological examinations and tests, such as tuberculin skin tests and X-rays. We also discuss the diagnosis of tuberculosis in special settings: in HIV-infected patients, the diferential diagnosis should be broad, including other lung diseases (which can mask or be associated with tuberculosis); in neonates, a high level of suspicion is required, especially if the mother has tuberculosis at delivery. In suspected cases of multidrug-resistant tuberculosis, attempts should be made to identify the source of infection
Assuntos
Humanos , Criança , Adolescente , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Técnicas e Procedimentos DiagnósticosRESUMO
OBJECTIVES: To present an updated review concerning new assays for diagnosing tuberculosis based on in vitro interferon-gamma production by host T cells, and compare them with tuberculin skin test. METHODS: A literature review was carried out based on Medline and LILACS databases (2000-2008) searching for the following keywords: tuberculosis, interferon-gamma, quantiFERON, ELISPOT and T-SPOT.TB. RESULTS: These new assays proved to have, in general, equal or superior sensitivity and specificity than the tuberculin skin test not only in adults but also in children and immunosuppressed patients for the diagnosis of both latent tuberculosis infection or active disease, with some advantages such as less cross-reactivity as a result of previous BCG vaccination, less influence of anergy and better accuracy in small children. In the United States, these assays have been used instead of the tuberculin skin test and, although still very expensive, the World Health Organization will be making its economic viability a priority. CONCLUSIONS: Always having in mind the importance of clinical and epidemiological histories, these new assays based on interferon-gamma release present promising results and should be considered in tuberculosis investigation procedures for all patients, however with a special concern in the risk groups (i.e., children and immunosuppressed patients).