Infectious Diseases In Adults Research Articles

Convergence between Cardiometabolic and Infectious Diseases in Adults from a Syndemic Perspective: A Scoping Review.

Objective. Synthesize the approaches used to study the convergence between cardiometabolic and infectious diseases in adults from a syndemic perspective based on the scientific evidence available to date worldwide. Methods. Scoping review that follows the recommendations of the PRISMA statement. The protocol was registered in INPLASY202150048. The search for studies was carried out in MEDLINE, LILACS, Web of Science and Scopus. Results. Since the COVID-19 pandemic, there has been an increase in studies in the field of convergence between cardiometabolic and infectious diseases from a syndemic perspective, but only three studies were classified as true syndemics. There are weaknesses in the adherence to the elements of the syndemic theory, given a low incorporation of population measurements, and until now it has not been possible to find convincing empirical evidence that supports the bio-bio interface. Quantitative methods predominated through models focused on "sum scores". Conclusions. Future studies should comprehensively address the elements of syndemics, review discrepancies between additive analyses versus other modeling, and incorporate the influence of large-scale social forces. The lack of these aspects distances studies from the notion of syndemic, bringing them closer to comorbidity or multimorbidity approaches.

Epidemiology of Pertussis and Pertussis-Related Complications in Adults: A German Claims Data Analysis.

Pertussis is a highly contagious respiratory infection. It affects people of all ages, yet evidence of the impact of pertussis in adults with underlying conditions (UCs) is scarce. This study investigated the incidence and complication rate of pertussis in adult patients with and without UC. A retrospective analysis was conducted using routinely collected German claims data between 2015 and 2019. Patients with and without different pneumological, cardiovascular, endocrinological, musculoskeletal, and psychological UCs were matched for incidence estimation. Logistic regression models were used to estimate the risk of pertussis depending on the presence of UCs. Negative binomial models were used to assess complication rates in patients with pertussis and with and without UC. In total, 4383 patients were diagnosed with pertussis during the study period. Patients with any UC had an increased risk for pertussis compared to matched patients without UC (odds ratio [OR] 1.72; 95% confidence interval [CI]1.60-1.84, p < 0.0001). Underlying asthma had the highest risk of pertussis (OR 2.70; 95%CI 2.50-2.91, p < 0.0001), followed by chronic obstructive pulmonary disease (OR 2.35; 95%CI 2.10-2.60, p < 0.0001) and depression (OR 2.08; 95%CI 1.95-2.22, p < 0.0001). Severe complications occurred in 10.8% of the pertussis cohort (13.4% with UC vs. 9.5% without UC). The UC-attributable effect on the risk of severe pertussis-related complications was significantly increased for any UC (incidence rate ratio [IRR] 1.29, 95%CI 1.19-1.39). The severe complication risk was also increased for patients aged 60+ (IRR 1.59, 95%CI 1.46-1.72). This study shows that adults with certain UCs have an increased risk for pertussis and are more likely to have complications. These results provide further evidence that pertussis is a relevant and impactful infectious disease in adults with and without certain UC, indicating that these patients need to be considered when developing vaccination recommendations to avoid pertussis and its associated complications. A graphical abstract is available with this article.

Adult vaccination immunization strategies and research progress worldwide

Vaccination is the most cost-effective measure to prevent infectious diseases in both children and adults. At present, the global burden of infectious diseases in adults is still heavy. With the continuous development and improvement of vaccines, vaccination has shown great potential to prevent infectious diseases, further reduce the morbidity and mortality of infectious diseases in adults and improve people's life quality. This article summarizes the current status of adult immunization, immunization strategies of representative countries, different adult vaccination strategies, and the advantages and challenges of adult immunization to provide reference for further exploring adult immunization strategies and improving adult vaccination recommendations. More attention should be paid to the immunization strategies for different adult populations, and effective measures should be taken to improve the vaccination coverage for the better protection of people's life and health.

Diagnostic Performance and Clinical Impact of Metagenomic Next-Generation Sequencing for Pediatric Infectious Diseases.

Metagenomic next-generation sequencing (mNGS) has shown promise in the diagnosis of infectious diseases in adults, while its efficacy in pediatric infections remains uncertain. We performed a retrospective analysis of 1,493 mNGS samples from pediatric patients with blood, central nervous system, and lower respiratory tract infections. The positive percent agreement (PPA) and the negative percent agreement (NPA) of mNGS were compared to conventional microbiological tests (CMT) based on clinical diagnosis. The agreement of mNGS compared to CMT, as well as the clinical impact of mNGS, were valuated. Using the clinical diagnosis as a reference, mNGS demonstrated a significantly higher overall PPA compared to CMT (53.1% [95% CI = 49.7 to 56.6%] versus 25.8% [95% CI = 22.8 to 28.9%]), while maintaining a comparable overall NPA (93.2% [95% CI = 91.3 to 95.1%] versus 97.2% [95% CI = 95.9 to 98.4%]). In septic patients under 6 years of age or with immunosuppressive status, mNGS showed a higher PPA and a comparable NPA compared to CMT. The overall PPA and NPA of mNGS compared to CMT were 75.3 and 75.0%, respectively. The majority of cases of Streptococcus pneumoniae, Streptococcus agalactiae, Mycobacterium tuberculosis complex, and Pneumocystis jirovecii infections were identified by mNGS. A positive clinical impact of 14.0% (206/1,473), a negative impact of 0.8% (11/1,473), a nonimpact of 84.7% (1,248/1,473), and an unknown impact of 0.5% (8/1,473) were observed in the mNGS results. Notably, the positive impact was greater among immunosuppressed patients than among nonimmunosuppressed individuals (67/247, 27.1% versus 139/1,226, 11.3%; P < 0.001). mNGS is valuable for pathogen detection, diagnosis, and clinical management of infections among pediatric patients. mNGS was thus effective for the diagnosis of pediatric infections, which may guide clinical management. Patients with immunosuppressive conditions benefited more from mNGS testing.

Immunotoxic chemicals, childhood infections, and long-term health effects

BACKGROUND AND AIM: Environmental chemicals can act as immunotoxicants by dysregulating the immune system, and can modulate the effects of infectious agents. Several studies link exposure to environmental chemicals with susceptibility to infectious diseases in adults and children, but results are inconclusive. Also, the role of subclinical infections in long-term health effects has been little examined. We will present specific results from ongoing analyses in children and also discuss priority areas for research on the immunotoxic effects of environmental chemicals. METHODS: Results from ongoing analyses in three European birth cohorts [Born in Bradford (BiB), UK; Environment and Childhood (INMA), Spain), and Mother Child cohort study (RHEA), Greece], with information on immunotoxic chemicals in early life, humoral response to common natural infections, and long-term health effects, will be presented. The effects of common infections in children in relation to chemical exposures and their combined effects on the immune system and long-term health effects will be reviewed. RESULTS: Results from the RHEA cohort showed that maternal levels of polychlorinated biphenyls (PCBs) may increase susceptibility to persistent viral infections in the first years of life. Also, exposure to dichlorodiphenyltrichloroethane (DDT) during pregnancy and in childhood was associated with lower immunoglobulin-G levels against varicella from 6 to 11 years of age. Evidence of the immunotoxic effects of historical persistent organic pollutants such as PCBs and DDT is strong; however, evidence is still limited for the emerging chemicals including per- and polyfluoroalkyl substances and the non-persistent ones such phthalates and phenols. CONCLUSIONS: Exposure to immunotoxic agents in early-life may modulate humoral response to common natural infections in children. The potential for some of the most widely used chemical compounds to interfere with the developing immune system during critical periods of development is of great concern for public health given the current context of emerging epidemics.

Management of community-acquired pneumonia in adults with type 2 diabetes mellitus in a multidisciplinary hospital

Community-acquired pneumonia (CAP) is a common acute infectious disease in adults. Diabetes mellitus (DM) increases the incidence of CAP and worsens the prognosis. In this regard, the assessment of the current practice of CAP management in patients with concomitant DM and its compliance with clinical guidelines is of great interest.Purpose. To study the current practice of CAP treatment in adult patients with concomitant type 2 DM in a multidisciplinary hospital and evaluate its compliance with the national clinical guidelines.Methods. A cross-sectional observational study was carried out in a pulmonology department of a republican clinical hospital. The study recruited adult patients with a confirmed diagnosis of CAP and previously diagnosed type 2 DM. For each case, demographic characteristics, the severity of CAP, the presence and nature of complications, systemic antibiotic therapy (ABT) and compliance with 16 quality indicators (QI) were recorded. The quality indicators described the adequacy of examination, treatment and secondary prevention of CAP in the presence of concomitant DM. QIs were chosen based on the national clinical guidelines for CAP and algorithms for specialized medical care for patients with DM.Results. Altogether, 48 patients with the average age of 63.9 ± 10.5 years were enrolled. 81% of patients had mild CAP. The severity criteria were assessed in 60% of the patients, prognosis – in 17% of the patients. X-ray examination, pulse oximetry and complete blood count were performed on time in 100% of the cases. A total of 19% of patients had a culture of respiratory specimens. A blood culture was performed in 11,11% of the cases of severe CAP (SCAP). Rapid urine tests for pneumococcal and legionella antigens have not been used. Glycemia was monitored daily in 27% of the patients. ABT was initiated on time in 100% of the patients.Conclusion. Low adherence to many QIs, insufficient control of glycemia and correction of sugar-lowering therapy in the treatment of hospitalized patients with CAP and concomitant type 2 DM were observed, which can worsen clinical outcomes.

Spatial analysis of tuberculosis cure in primary care in Rio de Janeiro, Brazil

BackgroundTuberculosis (TB) presents a high burden of disease and is considered a global emergency by the World Health Organization (WHO), as the leading cause of death from infectious disease in adults. TB incidence is related directly to access to health services and socioeconomic determinants and inequality. Providing primary care settings can lead to improved access, shorter waiting times for patients, and enhanced TB case detection. The article aims to identify the spatial and temporal risk areas for TB and the relationship between TB cure and primary healthcare coverage from 2012 to 2014 in Rio de Janeiro, Brazil.MethodsA cross-sectional study was conducted in Rio de Janeiro, Brazil. All cases of TB reported to the Information System on Diseases of Notification (SINAN) from 2012 to 2014 were included. Socioeconomic variables from the 2010 Brazilian national census were also added. Socioeconomic variables were selected from multivariate analysis using principal factors analysis. Spatial association was verified with generalized additive model (GAM). It was possible to identify areas at higher risk of failure to cure TB.ResultsTB rates showed strong positive spatial autocorrelation. TB cure rate varied according to schooling (individuals with complete secondary schooling had higher cure rates than illiterate individuals; OR 1.72, 95% CI 1.30–2.29), alcohol consumption (OR 0.47, 95% CI 0.35–0.64), contact investigation (OR 2.00, 95% CI 1.56–2.57), positive HIV serology (OR 0.31, 95% CI 0.23–0.42), and census tracts with higher elderly rates (OR 9.39, 95% CI 1.03–85.26). Individuals who had been covered by primary healthcare (PHC) for 35 to 41 months had 1.64 higher odds of cure, compared to those with no PHC coverage (95% CI 1.07–2.51).ConclusionA comprehensive risk map was developed, allowing public health interventions. Spatial analysis allowed identifying areas with lower odds of TB cure in the city of Rio de Janeiro. TB cure was associated statistically with time of coverage by primary healthcare. TB cure rate also varied according to sociodemographic factors like schooling, alcohol abuse, and population density.This methodology can be generalized to other areas and/or other public health problems.HighlightsWe studied standardized municipal TB cure rates in an area of social inequality in Brazil.TB rates showed strong positive spatial autocorrelation.Higher rates were associated with population density and socioeconomic conditions. Illiterate individuals were less likely to achieve TB cure.TB cure was less likely in individuals with HIV and alcohol abuse.TB cure was greater in areas with high primary healthcare coverage.

It won't happen to me! Psychosocial factors influencing risk perception for respiratory infectious diseases: A scoping review.

Understanding the determinants of risk perception for COVID‐19 might help to promote self‐preventive behaviours. This scoping review aimed to map the extent, variety and characteristics of the evidence on the possible determinants of risk perception for COVID‐like diseases. PubMed, Scopus and Web of Science were searched for original, peer‐reviewed English‐written articles published up to March 2020 and investigating risk perception determinants for respiratory infectious diseases in adults. Titles and abstracts were screened, and full texts were analysed by the first author; when unsure, eligibility was discussed with the last author. Data were collected according to an extraction sheet developed by the first and last authors. The cross‐sectional evidence covers a variety of diseases, countries and timings of testing. Mostly, questionnaires recorded socio‐demographics, media exposure, trust in institutions, disease proximity and knowledge; psychological variables, including personality traits, distress and self‐efficacy, were less investigated. A miscellaneous operationalization of risk perception emerged, including the likelihood of getting sick, perceived dangerousness, concerns or a combination of them. A comprehensive understanding of the substantial amount of evidence may be challenging due to methodological heterogeneity. Referring to uniform theoretical frameworks is recommended; also, longitudinal research may be implemented to probe causal relationships.

Cytokine profiles and Lactobacillus species presence in pre-menopausal subjects with genital Mycoplasma genitalium or Ureaplasma urealyticum colonization.

Background and Purpose:Lactobacilli play a vital role in protecting the vagina against pathogens. Cytokines are vital components of defense against infections in women. The genital mycoplasmas, Mycoplasma genitalium and Ureaplasma urealyticum, are associated with various infectious diseases in adults and infants. The objective of our study is to identify differences in cytokine profile and Lactobacillus species dominance between a study group of non-pregnant pre-menopausal women with genital M. genitalium or U. urealyticum colonization and a control group of non-pregnant pre-menopausal women without genital M. genitalium or U. urealyticum colonization.Methods:A real-time polymerase chain reaction was performed to measure Lactobacillus species in vaginal swab samples. Cytokine analysis was performed using multiplex immunoassay techniques. Analysis of variance confirmed a significant difference in cytokine profiles between patient groups, with t-tests identifying the most significantly different cytokines. Categorical data analysis identified significant patterns of relative Lactobacillus species dominance in the study group.Results:Lactobacillus iners was the predominant Lactobacillus species in the control group (p = 0.005). There were no dominant Lactobacillus species observed in the study group. Vascular endothelial growth factor A (p = 0.002), interleukin-8 (p = 0.001), and interleukin-1β (p = 0.049) were expressed significantly higher in the study group, whereas interleukin-1 receptor antagonist (p < 0.001), interleukin-10 (p = 0.001), interleukin-12 (p = 0.002), and interferon-γ (p = 0.022) were expressed higher in the control group. Association matrices for cytokines were significantly different between two groups (p < 0.001), with mostly negative associations in the control group and mostly positive associations in the study group.Conclusion:Cytokine levels, their associations, and the patterns of Lactobacillus species dominance are observed to significantly diverge on the basis of M. genitalium and U. urealyticum colonization among non-pregnant pre-menopausal women.

Educational differences in acute infectious diseases in the Netherlands: results from a nationwide health survey.

It is unclear to what extent socioeconomic inequalities exist in common infectious diseases in high-income countries. We aimed to explore educational differences in five common acute infectious diseases in adults in the Netherlands. As part of a year-round repeated cross-sectional health survey, adults aged 25 and older were asked if they had experienced acute upper or lower respiratory tract infections, acute otitis media, urinary tract infections or gastro-enteritis in the two previous months. If so, participants were asked whether they had consulted their general practitioner and if they had been unable to perform their normal daily activities. These outcomes were analyzed per highest attained level of education. Data of 18 629 survey respondents were used in the analyses. People with a low educational level had lower odds of upper respiratory tract infections (OR 0.88, 95% CI 0.81-0.95), but higher odds of lower respiratory tract infections (OR 1.57, 95% CI 1.16-2.11). After adjustment for several covariates, the differences in upper respiratory tract infections remained statistically significant (aOR 0.84, 95% CI 0.77-0.91). The educational differences in lower respiratory tract infections were mitigated by adjusting for chronic diseases and health behaviours. For all infectious diseases, the likelihood of general practitioner consultation was highest for the lower educated group. Inability to work or perform normal daily activities due to an infectious disease was similar across all levels of education. This study shows that educational differences in incidence and care seeking behaviours exist for common acute infectious diseases in the Netherlands.

PHARMACOECONOMIC ANALYSIS OF MACROLIDES AND AZALIDE ANTIBIOTICS

The purpose of the work is to investigate the range of macrolides and azalide antibioticspresented on the domestic pharmaceutical market, their presence in normative documentsregulating the circulation of medicines in Ukraine and in the world. Determine thedistribution of drugs depending upon their use (vital or minor importance) and expensesfor treatment (low-, medium-, or expensive).Material and methods. According to the method of formal VEN analysis, a comparativeevaluation of preparations of macrolides antibiotics was carried out on the basis of theirpresence (vital) or absence (non-essential) in the State Formulary of Medicines of Ukraine, the National List of Essential Medicines, the renovated list of the basic medicinesof WHO and the British National Formulary. Preparations of macrolide and azalideantibiotics, recommended by the Unified Clinical Protocol for the medical care of thepatients with non-community pneumonia, have been identified. The assortment of macrolides and azalide preparations of different manufacturers, presented on the pharmaceutical market of Ukraine and their cost, have been analyzed.Results. The nomenclature of macrolides, presented in the domestic pharmaceutical market, includes 117 drugs, most of them are of foreign production - 75 preparations (64%).According to the results of the formal VEN analysis, it has been established that allmacrolides and azalid antibiotics (eryhromycin, spiramycin, midecamycin, roxithromycin,jozzamycin, clarithromycin, azithromycin), registered in Ukraine, were included to theState Formulary of Medicines of Ukraine. Only 3 drugs: erythromycin, azithromycin andclarithromycin are available in the National Service List of vital remidies. The renovatedWHO list of essential medicines contains 2 drugs: azithromycin and clarithromycin. Fourdrugs are included to the British National Formulary: erythromycin, azithromycin,claricide and telithromycin. Among them, only telithromycin is not registered in Ukraine.The Unified Clinical Protocol of the medical attendance to the patients with non-hospitalpneumonia provides 5 international non-proprietary medicines of macrolides and azolideantibiotics: erythromycin, clarithromycin, spiramycin, jazzamycin and azithromycin. Thegroup of low value preparations consists of: erythromycin, azithromycin, clarithromycinof the domestic manufacturers as well as aziklar (India), azitro Sandoz (Switzerland) andazithromycin Grindex (Portugal); clarithromycin (Darnytsia), clarithromycin Grindex(Portugal), azithroks (Czechia), azithromax and clarimax (Canada), clasid® (Italy),hemomycin (Serbia); macropen® and fromilid uno® (Slovenia) are of the middle value.Original preparations such as vilprafen® (Germany), rovamycin® (Italy), sumamed®,sumamed-forte® (Croatia) and fromilid® (Slovenia) are expensive. The most expensivedrugs are the original preparations in the form of tablets, which disperse - Sumamed®tablets dispersible (Croatia) and tablets-solutab - vilprofen-solutab® (France).Conclusions. The domestic pharmaceutical market has a significant assortment ofmacrolide and azalide trade names in different price categories, which allows to optimizethe choice of the preparation taking into account the spectrum of antimicrobial activity,sensitivity of the pathogenic microflora to it and financial competence of the patient. Erythromycin, azithromycin and clarithromycin are referred to the category of vital drugs.The presence of all macrolides, presented in the pharmacy network, in the State Formularyof Medicines of Ukraine confirms their therapeutic efficacy and expediency of includingthem to antibiotic therapy schemes of infectious diseases in adults and children.

Vaccinal prevention of infectious diseases in adults

The results of foreign and Russian author`s researches about immunization of adult population are presented in article. The analysis of the vaccinal prevention state of infectious diseases in adults in different countries of the world (national guidance on adults immunization, coverage of preventive vaccinations, financing mechanisms) is given. The tasks of improving immunization in adult population of Russia are defined.

The association between temperature, rainfall and humidity with common climate-sensitive infectious diseases in Bangladesh.

Bangladesh is one of the world’s most vulnerable countries for climate change. This observational study examined the association of temperature, humidity and rainfall with six common climate-sensitive infectious diseases in adults (malaria, diarrheal disease, enteric fever, encephalitis, pneumonia and bacterial meningitis) in northeastern Bangladesh. Subjects admitted to the adult medicine ward of a tertiary referral hospital in Sylhet, Bangladesh from 2008 to 2012 with a diagnosis of one of the six chosen climate-sensitive infectious diseases were enrolled in the study. Climate-related data were collected from the Bangladesh Meteorological Institute. Disease incidence was then analyzed against mean temperature, humidity and average rainfall for the Sylhet region. Statistical significance was determined using Mann-Whitney test, Chi-square test and ANOVA testing. 5033 patients were enrolled (58% male, 42% female, ratio 1.3:1). All six diseases showed highly significant (p = 0.01) rises in incidence between the study years 2008 (540 cases) and 2012 (1330 cases), compared with no significant rise in overall all-cause hospital admissions in the same period (p = 0.19). The highest number of malaria (135), diarrhea (266) and pneumonia (371) cases occurred during the rainy season. On the other hand, the maximum number of enteric fever (408), encephalitis (183) and meningitis (151) cases occurred during autumn, which follows the rainy season. A positive (P = 0.01) correlation was observed between increased temperature and the incidence of malaria, enteric fever and diarrhea, and a negative correlation with encephalitis, meningitis and pneumonia. Higher humidity correlated (P = 0.01) with a higher number of cases of malaria and diarrhea, but inversely correlated with meningitis and encephalitis. Higher incidences of encephalitis and meningitis occurred while there was low rainfall. Incidences of diarrhea, malaria and enteric fever, increased with rainfall, and then gradually decreased. The findings support a relationship between weather patterns and disease incidence, and provide essential baseline data for future large prospective studies.

Problems of Vaccinal Prevention in Adult Population

The analysis of the vaccine preventive status of infectious diseases in adults in Russia and various countries of the world is presented in the article. The problems and directions of improving the immunization of the adult population in Russia are identified.

Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia.

Community-acquired pneumonia is common and important infectious disease in adults. This work represents an update to 2009 treatment guideline for community-acquired pneumonia in Korea. The present clinical practice guideline provides revised recommendations on the appropriate diagnosis, treatment, and prevention of community-acquired pneumonia in adults aged 19 years or older, taking into account the current situation regarding community-acquired pneumonia in Korea. This guideline may help reduce the difference in the level of treatment between medical institutions and medical staff, and enable efficient treatment. It may also reduce antibiotic resistance by preventing antibiotic misuse against acute lower respiratory tract infection in Korea.

Conditioned Medium from Periodontal Ligament Stem Cells Enhances Periodontal Regeneration.

Periodontal disease is one of the most common infectious diseases in adults and is characterized by the destruction of tooth-supporting tissues. Mesenchymal stem cells (MSCs) comprise the mesoderm-originating stem cell population, which has been studied and used for cell therapy. However, because of the lower rate of cell survival after MSC transplantation in various disease models, paracrine functions of MSCs have been receiving increased attention as a regenerative mechanism. The aim of this study was to investigate the regenerative potential of transplanted conditioned medium (CM) obtained from cultured periodontal ligament stem cells (PDLSCs), the adult stem cell population in tooth-supporting tissues, using a rat periodontal defect model. Cell-free CM was collected from PDLSCs and fibroblasts, using ultrafiltration and transplanted into surgically created periodontal defects. Protein content of CM was examined by antibody arrays. Formation of new periodontal tissues was analyzed using microcomputed tomography and histological sections. PDLSC-CM transplantation enhanced periodontal tissue regeneration in a concentration-dependent manner, whereas fibroblast-CM did not show any regenerative function. Proteomic analysis revealed that extracellular matrix proteins, enzymes, angiogenic factors, growth factors and cytokines were contained in PDLSC-CM. Furthermore, PDLSC-CM transplantation resulted in the decreased mRNA level of tumor necrosis factor-α (TNF-α) in healing periodontal tissues. In addition, we found that PDLSC-CM suppressed the mRNA level of TNF-α in the monocyte/macrophage cell line, RAW cells, stimulated with IFN-γ. Our findings suggested that PDLSC-CM enhanced periodontal regeneration by suppressing the inflammatory response through TNF-α production, and transplantation of PDLSC-CM could be a novel approach for periodontal regenerative therapy.

Cure rates for tuberculosis in the municipality of Rio de Janeiro, Brazil, in 2012 compared with coverage by, and time of establishment of, Family Health units, and socio-economic and demographic factors.

Tuberculosis (TB) has high prevalence and is considered a world emergency by the World Health Organization (WHO), being the greatest cause of death from infectious diseases in adults. It is directly associated with access to health services and socio-economic factors. A reform of Primary Care in the municipality of Rio de Janeiro began in 2010, with coverage increasing from 7% in that year to 48.2% in 2014. This article compares the proportion of cures of TB, coverage by the Family Health Strategy (FHS), how long it has been in place, and socio-economic and demographic factors in the municipality of Rio, based on new cases notified in the year 2012. An association was found between cure of TB and the variable gender, being 40% greater in females - odds ratio 1.4 (CI95% 1.21-1.62); and with residence in favelas - OR 0.86 (CI95% 0.73-1.02), but there was no association with coverage of the FHS (OR 1.06; CI95% 0.92-1.22), nor with the time for which the teams had been in place. FHS coverage in the municipality of Rio was put in place as priority in areas of greater vulnerability; at the time of this study, more than 91% of the teams had been in place for less than five years before the date of diagnosis. These factors probably contributed to it not being possible to detect better results in the cure of tuberculosis in areas covered by the FHS in the year 2012.

ESTIMATED NUMBER OF TUBERCULOSIS IN CASES OF MUNICIPALITY CAPANEMA/PA FOR THE YEAR 2015 USING THE METHOD SIZED MOBILE

A decade ago, the World Health Organization (WHO) declared tuberculosis (TB) in a state of emergency in the world, which is still the leading cause of death from infectious disease in adults. According to WHO estimates, two billion people representing a third of the world population is infected with Mycobacterium tuberculosis. Of these, 8 million develop the disease and two million die each year. Tuberculosis is still a serious public health problem recognized by the Brazilian government. Therefore, due to their public policy purposes, assumed commitments with their citizens and the international community to control its evolution, seeking to reduce its prevalence in the population. In the Amazon, where about 60% of the country's indigenous population, the average incidence of tuberculosis has reached 75.1 cases per 100,000 population in 1980-2000, the highest among Brazilian geopolitical regions (the national average for this period was 59.2). In order to statistically verify the number of TB cases that may occur in the municipality of Capanema / PA based on the number of cases of the disease in previous years, there was a correlation capability of theMoving Average method for data collected as method useful to estimate the number of cases of thisdisease in 2015.

Missed opportunities for Hepatitis B vaccination among diabetic patients

Many infectious diseases in adults can be prevented by a ‘life-long vaccination strategy’. Hepatitis B disease burden was shown to be higher in diabetic patients. American Advisory Committee on Immunization Practices recommends to vaccinate diabetic patients against hepatitis B since 2011. In this study, we aimed to determine hepatitis B virus serology status to determine the rates of diabetic patients who have indications for hepatitis B vaccination. The electronic database of the hospital was searched to identify adult patients aged above 18 years and with hemoglobin A1C levels of 6.5% or above, who have been seen at General Medicine Outpatient Clinics of a university hospital during a 3-year period. A total of 5187 patients were included in the study. After exclusion of patients with an incomplete serological panel, 1358 patients were included for further analyses. Twenty-nine percent of the patients had indication for hepatitis B vaccination, whereas only 8% were vaccinated. This study showed that nearly one third of patients who had hepatitis B serological data had an indication for hepatitis B vaccination and this is a clear reflection of the need to keep a lifelong vaccination log and inquire vaccination data.

Proteins in Complementary Food: What Is the Healthiest Level?

Adequate protein consumption in infants is a heavily debated issue. First, it is related to the formation of a new scientific field — “Infant prerequisites of man’s wellness and illness,” which directly indicates that excessive intake of proteins during infancy has long-term consequences and greatly contributes to obesity and chronic infectious diseases in adults; second, it is related to new technologies, which improve the protein component of infant formulas and bring them at par with breast milk in terms of quality and quantity. High protein consumption is related to bottle feeding, because starter and further infant formulas are richer in protein than breast milk. Protein-rich menus trigger production of insulinogenic amino acids, insulin and the insulin-like growth factor (IGF-1). High IFTcombined with branched-chain amino acids (leucine, valine, isoleucine, threonine) activates a set of signalling molecules (mTOR), which are responsible for integrating metabolic and immune response. Repeated activation of mTOR coupled with regular intake of high-protein infant formulas causes health issues in adulthood. Diseases like diabetes type 2, obesity, arterial hypertension, cancer (particularly prostatic cancer), are related to overactivation of the mTOR signalling molecule complex. Intensive consumption of milk in today’s world is the key mTOR activator contributing to an increased risk of lifestyle diseases and triggering the mechanism of their development. The progressing infant formula industry allows to cut protein levels in starter and further infant formulas down to 12 g/l and, respectively, lower the risk of non-infectious diseases in adulthood.