Background The current epidemic of asthma and atopy has been explained by alterations in immune responses related to reduction in childhood infections. However, the findings of epidemiologic studies ...investigating the association between infection with atopy and asthma have been inconsistent. Objective We sought to investigate the effect of single or multiple infections (pathogen burden) on atopy and wheeze in urban children from Latin America. Methods Specific IgE against aeroallergens (sIgE) and skin prick test (SPT) reactivity for the most common local allergens were measured in 1128 children aged 4 to 11 years. Data on wheezing and potential confounders were collected by questionnaire. Infections by 8 pathogens were assessed by using serology and stool examination. Associations of wheeze and atopic outcomes with single and multiple infections were analyzed by means of logistic regression. Results Negative results for Toxoplasma gondii were associated with a higher prevalence of sIgE (≥0.70 kU/L), whereas negative results for Ascaris lumbricoides , T gondii , herpes simplex virus, and EBV were associated with a higher prevalence of SPT reactivity. Children with 3 or fewer infection markers had a higher prevalence of sIgE and SPT reactivity compared with those with 4 or more infection markers. However, isolated infections or pathogen burden were not associated with the prevalence of atopic or nonatopic wheeze. Conclusion The findings provide support for the idea that the hygiene hypothesis is operating in an urban Latin American context, but its expression is thus far restricted to the atopic status of patients and not the perceived asthma symptoms.
The causation of asthma is poorly understood. Risk factors for atopic and non-atopic asthma may be different. This study aimed to analyze the associations between markers of poverty, dirt and ...infections and wheezing in atopic and non-atopic children.
1445 children were recruited from a population-based cohort in Salvador, Brazil. Wheezing was assessed using the ISAAC questionnaire and atopy defined as allergen-specific IgE ≥ 0.70 kU/L. Relevant social factors, environmental exposures and serological markers for childhood infections were investigated as risk factors using multivariate multinomial logistic regression.
Common risk factors for wheezing in atopic and non-atopic children, respectively, were parental asthma and respiratory infection in early childhood. No other factor was associated with wheezing in atopic children. Factors associated with wheezing in non-atopics were low maternal educational level (OR 1.49, 95% CI 0.98-2.38), low frequency of room cleaning (OR 2.49, 95% CI 1.27-4.90), presence of rodents in the house (OR 1.48, 95% CI 1.06-2.09), and day care attendance (OR 1.52, 95% CI 1.01-2.29).
Non-atopic wheezing was associated with risk factors indicative of poverty, dirt and infections. Further research is required to more precisely define the mediating exposures and the mechanisms by which they may cause non-atopic wheeze.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Risk factors for death in patients with severe asthma Fernandes, Andréia Guedes Oliva; Souza-Machado, Carolina; Coelho, Renata Conceição Pereira ...
Jornal Brasileiro de Pneumologia,
07/2014, Letnik:
40, Številka:
4
Journal Article
Recenzirano
Odprti dostop
To identify risk factors for death among patients with severe asthma.
This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 ...at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates.
We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma.
In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality.
Environment may have a key role in the development of the immune system in childhood and environmental exposures associated with rural residence may explain the low prevalence of allergic and ...autoimmune diseases in the rural tropics. We investigated the effects of urban versus rural residence on the adaptive immune response in children living in urban and rural areas in a tropical region of Latin America.
We recruited school children in either rural communities in the Province of Esmeraldas or in urban neighborhoods in the city of Esmeraldas, Ecuador. We collected data on environmental exposures by questionnaire and on intestinal parasites by examination of stool samples. Peripheral blood leukocytes (PBLs) in whole blood were stimulated with superantigen, parasite antigens and aeroallergens and IFN-γ, IL-5, IL-10, IL-13, and IL-17 were measured in supernatants.
We evaluated 440 school children; 210 living in rural communities and 230 in the city of Esmeraldas. Overall, urban children had greater access to piped water (urban 98.7 % vs. rural 1.9 %), were more likely to have a household bathroom (urban 97.4 % vs. rural 54.8 %), and were less likely to be infected with soil-transmitted helminth infections (urban 20.9 % vs. rural 73.5 %). Generally, detectable levels of cytokines were more frequent in blood from children living in urban than rural areas. Urban residence was associated with a significantly greater frequency of IL-10 production spontaneously (adjusted OR 2.56, 95 % CI 1.05-6.24) and on stimulation with Ascaris (adj. OR 2.5, 95 % CI 1.09-5.79) and house dust mite (adj. 2.24, 95 % CI 1.07-4.70) antigens. Analysis of effects of environmental exposures on SEB-induced IL-10 production within urban and rural populations showed that some environmental exposures indicative of poor hygiene (urban - higher birth order, A. lumbricoides infection; rural - no bathroom, more peri-domiciliary animals, and living in a wood/bamboo house) were associated with elevated IL-10.
In our study population, the immune response of children living in an urban environment was associated more frequently with the production of the immune regulatory cytokine, IL-10. Some factors related to poor hygiene and living conditions were associated with elevated IL-10 production within urban and rural populations.
•We standardized an “in house” test to detect anti-Toxocara IgG antibodies in human serum.•We determined the frequency of antibodies to Toxocara in children of a poor urban Brazilian ...setting.•Toxocara infection is highly prevalent in the studied population.•Low maternal schooling and dog or cat ownership are important risk factors associated with the seroprevalence.
This study aimed to standardize an “in house” immunoassay to detect anti-Toxocara IgG antibodies in human serum to estimate the seroprevalence of Toxocara infection, and to identify its potential risk factors in children living in poor areas of Salvador, a large northeastern Brazilian city.
Parents of 1309 children answered a questionnaire containing possible risk factor for acquisition of this infection. Blood was collected and the presence of anti-Toxocara IgG antibodies was detected by indirect ELISA using T. canis larval excretory–secretory antigens in sera previously absorbed with Ascaris lumbricoides antigens.
Seroprevalence of Toxocara infection was 48.4%. Children's age, low maternal schooling, contact with dogs and cats, and household located in paved streets were shown to be risk factors for Toxocara infection.
The seroprevalence of Toxocara infection is high among children living in a poor urban setting of Brazil. The association of low maternal education with higher Toxocara infection supports studies showing that low socioeconomic status is a risk factor for the acquisition of this infection as a reflection of hygiene habits of the family. And both infected-dogs and cats may be involved in this parasite transmission in this children population.
FORMALDEHÍDO EN VIVIENDAS URBANAS EN SALVADOR, BAHÍA - BRASIL Soza Pineda, Norma Irene; dos Santos Prata, Pedro Reginaldo; Alves Cardoso, Maria Regina ...
Revista internacional de contaminación ambiental,
05/2017, Letnik:
33, Številka:
2
Journal Article
FORMALDEHÍDO EN VIVIENDAS URBANAS EN SALVADOR, BAHÍA - BRASIL Soza Pineda, Norma Irene; Prata, Pedro Reginaldo dos Santos; Alves Cardoso, Maria Regina ...
Revista internacional de contaminación ambiental,
2017, Letnik:
33, Številka:
2
Journal Article
Recenzirano
Odprti dostop
RESUMEN El formaldehído es un contaminante común en los espacios interiores. El objetivo de este estudio fue identificar la concentración de formaldehído en viviendas urbanas y la posible relación de ...las fuentes potenciales intramuros con dicha concentración. Se utilizó un método transversal anidado en un estudio longitudinal que investiga factores asociados con el asma y la alergia en niños escolares en Salvador. Entre febrero de 2007 y julio de 2008 se visitaron las viviendas de 1168 niños (4 - 13 años) para recolectar información sobre las características de las casas. Para la determinación de formaldehído gaseoso se utilizó un procedimiento fluorimétrico con el reactivo Fluoral P. Se evaluaron los indicadores de ventilación, fuentes de formaldehído y exposición al humo del cigarro según los niveles de formaldehído a través de una regresión logística, en la que se calculó la razón de productos cruzados (RPC) con un intervalo de confianza (IC) de 95 %. La concentración de formaldehído en general fue baja (media 0.80 µg/m3). Un mayor número de fuentes potencialmente emisoras de ese compuesto (RPC 1.30; 95 % IC 1.03-1.65), así como las mejores condiciones de ventilación (RPC 1.35; 95 % IC 1.07-1.70), estuvieron asociadas con una mayor concentración de formaldehído. Mientras que en las viviendas donde habitaban fumadores, la concentración de formaldehído fue menor (RPC 0.69; 95 % IC 0.52-0.90). El nivel de concentración del formaldehído en las viviendas estudiadas en Salvador fue inferior a los niveles máximos aceptables nacional e internacionalmente para ambientes interiores. Las características de las viviendas influyeron en la concentración de dicho compuesto. El método de muestreo ambiental utilizado permitió la determinación del formaldehído con suficiente confiabilidad.
Resumo Objetivo Identificar a prevalência de doenças crônicas não transmissíveis e fatores associados em pessoas vivendo com HIV (PVHIV). Métodos Trata-se de um estudo transversal retrospectivo ...realizado por meio de uma análise secundária dos dados coletados entre outubro de 2014 a maio de 2018. O banco analisado incluiu amostra de 550 pessoas, provenientes de cinco Serviços de Atendimento Especializado. Foi realizado teste qui-quadrado, Odds Ratio (OR), Razão de Prevalência (RP) e seus respectivos Intervalos de Confiança (IC) de 95%, teste de Wald da estimativa e valor p<0,05. Resultados As doenças crônicas não transmissíveis mais prevalentes foram hipertensão arterial (17,89%), diabetes mellitus (7,51%) e Doença Renal Crônica (4,83%). Ter doença crônica foi associado ao sexo feminino (RP=1,18, OR=1,3, p=0,022), idade maior que 45 anos (RP=2,15, OR=6,36, p=0,001), tempo de estudo menor ou igual a oito anos (RP=1,23, OR=1,92, p=0,005), ter dislipidemia (RP=1,16, OR=2,01, p=0,001), carga viral detectável (RP=2,32, OR=2,59, p=0,001) e a contagem de células TCD4+ menor que 350 células/mm3 (RP=1,5, OR= 1,6, p=0,019), o padrão se repetiu com a razão de prevalência. Conclusão Identificou-se alta prevalência de doenças crônicas não transmissíveis entre pessoas vivendo com HIV e diversos fatores associados, considerando assim uma exposição multifatorial. Neste contexto, ressalta-se o importante papel da equipe multiprofissional na prevenção das comorbidades.
•NSCLC in 40years old or less patients may have particular and diverse characteristics when compared to other NSCLC patients.•A very high proportion of these patients have no smoking history.•A high ...number of young patients with NSCLC present with CNS metastasis compared to other patients with NSCLC.•Driver mutations are frequently found in this population, and our study has confirmed this finding.•Treating patients with a targetable mutation showed a benefit in overall survival in this patient population.
A proportion of patients with NSCLC is diagnosed at 40 years or younger. These patients tend to be never-smokers, usually present with stage IV adenocarcinoma, and have somatic genomic alterations. Few studies have documented and analyzed epidemiological characteristics of this population.
We performed an international epidemiological analysis of 389 young patients with NSCLC. Data was collected from centers participating in the Latin American Consortium for Lung Cancer Research (AduJov-CLICaP). Patients were identified and data was retrospectively collected from different Latin American countries and Canada (Argentina=6, Canada=19, Colombia=29, Costa Rica=9, Mexico=219, Nicaragua=2, Panama=19, Perú=76 and Venezuela=10). The period of study was from 2012 to 2017. Inclusion criteria were: age 40 years or less and a histologically confirmed NSCLC. Clinical data was obtained, and EGFR mutation status and EML4-ALK translocation were collected.
NSCLC patients aged 40 years or less accounted for approximately 4% of the total NSCLC population. Female patients accounted for 54.5%, while median age was of 37 years. Adenocarcinoma accounted for 86.1% (n=335/389), 72.5% (n=282/389; unknown=5) of patients were non-smokers, and 90.3% (n=351/389) had stage IV disease. Site of metastasis was obtained from 260/351 (unknown=91) stage IV patients (lung metastasis=40.0%, CNS metastasis=35.7%, and bone metastasis=31.5%). OS for the total population was 17.3 months (95%CI=13.9-20.7). OS for EGFRm(+)=31.4months (95%CI=11.6-51.3), EGFRm(−)=14.5months (95%CI=11.0–17.9) (p=0.005). OS for alk(+)=9.8months (95%CI=3.1-16.5) and alk(−)=5.6months (95%CI=3.9–7.3) (p=0.315).
Patients aged 40 years or less account for a small but important proportion of NSCLC cases. Younger patients may have different characteristics compared to the older population. EGFRm and EML4-alk translocation frequency is higher than that of the general population.
Stem cell–based approaches have the potential to address the organ shortage in transplantation. Whereas both embryonic stem cells and induced pluripotent stem cells have been utilized as cellular ...sources for differentiation and lineage specification, their relative ability to be recognized by immune effector cells is unclear. We determined the expression of immune recognition molecules on hepatocyte-like cells (HLC) generated from murine embryonic stem cells and induced pluripotent stem cells, compared to adult hepatocytes, and we evaluated the impact on recognition by natural killer (NK) cells. We report that HLC lack MHC class I expression, and that embryonic stem cell–derived HLC have higher expression of the NK cell activating ligands Rae1, H60, and Mult1 than induced pluripotent stem cell–derived HLC and adult hepatocytes. Moreover, the lack of MHC class I renders embryonic stem cell–derived HLC, and induced pluripotent stem cell–derived HLC, susceptible to killing by syngeneic and allogeneic NK cells. Both embryonic stem cell–derived HLC, and induced pluripotent stem cell–derived HLC, are killed by NK cells at higher levels than adult hepatocytes. Finally, we demonstrate that the NK cell activation receptor, NKG2D, plays a key role in NK cell cytotoxicity of embryonic stem cell–derived HLC, but not induced pluripotent stem cell–derived HLC.
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