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1.
West Indian med. j ; 49(2): 148-53, Jun. 2000. tab, gra
Artigo em Inglês | MedCarib | ID: med-805

RESUMO

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1998 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses were calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8 percent) and 367 deaths (20.7 percent) were reported. For 32.1 percent of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS was 11.8 months (95 percent Confidence Interval (CI), 95 percent CI 10.2 - 14.1.) After this date median survival increased to 17.8 months (95 percent CI 18.6 - 22.5 ) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months. Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p<0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH : 1.17, 95 percent CI 1.07 - 1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95 percent CI 1.32 - 2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95 percent CI 1.71- 3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH : 0.68, 95 percent CI 0.52 - 0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95 percent CI 0.13 - 0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.(AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Adolescente , Síndrome de Imunodeficiência Adquirida/mortalidade , Inibidores de Proteases/uso terapêutico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Guadalupe/epidemiologia , Infecções por HIV/epidemiologia , Estudos Longitudinais , Prognóstico , Modelos de Riscos Proporcionais , Inibidores de Proteases/uso terapêutico , Comportamento Sexual , Análise de Sobrevida , Carga Viral
2.
Cancer Epidemiol Biomarkers Prev ; 5(9): 699-704, Sept.1996.
Artigo em Inglês | MedCarib | ID: med-2378

RESUMO

Adult T-cell leukemia/lymphoma (ATL) and human T-cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) are associated with differing patterns of immune dysfunction. Biomarkers of immune activation may correlate with perturbations of immune function associated with these diseases. We conducted a pilot cross-sectionalstudy to assess four candidate biomarkers of immune activation, beta 2-microglobulin, neopterin, tryptophan, and kynurenine levels were assayed in storedsera from asymptomatic, human T-cell leukemia virus type I (HTL V-I) seronegative (HTLV-I-) and HTLV-I-seropositive (HTLV-I+) individuals, and ATL and HAM/TSP patients previously enrolled in seroepidemiological studies in Jamaica. Mean levels of beta 2-microglobulin, neopterin, and kynurenine were significantly elevated among ATL patients compared to the other study groups. Mean tryptophan levels were signigicantly lower among ATL and HAM/TSP patients than HTLV-I- and HTLV-I+ groups. No significant differences in biomarkers were found between HTLV-I- and HTLV-I+ groups. Among HAM/TSP patients, a significant association was found between elevated neopterin levels and symptoms of less than 4 years duration. In Cox proportional hazards regression modeling, neopterin and tryptophan were found to be independent predictors of survival among ATL patients. This study demonstrates a differential pattern of biomarkers of immune activation among ATL and HAM/TSP patients compared to HTLV-I- amd HTLV-I+ individuals. Neopterin and tryptophan may be useful clinical indicators of disease severity and prognosis among HAM/TSP and ATL patients. (AU)


Assuntos
Adulto , Estudo Comparativo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Biomarcadores/sangue , Leucemia-Linfoma de Células T do Adulto/imunologia , Paraparesia Espástica Tropical/imunologia , /análise , Biopterina/análogos & derivados , Biopterina/sangue , Estudos Transversais , Previsões , Jamaica , Cinurenina/sangue , Anticorpos Anti-HTLV-I/sangue , Leucemia-Linfoma de Células T do Adulto/sangue , Paraparesia Espástica Tropical/sangue , Projetos Piloto , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Triptofano/sangue
3.
BMJ ; 311(7020): 1600-2, Dec. 16 1995.
Artigo em Inglês | MedCarib | ID: med-3510

RESUMO

OBJECTIVE: To examine whether simple interventions in a sickle cell clinic improve survival in sickle cell disease. DESIGN: Survival curve analysis and hazard ratios in a cohort study followed from birth. SETTING: MRC Laboratories (Jamaica) at the University of the West Indies, and Victoria Jubilee Hospital, Kingston, Jamaica. SUBJECTS: 315 patients with homozygous sickle cell disease detected during the screening of 100,000 consecutive non-operative deliveries between June 1973 and December 1981 at the main government maternity hospital, Kingston, Jamaica. INTERVENTIONS: Prophylactic penicillin to prevent pneumococcal septicaemia, parental education in early diagnosis of acute splenic sequestration, close monitoring in sickle cell clinic. MAIN OUTCOME MEASURES: Survival. RESULTS: Survival appeared to improve, the log rank test for trend comparing the first, second, and last third of the study reaching borderline significance (P = 0.05). Combined deaths from acute splenic sequestration and pneumococcal septicaemia-meningitis declined significantly (test for trend, P = 0.02). CONCLUSION: Early diagnosis and simple prophylactic measures significantly reduce deaths associated with homozygous sickle cell disease (AU)


Assuntos
Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Anemia Falciforme/mortalidade , Anemia Falciforme/genética , Anemia Falciforme/terapia , Estudos de Coortes , Homozigoto , Jamaica/epidemiologia , Meningite/mortalidade , Meningite/prevenção & controle , Pais/educação , Penicilinas/uso terapêutico , Infecções Pneumocócicas/mortalidade , Infecções Pneumocócicas/prevenção & controle , Modelos de Riscos Proporcionais , Sepse/mortalidade , Sepse/prevenção & controle , Esplenopatias/diagnóstico , Esplenopatias/mortalidade , Taxa de Sobrevida
4.
J Trop Med Hyg ; 93(2): 127-32, Apr. 1990.
Artigo em Inglês | MedCarib | ID: med-12536

RESUMO

In a screening programme for sickle cell haemoglobinopathies at a maternity hospital in Kingston, Jamaica, 100,000 newborns were screened with the detection of 315 cases of SS disease, and 201 cases of SC disease. There was no upward or downward trend in the frequency of SS or SC births during the screening programme. The sequence numbers of the SS and SC births were analysed to examine whether these cases were randomly distributed among the 100,000 newborns. The occurence of SS births seems to accord well with the random model but there was an excess of very long intervals between SC births. (AU)


Assuntos
Humanos , Recém-Nascido , Anemia Falciforme/epidemiologia , Doença da Hemoglobina SC/epidemiologia , Jamaica/epidemiologia , Probabilidade , Modelos de Riscos Proporcionais
5.
Int J Epidemiol ; 18(4): 808-16, Dec. 1989.
Artigo em Inglês | MedCarib | ID: med-7902

RESUMO

A ten year community survey was undertaken to investigate the high coronary heart (CHI) incidence among people of Indian (South Asian) descent in Trinidad, West Indies. Of 2491 individuals aged 35-69, 2215 (89 percent) were examined and 2069 (83 percent) found to be clinically free of CHD at baseline. After exclusion of 71 of minority ethnic groups, 786 African, 598 Indian, 147 European and 467 adults of mixed descent were followed for CHD morbidity and mortality. In both sexes, adults of Indian origin had higher prevalence rates of diabetes mellitus, a low concentration of high density lipoprotein(HDL) cholesterol, and recent abstinence from alcohol than other ethnic groups. Indian men also had larger skinfold thicknesses than other men. In participants free of CHD at entry, the age-adjusted relative risk of a cardiac event believed due to CHD, was at least twice as high in Indian men and women as in other ethnic groups. In men, blood pressure, diabetes mellitus and low-density lipoprotein(LDL) cholesterol concentration were positively and independently related to risk of CHD, wheras alcohol consumption and HDL cholesterol concentration were inversely associated with risk after allowing for age and ethnic group. The ethnic contrast in CHD persisted when these characteristics were taken into account. In the smaller sample of women, only ethnic groups were predictive of CHD as defined. The failure of point estimates of risk to explain the high CHD incidence in Indians calls for focus on age of onset of risk and examination of other potential risk factors such as insulin concentration. (AU)


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Doença das Coronárias/etnologia , Países em Desenvolvimento/estatística & dados numéricos , África/etnologia , Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Europa (Continente)/etnologia , Seguimentos , Índia/etnologia , Modelos Lineares , HDL-Colesterol/sangue , Oriente Médio/etnologia , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Trinidad e Tobago/epidemiologia , China/etnologia
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