RESUMO
Paragangliomas and pheocromocytomas are rare neuroendocrine tumors with different clinical presentation, being responsible for secondary arterial hypertension with target-organ lesions. Surgery is a curative therapy in these tumors and demands a multidisciplinary approach. These tumors are more frequent between the 4th and 5th decades of life and their clinical manifestations are related to catecholamines production: headache, palpitations, variable blood pressure. This article presents 13 clinical cases of patients with neuroendocrine tumors, with an median-age of 56,7 years, submitted to surgery between 2014 and 2017. The diagnosis was made based on clinical suspicion, serum and urinary catecholamines and metanephrins, imagiologic evaluation with CT or abdominal and pelvic MRI and MIBG scintigraphy. After surgery, the majority of patients remained with normal blood pressure, without anti-hypertensive therapy and follow-up was maintained in Outpatient Clinic, with periodic blood tests and imaging reevaluation.
RESUMO
Juxtaglomerular cell tumors are rare, generally benign, and they are one of the secondary surgically treatable causes of arterial hypertension. There are about 100 reported cases on literature, and the diagnosis is usually carried out based on a high clinic suspicion index, mostly in patients with hypokalemia and arterial hypertension. The diagnosis involves blood tests and imaging studies, but it is only definite with histopathological exam after surgical treatment. We present a case of a 22-year-old woman with resistant arterial hypertension and renal and cardiovascular target-organ lesions. High plasmatic renin and a nodular renal mass on magnetic resonance imaging were present. A tumorectomy was performed and the histological exam confirmed a reninoma. After surgery, blood pressure and serum renin values returned to normal without medication. This work focuses on the need to exclude rare secondary causes of hypertension in young patients with resistant forms of this disease.
RESUMO
BACKGROUND: Topical tretinoin cream is the gold standard treatment for skin ageing, particularly photoaging. The purpose of tretinoin peel was to obtain similar results, but in a shorter time, however, there have been few controlled trials on its effectiveness. OBJECTIVE: To compare efficacy and safety of tretinoin 0.05% cream and 5% as a peeling agent on photoaging and field cancerization of the forearms. METHODS: Clinical trial with therapeutic intervention, prospective, randomized (computer-generated randomization list), parallel, comparative (intrasubject) and evaluator-blinded (except for histology and immunohistochemistry), including 24 women (48 forearms) aged over 60 years who have not undergone hormone replacement and categorized as Fitzpatrick skin phototype II or III. The forearms of the participants were randomized for treatment with 0.05% tretinoin cream three nights a week, or 5% tretinoin peel every 2 weeks. The opinion of the participant, severity of photoaging, corneometry, profilometry, high-frequency ultrasound, histology (haematoxylin-eosin and Verhoeff stainings) and immunohistochemistry (p53, bcl-2, Ki67 and collagen I) were assessed. RESULTS: One participant dropped out. The mean photoaging score reduced 20% and the mean actinic keratosis (AK) count reduced 60% with no difference between treatments. Three efficacy parameters showed opposite effects between the tretinoin treatments (P < 0.05%): (i) thickness of the corneal layer decreased with 0.05% tretinoin and increased by 5%; (ii) dermis echogenicity increased by 0.05% and decreased by 5% and (iii) Ki67 expression increased by 0.05% and decreased by 5%. There was good tolerability for both regimens. CONCLUSION: Tretinoin as a cream 0.05% or peeling (5%) is safe and effective for the treatment of moderate photoaging and forearm field cancerization. The cream was superior in improving ultrasonographic parameters of ageing. Peeling was shown a superior performance in the stabilization of field cancerization.
Assuntos
Antineoplásicos/administração & dosagem , Abrasão Química , Ceratose Actínica/tratamento farmacológico , Envelhecimento da Pele/efeitos dos fármacos , Creme para a Pele/administração & dosagem , Tretinoína/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Derme/diagnóstico por imagem , Epiderme/diagnóstico por imagem , Feminino , Antebraço , Humanos , Ceratose Actínica/metabolismo , Ceratose Actínica/patologia , Antígeno Ki-67/metabolismo , Estudos Prospectivos , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Método Simples-Cego , Envelhecimento da Pele/patologia , Creme para a Pele/efeitos adversos , Fenômenos Fisiológicos da Pele/efeitos dos fármacos , Tretinoína/efeitos adversos , Proteína Supressora de Tumor p53/metabolismo , UltrassonografiaRESUMO
BACKGROUND: The intrinsic ageing and photoaged skin present biomechanical and morphological differences, which are reflected in the appearance of roughness, superficial and deep wrinkles, atrophy, reduced elasticity, hypo- and hyperpigmentation and actinic keratosis. OBJECTIVE: To evaluate and compare the characteristics of the flexor (with a predominance of intrinsic ageing) and extensor (chronically exposed to sunlight and other environmental factors, with a predominance of photoageing) skin surfaces of the forearms. METHODS: Interventional, prospective, diagnostic study, including 23 females, aged over 60 years. The extensor and flexor faces of forearms were compared in relation to clinical parameters and non-invasive instrumental measurements, such as skin surface, elasticity, hydration as well as dermal thickness and echogenicity. RESULTS: Regarding the water content of the stratum corneum, the flexor face presented an average value higher than the extensor face. The average of measures obtained through images of high-frequency ultrasound demonstrated greater echogenicity of flexor face compared to the extensor face. The measurements of the skin surface showed significant differences between the faces. The roughness and scaliness were lower in the flexor face. Regarding the depth of wrinkles, there was no significant difference between the faces. The average of the measurements was slightly higher in the flexor face, which demonstrated that wrinkles are present in the intrinsic ageing and photoageing. The presence of elastosis and the reduction in elasticity in the clinical aspect of the photoaged face of forearms were according to the results of the non-invasive measurements. CONCLUSION: Meaningful differences in the biophysical characteristics of the extensor and flexor faces of the forearms were detected. Because the non-invasive instrumental measurements correlated with clinical findings, they may represent useful tools to assess efficacy and safety of skin ageing treatments in clinical research.
Assuntos
Antebraço , Envelhecimento da Pele , Exposição Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Luz SolarRESUMO
OBJECTIVE: High-frequency ultrasound is a non-invasive tool used in skin ageing research to assess dermis thickness and echogenicity. This study evaluated the reliability of a range of high-frequency ultrasound parameters and tested their correlation with age and a validated clinical scale for the assessment of forearm skin photoageing; the difference between two body sites according to environmental exposition patterns was also investigated. METHODS: Twenty-three volunteers aged 28-82 years were divided into three groups according to forearm photoageing degree. A 20 MHz ultrasound unit was used to obtain cross-sectional images of the skin by two trained investigators on two different sites: the dorsal forearm (chronically photoexposed skin) and the proximal medial arm (non-photoexposed skin). Several echogenicity parameters were studied for each skin compartment: total dermis, upper dermis and lower dermis, and the ratio between upper and lower dermis. RESULTS: The intraclass correlation coefficient (for complete agreement) between investigators was higher for upper and total dermis echogenicity measures compared with the lower dermis. At the non-photoexposed site, the upper and lower dermis parameter ratio was better correlated with age. At the photoexposed area, total dermis parameters demonstrated higher correlations with clinical score. CONCLUSION: The authors discuss the choice of parameters for forearm photoageing assessment using high-frequency ultrasound.
Assuntos
Antebraço/efeitos da radiação , Luz , Envelhecimento da Pele , Ultrassom , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Cellulite refers to skin relief alterations in women's thighs and buttocks, causing dissatisfaction and search for treatment. Its physiopathology is complex and not completely understood. Many therapeutic options have been reported with no scientific evidence about benefits. The majority of the studies are not controlled nor randomized; most efficacy endpoints are subjective, like not well-standardized photographs and investigator opinion. Objective measures could improve severity assessment. Our purpose was to correlate non-invasive instrumental measures and standardized clinical evaluation. METHODS: Twenty six women presenting cellulite on buttocks, aged from 25 to 41, were evaluated by: body mass index; standardized photography analysis (10-point severity and 5-point photonumeric scales) by five dermatologists; cutometry and high-frequency ultrasonography (dermal density and dermis/hypodermis interface length). Quality of life impact was assessed. Correlations between clinical and instrumental parameters were performed. RESULTS: Good agreement among dermatologists and main investigator perceptions was detected. Positive correlations: body mass index and clinical scores; ultrasonographic measures. Negative correlation: cutometry and clinical scores. Quality of life score was correlated to dermal collagen density. CONCLUSION: Cellulite caused impact in quality of life. Poor correlation between objective measures and clinical evaluation was detected. Cellulite severity assessment is a challenge, and objective parameters should be optimized for clinical trials.
Assuntos
Tecido Adiposo/patologia , Pele , Adulto , Feminino , Humanos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Cellulite refers to changes in skin relief on the thighs and buttocks of women, with a prevalence of 80-90%, causing dissatisfaction and search for treatment. Etiopathogenesis is multifactorial, as follows: herniation of the hypodermis towards the dermis, facilitated by perpendicular fibrous septa, changes in the dermal extracellular matrix, decreased adiponectin, genetic polymorphism, microcirculation alterations and inflammatory process. There are numerous therapeutic approaches, with little evidence of effectiveness. The long-wave infrared (LWIR) radiation interacts with water, improves microcirculation and stimulates metabolic processes. To date, the use of tissues with potential reflection of LWIR radiation has not been systematically investigated as adjuvant treatment for cellulite. OBJECTIVE: To investigate the efficacy and safety of the treatment of cellulite through the use of compression stockings made with thread reflecting LWIR radiation. PATIENTS AND METHODS: Clinical study of therapeutic intervention, controlled and double-blind, including 30 women, aging from 25 to 40 years, with cellulite of grades II and III on the thighs and buttocks who used compression stockings, "pantyhose" model, made with reflector thread of LWIR radiation, on only one randomized side. Women under other treatments for cellulite and with venous and/or blood insufficiencies were excluded. Evaluation of efficacy by clinical parameters, photographs, Dermatology Life Quality Index (DLQI), cutometry and high frequency ultrasonography and security by observation of adverse events and venous EcoDoppler recordings. RESULTS: DLQI scores showed significant reduction; the two-dimensional high-frequency ultrasonography showed an insignificant increase in dermal echogenicity as well as other efficacy parameters demonstrated no or slight improvement, with no differences between the sides exposed or not to LWIR; and there were no severe adverse events. CONCLUSION: Compression stockings, with or without thread reflector of LWIR, showed slight effects in the appearance of cellulite, but the treatment determined a positive impact on women quality of life.
Assuntos
Tecido Adiposo/fisiopatologia , Nádegas/fisiopatologia , Técnicas Cosméticas , Meias de Compressão , Coxa da Perna/fisiopatologia , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/efeitos da radiação , Adulto , Nádegas/diagnóstico por imagem , Método Duplo-Cego , Feminino , Humanos , Qualidade de Vida , Coxa da Perna/diagnóstico por imagem , UltrassonografiaRESUMO
SETTING: A national survey of Mycobacterium tuberculosis resistance was conducted for the first time in Madagascar between October 2005 and July 2007. OBJECTIVE: To determine resistance rates among new and previously treated cases of pulmonary tuberculosis. METHODS: In a cluster sampling representative of the general population of the country, 1275 smear-positive tuberculosis patients recruited at 34 sites, 926 new patients and 87 previously treated patients underwent drug susceptibility testing against rifampicin (RMP), isoniazid (INH), streptomycin and ethambutol on Löwenstein-Jensen medium using the indirect proportion method. RESULTS: Resistance among new cases was 6.5% (95%CI 4.9-8) and among previously treated cases it was 11.5% (95%CI 4.8-18.2). Monoresistance among new cases was 5.8% (95%CI 4.2-7.3), mainly to INH (3.7%). Multiresistance to INH and RMP was 0.2% (95%CI 0-0.5) among new cases and 3.4% (95%CI 0-7.2) among previously treated cases. No significant difference was noted with regard to sex or age. CONCLUSION: The rates of resistance among new and previously treated cases remain relatively low in Madagascar.
Assuntos
Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Mycobacterium tuberculosis/isolamento & purificação , Vigilância da População/métodos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Madagáscar/epidemiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Estudos Retrospectivos , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto JovemRESUMO
In this paper, fractional Gaussian noise (fGn) was used to simulate a homogeneously spreading broadband signal without any dominant frequency band, and to perform a simulation study about the influence of time-series length in the number of intrinsic mode functions (IMFs) obtained after empirical mode decomposition (EMD). In this context three models are presented. The first two models depend on the Hurst exponent H, and the last one is designed for small data lengths, in which the number of IMFs after EMD is obtained based on the regularity of the signal, and depends on an index measure of regularity. These models contribute to a better understanding of the EMD decomposition through the evaluation of its performance in fGn signals. Since an analytical formulation to evaluate the EMD performance is not available, using well-known signals allows for a better insight into the process. The last model presented is meant for application to real data. Its purpose is to predict, in function of the regularity signal, the time-series length that should be used when one wants to divide the spectrum into a pre-determined number of modes, corresponding to different frequency bands, using EMD. This is the case, e.g., in heart rate and blood pressure signals, used to assess sympathovagal balance in the central nervous system.
Assuntos
Interpretação Estatística de Dados , Diagnóstico por Computador/métodos , Modelos Biológicos , Modelos Estatísticos , Processamento de Sinais Assistido por Computador , Animais , Simulação por Computador , HumanosRESUMO
Elevated erythrocyte destruction in sickle cell disease (SCD) results in chronic hyperbilirubinaemia and, in a subset of patients, cholelithiasis occurs. We investigated whether the (TA)n promoter polymorphism in the UDP-glucuronosyltransferase 1A1 gene (UGT1A1) may modify bilirubin metabolism, influencing bilirubinaemia, predisposition to cholelithiasis and subsequent cholecystectomy, in a group of 153 young SCD patients (mean age 12.0 +/- 9.0 years) predominantly of Bantu beta S haplotype. The concomitant effect of alpha thalassaemia was also analysed. Among the several UGT1A1 genotypes found, the most frequent were the (TA)6/(TA)6 (n = 37), (TA)6/(TA)7 (n = 60) and (TA)7/(TA)7 (n = 29). These groups of patients did not significantly differ in age, gender ratio and haemoglobin, foetal haemoglobin and reticulocyte levels. On the other hand, total bilirubin levels were significantly different between groups, with an increased (TA) repeat number being associated with higher bilirubinaemia. Furthermore, both cholelithiasis and cholecystectomy were more frequent in groups with higher (TA) repeat number, although the former association was not statistically significant. None of the mentioned parameters is statistically different within UGT1A1 groups with the presence of alpha thalassaemia. Thus, the UGT1A1 promoter polymorphism may represent an important nonglobin genetic modifier of Bantu SCD patients' clinical manifestations, even at a young age.
Assuntos
Anemia Falciforme/enzimologia , Anemia Falciforme/genética , Glucuronosiltransferase/genética , Adolescente , Anemia Falciforme/sangue , Anemia Falciforme/complicações , Bilirrubina/sangue , Criança , Pré-Escolar , Colelitíase/etiologia , Repetições de Dinucleotídeos , Feminino , Humanos , Lactente , Masculino , Polimorfismo Genético , Regiões Promotoras Genéticas , Talassemia alfa/enzimologia , Talassemia alfa/genéticaRESUMO
Non-invasive autonomic evaluation has used fast Fourier transform (FFT) to assign a range of low (LF) and high frequencies (HF) as markers of sympathetic and parasympathetic influences, respectively. However, FFT cannot be applied to brief transient phenomena, such as those observed on performing autonomic tests where the acute changes of cardiovascular signals (blood pressure and heart rate) that represent the first and most important stage of the autonomic performance towards a new state of equilibrium occur. Wavelet analysis has been proposed as a method to overcome and complement information taken exclusively in the frequency domain. With discrete wavelet transform (DWT), a time-frequency analysis can be done, allowing the visualization in time of the contribution of LF and HF to the observed changes of a particular signal. In this study, we evaluate with wavelets the acute changes in R-R intervals and systolic blood pressure that are observed in normal subjects during four classical autonomic tests: head-up tilt (HUT), cold pressor test (CPT), deep breathing (DB) and Valsalva manoeuvre (VM). Continuous monitoring of ECG and blood presure was performed. Also LF, HF and LF/HF were calculated. Consistent with previous interpretations, data showed an increase of sympathetic activity in HUT, CPT and VM. On DB, results reflected an increase in parasympathetic activity and frequencies. In conclusion, when compared with FFT, wavelet analysis allows the evaluation of autonomic variability during short and non-stationary periods of time and may constitute a useful advance in the assessment of autonomic function in both physiological and pathological conditions.
Assuntos
Sistema Nervoso Autônomo/fisiologia , Pressão Sanguínea/fisiologia , Exercícios Respiratórios , Frequência Cardíaca/fisiologia , Manobra de Valsalva/fisiologia , Adulto , Temperatura Baixa , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Teste da Mesa InclinadaRESUMO
UNLABELLED: An epidemiological investigation (Ministry of Health/Institut Pasteur de Madagascar (IPM)) was conducted in July 2002, in two districts of a same province (Fianarantsoa: Fianarantsoa II and Ikongo) considering the high frequency of deaths linked with acute respiratory infection (ARI). Morbidity and mortality data was collected in the Centre de Santé de Base (CSB) which gave the alert (village of Sahafata, district Fianarantsoa II). Analysis of monthly activity reports (MAR) allowed calculation of incidence rates of ARI/pneumonia in Fianarantsoa province. Virological data was based on the analysis of nasopharyngeal samples collected during the investigations. Clinical symptoms and homogeneity of laboratory results are consistent with an origin of these epidemics being related to the circulation of an influenza virus A subtype H3N2. Attack rates were very high. CFR was significantly higher in individuals of less than 1 year and more than 65 years. This data was confirmed by posterior investigations of teams from MoH/WHO. Surprisingly, this large epidemic was due to a known influenza virus that previously circulated in countries of northern hemisphere (the year before) and even in Antananarivo weeks before. Different hypothesis could be proposed to explain such phenomenon: great restriction of exchanges between different geographical zones, nutritional status.... CONCLUSION: The epidemic episodes of acute respiratory infections in Madagascar in July 2002 were due to an influenza virus A subtype H3N2 without any genotypic or phenotypic features. Various factors, could explain the importance of the epidemic and particular high lethality found in some age groups. This epidemic illustrates the relative incapacity for a developing country, to face and manage a flu epidemic caused by a classical influenza virus.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Vírus da Influenza A , Infecções Respiratórias/epidemiologia , Doença Aguda , Adolescente , Adulto , Distribuição por Idade , Idoso , Causas de Morte , Criança , Pré-Escolar , Notificação de Doenças , Métodos Epidemiológicos , Humanos , Incidência , Lactente , Madagáscar/epidemiologia , Pessoa de Meia-Idade , Morbidade , Nasofaringe/virologia , Vigilância da População , Características de Residência/estatística & dados numéricos , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Fatores de Risco , Estações do AnoRESUMO
The "Institut Pasteur de Madagascar" virology laboratory is the National WHO Centre for Influenza surveillance in Madagascar. On this surveillance collaborate the Ministry of Health with 9 sentinel centres. In the present article, the authors relate the results of influenza surveillance in Antananarivo between 1995 and 2002. Among 6341 patients with nasal and/or pharyngeal swabs, influenza virus were isolated from 427 patients (6.7%): 307 (68.4%) influenza virus A (H3N2), 124 (27.1%) influenza virus B, 8 (4.0%) influenza virus A (H1N1). The virus had been continually spreading all year long. The weak and the strong points of the influenza sentinel surveillance are also discussed in order to ameliorate the collection processes of influenzal and respiratory morbidity data.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Vírus da Influenza A , Vírus da Influenza B , Influenza Humana , Vigilância da População/métodos , Saúde da População Urbana/estatística & dados numéricos , Coleta de Dados/métodos , Coleta de Dados/normas , Países em Desenvolvimento , Humanos , Incidência , Vírus da Influenza A/classificação , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/classificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/epidemiologia , Influenza Humana/virologia , Madagáscar/epidemiologia , Morbidade , Nasofaringe/virologia , Avaliação das Necessidades , Saúde Pública , Estações do Ano , Gestão da Qualidade Total , Cultura de Vírus/métodosRESUMO
A method associating an anticoagulant rodenticide and an insecticide called Kartman bait-box aimed both at fighting reservoir and vectors of plague. It was evaluated in two neighbourhoods of Antananarivo (Madagascar) from October 2002 to May 2003. It involved the local community in the control. The study was carried out in Ambodirano-Ampefiloha refered as treated neighbourhood in which the Kartman bait box were laid out with an anticoagulant rodenticide and an insecticide with a rapid action versus a "pilot neighbourhood", Ankorondrano-Andranomahery in which the boxes were provided with non poisoning bait and non insecticidal white powder. The rodenticide used was Baraki (difethialone 25 ppm) and the insecticide was a powder of Propoxur 3%. The evaluation of effectiveness of this method was based on the four following parameters: (1) the number of dead rats collected daily inside and in the vicinity of the houses, (2) the daily number of baits non consumed in the Kartman bait box, (3) the cheopis index of the rats trapped using the BTS trap, and (4) the flea carrier index of the rats captured monthly with BTS trap. The cheopis index and the flea carrier index of the rats were calculated monthly. The number of rats that died in the treated neighbourhood was of 968 versus 3 in the pilot neighbourhood. The other parameters reached a stable level after 3 months. Between days 120 and 180, the mean number of unconsumed baits was 2.79 in the treated neighbourhood versus 0.14 in the pilot neighbourhood, the flea carriage (percentage of parasitized hosts) was 0% versus 61% in the pilot neighbourhood, and the cheopis index was 0.0 versus 5.0 in the pilot neighbourhood. This study demonstrates that Kartman bait-boxes reached the rat borne and the vectors of plague found in urban area. We propose to use this method extensively both during epidemic and inter-epidemic contexts.
Assuntos
Controle de Insetos/instrumentação , Peste/prevenção & controle , Controle de Roedores/instrumentação , Saúde da População Urbana , 4-Hidroxicumarinas , Animais , Reservatórios de Doenças , Vetores de Doenças , Doenças Endêmicas/prevenção & controle , Doenças Endêmicas/estatística & dados numéricos , Desenho de Equipamento , Humanos , Controle de Insetos/normas , Insetos Vetores/microbiologia , Inseticidas , Madagáscar , Projetos Piloto , Peste/epidemiologia , Peste/microbiologia , Peste/transmissão , Densidade Demográfica , Áreas de Pobreza , Propoxur , Controle de Roedores/normas , Rodenticidas , Sifonápteros/microbiologia , Fatores de Tempo , Saúde da População Urbana/estatística & dados numéricosRESUMO
In Madagascar, the epidemiological data actualized concerning the cancer of the collus of uterus are not available because of the absence of register of cancer. The objective of this study is to achieve a first assessment of the problem, to complete the epidemiological knowledge, to point out the tool of precoce detection of the precancerous lesions, to propose the measures aiming to improve the management of the patients and to contribute to the institution of a register of cancer. This is a retrospective survey on the frequency of the cancer of the cervix observed from 1992 to 2002 about 23,908 withdrawals addressed to the Institut Pasteur de Madagascar for anatomopathological exam and 12,605 cervical smears for cytological exam. In pathological anatomy, 2,621 (63.4%) of 4,136 cases of diagnosed cancer, have been observed in women. 687 cases (26.2%) of them were localized in the collus. The 3/4 of the cancers of the cervix is invasive and the mean age is 48.2 years old at the time of diagnosis. The cytology detects only 74 cases of invasive cancer of which most don't have an histological confirmation. 274 pre-lesions of cervix cancer were diagnosed for this period, the majority lesions are cytological diagnosis. In spite of a non representative recruitment of the general population, and by the number of withdrawals considered, these results may represent indicators of the epidemiological situation and justify the institution of program to detect the precancerous lesions in a national scale.
Assuntos
Neoplasias do Colo do Útero/epidemiologia , Centros Médicos Acadêmicos , Academias e Institutos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Madagáscar/epidemiologia , Programas de Rastreamento , Pessoa de Meia-Idade , Avaliação das Necessidades , Estadiamento de Neoplasias , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Vigilância da População , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Gestão da Qualidade Total , Neoplasias do Colo do Útero/classificação , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço VaginalRESUMO
Heart failure is a common disease with major social and economic repercussions for the health system. All potentially curable or reversible causes of heart failure should be investigated and treated if possible. Several experimental and clinical studies have demonstrated that supraventricular tachycardias can induce a form of dilated cardiomyopathy (tachycardiomyopathy), which may be reversible with ventricular frequency response control. In this article we present a clinical case, and review this clinical entity, so often underdiagnosed.
Assuntos
Cardiomiopatia Dilatada/etiologia , Taquicardia Supraventricular/complicações , Idoso , Animais , Cardiomiopatia Dilatada/fisiopatologia , Modelos Animais de Doenças , Cães , Humanos , Masculino , Taquicardia Supraventricular/fisiopatologiaRESUMO
In July 1999, after the return of the Kosovar refugees to their country, an outbreak of acute hepatitis A (HAV) and E (HEV) occurred. Epidemic hepatitis and diarrhoea are closely monitored communicable diseases which had been singled out as priorities by the health authorities of the former Republic of Yougoslavia. Several field surveys were undertaken: description of reported cases, serological study of clinical patients, study of anti-HAV seroprevalence in a school and a case control study to assess risk factors. The analysis of the reports indicates an epidemic peak at the end of September, 2 or 3 weeks after the start of the new school year, with an increase of cases relative to the age of the children in school. In a serologic study of 104 samples, we found an anti-HAV IgM positivity in 88% of the cases. Children were more likely to be positive when compared to teenagers and adults; likewise, consumers of well-water as versus those drinking network water (p = 0.03). The study of seroprevalence showed that transmission had taken place within the school. The case control study, in spite of its imperfections, indicated that consumption of water melon, the only fruit cultivated locally, is a factor which facilitates the HAV transmission. Circulation of the hepatitis E virus was confirmed for 4 sick persons (including 2 co-infected HAV-HEV) and in 4 persons without clinical symptoms. These results show the permanent risk of faeco-oral infections in this area and the need to develop a relevant prevention policy.
Assuntos
Hepatite A/epidemiologia , Hepatite E/epidemiologia , Estudos Soroepidemiológicos , Testes Sorológicos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Frutas , Hepatite A/diagnóstico , Hepatite A/transmissão , Vírus da Hepatite A/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatite E/diagnóstico , Humanos , Imunoglobulina M/sangue , Lactente , Masculino , Pessoa de Meia-Idade , Refugiados , Instituições Acadêmicas , Iugoslávia/epidemiologiaRESUMO
An international multicenter study of ready-to-eat foods, sandwiches, and ice creams or sorbets sold in the streets and their vendors was carried out to assess the microbiological quality of these foods and to identify characteristics of the vendors possibly associated with pathogens. Thirteen towns in Africa, America, Asia, and Oceania were involved in the study. A single protocol was used in all 13 centers: representative sampling was by random selection of vendors and a sample of foods bought from each of these vendors at a time and date selected at random. Microbiological analyses were carried out using standardized Association Française de Normalisation methods, and the use of a standardized questionnaire to collect data concerning the characteristics of the vendors. Fifteen surveys were carried out, with 3,003 food samples from 1,268 vendors. The proportion of unsatisfactory food samples was between 12.7 and 82.9% for ice creams and sorbets and between 11.3 and 92% for sandwiches. For ice creams and sorbets, the sale of a large number of units (>80 per day) increased the risk of unsatisfactory food by a factor of 2.8 (95% confidence interval [CI]: 1.5 to 5.1), lack of training in food hygiene by 6.6 (95% CI: 1.1 to 50). and by a factor of 2.8 (95% CI: 1.4 to 5.4) for mobile vendors. These risk factors were not identified for sandwiches, this difference may be due to the presence of a cooking step in their preparation. These results show that the poor microbiological quality of these street foods constitutes a potential hazard to public health, that the extent of this hazard varies between the cities studied, and that vendors' health education in food safety is a crucial factor in the prevention of foodborne infections.
Assuntos
Contaminação de Alimentos/análise , Manipulação de Alimentos/métodos , Contagem de Colônia Microbiana , Qualidade de Produtos para o Consumidor , Análise de Alimentos , Microbiologia de Alimentos , Humanos , Higiene , Sorvetes/microbiologia , Sorvetes/normas , Saúde Pública , SegurançaRESUMO
Capillary leakage Syndrome (CLS) is a rare clinical syndrome, that was first described in 1960, characterized by acute episodes of generalized edema, hemoconcentration, hypoproteinemia and monoclonal gammopathy, in the vast majority of cases. We describe a 39-year-old man with anasarca, bilateral pleural and pericardial effusions, ascites and diffuse alveolo-intersticial edema. Clinical and laboratory findings were consistent with an acute episode of CLS. Treatment with prednisone, furosemide and aminophylline was started, which lead to a gradual improvement in 48 hours. Pathophysiologically there is an increase in capillary permeability with the extravasation of fluid and plasmatic proteins to the extravascular space that can lead to hypovolaemic shock. In the second phase there is a reentry of the fluid overload leading to pulmonary edema. The etiology of this hyperpermeability still remains unclear. The role of cytokines has become central in the comprehension of pathophysiology of CLS. Adhesion molecules are probably also involved in the genesis of capillary leakage. CLS treatment remains empirical. However, at present it seems that the association of steroids with furosemide, aminophylline and terbutaline are capable of controlling the clinical manifestation of the acute episodes in most cases. To our knowledge no prophylatic therapy has clearly proven its efficacy. There are only a few series analyzing the long-term evolution of patients with CLS. Further studies are necessary with the objective to collect enough patients with CLS to observe natural history of the disease and evaluate the efficacy of empiric treatments.
Assuntos
Síndrome de Vazamento Capilar/fisiopatologia , Citocinas/fisiologia , Edema/etiologia , Adulto , Albuterol/uso terapêutico , Antibacterianos/uso terapêutico , Síndrome de Vazamento Capilar/complicações , Síndrome de Vazamento Capilar/tratamento farmacológico , Quimioterapia Combinada , Transfusão de Eritrócitos , Evolução Fatal , Furosemida/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Doença de Hodgkin/complicações , Humanos , Ipratrópio/uso terapêutico , Masculino , Pancitopenia/etiologia , Pancitopenia/terapia , Transfusão de Plaquetas , Prednisolona/uso terapêuticoRESUMO
A study of the microbiological quality of ice lice creams/sorbets sold on the streets of Phnom Penh city was conducted from April 1996 to April 1997. Socio-demographic and environmental characteristics with two ice/ice creams samples were collected from vendors selected in the city. A total of 105 vendors and 210 ice/ice creams samples were randomly selected for the study period. Ice/ice cream vendors in the streets of Phnom Penh were adults (mean age: 28 years old) with a male predominance (86.5%). Mean educational level of vendors was 5 years with no training in mass catering. Most ice creams and sorbets (81.7%) were made using traditional methods. Microbiological analysis performed in the laboratory of Pasteur Institute of Cambodia indicated the poor bacteriological quality of the samples. The proportions of samples classified unsafe according to microbiological criteria were 83.3% for total bacterial count at 30 degrees C, 70% for total coliforms, 30% for faecal coliforms, 12.2% for Staphylococcus aureus and 1.9% for presence of Salmonella spp. These bacterial results suggest that many other food products sold in the streets may be similarly poor. Safety measures should be undertaken to avoid potential threats. Regulation of the street food sector should be part of a larger strategy for enhanced food safety and environmental quality in the city.