RESUMO
BACKGROUND: The incidence of skin cancer has reached epidemic proportions in the white population and is significantly elevated in agricultural populations, who are exposed to ultraviolet radiation during their professional activities. In 2014, the Agricultural Social Insurance Mutual Benefit Fund (MSA) offered its customers who work in agriculture and live in rural areas with reduced access to dermatologists the ability to participate in a 1-day teledermoscopic (TDS) screening event. OBJECTIVE: This study's aim was to assess the feasibility of real-time mobile TDS triage of a large number of agricultural workers by trained medical officers and occupational physicians. METHODS: Fifteen TDS screening centres were located in different areas of France. Individuals older than 18 years who worked in agriculture and lived in rural area near a TDS screening centre were invited to participate in a 1-day screening event and were examined by an MSA physician. In cases of suspicious skin lesions, clinical and dermoscopic images were obtained and transferred immediately to four dermatologists who were simultaneously present at the tele-platform for diagnosis and decision-making. Low-quality images were retaken. RESULTS: Two-hundred eighty-nine patients underwent skin cancer screening. Among 199 patients (69%), 390 suspicious lesions were identified and generated 412 pictures. All lesions were analysed by dermatologists. For 105 patients (53%), no follow-up was required. Seventeen patients were referred to local dermatologists for rapid examination, including 12 cases of suspected malignant melanocytic lesions. Among the 12 patients with suspected melanoma, face-to-face visits were conducted within 10 days for 11 of them, and 1 case of melanoma was confirmed by histopathology. CONCLUSIONS: Our study suggests that teledermoscopy performed in the context of occupational medicine and targeted to agricultural populations is feasible and could be useful for improving skin cancer screening in at-risk populations while avoiding face-to-face examinations by a dermatologist in 53% of cases.
Assuntos
Doenças dos Trabalhadores Agrícolas/diagnóstico , Telefone Celular , Dermoscopia , Neoplasias Cutâneas/diagnóstico , Telemedicina , Doenças dos Trabalhadores Agrícolas/epidemiologia , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Unidades Móveis de Saúde , Neoplasias Cutâneas/epidemiologiaRESUMO
Syphilis diagnosis is based on clinical observation, serological analysis, and dark-field microscopy (DFM) detection of Treponema pallidum subsp. pallidum, the etiological agent of syphilis, in skin ulcers. We performed a nested PCR (nPCR) assay specifically amplifying the tpp47 gene of T. pallidum from swab and blood specimens. We studied a cohort of 294 patients with suspected syphilis and 35 healthy volunteers. Eighty-seven of the 294 patients had primary syphilis, 103 had secondary syphilis, 40 had latent syphilis, and 64 were found not to have syphilis. The T. pallidum nPCR results for swab specimens were highly concordant with syphilis diagnosis, with a sensitivity of 82% and a specificity of 95%. Reasonable agreement was observed between the results obtained with the nPCR and DFM methods (kappa = 0.53). No agreement was found between the nPCR detection of T. pallidum in blood and the diagnosis of syphilis, with sensitivities of 29, 18, 14.7, and 24% and specificities of 96, 92, 93, and 97% for peripheral blood mononuclear cell (PBMC), plasma, serum, and whole-blood fractions, respectively. HIV status did not affect the frequency of T. pallidum detection in any of the specimens tested. Swab specimens from mucosal or skin lesions seemed to be more useful than blood for the efficient detection of the T. pallidum genome and, thus, for the diagnosis of syphilis.
Assuntos
Técnicas Bacteriológicas/métodos , Técnicas de Laboratório Clínico/métodos , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase/métodos , Sífilis/diagnóstico , Treponema pallidum/isolamento & purificação , Adulto , Sangue/microbiologia , Proteínas de Transporte/genética , Estudos de Coortes , Feminino , Humanos , Lipoproteínas/genética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Úlcera Cutânea/microbiologia , Treponema pallidum/genéticaAssuntos
Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Antibacterianos/uso terapêutico , Doenças Assintomáticas , Técnicas de Tipagem Bacteriana , DNA Bacteriano/genética , Feminino , Humanos , Masculino , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Técnicas de Amplificação de Ácido NucleicoAssuntos
Antibacterianos/uso terapêutico , Uretrite/tratamento farmacológico , Uretrite/microbiologia , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Doxiciclina/uso terapêutico , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Masculino , Neisseria gonorrhoeae , Uretrite/diagnóstico , Uretrite/epidemiologiaRESUMO
Some studies (mostly retrospective) have pointed to an increasing frequency (up to 60%) of herpes simplex virus type 1 (HSV-1) in genital herpes (GH), but they were biased towards severe or atypical cases. We wished to evaluate the frequency of HSV-1 in patients attending our clinic for both first and recurrent episodes of GH. All patients (men and women) with genital lesions compatible with GH were included in a prospective study between May 1999 and April 2002. For all patients a standardized questionnaire, clinical examination, MRC5 culture (Dade Behring), polymerase chain reaction (PCR)-herpes consensus (Argène Biosoft) in case of negative culture and type-specific herpes serology HSV-1 and HSV-2 (Elisa Eurobio) were obtained. Predictive factors associated with HSV-1 and HSV-2 GH were studied by uni- and multivariable analyses. In all, 255 patients had a positive culture (n = 216) or PCR (n = 39). A total of 248 patients had typable herpes (148 men and 100 women). Median age was 33 (27-43); 20% had anal herpes; 48% had clinically recurrent lesions; 21% were HIV +; 20% of men were homosexual; 77% practised oral sex. In all, 36 were HSV-1 (14.5%): more in women, 25/100 (25%), than in men, 11/148 (7.5%) (odds ratio [OR]: 4 [1.8-9.1], P = 0.008). HSV-1 accounted for 23% of cases of first clinical episodes (women: 31.5%; men: 14.7%) (P = 0.02) and 6% of clinically recurrent episodes (women: 15%; men: 1.2%) (OR: 3.8 [1.6-9.1], P = 0.0033). Serological study was done in 239: primary infection was disclosed in 33 (HSV-1: 61%), HSV-2 non-primary first episode in 22 and recurrence in 184 (HSV-1: 8%). In all, 37% of recurrent episodes presented as a first clinical episode. HSV-1 was linked in men with homosexuality (P<0.01) and anilingus (P<0.01), in women with younger age (P<0.01), more sexual intercourses (P<0.0001) and more oral sex (P<0.001). Although HSV-1 is frequent in first clinical (23%) and primary (61%) episodes of GH, recurrent GH remains mostly due to HSV-2 (94%).
Assuntos
Instituições de Assistência Ambulatorial , Anticorpos Antivirais/sangue , Herpes Genital/epidemiologia , Herpesvirus Humano 1/isolamento & purificação , Herpesvirus Humano 2/isolamento & purificação , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Feminino , Herpes Genital/virologia , Herpesvirus Humano 1/genética , Herpesvirus Humano 1/imunologia , Herpesvirus Humano 2/genética , Herpesvirus Humano 2/imunologia , Humanos , Masculino , Paris , Reação em Cadeia da Polimerase , Prevalência , Estudos ProspectivosAssuntos
Uretrite , Antibacterianos/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis , Humanos , Masculino , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/microbiologia , Mycoplasma genitalium , Doenças Bacterianas Sexualmente Transmissíveis/tratamento farmacológico , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Uretrite/diagnóstico , Uretrite/tratamento farmacológico , Uretrite/etiologiaRESUMO
Our objective was to evaluate the seroprevalence of herpes simplex virus (HSV)-2 and HSV-1 in a population of men and women attending the STD clinic of Hôpital St-Louis (Paris, France). Four hundred and eighty-seven patients (264 men and 223 women) were tested for HSV-2 and HSV-1 antibodies by specific enzyme immunoassay (EIA) (Smithkline-Beecham Biologicals). Univariate and multivariate analyses were carried out for correlations with clinical, socio-epidemiological and behavioural data. HSV-2 seroprevalence was 55% (44.7% in men, 67.3% in women). HSV-1 seroprevalence was 93% (94.7% in men, 91% in women). The predictive factors of HSV-2 seropositivity being female (OR: 3.37), age (OR: 1.04), country of origin (Central Africa OR: 3.52, North Africa OR: 1.36), history of genital herpes (OR: 10.97), hepatitis B virus (HBV) markers (OR: 1.92) and hepatitis C virus (HCV) markers (OR: 3.96). The only protective factor was HSV-1 seropositivity (OR: 0.25). The predictive factors of HSV-1 seropositivity were only the country of origin (Central Africa OR: 2.95, North Africa OR: 1.83) and the absence of genital herpes (OR: 11.01). Only 23 (8.6%) HSV-2 seropositive patients had a history of genital herpes. This study underlines the very high HSV-2 seroprevalence of patients with STDs, only a few of whom have a history of genital herpes. Detection and counselling is urgently needed for these patients.
Assuntos
Herpes Genital/epidemiologia , Herpesvirus Humano 2 , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Interpretação Estatística de Dados , Feminino , França/epidemiologia , Herpes Genital/etnologia , Herpesvirus Humano 1 , Hospitais Urbanos , Humanos , Masculino , Estudos Soroepidemiológicos , Doenças Virais Sexualmente Transmissíveis/etnologiaRESUMO
Human immunodeficiency virus (HIV) infection is, to a great extent, a sexually transmitted disease (STD). Its diffusion among the heterosexual population is still limited. STD treatment centres are particularly well organized to watch this diffusion. At the STD centre of the Saint-Louis hospital, Paris, we conducted a 6-week prospective study concerning the systematic detection of HIV-1 infection in 240 consecutive female out-patients in 1988, and in 504 male out-patients in 1989. The results obtained were as follow: 5/240 women (2.1 percent) and 19/504 men (3.8 percent) were seropositive for HIV-1. Out of these 24 subjects, 15 did not know they were seropositive. Predictive factors for seropositivity were male homosexuality, addiction to heroin and, in women, drug addicts as sex partners. Altogether, 23 of the 24 seropositive subjects had the classical risk factors for HIV-1 infection. None of the 744 subjects in this study were HIV-2 seropositive, and only 1 out of 504 men was HTLV-1 seropositive. We conclude that the prevalence of HIV-1 infection was high in our centre, and this prompts us to suggest that the serological test should be proposed to all out-patients and that patient's education and preventive measures should be organized by STD centres, even though the infection is still limited to patients at a particularly high risk (drug addicts, homosexuals, country of origin).
Assuntos
Infecções por HIV/epidemiologia , HIV-1 , HIV-2 , Infecções por HTLV-I/epidemiologia , Adulto , Western Blotting , Ensaio de Imunoadsorção Enzimática , Feminino , França , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Infecções por HTLV-I/prevenção & controle , Infecções por HTLV-I/transmissão , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , PrevalênciaRESUMO
A search for Chlamydia trachomatis by cell culture was carried out in the urethra of 82 male patients consulting for condyloma acuminata at the Clinical and Biological Centre for Sexually Transmissible Diseases of the Saint-Louis hospital, Paris. Three patients had discreet urethral signs, but none had urethral discharge. Cell culture was positive for C. trachomatis in 36 of the 82 patients (44 percent). This high prevalence suggests that C. trachomatis should systematically be looked for in the urethra of male patients consulting for condylomata acuminata. If this cannot be done, then a systematic treatment with tetracyclines should be instituted.
Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Condiloma Acuminado/complicações , Neoplasias dos Genitais Masculinos/complicações , Doenças Uretrais/epidemiologia , Adulto , Portador Sadio , Infecções por Chlamydia/complicações , Infecções por Chlamydia/microbiologia , Gonorreia/complicações , Humanos , Masculino , Infecções por Mycoplasma/complicações , Prevalência , Infecções por Ureaplasma/complicações , Doenças Uretrais/complicações , Doenças Uretrais/microbiologiaRESUMO
Gonococcal urethritis being highly contagious, the ideal treatment should be effective, well tolerated and relatively cheap. Among antibiotics fulfilling these conditions, thiamphenicol and spectinomycin are widely used throughout the world and particularly in France. However, the ever increasing incidence of infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) strains, the growing number of strains with low sensitivity to penicillin and/or other antibiotics and the recent emergence of strains that are highly resistant to penicillin make it necessary from time to time to re-evaluate the main therapeutic approaches to gonococcal urethritis. In this study thiamphenicol and spectinomycin were compared for effectiveness as single-dose treatments of uncomplicated gonococcal urethritis in 207 male patients who consulted at the Clinical and Biological Centre for Sexually Transmitted Diseases, Saint-Louis Hospital, Paris, during April and May, 1985. Prior to the trial the patients had not received antibiotics for at least 2 weeks. They were allocated at random to two therapeutic groups: 89 patients received a single 2.5 g dose of thiamphenicol orally, and 84 patients received a single 2 g dose of spectinomycin by intramuscular injection. In every case the gonococcal origin of the urethritis had been confirmed by culture. The patients were examined 3 to 7 days after treatment for clinical and bacteriological evaluation. Specimens were cultivated on agar-blood medium, and N. gonorrhoeae was also identified by biochemical and antigenic reactions. The minimum inhibitory concentrations (MIC) of the two antibiotics were determined by the agar plate dilution method, using an agar nutrient medium. The possible production of beta-lactamase and the auxotypic and plasmidic profiles of the PPNG strains were investigated.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Gonorreia/tratamento farmacológico , Espectinomicina/uso terapêutico , Tianfenicol/uso terapêutico , Uretrite/tratamento farmacológico , Adulto , Resistência ao Cloranfenicol , Resistência Microbiana a Medicamentos , Gonorreia/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Espectinomicina/administração & dosagem , Tianfenicol/administração & dosagemAssuntos
Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Feminino , Humanos , MasculinoRESUMO
During the last decade, the incidence of male urethritis stopped declining in France. Risk factors associated with unprotected intercourse have been extensively studied in men who have sex with men, but not in men in general. The purpose of the study was to determine major risk factors for urethritis among men and to describe the sociodemographic and medical characteristics of this population in 2005. We conducted a prospective case-crossover study of sexual behaviors among men with acute urethritis attending at general practitioners or sexually transmitted infection (STI) clinics in France. Each patient filled out a selfcompleted questionnaire focusing on sociodemographic characteristics, and on sexual behaviors for the month before urethritis onset and for the preceding 3 months. The doctor reported medical information on a separate questionnaire. Between January and September 2005, 121 cases of male urethritis, defined as recent-onset pain on micturition and/or purulent or mucoid discharge, were included. Median age was 33 years, 22.3% were MSM, 55.1% were single, and 72.0% had at least high school education. Conditional logistic regression analysis showed that intercourse with only casual partners or with both casual and steady partners (OR = 2.6, CI 95%: 0.8-8.7, and OR = 8.7, CI 95%: 2.7-28.0), as well as inconsistent condom use (OR = 5.8, CI 95%: 1.7-19.2) significantly increased the risk of male urethritis. STI prevention campaigns should continue to focus on consistent condom use and should not neglect men over 30 years of age.
Assuntos
Comportamento Sexual , Parceiros Sexuais , Uretrite/etiologia , Adulto , Estudos Cross-Over , França/epidemiologia , Humanos , Modelos Logísticos , Masculino , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Uretrite/epidemiologiaRESUMO
In a retrospective study of 95 patients seen between 1950 and 1978, the outcome of malignant melanoma levels III, IV and V of Clark's classification was reviewed. Patients with lentigo malignant melanoma were excluded. The overall survival rate was 63% at 5 years and 48% at 10 years. For the whole population of patients significant differences in survival rate were associated with level (p = 0,00002), thickness (less than 2 mm or greater than or equal to 2 mm; p less than 0.0,0001) and histological type (p = 0,02). The significance of prognostic variables taken separately was calculated by the Breslow method and was found to be: p = 0,0005 for thickness, p = 0,0009 for patient's age and p = 0,02 for histological type. In analysis with two variables, including level, thickness was the variable that added most to the information on prognosis supplied by level. For the population of patients with melanoma levels III and IV significant differences in survival rate were associated with thickness (less than 2 mm or greater than or equal to 2 mm; p less than 0,001), though not with level. When the variables were studied separately, thickness and patient's age were significant (p = 0,02 and p = 0,03 respectively). Analysis with two variables, including thickness, showed that age was the variable that added most to the information on prognosis supplied by thickness.
Assuntos
Melanoma/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Melanoma/mortalidade , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/mortalidadeRESUMO
Ofloxacin is a new fluoroquinolone with excellent in vitro activity against N. gonorrhoeae. 32 adult males with acute uncomplicated gonococcal urethritis were treated with a single-dose of orally administered ofloxacin (400 mg). 1 out of 32 isolates was penicillinase-producing N. gonorrhoeae. Urethral cultures were obtained before treatment and on day 3-5. Microbiological cure was achieved in all patients (100%). No side effects were observed. According to these results, single-dose ofloxacin therapy (400 mg) is effective and safe against uncomplicated gonococcal urethritis in adult males.
Assuntos
Anti-Infecciosos/uso terapêutico , Gonorreia/tratamento farmacológico , Oxazinas/uso terapêutico , Uretrite/tratamento farmacológico , Adulto , Humanos , Masculino , OfloxacinoRESUMO
The goal of this study was to evaluate whether the new commercially available PCR-based assay Amplicor C. trachomatis (Roche Molecular Systems) could improve the diagnosis of chlamydial urogenital infections in men, compared with cell culture of C. trachomatis considered as the reference method. A total of 466 men attending the STD clinic were tested by the Amplicor test in urine and by cell culture in urethra. The prevalence of C. trachomatis was 13.7% (64/466) by cell culture and 14.4% (67/466) by the Amplicor test. After resolution of the discrepant results, the sensitivity of culture was 91.4% in male urethral specimens. The resolved sensitivity of the PCR assay was 92.7% in male urine and the specificity was 99.5%. We concluded that this rapid PCR-based assay showed an improvement in quality for diagnosing C. trachomatis infections in men.