RESUMO
PURPOSE: To analyze the referral patterns and the clinical and therapeutic features of patients diagnosed with uveitis in an Italian tertiary referral center to provide a comparison with previously published series from the same center. METHODS: Retrospective retrieval of data on all new referrals to the Ocular Immunology Unit in Reggio Emilia (Italy) between November 2015 and April 2022 and comparison with previously published series from the same center. RESULTS: Among the 1557 patients, the male-to-female ratio was 1:1.27. Anterior uveitis was the most common diagnosis (53.7%), followed by posterior (21.6%), pan- (18.5%), and intermediate (6.2%) uveitis. The most identifiable specific diagnoses were anterior herpetic uveitis (18.4%), Fuchs uveitis (12.8%), and tuberculosis (6.1%). Infectious etiologies were the most frequent (34.1%) and were more diffuse among non-Caucasian patients (p < 0.001), followed by systemic disease-associated uveitis (26.5%), and ocular-specific conditions (20%). Idiopathic uveitis accounted for 19.4% of cases. Fuchs uveitis presented the longest median diagnostic delay (21 months). Immunosuppressants were administered to 25.2% of patients. Antimetabolites, calcineurin inhibitors, and biologicals were prescribed to 18.4%, 3%, and 11.4% of cases, respectively. Compared to our previous reports, we observed a significant increase in foreign-born patients and in infectious uveitis, a decrease in idiopathic conditions, and an increasing use of non-biological and biological steroid-sparing drugs. CONCLUSIONS: The patterns of uveitis in Italy have been changing over the last 20 years, very likely due to migration flows. Diagnostic improvements and a more widespread interdisciplinary approach could reduce the incidence of idiopathic uveitis as well as diagnostic delay.
RESUMO
Uveitis is uncommon in children and its diagnosis and treatment are challenging. Little is known of the epidemiology of pediatric uveitis. Indeed, population-based studies in the literature are rare. However, there are many tertiary referral center reports that describe the patterns of uveitis in childhood, although few are from developed countries, and their comparison presents some issues. Anterior uveitis is the most frequent entity worldwide, especially in Western countries, where juvenile idiopathic arthritis is diffuse. Most cases of intermediate uveitis do not show any association with infectious or noninfectious systemic diseases. In low- and middle-income countries, posterior uveitis and panuveitis are prevalent due to the higher rates of infectious etiologies and systemic diseases such as Behçet disease and Vogt-Koyanagi-Harada disease. In recent decades, idiopathic uveitis rate has decreased thanks to diagnostic improvements.
Assuntos
Síndrome de Behçet , Uveíte Posterior , Uveíte , Síndrome Uveomeningoencefálica , Humanos , Criança , Estudos Retrospectivos , Uveíte/diagnóstico , Uveíte/epidemiologia , Uveíte/etiologia , Síndrome de Behçet/complicações , Síndrome Uveomeningoencefálica/complicações , Uveíte Posterior/complicaçõesRESUMO
Japanese encephalitis vaccine (Jevax) is an inactivated vaccine using the Nakayama viral strain. Until 2007, Jevax was the only Japanese encephalitis vaccine available in France but the duration of seroprotection after vaccination and exact timing of booster injections was unclear for travelers from non-endemic areas. The purpose of this report is to describe the results of a retrospective study in which neutralizing antibody levels were measured in 71 subjects previously vaccinated with Jevax. All subjects underwent testing at the Pasteur Institute Medical Center as part of preparation for humanitarian missions to endemic Japanese encephalitis areas in 2005-2006. A neutralizing antibody level greater than or equal to 20 was considered as protective. Findings showed that 49 of the 71 subjects (69%) still had protective antibody levels at a median of 4 years after the last Jevax immunization. In multivariate analysis, the only factor correlated with long-term seroprotection was the total number of vaccinations received. Based on these findings, it was concluded that long-term seroprotection after Jevax vaccination requires repeated booster injections even in subjects frequently exposed to the virus. No correlation was found between seroprotection and the interval between the booster injections.
Assuntos
Encefalite Japonesa/imunologia , Vacinas contra Encefalite Japonesa/uso terapêutico , Vacinas de Produtos Inativados/uso terapêutico , Anticorpos Antivirais/sangue , Esquema de Medicação , Vírus da Encefalite Japonesa (Subgrupo)/imunologia , Seguimentos , Humanos , Vacinas contra Encefalite Japonesa/administração & dosagem , Fatores de Tempo , Vacinas de Produtos Inativados/administração & dosagemRESUMO
The National Reference Centre for Rabies (NRC) was created at the Pasteur Institute after the fox epizootic reached the French territory. The missions of the NRC include, among others, the surveillance of rabies cases in humans and rabies post-exposure prophylaxis (PEP) treatments. The surveillance has been effective since 1982. A Bulletin on the Epidemiology and the Prophylaxis of Rabies in Humans in France is published every year. This Bulletin is now available on the Internet for Human Health and Veterinary national and local Authorities. Since 2005, data is collected with new software, Voozanoo, directly via the Internet. Twenty cases of rabies in humans have been reported since 1970. There were no indigenously acquired cases. The number of PEP treatments peaked in 1990, when the number of cases in the wild fauna was at its acme. Following the decrease of rabies cases in the wild fauna, PEP decreased by 60%. Nevertheless, about4,000 PEP treatments are still carried out. These patients have been exposed to bats or to rabid animals illegally introduced onto the French territory, or during a stay in rabies enzootic countries, or to unobservable animals. The study of this database leads to a number of conclusions: canine variants acquired directly in canine enzootic areas, that are translocated, or acquired through iatrogenic exposure, are responsible for the majority of cases; bats appear to be an increasing source of exposure; PEP surveillance is of utmost importance to monitor and to improve the quality of case management.
Assuntos
Vacina Antirrábica/administração & dosagem , Raiva/epidemiologia , Raiva/prevenção & controle , Viagem , Adolescente , Adulto , Idoso , Animais , Gatos , Criança , Pré-Escolar , Cães , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Evento SentinelaRESUMO
We report clinical findings, risk factors and neurological and cognitive long-term outcome in three Italian children aged 7, 8 and 5, respectively, who experienced cerebral venous sinus thrombosis (CVST). All children presented with headache, associated to nausea, vomiting and papilloedema. None suffered from epileptic seizures. In two of them a paresis of the sixth cranial nerve with diplopia was found. Diagnosis was confirmed by magnetic resonance imaging angiography (angio MRI) in all cases. In all patients plasma levels of protein C, protein S, antithrombin III (AT III), antiphospholipid antibodies (ApA) and homocysteine were detected. Furthermore, factor V Leiden mutation, prothrombin mutation G20210A and MTHFR mutation were searched for. A Protein C reduction was detected in all patients at onset; this finding, however, was not confirmed at follow-up in all of them. At one-year follow-up, neurological examination was normal in all children and neuropsychological assessment, aimed at excluding linguistic and non-linguistic cognitive deficits, revealed normal performances in two of them. In the third child, cognitive assessment confirmed a previously diagnosed developmental dyslexia.
Assuntos
Cognição/fisiologia , Doenças do Sistema Nervoso/etiologia , Trombose dos Seios Intracranianos/patologia , Trombose dos Seios Intracranianos/psicologia , Criança , Pré-Escolar , Dislexia/psicologia , Febre/patologia , Febre/psicologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Doenças do Sistema Nervoso/patologia , Exame Neurológico , Testes Neuropsicológicos , Proteína C/metabolismoRESUMO
In 1968, fox rabies was introduced on the French territory, in the Moselle department and from that time, spread southwards and westwards from the French-German border at the speed of 40 km per year. Consequently, a program aimed at controlling and eradicating the disease was carried out. Collaboration between human and veterinary medicine has been the key of the success of this program. In 2001, rabies in terrestrial animals was eradicated from France, while no indigenous human rabies case had been reported. Meanwhile, post-exposure treatments (PET) had been closely monitored. Data on rabies cases in animals, rabies cases in humans, PET, surveillance of exposures to baits and oral vaccines for the wild fauna, and exposures outside the French territory will be successively considered and discussed.
Assuntos
Raiva/prevenção & controle , Raiva/veterinária , Administração Oral , Adolescente , Adulto , Idoso , Animais , Animais Selvagens , Criança , Pré-Escolar , Quirópteros/virologia , Vetores de Doenças , Feminino , Raposas/virologia , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Raiva/transmissão , Vacina Antirrábica/administração & dosagemRESUMO
The follow-up study of a patient with permanent diabetes (DM) unrelated to islet cell antibody and anti-insulin antibodies and occurring 10 years after a transient neonatal DM episode is reported. A latent defect in insulin release was proved. It produced transient glucosuria during intercurrent illnesses and permanent hyperglycaemia and a decrease in growth velocity [with high stimulated growth hormone and low insulin-like growth factor I (IGF-I)] at the onset of puberty. After insulin therapy was re-introduced, catch-up growth and normalization of the blood glucose and IGF-I levels were noted.
Assuntos
Diabetes Mellitus Tipo 1/fisiopatologia , Autoanticorpos/sangue , Peso ao Nascer , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Seguimentos , Hemoglobinas Glicadas/análise , Glicosúria , Crescimento , Humanos , Insulina/uso terapêutico , Ilhotas Pancreáticas/imunologia , Masculino , Recidiva , Remissão EspontâneaRESUMO
Hypertension, one of the most frequent and important complications of insulin-dependent diabetes mellitus (IDDM), usually begins in the second decade of the disease and is rare in childhood. We analysed the blood pressure (BP) levels of 106 patients (48 males, 58 females, aged 2-16 years) in relation to sex and age and we studied the modification of BP with years (tracking). BP levels, registered every three to six months, were compared with the local standard levels for age and expressed as standard deviation scores (SDS) of the means. For each subject a regression line describing the change of the SDS over time was calculated by the method of least squares. The slope of this line is called trend and represents the tendency of BP to increase or decrease with time, i.e. to develop (or not) hypertension. All patients, except one 16 year old girl, had normal BP and no microalbuminuria but ten of them presented with mean levels in the upper quartile and/or a constantly upward BP trend and were considered at risk. After a three year follow-up four of these ten patients became frankly hypertensive with increased microalbuminuria. These results agree with previous findings and with the hypothesis that an increase of intraglomerular and/or systemic BP may precede the appearance of (and even could be responsible for) microalbuminuria. The BP tracking study in IDDM children and adolescents could be useful for an early recognition of patients at risk of developing hypertension and diabetic nephropathy.
Assuntos
Pressão Sanguínea , Diabetes Mellitus Tipo 1/fisiopatologia , Envelhecimento/fisiologia , Criança , Feminino , Humanos , Estudos Longitudinais , MasculinoRESUMO
The "campus" represents a good instrument to improve the independence of the child and adolescent with diabetes. What are the expectation of children taking part in it? For them, will it be a vacation or a period of hospitalization? To evaluate these aspects we have studied, in addition to the theoretical and practical knowledge, the emotional life of 53 young diabetics (31 males and 22 females, age 8.1-15.7 years, duration of disease 2 months 10 years, and HbA1c 6.5-12.6%). We observed that 80% of the patients improved the injection technique; we also found an increase of correct answers (from 60% to 73%, x = 3.8, p < 0.05) to a list of questions on different aspects of diabetes asked at the beginning and at the end of the campus. From the drawings collected at the end of the stay, we observed that 78% of the children lived the experience in a playful way, 11% in a medical and 11% in a educational way. It must be pointed out that the children who perceived the educational aspect of the stay were older than the others (11.5 +/- 2 vs. 13.9 +/- 1; p < 0.05). Consequently, we believe that educational programs on diabetes, like the "campus", should be reserved to children older than 12 years of age.
Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/psicologia , Insulina/administração & dosagem , Insulina/uso terapêutico , Educação de Pacientes como Assunto , Adolescente , Fatores Etários , Criança , Feminino , Educação em Saúde , Promoção da Saúde , Humanos , Masculino , AutoadministraçãoRESUMO
This study compares the results of a new immunoassay method (DCA2000, Ames) used to measure HbAlc concentration in 9 min using 1-microliter capillary blood sample with those obtained with an ion exchange traditional method (HPLC, DIAMAT, Biorad) in both a non-diabetic and a diabetic pediatric population. All HbAlc values were measured in the two methods on the same whole-blood venous aliquot after we had excluded differences in HbAlc values measured by DCA2000 on venous and capillary blood samples (8.5 +/- 1.4 vs 8.6 +/- 1.4%). Data analysis shows an excellent correspondence between the two assays (r = 0.97; p < 0.0001). HbAlc values obtained by DCA2000 method in diabetic patients are related to the mean value of the blood glucose levels collected at home in the last two months (r = 0.74; p < 0.003). The percentile distribution of the HbAlc values is similar both in DCA2000 (3-- = 4.4; 50-- = 5.3; 97-- = 6.0%) and in HPLC method (3-- = 4; 50-- = 5; 97-- = 5.9%). Within-run precision for DCA2000 ranges from 3.7 to 1.9% and between-run precision from 4.5 to 0.9%. The new immunoassay method gives accurate and reliable HbA1c values and compared with HPLC methodology has at least three advantages: it does not require venipuncture, provides HbA1c value within 9 miy and allows both physician and patient to verify in virtually' real time the degree of blood glucose control.
Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/imunologia , Hemoglobinas Glicadas/fisiologia , Imunoensaio/métodos , Adolescente , Anticorpos Monoclonais , Glicemia/fisiologia , Criança , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Adult patients with insulin-dependent diabetes mellitus frequently also show gastric disturbances. Knowledge of the prevalence of such abnormalities in children with insulin-dependent diabetes and the predictive value of anti-gastric parietal cell antibodies in blood may be of practical importance. PATIENTS AND METHODS: 68 patients (29 boys and 39 girls), aged from 5 yr 2 mo to 19 yr 10 mo, and treated for insulin-dependent diabetes from 1 mo to 14 yr 6 mo, were included in the study. Fasting blood concentrations of gastrin (G), pepsinogen (PG1), anti-gastric parietal cell antibodies (PCA) were measured. Fiberoptic endoscopy and biopsy of the gastroduodenal mucosa were performed in PCA+ patients and biopsy samples were examined for Helicobacter pylori (HP). RESULTS: 12 patients were PCA+; 3 of them had blood gastrin levels above 104 pg/ml and 4 had blood pepsinogen levels 24 ng/ml. Histologically, 3 patients had chronic diffuse gastritis (2 were HP+); 2 had chronic gastritis restricted to the antro-pyloric area (both were HP+); 3 had follicular lymphoid hyperplasia (without HP) and 4 had normal mucosa (without HP). CONCLUSION: The presence of PCA can predict the risk of chronic gastritis, possibly auto-immune in origin, in children with insulin-dependent diabetes.
Assuntos
Anticorpos/análise , Diabetes Mellitus Tipo 1/imunologia , Gastrite/imunologia , Células Parietais Gástricas/imunologia , Adolescente , Formação de Anticorpos , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/complicações , Feminino , Seguimentos , Mucosa Gástrica/imunologia , Gastrite/etiologia , Humanos , Masculino , Pepsinogênios/sangue , Valor Preditivo dos TestesRESUMO
The authors refer about a girl, 16 years old, affected by Down's syndrome which developed diabetes mellitus (type I) and soon after hypothyroidism following autoimmune thyroiditis. They underline the usefulness of monitoring endocrine function in these patients.
Assuntos
Doenças Autoimunes/diagnóstico , Diabetes Mellitus Tipo 1/diagnóstico , Síndrome de Down/diagnóstico , Hipotireoidismo/diagnóstico , Tireoidite Autoimune/diagnóstico , Adolescente , Doenças Autoimunes/etiologia , Diabetes Mellitus Tipo 1/etiologia , Síndrome de Down/complicações , Feminino , Humanos , Hipotireoidismo/etiologia , Tireoidite Autoimune/etiologia , Fatores de TempoRESUMO
Many authors have reported retarded growth in children with diabetes, though this has been a somewhat variable finding. However, with the newer treatment regimens for diabetes the problem of reduced growth rates has largely been solved.
Assuntos
Diabetes Mellitus Tipo 1/patologia , Crescimento , Adolescente , Adulto , Estatura , Doença Celíaca/complicações , Doença Celíaca/patologia , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/patologia , Humanos , Lactente , Insulina/uso terapêutico , Masculino , PuberdadeRESUMO
One of the most frequent and important complications of IDDM is hypertension. It begins usually in adulthood and is rare in children. In order to study the behaviour and control of BP in IDDM children and adolescents we analyzed the BP levels of 106 patients (48 males, 58 females; age 1.5-16 yrs) in relation to sex, age, duration of the disease, and different parameters of metabolic control; moreover we studied the modifications of BP levels with years (tracking). BP levels, registered every 3-6 mos, were compared to the standard levels for age of the local population (2000 students between 7 and 16 yrs of age) and expressed as standard deviation scores (SDS) of the means. For each subject a line describing the change of the SDS over time was calculated by the method of least squares: the slope of this line is called trend and represents the tendency of the BP to increase or maintain stable or decrease with time, i.e to develop or not hypertension. All patients, except one 16 y. old girl, had normal BP and no microalbuminuria, but 10 of them presented with mean levels in the upper quartile and a constantly upward BP trend. Two of these patients showed after a 2 year follow-up stable hypertension and microalbuminuria. Moreover, an analytical and statistical study pointed out that BP levels of IDDM children seem to be influenced in addition to age, sex, height, weight, ponderal excess, as the general population, by the duration of the disease the insulin dose and some metabolic parameters (HbA1, HbA1c, glycemia, creatininemia).(ABSTRACT TRUNCATED AT 250 WORDS)