ABSTRACT
Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. It is one of the main causes of death in Behçet's disease. Venous involvement is significantly more common than arterial disease and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressant's are the recommended first-line treatments in vasculo-Behçet. Furthermore, randomized controlled trials are still needed to assess the role of adding anticoagulation to current standard therapy in venous thrombosis in Behçet's disease and to assess the role of anti-TNF alpha therapy in vasculo-Behçet.
Subject(s)
Aneurysm , Behcet Syndrome , Thrombosis , Venous Thrombosis , Male , Humans , Behcet Syndrome/complications , Behcet Syndrome/diagnosis , Behcet Syndrome/drug therapy , Tumor Necrosis Factor Inhibitors/therapeutic use , Aneurysm/complications , Thrombosis/complications , Venous Thrombosis/etiology , Venous Thrombosis/complications , Pulmonary ArteryABSTRACT
Morocco is undergoing the third phase of its epidemiological transition. Mortality indicators have declined significantly. Life expectancy at birth has increased by 23 years over this 55-year study period. The total fertility rate has dropped from 7.06 in 1960 to 2.89 in 2015. The country is going through the epidemiological transition characterized by a shift in the overall burden of morbidity and mortality from infectious diseases to noncommunicable diseases and injuries. Chronic diseases now account for 75 % of all deaths. Cardiovascular diseases, diabetes, and cancer are among the leading causes of death (57 %). Accidents and injuries account for 7 % of deaths. The emerging diseases are largely related to changes in lifestyles, high blood pressure, obesity, smoking, and the harmful use of alcohol. This epidemiological transition, with its enormous health and economic consequences, presents many new challenges for the national health system, including in the organization of care pathways for diabetes and hypertension, the fight against overweight and obesity, and the therapeutic education of patients, health education in schools, and public awareness programs.
Subject(s)
Chronic Disease/epidemiology , Health Transition , Adolescent , Adult , Aged , Child , Child, Preschool , Epidemiologic Studies , Humans , Infant , Infant, Newborn , Life Expectancy , Middle Aged , Morocco/epidemiology , Mortality/trends , Time Factors , Young AdultABSTRACT
INTRODUCTION: Neuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is frequent in the absence of treatment, especially in the presence of HIV co-infection. OBJECTIVE: To determine the prevalence, epidemiological, clinical, biological and therapeutic aspects as well as the evolution of NMC for patients infected with HIV. PATIENTS AND METHODS: This is a retrospective study of 40 cases of neuromeningeal cryptococcosis diagnosed in HIV-infected patients. Data are collected for 7 years (from January 2010 to December 2016) in the registers of the parasitology laboratory and the infectious diseases department at the regional hospital center in Agadir. RESULTS: A reduction in the prevalence of neuromeningeal cryptococcosis in HIV-infected patients was noted from 2010 to 2016 (3.66% to 0.83%). The overall prevalence of NMC was 1.53%. The mean age was 37±10 years old, with 90% of patients aged less than 45 years. The main clinical symptomatology was headache (75%). The main cytochemical abnormalities of cerebrospinal fluid analysis were hyperproteinorachy (60%), hypoglycorachy (63%) and lymphocytosis (50%). The mean CD4 cell count was 47/mm3. Patients were initially treated with amphotericin B, relayed with fluconazole. The overall lethality was 35%. CONCLUSION: Neuromeningeal cryptococcosis is a serious opportunistic infection in patients HIV-infected, and the lethality rate remains unacceptable. Fighting NMC in HIV+ patients requires early diagnosis, increased access to antiretrovirals, rapid introduction of appropriate treatment and the prescription of effective systemic antifungals.