Assuntos
Anti-Infecciosos/uso terapêutico , Portador Sadio/tratamento farmacológico , Erradicação de Doenças/métodos , Poliomielite/tratamento farmacológico , Portador Sadio/epidemiologia , Erradicação de Doenças/organização & administração , Saúde Global , Humanos , Microbiota/efeitos dos fármacos , Poliomielite/epidemiologia , Poliomielite/etiologia , Poliovirus/efeitos dos fármacos , Poliovirus/imunologia , Vacina Antipólio de Vírus Inativado/administração & dosagem , Vacina Antipólio de Vírus Inativado/provisão & distribuição , Vacina Antipólio Oral/efeitos adversos , Eliminação de Partículas ViraisAssuntos
Febre Amarela/prevenção & controle , Febre Amarela/transmissão , Vírus da Febre Amarela/isolamento & purificação , Aedes/crescimento & desenvolvimento , Aedes/virologia , Animais , Europa (Continente)/epidemiologia , Humanos , Mosquitos Vetores/crescimento & desenvolvimento , Mosquitos Vetores/virologia , Viagem , Cobertura Vacinal , Febre Amarela/epidemiologia , Vacina contra Febre Amarela/administração & dosagem , Vírus da Febre Amarela/imunologiaRESUMO
This study presents the 6-year follow-up of French gendarmes exposed to the chikungunya (CHIK) infection in 2006 on Reunion Island. The aim was to see to what extent the subjective health differences observed in 2008 (30 months after infection) between CHIK infected (CHIK+) and noninfected (CHIK-) gendarmes still persisted in 2012, and to investigate a possible return to a pre-CHIK health status for CHIK+ subjects. Gendarmes were contacted by mail in 2012 and asked to complete a self-questionnaire asking for morbidity, health care and medicines consumption since the last follow-up in 2008. Quality of life (QoL) after 6 years was evaluated using the SF-36 scale. In comparison with CHIK- subjects (n = 171), CHIK+ (n = 81) presented with higher rheumatic but also nonspecific morbidity such as headaches and fatigue associated with a large psychological impact, frequent depressive moods and social disabilities, leading to a significant impairment of the QoL and higher health care consumption. When restricted to CHIK+ subjects, comparing the data with that of 2008 showed persistent but decreasing self-reported rheumatic morbidity, and an increase over time of chronic discomfort (headache, fatigue) and depressive moods, resulting in no overall improvement in QoL. Despite possible cohort attrition bias, the comparability of CHIK+/CHIK- subjects allows the assumption of a long-term impact of CHIK infection with less chance of returning to a previous health status. Although these results may be specific to the 2006 virus strain, we recommend that public health strategies in the epidemic-prone countries include a response to the consequences of chronic post-CHIK disorders.
Assuntos
Artralgia/epidemiologia , Artralgia/psicologia , Febre de Chikungunya/complicações , Qualidade de Vida , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Reunião/epidemiologia , Inquéritos e Questionários , Fatores de TempoRESUMO
The chikungunya outbreak on Reunion Island in 2005-2006 was followed by a high incidence of persistent arthralgia. A small group of patients developed chronic, sometimes destructive, post-chikungunya inflammatory rheumatism presenting as rheumatoid polyarthritis or spondylarthritis that required disease-modifying antirheumatic drugs such as methotrexate. We describe two patients under this treatment confronted with financial health insurance issues due to the lack of administrative recognition of post-chikungunya rheumatism as a long-term affliction or an occupational disease.
Assuntos
Infecções por Alphavirus/complicações , Infecções por Alphavirus/economia , Cobertura do Seguro/organização & administração , Doenças Reumáticas/economia , Doenças Reumáticas/etiologia , Adulto , Infecções por Alphavirus/epidemiologia , Febre de Chikungunya , Doença Crônica , Efeitos Psicossociais da Doença , Surtos de Doenças/economia , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/economia , Doenças Profissionais/etiologia , Reunião/epidemiologia , Doenças Reumáticas/epidemiologiaRESUMO
UNLABELLED: We report a case of a parathyroid adenoma during a long term lithium treatment without therapeutic overdose. CASE REPORT: A 73-years-old woman presented a demonstrative biological syndrome with hypercalcemia, elevated parathormone, normal urinary cyclic AMP, normocalciuria. CONCLUSION: This lithium induced hyperparathyroidism differs from the classic primary hyperparathyroidism with parthyroid adenoma where urinary cyclic AMP excretion is elevated and where there is hypercalciuria. Lithium is blocking the negative feedback of calcium on parathormone secretion and stimulates the growth of parathyroid adenoma. Treatment is surgical and consists in adenoma ablation. Calcemia follow up is indicated in patients with long term lithium therapy