RESUMO
BACKGROUND: Dengue fever is increasingly recognized in travelers returning from endemic areas with acute febrile illness; however, its true burden in nonendemic countries is unknown. Only few studies focus on clinical manifestations and serological findings in primarily nonimmune individuals. PATIENTS AND METHODS: We analyzed the epidemiology, clinical manifestations and virological results in patients with imported acute dengue infection who presented at our travel clinic in Frankfurt am Main, Germany, between September 1998 and November 2000. An immunochromatographic test and an immunofluorescence assay were used for antibody testing. RESULTS: Dengue fever was confirmed in 13 patients, thus being the second commonest tropical infection after malaria in patients with fever and a travel history to a tropical country (18 cases per 1,000 patient visits per year). Most patients had only spent a short time abroad, either in South Central or South East Asia or in the Caribbean. CONCLUSION: The clinical features considered typical for dengue were not always present. Antibody assays were typically negative early in the course of disease, with seroconversion occurring only after cessation of clinical symptoms. A high index of suspicion is needed in these patients who often present without typical features of dengue and whose early antibody tests may be negative.
Assuntos
Anticorpos Antivirais/análise , Dengue/epidemiologia , Viagem , Doença Aguda , Adulto , Idoso , Ásia/epidemiologia , Região do Caribe/epidemiologia , Dengue/imunologia , Dengue/patologia , Progressão da Doença , Reações Falso-Negativas , Feminino , Imunofluorescência , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Testes SorológicosRESUMO
Forty two examinations utilizing F-18 FDG-PET were performed in 23 patients with Hodgkin's disease to study for involved lymphoma regions and compared to conventional staging procedures. Twenty stagings were performed at diagnosis of untreated Hodgkin's disease or at first relapse, and 22 restagings during and after chemoradiotherapy. At diagnosis in 5 of 20 patients PET and other procedures revealed different extranodal manifestations and in 3 patients established different clinical staging. PET seemed to be accurate in the assessment of lymphoma involvement in nodal sites. During follow up, in 10 out of 22 investigations different results and discrepancy were recorded, mostly due to the different extent of F-18-FDG metabolism in residual masses in lymphatic tissues compared to CT, X-ray or ultrasonography. The results indicate that PET may have advantages in the assessment of remissions in nodal sites. Less conclusive results were observed with regard to extranodal involvement or inflammatory disease. In conclusion PET may be sufficient for the staging of the majority of patients with Hodgkin's disease and particularly for assessing remission status in nodal sites, but PET may have disadvantages in the evaluation of extranodal lymphoma and inflammatory disease.
Assuntos
Fluordesoxiglucose F18 , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/diagnóstico , Compostos Radiofarmacêuticos , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Intervalo Livre de Doença , Feminino , Doença de Hodgkin/patologia , Doença de Hodgkin/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Indução de Remissão , Tomografia Computadorizada de Emissão , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To determine the incidence of AIDS-defining opportunistic infections and malignancies over a 5-year period from 1992 to 1996. STUDY POPULATION: Subcohort of 1003 homosexual men with HIV infection and CD4 count less than 200 x 10(6) cells/l from the Frankfurt AIDS Cohort Study. METHODS: Data including the earliest date that a CD4 T-lymphocyte count < 200 x 10(6)/l was reached and the dates of AIDS-defining events were compiled from medical records. Incidence analyses for AIDS-defining events and death during the subsequent 5 years (1992-1996) were performed using rates per 100 person-years of exposure. RESULTS: During the observation period, the number of patients per year with CD4 T-lymphocyte counts < 200 x 10(6)/l varied between 402 and 511. In 1992, 56.7% of patients experienced at least one AIDS-defining illness, and 20.7% in 1996. The annual number of AIDS-defining events per 100 patient-years of observation declined from 143.5 in 1992 to 38.3 in 1996, and the number of AIDS-related deaths fell from 25.7 to 12.9. Analysis of the number of events confirmed this trend for malignancies and single opportunistic infections, with the exception of mycobacterial diseases. CONCLUSIONS: The incidence of AIDS-defining events in patients with advanced HIV infection at Frankfurt University Hospital has declined by more than 70% from 1992 to 1996.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Fármacos Anti-HIV/administração & dosagem , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Contagem de Linfócito CD4 , Estudos de Coortes , Quimioterapia Combinada , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Estudos Prospectivos , Estudos RetrospectivosAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Linfoma de Burkitt/tratamento farmacológico , Doenças do Sistema Nervoso Central/induzido quimicamente , Citarabina/efeitos adversos , Dexametasona/efeitos adversos , Metotrexato/efeitos adversos , Adolescente , Encéfalo/diagnóstico por imagem , Linfoma de Burkitt/diagnóstico por imagem , Linfoma de Burkitt/patologia , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Ciclofosfamida/administração & dosagem , Citarabina/administração & dosagem , Dexametasona/administração & dosagem , Eletroencefalografia/efeitos dos fármacos , Humanos , Ifosfamida/administração & dosagem , Injeções Espinhais , Masculino , Metotrexato/administração & dosagem , Estadiamento de Neoplasias , Prednisolona/administração & dosagem , Tomografia Computadorizada por Raios X , Vincristina/administração & dosagemRESUMO
With the advent of the Internet, college health professionals have available to them a new setting in which to network. The Internet provides opportunities for immediate communication with a large and diverse community of colleagues. Through both the Student Health Service (SHS) Discussion Group and numerous health-related databases, the Internet serves as a powerful research tool for program development and improvement. Answers to queries about practice options, solutions for local problems, and support of innovative policies can be received almost instantaneously from college health professionals from across the United States and Canada. In this article, the authors summarize the history and current use of the SHS Discussion Group, provide a brief overview of Internet basics, and identify more advanced uses of the Internet by college health professionals.