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1.
Infect Dis Poverty ; 9(1): 16, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32029005

RESUMO

BACKGROUND: Loiasis is an uncommon and poorly understood parasitic disease outside endemic areas of Africa. The aim of this study was to describe the clinical and biological patterns and treatment of imported loiasis by sub-Saharan migrants diagnosed in Madrid, Spain. METHODS: A retrospective study was conducted with sub-Saharan immigrants seen at the Tropical Medicine Unit of the Carlos III Hospital in Madrid, Spain, a reference center, over 19 years. Categorical variables were expressed as frequency counts and percentages. Continuous variables were expressed as the mean and standard deviation (SD) or median and interquartile range (IQR: Q3-Q1). Chi-square tests were used to assess the association between categorical variables. The measured outcomes were expressed as the odds ratio (OR) with a 95% confidential interval. Continuous variables were compared by Student's t-tests or Mann-Whitney U tests. Binary logistic regression models were used. P <  0.05 was considered a statistically significant difference. RESULTS: One hundred thirty-one migrants from tropical and subtropical areas with loiasis were identified. Forty-nine patients were male (37.4%). The migrants' mean age (±SD) was 42.3 ± 17.3 years, and 124 (94.7%) were from Equatorial Guinea. The median time (IQR) between arrival in Spain and the first consultation was 2 (1-7) months. One hundred fifteen migrants had eosinophilia, and one hundred thirteen had hyper-IgE syndrome. Fifty-seven patients had pruritus (43.5%), and thirty patients had Calabar swelling (22.9%). Seventy-three patients had coinfections with other filarial nematodes (54.2%), and 58 migrants had only Loa loa infections (45.8%). One hundred two patients (77.9%) were treated; 45.1% (46/102) patients were treated with one drug, and 54.9% (56/102) patients were treated with combined therapy. Adverse reactions were described in 14 (10.7%) migrants. CONCLUSIONS: Our patients presented early clinical manifestations and few atypical features. Thus, physicians should systematically consider loiasis in migrants with a typical presentation. However, considering that 72.5% of the patients had only positive microfilaremia without any symptoms, we suggest searching for microfilaremia in every migrant from endemic countries for loiasis presenting with eosinophilia.

2.
Travel Med Infect Dis ; : 101543, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31805400

RESUMO

BACKGROUND: From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit. METHOD: A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection. RESULTS: 817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32-42]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10-30). 602 (73.6%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2-34.9), 6.4 (95% CI: 1.2-33.3) and 72.3 (95% CI: 9.2-563.5) times greater probability of confirmed ZIKV infection, respectively. CONCLUSION: Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.

3.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(10): 633-639, dic. 2018. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-176928

RESUMO

Introduction: Onchocerciasis is caused by Onchocerca volvulus and mainly leads to pruritus and skin and visual disorders, including blindness. Seventeen million people are infected in 38 countries; 31 of these are in sub-Saharan Africa, six in Latin America and one on the Arabian Peninsula. More than 99% of cases occur in sub-Saharan Africa where 120 million people are at risk of infection. Eye disorders have been well-documented; however, skin disorders have not been described accurately. The objective of our study was to describe the epidemiology, main skin manifestations and treatment of imported onchocerciasis. Material and methods: A retrospective study was thus conducted by analysing the main demographic, clinical and treatment data regarding a cohort of 400 patients attending a reference clinical unit over a 17-year period. Results: Most patients were female (55%) with mean age 37.5 ± 16.7 years. All the migrants came from sub-Saharan countries. The most frequently occurring dermatological symptom was pruritus. Ivermectin had been used as first-line therapy and adverse reactions had been described in 11 patients (3.2%). Conclusions: The results indicate the fact that there should be a clinical suspicion of onchocerciasis regarding immigrants from endemic areas having skin lesions compatible with the disease's profile or asymptomatic patients having eosinophilia or unexplained high IgE. Moreover, skin snips from the buttocks region were very fruitful and treatment with ivermectin was seen to be safe. This is the largest case series regarding imported onchocerciasis described up to the present time


Introducción: La oncocercosis está causada por Onchocerca volvulus que produce fundamentalmente trastornos cutáneos, prurito y alteraciones visuales. Diecisiete millones de personas están infectadas en 38 países; 31 de ellos en África subsahariana, 6 en América Latina y uno en la península arábiga. Más del 99% de los casos se producen en el África subsahariana, donde 120 millones de personas están en riesgo de infección. Mientras los trastornos oculares han sido bien documentados, los trastornos cutáneos no se han descrito con precisión. El objetivo de nuestro estudio es describir la epidemiología, las principales manifestaciones cutáneas y el tratamiento de la oncocercosis importada. Material y métodos: Estudio retrospectivo de una cohorte de 400 pacientes atendidos en una unidad de referencia a lo largo de un período de 17 años con los principales datos demográficos, clínicos y de tratamiento. Resultados: La mayoría de pacientes eran mujeres (55%) con una edad media de 37,5 ± 16,7 años. Todos los migrantes procedían de países subsaharianos. El síntoma dermatológico más frecuente fue el prurito. La ivermectina fue el fármaco de elección, describiéndose reacciones adversas en 11 pacientes (3,2%). Conclusiones: Los resultados señalan de que se debe mantener una sospecha clínica de oncocercosis en inmigrantes procedentes de áreas endémicas y lesiones cutáneas sugerentes o en pacientes asintomáticos con eosinofilia o IgE inexplicada. Además, los pellizcos cutáneos de glúteos fueron altamente rentables. El tratamiento con ivermectina es seguro. Esta es la mayor serie de casos de oncocercosis importada descrita hasta la fecha


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Onchocerca volvulus/isolamento & purificação , Oncocercose/diagnóstico , Oncocercose/tratamento farmacológico , Doenças Negligenciadas , Dermatopatias/parasitologia , Estudos Retrospectivos , Estudos de Coortes , Emigração e Imigração , Dermatopatias/diagnóstico , Dermatopatias/tratamento farmacológico
4.
Enferm Infecc Microbiol Clin ; 36(10): 633-639, 2018 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29275076

RESUMO

INTRODUCTION: Onchocerciasis is caused by Onchocerca volvulus and mainly leads to pruritus and skin and visual disorders, including blindness. Seventeen million people are infected in 38 countries; 31 of these are in sub-Saharan Africa, six in Latin America and one on the Arabian Peninsula. More than 99% of cases occur in sub-Saharan Africa where 120 million people are at risk of infection. Eye disorders have been well-documented; however, skin disorders have not been described accurately. The objective of our study was to describe the epidemiology, main skin manifestations and treatment of imported onchocerciasis. MATERIAL AND METHODS: A retrospective study was thus conducted by analysing the main demographic, clinical and treatment data regarding a cohort of 400 patients attending a reference clinical unit over a 17-year period. RESULTS: Most patients were female (55%) with mean age 37.5±16.7 years. All the migrants came from sub-Saharan countries. The most frequently occurring dermatological symptom was pruritus. Ivermectin had been used as first-line therapy and adverse reactions had been described in 11 patients (3.2%). CONCLUSIONS: The results indicate the fact that there should be a clinical suspicion of onchocerciasis regarding immigrants from endemic areas having skin lesions compatible with the disease's profile or asymptomatic patients having eosinophilia or unexplained high IgE. Moreover, skin snips from the buttocks region were very fruitful and treatment with ivermectin was seen to be safe. This is the largest case series regarding imported onchocerciasis described up to the present time.


Assuntos
Doenças Transmissíveis Importadas , Oncocercose , Dermatopatias Parasitárias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oncocercose/diagnóstico , Oncocercose/tratamento farmacológico , Oncocercose/epidemiologia , Estudos Retrospectivos , Dermatopatias Parasitárias/diagnóstico , Dermatopatias Parasitárias/tratamento farmacológico , Dermatopatias Parasitárias/epidemiologia , Adulto Jovem
5.
Gac. sanit. (Barc., Ed. impr.) ; 31(6): 531-534, nov.-dic. 2017. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-168545

RESUMO

La actual epidemia por virus Zika ha generado gran alarma social, favorecida en parte por la falta de información de la población general. Para proporcionar información veraz y contrastada, la Unidad de Medicina Tropical y del Viajero del Hospital Carlos III-La Paz (Madrid) puso en marcha una línea de atención telefónica sobre la infección por el virus Zika. En este artículo se presentan los datos relativos a los primeros 6 meses de su funcionamiento. El perfil predominante de llamadas corresponde a mujeres solicitando información previa a la realización del viaje. Los destinos sobre los que más información se ha demandado han sido Brasil, Méjico y Colombia. La mayoría de las llamadas se resolvieron ofreciendo información exclusivamente. La implementación de dispositivos de atención telefónica que ofrezcan información contrastada y fiable en el contexto de enfermedades asociadas a gran alarma social es de gran interés sanitario, reduce el número de consultas innecesarias y ahorra costes (AU)


The current outbreak of Zika virus has caused great social alarm, generated in part by the lack of information in the general population. In order to provide accurate and verified information, the Tropical and Travel Medicine Unit of Hospital Carlos III-La Paz (Madrid, Spain) established a hotline for Zika virus infection. We present the data concerning the first 6 months of operation of the telephone hotline. The predominant call profile consisted of women seeking information about the risk of acquiring the disease before travelling. Brazil, Mexico and Colombia were the destinations for which the most information was requested. Most of the consultations were resolved by providing information only. The implementation of call devices that provide confirmed and reliable information on diseases associated with great alarm are of significant public health interest, as they reduce the number of unnecessary medical consultations and save on medical costs (AU)


Assuntos
Humanos , Infecção por Zika virus/epidemiologia , Telefone , Saúde do Viajante , Saúde Global/normas , Epidemias , Medicina Tropical/métodos , Brasil/epidemiologia , México/epidemiologia , Colômbia/epidemiologia , Análise Estatística
6.
Emerg Infect Dis ; 23(8): 1426-1428, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28628450

RESUMO

We evaluated the risk for the Spanish Olympic Team acquiring Zika virus in Rio de Janeiro, Brazil, during 2016. We recruited 117 team members, and all tested negative for Zika virus. Lack of cases in this cohort supports the minimum risk estimates made before the Games.


Assuntos
Esportes , Viagem , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologia , Zika virus , Aniversários e Eventos Especiais , Atletas , Brasil , Surtos de Doenças/prevenção & controle , Saúde Global , Humanos , Medição de Risco , Espanha
7.
Gac Sanit ; 31(6): 531-534, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28645459

RESUMO

The current outbreak of Zika virus has caused great social alarm, generated in part by the lack of information in the general population. In order to provide accurate and verified information, the Tropical and Travel Medicine Unit of Hospital Carlos III-La Paz (Madrid, Spain) established a hotline for Zika virus infection. We present the data concerning the first 6 months of operation of the telephone hotline. The predominant call profile consisted of women seeking information about the risk of acquiring the disease before travelling. Brazil, Mexico and Colombia were the destinations for which the most information was requested. Most of the consultations were resolved by providing information only. The implementation of call devices that provide confirmed and reliable information on diseases associated with great alarm are of significant public health interest, as they reduce the number of unnecessary medical consultations and save on medical costs.


Assuntos
Linhas Diretas , Medicina de Viagem/organização & administração , Medicina Tropical/organização & administração , Infecção por Zika virus , Surtos de Doenças , Feminino , Humanos , América Latina , Masculino , Espanha , Fatores de Tempo , Doença Relacionada a Viagens , Infecção por Zika virus/prevenção & controle
8.
Am J Trop Med Hyg ; 96(3): 701-707, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28167601

RESUMO

Epidemiological data on dengue in Africa are still scarce. We investigated imported dengue infection among travelers with a high proportion of subjects from Africa over a 9-year period. From January 2005 to December 2013, blood samples from travelers with clinical suspicion of dengue were analyzed. Dengue was diagnosed using serological, antigen detection, and molecular methods. Subjects were classified according to birthplace (Europeans versus non-Europeans) and last country visited. Overall, 10,307 serum samples corresponding to 8,295 patients were studied; 62% were European travelers, most of them from Spain, and 35.9% were non-Europeans, the majority of whom were born in Africa (mainly Equatorial Guinea) and Latin America (mainly Bolivia, Ecuador, and Colombia). A total of 492 cases of dengue were identified, the highest number of cases corresponding to subjects who had traveled from Africa (N = 189), followed by Latin America (N = 174) and Asia (N = 113). The rate of cases for Africa (4.5%) was inferior to Asia (9%) and Latin America (6.1%). Three peaks of dengue were found (2007, 2010, and 2013) which correlated with African cases. A total of 2,157 of past dengue infections were diagnosed. Non-Europeans who had traveled from Africa had the highest rate of past infection (67.8%), compared with non-Europeans traveling from Latin America (38.7%) or Asia (35%). Dengue infection in certain regions of Africa is underreported and the burden of the disease may have a magnitude similar to endemic countries in Latin America. It is necessary to consider dengue in the differential diagnosis of other febrile diseases in Africa.


Assuntos
Dengue/etnologia , Viagem , Adolescente , Adulto , África/etnologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Antígenos Virais/sangue , Criança , Pré-Escolar , Dengue/diagnóstico , Vírus da Dengue/isolamento & purificação , Humanos , Imunoglobulina M/sangue , Lactente , América Latina/etnologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
9.
Euro Surveill ; 21(36)2016 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-27631156

RESUMO

Since the first documented autochthonous transmission of chikungunya virus in the Caribbean island of Saint Martin in 2013, the infection has been reported within the Caribbean region as well as North, Central and South America. The risk of autochthonous transmission of chikungunya virus becoming established in Spain may be elevated due to the large numbers of travellers returning to Spain from countries affected by the 2013 epidemic in the Caribbean and South America, as well as the existence of the Aedes albopictus vector in certain parts of Spain. We retrospectively analysed the laboratory diagnostic database of the National Centre for Microbiology, Institute of Health Carlos III (CNM-ISCIII) from 2008 to 2014. During the study period, 264 confirmed cases, of 1,371 suspected cases, were diagnosed at the CNM-ISCIII. In 2014 alone, there were 234 confirmed cases. The highest number of confirmed cases were reported from the Dominican Republic (n = 136), Venezuela (n = 30) and Haiti (n = 11). Six cases were viraemic in areas of Spain where the vector is present. This report highlights the need for integrated active case and vector surveillance in Spain and other parts of Europe where chikungunya virus may be introduced by returning travellers.


Assuntos
Febre de Chikungunya/diagnóstico , Vírus Chikungunya/isolamento & purificação , Febre/etiologia , Viagem , Aedes/virologia , Animais , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Surtos de Doenças , República Dominicana , Feminino , Haiti , Humanos , Insetos Vetores/virologia , Masculino , RNA Viral , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Vigilância de Evento Sentinela , Espanha/epidemiologia , Venezuela
10.
Lancet Respir Med ; 3(7): 554-62, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26041403

RESUMO

BACKGROUND: In the current epidemic of Ebola virus disease, health-care workers have been transferred to Europe and the USA for optimised supportive care and experimental treatments. We describe the clinical course of the first case of Ebola virus disease contracted outside of Africa, in Madrid, Spain. METHODS: Herein we report clinical, laboratory, and virological findings of the treatment of a female nurse assistant aged 44 years who was infected with Ebola virus around Sept 25-26, 2014, while caring for a Spanish missionary with confirmed Ebola virus disease who had been medically evacuated from Sierra Leone to La Paz-Carlos III University Hospital, Madrid. We also describe the use of experimental treatments for Ebola virus disease in this patient. FINDINGS: The patient was symptomatic for 1 week before first hospital admission on Oct 6, 2014. We used supportive treatment with intravenous fluids, broad-spectrum antibiotics, and experimental treatments with convalescent plasma from two survivors of Ebola virus disease and high-dose favipiravir. On day 10 of illness, she had acute respiratory distress syndrome, possibly caused by transfusion-related acute lung injury, which was managed without mechanical ventilation. Discharge was delayed because of the detection of viral RNA in several bodily fluids despite clearance of viraemia. The patient was discharged on day 34 of illness. At the time of discharge, the patient had possible subacute post-viral thyroiditis. None of the people who had contact with the patient before and after admission became infected with Ebola virus. INTERPRETATION: This report emphasises the uncertainties about the efficacy of experimental treatments for Ebola virus disease. Clinicians should be aware of the possibility of transfusion-related acute lung injury when using convalescent plasma for the treatment of Ebola virus disease. FUNDING: La Paz-Carlos III University Hospital.


Assuntos
Doença pelo Vírus Ebola/terapia , Assistentes de Enfermagem , Doenças Profissionais/etiologia , Plasma , Síndrome do Desconforto Respiratório do Adulto/etiologia , Lesão Pulmonar Aguda/etiologia , Adulto , Amidas/uso terapêutico , Antivirais/uso terapêutico , Feminino , Humanos , Doenças Profissionais/terapia , Isolamento de Pacientes , Pirazinas/uso terapêutico , Síndrome do Desconforto Respiratório do Adulto/terapia , Espanha , Superinfecção/etiologia , Reação Transfusional , Carga Viral
11.
Am J Trop Med Hyg ; 88(4): 789-94, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23339201

RESUMO

A total of 1,220 subjects from Equatorial Guinea living in Spain (median age = 41 years; 453 male and 767 female) was examined for antibodies to human immunodeficiency virus (HIV) and Hepatitis B (HBV), C (HCV), and D (HDV) viruses. Extracted RNA and DNA from the positive samples were used to quantify viral load. The prevalence of HIV antibodies, HCV RNA, and HBV surface antigen (HBsAg) was 10.8% (N = 132), 11.6% (N = 141), and 7.9% (N = 96), respectively. The most prevalent HIV variant was CRF02_AG (38.5%; N = 40). HCV genotype 4 (60%; N = 36) and HBV genotype A3 (32%; N = 8) were the hepatitis variants most frequently found. Superinfection with HDV was seen in 20.9% (N = 24) of HBsAg carriers. A control group of 276 immigrants from other sub-Saharan countries showed similar rates of HIV and HBsAg, although no HCV cases were found. Immigrants constitute a major source of HIV and hepatitis viruses in Spain; therefore, it is important that control measures are intensified.


Assuntos
Emigrantes e Imigrantes , Infecções por HIV/etnologia , Hepatite B Crônica/etnologia , Hepatite C Crônica/etnologia , Hepatite D/etnologia , Adulto , Biomarcadores/sangue , Coinfecção/diagnóstico , Coinfecção/etnologia , Coinfecção/virologia , Guiné Equatorial/etnologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Anticorpos Anti-Hepatite/sangue , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/virologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/virologia , Hepatite D/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Espanha/epidemiologia , Fatores de Tempo , Carga Viral , Viremia/etnologia , Viremia/virologia , Adulto Jovem
12.
Malar J ; 11: 324, 2012 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-22970903

RESUMO

BACKGROUND: Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM.The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. METHODS: A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. RESULTS: SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). CONCLUSIONS: Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously described in endemic zones, and presence of vector in Europe has also been reported. Implementation of molecular tests in all asymptomatic individuals coming from endemic area is not economically feasible. So re-emergence of malaria (Plasmodium vivax) in Europe may be speculated.


Assuntos
Doenças Assintomáticas/epidemiologia , Malária/diagnóstico , Malária/epidemiologia , Plasmodium/isolamento & purificação , Adulto , Idoso , Técnicas de Laboratório Clínico/métodos , Emigração e Imigração , Feminino , Humanos , Malária/parasitologia , Malária/patologia , Masculino , Microscopia/métodos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex/métodos , Parasitologia/métodos , Reação em Cadeia da Polimerase/métodos , Estudos Retrospectivos , Espanha , Viagem
14.
Nephrol Dial Transplant ; 26(7): 2250-6, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20956810

RESUMO

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death among chronic kidney disease (CKD) patients. Vascular calcification is highly prevalent in this population and is an independent predictor of cardiovascular mortality. Vascular calcification in uraemic patients is known to be an active and regulated process subject to the action of many promoting and inhibitory factors. The role of vitamin D in this process remains controversial. We evaluated the relationship between serum levels of 25-hydroxyvitamin D (25(OH)D) and vascular calcification evaluated by plain X-ray images, in predialysis patients with CKD stages 4 and 5. METHODS: We performed a cross-sectional study with 210 CKD patients stages 4 and 5 managed at our predialysis unit. Patients were 63.5 ± 13 years of age, 60.5% males, 64.8% diabetics and 47.1% with a history of CVD. Plain X-ray images of pelvis, hands and lateral lumbar spine from all subjects were studied for calculation of semiquantitative vascular calcification scores as described by Adragao and Kauppila. RESULTS: We found a high prevalence of vascular calcification in our population. Adragao scores revealed only 47 patients (22.4%) without vascular calcification and 120 (57.1%) with scores higher than 3. Kauppila scores revealed only 29 patients (13.8%) without aortic calcifications and 114 patients (54.3%) with scores higher than 7. Higher vascular calcification scores were related to older age, diabetes, history of CVD and lower levels of 25(OH)D. Only 18.5% of patients had adequate levels of 25(OH)D (> 30 ng/mL), 53.7% of them had insufficient levels (15-30 ng/mL) and 27.8% had deficient levels (< 15 ng/mL). Multivariate analysis showed that age, diabetes and CVD were directly associated and 25(OH)D levels were inversely associated with vascular calcifications. CONCLUSIONS: Our results show an independent and negative association between serum levels of 25(OH)D and vascular calcification. Further and larger prospective studies are needed to clarify the possible role of vitamin D deficiency in the development of vascular calcification in CKD patients.


Assuntos
Calcinose/sangue , Calcinose/etiologia , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Doenças Vasculares/sangue , Doenças Vasculares/etiologia , Vitamina D/análogos & derivados , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/patologia , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/etiologia , Diabetes Mellitus/patologia , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/patologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Doenças Vasculares/patologia , Vitamina D/sangue , Adulto Jovem
15.
Enferm. emerg ; 9(1): 14-17, ene.-mar. 2007.
Artigo em Espanhol | IBECS | ID: ibc-87370

RESUMO

El virus de Chikungunya (CHIKV) - género Alphavirus, familia Togaviridae -endémico en África y Asia, es transmitido al hombre por la picadura de mosquitos infectados, habitualmente del género Aedes. Las manifestaciones clínicas de la fiebre de Chikungunya (CHIKF), son, habitualmente, fiebre, mialgias, artralgias/artritis y exantema maculopapular generalizado. La enfermedad se autolimita en pocos días, pero las artralgias/artritis pueden seguir un curso crónico, de meses a años de duración. No existe tratamiento específico alguno, sólo sintomático (AU)


Chikungunya (CHIKV) virus -genus Alphavirus and family Togaviridaeendemicin Africa and Asia, is transmitted to humans by the bite of infected mosquitoes, usually of the genus Aedes. Clinical manifestations, Chikungunya fever (CHIKF), are, usually, fever,muscle pain, arthralgias/arthritis, and maculopapular rash. Disease isself limited in few days, but arthralgias - arthritis may last several months/years. Management is supportive with respect to the arthralgias (AU)


Assuntos
Infecções por Alphavirus/epidemiologia , Infecções por Alphavirus/virologia , Vírus Chikungunya , África/epidemiologia , Ásia/epidemiologia
16.
J Med Microbiol ; 54(Pt 5): 449-52, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15824421

RESUMO

Automated light depolarization analysis could be a useful tool for diagnosing malarial infections. This work discusses the results of a diagnostic efficacy study on 411 samples from patients with suspected malaria infection performed with a Cell-Dyn 4000 analyser. Light dispersed at 90 degrees and depolarized can be used for identifying and counting eosinophils. However, other cell populations with depolarizing capacity occur in malarial samples; these result from leukocytes ingesting haemozoin that is derived from the degradation of the haem group of haemoglobin performed by the parasite. A sensitivity of 72 % and specificity of 98 % were recorded, with positive and negative predictive values of 78 % and 97 %, respectively. Although the sensitivity level of the automated light depolarization analysis is not adequate to replace the existing methods for the diagnosis of parasitic diseases, it could alert clinicians to unsuspected infections by parasites, particularly those from the genus Plasmodium.


Assuntos
Malária/diagnóstico , Parasitemia/diagnóstico , Plasmodium/isolamento & purificação , Adulto , Animais , Contagem de Células Sanguíneas , Pré-Escolar , Hemeproteínas , Humanos , Lasers , Luz , Malária/sangue , Microscopia de Polarização/métodos , Pigmentos Biológicos , Sensibilidade e Especificidade
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