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1.
JAMA ; 323(4): 339-351, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990315

RESUMO

Importance: Public health screening for type 1 diabetes in its presymptomatic stages may reduce disease severity and burden on a population level. Objective: To determine the prevalence of presymptomatic type 1 diabetes in children participating in a public health screening program for islet autoantibodies and the risk for progression to clinical diabetes. Design, Setting, and Participants: Screening for islet autoantibodies was offered to children aged 1.75 to 5.99 years in Bavaria, Germany, between 2015 and 2019 by primary care pediatricians during well-baby visits. Families of children with multiple islet autoantibodies (presymptomatic type 1 diabetes) were invited to participate in a program of diabetes education, metabolic staging, assessment of psychological stress associated with diagnosis, and prospective follow-up for progression to clinical diabetes until July 31, 2019. Exposures: Measurement of islet autoantibodies. Main Outcomes and Measures: The primary outcome was presymptomatic type 1 diabetes, defined by 2 or more islet autoantibodies, with categorization into stages 1 (normoglycemia), 2 (dysglycemia), or 3 (clinical) type 1 diabetes. Secondary outcomes were the frequency of diabetic ketoacidosis and parental psychological stress, assessed by the Patient Health Questionnaire-9 (range, 0-27; higher scores indicate worse depression; ≤4 indicates no to minimal depression; >20 indicates severe depression). Results: Of 90 632 children screened (median [interquartile range {IQR}] age, 3.1 [2.1-4.2] years; 48.5% girls), 280 (0.31%; 95% CI, 0.27-0.35) had presymptomatic type 1 diabetes, including 196 (0.22%) with stage 1, 17 (0.02%) with stage 2, 26 (0.03%) with stage 3, and 41 who were not staged. After a median (IQR) follow-up of 2.4 (1.0-3.2) years, another 36 children developed stage 3 type 1 diabetes. The 3-year cumulative risk for stage 3 type 1 diabetes in the 280 children with presymptomatic type 1 diabetes was 24.9% ([95% CI, 18.5%-30.7%]; 54 cases; annualized rate, 9.0%). Two children had diabetic ketoacidosis. Median (IQR) psychological stress scores were significantly increased at the time of metabolic staging in mothers of children with presymptomatic type 1 diabetes (3 [1-7]) compared with mothers of children without islet autoantibodies (2 [1-4]) (P = .002), but declined after 12 months of follow-up (2 [0-4]) (P < .001). Conclusions and Relevance: Among children aged 2 to 5 years in Bavaria, Germany, a program of primary care-based screening showed an islet autoantibody prevalence of 0.31%. These findings may inform considerations of population-based screening of children for islet autoantibodies.


Assuntos
Autoanticorpos/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Ilhotas Pancreáticas/imunologia , Programas de Rastreamento , Doenças Assintomáticas/epidemiologia , Doenças Assintomáticas/psicologia , Pré-Escolar , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/psicologia , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Pais , Inquéritos e Questionários
2.
Rev Med Suisse ; 15(668): 1926-1931, 2019 Oct 23.
Artigo em Francês | MEDLINE | ID: mdl-31643153

RESUMO

Chlamydia trachomatis (CT) infection is the most frequent notifiable sexually transmitted infection (STI) in Switzerland. The infection is most frequently observed in 15 to 24 year-old-women and in 25 to 34 year-old-men. 50-75 % of the Chlamydia trachomatis carriage are asymptomatic, making the infection difficult to diagnose and increasing the untreated specimen, leading to complications like infertility, ectopic pregnancy or pelvic inflammatory disease. Despite having a sexual prevention at school, the youths seem to have a lack of knowledge about CT, her transmission and her complications. We performed a survey, which showed that 60.5 % of the participants ignored that this bacteria is mostly asymptomatic. We also found that 11 % of the participants believed that there is no possible relapse of the infection. The prevention must be strengthened, mostly because there is no program in Switzerland, letting every physician to his own beliefs. The medical consultation is an ideal opportunity for this prevention and the youths shared their wish to discuss more about it with health professionals.


Assuntos
Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis , Metas , Educação em Saúde , Adolescente , Adulto , Doenças Assintomáticas/epidemiologia , Erradicação de Doenças , Feminino , Humanos , Infertilidade/epidemiologia , Infertilidade/microbiologia , Masculino , Doença Inflamatória Pélvica/epidemiologia , Doença Inflamatória Pélvica/microbiologia , Gravidez , Suíça/epidemiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 98(39): e17297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574853

RESUMO

As a modifiable risk factor for cardiovascular disease, presence of hypertension (HT) necessitates the awareness of asymptomatic organ damage (AOD). The aim of this study was to measure plasma micro RNA-21 (miR-21) and the parameters that reflect AOD such as carotid intima-media thickness (CIMT), microalbuminuria (MAU) in hypertensive patients compared with healthy controls. In addition, the aim of this study was to evaluate plasma miR-21 levels in HT patients with AOD.This study was designed as a cross-sectional observational study. The study includes 2 groups: 32 patients with HT and 32 healthy controls. First, we compared these 2 groups. Then, to underline the relationship between plasma miR-21 and HT, hypertensive patients were divided into 2 groups: with AOD and without AOD.Sixteen patients with HT had AOD. MiR-21 levels significantly correlated with clinical systolic and diastolic blood pressure, MAU, C-reactive protein, and CIMT. CIMT, miR-21, and MAU levels were significantly higher in patients with AOD.Our study showed increased miR-21 levels in HT patients with AOD.


Assuntos
Albuminúria , Doenças Cardiovasculares , Hipertensão , MicroRNAs/sangue , Adulto , Albuminúria/diagnóstico , Albuminúria/etiologia , Doenças Assintomáticas/epidemiologia , Pressão Sanguínea/fisiologia , Proteína C-Reativa/análise , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Espessura Intima-Media Carotídea , MicroRNA Circulante/análise , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/genética , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Turquia/epidemiologia
4.
Emerg Microbes Infect ; 8(1): 1337-1346, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31516090

RESUMO

Occult hepatitis B virus infection (OBI) is a low-level asymptomatic phase of HBV infection. Evidence of OBI clinical relevance is emerging but the mechanisms of its occurrence remain unclear. In this study, the molecular characteristics of 97 confirmed OBI from Chinese blood donors were analyzed and relevant mutations were identified. Recombinant HBsAg bearing these mutations were expressed in vitro and the antigenicity and HBsAg secretion properties were analyzed. Results showed that 45 (46.4%) genotype B, 50 (51.5%) genotype C, and 2 (2.1%) genotype D sequences were identified. Two groups of mutations in the S gene were significantly associated with OBI. The first group included mutations creating new N-linked glycosylation sites at positions s116, s123, s130, and s131 + s133 or removing the existing one at s146. Mutations TCT123-125NCT/NFT were associated with reduced antigenicity, while TST116-118NST, GTS130-132NTS, and TSM131-133NSS/NYT/NST were associated with varying levels of impaired HBsAg secretion. N146 mutations had no effect on HBsAg production pattern. The second group included substitutions within the S transmembrane domains TMD1-3. Only mutations C85R, L87R, L88R, and C90R within TMD2 were associated with defective HBsAg production. These mutations appear to be rare and mostly strain specific but they may contribute to the multifactorial occurrence of OBI.


Assuntos
Doenças Assintomáticas/epidemiologia , Doadores de Sangue , Antígenos de Superfície da Hepatite B/metabolismo , Hepatite B/epidemiologia , Proteínas Mutantes/metabolismo , Mutação de Sentido Incorreto , Processamento de Proteína Pós-Traducional , Substituição de Aminoácidos , Grupo com Ancestrais do Continente Asiático , Genótipo , Glicosilação , Hepatite B/patologia , Hepatite B/virologia , Antígenos de Superfície da Hepatite B/genética , Humanos , Proteínas Mutantes/genética
5.
Acta Orthop Traumatol Turc ; 53(5): 346-350, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400967

RESUMO

OBJECTIVE: The aim of this study was to investigate whether being the parents of children with developmental hip dysplasia (DDH) is a risk factor for asymptomatic dysplasia. METHODS: Asymptomatic parents of children who were diagnosed with DDH were assessed for presence of dysplasia by examining their anteroposterior pelvis radiographs at the neutral position. Eighty-six hips of 43 participants were included in the study group and 98 hips of 49 participants were included in the control group. Presence of hip dysplasia over the anteroposterior pelvis radiographs was analyzed for Wiberg's angle, acetabular index of the weight-bearing zone (the Tönnis angle), acetabular depth/width index, femoral head coverage ratio (FHCR) and femoral neck/shaft angle. RESULTS: The mean acetabular depth/width ratio was 44.3% in the study group and 53.5% in the control group. And, the mean FHCR was 80% in the study group and 82% in the control group. There was a statistically significant difference between the two groups in terms of mean acetabular depth/width ratio (p < 0.05) and FHCR (p < 0.05). In addition, 21 participants in the study group and 2 in the control group had a pathological acetabular depth/width ratio. And, the number of participants with a pathological FHCR was 22 in the study group and 13 in the control group. A statistically significant difference was found between the two groups regarding the number of pathological measurements of acetabular depth/width ratio (p < 0.05) and FHCR (p < 0.05). CONCLUSION: Having a parent with DDH is a definitive risk factor for the development of hip dysplasia in childhood. In addition, being a parent of a child with DDH is a risk factor for asymptomatic dysplasia. These parents should be screened by roentgenogram. LEVEL OF EVIDENCE: Level III, Diagnostic Study.


Assuntos
Acetábulo , Doenças Assintomáticas/epidemiologia , Luxação Congênita de Quadril , Articulação do Quadril , Pais , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Adulto , Criança , Correlação de Dados , Feminino , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/epidemiologia , Articulação do Quadril/anormalidades , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
6.
Radiol Med ; 124(12): 1199-1211, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31407223

RESUMO

BACKGROUND: There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. AIM: To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. MATERIALS AND METHODS: We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. RESULTS: WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). CONCLUSION: The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.


Assuntos
Serviço Hospitalar de Admissão de Pacientes , Doenças Assintomáticas , Achados Incidentais , Tomografia Computadorizada Multidetectores/métodos , Abdome/diagnóstico por imagem , Adulto , Distribuição por Idade , Idoso , Doenças Assintomáticas/epidemiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Neoplasias/diagnóstico por imagem , Neoplasias/epidemiologia , Doses de Radiação , Estudos Retrospectivos , Distribuição por Sexo , Coluna Vertebral/diagnóstico por imagem , Doenças Torácicas/diagnóstico por imagem , Tomografia Computadorizada Espiral
7.
Malar J ; 18(1): 242, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315624

RESUMO

BACKGROUND: The importance of submicroscopic malaria infections in high-transmission areas could contribute to maintain the parasite cycle. Regarding non-endemic areas, its importance remains barely understood because parasitaemia in these afebrile patients is usually below the detection limits for microscopy, hence molecular techniques are often needed for its diagnosis. In addition to this, the lack of standardized protocols for the screening of submicroscopic malaria in immigrants from endemic areas may underestimate the infection with Plasmodium spp. The aim of this study was to assess the prevalence of submicroscopic malaria in afebrile immigrants living in a non-endemic area. METHODS: A prospective, observational, multicentre study was conducted. Afebrile immigrants were included, microscopic observation of Giemsa-stained thin and thick blood smears, and two different molecular techniques detecting Plasmodium spp. were performed. Patients with submicroscopic malaria were defined as patients with negative blood smears and detection of DNA of Plasmodium spp. with one or both molecular techniques. Demographic, clinical, analytical and microbiological features were recorded and univariate analysis by subgroups was carried out with STATA v15. RESULTS: A total of 244 afebrile immigrants were included in the study. Of them, 14 had a submicroscopic malaria infection, yielding a prevalence of 5.7% (95% confidence interval 3.45-9.40). In 71.4% of the positive PCR/negative microscopy cases, Plasmodium falciparum alone was the main detected species (10 out of the 14 patients) and in 4 cases (28.6%) Plasmodium vivax or Plasmodium ovale were detected. One patient had a mixed infection including three different species. CONCLUSIONS: The prevalence of submicroscopic malaria in afebrile immigrants was similar to that previously described in Spain. Plasmodium vivax and P. ovale were detected in almost a third of the submicroscopic infections. Screening protocols for afebrile immigrants with molecular techniques could be useful for a proper management of these patients.


Assuntos
Doenças Assintomáticas/epidemiologia , Malária/epidemiologia , Plasmodium falciparum/isolamento & purificação , Plasmodium ovale/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Adulto , Coinfecção/epidemiologia , Coinfecção/parasitologia , Emigrantes e Imigrantes , Feminino , Humanos , Malária/parasitologia , Malária Falciparum/epidemiologia , Malária Falciparum/parasitologia , Malária Vivax/epidemiologia , Malária Vivax/parasitologia , Masculino , Microscopia , Pessoa de Meia-Idade , Prevalência , Espanha/epidemiologia
8.
Mycoses ; 62(10): 961-968, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31344286

RESUMO

Cryptococcus neoformans causes life-threatening meningoencephalitis, particularly in human immunodeficiency virus (HIV)-positive individuals with low CD4 levels (<100 cells/µL). Although the burden of cryptococcal meningoencephalitis (CM) in Turkey is low (0.13 cases per 100 000 persons), asymptomatic individuals at risk of cryptococcosis should be screened for antigenemia to prevent the disease and/or promote early CM diagnosis. A lateral flow assay (LFA) is used to detect Cryptococcus antigen (CrAg) in cerebrospinal fluid and serum. We determined Cryptococcus antigenemia prevalence in serum samples of HIV-positive and HIV-negative adult patients by using Dynamiker® CrAg-LFA, a point-of-care dipstick test. Patients' demographic data, CD4 count, HIV-RNA levels and anti-retroviral therapy status were recorded. CrAg was detected in 28 (11%) of 254 HIV-positive patients screened but not in 100 HIV-negative control individuals; a significant difference was observed in the CrAg-LFA positivity rate between HIV-positive and HIV-negative groups (x2  = 11.970; P < .05). In CrAg-positive patients, the median CD4 level was 666 cells/µL (115-1344 cells/µL), with a median viral load of 23 copies/mL (0-3.69 × 106  copies/mL). In HIV-positive CrAg-negative patients, the median CD4 level was 633 cells/µL (31-2953 cells/µL) and the median viral load was 12 copies/mL (0-1.95 × 106  copies/mL; P > .05). Results indicate that HIV-positive patients with both low (<200 cells/µL) and high (>200 cells/µL) CD4 counts should be screened for asymptomatic cryptococcal antigenemia. HIV-associated asymptomatic cryptococcosis is not uncommon in Turkey, which warrants systematic screening. Updated strategies for CM prevention among HIV-positive patients should be used even in non-endemic countries.


Assuntos
Antígenos de Fungos/sangue , Criptococose/diagnóstico , Testes Diagnósticos de Rotina/métodos , Infecções por HIV/complicações , Imunoensaio/métodos , Adolescente , Adulto , Idoso , Doenças Assintomáticas/epidemiologia , Contagem de Linfócito CD4 , Criptococose/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Prevalência , Turquia/epidemiologia , Carga Viral , Adulto Jovem
9.
PLoS Negl Trop Dis ; 13(6): e0007461, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31158223

RESUMO

Concomitant infection with human immunodeficiency virus (HIV) and the Leishmania parasite is a growing public health problem, the result of the former spreading to areas where the latter is endemic. Leishmania infection is usually asymptomatic in immunocompetent individuals, but the proportion of HIV+ individuals in contact with the parasite who remain asymptomatic is not known. The aim of the present work was to examine the use of cytokine release assays in the detection of asymptomatic immune responders to Leishmania among HIV+ patients with no previous leishmaniasis or current symptomatology. Eighty two HIV+ patients (all from Fuenlabrada, Madrid, Spain, where a leishmaniasis outbreak occurred in 2009) were examined for Leishmania infantum infection using molecular and humoral response-based methods. None returned a positive molecular or serological result for the parasite. Thirteen subjects showed a positive lymphoproliferative response to soluble Leishmania antigen (SLA), although the mean CD4+ T lymphocyte counts of these patients was below the normal range. Stimulation of peripheral blood mononuclear cells (PBMC) or whole blood with SLA (the lymphoproliferative assay and whole blood assay respectively), led to the production of specific cytokines and chemokines. Thus, despite being immunocompromised, HIV+ patients can maintain a Th1-type cellular response to Leishmania. In addition, cytokine release assays would appear to be useful tools for detecting these individuals via the identification of IFN-γ in the supernatants of SLA-stimulated PBMC, and of IFN-γ, MIG and IL-2 in SLA-stimulated whole blood. These biomarkers appear to be 100% reliable for detecting asymptomatic immune responders to Leishmania among HIV+ patients.


Assuntos
Doenças Assintomáticas/epidemiologia , Infecções por HIV/complicações , Leishmania infantum/imunologia , Leishmaniose Visceral/epidemiologia , Adulto , Idoso , Proliferação de Células , Citocinas/metabolismo , Feminino , HIV , Humanos , Leucócitos Mononucleares/imunologia , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Adulto Jovem
10.
Emerg Infect Dis ; 25(7): 1354-1362, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31211672

RESUMO

We investigated dengue virus (DENV) and asymptomatic DENV infections in rural villages of Kampong Cham Province, Cambodia, during 2012 and 2013. We conducted perifocal investigations in and around households for 149 DENV index cases identified through hospital and village surveillance. We tested participants 0.5-30 years of age by using nonstructural 1 rapid tests and confirmed DENV infections using quantitative reverse transcription PCR or nonstructural 1-capture ELISA. We used multivariable Poisson regressions to explore links between participants' DENV infection status and household characteristics. Of 7,960 study participants, 346 (4.4%) were infected with DENV, among whom 302 (87.3%) were <15 years of age and 225 (65.0%) were <9 years of age. We identified 26 (7.5%) participants with strictly asymptomatic DENV infection at diagnosis and during follow-up. We linked symptomatic DENV infection status to familial relationships with index cases. During the 2-year study, we saw fewer asymptomatic DENV infections than expected based on the literature.


Assuntos
Doenças Assintomáticas/epidemiologia , Vírus da Dengue , Dengue/epidemiologia , Dengue/virologia , Adolescente , Adulto , Fatores Etários , Camboja/epidemiologia , Criança , Pré-Escolar , Dengue/diagnóstico , Dengue/história , Surtos de Doenças , Feminino , História do Século XXI , Humanos , Masculino , Programas de Rastreamento , Vigilância em Saúde Pública , Vigilância de Evento Sentinela , Adulto Jovem
11.
PLoS Negl Trop Dis ; 13(5): e0007290, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31042707

RESUMO

BACKGROUND: Knowledge of the foci of Plasmodium species infections is critical for a country with an elimination agenda. Namibia is targeting malaria elimination by 2020. To support decision making regarding targeted intervention, we examined for the first time, the foci of Plasmodium species infections and regional prevalence in northern Namibia, using nested and quantitative polymerase chain reaction (PCR) methods. METHODS: We used cross-sectional multi-staged sampling to select 952 children below 9 years old from schools and clinics in seven districts in northern Namibia, to assess the presence of Plasmodium species. RESULTS: The median participant age was 6 years (25-75%ile 4-8 y). Participants had a median hemoglobin of 12.0 g/dL (25-75%ile 11.1-12.7 g/dL), although 21% of the cohort was anemic, with anemia being severer in the younger population (p<0.002). Most of children with Plasmodium infection were asymptomatic (63.4%), presenting a challenge for elimination. The respective parasite prevalence for Plasmodium falciparum (Pf), Plasmodium vivax (Pv) and Plasmodium ovale curtisi (Po) were (4.41%, 0.84% and 0.31%); with Kavango East and West (10.4%, 6.19%) and Ohangwena (4.5%) having the most prevalence. Pv was localized in Ohangwena, Omusati and Oshana, while Po was found in Kavango. All children with Pv/Pf coinfections in Ohangwena, had previously visited Angola, affirming that perennial migrations are risks for importation of Plasmodium species. The mean hemoglobin was lower in those with Plasmodium infection compared to those without (0.96 g/dL less, 95%CI 0.40-1.52 g/dL less, p = 0.0009) indicating that quasi-endemicity exists in the low transmission setting. CONCLUSIONS: We conclude that Pv and Po species are present in northern Namibia. Additionally, the higher number of asymptomatic infections present challenges to the efforts at elimination for the country. Careful planning, coordination with neighboring Angola and execution of targeted active intervention, will be required for a successful elimination agenda.


Assuntos
Malária Vivax/parasitologia , Malária/parasitologia , Plasmodium ovale/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Doenças Assintomáticas/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , DNA de Protozoário/genética , Feminino , Humanos , Lactente , Malária/diagnóstico , Malária/epidemiologia , Malária Vivax/diagnóstico , Malária Vivax/epidemiologia , Masculino , Namíbia/epidemiologia , Plasmodium ovale/genética , Plasmodium vivax/genética , Reação em Cadeia da Polimerase
12.
J Vector Borne Dis ; 56(1): 25-31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070162

RESUMO

Malaria elimination is a health priority of India for the national development and to meet UN sustainable development goals. In this article, an attempt has been made to highlight some of the key issues that need attention and consideration. These include addressing the gaps in malaria burden and adopting District Health Information System (DHIS) for real time data gathering, transfer and analysis for rapid response. The article highlights threat to malaria elimination from human migration, asymptomatic malaria, P. malariae as a neglected species, need for updating vector information and devising strategies to control relay vector species especially in the high burden states of India. Additionally, scale-up of vector control interventions, integrated vector management and enhancement of vector control capacity and capability have been emphasized. It is suggested that process, performance and progress indicators for malaria elimination may be clearly spelt out and disseminated. What are the data needs for malaria elimination certification, must be well-understood? Lessons learnt by the countries that have eliminated malaria recently shall be of great value to malaria elimination efforts in India.


Assuntos
Erradicação de Doenças/organização & administração , Malária/epidemiologia , Malária/prevenção & controle , Controle de Mosquitos , Animais , Doenças Assintomáticas/epidemiologia , Vetores de Doenças , Migração Humana , Humanos , Índia/epidemiologia
13.
Medicina (Kaunas) ; 55(4)2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31009994

RESUMO

Background and objective: Orthostatic hypotension (OH) is a decrease in systolic blood pressure (BP) of 20 mm Hg and in diastolic BP of 10 mm Hg when changing the position from lying to standing. Arterial hypertension (AH), comorbidities and polypharmacy contribute to its development. The aim was to assess the presence of OH and its predictors in asymptomatic chronic kidney disease (CKD) patients. Material and methods: 45 CKD patients with estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m2 (CKD+) were examined for signs of OH and its predictors. The results were compared with the control group of 22 patients with eGFR > 60 mL/min/1.73 m2 (CKD-). Asymptomatic patients without ischemic heart disease and previous stroke were qualified. Total blood count, serum creatinine, eGFR, urea, phosphates, calcium, albumins, parathyroid hormone, uric acid, C reactive protein, N-terminal pro b-type natriuretic peptide, lipid profile, and urine protein to creatinine ratio were assessed. Simultaneously, patients underwent echocardiography. To detect OH, a modified Schellong test was performed. Results: OH was diagnosed in 17 out of 45 CKD+ patients (average age 69.12 ± 13.2) and in 8 out of 22 CKD- patients (average age 60.50 ± 14.99). The CKD+ group demonstrated significant differences on average values of systolic and diastolic BP between OH+ and OH- patients, lower when standing. In the eGFR range of 30-60 mL/min/1.73 m2 correlation was revealed between OH and ß-blockers (p = 0.04), in the entire CKD+ group between ß-blockers combined with diuretics (p = 0.007) and ACE-I (p = 0.033). Logistic regression test revealed that chronic heart failure (CHF, OR = 15.31), treatment with ß-blockers (OR = 13.86) were significant factors influencing the presence of OH. Conclusions: Predictors of OH in CKD may include: CHF, treatment with ß-blockers, combined with ACE-I and diuretics.


Assuntos
Doenças Assintomáticas/epidemiologia , Hipotensão Ortostática/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Antagonistas Adrenérgicos beta/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Doença Crônica , Comorbidade , Diuréticos/efeitos adversos , Quimioterapia Combinada , Feminino , Insuficiência Cardíaca/complicações , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estatísticas não Paramétricas
14.
Viral Immunol ; 32(4): 186-191, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31021251

RESUMO

Globally, infection of pregnant women by human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) pose a significant health challenge for not just the mothers but also the newborn infant. This study was undertaken to assess the prevalence of HIV, HCV, and HBV among pregnant women attending antenatal clinic in Kogi State University Teaching Hospital (KSUTH), Anyigba, Nigeria. Sera samples obtained from 200 consented pregnant women were screened for hepatitis B surface antigen (HBsAg), anti-HCV, and anti-HIV antibodies using commercially available immunoassay test kit. Demographic variables and obstetric characteristic were obtained using structured questionnaire. Of the 200 sera tested, the seroprevalence rates were 1.0%, 0.5%, and 8.5% for HBsAg, anti-HCV, and anti-HIV antibodies, respectively. Although 0.5% were coinfected with HIV/HCV, none was simultaneously infected by the three viruses. Age, marital status, trimester, and educational and occupational status did not significantly affect the prevalence of HIV, HCV, and HBV infections. However, factors such as history of abortion/miscarriage (p = 0.04), intravenous drug use (p = 0.001), and history of other sexually transmitted infection (p = 0.01) were significantly higher in relation to HIV seropositivity. In conclusion, findings from this study revealed high HIV seroprevalence and a clear decline of hepatitis C and B infection prevalence compared with previous epidemiological data. Reason for the latter could be attributed to the current efforts to reduce mother-to-child transmission and possible HBV vaccination programs. High burden of HIV infection in our study suggests the needs to strengthen the national prevention programs including education of the people on the risk factors of HIV transmission.


Assuntos
Doenças Assintomáticas/epidemiologia , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Anticorpos Anti-HIV/sangue , Antígenos de Superfície da Hepatite B/sangue , Anticorpos Anti-Hepatite C/sangue , Hospitais de Ensino , Humanos , Nigéria/epidemiologia , Gravidez , Fatores de Risco , Estudos Soroepidemiológicos , Adulto Jovem
15.
Scand J Immunol ; 89(6): e12763, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30887554

RESUMO

The clinical consequences of isolated decreased serum immunoglobulin (Ig)M are not sufficiently known. Therefore, it is difficult to determine the clinical policy following such a finding. Only few reported IgM-deficient patients fulfil the European Society for Immunodeficiencies (ESID) diagnostic criteria for selective IgM deficiency (true sIgMdef), or their diagnosis is uncertain due to insufficient laboratory data (possible sIgMdef). Decreased serum IgM is often incidentally found in asymptomatic adults. The objective of our study was to further characterize true sIgMdef and to compare the European data collected through the ESID Registry community (tertiary centres) to our previously published Dutch cohort (secondary centre). Fifteen centres (12 countries) participated with 98 patients. Patients were excluded if serum IgM was only determined once (n = 14), had normalized (n = 8), or if they also had other immunological abnormalities (n = 15). Ten patients (5 adults) completely fulfilled the ESID criteria for true sIgMdef. Age-matched cut-off values varied widely between centres; when using the ESID diagnostic protocol reference values, only six patients (five adults) had true sIgMdef. Because of these small numbers, further analyses were performed in patients with true or possible sIgMdef (13 adults, 48 children). Respiratory infections were commonly reported at presentation (adults 54%, children 60%). Symptomatic adults had lower serum IgM levels (mean 0.27 g/L, 95% CI 0.22-0.31) than those without symptoms (mean 0.33 g/L, 95% CI 0.30-0.36; P = 0.02). To be able to explore the clinical consequences of true sIgMdef, we should fully analyse and accurately describe those patients in whom a decreased serum IgM is found.


Assuntos
Subpopulações de Linfócitos B/imunologia , Imunoglobulina M/sangue , Síndromes de Imunodeficiência/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/imunologia , Subpopulações de Linfócitos T/imunologia , Adolescente , Adulto , Doenças Assintomáticas/epidemiologia , Subpopulações de Linfócitos B/citologia , Criança , Pré-Escolar , Feminino , Humanos , Síndromes de Imunodeficiência/sangue , Síndromes de Imunodeficiência/imunologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Subpopulações de Linfócitos T/citologia , Adulto Jovem
16.
Acta Trop ; 193: 142-147, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30836060

RESUMO

In malaria-endemic areas, most pregnant women are susceptible to asymptomatic Plasmodium falciparum infections. We present here the results of a cross-sectional study conducted in Madibou, a southern district of Brazzaville in the Republic of Congo, between March 2014 and April 2015. The main aim was to characterize P. falciparum infections. Blood samples corresponding to peripheral, placental and cord from 370 asymptomatic malaria women at delivery were diagnosed for plasmodium infection by thick blood smears (microscopic infection). Sub-microscopic infection was detected by PCR, using the MSP-2 gene as marker. Microscopic infections were detected in peripheral, placental and cord blood samples with a prevalence of respectively 7.3% (27/370), 2.7% (10/370) and 0%. The negative samples were submitted to sub-microscopic detection, with respective prevalence of 25.4% (87/343), 16.7% (60/360) and 9.4% (35/370) (P < 0.001). We further investigated the genetic diversity of the parasite by characterizing MSP2 allelic families 3D7 (24 distinct alleles) and FC27 (20 distinct alleles). The total number of alleles for these two families were 31, 25 and 19 in peripheral, placental and cord samples respectively. The 3D7 MSP-2 was the predominant allelic family. The multiplicity of infections (MOI) in peripheral (mean 1.4 ± 0.01; range 1-4), placental (mean 1.2 ± 0.01; range 1-3) and cord samples (1.4 ± 0.01; range 1-3) were similar (P = 0.9) and are unaffected by age, gravidity or sulfadoxine-pyrimethamine. These results shown a high prevalence of sub-microscopic infection and a high genetic diversity of Plasmodium falciparum strains in Congo. Age, gravidity and doses of preventive treatment based on sulfadoxine-pyrimethamine do not interfere with the multiplicity of infections.


Assuntos
Sangue Fetal/parasitologia , Malária Falciparum/epidemiologia , Placenta/parasitologia , Plasmodium falciparum/genética , Plasmodium falciparum/isolamento & purificação , Proteínas de Protozoários/genética , Adulto , Alelos , Doenças Assintomáticas/epidemiologia , Congo/epidemiologia , Estudos Transversais , Feminino , Variação Genética , Humanos , Malária Falciparum/sangue , Malária Falciparum/parasitologia , Gravidez , Prevalência , Adulto Jovem
18.
Int J Cardiol ; 282: 93-98, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30745254

RESUMO

Cardiac troponin is a sensitive and specific biomarker for acute myocardial injury and has been used in the diagnosis of acute coronary syndromes, and has emerged as a tool for identifying high risk individuals for primary preventive therapy. Recent evidence has emerged indicating that high-sensitivity cardiac troponin assays, which allow robust detection of very low troponin concentrations, could detect subclinical injury in asymptomatic patients. On 24 March 2018, a group of cardiologists from the Asia Pacific region convened to review the data and discuss the potential utility of high-sensitivity troponin I (hsTnI) in the risk assessment of cardiovascular disease in the general population. The group recognized the immense burden of cardiovascular disease in the Asia-Pacific region, and the limitations of current risk stratification strategies. Data demonstrates that cardiac biomarkers like hsTnI could improve risk stratification, and thresholds for hsTnI in cardiovascular disease risk classification have been developed in Caucasian populations but not validated in Asian populations. There is an urgent need to improve cardiovascular risk assessment in the Asia Pacific general population, validate the Asian threshold of high risk and prove the utility of targeting these high-risk individuals for primary preventive strategies.


Assuntos
Doenças Assintomáticas/epidemiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Troponina I/sangue , Ásia/epidemiologia , Biomarcadores/sangue , Humanos , Oceano Pacífico/epidemiologia , Medição de Risco , Fatores de Risco
19.
Rev. esp. cardiol. (Ed. impr.) ; 72(2): 138-144, feb. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182545

RESUMO

Introducción y objetivos: La miocardiopatía hipertrófica (MCH) es la enfermedad cardiaca hereditaria más frecuente. El desafío actual radica en la clasificación precisa de la patogenicidad de variantes asociadas a las MCH. Para la evaluación inicial de la MCH se recomienda una ecocardiografía transtorácica (ETT). La cardiorresonancia magnética (CRM) también debe considerarse. El objetivo fue revaluar la penetrancia y expresión clínica de la variante patogénica MYBPC3 p.G263*. Métodos: Se estudiaron los principales genes sarcoméricos, mediante next-generation sequencing, en 384 índices con MCH y una cohorte control de 450 individuos sanos. Se identificaron todos portadores de MYBPC3 p.G263* y se realizó cribado familiar. Se recogió información clínica de manera retrospectiva hasta 2015 y prospectiva a partir de entonces. Se realizó un esfuerzo extra para realizar CRM en todos los portadores de la variante independientemente del resultado de la ETT. Resultados: Trece casos índice con MCH y ninguno de la cohorte control eran portadores de la variante MYBPC3 p.G263*, patogénica según el American College of Medical Genetics and Genomics y la Association for Molecular Pathology. Mediante cribado familiar se identificó a un total de 39 portadores. La mayoría se diagnosticó de MCH asintomática, con inicio tardío de la enfermedad y un curso relativamente benigno, pero con potenciales complicaciones tardías. Se encontró una penetrancia cercana al 70% evaluada por la ETT y del 87% por CRM. La penetrancia era edad-dependiente, y alcanzó el 100% en mayores de 55 años. Conclusiones: MYBPC3 p.G263* comparte con la mayoría de las variantes patogénicas truncantes en este gen un inicio tardío, un curso relativamente benigno en los jóvenes y una alta penetrancia. La CRM podría ser una herramienta útil en la evaluación de portadores independientemente de la ETT


Introduction and objectives: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease. The current challenge relies on the accurate classification of the pathogenicity of the variants. Transthoracic echocardiography (TTE) is recommended at initial evaluation and cardiac magnetic resonance (CMR) imaging should also be considered. We aimed to reappraise the penetrance and clinical expression of the MYBPC3 p.G263* variant. Methods: Three hundred and eighty-four HCM probands and a control cohort of 450 individuals were studied for the main sarcomere genes by next-generation sequencing. All MYBPC3 p.G263* carriers were identified and family screening was performed. Clinical information was recorded retrospectively before 2015 and prospectively thereafter. Extra effort was invested in performing CMR in all carriers, despite TTE results. Results: Thirteen HCM probands and none of the controls were carriers of the MYBPC3 p.G263* pathogenic variant (according to the American College of Medical Genetics and Genomics and the Association for Molecular Pathology). A total of 39 carriers were identified with family screening. Most patients with HCM were asymptomatic at the time of diagnosis and showed late-onset disease. Despite having a relatively benign course in the young, late HCM-related complications could occur. Penetrance was around 70% when evaluated by TTE and was 87.2% with TTE plus CMR. Penetrance was age-dependent, reaching 100% in carriers older than 55 years. Conclusions: MYBPC3 p.G263* shares with most truncating pathogenic variants in this gene a late onset, relatively benign clinical course in the young, and high penetrance. Cardiac magnetic resonance could be a useful tool to evaluate carriers despite TTE results


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Hemoglobinas Truncadas/análise , Cardiomiopatia Hipertrófica Familiar/genética , Estudos de Associação Genética/métodos , Ecocardiografia/métodos , Espectroscopia de Ressonância Magnética/métodos , Estudos de Casos e Controles , Doenças Assintomáticas/epidemiologia
20.
J Shoulder Elbow Surg ; 28(3): 587-595, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30639172

RESUMO

BACKGROUND: Heterotopic ossification (HO) is a known complication that can arise after total elbow arthroplasty (TEA). In most cases, it is asymptomatic; however, in some patients, it can limit range of motion and lead to poor outcomes. The objective of this review was to assess and report the incidence, risk factors, prophylaxis, and management of HO after TEA. METHODS: A systematic search was conducted using MEDLINE, Embase, and PubMed to retrieve all relevant studies evaluating the occurrence of HO after TEA. The search was performed in duplicate, and a quality assessment of all included studies was performed. RESULTS: A total of 1907 studies were retrieved, of which 45 were included involving 2256 TEA patients. HO was radiographically present in 10% of patients and was symptomatic in 3%. Fewer than 1% of patients went on to undergo surgical excision of HO, with outcomes after surgery reported as good or excellent as assessed by range of motion and the Mayo Elbow Performance Score. HO appears more likely to develop in patients undergoing TEA because of ankylosis, primary osteoarthritis, and distal humeral fractures. Surgical intervention is more likely to be required in patients in whom HO develops after TEA performed for ankylosis and post-traumatic osteoarthritis. CONCLUSION: HO is an uncommon complication after TEA, with most patients in whom HO develops being asymptomatic and requiring no surgical management. Routine HO prophylaxis for TEA is not supported by the literature. The effectiveness of prophylaxis in high-risk patients is uncertain, and future studies are required to clarify its usefulness.


Assuntos
Artroplastia de Substituição do Cotovelo/efeitos adversos , Doenças Assintomáticas/epidemiologia , Ossificação Heterotópica/epidemiologia , Anquilose/cirurgia , Doenças Assintomáticas/terapia , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/cirurgia , Incidência , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/terapia , Osteoartrite/cirurgia , Amplitude de Movimento Articular , Fatores de Risco
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