RESUMO
BACKGROUND: Cancer is the main complication of transplantation surgery. The literature concerning renal transplant recipients among the Afro-Caribbean population is scant. The aim of this study was to determine the incidence of cancer in these patients, with the secondary objective being to identify predisposing factors for cancer. PATIENTS AND METHODS: This was an epidemiological and retrospective study that included all Guadeloupians of phototype V-VI undergoing renal transplantation from 01/01/2004 to 31/12/2011. Skin cancer screening was performed before transplantation and during an annual dermatological consultation following transplantation. Screening for non-cutaneous cancers was guided by clinical symptoms or by the results of the screening examinations recommended in the current guidelines. At the study time-point (31/12/2011), all patients were examined by a dermatologist. RESULTS: One hundred and two patients were included : 42 women and 60 men (mean age: 52.1±11.6 years at transplantation). Eight cancers were diagnosed. The cumulative incidence of cancer was 7.8% at 3 years. Three factors were associated with more rapid onset of cancer: personal history or familial history of cancer, and genital lesion induced by HPV. CONCLUSION: Our results suggest a low incidence of cancer in Afro-Caribbean renal transplant patients. Personal or family history of cancer and HPV-induced genital lesions would appear to accelerate the onset of cancer in this population.
Assuntos
Transplante de Rim , Neoplasias/etnologia , Complicações Pós-Operatórias/etnologia , Neoplasias Cutâneas/etnologia , Adulto , África/etnologia , Região do Caribe/etnologia , Feminino , Guadalupe/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/etiologia , Neoplasias Induzidas por Radiação/etnologia , Síndromes Neoplásicas Hereditárias/etnologia , Infecções por Papillomavirus/etnologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Cutâneas/etiologia , Luz Solar/efeitos adversos , Infecções Tumorais por Vírus/etnologiaRESUMO
AIM: The prevalence of diabetes in the French West Indies is three times higher than in mainland France. We aimed to assess the associations between vitamin D deficiency, vitamin D receptor (VDR) gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes (T2D). METHODS: In this cross-sectional study of 277 patients, 25-hydroxyvitamin D was measured by radioimmunoassay. FokI, BsmI, ApaI and TaqI single nucleotide polymorphisms (SNPs) of the VDR gene were genotyped. Analysis of covariance and logistic regression were performed. RESULTS: The study included 76 patients of Indian descent and 201 patients of African descent. The prevalence of vitamin D deficiency (<20 ng/mL) was 42.6%. When patients were classified into groups with (G1) and without (G2) vitamin D deficiency, there were no significant differences in age, systolic blood pressure, low-density lipoprotein cholesterol and HbA(1c), although body mass index was significantly higher in G1. Vitamin D deficiency was significantly associated with increased diastolic blood pressure and triglyceride levels, and reduced high-density lipoprotein cholesterol (P<0.05). Prevalence of vitamin D deficiency was decreased in patients carrying the f allele of FokI (OR: 0.52; P=0.02) and the aa genotype of ApaI (OR: 0.46; P=0.05). BsmI and TaqI SNPs were not associated with vitamin D deficiency. CONCLUSION: The rate of vitamin D deficiency was high in our T2D patients, and was associated with the VDR gene FokI and ApaI polymorphisms and cardiovascular risk profile. Measurements of vitamin D may help to detect T2D patients with cardiovascular risk, and VDR polymorphisms might explain why vitamin D deficiency is so frequently seen in some T2D patients.
Assuntos
Doenças Cardiovasculares/genética , Diabetes Mellitus Tipo 2/genética , Angiopatias Diabéticas/genética , Polimorfismo de Nucleotídeo Único , Receptores de Calcitriol/genética , Deficiência de Vitamina D/genética , Biomarcadores/sangue , População Negra/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/etiologia , Feminino , Guadalupe/epidemiologia , Humanos , Índia/etnologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Vitamina D/genética , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologiaRESUMO
Infectious complications are a leading cause of morbidity and mortality in patients with sickle cell disease. Several mechanisms are supposed to contribute to this susceptibility. The exact reasons for the susceptibility of sickle cell patients to infection are not clear and are still a matter of debate. Interferon gamma (IFNgamma) is a key cytokine involved mainly in the defence against intracellular pathogens. We investigated a possible association of an IFNgamma +874 T/A polymorphism and infectious complications in sickle cell patients. Seventy-two sickle cell patients were typed for +874 T/A IFNgamma polymorphism. Genotype frequencies were different between cases and controls. Indeed, the T allele frequency was significantly higher in patients with infections than in patients without infections (P = 0.014). Our results suggest that the +874 T/A IFNgamma polymorphism is associated with infectious complications in sickle cell patients. T allele could be involved in infections in sickle cell patients.
Assuntos
Anemia Falciforme/genética , Infecções Bacterianas/genética , Interferon gama/genética , Polimorfismo de Nucleotídeo Único , Adulto , Alelos , Anemia Falciforme/epidemiologia , Anemia Falciforme/imunologia , Infecções Bacterianas/epidemiologia , Estudos de Casos e Controles , Comorbidade , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/genética , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Osteomielite/epidemiologia , Osteomielite/genética , Osteomielite/microbiologia , Sepse/epidemiologia , Sepse/genética , Sepse/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/genética , Adulto JovemRESUMO
Killer cell immunoglobulin-like receptors (KIRs) belong to a diverse family of natural killer (NK) cell receptors recognizing human leukocyte antigen (HLA) class I molecules. Due to this functional link, KIR molecules are expected to display a high polymorphism, such as their HLA ligands. Moreover, many studies conducted in mouse and human models have shown that NK-KIR receptors play an important role in haematopoietic stem cell transplantation (HSCT). A beneficial impact of peculiar KIR ligand (HLA) mismatching has been reported suggesting a role to this combinatory HLA-KIR polymorphism. It is thus important to investigate KIR diversity in various human populations. To this end, we used polymerase chain reaction-sequence-specific primers to evaluate KIR gene in five selected populations (France, Guadeloupe, Senegal, Finland and Réunion). Genotypic and haplotypic frequencies were computed, as well as genetic distances and dendrogram (phylip package). These data illustrate the genetic relationship of these five populations through the KIR polymorphism. Results revealed a wide diversity in KIR gene frequencies in Guadeloupe and Réunion, and a high specificity in Senegal. The obtained dendrogram indicated small genetic distances between France, Guadeloupe and Réunion as well as between France and Finland. Senegal showed a distant genetic relationship with the other countries and, interestingly, an inverted ratio of coding/non-coding (KIR2DS4/1D) alleles compared with Caucasians. These data expose the broad diversity in KIR genes worldwide and show that KIR genes are pertinent tools in human population genetics. If the role of KIR donor-recipient incompatibilities is confirmed, KIR diversity according to ethnicity should be taken into account during the selection of HSCT donors.
Assuntos
Alelos , Frequência do Gene/genética , Polimorfismo Genético/genética , Receptores Imunológicos/genética , Feminino , Finlândia , França , Frequência do Gene/imunologia , Genética Populacional/métodos , Genótipo , Guadalupe , Antígenos HLA/genética , Antígenos HLA/imunologia , Humanos , Masculino , Polimorfismo Genético/imunologia , Receptores Imunológicos/imunologia , Receptores KIR , Reunião , SenegalRESUMO
To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted disease (STD) clinics in Jamaica we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphilis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63% of cases of NGU but high prevalences were also found in asymptomatic STD contacts (59%), asymptomatic STD non-contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi2=4.78; odds ratio (OR)=1.76; P<0.05) and previous history of gonococcal infection (83% vs 42%; chi2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.
Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Transmissão de Doença Infecciosa/prevenção & controle , Infecções por HIV/transmissão , HIV-1 , Uretrite/epidemiologia , Estudos de Casos e Controles , Gonorreia/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Jamaica/epidemiologia , Masculino , Prevalência , Manejo de Espécimes , Sífilis/epidemiologia , Uretrite/complicações , Uretrite/microbiologiaRESUMO
To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted (STD) clinics in Jamaica, we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphillis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63 percent of cases of NGU but high prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71 percent vs 58 percent; x2=4.78; odds ratio OR=1.76; P<0.05) and previous history of gonococcal infection (83 percent vs 42 percent; x2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occured in 5.2 percent of cases of NGU and 50 percent and 90 percent, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.(Au)
Assuntos
Humanos , Masculino , Chlamydia trachomatis/isolamento & purificação , Infecções por Chlamydia/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , HIV-1 , Uretrite/epidemiologia , Infecções por HIV/transmissão , Estudos de Casos e Controles , Gonorreia/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Jamaica/epidemiologia , Prevalência , Manejo de Espécimes , Sífilis/epidemiologia , Uretrite/complicações , Uretrite/microbiologiaRESUMO
In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19% of the women had at least one pathogen: C. trachomatis was found in 16%, HTLV-1 in 2%, HIV-1, HBV and N. gonorrhoeae each in 0.5% C. trachomatis infection was more prevalent in women less than 20 years of age (31%) than in those 20 years and older (16%; OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica.
Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , HIV-1 , Humanos , Incidência , Recém-Nascido , Jamaica/epidemiologia , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle , Doenças Virais Sexualmente Transmissíveis/prevenção & controleRESUMO
In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19of the women had at least one pathogen: C. trachomatis was found in 16, HTLV-1 in 2, HIV-1, HBV and N. gonorrhoeae each in 0.5C. trachomatis infection was more prevalent in women less than 20 years of age (31) than in those 20 years and older (16; OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Complicações Infecciosas na Gravidez/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Virais Sexualmente Transmissíveis/epidemiologia , HIV-1 , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle , Doenças Virais Sexualmente Transmissíveis/prevenção & controle , Estudos Transversais , Gravidez , Incidência , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Jamaica/epidemiologia , Recém-NascidoRESUMO
This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-1995. 13,978 stool specimens collected in 1994-1995 were tested by parasitologic examination. Stool specimens were from patients hospitalised in the 3 principal hospitals of Martinique or coming to the Laboratoire départemental d'hygiène. The parasitism rate was 8.73%. This study showed a significant reduction of intestinal parasitism between results of 1988 and results of 1994-1995. The oro-faecal parasitism was not very important that reflected the good economic and sanitation level of Martinique. On the other hand, regarding the important prevalence of parasitism with Strongyloïdes stercoralis and hookworm, it would be good to improve detection, sanitary education and know better local contamination factors to decrease the prevalence of this parasitism.
Assuntos
Enteropatias Parasitárias/epidemiologia , Amebíase/epidemiologia , Amebíase/prevenção & controle , Fezes/parasitologia , Educação em Saúde , Helmintíase/epidemiologia , Helmintíase/prevenção & controle , Humanos , Enteropatias Parasitárias/prevenção & controle , Martinica , Infecções por Protozoários/epidemiologia , Infecções por Protozoários/prevenção & controleRESUMO
OBJECTIVES: To determine the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica. METHODS: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmunofluorescence (MIF) test. RESULTS: The DFA detected C trachomatis in 16% (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24% (31/129) and 25% (33/129) respectively. The overall prevalence of current chlamydial infection detected by the isolation techniques used was 25% (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95%, 61/64) was found in CSSW compared with blood donors (53%, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9%) and Candida albicans (7%) were found in comparatively low frequencies, while Trichomonas vaginalis (0%) was not found in specimens from the CSSW. CONCLUSIONS: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequelae of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.
PIP: The prevalence of Chlamydia trachomatis infection was investigated in 129 commercial sex workers (CSWs) recruited on the streets in Kingston, Jamaica. The direct fluorescent antibody method detected C. trachomatis in endocervical cytobrush specimens from 21 women (16%). When the specimens were cultured, current chlamydial infection was detected by iodine staining in 31 (24%) and by monoclonal antibodies in 33 (25%). The microimmunofluorescence test for chlamydial antibodies was performed on clotted blood samples obtained from 64 CSWs and, as controls, 435 blood bank donors. A significantly higher seroprevalence rate was found among CSWs (95%) than blood donors (53%) (p 0.001). Among CSWs, the most common clinical manifestation of C. trachomatis infection was vaginal discharge. The presence of C. trachomatis infection was not related to previous history of pelvic inflammatory disease, sexually transmitted disease (STD), or condom use. Neisseria gonorrhoeae was isolated from 11 (9%) endocervical swabs. This study confirms the predominance of C. trachomatis among the bacterial causes of STDs in high-risk groups in Jamaica, and suggests a need for screening and treatment to control the spread and prevent the severe clinical sequelae of chlamydial infection.