RESUMO
Identifying etiologies of acute febrile illnesses (AFI) is challenging due to non-specific presentation and limited availability of diagnostics. Prospective AFI studies provide a methodology to describe the syndrome by age and etiology, findings that can be used to develop case definitions and multiplexed diagnostics to optimize management. We conducted a 3-year prospective AFI study in Puerto Rico. Patients with fever ≤7 days were offered enrollment, and clinical data and specimens were collected at enrollment and upon discharge or follow-up. Blood and oro-nasopharyngeal specimens were tested by RT-PCR and immunodiagnostic methods for infection with dengue viruses (DENV) 1-4, chikungunya virus (CHIKV), influenza A and B viruses (FLU A/B), 12 other respiratory viruses (ORV), enterovirus, Leptospira spp., and Burkholderia pseudomallei. Clinical presentation and laboratory findings of participants infected with DENV were compared to those infected with CHIKV, FLU A/B, and ORV. Clinical predictors of laboratory-positive dengue compared to all other AFI etiologies were determined by age and day post-illness onset (DPO) at presentation. Of 8,996 participants enrolled from May 7, 2012 through May 6, 2015, more than half (54.8%, 4,930) had a pathogen detected. Pathogens most frequently detected were CHIKV (1,635, 18.2%), FLU A/B (1,074, 11.9%), DENV 1-4 (970, 10.8%), and ORV (904, 10.3%). Participants with DENV infection presented later and a higher proportion were hospitalized than those with other diagnoses (46.7% versus 27.3% with ORV, 18.8% with FLU A/B, and 11.2% with CHIKV). Predictors of dengue in participants presenting <3 DPO included leukopenia, thrombocytopenia, headache, eye pain, nausea, and dizziness, while negative predictors were irritability and rhinorrhea. Predictors of dengue in participants presenting 3-5 DPO were leukopenia, thrombocytopenia, facial/neck erythema, nausea, eye pain, signs of poor circulation, and diarrhea; presence of rhinorrhea, cough, and red conjunctiva predicted non-dengue AFI. By enrolling febrile patients at clinical presentation, we identified unbiased predictors of laboratory-positive dengue as compared to other common causes of AFI. These findings can be used to assist in early identification of dengue patients, as well as direct anticipatory guidance and timely initiation of correct clinical management.
Assuntos
Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Febre/epidemiologia , Febre/etiologia , Influenza Humana/epidemiologia , Doença Aguda , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doença Crônica/epidemiologia , Feminino , Cefaleia/etiologia , Humanos , Lactente , Recém-Nascido , Leucopenia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Porto Rico/epidemiologia , Distribuição por Sexo , Trombocitopenia/etiologia , Adulto JovemRESUMO
This is a case report of a congenital right labia majora hydrocele in a 13-year-old adolescent girl. Hydrocele of the canal of Nuck is a rare condition in females. A small invagination of the parietal peritoneum that fails to obliterate during the first year of life, can result in either an indirect hernia or a hydrocele of the canal of Nuck.
Assuntos
Canal Inguinal/patologia , Doenças Peritoneais/patologia , Vulva/patologia , Adolescente , Diagnóstico Diferencial , Feminino , Humanos , Canal Inguinal/diagnóstico por imagem , Canal Inguinal/cirurgia , Doenças Peritoneais/diagnóstico por imagem , Doenças Peritoneais/cirurgia , Ultrassonografia , Vulva/diagnóstico por imagem , Vulva/cirurgiaRESUMO
Pregnancy in adolescents is a public health problem that should be evaluated in the framework of a socio ecological model. Puerto Rico is among the countries with a higher pregnancy rate among adolescents, 42 per 1000 births for 2002. This is an observational cross-sectional study of deliveries of pregnant adolescents carried out at Hospital San Lucas II between the years 2000 to 2004. The total number of deliveries that fulfilled the selection criteria was 110. The data was obtained from the medical record of the mother and the newborn. The variables analyzed were: age, prenatal care, age of gestation, birthweight of the newborn, Apgar, maternal infections, infections in the newborn, education of the mother, work and marital state. The percentage of deliveries preterm was greater than the expected for adult women. The outcomes in the newborns preterm were worse than those born at term. The percentage of caesarean sections in the adolescents was smaller than in the population of women in general. Teenage mothers tend to drop out of school. The results of our study indicate the need of interventions following an ecological model in order to be more effective in the prevention of adolescent pregnancies and its consequences.