RESUMO
BACKGROUND: Soil-transmitted helminth (STH) infections have been suggested to protect from allergic sensitization and atopic diseases. Consequently, anthelminthic treatment would increase the prevalence of atopic disease in STH endemic populations. OBJECTIVE: To investigate the effect of deworming on allergic sensitization and atopic diseases in Cuban schoolchildren. METHODS: We followed up 108 STH positive schoolchildren aged 5-13 in six-monthly intervals for 24 months. Four consecutive groups of, respectively, 104, 56, 68, and 53 STH positive children were used as 'untreated' reference groups to assess general time trends. STH infections were diagnosed by stool examination. Asthma, allergic rhinoconjunctivitis, and atopic dermatitis were diagnosed by International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and allergic sensitization by skin prick testing (SPT). At each time point, STH positive children were treated with one single dose of 500 mg mebendazole. RESULTS: After deworming, the frequency of asthma significantly decreased (P < 0.001) while the frequency of allergic rhinoconjunctivitis and atopic dermatitis was not affected (P = 0.129 and P = 0.751, respectively). The percentage of SPT positives temporarily increased (P < 0.001) and subsequently returned to nearly baseline values (P = 0.093). In the references groups, no change over time was observed in the proportion of children with allergic sensitization and atopic diseases (P > 0.05). CONCLUSION & CLINICAL RELEVANCE: Our results indicate that atopic diseases do not increase after anthelminthic treatment. Allergic sensitization on the other hand increases after deworming. As this increase appears only temporarily, deworming of schoolchildren does not seem to be a risk factor for the development of allergic sensitization, nor for atopic diseases.
Assuntos
Helmintíase/complicações , Hipersensibilidade Imediata/epidemiologia , Hipersensibilidade Imediata/etiologia , Adolescente , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Cuba/epidemiologia , Feminino , Helmintíase/tratamento farmacológico , Helmintíase/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Prevalência , Fatores de RiscoRESUMO
The use of trabecular metal in the tibial surface may increase prosthetic survival in the population with severe or morbid obesity (BMI > 35 kg/m2). A prospective, descriptive study was conducted of patients with a BMI > 35 kg/m2 who underwent total knee replacement with a prosthesis with trabecular metal. Minimal follow-up was two years. The statistical analysis was done with Student's t test; the Knee Society Score and the Western Ontario and McMaster Universities Osteoarthritis Index were applied preoperatively and postoperatively. The chi2 test was applied to the BMI values relating them with more or less radiolucent images. The total number of patients was 39, but three were excluded for not having the radiographic follow-up. Mean follow-up was 34 months (25-43); 35 were females, mean age was 69.4 years (57-81), mean BMI was 39.43 kg/m2 (35-55). All patients had grades 3 and 4 tricompartmental arthrosis. The KSS (R and F) and WOMAC scales, with a 95% confidence interval, showed a statistically significant improvement in the assessment of preoperative results and at the end of the followup. Only a few studies measure long-term implant survival. Most authors define survival as the absence of the need to revise prosthetic implants. The end point of survival is the removal or exchange of prosthetic components. Trabecular metal (TM) is currently used in orthopedic surgery and its clinical applications are increasing more and more with good results.
Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Obesidade Mórbida/complicações , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Porosidade , Estudos Prospectivos , Falha de Prótese , Radiografia , Propriedades de Superfície , Tíbia/cirurgia , Resultado do Tratamento , Suporte de CargaRESUMO
OBJECTIVE: The aim of the study was to determine the frequency of antibodies to Toxocara in Cuban schoolchildren. METHODS: The frequency of antibodies to Toxocara canis was assessed with a commercial enzyme-linked immunosorbent assays kit in school-aged children from two municipalities of Cuba. Univariate analysis and a multivariable logistic regression analysis adjusted for age, sex, municipality and co-infection with helminth and/or protozoa were conducted. RESULTS: The percentage of children with antibodies to Toxocara was 38.8% (392/1011; 95% CI = 36.8-42.8). Antibody positivity was significantly associated with gender and co-infections with intestinal parasites, but not with age or municipality. CONCLUSION: Cuban children are highly exposed to the Toxocara parasite, corresponding well with reported environmental contamination with Toxocara parasite eggs and T. canis prevalences in dogs in Cuba. Relevant policy makers and the Cuban population need to be better informed about this preventable infection.
Assuntos
Anticorpos Anti-Helmínticos/sangue , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/imunologia , Toxocara canis/imunologia , Toxocaríase/epidemiologia , Toxocaríase/imunologia , Adolescente , Distribuição por Idade , Animais , Criança , Pré-Escolar , Coinfecção/sangue , Coinfecção/epidemiologia , Cuba/epidemiologia , Doenças do Cão/epidemiologia , Cães , Ensaio de Imunoadsorção Enzimática/métodos , Fezes/parasitologia , Feminino , Humanos , Enteropatias Parasitárias/sangue , Masculino , Prevalência , Distribuição por Sexo , Toxocaríase/transmissãoRESUMO
The medical records of the 185 children who, in 2007, were admitted to the Academic Paediatric Hospital 'Centro Habana', in the Cuban capital of Havana, because of giardiasis were analysed retrospectively. A standardized form was used to collect data on the socio-demographic characteristics, clinical features, laboratory diagnosis, treatment and length of stay of each child. Information on the 15 children who had incomplete medical records was excluded from the data analysis. Of the remaining 170 children, 85 (50·0%) were aged 1-4 years, 97 (57·1%) were male, and 106 (62·4%), 92 (54·1%) and 69 (40·6%) had presented with diarrhoea, vomiting, and/or abdominal pain, respectively. Most (91·2%) of the cases had been diagnosed by the microscopical examination of a duodenal aspirate, and the drugs that had been most used frequently were quinacrine and tinidazole, which had been given to 72 (42·4%) and 62 (36·5%) of the cases, respectively. The mean length of hospital stay was 4·9 days. Such information on the clinical characteristics of giardiasis among children living in an endemic area may be valuable to paediatricians and public-health officials who wish to screen for the disease.
Assuntos
Giardíase/diagnóstico , Giardíase/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Dor Abdominal/parasitologia , Antiprotozoários/uso terapêutico , Criança , Pré-Escolar , Cuba/epidemiologia , Diarreia/parasitologia , Feminino , Giardíase/complicações , Giardíase/epidemiologia , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Prontuários Médicos , Metronidazol/análogos & derivados , Metronidazol/uso terapêutico , Quinacrina/uso terapêutico , Estudos Retrospectivos , Tinidazol/uso terapêutico , Resultado do Tratamento , Vômito/parasitologiaRESUMO
The risk factors associated with Giardia infection, in children hospitalized in Havana, Cuba, were recently explored. Children aged ≥5â years were more likely to be positive for Giardia infection than the younger children, with an odds ratio (OR) of 3·41 [95% confidence interval (CI) = 1·36-9·69]. The risk factors found to be associated with Giardia infection in univariate analyses were rural residence (OR = 3·01; CI = 1·23-7·35), belonging to a household that did not receive water from an aqueduct (OR = 3·27; CI = 1·21-8·91), drinking unboiled water (OR = 3·64; CI = 2·14-6·26), nail biting (OR = 3·47; CI = 1·97-6·08), eating unwashed vegetables raw (OR = 4·84; CI = 2·33-10·14), and a personal (OR = 3·23; CI = 1·58-6·59) or family history (OR = 3·96; CI = 1·53-10·47) of previous parasitic infection. In multivariate analyses, however, only two (modifiable) risk factors were found to be independently and significantly associated with Giardia infection: nail biting and eating unwashed vegetables raw. It therefore seems that, at least at the individual level, giardiasis-prevention activities in Havana should be focussed on health education to improve personal hygiene and food-related practices. If appropriately managed, the surveillance of drinking water and foodstuffs, for Giardia and other parasites, might also help to reduce the hospitalization of Cuban children.
Assuntos
Fezes/parasitologia , Giardia lamblia/patogenicidade , Giardíase/prevenção & controle , Hospitalização/estatística & dados numéricos , Abastecimento de Água/normas , Água/parasitologia , Adolescente , Animais , Criança , Pré-Escolar , Cuba/epidemiologia , Feminino , Giardíase/epidemiologia , Giardíase/etiologia , Humanos , Higiene/educação , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Hábito de Roer Unhas , Razão de Chances , Fatores de Risco , Inquéritos e Questionários , Verduras/parasitologiaRESUMO
Molecular and epidemiological studies of Cryptosporidium infections amongst 28 Cuban children (aged 2-8 years) with diarrhoea are described. As few of the younger infected children but most of the older infected children had been breastfed, short-term protection from maternal antibodies passed to infants during breastfeeding may result in a lack of cryptosporidial infection in infancy. This protection of breastfeeding children may, however, result in such children developing less anti-Cryptosporidium immunity of their own (than their bottle-fed counterparts), so that, by school age, the children who had been breastfed are those most likely to be found infected. In the present study, in contrast with the observations made during a previous study of cryptosporidiosis in Cuban children, vomiting was rare (7%) whereas abdominal pain was common (57%). These differences in expression of symptoms between studies may be age-related. As seen in other studies from similar countries, including those of the Caribbean and Latin America, C. hominis was found to predominate, the results of the successful molecular analyses revealing 10 C. hominis infections but no C. parvum. Subgenotyping (at the gp60 locus) indicated that the C. hominis infections included a wide range of subtypes, with isolates from three subtype families (Ia, Ib and Id) being detected.
Assuntos
Criptosporidiose/epidemiologia , Cryptosporidium/genética , Animais , Anorexia/epidemiologia , Anorexia/parasitologia , Sequência de Bases , Criança , Pré-Escolar , Cuba/epidemiologia , Diarreia/epidemiologia , Diarreia/parasitologia , Fezes/parasitologia , Feminino , Genes de Protozoários , Genótipo , Humanos , Masculino , Dados de Sequência Molecular , Oocistos , RNA Ribossômico 18S/análiseRESUMO
Stool samples containing Giardia duodenalis cysts were collected from 95 primary-school children in central Cuba, and preserved by storing at -20 degrees C in 70% ethanol. Clinical data were collected for each child. Although 57% of the children were asymptomatic, the remaining 43% each reported between one and three symptoms. Following cyst quantification and isolation, molecular analyses were attempted on all cyst isolates, with the focus on the parasite's beta-giardin and glutamate-dehydrogenase (gdh) genes. Unfortunately, the cyst-preservation procedure appeared to have a deleterious effect on the cysts, since genotyping data could only be obtained for 20 of the 95 isolates. These data indicated, however, an approximately equal distribution between assemblage A (nine isolates) and assemblage B (11 isolates). Children found to be excreting relatively large numbers of cysts were more likely to be symptomatic than children who were excreting fewer cysts, and children with Giardia isolates from assemblage B were more likely to have symptomatic infections than children with isolates from assemblage A. Although considerable sequence variability was seen in the assemblage-B isolates, the assemblage-A isolates were relatively genetically homogeneous. This is the first publication from the Caribbean in which the Giardia genotypes circulating within the population have been identified, the first from the Americas providing information on associations between clinical presentation and the assemblage of the infecting Giardia, and the first to indicate that levels of cyst excretion may have clinical significance.
Assuntos
DNA de Protozoário/análise , Giardia/genética , Giardíase/parasitologia , Animais , Criança , Cuba/epidemiologia , DNA de Protozoário/isolamento & purificação , Feminino , Genótipo , Giardia/isolamento & purificação , Giardíase/epidemiologia , Humanos , Masculino , Saúde da População Rural , Análise de Sequência de DNA/métodosRESUMO
A cross-sectional study was carried out in 200 children aged 5-15 years, to examine the presence of intestinal parasitic infections (IPIs) and to assess the risk factors and clinical features associated with them in children in San Juan y Martinez (SIM), Cuba. Three fresh faecal samples were collected from each child and were examined by direct wet mount, brine flotation, formalin-ether and Kato-Katz techniques. Data relating to demography, source of drinking water, personal hygiene habits and clinical features were also collected Living in the rural area was significantly associated with the highest infection rates (p < 0.01). According to clinical features and laboratory examinations, children with abdominal pain were about four times more likely to have IPIs (OR 4.05, CI, 1.11, 13.18) especially soil-transmitted helminths (STH). We suggest that IPIs, especially STH, in SJM should be strongly suspected in children with abdominal pain from rural areas. Targeted and frequent interventions to control these infections are needed in this municipality.
Assuntos
Enteropatias Parasitárias/epidemiologia , População Rural/estatística & dados numéricos , Solo/parasitologia , Água/parasitologia , Dor Abdominal/diagnóstico , Dor Abdominal/parasitologia , Adolescente , Animais , Criança , Pré-Escolar , Intervalos de Confiança , Estudos Transversais , Cuba/epidemiologia , Fezes/parasitologia , Feminino , Helmintíase/diagnóstico , Helmintíase/epidemiologia , Humanos , Higiene , Enteropatias Parasitárias/diagnóstico , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Abastecimento de Água/normasRESUMO
A cross-sectional study was carried out to determine the prevalence of intestinal parasitic infections and the intensity of soil-transmitted helminths (STHs) among children who attend the educational centres of San Juan y Martinez, Cuba. Ascaris lumbricoides, Blastocystis hominis and Giardia lamblia were the most common parasites found, with prevalence rates of 40.5%, 38.5% and 25%, respectively. In total, 91% of children harboured at least one type of intestinal parasite. The rates and intensity of intestinal parasitic infections found permit us to speculate that the conditions that predispose to acquire intestinal protozoan and STH infections persist in this municipality.