Assuntos

RESUMO

The variability in the host immune response directed against dengue virus (DENV) has demonstrated the need to understand the immune response associated with protection in incident infection. The objective was to estimate the association between serostatus and the risk of incident DENV infection. We used a prospective study from 2014 to 2016 in the localities of Axochiapan and Tepalcingo, Morelos, Mexico. We recruited 966 participants, of which, according to their infection history registered were categorized in four groups. To accomplish the objectives of this study, we selected to 400 participants older than 5 years of age were followed for 2.5 years. Blood samples were taken every 6 months to measure serological status and infection by ELISA. In individuals with at least two previous infections the risk of new infection was lower compared to a seronegative group (hazard ratio adjusted 0.49, 95% CI 0.24-0.98), adjusted for age and locality. Therefore, individuals who have been exposed two times or more to a DENV infection have a lower risk of re-infection, thus showing the role of cross-immunity and its association with protection.

Assuntos

RESUMO

OBJECTIVES: To estimate the association between tuberculosis (TB) patients' race and patients' access to diagnostic testing in Brazil. In addition, we evaluated if the associations could be explained by a geographic codistribution between racial groups and diagnostic testing. STUDY DESIGN: It is a cross-sectional study based on secondary data from a national surveillance system of new TB cases diagnosed in 2015. METHODS: We evaluated the association between TB patients' race (independent variable) and the HIV testing and TB mycobacterial culture providing (dependent variables) with logistic regression models. We used multilevel models to consider different geopolitical levels (region, state and municipality). In addition, we used conditional logistic regressions matched by health-care unit. All models were adjusted by individual covariates associated with the outcomes. RESULTS: Compared with non-Afro-Brazilian patients, Afro-Brazilian patients had significantly lower odds to have had HIV testing [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.69-0.75] and mycobacterial culture performed (OR: 0.74; 95% CI: 0.71-0.77). However, these statistically significant negative associations between Afro-Brazilian racial category and testing disappeared when patients were considered as nested in geopolitical contexts or matched for health-care unit. CONCLUSIONS: Afro-Brazilian TB patients had lower probability to have HIV test and mycobacterial culture performed. However, these associations seem to be macrodeterminated by the geographic distribution of both racial groups and diagnostic testing. Our findings can support the formulation of public policies aiming to mitigate regional disparities as a strategy to improve racial equity in access to healthcare. The approach presented can be applied in a range of scenarios to identify disparities, localize its source and support decision-making.

Assuntos

RESUMO

BACKGROUND: Cardiac autonomic dysfunction has been proposed as an important contributing factor to the increased cardiovascular risk observed in major depression (MDD). However, the evidence regarding alterations in heart rate variability (HRV) in otherwise healthy depressed subjects has been inconclusive. METHODS: A case-control study in 50 treatment-naïve young adults with a first MDD episode without comorbid psychiatric disorders and 50 healthy control subjects was conducted. Time- and frequency-domain indexes of HRV were determined at baseline supine and after 5-min of orthostatic stress at 60°. RESULTS: There were no significant differences in the time- or frequency-domain variables of HRV between depressed patients and controls. However, a random-effect ANOVA model showed that during orthostatic stress depressed men had a reduced HRV and decreased parasympathetic activity compared to control subjects, while no differences were found between depressed women and controls. CONCLUSION: These results suggest a sex-dependent relationship between major depression and cardiac autonomic dysfunction and provide one potential explanation for sex differences in the association of depressive symptoms with cardiovascular morbidity.

Assuntos

RESUMO

We prospectively collected data on all patients with stage IB1 cervical cancer, who underwent total laparoscopic radical hysterectomy with the use of a modified uterine manipulator. From January 2000 to December 2005, 54 patients met the study criteria. The mean age was 41.8 +/- 7.47 years. Average BMI (kg/m(2)) was 27.38 +/- 3.13. Squamous carcinoma and adenocarcinoma were found in 88.88% and 11.11% of the cases, respectively. The average surgical time was 265 +/- 70.8 min. The mean estimated blood loss was 276.11 +/- 123.03 ml. The average patient lymph node count was 19.64 +/- 5.08. Positive malignant lymph nodes were identified in 11.11% of the cases. Surgical margins were free of disease in all patients. The mean hospital stay was 1.5 +/- 1 days. There was no mortality. Total laparoscopic radical hysterectomy can be considered a safe alternative to laparotomy. The use of a uterine manipulator does not pose an increased surgical risk and allows for a simpler and more feasible procedure.

Assuntos

RESUMO

INTRODUCTION: Spontaneous haemorrhage is an important cause of hospitalisation in dengue patients. Early predictors of these complications could help to make opportune decisions. METHODS: We prospectively evaluated 51 febrile patients (without previous spontaneous haemorrhage), including 32 cases of dengue fever. Initial evaluation was performed during the first 96 hours after the onset of fever and included complete blood cell count and coagulation tests. Participants were followed-up daily until the seventh day of the disease. RESULTS: Overall, 15 patients developed spontaneous haemorrhage during the follow-up. Tourniquet test and dengue infection were not associated with haemorrhage (p-value is greater than 0.2). In a logistic regression analysis, platelet count (odds-ratio [OR] 0.78; 95 percent confidence interval [CI] 0.65-0.94) and partial thromboplastin time (OR 1.78; 95 percent CI 1.06-2.99) were independently associated with spontaneous haemorrhage. CONCLUSION: Early alterations in platelet count and coagulation test could predict spontaneous bleeding in the acute febrile syndrome.

Assuntos

RESUMO

OBJECTIVE: To identify clinical manifestations and laboratory findings useful for the early diagnosis of dengue in children. MATERIALS AND METHODS: We prospectively evaluated 125 children (aged 5 to 12 years old) with acute febrile syndrome with no apparent etiology. Paired serologic tests and/or viral culture were performed and dengue infection was confirmed in 40 patients and ruled out in 68 (17 indefinite cases). Early clinical manifestations (within the first 4 days of the disease) in the groups with dengue and other causes of febrile syndrome were compared. Independent indicators of dengue were determined in a multivariate logistic regression analysis. RESULTS: When clinical manifestations and complete blood count were considered, the independent indicators of dengue were: absence of nasal discharge, facial flushing, and leukocyte count < or = 4,500/.l. With at least two of these findings, a sensitivity of 67 % and a specificity of 72 % for the diagnosis of dengue were obtained. When coagulation tests were considered, a model for diagnosis was composed of: absence of nasal discharge, leukocyte count < or = 4500/.l, prothrombin time > 14 seconds, and partial thromboplastin time > 29 seconds. Two of these findings suggested a diagnosis of dengue with a sensitivity of 90 % and a specificity of 52.9 %. With at least 3 findings, specificity increased to 89.7 % and sensitivity decreased to 50 %. The presence of the four components of this latter model shows a specificity of 100 %. CONCLUSIONS: Some clinical manifestations and simple laboratory tests could aid the early detection of dengue infection in children.

Assuntos

RESUMO

In acute pancreatitis determination of glandular necrosis has been difficult because of the lack of an objective method; with dynamic enhanced tomography (bolus injection of contrast media) we have reasonably classify 28 patients with acute pancreatitis. With this technique 5 grades of sequelae of acute pancreatitis are identified: I. Non complicated acute pancreatitis; II. pancreatic abscess: III. peripancreatic necrosis; IV. less than 50% pancreatic necrosis and V. more than 50% pancreatic necrosis. A 100% correlation was found between tomography and surgical findings. This is the first report in Mexico of this method to identify pancreatic or peripancreatic necrosis; we also present the surgical results with a programmed pancreatic debridation; mortality has decreased form 80 to 31.9% in our hospital in recent years.

Assuntos

RESUMO

Fifty three consecutive patients undergoing open heart surgery were prospectively studied to assess current techniques for diagnosing perioperative myocardial infarction (PMI). All patients had preoperative and postoperative electrocardiograms, serial determinations of serum creatine phosphokinase (CK), myocardial fraction of CK (CK-MB) and scintigraphy with technetium-99m labeled pyrophosphate. Seven patients (13.2%) sustained perioperative myocardial infarction. Four of these patients exhibited abnormal Q waves, and one poor R wave progression. Three of them had a positive scintigram. Two patients with a non-Q-wave infarction had a abnormal radioisotopic imaging. The CK and CK-MB were higher in patients with infarction (818.1 U) than in those without this complication (349 U) p less than 0.05. The relative sensitivity and relative specificity of given variables in the diagnosis of PMI were as follows: electrocardiogram 71.4% and 97.5% respectively; scintigraphy 71.4% and 94.1%; and serum enzymes 100% and 71.8%. Age, incidence of prior myocardial infarction, unstable angina, elevated left ventricular filling pressure, number of diseased coronary arteries, and number of grafts per patient did not correlate with PMI. Duration of extracorporeal circulation and number of electric shocks during surgery were slightly higher in the infarction group, but the difference was not significant. These results indicate that the combination of these three diagnostic procedures is the best way to evaluate myocardial damage after open heart surgery.

Assuntos

RESUMO

Between 1970 and 1979 one hundred and sixty seven patients underwent open mitral commissurotomy (OMC). In 22 of these cases the surgeon had to replace the mitral valve by a prosthesis. The authors discuss the pre-operative cardiac status, the surgical findings and mishaps which led to prosthetic implantation. Mean age for the group was 35 years; atrial fibrillation was found in 73%. Most patients were in class II and III of the NYHA, with a cardiac-thoracic ratio of 56-60%. On X-ray systemic emboli had occurred in 45% prior to surgery. All had predominant mitral stenosis without other valve lesions. Surgical findings were: valve fibrosis in 59%, sub-valvular fibrosis in 33%, moderate calcification in 27% and intracavitary thrombus in 12%. Half of the patients had associated mitral regurgitation (MR) of slight degree. In 11 patients, (50%), the surgeon aggravated the pre-existing MR while performing the valvotomy and had to replace the mitral valve (MVR). In 4 other patients, without previous MR a severe regurgitation was produced during valvotomy and MVR was required. In the 7 remaining, patients MVR was indicated because of valvular, subvalvular fibrosis or calcification. Surgical mortality was 14% as compared to less than 1% for OMC.

Assuntos