RESUMO
OBJECTIVES: To investigate prospectively whether the incidence of diagnosed celiac disease (CD) is increasing in the Netherlands and whether the clinical presentation is changing. STUDY DESIGN: All newly diagnosed cases of CD throughout the Netherlands were registered prospectively from 1993 to 2000. The clinical picture was compared with that noted in our former study (1975-1990). RESULTS: The overall incidence rate of CD was 0.81/1000 live births, with a linear increase from 1993 to 2000. There was a significant increase in the number of subjects with partial villous atrophy of the small bowel mucosa. The clinical presentation has changed significantly: abdominal distention, chronic diarrhea, and failure to thrive are less common, and more children presented with weight < P10, abdominal pain, and lassitude. The median age at diagnosis also increased. CONCLUSION: The recognition of childhood CD in the Netherlands has increased significantly during the last few years, and the clinical picture has changed as well. Our data may indicate an increasing awareness of the Dutch doctors working in Child Public Health, general practitioners, and pediatricians to recognize more subtle expressions of the disease.
Assuntos
Doença Celíaca/epidemiologia , Vigilância da População/métodos , Doença Celíaca/diagnóstico , Doença Celíaca/fisiopatologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Países Baixos/epidemiologia , Estudos ProspectivosRESUMO
To determine the epidemiological characteristics of human T cell leukemia/lymphoma virus type I (HTLV-I) infection in the endemic village of Maripasoula, French Guiana, 1,614 persons (83.2% of the population) aged 2 to 91 years (mean age 21) were studied from November 1994 through April 1995. Plasma samples were screened by an HTLV-I ELISA and an IFA test (on MT2 cells), and positive samples were tested by an HTLV-I and -II type-specific Western blot. Overall seropositivity in the village was 6.7%, but HTLV-I infection was restricted to 3 of 6 ethnic groups, including the Noir-Marron (descendants of escaped African slaves, 8%), the Creoles (4.1%) and those of mixed Noir Marron/other ethnicity (3.6%). In the Noir-Marron population of 1,222 persons, including 606 men and 616 women and representing 76% of those tested, HTLV-I seroprevalence increased significantly with age in both sexes, reaching 40% in women older than 50 years. Univariate risk factors for HTLV-I seropositivity in women included older age, more pregnancies, more live births and a history of hospitalization. A cross-sectional analysis of sexual partners demonstrated an excess of discordant female HTLV-I+/male HTLV-I- couples, indicating preferential male-to-female sexual transmission. The demonstration of II HTLV-I-seropositive children aged less than 15 years, of whom 9 had a seropositive mother, suggested maternal-child HTLV-I transmission. Our results demonstrate a very high seroprevalence of HTLV-I in this South American population descended from African slaves, probably due to high rates of mother-to-child and sexual transmission within this rather isolated group.
Assuntos
Doenças Endêmicas , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Guiana Francesa/epidemiologia , Infecções por HTLV-I/etnologia , Infecções por HTLV-I/imunologia , Infecções por HTLV-I/transmissão , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , Infecções Sexualmente Transmissíveis/imunologiaRESUMO
A monitorizacao das trocas hidricas durante a hemodialise e essencial para a segurança e eficácia do procedimento. A bioimpedancia tem sido usada para a aferiçäo dos compartimentos corporais em muitas circunstäncias, mas a experiência durante a hemodialise e relativamente escassa. Num estudo prospectivo de 28 casos de insuficiencia renal crônica tratados por dialise crônica ambulatorial, os estudos de composicao corporea foram realizados imediatamente antes e após a sessäo de dialise. Os métodos abrangiam peso corporal, albumina serica, hematocrito, hemoglobina, sodio e osmolaridade plasmatica. Estas variáveis foram comparadas com os achados de bioimpedancia, nominalmente massa magra, gordura corporal, agua total, agua intra e extracelular, terceiro espaço, e relaçäo sódio/potassio permutavel. Os pacientes perderam peso e melhoraram o hematocrito, hemoglobina, osmolaridade e sódio serico no decurso da terapeutica, e as medidas de impedancia revelaram-se compativeis com estas modificaçöes...