Subject(s)
Malaria , Humans , Malaria/epidemiology , Malaria/prevention & control , Martinique , West IndiesABSTRACT
Melioidosis has been detected in the Caribbean, and an increasing number of cases has been reported in the past few decades, but only 2 cases were reported in Guadeloupe during the past 20 years. We describe 3 more cases that occurred during 2016-2017 and examine arguments for increasing endemicity.
Subject(s)
Burkholderia pseudomallei/isolation & purification , Melioidosis/diagnosis , Aged , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Fatal Outcome , Female , Humans , Male , Melioidosis/diagnostic imaging , Melioidosis/drug therapy , Middle Aged , Tomography, X-Ray ComputedABSTRACT
We conducted an observational study to describe the characteristics of infective endocarditis (IE) in French West Indies (FWI) and to identify variables associated with in-hospital case fatality. The records of the patients admitted for IE to the University Hospital of Martinique between 2000 and 2012 were collected using an electronic case report form. Only Duke-Li definite cases were considered for this analysis. Variables associated with in-hospital mortality were tested using univariate logistic regression analysis. The analysis included 201 patients (median age 58 years, sex ratio: two males to one female). There was no previously known heart disease in 45.8%, a prosthetic valve in 21.4%, and previously known native valve disease in 32.8% of the cases. Community-acquired IE represented 59.7% of all cases, health-care-associated IE represented 38.3% and injection-drug-use-acquired IE represented 1.5%. Locations of IE were distributed as follows: 42.3% were mitral valve IE, 34.8% were aortic valve IE, and 7% were right-sided IE. Microorganisms recovered from blood cultures included 30.4% streptococci, 28.9% staphylococci, and 5% enterococci. Blood cultures were negative in 20.9% of the cases. Surgical treatment was performed in 53% of the patients. In-hospital case fatality rate was 19%. Advanced age, Staphylococcus aureus IE, and health-care-associated IE were associated with in-hospital case fatality. The epidemiological and microbiological profile of IE in FWI is in between those observed in developed countries and developing countries: patients were younger, blood cultures were more frequently negative, and IE due to group D streptococci and enterococci were less common than in industrialized countries.
Subject(s)
Developed Countries/statistics & numerical data , Developing Countries/statistics & numerical data , Endocarditis/epidemiology , Endocarditis/mortality , Adult , Age Factors , Female , Humans , Male , Martinique/epidemiology , Middle Aged , Risk Factors , West Indies/epidemiologyABSTRACT
Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC.
Subject(s)
Adolescent Behavior/psychology , Antiphospholipid Syndrome , Arthritis, Juvenile , Contraception/methods , Family Planning Services , Lupus Erythematosus, Systemic , Adolescent , Contraception Behavior/psychology , Humans , Patient Education as TopicABSTRACT
ABSTRACT Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC.
RESUMO A contracepção é uma questão importante e deve ser um motivo de preocupação em toda consulta médica de pacientes adolescentes e jovens com doenças reumáticas crônicas. Esta revisão narrativa discute métodos contraceptivos em adolescentes com lúpus eritematoso sistêmico (LES), síndrome antifosfolipídica (SAF), artrite idiopática juvenil (AIJ) e dermatomiosite juvenil (DMJ). Os métodos de barreira são seguros e todos os adolescentes com doenças reumáticas crônicas devem ser incentivados a usá-los. Os contraceptivos orais combinados (COC) são estritamente proibidos para pacientes com LESJ e SAF com anticorpos antifosfolípides positivos. A contracepção reversível de ação prolongada pode ser incentivada e oferecida rotineiramente a paciente adolescente com LES e outras doenças reumáticas. As pílulas que contêm somente progestina são seguras na maior parte das doenças reumáticas, embora a principal preocupação relacionada com seu uso por adolescentes seja a baixa adesão em decorrência da irregularidade menstrual. As injeções de acetato de medroxiprogesterona de depósito a cada três meses são uma estratégia altamente eficaz de contracepção, embora o seu uso em longo prazo esteja associado à diminuição na densidade mineral óssea. Contraceptivos orais combinados ou outros contraceptivos hormonais combinados podem ser opções para pacientes com AIJ e DMJ. O levonorgestrel oral deve ser considerado como um método de contracepção de emergência para todas as adolescentes com doenças reumáticas crônicas, incluindo pacientes com contraindicação para COC.
Subject(s)
Humans , Adolescent , Arthritis, Juvenile , Adolescent Behavior/physiology , Antiphospholipid Syndrome , Contraception/methods , Family Planning Services , Lupus Erythematosus, Systemic , Patient Education as Topic , Contraception Behavior/psychologyABSTRACT
OBJECTIVE: To investigate the association between exposure to air pollutants in the Sao Paulo metropolitan area and disease activity in juvenile-onset systemic lupus erythematosus (SLE) patients. METHODS: A longitudinal panel study based on 409 consecutive visits of juvenile-onset SLE patients living in the Sao Paulo metropolitan area was carried out. Disease activity was evaluated in accordance with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and the patients were divided into 2 groups: those with SLEDAI scores ≤8 and those with SLEDAI scores >8. Daily concentrations of inhaled particulate matter (PM10 ), sulfur dioxide, nitrogen dioxide (NO2 ), ozone, and carbon monoxide (CO) were evaluated on the 21 days preceding the medical visits. A generalized estimation equation model was used to assess the impact of these measurements on SLEDAI-2K scores, considering the fixed effects for repetitive measurements. The models were adjusted for erythrocyte sedimentation rate, corticosteroid use (daily and cumulative doses), antimalarial use, the use of immunosuppressive agents, the presence of infection 20 days preceding the medical appointment, and the minimum temperature and relative humidity outdoors. RESULTS: PM10 , NO2 , and CO were risk factors for juvenile-onset SLE disease activity (SLEDAI-2K score >8) approximately 2 weeks after exposure. A 13.4 µg/m(3) increase in the PM10 moving average (from lag 12 to lag 15) was associated with a 34% increase (95% confidence interval 7.0-68.0) in the risk of a SLEDAI-2K score >8. CONCLUSION: This is the first study to show that exposure to inhaled pollutants may increase the risk of disease activity in children with juvenile-onset SLE in a large urban center.
Subject(s)
Air Pollutants/adverse effects , Disease Progression , Environmental Exposure/adverse effects , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/epidemiology , Adolescent , Brazil/epidemiology , Child , Female , Humans , Longitudinal Studies , Male , Particulate Matter/adverse effects , Urban Population , Young AdultABSTRACT
Introdução: Muitos dos efeitos nocivos sobre a saúde humana são provocados por poluentes atmosféricos como as partículas menores que 10 micrômetros de diâmetro (material particulado - PM10). Essas partículas se originam principalmente das emissões de veículos automotores em áreas urbanas. Uma porção significativa do material particulado é constituída por sulfatos, nitratos, metais, hidrocarbonetos e outras substâncias adsorvidas em suas moléculas. A poluição do ar relacionada a emissões de fontes veiculares é um importante problema de saúde pública dos grandes centros urbanos sendo as crianças e adolescentes suscetíveis aos efeitos nocivos dessa poluição. No entanto, existem poucos estudos que avaliaram a associação entre a exposição à poluição do ar e doenças autoimunes nessa população, e para nosso conhecimento, nenhum estudo avaliou a influência dos poluentes atmosféricos sobre a atividade do lúpus eritematoso sistêmico juvenil (LESJ). Objetivos: (1). Avaliar a presença de associação entre variações agudas nas concentrações dos poluentes atmosféricos da Região Metropolitana de São Paulo (RMSP) e o risco de atividade da doença através do Índice de Atividade do Lúpus Eritematoso Sistêmico (SLEDAI-2K) em crianças e adolescentes com LESJ e (2). Avaliar a influência da exposição à poluição atmosférica dos 21 dias anteriores a cada consulta (estrutura de defasagem) sobre risco de atividade da doença através do SLEDAI-2K em crianças e adolescentes com LESJ. Métodos: Estudo longitudinal retrospectivo de painel realizado com base em 409 visitas consecutivas de pacientes com LESJ (critérios do American College of Rheumatology - ACR) que vivem na Região Metropolitana de São Paulo. A atividade da doença foi avaliada de acordo com o Índice de Atividade do Lúpus Eritematoso Sistêmico revisado em 2000 (SLEDAI-2K), e os valores de cada consulta foram divididos em dois grupos: SLEDAI <= 8 e SLEDAI > 8. Concentrações diárias de material particulado (PM10), dióxido de...
Introduction: Many of the harmful effects on human health caused by atmospheric pollutants have been linked to particles smaller than 10 micrometers in diameter (PM10). These particles mainly originate from automotive vehicle emissions in urban areas. A significant portion of the particulate matter is composed of sulfates, nitrates, metals, hydrocarbons and other substances adsorbed in these molecules. Air pollution related to vehicular emission sources is an important public health problem in large cities, and children and adolescents are susceptible to the harmful effects of this pollution. However, there are few studies evaluating the association between exposure to air pollutants and autoimmune diseases in this population and to our knowledge, no study has assessed the influence of atmospheric pollutants on disease activity of childhood-onset systemic lupus erythematosus (C-SLE) patients. Objectives: (1). Evaluate the presence of association between acute variations in the concentrations of atmospheric pollutants in the Metropolitan Region of São Paulo (MRSP) and the risk of disease activity through the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) in children and adolescents with C-SLE and (2). Evaluate the influence of exposure to air pollution of 21 days prior to each consultation on risk of disease activity through the SLEDAI-2K in children and adolescents with C-SLE. Methods: A longitudinal panel retrospective study was carried out based on 409 consecutive visits of C-SLE patients (American College of Rheumatology - ACR criteria) living in the Metropolitan Region of São Paulo. Disease activity was evaluated according to Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and the patients were divided in two groups: SLEDAI <= 8 and SLEDAI > 8. Daily concentrations of inhaled particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) and carbon monoxide (CO) were evaluated...
Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Adolescent , Air Pollutants , Air Pollution , Child , Environmental Pollution , Lupus Erythematosus, Systemic , PediatricsABSTRACT
OBJECTIVE: The objective of the present study was to evaluate radiographic changes of the temporomandibular joint (TMJ) in patients with juvenile systemic lupus erythematosus (JSLE) and a control group. PATIENTS AND METHODS: Panoramic radiographies of the TMJ of 26 JSLE patients and 28 healthy individuals were evaluated. Multislice computed tomography (MCT) was performed on those patients who presented flattening and/or destruction of mandibular condyles. Demographic data, oral health indices, clinical manifestations, laboratory exams, and treatment were evaluated. RESULTS: Important radiographic changes consistent with osteonecrosis of the mandible, confirmed by MCT of the TMJ, were observed in 2/26 (8%) JSLE patients versus 0% in the control group (P = 0.22). Mild clinical dysfunction and abnormal TMJ mobility were observed in 67% and 54% of the patients, respectively. Age of onset, disease duration, and current age were similar in JSLE patients with and without severe radiographic changes of TMJ (9.3 versus 10.8 years, P = 0.77; 3.3 versus 2 years, P = 0.63; 12.6 versus 13.5 years, P = 0.74, respectively). Significant differences in gender, socioeconomical status, oral health indices, clinical manifestations, laboratory exams, and treatment were not observed between both subgroups (P 0.05). Both JSLE patients with osteonecrosis of the mandible had active chronic disease, used corticosteroids for a prolonged period, and had mild TMJ dysfunction. Antiphospholipid antibodies were not observed in those two patients, and neither one had been treated with bisphosphonate. CONCLUSIONS: Osteonecrosis of the mandible with mild TMJ dysfunction was observed in some of the patients, demonstrating the importance of odontological assessment during clinical follow-up.
Subject(s)
Jaw Diseases/diagnostic imaging , Jaw Diseases/etiology , Lupus Erythematosus, Systemic/complications , Osteonecrosis/diagnostic imaging , Osteonecrosis/etiology , Child , Child, Preschool , Female , Humans , Male , RadiographyABSTRACT
OBJETIVO: O objetivo deste estudo foi avaliar alterações radiográficas da articulação temporomandibular (ATM) em pacientes com lúpus eritematoso sistêmico juvenil (LESJ) e controles. PACIENTE E MÉTODOS: Vinte e seis pacientes com LESJ e 28 controles foram avaliados com radiografia panorâmica da ATM. Tomografia computadorizada multislice (TCM) da ATM foi realizada naqueles que tiveram achatamento e/ou destruição dos côndilos mandibulares. Foram avaliados dados demográficos, índices de saúde bucal, manifestações clínicas, exames laboratoriais e tratamentos. RESULTADOS: Alterações radiográficas importantes compatíveis com osteonecrose de mandíbula e confirmadas pela TCM da ATM foram observadas em 2/26 (8 por cento) de LESJ versus 0 por cento do grupo controle (P = 0,22). Disfunção clínica leve e mobilidade alterada de ATM foram observadas em 67 por cento e 54 por cento, respectivamente. A idade de início, duração da doença e idade atual foram semelhantes nos pacientes com LESJ com e sem alterações radiográficas graves da ATM (9,3 versus 10,8 anos, P = 0,77; 3,3 versus 2 anos, P = 0,63; 12,6 versus 13,5 anos, P = 0,74; respectivamente). Assim como não foram evidenciadas diferenças estatísticas em ambos os grupos com relação a sexo, classe socioeconômica, índices de saúde bucal, manifestações clínicas, exames laboratoriais e tratamentos (P > 0,05). Esses dois pacientes com LESJ e osteonecrose de mandíbula tiveram curso crônico ativo da doença, utilizaram corticosteroides por um longo período e apresentaram disfunção clínica leve da ATM. Nenhum deles teve anticorpos antifosfolipídeos e não foram tratados previamente com bisfosfonatos. CONCLUSÕES: Osteonecrose de mandíbula com leve disfunção clínica da ATM foi observada em alguns pacientes, demonstrando a importância da avaliação odontológica durante o acompanhamento clínico.
OBJECTIVE: The objective of the present study was to evaluate radiographic changes of the temporomandibular joint (TMJ) in patients with juvenile systemic lupus erythematosus (JSLE) and a control group. PATIENTS AND METHODS: Panoramic radiographies of the TMJ of 26 JSLE patients and 28 healthy individuals were evaluated. Multislice computed tomography (MCT) was performed on those patients who presented flattening and/or destruction of mandibular condyles. Demographic data, oral health indices, clinical manifestations, laboratorial exams, and treatment were evaluated. RESULTS: Important radiographic changes consistent with osteonecrosis of the mandible, confirmed by MCT of the TMJ, were observed in 2/26 (8 percent) JSLE patients versus 0 percent in the control group (P = 0.22). Mild clinical dysfunction and abnormal TMJ mobility were observed in 67 percent and 54 percent of the patients, respectively. Age of onset, disease duration, and current age were similar in JSLE patients with and without severe radiographic changes of TMJ (9.3 versus 10.8 years, P = 0.77; 3.3 versus 2 years, P = 0.63; 12.6 versus 13.5 years, P = 0.74, respectively). Significant differences in gender, socioeconomical status, oral health indices, clinical manifestations, laboratorial exams, and treatment were not observed between both subgroups (P 0.05). Both JSLE patients with osteonecrosis of the mandible had active chronic disease, used corticosteroids for a prolonged period, and had mild TMJ dysfunction. Antiphospholipid antibodies were not observed in those two patients, and neither one had been treated with bisphosphonate. CONCLUSIONS: Osteonecrosis of the mandible with mild TMJ dysfunction was observed in some of the patients, demonstrating the importance of odontological assessment during clinical follow-up.
Subject(s)
Humans , Male , Female , Child , Adolescent , Autoimmune Diseases , Cultural Factors , Statistical Data , Diagnostic Imaging , Lupus Erythematosus, Systemic , Mandible , Osteonecrosis , Socioeconomic Factors , Temporomandibular JointABSTRACT
Objetivo: relatar dois casos de artrite idiopática juvenil com fraturas vertebrais. Descrição: dois pacientes com artrite idiopática juvenil, com atividade clínica persistente e uso crônico de corticosteróides, apresentaram fraturas vertebrais consequentes à osteoporose...
