RESUMO
AIMS: To assess the diagnostic accuracy of four undiagnosed Type 2 diabetes mellitus risk scores accounting for erectile dysfunction status. METHODS: This was a population-based cross-sectional study. Type 2 diabetes was defined according to a oral glucose tolerance test and self-reported physician diagnosis. Erectile dysfunction was defined according to the answer to the question, 'Have you had difficulties obtaining an erection in the last 6 months?' (yes/no). The risk scores used were the FINDRISC, LA-FINDRISC, American Diabetes Association score and the Peruvian Risk Score. A Poisson regression model was fitted to assess the association between Type 2 diabetes and erectile dysfunction. The area under the receiver-operating characteristic curve was estimated overall and by erectile dysfunction status. RESULTS: A total of 799 men with a mean (sd) age of 48.6 (10.7) years were included in the study. The overall prevalence of Type 2 diabetes was 9.3%. Compared with healthy men, men with Type 2 diabetes had 2.71 (95% CI 1.57-4.66) higher chances of having erectile dysfunction. Having excluded men aware of Type 2 diabetes status (N=38), the area under the receiver-operating characteristic curve of three of the risk scores (not the American Diabetes Association score) improved among those who had erectile dysfunction in comparison with those who did not; for example, the area under the receiver-operating characteristic curve of the LA-FINDRISC score was 89.6 (95% CI 78.7-99.9) in men with erectile dysfunction and 76.5 (95% CI 68.5-84.4) overall. CONCLUSIONS: In a population-based study, erectile dysfunction was more common in men with Type 2 diabetes than in the otherwise healthy men. Screening for erectile dysfunction before screening for Type 2 diabetes seems to improve the accuracy of well-known risk scores for undiagnosed Type 2 diabetes.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Disfunção Erétil/diagnóstico , Programas de Rastreamento/métodos , Adulto , Idoso , Glicemia/análise , Glicemia/metabolismo , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Disfunção Erétil/complicações , Disfunção Erétil/epidemiologia , Teste de Tolerância a Glucose , Humanos , Masculino , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Melhoria de Qualidade , Fatores de RiscoRESUMO
BACKGROUND: Rheumatic fever (RF) and rheumatic heart disease (RHD) are still major medical and public health problems mainly in developing countries. Pilot studies conducted during the last five decades in developed and developing countries indicated that the prevention and control of RF/RHD is possible. During the 1970s and 1980s, epidemiological studies were carried out in selected areas of Cuba in order to determine the prevalence and characteristics of RF/RHD, and to test several long-term strategies for prevention of the diseases. METHODS: Between 1986 and 1996 we carried out a comprehensive 10-year prevention programme in the Cuban province of Pinar del Rio and evaluated its efficacy five years later. The project included primary and secondary prevention of RF/RHD, training of personnel, health education, dissemination of information, community involvement and epidemiological surveillance. Permanent local and provincial RF/RHD registers were established at all hospitals, policlinics and family physicians in the province. Educational activities and training workshops were organised at provincial, local and health facility level. Thousands of pamphlets and hundreds of posters were distributed, and special programmes were broadcast on the public media to advertise the project. RESULTS: There was a progressive decline in the occurrence and severity of acute RF and RHD, with a marked decrease in the prevalence of RHD in school children from 2.27 patients per 1,000 children in 1986 to 0.24 per 1,000 in 1996. A marked and progressive decline was also seen in the incidence and severity of acute RF in five- to 25-year-olds, from 18.6 patients per 100,000 in 1986 to 2.5 per 100,000 in 1996. There was an even more marked reduction in recurrent attacks of RF from 6.4 to 0.4 patients per 100,000, as well as in the number and severity of patients requiring hospitalisation and surgical care. Regular compliance with secondary prophylaxis increased progressively and the direct costs related to treatment of RF/RHD decreased with time. The implementation of the programme did not incur much additional cost for healthcare. Five years after the project ended, most of the measures initiated at the start of the programme were still in place and occurrence of RF/RHD was low.
Assuntos
Serviços de Saúde Comunitária , Países em Desenvolvimento , Atenção Primária à Saúde , Prevenção Primária , Febre Reumática/prevenção & controle , Cardiopatia Reumática/prevenção & controle , Prevenção Secundária , Adolescente , Adulto , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Serviços de Saúde Comunitária/economia , Análise Custo-Benefício , Estudos Transversais , Cuba/epidemiologia , Custos de Cuidados de Saúde , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Humanos , Incidência , Meios de Comunicação de Massa , Prevalência , Atenção Primária à Saúde/economia , Prevenção Primária/economia , Prevenção Primária/educação , Avaliação de Programas e Projetos de Saúde , Recidiva , Sistema de Registros , Febre Reumática/complicações , Febre Reumática/economia , Febre Reumática/mortalidade , Cardiopatia Reumática/economia , Cardiopatia Reumática/etiologia , Cardiopatia Reumática/mortalidade , Prevenção Secundária/economia , Prevenção Secundária/educação , Fatores de Tempo , Adulto JovemRESUMO
We are reporting on the case of a 46XY male patient that presented a bilateral testicular seminoma in the setting of bilateral cryptorchidia and left inguinal hernia. The patient received five courses of cisplatin/ciclophosphamide followed by 3,000 cGy of radiation. The patient then, underwent resection of the residual mass and of an unrecognizable pelvic structure. The histopathological analysis revealed necrosis of the residual seminoma and an atrophic uterus. Currently, the patient is alive and asymptomatic at 88 months of follow-up. This is the third case reported of a patient with persistent mullerian duct syndrome and bilateral seminoma.
Assuntos
Neoplasias Abdominais/patologia , Ductos Paramesonéfricos/anormalidades , Neoplasias Primárias Múltiplas/patologia , Seminoma/patologia , Neoplasias Testiculares/patologia , Neoplasias Abdominais/terapia , Adulto , Terapia Combinada , Criptorquidismo/complicações , Humanos , Masculino , Neoplasias Primárias Múltiplas/terapia , Seminoma/terapia , Síndrome , Neoplasias Testiculares/terapiaRESUMO
OBJECTIVE: To study the level of exposure to carbon monoxide (CO), factors contributing to this exposure, and the exposure's potential effects on the health of vendors who have kiosks located on an avenue with heavy vehicular traffic in the city of Valencia, Venezuela. METHODS: We measured the concentration of CO in the air (CO-air) in 16 kiosks in Valencia and also determined the concentration of carboxyhemoglobin (COHb) in the blood of 20 individuals who worked in those kiosks. We also determined the COHb concentrations in a control group made up of 23 professors, students, and workers from Simón Rodríguez University, which is in a town some 120 km from Valencia, in a remote mountainous area without noticeable pollution. RESULTS: In seven of the Valencia kiosks (43.7%) the permissible CO-air limits were exceeded. Among the vendors experimental group there was no correlation between the concentrations of CO-air and of COHb. The COHb average for the experimental group (2.9%) was significantly higher than that of the control group (1.6%) and that of the permissible level, according to the analytical method used (< 1.5%). Of a group of symptoms possibly related to CO exposure that were assessed as to whether or not they occurred on a daily basis, all of these symptoms affected a larger percentage of individuals in the experimental group than in the control group. The most common of these symptoms among the experimental group were fatigue and strong headaches. CONCLUSIONS: While the vendors' COHb average does not seem alarming, the CO exposures found could have an adverse impact on these workers' health, especially if they suffered from cardiovascular disorders, or as the result of additive interactions with other environmental pollutants. We recommend carrying out additional studies with more frequent and extended measurements of air quality, to produce information that could be applied in efforts to prevent and control adverse CO health effects.
Assuntos
Poluição do Ar/análise , Intoxicação por Monóxido de Carbono/epidemiologia , Exposição Ambiental/análise , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Urbana , VenezuelaRESUMO
A general overview of hypertension as a major health problem in Cuba in the last 25 years are presented. In the first period, 1974-1990 was created a National Hypertension High Commission by the Minister of Public and the First national program for prevention and Control of Hypertension in Cuba was launched. To define high blood pressure in adults 15 years and older the cut-off point was set at 160/95 mmHg. The prevalence found was 15% in urban areas and 7-8% in rural areas. The second period, 1991-1998 the original National program was re-evaluated in 1990 and 1995. The new blood pressure cut-off point was set at 140/90 mmHg. The prevalence increased to 30.6% in urban areas and 15% in rural areas and incidence of 2.5% annual. A total of 862,303 hypertensive patients were registry at the end of 1997 which represents less than 40% of the total number of possible hypertensive patients. A National Campaign was launched in 1998. In 9 months the preliminary reports were: 25% increase in prevalence, registry and follow-up of hypertensive patients 15 years old and older (8.5% to 12.5%); 92.9% of primary care doctors and 89.5% of primary care nurses received training; improvement in public education and social support; improvement in risk factor awareness in general public and improvement of hypotensive drugs availability and splygmomanometers supplies.
Assuntos
Hipertensão/epidemiologia , Cuba/epidemiologia , Humanos , Hipertensão/prevenção & controle , Fatores de TempoRESUMO
Se señala en general la eficacia del factor de transferencia en multiples enfermedades, y se expone en particular la experiencia de su uso en pacientes con inmunodeficiencia celular y sepsis respiratoria aguda. Los resultados fueron satisfactorios en ambas afecciones, donde produce una inmunodeficiencia positiva de la respuesta inmune celular
Assuntos
Imunidade Celular , Infecções Respiratórias , Fator de TransferênciaRESUMO
Se hace un análisis genral del bienestar del anciano y se particularizan aspectos importantes estudiados en la provincia de Cienfuegos.Se destaca el estado matrimonial, las deficiencias visuales y auditivas y las enfermedades crónicas más frecuentes.El grado de satisfacción de la tercera edad se considera por el propio anciano como bueno y se explica por el resultado de los factores sociales,económicos,de asistencia social y de salud que el estado les garantiza
Assuntos
Saúde do IdosoRESUMO
Cardiovascular diseases are the first cause of death in all developed countries and in many underdeveloped countries (1). In Cuba they have constituted the first cause of death in the last 20 years, with a tendency to increase, with the characteristic that this tendency is due to ischemic heart disease (IHD) (2). The frequency of IHD increases with age, but it has increased in the population under 50 years of age lately (3, 4, 5). Although the cause of atherosclerosis is unknown, in the last years an epidemiologic association has been demonstrated between the atherosclerotic disease (mainly IHD) and a series of pathologies, habits of the population, genetical, biochemical, physiological and environmental factors, which influence directly and indirectly the early development, frequency, severity evolution and prognosis of IHD and have been called coronary risk factors (CRF); at present, the disease is considered to be multifactorial and its magnitude and severity are influenced by the exposure time and the combination of CRF; it has also been demonstrated that it is decreased by the application of measures for the pressure measurements with Hg sphygmomanometer, in the population (1, 5, 6, 7, 8, 9, 10, 11). In our country, a series of studies have been made to ascertain the magnitude and characteristics of cardiovascular diseases (12-14); through these works we will know the incidence of IHD, some of its characteristics and its relation with some coronary risk factors hypercholesterolemia, arterial hypertension, (AH), diabetes mellitus, smoking habit and obesity).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Doença das Coronárias/epidemiologia , Hipercolesterolemia/complicações , Hipertensão/complicações , Obesidade/complicações , Adulto , Doença das Coronárias/etiologia , Cuba , Humanos , Pessoa de Meia-Idade , Fatores de RiscoAssuntos
Infecções Respiratórias/epidemiologia , Doença Aguda , Adolescente , Infecções Bacterianas/diagnóstico , Criança , Pré-Escolar , Colômbia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/etiologia , Viroses/diagnóstico , Viroses/epidemiologiaRESUMO
El laboratorio, mediante la inoculacion en animal de una biopsia de cerebro, comprueba un caso de la enfermedad de Creutzfeldt-Jakob que se habia diagnosticado en Cali clinicamente. Se hace una resena historica de la entidad, de sus caracteristicas clinicas y patologicas y se destaca el peligro potencial de transmision a traves de instrumentos utilizados en procedimientos quirurgicos o autopsias a nivel del sistema nervioso central en pacientes con esta enfermedad
Assuntos
Humanos , Animais , Síndrome de Creutzfeldt-JakobAssuntos
Teste de Esforço , Adolescente , Adulto , Fatores Etários , Idoso , Pressão Sanguínea , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
For public health reasons, it is important that the etiologic agents of early childhood diarrhea be isolated and identified, and that their routes of transmission be defined. This is especially true in tropical and subtropical developing countries, where childhood patterns of exposure to diarrheal disease agents usually differ from those in developed countries, and where diarrheal illness is a frequent harbinger of death among children under five years of age. This artical describes a study designed to identify diarrheal disease agents and transmission patterns in Cali, a large city of western Colombia's fertile Cauca River Valley. The study area, composed of five working-class districts with a total population of some 40,000, appeared to provide an environment fairly similar to those of many other "average" working-class communities in Latin America. Beginning in July 1962, a cohort of 296 children being born in these districts was studied, the period of investigation starting with the date of birth and continuing until each child's second birthday or its premature withdrawal from the study. Weekly home visits were made to establish defecation patterns, feeding practices, and anthropometry. The resulting data were then analyzed in terms of defecation frequencies, occurrence of liquid stools, and the presence of blood, mucus, or pus in the stools. Differences were noted in male and female defecation patterns and in the defecation frequencies of different age groups. Stool specimens for bacteriologic, virologic, and parasitologic examination were collected monthly on a regular basis and weekly when diarrhea occurred. Numerically, viruses were isolated and identified more often than other agents. The most commonly isolated parasite species and viral and bacterial serotypes were G. lamblia (from 222 subjects), echovirus 11 (from 166 subjects), and enteropathogenic Escherichia coli 026:B6 (from 138 subjects). Compared with the findings of several studies in other countries, isolations of shigellae were relatively rare.
Assuntos
Diarreia Infantil/etiologia , Fatores Etários , Colômbia , Defecação , Diarreia Infantil/epidemiologia , Diarreia Infantil/microbiologia , Diarreia Infantil/parasitologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fatores Sexuais , Fatores Socioeconômicos , Manejo de EspécimesRESUMO
One hundred eighty children hospitalized for acute respiratory disease were studied in Cali, Colombia. In the majority of patients, pneumonia was the reason for hospitalization and remained the final diagnosis. Fifty-one cases of pneumonia of indeterminate etiology comprised the largest single diagnostic category, followed by 38 cases of pneumonia associated with measles, and 22 cases assocaited with serologic evidence of infection with other viral agents or Mycoplasma pneumoniae. Etiologic diagnosis could be assigned with a reasonable degree of confidence in 116 of the 180 patients (64%). The laboratory procedure found most likely to provide the etiologic diagnosis in this series was paired sera specimens for demonstration of rise in antibody titer against the common viral respiratory pathogens. Those most frequently implicated serologically as etiologic agents in the cases studied were, in order of decreasing frequency, measles, influenza, parainfluenza, and adenoviruses.
Assuntos
Doenças Respiratórias/etiologia , Adolescente , Asma/diagnóstico , Broncopatias/diagnóstico , Broncopneumonia/diagnóstico , Criança , Pré-Escolar , Colômbia , Crupe/diagnóstico , Difteria/diagnóstico , Feminino , Humanos , Lactente , Masculino , Sarampo/diagnóstico , Tuberculose/diagnóstico , Coqueluche/diagnósticoRESUMO
In this study of 99 tuberculous meningitis patients from Cali, Colombia, treatment with steroids (in conjunction with antituberculous drugs) was shown to be more effective in reducing mortality than treatment with antibacterial drugs alone. Results further suggest that low dosages of steroids (1 mg/kg of prednisone daily for r 30 days) are equally effective in treating the disease as high dosages (10 mg/kg of prednisone at the start of treatment, gradually reduced over a 30-day period). These results are band 4(-43 and -kk mg/100 ml) demonstrated cerebral release. Arterial blood hyperammonemia can be detoxified safely in the brain as long as the levels do not exceed approximately 300 mug/100 ml. Beyond that level lactic acidosis is observed, particularly in cerebral venous drainage. Arterial blood hyperammonemia was also related to the extent of alveolar hyperventilation. These findings are very similar to those seen in experimental hyperammonemia and support the concept that neurotoxicity in children with Reye's syndrome is at least partly due to impaired oxidative metabolism secondary to hyperammonemia.
Assuntos
Prednisona/uso terapêutico , Tuberculose Meníngea/mortalidade , Adolescente , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Ensaios Clínicos como Assunto , Colômbia , Países em Desenvolvimento , Relação Dose-Resposta a Droga , Esquema de Medicação , Avaliação de Medicamentos , Quimioterapia Combinada , Humanos , Lactente , Recém-Nascido , Prednisona/administração & dosagem , Tuberculose Meníngea/tratamento farmacológicoRESUMO
Thirty-three children were hospitalized for pneumonia associated with measles. Eight did not have rash but had serologic evidence of measles infection and an otherwise compatible clinical picture. Lung puncture and tracheal aspirations were performed on 21 of the patients. Mortality was 15.2% (five patients) and was not associated with the use of these procedures.