RESUMO
This study compares the humoral immune response of a cohort of renal transplant recipients (RTRs), in Trinidad & Tobago following two-dose primary immunization with non-mRNA vaccines amidst the COVID-19 pandemic. RTRs along with healthy, age-and gender-matched controls received either the adenoviral vector vaccine, AstraZeneca-Vaxzevria (AZ) or the inactivated vaccine, Beijing CNBG-BBIBP- CorV/Sinopharm (SP). Samples were taken after completion of a two-dose primary immunization during the period November 2021 to December 2021, at a mean interval of 138 days following immunization. 38/72 RTRs (53 %) failed to generate any protective antibody responses, compared with 7/73 participants, approximately 10 % in the healthy, age and gender-matched control group. In the RTRs, there was no significant correlation of their antibody concentration with either the timing of sample collection or the interval since transplantation. The study provides necessary information about the humoral response after two- doses of non-mRNA vaccines in a group of transplant recipients.
RESUMO
BACKGROUND: Leprosy is a leading cause of preventable disability worldwide. Delay in diagnosis of patients augments the transmission of infection, and allows progression of disease and more severe disability. Delays in diagnosis greater than ten years have been reported in Brazil. To reduce this delay, it is important to identify factors that hinder patients from presenting to doctors, and those that delay doctors from diagnosing patients once they have presented. This study aimed to explore factors associated with the delayed diagnosis of leprosy in Brazil. METHODOLOGY/ PRINCIPAL FINDINGS: This is an exploratory study using a self-constructed questionnaire delivered to patients attending three leprosy referral clinics across three states in Brazil. Data were analysed to determine associations between variables and the time taken for participants to present to the health-service, and between variables and the time taken for doctors to diagnose participants once they had presented. Participants who suspected they had leprosy but feared community isolation were 10 times more likely to wait longer before consulting a doctor for their symptoms (OR 10.37, 95% CI 2.18-49.45, p = 0.003). Participants who thought their symptoms were not serious had a threefold greater chance of waiting longer before consulting than those who did (OR 3.114, 95% CI 1.235-7.856, p = 0.016). Forty-two point six per cent of participants reported initially receiving a diagnosis besides leprosy. These had a three times greater chance of receiving a later diagnosis of leprosy compared to those not misdiagnosed or not given a diagnosis (OR 2.867, 95% CI 1.288-6.384, p = 0.010). CONCLUSIONS/ SIGNIFICANCE: This study implies a need for patient education regarding leprosy symptoms and the reduction of stigma to encourage patients to present. The high rate of misdiagnosis reported suggests a need to increase clinician suspicion of leprosy. Further education regarding disease symptoms in medical school curriculums may be advisable.
Assuntos
Diagnóstico Tardio , Erros de Diagnóstico , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hanseníase/transmissão , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estigma Social , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Leprosy is a leading cause of preventable disability worldwide. Delay in diagnosis of patients augments the transmission of infection, and allows progression of disease and more severe disability. Delays in diagnosis greater than ten years have been reported in Brazil. To reduce this delay, it is important to identify factors that hinder patients from presenting to doctors, and those that delay doctors from diagnosing patients once they have presented. This study aimed to explore factors associated with the delayed diagnosis of leprosy in Brazil. METHODOLOGY/ PRINCIPAL FINDINGS: This is an exploratory study using a self-constructed questionnaire delivered to patients attending three leprosy referral clinics across three states in Brazil. Data were analysed to determine associations between variables and the time taken for participants to present to the health-service, and between variables and the time taken for doctors to diagnose participants once they had presented. Participants who suspected they had leprosy but feared community isolation were 10 times more likely to wait longer before consulting a doctor for their symptoms (OR 10.37, 95% CI 2.18-49.45, p = 0.003). Participants who thought their symptoms were not serious had a threefold greater chance of waiting longer before consulting than those who did (OR 3.114, 95% CI 1.235-7.856, p = 0.016). Forty-two point six per cent of participants reported initially receiving a diagnosis besides leprosy. These had a three times greater chance of receiving a later diagnosis of leprosy compared to those not misdiagnosed or not given a diagnosis (OR 2.867, 95% CI 1.288-6.384, p = 0.010). CONCLUSIONS/ SIGNIFICANCE: This study implies a need for patient education regarding leprosy symptoms and the reduction of stigma to encourage patients to present. The high rate of misdiagnosis reported suggests a need to increase clinician suspicion of leprosy. Further education regarding disease symptoms in medical school curriculums may be advisable.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Brasil/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Fatores de Risco , Erros de Diagnóstico , Diagnóstico Tardio , Estigma Social , Hanseníase/transmissãoRESUMO
Chagas disease, primarily spread in Bolivia by the vector Triatoma Infestans, persists as an important public health problem. Preventative insecticide campaigns target spraying on the basis of anecdotal evidence and there is a need for an accurate classification score to correctly identify 'at risk' houses. Data were collected from 337 households on 11 variables through the use of a standardised questionnaire and survey. Risk factors for infestation were identified and a risk score was developed and validated on a separate cohort of 165 houses. Five significant risk factors were identified: cracks in the walls of houses; adobe walls; junk in the peridomiciliary area; no insecticide spraying in the previous two years; and freely ranging animals. A risk score was generated and then calculated for each house. Three risk categories were defined: low, medium and high risk. In the development cohort the infestation rates were 2%, 18% and 69% respectively. The corresponding infestation rates in the validation cohort were 7%, 30% and 75% respectively. Sensitivity and specificity for this test were 81% and 84% and the positive predictive and negative predictive values were 71% and 90%. The risk score developed could be used to inform decision making in underfunded multilateral preventative initiatives.
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Criação de Animais Domésticos/normas , Doença de Chagas/prevenção & controle , Doença de Chagas/transmissão , Ectoparasitoses/prevenção & controle , Habitação/normas , Triatoma/crescimento & desenvolvimento , Animais , Bolívia/epidemiologia , Doença de Chagas/epidemiologia , Ectoparasitoses/epidemiologia , Inquéritos Epidemiológicos , Humanos , Inseticidas , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , População Rural , Sensibilidade e Especificidade , Fatores SocioeconômicosRESUMO
AIM: The rheological properties of erythrocytes are impaired in diabetes mellitus, especially because of changes in their membrane lipid composition.The aim of this study was to determine and examine the relationship between red blood cell (RBC) membrane and serum lipid composition in type II diabetes subjects with and without nephropathy. METHODS: Trinidadian subjects aged 18-65 years were recruited for the study regardless of gender and ethnicity. Fasting blood samples were collected from 60 subjects of whom 20 were healthy individuals, 20 had type II diabetes without complications, and 20 were type II diabetics with nephropathy. Weight, height, waist/hip ratio, and blood pressure were recorded. All the blood samples were analysed to determine the serum lipid concentration, membrane lipid composition and plasma glucose concentration. RESULTS: The body mass index and the systolic blood pressure of the diabetics (28.17 +/- 4.98 kg/m2, 153.21 +/- 22.10 mmHg) and those with nephropathy (25.87 +/- 4.68, 158.60 +/- 22.49 mmHg) were higher when compared with controls (24.67 +/- 5.18, 119.15 +/- 13.03 mmHg). The diabetic (175.89 +/- 102.73 microg/mgprotein) and diabetic nephropathy (358.80 +/- 262.66) subjects showed significantly higher levels of RBC membrane cholesterol compared with controls (132.27 +/- 66.47). The membrane phospholipids, protein and Na+/K+ATPase concentrations were altered in diabetics and diabetic nephropathy patients when compared with controls. The trends of increased serum cholesterol and decreased high-density lipoprotein in diabetics and diabetic nephropathy patients were noted as compared with controls but they are not significant as expected. The low-density lipoprotein cholesterol was significantly higher in diabetics when compared with diabetic nephropathy and control subjects. CONCLUSIONS: Our data suggest that there is a relationship between RBC membrane and serum lipid composition in subjects with type II diabetes with and without nephropathy. This relationship shows that diet and lifestyle plays a significant role in the alterations of the lipids both in serum and RBC membrane. The membrane and serum lipid composition may be used as possible indicators for type II diabetic patients with and without nephropathy to control their diet in the beginning stages to prevent them from further complications.
Assuntos
Diabetes Mellitus Tipo 2/sangue , Nefropatias Diabéticas/sangue , Membrana Eritrocítica/química , Lipídeos de Membrana/sangue , Adolescente , Adulto , Idoso , Glicemia/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , Colesterol/sangue , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/etnologia , Nefropatias Diabéticas/fisiopatologia , Dieta , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Fosfolipídeos/sangue , Comportamento de Redução do Risco , ATPase Trocadora de Sódio-Potássio/sangue , Trinidad e Tobago , Relação Cintura-Quadril , Adulto JovemRESUMO
AIM: The rheological properties of erythrocytes are impaired in diabetes mellitus, especially because of changes in their membrane lipid composition.The aim of this study was to determine and examine the relationship between red blood cell (RBC) membrane and serum lipid composition in type II diabetes subjects with and without nephropathy. METHODS: Trinidadian subjects aged 18-65 years were recruited for the study regardless of gender and ethnicity. Fasting blood samples were collected from 60 subjects of whom 20 were healthy individuals, 20 had type II diabetes without complications, and 20 were type II diabetics with nephropathy. Weight, height, waist/hip ratio, and blood pressure were recorded. All the blood samples were analysed to determine the serum lipid concentration, membrane lipid composition and plasma glucose concentration. RESULTS: The body mass index and the systolic blood pressure of the diabetics (28.17 +/- 4.98 kg/m2, 153.21 +/- 22.10 mmHg) and those with nephropathy (25.87 +/- 4.68, 158.60 +/- 22.49 mmHg) were higher when compared with controls (24.67 +/- 5.18, 119.15 +/- 13.03 mmHg). The diabetic (175.89 +/- 102.73 microg/mgprotein) and diabetic nephropathy (358.80 +/- 262.66) subjects showed significantly higher levels of RBC membrane cholesterol compared with controls (132.27 +/- 66.47). The membrane phospholipids, protein and Na+/K+ATPase concentrations were altered in diabetics and diabetic nephropathy patients when compared with controls. The trends of increased serum cholesterol and decreased high-density lipoprotein in diabetics and diabetic nephropathy patients were noted as compared with controls but they are not significant as expected. The low-density lipoprotein cholesterol was significantly higher in diabetics when compared with diabetic nephropathy and control subjects.
Assuntos
Humanos , Membrana Eritrocítica , Fosfolipídeos , Proteínas , Diabetes Mellitus Tipo 2 , Trinidad e TobagoRESUMO
BACKGROUND: Serum sialic acid and C reactive protein are the markers for inflammation. The main objective of this study was to determine the sialic acid level in Caribbean type 2 diabetic patients with and without microvascular complications and its relationship with metabolic and anthropometric variables. RESEARCH DESIGN AND METHOD: The Caribbean subjects aged 1560 years with type 2 diabetes were recruited for the study. Simultaneously urine samples were also collected from each of the subjects. All the blood samples were processed for lipid profile, glucose, HbA1C, C-reactive protein and sialic acid. The urine samples were analysed for sialic acid and microalbumin. RESULTS: Serum sialic acid concentrations were significantly higher among diabetic subjects (66.0 ñ 11.7 mg per cent) as compared to controls (55.2 ñ 8.3 mg per cent). There was a significantly increasing trend of serum sialic acid with severity of nephropathy (71.6 ñ 23.6 mg per cent) and degree of urinary albumin excretion (794.3 ñ 805.9). The diabetic retinopathy patients also demonstrated significantly higher values of serum sialic acid (77.9 ñ 29.0) and urine microalbumin (351.1 ñ 559.9). Elevated serum sialic acid microalbumin concentrations were associated with cardiovascular risk factors such as hypertension, increased waist to hip ratios. (P < 0.05). Sialic acid had no correlation with CRP or any component of the lipid profile. CONCLUSION: The increased serum sialic acid and microalbumin were strongly related to the presence of microvascular complications like diabetic nephropathy and diabetic retinopathy and cardiovascular risk factors like hypertension and waist to hip ratios in Caribbean type-2 diabetic patients. The serum sialic acid may be used as an inflammatory marker and possible indicator of microvascular complications in type-2 diabetic patients.
Assuntos
Humanos , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Angina Microvascular/complicaçõesRESUMO
Fifty seven children with idiopathic nephrotic syndrome who were seen at two hospitals in Trinidad between 1989 and 1995 (median follow-up period, 38 months) were classified according to their response to glucocorticoids. 27 (47 percent) were two to six years old at presentation; 37 (65 percent) were of East Indian descent, 7 (12 percent) were of African descent, and 12 (21 percent) were of mixed race. 55 (96 percent) responded to glucocorticoids. Renal biopsies in 15 patients revealed membranoproliferative glomerulonephritis and membranous nephropathy in the two patients who had not responded to glucocorticoids. Ten patients showed mesangial hypercellularity, associated with immunoglobulin deposits in 7 cases. Age, presentation with nephrotic features, mesangial hypercellularity and immunoglobulin deposits did not predict for unresponsiveness to glucocorticoids. These findings may be explained by the predominance of East Indians in the study group.(AU)
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Síndrome Nefrótica/terapia , Glucocorticoides/uso terapêutico , Síndrome Nefrótica/etnologia , Síndrome Nefrótica/patologia , Biópsia , Recidiva , Idade de Início , Trinidad e Tobago , Glomerulonefrite MembranoproliferativaRESUMO
The burden of illness which hypertension places on the Trinidadian population is great. In an attempt to adequately plan health care delivery we examined the relationship between pregnancy-induced hypertension (PIH) and essential hypertension (EH) in our country. Ninety-eight women who had been admitted to Mount Hope Women's Hospital because of a pregnancy complicated by hypertension in 1981 were recalled to evaluate their current hypertensive status. A response rate of 34.3 per cent was obtained. We looked at predictive factors contributing to the development of EH. These included age of the patient, severity of hypertension, family history of hypertension, mother's parity and birth weight of the baby. Of the 34 women who responded, twenty-three (67.6 per cent) were not hypertensive while eleven were (32.4 per cent). Neither age nor the severity of hypertension was any indication as to the subsequent development of EH. The mother's parity, a family history of hypertension and the baby's birth weight appeared to be predictors of long-term hypertension. This study did not address other predisposing factors for the development of hypertension such as smoking or obesity. Despite similarities in the two cohorts with respect to blood pressures, more babies with birth weights < 2,500g were born to mothers who subseuqently became hypertensive. PIH was a recurring problem. Seventy-three per cent of women seen (72.7 per cent) had a previous or subsequent pregnancy that was complicated by hypertension. A prospective multicentre study in Trinidad examining this relationship between PIH and EH would substantiate these preliminary findings, albeit limited by the retrospective methodology and low recall. This information would assist future health planning (AU)
Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez , Hipertensão/etiologia , Paridade , Peso ao Nascer , Trinidad e Tobago , Fatores de RiscoAssuntos
Humanos , Masculino , Feminino , Lúpus Eritematoso Sistêmico , Trinidad e Tobago/epidemiologiaRESUMO
Over the period 1980-1989, a retrospective study of 77 patients presenting to the Renal Unit with SLE nephritis was undertaken. The overwhelming majority of patients were female (85.7 per cent) presenting at a mean age of 28 years. The ethnic distribution showed that 63 per cent of patients were of African and 19.5 per cent of East Indian descent; 1.3 per cent had a positive family history of SLE. The predominance of Africans in this study is different from the Renal Clinic population where there is equal representation of the major ethnic groups and is also different from the population of patients with significant proteinuria attending the Renal Clinic. The difference in presentation between the two major ethnic groups in this study should be further evaluated in a prospective study, using case controls (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Nefrite Lúpica , Trinidad e TobagoRESUMO
Between 1976 and 1982, blood was collected from all consenting adults in a known censused area of Plymouth, Bethesda in Tobago. Serum was tested using the ELISA test. One hundred and seventeen of 532 persons showed evidence of exposure to leptospires at titres of > 1:50. The serogroup most commonly detected was Bataviae. Agricultural workers tended to have high exposure rates particularly to Pyrogenes, Syroe, Bataviae and Canicola. The presence of animals associated with the homes studied appeared to increase exposure to leptospires (AU)
Assuntos
Humanos , Leptospirose/sangue , Leptospirose/diagnóstico , Ensaio de Imunoadsorção Enzimática/instrumentação , Doenças dos Trabalhadores Agrícolas , Trinidad e Tobago/epidemiologiaRESUMO
Three cases are reported of patients with the acquired immune deficiency syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised malculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned. (AU)
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Síndrome da Imunodeficiência Adquirida/complicações , Dermatomicoses/etiologia , Histoplasmose/etiologia , Anfotericina B/uso terapêutico , Biópsia , Dermatomicoses/tratamento farmacológico , Dermatomicoses/patologia , Ensaio de Imunoadsorção Enzimática , Histoplasmose/tratamento farmacológico , Histoplasmose/patologia , Cetoconazol/uso terapêutico , Trinidad e TobagoRESUMO
Eighteen patients with the acquired-immunodeficiency syndrome (AIDS) presented with primary skin manifestations at the Port-of-Spain General Hospital in 1986. The lesions included local (3) and generalised (4) dermatitis, pustules, plaques (2), crateriform ulcers (2), erythematous lesions (4) and maculo-papular rashes (7). Some patients had a mixture of lesions. The maculo-papular rashes were commonest. Full-thickness skin biopsies were stained with periodic acid-Schiff and methamanine silver; yeast forms of Histoplasma capsulatum were found in 11 cases. Three of these cases had a post-mortem examination; this revealed the presence of the fungus in all the tissues sampled which included brain, liver, spleen and lymph nodes. The skin lesions were the only presenting clinical manifestations of disseminated histoplasmosis in these patients. Histoplasmosis capsulatum is endemic in Trinidad and Tobago but clinical infection was extremely rare before the advent of the AIDS epidemic. In areas endemic for H. capsulatum, clinicians should be alerted to the fact that cutaneous lesions in patients with AIDS may suggest histoplasmosis. Given the facts that cultures may be negative and unnecessarily delay treatment, that the histoplasmin skin test is of doubtful value and that serological titres are unreliable in the immunocompromised, we advocate full-thickness skin biopsy to diagnose histoplasmosis in AIDS patients (AU)
Assuntos
Humanos , Síndrome da Imunodeficiência Adquirida/complicações , Manifestações Cutâneas , Histoplasmose/complicações , Trinidad e Tobago , Manifestações Cutâneas , BiópsiaRESUMO
Lupus nephritis has a high mortality and morbidity rate at the General Hospital, Port-of-Spain. We analysed 52 consecutive systemic lupus erythematosus patients with clinical nephritis, seen at the renal unit between January, 1983 and October, 1987. There were 44 females and 8 males. Evidence for nephritis was the presence of urinary casts, haematuria, proteinuria or an elevated creatinine level. In Trinidad, this is a disease of the young African female. The modal age group was 20-29 yrs. 71 percent of patients were of African descent, 15 percent Indian and 14 percent of mixed ethnicity. All the male patients were African. East Indian females presented with nephropathy late in the course of lupus. Proteinuria was the most frequent presentation (78 percent). End-stage renal failure was seen in 14 percent of patients at presentation. Such late presentation could have been avoided if patients with epilepsy, psychiatric disturbance and resolving proteinuria had been investigated for lupus. Classes II (37 percent) and V (23 percent) were the most frequent histological patterns. The 1-yr survival rate, over a 23-month follow-up period, was 66 percent. This low figure reflects defects in our renal substitution therapy rather than aggressive disease; uraemia (14), sepsis (7), extra renal activity (4) and hypoglycaemia (1) were the causes of death. During the short follow-up, we saw no vascular complications. Sixty per cent of dialysed patients died, after a mean time of 3.5 months, from uraemia or peritoneal dialysis-related sepsis. We could recommend maintenance haemodialysis (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Nefrite Lúpica/mortalidade , Trinidad e Tobago/epidemiologiaRESUMO
A patient with two uncommon manifestations of Behcet's Syndrome, oesophageal ulceration, and glomerular disease is presented. In both systems, as in all others affected by Behcet's Syndrome, there was vasculitis principally involving veins, venules, and capillaries. Response to conventional management was not successful. (AU)
Assuntos
Humanos , Relatos de Casos , Síndrome de Behçet/complicações , Doenças do Esôfago/etiologia , Glomerulonefrite/etiologia , Vasculite/terapiaRESUMO
Sixty-nine patients who had renal biopsies because of proteinuria of > 1 gm per day, oedema and normal sized kidneys were investigated. There were 58 adults and 11 children. Of the adults, 26 were male, and 32 female; of the 11 children, there were 10 males and 1 female. The modal age of the patients was 15 - 19 years. The majority of the patients (67 percent) had primary glomerular disease. The two most common histological patterns were minimal change and mesangio-capillary glomerulo-nephritis. Minimal-change nephritis was observed in 73 percent of children's kidney biopsies. The pattern was unlike that seen in tropical Africa. Mesangial-proliferative disease did not contribute remarkably (11 percent) to significant proteinuria. Membranous nephropathy, which usually accounts for the majority of idiopathic adult nephrotics in the developed countries, was rare in our Trinidadian series. Systemic lupus erythematous comprised the majority of patients (83 percent) who had secondary proteinuria. This may reflect a bias in the selection of patients for renal biopsy. Even though the incidence of the sickle-cell gene is high in Trinidad, sickle-cell disease did not contribute to the presence of nephropathy. The prognosis for patients with primary glomerular disease (21 percent mortality) was better than for thos with systemic disease (79 percent mortality). Our observations suggest that the pattern of proteinuria in Trinidad does not resemble that seen in tropical Africa but is some what similar to that observed in Jamaica (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Proteinúria , Nefropatias/diagnóstico , Trinidad e TobagoRESUMO
A case of acute renal failure in an adult who was stung by over 1,000 Africanised bees is reported. The patient has made full recovery. This is the first such case to be reported from Trinidad (AU)
Assuntos
Idoso , Humanos , Masculino , Injúria Renal Aguda/etiologia , Abelhas , Mordeduras e Picadas de Insetos/complicações , Trinidad e TobagoRESUMO
A few scattered reports have appeared in the literature in the last few years suggesting that focal and segmental glomerulosclerosis may be associated with the acquired immunodeficiency syndrome, leading to rapid deterioration of renal function with uraemia. This communication describes the first such case seen at Port-of-Spain General Hospital, Trinidad (AU)