RESUMO
UNLABELLED: The aim of this study was to determine the risk factors and mechanism of cerebral infarction in young women. METHODS: We evaluated 130 consecutive women younger than 41 years of age with cerebral infarction and compared the risk factors with a control group of 122 healthy, age-matched women. RESULTS: The leading risk factors in patients with cerebral infarction were migraine (15%), tobacco use (15%), and oral contraceptive (OC) use (12%). Cerebral arteriograms were abnormal in 59% of patients (57 of 96). The causes of cerebral infarction were cardiac embolism in 36%, nonatherosclerotic vasculopathy in 25%, hematologic disorders in 8%, and migraine in 8%. The etiology could not be determined in 23% of patients. CONCLUSION: Migraine and OCs are independent risk factors for cerebral infarction in young women. The leading etiologies were rheumatic valve disease and nonatherosclerotic vasculopathy, hematologic disturbances, and migraine were responsible for a few cases.
PIP: This study examines the risk factors and mechanism of cerebral infarction in 130 women younger than 41 years of age with cerebral infarction. A control group of 122 healthy, age-matched women were used for comparison. Each patient underwent the following: complete blood count, biochemical profile, lipid profile, venereal disease laboratory test, erythrocyte sedimentation rate, and rheumatologic profile (rheumatoid factor, antinuclear antibodies, anti-DNA, C-reactive protein). All patients underwent computed tomography or magnetic resonance imaging, transthoracic or transesophageal echocardiography; while transcranial Doppler or sonography of vessels of the neck and cerebral angiography were performed electively. The results of evaluation revealed that the leading factors among patients with cerebral infarction were migraine (15%), tobacco use (15%), and oral contraceptive (OC) use (12%). Cerebral arteriograms were abnormal in 59% of patients. The causes of cerebral infarction were cardiac embolism (36%), nonatherosclerotic vasculopathy (25%), hematologic disorders (8%), and migraine (8%). The etiology could not be determined in 23% of patients. Migraine and OCs were considered as independent risk factors for cerebral infarction in young women.
Assuntos
Infarto Cerebral/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Anticoncepcionais Orais/efeitos adversos , Feminino , Humanos , Transtornos de Enxaqueca/complicações , Fatores de Risco , Fumar/efeitos adversosRESUMO
Oral poliovirus vaccine (OPV) developed by A. Sabin has been effectively used to control poliomyelitis in Brazil, and the last case with the isolation of a wild poliovirus strain occurred in March 1989. Although the vaccine controlled the circulation of wild strains and poliomyelitis cases associated with these strains were not detected during the last eight years, rare cases classified as vaccine-associated paralytic poliomyelitis (VAPP) have been detected. Molecular characterization studies of poliovirus strains isolated from VAPP cases and from healthy contacts have confirmed that the isolates are derived from the Sabin vaccine strains and also detected genomic modifications known or suspected to increase neurovirulence such as mutations and recombination. The molecular characterization of polioviruses isolated during the last eight years from paralysis cases classified as Guillain-Barré (GBS) syndrome and transverse myelitis (TM), and from facial paralysis (FP) cases also confirmed the vaccine origin of the strains and demonstrated mutations known to increase neurovirulence. Analysis of the epidemiologic data of these GBS, TM and FP cases demonstrated that in most of them the last OPV dose was given months or years before the onset of the disease and the isolation of the polioviruses. The temporal association between the isolation of these strains and the GBS, TM and FP suggested that the Sabin vaccine-derived poliovirus strains could also rarely trigger the diseases.
Assuntos
Paralisia Facial/virologia , Mielite Transversa/virologia , Poliomielite/prevenção & controle , Vacina Antipólio Oral/efeitos adversos , Polirradiculoneuropatia/virologia , Brasil , Paralisia Facial/genética , Humanos , Mielite Transversa/genética , Poliovirus/genética , Polirradiculoneuropatia/genéticaRESUMO
Malignant hypertension is a rare consequence of contraceptive use. We report here on two young women with malignant hypertension secondary to contraceptive use whose main symptomatology was neurological. Both patients had renal failure, severe left ventricle hypertrophy, and hemorrhagic stroke, all reversible after control of blood pressure and discontinuation of the contraceptive pill.
PIP: Although an association between oral contraceptives (OCs) and arterial hypertension has been well-documented, most studies have found only mild or moderate hypertension with reversal to normal levels 3 months after OC discontinuation. This paper presents two cases in which young women developed severe left ventricular hypertrophy and renal failure due to OC-induced malignization of hypertension. The first patient, a 23-year-old, was admitted to the hospital with a 3-day history of headache, mental confusion, and aggressiveness. 6 months before presentation, severe arterial hypertension had been diagnosed. At that time, she was advised to discontinue OCs (30 mcg of ethinyl estradiol and 150 mcg of levonorgestrel), which she had been taking for a year; she did not comply with this directive. The second patient, 21 years old, was admitted with accelerating hypertension. She had initiated OC use (30 mg of ethinyl estradiol and 150 mcg of levonorgestrel) 6 months earlier. 3 months after starting OC use, she developed headache and fatigue. Both women had a hemorrhagic cerebral accident as a complication of malignant hypertension. All neurologic, renal, and cardiovascular complications were reversible after OC discontinuation. OC-related malignant hypertension can be averted through effective control of blood pressure in OC users.
Assuntos
Injúria Renal Aguda/etiologia , Hemorragia Cerebral/etiologia , Etinilestradiol/efeitos adversos , Hipertensão Maligna/induzido quimicamente , Hipertrofia Ventricular Esquerda/etiologia , Levanogestrel/efeitos adversos , Adulto , Anti-Hipertensivos/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Cefaleia/etiologia , Hemianopsia/etiologia , Humanos , Hipertensão Maligna/complicações , Convulsões/etiologiaRESUMO
Chronic myelopathy associated with human T-lymphotropic virus type I (HTLV-I) has been described in several endemic areas in Brazil. In Salvador, 102 patients with myelopathy were screened for HTLV-I/II by ELISA and Western blot assays. We found 36 patients with HTLV-I/II associated myelopathy confirming the high prevalence of HAM in Salvador. The initial complaint of our patients were urinary urgency, back pain and progressive unsteadiness on walking. On examination all of them had a spastic paraparesis, variable degrees of lower motor neuron syndrome, deep and superficial sensitive syndrome. MRI analysis revealed lesions in the periventricular white matter in addition to atrophy of the thoracic spinal cord. Clinical and magnetic resonance findings reveal that the inflammatory lesions of HAM involve not only the spinal cord but also the brain and peripheral nervous system.
PIP: During November 1990 and June 1992 a total of 102 patients with myelopathy who attended four hospitals in the city of Salvador, Bahia, Brazil, were studied. The human T-cell lymphotropic virus types I and II (HTLV-I/II) was obtained by means of enzyme-linked immonosorbent assay (ELISA) and Western blot tests. There were 36 patients who had HTLV-I/II associated myelopathy (HAM) of whom 26 were women (72%). The age range was 8 to 82 years, and the average age of those with HTLV-I myelopathy was 45.8 years. Previous history of blood transfusion was established in 6 patients. Only 3 patients had a history of promiscuity, defined as more than 5 partners in a year. The most frequent clinical symptoms included progressive weakness in the lower extremities (29/36), followed by lumbar pain (18/36), and urinary urgency (15/36). The progression of myelopathy was slow and gradual in 25 cases and more rapid in 11 cases, reaching severe muscular force in about 2 years. Except for 2 patients all others reported asymmetry in the muscular force of the lower extremities. On examination all of them had a spastic paraparesis, variable degrees of lower motor neuron syndrome, and deep and superficial sensitive syndrome. Clinical and magnetic resonance findings revealed that the inflammatory lesions of HAM involved not only the spinal cord but also the brain and the peripheral nervous system. Magnetic resonance examination of the thoracic column of 19 patients demonstrated encephalitic disorder in 11 patients. The cerebrospinal fluid (LCR) indicated cellular augmentation in 24 patients with the range of cells from 1 to 40 per cubic millimeter and with the predomination of lymphocytes. Electrophoresis of proteins of LCR showed the increase of albumin in 8 patients and the increase of gamma globulin in 29 patients. HIV antibodies were detected in 2 patients.
Assuntos
Paraparesia Espástica Tropical/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica Tropical/diagnósticoRESUMO
PIP: A sample of 16 asymptomatic female HIV carriers (in CDC stages I and II) infected heterosexually and a sample of 26 seronegative women hospitalized in Porto Alegre were studied in order to determine the nervous system manifestations of HIV infection. They answered the computerized version of the Wisconsin Card Sorting Test (WCST) to ascertain how the frontal lobe and the frontotemporal connection were functioning. There was a significant difference between cases and controls (p = 0.0132) with respect to the level of education. The cases performed worse in all measured parameters than the controls (p = 0.0060). The cases made a higher number of total errors (p = 0.00060), a higher percentage of perseverative errors (p = 0.00148) and nonperseverative errors (p = 0.0133). In order to find out whether a possible confounder was at play in the educational level, a stratified analysis was carried out. There was a significant difference between them regarding the total number of errors at the third grade educational level. Differences also appeared at the third grade level with regard to perseverative errors. There was also a significant difference between the two groups in the total number of errors (p 0.05) and perseverative errors (p 0.01) at the level of university education. Multivariate analysis (ANOVA) indicated that age did not alter either the percentage of errors or the number of perseverative responses. The level of education was of importance, but diagnosis was more important to the effect that it was significant in the multivariate equation. With respect to nonperseverative errors, which was altered by the level of education, this factor was isolated as the most important one which maintained significance in this type of analysis. This pilot project should be expanded in the future by applying neuropsychometric tests and depression and anxiety scales in order to confirm the validity of this evaluation.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Estudos de Casos e Controles , Infecções por HIV , Análise Multivariada , Manifestações Neurológicas , Projetos de Pesquisa , Sinais e Sintomas , América , Biologia , Brasil , Países em Desenvolvimento , Doença , América Latina , Fisiologia , América do Sul , VirosesRESUMO
In 1985, the Pan American Health Organization adopted the goal of eradication of poliomyelitis from the Americas by 1990. Strategies to accomplish this included high vaccination coverage, aggressive outbreak control, and active surveillance for acute flaccid paralysis (AFP). Although the sensitivity of AFP surveillance for detecting paralytic poliomyelitis cases is high, studies have shown the specificity to be low. In 1990, 2497 notified cases of AFP were investigated in the Americas of which 2146 had stool specimens collected. However, only 18 were confirmed as poliomyelitis by isolation of wild poliovirus from stool specimens, 71 were classified as being compatible with poliomyelitis. Cases of AFP due to causes other than poliomyelitis result in extensive but unnecessary outbreak control measures. To predict, at initial clinical evaluation, the likelihood of future confirmation as a case of poliomyelitis, likelihood ratios (LR) were calculated for different combinations of clinical characteristics of AFP cases (249) from Mexico in 1989 and 1990. The best predictors in a child with AFP were proximal muscle involvement which progressed '4 days together with fever at onset of paralysis, and proximal and unilateral involvement with either fever at onset or paralysis which progressed '4 days. The odds would increase by 12 that the child would eventually be confirmed as poliomyelitis (19), based on a stool culture positive for wild poliovirus (95% confidence interval (CI) 2.6-55.9). A guide for use in the field is proposed whereby local health officials, often with little training in neurological evaluation, can predict at initial clinical examination the likelihood that an AFP case will subsequently be confirmed as poliomyelitis.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Paralisia/microbiologia , Poliomielite/diagnóstico , Poliomielite/epidemiologia , Adolescente , Criança , Pré-Escolar , Surtos de Doenças/prevenção & controle , Humanos , Funções Verossimilhança , México/epidemiologia , Hipotonia Muscular/microbiologia , Razão de Chances , Paralisia/fisiopatologia , Poliomielite/prevenção & controleRESUMO
Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programmes for hearing impairment do not currently exist. The problems involved in implementing screening programmes in developing and industrial countries are very different, and in selecting screening procedures for a particular population the following factors have to be taken into consideration: the environmental test conditions; the availability of resources for equipment and the training of testers; the local attitudes towards disability; the level of hearing impairment that may cause handicaps; and the major types of pathology causing hearing impairment. We suggest that in developing countries children should be screened at school entry using a simple field audiometer and that the external ear be inspected for the presence of a discharge. There is an urgent need to develop reliable and simple screening procedures for infants and young children; where possible, all children should be screened for severe or significant hearing impairment before the age of 2 years. No screening should, however, be implemented until appropriate follow-up services are available.
PIP: Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programs for hearing impairment do not currently exist. The problems involved in implementing screening programs in developing and industrial countries are very different, and in selecting screening procedures for a particular population the following factors have to be taken into consideration: the environmental test conditions; the availability of resources for equipment and the training of testers; the local attitudes towards disability; the level of hearing impairment that may cause handicaps; and the major types of pathology causing hearing impairment. The author suggest that in developing countries, children should be screened at school entry using a simple field audiometer and that the external ear be inspected for the presence of a discharge. There is an urgent need to develop reliable and simple screening procedures for infants and young children; where possible, all children should be screened for severe or significant hearing impairment before the age of 2 years. No screening should, however, be implemented until appropriate follow-up services are available. (author's)
Assuntos
Países em Desenvolvimento , Transtornos da Audição/epidemiologia , Programas de Rastreamento , Testes de Impedância Acústica , Audiometria/métodos , Criança , Pré-Escolar , Transtornos da Audição/diagnóstico , Humanos , LactenteRESUMO
Report of an unusual case of myopathy in an HIV infected patient, responsive only to the immunosuppressor drug methotrexate. The patient was a 39 year old homosexual male with no past history of HIV-related manifestations. One month prior to admission he noticed that his left thigh was swollen and painful. Two weeks later both arms became enlarged and tender. A few days before admission he noticed intermittent fever and progressive dyspnea. Upon admission, oral thrush, dyspnea and global enlargement of both arms was noted. There was no articular involvement. Fiberoptic bronchoscopy revealed Pneumocystis carinii pneumonia (PCP). Serology for HIV was positive. Tests for antinuclear antibodies were negative. Serum CPK level was 1019 IU. Capillaroscopy was compatible with vasculitis. Muscle biopsy revealed multifocal myonecrosis. PCP was successfully treated with standard doses of TMP/SMZ. Although indomethacin, prednisone and dexamethasone were administered in succession, there was relentless progression of myopathy and persistence of fever. Six days after administration of methotrexate, the patient defervesced, volume of arms and legs diminished. CPK levels returned to normal after a second course of methotrexate. Upon reduction of the dose thigh enlargement recrudesced. The patient remained asymptomatic on weekly doses of methotrexate. He died five months later of acute respiratory failure.
PIP: Myopathy may be associated with the syndrome of seroconversion in individuals infected by the human immunodeficiency virus (HIV) or may represent the initial symptom of AIDS. In 1990, 39-year old white, single homosexual who was admitted 1 month prior had experienced an episode of edema and pain in the left thigh that faded with the use of nonhormonal antiinflammatory drugs. 15 days later both forearms became enlarged accompanied by pain and erythema. Erythromycin and cefalexine were used without success. Intermittent fever started to appear before admission accompanied by dyspnea when straining. Examination showed tachypnea, oral candidiasis, and enlargement of both upper arms with pain and local erythema without articular involvement. Neurological examination revealed hypotonia and generalized hyperreflexia with intact muscle strength. Serology was positive for HIV, rheumatic activity tests were negative, and muscle biopsy indicated multifocal myonecrosis. Creatinine phosphokinase was 1019 IU (decrease to 44 IU after treatment), aldolase was 19 IU (decrease to 5.6 IU), and glutamic-pyruvic transminase was 50 IU (decrease to 22 IU). Radiography of the thorax indicated interstitial infiltration. Fiberoptic bronchoscopy indicated Pneumocystis carinii pneumonia. Sulfamethoxazole and trimetropim treatment cured the dyspnea and hypoxemia, but the enlargement of both arms progressed. Capillaroscopy indicated vasculitis that was treated without success with indomethacin (150 mg/day), for 7 days; prednisone (40-80 mg/day) for 10 days; and dexamethasone (280 mg/day) for 2 days. 6 days after methotrexate (50 mg/dose/week) treatment the fever disappeared and the enlargement in the extremities receded, but a lower dose of 7.5 mg caused the return of fever and edema in the right thigh. The myopathy remained asymptomatic for 5 months with a weekly dose of 15 mg of methotrexate.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Doenças Musculares/complicações , Adulto , Humanos , Masculino , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Músculos/enzimologia , Músculos/patologia , Doenças Musculares/tratamento farmacológicoRESUMO
PIP: Human retroviruses, or RNA viruses, including the 2 HIV agents associated with AIDS, and the 2 HTLV agents causing leukemia, are described from the viewpoint of history, detection, serology, transformation mechanism, disease pathophysiology, genetic function, associated disease, and related viruses. Both HTLV and HIV infect the human T-lymphocytes, also known as CD4 or helper cells. Both can now be grown in culture, and their genomes are well characterized. HTLV, an acronym for human T-lymphotropic leukemia virus, causes the fulminating adult T-cell leukemia-lymphoma (ATLL), 1st described in 1977. It is prevalent in population clusters, notably in the Caribbean and in southwestern Japan, and is spread by sexual, blood and perinatal routes, as is HIV. It is thought to promote transformation of target cells by release of growth promoting, soluble factor, perhaps a product of the viral "tat" gene. Besides leukemia, HTLV-1 causes a myelopathy sometimes called tropical spastic paraparesis. HIV, formerly known as HTLV-III, causes depletion of the T-cells, and also infects the brain and nervous system. IT has also been isolated from semen, cervical secretions, saliva, monocytes, milk, endothelial cells, tears and cornea. HIV has 5 more genes than HTLV, which regulate transcription, mRNA processing and virus maturation. Parts of the HIV genome are highly heterogeneous, and mutate rapidly, notable sections of the envelope protein. Thus, HIV has 2 main subtypes, but others are known and probably exist. Approaches toward developing AIDS therapeutic agents as of 1987 are outlined: an effective drug should cross the blood-brain barrier. Several anti-viral drugs that block the enzyme reverse transcriptase area being investigated. Possible mechanisms for growth of Kaposi's sarcoma, activation of herpes type viruses, and animal viruses related to HTLV and HIV are discussed.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por Deltaretrovirus , Infecções por Retroviridae , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , África , Animais , Deltaretrovirus/isolamento & purificação , Infecções por Deltaretrovirus/complicações , Infecções por Deltaretrovirus/diagnóstico , Infecções por Deltaretrovirus/epidemiologia , HIV/isolamento & purificação , Humanos , Japão , Infecções por Retroviridae/epidemiologia , Infecções por Retroviridae/veterinária , Índias OcidentaisRESUMO
The neuropathologic study of 22 Brazilian cases of acquired immuno-deficiency syndrome (AIDS) was performed. Thirteen cases (59%) showed neuropathologic lesions. These included infection by Toxoplasma (n = 4), Cryptococcus neoformans (n = 3), viral encephalitis (n = 4), primary lymphomas (n = 2), isolated cerebral infarct (n = 1), and reactive gliosis (n = 1). In 2 cases, primary lymphoma and viral encephalitis were associated. Axonal spheroids in the gracilis and cuneatus nuclei were present in a case of toxoplasmosis. Mammillary bodies lesions consistent with Wernicke's encephalopathy were found in a case of viral encephalitis. In addition, circulatory changes (focal cortical infarcts) were associated lesions in 3 cases. These findings were compared with the main series reported in American and European literature.
PIP: Involvement of the central nervous system is not uncommon in patients with acquired immunodeficiency syndrome (AIDS). The neuropathologic aspects of 22 consecutive autopsies of Brazilian AIDS victims were investigated to gain more information on this manifestation. 13 (59%) of these cases exhibited neuropathologic changes, including infection by Toxoplasma (4 cases), Cryptococcus neoformans (3 cases), viral encephalitis (4 cases), primary lymphomas (2 cases), isolated cerebral infarct (1 case), and reactive gliosis (1 case). In 2 cases, primary lymphoma and viral encephalitis were associated. 3 of the 4 cases of toxoplasmosis had macroscopical abscesses in the region of the internal capsule, basal ganglia, or thalamus. Axonal spheroids in the gracilis and cuneatus nuclei were present. All 3 cryptococcosis cases demonstrated a meningeal inflammatory process; in addition, multiple microcysts were found in the cortex of the cerebral hemispheres and in the basal ganglia in 2 of these cases. The 4 encephalitis cases showed multiple microglial nodules and occasional foci of perivascular lymphocytic cuffings, with dissemination of lesions throughout the grey structures of the central nervous system. All 22 patients autopsied in this series were male; 19 were homosexual. Previous studies of the incidence of neurologic complications in AIDS reported in the US and European literature have yielded rates between 23-73%.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Encefalopatias/patologia , Encéfalo/patologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Abscesso Encefálico/etiologia , Abscesso Encefálico/patologia , Encefalopatias/etiologia , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/patologia , Brasil , Criptococose/patologia , Humanos , Linfoma/etiologia , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Toxoplasmose/patologiaRESUMO
PIP: The clinical trial of a longacting levonorgestrel implant, Norplant, as a reversible method of contraception in 2 outpatient clinics of 2 hospitals in Colombia, has had very promising results. In almost 400 acceptors, with thus far more than 2600 woman-months, the pregnancy rate has been nil. Results of the 1st 300 cases are summarized, illustrating 2 sites of insertion--the inner region of the left arm and the left scapular region, both of which present some advantages. Secondary effects and other parameters are analyzed, including irregular bleeding and amenorrheas. Finally, some comments are made in relation to site, extraction, acceptability, and future use of the method. (author's) modified^ieng
Assuntos
Comportamento , Comportamento Contraceptivo , Anticoncepção , Anticoncepcionais Femininos , Estudos de Avaliação como Assunto , Hormônios , Incidência , Levanogestrel , Aceitação pelo Paciente de Cuidados de Saúde , Substâncias para o Controle da Reprodução , Projetos de Pesquisa , Pesquisa , Comportamento Sexual , Estatística como Assunto , Fatores Etários , Amenorreia , América , Antropometria , Biologia , Peso Corporal , Colômbia , Anticoncepcionais , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Diagnóstico , Doença , Dismenorreia , Escolaridade , Sistema Endócrino , Serviços de Planejamento Familiar , Fertilidade , Cefaleia , Hemorragia , América Latina , Ciclo Menstrual , Menstruação , Distúrbios Menstruais , Manifestações Neurológicas , Paridade , Fisiologia , População , Características da População , Dinâmica Populacional , Reprodução , Sinais e Sintomas , América do SulRESUMO
Twenty Haitian patients, hospitalized from 1 April 1980 to 20 June 1982, had Pneumocystis carinii pneumonia, central nervous system toxoplasmosis, esophageal candidiasis, cryptococcosis, disseminated cytomegalovirus, progressive herpes simplex virus, chronic enteric coccidiosis, or invasive Kaposi's sarcoma. Ten patients died. Opportunistic infections were frequently multiple and were recurrent in three patients. In seven patients disseminated tuberculosis preceded the other infections by 2 to 15 months. There was no evidence of an underlying immunosuppressive disease, and no history of homosexuality or intravenous drug abuse. At least three patients probably acquired the syndrome in Haiti. Lymphadenopathy was common. Seventeen patients tested had anergy, and 18 had lymphopenia. Monoclonal antibody analysis of peripheral-blood T-cell subsets done on 11 patients showed a marked decrease in T-helper cells and an inversion of the normal ratio of T-helper cells to T-suppressor cells. This syndrome among heterosexual Haitians is strikingly similar to the syndrome of immunodeficiency described recently among American homosexuals.
Assuntos
Síndrome da Imunodeficiência Adquirida/imunologia , Sarcoma de Kaposi/imunologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adulto , Anticorpos Antibacterianos/análise , Anticorpos Antifúngicos/análise , Anticorpos Antivirais/análise , Peso Corporal , Candida/imunologia , Citomegalovirus/imunologia , Comportamento Alimentar , Feminino , Haiti , Herpesvirus Humano 4/imunologia , Humanos , Contagem de Leucócitos , Masculino , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/imunologia , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/epidemiologia , Simplexvirus/imunologia , Dobras Cutâneas , Linfócitos T/imunologia , Toxoplasma/imunologia , Treponema/imunologiaRESUMO
PIP: Before the Cuban Revolution in 1959, poliomyelitis was endoepidemic, with epidemic peaks every 5-7 years and subsiding peaks in the intervening intervals. 18 mass poliomyelitis vaccination campaigns have been conducted since 1962, and there have been only 6 notified cases. In each case, vaccine administration was preceded by a survey of the level of immunity to polio vriuses and the results of serologhic analyses were used to determine the age of vaccination and the type of vaccine used. Starting with the 9th campaign, trivalent vaccine has been administered in candy form in 2 doess to children 1 month-3 years and a booster is given at 9 years of age to reactivate immunity. Except for the 1st immunization campaign, when 98.6% coverage was achieved, coverage has exceeded 100%. The age group with the lowest prevalence of immunization has consistently been infant under 1 year of age. Serologic surveys indicate that the proportion of resistant individuals rises progressively with age. Resistance tends to level off, however, at 3 years of age, suggesting that once a give level of immunity is attained, it is dufficult to raise it. Protective antibody levels against the 3 polio viruses in persons over 14 years of age is estimated to be about 90%.^ieng