RESUMEN
People over age 50 living with HIV experience frailty including functional declines and illnesses usually attributed to aging, more frequently and ten years earlier than people without HIV. As the number of people living with HIV over age 50 is expected to triple by the year 2040, those experiencing early frailty will continue to grow. This review synthesizes the known correlates and contributors to musculoskeletal frailty in people living with HIV. A conceptual model of musculoskeletal frailty in HIV that outlines chronic inflammation, altered energy metabolism, immune activation, and endocrine alterations as mechanisms associated with frailty development is presented. Additionally, the potential ability of aerobic exercise to modify the risk of frailty is highlighted as an important intervention.
Asunto(s)
Fragilidad , Infecciones por VIH , Envejecimiento , Fragilidad/epidemiología , Humanos , InflamaciónRESUMEN
OBJECTIVE: To describe clinical presentation across age groups in 2855 children with pulmonary tuberculosis (TB) attending the Children's Hospital, Lima, Peru, to improve the diagnosis, treatment and care of childhood TB. DESIGN: Children aged 0-14 years admitted between 1 January 1973 and 31 December 1997 with active pulmonary TB were enrolled. Demographic information, history, physical examination data, laboratory and microbiological results, chest radiograph data, disease classification, treatment and adverse effect data, and outcome at the time of discharge were recorded by pulmonologists using detailed chart abstractions. RESULTS: Of the 2855 enrollees, 47% were malnourished and 56% had a household contact. Older children presented with classic TB symptoms, while weight loss and anorexia were rare in children aged <5 years. Microbiological or pathologic confirmation was obtained in 71% of children aged 10-14 years compared with 34% of children aged <2 years; however, severe extra-pulmonary TB was most common among children aged <2 years (41%). CONCLUSION: Classic TB symptoms should be considered when making a diagnosis; however, systematic symptoms among young children are also important. In high-burden settings, clinicians should have a low threshold to diagnose and treat children for TB across all ages, even in the context of a negative tuberculin skin test result and lack of micro-pathological confirmation.
Asunto(s)
Tuberculosis Pulmonar/diagnóstico , Adolescente , Factores de Edad , Antituberculosos/uso terapéutico , Técnicas Bacteriológicas , Niño , Preescolar , Comorbilidad , Trazado de Contacto , Países en Desarrollo , Femenino , Vivienda , Humanos , Lactante , Recién Nacido , Masculino , Estado Nutricional , Perú/epidemiología , Valor Predictivo de las Pruebas , Radiografía Torácica , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Prueba de Tuberculina , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/transmisiónRESUMEN
Alopecia, a common sequel of radiation treatment of brain tumors, increases patient stress to the extent that refusal of treatment may occur. The expectation that loss of hair will be prevented, or that regrowth will occur, is extremely important to patients. To investigate prostaglandin-induced radiation protection against alopecia, the hair of B6D2F1 male mice was plucked from the right thigh and surrounding area to induce anagen. Fourteen days later, mice were injected subcutaneously in the neck with 10 micrograms 16,16 dm PGE2 in 0.2 ml of vehicle, or with the vehicle alone. In another group of previously plucked mice, 16,16 dm PGE2 in the same concentration, or the vehicle was applied topically. One hour later, graded single doses from 6.5 to 12.5 Gy 137Cs gamma irradiation were given to groups of six animals. On day 21 post-plucking, all animals were killed and a portion of the irradiated site was excised. The average hair counts per field in irradiated animals were 85 +/- 4 (6.5 Gy), 25 +/- 5 (8.5 Gy), and 5.5 +/- 0.7 (10 Gy). Animals receiving the prostaglandin systemically had values of 60 +/- 10 (6.5 Gy), 54 +/- 3 (8.5 Gy), 66 +/- 6 (10 Gy), and 30.1 +/- 8 (12.5 Gy). Topical application of the prostaglandin resulted in protection that yielded 52 +/- 3 (8.5 Gy), 34 +/- 4 (10 Gy), and 3.2 +/- 0.9 (12.5 Gy) hairs per field. Both systemic and topical application of 16,16 dm PGE2 protected from some degree of radiation-induced alopecia, which supports the conclusion that prostaglandins may be useful in the protection of hair follicles in patients treated with radiation for brain tumors.
Asunto(s)
16,16-Dimetilprostaglandina E2/uso terapéutico , Alopecia/prevención & control , Protectores contra Radiación/uso terapéutico , Radioterapia/efectos adversos , 16,16-Dimetilprostaglandina E2/administración & dosificación , Administración Tópica , Alopecia/etiología , Animales , Inyecciones Subcutáneas , Masculino , Ratones , Protectores contra Radiación/administración & dosificaciónRESUMEN
Misoprostol, a prostaglandin (PG) E1 analogue, is one of the most effective radiation protectors of the PGs investigated to date. Misoprostol-induced protection is also additive to protection by the widely studied thiol compound, WR-2721. The mechanism of PG-induced radiation protection and its interaction with WR-2721 is unknown. One important step in the investigation of the mechanism is to determine if PG-induced protection and its interaction with WR-2721 is mediated through PG receptor sites. A direct determination of receptor sites on murine intestinal clonogenic cells could not be made; however an indirect approach was possible. Misoprostol is composed of four stereoisomers of about equal proportions of which only one is gastric antisecretory and cytoprotective. Studies reported here compared radiation protection by this active isomer with that of one of the three inactive isomers. Furthermore, the additional protection of the two isomers when administered with WR-2721 was investigated. Results showed that only the active isomer was protective from radiation injury and this isomer was the only one which afforded additional protection with WR-2721. These data show that PG-induced radiation protection is receptor site dependent and stereospecific.