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INTRODUCTION: Hypertension is a very common disease worldwide, and medication is needed to prevent its short-term and long-term complications. Our objective was to determine the characteristics and factors associated with antihypertensive medication use in patients attending Peruvian health facilities. MATERIALS & METHODS: We performed a multicenter, cross-sectional study with secondary data. We obtained self-reported antihypertensive medication from patients attending health facilities in 10 departments of Peru. We looked for associations of the antihypertensive treatment according to sociopathological factors and obtained p values using generalized linear models. RESULTS: Of the 894 patients with hypertension, 61% (547) were women and 60% (503) were on antihypertensive treatment, of which 82% (389) had monotherapy and 52% (258) had recently taken their medication. Antihypertensive treatment was positively correlated with the patient's age (adjusted prevalence ratio [aPR]: 1.01; 95% confidence interval [CI]: 1.007 to 1.017; p value < 0.001), diabetes (aPR: 1.31; 95% CI: 1.11 to 1.55; p value = 0.001) and cardiovascular disease (aPR: 1.38; 95% CI: 1.26 to 1.51; p value < 0.001). Conversely, the frequency of antihypertensive treatment decreases with physical activity (aPR: 0.80; 95% CI: 0.70 to 0.92; p value = 0.001). CONCLUSION: Patients who have comorbidities and advanced age are more likely to be on antihypertensive treatment. In contrast, patients with increased physical activity have a lower frequency of antihypertensive treatment. It is important to consider these factors for future preventive programs and to improve therapeutic compliance.
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The management of symptomatic hyperthyroidism in patients with end stage renal disease (ESRD) is challenging because of altered clearance of medications and iodine with dialysis; moreover, many patients meeting these criteria are medically fragile. A 77-year-old man with type 2 diabetes and ESRD requiring hemodialysis, with dilated cardiomyopathy and paroxysmal atrial fibrillation, was found to have subclinical hyperthyroidism. Over a 2-year period he became clinically hyperthyroid with serum TSH level of <0.05 mIU/L and free T4 level of 4.3 ng/dL, attributed to toxic multinodular goiter. Despite antithyroid medication, he developed rapid ventricular rate from his atrial fibrillation that resulted in decompensated heart failure and multiple hospitalizations. His hyperthyroidism was successfully controlled with high dose methimazole and potassium iodide treatment, which were eventually discontinued after prolonged use. Nearly 6 months off medications, his hyperthyroidism recurred but was readily resolved when methimazole was restarted. Hyperthyroidism in the medically fragile ESRD patient may precipitate emergent conditions. Antithyroid medications are effective and should be considered as primary therapy for the treatment of hyperthyroidism in patients with hemodialysis. Moreover, clinical guidelines for the characterization and management of individuals with ESRD and subclinical hyperthyroidism should be developed.
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Bocio Nodular/tratamiento farmacológico , Fallo Renal Crónico , Diálisis Renal , Tirotoxicosis/tratamiento farmacológico , Anciano , Humanos , MasculinoRESUMEN
We report an unusual case of miliary tuberculosis in a 77-year-old Filipino man with hypertension, diabetes mellitus, nephrolithiasis status-post left nephrectomy, presenting with 1 month of fever, generalised weakness and weight loss. Laboratory data were significant for anaemia, hypercalcaemia and acute kidney injury. Chest radiograph showed ground glass opacities and interstitial infiltrates. Extensive workup was performed to evaluate fever and hypercalcaemia. Malignancy, hormonal and septic workup were all unremarkable. Tuberculin skin test was negative. Sputum, pleural fluid, bronchoalveolar lavage and cerebrospinal fluid were acid-fast bacilli (AFB) smear negative. Remarkably, urine AFB smear was positive. Caseating granulomas were seen on transbronchial biopsy. Antituberculosis therapy was initiated which lead to defervescence and initial clinical improvement. However, hospital course became complicated by small bowel obstruction and respiratory failure. He subsequently developed pulseless electrical activity and expired. An autopsy confirmed the presence of tuberculosis in multiple organs including his remaining kidney.