RESUMEN
SETTING: Seven public tuberculosis (TB) dispensaries in Istanbul, Turkey. OBJECTIVE: To investigate the risk of active TB among adult household contacts (age > or = 15 years) of newly diagnosed sputum smear-positive pulmonary TB (PTB) cases in Istanbul. DESIGN: A retrospective analysis of adult household contacts of 1570 pulmonary TB cases registered at seven TB dispensaries in Istanbul between 1997 and 2000. RESULTS: A total of 6188 household contacts (mean contact/index case: 3.9) were included in the study, of whom 4114 (67%) were aged > or = 15 years (mean contact/index case: 2.6); 3310 (80.5%) of these participated in a contact investigation. The mean duration of follow-up was 2.2 years (range 1-4 years); 222 active TB cases (rate 5.4%, 95%CI 5.2-5.6) were detected, 171 within the first year. The incidence of active TB was 2491/100 000 (3555/100 000 in the 15-34 year age group and 1195/100 000 in the > or = 35 year age group, P < 0.0001). Rates of active TB were highest in the 15-24 year (8.5%) and 25-34 year (6.5%) age groups. CONCLUSION: The incidence of active TB among adult household contacts of sputum smear-positive PTB cases was high. This high incidence justifies the prescription of chemopropylaxis not only for children but also for all contacts, especially those aged between 15 and 34 years.
Asunto(s)
Salud de la Familia , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Factores de Edad , Trazado de Contacto , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esputo/microbiología , Turquía/epidemiología , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening KATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. METHODS: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n = 7) received no further treatment. In Group 2 (non-treated; n = 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n = 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. RESULTS: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P = 0.019). The tissue Na+-K+ ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P = 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P = 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. CONCLUSIONS: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.