RESUMO
Pharmaceutical and personal care products (PPCPs) are part of the emerging contaminants (ECs) in the environment due to their known or suspected adverse effects in aquatic and terrestrial organisms, as well as in human health. Presence of PPCPs in aquatic and terrestrial ecosystems has been mainly attributed to the effluents of wastewater treatment plants (WWTPs). Although several PPCPs have been detected in wastewater, their removal from wastewater via biological processes is limited. Removal of PPCPs depends on their chemical structure, concentration, solubility, and technology used to treat the wastewater. Electrochemical Advanced Oxidation Processes (EAOPs) are some of the most sought-after methods for dealing with organic pollutants in water including PPCPs, due to generation of strong oxidants such as â¢OH, H2O2 and O3- by using directly or indirectly electrochemical technology. This review is focused on the removal of main PPCPs via EAOPs such as, anodic oxidation, electro-Fenton, photoelectron-Fenton, solar photoelectron-Fenton, photoelectrocatalysis and sonoelectrochemical processes. Although more than 40 PPCPs have been identified through different analytical approaches, antibiotics, anti-inflammatory and antifungal are the main categories of PPCPs detected in different water matrices. Application of EAOPs has been centered in the removal of antibiotics and analgesics of high consumption by using model media, e.g. Na2SO4. Photoelectrocatalysis and Electro-Fenton processes have been the most versatile EAOPs applied for PPCPs removal under a wide range of operating conditions and a variety of electrodes. Although EAOPs have gained significant scientific interest due to their effectiveness, low environmental impact, and simplicity, further research about the removal of PPCPs and their by-products under realistic concentrations and media is needed. Moreover, mid-, and long-term experiments that evaluate EAOPs performance will provide knowledge about key parameters that allow these technologies to be scaled and reduce the potential risk of PPCPs in aquatic and terrestrial ecosystem.
Assuntos
Cosméticos , Poluentes Químicos da Água , Antibacterianos , Cosméticos/análise , Ecossistema , Humanos , Peróxido de Hidrogênio , Preparações Farmacêuticas , Rios , Eliminação de Resíduos Líquidos/métodos , Águas Residuárias/química , Água , Poluentes Químicos da Água/análiseRESUMO
OBJECTIVE: To describe the clinical features of extrapulmonary tuberculosis (EXPTB) and to evaluate epidemiological data to search for potential explanations for its high frequency in the state of Aguascalientes, Mexico. MATERIALS AND METHODS: Clinical records of all patients with tuberculosis seen in Aguascalientes in 2008 were reviewed, and official databases were analyzed. RESULTS: EXPTB comprised 60.5% of the 86 cases evaluated, being lymph nodes the main site affected. Patients with EXPTB were younger and more obese than subjects with pulmonary tuberculosis (PTB). One third of cases in either group had diabetes, a frequency much higher than expected. Epidemiological analysis showed that PTB incidence, but not EXPTB incidence, decreases as geographical altitude increases, and had a descendent trend from 1997 to 2011. CONCLUSIONS: The lower frequency of PTB (due to its inverse relationship with altitude and its descendent trend in last years) might explain the high frequency of EXPTB. Obesity appeared to protect against developing pulmonary involvement, and diabetes was more frequent than expected among PTB and EXPTB cases.
Assuntos
Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Objective. To describe the clinical features of extrapulmonary tuberculosis (EXPTB) and to evaluate epidemiological data to search for potential explanations for its high frequency in the state of Aguascalientes, Mexico. Materials and methods. Clinical records of all patients with tuberculosis seen in Aguascalientes in 2008 were reviewed, and official databases were analyzed. Results. EXPTB comprised 60.5% of the 86 cases evaluated, being lymph nodes the main site affected. Patients with EXPTB were younger and more obese than subjects with pulmonary tuberculosis (PTB). One third of cases in either group had diabetes, a frequency much higher than expected. Epidemiological analysis showed that PTB incidence, but not EXPTB incidence, decreases as geographical altitude increases, and had a descendent trend from 1997 to 2011. Conclusions. The lower frequency of PTB (due to its inverse relationship with altitude and its descendent trend in last years) might explain the high frequency of EXPTB. Obesity appeared to protect against developing pulmonary involvement, and diabetes was more frequent than expected among PTB and EXPTB cases.
Objetivo. Describir las características clínicas de la tuberculosis extrapulmonar (TBEXP) y evaluar datos epidemiológicos para buscar posibles explicaciones de su alta frecuencia en Aguascalientes, México. Material y métodos. Se revisaron expedientes de todos los pacientes con tuberculosis atendidos en Aguascalientes en 2008 y se analizaron bases de datos oficiales. Resultados. La TBEXP constituyó 60.5% de los 86 casos evaluados, con afectación más común en ganglios linfáticos. Los pacientes con TBEXP fueron más jóvenes y más obesos que aquéllos con tuberculosis pulmonar (TBP). Un tercio de cada grupo tenía diabetes, una frecuencia muy superior a la esperada. El análisis epidemiológico mostró que la incidencia de TBP, pero no de TBEXP, es menor conforme aumenta la altitud geográfica y además está disminuyendo (l997-2011). Conclusiones. La menor incidencia de TBP (por su relación inversa con la altitud y por su tendencia a disminuir en los últimos años) podría explicar la alta frecuencia de TBEXP. La obesidad parece proteger contra la afectación pulmonar, y la diabetes fue más frecuente de lo esperado tanto en TBP como en TBEXP.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Estudos Transversais , Incidência , México/epidemiologia , Estudos RetrospectivosAssuntos
Humanos , Suplementos Nutricionais , Micronutrientes/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Vitamina A/uso terapêutico , Zinco/uso terapêutico , Colesterol/sangue , Mycobacterium tuberculosis/isolamento & purificação , Ensaios Clínicos Controlados Aleatórios como Assunto , Escarro/microbiologia , Tuberculose Pulmonar/microbiologiaAssuntos
Suplementos Nutricionais , Micronutrientes/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Vitamina A/uso terapêutico , Zinco/uso terapêutico , Colesterol/sangue , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Ensaios Clínicos Controlados Aleatórios como Assunto , Escarro/microbiologia , Tuberculose Pulmonar/microbiologiaRESUMO
INTRODUCTION: During arthroscopy for the treatment of patellofemoral lateral hyper-pressure syndrome (LHS), intra-articular morphine or its derivatives (fentanyl) may reduce postoperative pain when combined with anesthetics. We therefore decided to determine whether adding fentanyl to epinephrine and bupivacaine produced an increased analgesia. MATERIAL AND METHODS: We randomly distributed 40 patients into two groups. The experimental group (n=20) was given 0.5% bupivacaine (2 mg/kg), epinephrine (100 microg) and fentanyl (2.5 microg/kg). The control group (n=20) received 0.5% bupivacaine (2 mg/kg) and epinephrine (100 microg). Patients underwent chondroplasty and retinacular release, and we assessed pain, time of analgesia and postoperative range of motion at postoperative hours 6 and 24. RESULTS: The age and the grade of patellofemoral chondromalacia (PFC) were similar in both groups (p > 0.05). No differences were found in pain and ranges of motion intraoperatively and at postoperative hours 6 and 24 (p > 0.05) between both groups. The postoperative analgesia time was similar (p > 0.05). CONCLUSIONS: Adding intra-articular fentanyl to the combination of epinephrine plus bupivacaine did not decrease pain, and did not increase neither the analgesia time nor the range of motion in patients with LHS undergoing knee arthroscopy.
Assuntos
Artroscopia , Condromalacia da Patela/tratamento farmacológico , Fentanila/uso terapêutico , Articulação do Joelho/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Condromalacia da Patela/cirurgia , Ensaios Clínicos Controlados como Assunto , Interpretação Estatística de Dados , Método Duplo-Cego , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Feminino , Fentanila/administração & dosagem , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Simpatomiméticos/administração & dosagem , Simpatomiméticos/uso terapêutico , Fatores de TempoRESUMO
BACKGROUND: chronic alcoholic liver disease (EHAC) associates to recurrent pleural effusion. Generally thoracocentesis is not performed for considering this fluid a trasudate. Our objective was to determine the usefulness of thoracocentesis and causes of recurrent pleural effusion. METHODS: we analyzed samples of pleural fluid of patients with chronic alcoholic liver disease, recurrent pleural effusion and respiratory failure. Blood tests, chest x-rays and pleural fluid analyses were evaluated. RESULTS: we included 27 cases. Mean age of patients was >60 year old, mean evolution time of liver disease was approximately 4 years. 55.6% were exudates and 44.4% trasudates. Causes of recurrent pleural effusion were portal hypertension in 12 (44.4%) cases. In patients with exudate, the origin was infectious in 8 (29.6%) cases; in 4 (14.8%) the cause was malignancy; one more with pulmonary embolism, and in other two patients the cause was not identified. CONCLUSIONS: we found that more than half of patients with chronic alcoholic liver disease and recurrent pleural effusion was an exudate, thus thoracocentesis should be frequently performed in these patients.
Assuntos
Hepatopatias Alcoólicas/complicações , Paracentese , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , TóraxRESUMO
BACKGROUND: we have recently published the hypothesis that hypocholesterolemia might be a risk factor for the development of pulmonary tuberculosis. In this sense, albeit patients with pulmonary tuberculosis often have total cholesterol levels lower than the general population, it is not known if the latter have had a recent exposure to Mycobacterium tuberculosis. OBJECTIVE: to evaluate serum lipids in subjects exposed to mycobacteria. METHODS: we studied 25 pulmonary tuberculosis patients and 44 household contacts, and compared their serum lipid profile. RESULTS: We found that total cholesterol, LDL and triglycerides concentrations increased with age in contacts but not in pulmonary tuberculosis patients, with statistically significant differences in regression lines (age versus lipid level). Multiple linear regression analysis confirmed that being a household contact was associated with higher levels of total cholesterol, LDL, HDL and triglycerides. CONCLUSIONS: We conclude that lipid profile differed between pulmonary tuberculosis patients and their household contacts, thus supporting that low cholesterol levels might be a risk factor for developing pulmonary tuberculosis.
Assuntos
Colesterol/sangue , Saúde da Família , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Triglicerídeos/sangue , Tuberculose Pulmonar/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: To describe clinical and radiological features of patients with pleural mesothelioma, according to main histological types. METHODS: Clinical records of inpatients admitted with diagnosis of pleural mesothelioma to the Instituto Nacional de Enfermedades Respiratorias in the last 11 years, were reviewed. RESULTS: We analyzed 85 cases confirmed by immunohistochemistry. The most frequent histological type was epithelial (84.7 %), followed by sarcomatous (12.9 %) and mixed (2.4 %) types. Comparison between epithelial and sarcomatous types showed no differences in age (53.7 +/- 13.1 vs. 55.9 +/- 11.0 years, respectively), male : female ratio (2.3 : 1 vs. 1.8 : 1), history of asbestos exposure (34.7 vs. 27.2 %), tobacco habit (54.2 vs 45.4 %), occupation, evolution time (4.8 +/- 3.3 vs. 4.4 +/- 3.7 months), pain, dyspnea and cough, right-side predominance (55.6 vs. 81.8 %), radiological image with pleural effusion (59.7 vs. 36.4 %) or pleural thickening (38.9 vs. 63.6 %), and diagnostic efficiency of closed pleural biopsy (58.3 vs. 27.2 %). CONCLUSIONS: Our results suggest that clinical and radiological features of epithelial and sarcomatous histological types are very similar. Additionally, we found a high frequency of epithelial mesothelioma, which contrasts with findings from other countries, suggesting that the type of asbestos or other factors involved in the development of pleural mesothelioma differ from those existing in other regions of the world.
Assuntos
Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Feminino , Humanos , Masculino , Mesotelioma/diagnóstico por imagem , Mesotelioma/patologia , México , Pessoa de Meia-Idade , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/patologia , RadiografiaRESUMO
La implementación de un tratamiento empírico en los pacientes con tuberculosis multifarmacorresistente, sin pruebas de cultivo y de farmacosensibilidad, lleva a un gran número de fracasos. Diversos estudios han demostrado que el retratamiento de segunda línea estandarizado no logra la curación en un alto porcentaje y es en principio un régimen empírico, por lo que no parece ser la mejor conducta terapéutica y es, definitivamente, más conveniente que estos pacientes sean tratados con un esquema individualizado por médicos expertos en esta forma especial de la tuberculosis.
The implementation of an empirical treatment in patients with muitidrug resistant (MDR) tuberculosis (TB) without sputum culture and drug-susceptibility tests leads to a high number of failures. Several studies have shown that standardized second line retreatment does not provide a high cure rate and is an empirical regime. Therefore, this does not appear to be the best therapeutic choice; MDRTB patients should be treated with an individualized treatment by physicians expert in this very special form of tuberculosis.
RESUMO
Although one-third of the world's population is infected by Mycobacterium tuberculosis, only approximately 10% will develop the overt clinical disease due to a yet undefined risk factor. We hypothesize that hypocholesterolemia might constitute such a factor, because: (a) cholesterol is an important molecule for the good functioning of an immune system, and is necessary for macrophages to uptake and engulf mycobacteria, (b) tuberculous patients often have hypocholesterolemia, in comparison with the general population and household contacts, (c) cholesterol has a beneficial effect against pulmonary tuberculosis, since a cholesterol-rich diet accelerates the bacteriological sterilization of sputum, and (d) many conditions traditionally considered major risk factors for tuberculosis are accompanied by hypocholesterolemia. If this hypothesis proves to be true, cholesterol might be given to hypocholesterolemic subjects who are at high risk for developing pulmonary tuberculosis.
Assuntos
Colesterol/deficiência , Dislipidemias/epidemiologia , Modelos Biológicos , Medição de Risco/métodos , Tuberculose Pulmonar/epidemiologia , Causalidade , Comorbidade , Humanos , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: Hypocholesterolemia is common among tuberculous patients and is associated with mortality in miliary cases. Some in vitro studies have shown that cholesterol is necessary for the good functioning of macrophages and lymphocytes. STUDY OBJECTIVES: To determine whether a cholesterol-rich diet could accelerate sputum sterilization in patients with pulmonary tuberculosis. DESIGN: An 8-week follow-up, randomized, controlled trial carried out from March 2001 to January 2002. SETTING: A third-level hospital for respiratory diseases in Mexico City. PATIENTS AND INTERVENTIONS: Adult patients with newly diagnosed pulmonary tuberculosis were hospitalized for 8 weeks and randomly assigned to receive a cholesterol-rich diet (800 mg/d cholesterol [experimental group]) or a normal diet (250 mg/d cholesterol [control group]). All patients received the same four-drug antitubercular regimen (ie, isoniazid, rifampin, pyrazinamide, and ethambutol). MEASUREMENTS AND RESULTS: Every week, a quantitative sputum culture and laboratory tests were done and respiratory symptoms were recorded. Patients in the experimental group (10 patients) and the control group (11 subjects) were HIV-negative and harbored Mycobacterium tuberculosis that was fully sensitive to antitubercular drugs. Sterilization of the sputum culture was achieved faster in the experimental group, as demonstrated either by the percentage of negative culture findings in week 2 (80%; control group, 9%; p = 0.0019) or by the Gehan-Breslow test for Kaplan-Meier curves (p = 0.0037). Likewise, the bacillary population decreased faster (p = 0.0002) in the experimental group. Respiratory symptoms improved in both groups, but sputum production decreased faster in the experimental group (p < 0.05). Laboratory test results did not differ between the groups. CONCLUSIONS: A cholesterol-rich diet accelerated the sterilization rate of sputum cultures in pulmonary tuberculosis patients, suggesting that cholesterol should be used as a complementary measure in antitubercular treatment.
Assuntos
Antituberculosos/uso terapêutico , Colesterol/deficiência , Interações Alimento-Droga , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Pulmonar/dietoterapia , Adulto , Técnicas Bacteriológicas , Colesterol/sangue , Contagem de Colônia Microbiana , Terapia Combinada , Esquema de Medicação , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , México , Pessoa de Meia-Idade , Escarro/microbiologia , Resultado do Tratamento , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/microbiologiaRESUMO
El empiema tuberculoso es considerado como una entidad poco frecuente y habitualmente es la complicación de una tuberculosis pleural, sin embargo hay condiciones clínicas que pueden favorecer su desarrollo como son el plombage, oleotórax y neumotórax terapéutico, también se puede desarrollar a partir de una cicatriz fibrosa, por una neumonectomía o por una toracoplastia. Su fisiopatogenia es poco conocida, pero a diferencia de la tuberculosis pleural, el empiema de tipo tuberculoso es ocasionado por una infección de la cavidad pleural por el Mycobacterium tuberculosis. Sus cuadros clínico y radiológico no son muy diferentes al derrame pleural tuberculoso, pero la presencia de fístula broncopleural puede complicar su cuadro clínico. El tratamiento requiere de un manejo con medicamentos antituberculosos, conjuntamente con manejo quirúrgico. El manejo quirúrgico se basa en el drenaje del material purulento, y puede ser tan sencillo como el colocar una sonda endopleural, pero en algunos casos será necesario un manejo más agresivo como la pleurotomía abierta o bien, la toracotomía.
Assuntos
Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/fisiopatologia , Empiema Tuberculoso/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia/estatística & dados numéricosRESUMO
Introducción. La tuberculosis es uno de los mayores problemas de salud a nivel mundial, pues una tercera parte de la población está infectada por Mycobacterium tuberculosis, y es considerada como causa importante de muerte. Investigaciones sobre nuevos métodos de diagnóstico y nuevas alternativas de tratamiento son realizadas a nivel mundial. Diagnóstico. Se utilizan dos métodos para determinar la presencia de drogorresistencia, el método de las proporciones y el método de concentraciones absolutas, este último se utiliza en países en vías de desarrollo. Tipos de resistencia. Se conocen dos tipos de resistencia del Mycobacterium a los antituberculosos, la primaria y la secundaria, esta diferencia es debida a la exposición previa de las micobacterias a los diferentes antituberculosos. Es posible encontrar resistencia cruzada entre algunos fármacos. Causas de resistencia. La resistencia es ocasionada por los tratamientos inadecuados o por poca cooperación de los pacientes. Clasificación. Se clasifica con base al número de antituberculosos a los que hay resistencia, en monorresistencia, multidrogorresistencia y "otras resistencias". Mutantes. En toda población bacilar se encuentran normalmente micobacterias mutantes, es decir presentan resistencia a los diferentes antituberculosos. La selección de estas micobacterias por deficiencias en los tratamientos lleva a los pacientes con tuberculosis a la drogorresistencia para cada antituberculoso. Conductas a seguir. Generalmente las medidas que favorecen el éxito de un tratamiento son aquellas que evitan la drogorresistencia, por lo que el garantizar un tratamiento adecuado disminuimos la frecuencia de tuberculosis drogorresistente
Assuntos
Humanos , Resistência a Medicamentos , Métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico , Tuberculose/terapia , Métodos Epidemiológicos , Controle de QualidadeRESUMO
Antecedentes: Aunque la tuberculosis miliar puede coexistir con tuberculosis de reactivación, la información sobre esta forma mixta es sumamente escasa. Diseño del estudio. Se revisaron expedientes de pacientes hospitalizados entre 1989 y 1993 en el Instituto Nacional de Enfermedades Respiratorias (Ciudad de México), con tuberculosis miliar confirmada bacteriológicamente o histológicamente. Resultados. De 88 pacientes con tuberculosis miliar, 59 por ciento tenían sólo patrón miliar (grupo TM), mientras que 41 por ciento tuvieron además imagen radiológica de tuberculosis de reactivación (grupo TMR). Ambos grupos se compararon con 130 pacientes con tuberculosis de reactivación (grupo TR). En los tres grupos predominó el sexo masculino (~1.9:1) y la disnea fue más frecuente en hombres. En comparación con el grupo TR, los pacientes TMR y TM fueron ligeramente más jóvenes, buscaron atención médica más rápido, tuvieron menor frecuencia de esputo y su albúmina sérica fue menor. El 38.8 por ciento de pacientes TMR y el 59.2 por ciento de TR tuvieron cavitación. El PPD fue más frecuentemente positivo en el grupo TR (73.1 porciento) que en el grupo TM (19.4 por ciento), que a su vez fue similar al grupo TMR (33.3 por ciento). El porcentaje de positividad de baciloscopia en esputo fue similar entre pacientes TMR (86.1 por ciento) y TR (96.9 por ciento), ambos mayores que en TM (66 por ciento). La frecuencia de cultivos de esputo positivos fue similar en los tres grupos. La mortalidad en pacientes miliares se asoció a edad =40, colesterol ó90 mg/dL, y albúmina ó3.0 g/dL. Conclusiones. La tuberculosis miliar en reactivación fue muy frecuente; sus características clínicas fueron similares a la tuberculosis miliar pura, aunque bacteriológicamente se asemejó más a la tuberculosis de reactivación
Assuntos
Humanos , Masculino , Feminino , Adulto , Diagnóstico , Interpretação Estatística de Dados , Tuberculose Miliar/diagnóstico , Tuberculose/classificaçãoRESUMO
El Síndrome hepatopulmonar (SHP) es una entidad clínica reconocida por vez primera en 1884 por Flückiger, sin embargo fue hasta 1977 cuando Kennedy y Knudson la consideraron como un síndrome, el cual se caracteriza por una tríada conformada por insuficiencia hepática, vasodilatación pulmonar e hipoxemia. Entre las causas de esta entidad clínica se encuentra la insuficeincia hepatica, ya sea aguda o crónica. El factor relajante del endotelio es aparentemente la principal causa de las alteraciones vasculares pulmonares. La sintomatología es la producida por la insuficiencia hepática per se como ascitis, ictericia, eritema palmar, varices esofágicas, hemorragia del tubo digestivo, y por el componente pulmonar como son, ortodeoxia, hipocratismo digital y cianosis. Los mecanismos de hipoxemia en el SHP son alteraciones de la ventilación perfusión, cortos circuitos y trastornos de la difusión. El diagnóstico se realiza con base en diferentes estudios, como son la radiografía de tórax, el gammagrama perfusorio, la ecocardiografía contrastada bidimensional y la angiografía. Hasta el momento, no hay un tratamiento conocido que sea totalmente efectivo, no obstante el trasplante hepático ha sido considerado como la mejor opción, aunque otros como la embolización y terapia farmacológica pueden ser utilizados
Assuntos
Humanos , Cirrose Hepática/complicações , Endotélio Vascular/fisiopatologia , Hipóxia/etiologia , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Doenças Vasculares/diagnóstico , Doenças Vasculares/tratamento farmacológico , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia , VasodilataçãoRESUMO
Antecedentes: La tuberculosis es un problema mundial de salud, y los ancianos son una población con alto riesgo de desarrollar la enfermedad. Se ha sugerido que la presentación clínica de la tuberculosis en los ancianos es diferente a la de sujetos más jóvenes. Objetivo: Evaluar diferencias en las características clínicas, radiológicas y de laboratorio de la tuberculosis pulmonar en ancianos y en otras edades. Diseño del Estudio: Se revisaron los expedientes clínicos de 62 ancianos (= 65 años) y de 190 pacientes de menor edad (16-64 años) hospitalizados por tuberculosis en el Instituto Nacional de Enfermedades Respiratorias (Ciudad de México) entre 1991 y 1994. Resultados: Ambos grupos de pacientes tuberculosos tuvieron predominio del sexo masculino (1.8:1) y un gran retardo para el diagnóstico (> 6 meses en cerca del 45 por ciento de los pacientes). La mayoría de los síntomas (tos, fiebre, pérdida ponderal y disnea) fueron similares en ambos grupos, pero la producción de expectoración fue mayor en los ancianos. De la misa manera, en la radiografía de tórax más ancianos presentaron lesiones basales y multilobares. En ambos grupos se encontró anemia y bajos niveles séricos de albúmina. Aunque los demás exámenes de sangre periférica (leucocitos, linfocitos y sodio en comparación con los pacientes más jóvenes. Conclusiones: Los resultados sugieren que la tuberculosis pulmonar tiene una presentación parecida entre ancianos y otras edades, si bien existen algunas diferencias que hay que considerar al momento del diagnóstico