ABSTRACT
OBJECTIVE: El presente estudio se efectuó para determinar la prevalencia del virus de la inmunodeficiencia humana tipo 1 (VIH-1) en pacientes con tuberculosis pulmonar del National Chest Hospital en Jamaica. MÉTODOS: En este estudio retrospectivo se revisaron los expedientes hospitalarios de 537 pacientes ingresados a lo largo de un período de siete años, de 1995 a 2001. Utili- zamos un formulario uniformado para obtener los datos relacionados con las características sociodemográficas; los rasgos, signos y síntomas clínicos; el diagnóstico de laboratorio; el tratamiento administrado, y los resultados observados. RESULTADOS: Encontramos que 11,6% (47/406) de los pacientes que satisfacían los criterios de inclusión y a quienes se les había diagnosticado tuberculosis pulmonar tenían seropositividad al VIH-1. La mayoría de los pacientes tuberculosos con positividad a VIH eran de sexo masculino, y la mayor prevalencia de infección simultánea con VIH en pacientes tuberculosos se observó en personas entre los 30 y 39 años de edad. La tasa de mortalidad en pacientes con tuberculosis e infección por VIH fue de 23,4% (11/47), en comparación con 3,9% (14/359; P = 0,001) en pacientes sin infección por VIH. A los pacientes se les administró el tratamiento estándar con cuatro medicamentos. No se observó ninguna resistencia en las cepas aisladas de Mycobacterium tuberculosis. CONCLUSIONES: En Jamaica la prevalencia de VIH en pacientes con tuberculosis es parecida a la observada en otros países en desarrollo, pero la tasa de mortalidad en estos pacientes es mayor. Por lo tanto, es imprescindible diagnosticar la infección por VIH en etapa temprana e iniciar de inmediato el tratamiento antirretrovírico de gran actividad.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , HIV-1 , HIV Infections/epidemiology , Tuberculosis, Pulmonary/epidemiology , HIV-1 , Age Factors , Antitubercular Agents/pharmacology , Antitubercular Agents/therapeutic use , Comorbidity , Cross-Sectional Studies , Data Interpretation, Statistical , HIV Seronegativity , HIV Seropositivity/epidemiology , HIV Seropositivity/mortality , Hospitals, Special , Jamaica/epidemiology , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/isolation & purification , Retrospective Studies , Sex Factors , Sputum/microbiology , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/mortalityABSTRACT
The HLA phenotypes were investigated in 30 Jamaican patients with systemic lupus erythematosus (SLE), 30 with rheumatoid arthritis (RA) an d forty healthy controls. HLA phenotypes were determined by the microcytotoxicity technique, using commercially prepared typing trays. In this study, the HLA phenotypic associations with SLE (HLA-B14, RR 4.3: HLA-A28, RR 4.3) were not statiscally significant. However, a statistically significant lack of HLA-A9 (p<0.01;CP<0.1) was observed in SLE patients compared to healthy controls. In RA patients, a statistically significant associations was noted with HLA-A2 (RR5.1; CP<0.01). No HLA class 11 associations were noted with SLE. Class 11 associations with RA did not achieve statistical significance but included those previously established in other populations. The preliminary data obtained from this study indicate differences in the patterns of HLA phenotypes in Jamaican patients with SLE and RA compared to those observed in such patients elsewhere. Further studies involving larger groups of patients and typing at the serological, cellular and molecular levels are clearly warranted
Subject(s)
Humans , Arthritis, Rheumatoid/immunology , HLA Antigens/genetics , Lupus Erythematosus, Systemic/immunology , Phenotype , Ethnicity/genetics , Risk Factors , JamaicaABSTRACT
Cardiologic and laboratory parameters were studied in 21 patients with systemic lupus erythematosus (SLE) with cadiopulmonary symptoms (CPS), 20 SLE patients without CPS and 45 age-and sex- matched healthy controls. The most frequent cardiac abnormalities in patients with CPS included pericardial effusion (24 per cent), ventricular enlargement (20 per cent), mitral regurgitation (19 per cent) and tricuspid regurgitation (14 per cent). No structural abnormalities were observed in SLE patients without CPS. Mean calculated and derived echocardiacgraphic values in both groups of SLE patients differed significantly from those observed in normal controls (p< 0.004). Patients with CPS had significantly lower mean values of ejection fraction (p< 0.05) and fractional shortening (p< 0.03). However, the frequencies of functional abnormalities in patients with CPS did not differ significantly from those observed in patients without CPS. There were no remarkable laboratory findings in SLE patients with CPS compared to those without. The finding that some SLE patients may have functional cardiac abnormalities in the absence of CPS is an important one. It raises the question as to whether asymptomatic cardiac involvement in SLE is a separate entity or whether it heralds symptomatic cardiopulmonary involvement