ABSTRACT
ABSTRACT Extrapulmonary tuberculosis associated with immune thrombocytopenia (ITP) is extremely rare. A likely association between ITP and pulmonary and lymph node tuberculosis was reported in a 29-year-old male patient. His platelet count decreased to 4,000/µL. Chest tomography revealed mediastinal adenomegaly, lymph node clusters in the aorta, and consolidation in the left upper lung lobe. Immunoglobulin and methylprednisolone were administered intravenously. The histopathology of the left upper lung lobe confirmed tuberculosis. The rifampicin/isoniazid/pyrazinamide/ethambutol regimen was initiated, and the corticosteroids were tapered off. This case suggests an association of tuberculosis with ITP, since the platelet count effectively normalized after tuberculosis treatment.
ABSTRACT
A disfunção endotelial é definida como sendo o conjunto de alterações encontradas na interface entre os elementos sanguíneos e os tecidos adjacentes. A disfunção endotelial é estudada em diversas condições, como aterosclerose, diabetes mellitus (DM), hipertensão arterial (HAS), hipercolesterolemia, entre outras. Esta revisão tem como objetivo descrever quais as evidências existentes, e/ou teorias propostas sobre a disfunção endotelial no contexto do diabetes mellitus tipo 2, contemplando não só a sua interferência na gênese da disfunção endotelial, como também sua relevância para o tratamento e até mesmo prevenção desta lesão, que sinaliza o início de muitas mazelas cardiovasculares dos pacientes com diabetes. Os mecanismos pelos quais o diabetes contribui para a disfunção endotelial não estão totalmente elucidados, mas é provável que a hiperglicemia seja um insulto importante para sua ocorrência. As concentrações de óxido nítrico derivado do endotélio (e-NO) muitas vezes têm sido descritas como normal nos pacientes diabéticos euglicêmicos, com tratamento otimizado, e com programas de exercício físico regular, porém, no estado hiperglicêmico a sua degradação e função se encontram alteradas. O conceito de disfunção endotelial como um mediador potencial para um aumento de risco de complicações cardiovasculares em pacientes com diabetes mellitus tipo 2 é bastante difundido na literatura, sendo que a restauração ou manutenção da função endotelial a partir de medidas não farmacológicas, principalmente pelo efeito do exercício físico, são aventadas como bastante importantes no desfecho final destes pacientes.
Endothelial dysfunction is defined as the set of changes found in the interface between blood elements and the surrounding tissues. Endothelial dysfunction is studied under various conditions such as atherosclerosis, diabetes mellitus, hypertension, hypercholesterolemia, among others. This review intends to describe the existing evidence and / or proposed theories about endothelial dysfunction in the context of type 2 diabetes mellitus, covering not only its interference in the genesis of endothelial dysfunction, as well as their relevance to the treatment and even prevention to this lesion that signalsthe beginning of many ills of cardiovascular patients with diabetes. The mechanisms by which diabetes contributes to endothelial dysfunction are not fully elucidated, but it is likely that hyperglycemia is a major insult to their occurrence. The concentrations of endothelium-derived nitric oxide have often been described as normal in the euglycemic diabetic patients with optimal treatment and programs of regular exercise, but in the hyperglycemic state, their degradation and function are altered. The concept of endothelial dysfunction as a potential mediator for increased risk of cardiovascular complications in patients with type 2 diabetes mellitus is widespread in the literature, and restoration or maintenance of endothelial function from non-pharmacological measures, especially the effect of exercise physical, are suggested as very important in the ending outcome of these patients.