ABSTRACT
Introduction: Potentially hepatotoxic drugs are used in tuberculosis treatment. The incidence range of drug-induced liver injury (DILI) varies from 0.6 to 33 percent. Adverse reactions can be asymptomatic; therefore periodical liver tests are required. Multiple risk factors are described, such as age and HIV infection, among others. Objective: To determine risk factors associated to DILI and secondary lethality in patients receiving anti-tuberculosis drugs. Materials and Methods: The database from the Servicio de Salud Metropolitano Central de Chile was used. 1,249 patients were analyzed from 2003 to 2008 to determine DILIs frequency and time of appearance. Multivariate binominal regression was used to study possible risks associated to hepatotoxicity. Results: 2,8 percent of our patients presented DILI (n = 35), three of them died from this cause (8.5 percent). Association between DILI and HIV infection and extrapulmonary tuberculosis was observed (p < 0.01). DILI was present in 50 percent of our patients before the 23rd day. Conclusions: We propose a more exhaustive control of the liver function in patients with DILI risk factors, including HIV carriers and extrapulmonary tuberculosis.
Introducción: El tratamiento antituberculosis incluye drogas hepatotóxicas, estimándose una incidencia de daño hepático inducido por medicamentos (DHIM) entre 0,6 y 33 por ciento. Puede ser asintomático, debiendo evaluarse periódicamente con perfil hepático. Se han descrito múltiples factores de riesgo, como mayor edad e infección por VIH, entre otros. Objetivo: Determinar factores asociados al desarrollo de DHIM y letalidad secundaria a tratamiento antituberculosis. Materiales y Métodos: Base de datos del Programa de Tratamiento antituberculosis del Servicio de Salud Metropolitano Central de Chile. Se analizaron 1.249 pacientes entre 2003 y 2008. Se determinó frecuencia y tiempo de aparición de DHIM. Se estudiaron posibles factores asociados a hepatotoxicidad mediante regresión binomial. Resultados: se diagnosticó DHIM en 2,8 por ciento de los pacientes (n = 35), falleciendo 3 de ellos por esta causa (8,5 por ciento). Se observó asociación entre DHIM con ser portador de VIH (+) y tuberculosis extrapulmonar (p < 0,01). Aparición de DHIM antes del día 23 en 50 por ciento de los casos. Conclusión: Sugerimos un control más exhaustivo del perfil hepático en pacientes con factores de riesgo, entre los cuales deben considerarse los portadores de VIH y tuberculosis extrapulmonar.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Antitubercular Agents/adverse effects , Chemical and Drug Induced Liver Injury/epidemiology , Tuberculosis/complications , Incidence , Regression Analysis , Retrospective Studies , Risk Factors , Tuberculosis/drug therapyABSTRACT
El melanoma es un cáncer que afecta principalmente a la piel. La Organización Mundial de la Salud estima que las cifras de incidencia y mortalidad anual son 2,8 y 0,6 por ciento habitantes, respectivamente. El presente trabajo pretendió revisar la información científica publicada sobre incidencia y sobrevida, y analizar la mortalidad (desde 1983 al 2008). La tasa de incidencia estandarizada estimada para el año 2008 fue 2,2, ese mismo año la tasa de mortalidad estandarizada fue 0,65. Entre 1983 y 2008 la tasa de mortalidad promedio fue 0,77, observándose un 25 por ciento de aumento, estadísticamente significativo. En cuanto a sobrevida, solo hay trabajos locales donde se observa que ésta oscila entre 100 por ciento y 33 por ciento a los 5 años de acuerdo al nivel de Clark y estadío TNM. En general, hay escasa información sobre la epidemiología del melanoma en Chile. Se requieren más estudios y focalizar las estrategias en la prevención.
Melanoma affects mainly the skin. The World health Organization estimates that standardized incidence and mortality rates are 2.8 an 0.6 percent inhabitants respectively. This study reviewed the published scientific information regarding incidence and survival and analyzed mortality data from 1983 to 2008. 2008 standardized incidence rate was 2.2 percent inhabitants and standardized mortality rate for the same year was 0.65. Mean mortality rate from 1983 to 2008 was 0.77. A 25 percent increase was found. Regarding survival, only local data is available and it ranged from 100 percent to 33 percent according to Clark Level and TNM classification. Melanoma epidemiology information is scarce in Chile. More studies are needed and prevention strategies must be implemented.
Subject(s)
Humans , Melanoma/epidemiology , Skin Neoplasms/epidemiology , Chile/epidemiology , Disease Prevention , Incidence , MortalityABSTRACT
Background: Adult women with adrenal congenital hyperplasia (AH) have a higher risk for insulin resistance, dyslipidemia, hypertension, high body mass index (BMI) and increased body fat. All these factors are associated with cardiovascular risk and metabolic syndrome (MS). Aim: To evaluate the presence of MS in pubertal classic AH girls (CAH) and a control group (C). Material and Methods: We studied 15 pubertal AH patients (12.0 +/- 1.9 years) and 26 controls (11.7+/- 0.3 years) matched by age and tanner stage. Weight, height, BMI, waist/hip ratio, blood pressure and serum lipids were measured. An oral glucose tolerance test (OGTT) and insulin curve was performed in CAH girls whereas in controls basal insulin and glucose were determined. The homeostasis model assessment for insulin resistance (HOMAIR) was calculated. Cook, Ferranti and international diabetes federation (IDF) criteria were used to determine the presence of MS. Results: CAH and C girls had similar BMI (22.0 +/- 5.1 and 20.1 +/- 3.6 kg/m2 respectively; p = 0,11). CAH girls had higher basal blood glucose (80.8 +/- 7.7 and 60.6 +/- 10.6 mg/dl respectively, p < 0.01) and controls had higher triglyceride levels (147.0 +/- 69.3 and 79.7 +/-16.3 mg/dl respectively, p < 0.01) and lower HDL cholesterol levels (45.8 +/- 12.8 and 56.9 +/- 17.5 mg/dl respectively, p = 0.02). According to cook criteria 4 percent of CAH girls and 23 percent of controls has MS. These figures were 14 and 32 percent respectively according to Ferranti criteria and 0 and 5 percent respectively according to IDF criteria. Conclusions: CAH puberal patients do not have a higher prevalence of metabolic syndrome, compared with controls with similar Tanner stage and BMI.