Tuberculosis: características epidemiológicas en un hospital tipo IV / Tuberculosis: epidemiological characteristics in a type IV hospital

La tuberculosis (TB) es un problema de salud pública. Analizar la epidemiologia de la tuberculosis en los últimos 10 años. Se diseñó un estudio de casos, descriptivo y analítico, observacional, transversal y retrospectivo en una muestra no probabilística, que incluye 100% de las historias de pacientes mayores de 14 años de edad, de cualquier sexo, con diagnóstico de TB en cualquiera de sus formas clínicas, atendidos en el Hospital General del Oeste, Dr. José Gregorio Hernández, de Caracas, durante el periodo comprendido entre enero de 2004 y diciembre 2013, divididos en dos grupos de 5 años consecutivos denominados A y B. Se analizaron 475 historias médicas, correspondientes a 241 pacientes del grupo A y 234 del B. La edad promedio del grupo total fue 38,97 ± 15,97 con un predominio del género masculino en 60.6%. La mayor parte de la muestra fueron personas que provienen de Caracas en ambos grupos. El estrato socioeconómico fue predominantemente IV de la clasificación de Graffar y representó el 41% en el grupo A y a 73,9% en el B con diferencia estadísticamente significativa. Se identificaron14, 1% y 19,7% de pacientes con enfermedad relacionada con el VIH en los Grupos A y B. Pocos sujetos tenían enfermedades debilitantes crónicas predisponentes y la más importante fue la desnutrición que duplicó la frecuencia en el grupo B (26,5%) vs (12%) en el A , estadísticamente significativa. La radiología de tórax fue el método más utilizado. En el Grupo A recibieron Prueba Terapéutica 52 pacientes mientras que en grupo B, 70. El grupo representó tuberculosis pulmonar en 71,78% para el grupo A y 68,37% para el B: el resto fue en diversas localizaciones extra pulmonares donde predominaron la pleura y los ganglios. Se cumplió la meta terapéutica en 77,1% de grupo A y 80.36% del grupo B y los restantes en ambos grupos correspondieron al abandono de tratamiento o fallecimiento. La desnutrición fue muy importante en el grupo de estudio reciente y el VIH se mantuvo...

Tuberculosis is a public health problem. To analyze the epidemiology of tuberculosis in the last 10 years. A case study, descriptive and analytical, observational, cross-sectional and retrospective in a non random sample, which includes 100% of the records of patients over 14 years of age, of any gender, diagnosed with TB in any one of its clinical forms, treated in the Hospital Dr. José Gregorio Hernández, Caracas, during the period between January 2004 and December 2013 divided in two groups of 4 consecutive years called A and B. 475 medical records were analyzed corresponding to 241 patients in group A and 234 in B. The average age of the total group was 38.97 ± 15.97 with a predominance of the male gender in 60.6%. The majority of the sample belonged to people coming from Caracas in both groups. Socioeconomic level classification Graffar IV was predominant and accounted for 41% in group A and 73.9% in group B with significant statistical difference. 14.1% and 19.7% of patients were identified with HIV-related in Groups A and B. Few patients had chronic debilitating diseases and malnutrition was the most important and it doubled its frequency in group B (26.5%) vs (12%) with a statistically significant difference. The chest x-ray was the most used method. In Group A, 52 patients received therapeutic test while in group B were 70. The group accounted for pulmonary tuberculosis in 71.78% in group A and 68.37% for the B: the rest were in various extrapulmonary sites where it dominated in pleura and ganglia. The therapeutic goal was fulfilled in 77, 1% of group A and 80, 36% in group B and the rest in both groups corresponded to treatment abandonment or death. Malnutrition was very important in the second study group and HIV remained with similar frequency in both groups

Prevalencia de Encephalitozoon intestinalis y Enterocytozoon bieneusi en pacientes VIH positivos de Maracaibo, Venezuela / Prevalence of Encephalitozoon intestinalis and Enterocytozoon bieneusi in HIV positive patients to Maracaibo, Venezuela

Los microsporidios pueden provocar infecciones emergentes y oportunistas en individuos inmunocomprometidos de todo el mundo. Se realizó éste estudio para identificar las especies de microsporidios intestinales presentes en pacientes con VIH-SIDA del Servicio Autónomo Hospital Universitario de Maracaibo (SAHUM). Se recolectaron 50 muestras fecales de individuos con diagnóstico confirmado de VIH durante los años 2007-2008; se obtuvieron las cifras de CD4 de solo 42 pacientes. Las muestras se analizaron mediante PCR separadas para la identificación de Encephalitozoon intestinalis y Enterocytozoon bieneusi. Las especies de microsporidios presentaron un 36% de prevalencia, 10 pacientes presentaron Encephalitozoon intestinalis, 4 Enterocytozoon bieneusi y 4 ambas especies. Se determinó una relación inversamente proporcional y estadísticamente significativa entre el contaje de CD4 y la presencia de microsporidios en la muestra fecal. Es destacable la elevada prevalencia de especies de microsporidios observada en los pacientes VIH estudiados, donde predominó E. intestinalis.

Microsporidioses are considered emerging and opportunistic infections in immunocompromised individuals worldwide. The purpose of this study was to identify the species of intestinal microsporidia in patients with HIV-AIDS from the Servicio Autónomo Hospital Universitario de Maracaibo, Venezuela (SAHUM). Fecal samples were collected from 50 patients with confirmed diagnosis of HIV, during the years 2007 and 2008; the CD4 values were obtained from 42 patients. The samples were analyzed by separate PCRs to identify Encephalitozoon intestinalis and Enterocytozoon bieneusi. Microsporidia species showed a 36% prevalence: ten patients had Encephalitozoon intestinalis, four Enterocytozoon bieneusi and four both species. An inverse and statistically significant relationship between the CD4 count and the presence of microsporidia in the fecal sample was also found. It is remarkable the high prevalence of microsporidia species observed in the HIV patients studied, with a predominance of E. intestinalis.

Global nutrition policy review: What does it take to scale up nutrition action?

Este informe presenta los actuales desafíos globales de nutrición, sobre la base de datos de diversas fuentes, incluyendo bases de datos existentes de nutrición mundiales de la OMS está administrado por el Departamento de Nutrición para la Salud y el Desarrollo, los métodos y los principales resultados de la Revisión de la Política Global de Nutrición, mostrando el alcance de la política y la ejecución de los programas y la gestión nutricional en 119 Estados Miembros de la OMS y 4 territorios que proporciona respuestas , las conclusiones sumarias y el camino a seguir. Aunque los países tienen diferentes preocupaciones nutricionales, algunas intervenciones son relevantes a nivel mundial; por ejemplo, los que se ocupan de la "ventana de oportunidad" desde el embarazo hasta los 2 años de edad, como la lactancia materna óptima y las prácticas adecuadas de alimentación complementaria. Debido a que muchos países de una región tienen problemas de nutrición similares, los datos están desglosados por regiones en la mayoría de las partes del informe. El informe también incluye una evaluación de lo bien actual políticas y programas relacionados con la nutrición se encuentran los problemas de nutrición que se enfrentan los países, y de la política y la gobernanza para la ampliación de las actividades de nutrición. La comunidad internacional debe comprender los desafíos en la implementación de la nutrición políticas y programas con el fin de prestar apoyo a las áreas de mayor necesidad y las áreas donde serán más efectivos. Entender "el paisaje de nutrición" y su "arquitectura" en los países, y la identificación de las formas de superar los desafíos, se asegurará el uso eficaz de los recursos. Este informe está dirigido a las partes interesadas que están trabajando con los países para aplicar políticas y programas de nutrición; incluidos los organismos internacionales y bilaterales, organizaciones no gubernamentales (ONG), la sociedad civil y el sector privado.

Supplementary Feeding in the Care of the Wasted HIV Infected Patient

Wasting and food insecurity are commonly seen in patients receiving antiretroviral treatment (ART) programs in sub-Saharan Africa and south Asia; and supplementary feeding is often offered in conjunction with ART. Evidence for the effectiveness of such supplementary feeding is scant. A randomised; investigatorblinded; controlled clinical trial of two types of supplementary food; corn/ soy blended flour and a ready-to-use peanut butterbased lipid paste; in wasted adults in Blantyre; Malawi is described and the results summarised. A historical control group who did not receive supplementary food is described as well. Provision of about half of the daily energy requirement as a supplementary food for 14 weeks resulted in more rapid restoration of a normal BMI; and the energy-dense; ready-to-use paste was associated with more rapid weight gain than the blended flour. Survival was similar among the 3 groups. The strong association between lower BMI and survival indirectly suggests that there may well be clinical benefit from supplementary feeding in this population. No differences were seen in ART adherence or quality of life with more rapid restoration of BMI. Further research is urgently needed concerning the widespread practice of supplementary feeding in HIV/ AIDS care to most effectively utilize this intervention

O papel do hormônio de crescimento no tratamento dos distúrbios endócrino-metabólicos do paciente com a síndrome da imunodeficiência adquirida (Aids): [revisão] / The use of growth hormone to treat endocrine-metabolic disturbances in acquired immunodeficiency syndrome (Aids) patients: [review]

As primeiras descrições da síndrome da imunodeficiência adquirida (Aids) associavam-se à síndrome de emaciamento, e os distúrbios metabólicos às alterações na composição corporal. Após a introdução da terapia anti-retroviral altamente ativa (HAART), houve declínio na desnutrição, e surge a lipodistrofia como importante distúrbio metabólico. A Aids também se caracteriza por distúrbios hormonais, principalmente no eixo hormônio de crescimento/fator de crescimento insulina-like tipo 1 (GH/IGF-1). O uso do GH recombinante humano (hrGH) foi inicialmente indicado na síndrome de emaciamento, a fim de aumentar a massa muscular. Embora também não existam dúvidas quanto aos efeitos do hrGH na lipodistrofia, a diminuição na sensibilidade à insulina limita o seu uso, o qual ainda não está oficialmente aprovado. A diversidade nos esquemas de tratamento é outro limitante do uso dessa medicação em pacientes com Aids. Esta revisão apresenta os principais distúrbios endócrino-metabólicos associados à Aids e ao uso do hrGH nessas condições.

Acquired Immunodeficiency Syndrome (Aids) was initially related to HIV-associated wasting syndrome, and its metabolic disturbances to altered body composition. After Highly Active Antiretroviral Therapy (HAART) was started, malnutrition has declined and HIV-associated lipodystrophy syndrome has emerged as an important metabolic disorder. Aids is also characterized by hormonal disturbances, principally in growth hormone/insulin-like growth factor 1 (GH/IGF-1) axis. The use of recombinant human GH (hrGH) was formerly indicated to treat wasting syndrome, in order to increase lean body mass. Even though the use of hrGH in lipodystrophy syndrome has been considered, the decrease in insulin sensitivity is a limitation for its use, which has not been officially approved yet. Diversity in therapeutic regimen is another limitation to its use in Aids patients. The present study has reviewed the main HIV-related endocrine-metabolic disorders as well as the use of hrGH in such conditions.

Terapia nutricional na diarréia crônica refratária associada à síndrome consumptiva em paciente HIV positivo: relato de caso / Nutritional therapy in chronic diarrhea rephractive associated with consumptive sydrome in positive HIV/AIDS patients: case report

A suplementação dietética de fibras solúveis e L-glutamina tem mostrado efeitos benéficos na diarréia crônica relacionada à AIDS. O objetivo deste trabalho foi avaliar o efeito da suplementação enteral com L-glutamina e goma guar parcialmente hidrolisada em paciente com diarréia refratária associada à Sindrome Consumptiva do HIV/AIDS. Paciente sexo feminino, 45 anos, HIV há 10 anos, diagnóstico de Síndrome Consumptiva (1 ano), apresentando diarréia aquosa sem sangue ou muco (8 - 10 evacuações/dia) há 6 meses. A avaliação antropométrica indicou um IMC = 15,2 kg/m2, perda de peso de 20,7%, circunferência do braço e prega cutânea tricipital com adequação de 54% e 38%, respectivamente, caracterizando desnutrição grave. A paciente recebeu 30g de L-glutamina e 35g de goma guar durante 10 dias por via enteral adicionada a uma dieta semi-elementar. A partir do 2° dia, o número de evacuações foi reduzido, sem alteração de consistência. No 4° dia, 1 evacuação líquida e a partir do 5° dia, ocorreu normalização da função intestinal, com fezes pastosas 1 vez/dia e melhora do estado clínico geral. A terapia nutricional enteral acrescida de L-glutamina e fibra solúvel mostrou-se eficaz no controle da diarréia, provavelmente por auxiliar no reparo da mucosa colônica, favorecendo a rápida recuperação intestinal.

Metabolic and morphologic complication of Hiv infection

In the era of highly active antiretroviral therapy, long-term complications of HIV infection and antiretroviral therapy deserve heightened attention. Morphologic and metabolic complications seen during the course of HIV infections encompass a variety of entities that may share a common pathophysiologic pathway. This review article will discuss clinical syndromes such as wasting, lipoatrophy/ lipohypertrophy, polymetabolic syndrome as well as hyperlipidemia, cardiovascular disease, lactic acidosis, and metabolic bone disease in HIV-infected patients

HIV/AIDS wasting syndrome in Manipur - a case report.

A-30-years old married man with HIV/AIDS wasting syndrome is being reported. The patient had history of injecting heroin with rampant sharing with his drug partners, weight loss, night sweats, productive cough, severe muscle wasting, chronic diarrhoea >30 days and fever > 30 days. This syndrome indicates the long-standing complication of HIV infection. Blood, sputum, CSF, faeces and urine routine and culture examination findings to rule out opportunistic infections were repeatedly negative. No malignant cells were found. HIV testing was positive. The CD 4 positive T-lymphocyte count was measured before and after six months of treatment. In the present case report, evaluation of the symptoms yielded no specific pathogen and had no evidence of opportunistic infections. He is being placed under observation with highly active antiretroviral therapy (HAART) along with nutritional support. He is improving clinically and immunologically by raising in the patient's CD4 count. Early antiretroviral therapy along with meticulous nutritional support is ideal to improve the quality of life of AIDS patients.

Manifestações endócrinas e metabólicas da Síndrome de Imunodeficiência Adquirida / Endocrine and metabolic manifestations of Acquired Immunodeficiency Syndrome

Os autores revisam os principais distúrbios endócrinos e metabólicos associados à síndrome da imunodeficiência adquirida (Sida/Aids).

In the present paper the endocrine compromising in acquired immunodificiency syndrome (Aids) is reviewed.

D-xylose absorption in non-chronic diarrhea AIDS patients with the wasting syndrome.

OBJECTIVE: To compare the intestinal absorptive capacity, permeability function and duodenal histopathology in human immunodeficiency virus (HIV) patients with or without wasting syndrome who had not suffered from chronic diarrhea. METHOD: Adult HIV patients who attended Chulalongkorn Hospital were included. The subjects were classified into wasting and non-wasting groups (group I and group II). 25 g oral D-xylose test, oral phenolsulfonephthalein test and duodenal histopathology were performed. RESULTS: Of thirty-two HIV patients, aged between 25-50 years enrolled, there were 18 and 14 patients in group I and group II, respectively. In both groups, the baseline data, permeability function and histopathology were similar. Intestinal absorptive capacity was statistically different, i.e. 5-hour urine D-xylose was 3.96 +/- 2.81 g and 5.95 +/- 2.47 g in group I and group II respectively (p < 0.05). CONCLUSION: This study demonstrated that D-xylose absorption was decreased in non-diarrheal, wasting HIV infected patients. Abnormal absorptive capacity is a common phenomenon found in HIV patients with wasting syndrome as determined by standard 25 g oral D-xylose test.

AIDS-associated diarrhea and wasting in northeast Brazil is associated with subtherapeutic plasma levels of antiretroviral medications and with both bovine and human subtypes of Cryptosporidium parvum

Advanced HIV infection is frequently complicated by diarrhea, disruption of bowel structure and function, and malnutrition. Resulting malabsorption of or pharmacokinetic changes in antiretroviral agents might lead to subtherapeutic drug dosing and treatment failure in individual patients, and could require dose adjustment and/or dietary supplements during periods of diarrheal illness. We determined the plasma levels of antiretroviral medications in patients that had already been started on medication by their physicians in an urban infectious diseases hospital in northeast Brazil. We also obtained blood samples from patients hospitalized for diarrhea or AIDS-associated wasting, and we found reduced stavudine and didanosine levels in comparison with outpatients without diarrhea or wasting who had been treated at the same hospital clinic. There was a predominance of the protozoal pathogens Cryptosporidium and Isospora belli, typical opportunistic pathogens of AIDS-infected humans, in the stool samples of inpatients with diarrhea. We conclude that severe diarrhea and wasting in this population is associated with both protozoal pathogens and subtherapeutic levels of antiretroviral medications

Nutritional supplementation according to energy and protein requirements in malnourished HIV-infected patients

To evaluate the effects of nutritional supplements on nitrogen and energy balances, body composition and immune parameters, HIV-infected malnourished adult outpatients were prospectively studied. Forty-six patients (4 females and 42 males; 37 +/- 12 y) were supplemented with a polymeric diet (PD) or regular foods (RF) on two consecutive 45-day periods on a crossover design. Weight, skinfold thicknesses, plasma albumin (PA), CD4 and CD8 lymphocyte counts (LC), resting energy expenditure (REE) and urinary nitrogen excretion were measured at baseline, 45 and 90-day. Food intake was weekly recorded by food surveys. Thirty-five patients completed the protocol (18 in Group 1:PD-->RF; 17 in Group 2:RF-->PD). In both groups, weight, fat free mass (FFM), energy balance (EB) and nitrogen balance (NB) increased significantly after PD, whereas LC and PA remained unchanged in both groups. The best results in terms of weight gain were obtained in the PD group and PD plus zidovudine subgroup (n = 8) during the first 45 days (weight gain/FFM gain: 4.8/2.6 kg and 6.8/3.1 kg, respectively). Nutritional supplement with PD, according to the EB and NB goals, was well tolerated and permitted to achieve a significant weight and FFM gain over a 90-day follow-up.

Role of nutrition in the management of HIV infection/AIDS.

In patients with HIV infection/AIDS, in addition to the antiretrovival therapy nutritional support is needed to maintain optimum nutrition during the symptomatic period, to prevent further deterioration of nutritional status during acute episodes of infections and to improve nutritional status during the stable symptom free period. This can be achieved by (a) nutritional assessment, (b) nutritional screening, (c) nutritional intervention and by providing (d) psychosocial support for nutrition.

Epidemiologic and clinical features of HIV infection/AIDS in Koreans / 대한내과학회지

BACKGROUND: The epidemiologic and clinical features of HIV infection/AIDS are different among various races, regions, and countries. To determine the epidemiologic and clinical characteristics of HIV infection in Korea, we analyzed and compared with that of other populations. METHODS: Medical records of 176 HIV-infected persons in Severance Hospital of Yonsei University College of Medicine and Hospital of Pusan University College of Medicine from year 1985 to 2000 were reviewed retrospectively. RESULTS: One hundred and seventy six patients were analyzed among which 156 (88.6%) were male and 20 (11.4%) were female with a male to female ratio of 7.8:1. At the time of diagnosis, the age distribution was 78 cases (44.3%) in the thirties, 44 cases (25.0%) in the twenties, and 35 cases (19.9%) in the fourties, and the mean age was 35.9+/-9.3. Heterosexual contact was the most frequent transmission route (92 cases, 52.3%), and 42 cases (23.9%) were transmitted by homosexual contact. At initial visit, asymptomatic HIV infection constituted 75 cases (42.6%), and AIDS 72 cases (40.9%). At initial visit, mean value of CD4+ lymphocyte counts was 252/mm3 and HIV RNA 226,035 copies/mm3. One hundred and twenty one of 176 patients developed 317 cases of opportunistic diseases. At the diagnosis of HIV-related opportunistic diseases, mean CD4+ lymphocyte count was 140/mm3 and mean HIV RNA 347,403 copies/mm3. Candidiasis (50 cases, 28.4%) was the most frequent opportunistic disease followed by pneumocystis carinii pneumonia (PCP) (37 cases, 21.0%), tuberculosis (29 cases, 16.5%), cytomegalovirus (CMV) infection (21 cases, 11.9%), HIV encephalopathy (9 cases, 5.1%), and herpes zoster (9 cases, 5.1%). There were 3 cases (1.7%) of malignant lymphoma and 2 cases (1.1%) of Kaposi's sarcoma. At the diagnosis of opportunistic diseases, mean CD4+ lymphocyte counts of patients with candidiasis was 71/mm3, PCP 63/mm3, and tuberculosis 142/mm3, and the mean HIV RNA level was 338,474 copies/mm3, 281,967 copies/mm3, and 817,012 copies/mm3 respectively. Among the 317 opportunistic diseases, AIDS-defining diseases were 150 cases (47.3%), of which PCP was 37 cases (24.7%), tuberculosis 29 cases (19.3%), CMV infection 21 cases (14.0%), HIV wasting syndrome 15 cases (10.0%), and esophageal candidiasis 14 cases (9.3%). The earliest AIDS-defining diseases to manifest in AIDS patients were tuberculosis (25 cases, 33.3%), followed by PCP (17 cases, 22.6%), esophageal candidiasis (14 cases, 18.7%), CMV infection (5 cases, 6.6%), and HIV wasting syndrome (4 cases, 5.3%). Thirty five (19.9%) of 176 patients were died. The common causes of death were tuberculosis (9 cases, 25.7%), PCP (9 cases, 25.7%), bacterial pneumonia (7 cases, 20.0%) and HIV encephalopathy (3 cases, 8.5%). CONCLUSION: The epidemiologic and clinical features of HIV infection/AIDS in Korea are different from that of developing countries such as Southeast Asia and Africa as well as from that of developed countries.

Informe anual del programa de control de tuberculosis VI: 1998

Corresponde al informe anual que realiza el programa de tuberculosis del MINSA. Refleja el analisis de las actividades durante el año 1998, los resultados del tratamiento de 1997 y la la captacion de 1998 por SILAIS en el pais, con la finalidad de cada uno de ellos conozca la situacion local y se planteen estrategias eficaces en aquellos con dificultades o se fortalezcan las ya existentes. Presenta en graficos la incidencia de todas las formas de tuberculosis por SILAIS , En investigaciones presenta los estudios de prevalencia del VIH/TB y el estudio de resistencia inicial a medicamentos por SILAIS. Contiene conclusiones y recomendaciones

Pneumocystis carinii pneumonia versus wasting syndrome among AIDS cases in Puerto Rico: a survival analysis

OBJECTIVE: To compare mortality of wasting syndrome (WS) versus Pneumocystis carinii pneumonia (PCP) in AIDS patients reported in Puerto Rico after controlling for gender, age, and CD4 levels. METHODS: AIDS patients for which a diagnosis of WS (n = 1,180) or PCP (n = 765), who were reported to the AIDS Surveillance System of Puerto Rico between 1989 and 1992, were used to analyze the mortality risk among these diagnoses using a Cox's proportional hazard regression model. RESULTS: Cox model showed that WS patients had a 14 per cent to 33 per cent reduction in mortality risk compared with PCP patients after adjusting for gender and age (95 per cent confidence level). Mortality risks for males were 18 per cent (95 per cent CI: 1 per cent, 39 per cent) higher than females risk after adjusting for AIDS defining condition and age. It was shown that a decrease in 100 CD4 cells increased the mortality by 37 per cent (95 per cent CI: 16 per cent, 62 per cent) after adjusting for AIDS defining conditions, gender, and age.