Evaluation of disease patterns, treatment and prognosis of tuberculosis in AIDS patient

Patterns of disease, diagnosis, treatment and prognosis of tuberculosis in 100 patients co-infected with AIDS at Casa da AIDS clinic was studied. Demographic characteristics were as follows: 76 male patients, 24 female patients, 67 caucasian, average 35.8 years-old (SD +/- 8.5). Sexual transmission of HIV was reported in 68 patients. Pulmonary tuberculosis was seen in 40 patients, extrapulmonary in 11, and combined in 49 patients. In 63 patients, TCD(4)(+) counts were below 200/mm(3) when tuberculosis was diagnosed. Fifty-five patients had their diagnoses confirmed by bacteriological identification of Mycobacterium; either through direct observation and/or culture. Tuberculosis was treated with rifampin, isoniazid and pyrazinamide in 60 patients, reinforced treatment in 14 and alternative treatment in the other 13 patients. Tuberculosis therapy lasted up to 9 months in 66 of the patients. Fifty-four patients were treated with a two-drug antiretroviral regimen and the remaining 46 patients received a triple regimen, which included a protease inhibitor. Among the latter, 35 patients were co-treated with rifampin. The occurrence of hepatic liver enzyme abnormalities was statistically related to alternative antiretroviral regimens (p = 0.01) and to the co-administration of rifampin and protease inhibitor (p = 0.019). Clinical resolution of tuberculosis was obtained in 74 patients. Twelve patients died during tuberculosis treatment. Resolution of tuberculosis was statistically significant related to antituberculosis treatment adherence (p = 0.001). The risk of no response to the treatment was 1.84 times more frequent among patients treated with alternative regimens regardless of the duration of the therapy. We conclude that the characteristics of tuberculosis in HIV infected patients requires that special attention be directed to the types and duration of both antiretroviral and anti-TB therapy in order to achieve the highest level of care.

Amiodarona: uma agressäo à funçäo tiroidiana / Amiodarone: a agression to the thyroid function

A presente revisao foi realizada com a finalidade de verificar os efeitos da amiodarona sobre a funcao tiroidiana , visto que a droga e um derivado benzofurano de estrutura similar a iodo-tironina e tambem possui atomos de iodo em sua composicao molecular. O estudo foi baseado na analise retrospectiva dos ultimos 10 anos, quanto as propriedades da aminodarona em relacao ao tempo de administracao e quanto aos possiveis efeitos sobre os hormonios tiroidianos TSH e proteinas ligadoras de tiroxina, bem como o desencadeamento do fenomeno autoimune corroborando numa das provaveis patogeneses do desenvilvimento de hipo ou hipertiroidismo. Foram tambem relatados estudos da cinetica dos hormonimos tiroidianos e acoes farmacologicas da aminodarona em outros orgaos. Um numero significativo de pacientes desenvolveu alteracoes da glandula tireoide durante a terapia com amiodarona e tal fato pode ser explicado pelo excesso de iodo contido na droga, o qual pode acarretar tanto hipotiroidismo como hipertiroidismo, existindo controversias quanto a incidencia de ambos. A aminodarona e um antiarritmico de classe III, usado no tratamento e prevencao das arritmias cardiacas, sendo de suma importancia que sua administracao seja criteriosa, uma vez conhecidas as anormalidades induzidas pela droga, principalmente na glandula tireoide. Se possivel proscrever o seu uso em individuos com antecedente pessoal ou familiar, com patologias da tireoide