Long-term follow-up for multidrug-resistant tuberculosis.

Patients treated in Peru for multidrug-resistant tuberculosis (MDR-TB) were followed-up for a median of 67 months. Among 86 patients considered cured after completion of treatment, 97% remain healthy; 1 patient relapsed. Employment increased from 34% before treatment to 71%. We observed favorable long-term outcomes among MDR-TB patients.

Hypokalemia among patients receiving treatment for multidrug-resistant tuberculosis.

INTRODUCTION: Between January 1999 and December 2000, 125 patients in Lima, Peru were enrolled in individualized treatment for multidrug-resistant tuberculosis (MDR-TB). Hypokalemia was observed to be an important adverse effect encountered in this cohort. OBJECTIVE: To identify risk factors associated with the development and persistence of hypokalemia during MDR-TB therapy, and to review the incidence and management of hypokalemia in patients receiving MDR-TB therapy. METHODS: A retrospective case series of 125 patients who received individualized therapy for MDR-TB between January 1, 1999, and December 31, 2000. RESULTS: Among 115 patients who were screened for electrolyte abnormalities, 31.3% had hypokalemia, defined as a potassium level of < 3.5 mEq/L. Mean serum potassium at time of diagnosis was 2.85 mEq/L. Diagnosis of low serum potassium occurred, on average, after 5.1 months of individualized therapy. Multivariate analysis of risk factors for this adverse reaction identified two causes: administration of capreomycin, and low initial body weight. Normalization of potassium levels was achieved in 86% of patients. CONCLUSIONS: Electrolyte disturbance was frequently encountered in our cohort of patients with MDR-TB. Successful screening and management of hypokalemia was facilitated by training the health-care team in the use of a standardized algorithm. Morbidity from hypokalemia can be significant; however, effective management of this side effect is possible without sacrificing MDR-TB treatment efficacy.

Treatment of multidrug-resistant tuberculosis during pregnancy: a report of 7 cases.

Multidrug-resistant tuberculosis (MDR-TB) is a global public health problem affecting women of childbearing age. Little is known, however, about the safety of the drugs used to treat MDR-TB during pregnancy. We describe 7 patients who were treated for MDR-TB during pregnancy. These patients had chronic tuberculosis that had caused extensive parenchymal damage and had high-grade resistance to antituberculous drugs. All patients received individualized antituberculous therapy prior to delivery of healthy term infants. Neither obstetrical complications nor perinatal transmission of MDB-TB was observed. One patient experienced treatment failure, and another abandoned therapy. The other 5 patients are currently cured or in treatment and have culture-negative status. In each of these 7 cases, excellent treatment outcomes were obtained for the women and their children. Under certain circumstances, MDR-TB can be successfully treated during pregnancy.

Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru.

BACKGROUND: Despite the prevalence of multidrug-resistant tuberculosis in nearly all low-income countries surveyed, effective therapy has been deemed too expensive and considered not to be feasible outside referral centers. We evaluated the results of community-based therapy for multidrug-resistant tuberculosis in a poor section of Lima, Peru. METHODS: We describe the first 75 patients to receive ambulatory treatment with individualized regimens for chronic multidrug-resistant tuberculosis in northern Lima. We conducted a retrospective review of the charts of all patients enrolled in the program between August 1, 1996, and February 1, 1999, and identified predictors of poor outcomes. RESULTS: The infecting strains of Mycobacterium tuberculosis were resistant to a median of six drugs. Among the 66 patients who completed four or more months of therapy, 83 percent (55) were probably cured at the completion of treatment. Five of these 66 patients (8 percent) died while receiving therapy. Only one patient continued to have positive cultures after six months of treatment. All patients in whom treatment failed or who died had extensive bilateral pulmonary disease. In a multiple Cox proportional-hazards regression model, the predictors of the time to treatment failure or death were a low hematocrit (hazard ratio, 4.09; 95 percent confidence interval, 1.35 to 12.36) and a low body-mass index (hazard ratio, 3.23; 95 percent confidence interval, 0.90 to 11.53). Inclusion of pyrazinamide and ethambutol in the regimen (when susceptibility was confirmed) was associated with a favorable outcome (hazard ratio for treatment failure or death, 0.30; 95 percent confidence interval, 0.11 to 0.83). CONCLUSIONS: Community-based outpatient treatment of multidrug-resistant tuberculosis can yield high cure rates even in resource-poor settings. Early initiation of appropriate therapy can preserve susceptibility to first-line drugs and improve treatment outcomes.

Prevalencia y tipos mas frecuentes de epilepsia / Prevalence and most frequent types of epilepsia

Antecedentes: La Epilepsia es una de las enfermedades mas antiguas que se conocen, siendo descrita hace unos 2,500 años; sin embargo en nuestro pais es poco lo que se ha reportado sobre sus características en nuestra población. Este trabajo pretende aportar detalles importantes sobre esta histórica enfermedad en la República Dominicana. Materiales y métodos: Fue un estudio retrospectivo donde revisamos 585 casos de pacientes con diagnósticos de Epilepsia vistos en la Sociedad Dominicana contra la Epilepsia desde el 1 de enero hasta el 31 de Diciembre de 1994, con la finalidad de conocer el comportamiento de la enfermedad en nuestro medio. Resultados: Encontramos que la enfermedad ocurre con mayor frecuencia en niños, ya que 319 pacientes (54.5//), contaban con menos de 16 años; la edad pediátrica mas frecuentemente afectada fue de 1 a 3 años con 87 pacientes (14.9// del total). El sexo masculino resultó 1.6 veces mas afectado que el femenino; el 61.9// de los casos recibieron atención médica especializada en el centro un año después de la primera crisis. La pérdida del conocimiento fue el principal signo descrito de las crisis convulsivas. El 90.4// de los casos no presentaron antecedentes patológicos, el 91.5// no tuvo hallazgos positivos al examen neurológico. La causa fue idiopática en un 80.5// de los casos y las epilepsias generalizadas primarias, tónico-clónicas (grand mal) con 90.8// fueron las más frecuentes. El fenobarbital fue el fármaco más utilizado para el manejo y prevención de las crisis

Neuroma de amputaçäo e hanseníase: relato de caso / Amputation neuroma and leprosy: case report

Os autores apresentam um caso de neurite ciática hipertrófica hanseniana associada a neuroma de amputaçao. Nesta enfermidade, o envolvimento do nervo ciático e a formaçao de neuroma sao incomuns.