Características clínicas de la tuberculosis incidente en inmigrantes y autóctonos, en 2 hospitales de Cataluña (2000-2011) / Clinical characteristics of tuberculosis in immigrants and autochthonous populations, in 2 hospitals of Catalonia

Antecedentes y objetivos. La tuberculosis es una endemia difícil de controlar. En España la tasa de incidencia es superior a la de otros países del entorno en los últimos años, a expensas de un mayor número de extranjeros afectos. Este estudio se propuso comparar sus características entre población inmigrante y autóctona en la última década. Pacientes y método. Estudio observacional, retrospectivo (2000-2011), multicéntrico en 2 áreas urbanas de Cataluña, comparativo de la presentación clínica (factores de riesgo, localización, infectividad), del retraso diagnóstico y cumplimentación del tratamiento de la tuberculosis, entre inmigrantes-autóctonos. Resultados. Se incluyó a 503 pacientes, 181 inmigrantes y 322 españoles. Los inmigrantes fueron más jóvenes (31 frente a 46 años de edad media; p<0,001). El 70,8% llevaba en España menos de 5 años. La tuberculosis pulmonar fue la forma de presentación clínica más común (61,4%), con frecuencias similares en inmigrantes o autóctonos. Solo la afectación osteoarticular fue significativamente más frecuente en inmigrantes procedentes del África subsahariana. La mediana de retraso diagnóstico fue de 32 días, sin diferencias con respecto a la población española. La correcta cumplimentación del tratamiento tuberculostático tendió a ser inferior en inmigrantes (84,3% frente a 88,3%; p=0,051). Los abandonos del tratamiento fueron más frecuentes en inmigrantes (8 abandonos; p<0,001). Conclusión. Las principales características clínicas, así como del manejo diagnóstico y terapéutico de los pacientes inmigrantes con tuberculosis incluidos en este estudio fueron similares a los de la población autóctona (AU)

Background and objectives. Tuberculosis is a difficult-to-control endemic, and its incidence rate in Spain is greater than that of neighboring countries. In recent years, this has been due to an increased number of foreigners infected with the disease. The aim of this study was to compare the characteristics of this disease between immigrant and native populations in the last decade. Patients and method. Observational, retrospective (2000-2011) multicenter study in 2 urban areas of Catalonia comparing the clinical presentation (risk factors, location and infectivity), the diagnostic delay and the completion of tuberculosis treatment between immigrants and natives. Results. A total of 503 patients (181 immigrants and 322 Spaniards) were included. The immigrants were younger (mean age of 31 versus 46 years; P<.001), and 70.8% had lived in Spain for less than 5 years. Pulmonary tuberculosis was the most common clinical presentation (61.4%), with similar frequencies in immigrants and natives. Only osteoarticular involvement was significantly more common in immigrants from sub-Saharan Africa. The median diagnostic delay was 32 days, with no differences compared with the Spanish population. Proper adherence to the tuberculostatic treatment tended to be lower for immigrants (84.3% vs. 88.3%, P=.051). Treatment dropout was more common in immigrants (8 dropouts, P<.001). Conclusion. The main clinical characteristics and the diagnostic and therapeutic handling of immigrant patients with tuberculosis included in this study were similar to those of the native population (AU)

Clinical characteristics of tuberculosis in immigrants and autochthonous populations, in 2 hospitals of Catalonia. / Características clínicas de la tuberculosis incidente en inmigrantes y autóctonos, en 2 hospitales de Cataluña (2000-2011).

BACKGROUND AND OBJECTIVES: Tuberculosis is a difficult-to-control endemic, and its incidence rate in Spain is greater than that of neighboring countries. In recent years, this has been due to an increased number of foreigners infected with the disease. The aim of this study was to compare the characteristics of this disease between immigrant and native populations in the last decade. PATIENTS AND METHOD: Observational, retrospective (2000-2011) multicenter study in 2 urban areas of Catalonia comparing the clinical presentation (risk factors, location and infectivity), the diagnostic delay and the completion of tuberculosis treatment between immigrants and natives. RESULTS: A total of 503 patients (181 immigrants and 322 Spaniards) were included. The immigrants were younger (mean age of 31 versus 46 years; P<.001), and 70.8% had lived in Spain for less than 5 years. Pulmonary tuberculosis was the most common clinical presentation (61.4%), with similar frequencies in immigrants and natives. Only osteoarticular involvement was significantly more common in immigrants from sub-Saharan Africa. The median diagnostic delay was 32 days, with no differences compared with the Spanish population. Proper adherence to the tuberculostatic treatment tended to be lower for immigrants (84.3% vs. 88.3%, P=.051). Treatment dropout was more common in immigrants (8 dropouts, P<.001). CONCLUSION: The main clinical characteristics and the diagnostic and therapeutic handling of immigrant patients with tuberculosis included in this study were similar to those of the native population.

Influence of the type of pegylated interferon on the onset of depressive and neuropsychiatric symptoms in HIV-HCV coinfected patients.

This is a prospective observational comparative 48-week study to assess the impact of the different types of Peg-IFN on depressive and neuropsychiatric symptoms during treatment in HIV-HCV coinfected patients. Thirty-one patients treated with Peg-IFN alpha-2b 1.5 microg/kg/w plus ribavirine (RBV) (Peg-IFN alpha-2b Group) and 32 patients receiving Peg-IFN alpha-2a 180 microg/w plus RBV (Peg-IFN alpha-2a Group) were included. Depressive and neuropsychiatric symptoms, quality of life and adherence were assessed. Fifteen subjects (23%) discontinued therapy (p = 0.3, between groups). Overall, 37 patients presented mild to moderate depressive symptoms, 9 moderate to severe and 3 severe, without differences between groups. Patients in Peg-IFN alpha-2b reported higher fatigue and dizziness at weeks 12 (p < 0.05) and 24 (p < 0.05), and irritability and memory loss at week 24 (p < 0.05) with respect to Peg-IFN alpha-2a Group. At week 12, role functioning, general health perception, vitality, emotional role, mental health and the summary areas of physical health and mental health were lower in Peg-IFN alpha-2b Group (p < 0.05). The same was observed in physical functioning (p = 0.05) and role functioning, general health perception, emotional role and mental health (p < 0.001) at week 24. Three months after finishing treatment, no patient had depressive or neuropsychiatric symptoms, and quality of life improved. Antiretroviral adherence was low but adherence to anti-HCV therapy remained high in both groups. According to our data, Peg-IFN alpha-2a and Peg-IFN alpha-2b exert a similar impact on the overall rate of depressive symptoms, although patients treated with Peg-IFN alpha-2a experience less fatigue and fewer neuropsychiatric symptoms and a lower impairment in their physical and mental quality of life.

Effect of warfarin on prothrombin synthesis and secretion in human Hep G2 cells.

Prothrombin synthesis and secretion were studied in a human hepatoma cell line (Hep G2) incubated with 35S-methionine for 2 to 24 hours at 37 degrees C. Extracellular and intracellular prothrombin were detected by immunoprecipitation with affinity-purified antiprothrombin antibody. Incorporation of 35S-methionine into prothrombin was monitored by counting specific bands excised from 10% sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Prothrombin represented 0.3% to 0.7% of total newly synthesized protein secreted into the media. Warfarin had no effect on total prothrombin synthesis (extracellular plus intracellular). However, warfarin inhibited secretion of newly synthesized prothrombin by 58% to 73% over a 2 to 4 hour period. This was accompanied by the intracellular accumulation of an immunoprecipitable species of prothrombin of 78 kd, 6 kd less than extracellular prothrombin. At the end of the 4-hour incubation with warfarin, intracellular prothrombin increased from 44% to 82% (twofold) of total prothrombin, whereas extracellular prothrombin decreased from 56% to 19% (threefold) of total prothrombin. After 24-hour incubation with warfarin, intracellular and extracellular immunoprecipitable prothrombin approached control values. Deglycosylation of extracellular and intracellular prothrombin with hydrofluoric acid (HF) resulted in a decrease in mol wt for both species to 66 kd. Endoglycosidase-H treatment, which digests "early mannosyl" residues, resulted in a decrease in the mol wt of the intracellular species of 8 kd with no effect on the extracellular species. Thus, the lower mol wt intracellular species that accumulates following early warfarin treatment is due to the presence of incompletely processed carbohydrate chain. The data are compatible with the hypothesis that optimum glycosylation and secretion require Vitamin K-dependent carboxylation.