Determinants of thyrotoxic cardiomyopathy recovery.

The purpose was to evaluate the effect of the disease duration prior to treatment, thyroid hormones level, or both on the reversibility of dilated cardiomyopathy. Between January 2006 and December 2010, a longitudinal study with a 6 months follow-up was carried on. One hundred and seventy patients with hyperthyroidism were referred to the cardiologist, and 127 had a 6 months followup after antithyroid treatment and were evaluated by echocardiography. Dilated cardiomyopathy reversibility criteria were established according to echocardiographic parameters. Complete reversibility existed when all parameters were met, partial reversibility when LVEF was ≥55% plus two or three other parameters, and no reversibility when LVEF was ≤55% regardless of other parameters. The results showed that echocardiography parameters related to the regression of myocardial mass were associated with a disease duration shorter than 10.38 months. This was the main predictive variable for reversal of dilated cardiomyopathy, followed by ß -blocker treatment, and the last predictive variable was the serum level of free triiodothyronine. This study showed that the effect on the myocardium related to thyrotoxicosis was associated with the disease duration before treatment.

Evaluación del diagnóstico serológico en la tuberculosis CMQBB / Assesment of serologic diagnosis of tuberculosis

A fin de conocer el aporte diagnóstico del serodiagnóstico TBC en los casos de tuberculosis paucibacilar en quienes la baciloscopía presenta baja sensibilidad (S) y el cultivo BK da resultados tardios, estudiamos 100 pacientes utilizando el antígeno KD 38 del bacilo de Koch. Comparamos 2 grupos de pacientes uno con tuberculosis confirmada y otra sin tuberculosis. En el primer grupo fueron 42 pacientes en el periódo Enero 1994 a Enero 1995, 4 presentarón baciloscopía o cultivo BK positivos o histopatología confirmada y en quienes se encontro resultados positivos en el 29 y 13 negativos. En el segundo grupo ingresaron 58 pacientes que no presentaron enfermedad ni sospecha de TB y en ellos la prueba dio resultado positivo en 29 y negativo 13. Esto demuestra que la S es de 69 por ciento y la especifidad (E) del 84 por ciento. En método de serodiagnóstico para antígeno KD 38 puede permitirnos un aporte adicional al diagnóstico de la tuberculosis pulmonar inicial, extrapulmonar e infantil en las cuales el diagnóstico bacteriológico es pobre. Estudios internacionales sobre el tema encuentran alta S y E en la medida de la utilización de antígenos mas específicos que no siempre estan disponibles para países subdesarrollados. El estudio actual con sus resultados aceptables en S y E pueden servirnos por su practicidad y bajo costo para el despistaje (Screning) de estudios masivos de sospecha de TBC pulmonar inicial, TBC extrapulmonar e infantil para seleccionar los casos en los cuales debe realizarse estudios para cultivo BK o histopatología TBC.

Energy metabolism and hormonal profile in children with edematous protein-calorie malnutrition.

Modifications in energy metabolism and endocrine homeostasis (plasma insulin and growth hormone values, glucose and free fatty acid levels, serum thyroxine and TSH, free thyroxine index, and urinary catecholamines) were investigated in eight children with edematous protein-calorie malnutrition. Caloric expenditure was low at admission and correlated linearly with increased caloric intake throughout the study. The hormonal changes at admission were characterized by a negligible insulin response to intravenous arginine or glucose and by markedly elevated growth hormone levels which were neither increased by arginine nor suppressed by intravenous glucose. Serum thyroxine values were low, but free thyroxine index and serum TSH levels were within normal limits. At admission to the study, 24-hour urinary excretion of dopamine and norepinephrine was relatively reduced in relation to the excretion of epinephrine. All these modifications were corrected at time of the recovery study. It is suggested that in edematous protein-calorie malnutrition, insulin acts as the primary regulator of peripheral fuel release and that the high, nonsuppressible growth hormone levels may form part of an important homeostatic mechanism to provide substrates for brain metabolism via lipolysis.