Subject(s)
Contact Tracing , Mass Screening/methods , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Family Characteristics , Family Health , Follow-Up Studies , Humans , Middle Aged , Prevalence , Tuberculin Test , Tuberculosis, Pulmonary/microbiology , Young AdultABSTRACT
Background: Contact investigation is cardinal in the control of tuberculosis (TB) since it helps to stop its transmission. In Chile, the National TB Program strategy does not include latent TB infection testing, regular chemoprophylaxis or follow-up in adults. Active TB was found in only 1.2% of contacts at country-level during 2018. Aim: To evaluate the performance of a systematic screening of adult household contacts with targeted chemoprophylaxis and prolonged active follow-up. Material and Methods: Prospective cohort of household contacts in Santiago. Two face-to-face visits (at 0 and 12 weeks) that included QuantiFERON TB-Gold plus tests (QFT), chest radiography (CXR) at 0 and 24 weeks and, periodic text messaging or phone call follow-up for up to 48 weeks were implemented. Contacts with positive QFT were referred for TB chemoprophylaxis. Results: A total of 200 contacts were enrolled, 69% were migrants. At baseline evaluation, 45% had a positive QFT result and 1.6% had co-prevalent active TB. At follow-up, 13% contacts further converted to QFT (+), and 5.1% more were diagnosed with active TB (mean follow-up time 32 weeks). Of these 10 further active TB cases, 6 (60%) had a negative QFT and all (100%) had normal CXR at baseline; while three cases occurred in QFT converters. Conclusions: In this cohort of household contacts, 6.7 % were diagnosed with active TB (more than 2/3 at follow-up) and 13% had a late QFT (+) conversion. Active and prolonged contacts' follow-up are essential to detect new infections and tackle the TB epidemic in Chile.
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Young Adult , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/epidemiology , Mass Screening/methods , Contact Tracing , Tuberculosis, Pulmonary/microbiology , Tuberculin Test , Family Characteristics , Family Health , Prevalence , Follow-Up StudiesABSTRACT
BACKGROUND: Treatment has a definitive impact on mortality in hypertension. The magnitude of blood pressure reduction, the type of drug used and the associated risk factors may modulate the effect of treatment on mortality. AIM: To report the effects of treatment of essential hypertension, in a cohort followed for up to 26 years. PATIENTS AND METHODS: A cohort of 1,172 essential hypertensive patients followed up to 26 years. Patients were treated with different antihypertensive drugs, alone or in combination (diuretics, beta blockers, calcium channel blockers and angiotensin converting enzyme inhibitors) according to international rules and consensus. Subjects were followed until death or loss from follow-up. Blood pressure reduction was aimed to obtain figures near 140/90 mm Hg. Causes of death and complications were obtained from hospital records, phone and death certificates. Survival was studied using life tables (Kaplan Meier method and intention to treat analysis) and Cox proportional hazard analysis. RESULTS: Initial blood pressure dropped significantly from 181/109 to 154/92 mm Hg, p < 0.001. Mean follow-up time was 10.6 +/- 6.1 years. There were 143 cardiovascular deaths, 142 acute myocardial infarctions, 101 strokes, 83 subjects had cardiac failure and 49 had renal failure. The observed rates were 0.92% per year for cardiovascular mortality, 1.36% per year for coronary heart disease, 0.94% per year for stroke. CONCLUSIONS: Our mortality rate is lower than that found in classical randomized studies but similar or slightly higher than the more recent ones. Morbidity rates were also very similar. Except for mortality rate, frequency of complications did not change in comparison to our previous report after 15 year of follow up. Aging did not seem to negatively influence mortality rates in adequately treated hypertensive patients.
Subject(s)
Hypertension/epidemiology , Antihypertensive Agents/therapeutic use , Chile/epidemiology , Female , Follow-Up Studies , Humans , Hypertension/drug therapy , Hypertension/mortality , Male , Middle Aged , Prospective Studies , Risk FactorsABSTRACT
La introducción de la ecocardiografía bidimensional y el Doppler ha permitido su aplicación simultánea al estudio de la hemodinamia arterial periférica, por lo que se ha diseñado un estudio en arteria braquial en hipertensos no tratados para establecer sus características hemodinámicas en comparación a un grupo normal de control. En 76 hipertensos, edad promedio 60 ñ 12 años; PA promedio = 176/105 mmHg y en 57 normales, PA promedio 118/73 mmHg, con distribución por edad y sexo comparables, se midió diámetro y velocidad de flujo arteriales y se calcularon volumen sanguíneo local, resistencia vascular y distensibilidad arterial. Se comprobó que para similar sexo y edad, los hipertensos tienen significativamente mayor diámetro arterial y menor velocidad de flujo que los normales, y que los hipertensos jóvenes presentan precozmente aumento importante del diámetro, con aumento de la resistencia vascular y disminución de la distensibilidad. A mayor PA sistólica correspondió mayor diámetro arterial (r = 0,50) tanto en normales como hipertensos. La velocidad de flujo, que depende del tono de las arterias, tuvo en cambio "r" límite significativo con la PA diastólica (r = 0,44) para el total de normales e hipertensos. Se concluye que esta técnica aporta datos hemodinámicos significativos para el diagnóstico precoz del hipertenso al revelar un aumento importante del diámetro arterial y de la resistencia vascular y una disminución de la distensibilidad arterial
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Echocardiography, Doppler , Hemodynamics , Hypertension/diagnosis , Age Factors , Brachial Artery , Control Groups , Sex FactorsABSTRACT
Indapamida, fármaco hipotensor con propiedades diuréticas, fue probado en su posible efecto vasodilatador directo arterial en un grupo de 20 hipertensos esenciales moderados, 12 hombres y 8 mujeres, con edad promedio de 58 +- 9,2 años (rango 47 - 71 años) mediante estudio hemodinámico no invasivo de la arteria braquial, usando un sistema Duplex Eco-doppler que permite determinar el diámetro y la velocidad media de flujo arterial; mediante la determinación simultánea de la P.A. en la misma arteria con el método del manguito, se puede calcular resistencia y compliance arterial. Indapamida se usó en dosis crecientes de 2,5 y 5 mg durante 12 semanas. La dosis de 2,5 mg. produjo un descenso significativo de la P.A., acompañado de aumento del diámetro de la arteria braquial y aumento de la velocidad de flujo arterial. Concomitantemente, se observó una reducción de la resistencia periférica y aumento de la compliance arterial. Con la dosis de 5 mg. no hubo mayor reducción de la P.A. ni mayor aumento de la velocidad de flujo, pero sí un aumento mayor de diámetro arterial y del volumen circulante con reducción mayor de la R. periférica. La distensibilidad aumentó en forma no proporcional a la reducción de la P.A. Se concluye que indapamida vasodilata simultáneamente arteriolas y grandes arterias, lo que sugiere fuertemente un efecto directo de la droga sobre el tono arterial y/o las propiedades viscoelásticas de la pared de grandes arterias
