ABSTRACT
En la literatura se encuentra ampliamente descrita la relación entre el desarrollo de una hiponatremia y el tratamiento con diuréticos tiazídicos y en asociación. Aportamos un caso llamativo por la intensidad de la hiponatremia (Na+p: 104 mEq/L), que respondió bien al tratamiento con suero salino hipertónico y cuyo diagnóstico de certeza se llevó a cabo mediante el estudio del aclaramiento de agua libre, aclaración de agua libre de electrolitos y del gradiente trastubular de potasio. Proponemos el abordaje diagnóstico de esta entidad mediante el uso de éstos conceptos y el control riguroso de factores de riesgo en pacientes susceptibles de desarrollar esta complicacion
In the literatura it is found widely described, the relationship between development o fan hyponatremia and the prescription of thiazidic and mixed diuretic. We contribute with a notorius case, by the intensity of the hyponatremia, that responded well to treatment with hypertonic saline serum and whose certainly diagnosis was carried out by the study of the free water clearance, free water electrolytes clearance and transtubular potassium gradient. We propose the diagnostic approach of this entity by the use of these concepts with the accuracy control of risk factors in susceptible patients to develop such complication
Subject(s)
Female , Aged , Humans , Hyponatremia/chemically induced , Amiloride/adverse effects , Hydrochlorothiazide/adverse effects , Risk Factors , Osmolar Concentration , Diagnosis, DifferentialABSTRACT
Tuberculosis constitutes a public health problem that has become more serious in the past couple of years primarily due to the pandemic of human immunodeficiency virus (HIV). This study analyzes the evolutionary, clinical, and epidemiological characteristics of the extrapulmonary and disseminated forms of tuberculosis (TBD/E) in AIDS patients diagnosed in the province of Cádiz. Data for 103 patients who manifested both diseases were gathered prospectively. The prevalence of TBD/E was 30 percent among patients with AIDS. The primary risk factor was addiction to parenteral drugs (91 percent). Seventy-five percent of the patients were diagnosed with disseminated forms of the illness and 25 percent with extrapulmonary forms. The organs affected tended to be lymphatic ganglions and the lungs. Worthy of note is the lateness in seeking medical attention (45.6 +/- 4.5 days; range: 4-240 days). We conclude that tuberculosis constitutes a common pathology with an appreciable mortality in AIDs patients. Disseminated forms of tuberculosis predominate and may adopt a wide range of clinical manifestations. The lateness with which patients seek medical attention is a fact worth emphasizing.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Tuberculosis/complications , Acquired Immunodeficiency Syndrome/mortality , Adult , Cause of Death , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Spain , Survival Rate , Tuberculosis/epidemiologyABSTRACT
BACKGROUND: The epidemiological characteristics, clinical manifestations and survival were analyzed in 269 patients with acquired immunodeficiency syndrome (AIDS) diagnosed in the province of Cadiz up to June 1970. METHODS: A multicenter protocol study including the 7 hospitals attending practically all of the population of the area of Cadiz was carried out. The diagnosis of AIDS was performed according to the 1987 CDC criteria. The Kaplan and Meier actuarial method was used for the survival study. RESULTS: The prevalence was of 10 cases in 1986, 37 in 1987, 61 in 1988, 121 in 1989 and 40 during the first 5 months of 1990. Males dominated (84%) and mean age was of 28.6 years. The predominant risk factor was parenteral drug abuse (84%) with signs of social unacceptance (unemployment 70% and with prison records 68%). Thirty eight percent of the patients were no longer drug addicts at the time of diagnosis. The number of cases of women who acquired the disease through heterosexual transmission has increased over the last 2 years (13 cases). Opportunistic infections made up 93% of the diagnostic criteria with esophageal candidiasis (EC) (45%) and extrapulmonary tuberculosis (ET) (34%) being the most frequent. The probability of survival was 14% at 35 months. When ET was the exclusive diagnostic criteria, survival was higher (30% vs 9%) and the mean of T4 lymphocytes in this group was higher (228 vs 154), all being statistically significant. CONCLUSIONS: AIDS is a serious, progressive problem of the Public Health Department in the province of Cadiz and predominantly affects parenteral drug addicts with a percentage higher than other Spanish series in socially unaccepted people. The increase in the cases of women with AIDS from heterosexual transmission is worrisome. EC and ET are the most verified diagnostic criteria. The prognosis of AIDS remains bad at short term, with survival being greater in those patients with ET as the exclusive criteria due to lesser cellular immunodeficiency.