Calidad de vida relacionada con la salud en pacientes con diagnóstico de tuberculosis pulmonar / Health-related quality of life in patients diagnosed with pulmonary tuberculosis

INTRODUCCIÓN. La tuberculosis es la novena causa de muerte a nivel mundial y la principal causa de defunción por un agente infeccioso. La localización pulmonar es frecuente, tiene síntomas inespecíficos y tendencia a la cronicidad. OBJETIVO. Evaluar la calidad de vida en una cohorte de pacientes con diagnóstico de tuberculosis pulmonar. MATERIALES Y MÉTODOS. Estudio observacional, analítico de casos y controles. Población y muestra conocida de 129 datos de Historias Clínicas, 43 casos y 86 controles sanos, en 15 Centros de Salud en Quito, de mayo a junio 2015. Criterios de inclusión (casos): mayor de 18 años, diagnóstico de tuberculosis pulmonar en tratamiento; (controles): no tener diagnóstico de tuberculosis pulmonar o extrapulmonar ni patologías crónicas. Los datos se tomaron de las Historias Clínicas, se aplicó una encuesta personalizada y el cuestionario de calidad de vida Short Form-36 versión 2. Se realizó un análisis univarial, bivarial y multivarial. Para el análisis de datos se utilizó el programa estadístico International Business Machines Statistical Package for the Social Sciences versión 23. RESULTADOS. Los casos tuvieron puntuaciones de calidad de vida bajos comparados con los contro- les (DM=34,11 IC 29,7-38,4). La dimensión más afectada fue función física (DM=46,5 IC 39,2­53,8) y la menos afectada fue dolor corporal (DM=24,1 IC 16,9­31,4). DISCUSIÓN. Se evidenció resultados similares de otros países con alta prevalencia de tuberculosis pulmonar que afectó la calidad de vida de los pacientes. CONCLUSIÓN. La tuberculosis pulmonar fue un factor determínate del deterioro de la calidad de vida.

INTRODUCTION. Tuberculosis is the ninth leading cause of death worldwide and the leading cause of death from an infectious agent. The pulmonary location is frequent, has nonspecific symptoms and a tendency to chronicity. OBJECTIVE. To assess the quality of life in a cohort of patients with a diagnosis of pulmonary tuberculosis. MATERIALS AND METHODS. Observational, analytical case-control study. Population and known sample of 129 data from Medical Records, 43 cases and 86 healthy controls, in 15 Health Centers in Quito, from may to june 2015. Inclusion criteria (cases): older than 18 years, diagnosis of pulmonary tuberculosis under treatment; (controls): not having a diagnosis of pulmonary or extrapulmonary tuberculosis or chronic pathologies. The data were taken from the Medical Records, a personalized survey and the Short Form-36 version 2 quality of life question- naire were applied. A univariate, bivariate and multivariate analysis was performed. For data analysis, the statistical program International Business Machines Statistical Package for the Social Sciences version 23 was used. RESULTS. The cases had low quality of life scores compared to the controls (MD=34,11 CI 29,7-38,4). The dimension most affected was physical function (MD=46,5 CI 39,2-53,8) and the least affected was body pain (MD=24,1 CI 16,9-31,4). DISCUSSION. Similar results were found in other countries with a high prevalence of pulmonary tuberculosis that affected the quality of life of patients. CONCLUSION. Pulmonary tuberculosis was a determining factor in the deterioration of quality of life.

Allergy Testing: Common Questions and Answers.

An estimated 10% to 30% of the global population has an allergic disease. Clinical presentations of allergic diseases, respiratory infections, and autoimmune conditions have similar features. Allergy and immunologic testing can help clarify the diagnosis and guide treatment. Immediate immunoglobulin E (IgE) and delayed T cell-mediated reactions are the main types of allergic responses. The allergens suspected in an immediate IgE-mediated response are identified through serum IgE-specific antibody or skin testing. For patients with an inhalant allergy, skin or IgE-specific antibody testing is preferred. In patients with food allergies, eliminating the suspected allergenic food from the diet is the initial treatment. If this is ineffective, IgE-specific antibody or skin testing can exclude allergens. An oral food challenge should be performed to confirm the diagnosis. Patients with an anaphylactic reaction to an insect sting should undergo IgE-specific antibody or skin testing. Skin testing for penicillin has a high negative predictive value and can help when penicillin administration is indicated and there are limited alternatives. Testing for other drug allergies has less well-determined sensitivity and specificity, but can guide the diagnosis. Patch testing can help identify the allergen responsible for contact dermatitis.

Hereditary Angioedema: Implications of Management.

Hereditary angioedema (HAE) is a genetic condition that is characterized by frequent episodes of localized angioedema. It is a rare disorder that a primary care provider, otolaryngologist, dermatologist, or rheumatologist may encounter only occasionally. This disease is being reviewed because of the significant advances in further understanding the genetics, biology, and therapeutic management surrounding the condition. Histamine-mediated angioedema responds to steroids, antihistamines, and epinephrine, whereas bradykinin-mediated angioedema is resistant to those interventions and requires specialized therapy. Previously used medications have significant adverse effects. Approved medications for HAE have been effective in decreasing morbidity and mortality in patients with this condition. We review the presentation, diagnosis, and available pharmaceutical options for HAE and explore the limitations of implementing recommended therapy.

Management of granulomatous lymphocytic interstitial lung disease in a patient with common variable immune deficiency.

A 61-year-old woman presented with longstanding cough and progressive dyspnoea. She underwent an extensive evaluation and was diagnosed with common variable immunodeficiency (CVID) with granulomatous lymphocytic interstitial lung disease (GLILD). She was initially treated with subcutaneous immunoglobulin therapy, having declined intravenous immunoglobulin (IVIG) therapy. She also declined treatment with oral glucocorticoids. Over several months, she became increasingly symptomatic and developed increased pulmonary infiltrates, pleural effusions, mediastinal adenopathy, splenomegaly, pancytopenia and ascites. An interdisciplinary team composed of an immunologist, pulmonologist and haematologist deliberated over a therapeutic management approach. The patient received a recently reported immunotherapy regimen with azathioprine and rituximab. The therapy led to rapid improvement of her constitutional and respiratory symptoms, with clinical and radiographic improvement in her interstitial lung disease, lymphadenopathy, pleural effusions and ascites. This case report reviews the literature surrounding the diagnosis and management of GLILD.

ACE inhibitors: upper respiratory symptoms.

Cough and angioedema are well-known adverse reactions of ACE inhibitors. However, other adverse effects of upper airways such as postnasal drainage, rhinitis and nasal blockage, are less frequently recognised. These might share the same pathophysiological mechanism: bradykinin accumulation. We present two patients with ACE inhibitor-induced upper respiratory symptoms that improved after the discontinuation of ACE-inhibitors and substitution with angiotensin II receptor blockers. The incidence of these adverse events is not accurately known, since these are not required to be reported, but it is estimated to be low. This presents challenges to the physician and demonstrates the importance of keeping it as a differential diagnosis. Most physicians are aware of ACE inhibitor-induced cough but not of ACE inhibitor-induced nasal blockage, rhinitis or postnasal drainage. Identifying these can avoid unnecessary diagnostic tests and inappropriate treatment.

The silent sinus syndrome: protean manifestations of a rare upper respiratory disorder revisited.

Silent Sinus Syndrome (SSS) is known to be a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and alteration of the orbital floor. Most of the patients with this syndrome present with ophthalmological complaints without any nasal sinus symptoms, and it typically has a painless course and slow development, ergo the term "silent." Here we present a case report of a patient with occasional coughing spells as the presenting symptom of Silent Sinus Syndrome, which has not been previously described in the literature. The CT scan findings suggested chronic rhinosinusitis. The radiological findings were suggestive of maxillary sinus hypoplasia, with evidence of maxillary sinus atelectasis. Awareness of this syndrome is important for specialists who work with nasal sinus disease, since its management is different than chronic rhinosinusits.

Practical considerations for dysphonia caused by inhaled corticosteroids.

Inhaled corticosteroid (ICS) therapy has become standard in the treatment of asthma. A common local adverse effect of ICS therapy is dysphonia, which has been reported to affect 5% to 58% of patients. Although causes of dysphonia associated with ICS therapy have been underinvestigated, it may result from deposition of an active ICS in the oropharynx during administration, which then causes myopathy or a mucosal effect in the laryngopharynx. Use of ICS should be considered during any evaluation of dysphonia. We recommend using the lowest effective dosage of ICS, administering medication with a spacer, gargling, rinsing the mouth and washing the face after inhalation, and washing the spacer. If dysphonia develops despite these interventions, ICS use should be suspended until symptoms resolve, provided that asthma control is not compromised.

Chronic cough as the presenting symptom of hydrocephalus.

Chronic cough is defined as a daily cough lasting for more than eight weeks. We report an unusual case of chronic cough as the primary manifestation of obstructive hydrocephalus. Chronic cough in our case was determined to be of neurogenic origin only after exhaustive investigations failed to reveal a systemic cause, and, in particular, after a positive response to treatment of the hydrocephalus was observed. To the best of our knowledge, this is the first report of hydrocephalus presenting as chronic cough. We believe this case will remind physicians of the importance of considering neurological disease as a cause of chronic cough after common causes are excluded.

Seasonal distribution in newly diagnosed cases of eosinophilic esophagitis in adults.

OBJECTIVES: The etiology of eosinophilic esophagitis (EoE) is not well understood. It has been proposed that eosinophils migrate to the esophagus in response to various ingested and inhaled allergens. Recent reports in children found an increased proportion of cases of EoE during months with higher outdoor aeroallergens. To our knowledge, this has not been evaluated in adults. We aimed to determine whether there is a seasonal distribution in the number of newly diagnosed cases of EoE in an adult population. METHODS: We conducted a retrospective review of consecutive adult cases newly diagnosed with EoE in 1 year. Cases were grouped based on the index month when the diagnosis was made at endoscopy. To test the consistency of the observations, a second cohort of consecutive cases of similar sample size diagnosed at a different period in time was also analyzed. RESULTS: In total, 41 patients were diagnosed with EoE at our center during the study period, providing an annual prevalence of 0.98%. More cases were diagnosed with EoE during the months of April and May than any other month (P<0.001). When patients were grouped seasonally, there was a significant increase of EoE cases in spring and summer months (n=28) when compared with the fall and winter months (n=13) (P=0.019). Analysis of the second cohort of cases (n=37) from 2002 to 2006 confirmed a similar seasonal diagnostic pattern for EoE during the outdoor seasons. CONCLUSIONS: Our data demonstrate that EoE has a seasonal prevalence in adults. The seasonal variation pattern found in newly diagnosed EoE cases in adults supports the potential role of aeroallergens in the pathogenesis of EoE.

Successful progressive challenge after a cutaneous reaction to imatinib mesylate (Gleevec): a case report and review of the literature.

The use of imatinib mesylate (Gleevec), a selective tyrosine kinase inhibitor, has become the new gold standard for the treatment of chronic myeloid leukemia. Unfortunately, the medication has been commonly associated with mild to severe cutaneous reactions, which has limited its use for some patients. We describe a case of a successful progressive challenge of a patient with a drug-induced exanthem from imatinib mesylate and a review of the literature.

Diagnosis and treatment of postprandial nausea, allergy, and eosinophilia.

We report a case of a 16-year-old male patient who presented with postprandial fullness and nausea. He had a history of seasonal allergies, asthma, and peripheral eosinophilia. Endoscopy of the stomach with mucosal biopsies revealed predominate eosinophils. A diagnosis of eosinophilic gastroenteritis was made. The patient's disease course and management is described in this article.