RESUMO
PURPOSE: It remains unclear whether there is a pathogenic link between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases. Subclinical carotid atherosclerosis is a predictor of future cardiovascular events. Exacerbations increase all-cause mortality in COPD, and exacerbation-like episodes have been described in subjects without COPD. Our objectives were as follows: (1) to confirm the independent association between COPD and carotid atherosclerosis and (2) to asses the possible relationship between COPD exacerbations or exacerbation-like episodes and a higher risk of atherosclerosis. METHODS: 127 COPD subjects and 80 control subjects with smoking history were studied. Carotid ultrasound examination was carried out in all subjects. Univariate and multivariate logistic regression analyses were performed in order to assess the relationship between both COPD diagnosis and previous COPD exacerbations (or exacerbation-like episodes in non-COPD subjects) and the presence of carotid atherosclerosis. RESULTS: The prevalence of carotid atherosclerosis was higher in COPD group (65.3 vs. 47.5%, p = 0.01; OR 2.18, 95% CI 1.23-3.88, p < 0.01). Diagnosis of COPD was not independently associated with atherosclerosis, after adjusting for potential confounders. Neither COPD exacerbations nor exacerbation-like episodes in control subjects were associated with a higher risk of atherosclerosis. CONCLUSION: There is a higher prevalence of carotid atherosclerosis in COPD than in control smokers or ex-smokers, but the differences seem to be related to shared risk factors. We have not found evidence for an increased risk of atherosclerosis associated with COPD exacerbations or exacerbation-like events. Further longitudinal studies should be carried out to confirm these findings.
Assuntos
Doenças das Artérias Carótidas/epidemiologia , Progressão da Doença , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Exacerbação dos Sintomas , Idoso , Doenças Assintomáticas/epidemiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fumar/epidemiologiaRESUMO
BACKGROUND: Several studies suggest that there is a pathogenic link between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases. On the other hand, increased sympathetic tone has been described in several respiratory diseases. Our objective was to determine whether hypertension mediated by sympathetic overactivity is a mechanism that explains the association between COPD and cardiovascular diseases. METHODS: Prospective nested case-control observational study; 67 COPD patients were matched 1:1 by sex and age to controls with smoking history. 24 hour-blood pressure monitoring, urinary catecholamines and their metabolites measurement, echocardiography, carotid ultrasound examination, nocturnal oximetry and retinography were performed. FINDINGS: classic cardiovascular risk factors and comorbidities were similarly distributed between cases and controls. No significant differences for blood pressure variables (difference for mean systolic blood pressure: -0·13 mmHg; 95% CI: -4·48,4·20; p = 0·94; similar results for all blood presssure variables) or catecholamines values were found between both groups. There was a tendency for lower left ventricle ejection fraction in the COPD cases, that approached statistical significance (64·8 ± 7·4 vs 67·1 ± 6·2, p = 0·05). There were no differences in the retinal arteriovenous ratio, the carotid intima-media thickness, or the number of carotid plaques, between cases and controls. Fibrinogen values were higher in the COPD group (378·4 ± 69·6 vs 352·2 ± 45·6 mg/dL, p = 0·01) and mean nocturnal oxygen saturation values were lower for COPD patients (89·0 ± 4·07 vs 92·3 ± 2·2%, p < 0·0001). INTERPRETATION: Hypertension induced by sympathetic overactivity does not seem to be a mechanism that could explain the association between COPD and cardiovascular disease.
Assuntos
Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/epidemiologia , Catecolaminas/urina , Hipertensão/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Determinação da Pressão Arterial , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVES: To focus on the need of including tuberculosis among differential diagnoses of any epidymo-testicular mass, especially if its evolution is torpid. METHODS/RESULTS: A 73-year-old man who presented with scrotum abscess underwent surgical drainage and antibiotic treatment, but suppuration relapsed through cutaneous fistulae. A epipidymectomy was then performed, which demonstrated tuberculous granulomas. Torax Rx showed a cystic apical pulmonary wound which was treated with 3 antituberculostatics for 12 months. Sputum culture was positive for Micobacterium Bovis. CONCLUSIONS: Aspirative punction under sonographic control is a valuable technique to avoid mutilating surgeries and to permit an almost always effective treatment, before the appearance of permanent lesions which lead to sterility.
Assuntos
Epididimite/microbiologia , Mycobacterium bovis/isolamento & purificação , Doenças Profissionais/microbiologia , Tuberculose dos Genitais Masculinos/microbiologia , Abscesso/microbiologia , Idoso , Criação de Animais Domésticos , Animais , Antibacterianos , Antituberculosos/uso terapêutico , Bovinos , Quimioterapia Combinada/uso terapêutico , Epididimite/diagnóstico , Epididimite/tratamento farmacológico , Humanos , Isoniazida/uso terapêutico , Masculino , Doenças Profissionais/diagnóstico , Doenças Profissionais/tratamento farmacológico , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Escroto , Tuberculose Bovina , Tuberculose dos Genitais Masculinos/diagnóstico , Tuberculose dos Genitais Masculinos/tratamento farmacológicoRESUMO
OBJETIVOS: Enfatizar sobre la necesidad de incluir la tuberculosis en el diagnóstico diferencial de cualquier masa epidimo-testicular especialmente si su curso es tórpido. MÉTODO/RESULTADOS: Presentamos a un varón de 73 años que acude por clínica compatible con absceso escrotal que es drenado y tratado con antibióticos pero que presenta recidiva de la supuración apareciendo trayectos fistulosos cutáneos por lo que se practica epidimectomía que mostró afectación tuberculosa del mismo. Se comprobó entonces una lesión pulmonar quístico-cavitaria apical izquierda iniciándose tratamiento antituberculostático con 3 drogas durante 12 meses. El cultivo de esputo resultó positivo para M. Bovis. CONCLUSIÓN: La PAAF con control ecográfico es una técnica muy útil para evitar cirugías mutilantes y permitir un tratamiento, casi siempre efectivo, antes de que aparezcan lesiones permanentes que conduzcan a la esterilidad (AU)
Assuntos
Animais , Bovinos , Idoso , Masculino , Humanos , Escroto , Rifampina , Tuberculose Bovina , Tuberculose dos Genitais Masculinos , Mycobacterium bovis , Pirazinamida , Criação de Animais Domésticos , Antituberculosos , Abscesso , Isoniazida , Epididimite , Quimioterapia Combinada , Doenças ProfissionaisAssuntos
Dor Abdominal/diagnóstico , Febre/diagnóstico , Dor Abdominal/complicações , Idoso , Febre/complicações , Infecções por HIV/complicações , Humanos , Masculino , Baço/cirurgia , Esplenomegalia/diagnóstico , Fatores de Tempo , Tuberculose Miliar/diagnóstico , Tuberculose Esplênica/diagnóstico , Redução de PesoRESUMO
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