RESUMO
OBJECTIVE: To examine the prevalence and magnitude of chronic lung disease (CLD) and its association with empiric anti-tuberculosis treatment (due to lack of bacteriologic confirmation) among recurrent tuberculosis (TB) survivors in a human immunodeficiency virus (HIV) prevalent setting. METHODS: Prospective cohort study of retreatment TB survivors in Harare, Zimbabwe. At median follow-up of 2 years post-treatment initiation, we characterized mortality, respiratory impairment, and mental health. RESULTS: Among 175 retreatment TB survivors, 65% of whom were HIV-positive and 21% had been empirically treated, multiparameter CLD was noted at follow-up among 14% of patients (95%CI 9.0-19.7), with a six-fold increase in age-adjusted death in the first year following treatment completion. Empirically treated TB (relative risk [RR] 3.4, 95%CI 1.4-8.3) was associated with CLD, as was the number of previous anti-tuberculosis treatment courses in dose-dependent fashion (three vs. one, RR 6.2, 95%CI 1.7-22.1). Among retreatment TB survivors, 33% (95%CI 26.0-40.1) had persistent respiratory symptoms (Chronic Obstructive Pulmonary Disease Assessment Test score î¶10); 26% (95%CI 19.8-33.0) significant deficits in exercise capacity (median incremental shuttle walk test distance, 550 m; Q1-Q3 440-730 m); 83% (95%CI 75.7-89.7) residual radiographic abnormalities on chest X-ray; 12% (95%CI 6.6-16.1%) moderate-to-severe obstruction on spirometry; and 13% (95%CI 7.6-17.5%) major depression. CONCLUSIONS: Despite successful treatment, retreatment TB survivors retain a substantial risk of morbidity and mortality.
Assuntos
Antituberculosos/administração & dosagem , Infecções por HIV/epidemiologia , Pneumopatias/epidemiologia , Tuberculose/epidemiologia , Adulto , Doença Crônica , Estudos de Coortes , Feminino , Seguimentos , Humanos , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Recidiva , Retratamento , Sobreviventes , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Zimbábue/epidemiologiaRESUMO
Pre-tracheal air cysts or aeroceles are rare complications of tracheostomy. This is believed to be the first reported case in an adult presenting with a pre-tracheal air cyst 12 years after a tracheostomy. Only three case reports in children have been reported to date. The pathogenesis and treatment options are discussed and a method of managing this condition is suggested.
Assuntos
Cistos/etiologia , Enfisema/etiologia , Doenças da Traqueia/etiologia , Traqueostomia/efeitos adversos , Adulto , Cistos/diagnóstico por imagem , Enfisema/diagnóstico por imagem , Feminino , Humanos , Tomografia Computadorizada por Raios X , Doenças da Traqueia/diagnóstico por imagemRESUMO
Cultures of the first cloudy dialysates from 51 consecutive episodes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis were carried out using concentrated nutrient broth and Bactec blood culture media in addition to primary culture on solid media. Thirty-seven episodes (73%) were positive on solid media, and 42 episodes (82%) were positive by both nutrient broth and Bactec methods. The value of Gram-stained smears and WBC counts on dialysates is discussed.
Assuntos
Bactérias/isolamento & purificação , Meios de Cultura , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/microbiologia , Humanos , Contagem de Leucócitos , Peritonite/etiologiaRESUMO
A total of 83 male homosexuals were studied to ascertain the carriage of intestinal protozoal cysts. The homosexual group had a significantly (p less than 0.0005) higher prevalence than a control group. One or more types of protozoa were found in 33 homosexuals. The carriage of intestinal protozoal cysts was associated with particular sexual practices and promiscuity, but not with symptomatic bowel disorders. The possible implications of the carriage of these cysts are discussed.