RESUMEN
OBJECTIVE: The purpose of this paper is to review the literature on the impact of antidepressants on depressive symptom severity, quality of life (QoL), morbidity, and mortality in patients with heart failure (HF). METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies published from December 1969 to December 2019 that pertain to depression and HF were identified through the use of the PubMed and PsycINFO databases, using the keywords: 'antidepressant*' and 'heart failure.' Two authors independently conducted a focused analysis and reached a final consensus on 17 studies that met the specific selection criteria and passed the study quality checks. RESULTS: Studies varied in types of antidepressants used as well as in study designs. Ten studies were analyzed for the impact of antidepressant medications on depressive symptom severity. Five of these were randomized controlled trials (RCTs), out of which sertraline and paroxetine showed a significant reduction in depressive symptoms despite the small samples utilized. Four of the 17 studies addressed QoL as part of their outcomes showing no difference for escitalopram (RCT), significantly greater improvements for paroxetine controlled release (RCT), statistical significance for sertraline compared to control (pilot study), and showing significant improvement before and after treatment (open-label trial) for nefazodone. Thirteen of the 17 studies included measures of morbidity and mortality. Although early analyses have pointed to an association of antidepressant use and mortality particularly with fluoxetine, the reviewed studies showed no increase in mortality for antidepressants, and secondary analyses showed improved mortality in patients who achieved remission of depressive symptoms. CONCLUSION: Out of the various antidepressants studied, which included sertraline, paroxetine, escitalopram, citalopram, bupropion, nefazodone, and nortriptyline, selective serotonin reuptake inhibitors seem to be a safe treatment option for patients with depression and HF. However, due to the variety of study designs as well as the mixed results for each antidepressant, more information for reducing depression severity, morbidity, and mortality and improving quality of life in patients with HF should be examined using robust large sample RCTs.
RESUMEN
La tuberculosis (TB) extrapulmonar constituye el 10-20% del total de casos de tuberculosis que padecen los enfermos especialmente inmunocompetentes, esta frecuencia se incrementa notablemente en las personas portadoras de algún grado de inmunodeficiencia. La coinfección TB-VIH en la que los pacientes están severamente inmunodeprimidos pueden presentar localizaciones extrapulmonares hasta en un 60% de los casos. Se entiende como tuberculosis extrapulmonar a la infección por Mycobacterium tuberculosis en cualquier localización fuera del pulmón: ganglionar, urogenital, osteoarticular y otros, sin dejar de ser el foco inicial el pulmón. El diagnóstico de este tipo de tuberculosis está basado en la clínica y pocos son los métodos que permiten un diagnóstico certero y rápido ya que las muestras son generalmente paucibacilares.El tratamiento de la tuberculosis extrapulmonar solo es diferente en ciertas situaciones especiales como la tuberculosis meníngea, aunque es muy raro encontrar tuberculosis extrapulmonar farmacorresistentes se vio algunos casos que se verán en este artículo. La tuberculosis extrapulmonar suele estar asociada con enfermedades que causan trastorno en el sistema inmunitario, la principal de estas es el VIH la cual en nuestro medio ha venido aumentando con los años. Una alternativa para el diagnóstico es el ensayo MODS (Microscopic Observation Drug Susceptibility), el mismo que tiene como fundamento la observación del desarrollo de cordones tempranos característica desarrollada solo por Mycobacterium tuberculosis, los mismos que son visualizados con un microscopio invertido, este ensayo ofrece una posible solución al problema de la tardanza y falta de confiabilidad en los métodos tradicionales de cultivo microbiológico.
Extrapulmonary Tuberculosis (TB) constitute 10-20% of the TB sufferers immunocompetent patients , this frequency is greatly increased in people who carry some degree of immunodeficiency. TBHIV co-infection patients who are severely immunocompromised may have extrapulmonary sites by up to 60% of cases. It is understood as extrapulmonary tuberculosis a Mycobacterium tuberculosis infection in any location outside the lung: Nodal, urogenital, osteoarticular and others. While always the initial focus being the lung. The diagnosis of this type of tuberculosis is based on clinical and few methods that doesn´t allow an accurate diagnosis because samples are usually paucibacillary. The diagnosis of this type of tuberculosis is based on clinical and few methods that allow rapid and accurate diagnosis because samples are usually paucibacillary. The treatment of extrapulmonary tuberculosis is only different for certain special situations such as meningeal tuberculosis, although it is very rare to find drug-resistant tuberculosis extrapulmonary some cases to be argued in this article was.Extrapulmonary tuberculosis is often associated with diseases that cause disorder in the immune system, the principal of these is HIV in our midst which it was found that the incidence of this disease increases with age. An alternative diagnosis is the MODS test (microscopic observation drug susceptibility) based on the observation of the development of early cords, feature developed only by Mycobacterium tuberculosis, they are visualized with an inverted microscope, this essay offers a possible solution to the problem of delays and unreliability in the traditional methods of microbiological culture.
