High parathyroid hormone predicts exacerbations in COPD patients with hypovitaminosis D.

BACKGROUND: Hypovitaminosis D has been linked to deterioration in clinical parameters and lung function in COPD. As a response to low levels of vitamin D serum Parathyroid Hormone (iPTH) is increased in some, but not all, patients. The aim of this study was to determine whether COPD patients with elevated PTH levels are at higher risk of COPD exacerbations and hospitalizations. METHODS: 166 COPD outpatients were randomly preselected. Clinical and analytical characteristics were assessed at baseline. After excluding patients with other conditions known to disturb calcium metabolism 141 patients were identified. Except one, all patients were prospectively followed for 12 months after obtaining the blood samples. Hypovitaminosis D was considered when serum 25(OH)D < 30 ng/mL. Secondary hyperparathyroidism was considered when serum iPTH was higher than normal (50 pg/mL) in patients with hypovitaminosis D. COPD exacerbations and hospital admissions were recorded during the follow-up. RESULTS: Prevalence of hypovitaminosis D in COPD patients was 89.3%, prevalence of secondary hyperparathyroidism associated with hypovitaminosis D was 22,9%. Cox proportional risk analysis showed that patients belonging to the high iPTH-low 25(OH)D group were at a higher risk of moderate COPD exacerbations (HR 1.81 (CI95% 1.043-3.127), p = 0.035) and hospital admissions (HR 5.45 (CI95% 2.018-14.720), p = 0.002) as compared with those with normal iPTH-low 25(OH)D levels. CONCLUSIONS: COPD patients with hypovitaminosis D and elevated iPTH have higher risk of moderate exacerbations and hospitalizations than those with hypovitaminosis D and normal iPTH.

Características clínicas de la tuberculosis pulmonar bacilífera. Hospital Regional de Loreto enero 1998 - diciembre 2002 / Clinical characteristics of the pulmonary tuberculosis bacilífera. Loreto's Regional hospital January, 1998 - December, 2002

Objetivo: Determinar las características clínicas del paciente con tuberculosis (TBC) pulmonar bacilífera, del Hospital Regional de Loreto (HRL) de enero de 1998 a diciembre del 2002. Materiales y Métodos: Es un trabajo descriptivo, retrospectivo, transversal. Se revisó la ficha clínica de 271 pacientes con tuberculosis pulmonar bacilífera que ingresaron al programa de control de tuberculosis del HRL durante 5 a±os. Resultados: De los 271 pacientes el tiempo de enfermedad mßs frecuente fue mayor que 1 mes a 6 meses (44.7 por ciento), de inicio insidioso (93 por ciento), los signos y síntomas predominantes fueron tos (96.7 por ciento), baja de peso (86 por ciento), expectoración (83 por ciento) y pérdida del apetito (72.3 por ciento); al examen pulmonar predominaron respiración ruda(29.2 por ciento), subcrépitos (28.8 por ciento); las radiografías patológicas mostraron compromiso pulmonar bilateral (43.3 por ciento), 38 por ciento fueron BK(+) y 31 por ciento BK(+++), la baciloscopía de esputo fue positiva en la primera muestra en 64.2 por ciento y solo 18.1 por ciento presentaron enfermedad asociada, principalmenteanemia y diabetes mellitus. Conclusiones: Los pacientes con TBC pulmonar bacilífera presentaron un tiempo de enfermedad 1-6 meses, inicio insidioso, con tos, baja de peso, expectoración y pérdida del apetito; con respiración ruda y subcrépitos al examen, compromiso pulmonar bilateral en la radiografía; BK(+) y baciloscopía positiva en la primera muestra de esputo.