[Current characteristics of tuberculosis and human immunodeficiency virus co-infection in a cohort of hospitalized patients in Medellín, Colombia].

INTRODUCTION: Tuberculosis (TB) is an important cause of morbidity and mortality in HIV patients. It is unknown if the advent of molecular diagnostic methods and a greater availability of antiretroviral therapy (ART) in our country have changed some characteristics of the TB/HIV co-infection. OBJECTIVE: To describe the epidemiology, clinical features, diagnosis, resistance patterns, tuberculosis drug effects and mortality in co-infected patients. MATERIALS AND METHODS: Retrospective study based on the review of medical records of hospitalized co-infected adults in a university hospital in Medellín, Colombia. RESULTS: A total of 178 patients was included in the study. TB and HIV diagnosis was simultaneous in 49.4%. In the moment of TB diagnosis, the median CD4 count was 61 cells/µL (27-145). Pulmonary tuberculosis (PTB) occurred in 28% of patients, extrapulmonary (EPTB) in 23%, and mixed TB in 48.9%. The main EPTB affectations were lymphatic (55.4%), gastrointestinal (35.9%), and of the central nervous system (18.7%). Ziehl-Neelsen stain was positive in 137 patients (77%), mycobacterium culture in 121 (68%), and TB-PCR, in 85 of those patients in whom the test was done. Rifampicin resistance was detected in six cases (4.9%). Transaminases (ALT) increased in half of the patients during TB treatment, but only 10% met liver-toxicity criteria. In-hospital mortality was 11.3%. The single risk factor associated with mortality was CD4 count <50/µL (RR=3.9; 95% CI: 1.36-11.37; p=0.01). CONCLUSIONS: When it occurs as an opportunistic infection, TB usually leads to the diagnosis of advanced HIV disease. If used appropriately, TB diagnosis in these patients can be done by conventional methods. It is always necessary to monitor liver function during TB treatment and to rule out drug resistance.

Asociación entre la terapia hormonal y el desarrollo craneofacial en personas con deficiencia hormonal entre los 10 y 18 años de edad. Revisión sistemática / Association between hormonal therapy and craniofacial development in subjects between 10 and 18 years of age. Systematic review

Introducción: Las deficiencias hormonales pueden afectar el complejo craneofacial durante el crecimiento y desarrollo esque- lético. Objetivo: Determinar si existía evidencia científica acerca de la asociación entre el tratamiento hormonal y el crecimiento craneofacial en personas con deficiencia hormonal entre los 10 y 18 años de edad evaluados cefalométricamente. Materiales y método: Revisión sistemática de la literatura en Pubmed, Google acadé - mico, Lilacs, Embase, ScienceDirect, sin límite de año de publicación. Se incluye - ron ensayos clínicos, estudios de casos y controles, cohorte, revisiones sistemáticas y meta-análisis. Se hizo lectura ciega e in - dependiente por parte de 2 investigadores, de los resúmenes y los artículos completos. Resultados: De 1085 artículos encontra - dos se excluyeron 1074 por no cumplir criterios de inclusión. Luego de la lectura completa se excluyeron 5 por ser estudios transversales y uno porque no se tuvo ac- ceso a él, quedando un total de 6 artículos incluidos. Estas investigaciones reportaron que los pacientes tratados con terapias de sustitución hormonal presentaron cambios favorables en las estructuras craneofaciales, especialmente la longitud total mandibular, longitud de la rama y cuerpo mandibular; también presentaron mejoría del perfil fa - cial, relaciones intermaxilares y estructuras óseas corporales. Conclusiones: A pesar de la heteroge - neidad de los estudios,se encontró queel tratamiento temprano de sustitución hor - monal, independientemente de la dosis y siempre y cuando sea a largo plazo, acelera el desarrollo de estructuras craneofaciales, principalmente de la mandíbula, hasta lo - grar los patrones esqueléticos establecidos genéticamente. Se requieren estudios que evalúen el efecto de la terapia de sustitución hormonal en pacientes sin compromisos sistémicos adicionales.

Background: Hormone deficiency could affect craniofacial complex during esque- letal growth and development. Objective: Determine whether there is scientific evidence of the association bet - ween hormonal treatment and craniofacial growth measured by cephalometry films, in subjects of 10 to 18 years with hormonal treatment. Materials and Methods: A systematic re- view. For the articles published in PubMed, Google Scholar, Lilacs, Embase and Scien - ce Direct databases, without restriction of publication year was performed. Clinical trials, case control studies, cohort, syste - matic reviews and meta analysis studies were included. Reading of the abstracts and the complete articles were made by two researchers. Results: Among 1085 articles found, 1074 were excluded because did not meet the inclusion criteria. After complete reading of the articles, five were excluded because they were cross-sectional studies and one was not recovered in the full text. In total, 6 articles were included. These studies report that patients who were treated with hormo - ne substitution therapy showed favorable changes in their craniofacial structures, especially in mandibular total length, ramus length and mandibular body length. These positive changes led to an improvement in profile, inter-maxillary relations, and other osseous body structures. Conclusions: Despite the heterogeneity of the studies it was found that early replace - ment with hormone treatment, regardless of the dose and long-term treatment, ac - celerates the development of craniofacial structures, mainly the mandible, to reach the skeletal patterns genetically established. Studies are required to evaluate replace hormone treatment in patients without additional systemic compromises.