RESUMO
Abstract Introduction: heart failure with reduced ejection fraction has a growing therapeutic arsenal. Thus, the indications for each therapy must be refined. Methods: a systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, to update the systematic search performed in the development of the "Clinical Practice Guidelines for Prevention, Diagnosis, Treatment and Rehabilitation" (CPG) of the Colombian Ministry of Health. Results: six new clinical trials were found which substantially modify the main recommendations of the CPG. Angiotensin receptor antagonists combined with neprilysin inhibitors (ARNI), sodium-glucose cotransporter 2 (SGLT2) inhibitors, betablockers and mineralocorticoid receptor antagonists (MRA) are now the main core of treatment for patients with heart failure with reduced ejection fraction. Other therapeutic options should be considered after beginning and titrating the doses of these four medications. Discussion: given the robustness of the evaluating studies, the proposed practical scheme, as the central core with four fundamental therapeutic strategies, will improve the treatment of patients with heart failure and allow the stepwise inclusion of other alternatives, plotted as orbits, to impact on other individual outcomes. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.2108).
RESUMO
BACKGROUND: Alteration of vitamin D is a risk factor for tuberculosis (TB). AIM: To evaluate the pulmonary and serum levels of 25-hydroxy vitamin D (25OHD) in patients with and without pulmonary TB. METHODS: Two-stage study: the first part was retrospective cross-sectional and the second prospective. Those > 18 years of age who underwent fiberoptic bronchoscopy for suspected pulmonary TB and in whom the infection was confirmed were included. Patients with another type of infection without TB and non-infectious diseases were taken as controls for the first stage and infectious controls without TB in the prospective phase. The measurement of 25OHD was performed by ELFA (enzyme-linked fluorescence assay). The Kruskal-Wallis test was used to evaluate association, considering a value of p < 0.05 to be significant. The data were processed with the SPSS version 23 program. RESULTS: The total sample was 77 patients (35 in the first stage and 42 in the second). The characteristics between the groups were homogeneous. Serum (second phase) and broncho-alveolar lavage (first and second phase) levels of 25OHD were lower in TB patients compared to controls and were independent of serum calcium level (serum: 22.4 ng/mL vs 33 ng/mL, p = 0.006 and broncho-alveolar lavage: 9.7 ng/mL vs 12.2 ng/mL; p = 0.012). CONCLUSIONS: There was a significant difference between the levels of 25OHD in both serum and broncho-alveolar lavage in patients with pulmonary TB in relation to their controls.
Assuntos
Tuberculose Pulmonar , Deficiência de Vitamina D , Estudos Transversais , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Irrigação Terapêutica , Vitamina DRESUMO
INTRODUCCIÓN: La alteración de la vitamina D es un factor de riesgo para enfermar de tuberculosis (TBC). OBJETIVO: Evaluar la concentración pulmonar y sérica del compuesto 25-hidroxi-vitamina D (25OHD) en pacientes con y sin TBC pulmonar. METODOLOGÍA: Estudio de dos etapas: la primera parte fue de corte transversal, retrospectiva, y la segunda prospectiva. Se incluyeron > 18 años a los que se les realizó fibrobroncoscopia por sospecha de TBC pulmonar y en quienes se confirmó la infección. Se tomaron como controles a pacientes con otro tipo de infección no TBC, y enfermedades no infecciosas para la primera etapa y controles infecciosos sin TBC en la fase prospectiva. La medición de 25OHD se realizó mediante ELFA (ensayo de fluorescencia ligado a enzima). Se empleó la prueba de Kruskal-Wallis para evaluar asociación considerando significativo un valor de p < 0,05. Los datos se procesaron con el programa SPSS versión 23. RESULTADOS: La muestra total fue de 77 pacientes (35 en la primera etapa y 42 en la segunda). Las características entre los grupos fueron homogéneas. Las concentraciones en suero (segunda fase) como en el lavado bronco-alveolar (primera y segunda fase) de 25OHD fueron más bajas en pacientes con TBC comparado con los controles e independientes de la concentración de calcio sérico (suero: 22,4 ng/mL vs 33 ng/mL, p = 0,006 y lavado bronco-alveolar: 9,7 ng/mL vs 12,2 ng/mL; p = 0,012). CONCLUSIONES: Hubo una diferencia significativa entre las concentraciones de 25OHD, tanto en suero como en lavado bronco-alveolar, en pacientes con TBC pulmonar con relación a sus controles.
BACKGROUND: Alteration of vitamin D is a risk factor for tuberculosis (TB). AIM: To evaluate the pulmonary and serum levels of 25-hydroxy vitamin D (25OHD) in patients with and without pulmonary TB. METHODS: Two-stage study: the first part was retrospective cross-sectional and the second prospective. Those > 18 years of age who underwent fiberoptic bronchoscopy for suspected pulmonary TB and in whom the infection was confirmed were included. Patients with another type of infection without TB and non-infectious diseases were taken as controls for the first stage and infectious controls without TB in the prospective phase. The measurement of 25OHD was performed by ELFA (enzyme-linked fluorescence assay). The Kruskal-Wallis test was used to evaluate association, considering a value of p < 0.05 to be significant. The data were processed with the SPSS version 23 program. RESULTS: The total sample was 77 patients (35 in the first stage and 42 in the second). The characteristics between the groups were homogeneous. Serum (second phase) and broncho-alveolar lavage (first and second phase) levels of 25OHD were lower in TB patients compared to controls and were independent of serum calcium level (serum: 22.4 ng/mL vs 33 ng/mL, p = 0.006 and broncho-alveolar lavage: 9.7 ng/mL vs 12.2 ng/mL; p = 0.012). CONCLUSIONS: There was a significant difference between the levels of 25OHD in both serum and broncho-alveolar lavage in patients with pulmonary TB in relation to their controls.
