Increased incidence of nonfatal cardiovascular events in stroke patients with sleep apnoea: effect of CPAP treatment.

Obstructive sleep apnoea (OSA) is a risk factor for stroke, but little is known about the effect of OSA and continuous positive airway pressure (CPAP) on the incidence of long-term, nonfatal cardiovascular events (CVE) in stroke patients. A prospective observational study was made in 223 patients consecutively admitted for stroke. A sleep study was performed on 166 of them. 31 had an apnoea/hypopnoea index (AHI) <10 events · h(-1); 39 had an AHI between 10 and 19 events · h(-1) and 96 had an AHI ≥ 20 events · h(-1). CPAP treatment was offered when AHI was ≥ 20 events · h(-1). Patients were followed up for 7 yrs and incident CVE data were recorded. The mean ± SD age of the subjects was 73.3 ± 11 yrs; mean AHI was 26 ± 16.7 events · h(-1). Patients with moderate-to-severe OSA who could not tolerate CPAP (AHI ≥ 20 events · h(-1); n = 68) showed an increased adjusted incidence of nonfatal CVE, especially new ischaemic strokes (hazard ratio 2.87, 95% CI 1.11-7.71; p = 0.03), compared with patients with moderate-to-severe OSA who tolerated CPAP (n = 28), patients with mild disease (AHI 10-19 events · h(-1); n = 36) and patients without OSA (AHI <10 events · h(-1); n = 31). Our results suggest that the presence of moderate-to-severe OSA is associated with an increased long-term incidence of nonfatal CVE in stroke patients and that CPAP reduces the excess of incidence seen in these patients.

Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial.

The aim of the present study was to assess the impact of nasal continuous positive airway pressure (nCPAP) in ischaemic stroke patients followed for 2 yrs. Stroke patients with an apnoea-hypopnoea index ≥ 20 events·h⁻¹ were randomised to early nCPAP (n = 71; 3-6 days after stroke onset) or conventional treatment (n = 69). The Barthel Index, Canadian Scale, Rankin Scale and Short Form-36 were measured at baseline, and at 1, 3, 12 and 24 months. The percentage of patients with neurological improvement 1 month after stroke was significantly higher in the nCPAP group (Rankin scale 90.9 versus 56.3% (p < 0.01); Canadian scale 88.2 versus 72.7% (p < 0.05)). The mean time until the appearance of cardiovascular events was longer in the nCPAP group (14.9 versus 7.9 months; p = 0.044), although cardiovascular event-free survival after 24 months was similar in both groups. The cardiovascular mortality rate was 0% in the nCPAP group and 4.3% in the control group (p = 0.161). Early use of nCPAP seems to accelerate neurological recovery and to delay the appearance of cardiovascular events, although an improvement in patients' survival or quality of life was not shown.

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Thoracic empyema in HIV-infected patients: microbiology, management, and outcome.

OBJECTIVES: To evaluate etiology, bacteriology, stage of disease, treatment, and outcome of HIV-infected patients with thoracic empyema (TE) over a 9-year period at a hospital teaching center. DESIGN: We have retrospectively reviewed the charts of all HIV-infected patients with a hospital discharge diagnosis of empyema between January 1985 and November 1993. PATIENTS: Twenty-three patients were identified (22 male and 1 female). The average patient age was 28.7+/-5.3 years. All the patients were injection-drug users, and 10 (43%) fulfilled criteria for an AIDS diagnosis. In 15 cases (65%), the empyema was the first cause of medical consultation, which then led to an HIV infection diagnosis in 11 of them (48%). MEASUREMENTS: In each case, symptoms, chest studies, culture results, procedure timing, length of hospitalization, and outcome were reviewed. RESULTS: Twenty-one patients (91%) had developed an empyema secondary to community-acquired pneumonia. The cultures of pleural fluid were positive in 19 cases (83%). Anaerobes were isolated from 6 patients and aerobes from 13. A single bacteria was isolated from 10 (52%), and multiple organisms (average 2.66 per case) grew in the remaining 9 positive cultures. The most common organism culture growths were Staphylococcus aureus (23%) and Gram-negative bacilli (36%). Length of hospitalization averaged 25.6 days (+/-15). Intercostal tube drainage was necessary in 18 patients and none required surgery. Patients with AIDS diagnosis needed a longer period of hospitalization, and the presence of bacteremia and bronchopleural fistula was more frequent. However, this did not influence a patient's final outcome. A follow-up was available in 18 cases, with 4 deaths recorded (average survival, 35 months; range, 4 to 84 months). CONCLUSIONS: In our series, TE associated with HIV infection was often the primary cause leading to hospital admission and later HIV diagnosis. IV drug abuse was the predominant factor for HIV infection and was also related to clinical presentation and microbiological findings. The best approach to treatment is--as with other patient groups--a prompt drainage and appropriate antibiotic treatment, since a favorable outcome is expected.

[Pseudochylothorax. Review of 5 cases]. / Seudoquilotórax. Revisión de 5 casos.

We undertook a retrospective review of five patients with pseudo-chylothorax diagnosed at our hospital between 1984 and 1994. Pseudo-chylothorax was diagnosed if crystals of cholesterol were observed (CC) or if cholesterol concentrations were over 150 mg/dl, but chylomicrons were absent from pleural effusions with cloudy supernatants after centrifugation. The five patients were males and their mean age was 53 years. All had history of pulmonary or pleural tuberculosis (mean 31 years since diagnosis). All had received chemotherapy and four had undergone therapeutic pneumothorax. Two patients were diagnosed in the course of examination for other reasons, Three were diagnosed while being examined for the cause of pleural effusion. The diagnosis of four patients was based on the presence of CC. Three patients received specific treatment and Mycobacterium tuberculosis was isolated in the pleural fluid of two. One patient required a pleural drain and antibiotics because of empyema related to pseudo-chylothorax. Decortication was needed by two. 1) Pseudo-chylothorax is at present rare. 2) All the cases we saw were associated with earlier tuberculosis infection with residual pleural lesions. 3) Diagnosis usually occurs in the course of examination for the other motives, but the possibility of infected pleural effusion or reactivation of tuberculosis should be considered.

[Outcome of treating initial tuberculosis in the area south of Seville in a 5-year period (1994-1998]. / Resultados del tratamiento de la tuberculosis inicial en el área sur de Sevilla en un período de 5 años (1994-1998).

OBJECTIVE: To analyze the outcome of treating initial tuberculosis (ITB) in the hospital district south of Seville (Spain). MATERIAL AND METHOD: A descriptive study of treatment outcome in cases of ITB in our district between 1 January 1994 and 31 December 1998. Outcome was classified according to World Health Organization guidelines:successful (S) potentially unsuccessful (PU), exitus (EX) and transferred out (T).Four hundred fifty-four patients (mean age 35 years) were enrolled; 22% were HIV+ and 21% were intravenous drug users (IVDU). Treatment was self-administered in all cases, with 98% being given the standard prescription of 6 or 9 drugs. No subsequent case history was found for 15 cases, such that outcome could not be assessed. RESULTS: Of the 439 evaluable cases, outcome was S for 74% (326/439), PU for 16% (70/439), EX for 8% (36/439) and T for 6. Outcome for HIV + patients was poorer than for HIV- patients (S: 35/98 versus 291/341, p < 0.00005;PU: 40/98 versus 30/341, p < 0.00005), and the mortality rate of HIV+ patients was higher than that of HIV- patients (EX:18/98 versus 18/341, p < 0.0008). Among those classified PU,no cases of treatment failure were recorded and up to 78% (31/40)were cases of loss of follow-up or abandonment. The variable most closely related to PU was IVDU status (OR = 10.5, p < 0.00005). CONCLUSION: a) Outcomes for the general population are acceptable. b)A marginal group has been identified as characterized by two variables, HIV+ and IVDU, which are the factors associated with poorer outcome of self-administered treatment, indicating that supervised treatment is advisable in cases where those factors are present.

[Cytohistological agreement of fine-needle transthoracic lung puncture-aspiration (FNTLPA) in malignant lesions]. / Concordancia citohistológica de la punción-aspiración pulmonar transtorácica con aguja fina (PAPTAF) en lesiones malignas.

To assess agreement between cyto-histological results and fine needle aspiration (FNA) biopsy of malignant pulmonary lesions, and to study the relation with type of lesion. specimen and impact on patient management. Retrospective study of FNA performed over the past 4 years if a biopsy was available (obtained by fiberoptic bronchoscopy, thoracotomy or biopsy of extrapulmonary organs) for comparison. We recorded overall agreement (OA) and agreement by type of disease or neoplasm (DA). Also studied were the features of the lesion, the puncture technique and material obtained in function of agreement. Eighty samples were available for comparison. OA was 58.7% (K = 0.17). DA was good for epidermoid carcinoma (87%, K = 0.64) and poor for adenocarcinoma (87.5%, K = 0.30). The lowest agreement was for undifferentiated large cell carcinoma (10.3%, K = 0.07). In such cases FNA specimens were not useful for classifying 61.5% of adenocarcinomas and 21.6% of epidermoid carcinomas. Cyto-histological inaccuracy was clinically significant, however, in only 3 (3.7%) patients. Lesions for which diagnosis was consistent were larger in size (4.6 +/- 2.2 versus 4 +/- 1.6 cm, p = NS), were nearer to the visceral pleura (1.5 +/- 2.3 versus 2 +/- 2.2 cm, p = NS) and tended to have been sampled with the guidance of computerized tomography (65% versus 35%), although this did not affect the features or amount of material obtained. We found poor OA for adenocarcinoma and undifferentiated large cell carcinoma. Although disagreement was clinically significant in only 3.7% of cases, the implications indicate that the specificity of the technique should be improved, above all in small cell carcinomas. We observed no differences as to type of lesion or specimen obtained that might predict interpretive difficulties.

[Trends in the incidence of tuberculosis in the area of Seville-South (Spain) during the 1990s]. / Evolución de la incidencia de la tuberculosis en el Area Sur de Sevilla en la década de los noventa.

OBJECTIVE: To describe the incidence of tuberculosis (TB) in the hospital area of Seville-South between 1990 and 1999. METHOD: Study of the incidence of TB in the area's population between 1990 and 1999 by way of periodic survey of informants who were likely to see cases. RESULTS: The annual incidence of TB rose from 1990 (26.64/105) to its peak in 1992 (38.3/105), stabilized between 1992 and 1995, and later fell to 15.7/105 in 1999. Bacillary cases followed a similar pattern, with a peak of 13.76/105 in 1992 and a low of 6.06/105 in 1998. The annual incidence of TB-AIDS rose between 1990 (2.63/105) and 1995 (9.08/105), and then fell to 4.13/105 by 1999. The highest incidences were in the 25-to-34-year-old range in the periods from 1990 to 1993 (50.74/105) and 1994 to 1996 (61.49/105), whereas the incidence decreased among 55-to-64-year-olds (28.55/105) from 1997 to 1999. The age distribution was affected by rates in the TB-AIDS group, which contributed 48%, 50% and 55% in each period, respectively, for individuals in the 25-to-34-year-old range. CONCLUSIONS: The annual incidence of TB was 41,1% lower in 1999 than in 1990, as a result of the marked decrease beginning in the middle of the decade. The impact of TB-AIDS patients on the evolution of annual incidence and on age distribution was considerable throughout the decade.

[Factors related to diagnostic yield and complications of transbronchial biopsy]. / Factores relacionados con la rentabilidad diagnóstica y aparición de complicaciones de la biopsia transbronquial.

To study the diagnostic yield of transbronchial biopsy (TBB) in lung diseases of different ethiology, as well as to examine several factors implicated in diagnostic yield and complications of TBB. Retrospective study of a series of 172 patients (98 women and 74 men) undergoing TBB. Clinical variables, x-ray and CT patterns and technical factors related to TBB were analyzed in relation to diagnostic yield and definitive diagnosis. We recorded the main complications and studied the possible mechanisms implicated in their appearance. The results of TBB were classified as follows: 1) diagnostic TBB (42.8%); 2) nonspecific TBB (21.1%); absence of parenchyma (NP) (9.7%); 4) normal parenchyma (23.4%); 5) incorrect diagnosis (2.9%). Overall yield was 43.6% but rose to 52% when NP and no infiltrative pneumopathies were excluded. The main findings were infections (23.4%), neoplasms (19.4%), sarcoidosis (14.2%), idiopathic pulmonary fibrosis (IPF) (17.7%); and other (23.4%). Significant differences in diagnosis were found for age, sex, time of evolution prior to TBB, and x-ray and CT patterns. Complications and pneumothorax appeared more frequently in IPF, neoplasms and infections, although the differences were non significant. Diagnostic value depended mainly on type of disease and ranged from 60% for sarcoidosis to 24% for IPF (p < 0.05), with no differences related to age, sex, presence of immunosuppression, number of TBB or tolerance to exploration. Yield was higher, however, for patients with no loss of radiographic pulmonary volume (56.3% versus 37.5%) and with absence of a CT reticular pattern (44.7% versus 27.3%). Type of opacites also influenced yield (53.4% for ground glass versus 26.7% for reticular patterns), as did distribution of lesions (8.4% for peripheral patterns versus 48.3% for diffuse patterns and 50% for peribronchio-vascular patterns). The site of TBB was the only factor showing clearly significant differences in yield (100% in mild lobe versus 29.5% in upper lobes). Tolerance was poorer in older patients (63.5 +/- 10 versus 52.2 +/- 17 years) and with greater function abnormalities (%FEV1: 48.2 +/- 16.8 versus 70.2 +/- 17.1). Poor tolerance of exploration was associated with the appearance of complications (16.6% vs 6.3) and pneumothorax (25% versus 6.8%). The diagnostic yield of TBB was mainly influenced by the type of disease studied. The various imaging techniques were fundamental for establishing preliminary diagnoses and degree of evolution of a specific cases. In our series, tolerance of the technique was a reliable predictor of complications and the presence of post-biops pneumothorax.

[Usefulness of transthoracic pulmonary aspiration biopsy in lung abscess secondary to neoplasm]. / Utilidad de la punción aspirativa pulmonar transtorácica en el absceso pulmonar secundario a neoplasia.

OBJECTIVE: To evaluate the usefulness of transthoracic needle biopsy (TNB) for the diagnosis of bronchial carcinoma underlying lung abscess (LA), and to determine the bacteriology of lung abscess secondary to neoplasm (LASN). PATIENTS AND METHOD: One hundred thirteen consecutive patients diagnosed of LA were enrolled. Radiologically guided TNB was performed on all patients using 20-22 G needles. Microbiological and cytological samples were processed. Fiberoptic bronchoscopy (FB) was performed if there were risk factors for lung cancer. TNB-diagnosed cases were compared with the remaining cases of LA. RESULTS: Neoplasia was found in 21 LA patients. TNB samples provided diagnostic information in 15 cases, there were 2 false negatives, and no cytology sample was processed in 4 cases. Diagnosis was based on FB in 17 cases. All neoplasias were diagnosed with one technique or the other. TNB culture was positive in 90% (19/21) of the LASN patients, H. influenzae being the most frequently isolated bacterium. The number of cultures that presented a single microbe was significantly greater (p < 0.02) among LASN patients (14/19 versus 33/79). These patients also had significantly more aerobic bacteria (19/19 versus 45/79; p < 0.001) and fewer anaerobies (4/19 versus 52/79; p < 0.001) than did the primary LA patients. CONCLUSIONS: 1) TNB is highly useful for arriving at a bacteriologic diagnosis of LASN and in associated cancer. 2) TNB complements FB for the diagnosis of neoplasia underlying LA and helps to reduce the number of unnecessary thoracotomies. 3) A great variety of germs, particularly aerobic bacteria, are implicated in LASN.

Prevalencia y características clínicas de la apnea del sueño en una población de mujeres diagnosticadas de cáncer de mama / Prevalence and clinical characteristics of sleep apnea in a population of women diagnosed with breast cancer

Objetivo: a pesar del interés creciente en la asociación entre apnea de sueño (AS) y cáncer, apenas existen estudios que investiguen tumores concretos. Nuestro objetivo fue analizar la prevalencia y características clínicas de la AS en mujeres con cáncer de mama (CM). Métodos: estudio piloto transversal. Se incluyen consecutivamente 83 mujeres entre 18 - 65, años diagnosticadas por primera vez de CM. En todos los casos se realizó un cuestionario clínico y una poligrafía respiratoria domiciliaria. La AS se definió como un índice de apneas-hipopneas (IAH) ≥5, y el síndrome de apneas-hipopneas del sueño (SAHS) como la asociación de un IAH ≥5 y excesiva somnolencia diurna (ESD, Epworth >10). Resultados: la media (DE) de edad fue de 48,8 (8,8) años, el índice de masa corporal (IMC) de 27,4 (5,4) y el 50,6% eran postmenopáusicas. La prevalencia de AS fue del 51,8% (43 casos), y la mediana de IAH de 5,1 (RIQ 2 - 9,4). De las 43 pacientes con AS, 32 presentaron un IAH 5 - 14,9 y 11 IAH ≥15. La prevalencia de SAHS fue del 10,8% (9 casos). Comparadas con las mujeres sin AS, aquellas con AS presentaron más ronquido, pero no hubo diferencias en otros síntomas relacionados con el sueño. En el análisis multivariado, la edad y las variables antropométricas, pero no la ESD, se asociaron independientemente a la AS. Conclusión: la prevalencia de AS es elevada en mujeres de mediana edad diagnosticadas de CM, aunque la mayoría no presentan ESD ni otras características diferenciales. La edad y la obesidad fueron predictores de AS en esta población

Objective: Despite growing interest in the association between sleep apnea and cancer, there are hardly any studies that research specific tumors. Our objective was to analyze the prevalence and characteristics of sleep apnea in women with breast cancer. Methods: A transversal pilot study. 83 women between the ages of 18 and 65 diagnosed with breast cancer for the first time were included consecutively. All participants completed a clinical questionnaire and underwent home respiratory polygraphy. Sleep apnea was defined as an apnea-hypopnea index (AHI) ≥5 and sleep apnea-hypopnea syndrome (SAHS) was defined as the association between an AHI ≥5 and excessive daytime sleepiness (EDS, Epworth >10). Results: The average (SD) age was 48.8 (8.8) years old, the body mass index (BMI) was 27.4 (5.4) and 50.6% were postmenopausal. The prevalence of sleep apnea was 51.8% (43 cases) and the average AHI was 5.1 (IQR: 2 - 9.4). Of the 43 patients with sleep apnea, 32 had an AHI between 5 and 14 and 11 had an AHI ≥15. The prevalence of SAHS was 10.8% (9 cases). Compared to women without sleep apnea, those with the disease snored more, but there were no differences in other sleep-related symptoms. In the multivariate analysis, age and anthropometric variables, but not EDS, were independently associated with sleep apnea. Conclusion: The prevalence of sleep apnea is higher in middle-aged women diagnosed with breast cancer, although the majority do not present with EDS or other distinguishing characteristics. Age and obesity were predictors for sleep apnea in this population

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Prevalencia de factores de riesgo cardiovascular en pacientes con síndrome de apneas-hipopneas obstructivas del sueño / Prevalence of cardiovascular risk factors in patients with obstructive sleep apnea/hypoapnea syndrome

OBJETIVO: Analizar la prevalencia de factores de riesgo cardiovascular(FRV) en pacientes con síndrome de apneas-hipopneasobstructivas del sueño (SAHOS).PACIENTES Y MÉTODO: Se incluyeron todos los pacientesdiagnosticados de SAHOS mediante estudio de sueño entre Enerode 1994 y Diciembre de 2000, analizándose los siguientes FRV:edad, sexo, hipertensión arterial (HTA), tabaquismo, obesidad,diabetes mellitus (DM), hipercolesterolemia (HCL) e hipertrigliceridemia(HTG).RESULTADOS: Se incluyeron 879 pacientes con edad media55,4±10.6 años, IAH 54,9±28,7, de los cuales 711 (80,9%) eranhombres. La prevalencia de los diferentes FRV fue la siguiente:obesidad 719 (81,8%) casos, tabaquismo 589 (67%), HTA 535(60,9%), HCL 581 (66%), HTG 191 (21,7%) y DM 312 (35,4%). Lamedia de FRV por paciente (excluyendo edad y sexo) fue de3,4±1,2, y 660 (75%) casos asociaron 3 ó más FRV. Los pacientescon IAH>30 presentaron más FRV que aquellos con IAH<30 (3,5 ±1,2 vs. 3,1 ± 1,2; p=0,02).CONCLUSIONES: Los pacientes con SAHOS presentaronuna elevada prevalencia de FRV y una tendencia acusada a la asociaciónde varios FRV en un mismo paciente. Los SAHOS gravestenían más FRV que los casos no graves

OBJECTIVE: To analyze the prevalence of cardiovascularrisk factors (CRF) in patients with obstructive sleepapnea/hypoapnea syndrome (OSHAS).PATIENTS AND METHOD: all patients diagnosed withOSHAS during a sleep study between January 1994 and December2000 were included, with the following CRF being analyzed: age,sex, arterial hypertension (AHT), smoking habits, obesity, diabetesmellitus (DM), hypercholesterolemia (HCL) and hypertriglyceridemia(HTG).RESULTS: 879 patients were included in the study, with anaverage age of 55.4±10.6 years, with an AHI (apnea/hypoapneaindex) of 54.9±28.7, of which 711 (80.9%) were men. The prevalenceof the various CRF was as follows: obesity 719 (81.8%) cases,smoking 589 (67%), AHT 535 (60.9%), HCL 581 (66%), HTG 191(21.7%) and DM 312 (35.4%). The average CRF per patient(excluding age and sex) was 3.4±1.2, and in 660 (75%) cases, therewere 3 or more associated CRF. The patients with AHI>30 presentedmore CRF than those with an AHI < 30 (3.5 ± 1.2 vs. 3.1 ±1.2; p=0.02).CONCLUSIONS: Patients with OSHAS presented anincreased prevalence of CRF and there was a marked tendency toassociate several CRF in one single patient. Serious OSHAS caseshad more CRF than the less serious cases

Resultados del tratamiento de la tuberculosis inicial en el área sur de Sevilla en un período de 5 años (1994-1998) / Outcome of treating initial tuberculosis in the area south of Seville (Spain) over a five-year period (1994-1998)

OBJETIVO: Analizar los resultados del tratamiento de la tuberculosis inicial (TBI) en el Área Hospitalaria Sur de Sevilla. MATERIAL Y MÉTODO: Estudio descriptivo de los resultados obtenidos en los casos de TBI diagnosticados en nuestra área entre el 1 de enero de 1994 y el 31 de diciembre de 1998. Los resultados finales se han clasificado en cuatro categorías atendiendo a las recomendaciones de la Organización Mundial de la Salud (OMS): satisfactorios (RS), potencialmente insatisfactorios (RPI), fallecimientos (EX) y traslados (TD). Se incluyen 454 casos con una edad media de 35 años, de los cuales el 22 por ciento eran VIH positivo y el 21 por ciento eran adictos a drogas por vía parenteral (ADVP). En todos los casos el tratamiento fue autoadministrado, y al 98 por ciento se les prescribió un régimen estándar de 6 o 9 fármacos. En 15 casos no se encontró la historia clínica para evaluar el resultado del tratamiento. RESULTADOS: De los 439 casos evaluables, hubo un 74 por ciento (326/439) de RS, un 16 por ciento (70/439) de RPI, un 8 por ciento (36/439) de EX y 6 TD. Los pacientes VIH positivo presentaron peores RS (35/98 frente a 291/341; p < 0,00005) y RPI (40/98 frente a 30/341; p < 0,00005), así como una mayor mortalidad (18/98 frente a 18/341; p < 0,0008) que los VIH negativos. Entre los RPI, no se detectaron fracasos, y hasta el 78 por ciento (31/40) fueron debidos a pérdida o abandono. La variable que mejor se correlacionó con el RPI fue la ADVP (OR: 10,5; p < 0,00005). CONCLUSIÓN: a) Los resultados obtenidos en población general son aceptables, y b) existe un grupo marginal, caracterizado por el binomio VIH-ADVP, que tienen unos pésimos resultados con el tratamiento autoadministrado, y en los que sería necesario aplicar tratamientos supervisados (AU)

Evolución de la incidencia de la tuberculosis en el área sur de Sevilla en la década de los noventa / Trends in the incidence of tuberculosis in the area of Seville-south (Spain) during the 1990s

OBJETIVO: Describir la incidencia de la tuberculosis (TB) en el Área Hospitalaria Sur de Sevilla entre 1990 y 1999.MÉTODO: Estudio de incidencia de la TB en la población del área entre 1990 y 1999, mediante la consulta periódica de todas las fuentes susceptibles de aportar casos. RESULTADOS: La tasa de incidencia anual (TIA) de TB ascendió desde 1990 (26,64/105) hasta alcanzar su pico en 1992 (38,3/105), se estabilizó entre 1992 y 1995 y, posteriormente, sufrió un descenso mantenido hasta 1999 (15,7/105). La curva de bacilíferos siguió una evolución similar, con un pico de 13,76/105 en 1992 y un mínimo de 6,06/105 en 1998. La TIA en el grupo TB-sida ascendió desde 1990 (2,63/105) hasta 1995 (9,08/105), descendiendo posteriormente de forma mantenida hasta 1999 (4,13/105). Por edades, las tasas más elevadas se registraron en el grupo de edad de 25-34 años, tanto en el período 1990-1993 (50,74/105) como en 1994-1996 (61,49/105), mientras que en 1997-1999 recayeron en el grupo de 55-64 años (28,55/105). Esta distribución por edades estuvo influida por el grupo de TB-sida, que contribuyó con un 48, un 50 y un 55 por ciento, respectivamente, en cada período a la tasa global del grupo de 25-34 años. CONCLUSIONES: La TIA de TB para el global de casos se redujo en un 41,1 por ciento en 1999 respecto al valor de 1990, produciéndose este acusado descenso a partir de la mitad de la década. Los pacientes con TB-sida tuvieron una influencia importante tanto en la evolución de las TIA a lo largo de la década, como en la morfología de la curva por edades. (AU)