RESUMO
Assuntos
Gastos em Saúde , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Estudos Transversais , Características da Família , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural , Fatores Socioeconômicos , África do Sul/epidemiologia , Tuberculose Pulmonar/economia , Tuberculose Pulmonar/etiologia , Adulto JovemRESUMO
SETTING: Fifty-six public clinics in Limpopo Province, South Africa.OBJECTIVE: To evaluate the association between tuberculosis (TB) patient costs and poverty as measured by a multidimensional poverty index.DESIGN: We performed cross-sectional interviews of consecutive patients with TB. TB episode costs were estimated from self-reported income, travel costs, and care-seeking time. Poverty was assessed using the South African Multidimensional Poverty Index (SAMPI) deprivation score (a 12-item household-level index), with higher scores indicating greater poverty. We used multivariable linear regression to adjust for age, sex, human immunodeficiency virus status and travel time.RESULTS: Among 323 participants, 108 (33%) were 'deprived' (deprivation score >0.33). For each 0.1-unit increase in deprivation score, absolute TB episode costs were 1.11 times greater (95%CI 0.97-1.26). TB episode costs were 1.19 times greater with each quintile of higher deprivation score (95%CI 1.00-1.40), but lower by a factor of 0.54 with each quintile of lower self-reported income (higher poverty, 95%CI 0.46-0.62).CONCLUSION: Individuals experiencing multidimensional poverty and the cost of tuberculosis illness in Limpopo, South Africa faced equal or higher costs of TB than non-impoverished patients. Individuals with lower self-reported income experienced higher costs as a proportion of household income but lower absolute costs. Targeted interventions are needed to reduce the economic burden of TB on patients with multidimensional poverty.
Assuntos
Efeitos Psicossociais da Doença , Gastos em Saúde , Pobreza , Tuberculose Pulmonar/economia , Adulto , Estudos Transversais , Feminino , Humanos , Renda , Modelos Lineares , Masculino , Pessoa de Meia-Idade , África do SulRESUMO
A male alcoholic who presented with hypothermia and confusion was diagnosed as suffering from Wernicke's encephalopathy. He showed in addition signs of bulbar damage with cranial nerve signs, weakness of all limbs and absent oculo-vestibular responses. His course was complicated by recurrent episodes of aspiration pneumonia with death resulting from this cause. Neuropathological findings included typical features of Wernicke's encephalopathy as well as central pontine myelinolysis.
Assuntos
Doenças Desmielinizantes/complicações , Hipotermia/etiologia , Ponte , Encefalopatia de Wernicke/complicações , Adulto , Doenças Desmielinizantes/diagnóstico , Doenças Desmielinizantes/patologia , Humanos , Masculino , Ponte/patologia , Encefalopatia de Wernicke/diagnósticoRESUMO
The mechanism of D-penicillamine induced thrombocytopenia in rheumatoid arthritis was investigated by measuring platelet life-span and platelet production rate in 2 groups of rheumatoid arthritis patients treated with 250-750 mg/day D-penicillamine, 14 with a normal platelet count and 9 with thrombocytopenia (platelet count 50-130 X 10(9)/1). Age matched control patients not treated with D-penicillamine included 14 with rheumatoid arthritis and 9 with osteoarthritis. The platelet life-span was normal, but platelet production rate was significantly reduced in the thrombocytopenic patients, suggesting that D-penicillamine causes thrombocytopenia through bone marrow suppression.