Biomedical subjects

H Villarreal-Velarde

Publications and source records attributed to H Villarreal-Velarde.

6 recordsLinked to original sources

PubMed2003

Diabetes modifies the male:female ratio in pulmonary tuberculosis.

SETTING: Socio-cultural factors have been invoked to explain the male predominance among patients with pulmonary tuberculosis, but there is no conclusive evidence of their role. OBJECTIVE: To assess male predominance in a group of diabetics with pulmonary tuberculosis compared with patients with pulmonary tuberculosis alone. DESIGN: Clinical records of in-patients with pulmonary tuberculosis and with (TBDM group, n = 202) or without (TB group, n = 226) diabetes mellitus were reviewed, and the male percentages in each of six age groups (15-29, 30-39, 40-49, 50-59, 60-69, > or = 70 years) calculated. RESULTS: In the TB group, no gender difference (51% males) was found in the first age period, followed by a male predominance thereafter (71%, 68%, 75%, 63% and 58%). The TBDM group showed a similar pattern in the first two age groups (56% and 74%), followed by a steadily decline (r(S) = -0.90, P = 0.04) in male percentage (60%, 44%, 45%, 27%), leading to a female predominance after age 50. The association of age and gender was also corroborated by logistic regression in TBDM (P = 0.02), but not in TB (P = 0.19) patients. CONCLUSIONS: Diabetes was associated with a progressive shift of male predominance in pulmonary tuberculosis. Because diabetes is a disease that affects social activities similarly in men and women, our results suggest that factors other than socio-cultural ones are also important for determining the male predominance in pulmonary tuberculosis.

Adolescent↗

PubMed2002

Results of a 12-month regimen for drug-resistant pulmonary tuberculosis.

SETTING: Several therapeutic regimens for drug-resistant tuberculosis have been suggested, most of them with a total duration of 18-24 months. OBJECTIVE: To report our experience using a shorter regimen. DESIGN: Fifty patients with drug-resistant pulmonary tuberculosis were managed by withdrawing all anti-tuberculosis drugs until the results of a drug sensitivity test were obtained (approximately 3 months), and then a 12-month self-administered regimen with four to six anti-tuberculosis drugs at full daily doses was initiated, based primarily on the sensitivity test and secondarily on the history of previous treatment. RESULTS: In 31 patients treatment was completed as planned, in six it was irregular and 13 definitively abandoned it. In the best scenario, 90.3% (28/31) of patients with full treatment were cured; this outcome was similar for both multidrug-resistant (MDR, n = 18, 88.9%) and non-MDR (n = 13, 92.3%) patients. Six months later, the relapse rate was 4.8%, and after a 5-year follow-up 14 out of 18 cured patients who were located remained asymptomatic (77.8%). If the worst scenario was applied, a 62.0% cure rate (31/50) was obtained. CONCLUSIONS: A 12-month regimen with a minimum of four anti-tuberculosis agents at full dose, essentially selected on drug sensitivity testing, could be an alternative option for the treatment of drug-resistant pulmonary tuberculosis.

Adolescent↗

PubMed2001

Atypical radiological images of pulmonary tuberculosis in 192 diabetic patients: a comparative study.

SETTING: Comparative studies of pulmonary tuberculosis images in diabetics have yielded conflicting results. OBJECTIVE: To assess radiological images of pulmonary tuberculosis in a large population of diabetic patients. DESIGN: Radiographs from in-patients admitted with pulmonary tuberculosis and diabetes (TBDM group, n = 192) were reviewed and compared with a control group of patients with pulmonary tuberculosis alone (TB group, n = 130). RESULTS: Both groups had a similar evolution time of tuberculosis (approximately 2 years). Statistical differences were observed as follows: TBDM patients were older (51.3+/-0.9 vs. TB group 44.9+/-1.8 years, mean +/- SEM), and had a decreased frequency of upper (17% vs. 56%), and an increased frequency of lower (19% vs. 7%) and upper + lower (64% vs. 36%) lung field lesions. More TBDM patients developed cavitations (82% vs. 59%) more often in the lower lung fields (29% vs. 3%). More multiple cavities were seen in TBDM patients (25% vs. 2%). TBDM group had a lower total leukocyte count (8836.7+/-219.5 vs. 10013.1+/-345.2 cells/mm3), mainly due to a lower number of non-lymphocyte cells (6815.8+/-221.8 vs. 8095.7+/-321.9 cells/mm3). Multiple logistic regression showed that being a diabetic patient was the most important factor determining lower lung field lesions and cavities. CONCLUSIONS: This study in a large number of diabetics with pulmonary tuberculosis confirmed that their chest X-ray images significantly depart from the typical presentation. Clinicians must keep this in mind to avoid misdiagnosis.

Adult↗

PubMed2000

Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes.

Atypical radiologic images of pulmonary tuberculosis are common in elderly and in diabetic patients. To investigate the relationship of chest radiographic findings of tuberculosis to age in diabetic and nondiabetic patients, we compared the chest radiographic findings of 192 inpatients with pulmonary tuberculosis and diabetes with those of 130 patients with pulmonary tuberculosis alone. The proportion of patients with lower lung field lesions progressively increased with age (r(S) = 0.89, p < 0.01), whereas the frequency of cavitation steadily decreased with age (r(S) = -0.79, p < 0.05). In diabetic patients, a high frequency of lower lung lesions and cavitation was observed in all age groups. We speculated that, in older patients and in diabetics, the increased alveolar oxygen pressure in the lower lobes favors development of lower lobe disease in these groups.

Adolescent↗

PubMed1999

Does aging modify pulmonary tuberculosis?: A meta-analytical review.

STUDY OBJECTIVES: To evaluate the differences in the clinical, radiologic, and laboratory features of pulmonary tuberculosis (TB) in older patients, as compared to younger patients. DESIGN: A meta-analysis (the Schmidt-Hunter method) of published works found in MEDLINE and other sources was performed. A total of 12 studies were collected, and each variable was submitted to meta-analysis. RESULTS: No differences were found between older (>/= 60 years old) and younger TB patients with respect to male predominance, evolution time before diagnosis, prevalence of cough, sputum production, weight loss, fatigue/malaise, radiographic upper lobes lesions, positive acid-fast bacilli in sputum, anemia or hemoglobin level, and serum aminotransferases. A lower prevalence of fever, sweating, hemoptysis, cavitary disease, and positive purified protein derivative, as well as lower levels of serum albumin and blood leukocytes were noticed among older patients. In addition, the older population had a greater prevalence of dyspnea and some concomitant conditions, such as cardiovascular disorders, COPD, diabetes, gastrectomy history, and malignancies. CONCLUSIONS: This meta-analytical review identified the main differences of older TB patients, as compared to younger TB patients, that should be considered during the diagnostic evaluation. Most of these differences are explained by the already known physiologic changes that occur during aging.

Adolescent↗

PubMedDate not supplied

Diagnostic methods of primary tuberculous pleural effusion in a region with high prevalence of tuberculosis. A study in Mexican population.

STUDY OBJECTIVES: 1) To determine the age distribution of the patients with pleural tuberculosis in a region with high prevalence of tuberculosis; and 2) to evaluate the efficiency of the methods used in its diagnosis. SETTING: The National Institute of Respiratory Diseases in Mexico City, a tertiary reference center for pulmonary diseases. DESIGN: A retrospective study. PATIENTS: 452 consecutive inpatients with diagnosis of pleural effusion from January 1991 to September 1996 were reviewed: 133 patients had a diagnosis of tuberculous pleural effusion of primary origin without parenchymal abnormalities by chest roetgenogram. The others were excluded because of reactivated tuberculosis or non-tuberculous effusion. MEASUREMENTS AND RESULTS: The patients had a mean age of 42 +/- 17 years (98 male, 35 female). Pleural granulomas in the morphological study were found in 87% whereas the baciloscopy and the culture of the fluid were positive in only 8% and 19% respectively. The determination of adenosine deaminase (ADA) gave a diagnostic yield of 84%. CONCLUSIONS: 1) Primary tuberculosis pleural effusion, reported in the English literature, was also present in our adults; 2) the pleural biopsy continued to be the most effective method in the diagnosis of the pathology; and 3) the determination of ADA in an area with high prevalence of the disease was a reliable and unexpensive diagnostic method.

Adenosine Deaminase↗