OBJECTIVE: To determine the prevalence, demographic, clinical profile, diagnostic and treatment outcomes of adult patients diagnosed with disseminated tuberculosis

METHODS: This is a cross sectional study of patients referred to the UP-PGH TB DOTS clinic with a diagnosis of disseminated TB from January 2011 to December 2015.

RESULTS: The prevalence of disseminated tuberculosis was 1.7 %.Mean age at diagnosis was 33.9 years (range 19-64 years) with a male: female ratio of 1:1. The most common comorbidity was HIV (5.8%). The mean duration of symptoms before initial consult was 281 days (SD 510.7). The most common presenting symptoms were abdominal pain (19%), back pain (13%), and abdominal enlargement (11%). The lungs (86%) are still the most commonly involved site, followed by the gastrointestinal tract (22%) and the vertebra (27%). Majority were started with Category I treatment regimen (54%, 37 patients). Of the 68 patients, only 16% (11 patients) continued follow-up at PGH; all had documented treatment completion.

CONCLUSION: Patients with disseminated tuberculosis are young and majority had no comorbid illness. They have long latency of symptoms prior to diagnosis, and usually present with nonpulmonary symptoms despite high evidence of pulmonary involvement. To date, this is the largest local study on disseminated TB known to the authors.

Human ; Male ; Female ; Middle Aged ; Adult ; Comorbidity ; Abdomen ; Treatment Outcome ; Abdominal Pain ; Gastrointestinal Tract ; Tuberculosis ; Back Pain ; Hiv Infections

Objectives: Systemic consequence of Chronic Obstructive Pulmonary Disease (COPD) is associated with progressive loss of muscle mass and function. Preliminary studies showed presence of sarcopenia in COPD leads to reduced pulmonary function and quality of life; studies on whether this condition results in consequent loss of bone mineral density (BMD) is still inconsistent. This study aims to examine the association of sarcopenia in COPD with osteoporosis. Methods: This is a post-hoc analysis of a study on forty-one (n ¼ 41) participants with COPD seen in a tertiary public hospital in Manila, Philippines who underwent pulmonary function test and dual-energy x-ray absorptiometry. Sarcopenia was defined using a Philippine-based criteria of low fat free mass index (FFMI) and low muscle strength - hand grip strength, and osteoporosis using World Health Organization T-score diagnostic criteria. Results: The prevalence of osteoporosis among COPD is 44%, and 63% in COPD with sarcopenia. There was no statistical difference seen in pulmonary function variables between COPD with and without osteoporosis. Significant positive correlations were observed between Forced Expiratory Volume in 1 s, FFMI, and appendicular lean muscle with total body BMD. Sarcopenia in COPD was associated with significantly increased risk for osteoporosis. Conclusions High prevalence rate of osteoporosis, and even higher among sarcopenic Filipino COPD patients should be further studied. The findings also suggest that sarcopenia in COPD is associated with increased risk of osteoporosis, and osteoporosis alone does not seem to affect lung function.

Introduction: Recent studies on critically ill adults has shown that use of normal saline with its supraphysiologic chloride content has been associated with an increased incidence of hyperchloremic metabolic acidosis, acute kidney injury (AKI), renal replacement therapy (RRT), hypotension and death. The objective of this meta-analysis was to assess the clinical outcomes associated with the use of balanced crystalloids versus normal saline solution. Methods: We searched PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Our inclusion criteria were the following: randomized controlled trials, adult critically ill patients, comparisons between patients receiving either balanced crystalloids (lactated ringer’s solution, plasma-lyte) or normal saline, and at least one endpoint that measure intensive care unit mortality, risk of AKI (defined as stage 2 or greater in the RIFLE criteria) and risk of RRT. Risk ratios (RRs) and confidence intervals (C.I) were calculated via Review Manager Version 5.3 using the fixed-effect modelling. Results: A total of four randomized controlled trials, which were all assessed to be good quality and low risk of bias, with 19,105 patients were included. Use of balanced crystalloids showed a trend towards lower incidence of AKI (RR 0.94, 95% C.I [0.87-1.02], P=0.69), RRT use (RR 0.91, 95% C.I. [0.771.07], P=0.29) and ICU mortality (RR 0.91, 95% C.I. [0.82-1.01], P=0.95). There is no significant heterogeneity identified. Conclusion Use of balanced crystalloids as intravenous fluid therapy among critically ill patients demonstrated a trend toward lower incidence of AKI, RRT and ICU mortality, compared to normal saline solution.
Acute Kidney Injury ; Critical Illness