jurnal dr riko tb dan dm
TRANSCRIPT
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Impact of diabetes on the
presenting features of
tuberculosis in hospitalizedpatients
Pulmunology Subdivision
Internal Medicine DepartmentMedical Faculty Of Andalas UniversityDr. M. Djamil ospital Padang
!"#$
Dr. Riko Jumatullah
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Introduction
Tuberculosis (TB) incidence has declined in some
developed countries, but has risen in countries with high
rates of HIV.
Man studies
TB increased among diabetics patients,especiall with poor glcemic control.
!M causes dsfunction of the immune sstem, which can
increase the susceptibilit to TB
at the same time, TB ma increase the blood glucoselevels and trigger a ""latent diabetes##interleu$in % and
T&' alpha increasestimulate anti insulin hormone
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ifampicin, as an inducer of the hepatic microsomal
enme sstem
increases metabolism ofsulphonlureas and biguanides
Hperglcemia on !M can lowers the bioavailabilit
of rifampicin
Introduction
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Material and methods
Study conducted at theRespiratory Department ofCentro Hospitalar Lisboa NorteHospital Pulido Valente.
Review medical record patient!!!"!!#$ %& patient with '(and D)$ also %& patient 'bwithout D) * control +roup,
Patient with H-Vecluded
No patient withimmunosuppresive therapy
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Review parameters
a+e$ +ender$ immi+ration$ lun+ lesionslocation$ cavitary lesions$ etra"pulmonary'( manifestations$ multidru+"resistant '(*)DR"'(,$ adverse effects of anti"'(dru+s$ len+th of hospital stay and in"hospital mortality.
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Radiographic interpretation
isolated lowerlun+ /eld *LL0,
involvement
isolated upperlun+ /eld *1L0,
involvement
)ultilobarinvolvement
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Analysis
usin+ SPSS*Statistical Pac2a+e
for the Social
Sciences, version %3.!
'"test$ Chi"s4uareand binary lo+istic
re+ression*si+ni/cance level
p5!.!3,.
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R!"#$
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66 patients *#!.37, prior dia+nosis D)89 ural and 3
+ot insulin$ and in 9 *%6.37, cases the dia+nosis was
con/rmed durin+ the admission
'he mean a+e of patients in the diabetic +roup was
36.:%9.9 years$ while in the nondiabetic +roup it was
9%.9:%&.# years
'here were #8 males *8!.87, in the diabetic +roup and #;
*;6.67, in the nondiabetic +roup.
'he nondiabetic +roup had immi+rants *&!.67, while
the diabetic +roup had %6 *%3.37,
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'he dia+nosis of )DR"'(3 patients *9.%7, of the
diabetic +roup and cases were etensively dru+"resistant'( *
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DI!%"!!I&'
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!M affected
presenting features of TBa higher fre*uenc of e+tra
pulmonar TB
isolated --' involvement.
. !iabetic patients alsoshowed a higher inhospital
mortalit rate
maor strengths of this studwere the signi/cant sie of
the sample, the good *ualitof data collection and the
inclusion of a control group
Maor limitationthecontrol group was not
perfectl matched with thediabetic group
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'hese study showed hi+her rate of LL0 involvement in the diabetic+roup than in nondiabetic
?2to+uetal. found a hi+her rate of LL0 '( amon+ diabetics ascompared withnondiabetics*%%7and3.&7$respectively,
P@reA"BuAmnetallhi+her rate of LL0 lesions in '( D)comparison with the '( +roup *%67 vs 87,
-n fact$ the clinical and radiolo+ical presentation of '( in diabetic
patients has some similarities to that seen in H-V infected patients
Dooley et al.showed that patients with D) had .! times hi+her odds ofdeath than patients without D)
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%&'%#"!I&'
!M affected some
clinical andradiologicalpresenting featuresin hospitalied TBpatients.
LL0
involvementand etra"
pulmonary '(
manifestationswere morefre4uent indiabetic
patients
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$(A')!