BackgroundPulmonary tuberculosis (TB) persists an important contributor to the burden of diseases in developing countries. TB control success is based on the patient’s compliance to the treatment. Depressive disorders have been negatively associated with compliance of therapeutic schemes for chronic diseases. This study aimed to estimate the significance and magnitude of major depressive episode as a hazard factor for negative outcomes (NO), including abandon or death in patients receiving TB treatment.Methodology/Principal FindingsA longitudinal study was conducted to evaluate the association of major depressive episode (MDE), as measured by a 5-item version of the Center for Epidemiological Studies Depression Scale (CES-D) with NO to TB treatment. Patients with confirmed TB were enrolled before the start of TB treatment. Baseline measurements included socio-demographic variables as well as the CES-D, which was also applied every month until the end of the treatment. Death and treatment default were assessed monthly. Survivor function (SF) for NO according to MDE status (CES-D≥6) at baseline (MDEb) was estimated. Cox’s Regression was performed for bivariate analyses as well as for the multivariate model. A total of 325 patients accepted to participate in the study, of which 34 where excluded for diagnosis of MDR-TB. NO was observed in 24 patients (8.2%); 109 (37%) presented MDEb. Statistically significant difference was found on the SF of patients with and without MDEb (0.85 vs. 0.96, p-value = 0.002). The hazard ratio for NO, controlled for age, sex, marital status and instruction level was 3.54 (95%CI 1.43–8.75; p-value = 0.006).ConclusionThe presence of MDE at baseline is associated to NO of TB treatment. Targeting detection and treatment of MDE may improve TB treatment outcomes.

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The four auricular arrhythmias, premature systoles, paroxysmal tachycardia, flutter, and fibrillation, have been investigated in over 200 dogs by three methods: (1) high speed cinematography, (2) cathode-ray oscillography, and (3) multiple-channel electrocardiography. The hitherto unexplored body of the left auricle has been surgically exposed and thoroughly studied. Results indicate that all four arrhythmias are of unitary origin and may occur from one ectopic focus. The resulting arrhythmia depends largely upon the rate of discharge from that focus. There is no circus movement. Corroborative observations have been made on the arrhythmias in man. This conception of the auricular arrhythmias simplifies the understanding of their mechanism.S INCE the classic studies of Lewis and his associates' on the nature of the auricular arrhythmias, comparatively little has been published on this phase of the subject. Levi is believed that his experiments established the following concepts concerning the mechanisms of the auricular arrhythmias:1. That auricular flutter is due to a regular circus movement in the auricles which sweeps around the openings of the venae cavae. The main impulse usually travels in a counterclockwise direction up the right auricle, circling the superior vena cava, then down the left auricle, and around the inferior vena cava, thus completing the circus. Regular daughter waves are sent off the main wave to the remainder of the auricles.2. Auricular fibrillation is due to a circus movement of the same general type as that of auricular flutter, but in this instance the impulse pursues a tortuous and redundant path around the venae cavae and sends off irregular daughter waves to the remainder of the auricles.3. Paroxysmal auricular tachycardia is of a different nature. Lewis believed that a rapidly discharging ectopic focus in the auricle is responsible for the arrhythmia; no circus movement is present. Other investigators, however, do favor circus movement as the mechanism of auricular tachycardia. The evidence that Lewis gathered with regard to circus movement appeared so complete that his conclusions have been accepted as fact in most modern textbooks of physiology, cardiology, and medicine.For the past three years we have been taking high-speed, colored cinematographs of the auricles of the intact dog's heart. A Western Electric Fastax 16-mm. camera was used with which films were taken at speeds up to 2,000 frames per second. When films taken at 2,000 frames per second are projected at eight frames per second the motion of the auricles is slowed 250 times. Auricular events that occur in one second take four minutes to view on the screen. A magnifying lens is used which enlarges the auricle 100 or more times on projection. By careful photographic technic, and lighting the field with twelve RSP-2 photospot incandescent lamps, excellent pictures are obtained showing the most minute detail of auricular activity. By means of such pictures, the auricular contraction wave can actually be seen for the first...

ES prevalence in Lima's public transportation drivers is in a medium range as suggested by previous regional studies.

We have studied the pulmonary circulation of three closely related animals, the llama, alpaca, and guanaco. The mean pulmonary arterial pressure of 12 llamas and one alpaca indigenous to high altitude in the Andes was found to be slightly but significantly higher than that of three llamas and three guanacos born and bred at low altitude in England. On the other hand, the medial thickness of the muscular pulmonary arteries and the relative weights of the two ventricles were the same in three llamas and one alpaca at high altitude as they were in one llama and two guanacos at low altitude. It is concluded that the pulmonary vasoconstrictive response to hypoxia, while present, is greatly reduced in this species and it is suggested that this may have taken place by evolutionary adaptation.Man and cattle develop pulmonary hypertension when living at high altitude.1-3 Confirmatory evidence of the raised pulmonary arterial pressure has come from the demonstration of an increased thickness of the media of the muscular pulmonary arteries and muscularisation of the terminal portions of the pulmonary arterial tree,4-6 and from an increase in the weight of the right ventricle relative to the left.7 8 There is anatomical evidence that at least two species may be the exception to this rule: the mountain viscacha (Lagidium peruanum)8 and the llama (Lama glama).4 9 In these previous studies we observed that in the llama native to high altitude there was no right ventricular hypertrophy and the walls of the pulmonary trunk and small pulmonary arteries were thin.Banchero and his colleagues'0 produced evidence in opposition to these observations. They found that the mean pulmonary arterial pressure of three young llamas, born and bred at a low altitude of 260 m rose from an average of 14 mm Hg to 23 mm Hg after 10 weeks' residence at an altitude of 3420 m.

(1974). Thorax, 29,[463][464][465][466][467][468][469][470][471]. The heart and pulmonary vasculature of the llama (Lama glama). A qualitative and quantitative histological study was made of the pulmonary trunk and muscular pulmonary arteries of a male and a pregnant female llama born and living at an altitude of 4,720 m above sea-level in the Peruvian Andes. A similar study was made on the fetal llama. The individual cardiac chambers of the two adults were weighed. Our results show that in the adult llama there is no hypertrophy of the right ventricle or of the media of the pulmonary trunk or small pulmonary arteries. This appears to be of evolutionary significance in respect of survival at high altitude and suggests that the llama does not have a sustained significant pulmonary hypertension. The pulmonary arteries of the fetal llama are thick-walled and we associate this with the physiological pulmonary hypertension of fetal life.There is now much convincing evidence that in most species the pulmonary arterial tree responds to a hypoxic stimulus by constriction. This leads to an increase in medial thickness of the terminal portions of the pulmonary arterial tree, an elevated pulmonary vascular resistance, and consequent right ventricular hypertrophy. Thus Abraham, Kay, Cole, and Pincock (1971) subjected rats to a simulated high altitude of 5,500 m in a decompression chamber and found that during the course of 33 days they showed a progressive rise in right ventricular mean pressure and weight and the development of muscularized pulmonary arterioles and increased medial thickness of muscular pulmonary arteries. Arias-Stella and Saldan'a (1963) showed that the same phenomenon occurs naturally in men exposed to the chronic hypoxia associated with mountain dwelling. They found that in the Quechua Indians living permanently in Andean towns above altitudes of 3,440 m there is a greater amount of muscle in the more distal segments of the pulmonary arterial tree. In some species the effect of hypoxia on the pulmonary circulation is severe. Thus cattle living at high altitude in the region of Salt Lake City may develop 'brisket disease' in which an increased pulmonary vascular resistance is produced by the hypoxia and leads on to right ventricular hypertrophy and congestive cardiac failure (Hecht et al., 1959); the increased pulmonary vascular resistance is associated with medial hypertrophy of the small pulmonary arteries (Alexander, 1962). In a previous study we found that the pulmonary arteries of cats and dogs living at high altitude are thick compared to representatives of the same species living at sea level (Heath, Castillo, Arias-Stella, and Harris, 1969). In the same study we found that the pulmonary arteries of a llama were much thinner and suggested that this might be of evolutionary significance in respect of survival at high altitude. This view was subsequently challenged by Banchero, Grover, and Will (1971) who illustrated a thickwalled muscular pulmonary artery and a muscularized pulmonary arteriole in...

BackgroundTraffic related injuries are leading contributors to burden of disease worldwide. In developing countries a high proportion of them can be attributed to public transportation vehicles. Several mental disorders including alcohol and drug abuse, psychotic disorders, mental stress, productivity pressure, and low monetary income were found predictors of high rates of traffic related injuries in public transportation drivers. The goal of this study was to estimate the prevalence of common mental disorders in the population of public transportation drivers of buses and rickshaws in Lima, Peru.Methodology/Principal FindingsCross sectional study. A sample of bus and rickshaw drivers was systematically selected from formal public transportation companies using a snowball approach. Participants completed self-administered questionnaires for assessing major depressive episode, anxiety symptoms, alcohol abuse, and burnout syndrome. Socio demographic information was also collected. The analyses consisted of descriptive measurement of outcomes taking into account both between and within cluster standard deviation (BCSD and WCSD). A total of 278 bus and 227 rickshaw drivers out of 25 companies agreed to participate in the study. BCSD for major depressive episode, anxiety symptoms and burnout syndrome was not found significant (p>0.05). The estimated prevalence of each variable was 13.7% (IC95%: 10.7–16.6%), 24.1% (IC95%: 19.4–28.8%) and 14.1% (IC95%: 10.8–17.4%) respectively. The estimated prevalence of alcohol abuse was 75.4% (IC95%: 69–81.7%, BCSD = 12.2%, WCSD = 41.9%, intra class correlation (ICC): 7.8%).ConclusionCommon mental disorders such as alcohol abuse, major depressive episode, anxiety symptoms and burnout syndrome presented higher rates in public transportation drivers than general population.

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