Prevalence of positive tuberculin skin test in a Brazilian sample of rheumatoid arthritis and spondylarthritis patients

SUMMARY OBJECTIVE: Patients with rheumatic diseases have an increased risk of infections, especially tuberculosis. In this study, we aimed to recognize the positivity rate of tuberculosis skin test in patients with rheumatoid arthritis and spondyloarthritis and the characteristics of the patients with positive results. METHODS: Retrospective study of tuberculosis skin test results in patients followed from 2004 to 2021 in a single rheumatology unit. Data related to clinical and epidemiological features, along with treatment information referring to the period in which the tuberculosis skin test was performed, were collected from patients' charts. RESULTS: A total of 723 tests were identified (448 tests in 269 rheumatoid arthritis patients and 275 in 174 spondyloarthritis patients). In the rheumatoid arthritis sample, 31/275 (11.5%) individuals had positive tests, and in the spondyloarthritis, 38/174 (21.8%) had positive tests. In the rheumatoid arthritis sample, patients with positive tuberculosis skin tests used a higher dose of methotrexate than those with negative results (median of 25 mg/week versus median of 20 mg/week respectively; p=0.02). In the spondyloarthritis sample, tuberculosis skin test positivity was associated with alcohol ingestion (13.1% versus 2.9% in users and non-users respectively; p=0.02) and sulfasalazine use (15.7% of positivity in users versus 5% in non-users; p=0.01). CONCLUSION: The tuberculosis skin test-positive prevalence in rheumatoid arthritis was lower than in the spondyloarthritis sample. Patients with rheumatoid arthritis using a higher dosage of methotrexate or with spondyloarthritis using sulfasalazine had more frequency of tuberculosis skin test positivity and should be carefully followed by the attending physician in order to avoid the appearance of full-blown tuberculosis.

Qual é o perfil dos pacientes atendidos em pronto atendimento ortopédico de um hospital pediátrico? / What is the profile of patients attended in orthopedic emergency care in a pediatric hospital?

Racional: O perfil do paciente traumatizado pode dizer muito sobre o padrão da lesão e deve ser levado em conta a idade, o gênero e o comportamento individual. Objetivo: Avaliar os tipos de trauma musculoesquelético mais frequentes por gênero e faixa etária, identificando o tempo decorrido do acidente até a procura por atendimento. Método: Análise de prontuários dos pacientes atendidos em um hospital pediátrico de na faixa etária até 18 anos. Resultados: Dos 1822 pacientes que preencheram os critérios pré-estabelecidos, 1035 eram meninos e 837 meninas. Em relação à faixa etária e gênero masculino e feminino os resultados foram, respectivamente: abaixo de 2 anos, 23 (1,3%) e 29 (1,5%); entre 2 e 13 anos, 804 (43%) e 662 (35,4%); acima de 13 anos, 208 (11%) e 146 (7,8%). Apenas na faixa abaixo de 2 anos é que houve pequeno predomínio do gênero feminino. O mecanismo do trauma, não foi relatado em 45%, queda de mesmo nível em 15,2%, trauma indireto em 13,5%, trauma direto em 12,27% e queda de altura em 10,4% da amostra. Conclusão: Traumas ocorrem com maior prevalência no gênero masculino, na faixa etária escolar, sendo o mecanismo mais frequente a queda de mesmo nível, trauma indireto e trauma direto. A maioria dos pacientes procurou atendimento e foi atendida dentro de 24 horas do trauma, em todas as faixas etárias abordadas.

Background: The trauma patient's profile can say a lot about the injury pattern and must be taken into account by age, gender and individual behavior.Objective: To assess the most frequent types of musculoskeletal trauma by gender and age group, identifying the time elapsed from the accident to seeking care. Method: Analysis of medical records of patients seen at a pediatric hospital aged up to 18 years. Results: Of the 1822 patients who met the pre-established criteria, 1035 were boys and 837 girls. In relation to age group and male and female, the results were, respectively: below 2 years, 23 (1.3%) and 29 (1.5%); between 2 and 13 years, 804 (43%) and 662 (35.4%); over 13 years, 208 (11%) and 146 (7.8%). Only in the age group below 2 years old was seen a small predominance of females. The trauma mechanism was not reported in 45%, falls on the same level in 15.2%, indirect trauma in 13.5%, direct trauma in 12.27% and fall from heights in 10.4% of the sample. Conclusion: Traumas occur with greater prevalence in males, in the school age group, the most frequent mechanism being falls on the same level, indirect trauma, and direct trauma. Most patients sought care and attended within 24 hours of the trauma.

Manejo conservador com sucesso de vítima de ferimento de arma de fogo abdominal, com exame FAST (focused assessment with sonography for trauma) positivo, ausência de peritonite e estabilidade hemodinâmica / Successful non operative management of gunshot abdominal wound victim, with positive FAST (focused assessment with sonography for trauma), abscence of peritonitis and hemodynamic stability

A segurança do manejo conservador de lesões abdominais por arma de fogo é um conceito ainda sem consenso na literatura moderna. Este artigo relata um caso de manejo conservador com sucesso de lesão penetrante abdominal por arma de fogo em paciente com líquido livre em cavidade, porém estável hemodinâmicamente e sem sinais de peritonite, em um centro terciário de trauma de referencia no Brasil

The safety of non operative management of abdominal gunshot wounds still is a concept without consensus in modern literature. This article reports a case of sucessful non operative management of abdominal gunshot wound, in a patient with free abdominal fluid, but hemodynamically stable and without peritonitis, in a tertiary reference trauma center in Brazil