Fibrohistiocitoma maligno / Malignant fibrohystiocytoma

RESUMEN El fibrohistiocitoma maligno es el sarcoma de partes blandas más frecuente en adultos; es poco frecuente como tumor primario cutáneo. Presenta predilección por el sexo masculino con una mayor incidencia entre la quinta y sexta década de la vida. Se localiza predominantemente en las extremidades. Presentamos a continuación el caso clínico de un paciente con diagnóstico de fibrohistiocitoma maligno localizado en hallux de pie derecho y realizaremos una revisión de la literatura.

ABSTRACT Malignant fibrohistiocytoma is the most frequent soft tissue tumor in adults; it is rare as a primary cutaneous tumor. It presents a predilection for males with the highest incidence between the fifth and sixth decade of life. It is located predominantly on the extremities. We will perform a literature review. We present below the clinical case of a patient diagnosed with malignant fibrohistiocytoma located in hallux of the right foot.

Guerra civil não-declarada? Um recorte do status da violência urbana em uma capital no Brasil / Undeclared civil war? Urban violence in major city in Brazil

RESUMO Objetivo: a violência civil é responsável por 2,5% da mortalidade mundial, matou mais pessoas no século XXI do que o somatório de todas as guerras deste período. Este estudo descreve as vítimas de violência admitidas em um hospital de referência em trauma em Salvador - Bahia, Brasil e analisa o impacto dos diferentes tipos de violência interpessoal. Métodos: foram incluídos vítimas de violência interpessoal admitidas entre julho de 2015 e julho de 2017. 1296 pacientes (média de idade foi 30,3 anos, 90% do sexo masculino) foram divididos em três grupos de acordo com o mecanismo de violência interpessoal: espancamento, ferimentos por projétil de arma de fogo (FPAF), ferimentos por arma branca (FAB). Os grupos foram comparados de acordo com as seguintes variáveis: idade, sexo, mecanismo de trauma, Revised Trauma Score (RTS) na admissão, necessidade de internamento em unidade de tratamento intensivo (UTI), tempo de internamento, necessidade de transfusão de hemocomponentes e morte. Resultados: FPAF foram o principal mecanismo de injúria (59%), seguido por agressão (24%) e FAB (17%). As vítimas de FPAF apresentaram a menor média de RTS na admissão, maior necessidade de uso de hemocomponentes e de internamento em UTI. Vítimas de espancamento tiveram a maior média de duração de internação hospitalar (11,6±19,6 dias). Os FPAF causaram 77,4% das mortes. Conclusão: vítimas de FPAF são mais críticas, requerendo maior tempo de tratamento em UTI, mais hemocomponentes e maior mortalidade comparativamente às vítimas de FAB e espancamento.

ABSTRACT Purpose: Civil violence is responsible for 2.5% of deaths worldwide; it killed more people in the 21st century than the sum of all wars. This study describes violence victims treated at a trauma reference hospital in Salvador, Brazil and analyzes the impact of different types of interpersonal violence. Methods: Interpersonal violence victims admitted between July 2015 and July 2017 were included. The 1,296 patients (mean age: 30.3 years; 90% male) were divided into three groups according to the mechanism of interpersonal violence: 1) beating, 2) firearm injury and 3) stab wound (STW) injury. The groups were compared for the following variables: age, gender, trauma mechanism, Revised Trauma Score (RTS) at admission, need for intensive care unit (ICU) attention, length of hospital stay, need for transfusion of blood products and death. Results: Gunshot wounds (GSW) were the primary mechanism of injury (59%), followed by beating (24%) and STW (17%). Gunshot wound victims had a lower mean RTS upon admission, increased need for blood products and more Intensive Care Unit (ICU) admissions. Beating victims had the longest mean hospital stay (11.6 ± 19.6 days). The GSW group accounted for 77.4% of all deaths. The in-hospital mortality rate was significantly higher in the GSW group (12.7%) than in the beating group (5.4%) and in the STW group (4.9%). Conclusions: Gunshot wound victims are more critical: they require longer ICU stays, more transfusions of blood products and exhibit increased mortality compared with STW and beating victims.

Infectious disease morbidity and growth among young HIV-exposed uninfected children in Jamaica / Morbilidad por enfermedades infecciosas y crecimiento en niños pequeños no infectados pero expuestos al VIH en Jamaica

ABSTRACT Objective There is a growing body of data that demonstrates increased infectious disease outcomes for HIV-exposed uninfected (HIV-EU) infants as compared to their HIV-unexposed (HU) counterparts. We hypothesized that these HIV-EU infants are at greater risk for infectious morbidity and mortality when compared to the general childhood population. We therefore aimed to characterize infections and growth outcomes among HIV-EU infants in Jamaica during their first two years of life. By identifying these outcomes, specific interventions could be implemented to mitigate this risk of morbidity and mortality. Methods HIV-EU infants born between 1 January 2004 and 31 December 2006 in Kingston, Jamaica, were enrolled and followed in multicenter health facilities, using standardized protocols. HIV status was determined by RNA/DNA polymerase chain reaction (PCR) and confirmatory HIV enzyme-linked immunoassay (ELISA). Data were collected on demographic and anthropometric characteristics, infectious morbidity and mortality, and hospitalizations. Outcomes (incidence of infections and hospitalizations; growth (z scores for weight)) were determined, using univariate analyses. Results Of 195 HIV-EU infants followed for 25.9 months (standard deviation, 10.9 months), 102 (52%) were male, 185 (95%) were non-breast-fed, 161 (83%) experienced at least one infection, and 58 (30%) were hospitalized at least once. Infectious disease incidence per 1 000 child-weeks included upper respiratory tract infection of 7.25 (95% confidence interval (CI): 5.92–8.90), otitis media of 4.12 (3.21–5.20), and acute gastroenteritis (AGE) of 1.92 (1.35–2.65). Hospitalization incidence per 1 000 child-weeks included lower respiratory tract infections (LRTIs) of 0.89 (0.53–1.40), sepsis of 0.48 (0.23–0.89), and AGE of 0.43 (0.20–0.81). These infection incidence rates among the HIV-EU infants were higher than those for published community controls. Among the HIV-EU infants, the low-birthweight ones and those born via cesarean section had significantly higher hospitalization rates from LRTI and sepsis than did published community controls. The mean z score for weight during the infants’ first 6 months ranged from -0.06 to 0.78 in this predominantly non-breast-fed population. That score trended upwards to 24 months of age. Conclusions Infectious disease morbidity was higher but growth was normal in this cohort of HIV-EU non-breast-fed infants, in comparison to published community controls. Specific interventions should be implemented to mitigate the risk in this setting.

RESUMEN Objetivo Existe un volumen cada vez mayor de datos que muestran un aumento de casos de enfermedades infecciosas en lactantes no infectados pero expuestos al VIH en comparación con lactantes no expuestos al virus. Formulamos la hipótesis de que los lactantes no infectados pero expuestos presentan mayor riesgo de morbilidad y mortalidad por enfermedades infecciosas comparados con la población general de niños. Por consiguiente, nos propusimos caracterizar las infecciones y los resultados de crecimiento en lactantes no infectados pero expuestos al VIH en Jamaica durante sus dos primeros años de vida. Al determinarse estos resultados, podrían ejecutarse intervenciones específicas para mitigar este riesgo de morbilidad y mortalidad. Métodos Se inscribieron lactantes no infectados pero expuestos al HIV nacidos entre el 1 de enero del 2004 y el 31 de diciembre del 2006 en Kingston (Jamaica), y se les hizo seguimiento en establecimientos multicéntricos de salud, con protocolos estandarizados. El estado con respecto a la infección por el VIH se determinó mediante la reacción en cadena de la polimerasa (PCR) para ARN/ADN y prueba confirmatoria de inmunoadsorción enzimática (ELISA). Se recopilaron datos sobre características demográficas y antropométricas, morbilidad y mortalidad por infecciones y hospitalizaciones. Los resultados (incidencia de infecciones y hospitalizaciones; crecimiento [puntuaciones z para el peso]) se determinaron usando un análisis de una sola variable. Resultados De 195 lactantes no infectados pero expuestos a los que se les dio seguimiento durante 25,9 meses (desviación estándar, 10,9 meses), 102 (52%) eran de sexo masculino, 185 (95%) no fueron amamantados, 161 (83%) presentaron al menos una infección y 58 (30%) fueron hospitalizados por lo menos una vez. La incidencia de enfermedades infecciosas por 1 000 niño-semanas incluyó infecciones de las vías respiratorias superiores de 7,25 (intervalo de confianza [IC] de 95%: 5,92–8,90), otitis media de 4,12 (3,21–5,20) y gastroenteritis aguda (AGE) de 1,92 (1,35–2,65). La incidencia de hospitalización por 1 000 niño-semanas incluyó infecciones de las vías respiratorias inferiores de 0,89 (0,53–1,40), septicemia de 0,48 (0,23–0,89) y gastroenteritis aguda de 0,43 (0,20–0,81). Estas tasas de incidencia de infecciones en los lactantes no infectados pero expuestos fueron más altas que las de los controles comunitarios publicados. En los lactantes no infectados pero expuestos, aquellos con peso bajo al nacer y aquellos nacidos por cesárea registraron tasas de hospitalización significativamente más altas por infecciones de las vías respiratorias inferiores y septicemia que los controles comunitarios publicados. La media de la puntuación z para el peso durante los 6 primeros meses de los lactantes se ubicó entre -0,06 y 0,78 en esta población que en su mayoría no fue amamantada. Esa puntuación mostró una tendencia ascendente a los 24 meses de edad. Conclusiones La morbilidad por enfermedades infecciosas fue mayor, pero el crecimiento fue normal en esta cohorte de lactantes no infectados pero expuestos al VIH y no amamantados, en comparación con los controles comunitarios publicados. Deben realizarse intervenciones específicas para mitigar el riesgo en este entorno.