Efeitos adversos às drogas antituberculose: hepatotoxicidade / Adverse effects to antituberculosis drugs: hepatotoxicity

Objetivo: Verificar a frequência de efeitos adversos em pacientes em uso de drogas antituberculose de primeira linha, além dos fatores de risco associados aos efeitos adversos e à hepatotoxicidade. Métodos: Estudo transversal, envolvendo 196 pacientes portadores de tuberculose em Maceió (AL), de agosto de 2017 a junho de 2018. Os efeitos adversos foram classificados de acordo com o Manual de Recomendações para Controle da Tuberculose de 2011, do Ministério da Saúde, em efeitos menores (queixas gastrintestinais, cutâneos, articulares e neurológicos) e maiores (psicose e hepatotoxicidade). Os fatores de risco avaliados foram: idade superior a 40 anos, etilismo, sexo feminino, anemia, doença hepática anterior, diabetes e infecção por HIV. Resultados: Foram observados efeitos adversos às drogas antituberculose em 85 pacientes (43,4%); destes, 40,8% eram menores e 8,2%, maiores. Os mais frequentes foram distúrbios gastrintestinais (25,5%) e cutâneos (15,3%). Identificaram-se como fatores de risco anemia, diabetes e doença hepática anterior. Hepatotoxicidade foi diagnosticada em 15 pacientes (10,6%), dos quais 80% eram sintomáticos, sendo fatores de risco doença hepática anterior e diabetes. Houve suspensão da terapia em todos os casos de hepatotoxicidade com modificação do esquema em 80% dos casos. Conclusão: Demonstrou-se frequência elevada de efeitos adversos às drogas antituberculose, associada à doença hepática anterior e ao diabetes. A hepatotoxicidade representou o efeito adverso mais grave, responsável pela suspensão e pela adequação do esquema terapêutico.

Objective: To determine the adverse effects frequency in patients on first-line antituberculosis drugs, as well as the risk factors associated with adverse effects and hepatotoxicity. Methods: Cross-sectional study, involving 196 tuberculosis patients in Maceió (AL), from August 2017 to June 2018. Adverse effects were classified according to the Manual de Recomendações para Controle da Tuberculose, of the Brazilian Health Ministry, in minor effects (gastrointestinal, cutaneous, articular, neurologic complaints) and major effects (psychosis and hepatotoxicity). The risk factors evaluated were age over 40 years, alcoholism, female sex, anemia, previous hepatic disease, diabetes, and infection by HIV. Results: Adverse effects to the antituberculosis drugs were observed in 85 patients (43.4%) and, among those, 40.8% were minor and 8.2% were major effects. The most frequent were gastrointestinal (25.5%) and skin (15.3%) disorders. Risk factors were identified as anemia, diabetes, and previous hepatic disease. Hepatotoxicity was diagnosed in 15 patients (10.6%), from which 80% were symptomatic, with previous hepatic disease and diabetes being the risk factors. Therapy was discontinued in all cases of hepatotoxicity with regimen modification in 80% of cases. Conclusion: An elevated frequency of adverse effects to antituberculosis drugs was demonstrated. Hepatotoxicity represented the most severe adverse effect, being responsible for the discontinuation and adaptation of the therapeutic regimen.

Contribution of audiovestibular tests to the topographic diagnosis of sudden deafness

Sudden hearing loss (SHL) is an ENT emergency defined as sensorineural hearing loss (SNHL) > 30 dB HL affecting at least 3 consecutive tonal frequencies, showing a sudden onset, and occurring within 3 days. In cases of SHL, a detailed investigation should be performed in order to determine the etiology and provide the best treatment. Otoacoustic emission (OAE) analysis, electronystagmography (ENG), bithermal caloric test (BCT), and vestibular evoked myogenic potential (VEMP) assessments may be used in addition to a number of auxiliary methods to determine the topographic diagnosis. OBJECTIVE: To evaluate the contribution of OAE analysis, BCT, VEMP assessment, and magnetic resonance imaging (MRI) to the topographic diagnosis of SHL. METHOD: Cross-sectional and retrospective studies of 21 patients with SHL, as defined above, were performed. The patients underwent the following exams: audiometry, tympanometry, OAE analysis, BCT, VEMP assessment, and MRI. Sex, affected side, degree of hearing loss, and cochleovestibular test results were described and correlated with MRI findings. Student's t-test was used for analysis of qualitative variables (p < 0.05). RESULTS: The mean age of the 21 patients assessed was 52.5 ± 15.3 years; 13 (61.9%) were women and 8 (38.1%) were men. Most (55%) had severe hearing loss. MRI changes were found in 20% of the cases. When the audiovestibular test results were added to the MRI findings, the topographic SHL diagnosis rate increased from 20% to 45%. CONCLUSION: Only combined analysis via several examinations provides a precise topographic diagnosis. Isolated data do not provide sufficient evidence to establish the extent of involvement and, hence, a possible etiology...

Occurrence of the Indo-Pacific freshwater prawn Macrobrachium equidens Dana 1852 (Decapoda, Palaemonidae) on the coast of Brazilian Amazonia, with notes on its reproductive biology

The freshwater prawn Macrobrachium equidens, which is native species of the Indo-Pacific Region, was recorded for the first time on the Amazon coast of Brazil. This species was found to inhabit the same environment as two native Macrobrachium species, M. amazonicum and M. acanthurus, and is morphologically very similar to the latter. The identification of the species was confirmed by the genetic analysis of sequences of the mitochondrial Cytochrome Oxidase (COI) gene. A detailed description of the morphological features and reproductive biology of M. equidens in this new environment is presented.

O camarão de água doce Macrobrachium equidens, nativo da região do Indo-Pacífico, foi registrada pela primeira vez na costa da Amazônia Brasileira. Esta espécie foi encontrada habitando o mesmo ambiente que duas espécies nativas do gênero Macrobrachium: M. amazonicum e M. acanthurus, e é morfologicamente muito similar à última. A identificação dessa espécie foi confirmada pela análise da seqüência genética do gene mitocondrial Citocromo Oxidase (COI). Uma descrição detalhada das características morfológicas e biologia reprodutiva de M. equidens neste novo ambiente é apresentada.

Ensino Prático Integrado de Obstetrícia e Neonatologia em Maternidade: Relato da Experiência da UFPE / Integrated Practical Training in Obstetrics and Neonatology in a Maternity Hospital: A Case Report from Federal University in Pernambuco

Resumo: A atenção à saúde materno-infantil no período neonatal exige dos profissionais uma compreensão integral do binômio mãe-filho. Os conhecimentos estudados pela Obstetrícia e pela Neonatologia são intimamente relacionados e devem ser abordados de forma integrada, sobretudo durante a graduação médica, quando o futuro médico constrói a base de seus raciocínio clínico. Os alunos do 6o período do curso médico da UFPE realizam as atividades práticas de Obstetrícia e Neonatologia integradas em maternidades-escola, acompanhadas de monitores. A concepção teórica e a concretização prática deste ensino integrado contaram com algumas dificuldades no início de seu funcionamento. A dificuldade de compreensão da importância da prática integrada e a falta de motivação de alguns professores foram relatadas como dificuldades menores. O maior problema desde o início tem sido a infra-estrutura e demanda de pacientes atendidos nas maternidades. O trabalho democrático e participativo de construção coletiva do projeto de ensino realizado por alunos, monitores e a coordenação do estágio tem-se mostrado uma estratégia eficiente para a superação das dificuldades.

Abstract: Mother-child health care during the prenatal period demands that health care professionals have an integral understanding of the mother-child dyad. The bodies of knowledge studied by Obstetrics and Neonatology are intimately related and should receive an integrated approach, especially during basic medical training, when future physicians build the basis for their clinical reasoning. Sixth-semester students in the school of Medicine at UFPE perform integrated practical activities in Obstetrics and Neonatology at teaching maternity hospitals, accompanied by monitors. The theoretical concept and practical implementation of the integrated teaching process enconuntered several difficulties in its early stages. Difficulty in understanding the importance of integrated practice and lack of motivation on the part of some professors were reported as minor problems. The greatest problems have been with the infrastructure and patient demand served at the maternity hospitals. A democratic and participatory work process involving collective development of teaching proposal by students, monitors, and the rotation coordinators has proven be an efficient strategy for overcoming difficulties.

Desmoid tumor of the mediastinum

A desmoid tumor of the mediastinum was diagnosed and terated in a 35 year-old white male who presented with a right supraclavicular mass. He was treated with resection, which involved several vascular structures, requiring multiple vascular reconstructions followed by postoperative radiotherapy. The authors concluded that, when located in tha mediastinum, the invasive character of such tumors and its tendency to recur may pose a considerable surgical challenge, requiring careful preoperative planing and postoperative planning follow-up. The role of radiation therapy is limited to the control of local recurrences