Uterine cavity embryonal rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is a rare solid tumor in childhood and adolescence. The higher incidence is predominant during the first two decades of life. According to the Intergroup RMS Study Group, the embryonal RMS (ERMS), botryoidal variant, constitutes a histological subtype characterized as a "grape-like" lesion of 2.0 cm to 9.5 cm. The treatment involves chemotherapy, surgery, and/or radiotherapy. We present the case of a 14-year-old female patient diagnosed with ERMS, botryoidal variant, which originated in the uterine cervix with vaginal externalization. The initial therapeutic approach comprised an initial prolapsed mass excision followed by Wertheim­Meigs surgery due to the tumor extension. No consensual protocol to ERMS treatment is found in the medical literature; however, a combined approach seems to offer a better result. The postoperative time period was uneventful and the patient followed an adjuvant therapy with vincristine, d-actinomycin, and cyclophosphamide. A comprehensive evaluation of the therapeutic options preserving the reproductive function­unfortunately not always possible­is part of a multi-disciplined care team concerning the pediatric patients.

Prevalência de TB ativa e TB latente em internos de um hospital penal na Bahia / Prevalence of active and latent TB among inmates in a prison hospital in Bahia, Brazil

OBJETIVO: Estimar as prevalências de TB latente e TB ativa entre custodiados de um hospital penal na Bahia. MÉTODOS: Foram avaliados através de estudo de corte transversal com coleta prospectiva de dados 237 internos no Hospital Penal da Bahia entre julho de 2003 e abril de 2004. Um questionário padronizado foi preenchido por estudantes de medicina. Os indivíduos foram sistematicamente submetidos aos seguintes exames: teste tuberculínico, radiografia de tórax em incidência póstero-anterior, baciloscopia e cultura para micobactérias. Os eventos de interesse foram TB ativa e TB latente. RESULTADOS: A média de idade foi de 36,6 anos, sendo 89,9 por cento homens. Tabagismo e alcoolismo foram relatados por 70.0 por cento e 43.9 por cento dos internos, respectivamente. História de tratamento para TB foi relatada por 11,3 por cento dos indivíduos. Dos internos avaliados, 36,3 por cento relataram tosse e 31,4 por cento, expectoração. Outros sintomas menos frequentemente referidos foram astenia (26,2 por cento), perda de peso (23,1 por cento), inapetência (17,7 por cento), febre (11,3 por cento) e hemoptise (6,7 por cento). Nenhum dos 86 internos testados apresentou sorologia anti-HIV positiva. Entre os 156 submetidos ao teste tuberculínico, a prevalência de TB latente foi de 61,5 por cento (146 casos). Do total, 6 casos de TB ativa foram detectados (prevalência de 2,5 por cento). A presença de tosse foi um determinante de TB ativa (razão de prevalência = 8,8; IC95 por cento: 1,04-73,9; p = 0,025). CONCLUSÕES: A população de internos do Hospital Penal da Bahia tem altas prevalências de TB latente e ativa. Estes achados justificam a necessidade de implantação de políticas públicas especificamente direcionadas para o controle da TB nesta população

OBJECTIVE: To determine the prevalence of latent and active TB among detainees in a prison hospital in Bahia, Brazil. METHODS: A cross-sectional study with prospective data collection was carried out comprising 237 inmates in the Bahia State Prison Hospital between July 2003 and April 2004. A standardized questionnaire was applied and completed by medical students. The detainees were systematically submitted to the following tests: tuberculin skin test, chest X-ray (anteroposterior), sputum smear microscopy and culture for mycobacteria. The events of interest were active TB and latent TB. RESULTS: The mean age of the participants was 36.6 years, and 89.9 percent were male. Smoking and alcohol consumption were reported by 70.0 percent and 43.9 percent of the inmates, respectively. A history of treatment for TB was reported by 11.3 percent of the inmates. Of the inmates evaluated, 36.3 percent reported cough and 31.4 percent reported expectoration. Other less common symptoms were asthenia (in 26.2 percent), weight loss (in 23.1 percent), loss of appetite (in 17.7 percent), fever (in 11.3 percent) and hemoptysis (in 6.7 percent). Of the 86 inmates tested, none presented positive HIV serology. The prevalence of latent TB was 61.5 percent (96 of the 156 inmates submitted to tuberculin skin tests), whereas that of active TB was 2.5 percent (6 of the 237 inmates evaluated). The presence of cough was a determinant of active TB (prevalence ratio = 8.8; 95 percent CI: 1.04-73.9; p = 0.025). CONCLUSIONS: Active and latent TB are highly prevalent among inmates hospitalized in the Bahia State Prison Hospital. Our findings justify the need to implement public policies specifically directed towards the control of TB in this population.

Anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from patients in a tertiary hospital in Bahia

Anti-tuberculosis drug resistance, particularly multiresistance, is a crucial issue in the control of tuberculosis (TB). This study estimated the prevalence of primary and acquired anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from hospitalized patients, to identify the risk factors for resistance, and to evaluate the its impact on hospital mortality for tuberculosis. Strains of Mycobacterium tuberculosis from 217 patients hospitalized for TB were analyzed. Subjects were recruited sequentially at a TB reference hospital in Salvador, Bahia, Brazil from July 2001 to July 2003. Multiresistant (MR) strains were defined as strains resistant to rifampicin and isoniazid. Of a total of 217 strains isolated, 41 (19.0 percent, 95 percentCI: 14.1-24.5 percent) were resistant to at least one drug. Prevalence of primary resistance was 7.0 percent (10/145), while a prevalence of 43.1 percent (31/72) was found for acquired resistance. Primary resistance to one drug alone was found in 2.1 percent (3/145) and acquired monoresistance in 5.6 percent (4/72). Prevalence of MR strains in general was 14.3 percent (31/217), of which 4.2 percent (6/145) consisted of primary MR and 34.7 percent (25/72) of acquired MR. Three strains showed resistance to more than one drug, but were not classified as MR. In the multivariate analysis, abandoning treatment remained strongly associated with resistance (adjusted OR: 7.21; 95 percentCI: 3.27-15.90; p<0.001) following adjustment for 3 potential confounders (gender, alcohol dependence and HIV-infection). An association was found between resistance and mortality from tuberculosis, even after adjustment for HIV status, age, sex and alcohol dependence (adjusted OR: 7.13; 95 percentCI: 2.25-22.57; p<0.001). High prevalences of resistance, principally acquired resistance including MR, were found in patients hospitalized for TB in Bahia. This finding was strongly associated with having abandoned...

Prevalence of HIV infection in patients hospitalized for tuberculosis in Bahia, Brazil

HIV infection is an important risk factor for the development of tuberculosis (TB), and also affects its morbidity and mortality. This study estimated the prevalence of HIV infection in patients hospitalized for TB in Bahia (in northeastern Brazil) and to evaluate its impact on in-hospital mortality. A total of 375 patients with TB, admitted consecutively to a TB reference hospital in Salvador (Bahia, Brazil), were evaluated between July 2001 and July 2003. Anti-HIV serology was performed in all patients irrespective of clinical and/or epidemiological data suggestive of HIV infection. Death during hospitalization was the principal event-dependent variable. Mean age of patients was 41.4 ± 16.2 years and the male/female ratio was 3.4:1.0. The prevalence of HIV infection was 8.8 percent (95 percentCI: 6.2-12.0 percent). Patients in the HIV-positive group were younger than those in the HIV-negative group (37.1 versus 41.9 years; p=0.05). In-hospital mortality was 10.9 percent for the whole group (95 percentCI: 9.4-15.9 percent), but was significantly greater in the HIV-positive group compared to the HIV-negative group (27.3 percent versus 9.4 percent; RR=2.9; 95 percentCI: 1.5-5.6; p=0.002). The prevalence of HIV infection in patients hospitalized for TB in Bahia (northeastern Brazil) is relatively high (8.8 percent) and mortality is significantly higher (2.9-fold) in the HIV-positive group. These findings justify carrying out HIV testing, as recommended by the Brazilian Ministry of Health, in all TB patients, particularly those requiring hospitalization.

Uncapping activity of Apis mellifera L. (Hymenoptera: Apidae) towards worker brood cells infested with the mite Varroa destructor Anderson & Treuman (Mesostigmata: Varroidae)

Varroosis, a disease caused by the mite Varroa destructor Anderson and Treuman has killed hundreds of thousands of Apis mellifera L. colonies in various parts of the world. Nevertheless, the damage caused by this mite varies with the type of bee and climate conditions. Varroa causes little damage to Africanized bee colonies in Brazil, as the infestation rates are relatively stable and low. We evaluated the hygienic behavior (uncapping and removal of brood) of highly hygienic Africanized bees using combs with worker brood cells infested (naturally) and no infested with V. destructor. The daily uncapping rate, measured in eight colonies during six days, was 3.5 fold higher in the combs infested with varroa compared to no infested combs. The results show that the Africanized bees are able to recognise and remove brood cells naturally infested with V. destructor what is an important mechanism for tolerance against varroa.

A varroosis, doença causada pelo ácaro Varroa destructor Anderson & Treuman, é responsável pela mortalidade de milhares de colônias de Apis mellifera L. em várias partes do mundo. Contudo, o dano causado por esse ácaro varia com a raça de abelhas e condições climáticas. A varroa causa poucos danos nas colônias de abelhas africanizadas no Brasil, os níveis de infestação são relativamente baixos e estáveis. Foi avaliado o comportamento higiênico (desoperculação e remoção de crias mortas ou parasitadas) em colônias de abelhas africanizadas altamente higiênicas usando favos infestados naturalmente com o ácaro V. destructor. A taxa diária de células desoperculadas, medida em oito colônias durante seis dias, foi 3,5 vezes maior em favos infestados com varroa comparados quando com favos não infestados. Os resultados mostram que as abelhas africanizadas reconhecem e removem crias parasitadas naturalmente com o ácaro V. destructor o qual é um mecanismo de tolerância da praga varroosis.

Hiperfosfatasemia transitória benigna na infância / Benign transient hyperphosphatasemia in childhood

A hiperfosfatasemia transitória benigna na infância (HTBI) é uma condição pouco conhecida, que se traduz por um estado benigno e de bom prognóstico. A HTBI resulta do aumento súbito e transitório na concentração sérica da fosfatase alcalina (FA) em crianças sadias. A sua etiopatogenia é ainda incerta, porém a diminuição do clearance da enzima na circulação tem sido considerada o mecanismo mais provável. Para divulgar os conhecimentos atuais acerca do diagnóstico da HTBI, foram selecionados, no Medline, os artigos de periódicos médicos internacionais mais relevantes desde a descrição inicial desta condição, em 1954. Os critérios para diagnóstico de HTBI são: acometer crianças com idade inferior a cinco anos, ausência de sintomas ou presença de sintomas associados a doenças não relacionadas, sem evidência clínica ou laboratorial de doença óssea ou hepática. A elevação da fosfatase alcalina varia entre 3 e 50 vezes o limite superior do valor para a idade. A análise das isoenzimas mostra elevação das formas óssea e hepática. Os níveis séricos da fosfatase alcalina retornam ao normal em quatro meses. A elevação sérica da fosfatase alcalina foi relatada em patologias como hiperfosfatasemia familiar persistente assintomßtica e sintomática e hiperfosfatasemia persistente não-familiar. É indispensável que a HTBI seja considerada no diagnóstico diferencial de um aumento considerável dos níveis séricos de fosfatase alcalina em crianças, sem que seja detectada uma causa óbvia, o que evitará procedimentos desnecessários e dispendiosos durante a investigação diagnóstica.