Nevirapine-induced side effects in pregnant women: experience of a brazilian university hospital

Nevirapine-based therapy is associated with increased frequency of adverse events among HIV-infected pregnant women. The aim of this article was to evaluate the incidence of adverse effects in HIV-infected women who started nevirapine during pregnancy. A retrospective study was performed in our center between January 2003 and December 2006 analyzing all women prescribed nevirapine during pregnancy. Women presenting any risk factor for hepatotoxicity were excluded from the analysis. Patients were divided into two groups according to the presence or absence of adverse effects, and a correlation to CD4 counts was performed. Liver function abnormality was graded according to the Division of AIDS toxicity guidelines. A total of 170 women initiated nevirapine during pregnancy, but only 133 were included in the study. Twenty-seven women (20.3 percent) presented adverse effects, skin rash accounting for 77.8 percent (21/27 women) and liver function abnormalities for 22.2 percent (6/27) of the cases. Baseline CD4 counts, viral loads and transaminases were similar in both groups. All nevirapine side effects were developed in less than seven weeks. Four of 31 women with CD4 counts <250 cells/µL (12.9 percent) and 23 of 102 women with CD4 counts ≥250 cells/µL (22.5 percent) developed adverse events. All patients who experienced hepatotoxicity had pretreatment CD4 counts >250cells/µL. The incidence of adverse events with nevirapine in our study was high, but most of them were cutaneous. There was no correlation between high CD4 counts and adverse events when analyzing both cutaneous and hepatic reactions; nevertheless, hepatotoxicity occurred only in pregnant women with CD4 counts ≥250cells/µL.

Fibroma condromixóide de tíbia: relato de uma rara neoplasia e revisão de literatura / Chndromyxoi fribroma of the tibia: case report of the rare neoplasm and literature review

O Fibroma condromixóide é um raro tumor benigno, que acomete preferencialmente ossos longos. Os autores relatam um caso de paciente masculino, 11 anos, que apresentou queixa de dor em joelho esquerdo. O exame radiográfico mostrou lesão excêntrica, bem delimitada e radiolucente em tíbia proximal, junto à cartilagem de crecimento. A ressonãncia nuclear magnética confirmou os achados radiográficos além de mensurar a lesão em 5 cm no maior eixo e excluir envolvimento de partes moles. Optou-se inicialmente por uma biopsia incisional que revelou neoplasia cartilaginosa, condizente com fibroma condromixóide. Como tratamento foi realizada curetagem intralesional, complementada com termoterapia intracavitária e preenchimento desta por cimento ortopédico. O paciente encontra-se assintomático em seguimento de cinco meses em nosso serviço.

Elastofibroma de dorso: uma rara lesão reativa de partes moles / Elastobibroma dorsi: a rare reactive lesion of soft tissue

O elastofibroma é uma rara lesão fibroproliferativa de crescimento lento, mais comumente localizada sob os músculos rombóide maior e grande dorsal. É geralmente unilateral e o envolvimento bilateral varia de 10 a 50 por cento.Relata-se um caso de paciente do sexo feminino, que procurou atendimento médico devido à massa indolor de crescimento lento e gradual de dois anos. Exames de imagem mostraram lesão mal delimitada em região subescapular direita com aproximadamente 6cm no maior eixo. Posteriormente foi realizada cirurgia com excisão completa da lesão. O exame anátomo-patológico confirmou o diagnóstico de elastrofibroma.