Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality.

OBJECTIVES: To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB) patients. METHODS: This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. RESULTS: A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment of treatment included male gender (OR=2.05; 95% CI=1.15-3.65) and nonadherence to previous treatment (OR=3.14; 95% CI=1.96-5.96). In addition, the presence of extrapulmonary TB was a protective factor (OR=0.33, 95% CI=0.14-0.76). The following risk factors were associated with mortality: age over 40 years (OR=2.61, 95% CI=1.76-3.85), coinfection with HIV (OR=6.01, 95% CI=3.78-9.56), illiteracy (OR=1.88, 95% CI=1.27-2.75), the presence of severe extrapulmonary TB (OR=2.33, 95% CI=1.24-4.38), and retreatment after relapse (OR=1.95, 95% CI=1.01-3.75). CONCLUSIONS: Male gender and retreatment after abandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with HIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we suggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure and TB-associated mortality.

Tumor neuroectodérmico primitivo: relato de caso / Primitive neuroectodermal tumor: case report

JUSTIFICATIVA E OBJETIVOS: O tumor neuroectodérmico primitivo (PNET) pertence a um grupo de tumores de pequenas células redondas e, devido a sua semelhança biológica com os sarcomas de Ewing, tem sido incluído nesta família. O objetivo deste estudo foi descrever o quadro clínico, características de imagem e evolução de um caso de processo expansivo em coxa direita, com histologia consistente com sarcoma de Ewing extraesquelético. RELATO DO CASO: Paciente do sexo feminino, 21 anos, branca, apresentava queixa de dificuldade para deambular e dor na perna direita há aproximadamente seis meses. Ao exame físico foi detectada massa sólida na raiz da coxa direita. Exames de imagens identificaram formação expansiva sólida, sendo o estudo histopatológico/imuno-histoquímico compatível com PNET/sarcoma de Ewing extraesquelético. Foi instituído tratamento quimioterápico, que nãofoi suspenso mesmo após diagnóstico de gestação. A gravidez evoluiu com oligodramnia e óbito fetal. Dois meses após o diagnóstico, a paciente apresentou depressão, piora do estado geral e óbito. CONCLUSÃO: O estudo relatado reflete a agressividade desta doença apesar da possibilidade de multimodalidade terapêutica. A aplicação da genética molecular em estudos recentes correlaciona o rearranjo genético da translocação entre os cromossomas 11e 22 com o prognóstico.

BACKGROUND AND OBJECTIVES: Primitive neuroectodermal tumor (PNET) belongs to a family of small round cell tumors, and because of their biological similarity has been includedin the family of Ewing's sarcomas. The objective of this case was to describe the clinical, imaging characteristics and outcome of a case of an expansive process in the right thigh, with histology consistent with extraskeletal Ewing's sarcoma. CASE REPORT: Female patient, 21 years, white, featured a complaint of difficulty in walking and pain in his right leg for about six months. On examination a solid mass was detected at the root of the right thigh. Imaging techniques identified an expansive solid mass and histopathology was compatible with PNET/extra-skeletal Ewing's sarcoma. Chemotherapy was instituted, which was not suspended even after pregnancy diagnosis. It progressed with oligohydramnios and fetal death. In two months, the patient had depression, poor general condition and death. CONCLUSION: The study reported reflects the aggressive nessof this disease despite multimodality therapy. The application of molecular genetics in recent studies correlating the genetic rearrangement of the translocation between chromosomes 11:22 prognosis.

Prevalence and variables predictive of depressive symptoms in patients hospitalized for heart failure.

BACKGROUND: Our study set out to determine the prevalence of depressive symptoms and variables that influence its presence in patients hospitalized for heart failure. Depression is associated with a substantially increased risk of developing heart failure in individuals at risk, and has been related to adverse outcomes in patients with established heart failure. It is important to determine its prevalence in different populations and assess related causes. METHODS: We conducted a cross-sectional study of 103 patients with heart failure, admitted to public hospital, via a questionnaire that evaluates clinical variables, socio-demographics and we applied the Beck Depression Inventory to determine the prevalence of depressive symptoms and predictors of their presence. We used the chi2, Student test and considered significant when < 0.05 and subjected to logistic regression analysis when between 0.05 and 0.1. RESULTS: The mean age of the patients in our study was 65.4 ± 13.6. Depressive symptoms were present in 69 (67%) patients: 35 (34%) had mild depressive symptoms, 22 (21.3%) had moderate symptoms and 12 (11.6%) patients presented severe symptoms. Marital status was significant when analyzed, and the predictors of depressive symptoms were marital status, sex, living arrangements and heart failure etiology. CONCLUSIONS: Because depressive symptoms in patients hospitalized for heart failure are very common, it is important to detect these disorders. The prevalence of these varies according to socio-demographic and clinical data, and these factors should be taken into consideration when planning future studies, as well as screening and intervention programs for co-morbid depressive disorders in hospitalized patients with heart failure.

Teratoma benigno de tireoide em criança de 5 anos: relato de caso / Thyroids benign teratoma in 5 years child: case report

Objetivo: Relatar um caso de teratoma de tireoide e destacar que, apesar de raro, deve ser incluído no diagnóstico diferencial das massas cervicais. Descrição: Teratomas são neoplasias derivadas das células germinativas com componentes dos três folhetos embrionários: ectoderma, endoderma e mesoderma. Ocorrem mais frequentemente nas gônadas, região sacrococcígea, mediastino e região pineal. Teratomas de tireoide são neoplasias raras, geralmente de caráter benigno, mas que se não tratados precocemente podem evoluir com insuficiência respiratória devido ao efeito de massa do tumor. Conclusões: Apesar de raro, o teratoma de tireoide deve ser incluído no diagnóstico diferencial das massas cervicais, pois evolui para óbito em 80% dos casos não tratados precocemente.

Objective: To report a case of teratoma of the thyroid and stress that, although rare, should be included in the differential diagnosis of neck masses. Description: Teratomas are neoplasms derived from germ cells with components of the three germ layers: ectoderm, endoderm and mesomesoderm. Occur more frequently in the gonads, sacrococcygeal region, mediastinum and pineal region. Thyroid teratomas are rare neoplasms, usually benign, but if not treated promptly can develop respiratory failure due to tumor mass effect. Conclusions: Although rare, thyroid teratoma should be included in the differential diagnosis of neck masses, because evolved to death in 80% of cases not treated early.