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.