Morbidade e mortalidade neonatal intra-hospitalar.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Pediatria, Curso de Medicina, Florianópolis, 198

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Aspectos clínicos da miastenia grave em nosso meio.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Médica, Curso de Medicina, Florianópolis, 198

Intramedullary spinal teratoma: a rare condition with a good outcome Teratoma intramedular: bom resultado em caso incomum

Approximately one-third of spinal tumors in child-hood1 are intramedullary neoplasms1 and up to 80 % are gliomas2. The occurrence of teratomas in the spine is ex-tremely rare3. Except for in the sacrococcygeal region, teratomas constitute less than 0.5 % of all intraspinal tu-mors. It is believed that they arise from multipotential germinal cells misplaced in the early embryonic develop-ment. It was also proposed that teratomas represent abor-tive “twin ” formation cystic component ependymal diver-ticula of the central canal of the spinal cord4,5. Teratomas may be intra- or extramedullary and usually fill the spinal canal. Some teratomas have been reported in association with split cord malformations and other developmental spinal abnormalities, like myelomeningoceles3,6,7. The tu-mor may be partially solid or wholly cystic. Intramedul

Brain tumors in the first three years of life: a review of twenty cases Tumores do sistema nervoso central nos primeiros três anos de vida: revisão de vinte casos

OBJECTIVE AND METHOD: To review the clinical and neuropathological findings as well as the type of therapy and outcome in 20 infants under 3 years-old with central nervous system (CNS) tumor. They were treated at the Department of Neurology, "Hospital das Clínicas" University of São Paulo Medical School, from January 1997 to May 2001. RESULTS: Astrocytoma was the most common histological type (n=7), followed by ependymoma (n=3), medulloblastoma (n=2), craniopharyngioma (n=2) and desmoplastic ganglioglioma (n=2). The location of the tumor was predominantly supratentorial. Mean follow-up time was 20.2 months with recurrence in 7 cases. For each type of tumor we have emphasized the treatment currently recommended. CONCLUSION: Although follow-up time is not sufficient for analyzing survival, a trend of improvement in prognosis was noted, compared to another series of cases from our Institution that had been evaluated before 1990.OBJETIVO E MÉTODO: Avaliar os aspectos clínicos e histopatológicos, o tipo de tratamento e a evolução de 20 crianças menores de três anos de idade, com o diagnóstico de tumor de sistema nervoso central, que foram tratadas em nossa Instituição no período de janeiro de 1997 a maio de 2001. RESULTADOS: O astrocitoma foi o tumor mais comum (n=7), seguido pelo ependimoma (n=3), meduloblastoma (n=2), craniofaringioma (n=2) e ganglioglioma desmoplásico infantil (n=2). A localização do tumor foi predominantemente supratentorial. A média de seguimento foi 20,2 meses e houve recidiva em sete casos. Para cada tipo de tumor enfatizamos o tipo de tratamento recomendado na atualidade. CONCLUSÃO: Embora o tempo de seguimento não seja suficiente, ainda, para analisar a sobrevida, foi notada nítida tendência a melhor prognóstico em comparação com a casuística proviniente de nossa Instituição que analisou casos abordados antes da década de 90