Intestinal tuberculosis in immunocompetent/HIV negative patients: case report of two patients

In the past, extrapulmonary tuberculosis affected approximately 70% of patients with advanced pulmonary tuberculosis. However, with the advent of highly effective therapy, intestinal tuberculosis has become rare ― even more unusual in patients without immunodeficiency, HIV and pulmonary disease. The purpose of this study was to report the case of two patients diagnosed with intestinal tuberculosis and no immunodeficiency, HIV or lung disease. The first patient was diagnosed by colonoscopy performed in a mass located in the ileocecal region. After the tuberculosis treatment, the patient presented improvement regarding the mass and symptoms. The diagnosis of the second patient was achieved only with surgical resection of the lesion in proximal transverse colon. It is important for health professionals to know that intestinal tuberculosis should be considered as differential diagnosis of intestinal diseases, also for immunocompetent patients, even regarded as a rare disease.No passado, a tuberculose extrapulmonar acometia cerca de 70% dos pacientes com tuberculose pulmonar avançada. Porém, com o surgimento da terapia de alta eficácia, a tuberculose intestinal tornou-se de ocorrência mais rara - sendo ainda mais incomum de ocorrer em pacientes sem imunodeficiência, HIV e doença pulmonar. O objetivo deste estudo foi apresentar o caso de dois pacientes diagnosticados com tuberculose intestinal, sem sinais de imunodeficiência, HIV ou doença pulmonar. A primeira paciente foi diagnosticada por meio de biópsias realizadas por colonoscopia em uma massa localizada em região ileocecal; após o tratamento da tuberculose a paciente apresentou melhora da lesão e dos sintomas. O diagnóstico do segundo paciente só foi obtido com a ressecção cirúrgica da lesão em cólon transverso proximal. É importante que os profissionais da saúde saibam que a tuberculose intestinal deve ser considerada como diagnóstico diferencial de patologias intestinais, até mesmo em pacientes imunocompetentes, mesmo sendo rara

Staging of colorectal cancer in the private service versus Brazilian National Public Health System: what has changed after five years?

INTRODUCTION: Cancer is a disease that affects a large population, being the colorectal cancer one of the most prevalent. The early diagnosis of these neoplasms represents a better life expectancy. The high cost of diagnostic tests and the low socioeconomic status are considered factors leading to delayed diagnosis. OBJECTIVES: Assess the difference between colorectal cancer staging in patients of private clinics and patients of the Brazilian National Health Service (SUS) and assess the changes in cancer staging in the past five years. METHODS: This retrospective study was conducted with 53 patients divided in two groups (SUS and private clinic) diagnosed with colorectal cancer and treated in 2009. Staging of patients diagnosed in 2009 was compared with data from patients diagnosed in 2004, already published in 2005. RESULTS: Both groups were similar in gender and age. Regarding the staging of patients, no statistical difference was observed between the two groups (p=0.147). When comparing the staging of patients diagnosed in 2009 with that of patients studied in 2004, patients diagnosed in 2009 presented early stages (II and III) in relation to patients analyzed in 2004 (III and IV), pINTRODUÇÃO: O câncer é uma doença que afeta grande parte da população, sendo o câncer colorretal um dos mais prevalentes. O diagnóstico precoce dessas neoplasias resulta em uma melhor expectativa de vida. O alto custo dos exames diagnósticos e o baixo nível socioeconômico são apontados como fatores que levam ao atraso no diagnóstico. OBJETIVOS: Avaliar a diferença no estadiamento de câncer colorretal no momento do diagnóstico de pacientes oriundos da clínica privada e pacientes do Sistema Único de Saúde (SUS), assim como, avaliar as mudanças no estadiamento nos últimos cinco anos. MÉTODOS: Estudo retrospectivo envolvendo 54 pacientes divididos em dois grupos (SUS e clínica privada) diagnosticados no ano de 2009. Os estadiamentos dos pacientes diagnosticados em 2009 foram comparados com os dados de pacientes diagnosticados em 2004, já publicados em 2005. RESULTADOS: Ambos os grupos eram similares em gênero e idade. Em relação ao estadiamento dos pacientes não houve diferença estatística entre os dois grupos (p=0,147). Na comparação entre os pacientes de 2009 e os pacientes estudados em 2004 se evidencia que os pacientes de 2009 apresentaram-se com estádios mais precoces (II e III) em relação aos pacientes de 2004 (III e IV), p<0,001. CONCLUSÃO: Não há diferença no estadiamento dos pacientes do SUS comparado ao estadiamento dos pacientes da clínica privada. Os pacientes tratados no ano de 2009 se apresentaram com estádios mais precoces em relação aos tratados em 2004

Association between primary headaches and depression in young adults in southern Brazil

OBJECTIVE: To verify the association between depression and headache in young adults, as well as to identify the features of headache associated with depression and the influence of this mood disorder on headache-related disability. METHODS: A cross-sectional study with self-administered questionnaires about headache and depression was conducted at the Universidade de Caxias do Sul. Beck Depression Inventory (BDI) and Migraine Disability Assessment (MIDAS) were used to evaluate depressive symptoms and headache-related disability, respectively. Depression was considered if BDI > 15. RESULTS: A thousand and thirteen young adults were included in the study. A clear relationship was observed between headache and depression among the participants. Multivariate analyses demonstrated that nausea or vomiting related to headache and higher headacherelated disability scores were independent factors associated with depression. Migraine was more associated with depression than the other types of headache. CONCLUSION: The results demonstrate an association between headache and depression. Depressive symptoms are more likely to be found in young adults with more disabling headaches

Hypoglossal-Facial Anastomosis for Facial Nerve Reconstruction: Outcomes using the Side-to-End Surgical Technique

Introduction The side-to-end hypoglossal-facial anastomosis (HFA) technique is an excellent alternative technique to the classic end-terminal anastomosis, because it may decrease the symptoms resulting from hypoglossal-nerve transection. Methods Patients with facial nerve palsy (House-Brackmann [HB] grade VI) requiring facial reconstruction from 2014 to 2017were retrospectively included in the study. Results In total, 12 cases were identified, with a mean follow-up of 3 years. The causes of facial paralysis were due to resection of posterior-fossa tumors and trauma. There was improvement in 91.6% of the patients (11/12) after the HFA. The rate of improvement according to the HB grade was as follows: HB III - 58.3%; HB IV - 16.6%; and HB II - 16.6%. The first signs of improvement were observed in the patients with the shortest time between the paralysis and the anastomosis surgery (3.5 months versus 8.5 months; p = 0.011). The patients with HB II and III had a shorter time between the diagnosis and the anastomosis surgery (mean: 5.22 months), while the patients with HB IV and VI had a longer time of paresis (mean: 9.5 months; p = 0.099). We did not observe lingual atrophy or changes in swallowing. Discussion and Conclusion Hypoglossal-facial anastomosis with the terminolateral technique has good results and low morbidity in relation to tongue motility and swallowing problems. The HB grade and recovery appear to be better in patients operated on with a shorter paralysis time