Experiência de 555 tireoidectomias consecutivas no Hospital de Clínicas de Porto Alegre (1987 a 2000)

OBJECTIVE: To describe the profile of patients who were submitted to thyroidectomy. MATERIAL AND METHODS: We retrospectively reviewed 593 surgeries at the Hospital de Clínicas de Porto Alegre (555 patients), carried out between 1987 and 2000, in terms of preoperative diagnosis, pathology, surgical technique, and complications. We calculated the sensitivity, specificity, positive and negative predictive values of fine needle aspiration biopsy and frozen section. Our population included 504 female patients (85%) and the age average was of 48.1 years. The most frequent preoperative diagnosis was suspected malignancy (58.3%), and the most frequent surgical procedure used was lobectomy (n = 218; 53.3%). RESULTS: Colloid goiter represented 70% of all anatomicopathological findings and malignancy was confirmed in 99 surgical procedures (16.1%). The most frequent complications were transient hypoparathyroidism (8.6%), permanent hypoparathyroidism (4.7%), and unilateral recurrent laryngeal nerve palsy (4,9%). CONCLUSION: Thyroidectomy presented zero mortality and an acceptable morbidity rate.OBJETIVO: O objetivo deste estudo foi de descrever o perfil de pacientes submetidos à cirurgia de tireóide. MATERIAIS E MÉTODOS: Descrevemos o perfil de 555 pacientes submetidos a 593 cirurgias de tireóide no Hospital de Clínicas de Porto Alegre, entre 1987 e 2000, no que diz respeito à indicação cirúrgica, tipo de patologia, cirurgia realizada e incidência de complicações. Definimos também a sensibilidade, especificidade e valores preditivos da punção biópsia aspirativa e anatomopatológico de congelação. Dos pacientes operados, 504 (85%) eram do sexo feminino. A idade média foi de 48,1 anos. A indicação cirúrgica mais freqüente foi suspeita de malignidade (58,3%), sendo o procedimento mais comumente realizado a lobectomia (53,3%). RESULTADOS: O achado anatomopatológico mais comum foi o bócio colóide em 70%. Neoplasias foram encontradas em 99 procedimentos (16,1%). As complicações mais incidentes foram hipoparatireoidismo transitório (8,6%), hipoparatireoidismo permanente (4,7%) e lesão transitória unilateral do nervo laríngeo inferior (4,9%). CONCLUSÃO: A cirurgia de tireóide é um procedimento seguro e que apresenta taxas aceitáveis de complicações

Molecular detection of rifampin and isoniazid resistance to guide chronic TB patient management in Burkina Faso

<p>Abstract</p> <p>Background</p> <p>Drug-resistant tuberculosis (DR-TB) is considered a real threat to the achievement of TB control. Testing of mycobacterial culture and testing of drug susceptibility (DST) capacity are limited in resource-poor countries, therefore inadequate treatment may occur, favouring resistance development. We evaluated the molecular assay GenoType^®MTBDR<it>plus </it>(Hain Lifescience, Germany) in order to detect DR-TB directly in clinical specimens as a means of providing a more accurate management of chronic TB patients in Burkina Faso, a country with a high TB-HIV co-infection prevalence.</p> <p>Methods</p> <p>Samples were collected in Burkina Faso where culture and DST are not currently available, and where chronic cases are therefore classified and treated based on clinical evaluation and sputum-smear microscopy results. One hundred and eight chronic TB patients (sputum smear-positive, after completing a re-treatment regimen for pulmonary TB under directly observed therapy) were enrolled in the study from December 2006 to October 2008. Two early morning sputum samples were collected from each patient, immediately frozen, and shipped to Italy in dry ice. Samples were decontaminated, processed for smear microscopy and DNA extraction. Culture was attempted on MGIT960 (Becton Dickinson, Cockeysville, USA) and decontaminated specimens were analyzed for the presence of mutations conferring resistance to rifampin and isoniazid by the molecular assay GenoType^®MTBDR<it>plus</it>.</p> <p>Results</p> <p>We obtained a valid molecular test result in 60/61 smear-positive and 47/47 smear-negative patients.</p> <p>Among 108 chronic TB cases we identified patients who (i) harboured rifampin- and isoniazid-susceptible strains (n 24), (ii) were negative for MTB complex DNA (n 24), and (iii) had non-tuberculous mycobacteria infections (n 13). The most represented mutation conferring rifampin-resistance was the D516V substitution in the hotspot region of the <it>rpoB </it>gene (43.8% of cases). Other mutations recognized were the H526D (15.6%), the H526Y (15.6%), and the S531L (9.4%).</p> <p>All isoniazid-resistant cases (n 36) identified by the molecular assay were carrying a S315T substitution in the <it>katG </it>gene. In 41.7% of cases, a mutation affecting the promoter region of the <it>inhA </it>gene was also detected.</p> <p>Conclusion</p> <p>The GenoType^®MTBDR<it>plus </it>assay performed directly on sputum specimens improves the management of chronic TB cases allowing more appropriate anti-TB regimens.</p

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements