Factors associated with mortality or survival of patients with tuberculosis: an integrative review

Objective: To identify factors associated with mortality or survival of patients with isolated Tuberculosis (TB) or TB/HIV co-infection. Methods: A literature review was performed in the following databases: PubMed, Web of Science, Scopus, Health Virtual Library, and SciELO sing the following search terms: “Survival” OR “Mortality” AND “Epidemiological factors” OR “Epidemiological determinants” OR “Associated factors.” Recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyzes methodology were used. Results: The factors associated with mortality or reduced survival were male sex, age >30 years in TB/HIV co-infection cases, advanced age in isolated TB cases, low schooling or up to 8 years of schooling, unemployment, TB/HIV co-infection, recent diagnosis of HIV, CD4 <50 cells, other immunosuppressive diseases, diabetes, renal disease, smoking, alcoholism, weight loss, and recently treatment started. Final considerations: Factors associated with TB mortality or survival did not differ from those associated with TB morbidity. However, excluding TB/HIV co-infection, the socioeconomic factors are evidenced.

Maternal Mortality Due to an Undiagnosed Large Thymoma in Puerperium: A Case Report

Introduction: Delayed or avoided medical care due to coronavirus disease 2019 (COVID-19) related concerns may increase morbidity and mortality associated with both acute and chronic health conditions. Thymoma is uncommon in pregnancy, although it could be accompanied with unfavorable outcomes. We report a puerperal woman presented with dyspnea and cardiac arrest with a recent diagnosis of thymoma that led to maternal mortality. Case Presentation: A 38-year-old woman with occasional dyspnea during pregnancy without medical referral was admitted to the hospital with severe dyspnea and orthopnea three days after cesarean section. Spiral computed tomography (CT) angiography showed a 64 × 84-centimeter mass with soft tissue density in the left perivascular that was originated from the anterior mediastinum; in biopsy, thymoma was suggested. She died shortly after due to severe dyspnea and cardiac arrest. Conclusions: Prenatal care during COVID-19 pandemic should not be postponed. Indeed, any symptom similar to the physiologic changes in pregnancy needs to be evaluated for optimal clinical management.

COVID-19 impact on testing, diagnosis and care of people with sexually transmitted infections in a low human development region, Minas Gerais, Brazil

This study aimed to analyze the impact of the COVID-19 pandemic on the care of people with Sexually Transmitted Infections (STIs) in a region of low human development, located in Minas Gerais, Brazil. Methods: The number of monthly procedures during pandemic period, January to December 2020, and comparison period, January to December 2019, in a SUS regional clinic, a reference for STIs, were analyzed. Visits were categorized into follow-up appointments, rapid tests, viral loads and first appointment due a recent diagnosis. Comparison between both periods was performed by frequency analysis, difference in the mean monthly attendances (DM) and prevalence ratios (PR), considering ratio between the proportion of attendances in the pandemic period/proportion of attendances in the comparative period. During the pandemic period, the average number of monthly consultations reduced for all consultations (DM = -105.25) and categories. Proportion of consultations reduced for rapid tests (PR = 0.46; 95% CI = 0.41-0.52) and first consultation due recent diagnosis (PR = 0.90; 95% CI = 0.65-1, 25), procedures that are usually scheduled by the user. There was an increase in the proportion of follow-up visits (PR = 1.18; 95% CI = 1.09-1.27) and viral load tests (PR = 1.41; 95% CI = 1.32-1, 88), monitoring procedures usually scheduled by the clinic. There was a trend to maintain risk exposure for STIs. Conclusion: These findings may guide better strategies to care for individuals with STIs.

Dermatomyositis- Related Intestinal Dysmotility

Dermatomyositis (DM) is an inflammatory myopathy characterized by proximal muscle weakness and pathognomonic skin lesions. A 69-year-old woman with a recent diagnosis of DM one month prior, treated with corticosteroids and immunomodulators, presented to our inpatient rehabilitation with worsening dysphagia and constipation. At the time of our evaluation, physical examination was notable for erythematous papules over the MCPs, PIPs, elbows, and knees as well as a violaceous rash on the face. Muscle strength was diminished bilaterally with proximal distribution being affected greater than distal. Laboratory studies were notable for CK level 31 IU/ L, ANA by immunofluorescence of 1:80, and aldolase 4 u/L. The eleven-antibody myositis panel was negative. Skeletal muscle biopsy of the left thigh showed partially treated acquired inflammatory myopathy with perifascicular atrophy. During hospitalization, she was found to have pulmonary embolism. She received enoxaparin 1 mg/kg subcutaneous BID. Soon after, she developed rectal bleeding. Colonoscopy showed a stercoral ulcer caused by chronic constipation. While dysphagia is common, being present in 25-50% of patients with DM, lower gastrointestinal problems involving the small and large intestine are rare and typically present as a late manifestation of the disease. Decreased peristalsis in the large colon can lead to constipation, impaction, and subsequent mucosal ulceration, and pressure necrosis induced by fecaloma formation. Although rare, our case highlights the importance of recognizing gastrointestinal complications that dermatomyositis can cause and the effects that those complications have on morbidity and mortality.

Accuracy of Cell-Free DNA (cfDNA) in Colorectal Cancer Diagnosis

Background: The requirement for malaria elimination to be recognized is to prove Background. Colorectal cancer is the third most common type of cancer following lung and breast cancer with the second most common cause of cancer-related death globally. Delayed diagnosis due to limited source and modality to perform early diagnosis lead to advanced-stage condition which contributes to higher morbidities and mortalities. Recent diagnosis of colorectal cancer depends on biopsy of suspected tissues, either obtained surgically or per colonoscopy. Colorectal cancer detection through cell-free DNA measurement allowing small-size cancer being detected even in early stage. cfDNA originated from derivates of increased and abnormality apoptosis-necrosis pathway from cancer lesion, therefore can be managed as specific tumor marker. Methods: Diagnostic test was performed at the Gastroentero Hepatology Outpatient Unit and Internal Medicine Inpatient Unit of Dr. Mohammad Hoesin General Hospital Palembang from March to June 2021. Data processing and analysis using SPSS version 26.0 for Windows. Results: Among 50 subjects included, 39 subjects (78%) are diagnosed with colorectal cancer, whereas 11 subjects (22%) as control. The median of cfDNA result is 59,71 ng/mL with 92,3% sensitivity, 90,9% specificity, 95,2% positive predictive value, 82,3% negative predictive value, and 92,4% accuracy rate. Combination the measurement of cfDNA, CEA, and CA19-9 appears to have better AUC instead of single measurement. Conclusion: The study reveals that cell-free DNA (cfDNA) demonstrated a very promising accuracy rate in diagnosing colorectal cancer.

Effect of adrenalectomy on remission of subclinical left ventricular dysfunction in patients with pheochromocytoma: a speckle-tracking echocardiography study

Background: Pheochromocytomas (PHEO) are tumours with the ability to produce, metabolize and secrete catecholamines. Catecholamines overproduction leads to the decrease of longitudinal function of the left ventricle (LV) measured by speckle tracking echocardiography. Patients with PHEO have lower magnitude of global longitudinal strain (GLS) than patients with essential hypertension. GLS normalization is expected after resolution of catecholamine overproduction. Methods: Twenty-four patients (14 females and 10 males) with recent diagnosis of PHEO have been examined before and one year after adrenalectomy. An echocardiographic examination including speckle tracking analysis with the evaluation of GLS and regional longitudinal strain (LS) in defined groups of LV segments (basal, mid-ventricular and apical) was performed. Results: One year after adrenalectomy magnitude of GLS increased (−14.3 ± 1.8 to −17.7 ± 1.6 %; p < 0.001). When evaluating the regional LS, the most significant increase in the differences was evident in apical segment compared to mid-ventricular and basal segments of LV (-5.4 ± 5.0 vs. -1.9 ± 2.7 vs.-1.6 ± 3.8; p < 0.01). Conclusions: In patients with PHEO, adrenalectomy leads to an improvement of subclinical LV dysfunction represented by increasing magnitude of GLS, which is the most noticeable in apical segments of LV.

Disseminated Kaposi Sarcoma

Case Presentation: A 28-year-old male with a recent diagnosis of human immunodeficiency virus presented to the emergency department with odynophagia and dysphagia for a month. Physical exam revealed Kaposi sarcoma partially occluding the airway. Point-of-care ultrasound was used to assist with the diagnosis of reactive lymphadenopathy, and computed tomography revealed systemic disease. Otolaryngology was urgently consulted, and the patient was admitted for prompt tracheostomy the following day. Discussion: Kaposi sarcoma is a violaceous vascular neoplasm that is an acquired immuno-deficiency syndrome (AIDS)-defining illness. Mucocutaneous membranes should be thoroughly evaluated with patients suspected of AIDS. This case demonstrates the vital evaluation of the patient’s airway to assess patency. Highly active antiretroviral therapy should be initiated promptly, as well as chemotherapy in severe systemic cases.

Evidence-Based Optimization of the Mandarin Version of the Post Stroke Checklist: A Mixed Methods Study

Background: The Post Stroke Checklist has been proved to be feasible and useful in standardizing the process for long-term post-stroke care and we developed a Mandarin version of it (M-PSC). However, it is not capable of enforcing follow-up care after stroke and further optimization is needed.Methods: Participants were consecutively recruited from 13 departments in a specialized hospital on the discharge date. The trained clinicians contacted them by telephone calls at six months since the most recent diagnosis. A satisfaction questionnaire was sent to the participant whilst clinicians completed a satisfaction questionnaire and the Pragmatic Face and Content Validity Test (PRAC-Test). Then, a debriefing meeting was held to discuss potential problems of the M-PSC. Quantitative and qualitative data were both collected from April 2021 to May 2021.Results: A total of 167 individuals consented to take part in the study.113 participants completed the assessment at six months and three were excluded due to missing data. The M-PSC identified a wide range of unmet needs related to stroke and at least one need was reported in 76.4% of participants. The average time taken to administer the M-PSC was 8 mins. Satisfaction ratings were high for participants (8.5/10) and clinicians (9.6/10). Totally 31 further screenings were conducted and 33 appropriate referrals were accomplished. Several areas for improvement were identified and revised.Conclusions: The M-PSC is a feasible and useful measure in enforcing follow-up care and promising to be an approach in standardizing post-stroke follow-up practice in telehealth during the coronavirus disease 2019 pandemic.