External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes

ABSTRACT Introduction Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. Materials and methods We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-one-out, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. Results We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. Conclusions In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.

Tuberculose pulmonar / Pulmonary tuberculosis

A tuberculose (TB) é uma doença infecto-contagioda, prevenível e curável, constituindo ainda hoje uma ameaça para a saúde pública no Brasil. A TB nunca deixou de ser um problema do terceiro mundo, em geral. Segundo a Organização Mundial da Saúde (OMS), o Brasil ocupa hoje o 14º lugar entre os 23 países responsáveis por 80 por cento do total de casos de tuberculose. No Brasil, desde a década de 1980, vêm sendo notificados em torno de 80 mil a 90 mil casos anuais, mais ou menos estáveis, com uma mortalidade aproximadamente de 6 mil casos por ano. Apresenta-se sob a forma pulmonar ou extrapulmonar. Deve-se fazer o diagnóstico de forma rápida, tendo em vista iniciar logo o tratamento, reduzindo o tempo de transmissão da doença e conseqüentemente o número de infectados.

Tuberculosis (TB) is an infectious and contagious illness, healing and preventive that still constitute nowadays a treat for the public health in Brazil. TB has always been a third world problem. In accordance with OMS, Brazil rank today the 14th place, among 23 countries responsible for 80 per cent of the cases of TB. In Brazil, since the 80's, around 80 to 90 thousand cases yearly are notified, with mortality nearby 6 thousand cases per annum. Present itself in a pulmonary or extrapulmonary way. The diagnosis must be early, to treat it fast, to reduce the time of transmission and the number of sick patients.

Tratamento da insuficiência cardíaca descompensada / Decompensated heart failure treatment

A insuficiência (IC) descompensada é causa freqüente de internações hospitalares em todo o mundo. Constitui o principal motivo de internações de pacientes com mais de 65 anos de idade, apresentando elevada taxa de mortalidade. A IC pode ser classificada como leve, moderada ou severa (NYHA), mas freqüentemente seus sintomas e sua evolução são insidiosos, em geral decorrentes de lesões no músculo cardíaco. Diagnóstico e trataemtno precoces são essenciais para diminuir a evolução da doença.