Predictive factors for hospital self-discharge in tuberculosis admissions in the state of Rio de Janeiro, from 2011-2018: a retrospective cohort study.

OBJECTIVE: To assess factors associated with hospital self-discharge of patients with tuberculosis in the state of Rio de Janeiro, Brazil, 2011-2018. METHODS: This was a retrospective cohort study in a referral hospital. Clinical and epidemiological characteristics were compared according to hospitalization outcome (self-discharge, formal discharge, or death). Hazard ratios (HR) with 95% confidence intervals (95%CI) for the association of self-discharge with explanatory variables were estimated using Cox regression. RESULTS: Of the 1429 hospitalizations, 10.4% ended in self-discharge. Female sex (HR = 1.47; 95%CI 1.03;2.11), age ≤ 42 years (HR = 2.01; 95%CI 1.38; 2.93), substance use (HR = 1.62; 95%CI 1.12; 2.34), hospitalization after treatment dropout (HR = 2.04; 95%CI 1.37; 3.04), and homelessness (HR = 2.5; 95%CI 1.69; 3.69) were associated with self-discharge. CONCLUSION: Patients with social vulnerability require more careful monitoring during hospitalization. MAIN RESULTS: Homeless people, illicit drug use, female sex and history of dropout from previous treatment showed association with hospital self-discharge in patients with tuberculosis admitted to a reference hospital in the state of Rio de Janeiro. IMPLICATIONS FOR SERVICES: Need for more comprehensive support for vulnerable patients, in addition to promoting treatment adherence and training health professionals to deal with the complex psychosocial issues related to tuberculosis. PERSPECTIVES: It is crucial to develop public policies that consider social factors in tuberculosis management, as well as promoting cooperation and multisectoral approaches to address both tuberculosis and underlying social issues.

Predictive factors for hospital self-discharge in tuberculosis admissions in the state of Rio de Janeiro, from 2011-2018: a retrospective cohort study / Fatores preditivos para a evasão hospitalar nas internações por tuberculose no estado do Rio de Janeiro, de 2011 a 2018: estudo de coorte retrospectivo / Factores predictivos para el alta hospitalaria en las admisiones por tuberculosis en el estado de Río de Janeiro, de 2011 a 2018: un estudio de cohorte retrospectivo

ABSTRACT Objective To assess factors associated with hospital self-discharge of patients with tuberculosis in the state of Rio de Janeiro, Brazil, 2011-2018. Methods This was a retrospective cohort study in a referral hospital. Clinical and epidemiological characteristics were compared according to hospitalization outcome (self-discharge, formal discharge, or death). Hazard ratios (HR) with 95% confidence intervals (95%CI) for the association of self-discharge with explanatory variables were estimated using Cox regression. Results Of the 1429 hospitalizations, 10.4% ended in self-discharge. Female sex (HR = 1.47; 95%CI 1.03;2.11), age ≤ 42 years (HR = 2.01; 95%CI 1.38; 2.93), substance use (HR = 1.62; 95%CI 1.12; 2.34), hospitalization after treatment dropout (HR = 2.04; 95%CI 1.37; 3.04), and homelessness (HR = 2.5; 95%CI 1.69; 3.69) were associated with self-discharge. Conclusion Patients with social vulnerability require more careful monitoring during hospitalization.

RESUMO Objetivo Analisar fatores associados à evasão hospitalar de pacientes com tuberculose no estado do Rio de Janeiro, de 2011 a 2018. Métodos Trata-se de estudo de coorte retrospectivo em hospital de referência. Foram comparadas as características clínicas e epidemiológicas segundo desfecho da internação (evasão, alta ou óbito). Hazard ratios (HR) com intervalos de confiança de 95% (IC95%) da associação da evasão com as variáveis explicativas foram estimados por regressão de Cox. Resultados Das 1.429 internações, 10,4% tiveram evasão como desfecho. Sexo feminino (HR = 1,47; IC95% 1,03;2,11), idade ≤ 42 anos (HR = 2,01; IC95% 1,38;2,93), uso de drogas (HR = 1,62; IC95% 1,12;2,34), internação após abandono de tratamento (HR = 2,04; IC95% 1,37;3,04) e pessoas vivendo em situação de rua (HR = 2,50; IC95% 1,69;3,69) foram associados à evasão. Conclusão Pacientes com vulnerabilidade social necessitam de monitoramento mais cuidadoso durante a internação.

RESUMEN Objetivo Analizar los factores asociados con la deserción hospitalaria de pacientes con tuberculosis en el estado de Río de Janeiro, en 2011 y 2018. Métodos Estudio de cohorte retrospectivo en un hospital de referencia. Se compararon las características clínicas y epidemiológicas según el desenlace (deserción, alta o fallecimiento). Se estimaron los hazard ratios (HR) con intervalos de confianza del 95% (IC95%) para la asociación de la deserción con las variables explicativas mediante regresión de Cox. Resultados De las 1429 hospitalizaciones, 10,4% desertaron. El sexo femenino (HR= 1,47; IC95% 1,03; 2,11), la edad ≤ 42 años (HR = 2,01; IC95% 1,38; 2,93), el consumo de drogas (HR=1,62; IC95% 1,12;2,34), la hospitalización después del abandono del tratamiento (HR = 2,04; IC95% 1,37; 3,04) y la situación de calle (HR = 2,5; IC95% 1,69; 3,69) se asociaron con la deserción. Conclusión Pacientes vulnerables requieren un monitoreo más cuidadoso durante la hospitalización.

Vasculite reumatoide - Relato de caso / Rheumatoid Vasculitis - Case Report

Resumo A artrite reumatoide (AR) é uma doença crônica autoimune inflamatória sistêmica e sua principal manifestação é a sinovite persistente, que compromete articulações periféricas de forma simétrica. Apesar do seu potencial destrutivo, a evolução da AR é muito variável. Alguns pacientes podem ter apenas um processo de curta duração oligoarticular com lesão mínima, enquanto outros sofrem uma poliartrite progressiva e contínua e evoluem com acometimento de outros órgãos e sistemas, como pele, coração, pulmões, músculos e mais raramente vasos sanguíneos, que leva à vasculite reumatoide. O objetivo deste estudo foi descrever um caso de vasculite reumatoide, uma condição rara e grave.

Abstract Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease and its main manifestation is persistent synovitis affecting peripheral joints symmetrically, In spite of its destructive potential, the evolution of RA is highly variable. Some patients may have only a short-term process oligoarticular with minimum lesion, while others suffer a polyarthritis evolving with progressive and continuous involvement of other organ systems such as skin, heart, lungs, muscles and blood vessels rarely leading to rheumatoid vasculitis. The aim of this study was to describe a case of rheumatoid vasculitis a rare and severe condition.

Association between serum selenium level and conversion of bacteriological tests during antituberculosis treatment.

OBJECTIVE: To determine whether serum selenium levels are associated with the conversion of bacteriological tests in patients diagnosed with active pulmonary tuberculosis after eight weeks of standard treatment. METHODS: We evaluated 35 healthy male controls and 35 male patients with pulmonary tuberculosis, the latter being evaluated at baseline, as well as at 30 and 60 days of antituberculosis treatment. For all participants, we measured anthropometric indices, as well as determining serum levels of albumin, C-reactive protein (CRP) and selenium. Because there are no reference values for the Brazilian population, we used the median of the serum selenium level of the controls as the cut-off point. At 30 and 60 days of antituberculosis treatment, we repeated the biochemical tests, as well as collecting sputum for smear microscopy and culture from the patients. RESULTS: The mean age of the patients was 38.4 ± 11.4 years. Of the 35 patients, 25 (71%) described themselves as alcoholic; 20 (57.0%) were smokers; and 21 (60.0%) and 32 (91.4%) presented with muscle mass depletion as determined by measuring the triceps skinfold thickness and arm muscle area, respectively. Of 24 patients, 12 (39.2%) were classified as moderately or severely emaciated, and 15 (62.5%) had lost > 10% of their body weight by six months before diagnosis. At baseline, the tuberculosis group had lower serum selenium levels than did the control group. The conversion of bacteriological tests was associated with the CRP/albumin ratio and serum selenium levels 60 days after treatment initiation. CONCLUSIONS: Higher serum selenium levels after 60 days of treatment were associated with the conversion of bacteriological tests in pulmonary tuberculosis patients.

Association between serum selenium level and conversion of bacteriological tests during antituberculosis treatment / Associações entre níveis de selênio sérico e conversão de testes bacteriológicos durante o tratamento antituberculose

Objective: To determine whether serum selenium levels are associated with the conversion of bacteriological tests in patients diagnosed with active pulmonary tuberculosis after eight weeks of standard treatment. Methods: We evaluated 35 healthy male controls and 35 male patients with pulmonary tuberculosis, the latter being evaluated at baseline, as well as at 30 and 60 days of antituberculosis treatment. For all participants, we measured anthropometric indices, as well as determining serum levels of albumin, C-reactive protein (CRP) and selenium. Because there are no reference values for the Brazilian population, we used the median of the serum selenium level of the controls as the cut-off point. At 30 and 60 days of antituberculosis treatment, we repeated the biochemical tests, as well as collecting sputum for smear microscopy and culture from the patients. Results: The mean age of the patients was 38.4 ± 11.4 years. Of the 35 patients, 25 (71%) described themselves as alcoholic; 20 (57.0%) were smokers; and 21 (60.0%) and 32 (91.4%) presented with muscle mass depletion as determined by measuring the triceps skinfold thickness and arm muscle area, respectively. Of 24 patients, 12 (39.2%) were classified as moderately or severely emaciated, and 15 (62.5%) had lost > 10% of their body weight by six months before diagnosis. At baseline, the tuberculosis group had lower serum selenium levels than did the control group. The conversion of bacteriological tests was associated with the CRP/albumin ratio and serum selenium levels 60 days after treatment initiation. Conclusions: Higher serum selenium levels after 60 days of treatment were associated with the conversion of bacteriological tests in pulmonary tuberculosis patients. .

Objetivo: Determinar se os níveis séricos de selênio estão associados à conversão dos testes bacteriológicos em pacientes diagnosticados com tuberculose pulmonar ativa após oito semanas de tratamento-padrão. Métodos: No início do estudo, avaliamos 35 controles saudáveis, do sexo masculino, e 35 pacientes do sexo masculino com tuberculose pulmonar. Estes foram também avaliados após 30 e 60 dias de tratamento antituberculose. Todos os participantes submeteram-se a medições antropométricas e quantificação dos níveis séricos de albumina, proteína C reativa (PCR) e selênio. Como não há valores de referência para a população brasileira, usamos a mediana dos resultados de selênio sérico dos controles como ponto de corte. Aos 30 e 60 dias do tratamento antituberculose, todos os testes bioquímicos foram repetidos, e foram coletadas amostras de escarro para baciloscopia e cultura. Resultados: A média de idade dos pacientes foi de 38,4 ± 11.4 anos. Dos 35 pacientes, 25 (71,0%) referiram alcoolismo, 20 (57,0%) eram fumantes, e 21 (60,0%) e 32 (91,4%) apresentavam depleção muscular pela medição da dobra cutânea tricipital e da área muscular do braço, respectivamente. De 24 pacientes, 12 (39,2%) foram classificados em moderadamente ou gravemente magros, e 15 (62,5%) apresentaram perda de peso > 10% em até seis meses antes do diagnóstico. No início do estudo, o grupo com tuberculose apresentou menores níveis de selênio sérico que os controles. A conversão dos testes bacteriológicos associou-se à relação PCR/albumina e aos níveis de selênio sérico 60 dias após o início do tratamento. Conclusões: Níveis maiores de selênio sérico após 60 ...

Epidemiological profile of hospitalized patients with TB at a referral hospital in the city of Rio de Janeiro, Brazil.

OBJECTIVE: To determine the epidemiological profile of inpatients at a TB referral hospital. METHODS: This was a descriptive, retrospective study of the medical charts of patients with TB hospitalized at the Hospital Estadual Santa Maria (HESM), in the city of Rio de Janeiro, Brazil, between January of 2002 and December of 2003. Data were collected using a standardized form. RESULTS: Of the 451 patients included in the study, 313 (69.4%) had been referred to the HESM from health care clinics, and 302 (67.0%) were male. Most of the patients were in the 30-59 year age bracket, 443 (98.2%) lived in the greater metropolitan region of Rio de Janeiro, and 298 (66.1%) lived in the city of Rio de Janeiro itself. The most common reason for hospitalization was poor health status (in 237, 52.5%). The most common comorbidity was AIDS (in 137, 30.4%). The most common signs and symptoms at admission were weight loss, fever and productive cough. Sputum smear microscopy was positive in 122 (71.0%) of the patients presenting with productive cough at admission. Of the 212 patients being retreated, 156 (73.6%) reported noncompliance with previous treatment. Regarding the outcome, 273 (65.8%) of the patients were referred to municipal health care centers, 83 (18.4%) died, 44 (9.8%) were cured, and 27 (6%) were discharged against medical advice. CONCLUSIONS: Providing hospitals specializing in TB is relevant for TB control, especially in metropolitan regions. In addition to taking biosafety measures, these hospitals must be prepared to treat patients with TB-related comorbidities and social problems. This study has resulted in improvements at the HESM.

Perfil epidemiológico de pacientes portadores de TB internados em um hospital de referência na cidade do Rio de Janeiro / Epidemiological profile of hospitalized patients with TB at a referral hospital in the city of Rio de Janeiro, Brazil

OBJETIVO: Analisar o perfil epidemiológico dos pacientes internados em um hospital especializado no tratamento da TB. MÉTODOS: Foi realizado estudo descritivo e retrospectivo dos prontuários dos pacientes internados com TB no Hospital Estadual Santa Maria (HESM), na cidade do Rio de Janeiro, entre janeiro de 2002 e dezembro de 2003, por meio de formulário previamente padronizado. RESULTADOS: Dos 451 pacientes incluídos, 313 (69,4 por cento) foram referenciados para o HESM por unidades de saúde, e 302 (67,0 por cento) eram do gênero masculino. A maioria dos pacientes tinha entre 30 e 59 anos, 443 (98,2 por cento) residiam na região metropolitana, e 298 (66,1 por cento) residiam no município do Rio de Janeiro. O motivo de internação mais frequente foi mau estado geral (em 237, 52,5 por cento). A AIDS foi a comorbidade mais frequente (em 137, 30,4 por cento). Os sinais e sintomas mais frequentes no momento da internação foram emagrecimento, febre e tosse produtiva. A baciloscopia foi positiva em 122 casos (71,0 por cento) com tosse produtiva no momento da internação. Dos 212 pacientes que estavam em retratamento, 156 (73,6 por cento) referiram abandono a tratamento anterior. Quanto ao desfecho, 297 (65,8 por cento) foram encaminhados para centros municipais de saúde, 83 (18,4 por cento) evoluíram para óbito, e 44 (9,8 por cento) curaram. As altas indesejadas ocorreram em 27 (6,0 por cento) dos casos. CONCLUSÕES: A provisão de hospitais especializados em TB é de relevância para o controle da TB, principalmente em regiões metropolitanas. Esses hospitais precisam estar adequados a medidas de biossegurança, assim como estar mais bem equipados e capacitados para prestar atendimento a pacientes com diversas comorbidades e problemas sociais associados à TB. A realização deste estudo resultou em melhorias para o HESM.

OBJECTIVE: To determine the epidemiological profile of inpatients at a TB referral hospital. METHODS: This was a descriptive, retrospective study of the medical charts of patients with TB hospitalized at the Hospital Estadual Santa Maria (HESM), in the city of Rio de Janeiro, Brazil, between January of 2002 and December of 2003. Data were collected using a standardized form. RESULTS: Of the 451 patients included in the study, 313 (69.4 percent) had been referred to the HESM from health care clinics, and 302 (67.0 percent) were male. Most of the patients were in the 30-59 year age bracket, 443 (98.2 percent) lived in the greater metropolitan region of Rio de Janeiro, and 298 (66.1 percent) lived in the city of Rio de Janeiro itself. The most common reason for hospitalization was poor health status (in 237, 52.5 percent). The most common comorbidity was AIDS (in 137, 30.4 percent). The most common signs and symptoms at admission were weight loss, fever and productive cough. Sputum smear microscopy was positive in 122 (71.0 percent) of the patients presenting with productive cough at admission. Of the 212 patients being retreated, 156 (73.6 percent) reported noncompliance with previous treatment. Regarding the outcome, 273 (65.8 percent) of the patients were referred to municipal health care centers, 83 (18.4 percent) died, 44 (9.8 percent) were cured, and 27 (6 percent) were discharged against medical advice. CONCLUSIONS: Providing hospitals specializing in TB is relevant for TB control, especially in metropolitan regions. In addition to taking biosafety measures, these hospitals must be prepared to treat patients with TB-related comorbidities and social problems. This study has resulted in improvements at the HESM.