Treatment of latent tuberculosis infection with short-course regimens in potential living kidney donors.

BACKGROUND: Treatment data for latent tuberculosis infection (LTBI) among potential living kidney donors are scarce. METHODS: This retrospective study was performed to evaluate the prevalence of positive QuantiFERON-TB Gold In-Tube (QFT-GIT) among potential living kidney donors that were screened from 2009 to 2017. We investigated if there was any difference in the time to donation between QFT-GIT-positive and QFT-GIT-negative donors. We assessed the regimens used to treat LTBI and whether the recipients of QFT-GIT-positive donors developed active tuberculosis (TB). RESULTS: Forty out of 427 (9%) potential living kidney donors had a positive QFT-GIT. QFT-GIT-positive donors were as likely as negative donors to undergo donation (30 [75%] vs 315 [81%], P = .33). The time from QFT-GIT testing to donation was longer among QFT-GIT-positive donors (median 221 days [range: 4-1139] vs 86 days [range: 3-1887], P = .001). Twelve-week rifapentine (RPT)/Isoniazid (INH) was the most common treatment used and was not associated with significant adverse reactions. There was a trend toward longer time to donation among QFT-GIT-positive donors who were treated for LTBI compared with QFT-GIT-positive donors who were not (252 days [range: 88-1139] vs 95 days [range: 4-802], P = .05). Twenty-nine recipients of QFT-GIT-positive living kidney donors were evaluated. Eleven of these recipients received kidneys from donors that were not treated for LTBI. Two of these recipients were treated with INH post-transplantation. CONCLUSIONS: The time from QFT-GIT testing to donation was longer among QFT-GIT-positive donors. The short-course regimens appear to be excellent options for LTBI treatment among living kidney donors and avoid delaying organ donation further.

Twelve-Week Rifapentine Plus Isoniazid Versus 9-Month Isoniazid for the Treatment of Latent Tuberculosis in Renal Transplant Candidates.

BACKGROUND: Renal transplant candidates (RTC) with latent tuberculosis infection (LTBI) are at significant risk for tuberculosis reactivation. Twelve-week rifapentine (RPT)/isoniazid (INH) is effective for LTBI but clinical experience in RTC is scarce. METHODS: We conducted a retrospective study of RTC with LTBI treated with either 12-week RPT/INH or 9-month INH from March 1, 2012, through February 28, 2014. We evaluated both groups for differences in rates of treatment completion, monthly follow-up visit compliance, transaminase elevations, and adverse reactions leading to discontinuation of LTBI treatment. The utility of weekly reminders was also evaluated in the 12-week regimen. Direct observed therapy was not performed in our study. RESULTS: Of 153 patients, 43 (28%) and 110 (72%) were started on 12-week RPT/INH and 9-month INH, respectively. The treatment completion and monthly follow-up visit compliance rates were higher in the 12-week RPT/INH group (40 [93%] vs 52 [47%], P < 0.001) and (11/40 [28%] vs 13/104 [13%], P = 0.03), respectively. Transaminase elevations were not observed in the RPT/INH group, but occurred in 6 (5%) of the INH group. There were no differences in adverse reactions leading to discontinuation of LTBI treatment. CONCLUSIONS: Twelve-week RPT/INH appears to be an excellent choice for LTBI in RTC. It has a higher treatment completion rate and causes less transaminase elevations, and weekly reminders may be an alternative when direct observed therapy is not feasible.

Saúde Mental de Ingressantes no Curso Médico: uma Abordagem segundo o Sexo / Mental Health of First-Year Academics in the Medical School: a Gender Approach

RESUMO O curso de Medicina possui elevada carga horária e habitualmente demanda grande envolvimento dos estudantes. Em consequência, acadêmicos de Medicina podem apresentar alta prevalência de estresse, Síndrome de Burnout e sintomas depressivos, que podem comprometer a qualidade de sua vida. Tais aspectos demonstram a necessidade de estudos mais profundos deste grupo populacional, especialmente em um novo contexto de acesso ao ensino superior. O presente estudo teve por objetivo avaliar globalmente a saúde mental dos acadêmicos ingressantes no curso médico, com ênfase em qualidade de vida, Transtornos Mentais Comuns, sintomas depressivos, nível de sonolência diurna e Burnout, segundo o sexo. Trata-se de estudo transversal, realizado com acadêmicos do primeiro período de graduação em Medicina, oriundos de três instituições do Norte de Minas. Foram aplicados questionários de avaliação de sonolência diurna, sintomas depressivos, Transtornos Mentais Comuns, Burnout e qualidade de vida, além de um questionário com informações sociodemográficas. Os acadêmicos foram abordados na própria faculdade onde estudam, no início ou no término da aula. Na análise dos dados utilizou-se o Teste Qui-Quadrado e o t de Student para amostras independentes, na comparação entre os sexos. Foram avaliados dados de 101 estudantes ingressantes. O estresse esteve presente em 45,5% dos estudantes. A prevalência de sintomas depressivos em grau variado também foi significativa, afetando 43,6% dos estudantes. Houve diferença estatisticamente significante no componente mental da qualidade de vida e na presença de Transtornos Mentais Comuns entre homens e mulheres. Uma parcela bastante significativa apresentou níveis patológicos de sonolência diurna, sintomas de Transtornos Mentais Comuns, sintomas depressivos de graus variados, exaustão emocional e despersonalização. Mais de um terço dos acadêmicos considera sua qualidade de vida ruim, tanto no domínio físico, quanto no mental. A qualidade do curso e da assistência à saúde requer um profissional humanizado e que busque boas condições de saúde. Por isso, é essencial que as universidades discutam estratégias que visem à promoção de saúde e à prevenção de sintomas que comprometem a saúde mental dos acadêmicos.

ABSTRACT The medical school has a high academic load and usually demands a great student involvement. As a result, medical students may experience high prevalence of stress, Burnout syndrome and even depressive symptoms. Such factors can compromise the students' quality of life. All of these aspects emphasize the need of deeper studies of this population group, especially in a new context of access to higher education. The objective of this study was to evaluate the overall medical students' mental health entering the medical school, with emphasis on quality of life, Common Mental Disorders, depressive symptoms, daytime sleepiness level and Burnout, according to the gender. This is a cross-sectional study, performed with first-year undergraduate medical students from three institutions from the north of Minas Gerais. Questionnaires were applied to evaluate daytime sleepiness, depressive symptoms, Common Mental Disorders, Burnout and quality of life, as well as a questionnaire with sociodemographic information. Academics were approached at the college where they study, at the beginning or at the end of the class. Data were analyzed using the chi-square test, and Student's t-test for independent samples, in the comparison between genders. Data from 101 incoming students were evaluated. Stress was present in 45.5% of the students. The prevalence of depressive symptoms of varying degrees was also significant, affecting 43.6% of the students. There was a statistically significant difference in the mental component of quality of life and in the presence of Common Mental Disorders between men and women. It was possible to observe that a significant portion had pathological levels of daytime sleepiness, symptoms of Common Mental Disorders, depressive symptoms of varying degrees, emotional exhaustion and depersonalization. More than a third of the academics consider their quality of life bad when it comes to the physical and mental domain. The quality of the course and health care requires a humanized professional who seek good health, that's why it is essential that universities discuss strategies that promote health and the prevention of symptoms that compromise the mental health of academics.

Violencia doméstica de la pareja y su relación con la preeclampsia en gestantes atendidas en el Hospital San Juan de Lurigancho. Enero-julio, 2015 / Domestic violence of the partner and its relationship with preeclampsia in pregnant women at the Hospital San Juan de Lurigancho. January-July, 2015

Objetivo: Determinar la relación entre la violencia doméstica de la pareja y la preeclampsia en gestantes atendidas en el Hospital San Juan de Lurigancho enero - julio, 2015. Material y métodos: Estudio retrospectivo, analítico de casos y controles en 80 gestantes (40 gestantes con preeclampsia y 40 gestantes normotensas) atendidas en el Hospital San Juan de Lurigancho durante el periodo enero - julio, 2015. Con la finalidad de evaluar la presencia o ausencia de violencia doméstica de la pareja durante el embarazo. Los datos se recopilaron a través de la revisión de historias clínicas y un cuestionario válido para la violencia intrafamiliar durante el embarazo. En el análisis se aplicó estadísticas descriptivas, distribución de frecuencias y proporciones en las variables cualitativas. Para las variables cuantitativas se aplicó medidas de tendencia central, promedios y desviaciones estándar. Para las inferencias estadísticas se aplicó la prueba de Chi-Cuadrado en las variables cualitativas. Para la determinación de las relaciones se aplicó la razón de productos cruzados (OR) con sus intervalos de confianza al 95 por ciento, regresión logística binaria, regresión de Cox y Snell y se aplicó la prueba de Hosmer y Lemeshow para la validación del modelo, considerándose adecuado cuando el p>0.05. Resultados: El promedio de edad de las gestantes preeclámpticas (casos) fue 27.83 y 27.35 para las gestantes normotensas (controles). En ambos grupos, la educación secundaria completa fue mayoritaria, 72.5 por ciento en los casos y 57.5 por ciento en los controles. El 85 por ciento de los casos manifestaron ser amas de casa al igual que los controles, 72.5 por ciento. El 62.5 por ciento de los casos tienen una procedencia de nacimiento de la costa y el 40 por ciento de los controles procede de la sierra. En ambos grupos el estado civil conviviente fue mayoritario, 72.5 por ciento en los casos y el 80 por ciento en los controles. Asimismo el tiempo de cohabitación sexual...

Objective: To determine the relationship between domestic partner violence and preeclampsia in pregnant women treated at the Hospital San Juan de Lurigancho January to July 2015. Materials and methods: Retrospective, analytical case-control study of 80 pregnant women (40 pregnant women with preeclampsia and 40 normotensive pregnant) at the Hospital San Juan de Lurigancho for the period January-July 2015. In order to assess the presence or absence of domestic partner violence during pregnancy. Data were collected through review of medical records and valid for domestic violence during pregnancy questionnaire. In the analysis descriptive statistics, frequency distributions and proportions for qualitative variables applies. F or quantitative variables measures of central tendency, means and standard deviations was applied. For the statistical inferences Chi-Square test is applied in the qualitative variables. To determine the relationship was applied the odds ratio (OR) with confidence intervals of 95 per cent, binary logistic regression, Cox and Snell products and the Hosmer-Lemeshow test was used to validate the model, considering suitable when the p>0.05. Results: The mean age of preeclamptic pregnant women (cases) was 27.83 and 27.35 for normotensive pregnant women (controls). In both groups, the majority was completed secondary education, 72.5 per cent in cases and 57.5 per cent in controls. 85 per cent of cases being housewives expressed as the controls, 72.5 per cent. The 62.5 per cent of cases have a source of birth of the coast and 40 per cent of controls comes from the mountains. In both groups the majority law marriage was 72.5 per cent in cases and 80 per cent in controls. Also the time of sexual cohabitation with the couple represented 57.5 per cent and 92.5 per cent for cases and controls, respectively. The chance of having preeclampsia when physical violence (OR: 2.1; 95 per cent Cl 0.706-6.253) presented is more than twice and almost three times....