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Fortaleza, Brazil

Callado M.R.M.,University of Sao Paulo | Lima J.R.C.,University of Campinas | Nobre C.A.,Hospital Geral de Fortaleza
Revista Brasileira de Reumatologia | Year: 2011

Objective: To identify tuberculosis infection in rheumatic patients on infliximab by use of PPD testing prior to immunobiologic therapy. Methods: This study comprised 157 patients undergoing infliximab treatment and 734 other patients undergoing laboratory screening for tuberculosis infection originating from several services. The Mantoux technique was used for PPD testing, and an induration of at least 5 mm was considered reactive status. Results: In the infliximab group, 13% of the patients reacted to PPD, while, in the other group, 27% of the patients reacted to PPD (χ2 = 13; P = 0.0003). These patients were divided into categories: adults with chronic diseases, PPD reactivity of 22%; and other controls, PPD reactivity of 31%. This shows the heterogeneous response of that population (χ2 = 7; P < 0.009). In the infliximab group, subdivided according to pathologies [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PA)], different reactivity rates were observed, the lowest value occurring among RA patients: (RA x AS: OR = 0.13; CI: 0.03-0.47; χ2 = 12; P = 0.0004) and (RA × PA: OR = 0.16; CI: 0.02-1.04; χ2Yates corrected = 3.6; P = 0.05). The PPD reactivity in the RA subgroup (4%) was also lower as compared with that of the chronic patients group (22%) (OR = 0.16; CI: 0.05-0.49; χ2 = 14; P = 0.0002), even when reclassified into four subgroups: rheumatology (OR = 0.19; CI: 0.04-0.72), kidney transplantation (OR = 0.16; CI: 0.05-0.51), infectology (OR = 0.21; CI: 0.05-0.75), and other conditions (OR = 0.13; CI: 0.04-0.44). Conclusion: The low prevalence of PPD reaction in this Brazilian population, mainly in chronic patients, with the worst performance among RA patients, shwoed that the test has limited value for diagnosis of tuberculosis infection in candidates to infliximab therapy. © Elsevier Editora Ltda. Source


De Carvalho J.J.F.,Hospital Geral de Fortaleza | Alves M.B.,Hospital Israelita Albert Einstein | Viana G.A.A.,State of Ceara | Machado C.B.,State of Ceara | And 5 more authors.
Stroke | Year: 2011

Background and Purpose: Little information exists on the epidemiology and patterns of treatment of patients admitted to Brazilian hospitals with stroke. Our objective was to describe the frequency of risk factors, patterns of management, and outcome of patients admitted with stroke in Fortaleza, the fifth largest city in Brazil. Methods: Data were prospectively collected from consecutive patients admitted to 19 hospitals in Fortaleza with a diagnosis of stroke or transient ischemic attack from June 2009 to October 2010. Results: We evaluated 2407 consecutive patients (mean age, 67.7±14.4 years; 51.8% females). Ischemic stroke was the most frequent subtype (72.9%) followed by intraparenchymal hemorrhage (15.2%), subarachnoid hemorrhage (6.0%), transient ischemic attack (3%), and undetermined stroke (2.9%). The median time from symptoms onset to hospital admission was 12.9 (3.8-32.5) hours. Hypertension was the most common risk factor. Only 1.1% of the patients with ischemic stroke received thrombolysis. The median time from hospital admission to neuroimaging was 3.4 (1.2-26.5) hours. In-hospital mortality was 20.9% and the frequency of modified Rankin Scale score ≤2 at discharge was less than 30%. Older age, prestroke disability, and having a depressed level of consciousness at admission were independent predictors of poor outcome; conversely, male gender was a predictor of good outcome. Conclusions: The prevalence of stroke risk factors and clinical presentation in our cohort were similar to previous series. Treatment with thrombolysis and functional independency after a stroke admission were infrequent. We also found long delays in hospital admission and in evaluation with neuroimaging and high in-hospital mortality. © 2011 American Heart Association, Inc. Source


Tarabichi M.,Center for Ear Endoscopy | Marchioni D.,University of Modena and Reggio Emilia | Presutti L.,University of Modena and Reggio Emilia | Nogueira J.F.,Hospital Geral de Fortaleza | Pothier D.,University of Toronto
Otolaryngologic Clinics of North America | Year: 2013

The authors present a manual of transcanal ear dissection, a completely clinically focused discussion of the goals, steps, and outcomes of endoscopic dissection of the middle ear. From operating station setup through instrumentation and tasks, the reader is presented with detailed technique steps interspersed with observe notes that provide anatomic and technique pearls, such as "by removing the skin of the canal and the epithelial layer of the tympanic membrane (TM), you have largely eliminated the bleeding elements of the external ear and TM" © 2013 Elsevier Inc. Source


Tarabichi M.,Center for Ear Endoscopy | Ayache S.,ORPAC | Nogueira J.F.,Hospital Geral de Fortaleza | Al Qahtani M.,Riyadh Military Hospital | Pothier D.D.,University of Toronto
Otolaryngologic Clinics of North America | Year: 2013

The endoscope allows for better inspection for cholesteatoma in cases with chronic otitis media, better access to selective epitympanic poor ventilation and secondary selective chronic otitis media, better visualization of anterior poor ventilation of the mesotympanum (reestablishing adequate ventilation to the mesotympanum), better visualization and reconstruction of anterior tympanic membrane perforations, allows use of Sheehy's lateral graft tympanoplasty through a transcanal approach, and increases the odds of preoperative detection of ossicular chain disruption associated with perforations. © 2013 Elsevier Inc. Source


Dia A.,University of Illinois at Chicago | Nogueira J.F.,Hospital Geral de Fortaleza | O'Grady K.M.,University of Illinois at Chicago | Redleaf M.,University of Illinois at Chicago
Otology and Neurotology | Year: 2014

Results: Twenty-five endoscopic cochlear implantations were performed in 24 ears on 11 female and 10 male subjects aged 7-65 years. Eight patients were implanted in Brazil, and 13 patients (17 yr) were implanted in the United States. All implants were fully inserted into the scala tympani, and 24 functioned normally with appropriate thresholds. Mean time of follow-up was 16 months (SD, ±7.2). The chorda tympani was sacrificed in 2 of 25 procedures, 12 EAC/TM tears occurred which healed by the second follow-up visit. No injury to the facial nerve was observed. One postoperative wound infection and 1 otitis externa each resolved with 1 week of antibiotics. Implant array was visible through the EACs skin but not exposed in 6 of 24 ears.Conclusion: Endoscopic cochlear implantation may become a viable, safe, and feasible alternative to the standard open transmastoid approach.Objectives: To report patient outcomes after transcanal endoscopic cochlear implantation for sensorineural hearing loss.Patients: Males and female subjects more than 7 years old with sensorineural hearing loss (confirmed with audiologic studies) were selected. CT imaging was used to rule out any anatomic anomalies of the temporal bone. Smaller pediatric patients whose canal might still be growing and who might have a higher incidence of otitis media and otitis externa were excluded. Obese adults whose canal skin was too thick to allow good access down the ear canal were also excluded.Intervention(s): Surgical (therapeutic). Endoscopic cochlear implantation using a transcanal approach.Main Outcome Measure(s): Implant position and function. Postoperative complications specifically related to transcanal approach and use of the endoscope. © 2014, Otology & Neurotology, Inc. Source

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