ABSTRACT Background: Multidrug-resistant tuberculosis (MDR-TB) is a serious global public health concern associated with social vulnerability. In Brazil, the Unified Health System (SUS, Portuguese) provides free diagnosis and treatment for MDR-TB; however, other expenses may still be incurred for patients and their families which, according to the World Health Organization (WHO), can be catastrophic when these costs surpass 20.0% of the annual household income. This study aimed to assess the extent of catastrophic costs related to the diagnostic and therapeutic aspects of MDR-TB among patients receiving care at an outpatient clinic in Rio de Janeiro. Methods: This prospective study used convenience sampling from July 2019 to June 2021. Data regarding direct and indirect costs were collected using a standardized questionnaire endorsed by the WHO. To analyze any impoverishment occurred from MDR-TB, a threshold established by the Brazilian Institute of Geography and Statistics for 2019 and 2020 of US$ 79,562 and US$ 94,5273, respectively, was applied. Descriptive statistics were used for data analysis, including mean; standard deviation; variation coefficient; median; and maximum, minimum, and interquartile ranges. Results: A total of 65 patients were interviewed. Among the participants, 73.8% experienced catastrophic costs, with indirect costs exerting the most significant impact (median: US$ 3,825.9), in contrast to direct costs (median: US$ 542.7). When comparing the periods before and after diagnosis, the prevalence of poverty increased from 12.0% to 28.0%. Conclusions: Despite the support from the SUS in Brazil, diagnostic and therapeutic cascades incur additional costs, exacerbating social vulnerability among patients with MDR-TB.

Abstract INTRODUCTION Chikungunya causes fever and severe and persistent joint pain. METHODS We reported a chikungunya outbreak that occurred in Ceará State, Brazil between 2016 and 2017 with emphasis on epidemiological characterization of cases, high number of deaths, mortality-associated factors, and spatial and temporal spread of the epidemic among municipalities. RESULTS: In November 2015, the first autochthonous cases of chikungunya were confirmed in Ceará, Brazil. In 2016-2017, 195,993 cases were reported, with an incidence of 2,186.5/100,000 inhabitants and 244 confirmed deaths. CONCLUSIONS: Rapid transmission and high mortality rate are serious problems, especially in regions with co-circulating arboviruses.

Resumo: O objetivo deste trabalho foi estabelecer a folha diagnose e os valores do índice de suficiência de nitrogênio (ISN) mais adequados para estimar a necessidade de N pela cultura do feijoeiro (Phaseolus vulgaris) comum 'Pérola', mediante monitoramento com clorofilômetro. A definição da folha diagnose foi feita em experimento com cinco doses de N, e até quatro épocas de amostragem das folhas diagnóstico foram avaliadas (primeira, segunda e terceira folhas completamente expandidas a partir do ápice). O ISN foi estabelecido em duas safras, sob seis manejos de N: M1, 40 kg ha-1 de N na semeadura + 80 kg ha-1 10 dias após a emergência (DAE) + 80 kg ha-1 20 DAE (referência); M2, 20 kg ha-1 na semeadura + 40 kg ha-1 10 DAE + 40 kg ha-1 20 DAE (dose recomendada); M3, 20 kg ha-1 na semeadura + 30 kg ha-1 quando ISN<96%; M4, 20 kg ha-1 na semeadura + 30 kg ha-1 quando ISN<93%; M5, 20 kg ha-1 na semeadura + 30 kg ha-1 quando ISN<90%; e M6, sem aplicação de N. As leituras do índice relativo de clorofila na segunda folha completamente expandida, aos 21 DAE, e na terceira folha, aos 28 e 35 DAE, são mais precisas para estimar a demanda de N pelo feijoeiro comum. O ISN de 90% é mais eficiente que os de 93 ou 96%, na definição do momento de aplicação do N em cobertura.

Abstract: The objective of this work was to establish the diagnostic leaf and the nitrogen sufficiency index (NSI) values most appropriate to estimate N requirement by the 'Pérola' common bean (Phaseolus vulgaris), based on chlorophyll meter monitoring. The diagnostic leaf was defined in an experiment with five N rates, and up to four sampling dates of the diagnostic leaves were evaluated (first, second, and third completely expanded leaves from the apex). The NSI was established in two crop seasons, under six N managements: M1, 40 kg ha-1 N at sowing + 80 kg ha-1 10 days after emergence (DAE) + 80 kg ha-1 20 DAE (reference rate); M2, 20 kg ha-1 at sowing + 40 kg ha-1 10 DAE + 40 kg ha-1 20 DAE (recommended rate); M3, 20 kg ha-1 at sowing + 30 kg ha-1 when NSI<96%; M4, 20 kg ha-1 at sowing + 30 kg ha-1 when NSI<93%; M5, 20 kg ha-1 N at sowing + 30 kg ha-1 when NSI<90%; and M6, without N application. The relative chlorophyll index readings on the second fully expanded leaf, at 21 DAE, and on the third leaf, at 28 and 35 DAE, are more precise to estimate the requirement of N by common bean. The NSI of 90% is more effective than the NSI of 93 or 96% for defining the moment for N topdressing application.

RESUMO A necessidade do conhecimento da diversidade genética da cultura do pinhão manso é importante para conservação dos recursos genéticos e melhoramento genético dessa espécie. O objetivo desse trabalho foi avaliar a divergência genética e o desempenho e de clones de pinhão manso, através de caracteres morfoagronômicos, visando a seleção de variedades clonais produtivas para a produção de biocombustíveis. Os clones foram obtidos, através de estaquia, a partir da seleção em uma população de progênies meio -irmãos. A caracterização morfoagronômica dos clones foi realizada aos 180 dias após o transplante e foram avaliados a estatura da planta, diâmetro do caule, número de ramificações primárias e ramificações secundárias, número de cachos e número de frutos por planta. Quanto ao desempenho, resultados significativos foram encontrados para o número de ramos secundários. Quanto às análises de divergência genética as medidas de dissimilaridade genética apresentaram uma variação de 0,62 a 13,11, assim, os clones UFRBPR14 e UFRBPR15 foram mais divergentes. Pelo método de Tocher verificou-se a formação de quatro grupos. Os caracteres que mais contribuíram para a divergência entre os clones foram número de ramos secundários, estatura e número de cachos, a que menos contribuiu foi o diâmetro do caule. Os clones de pinhão manso diferiram apenas quanto ao número de ramos secundários, a análise multivariada detectou divergência entre os clones de pinhão manso com formação de quatro grupos. Além disso, caracteres que mais contribuíram para a divergência genética foram número de ramos secundários, estatura da planta e número de cachos.

ABSTRACT The knowledge about genetic diversity of jatropha crop is important for genetic conservation resources and breeding of this species. The aim of this study was to evaluate the genetic diversity and performance of jatropha clones through morphological characterization to selection of clonal varieties for biofuels production. The clones were obtained through shoot cuttings from previous selection in a population of half-sibs progenies. The morphoagronomic analyses of clones was carried out at 180 days after transplantation and were evaluated plant height, stem diameter, number of primary branches and number of secondary branches, number of bunches and number of fruits per plant. Evaluating clones performance, significant results were found for the number of secondary branches. About analysis of genetic diversity, the measures of dissimilarity genetic varied from 0.62 to 13.11, this way, the UFRBPR14 and UFRBPR15 clones were more divergent. The Tocher method was efficient to verify formation of four groups. The characteristics that most contributed to the divergence among clones were branches number, height and number of bunches, and, stem diameter had lower contribution. The jatropha clones differed only in the secondary branches number and multivariate analysis showed divergence among the jatropha clones with formation of four groups. Also, branches number, plant height and number of bunches were characteristic that contributed to genetic divergence.

Objetivou-se avaliar a parte aérea da mandioca ensilada in natura, sem e com adição de 10% de farinha de varredura, farelo de jaca ou bagaço de laranja, na alimentação de ovinos confinados. Avaliou-se o desempenho produtivo e parâmetro sanguíneo, de 28 cordeiros não castrados, mestiços da raça Santa Inês, pesando inicialmente em média 22,0kg. Foram 14 dias de adaptação dos animais às dietas e às instalações e 56 de coleta de dados. Os consumos (g/animal/dia) de matéria seca, matéria orgânica, proteína bruta, extrato etéreo, fibra insolúvel em detergente neutro (FDN), carboidratos não fibrosos e FDN corrigido para cinzas e proteína, não diferiram e apresentaram as seguintes médias: 1466,7; 1448,5; 253,4; 69,8; 498,7; 662,0 e 410,8 respectivamente. A concentração média (24,8mg/dL) de nitrogênio ureico plasmático, não diferiu, mas, o efeito de tempo após alimentação apresentou comportamento quadrático, com pico de concentração, aproximadamente, às 3 horas. O ganho de peso médio (207,5g/dia), a média de peso final (30,1kg PC), o ganho de peso médio total (11,6kg) e a conversão alimentar (7,3kg MS/kg peso ganho) não foram influenciados pelas dietas. Conclui-se que as silagens de parte aérea da mandioca com ou sem os aditivos alternativos podem ser utilizadas na alimentação de ovinos.

The objective was to evaluate the aerial part of cassava foliage in natura ensiled, without and with addition of 10% cassava meal, bran or jackfruit orange bagasse, in confined sheep feeding. It was evaluated the growth performance and sanguineous parameters of 28 cuts of Santa Ines lambs, non castrated, matzos Santa Inês breed, initially weighing on average 22kg. There were 14 days of adaptation the diets of the animals and installations and 56 of data collection. The intakes (g/ animal/ day) of dry matter, organic matter, crude protein, ether extract, neutral detergent insoluble fiber (NDF), non-fiber carbohydrates and NDF adjusted for ash and protein did not differ and have submitted the following averages: 1466.7, 1448.5, 253.4, 69.8, 498.7, 662.0 and 410.8, respectively. The mean concentration (24.8mg/dL) of plasma urea nitrogen did not differ, but the effect of time after feeding presented a quadratic response, with peak concentration approximately at 3 hours. The mean weight gain (207.5g/day), the average the final weight (30.1kg BW), the total mean weight gain (11.6kg) and feed conversion (7.3kg DM/kg weight gain) have not been affected by diets. It is concluded that, silages aerial part of cassava with or without alternatives additives can be used for sheep feeding.

Background: Induction therapy followed by high-dose chemotherapy and autologous transplantation is the standard treatment for suitable patients with multiple myeloma. Objective: The aim of this study was to assess whether induction therapy with thalidomidecontaining regimens was associated with improved results compared to vincristine, doxorubicin, and dexamethasone, and whether cyclophosphamide, thalidomide, and dexamethasone were associated with better results than thalidomide and dexamethasone. Methods: The records of 152 patients who underwent autologous transplantation at this institution from August of 2004 to January of 2012 were reviewed, selecting those with at least partial response to a maximum of eight cycles of induction therapy and sufficient follow-up information for analysis. Results: This study included 89 patients; 44 were female, with a mean age of 55 years (there was a significant trend for increasing age over the years of the study).The median number of induction therapy cycles was four, again with a trend of increase over the years.At least a very good partial response to induction therapy was achieved more often in the cyclophosphamide, thalidomide, and dexamethasone group (61.1%) and in the thalidomide and dexamethasone group (59.2%) than in the vincristine, doxorubicin, and dexamethasone group (16.2%). The overall median progression-free survival was 34 months, with no statistically significant difference between the three groups. The overall median survival was not reached, and there was no significant difference between the three groups; the estimated five-year overall survival was 55%. Conclusion: Although the quality of responses appeared to be better with thalidomidecontaining regimens, these improvements did not translate into improved long-term outcomes. Given its track record, cyclophosphamide, thalidomide, and dexamethasone is currently considered the preferred regimen for first-line induction therapy in the Brazilian public health system.

The aim of this study was to use cone-beam computed tomography (CBCT) images to evaluate the prevalence and configurations of C-shaped canals in permanent mandibular second molars among members of a Brazilian subpopulation. CBCT exams of 214 patients (406 teeth) were evaluated for: presence of C-shaped root canals, number of canals and direction of the root grooves (buccal or lingual). Of the 214 CBCT images examined, 192 showed intact bilateral molars, which were used to analyze the distribution of unilateral and bilateral occurrences of C-shaped canals. The prevalence of these canals was correlated with gender and age, and the number of canals was correlated with the direction of the root grooves using the chi-squared test (α = 0.05). The prevalence of C-shaped canals was 15.3%. This prevalence did not differ with gender or age. Most of the C-shaped molars had three (43.5%) or two (37.1%) canals; 69.4% of the C-shaped canals were grooved in the buccal direction; 68.3% of the C-shaped cases were unilateral. In conclusion, there was a significant prevalence of C-shaped canals in the mandibular second molars of the population studied; the C-shaped canal system varied in configuration, with a higher prevalence of three and two canals and unilateral occurrence; CBCT is a useful tool for endodontic diagnosis and treatment.

Estudou-se o efeito do tratamento de sementes de algodão com cloreto de mepiquat sobre o crescimento inicial de raízes e parte aérea. O experimento, realizado em casa de vegetação, utilizou vasos de PVC adaptados com uma parede frontal de vidro e os tratamentos foram constituídos por cinco doses do cloreto de mepiquat (CM) do ingrediente ativo (i.a.): 0, 3, 6, 9 e 12 g kg-1 de sementes, pulverizado sobre as sementes, e a cultivar FM 993. Massa de matéria seca da parte aérea (folhas, pecíolos e haste), massa de matéria seca da raiz, área foliar, relação parte aérea:raiz, relação área foliar:crescimento radicular, o comprimento da parte aérea foram avaliados aos 21 dias após a semeadura. Crescimento radicular foi avaliado a cada três dias até os 18 dias. O CM aplicado às sementes do algodão promove redução da altura da planta e da área foliar, sem, contudo, afetar produção de massa de matéria seca da parte aérea e raiz, relação parte aérea:raiz, relação área foliar:crescimento radicular e comprimento total de raízes do algodoeiro. Assim, no presente experimento não foi observado efeito negativo do CM aplicado às sementes do algodoeiro na absorção de água pela planta.

The effects of mepiquat chloride (MC) application to cotton seeds on the initial growth of the plant roots and shoots were studied in a greenhouse experiment. Glass-front containers with 27 L of soil were used in the experiment. Cotton seeds of the cultivar FM 993 were sprayed with MC at five different doses of active ingredient (a.i.): 0, 3, 6, 9 and 12 g kg-1 seed. The shoot and root dry matter, leaf area, shoot:root ratio, leaf area: root growth ratio, and shoot length were evaluated 21 days after sowing. The root growth was evaluated every three days up to 18 days. The application of MC to cotton seeds decreased the shoot length but had no significant effect on the dry matter production, root length, shoot:root ratio or leaf area: root length ratio. Thus, the application of MC to cotton seeds is not expected to have a deleterious effect on plant water acquisition.

Objetivou-se avaliar o efeito do estimulante vegetal Stimulate®, via pulverização foliar, sobre o crescimento e produção de fumo (Nicotiana tabacum L.). Foram utilizados fumo Brasil-Bahia e Stimulate®, nas doses 0,0 mL L-1; 1,0 mL L-1; 3,0 mL L-1; 5,0 mL L-1; e 11,0 mL L-1. A partir de 15 dias após a semeadura (DAS), foram aplicadas um total de seis pulverizações, uma vez por dia, a cada cinco dias. No viveiro convencional, após 43 DAS, avaliou-se o número de folhas; comprimentos da haste e raiz; massa de matéria seca de hastes, folhas e raízes; e área foliar. No campo, as plantas permaneceram por 64 dias (107 DAS) e avaliou-se o número de folhas; número de folhas viáveis; altura da planta; massa de matéria seca de folhas e hastes; e área foliar. No viveiro convencional, o Stimulate® diminuiu a massa de matéria seca da haste, raiz e folha e a área foliar do fumo, porém, foi eficiente no aumento do número de folhas e comprimento da haste, para o fumo Brasil-Bahia. No campo, o Stimulate® não foi eficiente no aumento da produção de folhas, porém, incrementou a altura e a massa de matéria seca do caule.

The purpose of the study was to evaluate the effect of the Stimulate® plant stimulant, applied to leaves by spraying, on tobacco (Nicotiana tabacum L.) growth and production. The Brasil-Bahia tobacco and Stimulate®, at the doses of 0.0 mL L-1 (control - water); 1.0 mL L-1; 3.0 mL L-1; 5.0 mL L-1; and 11.0 mL L-1, in watery solution, were used. On the fifteenth day after sowing (DAS), the treatments were applied. A total of six sprayings were made, once a day, each five days. After forty-three DAS, the number of leaves; stem and root length; stem, roots, and leaves dry matter; and leaf area were evaluated, under nursery conditions. In the field, the plants remained for 64 days (107 DAS) and the number of leaves; number of viable leaves; plant height; stem and leaves dry matter; and leaf area were evaluated. Stimulate®, under nursery conditions, decreased stem, root and leaf dry matter and leaf area for tobacco. Stimulate® was also efficient to increase the number of leaves and stem length, under nursery conditions, for the Brasil-Bahia tobacco. Under field conditions, Stimulate®, applied during the vegetative stage, was not efficient to increase leaf production, however, it increased stem height and dry matter.

Postoperative pain management in children is a complex, multidimensional and subjective phenomenon. It represents a challenge for children, parents and health professionals. This study aimed to understand how mothers assess their children's pain management by the nursing team in the late postoperative phase of cardiac surgery. Empirical data collection was carried out through semistructured interviews with 17 mothers who accompanied their children. Data were subject to qualitative analysis, revealing that, for the mothers, taking good care results from the confidence they vest in the nursing team and from the observation of the medication interventions this team performs. Not taking good care of their children is a consequence of lack of information or inadequate communication between the team and the mothers. The results of this study permit identifying aspects that strengthen and weaken nursing care for these clients, contributing to the improvement of the delivered care.

El manejo del dolor posoperatorio en el niño es un fenómeno complejo, multidimensional y subjetivo; siendo que se constituye en un desafío para los niños, padres y profesionales de la salud. El objetivo de este trabajo fue comprender como las madres evalúan el manejo del dolor de sus hijos, realizado por el equipo de enfermería, en el posoperatorio tardío de cirugía cardíaca. La recolección de datos empíricos fue realizada por medio de entrevista semiestructurada con 17 madres que acompañaron a sus hijos. Los datos fueron analizados cualitativamente. Aprendimos que para las madres cuidar bien es resultante de la confianza que ellas depositan en el equipo de enfermería y de la observación de las intervenciones medicamentosas que ese equipo realiza. El no cuidar bien de sus hijos es consecuencia de la falta de información o comunicación inadecuada entre el equipo y las madres. Los resultados de este estudio posibilitaron identificar aspectos que pueden fortalecer o fragilizar el cuidado de enfermería a esa clientela, de esa manera contribuyendo para la mejoría del cuidado prestado.

O manejo da dor pós-operatória na criança é fenômeno complexo, multidimensional e subjetivo. Constitui-se em desafio, para as crianças, pais e profissionais de saúde. O objetivo deste trabalho foi compreender como as mães avaliam o manejo da dor de seus filhos, implementado pela equipe de enfermagem, no pós-operatório tardio de cirurgia cardíaca. A coleta de dados empíricos foi realizada por meio de entrevista semiestruturada com 17 mães que acompanharam seus filhos. Procedeu-se à análise qualitativa dos dados e se apreendeu que, para as mães, cuidar bem é resultante da confiança que elas depositam na equipe de enfermagem e da observação das intervenções medicamentosas que essa equipe realiza. Não cuidar bem de seus filhos é consequência da falta de informação, ou comunicação inadequada entre equipe e mães. Os resultados deste estudo possibilitam identificar aspectos que fortalecem e fragilizam o cuidado de enfermagem a essa clientela, contribuindo para a melhoria do cuidado prestado.

O manejo da dor pós-operatória na criança é fenômeno complexo, multidimensional e subjetivo. Constitui-se em desafio, para as crianças, pais e profissionais de saúde. O objetivo deste trabalho foi compreender como as mães avaliam o manejo da dor de seus filhos, implementado pela equipe de enfermagem, no pós-operatório tardio de cirurgia cardíaca. A coleta de dados empíricos foi realizada por meio de entrevista semiestruturada com 17 mães que acompanharam seus filhos. Procedeu-se à análise qualitativa dos dados e se apreendeu que, para as mães, cuidar bem é resultante da confiança que elas depositam na equipe de enfermagem e da observação das intervenções medicamentosas que essa equipe realiza. Não cuidar bem de seus filhos é consequência da falta de informação, ou comunicação inadequada entre equipe e mães. Os resultados deste estudo possibilitam identificar aspectos que fortalecem e fragilizam o cuidado de enfermagem a essa clientela, contribuindo para a melhoria do cuidado prestado.

Postoperative pain management in children is a complex, multidimensional and subjective phenomenon. It represents a challenge for children, parents and health professionals. This study aimed to understand how mothers assess their children's pain management by the nursing team in the late postoperative phase of cardiac surgery. Empirical data collection was carried out through semistructured interviews with 17 mothers who accompanied their children. Data were subject to qualitative analysis, revealing that, for the mothers, taking good care results from the confidence they vest in the nursing team and from the observation of the medication interventions this team performs. Not taking good care of their children is a consequence of lack of information or inadequate communication between the team and the mothers. The results of this study permit identifying aspects that strengthen and weaken nursing care for these clients, contributing to the improvement of the delivered care.

El manejo del dolor posoperatorio en el niño es un fenómeno complejo, multidimensional y subjetivo; siendo que se constituye en un desafío para los niños, padres y profesionales de la salud. El objetivo de este trabajo fue comprender como las madres evalúan el manejo del dolor de sus hijos, realizado por el equipo de enfermería, en el posoperatorio tardío de cirugía cardíaca. La recolección de datos empíricos fue realizada por medio de entrevista semiestructurada con 17 madres que acompañaron a sus hijos. Los datos fueron analizados cualitativamente. Aprendimos que para las madres cuidar bien es resultante de la confianza que ellas depositan en el equipo de enfermería y de la observación de las intervenciones medicamentosas que ese equipo realiza. El no cuidar bien de sus hijos es consecuencia de la falta de información o comunicación inadecuada entre el equipo y las madres. Los resultados de este estudio posibilitaron identificar aspectos que pueden fortalecer o fragilizar el cuidado de enfermería a esa clientela, de esa manera contribuyendo para la mejoría del cuidado prestado.

A presença de sódio (Na) e de cloro (Cl) no substrato tem ocasionado redução no crescimento dos vegetais, em virtude desses íons causarem, entre outros efeitos negativos, mudanças na capacidade das plantas em absorver, transportar e utilizar alguns dos nutrientes. Assim, o objetivo do presente trabalho foi o de avaliar a influência da salinidade sobre o crescimento e a absorção e distribuição do Na e Cl e dos macronutrientes em plântulas de Maracujazeiro-amarelo, durante 50 dias de crescimento sob condições salinas, em vasos com capacidade para 2,2 dm³. Foram utilizados três níveis de NaCl (0, 50 e 100 m mol L-1). Observou-se que a altura, o número de folhas, a área foliar e a massa seca de todas as partes da planta foram significativamente reduzidas pela salinidade. A concentração dos íons Na e Cl aumentaram com o acréscimo da salinidade no meio de cultivo, porém, foram parcialmente retidos na raiz, no caso do Cl, e nas folhas mais velhas, no caso do Na. As concentrações de nitrogênio (N), fósforo (P) e cálcio (Ca) não foram afetadas pela salinidade. As concentrações de potássio (K), ao contrário, decresceram em todas as partes da planta, enquanto as do enxofre (S) foi reduzida apenas nas raízes. Dada a pequena redução nas características de crescimento conclui-se que o Maracujazeiro-amarelo é uma espécie moderadamente tolerante ao estresse salino.

The presence of sodium (Na) and chloride (Cl) in growth medium have leaded to crop growth due to because of negative effects of these ions such as changes in plant capacity of uptake, transport and use of essential nutrients. The objective of this work was to evaluate the influence of salinity on growth, uptake and transport of Na, Cl and macronutrients in yellow passion fruit plants. Three levels of NaCl (0, 50 and 100 m mol L-1) were tested. Experiment was finished after 50 days of growing in 2.2 dm³ pots. It was noticed that height, leaf number, leaf area and dry mass of all parts of the plant were reduced by salinity. The concentration of Na and Cl ions increased with the increasing of salinity. However, ions were retained partially in roots (Cl) and in older leaves (Na). Concentration of nitrogen (N), phosphorous (P) and calcium (Ca) were not affected by salinity. Actually, concentration of potassium (K) was reduced in all parts of the plant while sulfur (S) was reduced only in roots. Based upon the short reduction on growth characteristics, it was concluded thatyellow passion fruit crop has a moderated tolerance to saline stress.

Com a melhora do prognóstico nos pacientes com dermatomiosite juvenil (DMJ), as crianças tornam-se adolescentes com possibilidade de início da vida sexual e risco de engravidar. No período entre 1983 e 2004, 4.638 pacientes foram seguidos em nosso serviço, entre os quais 117 (86/74% do sexo feminino) apresentaram o diagnóstico de DMJ. Entre as pacientes com DMJ, três engravidaram durante o acompanhamento. A idade da primeira atividade sexual variou entre 15 (caso 1) e 14 anos (casos 2 e 3). As gestações, todas não planejadas, ocorreram aos 16 anos e 3 meses (caso 1), 15 anos e 4 meses (caso 2) e 14 anos e 7 meses (caso 3). A paciente 1 apresentava-se em atividade cutânea da DMJ no início da gravidez, mas evoluiu com completa remissão no 6º mês da gestação; foram mantidos gamaglobulina endovenosa (2g/kg/mês) nos primeiros 5 meses e prednisona (5mg/dia) durante toda a gestação; o pré-natal foi sem intercorrências; o parto foi fórcipe; o recém-nascido (RN) nasceu sem intercorrências. As pacientes 2 e 3 estavam em remissão no início da gravidez e também não apresentaram intercorrências no período pré-natal. O parto da paciente 2 foi vaginal e o RN nasceu bem, de termo e adequado para idade gestacional. No caso 3, o parto foi cesariano por redução do líquido amniótico e o RN nasceu prematuro (36 semanas), mas bem e adequado para a idade gestacional. Em nenhuma das pacientes observou-se reativação da DMJ no período pós-natal. A atividade sexual precoce e o aumento da gravidez em adolescentes com DMJ são assuntos que devem ser considerados na rotina do atendimento desses pacientes.

The prognosis of patients with juvenile dermatomyositis (JDM) has improved, allowing adolescents and young adults to have an increased chance of sexual activities and pregnancy. From 1983 to 2004, 4,638 patients were followed at the Pediatric Rheumatology Unit of the Pediatric Department of FMUSP, of which 117 (86/74% female) were diagnosed with JDM and 3 of them became pregnant during the follow-up. The first sexual intercourse occurred at 15 years old (case 1) and at 14 years old (cases 2 e 3). The pregnancies, all of them not planned, occurred at 16 years old and 3 months (case 1), 15 years old and 4 months (case 2) and 14 years old and 7 months (case 3). The disease of patient 1 was active when she became pregnant, but she was at remission by the end of the second trimester of gestation, she was given 2 g/kg/month of intravenous immunoglobulin (during the first 5 months) and prednisone (during all the period); she had a full-term pregnancy with a normal birth. Patients 2 and 3 were on disease remission when they became pregnant and their gestations developed with no complications. Patient 2 had a full-term delivery; her newborn was adequate for gestational age and had no complications. Patient 3 had a Cesarean delivery due to low amniotic fluid; her newborn was premature (36 weeks) but adequate for gestational age and with no problems during neonatal period. None of the patients presented disease flare-up after delivery. Precocious sexual activity and pregnancy increase in adolescents with JDM should be considered in the routine clinical follow-up of these patients.

Introduction: In developing countries, there is little information about the risk factors that predict noncompliance with tuberculosis (TB) treatment in hospitals. Objective: This study analyzes possible factors associated with noncompliance with TB treatment among patients treated at HAA. Design: A retrospective cohort study was made including all patients who initiated TB treatment at HAA, from January to December 1998. A standard form was used to review medical records and to collect data on each patient. This data was evaluated in comparison with data from the state TB control program. Results: Of the 341 patients included in the study, 186 (61.2%) were considered cured and 67 (22%) were non-compliant. The factors associated with noncompliance were: previous anti-TB treatment (RR = 1.95, 95% CI 1.29 to 2.93), prescription of drugs other than the standard first-line regimen proposed by the Brazilian Health Ministry (Rifampin + Isoniazide + Pyrazinamide) (RR = 0.54, 95% CI 0.35 to 0.83), the need for hospitalization (RR = 2.19, 95% CI 1.46 to 3.29) and non-inclusion in the hospital's TB Control Program for treatment follow up (RR = 0.54, 95% CI 0.35 to 0.82). Setting: Anuar Auad Hospital (HAA) - Goiânia, Goiás, Brazil. Conclusion: Our results indicate the importance of establishing Tuberculosis Control Programs in hospitals, while paying special attention to patients with risk factors for noncompliance with TB treatment.