Resumo: Introdução: A pandemia de Covid-19 impactou negativamente a saúde mental de médicos e estudantes de Medicina. Muito tem sido discutido sobre as lições aprendidas, no que se refere a aspectos clínicos, de diagnóstico, tratamento e prevenção. Entretanto, os médicos são treinados para o cuidado dos pacientes, o que envolve técnica e humanidade. Objetivo: Este estudo apresenta e discute as lições e reflexões aprendidas por internos de Medicina e médicos recém-formados durante a pandemia de Covid-19. Método: Trata-se de um estudo quali-quantitativo realizado durante a segunda quinzena de setembro de 2020 (seis meses após o início da pandemia) por meio de formulário em plataforma digital. Todos os alunos do internato e todos os médicos formados desde 2018 nas três faculdades de Medicina de Sergipe foram convidados a participar da pesquisa. Resultado: Obtiveram-se 148 questionários respondidos, dos quais quatro não continham respostas nos campos abertos. Quanto ao estágio de formação universitária, 36,5% eram recém-formados (n = 54), dos quais 90,7% trabalharam na linha de frente do atendimento aos pacientes com Covid-19. Ao serem questionados sobre os principais aprendizados que a pandemia havia trazido, 41 respostas estiveram voltadas para a paciência, a imprevisibilidade do futuro e a resiliência no enfrentamento das adversidades. Aproximadamente 42% (n = 62) dos participantes conheciam ao menos uma pessoa que faleceu por Covid-19, e isso se associou à necessidade de aproveitar o tempo, a vida e as pessoas (p = 0,009). Um total de 34 respostas (23%) demonstrou uma atitude positiva de reaprendizado e esperança quando os participantes foram perguntados sobre como imaginavam o trabalho e o ensino médico após pandemia. A necessidade de um retorno cauteloso foi citada em 34 (23%) respostas. Conclusão: Os estudantes de Medicina e os médicos recém-formados relataram aprendizados relacionados à paciência e resiliência. A perda de familiares e amigos por Covid-19 esteve relacionada à necessidade de aproveitar o momento presente.

Abstract: Introduction: The COVID-19 pandemic has affected the mental health of doctors and medical students. There has been plenty of discussion about the lessons learned, in relation to clinical aspects, diagnosis, treatment and prevention. However, doctors are trained in patient care, which involves technique and humanity. Objective: Presentation and discussion of lessons learned from the COVID-19 pandemic for medical interns and newly graduated doctors. Method: This is a quali-quantitative study performed in the second half of September 2020 (six months after the start of the pandemic) using a digital platform. All medical internship students and all physicians graduated since 2018 from the three medical schools in Sergipe-NE-Brazil were invited to participate. Result: 148 forms were obtained, and four of them did not contain answers in the open fields. As regards the university training internship, 36.5% were newly graduated physicians (n=54), of which 90.7% worked on the front line of care for patients with COVID-19. When asked about the main lessons that the pandemic brought, 41 responses referred to patience, unpredictability of the future and resilience in facing the adversities of the pandemic. About 42% (n=62) of the participants knew at least one person who died of COVID-19, and this was associated with the need to enjoy time, life and people (p=0.09). A total of 34 participants (23%) responded with a positive attitude of relearning and hope when asked about how they imagined work and medical education after the pandemic. The need for a cautious return was cited in 34 (23%) responses. Conclusion: Newly qualified doctors and medical students reported learnings related to patience and resilience. The loss of family and friends by COVID-19 was associated with the need to seize the moment.

RESUMO Objetivo: Basear-se na distribuição espacial do traço falciforme (TF) para analisar a frequência dos portadores da hemoglobina S (HbS) em Sergipe. Métodos: A amostra foi constituída por todos os indivíduos nascidos em Sergipe, no período de outubro de 2011 a outubro de 2012, submetidos à triagem neonatal pelo Sistema Único de Saúde, ano de início da triagem universal no Estado. Os testes foram realizados em unidades básicas de saúde e encaminhados para o laboratório do Hospital Universitário, onde foram analisados. A análise da distribuição espacial dos indivíduos heterozigotos para hemoglobinopatias foi realizada por autocorrelação espacial (índice de Moran). Resultados: Dentre os 32.906 recém-nascidos estudados, 1.202 apresentaram outras hemoglobinas além da Hemoglobina A. Houve correlação positiva entre a porcentagem de negros e mestiços e a incidência de TF. A maioria dos casos foi encontrada nos municípios de Aracaju (n=273; 22,7%), Nossa Senhora do Socorro (n=102; 8,4%), São Cristóvão (n=58; 4,8%), Itabaiana (n=39; 4,2%), Lagarto (n=37; 4,01%) e Estância (n=46; 4,9%). Conclusões: Na análise de distribuição espacial por autocorrelação, identificaram-se regiões no Estado com maior frequência de HbS, o que é de extrema importância para o planejamento do sistema de saúde, podendo a mesma metodologia ser aplicada para identificação de outros locais com maior necessidade de centros para cuidados e orientações a portadores de doença falciforme e seus familiares.

ABSTRACT Objective: To use the spatial distribution of the sickle cell trait (SCT) to analyze the frequency of hemoglobin S (HbS) carriers in Sergipe. Methods: The sample consisted of all individuals born in Sergipe from October 2011 to October 2012 who underwent neonatal screening in the public health system. Tests were carried out in basic health units and forwarded to the University Hospital laboratory, where they were analyzed. We used spatial autocorrelation (Moran’s index) to assess the spatial distribution of heterozygous individuals with hemoglobinopathies. Results: Among 32,906 newborns, 1,202 showed other types of hemoglobin besides Hemoglobin A. We found a positive correlation between the percentage of black and multiracial people and the incidence of SCT. Most SCT cases occurred in the cities of Aracaju (n=273; 22.7%), Nossa Senhora do Socorro (n=102; 8.4%), São Cristóvão (n=58; 4.8%), Itabaiana (n=39; 4.2%), Lagarto (n=37; 4.01%), and Estância (n=46; 4.9%). Conclusions: The spatial distribution analysis identified regions in the state with a high frequency of HbS carriers. This information is important health care planning. This method can be applied to detect other places that need health units to guide and care for sickle cell disease patients and their families.

Abstract Introduction Adenotonsillar hypertrophy is more common in children with sickle cell disease, and can lead to sleep-disordered breathing. Objectives To determine the frequency of adenotonsillar hypertrophy in pre-school children with sickle cell disease and assess the diagnostic accuracy of the sleepdisordered breathing subscale in the Sleep Disturbance Scale for Children. Method Observational study with a group of 48 children with sickle cell disease and a control group of 35 children without the disease. The children underwent oropharingoscopy and video nasal endoscopy. The parents and/or guardians answered the questions of the subscale. Results Adenotonsillar hypertrophy was observed in 25% of the children in the study group, and in 20% of the children in the control group, with no statistical difference between the groups. The subscale score ranged from 3 to 11 in both groups. There was a statistical significance in the study group. The average was 4.79 (standard deviation [SD] ± 2.50), with 4.19 (SD ± 1.72) among the children without adenotonsillar hypertrophy, and 6.5 (SD ± 3.40) among the children with adenotonsillar hypertrophy. There was also a statistical significance in the control group. The average was 5.23 (SD ± 2.81), with 4.44 (SD ± 2.2) among the children without adenotonsillar hypertrophy, and 7.87 (SD ± 2.89) among the children with adenotonsillar hypertrophy. Conclusion Adenotonsillar hypertrophy was not associated with sickle cell disease in pre-school children. The subscale of sleep-disordered breathing in the Sleep Disturbance Scale for Children was a useful tool for the diagnostic suspicion of adenotonsillar hypertrophy in children in this age group.

ABSTRACT OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45–60 days and 6–8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1–0.31 and elective C-section: 0.36, 95%CI 0.27–0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29–0.63 and elective C-section: 0.44, 95%CI 0.33–0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2–0.88) and roomed-in less 0.85 (95%CI 0.77–0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04–1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14–2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction.

ABSTRACT OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45–60 days and 6–8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1–0.31 and elective C-section: 0.36, 95%CI 0.27–0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29–0.63 and elective C-section: 0.44, 95%CI 0.33–0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2–0.88) and roomed-in less 0.85 (95%CI 0.77–0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04–1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14–2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction.

Resumo Objetivo: Descrever as práticas e intervenções utilizadas durante o trabalho de parto e o parto e fatores associados em puérperas do estado de Sergipe. Método: Estudo transversal com 768 puérperas das 11 maternidades do estado com entrevista após 6h do parto e dados do prontuário da puérpera e dos recém-nascidos. As associações entre as boas práticas e intervenções utilizadas durante o trabalho de parto e o parto com as variáveis de exposição foram descritas em frequências simples, percentuais, razões de chances brutas e ajustadas (ORa) com o intervalo de confiança. Resultados: Das mulheres estudadas, 10,6% receberam alimentos e 27,8% movimentaram-se durante o trabalho de parto; medidas não farmacológicas para alívio da dor foram realizadas em 26,1%; o partograma estava preenchido em 39,4% dos prontuários; o acompanhante esteve presente em 40,6% dos partos. O uso de ocitocina, amniotomia e analgesia ocorreram em 59,1%, 49,3% e 4,2% das mulheres, respectivamente. O parto ocorreu na posição de litotomia em 95,2% dos casos, houve episiotomia em 43,9% e manobra de Kristeller em 31,7%. Os fatores mais associados à cesariana foram ser usuárias do setor privado de saúde (ORa=4,27; 95CI 2,44-7,47), ter maior escolaridade (ORa=4,54; 95CI 2,56-8,3) e alto risco obstétrico (ORa=1,9; 95CI 1,31-2,74). Usuárias do setor privado tiveram maior presença do acompanhante (ORa=2,12; 95CI 1,18-3,79) e analgesia (ORa=4,96; 95CI 1,7-14,5). Conclusão: Boas práticas obstétricas são pouco utilizadas e intervenções desnecessárias são frequentes, e os fatores mais associados à cesariana foram ser usuária do setor privado de saúde, ter maior escolaridade e alto risco obstétrico.

Summary Objective: To describe practices and interventions used during labor and childbirth and factors associated with such practices in puerperae in the state of Sergipe. Method: A cross-sectional study with 768 postpartum women from 11 maternity hospitals interviewed 6 hours after delivery, and hospital records review. The associations between best practices and interventions used during labor and delivery with exposure variables were described using simple frequencies, percentages, crude and adjusted odds ratio (ORa) with the confidence interval. Results: Of the women in the study, 10.6% received food and 27.8% moved during labor; non-pharmacological methods for pain relief were performed in 26.1%; a partogram was filled in 39.4% of the charts; and an accompanying person was present in 40.6% of deliveries. Oxytocin, amniotomy and labor analgesia were used in 59.1%, 49.3% and 4.2% of women, respectively. Lithotomy position during childbirth was used in 95.2% of the cases, episiotomy in 43.9% and Kristeller maneuver in 31.7%. The variables most associated with cesarean section were private financing (ORa=4.27, 95CI 2.44-7.47), higher levels of education (ORa=4.54, 95CI 2.56-8.3) and high obstetric risk (ORa=1.9, 95CI 1.31-2.74). Women whose delivery was funded privately were more likely to have an accompanying person present (ORa=2.12, 95CI 1.18-3.79) and to undergo labor analgesia (ORa=4.96, 95CI 1.7-14.5). Conclusion: Best practices are poorly performed and unnecessary interventions are frequent. The factors most associated with c-section were private funding, greater length of education and high obstetric risk.

ABSTRACT Background: To establish determinants of maximum walking distance in the 6-minute walk test of children and adolescents with sickle cell anemia, and to compare the performance in this test with physical activity level between patients and healthy controls. Methods: A cross-sectional study was performed in which the participants answered the Physical Activity Questionnaire for Older Children and Adolescents, and completed the 6-minute walk test. Main results: Fifty-seven patients and 58 controls were studied. By univariate analysis of the patients, age (p < 0.0001) and indirect bilirubin (p = 0.008) were associated with maximum walking distance in the 6-minute walk test. In multivariate analysis, age was positively associated (p < 0.0001; beta: 0.75), while body mass index was inversely associated with distance walked (p = 0.047; beta: -0.32). This yields the following equation: maximum distance walked = 487.7 (age × 18.3) - (12 × body mass index) meters. Patients reported a lower physical activity level however there was no significant difference in the distance walked in six minutes between patients (500.6 ± 88.7 m) and controls (536.3 ± 94 m). Conclusion: The determinants for the 6-minute walk test in children and adolescents with sickle cell anemia were age and body mass index. There was no significant difference in the 6-minute walk test but patients with sickle cell anemia had a lower physical activity level compared to healthy controls.

Resumo Objetivo: Investigar o estado de resistência vascular arterial orbitária por meio de dopplervelocimetria em portadores de anemia falciforme e sua relação com biomarcadores de hemólise. Materiais e Métodos: Dois grupos foram examinados neste estudo transversal: um grupo composto de 71 pacientes portadores de anemia falciforme, e o outro grupo, controle, formado por 32 sujeitos saudáveis, pareados por gênero e idade. Todos os participantes foram avaliados por meio de ultrassonografia Doppler das órbitas e de testes laboratoriais. Resultados: Todos os marcadores laboratoriais foram anormais nos portadores de anemia falciforme em comparação aos controles (p < 0,0001). A avaliação dopplervelocimétrica mostrou velocidades aumentadas na artéria oftálmica e reduzidas na artéria central da retina, bem como índices de resistência (IR) e de pulsatilidade (IP) vascular elevados em ambas as artérias no grupo anemia falciforme em relação ao grupo controle (p < 0,0001). A análise da relação entre os marcadores de hemólise e os índices IR e IP mostrou associação significativa, com moderada correlação direta entre reticulócitos e IR e IP na artéria oftálmica e forte correlação inversa entre hemoglobina e IR e IP na artéria central da retina. Conclusão: A resistência vascular arterial das órbitas, aferida por meio de dopplervelocimetria, é elevada em portadores de anemia falciforme, com moderada a forte correlação com os biomarcadores de hemólise.

Abstract Objective: To investigate orbital vascular resistance by Doppler velocimetry in patients with steady-state sickle cell anemia, as well as to characterize its relationship with biomarkers of hemolysis. Materials and Methods: This was a cross-sectional study of two groups: 71 outpatients with sickle cell anemia; and 32 age- and gender- matched, healthy subjects (control group). All participants underwent Doppler velocimetry of the orbital arteries and laboratory tests. Results: All biochemical laboratory markers were abnormal in the sickle cell anemia patients (p < 0.0001 vs. controls). In the patient group, Doppler velocimetry revealed increased flow velocities in the ophthalmic artery and reduced flow velocities in the central retinal artery, as well as high values for the resistance index (RI) and pulsatility index (PI) in both arteries (p < 0.0001 vs. controls). Biomarkers of hemolysis were found to correlate significantly with the RI and PI indices. In the ophthalmic artery, the reticulocyte count showed a moderate direct correlation with RI and with PI. In the central retinal artery, hemoglobin showed a strong inverse correlation with RI and with PI. Conclusion: Orbital vascular resistance, as evaluated by Doppler velocimetry, is elevated in patients with steady-state sickle cell anemia and shows a significant correlation with biomarkers of hemolysis.

OBJECTIVE: The aims of this study were to estimate the frequency of left ventricular hypertrophy and to identify variables associated with this condition in under 25-year-old patients with sickle cell anemia.METHODS: A cross-sectional study was performed of children, adolescents and young adults with sickle cell anemia submitted to a transthoracic Doppler echocardiography. The mass of the left ventricle was determined by the formula of Devereux et al. with correction for height, and the percentile curves of gender and age were applied. Individuals with rheumatic and congenital heart disease were excluded. The patients were divided into two groups according to the presence or absence of left ventricular hypertrophy and compared according to clinical, echocardiographic and laboratory variables.RESULTS: A total of 37.6% of the patients had left ventricular hypertrophy in this sample. There was no difference between the groups of patients with and without hypertrophy according to pathological history or clinical characteristics, except possibly for the use of hydroxyurea, more often used in the group without left ventricular hypertrophy. Patients with left ventricular hypertrophy presented larger left atria and lower hemoglobin and hematocrit levels, reticulocyte index and a higher albumin:creatinine ratio in urine.CONCLUSION: Left ventricular hypertrophy was observed in more than one-third of the young patients with sickle cell anemia with this finding being inversely correlated to the hemoglobin and hematocrit levels, and reticulocyte index and directly associated to a higher albumin/creatinine ratio. It is possible that hydroxyurea had had a protective effect on the development of left ventricular hypertrophy.

OBJETIVO:Avaliar a evolução clínica, o crescimento e a taxa de aleitamento materno exclusivo de recém-nascidos prematuros assistidos pelo Método Canguru, ao nascimento, na alta e aos seis meses de idade.MÉTODOS:Estudo prospectivo de uma coorte de prematuros atendidos pelo Método Canguru, em uma maternidade pública de nível terciário do Nordeste do Brasil, com peso ao nascer ≤1750g e em condições clínicas necessárias para se aplicar o método.RESULTADOS:A amostra constituiu-se de 137 recém-nascidos prematuros, sendo 62,8% do sexo feminino, com peso médio ao nascer de 1365±283g, idade gestacional média de 32±3 semanas e 26,2% eram adequados para a idade gestacional. Foram admitidos na Enfermaria Canguru com mediana de 13 dias de vida, pesando 1430±167g, sendo que, nesse momento, 57,7% foram classificados como pequeno, para a idade gestacional corrigida. Tiveram alta hospitalar com 36,8±21,8 dias de vida, pesando 1780±165g e 67,9% eram pequenos para a idade gestacional corrigida. Aos seis meses de idade cronológica (n=76), tinham peso médio de 5954±971g, estando 68,4% com peso corrigido para a idade gestacional entre os percentis 15 e 85 da curva da Organização Mundial da Saúde (OMS). A frequência de aleitamento materno exclusivo na alta foi de 56,2% e, aos seis meses de idade cronológica, de 14,4%.CONCLUSÕES:Na amostra estudada, aproximadamente dois terços das crianças assistidas pelo Método Canguru encontravam-se, aos seis meses de idade cronológica, entre os percentis 15 e 85 da curva de peso corporal da OMS. A frequência de aleitamento exclusivo aos seis meses foi baixa.

OBJECTIVE:To evaluate clinical outcomes, growth and exclusive breastfeeding rates in premature infants assisted by Kangaroo Mother Care at birth, at discharge and at six months of life.METHODS: Prospective study of a premature infants cohort assisted by Kangaroo Mother Care in a tertiary public maternity in Northeast Brazil with birth weight ≤1750g and with clinical conditions for Kangaroo care.RESULTS: The sample was composed by 137 premature infants, being 62.8% female, with average birth weight of 1365±283g, average gestational age of 32±3 weeks and 26.2% were adequate for gestational age. They have been admitted in the Kangaroo Ward with a median of 13 days of life, weighing 1430±167g and, at this time, 57.7% were classified as small for corrected gestational age. They were discharged with 36.8±21.8 days of chronological age, weighing 1780±165g and 67.9% were small for corrected gestational age. At six months of life (n=76), they had an average weight of 5954±971g, and 68.4% presented corrected weight for gestational age between percentiles 15 and 85 of the World Health Organization (WHO) weight curve. Exclusive breastfeeding rate at discharge was 56.2% and, at six months of life, 14.4%.CONCLUSIONS: In the studied sample, almost two thirds of the children assisted by Kangaroo Mother Care were, at six months of life, between percentiles 15 and 85 of the WHO weight curves. The frequency of exclusive breastfeeding at six months was low.

OBJETIVO:Evaluar la evolución clínica, el crecimiento y la tasa de lactancia materna exclusiva de recién nacidos prematuros asistidos por el Método Canguro, al nacimiento, en el alta y a los seis meses de edad.MÉTODOS: Estudio prospectivo de una cohorte de prematuros atendidos por el Método Canguro, en una maternidad pública de nivel terciario en el Nordeste de Brasil, con peso al nacer ≤1750g y en condiciones clínicas necesarias a la aplicación del método.RESULTADOS: La muestra se constituyó por 137 recién nacidos prematuros, siendo el 62,8% del sexo femenino, con peso mediano al nacer de 1365±283g, edad gestacional mediana de 32±3 semanas y 26,2% eran adecuados para la edad gestacional. Se admitieron en la Enfermería Canguro con mediana de 13 días de vida, pesando 1430±167g en promedio, siendo que, en ese momento, el 57,7% fueron clasificados como pequeño para la edad gestacional corregida. Tuvieron alta hospitalaria con 36,8±21,8 días de vida, pesando 1780±165g y el 67,9% eran pequeños para la edad gestacional corregida. A los seis meses de edad cronológica (n=76), tenían peso mediano de 5954±971g, estando el 68,4% con peso corregido para la edad gestacional entre los percentiles 15 y 85 de la curva de la Organización Mundial de la Salud (OMS). La frecuencia de lactancia materna exclusiva en el alta fue del 56,2% y, a los seis meses de edad cronológica, del 14,4%.CONCLUSIONES: En la muestra estudiada, aproximadamente dos tercios de los niños asistidos por el Método Canguro se encontraban, a los seis meses de edad cronológica, entre los percentiles 15 y 85 de la curva de peso corporal de OMS. La frecuencia de lactancia exclusiva a los seis meses fue baja.

OBJETIVOS: Descrever e classificar alterações retinianas encontradas em portadores de anemia falciforme com genótipo SS, bem com comparar métodos diagnósticos (mapeamento de retina e angiofluoresceinografia). MÉTODOS: Neste estudo transversal foram avaliados pacientes portadores de anemia falciforme com idade igual ou superior a sete anos. Esses pacientes foram submetidos a mapeamento de retina e angiofluoresceinografia. Os achados do mapeamento de retina foram agrupados em três classes: sem alterações; alterações não proliferativas e alterações proliferativas. Os resultados à angiofluoresceinografia foram classificados de acordo com os estágios de Goldberg, variando de I a V e expressando gradiente crescente de gravidade. RESULTADOS: Foram avaliados 61olhos de 31pacientes. A retinopatia falciforme foi encontrada em 38/61 (62,3%) dos olhos examinados. A média de idade do grupo de portadores de retinopatia foi menor que dos pacientes sem retinopatia (14,4 versus 17,4 anos, p=0,04). Observou-se elevada freqüência de retinopatia não proliferativa, especialmente as tortuosidades vasculares (27,9%), seguidas por anastomoses arteriovenosas na periferia da retina (24,6%) e oclusões arteriolares (8,2%). Em um olho foi observado neovascularização. Em 16,4% dos olhos obteve-se resultado normal no mapeamento de retina e alterado à angiofluoresceinografia. CONCLUSÕES: As alterações retinianas do tipo não proliferativa são frequentes e precoces nos portadores de anemia falciforme do tipo SS, sendo a angiofluoresceinografia mais sensível no diagnóstico quando comparada ao mapeamento de retina.

PURPOSES: To describe and categorize retinal vascular changes in patients with sickle cell anemia, as well as to compare diagnostic methods (indirect ophthalmoscopy and fluorescein angiography). METHODS: Patients with sickle cell anemia over the age of seven were examined. Complete ophthalmologic examination with indirect ophthalmoscopy and angiography was performed in each patient. The fundoscopy results were grouped in 3 classes: normal; non-proliferative retinopathy, which includes vascular tortuosity, black sunburst, salmon-patch and peripheral closure/anastomoses; and proliferative retinopathy, related to neovascular proliferation. Angiography results were classified according to Goldberg classifications from stage I to V. RESULTS: Retinopathy related to sickle cell anemia was seen in 62.3% (38/61) of the eyes checked. Neovascularization was observed in one eye. The frequency of bilateral changes in angiography was high. Non-proliferative retinopathy was more common, especially vascular tortuosities (17/61), followed by arteriovenous anastomoses in the retinal periphery (15/61) and arterial occlusions (5/61). The mean age of retinopathy group was 14.4 years old, significantly lower than the mean age of non-retinopathy group, which was 17.4. The result was normal in16.4% (10/61) of the eyes in the fundoscopy exam, while angiography showed alterations. CONCLUSIONS: All the results pointed to the conclusion that the non-proliferative retinal vascular changes are frequent and precocious in patients with sickle cell anemia (SS genotype). Fluorescein angiography is more sensitive in the diagnosis of retinopathy when compared to indirect ophthalmoscopy.

OBJETIVO: Avaliar o tratamento das cardiopatias congênitas realizadas de 2000 a 2009. MÉTODOS: A amostra constituiu-se de todos os pacientes submetidos a correção cirúrgica para cardiopatias congênitas por dez anos em Sergipe, Brasil. Os pacientes foram operados em três hospitais localizados na cidade de Aracaju (SE, Brasil), capital do estado de Sergipe. O estudo foi dividido em dois períodos, definidos pela data do início da centralização das cirurgias. As variáveis coletadas foram: faixa etária, gênero, diagnóstico pós-operatório, destino, tipo de cirurgia e hospital em que foi realizado o procedimento e a classificação RACHS -1. RESULTADOS: No período I, a estimativa do déficit de cirurgia foi de 69%, ocorrendo decréscimo no período II para 55,3%. O diagnóstico pós-operatório mais frequente foi de fechamento de comunicação interventricular (20,5%), fechamento de canal arterial (20,2%) e da comunicação interatrial (19%). Houve correlação estatisticamente significativa entre mortalidade esperada pelo RACHS-1 e a observada na amostra. A avaliação do RACHS-1 como fator preditor da mortalidade hospitalar por meio da curva ROC demonstrou área de 0,860 IC 95% 0,818 a 0,902, com P < 0,0001. CONCLUSÃO: Os resultados deste estudo indicam que a centralização e a organização dos recursos existentes são necessárias para melhora no desempenho das correções cirúrgicas das cardiopatias congênitas.

OBJECTIVE: This study aims evaluate the treatment of congenital heart disease conducted from 2000 to 2009. METHODS: The sample consisted of all patients undergoing surgical correction for congenital heart disease for ten years in Sergipe, Brazil. The patients were operated in three hospitals located in the city of Aracaju, capital of the state of Sergipe (Brazil). The study was divided into two periods defined by the start date of centralization of surgery. The variables collected were: age, sex, postoperative diagnosis, destination, type of surgery and hospital where the procedure was performed and the classification RACHS -1. RESULTS: In the period I, the estimate deficit of surgery was 69% decrease occurring in the period II to 55.3%. The postoperative diagnosis was more frequent closure of the interventricular communication (20.5%), closure of patent ductus arteriosus (20.2%) and atrial septal defect (19%). There was a statistically significant correlation between the expected mortality RACHS-1 and observed in the sample. The evaluation of RACHS-1 as a predictor of hospital mortality by ROC curve showed area of 0.860 95% CI 0.818 to 0.902 with P <0.0001. CONCLUSION: The results of this study indicate that the centralization and organization of existing resources are needed to improve the performance of surgical correction of congenital heart diseases.

OBJECTIVE: To evaluate viral vaccine antibody levels in children with acute lymphoblastic leukemia after chemotherapy and after vaccine booster doses. METHODS: Antibody levels against hepatitis B, rubella, measles and mumps vaccine antigens were evaluated in 33 children after completing chemotherapy (before and after vaccine booster doses) and the results were compared to the data of 33 healthy children matched for gender, age and social class. RESULTS: After chemotherapy, 75.9%, 67.9%, 59.3% and 51.7% of the patients showed low antibody titers that would be unlikely to protect against exposure to measles, rubella, hepatitis B and mumps, respectively. After receiving a vaccine booster dose for these antigens the patients had high antibody levels consistent with potential protection against measles, mumps and hepatitis B, but not against rubella. CONCLUSION: Extra doses of measles-mumps-rubella plus hepatitis B vaccines are recommended in acute lymphoblastic leukemia patients submitted to treatment after hematologic recovery. After this, viral vaccine antibody levels should be verified to define the individual's protective status.

OBJETIVO: Determinar o grau de subestimação de core biopsy, guiada por imagem, de lesões impalpáveis da mama subsequentemente submetidas à exérese cirúrgica. MÉTODOS: Foram revisados retrospectivamente 352 casos com biópsias de fragmento que foram submetidos à cirurgia entre fevereiro de 2000 e dezembro de 2005, cujo laudo histopatológico estava registrado no sistema interno de informação. Os resultados foram comparados com os da cirurgia e a taxa de subestimação foi calculada dividindo-se o número de carcinoma in situ e/ou invasivo à cirurgia pelo número de lesões de alto risco ou carcinoma in situ que foram submetidas à cirurgia. O grau de concordância entre os resultados foi obtido pelo percentual de concordância e pelo coeficiente kappa de Cohen. A associação das variáveis estudadas com a subestimação do diagnóstico foi verificada pelos testes do c2 exato de Fisher, ANOVA e Mann-Whitney U. O risco de subestimação foi medido por meio do risco relativo acompanhado dos respectivos intervalos com 95% de confiança (IC95%). RESULTADOS: Core biopsy foi inconclusiva em 15,6%. O laudo histopatológico foi benigno em 26,4%, sugestivo de lesão de alto risco em 12,8% e maligno em 45,2%. A concordância entre a core biopsy e a cirurgia foi de 82,1% (kappa=0,75). A taxa de falso negativo foi de 5,4% e a lesão foi completamente removida em 3,4%. A taxa de subestimação foi de 9,1% e esteve associada com BI-RADS® categoria 5 (p=0,01), microcalcificações (p < 0,001) e estereotaxia (p= 0,002). Todos os casos subestimados apresentavam diâmetro menor que 20 mm e em todos foram retirados pelo menos cinco fragmentos. A taxa de subestimação para lesões de alto risco foi de 31,1%, 41,2%, para hiperplasia ductal atípica, 31,2% para lesões papilíferas, 16,7% para tumor filóides e 41,9% para carcinoma ductal in situ. CONCLUSÕES: Core biopsy guiada por imagem é um procedimento confiável, contudo permanece a recomendação de ressecção cirúrgica de lesões de alto risco detectadas à biópsia de fragmento já que não foi possível estabelecer características clínicas, imaginológicas, do procedimento e patológicas que pudessem predizer subestimação e evitar a cirurgia. Amostras representativas da lesão são mais importantes que o número de fragmentos.

PURPOSE: To determine the rate of underestimation of an image-guided core biopsy of nonpalpable breast lesions, with validation by histologic examination after surgical excision. METHODS: We retrospectively reviewed 352 biopsies from patients who were submitted to surgery from February 2000 to December 2005, and whose histopathologic findings were recorded in the database system. Results were compared to surgical findings and underestimation rate was determined by dividing the number of lesions that proved to be carcinomas at surgical excision by the total number of lesions evaluated with excisional biopsy. Clinical, imaging, core biopsy and pathologic features were analyzed to identify factors that affect the rate of underestimation. The degree of agreement between the results was obtained by the percentage of agreement and Cohen's kappa coefficient. The association of variables with the underestimation of the diagnosis was determined by the chi-square, Fisher exact, ANOVA and Mann-Whitney U tests. The risk of underestimation was measured by the relative risk (RR) together with the respective 95% confidence intervals (95%CI). RESULTS: Inconclusive core biopsy findings occurred in 15.6% of cases. The histopathological result was benign in 26.4%, a high-risk lesion in 12.8% and malignant in 45.2%. There was agreement between core biopsy and surgery in 82.1% of cases (kappa=0.75). The false-negative rate was 5.4% and the lesion was completely removed in 3.4% of cases. The underestimation rate was 9.1% and was associated with BI-RADS® category 5 (p=0,01), microcalcifications (p CONCLUSIONS: The core breast biopsy under image guidance is a reliable procedure but the recommendation of surgical excision of high-risk lesions detected in the core biopsy remains since it was not possible to assess clinical, imaging, core biopsy and pathologic features that could predict underestimation and avoid excision. Representative samples are much more important than number of fragments.

OBJETIVO: Identificar variáveis preditoras de sobrecarga de ferro em portadores de anemia falciforme e correlacionar indicadores bioquímicos e imaginológicos. MATERIAiS E MÉTODOS: Foi realizado estudo transversal envolvendo 32 portadores de anemia falciforme, que foram submetidos a dosagem sérica de ferro, ferritina e a ressonância magnética do fígado. Foram realizadas cinco sequências gradiente-eco e uma spin-eco. A intensidade de sinal foi obtida em cada sequência pelas médias das regiões de interesse no fígado e musculatura paravertebral para obter a razão da intensidade de sinal (RIS) fígado/músculo. A partir da RIS foi obtida a concentração hepática estimada de ferro (CHEF) pela fórmula: e[5,808 - (0,877 × T2*) - (1,518 × PI)], onde T2* é a RIS na sequência com TE de 13 ms e PI é a RIS da sequência com ponderação intermediária. Os pacientes foram agrupados segundo o regime de transfusão de hemácias (regulares mensais versus esporádicas). RESULTADOS: Os grupos transfusionais foram comparados pelas variáveis clínico-laboratoriais, sendo significativas as diferenças entre RIS, CHEF e ferritina sérica: o grupo que recebeu transfusões regulares apresentou sobrecarga de ferro hepático mais intensa. CONCLUSÃO: A ressonância magnética foi ferramenta eficiente para avaliação de sobrecarga hepática de ferro em portadores de anemia falciforme.

OBJECTIVE: To identify predictive variables of iron overload in patients with sickle cell anemia, correlating biochemical and imaging markers. MATERIALS AND METHODS: The authors developed a cross-sectional study involving 32 patients with sickle cell anemia who were evaluated for ferritin and iron serum levels and submitted to liver magnetic resonance imaging with one spin-echo and five gradient-echo sequences. The signal intensity was obtained at each sequence, corresponding to the arithmetical mean of the measurements on regions of interest in the liver and paraspinal muscles to obtain the liver/muscle signal intensity ratio (SIR). Based on such SIR, the liver iron concentration (LIC) was estimated by means of the following formula: e[5.808 - (0.877 × T2*) - (1.518 × IW)], where T2* is the SIR on the sequence with echo time = 13 ms and IW is the SIR on the intermediate-weighted sequence. Patients were grouped according to their blood transfusion regimen (regular monthly versus sporadic transfusions). RESULTS: The comparison between the transfusion groups was based on clinical-laboratory variables, with significant differences in SIR, LIC and serum ferritin levels: the group with regular transfusions demonstrated greater hepatic iron overload. CONCLUSION: Magnetic resonance imaging is an efficient tool for evaluating liver iron overload in patients with sickle cell anemia.