Abstract Accumulated evidence has shown that the oral cavity may be an important reservoir for SARS-CoV-2. Some authors have suggested that the use of mouthrinses could reduce SARS-CoV-2 viral load in the saliva. Thus, the aim of this review was to synthesize evidence about the efficacy of mouthrinses in reducing the salivary viral load of SARS-CoV-2. 2. Nine randomized controlled trials (RCTs) have investigated the efficacy of different mouthrinses in reducing salivary SARS-CoV-2 loads. Various active ingredients have been tested in these trials: 0.5%,1% and 2% povidone-iodine, 0.2% and 0.12% chlorhexidine (CHX), 0.075% cetylpyridinium chloride (CPC), 0.075% CPC with Zinc lactate, 1% and 1.5% hydrogen peroxide (HP), 1.5% HP + 0.12% CHX and ß-cyclodextrin and citrox. The studies reported an intra-group reduction in the salivary levels of the virus, when compared with the baseline. However, the majority of these trials failed to demonstrate a significant inter-group difference between active groups and the control group relative to the decrease in salivary SARS-CoV-2 loads. Although promising, these results should be confirmed by larger trials.

Abstract emotional regulation in adolescents is an aspect little observed, especially by researchers and health professionals in Brazil. This study aimed to translate, adapt and examine the psychometric properties, internal consistency and construct validity of The Security in the Interparental Subsystem Scale (SIS) in a sample of 345 adolescents aged 14 to 18 years (M = 16.06 years, SD = 1.22). The results, obtained by Structural Equation Modeling, showed a six-factor version, namely: emotional reactivity, behavioral dysregulation, avoidance, involvement, destructive representations of the family, and representations of conflict overflow. The models showed good adjustment with invariance between the analyzed groups. The reliability of the scale showed adequate values. The tests performed suggest that the SIS presents satisfactory psychometric properties in the population of adolescents in the sample, therefore, a reliable measuring instrument for use in Brazil by clinicians and researchers.

Resumen la regulación emocional en los adolescentes es un aspecto poco observado, especialmente por los investigadores y los profesionales de la salud en Brasil. Este estudio tuvo como objetivo traducir, adaptar y examinar las propiedades psicométricas, la consistencia interna y la validez de constructo de La Escala de Seguridad en el Subsistema Interparental (SIS) en una muestra de 345 adolescentes de 14 a 18 años (M = 16.06 años, DT = 1.22). Los resultados, obtenidos mediante Modelización de Ecuaciones Estructurales, mostraron una versión de seis factores: reactividad emocional, desregulación conductual, evitación, implicación, representaciones destructivas de la familia, representaciones del desbordamiento del conflicto. Los modelos mostraron un buen ajuste con invarianza entre los grupos analizados. La confiabilidad de la escala mostró valores adecuados. Las pruebas realizadas sugieren que el SIS tiene propiedades psicométricas satisfactorias en la muestra de adolescentes, por lo tanto, un instrumento de medición fiable para su uso en Brasil por clínicos e investigadores.

Resumo a regulação emocional em adolescentes é um aspecto pouco observado, sobretudo, por pesquisadores e profissionais de saúde no Brasil. Este estudo teve como objetivo traduzir, adaptar e examinar as propriedades psicométricas, consistência interna e validade de constructo da The Security in the Interparental Subsystem Scale (SIS) em uma amostra de 345 adolescentes com idades entre com idades entre 14 e 18 anos (M = 16,06 anos, DP = 1,22). Os resultados, obtidos pela Modelagem de Equações Estruturais, evidenciaram uma versão de seis fatores, são eles: reatividade emocional, desregulação comportamental, evasão, envolvimento, representações destrutivas da família, representações do transbordamento do conflito. Os modelos apresentaram bom ajuste com invariância entre os grupos analisados. A confiabilidade da escala apresentou valores adequados. Os testes realizados sugerem que a SIS apresenta propriedades psicométricas satisfatórias na população de adolescentes da amostra, portanto, um instrumento de medida confiável para uso no Brasil por clínicos e pesquisadores.

Resumo: Introdução: O termo aprender a aprender, inicialmente desenvolvido como contraponto à Escola Tradicional, visando uma maior emancipação dos estudantes em relação à construção do conhecimento em sala de aula, assim como um incentivo à democracia e autonomia civil destes, passou a ser utilizado, de forma recorrente, como slogan neoliberal nas escolas médicas. Incorporado pelo mercado como sinônimo do termo norte-americano “do it yourself” (faça você mesmo), o conceito de aprender a aprender tornou-se significado de um construtivismo naturalista, partindo do princípio de que os estudantes constroem seus próprios conceitos, habilidades e valores de forma adequada e satisfatória. Desenvolvimento: Na Educação Médica, em especial, o termo aprender a aprender figura como proposta pedagógico-metodológica de forma recorrente. Convém salientar que a presença do termo, por si só, não deve ser concebida como danosa à Educação Médica, mas, sim, o contexto pedagógico em que se encontra inserido. Há, portanto, um esvaziamento do papel docente, enquanto regulador, da relação estabelecida entre o estudante e o mundo. Apresentamos três premissas teóricas, a partir da perspectiva histórico-cultural, para refletir e problematizar a natureza e os significados associados ao slogan “aprender a aprender”, com foco sobre a aprendizagem e o desenvolvimento do estudante, destacando a importância do médico-docente neste processo. Conclusão: Tanto a atividade de ensino como a de estudo necessitam se transformar em atividades conscientes por parte dos seus protagonistas, atentando-se à unidade criação de significado/aprendizagem conduzindo ao desenvolvimento, como princípio dialético central e como condição indispensável para o que compreendemos como desenvolvimento humano. Somente na atividade torna-se visível a universalidade do sujeito humano e a constituição da personalidade (médica). Deste modo, asseveramos que os médicos-docentes são fundamentais para que os estudantes de Medicina possam ser orientados a atuar nos termos da superação e mudança.

Abstract: Introduction: The term learning how to learn, initially developed as a counterpoint to the Traditional School, aiming at a greater emancipation of the students in relation to the construction of knowledge in the classroom, as well as an incentive to their democracy and civil autonomy, started to be used recurrently as a neoliberal slogan in medical schools. Incorporated by the market as a synonym for the American term “do it yourself”, the concept of learning how to learn has become the meaning of a naturalistic constructivism, assuming that students construct their own concepts, skills, and values in an appropriate and satisfactory manner. Development: In Medical Education, especially, the term learning to learn appears as a recurrent pedagogical-methodological proposal. It should be noted that the presence of the term, by itself, should not be conceived as harmful to Medical Education, but rather the pedagogical context in which it is inserted. There is, therefore, an emptying of the teaching role as regulator of the relationship established between the student and the world. We present three theoretical premises, from the cultural-historical perspective, to reflect on and problematize the nature and meanings associated with the slogan “learning how to learn”, with a focus on student learning and development, highlighting the importance of the medical professor in this process. Conclusion: Both the teaching and the study activities need to become conscious activities by their protagonists, paying attention to the unity of meaning creation/learning leading to development, as a central dialectic principle and as an indispensable condition for what we understand as human development. Only in activity does the universality of the human subject and the constitution of the (medical) personality become visible. Thus, we assert that medical professors are fundamental for medical students to be guided to act in terms of overcoming and changing.

ABSTRACT Introduction Influenza is an important cause of morbimortality worldwide. Although people at the extremes of age have a greater risk of complications, influenza has been more frequently investigated in the elderly than in children, and inpatients than outpatients. Yearly vaccination with trivalent or quadrivalent vaccines is the main strategy to control influenza. Objectives Determine the clinical and molecular characteristics of influenza A and B infections in children and adolescents with influenza-like illness (ILI). Methods: A cohort of outpatient children and adolescents with ILI was followed for 20 months. Influenza was diagnosed with commercial multiplex PCR platforms. Results: 179 patients had 277 episodes of ILI, being 79 episodes of influenza A and 20 episodes of influenza B. Influenza A and B cases were mild and had similar presentation. Phylogenetic tree of influenza B viruses showed that 91.6% belonged to the B/Yamagata lineage, which is not included in trivalent vaccines. Conclusions: Influenza A and B are often detected in children and adolescents with ILI episodes, with similar and mild presentation in outpatients. The mismatch between the circulating influenza viruses and the trivalent vaccine offered in Brazil may have contributed to the high frequency of influenza A and B in this population.

Resumo Dificuldades no exercício da coparentalidade reverberam em problemas externalizantes em adolescentes. Entretanto, há escassez no entendimento sobre mecanismos que medeiam essa relação. A regulação emocional apresenta-se como possível ligação entre esses construtos. O objetivo deste estudo foi testar um modelo estrutural no qual a desregulação emocional é mediadora entre coparentalidade e problemas externalizantes em adolescentes. Trata-se de estudo com delineamento quantitativo, transversal, explicativo. Contou com uma amostra de 229 adolescentes entre 11 a 18 anos, residentes no interior do Rio Grande do Sul. Foi utilizada modelagem de equações estruturais para testar a validade empírica do modelo teórico proposto. Os resultados forneceram evidências para o avanço do estudo das relações familiares e mecanismos explicativos no desenvolvimento de problemas externalizantes. Alguns domínios de desregulação emocional são mediadores da associação entre dimensões negativas de coparentalidade e problemas externalizantes. As relações diretas e indiretas entre as variáveis do modelo são analisadas e discutidas.

Abstract Difficulties in coparenting performance reverberate in externalizing problems in adolescents. However, understanding on the mechanisms mediating this relationship is scarce. Emotion regulation is a possible link between these constructs. This study aims to test a structural model in which emotional dysregulation mediates coparenting and externalizing problems in adolescents. This is a quantitative, cross-sectional, and explanatory study. The sample consisted of 229 adolescents aged between 11 and 18, living in inland cities of Rio Grande do Sul. Structural equation modeling was used to test the empirical validity of the proposed theoretical model. Results provided evidence for the advance of the study on family relationships and explanatory mechanisms in the development of externalizing problems. Some domains of emotion deregulation mediate the association between coparenting negative dimensions and externalizing problems. Direct and indirect relationships between the model variables are analyzed and discussed.

Resumen Las dificultades en la coparentalidad reverberan en problemas de externalización en adolescentes. Sin embargo, existe una falta de comprensión sobre los mecanismos que median esta relación. La regulación emocional es un posible vínculo entre estos constructos. El objetivo de este estudio fue probar un modelo estructural en el que la desregulación emocional es mediadora entre la coparentalidad y los problemas de externalización en adolescentes. Este es un estudio cuantitativo, transversal y explicativo. Cuenta con una muestra de 229 adolescentes entre 11 y 18 años que viven en el interior de Rio Grande do Sul. Se utilizó el modelo de ecuaciones estructurales para probar la validez empírica del modelo teórico propuesto. Los resultados proporcionaron evidencia para el avance del estudio de las relaciones familiares y los mecanismos explicativos en el desarrollo de problemas de externalización. Algunos dominios de desregulación emocional median la asociación entre las dimensiones negativas de los problemas de coparentalidad y problemas de externalización. Se analizan y discuten las relaciones directas e indirectas entre las variables del modelo.

Resumo O objetivo deste estudo foi testar um modelo estrutural no qual a regulação emocional é mediadora entre dimensões negativas da coparentalidade e sintomas internalizantes em adolescentes. A amostra foi composta de 229 adolescentes entre 11 a 18 anos. Modelagem de equações estruturais foi utilizada para testar a validade empírica do modelo teórico proposto. Os resultados indicaram que regulação emocional é mediadora da associação entre dimensões negativas de coparentalidade e sintomas internalizantes em adolescentes. Em contraste, associação direta entre coparentalidade e sintomas internalizantes não se manteve significativa no modelo com mediação. Conclui-se que a regulação emocional possui papel determinante para o desenvolvimento de sintomas internalizantes no contexto de dificuldades coparentais.

Abstract The objective of this study was to test a structural model in which emotional regulation mediates the negative dimensions of coparenting and internalizing symptoms in adolescents. The sample consisted of 229 adolescents aged 11 to 18 years. Structural equations modeling was used to test the empirical validity of the proposed theoretical model. The results indicated that emotional regulation mediates the association between negative dimensions of coparenting and internalizing symptoms in adolescents. In contrast, a direct link between coparenting and internalizing symptoms did not remain significant in the mediation model. It is concluded that emotional regulation plays a determining role in the development of internalizing symptoms in the context of coparental difficulties.

Resumo Este artigo teve por objetivo evidenciar e analisar as mudanças relativas às expectativas do tornar-se médico ao longo da graduação em medicina. Fizeram parte da pesquisa, realizada entre abril e junho de 2018, estudantes de medicina matriculados na primeira, quinta, oitava e décima segunda fases de uma instituição pública de Ensino Superior de Santa Catarina. Após aplicação de questionário, foram analisadas 145 respostas à seguinte pergunta: Por que você escolheu cursar medicina? Por meio de análise de conteúdo, evidenciou a presença crescente, no decorrer do curso, por aquilo que denominamos de 'retorno financeiro' e, de maneira inversa, o decrescente interesse por 'ajudar ao próximo'. Os resultados, analisados com base em teorias que abordam os processos de socialização e de formação identitária mostraram que, apesar de inseridos em realidades socioculturais distintas, os indivíduos se encontram envoltos por ritos e estereótipos comuns, socialmente convencionados por padrões social e historicamente construídos pelo processo de constituição da identidade médica.

Abstract The article had the goal of evidencing and analyzing the changes regarding the expectations involving becoming a doctor throughout Medicine undergraduate studies. Between April and June 2018, Medicine students enrolled in the first, fifth, eighth and tenth stages of a public higher education institution in the state of Santa Catarina, Brazil, took part in the study. After a questionnaire was applied, we analyzed 145 answers regarding the following question: Why did you choose to take Medicine course? Through content analysis, the data analysis evidenced a growing presence, throughout the course, of what we call 'financial return,' and, inversely, a decreasing interest in 'helping others.' The results, which were analyzed based on theories that approach the socialization and identity development processes, revealed that, in spite the fact that they are inserted into different sociocultural realities, the individuals find themselves involved with rituals and common stereotypes that are socially arbitrated by patterns that were socially and historically developed by the process of constitution of the medical identity.

Resumen Este artículo se planteó como objetivo evidenciar y analizar los cambios relacionados a las expectativas de convertirse en médico a lo largo de la carrera de medicina. El estudio, realizado entre abril y junio del 2018, incluyó a estudiantes de medicina de una institución pública de Enseñanza Superior del Estado de Santa Catarina, Brasil, matriculados respectivamente en los períodos primero, quinto, octavo y duodécimo. Después de aplicar el cuestionario se analizaron 145 respuestas a la siguiente pregunta: ¿Por qué usted eligió cursar medicina? Los datos analizados por medio del análisis de contenido mostraron un aumento a lo largo de la carrera por lo que se conoce como 'retorno de la inversión' y una disminución del interés en 'ayudar al prójimo'. Los resultados, analizados con base en teorías que abordan los procesos de socialización y de formación de la identidad, mostraron que a pesar de estar inmersos en diferentes realidades socioculturales, los individuos se encuentran rodeados por rituales y estereotipos comunes, aceptados socialmente por las normas sociales y construidos históricamente por el proceso de constitución de la identidad médica.

RESUMO O presente ensaio apresenta uma breve análise histórica da educação médica no Brasil por meio de sua evolução acadêmica e pedagógica. Evidenciam-se, nas últimas décadas, novos modelos de ensino como opção para a formação de profissionais médicos, estando estes envolvidos com os conceitos contemporâneos de saúde e doença, voltados ao atendimento das demandas sociais, suscitadas nacional e internacionalmente. Neste ensaio abordaremos os seguintes focos de estudo: (a) ensino superior e escolas médicas no Brasil, (b) arquitetura curricular na educação médica: desafios e possibilidades e (c) reflexos das mudanças curriculares e das metodologias ativas no perfil do médico formado. Acerca de mudanças na formação profissional médica, chegamos à conclusão de que mudanças nas arquiteturas curriculares parecem não bastar, como agentes isolados, na alteração do perfil dos profissionais. No Brasil, ainda são escassos os estudos acerca do médico formado pelos diferentes métodos e currículos, ficando em aberto a discussão acerca da eficiência transformadora das arquiteturas curriculares distintas.

ABSTRACT This essay presents a brief historical analysis of medical education in Brazil throughout its academic and pedagogical evolution. In order to meet social demands and the contemporary concepts of health and sickness, new models of education have emerged in recent decades, as options for the training of medical professionals, both nationally and internationally. In this essay, we focus on the following topics: a) higher education and medical schools in Brazil, b) curricular architecture in medical education: challenges and possibilities; and c) reflections on curricular changes and active methodologies in the profile of the graduate physician. Regarding the changes in medical professional training, we come to the conclusion that changes in curricular architectures do not appear to be sufficient, in themselves, to change the profile of professionals. In Brazil, there are very few studies about physicians trained by the different methods and curricula, and the discussion about the transformative efficiency of the different curricular architectures remains unresolved.

ABSTRACT Hematopoietic stem cell transplant (HSCT) recipients should be routinely revaccinated after transplantation. We evaluated the difficulties met in the revaccination program and how a prospective and tailored follow-up could help to overcome these obstacles. HSCT recipients (n=122) were prospectively followed up and categorized into Group 1 (n=72), recipients who had already started the revaccination program, and Group 2 (n=50), recipients starting their vaccines. Whenever a difficulty was reported, interventions and subsequent evaluations were performed. Reported problems were related to patient compliance, HSCT center and/or vaccination center. Problems related to patient compliance were less frequent than those related to HSCT center modifications of previous recommendations, or to errors made by the vaccination center. The main gap found was vaccination delays (81.9%). Advisory intervention was needed in 64% and 46% of Group 1 and Group 2, respectively (p=0.05), and was partially successful in around 70% of the cases. Total resolution was achieved in more than 35% in both groups. Improvements are needed in the Brazilian vaccination program for HSCT recipients to assure a complete and updated revaccination schedule. HSCT centers should assign nurses and transplant infectious disease specialist physicians to organize the revaccination schedule and to monitor the program development.

SUMMARY Zika virus (ZKV) infection is a huge public health problem in Brazil because of the increased incidence of microcephaly in neonates from infected mothers. Detection of specific IgG antibodies in maternal serum samples constitutes an important approach for diagnosing ZKV infection and evaluating its relationship with neonatal microcephaly. However, as there is no serological test produced in Brazil to detect IgM and IgG antibodies against ZKV, we sought to examine specific IgG in serum samples from patients or suspected mothers to detect previous infection and to test for specificity with regard to flaviviral infections occurring in the same area. Brazilian Zika virus native antigens were obtained from infected Vero cell layers or free virions in the culture medium and then used in ELISA. We tested sera from eight ZKV RNA-diagnosed infected patients (ZKVR), seven neonates with microcephaly and their mothers after delivery (MM), 140 dengue virus IgM-positive (DM) and IgG (DG)-positive patients, and 100 yellow fever (YF)-vaccinated patients. According to the ELISA, ZKVR samples were mostly positive (7/8), and all the MM serum samples were positive for ZKV IgG (7/7). In contrast, cross-reactions for dengue or yellow fever-vaccinated patients were observed, including DM (48/95), DG (10/45) or YF (3/100) serum samples; however, these cross-reactions exhibited low antigen avidity so that 6 M urea largely removed this cross-reactivity, with only a few cross-reacting samples remaining (8/140). ELISA based on extracted virions was much more specific, with all ZKVR (8/8) and MM sera being positive for ZKV IgG (7/7) and only borderline cross-reactivity found for DM (6/95), DG (3/45) or YF (4/100)-vaccinated serum samples. This technique (ELISA) can identify specific IgG in ZKV-infected patients and may be helpful in diagnosing congenital infetions after maternal RNA virus clearance or in epidemiological studies.

Abstract: Chromoblastomycosis is a chronic subcutaneous fungal infection caused by traumatic implantation of dematiaceous fungi in the skin. The clinical presentation is usually a verrucous plaque lesion and the diagnosis is confirmed by the visualization of muriform bodies at direct examination or at the histologic study. This report describes a rare case of tumoral chromoblastomycosis confirmed by histologic study and whose agent was identified by culture and micromorphology.

The aim of this study was to characterize the urinary excretion of the BK (BKV) and JC (JCV) human polyomaviruses in a cohort of human immunodeficiency virus (HIV)-infected children and adolescents. One hundred and fifty-six patients were enrolled: Group I included 116 HIV-infected children and adolescents [median age = 11.4 years (y); range 1-22 y]; Group II included 40 non-HIV-infected healthy controls (median age = 11.37 y; range 7-16 y). Single urine samples from both groups were screened for the presence of JCV and BKV DNA by polymerase chain reaction at enrolment. The overall rate of JCV and BKV urinary excretion was found to be 24.4% and 40.4%, respectively (n = 156). Group I had urinary excretion of JCV and BKV in 27.6% and 54.3% of subjects, respectively. In contrast, Group II showed positive results for JCV in 17.5% of subjects and for BKV in 12.5% of subjects (p Pearson JCV = 0.20; p Pearson BKV < 0.0001). In Group I, there was no association between JCV/BKV shedding and age, gender or CD4 values. Patients with an HIV viral load < 50 copies/mL had a lower excretion of BKV (p < 0.001) and a trend of lower JCV excretion (p = 0.07). One patient in Group I (1/116, 0.9%) showed clinical and radiological features consistent with progressive multifocal leukoencephalopathy, suggesting that children with HIV/polyomavirus coinfection should be kept under surveillance.

Infecções respiratórias virais são a principal causa de hospitalização infantil e podem ser extremamente graves em crianças com cardiopatia congênita. O diagnóstico rápido e sensível é importante para a introdução precoce de tratamento antiviral e implantação de precauções para controle da transmissão, reduzindo o risco de infecções nosocomiais. Neste estudo, comparamos o desempenho de diferentes técnicas no diagnóstico de vírus respiratórios em crianças com cardiopatia congênita e sintomas respiratórios. Trinta e nove amostras de aspirado de nasofaringe foram obtidas de crianças com sintomas de infecção respiratória. Ensaio de PCR Multiplex que detecta 12 vírus respiratórios (Seeplex® RV 12 ACE Detection) foi comparado à Imunofluorescência Direta (IFD) e à PCR específica, ambas direcionadas a sete vírus. A positividade da IFD foi 33,3%, do Multiplex foi 51,3% e da PCR 48,7%. O índice kappa comparando IFD e Multiplex, IFD e PCR, e PCR e Multiplex foi, respectivamente, 0,542, 0,483 e 0,539, sendo a concordância considerada moderada. O Multiplex e a PCR detectaram significantemente mais vírus que a IFD (p < 0,0001 e 0,002, respectivamente). Como o desempenho dos testes varia o uso de mais de uma técnica pode aumentar a sensibilidade diagnóstica favorecendo a introdução precoce de terapia antiviral e implantação de medidas profiláticas

Respiratory virus infections are the main cause of infant hospitalization and are potentially severe in children with congenital heart disease (CHD). Rapid and sensitive diagnosis is very important to early introduction of antiviral treatment and implementation of precautions to control transmission, reducing the risk of nosocomial infections. In the present study we compare different techniques in the diagnosis of respiratory viruses in CHD infants. Thirty-nine samples of nasopharyngeal aspirate were obtained from CHD infants with symptoms of respiratory infection. The Multiplex PCR (Seeplex® RV 12 ACE Detection) driven to the detection of 12 respiratory viruses was compared with the direct immunofluorescence assay (DFA) and PCR, both targeting seven respiratory viruses. The positivity found by DFA, Multiplex and PCR was 33.3%, 51.3% and 48.7%, respectively. Kappa index comparing DFA and Multiplex, DFA and PCR and PCR and Multiplex PCR was 0.542, 0.483 and 0.539, respectively. The concordance between techniques was considered moderate. Both Multiplex PCR (p = 0.001) and PCR (p = 0.002) detected significantly more respiratory virus than DFA. As the performance of the tests may vary, the combination of two or more techniques may increase diagnostic sensitivity favoring the diagnosis of co-infections, early introduction of antiviral therapy and implementation of appropriate measures.

A malária é complicação incomum após o transplante de células-tronco hematopoiéticas em países endêmicos. No entanto, candidatos a transplantes, receptores e doadores que vivem em regiões endêmicas frequentemente relatam episódios anteriores de malária. Este fato pode representar um risco importante para receptores imunossuprimidos, que podem desenvolver casos de malária grave. Relatamos um caso de transplante de células-tronco hematopoiéticas (TCTH) em que o doador teve história de malária anterior e um monitoramento por meio de exames parasitológicos e moleculares foi realizado antes e após o procedimento. O doador apresentou Plasmodium vivax na gota espessa um mês após o transplante e foi tratado de acordo com as orientações do Ministério da Saúde brasileiro. A reação em cadeia da polimerase (PCR) foi capaz de detectar a infecção por malária no doador uma semana mais cedo do que a gota espessa. Mesmo sem resultados positivos, o receptor foi preventivamente tratado com cloroquina, a fim de prevenir as formas sanguíneas assexuadas. Destacamos a importância do monitoramento de receptores e doadores em procedimentos de transplante, com o objetivo de reduzir o risco de transmissão da malária.

Malaria is an unusual complication after hematopoietic stem cell transplantation in non-endemic countries. However, transplant candidates, recipients and donors living in endemic regions frequently report previous episodes of malaria. This fact could represent an important risk for immunosuppressed recipients that could develop severe malaria cases. We report a case of hematopoietic stem cell transplant (HSCT) in which the donor had a history of previous malaria, and close monitoring was performed before and after procedure by parasitological and molecular tests. The donor presented Plasmodium vivax in thick blood smears one month after transplant and was treated according to Brazilian Health Ministry guidelines. The polymerase chain reaction (PCR) was able to detect malaria infection in the donor one week earlier than thick blood film. Even without positive results, the recipient was pre-emptively treated with chloroquine in order to prevent the disease. We highlight the importance of monitoring recipients and donors in transplant procedures with the aim of reducing the risk of malaria transmission.

Os distúrbios hereditários das hemoglobinas são as doenças genéticas mais frequentes do homem e mais difundidas no mundo, abrangendo sobretudo continentes como África, Américas, Europa e extensas regiões da Ásia. Estima-se que haja 270 milhões de portadores de hemoglobinopatias no mundo, dos quais 80 milhões são portadores de talassemia. Aproximadamente 60 mil crianças nascem anualmente no mundo com talassemia e 250 mil com anemia falciforme, dando uma frequência de 2,4 crianças afetadas para cada 1.000 nascimentos. No Brasil, a doenca falciforme é a doença hereditária monogênica mais comum, estimando-se que haja entre 20 a 30 mil pacientes portadores desta doenca. O transplante de células-tronco hematopoéticas alogênico (TCTH alo) é atualmente a única modalidade terapêutica capaz de curar pacientes com hemoglobinopatias. Neste artigo discutiremos os dados disponíveis na literatura e sugerimos os critérios para a indicação do TCTH nas hemoglobinopatias.

Hemoglobinopathies are the most prevalent genetic diseases in man. Most cases are described in Europe, Africa and in the Americas. About 270 million hemoglobinopathy carriers are alive today with 80 million being carriers of thalassemia. We estimate that, throughout the world, about 60,000 children are born annually with thalassemia and 250,000 with sickle cell disease with an estimated frequency of 2.4 children in every 1000 births. Sickle cell disease is the most common monogenic hereditary disease in Brazil with a total of from 20,000 to 30,000 patients. Allogeneic stem cell transplantation is the only curative approach. Here we describe published data and propose criteria to indicate stem cell transplantation in thalassemia and sickle cell disease patients.