BACKGROUND Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVE The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral to determine markers associated with fatal outcome. METHODS Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and then sequenced. Patients were classified in two groups: survival or death. FINDINGS In the univariate analysis the following variables were associated with outcome: alanin aminotransferase (ALT), aspartat aminotransferase (AST), AST/ALT ratio, total bilirubin (TB), chronic kidney disease epidemiology collaboration (CKD-EPI), ammonia, lipase, factor V, international normalised ratio (INR), lactate and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.007 to 1.030, p = 0.002], and factor V (OR -0.955, 95% CI 0.929 to 0.982, p = 0.001). The estimated lipase and factor V cut-off values that maximised sensitivity and specificity for death prediction were 147.5 U/L [area under the curve (AUC) = 0.879], and 56.5% (AUC = 0.913). MAIN CONCLUSIONS YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.

Objective: To present a series of 50 consecutive patients with non-metastatic extremity osteosarcoma, and attempt to correlate expression of the vascular endothelial growth factor (VEGF) protein in biopsy tissue to their prognosis regarding overall survival, disease-free survival and local recurrence.Methods: Fifty cases of non-metastatic osteosarcoma of the extremities treated between 1986 and 2006 at Instituto de Ortopedia e Traumatologia da Universidade de São Paulo, São Paulo, Brasil, were evaluated regarding expression of the VEGF protein. There were 19 females and 31 males. The mean age was 16 years old (range 5-28 years old) and the mean follow-up was 60.6 months (range 25-167 months). The variables studied were age, gender, anatomic location, type of surgery, surgical margins, tumor size, post chemotherapy necrosis, local recurrence, pulmonary metastasis and death.Results: Thirty-six patients showed VEGF expression on 30% or less cells (low), and the remaining 14 cases had VEGF expression above 30% (high). Among the 36 patients with low VEGF expression, nine developed pulmonary metastasis and four died (11.1%). Among the 14 patients with high VEGF expression, six developed pulmonary metastasis and three died (21.4%).Conclusion: There was no statistically significant correlation between the expression of VEGF and any of the variables studied. Level of Evidence IV, Therapeutic Study.

BACKGROUND: Secondary myeloid neoplasms comprise a group of secondary diseases following exposure to myelotoxic agents or due to congenital diseases. The improvement of anticancer agents and immunosuppressive drugs seem to be associated with an increased incidence of secondary myeloid neoplasms. Karyotyping of bone marrow is essential for diagnosis and prognosis. Previous use of alkylating agents and radiation are associated with clonal abnormalities such as recurrent unbalanced -5/5q-, -7/7q- and complex karyotypes, whereas topoisomerase-II inhibitors lead to changes such as the balanced 11q23 rearrangement, t(8;21), t(15;17) and inv(16). OBJECTIVE: To study the clinical and cytogenetic data of patients with secondary myeloid neoplasms who took antineoplastic and/or immunosuppressive drugs or progressed from aplastic anemia. METHODS: The clinical and cytogenetic characteristics of 42 patients diagnosed with secondary myeloid neoplasms in one institution were retrospectively evaluated. Of these, 25, 11 and 6 patients had had oncological diseases, aplastic anemia and other diseases, respectively. Conventional cytogenetic and FISH analyses were performed for monosomy 7. RESULTS: The cytogenetic study was conclusive in 32 cases with 84.4% of clonal abnormalities. Monosomy 7 and complex karyotypes were present in 44.4% and 37%, respectively. A high prevalence of unbalanced abnormalities (96.3%) was observed. Monosomy 7 was more prevalent in patients with myelodysplastic syndromes/myeloid neoplasms after aplastic anemia (66.6%). The median survival after diagnosis of myeloid neoplasms was only 5.7 months. Normal cytogenetics was associated to better survival (p-value = 0.03). There was a slightly worse trend of survival for patients with complex karyotypes (p-value = 0.057). Abnormal karyotype was an independent risk factor for poor survival (p-value = 0.012). CONCLUSION: This study enhances the importance of cytogenetic analysis of patients at the time of diagnosis of secondary myeloid neoplasms.

OBJETIVOS: Definir o perfil do médico residente atendido em um serviço de assistência à saúde mental a fim de contribuir para o conhecimento das necessidades deste grupo. MÉTODOS: Estudo observacional do tipo coorte retrospectivo. Os dados foram obtidos por meio de revisão de prontuários de uma série de residentes atendidos pelo Grupo de Assistência Psicológica ao Aluno (Grapal) no período de 1998 a 2002 e pelo acesso ao registro geral de matrícula de residentes. Inclui a descrição da proporção de residentes atendidos segundo ano [cronológico], ano de residência, sexo, idade, especialidade, faculdade de origem e distância do núcleo familiar; e a análise das diferenças de proporções entre as categorias das variáveis investigadas. RESULTADOS: Durante o período estudado temos o registro de 2.131 residentes matriculados, totalizando 4.727 residentes-ano de seguimento. Neste conjunto, computando-se somente o primeiro atendimento, temos 104 residentes atendidos pelo Grapal (4,9% residentes atendidos, ou 2,2 atendidos para cada 100 residentes-ano de seguimento). Os dados revelam maior proporção de residentes atendidos com as seguintes características: primeiro ano de residência (4,5%), idade inferior a 26 anos (6,1%), sexo feminino (6,9%), egresso de outras escolas médicas (5,9%) e residentes de especialidades cognitivas (6,7%). CONCLUSÃO: A assistência psiquiátrica mostrou-se associada ao gênero, a fatores ligados a crises adaptativas e a especialidades cognitivas. Não houve crescimento da proporção de residentes atendida pelo serviço durante o período analisado.

OBJECTIVES: To define the profile of medical residents assisted by a mental health care service, aiming to contribute to the understanding of this group's needs. Methods: Observational study, retrospective cohort design. Data were collected from the medical records of a series of residents assisted by the group of psychological care for students of the Sao Paulo University School of Medicine , during the period 1998-2002; and from the institution's general register of residents. Proportions of residents assisted according to time, year of residency, gender , age, specialty, graduation school and distance from family home are described and differences between proportions of these variables categories are analyzed. RESULTS: The total of residents included was 2,131 with a follow-up time of 4,727 resident-years. Among them, computing first episode of care only, there were 104 residents assisted (4.9% residents assisted, or 2.2 residents assisted per 100 resident-years of follow-up). Their most frequent characteristics were: first year of residency (4.5%), age under 26 years (6.1%), female (6.9%), graduates from other schools (5.9%), and residents of cognitive specialties (6.7%).Psychiatric assistance in this sample shows an association with gender and factors related to a crisis of adaptation. The proportion of residents assisted has not increased during the period analyzed.

OBJETIVO: Avaliar casos de sarcoma sinovial não-metastático das extremidades no que se refere a fatores prognósticos, e propor um sistema histológico de pontuação com significado prognóstico. MATERIAL E MÉTODO: Vinte casos (14 do sexo feminino e 6 do sexo masculino) de sarcomas sinoviais não-metastáticos das extremidades tratados entre 1985 e 1998 no departamento de Ortopedia foram avaliados retrospectivamente no que se refere a fatores prognósticos e está sendo proposto um sistema de pontuação histológico com significado prognóstico. RESULTADOS: A média dos períodos de acompanhamento foi 48,4 meses (mínimo 16 meses, máximo 116). Houve recorrência localizada em 3 casos (15%), sendo a margem cirúrgica microscópica o único fator prognóstico identificado. Sete pacientes (35%) morreram da doença, todos em período pós-operatório médio de 31,7 meses (mínimo 16 meses, máximo 53), todos com metástase pulmonar ou cerebral. A sobrevida foi de 65% em 48,4 meses de acompanhamento. CONCLUSÃO: Os fatores prognósticos desfavoráveis identificados referentes à sobrevida foram: grau histológico alto, tumores proximais de joelho ou cotovelo e necrose espontânea de tumor acima de 25%. Neste estudo, a recorrência localizada não influiu na sobrevida. Parece que a presença de mastócitos influi positivamente na sobrevida, porém não obtivemos significado estatístico (p=0,07). O resultado oncológico e funcional foi bom em seis casos (30%), regular em sete (35%) e insatisfatório em sete (35%).

PURPOSE: To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS: The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).

Alguns testes sorológicos têm sido utilizados para detectar, indiretamente, a presença de possíveis agentes etiológicos infecciosos durante a gestação, que sendo transmitidos ao feto, por via placentária, causam infecções congênitas com seqüelas leves ou graves e até morte fetal. Foram estudadas 481 gestantes, com idade média de 24,5 anos (de 14 a 46 anos), atendidas em primeira consulta nos Centros de Saúde, na Cidade de São Paulo, SP (Brasil) no período de abril a outubro de 1988. Segundo o trimestre gestacional, 230 pacientes (47,8%) estavam no primeiro trimestre; 203 (42,2%) no 2º e 48 (10,0%) no 3º. Das 474 pacientes que declararam algum tipo de renda mensal, 309 (65,2%) pertenciam a familias com renda até 1 SMPC (salário mínimo per capita) e somente 15 (3,2%) pertenciam a famílias com renda superior a 3 SMPC, caracterizando o baixo nível econômico das gestantes. Das 481 pacientes 159 (33,1%) eram nascidas no Estado de São Paulo e as 322 (66,9%) restantes eram imigrantes procedentes de outros Estados, destacando-se Bahia (23,1%); Minas Gerais (11,4%); Paraná (7,5%); Paraíba (5,4%) e Pernambuco(5,4%). Foram realizados testes imunodiagnósticos para sífilis, toxoplasmose e doença de Chagas. Foram observados resultados positivos para sífilis em 25 gestantes (5,2%). Para toxoplasmose, 157 (32,4%) não tinham anticorpos em nível detectável e 67 (13,9%) apresentaram títulos elevados, indicativos de infecção ativa, das quais em 6 (10,3%) foram detectados anticorpos da classe IgM. Para doença de Chagas foram encontrados anticorpos específicos em 14 (2,9%) gestantes, sendo que destas, 10 (71,4%) eram procedentes da Bahia e Minas Gerais.

The diagnosis of some infectious diseases contracted during pregnancy is very important, as these diseases can be transmitted to the fetus. Four hundred and eighty-one pregnant women were studied, of an average 24.5 years of age (from 14 to 46), during their first prenatal visit to the State of S. Paulo's Health Care Centres in the subdistrict of Paz (Butantan), City of S. Paulo, Brazil, between April and October, 1988. Classified by trimester of pregnancy, 230 patients (47.8%) fell into the first, 203 (42.2%) into the second and 48 (10%) into the third trimester. Of the 474 patients that declared their income, 309 (65.2%) earned 1 MSPC (minimum salary per capita) per month, which gives some indication of the low socioeconomic status of our patients is. The sorologic tests for syphilis, toxoplasmosis and Chagas' disease were analysed for each patient, more than one technique being used for each. The results were as follows: 25 patients (5.2%) had a positive test for syphilis; in 67 patients (13.9%) active toxoplasmosis was diagnosed (Presence of IgM antibodies in 6); 14 patients (2.9%) were positive for Chagas' disease, among which 10 (71.4%) came from the States of Bahia and Minas Gerais, where this disease has a high prevalence.

Alguns testes sorológicos têm sido utilizados para detectar, indiretamente, a presença de possíveis agentes etiológicos infecciosos durante a gestação, que sendo transmitidos ao feto, por via placentária, causam infecções congênitas com seqüelas leves ou graves e até morte fetal. Foram estudadas 481 gestantes, com idade média de 24,5 anos (de 14 a 46 anos), atendidas em primeira consulta nos Centros de Saúde, na Cidade de São Paulo, SP (Brasil) no período de abril a outubro de 1988. Segundo o trimestre gestacional, 230 pacientes (47,8%) estavam no primeiro trimestre; 203 (42,2%) no 2º e 48 (10,0%) no 3º. Das 474 pacientes que declararam algum tipo de renda mensal, 309 (65,2%) pertenciam a familias com renda até 1 SMPC (salário mínimo per capita) e somente 15 (3,2%) pertenciam a famílias com renda superior a 3 SMPC, caracterizando o baixo nível econômico das gestantes. Das 481 pacientes 159 (33,1%) eram nascidas no Estado de São Paulo e as 322 (66,9%) restantes eram imigrantes procedentes de outros Estados, destacando-se Bahia (23,1%); Minas Gerais (11,4%); Paraná (7,5%); Paraíba (5,4%) e Pernambuco(5,4%). Foram realizados testes imunodiagnósticos para sífilis, toxoplasmose e doença de Chagas. Foram observados resultados positivos para sífilis em 25 gestantes (5,2%). Para toxoplasmose, 157 (32,4%) não tinham anticorpos em nível detectável e 67 (13,9%) apresentaram títulos elevados, indicativos de infecção ativa, das quais em 6 (10,3%) foram detectados anticorpos da classe IgM. Para doença de Chagas foram encontrados anticorpos específicos em 14 (2,9%) gestantes, sendo que destas, 10 (71,4%) eram procedentes da Bahia e Minas Gerais.

The diagnosis of some infectious diseases contracted during pregnancy is very important, as these diseases can be transmitted to the fetus. Four hundred and eighty-one pregnant women were studied, of an average 24.5 years of age (from 14 to 46), during their first prenatal visit to the State of S. Paulo's Health Care Centres in the subdistrict of Paz (Butantan), City of S. Paulo, Brazil, between April and October, 1988. Classified by trimester of pregnancy, 230 patients (47.8%) fell into the first, 203 (42.2%) into the second and 48 (10%) into the third trimester. Of the 474 patients that declared their income, 309 (65.2%) earned 1 MSPC (minimum salary per capita) per month, which gives some indication of the low socioeconomic status of our patients is. The sorologic tests for syphilis, toxoplasmosis and Chagas' disease were analysed for each patient, more than one technique being used for each. The results were as follows: 25 patients (5.2%) had a positive test for syphilis; in 67 patients (13.9%) active toxoplasmosis was diagnosed (Presence of IgM antibodies in 6); 14 patients (2.9%) were positive for Chagas' disease, among which 10 (71.4%) came from the States of Bahia and Minas Gerais, where this disease has a high prevalence.