ABSTRACT Purpose: Determine the sociodemographic and nutritional factors associated with anemia in children aged 1 to 5 years in Peru according to the Demographic and Health Survey (DHS). Methods: To determine the possible sociodemographic and nutritional factors associated with anemia, a sub-analysis of the DHS 2017 was carried out, taking into account a 95% confidence interval and considering the complexity of survey parameters. Relative frequencies were described in univariate analysis. For bivariate analysis, the chi-square test was used for categorical variables and Student t-test for continuous variables. For the multivariable analysis, a crude and an adjusted Poisson regression was done with backward method for variable selection. Main results: Independently associated factors were low wealth (aPR: 1.23; 95% CI: 1.0-1.4), no degree or primary education level of the mother (aPR: 1.25; 95%CI: 1.0-1.5), mother’s age under 19 years (aPR: 1.34; 95%CI: 1.1-1.7), not delivering in a health facility (aPR: 1.24; 95%CI: 1.1-1.5), no consumption of antiparasitic drugs (aPR: 1.13; 95%CI: 1.0-1.3) and living at greater than or equal to 4000 meters above sea level (aPR: 1.45; 95%CI: 1.2-1.8). Conclusions: The prevalence of anemia in children aged 1 to 5 years in 2017 was moderate. There are sociodemographic and nutritional factors associated with this condition.

RESUMEN Objetivo: Determinar los factores sociodemográficos y nutricionales asociados a la anemia en niños de 1 a 5 años de Perú según la Encuesta Nacional Demográfica y de Salud Familiar (DHS, por sus siglas en inglés Demographic and Health Survey). Metodología: Para determinar los posibles factores sociodemográficos y nutricionales asociados a la anemia, se hizo un subanálisis de la DHS 2017, tomando en cuenta un intervalo de confianza del 95% y considerando los parámetros de complejidad de la encuesta. Se describieron las frecuencias relativas en el análisis univariado. Para el análisis bivariado se empleó el test de chi cuadrado para las variables categóricas y t-Student para las variables continuas. Para el modelo de regresión múltiple, se realizó una regresión de Poisson cruda y ajustada con el método de selección de variables tipo backward. Principales resultados: La prevalencia de anemia fue de 38.5%. Los factores independientemente asociados fueron quintil de riqueza bajo (RP(a): 1,23; IC95%: 1,0-1,4), ningún grado de instrucción o grado de instrucción primaria de la madre (RP(a): 1,25; IC95%: 1,0-1,5), edad de la madre menor de 19 años (RP(a): 1,34; IC95%: 1,1-1,7), lugar del parto no institucionalizado (RP(a): 1,24; IC95%: 1,1-1,5), no consumo de antiparasitarios (RP(a): 1,13; IC95%:1,0-1,3) y altitud mayor o igual a 4000 msnm (RP(a): 1,45; IC95%: 1,2-1,8). Conclusiones: La prevalencia de anemia en niños de 1 a 5 años en el 2017 fue moderada. Existen factores sociodemográficos y nutricionales asociados a dicha condición.

Abstract Objectives: To determine the association between sociodemographic and reproductive factors with unwanted additional fertility (UAF) in Peru. Materials and methods: We carried out an observational, cross-sectional analytical study based on the 2018 Demographic and Family Health Survey (DHS) in Peru. The UAF variable was defined as the numerical difference between the general fertility rate and the total fertility rate. This variable was divided into 2 categories, UAF was considered when the numerical difference was positive. The Poisson regression was used, both crude and adjusted. Results: We analyzed data from 6,944 women with an average age of 44.3 years (range, 40 to 49). The prevalence of UAF was found to be 72.5% (95% CI: 70.4%-74.4%). In the adjusted model, patients in the top wealth quintile (aPR 0.80; 95% CI: 0.69-0.93) were found to have a lower probability of having unwanted pregnancies when compared to those in the middle quintile. On the other hand, patients from rural areas (aPR 1.07; 95% CI: 1.01-1.14) had a higher probability of having unwanted pregnancies when compared to those from urban áreas. Conclusions: The prevalence of UAF in Peruvian women between 40 and 49 years old who participated in the 2018 DHS is high. Patients from rural areas have a higher probability of having unwanted pregnancies, and those in the top wealth quintile have a lower probability.

Resumen Objetivos: Determinar la asociación entre los factores sociodemográficos y reproductivos con la fecundidad adicional no deseada (FAND) en el Perú. Materiales y métodos: Se realizó un estudio observacional, analítico transversal, a partir de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018 en el Perú. La FAND es una variable que se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada. La variable FAND, se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada y se agrupó en dos categorías donde la diferencia numérica positiva correspondió a la presencia de FAND. Se realizó una regresión de Poisson, tanto cruda como ajustada. Resultados: Se analizaron los datos de 6944 mujeres entre 40 y 49 años, con una edad promedio de 44,3 años. Se halló una prevalencia de FAND de 72,5% (IC95%: 70,4%-74,4%). En el modelo ajustado, se observó que pertenecer al quintil superior de riqueza (RPa 0,80; IC95%: 0,69-0,93) disminuía la probabilidad de FAND con respecto al quintil intermedio. Por otro lado, provenir del ámbito rural (RPa 1,07; IC95%: 1,01-1,14), aumenta la probabilidad de FAND con respecto al provenir del ámbito urbano. Conclusiones: La prevalencia de FAND en mujeres peruanas de 40 a 49 años que participaron de la ENDES 2018 es alta. Provenir del área rural aumenta la probabilidad de FAND; y pertenecer al quintil superior de riqueza, la disminuye.

Abstract Objectives: To determine the association between sociodemographic and reproductive factors with unwanted additional fertility (UAF) in Peru. Materials and methods: We carried out an observational, cross-sectional analytical study based on the 2018 Demographic and Family Health Survey (DHS) in Peru. The UAF variable was defined as the numerical difference between the general fertility rate and the total fertility rate. This variable was divided into 2 categories, UAF was considered when the numerical difference was positive. The Poisson regression was used, both crude and adjusted. Results: We analyzed data from 6,944 women with an average age of 44.3 years (range, 40 to 49). The prevalence of UAF was found to be 72.5% (95% CI: 70.4%-74.4%). In the adjusted model, patients in the top wealth quintile (aPR 0.80; 95% CI: 0.69-0.93) were found to have a lower probability of having unwanted pregnancies when compared to those in the middle quintile. On the other hand, patients from rural areas (aPR 1.07; 95% CI: 1.01-1.14) had a higher probability of having unwanted pregnancies when compared to those from urban áreas. Conclusions: The prevalence of UAF in Peruvian women between 40 and 49 years old who participated in the 2018 DHS is high. Patients from rural areas have a higher probability of having unwanted pregnancies, and those in the top wealth quintile have a lower probability.

Resumen Objetivos: Determinar la asociación entre los factores sociodemográficos y reproductivos con la fecundidad adicional no deseada (FAND) en el Perú. Materiales y métodos: Se realizó un estudio observacional, analítico transversal, a partir de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018 en el Perú. La FAND es una variable que se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada. La variable FAND, se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada y se agrupó en dos categorías donde la diferencia numérica positiva correspondió a la presencia de FAND. Se realizó una regresión de Poisson, tanto cruda como ajustada. Resultados: Se analizaron los datos de 6944 mujeres entre 40 y 49 años, con una edad promedio de 44,3 años. Se halló una prevalencia de FAND de 72,5% (IC95%: 70,4%-74,4%). En el modelo ajustado, se observó que pertenecer al quintil superior de riqueza (RPa 0,80; IC95%: 0,69-0,93) disminuía la probabilidad de FAND con respecto al quintil intermedio. Por otro lado, provenir del ámbito rural (RPa 1,07; IC95%: 1,01-1,14), aumenta la probabilidad de FAND con respecto al provenir del ámbito urbano. Conclusiones: La prevalencia de FAND en mujeres peruanas de 40 a 49 años que participaron de la ENDES 2018 es alta. Provenir del área rural aumenta la probabilidad de FAND; y pertenecer al quintil superior de riqueza, la disminuye.

Relatar um caso de sobrecarga de ferro secundária à xerocitose, uma doença rara, em uma adolescente, diagnosticada por meio de ressonância magnética em T2*. Relatamos o caso de uma paciente sintomática com xerocitose, nível de ferritina de 350ng/mL e sobrecarga de ferro cardíaca significativa. Ela foi diagnosticada por ressonância magnética em T2* e recebeu terapia de quelação. Análise por ectacitometria confirmou o diagnóstico de xerocitose hereditária. Na sequência, a ressonância magnética em T2* demonstrou resolução completa da sobrecarga de ferro em vários órgãos e novo ecocardiograma revelou resolução completa das alterações cardíacas anteriores. A paciente permanece em terapia de quelação. Xerocitose é uma desordem genética autossômica dominante rara, caracterizada por estomatocitose desidratada. O paciente pode apresentar fadiga intensa e sobrecarga de ferro. Sugerimos o uso regular de ressonância magnética em T2* para o diagnóstico e controle da resposta à quelação de ferro em xerocitose e acreditamos que o exame pode ser útil também em outras anemias hemolíticas que necessitam de transfusões.

To report a case of iron overload secondary to xerocytosis, a rare disease in a teenager, diagnosed, by T2* magnetic resonance imaging. We report the case of a symptomatic patient with xerocytosis, a ferritin level of 350ng/mL and a significant cardiac iron overload. She was diagnosed by T2* magnetic resonance imaging and received chelation therapy Ektacytometric analysis confirmed the diagnosis of hereditary xerocytosis. Subsequent T2* magnetic resonance imaging demonstrated complete resolution of the iron overload in various organs, as a new echocardiography revealed a complete resolution of previous cardiac alterations. The patient remains in chelation therapy. Xerocytosis is a rare autosomal dominant genetic disorder characterized by dehydrated stomatocytosis. The patient may present with intense fatigue and iron overload. We suggest the regular use of T2* magnetic resonance imaging for the diagnosis and control of the response to iron chelation in xerocytosis, and we believe it can be used also in other hemolytic anemia requiring transfusions.

OBJETIVO: Avaliar dois tipos de correção de hérnias inguinais sem o uso de tela e avaliar a taxa de recidiva. MÉTODOS: Foram operados sequencialmente 98 homens e 15 mulheres portadores de 144 hérnias inguinais unilaterais ou bilaterais entre dezembro de 1988 e abril de 2007. As cirurgias foram realizadas por dois cirurgiões experientes e divididas em dois grupos: reconstruções pela técnica de Bassini ou McVay. Os reforços tipo Bassini foram utilizados para hérnias do tipo Nyhus II e IIIB, em que havia menor destruição da parede posterior do canal inguinal. Os pacientes com hérnias do tipo Nyhus IIIA e Nyhus IIIB, em que havia maior destruição da fáscia transversalis, e Nyhus IIIC foram submetidos à técnica de McVay. RESULTADOS: Setenta e cinco hérnias foram corrigidas utilizando-se a técnica de McVay. Somente duas recidivas (2,67%) foram observadas nesse grupo. No grupo Bassini, foram observadas duas recidivas (2,89%) entre 69 hérnias operadas (p=0,658). A média de idade para o grupo de pacientes com recidiva foi de 56 anos. Não foram observadas diferenças de idades entre homens e mulheres (52 anos). CONCLUSÃO: Os reparos sem telas nas hérnias inguinais podem ser seguramente utilizados, se realizados por cirurgiões experientes.

OBJECTIVE: To evaluate two types of meshless open inguinal repair and to evaluate the recurrence rate. METHODS: We operated on sequentially 98 men and 15 women with 144 unilateral or bilateral inguinal hernias between December 1988 and April 2007. The surgeries were performed by two experienced surgeons and divided into two groups: Bassini or McVay reconstructive surgery techniques. Bassini type reinforcements were employed for Nyhus II and IIIB with minor destruction of the posterior wall. Patients with Nyhus type IIIA, type IIIB with major destruction of the fascia transversalis, and type IIIC were subjected to the McVay technique. RESULTS: Seventy-five hernias were corrected using the McVay technique. Only two recurrences (2.67%) were observed in this group. For group Bassini, two recurrences for 69 hernias (2.89%) were observed (p=0.658). Mean age for the recurrent group was 56 years. No differences were observed between the ages of males and females (52 years). CONCLUSIONS: Non-mesh repair in inguinal hernia can be safely used if performed by experienced surgeons.

O pico de incidência do linfoma de Hodgkin coincide com a idade fértil feminina, sendo atualmente a quarta neoplasia mais diagnosticada na gravidez. Entretanto, não existe consenso na literatura sobre como tratar essas pacientes, devido aos riscos da quimioterapia tanto para a gestante quando para o feto. Relatamos três casos de gestantes acometidas por linfoma de Hodgkin e realizamos a revisão de literatura com o objetivo sugerir um protocolo de tratamento para essas pacientes.

The peak frequency of Hodgkin's disease convergesmatches with women of reproductive fertility age. Currently, this disease is the fourth more diagnosed neoplasia during pregnancy. In addition, there is no consensus in the literature on how to treat pregnant women because of the risks of chemotherapy for mothers and for fetuses. We report three cases of pregnant women with Hodgkin's disease. A review of the literature was made aiming to suggest a protocol to treat these patients.

OBJETIVO: Correlacionar a localização das alterações clínicas de portadores de linfedema com as dos achados linfocintilográficos. MÉTODO: Foram avaliados 34 pacientes com linfedema dos membros inferiores atendidos no Setor de Linfologia da Disciplina de Cirurgia Vascular da Faculdade de Medicina do ABC. As linfocintilografias com imagens adquiridas em dois tempos - 20 minutos e 3 horas - foram analisadas quanto aos seguintes parâmetros: vasos linfáticos, refluxo dérmico, circulação colateral, linfonodos poplíteos e inguinais. Correlacionaram-se os resultados com a localização do edema no membro: grupo A (sem edema), grupo B (pé), grupo C (tornozelo), grupo D (perna) e grupo E (coxa). RESULTADO: A maioria das imagens linfocintilográficas apresentou anormalidades nos vasos linfáticos e linfonodos inguinais e pouca alteração em relação aos outros parâmetros. Dos 34 pacientes, 12 apresentaram linfedema unilateral clinicamente. Destes, 11 apresentaram alteração linfocintilográfica bilateral. CONCLUSÃO: A localização do linfedema ao exame físico não correspondeu, na maioria dos casos, às alterações linfocintilográficas. Em todos os grupos, as alterações linfocintilográficas ocorreram na perna e na coxa. O exame físico do membro pode estar normal e ainda assim apresentar anormalidades na linfocintilografia.

OBJECTIVE: To correlate the location of clinical alterations of patients with lymphedema with lymphoscintigraphic findings. METHOD: Thirty-four patients with lower limb lymphedema were assessed at the Service of Lymphology at the Faculdade de Medicina do ABC. The lymphoscintigraphic images were acquired at 20 minutes and 3 hours and analyzed according to the following parameters: lymphatic vessels, dermal backflow, collateral circulation, popliteal and inguinal lymph nodes. Results were correlated with the location of the edema in the limb: group A (without edema), group B (foot), group C (ankle), group D (leg), and group E (thigh). RESULT: Most lymphoscintigraphic images presented abnormalities in lymphatic vessels and inguinal lymph nodes, and few alterations concerning the other parameters. Of the 34 patients, 12 had clinically unilateral lymphedema. Of these, 11 had bilateral lymphoscintigraphic alterations. CONCLUSION: The location of the lymphedema at physical examination did not corresponded, in most cases, to the lymphoscintigraphic alterations. In all groups, the lymphoscintigraphic alterations occurred in the leg and thigh. The physical examination of the limb may be normal, even though the lymphoscintigraphy could be abnormal.