ABSTRACT Since the World has been facing the COVID-19 pandemic, special attention has been taken concerning cancer patients; related to their immunosuppression status, adding risk for more aggressive COVID-19 and mortality, but also concerns about the access and the quality of care in cancer therapy. The COVID-19 pandemic impacts the number of infected, its related mortality, as well as the care of cancer patients. Multiple myeloma patients are a particular group with several important aspects to be considered during pandemic times. In essence, they are immunosuppressed in different intensities during their treatment. Most of them are elderly and all of them require long-term therapy, with prolonged contact with the health care system, possibly including a stem cell transplant during the treatment. A panel of experts in multiple myeloma and infectious diseases discusses pieces of evidence and the lack of the same in the scenario of COVID-19 in myeloma patients, while also exposing what is expected for the next phases of the COVID-19 pandemic.

ABSTRACT Background: The treatment of multiple myeloma (MM) has evolved significantly in the past decade, and new drug combinations have improved the response rates and prolonged survival. Studies comparing different induction chemotherapy regimens have shown that triple combinations have better results than double combinations. However, comparisons among different triple combinations are rare in the literature. Methods: We retrospectively compared two triple combinations comprising bortezomib, cyclophosphamide and dexamethasone (VCD) versus thalidomide, cyclophosphamide and dexamethasone (CTD), and aimed at identifying which of the two combinations would yield better response rates following four induction cycles prior to hematopoietic cell transplantation in patients with untreated multiple myeloma. Results: We retrospectively reviewed the medical records of 311 patients from 24 different centers.The VCD regimen was used as induction therapy by 117 (37.6%) patients, whereas 194 (62.4%) patients received the CTD regimen. After four cycles of induction on an intention-to-treat basis, 54% of the patients in the VCD group achieved at least very good partial response versus 42.8% in the CTD group (p = 0.05). We observed no difference in neuropathy or thrombotic events rates among the two regimens. Conclusion: Our results corroborate the superiority of the triple combination regimes containing bortezomib over the triple combination with thalidomide as pre ASCT induction therapy in MM.

Abstract Background: Urinary parameters, anti-dsDNA antibodies and complement tests were explored in patients with childhood-Systemic Lupus Erythematosus (cSLE) early-onset lupus nephritis (ELN) from a large multicenter cohort study. Methods: Clinical and laboratory features of cSLE cases with kidney involvement at presentation, were reviewed. Disease activity parameters including SLEDAI-2 K scores and major organ involvement at onset and follow up, with accrued damage scored by SLICC-DI, during last follow up, were compared with those without kidney involvement. Autoantibodies, renal function and complement tests were determined by standard methods. Subjects were grouped by presence or absence of ELN. Results: Out of the 846 subjects enrolled, mean age 11.6 (SD 3.6) years; 427 (50.5%) had ELN. There was no significant difference in the ELN proportion, according to onset age, but ELN frequency was significantly higher in non-Caucasians (p = 0.03). Hematuria, pyuria, urine casts, 24-h proteinuria and arterial hypertension at baseline, all had significant association with ELN outcome (p < 0.001). With a similar follow up time, there were significantly higher SLICC-DI damage scores during last follow up visit (p = 0.004) and also higher death rates (p < 0.0001) in those with ELN. Low C3 (chi-square test, p = 0.01), but not C3 levels associated significantly with ELN. High anti-dsDNA antibody levels were associated with ELN (p < 0.0001), but anti-Sm, anti-RNP, anti-Ro, anti-La antibodies were not associated. Low C4, C4 levels, low CH50 and CH50 values had no significant association. High erythrocyte sedimentation rate (ESR) was associated with the absence of ELN (p = 0.02). Conclusion: The frequency of ELN was 50%, resulting in higher morbidity and mortality compared to those without ELN. The urinary parameters, positive anti-dsDNA and low C3 are reliable for discriminating ELN.

RESUMO Ao longo deste artigo procuramos avaliar a robustez teórica do assim chamado Novo Teorema de Pasinetti, segundo o qual numa economia na qual a diferenciação entre as propensões a poupar a partir dos lucros e dos salários deve-se a natureza da renda empresarial, não a filiação a uma classe social específica; a taxa de lucro ao longo da trajetória de crescimento de Golden Age é independente da propensão a poupar dos trabalhadores, sendo determinada pelo coeficiente de retenção de lucros das firmas, pela fração do investimento que as empresas desejam financiar com recursos de terceiros e pela taxa natural de crescimento.

ABSTRACT Throughout this article we try to evaluate the theoretical robustness of the so-called New Theorem of Pasinetti, according to which in an economy in which the differentiation between the propensities to save from the profits and the salaries is due to the nature of the business income, not the affiliation to a specific social class; the rate of profit along the Golden Age growth path is independent of workers ‘propensity to save, being determined by the firms’ profit retention coefficient, by the fraction of the investment firms wish to finance with third-party resources and by the natural rate growth.

ABSTRACT The control of dyslipidemia by using herbal products is an important subject for studies. In this study, we evaluated the effects of dry Passiflora incarnata L. extract over dyslipidemia, left ventricular hypertrophy, and hepatic oxidative stress of LDL receptor knockout mice (LDLr-/-). Forty 4-month old male LDLr-/- mice were distributed into four groups: Group standard diet; Group standard diet and 200 mg/kg of body weight of Passiflora incarnata L. leaf dry extract; Group high-fat diet; Group high-fat diet and 200 mg/kg of body weight of Passiflora incarnata L. leaf dry extract. After 30 days, Passiflora incarnata L. dry extract reduced the effects of the high-fat diet, with a decrease of total cholesterol, triglycerides, and increase of high-density lipoprotein (HDL), as well as a reduction of C-reactive protein, alkaline phosphatase and insulin. There was no effect on glucose, Homa index and enzymes aspartate aminotransferase and alanine aminotransferase. However, the prevention of left ventricular hypertrophy occurred, as well as lipid peroxidation and the production of carbonyl proteins, which are both oxidative stress markers. In conclusion, Passiflora incarnata L. dry extract acts in the prevention of dyslipidemia, consequently, hindering the occurrence of hepatic oxidative stress and the development of left ventricular hypertrophy by the increase of serum HDL, in mice that had the effects of a high-fat diet.

ABSTRACT Despite the high number of accidents due to scorpion stings in Brazil, severe cases in adults are seldomly reported. In the Northeast region of Brazil, Tityus stigmurus is the most prevalent species. A 69 year-old woman who was stung by a scorpion attended the emergency room 5 hours after envenomation. She got worse due to abdominal pain. Clinical findings were concordant with class III scorpion envenomation (major systemic manifestations), complicated by acute kidney injury and acute pancreatitis. Intensive supportive therapy was adopted. In the follow-up, 3 months later, she was completely recovered. This report is being brought to recommend the thorough management of victims of scorpion accidents, enabling early diagnosis of severe complications, which could lead to death if aggressive supportive measures are not early and adequately taken.

Fundamento: A reserva de velocidade de fluxo coronariano (RVFC) ≥ 2 é adequada para inferir bom prognóstico ou ausência de coronariopatia importante. Objetivo: Identificar parâmetros relevantes na obtenção da RVFC (adequada ou inadequada) na descendente anterior (ADA), durante o ecocardiograma sob estresse com dobutamina (EED). Métodos: Avaliação de 100 pacientes encaminhados para pesquisa de isquemia miocárdica através do EED, orientados para suspender o betabloqueador 72 horas antes do exame. Calculou-se a RVFC pela divisão do pico de velocidade (cm/s) diastólica (PVD) verificado no EED (PVD-EED) pelo de repouso (PVD-REP). No grupo I, a RVFC < 2 e no grupo II a RVFC ≥ 2. Foram utilizados o teste t de Student e o exato de Fisher. Significância estatística quando p < 0,05. Resultados: Em repouso, o tempo (segundos) para obter o Doppler na ADA nos grupos I e II não diferiu (53 ± 31 vs. 45 ± 32; p = 0,23). No EED, registrou-se a ADA em 92 pacientes. O grupo I evidenciou pacientes mais velhos (65,9 ± 9,3 vs. 61,2 ± 10,8 anos; p = 0,04), menor fração de ejeção (61 ± 10 vs. 66 ± 6%; p = 0,005), maior PVD-REP (36,81 ± 08 vs. 25,63 ± 06 cm/s; p < 0,0001) e menor RVFC (1,67 ± 0,24 vs. 2,53 ± 0,57; p < 0,0001), entretanto o PVD-EED não diferiu (61,40 ± 16 vs. 64,23 ± 16 cm/s; p = 0,42). A suspensão do betabloqueador associou-se à chance 4 vezes maior de ocorrer RVFC < 2 (OR = 4; 95% IC [1,171 - 13,63], p = 0,027). Conclusão: O PVD-REP foi o principal parâmetro para determinar uma RVFC adequada. A suspensão do betabloqueador associou-se significativamente com RVFC inadequada. A elevada exequibilidade e o tempo para registro da ADA favorecem a utilização dessa metodologia.

Background: A coronary flow velocity reserve (CFVR) ≥ 2 is adequate to infer a favorable prognosis or the absence of significant coronary artery disease. Objective: To identify parameters which are relevant to obtain CFVR (adequate or inadequate) in the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE). Methods: 100 patients referred for detection of myocardial ischemia by DSE were evaluated; they were instructed to discontinue the use of β-blockers 72 hours prior to the test. CFVR was calculated as a ratio of the diastolic peak velocity (cm/s) (DPV) on DSE (DPV-DSE) to baseline DPV at rest (DPV-Rest). In group I, CFVR was < 2 and, in group II, CFVR was ≥ 2. The Fisher's exact test and Student's t test were used for the statistical analyses. P values < 0.05 were considered statistically significant. Results: At rest, the time (in seconds) to obtain Doppler in LAD in groups I and II was not different (53±31 vs. 45±32; p=0.23). During DSE, LAD was recorded in 92 patients. Group I patients were older (65.9±9.3 vs. 61.2±10.8 years; p=0.04), had lower ejection fraction (61±10 vs. 66±6%; p=0.005), higher DPV-Rest (36.81±08 vs. 25.63 ± 06cm/s; p<0.0001) and lower CFVR (1.67 ± 0.24 vs. 2.53 ± 0.57; p<0.0001), but no difference was observed regarding DPVDSE (61.40±16 vs. 64.23±16cm/s; p=0.42). β-blocker discontinuation was associated with a 4-fold higher chance of a CFVR < 2 (OR= 4; 95% CI [1.171-13.63], p=0.027). Conclusion: DPV-Rest was the main parameter to determine an adequate CFVR. β-blocker discontinuation was significantly associated with inadequate CFVR. The high feasibility and the time to record the LAD corroborate the use of this methodology.

ABSTRACT Introduction: Complex procedures and implants are required in the final stages of chest wall reconstruction after tumor excision. This process requires multidisciplinary care with participation from thoracic and plastic surgeons, a radiologist, and a physical therapist. The goal of this study was to describe the options for chest wall reconstruction after neoplasm resection at Hospital Sarah Brasilia. Method: A retrospective study of one-time chest wall reconstruction after tumor excision, respiratory physical therapy with noninvasive ventilation, and exercises was conducted. Results: Between 2007 and 2012, 10 patients underwent surgery (seven men, three women; age range: 10-31 years); eight patients had metastatic thoracic tumors (e.g., osteosarcoma, synovial sarcoma, sclerosing epithelioid fibrosarcoma, and rhabdomyosarcoma) and two had tumors originating from the chest wall (fibromatosis and chondrosarcoma). The outcomes were good after the immediate postoperative period, with extubation occurring at the end of surgery and chest tube removal between the fifth and eighth postoperative day. Three cases (30%) involved complications of atelectasis (10%), tumor recurrence (10%), or death. Conclusion: One-time chest wall reconstruction using polypropylene mesh, polymethylmethacrylate, and muscle flaps was possible and was associated with early recovery of pulmonary function and a low rate of immediate complications.

RESUMO Introdução: Nos estágios finais da reconstrução torácica, consequente a exéreses tumorais, são necessários procedimentos complexos e implantes. O que requer cuidados multidisciplinares, com a participação dos cirurgiões torácicos, plástico, radiologista e fisioterapeuta. O objetivo foi descrever as opções de reconstrução torácica após ressecção de neoplasia, realizado no Hospital Sarah Brasília. Método: Estudo retrospectivo de reconstrução torácica em tempo único, após excisão de tumor, fisioterapia respiratória com ventilação não invasiva e exercícios. Resultados: Entre 2007 a 2012 foram operados 10 pacientes, sete homens e três mulheres; idade 10 a 31 anos; oito apresentavam tumores torácicos metastáticos (osteosarcoma, sinoviosarcoma, Fibrosarcoma epitelioide esclerosante e Rabdomiosarcoma) e dois originários da parede torácica (fibromatose e condrosarcoma). Observou-se boa evolução no pós-operatório imediato, com extubação ao final da cirurgia, retirada do dreno torácico entre 5° e 8° PO. As complicações foram: atelectasia (10%), recorrência tumoral (10%), e óbito em 3 (30%) casos . Conclusão: Foi possível a reconstrução torácica em tempo único utilizando tela de polipropileno, polimetilmetacrilato e retalhos musculares, com recuperação precoce da função pulmonar e baixo índice de complicações imediatas.

Embolia balística é uma complicação rara de ferimentos por arma de fogo. Apresentamos um caso de um homem de 24 anos, vítima de um ferimento por arma de fogo em hemitórax posterior esquerdo (região escapular), sem orifício de saída. Radiografias e tomografia computadorizada do abdome evidenciaram um projétil em topografia intra-abdominal (intra-hepática); no entanto, a laparotomia exploradora demonstrou ausência de lesões intra-abdominais. Após a cirurgia, novo exame tomográfico revelou a migração da bala para a região da veia ilíaca interna (VII) direita. Realizada uma flebografia, esta confirmou a migração do projétil para a VII direita; tentou-se retirar o projétil durante o procedimento, sem sucesso. Optou-se, então, por deixá-la impactada na VII direita e manter o paciente em anticoagulação oral. O paciente evoluiu sem intercorrências até o sexto mês de seguimento.

Bullet embolism is a rare complication of penetrating gunshots. We present a case of a 24-year-old man with a gunshot wound in the left scapular area, with no exit wound. Abdominal X-rays and a computed tomography (CT) scan suggested that the bullet was located within the intra-abdominal topography (intrahepatic), but laparotomy revealed no intra-abdominal injuries. After surgery, a sequential CT scan showed that the bullet had migrated to the right internal iliac vein (IIV). Venography confirmed the diagnosis of right IIV embolism and the decision was taken to attempt snare retrieval of the bullet, which was unsuccessful. It was therefore decided to leave the missile impacted inside the right IIV and the patient was put on oral anticoagulation. The patient recovered and was event free at 6 months' follow up.

Introduction Human migration and the presence of natural vectors (mollusks) of Schistosoma mansoni are the primary causes of the expansion of mansoni schistosomiasis into southern areas of South America. Water conditions are favorable for the expansion of this disease because of the extensive hydrographic network, which includes the basins of the Paraná and Uruguay rivers and favors mollusk reproduction. These rivers also aid agriculture and tourism in the area. Despite these favorable conditions, natural infection by S. mansoni has not yet been reported in Argentina, Uruguay, or Paraguay. Methods Two species of planorbid from Argentina, Biomphalaria straminea and B. tenagophila, were exposed to the miracidia of five Brazilian strains of S. mansoni. Results Biomphalaria tenagophila (Atalaya, Buenos Aires province) was infected with the SJS strain (infection rate 3.3%), confirming the experimental susceptibility of this Argentinian species. Biomphalaria straminea (Rio Santa Lucía, Corrientes province) was susceptible to two Brazilian strains: SJS (infection rate 6.7%) and Sergipe (infection rate 6.7%). Conclusions These results demonstrate that species from Argentina have the potential to be natural hosts of S. mansoni and that the appearance of foci of mansoni schistosomiasis in Argentina is possible.

The objective of the study was to validate the content of the dimensions that constituted nonadherence to treatment of arterial systemic hypertension. It was a methodological study of content validation. Initially an integrative review was conducted that demonstrated four dimensions of nonadherence: person, disease/treatment, health service, and environment. Definitions of these dimensions were evaluated by 17 professionals, who were specialists in the area, including: nurses, pharmacists and physicians. The Content Validity Index was calculated for each dimension (IVCi) and the set of the dimensions (IVCt), and the binomial test was conducted. The results permitted the validation of the dimensions with an IVCt of 0.88, demonstrating reasonable systematic comprehension of the phenomena of nonadherence.

El objetivo del estudio fue realizar la validación del contenido de las dimensiones que constituyen la falta de adherencia al tratamiento de la hipertensión arterial sistémica. Estudio metodológico de validación del contenido. Inicialmente se realizó una revisión integradora que demostró cuatro dimensiones de la falta de adherencia: persona, enfermedad/tratamiento, servicio de salud y ambiente. Las definiciones de estas dimensiones fueron evaluadas por 17 profesionales expertos en el tema, entre ellos enfermeras, farmacéuticos y médicos. Se calculó el Índice de Validez del Contenido de cada dimensión (IVCi) y del conjunto de las dimensiones (IVCt), y se realizó la prueba binomial. Los resultados permitieron la validación de las dimensiones con un IVCt de 0.88, demostrando razonable comprensión sistémica del fenómeno de la falta de adherencia.

O objetivo do estudo foi realizar a validação de conteúdo das dimensões constitutivas da não adesão ao tratamento da Hipertensão Arterial Sistêmica. Estudo metodológico de validação de conteúdo. Inicialmente foi realizada uma revisão integrativa que demonstrou quatro dimensões da não adesão: pessoa, doença/tratamento, serviço de saúde e ambiente. As definições dessas dimensões foram avaliadas por 17 profissionais especialistas na temática, entre enfermeiros, farmacêuticos e médicos. Foi calculado o Índice de Validade de Conteúdo de cada dimensão (IVCi) e do conjunto das dimensões (IVCt) e realizado o teste binomial. Os resultados permitiram a validação das dimensões com um IVCt de 0,88, demonstrando razoável compreensão sistêmica do fenômeno da não adesão.

O objetivo do estudo foi realizar a validação de conteúdo das dimensões constitutivas da não adesão ao tratamento da Hipertensão Arterial Sistêmica. Estudo metodológico de validação de conteúdo. Inicialmente foi realizada uma revisão integrativa que demonstrou quatro dimensões da não adesão: pessoa, doença/tratamento, serviço de saúde e ambiente. As definições dessas dimensões foram avaliadas por 17 profissionais especialistas na temática, entre enfermeiros, farmacêuticos e médicos. Foi calculado o Índice de Validade de Conteúdo de cada dimensão (IVCi) e do conjunto das dimensões (IVCt) e realizado o teste binomial. Os resultados permitiram a validação das dimensões com um IVCt de 0,88, demonstrando razoável compreensão sistêmica do fenômeno da não adesão.

The objective of the study was to validate the content of the dimensions that constituted nonadherence to treatment of arterial systemic hypertension. It was a methodological study of content validation. Initially an integrative review was conducted that demonstrated four dimensions of nonadherence: person, disease/treatment, health service, and environment. Definitions of these dimensions were evaluated by 17 professionals, who were specialists in the area, including: nurses, pharmacists and physicians. The Content Validity Index was calculated for each dimension (IVCi) and the set of the dimensions (IVCt), and the binomial test was conducted. The results permitted the validation of the dimensions with an IVCt of 0.88, demonstrating reasonable systematic comprehension of the phenomena of nonadherence.

El objetivo del estudio fue realizar la validación del contenido de las dimensiones que constituyen la falta de adherencia al tratamiento de la hipertensión arterial sistémica. Estudio metodológico de validación del contenido. Inicialmente se realizó una revisión integradora que demostró cuatro dimensiones de la falta de adherencia: persona, enfermedad/tratamiento, servicio de salud y ambiente. Las definiciones de estas dimensiones fueron evaluadas por 17 profesionales expertos en el tema, entre ellos enfermeras, farmacéuticos y médicos. Se calculó el Índice de Validez del Contenido de cada dimensión (IVCi) y del conjunto de las dimensiones (IVCt), y se realizó la prueba binomial. Los resultados permitieron la validación de las dimensiones con un IVCt de 0.88, demostrando razonable comprensión sistémica del fenómeno de la falta de adherencia.

A arterite induzida por radiação é uma rara mas bem documentada complicação da radioterapia. O presente relato descreve o caso de uma mulher de 34 anos, diagnosticada com neoplasia de colo do útero, a qual, dois anos após sessões de radioterapia desenvolveu trombose venosa profunda (TVP) iliofemoral esquerda; dois meses depois, durante tratamento para TVP com devida anticoagulação, a paciente apresentou quadro de insuficiência arterial aguda do membro inferior esquerdo secundária a uma longa lesão suboclusiva da artéria ilíaca externa. A paciente foi tratada com angioplastia transluminal percutânea e implantação de stent autoexpansível, recuperando-se sem intercorrências após o procedimento endovascular.

Radiation-induced arteritis is a rare but well-known complication of radiotherapy. This report describes the case of a 34-year-old woman with uterine cervical cancer who was diagnosed with left iliofemoral deep vein thrombosis (DVT) 2 years after radiotherapy, and 2 months later, during the treatment of DVT with effective anticoagulation, developed an episode of acute arterial ischemia of the left lower limb secondary to a long subocclusive lesion of the external iliac artery. The patient was treated with angioplasty and stenting of the lesion and recovered uneventfully after the endovascular procedure.

OBJETIVO Analisar as características das vítimas, vias e veículos envolvidos em acidentes de trânsito e os fatores de risco de acidentes com ocorrência de óbito.  MÉTODOS Estudo de coorte não concorrente considerando os acidentes de trânsito em Fortaleza, CE, de janeiro de 2004 a dezembro de 2008. Foram utilizados dados do Sistema de Informação de Acidente de Trânsito de Fortaleza, do Sistema de Informações de Mortalidade, do Sistema de Informações Hospitalares e dos bancos de dados de Habilitação e Veículos do Departamento Estadual de Trânsito. Técnicas de relacionamento determinístico e probabilístico foram aplicadas para integrar as bases de dados. Efetuou-se a análise descritiva das variáveis relativas às pessoas, às vias, aos veículos e ao tempo. Foram utilizados os modelos lineares generalizados na investigação de fatores de risco para óbito por acidente de trânsito. O ajuste do modelo foi verificado pela razão de verossimilhança e análise ROC.  RESULTADOS Registraram-se 118.830 acidentes no período. Predominaram colisão/abalroamento (78,1%), atropelamentos (11,9%) e choque com obstáculo fixo (3,9%) e com motocicletas (18,1%). Ocorreram óbitos em 1,4% dos acidentes. Estiveram independentemente associados ao óbito por acidente de trânsito: bicicletas (OR = 21,2; IC95% 16,1;27,8), atropelamentos (OR = 5,9; IC95% 3,7;9,2), choque com obstáculo fixo (OR = 5,7; IC95% 3,1;10,5) e acidentes com motociclistas (OR = 3,5; IC95% 2,6;4,6). Os principais fatores contribuintes foram envolvimento de uma única pessoa (OR = 6,6; IC95% 4,1;10,73), presença de condutores não habilitados (OR = 4,1; IC95% 2,9;5,5) um único veículo envolvido (OR = 3,9; IC95% 2,3;6,4), sexo masculino (OR = 2,5; IC95% 1,9;3,3), tráfego em vias de jurisdição federal (OR = 2,4; IC95% 1,8;3,7), horário madrugada (OR = 2,4; IC95% 1,8;3,0) e dia de domingo (OR = 1,7; IC95% 1,3;2,2), todas ajustadas segundo modelo log-binomial.  CONCLUSÕES As ações de promoção e prevenção de acidentes no trânsito devem focar os acidentes com veículos de duas rodas, que mais frequentemente envolvem uma única pessoa, não habilitada, do sexo masculino, em horários noturnos, em finais de semana e nas vias onde se desenvolvem maiores velocidades.

OBJECTIVE : To describe the main characteristics of victims, roads and vehicles involved in traffic accidents and the risk factors involved in accidents resulting in death. METHODS A non-concurrent cohort study of traffic accidents in Fortaleza, CE, Northeastern Brazil, in the period from January 2004 to December 2008. Data from the Fortaleza Traffic Accidents Information System, the Mortality Information System, the Hospital Information System and the State Traffic Department Driving Licenses and Vehicle database. Deterministic and probabilistic relationship techniques were used to integrate the databases. First, descriptive analysis of data relating to people, roads, vehicles and weather was carried out. In the investigation of risk factors for death by traffic accident, generalized linear models were used. The fit of the model was verified by likelihood ratio and ROC analysis. RESULTS There were 118,830 accidents recorded in the period. The most common types of accidents were crashes/collisions (78.1%), running over pedestrians (11.9%), colliding with a fixed obstacle (3.9%), and with motorcycles (18.1%). Deaths occurred in 1.4% of accidents. The factors that were independently associated with death by traffic accident in the final model were bicycles (OR = 21.2, 95%CI 16.1;27.8), running over pedestrians OR = 5.9 (95%CI 3.7;9.2), collision with a fixed obstacle (OR = 5.7, 95%CI 3.1;10.5) and accidents involving motorcyclists (OR = 3.5, 95%CI 2.6;4.6). The main contributing factors were a single person being involved (OR = 6.6, 95%CI 4.1;10.73), presence of unskilled drivers (OR = 4.1, 95%CI 2.9;5.5) a single vehicle (OR = 3.9, 95%CI 2,3;6,4), male (OR = 2.5, 95%CI 1.9;3.3), traffic on roads under federal jurisdiction (OR = 2.4, 95%CI 1.8;3.7), early morning hours (OR = 2.4, 95%CI 1.8;3.0), and Sundays (OR = 1.7, 95%CI 1.3;2.2), adjusted according to the log-binomial model. CONCLUSIONS Activities promoting the prevention of traffic accidents should primarily focus on accidents involving two-wheeled vehicles that most often involves a single person, unskilled, male, at nighttime, on weekends and on roads where they travel at higher speeds.

OBJETIVO Analizar las características de las víctimas, vías y vehículos involucrados en accidentes de tránsito y los factores de riesgo de accidentes con ocurrencia de óbito. MÉTODOS Estudio de cohorte no concurrente considerando los accidentes de tránsito en Fortaleza, CE, de enero de 2004 a diciembre de 2008. Se utilizaron datos del Sistema de Informaciones de Mortalidad, del Sistema de Informaciones Hospitalarias y de los bases de datos de Licencia para conducir y Vehículos del Departamento Estatal de Tránsito. Técnicas de relacionamiento determinístico y probabilístico se aplicaron para integrar las bases de datos. Se efectuó el análisis descriptivo de las variables relacionadas con las personas, las vías los vehículos y el tiempo. Se utilizaron los modelos lineales generalizados en la investigación de los factores de riesgo para óbito por accidente de tránsito. El ajuste del modelo fue verificado por la tasa de vero-semejanza y el análisis ROC. RESULTADOS Se registraron 118.830 accidentes en el período. Predominaron colisión/choque (78,1%), atropellamientos (11,9%), choque con obstáculo fijo (3,9%), con motocicletas (18,1%). Ocurrieron óbitos en 1,4% de los accidentes. Estuvieron independientemente asociados al óbito por accidente de tránsito: bicicletas (OR= 21,2; IC95% 16,1;27,8), atropellamientos (OR= 5,9; IC95% 3,7;9,2), choque con obstáculo fijo (OR= 5,7; IC95% 3,1;10,5) y accidentes con motociclistas (OR= 3,5; IC95% 2,6;4,6). Los principales factores contribuyentes fueron envolvimiento de una única persona (OR= 6,6; IC95% 4,1;10,73), presencia de conductores sin licencia para conducir (OR= 4,1; IC95% 2,9;5,5), un único vehículo involucrado (OR= 3,9; IC95% 2,3;6,4), sexo masculino (OR= 2,5; IC95% 1,9; 3,3), tránsito en vías de jurisdicción federal (OR= 2,4; IC95% 1,8;3,7), horario madrugada (OR= 2,4; IC95% 1,8;3,0), y día domingo (OR= 1,7; IC95% 1,3;2,2), todas ajustadas de acuerdo con el modelo log-binomial. CONCLUSIONES Las acciones de promoción y prevención de accidentes en el tránsito deben enfocarse en accidentes con vehículos de dos ruedas, que más frecuentemente involucran una única persona, sin licencia para conducir, del sexo masculino, en horarios nocturnos, en fines de semana y en las vías donde se desarrollan mayores velocidades.

OBJETIVO Analisar as características das vítimas, vias e veículos envolvidos em acidentes de trânsito e os fatores de risco de acidentes com ocorrência de óbito.  MÉTODOS Estudo de coorte não concorrente considerando os acidentes de trânsito em Fortaleza, CE, de janeiro de 2004 a dezembro de 2008. Foram utilizados dados do Sistema de Informação de Acidente de Trânsito de Fortaleza, do Sistema de Informações de Mortalidade, do Sistema de Informações Hospitalares e dos bancos de dados de Habilitação e Veículos do Departamento Estadual de Trânsito. Técnicas de relacionamento determinístico e probabilístico foram aplicadas para integrar as bases de dados. Efetuou-se a análise descritiva das variáveis relativas às pessoas, às vias, aos veículos e ao tempo. Foram utilizados os modelos lineares generalizados na investigação de fatores de risco para óbito por acidente de trânsito. O ajuste do modelo foi verificado pela razão de verossimilhança e análise ROC.  RESULTADOS Registraram-se 118.830 acidentes no período. Predominaram colisão/abalroamento (78,1%), atropelamentos (11,9%) e choque com obstáculo fixo (3,9%) e com motocicletas (18,1%). Ocorreram óbitos em 1,4% dos acidentes. Estiveram independentemente associados ao óbito por acidente de trânsito: bicicletas (OR = 21,2; IC95% 16,1;27,8), atropelamentos (OR = 5,9; IC95% 3,7;9,2), choque com obstáculo fixo (OR = 5,7; IC95% 3,1;10,5) e acidentes com motociclistas (OR = 3,5; IC95% 2,6;4,6). Os principais fatores contribuintes foram envolvimento de uma única pessoa (OR = 6,6; IC95% 4,1;10,73), presença de condutores não habilitados (OR = 4,1; IC95% 2,9;5,5) um único veículo envolvido (OR = 3,9; IC95% 2,3;6,4), sexo masculino (OR = 2,5; IC95% 1,9;3,3), tráfego em vias de jurisdição federal (OR = 2,4; IC95% 1,8;3,7), horário madrugada (OR = 2,4; IC95% 1,8;3,0) e dia de domingo (OR = 1,7; IC95% 1,3;2,2), todas ajustadas segundo modelo log-binomial.  CONCLUSÕES As ações de promoção e prevenção de acidentes no trânsito devem focar os acidentes com veículos de duas rodas, que mais frequentemente envolvem uma única pessoa, não habilitada, do sexo masculino, em horários noturnos, em finais de semana e nas vias onde se desenvolvem maiores velocidades.

OBJECTIVE : To describe the main characteristics of victims, roads and vehicles involved in traffic accidents and the risk factors involved in accidents resulting in death. METHODS A non-concurrent cohort study of traffic accidents in Fortaleza, CE, Northeastern Brazil, in the period from January 2004 to December 2008. Data from the Fortaleza Traffic Accidents Information System, the Mortality Information System, the Hospital Information System and the State Traffic Department Driving Licenses and Vehicle database. Deterministic and probabilistic relationship techniques were used to integrate the databases. First, descriptive analysis of data relating to people, roads, vehicles and weather was carried out. In the investigation of risk factors for death by traffic accident, generalized linear models were used. The fit of the model was verified by likelihood ratio and ROC analysis. RESULTS There were 118,830 accidents recorded in the period. The most common types of accidents were crashes/collisions (78.1%), running over pedestrians (11.9%), colliding with a fixed obstacle (3.9%), and with motorcycles (18.1%). Deaths occurred in 1.4% of accidents. The factors that were independently associated with death by traffic accident in the final model were bicycles (OR = 21.2, 95%CI 16.1;27.8), running over pedestrians OR = 5.9 (95%CI 3.7;9.2), collision with a fixed obstacle (OR = 5.7, 95%CI 3.1;10.5) and accidents involving motorcyclists (OR = 3.5, 95%CI 2.6;4.6). The main contributing factors were a single person being involved (OR = 6.6, 95%CI 4.1;10.73), presence of unskilled drivers (OR = 4.1, 95%CI 2.9;5.5) a single vehicle (OR = 3.9, 95%CI 2,3;6,4), male (OR = 2.5, 95%CI 1.9;3.3), traffic on roads under federal jurisdiction (OR = 2.4, 95%CI 1.8;3.7), early morning hours (OR = 2.4, 95%CI 1.8;3.0), and Sundays (OR = 1.7, 95%CI 1.3;2.2), adjusted according to the log-binomial model. CONCLUSIONS Activities promoting the prevention of traffic accidents should primarily focus on accidents involving two-wheeled vehicles that most often involves a single person, unskilled, male, at nighttime, on weekends and on roads where they travel at higher speeds.

OBJETIVO Analizar las características de las víctimas, vías y vehículos involucrados en accidentes de tránsito y los factores de riesgo de accidentes con ocurrencia de óbito. MÉTODOS Estudio de cohorte no concurrente considerando los accidentes de tránsito en Fortaleza, CE, de enero de 2004 a diciembre de 2008. Se utilizaron datos del Sistema de Informaciones de Mortalidad, del Sistema de Informaciones Hospitalarias y de los bases de datos de Licencia para conducir y Vehículos del Departamento Estatal de Tránsito. Técnicas de relacionamiento determinístico y probabilístico se aplicaron para integrar las bases de datos. Se efectuó el análisis descriptivo de las variables relacionadas con las personas, las vías los vehículos y el tiempo. Se utilizaron los modelos lineales generalizados en la investigación de los factores de riesgo para óbito por accidente de tránsito. El ajuste del modelo fue verificado por la tasa de vero-semejanza y el análisis ROC. RESULTADOS Se registraron 118.830 accidentes en el período. Predominaron colisión/choque (78,1%), atropellamientos (11,9%), choque con obstáculo fijo (3,9%), con motocicletas (18,1%). Ocurrieron óbitos en 1,4% de los accidentes. Estuvieron independientemente asociados al óbito por accidente de tránsito: bicicletas (OR= 21,2; IC95% 16,1;27,8), atropellamientos (OR= 5,9; IC95% 3,7;9,2), choque con obstáculo fijo (OR= 5,7; IC95% 3,1;10,5) y accidentes con motociclistas (OR= 3,5; IC95% 2,6;4,6). Los principales factores contribuyentes fueron envolvimiento de una única persona (OR= 6,6; IC95% 4,1;10,73), presencia de conductores sin licencia para conducir (OR= 4,1; IC95% 2,9;5,5), un único vehículo involucrado (OR= 3,9; IC95% 2,3;6,4), sexo masculino (OR= 2,5; IC95% 1,9; 3,3), tránsito en vías de jurisdicción federal (OR= 2,4; IC95% 1,8;3,7), horario madrugada (OR= 2,4; IC95% 1,8;3,0), y día domingo (OR= 1,7; IC95% 1,3;2,2), todas ajustadas de acuerdo con el modelo log-binomial. CONCLUSIONES Las acciones de promoción y prevención de accidentes en el tránsito deben enfocarse en accidentes con vehículos de dos ruedas, que más frecuentemente involucran una única persona, sin licencia para conducir, del sexo masculino, en horarios nocturnos, en fines de semana y en las vías donde se desarrollan mayores velocidades.