Scielo RSS <![CDATA[Sao Paulo Medical Journal]]> http://www.scielo.br/rss.php?pid=1516-318020120004&lang=en vol. 130 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[<b>Bonus?</b><b> </b><b>no, just an onus</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400001&lng=en&nrm=iso&tlng=en <![CDATA[<b>The concept of heart team in cardiac diseases</b>: <b>the patient is back as a priority in medical decisions</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Association between human leukocyte antigens and graft-versus-host disease occurrence after allogenic hematopoietic stem cell transplantation</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400003&lng=en&nrm=iso&tlng=en CONTEXT AND OBJECTIVE: Graft-versus-host disease (GVHD) is one of the complications following allogenic stem cell transplantation. This study investigated an association between human leukocyte antigen (HLA) and the occurrence of acute and chronic GVHD in patients who had received stem cell transplantations from HLA-identical siblings. DESIGN AND SETTING: Retrospective study at Hematology and Hemotherapy Center, Universidade Estadual de Campinas (Unicamp). METHODS: The participants were 176 patients whose first transplant was between 1997 and 2009. HLA genotyping was performed serologically and using the polymerase chain reaction with specific primer sequence. RESULTS: Acute GVHD was positively associated with HLA-A10 (P = 0.0007), HLA-A26 (P = 0.002), B55 (P = 0.001), DRB1*15 (P = 0.0211) and DQB1*05 (P = 0.038), while HLA-B16 (P = 0.0333) was more frequent in patients without acute GVHD. Chronic GVHD was positively associated with HLA-A9 (P = 0.01) and A23 (P = 0.0292) and negatively with HLA-A2 (P = 0.0031) and B53 (P = 0.0116). HLA-B35 (P = 0.0373), B49 (P = 0.0155) and B55 (P = 0.0024) were higher in patients with acute GVHD grade 3 or above, than in other patients. In patients with extensive chronic GVHD, HLA-A9 (P = 0.0004), A24 (P = 0.0059) and A26 (P = 0.0411) were higher than in other patients, while HLA-A2 was lower (P = 0.0097). CONCLUSION: This study suggests that HLA can influence the incidence and severity of acute and chronic GVHD. However, a study with a better design and more patients will be needed to confirm these results.<hr/>CONTEXTO E OBJETIVO: A doença do enxerto contra o hospedeiro (DECH) é uma das complicações pós-transplante alogênico de células progenitoras hematopoéticas. Este estudo investigou uma associação entre o antígeno leucocitário humano (HLA) e a ocorrência de DECH aguda e crônica, em pacientes que receberam transplantes de irmãos HLA-idênticos. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo no Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas (Unicamp). MÉTODOS: Os participantes foram 176 pacientes cujo primeiro transplante foi entre 1997 e 2009. A tipagem HLA foi realizada por sorologia e reação em cadeia da polimerase (PCR) com sequência específica de primers. RESULTADOS: A DECH aguda foi associada positivamente com HLA-A10 (P = 0,0007), HLA-A26 (P = 0,002), B55 (P = 0,001), DRB1*15 (P = 0,0211) e DQB1*05 (P = 0,038), enquanto HLA-B16 (P = 0,0333) foi mais frequente em pacientes sem DECH aguda. A DECH crônica foi associada positivamente com HLA-A9 (P = 0,01) e A23 (P = 0,0292) e, negativamente, com HLA-A2 (P = 0,0031) e B53 (P = 0,0116). HLA-B35 (P = 0,0373), B49 (P = 0,0155) e B55 (P = 0,0024) estavam aumentados em pacientes com DECH aguda grau 3 ou maior, em comparação aos outros pacientes. Em pacientes com DECH crônica extensa, HLA-A9 (P = 0,0004), A24 (P = 0,0059) e A26 (P = 0,0411) estavam aumentados em comparação aos outros pacientes, enquanto HLA-A2 estava diminuído (P = 0,0097). CONCLUSÕES: Este estudo sugere que o HLA pode influenciar a ocorrência de DECH aguda e crônica e a sua gravidade. No entanto, um estudo com melhor desenho e com mais pacientes será necessário para confirmar esses resultados. <![CDATA[<b>Prevalence of overweight preschool children in public day care centers</b>: <b>a cross-sectional study</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400004&lng=en&nrm=iso&tlng=en CONTEXT AND OBJECTIVE: Brazil is undergoing a period of epidemiological transition associated with demographic and nutritional changes. The prevalence of obesity is also increasing in children and is causing numerous health problems that are becoming public health issues. The aim here was to evaluate the prevalence of overweight among children of two and three years of age. DESIGN AND SETTING: Cross-sectional study in municipal day care centers in Taubaté, state of São Paulo, Brazil. METHODS: Weight and height measurements were made on 447 preschool children forming a probabilistic randomized sample. Their body mass index (BMI) was calculated. Their nutritional status was classified using the World Health Organization reference cutoff points (2006). Their mean weight, height and BMI were compared according to their age and sex. RESULTS: The mean values for the final sample (n = 447) were as follows: mean age: 38.6 months (± 3.5) and Z scores for: weight/height (W/H): 0.50 (± 1.22); height/age: -0.03 (± 1.07); weight/age (W/A): 0.51 (± 1.23); and BMI: 0.51(± 1.23). The prevalence of overweight children (BMI &gt; 1 z) was 28.86%, while the prevalence of underweight children (BMI < -2 z) was 0.89%. There were no differences in mean BMI among the two and three-year age groups (P = 0.66). CONCLUSION: A high prevalence of overweight was observed in the sample of two and three-year-old children, with practically no malnutrition, thus showing that a significant nutritional transition may already be occurring, even in medium-sized cities of developing countries.<hr/>CONTEXTO E OBJETIVO: O Brasil atravessa um período de transição epidemiológica com mudanças demográfica e nutricional. A prevalência de obesidade está aumentando também entre crianças, causando inúmeros problemas de saúde, que estão se tornando questões de saúde pública. Objetivou-se avaliar a prevalência de excesso de peso em crianças de dois e três anos. TIPO DE ESTUDO E LOCAL: Estudo transversal em creches municipais de Taubaté, São Paulo, Brasil. MÉTODOS: Em amostra probabilística e randomizada de 447 pré-escolares, foram mensurados peso e altura, e calculado o índice de massa corporal (IMC). O estado nutricional foi classificado segundo pontos de corte do referencial da Organização Mundial de Saúde (2006). Compararam-se os valores médios de peso, estatura e IMC das crianças segundo a idade e sexo. RESULTADOS: A amostra final (n = 447) apresentou as seguintes médias. Idade: 38,6 meses (± 3,5), escore Z de peso para estatura (P/E): 0,50 (± 1,22), estatura para idade (E/I): -0,03 (± 1,07), peso para idade (P/I): 0,51 (± 1,23) e IMC: 0,51(± 1,23). A prevalência de excesso de peso (IMC &gt; 1 z) foi de 28,86% e de crianças abaixo do peso ideal (IMC < -2 z) foi de 0,89%. Não houve diferença das médias de IMC entre as idades de dois e três anos (P = 0,66). CONCLUSÃO: Na população de crianças de dois e três anos de idade, já se evidencia elevada prevalência de excesso de peso, praticamente sem desnutrição, indicando que já pode estar ocorrendo uma transição nutricional importante inclusive em cidades médias de países em desenvolvimento. <![CDATA[<b>Epidemiological and serological aspects of hepatitis A among children and teenagers in the city of Santos</b>: <b>a cross-sectional study</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400005&lng=en&nrm=iso&tlng=en CONTEXT AND OBJECTIVE: Viral hepatitis A is still a concern at public health level in Brazil and around the world, due both to the number of affected subjects and the possibility of complications in the acute forms. The Brazilian Ministry of Health estimates that at least 70% of this country's population has already had contact with the hepatitis A virus (HAV). The aim here was to discover the prevalence of serological markers for the hepatitis A virus among children and teenagers at daycare facilities, kindergartens and elementary schools in the city of Santos. DESIGN AND SETTING: Cross-sectional study in kindergartens and elementary schools within the municipal education network in several regions of the city of Santos. METHOD: Students' family members were surveyed using a questionnaire and 4,680 finger-prick blood samples were taken and assayed by means of the ELISA technique. RESULTS: The general prevalence of anti-HAV IgG was 9.72% and, of these cases, 74.6% were reactive to anti-HAV IgM. There was higher prevalence of anti-HAV IgG among older children, females, children who played in streams, those whose homes were not connected to the sewage system, those whose parents had low education levels, those with low household income and those who did not live along the seashore. The prevalence of anti-HAV IgM peaked in the early years and subsequently fell, and it was lower on the hills and in the Northwestern Zone. CONCLUSION: The general prevalence of serological markers for hepatitis A was low in Santos.<hr/>CONTEXTO E OBJETIVO: A hepatite viral A continua sendo uma preocupação em nível de saúde pública no Brasil e no mundo, tanto pelo número de indivíduos atingidos, como pela possibilidade de complicação das formas agudas. O Ministério da Saúde estima que pelo menos 70% da população do Brasil já tiveram contato com o vírus da hepatite A. O objetivo foi conhecer a prevalência de marcadores sorológicos do vírus da hepatite A em crianças e adolescentes de creches e escolas de ensino infantil e fundamental na cidade de Santos. TIPO DE ESTUDO E LOCAL: Estudo transversal em pré-escolas e de ensino fundamental da rede municipal em diversas regiões da cidade de Santos. MÉTODO: Foi aplicado um questionário aos familiares dos estudantes e coletadas 4.680 amostras de sangue através de punção capilar para realização da sorologia pela técnica ELISA. RESULTADOS: A prevalência geral do anti-HVA IgG foi de 9,72% e, desses, 74,6% foram anti-HVA IgM reagentes. A prevalência de anti-HVA IgG foi maior entre as crianças mais velhas, meninas, aquelas que brincavam em córregos, sem rede de coleta de esgoto em sua moradia, de pais com baixa instrução, de baixa renda familiar e aquelas que não eram moradoras da orla. A prevalência de anti-HVA IgM teve pico nos primeiros anos e posterior queda e, no morro e Zona Noroeste, foi mais baixa. CONCLUSÃO: A prevalência geral dos marcadores sorológicos para hepatite A foi baixa em Santos. <![CDATA[<b>Cephalometric</b><b> evaluation of the airway space and hyoid bone in children with normal and atypical deglutition</b>: <b>correlation study</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400006&lng=en&nrm=iso&tlng=en CONTEXT AND OBJECTIVE: Although there is a close relationship between swallowing and breathing, there are no studies evaluating the radiographic anatomy of the airway and its possible correlation with the radiographic position of the hyoid bone. The aim of this study was to evaluate the possible correlation of the radiographic position of the hyoid bone and airway space (PAS) in lateral radiographs on children with atypical deglutition, in comparison with those with normal swallowing. DESIGN AND SETTING: Cross-sectional analytical study with control group in a public university. METHODS: Using cephalometric analysis on lateral teleradiographs, the distance from the hyoid bone to the mandibular plane (MP-H) and the distance from the hyoid bone to the tuber (T-H) were correlated with the PAS measurement (airway) in two groups: 55 teleradiographs in the experimental group (with atypical deglutition) and 55 teleradiographs in the control group (normal deglutition). Both groups included subjects at the mixed dentition stage. RESULTS: The variable T-H presented a statistically significant correlation with PAS (0.0286) and the variable MP-H had a significant correlation with the variable PAS (0.0053). This positive correlation was significant only in the control group and not in the group with atypical swallowing. CONCLUSIONS: There was a positive correlation between the MP-H and PAS measurements and between the T-H and PAS measurements only in the group with normal swallowing. These correlations were not observed in the group with atypical swallowing.<hr/>CONTEXTO E OBJETIVO: Embora haja estreita relação entre respiração e deglutição, não existem estudos que avaliem a anatomia radiográfica de via aérea e sua possível correlação com a posição radiográfica do osso hioide. O objetivo deste estudo foi avaliar possível correlação da posição radiográfica do osso hioide e do espaço aéreo na radiografia lateral de crianças com deglutição atípica quando comparada com aquelas com deglutição normal. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico com grupo controle em universidade pública. MÉTODOS: Por meio de análise cefalométrica em telerradiografias laterais, foi correlacionada a distância do osso hioide ao plano mandibular (MP-H) e do túber ao osso hioide (T-H) com a medida do espaço da via aérea (PAS) em dois grupos: 55 telerradiografias do grupo experimental (com deglutição atípica) e 55 telerradiografias do grupo controle (deglutição normal). Ambos os grupos incluíram indivíduos em fase de dentição mista. RESULTADOS: A variável T-H apresentou correlação estatisticamente significativa com PAS (0,0286) e a variável MP-H teve correlação significativa com a variável PAS (0,0053). Esta correlação positiva foi significativa apenas no grupo controle e não no grupo de deglutição atípica. CONCLUSÕES: Há correlação positiva entre as medidas MP-H e PAS e entre as medidas T-H e PAS somente no grupo de deglutição normal. Estas correlações não foram observadas no grupo de deglutição atípica. <![CDATA[<b>Association between maternal and fetal weight gain</b>: <b>cohort study</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400007&lng=en&nrm=iso&tlng=en CONTEXT AND OBJECTIVE: Excessive gestational weight gain is related to many complications (both maternal and fetal), such as macrosomia. The most common complications in macrosomic fetuses include: increased risk of intrauterine death, need for intensive care, fractures, neonatal hyperbilirubinemia, paralysis of the brachial plexus and obesity in childhood and adulthood. The aim of this study was to evaluate the association between gestational and fetal weight gain and the incidence of macrosomia in two maternity hospitals. DESIGN AND SETTING: Cohort study in two public maternity hospitals in Goiânia, Brazil. METHODS: This was a cohort study on 200 healthy pregnant women with normal body mass index, divided into two groups: one with normal weight gain and the other with excessive weight gain during pregnancy. RESULTS: The cohorts were similar regarding maternal age, per capita income, schooling level and reproductive behavior. The fetal weight was greater in the cohort with excessive maternal weight gain (3,388.83 g ± 514.44 g) than in the cohort with normal weight (3,175.86 g ± 413.70 g) (P < 0.01). The general incidence of macrosomia was 6.5%: 13.0% (13 cases) in the cohort with excessive maternal weight gain and 0.0% (0 cases) in the cohort with adequate weight gain. CONCLUSION: Excessive maternal weight gain was associated with increased fetal birth weight and incidence of macrosomia.<hr/>CONTEXTO E OBJETIVO: O ganho de peso gestacional excessivo está relacionado a inúmeras complicações tanto maternas como fetais, como por exemplo, a macrossomia. Esta, por sua vez, pode aumentar o risco de morte intra-uterina, necessidade de cuidados intensivos, fraturas, hiperbilirrubinemia neonatal, paralisia do plexo braquial e obesidade na infância e fase adulta. O objetivo deste estudo foi avaliar a associação do ganho de peso gestacional com o ganho de peso fetal e a incidência de macrossomia em duas maternidades. TIPO DE ESTUDO E LOCAL: Estudo de coorte em duas maternidades públicas em Goiânia, Brasil. MÉTODOS: Estudo de coorte com 200 gestantes saudáveis com índice de massa corporal normal, divididas em dois grupos, um com ganho de peso adequado e o outro com peso excessivo na gravidez. RESULTADOS: As coortes foram semelhantes quanto à idade materna, renda per capita, escolaridade e comportamento reprodutivo. O peso fetal foi maior na coorte de ganho de peso materno excessivo (3388,83 g ± 514,44 g) do que na de peso normal (3175,86 g ± 413,70 g) (P < 0,01). A incidência geral de macrossomia foi 6,5% sendo de 13,0% (13 casos) na coorte com ganho de peso materno excessivo e de 0,0% (0 casos) na de peso adequado. CONCLUSÃO: O ganho de peso materno excessivo esteve associado ao aumento do peso fetal ao nascer e à incidência de macrossomia. <![CDATA[<b>Molecular characterization of hemoglobin D Punjab traits and clinical-hematological profile of the patients</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400008&lng=en&nrm=iso&tlng=en CONTEXT AND OBJECTIVE: Hemoglobin (Hb) D hemoglobinopathies are widespread diseases in northwestern India and usually present with mild hemolytic anemia and mild to moderate splenomegaly. The heterozygous form of Hb D is clinically silent, but coinheritance of Hb D with Hb S or beta-thalassemia produces clinically significant conditions like thalassemia intermedia of moderate severity. Under heterozygous conditions with coinheritance of alpha and beta-thalassemia, patients show a degree of clinical variability. Thus, our aim was to molecularly characterize the Hb D trait among individuals who were clinically symptomatic because of co-inheritance of alpha deletions or any beta-globin gene mutations. DESIGN AND SETTING: This was a cross-sectional study conducted in an autonomous tertiary-care hospital. METHODS: Complete blood count and red cell indices were measured using an automated cell analyzer. Quantitative assessment of hemoglobin Hb F, Hb A, Hb A2 and Hb D was performed by means of high performance liquid chromatography (HPLC). DNA extraction was done using the phenol-chloroform method. Molecular analyses on common alpha deletions and common beta mutations were done using the Gap polymerase chain reaction and Amplification Refractory Mutation System, respectively. RESULTS: We evaluated 30 patients and found clinical variation in the behavior of Hb D traits. In six patients, the Hb D traits were clinically symptomatic and behaved like those of thalassemia intermedia. Molecular characterization showed that three out of these six were IVS-1-5 positive. CONCLUSIONS: HPLC may not be the gold standard for diagnosing symptomatic Hb D Punjab traits. Hence, standard confirmation should include molecular studies.<hr/>CONTEXTO E OBJETIVO: Hemoglobinopatias da hemoglobina (Hb) D são doenças amplamente disseminadas no noroeste da Índia e geralmente se apresentam com anemia hemolítica leve e esplenomegalia leve a moderada. A forma heterozigótica de Hb D é clinicamente silenciosa, mas co-herança de Hb D com Hb S ou beta-talassemia produzem condições clinicamente significativas, como talassemia intermediária de gravidade moderada. Em condição heterozigótica com co-herança de alfa e beta-talassemia, pacientes mostram variabilidade clínica. Assim, nosso objetivo foi a caracterização molecular dos traços da Hb D em individuos clinicamente sintomáticos, devido à co-herança de deleções de alfa ou quaisquer mutações gênicas de beta-globina. TIPO DE ESTUDO E LOCAL: Estudo transversal; realizado em um hospital de cuidado terciário autônomo. MÉTODOS: Hemograma completo e índices de células vermelhas foram medidos pelo analisador automatizado de células. Avaliação quantitativa de hemoglobina Hb F, Hb A, Hb A2 e Hb D foi realizada por cromatografia líquida de alta eficiência. Extração de DNA foi feita pelo método de fenol-clorofórmio. Estudo molecular para deleções comuns de alfa e mutações comuns de beta foi feito por Gap-reação em cadeia da polimerase e amplificação refratária de mutação, respectivamente. RESULTADOS: Avaliamos 30 pacientes e verificamos variação clínica no comportamento dos traços da Hb D. Em seis pacientes, os traços da Hb D foram clinicamente sintomáticos e se comportavam como os de talassemia intermédia. A caracterização molecular mostrou que três desses seis pacientes eram IVS-1-5 positivos. CONCLUSÕES: HPLC pode não ser o padrão ouro para o diagnóstico de traços de Hb D Punjab sintomáticos. Assim, a confirmação padrão ouro deve incluir estudos moleculares. <![CDATA[<b>Mentors also need support</b>: <b>a study on their difficulties and resources in medical schools</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400009&lng=en&nrm=iso&tlng=en CONTEXT AND OBJECTIVE: Mentors have been recognized as important elements in the personal and professional development of medical students. However, few investigations have sought to understand their development, needs and difficulties. Our objective was to investigate the perceptions of a group of mentors regarding difficulties experienced over time and the resources used to face up to them. DESIGN AND SETTING: Qualitative exploratory study on mentors at Faculdade de Medicina da Universidade de São Paulo (FMUSP). In the FMUSP Mentoring Program, mentors follow and guide students throughout the course, and are responsible for heterogeneous group of students, in relation to the academic year. METHOD: Semi-structured interviews were conducted with 14 FMUSP mentors. RESULTS: For many of the mentors, the difficulties related to initial doubts about the role, frustration with the students' attendance and overloading of daily tasks. To address such difficulties, these mentors used external resources and their own life experience and personal way of dealing with situations. Some mentors did not perceive difficulties for themselves or for students. CONCLUSIONS: Like in other mentoring programs, many difficulties perceived by mentors seem to be derived from the context of medical education itself. However, unlike in other experiences, FMUSP mentors do not feel that there is lack of support for their role, since this is regularly provided in the structure and dynamics of the program. The "difficulty in perceiving difficulties", presented by some mentors, demands further investigation for better and greater understanding.<hr/>CONTEXTO E OBJETIVOS: Mentores têm sido reconhecidos como elementos importantes para o desenvolvimento pessoal e profissional de estudantes de Medicina. Entretanto, poucas investigações buscam compreendê-los em seu desenvolvimento, necessidades e dificuldades. Nosso objetivo foi investigar as percepções de um grupo de mentores sobre as dificuldades vivenciadas ao longo do tempo e os recursos utilizados para enfrentá-las. TIPO DE ESTUDO E LOCAL: Estudo qualitativo e de caráter exploratório, com mentores da Faculdade de Medicina da Universidade de São Paulo (FMUSP). No Programa Tutores, mentores acompanham e orientam alunos ao longo do curso, sendo responsáveis por grupos heterogêneos de alunos em relação ao ano acadêmico. MÉTODO: Entrevistas semi-estruturadas foram realizadas com 14 mentores da FMUSP. RESULTADOS: Muitos mentores reconheceram como dificuldades as dúvidas iniciais com o papel, a frustração com a adesão dos alunos e a sobrecarga de tarefas do cotidiano. Para enfrentá-las, eles utilizam recursos externos, sua própria experiência de vida e o modo pessoal de abordar as situações. Uma parcela dos mentores não reconheceu dificuldades, para eles ou para os alunos. CONCLUSÕES: Como em outros programas, muitas das dificuldades percebidas pelos mentores mostram ser derivadas do próprio contexto da formação médica. Entretanto, diferentemente de outras experiências, os mentores FMUSP não se ressentem da falta de suporte para a sua função, estando este presente regularmente na estrutura e dinâmica do programa. A "dificuldade em perceber dificuldades", apresentada por alguns mentores, demanda investigações posteriores para melhor e maior compreensão. <![CDATA[<b>Subacute</b><b> combined spinal cord degeneration and pancytopenia secondary to severe vitamin B12 deficiency</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400010&lng=en&nrm=iso&tlng=en CONTEXT: Decreased vitamin B12 concentration does not usually result in clinical or hematological abnormalities. Subacute combined spinal cord degeneration and pancytopenia are two serious and rarely displayed consequences that appear in severe deficits. CASE REPORT: We present the case of a patient with subacute combined spinal cord degeneration and pancytopenia secondary to severe and sustained vitamin B12 deficiency. Such cases are rare nowadays and have potentially fatal consequences. CONCLUSIONS: Vitamin B12 deficiency should be taken into consideration in the differential diagnosis in cases of blood disorders or severe neurological symptoms. Early diagnosis and treatment can avoid irreversible consequences.<hr/>CONTEXTO: El descenso de la concentración de vitamina B12 no suele derivar en alteraciones clínicas o hematológicas. La degeneración combinada subaguda medular y la pancitopenia son dos consecuencias graves y poco frecuentes que aparecen en los déficit severos. CASO CLÍNICO: Presentamos el caso de un paciente con una degeneración combinada subaguda medular y pancitopenia secundarios a un déficit severo y mantenido de vitamina B12. Un caso poco común en nuestros días y con consecuencias potencialmente fatales. CONCLUSIONES: Debemos considerar el déficit de vitamina B12 dentro del diagnóstico diferencial en caso de alteraciones hematológicas o síntomas neurológicos graves. Su diagnóstico y tratamento precoz pueden evitar secuelas irreversibles. <![CDATA[<b>Leukocyte adhesion deficiency syndrome</b>: <b>report on the first case in Chile and South America</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400011&lng=en&nrm=iso&tlng=en CONTEXT: Adhesion molecule deficiency type 1 is a rare disease that should be suspected in any patient whose umbilical cord presents delay in falling off, and who presents recurrent severe infections. Early diagnostic suspicion and early treatment improve the prognosis. CASE REPORT: The case of a four-month-old boy with recurrent hospitalizations because of severe bronchopneumonia and several episodes of acute otitis media with non-purulent drainage of mucus and positive bacterial cultures is presented. His medical history included neonatal sepsis and delayed umbilical cord detachment. Laboratory studies showed marked leukocytosis with predominance of neutrophils and decreased CD11b and CD18. These were all compatible with a diagnosis of leukocyte adhesion deficiency type I [LAD type 1].<hr/>CONTEXTO: El deficit de moleculas de adhesión tipo 1 es una enfermedad rara que debe ser sospechada en todo paciente que presente un retardo en la caída del cordón unmbilical, además de infecciones graves a repetición. Un sospecha diagnóstica precoz y un tratamiento oportuno mejorarán el pronóstico. INFORMES DE CASO: Se presenta el caso de un niño de cuatro meses de edad, con hospitalizaciones recurrentes a causa de bronconeumonía severa y varios episodios de otitis media aguda con drenaje mucoso, no purulento, y cultivos bacterianos positivos. Su historial médico incluye la sepsis neonatal y el desprendimiento tardío del cordón umbilical. Los estudios de laboratorio mostraron leucocitosis marcada con predominio neutrofílico y disminución de CD11b y CD18, todos compatibles con el diagnóstico del tipo de deficiencia de adhesión leucocitaria 1 [tipo LAD 1]. <![CDATA[<b>Drugs available through the Farmácia Dose Certa program and Beers criteria</b>: <b>a further analysis</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400012&lng=en&nrm=iso&tlng=en CONTEXT: Adhesion molecule deficiency type 1 is a rare disease that should be suspected in any patient whose umbilical cord presents delay in falling off, and who presents recurrent severe infections. Early diagnostic suspicion and early treatment improve the prognosis. CASE REPORT: The case of a four-month-old boy with recurrent hospitalizations because of severe bronchopneumonia and several episodes of acute otitis media with non-purulent drainage of mucus and positive bacterial cultures is presented. His medical history included neonatal sepsis and delayed umbilical cord detachment. Laboratory studies showed marked leukocytosis with predominance of neutrophils and decreased CD11b and CD18. These were all compatible with a diagnosis of leukocyte adhesion deficiency type I [LAD type 1].<hr/>CONTEXTO: El deficit de moleculas de adhesión tipo 1 es una enfermedad rara que debe ser sospechada en todo paciente que presente un retardo en la caída del cordón unmbilical, además de infecciones graves a repetición. Un sospecha diagnóstica precoz y un tratamiento oportuno mejorarán el pronóstico. INFORMES DE CASO: Se presenta el caso de un niño de cuatro meses de edad, con hospitalizaciones recurrentes a causa de bronconeumonía severa y varios episodios de otitis media aguda con drenaje mucoso, no purulento, y cultivos bacterianos positivos. Su historial médico incluye la sepsis neonatal y el desprendimiento tardío del cordón umbilical. Los estudios de laboratorio mostraron leucocitosis marcada con predominio neutrofílico y disminución de CD11b y CD18, todos compatibles con el diagnóstico del tipo de deficiencia de adhesión leucocitaria 1 [tipo LAD 1]. <![CDATA[<b>"Farmácia Dose Certa" program and Beers-Fick criteria</b>: <b>general <i>versus</i> specific analysis</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400013&lng=en&nrm=iso&tlng=en CONTEXT: Adhesion molecule deficiency type 1 is a rare disease that should be suspected in any patient whose umbilical cord presents delay in falling off, and who presents recurrent severe infections. Early diagnostic suspicion and early treatment improve the prognosis. CASE REPORT: The case of a four-month-old boy with recurrent hospitalizations because of severe bronchopneumonia and several episodes of acute otitis media with non-purulent drainage of mucus and positive bacterial cultures is presented. His medical history included neonatal sepsis and delayed umbilical cord detachment. Laboratory studies showed marked leukocytosis with predominance of neutrophils and decreased CD11b and CD18. These were all compatible with a diagnosis of leukocyte adhesion deficiency type I [LAD type 1].<hr/>CONTEXTO: El deficit de moleculas de adhesión tipo 1 es una enfermedad rara que debe ser sospechada en todo paciente que presente un retardo en la caída del cordón unmbilical, además de infecciones graves a repetición. Un sospecha diagnóstica precoz y un tratamiento oportuno mejorarán el pronóstico. INFORMES DE CASO: Se presenta el caso de un niño de cuatro meses de edad, con hospitalizaciones recurrentes a causa de bronconeumonía severa y varios episodios de otitis media aguda con drenaje mucoso, no purulento, y cultivos bacterianos positivos. Su historial médico incluye la sepsis neonatal y el desprendimiento tardío del cordón umbilical. Los estudios de laboratorio mostraron leucocitosis marcada con predominio neutrofílico y disminución de CD11b y CD18, todos compatibles con el diagnóstico del tipo de deficiencia de adhesión leucocitaria 1 [tipo LAD 1]. <![CDATA[<b>Disposable surgical face masks for preventing surgical wound infection in clean surgery</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400014&lng=en&nrm=iso&tlng=en BACKGROUND: Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. OBJECTIVES: To determine whether disposable surgical face masks worn by the surgical team during clean surgery prevent postoperative surgical wound infection. SEARCH METHODS: We searched The Cochrane Wounds Group Specialised Register (searched 14 September 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (2008 to August Week 5 2011); Ovid MEDLINE (In-Process &Other Non-Indexed Citations September 13, 2011); Ovid EMBASE (2008 to 2011 Week 35); and EBSCO CINAHL (2008 to 9 September 2011). SELECTION CRITERIA: Randomized controlled trials (RCTs) and quasi-randomized controlled trials comparing the use of disposable surgical masks with the use of no mask. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. MAIN RESULTS: Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. AUTHORS' CONCLUSIONS: From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery. <![CDATA[<b>Antiemetics</b><b> for reducing vomiting related to acute gastroenteritis in children and adolescents</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000400015&lng=en&nrm=iso&tlng=en BACKGROUND: Vomiting is a common manifestation of acute gastroenteritis in children and adolescents. When untreated, it can be a hindrance to oral rehydration therapy, which is the cornerstone in the management of acute gastroenteritis. Evidence is needed concerning the safety and efficacy of antiemetic use for vomiting in acute gastroenteritis in children. OBJECTIVES: To assess the safety and effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register comprising references identified from comprehensive electronic database searches and hand searches of relevant journals and abstract books of conferences. The search was re-run and is up to date as on 20 July 2010. SELECTION CRITERIA: Randomized controlled trials comparing antiemetics with placebo or no treatment, in children and adolescents under the age of 18, for vomiting due to gastroenteritis. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: We included seven trials involving 1,020 participants. Mean time to cessation of vomiting in one study was 0.34 days less with dimenhydrinate suppository compared to placebo (P value = 0.036). Pooled data from three studies comparing oral ondansetron with placebo showed: a reduction in the immediate hospital admission rate (RR 0.40, NNT 17, 95% CI 10 to 100) but no difference between the hospitalization rates at 72 hours after discharge from the Emergency Department (ED); a reduction in IV rehydration rates both during the ED stay (RR 0.41, NNT 5, 95% CI 4 to 8), and in follow-up to 72 hours after discharge from the ED stay (worst-best scenario for ondansetron RR 0.57, NNT 6, 95% CI 4 to 13) and an increase in the proportion of patients with cessation of vomiting (RR 1.34, NNT 5, 95% CI 3 to 7). No significant difference was noted in the revisit rates or adverse events, although diarrhea was reported as a side effect in four of the five ondansetron studies. In one study the proportion of patients with cessation of vomiting in 24 hours was (58%) with IV ondansetron, (17%) placebo and (33%) in the metoclopramide group (P value = 0.039). AUTHORS' CONCLUSIONS: Oral ondansetron increased the proportion of patients who had ceased vomiting and reduced the number needing intravenous rehydration and immediate hospital admission. Intravenous ondansetron and metoclopramide reduced the number of episodes of vomiting and hospital admission, and dimenhydrinate as a suppository reduced the duration of vomiting.