Prevalence of Gender Dysphoria in Southern Brazil: A Retrospective Study.

To ensure that public health services provide comprehensive and inclusive health care to the general population, it is important for countries to estimate how many of their citizens experience gender dysphoria and wish to receive specialized hormone treatment or gender-affirming surgery. The aim of this study was to estimate the prevalence of individuals with gender dysphoria seeking transgender health care in a public teaching hospital in southern Brazil. In this retrospective follow-up study, we analyzed the medical records and sociodemographic data of individuals aged > 15 years living in Rio Grande do Sul, Brazil, that enrolled in a specialized program to receive hormone therapy and gender-affirming surgery between 2000 and 2018. This study is the first to attempt estimating the prevalence of gender dysphoria in Rio Grande do Sul; it describes novel data on the clinical profile of individuals with gender dysphoria treated in a public hospital specialized in providing transgender health care. Prevalence estimates were calculated based on statewide annual population data in the study period. Of 934 identified individuals, 776 (601 trans women and 175 trans men) were included in this study. The overall prevalence of individuals with gender dysphoria was 9.3 per 100,000 individuals (95% CI: 8.6 to 9.8). Meanwhile, there were 15 trans women per 100,000 people (95% CI: 14 to 16) and 4.1 trans men per 100,000 people (95% CI: 3.5 to 4.8). There was a progressive increase in the number of people seeking hormone therapy and gender-affirming surgery during the study period. Future research is needed to determine the size of the trans population in other regions of Brazil and to expand the knowledge regarding gender dysphoria to allow for the development of effective public policies for people with gender dysphoria.

Corrigendum: The impact of the COVID-19 pandemic on the lives of people with Gender Dysphoria.

[This corrects the article DOI: 10.3389/fpubh.2022.878348.].

The Impact of the COVID-19 Pandemic on the Lives of People With Gender Dysphoria.

Objective: To analyze the impact on the psychological and social aspects caused by the COVID-19 pandemic in individuals diagnosed with Gender Dysphoria (GD). Methods: Google Forms inventory was sent via WhatsApp, including qualitative and quantitative questions evaluating three life dimensions denominated as Sociodemographic, Economic, and COVID-19 pandemic. It was applied in two periods: At the beginning of the pandemic (June-2020) (P1) and one year later (June-2021) (P2). The inventory also included questions about economic dimensions before the pandemic for individual comparison purposes (P0). 48 individuals (28 transsexual women, 20 transsexual men) participated in both periods. Results: 77.1% (n = 37) lived in Rio Grande do Sul, 50.0% (n = 24) refereed incomplete high school; Monthly Income increased significantly between the periods (P0) and (P1). Emergence aid approval was significantly higher in (P2), 56.3% (n = 27), compared to (P1), 39.6% (n = 19). A statistically significant difference was detected in the feeling of depression in the (P2) among the cases that requested Emergency Aid. Conclusion: The studied population presented deterioration regarding their condition of social vulnerability in relation to formal employment, access to health services, and mental health.

Descriptive Study of Transgender Youth Receiving Health Care in the Gender Identity Program in Southern Brazil.

Since 2014, the Gender Identity Program (PROTIG) of Hospital de Clínicas de Porto Alegre (HCPA) has been assisting transgender youth seeking gender-affirmative treatment offered at a public health-care service specializing in gender in southern Brazil. This article aims to analyze sociodemographic and clinical data regarding the diagnoses of gender dysphoria and gender incongruence, psychiatric comorbidities, and clinical aspects of a sample of transgender youths seeking health care in the gender identity program. The research protocol consisted of a survey of the data collected in the global psychological evaluation performed at the health-care service for youths diagnosed with gender incongruence and their caretakers. Participating in this research were 24 transgender youths between 8 and 16 years old with diagnostic overlap of gender dysphoria [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)] and gender incongruence [International Classification of Diseases, 11th Revision (ICD-11)] and 34 of their caregivers. Of the young people, 45.8% were positive for some psychiatric comorbidity throughout their lives, with almost half (45.4%) having two or more psychiatric comorbidities in addition to gender dysphoria. The mental health professionals comprising affirmation care teams face the challenge of adapting the care protocols to the uniqueness of each demand by developing individualized forms to promote healthy development. This can be done by focusing not only on medical and physical interventions for gender affirmation but also on the promotion of mental health and general emotional well-being. Thus, the gender affirmation model, which advocates for global assessment and personalized guidance, proved to be adequate. Nevertheless, access to multidisciplinary health services specializing in gender is essential for promoting the general well-being of the population of transgender youth.

Corrigendum: Descriptive Study of Transgender Youth Receiving Health Care in the Gender Identity Program in Southern Brazil.

[This corrects the article DOI: 10.3389/fpsyt.2021.627661.].

Is nosocomial Escherichia coli bacteremia a predictive risk factor for mortality?

The objective of this study was to determine risk factors associated with mortality in patients with nosocomial Escherichia coli bacteremia from January 2009 to January 2011. In a retrospective study the medical records of 88 patients over 18 years with nosocomial bacteremia caused by E. coli were analyzed. In univariate analysis several risk factors, including chronic renal failure, altered mental status, leukocytosis, and higher Charlson index of comorbidities were associated with mortality. In multivariate analysis only altered mental status remained independently associated with mortality. Mental confusion can be a risk factor for mortality in patients with E. coli bacteremia.

Vitamin D and skin repair: a prospective, double-blind and placebo controlled study in the healing of leg ulcers.

OBJECTIVE: To analyze the relation between vitamin D insufficiency and wound healing in patients with venous ulcers; to correlate vitamin D insufficiency with characteristics of the ulcer (size and pain) and to evaluate if reposition of vitamin D in these subjects expedites ulcer healing. METHODS: We selected 26 patients with leg ulcers, and 26 control patients without ulcers, matched for gender, age, systemic arterial hypertension and tobacco use. The venous ulcer group was divided in two subgroups: one that received placebo (nine patients) and other receiving vitamin D, 50.000 IU per week over two months (13 patients). Blood was collected for 25 OH vitamin D dosage before and after the medication. In the ulcer group, we obtained data concerning demographics, leg ulcer size, as well as pain severity, measured by an analogical visual scale. Data was grouped in contingency and frequency tables, the tests of Fisher and chi-squared being used for nominal variables and Mann-Whitney for numerical variables. The adopted significance was of 5%. RESULTS: We found vitamin D insufficiency in the great majority of the patients. The median level in the ulcer group was 17.05 ng/dl and 22.75 ng/dl in the group without ulcer (p=0,0182) No relation was found between the ulcer size without treatment and the level of vitamin D. After treatment, the average size of the ulcer changed from 25 cm² to 18 cm² in the patients that took vitamin D and from 27 cm² to 24,5 cm² in the placebo group (p=0,7051 and p=0,7877, respectively). Considering the variability of the size of the ulcer in the treatment group versus placebo group, the average size was equal to -0,75 cm² in the first group and +4cm² in the second (p=0,0676) CONCLUSION: Patients with leg ulcers have more vitamin D deficiency. No difference in the ulcer characteristics was noted between those with and without vitamin D deficiency. There was a trend toward a better healing in those with vitamin D reposition.

Complicações cirúrgicas das cirurgias conservadoras de mama segundo a classificação de Clavien / Surgical complications of conservative breast surgery by Clavien classification

Introdução: pela alta taxa de mortalidade, o câncer de mama é uma das neoplasias mais estudadas no mundo. Metodologia: o presente artigo é um estudo epidemiológico, transversal e retrospectivo analítico que teve como objetivo avaliar a gravidade das complicações, utilizando, para isso, a classificação das complicações cirúrgicas de Clavien. Foi realizada numa coleta de dados de prontuário físico e eletrônico de pacientes com câncer de mama ductal ou lobular invasor, submetida à cirurgia conservadora de mama, realizada entre janeiro de 2009 e dezembro de 2010 no Hospital Erasto Gaertner. Resultados: foram analisados 298 casos de quadrantectomia de mama. Destes, 117 foram ressecção do linfonodo sentinela, nos quais foram verificadas complicações em aproximadamente 30% das pacientes, sendo predominante as de 1º Grau. Com esvaziamento axilar, foram 181 cirurgias, das quais 86 apresentaram complicações, sendo predominante as de 2º e 3º Grau. Conclusõses: A classificação de Cavien-Dindo permite observar que há menos complicações quando as pacientes são submetidas à quadrantectomia com linfonodo sentinela em comparação às com esvaziamento axilar.

Introduction: Due to the high mortality rate, breast cancer is one of the most studied neoplams in the world. Methods: This article is an epidemiological cross-sectional and retrospective analytical study aimed to evaluate the rate of surgical complications of breast conservative surgery and assess the severity of complications, using, for it, the classification of surgical complications of Clavien. We performed a data collection of physical and electronic medical records of patients with breast cancer or ductal lobular invasive, underwent breastconserving surgery, performed between January 2009 and December 2010 at the Hospital Erasto Gaertner. Results: We analyzed 298 cases of breast quadrantectomy. Of these, 117 were with sentinel lymph node resection and these complications were found in approximately 30% of patients, predominantly the 1st degree. With axillary dissection, were 181 surgeries, of which 86 had complications, complications predominant 2nd and 3rd degree. Conclusion: The Clavien-Dindo classification allows us to observe that there are fewer complications when patients are undergoing quadrantectomy with sentinel node compared with the axillary dissection.

Vitamina D e cicatrização de pele: estudo prospectivo, duplo-cego, placebo controlado na cicatrização de úlceras de perna / Vitamin D and skin repair: a prospective, double-blind and placebo controlled study in the healing of leg ulcers

OBJETIVO: Estudar a relação entre deficiência de vitamina D e cicatrização de pele em pacientes com úlceras de perna, relacionar esta deficiência com características da úlcera e avaliar se a reposição de vitamina D nos indivíduos deficientes acelera a cicatrização da úlcera. MÉTODOS: Foram escolhidos aleatoriamente 26 pacientes com úlceras venosas de perna e 26 sem úlcera pareados para sexo, idade, HAS e tabagismo. Os grupos foram comparados com relação à dosagem sérica de vitamina D. O grupo úlcera foi dividido em dois subgrupos: um que tomou placebo e outro que recebeu vitamina D 50.000UI por semana durante dois meses. Foi realizada a dosagem da 25-OH-vitamina D e avaliados o tamanho da úlcera e a gravidade da dor, antes e após o tratamento. RESULTADOS: A maioria dos pacientes apresentava níveis insuficientes de vitamina D. Não foi encontrada correlação entre o tamanho da úlcera sem tratamento e os níveis de vitamina D. Nos pacientes que receberam vitamina D, após o tratamento, o tamanho mediano da área da úlcera, diminui de 25cm², para 18cm² e no grupo placebo, de 27cm² para 24,5cm² (p=0,7051 e p=0,7877, respectivamente). Considerando-se a variabilidade da área da úlcera do grupo vitamina D versus placebo, a mediana foi igual a -0,75cm² no primeiro grupo e 4cm² no segundo grupo (p=0,0676). CONCLUSÃO: Pacientes com úlcera de perna têm mais deficiência de vitamina D que os sem. A deficiência de vitamina D não influiu nas características das lesões. A cicatrização nos pacientes com hipovitaminose D mostrou tendência para ser maior naqueles que receberam reposição vitamínica.

OBJECTIVE: To analyze the relation between vitamin D insufficiency and wound healing in patients with venous ulcers; to correlate vitamin D insufficiency with characteristics of the ulcer (size and pain) and to evaluate if reposition of vitamin D in these subjects expedites ulcer healing. METHODS: We selected 26 patients with leg ulcers, and 26 control patients without ulcers, matched for gender, age, systemic arterial hypertension and tobacco use. The venous ulcer group was divided in two subgroups: one that received placebo (nine patients) and other receiving vitamin D, 50.000 IU per week over two months (13 patients). Blood was collected for 25 OH vitamin D dosage before and after the medication. In the ulcer group, we obtained data concerning demographics, leg ulcer size, as well as pain severity, measured by an analogical visual scale. Data was grouped in contingency and frequency tables, the tests of Fisher and chi-squared being used for nominal variables and Mann-Whitney for numerical variables. The adopted significance was of 5%. RESULTS: We found vitamin D insufficiency in the great majority of the patients. The median level in the ulcer group was 17.05 ng/dl and 22.75 ng/dl in the group without ulcer (p=0,0182) No relation was found between the ulcer size without treatment and the level of vitamin D. After treatment, the average size of the ulcer changed from 25 cm² to 18 cm² in the patients that took vitamin D and from 27 cm² to 24,5 cm² in the placebo group (p=0,7051 and p=0,7877, respectively). Considering the variability of the size of the ulcer in the treatment group versus placebo group, the average size was equal to -0,75 cm² in the first group and +4cm² in the second (p=0,0676) CONCLUSION: Patients with leg ulcers have more vitamin D deficiency. No difference in the ulcer characteristics was noted between those with and without vitamin D deficiency. There was a trend toward a better healing in those with vitamin D reposition.

Síndrome de Grisel / Grisel Syndrome

A síndrome de Grisel é uma subluxação não traumática atlantoaxial associada a condições inflamatórias da cabeça e do pescoço. É uma patologia eminentemente pediátrica. Esse artigo apresenta relato de um paciente de 5 anos de idade, do sexo masculino que se queixou de rigidez cervical.