[Genetic counseling for individuals with hemoglobin disorders and for their relatives: a systematic literature review]. / Aconselhamento genético para indivíduos com alterações das hemoglobinas e seus familiars: revisão sistemática de literatura.

OBJECTIVE: To identify genetic counseling programs that do not encourage therapeutic abortion for individuals with hemoglobin disorders and/or for their relatives. METHOD: Systematic literature review of articles published from 2001 to 2012 that are located in the PubMed, LILACS, SciELO and SCOPUS databases using keywords in Portuguese, English and Spanish and that met the inclusion and exclusion criteria described on a standardized form. RESULTS: A total of 409 articles were located, but only eight (1.9%) were selected for analysis. CONCLUSION: Although seldom mentioned in the literature, educational/preventive programs targeting hemoglobinopathies are feasible and allow the affected individuals to acquire knowledge on the consequences of this condition and their odds of transmitting it.

Detection of arboviruses in Aedes aegypti through transovarian analysis: A study in Goiânia, Goiás.

BACKGROUND: Arboviral diseases are a group of infectious diseases caused by viruses transmitted by arthropods, mainly mosquitoes. These diseases, such as those caused by the dengue (DENV), Zika (ZIKV), chikungunya (CHIKV), and yellow fever (YFV) viruses, have a significant impact worldwide. In this context, entomological surveillance plays a crucial role in the control and prevention of arboviruses by providing essential information on the presence, distribution, and activity of vector mosquitoes. Based on entomological surveillance, transovarian transmission provides information regarding the maintenance and dissemination of arboviruses. The objective of this study was to detect these arboviruses in Goiânia, Goiás, and analyze the occurrence of transovarian transmission. METHODS: Aedes aegypti eggs were collected from different regions of Goiânia and cultivated under controlled laboratory conditions until the emergence of adult mosquitoes. Adult females were grouped into pools containing their heads and thoraxes. These pools were subsequently evaluated using reverse-transcription quantitative polymerase chain reaction (RT-qPCR) assay. RESULTS: A total of 157 pools (N=1570) were analyzed, with two pools testing positive for CHIKV and one pool testing positive for ZIKV, indicating that the offspring resulting from transovarian transmission are potentially infectious. CONCLUSIONS: In summary, the demonstration of the vertical transmission mechanisms of CHIKV and ZIKV in A. aegypti serves as an alert to health authorities, as these diseases are still underreported, and their primary urban vector has likely acquired this capacity, contributing to the dissemination of these infections.

Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review.

BACKGROUND: Chromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries. OBJECTIVES: The primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test. METHODS: MEDLINE, LILACS and Scielo databases were consulted using the terms "chromoblastomycosis" AND "diagnosis". The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods. RESULTS: Considering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S =  50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S  of 36% - 99%; and Sp  of 80% - 100%; while the intradermal test showed S  of 83.3% - 100% and Sp  of 99.4% - 100%. STUDY LIMITATIONS: The small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis. CONCLUSIONS: Direct mycological examination, culture, intradermal test and serology show sensitivity and specificity values ​​for the diagnosis of chromoblastomycosis with no significant difference between the studies.

Safe surgery checklist: evaluation in a neotropical region.

OBJECTIVE: assess patient responses and associated factors of items on a safe surgery checklist, and identify use before and after protocol implementation from the records. METHODS: a cohort study conducted from 2014 to 2016 with 397 individuals in stage I and 257 in stage II, 12 months after implementation, totaling 654 patients. Data were obtained in structured interviews. In parallel, 450 checklist assessments were performed in medical records from public health institutions in the Southwest II Health Region of Goiás state, Brazil. RESULTS: six items from the checklist were evaluated and all of these exhibited differences (p < 0.000). Of the medical records analyzed, 69.9% contained the checklist in stage I and 96.5% in stage II, with better data completeness. In stage II, after training, the checklist was associated with surgery (OR; 1.38; IC95%: 1.25-1.51; p < 0.000), medium-sized hospital (OR; 1.11; CI95%; 1.0-1.17; p < 0.001), male gender (OR; 1.07; CI95%; 1.0-1.14; p < 0.010), type of surgery (OR; 1.7; CI95%: 1.07-1.14; p < 0.014) and antibiotic prophylaxis 30 to 60 min after incision (OR; 1.10; CI95%: 1.04-1.17; p < 0.000) and 30 to 60 min after surgery (OR; 1.23; CI95%: 1.04-1.45; p = 0.015). CONCLUSIONS: the implementation strategy of the safe surgery checklist in small and medium-sized healthcare institutions was relevant and associated with better responses based on patient, data availability and completeness of the data.

Detection of arboviruses in Aedes aegypti through transovarian analysis: A study in Goiânia, Goiás

Abstract Background: Arboviral diseases are a group of infectious diseases caused by viruses transmitted by arthropods, mainly mosquitoes. These diseases, such as those caused by the dengue (DENV), Zika (ZIKV), chikungunya (CHIKV), and yellow fever (YFV) viruses, have a significant impact worldwide. In this context, entomological surveillance plays a crucial role in the control and prevention of arboviruses by providing essential information on the presence, distribution, and activity of vector mosquitoes. Based on entomological surveillance, transovarian transmission provides information regarding the maintenance and dissemination of arboviruses. The objective of this study was to detect these arboviruses in Goiânia, Goiás, and analyze the occurrence of transovarian transmission. Methods: Aedes aegypti eggs were collected from different regions of Goiânia and cultivated under controlled laboratory conditions until the emergence of adult mosquitoes. Adult females were grouped into pools containing their heads and thoraxes. These pools were subsequently evaluated using reverse-transcription quantitative polymerase chain reaction (RT-qPCR) assay. Results: A total of 157 pools (N=1570) were analyzed, with two pools testing positive for CHIKV and one pool testing positive for ZIKV, indicating that the offspring resulting from transovarian transmission are potentially infectious. Conclusions: In summary, the demonstration of the vertical transmission mechanisms of CHIKV and ZIKV in A. aegypti serves as an alert to health authorities, as these diseases are still underreported, and their primary urban vector has likely acquired this capacity, contributing to the dissemination of these infections.

Diagnosis of chromoblastomycosis: an historical review

Chromoblastomycosis is a skin infection caused by dematiaceous fungi, characterized by a verrucous plaque on the limbs. It mainly affects rural workers in tropical countries. The purpose of this review is to identify how the diagnostic methods used in the propaedeutic of chromoblastomycosis emerged and were developed. The MeSH terms "chromoblastomycosis" or "chromomycosis" or "verrucous dermatitis" and "diagnosis" were used to search articles indexed in MEDLINE and LILACS databases. The description of a first-time-used method in diagnosing chromoblastomycosis or modifications and innovations in an existing technique was the criteria used to deem the article eligible. The first methods described in diagnosing chromoblastomycosis were histopathological examination and culture, which characterizes and defines the disease in the early 20th century. Subsequently, they were described as direct microscopic examination, fine needle aspiration for cytology, electron microscopy, serology, molecular tests, scintigraphy, nuclear magnetic resonance and dermoscopy. Tests based on the direct identification of the fungus through biopsy, culture, or direct microscopy are the oldest and more employed methods for diagnosing chromoblastomycosis. The polymerase chain reaction was introduced in the last few decades and is a promising technique. Dermoscopy of chromoblastomycosis shows blackish red dots and white and pink areas along with scaling. Other techniques, such as serology and skin testing for delayed-type hypersensitivity, have not been incorporated into clinical practice

Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review

Abstract Background: Chromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries. Objectives: The primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test. Methods: MEDLINE, LILACS and Scielo databases were consulted using the terms ‟chromoblastomycosis" AND ‟diagnosis". The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods. Results: Considering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S = 50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S of 36% - 99%; and Sp of 80% - 100%; while the intradermal test showed S of 83.3% - 100% and Sp of 99.4% - 100%. Study limitations: The small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis. Conclusions: Direct mycological examination, culture, intradermal test and serology show sensitivity and specificity values for the diagnosis of chromoblastomycosis with no significant difference between the studies.

Safe surgery checklist: evaluation in a neotropical region / Checklist de cirurgia segura: avaliação em uma região neotropical

ABSTRACT Objective: assess patient responses and associated factors of items on a safe surgery checklist, and identify use before and after protocol implementation from the records. Methods: a cohort study conducted from 2014 to 2016 with 397 individuals in stage I and 257 in stage II, 12 months after implementation, totaling 654 patients. Data were obtained in structured interviews. In parallel, 450 checklist assessments were performed in medical records from public health institutions in the Southwest II Health Region of Goiás state, Brazil. Results: six items from the checklist were evaluated and all of these exhibited differences (p < 0.000). Of the medical records analyzed, 69.9% contained the checklist in stage I and 96.5% in stage II, with better data completeness. In stage II, after training, the checklist was associated with surgery (OR; 1.38; IC95%: 1.25-1.51; p < 0.000), medium-sized hospital (OR; 1.11; CI95%; 1.0-1.17; p < 0.001), male gender (OR; 1.07; CI95%; 1.0-1.14; p < 0.010), type of surgery (OR; 1.7; CI95%: 1.07-1.14; p < 0.014) and antibiotic prophylaxis 30 to 60 min after incision (OR; 1.10; CI95%: 1.04-1.17; p < 0.000) and 30 to 60 min after surgery (OR; 1.23; CI95%: 1.04-1.45; p = 0.015). Conclusions: the implementation strategy of the safe surgery checklist in small and medium-sized healthcare institutions was relevant and associated with better responses based on patient, data availability and completeness of the data.

RESUMO Objetivo: avaliar as respostas de pacientes e fatores associados quanto a itens do checklist de cirurgia segura. Identificar o uso antes e após a implantação de um protocolo a partir dos registros. Métodos: estudo de coorte realizado entre 2014-2016 com 397 pessoas na etapa I e 257 na etapa II, 12 meses depois da implementação, totalizando 654 pacientes. Os dados foram obtidos mediante entrevista estruturada. Paralelamente, realizaram-se 450 avaliações de checklist em prontuários de instituições públicas de saúde, da Região de Saúde Sudoeste II, Goiás. Resultados: seis itens foram avaliados da lista, e todos apresentaram diferenças (p < 0,000). Em 69,9% dos prontuários continham o checklist na etapa I, e, após a capacitação, foi identificado em 96,5% dos registros, tendo melhor completude. O checklist, foi associado à cirurgia realizada na segunda etapa, depois da ação educativa, (RP; 1,38; IC95%: 1,25-1,51; p < 0,000), ao hospital de médio porte, (RP; 1,11; IC95%; 1,0-1,17; p < 0,001); sexo masculino (RP; 1,07; IC95%; 1,0-1,14; p < 0,010), tipo de cirurgia, (RP; 1,7; IC95%: 1,07-1,14; p < 0,014) e antibioticoprofilaxia de 30 a 60 min após a incisão (RP; 1,10; IC95%: 1,04-1,17; p < 0,000) e 30 a 60 min após o término da cirurgia (RP; 1,23; IC95%: 1,04-1,45; p = 0,015). Conclusões: a estratégia de implantação do checklist de cirurgia segura nas instituições de pequeno e médio foram relevantes e associadas a uma melhoria a partir das respostas dos pacientes, na disponibilização e maior completude dos dados.

Um programa de mentoria para estudantes de Medicina de uma universidade do Centro-Oeste brasileiro / A mentoring program for medicine students at a University inthe Midwest of Brazil

Resumo: Introdução: Neste artigo, fazemos um relato de experiência da implantação e do funcionamento de um programa de mentoria aplicado a estudantes de graduação do curso de Medicina de uma universidade do Centro-Oeste brasileiro. É consenso que a pressão dos cursos de Medicina provoca sobrecarga emocional e afeta negativamente os estudantes, e é preciso que medidas de apoio sejam implementadas. Relato de experiência: O programa de mentoria da Faculdade de Medicina da Universidade Federal de Goiás teve um processo de construção lógico. Foi criado no início de 2015, pelo reconhecimento da necessidade da instituição em apoiar os acadêmicos durante sua graduação, fato evidenciado a partir do atendimento psicológico ao aluno e de uma pesquisa in loco. Os seguintes aspectos-chave caracterizam o programa: é oferecido como uma disciplina eletiva, pode ser feito até cinco vezes e,além de um encontro mensal com o mentor, o estudante escolhe as oficinas de que deseja participar, diversificando assim sua formação. Após 12 semestres de funcionamento, sintetizamos neste artigo uma parte de nossos resultados e algumas reflexões sobre o que queremos para o futuro do programa. Discussão: A implementação da mentoria e suas adequações foram resultados de pesquisa, capacitação, discussões dos docentes e avaliação periódica pelos mentorados. As mudanças procuraram atender às expectativas e sugestões dos estudantes, objetivando atrair a atenção e satisfazer aos anseios dos discentes. Ao longo dos 12 semestres de funcionamento do programa, o interesse dos alunos pela matrícula na disciplina cresceu, com forte avaliação positiva, especialmente pela livre escolha e diversidade de oficinas, e pelo envolvimento do tutor. Conclusão: As instituições de ensino devem estimular a criação de programas de mentoria. O programa relatado neste artigo tem tido boa aceitação por parte dos alunos e nos aponta bons resultados.

Abstract: Introduction: This article reports on the experience of implementing and running a mentoring program for medical school students at a Brazilian university in the Midwest region. It is widely accepted that the pressure at medical school is detrimental to the students and often leads to emotional overload. Therefore, supporting mechanisms must be implemented. Experience report: The mentoring program at the Federal University of Goiás had a logical beginning. It was created in early 2015, after psychotherapy services offered to the students led to an in loco research study, which in turn pointed out the need to provide support to students throughout their undergraduate studies. There are some key characteristic aspects of the program: it's an elective course, which can be taken up to 5 times, and the students can choose the workshops they want to attend in addition to the monthly meeting with the mentor, which allows for diverse paths to be followed. After twelve semesters in existence, this article presents a summary of some of the results obtained and reflections on the future of this program. Discussion: The implementation of the program and its adaptations resulted from research, professional development, discussions among professors and regular assessments by the mentees. Changes were made according to the expectations and suggestions of participating students, aiming to effectively meet their needs and represent a desirable course. Since its inception, the program has attracted increasingly more students, and enjoyed a strong positive evaluation, mainly due to the various workshops to choose from and engagement with the mentor. Conclusion: Universities should support the creation of such mentoring programs. The program discussed in this article has been well received and points towards positive outcomes.

Behaviour and recovery of human adenovirus from tropical sediment under simulated conditions.

This study assessed the contributions of pH and organic matter (OM) on the recovery of infectious human adenovirus 5 (HAdV-5) and genome copies (GCs) in waters that were artificially contaminated with tropical soil. The use of a mathematical equation was proposed based on the flocculation index of clay to assess the recovery of total GCs in these controlled assays. The results suggest that solids in the water reduced the viral genome copy loads per millilitre (GC · mL(-1)) and viral infectivity. OM did not influence the GC · mL(-1) recovery rate (p > 0.05) but led to a 99% (2 log10) reduction in plaque-forming unit counts per millilitre (PFU/mL), which indicates that infectivity and gene integrity were non-related parameters. Our findings also suggest that acidic pH levels hinder viral inactivation and that clay is the main factor responsible for the interactions of HAdV-5 with soil. These findings may be useful for future eco-epidemiological investigations and studies of viral inactivation or even as parameters for future research into water quality analysis and water treatment.

Intra-familial and extra-familial risk factors associated with Cryptosporidium parvum infection among children hospitalized for diarrhea in Goiânia, Goiás, Brazil.

A cross-sectional study was conducted for assessing the prevalence of and risk factors associated with Cryptosporidium parvum in diarrheic children who were hospitalized in Goiânia, capital of Goiás State in Brazil. A crude prevalence of 14.4% (64 of 445) was observed using a direct immunfluorescent assay (DFA), but the true prevalence was 18.7% (83 of 445) when a gold standard of immunomagnetic separation was used in combination with the DFA. Infection was more predominant in children less than 24 months old (odds ratio [OR] = 0.50, 90% confidence interval [CI] = 0.36-0.68, P = 0.0001), and males were 2.2 times more at risk for infection when compared with females (OR = 2.2. 90% CI = 0.13-3.8, P = 0.01). The socioeconomic, intra-familial, and environmental factors associated with cryptosporidiosis were day care attendance, household children with diarrhea up to 30 days prior to the interview, contact with surface water within past 30 days prior to the interview, dwelling distance from a body of water, and the late rainy season (P < 0.10). C. parvum was not associated with the parent's occupation, household sleeping arrangements, number of caregivers, breast-fed children, diet and type of food hygiene, source and type of treatment of drinking water, presence of sewage, and animal exposure (P > 0.10). Although weight was not found to be associated with infection, children infected with C parvum weighed on average 2.0% less than children not infected with C. parvum (P > 0.10). Thus, C. parvum is an important etiologic agent of childhood diarrhea and should be identified in routine parasitologic tests of diarrheal stool samples.

[Chlamydia trachomatis and Neisseria gonorrhoeae infection: factors associated with infertility in women treated at a human reproduction public service]. / Infecção por Chlamydia trachomatis e Neisseria gonorrhoeae: fatores associados à infertilidade em mulheres atendidas em um serviço público de reprodução humana.

PURPOSE: To evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women undergoing assisted reproduction in a public reference service in the midwestern region of Brazil. METHODS: A cross-sectional study was conducted on 340 women aged from 20 to 47 years with a history of infertility, undergoing assisted reproduction techniques. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae identified in urine specimens by PCR, and the profile of infertility were analyzed. We used the χ(2) test or Fisher's exact test to evaluate the association between infection and variables. RESULTS: The prevalence of Chlamydia trachomatis infection was 10.9%, and Neisseria gonorrhoeae co-infection was observed in 2 cases. Women infected with Chlamydia trachomatis had more than 10 years of infertility (54.1%; p<0.0001). The tubal factor was the main cause in infected cases (56.8%; p=0.047). Tubal occlusion was found in 67.6% of cases with positive infection (p=0.004). CONCLUSION: There was an association of tubal obstruction with infection by Chlamydia trachomatis and Neisseria gonorrhoeae, reinforcing the need for effective strategies for an early detection of sexually transmitted diseases, especially in asymptomatic women of childbearing age.

Neurosurgery Simulators Developed for Neurosurgical Training in Brazil: A Systematic Review

Introduction Simulation in neurosurgery is a growing trend in medical residency programs around the world due to the concerns there are about patient safety and the advancement of surgical technology. Simulation training can improve motor skills in a safe environment before the actual setting is initiated in the operating room. The aim of this review is to identify articles that describe Brazilian simulators, their validation status and the level of evidence (LoE). Methodology This study was conducted using the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A search was performed in the Medline, Scielo, and Cochrane Library databases. The studies were evaluated according to the Medical Education Research Quality Instrument (MERSQI), and the LoE of the study was established according to the classification system of the Oxford Centre for Evidence-Based Medicine (OCEBM), which has been adapted by the European Association of Endoscopic Surgery. Results Of all the studies included in this review, seven referred to validated simulators. These 7 studies were assigned an average MERSQI score of 8.57 from 18 possible points. None of the studies was randomized or conducted in a high-fidelity environment. The best evidence was provided by the studies with the human placenta model, which received a score of 2b and a degree of recommendation of 3. Conclusion Brazilian simulators can be reproduced in the different laboratories that are available in the country. The average MERSQI score of Brazilian studies is similar to the international average score. New studies should be undertaken to seek greater validation of the simulators and carry out randomized controlled trials.

Ceratose seborreica em idosos de uma região de savana tropical / Seborrheic keratosis in elderly of a tropical savanna region / Queratosis seborreica em ancianos de una region de savana tropical

Objetivo: verificar a prevalência de ceratose seborreica em idosos residentes em região de savana tropical. Método: estudo descritivo transversal, realizado em Palmas, Tocantins, no primeiro semestre de 2016, com idosos de ambos os sexos. Resultados: participaram do estudo 259 idosos, sendo identificada prevalência de 8,5% de ceratose seborreica, com maior ocorrência no sexo masculino, na faixa etária de 70 a 79 anos, e que se auto declararam negros. Quanto às características da pele dos idosos com ceratose seborreica, a maioria apresentava pele ressecada e com diminuição do turgor cutâneo. Considerações finais: dados relacionados aos fatores ressecamento da pele e diminuição do turgor alertam para a necessidade de maior atenção e cuidados preventivos especificamente voltados a pessoa idosa. Esse estudo, representa o início para compreensão sobre a prevalência de ceratose seborréica em idosos em área de savana tropical, e destaca a importância de realização de outros estudos acerca dos fatores intervenientes, ampliando a compreensão sobre o fenômeno.

Objective: verify the prevalence of seborrheic keratosis in elderly residents of a tropical savanna region. Method: this is a descriptive cross-sectional study, carried out in Palmas, Tocantins, in the first half of 2016, with elderly men and women. Results: a total of 259 elderly people participated in the study, that identified a prevalence of 8.5% of seborrheic keratosis, with the highest occurrence in males, aged 70 to 79 years, and who declared themselves black. As to the skin characteristics of the elderly with seborrheic keratosis, the majority had dry skin and decreased skin turgor. Conclusion: the data related to skin dryness and turgor reduction factors point to the need for greater attention and preventive care specifically to the elderly. This study represents the beginning of an understanding about the prevalence of seborrheic keratosis in the elderly in a tropical savanna area, and highlights the importance of other studies about the intervening factors, increasing the understanding about the phenomena.

Objetivo: verificar la prevalencia de queratosis seborreica en ancianos residentes en la región de savana tropical. Método: estudio descriptivo transversal, realizado en Palmas, Tocantins, en el primer semestre de 2016, con ancianos de ambos sexos. Resultados: participaron del estudio 259 ancianos, fue identificada prevalencia de 8,5% de queratosis seborreica, con mayor ocurrencia en el sexo masculino, en el grupo etario de 70 a 79 años, y que se auto declararon negros. En cuanto a las características de la piel de los ancianos con queratosis seborreica, la mayoría presentaba piel reseca y con diminución do turgencia cutánea. Conclusión: datos relacionados a los factores de resecamiento de la piel y diminución de la turgencia alertan sobre la necesidad de mayor atención y cuidados preventivos específicamente orientados a la persona anciana. Ese estudio representa el inicio para la comprensión sobre la prevalencia de queratosis seborreica en ancianos en área de savana tropical, y destaca la importancia de la realización de otros estudios acerca de los factores intervinientes, ampliando la comprensión del fenómeno.

A model of genetic guidance for hemoglobinopathy patients and laboratory diagnosis of family members as educational and preventive measures.

BACKGROUND: The high frequency of hemoglobinopathies in Brazil constitutes a public health problem and thus educational and preventive measures are necessary to reduce the incidence. Genetic guidance, a modality of genetic counseling, and family screening are measures that can assist in reproductive decisions and mitigate clinical, psychological and social problems of families with these disorders. OBJECTIVE: The objective of the current study was to evaluate the effectiveness of educational and preventive measures for hemoglobinopathies using genetic guidance and laboratory screening of families. METHODS: The diagnoses of patients with hemoglobinopathies were confirmed and then the level of knowledge about their disease was evaluated and genetic guidance was provided. Three months later, the level of assimilated information of these patients was evaluated. In addition, laboratory diagnosis of family members was carried out. RESULTS: Diagnosis of sickle cell anemia was confirmed for most patients. Moreover, the majority of the patients who had a low level of knowledge before genetic guidance (68.8%) demonstrated a higher level of assimilated information after the process (81.8%). Almost 70% of the family members had hemoglobin changes and some had hemoglobinopathies(2.6%). They were duly informed about the results of the examinations, which made it possible to investigate further. CONCLUSION: Genetic guidance and family screening were effective preventive and educational measures that improved the quality of life of patients, preventing complications and sequels and allowed the referral of those who may transmit altered genes for clinical diagnosis and to genetic counseling services.

Cervical Cytopathology in a Population of HIV-Positive and HIV-Negative Women.

The association between abnormal cervical cytology and HIV infection status in women was evaluated to correlate with CD4 cell count and viral load in HIV-positive patients with the presence of low-grade (LSIL) and high-grade squamous intraepithelial lesion (HSIL). Cervical samples were collected at the Tropical Disease Hospital, Maternal and Child Healthcare Hospital and at the Nascer Cidadão Maternity Hospital in Goiânia, Goiás, Brazil. An Ayre's spatula was used to collect samples from the ectocervix and a cytology brush to collect samples from the endocervix. Of a total of 237 women, 125 were HIV positive and 112 were HIV negative. Abnormal cytology (n = 21; 8.9%) was more common in the HIV positive group (n = 15; 12.1%) compared to the HIV-negative group (n = 6; 5.4%) (P = 0.05). Cytological abnormalities were not found to be associated with immunosuppression, defined as CD4 count < 200 cells/mm(3). A higher frequency was found between higher viral loads (>10,000/mm(3)) and the presence of abnormal cytology. Pregnant women, irrespective of whether they were HIV positive or negative, were less likely to have lesions compared to the nonpregnant women in the same groups. The higher frequency of abnormal findings in Papanicolaou cytology in HIV-positive women with higher viral loads suggests the association between preinvasive cervical lesions and human immunodeficiency.

Fatores influenciadores na escolha pela medicina de família segundo estudantes numa região neotropical do Brasil / Influencing factors in choice for family medicine by students in a neotropical region of Brazil

Objetivo: Analisar as percepções de estudantes, em uma escola médica no interior do estado de Goiás, sobre os fatores influenciadores na escolha ou na repulsa estudantil pela carreira em Medicina de Família e Comunidade. Metodologia: Pesquisa qualitativa, exploratória e transversal. Foi adotada a Análise de Conteúdo, de Laurence Bardin. O instrumento adotado foi um roteiro para entrevista semiestruturada e um questionário socioeconômico. O roteiro possuía perguntas fechadas abordando a preferência do aluno por determinadas especialidades médicas. A partir daí, perguntou-se por que escolheram ou não a Medicina de Família e Comunidade. Roteiro aplicado em 2013, para todos os 42 estudantes do último ano de um curso de medicina. Resultados: Nenhum estudante pesquisado escolheu a Medicina de Família e Comunidade. A relevância social da profissão, a abrangência de diversos problemas na prática clínica, o vínculo contínuo com pacientes, uma exposição maior a esta especialidade e, principalmente, a presença de médicos de família na graduação seriam influências positivas para a escolha destes alunos pela Medicina de Família e Comunidade. O desprestígio na universidade, identificado no discurso de professores e médicos preceptores, além da falta de reconhecimento da sociedade e a baixa remuneração foram os principais fatores desmotivadores na escolha pela área. Conclusão: A valorização da Medicina de Família e Comunidade, com o aumento da participação de mais especialistas no curso de medicina, além de uma valorização na comunidade universitária e na gestão do sistema de saúde podem ser ações que provoquem uma atração maior de estudantes para esta especialidade.

Objective: To analyze the perceptions of students in a medical school in the interior of a state of Goiás, on the factors influencing the choice or rejection of students by Family and Community Medicine as a medical career. Methodology: Qualitative, exploratory and transversal research. Content Analysis was adopted by Laurence Bardin. The instrument adopted was a script for a semi-structured interview and a socioeconomic questionnaire. The script had closed questions about which medical specialty the students were choosing. From then on, was asked why they chose or did not choose the Family and Community Medicine. Roadmap applied in 2013 to all 42 seniors in a medical school. Results: No students studied chose Family and Community Medicine. The social relevance of the specialty, the coverage of several different problems in clinical practice, the continuous link with patients and a greater exposure to this specialty, and especially the presence of experts in the undergraduate would be positive influences for the choice Family and Community Medicine. The lack of prestige in the university, identified in the discourse of preceptor teachers and doctors, in addition to the lack of recognition of society and the low remuneration were the main demotivating factors in this choice. Conclusion: The increase in the participation of more Family and Community Medicine specialists in the medical school, as well as a valuation in the university community and in the management of the health system can be actions that provoke a greater attraction of students to this specialty.

[Land use and occupation and hantavirosis dissemination in the São Sebastião region, Federal District: 2004 - 2008]. / Uso e ocupação do solo e a disseminação da hantavirose na região de São Sebastião, Distrito Federal: 2004 - 2008.

INTRODUCTION: Hantavirosis has worldwide distribution and is an important public health problem. The epidemiology of hantavirosis in Brazil shows that the number of cases notified and the number of variants discovered in several states and the Federal District have been increasing year by year. Within this context, the main objective of this study was to examine land use and occupation in relation to the spread of hantavirosis in the Federal District, between 2004 and 2008. METHODS: To carry out this investigation, epidemiological and land use data were used to drafting tables and cartograms in order to detail the special spread of hantavirosis in this area. RESULTS: Out of the 40 likely infection sites plotted on the coverage and land use map, 19 (47%) were in pasture areas, 10 (25%) in urban areas (periurban), 6 (15%) in areas used for agriculture and 5 (12%) in savanna areas. CONCLUSIONS: It can thus be seen that agricultural activities and urban expansion towards the savanna areas have favored the spread of hantavirosis in the Federal District and especially in São Sebastião.

PREVALÊNCIA DE CERATOSE ACTÍNICA EM IDOSOS DE UMA REGIÃO NEOTROPICAL / PREVALENCE OF ACTINIC KERATOSIS IN THE ELDERLY OF A NEOTROPICAL REGION / PREVALENCIA DE QUERATOSIS ACTÍNICA EN LOS ADULTOS MAYORES DE UNA REGIÓN NEOTROPICAL

Objetivo: identificar a prevalência de ceratose actínica (CA) em idosos residentes no município de Palmas, TO, Brasil. Método: estudo epidemiológico, observacional, transversal realizado no município de Palmas, no período de janeiro a junho de 2016, com pessoas, de ambos os sexos, com idade acima de 60 anos. Resultados: fizeram parte do estudo 259 idosos, com predomínio na faixa etária entre 60 e 69 anos, média de idade de 72 anos. A prevalência de CA foi de 2,3%, com predomínio no sexo feminino (66,7%), na faixa etária entre 68 e 91, e que se declararam brancos (66,7%). Conclusão: estudos alertam quanto ao risco de desenvolvimento de CA por pessoas idosas, relacionando a exposição solar ao longo da vida. Embora esse estudo não tenha investigado os hábitos de vida quanto ao histórico de exposição solar, os resultados confirmam o risco para idosos. Evidencia a importância de cuidados preventivos com a pele, especialmente quanto a exposição solar, visando a prevenção da CA.

Objective: Identify the prevalence of Actinic Keratosis (CA) in elderly residents in the city of Palmas, TO, Brazil. Method: it is an observational, cross-sectional epidemiologic study, conducted in the city of Palmas from January to June of 2016, with subjects of both sexes, aged above 60 years. Results: two hundred sixty-nine elders were part of this study, most of them aged between 60 and 69 years, with an average age of 72 years. The CA prevalence was 2.3%, mostly women (66.7%), aged between 68 and 91, and who declared themselves white (66.7%). Conclusion: Studies warn about the risk of elderly people developing CA related to solar exposure throughout the life. Although this study did not investigate the life habits related to sun exposure, the results confirm this risk for seniors. This study highlights the importance of preventive skin care, especially related to sun exposure, aiming the CA prevention.

Objetivo: identificar la prevalencia de queratosis actínica (CA) en los adultos mayores residentes en la ciudad de Palmas, Tocantins, Brasil. Método: estudio epidemiológico, observacional, transversal, realizado en la ciudad de Palmas, en el período de enero a junio de 2016, con las personas de ambos sexos, mayores de 60 años. Resultados: los sujetos fueron 259 ancianos, predominantemente con edades comprendidas entre 60 y 69 años, con una edad media de 72 años. La prevalencia de la CA fue de 2,3%, con predominio en mujeres (66,7%), con edades comprendidas entre los 68 y 91, y que se declararon raza blanca (66,7%). Conclusión: estudios advierten sobre el riesgo de desarrollo de CA para las personas ancianas que une la exposición al sol durante toda la vida. Aunque este no estudio ha investigado los hábitos de vida como la historia de la exposición al sol, los resultados confirman el riesgo para ancianos. Destaca la importancia de la atención preventiva de la piel, sobre todo por exposición al sol, con el objetivo de la prevención del CA.