High prevalence of hepatitis B virus and low vaccine response in children and adolescents in Northeastern Brazil

ABSTRACT Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson's regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations.

HPV 18 variants in women with cervical cancer in Northeast Brazil

Abstract Background Human Papillomavirus (HPV) is the main etiological factor for the development of cervical cancer. HPV 18 is the second most frequent type, accounting for up to 65% of all cases. HPV intratypic variation may influence the potential for progression to invasive cancer. The aim of this study was to evaluate the prevalence of human papillomavirus 18 intratypic variants in cervical cancer samples from women in the state of Maranhão, Brazil. Methods The study included 118 women over 18 years of age with a diagnosis of cervical cancer. Tumor fragments were collected and subjected to DNA extraction and Polymerase Chain Reaction (PCR) for HPV detection using the PGMY09/11 and GP+5/6 primers. Positive samples were submitted to automated sequencing for viral genotyping. To determine the HPV 18 lineages, positive samples were submitted to PCR, using specific primers to amplify the LCR and E6 regions of HPV 18 virus. Results HPV was present in 88 women (73.3%). Of those, 48 (54%) were HPV 16, the most prevalent, followed by 12 (13.6%) HPV 18. Histologically, squamous cell carcinoma was predominant (79.1%). Among the HPV 18 variants identified, 10 (80%) belonged to lineage A, and sublineages A1, A2, A3, and A4. Two (29%) HPV 18 B variant was also detected, with the sublineages B1 and B2. In this study, the C variant was not found. There was no statistically significant association between the HPV 18 lineages found and sociodemographic and lifestyle variables (p > 0.05). Conclusions A higher frequency of HPV 16 and 18 were found in women with cervical cancer in the state of Maranhão, Brazil, with a high prevalence of the lineage A among women with HPV 18.

Epidemiological profile of patients co-infected with visceral leishmaniasis and HIV/AIDS in Northeast, Brazil

Abstract INTRODUCTION: Visceral leishmaniasis (VL) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-infection has been a research topic of interest worldwide. In Brazil, it has been observed that there is a relative underreporting and failure in the understanding and management of this important association. The aim of this study was to analyze epidemiological and clinical aspects of patients with VL with and without HIV/AIDS. METHODS: We conducted an observational and analytical study of patients with VL followed in a Reference Service in the State of Maranhão, Brazil from 2007-2013. RESULTS: In total 126 patients were enrolled, of which 61 (48.4%) were co-infected with HIV/AIDS. There were more males among those with HIV/AIDS (85.2%, P>0.05) or with VL only (81.5%, P>0.05). These findings significantly differed based on age group (P<0.003); the majority of patients were aged 31-40 years (41.0%) and 21-30 years (32.3%) among those with and without HIV/AIDS co-infection, respectively. The incidence of diarrhea and splenomegaly significantly differed between the two groups (P=0.0014 and P=0.019, respectively). The myelogram parasitic examination was used most frequently among those with HIV/AIDS (91.8%), followed by those with VL only (69.2%). VL recurrences and mortality were significantly higher in the HIV/AIDS co-infected patients (P<0.0001 and P=0.012, respectively). CONCLUSIONS: Patients with VL with or without HIV/AIDS co-infection were mostly adult men. Diarrhea was more frequent in HIV/AIDS co-infected patients, whereas splenomegaly was more common in patients with VL only. In the group of HIV/AIDS co-infected patients, there was a higher rate of VL recurrence and mortality.

Burnout no trabalho de médicos pediatras / Pediatricians' job burnout

Contexto: A síndrome de esgotamento profissional ou burnout é uma reação de estresse excessivo relacionada ao trabalho, a qual se apresenta em três dimensões: exaustão emocional, despersonalização e reduzida realização profissional. Objetivos: O presente estudo teve como objetivo identificar e comparar essas três dimensões presentes nos pediatras do Hospital Universitário da Universidade Federal do Maranhão (UFMA) ­ Unidade Materno Infantil. Métodos: Trata-se de um estudo quantitativo e descritivo envolvendo 78 profissionais. Utilizou-se como instrumento de pesquisa o Maslach Burnout Inventory e o questionário sociodemográfico. Resultados: A análise dos dados apontou que a prevalência de burnout foi de 2,6%. Níveis elevados de exaustão emocional, despersonalização e reduzida realização profissional foram encontrados em 42,3, 38,5 e 6,4% dos entrevistados, respectivamente. A prevalência de nível elevado em duas dimensões foi de 23,1%. Conclusões: Os pediatras apresentaram altos valores de exaustão emocional e baixos valores de despersonalização e reduzida realização profissional. Ressalta-se a necessidade de estruturação de programas de enfrentamento de burnout a fim de evitar o adoecimento de profissionais envolvidos com a promoção da saúde de crianças e adolescentes.

Background: Burnout is an excessive work-related stress response that involves three main dimensions: emotional exhaustion, depersonalization and reduced professional achievement. Aims: The present study aimed to identify and compare these three dimensions among pediatricians at the Mother-Child Unit of University Hospital, Federal University of Maranhão (Universidade Federal do Maranhão ­ UFMA). Methods: The present quantitative and descriptive study included 78 professionals. The Maslach Burnout Inventory and a sociodemographic questionnaire were used for data collection. Results: Data analysis showed that the prevalence of burnout was 2.6%. High levels of emotional exhaustion, depersonalization and reduced professional achievement were found in 42.3%, 38.5% and 6.4% of the participants, respectively. The prevalence of high levels in two of these dimensions simultaneously was 23.1%. Conclusions: The analyzed pediatricians exhibited high levels of emotional exhaustion and low values of depersonalization and reduced personal accomplishment. The need to develop programs against burnout is emphasized to avoid the occurrence of illness among professionals involved in the promotion of child and adolescent health.

Knowledge and perceptions on toxoplasmosis among pregnant women and nurses who provide prenatal in primary care

ABSTRACT Background Toxoplasmosis is an infection that affects almost a third of the world population. In adults, it is often asymptomatic, although having important manifestation in children- infected by placental transmission. The prenatal is an important moment, requiring actions in women’s care during pregnancy, in order to prevent diseases that could compromise the mother and the child’s life. Methods This is a descriptive study of qualitative approach aimed to understand the perception of nurses and pregnant women about toxoplasmosis during primary – prenatal care. The study was conducted in five selected primary health care units, in the municipality of São Luis - MA. The sample consisted of 15 nurses working in nursing consultation and 15 pregnant women attended in prenatal care. For data collection, a semi-structured questionnaire and an interview guide covering issues related to knowledge and conduct on toxoplasmosis were used. For analysis, the content analysis technique was used. Results The answers were transcribed, organized and grouped thematically, where the following categories emerged: knowledge about examination requests; knowledge about toxoplasmosis; guidance during prenatal consultation; knowledge of nurses about the avidity test; procedures and guidelines on reagent cases. Pregnant women showed unawareness about toxoplasmosis and its effects. Nurses, although having basic knowledge about the subject, showed little applicability regarding pregnant women’s guidance. Conclusion The nurse plays an important role in educational activities regarding pregnant women, contributing to the quality of prenatal care. Pregnant women were shown to have some knowledge about toxoplasmosis, although they said they did not have assurance about prevention.

Avaliação ergonômica do trabalho em indústria de aço inox: análise de condições psicofisiológicas / Ergonomic evaluation of the stainless steel industry: analysis of psycho physiological conditions

Contexto: Apresenta-se um método de intervenção ergonômica, em que são investigadas as condições psicofisiológicas do trabalho de operários em postos de trabalho em indústria de aço inox. Objetivo: Avaliar as condições de trabalho e propor sugestões que viabilizem um ambiente de trabalho ergonômico. Métodos: Estudo descritivo e retrospectivo obtido a partir de levantamento de dados de 47 funcionários oriundos de uma metalúrgica de aço inox, em São Luís, Maranhão, no período de janeiro a dezembro de 2011, através de visita técnica. Resultados: Nos postos de trabalhos observados neste estudo, o tipo de tarefa exercida é de livre postura, ora estando em pé, ora estando sentado ou semissentado. O tipo de banco utilizado é questionável, pois não possui nenhum encosto. Os problemas observados foram: acidentário e arquitetural, devido à falta de planejamento de espaços e ambientação agradáveis ao trabalho; biológico, pela sujeira acumulada e não adequação às normas de higiene; físico-ambiental, pela falta de iluminação suficiente para execução principalmente de trabalhos que requerem precisão; interfacial, sendo observadas as bancadas de trabalho e principalmente os bancos sem qualquer tipo de apoios para execução das tarefas; químico-ambiental, pela falta de limpeza no local de trabalho, expondo diariamente o trabalhador a substâncias pesadas prejudiciais à saúde. Conclusão: A pesquisa demonstra a fragilidade das condições de trabalho em uma empresa de São Luís. É importante realizar mudanças com vistas à garantia de melhores condições de serviço, de acordo com a ergonomia.

Context: We present a method for ergonomic intervention, in which the psychophysiological work conditions of workers of the stainless steel industry are investigated. Objective: To assess the working conditions and propose suggestions that enable an ergonomic work environment. Methods: This was a descriptive, retrospective study obtained from survey data of 47 employees from a stainless steel metallurgical in São Luís, Maranhão, Brazil, from January to December 2011, trough technical visit. Results: In the workstations observed in this study, the body posture is free posture, sometimes in standing position, sitting or semi-sitting. The type of bank used is questionable, as there is no backrest. The observed problems were: accidental and architectural, due to the lack of planning space and pleasant ambience to work; biological, due to accumulated dirt and non compliance to hygiene standards; physical and environmental, due to the lack of sufficient lighting especially in jobs that require precision; interfacial, with work benches and especially banks without any kind of support for the execution of tasks; chemical and environmental, due to the lack of a clean workplace, exposing the worker to heavy substances harmful to health on a daily baisis. Conclusion: The study shows the fragility of working conditions in a company of São Luís. It is important to make changes in order to guarantee better conditions of service, according to ergonomics.

Osteoporosis in primary care: an opportunity to approach risk factors / Osteoporose na atenção primária: uma oportunidade para abordar os fatores de risco

ABSTRACT Introduction: Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. Objectives: Identify risk factors related to osteoporosis in women attending Propis/Proex/UFMA, tracing a socio-demographic characterization and considering community lifestyles. Material and methods: This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís (MA) with 107 women treated at the Programa de Práticas de Integralidade em Saúde (Propis - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info® software, version 3.4.1. Results: The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p < 0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p < 0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. Conclusion: The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high.

RESUMO Introdução: As mulheres no climatério estão suscetíveis a uma série de mudanças, entre elas a osteoporose. A osteoporose é uma doença caracterizada por uma baixa massa óssea e susceptibilidade à fratura. Atualmente, essa doença é um problema de saúde pública e é necessário reconhecer seus fatores de risco. Objetivos: Identificar os fatores de risco relacionados com a osteoporose em mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis)/Proex/UFMA, traçar uma caracterização sociodemográfica e considerar o estilo de vida da comunidade. Material e métodos: Trata-se de um estudo transversal retrospectivo clínico com uma abordagem quantitativa, feito entre março e junho de 2013, em São Luís (MA), com 107 mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis). O estudo foi aprovado pelo Comitê de Ética do Hospital Universitário da UFMA, sob parecer nº 362/07. Os dados foram tabulados e analisados com o software epidemiológico Epi-Info®, versão 3.4.1. Resultados: A etnia parda foi predominante, a união estável mostrou ser um fator protetor e a baixa escolaridade foi um fator de risco. A idade média do grupo com menopausa foi de 54,1 anos e a do sem menopausa de 31,3 anos (p < 0,0001). A idade média da menopausa foi de 43,7 anos. O ciclo menstrual irregular foi um fator protetor. O número médio de gestações foi de 4,56 para o grupo com menopausa e 2,45 para o grupo sem menopausa, com a maior parte dos partos normal (p < 0,0001). O tabagismo, a inatividade física e o consumo de cafeína foram fatores de risco, enquanto a ausência de alcoolismo e de ingestão de refrigerante foram fatores de proteção para a doença. Conclusão: Os pacientes seguiram o perfil socioeconômico e demográfico do Maranhão. A maior parte teve a menarca e a menopausa em períodos apropriados, não apresentava antecedentes familiares de osteoporose, não costumava ingerir bebida alcoólica, era sedentária e consumia uma elevada quantidade de cafeína.

Patologias osteomusculares como causa de aposentadoria por invalidez em servidores públicos do município de São Luís, Maranhão / Musculoskeletal pathology as a cause of disability retirement for public servants in the municipality of São Luís, Maranhão

Introdução: É evidente a preocupação do governo em regulamentar as ações relacionadas à saúde. É passível de aposentadoria por invalidez o servidor acometido de espondilite anquilosante e outras doenças osteomusculares. Objetivo: Descrever o perfil de morbidade por patologias osteomusculares dos servidores públicos do município de São Luís aposentados por invalidez. Materiais e Métodos: Trata-se de um estudo observacional, descritivo e retrospectivo, de 60 fichas de funcionários contendo informações registradas pela Comissão de Perícia Médica no período de janeiro de 2009 a dezembro de 2011. Calculou-se como indicador de impacto da aposentadoria por invalidez em doenças osteomusculares os somatórios dos anos perdidos em decorrência da aposentadoria. A condução do estudo recebeu anuência da Comissão de Perícia Médica do IPAM e dos funcionários por meio do Termo de Compromisso de Utilização de Prontuários e Termo de Consentimento Livre e Esclarecido. Resultados: A análise de aposentadoria por invalidez em razão do diagnóstico por patologias osteomusculares demonstra que ocorreu prevalência do sexo masculino (90,00%) na faixa etária de 61 a 65 anos, e as profissões mais acometidas foram professores e agente administrativo. As patologias osteomusculares ocorreram em 10,00% da amostra do estudo, e os profissionais que mais se aposentaram por invalidez tipo integral e/ou proporcional foram agente administrativo e auxiliar de serviços gerais. Conclusão: O estudo mostra a necessidade de promoção de saúde e vigilância em relação à saúde do trabalhador, propiciando melhores condições de trabalho e reduzindo o adoecimento dos servidores, diminuindo o número de aposentadoria por invalidez por patologias osteomusculares.

Background: It is clear the concern of governments to discipline the actions related to health. It is likely to disability retirement the server stricken with ankylosing spondylitis and other musculoskeletal diseases. Objective: Describe the morbidity profile for musculoskeletal pathologies of public in São Luís retired due to disability. Materials and Methods: This was an observational, descriptive and retrospective, study of 60 employee records containing information recorded by the Commission of Forensic Medicine between January 2009 and December 2011. The sums of years lost due to retirement were calculated as an indicator of the impact of disability retirement in musculoskeletal diseases. The conduct of the study received approval from the Commission of Forensic Medicine Division of IPAM and staff through the Commitment Term Use of Medical Records and Statement of Consent. Results: The analysis of disability retirement due to musculoskeletal disorders diagnosis shows that occurred primarily in men (90.00%) aged 61 ? 65 years, and the professionals most affected were teachers and administrative agent. The musculoskeletal disorders occurred in 10.00% of the study sample, and the most retired for disability integral type and/or proportional were administrative agent and assistant general services. Conclusion: The study shows the need for health promotion and surveillance in relation to workers' health, providing better working conditions and reducing illness among servers, reducing the number of disability pension for musculoskeletal pathologies.

Gaucher disease in a family from Maranhão

Background: Gaucher disease is an inborn, autosomal recessive error of the metabolism which belongs to the group of lysosomal storage disorders. Objective: This work reports on the treatment of Gaucher disease in several members of the same family from the countryside of Maranhão. Methods: This was an observational, retrospective and prospective, descriptive case study about the efficacy of enzyme replacement therapy. Results: The results showed that women were more affected (80% of patients) by the disease, age at diagnosis ranged from 24 to 33 years, the predominant ethnicity was mulatto (80%) and all cases were classified as type 1. The diagnosis of these patients was performed by measuring the levels of glucocerebrosidase and chitotriosidase enzymes and confirmed by genotyping. All patients suffering from Gaucher disease had low glucocerebrosidase levels. Before replacement therapy, hepatosplenomegaly was the most common clinical manifestation (100%) and osteopenia was seen in 80% of the cases. Regarding hematological manifestations, anemia and leukopenia were found in 40% of patients at diagnosis; however the hemoglobin and leukocyte levels were normalized after four years of therapy. Thrombocytopenia, observed in 20% of cases, was normalized after the second year of treatment. Conclusion: In these cases, despite gaps in the treatment as the family resides in the rural region of the state, the patients with Gaucher disease showed satisfactory therapeutic response over time...

Interferon beta11a treatment in htlv-1-associatd myelopathy/tropical spastic pparaparesis: a case report / Tratamento com interferon beta-1a em mielopatia associada ao HTLV-1/paraparesia espástica tropical: relato de caso

Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved.

Descreve-se caso de mielopatia associada ao HTLV-1/paraparesia espástica tropical tratada com interferon beta-1a em paciente jovem de 21 anos e com história de dermatite infecciosa na infância. Foi estabelecida clinicamente paraparesia espástica tropical (HAM/TSP), confirmada laboratorialmente pela presença de anticorpos para HTLV-1 no LCR e excluídas caxumba, citomegalovirus, Epstein-Barr, esquistossomose, herpes virus 1 e 2, rubéola, sarampo, toxoplasmose varicela-zoster, hepatite, HIV e sífilis por sorologias. Foi diagnosticada bexiga neurogênica, com quadro clínico de nictúria, urgência urinária, parestesia no membro inferior esquerdo e discreta redução de força muscular nos membros superiores, mais acentuada nos membros inferiores. Na 4a semana de tratamento com interferon beta-1a houve desaparecimento da urgência urinária e da parestesia e melhora da clínica motora.

Avaliação da resposta IgE para o entendimento do papel de fungos do ar na alergia respiratória em crianças / Evaluation of IgE responses for a better understanding of the role of airborne fungi in respiratory allergy in children

Este estudo realizou-se na cidade de São Luis, Maranhão, com a finalidade de investigar possível relação entre alergia respiratória e elevação sérica de IgE total e IgE específica para fungos isolados de ambientes externos. Métodos: Fizeram parte deste estudo 98 crianças com diagnóstico clínico de asma e/ou rinite alérgica, com idades entre 4 e 12 anos, sendo 65(66,3%) do sexo masculino e 33 (33,7%) do sexo feminino. Quantificaram-se no soro dessas crianças os níveis de IgE total e IgE específica para Aspergillus spp e Penicillium spp, pelo método de ELISA. Resultados: IgE total foi detectada em 95 crianças (96,9%); 73 (74,5%) apresentaram níveis detectáveis de IgE anti-Aspergillus spp e 85 (86,7%) de IgE anti-Penicillium spp. Não houve significância estatística quando foram correlacionados níveis de IgE total, sexo e área de residência das crianças estudadas (p = 0,88). Na correlação entre IgE total e faixa etária verificou-se distribuição não normal dos dados, com destaque à faixa etária de 11 anos, onde os níveis deIgE total foram mais elevados (Teste de Shapiro p < 0,05). Não houve correlação entre IgE anti-Aspergilluse IgE anti-Penicillium com idade, sexo e área de residência. Conclusão: Anticorpos IgE contra os fungos estudados possivelmente fazem parte de uma polissensibilização, já que os fungos estão presentes em todas as áreas e durante todo o ano na cidade de São Luis, Maranhão, Brasil. Serão necessários mais estudos para o entendimento da alergia respiratória por fungos do ar em São Luis, Maranhão...

The present study was carried out in the city of São Luís, capital of the state of Maranhão, northeastern Brazil, with the aim of investigating a possible relationship between respiratory allergies and high serum levels of total IgE and specific IgE for fungi isolated in outdoor environments. Methods: The study included 98 children with a clinical diagnosis of asthma and/or allergic rhinitis, aged 4 to 12 years. Sixty-five (66.3%) were male and 33 (33.7%) female. Total IgE, Aspergillus spp-specific IgE, and Penicillium spp-specific IgE were quantified in the serum of the children using the ELISA method. Results: Total IgE was detected in 95 children (96.9%). Seventy-three (74.5%) showed detectable levels of Aspergillus spp-specific IgE, and 85 (86.7%), of Penicillium spp-specific IgE. There was no significant correlation between total IgE levels, sex, and area of residence among the children assessed (p = 0.88). When assessing the correlation between total IgE levels and age, data were found to have a non-normal distribution, especially in the 11-year old age group, where total IgE levels were higher than in the other ages (Shapiro test, p < 0.05). There was no significant correlation of Aspergillus spp- and Penicillium spp-specific IgE with age, gender, and area of residence. Conclusion: IgE antibodies against the fungi investigated are possibly a part of polysensitization, as these fungi are present in all areas and throughout the year in the city investigated. Further studies are necessary for a better understanding of the role played by fungal sensitization in respiratory allergy in São Luís, Maranhão...

Seroprevalence of HTLV-1/2 among blood donors in the state of Maranhao, Brazil

Background: Infection with human T-lymphotropic virus 1 or 2 (HTLV-1/2) is a major health problem. There is a public health policy defining measures for state hematology and hemotherapy centers in Brazil, in order to avoid virus transmission through blood donors. Objective: This study aimed to evaluate the seroprevalence of HTLV -1/2 in blood donors in the State of Maranhão, Brazil, during routine blood unit screening. Methods: Screening tests of blood donors using the enzyme-linked immunosorbent assay (ELISA) to detect seropositivity for HTLV-1/2 performed at the Hematology and Hemotherapy Center of the State of Maranhão (HEMOMAR) between July of 2003 and December of 2009 were retrospectively evaluated. Results: Of the 365,564 blood donors, 561 (0.15%) were HTLV-1/2-positive, of whom 72 (12.8%) performed the confirmatory test (Western blot). In donors who had a confirmatory test, 53 (73.6%) were positive. The ages of the infected individuals ranged from 18 to 65 years; 305 (54%) were aged over 40 years. Among the infected individuals, 309 (55%) were male, 399 (71%) were mixed-race, and 259 (46%) were single. Co-infections were frequently found, especially with hepatitis B (in 68.6% of the cases). Conclusion: The results obtained will contribute to the planning and implementation of control measures by the epidemiological surveillance agency of Maranhão, and will also contribute to reducing morbidity. The high seropositivity in a small sample in donors who had confirmatory tests indicates the need for confirmatory tests for all donors who initially test as seropositive. .

Tumor filoide em adolescente: relato de caso em jovem de 13 anos / Phyllodes tumor in adolescent: a case report of a 13-year-old girl

Os tumores filoides são neoplasias fibroepiteliais raras de mama. Em sua forma menos agressiva, comportam-se semelhantemente ao fibroadenoma, diferenciando-se apenas pelo tamanho do tumor e/ou velocidade do crescimento. Relatou-se um caso de uma menor de idade, apresentando ginecomastia bilateral, submetida à mastectomia esquerda e quadrantectomia na mama direita. O diagnóstico anatomopatológico demonstrou proliferação estromal, compatível com tumor filoide, o que comprometeu toda a extensão das peças cirúrgicas, inclusive a pele da região areolar. O diagnóstico de tumor filoide é raro nas mamas de adolescentes. O caso relatado adquire grande importância em função da idade da paciente, da localização e da extensão da lesão.

Phyllodes tumors are rare fibroepithelial breast neoplasms. In a less aggressive form, they behave in a similar fashion to the fibroadenoma, and the only differences can be seen in the tumor size and/or speed of growth. We reported the case of an underage girl, with bilateral gynecomastia, who underwent left mastectomy and right breast quadrantectomy. The histopathological diagnosis showed stromal proliferation, consistent with phyllodes tumor that compromised the entire length of the surgical specimens, including the skin areolar region. Diagnosis of phyllodes tumor is rare in breasts of adolescents. The reported case is of great importance due to the patient?s age, and location and extent of the injury