Aspectos epidemiológicos e sociais da doença falciforme / Epidemiologic and social aspects of sickle cell disease

A doença falciforme (DF) é uma doença genética frequente. Predomina entre negros e pardos e, no Brasil, a cada ano, nascem 3.500 crianças com DF e 200.000 com traço falciforme. As hemácias com hemoglobina S assumem, em condições de hipóxia, forma semelhante à foice, podendo levar à oclusão dos capilares, provocando lesões teciduais agudas e crônicas de órgãos, quase sempre acompanhadas de dor. Através de visitas domiciliares objetivou-se ampliar o conhecimento dos aspectos epidemiológicos e de enfrentamento da doença. Foram estudados 47 pacientes falcêmicos da cidade de Uberaba (MG), com idade igual ou superior a 18 anos, sendo 78,7 por cento negros, 17 por cento pardos e 4,3 por cento brancos, preponderando o gênero feminino (59,6 por cento). Quanto ao tipo de hemoglobinopatia, 63,8 por cento eram SS, 17 por cento SC e 10,6 por cento β-talassemia. A maioria (74,5 por cento) residia em bairros periféricos; 42,5 por cento tinham o segundo grau completo; 38,2 por cento eram aposentados ou não tinham profissão definida. A renda per capita de 48,9 por cento era de até um salário mínimo e 19,1 por cento não percebiam qualquer rendimento. Quanto aos sentimentos relacionados à doença, 38,3 por cento referiram aceitação, 21,3 por cento revolta, 17 por cento tristeza; 46,8 por cento relatavam, após o diagnóstico, mudança para pior em relação ao trabalho e 31,9 por cento em relação ao lazer. Verificou-se neste estudo que a DF reflete negativamente nas atividades laborais e na qualidade de vida do paciente. Contudo, as dificuldades no enfrentamento da doença, habitação precária, desemprego e/ou trabalho mal remunerado poderiam ser minimizadas com acompanhamento social e psicoterápico adequados, que deveriam ser disponibilizados a todo doente falciforme.

Sickle cell disease (SCD) is the commonest genetic illness of human beings. In Brazil it is predominant among black and dark-skinned people; every year 3,500 children are born with SCD and 200,000 with the sickle cell trait. In conditions of hypoxia, red blood cells assume the shape of a sickle. Patients may evolve with capillary occlusion causing acute and chronic tissue lesions in organs, which is almost always accompanied by pain. With the purpose of improving knowledge related to the epidemiologic aspects of the illness and how patients cope with it, 47 over 18-year-old patients from the city of Uberaba were studied during home visits. Of these predominantly female patients (59.6 percent), 78.7 percent were black, 17 percent dark-skinned and 4.3 percent white. In respect to the type of hemoglobinopathy, 63.8 percent had hemoglobin SS; 17 percent had hemoglobin SC and 10.6 percent had sickle beta-thalassemia. The majority (74.5 percent) lived in poor regions of the city, 42.5 percent had concluded high school, 38.2 percent were either retired or did not have any specific profession, 48.9 percent earned up to one minimum wage and 19.1 percent did not receive any wages. In respect to their feelings, 38.3 percent showed they accepted their illness, 21.3 percent were resentful, 17 percent were sad and 46.8 percent said their lives had changed for the worse in relation to work and 31.9 percent in relation to leisure. It was possible to show with this study that SCD negatively reflects on activities related to work and on the patient's quality of life. Thus, difficulties in coping with the illness, such as poor housing, unemployment and/or badly paid jobs, may be minimized with social and psychotherapeutic accompaniment, which should be made available to every SCD patient.

Terson's syndrome: report of case with favorable outcome

Terson's syndrome is characterized by presence of a subarachnoid hemorrhage accompanied by retinal and vireous hemorrhage leading to a not very favorable prognosis. We describe a case with a good outcome, probably because of a early diagnosis and medical intervention. We emphasize the routine optician's check up as very important in the evaluation of a prognosis in the cases of a suspect intracranial hemorrhage.