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Background: Little is known about the best strategy for weaning patients with chronic obstructive pulmonary disease (COPD) from mechanical ventilation. Spontaneous breathing trials (SBT) using a T-piece or pressure-support ventilation (PSV) have a central role in this process. Our aim was to compare T-piece and PSV SBTs according to the duration of mechanical ventilation (MV) in patients with COPD., Methods: Patients with COPD who had at least 48 hours of invasive MV support were randomized to 30 minutes of T-piece or PSV at 10 cm H2O after being considered able to undergo a SBT. All patients were preemptively connected to non-invasive ventilation after extubation. Tracheostomized patients were excluded. The primary outcome was total invasive MV duration. Time to liberation from MV was assessed as secondary outcome., Results: Between 2012 and 2016, 190 patients were randomized to T-piece (99) or PSV (91) groups. Extubation at first SBT was achieved in 78% of patients. The mean total MV duration was 10.82 ± 9.1 days for the T-piece group and 7.31 ± 4.9 days for the PSV group (p < 0.001); however, the pre-SBT duration also differed (7.35 ± 3.9 and 5.84 ± 3.3, respectively; p = 0.002). The time to liberation was 8.36 ± 11.04 days for the T-piece group and 4.06 ± 4.94 for the PSV group (univariate mean ratio = 2.06 [1.29-3.27], p = 0.003) for the subgroup of patients with difficult or prolonged weaning. The study group was independently associated with the time to liberation in this subgroup., Conclusions: The SBT technique did not influence MV duration for patients with COPD. For the difficult/prolonged weaning subgroup, the T-piece may be associated with a longer time to liberation, although this should be clarified by further studies., Trial Registration: ClinicalTrials.gov NCT01464567, at November 3, 2011., Competing Interests: The authors have declared that no competing interests exist.

Background: The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain., Methods: We searched MEDLINE, EMBASE, CENTRAL, CINAHL, Evidence-Based Medicine Reviews, Ovid Health Star, proceedings of five conferences (1990-2016), and reference lists for randomized trials comparing SBT techniques in intubated adults or children. Primary outcomes were initial SBT success, extubation success, or reintubation. Two reviewers independently screened citations, assessed trial quality, and abstracted data., Results: We identified 31 trials (n = 3541 patients). Moderate-quality evidence showed that patients undergoing pressure support (PS) compared with T-piece SBTs (nine trials, n = 1901) were as likely to pass an initial SBT (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.89-1.11; I 2  = 77%) but more likely to be ultimately extubated successfully (RR 1.06, 95% CI 1.02-1.10; 11 trials, n = 1904; I 2  = 0%). Exclusion of one trial with inconsistent results for SBT and extubation outcomes suggested that PS (vs T-piece) SBTs also improved initial SBT success (RR 1.06, 95% CI 1.01-1.12; I 2  = 0%). Limited data suggest that automatic tube compensation plus continuous positive airway pressure (CPAP) vs CPAP alone or PS increase SBT but not extubation success., Conclusions: Patients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2-10%) more likely to be extubated successfully and, if the results of an outlier trial are excluded, 6% (95% CI 1-12%) more likely to pass an SBT. Future trials should investigate patients for whom SBT and extubation outcomes are uncertain and compare techniques that maximize differences in support.

Methods:: Transcranial doppler was performed in accordance with the Stroke Prevention Trial in Sickle Cell Anemia Protocol., Results:: Of the 396 patients, 69.5% had homozygous SS hemoglobin. The TCD result was abnormal in 4.8%, conditional in 12.6%, inadequate in 4.3% and abnormally low in 1% of patients. The highest mean flow velocities were 121±23.83cm/s and 124±27.21cm/s in the left and right middle cerebral artery respectively. A total of 28.8% patients (mean age 9.19±5.92 years) were evaluated with TCD for the first time., Conclusions:: The SCD patients were evaluated with TCD at an older age, representing an important missed opportunity for stroke prevention. Since TCD screening in patients with SCD is important to detect those at high risk for stroke, it is recommended that this screening should be made more readily available.

Spontaneous breathing trials (SBTs) are among the most commonly employed techniques to facilitate weaning from mechanical ventilation. The preferred SBT technique, however, is still unclear. To clarify the preferable SBT (T-piece or pressure support ventilation [PSV]), we conducted this systematic review. We then searched the MEDLINE, EMBASE, SciELO, Google Scholar, CINAHL, ClinicalTrials.gov, and Cochrane CENTRAL databases through June 2015, without language restrictions. We included randomized controlled trials involving adult subjects being weaned from mechanical ventilation comparing T-piece with PSV and reporting (1) weaning failure, (2) re-intubation rate, (3) ICU mortality, or (4) weaning duration. Anticipating clinical heterogeneity among the included studies, we compared prespecified subgroups: (1) simple, difficult, or prolonged weaning and (2) subjects with COPD. We summarized the quality of evidence for intervention effects using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. We identified 3,674 potentially relevant studies and reviewed 23 papers in full. Twelve studies (2,161 subjects) met our inclusion criteria. Overall, the evidence was of very low to low quality. SBT technique did not influence weaning success (risk ratio 1.23 [0.94-1.61]), ICU mortality (risk ratio 1.11 [0.80-1.54]), or re-intubation rate (risk ratio 1.21 [0.90-1.63]). Prespecified subgroup analysis suggested that PSV might be superior to T-piece with regard to weaning success for simple-to-wean subjects (risk ratio 1.44 [1.11-1.86]). For the prolonged-weaning subgroup, however, T-piece was associated with a shorter weaning duration (weighted mean difference -3.08 [-5.24 to -0.92] d). In conclusion, low-quality evidence is available concerning this topic. PSV may be associated with lower weaning failure rates in the simple-to-wean subgroup. In contrast, in prolonged-weaning subjects, T-piece may be related to a shorter weaning duration, although this is at high risk of bias. Further study of the difficult-to-wean and COPD subgroups is required., (Copyright © 2016 by Daedalus Enterprises.)

Objective: To evaluate the correlation between hemoglobin levels of mothers and their children on exclusive breastfeeding in the first six months of life., Methods: Cross-sectional study with 221 binomials (mother-child) enrolled in a breastfeeding support program, who were stratified into six groups according to the children's age group. The sample consisted of children born at term with normal weight, with no neonatal complications and whose mothers did not have anemia or infectious disease at the time of data collection. Interviews were carried out with the mothers, blood was collected by peripheral venipuncture from mothers and children, and children's anthropometric data were assessed. Pearson's correlation coefficients between the hemoglobin levels of mothers and children were calculated. Six multiple linear regression models were adjusted with regression coefficient estimates, considering as statistically significant associations with p≤0.05., Results: The correlation coefficients of hemoglobin levels of mothers and children ranged from 0.253, at three months, to 0.601, at five months. The hemoglobin level of mothers was correlated with the hemoglobin level of their children at four months (r=0.578) and at five months (r=0.601). In the adjusted multiple linear regression, the regression coefficients were higher at four months (β=1.134; p=0.002) and at five months (β=0.845; p<0.001)., Conclusion: These findings allow for the conclusion that there is a correlation between the hemoglobin of mothers and the hemoglobin of their children on exclusive breastfeeding in the first six months of life., (Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Purpose: The purpose of the study is to look at the performance of the Prognosis for Prolonged Ventilation (ProVent) score with a short-term outcome as well as when used earlier during the course of prolonged mechanical ventilation (MV)., Materials and Methods: This retrospective study was performed in a tertiary public hospital from August 2011 to August 2012. All patients admitted to the intensive care unit (ICU) during this period were included in the study. Chronically critically ill (CCI) patients were defined as those with 21 days of MV. In a subsequent analysis, we considered CCI patients to be those with 14 days of MV. The data were collected in 2 ways: review of a prospectively elaborated database and review of electronic records., Results: During the study period, 1360 patients were admitted to the ICU. Of these, 152 patients (11.2%) were considered CCI. Patients with high ProVent score presented higher ICU mortality. Mortality ranged from 25.0% for patients with a score of 0 to 84.0% for patients with a score of greater than or equal to 4. The analysis of the ProVent score performed earlier during the evolution (14 days of MV) was similar., Conclusions: The ProVent score can be used for short-term prognosis (mortality in the ICU) and earlier in the evaluation of CCI patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: There is a gap in knowledge on the growth of children exclusively breastfed during the fifth and sixth months of life. This study aimed to assess the growth of infants who were exclusively breastfed for the first 6 months of life and compare the distributions of anthropometric measures based on the National Center for Health Statistics (NCHS, 1977) and World Health Organization (WHO, 2006) curves., Methods: Cross-sectional study that measured the weight and length of 360 healthy and exclusively breastfed infants who were enrolled in a primary care program in Belem, Brazil from October 2006 to December 2008. The children were evenly grouped into age groups from 1 to 6 months of age., Results: The mean weights were higher than the NCHS, 1977 mean weight for all of the studied groups regardless of gender and showed greater similarity to the WHO, 2006 mean weight, especially when standard deviations were considered. Regarding length, although the average length at birth was smaller, females had higher averages in the second and sixth months compared with the reference curves (p < 0.05)., Conclusions: Exclusive breastfeeding in the first 6 months of life provides adequate physical growth, resulting in height and weight gain curves that are similar to or greater than the NCHS, 1977 and WHO, 2006 curves. The greater mean weight at the fifth and sixth months of life suggests that the second-quarter growth curves of children who are exclusively breastfed are greater than those of children who receive other types of food.

Objective: To evaluate the frequency of infectious complications in children with sickle cell disease (SCD) after surgical splenectomy for acute splenic sequestration crisis., Methods: Retrospective cohort of children with SCD who were born after 2002 and were regularly monitored until July 2013. Patients were divided into two groups: cases (children with SCD who underwent surgical splenectomy after an episode of splenic sequestration) and controls (children with SCD who did not have splenic sequestration and surgical procedures), in order to compare the frequency of invasive infections (sepsis, meningitis, bacteremia with positive blood cultures, acute chest syndrome and/or pneumonia) by data collected from medical records. Data were analyzed by descriptive statistical analysis., Results: 44 patients were included in the case group. The mean age at the time of splenectomy was 2.6 years (1-6.9 years) and the mean postoperative length of follow-up was 6.1 years (3.8-9.9 years). The control group consisted of 69 patients with a mean age at the initial follow-up visit of 5.6 months (1-49 months) and a mean length of follow-up of 7.2 years (4-10.3 years). All children received pneumococcal conjugate vaccine. No significant difference was observed between groups in relation to infections during the follow-up., Conclusions: Surgical splenectomy in children with sickle cell disease that had splenic sequestration did not affect the frequency of infectious complications during 6 years of clinical follow-up., (Copyright © 2015 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.)

Helicobacter pylori and immune thrombocytopenic purpura (ITP) association is not well established in chronic ITP (cITP) in children, although the cure of thrombocytopenia in approximately half of H. pylori eradicated adult patients has been described. The aim of this study was to investigate the effect of H. pylori eradication on platelet (PLT) recovery in cITP children and adolescents through a randomized, controlled trial. A total of 85 children (mean age 11.4 years) with cITP were prospectively enrolled. Diagnosis of H. pylori was established by two locally validated tests, (13)C-urea breath test and monoclonal stool antigen test. Twenty-two infected patients were identified, and randomly allocated into two groups: H. pylori treatment group (n = 11) and the non-intervention control group (n = 11). The control group was offered treatment if the thrombocytopenia persisted after the follow-up. At baseline, there were no differences regarding age, sex, duration of disease, and PLT count between groups. Sixty three of 85 patients were uninfected. PLT response was classified as complete response: PLT > 150 × 10(9 )l(-1); partial response: PLT 50-150 × 10(9 )l(-1), or an increase of 20-30 × 10(9 )l(-1); no response: PLT < 50 × 10(9 )l(-1) or an increase of <20 × 10(9 )l(-1) after at least 6 months of follow-up. Complete response was observed in 60.0% (6/10, one excluded) H. pylori eradicated patients vs. 18.2% (2/11) in non-eradicated patients (p = 0.08; OR = 6.75) after 6-9 months of follow-up. Among uninfected patients, only 13.8% (8/58) presented complete response. Two non-treated controls were treated after 6-12 months of follow-up, and PLT response was observed in 61.5% (8/13) of H. pylori eradicated patients, and in 19.0% (11/58) of uninfected patients (p = 0.004). Cytotoxin associated gene A and vacuolating cytotoxin gene A IgG antibodies were present in almost all infected patients. Therefore, the study suggests that H. pylori eradication plays a role in the management of H. pylori infected cITP children and adolescents.

Background and Objective: Sickle cell anaemia (SCA) is the most frequent haematological hereditary disease. Children with SCA are submitted to long-term prophylactic therapy with penicillin, but little is known about its impact on oral microflora. The aim of this study was to evaluate the oral microbial colonization of paediatric patients with SCA., Design: Forty children (4-11yrs old) with SCA (genotype SS) under long-term prophylactic treatment with penicillin were included in the study. Age/gender-matched control group of healthy children was also included. Scores of dmft/DMFT (number of decayed (D), missing (M), or filled (F) teeth; dmft, for primary dentition; DMFT, for permanent dentition) were obtained and stimulated saliva was sampled. Salivary flow rate and buffering capacity were evaluated. Counts of microorganisms (mutans streptococci, lactobacilli and yeasts) were determined by plating method. Yeasts were identified by API 20C AUX and PCR., Results: Mean dmft/DMFT values were similar in the studied groups (SCA 2.13/1.60 and control 2.38/1.3). Although no significant differences between cariogenic microorganism counts were observed, significantly higher yeasts oral levels were observed in SCA group. Controls showed lower salivary buffering capacity. Candida albicans was the most frequently isolated species in both groups. Candida famata, Candida parapsilosis and Candida tropicalis were also isolated from controls. Candida dubliniensis, Candida rugosa and Candida sphaerica were found only in SCA group., Conclusions: Based on the results, it could be concluded that paediatric patients with SCA showed significantly higher oral level of yeasts. Uncommon fungal species were found in SCA group. Similar caries prevalence and counts of lactobacilli and streptococci in relation to controls were observed., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: To analyze the frequency of β(S)-globin haplotypes and alpha-thalassemia, and their influence on clinical manifestations and the hematological profile of children with sickle cell anemia., Method: The frequency of β(S)-globin haplotypes and alpha-thalassemia and any association with clinical and laboratorial manifestations were determined in 117 sickle cell anemia children aged 3-71 months. The confirmation of hemoglobin SS and determination of the haplotypes were achieved by polymerase chain reaction-restriction fragment length polymorphism, and alpha-thalassemia genotyping was by multiplex polymerase chain reaction (single-tube multiplex-polymerase chain reaction)., Results: The genotype distribution of haplotypes was 43 (36.7%) Central African Republic/Benin, 41 (35.0%) Central African Republic/Central African Republic, 20 (17.0%) Rare/atypical, and 13 (11.1%) Benin/Benin. The frequency of the α3.7 deletion was 1.71% as homozygous (-α3.7/-α3.7) and 11.9% as heterozygous (-α3.7/αα). The only significant association in respect to haplotypes was related to the mean corpuscular volume. The presence of alpha-thalassemia was significantly associated to decreases in mean corpuscular volume, mean corpuscular hemoglobin and reticulocyte count and to an increase in the red blood cell count. There were no significant associations of β(S)-globin haplotypes and alpha-thalassemia with clinical manifestations., Conclusions: In the study population, the frequency of alpha-thalassemia was similar to published data in Brazil with the Central African Republic haplotype being the most common, followed by the Benin haplotype. β(S)-globin haplotypes and interaction between alpha-thalassemia and sickle cell anemia did not influence fetal hemoglobin concentrations or the number of clinical manifestations., (Copyright © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To assess the performance of central venous oxygen saturation, lactate, base deficit, and C-reactive protein levels and SOFA and SWIFT scores on the day of discharge from the intensive care unit as predictors of patient readmission to the intensive care unit., Methods: This prospective and observational study collected data from 1,360 patients who were admitted consecutively to a clinical-surgical intensive care unit from August 2011 to August 2012. The clinical characteristics and laboratory data of readmitted and non-readmitted patients after discharge from the intensive care unit were compared. Using a multivariate analysis, the risk factors independently associated with readmission were identified., Results: The C-reactive protein, central venous oxygen saturation, base deficit, and lactate levels and the SWIFT and SOFA scores did not correlate with the readmission of critically ill patients. Increased age and contact isolation because of multidrug-resistant organisms were identified as risk factors that were independently associated with readmission in this study group., Conclusion: Inflammatory and perfusion parameters were not associated with patient readmission. Increased age and contact isolation because of multidrug-resistant organisms were identified as predictors of readmission to the intensive care unit.

Background: The aim of this study was to evaluate the frequency of Candida species and presence of lesions in the oral cavity of patients with sickle cell anemia (SS)., Methods: The study included 30 patients diagnosed with sickle cell anemia and taking hydroxyurea for at least 90 days (SS/HU+); and 39 patients with sickle cell anemia and without hydroxyurea therapy (SS/HU-). Two control groups were constituted by healthy individuals matched to the test groups in age, gender, and oral conditions (C/HU+ for SS/HU+ and C/HU- for SS/HU-). Oral clinical examination and anamnesis were performed. Yeasts were collected by oral rinses and identified by API system. Antifungal susceptibility evaluation was performed according to the CLSI methodology. Data obtained for microorganisms counts were compared by Student's t test (SS/HU+ vs. C/HU+ and SS/HU- vs. C/HU-) using MINITAB for Windows 1.4. Significance level was set at 5%., Results: No oral candidosis lesions were detected. Significant differences in yeasts counts were observed between SS/HU- group and the respective control, but there were no differences between SS/HU+ and C/HU+. Candida albicans was the most prevalent species in all groups. Candida famata was observed both in SS and control groups. Candida dubliniensis, Candida glabrata, Candida krusei, Candida tropicalis, Candida pelliculosa, and Candida parapsilosis were observed only in SS groups. Most strains were susceptible to all antifungal agents., Conclusion: Hydroxyurea therapy seems to decrease candidal counts and resistance rate in sickle cell anemia patients. However, further studies should be conducted in the future to confirm this finding. Hydroxyurea therapy in sickle cell anemia patients maintains fungal species balance in oral cavity., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Food fortification is advocated to tackle iron deficiency in anemic populations. Our objective was to evaluate the impact of iron-fortified rice (Ultrarice(®)) weekly on hemoglobin and anemia levels compared with standard rice (control). This cluster-randomized study deals with infants (10-23 months) from two public child day care centers in Brazil, n = 216, in an 18 week intervention. The intervention group received individual portions of fortified rice (50 g) provided 56.4 mg elemental/Fe. For intervention center: baseline mean hemoglobin was 11.44 ± 1.07 g/dl, and after intervention 11.67 ± 0.96 g/dl, p < 0.029; for control: baseline mean hemoglobin value was 11.35 ± 4.01 g/dl, and after intervention 11.36 ± 2.10 g/dl, p = 0.986. Anemia prevalence for intervention center was 31.25% at baseline, and 18.75% at end of study, p = 0.045; for control 43.50% were anemic at baseline, and 37.1% at the end of study, p = 0.22. Number Needed to Treat was 7. Iron-fortified rice was effective in increasing hemoglobin levels and reducing anemia in infants.

This study evaluates the impact of a milk-based cornstarch porridge fortified with iron, in 4-year olds, compared with control on hemoglobin levels and anemia prevalence. This trial was a cluster-randomized, double-blind one, and used milk-based cornstarch porridge fortified with 10 mg elemental iron (FeSO(4)), daily, during 14 weeks, compared with control. The study population comprised 4-year-old preschoolers (n = 131). Mean hemoglobin values at baseline were found to be 10.6 ± 0.61 g dl(-1) for intervention group, and after intervention 11.5 ± 0.80 g/dl, p < 0.0001. For control, mean hemoglobin values at baseline were 10.9 ± 0.53 g/dl, and after intervention 11.2 ± 0.73, p < 0.0001. The increase in mean hemoglobin was much greater in the intervention than in the control group, 0.86-0.26 g dl(-1), respectively (p < 0.0001). Anemia prevalence reduced from 75% to 20%, p < 0.0001, in the intervention group, with no reduction in the control group. Number needed for treatment was four. This study showed that milk-based cornstarch porridge fortified with ferrous sulfate increased hemoglobin levels and reduced anemia prevalence in 4-year-old preschoolers.

Objective: To evaluate the impact of the fortification of rolls with microencapsulated iron sulfate with sodium alginate on the hemoglobin levels in preschoolers as compared to controls., Methods: Double-blind randomized controlled trial comprised of children aged 2 to 6 years with initial hemoglobin exceeding 9 g/dL from four not-for-profit daycares randomly selected in the city of São Paulo - Brazil. Children of 2 daycares (n = 88) received rolls with fortified wheat flour as the exposed group (EC) and children of 2 daycares (n = 85) received rolls without fortification as the control group (CG) over a 24-week period. Rolls with 4 mg iron each were offered once a day, five days a week. Hemoglobin concentrations were determined in capillary blood by HemoCue® at three moments of trial: baseline (Ml), after 12 and 24 weeks of intervention (M2, M3)., Results: Hemoglobin concentration presented significant increase up to M3 in EG (11.7-12.5-12.6 g/dL) and in CG (11.1-12.4-12.3 g/dL) with higher elevations in children initially with anemia. There was significant reduction in the occurrence of anemia from 22% to 9% in EG and from 47% to 8.2% in CG at M3., Conclusion: Rolls fortified with microencapsulated iron sulfate were well tolerated, increased hemoglobin levels and reduced the occurrence of anemia, but with no difference compared to the control group.

Objective: This study analyses the impact of weekly iron supplementation with ferrous sulphate heptahydrate (FeSO4) in 5-year-olds compared with placebo, on hemoglobin (Hb) and hematocrit (Ht) values and anemia., Design: The study concerns a cluster-randomized, placebo-controlled double-blind trial. Intervention participants received 50 mg elemental iron for 14 weeks., Setting: The study population comprised pre-school children (n = 135) from one randomly chosen public school in the northeast of Brazil., Subjects: Participants were 5-year-old students from a public school., Results: Mean Hb and Ht values increased after iron supplementation, with p < 0.0001. There was no statistically significant increase in the placebo group. After intervention, anemia prevalence reduced only in the intervention group, from 48.0% to 26.0%., Conclusions: Weekly iron supplementation was effective in reducing anemia in 5-year-olds.

Objective: To determine erythrocyte phenotyping in blood donors and patients with sickle cell anemia (SS) treated at Hemocentro of Alagoas and describe the frequency and factors associated with erythrocyte alloimmunization., Methods: Cross-sectional study with 102 SS patients and 100 blood donors. The following tests were performed: erythrocyte phenotyping, Direct and Indirect antiglobulin test, and detection of irregular antibodies by panel of phenotyped red blood cells. Data were compared by Mann-Whitney, chi-square or Fisher's exact tests. Factors associated with alloimmunization were studied by univariate and multiple logistic regression analysis., Results: The most frequent antigens found in patients and blood donors were: c, e, M, s, JK(a). Significant differences were observed between the frequency of the phenotype of patients and donors in regard to antigens s, FY(a) and JK(b). Of 79 transfused patients, 10 presented positive Indirect Coombs. Thirteen alloantibodies were found, 7 of the Rh system, 2 of Kell and 4 were not identified. Factors associated with alloimmunization were the period of time between the last transfusion and the date of the test and more than 10 red blood cell transfusions. Patients who received more than 10 transfusions were 16.39 (95% CI: 2.23-120.59) times more likely to be alloimmunized than patients with fewer transfusions., Conclusion: The prevalence of alloimmunization in SS patients was 12.7%, with 70% of antibodies belonging to the Rh and Kell systems. This study shows the importance of performing erythrocyte phenotyping in blood donors and receptors to decrease the risk of alloimmunization.

Context and Objective: Transcranial Doppler (TCD) detects stroke risk among children with sickle cell anemia (SCA). Our aim was to evaluate TCD findings in patients with different sickle cell disease (SCD) genotypes and correlate the time-averaged maximum mean (TAMM) velocity with hematological characteristics., Design and Setting: Cross-sectional analytical study in the Pediatric Hematology sector, Universidade Federal de São Paulo., Methods: 85 SCD patients of both sexes, aged 2-18 years, were evaluated, divided into: group I (62 patients with SCA/Sß(0) thalassemia); and group II (23 patients with SC hemoglobinopathy/Sß(+) thalassemia). TCD was performed and reviewed by a single investigator using Doppler ultrasonography with a 2 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. The hematological parameters evaluated were: hematocrit, hemoglobin, reticulocytes, leukocytes, platelets and fetal hemoglobin. Univariate analysis was performed and Pearson's coefficient was calculated for hematological parameters and TAMM velocities (P < 0.05)., Results: TAMM velocities were 137 ± 28 and 103 ± 19 cm/s in groups I and II, respectively, and correlated negatively with hematocrit and hemoglobin in group I. There was one abnormal result (1.6%) and five conditional results (8.1%) in group I. All results were normal in group II. Middle cerebral arteries were the only vessels affected., Conclusion: There was a low prevalence of abnormal Doppler results in patients with sickle-cell disease. Time-average maximum mean velocity was significantly different between the genotypes and correlated with hematological characteristics.

Background: Sickle cell disease is the most common monogenic hereditary disease in Brazil. Although strokes are one of the main causes of morbidity and mortality in these patients, the use of transcranial Doppler to identify children at risk is not universally used., Objective: To develop Brazilian guidelines for the use of transcranial Doppler in sickle cell disease children and adolescents, so that related health policies can be expanded, and thus contribute to reduce morbidity and mortality., Methods: The guidelines were formulated in a consensus meeting of experts in transcranial Doppler and sickle cell disease. The issues discussed were previously formulated and scientific articles in databases (MEDLINE, SciELO and Cochrane) were carefully analyzed. The consensus for each question was obtained by a vote of experts on the specific theme., Results: Recommendations were made, including indications for the use of transcranial Doppler according to the sickle cell disease genotype and patients age; the necessary conditions to perform the exam and its periodicity depending on exam results; the criteria for the indication of blood transfusions and iron chelation therapy; the indication of hydroxyurea; and the therapeutic approach in cases of conditional transcranial Doppler., Conclusion: The Brazilian guidelines on the use of transcranial doppler in sickle cell disease patients may reduce the risk of strokes, and thus reduce the morbidity and mortality and improve the quality of life of sickle cell disease patients.

Objectives: To evaluate the effects of fortified drinking water, with different concentrations of iron added, on hemoglobin and hematocrit values in preschoolers., Methods: Double-blind, randomized cluster clinical trial, with children aged 2 to 5 years of age, from 4 state-run schools, forming 1 group for each school. For fortification, ferrous sulphate in concentrations of 5 mg of elemental iron per liter of water (group A), 7.5 mg (group B), and 10 mg (group C), was used during a period of 4 months. In group D, the control, a placebo (Bixa orellana) was added. Hemoglobin and hematocrit values were checked before and after intervention., Results: Before fortification, hemoglobin and hematocrit averages were below the reference values adopted in all groups. After fortification, the prevalence of anemia showed a reduction in the 4 groups, which was more pronounced in group B, at 48.3%. The hemoglobin values in groups B (11.5) and C (11.4) were statistically similar. However, the average consumption of water/day/student was lower in group C. Comparison of hemoglobin values between groups A (11.2) and D (11.0) did not show a significant difference, suggesting insignificant efficacy with 5 mg Fe/L fortification., Conclusions: The consumption of drinking water fortified with 7.5 mg of elemental iron/L water resulted in greater adhesion and an increase in hemoglobin values, with a reduction in the prevalence of anemia.

Objective: To evaluate the nutritional status and the prevalence of iron deficiency anemia in children attending public day care centers in the city of Guaxupé (MG), Brazil., Methods: Children of both genders, from 6 to 72 months, registered in public day-care centers in the city of Guaxupé, were studied. Nutritional evaluation was conducted using the Z-score for height-to-age and weight-to-height relationships. Hemoglobin dosage, serum iron, total iron binding capacity and the transferrin saturation index were used for diagnosis of anemia., Results: Z score < - 2 was observed in 3.3% of the children for the height-to-age relationship and of 0.4% for the weight-to-height relationship. Prevalence of total iron deficiency anemia was of 16.1%. In the age span from 6 to 36 months it was of 44.6%. The entire sample showed 45% with low serum iron, 37.9% with high total iron binding capacity and 43.1% with a low transferrin saturation index., Conclusion: Malnutrition was not considered to be a problem due to its low prevalence; however, an important prevalence of iron deficiency was observed. Iron deficiency anemia is more prevalent in children between 6 and 36 months confirming that this age span is more vulnerable. No association between iron deficiency anemia and the Z score of the studied anthropometry relationships was found.

HIV subtype C is the most prevalent subtype in the world. Despite its recent expansion in Brazil, HIV-1C already prevails in the southernmost state of Brazil, Rio Grande do Sul. This unique HIV epidemiology has prompted us to characterize that population. Seventy-seven HIV-1-infected subjects attending the largest HIV/AIDS clinic of the state had the protease and reverse transcriptase (RT) genes of their virus subtyped and genotyped. When subtype-specific infections were plotted according to year of diagnosis, the prevalence of subtype C was shown to increase over the last 18 years of the epidemic, along with a concomitant decrease of subtype B. Comparison of subtype C-infected treated and untreated subjects revealed amino acid differences in protease and RT, especially in the RT mutation D/G123S. The overall analysis of drug resistance mutations in viruses from treated subjects has highlighted some associations between subtypes and particular mutations, such as V82A/F/T/S in protease and subtype F1 and M41L and L210W in RT and subtype B. The characterization of this important population, which is one of a few in the developing world where a large number of HIV-1C-infected subjects are under antiretroviral treatment, underscores its potential usefulness in clinical, treatment, and vaccine trials in Brazil.