An overview of recently published medical papers in Brazilian scientific journals

A brief review intended as information to the readership of Clinics on papers recently published under various medical headings in Brazilian scientific journals recently indexed or about to be indexed in ISI-THOMSON Journal Citation Reports. Journals covered in this review are Acta Ortopédica Brasileira, Arquivos Brasileiros de Cardiologia, Jornal Brasileiro de Pneumologia, Revista Brasileira de Cirurgia Cardiovascular and Revista da Associação Médica Brasileira.

INTRODUCTION

This paper represents an informative insight report into general medical research articles recently published in Brazilian journals. Selected journals were recently introduced or are about to be introduced to the Journal Citation Reports of ISI THOMSON. We understand that this contributes information to the readers of Clinics.

A total of 80 articles were collected from recent years in four Brazilian journals. Articles relating strictly to the cardiopulmonary system were excluded for presentation in a later insight review. Table 1 displays the various medical headings into which this review is divided.

Table 1.

General distribution of articles under medical headings∗.

SUBJECT	REFERENCES	SUBJECT	REFERENCES
Gynecology	16	Infectology	4
Orthopedics	13	Psychiatry	4
Education	8	Trauma	4
Metabolism	7	Urology & Nephrology	4
Oncology	7	Ethics	3
Tobacco & Smoking	7	Endocrinology	2
Gastroenterology	6	Ophthalmology	2
Geriatrics	4	Pediatrics	2

∗

Total (93) exceeds number of references because some references fall under more than one Medical heading.

REVIEW

The following is a brief review of the eighty highlighted articles. Medical headings are sequenced according to frequency of citations in each section.

GYNECOLOGY

Sixteen papers cover the general field of gynecology. Gomes and da Silva1 described prevalence of stress urinary incontinence in women over 20 years of age, who participate in the Family Health Program in the city of Dourados, State of Mato Grosso do Sul, Brazil and conclude that prevalence is similar to that of other studies. Tanuri et al.2 compared results of retropubic and transobturator sling for surgical treatment of female stress urinary incontinence which were effective at one-year follow-up. Rolnik et al.3 described chromosomal abnormalities in spontaneous abortion material and found that cytogenetic alterations are an important cause of pregnancy loss and their detection helps the genetic counseling to the couple. Trisomy 16 is the most often found change. Santos et al.4 evaluated Cesarean uterine scars by the grey-level histogram in women with a previous Cesarean section, performed either during labor or before labor (elective cesarean) and found a significant difference in results, namely a larger tissue change in the elective Cesarean.

The perinatal period was the object of five studies. Carvalho et al.5 determined the prevalence and factors associated with episiotomy in a reference center of Pernambuco. Prevalence was 29% and associated factors were maternal diseases and absence of previous vaginal delivery. Ferreira et al.6 assessed the impact of breast-feeding on the occurrence of anthropometric deviations among preschool children of the semiarid region of Alagoas (Brazil) and possible associated factors. They find that breast-feeding for a minimum period of thirty days had a protective effect against overweight in preschool children of the semiarid region of Alagoas. Nardozza et al.7 assessed and compared accuracy of birth weight prediction using a combination of two-dimensional (abdominal circumference - AC and femur length - FL) and three-dimensional parameters (fetal arm -VolArm and thigh -VolTh volumes). And developed a formula using VolArm, VolTh, AC and FL which was more accurate for prediction of birth weight than formulae using only two-dimensional parameters. Assunção et al.8 evaluated the perinatal outcome of twin pregnancies delivered in a tertiary teaching hospital according to chorionicity and conclude that the rate of preterm deliveries and low birth weight is higher in monochorionic pregnancies when compared to dichorionic twins. But survival rates were similar in both groups. Nomura et al.9 studied fetal vitality assessed in pregnancies after gastroplasty with Roux-en-Y gastric bypass to check for maternal complications and perinatal results and conclude that fetal vitality was not compromised in pregnancies after the procedure. The main complication was anemia, requiring specific nutritional counseling and a broad evaluation for micronutrient deficiencies at early pregnancy.

Endometriosis is covered by two studies. Clinical characteristics of endometriosis and Th1/Th2 immune response patterns were analyzed by Podgaec et al.10 and found that when specific clinical data are associated with a higher production of certain cytokines, there is a Th1 response pattern that may be related to deep infiltrating endometriosis. Bellelis et al.11 found that endometriosis is most often diagnosed in the fourth decade of life.

Menopause was studied by Del Giorno et al.12 and by Wolff et al.13 The former evaluated effects of treatment with Trifolium pratense on climacteric symptoms and sexual satisfaction in postmenopausal women and found no results on menopausal symptoms or sexual satisfaction. The latter evaluated the endometrial morphology and histology of non-bleeding postmenopausal women. They claim that diagnostic hysteroscopy associated with aspiration biopsy (Pipelle) performed in the day care facility can reveal endometrial alterations that cannot be diagnosed by transvaginal ultrasound.

Three articles cover gynecological oncology. Bagnoli et al.14 verified the expression levels and correlation of aromatase, matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9) and CD44 in ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC) when both are found in the same breast and conclude that aromatase through local estrogen synthesis in breast tissue plays an important role in breast carcinogenesis, mainly influencing MMP-2 and MMP-9 which are important participants in tumor cell invasion and dependence of their connection to CD44 for action. Bacchi et al.15 looked at the 21-gene expression assay as a support to the decision regarding use of chemotherapy in early breast cancer. They conclude that considering the current price for the 21-gene expression assay in Brazil, our economic analysis suggests that such testing is an overall cost-saving, from the perspective of third party payers. Carvalho et al.16 evaluated the distribution of molecular subtypes of breast tumors diagnosed in young Brazilian women as well as the frequency of loss of heterozygocity (LOH) in BRCA1 among different molecular subtypes of early-onset breast cancer. They claim that basal-like tumor was the second most frequent molecular type was only observed in women diagnosed under the age of 35 years.

ORTHOPEDICS

Thirteen papers cover orthopedic pathology. Belangero et al.17 evaluated the performance of HIMEX, an extensible nail with hooks, in osteogenesis imperfecta deformities and claim that it significantly reduced the number of fractures, presenting lower incidence of migration and higher survival rates than those described in literature. Canto et al.18 determined the influence of vertebral posterior elements decortication in bone graft integration, and find that it accelerated the histologic process of integration. Cruz et al.19 analyzed the biomechanical characteristics of balance in elderly people, based on pressure center oscillation in five foot positions, with open and closed eyes and find that visual feedback contributed to posture control. Ferreira et al.20 implemented a “Back School” program for low-back chronic pain. And claim that it improved the quality of life and functional capacity of the participants. Morelli et al.21 compares results of the treatment of patients with proximal humerus fractures using two different fixation methods: the t plate vs. the locking screw plate and found no early or late differences between groups. The treatment and the angular deviations tolerated in diaphyseal forearm fractures in children evoke divergent opinions in literature. In view of this controversy, Nicolini et al.22 evaluate the preferred treatment methods for this injury, during the 39th Brazilian Congress on Orthopedics and Traumatology and found that among orthopedic surgeons less than 30 years old, the choice for less invasive treatments and greater acceptance of angular values prevailed Pires-Neto et al.23 determined whether a biopsy of the synovia of the carpal tunnel is able to identify systemic diseases that were not diagnosed by clinical examination and laboratory tests and conclude it did not contribute to early diagnosis, and added extra costs to the procedure. Silva and Fucs24 retrospectively evaluated the treatment of the spastic pes planus valgus with the technique proposed by Pisani; they also examined 12 radiographic parameters and concluded that the technique is still a good option when compared with osteotomies and arthrodesis for the treatment of flexible deformities. Souza et al.25 conducted an epidemiological study of facial fractures in children in an emergency room and alert that a policy of prevention is necessary, with special attention to traffic accidents and falls, which were the etiologic agents that caused most of the fractures. The effect of the neuregulins 1-alpha and 1-beta on the regeneration the sciatic nerves of male adult C57BL/6J mice, using the tubulization technique was examined by Souza et al.26, who found that the addition of neuregulins provided a significant increase in the number of myelinized fibers. Umeda et al.27 examined the clinical results of triple arthrodesis in Cerebral Palsy patients and determined whether there is any correspondence between the results and the AOFAS scale, and changes in radiographic angles between the pre- and postoperative periods. They conclude that the procedure corrects or improves these deformities but that the AOFAS scale had low correlation with the result. Two articles cover Geriatric orthopedics. Gai et al.28 checked factors related to falls of a group of independent and autonomous elderly women and found that body balance condition was the major factor related to fall occurrences. Gawryszewski29 analyzed characteristics of fall related injuries, with emphasis on falls on the same level, of those with 60 years or more of age resident in the state of São Paulo and conclude that urgent programs to implement fall prevention are required.

EDUCATION

Education contributed eight highlighted articles. Two of these regard scientific initiation. Fede et al.30 evaluated the number of studies presented during oral sessions, selected for awards and published from 2002 to 2007 at the Undergraduate Medical Congress of the ABC Foundation School of Medicine. They understand that institutional scientific production is relevant and should continue to be stimulated. Fernandes et al.31 evaluated the experience gained through LCCT implementation and understand that it has met its goals, since most current and former members recognized its role in their medical training. Colicchio and Passos32 studied traffic behavior of medical students comparing current patterns with those observed in a study previously carried out in the same institution. Risky traffic behavior was found to be very frequent among these participants directly involved in accidents with victims. Because this is a segment of the population, that is aware and has direct contact with the consequences of traffic accidents, authors would hope to find a lower incidence of such high risk behavior. Information provided by this investigation should lead to a reflection from the academic community intending to introduce educational programs to effectively change student behavior. On a similar note, Petroianu et al.33 assessed the prevalence of alcohol, tobacco and psychotropic drug consumption by students of the Medical School of the Federal University of Minas Gerais, Brazil, and found that alcohol was the drug most used and was related to other drug addictions. Drugs were most frequently used by single, male students, who live alone and do not support themselves. On a different note, Lourenção et al.34 highlight the relationship between health and quality of life among the resident medical staff and find that an adequate training program is needed not only to increase professional qualification and personal quality of life, but also to provide safety during patient treatment. Silva et al.35 evaluated the competence of senior medical students in diagnosing tuberculosis based on their reading of chest X-rays and found that in this sample of medical students, who had received formal training in radiology early in their medical school course, the competence in interpreting the chest X-rays of TB patients was good. Since being introduced as an elective discipline (non-obligatory) in the second semester of 2002, acupuncture has been taught in the University of São Paulo School of Medicine. Amadera et al.36 conducted a study to verify interest and acceptance among under graduate medical students and to discern a positive influence contributing to improving their skills. A genuine interest to learn acupuncture was noted with almost 30% of all students volunteering for a brief training in the field while some of them choose additional training of two years due to the importance of acupuncture as part of professional skills. Results indicate that acupuncture should be included as an elective discipline for medical students. On a different note, Araujo et al.37 endeavored to determine the literacy level of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo outpatients, for the purpose of identifying recommendations to adapt the writing of the informed consent form to the outpatients literacy level. The results and the orientations for the text writing centered on the reader allowed us to make recommendations to render the consent form easier to read.

METABOLISM

Nine highlighted articles cover metabolism, with a special emphasis on dyslipidemia. Pereira et al.38 assessed diagnostic validity of four reference tables for waist circumference in female teenagers in order to detect lipid alterations, hyperinsulinism, elevated homeostasis model assessment, hyperleptinemia and excess of body adiposity. The claim that the cutoffs for waist circumference used by McCarthy et al. were the most appropriate for populational assessments. Freedman's et al. proposal is appropriate for clinical use since it presents higher specificity. In addition, it can substitute high costs exams, out of the professionals' reach such as insulin and leptin. Poeta et al.39 evaluated health-related quality of life of obese children and claim that such children had a poorer quality of life related to health when compared to normal children. Pannunzio et al.40 find that some stimulated whole saliva parameters (phosphate, free sialic acid, proteins and peroxiclase activity) are influenced by an increase of Body Mass Index creating conditions favorable for dental caries. Mendonça et al.41 endeavored to establish prevalence of overweight and obesity in children and adolescents from the city of Maceió, Alagoas, Brazil, and investigate the association of risk of overweight and obesity with gender, age and type of school. The prevalence of overweight and obesity were, respectively 9.3% and 4.5%. Overweight and obesity were significantly more frequent among private school students. Feliciano-Alfonso et al.42 estimated prevalence and distribution of modifiable cardiovascular risk factors and Metabolic Syndrome (MS) in young individuals admitted to the National University of Colombia in Bogota and found it to justify promotion of therapeutic lifestyle changes among this age group in Colombia. Costa et al.43 correlated anthropometric data and respiratory muscle strength of normal-weight and obese women. They found that bioelectrical impedance and obesity showed a direct correlation with RMS. WC and WHR had no influence on RMS of obese women; however, a relevance to risk factors for associated diseases was observed. These results appear to be due to an adjustment to excess body weight over the years. Trevisan et al.44 analyzed the influence of soy protein ingestion and exercises with weights, on resting energy expenditure of women in post-menopause. They found them to be determinants for increase in resting energy expenditure of women in post-menopause, and can be potentiated by ingestion of soy protein.

ONCOLOGY

Seven articles are highlighted with respect to oncological findings. Cancer mortality rates began to decline in developed countries in the 1990s, but their behavior in developing countries is less well-known, which led Fonseca et al.45 to re-examine the Brazilian situation finding that, as seen in developed countries, general cancer mortality rates tended to decline in Brazilian state capitals over the period 1980-2004, a tendency largely due to a decline in stomach cancer death rates for both genders. Younes et al.46 evaluated the accuracy of preoperative clinical staging with computed tomography in predicting the correct pathological stage. And conclude that clinical staging presents limited efficacy for the correct staging of non-small cell lung cancer patients in a sample of the Brazilian population. Zuliani et al.47 compared survival and toxicity of three different treatments for stage IIIB cervix cancer: low-dose-rate, high-dose-rate, brachytherapy and association of high-dose-rate and chemotherapy. They find that patients receiving high-dose-rate had better survival. The high-dose-rate cum chemotherapy association showed no benefit when compared to high-dose-rate only. Toxicity rates showed no difference between the three groups. Leme et al.48 endeavored to establish the clinical and demographic profile and identify risk factors among patients with head and neck cancer and relate them to the polymorphism of GSTT1 and GSTM1. An association was established between GSTM1 null genotypes and head and neck cancer. Bagnoli et al.14 verified the expression levels and correlation of aromatase, matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9) and CD44 in ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC) when both are found in the same breast and conclude that aromatase through local estrogen synthesis in breast tissue plays an important role in breast carcinogenesis, mainly influencing MMP-2 and MMP-9 which are important participants in tumor cell invasion and dependence of their connection to CD44 for action. Matos et al.49 present a series of 93 consecutive patients who had elective surgery for known gallbladder polyps, treated from January 2003 to December 2007 and claim that cholecystectomy is the appropriate surgical treatment for gallbladder polyps, when removal is warranted. Saad et al.50 have previously suggested that pretreatment levels of CA 19-9 correlate with overall survival among patients with advanced pancreatic cancer treated with gemcitabine; they sought to confirm the prognostic role of the pretreatment level of CA 19-9 and found further evidence in favor of the concept. Fanger et al.51 describe high prevalence rates of depression and suicidal behavior among cancer patients and suggest that simple screening instruments and specific questions during interviews are needed to detect these clinical conditions.

TOBACCO and SMOKING

Seven papers on problems related to smoking are highlighted. Neto et al.52 studied factors associated with smoking experimentation and initiation among adolescent students (11-14 years of age). And found that alcohol consumption and the influence of peers and relatives who smoke showed a strong association with smoking experimentation. Paternal smoking and media influence were found to increase the chances of adolescent smoking. Smoking prevalence was the object of Malta et al.53 who evaluated the prevalence of smoking in the adult population of Brazil. Estimates indicate a reduction in the prevalence of smoking, which was, however, still greater among males than among females. Souza et al.54 developed a new scale aimed at evaluating smoking motivation by incorporating questions and domains from the 68-item Wisconsin Inventory of Smoking Dependence Motives into the Modified Reasons for Smoking Scale. They claim that the new scale provides an acceptable framework of motivational factors for smoking, with satisfactory psychometric properties and reliability. At the geriatric end of the scale, Carvalho et al.55 evaluated the prevalence of smoking among elders and find that such patients in Brasilia exhibit a high prevalence of smoking and a low motivation for smoking cessation. On a similar note, Russo and Azevedo56 list reasons smokers give for seeking smoking cessation treatment, and correlate them with sociodemographic characteristics, clinical data, stage of readiness to change, and severity of nicotine dependence. The findings of this study highlight the role of health professionals in the approach to smoking cessation and suggest the importance of interventions that are more targeted, in view of the differences between men and women. Castro et al.57 compared smokers and never smokers in terms of quality of life; BMI; hospitalizations; functionality; family history of mental disorder; tobacco-related diseases; depression; and psychoactive substance use. This study suggests that, for smoking cessation programs, subgroups of smokers with specific characteristics (early age at smoking onset, tobacco-related diseases, depressive disorders and Use of psychoactive substances) should be identified. To determine the prevalence of respiratory symptoms and smoking, as well as pulmonary function parameters among charcoal production workers in three cities in southern Brazil, Souza et al.58 conducted a study which found that respiratory symptoms and airflow reduction were more common in the smoking workers.

GASTROENTEROLOGY

We highlight six articles on the gastrointestinal system. Nomura et al.9 studied fetal vitality assessed in pregnancies after gastroplasty with Roux-en-Y gastric bypass to check for maternal complications and perinatal results and conclude that fetal vitality was not compromised in pregnancies after the procedure. The main complication was anemia, requiring specific nutritional counseling and a broad evaluation for micronutrient deficiencies at early pregnancy. Portela et al.59 investigated whether liver transplants were cost effective at a University Hospital in the state of Ceará, Brazil. Results were similar to those found by other Brazilian transplant centers showing that it is an economically viable procedure based upon the financial transfer from the Brazilian National Health Service (SUS). Macedo et al.60 determined the occurrence of hepatopulmonary syndrome in cirrhosis patients who are candidates for liver transplantation and found a high prevalence of the syndrome, which however did not correlate with any of the variables analyzed. Matos et al.49 present a series of 93 consecutive patients who had elective surgery for known gallbladder polyps, treated from January 2003 to December 2007 and claim that cholecystectomy is the appropriate surgical treatment for gallbladder polyps, when removal is warranted. The etiology of acute pancreatitis cannot be found by clinical, biological and imaging investigations in 30% of these cases. This led Ardengh et al.61 to evaluate results from endoscopic ultrasonography for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic) acute pancreatitis and found it to be a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. Saad et al.50 have previously suggested that pretreatment levels of CA 19-9 correlate with overall survival among patients with advanced pancreatic cancer treated with gemcitabine; they sought to confirm the prognostic role of the pretreatment level of CA 19-9 and found further evidence in favor of the concept. Coelho et al.62 compared data of patients submitted to appendectomy for acute appendicitis at a public and at a private hospital. They found important differences in the diagnosis and outcomes between the two types of institutions.

GERIATRICS

Four papers on geriatrics are reviewed. Salgado et al.63 investigated the relationship between serum albumin levels, drugs used, length of hospitalization and number of diseases within the prognosis of hospitalized elderly and describe a mathematical equation obtained by this study which shows that albumin and days of hospitalization were inversely correlated with death and directly correlated with the number of drugs bound to albumin. A previously discussed study by Carvalho et al.55 covers the prevalence of smoking among elderly patients Also previous discussed are two studies, one by Gai et al.28 on factors related to falls of a group of independent and autonomous elderly women, one by Gawryszewski29 on characteristics of fall related injuries.

INFECTOLOGY

Infectology is the highlighted subject of four studies, with prominence to human immunodeficiency virus infection, which has increased considerably among middle-aged women as found by Valadares et al.64 On a different note, and because sexually transmitted diseases are common reasons for seeking medical assistance, Passos et al.65 analyzed the temporal distribution of first appointments in a sexually transmitted disease clinic from January 1993 to December 2005 to verify whether there is a seasonal increase in sexually transmitted disease after Carnival. No such influence was detected. An analysis of the professional profile of physicians who prescribe antiretroviral drugs to HIV infected persons in the State of São Paulo led Scheffer et al.66 to conclude that the absolute majority of HIV patients receive their prescriptions from duly trained and experienced physicians. Nevertheless, the large number of non-qualified physicians together with the reduced number of physicians in HIV high incidence regions make up the major challenge for comprehensive and adequate care of HIV patients. A study by Teixeira and Taquette67 identified factors associated with unprotected sexual activity in females under the age of 15 years and found that multiple types of violence suffered by teenagers, including structural, intrafamily, and sexual violence, increase their vulnerability to early, unprotected sexual activity and to STIs and unexpected pregnancy.

PSYCHIATRY

Four articles fall under the heading of Psychiatry. As previously noted, Teixeira and Taquette67 identified factors associated with unprotected sexual activity in females under the age of 15 and their consequences. On a different note, Junges and Bagatini68 present data on how chronically ill persons reframe life through their discursive practices and show that self-satisfaction relies on finding the thread to bring together the elements of existence based on a new model permitting a new identity. As shown above, Fanger et al.51 determine prevalence rates of depression and suicidal behavior among cancer inpatients and factors associated with these conditions. Also discussed is a paper by Ferreira et al.6 who assessed the impact of breast-feeding on the occurrence of anthropometric deviations among preschool children of the semiarid region of Alagoas (Brazil).

TRAUMA

Trauma is highlighted in four original articles. Parreira et al.69 assessed characteristics of trauma patients who sustained falls from their own height, focusing on presence of severe injuries, diagnosis and treatment and conclude that the importance of the trauma mechanism in victims of falls from own height should be emphasized due to a considerable possibility of occult severe injuries, mainly in the cephalic segment. On the same note, Parreira et al.70 assessed characteristics of trauma in the elderly by comparison to a group of younger trauma patients. And found that the elderly group was characterized by a higher frequency of falls from their own height concomitant diseases and severe injuries in the head, mainly subdural hematomas, cerebral contusions and subarachnoid hemorrhage. Nunes and Nascimento71 identified clusters of municipalities with high rates of hospitalization due to motorcycle accidents in the “Vale do Paraíba” region of the state of São Paulo, thereby locating the residence of those hospitalized for motorcycle accidents, highlighting municipalities where preventive measures should be enforced. Colicchio and Passos32 studied traffic behavior of medical students comparing current patterns with those observed in a study previously carried out in the same institution. Risky traffic behavior was found to be very frequent among these participants directly involved in accidents with victims. Because this is a segment of the population, that is aware and has direct contact with the consequences of traffic accidents, authors would hope to find a lower incidence of such high risk behavior. Information provided by this investigation should lead to a reflection from the academic community intending to introduce educational programs to effectively change student behavior.

UROLOGY and NEPHROLOGY

Urology and nephrology contribute four studies to this series. In two previously discussed articles Gomes and da Silva1 described prevalence of stress urinary incontinence in women over 20 years of age, who participate in the Family Health Program in the city of Dourados, State of Mato Grosso do Sul, Brazil and conclude that prevalence is similar to that of other studies. Tanuri et al.2 compared results of retropubic and transobturator sling for surgical treatment of female stress urinary incontinence which were effective at one-year follow-up. Oliveira et al.72 evaluated risk factors related to occurrence of female urinary incontinence and found that independent risk factors include age, vaginal delivery, forceps delivery, and weight of largest infant and as a protective factor, cesarean section delivery. Carvalho et al.73 assessed frequency and type of cardiovascular and renal/collecting system abnormalities seen in a sample of patients with Turner Syndrome and found that abnormalities found in this study was similar to those of previous studies, but most were found in routine exams after Turner Syndrome diagnosis. Thus, early detection of associated anomalies depends on early detection of TS.

ETHICS

Ethics is the subject of three articles. Fortes74 writes about the meaning assigned to ethical thought that should guide Brazilian bioethicists regarding the equity of a Health System and found a pluralism of values that jeopardizes determination of moral equity in the health system. Extensive discussion among all interested parties is necessary to reach a possible consensus. Duque et al.75 present their practical experience in obtaining informed consent for a study performed at the “Instituto Nacional de Câncer” involving research on stored biologic samples from patients operated for colon cancer from 2000 to 2004. And conclude that obtaining consent by postal and phone communication for retrospective genetic research with stored tissue samples is feasible. Most responded to contact and consented to participate, but there were costs and risks that cannot be neglected. As noted above, Teixeira and Taquette 67 identified factors associated with unprotected sexual activity in females under the age of 15 and refer to the multiple types of violence suffered by teenagers, including structural, intrafamily, and sexual violence, increase their vulnerability to early, unprotected sexual activity and to STIs and unexpected pregnancy. The synergistic effects of poverty, low educational achievement, and low self-esteem reduces the odds that adolescents will build the tools required for self-protection and exposes them to further victimization outside the family environment.

ENDOCRINOLOGY

Diabetes is the subject of two articles. Rodrigues et al.76 evaluated the prevalence of chronic vascular complications and associated factors in patients with type 1 diabetes mellitus and found a high prevalence of microvascular complications. The relation between diabetes and physical activity was studied by Pitanga et al.77 in terms of how much total physical activity (intensity and duration) is required and its different domains (work, commuting, household, and leisure time) as predictors of absence of diabetes in the black ethnicity population. They conclude that physical activity accumulated in different domains should be suggested in amounts suitable for a black ethnicity population in order to contribute to diabetes prevention.

OPHTHALMOLOGY

Two articles on ophthalmology are reviewed. Rosa et al.78 describe the clinical characteristics of a sample of patients with cat eye syndrome who were seen at their service. The phenotype observed in cat eye syndrome is highly variable and may be superimposed on the phenotype of the ocular-auricular-vertebral spectrum. Although these patients usually have good prognosis, including from a neurological point of view, they believe that all patients with the syndrome should be assessed very early on for the presence of cardiac, biliary and anorectal malformations, which may avoid possible complications in the future, including patient deaths. Toledo et al.79 examined the early detection of visual impairment in schoolchildren and investigated its association with academic performance. Results suggest that there is an association between low visual accuracy and poor academic performance in the sample assessed.

PEDIATRICS

Two pediatric papers are highlighted. The previously reported study by Nardozza et al.7 assessed and compared accuracy of birth weight prediction using a combination of two-dimensional (abdominal circumference - AC and femur length - FL) and three-dimensional parameters (fetal arm -VolArm and thigh -VolTh volumes). They developed a formula using VolArm, VolTh, AC and FL which was more accurate for prediction of birth weight than formulae using only two-dimensional parameters. Grosso et al.80 report that the majority of pediatricians in the city of São Paulo were not familiar with the Guidelines for Prevention of Atherosclerosis in Childhood and Adolescence. Individual strategies were rarely found. Medical education and adequate disclosure of the Guidelines are necessary for active control of populational risk factors.