Seroconversion in asymptomatic COVID-19 pediatric patients with rheumatic diseases of one tertiary referral hospital.

OBJECTIVES: To evaluate seroconverted asymptomatic COVID-19 in pediatric Autoimmune Rheumatic Diseases (ARDs) patients and to identify the risk factors related to contagion. METHODS: A cross-sectional study was conducted in March 2021, before vaccination of children and adolescents in Brazil, including 77 pediatric ARDs patients, followed at a tertiary hospital and 45 healthy controls, all of them without a previous diagnosis of COVID-19. Data was obtained by a questionnaire with demographic data, symptoms compatible with COVID-19 over the previous year, and contact with people with confirmed COVID-19. Patient's medical records were reviewed to access data regarding disease and current medications. A qualitative immunochromatographic SARS-CoV-2 test was performed on all participants. RESULTS: Patients and controls were similar in terms of female gender (70.1% vs. 57.8%, p = 0.173), age (14 vs. 13 years, p = 0.269) and SARS-CoV-2 positive serology (22% vs. 15.5%, p = 0.481). 80.5% of rheumatic patients were in use of immunosuppressive drugs: 27.3% of them used corticosteroids (33.3% in high doses), and 7.8% on immunobiologicals. No statistical differences were found between positive (n = 17) and negative serology (n = 60) patients regarding demographic/socioeconomic data, contact with people with confirmed COVID-19, use and number of immunosuppressive drugs, use and dose of corticosteroids, use of hydroxychloroquine and immunobiological drugs (p > 0.05). CONCLUSIONS: Pediatric rheumatic disease patients were infected at the same rate as healthy ones. Neither the underlying pathology nor its immunosuppressive treatment seemed to interfere with contagion risk.

Measuring early childhood development in Brazil: validation of the Caregiver Reported Early Development Instruments (CREDI).

OBJECTIVE: The present study aims to analyze the psychometric properties and general validity of the Caregiver Reported Early Development Instruments (CREDI) short form for the population-level assessment of early childhood development for Brazilian children under age 3. METHOD: The study analyzed the acceptability, test-retest reliability, internal consistency and discriminant validity of the CREDI short-form tool. The study also analyzed the concurrent validity of the CREDI with a direct observational measure (Inter-American Development Bank's Regional Project on Child Development Indicators; PRIDI). The full sample includes 1,265 Brazilian caregivers of children from 0 to 35 months (678 of which comprising an in-person sample and 587 an online sample). RESULTS: Results from qualitative interviews suggest overall high rates of acceptability. Most of the items showed adequate test-retest reliability, with an average agreement of 84%. Cronbach's alpha suggested adequate internal consistency/inter-item reliability (α>0.80) for the CREDI within each of the six age groups (0-5, 6-11, 12-17, 18-23, 24-29 and 30-35 months of age). Multivariate analyses of construct validity showed that a significant proportion of the variance in CREDI scores could be explained by child gender and family characteristics, most importantly caregiver-reported cognitive stimulation in the home (p<0.0001). Regarding concurrent validity, scores on the CREDI were significantly correlated with overall PRIDI scores within the in-person sample at r=0.46 (p<0.001). CONCLUSIONS: The results suggested that the CREDI short form is a valid, reliable, and acceptable measure of early childhood development for children under the age of 3 years in Brazil.

Seroconversion in asymptomatic COVID-19 pediatric patients with rheumatic diseases of one tertiary referral hospital

Abstract Objectives: To evaluate seroconverted asymptomatic COVID-19 in pediatric Autoimmune Rheumatic Diseases (ARDs) patients and to identify the risk factors related to contagion. Methods: A cross-sectional study was conducted in March 2021, before vaccination of children and adolescents in Brazil, including 77 pediatric ARDs patients, followed at a tertiary hospital and 45 healthy controls, all of them without a previous diagnosis of COVID-19. Data was obtained by a questionnaire with demographic data, symptoms compatible with COVID-19 over the previous year, and contact with people with confirmed COVID-19. Patient's medical records were reviewed to access data regarding disease and current medications. A qualitative immunochromatographic SARS-CoV-2 test was performed on all participants. Results: Patients and controls were similar in terms of female gender (70.1% vs. 57.8%, p = 0.173), age (14 vs. 13 years, p = 0.269) and SARS-CoV-2 positive serology (22% vs. 15.5%, p = 0.481). 80.5% of rheumatic patients were in use of immunosuppressive drugs: 27.3% of them used corticosteroids (33.3% in high doses), and 7.8% on immunobiologicals. No statistical differences were found between positive (n = 17) and negative serology (n = 60) patients regarding demographic/socioeconomic data, contact with people with confirmed COVID-19, use and number of immunosuppressive drugs, use and dose of corticosteroids, use of hydroxychloroquine and immunobiological drugs (p > 0.05). Conclusions: Pediatric rheumatic disease patients were infected at the same rate as healthy ones. Neither the underlying pathology nor its immunosuppressive treatment seemed to interfere with contagion risk.

Georeferenced and secure mobile health system for large scale data collection in primary care.

INTRODUCTION: Mobile health consists in applying mobile devices and communication capabilities for expanding the coverage and improving the effectiveness of health care programs. The technology is particularly promising for developing countries, in which health authorities can take advantage of the flourishing mobile market to provide adequate health care to underprivileged communities, especially primary care. In Brazil, the Primary Care Information System (SIAB) receives primary health care data from all regions of the country, creating a rich database for health-related action planning. Family Health Teams (FHTs) collect this data in periodic visits to families enrolled in governmental programs, following an acquisition procedure that involves filling in paper forms. This procedure compromises the quality of the data provided to health care authorities and slows down the decision-making process. OBJECTIVES: To develop a mobile system (GeoHealth) that should address and overcome the aforementioned problems and deploy the proposed solution in a wide underprivileged metropolitan area of a major city in Brazil. METHODS: The proposed solution comprises three main components: (a) an Application Server, with a database containing family health conditions; and two clients, (b) a Web Browser running visualization tools for management tasks, and (c) a data-gathering device (smartphone) to register and to georeference the family health data. A data security framework was designed to ensure the security of data, which was stored locally and transmitted over public networks. RESULTS: The system was successfully deployed at six primary care units in the city of Sao Paulo, where a total of 28,324 families/96,061 inhabitants are regularly followed up by government health policies. The health conditions observed from the population covered were: diabetes in 3.40%, hypertension (age >40) in 23.87% and tuberculosis in 0.06%. This estimated prevalence has enabled FHTs to set clinical appointments proactively, with the aim of confirming or detecting cases of non-communicable diseases more efficiently, based on real-time information. CONCLUSION: The proposed system has the potential to improve the efficiency of primary care data collection and analysis. In terms of direct costs, it can be considered a low-cost solution, with an estimated additional monthly cost of U$ 0.040 per inhabitant of the region covered, or approximately U$ 0.106 per person, considering only those currently enrolled in the system.

Relation between birth weight, growth, and subclinical atherosclerosis in adulthood.

BACKGROUND AND OBJECTIVES: Adverse conditions in the prenatal environment and in the first years of life are independently associated with increased risk for cardiovascular disease. This paper aims to study the relation between birthweight, growth in the first year of life, and subclinical atherosclerosis in adults. METHODS: 88 adults aged between 20 and 31 were submitted to sociodemographic qualities, anthropometric data, blood pressure measurements, metabolic profile, and evaluation of subclinical atherosclerosis. RESULTS: Birthweight<2,500 grams (g) was negatively correlated with (a) increased waist-to-hip ratio (WHR), according to regression coefficient (RC) equal to -0.323, 95% CI [-0.571, -0.075] P<0.05; (b) diastolic blood pressure (RC=-4.744, 95% CI [-9.017, -0.470] P<0.05); (c) low HDL-cholesterol (RC=-0.272, 95% CI [-0.516, -0.029] P<0.05); (d) frequency of intima-media thickness (IMT) of left carotid>75th percentile (RC=-0.242, 95% CI [-0.476, -0.008] P<0.05). Birthweight>3,500 g was associated with (a) BMI>25.0 kg/m2, (RC=0.317, 95% CI [0.782, 0.557] P<0.05); (b) increased waist circumference (RC=0.284, 95% CI [0.054, 0.513] P<0.05); (c) elevated WHR (RC=0.280, 95% CI [0.054, 0.505] P<0.05); (d) minimum subcutaneous adipose tissue (SAT) (RC=4.354, 95% CI [0.821, 7.888] P<0.05); (e) maximum SAT (RC=7.095, 95% CI [0.608, 13.583] P<0.05); (f) right lobe of the liver side (RC=6.896, 95% CI [1.946, 11.847] P<0.001); (g) frequency's right lobe of the liver>75th percentile (RC=0.361, 95% CI [0.169, 0.552] P<0.001). Weight gain in the first year of life was inversely correlated with (a) mean IMT of left carotid (RC=-0.046, 95% CI [-0.086, -0.006] P<0.05; (b) frequency IMT of left carotid>75th percentile (RC=-0.253, 95% CI [-0.487, -0.018] P<0.05); (c) mean IMT (RC=-0.038, 95% CI [0.073, -0.002] P<0.05); (d) the frequency of the mean IMT>75th percentile (RC=-0.241, 95% CI [-0.442, -0.041] P<0.05). CONCLUSIONS: Adults birthweight<2,500 g and >3,500 g and with insufficient weight gain in the first year of life have showed different metabolic phenotypes, but all of them were related to subclinical atherosclerosis.

Measuring early childhood development in Brazil: validation of the Caregiver Reported Early Development Instruments (CREDI) / Medição do desenvolvimento na primeira infância no Brasil: validação dosInstrumentos sobre o Desenvolvimento na Primeira Infância Relatado por Cuidadores(CREDI)

Abstract Objective The present study aims to analyze the psychometric properties and general validity of the Caregiver Reported Early Development Instruments (CREDI) short form for the population-level assessment of early childhood development for Brazilian children under age 3. Method The study analyzed the acceptability, test-retest reliability, internal consistency and discriminant validity of the CREDI short-form tool. The study also analyzed the concurrent validity of the CREDI with a direct observational measure (Inter-American Development Bank's Regional Project on Child Development Indicators; PRIDI). The full sample includes 1,265 Brazilian caregivers of children from 0 to 35 months (678 of which comprising an in-person sample and 587 an online sample). Results Results from qualitative interviews suggest overall high rates of acceptability. Most of the items showed adequate test-retest reliability, with an average agreement of 84%. Cronbach's alpha suggested adequate internal consistency/inter-item reliability (α > 0.80) for the CREDI within each of the six age groups (0-5, 6-11, 12-17, 18-23, 24-29 and 30-35 months of age). Multivariate analyses of construct validity showed that a significant proportion of the variance in CREDI scores could be explained by child gender and family characteristics, most importantly caregiver-reported cognitive stimulation in the home (p < 0.0001). Regarding concurrent validity, scores on the CREDI were significantly correlated with overall PRIDI scores within the in-person sample at r = 0.46 (p < 0.001). Conclusions The results suggested that the CREDI short form is a valid, reliable, and acceptable measure of early childhood development for children under the age of 3 years in Brazil.

Resumo Objetivo O presente estudo visa analisar as propriedades psicométricas e a validade geral do formulário curto dos Instrumentos sobre o Desenvolvimento na Primeira Infância Relatado por Cuidados (CREDI) para avaliação em nível populacional do desenvolvimento na primeira infância de crianças brasileiras com menos de três anos. Método O estudo analisou a aceitabilidade, a confiabilidade teste-reteste, a consistência interna e a validade discriminante da ferramenta CREDI. O estudo também analisou a validade concorrente do CREDI com uma medida observacional direta (Projeto Regional sobre os Indicadores de Desenvolvimento na Infância do Banco Interamericano de Desenvolvimento; PRIDI). A amostra total inclui 1.265 cuidadores brasileiros de crianças de 0 a 35 meses (678 em uma amostra presencial e 587 em uma amostra on-line). Resultados Os resultados das entrevistas qualitativas sugerem altas taxas gerais de aceitabilidade. A maior parte dos itens mostrou confiabilidade teste-reteste adequada, com concordância média de 84%. O coeficiente alfa de Cronbach sugeriu consistência interna/confiabilidade entre itens (α > 0,80) para o CREDI em cada uma das seis faixas etárias (0-5 α = 6-11, 12-17, 18-23, 24-29 e 30-35 meses de idade). As análises multivariadas da validade do constructo mostraram que uma proporção significativa da variação nas pontuações do CREDI pode ser explicada pelo sexo da criança e pelas características familiares, mais importante o estímulo cognitivo em casa relatado pelo cuidador (p < 0,0001). Com relação à validade concorrente, as pontuações do CREDI foram significativamente correlacionadas às pontuações gerais do PRIDI na amostra presencial em r = 0,46 (p < 0,001). Conclusões Os resultados sugerem que o formulário curto CREDI é uma medida válida, confiável e aceitável de desenvolvimento na primeira infância para crianças com menos de três anos no Brasil.

The intergenerational effects on birth weight and its relations to maternal conditions, São Paulo, Brazil.

BACKGROUND AND OBJECTIVES: Parents' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. The present research aims to study the correlation between the child's low or increased birth weight, the mother's birth weight, and maternal conditions. METHODS: 773 mother-infant binomials were identified with information on both the baby's and the mother's birth weight recorded. Group studies were constituted, dividing the sample according to birth weight (<2,500 grams (g) and ≥3,500 grams (g)). The length at birth was also studied in children ≤47.5 cm (lower quartile). Chi(2) test or Fisher's exact test, Spearman's Rho, and odds ratio were performed in order to investigate the relation between the children's weight and length at birth and the mothers' and children's variables. RESULTS: The girls were heavier at birth than their mothers, with an average increase at birth weight between the generations of 79 g. The child's birth weight <2,500 g did not show any correlation with maternal birth weight <2,500 g (Fisher 0.264; Spearman's Rho 0.048; OR 2.1 and OR lower 0.7) or with maternal stature below the lower quartile (<157 cm) (Chi (2) sig 0.323; with Spearman's Rho 0.036; OR 1.5 and OR lower 0.7). The child's low birth weight (<2,500 g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083; Spearman's Rho 0.080; OR 4.9 and OR lower 1.0). The child's birth weight <2,500 g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi (2) sig 0.002; Spearman's Rho 0.113; OR 3.2 and OR lower 1.5). The child's weight at birth ≥3,500 g showed strong correlation with maternal weight at birth ≥3,500 g (Chi (2) sig 0; Spearman's Rho +0.142; OR 0.5 and OR upper 0.7). It was also revealed that the higher the maternal prepregnancy BMI, the stronger the correlation with child's birth weight ≥3,500 g ((maternal prepregnancy BMI > 25.0 with Chi (2) sig 0.013; Spearman's Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal prepregnancy BMI > 30.0 with Chi (2) sig 0 Spearman's Rho 0.137; OR 2.58 and OR upper 4.26)). The child's length at birth in the lower quartile (≤47.5 cm) showed strong correlation with drug use by the mother during pregnancy (Chi (2) sig 0.004; Spearman's Rho 0.105; OR 4.3 and OR lower 1.5). CONCLUSIONS: The mother's increased weight at birth and the prenatal overweight or obesity were correlated with increased weight and length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures.

[Rotavirus A infections and reinfections: genotyping and vaccine implications]. / Infecções e reinfecções por Rotavirus A: genotipagem e implicações vacinais.

OBJECTIVE: To identify rotavirus A and the most prevalent G and P genotypes in children with acute diarrhea, and to the describe the occurrence of rotavirus infection and reinfection. METHODS: Group A rotavirus specimens were obtained from fecal samples from children with acute diarrhea in Goiânia, state of Goiás, Brazil from July 2000 to October 2002. Rotavirus A positive children and a control group (children of the same age and sex, without diarrhea and with no evidence of rotavirus in the first fecal samples) were followed prospectively during one year. All rotavirus A positive samples were genotyped using RT-PCR/nested-PCR. RESULTS: A total of 77 group A rotavirus strains (37.2%) were identified in the diarrheic samples of 207 children. The following G genotypes were identified: G1 (62.3%), G9 (34.4%) and G4 (3.3%). With regard to P genotyping, 59% were characterized as P[8], 7.7% as P[6], 23.1% as P[6]+P[8], 7.7% as P[4]+P[8] and 2.6% as P[4]+P[8]. The following associations were observed: G1P[8] (77.8%), G9P[8] (11.1%), G4P[8] (5.6%) and G1P[6] (5.6%). No reinfection was observed in the 40 rotavirus A (+) children. However, but two of 40 children who were initially negative for this agent developed rotavirus infection during the same period. CONCLUSIONS: The predominant G and P genotypes observed were similar to those found in new vaccines. No reinfection occurred during one-year of follow-up for any of the genotypes identified.

A phase I clinical trial of a new 5-valent rotavirus vaccine.

We conducted a phase I, double-blind, placebo-controlled trial to evaluate a new 5-valent oral rotavirus vaccine's safety and immunogenicity profiles. Subjects were randomly assigned to receive 3 orally administered doses of a live-attenuated human-bovine (UK) reassortant rotavirus vaccine, containing five viral antigens (G1, G2, G3, G4 and G9), or a placebo. The frequency and severity of adverse events were assessed. Immunogenicity was evaluated by the titers of anti-rotavirus IgA and the presence of neutralizing antibodies anti-rotavirus. No severe adverse events were observed. There was no difference in the frequency of mild adverse events between experimental and control groups. The proportion of seroconversion was consistently higher in the vaccine group, for all serotypes, after each one of the doses. The 5-valent vaccine has shown a good profile of safety and immunogenicity in this small sample of adult volunteers.

Self-reported morbidity and its conditionings in children 5 to 9 years old in Sobral, CE, Brazil.

INTRODUCTION: This study was based on a random sample of 3,276 children aged between 5 and 9 years from the urban region of Sobral - CE, Brazil. OBJECTIVE: The main goal was to describe reported morbidity in children aged between 5 to 9 years and to analyze their conditionings. METHODOLOGY: Home interviews were carried out with 3,276 children and clinical exams were conducted in a sub-sample of 2,594. Health problems reported by mothers were classified according to the tenth revision of the International Disease Classification. Analyses were performed using Stata 7.0. Outcomes analyzed were reported morbidity in the past 15 days. The independent variables were grouped into socioeconomic, environmental, health service access, and nutritional status. RESULTS: The most prevalent morbidities were diseases of the respiratory system (DRS), 28.7%; diseases of the skin and subcutaneous tissue, 3.4%; infectious and parasitic diseases, 2.2%. The independent variables that had statistically significant correlations with the prevalence of DRS were related to the children who lived in the main urban center, had a history of malnutrition, and low school attendance, with odds ratio of respectively, 1.48 (1.10-1.9995%CI), 1.30 (1.05-1.6095%CI), 1.54 (1.02-2.3295%CI). DISCUSSION: A high prevalence of DRS was observed in children in the main urban center. DRS prevalence was about twice higher than that observed in other studies with similar methodology. This observation has raised the hypotheses of over reporting or environmental pollution. Most children had minor health problems. They also had facilitated access to health services, especially to the FHP.

Morbidade referida e seus condicionantes em crianças de 5 a 9 anos em Sobral, CE, Brasil / Reported morbidity and its conditionings in children 5 to 9 years old in Sobral, CE, Brazil

Objetivo: Descrever a morbidade referida em crianças de 5 a 9 anos e analisar seus possíveis condicionantes. Metodologia: Corte de base populacional com amostra aleatória e representativa em crianças de 5 a 9 anos da zona urbana de Sobral - CE, Brasil. Entrevistas domiciliares com 3.276 crianças e exame clínico em 2.594. A morbidade referida foi classificada segundo a CID-10. O desfecho analisado foi morbidade referida nos últimos 15 dias, utilizando Stata 7.0. Resultados: 43,9 por cento das crianças apresentaram morbidade referida: Doenças do Aparelho Respiratório (DAR), 28,7 por cento; doenças da pele, 3,4 por cento; doenças infecciosas, 2,2 por cento. Daquelas que adoeceram, 41,5 por cento procuraram atendimento. Dessas, 77,4 por cento em Unidades de Saúde Familiar. Apresentaram maiores chances de DAR as crianças com as seguintes características: residir no núcleo urbano principal do município, ter antecedente de desnutrição e frequentar escola, com um valor de ODDS Ratio, respectivamente de 1,48 (IC95 por cento1,10-1,99), 1,30 (IC95 por cento1,05-1,60) e 1,54 (IC95 por cento1,02-2,32). Discussão: Chamou a atenção a elevada prevalência de DAR em crianças do núcleo urbano principal, cerca de duas vezes maior que a observada em outros estudos de metodologia similar, levantando hipóteses de sobrerelato ou poluição ambiental. A maioria das crianças apresentou problemas de saúde de menor gravidade e teve acesso facilitado aos serviços de saúde, principalmente ao PSF. Conclusões: Serão necessários novos estudos para identificar possíveis causas da elevada prevalência de DAR em crianças do núcleo urbano principal do município. As ocasiões em que as crianças demandam os serviços de saúde da família por doenças de baixa gravidade podem ser aproveitadas para medidas de prevenção e promoção da saúde.

Introduction: This study was based on a random sample of 3,276 children aged between 5 and 9 years from the urban region of Sobral - CE, Brazil. Objective: The main goal was to describe reported morbidity in children aged between 5 to 9 years and to analyze their conditionings. Methodology: Home interviews were carried out with 3,276 children and clinical exams were conducted in a sub-sample of 2,594. Health problems reported by mothers were classified according to the tenth revision of the International Disease Classification. Analyses were performed using Stata 7.0. Outcomes analyzed were reported morbidity in the past 15 days. The independent variables were grouped into socioeconomic, environmental, health service access, and nutritional status. Results: The most prevalent morbidities were diseases of the respiratory system (DRS), 28.7 percent; diseases of the skin and subcutaneous tissue, 3.4 percent; infectious and parasitic diseases, 2.2 percent. The independent variables that had statistically significant correlations with the prevalence of DRS were related to the children who lived in the main urban center, had a history of malnutrition, and low school attendance, with odds ratio of respectively, 1.48 (1.10-1.9995 percentCI), 1.30 (1.05-1.6095 percentCI), 1.54 (1.02-2.3295 percentCI). Discussion: A high prevalence of DRS was observed in children in the main urban center. DRS prevalence was about twice higher than that observed in other studies with similar methodology. This observation has raised the hypotheses of over reporting or environmental pollution. Most children had minor health problems. They also had facilitated access to health services, especially to the FHP.

Aleitamento materno e desenvolvimento neuropsicomotor: uma revisão da literatura / Breastfeeding and neurodevelopment: a review of literature

Introdução: O aleitamento materno previnemortes na infância, promove o desenvolvimentoda saúde física, mental e psíquica da criança e temefeitos a curto e longo prazo. Dentre estes, está odesenvolvimento neuropsicomotor. Objetivo:Revisar os efeitos do aleitamento materno sobreo desenvolvimento neuropsicomotor da criança.Método: Foi feita uma revisão da literatura pelaconsulta aos sites SciELO e PubMed à procura deartigos publicados nos últimos 20 anos, além debusca no Google Acadêmico por artigos citadospelas referências consultadas. Síntese dos dados:Aleitamento materno e desenvolvimento neurológico- os artigos consultados relatam a existênciade confundidores não controlados que podemfavorecer o desenvolvimento neurológico. Apesardisso, alguns citam que os nutrientes do leitematerno complementam a ação um do outro e sãocapazes de beneficiar o desenvolvimento neurológico.O mais especulado é o ácido graxo de cadeialonga, por maturar as funções corticais do cérebro.Aleitamento materno e desenvolvimento cognitivopermanece assunto incerto, pois os resultados deestudos não são consistentes, devido aos efeitos dosconstituintes do leite materno e a interação físicae social da amamentação. Este é consequente deum bom desenvolvimento neurológico. Outrosnutrientes que favorecem o desenvolvimentomotor são as proteínas do leite materno, cálcio emagnésio, oligossacarídeos e lipídeos. Conclusão:Os constituintes do leite materno favorecem obom desenvolvimento neurológico e, consequentemente,o motor. Dados são inconclusivos quantoao desenvolvimento cognitivo.

Introduction: Breast-feeding prevents childhooddeaths promotes the development of physical,mental and emotional child and has a short and longterm. Among these is the psychomotor development.Objective: To review the effects of breastfeedingon the neurodevelopment of the child. Methods: Areview of the literature by consulting the websitesand SciELO PubMed looking for articles publishedin the last 20 years, and search on Google Scholarfor articles cited by the publications reviewed. Datasynthesis: Breastfeeding and neurological development- the source articles reporting the existenceof uncontrolled confounding factors that can lead toneurological development. However, some report thatthe nutrients in breast milk complement the actionof each other and are able to benefit from neurologicaldevelopment. The most speculation is the fattyacid long chain of the mature cortical functions ofthe brain. Breastfeeding and cognitive development- the subject remains unclear because the resultsof studies are not consistent due to the effects of theconstituents of breast milk and social and physicalinteraction of breastfeeding. This is the consequenceof a good neurological development. Other nutrientsthat promote motor development are the proteins ofmilk, calcium and magnesium, oligosaccharides andlipids. Conclusion: The constituents of breast milkpromote the proper neurological development andtherefore the engine. Data are inconclusive as to thecognitive development.

Infecções e reinfecções por Rotavirus A: genotipagem e implicações vacinais / Rotavirus A infections and reinfections: genotyping and vaccine implications

OBJETIVOS: Identificar Rotavirus A em crianças com diarréia aguda, determinando os genótipos G e P prevalentes e avaliar a ocorrência de infecções e reinfecções por rotavírus do grupo A em crianças. MÉTODOS: Foram estudadas, prospectivamente, crianças com doença diarréica aguda e identificação de Rotavirus A em Goiânia (GO), durante o período de julho de 2000 a outubro de 2002. Igual número de crianças, pareadas por idade e sexo, que não apresentavam diarréia aguda e sem identificação de rotavírus nas amostras fecais à admissão ao estudo, representou o grupo controle. Foram analisadas a ocorrência de infecções ou reinfecções sintomáticas ou assintomáticas por rotavírus durante o período de estudo, durante um ano de seguimento em ambos os grupos. Todas as amostras positivas foram submetidas a genotipagem G e P através das reações de RT-PCR e Nested PCR. RESULTADOS: A infecção por rotavírus ocorreu em 37,2 por cento (77 de 207 amostras fecais) das crianças com diarréia aguda durante o período do estudo. Os genótipos G e P identificados foram, simultaneamente: G1 (62,3 por cento), G9 (34,4 por cento) e G4 (3,3 por cento) e P[8] (59 por cento), P[6] (7,7 por cento), P[6]+P[8] (23,1 por cento), P[4]+P[8] (7,7 por cento) e P[4]+P[6] (2,6 por cento). As associações de genótipos G e P identificados durante o estudo foram: G1P[8] (77,8 por cento), G9P[8] (11,1 por cento), G4P[8] (5,6 por cento) e G1P[6] (5,6 por cento). Não houve reinfecção por rotavírus nos pacientes do grupo Rotavirus A (+) durante o período de seguimento, enquanto duas crianças do grupo controle apresentaram infecções sintomáticas por rotavírus durante o mesmo período. CONCLUSÕES: Os genótipos G e P predominantes correspondem aos das candidatas atuais à vacina contra rotavírus. Não houve reinfecção por rotavírus pelo período de um ano em relação a todos os genótipos identificados.

Abscesso de músculo psoas em crianças / Psoas muscular abcess in children

Os sintomas de abscesso de músculo psoas em crianças säo inespecíficos, e o diagnóstico diferencial se faz principalmente dentre as doenças que compöem a síndrome do quadril doloroso na infância, sendo necessário métodos de imagem para confirmaçäo diagnóstica. Durante o primeiro semestre de 1995, foram atendidas 48.550 crianças no Pronto Socorro do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, sendo que quatro crianças tiveram o diagnóstico de abcesso de músculo psoas (2 do sexo feminino e 2 do sexo masculino). A idade variou de 1 a 12 anos. Todas apresentavam quadro clínico de longa duraçäo e sintomas inespecíficos, sendo o diagnóstico confirmado por ultra-som e/ou tomografia abdominal. Em 3 delas, foi isolado o Staphylococcus aureus como agente etiológico. Os dados observados säo semelhantes aos da literatura.

Traqueobronquite necrotisante: relato de um caso em lactente / Necrotizing tracheobronchitis in an infant

Objetivo: Alertar os pediatras emergencistas para uma causa pouco comum de obstruçäo de vias aéreas em crianças submetidas a ventilaçäo mecânica. Métodos: Os autores relatam um caso de traqueobronquite necrotisante em lactente de 8 meses e discutem a fisiopatologia, diagnóstico e abordagem terapêutica. Resultados: A crianca apresentou evoluçäo favorável associado ao diagnóstico precoce e pronta intervençäo broncoscópica. Conclusöes: Os pediatras emergencistas devem suspeitar de traqueobronquite necrotisante em todas as crianças sob ventilaçäo mecânica que apresentarem o quadro clínico típico caracterizado por obstruçäo aguda das vias aéreas, hiperinsuflaçäo pulmonar, mesmo fora do período neonatal. Essa situaçäo, uma vez reconhecida, constitui indicaçäo precisa de traqueobroncoscopia de urgência...

Tuberculose peritoneal: relato de caso e comparacao de metodos diagnosticos / Peritoneal tuberculosis: case report and diagnostic methods

Descricao de caso de uma paciente, de 5 anos e 9 meses apresentando quadro de febre ha 20 anos, emagrecimento de 2kg e aumento de volume abdominal. Nao havia recebido a vacina BCG. Ao exame fisico observou-se...

Sepse por Klebsiella pneumoniae: revisäo de 28 casos / Septicaemia caused by Klebsiella pneumoniae: a review of 28 cases

Foram estudadas 28 crianças de 1 mês a 12 anos de idade com quadro séptico e hemocultura positiva para Klebsiella pneumoniae e comparadas com um grupo de crianças com sepse para outros patógenos ou sem etiologia definida. Constatou-se qeu a sepse por Klebsiella pneumoniae ocorreu mais freqüentemente em crianças maiores de 2 anos, näo havendo diferença em relaçäo ao sexo acometido. A maioria das crianças estudadas havia sido internada em hospital nos últimos trinta dias, era portadora de cateter central, 64,3 por cento dos casos com patologia de base, salientando-se as hepatopatias e doenças oncológicas. O quadro clínico inicial caracterizou-se principalmente por acometimento do trato respiratório (35,7 por cento) e por doença diarréica aguda (28,6 por cento). A letalidade foi alta dos dois grupos e o agente infeccioso näo aumentou o risco relativo de óbito. Verificou-se que as cepas isoladas de Klebsiella pneumoniae apresentaram bons índices de sensibilidade à colistina (92,9 por cento) e à cefoxitina (82,1 por cento) e baixos índices às cefalosporinas de 3ª geraçäo e ao imipenen.