Impact of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on childhood pneumonia hospitalizations in Brazil two years after introduction.

INTRODUCTION: Pneumococcal disease is a major public health problem worldwide. From March to September of 2010, 10-valent pneumococcal non-typeable Haemophilus influenzae protein conjugate vaccine (PHiD-CV) was introduced in the Brazilian childhood National Immunization Program (NIP) in all 27 Brazilian states. The aim of the present study is to report national time-trends in incidence of hospital admissions for childhood pneumonia in Brazil before and after two years of introduction of this new pneumococcal conjugate vaccine. METHODS: Analysis of hospitalization data of children aged 0-4 years in Brazilian public health system with an admission diagnosis of pneumonia from 2002 to 2012 was performed comparing pre (2002-2009) and post-vaccination periods (2011-2012). Hospital number of admission due to pneumonia and all non-respiratory diseases were obtained from DATASUS, the Brazilian government open-access public health database system. Incidence of pneumonia hospitalization was compared to incidence of all non-respiratory admissions. RESULTS: Admission rates for pneumonia decreased steadily from 2010 to 2012. In children aged less than four years, incidence of pneumonia hospitalizations decreased 12.65% when pre (2002-2009) and post-vaccination introduction periods (2011-2012) were compared and adjusted for seasonality and secular-trend (p<0.001). On the other hand, non-respiratory admission rates remained stable comparing both periods (p=0.39). CONCLUSION: Childhood pneumonia hospitalization rates were fluctuating prior to 2010 and decreased significantly in the two years after PHiD-CV introduction. Conversely, rate of non-respiratory admissions has shown no decrease. These data are an evidence of the effectiveness and public health impact of this new pneumococcal vaccine.

Manejo da asma em crianças na sala de emergência / Asthma management in children at emergency room

As crises de asma são episódicas, mas a inflamação da via aérea é cronicamente presente. Estas são normalmente reversíveis, espontaneamente ou com tratamento, mas podem ser graves e fatais. Devem ser classificadas segundo sua gravidade e o tratamento instituído o mais precocemente possível, pois uma falha ou atraso no seu reconhecimento para adoção de medidas terapêuticas efetivas pode colocar em risco a vida do paciente pediátrico.

The acute exacerbations are episodic, but airway inflammation is chronically present. These are usually reversible, either spontaneously or with treatment, but can be serious and fatal. Asthma attacks are classified according to their severity and treatment implemented as soon as possible, because a failure in their recognition or a delay in the adoption of effective therapeutic interventions may threat the life of pediatric patients.

Melanoma: diagnóstico e manejo / Melanoma: what to do after diagnosis?

O melanoma maligno é o tipo mais fatal de câncer de pele, e o seu diagnóstico precoce oferece um prognóstico melhor. Para isso, são necessários a correta suspeição e o diagnóstico o mais brevemente possível. Esse capítulo abordará os passos a serem seguidos a partir de uma lesão suspeita.

The melanoma of the skin is the most commonly fatal form of skin cancer, and the soon diagnosis offers a better prognostic. Because of that, the suspicion and correct diagnosis have to occur briefly. This chapter will approach the steps from de suspicion until treatment.