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.

Avaliação da migração de neutrófilos e da frequência relativa de linfócitos CD4+/CD8+ em crianças com síndrome de Down e controles / Evaluation of both neutrophil migration and the relative frequency of CD4+/CD8+ limphocytes in children with Down syndrome and controls

Objetivos: Avaliar a migração de neutrófilos e a frequência relativa de linfócitos CD4+/CD8+ em crianças com síndrome de Down e controles saudáveis.Métodos: Este foi um estudo de caso-controle realizado no Instituto de Pesquisas Biomédicas, no Hospital São Lucas da PUCRS. Os pacientes do grupo de estudo foram selecionados por uma amostragem de conveniência, representando todas as crianças com síndrome de Down e idade entre três e 13 anos, que frequentavam os ambulatórios de Pediatria e de Otorrinolaringologia do Hospital São Lucas da PUCRS e do Kinder - Centro de Integração da Criança Especial, em Porto Alegre, Rio Grande do Sul, nos meses de janeiro e dezembro de 2012. Para o grupo controle foram recrutadas crianças saudáveis e sem síndrome de Down, participantes de outro estudo em andamento no Instituto de Pesquisas Biomédicas. Foram selecionados os pacientes com maior volume de células armazenadas em criotubos. Para avaliar os parâmetros da resposta imune, foram realizados ensaio de quimiotaxia de neutrófilos e imunofenotipagem de células T CD4+ e CD8+. Associações foram avaliadas pelo teste do qui-quadrado, t de Student ou Mann-Whitney. Todos os testes foram bidirecionais e as diferenças foram consideradas significativas quando p menor que 0,05.Resultados: Foram incluídos 19 pacientes (13 com síndrome de Down e seis controles), com médias de idade de 8,13 e 9,83 anos, respectivamente. Não foram observadas alterações significativas no grupo com síndrome de Down em relação à capacidade de migração dos neutrófilos. Houve uma tendência a valores percentuais menores de células T CD4+ e maiores de CD8+ para o grupo com síndrome de Down. Houve diferença significativa na relação CD4+/CD8+ entre os dois grupos, sendo a mesma menor no grupo com síndrome de Down.Conclusões: Este estudo sugere que os pacientes com síndrome de Down apresentam uma taxa CD4+/CD8+ diminuída, o que pode contribuir para as infecções frequentes e recorrentes nessas crianças.

Aims: To evaluate neutrophil migration and the relative frequency of CD4+/CD8+ lymphocytes in children with Down syndrome and in healthy controls.Methods: This was a case-control study carried out at the Institute of Biomedical Research, affiliated with São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul (PUCRS). Patients with Down syndrome were selected by convenience sampling, including all children with Down syndrome aged 3 to 13 years treated at the Pediatric and Otolaryngology Outpatient Clinics of São Lucas Hospital and at Kinder - Center for Children with Special Needs, in Porto Alegre, State of Rio Grande do Sul, Brazil, between January and December 2012. Healthy children without Down syndrome, participants in another ongoing study conducted by Institute of Biomedical Research, were recruited to the control group. Those patients with the largest volume of cells stored in cryotubes were selected. A neutrophil chemotaxis assay and immunophenotyping of CD4+ and CD8+ T cells were performed to evaluate the functionality of the immune response. Associations were assessed by the chi-squared test, Student's t test, or Mann-Whitney's test. All tests were bidirectional, and p values less than 0.05 were regarded as statistically significant.Results: This study included 19 patients (13 with Down syndrome and six controls), with a mean age of 8.13 and 9.83 years, respectively. No significant changes concerning neutrophil migration were observed in the Down syndrome group. However, patients with Down syndrome tended to have a lower rate of CD4+ T cells and a higher rate of CD8+ T cells. The CD4+/CD8+ ratio revealed significant difference between the groups, being lower in patients with Down syndrome.Conclusions: This study suggests that patients with Down syndrome show a decreased CD4+/CD8+ ratio, which may contribute to the frequent and recurrent infections in these children.

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.