The balance between the serum levels of IL-6 and IL-10 cytokines discriminates mild and severe acute pneumonia.

BACKGROUND: To identify markers for earlier diagnosis of severe pneumonia, we assess the correlation between serum cytokine profile of children with different pneumonia severity. METHODS: In 25 hospitalized children, 7 with mild pneumonia and 18 with severe pneumonia, the serum concentration of 11 cytokines in three sampling times were dosed. Statistical analysis included parametric and non-parametric tests, Pearson correlation and ROC curve for cut-off definition of cytokines. RESULTS: At admission, IL-6 serum levels were high in mild or severe pneumonia, and was associated to vomiting (P = 0.019) in both groups; and also to dyspnea (P = 0.012) and white blood cell count (P = 0.045) in patients with severe pneumonia. IL-10 levels were also high in patients with pneumonia and were associated to lymphocytosis (P = 0.025). The ROC curve of the IL-6:IL-10 serum levels ratio discriminated severe pneumonia cases at admission, and persistence of infection in the third day of antibiotic therapy, with positive predictive values of 93% and 89%, respectively. CONCLUSIONS: The balance between IL-6 and IL-10 serum levels showed to be a more discriminative marker for severity definition and evaluation of recovery in patients with pneumonia.

Acute diarrhoea in a community cohort of children who received an oral rotavirus vaccine in Northeast Brazil.

Rotavirus is an important cause of childhood diarrhoea. A monovalent rotavirus vaccine (Rotarix®) was introduced into the Immunization Program of Brazil in 2006. In this study, we describe the incidence and burden of disease of rotavirus diarrhoea in two cohorts of children (vaccinated and unvaccinated). We followed two groups of 250 children under one year old, who were enrolled in December 2006 from a low-income residential area in Northeast Brazil. The children were monitored every two weeks for two years. Stool samples from children with diarrhoea were examined for the presence of rotavirus. Rotaviruses were genotyped using real time-polymerase chain reaction. The mean numbers of all-cause diarrhoea episodes/child (adjusted for age) in the first year were 0.87 and 0.84, in vaccinated and unvaccinated children, respectively. During the second year, the number of episodes/child decreased to 0.52 and 0.42. Only 16 (4.9%) of 330 stool samples were rotavirus-positive (10 vaccinated and 6 unvaccinated children) and only P[4]G2 rotaviruses were identified. All-cause diarrhoea episodes were more severe in unvaccinated children in the first year of age (p < 0.05), while vaccinated children had more severe episodes 18 months after vaccination. Rotavirus diarrhoea incidence was very low in both groups.

Ability of mothers to assess the presence of fever in their children without using a thermometer.

Fever is a common complaint in paediatrics and the ability of mothers to identify high temperatures in their children when there is no thermometer available needs to be assessed. Atotal of 169 mothers from a low social and economic background were studied to assess the accuracy of fever diagnosis in their children by palpation. In 137 children with axillary temperatures > or = 38 C as measured by a mercury glass thermometer, mothers were able to detect fever by palpation in 104 cases (sensitivity of 75.9%). In another 32 children without fever, 29 were correctly identified (specificity of 90.6%). Only 21% of mothers in the study had a thermometer in their home and only 44% of these knew how to use it properly. Results show that mothers use palpation to assess the presence of fever in their children and are able to do it correctly in most cases.

Clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011) / Características clínicas e desfechos de pneumonia comunitária aguda em crianças hospitalizadas em serviço público de referência de Pernambuco, Brasil (2010-2011)

Abstract Objectives: to describe the clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011) Methods: pneumonia case series of 80 children aged 28 days to 14 years old at Hospital da Restauração in Pernambuco, Brazil, from 2010 to 2011. Information was noted from medical files, and two comparison groups were created according to the severity of the disease, considering the presence of pleural effusion. Fisher or Mann-Whitney tests were used for comparative analyses. Results: severe pneumonia with pleural effusion was more frequent in children under five years of age (p=0,025), and was associated with longer period of fever (19 x 15 days) and coughing (17 x 13 days), when compared to non-complicated pneumonia cases. Six children (7,5%, 6/80) died, 50% before the fourth day of hospitalization (p=0,001). All deaths were from the pleural effusion group in children from the countryside (p=0,026). Conclusions: the severity of pneumonia in children attended at this hospital is related to younger children, and those transferred from the health units in the countryside, so, early diagnosis and medical intervention are limited by infrastructure and available resources for the health.

Resumo Objetivos: descrever as características clínicas e desfechos de pneumonia comunitária aguda em crianças assistidas em hospital público de referência no Estado de Pernambuco, Brasil (2010-2011). Métodos: série de casos de pneumonia em 80 crianças de 28 dias a 14 anos no Hospital da Restauração em Pernambuco, Brasil, entre maio de 2010 a 2011. As informações foram anotadas do registro hospitalar, sendo criado dois grupos de comparação de acordo com a gravidade da doença, considerando a presença ou não de derrame pleural. A análise comparativa utilizou os testes de Fisher ou Mann-Whitney. Resultados: pneumonia grave com derrame pleural foi mais frequente em menores de cinco anos (p=0,025), associado a maior período de febre (19 x 15 dias) e tosse (17 x 13 dias), compardo com casos de pneumonia não-complicada. Seis crianças (7,5%, 6/80) morreram. 50% antes do quarto dia de internação (p= 0,001). As mortes foram no grupo com derrame pleural, em crianças do interior do estado (p= 0,026). Conclusões: a gravidade da pneumonia em crianças atendidas neste hospital está relacionada a crianças menores, e naquelas transferidas de unidades de saúde do interior, cujo diagnóstico precoce e intervenção médica adequada são limitados pela infraestrutura e recursos disponíveis para a saúde.

Avaliação das salas de vacinação do Estado de Pernambuco no ano de 2011 / Evaluation of vaccination rooms of the state of Pernambuco in 2011

Objetivo: avaliar o grau de implantação das normas e diretrizes, componentes estruturais e operacionais do Programa Nacional de Imunizações (PNI) nas salas de vacinação do Estado de Pernambuco, Brasil, em 2011. Métodos: realizou-se estudo de corte transversal, com amostra aleatória de 318 salas de vacinação; as variáveis, agrupadas em quatro componentes, foram coletadas mediante entrevista com técnicos de enfermagem e observação não participante; classificou-se o grau de implantação das normas e diretrizes como implantado (=90 por cento das salas com situação preconizada), parcialmente implantado (70-89 por cento), insuficientemente implantado (40-69 por cento) e não implantado (<40 por cento). Resultados: o grau de implantação dos componentes do PNI nas salas de vacinação variou de 67,0 por cento (ações de vigilância epidemiológica e educação em saúde) a 74,2 por cento (indicação e aplicação de imunobiológicos); a estrutura e organização das salas (70,4 por cento) e a rede de frio (73,6 por cento) apresentaram situação intermediária. Conclusão: o programa de imunização encontra-se parcialmente implantado (71,4 por cento) na rotina dos serviços de saúde de Pernambuco.

Objective: evaluate the degree of implementation of the standards and guidelines of PNI in 2011 in vaccination rooms of Pernambuco State, northeastern Brazil, considering its structural and operational components. Methods: a cross-sectional study was conducted with a random sample of 318 vaccination rooms. The variables grouped into four components were collected by interviews with nursing staff and non-participant observations. The degree of implementation of standards and guidelines was classified as: implemented (=90 per cent of rooms with the situation preconized), partially implemented (70-89 per cent), insufficiently implemented (40-69 per cent) and not implemented (<40 per cent). Results: the degree of implementation of components of PNI into vaccination rooms ranged from 67.0 per cent (for epidemiological surveillance and health education) to 74.2 per cent (for indication and application of immunobiologicals). The structure and organization of rooms (70.4 per cent) and cold chain (73.6 per cent) had intermediate situation. Conclusion: the immunization program is partially implemented (71.4 per cent) in routine of health services in Pernambuco.

Frequência de Escherichia coli e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda / The frequency of Escherichia coli and its sensitivity to antimicrobials in children aged under five years admitted to hospital for treatment of acute diarrhea

Determinar a frequência de Escherichia coli diarreiogênica e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda. MÉTODOS: estudo prospectivo tipo corte transversal realizado no Instituto de Medicina Integral Prof. Fernando Figueira, entre janeiro de 2010 e fevereiro de 2011. Foram excluídas as crianças com diagnóstico de imunodeficiência ou usando antimicrobianos. Para cada paciente foi feito uma única coleta de swab retal nas primeiras 24 horas de internação. Os patógenos foram identificados na coprocultura e sorotipagem. Os antibiogramas foram obtidos por disco-difusão. RESULTADOS: 140 crianças foram arroladas, em sua maioria provinham de famílias de baixa renda da Região Metropolitana do Recife. Foram isolados 99 microorganismos: 9 (6,4 por cento) E. coli enteropatogênica (EPEC) e 4 (2,9 por cento) E. coli enteroinvasora (EIEC) e 80 (57,1 por cento) outras E.coli não EPEC, não EIEC, 3 (2,1 por cento) Shigella spp e 3 (2,1 por cento) Salmonella spp. O perfil de sensibilidade aos antimicrobianos demonstrou níveis elevados de resistência à ampicilina e sulfametoxazol-trimetoprima. CONCLUSÕES: a baixa frequência de EPEC observada pode estar associada às condições de saneamento básico favoráveis apresentadas pelos pacientes do estudo. A análise local do perfil da sensibilidade da E. coli aos antimicrobianos reforça a recomendação da Organização Mundial de Saúde para o uso racional dessas drogas visando prevenção da resistência bacteriana...

To determine the frequency of diarrheic Escherichia coli and its sensitivity to antimicrobials in children aged under five years admitted to hospital for treatment of acute diarrhea. METHODS: a prospective cross-sectional study was carried out at the Instituto de Medicina Integral Prof. Fernando Figueira, between January 2010 and February 2011. Children were excluded if they had been diagnosed as immunodeficient or were using antimicrobials. A single rectal swab was taken from each patient during the first 24 hours of hospitalization. The pathogens were identified in the coproculture and serotyping. Antibiograms were obtained using disc-diffusion. RESULTS: 140 children were recruited. Most were from low-income families in the Metropolitan Region of Recife. Ninety-nine micro-organisms were isolated: 9 (6.4 percent) enteropathogenic E. coli (EPEC) and 4 (2.9 percent) enteroinvasive E. coli (EIEC) and 80 (57.1 percent) other E.coli that are neither EPEC nor EIEC, 3 (2.1 percent) Shigella spp and 3 (2.1 percent) Salmonella spp. The profile of sensitivity to antimicrobials showed high levels to resistance to ampicillin and sulfametho-xazol-trimetropime. CONCLUSIONS: the low frequency of EPEC found may be associated with basic sanitary conditions among the patients in the study. The local analysis of the profile of sensitivity of E. coli to antimicrobials corroborates the World Health Organization recommendation that these drugs be used prudently to ensure prevention of resistance in bacteria...

Acute diarrhoea in a community cohort of children who received an oral rotavirus vaccine in Northeast Brazil

Rotavirus is an important cause of childhood diarrhoea. A monovalent rotavirus vaccine (Rotarix®) was introduced into the Immunization Program of Brazil in 2006. In this study, we describe the incidence and burden of disease of rotavirus diarrhoea in two cohorts of children (vaccinated and unvaccinated). We followed two groups of 250 children under one year old, who were enrolled in December 2006 from a low-income residential area in Northeast Brazil. The children were monitored every two weeks for two years. Stool samples from children with diarrhoea were examined for the presence of rotavirus. Rotaviruses were genotyped using real time-polymerase chain reaction. The mean numbers of all-cause diarrhoea episodes/child (adjusted for age) in the first year were 0.87 and 0.84, in vaccinated and unvaccinated children, respectively. During the second year, the number of episodes/child decreased to 0.52 and 0.42. Only 16 (4.9 percent) of 330 stool samples were rotavirus-positive (10 vaccinated and 6 unvaccinated children) and only P[4]G2 rotaviruses were identified. All-cause diarrhoea episodes were more severe in unvaccinated children in the first year of age (p < 0.05), while vaccinated children had more severe episodes 18 months after vaccination. Rotavirus diarrhoea incidence was very low in both groups.