The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years.

INTRODUCTION:: Acute diarrheal disease is the second cause of death in children under 5 years. In Brazil, from 2003 to 2009, acute diarrhea was responsible for nearly 100,000 hospital admissions per year and 4% of the deaths in children under 5 years. Rotavirus is the leading cause of severe acute diarrhea worldwide. In 2006, the rotavirus monovalent vaccine (RV1) was added to the Brazilian National Immunization Program. OBJECTIVES:: To analyze the impact of the RV1 on emergency department (ED) visits and hospital admissions for acute diarrhea. METHOD:: A retrospective ecologic study at the University Hospital, University of São Paulo. The study analyzed the pre-vaccine (2003-2005) and the post-vaccine (2007-2009) periods. We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (%) = (1 - odds ratio) x 100. RESULTS:: The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001). The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001). CONCLUSION:: The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.

The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years / Impacto da vacinação contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de 5 anos de idade

Summary Introduction: Acute diarrheal disease is the second cause of death in children under 5 years. In Brazil, from 2003 to 2009, acute diarrhea was responsible for nearly 100,000 hospital admissions per year and 4% of the deaths in children under 5 years. Rotavirus is the leading cause of severe acute diarrhea worldwide. In 2006, the rotavirus monovalent vaccine (RV1) was added to the Brazilian National Immunization Program. Objectives: To analyze the impact of the RV1 on emergency department (ED) visits and hospital admissions for acute diarrhea. Method: A retrospective ecologic study at the University Hospital, University of São Paulo. The study analyzed the pre-vaccine (2003–2005) and the post-vaccine (2007–2009) periods. We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (%) = (1 - odds ratio) x 100. Results: The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001). The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001). Conclusion: The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.

Resumo Introdução: a doença diarreica aguda é a segunda causa de morte em crianças abaixo de 5 anos de idade. No Brasil, entre 2003 e 2009, a diarreia aguda foi responsável por cerca de 100 mil internações por ano e por 4% das mortes em crianças abaixo de 5 anos de idade. O rotavírus é a principal etiologia de diarreia aguda grave. A vacina monovalente (RV1) contra o rotavírus foi introduzida em 2006. Objetivos: verificar o impacto da vacina monovalente contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de 5 anos de idade. Método: foi realizado um estudo ecológico retrospectivo no Hospital Universitário da Universidade de São Paulo. O período foi dividido em pré-vacina (2003 a 2005) e pós-vacina (2007 a 2009). Foram incluídas todas as crianças abaixo de 5 anos que passaram em consulta no pronto-socorro. Foram obtidas as taxas de consultas no pronto-socorro e internações por doença diarreica aguda. A redução nas taxas foi obtida através da fórmula: redução (%) = (1 - odds ratio) x 100. Resultados: no período pré-vacina, a taxa de consultas por diarreia aguda foi de 85,8 consultas por 1.000 consultas gerais, enquanto no período pós-vacina a taxa de consultas por diarreia aguda foi 80,9 por 1.000, uma redução de 6% (IC95% 4-9, p<0,001). A taxa de internação por diarreia aguda era 40,8 internações por 1.000 e caiu para 24,9 por 1.000, redução de 40% (IC95% 22-54, p<0,001). Conclusão: após a introdução da vacina contra rotavírus houve uma redução de 6% nas consultas por diarreia aguda no pronto-socorro e de 40% nas internações por diarreia aguda.

Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock.

OBJECTIVES: The primary outcome was to compare the effects of dopamine or epinephrine in severe sepsis on 28-day mortality; secondary outcomes were the rate of healthcare-associated infection, the need for other vasoactive drugs, and the multiple organ dysfunction score. DESIGN: Double-blind, prospective, randomized controlled trial from February 1, 2009, to July 31, 2013. SETTING: PICU, Hospital Universitário da Universidade de São Paulo, Brazil. PATIENTS: Consecutive children who are 1 month to 15 years old and met the clinical criteria for fluid-refractory septic shock. Exclusions were receiving vasoactive drug(s) prior to hospital admission, having known cardiac disease, having already participated in the trial during the same hospital stay, refusing to participate, or having do-not-resuscitate orders. INTERVENTIONS: Patients were randomly assigned to receive either dopamine (5-10 µg/kg/min) or epinephrine (0.1-0.3 µg/kg/min) through a peripheral or intraosseous line. Patients not reaching predefined stabilization criteria after the maximum dose were classified as treatment failure, at which point the attending physician gradually stopped the study drug and started another catecholamine. MEASUREMENTS AND MAIN RESULTS: Physiologic and laboratory data were recorded. Baseline characteristics were described as proportions and mean (± SD) and compared using appropriate statistical tests. Multiple regression analysis was performed, and statistical significance was defined as a p value of less than 0.05. Baseline characteristics and therapeutic interventions for the 120 children enrolled (63, dopamine; 57, epinephrine) were similar. There were 17 deaths (14.2%): 13 (20.6%) in the dopamine group and four (7%) in the epinephrine group (p=0.033). Dopamine was associated with death (odds ratio, 6.5; 95% CI, 1.1-37.8; p=0.037) and healthcare-associated infection (odds ratio, 67.7; 95% CI, 5.0-910.8; p=0.001). The use of epinephrine was associated with a survival odds ratio of 6.49. CONCLUSIONS: Dopamine was associated with an increased risk of death and healthcare-associated infection. Early administration of peripheral or intraosseous epinephrine was associated with increased survival in this population. Limitations should be observed while interpreting these results.

Orquite em dois meninos com púrpura de Henoch-Schonlein / Orchitis in two boys with Henoch-Schonlein purpura

Objetivo: descrever dois casos de orquite da púrpura de Henoch-Schonlein. Descrição de casos: duas crianças apresentaram orquite durante a evolução da púrpura de Henoch-Schonlein. Foram acompanhadas evolutivamente com ultrassonografia com Doppler colorido, para avaliar uma possível torção testicular, que não ocorreu / Objective: to describe two cases of Henoch-Schonlein purpura. They were accompanied according to the evolution with Doppler coloured ultraonography to evaluate a testicular torsion occurrence, which did not happen. The cases werre treated wich prednisone with improvement in one week...

Fumantes passivos: a cotinina urinária em crianças internadas / Passive smokers: urinary cotinine in hospitalized children

Objetivo: avaliar o fumo passivo como fator de risco para doença aguda do trato respiratório inferior(DTRI). Métodos: foi realizado estudo que avaliou a presença de nicotina, e de seu metabolito cotinina, em duas coortes de crianças internadas, com DTRI e com outras doenças (SDR). Foi previamente estabelecido que a seleção de casos abrangeria cerca de 35 crianças de zero até 5 anos de idade para cada grupo...

Taquicardia supraventricular revertida por manobra vagal: relato de caso / Supraventricular tachycardia treated trough vagal maneuver: a case report

Objetivo: descrever um episódio de taquicardia paroxísticasupraventricular (TSVP) revertido por manobra vagal. Relato de caso: uma menina de 4 anos apresentava episódios de TSVP desde o primeiro mês de vida. Era acompanhada em serviço cardiológico com escapes ocasionais tratados nese serviço. Em um episódio, buscou serviço pediátrico de urgência, com febre e dor abdominal, com duração de um dia / Objective: to describe a case of supraventricular paroxysmal tachycardia (TSVP) reverted through vagal maneuver. Case report: a four-year-old girl presented TSVP episodes since the first month of life...