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1.
An. pediatr. (2003. Ed. impr.) ; 92(4): 241.e1-241.e11, abr. 2020. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186847

RESUMO

El 31 de diciembre de 2019, la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre la existencia de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre, incluyendo 7 casos graves, con exposición común a un mercado de marisco, pescado y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, denominado temporalmente «nuevo coronavirus», 2019-nCoV. El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declara el brote una Emergencia Internacional. El día 11 de febrero la OMS le asigna el nombre de SARS-CoV2 e infección COVID-19 (Coronavirus Infectious Disease). El Ministerio de Sanidad convoca a las Sociedades de Especialidades para la elaboración de un protocolo clínico de manejo de la infección. La Asociación Española de Pediatría nombra un grupo de trabajo de las Sociedades de Infectología Pediátrica y Cuidados Intensivos Pediátricos que se encargan de elaborar las presentes recomendaciones con la evidencia disponible en el momento de su realización


On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19). The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Coronavirus/classificação , Coronavirus/genética , Reação em Cadeia da Polimerase em Tempo Real , Índice de Gravidade de Doença , Sociedades Médicas , Espanha
2.
Texto & contexto enferm ; 29: e20180348, Jan.-Dec. 2020. tab
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1059138

RESUMO

ABSTRACT Objective: To identify the factors associated with clinical deterioration recognized by a Pediatric Early Warning Score. Method: A cross-sectional study conducted in a tertiary pediatric public hospital with 271 children aged from zero to ten, hospitalized between May and October 2015. For the identification of the children with and without signs of clinical deterioration, the translated, adapted and validated version of the Brighton Pediatric Early Warning Score was applied to the Brazilian context. Logistic regression analysis and prevalence ratio (PR) were used to measure the association between the variables studied. A 95% Confidence Interval (CI) and p value were adopted as a measure of statistical significance to identify potential associated factors. Results: The factors associated with the clinical deterioration of the children studied were age ≤ 2 years old (p=0.000), hospitalization in the emergency unit (p=0.000), comorbidity (p=0.020) and clinical diagnosis of respiratory disease (p=0.000). Conclusion: Children ≤ 2 years old, with comorbidity, diagnosed with respiratory disease and hospitalized in the emergency unit showed an increased likelihood of clinical deterioration. The identification of factors associated with clinical deterioration may alert and direct the health team to children more susceptible to this phenomenon.


RESUMEN Objetivo: identificar los factores asociados al deterioro clínico reconocido por una Puntuación Pediátrica de Alerta Temprana. Método: estudio de corte transversal realizado en un hospital público pediátrico terciario con 271 niños de cero a diez años de edad, hospitalizados entre mayo y octubre de 2015. Para identificar a los niños con y sin signos de deterioro clínico, se aplicó la versión traducida, adaptada y validad del Brighton Pediatric Early Warning Score para el contexto brasileño. Se utilizaron el análisis de regresión logística y la relación de prevalencia (RP) para medir la asociación entre las variables estudiadas. Se adoptaron el Intervalo de Confianza (IC) del 95% y el Valor de p como medida de significancia estadística para identificar los potenciales factores asociados. Resultados: los factores asociados al deterioro clínico de los niños estudiados fueron los siguientes: edad ≤ 2 años (p=0,000), internación en la unidad de emergencia (p=0,000), comorbilidad (p=0,020) y diagnóstico clínico de enfermedad respiratoria (p=0,000). Conclusión: los niños con una edad máxima de 2 años, con alguna comorbidad, con diagnóstico de enfermedad respiratoria e internadas en la unidad de emergencia presentaron una mayor probabilidad de deterioro clínico. Identificar factores asociados al deterioro clínico puede servir como alerta y orientar al equipo de salud hacia los niños más susceptibles a este fenómeno.


RESUMO Objetivo: identificar os fatores associados à deterioração clínica reconhecida por um Escore Pediátrico de Alerta Precoce. Método: estudo de corte transversal, realizado num hospital público pediátrico terciário, com 271 crianças de zero a dez anos, hospitalizadas entre maio e outubro de 2015. Para a identificação das crianças com e sem sinais de deterioração clínica, foi aplicada a versão traduzida, adaptada e validada do Brighton Pediatric Early Warning Score para o contexto brasileiro. Foram utilizadas a análise de regressão logística e a razão de prevalência (RP) para medir a associação entre as variáveis estudadas. O Intervalo de Confiança (IC) de 95% e Valor de p foram adotados como medida de significância estatística para a identificação dos potenciais fatores associados. Resultados: os fatores associados à deterioração clínica das crianças estudadas foram idade ≤ 2 anos (p=0,000), internamento na unidade de emergência (p=0,000), comorbidade (p=0,020) e diagnóstico clínico de doença respiratória (p=0,000). Conclusão: crianças ≤ 2 anos, portadoras de comorbidade, com diagnóstico de doença respiratória e internadas na unidade de emergência apresentaram aumento da probabilidade de deterioração clínica. A identificação de fatores associados à deterioração clínica pode alertar e direcionar a equipe de saúde para crianças mais suscetíveis a esse fenômeno.


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Enfermagem Pediátrica , Criança Hospitalizada , Saúde , Saúde da Criança , Deterioração Clínica , Alerta , Hospitalização
3.
Goiânia; s.n; out. 02, 2020. 1-24 p. ilus, tab, mapas, graf.(Boletim Epidemiológico Covid-19, 26).
Monografia em Português | Coleciona SUS, CONASS, SES-GO | ID: biblio-1121439

RESUMO

O Boletim Epidemiológico COVID-19 objetiva documentar e divulgar informações oficiais atualizadas da situação epidemiológica no Estado de Goiás-GO, Brasil. Resume que desde os primeiros registros na China em dezembro de 2019 até o dia 26 de setembro foram confirmados 32.730.945 casos de COVID-19 no mundo. Deste total, 991.224 evoluíram a óbito. Quando comparados o número de casos e óbitos confirmados desta semana epidemiológica (SE 39) com a semana anterior, houve aumento de 6,7% nos casos e 3,8% nos óbitos. Sintetiza que, no Brasil, neste mesmo intervalo de tempo, o aumento foi 4,2% e 3,5% no número de casos e óbitos, respectivamente. No país o primeiro caso foi confirmado no dia 26 de fevereiro e até 26 de setembro foram registrados 4.717.991 casos confirmados com 141.406 óbitos. Informa que o registro dos primeiros casos suspeitos em Goiás foi a partir de 04 de fevereiro e até 26 de setembro foram notificados à Vigilância Epidemiológica 595.334 casos de COVID-19. Infere que, nesta última semana epidemiológica (SE 39) houve a confirmação de 17.551 casos novos, representando um aumento nos casos de COVID-19 de 9,5%, superior ao aumento observado no Brasil 4,2%. No Estado, 202.528 (34,0%) foram confirmados sendo 196.210 (96,9%) por critério laboratorial, 4.408 (2,2%) pelo critério clínico-epidemiológico, 589 (0,3%) por critério clínico imagem e 802 (0,4%) pelo critério clínico, 148.086 (24,9%) foram descartados e 221.461 (37,2%) continuam como suspeitos


The COVID-19 Epidemiological Bulletin aims to document and disseminate updated official information on the epidemiological situation in the State of Goiás-GO, Brazil. It summarizes that since the first registrations in China in December 2019 until the 26th of September, 32,730,945 cases of COVID-19 have been confirmed worldwide. Of this total, 991,224 died. When comparing the number of confirmed cases and deaths of this epidemiological week (SE 39) with the previous week, there was an increase of 6.7% in cases and 3.8% in deaths. It synthesizes that, in Brazil, in this same time interval, the increase was 4.2% and 3.5% in the number of cases and deaths, respectively. In the country, the first case was confirmed on February 26 and until September 26, 4,717,991 confirmed cases were recorded, with 141,406 deaths. Informs that the record of the first suspected cases in Goiás was from February 4 and until September 26, 595,334 cases of COVID-19 were notified to the Epidemiological Surveillance. It infers that, in this last epidemiological week (SE 39), 17,551 new cases were confirmed, representing an increase in the cases of COVID-19 of 9.5%, higher than the increase observed in Brazil 4.2%. In the State, 202,528 (34.0%) were confirmed, 196,210 (96.9%) by laboratory criteria, 4,408 (2.2%) by clinical-epidemiological criteria, 589 (0.3%) by clinical image criteria and 802 (0.4%) by the clinical criterion, 148,086 (24.9%) were discarded and 221,461 (37.2%) remain as suspects


Assuntos
Humanos , Animais , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Monitoramento Epidemiológico
5.
Goiânia; s.n; Out. 14, 2020. ilus, tab, mapas, graf.(Boletim Epidemiológico Covid-19, 28).
Monografia em Português | Coleciona SUS, CONASS, SES-GO | ID: biblio-1123103

RESUMO

Esta edição do Boletim Epidemiológico COVID19 apresenta um panorama geral desde os primeiros registros na China em dezembro de 2019 até o dia 10 de outubro foram confirmados 37.109.851 casos de COVID-19 no mundo. Deste total, 1.070.355 evoluíram a óbito. Quando comparados o número de casos e óbitos confirmados desta semana epidemiológica (SE 41) com a semana anterior, houve aumento de 6,6% nos casos e 3,8% nos óbitos. No Brasil, neste mesmo intervalo de tempo, o aumento foi 3,6% e 2,7% no número de casos e óbitos, respectivamente. No país o primeiro caso foi confirmado no dia 26 de fevereiro e até 10 de outubro foram registrados 5.103.408 casos confirmados com 150.689 óbitos. Apresenta os dados referentes a situação epidemiológica COVID-19 no período de 02 de fevereiro a 10 de outubro de 2020 no Estado de Goiás, Brasil, informando que o registro dos primeiros casos suspeitos em Goiás foi a partir de 04 de fevereiro e até 10 de outubro foram notificados à Vigilância Epidemiológica 656.938 casos de COVID-19. Nesta última semana epidemiológica (SE 40) houve a confirmação de 12.721 casos novos, representando um aumento de 5,9%, superior ao aumento observado no Brasil 3,6%. No Estado, 228.717 (34,8%) foram confirmados sendo 220.473 (96,4%) por critério laboratorial, 5.565 (2,4%) pelo critério clínico-epidemiológico, 780 (0,3%) por critério clínico-imagem e 1.393 (0,6%) pelo critério clínico, 168.061 (25,6%) foram descartados e 228.443 (34,8%) continuam como suspeitos


This edition of the EPIDEMIOLOGICAL BULLETIN COVID19 presents an overview from the first records in China in December 2019 to October 10, 37,109,851 cases of COVID-19 worldwide were confirmed. Of this total, 1,070,355 died. When comparing the number of confirmed cases and deaths of this epidemiological week (SE 41) with the previous week, there was an increase of 6.6% in cases and 3.8% in deaths. In Brazil, in this same time interval, the increase was 3.6% and 2.7% in the number of cases and deaths, respectively. In the country the first case was confirmed on February 26 and until October 10, 5,103,408 confirmed cases with 150,689 deaths were recorded. It presents data regarding the epidemiological situation COVID-19 from February 2 to October 10, 2020 in the State of Goiás, Brazil, stating that the registration of the first suspected cases in Goiás was from February 4 and until October 10, 656,938 cases of COVID-19 were reported to epidemiological surveillance. In this last epidemiological week (SE 40) there was the confirmation of 12,721 new cases, representing an increase of 5.9%, higher than the increase observed in Brazil 3.6%. In the State, 228,717 (34.8%) were confirmed to be 220,473 (96.4%) by laboratory criterion, 5,565 (2.4%) by clinical and epidemiological criteria, 780 (0.3%) by clinical-imaging criterion and 1,393 (0.6%) by clinical criterion, 168,061 (25.6%) were discarded and 228,443 (34.8%) continue as suspects


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Brasil/epidemiologia , Incidência , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Monitoramento Epidemiológico
6.
Artigo em Inglês | MEDLINE | ID: mdl-33036326

RESUMO

Physical activity is known to decline during pregnancy and the postnatal period, yet physical activity is recommended during this time due to the significant health benefits for mothers and their offspring. As a result of the COVID-19 pandemic and the restrictions imposed to reduce infection rates, pregnant and postnatal women have experienced disruption not just to their daily lives but also to their pregnancy healthcare experience and their motherhood journey with their new infant. This has included substantial changes in how, when and why they have engaged with physical activity. While some of these changes undoubtedly increased the challenge of being sufficiently active as a pregnant or postnatal woman, they have also revealed new opportunities to reach and support women and their families. This commentary details these challenges and opportunities, and highlights how researchers and practitioners can, and arguably must, harness these short-term changes for long-term benefit. This includes a call for a fresh focus on how we can engage and support those individuals and groups who are both hardest hit by COVID-19 and have previously been under-represented and under-served by antenatal and postnatal physical activity research and interventions.


Assuntos
Infecções por Coronavirus/psicologia , Exercício Físico , Mães/psicologia , Pandemias , Pneumonia Viral/psicologia , Complicações Infecciosas na Gravidez/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Promoção da Saúde , Humanos , Lactente , Motivação , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Cuidado Pós-Natal , Gravidez , Complicações Infecciosas na Gravidez/psicologia
7.
Khirurgiia (Mosk) ; (9): 38-42, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030000

RESUMO

OBJECTIVE: To report treatment outcomes in patients with congenital aortic arch disease. MATERIAL AND METHODS: There were 65 patients (45 boys and 20 girls) for the period from 2005 to 2019. Mean age of patients was 53±12 days (range 1-98), weight - 3,3±1,3 kg (range 2.2-4.6). All patients were divided into 2 groups depending on the method of surgical repair. The 1st group included 33 patients who underwent patch repair, the 2nd group (n=32) - anastomosis in end-to-side fashion. RESULTS: In group I, recurrent aortic arch coarctation was observed in 16.8% of cases, in group II - only in 4% of cases (p=0.02). Analysis of systolic pressure in both groups revealed that arterial hypertension was detected in 39% of cases in group I and only in 9,1% of cases in group II (p=0,0025). CONCLUSION: Surgical treatment of aortic arch disease using anastomosis in end-to-side fashion is associated with reduced risk of recurrent aortic arch coarctation and residual arterial hypertension in long-term postoperative period.


Assuntos
Aorta Torácica , Coartação Aórtica , Anastomose Cirúrgica , Pressão Sanguínea , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
8.
Artigo em Chinês | MEDLINE | ID: mdl-33040500

RESUMO

Objective:To report the nonsurgical correction of congenital auricular deformities in children older than 3 months, analysis the effect and the recurrence and the influencing factors. Method:Patients with auricular deformities who came to our department from July 2017 to August 2019 were collected. EarWell correction was performed for non-invasive correction. Follow-up was performed for at least 3 months after treatment. Data was collected to analysis the effect and the recurrence and the influencing factors. Result:At the end of follow-up, 76 cases of 88 ears were collected, at the end of treatment in this group, the efficiency was 87.5%, and the recurrence rate was 19.48%, 3 months after the end of treatment. There was a statistically significant difference in the distribution of auricle deformities(P=0.018) and the age of first treatment(P=0.028) between children in the effective group and those in the ineffective group. Of all the auricle deformities, the treatment of cryptotia was the most effective, and the effectiveness of prominent ears was the lowest. The family history(P=0.314), gender(P=0.421), and feeding method(P=0.557) of the effective and ineffective groups. There was no significant difference in the gestational weeks at birth(P=0.641), the mode of production(P=0.849), and birth weight(P=0.08). There was no significant difference in age between the relapsed group and the non-relapsed group at the age of first treatment(P=0.833).There was significant difference in the distribution of auricle deformities between the relapsed group and the non-relapsed group(P=0.013). There was no statistically significant difference between the effective group and the ineffective group at the age of first diagnosis and treatment time if we exclude cryptotia. Conclusion:For children who are treated beyond the treatment time window, the main factor affecting the treatment effect is the type of deformity. Nonsurgical correction can still be tried for older than 3 months with auricular deformities, especially for cryptotia, ear wheel deformities, and auricular cavity deformities. We do not recommend to try nonsurgical correction for children older than 3 months with prominent ears and cup ears.


Assuntos
Anormalidades Congênitas , Pavilhão Auricular , Orelha Externa , Criança , Anormalidades Congênitas/terapia , Pavilhão Auricular/anormalidades , Orelha Externa/anormalidades , Humanos , Lactente , Recém-Nascido , Anamnese , Recidiva
9.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(9): 1035-1043, 2020.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33051416

RESUMO

OBJECTIVES: Long non-coding RNAs (lncRNAs) were involved in the development and regulation of necrotizing enterocolitis (NEC) in premature infants. To investigate the changes of lncRNA expression profile in intestinal tissues of NEC for its possible mechanisms. METHODS: Intestinal samples were collected from 11 patients with NEC who needed surgery(the NEC group), and 7 from neonatal non-NEC patients with surgery (the Control group).LncRNA's changes in intestinal samples (3 in the Control group and 3 in the NEC group) were analyzed with high-throughput sequencing.Part of the remaining samples were detected by real-time polymerase chain reaction (real-time PCR), and the results were used to validate the results of high-throughput sequencing. Gene Ontology (GO) analysis and KEGG signaling pathway analysis were performed on differentially expressed genes. RESULTS: There were 5 257 different lncRNAs between the control group and the NEC group. The results of up-regulated lncRNAs (NONHSAG008675.3, NONHSAG020715.2, NONHSAG038187.2) and down-regulated lncRNA (NONHSAG028744.3) were confirmed to be consistent with the results of high-throughput sequencing. Expressions of DUOX2, IL-6, TNF, and SAA1 were up-regulated in intestinal tissues of NEC. GO analysis showed that the different lncRNAs were involved in regulation of stimulation, molecular junction and function, and signal transduction and transcription. KEGG analysis identified mainly biological pathways involved in inflammatory bowel disease, PI3K-Akt, NF-κB, etc. CONCLUSIONS: LncRNAs might be involved in the pathogenesis of NEC and the inflammation-related lncRNAs may be one of the key factors.


Assuntos
Enterocolite Necrosante , RNA Longo não Codificante , Animais , Oxidases Duais , Enterocolite Necrosante/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lactente , Recém-Nascido , Intestinos , Fosfatidilinositol 3-Quinases , RNA Longo não Codificante/genética
10.
J Indian Soc Pedod Prev Dent ; 38(3): 232-237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33004720

RESUMO

Background: Dental trauma can determine the occurrence of sequelae in the deciduous tooth and due to the anatomical proximity to the germ of the successor permanent tooth, it frequently causes changes to the developing teeth. Aims: The objective of this study was to analyze clinically and radiographically traumatized primary teeth and permanent successors in children aged 0-8 years. Materials and Methods: Initially, a sample selection of medical records was made, designating the patients who fit the requirements; 247 patients were analyzed, totaling 379 traumatized primary teeth and 162 successive permanent teeth. Statistical Analysis: The results were developed using the Proportion Test and the Chi-square test at the 5% significance level. Results: Injuries to hard tissue prevailed (57%), with emphasis on coronary enamel fracture (49.1%). After clinical and radiographic examinations, 78% of traumatized primary teeth maintained pulpal vitality. At the clinical evaluation, the frequency of the developmental disorders observed in permanent successors was 10.5%, with enamel hypocalcification being the most common sequela. 17.3% of the clinical changes in the successor permanent teeth were caused by trauma to the supporting tissue, with the intrusive dislocation being responsible for the largest number of damages (37.5%). Conclusion: Based on the results found, it was concluded that the trauma occurring in the primary dentition were recorded and monitored more precisely and about the evaluated successive permanent teeth, except for the prevalence of sequelae found, the other factors are in agreement with the findings in the literature.


Assuntos
Hipoplasia do Esmalte Dentário , Avulsão Dentária , Criança , Pré-Escolar , Dentição Permanente , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Dente Decíduo
11.
J Indian Soc Pedod Prev Dent ; 38(3): 311-314, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33004731

RESUMO

Eruption of the first tooth at 6 months of age is a significant stage in a child's life. However, the presence of a tooth in the oral cavity of a newborn can lead to a lot of delusions. Natal and neonatal teeth are of utmost importance not only to a dentist but also for a pediatrician due to parental anxiety, folklore superstitions, and numerous complications associated with it. The present case report describes a 1.5 cm × 1.5 cm, slow-growing, soft-tissue gingival mass which developed following the extraction of a tooth-like structure in a 4-month-old male patient. Histological examination revealed that it contained a tooth-like hard tissue intermingled with bone and fibrous tissue. Based on clinical and histological findings, the present case was diagnosed as gingival hyperplasia with displaced tooth buds of 71 and 81, which might be due to chronic irritation or traumatic extraction of the neonatal teeth. No abnormal recurrence of the lesion was detected during the follow-up period. However, postoperative clinical and radiographic photographs further reconfirmed the absence of tooth in relation to 71 and 81.


Assuntos
Dentes Natais/cirurgia , Extração Dentária/efeitos adversos , Osso e Ossos , Criança , Gengiva , Humanos , Lactente , Recém-Nascido , Masculino , Erupção Dentária
12.
Lancet Respir Med ; 8(10): 975-986, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33007285

RESUMO

BACKGROUND: Chronic pulmonary infection with Pseudomonas aeruginosa is one of the most important causes of mortality and morbidity in cystic fibrosis. If antibiotics are commenced promptly, infection can be eradicated. The aim of the trial was to compare the effectiveness and safety of intravenous ceftazidime and tobramycin versus oral ciprofloxacin in the eradication of P aeruginosa. METHODS: We did a multicentre, parallel group, open-label, randomised controlled trial in 72 cystic fibrosis centres (70 in the UK and two in Italy). Eligible participants were older than 28 days with an isolate of P aeruginosa (either the first ever isolate or a new isolate after at least 1 year free of infection). Participants were excluded if the P aeruginosa was resistant to, or they had a contraindication to, one or more of the trial antibiotics; if they were already receiving P aeruginosa suppressive therapy; if they had received any P aeruginosa eradication therapy within the previous 9 months; or if they were pregnant or breastfeeding. We used web-based randomisation to assign patients to 14 days intravenous ceftazidime and tobramycin or 12 weeks oral ciprofloxacin. Both were combined with 12 weeks inhaled colistimethate sodium. Randomisation lists were generated by a statistician, who had no involvement in the trial, using a computer-generated list. Randomisation was stratified by centre and because of the nature of the interventions, blinding was not possible. Our primary outcome was eradication of P aeruginosa at 3 months and remaining free of infection to 15 months. Primary analysis used intention to treat (powered for superiority). Safety analysis included patients who received at least one dose of study drug. TORPEDO-CF was registered on the ISRCTN register, ISRCTN02734162, and EudraCT, 2009-012575-10. FINDINGS: Between Oct 5, 2010, and Jan 27, 2017, 286 patients were randomly assigned to treatment: 137 to intravenous antibiotics and 149 to oral antibiotics. 55 (44%) of 125 participants in the intravenous group and 68 (52%) of 130 participants in the oral group achieved the primary outcome. Participants randomly assigned to the intravenous group were less likely to achieve the primary outcome, although the difference between groups was not statistically significant (relative risk 0·84, 95% CI 0·65-1·09; p=0·18). 11 serious adverse events occurred in ten (8%) of 126 participants in the intravenous antibiotics group and 17 serious adverse events in 12 (8%) of 146 participants in the oral antibiotics group. INTERPRETATION: Compared with oral therapy, intravenous antibiotics did not achieve sustained eradication of P aeruginosa in a greater proportion of patients with cystic fibrosis and was more expensive. Although there were fewer hospitalisations in the intravenous group than the oral group during follow-up, this confers no advantage over oral treatment because intravenous eradication frequently requires hospitalisation. These results do not support the use of intravenous antibiotics to eradicate P aeruginosa in cystic fibrosis. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Antibacterianos/administração & dosagem , Ceftazidima/administração & dosagem , Fibrose Cística/microbiologia , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa , Tobramicina/administração & dosagem , Administração Intravenosa , Administração Oral , Adolescente , Adulto , Criança , Pré-Escolar , Fibrose Cística/tratamento farmacológico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/complicações , Resultado do Tratamento , Adulto Jovem
13.
Ann Emerg Med ; 76(4): 413-426, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33012377

RESUMO

STUDY OBJECTIVE: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of coronavirus disease 2019 (COVID-19)-affected populations, especially in low- and middle-income countries with less rapid and reliable vital statistics registration systems. Although official COVID-19 statistics in Mexico report almost exclusively inhospital mortality events, excess out-of-hospital mortality has been identified in other countries, including 1 EMS study in Italy that showed a 58% increase. Additionally, EMS and hospital reports from several countries have suggested that silent hypoxemia-low Spo2 in the absence of dyspnea-is associated with COVID-19. It is unclear, however, how these phenomena can be generalized to low- and middle-income countries. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many low- and middle-income country settings. METHODS: In this observational study, we calculated numbers of weekly out-of-hospital deaths and respiratory cases handled by EMS in Tijuana, and estimated the difference between peak epidemic rates and expected trends based on data from 2014 to 2019. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status, and examined for changing demographic or clinical features, including mean Spo2. RESULTS: An estimated 194.7 excess out-of-hospital deaths (95% confidence interval 135.5 to 253.9 deaths) occurred during the peak window (April 14 to May 11), representing an increase of 145% (95% CI 70% to 338%) compared with expected levels. During the same window, only 5 COVID-19-related out-of-hospital deaths were reported in official statistics. This corresponded with an increase in respiratory cases of 236.5% (95% CI 100.7% to 940.0%) and a decrease in mean Spo2 to 77.7% from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-socioeconomic-status areas, although respiratory cases were more concentrated in high-socioeconomic-status areas. CONCLUSION: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in low- and middle-income countries. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly 3-fold greater than increases reported in EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine whether excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of health care. We also found evidence of worsening rates of hypoxemia among respiratory patients treated by EMS, suggesting a possible increase in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed social disparities in out-of-hospital death that warrant monitoring and amelioration.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Serviços Médicos de Emergência/estatística & dados numéricos , Hipóxia/virologia , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Criança , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias , Vigilância em Saúde Pública , Classe Social , Adulto Jovem
15.
Rev Saude Publica ; 54: 90, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33027343

RESUMO

OBJECTIVE: To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia. METHOD: A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs. RESULTS: Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07-0.85), children under five years old (PR = 4.05; 95%CI 1.70-9.68), water from deep wells (PR = 16.90; 95%CI 2.45-116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27-103.29), toilets availability (PRA = 0.23; 95%CI 0.06-0.96), and swine presence (PR = 0.20; 95%CI 0.05-0.74) were significantly associated with the occurrence of diarrheal disease. CONCLUSION: Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.


Assuntos
Diarreia/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Inquéritos Epidemiológicos , Humanos , Lactente , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
16.
Hum Resour Health ; 18(1): 75, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028347

RESUMO

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidado do Lactente/organização & administração , Serviços de Saúde Materna/organização & administração , Tocologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Betacoronavirus , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Quênia/epidemiologia , Pandemias , Gravidez
17.
J Biol Regul Homeost Agents ; 34(4 Suppl. 2): 1-1, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33000592

RESUMO

This special issue provides a rich blend of news, reviews and clinical studies on many aspects of the understanding, management and prevention of cardiovascular disease in childhood. Primary care in pediatric cardiology, principally, must concern with prevention of heart disease and early detection of existing illness. In addition, pediatricians must be able to maintain the vigilance of "healthy" children in order to prevent cardiovascular risk in adulthood. With these goals, the themes presented in this "mosaic" of topics include - Cardiovascular involvement in genetic syndromes, SIDS and infectious, endocrine, kidney, storage or autoimmune diseases. - Pulmonary hypertension and patent ductus arteriosus in premature infants. - Cardiovascular risk in obese or hypertensive children. - Bicupid aortic valve and aortic dysfunction - Covid 19 and heart disease in childhood I thank the Researchers and Professors of Catanzaro, Palermo, Pavia, Brescia, Taormina and Messina University for their interesting and up-to-date scientific contributions, and I hope the information gathered in this issue will be useful to the reader.


Assuntos
Cardiologia , Pediatria , Betacoronavirus , Criança , Infecções por Coronavirus , Humanos , Lactente , Pandemias , Pneumonia Viral
18.
J Biol Regul Homeost Agents ; 34(4 Suppl. 2): 121-125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33000610

RESUMO

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first described in a cluster of patients in Wuhan, China, in December of 2019. Over the past few months, COVID-19 has rapidly spread worldwide becoming the first pandemic of the 21st century. COVID-19 results in mild symptoms in most infected children but can cause acute cardiac injury and death. In comparison to younger children, teenagers and infants are at higher risk for morbidity and mortality, with particular risk factors including pre-existing conditions like cardiovascular disease. Since this is an emerging infectious disease, there are limited data about the effects of this infection on patients especially in the pediatric population. We summarize here with the data on cardiovascular involvement in children and adolescents.


Assuntos
Infecções por Coronavirus/complicações , Cardiopatias/virologia , Pneumonia Viral/complicações , Adolescente , Betacoronavirus , Criança , Infecções por Coronavirus/fisiopatologia , Humanos , Lactente , Pandemias , Pneumonia Viral/fisiopatologia , Fatores de Risco
19.
MMWR Morb Mortal Wkly Rep ; 69(40): 1464-1468, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031360

RESUMO

Wild poliovirus type 1 (WPV1) transmission is ongoing only in Afghanistan and Pakistan (1). Following a decline in case numbers during 2013-2016, the number of cases in Afghanistan has increased each year during 2017-2020. This report describes polio eradication activities and progress toward polio eradication in Afghanistan during January 2019-July 2020 and updates previous reports (2,3). Since April 2018, insurgent groups have imposed bans on house-to-house vaccination. In September 2019, vaccination campaigns in areas under insurgency control were restarted only at health facilities. In addition, during March-June 2020, all campaigns were paused because of the coronavirus disease 2019 (COVID-19) pandemic. The number of WPV1 cases reported in Afghanistan increased from 21 in 2018 to 29 in 2019. During January-July 2020, 41 WPV1 cases were reported as of August 29, 2020 (compared with 15 during January-July 2019); in addition, 69 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2), and one case of ambiguous vaccine-derived poliovirus type 2 (aVDPV2) (isolates with no evidence of person-to-person transmission or from persons with no known immunodeficiency) were detected. Dialogue with insurgency leaders through nongovernmental and international organizations is ongoing in an effort to recommence house-to-house campaigns, which are essential to stopping WPV1 transmission in Afghanistan. To increase community demand for polio vaccination, additional community health needs should be addressed, and polio vaccination should be integrated with humanitarian services.


Assuntos
Erradicação de Doenças , Poliomielite/prevenção & controle , Vigilância da População , Adolescente , Afeganistão/epidemiologia , Criança , Pré-Escolar , Humanos , Programas de Imunização , Esquemas de Imunização , Lactente , Poliomielite/epidemiologia , Poliovirus/isolamento & purificação , Vacina Antipólio Oral/administração & dosagem , Vacinação/estatística & dados numéricos
20.
MMWR Morb Mortal Wkly Rep ; 69(41): 1494-1496, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33056949

RESUMO

CDC works with other federal agencies to identify counties with increasing coronavirus disease 2019 (COVID-19) incidence (hotspots) and offers support to state, tribal, local, and territorial health departments to limit the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Understanding whether increasing incidence in hotspot counties is predominantly occurring in specific age groups is important for identifying opportunities to prevent or reduce transmission. The percentage of positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results (percent positivity) is an important indicator of community transmission.* CDC analyzed temporal trends in percent positivity by age group in COVID-19 hotspot counties before and after their identification as hotspots. Among 767 hotspot counties identified during June and July 2020, early increases in the percent positivity among persons aged ≤24 years were followed by several weeks of increasing percent positivity in persons aged ≥25 years. Addressing transmission among young adults is an urgent public health priority.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Pandemias , Estados Unidos/epidemiologia , Adulto Jovem
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