Herpes zoster infection in childhood-onset systemic lupus erythematosus patients: a large multicenter study.

OBJECTIVE: The aim of this multicenter study in a large childhood-onset systemic lupus erythematosus (cSLE) population was to assess the herpes zoster infection (HZI) prevalence, demographic data, clinical manifestations, laboratory findings, treatment, and outcome. METHODS: A retrospective multicenter cohort study (Brazilian cSLE group) was performed in ten Pediatric Rheumatology services in São Paulo State, Brazil, and included 852 cSLE patients. HZI was defined according to the presence of acute vesicular-bullous lesions on erythematous/edematous base, in a dermatomal distribution. Post-herpetic neuralgia was defined as persistent pain after one month of resolution of lesions in the same dermatome. Patients were divided in two groups for the assessment of current lupus manifestations, laboratory findings, and treatment: patients with HZI (evaluated at the first HZI) and patients without HZI (evaluated at the last visit). RESULTS: The frequency of HZI in cSLE patients was 120/852 (14%). Hospitalization occurred in 73 (61%) and overlap bacterial infection in 16 (13%). Intravenous or oral aciclovir was administered in 113/120 (94%) cSLE patients at HZI diagnosis. None of them had ophthalmic complication or death. Post-herpetic neuralgia occurred in 6/120 (5%). After Holm-Bonferroni correction for multiple comparisons, disease duration (1.58 vs 4.41 years, p < 0.0001) was significantly lower in HZI cSLE patients compared to those without HZI. Nephritis (37% vs 18%, p < 0.0001), lymphopenia (32% vs 17%, p < 0.0001) prednisone (97% vs 77%, p < 0.0001), cyclophosphamide (20% vs 5%, p < 0.0001) and SLE Disease Activity Index 2000 (6.0 (0-35) vs 2 (0-45), p < 0.0001) were significantly higher in the former group. The logistic regression model showed that four independent variables were associated with HZI: disease duration < 1 year (OR 2.893 (CI 1.821-4.597), p < 0.0001), lymphopenia <1500/mm(3) (OR 1.931 (CI 1.183-3.153), p = 0.009), prednisone (OR 6.723 (CI 2.072-21.815), p = 0.002), and cyclophosphamide use (OR 4.060 (CI 2.174-7.583), p < 0.0001). CONCLUSION: HZI is an early viral infection in cSLE with a typical dermatomal distribution. Lymphopenia and immunosuppressive treatment seem to be major factors underlying this complication in spite of a benign course.

Epidemiologia da anafilaxia no Brasil: Registro Brasileiro de Anafilaxia (RBA) da Associação Brasileira de Alergia e Imunologia (ASBAI) / Epidemiology of anaphylaxis in Brazil: The Brazilian Registry of Anaphylaxis (RBA) of the Brazilian Association of Allergy and Immunology (ASBAI)

INTRODUÇÃO: A anafilaxia é uma reação alérgica multissistêmica grave, de início agudo e potencialmente fatal. Poucos são os dados sobre sua epidemiologia no Brasil. O Registro Brasileiro de Anafilaxia da Associação Brasileira de Alergia e Imunologia (RBAASBAI) teve como objetivo ampliar o conhecimento sobre anafilaxia em indivíduos brasileiros. MÉTODOS: Estudo observacional transversal com questionário online sobre dados demográficos, desencadeantes suspeitos, manifestações clínicas, atendimento durante a reação, investigação diagnóstica e aconselhamento após a reação de pacientes que experimentaram uma reação anafilática. RESULTADOS: Entre junho/2021 e abril/2023, foram incluídos 237 pacientes (131 femininos): 99 crianças/adolescentes; 127 adultos e 11 idosos. Houve predomínio de meninos entre crianças/adolescentes (55,5%), e de mulheres entre os adultos (64,5%), e mediana de idade de 22 anos (< 1 a 77 anos). As manifestações cutâneas (92,8%) foram as mais frequentes, seguidas pelas respiratórias (70,1%), gastrointestinais (52,3%), neurológicas (36,3%) e cardiovasculares (35,3%). Os principais desencadeantes foram: alimentos (43,0%), medicamentos (26,2%), himenópteros (21,6%) e látex (2,5%); os alimentos entre crianças (leite, ovo, amendoim/castanhas), e os fármacos (anti-inflamatórios e antibióticos) entre os adultos. Quanto ao tratamento, 61,1% recebeu adrenalina (52,7% por profissional e 8,4% via autoinjetor de adrenalina -AIA). Uma adolescente (12 anos) faleceu após picada de abelha. A maioria recebeu plano escrito de emergência (78,1%) e foi ensinada a usar o AIA (70%). CONCLUSÃO: Os alimentos foram os desencadeantes mais comuns entre crianças/adolescentes, e os fármacos entre adultos brasileiros. A adrenalina continua sendo subutilizada, reforçando a necessidade de maior disseminação do tratamento adequado da anafilaxia.

INTRODUCTION: Anaphylaxis is a life-threatening, acute, severe multisystem allergic reaction.There is little data on its epidemiology in Brazil. The Brazilian Anaphylaxis Registry of the Brazilian Association of Allergy and Immunology (RBA-ASBAI) was devised to expand knowledge about anaphylaxis in Brazilian individuals. METHODS: Cross-sectional observational study using an online questionnaire to collect data on demographics, suspected triggers, clinical manifestations, treatment during the reaction, diagnostic workup, and post-reaction counseling in patients who have experienced an anaphylactic reaction. RESULTS: Between June 2021 and April 2023, 237 patients were included (131 female): 99 children/adolescents (<18yo), 127 adults (18-64yo), and 11 older adults (65-77yo). There was a male predominance in the pediatric group (55.5%), while females were predominant among adults (64.5%). The median age was 22 years (range, <1 to 77). The most frequent clinical manifestations were cutaneous (92.8%), followed by respiratory (70.1%), gastrointestinal (52.3%), neurological (36.3%), and cardiovascular (35.3%). The most common triggers were foods (43.0%), drugs (26.2%), venoms (21.6%), and latex (2.5%). Foods (milk, egg, peanuts/tree nuts) predominated among children, versus drugs (mostly nonsteroidal anti-inflammatory drugs and antibiotics) among adults. Regarding treatment, 61.1% received epinephrine (52.7% by a healthcare professional and 8.4% via epinephrine auto-injector [EAI]). One teenager (12yo) died due to a bee sting. Most patients received a written emergency plan (78.1%) and were taught how to use the EAI (70%). CONCLUSION: Foods were the most common triggers of anaphylaxis among Brazilian children and adolescents, while drugs predominated among adults. Epinephrine continues to be underused, highlighting the need for greater awareness of proper treatment of anaphylaxis.

Paroxysmal atrial fibrillation in seven dogs with presumed neurally-mediated syncope.

OBJECTIVES: To document the electrocardiographic findings of vagally-induced paroxysmal atrial fibrillation following a presumed reflex syncopal episode in the dog. ANIMALS: Seven dogs with a syncopal episode followed by a paroxysm of atrial fibrillation recorded on a 24-hour Holter. METHODS: Twenty-four hour Holter monitors were retrospectively reviewed, analysing the cardiac rhythm associated with syncopal events. Each recording was analysed from 10 min before the syncopal episode to until 10 min after a normal sinus rhythm had returned. RESULTS: Nine episodes were recorded in seven dogs, with one patient experiencing three events during one Holter recording. Five of the seven dogs presented with underlying structural heart disease. In two the syncopal episodes occurred following exercise, two associated with coughing and three were during a period of rest. All dogs had documented on the Holter recording a rhythm abnormality during syncope. The most common finding leading up to the syncopal event was development of a progressive sinus bradycardia, followed by sinus arrest interrupted by a ventricular escape rhythm and then ventricular arrest. This was then followed by an atrial fibrillation. The atrial fibrillation was paroxysmal in seven recordings and persistent in two. In two dogs, the atrial fibrillation reorganised into self-limiting runs of atypical atrial flutter. CONCLUSIONS: This combination of electrocardiographic arrhythmias are probably caused by an inappropriate parasympathetic stimulation initiating a reflex or neurally-mediated syncope, with abnormal automaticity of the sinus node and of the subsidiary pacemaker cells and changes in the electrophysiological properties of the atrial muscle, which promoted the paroxysmal atrial fibrillation.

Vitamin A status of young children in Southern Brazil.

A comprehensive survey was carried out to assess the vitamin A status of preschool children of poor migrant families in the periurban population of Ribeirao Preto, a typical agricultural town in the sugarcane and coffee region of the State of Sao Paulo in Southern Brazil. The intake of vitamin A and carotenoids from the rice and bean based diet of these children is considered low and appears to influence blood concentrations and liver reserves of this vitamin. With respect to plasma vitamin A, 1.8% of the children had a deficient level (less than 10 micrograms%), whereas 48.8% of the children had a low level (less than 20 micrograms%). Most children with inadequate plasma vitamin A (less than 20 micrograms%) responded positively to a massive dose of 200,000 IU vitamin A, suggesting that these children may be at risk of having low liver stores of vitamin A. Rose Bengal staining test and rapid dark adaptation time did not indicate definite signs of conjunctival xerosis and night blindness among these children. No ocular evidence of hypovitaminosis A was found in the children studied, but marginal or inadequate vitamin A status appears to be a common public health problem among young children in this region of Brazil.

[The school health program in the municipality of Ribeirao Preto]. / O programa de saúde escolar no município de Ribeirão Preto.

The present article reports on the trajectory of the Primary School Health Care Program (PROASE) at the municipality of Ribeirão Preto and describes some reflections about this proposal.

[Perceptions of social actors about the care delivered by the optical laboratory in the primary school health care program (PROASE) in the municipality of Ribeirao Preto]. / Percepções dos atores sociais sobre o atendimento prestado pelo laboratório óptico do programa de assistência primária de saúde escolar (PROASE) no município de Ribeirão Preto.

This study aimed at evaluating the care delivered by the Optical Laboratory of the Program of Primary Care to Schoolchildren (PROASE) according to the perceptions of relatives and teachers of children who had acquired glasses from 1991 to 1995 in the municipality of Ribeirão Preto. The content analysis technique was used for data analysis and, in order to observe the meanings shown in the qualitative material, the thematic analysis technique was utilized. It was concluded that that the social actors showed a positive attitude concerning the importance of the program and clearly expressed that PROASE has given relevant contribution to the health of schoolchildren.

[An exploratory study of the opinions of mothers about the health of children under 5 years old]. / Estudo exploratório de opiniões de màes sobre a saúde das crianças menores de 5 anos.

This study presents opinions of mothers about aspects of children health, 0-59 months, living in suburbs of the city of Ribeirão Preto, using home interviews. Several social-economic characteristics of this population were noted, especially the concerns of mothers related to: childhood disease, general care of their children, distribution of milk tickets, immunisation, children's growth and development process. Mothers' opinions present concerns about diseases, signs and symptoms, mothers' care, criteria for inclusion-exclusion in the Programme of Food Supplementation and aspects about the utilization of the immunisation in the Local Basic Health Unit, offering several elements which can contribute to a reflection on the care given to children at the basic level of health services in the city of Ribeirão Preto.

[A survey of the knowledge and contact with drugs in the community of firstgraders in public and private schools in Ribeirão Preto]. / Levantamiento del conocimiento y del contacto con drogas en la comunidad de alumnos de 1er, grado de enseñanza pública y privada en Ribeirão Preto.

This study refers to an essay concerning knowledge and contact with drugs among students, first grade, in private and public schools in the city of Ribeirão Preto, in different social layers. Looking for a better understanding of our data, we decided to work in this empirical survey with the concept of social stratum: a group of person with determined measurable features in common, that is, common status and that can be defined by distinct criteria. Schools were sorted according to the kind of student they had: after, schools were divided in four groups and we drew lots of each school. We used a questionnaire to collect data with opened and closed questions. According to data obtained we concluded that all students, no matter what socio-economic level, have a superficial knowledge about the subject: 48.2% said they knew people addicted to drugs in their neighbourhood; 8.8% of the children said they had offerings of drugs and the drugs were: cocaine, marijuana, haxixe, cigarettes and toxic pencil; and 63% of the remaining group said they never had an orientation related to drugs.

[The meaning of sexuality for adolescents living in the streets of Goiania]. / A sexualidade para o adolescente em situação de rua em Goiânia.

This study aimed at reflecting on the sexuality for adolescents living on the street, based on their point of view. Authors used a qualitative approach in order to identify general aspects related to the sexuality of adolescents living on the street in Goiânia. Data were collected through semi-structured interviews and participant observation. Results showed that these adolescents consider the sexuality reduced to the sexual act, and that even on the streets they are not deprived of it. Also, the prevention is a practically non-existent attitude in their daily life. Thus, authors pointed out the importance of nurses commitment to that group through health education and promotion.

[In search of a definition of current guidelines for outlining studies on children's and school-age adolescents' health]. / Em busca da definição de pautas atuais para o delineamento de estudos sobre a saúde da criança e do adolescente em idade escolar.

This work is a reflection of the search for a definition of current guidelines for outlining studies on the assistance to the child's and school-age adolescent's health based on current literature and on the discussion among professionals in the fields of Health and Education. The guidelines: Assistance to the child's and school-age adolescent's health; Education, Health and Society--current historical transformation; Health, Education and Life Conditions lead to the following questions: how to promote the child's and school-age adolescent's health within the principles of the Unified Health System (SUS) and how to deal with issues such as Health and Education in an inter-sectorial, multi-professional and interdisciplinary fashion by taking into account the New National Curricular Standards? In the conclusion, actions are proposed to eradicate the idea that students are at fault in relation to school failure as well as to change the vision based on current concepts and standings by considering all the changes that have taken place in the field of education with the new Law of Bases and Directives and the recent introduction and application of the New National Curricular Standards.

[Importance of oral health for adolescents from different social levels in the municipality of Ribeirao Preto]. / A importância da saúde bucal para adolescentes de diferentes estratos sociais do município de Ribeirão Preto.

The objective of the present study is to know the importance of buccal health for adolescents of different social strata, identifying the importance of dental aesthetics, and the care that these students take in relation to their buccal health. The methodological process adopted in this investigation is of qualitative nature, using as technique of collection of data the semistructured interview. We know the importance of buccal health in several contexts of their lives, as in their personal appearance, sexuality, employment, and general health. This investigation allows us to know the motivations of adolescents to preserve their buccal health, and we believe to be so valid to develop health promotion through health education.

[Health education: what it can be, but it is not]. / Salud-educación: lo que pudo ser y no es.

Based on his knowledge and experience, the author evaluates the concept and view of the medicine, health and education practices as well as the citizen's role. Then, the author aims at inquiring and interpreting the causes of the inefficiency of the health system and its changes due to scientific and technological improvement.

[The meaning of school failure to social activists who use the program of primary care school health--PROASE at the municipality of Ribeirao Preto]. / Significado do fracasso escolar para os atores sociais que utilizam o programa de assistência primária de saúde escolar--PROASE no município de Ribeirão Preto.

The present study has the purpose to identify and analyze the meaning of school failure to social actors that use or work in the Program of School Health Primary Care--PROASE (family members, health and education professionals) and to articulate their discourse with the official discourse in order to establish the program's future actions. Our study has a qualitative theoretical framework based in Minayo (1992). One area where PROASE develops its activities was chosen and by semistructured interviews and documentation analysis it was possible to know how the three segments that compose the sample understand the meaning of school failure.

[Group work: reflections on the daily work, report on an experience]. / O trabalho de grupo: reflexões do cotidiano, relato de uma experiência.

The purpose of the present study was to analyze the meaning of the care delivered by a group of professionals at a basic health unit, in order to propose nursing actions that are not linked to medical actions. As theoretical references, authors used ALMEIDA & ROCHA(1997) and the ideas of CAMPOS (1992) and MERHY(1995). Regarding the group activities, authors used MUNARI & RODRIGUES(1997) and LOPES & MANZOLI(1996) considerations. From August 1995 to December 1997, authors attended 108 clients that spontaneously asked for nursing orientation in order to loose weight. All those showed significant changes in theirs lives and 85% lost weight. Nowadays, the group is recognized by the clientele and by the health team.

[Health care for children: perspectives for community health services]. / Atenção à saúde da criança: perspectiva da prática de enfermagem comunitária.

The study aims at analysing the community health nursing practice in the care of children and to point out the perspectives for the coming millennium. The study was conducted by review of the literature. It provides a brief synthesis of the current social context and a short historic reflection about health practices with children and community health nursing practice. It is observed that the practice of nursing is conducted according to the official Health Assistance Program for Children. Despite its goals, however, the program has not been efficient. In this way it will be valued the multiprofessional work in the accompaniment of the growth and development, domiciliary visit, and "groups of mothers" in which the nurse will be a co-participant of the staff, with the great contribution that health professionals with preventions and promotions background frequently offer.

[Sexuality in adolescence: a bibliographic study]. / Sexualidade na adolescência: um estudo bibliográfico.

This is a bibliographical study that aimed at pointing out the history of sexuality as well as its cultural, social and religious influences. The goals were to find out in literature the causes of the difficulties faced by the actual men to approach themes related to sexuality mainly with their adolescent children that need this orientation in order to live a safer and healthier sexuality.

[Accumulation of data about adolescence by nurses: period from 1983 to 1996]. / A produção do conhecimento sobre adolescência na enfermagem: período 1983 a 1996.

In the last ten years adolescence has been object of study of many researchers and considered by National and International Organizations as an age band with priority to actions of promotion, prevention and protection. Many factors contributed to this concern with adolescence, between them, we can emphasize the importance of this populational contingent that represents 30% of world population, besides the questions of precocious pregnancy, AIDS and drugs. As nurse researchers, we are interested in experiencing and characterizing quantitatively and qualitatively the scientific production about adolescence in nursing, using as source of data collection the national specific nursing periodicals. Data obtained in this research show that the adolescence theme is not explored by the nursing staff, and the most important aspects are related to sexuality.

[Perception of health for obese adolescents]. / A percepção de saúde para adolescentes obesos.

This work aims at learning about the perception of health of overweight adolescents participating in the Multidisciplinary Program of Assistance to Overweight Adolescents developed in the Campus of Ribeirão Preto (University of São Paulo). The qualitative approach based on Minayo (1994) was adopted. Data were collected from sentences and compositions done by 17 adolescents, who were participating in the program. The theme of the compositions and sentences were: "What being healthy means?". Data analysis and interpretation was done based on the thematic analysis technique proposed by Bardin (1976). Through this analysis, the following meaning units were identified: "health is beauty", "diet and hygiene" and "practice of sports". Therefore, the study showed that the ideal body image adolescents want for themselves is related to the beauty standards established by the media and to the stereotypes of physical perfection. Another aspect detected by the study was that adolescents are aware of the need of practicing sports and having a balanced diet.