Probiotics for infantile colic: Is there evidence beyond doubt? A meta-analysis and systematic review.

AIM: This study is a systematic review and meta-analysis of randomised controlled trials that employed probiotics and symbiotics for treating infantile colic. METHODS: We performed electronic systematic literature searches in Embase, PubMed and Web of Science, to identify articles published between 1950 and April 2023. Only RCT involving infants with infantile colic under 3 months were included. The treatment plan comprised 15 probiotics, which included Lactobacillus reuteri DSM 17938 and Bifidobacterium animalis lactis BB-12. The probiotics were administered alone or in combination with a prebiotic, vs. no intervention or a placebo. RESULTS: Probiotics resulted in an average reduction of 51 min of crying per day (p = 0.001). Further analysis of subgroups showed that the reduction was -39.30 min for vaginal delivery (p = 0.003), -64.66 min for Lactobacillus reuteri DSM 17938 (p = 0.03), -40.45 min for other strains (p < 0.00001), -74.28 min for exclusively breastfed infants (p = 0.0003) and -48.04 min for mixed feeding (p < 0.00001). CONCLUSION: All probiotic strains seem effective in treating infantile colic. Exclusively breastfed infants have demonstrated more significant reduction in crying time. However, the available evidence on the effectiveness of probiotics in formula-fed and caesarean-born infants is limited.

Profile analysis of emerging respiratory virus in children.

Acute respiratory infections (ARIs) are caused by a variety of microorganisms. Of all ARIs, 80% are caused by viruses such as human respiratory syncytial virus, metapneumovirus, influenza, parainfluenza, rhinovirus, and, more recently, Sars-CoV-2, which has been responsible for the COVID-19 pandemic. The objective of our study was to evaluate clinical data from a viral panel performed in children hospitalized with SARS or COVID-19 in the infirmary or ICU of 5 pediatric hospitals in the city of Goiânia, Goiás, Brazil. Demographic, clinical, and laboratory data were collected for analysis, and data on the outcomes underwent statistical treatment. A total of 128 patients were selected for the study, 54% of whom were male and 46% female. The viral panel included rhinovirus, COVID-19, metapneumovirus, adenovirus, and parainfluenza. Descriptive analyses of age profile showed differences in the involvement of particular viruses. The percentage of patients who required hospitalization in the ICU, infirmary, as well as individuals who were discharged after therapy or who died, were described. Our work shows that epidemiological surveillance measures are indispensable, especially if used in the continued analysis of viral panels in all pediatric patients with SARS.

Influenza and other respiratory viruses in children: prevalence and clinical features.

With the COVID-19 pandemic still ongoing, the annual season of influenza and other respiratory virus epidemics has arrived. Specimens from patients suspected of respiratory viruses infection were collected. Viral detection was performed following RNA extraction and real-time RT-PCR. During the study period, we received and tested a total of 606 specimens. Rhinovirus virus was the viral type most prevalent, detected in 186 (45.47%) specimens. The age range of patients positive for influenza A, influenza A (H1N1), and influenza B was 18 days to 13 years. With female prevalence for this viral type, cough and asthma were the main clinical manifestations presented by this viral type. Our results indicate that rhinoviruses, adenoviruses, metapneumoviruses, and influenza are among the most important agents of ARI in pediatrics. The epidemic period of respiratory infections observed in Goiânia can be useful for planning and implementing some prevention strategies.

Three-dimensional assessment of craniofacial asymmetry in children with transverse maxillary deficiency after rapid maxillary expansion: A prospective study.

OBJECTIVE: The aim of this study was to evaluate craniofacial asymmetry in children with transverse maxillary deficiency, with or without functional unilateral posterior crossbite (UPC), before and after rapid maxillary expansion (RME). SETTING AND SAMPLE POPULATION: A sample of 51 children with cone beam computed tomography scans obtained before RME (T1) and a year after RME (T2). MATERIAL AND METHODS: This prospective study consisted of 2 groups: 25 children with functional UPC (6.77 ± 1.5 years) and 26 children without UPC (7.41 ± 1.31 years). Linear and angular measurements were obtained from zygomatic, maxilla, glenoid fossa and mandible, using original and mirrored 3D overlapped models. All right and left side comparisons in both groups and intergroups asymmetries were compared using MANOVA and t test for independent samples, respectively, statistically significant at P < .05. RESULTS: The UPC group showed no side differences, but mandibular horizontal rotation at T1, and this asymmetry was improved in T2. The non-UPC group showed at baseline significant lateral asymmetry in orbitale, position of palatine foramen, respectively, in average 2.95 mm and 1.16 mm, and 0.49 mm of average asymmetry in condylar height. The glenoid fossa was symmetric in both groups at T1 and T2. CONCLUSIONS: Children with transverse maxillary deficiency showed slight morphological asymmetry, located in the mandible position in cases of UPC, and in the orbital and maxillary regions in cases without UPC. One year after RME, patients improved their craniofacial asymmetry, with significant changes in the mandible and correction of the mandibular rotation in patients who presented UPC.

Analgesia for adenotonsillectomy in children: a comparison between peritonsillar infiltration of tramadol, ketamine, and placebo.

INTRODUCTION: Post-tonsillectomy pain is mediated by nociceptive C-fibers located at peritonsillar space. Peritonsillar infiltration of medication could relieve post-operative pain blocking the afferent via. PURPOSE: To evaluate the effect of peritonsillar infiltration of tramadol, ketamine, and placebo on post-operative pain in cases of adenotonsillectomy. METHODS: This is a double-blind randomized placebo-controlled study. Children ASA I-II aged 3-13 years scheduled for adenotonsillectomy were included in the study. Patients were randomized to receive either 2 mg/kg of peritonsillar tramadol (Group T), 0.5 mg/kg of peritonsillar ketamine hydrochloride (Group K), and 3 mL of peritonsillar saline (Group P). Post-operative pain was recorded using the modified visual analogue scale at 2 h, 6 h, 12 h, and 24 h. Side effects, analgesia requirement, and first oral intake were also recorded. RESULTS: There were included 112 patients and five were excluded until final evaluation. We evaluated 36 children of Group T, 36 of Group K, and 35 of Group P. Groups were similar regarding to age, weight, height, gender, tonsil and adenoid size, hemodynamic parameters during the surgery, surgery, and anesthesia time. There were no differences between the groups in relation to pain scores, analgesia requirement, or first time of oral intake (p > 0.05). Group T presented a higher incidence of vomit between 2 and 6 h after surgery (p > 0.05). CONCLUSION: This study showed that peritonsillar infiltration of tramadol or ketamine were not superior to placebo in reducing post-operative pain in children undergone adenotonsillectomy. The use of tramadol increased the risk of nausea and vomit between 2 and 6 h after surgery.

Position paper of diagnosis and treatment of post-extubation laryngitis in children: a multidisciplinary expert-based opinion.

OBJECTIVES: To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. METHODS: A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. RESULTS: Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. CONCLUSIONS: Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.

Detection of Oxacillin/Cefoxitin Resistance in Staphylococcus aureus Present in Recurrent Tonsillitis.

BACKGROUND: Recurrent tonsillitis is one of the most common diseases in childhood, caused many times by ß-lactam-resistant S. aureus. The objective of this study was to investigate an alternative method to identify resistance to oxacillin/cefoxitin in S. aureus from hospitalized children with recurrent tonsillitis. METHODS: The samples of S. aureus came from patients with recurrent tonsillitis and were used in 16S rRNA sequencing and an antibiogram test for identification and verifying resistance, after which HSI methodology were applied for separation of S. aureus resistances. RESULTS: The S. aureus isolated showed sensitivity to oxacillin/cefoxitin and the diagnostic images show a visual description of the resistance different groups formed, that may be related to sensitivity and resistance to oxacillin/cefoxitin, characterizing the MRSA S. aureus. CONCLUSIONS: Samples that showed phenotypic resistance to oxacillin/cefoxitin were clearly separated from samples that did not show this resistance. A PLS-DA model predicted the presence of resistance to oxacillin/cefoxitin in S. aureus samples and it was possible to observe the pixels classified as MRSA. The HSI was able to successfully discriminate samples in replicas that were sensitive and resistant, based on the calibration model it received.

Staphylococcus spp. Causatives of Infections and Carrier of blaZ, femA, and mecA Genes Associated with Resistance.

Staphylococcus spp. have been associated with cases of healthcare associated infections due to their high incidence in isolates from the hospital environment and their ability to cause infections in immunocompromised patients; synthesize biofilms on medical instruments, in the case of negative coagulase species; and change in genetic material, thus making it possible to disseminate genes that code for the acquisition of resistance mechanisms against the action of antibiotics. This study evaluated the presence of blaZ, femA, and mecA chromosomal and plasmid genes of Staphylococcus spp. using the qPCR technique. The results were associated with the phenotypic expression of resistance to oxacillin and penicillin G. We found that the chromosomal femA gene was present in a greater proportion in S. intermedius when compared with the other species analyzed, while the plasmid-borne mecA gene was prevalent in the S. aureus samples. The binary logistic regression performed to verify the association among the expression of the genes analyzed and the acquisition of resistance to oxacillin and penicillin G were not significant in any of the analyses, p > 0.05.

Characterization of T Helper 1 and 2 Cytokine Profiles in Newborns of Mothers with COVID-19.

An infectious disease caused by SARS-CoV-2, COVID-19 greatly affects the pediatric population and is 3 times more prevalent in newborns than in the general population. In newborns, the overexpression of immunological molecules may also induce a so-called cytokine storm. In our study, we evaluated the expression of cytokines in newborns admitted to a neonatal ICU whose mothers had SARS-CoV-2 and symptoms of SARS. The blood of newborns of infected and healthy mothers was collected to identify their Th1 and Th2 cytokine profiles, and via flow cytometry, the cytokines TNF-α, IFN-γ, IL-2, IL-6, and IL-10 were identified. Overexpression was observed in the Th1 and Th2 cytokine profiles of newborns from infected mothers compared with the control group. Statistical analysis also revealed significant differences between the cellular and humoral responses of the infected group versus the control group. The cellular versus humoral responses of the newborns of infected mothers were also compared, which revealed the prevalence of the cellular immune response. These data demonstrate that some cytokines identified relate to more severe symptoms and even some comorbidities. IL-6, TNF-α, and IL-10 may especially be related to cytokine storms in neonates of mothers with COVID-19.

Viral Coinfection of Children Hospitalized with Severe Acute Respiratory Infections during COVID-19 Pandemic.

The main pathogens of severe respiratory infection in children are respiratory viruses, and the current molecular technology allows for a rapid and simultaneous detection of a wide spectrum of these viral pathogens, facilitating the diagnosis and evaluation of viral coinfection. METHODS: This study was conducted between March 2020 and December 2021. All children admitted to the ICU with a diagnosis of SARI and who were tested by polymerase chain reaction on nasopharyngeal swabs for SARS-CoV-2 and other common respiratory viral pathogens were included in the study. RESULTS: The result of the viral panel identified 446 children, with one infected with a single virus and 160 co-infected with two or more viruses. This study employed descriptive analyses, where a total of twenty-two coinfections among SARI-causing viruses were identified. Thus, the five most frequent coinfections that were selected for the study are: hRV/SARS-CoV-2 (17.91%), hRV/RSV (14.18%), RSV/SARS-CoV-2 (12.69%), hRV/BoV (10.45%), and hRV/AdV (8.21%). The most significant age group was 38.1%, representing patients aged between 24 and 59 months (61 individuals). Patients older than 59 months represented a total of 27.5%, comprising forty-four patients. The use of oxygen therapy was statistically significant in coinfections with Bocavirus, other CoVs, Metapneumovirus, and RSV. Coinfections with SARS-CoV-2 and the other different coinfections presented a similar time of use of oxygen therapy with a value of (p > 0.05). In the year 2020, hRV/BoV was more frequent in relation to other types of coinfections, representing a total of 35.1%. The year 2021 presented a divergent profile, with hRV/SARS-CoV-2 coinfection being the most frequent (30.8%), followed by hRV/RSV (28.2%). Additionally, 25.6% and 15.4% represented coinfections between RSV/SARS-CoV-2 and hRV/AdV, respectively. We saw that two of the patients coinfected with hRV/SARS-CoV-2 died, representing 9.52% of all deaths in the study. In addition, both hRV/hBoV and hRV/RSV had death records for each case, representing 8.33% and 6.67% of all deaths, respectively. CONCLUSION: Coinfections with respiratory viruses, such as RSV and hBoV, can increase the severity of the disease in children with SARI who are admitted to the ICU, and children infected with SARS-CoV-2 have their clinical condition worsened when they have comorbidities.

Congenital laryngeal webs: from diagnosis to surgical outcomes.

INTRODUCTION: Congenital laryngeal webs are rare, may be associated with other airway abnormalities and be one of many features of microdeletion 22q11. Meticulous evaluation is imperative when deciding which surgical technique to use. The choice of appropriate stenting may be decisive to avoid persistent anterior commissure synechia and poor voice results. OBJECTIVE: To report outcomes for endoscopic and open surgical approaches in the treatment of congenital laryngeal webs and the challenges one may encounter while applying the current classification and deciding for the best treatment option. METHODS: Retrospective review of medical and surgical charts for congenital laryngeal webs treated in two tertiary university centers. RESULTS: Seven patients were included; following Cohen's classification there were: three type II webs, one of them with an atypical posterior synechia, two type III webs and two type IV webs. Six patients were submitted to laryngotracheal reconstruction and one was treated with an endoscopic approach. Description of precise glottic and subglottic involvement and tailored surgical options are presented. The LT mold® stent was used for long-term stenting that varied between 40 to 60 days. All patients were successfully decannulated with good voice quality and after follow-up of over one year, there were no complications associated with the surgeries. CONCLUSION: Congenital laryngeal webs should be suspected and thoroughly evaluated in the presence of neonatal dysphonia and early onset of laryngitis. Otolaryngologists must be familiar with associated lesions and genetic conditions that may be associated to congenital laryngeal webs. Congenital laryngeal webs may be successfully treated at an early age. The correct choice of surgical technique after meticulous evaluation of glottic and subglottic components of the web, presence of concomitant lesions and appropriate stenting, is imperative to avoid persistent scarring and poor voice quality.

Correlation between cow's milk protein allergy and otitis media: a systematic review.

OBJECTIVES: To review the evidence pertaining to the association between cow's milk protein allergy and recurrent acute otitis media and otitis media with effusion. METHODS: The CENTRAL, Web of Science, EMBASE, MEDLINE, LILACS databases, and gray literature were searched. RESULTS: Four studies were included, identifying the prevalence rates: 0.2% of delayed speech due to chronic otitis media with effusion in 382 children with cow's milk protein allergy, 10.7% of cow's milk protein allergy in 242 children who underwent ENT procedures, 40% of cow's milk protein allergy in 25 children with recurrent otitis media with effusion and higher tendency to otitis media in children with cow's milk protein allergy of 186 children (1.5 + 0.6 vs. 0.4 + 0.1; p < 0.1). CONCLUSION: Considering the characteristics and methodological variations of the identified studies, it is not possible to state that there is reliable evidence of an association between cow's milk protein allergy and otitis media.

Severe Neurological Manifestation in a Child with Multisystem Inflammatory Syndrome.

BACKGROUND AND OBJECTIVES: During the COVID-19 pandemic, we followed with concern the evolution of several children diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C). The purpose of this study is to describe the evolution of MIS-C in a previously healthy 3-year-old girl. METHODS: We tracked the daily medical report of all children admitted with suspected MIS-C to the five largest regional hospitals. RESULTS: Our screening identified a child who had several neurological complications associated with MIS-C. We report hematological alterations, transient cardiac dysfunction, and cerebral involvements such as laminar cortical necrosis caused by ischemic stroke. We present the course of treatment and clinical outcome, and other complications such as a severe subglottic stenosis occurring after extubation. CONCLUSION: Subglottic stenosis is an expected complication after prolonged intubation, and the presence of dysphonia and/or stridor is an important predictive factor. MIS-C with severe neurological alteration may occur in a healthy child, and early diagnosis and treatment with a pulse of corticoid with immunoglobulin are essential for a favorable outcome.

Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing.

Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p -values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

Olfactory dysfunction in the scenario of COVID-19 pandemic in patients screened by the telemonitoring.

OBJECTIVE: To assess the clinical and epidemiological profile of patients with olfactory dysfunction in the scenario of COVID-19 pandemic. METHODS: The study selected patients with loss of smell, previously screened by telemonitoring system of the Municipal Health Department of Goiânia (GO), Brazil, who agreed to answer a questionnaire about COVID-19 symptoms and findings of exams. The interviews were conducted by six otolaryngologists, who applied the specific questionnaire, over the phone. RESULTS: A total of 13,910 patients underwent telemonitoring, and 627 (4.51%) had olfactory loss complaints. Out of them, 330 were included in the survey. We observed a higher prevalence of altered smell in women (67%), and in patients aged under 50 years (86%). In most cases the manifestations had a sudden onset (70%), and in the first 5 days of illness (80%). The most prevalent associated symptom was a change in taste (89%), and only 2.7% of interviewed patients required hospitalization. CONCLUSION: Anosmia in COVID-19 is more prevalent in females and individuals aged under 50 years. It is a relevant initial symptom predictive of the disease, together with dysgeusia.

A Periorbital Abscess with Combined Retinal Artery Occlusion and Retinal Vein Occlusion: A Case Report.

BACKGROUND Periorbital abscesses are uncommon complications of acute bacterial rhinosinusitis; with the evolution of diagnostic and therapeutic methods, it is rare that the patient progresses to irreversible blindness. Central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) rarely occur simultaneously and the factors that influence this occurrence are not well understood. CASE REPORT This is a case report of an immunocompetent healthy adolescent girl, who developed irreversible blindness caused by a periorbital abscess secondary to acute bacterial rhinosinusitis due to CRAO and CRVO. Despite 6 days of clinical treatment, including intravenous antibiotics (vancomycin-associated piperacillin with tazobactam), she had a large periorbital abscess and could not open her left eye. Therefore, she was transferred to a tertiary hospital; 1 day after her admission, she underwent surgical treatment to drain the abscess through external and endoscopic access. In addition, she received broad-spectrum antibiotics (meropenem with vancomycin) for 3 weeks. She was no longer able to perceive light with the left eye, despite her clinical improvement. This case report discusses the factors that could have contributed to this poor outcome, despite clinical and surgical treatment. CONCLUSIONS We conclude that there are several mechanisms that can lead to the loss of vision and when the indicated surgical intervention is delayed, it can increase the risk of visual sequelae.

Rhinophototherapy, an alternative treatment of allergic rhinitis: Systematic review and meta-analysis.

INTRODUCTION: Allergic rhinitis is a chronic inflammatory disease of the nasal mucosa, mediated by immunoglobulin E, affecting 1 in 6 individuals. The treatment aims at attaining symptomatic control with minimal side effects, a requirement for new alternative therapies, including phototherapy, as it has an immunosuppressive and immunomodulatory effect. OBJECTIVE: To identify the effectiveness of phototherapy in the treatment of allergic rhinitis through a meta-analysis. METHODS: We searched Web of Science, Scielo, PubMed, SCOPUS, PEDro, and LILACS databases, using the terms: "intranasal irradiation", "phototherapy" and "allergic rhinitis". The R software Metafor package was used for the meta-analysis and the effect size was calculated for each symptom individually. RESULTS: All symptoms decreased considerably after phototherapy: rhinorrhea (ES• = -1.35; p < 0.0001; I2 = 91.84%), sneezing (ES• = -1.24; p <  0.0001; I2 = 91.43%), nasal pruritus (ES• = -1.10; p < 0.0001; I2 = 91.43%); nasal obstruction (ES• = -1.11; p < 0.0001; I2 = 91.88%). The effects were more significant in perennial allergic rhinitis than in the seasonal type. CONCLUSION: Considering the effect size and the statistical significance attained in our study, rhinophototherapy showed to be an effective treatment for reducing the nasal symptom scores triggered by AR.

SYSTEMATIC REVIEW OF THE LITERATURE ON SURGICAL TREATMENT OF CHRONIC RHINOSINUSITIS IN CHILDREN: WHAT IS THE BEST APPROACH?

OBJECTIVE: To carry out a systematic literature review on the surgical treatment of chronic rhinosinusitis in the pediatric population. DATA SOURCES: A bibliographic review methodology was used, based on data from National Library of Medicine (Medline), PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SciELO), of the indexed works from 2006 to 2016, including the pediatric population from zero to 13 years of age. The search keywords according to Medical Subject Heading (MESH) and Health Sciences Descriptors (DeCS) were: child, surgery, sinusitis and chronic disease. A total of 318 articles were collected, five of which met the inclusion criteria and were used as a basis for this review. All articles were prospective cohort studies, level of evidence 2B, according to the criterion used by evidence-based medicine. DATA SYNTHESIS: The literature agreed that the next step for the cases refractory to drug treatment in chronic rhinosinusitis in childhood would be surgery. Adenoidectomy would be the initial method, for the safety of the procedure and improvement in about 50% of the cases, although more significant results were found in patients who associated this procedure with facial sinus surgery. CONCLUSIONS: Surgical treatment should be indicated for chronic rhinosinusitis in childhood after treatment failure. The results pointed out that adenoidectomy, when associated with some type of approach to the facial sinus, present better results.

Pediatric tracheostomy: epidemiology and characterization of tracheal secretion - a literature review.

INTRODUCTION: Despite the benefits, tracheostomized children are susceptible to respiratory infections, since the tube is located in a strategic region where there is colonization by several bacteria and biofilm formation. Biofilm is formed when the bacteria adhere strongly to the surfaces of the tubes, providing protection against various types of aggression, such as antibiotic treatment. OBJECTIVE: To carry out a literature review of the last ten years on tracheostomized pediatric patients, in order to characterize the bacteria isolated in children's tracheal secretions, and verify which ones are the most frequent. METHODS: Two authors searched the Lilacs, SciELO, Medline Plus, and PubMed databases. The MeSH terms used were: 'tracheostomy' and 'tracheotomy' associated with 'infections', 'children', 'child', and 'bacterial' as qualifiers. RESULTS: Of the 512 studies on the subject, 19 were selected for review. The total number of children evaluated in the studies was 4,472, with a mean age of 7.5 years. As for the bacteria found in the secretions of tracheostomized children, 12 species of bacteria were more frequent, P. aeruginosa was the predominant bacterium, followed by S. aureus (63.1%), Klebsiella pneumoniae (57.8%), Streptococcus pneumoniae (47.3%), and Stenotrophomonas maltophilia (47.3%). CONCLUSION: One of the main complications treated in tracheostomized patients were infections, since the respiratory system is colonized by several bacteria that can cause serious infections, which are associated with the formation of biofilms. The predominant bacterium in most of the studies was P. aeruginosa, and the second species commonly reported was S. aureus.

Cerumenogram: a new frontier in cancer diagnosis in humans.

Cancer is the deadliest human disease and the development of new diagnosis methods is important to increase the chances of a cure. In this work it was developed a new method, named here for the first time as cerumenogram, using cerumen (earwax) as a new biomatrix for diagnosis. Earwax samples collected from cancer patients (cancer group) and cancer-free patients (control group) were analyzed by Headspace/Gas Chromatography-Mass Spectrometry (HS/GC-MS), following with multivariate analysis steps to process the raw data generated. In total, 158 volatile organic metabolites (VOMs) were identified in the cerumen samples. The 27 selected as potential VOMs biomarkers for cancer provided 100% discrimination between the cancer and control groups. This new test can thus be routinely employed for cancer diagnoses that is non-invasive, fast, cheap, and highly accurate.