Clinical forms and diagnosis of tuberculosis in children and adolescents during the COVID-19 pandemic / Formas clínicas e diagnóstico da tuberculose em crianças e adolescentes durante a pandemia de COVID-19

ABSTRACT Objective: The present study aimed to describe the clinical forms and the time taken to diagnose new tuberculosis cases and to statistically analyze the isolated and combined forms of the disease in children and adolescents treated at a university hospital in Rio de Janeiro during the first year of the COVID-19 pandemic in Brazil. Methods: This was a cross-sectional study that used retrospective data on children (0-9 years old) and adolescents (10-18 years old) with pulmonary (PTB), extrapulmonary (EPTB), and combined tuberculosis (PTB + EPTB) followed up at the outpatient clinic from January 2019 to March 2021. Categorical data were analyzed by descriptive statistics and expressed as frequency and proportions. Categorical variables were compared using the Chi-square test, and numerical variables using Student's T-test. Results: A total of 51 cases were included, 63% (32/51) of which comprised patients in the year of the pandemic (group A), while 37% (19/51) were patients attended in previous years (group B). In group A, 19% (6/32) of the patients presented PTB, 59% (16/32) had EPTB, and 31% (10/32) had PTB+EPTB. In group B, 42% (8/19) of the patients presented PTB, 42% (8/19) had EPTB, and 16% (3/19) had PTB+EPTB. Conclusion: Our study revealed more tuberculosis cases in the first year of the pandemic than in the same period of the previous year, with greater variation of sites affected by the disease, including rarer and more severe forms.

RESUMO Objetivo: O presente estudo teve como objetivo descrever as formas clínicas e o tempo de diagnóstico de novos casos de tuberculose e analisar estatisticamente as formas isoladas e combinadas da doença em crianças e adolescentes atendidos em um hospital universitário do Rio de Janeiro durante o primeiro ano da pandemia de COVID-19 no Brasil. Métodos: Este estudo transversal utilizou dados retrospectivos de crianças (0-9 anos) e adolescentes (10-18 anos) com tuberculose pulmonar (TBP), extrapulmonar (TBEP) e combinada (TBP + TBEP) acompanhados no ambulatório de janeiro de 2019 a março de 2021. Os dados categóricos foram analisados por estatística descritiva e expressos em frequência e proporções. As variáveis categóricas foram comparadas pelo teste Qui-quadrado e as variáveis numéricas pelo teste T de Student. Resultados: Foram incluídos 51 casos, sendo 63% (32/51) pacientes no ano da pandemia (grupo A) e 37% (19/51) pacientes atendidos em anos anteriores (grupo B). No grupo A, 19% (6/32) dos pacientes apresentavam TBP, 59% (16/32) TBEP e 31% (10/32) TBP+TBEP. No grupo B, 42% (8/19) dos pacientes apresentavam TBP, 42% (8/19) TBEP e 16% (3/19) TBP+TBEP. Conclusão: Nosso estudo evidenciou mais casos de tuberculose no primeiro ano da pandemia do que no mesmo período do ano anterior, com maior variação de locais acometidos pela doença, incluindo formas mais raras e mais graves.

Alimentos saludables y no saludables en la opinión de adolescentes de las escuelas públicas y privadas en la capital del nordeste brasileño / Opinions on healthy and unhealthy foods among adolescentes from public and private schools in a Northeastern Brazilian capital city

RESUMEN Objetivo. Analizar la opinión de los adolescentes sobre alimentos saludables y no saludables. Estudio transversal con adolescentes de escuelas públicas y privadas. Métodos. La muestra se estratificó en tres etapas: escuela, clase y alumno, resultando en 1507 adolescentes estudiados. Los adolescentes respondieron sobre alimentos saludables y no saludables. Resultados: 995 adolescentes respondieron al cuestionario de forma completa. Los adolescentes concordaron con los beneficios de las frutas para la salud. Hubo discordancia entre las respuestas de los estudiantes de escuelas públicas y privadas sobre los maleficios de los saladitos ultraprocesados y las papas fritas para la salud; estudiantes de la red privada de enseñanza, así como del sexo femenino concordaron que las gaseosas ayudan a engordar y provocan obesidad, mientras que los de la red pública discreparon; adolescentes de escuelas privadas, de sexo femenino y grupo de edad de 15 a 17 años discreparon que carnes rojas y grasas protegen contra enfermedades del corazón. Conclusión: Los adolescentes de las escuelas de la red privada de enseñanza parecen presentar una mejor percepción acerca de los refrescos y carnes y sus maleficios a la salud, como aquellos que presentaron la mayor edad y del sexo femenino.

ABSTRACT Objective: To analyze adolescents' opinion on healthy and unhealthy foods. We conducted a cross-sectional study involving adolescents from public and private schools. Methods: The sample was stratified in three stages: school, class and student, resulting in 1507 surveyed adolescents. The adolescents answered questions on healthy and unhealthy foods. Results: A total of 995 adolescents answered the questionnaire and were considered for analysis. By and large, adolescents agreed on the benefits of fruits for health. There was disagreement between responses of public versus private school students with regard to the health risks of processed salty snacks and French fries; private school students, as well as females, agreed that soft drinks contribute to weight gain and obesity, while those belonging to the public schools disagreed; adolescents from private schools, female and adolescents aged 15 to 17 years disagreed that red and fatty meats protect against heart diseases. Conclusion: Adolescents from private versus public schools, females compared to males, and who were older demonstrated a better understanding of the negative health effects of soft drinks and meat consumption

Antibody persistence following meningococcal C conjugate vaccination in children and adolescents infected with human immunodeficiency virus / Persistência de anticorpos seguida de vacina conjugada meningocócica C em crianças e adolescentes infectados por vírus da imunodeficiência humana

Abstract Objective: HIV-infected individuals (HIVI) are threatened by meningococcal infection and presented lower response to vaccines. Data are scarce on long-term persistence of human serum bactericidal antibody (hSBA) after a meningococcal C conjugate (MCC) vaccine in HIVI youth; the authors aimed to describe this persistence in HIVI. Methods: HIVI and HIV uninfected individuals (HIVU), aged 2-18 years, CD4 >15% were recruited. Seroprotection (hSBA ≥1:4) at baseline and at 12-18 months after immunization was evaluated and the association of the different factors with the long-term persistence was calculated using logistic regression. Results: A total of 145 HIVI, 50 HIVU were recruited and immunized, and their median age was 11 years (median age in HIVI group was 12 years, and 10 years in HIVU group, p-value = 0.02). 85 HIVI (44%) had undetectable viral load (UVL). Seroprotection rate was 27.2%: 24.1% in HIVI and 36% in HIVU 12-18 months after immunization (p = 0.14). Baseline immunity (odds ratio [OR] = 70.70, 95% CI: 65.2-766.6); UVL at entry (OR: 2.87, 95% CI: 0.96-8.62) and lower family income (OR: 0.09, 95% CI: 0.01-0.69) were associated with seroprotection among HIVI. Conclusion: Seroprotection at 12-18 months after single dose of MCC was low for both groups, and higher among individuals who presented baseline immunity. Among HIVI, vaccine should be administered after UVL is achieved.

Resumo Objetivo: As pessoas infectadas pelo HIV (HIVI) estão sujeitas a infecção meningocócica e apresentam menor resposta a vacinas. São escassos os dados a respeito da persistência de longo prazo do anticorpo bactericida no soro humano (hSBA) após vacina conjugada meningocócica C (MCC) em HIVI jovens e visamos a descrever essa persistência em HIVI. Métodos: Foram recrutadas pessoas HIVI e pessoas não infectadas por HIV (HIVU), entre 2 e 18 anos, CD4 > 15%. A seroproteção (hSBA ≥ 1:4) basal aos 12-18 meses após a imunização foi avaliada e a associação dos diferentes fatores com a persistência de longo prazo foi calculada com a regressão logística. Resultados: Foram recrutados 145 HIVI e 50 HIVU e imunizados e sua idade média foi determinada em 11 anos (12 no grupo HIVI e 10 no grupo HIVU, valor de p = 0,02); 85 HIVI (44%) apresentaram carga viral indetectável (CVI). A taxa de seroproteção foi 27,2%: 24,1% no grupo HIVI e 36% no grupo HIVU 12-18 meses após imunização (p = 0,14). A imunidade basal [razão de chance (RC) = 7070, IC: 65,2-7666]; CVI no momento da participação (RC: 2,87, IC de 95%: 0,96-8,62) e renda familiar mais baixa (RC: 0,09, IC de 95%: 0,01-0,69) foram associadas a seroproteção entre as pessoas HIVI. Conclusão: A seroproteção aos 12-18 meses após única dose de MCC mostrou-se baixa em ambos os grupos e mais elevada entre as pessoas que apresentaram imunidade basal. Entre as pessoas HIVI, as vacinas devem ser administradas após a CVI ser atingida.

Prevalence of carotid artery calcifications detected on panoramic radiographs and confirmed by Doppler ultrasonography: Their relationship with systemic conditions.

Context: Atherosclerosis affects large and medium caliber arteries by forming calcific atheromas, precursors of cerebral vascular disease. Diabetes mellitus, obesity, and hypertension are considered as risk factors of atherosclerosis. Panoramic radiographs can display images suggestive of carotid artery calcifications (CACs). Aims: To investigate the prevalence of images suggestive of CAC in panoramic radiographs of the jaws (PRJs) and confirm them by Doppler ultrasonography. To evaluate their anatomic locations and relationships between systemic conditions (diabetes, hypertension, and obesity) and the presence of unilateral or bilateral CAC detected on PRJ or by Doppler ultrasonography. Materials and Methods: Of the 723 routinely performed PRJ in patients over 40 years at the Radiology Center in São Luís, Maranhão, Brazil, 21 PRJ containing images suggestive of CAC were selected in this cross‑sectional study. The findings from the PRJ were confirmed by Doppler sonography. Results: Images suggestive of CAC was detected in 21 (2.9%) of the PRJ evaluated, consisting of 11 (52.4%) hypertensive, 7 (33.3%) diabetics, and 9 (42.9%) obese. There was a higher prevalence of hypertensive patients in the unilateral CAC group (100%) and bilateral CAC (60%) compared to patients without CAC (25%). Conclusions: CACs can be detected in PRJs, and are more frequent in common carotid arteries. No significant associations were detected between the presence of unilateral or bilateral CAC in PRJ and hypertension, diabetes, or obesity.

Tuberculosis in HIV-infected infants, children, and adolescents in Latin America

Objective: To evaluate the occurrence, clinical presentations and diagnostic methods for tuberculosis in a cohort of HIV-infected infants, children and adolescents from Latin America. Methods: A retrospective analysis of children with tuberculosis and HIV was performed within a prospective observational cohort study conducted at multiple clinical sites in Latin America. Results: Of 1114 HIV-infected infants, children, and adolescents followed from 2002 to 2011, 69 that could be classified as having confirmed or presumed tuberculosis were included in this case series; 52.2% (95% CI: 39.8-64.4%) had laboratory-confirmed tuberculosis, 15.9% (95% CI: 8.2-26.7%) had clinically confirmed disease and 31.9% (95% CI: 21.2-44.2%) had presumed tuberculosis. Sixty-six were perinatally HIV-infected. Thirty-two (61.5%) children had a history of contact with an adult tuberculosis case; however information on exposure to active tuberculosis was missing for 17 participants. At the time of tuberculosis diagnosis, 39 were receiving antiretroviral therapy. Sixteen of these cases may have represented immune reconstitution inflammatory syndrome. Conclusions: Our study emphasizes the need for adequate contact tracing of adult tuberculosis cases and screening for HIV or tuberculosis in Latin American children diagnosed with either condition. Preventive strategies in tuberculosis-exposed, HIV-infected children should be optimized. .

Prevalence of lipodystrophy and risk factors for dyslipidemia in HIV-infected children in Brazil

The aim of present study was to describe the frequency of lipodystrophy syndrome associated with HIV (LSHIV) and factors associated with dyslipidemia in Brazilian HIV infected children. HIV infected children on antiretroviral treatment were evaluated (nutritional assessment, physical examination, and laboratory tests) in this cross-sectional study. Univariate analysis was performed using Mann-Whitney test or Fisher's exact test followed by logistic regression analysis. Presence of dyslipidemia (fasting cholesterol >200 mg/dl or triglycerides >130 mg/dl) was the dependent variable. 90 children were enrolled. The mean age was 10.6 years (3-16 years), and 52 (58%) were female. LSHIV was detected in 46 children (51%). Factors independently associated with dyslipidemia were: low intake of vegetables/fruits (OR = 3.47, 95%CI = 1.04-11.55), current use of lopinavir/ritonavir (OR = 2.91, 95%CI = 1.11-7.67). In conclusion, LSHIV was frequently observed; inadequate dietary intake of sugars and fats, as well as current use of lopinavir/ritonavir was associated with dyslipidemia.

Sensitivity and accuracy of panoramic radiography in identifying calcified carotid atheroma plaques

Atherosclerosis is a chronic inflammatory disease that can cause death and physical and/ormental disabilities. It represents a serious public health problem owing to the high healthcare costsinvolved in rehabilitating patients. Among the different methods available for diagnosingatherosclerotic disease, color Doppler examination may be considered the “gold standard.” Onthe other hand, panoramic radiography of the jaws (PRJ) is a diagnostic resource commonlyused by dentists, and the obtained images allow examining other structures apart from the maxillaand the mandible. Aim: To evaluate the sensitivity and accuracy of panoramic radiography inidentifying calcified carotid atheroma, and compare the results to those obtained with color Dopplerexamination. Methods: Forty-two cervical regions were evaluated in panoramic radiographsand color Doppler scans. The kappa test (p < 0.05) was used to assess agreement between theexaminations. Data were tested for sensitivity, specificity and negative predictive value, as well aspositive and negative likelihood ratios. Results: The kappa value was 0.11. The sensitivity andspecificity of PRJ were 73.9 and 36.8%, respectively, and the positive and negative likelihoodratios were 1.2 and 0.7, respectively. Conclusions: Although a low correlation between PRJand color Doppler examination was observed, as shown by the kappa test, the sensitivity of PRJin identifying calcified carotid atheroma was considered acceptable.

Avaliação dos hábitos de higiene bucal em crianças durante período de internação hospitalar / Evaluation of oral hygiene habits of children during hospitalization

O objetivo deste estudo foi o de avaliar os hábitos de higiene bucal empregados por crianças durante operíodo de internação hospitalar, a fim de orientar na formulação de estratégias para abordagem da saúde bucal neste espaço diferenciado. Foi realizado um estudo observacional de corte transversal, no qualforam coletados dados de 91 crianças por meio de seus cuidadores, utilizando-se um questionário cujo conteúdo incluiu dados pessoais do cuidador e da criança, acesso à assistência odontológica, comportamentos e hábitos de higiene bucal adotados durante o período de internação hospitalar. Observou-se uma baixa adesão a procedimentos de higiene bucal (67%), reduzido acesso à assistência odontológica(9,9%) e a desvalorização da saúde bucal no contexto da criança hospitalizada. Além disso, observou-se associação significante (p<0,05) entre a adoção de hábitos de higiene bucal e as variáveis: idade da criança,uso de chupeta e atendimento prévio por um cirurgião-dentista. Os resultados sugerem a necessidade de problematizar a abordagem da promoção de saúde bucal em ambiente hospitalar.

The aim of this study was to evaluate the oral hygiene habits employed by children hospitalization toformulate strategies for dealing oral health in this different space. This was a cross-sectional study inwhich data were collected from 91 children by their caregivers, using a questionnaire which includedpersonal data of the caregiver and the children, access to dental care, behavior and habits of oral hygieneused during the period of hospitalization. There was a low adherence to procedures (67%) and oralhygiene, reduced access to dental care (9.9%) and oral health devaluation in the hospitalized child. Inaddition there was an association significant (p<0.05) between the use of oral hygiene habits and thevariables: age child, pacifier use and prior access to dental care. The results suggest the need to discuss the approach oral health promotion in hospitals.

Radiografia panorâmica como possível método de diagnóstico de pacientes com risco de acidente vascular cerebral: revisão da literatura / Panoramic radiography as possible diagnostic method for patients with stroke risk: a literature review

Introdução: A aterosclerose é uma doença inflamatória crônica que pode ser causa de morte e incapacitação física/mental, representando um sério problema de saúde pública devido aos altos custos desprendidos com a reabilitação dos pacientes. Dentre os diferentes métodos para diagnosticar doenças ateroscleróticas, a angiografia é considerada o "padrão-ouro". No entanto, outros métodos de diagnóstico de imagem têm sido citados na literatura. Desde 1981, a presença de determinadas imagens radiopacas em radiografias panorâmicas tem sido descrita como sinal da presença de placas de ateroma carotídeas calcificadas. Apesar do benefício social que a radiografia panorâmica traria como novo método de diagnóstico para esse tipo de doença aterosclerótica, diminuindo assim o risco de acidente vascular cerebral, ainda existem controvérsias na literatura sobre seu uso como método confiável para esse fim. Objetivo: Nessa revisão vamos expor algumas das obras mais relevantes publicadas sobre esse assunto desde o primeiro estudo, em 1981, analisando a possibilidade do uso da radiografia panorâmica como exame de triagem para pacientes suscetíveis a acidente vascular cerebral. Métodos: No período de setembro de 2010 a março de 2011 foram utilizados os bancos de dados eletrônico do Medline e Lilacs para a seleção dos estudos. Foram incluídos aqueles que relacionavam o exame radiográfico panorâmico e a doença aterosclerótica. Conclusão: Existem divergências na literatura estudada, no que se refere à confiabilidade da radiografia panorâmica como método de diagnóstico de pacientes com risco de Acidente Vascular Cerebral. Novos estudos devem ser realizados a fim de determinar a sensibilidade e especificidade, bem como os valores preditivos, positivo e negativo, desse exame na identificação de placa de ateroma carotídea calcificada. Além disso, a generalização do conhecimento sobre o referido tema, bem como a capacitação de cirurgiões dentistas gerais na identificação do problema deve ser instituída.

Introduction: Atherosclerosis is a chronic inflammatory disease that can cause death and physical/mental disability, representing a serious public health problem due to cost related to the rehabilitation of the patients. Among the different methods to diagnose atherosclerotic disease, angiography is considered the "gold standard". However, other methods of diagnostic imaging have been cited in the literature. Since 1981, the presence of certain radiopaque images in panoramic radiographs has been described as a sign of the presence of calcified carotid atheromatous plaques. Despite the social benefit that panoramic radiography would provide as a new diagnostic method for this type of atherosclerotic disease, thereby reducing the risk of stroke, there is still controversy in literature about its use as a reliable method for this purpose. Objective: This review will expose some of the most relevant works published on this subject since the first study in 1981 examining the possibility of the use of panoramic radiography as a screening test for patients susceptible to stroke. Methods: From September 2010 to March 2011 was used the electronic databases Medline and Lilacs for the selection of studies. Was included those that related the panoramic radiographs and atherosclerotic disease. Conclusion: There are differences in the literature studied in relation to the reliability of panoramic radiography as a method to diagnose patients at risk for stroke. Further studies should be conducted to determine the sensitivity and specificity as well as predictive values, positive and negative, in this radiography for the identification of calcified carotid atheroma. Moreover, the generalization of knowledge on that topic as well as training of general dentists in identifying the problem should be instituted.

Neonatal factors associated with HIV long term non-progressors in a cohort of vertically infected children in Rio de Janeiro, Brazil ("Peixe" Project)

There are only scarce data on HIV progression in vertically infected children in developing countries. The aim of this study is to describe factors from neonatal period associated with long term non-progression (LTNP), in a Brazilian cohort. A cohort study, with data systematically collected from the "Peixe" Cohort (cohort study of children conducted at the main HIV Pediatric Center in Rio de Janeiro, from 1996 to 2005). The study included children who were vertically infected and started follow up at 5 years of age or younger. LTNP, defined as not reaching category C or severe immunosuppression before 5 years of age. Neonatal and demographic factors were studied. Variables with p-value<0.15 were included in a logistic regression model. 213 patients were included, of whom 42 percent (89/213) were classified as LTNP. Variables independently associated with LTNP were: baseline (at study entry) CD4+ cells (per percent) (OR= 1.06, 95 percentCI=1.01-1.12); age of initiating follow-up, per month (OR= 1.03, 95 percentCI=1.01-1.06); ZDV use duriing newborn period (OR= 3.31, 95 percentCI=0.86-12.71); use of antiretroviral (ART) before classification C or severe immunosuppression (OR= 5.89, 95 percentCI=2.03-17.10). Adjusting for age at the beginning of follow-up, antiretroviral that was unsuccessfully used to prevent maternal-to-child transmission (ZDV use in neonatal period) was associated with better prognosis. ARTs initiation before category C or severe immunosuppression was also associated with LTNP.

AIDS in childhood: cardiac involvement with and without triple combination antiretroviral therapy / AIDS na infância: acometimento cardíaco com e sem a terapia anti-retroviral tríplice combinada

OBJETIVO: Descrever a prevalência de alterações cardíacas ao ecocardiograma em crianças com AIDS acompanhadas em serviço de referência aos 18±6 meses do diagnóstico confirmado de AIDS. MÉTODOS: Estudo transversal, com corte aos 18±6 meses do diagnóstico de AIDS. Incluídas 93 crianças com diagnóstico confirmado de AIDS por transmissão vertical, sem doença maligna, que, na avaliação cardiológica, realizaram ecocardiograma (eco). De forma exploratória avaliaram-se as alterações cardíacas nos pacientes sem uso (G1) e com uso (G2) de terapia combinada anti-retroviral. RESULTADOS: Quando do diagnóstico de AIDS, as crianças tinham em média 3,07 anos e 50,50 por cento eram do sexo feminino. Esquema de terapia combinado com anti-retrovirais foi utilizado por 47 pacientes (G2). O acometimento cardíaco esteve presente em 40 crianças (43,00 por cento). A presença de disfunção ventricular esquerda (G1:39,10 por cento;G2:10,60 por cento) e o aumento isolado de ventrículo esquerdo (G1:6,60 por cento;G2:14,90 por cento) foram os achados mais freqüentes. Observou-se associação significativa entre os grupos sem e com terapia anti-retroviral combinada quanto à presença de disfunção ventricular esquerda (RP=3,42; [1,41-8,26]; p =0,02) e de desnutrição (RP=1,79; [1,00-3,20]; p=0,04). CONCLUSÃO: O acometimento cardíaco foi freqüente nas crianças com AIDS, sendo a disfunção ventricular esquerda a alteração mais observada ao ecocardiograma. Houve diferença estatisticamente significativa entre os grupos com e sem tratamento tríplice combinado quanto à presença de disfunção ventricular esquerda e de desnutrição.

OBJECTIVE: To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18±6 months of AIDS confirmed diagnosis. METHODS: A cross-section study with a cohort after 18±6 months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical transmission, with no malignancies and who underwent echocardiogram (echo) during cardiologic evaluation. Cardiac abnormalities were assessed in patients who were not treated (G1) and patients who were treated (G2) with combination antiretroviral therapy. RESULTS: When diagnosed with AIDS, the children were on average 3.07 years old and 50.50 percent were female. The combination regimen with antiretroviral agents was used by 47 patients (G2). Cardiac involvement was present in 40 children (43.00 percent). The presence of left ventricular dysfunction (G1: 39.10 percent; G2: 10.60 percent) and the isolated enlargement of left ventricle (G1: 6.60 percent; G2: 14.90 percent) were the most frequent findings. We observed a significant association between the groups without and with combination antiretroviral therapy asregards the presence of left ventricular dysfunction (PR= 3.42; [1.41-8.26]; p = 0.02) and malnutrition (PR = 1.79; [1.00-3.20]; p = 0.04). CONCLUSION: Cardiac involvement was frequent in children with AIDS and left ventricular dysfunction was the most common abnormality on echocardiogram. There was a statistically significant difference between the groups with and without triple combination treatment as regards the presence of left ventricular dysfunction and malnutrition.

Deficiência da glicose-6-fosfato desidrogenase com infeções de repetição: relato de caso / Glucose-6-phosphate dehydrogenase deficiency with recurrent infections: case report

Objetivo: relatar a ocorrência de uma deficiência funcional de neutrófilos rara, com quadro clínico e laboratorial semelhante ao da doença granulomatosa crônica. Métodos: relato de caso de paciente com deficiência acentuada da glicose-6-fosfato desidrogenase e infecções de repetição. Realizada pesquisa bibliográfica utilizando as bases de dados Medline e Lilacs abrangendo o período de 1972 a 2000. Resultados: paciente com nível da glicose-6-fosfato desidrogenase extremamente reduzido e quadro de infecções graves com melhora clínica após uso de cotrimoxazol contínuo. Os leucócitos do paciente apresentam defeito no metabolismo oxidativo, similar ao da doença granulomatosa crônica. Conclusões: o diagnóstico da deficiência da glicose-6-fosfato desidrogenase em neutrófilos deve ser considerado em qualquer paciente com anemia hemolítica não esferocítica congênita no qual o nível da glicose-6-fosfato desidrogenase esteja anormalmente baixo ou apresente infecções de repetição. É diagnóstico diferencial da doença granulomatosa crônica

Successful prevention of HIV transmission from mother to infant in Brazil using a multidisciplinary team approach

Objectives: To determine the HIV vertical transmission rate (VTR) and associated risk factors by use of zidovudine and infant care education in Brazil. Methods: Since 1995, a prospective cohort of HIV infected pregnant womwn has been followed at the Federal University of Rio de Janeiro. A multidisciplinary team was established to implement the best available strategy to prevent maternal-infant HIV transmission. Patients with AIDS or low CD4 and high viral load received anti-retroviral drugs in addition to zidovudine. Children were considered infected if they had 2 positive PCR-RNA test between 1 and 4 months of age, or were HIV antibody positive after 18 months. Education regarding infant treatment and use of formula insteadof breast feeding was provided. Results: Between 199 and August, 2000. HIV status was determined for 145 infants. Compliance with intra-partum treatment, infant treatment and use of formula was 88.2 percent. Intra-partum zidovudine treatment was completed in 134/145 (92.6 percent) of patients; 88.1 percent had rupture of membranes < 4 hours; 85.4 percent of mothers were asymptomatic. The mean CD4 count was 428,4 cells and mean viral load 39,050 copies. HIV vertical transmission rate was 4/145 (2.75 percent; CI: 0.1 percent - 5.4 percent). The only risk factor significantly associated with transmission was a failure to use zidovudine intra-partum in 2 of the 4 mothers (50 percent versus 6.4 percent in non-transmitting mothers). A trend toward low CD4 and high viral load at entry, and rupture of membranes > 4 hours were associated with increased HIV transmission. Conclusion: HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high levelof compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.

A eosinofilia na paracoccidioidomicose infantil / The eosinophilia in infantile paracoccidioidomycosis

Säo revistos 38 casos de paracoccidioidomicose (PCM) em crianças entre três e 14 anos de idade, internadas em três instituiçöes da cidade do Rio de Janeiro (1981 a 1996). Seus hemogramas foram estudados visando fundamentalmente a contagem dos eosinófilos, taxas de hematócritos e de VHS na 1ª hora. Faz-se o estudo específico da série sobre o comportamento dos eosinófilos em sangue periférico, em um, dois ou mais hemogramas de maior expressäo. Vinte e três crianças tiveram contagens absolutas de eosinófilos acima de 500/mmü, nove acima de 3.000/mmü e sete acima de 5.000/mmü. As observaçöes das nove crianças que tiveram mais de 3.000 eosinófilos/mmü säo apresentadas com a finalidade de ampliar as informaçöes da história natural da PCM nestas faixas etárias. As eosinofilias e hipereosinofilias vistas foram transitórias, às vezes flutuantes, nunca persistentes, desapareceram espontaneamente ou após a terapêutica antifúngica e, em duas crianças, surgiram, durante a mesma. Taxas de eosinófilos muito elevadas trouxeram à baila diagnósticos diferenciais com outras causas de hipereosinofilias, particularmente parasitoses intestinais, larva migrans visceral, esquistossomose aguda, leucemia eosinofílica, síndrome hipereosinofílico e outras condiçöes. Provavelmente as taxas elevadas de eosinófilos nesta micose representem mecanismos de defesa näo muito aperfeiçoados. Säo revistos alguns dados referentes à origem das eosinofilias, assim como o papel dos eosinófilos nestas situaçöes.

A eosinofilia em crianças de 3 a 7 anos com paracoccidioidomicose / The eosinnophilia in infancy (3 to 7 years) with paracoccidioidomycosis

Com base em uma série de 38 crianças entre três e catorze anos , internadas com paracoccidioidomicose (PCM) em três instituiçöes do Rio de Janeiro (entre 1981 e 1996), foram separadas onze dentro de uma faixa etária estabelecida entre três e sete anos, sendo estudadas quanto às suas taxas de eosinófilos no sangue periférico. Todas tiveram taxas absolutas acima de 500 por mm3. Cinco foram selecionadas e suas observaçöes detalhadas, por aparesentarem níveis absolutos de eosinófilos acima de 3.000/mm3, uma delas chegando a 20.000/mm3. As hipereosinofilias registradas näo dependeram de parasitoses; näo foram duradouras; sofreram modificaçöes, às vezes em curtos prazos; e desapareceramcom a terapêutica da micose ou mesmo espontaneamente. Quando hipereosinofilias acentuadas säo observadas no curso da PCM, geralmente indicam a doença grave em atividade, como as que foram vistas na presente série e as já publicadas na literatura. Faz-se uma revisäo das funçöes dos eosinófilos, assim como da gênese das eosinofilias em tais situaçöes

Tuberculose peritoneal: Relato de um caso / Peritoneal tuberculosis: A case report

Os autores descrevem um caso de tuberculose peritoneal solucionado através de prova terapêutica. Tratava-se de menina de nove anos com ascite cuja punçäo mostrou líquido amarelo com elevaçäo de proteínas e predomínio de linfócitos. A evoluçäo foi favorável

Linfadenite inguinal ulcerada tuberculosa / Ulcered inguinal lynfadenitis tuberculose

Os autores apresentam relato de três casos de linfadenite inguinal ulcerada tuberculosa. A escassez de casos na literatura motivou-nos esta apresentaçäo