Clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011) / Características clínicas e desfechos de pneumonia comunitária aguda em crianças hospitalizadas em serviço público de referência de Pernambuco, Brasil (2010-2011)

Abstract Objectives: to describe the clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011) Methods: pneumonia case series of 80 children aged 28 days to 14 years old at Hospital da Restauração in Pernambuco, Brazil, from 2010 to 2011. Information was noted from medical files, and two comparison groups were created according to the severity of the disease, considering the presence of pleural effusion. Fisher or Mann-Whitney tests were used for comparative analyses. Results: severe pneumonia with pleural effusion was more frequent in children under five years of age (p=0,025), and was associated with longer period of fever (19 x 15 days) and coughing (17 x 13 days), when compared to non-complicated pneumonia cases. Six children (7,5%, 6/80) died, 50% before the fourth day of hospitalization (p=0,001). All deaths were from the pleural effusion group in children from the countryside (p=0,026). Conclusions: the severity of pneumonia in children attended at this hospital is related to younger children, and those transferred from the health units in the countryside, so, early diagnosis and medical intervention are limited by infrastructure and available resources for the health.

Resumo Objetivos: descrever as características clínicas e desfechos de pneumonia comunitária aguda em crianças assistidas em hospital público de referência no Estado de Pernambuco, Brasil (2010-2011). Métodos: série de casos de pneumonia em 80 crianças de 28 dias a 14 anos no Hospital da Restauração em Pernambuco, Brasil, entre maio de 2010 a 2011. As informações foram anotadas do registro hospitalar, sendo criado dois grupos de comparação de acordo com a gravidade da doença, considerando a presença ou não de derrame pleural. A análise comparativa utilizou os testes de Fisher ou Mann-Whitney. Resultados: pneumonia grave com derrame pleural foi mais frequente em menores de cinco anos (p=0,025), associado a maior período de febre (19 x 15 dias) e tosse (17 x 13 dias), compardo com casos de pneumonia não-complicada. Seis crianças (7,5%, 6/80) morreram. 50% antes do quarto dia de internação (p= 0,001). As mortes foram no grupo com derrame pleural, em crianças do interior do estado (p= 0,026). Conclusões: a gravidade da pneumonia em crianças atendidas neste hospital está relacionada a crianças menores, e naquelas transferidas de unidades de saúde do interior, cujo diagnóstico precoce e intervenção médica adequada são limitados pela infraestrutura e recursos disponíveis para a saúde.

Polimorfismos do gene NRAMP1 em indivíduos com reações hansênicas, atendidos em dois Centros de Referência no Recife, nordeste do Brasil / NRAMP1 gene polymorphisms in individuals with leprosy reactions attended at two reference centers in Recife, northeastern Brazil

INTRODUÇÃO: Para investigar susceptibilidade às reações hansênicas, três polimorfismos do gene natural resistance-associated macrophage protein (NRAMP1), foram determinados em 201 indivíduos, atendidos em dois centros de referência no Recife, entre 2007 e 2008, sendo 100 paucibacilares e 101 multibacilares. MÉTODOS: A determinação dos polimorfismos 274C/T, D543N e 1729+55del4 do gene NRAMP1 foi realizada utilizando a técnica do polimorfismo de fragmento de restrição em DNA extraído de sangue periférico e as estimativas das freqüências alélicas e genotípicas foram feitas por contagem direta. RESULTADOS: Os genótipos predominantes foram: CC (51,8 por cento) para 274C/T, GG (86,6 por cento) para D543N e +-TGTG (59,9 por cento) para 1729+55del4. O genótipo mutante 274 TT predominou na negatividade da reação reversa (p=0,03) e na positividade do eritema nodoso (p=0,04). CONCLUSÕES: Nossos resultados sugerem que o polimorfismo 274 C/T do gene NRAMP1 pode auxiliar na determinação da susceptibilidade à reação tipo II em indivíduos com hanseníase.

INTRODUCTION: To investigate susceptibility to leprosy reactions, three polymorphisms of the natural resistance-associated macrophage protein (NRAMP1) gene were determined in 201 individuals who were attended at two reference centers in Recife, between 2007 and 2008. Of these, 100 were paucibacillary and 101 were multibacillary. METHODS: The 274C/T, D543N and 1729+55del4 polymorphisms of the NRAMP1 gene were determined using the technique of restriction fragment polymorphism on DNA extracted from peripheral blood. Allelic and genotypic frequencies were estimated by direct counting. RESULTS: The predominant genotypes were: CC (51.8 percent) for 274C/T; GG (86.6 percent) for D543N; and +-TGTG (59.9 percent) for 1729+55del4. The mutant genotype 274 TT predominated in negativity of the reverse reaction (p = 0.03) and in positivity of erythema nodosum leprosum (p = 0.04). CONCLUSIONS: Our results suggest that 274 C/T polymorphism of the NRAMP1 gene may aid in determining the susceptibility to type II reactions among leprosy patients.

Prevalence of cagA and vacA genes in isolates from patients with Helicobacter pylori-associated gastroduodenal diseases in Recife, Pernambuco, Brazil

Geographical differences in the prevalence of Helicobacter pylori genes and their association with disease severity have been identified. This study analyzes the prevalences of the cagA gene and alleles of the vacA gene in H. pylori-associated gastroduodenal diseases in isolates from Recife, PE, Brazil. Gastric biopsy of 61 H. pylori-positive patients were submitted to DNA extraction and gene amplification by polymerase chain reaction. Among the 61 patients, 21 suffered from duodenal ulcer (DU) and 40 from gastritis (GT). The prevalence of H. pylori strains harbouring the cagA gene was higher in the DU group (90.5 percent) than in the GT group (60 percent) (p = 0.02). The vacA gene was amplified in 56 out of 61 biopsies, of which 43 (76.8 percent) contained bacteria carrying the s1 allele and 13 (23.2 percent) the s2. However, the prevalence of the vacA s1 genotying was the same in either DU or GT group. The majority of the s1-typed strains, 39 (90.7 percent) out of 43, were subtype s1b. In resume there was a strong association between the H. pylori cagA+ gene and DU. However, there were no differences between the DU and GT groups in relation to the vacA s1 and s2 alleles distribution, albeit the subtype s1b was predominat