Prevention of respiratory syncytial virus infections.

Respiratory syncytial virus is the most important cause of viral lower respiratory illness in infants and children worldwide. By the age of 2 years, nearly every child has become infected with respiratory syncytial virus and re-infections are common throughout life. Most infections are mild and can be managed at home, but this virus causes serious diseases in preterm children, especially those with bronchopulmonary dysplasia. Respiratory syncytial virus has also been recognized as an important pathogen in people with immunossupressive and other underlying medical problems and institutionalizated elderly, causing thousands of hospitalizations and deaths every year. The burden of these infections makes the development of vaccines for respiratory syncytial virus highly desirable, but the insuccess of a respiratory syncytial virus formalin-inactivated vaccine hampered the progress in this field. To date, there is no vaccine available for preventing respiratory syncytial virus infections, however, in the last years, there has been much progress in the understanding of immunology and immunopathologic mechanisms of respiratory syncytial virus diseases, which has allowed the development of new strategies for passive and active prophylaxis. In this article, the author presents a review about novel approaches to the prevention of respiratory syncytial virus infections, such as: passive immunization with human polyclonal intravenous immune globulin and humanized monoclonal antibodies (both already licensed for use in premature infants and children with bronchopulmonary dysplasia), and many different vaccines that are potential candidates for active immunization against respiratory syncytial virus.

[Controversial drugs in otorhinolaryngology] / Medicamentos controversos em otorrinolaringologia.

OBJECTIVES: To present a review on the most important groups of drugs used to treat otorhinolaryngological disorders. METHOD: Review of the literature about treatment of pediatric upper respiratory infections and allergy, using MEDLINE and LILACS data. RESULTS AND COMMENTS: Pediatric otorhinolaryngological disorders are extremely frequent and most of the time acute. They are one of the major reasons for pediatric visits. The therapeutical management of these conditions in many cases accounts for an over use of drugs, specially antibiotics, antipyretic and drugs of doubtful value, such as decongestants and expectorants. Judicious use, correct indication, and side effects of these drugs must be better known by physicians who deal with the child's health.

[Recommended vaccines and immunoglobulins for immunocompromised patients]. / Indicação de vacinas e imunoglobulinas em indivíduos que apresentam comprometimento da imunidade.

A revision of the literature was made as to the recommendations given for the use of vaccines and immune globulins in persons who presented total or partial immunodeficiency, mainly related to the nineties. The analysis of 75 references led to the following principal conclusions: the vaccines containing living agents are generally inappropriate for persons who present conditions which determine serious immunodeficiency; the vaccines which contain dead agents or only antigenic fractions, despite their being less immunogenic and conferring lower rates of protection to severely immunocompromised persons as compared to normal persons, are safe and should be administered to them. Immunocompromised patients should receive immune globulins for the same indications and in the same doses as immunocompetent persons, with the exception of immune globulin to prevent measles, as recommended in a dosage of 0.5 mL/Kg for immunodeficients (15 mL, maximum).

Experience in the evaluation of children with hepatosplenomegaly at a teaching ambulatory, São Paulo, Brazil.

OBJECTIVES: Describe cases of children with hepatosplenomegaly (HS) attended at the General Pediatric Teaching Ambulatory (AGER) of Instituto da Criança, São Paulo, identifying the main causes, evolution, necessity for hospitalization and/or referral to specialists. METHODOLOGY: Retrospective analysis of the records of children presenting HS on admission at AGER from September 1, 1993 to August 31, 1996. RESULTS: Of the 89 children included (age range, 1 to 148 months; 24 months), 64 (72%) were referred from other services for HS investigation. Most common presenting complaints were: fever--39 (44%); pallor--26 (29%); weight loss--21 (24%) and jaundice--14 (16%). Main alterations noticed on physical examination were: pallor--47 (53%) and short stature--17 (19%). Anemia was diagnosed in 70 children (79%); 35 children (39%) had infections; 7 (8%) metabolic disorders and 5 (6%) neoplastic disorders. The most frequent infections were of the urinary tract--9 (10%) and hepatitis A--6 (7%). Thirty six children (40%) were referred to specialists, 17 of which were already diagnosed. CONCLUSIONS: Most of the children with HS present deficiency anemia associated with infections which the general pediatrician is able to diagnose. Persistence of unexplained HS for more than 2 months, especially when there is substantial volume enlargement or alteration in the organs consistency, is an indication for referral to specialists.

[Use of medicines by children attending nursery schools]. / Utilização de medicamentos por crianças atendidas em creches.

In order to study the pattern of the use of medicines by children, 1,382 children seen at 15 of the 16 day-care centers of Pinheiros, S. Paulo city (SP) (Brasil), were followed-up for 2 months. Of these, 37% received 1,409 drugs. Average drug use was 50.9 medicines/100 children/month and the number of medicines used by each child ranged from 0 to 13. Younger children (0-2 years) received more medicines and more frequently than older children; over 80% of the younger children received one or more medicines, and more than 20% received 5 or more medicines vs. less than 45% and 5%, respectively, in the group of children aged 2-7 years. The medications most frequently employed were anti-infective, respiratory medicines and antipyretics used by, respectively. 20.1%, 19.0% and 14.0% of the children studied (usually for respiratory problems). Physicians prescribed 93% of medicines, but there were many inappropriate therapies for benign conditions, such as bronchitis and common colds. Antibiotic measure was observed (66%) including an excessive number of cloramphenicol prescriptions. Also, there were many prescriptions of doubtful value (decongestants, expectorants, vitamin and mineral supplements) and usage of as yet un approved medications for children (diclofenac, benzidamin, iodides).

[Pneumococcal vaccine: overview about the protective efficacy in different high risk groups and new progress in the development of a conjugate pneumococcal vaccine]. / Vacina anti-pneumocócica: eficácia em diferentes grupos de risco e recentes avanços no desenvolvimento de uma vacina mais imunogênica--atualização.

The author presents a review about the protective efficacy of polyvalent pneumococcal polysaccharide vaccines in different groups at high risk for severe pneumococcal infection and the difficulties in the development of a conjugate pneumococcal vaccine capable of offering protection to younger children.

Reuniao anatomo-clinica do Instituto da Crianca. / Anatomo-clinical meeting of the Instituto da Crianca

Os autores descrevem o caso de uma crianca de 3 anos e 8 meses de idade com sinais e sintomas de hipertensao portal. A necropsia revelou ser a causa uma doenca veno-oclusiva hepatica com comprometimentos, em extensao, das veias supra-hepaticas. A crianca faleceu 7 meses apos a internacao. E comentado o diagnostico diferencial com a Sindrome de Budd-Chiari, bem como os aspectos rediologicos dos quadros com hipertensao portal