Hepatitis A: How We Are after the Introduction of Vaccines

Hepatitis A is a disease known for a long time. It has a universal distribution, although it has a higher prevalence in places with poor sanitary conditions due to its main form of transmission: fecal-oral. The local health conditions also influence the age of acquisition of the disease and, therefore, its clinical presentation, because the disease in young children is usually asymptomatic. It is a viral disease whose prevention is possible through improvements in the population’s basic sanitation conditions and vaccination. Since the introduction of vaccines, it has been possible to see a reduction in its incidence, especially in places where universal vaccination of children has been instituted. In recent years immunoglobulin therapy is being replaced by vaccination in pre- and postexposure prophylaxis (PEP), except in specific situations. Its incidence, even in developing countries, has decreased after introduction of hepatitis A vaccine. The vaccine is recommended in two doses for children, starting at the age of 1. Argentina and, more recently, Brazil have adopted the universal vaccination of all children upon completion of 12 months of age in a single-dose regimen. Despite this breakthrough isolated outbreaks in homeless and drug users are still described in developed countries

Telepediatria: normas, legislação e ética: Telepaediatrics: standards, legislation and ethics

A pandemia pela Covid-19 alterou de forma significativa a forma de oferta de cuidados e a atenção à saúde. A telessaúde passou por uma transformação rápida e massiva, com um grande aumento de pacientes e provedores experientes em seu uso. As novas práticas devem considerar modelos de prestação de cuidados nos quais a telessaúde e o atendimento presencial sejam ainda mais integrados, seguindo as legislações e regras de convivência. Este artigo tem como objetivo discutir as legislações atuais para esta nova prática, em especial ao que se refere à telepediatria. No Brasil, novas leis e resoluções foram publicadas. A Sociedade Brasileira de Pediatria elaborou um guia para propiciar dados e orientações sobre estas novas práticas. O padrão ouro é a consulta presencial, mas a telemedicina atualmente ocupa papel de destaque na atenção à saúde. Neste novo modelo é importante auxiliar os profissionais e os pais/responsáveis pelos pacientes a utilizar de forma legal e responsável as ferramentas disponíveis. As legislações que asseguram a confidencialidade, sigilo e segurança dos dados tem sido cada vez mais aprimoradas. A questão ética para a assistência não difere da forma presencial e as boas práticas de publicidade devem ser seguidas

Enfrentamento à pandemia: conhecimento acessível à comunidade / Coping with the pandemic: Knowledge accessible to the community

A pandemia pela COVID-19 altera a saúde global e coloca em risco a comunidade e o grupo de pessoas com deficiência visual e surdas. Docentes e alunos da Universidade Federal de Minas Gerais decidiram ofertar curso via e-mail e via página eletrônica para disseminar conhecimento sobre medidas preventivas e combate às fake News. A divulgação ocorreu dentro da comunidade universitária e em grupos comunitários. O objetivo deste estudo foi avaliar duas metodologias (por e-mail e pela página eletrônica) do curso, com avaliação do perfil dos participantes, da adesão e do desempenho. O curso contou com 1.841 inscritos. O grupo de participantes via e-mail apresentou em relação aos demais:  idade superior (p<0,001); maior número de deficientes (p=0,008) e de mulheres (p<0,001); maior escolaridade (p<0,001). Constatou-se associação entre a metodologia do curso e ter ou não recebido o auxílio financeiro emergencial (p=0,001) devido à pandemia e possuir filhos (p<0,001). Ocorreu progressão no conhecimento em ambos os grupos. A persistência até o final do curso foi maior no sexo masculino com correlação positiva (p=0,03; força de associação de 5,1%). Aqueles que não finalizaram o curso apresentaram média de idade superior (37,5 anos) aos que finalizaram (35,6 anos), com p=0,04. Apesar da baixa adesão geral, o curso contribuiu de forma acessível para disseminação do conhecimento científico sobre a COVID-19

Mídia digital na educação em saúde: Uma forma de enfrentamento da pandemia da COVID-19

A pandemia de Covid-19 veio associada à disseminação de grande volume de informações, verdadeiras e falsas, sobre a doença, com potencial impacto no seu controle, por interferir em comportamentos e condutas preventivas e terapêuticas. Motivados pela necessidade de produzir informações confiáveis e combater ‘fakenews’, professores e alunos da Universidade Federal de Minas Gerais desenvolveram projeto de extensão abordando a Covid-19, com o propósito de divulgar materiais educativos para a população em geral, por meio de postagens científicas e realização de webconferências. As plataformas digitais utilizadas foram Instagram e YouTube. O objetivo deste estudo é descrever a ação extensionista e discutir as mídias sociais como estratégia de educação em saúde. As métricas do Instagram foram analisadas de maio a fevereiro de 2022, com média mensal de alcance de 1.928 e engajamento de 552 pessoas. Tivemos um total de 649 seguidores, sendo a maioria mulheres (80,8%) e adultos jovens até 34 anos (38,4%), provenientes da cidade de Belo Horizonte (57,4%). As webconferências abordaram os temas: retorno às atividades escolares presenciais, saúde mental infantil, aspectos bioéticos e direito à vacinação, testagem e atualização sobre vacinas contra Covid-19 para crianças. Em conjunto, houve mais de 6.000 visualizações. A estratégia de educação em saúde por meio de mídias digitais e transmissões on-line constitui importante ferramenta no cenário de distanciamento e do isolamento social imposto pela pandemia, contribuindo para a disseminação do conhecimento científico de qualidade. Palavras-chave: Educação em saúde, Coronavírus, Redes Sociais, Extensão Universitária Digital media in health education: A means to face the COVID-19 pandemic Abstract: The Covid-19 pandemic was associated with disseminating a large volume of true and false information, potentially impacting disease control by interfering with preventive and therapeutic behaviors and conduct. Motivated by the need to produce reliable information and mitigate "fake news," professors and students of the Federal University of Minas Gerais developed an extension project on Covid-19 to disseminate educational materials to the general population through scientific posts and web conferencing. The digital platforms used for this purpose were Instagram and YouTube. This study aimed to describe the extensionist action and discuss social media as a health education strategy. Instagram metrics were analyzed from May to February 2022, with a monthly average reach of 1,928 and an engagement of 552 people. We had a total of 649 followers, most of them women (80.8%) and young adults up to 34 years old (38.4%) from the city of Belo Horizonte (57.4%). The web conferences addressed the topics: of return to face-to-face school activities, child mental health, bioethical aspects, and the right to vaccination, testing, and updating on vaccines against Covid-19 for children. Altogether, there were over 6,000 views. The health education strategy through digital media and online broadcasts is a crucial tool in the scenario of distancing and social isolation imposed by the pandemic, contributing to disseminating reliable scientific knowledge. Keywords: Health education, Coronavirus, Social Networks, University Extensio

COVID-19 in Brazilian children and adolescents: findings from 21 hospitals / COVID-19 em crianças e adolescentes brasileiros: registros de 21 hospitais

Introdução: Crianças e adolescentes com Covid-19 apresentam menor mortalidade e sintomas menos intensos quando comparados aos adultos. Os estudos no Brasil baseiam-se apenas no sistema de notificação compulsória. Objetivo: Analisar as características clínicas, laboratoriais, radiológicas e desfechos de pacientes hospitalizados com menos de 20 anos de idade com Covid-19. Métodos: Série de casos de pacientes internados com Covid-19, confirmado, com idade inferior a 20 anos, obtida em estudo de coorte em 21 hospitais de cinco estados brasileiros. Resultados: Dos 36 pacientes, 20 (55,5%) eram adolescentes, 20 (55,5%) eram do sexo masculino, 18 (50,0%) apresentavam comorbidades, 2 estavam grávidas; e em 7 (19,4%) os sintomas iniciais ocorreram durante a internação por outras causas, dos quais 3 foram possivelmente infectados no hospital. Febre (61,1%), dispneia (33,3%) e sintomas neurológicos (33,0%) foram as queixas mais comuns. A proteína C reativa estava acima de 50mg / L em 16,7% e o dímero-D estava acima do limite de referência em 22,2%. Radiografias de tórax foram realizadas em 20 (55,5%) pacientes, 9 apresentavam anormalidades; e tomografias computadorizadas de tórax em 5. O tempo de internação variou de 1-40 dias (mediana 5 [intervalo interquartil 3-10]), 16 (44,4%) necessitaram de cuidados intensivos, 6 (16,7%) necessitaram de ventilação mecânica e um paciente (2,8%) faleceu. Conclusão: Em uma amostra de pacientes menores de 20 anos, procedentes de hospitais de 5 estados do Brasil, as comorbidades foram frequentes e os sintomas mais comuns foram febre, dispneia e sintomas neurológicos. Quarenta e quatro por cento dos pacientes necessitaram de cuidados intensivos, mostrando que na amostra avaliada a doença não era tão leve quanto o esperado, e um paciente morreu. 

Teaching basic life support for medical students: Assessment of learning and knowledge retention

BACKGROUND: Education mediated by simulation is a widely used method for teaching basic life support (BLS). The American Heart Association recommends protocols based on scientific evidence to reduce sequelae and mortality. We aimed to assess learning and retention of knowledge of BLS in students of the first semester of the medical course using teaching methods of dialogic expository class (group 1), expository and demonstrative class (group 2), and the two previous methodologies associated with simulated practice (group 3), and after 3 months, memory retention. MATERIALS AND METHODS: This was an experimental, prospective, randomized study. Participants were assessed in terms of performance in theoretical and simulated practical tests, satisfaction with training (Likert scale), and knowledge retention. RESULTS: The practical test results were analyzed by two experienced observers. Students had 20% progression in knowledge and 80% retention of knowledge after 3 months of exposure comparing the theoretical pre- and posttest. The students in group 3 performed better than the others (P = 0.007) in the posttest. With the simulated practice, the knowledge acquired was maintained after 3 months with a mean performance of 90%, but in the test of the infant age group, there was a loss of learning retention by 10%. There was no difference of the results between the two evaluators (P < 0.001). The training was positively assessed by the participants. CONCLUSION: The use of different methodologies promoted knowledge progression, with emphasis on simulated practice. Learning retention was maintained after 3 months. In order to teach BLS to infants, it may be necessary to improve teaching techniques

E-Learning and Simulation on a Pré-Hospital Emergency Course: A Participant’s Perspective

ABSTRACT The use of simulation and e-learning has increased considerably in healthcare related educational activities, enabling the acquisition of skills ethically and safely. The objective is to describe the design and evaluation of a semi-distance pre-hospital emergency course for physicians and nurses at the Public Health Department of Belo Horizonte City, Minas Gerais, Brazil. The course comprised 13 online lessons and ten stations, which used simulated scenarios. The participants answered a semi-structured questionnaire using the Likert scale to evaluate the course. Course participation included 203 (63.6%) physicians and 116 (36.4%) nurses; most physicians (72.1%) had finished their studies over five years prior to the study, and had little practice (72.9%) on advanced life support measures. The distance course was well evaluated in terms of general quality, video quality, use of images and animations and usability. The e-learning system was considered to be user friendly by doctors and nurses, and the practical activities were well rated. The course used methodology based on simulation and distance education, and received positive evaluations. The system was rated as good and easy to use

Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center

CONTEXT: Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication - the upper gastrointestinal bleeding. OBJECTIVE: To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. METHODS: This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound. RESULTS: Of the 55 studied patients, 30 (54.5%) were male. In 29 patients (52.7%), none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%). In 20 patients (36.4%), the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9%) showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. CONCLUSIONS: The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an appropriate diagnostic and treatment approach is desirable in an attempt to reduce morbidity and mortality