Diagnosis of Tuberculosis among Children and Adolescents

The authors discuss the challenging aspects of the diagnosis of tuberculosis in children and adolescents, since there is no gold standard for its diagnosis. The different clinical and radiological presentations and the low bacteriological positivity of tuberculosis in childhood are grounds for confrontation to the present. Immunological tests called interferon gamma release assays (IGRAs) failed to overcome the tuberculin skin test in practice. Advances with nucleic acid amplification tests, on the other hand, have contributed to the diagnosis of tuberculosis among adolescents. Standardized systems for diagnosis can be useful as tools for screening or for decision‐making in childhood tuberculosis

Avaliação retrospectiva de sistema de pontuação pelo Ministério da Saúde do Brasil, no diagnóstico de tuberculose pulmonar na criança: estudo controle de casos

Based on a retrospective case-control study we evaluated the score system adopted by the Ministry of Health of Brazil (Ministério da Saúde - MS), to diagnose pulmonary tuberculosis (PTB) in childhood. This system is independent of bacteriological or histopathological data to define a very likely (>; or = 40 points), possible (30-35 points) or unlikely (;10mm (OR = 8.23). The best cut-off point to the diagnosis of PTB was 30 points, where the score system was more accurate, with sensitivity of 88.9% and specificity of 86.5%.Avaliou-se o sistema de pontuação adotado pelo Ministério da Saúde do Brasil para o diagnóstico de tuberculose pulmonar (TP) na infância através de estudo caso-controle retrospectivo. Tal sistema independe de dados bacteriológicos ou histopatológicos e define o diagnóstico de tuberculose como muito provável (>; ou = 40 pontos); possível (30 a 35 pontos) ou pouco provável (; 10 mm (OR = 8,23). O melhor ponto de corte para o diagnóstico de TP foi 30 pontos, no qual houve maior acurácia do sistema, com sensibilidade de 99,9% e especificidade de 86,5%

O ESTRESSE EM CRIANÇAS E ADOLESCENTES COM ASMA

Objetivos: verificar a presença do estresse em crianças e adolescentes com asma e avaliar aassociação do estresse com variáveis clínicas e psicossociais. Método: estudo transversal com criançase adolescentes asmáticos entre 7 e 12 anos de idade, atendidos em ambulatório de pneumologiapediátrica. Utilizou-se a Escala de Estresse Infantil, o Critério de Classificação Econômica Brasil equestionário padronizado para coleta de informações. A análise estatística foi realizada através doteste qui-quadrado, curva ROC, teste exato de Fisher e Mann-Whitney, sendo utilizado o modelo deregressão logística após análise univariada. Resultados: o estresse foi detectado em 38 % (19/50)dos pacientes, com predomínio de reações psicológicas. Foram encontradas associações comsignificância estatística entre o estresse e dificuldades escolares (p = 0,026), classe sócio-econômicaC2 e D (p=0,013) e sintomas da doença há sete anos ou menos (p = 0,0037). Estas associaçõespermaneceram após a regressão logística. Não foram encontradas associações com significânciaestatística entre a gravidade da asma e o estresse. Conclusões: houve estresse em mais de umterço dos casos de crianças e adolescentes com asma. Houve maior frequência de estresse emcrianças e adolescentes de classes sócio-econômicas desfavorecidas e naqueles que apresentavamsintomas de asma em período inferior ou igual a 7 anos e com dificuldades escolares.Objective: To evaluate stress in children and adolescents with asthma and its association withclinical and psychosocial features. Methods: Cross-sectional study conducted with asthmatic childrenand adolescents between 7 and 12 years old, seen at the pediatric pulmonary outpatient clinic. TheStress Childhood Scale, the Criterion of Economic Classification Brazil and a questionnaire wereused to collect data. Statistical analysis was realized using the Chi-square Test, ROC curve, FisherTest and Mann-Whitney. A logistic regression analysis model was used after univariety analysis.Results: Stress was detected in 38 % (19/50) of the patients, with predominance of psychologicalreactions. Statistical significance associations were found between stress and scholar difficulties,socioeconomic class C2 and D (p = 0,013) and asthma symptoms in a period less than or equal to 7years (p = 0,003). These associations remained after logistic regression model. There was no statisticalsignificance association between asthma gravity and stress. Conclusions: More than one-third ofchildren and adolescents with asthma were stressed. This rate was higher in lower socioeconomicclasses and in those patients with scholar difficulties and with symptoms of asthma in a period lessthan or equal to 7 years

Radiologic findings of pulmonary tuberculosis in adolescents

AbstractObjectiveTo describe radiologic findings of pulmonary tuberculosis (TB) in adolescents.MethodsRetrospective, cross-sectional, observational study of 850 patients with TB, aged 10 to 19 years, and notified to the Brazilian Ministry of Health. Data were collected from the TB notification and medical records in the cities of Manaus, Amazonas State, and Salvador, Bahia State, in the 1996–2003 period. Data are shown in tables and analyzed using the chi-square and Mann-Whitney tests, with a 5% significance level.ResultsMean age was 15.6 years; 443 (52.1%) patients were males. The most common radiologic lesion was the upper pulmonary lobe infiltrate (53.3%), and isolated cavitation was found in 32.4% of the patients. Both lungs were affected in 29.2% of the patients. The finding of bilateral radiologic lesions was significantly associated with longer disease duration (p = 0.0005).ConclusionsPulmonary TB in adolescents has similar characteristics to TB in adults, evidencing the important role played by adolescents in community disease transmission

Tuberculose em adolescentes em duas capitais brasileiras

Analisamos o perfil clínico-radiológico da tuberculose (TB) em adolescentes de duas capitais brasileiras, segundo a revisão de 2010 das normas do Programa Nacional de Controle da Tuberculose; estudo descritivo, retrospectivo, transversal de casos notificados de TB em Manaus e Salvador, de 1996 a 2003, em dois grupos: 10 a 14 anos e &#8805; 15 a 19 anos com estatística descritiva. Havia 1.781 adolescentes [928 (52,1%) do sexo masculino]. A média de idade = 16 anos (mediana = 16; DP = 2,3). Encontramos 1.447 (82,9%) pacientes com TB pulmonar; 179 (10,3%) com TB pleural e 81 (4,6%) com ganglionar periférica. A tosse ocorreu mais no grupo &#8805; 15 anos (p < 0,001). A baciloscopia foi positiva em 150 (72,1%) com TB pulmonar no grupo de 10 a 14 anos, e em 870 (84,4%) no grupo de &#8805; 15 anos. Havia radiografias de tórax do tipo adulto em 1.088 (98.6%) no grupo de &#8805; 15 anos, e em 58 (98.1%) no grupo < 15 anos (p < 0.0001). Houve tendência à maior ocorrência de TB bacteriológica do tipo adulto na medida em que o paciente aumentava de idade

Há associação entre o valor do volume expiratório forçado no 1º segundo e o Teste de Controle da Asma e a classificação do grau de controle proposta pelo Global initiative for Asthmaem crianças e adolescentes asmáticos tratados com corticosteroide inalató

Objective: Evaluate the presence of association between the classification of the level of asthma control, using the method proposed by the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT)/Childhood-ACT and the forced expiratory volume in the 1st second (FEV1), in asthmatic children and adolescents treated with inhaled corticosteroids, followed up at the National Institute of Women's, Children's and Adolescents' Health FernandesFigueira of the Oswaldo Cruz Foundation (IFF / FIOCRUZ). Method: A cross-sectional study was carried out with a review of the medical records of all children between 7 and 17 years of age followed up at the Asthma Outpatient Clinic and referred to the Respiratory Insertion Test (PFR) sector between March 2013 and September 2014. In the same day were applied the C-ACT/ACT questionnaires, an asthma control method proposed by the GINA and the FEV1 value in a spirometrictest. Results: From the total number of records evaluated (72), 16 children were excluded because they did not meet the required criteria for performing spirometry. The sample studied (56 children) was predominantly male (58.9%) and median age was 12 (7-17) years. It was observed an association between FEV1 and GINA values ??(p &lt;0.01). Conclusion: The results found in this study indicate that FEV1 measurement is a useful component among the instruments for assessing clinical control of asthma by GINA.Objetivo: Avaliar a presença de associação entre a classificação do grau de controle da asma, usando a proposta pelo Global initiative for Asthma(GINA), o AsthmaControl Test (ACT)/Childhood-ACT, e o volume expiratório forçado no 1º segundo (VEF1), em crianças e adolescentes asmáticos em tratamento com corticoide inalatório, atendidos no Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira da Fundação Oswaldo Cruz(IFF/FIOCRUZ). Método: Estudo transversal, com revisão de prontuários de todas as crianças entre 7 e 17 anos acompanhadas no Ambulatório de Asma e encaminhados ao setor de Prova de Função Respiratória (PFR) entre março de 2013 e setembro de 2014. Foram aplicados no mesmo dia, os questionários C-ACT/ACT, a classificação do grau de controle da asma proposta pelo GINA e o valor do VEF1 obtido em exame espirométrico. Resultados: Do total de prontuários avaliados (72), 16 crianças foram excluídas por não preencherem os critérios exigidos para realização da espirometria. A amostra estudada (56 crianças) apresentou predomínio do sexo masculino (58,9%) e mediana de idade igual a 12 (7-17) anos. Observou-se associação entre os valores de VEF1 e o GINA (p&lt;0,01). Conclusão: Os resultados encontrados nesse estudo indicam que a medida do VEF1é um componente útil dentre os instrumentos para avaliação do controle clínico da asma pelo GINA

Signs and symptoms indicative of community-acquired pneumonia in infants under six months

OBJECTIVE: Evaluation of the clinical signs and symptoms predicting bacterial and viral pneumonia, in accordance with the Brazilian National Control Program for Acute Respiratory (ARI). METHODS: Observational prospective study. Seventy-six children from birth to six months of age who had pneumonia were studied in the emergency room. The patients were subdivided into two groups, based on radiological findings (gold-standard): 47 had bacterial pneumonia, and 29 had viral pneumonia. The frequencies, sensitivities, and specificities of the signs and symptoms were evaluated. RESULTS: The sensibilities and sensitivities of general findings in bacterial pneumonia were, respectively: fever 53.2%/40.0%; hypoactivity 68.4%/55.6% and prostration detected by the doctor 72.7%/55.0%. The same findings in viral pneumonias showed, respectively: 37.9%/40.0%, 66.7%/55.6% and 66.7%/55.6%. The sensibilities and sensitivities of respiratory findings in bacterial pneumonia were, respectively: coughing 66.0/38.1%, Respiratory rate = 50 ripm 76.6%/38.1%, altered respiratory auscultation 91.3%/10.5%, and chest indrawing 46.7%/80.0%. The same findings in viral pneumonias were, respectively: 69.0%/38.1%, 86.2%/38.1%, 85.7%/10.5% and 44.8%/80.0%. CONCLUSION: Analysis of signs and symptoms in each group did not distinguish bacterial from viral pneumonia. Our findings reinforce the adequacy of the ARI program in Brazil, which gives an early diagnosis of pneumonia, independent of its etiology