Association Between Ventilation Index And Time On Mechanical Ventilation In Infants With Acute Viral Bronchiolitis

Objective: To evaluate the association between time on mechanical ventilation and anthropometric, clinical and pulmonary function variables, measured early, in infants on invasive mechanical ventilation with acute respiratory failure due to viral bronchiolitis, and the temporal progression of variables with significant correlations. Methods: Twenty-nine infants admitted to the pediatric intensive care unit of UNICAMP university hospital were studied. Acute viral bronchiolitis was defined according to clinical and radiological criteria. Children with chronic diseases and those that were hemodynamically unstable were excluded. All measurements were taken after 24 to 72 hours' mechanical ventilation, using volumetric capnography and blood gas analysis. Mechanical ventilation time was divided into: ≤ 7 days and > 7 days. Association between time on mechanical ventilation and the variables analyzed was determined by Spearman's Correlation Coefficient (r s). Results: Time on mechanical ventilation showed a significant positive correlation with PaCO 2 (r s = 0.45, p = 0.01) and ventilation index (r s = 0.51, p = 0.005), and a negative correlation with pH (r s = -0.40, p = 0.03). Ventilation indices of 37, measured between day one and day five, was associated with a progressively increased risk of more than 7 days on mechanical ventilation (OR = 4.2 on the first day to 15.71 on the fourth day). Conclusions: Ventilation index, PaCO 2 and pH, measured early, were associated with prolonged mechanical ventilation, reflecting the severity of ventilatory disturbance and the need for support. Copyright © 2005 by Sociedade Brasileira de Pediatria.816466470Shay, D.K., Holman, R.C., Newman, R.D., Liu, L.L., Stout, J.W., Anderson, L.J., Bronchiolitis-associated hospitalizations among US children, 1980-1996 (1999) JAMA, 282, pp. 1440-1446Torres, A., Gatell, J.M., Aznar, E., El-Ebiary, M., Puig De La Bellacasa, J., Gonzalez, J., Re-intubation increases the risk for nosocomial pneumonia in patients needing mechanical ventilation (1995) Am J Respir Crit Care Med, 152, pp. 137-141Esteban, A., Alia, I., Gordo, F., Fernandez, R., Solsona, J.F., Vallverdu, I., Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation (1997) Am J Respir Crit Care Med, 156, pp. 459-465. , The Spanish Lung Failure Collaborative GroupBont, L., Kavelaars, A., Heijnen, C.J., Van Vught, A.J., Kimpen, J.L., Monocyte interleukin-12 production is inversely related to duration of respiratory failure in respiratory syncytial virus bronchiolitis (2000) J Infect Dis, 181, pp. 1772-1775Tasker, R.C., Gordon, I., Kiff, K., Time course of severe respiratory syncytial virus infection in mechanically ventilated infants (2000) Acta Paediatr, 89, pp. 938-941Arnold, J.H., Thompson, J.E., Arnold, L.W., Single breath CO 2 analysis: Description and validation of a method (1996) Crit Care Med, 24, pp. 96-102Riou, Y., Leclerc, F., Neve, V., Dupuy, L., Noizet, O., Leteurtre, S., Reproducibility of the respiratory dead space measurements in mechanically ventilated children using the CO 2SMO monitor (2004) Intensive Care Med, 30, pp. 1461-1467Hubble, C.L., Gentile, M.A., Tripp, D.S., Craig, D.M., Meliones, J.N., Cheifetz, I.M., Deadspace to tidal volume ratio predicts successful extubation in infants and children (2000) Crit Care Med, 28, pp. 2034-2040Main, E., Stocks, J., The influence of physiotherapy and suction on respiratory deadspace in ventilated children (2004) Intensive Care Med, 30, pp. 1152-1159Law, B.J., Carbonell-Estrany, X., Simoes, E.A., An update on respiratory syncytial virus epidemiology: A developed country perspective (2002) Respir Med, 96 (SUPPL. B), pp. S1-7Davison, C., Ventre, K.M., Luchetti, M., Randolph, A.G., Efficacy of interventions for bronchiolitis in critically ill infants: A systematic review and meta-analysis (2004) Pediatr Crit Care Med, 5, pp. 482-489Frankel, L.R., Lewiston, N.J., Smith, D.W., Stevenson, D.K., Clinical observations on mechanical ventilation for respiratory failure in bronchiolitis (1986) Pediatr Pulmonol, 2, pp. 307-311Wang, E.E., Law, B.J., Boucher, F.D., Stephens, D., Robinson, J.L., Dobson, S., Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of admission and management variation in patients hospitalized with respiratory syncytial viral lower respiratory tract infection (1996) J Pediatr, 129, pp. 390-395Paret, G., Ziv, T., Barzilai, A., Bem-Abraham, R., Vardi, A., Manisterski, Y., Ventilation index and outcome in children with acute respiratory distress syndrome (1998) Pediatr Pulmonol, 26, pp. 125-12

Quality Of Sleep And Quality Of Life In Adolescents Infected With Human Immunodeficiency Virus [qualidade Do Sono E Qualidade De Vida Em Adolescentes Infectados Pelo Vírus Da Imunodeficiência Humana]

Objectives: To assess sleep characteristics of adolescents infected by HIV, and to ascertain whether psychosocial aspects are associated to the quality of sleep. Methods: A cross-sectional study assessing 102 HIV-infected adolescents of both genders, aged between 10 and 20 years-old and 120 Controls. Data collection was performed by applying the Sleep Disturbance Scale for Children, the Epworth Sleepiness Scale, and the Pediatric Quality of Life Inventory. Results: A sleep disturbance prevalence of 77.4% was found in patients, and a 75% prevalence in controls, and there was correlation between quality of sleep and of life. HIV-infected adolescents scored higher for sleep breathing disorders and had higher prevalence of excessive daytime sleepiness. Conclusions: HIV-infected adolescents had similar quality of sleep compared to healthy adolescents. This may be explained by the steady improvements in daily living as a result of successful anti-retroviral therapy, and by the vulnerability that affects Brazilian adolescents living in major urban centers.706422427Carskadon, M.A., Sleep in adolescents: The perfect storm (2011) Pediatr Clin North Am, 58, pp. 637-647Owens, J.A., Belon, K., Moss, P., Impact of delaying school start time on adolescent sleep, mood, and behavior (2010) Arch Pediatr Adolesc Med, 164, pp. 608-614de-la-Llata-Romero, M., Castorena-Maldonado, A., Corsi-Cabrera, M., Sleep medicine: Development, contributions and perspectives Report of the work group on sleep medicine (2011) Rev Invest Clin, 63, pp. 90-99Mindell, J.A., Owens, J., Alves, R., Give children and adolescents the gift of a good night's sleep: A call to action (2011) Sleep Med, 12, pp. 203-204Moore, M., Meltzer, L.J., The sleepy adolescent: Causes and consequences of sleepiness in teens (2008) Paediatr Respir Rev, 9, pp. 114-120(2010) Global report: UNAIDS report on the global AIDS epidemic, , http://www.unaids.org/globalreport/documents/20101123_GlobalReport_full_en.pdf, Joint United Nations Programme on HIV/AIDS (UNAIDS), [cited 16 May 2011]. Available at(2011) Ministério da Saúde 2010, , http://www.aids.gov.br/publicacao/boletim-epidemiologico-2010, Brasil, Departamento de DST, Aids e Hepatites Virais. Boletim Epidemiológico AIDS 2010 (versão preliminar). [cited 21 March]. Available atHazra, R., Siberry, G.K., Mofenson, L.M., Growing up with HIV: Children, adolescents, and young adults with perinatally acquired HIV infection (2010) Ann Rev Med, 61, pp. 169-185Ramos, A.N., Matida, L.H., Hearst, N., Heukelbach, J., AIDS in Brazilian children: History, surveillance, antiretroviral therapy, and epidemiologic transition, 1984-2008 (2011) AIDS Patient Care STDS, 25, pp. 245-255Franck, L.S., Johnson, L.M., Lee, K., Sleep disturbances in children with human immunodeficiency virus infection (1999) Pediatrics, 104, pp. 1-5Reid, S., Dwyer, J., Insomnia in HIV Infection: A systematic review of prevalence, correlates and management (2005) Psychosomatic Med, 67, pp. 260-269Rocha, C.R.S., Rossini, S., Reimão, R., Sleep disorders in high school and pre-university students (2010) Arq Neuropsiquiatr, 68, pp. 903-907Mesquita, G., Reimão, R., Nightly use of computer by adolescents: Its effect on quality of sleep (2007) Arq Neuropsiquiatr, 65, pp. 428-432Varni, J.W., Seid, M., Rode, C.A., The PedsQL: Measurement model for the pediatric quality of life inventory (1999) Med Care, 37, pp. 126-139(2009) Ministério da Saúde, , Brasil, Secretaria de Vigilância em Saúde. Programa Nacional de DST e Aids. Recomendações para Terapia Antirretroviral em Crianças e Adolescentes Infectados polo HIV. Manual de bolso. Ministério da Saúde, Secretaria de Vigilância em Saúde, Programa Nacional de DST e Aids. Brasília: Ministério da SaúdeBruni, O., Salvatori, O., Guidetti, V., The sleep disturbance scale for children (SDSC) Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence (1996) J Sleep Res, 5, pp. 251-261Johns, M.W., A new method for measuring daytime sleepiness: The Epworth sleepiness scale (1991) Sleep, 14, pp. 540-545Ferreira, V.R., Carvalho, L.B.C., Ruotolo, F., Morais, J.F., Prado, L.B.F., Prado, G.F., Sleep disturbance scale for children: Translation, cultural adaptation and validation (2009) Sleep Med, 10, pp. 457-463Bertolazi, N.A., Fagondes, S.C., Hoff, L.S., Pedro, V.D., Barreto, S.S.M., Johns, M.W., Validação da escala de sonolência de Epworth em português para uso no Brasil (2009) J Bras Pneumol, 35, pp. 877-883Klatchoian, D.A., Len, C.A., Terreri, M.T., Quality of life of children and adolescents from São Paulo: Reliability and validity of the Brazilian version of the Pediatric Quality of Life Inventory TM version 4.0 Generic Core Scales (2008) J Pediatr (Rio J), 84, pp. 308-315Potasz, C., Juliano, M.L., Varela, M.J., Prevalence of sleep disorders in children of a public hospital in São Paulo (2010) Arq Neuropsiquiatr, 68, pp. 235-241Carotenuto, M., Bruni, O., Santoro, N., Giudice, E.M., Perrone, L., Pascotto, A., Waist circumference predicts the occurrence of sleep-disordered breathing in obese children and adolescents: A questionnaire-based study (2006) Sleep Med, 7, pp. 357-361Ramalho, L.C.B., Gonçalves, E.M., Carvalho, W.R.G., Abnormalities in body composition and nutritional status in HIV-infected children and adolescents on antiretroviral therapy (2011) Int J STD AIDS, 22, pp. 453-456Chan, E.Y., Ng, D.K., Chan, C.H., Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: A retrospective study (2009) Sleep Breath, 13, pp. 59-63Melendres, M.C., Lutz, J.M., Rubin, E.D., Marcus, C.L., Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing (2004) Pediatrics, 114, pp. 768-775van Litsenburg, R.R., Huisman, J., Hoogerbrugge, P.M., Egeler, R.M., Kaspers, G.J., Gemke, R.J., Impaired sleep affects quality of life in children during maintenance treatment for acute lymphoblastic leukemia: An exploratory study (2011) Health Qual Life Outcomes, 18, pp. 9-25Erickson, J.M., Beck, S.L., Christian, B.R., Fatigue, sleep-wake disturbances, and quality of life in adolescents receiving chemotherapy (2011) J Pediatr Hematol Oncol, 33, pp. 17-25Mitchell, R.B., Boss, E.F., Pediatric obstructive sleep apnea in obese and normal-weight children: Impact of adenotonsillectomy on quality-of-life and behavior (2009) Dev Neuropsychol, 34, pp. 650-661Crabtree, V.M., Varni, J.W., Gozal, D., Health-related quality of life and depressive symptoms in children with suspected sleep-disordered breathing (2004) Sleep, 27, pp. 1131-1138Ong, L.C., Yang, W.W., Wong, S.W., Alsissiq, F., Khu, Y.S., Sleep habits and disturbances in Malaysian children with epilepsy (2010) J Paediatr Child Health, 46, pp. 80-8

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

Endocarditis By Kocuria Rosea In An Immunocompetent Child

Kocuria rosea belongs to genus Kocuria (Micrococcaceae family, suborder Micrococcineae, order Actinomycetales) that includes about 11 species of bacteria. Usually, Kocuria sp are commensal organisms that colonize oropharynx, skin and mucous membrane Kocuria sp infections have been described in the last decade commonly affecting immunocompromised patients, using intravenous catheter or peritoneal dialysis. These patients had mainly bacteremia/recurrent sepsis. We hereby describe the case of a 10-year-old girl, immunocompetent, who had endocarditis/sepsis by K. rosea which was identified in five different blood cultures by Vitek 2 ID-GPC card (BioMérieux, France). Negative HIV serology, blood count within normal range of leukocytes/neutrophils and lymphocytes, normal fractions of the complement, normal level of immunoglobulins for the age lymphocyte immunophenotyping was also within the expected values. Thymus image was normal at chest MRI. No catheters were required. Identification of K. rosea was essential to this case, allowing the differentiation of coagulase-negative staphylococci and use of an effective antibiotic treatment. Careful laboratory analysis of Gram-positive blood-born infections may reveal more cases of Kocuria sp infections in immunocompetent patients, which may collaborate for a better understanding, prevention and early treatment of these infections in pediatrics.1918284Savini, V., Catavitello, C., Masciarelli, G., Drug sensitivity and clinical impact of members of the genus Kocuria (2010) J Med Microbiol, 59, pp. 1395-1402Becker, K., Rutsch, F., Uekötter, A., Kocuria rhizophila adds to the emerging spectrum of micrococcal species involved in human infections (2008) J Clin Microbiol, 46, pp. 3537-3539Dotis, J., Printza, N., Papachristou, F., Peritonitis attributable to Kocuria rosea in a pediatric peritoneal dialysis patient (2012) Perit Dial Int, 32, pp. 577-578Moissenet, D., Becker, K., Mérens, A., Persistent bloodstream infection with Kocuria rhizophila related to a damaged central catheter (2012) J Clin Microbiol, 50, pp. 1495-1498Chen, H.M., Chi, H., Chiu, N.C., Kocuria kristinae: a true pathogen in pediatric patients (2013) J Microbiol Immunol InfectKaradag Oncel, E., Boyraz, M.S., Kara, A., Black tongue associated with Kocuria (Micrococcus) kristinae bacteremia in a 4-month-old infant (2012) Eur J Pediatr, 171, p. 593Lai, C.C., Wang, J.Y., Lin, S.H., Catheter-related bacteraemia and infective endocarditis caused by Kocuria species (2011) Clin Microbiol Infect, 17, pp. 190-192Rushani, D., Kaufman, J.S., Ionescu-Ittu, R., Infective endocarditis in children with congenital heart disease: cumulative incidence and predictors (2013) Circulation, 128, pp. 1412-1419Srinivasa, K.H., Agrawal, N., Agarwal, A., Dancing vegetations: Kocuria rosea endocarditis (2013) BMJ Case Rep, 28Kumar, C.G., Sujitha, P., Kocuran an exopolysaccharide isolated from Kocuria rosea strain BS-1 and evaluation of its in vitro immunosuppression activities (2014) Enzyme Microb Technol, 55, pp. 113-120Ben-Ami, R., Navon-Venezia, S., Schwartz, D., Erroneous reporting of coagulase-negative staphylococci as Kocuria spp. by the Vitek 2 system (2005) J Clin Microbiol, 43, pp. 1448-1450Boudewijns, M., Vandeven, J., Verhaegen, J., Vitek 2 automated identification system and Kocuria kristinae (2005) J Clin Microbiol, 43, p. 583

Prognostic Factors For Mechanical Ventilation In Infants With Acute Lower Respiratory Disease [fatores Prognósticos Para Ventilação Mecânica Em Lactentes Com Doença Respiratória Aguda Baixa]

OBJECTIVE. Acute lower respiratory tract infections are the most common cause of hospital admission in pediatrics. A number of admitted patients need invasive mechanical pulmonary ventilation (IMPV). This study aimed to evaluate prognostic factors for IMPV in infants admitted due to acute lower respiratory infection. METHODS. A prospective cohort study was conducted from April to September, 2004, in two university hospitals of the Campinas metropolitan area, São Paulo, Brazil. One hundred, fifty-two infants were enrolled. Epidemiological and clinical data were recorded at admission and follow-up. Two groups were analyzed, according to the need of IMPV, with a comparison of prognostic factors. Association between risk factors and the outcome were studied and assessed by Relative Risk (RR), with confidence intervals of (95%CI). RESULTS. Twenty-one patients (13.81%) needed IMPV. Factors significantly associated with IMPV on admission were: age 10 days (RR=13.69, 95%CI:4.92-38.09), oxygen therapy > 10 days (RR=13.57, 95%CI:5.41-34.03), antibiotic usage (RR=3.03, 95%CI:1.34-6.89) and readmission (RR=5.23, 95%CI:2.12-12.91) were observed. CONCLUSION. The associations between need of IMPV and early age, reduced breast feeding and cyanosis demonstrate diminished physiological reserves in the young infant with lower respiratory infection. These patients require prolonged and intensive hospital support and readmission.525342346Denny Jr., F.W., The impact of respiratory virus infections on the world's children (2001) Asthma and Respiratory Infections, pp. 1-22. , Skoner DP, editor. New York: Marcel DekerAntuñano, F.J.L., Epidemiologia de lãs infecciones respiratórias agudas em niños: Panorama regional (1997) Infecciones Respiratórias Em Niños, pp. 3-23. , Benguigui Y, Antuaño FJL, Schmunis G, Yunes J, editores. New York: Organización Panamericana de la SaludInitiative for Vaccine Research (IVR). Acute Respiratory Infections, , http://www.who.int/vaccine_research/diseases/ari/en, World Health Organization. [cited 2004 aug 23]. Avaliable fromDenny, F.W., Acute respiratory infections in children: Etiology and epidemiology (1987) Pediatr Rev, 9, pp. 135-146. , (review)Júven, T., Mertsola, J., Waris, M., Leinonen, M., Meurman, O., Roivanen, M., Etiology of community-acquired pneumonia in 254 hospitalized children (2000) Pediatr Infect Dis J, 19, pp. 293-298Meissner, H.C., Uncertainty in the management of viral lower respiratory tract disease (2001) Pediatr, 108, pp. 1000-1004Wennergren, G., Kristjansson, S., Wheezing in infancy and its long-term consequences (2002) Eur Resp Mon, 19, pp. 116-130Gold, D.R., Burge, H.Á., Carey, V., Milton, D.K., Platts-Milss, T., Weiss, S.T., Predictors of repeated wheeze in the first year of life (1999) Am J Resp Crit Care Med, 160, pp. 227-236Millán, T., Serani, F., Vargas, N.A., Valenzuela, M.S., Características biológicas y sociales de los menores de un año muertos por neumonía en la región metropolitana de Chile, 1995 (1999) Rev Panam Salud Públ, 6, pp. 333-341Post, C.L.A., Victora, C.G., Valente, J.G., Leal, M.C., Niobey, F.M.L., Sabroza, P.C., Fatores prognósticos de letalidade hospitalar por diarréia ou pneumonia em menores de um ano de idade (1992) Estudo de Caso e Controle. Rev Saúde Pública, 26, pp. 369-378Sehgal, V., Sethi, G.R., Sachved, H.P.S., Satyanarayana, L., Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections (1997) Indian Pediatr, 34, pp. 213-219Willson, D.F., Landrigan, C.P., Horn, S.D., Smout, R.J., Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia (2003) J Pediatr, 143, pp. S142-S149Fundação Sistema Estadual de Análise de Dados. População/Estatísticas Vitais/SP Demográfico/ Estatísticas Vitais Do Estado de São Paulo, , http://www.seade.gov.br, [citado 2004]. Disponível emJorden, R.C., Typical vital signs in the pediatric population (1982) Multiple Trauma in Emergency Medicine: Concepts and Clinical Practice. 3 rd Ed., pp. 281-282. , Rosen P, Barkin R, et al., editors. St Louis: Mosby-Year Book, IncRosenthal, M., Bush, A., The growing lung: Normal development, and the long-term effects of pre and postnatal insults (2002) Eur Respir Mon, 19, pp. 1-24Pettigrew, M.M., Klodaee, M., Gillespie, B., Schwartz, K., Bobo, J.K., Foxman, B., Duration of breastfeeding, daycare and physician visits among infants 6 months and younger (2003) Ann Epidemiol, 13, pp. 431-435Albernazi, E.P., Menezes, A.N.G., César, J.Á., Victora, C.G., Barros, F.C., Helpern, R., Risk factors associated with hospitalization for bronchiolitis in the post-neonatal period (2003) Rev Saúde Pública, 37, pp. 485-493Duarte, D.M.G., Perfil clínico de crianças menores de cinco anos com infecção respiratória aguda (2000) J Pediatr, 76, pp. 207-212. , (Rio de J)Wang, E.E.L., Law, B.J., Stephens, D., Langley, J.M., MacDonald, N.E., Robinson, J.L., Study of interobserver reliability in clinical assesment of RSV lower respiratory illness: A pediatric investigators collaborative network for infections in Canada (PICNIC) study (1996) Pediatr Pulmonol, 22, pp. 23-27Shann, F., Fracp, J.B., Poore, P., Clinical signs that predict death in children with severe pneumonia (1999) Pediatr Infect Dis J, 8, pp. 852-855Kneyber, M.C.J., Moons, K.G.M., De Groot, R., Moll, H.A., Prediction of duration of hospitalization in respiratory syncytial virus infection (2002) Pediatr Pulmonol, 33, pp. 453-457Farias, J.A., Frutos, F., Esteban, A., Casado Flores, J., Retta, A., Baltodano, A., What is the daily practice of mechanical ventilation in pediatric intensive care units? 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Initial Experience At A University Teaching Hospital From Using Telemedicine To Promote Education Through Video Conferencing [experiência Inicial De Um Hospital Universitário Utilizando A Telemedicina Na Promoção De Educação Através De Vídeo-conferências]

CONTEXT AND OBJECTIVE: Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. DESIGN AND SETTING: Retrospective study at Universidade Estadual de Campinas. METHODS: Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. RESULTS: A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. CONCLUSION: Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.13013236Bashshur, R.L., On the definition and evaluation of telemedicine (1995) Telemed J, 1 (1), pp. 19-30Alverson, D.C., Edison, K., Flournoy, L., Telehealth tools for public health, emergency, or disaster preparedness and response: A summary report (2010) Telemed J E Health, 16 (1), pp. 112-114Ereso, A.Q., Garcia, P., Tseng, E., Live transference of surgical subspecialty skills using telerobotic proctoring to remote general surgeons (2010) J Am Coll Surg, 211 (3), pp. 400-411Mauer, U.M., Kunz, U., Management of neurotrauma by surgeons and orthopedists in a military operational setting (2010) Neurosurg Focus, 28 (5), pp. E10Huang, C.M., Chan, E., Hyder, A.A., Web 2.0 and internet social networking: A new tool for disaster management? --lessons from Taiwan (2010) BMC Med Inform Decis Mak, 10, p. 57Blanche, P.A., Bablumian, A., Voorakaranam, R., Holographic three-dimensional telepresence using large-area photorefractive polymer (2010) Nature, 468 (7320), pp. 80-83Jabbour, P., Gonzalez, L.F., Tjoumakaris, S., Randazzo, C., Rosenwasser, R., Stroke in the robotic era (2010) World Neurosurg, 73 (6), pp. 603-604Latifi, R., Stanonik, M.L., Merrell, R.C., Weinstein, R.S., Telemedicine in extreme conditions: Supporting the Martin Strel Amazon Swim Expedition (2009) Telemed J E Health, 15 (1), pp. 93-100Landers, S.H., Why health care is going home (2010) N Engl J Med, 363 (18), pp. 1690-1691Hede, K., Teleoncology gaining acceptance with physicians, patients (2010) J Natl Cancer Inst, 102 (20), pp. 1531-1533García jordá, E., Telemedicine: Shortening distances (2010) Clin Transl Oncol, 12 (10), pp. 650-651Latifi, R., Telepresence and telemedicine in trauma and emergency (2008) Stud Health Technol Inform, 131, pp. 275-280Hays, R.B., Peterson, L., Options in education for advanced trainees in isolated general practice (1996) Aust Fam Physician, 25 (3), pp. 362-366Ekeland, A.G., Bowes, A., Flottorp, S., Effectiveness of telemedicine: A systematic review of reviews (2010) Int J Med Inform, 79 (11), pp. 736-771Scuffham, P., Systematic review of cost effectiveness in telemedicine. Quality of cost effectiveness studies in systematic reviews is problematic (2002) BMJ, 325 (7364), p. 598. , author reply 598Rezende, E.J.C., Melo, M.C.B., Tavares, E.C., Santos, A.F., Souza, C., Ethics and eHealth: Reflections for a safe practice (2010) Rev Panam Salud Pública = Pan Am J Public Health, 28 (1), pp. 58-65Motoi, K., Ogawa, M., Ueno, H., A fully automated health-care monitoring at home without attachment of any biological sensors and its clinical evaluation (2009) Conf Proc IEEE Eng Med Biol Soc, 2009, pp. 4323-4326Azpiroz-Leehan, J., Martínez, L.F., Cadena, M.M., Imaging Facilities for Basic Medical Units: A Case in the State of Guerrero, Mexico (2010) J Digit Imaging, , Epub ahead of printKailas, A., Chong, C.C., Watanabe, F., From mobile phones to personal wellness dashboards (2010) IEEE Pulse, 1 (1), pp. 57-63Eron, L., Telemedicine: The future of outpatient therapy? (2010) Clin Infect Dis, 51 (SUPPL. 2), pp. S224-S230Nakajima, I., Japanese telemedical concept of ambulatory application (2011) J Med Syst, 35 (2), pp. 215-220Haidegger, T., Sándor, J., Benyó, Z., Surgery in space: The future of robotic telesurgery (2011) Surg Endosc, 25 (3), pp. 681-690Machado, F.S.N., Carvalho, M.A.P., Mataresi, A., Use of telemedicine technology as a strategy to promote health care of riverside communities in the Amazon: Experience with interdisciplinary work, integrating NHS guidelines (2010) Ciên Saúde Coletiva, 15 (1), pp. 247-254Latifi, R., Hadeed, G.J., Rhee, P., Initial experiences and outcomes of telepresence in the management of trauma and emergency surgical patients (2009) Am J Surg, 198 (6), pp. 905-910Bulik, R.J., Shokar, G.S., Integrating telemedicine instruction into the curriculum: Expanding student perspectives of the scope of clinical practice (2010) J Telemed Telecare, 16 (7), pp. 355-35

The Use Of Growth Hormone To Treat Endocrine-metabolic Disturbances In Acquired Immunodeficiency Syndrome (aids) Patients [o Papel Do Hormônio De Crescimento No Tratamento Dos Distúrbios Endócrino-metabólicos Do Paciente Com A Síndrome Da Imunodeficiência Adquirida (aids)]

Acquired Immunodeficiency Syndrome (Aids) was initially related to HIV-associated wasting syndrome, and its metabolic disturbances to altered body composition. After Highly Active Antiretroviral Therapy (HAART ) was started, malnutrition has declined and HIV-associated lipodystrophy syndrome has emerged as an important metabolic disorder. Aids is also characterized by hormonal disturbances, principally in growth hormone/insulin-like growth factor 1 (GH/IGF-1) axis. The use of recombinant human GH (hrGH) was formerly indicated to treat wasting syndrome, in order to increase lean body mass. Even though the use of hrGH in lipodystrophy syndrome has been considered, the decrease in insulin sensitivity is a limitation for its use, which has not been officially approved yet. Diversity in therapeutic regimen is another limitation to its use in Aids patients. The present study has reviewed the main HIV-related endocrine-metabolic disorders as well as the use of hrGH in such conditions. copyright© ABE&M todos os direitos reservados.525818832(2007) Unaids. Aids Epidemic Update, , http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf, December. Disponível emSecretaria de Vigilância em Saúde. 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Effects of growth hormone on visceral adipose tissue and dyslipidemia in HIV, an erratum. J Acquir Immune Defic Syndr. 2006;43:378-80Falutz, J., Therapy insight: Body-shape changes and metabolic complications associated with HIV and highly active antiretroviral therapy (2007) Nat Clin Pract Endocrinol Metab, 3, pp. 651-661Tesselaar, K., Miedema, F., Growth hormone resurrects adult human thymus during HIV-1 infection (2008) J Clin Invest, 3, pp. 844-847Lo, J.C., Mulligan, K., Noor, M.A., Schwarz, J.M., Halvorsen, R.A., Grunfeld, C., The effects of recombinant human growth hormone on body composition and glucose metabolism in HIV-infected patients with fat accumulation (2001) J Clin Endocrinol Metab, 86, pp. 3480-3487Antiretroviral therapy, fat redistribution and hyperlipidaemia in HIV-infected children in Europe (2004) Aids, 18, pp. 1443-1451. , European Paediatric Lipodystrophy GroupMinistério da Saúde. Brasil 2004. Secretaria de Vigilância em Saúde. Programa Nacional de DST e Aids Brasília (PN DSTAids). Série Manuais no 60. [atualizaç ão não disponívelacesso em 2008 Apr 28]. Disponível em: http://www.aids.gov.brZidovudine, didanosine, and zalcitabine in the treatment of HIV infection: Meta-analyses of the randomised evidence (1999) Lancet, 353, pp. 2014-2025. , HIV Trialists' Collaborative GroupChantry, C., Byrd, R., Englund, J., Baker, C.J., McKinney Jr, R.E., Pediatric Aids Clinical Trials Group Protocol 152 Study Team. Growth, survival and viral load in childhood HIV infection (2003) Pediatr Infect Dis J, 22, pp. 1033-1039Wanke, C., Kotler, D., The HIV wasting collaborative consensus committee. Collaborative recommendations. The approach to diagnosis and treatment of HIV wasting (2004) J Acquir Immune Defic Syndr, 37 (SUPPL. 5), pp. S284-S288Burgoyne, R.W., Tan, D.H., Prolongation and quality of life for HIV-infected adults treated with highly active antiretroviral therapy (HAART ): A balancing act (2008) J Antimicrob Chemother, 61, pp. 469-473Dreimane, D., Nielsen, K., Deveikis, A., Bryson, Y.J., Geffner, M.E., Effect of protease inhibitors combined with standard antiretroviral therapy on linear growth and weight gain in human immunodeficiency virus type 1-infected children (2001) Pediatr Infect Dis J, 20, pp. 315-316Verweel, G., Van Rossum, A.M.C., Hartwig, N.G., Wolfs, T., Scherpbier, H.J., de Groot, R., Treatment with highly active antiretroviral therapy in human immunodeficiency virus type-1-infected children is associated with a sustained effect on growth (2002) Pediatrics, 109, pp. E25Sterne, J.A., Hernán, M.A., Ledergerber, B., Tilling, K., Weber, R., Sendi, P., Swiss HIV cohort study. Long-term effectiveness of potent antiretroviral therapy in preventing Aids and death: A prospective cohort study (2005) Lancet, 366, pp. 378-384Patel, K., Hernán, M.A., Williams, P.L., Seeger, J.D., McIntosh, K., Van Dyke, R.B., Pediatric Aids Clinical Trials Group 219/219C Study Team. Long-term effectiveness of highly active antiretroviral therapy on the survival of children and adolescents with HIV infection: A 10-year follow-up study (2008) Clin Infect Dis, 46, pp. 507-515Scevola, D., DiMatteo, A., Giglio, O., Uberti, F., HIV infection-related cachexia and lipodystrophy (2006) Cachexia and wasting: A modern approach, pp. 407-428. , Mantovani G, editor, Milan: Springer;revised classification system for human immunodeficiency virus infection in children less than 13 years of age (1994) MMWR Morb Mortal Wkly Rep. 1994, 43, pp. 1-10. , Centers for Disease Control and PreventionMangili, A., Murman, D.H., Zampini, A.M., Wanke, C.A., Nutrition and HIV infection: Review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort (2006) Clin Infect Dis, 42, pp. 836-842Leonard, E.G., McComsey, G.A., Antiretroviral therapy in HIV-infected children: The metabolic cost of improved survival (2005) Infect Dis Clin North Am, 19, pp. 713-729Polo, R., Gómez-Candela, C., Miralles, C., Locutura, J., Alvarez, J., Barreiro, F., SPNS/GEAM/SENBA/SENPE/AEDN/SEDCA/GESIDA. Recommendations from SPNS/GEAM/SENBA/SENPE/AEDN/SEDCA/GESIDA on nutrition in the HIV-infected patient (2007) Nutr Hosp, 22, pp. 229-243Chantry, C.J., Frederick, M.M., Meyer 3rd, W.A., Handelsman, E., Rich, K., Paul, M.E., Endocrine abnormalities and impaired growth in human immunodeficiency virus-infected children (2007) Pediatr Infect Dis J, 26, pp. 53-60Valente, A.M.M., Reis, A.F., Machado, D.M., Succi, R.C.M., Chacra, A.R., Alterações metabólicas da síndrome lipodistrófica do HIV. (2005) Arq Bras Endocrinol Metab, 49, pp. 871-881Saint-Marc, T., Partisani, M., Poizot-Martin, I., Bruno, F., Rouviere, O., Lang, J.M., A syndrome of peripheral fat wasting (lipodystrophy) in patients receiving long-term nucleoside analogue therapy (1999) Aids, 13, pp. 1659-1667Lundgren, J.D., Battegay, M., Behrens, G., De Wit, S., Guaraldi, G., Katlama, C., EACS Executive Committee. European Aids Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV (2008) HIV Medicine, 9, pp. 72-81Laue, L., Pizzo, P.A., Butler, K., Cutler Jr., G.B., Growth and neuroendocrine dysfunction in children with acquired immunodeficiency syndrome (1990) J Pediatr, 117, pp. 541-545Matarazzo, P., Palomba, E., Lala, R., Ciuti, E., Altare, F., de Sanctis, L., Growth impairment, IGF I hyposecretion and thyroid dysfunction in children with perinatal HIV-1 infection (1994) Acta Paediatr, 83, pp. 1029-1034Panamonta, O., Kosalaraksa, P., Thinkhamrop, B., Kirdpon, W., Ingchanin, C., Lumbiganon, P., Endocrine function in Thai children infected with human immunodeficiency virus (2004) J Pediatr Endocrinol Metab, 17, pp. 33-40Rondanelli, M., Caselli, D., Aricò, M., Maccabruni, A., Magnani, B., Bacchella, L., Insulin-like growth factor I (IG F-I) and IG F-binding protein 3 response to growth hormone is impaired in HIV-infected children (2002) Aids Res Hum Retroviruses, 18, pp. 331-339Fliers, E., Unmehopa, U.A., Manniesing, S., Vuijst, C.L., Wiersinga, W.M., Swaab, D.F., Decreased neuropeptide Y (NPY) expression in the infundibular nucleus of patients with nonthyroidal illness (2001) Peptides, 22, pp. 459-465Eledrisi, M.S., Verghese, A.C., Adrenal insufficiency in HIV infection: A review and recommendations (2001) Am J Med Sci, 321, pp. 137-144Tovo, P.A., de Martino, M., Gabiano, C., Cappello, N., D'Elia, R., Loy, A., Prognostic factors and survival in children with perinatal HIV infection (1992) Lancet, 339, pp. 1249-1253Nachman, S.A., Lindsey, J.C., Pelton, S., Mofenson, L., McIntosh, K., Wiznia, A., Growth in human immunodeficiency virus-infected children receiving ritonavir-containing antiretroviral therapy (2002) Arch Pediatr Adolesc Med, 156, pp. 497-503Congote, L.F., Monitoring insulin-like growth factors in HIV infection and aids (2005) Clin Chim Acta, 361, pp. 30-53Meininger, G., Grinspoon, S., Regulation of the growth hormone/ insulin-like growth factor-I axis in HIV disease (2001) Endocrinologist, 11, pp. 188-195Frost, R.A., Fuhrer, J., Steigbigel, R., Mariuz, P., Lang, C.H., Gelato, M.C., Wasting in the acquired immune deficiency syndrome is associated with multiple defects in the serum insulin-like growth factor system (1996) Clin Endocrinol (Oxf), 44, pp. 501-514Heijligenberg, R., Sauerwein, H.P., Brabant, G., Endert, E., Hommes, M.J., Romijn, J.A., Circadian growth hormone secretion in asymptomatic human immune deficiency virus infection and acquired immunodeficiency syndrome (1996) J Clin Endocrinol Metab, 81, pp. 4028-4032Rondanelli, M., Solerte, S.B., Fioravanti, M., Scevola, D., Locatelli, M., Minoli, L., Circadian secretory pattern of growth hormone, insulin-like growth factor type I, cortisol, adrenocorticotropic hormone, thyroid-stimulating hormone and prolactin during HIV infection (1997) Aids, 13, pp. 1243-1249Stanley TL, Grinspoon SK. GH/GHRH axis in HIV lipodystrophy. Pituitary. 2008 Feb 13 [Epub ahead of print]Viganò, A., Mora, S., Brambilla, P., Schneider, L., Merlo, M., Monti, L.D., Impaired growth hormone secretion correlates with visceral adiposity in highly active antiretroviral treated HIV- infected adolescents (2003) Aids, 17, pp. 1435-1441Van Rossum, A.M.C., Gaaker, M.I., Verweel, G., Hartwig, N.G., Wolfs, T.F., Geelen, S.P., Endocrinology and immunologic factors associated with recovery of growth in children with human immunodeficiency virus type 1 infection treated with protease inhibitors (2003) Pediatric Infect Dis J, 22, pp. 70-76Schambelan, M., Mulligan, K., Grunfeld, C., Daar, E.S., LaMarca, A., Kotler, D.P., Recombinant human growth hormone in patients with HIV-associated wasting. A randomized, placebo-controlled trial. Serostim Study Group (1996) Ann Intern Med, 125, pp. 873-882Krentz, A.J., Koster, F.T., Crist, D.M., Finn, K., Johnson, L.Z., Boyle, P.J., Anthropometric, metabolic, and immunological effects of recombinant human growth hormone in Aids and Aids-related complex (1993) J Acquir Immune Defic Syndr, 6, pp. 245-251McNurlan, M.A., Garlick, P.J., Steigbigel, R.T., DeCristofaro, K.A., Frost, R.A., Lang, C.H., Responsiveness of muscle protein synthesis to growth hormone administration in HIV-infected individuals declines with severity of disease (1997) J Clin Invest, 100, pp. 2125-2132Waters, D., Danska, J., Hardy, K., Koster, F., Qualls, C., Nickell, D., Recombinant human growth hormone, insulin-like growth factor 1, and combination therapy in Aids-associated wasting: A randomized, double-blind, placebocontrolled trial (1996) Ann Intern Med, 125, pp. 865-872Esposito, J.G., Thomas, S.G., Kingdon, L., Ezzat, S., Growth hormone treatment improves peripheral muscle oxygen extraction-utilization during exercise in patients with human immunodeficiency virus-associated wasting: A randomized controlled trial (2004) J Clin Endocrinol Metab, 89, pp. 5124-5131Moyle, G.J., Daar, E.S., Gertner, J.M., Kotler, D.P., Melchior, J.C., O'Brien, F., Serono 9037 Study Team. Growth hormone improves lean body mass, physical performance, and quality of life in subjects with HIV-associated weight loss or wasting on highly active antiretroviral therapy (2004) J Acquir Immune Defic Syndr, 35, pp. 367-375Storer, T.W., Woodhouse, L.J., Sattler, F., Singh, A.B., Schroeder, E.T., Beck, K., A randomized, placebocontrolled trial of nandrolone decanoate in human immunodeficiency virus-infected men with mild to moderate weight loss with recombinant human growth hormone as active reference treatment (2005) J Clin Endocrinol Metab, 90, pp. 4474-4482Wanke, C., Gerrior, J., Kantaros, J., Coakley, E., Albrecht, M., Recombinant human growth hormone improves the fat redistribution syndrome (lipodystrophy) in patients with HIV (1999) Aids, 13, pp. 2099-2103Zeitler, P.S., Travers, S., Kappy, M.S., Advances in the recognition and treatment of endocrine complications in children with chronic illness (1999) Adv Pediatr, 46, pp. 101-149Napolitano, L.A., Schmidt, D., Gotway, M.B., Ameli, N., Filbert, E.L., Ng, M.M., Growth hormone enhances thymic function in HIV-infected adults (2008) J Clin Invest, 118, pp. 1085-109

Respiratory Syncytial Virus (rsv) In Infants Hospitalized For Acute Lower Respiratory Tract Disease: Incidence And Associated Risks

Respiratory syncytial virus (RSV) is one of the main causes of acute lower respiratory tract infections worldwide. We examined the incidence and associated risks for RSV infection in infants hospitalized in two university hospitals in the state of São Paulo. We made a prospective cohort study involving 152 infants hospitalized for acute lower respiratory tract infections (ALRTI) in two university hospitals in Campinas, São Paulo, Brazil, between April and September 2004. Clinical and epidemiological data were obtained at admission. RSV was detected by direct immunofluorescence of nasopharyngeal secretions. Factors associated with RSV infection were assessed by calculating the relative risk (RR). The incidence of RSV infection was 17.5%. Risk factors associated with infection were: gestational age less than 35 weeks (RR: 4.17; 95% confidence interval (CI) 2.21-7.87); birth weight less than or equal to 2,500 grams (RR: 2.69; 95% CI 1.34-5.37); mother's educational level less than five years of schooling (RR: 2.28; 95% CI 1.13-4.59) and pulse oximetry at admission to hospital lower than 90% (RR: 2.19; 95% CI 1.10-4.37). Low birth weight and prematurity are factors associated with respiratory disease due to RSV in infants. Low educational level of the mother and poor socioeconomic conditions also constitute risk factors. Hypoxemia in RSV infections at admission indicates potential severity and a need for early oxygen therapy. © 2006 by The Brazilian Journal of Infectious Diseases and Contexto Publishing. 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