Sedação com midazolam e hidroxizina por via oral em Odontopediatria: ensaio clínico randomizado, controlado e cruzado

The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0 mg/kg), or MH - midazolam (0.75 mg/kg) plus hydroxyzine (2.0 mg/kg). Vital signs (blood pressure, breathing rate, pulse and oxygen saturation) and behavior parameters (consciousness, crying, movement, overall behavior) were evaluated every 15 minutes. Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group. Normal values of vital signs were usually registered. Heart rate increased in groups P and M as the session went on. Group M presented less crying and movement at the first 15 minutes of treatment. Group MH caused more drowsiness at the beginning of the session. Overall behavior was better in group M than in groups P or MH. Group M produced effective sedation in 77% of the cases, and group MH did so in 30.8%. It was concluded that midazolam was effective and safe, and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation.Há controvérsias quanto aos benefícios do midazolam na sedação de crianças durante a atenção odontológica. Conduziu-se um ensaio clínico controlado, cruzado e duplo-cego para comparar o efeito sedativo em Odontopediatria da administração oral do midazolam, associado ou não à hidroxizina. Trinta e sete sessões foram realizadas em 11 crianças menores de cinco anos, ASA I. Em cada atendimento, os pacientes receberam aleatoriamente o medicamento conforme os grupos: P - placebo, M - midazolam (1,0 mg/kg); MH - midazolam (0,75 mg/kg) associado à hidroxizina (2,0 mg/kg). Os sinais vitais (pressão arterial, freqüência respiratória, pulso e saturação de oxigênio) e os parâmetros comportamentais (consciência, choro, movimento, comportamento geral) foram avaliados a cada 15 minutos. As comparações entre grupos e entre momentos de atendimento num mesmo grupo foram estabelecidas estatisticamente através dos testes Friedman e Wilcoxon. Os grupos P, M e MH não diferiram quanto aos sinais vitais, os quais se mantiveram dentro de valores aceitáveis. A freqüência cardíaca aumentou nos grupos P e M com o transcorrer da sessão. O grupo M esteve associado a menos choro e movimento nos primeiros 15 minutos de tratamento. O grupo MH apresentou mais sonolência no início da sessão. O comportamento geral foi melhor em M do que em P e MH. M produziu sedação efetiva em 77% dos casos, e MH em 30,8%. Concluiu-se que o midazolam foi efetivo e seguro, e que sua associação à hidroxizina não repercutiu em vantagens adicionais na sedação odontopediátrica

Detection of calicivirus from fecal samples from children with acute gastroenteritis in the West Central region of Brazil

The objective of this study was to describe the circulation of caliciviruses in the West Central region of Brazil and its correlation with children's gender and age, as well as with the year and months of the sample collection. Reverse transcriptase-polymerase chain reaction was performed to detect the human calicivirus genome in 1006 fecal samples that were collected in Goiânia (n = 696) and Brasília (n = 310). Viral RNA was detected in 8.6% of the samples. No significant difference in viral prevalence was found regarding gender, age or year of the sample. However, it was observed that in Goiânia, there is a higher incidence of caliciviruses from September to March. The analysis employing three primer pairs demonstrated that the Ni/E3 or JV12/13 primer pairs, which detect norovirus (NoV), detected 41 positive samples while the 289/290 primer pair, which detects NoV or sapovirus, detected the remaining 46 samples. Calicivirus circulates in the West Central region of Brazil and for better detection of this virus it is important to use more than one primer pair. Also, we conclude that the seasonality presented by this virus is related to higher humidity in the period

Perfil clínico-epidemiológico da criptococose associada e não associada à infecção pelo HIV na região Centro-Oeste do Brasil / Clinical and epidemiological aspects of cryptococcosis associated and non-associated to HIV infection in Central Western region of Brazil

Objetivo: Analisar as características clínicas-epidemiológicas, segundo a infecção pelo HIV, dos casos de criptococose no estado de Goiás. Métodos: Estudo transversal dos casos de criptococose no período de 2011 a 2014. Utilizou-se registros laboratoriais e prontuários médicos de unidades de saúde referência para a doença. Aplicou testes estatísticos para comparar o grupo HIV positivos e HIV negativos com as variáveis estudadas. Resultados: Identificou 130 casos de criptococose, 116(89,2%) HIV positivos e 14(10,8%) negativos. A meningoencefalite foi a forma clínica predominante em ambos os grupos, assim como a espécie Cryptococcus neoformans. Entre os casos HIV negativos (64,3%) usavam medicamentos imunossupressores. A média da contagem de células TCD4 dos casos HIV positivos foi 58,7 células/mm3e 60,8% foram a óbito, entre os sobreviventes, 43,1% ficaram com sequelas, sendo o déficit visual o mais frequente. Conclusões:  A criptococose é uma doença grave, dada a elevada letalidade e potencial de provocar danos funcionais

Molecular characterization of the NSP4 gene of human group A rotavirus samples from the West Central region of Brazil

Nonstructural protein 4 (NSP4), encoded by group A rotavirus genome segment 10, is a multifunctional protein and the first recognized virus-encoded enterotoxin. The NSP4 gene has been sequenced, and five distinct genetic groups have been described: genotypes A-E. NSP4 genotypes A, B, and C have been detected in humans. In this study, the NSP4-encoding gene of human rotavirus strains of different G and P genotypes collected from children between 1987 and 2003 in three cities of West Central region of Brazil was characterized. NSP4 gene of 153 rotavirus-positive fecal samples was amplified by reverse transcriptase-polymerase chain reaction and then sequenced. For phylogenetic analysis, NSP4 nucleotide sequences of these samples were compared to nucleotide sequences of reference strains available in GenBank. Two distinct NSP4 genotypes could be identified: 141 (92.2%) sequences clustered with NSP4 genotype B, and 12 sequences (7.8%) clustered with NSP4 genotype A. These results reinforce that further investigations are needed to assess the validity of NSP4 as a suitable target for epidemiologic surveillance of rotavirus infections and vaccine development

Clinical-Epidemiological Characteristics and Outcomes of Latent Tuberculosis Treatment at a Tertiary Center in Central-West Brazil from 2017 to 2019

Detailed information concerning latent tuberculosis infection (LTBI) and treatment outcomes is scarce in Brazil. This retrospective cross-sectional study aimed to describe LTB treatment (LTBT) at a tertiary center in Central-West Brazil from 2017 to 2019. We recommended the use of LTBTs before the implementation of a rifapentine-isoniazid (3HP) regimen in Brazil. We conducted a descriptive analysis using chi-square or t-tests to assess differences in the proportions and means. Of 79 notified adult patients (males, 68%; median age, 40 (interquartile range, 30–51) years), most people were living with human immunodeficiency virus (PLHIV) (82%) or receiving immunosuppressant medication (15%), and 92% were receiving their first treatment. Isoniazid (INH) for 6–9 months had previously been proposed for 95% of the patients, with only 35% completeness. Four patients treated with rifampicin (4RMP) completed the regimen (p = 0.009). Adverse events occurred in 19% of the patients. In this Brazilian tertiary center, the target population for LTBT were young PLHIV patients under immunosuppression with low education levels. However, the INH monotherapy dropout rate was 65%. Therefore, shorter courses, such as 3HP and 4RMP, are promising alternatives. Behavioral aspects, education level, and regimen length can influence the course completion, and further studies are required to evaluate the 3HP regime in Brazil

Análise da taxa de transmissão vertical do HIV e fatores de risco materno-fetais em crianças expostas nascidas em centro de referência do estado de Goiás

Objetivos: Estimar a taxa de transmissão vertical do HIV e os fatores de risco materno-fetais em crianças nascidas em 2015 em seguimento durante os anos de 2015 a 2017 no maior centro de referência para tratamento para HIV do estado de Goiás. Métodos: Estudo de coorte retrospectivo de 111 crianças expostas ao HIV nascidas em 2015 de mães HIV positivas. Resultados: Entre as mães, 85 (92,4%) utilizaram TARV durante a gestação. Das 92 crianças que mantiveram seguimento, 4 (4,34%) adquiriram infecção perinatal pelo HIV. 81 (88%) recém-nascidos fizeram uso de profilaxia antirretroviral. Um fator protetor importante de transmissão vertical do HIV foi a profilaxia antirretroviral do RN (OR = 0,02; IC 95%: 0,00-0,56; p = 0,04). Outros fatores investigados, como uso de TARV durante a gestação, não foram estatisticamente significativas para risco. Conclusão: A taxa de transmissão vertical do HIV ainda se encontra elevada no estado de Goiás e os desafios para sua prevenção consistem na perda de seguimento e falhas nas medidas estratégicas.Objectives: To estimate the mother-to-child transmission rate of HIV and the maternal-fetal risk factors in children born in 2015 in follow-up during the years 2015 to 2017 in the largest reference center for HIV treatment in the state of Goiás. Methods: Retrospective cohort study of 111 HIV-exposed children born in 2015 of HIV-positive mothers, with 19 follow-up losses. Results: Among the mothers, 85 (92.4%) used ART during pregnancy. Of the 92 children who maintained follow-up, 4 (4.34%) acquired perinatal HIV infection. 81 (88%) newborns used antiretroviral prophylaxis. An important protective factor for vertical HIV transmission was neonatal prophylaxis (OR:0.02, 95%; CI: 0.00-0.56, p = 0.04). Other investigated factors, such as ART during pregnancy, were not statistically significant for risk. Conclusion: The vertical transmission rate of HIV is still high in the State of Goiás and the challenges for its prevention consist in the loss of follow-up and failures in the strategic measures

Astrovirus infection in children living in the Central West region of Brazil

This study presents data regarding the circulation of astrovirus in Goiânia-GO and Brasília-DF. These viruses were detected in fecal samples from hospitalized children up to five years old with and without acute gastroenteritis. A total of 1244 fecal samples were collected in two periods, 1994 to 1996 (Brasília) and 1998 to 2002 (Goiânia and Brasília), and were analyzed for viral RNA using the reverse transcription-polymerase chain reaction (RT-PCR). Positivity rates of 4.3 and 0.5% for astrovirus were observed in children with acute gastroenteritis and those without gastroenteritis, respectively. Among children with gastroenteritis no statistically significant difference was seen with regards to viral positivity rates in relation to gender and age. However, a higher incidence rate was observed for children from Brasília aged 36 months or more. Overall, astroviruses occurred predominantly from September to March in the two cities, suggesting a seasonal pattern for these viruses which coincides with the highest relative air humidity period. The results of this study highlight the importance of astrovirus as an etiologic agent of acute gastroenteritis in children of the Central West region of Brazil