Epidemiological Profile of Children Infected with Bordetella pertussis at Varela Santiago Children’s Hospital: a Retrospective Study

Abstract Background: Pertussis, also called whooping cough, is an acute infectious disease of high transmissibility transmitted through aerosol particles released during the catarrhal phase and paroxysmal cough. Since the 1990s its incidence has increased and atypical clinical forms have been identified, mainly in newborns and adults. We hypothesized that there is a relationship between the high incidence of pertussis infection in children up to 6 months of age and genetic changes in the circulating strains of B. pertussis leading to inefficacy of diphtheria, tetanus, and pertussis vaccine (DTP). Methods: Data were obtained from the medical records of hospitalized patients at the Varela Santiago Children’s Hospital in Brazil from January 1, 2013 to December 31, 2013. Results: A total of 33 cases of pertussis hospitalizations were found, where 75.7% (25/33) of the patients were 6 months of age or younger (6 patients were 30 days old or younger while 19 ranged in age from 31 days to 6 months). Of these, 54.5% (14/25) were in exclusive breastfed children. Only 18.2% (6/33) of the patients had the appropriate administration of DTP doses according to their age. Signs and symptoms were: cough 100%, cyanosis 63.6%, fever 48.5% and inspiratory winch 33.3%. Azithromycin was used as monotherapy in 90% (30/33) of the cases and the mean time of hospitalization was 9.48 days ranging from 6 to 30 days. No patient died. Conclusion: We identified a high prevalence (75.7%) of B. pertussis infection in children up to 6 months of age. This is likely explained by the low vaccination rate (18.2%) and the low percentage of exclusive breastfeeding of the studied population. The low rate of vaccination is unexpected, given that there has been greater access to vaccination in recent decades in Brazil. In addition, the cases evolved with an atypical clinical presentation, since the classic symptoms of the catarrhal stage were absent or had a such short duration that such symptoms were no longer present at the time of hospitalization. Our study does not exclude the possibility that genetic changes are occurring in the circulating strains of B. pertussis and that DTP seems to have less efficacy on these new strains, but future studies will be needed to specifically test this hypothesis. Disclosures All authors: No reported disclosures

Perinatal Case Fatality Rate Related to Congenital Zika Syndrome in Brazil: a Cross-Sectional Study

Abstract Background: Many studies have demonstrated a causal link between Zika virus (ZIKV) infection, microcephaly (MCP), and other congenital abnormalities (CA). This study aimed to determine perinatal case fatality rate in cases of Congenital Zika Syndrome (CZS) in the Rio Grande do Norte State (RN), a Brazilian Northeast State highly impacted by the Zika virus outbreak. Methods: A cross-sectional study was conducted using data obtained through the State Health Department (SHD) for cases of MCP and CA in Rio Grande do Norte from April 2015 to February 5, 2016. Definition of perinatal period: commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. Results: During the study period, there were 486 cases of MCP and others CA notified in RN, of which 142 were confirmed and 108 remain under investigation. The remaining 236 cases have been ruled out by presenting normal examinations or due to presenting microcephaly by noninfectious causes. Of the total confirmed cases, 26.7% (38/142) died after birth or during pregnancy. 15.78% (06/38) of confirmed deaths had ZIKV infection during pregnancy and 2.63% (01/38) had a positive TORCH blood test. The six cases related to ZIKV were confirmed by RT–PCR and/or IgM/IgG antibodies against ZIKV. The remaining cases of deaths remain either under investigation or have been ruled out. Conclusion: This study highlights a high rate of perinatal lethality (15.78%) in cases of CZS. Despite the growing number of CZS cases, the real incidence and prevalence might be higher due to the underreporting and lack of resources for confirmatory diagnostic tests (laboratory and imaging). Due to the high rate of lethality and the ongoing uncontrolled ZIKV outbreak, this study predicts an increase in the infant mortality rate in Brazil and highlights the need for developing public health programs to control the ZIKV outbreak. Disclosures All authors: No reported disclosures

ASSISTÊNCIA HUMANIZADA: PERCEPÇÃO DO ENFERMEIRO INTENSIVISTA

Objetivo: analisar a percepção do enfermeiro intensiva sobre a assistência humanizada. Método: estudo qualitativo de cunho analítico realizado em um hospital público do estado de Alagoas, Brasil, nos meses de setembro e outubro de 2016. O instrumento de coleta de dados foi a entrevista semiestruturada aplicada junto a dez enfermeiros. Os dados foram trabalhados mediante análise de conteúdo na modalidade temática. Resultados: as três categorias que emergiram das falas tratam de aspectos da humanização como ferramenta de trabalho, associada ao uso da tecnologia e sua influência na recuperação do paciente crítico. Conclusão: na percepção dos enfermeiros intensivistas, ofertar uma assistência agregada à humanização é importante, por influenciar no tratamento e na recuperação do paciente.Descritores: Humanização da assistência. Unidade de Terapia Intensiva. Cuidados de enfermagem.</p

Combination therapy with liposomal amphotericin b (ambisome), n-methylglucamine antimoniate (glucantime), and pentamidine isethionate in a refractory visceral leishmaniasis case

Abstract Visceral leishmaniasis is a systemic disease that is potentially severe and endemic in Brazil. It clinically manifests as fever, weight loss, swelling, hepatosplenomegaly, paleness, and edema. In this study, we discuss a case of a 1-year-old child diagnosed with refractory visceral leishmaniasis after being treated with liposomal amphotericin B in two distinct occasions. Considering the persistent clinical features and weak response to conventional treatment, a combination therapy with liposomal amphotericin B (ambisome), n-methylglucamine antimoniate (glucantime), and pentamidine isethionate was initiated, and response to treatment was good

Prevalence of TMD and level of chronic pain in a group of Brazilian adolescents.

AIMS:To determine the prevalence of temporomandibular disorders and associated factors in an adolescent sample from Recife, Brazil. MATERIALS AND METHODS:A cross-sectional study was conducted with 1342 adolescents aged 10-17 years. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used by calibrated examiners to evaluate the presence and levels of chronic pain. To evaluate the socioeconomic conditions, the subjects answered the Brazilian Economic Classification Criteria (CCEB) questionnaire. Data were analyzed by means of binary logistic regression in SPSS. RESULTS:The results showed that 33.2% of the subjects had TMD irrespective of age (p = 0.153) or economic class (p = 0.653). Statistically significant associations were found between TMD and female gender (p = 0.017), headache/migraine in the past six months (p<0.001), chronic pain (p<0.001) and chronic pain level (p<0.001). In the final model, logistic regression showed that the level of chronic pain and the headache/migraine in the past six months were related to the presence of TMD. CONCLUSIONS:The prevalence of TMD was considered high (33.2%) and adolescents with chronic pain and headache in the past six months were more likely to have TMD. CLINICAL RELEVANCE:The data contribute to the understanding of TMD among adolescents and to the development of preventive measures and polices to identify the dysfunction promptly

In Vitro morphological, optical and microbiological evaluation of nanosilver fluoride in the remineralization of deciduous teeth enamel

Nanosilver fluoride (NSF) was developed as an alternative in the prevention of dental caries

Investigação etiológica de uma epizootia em saguis (Callithrix jacchus) numa área indene para febre amarela

Trabalho apresentado no Congresso Brasileiro de Primatologia, 11., 2005, Porto Alegre.Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil.Secretaria Estadual de Saúde do Estado do Rio Grande do Norte. Natal, RN, Brasil.Secretaria Estadual de Saúde do Estado do Rio Grande do Norte. Natal, RN, Brasil.Parque Estadual Dunas do Natal. Natal, RN, Brasil.Secretaria Municipal de Saúde de Natal. Natal, RN, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.Fundação Oswaldo Cruz. Rio de Janeiro, RJ, BrasilSecretaria de Saúde Pública do Estado do Rio Grande do Norte. Natal, RN, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasilia, DF, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Centro Nacional de Primatas. Belém, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Centro Nacional de Primatas. Belém, PA, Brasil.Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis. Brasília, DF, Brasil.Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil.Epizootias com impacto sobre as populações de gorilas e chimpanzés têm sido documentadas na África. No Brasil, há registros de morte de primatas não humanos devido ao vírus da febre amarela silvestre. O presente trabalho relata uma epizootia ocorrida em uma população de sagüis no Parque Estadual Dunas do Natal em 2004. Esse primata é utilizado como modelo experimental em pesquisas biomédicas, dada sua proximidade filogenética com o homem, com o qual compartilha a susceptibilidade a diversos agentes patogênicos. Considerando esses aspectos a Vigilância Epidemiológica do Estado do Rio Grande do Norte formou uma equipe interinstitucional de especialistas para investigar o caso sob a supervisão técnica do Ministério da Saúde. lnicialmente objetivou-se a pesquisa de febre amarela, pois um levantamento entomológico prévio na área detectara vetores para o vírus amarílico. Posteriormente, foram também investigadas raiva e infecções bacterianas. Quarenta e seis animais foram capturados durante a epizootia, sendo dez destes submetidos a exames clínicos e necropsia. Foram coletadas amostras para análise histopatológica, bacteriológica e pesquisa viral. Os sinais clínicos mais freqüentes observados foram edema facial, hipotermia e desidratação. Pneumonia, hepatoesplenomegalia, petéquias hepáticas e linfadenite foram achados macroscópicos comuns à necropsia. A histopatologia revelou quadro séptico com microabcessos em diversos órgãos, broncopneumonia e pneumonia intersticial. Foram isoladas, por hemocultura, Pseudomonas aeruginosa, Staphylococcus aureús, Bordeteli.a bronchiseptica e Escherichia coli. A pesquisa de febre amarela e de outros arbovírus, raiva e citomegalovírus foi negativa, porém foi positiva em cinco animais para adenovírus, avaliada através de imunohistoquímica. A adenovirose é sugerida como causa da epizootia.Epizooties with impact on gorilla and chimpanzee populations have been reported in Africa. In Brazil, there are records af death of non-human primates due to selvatic yellow rever. This chapter reports an epizoot in a population of common marmosets in the Dunas do Natal State Park in 2004. This monkey is an imp9rtant experimental model used in biomedical research because of susceptibility to several pathogenic agents. Based on the Epidemiological Surveillance in the State of Rio Grande do Norte, Brazil, an interinstitutional team of experts was organized to investigate the case under the technical supervision of lhe Ministry ofHealth. The research began with a yellow rever evaluarion because a previous entomological survey at lhe site had found the vectors ofits virus. Later, rabies and bacterial infections were algo investigated. Forty-six animaIs were found dead or dying during the epizootten of which were submitted for clinical exams and necropsy. Samples for histopathologic and bacteriological analyses and viral research were collected. The most frequent clinical signals observed were racial edema, hypothermia and dehydration. Pneumonia, hepatosplenomegaly, hepatic petechiae and lymphadenitis were found macroscopically during necropsy. The histopathology revealed sepsis with mícroabscesses in. several organs, bronchopneumonia and interstitial pneumonia. Hemoculture isolated Pseudomonas aeruginosa, StaphyococclIs aureus, Bordetela bronchiseptica and Escherichia coli. The results for arboviruses, rabies and cytomegalovirus were negative. However, tive animaIs were positive for adenovirus evaluated by immunohistochemistry. The adenovirosis is suggested as the cause of the epizooty

Comentarios a una sentencia anunciada : el proceso Lula

El centenar de textos que conforman este libro -escritos por un movimiento de prestigiosos/as juristas y abogados- desgranan el procedimiento al que fue sometido Lula. En la opinión de las y los autores de los artículos las normas no fueron observadas, y su inobservancia llevó a que se dictaminase una decisión injusta. Frases del estilo "Voy a tomar una decisión revolucionaria, dejando de lado la ley, porque por la ley no se puede condenarlo de ninguna manera”, dichas en los juicios por las más altas autoridades judiciales militares y civiles, hoy son conocidas gracias a quienes se abocaron al trabajo de escuchar los audios de aquellas sesiones, nutriendo las reflexiones que argumentan sobre el imperativo de la hora: restablecer el estado de derecho y absolver al presidente Lula Da Silva

Comenta&#769;rios a uma sentenc&#807;a anunciada : o processo Lula

“Comentários a uma sentença: o Caso Lula” é talvez o mais importante documento jurídico publicado no Brasil em décadas. A presente coletânea de artigos nasceu de um movimento espontâneo e bastante significativo de juristas brasileiros e estrangeiros que examinaram cuidadosamente a sentença proferida no âmbito do processo que tramitou na 13ª Vara Federal de Curitiba, no caso que ficou conhecido na mídia como o do “tríplex do Guarujá”. <br>De la presentación de Geraldo Prad