Heliane Brant Machado Freire

Analysis of variables related to fatal outcomes of scorpion envenomation in children and adolescents in the state of Minas Gerais, Brazil, from 2001 to 2005

OBJECTIVES To describe and evaluate notified scorpion envenomation incidents in children and adolescents in the Brazilian state of Minas Gerais between 2001 and 2005, and to calculate the incidence and mortality and identify factors related to fatal outcomes. METHODS Analysis of 14,406 mandatory notifications of scorpion envenomation involving patients aged 0 to 19 years in Minas Gerais. After performing a univariate analysis of factors related to mortality (p < 0.25), multivariate analysis was carried out using logistic regression. RESULTS The number of notifications of accidents involving scorpions increased over the period. The age group that suffered most accidents was 5 to 9 years. Local pain was reported in 95% of cases. The majority of cases were classified as mild (60%) and antivenom was given to 42% of this population. The mean mortality rate was 0.7%. The state capital, Belo Horizonte, was the municipality with the greatest occurrence of incidents. Each hours delay before receiving first medical care was associated with a 9% increase in the odds ratio for the likelihood of death, which was 46 times greater in the severe group than in the moderate and mild groups. A decrease of 1 year in patient age was associated with a 13% increase in the odds ratio for the likelihood of death. CONCLUSIONS There was an increase in the number of notifications over the period studied. The following factors were identified as linked with a higher odds ratio for the likelihood of death: delayed first medical care, being classified as a severe case, and younger age of victim.

É possível identificar a dengue em crianças a partir do critério de caso suspeito preconizado pelo Ministério da Saúde

OBJECTIVES: To identify clinical characteristics indicative of dengue and to evaluate the applicability to children of the Health Ministry criteria for suspected cases. METHODOS: A cross-sectional study undertaken at the General Pediatrics Center of the Fundacao Hospitalar de Minas Gerais. Children were enrolled if presenting acute febrile conditions with no definite etiology, lasting > 24 hours and < 7 days and if resident in the Metropolitan Region of Belo Horizonte. Clinical variables were investigated, specific tests were performed and aspartate-aminotransferase assayed, during a period considered both endemic and epidemic for the disease. The subset of children who did have dengue was compared with the subset of nonspecific acute febrile diseases. The Health Ministry criteria for suspected cases was evaluated. RESULTS: Dengue was diagnosed in 50.4% of the 117 children studied. There were no statistically significant associations between the disease and the majority of the symptoms analyzed. Only exanthema was more often associated with dengue (Prevalence Ratio = 1.49; 95% CI: 1.05-2.11). The criteria for suspected cases of dengue had a sensitivity of just 50.8% and a positive predictive value of 62.5%. These values were greater among schoolchildren and during the period of greater disease incidence. CONCLUSIONS: Dengue is common among febrile diseases of childhood, with prevalence that varies according to the epidemiological situation. The clinical status of children with dengue was very similar to that of children with other nonspecific diseases. The Health Ministry criteria for suspected cases were shown to be of little use, particularly with smaller children and during periods of reduced incidence.

Análise de variáveis relacionadas à evolução letal do escorpionismo em crianças e adolescentes no estado de Minas Gerais no período de 2001 a 2005

OBJECTIVES: To describe and evaluate notified scorpion envenomation incidents in children and adolescents in the Brazilian state of Minas Gerais between 2001 and 2005, and to calculate the incidence and mortality and identify factors related to fatal outcomes. METHODS: Analysis of 14,406 mandatory notifications of scorpion envenomation involving patients aged 0 to 19 years in Minas Gerais. After performing a univariate analysis of factors related to mortality (p < 0.25), multivariate analysis was carried out using logistic regression. RESULTS: The number of notifications of accidents involving scorpions increased over the period. The age group that suffered most accidents was 5 to 9 years. Local pain was reported in 95% of cases. The majority of cases were classified as mild (60%) and antivenom was given to 42% of this population. The mean mortality rate was 0.7%. The state capital, Belo Horizonte, was the municipality with the greatest occurrence of incidents. Each hours delay before receiving first medical care was associated with a 9% increase in the odds ratio for the likelihood of death, which was 46 times greater in the severe group than in the moderate and mild groups. A decrease of 1 year in patient age was associated with a 13% increase in the odds ratio for the likelihood of death. CONCLUSIONS: There was an increase in the number of notifications over the period studied. The following factors were identified as linked with a higher odds ratio for the likelihood of death: delayed first medical care, being classified as a severe case, and younger age of victim.

Diagnosis of meningitis with reagent strips

OBJETIVO: determinar a utilidade de fitas reagentes para a avaliacao liquorica de pleocitose, glicorraquia e proteinorraquia no diagnostico precoce e rapido de meningites em criancas. METODOS: Foram incluidas no estudo amostras de liquor provenientes de 164 criancas admitidas no ambulatorio de doencas infecto-contagiosas do Centro Geral de Pediatria (CGP-FHEMIG), com suspeita clinica de meningite, no periodo diurno de Maio/97 a Maio/99. A faixa etaria dos pacientes variou de um mes a 12 anos (mediana de 12 meses), sendo obtidos resultados da citobioquimica liquorica (celularidade, glicorraquia e proteinorraquia) de 154 desses pacientes. Esses achados foram comparados com reacoes do liquor em fitas reagentes. RESULTADOS: Atraves da citobioquimica liquorica foram identificados 43 casos de provavel meningite bacteriana, 19 provavelmente viroticas e 83 amostras sem alteracoes. Pelas fitas reagentes, detectaram-se 41 casos de provavel meningite bacteriana, dois casos de infeccao meningea provavelmente virotica, e em 71 exames nao se verificaram alteracoes. Comparando os resultados obtidos por meio das fitas reagentes com a citobioquimica convencional, observou-se sensibilidade, especificidade, valores preditivos positivo e negativo e acuracia (90,7; 98,1; 95,1; 96,4; 96,1%, respectivamente). Ademais, a analise estatistica pelo teste de Mc Nemar nao evidenciou discordância significativa no diagnostico de meningite bacteriana obtido atraves de ambos os metodos (p=0,68) e, pela estatistica Kappa, verificou-se elevado grau de concordância entre os testes (p<0,0001). CONCLUSOES: Os resultados sugerem que o emprego de fitas reagentes pode se tornar recurso auxiliar util para o diagnostico de meningites bacterianas, principalmente em casos de dificuldades para a obtencao de volume suficiente do liquor e/ou para direcionar a terapeutica inicial.

Etiology and evolution of bacterial meningitis in a pediatric center

OBJECTIVE: To establish the prevalence of the etiological agents of bacterial meningitis in a reference center for the treatment of infectious diseases in the state of Minas Gerais. METHODS: Descriptive study including all children with probable diagnosis of meningitis between June/1999 and November/1999. RESULTS: There were 210 cases of meningitis, and 111 (52.9%) were caused by bacteria. Actually, 52 were probable bacterial meningitis (with liquor alterations) and 59 were confirmed (with culture and/or antigen tests). The main agents were: Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae. The initial treatment for children aged between three months and five years consisted of ampicillin and chloramphenicol. Later, the antibiotic was changed to penicillin in cases of Neisseria meningitidis and Streptococcus pneumoniae. and to chloramphenicol in cases of Haemophilus influenzae. Extended spectrum antimicrobial agents were used on clinical or laboratory basis, but resistant microorganisms were not found in cultures. CONCLUSIONS: The epidemiology of meningitis should be continuous and should consider local data in order to guide antimicrobial therapy. The continuous monitoring of the prevalent agents in each institution and their resistance is fundamental to the selection of antimicrobial drugs, preserving the antimicrobial agents, and causing less interference with individual colonization, without contributing to the increasing resistance of the agents responsible for meningeal infections.

Factors associated with intracranial hypertension in children and teenagers who suffered severe head injuries

OBJECTIVE To analyze factors associated with intracranial hypertension in pediatric patients who suffered severe head injuries. METHODS Retrospective cohort study, with data collected from September 1998 through August 2003, including patients aged 0 to 16 who suffered severe head injuries, Glasgow score < 9, and submitted to intracranial pressure (ICP) monitoring (n = 132). Intracranial hypertension (IH) was defined as an episode of ICP > 20 mmHg requiring treatment, while refractory IH was ICP over 25 mmHg requiring barbiturates or decompressive craniectomy. Univariate analysis was followed by multivariate analysis; variables were considered significant if p < 0.05. RESULTS Ages ranged from 2 months to 16 years, median age 9.7 (6.0-2.3) years. Glasgow scores ranged from 3 to 8, median 6 (4-7). Traffic accidents were responsible for 79.5% of events. Monitoring devices were installed, on average, 14 hours after trauma, median time 24 hours. One hundred and three patients (78%) had IH, while 57 (43.2%) had refractory IH. In multivariate analysis, younger age ranges were associated with IH [relative risk = 1.67 (1.03-2.72); p = 0.037], and abnormal postures were associated with refractory IH [relative risk = 2.25 (1.06-4.78)]. The group mortality rate was 51.5%; it was correlated with use of barbiturates in refractory IH and low cerebral perfusion pressure at the intensive care unit. CONCLUSIONS IH and refractory IH were frequent events in pediatric patients who suffered severe head injuries. The younger the patient, the greater the chance of developing IH. The presence of abnormal postures was found to be a risk factor for refractory IH.

Active and passive immunization against acute viral hepatitis

OBJECTIVE: The authors present the main indications related to the use of passive and active immunization against acute viral hepatitis, specially the composition, characteristics and current aspects of hepatitis A vaccination. Measures for hepatitis B prevention are also discussed. METHODS: The most recent and relevant articles published about the subject were selected and the special aspects of the immunological response, through different pediatric ages, are shown. RESULTS: The text analyzes the general measures for prevention of hepatitis A using the two inactivated vaccines, and also summarizes the indications and composition of the hepatitis B vaccines. CONCLUSIONS: Literature provides the guidelines for active and passive immunization against viral hepatitis and the present review is an update in the subject.