Abstract Sugammadex is a distinctive neuromuscular reversal drug that acts by encapsulating the neuromuscular relaxant molecule and dislodging it from its site of action. Sugammadex has been approved for pediatric patients over 2 years of age. Although arrhythmias have been reported, there is no report of adverse effects in healthy children, such as severe bradycardia requiring intervention. We report two cases of severe bradycardia immediately after the administration of sugammadex in healthy children. Our aim is to alert to the occurrence of one of the most severe adverse effects of sugammadex, in the healthy pediatric population as well.

Objective: To estimate the prevalence of SARS-CoV-2 infection among workers in the Espírito Santo prison system between August and September 2020. Methods: A stratified sample survey through interviews and serological tests for SARS-CoV-2.Results: In the 986 respondents, the prevalence of SARS-CoV-2 infection was 11.9% (CI95% 8,1%;15,7%) among health professionals and 22.1% (CI 95%; 18,8%; 25,3%) among prison officers. Positivity was more frequent in health professionals from the North region (19.7%), and in male prison officers (24.0%). Among the positive ones, fatigue was the most frequent symptom among prison officers (13.4%) and miracle among health professionals (10.8%); and the most prevalent comorbidities among thepositive ones were: asthma or bronchitis (16.2%) for health professionals, and hypertension for prison officers (12.8%). Conclusion: The prevalence of SARS-Cov-2 was higher in prison officers, supporting disease control and prevention actions in this scenario.

Objetivo: Estimar la prevalencia de la infección por SARS-CoV-2 en trabajadores del sistema penitenciario de Espírito Santo entre agosto y septiembre de 2020. Métodos: Encuesta muestral estratificada mediante entrevistas y pruebasserológicas para SARS-CoV-2. Resultados: En los 986 encuestados, la prevalencia de la infección por SARS-CoV-2 fue del 11,9% (IC95% 8,1%;15,7%) entre los profesionales de la salud y del 22,1% (IC95% 18,8%;25,3%) entre los funcionarios deprisiones. La positividad fue más frecuente en los profesionales de la salud de la región Norte (19,7%) y en los funcionarios de prisiones varones (24,0%). Entre los positivos, la fatiga fue el síntoma más frecuente entre los funcionarios de prisiones (13,4%) y el milagro entre los profesionales de la salud (10,8%); y las comorbilidades másprevalentes entre las positivas fueron: asma o bronquitis (16,2%) para los profesionalesde la salud e hipertensión para los funcionarios de prisiones (12,8%). Conclusión: La prevalencia del SARS-Cov-2 fue mayor en los funcionarios de prisiones, apoyando las acciones de control y prevención de enfermedades en este escenario.

Objetivo: Estimar a prevalência de infecção por SARS-CoV-2 entre trabalhadores do sistema prisional do Espírito Santo, Brasil, no período agosto-setembro de 2020. Métodos: Inquérito em amostra estratificada, mediante entrevistas e testes sorológicos para SARS-CoV-2. Resultados: Nos 986 pesquisados, a prevalência deinfecção por SARS-CoV-2 foi de 11,9% (IC95% 8,1%;15,7%) nos profissionais de saúde, e de 22,1% (IC95%; 18,8%;25,3%) nos agentes penitenciários. A positividade foi mais frequente nos profissionais da saúde do norte do estado (19,7%) e em agentes penitenciários do sexo masculino (24,0%). Entre soropositivos, a fadiga foi o sintoma mais frequente nos agentes penitenciários (13,4%) e a mialgia nos profissionais de saúde (10,8%); e as comorbidades mais prevalentes entre os positivos foram asma ou bronquite (16,2%), para profissionais de saúde, e hipertensão para agentes penitenciários (12,8%). Conclusão: A prevalência de SARS-Cov-2 foi maior nos agentes penitenciários, achado que deve subsidiar ações de controle e prevenção dadoença nesse cenário.

Introdução: A cirrose hepática (CH) é o estágio final de múltiplos processos que conduzem à insuficiência hepática e corresponde à 10ª causa de morte mais comum no mundo Ocidental. As infeções bacterianas são uma complicação frequente nos doentes com CH, devido ao seu estado de imunossupressão. Aproximadamente 60% das infeções bacterianas em cirróticos são adquiridas na comunidade (AC) e 40% são nosocomiais. As infeções bacterianas mais comuns em cirróticos são Peritonite Bacteriana Espontânea (PBE) (25%), Infeção do Trato Urinário (ITU) (20%), Pneumonia (15%), Bacteriemia (12%) e Celulite (2-11%). O objetivo deste estudo é avaliar as infeções mais frequentes em doentes com CH e descrever a evolução da microbiologia nos mesmos. Material e Métodos: Análise retrospetiva de quatro anos intercalados (2008, 2010, 2012 e 2014) que incluiu trezentos e setenta e dois doentes. Características demográficas: género, idade, tipo de infeção, perfil de resistência bacteriana, uso de antibióticos, scores Child-Pugh-Turcotte e Model for End-Stage Liver Disease e taxa de mortalidade. Resultados: A idade média dos doentes incluídos neste estudo foi de 64.5 ± 12.2 anos. Os homens foram, significativamente, mais prevalentes que as mulheres (72 vs. 28%). Nos quatro anos intercalados, ocorreram: 71 infeções (49% AC e 51% nosocomiais) em 2008; 86 infeções (60.5% AC e 39.5% nosocomiais) em 2010; 99 infeções (56.6% AC e 43.4% nosocomiais) em 2012 e 116 infeções (70.7% AC e 29.3% nosocomiais) em 2014. As infeções mais frequentes foram a ITU (32.5%), Infeção do Trato Respiratório (29.3%), PBE (26.1%) e Celulite (6.2%). Identificou-se o agente microbiológico em 32.4, 59.3, 53.5 e 61.2% das infeções em 2008, 2010, 2012 e 2014, respetivamente, com predomínio de bacilos Gram-negativos. Em todas as séries, as cefalosporinas de terceira geração foram o antibiótico mais utilizado empiricamente. A grande maioria dos doentes encontra-se no estadio B (42,7%) do score Child-Pugh-Turcotte, seguido de C (39.3%) e A (18%). A mortalidade aumentou, significativamente, de 7% em 2008 para 25% em 2014 (p = 0.016). Conclusões: O presente estudo mostrou uma elevada prevalência de infeções bacterianas em doentes com CH. É necessário uma alta suspeita clínica para infeção nestes doentes, pois o tratamento antibiótico precoce e apropriado pode diminuir a morbilidade e a mortalidade.

Background and Aims: Liver cirrhosis (LC) is the end stage of multiple processes that lead to hepatic failure and is the 10th most common cause of death in the Western world. Bacterial infections are one of the most important clinical problems in patients with LC, as their underlying immune status is compromised. Approximately 60% of bacterial infections in cirrhotic patients are community acquired (CA) and 40% are nosocomial. The most common infections in cirrhotic patients are spontaneous bacterial peritonitis (SBP) (25%), urinary tract infection (UTI) (20%), pneumonia (15%), bacteremia (12%), and cellulitis (2-11%). The aim of this study was to evaluate the most frequent infections in patients with LC and describe the evolution of the microbiology in these patients. Material and Methods: This is a retrospective analysis of 4 interspersed years (2008, 2010, 2012, and 2014) that included 372 patients. Demographic characteristicswere evaluated, including gender, age, type of infection, bacteria resistance profile, antibiotic use, Child-Pugh-Turcotte and Model for End-Stage Liver Disease scores, and mortality rate. Results: The mean age of all patients enrolled in this study was 64.5 ± 12.2 years. Male patients were significantly more prevalent than female ones (72 vs. 28%). In the 4 analyzed years, the following numbers of infections occurred: 71 infections (49% CA and 51% nosocomial) in 2008; 86 infections (60.5% CA and 39.5% nosocomial) in 2010; 99 infections (56.6% CA and 43.4% nosocomial) in 2012; and 116 infections (70.7% CA and 29.3% nosocomial) in 2014. The most frequent infections were UTI (32.5%), respiratory tract infection (29.3%), SBP (26.1%), and cellulitis (6.2%). A microbiological agent was identified in 32.4, 59.3, 53.5, and 61.2% of infections in 2008, 2010, 2012, and 2014, respectively, with a predominance of gram-negative bacilli. In all series, a third-generation cephalosporin was the most frequent antibiotic used empirically. The majority of patients was in stage B (42.7%) of the Child-Pugh-Turcotte score, followed by stage C (39.3%) and stage A (18%). Mortality increased significantly over the years, from 7% in 2008 to 25% in 2014 (p = 0.016). Conclusions: The present study showed a high prevalence of bacterial infections in patients with LC. A high rate of suspicion is needed for an infectious process in these patients, and an appropriate antibiotic treatment can decrease the morbidity and mortality in cirrhotic patients.

The present study investigated whether late maternal inflammation disrupts the mother/pup interaction, resulting in long-lasting effects on pup behavior and alterations in biological pathways, thereby programming prepubertal behavior and the pups' inflammatory responses after bacterial endotoxin treatment. Female rats received 100 μg/kg lipopolysaccharide (LPS) or .9% saline solution on gestation day 18. Reproductive performance was observed at birth. On lactation days (LD) 5 and LD 6, respectively, maternal behavior and maternal aggressive behavior were assessed. In pups, maternal odor preference on LD 7, open field behavior on LD 21, and serum tumor necrosis factor α (TNF-α) levels after LPS challenge on LD 21 were investigated. The results showed that prenatal LPS exposure improved maternal care and reduced maternal aggressive behavior but did not alter maternal reproductive performance. Male offspring exhibited increased body weights at birth and reduced maternal odor preference. Lipopolysaccharide challenge increased the duration of immobility in the open field and induced a slight increase in serum TNF-α levels. Prenatal exposure to LPS during late pregnancy improved maternal care, reduced maternal olfactory preference, and induced TNF-α hyporesponsiveness to a single dose of LPS in pups.