ABSTRACT Objective: In order to study the scenario of respiratory infections in pediatrics after the emergence of SARS-CoV-2 in Brazil, this study aimed to compare characteristics of children admitted for SARS or upper airway infection caused by either RSV or SARS-CoV-2. Methods: This was a cross-sectional study involving children up to 48 months of age admitted to a tertiary pediatric hospital with a diagnosis of SARS or upper airway infection between April of 2020 and April of 2021. Respiratory secretion samples were collected 2-5 days after hospitalization, and antigen/PCR tests for viral etiologies were performed. In this analysis, patients with laboratorial diagnosis of SARS-CoV-2 and/or RSV were selected, and their clinical and epidemiological characteristics were compared using logistic regression. Results: Our sample initially comprised 369 participants. SARS-CoV-2 and RSV infections were confirmed in 55 (15%) and 59 children (16%), respectively. Mean age was 12 months (0-48 months), and 47 were female. The following characteristics were significantly more frequent in patients with RSV when compared with those with COVID-19: younger age (OR = 0.94; 95% CI: 0.90-0.98); lower frequency of fever (OR = 0.18; 95% CI: 0.05-0.66); and more frequent upper airway symptoms: cough (OR = 7.36; 95% CI: 1.04-52.25); and tachypnea (OR = 6.06; 95% CI: 1.31-28.0). Conclusions: Children with RSV-related SARS were younger, had lower frequency of fever at admission, but had a higher frequency of signs of upper airway infection and lower systemic inflammation when compared with children hospitalized for COVID-19 during the first year of the pandemic. Objective SARSCoV2 SARSCoV CoV 2 SARS-CoV- Brazil SARSCoV2. 2. Methods crosssectional cross sectional 4 202 2021 25 5 2- hospitalization antigenPCR antigen PCR performed analysis andor selected regression Results 36 participants 15% 15 (15% 16%, 16 16% , (16%) respectively 1 048 0 (0-4 months, months) female COVID19 COVID 19 OR 0.94 094 94 95 CI 0.900.98 090098 0.90 0.98 90 98 0.90-0.98) 0.18 018 18 0.050.66 005066 0.05 0.66 05 66 0.05-0.66) symptoms 7.36 736 7 1.0452.25 1045225 1.04 52.25 04 52 1.04-52.25) 6.06 606 6 06 1.3128.0. 131280 1.31 28.0 . 31 28 1.31-28.0) Conclusions RSVrelated related admission COVID-1 pandemic SARS-CoV 20 3 (15 (16% (0- COVID1 0.9 09 9 900 0.900.9 09009 090 098 0.90-0.98 0.1 01 050 0.050.6 00506 005 0.0 066 0.6 0.05-0.66 7.3 73 0452 1.0452.2 104522 104 1.0 5225 52.2 1.04-52.25 6.0 60 3128 1.3128.0 13128 131 1.3 280 28. 1.31-28.0 COVID- (1 (16 (0 0. 0.900. 0900 0.90-0.9 0.050. 0050 00 0.05-0.6 7. 045 1.0452. 10452 10 1. 522 52. 1.04-52.2 6. 312 1.3128. 1312 13 1.31-28. ( 0.900 0.90-0. 0.050 0.05-0. 1.0452 1045 1.04-52. 1.3128 1.31-28 0.90-0 0.05-0 1.045 1.04-52 1.312 1.31-2 0.90- 0.05- 1.04-5 1.31- 1.04-

RESUMO Objetivo: O presente estudo teve como objetivo descrever as formas clínicas e o tempo de diagnóstico de novos casos de tuberculose e analisar estatisticamente as formas isoladas e combinadas da doença em crianças e adolescentes atendidos em um hospital universitário do Rio de Janeiro durante o primeiro ano da pandemia de COVID-19 no Brasil. Métodos: Este estudo transversal utilizou dados retrospectivos de crianças (0-9 anos) e adolescentes (10-18 anos) com tuberculose pulmonar (TBP), extrapulmonar (TBEP) e combinada (TBP + TBEP) acompanhados no ambulatório de janeiro de 2019 a março de 2021. Os dados categóricos foram analisados por estatística descritiva e expressos em frequência e proporções. As variáveis categóricas foram comparadas pelo teste Qui-quadrado e as variáveis numéricas pelo teste T de Student. Resultados: Foram incluídos 51 casos, sendo 63% (32/51) pacientes no ano da pandemia (grupo A) e 37% (19/51) pacientes atendidos em anos anteriores (grupo B). No grupo A, 19% (6/32) dos pacientes apresentavam TBP, 59% (16/32) TBEP e 31% (10/32) TBP+TBEP. No grupo B, 42% (8/19) dos pacientes apresentavam TBP, 42% (8/19) TBEP e 16% (3/19) TBP+TBEP. Conclusão: Nosso estudo evidenciou mais casos de tuberculose no primeiro ano da pandemia do que no mesmo período do ano anterior, com maior variação de locais acometidos pela doença, incluindo formas mais raras e mais graves.

ABSTRACT Objective: The present study aimed to describe the clinical forms and the time taken to diagnose new tuberculosis cases and to statistically analyze the isolated and combined forms of the disease in children and adolescents treated at a university hospital in Rio de Janeiro during the first year of the COVID-19 pandemic in Brazil. Methods: This was a cross-sectional study that used retrospective data on children (0-9 years old) and adolescents (10-18 years old) with pulmonary (PTB), extrapulmonary (EPTB), and combined tuberculosis (PTB + EPTB) followed up at the outpatient clinic from January 2019 to March 2021. Categorical data were analyzed by descriptive statistics and expressed as frequency and proportions. Categorical variables were compared using the Chi-square test, and numerical variables using Student’s T-test. Results: A total of 51 cases were included, 63% (32/51) of which comprised patients in the year of the pandemic (group A), while 37% (19/51) were patients attended in previous years (group B). In group A, 19% (6/32) of the patients presented PTB, 59% (16/32) had EPTB, and 31% (10/32) had PTB+EPTB. In group B, 42% (8/19) of the patients presented PTB, 42% (8/19) had EPTB, and 16% (3/19) had PTB+EPTB. Conclusion: Our study revealed more tuberculosis cases in the first year of the pandemic than in the same period of the previous year, with greater variation of sites affected by the disease, including rarer and more severe forms.

ABSTRACT Objective: To analyze adolescents' opinion on healthy and unhealthy foods. We conducted a cross-sectional study involving adolescents from public and private schools. Methods: The sample was stratified in three stages: school, class and student, resulting in 1507 surveyed adolescents. The adolescents answered questions on healthy and unhealthy foods. Results: A total of 995 adolescents answered the questionnaire and were considered for analysis. By and large, adolescents agreed on the benefits of fruits for health. There was disagreement between responses of public versus private school students with regard to the health risks of processed salty snacks and French fries; private school students, as well as females, agreed that soft drinks contribute to weight gain and obesity, while those belonging to the public schools disagreed; adolescents from private schools, female and adolescents aged 15 to 17 years disagreed that red and fatty meats protect against heart diseases. Conclusion: Adolescents from private versus public schools, females compared to males, and who were older demonstrated a better understanding of the negative health effects of soft drinks and meat consumption

RESUMEN Objetivo. Analizar la opinión de los adolescentes sobre alimentos saludables y no saludables. Estudio transversal con adolescentes de escuelas públicas y privadas. Métodos. La muestra se estratificó en tres etapas: escuela, clase y alumno, resultando en 1507 adolescentes estudiados. Los adolescentes respondieron sobre alimentos saludables y no saludables. Resultados: 995 adolescentes respondieron al cuestionario de forma completa. Los adolescentes concordaron con los beneficios de las frutas para la salud. Hubo discordancia entre las respuestas de los estudiantes de escuelas públicas y privadas sobre los maleficios de los saladitos ultraprocesados y las papas fritas para la salud; estudiantes de la red privada de enseñanza, así como del sexo femenino concordaron que las gaseosas ayudan a engordar y provocan obesidad, mientras que los de la red pública discreparon; adolescentes de escuelas privadas, de sexo femenino y grupo de edad de 15 a 17 años discreparon que carnes rojas y grasas protegen contra enfermedades del corazón. Conclusión: Los adolescentes de las escuelas de la red privada de enseñanza parecen presentar una mejor percepción acerca de los refrescos y carnes y sus maleficios a la salud, como aquellos que presentaron la mayor edad y del sexo femenino.

Resumo Objetivo: As pessoas infectadas pelo HIV (HIVI) estão sujeitas a infecção meningocócica e apresentam menor resposta a vacinas. São escassos os dados a respeito da persistência de longo prazo do anticorpo bactericida no soro humano (hSBA) após vacina conjugada meningocócica C (MCC) em HIVI jovens e visamos a descrever essa persistência em HIVI. Métodos: Foram recrutadas pessoas HIVI e pessoas não infectadas por HIV (HIVU), entre 2 e 18 anos, CD4 > 15%. A seroproteção (hSBA ≥ 1:4) basal aos 12–18 meses após a imunização foi avaliada e a associação dos diferentes fatores com a persistência de longo prazo foi calculada com a regressão logística. Resultados: Foram recrutados 145 HIVI e 50 HIVU e imunizados e sua idade média foi determinada em 11 anos (12 no grupo HIVI e 10 no grupo HIVU, valor de p = 0,02); 85 HIVI (44%) apresentaram carga viral indetectável (CVI). A taxa de seroproteção foi 27,2%: 24,1% no grupo HIVI e 36% no grupo HIVU 12-18 meses após imunização (p = 0,14). A imunidade basal [razão de chance (RC) = 7070, IC: 65,2–7666]; CVI no momento da participação (RC: 2,87, IC de 95%: 0,96-8,62) e renda familiar mais baixa (RC: 0,09, IC de 95%: 0,01-0,69) foram associadas a seroproteção entre as pessoas HIVI. Conclusão: A seroproteção aos 12-18 meses após única dose de MCC mostrou-se baixa em ambos os grupos e mais elevada entre as pessoas que apresentaram imunidade basal. Entre as pessoas HIVI, as vacinas devem ser administradas após a CVI ser atingida.

Abstract Objective: HIV-infected individuals (HIVI) are threatened by meningococcal infection and presented lower response to vaccines. Data are scarce on long-term persistence of human serum bactericidal antibody (hSBA) after a meningococcal C conjugate (MCC) vaccine in HIVI youth; the authors aimed to describe this persistence in HIVI. Methods: HIVI and HIV uninfected individuals (HIVU), aged 2–18 years, CD4 >15% were recruited. Seroprotection (hSBA ≥1:4) at baseline and at 12–18 months after immunization was evaluated and the association of the different factors with the long-term persistence was calculated using logistic regression. Results: A total of 145 HIVI, 50 HIVU were recruited and immunized, and their median age was 11 years (median age in HIVI group was 12 years, and 10 years in HIVU group, p-value = 0.02). 85 HIVI (44%) had undetectable viral load (UVL). Seroprotection rate was 27.2%: 24.1% in HIVI and 36% in HIVU 12–18 months after immunization (p = 0.14). Baseline immunity (odds ratio [OR] = 70.70, 95% CI: 65.2–766.6); UVL at entry (OR: 2.87, 95% CI: 0.96–8.62) and lower family income (OR: 0.09, 95% CI: 0.01–0.69) were associated with seroprotection among HIVI. Conclusion: Seroprotection at 12–18 months after single dose of MCC was low for both groups, and higher among individuals who presented baseline immunity. Among HIVI, vaccine should be administered after UVL is achieved.

Objective:To evaluate the occurrence, clinical presentations and diagnostic methods for tuberculosis in a cohort of HIV-infected infants, children and adolescents from Latin America.Methods:A retrospective analysis of children with tuberculosis and HIV was performed within a prospective observational cohort study conducted at multiple clinical sites in Latin America.Results:Of 1114 HIV-infected infants, children, and adolescents followed from 2002 to 2011, 69 that could be classified as having confirmed or presumed tuberculosis were included in this case series; 52.2% (95% CI: 39.8-64.4%) had laboratory-confirmed tuberculosis, 15.9% (95% CI: 8.2-26.7%) had clinically confirmed disease and 31.9% (95% CI: 21.2-44.2%) had presumed tuberculosis. Sixty-six were perinatally HIV-infected. Thirty-two (61.5%) children had a history of contact with an adult tuberculosis case; however information on exposure to active tuberculosis was missing for 17 participants. At the time of tuberculosis diagnosis, 39 were receiving antiretroviral therapy. Sixteen of these cases may have represented immune reconstitution inflammatory syndrome.Conclusions:Our study emphasizes the need for adequate contact tracing of adult tuberculosis cases and screening for HIV or tuberculosis in Latin American children diagnosed with either condition. Preventive strategies in tuberculosis-exposed, HIV-infected children should be optimized.

The aim of present study was to describe the frequency of lipodystrophy syndrome associated with HIV (LSHIV) and factors associated with dyslipidemia in Brazilian HIV infected children. HIV infected children on antiretroviral treatment were evaluated (nutritional assessment, physical examination, and laboratory tests) in this cross-sectional study. Univariate analysis was performed using Mann-Whitney test or Fisher's exact test followed by logistic regression analysis. Presence of dyslipidemia (fasting cholesterol >200 mg/dl or triglycerides >130 mg/dl) was the dependent variable. 90 children were enrolled. The mean age was 10.6 years (3-16 years), and 52 (58%) were female. LSHIV was detected in 46 children (51%). Factors independently associated with dyslipidemia were: low intake of vegetables/fruits (OR = 3.47, 95%CI = 1.04-11.55), current use of lopinavir/ritonavir (OR = 2.91, 95%CI = 1.11-7.67). In conclusion, LSHIV was frequently observed; inadequate dietary intake of sugars and fats, as well as current use of lopinavir/ritonavir was associated with dyslipidemia.

There are only scarce data on HIV progression in vertically infected children in developing countries. The aim of this study is to describe factors from neonatal period associated with long term non-progression (LTNP), in a Brazilian cohort. A cohort study, with data systematically collected from the "Peixe" Cohort (cohort study of children conducted at the main HIV Pediatric Center in Rio de Janeiro, from 1996 to 2005). The study included children who were vertically infected and started follow up at 5 years of age or younger. LTNP, defined as not reaching category C or severe immunosuppression before 5 years of age. Neonatal and demographic factors were studied. Variables with p-value<0.15 were included in a logistic regression model. 213 patients were included, of whom 42% (89/213) were classified as LTNP. Variables independently associated with LTNP were: baseline (at study entry) CD4+ cells (per %) (OR= 1.06, 95%CI=1.01-1.12); age of initiating follow-up, per month (OR= 1.03, 95%CI=1.01-1.06); ZDV use duriing newborn period (OR= 3.31, 95%CI=0.86-12.71); use of antiretroviral (ART) before classification C or severe immunosuppression (OR= 5.89, 95%CI=2.03-17.10). Adjusting for age at the beginning of follow-up, antiretroviral that was unsuccessfully used to prevent maternal-to-child transmission (ZDV use in neonatal period) was associated with better prognosis. ARTs initiation before category C or severe immunosuppression was also associated with LTNP.

OBJETIVO: Descrever a prevalência de alterações cardíacas ao ecocardiograma em crianças com AIDS acompanhadas em serviço de referência aos 18±6 meses do diagnóstico confirmado de AIDS. MÉTODOS: Estudo transversal, com corte aos 18±6 meses do diagnóstico de AIDS. Incluídas 93 crianças com diagnóstico confirmado de AIDS por transmissão vertical, sem doença maligna, que, na avaliação cardiológica, realizaram ecocardiograma (eco). De forma exploratória avaliaram-se as alterações cardíacas nos pacientes sem uso (G1) e com uso (G2) de terapia combinada anti-retroviral. RESULTADOS: Quando do diagnóstico de AIDS, as crianças tinham em média 3,07 anos e 50,50% eram do sexo feminino. Esquema de terapia combinado com anti-retrovirais foi utilizado por 47 pacientes (G2). O acometimento cardíaco esteve presente em 40 crianças (43,00%). A presença de disfunção ventricular esquerda (G1:39,10%;G2:10,60%) e o aumento isolado de ventrículo esquerdo (G1:6,60%;G2:14,90%) foram os achados mais freqüentes. Observou-se associação significativa entre os grupos sem e com terapia anti-retroviral combinada quanto à presença de disfunção ventricular esquerda (RP=3,42; [1,41-8,26]; p =0,02) e de desnutrição (RP=1,79; [1,00-3,20]; p=0,04). CONCLUSÃO: O acometimento cardíaco foi freqüente nas crianças com AIDS, sendo a disfunção ventricular esquerda a alteração mais observada ao ecocardiograma. Houve diferença estatisticamente significativa entre os grupos com e sem tratamento tríplice combinado quanto à presença de disfunção ventricular esquerda e de desnutrição.

OBJECTIVE: To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18±6 months of AIDS confirmed diagnosis. METHODS: A cross-section study with a cohort after 18±6 months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical transmission, with no malignancies and who underwent echocardiogram (echo) during cardiologic evaluation. Cardiac abnormalities were assessed in patients who were not treated (G1) and patients who were treated (G2) with combination antiretroviral therapy. RESULTS: When diagnosed with AIDS, the children were on average 3.07 years old and 50.50% were female. The combination regimen with antiretroviral agents was used by 47 patients (G2). Cardiac involvement was present in 40 children (43.00%). The presence of left ventricular dysfunction (G1: 39.10%; G2: 10.60%) and the isolated enlargement of left ventricle (G1: 6.60%; G2: 14.90%) were the most frequent findings. We observed a significant association between the groups without and with combination antiretroviral therapy asregards the presence of left ventricular dysfunction (PR= 3.42; [1.41-8.26]; p = 0.02) and malnutrition (PR = 1.79; [1.00-3.20]; p = 0.04). CONCLUSION: Cardiac involvement was frequent in children with AIDS and left ventricular dysfunction was the most common abnormality on echocardiogram. There was a statistically significant difference between the groups with and without triple combination treatment as regards the presence of left ventricular dysfunction and malnutrition.

OBJETIVO: relatar a ocorrência de uma deficiência funcional de neutrófilos rara, com quadro clínico e laboratorial semelhante ao da doença granulomatosa crônica. MÉTODOS: relato de caso de paciente com deficiência acentuada da glicose-6-fosfato desidrogenase e infecções de repetição. Realizada pesquisa bibliográfica utilizando as bases de dados Medline e Lilacs, abrangendo o período de 1972 a 2000. RESULTADOS: paciente com nível da glicose-6-fosfato desidrogenase extremamente reduzido e quadro de infeções graves com melhora clínica após uso de cotrimoxazol contínuo. Os leucócitos do paciente apresentam defeito no metabolismo oxidativo, similar ao da doença granulomatosa crônica. CONCLUSÕES: o diagnóstico da deficiência da glicose-6-fosfato desidrogenase em neutrófilos deve ser considerado em qualquer paciente com anemia hemolítica não esferocítica congênita no qual o nível da glicose-6-fosfato desidrogenase esteja anormalmente baixo ou apresente infeções de repetição. É diagnóstico diferencial da doença granulomatosa crônica.

OBJECTIVE: To report a case of rare neutrophil functional disorder with clinical and laboratory findings similar to those of chronic granulomatous disease. METHODS: Patient with extremely reduced level of glucose-6-phosphate dehydrogenase and recurrent infections that improved after continuous use of cotrimoxazole. The patient presented leukocytes with defective respiratory burst, similar to what occurs in chronic granulomatous disease. COMMENTS: The diagnosis of glucose-6-phosphate dehydrogenase deficiency in neutrophils should be considered in any patient with hemolytic anemia whose level of G6PD is extremely low or in any patient that presents recurrent infections as differential diagnosis of chronic granulomatous disease.

OBJECTIVES: To determine the HIV vertical transmission rate (VTR) and associated risk factors by use of zidovudine and infant care education in Brazil. METHODS: Since 1995, a prospective cohort of HIV infected pregnant women has been followed at the Federal University of Rio de Janeiro. A multidisciplinary team was established to implement the best available strategy to prevent maternal-infant HIV transmission. Patients with AIDS or low CD4 and high viral load received anti-retroviral drugs in addition to zidovudine. Children were considered infected if they had 2 positive PCR-RNA tests between 1 and 4 months of age, or were HIV antibody positive after 18 months. Education regarding infant treatment and use of formula instead of breast feeding was provided. RESULTS: Between 1995 and August, 2000, HIV status was determined for 145 infants. Compliance with intra-partum treatment, infant treatment and use of formula was 88.2%. Intra-partum zidovudine treatment was completed in 134/145 (92.6%) of patients; 88.1% had rupture of membranes < 4 hours; 85.4% of mothers were asymptomatic. The mean CD4 count was 428.4 cells and mean viral load 39,050 copies. HIV vertical transmission rate was 4/145 (2.75%; CI: 0.1%-5.4%). The only risk factor significantly associated with transmission was a failure to use zidovudine intra-partum in 2 of the 4 mothers (50% versus 6.4% in non-transmitting mothers). A trend toward low CD4 and high viral load at entry, and rupture of membranes > 4 hours were associated with increased HIV transmission. CONCLUSION: HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high level of compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.