ABSTRACT Objective: The benefit of atropine in pediatric tracheal intubation is not well established. The objective of this study was to evaluate the effect of atropine on the incidence of hypoxemia and bradycardia during tracheal intubations in the pediatric emergency department. Methods: This is a single-center observational study in a tertiary pediatric emergency department. Data were collected on all tracheal intubations in patients from 31 days to incomplete 20 years old, performed between January 2016 and September 2020. Procedures were divided into two groups according to the use or not of atropine as a premedication during intubation. Records with missing data, patients with cardiorespiratory arrest, cyanotic congenital heart diseases, and those with chronic lung diseases with baseline hypoxemia were excluded. The primary outcome was hypoxemia (peripheral oxygen saturation ≤88%), while the secondary outcomes were bradycardia (decrease in heart rate >20% between the maximum and minimum values) and critical bradycardia (heart rate <60 bpm) during intubation procedure. Results: A total of 151 tracheal intubations were identified during the study period, of which 126 were eligible. Of those, 77% had complex, chronic underlying diseases. Atropine was administered to 43 (34.1%) patients and was associated with greater odds of hypoxemia in univariable analysis (OR: 2.62; 95%CI 1.15–6.16; p=0.027) but not in multivariable analysis (OR: 2.07; 95%CI 0.42–10.32; p=0.37). Critical bradycardia occurred in only three patients, being two in the atropine group (p=0.26). Bradycardia was analyzed in only 42 procedures. Atropine use was associated with higher odds of bradycardia in multivariable analysis (OR: 11.00; 95%CI 1.3–92.8; p=0.028). Conclusions: Atropine as a premedication in tracheal intubation did not prevent the occurrence of hypoxemia or bradycardia during intubation procedures in pediatric emergency.

RESUMO Objetivo: Avaliar o efeito da atropina na incidência de hipoxemia e bradicardia durante a intubação orotraqueal no departamento de emergência pediátrica. Métodos: Estudo observacional, realizado em departamento de emergência pediátrica terciário em que foram analisados os registros de intubações orotraqueais de pacientes com 31 dias a 20 anos incompletos, entre janeiro de 2016 e setembro de 2020. Os procedimentos foram divididos em dois grupos de acordo com o uso ou não da atropina como pré-medicação durante a intubação. Foram excluídos os procedimentos com falhas no preenchimento dos dados, pacientes com parada cardiorrespiratória, cardiopatias congênitas cianóticas, e aqueles com pneumopatias crônicas com hipoxemia basal. O desfecho primário foi hipoxemia (saturação periférica de oxigênio ≤88%), enquanto os desfechos secundários foram bradicardia (queda >20% entre a frequência cardíaca máxima e mínima) e bradicardia crítica (frequência cardíaca <60 bpm) durante o procedimento de intubação Resultados: Foram identificados 151 procedimentos de intubação orotraqueal, sendo 126 elegíveis para o estudo. Desses, 77% tinham doenças subjacentes complexas e crônicas. A atropina foi administrada em 43 (34,1%) pacientes e foi associada a maiores chances de hipoxemia na análise univariada (OR: 2,62; IC95% 1,15–6,16; p=0,027), porém, não na análise multivariada (OR: 2,073; IC95% 0,416–10,32; p=0,373). A bradicardia crítica ocorreu em apenas três pacientes, sendo dois no grupo atropina (p=0,268). A bradicardia foi analisada em apenas 42 procedimentos. O uso de atropina foi associado a maior probabilidade de bradicardia (OR: 11,00; IC95% 1,3–92,8; p=0,028) na análise multivariável. Conclusões: Atropina como pré-medicação na intubação orotraqueal não evitou a ocorrência de hipoxemia ou bradicardia durante os procedimentos de intubação na emergência pediátrica.

Chikungunya fever is caused by an RNA arbovirus belonging to the Togaviridae family of the alphavirus genus, called "chikungunya virus", this virus is vectored by Aedes aegypti and Aedes albopictus. In its acute phase, the disease is manifested by fever, arthritis or severe arthralgia, myalgia, headache, photophobia, lymphadenopathy and skin rashes. The symptoms can progress to a subacute to chronic phase, where joint manifestations and fatigue persist. A bibliographic search was carried out in the PubMed, Cochrane, Dovepress and SciELO databases, using the keywords: chikungunya and chikunguña, crossed with the words: chronic arthritis and treatment. A total of 16 articles were included: 6 review articles, 1 systematic review, 4 original articles, 2 clinical trials, 1 letter to Editor letter and 2 case reports. Among the pharmacological options, methotrexate is the most studied drug and competes with the effects of NSAIDs. Non-pharmacological therapies are physiotherapy and physical therapy, used as complements to pharmacological therapy. The use of home therapies, including homeopathy, could also be added, mainly addressing the psychological and cultural factors of the patients.

La fiebre Chikungunya es causada por un arbovirus ARN perteneciente a la familia Togaviridae del género alphavirus, llamado “virus del chikungunya”, este virus tiene como vector el Aedes aegypti y el Aedes albopictus. En su fase aguda la enfermedad se manifiesta por fiebre, artritis o artralgias severas, mialgias, cefalea, fotofobia, linfadenopatías y brotes cutáneos, los síntomas pueden progresar a una fase subaguda hasta crónica, donde persisten las manifestaciones articulares y la fatiga. Se realizó una revisión sistemática en las bases de PubMed, Cochrane, Dovepress y SciELO, utilizando las palabras claves: chikungunya y chikunguña, cruzadas con las palabras: artritis crónica y tratamiento. Se incluyeron en el estudio un total de 16 artículos, 6 artículos de revisión, 4 artículos originales, 2 ensayos clínicos, 2 reportes de caso, 1 revisión sistemática y 1 carta al editor. Entre las opciones farmacológicas, el metotrexato es el fármaco más estudiado y compite con los efectos de los AINE. Como terapias no farmacológicas se encuentran la fisioterapia y la terapia física, utilizados como complementos a la terapia farmacológica. El uso de terapias caseras, incluso la homeopatía, también podrían agregarse, atendiendo principalmente el factor psíquico y cultural de los pacientes.

ABSTRACT Background: Acute myeloid leukemia presenting the MYST3-CREBBP fusion gene is a rare subgroup associated with hemophagocytosis in early infancy and monocytic differentiation. The aim of this study was to define the relevant molecular cytogenetic characteristics of a unique series of early infancy acute myeloid leukemia cases (≤24 months old), based on the presence of hemophagocytosis by blast cells at diagnosis. Methods: A series of 266 infant cases of acute myeloid leukemia was the reference cohort for the present analysis. Acute myeloid leukemia cases with hemophagocytosis by blast cells were reviewed to investigate the presence of the MYST3-CREBBP fusion gene by fluorescence in situ hybridization (FISH) and reverse transcription polymerase chain reaction. Results: Eleven cases with hemophagocytosis were identified with hemophagocytic lymphohistiocytosis being ruled out. Six cases were classified as myelomonocytic leukemia, three as AML-M7 and two as AML-M2. In five cases, the presence of the MYST3-CREBBP fusion gene identified by molecular cytogenetics was confirmed by fluorescence in situ hybridization. All patients received treatment according to the Berlin-Frankfürt-Münster acute myeloid leukemia protocols and only one out of the five patients with the MYST3-CREBBP fusion gene is still alive. Conclusions: Our findings demonstrate that the presence of hemophagocytosis in acute myeloid leukemia was not exclusively associated to the MYST3-CREBBP fusion gene. Improvements in molecular cytogenetics may help to elucidate more complex chromosomal rearrangements in infants with acute myeloid leukemia and hemophagocytosis.

Abstract: Dengue infection has not been routinely investigated among pregnant women and parturients with acute febrile syndrome in endemic settings. Here, we report two cases of dengue fever detected at the time of delivery in parturients enrolled in a cohort prospective study conducted in a hospital in Recife, Brazil. The parturients reported fever onset within seven days prior to delivery, and dengue infection was confirmed upon detection of viral ribonucleic acid (RNA) by using the reverse transcriptase-polymerase chain reaction. Dengue infection should be considered as a diagnostic possibility in cases of fever during pregnancy and labor, especially in endemic areas.

Neste trabalho, avaliou-se a eficiência do tratamento de águas residuárias do beneficiamento de café por via úmida em reatores anaeróbios de fluxo ascendente com manta de lodo (UASB), em dois estágios, em escala de bancada, seguidos de pós-tratamento com lodos ativados em batelada. O primeiro reator UASB foi submetido a tempo de detenção hidráulica (TDH) de 6,2 d e a cargas orgânicas volumétricas (COV) de 2,3 e 4,5 g DQOtotal (L d)-1, e o segundo reator UASB a TDH de 3,1 d e a COV de 0,4 e 1,4 g DQOtotal (L d)-1. Os valores médios de DQOtotal do afluente aumentaram de 13.891 para 27.926 mg L-1, e as eficiências médias de remoção de DQOtotal diminuíram de 95 para 91%, respectivamente, nos reatores UASB, em dois estágios. A produção volumétrica de metano aumentou de 0,274 para 0,323 L CH4 (L reator d)-1com o acréscimo na COV. As concentrações médias de fenóis totais no afluente foram de 48 e 163 mg L-1, e as eficiências médias de remoção nos reatores UASB em dois estágios, de 92 e 90%, respectivamente, e aumentaram para 97% com o pós-tratamento. As eficiências médias de remoção de nitrogênio e fósforo total variaram, respectivamente, de 57 a 80% e de 44 a 60% nos reatores UASB em dois estágios e aumentaram para 91 e 84% com a inclusão do pós-tratamento.

In this study it was evaluated the efficiency of the treatment of wet-processed coffee wastewater in upflow anaerobic sludge blanket (UASB) reactors in two stages, in bench scale, followed by post-treatment with activated sludge in batch. The first UASB reactor was submitted to an hydraulic retention time (HRT) of 6.2 d and organic loading rates (OLR) of 2.3 and 4.5g CODtotal (L d)-1, and the second UASB reactor to HRT of 3.1 d with OLR of 0.4 and 1.4g CODtotal (L d)-1. The average values of the affluent CODtotal increased from 13,891 to 27,926mg L-1 and the average efficiencies of removal of the CODtotal decreased from 95 to 91%, respectively, in the UASB reactors in two stages. The volumetric methane production increased from 0.274 to 0.323L CH4 (L reactor d)-1 with increment in the OLR. The average concentrations of total phenols in the affluent were of 48 and 163mg L-1, and the removal efficiencies in the UASB reactors in two stages of 92 and 90%, respectively, and increased to 97% with post-treatment. The average values of the removal efficiencies of total nitrogen and phosphorus were of 57 to 80% and 44 to 60%, respectively, in the UASB reactors in two stages and increased to 91 and 84% with the post-treatment.

Neste trabalho, avaliou-se a eficiência do tratamento de águas residuárias do beneficiamento de café por via úmida em reatores anaeróbios de fluxo ascendente com manta de lodo (UASB), em dois estágios, em escala de bancada, submetidos a tempos de detenção hidráulica (TDH) de 4,0; 5,2 e 6,2 dias e cargas orgânicas volumétricas (COV) de 5,8; 3,0 e 3,6 g DQO total (L d)-1, no primeiro reator (R1), e TDH de 2,0; 2,6 e 3,1 dias e COV de 5,8; 0,5 e 0,4 g DQO total (L d)-1, no segundo reator (R2). Os valores médios de DQO do afluente variaram de 15.440 a 23.040 mg O2 L-1. As eficiências médias de remoção de DQO total e SST foram de 66 a 98% e de 93 a 97%, respectivamente, nos reatores UASB, em dois estágios. O teor médio de metano no biogás variou de 69 a 89%, no reator R1, e de 52 a 73%, no reator R2. A produção volumétrica máxima de metano de 0,708 L CH4 (L reator d)-1 foi obtida com COV de 3,6 g DQO (Ld)-1 e TDH de 6,2 d, no reator R1. Os valores médios de pH variaram de 4,7 a 7,7 e de 4,9 a 8,0 nos efluentes dos reatores R1 e R2, respectivamente. As concentrações de ácidos voláteis totais nos efluentes mantiveram-se estáveis com valores inferiores a 100 mg L-1, com TDH de 5,2 e 6,2 dias, no reator R1, e TDH de 2,6 e 3,1 dias, no reator R2. As concentrações médias de fenóis totais no afluente variaram de 80 a 97 mg L-1 e as eficiências médias de remoção nos reatores UASB, em dois estágios, foram de 72 a 90%.

In this work, it was evaluated the efficiency of two stage up flow anaerobic sludge blanquet (UASB) reactors, in bench scale, treating a liquid effluent from the coffee pulping, submitted to hydraulic detention time (HDT) of 4.0; 5.2 and 6.2 days, resulting in organic loading rate (OLR) of 5.8; 3.6 and 3.0 g COD (L d)-1 in the first reactor (R1) and HDT of 2.0; 2.6 and 3.1 days with OLR of 5.8; 0.5 and 0.4 g DQO total (L d)-1 in the second reactor (R2). The medium values of total COD affluent varied from 15,440 to 23,040 mg O2 L-1. The medium values of removal efficiencies of total COD and TSS varied from 66 to 98% and 93 to 97%, respectively, in the system of treatment with the UASB reactors in two stages. The content of methane in the biogas varied from 69 to 89% in the R1 and from 52 to 73% in the R2. The maximum volumetric methane production of 0.708 L CH4 (L reactor d)-1 was obtained with OLR of 3.6 g total COD (Lreactor d)-1 and HDT of 6.2 days in the R1. Average pH values ranged from 4.7 to 7.7 and 4.9 to 8.0 in the effluents of R1 and R2, respectively. Total volatile acids concentrations was kept below 100 mg L-1 with HDT of 5.2 and 6.2 days in the R1 and HDT of 2.6 and 3.1 days in the R2. The medium values of total phenols of affluent ranged from 80 to 97 mg L-1 and the average removal efficiencies ranged from 72 to 90% in the UASB reactors in two stages.