Abstract Objective We sought to describe the prevalence of microcephaly and to compare the different cutoff points established by the Brazilian Ministry of Health at various times during a Zika virus epidemic. As a secondary aim, we investigated the possible etiology of the microcephaly. Method This retrospective study utilized newborn participants in the Zika Cohort Study Jundiaí. Newborns from the Zika Cohort Study Jundiaí with an accurate gestational age determination and complete anthropometric data were analyzed, and microcephaly was diagnosed according to the INTERGROWTH-21st curve. At delivery, fluids were tested for specific antibodies and for viruses. Brain images were evaluated for microcephaly. Receiver Operating Characteristic curves were plotted to define the accuracy of different cutoff points for microcephaly diagnosis. Results Of 462 eligible newborns, 19 (4.1%) were positive for microcephaly. Cutoff points corresponding to the curves of the World Health Organization yielded the best sensitivity and specificity. Three of the microcephaly cases (15.8%) were positive for Zika virus infections; nine (47.4%) had intrauterine growth restriction; one had intrauterine growth restriction and was exposed to Zika virus; three had a genetic syndrome (15.8%); and three had causes that had not been determined (15.8%). Conclusions Microcephaly prevalence was 4.1% in this study. Cutoff values determined by the World Health Organization had the highest sensitivity and specificity in relation to the standard IG curve. The main reason for microcephaly was intrauterine growth restriction. All possible causes of microcephaly must be investigated to allow the best development of an affected baby.

RESUMO Objetivo: Rever os conceitos de coqueluche grave, atualizar epidemiologia, fisiopatologia e apresentação clínica, verificar as recomendações de antibioticoterapia e conhecer opções terapêuticas auxiliares na sintomatologia e complicações, por meio de revisão sistemática. Fontes de dados: Foram pesquisados trabalhos publicados nos últimos 30 anos nas bases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane e Google Scholar, bem como protocolos do Ministério da Saúde e recomendações do Centers for Disease Control and Prevention, relacionados à coqueluche na infância, com ênfase na forma grave. Apesquisa baseou-se em palavras-chave derivadas dos termos “coqueluche”, “azitromicina”, “antitussígenos” e “redução de leucócitos”, nos idiomas português e inglês. Foramexcluídos estudos em duplicata ou texto integral indisponíveis. Síntese dos dados: Dos 556 registros encontrados, foram selecionados 54 para análise. A coqueluche, como doença reemergente, tem acometido todas as faixas etárias, evidenciando a imunidade transitória conferida pela infecção e pela vacinação. Quadros graves ocorrem em neonatos e lactentes, com complicações virais e bacterianas secundárias e pertussis maligna, com hiperleucocitose, insuficiência respiratória e choque refratário. Os macrolídeos continuam como antibióticos de escolha. Os sintomáticos da tosse não demonstraram eficácia. O suporte precoce em Unidade de Terapia Intensiva melhorou o prognóstico dos casos graves e a exsanguineotransfusão se mostrou a mais promissora entre os procedimentos para leucorredução. Conclusões: A abordagem da coqueluche grave na infância segue como desafio diagnóstico e terapêutico. As opções terapêuticas disponíveis ainda são insatisfatórias. Espera-se que as estratégias de prevenção reduzam a ocorrência de casos graves e que novos estudos confirmem o papel das terapias adjuvantes.

ABSTRACT Objective: Through a systematic review, this essay aimed at revising the concepts of severe pertussis, updating the epidemiology, pathophysiology, clinical presentation, antibiotic therapy and auxiliary therapeutic options for symptomatology and complications. Data sources: This review considered publications from the last 30years in the databases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane, Google Scholar, as well as protocols of the Ministry of Health and recommendations of the Centers for Disease Control and Prevention, related to childhood pertussis (whooping cough), with emphasis on its severe form. This research was based on keywords derived from the terms “pertussis”, “azithromycin”, “antitussives”, “leukocyte reduction” in Portuguese and English. Duplicate studies and those with unavailable full-text were excluded. Data synthesis: Among 556 records found, 54 were selected for analysis. Pertussis, as a reemerging disease, has affected all age groups, evidencing the transient immunity conferred by infection and vaccination. Severe cases occur in neonates and infants, with secondary viral and bacterial complications and malignant pertussis, a longside hyperleukocytosis, respiratory failure and shock. Macrolides continue to be the chosen antibiotics, while antitussives for coughing remain without efficacy. The prompt treatment in Intensive Care Units improved the prognostic in severe cases, and transfusion was promising among procedures for leukoreduction. Conclusions: Approaching severe pertussis in childhood remains a challenge for diagnostic and therapy, as the available therapeutic options are still unsatisfactory. Strategies of prevention are expected to reduce the occurrence of severe cases, while new studies should confirm the role of auxiliary therapies.

RESUMO Objetivo: Avaliar o nível de conhecimento do cuidador em relação aos sinais e sintomas respiratórios de Infecções Respiratórias Agudas (IRA) e a percepção dos mesmos em relação às crianças que necessitam de assistência médica. Métodos: Estudo prospectivo e transversal, no qual um questionário padronizado com itens relacionados à percepção da gravidade dos sinais e sintomas de IRA foi administrado a cuidadores de pacientes pediátricos admitidos no serviço de emergência de um hospital universitário no período de agosto de 2011 a maio de 2012. A análise estatística foi realizada com os testes do qui-quadrado e t-Student para determinar quais variáveis contribuíram para o reconhecimento pelos cuidadores da gravidade das doenças respiratórias agudas. Resultados: Foram entrevistados 499 cuidadores. As causas de IRA mais citadas foram Síndrome gripal (78,6%), Resfriado comum (73,9%), Faringites (64,1%) e Pneumonia (54,5%). Febre (34,1%) e Tosse (15,8%) foram as principais razões para a procura de atendimento. Os sinais de gravidade mais citados pelos cuidadores foram: febre (99,6%), dispneia (91,4%), sibilância (86,4%), adinamia (80,2%), tosse (79,8%) e taquipneia (78,6%). O histórico de doença respiratória anterior do paciente (p=0,002), a idade (p=0,010) e o estado civil do cuidador (p=0,014) foram as variáveis significativamente associadas com taquipneia, o sintoma mais grave de IRA. Conclusões: Embora cuidadores pediátricos possam perceber os principais sinais de IRA, eles não são capazes de reconhecer a gravidade destes, o que pode atrasar os cuidados médicos e impedir o tratamento precoce.

ABSTRACT Objective: To assess the level of caregiver knowledge about respiratory signs and symptoms of acute respiratory infection (ARI) as well as their ability to detect the early warning signs and need for medical assistance in children referred to an emergency service. Methods: This is a prospective, cross-sectional study. A standardized questionnaire with questions on the perception of the severity of ARI signs and symptoms was applied to caregivers of pediatric patients assisted in the emergency room of a university hospital from August 2011 to May 2012. Chi-square and Student’s t-tests were used to determine which variables contributed with caregivers’ recognition of severity of acute respiratory diseases. Results: 499 caregivers were interviewed. The most cited causes of ARI were flu syndrome (78.6%), common cold (73.9%), pharyngitis (64.1%), and pneumonia (54.5%). Fever (34.1%) and cough (15.8%) were major reasons for referral to hospital. The most cited signs of severity recognized by caregivers were fever (99.6%), dyspnea (91.4%), wheezing (86.4%), adynamia (80.2%), coughing (79.8%), and tachypnea (78.6%). Children’s history of respiratory diseases (p=0.002), caregiver’s age (p=0.010) and marital status (p=0.014) were significantly associated with tachypnea, the most severe ARI symptom. Conclusions: Although caregivers of children can recognize ARI most important signs and symptoms, they are unable to judge severity, which may delay medical care and early treatment.

Introduction The relevance of allergic rhinitis is unquestionable. This condition affects people s quality of life and its incidence has increased over the last years. Objective Thus, this study aims to analyze the effectiveness of subcutaneous injectable immunotherapy in cases of nasal itching, sneeze, rhinorrhea and nasal congestion in allergic rhinitis patients. Methods In the present study, the same researcher analyzed the records of 281 patients. Furthermore, the researchers identified allergens through puncture cutaneous tests using standardized extracts containing acari, fungi, pet hair, flower pollen, and feathers. Then, the patients underwent treatment with subcutaneous specific immunotherapy, using four vaccine vials for desensitization, associated with environmental hygiene. The authors analyzed conditions of nasal itching, sneeze, rhinorrhea, and nasal congestion throughout the treatment, and assigned them with a score ranging from zero (0), meaning absence of these symptoms to three (3), for severe cases. The symptoms were statistically compared in the beginning, during, and after treatment. Results In this study, authors analyzed the cases distribution according to age and the evolution of symptomatology according to the scores, comparing all phases of treatment. The average score for the entire population studied was 2.08 before treatment and 0.44 at the end. These results represent an overall improvement of ±79% in symptomatology of allergic rhinitis in the studied population. Conclusion The subcutaneous immunotherapy as treatment of allergic rhinitis led to a reduction in all symptoms studied, improving the quality of life of patients, proving itself as an important therapeutic tool for these pathological conditions.

Background: Human parainfluenza viruses account for a significant proportion of lower respiratory tract infections in children.Objective: To assess the prevalence of Human parainfluenza viruses as a cause of acute respiratory infection and to compare clinical data for this infection against those of the human respiratory syncytial virus.Methods: A prospective study in children younger than five years with acute respiratory infection was conducted. Detection of respiratory viruses in nasopharyngeal aspirate samples was performed using the indirect immunofluorescence reaction. Length of hospital stay, age, clinical history and physical exam, clinical diagnoses, and evolution (admission to Intensive Care Unit or general ward, discharge or death) were assessed. Past personal (premature birth and cardiopathy) as well as family (smoking and atopy) medical factors were also assessed.Results: A total of 585 patients were included with a median age of 7.9 months and median hospital stay of six days. No difference between the HRSV+ and HPIV+ groups was found in terms of age, gender or length of hospital stay. The HRSV+ group had more fever and cough. Need for admission to the Intensive Care Unit was similar for both groups but more deaths were recorded in the HPIV+ group. The occurrence of parainfluenza peaked during the autumn in the first two years of the study.Conclusion: Parainfluenza was responsible for significant morbidity, proving to be the second-most prevalent viral agent in this population after respiratory syncytial virus. No difference in clinical presentation was found between the two groups, but mortality was higher in the HPIV+ group.

Rever se a poluição e as alterações do clima podem influenciar nas infecções respiratórias de crianças. Fontes de dados: foram revisados artigos publicados sobre o tema no PubMed, SciELO, Bireme, EBSCO e UpToDate. Os seguintes critérios de inclusão foram levados em consideração: trabalhos científicos entre 2002 e 2012, delineamento de estudo, população pediátrica, documentos de referência, como Cetesb e Organização Mundial da Saúde. Síntese dos dados: foram analisadas as pesquisas que correlacionavam vírus respiratórios e alterações do clima e/ou poluição. O vírus sincicial respiratório tem sido o vírus mais relacionado com alterações climáticas e umidade. Outros "velhos e novos" vírus respiratórios, como parainfluenza (VPH), metapneumovírus humano (hMPV), bocavírus (HBoV) e parechovirus (HPeV), precisariam ser investigados pela sua importância clínica. Embora muito se tenha estudado sobre a relação das mudanças climáticas na saúde coletiva, estudos específicos sobre sua influência na saúde das crianças ainda são escassos.

To review if pollution and climate changes can influence respiratory tract infections in children. Data source: articles published on the subject in PubMed, SciELO, Bireme, EBSCO and UpTodate were reviewed. The following inclusion criteria were considered: scientific papers between 2002 and 2012, study design, the pediatric population, reference documents such as the CETESB and World Health Organization Summary of the data: We analyzed research that correlated respiratory viruses and climate and/or pollution changes. Respiratory syncytial virus has been the virus related most to changes in climate and humidity. Other "old and new" respiratory viruses such as Human Bocavirus, Metapneumovirus, Parechovirus and Parainfuenza would need to be investigated owing to their clinical importance. Although much has been studied with regard to the relationship between climate change and public health, specific studies about its influence on children's health remain scarce.

Introduction The presence of respiratory viruses in lymphoid tissues of the nasopharynx and oropharynx and its impact on recurrent infections and hypertrophy of these tissues are not yet fully understood. Objective To identify and determine the prevalence of major respiratory viruses in nasopharyngeal secretions and adenoid tissue pre- and postoperatively of children undergoing adenoidectomy. Methods A prospective observational study was conducted in 36 patients under 12 years of age with upper airway lymphoid hypertrophy who were undergoing adenoidectomy, in which various respiratory viruses were investigated using real-time polymerase chain reaction in adenoid tissue and nasopharyngeal secretions collected preoperatively and 30 days postoperatively. Results At least 1 viral agent was isolated in any of the samples collected in 58.3% of children and 25.9% of total samples. Respiratory viruses were identified in 33.8% of preoperative nasopharyngeal specimens and in 19.8% of postoperative secretion. Of the 21 patients with positive results for any respiratory virus, 6 (28.6%) had more than 1 virus. Considering all 36 respiratory viruses found, the main agent isolated was rhinovirus (27.8%), followed by bocavirus (22.2%). Conclusion The virus found more frequently in all samples was rhinovirus. After removal of adenoid tissue, there was a decrease in the prevalence of the virus contained in nasopharyngeal secretion 30 days after surgery.

OBJECTIVE: To study the antibody prevalence against dengue in the municipality of Jundiaí, São Paulo, Brazil, due to the low number of official confirmed autochthonous cases. METHODS: A serological study on dengue infection was conducted during January 2010 and previous reports on dengue and entomological surveillance during that period were reviewed. RESULTS: A prevalence of 7.8% IgG positive (68:876) was found. Furthermore, based on the detection of IgM antibodies in five samples, it was observed that the incidence of dengue in the city at the time of the survey contrasts with the absence of notifications by local health authorities over the same period of time. CONCLUSION: These results highlight the discrepancies between the actual and the detected number of dengue infections, possibly due to significant numbers of asymptomatic infections aggravated by difficulties with dengue clinical diagnosis.

OBJETIVO: Determinar a prevalência, distribuição etária, sazonalidade, características clínicas da doença Lyme-símile em menores de 15 anos. MÉTODOS: De julho/1998 a dezembro/2000 foi conduzido um estudo transversal em 333 pacientes, com exantema e febre. Foram coletadas amostras pareadas de sangue para a identificação de patógenos. Somente em 193 amostras, negativas aos outros patógenos (Parvovirus B19, Herpesvírus 6 humano, Sarampo, Rubéola, Dengue, Escarlatina e Enterovírus), foram realizadas a pesquisa da borreliose pelos métodos de Enzyme-Linked Immunosorbent Assay e Western-blotting. Outras variáveis clínicas, socioeconômicas, demográficas e climáticas foram estudadas. RESULTADOS: A prevalência da doença foi de 6,2%(12/193). Das variáveis estudadas, houve predomínio em <6anos(83,2%); sexo feminino (66,7%); procedência da cidade de Franco da Rocha (58,3%); com sazonalidade no outono-verão. O intervalo de atendimento foi de quatro dias. Sinais e sintomas com significância estatística: prurido, ausência da fissura labial e bom estado clínico. Outros dados presentes foram: irritabilidade (80%); febre (?38ºC) (58,3%) com duração de um a três dias. O exantema foi do tipo máculo-papular (33,3%), urticariforme (25%) e escarlatiniforme (16,7%); predominando em tronco (60%). Não houve apresentação clínica característica para diagnóstico da doença de Lyme-símile nestes pacientes. A sensibilidade e especificidade para o diagnóstico clínico contraposta com o diagnóstico laboratorial foi zero. O acompanhamento de 10 casos durante dois anos não evidenciou complicações cardiológicas ou neurológicas. Este é o primeiro estudo desta doença em crianças brasileiras. CONCLUSÃO: A prevalência da doença Lyme-símile foi baixa, não tendo sido lembrada no diagnóstico inicial dos exantemas, mas seu conhecimento é necessário, necessitando maior atenção médica.

BACKGROUND: To determine the prevalence, age distribution, seasonality and clinical characteristics of Lyme-simile disease in Brazilians less than 15 years of age. METHODS. From July, 1998 to November, 2000, a cross-sectional study was conducted in 333 patients with skin rash and fever. Paired blood samples were collected for identification of the pathogens. Only 193 samples which were negative for other pathogens (Parvovirus B19 Human, Herpesvirus 6 Human, Measles, Rubella, Dengue, Scarlet fever and Enterovirus), were tested for borreliosis by Enzyme-Linked Immunosorbent Assay and Western-blotting. Other clinical, socioeconomic, demographic and climatic variables were studied. RESULTS: Prevalence of the disease was 6.2%(12/193). Of the variables studied, there was predominance in: <6 years old (83.2%); females (66.7%); being from the city of Franco da Rocha (58.3 %); and a summer/fall seasonality. The duration of care was 4 days. Signs and symptoms with statistical significance were itching; absence of lip notch and ocular pain; irritability and good clinical condition. Other clinical data presented were: pruritus (90%), irritability (80%) and fever (?38ºC) (58.3%) with a duration of 1 to 3 days. Erythema was maculo-papular (40%), urticaria-like (25%) and scarlatiniform (16.7%), occurring predominately on the trunk (60%). There were no primary clinical evidences of Lyme-simile disease in the patients under study. The sensitivity and specificity of the clinical diagnosis as opposed to the laboratory diagnosis was zero. There was no initial clinical suspicion of the disease in the 10 cases studied and followed up for two years that showed no evidence of cardiologic or neurological complications. This is the first study of Lyme-simile in Brazilian children. CONCLUSION: Prevalence of Lyme-simile disease was low, and it was not remembered at the initial diagnosis of those with skin rash. However, practical knowledge is necessary, demanding increased medical attention.

OBJETIVO: Determinar a prevalência de obesidade de acordo com o nível socioeconômico e o sexo, em escolares do ensino fundamental, segundo dois critérios diagnósticos. MÉTODOS: Realizou-se um estudo transversal nas escolas públicas de ensino fundamental de Jundiaí, São Paulo, com 662 alunos de quinta a oitava séries, com idades entre dez e 18 anos, em 2005. A amostra foi selecionada por meio de procedimento sistemático, de acordo com a série e o sexo. Calculou-se o índice de massa corpórea (IMC). Os pontos de corte para classificação do estado nutricional foram escolhidos de acordo com dois critérios antropométricos: valores de IMC em percentil e valor numérico de IMC como ponto de corte. RESULTADOS: A prevalência de sobrepeso foi 17% quando se utilizou o critério de percentil e 13% ao usar o corte por valor numérico. A prevalência de obesidade foi 8 e 9%, respectivamente. Houve diferença quanto ao sexo, quando se utilizou a classificação por percentil, com maior percentual de magreza encontrado no sexo masculino. O sobrepeso e a obesidade foram mais observados em adolescentes de melhor condição socioeconômica. CONCLUSÕES: A prevalência de sobrepeso e obesidade foi elevada, sendo maior nas classes mais favorecidas. A medida do IMC por percentil detectou maior número de adolescentes com sobrepeso e obesidade, comparada à classificação por valor numérico.

OBJECTIVE: To determine the prevalence of obesity related to gender and socioeconomic level in students of public schools, according to two different nutritional criteria. METHODS: A cross-sectional study was performed in public schools of the city of Jundiaí, São Paulo, Brazil, and included 662 students with 10-18 years old that attended 5th-8th grades, in 2005. The sample was selected using systematic procedure, according to the student’s grade and gender. The body mass index (BMI) was calculated and cutoff points were selected for classification of nutritional state according to two anthropometrics criteria: values of BMI as percentiles and as sharp cutoff point. RESULTS: The prevalence of overweight was 17% using the percentile criteria and 13% with the numerical cutoff. The frequency of obesity was 8 and 9%, respectively for both criteria. Difference between genders was found using the percentile criteria, with higher percentage of leanness in males. Overweight and obesity were more frequent among adolescents of better socioeconomic status. CONCLUSIONS: The prevalence of overweight and obesity were higher in students of better economic classes. The BMI percentiles detected a higher number of adolescents with overweight and obesity compared to the numerical cutoff.