BACKGROUND AND OBJECTIVES: Definitions for pediatric sepsis were established in 2005 without data-driven criteria. It is unknown whether the more recent adult Sepsis-3 definitions meet the needs of providers caring for children. We aimed to explore the use and applicability of criteria to diagnose sepsis and septic shock in children across the world. METHODS: This is an international electronic survey of clinicians distributed across international and national societies representing pediatric intensive care, emergency medicine, pediatrics, and pediatric infectious diseases. Respondents stated their preferences on a 5-point Likert scale. RESULTS: There were 2835 survey responses analyzed, of which 48% originated from upper-middle income countries, followed by high income countries (38%) and low or lower-middle income countries (14%). Abnormal vital signs, laboratory evidence of inflammation, and microbiologic diagnoses were the criteria most used for the diagnosis of “sepsis.” The 2005 consensus definitions were perceived to be the most useful for sepsis recognition, while Sepsis-3 definitions were stated as more useful for benchmarking, disease classification, enrollment into trials, and prognostication. The World Health Organization definitions were perceived as least useful across all domains. Seventy one percent of respondents agreed that the term sepsis should be restricted to children with infection-associated organ dysfunction. CONCLUSIONS: Clinicians around the world apply a myriad of signs, symptoms, laboratory studies, and treatment factors when diagnosing sepsis. The concept of sepsis as infection with associated organ dysfunction is broadly supported. Currently available sepsis definitions fall short of the perceived needs. Future diagnostic algorithms should be pragmatic and sensitive to the clinical settings.

BackgroundIn this review, we discuss some important aspects of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), a new syndrome that is temporally related to previous exposure to SARS-CoV-2 infection. This virus has a broad spectrum of presentation that may overlap with Kawasaki disease in terms of presenting symptoms and laboratory and cardiac findings. Our objective was to review and summarise published evidence regarding the most important aspects of PIMS-TS, with special emphasis on the treatment strategies suggested for middle-income and low-income countries.MethodsA systematic review of the literature was performed in the principal medical databases including PubMed, Embase (OVID) and Google Scholar between December 2019 and August 2020.ResultsA total of 69 articles were identified in the described databases. Altogether, 13 articles met the inclusion criteria and were eligible. The most frequently described symptoms of PIMS-TS include fever (82%), shock (67%) and gastrointestinal (87%), skin (71%) and cardiac disorders (75%). In most series, it has been observed between 4 and 6 weeks after the pandemic appears in the general population. Multisystem inflammatory syndrome in children is presented as a great systemic inflammatory response syndrome, which sometimes presents as shock requiring fluid resuscitation and vasoactive drug support (26%). Several treatment strategies have been used, including immunoglobulin, steroids, aspirin, anakinra and anticoagulation among others. These general and specific interventions should be guided by an interdisciplinary and multidisciplinary team, especially in settings with limited resources.ConclusionsPIMS-TS COVID-19 is a new type of presentation of SARS-CoV-2 infection, with an exaggerated inflammatory response and frequent—but not exclusive—digestive and myocardial involvement. It is important to describe the clinical course and outcomes in countries with limited resources as well as establish the role of biomarkers for early diagnosis, effective therapeutic strategies and outpatient follow-up schemes.

Objetivo: O objetivo desse estudo foi avaliar hábitos alimentares e estilo de vida de adultos estudantes do Centro Universitário AGES. Métodos: Trata-se de estudo transversal descritivo, de campo, conduzido por 161 indivíduos, de ambos os sexos, idade de 20 a 59 anos. Os pacientes foram avaliados de acordo com a definição de alimentos funcionais. A restrição alimentar destes foi analisada por um questionário de frequência alimentar, que foi readaptado para alguns alimentos, de acordo com as categorias de consumo: habitual, não habitual, raramente consumido e nunca consumido. O estudo foi aprovado por Comitê de Ética em Pesquisa sob o parecer nº 024-2017. Resultados: Cerca de 43% dos participantes da amostra que declararam consumir refrigerante, consomem mais de um litro por dia, causando riscos à saúde. Apesar dos resultados negativos já citados, o estudo aponta que há preocupação dos estudantes na qualidade dos hábitos alimentares, quando 45% destes alegam que preferem sucos naturais, 44% dos universitários relataram que só tomam refrigerante raramente e 53% responderam que leem os rótulos dos alimentos. Conclusão: Conclui-se que foi possível perceber que o consumo de industrializados de forma geral ainda é crescente, principalmente no público adulto e universitário, fazendo-se necessário a criticidade durante a compra do produto, bem como no momento das escolhas alimentares.

Background: the quest for new adjunctive sepsis therapiesIn 2017, an estimated 3 million neonates, children and adolescents succumbed to sepsis globally, and as many as 25 million suffered from sepsis (1). Sepsis, more recently defined as infection with associated organ dysfunction (2), thus accounts for most childhood deaths due to infection