Background COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population. MethodsWe did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function. FindingsOf the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14•2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7•6%) died in hospital (at a median 6 days [IQR 3-15] after hospital admission), 10 041 (86•5%) patients were discharged from the hospital, 369 (3•2%) were in hospital at the time of analysis, and 317 (2•7%) were missing information on outcome. The estimated probability of death was 4•8% during the first 10 days after hospital admission, 6•7% during the first 20 days, and 8•1% at the end of follow-up. Probability of discharge was 54•1% during the first 10 days, 78•4% during the first 20 days, and 92•0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2•36 [95% CI 1•94-2•88]) or adolescents aged 12-19 years (2•23 [1•84-2•71]) relative to children aged 2-11 years; those of Indigenous ethnicity (3•36 [2•15-5•24]) relative to those of White ethnicity; those living in the Northeast region (2•06 [1•68-2•52]) or North region (1•55 [1•22-1•98]) relative to those in the Southeast region; and those with one (2•96 [2•52-3•47]), two (4•96 [3•80-6•48]), or three or more (7•28 [4•56-11•6]) pre-existing medical conditions relative to those with none.Interpretation Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil.

The aim of the present study was to analyze the prevalence of nonsyndromic oral clefts in children receiving treatment at the Center for the Rehabilitation of Craniofacial Anomalies, José do Rosário Vellano University, Alfenas, MG, Brazil. All the data for the epidemiological study was retrieved from the files of 126 pediatric patients with oral clefts without any additional malformation, who came to the center for treatment between 2000 and 2005. A predominance of clefts was observed in Caucasians, and the ratio of male to female was 1.3. Males were 2.57 times more affected by cleft lip and palate (CLP) than females. CLP with a prevalence of 39.68% and isolated cleft lip (CL) with a prevalence of 38.09% were the most common anomalies, followed by isolated cleft palate (CP; 22.23%). Complete and unilateral CLP (26.19%) presented the highest prevalence, followed by incomplete and unilateral CL (23.81%). The present study presents the experience of a reference hospital in the state of Minas Gerais; however, the real prevalence of oral clefts in Brazil is still unknown. Our findings differ from those of a few previous Brazilian reports because they suggest similar prevalences of CLP and CL, and a higher prevalence of CLP in Caucasian males.

O objetivo deste estudo foi descrever o perfil epidemiológico dos acidentes ofídicos da macrorregião de saúde do Norte do Estado de Minas Gerais, Brasil. Foram analisadas informações sobre os acidentes ofídicos relativos ao período compreendido entre janeiro de 2002 a dezembro de 2006, por meio de bancos de dados. Os resultados demonstraram 10.553 casos notificados, com ênfase para a maior casuística em meses de tempo quente e chuvoso, em áreas urbanas (54,1%), faixa etária menor de 20 anos (39,7%), acometendo mais homens e estudantes (53,1% e 29,1%) respectivamente. Os membros inferiores (pé, dedo do pé, perna e coxa) foram os locais mais afetados (35,9%), as serpentes prevalentes foram do gênero Bothrops (82,9%) e a gravidade da maioria dos acidentes foi leve (66,2%). Observou-se nesse estudo um importante impacto da sazonalidade, urbanização, subnotificação das espécies envolvidas nesses acidentes e busca rápida pelo pronto atendimento. Espera-se que os dados inéditos da casuística obtida possam servir de substrato para o planejamento e execução de medidas voltadas para vigilância em saúde e atendimento.

Coronavirus 2019 (COVID-19), caused by the pathogen SARS-CoV-2, was declared a pandemic in March 2020. Recently, studies have discussed reports of patients infected with COVID-19 associated with vesicular manifestations of Herpes Zoster. The objective of this study was to compare the data from the Unified Health System (SUS), on the number of diagnoses of Herpes Zoster from March to September 2017 to 2019, with the same period of 2020, in the five Brazilian regions (North, Northeast, Southeast, South and Midwest). The analyzed data were extracted from the public database (DATASUS) of the Ministry of Health of Brazil. The data showed an increase in the number of Herpes Zoster diagnoses over the years, and the negative impact from the COVID-19 disease, revealing an increase corresponding to an average of over extra 10.7 cases per million of inhabitants during the COVID-19 pandemic in all Brazilian Regions. Therefore, although the association between HZ and COVID-19 is not well stablished, we observed in this study an increase in HZ cases during the COVID -19 pandemic, which suggests a correlation between these diseases.

Objective: To describe the main characteristics, including stage of disease and local treatment of patients admitted to two reference services for the treatment of breast cancer in the North of Minas Gerais. Methods: We conducted a cross-sectional descriptive study. We evaluated medical records of 288 female patients with breast cancer admitted between January 2006 and December 2009, referred from a public hospital and a private clinic. Variables were analyzed using the chi-square test and multinomial logistic regression. Results: 68.1% of patients were referred from the public hospital. There was a predominance of patients over 50 years old (54.5%), married (59%) and with children (87.8%). The mean age of the population studied was 63 years old. Time between suspected cancer and confirmation of diagnosis was over six months in 42.7% of patients. Cancer diagnosis was late (stage III and IV) in 47.6% of patients. Family history of breast cancer was present in 20.1%, 20.8% of them had performed self-breast examination, and 41% had been submitted to a mammogram. Conclusion: There was a higher prevalence of stage III/IV patients from the public service when compared to the private sector. We found that the major factors associated with the late diagnosis of breast cancer were the delay between suspected and confirmed diagnosis, the absence of family history of breast cancer and not having a mammogram.

III PALAVRAS-CHAVE:-Consumo de Bebidas Alcoólicas

Objective To evaluate the severity and clinical outcomes of the SARS-CoV-2 gamma variant in children and adolescents hospitalized with COVID-19 in Brazil. Study design In this observational retrospective cohort study, we performed an analysis of all 21,591 hospitalized patients aged < 20 years with confirmed SARS-CoV-2 infection registered in a national database in Brazil. The cohort was divided into two groups according to the predominance of SARS-CoV-2 lineages (WAVE1, n = 11,574 and WAVE2, n = 10,017). The characteristics of interest were age, sex, geographic region, ethnicity, clinical presentation, and comorbidities. The primary outcome was time to death, which was evaluated by competing-risks analysis, using cumulative incidence function. A predictive Fine-Gray competitive risks model was developed based on WAVE1 cohort with temporal validation in WAVE2 cohort. Results Children and adolescents admitted during the second wave had significantly more hypoxemia (52.5% vs. 41.1%, P < 0.0001), admission to ICU (28.3% vs. 24.9%, P < 0.0001), and needed more non-invasive ventilatory support (37.3% vs. 31.6%, P < 0.0001). The in-hospital deaths and death rates in the first and second waves were respectively 896 (7.7%) and 765 (7.6%) (P=0.07). The prediction model of death included age, ethnicity, region, respiratory symptoms, and comorbidities. In the validation set (WAVE2), the C statistics was 0.750 (95%CI, 0.741 to 0.758, P < 0.0001). Conclusions This large national study found a more severe spectrum of risk for pediatric patients with COVID-19 caused by the Gamma variant. However, there was no difference regarding the probability of death between the waves.

CONTEXT AND OBJECTIVE: Retinopathy of prematurity (ROP) is a known cause of blindness in which diagnosis and timely treatment can prevent serious harm to the child. This study aimed to evaluate the incidence of ROP and its association with known risk factors. DESIGN AND SETTING: Longitudinal incidence study in the neonatal intensive care unit (NICU) of Universidade Estadual de Montes Claros. METHODS: Newborns admitted to the NICU with gestational age less than 32 weeks and/or birth weight less than 1,500 grams, were followed up over a two-year period. The assessment and diagnosis of ROP were defined in accordance with a national protocol. The chi-square test or Fisher's exact test were used to determine associations between independent variables and ROP. Analysis on the independent effect of the variables on the results was performed using multiple logistic regression. RESULTS: The incidence of ROP was 44.5% (95% confidence interval, CI = 35.6-46.1) in the study population. The risk factors associated with the risk of developing the disease were: birth weight less than 1,000 grams (odds ratio, OR = 4.14; 95% CI = 1.34-12.77); gestational age less than 30 weeks (OR = 6.69; 95% CI = 2.10-21.31); use of blood derivatives (OR = 4.14; 95% CI = 2.99-8.99); and presence of sepsis (OR = 1.99; 95% CI = 1.45-2.40). CONCLUSIONS: The incidence of ROP was higher than that found in the literature. The main risk factors were related to extreme prematurity. RESUMO CONTEXTO E OBJETIVO:A retinopatia da prematuridade (ROP) é causa conhecida de cegueira e diagnóstico e tratamento oportunos podem evitar graves danos à criança. Este estudo objetivou avaliar a incidência da ROP e sua associação com fatores de risco conhecidos.