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BackgroundTo identify markers for earlier diagnosis of severe pneumonia, we assess the correlation between serum cytokine profile of children with different pneumonia severity.MethodsIn 25 hospitalized children, 7 with mild pneumonia and 18 with severe pneumonia, the serum concentration of 11 cytokines in three sampling times were dosed. Statistical analysis included parametric and non-parametric tests, Pearson correlation and ROC curve for cut-off definition of cytokines.ResultsAt admission, IL-6 serum levels were high in mild or severe pneumonia, and was associated to vomiting (P = 0.019) in both groups; and also to dyspnea (P = 0.012) and white blood cell count (P = 0.045) in patients with severe pneumonia. IL-10 levels were also high in patients with pneumonia and were associated to lymphocytosis (P = 0.025). The ROC curve of the IL-6:IL-10 serum levels ratio discriminated severe pneumonia cases at admission, and persistence of infection in the third day of antibiotic therapy, with positive predictive values of 93% and 89%, respectively.ConclusionsThe balance between IL-6 and IL-10 serum levels showed to be a more discriminative marker for severity definition and evaluation of recovery in patients with pneumonia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0324-z) contains supplementary material, which is available to authorized users.

OBJETIVOS: verificar a freqüência do rotavírus em crianças de zero a cinco anos com doença diarréica e desnutrição moderada e grave, hospitalizadas no Instituto Materno Infantil Prof. Fernando Figueira (IMIP). MÉTODOS: foi realizado um estudo série de casos durante o período de agosto de 2004 e junho de 2005. No total fizeram parte do estudo 50 crianças. Utilizou-se um questionário pré-codificado e foi montado um banco de dados no software Epi-info 6.0. As amostras de fezes foram analisadas quanto à presença do rotavírus, através de técnicas de imunoensaio enzimático. RESULTADOS: verificou-se que a freqüência do rotavírus na doença diarréica do grupo estudado foi de 24,0%. Em geral as famílias eram pobres, 96,0% delas com renda familiar per capita inferior a R$150,00. Com relação às crianças dois terços (60,4%) receberam leite materno por um período inferior a três meses e 10% delas nunca haviam sido vascinadas. CONCLUSÕES: o estudo traz contribuição para o conhecimento da etiologia da diarréia na criança com desnutrição, no entanto, se faz necessária a realização de estudos com um maior número de crianças para que os resultados possam ser mais conclusivos.

Fever is a common complaint in paediatrics and the ability of mothers to identify high temperatures in their children when there is no thermometer available needs to be assessed. Atotal of 169 mothers from a low social and economic background were studied to assess the accuracy of fever diagnosis in their children by palpation. In 137 children with axillary temperatures > or = 38 C as measured by a mercury glass thermometer, mothers were able to detect fever by palpation in 104 cases (sensitivity of 75.9%). In another 32 children without fever, 29 were correctly identified (specificity of 90.6%). Only 21% of mothers in the study had a thermometer in their home and only 44% of these knew how to use it properly. Results show that mothers use palpation to assess the presence of fever in their children and are able to do it correctly in most cases.

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Rotavirus is an important cause of childhood diarrhoea. A monovalent rotavirus vaccine (Rotarix ® ) was introduced into the Immunization Program of Brazil in 2006. In this study, we describe the incidence and burden of disease of rotavirus diarrhoea in two cohorts of children (vaccinated and unvaccinated). We followed two groups of 250 children under one year old, who were enrolled in December 2006 from a low-income residential area inNortheast Brazil. The children were monitored every two weeks for two years. Stool samples from children with diarrhoea were examined for the presence of rotavirus. Rotaviruses were genotyped using real time-polymerase chain reaction. The mean numbers of all-cause diarrhoea episodes/child (adjusted for age) in the first year were 0. 87 and 0.84, in vaccinated and unvaccinated children, respectively. During the second year, the number of episodes/ child decreased to 0.52 and 0.42. Only 16 (4.9%) of 330 stool samples were rotavirus-positive (10 vaccinated and 6 unvaccinated children) and only P[4]G2 rotaviruses were identified. All-cause diarrhoea episodes were more severe in unvaccinated children in the first year of age (p < 0.05), while vaccinated children had more severe episodes 18 months after vaccination. Rotavirus diarrhoea incidence was very low in both groups. Key words: diarrhoea -rotavirus -vaccine -cohort -children -BrazilRotavirus diarrhoea in vaccinated children • Sarah Cristina Fontes Vieira et al. 331ties were visited at home in 2006 and their parents were invited to enrol their children in the study, independent of their vaccination status. The parents of the first 250 children who had received two oral doses of the Rotarix ® vaccine (GlaxoSmithKline Biologicals, Rixensart, Belgium) at two and four months of age (vaccinated cohort) were invited to participate and a further 250 children who had not received the vaccine comprised the unvaccinated cohort. Vaccination status was verified using the child's vaccination card and the Health Centre's databases. The youngest unvaccinated children registered were selected, despite the fact that the two groups could not be matched by age, as unvaccinated children had to be ineligible for vaccination at the time of enrolment, and therefore at least four months of age. Unvaccinated children serving as the control group were not offered the vaccine due to EPI guidelines that exclude children greater than or e�ual to four months of age to avoid the risk of intussusception among older infants (WHO 2007).After obtaining informed parental consent, all children were visited at home for the following two years, independently of their age at the time of enrolment. Visits were conducted every two weeks by three trained interviewers who in�uired as to whether or not the child had experienced diarrhoea episodes during the previous twoweek period. If the parent indicated that the child had diarrhoea, the interviewer collected information regarding the date of the episode and clinical presentation. The severity of the diarrhoea episodes wa...

OBJETIVOS: determinar a frequência de Escherichia coli diarreiogênica e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda. MÉTODOS: estudo prospectivo tipo corte transversal realizado no Instituto de Medicina Integral Prof. Fernando Figueira, entre janeiro de 2010 e fevereiro de 2011. Foram excluídas as crianças com diagnóstico de imunodeficiência ou usando antimicrobianos. Para cada paciente foi feito uma única coleta de swab retal nas primeiras 24 horas de internação. Os patógenos foram identificados na coprocultura e sorotipagem. Os antibiogramas foram obtidos por disco-difusão. RESULTADOS: 140 crianças foram arroladas, em sua maioria provinham de famílias de baixa renda da Região Metropolitana do Recife. Foram isolados 99 microorganismos: 9 (6,4%) E. coli enteropatogênica (EPEC) e 4 (2,9%) E. coli enteroinvasora (EIEC) e 80 (57,1%) outras E.coli não EPEC, não EIEC, 3 (2,1%) Shigella spp e 3 (2,1%) Salmonella spp. O perfil de sensibilidade aos antimicrobianos demonstrou níveis elevados de resistência à ampicilina e sulfametoxazol-trimetoprima. CONCLUSÕES: a baixa frequência de EPEC observada pode estar associada às condições de saneamento básico favoráveis apresentadas pelos pacientes do estudo. A análise local do perfil da sensibilidade da E. coli aos antimicrobianos reforça a recomendação da Organização Mundial de Saúde para o uso racional dessas drogas visando prevenção da resistência bacteriana.

Objectives: to describe the clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011) Methods: pneumonia case series of 80 children aged 28 days to 14 years old at Hospital da Restauração in Pernambuco, Brazil, from 2010 to 2011. Information was noted from medical files, and two comparison groups were created according to the severity of the disease, considering the presence of pleural effusion. Fisher or Mann-Whitney tests were used for comparative analyses. Results: severe pneumonia with pleural effusion was more frequent in children under five years of age (p=0,025), and was associated with longer period of fever (19 x 15 days) and coughing (17 x 13 days), when compared to non-complicated pneumonia cases. Six children (7,5%, 6/80) died, 50% before the fourth day of hospitalization (p=0,001). All deaths were from the pleural effusion group in children from the countryside (p=0,026). Conclusions: the severity of pneumonia in children attended at this hospital is related to younger children, and those transferred from the health units in the countryside, so, early diagnosis and medical intervention are limited by infrastructure and available resources for the health.