COVID-19 vaccination in children: a public health priority

OBJECTIVE

Covid-19 had a direct impact on children's health. The aim of this review was to analyze epidemiological and clinical data, the consequences of the pandemic, and vaccination aspects in this group.

SOURCES OF DATA

The searches were carried out from January 2020 to November 2022, in the MEDLINE databases (PubMed) and publications of the Brazilian Ministry of Health and the Brazilian Society of Pediatrics.

SUMMARY OF FINDINGS

Covid-19 has a mild presentation in most children; however, the infection can progress to the severe form and, in some cases, to MIS-C. The prevalence of the so-called long Covid in children was 25.24%. Moreover, several indirect impacts occurred on the health of children and adolescents. Vaccination played a crucial role in enabling the reduction of severe disease and mortality rates. Children and adolescents, as a special population, were excluded from the initial clinical trials and, therefore, vaccination was introduced later in this group. Despite its importance, there have been difficulties in the efficient implementation of vaccination in the pediatric population. The CoronaVac vaccines are authorized in Brazil for children over three years of age and the pediatric presentations of the Pfizer vaccine have shown significant effectiveness and safety.

CONCLUSIONS

Covid-19 in the pediatric age group was responsible for the illness and deaths of a significant number of children. For successful immunization, major barriers have to be overcome. Real-world data on the safety and efficacy of several pediatric vaccines is emphasized, and the authors need a uniform message about the importance of immunization for all children.

COVID-19 in a child with down syndrome and extensive pulmonary tuberculosis: a case report

Abstract Introduction: although pediatric patients have comparatively fewer cases of COVID-19, children with Down Syndrome exhibit comorbidities such as immunodeficiency, diabetes and, in this perspective, are considered a population at risk for severe COVID-19. In addition, the literature also points to an unfavorable perspective on co-infection with Mycobacterium tuberculosis, considered an important comorbidity and a predictor of a worse clinical outcome. Description: female child, nine years old, with Down Syndrome, congenital heart disease and prematurity, with significant weight loss and intermittent fever for six months. A week ago, she had an intensification of fever, productive cough and mild respiratory distress. RT-PCR for SARS-CoV-2 detectable in nasopharynx swab, chest X-ray with diffuse alveolar infiltrate, chest CT with consolidations, excavation, solid micronodules in a sprouting tree pattern mainly in the right upper and lower lobes. Molecular rapid test for Mycobacterium tuberculosis detectable in gastric lavage. After specific treatment, the patient progressed well and was discharged from the hospital after 72 hours without fever and improvement in her breathing pattern. Discussion: despite the extensive pulmonary involvement, the patient did not require invasive ventilatory support and presented a satisfactory short-term outcome. Therefore, the relevance of the association of Tuberculosis and COVID-19 and other comorbidities in the pediatric age group still remains uncertain.

Clinical and laboratory profiles of children with severe chikungunya infection

INTRODUCTION

Chikungunya infection presents with distinct clinical features depending on the patient age group.

METHODS

Medical records of children with positive IgM for the chikungunya virus who were hospitalized in a pediatric ward in Fortaleza, Ceará, Brazil were analyzed.

RESULTS

Fourteen children with a median age of 4 months (36 days to 15 years) were included. All patients presented with fever persisting for an average of 5 days. The joints were involved in 6 (42.8%) children, and 8 (57.1%) children presented with bullous rash.

CONCLUSIONS

Systemic involvement and atypical clinical manifestations characterize severe forms of chikungunya infection in children.

Efficacy and safety of available treatments for visceral leishmaniasis in Brazil: A multicenter, randomized, open label trial

Background

There is insufficient evidence to support visceral leishmaniasis (VL) treatment recommendations in Brazil and an urgent need to improve current treatments. Drug combinations may be an option.

Methods

A multicenter, randomized, open label, controlled trial was conducted in five sites in Brazil to evaluate efficacy and safety of (i) amphotericin B deoxycholate (AmphoB) (1 mg/kg/day for 14 days), (ii) liposomal amphotericin B (LAMB) (3 mg/kg/day for 7 days) and (iii) a combination of LAMB (10 mg/kg single dose) plus meglumine antimoniate (MA) (20 mg Sb⁺⁵/kg/day for 10 days), compared to (iv) standard treatment with MA (20 mg Sb⁺⁵/kg/day for 20 days). Patients, aged 6 months to 50 years, with confirmed VL and without HIV infection were enrolled in the study. Primary efficacy endpoint was clinical cure at 6 months. A planned efficacy and safety interim analysis led to trial interruption.

Results

378 patients were randomized to the four treatment arms: MA (n = 112), AmphoB (n = 45), LAMB (n = 109), or LAMB plus MA (n = 112). A high toxicity of AmphoB prompted an unplanned interim safety analysis and this treatment arm was dropped. Per intention-to-treat protocol final analyses of the remaining 332 patients show cure rates at 6 months of 77.5% for MA, 87.2% for LAMB, and 83.9% for LAMB plus MA, without statistically significant differences between the experimental arms and comparator (LAMB: 9.7%; CI95% -0.28 to 19.68, p = 0.06; LAMB plus MA: 6.4%; CI95% -3.93 to 16.73; p = 0.222). LAMB monotherapy was safer than MA regarding frequency of treatment-related adverse events (AE) (p = 0.045), proportion of patients presenting at least one severe AE (p = 0.029), and the proportion of AEs resulting in definitive treatment discontinuation (p = 0.003).

Conclusions

Due to lower toxicity and acceptable efficacy, LAMB would be a more suitable first line treatment for VL than standard treatment. ClinicalTrials.gov identification number: NCT01310738.

Trial registration

ClinicalTrials.gov NCT01310738

Visceral leishmaniasis remains a worldwide public health concern with high mortality even when proper treatment is instituted. There is a need to develop efficacious, safer and shorter treatment alternatives as the current options suffer from high toxicity and long treatment duration. Combination therapies emerge as an alternative, and WHO has encouraged the conduct of studies to evaluate drug combinations where evidence for current treatment regimens is not available. In Brazil, there is no local evidence to support the current treatment recommendations. Therefore, a clinical trial was conducted in five hospitals in Brazil to evaluate the efficacy and safety of the current available treatments—meglumine antimoniate, amphotericin B deoxycholate and liposomal amphotericin B—and of a combination of liposomal amphotericin B, single dose, and meglumine antimoniate, in a shorter administration regimen. Preliminary safety results led to the discontinuation of the amphotericin B deoxycholate treatment arm and a planned interim analysis resulted in the trial interruption. The final results, comparing liposomal amphotericin B and liposomal amphotericin B plus meglumine antimoniate to the standard meglumine antimoniate treatment, did not show a statistically significant difference in cure rates, though cure rate was higher in the liposomal amphotericin B group. Liposomal amphotericin B treatment showed a better safety profile compared to meglumine antimoniate. These results will support future changes in treatment protocols in Brazil and potentially in Latin America.

Association of Polymorphisms in IL1β -511C>T, IL1RN 86 bp VNTR, and IL6 -174G>C Genes with Clinical Dengue Signs and Symptoms in Brazilian Dengue Patients

Dengue is an important infectious disease that has high morbidity and mortality rates in most tropical and subtropical areas of the world. The diversity of the clinical manifestations involved in the outcome of dengue virus infection is affected by the relationship between serotype/genotype of the virus, host immune status, host genetic background, and environmental factors. Polymorphisms in interleukin (IL) genes have been associated with risk of developing symptomatic dengue. This study aimed to determine the association of the single-nucleotide polymorphisms of IL1β -511C>T, IL1RN 86 bp VNTR, and IL6 -174G>C genes with the clinical features of 198 individuals admitted to the São José Infectious Diseases Hospital with suspected dengue infection. Dengue was confirmed in 118 of the patients. The control group consisted of 80 other individuals who had symptoms similar to dengue, but negative for that. A higher frequency of increased hematocrit (p = 0.009), leukopenia (p = 0.000007), neutropenia (p = 0.0004), lymphocytosis (p = 0.00001), monocytosis (p = 0.004), atypical lymphocytes (p = 0.03), and thrombocytopenia (p = 0.0000009) was observed in the dengue patients. Among the polymorphisms studied, only IL1β (-511C>T) was associated with dizziness, (p = 0.01), suggesting that IL1β may be related to hypotensive episodes and increased vascular permeability. These results pointed out the importance of the IL1β (-511C>T) polymorphism in the development of clinical symptoms of dengue symptomology.

Linear and daily undulating resistance training periodizations have differential beneficial effects in young sedentary women

The aim of this randomized controlled study was to verify the impact of a 12-weeks muscular endurance (ME) training of high repetitions (i. e., 15-30) with 2 different periodization models on body composition, maximal strength, muscular endurance and cardiorespiratory fitness. Twenty eight sedentary women aged 20-35 years were randomly assigned to: control (CON) (n=8), linear periodization (LP) (n=10) and daily undulating periodization (DUP) (n=10). LP and DUP models significantly improved body composition, maximal strength and ME. However, no significant changes were detected for cardiorespiratory fitness. LP showed a higher body fat loss (- 12.73%) compared to DUP (- 9.93%) (p=0.049), and systematically higher effect sizes (ES) when compared with DUP for maximal strength and cardiorespiratory fitness parameters (e. g. ES=0.53 for ventilatory threshold). In contrast, DUP exhibited a significantly (p=0.002) greater ME gain (129.43%) compared to LP (70.72%) in bench press, and greater ES in all exercises. It may be suggested that LP performed with a high number of repetitions may be considered an appropriate periodization model for untrained young women that would likely lead to the improvement of body composition and maximum strength performance, whereas DUP is more effective for the development of ME.

Resistance training and glycogen content in ovariectomized rats

The aim of the present study was to investigate the effects of resistance training on glycogen content and muscle cross-sectional area (CSA) in ovariectomized rats. Wistar rats were divided into: sedentary; ovariectomized sedentary; resistance trained; and ovariectomized resistance trained. In the 12-week resistance training, the animals climbed a 1.1 m vertical ladder, 3 days per week, with 4-8 climbs. Cardiac, liver and muscle glycogen content was determined. After the 12-week resistance training period there was a higher hepatic and muscle glycogen content in the resistance training group compared with the other groups (p<0.01). CSA was higher in soleus for the resistance trained, ovariectomized resistance trained and sedentary compared with ovariectomized sedentary (p<0.05). Ovariectomy attenuated the increase in liver and muscle glycogen content, while soleus muscle cross-sectional area increased with resistance training, even in ovariectomized rats. Resistance training could be an important exercise to increase muscle function in situations of reduced estrogen and progesterone.

Acute effect of resistance training volume on hormonal responses in trained men

AIM

The purpose of this study was to investigate the acute hormonal response to resistance training sessions with different volumes in men.

METHODS

Ten recreationally trained men (24.5±7.6 years; 76.2±9.2 kg; 175.6±1.5 cm; 24.5±5.5 kg/m(-2)) participated in the study. All subjects completed two experimental protocols with different volumes. The first protocol consisted of 3 sets at 80% of 6 RM and the second protocol was 3 sets at 80% of 12 RM with 2 minutes rest between sets and exercises, separated by seven days between them. The exercise order used was: barbell bench press, leg press, machine front lat-pull down, leg curl, shoulder abduction and leg extension. The blood variables analyzed were: testosterone, growth hormone (GH), cortisol and testosterone/cortisol ratio (T:C) before (Pre) and immediately after (Post) each exercise session.

RESULTS

The intra-groups comparison for testosterone and hGH revealed a significant increase in 80%-6RM and 80%-12RM. Cortisol levels was significantly higher in 80%-12RM and T:C ratio in 80% 6 RM when compared Pre and Post values. Inter-groups comparison showed higher hGH and cortisol levels and lower T:C ratio for 80% 12 RM. There was no statistically significant different between 80%-6RM and 80%-12RM for testosterone.

CONCLUSION

The present study confirms that the volume of resistance training can be an important factor in the modulation of acute hormonal responses.

Effects of resistance training on matrix metalloproteinase-2 activity and biomechanical and physical properties of bone in ovariectomized and intact rats

The purpose of this study was to investigate the influence of resistance training on the activity of matrix metalloproteinase (MMP)-2 and bone biomechanical properties in ovariectomized and intact rats. Forty-eight female rats were divided into two distinct groups, ovariectomized (OVX) and intact (Int), which were subdivided into three similar subgroups: sedentary, acute exercise and chronic exercise. Rats performed a resistance training for 12 weeks in which animals climbed a vertical ladder of 1.1 m with weights attached to their tails. Sessions were performed with an interval of 3, 4-9 and 8-12 days scaled dynamic movements of climbing. Biomechanical and physical analyses were performed using a universal testing machine, and MMP-2 activity analysis by zymography. Bone density (BD), mineral density (MD), maximum load and fracture load was reduced in sedentary and acute exercise OVX groups compared with the sedentary intact group (P<0.05); in contrast, chronically trained groups (OVX and Int) showed a significant increase in BD, MD and fracture load compared with all the other groups. MMP-2 activity in chronically trained groups also showed a significant increase, while the sedentary OVX group showed a decrease in MMP-2 activity compared with the intact sedentary group (P<0.05). Our results suggest that the resistance training proposed in our work was efficient in reverting the deleterious effects of ovariectomy on bone tissue, and also produced modeling effects in intact rats. On the other hand, ovariectomy reduced the activity of MMP-2 and produced deleterious effects on bone tissue, mimicking menopause intrinsically.

Refractory congenital chylous ascites

Refractory congenital chylous ascites (CCA) is an uncommon clinical condition. Few cases have been described and no gold standard treatment has been defined so far. This report describes a case of refractory CCA in a newborn child which was treated by surgery. Preoperative lower-limb lymphoscintigraphy associated with intraoperative patent blue testing and fibrin glue application were useful in order to provide a successful outcome.

Condições sociodemográficas de crianças de zero a dois anos filhas de mães com HIV/Aids, Fortaleza, CE, Brasil

OBJETIVOS: identificar as condições sociodemográficas das crianças de 0 a 2 anos de idade nascidas de mães HIV + / AIDS em Fortaleza, Ceará, Nordeste do Brasil. MÉTODOS: estudo transversal utilizando um questionário semiestruturado com cuidadores (63 mães e 5 avós) de crianças no ambulatório de um hospital estadual, entre Dezembro de 2005 e Abril de 2006. RESULTADOS: a idade média das mães foi de 26 anos de idade. Aproximadamente 16% eram analfabetas, 57,3% eram casadas e 5,9% viúvas. Mais de dois terços (79,4%) das mulheres participantes do estudo tornou-se ciente de seu status de HIV + no último parto e 51,5% relataram não receber qualquer tipo de assistência social do governo. A idade média das crianças foi de 15,6 meses e 13% não tiveram um teste de HIV. A maioria delas era proveniente de áreas rurais (60,3%), com renda familiar média mensal de R$ 446,32. Verificou-se que 57,9% das crianças viviam em uma casa com cinco ou mais pessoas, e 31% relataram ter quatro ou mais crianças morando na mesma casa. CONCLUSÕES: há necessidade de estratégias de prevenção e promoção à saúde, levando em consideração o contexto social das famílias que vivem com HIV/AIDS.

MMP-2, jumping exercise and nandrolone in skeletal muscle

Matrix metalloproteinases (MMPs) are crucial to the development and maintenance of healthy tissue. The aim of this study was to investigate MMP-2 activity in gastrocnemius, soleus, extensor digitorium longus (EDL) and tibialis anterior (TA) muscles after exercise associated with an anabolic androgenic steroid (AAS). Wistar rats were grouped into: sedentary (S); sedentary with AAS (AAS); trained without (T) and with (AAST) AAS. Exercised groups performed a 7-week water-jumping program. The exercise increased MMP-2 activity in gastrocnemius and soleus, but not in TA and EDL. The AAS treatment decreased MMP-2 activity of EDL, as compared to the S group, with no effect in gastrocnemius and soleus. The association of AAS and training restored the normal MMP activity of EDL. Training increases tissue turnover in primary motor muscles, which in turn respond differently to AAS treatment. This data may be useful for a better understanding of muscular physiology under AAS use.