Saint Clair Gomes Junior

Objective: To analyze the time trend of reported tuberculosis cases in the pediatric population in Rio de Janeiro State from 2010 to 2023. Methods: Data on new tuberculosis cases were obtained from the Notifiable Diseases Information System. Joinpoint regression analysis was used to identify inflection points and segment the time series into periods with distinct incidence trends. These segments were then used to assess statistically significant differences in the distribution of sociodemographic, clinical, and outcome variables. Results: The findings reveal significant fluctuations throughout the period, with a marked increase from 2020 to 2023, particularly among children under five years of age. During this period, a decrease in the Municipal Human Development Index and an increase in both infant mortality and the Gini index were also observed. Conclusion: Despite a decline in the number of reported cases, There was an upward trend in tuberculosis incidence among children and adolescents between 2020 to 2023 in Rio de Janeiro State, coinciding with a decline in development indicators. Although definitive causal relationships cannot be established, the observed patterns reinforce the need for robust epidemiological surveillance tailored to age-specific characteristics, as well as targeted interventions.

Background/Objectives: The primary objective was to assess reference intervals for fetal Global Longitudinal Strain (GLS) using bidimensional speckle-tracking echocardiography (2D-STE), including only prospective studies specifically designed for this purpose. An additional objective was to evaluate studies’ methodological quality and reproducibility. Methods: This is a systematic review registered at PROSPERO (CRD420251038889). Five electronic databases (Web of Science, Scopus, MEDLINE/PubMed, EMBASE and LILACS) were searched, from inception to May 2025. Prospective studies specifically designed to establish 2D-STE GLS reference intervals in low-risk singleton pregnancies with normal fetuses were included. Data were independently extracted by two reviewers. Risk of bias was assessed using an adapted tool, including study design and statistical and reporting methods. Results: After the initial identification of 187 records, nine studies published between 2012 and 2025 were included. There was marked heterogeneity among the studies. Four articles achieved high-quality scores (>70%) and three of them reported similar left ventricular (LV) GLS at 24 weeks (−22%). Right ventricular absolute GLS values were slightly lower than LV numbers. Regression models for both ventricles showed GLS absolute values decreased with gestation across studies. The 2D-STE algorithm (endocardial versus myocardial) was the main source of discrepancy between studies. Conclusions: High-quality prospective studies show a consistent pattern of biventricular GLS variation with gestational age. However, technical heterogeneity, lack of standardization, operator subjectivity and vendor-specific algorithm differences currently limit the applicability of the method. Multicentric studies with large sample sizes, standardized protocols and artificial intelligence-assisted tools are needed to consolidate this technique.

Background: Stenotrophomonas maltophilia complex (SMC) is an emerging multidrug-resistant nosocomial pathogen, particularly among critically ill patients. Predictors of SMC-related sepsis in adult ICU patients remain poorly defined, limiting management strategies. Methods: A hybrid prospective longitudinal cohort study of patients with Sepsis-2/adapted Sepsis-3, in which blood and other cultures were collected and antimicrobial therapy was instituted in a tertiary-public medical-surgical ICU in Rio de Janeiro. Multilevel Cox regression analyses with patient-level random effects and time-dependent covariates (daily exposure to carbapenems, polymyxins and polymyxin-carbapenem combination, PCC) were used to identify predictors of sepsis associated with (SMC-AS) and caused by (SMC-S) SMC. Findings: Among 933 hospitalizations followed over 11,108 patient-days, we detected 52 SMC-AS and 20 SMC-S, most of which were recurrent and polymicrobial, with other non-fermenting Gram-negative bacilli (NF-GNB). These episodes corresponded to 165 and 60 antibiotic-exposure periods in 22 and 17 patients, respectively. The remaining episodes comprised the comparator group (304 episodes, 218 patients, 660 periods). Age, Simplified Acute Physiology Score 3, and prior sepsis due to NF-GNB were independent predictors of both outcomes. Time-dependent exposure to polymyxins or carbapenems and urinary catheterization were associated with increased risk, whereas PCC had a protective effect for SMC-AS. Gastrointestinal disease and immunosuppressive therapy were predictors of SMC-S. Interpretation: Distinct demographic and clinical characteristics and time-varying antibiotic-exposure patterns were associated with SMC-related sepsis in critically ill adults. These findings may support earlier recognition and risk stratification in ICUs where SMC is incident; however, validation in larger multicentre cohorts is needed.Funding: Oswaldo Cruz Foundation.

Introduction: Cervical intraepithelial neoplasia grade 2 (CIN2) includes both transient HPV infections and precursor lesions of cervical cancer. Conservative management aims to avoid overtreatment, especially in reproductive-aged women. Objective: To describe the clinical outcomes and time to lesion regression among conservatively managed, biopsy-confirmed CIN2 cases, and to explore whether baseline characteristics, including p16 and Ki-67, were associated with lesion regression. Materials and methods: An observational cohort study was conducted in patients with CIN2, as determined by cervical biopsy. Participants were followed up with cytology and colposcopy every 6 months, and outcomes were categorized as regression or no regression. At least two pathologists evaluated p16 immunohistochemical staining according to LAST criteria. Ki-67 staining was considered positive when at least 50% of cells in the lesion were stained, as determined by digital quantification. Bivariate analysis and survival curve analyses were conducted, with significant associations defined as p-values <0.05. Results: Fifty patients with a mean age of 30.5 years were included in the study; 76% (38/50) showed regression. The median time to regression was 357 days (SE = 61.4 days; 95% CI: 236.6–477.4 days). The baseline characteristics, including p16 and Ki-67, were not statistically associated with regression, likely due to the small sample size. Conclusion: CIN2 regression occurred in 76% of cases, with median times of approximately 12 months for regression and 32 months for progression. No statistically significant associations were detected between baseline characteristics, including biomarkers, and lesion regression in this exploratory study.

RESUMO Este artigo propõe uma reflexão sobre a saúde mental dos adolescentes, entendendo-a como resultado de interações complexas entre fatores biológicos, psicológicos e sociais. Essa perspectiva possibilita pensar a ética do cuidado, que defende a valorização dos laços humanos, promovendo uma prática de cuidado que faz coincidir senso de responsabilidade e atenção com o outro de maneira interdependente e buscando a horizontalidade alcançada pela cooperação; o artigo tem como objetivo compreender como a perspectiva trazida pela ética do cuidado pode contribuir para a promoção da saúde dos adolescentes. Também busca identificar que aspectos os adolescentes relacionam como negativos e positivos e os impactos que estes têm sobre sua saúde mental. Partindo da perspectiva etnográfica no campo da saúde, foi utilizada como técnica de investigação e coleta de dados a observação participante, privilegiando as interações espontâneas, a imersão no campo e a presença responsável da pesquisadora. Em um momento posterior, foram realizados grupos focais com os adolescentes. A análise se deu a partir dos resultados da proposta que incluiu observação participante e grupos focais. Ações coletivas são agentes de inovação, gerando forças propulsoras que rompem paradigmas e ampliam as possibilidades de escuta e cuidado, promovendo a construção de soluções compartilhadas.

INTRODUCTION Acute viral bronchiolitis (AVB) is the infection of the lower airways, most common in the pediatric population, primarily caused by the respiratory syncytial virus (RSV). It typically follows a self-limited course with variable severity.(,) Among respiratory support options, the high-flow nasal cannula (HFNC) has been promising for this population in several studies.(,–) However, only […] INTRODUCTION Acute viral bronchiolitis (AVB) is the infection of the lower airways, most common in the pediatric population, primarily caused by the respiratory syncytial virus (RSV). It typically follows a self-limited course with variable severity.(,) Among respiratory support options, the high-flow nasal cannula (HFNC) has been promising for this population in several studies.(,–) However, only […]

This article aims to assess the neurodevelopment of children with and without in utero Zika virus (ZIKV) exposure, in the absence of microcephaly at birth, and to explore social and biological factors associated with develop- mental outcomes. Cross-sectional analysis of 172 children (94 ZIKV-exposed, 78 unexposed), aged 11-39 months, were evaluated using the Bayley Scales of Infant and Toddler Development. . Outcomes were classified as delayed (<70) or at risk (70-84) across cognitive, language, and motor domains. Exposure was confirmed by maternal RT-P- CR or neonatal IgM. Overall, 30.8% of children presented with developmental delay or risk in at least one domain. The most affected domain was language (26.7%). There were no statistically significant differences in delay frequency cognitive and motor domains.

Background/Objectives: Pediatric drug administration is hindered by difficulties in swallowing conventional medications and the unpalatable taste of many drugs. Among diseases highlighting the need for improved pediatric delivery, tuberculosis (TB) stands out. One form of the disease is latent TB infection (LTBI), which is concerning in children. Effective LTBI treatment is crucial for prevention, with isoniazid (INH) widely used for its proven efficacy and safety. This study aims to develop innovative 3D-printed chewable gels containing INH for LTBI treatment. Methods: The gels were formulated using gelatin and carrageenan gum, sugar-free sweeteners, and flavoring. Two batches were prepared, and using 3D printing (3DP) with a semi-solid extrusion (SSE) module, chewable gels were produced. Rheological properties were measured to assess the feasibility of 3DP-SSE, evaluating the structural integrity and adequate fluidity of the formulation. The 3D-printed chewable gels were evaluated by visual, mass, and dimensional characteristics. In addition, the water activity, texture profile, INH and degradation product content, in vitro release, and taste-masking were investigated. Results: The optimized formulation maintained suitable rheological properties for 3DP-SSE, demonstrating consistent weight, dimensions, and stability after the process. The texture achieved a balance between printing parameters and shape maintenance, and the INH presented an immediate-release profile (>85% within 30 min). The chewable gels showed an improvement in palatability compared to conventional INH tablets. Conclusions: This innovative approach offers a promising solution for pediatric LTBI treatment, as it improves efficacy, medication acceptability, and on-demand access.