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OBJECTIVES: evaluate the profile of children exposed intrauterine to HIV born in a tertiary hospital in southern Brazil, describe the prevalence of children classified as high risk and the rate of vertical transmission in this population. METODOLOGY: cross-sectional analytical-observational study. All HIV-exposed children born in 2019 and 2020 at the Clinical Hospital of the Federal University of Paraná were included. Data were collected from the hospitals operating systems, physical records and SISCEL. Study approved by the hospital ethics committee. RESULTS: 142 patients were included. Among the mothers, 26.06% had a detectable viral load in the last trimester, of which 54.05% were above 1000 copies; 37.32% were diagnosed during pregnancy; 40% of women who were diagnosed during pregnancy had a detectable viral load in the 3rd trimester (p=0.01). Of those who had a detectable viral load in the third trimester, 88.89% used ART irregularly or did not use (p < 0.01); 44.37% of newborns were classified as high risk by the current protocol in the period, while with the current new protocol would be 63.38%. The vertical transmission rate was 1.41%. There was 42.26% of loss of follow-up. CONCLUSION: the prevalence of vertical transmission was low, comparable to developed countries. Quality prenatal care, early diagnosis and adherence to ART are factors that modify the rates of vertical transmission of HIV due to the reduction of maternal viral load in the third trimester.

Objective: To analyze the effectiveness, safety, outcomes, and associated factors of tuberculosis preventive treatment (TPT) in children and adolescents in Paraná, southern Brazil. Method: This was an observational cohort study with a retrospective collection of secondary data from the TPT information systems of the state of Paraná from 2009 to 2016, and tuberculosis in Brazil from 2009 to 2018. Results: In total, 1,397 people were included. In 95.4% of the individuals, the indication for TPT was a history of patient-index contact with pulmonary tuberculosis. Isoniazid was used in 99.9% of the cases with TPT, and 87.7% completed the treatment. The TPT protection was 98.7%. Among the 18 people who had TB, 14 (77.8%) became ill after the second year of treatment, and four (22.2%) in the first two years (p < 0.001). Adverse events were reported in 3.3% of cases, most of them were gastrointestinal and medication was discontinued in only 2 (0.1%) patients. No risk factors associated with the illness were observed. Conclusions: The authors observed a low rate of illness in pragmatics routine conditions in TPT for children and adolescents, especially within the first two years after the end of treatment, with good tolerability and a good percentage of adherence to the treatment. TPT should be encouraged to achieve the goals of the End TB Strategy of the World Health Organization as an essential strategy to reduce the incidence rate of the disease, but studies with new schemes must continue to be carried out in real-life scenarios.

ABSTRACT Objective: To describe the first known case of human Bertiellosis in Paraná (Brazil). Case description: A 6-year-old male residing in the Brazilian state of Paraná was suffering from intermittent nonspecific abdominal pain and abdominal distension, associated with expulsion of live tapeworms in his feces for 7 months. He had a history of interaction with monkeys on an island. His first feces analysis was inconclusive, with an initial hypothesis of an atypical Taenia. However, after additional research, the parasitologist identified pregnant proglottids of Bertiella sp. The patient was initially treated with an unknown dosage of albendazole and nitazoxanide, as it was believed he had been infected with Taenia sp. Since the symptoms persisted, praziquantel 10 mg/kg was prescribed without further proglottids elimination. Comments: Human Bertiellosis is a rare zoonosis, with less than one hundred cases reported. However, it is a cause of chronic abdominal pain and should be kept as a differential diagnosis, especially in cases reporting recurrent tapeworm expulsion in feces and refractory treatment with albendazole.

Introdução: Crianças que vivem com o vírus da imunodeficiência humana — HIV/AIDS requerem atendimento especializado. Objetivo: Descrever características clínicas e epidemiológicas de pacientes que vivem com HIV/AIDS. Métodos: Estudo observacional, descritivo, com dados de prontuários de pacientes com HIV/AIDS de até 14 anos de idade incompletos, aprovado pelo Comitê de Ética em Pesquisa da instituição sob o número 1.432.517. Resultados: Foram incluídos 60 casos. A mediana de acompanhamento foi de 6,8 anos; 50,0% eram do sexo masculino; 88,3% brancos; 75,0% naturais da capital e região metropolitana. Em 51 prontuários havia descrição de pré-natal, porém apenas 44,6% fizeram uso de terapia antirretroviral (TARV) na gestação (tempo médio de 3,3 meses). Em 28,3% o HIV foi pesquisado por sintomas clínicos, que ocorreram em proporções similares tanto por infecções habituais da infância como por oportunistas. De acordo com a classificação clínica dos Centers for Disease Control and Prevention — CDC (1994), ao início do acompanhamento, 56,6% dos pacientes apresentavam sintomas moderados ou graves e, na última consulta, se fossem reclassificados, seriam apenas 18,3% (p=0,016). Incialmente, 41,7% apresentavam evidência de imunossupressão, comparativamente aos 19,9% na ocasião do estudo (p=0,5). Apenas 6,6% permaneceram assintomáticos. Com o acompanhamento, verificou-se diminuição na média do número de hospitalizações. Conclusão: Dos casos que apresentaram seu diagnóstico por sintomas clínicos, metade foi por infecções habituais da infância e sem imunossupressão.

Introduction: Currently we are facing the challenge to deal with the first generation of adolescents HIV+, infected by vertical transmission. This is new, and creates the need to improve attention to self-care and knowledge on sexual and reproductive health. Issues like the exercise of sexuality, contraception, pregnancy, sexually transmitted diseases (STD), are not enough debated among professionals, families and adolescents, despite their importance, concerning the affective and sexual discoveries typical of that age. Objective: To assess and compare the knowledge among adolescents HIV+ and HIV-, the guidance received on sexual and reproductive health and their sexual behavior, in order to better assist an integral health attention. Methods: A prospective, quali-quantitative, observational, analytical and cross-sectional study that took place during one year at the public hospital of an university in Curitiba, interviewing 61 adolescents HIV+ and 61 adolescents HIV- after their outpatient attendance. A questionnaire with objective multi-choice questions, as well as open-ended questions thought to stimulate free narratives was the base of data acquisition. Statistical analysis have considered the adolescents HIV+ and HIV- matched by age, gender and education. To evaluate differences on continuous variables, Student’s t-test for normal distribution and Mann-Whitney test for asymmetric distribution were the tools. For categorical variables: Fisher exact tests and chi-square of Pearson. The analysis of answers for the openended questions was based on categorization of semantic equivalence. Significance level of 5% for all tests. Main variables of study in the amount enough to allow comparisons have driven the sample estimation, with less than 5% of significance level and minimum test power of 95%. Results: The study showed that adolescents don’t have good enough knowledge about reproductive health in both groups (p=0.01). They have initiated sexual activity at about 15 years old, they report using condoms, but not the habit of picking them up. The group of HIV + have expressed more opinions about the sexual and reproductive rights, they have received less guidance on emergency contraception (p

ABSTRACT This study investigated the potential use of the String Test (ST) for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. This is a case series of patients aged 4-15 years presenting with clinically presumed PTB and submitted to ST in three pediatric TB referral centers in Brazil, between November 2017 and July 2020. The ST was performed in the morning, after 4-12 h of fasting, followed by ingestion of the capsule by the patient, which was attached to the patient’s malar region. The material was collected for simultaneous smear microscopy (acid-fast bacilli - AFB), culture and the molecular investigation by the GeneXpert MTB/RIF®. Thirty-three patients with presumed PTB were included and ST was performed in 26 (78.8%) of them and 7 (21.2%) patients could not swallow the cord. The diagnosis of PTB was established in 11 (42.3%) of the 26 patients who underwent the ST. The diagnosis of PTB was confirmed (by culture or GeneXpert MTB/RIF®) in 5 patients, 4 of whom were also positive by the ST. Two of them showed positivity by the GeneXpert MTB/RIF® only in the ST sample. Two other patients had a positive ST following the induced sputum test (AFB, GeneXpert MTB/RIF®, and positive culture in both specimens). Thus, ST was positive in 36.4% of the patients in whom PTB was diagnosed. ST could be a useful test for diagnosing PTB in children and adolescents.

Mucormicose é uma infecçãoinvasiva causada por fungos da ordem dos Mucorales, ubíquos na natureza, O objetivo deste estudo é descrever as características epidemiológicas, clínicas e microbiológicas de um surto de mucormicose por Rhizomucor pussilus em uma unidade de TCTH) do HC -UFPR, Curitiba,. Métodos: Os casos de Mucormicose Invasiva (MI) foram definidos de acordo com os critérios do EORTC e NIAID MSG; uma curva epidemiológica dos casos de MI identificados na unidade nos últimos 5 anos (Outubro/16 a Setembro/21) foi construída para estabelecer a média de casos no período para definição do surto. Dados epidemiológicos,clínicos e microbiológicos dos pacientes foram analisados, assim como a investigação microbiológica do ambiente da unidade. Os isolados microbiológicos foram identificados fenotipicamente e por espectrometria de massa (MALDI-TOF) e identificação molecular; Resultados:: Nos últimos 12 meses, pudemos identificar 4 casos de MI, número muito acima da médica epidêmica da unidade nos últimos 5 anos. Três casos foram classificados como mucormicose invasiva disseminada provada (2 pediátricos e 1 adulto). Três pacientes Rhizomucor pussilus provadas, sendo que um paciente teve o diagnóstico confirmado pos mortem, e não recebeu tratamento. Outros 3 pacientes receberam terapia baseada em ABLC, combinados com isavuconazol. Ao fim de setembro/21, 0 3 pacientes estão vivos, sendo 1 deles considerado curado (mucormicose intestinal - tratamento cirúrgico e antifúngico), e os outros 2 pacientes ainda recebendo terapia antifúngica ambulatorial com isavuconazol. A investigação da fonte do surto, todos os quartos da unidade dispões de filtro HEPA; foi avaliada a linha do tempo da localização dos pacientes na unidade, mas nenhuma exposição comum pôde ser identificada. Como os esporos de Rhizomucor pussilus podem ser encontrados na água, alimentos e sistemas de ar, foram coletadas amostras de fontes do ambiente, sem achados positivos. Também foi considerada a possibilidade de que construções e reformas dentro e fora do HC-UFPR,pudessem explicar o recente aumento no número de casos de MI observados no último ano. No entanto, também esperaríamos um aumento no número de casos de aspergilose invasive neste cenário, o que não foi observado nas curvas epidemiológicas da unidade durante o período. Em conclusão, descrevemos os aspectos epidemiológicos, clínicos e microbiológicos de um surto de MI causada por Rhizomucor pussilus em uma unidade de TCTH np HC-UFPR.

ABSTRACT The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1 st , 2004, to December 1 st , 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB.

ABSTRACT Objective: To identify the most effective form of contact, as a possible intervention to reduce absenteeism in consultations of children with suspected or confirmed pulmonary tuberculosis. Methods: A randomized clinical trial was conducted with prospective data collection, between March 2017 and February 2018. Patients were randomized into three groups to be reminded about the appointment: telephone contact, SMS or WhatsApp, or no intervention. A convenience sample was obtained, with a significance level of 5%. Results: 78 children were included, with a median age of four years old (zero to 14); 59.0% of them were in treatment for a latent infection and 6.4% had active tuberculosis. Among the 78 children, 74.4% lived in Curitiba (Sourhern Brazil); 62.8% lived with both parents; 38.5% of the parents had formal employment and 47.4% of the mothers were housewives; 50.8% of the fathers and 55.7% of the mothers had more than nine years of schooling. In 78.2% of the families, per capita income was up to 0.5 minimum wages; 27.3% were enrolled in social programs; 28.2% lived in homes provided by the government. There was a total of 238 interventions made: 85 (35.7%) by telephone contact, 78 (32.8%) by text message (WhatsApp was 97.2% of these) and 75 (31.5%) had no further contact. There was no statistical difference among the sociodemographic and cultural characteristics studied. The absenteeism rate was 24.0% and the abandonment rate was 16.7%. Giving a reminder to the patient’s guardian prior to the consultation, regardless of the intervention (p=0.021) and specifically by WhatsApp message (p=0.032) was associated with no absenteeism, though it was not associated with abandonment of the treatment. Conclusions: Using new tools, such as WhatsApp, to remind guardians of appointments reduces absenteeism. Consequently, it may lead to a reduction in abandoning treatment and it may improvetreatment outcome of children with a tuberculosis infection or disease.

Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality—over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy–practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.

Objective: Evaluate risk factors for colorectal cancer recurrence after surgical treatment. Methods: Sixty-five patients with colorectal adenocarcinoma, stage I and II (TNM), undergoing curative-intent surgery and followed for five years were studied. Presence of adjuvant/neo adjuvant therapy, tumor differentiation degree, lymphatic and venous vascular infiltration, depth of tumor invasion, and disease staging was analyzed, using recurrence relative risk ratios for each parameter calculated at two years, after two years and five years of follow up. Results: At five years, recurrence was 21.4% (14/65), with equal incidence (10.7%) for the separated periods. Only lymphatic and venous vascular infiltration showed statistically significant association with recurrence during times analyzed. Relative risk (RR) of recurrence was significantly related to the presence of lymphatic infiltration [RR = 6 (1.3 – 28.5) p = 0.01] and venous infiltration [RR = 9.5 (2.6 – 34.9) p < 0.001] after two years of follow-up. At five years follow-up, only venous infiltration remained with significant relative risk for recurrence [RR = 3.9 (1.8 – 8.8) p < 0.001]. In a multivariate analysis, only venous vascular infiltration was associated with recurrence [accuracy 81.5% (p < 0.001)]. Conclusion: In this series, the factors associated with risk of colorectal cancer recurrence were the presence of lymphatic and venous vascular infiltration. Resumo: Objetivo: Analisar fatores de risco para recidiva de câncer colorretal após tratamento cirúrgico. Método: Avaliou-se 65 pacientes com adenocarcinoma colorretal, estadio I e II (TNM), submetidos à cirurgia com intenção curativa, acompanhados por cinco anos após a operação. Analisou-se presença de tratamento adjuvante/neoadjuvante, grau de diferenciação do tumor, infiltração vascular linfática e venosa, profundidade de invasão tumoral e estadiamento da doença, estabelecendo-se para cada um o risco relativo de recidiva aos dois anos, após dois anos e aos cinco anos de seguimento. Resultados: Recidiva global em cinco anos foi 21,4% (14/65), com idêntica incidência (10,7%) nos períodos separados. Somente as infiltrações vasculares linfáticas e venosas apresentaram associação estatisticamente significativa com a recidiva nos períodos de análise. Encontrou-se risco relativo (RR) estatisticamente significativo após dois anos relacionados à presença de infiltração linfática [RR = 6 (1,3 – 28,5) p = 0,01] e infiltração venosa [RR = 9,5 (2,6 – 34,9) p < 0,001]. Após cinco anos, apenas a infiltração venosa manteve a significância estatística, com risco relativo elevado para ocorrência de recidiva [RR = 3,9 (1,8 – 8,8) p < 0.001]. Na análise multivariada apenas a presença de infiltração vascular venosa com 81,5% de acerto foi associada à recidiva (p < 0.001). Conclusão: Nesta série, os únicos fatores associados com risco de recidiva do câncer colorretal foram a presença de infiltração vascular linfática e venosa. Keywords: Neoplastic invasiveness, Adenocarcinoma, Prognosis, Colorectal neoplasms, Palavras-chave: Invasividade neoplásica, Adenocarcinoma, Prognóstico, Neoplasias colorretais

The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from April 2001 to august 2002 have been evaluated. One hundred S. pneumoniae have been isolated, of which 15% were resistant to penicillin, 1% to cephalosporin and 0% to vancomycin. The serotypes most found were 14 (19%), 3 and 23F (10% each). When only the resistant serotypes were analyzed, the most prevalent was the 14 with 44%. The risk factors found in relation to the S. pneumoniae resistance were: age under one year old (p=0.01) and previous use of antibiotic (p=0.046). The resistance rates found, which were moderate to penicillin, low to cephalosporin and neutral to vancomycin, suggest the isolated use of a 3rd generation cephalosporin as an initial empirical therapy for the treatment of acute bacterial meningitis with a communitarian background.Este estudo teve como objetivo avaliar as taxas de resistência de Streptococcus pneumoniae, isolados de pacientes com meningite, à penicilina G, ceftriaxona e vancomicina; avaliar possíveis fatores de risco para resistência antimicrobiana; descrever os sorotipos encontrados e sugerir a terapêutica empírica inicial para meningite. Foram isoladas 100 amostras de S. pneumoniae, encontrando-se 15% de resistência à penicilina, 1% à cefalosporina e 0% à vancomicina. Os sorotipos mais encontrados foram 14 (19%), 3 e 23F (10% cada). Analisando-se os resistentes, o sorotipo 14 (44%) também foi o mais freqüente. Os fatores de risco para resistência de S. pneumoniae encontrados foram: idade menor que um ano (p=0,01) e o uso prévio de antibiótico (p=0,046). As taxas de resistência encontradas, moderada a penicilina, baixa para cefalosporina e nula para vancomicina, sugerem como terapêutica empírica inicial para tratamento da meningite bacteriana aguda de origem comunitária, a cefalosporina de terceira geração isoladamente.

OBJETIVO: Comparar o uso das soluções orais de manitol a 10% e de bifosfato de sódio no preparo mecânico do cólon quanto a qualidade da limpeza, a tolerabilidade e as alterações hidroeletrolíticas e da osmolaridade plasmática. MÉTODO: Foram analisados 60 pacientes de modo randomizado, duplo-cego e prospectivo, com indicação de colonoscopia. A qualidade da limpeza intestinal foi analisada pelo examinador através da classificação de Beck. A tolerabilidade à ingestão baseou-se na pesquisa do gosto, presença ou não de desconforto, aparecimento de efeitos adversos e a quantidade da solução ingerida. Foram dosados o sódio, potássio, cálcio, magnésio, fósforo, uréia, creatinina, glicose, hematócrito, hemoglobina e calculado a osmolaridade plasmática, antes e após a ingestão da solução oral de preparo inestinal. RESULTADOS: Ambas as soluções atingiram qualidade de preparo classificado como bom ou superior em mais de 80% dos pacientes. O uso do bifosfato de sódio determinou menor desconforto e melhor tolerância, apesar de não ter sido superior ao manitol quanto à análise do gosto e presença de efeitos adversos. O bifosfato induziu ao aumento e o manitol a uma redução da osmolaridade, reflexo do que ocorreu com o sódio plasmático nos dois grupos respectivamente. O bifosfato ainda determinou alteração significativa dos níveis séricos de fósforo, cálcio, magnésio e potássio, sem repercussões clínicas. CONCLUSÃO: Ambos os tipos de preparo intestinal determinaram qualidade de limpeza adequada. O bifosfato de sódio, apesar de melhor tolerado, determina maior quantidade de alterações hidroeletrolíticas.