Acute gastroenteritis and enteric viruses in hospitalised children in southern Brazil: aetiology,seasonality and clinical outcomes

Viral acute gastroenteritis (AG) is a significant cause of hospitalisation in children younger than five years. Group A rotavirus (RVA) is responsible for 30% of these cases. Following the introduction of RVA immunisation in Brazil in 2006, a decreased circulation of this virus has been observed. However, AG remains an important cause of hospitalisation of paediatric patients and only limited data are available regarding the role of other enteric viruses in these cases. We conducted a prospective study of paediatric patients hospitalised for AG. Stool samples were collected to investigate human adenovirus (HAdV), RVA, norovirus (NoV) and astrovirus (AstV). NoV typing was performed by nucleotide sequencing and phylogenetic analysis. From the 225 samples tested, 60 (26%) were positive for at least one viral agent. HAdV, NoV, RVA and AstV were detected in 16%, 8%, 6% and 0% of the samples, respectively. Mixed infections were found in nine patients: HAdV/RVA (5), HAdV/NoV (3) and HAdV/NoV/RVA (1). The frequency of fever and lymphocytosis was significantly higher in virus-infected patients. Phylogenetic analysis of NoV indicated that all of these viruses belonged to genotype GII.4. The significant frequency of these pathogens in patients with AG highlights the need to routinely implement laboratory investigations.     

Human Health Risks of Exposure to Estuary Waters

The convergence of data strongly suggests the presence of an estuary-related toxin (pfiesteria piscicida or similar organism) that produces adverse human health effects. A diversity of methodological approaches is necessary to answer important preliminary questions about the clinical syndrome, its immediate public health risk, prioritize ongoing scientific studies and direct future research. These include intensive case and multiple-case studies; case-control studies; and epidemiological cohort studies that are conducted in parallel with basic science research. Findings to date indicate the estuary-related toxin is neurotoxic to persons with high levels of exposure. The most pronounced effects are neurocognitive and include problems with complex attention, memory, and visual contrast sensitivity. The disturbances are detectable with standard neuropsychological procedures. Although the most debilitating effects are reversible, the possibility of a sensitization phenomenon exists. The Estuary Clinical Syndrome joins other well-documented outbreaks of human illness for which the specific toxin agent remains to be identified. The methodological approaches for identifying and investigating this newly identified syndrome in the absence of a known toxin may provide a model for the early investigation of other emerging toxins and related illnesses.     

Injuries to Hip Joint in Car Occupants

Four varieties of fracture, of dislocation, or of fracture dislocation of the hip are described that occur in car occupants after road accidents. It is suggested that, whereas most hip injuries to car occupants are produced by application of force to the knee, one important variety (central fracture dislocation) is the result of the direct application of force to the great trochanter. Central fracture dislocations might be prevented, or their severity minimized, by strengthening the sides of cars and of car doors and by improving the energy absorption characteristics of the facia panel.