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Abstract Objective To carry out a narrative review on the use of marketing strategies in child nutrition, as well as potential implications for health professionals and children. Data source Searches were carried out on the PubMed, SciELO, and Google platforms, using the terms "child nutrition" or "industrialized baby food" or "infant formula" or "breast milk" or "breastfeeding" and "marketing", with original articles, review articles, institutional reports, institutional position documents and websites considered relevant to the topic being analyzed. Data synthesis Children's food marketing started with the industrialization of food and the resulting actions aimed at increasing sales and meeting commercial interests. Since its inception to the present, infant formulas have been the most widely used products, which has impacted breastfeeding practices. International and national institutions, that care for children's health, are searching for strategies to limit the abusive marketing of industrialized children's foods. Marketing strategies interfere with medical knowledge and actions, potentially influencing the guidance provided by pediatricians to families, and finally, compromising healthy eating practices at a critical period in life, with possible long-term effects. Conclusions Health professionals, especially pediatricians, must provide the best care for children and families, and need to maintain the search for quality scientific information, not influenced by conflicts of interest. Updated and critical knowledge on the part of healthcare professionals can curb marketing strategies that aim to influence their actions.

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Much is known about the role of aeroallergens in asthma, but little is described about the damage caused by inhaled pollutants and irritants to the respiratory epithelium. In this context, the most frequent pollutants and irritants inhaled in the home environment were identified, describing the possible repercussions that may occur in the respiratory tract of the pediatric population with asthma and highlighting the role of the caregiver in environmental control through a salutogenic perspective. Searches were carried out in the MEDLINE/PubMed, Web of Science, Lilacs and Scopus databases for articles considered relevant for the theoretical foundation of this integrative review, in which interactions between exposure to pollutants and inhaled irritants and lung involvement. Articles published in the last 10 years that used the following descriptors were considered: air pollution; tobacco; particulate matter; disinfectants; hydrocarbons, fluorinated; odorants; chloramines; pesticide; asthma; and beyond Antonovsky's sense of coherence. Exposure to smoke and some substances found in cleaning products, such as benzalkonium chloride, ethylenediaminetetraacetic acid and monoethanolamine, offer potential risks for sensitization and exacerbation of asthma. The vast majority of the seven main inhaled products investigated provoke irritative inflammatory reactions and oxidative imbalance in the respiratory epithelium. In turn, the caregiver's role is essential in health promotion and the clinical control of paediatric asthma. From a salutogenic point of view, pollutants and irritants inhaled at home should be carefully investigated in the clinical history so that strategies to remove or reduce exposures can be used by caregivers of children and adolescents with asthma.

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OBJECTIVE: To carry out a narrative review on the use of marketing strategies in child nutrition, as well as potential implications for health professionals and children. DATA SOURCE: Searches were carried out on the PubMed, SciELO, and Google platforms, using the terms "child nutrition" or "industrialized baby food" or "infant formula" or "breast milk" or "breastfeeding" and "marketing", with original articles, review articles, institutional reports, institutional position documents and websites considered relevant to the topic being analyzed. DATA SYNTHESIS: Children's food marketing started with the industrialization of food and the resulting actions aimed at increasing sales and meeting commercial interests. Since its inception to the present, infant formulas have been the most widely used products, which has impacted breastfeeding practices. International and national institutions, that care for children's health, are searching for strategies to limit the abusive marketing of industrialized children's foods. Marketing strategies interfere with medical knowledge and actions, potentially influencing the guidance provided by pediatricians to families, and finally, compromising healthy eating practices at a critical period in life, with possible long-term effects. CONCLUSIONS: Health professionals, especially pediatricians, must provide the best care for children and families, and need to maintain the search for quality scientific information, not influenced by conflicts of interest. Updated and critical knowledge on the part of healthcare professionals can curb marketing strategies that aim to influence their actions.

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OBJECTIVE: To analyze the association between child exposure to intimate partner violence (CEIPV) committed against their mother and functional gastrointestinal disorders (FGIDs) in school-age children. METHODS: A prospective cohort study was carried out that evaluated 626 mother-child pairs living in a poor urban area in the Northeast of Brazil. The mothers were asked about their children's exposure to intimate partner violence. Holden's classification was used, which investigates ten types of CEIPV from prenatal care. The number of exposures, age of onset, and the perpetrator of the exposure were also verified. The FGIDs in children were identified from the mother's responses to the questionnaire about pediatric gastrointestinal symptoms, Roma III version parent-report, translated and cross-culturally adapted into Brazilian Portuguese. RESULTS: FGIDs were more frequent among children exposed to violence than those not exposed (OR: 1.64; 95% CI: 1.04-2.58; p = 0.03). Likewise, in children who suffered four or more types of exposure (OR: 1.81; 95% CI: 1.10-2.96; p  = 0.01), in which the exposure started in the first two years of life (OR: 1.93; 95% CI: 1.08-3.47; p = 0.02) and in those whose biological father was the perpetrator of the violence (OR; 1.62; 95% CI: 1, 05-2.48; p = 0.02). CONCLUSION: Corroborating the proposal of the biopsychosocial model, CEIPV increases the chance of occurrence of FGIDs in school-age children. Therefore, early identification and proposals for appropriate interventions are suggested both for the prevention of CEIPV and for the prevention and follow-up of FGIDs.

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Abstract Objective To analyze the factors associated with children's linear growth, according to the different subsystems of the 6Cs model and Bronfenbrenner's Bioecological Theory. Data sources Narrative review, carried out in the Scielo, Lilacs, Pubmed, and Science Direct databases, based on research using the terms Bioecological Theory, child growth, and risk factors, combined with the use of Boolean operators. Summary of findings According to the 6Cs model, proposed based on Bronfenbrenner's Bioecological Theory, the determining factors of children's linear growth are in six interrelated subsystems - cell, child, clan, community, country/state and culture. The empirical studies included in this review made it possible to analyze protection and risk factors within the subsystems. Among the protective factors: are adequate birth weight and satisfactory weight gain, breastfeeding for six months or more; proper hygienic habit of hand washing, proper elimination of feces, and access to clean water. As risk factors: low, birth weight and size, prematurity, multiple deliveries, short interval between deliveries, non-exclusive breastfeeding until the 3rd month, frequency and severity of infectious processes and anemia, little parental education, short maternal statur, inadequate maternal nutritional status, domestic violence, family poverty, food, and nutritional insecurity, living in rural areas or at high altitudes. Conclusion Children's linear growth is determined by interrelated factors that encompass aspects prior to the child's birth, as well as socioeconomic, political, family and community issues.

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Objetivo: analisar fatores sociodemográficos, escolares e de percepção da escola associados à vitimização por bullying entre estudantes. Materiais e método: estudo de corte transversal conduzido com 392 adolescentes de uma escola pública estadual de Pernambuco, nordeste do Brasil. Os dados foram coletados em 2018 com a aplicação de dois instrumentos: Questionário bullying, adaptado de Olweus, e Escala de Percepção da Escola como Comunidade. Na análise, foram adotados o teste qui-quadrado ou exato de Fisher e o t de Student. Resultados: a taxa de prevalência para a vitimização foi de 23,2%, com maior ocorrência entre meninos, que apresentam famílias com baixa renda, baixo desempenho escolar e relatos de solidão na escola. Formas diretas de bullying foram maiores nos meninos, enquanto as formas indiretas, nas meninas. As vítimas apresentaram maior dificuldade em criar relações interpessoais positivas e perceber sentimentos de colaboração, ajuda e proximidade na relação com os pares e seus professores. Conclusões: os achados reforçam a relevância de programas de intervenção do bullying que considerem o aumento do sentimento de pertencimento do adolescente com a comunidade escolar, o que requer o engajamento dos atores sociais no planejamento das estra- tégias de intervenção/enfrentamento baseadas no protagonismo dos estudantes, com a colaboração da enfermeira escolar.

Objetivo: analizar factores sociodemográficos, escolares y de percepción escolar asociados a la victimización por acoso escolar entre los estudiantes. Materiales y método: estudio transversal realizado con 392 adolescentes de una escuela pública en el estado de Pernambuco, nordeste de Brasil. Los datos fueron recolectados en 2018 con la aplicación de dos instrumentos: Cuestionario de Bullying, adaptado de Olweus, y Escala de Percepción Escolar como Comunidad. En el análisis se utilizaron la prueba chi-cuadrado, o prueba exacta de Fisher, y la prueba t de Student. Resultados: la tasa de prevalencia de victimización fue de 23,2 %, con mayor ocurrencia entre individuos de sexo masculino, provenientes de familias de bajos ingresos, con bajo rendimiento escolar y relatos de soledad en la escuela. Las formas directas de bullying fueron mayores en los niños, mientras que las formas indirectas afectaron principalmente a las niñas. Las víctimas reportaron dificultad para establecer relaciones interpersonales positivas y percibir sentimientos de colaboración, ayuda y cercanía en la relación con sus compañeros y sus profesores. Conclusiones: los hallazgos refuerzan la importancia de programas de intervención en contra del bullying que consideren el aumento del sentido de pertenencia de los adolescentes frente a su comunidad escolar. Esto requiere de la participación de diferentes actores sociales en la planificación de estrategias de intervención/afrontamiento basadas en el protagonismo de los estudiantes, en colaboración con los profesionales en enfermería adscritos a las instituciones educativas.

Objective: To analyze sociodemographic, school-related, and school perception factors associated with bullying victimization among students. Materials and method: Cross-sectional study conducted with 392 adolescents from a public school in the state of Pernambuco, northeastern Brazil. Data were collected in 2018 with the application of two instruments: the Bullying Questionnaire, adapted from Olweus, and the School Perception Scale as a Community. Data analysis involved the use of chi-square or Fisher's exact test and Student's t test. Results: The prevalence rate for victimization was 23.2%, with a higher occurrence in boys, from families with low income, low school performance, and reports of loneliness at school. Direct forms of bullying were higher in male students, while indirect forms were higher among females. Victims had greater difficulty in creating positive interpersonal relationships and perceiving feelings of collaboration, help, and closeness in the relationship with their peers and teachers. Conclusions: Our findings reinforce the relevance of bullying intervention programs that consider the increase in adolescents' sense of belongingness to their school community, which requires the engagement of social actors in the planning of intervention/coping strategies based on student protagonist role, with the collaboration of school nursing professionals.

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Through the last decades, Realistic Simulation for medical undergraduates has been consolidated as an important active learning method, known as Simulation Based Learning, a strategy able to foster self-confidence and courage to act in real situations as the medical students develop skills, attitudes and values related to the medical practice. This study aimed to evaluate the impact of realistic simulation in the teaching of pediatric emergencies in terms of promoting self-confidence in undergraduate among medical students. A prospective interventional study was conducted in a medical course at a public University in Brazil. The study sample included 40 medical students from the fourth to the eighth semesters of the course. The group attended to a workshop on pediatric emergencies entitled "Cardiopulmonary resuscitation in pediatrics" and at the end of this activity they engaged in a realistic simulation exercise. Then, a Scale for satisfaction and self-confidence, translated and validated for Portuguese in 2015, was applied to the medical students.The average age of the students ranged between 21.8 and 22.2 yo. As for gender, 60% were male and 40% female. Most students (67.5%) were in the fourth semester of the course and for 80 of them, this simulation activity represented their first experience with this learning method. In terms of self-confidence, 97% of the participants felt confident about the content of the simulation activity. Moreover, all the students involved in simulation activity felt more confident to act in a similar scenario in the real- life medical practice. Self-confidence resulting from realistic simulation can foster positive attitudinal changes among medical undergraduates. Higher self-confidence levels among medical students and physicians are related to more successful medical interventions as they can practice, test, and improve their medical skills before being exposed to similar real-life medical situations. Accordingly, there is a greater need to implement realistic simulations as an active learning methodology in the undergraduate medical curriculum.

A simulação realística tem se difundido nas escolas médicas nas últimas décadas, conferindo a esta o status de metodologia ativa denominada de Ensino Baseado em Simulação. Este tem se mostrado eficaz na promoção da autoconfiança de estudantes de medicina e relevante por estimular a segurança de agir, baseado nas habilidades, valores, metas e experiências vivenciadas na formação. Este estudo teve como objetivo avaliar o impacto do uso da simulação realística no ensino de emergências pediátricas para a promoção de autoconfiança de graduandos em medicina. Realizou-se um estudo prospectivo de intervenção educacional, em um curso de Graduação em Medicina no Brasil. A amostra por conveniência foi composta por 40 graduandos entre o segundo e o quarto ano do curso. Os estudantes participaram de um workshop sobre emergência pediátrica com tema "reanimação cardiopulmonar em pediatria", sendo ao final submetidos à simulação realística. Foi aplicada a Escala de Satisfação dos Estudantes e Autoconfiança com a Aprendizagem, traduzida e validada para o português em 2015. A idade dos estudantes variou entre 21,8 e 22,2 anos. Quanto ao sexo, 60% eram do masculino e 40% do feminino. Estavam matriculados no segundo ano do curso, 67,5% dos estudantes e 32,5% no terceiro e quarto. Para 80% dos estudantes, esta foi a primeira experiência com simulação e 90% deles não estavam participando de outra atividade extracurricular. Acerca da autoconfiança, 95% dos estudantes afirmaram que a simulação abordou o conteúdo necessário para a formação, 97,5% referiram estar confiantes sobre o domínio do conteúdo da atividade apresentada e 100% dos estudantes afirmou autoconfiança para realizar um atendimento em ambiente real, reportando os conhecimentos adquiridos na simulação. A autoconfiança promovida pela simulação é um pré-requisito necessário para mudanças positivas no comportamento e nas ações dos estudantes. Profissionais e estudantes de medicina, com maiores níveis de autoconfiança, têm melhores perspectivas de serem bem-sucedidos nas suas intervenções, pois conseguem prontamente testar e aplicar as suas competências. Assim, sinaliza-se para uma maior necessidade de incluir a simulação nos currículos dos cursos médicos como metodologia ativa.

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OBJECTIVE: To analyze the factors associated with children's linear growth, according to the different subsystems of the 6Cs model and Bronfenbrenner's Bioecological Theory. DATA SOURCES: Narrative review, carried out in the Scielo, Lilacs, Pubmed, and Science Direct databases, based on research using the terms Bioecological Theory, child growth, and risk factors, combined with the use of Boolean operators. SUMMARY OF FINDINGS: According to the 6Cs model, proposed based on Bronfenbrenner's Bioecological Theory, the determining factors of children's linear growth are in six interrelated subsystems - cell, child, clan, community, country/state and culture. The empirical studies included in this review made it possible to analyze protection and risk factors within the subsystems. Among the protective factors: are adequate birth weight and satisfactory weight gain, breastfeeding for six months or more; proper hygienic habit of hand washing, proper elimination of feces, and access to clean water. As risk factors: low, birth weight and size, prematurity, multiple deliveries, short interval between deliveries, non-exclusive breastfeeding until the 3rd month, frequency and severity of infectious processes and anemia, little parental education, short maternal statur, inadequate maternal nutritional status, domestic violence, family poverty, food, and nutritional insecurity, living in rural areas or at high altitudes. CONCLUSION: Children's linear growth is determined by interrelated factors that encompass aspects prior to the child's birth, as well as socioeconomic, political, family and community issues.

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BACKGROUND: The multifidus muscle plays a major role in the growth and postural control of children. Therefore, the reference values of the cross-sectional area (CSA) of the lumbar multifidus muscle represent an important tool for assessing muscle development and the early monitoring of musculoskeletal disorders. OBJECTIVE: The aim of this study was to provide percentile scores for the CSA of the lumbar multifidus muscle in eutrophic children aged 5 to 10 years. METHODS: This was a cross-sectional, observational study, involving 736 children. An anthropometric assessment was conducted and ultrasound (US) imaging was used to assess the CSA of the lumbar (vertebral level L5) multifidus muscle. The CSA was expressed as percentile scores. RESULTS: The CSA in the boys ranged from 1.8 cm2 to 5.3 cm2 and in girls from 1.9 cm2 to 5.9 cm. The CSA in the 50th percentile scores of both sexes was 3.4 cm2. There was an increase in the CSA between 5 and 7 years old in both sexes. The CSA presented a greater variance in girls than in boys. After 8 years of age, the multifidus CSA increased in girls and decreased in boys. CONCLUSION: The present study has provided percentile scores for the CSA of the lumbar multifidus muscle for eutrophic children aged 5 to 10 years. An increase was observed of the CSA of the multifidus muscle between the ages of 5 and 7 years and there were no differences in the CSA percentiles in relation to sex. An increase in the CSA after 8 years of age was only observed in the girls.

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Abstract Objective: To analyze the association between child exposure to intimate partner violence (CEIPV) committed against their mother and functional gastrointestinal disorders (FGIDs) in school-age children. Methods: A prospective cohort study was carried out that evaluated 626 mother-child pairs living in a poor urban area in the Northeast of Brazil. The mothers were asked about their children's exposure to intimate partner violence. Holden's classification was used, which investigates ten types of CEIPV from prenatal care. The number of exposures, age of onset, and the perpetrator of the exposure were also verified. The FGIDs in children were identified from the mother's responses to the questionnaire about pediatric gastrointestinal symptoms, Roma III version parent-report, translated and cross-culturally adapted into Brazilian Portuguese. Results: FGIDs were more frequent among children exposed to violence than those not exposed (OR: 1.64; 95% CI: 1.04-2.58; p = 0.03). Likewise, in children who suffered four or more types of exposure (OR: 1.81; 95% CI: 1.10-2.96; p = 0.01), in which the exposure started in the first two years of life (OR: 1.93; 95% CI: 1.08-3.47; p = 0.02) and in those whose biological father was the perpetrator of the violence (OR; 1.62; 95% CI: 1, 05-2.48; p = 0.02). Conclusion: Corroborating the proposal of the biopsychosocial model, CEIPV increases the chance of occurrence of FGIDs in school-age children. Therefore, early identification and proposals for appropriate interventions are suggested both for the prevention of CEIPV and for the prevention and follow-up of FGIDs.

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OBJECTIVES: This study investigated the occurrence of vomiting and gastric dysmotility in dysphagic children with congenital Zika syndrome (CZS) and assessed possible associations of these findings with the severity of dysphagia and the presence of tube feeding. METHODS: Forty-six children with CZS were assessed for dysphagia, and the occurrence of vomiting, dietary volume tolerance <15 mL/kg, and feeding time per meal >30 minutes were evaluated. Gastric antrum ultrasonography was used to detect the frequency of contractions and measure antral areas (at fasting and 15 minutes postprandial), from which the gastric emptying rate (GER) was calculated. Antral ultrasonography findings were compared with those of ten healthy controls. Vomiting and gastric motility were compared between CZS patients according to the severity of dysphagia and the requirement for tube feeding. RESULTS: Overall, 76% (35/46) of children with CZS had moderate-to-severe dysphagia (MSD), among whom 60% (21/35) were tube fed [MSD tube fed (MSDTF)]. Vomiting occurred in 54% (25/46) of children, whereas dietary volume intolerance and prolonged feeding time were observed in 59% (27/46) and 37% (17/46), respectively, most frequently in MSDTF patients. On ultrasound, 61% (28/46) of children with CZS had no antral contractions, whereas 90% (9/10) of controls did. Compared to healthy controls, GER was eight-fold lower in children with CZS and 60-fold lower in MSDTF children. CONCLUSIONS: In dysphagic children with CZS, vomiting, volume intolerance, and prolonged feeding time were frequent and possibly associated with impaired antral contraction and delayed gastric emptying, especially in cases of severe dysphagia and tube feeding.

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In the assessment of childhood asthma, identifying the risk factors associated with exacerbations and broadening this view to understand psychological stress and its repercussions on the inflammatory process of asthma allow a different perspective on this biopsychosocial disease. Psychological stress, as a risk factor for the onset and noncontrol of asthma, has been increasingly evaluated from the perspective of the repercussions on the body of the stimulus generated in the hypothalamic-pituitary axis and adrenal glands, with cortisol release and immune system action. These processes trigger changes in T helper 2 cells, which polarize allergic processes, and dysfunctions in immune tolerance mechanisms, with a decrease in regulatory T cells. Genetic and epigenetic changes in ß2-adrenergic and glucocorticoid receptors, with decreased response to these drugs, were also identified in studies, in addition to changes in respiratory function patterns, with worsening of obstruction and inflammation identified via decreased forced expiratory volume in one second and increased exhaled inflammatory gases in allergic asthma. Therefore, the present review sought to identify studies on the effect of personal and parental acute or chronic psychological stress, emphasizing the repercussions on genetics, epigenetics, and immune and pulmonary functional and inflammatory responses in the pediatric population.

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In the assessment of childhood asthma, identifying the risk factors associated with exacerbations and broadening this view to understand psychological stress and its repercussions on the inflammatory process of asthma allow a different perspective on this biopsychosocial disease. Psychological stress, as a risk factor for the onset and noncontrol of asthma, has been increasingly evaluated from the perspective of the repercussions on the body of the stimulus generated in the hypothalamic-pituitary axis and adrenal glands, with cortisol release and immune system action. These processes trigger changes in T helper 2 cells, which polarize allergic processes, and dysfunctions in immune tolerance mechanisms, with a decrease in regulatory T cells. Genetic and epigenetic changes in β2-adrenergic and glucocorticoid receptors, with decreased response to these drugs, were also identified in studies, in addition to changes in respiratory function patterns, with worsening of obstruction and inflammation identified via decreased forced expiratory volume in one second and increased exhaled inflammatory gases in allergic asthma. Therefore, the present review sought to identify studies on the effect of personal and parental acute or chronic psychological stress, emphasizing the repercussions on genetics, epigenetics, and immune and pulmonary functional and inflammatory responses in the pediatric population (AU)

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Introdução: A sobrecarga corporal devida à obesidade contribui no surgimento de alterações no sistema musculoesquelético e respiratório. Objetivo: Analisar as evidências científicas referentes à influência da obesidade sobre a postura do tronco, a resposta cinético-funcional do diafragma e a função pulmonar em crianças e adolescentes. Métodos: Trata-se de uma revisão de literatura, utilizando as bases de dados Medline, Cochrane, Embase, Lilacs e Web of Sciences, nos idiomas inglês, português e espanhol, nos últimos 10 anos. Foram utilizados os descritores: "obesidade', "postura", "diafragma", "função pulmonar", "adolescentes", "adultos jovens". Os critérios de exclusão foram: estudos que abordaram distúrbios neuromusculares associados, cifoescoliose, fibrose cística, enfisema pulmonar, asma e DPOC e artigos não disponíveis na íntegra. Resultados: Foram identificados 226 estudos, porém 10 foram analisados. Os resultados apontaram que a postura do tronco nos obesos é hipercifótica, hiperlordótica e com anteversão pélvica, além de apontar indícios de repercussão na dinâmica respiratória, com redução da mobilidade do diafragma e dos volumes e capacidades pulmonares. Conclusão: A obesidade contribui para a ocorrência de hipercifose, hiperlordose e anteversão da pelve, bem como na diminuição da atividade do diafragma e função pulmonar. (AU)

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Abstract Objective To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy. Sources of Data A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review. Synthesis of Data Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines. Conclusions Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost-effective preventative measure in future.

Resumo Objetivo Reiterar a importância epidemiológica da Shigella na diarreia aguda com sangue, fornecer uma visão geral do tratamento e ressaltar a necessidade da correta indicação da antibioticoterapia. Fontes dos dados Realizada pesquisa nos bancos de dados Medline e Scopus, além de documentos científicos e diretrizes da Organização Mundial da Saúde, com a identificação de artigos de revisão e artigos originais considerados relevantes para fundamentar a revisão do tipo narrativa. Síntese dos dados Diferentes patógenos têm sido associados à diarreia aguda com sangue, a Shigella é o mais frequente. As manifestações da shigelose em indivíduos saudáveis são geralmente de intensidade moderada e desaparecem em poucos dias. Pode haver progressão para disenteria franca com sangue e muco, dor em abdome inferior e tenesmo. A coprocultura bacteriana convencional é o padrão-ouro para o diagnóstico etiológico, porém novos testes moleculares foram desenvolvidos, os quais permitem ao médico iniciar tratamento antibacteriano direcionado, sanar uma grande preocupação atual, devido à crescente resistência da Shigella. Estratégias de prevenção incluem aleitamento, medidas de higiene, educação em saúde, tratamento da água e o potencial uso de vacinas. Conclusões A diarreia aguda é uma importante causa de mortalidade em crianças com menos de cinco anos e a shigelose é a principal causa de diarreia aguda com sangue em todo o mundo. A preocupação atual é o aumento da resistência microbiana aos antibióticos preconizados, o que traz uma dificuldade adicional ao manejo terapêutico. Embora ainda não exista vacina disponível para Shigella, várias candidatas estão em fase de testes clínicos, podem futuramente ser a medida preventiva mais custo-efetiva.

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OBJECTIVE: To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy. SOURCES OF DATA: A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review. SYNTHESIS OF DATA: Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines. CONCLUSIONS: Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost-effective preventative measure in future.

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