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Introduction Children with moderate or severe wasting are at particularly high risk of recurrent or persistent diarrhoea, nutritional deterioration and death following a diarrhoeal episode. Lactoferrin and lysozyme are nutritional supplements that may reduce the risk of recurrent diarrhoeal episodes and accelerate nutritional recovery by treating or preventing underlying enteric infections and/or improving enteric function.Methods and analysis In this factorial, blinded, placebo-controlled randomised trial, we aim to determine the efficacy of lactoferrin and lysozyme supplementation in decreasing diarrhoea incidence and improving nutritional recovery in Kenyan children convalescing from comorbid diarrhoea and wasting. Six hundred children aged 6–24 months with mid-upper arm circumference

The epidemiology of pediatric COVID-19 in sub-Saharan Africa and the role of fecal-oral transmission in SARS-CoV-2 are poorly understood. Among children and adolescents in Kenya, we identify correlates of COVID-19 infection, document the clinical outcomes of infection, and evaluate the prevalence and viability of SARS-CoV-2 in stool. We recruited a prospective cohort of hospitalized children aged two months to 15 years in western Kenya between March 1 and June 30 2021. Children with SARS-CoV-2 were followed monthly for 180-days after hospital discharge. Bivariable logistic regression analysis was used to identify the clinical and sociodemographics correlates of SARS-CoV-2 infection. We also calculated the prevalence of SARS-CoV-2 detection in stool of confirmed cases. Of 355 systematically tested children, 55 (15.5%) were positive and were included in the cohort. The commonest clinical features among COVID-19 cases were fever (42/55, 76%), cough (19/55, 35%), nausea and vomiting (19/55, 35%), and lethargy (19/55, 35%). There were no statistically significant difference in baseline sociodemographic and clinical characteristics between SARS-CoV-2 positive and negative participants. Among positive participants, 8/55 (14.5%, 95%CI: 5.3%-23.9%) died; seven during the inpatient period. Forty-nine children with COVID-19 had stool samples or rectal swabs available at baseline, 9 (17%) had PCR-positive stool or rectal swabs, but none had SARS-CoV-2 detected by culture. Syndromic identification of COVID-19 is particularly challenging among children as the presenting symptoms and signs mirror other common pediatric diseases. Mortality among children hospitalized with COVID-19 was high in this cohort but was comparable to mortality seen with other common illnesses in this setting. Among this small set of children with COVID-19 we detected SARS-CoV-2 DNA, but were not able to culture viable SARs-CoV-2 virus, in stool. This suggests that fecal transmission may not be a substantial risk in children recently diagnosed and hospitalized with COVID-19 infection.

Summary: Background: Mass drug administration of azithromycin to children in sub-Saharan Africa has been shown to improve survival in high-mortality settings. The period after hospital discharge is a time of elevated risk unaddressed by current interventions and might provide an opportunity for targeting empirical azithromycin administration. We aimed to assess the efficacy of azithromycin administered at hospital discharge on risk of death and rehospitalisation in Kenyan children younger than 5 years. Methods: In this double-blind, placebo-controlled randomised trial, children were randomly assigned (1:1) to receive a 5-day course of azithromycin (oral suspension 10 mg/kg on day 1, followed by 5mg/kg per day on days 2–5) or identically appearing and tasting placebo at discharge from four hospitals in western Kenya. Children were eligible if they were aged 1–59 months at hospital discharge, weighed at least 2 kg, and had been admitted to hospital for any medical reason other than trauma, poisoning, or congenital anomaly. The primary outcome was death or rehospitalisation in the subsequent 6-month period in a modified intention-to-treat population, compared by randomisation group with Cox proportional hazards regression and Kaplan-Meier. Azithromycin resistance in Escherichia coli isolates from a random subset of children was compared by randomisation group with generalised estimating equations. This trial is registered with ClinicalTrials.gov, NCT02414399. Findings: Between June 28, 2016, and Nov 4, 2019, 1400 children were enrolled in the trial at discharge from hospital, with 703 (50·2%) randomly assigned to azithromycin and 697 (49·8%) to placebo. Among the 1398 children included in the modified intention-to-treat analysis (702 in the azithromycin group and 696 in the placebo group), the incidence of death or rehospitalisation was 20·4 per 100 child-years in the azithromycin group and 22·5 per 100 child-years in the placebo group (adjusted hazard ratio 0·91, 95·5% CI 0·64–1·29, p=0·58). Azithromycin resistance was common in commensal E coli isolates from enrolled children before randomisation (37·7% of 406 isolates) despite only 3·7% of children having received a macrolide antibiotic during the hospitalisation. Azithromycin resistance was slightly higher at 3 months after randomisation in the azithromycin group (26·9%) than in the placebo group (19·1%; adjusted prevalence ratio 1·41, 95% CI 0·95–2·09, p=0·088), with no difference observed at 6 months (1·17, 0·78–1·76, p=0·44). Interpretation: We did not observe a significant benefit of a 5-day course of azithromycin delivered to children younger than 5 years at hospital discharge despite the overall high risk of mortality and rehospitalisation. These findings highlight the need for more research into mechanisms and interventions for prevention of morbidity and mortality in the post-discharge period. Funding: Eunice Kennedy Shriver National Institute of Child Health & Human Development.

Este artigo tem como objetivo seguir alguns traços da episteme moderno/colonial presentes no Documento Curricular do Estado do Pará - DCEPará. O aporte teórico é o do giro decolonial com Mignolo (2003, 2005, 2007, 2008, 2014), Castro-Gómez (2007a, 2007b, 2014), Palermo (2014), e dos estudos curriculares com Silva (1999), Macedo (2014, 2015) e Lopes (2004). A etnografia multilocal, constitui a arte do fazer, um procedimento emergente e contestado, mas produtivo para a análise de documentos (MARCUS, 2001). Os resultados indicam que no DCEPará há muitos traços da episteme moderno/colonial, entre os quais a estrutura disciplinar e a homogeneização cultural. Os agentes estatais desviaram a atenção destes traços, disseminando uma retórica pedagógico-cultural crítica que defende a prática interdisciplinar, a diversidade e a participação. Concluo argumentando que a desobediência epistêmica é capaz de produzir uma política do conhecimento outra, orientada pela política do lugar, pela transdisciplinaridade e pela interculturalidade.

O objetivo é refletir sobre as representações do corpo nas imagens do brinquedo de miriti, um bem cultural da cidade de Abaetetuba/Pará. Neste sentido, buscamos apoio no Estudos Culturais pós-críticos, contando, entre outros, com Hall (2016), Kellner (1995), Foucault (1987) e Silva (1999). A decisão metodológica é pelo alfabetismo crítico, um procedimento emergente para a análise de imagens. Ao ser intensamente disseminada em blogs, livros, camisetas e bolsas, as imagens da peça casal de namorados representam o corpo e o casal ideal e afetam a todos, particularmente jovens do ensino médio. Por constituir não apenas a cultura contemporânea, mas as subjetividades juvenis no cotidiano escolar, as imagens merecem a atenção, pois mesmo representando corpos, gêneros e sexualidades hegemônicas, sendo a representação reversível, é capaz de constituir outros modos de ser e de viver.

The quality parameters of sauerkraut fermented using Lactobacillus paracasei in terms of its lactic acid bacteria count, texture, colour and biochemical properties were studied. As a starter culture L. paracasei grown in tofu whey was used for sauerkraut fermentation. The experiments were planned using central composite rotatable design of response surface methodology for input variables - culture volume (ml), fermentation time (days) and salt concentration (g/100 g). The linear and interactive effect of variables on responses was understood by statistically significant (p < 0.01) second-order models. Amongst all the input variables culture volume was found to have an overwhelming effect over all the responses. There was a significant (p < 0.01) increase in the lactic acid bacteria count of finished product; it was less hard but there was a departure in colour from the traditional product. The optimized condition for sauerkraut fermentation in terms of culture volume (ml), fermentation time (day) and salt concentration (g/100 g) was 30 ml, 28 days and 1 g/100 g, respectively. It was also observed that phenolics content was better in starter culture sauerkraut over the one traditionally prepared.