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ARTIGOS APRESENTADOS
02-06-17 Unrecognized Emergence of Chikungunya Virus during a Zika Virus Outbreak in Salvador, Brazil
07-07-17 Establishment and cryptic transmission of Zika
09-06-17 Imaging of congenital Zika virus infection the route to
12-05-17 Mapping global environmental suitability
19-05-17 A Cost-Effectiveness Tool for Informing
23-06-17 Spatial Distribution of Dengue Incidence
26-05-17 Enhancement of Zika virus pathogenesis by preexisting antiflavivirus immunity_
22 05 2019 Fatores de risco para sífilis em mulheres
05 06 2019 Risk of Guillain-Barre ́ syndrome after 2010–2011 influenza
24-04-2019 Teste de HIV solicitado e espontâneo
10-04-2019 Gestational age at birth and mortality from infancy into
08-05-2019 An assessment of public health surveillance
27-03-2019 Concomitant transmission of dengue, chikungunya and Zika viruses in Brazil
27 de março, apresentado por Paulo
Título: Transmissão Concomitante dos Vírus da Dengue, Chikungunya e Zika no Brasil: Achados Clínicos e Epidemiológicos da Vigilância para Doença Febril Aguda.
Títle: Concomitant Transmission of Dengue, Chikungunya, and Zika Viruses in Brazil: Clinical and Epidemiological Findings From Surveillance for Acute Febrile Illness.
Autores: Silva MMO, Tauro LB, Kikuti M, Anjos RO, Santos VC, Gonçalves TSF, Paploski IAD, Moreira PSS, Nascimento LCJ, Campos GS, Ko AI, Weaver SC, Reis MG, Kitron U, Ribeiro GS.Revista de publicação: Clin Infect Dis. 2019 Sep 27;69(8):1353-1359. doi: 10.1093/cid/ciy1083.
Ano de publicação: 2019
RESUMO:
Background. Since their emergence in the Americas, chikungunya (CHIKV) and Zika (ZIKV) viroses co-circulate with dengue virus (DENV), hampering clinical diagnosis. We investigated clinical and epidemiological characteristics of arboviral infections during the introduction and spread of CHIKV and ZIKV through northeastern Brazil.
Methods. Surveillance for arboviral diseases among febrile patients was performed at an emergency health unit of Salvador, Brazil between Sep/2014-Jul/2016. We interviewed patients to collect data on symptoms, reviewed medical records to obtain the presumptive diagnoses, and performed molecular and serological testing to confirm DENV, CHIKV, ZIKV, or non-specific flavivirus (FLAV) diagnosis.
Results. Of 948 participants, 247 (26.1%) had an acute infection, of which 224 (23.6%) were single infections (DENV: 32, or 3.4%; CHIKV: 159, 16.7%; ZIKV: 13, 1.4%; and FLAV: 20, 2.1%), and 23 (2.4%) co-infections (DENV/CHIKV: 13, 1.4%; CHIKV/FLAV: 9, 0.9%; and DEN/ZIKV: 1, 0.1%). Na additional 133 (14.0%) patients had serological evidence for a recent arboviral infection. Patients with Zika presented rash (69.2%) and pruritus (69.2%) more frequently than those with dengue (37.5% and 31.2%, respectively) and chikungunya (22.9% and 14.7%, respectively) (P<0.001 for both comparisons). Conversely, arthralgia was more common in chikungunya (94.9%) and FLAV/CHIKV (100.0%) than in dengue (59.4%) and Zika (53.8%) (P<0.001). A correct presumptive clinical diagnosis was made for 9-23% of the confirmed patients.
Conclusions. Arboviral infections are frequent causes of febrile illness. Co-infections are not rare events during periods of intense, concomitant arboviral transmission. Given the challenge to clinically distinguish these infections, there is an urgent need for rapid, point-of-care, multiplex diagnostics.
Link para acesso: https://www.ncbi.nlm.nih.gov/pubmed/30561554
10 de abril, apresentado por Luciana
Revista de publicação: The Lancet Child & Adolescent Health VOLUME 3, ISSUE 6, P408-417, JUNE 01, 2019
Ano de publicação: 2019
RESUMO:
Background: Breakthroughs in the treatment of preterm birth approximately 40 years ago have enabled a generation of preterm survivors to now reach mid-adulthood. Understanding their health sequelae is essential for guiding their long-term care. We did a study to examine preterm birth in relation to mortality into mid-adulthood.
Methods: A national cohort study was done of all 4 296 814 singleton livebirths in Sweden between 1973 and 2015, who were followed up for mortality through Dec 31, 2017 (maximum age 45 years). Cox regression was used to examine gestational age at birth in relation to all-cause and cause-specific mortality, and cosibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors.
Findings: In 103·5 million person-years of follow-up, 43 916 (1·0%) deaths were reported. Gestational age at birth was inversely associated with mortality from infancy to mid-adulthood. Relative to full-term birth (39–41 weeks), the adjusted hazard ratios for mortality associated with gestational age at birth were: 66·14 (95% CI 63·09–69·34) for extremely preterm (22–27 weeks), 8·67 (8·32–9·03) for very preterm (28–33 weeks), 2·61 (2·52–2·71) for late preterm (34–36 weeks), and 1·34 (1·30–1·37) for early term (37–38 weeks), from birth to age 45 years; and 2·04 (0·92–4·55) for extremely preterm, 1·48 (1·17–1·87) for very preterm, 1·22 (1·07–1·39) for late preterm, and 1·16 (1·08–1·25) for early term, at ages 30–45 years. Preterm birth accounted for more deaths among males than females (additive interaction p<0·001). Multiple underlying causes were identified, including congenital anomalies; respiratory, endocrine, cardiovascular, and neurological diseases; cancer; and external causes. Cosibling analyses suggested that the observed associations were not due to shared genetic or environmental factors in families.
Interpretation: Preterm and early term birth should be recognised as chronic conditions that require long-term follow-up for adverse health sequelae in adulthood.
Link para acesso: https://www.ncbi.nlm.nih.gov/pubmed/30956154
24 de abril, apresentado por Fabiana
Revista de publicação: Cad. Saúde Pública 33 (10) 26 Out 2017
Ano de publicação: 2017
RESUMO:
Estudo transversal de base populacional foi realizado com o objetivo de descrever a prevalência, motivos e fatores associados para realização de teste para HIV entre mulheres de Pelotas, Sul do Brasil. Foram entrevistadas 1.222 mulheres. Foram estimados prevalência de teste (sim/não), teste solicitado e teste voluntário. A prevalência de teste foi de 66,1% (IC95%: 63,4-68,8), teste solicitado 52,4% (IC95%: 49,6-55,2) e teste espontâneo 13,6% (IC95%: 11,6-15,5). O principal motivo para realização de teste foi rastreamento pré-natal (52%). Idade, idade da primeira relação e possuir filhos se mostraram associadas à realização de teste espontâneo e solicitado. Escores de comportamentos sexuais de risco, situação conjugal e uso de preservativo se mostraram associados apenas a teste solicitado e prática de sexo anal apenas a teste espontâneo. Os resultados indicam que testagem para HIV parece estar fortemente relacionada com a assistência pré-natal e que a percepção de risco por parte dos profissionais de saúde parece ser mais adequada do que a percepção da própria mulher.
Link para acesso: https://doi.org/10.1590/0102-311X00074415
8 de maio, apresentado por Mabia
Revista de publicação: BMC Public Health. 2018;18(1):656. Published 2018 May 24. doi:10.1186/s12889-018-5566-7
Ano de publicação: 2018
RESUMO:
Background: We evaluated whether outbreaks of Zika virus (ZIKV) infection, newborn microcephaly, and Guillain-Barré syndrome (GBS) in Latin America may be detected through current surveillance systems, and how cases detected through surveillance may increase health care burden.
Methods: We estimated the sensitivity and specificity of surveillance case definitions using published data. We assumed a 10% ZIKV infection risk during a non-outbreak period and hypothetical increases in risk during an outbreak period. We used sensitivity and specificity estimates to correct for non-differential misclassification, and calculated a misclassification-corrected relative risk comparing both periods. To identify the smallest hypothetical increase in risk resulting in a detectable outbreak we compared the misclassification-corrected relative risk to the relative risk corresponding to the upper limit of the endemic channel (mean + 2 SD). We also estimated the proportion of false positive cases detected during the outbreak. We followed the same approach for microcephaly and GBS, but assumed the risk of ZIKV infection doubled during the outbreak, and ZIKV infection increased the risk of both diseases.
Results: ZIKV infection outbreaks were not detectable through non-serological surveillance. Outbreaks were detectable through serologic surveillance if infection risk increased by at least 10%, but more than 50% of all cases were false positive. Outbreaks of severe microcephaly were detected if ZIKV infection increased prevalence of this condition by at least 24.0 times. When ZIKV infection did not increase the prevalence of severe microcephaly, 34.7 to 82.5% of all cases were false positive, depending on diagnostic accuracy. GBS outbreaks were detected if ZIKV infection increased the GBS risk by at least seven times. For optimal GBS diagnosis accuracy, the proportion of false positive cases ranged from 29 to 54% and from 45 to 56% depending on the incidence of GBS mimics.
Conclusions: Current surveillance systems have a low probability of detecting outbreaks of ZIKV infection, severe microcephaly, and GBS, and could result in significant increases in health care burden, due to the detection of large numbers of false positive cases. In view of these limitations, Latin American countries should consider alternative options for surveillance.
Link para acesso: https://link.springer.com/article/10.1186/s12889-018-5566-7
22 de maio, apresentado por Aline
Revista de publicação: Rev. Saúde Pública [online]. 2017, vol.51, 78.
Ano de publicação: 2017
RESUMO:
OBJETIVO Determinar os fatores sociodemográficos, comportamentais e de assistência à saúde relacionados à ocorrência de sífilis em mulheres atendidas em maternidades públicas.
MÉTODOS Trata-se de um estudo caso-controle (239 casos e 322 controles) com mulheres admitidas em sete maternidades do município do Recife, no período de julho de 2013 a julho de 2014. As mulheres elegíveis foram recrutadas após o resultado do VDRL (Venereal Disease Research Laboratory) sob qualquer titulação. A seleção dos casos e controles considerou o resultado da sorologia por ELISA (enzyme-linked immunosorbent assay), variável dependente utilizada como diagnóstico para sífilis neste estudo. As variáveis independentes foram agrupadas em: sociodemográficas; comportamentais; e antecedentes clínicos e obstétricos; e assistência à saúde no pré-natal e na maternidade. As informações foram obtidas por meio de entrevista, durante o internamento, por aplicação de um questionário. Foi calculado odds ratio (OR), intervalo de confiança de 95% e realizada análise de regressão logística para identificar os fatores preditores da variável a ser explicada.
RESULTADOS A análise de regressão logística identificou como fatores determinantes para a sífilis gestacional: nível de escolaridade fundamental incompleto ou analfabeta (OR = 2,02), ausência de acesso a telefone (OR = 2,4), religião católica (OR = 1,70), quatro ou mais gestações (OR = 2,2), três ou mais parceiros sexuais no último ano (OR = 3,1), uso de drogas ilícitas antes dos 18 anos (OR = 3,0) e uso de drogas ilícitas por parte do atual companheiro (OR = 1,7). Além desses, foram observadas a ocorrência de apenas uma a três consultas ao pré-natal (OR = 3,5) e história anterior de infecção sexualmente transmissível (OR = 9,7).
CONCLUSÕES Fatores sociodemográficos, comportamentais e de assistência à saúde estão associados à ocorrência de sífilis em mulheres e devem ser levados em consideração na elaboração de estratégias universais direcionadas à prevenção e controle da sífilis, porém com foco em situações de maior vulnerabilidade.
Link para acesso: https://www.scielosp.org/article/rsp/2017.v51/78/pt/
5 de junho, apresentado por Ana Flávia
Revista de publicação: Eur J Epidemiol. 2013 May;28(5):433-44. doi: 10.1007/s10654-013-9797-8. Epub 2013 Mar 31.
Ano de publicação: 2013
RESUMO:
Influenza vaccination has been implicated in Guillain Barré Syndrome (GBS) although the evidence for this link is controversial. A case-control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged ≥18 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case-control analysis and a self-controlled case series analysis (SCCS). Case-control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations.
Link para acesso: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672511/
14 de agosto, apresentado por Paulo
Revista de publicação: Emerg Infect Dis. 2019;25(8):1485-1493.
Ano de publicação: 2019
RESUMO:
The Zika virus outbreak in Latin America resulted in congenital malformations, called congenital Zika syndrome (CZS). For unknown reasons, CZS incidence was highest in northeastern Brazil; one potential explanation is that dengue virus (DENV)–mediated immune enhancement may promote CZS development. In contrast, our analyses of historical DENV genomic data refuted the hypothesis that unique genome signatures for northeastern Brazil explain the uneven dispersion of CZS cases. To confirm our findings, we performed serotype-specific DENV neutralization tests in a case–control framework in northeastern Brazil among 29 Zika virus–seropositive mothers of neonates with CZS and 108 Zika virus–seropositive control mothers. Neutralization titers did not differ significantly between groups. In contrast, DENV seroprevalence and median number of neutralized serotypes were significantly lower among the mothers of neonates with CZS. Supported by model analyses, our results suggest that multitypic DENV infection may protect from, rather than enhance, development of CZS.
Link para acesso: https://dx.doi.org/10.3201/eid2508.190113
28 de agosto, apresentado por Luciana
Revista de publicação: Emerg Infect Dis. 2019;25(8):1452-1460.
Ano de publicação: 2019
RESUMO:
We report demographic, epidemiologic, and clinical findings for a prospective cohort of pregnant women during the initial phase of Zika virus introduction into Yucatan, Mexico. We monitored 115 pregnant women for signs of active or recent Zika virus infection. The estimated cumulative incidence of Zika virus infection was 0.31 and the ratio of symptomatic to asymptomatic cases was 1.7 (range 1.3–4.0 depending on age group). Exanthema was the most sensitive clinical sign but also the least specific. Conjunctival hyperemia, joint edema, and exanthema were the combination of signs that had the highest specificity but low sensitivity. We did not find evidence of vertical transmission or fetal anomalies, likely because of the low number of pregnant women tested. We also did not find evidence of congenital disease. Our findings emphasize the limited predictive value of clinical features in areas where Zika virus cocirculates with other flaviviruses.
Link para acesso: https://dx.doi.org/10.3201/eid2508.180915
11 de setembro, apresentado por Ana Flávia
Revista de publicação: N Engl J Med 2016; 375:1513-1523 DOI: 10.1056/NEJMoa1605564
Ano de publicação: 2016
RESUMO:
BACKGROUND: Zika virus (ZIKV) infection has been linked to the Guillain–Barré syndrome. From November 2015 through March 2016, clusters of cases of the Guillain–Barré syndrome were observed during the outbreak of ZIKV infection in Colombia. We characterized the clinical features of cases of Guillain–Barré syndrome in the context of this ZIKV infection outbreak and investigated their relationship with ZIKV infection.
METHODS: A total of 68 patients with the Guillain–Barré syndrome at six Colombian hospitals were evaluated clinically, and virologic studies were completed for 42 of the patients. We performed reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays for ZIKV in blood, cerebrospinal fluid, and urine, as well as antiflavivirus antibody assays.
RESULTS: A total of 66 patients (97%) had symptoms compatible with ZIKV infection before the onset of the Guillain–Barré syndrome. The median period between the onset of symptoms of ZIKV infection and symptoms of the Guillain–Barré syndrome was 7 days (interquartile range, 3 to 10). Among the 68 patients with the Guillain–Barré syndrome, 50% were found to have bilateral facial paralysis on examination. Among 46 patients in whom nerve-conduction studies and electromyography were performed, the results in 36 patients (78%) were consistent with the acute inflammatory demyelinating polyneuropathy subtype of the Guillain–Barré syndrome. Among the 42 patients who had samples tested for ZIKV by RT-PCR, the results were positive in 17 patients (40%). Most of the positive RT-PCR results were in urine samples (in 16 of the 17 patients with positive RT-PCR results), although 3 samples of cerebrospinal fluid were also positive. In 18 of 42 patients (43%) with the Guillain–Barré syndrome who underwent laboratory testing, the presence of ZIKV infection was supported by clinical and immunologic findings. In 20 of these 42 patients (48%), the Guillain–Barré syndrome had a parainfectious onset. All patients tested were negative for dengue virus infection as assessed by RT-PCR.
CONCLUSIONS The evidence of ZIKV infection documented by RT-PCR among patients with the Guillain–Barré syndrome during the outbreak of ZIKV infection in Colombia lends support to the role of the infection in the development of the Guillain–Barré syndrome.
Link para acesso:: https://www.nejm.org/doi/pdf/10.1056/NEJMoa1605564
25 de setembro, apresentado por Yure
Revista de publicação: BMC Infect Dis. 2018 Jan 30;18(1):61. doi: 10.1186/s12879-018-2976-1.
Ano de publicação: 2018
RESUMO:
BACKGROUND: In Colombia, the dengue virus (DENV) has been endemic for decades, and with the recent entry of the chikungunya virus (CHIKV) (2014) and the Zika virus (ZIKV) (2015), health systems are overloaded because the diagnosis of these three diseases is based on clinical symptoms, and the three diseases share a symptomatology of febrile syndrome. Thus, the objective of this study was to use molecular methods to identify their co-circulation as well as the prevalence of co-infections, in a cohort of patients at the Colombian-Venezuelan border.
METHODS: A total of 157 serum samples from patients with febrile syndrome consistent with DENV were collected after informed consent and processed for the identification of DENV (conventional PCR and real-time PCR), CHIKV (conventional PCR), and ZIKV (real-time PCR). DENV-positive samples were serotyped, and some of those positive for DENV and CHIKV were sequenced.
RESULTS: Eighty-two patients were positive for one or more viruses: 33 (21.02%) for DENV, 47 (29.94%) for CHIKV, and 29 (18.47%) for ZIKV. The mean age range of the infected population was statistically higher in the patients infected with ZIKV (29.72 years) than in those infected with DENV or CHIKV (21.09 years). Both co-circulation and co-infection of these three viruses was found. The prevalence of DENV/CHIKV, DENV/ZIKV, and CHIKV/ZIKV co-infection was 7.64%, 6.37%, and 5.10%, with attack rates of 14.90, 12.42, and 9.93 cases per 100,000 inhabitants, respectively. Furthermore, three patients were found to be co-infected with all three viruses (prevalence of 1.91%), with an attack rate of 4.96 cases per 100,000 inhabitants.
CONCLUSION: Our results demonstrate the simultaneous co-circulation of DENV, CHIKV, ZIKV and their co-infections at the Colombian-Venezuelan border. Moreover, it is necessary to improve the differential diagnosis in patients with acute febrile syndrome and to study the possible consequences of this epidemiological overview of the clinical outcomes of these diseases in endemic regions.
Link para acesso: https://www.ncbi.nlm.nih.gov/pubmed/29382300
09 de outubro, apresentado por Luciana & Ana Flávia
Revista de publicação: Am J Physiol Cell Physiol. 2008 Sep; 295(3): C567–C575.
Ano de publicação: 2008
RESUMO:
If you are reading this commentary, the title probably irked your professional sensibilities. That's good. During 32 years of publishing, I've experienced two authorship disputes. Both of these problems have demonstrated to me that there is a disturbing and pervasive lack of understanding of what authorship on scientific papers means, of the responsibilities that it conveys, and of how it is determined. The goal of this article is to discuss the ethics and responsibility of authorship and to raise awareness of an issue that is fundamental to the health of our profession. I provide an overview of the extensive discussion of authorship that has been ongoing within the scientific community for over three decades, use personal experiences with authorship disputes to illustrate aspects of this discussion, and provide recommendations on how to resolve and prevent authorship problems. It is my hope that this commentary sparks debate and action that will help to minimize abusive and damaging authorship practices.
Link para acesso: https://www.physiology.org/doi/full/10.1152/ajpcell.00208.2008
06 de novembro, apresentado por Jeane
Revista de publicação: Rev. Gaúcha Enferm. [online]. 2018, vol.39 [citado 2019-12-03], e20180025.
Ano de publicação: 2019
RESUMO:
OBJETIVO: Compreender os conhecimentos, as percepções e as práticas de cuidados de mulheres que contraíram o Zika vírus na gestação.
MÉTODOS: Estudo qualitativo, descritivo-exploratório. A coleta de dados ocorreu com 10 mulheres que contraíram o Zika vírus na gestação, através de entrevista aberta, em um município da Região Centro-Oeste, Brasil, em 2017. A análise de conteúdo temática permitiu apresentar duas categorias. O estudo respeitou os aspectos éticos para as pesquisas com seres humanos.
RESULTADOS: O conhecimento das gestantes infectadas se mostrou reduzido a poucas informações, sendo a fonte das informações a internet e a televisão, com pouca expressão dos serviços de saúde. Medo e a preocupação com o bebê estão presentes nos sentimentos influenciando as práticas de cuidado no período da gestação.
CONCLUSÃO: As gestantes recebem poucas informações dos serviços de saúde e suas práticas de prevenção se relacionam com o medo de transmitir a infecção para o bebê durante a gestação.
Link para acesso: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472018000100459&lng=pt&nrm=iso
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... 20 de novembro, apresentado por Mábia
Revista de publicação: PLoS ONE 13(8): e 0201452.
Ano de publicação: 2018
RESUMO:
17 de setembro, apresentado por LucianaA case report on rapid clinical recovery and satisfactory outcome of a toddler with probable Guillain-Barré Syndrome
Autores: Luciana Guerra Gallo, Ana Flávia de Morais Oliveira, Luíza Morais de Matos, Amanda Amaral Abrahão, Flávia de Assis Silva, João Pedro Mendes, Carolina Martins Pereira, Amanda Silva Franco Molinari, Ernane Pires Maciel
Revista de publicação: Journal of Human Growth and Development
Ano de publicação: 2020
RESUMO
Introdução: A Síndrome de Guillain-Barré (SGB) é a causa mais frequente de paralisia flácida aguda e subaguda desde a erradicação da poliomielite. Embora rara, é reconhecida como a principal causa de paralisia flácida entre pessoas internadas em terapia intensiva pediátrica por doenças neuromusculares agudas. Objetivo: Relatar um caso de paciente do sexo masculino, com 14 meses de idade, com diagnóstico provável de Síndrome de Guillain-Barré com neuropatia sensitivo motora, aguda, mielínica, com provável comprometimento axonal secundário, com rápida evolução e melhora. Descrição do caso: Foi admitido em hospital público materno-infantil de referência para o Distrito Federal um paciente masculino, residente na Região Integrada de Desenvolvimento do Distrito Federal e Entorno. A criança tinha 14 meses de idade e 8,6kg, situação vacinal atualizada e desenvolvimento neurospicomotor adequado para a idade, com quadro de paresia em membros inferiores, sem alterações cognitivas. Após 14 horas da admissão, diante do agravamento do quadro clínico e da dissociação albomino-citológica identificada pela análise de líquido cefalo-raquidiano foi iniciada imunoterapia (imunoglobulina humana endovenosa, 0,7g/ kg/dia por três dias). Após 24 horas do início do tratamento, a criança apresentou melhora em seu estado geral. O paciente teve alta hospitalar após cinco dias de internação. Após 76 dias da alta, foi constatada melhora significativa no desenvolvimento neuropsicomotor, apesar de leve atraso em seu desenvolvimento até o momento. Conclusão: Diante da raridade de casos em crianças, é importante que os profissionais de saúde se mantenham sensíveis a captar e tratar os casos de maneira oportuna. Recomendamos ainda que os casos identificados sejam acompanhados cuidadosamente, afim de verificar se a SGB, e suas variantes, podem explicar transtornos de desenvolvimento à posteriori.
PALAVRAS-CHAVE: Síndrome de Guillain-Barré, saúde da criança, desenvolvimento infantil.
ABSTRACT:
Introduction: Guillain-Barré Syndrome (GBS) is the most frequent cause of acute and sub-acute flaccid paralysis after polio eradication. Although rare, it is recognized as the leading cause of flaccid paralysis among the admissions to pediatric intensive care for acute neuromuscular diseases. Objective: To report the case of a 14-month-old male patient with a probable diagnosis of GBS with acute, myelinated motor sensitive neuropathy, with probable secondary axonal involvement, with rapid clinical recovery. Case Report: A male patient admitted in a reference hospital in the Federal District, Brazil, residing in the Integrated Development Region of the Federal District and Surroundings. The child was 14 months old and 8.6 kg, with an updated vaccination status and neuropsychomotor development appropriate for his age, with a condition of paresis in the lower limbs, without cognitive changes. After 14 hours of admission, due to the worsening of his clinical situation and the albumino-cytological dissociation identified by the analysis of cerebrospinal fluid, it was started immunotherapy with intravenous human immunoglobulin, 0.7g/kg/day for three days. Twenty four hours after start of treatment, the child showed a clinical improvement of his general condition. The patient was discharged after five days of hospitalization. After 76 days of discharge, there was a significant improvement in neuropsychomotor development, despite a slight delay in its development. Conclusion: Due to the rarity of Guillain-Barré Syndrome among young children, it is important that health professionals remain sensitive to capture and treat unusual cases in a timely manner. We also recommend that the identified cases be monitored carefully, in order to check if the Guillain-Barré Syndrome, and its variants, can explain developmental disorders a posteriori. Keywords: Guillain-Barre Syndrome, child health, child development.
17 de setembro, apresentado por LucianaAnother piece of the Zika puzzle: assessing the associated factors to microcephaly in a systematic review and meta-analysis
Autores: Luciana Guerra Gallo, Jorge Martinez-Cajas, Henry Maia Peixoto, Ana Carolina Esteves da Silva Pereira, Jillian E. Carter, Sandra McKeown, Bruno Schaub, Camila V. Ventura, Giovanny Vinícius Araújo de França, Léo Pomar, Liana O. Ventura, Vivek R. Nerurkar, Wildo Navegantes de Araújo e Maria P. Velez
Revista de publicação: BMC Public Health
Ano de publicação: 2020
RESUMO
Introdução: Embora se saiba que a infecção pelo vírus Zika (ZIKV) durante a gravidez possa levar à microcefalia no feto, os fatores de risco associados a esse trágico distúrbio ainda não estão claros. Realizamos uma revisão sistemática e metanálise para avaliar os fatores de risco associados à incidência de microcefalia na infecção congênita pelo ZIKV. Métodos: Realizamos uma pesquisa abrangente no Ovid MEDLINE, Ovid MEDLINE (R) Epub antes da impressão, Embase, Embase Classic, Web of Science, CINAHL, Cochrane CENTRAL, LILACS e várias bases de dados de teses para identificar estudos em humanos que relatam microcefalia associada à ZIKV congênita infecção. Solicitamos dados primários dos autores dos estudos incluídos nesta revisão para calcular estimativas sumárias e realizar meta-análises dos fatores mais prevalentes. Resultados: Foram selecionados 4.106 títulos e resumos e identificados 12 estudos para inclusão na revisão sistemática. A avaliação da infecção pelo ZIKV e a definição de microcefalia variaram entre os estudos. Um total de 6.154 crianças / fetos foram inscritos; desses, 1.120 (18,20%) tiveram diagnóstico de infecção pelo ZIKV, dos quais 509 (45,45%) foram diagnosticados com microcefalia. Nove estudos abordaram a ligação entre a infecção congênita pelo ZIKV e os achados neurológicos em fetos / crianças. Metade dos estudos forneceu dados primários. Dois dos onze fatores de interesse foram associados à microcefalia: sexo da criança - os homens apresentaram maior risco de microcefalia em comparação às mulheres (RR 1,30, IC 95% 1,14, 1,49); e o estágio da gravidez em que ocorreu a infecção - a infecção no primeiro trimestre da gravidez teve um risco maior de microcefalia (RR 1,41, IC 95% 1,09 a 1,82), em comparação à infecção em outros estágios da gravidez. Conclusão: Nossos achados apoiam a hipótese de resistência do sexo feminino e reforçam o risco associado ao estágio da gravidez quando a infecção pelo vírus Zika ocorre. A vigilância contínua do ZIKV durante a gravidez é necessária para identificar fatores adicionais que podem contribuir para o desenvolvimento da microcefalia nos fetos afetados.
PALAVRAS-CHAVE: Zika vírus; Microcefalia; Gravidez; Doença congênita; Fatores de risco; Revisão sistemática; Síndrome Congênita do Zika
ABSTRACT:
Background: Although it is known that Zika virus (ZIKV) infection during pregnancy may lead to microcephaly in the fetus, the prognostic factors associated with this tragic disorder remain unclear. We conducted a systematic review and meta-analysis to assess the prognostic factors associated with the incidence of microcephaly in congenital ZIKV infection. Methods: We conducted a comprehensive search in Ovid MEDLINE, Ovid MEDLINE (R) Epub ahead of print, Embase, Embase Classic, Web of Science, CINAHL, Cochrane CENTRAL, LILACS, and various thesis databases to identify human studies reporting microcephaly associated with congenital ZIKV infection. We requested primary data from the authors of the included studies to calculate summary estimates and conduct the meta-analysis of the most prevalent factors. Results: We screened 4106 titles and abstracts, and identified 12 studies for inclusion in the systematic review. The assessment of ZIKV infection and the definition of microcephaly varied among studies. A total of 6154 newborns/fetuses were enrolled; of those, 1120 (18.20%) had a diagnostic of ZIKV infection, of which 509 (45.45%) were diagnosed with microcephaly. Nine studies addressed the link between congenital ZIKV infection and neurological findings in newborns/fetuses. Half of the studies provided primary data. Three out of 11 factors of interest seem to be prognostic factors of microcephaly: infant’s sex – males compared to females: Relative Risk (RR) 1.30, 95% Confidence Interval (95% CI) 1.14 to 1.49; the stage of pregnancy when infection occurred – infection in the first trimester of pregnancy compared to infection at other stages of pregnancy: RR 1.41, 95% CI 1.09 to 1.82; and asymptomatic infection compared to symptomatic infection during pregnancy: RR 0.68; 95% CI 0.60 to 0.77. Conclusion: Our findings support the female-biased resistance hypothesis and reinforce the risk associated with the stage of pregnancy when ZIKV infection occurs. Continued surveillance of ZIKV infection during pregnancy is needed to identify additional factors that could contribute to developing microcephaly in affected fetuses. Protocol registration: This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD 42018088075.
KEYWORDS: Zika virus; Microcephaly; Pregnancy; Congenital disease; Risk factors; Systematic review; Congenital Zika syndrome
21 de setembro, apresentado por CarolTítulo: Vigilância ambulatorial e custos catastróficos relacionados a COVID-19 em área vulnerável
Title: Outpatient surveillance and catastrophic costs related to COVID-19 in a vulnerable area
Autor - Carol
O estudo consistirá na implementação de vigilância de base ambulatorial na Estrutural (RA XXV SCIA/Estrutural) com os objetivos de estimar a incidência de infecções por vírus respiratórios (SARS-CoV-2, vírus respiratório sincicial humano, vírus da parainfluenza humana I, II, e III, influenza A e B, adenovírus, metapneumovírus humano e outros) e arbovírus (Chikungunya, Dengue, Zika e outros), estimar os custos catastróficos e taxa de infecções secundárias, e caracterizar e mapear o perfil clínico, sociodemográfico, socioeconômico e epidemiológico dos casos positivos para COVID-19 e arboviroses em residentes da RA XXV SCIA/Estrutural. Estimamos uma amostra de 3.128 indivíduos residentes na Estrutural composta por 1) pessoas com sintomas de SRAG atendidas no Centro de Saúde 01 da Cidade Estrutural por demanda espontânea ou encaminhamento por um Agente Comunitário de Saúde e 2) pessoas residentes no mesmo domicílio que os pacientes identificados no Centro de Saúde. Todos os participantes do estudo responderão questionários individuais para coleta de dados de identificação e clínicos. A confirmação dos casos de infecção pelo SARS-CoV-2 se dará por RT-PCR, para os participantes entre o terceiro e o sétimo dia do início dos sintomas, e por análise sorológica, para aqueles entre o sétimo e o décimo quinto dia do início dos sintomas. A análise sorológica identificará também infecções pelos demais vírus. As visitas domiciliares, que permitirão estimar a taxa de transmissão secundária, acontecerão de 15 a 21 dias após a entrada do paciente índice. As residências serão georreferenciadas e os dados socioeconômicos e sociodemográficos serão coletados por meio de entrevistas. Todos os residentes que consintam em participar realizarão testes rápidos de diagnóstico e terão coletadas amostras para estudos de sorologia. Os que apresentarem sintomas de SRAG ou testarem positivo terão também swabs de nasofaringe coletados para diagnóstico por RT-PCR. Os participantes serão acompanhados por um período de até 12 meses após a entrada no estudo.
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