Assessing the hearing of children exposed to zika virus with an initially normal newborn hearing screen: a longitudinal cohort study.

BACKGROUND: Zika virus (ZIKV) infection can result in hearing loss in babies, consequently, audiological monitoring is necessary. AIMS: This study aimed to evaluate the frequency of hearing impairment in neonates and children exposed to ZIKV during the intrauterine period. MATERIALS AND METHODS: A cohort of 30 children born to mothers infected with ZIKV during pregnancy (March 2016-January 2017) underwent repeated hearing assessments performed 48 h after birth. Universal Newborn Hearing Screening revealed normal results in all children at 6, 13, 24, and 36 months. Children were divided into two subgroups based on real-time polymerase chain reaction: RT-PCR(+) and RT-PCR(-). RESULTS: At 24 months, the cumulative incidence of hearing alteration was 57.1%. There was no significant difference in the detection of hearing alteration between RT-PCR(+) and (-) groups. None of the children had sensorineural hearing loss. CONCLUSIONS AND SIGNIFICANCE: None of the children had sensorineural hearing loss. Total incidence conductive type (per 1000 live births), RT-PCR ZIKV (-) 2.2, prevalence 20% and RT-PCR ZIKV 3.1, prevalence 35.7%.The incidence of hearing alteration was highest at 24 months of age (57.1%, n = 8; only conductive type).

Prevalence and diagnostic accuracy of microcephaly in a pediatric cohort in Brazil: a retrospective cross-sectional study

Abstract Objective We sought to describe the prevalence of microcephaly and to compare the different cutoff points established by the Brazilian Ministry of Health at various times during a Zika virus epidemic. As a secondary aim, we investigated the possible etiology of the microcephaly. Method This retrospective study utilized newborn participants in the Zika Cohort Study Jundiaí. Newborns from the Zika Cohort Study Jundiaí with an accurate gestational age determination and complete anthropometric data were analyzed, and microcephaly was diagnosed according to the INTERGROWTH-21st curve. At delivery, fluids were tested for specific antibodies and for viruses. Brain images were evaluated for microcephaly. Receiver Operating Characteristic curves were plotted to define the accuracy of different cutoff points for microcephaly diagnosis. Results Of 462 eligible newborns, 19 (4.1%) were positive for microcephaly. Cutoff points corresponding to the curves of the World Health Organization yielded the best sensitivity and specificity. Three of the microcephaly cases (15.8%) were positive for Zika virus infections; nine (47.4%) had intrauterine growth restriction; one had intrauterine growth restriction and was exposed to Zika virus; three had a genetic syndrome (15.8%); and three had causes that had not been determined (15.8%). Conclusions Microcephaly prevalence was 4.1% in this study. Cutoff values determined by the World Health Organization had the highest sensitivity and specificity in relation to the standard IG curve. The main reason for microcephaly was intrauterine growth restriction. All possible causes of microcephaly must be investigated to allow the best development of an affected baby.

Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus.

Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up.

Neonatal consequences of maternal exposure to the chikungunya virus: Case reports.

RATIONALE: The chikungunya virus (CHIKV) was first isolated in a Tanzanian epidemic area between 1952 and 1953. The best description of the CHIKV transmission during pregnancy can be found in a well-documented epidemic in 2005, in the "La Reunion" island, a French territory located in the Indian Ocean, in which about one-third of the population was infected. Reports of arbovirus infections in pregnancy are increasing over time, but the spectrum of clinical findings remains an incognita among researchers, including CHIKV. PATIENT CONCERNS: In this report, it was possible to verify 2 cases exposed to CHIKV during foetal period and the possible implications of the infection on gestational structures and exposed children after the birth. DIAGNOSIS: In both cases, the mothers were positive by laboratory tests in serologic analysis for CHIKV, as ezyme-linked immunossorbent assay (ELISA), plaque reduction neutralisation testing (PRNT) and immunofluorescence (IF); but there were no positive tests in quantitative polymerase chain reaction (qPCR) for mothers or children. INTERVENTIONS: The exposed children were followed up in a paediatrics clinic in order not only to provide the medical assistance, but also to verify child development and the possible implications and neurocognitive changes caused by gestational infection. OUTCOMES: There were neurological and developmental changes in one of the children followed up on an outpatient basis. There was an improvement in the neurological situation and symptoms only 3 years and 1 month after birth. LESSONS: Based on the cases presented, we can conclude that clinical symptoms of CHIKV maternal infection may occur late in new-borns and can affect their development.

Prevalence and diagnostic accuracy of microcephaly in a pediatric cohort in Brazil: a retrospective cross-sectional study.

OBJECTIVE: We sought to describe the prevalence of microcephaly and to compare the different cutoff points established by the Brazilian Ministry of Health at various times during a Zika virus epidemic. As a secondary aim, we investigated the possible etiology of the microcephaly. METHOD: This retrospective study utilized newborn participants in the Zika Cohort Study Jundiaí. Newborns from the Zika Cohort Study Jundiaí with an accurate gestational age determination and complete anthropometric data were analyzed, and microcephaly was diagnosed according to the INTERGROWTH-21st curve. At delivery, fluids were tested for specific antibodies and for viruses. Brain images were evaluated for microcephaly. Receiver Operating Characteristic curves were plotted to define the accuracy of different cutoff points for microcephaly diagnosis. RESULTS: Of 462 eligible newborns, 19 (4.1%) were positive for microcephaly. Cutoff points corresponding to the curves of the World Health Organization yielded the best sensitivity and specificity. Three of the microcephaly cases (15.8%) were positive for Zika virus infections; nine (47.4%) had intrauterine growth restriction; one had intrauterine growth restriction and was exposed to Zika virus; three had a genetic syndrome (15.8%); and three had causes that had not been determined (15.8%). CONCLUSIONS: Microcephaly prevalence was 4.1% in this study. Cutoff values determined by the World Health Organization had the highest sensitivity and specificity in relation to the standard IG curve. The main reason for microcephaly was intrauterine growth restriction. All possible causes of microcephaly must be investigated to allow the best development of an affected baby.

Longitudinal visual acuity development in ZIKV-exposed children.

PURPOSE: To follow the visual acuity development of children exposed to or infected with the Zika virus (ZIKV) during gestation and to relate potential visual acuity deficits to their clinical condition. METHODS: In this prospective study, visual acuity was measured via Teller Acuity Cards in three groups of children: (1) those with confirmed ZIKV exposure (ZE) through the mother only, (2) those with confirmed infection (ZI), and (3) unaffected controls. Visual acuity was measured 2-4 times in each child during the first 30 months of age. RESULTS: The study included 22 children in the ZE group, 11 in the ZI group, and 27 controls. Visual acuity developed normally in both patient groups, including infected patients (ZI) that did not manifest clinical symptoms. In a small subgroup of patients with characteristics consistent with congenital Zika syndrome (CZS), visual acuity was within normative values, with the exception of single child with chorioretinal atrophy. CONCLUSIONS: In this southeastern Brazil study cohort, visual acuity development seemed to progress normally in infected children without CZS symptoms.

Detection of Zika virus in paired urine and amniotic fluid samples from symptomatic and asymptomatic women and their babies during a disease outbreak: association with neurological symptoms in newborns.

Paired maternal and newborn urine and amniotic fluid from 138 subjects collected during a Zika virus (ZIKV) outbreak was analyzed for ZIKV by gene amplification (RT-qPCR), and the findings were correlated with clinical symptoms and neurological anomalies in the babies. ZIKV was detected in 1 of 9 symptomatic women (11.1%) and in 19 of 129 asymptomatic women (14.7%). Neurological manifestations were present in 19 babies (13.7%), 10 of 20 (50%) positive and 9 of 119 (7.6%) negative (p < 0.001) for ZIKV. Twelve (8.6%) urines collected during gestation were ZIKV-positive; only 2 remained positive for ZIKV postpartum. Six (4.1%) newborn urines collected within 1 day of delivery were ZIKV-positive cases. In 3 of these cases, ZIKV was detected in mother's urine pre- and postpartum and in both mother's urine and babies' urine. Four of the amniotic fluid samples (2.9%) were ZIKV-positive. Among ZIKV-negative babies with neurological sequel, 87.5% were female; in contrast, 72.7% ZIKV-positive babies with neurological abnormalities were male (p = 0.019). We conclude that during a ZIKV outbreak, clinical symptoms and ZIKV detection in biological fluids are poor predictors of infection and adverse neurologic sequel in newborns.

2008 Ano Internacional do Planeta Terra: Terra, saúde e alterações climáticas

As causas ambientais de alguns problemas de saúde, relação entre alterações climáticas e saúde e as dinâmicas de algumas doenças emergentes no quadro das relações humanas com o meio ambiente. Visita ao Jardim Tropical de Lisboa, com os Professores Carla Oliveira, docente da Universidade Aberta e Jorge Atouguia, médico especialista em Medicina Tropical. Referência videográfica: Amador, Filomena, coord. - 2008 Ano Internacional do Planeta Terra [Em linha] : Terra, saúde e alterações climáticas. Realização de Abel Cardoso; Tecnóloga Ana Paula Antunes. Lisboa : Universidade Aberta. DCET, 2008. 1 prog. vídeo (15 min., 27 seg.) Link do vídeo: https://vimeo.com/user34119652/review/149167439/13a63a2a1f

Ciências do consumo alimentar: percepção do risco alimentar

Programa apresentado pela professora Ana Pinto Moura, docente da Universidade Aberta, sobre segurança e qualidade alimentar, o conceito de risco alimentar e o projeto AGRO 803 (Projeto Agro Consumidor, desenvolvido entre 2003 e 2007). Participação do professor Luís Miguel Cunha, da Faculdade de Ciências da Universidade do Porto. Referência Videográfica: Moura, Ana Pinto de - Ciências do consumo alimentar [Em linha]: percepção do risco alimentar. Realização de Ana Paula Antunes, Paulo Jorge Pereira ; Tecnóloga Ana Paula Antunes. Lisboa : Universidade Aberta, [2009]. 1 prog. vídeo (21 min., 47 seg.)

Ciências do consumo alimentar: determinantes da escolha alimentar

Programa com autoria e apresentação da professora Ana Pinto Moura, docente da Universidade Aberta. Participação de Luís Miguel Cunha, professor da Faculdade de Ciências da Universidade do Porto e de Maria Daniel Vaz de Almeida, professora da Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto. Referência videográfica: Moura, Ana Pinto de - Ciências do consumo alimentar [Em linha]: determinantes da escolha alimentar. Realização de Ana Paula Antunes, Paulo Jorge Pereira; Tecnóloga Ana Paula Antunes. Lisboa : Universidade Aberta. DCeT, [2009]. 1 prog. vídeo (33 min., 17 seg.)

Ciências do consumo alimentar: percepção do risco alimentar

Programa apresentado pela professora Ana Pinto de Moura, docente da Universidade Aberta, sobre segurança e qualidade alimentar, o conceito de risco alimentar e o projeto AGRO 803 (Projeto Agro Consumidor, desenvolvido entre 2003 e 2007). Participação do professor Luís Miguel Cunha, da Faculdade de Ciências da Universidade do Porto. Referência videográfica: Moura, Ana Pinto de - Ciências do consumo alimentar [Em linha]: percepção do risco alimentar. Realização de Ana Paula Antunes, Paulo Jorge Pereira ; Tecnóloga Ana Paula Antunes. Lisboa : Universidade Aberta, [2009]. 1 prog. vídeo (21 min., 47 seg.)

Ciências do consumo alimentar: nutrição e envelhecimento

Programa apresentado pela professora Ana Paula Vaz Fernandes, docente da Universidade Aberta, sobre nutrição e o envelhecimento saudável. Referência Videográfica: Fernandes, Ana Paula - Ciências do consumo alimentar [Em linha] : nutrição e envelhecimento. Realização de Ana Paula Antunes, Vanda Caxeiro; Tecnóloga Ana Paula Antunes. Lisboa : Universidade Aberta. DCeT, [2008]. 1 prog. vídeo (26 min., 38 seg.)

Validation of palpatory methods for evaluating anatomical bone landmarks of the cervical spine: a systematic review.

OBJECTIVE: The aim of this study was to systematically review the literature for validity of palpatory procedures for evaluating anatomical bone landmarks in the cervical spine. METHODS: A systematic search of electronic databases identified observational studies assessing validity and/or accuracy regarding evaluation of anatomical bone landmarks of cervical spine palpatory procedures. The databases used in the search included the US National Library of Medicine of the National Institutes of Health (MEDLINE/PubMed), the Regional Library of Medicine (Bireme), the Scientific Electronic Library Online (SciELO), the Physiotherapy Evidence Database (PEDro), the Latin American and Caribbean Health Sciences Literature database (LILACS), the Cochrane Library, and Coordination of Personnel Improvement of Higher Education (CAPES/Brazil). Data were extracted by a primary reviewer, and 2 independent reviewers used a critical appraisal tool to estimate the quality of the retrieved studies. The results were synthesized qualitatively within the Quality Assessment of Diagnostic Accuracy Studies criteria. After completing the synthesis and scoring, the reviewers applied classifications such as "low," "fair," and "good." RESULTS: The initial search yielded 69860 articles. After selection criteria were applied, 5 studies satisfied the eligibility criteria. Three studies verified the validity of the manual palpatory procedure, and 2 studies correlated the findings of the palpatory procedures with other measured results. According to Quality Assessment of Diagnostic Accuracy Studies criteria, 3 studies presented good methodological quality, and 2 presented fair methodological quality. Studies demonstrated an accuracy range from 51% to 87.8%. CONCLUSION: There are few studies that evaluate the validity of manual palpatory procedures for examining boney landmarks of the cervical spine. The 5 that were found showed fair to good methodological quality. However, we note that there may be poor external validity due to the sampling heterogeneity of these studies.

A institucionalização das políticas públicas de enfrentamento à violência contra as mulheres no Brasil (versão preliminar) / Nota Técnica n. 13 (Diest) : A institucionalização das políticas públicas de enfrentamento à violência contra as mulheres no Brasil

O presente estudo destina-se a analisar a espacialização dos serviços especializados, considerando as premissas da transversalidade das políticas públicas, da intersetorialidade e da capilaridade previstas pelo Pacto Nacional de Enfrentamento à Violência contra a Mulher.

Avaliando a efetividade da Lei Maria da Penha / Evaluating the effectiveness of Maria da Penha Law

A superação da violência doméstica é um dos grandes desafios das políticas públicas no Brasil. A Lei nº 11.340, conhecida como Lei Maria da Penha (LMP), sancionada em 2006, representou um marco institucional importante nesse caminho, pois procurou tratar de forma integral o problema da violência doméstica, e não apenas da imputação de uma maior pena ao ofensor. Contudo, mais de oito anos após a sanção da LMP, há uma completa lacuna acerca de estudos empíricos que procurassem avaliar o seu efeito, que foi o objeto deste trabalho. Construímos um modelo de diferenças em diferenças, em que os homicídios contra mulheres que ocorreram dentro das residências foram confrontados com aqueles que acometeram os homens. Nossos resultados indicaram que a lei cumpriu um papel relevante para conter a violência de gênero, ainda que sua efetividade não tenha se dado de maneira uniforme no país, uma vez que a sua eficácia depende da institucionalização de vários serviços protetivos nas localidades, qu

A prática de dispensação de medicamentos adaptada à dose prescrita: o papel do serviço de farmácia nos erros de medicação

Este projeto de pesquisa pretende avaliar se a prática de dispensação de medicamento adaptada à dose prescrita, feita pela Farmácia Central do Hospital Nossa Senhora da Conceição, em Porto Alegre/RS, pode ser um fator gerador de erros de medicação. Trata-se de uma pesquisa qualitativa, a qual terá como participantes os funcionários da enfermagem das unidades de internação para as quais possam ter sido dispensados medicamentos adaptados à dose. Os instrumentos para coleta de dados serão relatórios, prescrições médicas e uma entrevista semi-estruturada; os dados serão analisados pela técnica de análise de conteúdo. Desta forma, será possível conhecer alguns aspectos da rotina da enfermagem a respeito dos medicamentos dispensados e utilização da prescrição médica e propor uma reflexão sobre os processos de trabalho tendo como foco principal a segurança do paciente.

Intervenção osteopática em idosos e o impacto na qualidade de vida / Osteopathic intervention in the elderly and its impact on quality of life

INTRODUÇÃO: O envelhecimento evidencia a necessidade do idoso do controle das doenças e do bem-estar físico, psíquico e social. OBJETIVO: Avaliar o impacto da intervenção osteopática na qualidade de vida de idosos. MATERIAIS E MÉTODOS: Vinte e um indivíduos (72,1 ± 4,7 anos, 18 mulheres) completaram este estudo. Foi aplicado o questionário de qualidade de vida WHOQOL-bref no primeiro e sexto atendimentos no intervalo de 48 [39; 66] dias. A avaliação e o tratamento das disfunções somáticas encontradas foram feitos em todas as sessões e as técnicas de domínio osteopático foram utilizadas. Os dados foram analisados por meio do teste de Wilcoxon com significância em p < 0,05. RESULTADOS: Foi encontrada diferença significativa no domínio físico (pré-tratamento: 58,67 ± 12,91 por cento; pós-tratamento: 64,64 ± 13,75 por cento; p < 0,05). Não foram encontradas diferenças significativas nos domínios: psicológico (pré-tratamento: 63,10 ± 15,38 por cento; pós-tratamento: 64,38 ± 11,67 por cento; p = 0,846), relações sociais (pré-tratamento: 62,30 ± 14,34 por cento; pós-tratamento: 62,50 ± 12,82 por cento; p = 1,000) e meio ambiente (pré-tratamento: 52,08 ± 11,91 por cento; pós-tratamento: 52,19 ± 11,02 por cento; p = 0,806). O nível de escolaridade apresentou associação significativa com a pontuação total do questionário antes (r = 0,457; p = 0,019) e após (r = 0,380; p = 0,049) a intervenção. CONCLUSÃO: A medicina osteopática, com sua ampla abordagem, interferiu positivamente no domínio físico da qualidade de vida. Outros domínios (meio ambiente, psicológico e relações pessoais) não foram modificados pela intervenção osteopática, contribuindo para a manutenção da qualidade de vida geral.

INTRODUCTION: The aging process evidence the need to provide to the elderly either disease control and physical, psychological, and social well-being. OBJECTIVE: To evaluate the osteopathic intervention and its impact in quality of life of aged people. MATERIALS AND METHODS: Twenty-one subjects (72.1 ± 4.7 years, 18 women) were enrolled in and completed this study. The WHOQOL-bref questionnaire was applied at first and sixth session with an average time interval of 48 [39; 66] days. At each session, screening tests and treatment were performed for somatic dysfunctions; treatment techniques were selected among osteopathic domain. Data from questionnaire were analyzed with Wilcoxon test with significance established at p < 0.05. RESULTS: Significant difference was found in the physical domain (before: 58.67 ± 12.91 percent; after: 64.64 ± 13.75 percent; p < 0.05). No significant difference was found in psychological domain (before: 63.10 ± 15.38 percent; after: 64.38 ± 11.67 percent; p = 0.846), social relations (before: 62.30 ± 14.34 percent; after: 62.50 ± 12.82 percent; p = 1.000) and environment (before: 52.08 ± 11.91 percent; after: 52.19 ± 11.02 percent; p = 0.806). Educational level presented significant association with total scoring of the questionnaire before (r = 0.457; p = 0.019) and after (r = 0,380; p = 0,049) osteopathic intervention. CONCLUSION: Osteopathic medicine, in a broad approach, positively contributed to the physical domain of quality of life. Other domains (environmental, psychological, and social relations) were not modified by osteopathic intervention, resulting in unchanged overall quality of life.

Comparative genomic hybridization analysis of pediatric adamantinomatous craniopharyngiomas and a review of the literature.

OBJECT: The purpose of this study was to examine chromosomal gains and losses in 11 pediatric adamantinomatous craniopharyngiomas by using comparative genomic hybridization (CGH), as well as to review the cytogenetic literature that has contributed to the characterization of these tumors. One source of confusion in the cytogenetic and CGH literature concerning craniopharyngioma is that the authors of most studies fail to distinguish between pediatric and later-onset forms of the disease. Thus, this study was focused on pediatric craniopharyngioma. METHODS: To determine an overview of the genetic events leading to the development of these tumors, 10 adamantinomatous craniopharyngiomas were analyzed using CGH; none of the tumor specimens demonstrated gains or losses of DNA sequence. CONCLUSIONS: In view of these findings as well as those published in the majority of previous cytogenetic studies of craniopharyngiomas, the authors conclude that the recurrent acquisition of chromosomal imbalances does not play a major role in tumorigenesis and that chromosomal gains and losses are a relatively rare event in primary tumors of pediatric origin.