Early congenital syphilis: missed opportunities in a mother owing to many problems during pregnancy - a case report.

Untreated syphilis in pregnancy can result in an adverse outcome for the fetus. A multigravida woman with a previously poor obstetric history of early neonatal death, abortion and stillbirth was admitted in labour in the 7th month of pregnancy. On admission, syphilis screening with the qualitative rapid plasma reagin (RPR) test was negative. The infant had macules on the chest, abdomen and extremities, desquamating bullous skin lesions on the palms and soles, bilateral cataracts, an enlarged liver and spleen, anaemia, thrombocytopenia and conjugated hyperbilirubinaemia. A quantitative RPR test in the infant was positive in a 1:64 dilution and was subsequently positive in the mother in a 1:16 dilution after congenital syphilis was diagnosed. The mother later reported the father's high-risk behaviour and her previous visits to healthcare facilities for genital ulcers. The quantitative RPR test in the father was positive in a 1:32 dilution, and the parents and infant were treated for syphilis. The case demonstrates the importance of timely identification of high-risk pregnant women, early screening, repetition of the non-treponemal test on diluted serum when a routine screening test is negative, proper advice from the laboratory regarding selection of the most appropriate tests, and screening with the treponemal test first (reverse) algorithm utilising an automated enzyme immunoassay/chemiluminescence assay for the initial screening in high-risk cases, even in resource-limited settings to prevent a missed diagnosis.Abbreviations: ANC, antenatal care; BPG, benzathine penicillin G; CS, congenital syphilis; CSF, cerebrospinal fluid; CIA, chemiluminescence assay; EIA, enzyme immunoassay; HIC: high-income countries; IgM, immunoglobulin M; LMIC, low- and middle-income countries; MTCT: mother-to-child transmission; NTT, non-treponemal test; POC, point of care; RPR, rapid plasma reagin; RST, rapid syphilis test; STI, sexually transmitted infections; TT, treponemal test; TPHA, Treponema pallidum haemagglutination assay; VDRL, venereal disease research laboratory; WHO, World Health Organization.

Predictors of poor outcome in children with steroid sensitive nephrotic syndrome / Factores predisponentes a malos resultados en niños con síndrome nefrótico sensible a esteroides

BACKGROUND AND OBJECTIVE: Nearly 50% of the children with steroid sensitive nephrotic syndrome (SSNS) have a frequently relapsing (FR) or steroid dependent (SD) course, experiencing steroid toxicities and complications of immunosuppression. The study aimed to compare parameters between children with infrequent relapsing (IFR) and FR/SD nephrotic syndrome and to identify the factors associated with a FR/SD course. METHODS: A retrospective analysis of medical records from 2009 to 2014, of children with SSNS attending the pediatric nephrology clinic in a tertiary care medical college and hospital. RESULTS: Out of 325 children (226 males) with SSNS, 213 were IFR and 112 were FRNS/SDNS. The median age of onset was 34 (IQR 24-48) months. The median time to the first relapse was 4 (IQR 3-7) months and 6 (IQR 4-12) months in FR/SD and IFR group respectively. Multivariate logistic regression analysis showed "adequate treatment (≥12 weeks) of the first episode" (odds ratio 0.56, 95% CI 0.34-0.91; p value = 0.02) and "shorter median time to the first relapse" (odds ratio 1.04, 95% CI = 1.01-1.08; p value=0.04) to be independent predictors of FR/SD course. An ROC curve was constructed which showed that time to first relapse < 5.5 months was associated with a sensitivity of 69% and specificity of 60% in predicting a FR/SD course. CONCLUSION: Adequate treatment of the first episode is associated with less chance of an FR/SD course. After treatment of first episode, the first relapse occurring within 5.5 months may predict a frequently relapsing or steroid dependent course

ANTECEDENTES Y OBJETIVO: Casi el 50% de los niños con síndrome nefrótico sensible a esteroides (SNSE) presentan un curso frecuentemente recurrente (FR) o dependiente de esteroides (DE) y padecen toxicidades por esteroides y complicaciones por la inmunodepresión. El estudio tuvo como objetivo comparar los parámetros entre los niños con recurrencias infrecuentes (RI) y el síndrome nefrótico FR/DE, e identificar los factores asociados con un curso FR/DE. MÉTODOS: Un análisis retrospectivo de las historias clínicas de 2009-2014 de los niños con SNSE que asisten a la clínica de nefrología pediátrica en una facultad de medicina y un hospital de atención especializada. RESULTADOS: De 325 niños (226 varones) con SNSE, 213 fueron RI y 112 fueron SNFR/SNDE. La mediana de edad de inicio fue 34 (RIC: 24-48) meses. El tiempo medio hasta la primera recaída fue 4 (RIC: 3-7) meses y 6 (RIC: 4-12) meses en los grupos FR/DE e RI, respectivamente. El análisis de regresión logística multivariante mostró "tratamiento adecuado (≥ 12 semanas) del primer episodio" (razón de posibilidades: 0,56; IC del 95%: 0,34-0,91; valor p = 0,02) y "tiempo medio más corto hasta la primera recaída» (razón de posibilidades: 1,04; IC del 95%: 1,01-1,08; valor p = 0,04) para ser factores predisponentes independientes del curso FR/DE. Se construyó una curva ROC que mostró que el tiempo hasta la primera recaída < 5,5 meses se asoció con una sensibilidad del 69% y una especificidad del 60% en la predicción de un curso FR/DE. CONCLUSIÓN: El tratamiento adecuado del primer episodio se asocia con menos posibilidades de un curso FR/DE. Después del tratamiento del primer episodio, la primera recaída que ocurre dentro de los 5,5 meses puede pronosticar un curso frecuentemente recurrente o dependiente de esteroides