Comunicação do diagnóstico de infecção pelo HIV: experiência de jovens / Communication of the diagnosis of HIV infection: experience of young people / Comunicación del diagnóstico de infección por VIH: experiencia de los jóvenes

Resumo Esta pesquisa qualitativa foi conduzida com dez participantes da região Sul do Brasil com idade entre 15 e 24 anos e visou identificar os elementos do processo comunicativo do diagnóstico de infecção pelo HIV em sua experiência, por meio de análise de conteúdo a partir das categorias teóricas do modelo lasswelliano. O canal foi a consulta médica; o contexto foi determinado pelo tipo de exposição (vertical ou horizontal); os ruídos apresentaram questões veladas e incertezas; as falhas implicaram as situações que levavam o jovem a suspeitar do diagnóstico; e os efeitos envolveram reações emocionais imediatas que se dissipam com o tempo. A comunicação na adolescência foi pontual, indicando a necessidade de qualificar o processo comunicativo, e desencadeada por familiares com apoio de profissionais. A comunicação do diagnóstico de HIV geralmente é postergada pelos familiares quando se trata de criança ou adolescente, o que fere o princípio da autonomia, por desconsiderar o direito de saber.

Abstract This qualitative research aimed at identifying the elements of the communication process of HIV infection diagnosis in the experience of ten participants from Southern Brazil aged between 15 and 24 years old that was conducted via content analysis based on the theoretical categories of Lasswell's model. The channel was the medical consultation; the context was determined by the type of exposure (vertical or horizontal); the noises presented veiled issues and uncertainties; the failures involved situations that led the young person to suspect the diagnosis; and the effects involved immediate emotional reactions that dissipated over time. Communication in adolescence was punctual and triggered by family members with support from professionals, indicating the need to improve the communicative process. The communication of the HIV diagnosis is usually postponed by family members when it comes to children or adolescents, which violates the principle of autonomy by disregarding the right to know.

Resumen Esta investigación cualitativa fue realizada con diez participantes de la región sur de Brasil con edades entre 15 y 24 años y tuvo como objetivo identificar los elementos del proceso comunicativo del diagnóstico de infección por VIH en su experiencia; a través del análisis de contenido a partir de las categorías teóricas del modelo lasswelliano. El canal fue la consulta médica, el contexto fue determinado por el tipo de exposición (vertical u horizontal); los ruidos presentaron preguntas veladas e incertidumbres, los fracasos implicaron las situaciones que llevaron al joven a sospechar el diagnóstico, y los efectos implicaron reacciones emocionales inmediatas que se disipan con el tiempo. La comunicación en la adolescencia fue puntual, indicando la necesidad de calificar el proceso comunicativo, y desencadenada por familiares con apoyo profesional. La comunicación del diagnóstico del VIH suele ser postergada por los familiares cuando se trata de niños o adolescentes, lo que perjudica el principio de autonomía, porque ignora el derecho a saber.

Ocular Findings in Infants with Congenital Toxoplasmosis after a Toxoplasmosis Outbreak.

PURPOSE: We investigated the prevalence of ocular abnormalities in infants vertically exposed to Toxoplasma gondii infection during an outbreak in Santa Maria City, Brazil. DESIGN: Consecutive case series. PARTICIPANTS: A total of 187 infants were included. METHODS: The infants were recruited from January 2018 to November 2019. All mothers were screened for syphilis and human immunodeficiency virus before delivery. Toxoplasmosis infection was confirmed in all mothers and infants based on the presence of serum anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies. All infants underwent an ophthalmologic examination; ocular abnormalities were documented using a wide-field digital imaging system. Neonatal cranial sonography or head computed tomography was performed in 181 infants, and the cerebrospinal fluid (CSF) was screened for anti-T. gondii IgG and IgM antibodies in 159 infants. Peripheral blood samples from 9 infants and their mothers were analyzed for the presence of T. gondii DNA by real-time polymerase chain reaction. MAIN OUTCOME MEASURES: Ocular abnormalities associated with congenital toxoplasmosis. RESULTS: A total of 187 infants were examined. Twenty-nine infants (15.5%) had congenital toxoplasmosis, of whom 19 (10.2%) had ocular abnormalities, including retinochoroiditis in 29 of 38 eyes (76.3%), optic nerve abnormalities in 5 eyes (13.2%), microphthalmia in 1 eye (2.6%), and cataract in 2 eyes (5.3%). Bilateral retinal choroidal lesions were found in 10 of 19 infants (52.6%). Nine eyes of 6 infants had active lesions, with retinal choroidal cellular infiltrates at the first examination. Thirteen (7.2%) of 181 infants screened presented with cerebral calcifications. Eighty-three percent of the screened infants were positive for anti-T. gondii IgG and negative for IgM antibodies in the CSF. Congenital toxoplasmosis was higher in mothers infected during the third pregnancy trimester, and maternal treatment during pregnancy was not associated with a lower rate of congenital toxoplasmosis. CONCLUSIONS: High prevalence rates of clinical manifestations were observed in infants with congenital toxoplasmosis after a waterborne toxoplasmosis outbreak, the largest yet described. Cerebral calcifications were higher in infants with ocular abnormalities, and maternal infection during the third pregnancy trimester was associated with a higher rate of congenital toxoplasmosis independent of maternal treatment.

Perfil epidemiológico dos casos de toxoplasmose gestacional e congênita decorrentes do surto populacional / Epidemiological profile of gestational and congenital toxoplasmosis cases arising out of the population outbreak

Objetivo: traçar o perfil epidemiológico dos casos de toxoplasmose gestacional e congênita notificados na cidade de Santa Maria ­ RS, decorrentes do surto ocorrido no ano de 2018 e investigar a associação entre as variáveis maternas e o diagnóstico do bebê. Método: foram avaliados retrospectivamente os casos notificados entre o período de março de 2018 a março de 2019. O diagnóstico do bebê e variáveis maternas foram analisados através de estatística descritiva e teste qui-quadrado. Resultados: Durante o período do estudo, foram notificados 206 casos de toxoplasmose gestacional, dos quais 74 foram confirmados como infecção recente. A transmissão vertical foi confirmada em 27% dos casos. Houve maior freqüência de transmissão em gestantes que tiveram o diagnóstico no terceiro trimestre de gestação (p=0,001) e que não realizaram tratamento durante a gestação (p<0,001). Conclusão: A ocorrência da toxoplasmose congênita está associada ao diagnóstico tardio, no último trimestre da gestação, e consequente falta do tratamento adequado. Ainda, houve uma alta prevalência de crianças infectadas por transmissão vertical decorrentes do surto, o que reforça a importância de um acompanhamento pré-natal e a atenção à necessidade da realização do tratamento e cuidado adequados no decorrer do desenvolvimento das crianças infectadas.

Objective: To trace the epidemiological profile of cases of gestational and congenital toxoplasmosis reported in the city of Santa Maria - RS, resulting from the outbreak that occurred in 2018 and to investigate the association between maternal variables and the baby's diagnosis. Method: Cases reported between March 2018 and March 2019 were retrospectively evaluated. The baby's diagnosis and maternal variables were analyzed using descriptive statistics and chi-square test. Results: During the study period, 206 cases of gestational toxoplasmosis were reported, of which 74 were confirmed as a recent infection. Vertical transmission was confirmed in 27% of cases. There was a higher frequency of transmission in pregnant women who were diagnosed in the third trimester of pregnancy (p = 0.001) and who did not undergo treatment during pregnancy (p <0.001). Conclusion: The occurrence of congenital toxoplasmosis is associated with late diagnosis, in the last trimester of pregnancy, and consequent lack of adequate treatment. In addition, there was a high prevalence of children infected by vertical transmission due to the outbreak, which reinforces the importance of prenatal care and attention to the need for adequate treatment and care during the development of infected children.

Impact of maternal dTpa vaccination on the incidence of pertussis in young infants.

INTRODUCTION: Pertussis is an important public health problem worldwide, especially in infants. An increase in the incidence in many countries occurred after 2010, including Brazil. In 2013, dTpa vaccine was introduced in the Brazil national immunization schedule of pregnant women. The objective of this study was to evaluate the national trends in the incidence of pertussis in Brazil in children under 1 year old, and the impact of the introduction of dTpa vaccine during pregnancy. METHODS: The incidence of hospitalizations and non-hospitalized confirmed cases of pertussis in neonates (< 1 month age) and young infants (1 month-< 1 year age) were analyzed, comparing the incidence in pre maternal vaccination (2011-2013) with the post-vaccination (2015-2017). We used non-respiratory hospitalizations as comparison, during the same period. A database of the Brazilian Ministry of Health (DATASUS) was used to analyze cases from 2007 to 2017 and the subsets of 2011-2013 and 2015-2017, after Pertussis resurgence. The vaccination data was accessed through the link of the Information System of the National Immunization Program (pni.datasus.gov.br). RESULTS: Between 2007 and 2017, 17,818 children under one year of age were hospitalized due to pertussis in Brazil. In the pre maternal vaccination period 2011-2013, the mean annual incidence of non-hospitalized confirmed cases of pertussis in children under 1 month was 722.2 / 100,000 and in the period of 2015-2017 the average was 377.3 / 100,000, representing a decrease of 47.7% [IRR 0.52 (0.46-0.59)]. At those periods of time, the average incidence per year for children of one month-< 1 year aged was 64.9 / 100,000 (2011-2013) and 29.3 / 100,000 (2015-2017) [IRR 0.45 (CI 0.29-0.69)]. CONCLUSION: Vaccination of pregnant woman coincides with the reduction in the number of cases of pertussis in children under 1 month of age from 2015. Immunization of pregnant woman seems to have an important impact on the prevention of the disease in young infants who have not yet received their own pertussis vaccine.

Effect of congenital toxoplasmosis on the encoding of speech in infants.

OBJECTIVE: To investigate the effect of congenital toxoplasmosis (CTP) on the Frequency-Following Response (FFR) in infants. STUDY DESIGN: 11 infants diagnosed with CTP and 12 healthy infants with no risk indicators for hearing impairment, aged 29-90 days old. All infants underwent an FFR neurophysiological assessment. The test stimulus was the syllable [da], 40 ms in duration, which was monaurally presented to the right ear at an intensity of 80 dBnHL. Absolute latencies and amplitudes of the V, A, C, D, E, F, and O waves, the slope (µV/ms) and measure between onset (A) and offset (O), were compared between the two groups. RESULTS: Infants with CTP had increased latency of FFR waves V, A, E, F, and O, and decreased amplitude for waves A and F. They also showed a reduction in A-O slope and a higher latency difference between onset (A) and offset (O). CONCLUSION: The neurophysiological responses of Frequency-Following Response can be influenced by congenital toxoplasmosis. Since, the CTP showed prolongation of the V, A, E, F and O waves and decrease of the amplitude for waves A and F.

Comparison of two maintenance electrolyte solutions in children in the postoperative appendectomy period: a randomized, controlled trial / Comparação de duas soluções para manutenção hidroeletrolítica no pós-operatório de apendicectomia em crianças: um estudo controlado e randomizado

ABSTRACT OBJECTIVE: To compare two electrolyte maintenance solutions in the postoperative period in children undergoing appendectomy, in relation to the occurrence of hyponatremia and water retention. METHODS: A randomized clinical study involving 50 pediatric patients undergoing appendectomy, who were randomized to receive 2,000 mL/m2/day of isotonic (Na 150 mEq/L or 0.9% NaCl) or hypotonic (Na 30 mEq/L NaCl or 0.18%) solution. Electrolytes, glucose, urea, and creatinine were measured at baseline, 24 h, and 48 h after surgery. Volume infused, diuresis, weight, and water balance were analyzed. RESULTS: Twenty-four patients had initial hyponatremia; in this group, 13 received hypotonic solution. Seventeen patients remained hyponatremic 48 h after surgery, of whom ten had received hypotonic solution. In both groups, sodium levels increased at 24 h (137.4 ± 2.2 and 137.0 ± 2.7 mmol/L), with no significant difference between them (p = 0.593). Sodium levels 48 h after surgery were 136.6 ± 2.7 and 136.2 ± 2.3 mmol/L in isotonic and hypotonic groups, respectively, with no significant difference. The infused volume and urine output did not differ between groups during the study. The water balance was higher in the period before surgery in patients who received hypotonic solution (p = 0.021). CONCLUSIONS: In the post-appendectomy period, the use of hypotonic solution (30 mEq/L, 0.18%) did not increase the risk of hyponatremia when compared to isotonic saline. The use of isotonic solution (150 mEq/L, 0.9%) did not favor hypernatremia in these patients. Children who received hypotonic solution showed higher cumulative fluid balance in the preoperative period.

RESUMO OBJETIVO: Comparar duas soluções de manutenção hidroeletrolítica no período pós-operatório (PO) de crianças submetidas à apendicectomia quanto à ocorrência de hiponatremia e retenção hídrica. MÉTODOS: Estudo clínico randomizado que envolveu 50 pacientes pediátricos submetidos à apendicectomia, randomizados para receber 2.000 ml/m2/dia de solução isotônica (Na 150 mEq/L ou NaCl 0,9%) ou hipotônica (Na 30mEq/L ou NaCl 0,18%). Eletrólitos, glicose, ureia e creatinina foram mensurados no início do estudo, 24 e 48 horas após a cirurgia. Foram analisados volume infundido, diurese, peso e balanço hídrico. RESULTADOS: Apresentaram hiponatremia inicial 24 pacientes. Desses, 13 receberam solução hipotônica. Dezessete pacientes permaneceram hiponatrêmicas 48 horas após a cirurgia, 10 haviam recebido solução hipotônica. Nos dois grupos os níveis de sódio aumentaram na 24ª hora PO (137,4 ± 2,2 e 137,0 ± 2,7) e não houve diferença entre eles (p = 0,593). Níveis de sódio 48 h após a cirurgia foram 136,6 ± 2,7 e 136,2 ± 2,3 no grupo isotônico e hipotônico respectivamente sem diferença significativa. Os volumes infundidos e a diurese não diferiram entre os grupos durante o estudo. O balanço hídrico foi maior no período anterior à cirurgia no grupo de pacientes que receberam solução hipotônica (p = 0,021). CONCLUSÕES: No período pós-apendicectomia, o uso da solução hipotônica não aumentou o risco de hiponatremia quando comparado com uma solução salina isotônica. O uso da solução isotônica não favoreceu a hipernatremia nesses pacientes. Crianças que receberam solução hipotônica apresentaram maior balanço hídrico cumulativo no período pré-operatório.

Comparison of two maintenance electrolyte solutions in children in the postoperative appendectomy period: a randomized, controlled trial.

OBJECTIVE: To compare two electrolyte maintenance solutions in the postoperative period in children undergoing appendectomy, in relation to the occurrence of hyponatremia and water retention. METHODS: A randomized clinical study involving 50 pediatric patients undergoing appendectomy, who were randomized to receive 2,000mL/m(2)/day of isotonic (Na 150 mEq/L or 0.9% NaCl) or hypotonic (Na 30 mEq/L NaCl or 0.18%) solution. Electrolytes, glucose, urea, and creatinine were measured at baseline, 24h, and 48h after surgery. Volume infused, diuresis, weight, and water balance were analyzed. RESULTS: Twenty-four patients had initial hyponatremia; in this group, 13 received hypotonic solution. Seventeen patients remained hyponatremic 48h after surgery, of whom ten had received hypotonic solution. In both groups, sodium levels increased at 24h (137.4±2.2 and 137.0±2.7mmol/L), with no significant difference between them (p=0.593). Sodium levels 48h after surgery were 136.6±2.7 and 136.2±2.3mmol/L in isotonic and hypotonic groups, respectively, with no significant difference. The infused volume and urine output did not differ between groups during the study. The water balance was higher in the period before surgery in patients who received hypotonic solution (p=0.021). CONCLUSIONS: In the post-appendectomy period, the use of hypotonic solution (30 mEq/L, 0.18%) did not increase the risk of hyponatremia when compared to isotonic saline. The use of isotonic solution (150 mEq/L, 0.9%) did not favor hypernatremia in these patients. Children who received hypotonic solution showed higher cumulative fluid balance in the preoperative period.

Acompanhamento ambulatorial de crianças que tem HIV/AIDS: cuidado centrado na criança e na família / Outpatient follow-up of HIV children: assistance given to children and families / Acompañamiento de ambulatorio de niños que tienen VIH/SIDA: cuidado centrado en el niño y en la familia

A condição sorológica das crianças que têm HIV/aids demanda cuidados especiais de saúde, como, por exemplo, acompanhar o crescimento e desenvolvimento, clínico e terapêutico. O objetivo do estudo é descrever a experiência de desenvolvimento de grupo com familiares/cuidadores no acompanhamento ambulatorial de saúde das crianças que têm HIV/aids. As ações estão organizadas em um projeto de extensão no Hospital Universitário de Santa Maria/RS que desenvolve encontros grupais dialógicos com familiares/cuidadores e fundamentam-se no cuidado centrado na criança e na família, tendo a educação em saúde como eixo transversal. O diálogo grupal oportuniza compreender as interfaces temáticas do cotidiano dos familiares/cuidadores. A troca de vivências/experiências promove a construção coletiva do conhecimento e é permeada pelo respeito e pelo sigilo da identidade, do diagnóstico e das histórias compartilhadas. Conclui-se que o espaço dialógico medeia o cuidado profissional no hospital e as especificidades do cuidado familial, possibilitando o compartilhar de vivências, necessidades e dúvidas. Essas ações promovem adesão ao tratamento, redução dos índices de morbimortalidade, formação e qualificação dos profissionais para o cuidado e a investigação em saúde.

The HIV status of children with HIV / AIDS results in demands for particular health needs such as a follow-up on their growth and development process, as well as clinical and therapeutic care. Objective: to describe the experience of developing family members/caregivers groups on outpatient health monitoring of children who have HIV/AIDS. Methodology: the actions are organized in an extension Project in a university hospital in Santa Maria/RS that develops group meetings based on dialogue with family members/caregivers. Sharing experiences promotes group knowledge construction and brings respect for the anonymity, for the diagnosis, and for the shared histories. Conclusion: Dialogue space helps with the professional care in the hospital and with family care, making it possible to share experiences, needs and doubts.Such actions promote treatment adherence, morbidity and mortality rates reduction, professionals' education and qualification to care and investigate health needs.

La condición serológica de los niños VIH/SIDA demanda cuidados especiales de salud, como, por ejemplo, el acompañamiento del crecimiento y desarrollo clínico y terapéutico. El objetivo del estudio es describir la experiencia de desarrollo de grupo con familiares/cuidadores en el acompañamiento de ambulatorio de salud de los niños que tienen VIH/SIDA. Las acciones están organizadas en un proyecto de extensión en el Hospital Universitario de Santa Maria/RS (HUSM), que desarrolla encuentros grupales dialógicos con familiares/cuidadores y se fundamentan en el cuidado centrado en el niño y en la familia, teniendo la educación en salud como eje transversal. El diálogo grupal da la oportunidad para comprender las interfaces temáticas del cotidiano de los familiares/cuidadores. El cambio de vivencias/experiencias promueve la construcción colectiva del conocimiento y es permeado por el respeto y por el sigilo de la identidad, del diagnóstico y de las historias compartidas. Se concluye que el espacio dialógico intercede el cuidado profesional en el hospital y sus especificidades del cuidado familiar, posibilitando el compartir de vivencias, necesidades y dudas. Esas acciones promueven la adhesión al tratamiento, reducción de los índices de morbimortalidad, formación y cualificación de los profesionales para el cuidado y la investigación en salud.

Alimentação de crianças que convivem com a Aids: vivências de familiares/cuidadores em atividade grupal / Feeding of children that living with Aids: family/care guivers experiences in group activity

Objetivo: Descrever a experiência em grupo de familiares/cuidadores de crianças que convivem com a síndrome da imunodeficiência adquirida, destacando a temática alimentação infantil. Método: Relato de experiência acerca do atendimento prestado a essas crianças em um hospital-ensino. Resultados: O grupo Anjos da Guarda caracteriza-se pela maneira dinâmica e interativa que os participantes apresentam suas vivências, necessidades e dúvidas da condição clínica da criança e sua inserção social, mediadas pelo diálogo. Dentre os principais assuntos destaca-se a alimentação infantil como uma das dificuldades enfrentadas no cotidiano das famílias. Conclusões: As atividades grupais de educação em saúde reforçam a necessidade de desconstrução do modelo de assistência tradicional para um cuidado centrado nas necessidades das famílias e no desenvolvimento infantil através da continuidade do cuidado multiprofissional.

Objective: the objective is to describe the experience in a group with family members of children who living with acquired immunodeficiency syndrome, highlighting the theme of child feeding. Method: experience report on the care provided to children and their families / care givers in a teaching hospital. Results: the group Guardian Angels is characterized by dynamic and interactive way that the participants present their experiences, needs and concerns of the child's clinical condition and their social integration, mediated dialogue. Among the main issues, infant feeding stands out as one of the greatest difficulties faced in the families. Conclusions: group activities in health education reinforce the need to deconstruct the traditional care model for a care that is centered on the family members’ needs and child development through the continuity of a multi-professional care staff.

Objetivo: el presente estudio tiene por objetivo describir la experiencia en grupo de familiares/cuidadores de niños que conviven con el síndrome de inmunodeficiencia adquirida, destacando la temática alimentación infantil. Métodos: relato de experiencia acerca de la atención prestada a los niños en un hospital-enseñanza. Resultados: el grupo “Anjos da Guarda” se caracteriza por la manera dinámica e interactiva que los participantes presentan sus vivencias, necesidades y dudas de la condición clínica del niño y su inserción social, mediadas por el diálogo. Entre los principales asuntos se destaca la alimentación infantil como una de las dificultades enfrentadas en el cotidiano de las familias. Conclusiones: las actividades grupales de educación en salud refuerzan la necesidad de desconstrucción del modelo de asistencia tradicional para un cuidado centrado en las necesidades de las familias y en el desarrollo infantil a través de la continuidad del cuidado multiprofesional.