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.

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.

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.

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.

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.

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.