Follow-up of infants with congenital syphilis during the penicillin shortage period.

OBJECTIVE: To analyze the follow-up, in specialized outpatient clinics, of infants reported with congenital syphilis during the penicillin shortage. METHOD: A cross-sectional study was carried out in ten public maternity hospitals affiliated with the Brazilian Unified Health System in the city of Fortaleza, state of Ceará. Clinical records of infants reported with congenital syphilis who were born alive in 2015 were used to describe correlates of attendance at recommended clinical follow-up appointments. RESULTS: A total of 469 infants reported with CS from January 1/2015 to December 31/2015 were included in the analysis. The results show that most infants did not attend the follow-up visits (368/469, 78.5%) and the main associated factors are that the follow-up clinic is located in a different hospital from that where the infant was born (OR: 3.7; CI: 2.20-6.22; p < 0.001) and the use of illicit drugs by the mother (OR: 3.2; CI: 1.57-6.87; p = 0.002). Only 33.7% (34/101) were followed until discharge. CONCLUSION: The majority of infants with reported congenital syphilis during this period did not attend the follow-up visits. Public health efforts aimed at reaching the parents of infants with CS should be a priority to ensure appropriate clinical identification and management of the associated outcomes of this vertically transmitted infection.

Transient elevation of ST-segment due to pneumothorax and pneumopericardium.

ST-segment elevation, observed in the critically ill patients, almost always raises the suspicion of ischemic heart disease. However, nonischemic myocardial and non-myocardial problems in these patients may also lead to ST-segment elevation. Pneumothorax and pneumopericardium have been rarely reported as a cause of transient ST-segment elevation. The authors report the case of a patient admitted to the emergency care unit because of a respiratory failure requiring mechanical ventilatory support. As the patient showed signs of clinical deterioration, a pneumothorax was clinically diagnosed. Chest radiography after thorax drainage also disclosed a pneumopericardium. The 12-lead electrocardiogram recorded before the thoracic drainage revealed an ST-segment elevation, which normalized after the surgical procedure. Ischemic myocardial biomarkers were negative. The authors call attention to the right-sided pneumothorax associated with pneumopericardium as an unusual cause of ST-segment elevation.