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.

Prevalência de amenorreia em pacientes submetidas a tratamento quimioterápico / Prevalence of amenorrhea in patients submitted to chemotherapy

JUSTIFICATIVA E OBJETIVOS: A quimioterapia contra o câncer está associada à sequelas importantes em longo prazo, entre elas a falência reprodutiva. O objetivo deste estudo foi avaliar a prevalência de amenorreia e sintomas de climatério em mulheres em idade fértil submetidas a tratamento quimioterápico. MÉTODO: Foi realizado um estudo observacional transversal descritivo que abrangeu duas etapas: levantamento de prontuários e entrevista por telefone com as pacientes. RESULTADOS: Das 50 pacientes, 42 (84%) entraram em amenorreia durante ou após o tratamento. Destas, 24 não retornaram a menstruar após o término do tratamento (p = 0,044). Houve associação significante em relação ao uso de ciclofosfamida e adriamicina e a presença de amenorreia nas pacientes com diversos tipos de câncer (p = 0,007 e p = 0,009). Quanto aos sintomas de climatério, 7 pacientes apresentaram diminuição da libido, 22 ressecamento vaginal, 34 fogachos, 8 dispareunia e 16 ganho de peso durante o tratamento, sendo que em 18 casos não houve regressão dos sintomas. Apenas os sintomas de ressecamento vaginal e presença de fogachos apresentaram-se associados à amenorreia (p < 0,05). CONCLUSÃO: Observou-se elevada porcentagem de pacientes que entraram em falência ovariana após a quimioterapia, com consequente presença de sintomas de climatério. Demonstra-se a necessidade de informar às pacientes que serão submetidas a esse tipo de tratamento sobre a possibilidade de preservação da fertilidade.

BACKGROUND AND OBJECTIVES: Chemotherapy for cancer is associated with significant long-term sequelae, including reproductive failure. The objective of the study was to indentify the prevalence of amenorrhea and menopause symptoms in women after chemotherapy treatment. METHOD: It was performed a descriptive observational study composed by two stages: review of the medical records and interview by phone. RESULTS: From the 50 patients, 42 (84%) presented amenorrhea during or after the treatment. Twenty four patients of these patients do not have periods after the end of treatment (p = 0.044). A significant association regarding the use of cyclophosphamide and adriamycin and the presence of amenorrhea was observed in patients with various types of cancer (p = 0.007 and p = 0.009). As symptoms of menopause, seven patients had decreased libido, 22 had vaginal dryness, 34 flushing, and 8 had dyspareunia and 16 had weight gain during treatment, and in 18 cases there was regression of symptoms. Only the symptoms of vaginal dryness and the presence of hot flushes were associated with the presence of amenorrhea (p < 0.05). CONCLUSION: We observed that there were a high percentage of patients who entered in ovarian failure after chemotherapy, with consequent symptoms of menopause. It reinforces the necessity of inform patients that will undergo such treatment on the possibility of fertility preservation.

Avaliação da disfunção gonadal em pacientes do sexo masculino, submetidos a tratamento oncológico na infância / Evaluation of the male gonadal function submitted to treatment in the childhood cancer

INTRODUÇÃO: À medida que aumenta o número de adultos que sobrevivem ao tratamento do câncer infantil, observa-se a presença de efeitos tardios decorrentes do tratamento. ... OBJETIVO: Avaliar a função gonadal nos pacientes submetidos a diferentes esquemas de tratamento na infância e identificar os fatores de risco para disfunção gonadal neste grupo. CASUÍSTICA E MÉTODOS: Foram avaliados 151 pacientes, que fazem parte do GEPETTO (Grupo de Estudos Pediátricos dos Efeitos Tardios do Tratamento Oncológico) fora de tratamento há mais de 8 anos, que deram entrada no Hospital A.C. Camargo entre 1966 a 1994. ... RESULTADOS: Azoospermia foi observada em 43 pacientes. As dosagens séricas mostraram 36 pacientes com FSH alterada, 26 pacientes com testosterona total anormal e 18 pacientes com LH alterado. ... O estudo da regressão logística observou que a procarbazina (OR=7,7 para o grupo B e 10,3 para o grupo A), etoposide (OR=3,9 para o grupo A), doxorrubicina (OR=1,9 para o grupo C) e a Rxt testicular (OR=38 para o grupo C), tiveram impacto na disfunção gonadal. CONCLUSÕES: Os pacientes tratados na infância com regimes combinados de quimioterapia e/ou radioterapia apresentaram evidências de dano gonadal, com a presença de FSH alterado e/ou azoospermia e/ou volume testicular diminuído, sugerindo importante dano ao epitélio germinativo...

INTRODUCTION: As far as a majority of children with malignant diseases are cured, the late effects of the treatment are of major importance. The gonadal dysfunction is one of the undesirable late effects due to the treatment. OBJECTIVES: To evaluate the male gonadal function, submitted to treatment in the childhood and to identify the risk factors for gonadal dysfunction in this group. PATIENTS AND METHODS: Semen quality, hormonal status and testicular volume were evaluated in 151 patients treated from 1966 to 1994 in the A.C. Camargo Hospital. The age at diagnosis varied from 0.3 to 18.6 years old, with medium age 6.9 years; 114 (75.50%) patients were prepubertal (< 10 years) and 37 (24.50%) were pubertal. They were revaluated after a long period off (median of 14 years). The patients were separed in groups: group A (alterations at least in a variable: FSH, LH, testosterone, testicular volume and azoospermia), group B (increased FSH values and/or azoospermia) and group C (increased LH and/or testosterone values). RESULTS: Azoospermia was observed in 43 patients. Serum levels showed 36 patients with increased FSH values, 26 patients with abnormal total testosterone and 18 patient with increased LH values The testicular radiation was significant in three groups when compared the normal patients results versus abnormal ones (p<0.001). Nitrogen mustard and especially procarbazine were highly significant in group A and B (p<0.001),and daunorubicin (p<0.001) in group C. Logistic regression was observed that procarbazina showed the OR=7.7 for group B and OR= 10.3 for group A), etoposide (OR=3.9 for group A), doxorrubicina (OR=1.9 for group C), and testicular radiation (OR=38 for group C), were associated with impact in the gonadal dysfunction. CONCLUSIONS: The patients treated in the childhood with combined chemotherapy and/or radiotherapy presented evidences of gonadal, damage with increased FSH and/or azoospermia and/or reduction of testicular size, suggesting important damage to the germinal epithelium.

Tumor de células de Sertoli-Leydig do ovário: apresentação de um caso e revisão da literatura / Ovary tumor by Sertoli-Leydig cells tumor: a case report and review of the literature

Os autores relatam um caso de tumor de células de Sertoli e Leydig (TCSL), estádio Ia, no ovário direito de uma paciente com 10 anos de idade. O tumor era não funcionante e as manifestações iniciais foram dor e aumento do volume abdominal. Ao exame físico palpava-se uma massa endurecida na região hipogástrica. A criança não apresentava sinais de virilização ou puberdade precoce. O tratamento foi realizado com cirurgia: salpingo-ooforectomia direita e biópsia em cunha do ovário esquerdo. Histologicamente o tumor era bem diferenciado e não apresentava elementos heterólogos. A paciente apresenta há 26 meses sobrevida livre de doença. Acreditamos que este seja o primeiro caso de TCSL de ovário em crianças com idade igual ou inferior a 10 anos, publicado na literatura médica brasileira indexada.