Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies.

Congenital Zika syndrome is an emergent cause of a congenital infectious disorder, resulting in severe damage to the central nervous system and microcephaly. Despite advances in understanding the pathophysiology of the disease, we still do not know all the mechanisms enrolled in the vertical transmission of the virus. As has already been reported in other types of congenital infectious disorders in dizygotic twin pregnancies, it is possible that the virus affects only one of the fetuses. In this article, we report on two cases of twin pregnancies exposed to the Zika virus, but with only one of the fetuses affected with microcephaly and brain damage. This indicates the urgent need for more studies regarding the pathophysiology of viral infection and the mechanisms involved in the natural protection against the virus.

Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies / Evolução clínica discordante da infecção congénita do vírus Zika em gestação gemelar

ABSTRACT Congenital Zika syndrome is an emergent cause of a congenital infectious disorder, resulting in severe damage to the central nervous system and microcephaly. Despite advances in understanding the pathophysiology of the disease, we still do not know all the mechanisms enrolled in the vertical transmission of the virus. As has already been reported in other types of congenital infectious disorders in dizygotic twin pregnancies, it is possible that the virus affects only one of the fetuses. In this article, we report on two cases of twin pregnancies exposed to the Zika virus, but with only one of the fetuses affected with microcephaly and brain damage. This indicates the urgent need for more studies regarding the pathophysiology of viral infection and the mechanisms involved in the natural protection against the virus.

RESUMO A síndrome congênita do Zika vírus é uma causa de infecção congênita emergente, resultando em graves danos ao sistema nervoso central e microcefalia. Apesar dos avanços na compreensão da fisiopatologia da doença, ainda não conhecemos todo o mecanismo envolvido na transmissão vertical do vírus. Como já foi relatado em outros tipos de infecções congênitas em gestações gemelares dizigóticas, é possível que apenas um dos fetos seja afetado pelo vírus. Este artigo descreve 2 casos de gestações gemelares expostas ao vírus Zika, onde apenas um dos fetos foi afetado, com microcefalia associado a graves danos no sistema nervoso central. Isso indica a necessidade urgente de mais estudos sobre a fisiopatologia da infecção viral e os mecanismo envolvidos na proteção natural contra o vírus.

[Epidemiology and regional differences of diabetic retinopathy in Pernambuco, Brazil]. / Epidemiologia e diferenças regionais da retinopatia diabética em Pernambuco, Brasil.

PURPOSE: To evaluate the prevalence and severity of diabetic retinopathy among patients cared for in a screening program in Pernambuco, Brazil, comparing regional differences between urban and rural zones. METHODS: The charts of 2,223 diabetic patients (1,568 females and 655 males; mean age 59.3 +/- 12.0 years; mean duration of diabetes 8.1 +/- 6.3 years) that took part in a screening program for diabetic retinopathy at Altino Ventura Foundation from June 2004 to June 2005 were reviewed for the presence of the disease. Patients were divided into two groups: group I, patients living in Recife and the metropolitan area; group II, patients living in the interior of Pernambuco state. RESULTS: In group I, 477 (24.2%) patients had diabetic retinophathy, while in group II, 89 (39.4%) patients (p<0.0001). The frequency of proliferative diabetic retinophathy, macular edema, vitreous hemorrhage and retinal detachment was higher in group II patients (p<0.05). CONCLUSIONS: Patients living in the interior of Pernambuco state have a higher incidence of diabetic retinophathy and the advanced forms than patients living in Recife and the metropolitan area when examined in a screening program for diabetic retinopathy at the Altino Ventura Foundation. Telemedicine and descentralization actions are recommended for improvement of screening quality in patients living in the interior of Pernambuco state.

Epidemiologia e diferenças regionais da retinopatia diabética em Pernambuco, Brasil / Epidemiology and regional differences of diabetic retinopathy in Pernambuco, Brazil

OBJETIVOS: Avaliar os dados de freqüência e estadiamento da retinopatia diabética em Pernambuco, Brasil, comparando a região metropolitana com cidades do interior do estado. MÉTODOS: Os prontuários de 2.223 pacientes diabéticos (1.568 mulheres e 655 homens; idade média de 58,4 ± 12,0 anos; duração média do diabetes de 8,1 ± 6,3 anos), que fizeram parte de um programa de triagem para retinopatia diabética na Fundação Altino Ventura entre os meses de junho de 2004 e junho de 2005, foram revistos quanto à presença de retinopatia. Os pacientes foram divididos em dois grupos quanto à origem: grupo I, pacientes residentes em Recife e região metropolitana; grupo II, pacientes residentes no interior do estado de Pernambuco. RESULTADOS: No grupo I, 477 (24,2 por cento) pacientes apresentavam retinopatia diabética ao passo que no grupo II, 89 (39,4 por cento) pacientes (p<0,0001). A freqüência de retinopatia diabética proliferativa, edema macular, hemorragia vítrea e descolamento tracional de retina foi maior entre os pacientes do grupo II com significância estatística (p<0,05). CONCLUSÕES: Pacientes oriundos do interior do estado de Pernambuco apresentam maior prevalência de retinopatia diabética bem como de formas avançadas da doença em relação aos pacientes da região metropolitana quando atendidos na Campanha de Diabetes. Medidas de implantação de telemedicina ou descentralização das unidades são sugeridas para melhorar a qualidade da triagem de diabéticos residentes no interior do estado.

PURPOSE: To evaluate the prevalence and severity of diabetic retinopathy among patients cared for in a screening program in Pernambuco, Brazil, comparing regional differences between urban and rural zones. METHODS: The charts of 2,223 diabetic patients (1,568 females and 655 males; mean age 59.3 ± 12.0 years; mean duration of diabetes 8.1 ± 6.3 years) that took part in a screening program for diabetic retinopathy at Altino Ventura Foundation from June 2004 to June 2005 were reviewed for the presence of the disease. Patients were divided into two groups: group I, patients living in Recife and the metropolitan area; group II, patients living in the interior of Pernambuco state. RESULTS: In group I, 477 (24.2 percent) patients had diabetic retinophathy, while in group II, 89 (39.4 percent) patients (p<0.0001). The frequency of proliferative diabetic retinophathy, macular edema, vitreous hemorrhage and retinal detachment was higher in group II patients (p<0.05). CONCLUSIONS: Patients living in the interior of Pernambuco state have a higher incidence of diabetic retinophathy and the advanced forms than patients living in Recife and the metropolitan area when examined in a screening program for diabetic retinopathy at the Altino Ventura Foundation. Telemedicine and descentralization actions are recommended for improvement of screening quality in patients living in the interior of Pernambuco state.