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4.
J Trop Pediatr ; 65(4): 328-335, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30252119

RESUMO

OBJECTIVE: The objectives of this study were to describe the findings of the auditory screening in children of mothers with ZIKV during pregnancy or suspicious of congenital ZIKV, and to determine whether hearing loss was in the first 2 years in life, regardless of whether microcephaly was also present. METHODS: This is a cases report. The information was collected and recorded in a database between January 2016 and April 2018. We perform two auditory tests to 3 and 24 months of life. The study was developed in Aguachica (Cesar, Colombia). It is considered a high-risk area for ZIKV infection. Participants included children of mothers with confirmed ZIKV during pregnancy or suspicious of congenital ZIKV exposure of ZIKV infection during an epidemic period in a tropical area. We defined a positive case according to the epidemiological definition and clinical criteria based on maternal symptoms. However, other children of mothers without clinical signs of Zika were evaluated at the same time. The main outcome was the presence of sensorineural hearing loss. RESULTS: The median age in the study group (n = 43) was 3.5 months (rank: 0-6) and the comparison group (n: 23, children of mothers without clinical signs of ZIKV) was 3 months (rank: 0-12). Screening hearing test was done using distortion product otoacustic emissions. At 3 months follow-up, children were evaluated using distortion product otoacustic emissions and automatized auditory brainstem response. None of the patients evaluated in this study were found to have sensorineural hearing loss. CONCLUSIONS: We did not find hearing loss during the first 2 years in the children whose mother showed Zika during pregnancy. We recommend these children must be assessed to closed because there is a high risk the hearing loss as it usually may occur with CMV.

9.
Travel Med Infect Dis ; 23: 14-20, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29471046

RESUMO

The multiple, wide and diverse etiologies of congenital microcephaly are complex and multifactorial. Recent advances in genetic testing have improved understanding of novel genetic causes of congenital microcephaly. The recent Zika virus (ZIKV) epidemic in Latin America has highlighted the need for a better understanding of the underlying pathological mechanisms of microcephaly including both infectious and non-infectious causes. The diagnostic approach to microcephaly needs to include potential infectious and genetic etiologies, as well as environmental in-utero exposures such as alcohol, toxins, and medications. Emerging genetic alterations linked to microcephaly include abnormal mitotic microtubule spindle structure and abnormal function of centrosomes. We discuss the diagnostic challenge of congenital microcephaly in the context of understanding the links with ZIKV emergence as a new etiological factor involved in this birth defect.


Assuntos
Transmissão Vertical de Doença Infecciosa , Microcefalia/etiologia , Infecção por Zika virus/congênito , Infecção por Zika virus/complicações , Epidemias , Feminino , Humanos , América Latina , Gravidez , Complicações Infecciosas na Gravidez/virologia , Zika virus , Infecção por Zika virus/epidemiologia
10.
Curr Drug Discov Technol ; 15(2): 156-160, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29046161

RESUMO

BACKGROUND: Therapy with inhaled nitric oxide (iNO) is effective in the management of pulmonary hypertension and severe hypoxemia. However, these benefits have not been demonstrated in preterm infants (<34 weeks). The objective of this report is to present the experience of eight cases of preterm neonates with respiratory distress syndrome (RDS) and refractory hypoxemia, with oligohydramnios history. METHODS: We evaluated the clinical feature of 8 preterm neonates with severe hypoxemia who had maternal antecedents of oligoamnios, mainly due to premature rupture of membranes. They were treated with conventional management, with poor clinical response. Therefore, these neonates were treated with iNO, as a rescue strategy. iNO has been used with a dosage of 5 - 10 ppm. An echocardiogram was performed to determine the presence of structural malformations or persistent ductus arteriosus. RESULTS: All the infants showed improvement in oxygenation. The neonates had signs of low flow pulmonary, confirmed by echocardiogram. Five preterm infants survived without complications associated with the therapy. Two died from pulmonary bleeding secondary to ductus arteriosus and another for pneumothorax. CONCLUSION: iNO therapy can be useful in a subgroup of preterm infants with a high risk of death secondary to hypoxemia. Although this report is based on a small number of cases, it follows the directions of other studies that suggest that iNO therapy can benefit preterm neonates, particularly those exposed to oligohydramnios.


Assuntos
Hipóxia/tratamento farmacológico , Recém-Nascido Prematuro , Óxido Nítrico/administração & dosagem , Oligo-Hidrâmnio/tratamento farmacológico , Administração por Inalação , Feminino , Humanos , Hipóxia/diagnóstico por imagem , Hipóxia/etiologia , Recém-Nascido , Masculino , Oligo-Hidrâmnio/diagnóstico por imagem , Gravidez
12.
Arch. argent. pediatr ; 115(6): 432-435, dic. 2017. ilus, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-887408

RESUMO

Se reporta un caso de edema agudo hemorrágico de la infancia, en un lactante de 18 meses, después de un episodio de otitis media. El cuadro comenzó con máculas eritematosas en los muslos, seguidas de lesiones purpúricas en los brazos, las piernas y edema en los tobillos. Se interpretó, inicialmente, como urticaria, por lo que recibió esteroides. Sin embargo, las características clínicas fueron de edema agudo hemorrágico de la infancia, una vasculitis leucocitoclástica benigna que se presenta en niños de entre 4 y 24 meses y que se caracteriza por fiebre, máculas y lesiones purpúricas. Estas se ubican, principalmente, en la cara, los lóbulos de las orejas y las extremidades, y se asocian, muchas veces, a edema. Los diagnósticos diferenciales son eritema multiforme, urticaria, vasculitis inducida por droga, enfermedad de Kawasaki, eccema infectado, meningococcemia y maltrato infantil, algunas de ellas, con riesgo de mortalidad. El manejo es conservador, sin embargo, los esteroides podrían ser una opción terapéutica.


We report a case of acute hemorrhagic edema of infancy in an 18-month-old boy after an episode of otitis media. The clinical presentation begins with skin erythematous macules on the thighs, followed by purpuric lesions in arms, legs, and ankle edema. It was initially interpreted as urticaria, whereby steroids were indicated. However, the clinical feature was acute hemorrhagic edema of infancy, a benign leukocytoclastic vasculitis that occurs in children between 4 and 24 months of age and is characterized by fever, large purpuric palpable target-like skin lesions affecting the face, lobes of the ears, limbs and frequently associated with edema. Differential diagnosis includes erythema multiforme, hemorrhagic urticaria, drug-induced vasculitis, Kawasaki disease, infected eczema, sepsis (either meningococcal or non-meningococcal) and child abuse. Some of them have risk of mortality. Management is conservative, however, steroids may be a therapeutic option.


Assuntos
Humanos , Masculino , Lactente , Dermatopatias/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnóstico , Dermatopatias/tratamento farmacológico , Urticária/diagnóstico , Hidrocortisona/uso terapêutico , Prednisona/uso terapêutico , Doença Aguda , Vasculite Leucocitoclástica Cutânea/tratamento farmacológico , Diagnóstico Diferencial , Edema/diagnóstico , Hemorragia/diagnóstico , Anti-Inflamatórios/uso terapêutico
13.
Arch Argent Pediatr ; 115(6): e432-e435, 2017 12 01.
Artigo em Espanhol | MEDLINE | ID: mdl-29087129

RESUMO

We report a case of acute hemorrhagic edema of infancy in an 18-month-old boy after an episode of otitis media. The clinical presentation begins with skin erythematous macules on the thighs, followed by purpuric lesions in arms, legs, and ankle edema. It was initially interpreted as urticaria, whereby steroids were indicated. However, the clinical feature was acute hemorrhagic edema of infancy, a benign leukocytoclastic vasculitis that occurs in children between 4 and 24 months of age and is characterized by fever, large purpuric palpable target-like skin lesions affecting the face, lobes of the ears, limbs and frequently associated with edema. Differential diagnosis includes erythema multiforme, hemorrhagic urticaria, drug- induced vasculitis, Kawasaki disease, infected eczema, sepsis (either meningococcal or non-meningococcal) and child abuse. Some of them have risk of mortality. Management is conservative, however, steroids may be a therapeutic option.


Assuntos
Dermatopatias/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnóstico , Doença Aguda , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Edema/diagnóstico , Hemorragia/diagnóstico , Humanos , Hidrocortisona/uso terapêutico , Lactente , Masculino , Prednisona/uso terapêutico , Dermatopatias/tratamento farmacológico , Urticária/diagnóstico , Vasculite Leucocitoclástica Cutânea/tratamento farmacológico
14.
Rev Peru Med Exp Salud Publica ; 34(2): 332-336, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-29177397

RESUMO

Congenital toxoplasmosis continues to be a public health threat. Even existing guidelines, publicly known, its implementation and lack of appropriate interpretation of serological tests in pregnancy is often observed. This leds to failure in opportunities for positive and known interventions to decrease the fetal risk due to Toxoplasma gondii infection. We reported herein a case series, with variable neurological and systemic compromise (respiratory distress, hepatosplenomegaly, enterocolitis, brain calcifications, thrombocytopenia, ascites, shock), even fatal, calling for awareness about the fact that despite the Zika epidemics in 2015-2016 in Brazil, Colombia and other countries, precisely toxoplasmosis, is a differential diagnosis still prevalent in these territories, that can leds to severe consequences, with neurological disability and risk of ocular damage, even lately. Additionally, with varieties of T. gondii with more aggressive patterns in Latin America, which make worse those cases, including also a higher risk of death.


Assuntos
Toxoplasmose Cerebral/diagnóstico , Toxoplasmose Cerebral/epidemiologia , Toxoplasmose Congênita/diagnóstico , Toxoplasmose Congênita/epidemiologia , Infecção por Zika virus/diagnóstico , Colômbia/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência
15.
Infez Med ; 25(3): 241-246, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28956541

RESUMO

In this study, we investigated the weekly reported spatio-temporal distribution and topographic risk factors for Zika virus (ZIKV) infection in northeastern Colombia. Weekly reported surveillance data, including clinical, suspected and confirmed cases from the ongoing ZIKV epidemic in the Santander and Norte de Santander departments (Santanderes) in Colombia were used to estimate cumulative incidence rates. Spatial analysis was performed to develop hot spot maps and to identify spatial topographic risk factors for infection. From January 1, 2016 to March 19, 2016, 11,515 cases of ZIKV were reported in Santanderes, with cumulative rates of 316.07 cases/100,000 population for the region (representing 18.5% of the cases of the country). Five municipalities (four in Norte de Santander) reported high incidence of ZIKV infection (>1,000 cases/100,000 pop); these municipalities are close to the border with Venezuela. Most of the cases reported occurred mainly in low altitude areas, and persistent hot spots were observed. Higher infection rates were reported in the Northeastern part of the study area. Use of risk maps can help guide decisions for the prevention and control of ZIKV. Hotspots on the Colombia-Venezuela border can have implications for international spread.


Assuntos
Infecção por Zika virus/epidemiologia , Altitude , Cidades , Colômbia/epidemiologia , Surtos de Doenças , Geografia Médica , Humanos , Incidência , Estudos Retrospectivos , Risco , Doença Relacionada a Viagens , Venezuela , Infecção por Zika virus/transmissão
16.
Rev. peru. med. exp. salud publica ; 34(2): 332-336, abr.-jun. 2017. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS, LIPECS | ID: biblio-902908

RESUMO

RESUMEN La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun existiendo guías plenamente divulgadas y conocidas, se observa poca implementación de las mismas y falta de adecuada interpretación de pruebas serológicas en gestantes Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. Reportamos una serie de casos, con compromiso neurológico y sistémico (dificultad respiratoria, hepatoesplenomegalia, enterocolitis, calcificaciones cerebrales, trombocitopenia, corioretinis, ascitis, choque). Si bien el virus de Zika causó epidemia en 2015-2016 en Brasil, Colombia y otros países, toxoplasmosis es un diagnóstico diferencial aún prevalente en estos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Adicionalmente, existen algunas variedades de cepas de T. gondii con comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos, incluyendo además mayor riesgo de muerte.


ABSTRACT Congenital toxoplasmosis continues to be a public health threat. Even existing guidelines, publicly known, its implementation and lack of appropriate interpretation of serological tests in pregnancy is often observed. This leds to failure in opportunities for positive and known interventions to decrease the fetal risk due to Toxoplasma gondii infection. We reported herein a case series, with variable neurological and systemic compromise (respiratory distress, hepatosplenomegaly, enterocolitis, brain calcifications, thrombocytopenia, ascites, shock), even fatal, calling for awareness about the fact that despite the Zika epidemics in 2015-2016 in Brazil, Colombia and other countries, precisely toxoplasmosis, is a differential diagnosis still prevalent in these territories, that can leds to severe consequences, with neurological disability and risk of ocular damage, even lately. Additionally, with varieties of T. gondii with more aggressive patterns in Latin America, which make worse those cases, including also a higher risk of death.

17.
Rev Chil Pediatr ; 88(2): 280-284, 2017 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-28542663

RESUMO

Adequate pupil dilation is needed to evaluate some neonates at risk of developing illness during this stage. However, this procedure is not free of adverse effects, either local or systemic. One of these complications is the local vasoconstriction of the preterm baby’s skin following the application of mydriatic eye drops. OBJECTIVE: To describe secondary local and systemic complications of pharmacological pupil dilation in 2 newborns. Clinical case 1: Full term baby with diagnosis of low-birth weight and hydrocephalia. An ophtalmological evaluation was performed at 5 days of age due to the presence of corneal opacities. Peri ocular pallor was observed during the procedure, as well as tachycardia and hypertension 2 hours later, spontaneosly recovered. Case 2: Preterm newborn, 27 weeks of gestational age. Neonatal respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage and hydrocephalia were diagnosed at birth. At 28 days of life an ophtalmological evaluation was performed. After 10 minutes of mydriatic drops administration to evaluate preterm retinopathy, peri ocular pallor was observed, with spontaneous resolution; however, 24 hours later, the patient showed abdominal distention and feeding intolerance. Necrotizing enterocolitis was discarded, and symptoms were spontaneosly recovered. CONCLUSION: The establishment of protocols in relation to the number of drops to apply for dilation is needed to reduce deleterious effects on high risk infants, such as premature babies and those with hydrocephalus. Therefore this monitoring practice should be performed during the evaluation.


Assuntos
Hidrocefalia/fisiopatologia , Midriáticos/administração & dosagem , Vasoconstrição/efeitos dos fármacos , Permeabilidade do Canal Arterial/patologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Midriáticos/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/patologia
18.
Rev. chil. pediatr ; 88(2): 280-284, abr. 2017. ilus
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-844612

RESUMO

Una adecuada dilatación pupilar es necesaria para evaluar a neonatos con riesgo de desarrollar enfermedades oftalmológicas. Sin embargo, este procedimiento no está libre de efectos adversos locales o sistémicos. La vasoconstricción local posterior a la aplicación de midriáticos es una de estas complicaciones, existiendo además descritos efectos secundarios sistémicos. Objetivo: Presentar complicaciones asociadas al uso de midriáticos en 2 recién nacidos sometidos a evaluación oftalmológica. Caso clínico 1: Recién nacido de término con diagnóstico prenatal de restricción de crecimiento intrauterino e hidrocefalia. Al 5º día de vida se solicitó evaluación oftalmológica por presencia de opacidades corneales. Al realizar el procedimiento se evidenció palidez periorbitaria, al igual que taquicardia e hipertensión arterial en las siguientes 2 horas post procedimiento. Estos efectos secundarios se resolvieron espontáneamente pocas horas después del procedimiento. Caso clínico 2: Neonato de pretérmino de 27 semanas de gestación con antecedentes de síndrome de dificultad respiratoria, ductus arterioso persistente, hemorragia intraventricular grado III e hidrocefalia severa. Se solicitó examen oftalmológico a los 28 días de vida por sospecha de retinopatía del prematuro. A los 10 minutos post administración de midriáticos se observó palidez periorbitaria bilateral sin deterioro de signos vitales, presentando 24 horas después intolerancia a la alimentación y distensión abdominal. Se descartó enterocolitis necrotizante. Conclusión: Es necesario establecer protocolos clínicos en relación al uso de midriáticos para reducir efectos deletéreos en neonatos de alto riesgo, como son los prematuros y aquellos con hidrocefalia. Por lo tanto, la monitoría debería realizarse durante la evaluación.


Adequate pupil dilation is needed to evaluate some neonates at risk of developing illness during this stage. However, this procedure is not free of adverse effects, either local or systemic. One of these complications is the local vasoconstriction of the preterm baby’s skin following the application of mydriatic eye drops. Objective: To describe secondary local and systemic complications of pharmacological pupil dilation in 2 newborns. Clinical case 1: Full term baby with diagnosis of low-birth weight and hydrocephalia. An ophtalmological evaluation was performed at 5 days of age due to the presence of corneal opacities. Peri ocular pallor was observed during the procedure, as well as tachycardia and hypertension 2 hours later, spontaneosly recovered. Case 2: Preterm newborn, 27 weeks of gestational age. Neonatal respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage and hydrocephalia were diagnosed at birth. At 28 days of life an ophtalmological evaluation was performed. After 10 minutes of mydriatic drops administration to evaluate preterm retinopathy, peri ocular pallor was observed, with spontaneous resolution; however, 24 hours later, the patient showed abdominal distention and feeding intolerance. Necrotizing enterocolitis was discarded, and symptoms were spontaneosly recovered. Conclusion: The establishment of protocols in relation to the number of drops to apply for dilation is needed to reduce deleterious effects on high risk infants, such as premature babies and those with hydrocephalus. Therefore this monitoring practice should be performed during the evaluation.

19.
Arch. argent. pediatr ; 115(2): 140-147, abr. 2017. ilus, tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-838340

RESUMO

Introducción. Se hanreportado altas prevalencias de síntomas depresivos en familiares de recién nacidos hospitalizados en unidades de cuidado intensivo neonatal. Esto ocasiona un alto impacto negativo para el vínculo familiares-recién nacido. Objetivo. Determinar la prevalencia de síntomas depresivos y sus factores asociados en cuidadores de recién nacidos hospitalizados en una Unidad de Cuidado Intensivo Neonatal en Colombia. Materiales y métodos. Estudio de corte transversal analítico en una institución de salud de alto nivel de complejidad especializada en patologías cardiovasculares. Se aplicó el Inventario de Depresión de Beck-II al ingreso y ocho días después. Se consideró presencia de síntomas depresivos cuando los cuidadores presentaban depresión intermitente, moderada, grave o extrema. Se realizaron análisis bivariados y multivariados usando modelos de regresión binomial. Resultados. Se analizó un total de 107 niños con sus cuidadores. La prevalencia de síntomas depresivos fue 20,56% (IC 95%: 12,77-28,34) en la medición basal y 12,86% (IC 95%: 4,120,89) al octavo día. Los cuidadores de sexo masculino y de 30 años de edad o más tuvieron menor riesgo de presentar síntomas depresivos, mientras que ser cabeza de familia, tener nivel de primaria o ningún grado de escolaridad y que sus hijos hubieran tenido Apgar al nacer de 1-6 representaron factores de riesgo para síntomas depresivos. Conclusiones. La prevalencia de síntomas depresivos fue alta. Ser cabeza de familia, tener baja escolaridad y Apgar al nacer entre 1 y 6 fueron factores asociados a síntomas depresivos en los cuidadores.


Introduction. A high prevalence of depressive symptoms has been reported in family members of newborn infants hospitalized in neonatal intensive care units. This causes a high negative impact on the newborn infant-family bond.Objective. To establish the prevalence of depressive symptoms and their associated factors in caregivers of newborn infants hospitalized in a neonatal intensive care unit in Colombia. Materials and Methods. Cross-sectional, analytical study conducted at a tertiary care health facility specialized in cardiovascular disease.The Beck Depression Inventory-II was administered upon admission to the NICU and on Day 8. Depressive symptoms were considered present if caregivers had intermittent, moderate, severe, or extreme depression. Bivariate and multivariate analyses were done using binomial regression models.Results. A total of 107 children and their caregivers were studied. The prevalence of depressive symptoms was 20.56% (95% confidence interval [CI]: 12.77-28.34) at baseline and 12.86% (95% CI: 4.1-20.89) on Day 8. Male caregivers and caregivers older than 30 years old had a lower risk of having depressive symptoms whereas being the head of the household, having completed primary education or no education at all, and having a baby with an Apgar score at birth of 1-6 were risk factors for developing depressive symptoms. Conclusions. The prevalence of depressive symptoms was high. Being the head of the household, having a low level of education, and an Apgar score at birth of 1-6 were associated with depressive symptoms among caregivers.


Assuntos
Humanos , Recém-Nascido , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Cuidadores/psicologia , Depressão/epidemiologia , Unidades de Terapia Intensiva Neonatal , Prevalência , Estudos Transversais , Depressão/etiologia , Hospitalização
20.
Arch Argent Pediatr ; 115(2): 140-147, 2017 04 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28318179

RESUMO

INTRODUCTION: A high prevalence of depressive symptoms has been reported in family members of newborn infants hospitalized in neonatal intensive care units. This causes a high negative impact on the newborn infant-family bond. OBJECTIVE: To establish the prevalence of depressive symptoms and their associated factors in caregivers of newborn infants hospitalized in a neonatal intensive care unit in Colombia. MATERIALS AND METHODS: Cross-sectional, analytical study conducted at a tertiary care health facility specialized in cardiovascular disease. The Beck Depression Inventory-II was administered upon admission to the NICU and on Day 8. Depressive symptoms were considered present if caregivers had intermittent, moderate, severe, or extreme depression. Bivariate and multivariate analyses were done using binomial regression models. RESULTS: A total of 107 children and their caregivers were studied. The prevalence of depressive symptoms was 20.56% (95% confidence interval [CI]: 12.77-28.34) at baseline and 12.86% (95% CI: 4.1-20.89) on Day 8. Male caregivers and caregivers older than 30 years old had a lower risk of having depressive symptoms whereas being the head of the household, having completed primary education or no education at all, and having a baby with an Apgar score at birth of 1-6 were risk factors for developing depressive symptoms. CONCLUSIONS: The prevalence of depressive symptoms was high. Being the head of the household, having a low level of education, and an Apgar score at birth of 1-6 were associated with depressive symptoms among caregivers.


Assuntos
Cuidadores/psicologia , Depressão/epidemiologia , Adolescente , Adulto , Estudos Transversais , Depressão/etiologia , Feminino , Hospitalização , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
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