Clinical aspects of congenital microcephaly syndrome by Zika virus in a rehabilitation center for patients with microcephaly

SUMMARY OBJECTIVE In this study, we intend to identify the prevalence of clinical variables in children with microcephaly. METHODS This is a cross-sectional and observational study with data collected from medical records of patients admitted to the microcephaly outpatient clinic of a referral center in Teresina-PI. Demographic (gender and age) and clinical data (presence of epilepsy, dysphagia, irritability, and associated comorbidities) were collected. The frequency of Zika virus as a probable etiology was determined from computed tomography patterns and the exclusion of other etiologies by serological tests. RESULTS A total of 67 patient records were evaluated, of which 31 were male and 36 were female, with a mean age of 1 year and 10 months. The most prevalent clinical variables were epilepsy, present in 47 children (70.2%), and irritability in 37 (55.2%). Also with a high frequency, 22 had dysphagia (32.8%), and 13 had musculoskeletal comorbidities (19.4%). Only three patients in the sample had cardiac abnormalities (4.5%), and no endocrine comorbidity was found. A total of 38 children in the sample (56.7%) presented ZIKV as a probable etiology and, in these cases, there was a higher frequency of epilepsy and dysphagia compared to other etiologies, although not statistically significant. CONCLUSION Epilepsy, irritability, dysphagia, and musculoskeletal comorbidities were the most frequent clinical variables in children with microcephaly. There was a high prevalence of congenital ZIKV microcephaly syndrome in this sample.

RESUMO OBJETIVO Pretende-se, neste estudo, identificar a prevalência de variáveis clínicas em crianças com microcefalia. MÉTODOS Trata-se de um estudo transversal e observacional com dados coletados de prontuários de pacientes admitidos no ambulatório de microcefalia de um centro de referência em Teresina (PI). Foram coletados dados demográficos (gênero Ve idade) e clínicos (presença de epilepsia, disfagia, irritabilidade e comorbidades associadas). A frequência de Zika vírus como provável etiologia foi determinada a partir de padrões da tomografia computadorizada e da exclusão de outras etiologias por exames sorológicos. RESULTADOS Foram avaliados 67 prontuários de pacientes, sendo 31 do sexo masculino e 36 do sexo feminino, com idade média de 1 ano e 10 meses. As variáveis clínicas mais prevalentes foram epilepsia, presente em 47 das crianças (70,2%), e irritabilidade, em 37 (55,2%). Também com elevada frequência, 22 possuíam quadro de disfagia (32,8%) e 13 apresentavam comorbidades osteomusculares (19,4%). Apenas três pacientes da amostra tinham quadro de alterações cardiológicas (4,5%) e nenhuma comorbidade endocrinológica foi encontrada. Trinta e oito crianças da amostra (56,7%) apresentaram ZIKV como provável etiologia e, nesses casos, houve maior frequência de epilepsia e disfagia em comparação com outras etiologias, embora não de forma significativa estatisticamente. CONCLUSÕES Epilepsia, irritabilidade, disfagia e comorbidades osteomusculares foram as variáveis clínicas mais frequentes em crianças com microcefalia. Houve uma prevalência alta de síndrome de microcefalia congênita por ZIKV nessa amostra.

Patologias osteomusculares como causa de aposentadoria por invalidez em servidores públicos do município de São Luís, Maranhão / Musculoskeletal pathology as a cause of disability retirement for public servants in the municipality of São Luís, Maranhão

Introdução: É evidente a preocupação do governo em regulamentar as ações relacionadas à saúde. É passível de aposentadoria por invalidez o servidor acometido de espondilite anquilosante e outras doenças osteomusculares. Objetivo: Descrever o perfil de morbidade por patologias osteomusculares dos servidores públicos do município de São Luís aposentados por invalidez. Materiais e Métodos: Trata-se de um estudo observacional, descritivo e retrospectivo, de 60 fichas de funcionários contendo informações registradas pela Comissão de Perícia Médica no período de janeiro de 2009 a dezembro de 2011. Calculou-se como indicador de impacto da aposentadoria por invalidez em doenças osteomusculares os somatórios dos anos perdidos em decorrência da aposentadoria. A condução do estudo recebeu anuência da Comissão de Perícia Médica do IPAM e dos funcionários por meio do Termo de Compromisso de Utilização de Prontuários e Termo de Consentimento Livre e Esclarecido. Resultados: A análise de aposentadoria por invalidez em razão do diagnóstico por patologias osteomusculares demonstra que ocorreu prevalência do sexo masculino (90,00%) na faixa etária de 61 a 65 anos, e as profissões mais acometidas foram professores e agente administrativo. As patologias osteomusculares ocorreram em 10,00% da amostra do estudo, e os profissionais que mais se aposentaram por invalidez tipo integral e/ou proporcional foram agente administrativo e auxiliar de serviços gerais. Conclusão: O estudo mostra a necessidade de promoção de saúde e vigilância em relação à saúde do trabalhador, propiciando melhores condições de trabalho e reduzindo o adoecimento dos servidores, diminuindo o número de aposentadoria por invalidez por patologias osteomusculares.

Background: It is clear the concern of governments to discipline the actions related to health. It is likely to disability retirement the server stricken with ankylosing spondylitis and other musculoskeletal diseases. Objective: Describe the morbidity profile for musculoskeletal pathologies of public in São Luís retired due to disability. Materials and Methods: This was an observational, descriptive and retrospective, study of 60 employee records containing information recorded by the Commission of Forensic Medicine between January 2009 and December 2011. The sums of years lost due to retirement were calculated as an indicator of the impact of disability retirement in musculoskeletal diseases. The conduct of the study received approval from the Commission of Forensic Medicine Division of IPAM and staff through the Commitment Term Use of Medical Records and Statement of Consent. Results: The analysis of disability retirement due to musculoskeletal disorders diagnosis shows that occurred primarily in men (90.00%) aged 61 ? 65 years, and the professionals most affected were teachers and administrative agent. The musculoskeletal disorders occurred in 10.00% of the study sample, and the most retired for disability integral type and/or proportional were administrative agent and assistant general services. Conclusion: The study shows the need for health promotion and surveillance in relation to workers' health, providing better working conditions and reducing illness among servers, reducing the number of disability pension for musculoskeletal pathologies.

Prevalence and factors associated with thoracic alterations in infants born prematurely / Prevalência e fatores associados às alterações torácicas em lactentes nascidos prematuros

OBJECTIVE: To determine the prevalence of thoracic musculoskeletal alterations and associated factors in infants born prematurely. METHODS: This was a cross sectional study with infants in the first year of age, born prematurely with birth weight < 2,000 g, who were followed up at the Premature Clinic from February, 2007 to December, 2008. Exclusion criteria were: maj or congenital malformations as defined by the Centers for Disease Control and Prevention (CDC), grade III/IV intraventricular hemorrhage, or periventricular leucomalacia. Physical examinations performed independently by two physiotherapists were used to assess shoulder elevation and thoracic retractions. Comparisons between groups were performed using the chi-squared test or Fisher's exact test for categorical variables, and Mann-Whitney's test or Student's t-test were used for continuous variables. Interobserver reliability between the two physiotherapists was assessed by the kappa coefficient. Variables associated with these thoracic musculoskeletal alterations were studied by univariate and multiple logistic analyses. Statistical differences were considered significant when p < 0.05. This study was approved by the ethical committee of the institution, and parents/guardians signed an informed consent. RESULTS: 121 infants with a gestational age of 31.1 ± 2.8 weeks and birth weight of 1,400 ± 338 g were included. Thoracic alterations were detected by Physiotherapist 1 in 81 (66.9%) infants, and in 83 (68.6%) by Physiotherapist 2 (kappa coefficient = 0.77). By multivariate logistic regression analysis, factors associated with thoracic musculoskeletal alterations were: respiratory distress syndrome (odds ratio [OR] = 3.246, 95% confidence interval [CI]: 1.237-8.732), bronchopulmonary dysplasia (OR = 11.138, 95% CI: 1.339-92.621), and low length/age ratio (OR = 4.571, 95% CI: 1.371-15.242). CONCLUSION: The prevalence of thoracic alterations was high in infants born prematurely, and was associated with pulmonary disease and low length/age ratio.

OBJETIVO: Determinar a prevalência e os fatores associados às alterações torácicas musculoesqueléticas em lactentes nascidos prematuros. MÉTODOS: Estudo transversal com lactentes no primeiro ano de vida, nascidos prematuros com peso < 2000 g e acompanhados em um ambulatório de seguimento de prematuros, de fevereiro/2007 a dezembro/2008. Foram excluídas crianças com malformações maiores definidas pelo CDC ou com hemorragia peri-intraventricular grau III/IV ou leucomalácia periventricular. Duas fisioterapeutas realizaram o exame físico, avaliando, de modo independente, a elevação de ombros e as retracões da caixa torácica. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição, sendo solicitada assinatura do Termo de Consentimento pelos pais. As variáveis numéricas foram comparadas pelo teste t ou Mann-Whitney. O grau de concordância entre as avaliações das fisioterapeutas foi obtido pelo coeficiente kappa e as variáveis associadas às alterações torácicas foram estudadas por regressão logística univariada e múltipla. Considerou-se significante p < 0,05. RESULTADOS: Foram estudados 121 lactentes com idade gestacional de 31,1 ± 2,8 semanas e peso ao nascer de 1400 ± 338 g. A fisioterapeuta 1 detectou alterações torácicas em 81 (66,9%) lactentes e a fisioterapeuta 2 em 83 (68,6%) (coeficiente kappa = 0,77). Os fatores associados às alterações musculoesqueléticas foram: síndrome do desconforto respiratório no período neonatal (OR=3,246; IC 95%: 1,237-8,732), ter apresentado displasia broncopulmonar (OR=11,138; IC 95%: 1,339-92,621) e relação comprimento para a idade alterada (OR=4,571; IC 95%: 1,371-15,242). CONCLUSÃO: A prevalência de alterações torácicas foi alta em lactentes nascidos prematuros e associou-se a doença pulmonar no período neonatal e baixa relação comprimento/idade.

The presence of accessory soleous muscle in humans / Estudo da presença do músculo sóleo acessório em humanos

Objective: To verify the prevalence of the accessory soleus muscle in humans and according to gender. Methods: A total of 154 magnetic resonance images of the ankle were assessed in T1 weighted sagittal, coronal and axial planes. Results: An incidence of 11.6% of accessory soleus muscle in humans was observed; in that, 7.8% in males and 15.6% in females. Conclusion: The accessory soleus muscle incidence was 11.6% in the samples studied and it was more often present in females.

Objetivo: Verificar a prevalência do músculo sóleo acessório em humanos e em relação ao gênero. Métodos: Foram observadas 154 imagens de ressonância magnética do tornozelo em cortes sagitais, coronais e axiais ponderadas em T1. Resultados: Observamos a incidência de 11,6% do músculo sóleo acessório em humanos - 7,8% em indivíduos do gênero masculino e 15,6% em indivíduos do gênero feminino. Conclusão: O músculo sóleo acessório teve incidência de 11,6% nas amostras estudadas e sua presença foi maior em indivíduos do gênero feminino.

Prevalence of Birth Defects in Korean Livebirths, 2005-2006

We investigated the livebirths prevalence and occurrence pattern of birth defects in Korea. After the survey on birth defects was done in 2,348 medical institutions around the nation, the birth defect prevalence of livebirths in 2005-2006 was calculated. This study was based on the medical insurance claims database of the National Health Insurance Corporation. The number of livebirths in Korea was 883,184 from 2005-2006, and 25,335 cases of birth defects were notified to our study, equivalent to a prevalence of 286.9 per 10,000 livebirths. Anomalies of the circulatory system were the most common defects, accounting for 43.4% of birth defects with a prevalence of 124.5 per 10,000 livebirths. It was followed by the musculoskeletal system anomalies, the digestive system anomalies, and the urinary system anomalies. The five major birth defects based on the ranking of prevalence were atrial septal defect, ventricular septal defect, hydronephrosis, patent ductus arteriosus, and cleft lip/palate. Birth defects in livebirths were associated with a high proportion of low birthweight, prematurity, multiple births and advanced maternal age. The prevalence of birth defects in Korea is similar to or lower than those reported in developed countries. Our study suggests baseline data to explain the current status of birth defects and to establish a registry system of birth defects in Korea.

Incidence of congenital malformation in 2 major hospitals in Rivers state of Nigeria from 1990 to 2003

Although congenital malformations are believed to be on the rise in the oil production areas of Nigeria, few baseline data are available. This retrospective study documented the incidence of congenital abnormalities in 2 major hospitals in Port Harcourt, an oil-rich city in Rivers state, Nigeria. Delivery and nursery records were reviewed from January 1990 to December 2003. In the first hospital 78 congenital anomalies were recorded out of 19 572 births [4.00/1000], principally affecting the central nervous system [1.84/1000] and skeletal system [1.74/1000]. In the second hospital, 47 congenital anomalies were recorded out of 20 121 births [2.20/1000], with malformations of the central nervous system [0.80/1000] and skeletal system [1.14/1000] again predominating. More research is needed into long-term trends in congenital malformations and possible associations with environmental pollution in Rivers state

Prevalência de pectus carinatum e pectus excavatum em escolares de Manaus / Prevalence of pectus carinatum and pectus excavatum in students in the city of Manaus, Brazil

OBJETIVO: Determinar a prevalência das deformidades congênitas da parede torácica anterior em escolares de 11 a 14 anos. MÉTODOS: Participaram do estudo escolares da rede estadual de ensino da cidade de Manaus (AM). Para a composição de uma amostra estatisticamente significativa, com precisão de 1 por cento e IC95 por cento, foram incluídos 1.332 escolares. A deformidade pectus foi identificada através de exame físico do tórax, e os indivíduos com esta deformidade responderam a um questionário com questões sobre hereditariedade e sintomatologia decorrente da anomalia torácica. RESULTADOS: A idade média dos participantes foi de 11,7 anos. A prevalência da deformidade pectus foi de 1,95 por cento (pectus excavatum: 1,275 por cento; pectus carinatum: 0,675 por cento). Dos 26 escolares com deformidades pectus, 17 (65,4 por cento) tinham pectus excavatum, e 18 (69,2 por cento) eram do sexo masculino. Houve associação com a escoliose em 3 casos (11,5 por cento). História familiar de pectus foi relatada por 17 escolares (65,4 por cento), e 17 (65,4 por cento) relataram dor torácica, dispneia ou palpitações. CONCLUSÕES: A prevalência das deformidades pectus encontrada neste estudo (1,95 por cento) foi inferior àquela de trabalhos em outras regiões do país (3,6-4,9 por cento), porém, superior àquela relatada na literatura (média, 1 por cento).

OBJECTIVE: To determine the prevalence of congenital anterior chest wall deformities in 11- to 14-year-old students. METHODS: Students participating in the study were recruited from public schools in the city of Manaus, Brazil. The statistically significant sample (precision, 1 percent; 95 percent CI) comprised 1,332 students. Pectus deformities were identified by physical examination of the chest, and the individuals with one of these deformities completed a questionnaire regarding heredity and symptoms resulting from the chest abnormality. RESULTS: The mean age of the participants was 11.7 years. The prevalence of pectus abnormalities was 1.95 percent (pectus excavatum: 1.275 percent; pectus carinatum: 0.675 percent). Of the 26 students with a pectus deformity, 17 (65.4 percent) had pectus excavatum, and 18 (69.2 percent) were male. Concomitant scoliosis was observed in 3 cases (11.5 percent). A family history of pectus was reported by 17 students (65.4 percent), and 17 (65.4 percent) reported chest pain, dyspnea or palpitations. CONCLUSIONS: In this study, the prevalence of pectus deformities (1.95 percent) was lower than that reported in other studies conducted in Brazil (3.6-4.9 percent) but was higher than that reported in the literature (mean, 1 percent).

Congenital malformations among live births at Arvand hospital, Ahwaz, Iran - Aprospective study

The aim of the study was to determine the profile of congenital malformations [CM] among live births at Arvand hospital, in Ahwaz city. In this prospective study all of the neonates born at Arvand hospital in Ahwaz from 2004 to 2006 were registered. Stillbirths and those who died in a few hours after birth were excluded and finally 4660 newborns were enrolled. Of the 4660 live births 94 [20.2/1000] had at least a CM. The predominant systems involved were musculoskeletal [7.9/1000], followed by genitourinary [7.1/1000], central nervous [2.4 /1000], digestive [1.1/1000] and chromosomal anomalies [0.9/1000]. Although the frequency of malformations in the study was approximately similar to other investigations, if we include abortions, stillbirths and if we used screening tests and genetic studies, this rate was more than 20.1/1000

Down syndrome associated malformations.

This paper reports the associated malformations and the clinical findings that were observed in 417 cytogenetically confirmed Down Syndrome patients. Among them congenital heart defects have occurred more frequently [75; 17.98%] than osteoarticular malformations [23; 5.52]; eye anomalies [22; 5.27%]; and gastroenterological malformations [n 16; 3.84%]. With regard to prognosis and treatment appropriate counselling has been given to Down Syndrome patients and their families.

Malformaciones congénitas en recién nacidos vivos / Congenital malformations in living newborns

Se estudió retrospectivamente la incidencia y prevalencia de las malformaciones congénitas (MC) en recién nacidos vivos (RNV) registradas durante dos años (1987-1988) en el Hospital Universitario "Dr. José Eleuterio González", Monerrey, N.L. Los datos se tabularon siguiendo los códigos de clasificación de la Organización Mundial de la Salud, se agruparon por aparatos y sistemas y por sexo. De 9,675 nacidos vivos, 224 (2.31%) presentaron MC: 102 hombres , 121 mujeres y uno de sexo indererminado. La mayor incidencia le correspondió al sistema nervioso central, siguiendo en orden descendente las malformaciones cardiovasculares, el sistema músculo-esquelético, labio y paladar hendido, aparato digestivo, aparato genital, anomalías cromosómicas, aparato respiratorio, aparato urinario y catarata congénita. La prevalencia d elas MC en nuestro medio es semejante a la reportada en otros países respecto a los defectos del tubo neural. Las malformaciones músculo-esqueléticas y las múltiples son menos frecuentes que en otros centros hospitalarios.