El recién nacido expuesto a cocaína antenatal: una propuesta de intervención médica y psicosocial integrada / The newborn exposed to antenatal cocaine: a proposal for integrated medical and psychosocial intervention

Introducción: El consumo de cocaína durante la gestación gatilla isquemia, muerte y licuefacción celular en el cerebro fetal, consolidando en la infancia grados variables de retraso mental. El presente estudio busca identificar mediante test de drogas en orina los recién nacidos (RN) expuestos a cocaína en el embarazo y describir el procedimiento clínico y social a seguir. Metodología: Estudio de cohorte prospectivo enero 2016 y enero 2018 en RN con exposición antenatal a cocaína, Unidad de Neonatología del Hospital Clínico San Borja Arriarán. Resultados: Se estudió a 64 RN con test en orina positivo a cocaína. El 42% fue pequeño para la edad gestacional, 33% tenía microcefalia. Se encontraron malformaciones en sistema nervioso y vías urinarias, trastornos del ritmo cardíaco e hipoacusia. Solo 32,8% de las madres controló su embarazo y 52% rechazó la rehabilitación. Servicio Social interpuso medidas de protección a los RN e instó a las madres a programas de rehabilitación. El 12,5% de los RN no tenía familia de apoyo y debió ser derivado a instituciones gubernamentales. Conclusiones: Las consecuencias de la exposición a cocaína antenatal en el RN son devastadoras. Este trabajo permite orientar la pesquisa, estudio y pasos legales a seguir con los RN afectados y sus madres.

Introduction: The consumption of cocaine during pregnancy triggers events such as ischemia, death and cell liquefaction in the fetal brain, consolidating varying degrees of intellectual disability. This study proposed to identify by urine drug test the newborns (NB) with antenatal exposure to and describe the clinical and social procedure to follow with them and their mothers until neonatal discharge. Methodology: Prospective cohort study, conducted in RN who met criteria for risk of antenatal exposure to cocaine, Neonatology Unit of the San Borja Arriaran Clinical Hospital between January 2016 -2018. Results: Antenatal exposure to cocaine was confirmed on 64 NB. Forty-two percent of them were small for gestational age and 33% had microcephaly. Malformations were found in the nervous system urinary tract, as well as disorders in the rhythm of the heart and loss of hearing. Only 32% of mothers controlled her pregnancy, none of them was derived to the secondary. Social Services implemented all the NB protective measures in place and urged mothers to participate in rehabilitation programs. Fifty-two percent rejected rehabilitation and 12.5% of the NB have not family support and had to be referred to government institutions. Conclusions: The consequences of exposure to antenatal cocaine in the NB are devastating. This work allows orienting the research with the NB and showing the legal steps should be taken with the RN and their mothers.

O que sabemos das alterações auditivas centrais em crianças expostas ao álcool na gestação? Revisão sistemática / What we know of the central auditory disorders in children exposed to alcohol during pregnancy? Systematic review

RESUMO Objetivo Identificar os efeitos da ingestão de álcool na gestação sobre o sistema nervoso auditivo central em relação aos seus possíveis diagnósticos, Síndrome Fetal do Álcool, Síndrome Fetal do Álcool Parcial, Distúrbios ao Nascimento Relacionados ao Álcool e Distúrbio do Neurodesenvolvimento Relacionado ao Álcool, sua extensão e o método de avaliação auditiva. Estratégia de pesquisa Busca sistemática e integrativa nas bases de dados PubMed, LILACS e SciELO, com os termos em português e inglês “síndrome fetal do álcool”, “desordens relacionadas ao uso do álcool” associadas a “audição”. Critérios de seleção Dos 123 resumos identificados, foram seis selecionados, publicados até maio de 2015. Análise dos dados Foram elencados tópicos a serem respondidos, caracterização da casuística; o diagnóstico decorrente da exposição fetal nas crianças; método de avaliação auditiva; e resultados descritos. Resultados Entre as avaliações comportamentais, foram utilizados os testes dicóticos verbais com sílabas e com sentenças e o teste fala com ruído. Entre os testes eletrofisiológicos, no Potencial Evocado Auditivo de Tronco Encefálico, foi detectada alteração de sincronia neural, e no Potencial Evocado Auditivo de Longa Latência – P300, valores de latência precoces. Conclusão Existem evidências de que as crianças e adultos jovens expostos ao álcool na gestação apresentam sinais de comprometimento do sistema nervoso auditivo central, mas não foi possível caracterizar essas alterações nos diferentes subtipos diagnósticos do espectro. As vias auditivas corticais foram as mais investigadas e o método eletrofisiológico o mais utilizado, com um resultado inesperado em dois deles, a latência precoce da N2 e da P300.

ABSTRACT Purpose To identify the effects of alcohol intake during pregnancy on the central auditory nervous system in relation to their possible diagnosis, Fetal Alcohol Syndrome, partial Fetal Alcohol Syndrome, Alcohol-Related Birth Defects and Alcohol-Related Neurodevelopmental Disorder, his extension and the hearing assessment method. Research strategy Systematic and integrative review searched the databases PubMed, LILACS and SciELO, with terms in Portuguese and English “fetal alcohol syndrome”, “alcohol-related disorders” associated with “hearing”. Selection criteria: We identified 123 abstracts, six were selected and published until May 2015. Data analysis Were listed topics to be answered, characterization of the sample; the diagnosis result of fetal exposure; method of hearing assessment and described results. Results Among the behavioral assessments, Verbal Dichotic Tests with syllables and sentences and Speech in Noise Test, were used. Among the electrophysiological tests, the Brainstem Auditory Evoked Potential was detected change neural synchrony, and Long-Latency Auditory Evoked Potential – P300, early latency values. Conclusion There is evidence that children exposed to alcohol in utero present central auditory nervous system involvement signals, but it was not possible to identify the influence of different subtypes and their losses. Cortical auditory pathways were the most investigated and the electrophysiological method as used with an unexpected result in two of them, early N2 and P300 latency.

Are 2D: 4D finger-length ratios an indicator of androgenetic alopecia in males?

Abstract BACKGROUND: Although the pathogenesis of androgenetic alopecia is not completely understood, the roles of genetic susceptibility and androgens are well-known. A lower ratio of the second digit (index finger = 2D) to the fourth digit (ring finger = 4D) length has been hypothesized to reflect prenatal androgen exposure and/or higher sensitivity to androgens. OBJECTIVES: To determine the relationship between the second to fourth digit length ratio and androgenetic alopecia. METHODS: Finger length measurements were made by a digital vernier calliper. Androgenetic alopecia severity was assessed using the Hamilton-Norwood scale. Subjects with an androgenetic alopecia score of grade III or more were included in the study. RESULTS: A total of 189 males with androgenetic alopecia and 171 healthy controls were enrolled in the study. The age range of participants was 19-65 years. The 2D:4D ratios in patients with androgenetic alopecia were significantly lower than those of healthy controls for the right hand; however, no significant difference was found for the left hand. Average 2D:4D ratios in androgenetic alopecia patients were also lower than in controls. No significant relationship was observed between androgenetic alopecia severity and 2D:4D ratios. CONCLUSION: Our data support the anatomical evidence of in utero androgen exposure and/or an individual’s sensitivity to androgens in patients with androgenetic alopecia. Furthermore, the right hand 2D:4D ratio might be an indicator of androgenetic alopecia development.

Longitudinal assessment of mercury exposure in schoolchildren in an urban area of the Brazilian Amazon / Avaliação longitudinal da exposição ao mercúrio em crianças de uma área urbana na Amazônia brasileira

This study was a longitudinal assessment of mercury exposure in schoolchildren in an urban area of the Brazilian Amazon. The study population consisted of 90 children whose exposure levels were assessed by testing mercury levels in the umbilical cord blood and mothers' blood samples in 2000-2001, and in the children's hair and blood samples. The study also used a questionnaire on demographic and socioeconomic data, fish consumption, and self-reported disease history. Mean mercury level in hair in 2010 was approximately 1µg/g, ranging up to 8.22µg/g, similar to 2004 and 2006. These figures can be explained by low fish consumption. Mean blood mercury levels at birth exceeded 10µg/L, ranging up to nearly 60µg/L, which indicates mercury transfer across the placenta. There was a significant increase in blood mercury from 2004 to 2006 (p < 0.001), suggesting exposure through air pollution. The main exposure to mercury was during pregnancy.

O objetivo deste estudo foi realizar avaliação longitudinal da exposição de crianças de uma área urbana da Amazônia brasileira ao mercúrio (Hg). A população foi composta por 90 crianças, cuja exposição foi avaliada desde o nascimento por meio das análises dos teores de Hg no sangue do cordão umbilical e no sangue das mães em 2000/2001, e em amostras de cabelo e sangue das crianças. Os procedimentos incluíram também um questionário com informações demográficas, socioeconômicas, sobre consumo de peixes e morbidade referida. A média dos teores de Hg no cabelo em 2010 foi próxima a 1µg/g e sua amplitude 8,22µg/g, semelhantes aos anos 2004 e 2006, podendo ser explicada pela baixa ingestão de peixes. A média dos teores de Hg no sangue das crianças ao nascer ultrapassou 10µg/L e sua amplitude atingiu quase 60µg/L, indicando transferência do Hg através da barreira placentária. Ocorreu aumento significativo dos teores de Hg no sangue entre 2004 e 2006 (p < 0,001), sugerindo a possibilidade de exposição atmosférica ao Hg. O principal período de exposição ao Hg ocorreu durante a gestação.

Estudo da audição de crianças de gestantes expostas ao ruído ocupacional: avaliação por emissões otoacústicas - produto de distorção / Study of the hearing in children born from pregnant women exposed to occupational noise: assessment by distortion product otoacoustic emissions

OBJETIVO: Detectar precocemente uma possível perda auditiva em crianças de mulheres expostas ao ruído ocupacional durante o período de gestação e verificar se há diferença nos resultados das amplitudes de resposta das emissões otoacústicas - produto de distorção - entre as crianças de mães expostas ao ruído ocupacional e as crianças de mães não-expostas ao ruído ocupacional. MÉTODOS: Crianças de mulheres expostas ao ruído ocupacional durante a gestação e crianças de mulheres não-expostas foram avaliadas através das emissões otoacústicas - produto de distorção -, usando o equipamento GSI 60 DPOEA SYSTEM e empregando a razão de F2/F1 igual a 1,2 e a média geométrica de 2F1-F2. As intensidades das freqüências primárias mantiveram-se fixas, com valores de L1=65 dBNPS e L2=55 dBNPS para F1 e F2, respectivamente. Utilizou-se o teste t-Student em amostras emparelhadas e amostras independentes e o teste não-paramétrico de Wilcoxon. RESULTADOS: Não houve diferença nos valores das medidas das médias das amplitudes de resposta do produto de distorção entre os grupos controle e estudo. Também não houve diferença estatisticamente significante entre os sexos masculino e feminino nas amplitudes de respostas para os grupos controle e estudo, nem entre as orelhas direita e esquerda de cada grupo. CONCLUSÃO: Não foi observado prejuízo auditivo nas crianças de mães expostas ao ruído ocupacional durante a gestação em comparação as crianças de mães não-expostas. Não houve diferença entre as orelhas direita e esquerda e entre os sexos masculino e feminino de cada grupo.

AIM: To detect early on a probable hearing loss in children of women exposed to occupational noise during their pregnancy and to verify if there is any difference between the children from those women exposed to occupational noise during their pregnancy and the ones from mothers that do not work under the same conditions. METHODS: Children from women exposed to occupational noise during their pregnancy and children from women who were not exposed were evaluated through distortion product otoacoustic emissions, using the GSI 60 DPOEA SYSTEM equipment and the frequency-ratio F2/F1 equal to 1.2 and the geometric average of 2F1-F2. The intensity of the primary frequencies were kept steady with values of L1=65dBSPL and L2=55dBSPL for F1 and F2, respectively. Student T test in paired samples and independent samples were used. RESULTS: There were no differences in the response amplitude of distortion product otoacoustic emissions between the control and the study groups. There was no statistically difference between male and female children in response amplitude for the two groups aforementioned; and there were no differences between right and left ears from each group. CONCLUSION: We did not observe hearing impairment in children whose mothers were exposed to occupational noise during pregnancy when compared to the children from mothers who were not. There was no difference between the right and left ears, nor between male and female children in each group.