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1.
Article in Chinese | WPRIM | ID: wpr-921533

ABSTRACT

Objective To evaluate the effects of antiretroviral therapy(ART)for the prevention of mother-to-child transmission(PMTCT)of acquired immune deficiency syndrome(AIDS)on the growth and development of 18-month-old children born by human immunodeficiency virus(HIV)-positive pregnant women in Lingshan County,Guangxi Zhuang Autonomous Region,and provide scientific evidence for improving the ART medication plan for PMTCT.Methods Lingshan County,ranking the first in the HIV-epidemic counties of Guangxi,was selected as the research site.According to the design of retrospective case-control study,we assigned all the subjects into the case group and the control group:(1)The case group included the HIV-positive pregnant women who had received ART for PMTCT and their HIV-negative infants in Lingshan County from 2010 to 2017.The historical cards and PMTCT data of them were collected from the national PMTCT database.(2)The control group included the healthy pregnant women and their healthy babies born in the Lingshan Maternity and Infant Hospital in 2017,and the children's growth and development data were collected.The stunted growth in children was defined as at least one of the three main indicators of body height,body weight,and head circumference below the normal range.Results The number of HIV-positive mothers and their infants in the case group was 391 and 368,respectively,and 87.21%(341/391)and 95.38%(351/368)of mothers and infants respectively received ART medication.The HIV positive rate,mortality rate,and mother-to-child transmission rate of 18-month-old children were 1.36%(5/368),4.35%(16/368),and 2.01%(5/249),respectively.The incidence of stunted growth of 18-month-old children in the case group and the control group was 42.12%(155/368)and 23.06%(101/438),respectively,with significant difference(


Subject(s)
Case-Control Studies , China/epidemiology , Female , Growth and Development , HIV , HIV Infections/prevention & control , Humans , Infant , Infectious Disease Transmission, Vertical/prevention & control , Mothers , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Retrospective Studies
2.
Rev. chil. infectol ; 37(1): 51-63, feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1092722

ABSTRACT

Resumen La tuberculosis en etapa neonatal tiene una alta morbimortalidad, es de difícil diagnóstico e involucra al binomio madre-hijo y su entorno. Las características particulares del sistema inmune en la mujer gestante y el recién nacido, impactan en la presentación clínica de esta enfermedad. Su diagnóstico es complejo y la instauración del tratamiento debe ser oportuna e impostergable. Se abarcan aspectos relevantes para el diagnóstico y manejo del recién nacido expuesto a la tuberculosis


Abstract Tuberculosis in the neonatal stage has a high morbidity and mortality, is difficult to diagnose and involves the mother-child binomial and their environment. The particular characteristics of the immune system in pregnant women and the newborn, impact the clinical presentation of this disease. Its diagnosis is complex and the establishment of treatment must be timely and cannot be postponed. Relevant aspects for the diagnosis and management of the newborn exposes to the tuberculosis are covered.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Child , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/drug therapy , Tuberculosis/diagnosis , Tuberculosis/prevention & control , Tuberculosis/drug therapy
3.
Cad. Saúde Pública (Online) ; 36(1): e00057219, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055614

ABSTRACT

Abstract: To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.


Resumo: O estudo buscou avaliar a adequação do atendimento pré-natal oferecido nas capitais brasileiras e o diagnóstico da sífilis gestacional através de dados públicos dos sistemas de informação de saúde. Foi construído o indicador de Kotelchuck modificado para adequação do atendimento pré-natal, usando dados do Sistema de Informações sobre Nascidos Vivos (SINASC). Foram acessados em sites públicos os dados sobre sífilis gestacional, sífilis congênita, estimativa da cobertura populacional pela Estratégia Saúde da Família (ESF), Índice de Desenvolvimento Humano (IDH) municipal e dados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). O perfil das gestantes associado ao atendimento inadequado foi avaliado com base na regressão logística. Foram analisados um total de 685.286 nascimentos. Apenas 2,3% das mulheres não receberam atendimento pré-natal. A taxa média de adequação foi de 79,7%. Não foi encontrada correlação entre a adequação do pré-natal e a cobertura pela ESF (p = 0,172), mas houve correlação com o IDH municipal (p < 0,001). A inadequação da assistência pré-natal mostrou associação com a idade < 20 anos, escolaridade < 4 anos, raça/cor não-branca e situação conjugal sem companheiro. Entre os casos de sífilis congênita, 17,2% das mães não haviam recebido atendimento pré-natal, e a sífilis gestacional afetava mais as gestantes vulneráveis, incluindo uma proporção maior de adolescentes, mulheres com baixa escolaridade e mulheres não brancas. O PMAQ-AB mostrou uma disponibilidade mediana de 27,3% de testes rápidos para sífilis, 67,7% para penicilina benzatina e 86,7% para administração de penicilina benzatina pela equipe de saúde. O uso de dados públicos revelou baixa adequação do atendimento pré-natal nas capitais brasileiras, denotando qualidade insuficiente para o diagnóstico e tratamento da sífilis gestacional, apesar da disponibilidade de insumos. O monitoramento contínuo pode ser realizado com o uso de dados públicos, indicando estratégias locais para eliminar a sífilis congênita.


Resumen: El objetivo de este trabajo ha sido evaluar la adecuación de la atención prenatal que se ofreció en capitales brasileñas, y el diagnóstico de sífilis gestacional, mediante datos públicos de los sistemas de información de salud. El indicador modificado de Kotelchuck para la adecuación de la atención prenatal se construyó usando datos del Sistema de Información sobre Nacidos Vivos (SINASC). La información sobre sífilis gestacional, sífilis congénita, así como la cobertura de población estimada por la Estrategia Salud de Familia (ESF), Índice de Desarrollo Humano (IDH) municipal y datos del Programa Nacional para el Acceso Mejorado y Calidad de la Atención Básica (PMAQ-AB) se recabaron de sitios web públicos. El perfil de las mujeres embarazadas asociado con el cuidado inadecuado fue evaluado mediante regresión logística. En total, se analizaron 685.286 nacimientos. Solamente un 2,3% de las mujeres no atendieron a citas prenatales. La adecuación media fue de un 79,7%. No se encontró correlación entre la adecuación del cuidado prenatal y la cobertura de la ESF (p = 0,172), pero se encontró una correlación positiva con el MHDI (p < 0,001). La inadecuación del cuidado prenatal estuvo asociada con una edad < 20 años, escolaridad < 4 años, raza no blanca y no tener pareja. Entre los casos de sífilis congénita, un 17,2% de las madres no asistieron a la atención prenatal. La sífilis gestacional afectó más a menudo a las mujeres vulnerables, incluyendo una más alta proporción de adolescentes, mujeres con baja escolaridad, y mujeres de color no blanco. La PMAQ-AB mostró un promedio de disponibilidad de un 27,3%, en el caso de test rápidos de sífilis, un 67,7% para la penicilina benzatínica, y un 86,7% para la administración penicilina benzatínica por equipos de salud. El uso de los datos públicos mostró una baja adecuación del cuidado prenatal en capitales brasileñas, denotando una insuficiente calidad para el diagnóstico y tratamiento de la sífilis gestacional, a pesar de la disponibilidad de suministros. La supervisión continua se puede llevar a cabo usando datos públicos, apuntando a estrategias locales para eliminar la sífilis congénita.


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications, Infectious/diagnosis , Prenatal Care/standards , Syphilis/diagnosis , Pregnancy Complications, Infectious/drug therapy , Prenatal Diagnosis , Socioeconomic Factors , Syphilis, Congenital/prevention & control , Brazil , Information Systems , Syphilis/drug therapy , Disease Notification
4.
Rev. bras. ginecol. obstet ; 41(9): 539-547, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042335

ABSTRACT

Abstract Objective To describe a population of pregnant women diagnosed with toxoplasmosis and their respective newborns, describing the hospital protocol for treatment and follow-up. Methods Retrospective cohort of pregnant women with acute toxoplasmosis infection and risk of transplacental transmission who were sent to the Fetal Medicine Group of Hospital de Clínicas de Porto Alegre (HCPA) between - January 1, 2006 and December 31, 2016. All patients with confirmed disease were included. The diagnostic protocol and treatment were applied; a polymerase chain reaction (PCR) analysis of the amniotic fluid was used to diagnose toxoplasmosis and determine the treatment. The newborns were followed up at the pediatric outpatient clinic specializing in congenital infection. The patients who were not followed up or were not born in the HCPA were excluded. Results A total of 65 patients were confirmed to have gestational toxoplasmosis; 40 performed amniocentesis, and 6 (15%) were identified as having positive PCR in the amniotic fluid. In five of those cases, this result associated with the gestational age defined the triple therapy during pregnancy, and in one case, it defined the monotherapy (advanced gestational age). A total of 4 of these newborns were treated from birth with triple therapy for 10months, 1 was not treated (due to maternal refusal), and 1 progressed to death within the first 54 hours of life due to complications of congenital toxoplasmosis. Of the 34 remaining cases with a negative PCR, 33 were treated with monotherapy and 1 was treated with triple therapy (ultrasound findings); of these children, 9 (26.5%) presented negative immunoglobulin G (IgG), 24 (70.6%) presented positive IgG (but none presented positive immunoglobulin M [IgM]), and 1 (2,9%) presented alterations compatible with congenital disease and started treatment with the triple therapy soon after birth. Out of the total sample of 60 patients, among the 25 who did not perform amniotic fluid PCR, 5 were treated with triple therapy (ultrasound findings/prior treatment) and 20 patients were submitted to monotherapy; only two newborns underwent treatment for congenital toxoplasmosis. Among the 65 cases of gestational toxoplasmosis, 6 (9,2%) children had a diagnosis of congenital toxoplasmosis, and 2 patients with triple therapy felt severe adverse effects of the medications. Conclusions The present study suggests that research on PCR screening of the amniotic fluid may be useful to identify patients with a higher potential for fetal complications, who may benefit from the poly-antimicrobial treatment. Patients with negative PCR results must continue to prevent fetal infection with monotherapy, without risk of fetal or maternal impairment.


Resumo Objetivo Descrever uma população de pacientes diagnosticadas com toxoplasmose na gestação e seus respectivos recém-nascidos, relatando o protocolo do hospital durante o tratamento e seguimento. Métodos Coorte retrospectiva de gestantes com infecção aguda por toxoplasmose e risco de transmissão transplacentária, encaminhadas para acompanhamento pelo Grupo deMedicina Fetal doHospital de Clínicas de Porto Alegre (HCPA) entre 1o de janeiro de 2006 e 31 de dezembro de 2016. Todas as pacientes comdoença confirmada foram incluídas. O protocolo de diagnóstico e tratamento foi aplicado; uma análise da reação em cadeia da polimerase (RCP) no líquido amniótico foi utilizada para diagnosticar a toxoplasmose e determinar o tratamento. Os recém-nascidos foram acompanhados no ambulatório de pediatria especializadoeminfecções congênitas. Pacientes que não foramseguidas ou cujo parto não foi feito no hospital foram excluídas. Resultados A toxoplasmose gestacional foi confirmada em 65 pacientes; 40 realizaram amniocentese, e 6 (15%) foram identificadas com RCP positiva no líquido amniótico. Este resultado associado à idade gestacional definiu a terapia tríplice durante a gestação em 5 casos, e a monoterapia em 1 caso (por idade gestacional avançada). Quatro destas crianças foram tratadas desde o nascimento com terapia tríplice por 12 meses, 1 não foi tratada (por recusa materna), e 1 evoluiu com óbito dentro das primeiras 54 horas de vida devido a complicações da toxoplasmose congênita. Dos 34 casos remanescentes com RCP negativa, 33 foram tratados com monoterapia, e 1 foi tratado com terapia tríplice (por achados ultrassonográficos); destes recém-nascidos, 9 (26,5%) tiveram imunoglobulina G (IgG) negativa, 24 (70,6%) tiveram IgG positiva, mas nenhum apresentou imunoglobulina M (IgM) positiva, e 1 (2,9%) apresentou alterações compatíveis comdoença congênita e iniciou a terapia tríplice logo após o nascimento. Entre as 25 pacientes que não fizeram RCP no líquido amniótico, 5 foram tratadas com terapia tríplice (por achados ultrassonográficos/ tratamento prévio) e 20 receberam monoterapia; somente 2 recém-nascidos receberam tratamento para toxoplasmose congênita. Entre os 65 casos de toxoplasmose gestacional, 6 (9,2%) recém-nascidos tiveram o diagnóstico de toxoplasmose congênita. Um total de 2 pacientes submetidas à terapia tríplice apresentaram efeitos adversos severos das medicações utilizadas. Conclusão Este estudo sugere que a triagem da RCP para toxoplasmose do líquido amniótico pode ser útil no rastreamento de pacientes com maior potencial para complicações fetais, que podem se beneficiar do tratamento poli antimicrobiano. Pacientes com RCP negativa devem continuar a prevenir a infecção fetal com monoterapia, sem risco de comprometimento fetal ou materno.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/epidemiology , Toxoplasmosis/diagnosis , Toxoplasmosis/drug therapy , Toxoplasmosis/epidemiology , Brazil , Toxoplasmosis, Congenital/diagnosis , Toxoplasmosis, Congenital/drug therapy , Toxoplasmosis, Congenital/epidemiology , Retrospective Studies , Follow-Up Studies , Ultrasonography, Prenatal , Amniocentesis/statistics & numerical data , Hospitals, University , Antiprotozoal Agents/administration & dosage , Antiprotozoal Agents/therapeutic use
5.
Rev. bras. ginecol. obstet ; 41(2): 90-96, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003534

ABSTRACT

Abstract Objective: The present study assessed epidemiological and obstetrical data from pregnant women with syphilis at the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (UFTM, in the Portuguese acronym), describing this disease during pregnancy and its vertical transmission for future healthcare actions. Methods: Records from pregnant women who had been admitted to the Obstetrics Department of the Hospital de Clínicas of the UFTM and were diagnosed with syphilis between 2007 and 2016 were reviewed. A standardized form was used to collect epidemiological, obstetric data and outcomes of congenital infection. The present research has been authorized by the Ethics Committee of the institution. Results: There were 268 women diagnosed with syphilis, with an average age of 23.6 years old. The majority of the patients were from Uberaba. Inadequate prenatal care was observed in 37.9% of the pregnant women. Only 34.2% of the patients completed the treatment according to the guidelines issued by the Ministry of Health of Brazil, and 19.8% of the partners of the patients underwent adequate syphilis treatment; 37 (13.8%) couples (patients and partners) underwent correct treatment. Regarding the obstetric outcomes, 4 (1.5%) patients had a miscarriage and 8 (3.4%) had fetal losses (from the fetal loss group, 7 had no adequate treatment); 61 (25.9%) patients had premature births - this prematurity has been significantly correlated to inadequate or incomplete treatment in 49 (27.9%) patients, compared with 12 (13.0%) patients with premature births and adequate treatment (p = 0.006). The average live newborn weight was 2,840 g; 25.3% had a birth weight < 2,500 g; 74.2% had congenital syphilis, a data with heavy correlation to inadequate or incomplete prenatal care, prematurity, and low birth weight. Conclusion: Public awareness policies on adequate prenatal care, intensification of serological screening, and early treatment of syphilis are needed, considering the rise of cases diagnosed during gestation and its potentially preventable deleterious consequences related to congenital transmission.


Resumo Objetivo: O presente estudo avaliou dados epidemiológicos e obstétricos de gestantes com sífilis no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (UFTM), objetivando o conhecimento desta infecção no ciclo gravídico e a transmissão vertical para futuras ações em saúde pública. Métodos: Foram revisados registros de gestantes admitidas no Departamento de Ginecologia e Obstetrícia do Hospital de Clínicas da UFTM, diagnosticadas com sífilis entre 2007 e 2016. Para a coleta de dados, utilizou-se um formulário padronizado enfocando aspectos epidemiológicos, obstétricos e infecção congênita. A presente pesquisa foi autorizada pelo Comitê de Ética da instituição. Resultados: Obteve-se 268 gestantes diagnosticadas com sífilis, com idade media de 23,6 anos, sendo a maioria de Uberaba. A assistência pré-natal foi inadequada em 37,9% dos casos. O tratamento para sífilis, de acordo com as diretrizes do Ministério da Saúde do Brasil, foi realizado por 34,2% das gestantes e por 19,8% dos parceiros. Quanto aos desfechos obstétricos, observou-se que 4 (1,5%) pacientes evoluíram com abortamento e 8 (3,4%) com óbito fetal, das quais 7 não realizaram tratamento. Observou-se parto prematuro em 61 (25,9%) gestantes, e a prematuridade foi significativamente associada ao tratamento ausente/incompleto, com 49 (27,9%) casos, comparada a 12 (13,0%) casos nos quais o tratamento foi adequado (p = 0,006). Quanto aos recém-nascidos, o peso médio foi de 2.840 g, e 25,3% apresentaram peso < 2.500 g. Diagnosticou-se infecção congênita em 74,2%, dos casos, associada significativamente ao pré-natal inadequado, ao tratamento ausente/ incompleto, à prematuridade e ao baixo peso ao nascer. Conclusão: Políticas públicas de conscientização sobre pré-natal adequado, intensificação de rastreamento sorológico e tratamento precoce da sífilis são necessárias, haja vista a ascensão dos casos diagnosticados na gestação e suas consequências deletérias potencialmente evitáveis relacionadas à transmissão congênita.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Young Adult , Pregnancy Complications, Infectious/epidemiology , Syphilis/epidemiology , Penicillin G Benzathine/administration & dosage , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Prenatal Diagnosis , Prognosis , Syphilis, Congenital/drug therapy , Syphilis, Congenital/epidemiology , Ceftriaxone/administration & dosage , Brazil/epidemiology , Drug Administration Schedule , Syphilis/diagnosis , Syphilis/drug therapy , Retrospective Studies , Treatment Outcome , Hospitalization/statistics & numerical data , Hospitals, Public/statistics & numerical data , Anti-Bacterial Agents/administration & dosage
6.
Rev. bras. ginecol. obstet ; 41(2): 97-101, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003529

ABSTRACT

Abstract Objective To analyze the prescription of antimicrobial agents for pregnant women admitted into the obstetrics service who presented with acute pyelonephritis. Methods Three cross-sectional studies were performed comparing the prescription of antimicrobials for pyelonephritis in pregnant women in the time periods evaluated (2010-2011: 99 patients evaluated; 2013: 116 patients evaluated; 2015: 107 patients evaluated), at the Hospital Fêmina, Porto Alegre, in the state of Rio Grande do Sul, Brazil. The analysis was performed before and after the promotion of an institutional protocol for the treatment of pyelonephritis during pregnancy, and on a third occasion after the introduction of a smartphone-based mobile educational tool. Results The evaluation of the prescribing physicians and the adequacy of the prescriptions between the different periods studied revealed a significant increase in appropriate conduct for the choice of antimicrobial (2010: 83.8%; 2013: 95.7%; and 2015: 100%), route of administration (2010: 97%; 2013: 100%; and 2015: 100%), and interval (2010: 91.9%; 2013: 95.7%; and 2015: 100%), following the introduction of the protocol, and again after the implementation of the softwareapplicationwithorientationsontheantimicrobial treatment. Conclusion The use of specific mobile applications should be encouraged to attain a better quality and accuracy in prescriptions and to include strategies that not only reduce the risk of negative outcomes, but also improve the quality of care and treatment for maintaining the health both of the mother and of the baby.


Resumo Objetivo Analisar a prescrição de antimicrobianos para gestantes admitidas no serviço de obstetrícia que apresentaram pielonefrite aguda. Métodos Foram realizados três estudos transversais comparando a prescrição de antimicrobianos para pielonefrite em gestantes nos períodos avaliados (2010-2011: 99 indivíduos avaliados; 2013: 116 indivíduos avaliados; 2015: 107 indivíduos avaliados), no Hospital Fêmina, Porto Alegre, RS, Brasil. A análise foi realizada antes e após a promoção de um protocolo institucional para o tratamento da pielonefrite durante a gravidez e, em uma terceira ocasião, após a introdução de uma ferramenta educacional móvel para uso por smartphone. Resultados A avaliação das prescrições médicas e a adequação das prescrições entre os diferentes períodos estudados revelaram um aumento significativo na conduta adequada para a escolha do antimicrobiano (2010: 83,8%; 2013: 95,7%; e 2015: 100%), via de administração (2010: 97%; 2013: 100%; e 2015: 100%) e intervalo (2010: 91,9%; 2013: 95,7%; e 2015: 100%), após a introdução do protocolo, e novamente após a implementação do aplicativo com orientações sobre tratamento antimicrobiano. Conclusão O uso de aplicativos móveis específicos deve ser incentivado para obter melhor qualidade e precisão nas prescrições e incluir estratégias que não apenas reduzam o risco de resultados negativos, mas que também melhorem a qualidade dos cuidados e do tratamento para manter a saúde conjunta da mãe e do bebê.


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pyelonephritis/drug therapy , Mobile Applications , Anti-Bacterial Agents/therapeutic use , Obstetrics/education , Drug Prescriptions/standards , Quality of Health Care , Urinary Tract Infections/drug therapy , Practice Patterns, Physicians'/standards , Brazil , Clinical Protocols , Acute Disease , Cross-Sectional Studies , Retrospective Studies , Cell Phone , Education, Medical/methods , Hospitalization
7.
Clinics ; 74: e318, 2019. tab, graf
Article in English | LILACS | ID: biblio-1039577

ABSTRACT

OBJECTIVE: The present literature review aims to highlight gaps in the treatment of preventative mother-to-child HIV transmission and the risk factors in Brazil. METHODS: Among the 425 articles identified in SciELO and PubMed searches, 59 articles published between 1994 and 2016 were selected for reading and data extraction, and 33 articles were included in the present review. RESULTS: The rates of vertical HIV transmission described in the studies varied widely, from 1.8% to 27.8%, with a significant reduction over the years. However, recent rates were also found to be variable in different regions of Brazil, and despite the significant reduction in mother-to-child transmission, many gaps remain in prevention services. A failure to attend prenatal care is the main factor associated with the increased risk of vertical transmission of HIV, hindering early maternal diagnosis and the completion of preventative measures during the prenatal period and, often, the peripartum and postnatal periods. A small number of studies discussed the sociodemographic factors, including a low level of education for pregnant women and the inadequacies of health services, such as difficulties scheduling appointments and undertrained staff, associated with vertical transmission. As such, the current challenge is to better define the sociodemographic and infrastructural factors that increase the risk of mother-to-child transmission of HIV to provide the necessary investments to promote an earlier inclusion of these populations in prevention services. CONCLUSIONS: This review may serve as a guide for future programs to focus efforts on the prevention of vertical HIV transmission.


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications, Infectious/drug therapy , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Anti-HIV Agents/therapeutic use , Prenatal Care , Brazil , Zidovudine/therapeutic use , HIV Infections/prevention & control , Risk Factors , Drug Therapy, Combination
8.
Rev. chil. obstet. ginecol. (En línea) ; 83(3): 291-294, jun. 2018. graf
Article in Spanish | LILACS | ID: biblio-959517

ABSTRACT

RESUMEN El Staphylococcus sciuri es un estafilococo coagulasa negativo presente en animales de granja que en raras ocasiones se puede encontrar como microorganismo colonizador en humanos. Su importancia radica en que se ha asociado con infecciones graves como la endocarditis, peritonitis e infección del tracto urinario; constituyendo el 0,79% del número total de estafilococos coagulasa negativos aislados en muestras clínicas. Presentamos el caso de una primigesta de 22 años, con un embarazo de 17,5 semanas. La exploración física inicial evidenció taquicardia y temperatura de 39.3 ° C. Los estudios de laboratorio informaron leucocitos de 25,000, neutrófilos de 83%, plaquetas en 350,000, uroanálisis con marcada piuria, con más de 500 células/uL, nitritos negativos; tinción de Gram de orina con cocos Gram positivos. Después de tres días de tratamiento con Ceftriaxona un gramo cada doce horas intravenosamente, se obtienen informes positivos para S.sciuri multiresistente. Finalmente, se inició manejo con Clindamicina 600 mg cada seis horas intravenosamente, más Gentamicina a dosis de 1 mg/kg cada ocho horas intravenosamente. S.sciuri es una bacteria que se ha encontrado en el ambiente hospitalario y ocasionalmente es aislada en humanos, produciendo infecciones graves. Países como Colombia continúan tratando las infecciones sin tener en cuenta su propio entorno, en el cual los patógenos silvestres son causa frecuente de infecciones, debido al estrecho rango de coexistencia entre animales y humanos en las regiones rurales. Conclusión. Este caso pone de manifiesto la necesidad de considerar como agenta causal aquellos patógenos presentes en animales de granja que pueden causar infecciones en humanos, sobretodo en pacientes que proceden de las áreas lejanas a los centros urbanos.


SUMMARY Staphylococcus sciuri is a negative coagulase staphylococcus present in farm animals that can rarely be found as a colonizing microorganism in humans. Its importance is that it has been associated with serious infections such as endocarditis, peritonitis and urinary tract infection; constituting 0.79% of the total number of coagulase-negative staphylococci isolated in clinical samples. We present the case of a woman in her first pregnancy of 22 years, with a pregnancy of 17.5 weeks. The initial physical examination showed tachycardia and temperature of 39.3 ° C. Laboratory studies reported leukocytes of 25,000, neutrophils of 83%, platelets in 350,000, urinalysis with marked pyuria, with more than 500 cells / uL, negative nitrites; Gram stain of urine with Gram positive cocci. After three days of treatment with Ceftriaxone one gram every twelve hours intravenously, positive reports for multiresistant S. sciuri are obtained. Finally, management was started with Clindamycin 600 mg every six hours intravenously and Gentamicin at a dose of 1 mg / kg every eight hours intravenously. S.sciuri is a bacterium that has been found in the hospital environment and is occasionally isolated in humans, causing serious infections. Countries such as Colombia continue to treat infections without taking into account their own environment, in which wild pathogens are a frequent cause of infections, due to the narrow range of coexistence between animals and humans in rural regions. Conclusion. This case highlights the need to consider as a causal agent those pathogens present in animals that can cause infections in humans, especially in patients who come from areas far away from urban centers.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy Complications, Infectious/drug therapy , Staphylococcal Infections/complications , Staphylococcal Infections/diagnosis , Patient Isolation , Staphylococcal Infections/drug therapy , Staphylococcus , Sepsis
9.
Säo Paulo med. j ; 136(2): 129-135, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-904150

ABSTRACT

ABSTRACT BACKGROUND: Increasing genetic diversity of HIV-1 and emergence of drug-resistant mutations may reduce the efficacy of antiretroviral therapy and prophylaxis that are used to prevent mother-to-child transmission. The aim of this study was to assess the genetic diversity and prevalence of drug-resistant mutations among HIV-infected pregnant women. DESIGN AND SETTING: Cross-sectional study at an outpatient clinic for infectious diseases within gynecology and obstetrics. METHODS: This study evaluated the dynamics of HIV-1 subtypes and the prevalence of transmitted and acquired drug-resistant mutations among 38 HIV-infected pregnant women (20 previously exposed to antiretroviral therapy and 18 naive), in Ribeirão Preto (SP), Brazil, between 2010 and 2011. Genotyping was performed by means of molecular sequencing of the protease and reverse transcriptase regions of the HIV-1 pol gene. RESULTS: Subtype B was identified in 84.2% of the samples, recombinant forms between B and F in 7.9%, subtype F1 in 5.3% and the recombinant form K/F in 2.6%. No mutation associated with transmitted drug resistance was detected in the samples from the naive pregnant women, whereas mutations associated with acquired drug resistance were found in 35.0% of the pregnant women previously exposed to antiretroviral therapy. CONCLUSION: The results showed that subtype B predominated, while there was low prevalence of sequences with transmitted drug resistance.


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications, Infectious/virology , Genetic Variation , HIV Infections/virology , HIV-1/genetics , Anti-HIV Agents/therapeutic use , Drug Resistance, Viral/genetics , Mutation/genetics , Phylogeny , Pregnancy Complications, Infectious/drug therapy , Socioeconomic Factors , RNA, Viral/genetics , HIV Infections/drug therapy , Prevalence , Cross-Sectional Studies , HIV-1/drug effects , Genotype
10.
Rev. bras. ginecol. obstet ; 40(1): 43-46, Jan. 2018. tab
Article in English | LILACS | ID: biblio-1042312

ABSTRACT

Abstract Gestational syphilis is a prevalent disease in Brazil and other low and medium income countries. Desensitization to penicillin is recommended for pregnant women with syphilis who are allergic to β-lactams. This is a descriptive study utilizing outpatient medical records from 2011 to 2015 from a mother and child hospital that is part of the national healthcare system in the South of Brazil, which performs an average of 3,600 birth assistances per year. All cases of pregnant women with syphilis and presumptive diagnosis of β-lactam allergy during the study period were included. The patients referred for desensitization originated from the hospital prenatal care service, as well as from municipal/state antenatal care services. Oral desensitization was performed in the obstetric emergency room, and adult and pediatric intensive care units were available at all times. Ten patients underwent desensitization during the period of study. Personal history of urticaria was the most common reaction that demanded desensitization. All patients tolerated the procedure well, and showed no adverse reactions.We report a successful program of oral desensitization. None of the patients presented adverse reactions or complications, a fact that corroborates the feasibility and safety of the desensitization protocol. Oral administration of penicillin comes at a low cost, and optimizes the use of time and resources.


Resumo A sífilis gestacional é uma doença prevalente no Brasil e em outros países de baixa e média renda. A dessensibilização à penicilina é recomendada para mulheres grávidas com sífilis que são alérgicas a β-lactâmicos. Este é um estudo descritivo que utiliza registros médicos de 2011 a 2015 de um hospital público materno-fetal do Sul do Brasil com média de 3.600 partos anuais. Foram incluídos todos os casos de gestantes com sífilis e diagnóstico presuntivo de alergia a β-lactâmicos durante o período de estudo. As pacientes encaminhadas para dessensibilização originaram-se do serviço pré-natal hospitalar internamente, bem como dos serviços municipais e estaduais de atendimento pré-natal. A dessensibilização oral foi realizada na sala de emergência obstétrica, e a unidade de terapia intensiva estava disponível em todos os momentos para o atendimento de possíveis intercorrências. Dez pacientes foram submetidas à dessensibilização durante o período estudado. História pessoal de urticária foi a reação mais comum que exigiu dessensibilização à penicilina. Todas as pacientes toleraram bem o procedimento, e não mostraram reações adversas. Relatamos no presente manuscrito um programa bem-sucedido de dessensibilização oral à penicilina. Nenhuma das pacientes apresentou reações adversas ou complicações, corroborando a viabilidade e segurança do protocolo de dessensibilização. A administração oral de penicilina tem baixo custo, e otimiza o uso de tempo e recursos para o tratamento adequado de sífilis gestacional no cenário apresentado.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Penicillins/administration & dosage , Pregnancy Complications, Infectious/drug therapy , Syphilis/drug therapy , Desensitization, Immunologic , Anti-Bacterial Agents/administration & dosage , Administration, Oral , Treatment Outcome
11.
Semina cienc. biol. saude ; 39(1): 77-84, jan. 2018. tab
Article in Portuguese | LILACS | ID: biblio-988225

ABSTRACT

A retrospective study of pregnant women seen at the University Hospital of Londrina, Paraná, Brazil was performed to determine the prevalence of Group B Streptococcus (GBS) vaginal-rectal colonization, and the GBS susceptibility for antimicrobials used in intrapartum antibiotic prophylaxis. A vaginal-rectal swab was collected from 2,901 women between 35 and 37 weeks of gestation. Of these, 527 (18.2%) had a positive culture for GBS, and 0.4%, 10.2% and 10% of the isolates were resistant to penicillin, erythromycin and clindamycin, respectively. These results highlight the importance of continuous surveillance of GBS colonization in pregnant women for preventing GBS infections in neonates.


Um estudo retrospectivo foi realizado com gestantes atendidas no Hospital Universitário de Londrina, Paraná, Brasil para determinar a prevalência de colonização vaginal-retal por estreptococos do Grupo B (EGB) e o perfil de sensibilidade de EGB aos antimicrobianos utilizados para a antibioticoterapia profilática intraparto. Swabs vaginais-retais foram coletados de 2.901 mulheres entre a 35ª e 37ª semana de gestação. Destes, 527 (18,2%) apresentaram cultura positiva para EGB, e 0,4%, 10,2% e 10% dos isolados foram resistentes à penicilina, eritromicina e clindamicina, respectivamente. Estes resultados destacam a importância de vigilância contínua da colonização por EGB em gestantes para a prevenção de infecções em neonatos por EGB.


Subject(s)
Humans , Female , Pregnancy , Adult , Streptococcus agalactiae , Prevalence , Pregnancy Complications, Infectious/drug therapy , Penicillin Resistance , Anti-Bacterial Agents/pharmacology
12.
Rev. chil. infectol ; 35(6): 649-657, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-990848

ABSTRACT

Resumen La listeriosis es una infección infrecuente pero potencialmente grave, causada por Listeria monocytogenes. La principal vía de transmisión es por el consumo de alimentos contaminados, afecta generalmente a personas mayores, mujeres embarazadas y hospederos inmunosuprimidos, aunque también se ven casos en adultos y niños inmunocompetentes. Listeria monocytogenes es un bacilo grampositivo corto, anaerobio facultativo, no formador de esporas, móvil, que provoca una zona angosta de hemólisis en agar sangre. Es un patógeno intracelular facultativo, por lo que presenta una compleja patogenia. Esta bacteria tiene la habilidad de atravesar la barrera intestinal, la placenta y la barrera hemato-encefálica produciendo cuadros de gastroenteritis, infecciones materno-fetales y meningoencefalitis. Se diagnostica, generalmente, a partir de un cultivo positivo de un sitio estéril. El tratamiento de elección incluye el uso de ampicilina intravenosa sola o en combinación con gentamicina.


Listeriosis is an uncommon but potentially serious infection caused by Listeria monocytogenes. The main route of transmission is through the consumption of contaminated food. It generally affects elderly people, pregnant women and immunosuppressed hosts, although cases are also seen in immunocompetent adults and children. Listeria monocytogenes is a short, anaerobic, non-spore-forming gram-positive bacillus that causes a narrow zone of hemolysis in blood agar. It is a facultative intracellular pathogen, and therefore it shows a complex pathogenesis. This bacterium has the ability to cross the intestinal barrier, the placenta and the blood-brain barrier producing gastroenteritis, maternal-fetal infections and meningoencephalitis. It is most commonly diagnosed from a positive culture of a sterile site. The treatment of choice includes the use of intravenous ampicillin alone or in combination with gentamicin.


Subject(s)
Humans , Female , Pregnancy , Listeriosis/diagnosis , Listeriosis/prevention & control , Listeriosis/drug therapy , Listeria monocytogenes , Placenta/microbiology , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/microbiology , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/drug therapy
13.
Medicina (B.Aires) ; 77(2): 85-88, Apr. 2017. tab
Article in Spanish | LILACS | ID: biblio-894437

ABSTRACT

Presentamos los datos de un estudio descriptivo observacional retrospectivo realizado con el objetivo de evaluar las características de las mujeres embarazadas infectadas por HIV, analizar el nivel de control del embarazo y evaluar la adherencia al tratamiento y las pérdidas de seguimiento posterior al parto. Analizamos los datos informados de 104 embarazos, 32.7% de mujeres menores de 25 años. El diagnóstico se realizó durante el control del embarazo en 36.5% de ellos. La terapia antirretroviral (TARV) se inició antes de la semana 24 en 70% de los embarazos. El régimen utilizado incluyó 2 nucleós(t)idos + 1 inhibidor de la proteasa potenciado con ritonavir (IPr) en 84.5% de los casos. La cesárea electiva fue el modo mas frecuente de parto. La carga viral luego de la semana 32 de embarazo estaba disponible en el 82.7% de las pacientes siendo menor a 1000 copias/ml en 78 (75%) y menor a 200 en 70 (67.3%), no hallándose disponible en 18 (17.3%) de los casos. Observamos una alta frecuencia de fallos de adherencia y pérdidas de seguimiento posteriores al parto. Los datos comunicados deben alertar a los programas y centro de atención sobre la necesidad de implementar estrategias que promuevan el control temprano del embarazo e incrementen la adherencia y la retención en cuidado, especialmente en el período posterior al parto.


We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(t)ides and 1 ritonavir potenciated protease inhibitor (PIr) was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%), less than 200 cop/ml in 70 (67.3%) and not available in 18 (17.3%) of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy Complications, Infectious/drug therapy , HIV Infections/drug therapy , Infectious Disease Transmission, Vertical/prevention & control , Anti-HIV Agents/administration & dosage , Medication Adherence/statistics & numerical data , Pregnancy Complications, Infectious/diagnosis , Drug Administration Schedule , Enzyme-Linked Immunosorbent Assay , Blotting, Western , Retrospective Studies , Follow-Up Studies , CD4 Lymphocyte Count , Viral Load , Postpartum Period
14.
Medicina (B.Aires) ; 76(6): 349-354, dic. 2016. tab
Article in Spanish | LILACS | ID: biblio-841608

ABSTRACT

Se determinó la frecuencia de mutaciones asociadas a resistencia de HIV-1 a antirretrovirales en embarazadas del área metropolitana de Buenos Aires, 2008-2014. Se incluyeron 136 mujeres con carga viral ≥ 500 copias/ml: 77 (56.6%) eran naïve; las otras 59 (43.4%) eran expuestas, ya sea con tratamiento en curso (n: 24) o previo (n: 35). Se realizó análisis de resistencia genotípica basal en plasma de pacientes naïve y con experiencia de tratamiento antirretroviral. Las mutaciones se identificaron según las listas de la Organización Mundial de la Salud y la International Antiviral Society, respectivamente. Se comparó la frecuencia de mutaciones detectadas en los subperíodos 2008-2011 vs. 2012-2014. Un total de 37 (27.2%) mujeres presentaron ≥ 1 mutación asociada a resistencia: 25/94 (26.5%) en 2008-2011 y 12/42 (28.5%) en 2012-2014 (p > 0.05). Entre las naïve, 15 (19.5%) tenían ≥ 1 mutación: 10/49 (20.4%) en el subperíodo 2008-2011 y 5/28 (17.8%) en 2012-2014 (p > 0.05). Las mutaciones encontradas en pacientes naïve estuvieron asociadas a inhibidores no nucleosídicos de la transcriptasa reversa, y, como en estudios anteriores, K103N fue la más frecuente a lo largo de todo el período. Entre las pacientes expuestas, 22/59 (37.3%) presentaron ≥ 1 mutación asociada a resistencia. Este estudio demuestra una alta frecuencia de mutaciones asociadas a resistencia que se mantuvo estable a lo largo del período. Los niveles detectados sugieren una mayor circulación en nuestro medio de cepas de HIV-1 resistentes a antirretrovirales con respecto a los niveles previamente observados en Argentina.


The study aimed to determine the prevalence of antiretroviral resistance associated mutations in HIV-1 infected pregnant woman treated in Buenos Aires metropolitan area (period 2008-2014). A total of 136 women with viral load ≥ 500 copies/ml were included: 77 (56.6%) were treatment-naïve and 59 (43.4%) were antiretroviral-experienced patients either with current (n: 24) or previous (n = 35) antiretroviral therapy. Genotypic baseline resistance was investigated in plasma of antiretroviral-naïve patients and antiretroviral-experienced patients. The resistance mutations were identified according to the lists of the World Health Organization and the International Antiviral Society, respectively. Frequencies of resistance associated mutations detected in 2008-2011 and 2012-2014 were compared. A total of 37 (27.2%) women presented at least one resistance associated mutation: 25/94 (26.5%) in 2008-2011 and 12/42 (28.5%) in 2012-2014 (p > 0.05). Among naïves, 15 (19.5%) had at least one mutation: 10/49 (20.4%) in the period 2008-2011 and 5/28 (17.8%) in 2012-2014 (p > 0.05). The resistance mutations detected in naïves were associated with non nucleoside reverse transcriptase inhibitors, being K103N the most common mutation in both periods. In antiretroviral experienced patients, 22/59 (37.3%) had at least one resistance mutation. This study demonstrates a high frequency of resistance associated mutations which remained stable in the period analyzed. These levels suggest an increased circulation of HIV-1 antiretroviral resistant strains in our setting compared to previous reports from Argentina.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Pregnancy Complications, Infectious/drug therapy , HIV Infections/drug therapy , HIV-1/drug effects , Anti-HIV Agents/therapeutic use , Drug Resistance, Viral/drug effects , Argentina/epidemiology , Time Factors , HIV Infections/epidemiology , HIV Infections/virology , Age Factors , Gestational Age , HIV-1/genetics , Viral Load , Antiretroviral Therapy, Highly Active/methods , Drug Resistance, Viral/genetics , Genotype , Mutation
15.
Rev. chil. infectol ; 33(6): 650-655, dic. 2016. tab
Article in Spanish | LILACS | ID: biblio-844418

ABSTRACT

Introduction: Pediatric antiretroviral therapy (ART), changed the prognosis of the disease, allowing young women infected by vertical transmission (TV) to be pregnant without risk for their fetus of acquiring this infection. Aim: To describe the clinical-immune status in pregnant women that acquired HV by vertical transmission, treatments received, monitoring of pregnancy and newborn characteristics. Material and Methods: A protocol was performed, evaluating clinical and immunological parameters during pregnancy, ART used, protocol preventing vertical transmission (PPTV), and follow up of children to 18 months of age. Results: Of 358 HIV-positive patients vertically infected, five women became pregnant, between 14 and 24 years old. Pregnancies were controlled in clinical/immune-stage N2 C3. They had received two to five therapies. Full PPTV was performed in all binomials. Pre-natal undetectable viral loads ranged from 4,700 ARN copies/mL. Five living children were born by Caesarean section, four of them with 37 weeks of completed gestation and one of them with 34 weeks of gestation. All received zidovudine (AZT) for 6 weeks. CD4 at 72 hours of life ranged from 48% to 74.6%. All children were born uninfected with HIV. Only two had mild anemia. Conclusions: Expectations of HIV mothers vertically infected to have healthy children are similar to those infected by horizontal transmission, using PPTV


Introducción: La terapia anti-retroviral en pediatría (TARV), cambió el pronóstico de la enfermedad, permitiendo embarazarse a mujeres jóvenes infectadas por transmisión vertical (TV). Objetivos: Conocer las características clínico-inmunológicas de las mujeres embarazadas, tratamientos recibidos, condición al embarazo y seguimiento de sus recién nacidos. Material y Método: Se efectuó un protocolo, evaluando etapas clínico-inmunológicas en el embarazo, TARV usadas, protocolo de prevención de transmisión vertical (PPTV) y seguimiento de los niños hasta 18 meses. Resultados: De 358 pacientes con infección por VIH adquirida por TV, cinco mujeres se embarazaron, con edades entre 14 a 24 años, embarazos que fueron controlados por el equipo de salud, encontrándose en etapa clínico-inmunológica N2 a C3. Habían recibido dos a cinco esquemas de TARV. Se efectuó PPTV completo en todos los binomios. Las cargas virales previas al parto fluctuaron entre indetectable y 4.700 copias ARN/ml. Nacieron por cesárea cinco niños vivos, cuatro de término y uno con 34 semanas de gestación. Todos recibieron zidovudina (AZT) durante seis semanas. Los CD4 a las 72 h de vida fluctuaron entre 48 y 74,6%. Ninguno de los niños adquirió la infección por VIH en forma vertical. Sólo dos presentaron anemia leve. Conclusiones: Las expectativas de madres con infección por VIH de adquisición vertical de tener hijos sanos son semejantes a las infectadas por transmisión horizontal, al usar PPTV.


Subject(s)
Humans , Male , Pregnancy , Infant, Newborn , Adolescent , Young Adult , Pregnancy Complications, Infectious/virology , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Anti-HIV Agents/therapeutic use , Pregnancy Complications, Infectious/drug therapy , Pregnancy Outcome , HIV Infections/immunology , HIV Infections/prevention & control , Follow-Up Studies , CD4 Lymphocyte Count , Viral Load , Drug Therapy, Combination , Genotype
16.
Med. infant ; 23(4): 293-298, diciembre 2016. tab
Article in Spanish | LILACS | ID: biblio-885111

ABSTRACT

Introducción: La sífilis materna inadecuadamente tratada constituye un problema de salud pública ya que puede producir gran morbimortalidad fetal y neonatal. Objetivo: describir factores relacionados con falla en el diagnóstico y tratamiento de sífilis materna. Población y métodos: Estudio analítico de casos y controles en el Hospital Materno infantil de Malvinas Argentinas, 2014 y 2015. Casos: mujeres puérperas con sífilis sin tratamiento o inadecuado e hijos con sífilis congénita. Controles: mujeres puérperas e hijos recién nacidos vivos sanos. Se realizó revisión de historias clínicas. Estadística: Caracterización de grupos a través del test de Fisher y t-Student. Se estimó el OR individual y ajustado de "falla en el diagnóstico" y "falla en el tratamiento" fijando IC 95% (p<0,05) para cada variable estudiada en SPSS 24.0. Resultados: Hubo 106 casos de sífilis congénita y 100 controles. Recién nacidos de madres con ≤ 5 controles prenatales (CPN) tuvieron 4 veces más riesgo de presentar falla en el diagnóstico de sífilis materna respecto del grupo control (OR: 4,83; IC 95%: 1,79-12,98) patrón igualmente observado para baja escolaridad materna. Las madres ≤18 años y aquellas con número insuficiente de CPN constituyeron un factor de riesgo significativo para falla en el tratamiento (individual OR ajustado: 4,07; IC 95%: 1,43-11,57 y OR ajustado: 2,85; IC 95%: 1,29-6,28, respectivamente). Conclusiones: Resulta necesario implementar estrategias institucionales orientadas a mejorar el número de controles obstétricos, el índice de escolaridad materna y la tasa de embarazo en adolescentes, con el objeto de reducir fallas en el proceso de diagnóstico y tratamiento de la sífilis materna y por consiguiente disminuir la incidencia de sífilis congénita en nuestra población (AU)


Introduction: Inadequately treated maternal syphilis poses a public health problem as it may cause significant fetal and neonatal morbidity and mortality. Aim: To describe factors related to the misdiagnosis and failure of treatment of maternal syphilis. Population and methods: An analytical case-control study conducted at the Hospital Materno infantil de Malvinas Argentinas, from 2014 to 2015. Cases: post-partum women with syphilis without or with inadequate treatment and children with congenital syphilis. Controls: post-partum women and liveborn healthy neonates. Clinical charts were reviewed. Statistical analysis: The groups were evaluated using Fisher's test and the Student's t test. Individual and adjusted ORs were estimated for "misdiagnosis" and "treatment failure" setting a 95% CI (p<0.05) for each study variable using SPSS 24.0. Results: 106 cases of congenital syphilis and 100 controls were included in the study. Infants born to mothers with ≤ 5 prenatal controls (PNC) had a four-fold risk of presenting with a missed diagnosis of maternal syphilis compared to the control group (OR: 4.83; 95% CI: 1.79-12.98). A similar pattern was observed for maternal educational level. Mothers ≤18 years of age and those with an insufficient number of PNC were significant risk factors for treatment failure (individual OR: 4.07; 95% CI: 1.43-11.57 and adjusted OR: 2.85; 95% CI: 1.29-6.28, respectively). Conclusions: It would be necessary to implement institutional strategies developed to improve the number of pregnancy controls, maternal educational level, and teen pregnancy rates aimed at reducing failures in the diagnostic process and treatment of maternal syphilis thereby diminishing the incidence of maternal syphilis in our population (AU)


Subject(s)
Humans , Pregnancy , Infant, Newborn , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Prenatal Care , Syphilis, Congenital/epidemiology , Syphilis/diagnosis , Syphilis/drug therapy , Case-Control Studies , Fetal Mortality , Infant Mortality
17.
Rev. chil. infectol ; 33(supl.1): 60-66, oct. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-844436

ABSTRACT

Introduction: The risk of mother to child transmission (MTCT) of HIV increases in pregnant women diagnosed late in pregnancy. Some experts suggest that the use of raltegravir (RAL), as part of the antiretroviral treatment in these pregnant women, could reduce the risk of MTCT, since RAL can quickly decrease the viral load. Objective: To evaluate the available scientific information on the efficacy and safety of RAL, during the third trimester of pregnancy, in reducing MTCT of HIV. Methods: We conducted a systematic review of the literature. The following databases were consulted: MEDLINE, Tripdatabase, Cochrane, Lilacs and Web of Science. We included systematic reviews, clinical trials, observational studies or case reports. The search was not filtered by language. Results: Fourteen studies met the inclusion criteria. Selected studies were case reports or case series. We included, in total, 44 pregnancies (with 45 live births). A case of TMI of HIV was reported. Eight studies reported adverse events, of which four cases can be attributed to the use of RAL. Conclusion: There is insufficient evidence on the efficacy and safety of RAL to decrease the risk of MTCT in HIV pregnant women who present in the last trimester of pregnancy.


Introducción: El riesgo de transmisión materno-infantil (TMI) del VIH incrementa en mujeres gestantes diagnosticadas tardíamente en el embarazo. Algunos expertos sugieren que el uso de raltegravir (RAL), como parte del esquema de tratamiento anti-retroviral en estas pacientes, puede reducir el riesgo de TMI al disminuir rápidamente la carga viral. Objetivo: Evaluar la información científica existente sobre la eficacia y seguridad de RAL durante el tercer trimestre de gestación en la reducción de la TMI del VIH. Materiales y Métodos: Revisión sistemática de la literatura. Las bases de datos consultadas fueron: MED-LINE, Tripdatabase, Cochrane, Lilacs y Web of Science. En la búsqueda se incluyeron revisiones sistemáticas, ensayos clínicos, estudios observacionales o reportes de caso. La búsqueda no se filtró por idioma. Resultados: Catorce estudios cumplieron los criterios de inclusión. Los estudios seleccionados fueron reportes o series de caso. Se incluyeron 44 embarazos (con 45 nacidos vivos), se reportó un caso de TMI del VIH y ocho estudios reportaron eventos adversos, cuatro de ellos atribuibles al uso de RAL. Conclusión: No se encontró evidencia suficiente sobre la eficacia y seguridad RAL en mujeres gestantes con infección por VIH que se presentan en el último trimestre del embarazo, para disminuir el riesgo de TMI.


Subject(s)
Humans , Female , Pregnancy , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Raltegravir Potassium/therapeutic use , Pregnancy Complications, Infectious/drug therapy , Pregnancy Trimester, Third , Risk Factors , Treatment Outcome , Infectious Disease Transmission, Vertical/prevention & control
18.
An. bras. dermatol ; 91(2): 216-218, Mar.-Apr. 2016. graf
Article in English | LILACS | ID: lil-781357

ABSTRACT

Abstract Neonatal herpes is a serious condition. Newborns can be contaminated in utero via transplacental hematogenic transmission, upon delivery (the most frequent route), or during the postnatal period (indirect transmission). Optimal management requires prompt and accurate recognition, particularly in newborns, in order to prevent complications. Acyclovir is the treatment of choice, but its implementation is often delayed while awaiting test results, such as PCR and serology. Cytology for diagnostic purposes is rarely used in dermatology, despite the quick and reliable results. We report a case of neonatal herpes caused by type 2 herpes simplex virus diagnosed by cytology.


Subject(s)
Humans , Male , Infant, Newborn , Pregnancy Complications, Infectious/pathology , Herpesvirus 2, Human , Herpes Simplex/pathology , Antiviral Agents/therapeutic use , Pregnancy Complications, Infectious/drug therapy , Skin/pathology , Acyclovir/therapeutic use , Cytological Techniques , Herpes Simplex/drug therapy
19.
Cad. Saúde Pública (Online) ; 32(9): e00118215, 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-795300

ABSTRACT

Resumo: Este estudo teve por objetivo avaliar a cascata de cuidado da redução da transmissão vertical do HIV nos estados do Amazonas, Ceará, Espírito Santo, Rio de Janeiro, Rio Grande do Sul e no Distrito Federal, usando dados do Sistema de Informação de Agravos de Notificação (SINAN). Entre os anos de 2007 e 2012, cresceu a taxa de detecção de HIV na gestação em 5 estados, variando de 7,3% no Distrito Federal a 46,1% no Amazonas, com redução de 18,6% no Rio de Janeiro. Menos de 90% das mulheres usaram antirretroviral durante o pré-natal, incluídas as que já se sabiam portadoras do HIV. A realização de cesárea eletiva foi baixa. A taxa de detecção de AIDS em crianças menores de 5 anos como proxy da transmissão vertical do HIV apresentou uma redução de 6,3% entre 2007 e 2012, sendo a maior no Rio Grande do Sul (50%), que apresentou as maiores taxas do período, enquanto no Espírito Santo ocorreu o maior aumento (50%). A avaliação da cascata do cuidado do HIV na gestante apontou falhas em todos os pontos. É necessária uma conexão entre a atenção básica e os centros de referência para HIV/AIDS, ordenando o cuidado da família e o melhor desfecho para a criança.


Abstract: This study aimed to assess the cascade of care in the reduction of mother-to-child HIV transmission in the states of Amazonas, Ceará, Espírito Santo, Rio de Janeiro, and Rio Grande do Sul and the Distrito Federal, Brazil, using data from the Brazilian Information System on Diseases of Notification (SINAN). From 2007 to 2012, there was an increase (from 7.3% in Distrito Federal to 46.1% in Amazonas) in intra-gestational detection of HIV in 5 states, with a 18.6% reduction in Rio de Janeiro. Fewer than 90% of the women received antiretroviral therapy during their prenatal care, including those that already knew they were HIV-positive. The elective cesarean rate was low. The AIDS detection rate in children under 5 years as a proxy for mother-to-child HIV transmission showed a reduction of 6.3% from 2007 to 2012, and was highest in Rio Grande do Sul (50%), the state with the highest rates in the period, while Espírito Santo showed the highest increase (50%). Evaluation of the cascade of HIV care in pregnant women identified flaws in all the points. A link is needed between primary care and referral centers for HIV/AIDS, organizing care for the family and better outcomes for the children.


Resumen: Este estudio tuvo por objetivo evaluar la cascada de cuidado de la reducción de la transmisión vertical del VIH en los Estados del Amazonas, Ceará, Espírito Santo, Río de Janeiro, Río Grande do Sul y en el Distrito Federal, usando datos del Sistema de Información de Enfermedades de Notificación Obligatoria (SINAN por sus siglas en portugués). Entre los años de 2007 y 2012 creció la tasa de detección de VIH durante la gestación en 5 estados, variando de 7,3% en el Distrito Federal a 46,1% en Amazonas, con una reducción de 18,6% en Río de Janeiro. Menos de un 90% de las mujeres usaron antirretrovirales durante el período prenatal, incluidas quienes ya se sabían portadoras del VIH. La realización de cesárea electiva fue baja. La tasa de detección de SIDA en niños menores de 5 años como proxy de la transmisión vertical del VIH presentó una reducción de 6,3% entre 2007 y 2012, siendo la mayor en Río Grande do Sul (50%), la cual presentó las mayores tasas del período, mientras que en Espírito Santo se produjo el mayor aumento (50%). La evaluación de la cascada del cuidado del VIH en la gestante apuntó fallos en todos los puntos. Es necesaria una conexión entre la atención básica y los centros de referencia para VIH/SIDA, buscando el cuidado de la familia y el mejor desenlace para el niños.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy Complications, Infectious/prevention & control , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy Complications, Infectious/drug therapy , Prenatal Care , Socioeconomic Factors , Brazil , Information Systems , HIV Infections/diagnosis , HIV Infections/prevention & control , HIV Infections/drug therapy , Cross-Sectional Studies , Anti-HIV Agents/therapeutic use , Mothers
20.
Yonsei Medical Journal ; : 1271-1275, 2016.
Article in English | WPRIM | ID: wpr-79764

ABSTRACT

Mycoplasma hominis (M. hominis) and Ureaplasma urealyticum (U. urealyticum) are important opportunistic pathogens that cause urogenital infections and complicate pregnancy. The aim of this study was to investigate the prevalence, effects on pregnancy outcomes, and antimicrobial susceptibilities of M. hominis and U. urealyticum. We tested vaginal swabs obtained from 1035 pregnant women for the presence of genital mycoplasmas between June 2009 and May 2014. The laboratory and clinical aspects of genital mycoplasmas infection were reviewed retrospectively, and the identification and antimicrobial susceptibility of genital mycoplasmas were determined using the Mycoplasma IST-2 kit. A total of 571 instances of M. hominis and/or U. urealyticum were detected. Of them, M. hominis was detected in two specimens, whereas U. urealyticum was detected in 472 specimens. The remaining 97 specimens were positive for both M. hominis and U. urealyticum. Preterm deliveries were frequently observed in cases of mixed infection of M. hominis and U. urealyticum, and instances of preterm premature rupture of membrane were often found in cases of U. urealyticum. The rates of non-susceptible isolates to erythromycin, empirical agents for pregnant women, showed increasing trends. In conclusion, the prevalence of M. hominis and/or U. urealyticum infections in pregnant women is high, and the resistance rate of antimicrobial agents tends to increase. Therefore, to maintain a safe pregnancy, it is important to identify the isolates and use appropriate empirical antibiotics immediately.


Subject(s)
Adolescent , Adult , Anti-Bacterial Agents/pharmacology , Female , Humans , Infant, Newborn , Microbial Sensitivity Tests , Middle Aged , Mycoplasma Infections/drug therapy , Mycoplasma hominis/drug effects , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Outcome , Prevalence , Retrospective Studies , Ureaplasma Infections/drug therapy , Ureaplasma urealyticum/drug effects , Young Adult
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