Caracterização do potencial evocado auditivo de tronco encefálico em recém-nascidos infectados pelo Zika vírus / Characterization of auditory brainstem response in newborns infected by Zika virus

RESUMO Objetivo Caracterizar as avaliações seqüenciais do potencial evocado auditivo de tronco encefálico em recém-nascidos infectados pelo Zika vírus, correlacionando com a presença de microcefalia e com os sintomas de Zika nas mães durante a gestação. Métodos Estudo descritivo, longitudinal e quantitativo, do qual participaram 20 recém-nascidos, filhos de mães infectadas pelo Zika vírus no período gestacional. Foram analisados os prontuários desses bebês, que passaram por duas avaliações eletrofisiológicas, uma no primeiro mês de vida e outra, após 6 meses. Os dados comparativos foram tabulados e analisados por meio de estatística descritiva e inferencial. Resultados Setenta por cento dos bebês apresentaram microcefalia e 55% das mães tiveram os sintomas da infecção pelo Zika no primeiro trimestre de gestação. Não houve alteração significativa dos limiares eletrofisiológicos em nenhum dos momentos. Houve mudança estatisticamente significativa, principalmente das latências das ondas III e V, entre os exames, caracterizando maturação da via auditiva nos bebês. Não foi encontrada correlação entre a microcefalia e alterações nas latências do PEATE. Conclusão Bebês portadores de Zika apresentaram limiares eletrofisiológicos dentro da normalidade e diminuição das latências absolutas das ondas III e V e interpicos, confirmando a ação citotóxica do Zika. Houve dois casos de piora significativa do limiar eletrofisiológico. Não foi observada correlação entre resultados do PEATE e época de aparecimento dos sintomas durante a gestação, ou a presença de microcefalia.

ABSTRACT Purpose To characterize sequential assessments of auditory brainstem responses in newborns infected by zika virus, correlating with presence of microcephaly and with Zika virus symptoms in mothers during pregnancy. Methods A descriptive, longitudinal and quantitative study, in which 20 newborns, children of mothers infected by Zika virus during pregnancy, participated. Medical records of these babies were analyzed, and they underwent two electrophysiological assessments, one in the first month of life and the other, after 6 months. Comparative data were tabulated and analyzed using descriptive and inferential statistics. Results Seventy percent of babies had microcephaly and 55% of mothers had symptoms of Zika infection in the first trimester of pregnancy. There was no significant alteration in electrophysiological thresholds at any moments. There was a statistically significant change, mainly in the latencies of waves III and V, between the tests, characterizing maturation of the auditory pathway in babies. No correlation was found between microcephaly and changes in ABR latencies. Conclusion Babies with Zika had normal electrophysiological thresholds and decreased absolute latencies of waves III and V and interpeaks, confirming the cytotoxic action of Zika. There were two cases of significant worsening of the electrophysiological threshold. There was no correlation between ABR results and time of onset of the symptoms during pregnancy, or presence of microcephaly.

Nutritional profile of newborns with microcephaly and factors associated with worse outcomes

OBJECTIVE: To describe the nutritional profile of newborns with microcephaly and factors associated with worse outcomes during the first 14 days of life. METHODS: This investigation is a longitudinal, descriptive study carried out in 21 full-term neonates exposed vertically to the Zika virus and hospitalized in a neonatal intensive care unit from February to September 2016. Patients receiving parenteral nutrition were excluded. Data analysis was performed using a generalized estimating equation model and Student's t-test to evaluate the association between worsening weight-for-age z-scores and independent clinical, sociodemographic and nutritional variables during hospitalization, with p<0.05 indicating significance. RESULTS: During hospitalization, there was a decrease in the mean values of the weight-for-age z-scores. The factors associated with worse nutritional outcomes were symptomatic exposure to the Zika virus, low maternal schooling, absence of maternal income and consumption of infant formula (p<0.05). Calcification and severe microcephaly were also associated with poor nutritional outcomes. Energy and macronutrient consumption remained below the recommendations and had an upward trend during hospitalization. CONCLUSION: The presence of cerebral calcification, the severity of microcephaly and symptomatic maternal exposure to Zika virus affected the nutritional status of newborns. In terms of nutritional factors, human milk intake had a positive impact, reducing weight loss in the first days of life. Other known factors, such as income and maternal schooling, were still associated with a poor nutritional status.

Clinical and x-ray oral evaluation in patients with congenital Zika Virus

Abstract Objective: The aim of this study was to investigate possible malformations in the soft, bone and/or dental tissues in patients with congenital Zika Virus (ZIKV) by clinical and x-ray evaluation. Methodology: Thirty children born with ZIKV and 30 children born without ZIKV (control group) were included in the study. Patients were evaluated over 24 consecutive months according to the variables: sex, age, cleft palates, soft tissue lesions, alveolar ridge hyperplasia, short labial and lingual frenums, inadequate posture of the lingual and perioral muscles at rest, micrognathia, narrow palatine vaults, changes in the teeth shape and/or number, sequence eruption, spasms, seizures and eruption delay were evaluated. Chi-square test, Student's t-test and nominal logistic regression were used (p<0.05). Results: Among the 30 babies examined, the mean age of the first dental eruption was 10.8±3.8 with almost two-thirds of the children (n=18, 60%) experiencing eruptions of their first tooth after 9 months of age, nine children (30%) had inadequate lingual posture at rest, more than half of the children (n=18, 60%) had short labial or lingual frenums. ZIKV babies showed a high prevalence of clef palate (p<0.001), inadequate lingual posture at rest (p=0.004), micrognathia (p=0.002), changes in the shape and/or number of teeth (p=0.006), alteration in sequence of dental eruption (p<0.001) and muscles spasms (p=0.002). The delay eruption was associated with inadequate lingual posture at rest (p=0.047), micrognathia (p=0.002) and changes in the shape and/or number of teeth (p=0.021). The delayed eruption (p=0.006) and narrow palatine vaults (p=0.008) were independently associated with ZIKV. Moreover, female patients showed the most narrow palatine vaults (p=0.010). Conclusions: The children with ZIKV showed a greater tendency to have delayed eruption of the first deciduous tooth, inadequate lingual posture and short labial and lingual frenums.

Achados clínicos faciais em bebês com microcefalia / Facial clinical findings in babies with microcephal

A microcefalia pode ser definida como uma redução significante na circunferência ocipitofrontal da cabeça. Desta forma, ela é um achado clínico e não deve ser descrita como uma doença. Suas consequências são dependentes da área cerebral afetada. Sabendo que o crescimento facial é dependente do crescimento do crânio, supõem-se que a microcefalia também possa causar deformações faciais e distúrbios em funções como fonação, mastigação e deglutição. O Hospital Universitário da Universidade Federal de Sergipe desenvolve um trabalho com bebês microcefálicos e proporciona atendimento multiprofissional para acompanhamento desses pacientes, a Odontologia foi incluída nesse grupo de trabalho a partir da iniciativa desse estudo. O presente trabalho teve como objetivo analisar as funções orais de bebês diagnosticados com microcefalia em acompanhamento no Hospital Universitário de Sergipe. Achados clínicos de importante relevância foram descritos baseados no acompanhamento destes bebês. Os resultados obtidos mostraram que as funções mais afetadas foram da deglutição, respiração, tonicidade muscular e erupção dentária. Conclui-se que devido à variabilidade e à imprevisibilidade das consequências da microcefalia, é imprescindível o acompanhamento preventivo odontológico destes casos.(AU)

Microcephaly can be defined as a significant reduction in the ocipitofrontal circumference of the head. In this way, it is a clinical finding and should not be described as a disease. Its consequences are dependent on the affected brain area. Knowing that facial growth is dependent on skull growth, it is assumed that microcephaly can also cause facial deformities and disturbances in functions such as phonation, chewing and swallowing. The University Hospital of the Federal University of Sergipe develops a work with microcephalic babies and sends multiprofessional care to follow up the patients, a dentistry was included in the work group from the initiative of the study. The present study had as objective to analyze as oral functions of babies diagnosed with microcephalus in follow-up, not Hospital Universitário de Sergipe. Clinical findings of major relevance have been reported in the follow-up of these infants. The results obtained are demonstrated as more affected functions such as swallowing, breathing, muscular tone and dental eruption. It is concluded that due to the variability and the unpredictability of the consequences of microcephaly, it is essential the dental preventive follow-up of these cases.(AU)

Mowat-Wilson syndrome: neurological and molecular study in seven patients / Síndrome de Mowat-Wilson: estudo neurológico e molecular em sete pacientes

Objective To present a seven-cases serie of Mowat-Wilson syndrome (MWS). Method All patients with positive mutation for the ZEB2 were evaluated by a geneticist and a neurologist, with clinical and laboratorial characterization. Results A peculiar facies and mental retardation were present in all patients. The Denver II scale showed intense delay in all aspects, especially fine motor and adaptive. Acquired microcephaly was observed in five patients. Only one patient did not present epilepsy. Epilepsy was focal and predominating in sleep, with status epilepticus in three patients. The initial seizure was associated with fever in most patients (4/6). The EEG showed epileptic focal activity (5/7). The imaging studies revealed total agenesis (4/7) and partial agenesis of the corpus callosum (1/7). Conclusion Physicians who care for patients with mental retardation and epilepsy should be aware of SMW. .

Objetivo Apresentar uma série de sete casos da síndrome de Mowat-Wilson (SMW). Método Todos os pacientes com estudo positivo para a mutação ZEB2 foram avaliados por um geneticista e um neurologista, com a caracterização clínica e laboratorial. Resultados Todos apresentavam fácies peculiar e retardo mental. A escala de Denver II evidenciou intenso atraso em todos os aspectos, sobretudo motor fino e adaptativo. Microcefalia adquirida foi observada em cinco pacientes. Apenas um paciente não apresentava epilepsia, sendo esta focal e predominando no sono, sendo relatado estado de mal em três pacientes. A crise inicial estava associada à febre na maioria dos pacientes (4/6). O EEG evidenciou atividade epiléptica focal na maioria (5/7). Ao estudo de imagem foi observada agenesia total (4/7) e parcial do corpo caloso (1/7). Conclusão Médicos que lidam com pacientes com retardo mental e epilepsia devem saber distinguir as características peculiares da SMW. .

Complex regional pain syndromes: clinical characteristics and pathophysiological factors

To study relationship between clinical pattern of complex regional pain syndromes [CRPS] and inflammatory and sympathetic parameters. Twenty one CRPS patients and 15 healthy controls were examined. Clinical data, sympathetic skin response [SSR], TNFalpha and normetanephrine were evaluated. Fourteen patients had increased serum TNFalpha which showed significant relationship with some clinical parameters. Three patients had increased normetanephrine. Mean SSR latency was shortened in patients. No significant relationship between SSR and sweating manifestations and no correlation between serum normetanephrine, SSR, and serum TNFalpha were found. Inflammation plays a major role and SSR is enhanced in CRPS