Congenital rubella syndrome surveillance as a platform for surveillance of other congenital infections, Peru, 2004-2007.

BACKGROUND: Rubella during pregnancy can cause serious fetal abnormalities and death. Peru has had integrated measles/rubella surveillance since 2000 but did not implement congenital rubella syndrome (CRS) surveillance until 2004, in accordance with the Pan American Health Organization recommendations for rubella elimination. The article describes the experience from the CRS sentinel surveillance system in Peru. METHODS: Peru has maintained a national sentinel surveillance system for reporting confirmed and suspected CRS cases since 2004. A surveillance protocol was implemented with standardized case definitions and instruments in the selected sentinel sites. Each sentinel site completes their case investigations and report forms and sends the reports to the Health Region Epidemiology Department, which forwards the data to the national Epidemiology Department. CRS surveillance data were analyzed for the period 2004-2007. RESULTS: During the period 2004-2007, 16 health facilities, which are located in 9 of the 33 health regions, representing the 3 main geographical areas (coast, mountain, and jungle), were included as sentinel sites for the CRS surveillance. A total of 2061 suspected CRS cases were reported to the system. Of these, 11 were classified as CRS and 23 as congenital rubella infection. Factors significantly associated with rubella vertical transmission were: (1) in the mother, maternal history of rash during pregnancy (odds ratio [OR], 12.0; 95% confidence interval [CI], 3.8-37.8); (2) and in the infant, pigmentary retinopathy (OR, 18.4; 95% CI, 3.2-104.6), purpura (OR, 14.7; 95% CI, 2.8-78.3), and developmental delay (OR, 4.4; 95% CI, 1.75-11.1). CONCLUSIONS: The surveillance system has been able to identify rubella vertical transmission, reinforcing the evidence that rubella was a public health problem in Peru. This system may serve as a platform to implement surveillance for other congenital infections in Peru.

Aplasia cutis congénita truncal simétricaasociada a feto papiráceo / Symmetric truncal aplasia cutis congenita associated with papyraceous fetus

Se presenta el caso de una recién nacida a término, producto de gestación gemelar con feto papiráceo. Sus padres eran no consanguíneos, madre hipotiroidea en uso de levotiroxina, padre aparentemente sano. Al examen presentaba lesiones ulcerativas extensas de bordes bien delimitados, base con tejido de granulación y áreas fibrinoides, distribución en H simétrica de aproximadamente 15 x 10 cm en espalda con extensiones distales hacia muslos y bandas cicatrizales extendidas hacia abdomen anterior. Se consideró el caso de aplasia cutis congénita truncal simétrica asociada a feto papiráceo. Se brindaron cuidados neonatales de incubadora y cuna, el cuidado tópico consistió en mantener el defecto húmedo (suero fisiológico) y aséptico (mupirocina ungüento en compresas) logrando el cierre progresivo del mismo, que se completó a los 60 días de vida.

We report the case of a female newborn, product of a twin gestation with a papyraceous fetus. Her parents were nonconsanguineous, mother had hypothyroidism treated with levothyroxine, father was apparently healthy. On examination the patient presented extensive ulcerative lesions with clear borders, base with granulation tissue and fibrinoid areas, symmetric distribution in H shape of approximately 15 x 10 cm involving the back, with distal extensions toward thighs and narrow scar bands toward anterior abdomen. We considered the case as symmetric truncal aplasia cutis congenital associated with a papyraceous fetus. We provided standard neonatal care with incubator, the topic care consisted in maintain the wound moist (saline solution) and aseptic (compresses with mupirocin ointment) achieving the progressive closure of the defect, which was completed after 60 days of life.

Intoxicación por estricnina: a propósito de un caso pediátrico / strychnine poisoning: report of a pediatric case

La intoxicación por estricnina es una emergencia rara en nuestro media, ya que es una sustancia que se comercializa exclusivamente a nivel de Ministerio de Salud para el control de la rabia, y por lo tanto si diagnóstico debe ser rápidamente informado. En el presente artículo se presenta un reporte de caso del Hospital Nacional Cayetano Heredia, el cual tuvo una evolución clínica favorable. Se revisan algunos aspectos farmadinámicos de la droga así como consideraciones clínicas y terapéuticas, brindando algunas recomendaciones que puede orientar a su manejo.