Newborn screening: a national public health programme in Brazil.

The newborn screening programme started in Brazil (1976) through isolated initiatives, without governmental directions and/or policies. According to Health Ministry (2000) data the coverage was 55% and unevenly distributed. Only 17 out of 27 Brazilian states had more than 30% coverage. Public budgets covered only diagnostic examinations. There were no official data about assistance, patient follow-up or detected disorders. The creation of the National Programme (2001) has provided new perspective for newborn screening (NBS) in the public health system. It has provided important official data and established management and care units for each state: Reference Services in Newborn Screening. The programme screened about 13 million newborns from October 2001 to December 2005. The coverage increased to 80.2% (2005) and 74% of the states presented coverage of over 70%. Within 34 accredited Reference Services in 27 Brazilian states, all provide screening for PKU and CH. Ten of them provide screening for haemoglobinopathies as well, and three of them provide also for CF. The Reference Services altogether count on at least 170 health professionals, such as paediatricians, endocrinologists, nutritionists, psychologists and social workers. They are qualified to assist positive cases, within the policies established by the National Programme. There has been significant increase in NBS coverage and follow-up assuredness, including detected cases before the National Programme (10,935 positive cases) mostly in those regions where the programme did not exist. There has been significant evolution in the Newborn Screening as a Public Health Program in Brazil due to the government's commitment (federal and each component state).

Cytomegalovirus in human abortion in Espírito Santo, Brazil.

BACKGROUND: Despite the established implication of human cytomegalovirus (HCMV) in congenital infection, there are still conflicting reports regarding the association of HCMV with spontaneous abortion. Viral antigens and nucleic acid were already described in tissues from abortions cases, but did not indicate HCMV pathogenical role. OBJECTIVES: (1) To access viral seroprevalence (total and IgM antibodies) in pregnant, non-pregnant and in women in abortion process, (2) to evaluate if antigenemia assay can detect active infection in these populations, (3) to detect viral DNA in peripheral leukocytes, and (4) in abortion tissues. STUDY DESIGN: Blood samples from 95 patients in abortion process and from two control groups (40 pregnant and 60 non-pregnant women) were obtained for determination of viral seroprevalence, for detection of antigen and viral DNA by PCR from peripheral leukocytes. Specimens obtained from 88 patients in abortion process, spontaneous or induced, were submitted to gB gene amplification (PCR and nested-PCR). RESULTS: Viral seroprevalence were found in 97.3 with 2.5% of IgM positive cases. Antigenemia assay were negative in all cases, however, viral nucleic acid were found in 6.3 and in 6.0% of the patients in abortion and in control groups, respectively. Nucleic acid in conception tissue was present in 6.6%. CONCLUSION: This high seroprevalence observed is according to previous surveys in Brazil. If active infection due to viral reactivation occurred during the abortion process, it cannot be accessed by antigenemia or anti-IgM assays. Nucleic acid found by PCR in peripheral blood cells enriched with polymorphonuclear cells (PMN) corresponds to viral circulation in immunocompetent person, as similar results were found for the three groups. Although viral DNA had been found in 6.6% from abortion tissues, this result does not support HCMV as a major abortion-related factor as we could not found any correlation between abortion and active HCMV infection.

Radiographic plain film and CT findings in lipoid pneumonia in infants following aspiration of mineral oil used in the treatment of partial small bowel obstruction by Ascaris lumbricoides.

Four children developed lipoid pneumonia following ingestion of mineral oil for the treatment of partial small bowel obstruction by Ascaris lumbricoides whorl. CT of the chest showed negative Hounsfield numbers which may prove useful in diagnosis.

Hepatocellular carcinoma HBsAg positive in pregnancy.

The authors present a case of hepatocellular carcinoma diagnosed in a pregnant woman (four months pregnancy). The clinical evolution was complicated because of a severe hypoglicemia and the patient died 12 weeks after admission. The fetus died before a tentative of surgical delivery. The patient was HBsAg positive and five out of eight sons (inclusively the fetus), were HBsAg positive. There was not indication that the pregnancy had enhanced the tumor evolution.

Hepatocellular carcinoma HBsAg positive in pregnancy.

Um caso de carcinoma hepato-celular diagnosticado no quarto mes de gravidez, e relatado. A evolucao clinica foi complicada por hipoglicemia severa, tendo a paciente falecido 12 semanas apos a internacao. O feto morreu antes de se tentar parto cirurgico. A paciente era AgHbs positivo, assim como cinco de seus oito filhos (inclusive o feto). Nao houve indicacao de que a gravidez tivesse aumentado o crescimento tumoral

Pneumonias lipoides exogenas na infancia. / Exogenous lipoid pneumonia in infants

Quatro casos de pneumonias lipoides em criancas que aspiraram oleo mineral sao apresentados. Em tres houve iatrogenia. Em todos o diagnostico foi estabelecido associando uma historia de ingestao de oleo com radiografias, mostrando infiltrados difusos que nao involuiram com a terapeutica. Houve confirmacao anatomopatologica em tres casos