A repercussão da exposição intrauterina ao zika vírus no desenvolvimento neuropsicomotor de crianças com perímetro cefálico normal para idade gestacional ao nascimento

Introdução: Sabe-se que o vírus da Zika (ZIKV) é neurotrópico. A associação entre o ZIKV e os distúrbios neurológicos, como a síndrome de Guillain-Barré em adultos e a microcefalia em recém-nascidos está bem estabelecida, assim como as anormalidades oculares e auditivas. Essas alterações podem ocorrer durante os três trimestres da gestação. No entanto, grande parte das crianças cujas mães foram expostas e sintomáticas ao vírus durante a gestação, tem perímetro cefálico normal ao nascimento, podendo ter manifestações neurológicas incluindo atraso do desenvolvimento neuropsicomotor (ADNPM) e microcefalia após alguns meses de vida. Objetivo: Avaliar o desenvolvimento motor e habilidades neurocognitivas e realizar exame dismorfológico e neurológico nas crianças expostas ao ZIKV, que nasceram com perímetro cefálico normal para idade gestacional. Métodos: Os sujeitos de pesquisa foram aqueles cujo perímetro cefálico ao nascimento apresentava-se dentro dos limites da normalidade corrigidos por sexo e idade gestacional segundo Intergrowth-21st e que tiveram suspeita ou confirmação de exposição intrauterina pelo ZIKV. Foram revisados prontuários e aplicado um questionário estruturado, além da avaliação clínica dos pacientes, incluindo exame dismorfológico e neurológico detalhado. Para avaliação de desenvolvimento neuropsicomotor, foi aplicada a escala DENVER II. Resultados: Das 26 crianças avaliadas em março de 2018, 11 (42%) apresentaram algum tipo de atraso na escala DENVER II. A média de idade dos pacientes foi de 21,5 meses, variando de 18 a 25 meses. Uma criança apresentou atraso global de desenvolvimento, associado à microcefalia de início pós-natal, paralisia cerebral e distúrbio de deglutição, além de alteração da Ressonância Nuclear Magnética (RNM). As outras dez crianças apresentaram algum tipo de ADNPM associado a alterações específicas do exame neurológico, porém com neuroimagem sem alterações. Conclusão: Este estudo confirma a hipótese que crianças nascidas com perímetro cefálico adequado para a idade gestacional podem desenvolver quadros variáveis de envolvimento do Sistema Nervoso Central (SNC), incluindo ADNPM.Introduction: Zika virus (ZIKV) is known to be neurotropic. The link between ZIKV and neurological disorders such as Guillain-Barré syndrome in adults and microcephaly in newborns is well established, as are ocular and auditory abnormalities. These changes may occur during the three trimesters of gestation. However, most of the children whose mothers were exposed and symptomatic to the virus during pregnancy have a normal head circumference at birth and may have neurological manifestations including delayed neuro-psycho-motor development and microcephaly after a few months of life. Objective: To evaluate motor development and neurocognitive abilities and to perform dysmorphological and neurological examination in children exposed to ZIKV, who were born with a normal head circumference for gestational age. Methods: Research subjects were those whose cephalic perimeter at birth was within the limits of normality corrected for gender and gestational age according to Intergrowth-21st and who had suspected or confirmed intrauterine exposure by ZIKV. Records were reviewed and a structured questionnaire was applied, besides the clinical evaluation of the patients, including detailed dysmorphological and neurological examination. For evaluation of neuropsychomotor development, the DENVER II scale was applied. Results: Of the 26 children evaluated in March 2018, 11 (42%) presented some type of delay in the Denver II scale. The mean age of the patients was 21.5 months, ranging from 18 to 25 months. One child had a global developmental delay, associated with postnatal onset microcephaly, cerebral palsy, and swallowing disorder, as well as altered neurological examination and Magnetic Resonance Imaging. The other ten children had some type of delayed neuropsychomotor development associated with specific alterations of the neurological exam, but with neuroimaging without alterations. Conclusion: This study supports the hypothesis that children born with head circumpherence adequate for gestational age can develop variable frames of involvement of the Central Nervous System, including delayed motor and neurological development

Quality of life in patients rehabilitated with implant-supported prostheses

: To evaluate the impact of rehabilitation with implant-supported prostheses on the quality of life (QoL) of patients. Methods: The OHIP-14 questionnaire was applied to 114 patients and information regarding gender, age, type of prosthesis and time of use were obtained. To analyze whether there were any statistically significant differences between the mean scores of the seven parameters of the OHIP-14, the Mann-Whitney and Kruskal-Wallis test were used. All data were evaluated using a significance level of 5%. Results: Patients were predominantly female (78.9%) and single crowns users (41.2%). Patients reported a good QoL (3.07). Psychological discomfort and physical pain were the worst dimensions evaluated by the subjects. Results differed significantly (p<0.05) only for functional limitations and psychological discomfort in the different genders. Conclusions: Patients presented a high level of quality of life, regardless of age, duration of use and the type of prosthesis used. However, women presented more psychological distress and functional limitations than men