Avaliação neurológica de crianças microcefálicas com síndrome da zika e infecção congênita por citomegalovirus

Introdução: A infecção pelo vírus Zika foi considerada uma doença benigna até outubro de 2015, quando se detectou um aumento no número de neonatos nascidos com microcefalia. A associação entre a infecção pré-natal pelo vírus Zika e distúrbios do sistema nervoso central está bem estabelecida, sendo descrita a síndrome congênita associada ao vírus Zika (SCZ). No entanto, a evolução neurológica dessas crianças ainda é objeto de estudo. Sabe-se que as crianças com SCZ, além do atraso grave no desenvolvimento motor, frequentemente apresentam epilepsia e outros distúrbios neurológicos importantes. O principal diagnóstico diferencial é o citomegalovírus (CMV). Objetivo: Contribuir na descrição do acometimento neurológico de pacientes microcefálicos com infecção congênita pelo vírus Zika ou CMV. Metodologia: Foram coletados dados a partir do prontuário dos pacientes microcefálicos do Hospital de Clínicas de Porto Alegre, com data de nascimento a partir do ano de 2016, e com diagnóstico de infecção congênita confirmada ou presumida. Os dados pesquisados foram: tipo de infecção congênita, perímetro cefálico ao nascimento, presença de epilepsia, tipos de crises epilépticas, tratamento por mono ou politerapia, padrão eletroencefalográfico, exame físico neurológico e avaliação do desenvolvimento motor grosso. Resultados: Foram incluídas 21 crianças microcefálicas com as seguintes síndromes infecciosas congênitas: 9 por citomegalovírus (43%), 6 por vírus Zika (29%) e 6 por infecção presumida por Zika vírus (29%). Destas, 13 (62%) apresentavam diagnóstico de epilepsia, todas com crises generalizadas e 9 (69%) em uso de politerapia. Todas também apresentavam ritmos de base desorganizados e assimétricos. Quanto à atividade epileptiforme, cinco apresentaram atividade multifocal, quatro apresentaram atividade generalizada. Apenas uma apresentou atividade focal, e três apresentaram hipsarritmia. Todos os pacientes realizaram neuroimagem (1 ecografia transfontanelar, 13 tomografia computadorizada e 7 ressonância magnética): 12 (57%) apresentavam calcificações e 5 (24%) hidrocefalia. No exame neurológico, 17 (81%) apresentavam tônus axial diminuído e apendicular aumentado. Os reflexos miotáticos fásicos estavam aumentados em 16 (76%). Crianças com menor perímetro cefálico apresentaram maior comprometimento motor e gravidade da epilepsia. Não houve diferença na frequência de epilepsia entre as crianças com SCZ e CMV. Conclusão: A epilepsia se confirma como uma das mais importantes complicações das infecções congênitas por SZC e CMV. Nosso estudo reforça a importância dos exames de imagem e eletroencefalográficos nas crianças nascidas com microcefalia e suspeita de infecção congênita.Introduction: The infection caused by the Zika Virus was considered a benign disease until October 2015 when a new increase in the number of newborns with microcephaly had been detected. The association between the virus prenatal infection and central nervous system disorders has been well established and it has been described as the Congenital Syndrome Associated to the Zika Virus (CSZ). However, the neurological development in those patients is still an object of study. It is already known that children developing CSZ, beyond having a severe delay in motor development, could often develop epilepsy besides other significant neurological disorders. The main differential diagnosis is the Cytomegalovirus (CMV). Objective: Describe the involvement of microcephalic’ patients affected by the congenital infection by the Zika Virus or CMV. Methodology: Data has been collected from microcephalic patients records at the Porto Alegre Hospital of Clinics whose birth took place after 2016 and which also had the congenital infection confirmed or presumed. The researched data consists in: congenital infection, head circumference from birth, presence of epilepsy, treatment by mono or polytherapy, electroencephalographic patterns, neurological physical examination and evaluation of gross motor development. Results: 21 microcephalic children have been included showing the following congenital infectious syndromes: 9 were affected by cytomegalovirus (43%), 6 by the Zika virus (29%) and 6 ones by presumed infection due to the Zika virus (29%). From those ones, 13 (62%) presented epilepsy diagnosis including generalized crises and 9 (69%) were in current use of polytherapy. All of them also showed disorganized and asymmetrical base rhythms. Concerning the epileptiform activity, 5 presented multifocal activity and 3 ones hypsarrhythmia. All of the patients went under neuroimaging exams (1 transfontanellar ultrasound, 13 computed tomography and 7 MRI): 12 (57%) of them presented calcifications and 5 (24%) hydrocephalus. On the neurological exam, 17% presented a decreased axial tone and an enlarged appendicular. The phasic myotatic reflexes were increased in 16 (76%). Smaller head circumference children had greater motor impairment and severity in the epilepsy. There was no difference in the frequency of epilepsy between children with CSZ and CMV. Conclusion: Epilepsy is confirmed as one of the most important complications of congenital infections by CSZ and CMV. Our study reinforces the importance of imaging and electroencephalographic examinations in children born with microcephaly and suspected congenital infection

Prevalence of self-reported lifetime medical diagnosis of depression in Brazil : analysis of data from the 2019 Brazilian National Health Survey

Objectives: To assess the prevalence of and factors associated with the lifetime medical diagnosis of depression in Brazil. Design: Population-based, cross-sectional study. Setting: Analysis of data from the 2019 Brazilian National Health Survey. Participants: 90 846 individuals aged ≥15 years were included. Outcome measure: The self-reported medical diagnosis of depression at some point in one’s life was the main outcome. Prevalence ratios (PRs) with 95% CIs were calculated by Poisson regression with robust variance. The independent variables included the geographical area of residence, sociodemographic characteristics, current smoking status, alcohol abuse, daily screen time, and the presence of physical disorders and mental health comorbidities. Results: The self-reported lifetime prevalence of medical diagnosis of depression was 9.9% (95% CI 9.5% to 10.2%). The probability of having received a medical diagnosis of depression was higher among urban residents (PR 1.23; 95% CI 1.12 to 1.35); females (2.75; 2.52 to 2.99); those aged 20–29 years (1.17; 0.91 to 1.51), 30–39 years (1.73; 1.36 to 2.19), 40–49 years (2.30; 1.81 to 2.91), 50–59 years (2.32; 1.84 to 2.93) and 60–69 years (2.27; 1.78 to 2.90) compared with those under 20 years; white-skinned people (0.69 (0.61 to 0.78) for black-skinned people and 0.74 (0.69 to 0.80) for indigenous, yellow and brown-skinned people compared with white-skinned people); those with fewer years of education (1.33(1.12 to 1.58) among those with 9–11 years, 1.14 (0.96 to 1.34) among those with 1–8 years and 1.29 (1.11 to 1.50) among those with 0 years compared with those with ≥12 years of education); those who were separated/ divorced (1.43; 1.29 to 1.59), widowed (1.06; 0.95 to 1.19) and single (1.01; 0.93 to 1.10) compared with married people; smokers (1.26; 1.14 to 1.38); heavy screen users (1.31; 1.16 to 1.48) compared with those whose usage was <6 hours/day; those with a medical diagnosis of a physical disorder (1.80; 1.67 to 1.97); and individuals with a medical diagnosis of a mental health comorbidity (5.05; 4.68 to 5.46). Conclusion: This nationwide population-based study of self-reported lifetime medical diagnosis of depression in Brazil showed that the prevalence was almost 10%. Considering the current Brazilian population, this prevalence corresponds to more than 2 million people who have been diagnosed with depression at some point in their lives

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Neurological sequelae after encephalitis associated with herpes simplex virus in children : systematic review and meta-analysis

Background: Encephalitis is an inflammation of the cerebral parenchyma manifested by acute symptoms such as fever, headaches, and other neurological disorders. Its etiology is mostly viral, with herpes simplex virus being a frequent etiological agent in children. The development of neurological sequelae is a serious outcome associated with this infection. Objective: To assess the general prevalence and types of neurological sequelae in children after a case of acute viral encephalitis caused by HSV. Methods: This systematic review and meta-analysis was developed following the PRISMA guidelines. The literature search was carried out in the MEDLINE, Embase, SciELO, LILACS, Cochrane, CINAHL, PsycINFO, and Web of Science databases. Studies were included of children with confirmed HSV infection and that presented a description of neurological sequelae associated with that infection. For the meta-analysis of general prevalence and of the types of neurological sequelae a random effects model was used. Results: Of the 2827 articles chosen in the initial search, nine studies were included in the systematic review and meta-analysis. The general prevalence of neurological sequelae was 50.7% (95% CI 39.2–62.2). The most frequent sequelae were related to mental disability, with a 42.1% prevalence (95% CI 30–55.2); on the other hand, the least frequent sequelae were those related with visual impairment, with a 5.9% prevalence (95% CI 2.2–14.6). The included studies presented regular quality and substantial heterogeneity. Conclusion: Even with antiviral therapy, half of patients will develop some type of disability

Neurological evaluation of microcephalic children with Zika syndrome and congenital cytomegalovirus infection

Introduction: The association between the virus prenatal infection by Zika virus (ZIKV) and central nervous system disorders has been well established and it has been described as the Congenital Syndrome Associated to the Zika Virus (CSZ). However, the neurological development in those patients is still an object of study. The main differential diagnosis is the Cytomegalovirus (CMV). Objective: Describe the involvement of microcephalic patients affected by the congenital infection by the Zika Virus or CMV. Methodology: Data has been collected from microcephalic patients whose birth took place after 2016 and which also had the congenital infection confirmed or presumed. The researched data consists in: congenital infection, head circumference from birth, presence of epilepsy, treatment by mono or polytherapy, electroencephalographic patterns, neurological physical examination and evaluation of gross motor development. Results: 21 microcephalic children have been included showing the following congenital infectious syndromes: 9 were affected by cytomegalovirus (43%), 6 by the Zika virus (29%) and 6 ones by presumed infection due to the Zika virus (29%). From those ones, 13 (62%) presented epilepsy diagnosis including generalized crises and 9 (69%) were in current use of polytherapy. All of them also showed disorganized and asymmetrical base rhythms. Concerning the epileptiform activity, 5 presented multifocal activity and 3 ones hypsarrhythmia. All of the patients went under neuroimaging: 12 (57%) of them presented calcifications and 5 (24%) hydrocephalus. On the neurological exam, 17% presented a decreased axial tone and an enlarged appendicular. Smaller head circumference children had greater motor impairment and severity in the epilepsy. There was no difference in the frequency of epilepsy between children with CSZ and CMV. Conclusion: Epilepsy is confirmed as one of the most important complications of congenital infections by CSZ and CMV