Avaliação e monitoramento auditivo em crianças portadoras do vírus da imunodeficiência adquirida

O presente artigo trata de um relato sobre as atividades realizadas no programa de extensão “Avaliação e monitoramento audiológico em crianças portadoras de HIV com história de alterações otológicas”. Objetivamos avaliar a audição periférica e central de crianças portadoras do vírus HIV, além de outras técnicas e, orientação e promoção de saúde das crianças e seus familiares através do acompanhamento de acadêmicos do curso de Fonoaudiologia. Tornou-se evidente a necessidade da presença do fonoaudiólogo na equipe dos profissionais de saúde que irão acompanhar os portadores do vírus, conferindo interdisciplinaridade e ampliando a qualidade de vida dos pacientes

Association of Malaria Infection During Pregnancy With Head Circumference of Newborns in the Brazilian Amazon.

Importance: Malaria during pregnancy is associated with adverse events for the fetus and newborn, but the association of malaria during pregnancy with the head circumference of the newborn is unclear. Objective: To investigate the association of malaria during pregnancy with fetal head growth. Design, Setting, and Participants: Two cohort studies were conducted at the general maternity hospital of Cruzeiro do Sul (Acre, Brazil) in the Amazonian region. One cohort study prospectively enrolled noninfected and malaria-infected pregnant women who were followed up until delivery, between January 2013 and April 2015. The other cohort study was assembled retrospectively using clinical and malaria data from all deliveries that occurred between January 2012 and December 2013. Data analyses were conducted from January to August 2017 and revised in November 2018. Clinical data from pregnant women and anthropometric measures of their newborns were evaluated. A total of 600 pregnant women were enrolled through volunteer sampling (prospective cohort study), and 4697 pregnant women were selected by population-based sampling (retrospective cohort study). After application of exclusion criteria, data from 251 (prospective cohort study) and 232 (retrospective cohort study) malaria-infected and 158 (prospective cohort study) and 3650 (retrospective cohort study) noninfected women were evaluated. Exposure: Malaria during pregnancy. Main Outcomes and Measures: The primary end point was the incidence of altered head circumference in newborns delivered from malaria-infected mothers compared with that from noninfected mothers. Secondary end points included measures of placental pathology relative to newborn head circumference. Results: In total, 4291 maternal-child pairs were analyzed. Among 409 newborns in the prospective cohort study, the mothers of 251 newborns had malaria during pregnancy, infected with Plasmodium vivax, Plasmodium falciparum, or both. Among 3882 newborns in the retrospective cohort study, 232 were born from mothers that had malaria during pregnancy. The prevalence of newborns with a small head (19 [30.7%] in the prospective cohort study and 30 [36.6%] in the retrospective cohort study) and the prevalence of microcephaly among newborns (5 [8.1%] in the prospective cohort study and 6 [7.3%] in the retrospective cohort study) were higher among newborns from women infected with P falciparum during pregnancy. Multivariate logistic regression analyses revealed that P falciparum infection during pregnancy represented a significant risk factor for the occurrence of small head circumference in newborns (prospective cohort study: odds ratio, 3.15; 95% CI, 1.52-6.53; P = .002; retrospective cohort study: odds ratio, 1.91; 95% CI, 1.21-3.04; P = .006). Placental pathologic findings corroborated this association, with more syncytial nuclear aggregates and inflammatory infiltrates occurring in placentas of newborns born with decreased head circumference. Conclusions and Relevance: This study indicates that falciparum malaria during pregnancy is associated with decreased head circumference in newborns, which is in turn associated with evidence of placental malaria

Children and adolescents with the HIV virus: findings of the auditory evoked potential of long latency and P300 event-related potentials

OBJETIVOS: Descrever e analisar as respostas obtidas no potencial evocado auditivo de longa latência e no potencial cognitivo em crianças e adolescentes, portadoras do vírus HIV, comparando com o grupo controle; verificar possíveis correlações entre alterações nas avaliações eletrofisiológicas e o uso de medicações anti-retrovirais. MÉTODOS: Estudo comparativo, contemporâneo e transversal, composto por crianças e adolescentes, de 8 a 16 anos portadores do vírus HIV. Os participantes realizaram anamnese, audiometria tonal e vocal, medidas de imitância acústica e avaliação eletrofisiológica, por meio da pesquisa dos potenciais evocados auditivos de longa latência e potencial cognitivo. RESULTADOS: Foram estudadas 14 crianças e adolescentes do grupo controle e 14 do grupo pesquisa. Verificou-se aumento de latência das ondas, no complexo P1-N2 em ambas as orelhas e amplitude reduzida na orelha esquerda. Com relação ao P3, os sujeitos portadores do vírus apresentaram latência aumentada quando comparados com crianças e adolescentes do grupo controle. Houve diminuição da amplitude do P3, porém esta não foi significativa. Os medicamentos mais utilizados foram zidovudina, didanosina, lopinavir/r e lamivudina, não foi possível fazer a associação entre alteração nas avaliações eletrofisiológicas e o uso de alguma medicação anti-retroviral específica, já que os sujeitos usavam diversas medicações. CONCLUSÃO: Crianças e adolescentes portadores do vírus HIV apresentam alteração no potencial evocado auditivo de longa latência e no potencial cognitivo, principalmente com relação à latência. Evidencia-se a necessidade dessas avaliações na prática clínica, contribuindo para o diagnóstico de alterações na via auditiva central.OBJECTIVES: To describe and analyze the responses of evoked potential long-latency auditory and P300 Event-Related Potentials of children and adolescents with HIV, 8-16 years old, comparing with the control group; to compare the responses between sexes and age; to determine if there is a relationship between changes in the electrophysiological evaluation and the use of antiretroviral therapy. METHODS: A comparative, contemporary and cross-sectional study done with children and adolescents aged 8 to 16 years with HIV. They did anamnesis, tonal and speech audiometry, acoustic immittance measures, electrophysiological evaluation through research of evoked potential long-latency auditory and P300 Event-Related Potentials. RESULTS: 14 children and adolescents in the control group and 14 in the study group were analyzed. Increased latency in P1-N2 complex in both ears and only reduced amplitude in the left ear was found. About P3, subjects carrying the virus showed increased latency compared with children and adolescents in the control group. Amplitude decreased, but this was not significant. The most commonly used medications were zidovudine, didanosine, lopinavir/r and lamivudine. It is not possible to make the association between changes in the electrophysiological evaluation and the use of some specific medication, since the subjects used different drugs. CONCLUSION: Children and adolescents living with HIV have changes in auditory evoked potential long latency and P300 Event-Related Potentials, especially with regard to latency. It is important to stress the need for such assessments in clinical practice, contributing to the diagnosis of changes in the central auditory pathway

Children and adolescents with the HIV virus: findings of the auditory evoked potential of long latency and P300 event-related potentials

OBJETIVOS: Descrever e analisar as respostas obtidas no potencial evocado auditivo de longa latência e no potencial cognitivo em crianças e adolescentes, portadoras do vírus HIV, comparando com o grupo controle; verificar possíveis correlações entre alterações nas avaliações eletrofisiológicas e o uso de medicações anti-retrovirais. MÉTODOS: Estudo comparativo, contemporâneo e transversal, composto por crianças e adolescentes, de 8 a 16 anos portadores do vírus HIV. Os participantes realizaram anamnese, audiometria tonal e vocal, medidas de imitância acústica e avaliação eletrofisiológica, por meio da pesquisa dos potenciais evocados auditivos de longa latência e potencial cognitivo. RESULTADOS: Foram estudadas 14 crianças e adolescentes do grupo controle e 14 do grupo pesquisa. Verificou-se aumento de latência das ondas, no complexo P1-N2 em ambas as orelhas e amplitude reduzida na orelha esquerda. Com relação ao P3, os sujeitos portadores do vírus apresentaram latência aumentada quando comparados com crianças e adolescentes do grupo controle. Houve diminuição da amplitude do P3, porém esta não foi significativa. Os medicamentos mais utilizados foram zidovudina, didanosina, lopinavir/r e lamivudina, não foi possível fazer a associação entre alteração nas avaliações eletrofisiológicas e o uso de alguma medicação anti-retroviral específica, já que os sujeitos usavam diversas medicações. CONCLUSÃO: Crianças e adolescentes portadores do vírus HIV apresentam alteração no potencial evocado auditivo de longa latência e no potencial cognitivo, principalmente com relação à latência. Evidencia-se a necessidade dessas avaliações na prática clínica, contribuindo para o diagnóstico de alterações na via auditiva central.OBJECTIVES: To describe and analyze the responses of evoked potential long-latency auditory and P300 Event-Related Potentials of children and adolescents with HIV, 8-16 years old, comparing with the control group; to compare the responses between sexes and age; to determine if there is a relationship between changes in the electrophysiological evaluation and the use of antiretroviral therapy. METHODS: A comparative, contemporary and cross-sectional study done with children and adolescents aged 8 to 16 years with HIV. They did anamnesis, tonal and speech audiometry, acoustic immittance measures, electrophysiological evaluation through research of evoked potential long-latency auditory and P300 Event-Related Potentials. RESULTS: 14 children and adolescents in the control group and 14 in the study group were analyzed. Increased latency in P1-N2 complex in both ears and only reduced amplitude in the left ear was found. About P3, subjects carrying the virus showed increased latency compared with children and adolescents in the control group. Amplitude decreased, but this was not significant. The most commonly used medications were zidovudine, didanosine, lopinavir/r and lamivudine. It is not possible to make the association between changes in the electrophysiological evaluation and the use of some specific medication, since the subjects used different drugs. CONCLUSION: Children and adolescents living with HIV have changes in auditory evoked potential long latency and P300 Event-Related Potentials, especially with regard to latency. It is important to stress the need for such assessments in clinical practice, contributing to the diagnosis of changes in the central auditory pathway