Epidemiological study of congenital heart defects in children and adolescents: analysis of 4,538 cases

OBJECTIVE: To analyze the frequency and prevalence of congenital heart defects in a tertiary care center for children with heart diseases. METHODS: We carried out an epidemiological assessment of the first medical visit of 4,538 children in a pediatric hospital from January 1995 to December 1997. All patients with congenital heart defects had their diagnoses confirmed at least on echocardiography. The frequency and prevalence of the anomalies were computed according to the classification of sequential analysis. Age, weight, and sex were compared between the groups of healthy individuals and those with congenital heart defects after distribution according to the age group. RESULTS: Of all the children assessed, 2,017 (44.4%) were diagnosed with congenital heart disease, 201 (4.4%) with acquired heart disease, 52 (1.2%) with arrhythmias, and 2,268 (50%) were healthy children. Congenital heart diseases predominated in neonates and infants, corresponding to 71.5% of the cases. Weight and age were significantly lower in children with congenital heart defects. Ventricular septal defect was the most frequent acyanotic anomaly, and tetralogy of Fallot was the most frequent cyanotic anomaly. CONCLUSION: Children with congenital heart defects are mainly referred during the neonatal period and infancy with impairment in gaining weight. Ventricular septal defect is the most frequent heart defect.

Study of the cardiac alterations in HIV-infected children consequent to the antiretroviral therapy: prospective study of 47 cases

OBJECTIVE: Detect of cardiac alterations in children with AIDS and compare their evolution with the administration of only one anti-retroviral and the recent cases who received drugs in combination. METHODS: We prospectively studied 47 children in 3 groups: group 1, 20 cases treated only with zidovudine; group 2, 10 patients treated initially with zidovudine and later with a combination of drugs and in group 3, 17 patients, who receiced two or three since the beginning. In all patients it was done chest X-ray, EKG and echocardiography every 6 months and after death complete pathological study. RESULTS: Among the 45 patients cases 26 (57%) were index cases. Malnutrition, diarrhea tachycardia, signs of congestive heart failure, pericardial effusion, abnormal ventricular repolarization and arrhythmias were more frequent in group 1. Echocardiographic abnormalities were present in 10 (50%) children of group 1. They were less frequent in the others two groups. In regard to the outcome in group 1, two patients had worsening of sings of cardiomyopaty and 4 died. Cardiac dysfunction in all cases of group 2 and 3 improved with the medication. CONCLUSION:- The children who received combination and their cardiac alterations had more favorable outcome than those who received only one drug.

Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases

OBJECTIVE: To describe the relative incidence, presentation, and evolvement of fetuses with early ductus constriction. METHODS: Twenty fetal echocardiograms indicating ductus constriction were reviewed in a population of 7000 pregnants. RESULTS: The cases were divided into group A (related to maternal use of cyclooxygenase inhibitors [n=7] and group B (idiopathics [n=13]). Mean gestational age was 32.5±3.1 (27-38) weeks and maternal age was 28.2±8.5 (17-42) years. Mean systolic velocity in the ductus was 2.22±0.34 (1.66-2.81) m/s, diastolic velocity 0.79±0.28 (0.45-1.5) m/s, and pulsatility index 1.33±0.36 (0.52-1.83). Two cases of ductal occlusion were noted. In 65% of the cases, an increase occurred in the right cavities; in 90% of the cases, tricuspid or pulmonary regurgitation, or both, occurred, with functional pulmonary atresia in 1 case. Diastolic velocity was greater in group A (1.13±0.33) than in group B (0.68±0.15) (P=0.008). The other data were similar in the 2 groups. The evolvement was not favorable in 4 patients from group B, including 1 death and 2 cases of persistent pulmonary hypertension. CONCLUSION: The high incidence of idiopathic constriction of the ductus arteriosus suggests that its diagnosis is underestimated and that many cases of persistence of fetal circulation in newborns may be related to constriction of the ductus arteriosus not diagnosed during intrauterine life. Group B had a lower severity but a risk of an unfavorable evolvement, suggesting a distinct alteration.

Dosagem dos níveis de NT pro-BNP nas afecções pericárdicas e sua utilidade como método complementar de avaliação de restrição diastólica. Experiência inicial de 25 casos: 25 cases

OBJETIVO: Determinar se os níveis de NT pro-BNP encontram-se elevados em pacientes com afecções pericárdicas e avaliar a sua relação com medidas ecocardiográficas de disfunção diastólica. MÉTODOS: Vinte e cinco pacientes foram divididos em dois grupos: 1) derrame pericárdico (DP), 15 pacientes; 2) pericardite constritiva (PC), 10 pacientes. Foi constituído um grupo controle de 30 indivíduos sem doença cardíaca. O grau de derrame pericárdico foi avaliado pelo ecocardiograma bidimensional e a restrição avaliada pelo Doppler pulsátil do fluxo mitral. O diagnóstico de PC foi confirmado por meio da ressonância magnética. Os níveis de NT pro-BNP foram medidos por imunoensaio com detecção por eletroquimioluminescência. RESULTADOS: Dos 15 pacientes com DP, 14 apresentavam DP importante e apenas 1, moderado. Log NT pro-BNP esteve aumentado no DP (p <0,05), com média de log 2,31 pg/ml e PC (p <0,05), com média de log 2,67 pg/ml, quando comparados ao grupo controle, média de log 1,32 pg/ml. Não houve diferença entre DP e PC (p = 0,149). O log NT pro-BNP correlacionou-se com o pico de velocidade da onda E (r = 0,845; p = 0,001) e com a relação E/A (r=0,717; p= 0,003). CONCLUSÃO: O NT pro-BNP encontra-se aumentado nas afecções pericárdicas e apresenta relação com o grau de disfunção diastólica, podendo servir como método adicional na quantificação de restrição.

Alguns trematódeos monogenéticos da família Capsalidae Baird, 1853, em peixes do Oceano Atlântico - Costa Continental Portuguesa e Costa do Norte da África

No presente trabalho é feito um estudo de cinco trematódeos monogenéticos pertencentes à família Capsalidae Baird, 1853. Para a subfamília Benedeniinae Johnston, 1931, foram criadas duas espécies pertencenteso ao gênero Benedenia Diesing, 1858: Benedenia pompatica sp. n., que muito se assemelha a Benedenia sciaenae (Beneden, 1852), diferindo desta principalmente pela estrutura do 2º e 3º pares de macroganchos e Benedenia innobilitata sp. n. que mais se aproxima de Benedenia jaliscana Bravo-Hollis, 1951, afastando-se desta espécie pela ausência do cirro armado e também pela estrutura e localização da vagina. Da subfamília Trochopodiane (Price, 1936) são apresentados novos hospedadores: Lepidotrigla cavillone para Trochopus pini (Beneden & Hesse, 1863) e Serranus cabrilla para Megalocotyle grandiloba Paperna e Kohn, 1964, sendo apresentadas com novas descrições e ilustrações. Ainda desta subfamília é criada uma nova espécie do gênero Allomegalocotyle (Robinson, 1961) Yamaguti, 1963. A. gabbari sp. n. diferencia-se de A. johnstoni (Robinson, 1961), única espécie do gênero, pela morfologia dos macroganchos, localização do poro vaginal e vesícula seminal bem desenvolvida e externa.

Alguns nematódeos de peixes do Oceano Atlântico - Costa Continental Portuguesa e Costa do Norte da África

Os autores estudam 6 espécies de nematódeos encontrados em 21 peixes coletados no Oceano Atlântico na Costa Continental Portuguesa e Costa no Norte da África. Dos 21 peixes necropsiados 7 (33,3%) estavam parasitados por nematódeos. Os hospedeiros bem como os nematódeos encontrados e as freqüências de positividade são as seguintes: 6 exemplares de Beryx decadactylus um dos quais parasitado por Ascarophis morrhuae (16,6%); 3 Lethrinus atlanticus um dos quais parasitado por Luzonema cruzi gen. n. sp. n. (33,3%); 3 Scyliorhynus canicula sendo 2 parasitados por Proleptus obutusus (66,6%); 8 de Raja clavata sendo um parasitado por Proleptus robustus (12,5%) e outro por Pseudanisakis rajae (12,5%); 1 Conger conger parasitado por Cucullanus longispiculum sp. n. (100 %). Pseudanisakis rajae é referido pela primeira vez no Oceano Atlântico e como parasita de Raja clavata. Beryx decadactylus é referido pela primeira vez como hospedeiro de Ascarophis morrhuae.

Alguns acantocéfalos de peixes do Oceano Atlântico, Costa Continental Portuguesa e Costa do Norte da África

Foram estudadas quatro espécies de acantocéfalos encontrados na autópsia de 81 peixes capturados no Oceano Atlântico, na Costa Continental Portuguesa e na Costa Norte da África. Encontramos 16 peixes parasitados por acantocéfalos. As espécies de peixes necropsiados e os helmintos encontrados foram os seguintes: 11 meros (Epinephellus gigas) sendo 1 parasitado por fêmeas da família Rhadinorhynchidade; 5 sardas (Scomber scombrus) sendo duas parasitadas por Rhadinorhynchus tenuicornis; 62 pescadas (Merluccius merluccius merluccius) sendo 12 parasitadas por Aspersentis johni e 3 linguados (Solea solea) sendo 1 parasitado por Acanthocephaloides incrassatus. Aspersintis johni é pela primeira vez mencionado no Hemisfério Norte e Acanthocephaloides incrassatus é pela primeira vez referido no Oceano Atlântico.

The vertical dispersión of Anopheles (Kerteszia) cruzi in a forest in southern Brazil suggests that human cases of malaria of simian origin might be expected

By staining females of Anopheles cruzi with fluorescent coloured powders in a forest in the State of Santa Catarina, we showed that they move from canopy to ground and vice-versa to feed. This suggests that in areas where this mosquito is a vector of human and simian malarias sporadic infections of man with monkey plasmodia might be expected.

Intratypic differentiation of polioviruses isolated from suspected cases of poliomyelitis in Brazil during the period of 1990 to 1993

This study analyzed 3129 fecal samples derived from 1626 patients with sudden onset acute flaccid paralysis clinically compatible with poliomyelitis. The samples were collected in the period ranging from January 1990 to September 1993 in all regions of Brazil. Among the 1626 cases studied, 196 had isolation of poliovirus. Nevertheless, it was observed that some factors influenced the isolation rate and the intratypic characterization of these polioviruses. No cases of acute flaccid paralysis has been found to be etiologically related with wild polioviruses.

Acute Schistosomiasis: Report on Five Singular Cases

The cases of five patients with unusual manifestations of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyogenic liver abscesses caused by Staphylococcus aureus

Sylvatic vectors invading houses and the risk of emergence of cases of Chagas disease in Salvador, State of Bahia, Northeast Brazil

During the last twenty years, several adults of Triatoma tibiamaculata infected with Trypanosoma cruzi have been spontaneously caught by inhabitants, inside their houses in the new habitational district of Pituaçu of Salvador, Bahia. In this communication the authors call attention to the necessity of studies about the possibility of occurrence of new human cases of Chagas disease, to clarify the obscure origin of some positive blood donors in Salvador.