Daniele Machado Reinheimer

Anxiety, depression, and quality of life in mothers of newborns with microcephaly and presumed congenital Zika virus infection

Dear Editor, In Brazil, an unusual increase of newborns withmicrocephaly has been reported since August 2015 (França et al. 2016), with a strong evidence of association with congenital Zika virus (ZIKV) infection (Martines et al. 2016). In February 2016, the World Health Organization declared the clusters of microcephaly and other neonatal malformations reported in Brazil a Public Health Emergency of International Concern (WHO 2016). In June 2016, the Brazilian Ministry of Health confirmed 1410 cases of microcephaly in the Northeast region, out of which 111 (7.9 %) cases in the Sergipe state, the smallest state of the Brazilian Federation, with ∼2 million population (BRAZIL 2016). Studies have shown an increased risk of microcephaly when mothers are infected with ZIKV during the first trimester of pregnancy (Cauchemez et al. 2016; Johansson et al. 2016). Unfortunately, there is currently no vaccine or medication to prevent ZIKV infection, which may be asymptomatic in an estimate of 80% of cases (Duffy et al. 2009). Recently, in Colombia, four infants with microcephaly had laboratory evidence of congenital ZIKVwhose mothers had asymptomatic infection during pregnancy (Pacheco et al. 2016). Because of growing evidence, experts have suggested safety measures to avoid ZIKV infection during pregnancy, especially in areas where the virus has been circulating. Brazilian newborns with microcephaly have demonstrated severe abnormalities in the central nervous system including brain dysgenesis and intracranial calcifications consistent with an intrauterine infection (Microcephaly Epidemic Research Group 2016). The expectancy of microcephaly diagnosis may lead to higher levels of parental stress because of the uncertainty regarding the developmental outcome of their children. To the best of our knowledge, there have been no previous studies evaluation anxiety, depression, and quality of life in mothers of newborns with microcephaly and presumed congenital ZIKV infection. We evaluated nine consecutive mothers of babies with microcephaly born in a public maternity in Sergipe state, Brazil, from November 2015 to June 2016. The newborns with microcephaly presented typical alterations indicating congenital infection including intracranial calcifications, cerebral ventricles dilation, or changes in the posterior fossa and other clinical signs found by any image diagnostic method or ZIKV identification in laboratory tests (BRAZIL 2016).We compared data regarding anxiety, depression, and quality of life with those from a concurrent control group of 20 mothers of healthy newborns. Psychometric evaluation of anxiety and depression was performed using the State-Trait Anxiety Inventory and the Beck Depression Inventory, respectively. Quality of life was assessed using the World Health Organization Questionnaire—short version (WHOQOL-BREF). Differences between the groups were compared using the Mann-Whitney test with a significance level of 5 %. All participants signed the informed consent. Data were collected during the first 24 h after birth. The mothers’ age of newborns with microcephaly ranged from 18 to 39 years. Only three mothers were married and all * Paulo Ricardo Saquete Martins-Filho martins-filho@ufs.br

Papillary cystadenoma of the upper lip.

To the Editor: We found a rare case of oral papillary cystadenoma in a 53-year-old woman. The lesion appeared as a 0.5-cm–diameter, well-circumscribed, solid swelling at the upper lip mucosa (Fig. 1). The patient denied having a history of local trauma, and her medical history was not contributory. Surgical removal was the treatment of choice, and histologically, the specimen was characterized as a wellcircumscribed cystic nodule with a papillary intraluminal projection characterized by epithelial cells arranged in multiple microcystic spaces with proteinaceous fluid (Fig. 2A). The cystic spaces were lined by cuboidal and columnar cells with areas of oncocytic metaplasia (Fig. 2B). No lymphoid stroma was found, and there were no mitotic figures or cytologic atypia. The literature shows that papillary cystadenomas are common neoplasms in the appendix, ovary, and pancreas 1 but are extremely rare in the oral cavity, especially in the upper lip. Until this moment, only 4 cases in this location were described 2–5 (Table 1). Histologically, the lesions are characteristics and the presence of oncocytic cells is common, although the real significance of this differentiation is not fully understood. The major diagnostic challenge is to differentiate the lesion from cystadenocarcinoma because of the similar architecture of both neoplasms and the lack of atypia of cystadenocarcinoma. Differentiation of these tumor types depends largely on the identification of actual infiltration of salivary gland parenchyma or surrounding connective tissue by either cystic or solid epithelium in cystadenocarcinoma. 2,6 In the current study, no signs of malignant transformation were observed. We concluded that, although uncommon in the oral cavity, papillary cystadenoma should be included in the differential diagnosis of the nodular lesions located in the soft tissues, especially in the upper lip. In addition, an accurate histologic analysis is essential to avoid misdiagnosis and unnecessary treatments.

Femicide trends in Brazil: relationship between public interest and mortality rates

In this information epidemiology (infodemiology) study, we describe the online public interest about the issue of femicide in Brazil and analyze the relationship between search queries and femicide trends from 2004 to 2015. We showed that information-seeking behavior for femicide in the Brazilian states has been strongly influenced by female homicide rates. Educational and policy-related interventions are needed to improve the population’s knowledge and attitude toward femicide.