Luciana Macedo de Resende

Congenital Toxoplasmosis in Southeastern Brazil: Results of Early Ophthalmologic Examination of a Large Cohort of Neonates

OBJECTIVE To report results of early ophthalmologic examinations in a large cohort of newborns with congenital toxoplasmosis (CT) after neonatal screening. DESIGN Cross-sectional analysis of a cohort. PARTICIPANTS A total of 178 newborns with confirmed CT from 146,307 screened babies (95% of live births) from Minas Gerais state, southeastern Brazil. METHODS From November 2006 to May 2007, newborns underwent neonatal screening by immunoglobulin (Ig)M capture of dried blood samples. On all positive or suspected cases, confirmative serology was performed on babies and their mothers. Congenital toxoplasmosis was confirmed in newborns who had IgM and/or IgA and IgG, or IgG associated with suggestive ocular lesions (with IgM and IgG in the mother). Ophthalmologic evaluation consisted of indirect ophthalmoscopy with a lid speculum. Pediatric examination and radiologic studies of the central nervous system were also performed. In selected cases, biomicroscopy of the anterior segment, fundus photographs, or ultrasonography (B-scan) was performed. MAIN OUTCOME MEASURES Prevalence of retinochoroidal lesions, either cicatricial or active, and their location and associated findings, such as vascular sheathing, hemorrhage, vitreous opacities, and retinal detachment, were evaluated. The occurrence of cataract, microphthalmia, microcephaly, intracranial calcification, and hydrocephalus was also recorded. RESULTS Of 146,307 neonates screened, 190 had CT, yielding a prevalence of 1 in 770 live births, of whom 178 (93.7%) underwent standardized ophthalmologic examination at an average age of 55.6+/-16.6 days. Of these 178 infants, 142 (79.8%) had retinochoroidal lesions consistent with CT in at least 1 eye. Bilateral involvement was noted in 113 patients (63.5%). Macular involvement was seen in 165 eyes (46.3%) of 111 patients (62.4%). Active lesions were observed in 142 eyes (39.9%) of 85 patients (47.8%). These lesions were located in the macula of 75 eyes (21.1%) and were associated with retinal vascular sheathing in 44 eyes (12.4%). CONCLUSIONS A high prevalence of CT was encountered (1/770) with high rates of early retinochoroidal involvement ( approximately 80%) and many active lesions (in approximately 50%), indicating a possibly more severe ocular involvement by CT in Brazil than in other parts of the world. The hypotheses of higher parasite virulence and increased individual susceptibility are being currently investigated.

Triagem auditiva em hospital público de Belo Horizonte, Minas Gerais, Brasil: deficiência auditiva e seus fatores de risco em neonatos e lactentes

The objective of this study was to estimate the prevalence of hearing impairment in children in a public hospital in Belo Horizonte, Minas Gerais, Brazil, and to investigate the association with risk factors described in the literature. This study was cross-sectional and retrospective and analyzed 798 newborns and infants evaluated in the Universal Neonatal Hearing Screening Program from June 2002 to December 2003. The risk factors established by the Joint Committee on Infant Hearing in 1994 and Azevedo in 1996 were studied, besides prematurity. Prevalence of hearing impairment was 1.8% (15 cases). A multivariate logistic regression analysis was used to verify associations between risk factors and hearing impairment, showing a significant statistical association (p < 0.05) between hearing loss and suspicion of hearing loss by relatives, hyperbilirubinemia (serum level requiring exchange transfusion), ototoxic drugs, and low birth weight. A significant prevalence of hearing impairment in neonates and infants was confirmed. Attention should thus be focused on risk factors for hearing impairment, using hearing programs that ensure prevention, early detection, and intervention.

Hearing loss in congenital toxoplasmosis detected by newborn screening

UNLABELLED Congenital toxoplasmosis may cause sensorineural deficit in up to 20% of the patients and proper treatment in the first year improves prognosis. In Brazil, this infections impact on hearing impairment is unknown. AIM To evaluate hearing of newborns with congenital toxoplasmosis identified by the newborn screening service. METHOD This prospective study analyzed children with congenital toxoplasmosis identified by newborn screening (IgM anti-T.gondii) in Belo Horizonte during 2003/2004. The presence of IgM and/or IgA in the first 6 months or IgG at 12 months-of age in serology was used as case definition. Hearing tests were carried out at the time of diagnosis and 12 months later, including behavioral audiometry, evoked otoacoustic emission and brainstem evoked responses audiometry. RESULTS Among 30.808 screened children (97% of live births), 20 had congenital toxoplasmosis, 15 (75%) were asymptomatic at birth. Nineteen children were evaluated by hearing tests. Four had sensorineural impairment (21.1%). One child had other risk factors for hearing impairment; the other three had no other risk factors but toxoplasmosis. Two properly children treated still had hearing loss, in disagreement with current literature. CONCLUSION Results suggest that congenital toxoplasmosis, common in Brazil, is a risk factor for hearing impairment and its impact on hearing loss deserves further studies.

Contribuição do Mismatch Negativity na avaliação cognitiva de indivíduos portadores de esclerose múltipla

Mismatch Negativity is a functional index of the supratemporal auditory cortex. AIM: The aim of the present study on Mismatch Negativity (MMN) in multiple sclerosis (MS) patients was to evaluate if the MMN can be correlated with cognitive deficits assessed by the Paced Auditory Addition Task - PASAT. METHOD: a clinical study in forty females and 20 males separated in two groups: control individuals and those with a definite diagnosis of MS underwent a duration and frequncy MMN. The MMN latencies and negative amplitudes obtained from the MS group were compared to the ones from the control group. The scores from the Paced Auditory Addition Task were correlated either with the presence or the absence of MMN. RESULTS: MMN was found in 60% of the individuals with multiple sclerosis within the auditory stimulation protocol with varied durations, and in 45 % within the auditory stimulation protocol with frequency variations. There were no statistically significant differences in latencies and amplitudes when compared to controls. We found a statistically significant correlation for the lack of MMN wave together with cognitive disorder asserted by the PASAT. CONCLUSIONS: The MMN correlated to the cognitive deficit assessed by the PASAT.

Prevalência de alterações auditivas em crianças de risco

UNLABELLED Hearing impairment is prevalent in the general population; early intervention facilitates proper development. AIM To establish the prevalence of hearing impairment in infants at risk, born between June 2006 and July 2008, and to correlate the variables with hearing loss. TYPE OF STUDY descriptive and cross-sectional. MATERIALS AND METHODS 188 newborns were evaluated using evoked otoacoustic emissions and distortion product and auditory behavior. Tests were repeated if the results were altered. If altered results persisted, the child was referred for impedance testing and, when necessary, for medical evaluation. Infants with normal conduction were referred for brainstem auditory evoked potential testing. RESULTS Of 188 children two (1.1%) were excluded, and 174 (92.6%) had results within normal limits. Hearing impairment was found in 12 children (6.3%); hearing loss was retrocochlear in three infants (25%). Unilateral hearing loss was present in two infants (16.7%); bilateral hearing loss was present in 10 infants (83.3%). CONCLUSION The high prevalence of hearing impairment in this population underlines the importance of early audiological testing.Hearing impairment is prevalent in the general population; early intervention facilitates proper development. AIM: To establish the prevalence of hearing impairment in infants at risk, born between June 2006 and July 2008, and to correlate the variables with hearing loss. TYPE OF STUDY: descriptive and cross-sectional. MATERIALS AND METHODS: 188 newborns were evaluated using evoked otoacoustic emissions and distortion product and auditory behavior. Tests were repeated if the results were altered. If altered results persisted, the child was referred for impedance testing and, when necessary, for medical evaluation. Infants with normal conduction were referred for brainstem auditory evoked potential testing. RESULTS: Of 188 children two (1.1%) were excluded, and 174 (92.6%) had results within normal limits. Hearing impairment was found in 12 children (6.3%); hearing loss was retrocochlear in three infants (25%). Unilateral hearing loss was present in two infants (16.7%); bilateral hearing loss was present in 10 infants (83.3%). CONCLUSION: The high prevalence of hearing impairment in this population underlines the importance of early audiological testing.

Association Between IgG Subclasses Against Toxoplasma gondii and Clinical Signs in Newborns With Congenital Toxoplasmosis

Background: The aim of this study was to evaluate the association between clinical signs of congenital toxoplasmosis and IgG subclasses found in newborns participating in the Minas Gerais State Neonatal Screening Program. Methods: Neonates with confirmed congenital toxoplasmosis underwent standardized ophthalmologic evaluation, neuroimaging studies and hearing assessment, as well as enzyme-linked immunosorbent assay testing for total IgG and its subclasses (IgG1, IgG2, IgG3 and IgG4) against soluble (STAg) and recombinant (rSAG1 and rMIC3) antigens of Toxoplasma gondii. Results: Newborns with congenital toxoplasmosis but without ocular lesions were more likely to present anti-rMIC3 total IgG when compared with those newborns with active or cicatricial retinochoroidal lesions. Detection of anti-rMIC3 IgG2 and IgG4 was associated with presence of retinochoroidal lesions and intracranial calcifications, with higher mean reactivity index values than unaffected newborns with congenital toxoplasmosis. Anti-STAg IgG3 was associated with newborns without neurologic damage. Conclusions: Specific subclasses of IgG antibodies reacting with recombinant antigens of T. gondii may serve as biomarkers of neurologic and ocular changes in newborns with congenital toxoplasmosis.

Congenital toxoplasmosis: Auditory and language outcomes in early diagnosed and treated children

OBJETIVOS: descrever a evolucao audiologica e de linguagem em criancas com toxoplasmose congenita diagnosticada e tratada precocemente. METODOS: um estudo transversal descritivo incluiu todas as criancas diagnosticadas com toxoplasmose congenita pelo Programa Estadual de Triagem Neonatal de Minas Gerais entre setembro de 2006 e marco de 2007. Todas as criancas foram submetidas ao protocolo de tratamento com pirimetamina e sulfadiazina iniciado antes dos 2,5 meses de idade e com duracao de 12 meses, tendo realizado acompanhamento pediatrico, oftalmologico e fonoaudiologico periodico. Para avaliar a audicao foram usados, como instrumentos diagnosticos, medidas de imitância acustica, emissoes otoacusticas evocadas por estimulo transiente e produto de distorcao, potencial evocado auditivo de tronco encefalico e observacao do comportamento auditivo. Foi avaliada a acuidade auditiva e as alteracoes auditivas foram classificadas em condutivas, neurossensoriais e retrococleares. O desempenho de linguagem foi avaliado usando-se um instrumento de avaliacao do desenvolvimento da linguagem, e os resultados foram classificados como normais ou alterados. As seguintes variaveis foram estudadas: resultados audiologicos, condicoes neurologicas e oftalmologicas, linguagem e presenca de fator de risco para perda auditiva alem da toxoplasmose congenita. Foi realizada analise univariada pelo qui-quadrado ou teste exato de Fisher. RESULTADOS: entre setembro de 2006 e marco de 2007, 106 criancas foram diagnosticadas com toxoplasmose congenita pelo programa de triagem neonatal, sendo incluidas no estudo. A analise dos dados mostrou que 60 criancas apresentavam audicao normal (56,6%) e 46 criancas apresentavam audicao alterada, sendo 13 criancas (12,3%) com alteracao condutiva, 4 (3,8%) com perda auditiva neurossensorial e 29 (27,4%) com comprometimento retrococlear. Houve associacao entre presenca de alteracao auditiva e deficit de linguagem. A comparacao entre criancas ue apresentavam outro fator de risco alem da toxoplasmose e criancas que apresentavam somente a toxoplasmose como fator de risco para alteracao auditiva nao mostrou diferencas, o que sugere que os achados audiologicos alterados encontrados neste estudo devem-se exclusivamente a toxoplasmose congenita. CONCLUSOES: mesmo com o diagnostico e tratamento precoces, observou-se elevada prevalencia de comprometimento audiologico em criancas com toxoplasmose congenita.

Correlação entre as classificações de perdas auditivas e o reconhecimento de fala

Purpose: to check the correlation between Speech Reception Threshold and Index of Speech Recognition with mean audiometric results. Methods: we selected 241elderly patients who underwent examinations of the pure tone audiometry and speech audiometry. As inclusion, audiometry should have a sensorineural hearing loss. The tone thresholds for air obtained were classified according with the following averages: Average 1 – Average of frequencies of 500, 1000 and 2000 Hz; Average 2 – Average of frequencies of 500, 1000, 2000 and 4000 Hz; Average 3 – average of frequencies of 500, 1000, 2000 and 3000 Hz; and 4 average – average of frequencies of 500, 1000, 2000, 3000 and 4000 Hz. The data were compared with Speech Reception Threshold and Index of Speech Recognition, and treated statistically. Results: Average 1 showed higher correlation with the Speech Reception Threshold (rho = 0.934, CI = 0.901 to 0.958; eqm = 52.2). In relation to the Index of Speech Recognition, it was observed that the average 3 showed the highest degree of correlation with the test (rho = – 0.768, CI = –0.807 to –0.721; eqm = 245) followed averages 2 and 4. Conclusion: for elderly people with ski slop sensorineural hearing loss, the Speech Reception Threshold has the strongest correlation with the average frequencies 500 Hz, 1000 Hz and 2000 Hz, while the Index of Speech Recognition has the highest correlation with the average which include the frequencies 3000 Hz and 4000 Hz.

Medidas de biossegurança em audiologia

BACKGROUND: biosafety precautions for audiologic practice. PURPOSE: to review the biosafety precautions suggested in the literature for infection control in audiology. The biosafety precautions suggested for many health professionals were adapted for the inherent activities of audiologic practice in Audiology Service at Hospital das Clinicas of UFMG. CONCLUSION: the submitted biosafety precautions can be used by any institution, hospital or clinic where the audiologic performance is becoming more widespread and, consequently, demanding specific precautions for audiologic practice.

Mismatch Negativity contribution in Multiple Sclerosis patients

UNLABELLED Mismatch Negativity is a functional index of the supratemporal auditory cortex. AIM The aim of the present study on Mismatch Negativity (MMN) in multiple sclerosis (MS) patients was to evaluate if the MMN can be correlated with cognitive deficits assessed by the Paced Auditory Addition Task--PASAT. METHOD a clinical study in forty females and 20 males separated in two groups: control individuals and those with a definite diagnosis of MS underwent a duration and frequency MMN. The MMN latencies and negative amplitudes obtained from the MS group were compared to the ones from the control group. The scores from the Paced Auditory Addition Task were correlated either with the presence or the absence of MMN. RESULTS MMN was found in 60% of the individuals with multiple sclerosis within the auditory stimulation protocol with varied durations, and in 45 % within the auditory stimulation protocol with frequency variations. There were no statistically significant differences in latencies and amplitudes when compared to controls. We found a statistically significant correlation for the lack of MMN wave together with cognitive disorder asserted by the PASAT. CONCLUSIONS The MMN correlated to the cognitive deficit assessed by the PASAT.