Passive surveillance of infectious diseases with a high percentage of asymptomatic cases or long incubation periods, such as acquired immunodeficiency syndrome (AIDS), does not reflect the current transmission dynamics. Thus, a multi-strategic surveillance, such as the human immunodeficiency virus (HIV) sentinel surveillance proposed by the World Health Organization (WHO), is necessary. The Brazilian HIV sentinel surveillance was started in May 1992 with this purpose. The objectives of this study were to evaluate the feasibility and costs of HIV and hepatitis C virus (HCV) surveillance using dried blood spots (DBS) collected for neonatal screening of metabolic diseases in the state of Minas Gerais, Brazil. This was accomplished through the comparison of HIV and HCV seroprevalence with previous Brazilian studies. From December 2001 to June 2002, 24,905 newborns were tested for HIV and 4211 for HCV. HIV seroprevalence was 0.25% and the 95% confidence interval (CI) was 0.18, 0.31%; and HCV seroprevalence was 0.71% and the 95% CI was 0.46, 0.97%. These numbers are similar to previous Brazilian studies. Cost in this study was approximately US$ 3.10 per sample, which was roughly one third of the cost of the same exam at the Brazilian HIV sentinel surveillance. We conclude that it is possible and more cost-effective to use DBS for infectious diseases surveillance, albeit it is still necessary to compare these results with the usual sentinel methodology in a concomitant trial.

Neste artigo será relatado um caso de Hipoglicemia Hiperinsulinêmica Persistente Infantil (HHPI) e após seguirá uma revisão de literatura sobre tal assunto. Trata-se de uma recém-nascida que iniciou episódios de hipoglicemia nas primeiras 24 horas de vida e foi medicada com octreotide com boa resposta a esta terapêutica até o momento. A HHPI é a principal causa de hiperinsulinismo persistente na infância e pode ser extremamente deletéria ao desenvolvimento do sistema nervoso central. Há atualmente poucas opções de tratamento clínico, com eficácia muito variada, e o octreotide parece ser a melhor delas antes que tenha que ser realizada a terapêutica cirúrgica. Hoje em dia já é possível uma adequada diferenciação pré-operatória entre hiperinsulinemia de origem focal e difusa e isso permite a indicação precisa de pancreatectomia parcial nos casos focais, garantindo um maior sucesso do tratamento e reduzindo a ocorrência de efeitos adversos pós-operatórios.

This paper presents a clinical case of persistent hyperinsulinemic hypoglycemia of infancy (PHHI) and a literature review on this subject. We report on a newborn who presented with hypoglycemic episodes in her first 24hs of life and was treated successfully with octreotide until the moment. PHHI is the most common cause of persistent hyperinsulinism in infancy and can be hazardous for the development of the central nervous system. There are few current options for clinical treatment, with variable efficacy, and octreotide seems to be the best option before surgical treatment, the only way to control the disease. Preoperative evaluation allows one to adequately distinguish between focal or diffuse processes and suggests the extension of pancreatic resection, improving surgical results and reducing the incidence of postoperative sequelae. Partial pancreatectomy is the procedure of choice in focal disease.