ABSTRACT We report the long-term outcomes of a case of prenatal gastroschisis repair using a fully percutaneous fetoscopic approach with partial carbon dioxide insufflation. Surgery was performed as an experimental procedure before the scheduled elective birth. The fetal intestines were successfully returned to the abdominal cavity without any fetal or maternal complications. Ultrasonography performed 24 hours later revealed bowel peristalsis and no signs of fetal distress. After 48 hours, partial extrusion of the small bowel was observed, and the fetus was delivered. Gastroschisis repair was immediately performed upon delivery using the EXIT-like procedure as per our institutional protocol. The newborn did not require assisted mechanical ventilation, was discharged at 14 days of age and was then exclusively breastfed. At 3-year follow-up, the patient had no associated gastroschisis-related complications. This is the first case of prenatal repair of gastroschisis, which provides baseline knowledge for future researchers on the potential hurdles and management of prenatal repair.

ABSTRACT Acute hemorrhagic conjunctivitis (AHC) infection is highly contagious and can lead to explosive epidemics. In early February 2011, the Center for Epidemiologic Surveillance of the State of São Paulo Health Secretariat (SES-SP) in Brazil received reports of conjunctivitis outbreaks from rural areas of the state that subsequently spread statewide. This report describes that AHC epidemic and its etiologic agent. Data from the Ministry of Health Information System for Notifiable Diseases (SinanNet) and the SES-SP epidemiologic surveillance system for conjunctivitis, developed to detect outbreaks, confirm the etiologic agent, and carry out control measures, were analyzed. Eye (conjunctival swab) samples were taken from patients with clinical presentation of viral conjunctivitis to perform viral laboratory diagnosis. A total of 1 067 981 conjunctivitis cases were reported to the surveillance system for 2011; there was an increase in the number of cases in epidemiologic weeks 6–26 (summer season) versus previous years. Most cases occurred in the metropolitan region of Greater São Paulo. Of 93 collected samples, 57 tested positive for coxsackievirus-A24 (CV-A24), based on virus isolation in tissue-culture cell lines, reverse transcription polymerase chain reaction (RT-PCR), and enterovirus sequencing of RT-PCR. The data analysis showed that the fast-spreading etiologic agent of the AHC epidemic that occurred in the summer of 2011 was CV-A24. The AHC epidemic was due to an enterovirus that occurred sporadically, spread rapidly and with great magnitude, and had substantial socioeconomic impact due to the high level of absenteeism at work and school.

RESUMEN La conjuntivitis hemorrágica aguda es sumamente contagiosa y puede provocar epidemias fulminantes. A principios de febrero del 2011, el Centro para la Vigilancia Epidemiológica de la Secretaría Estatal de Salud de São Paulo (SES-SP), en el Brasil, recibió informes de brotes de conjuntivitis en zonas rurales del estado que posteriormente se difundieron por todo el territorio estatal. En este informe se describe esa epidemia de conjuntivitis hemorrágica aguda y su agente causal. Se analizaron datos del Sistema de Información para las Enfermedades de Notificación Obligatoria del Ministerio de Salud (SinanNet) y del sistema de vigilancia epidemiológica de la SES-SP para la conjuntivitis, que fue creado para detectar brotes, confirmar el agente causal y adoptar medidas de control. Se obtuvieron hisopados conjuntivales de pacientes con un cuadro clínico de conjuntivitis vírica para hacer el diagnóstico vírico en el laboratorio. En el 2011 se notificaron al sistema de vigilancia 1 067 981 casos de conjuntivitis; el número de casos observados de la semana epidemiológica 6 a la 26 (estación del verano) fue mayor que en años anteriores. La mayoría de los casos se produjeron en la zona metropolitana del gran São Paulo. De las 93 muestras obtenidas, 57 resultaron positivas para el virus Coxsackie tipo A24 (vC-A24), según los resultados del aislamiento vírico en líneas celulares obtenidas por histocultivo, la reacción en cadena de la polimerasa con retrotranscriptasa y la secuenciación enterovírica del producto de esta. El análisis de los datos reveló que el agente causal, de rápida propagación, de la epidemia de conjuntivitis hemorrágica aguda que tuvo lugar en el verano del 2011 fue el vC-A24. La epidemia se debió a un enterovirus que apareció de forma esporádica, tuvo una diseminación rápida y de gran magnitud y repercutió de manera importante en la esfera socioeconómica debido al gran ausentismo laboral y escolar que ocasionó.

Anticorpos para Enterovírus 71 (EV71) foram avaliados no Estado de São Paulo durante 1999-2005. O título de anticorpos neutralizantes contra EV71 foi determinado pelo ensaio microneutralização, e um título de > 1:8 foi definido como indicador de imunidade protetora. Anticorpos neutralizantes para EV71 foram observados em 12,4% (55/442) das amostras de soro, uma baixa taxa de proteção, sugerindo que a infecção pelo EV71 é incomum nesta região e que existe alta susceptibilidade a doenças relacionadas ao EV71, o que é preocupante considerando os recentes surtos asiáticos. Ainda, foi observada diferença significativa na soropositividade em relação à localização, onde 8,7% (21/241) e 16,9% (34/201) das amostras provenientes da região metropolitana de São Paulo, e demais municípios, respectivamente, apresentaram anticorpos neutralizantes para EV71. Um grande número de brasileiros vive em áreas rurais e à beira-mar, sem acesso adequado à água encanada ou saneamento. Essa situação pode contribuir para a disseminação de EV71 nessas regiões. A análise de amostras ambientais poderia gerar contribuição valiosa para estudos sobre a epidemiologia da EV71.

Antibodies to Enterovirus 71 (EV71) were evaluated in São Paulo State during 1999-2005. The titer of neutralizing antibodies against EV71 was determined by microneutralization assay, and a titer of > 1:8 was defined as indicative of protected immunity. Neutralizing antibodies to EV71 were observed in 12.4% (55/442) of sera samples, a low protective rate, suggesting that EV71 infection is uncommon in this region, but that there is a relatively high susceptibility to EV71 related diseases, which is worrying considering the recent Asian outbreaks. Also, a significant location-specific difference in seropositivity was observed. Neutralizing antibodies to EV71 were observed in 8.7% (21/241) of São Paulo metropolitan area sera samples, and 16.9% (34/201) of the sera samples from other municipalities. A high number of Brazilian residents live in country and coastal areas without adequate access to piped water or sanitation. This situation may contribute to the EV71 dissemination in these zones. The analysis of environmental samples could possibly make a valuable contribution to studies on the epidemiology of EV71.