IntroductionCongenital Zika Syndrome (CZS) has been associated with microcephaly and other central nervous system abnormalities including areas that have been implicated in the control of the lower urinary tract. As such, this descriptive case series has aimed to investigate whether CZS is linked with neurogenic bladder. Identifying such an association is paramount in the effort to recognize CZS complications that have putative treatment options that could mitigate the impact of CZS in infected children.MethodsFollowing IRB approval, urological assessment was performed in all patients referred to our clinic between June 2016 and May 2017 who presented with confirmed CZS-associated microcephaly. The research protocol consisted of obtaining clinical history, laboratory tests, lower and upper urinary tract ultrasounds, as well as a diagnostic urodynamic evaluation. ZIKA virus infection was previously confirmed by maternal history and positive PCR in babies and mothers. Microcephaly and other central nervous system abnormalities were established based on neurological assessment and associated imaging of the central nervous system (CT head and/or Brain MRI).ResultsTwenty-two consecutive CZS patients were tested and confirmed to have neurogenic bladder. Of the 22 patients assessed, 21 presented with an overactive bladder combined with reduced bladder capacity and elevated detrusor filling pressures. Clinically significant increases in postvoid residual (PVR) were confirmed in 40% of cases while a urinary tract infection (UTI) was identified in 23% of cases.ConclusionNeurogenic bladder, a known treatable health condition, was confirmed in 100% of patients tested in this study, most presenting with high-risk urodynamic patterns known to lead to renal damage when left untreated. Follow up studies are necessary to provide further insight onto long-term disease progression and to investigate the response to standard therapies for neurogenic bladder. Nonetheless, we emphasize the importance of proactive management of neurogenic bladder and prompt referral so as to help mitigate CZS disease burden for patients and their families.
Segundo a OPAS, só 2% dos 85 milhões de pessoas com deficiência têm assistência adequada na América Latina e 10% da população mundial vivem com deficiência, mas sem acesso a direitos constitucionalmente adquiridos. A deficiência precisa ser abordada em diferentes níveis: clínico, de reabilitação, social e político. Pobreza e deficiência estão fortemente relacionadas. Estigma, discriminação e incapacidade física e financeira limitam o acesso à educação e saúde, levando à cronificação e agravamento da morbidade, aumentando os custos do tratamento, formando-se um ciclo vicioso que tem que ser quebrado. Embora a Constituição Federal inclua direitos a pacientes deficientes, dando acesso à saúde e educação, eles não são obtidos e respeitados. Para compreender o problema, estudou-se o processo de obtenção de três destes benefícios em pacientes com deficiência física portadores de mielomeningocele em instituto de referência no Rio de Janeiro. Os resultados mostram um baixo índice de obtenção. A burocracia e o custo das múltiplas viagens foram as principais dificuldades para famílias próximas ou abaixo da linha de pobreza e filhos com problemas de locomoção e doença crônica. Outras dificuldades foram desinteresse profissional, descrédito, sistema educacional despreparado e dificuldades de acesso.
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