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Introducción: El síndrome o secuencia de Moebius se caracteriza por la afectación del nervio facial y nervio abducens y puede estar asociado a defectos congênitos orofaciales y de las extremidades. Adicionalmente en las dos últimas décadas se han reortada una posible asociación con exposición prenatal a misoprostol. Objetivo: Presentar un caso de síndrome de Moebius con cardiopatía compleja (comunicación interventricular y pseudocoartación de aorta) asociado a exposición prenatal a misoprostol. Caso clínico: Paciente de 5 años quien consulta por antecedente de retardo en el desarrollo psicomotor, anomalías craneofaciales, cardiacas y de las extremidades, con antecedente de exposición prenatal a misoprostol, a quien se le diagnóstica síndrome de Moebius. Conclusiones: Aunque la etiología de este síndrome no es clara, un mecanismo fisiopatológico involucrado es el de la hipoxia que puede ser secundario a la exposición prenatal a misoprostol.

Introduction: Moebius syndrome/sequence is characterized by facial and abducens nerve damage and may be associated with congenital orofacial and limb defects. Additionally, in the last two decades, a possible association with prenatal exposure to misoprostol has been reported. Objective: To present a case of Moebius Syndrome with complex heart disease (ventricular septal defect and pseudocoarctation of the aorta) associated with prenatal exposure to misoprostol. Case report: A 5 year old patient diagnosed with Moebius Syndrome who consulted specialists due to psychomotor retardation, craniofacial, heart and limb defects, and with a history of prenatal exposure to misoprostol is presented. Conclusions: Although the etiology of this syndrome is not clear, hypoxia is a pathophysiological mechanism involved, which can be secondary to prenatal exposure to misoprostol.

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This article puts into perspective the controversy between the association of the use of misoprostol for abortion and teratogenicity studies of the type found in a case report. The use of herbal medicinal drugs and the medical-obstetric and national and international norms governing the registration and circulation of pharmaceutical products were examined. Official documents of ANVISA, the Ministry of Health and the World Health Organization on the use of misoprostol, as well as 68 articles such as case reports published in national journals, linking abortion, misoprostol and teratogenicity were reviewed, systematically filed and analyzed using the monographic method. The legal prohibition of abortion prevents the proper prescription and use of a drug such as misoprostol that is both safe and effective. Thus, the danger for the health of women is linked not to the intrinsic characteristics of the drug, but to the moral arguments that constitute negligence and disregard for the fundamental rights of women.

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Este artigo coloca em perspectiva a controvérsia entre a associação do uso de misoprostol para aborto e teratogenicidade, encontrada em estudos do tipo relato de caso, e a consagração do uso de medicamentos à base do fármaco na área médico-obstétrica e em documentos normativos nacionais e internacionais que regulam o registro e a circulação de produtos farmacêuticos. Através do método monográfico, foram revisados, sistematizados e analisados documentos oficiais da Anvisa, Ministério da Saúde e Organização Mundial da Saúde sobre o uso do misoprostol, bem como 68 artigos do tipo relato de casos clínicos, publicados em periódicos científicos nacionais, que associam aborto, misoprostol e teratogenicidade. A interdição legal do aborto impede a prescrição e o uso adequados de uma droga que produz efeitos eficazes e seguros como o misoprostol. Assim, o grande malefício à saúde de mulheres está ligado não a características intrínsecas ao fármaco, mas a argumentos morais que representam descaso e desrespeito aos direitos fundamentais de mulheres.

This article puts into perspective the controversy between the association of the use of misoprostol for abortion and teratogenicity studies of the type found in a case report. The use of herbal medicinal drugs and the medical-obstetric and national and international norms governing the registration and circulation of pharmaceutical products were examined. Official documents of ANVISA, the Ministry of Health and the World Health Organization on the use of misoprostol, as well as 68 articles such as case reports published in national journals, linking abortion, misoprostol and teratogenicity were reviewed, systematically filed and analyzed using the monographic method. The legal prohibition of abortion prevents the proper prescription and use of a drug such as misoprostol that is both safe and effective. Thus, the danger for the health of women is linked not to the intrinsic characteristics of the drug, but to the moral arguments that constitute negligence and disregard for the fundamental rights of women.

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Moebius syndrome is a rare disease characterized by congenital facial paralysis and abducens palsy. Involvement of other cranial nerves, orofacial dysmorphism, and limb abnormalities are frequently associated. Reported here is the case of a 10-month-old child born with Moebius syndrome and presenting with holoprosencephaly, following exposure in utero to misoprostol. To our knowledge, this is the first published case report describing this association. The etiologic hypotheses of Moebius syndrome are also discussed.

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Objetivo: Descrever as anomalias ortopédicas em portadores de SM, investigando possível associação de tais alterações entre casos em que as mães não usaram misoprostol com outras em que a droga foi usada durante o primeiro trimestre de gravidez. Métodos: Foram analisados 42 portadores da SM, atendidos na Associação de Assistência à Criança Deficiente – Pernambuco, no período de 1999 a 2005. Entre os pacientes, 25 eram do sexo feminino e 17 do masculino. A idade no momento da pesquisa variou de oito meses a 15 anos e 11 meses, média de seis anos e um mês de idade. O diagnóstico da doença foi feito por equipe multidisciplinar formada por neuropediatra, oftalmologista, ortopedista e psicólogo. As mães dos investigados foram interrogadas quanto ao uso do misoprostol durante a gravidez. O estudo foi observacional, sendo descritos os achados ortopédicos de uma série de casos. Foi introduzido componente analítico para investigar se a freqüência de anomalias do aparelho locomotor estava ou não associada ao uso de misoprostol. Resultados: Das 42 mães desses pacientes, 25 (59,5%) utilizaram o misoprostol como abortivo durante o primeiro trimestre de gestação e 17 (40,5%) negaram ter usado abortivos durante a gestação. Houve acometimento do VI e do VII pares cranianos em todos os pacientes e do IX e do X pares, em 17 (40,5%). A associação com síndrome de Poland foi vista em um paciente e, com paralisia cerebral, em quatro. Entre os pacientes, 34 (80,9%) apresentaram alguma deformidade ortopédica, sendo o pé torto a mais comum. Conclusão: Anomalias ortopédicas foram observadas na grande maioria dos pacientes incluídos no estudo, sendo o pé torto congênito a mais encontrada. Não houve diferença estatisticamente significante entre a freqüência de anomalias ortopédicas em portadores da seqüência de Mõbius, filhos de mães que usaram misoprostol, quando comparadas com os casos em que a droga não foi usada

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Se presenta un caso clínico de síndrome de Moebius y artrogriposis asociado al uso de misoprostol durante el primer trimestre de gestación.

We present a case of Moebius syndrome and arthrogriposis associated to the use of misoprostol during the first trimester of gestation.

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OBJECTIVE(S): The aim of this study was to evaluate the orofacial manifestations in patients with Mobius syndrome (MS), establish an early adequate dental treatment and discuss the possible etiology of all cases examined based on information about the gestational intercurrences. DESIGN: Prospective study. SETTING: Special Care Dentistry Center, School of Dentistry, University of Sao Paulo, Brazil. Subject(s) and methods: Twenty-nine patients with MS aged 0 to 4 underwent prospective dental examination as well as early orthodontic treatment. RESULTS: All patients presented micrognathia, lack of lip seal, high arched palate and weak soft palate. The use of orthopedic appliances was recommended to all 29 patients, but only 13 adhered to treatment and were monitored for at least 24 months. We observed that, after 24 months of treatment, the palate was expanded and micrognathia became less severe in the majority of the cases. Pregnancy-related complications were reported by 27 (97%) of the 29 mothers. CONCLUSION(S): The early use of orthopedic appliances was important to prevent malocclusion and glossoptosis. Attempted abortion with misoprostol is associated with an increased risk of MS in infants.

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The psychiatric examination was performed with diagnostic instruments for autism (DSM-IV and Childhood Autism Rating Scale-CARS) in 23 children with Möbius sequence. From the 23 patients studied with Möbius sequence, five (26.1%) met the diagnostic criteria for infantile autism according DSM-IV and two (8.6%), under two years old, showed autistic-like behavior. The scores for six children were compatible to severe autism symptoms according CARS and one child met the criteria for moderate autism symptoms. Among five children with autism, three (60%) had positive history of misoprostol exposure during the first trimester of pregnancy and from two cases autistic-like, one (50%) had positive history of misoprostol exposure during pregnancy. According to our data, this is the first report of Möbius sequence with autism and positive history of misoprostol use during pregnancy.

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We report a patient affected with Moebius Syndrome (OMIM 157900) due to the use of misoprostol during the first trimester of the pregnancy, when abortion was intended twice using this drug, vias vaginal (600 mg) and oral (900 mg), with failure to induce abortion on both occasions. Since the use of misoprostol for abortion, without any medical indication or supervision, appears to be rather frequent in our population and since there are reports of severe malformations in children born after failed intents of abortion with this medication, it is necessary to alert the medical community and the population in general about the teratogenic risks of this drug.

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The psychiatric examination was performed with diagnostic instruments for autism (DSM-IV and Childhood Autism Rating Scale-CARS) in 23 children with Möbius sequence. From the 23 patients studied with Möbius sequence, five (26.1 percent) met the diagnostic criteria for infantile autism according DSM-IV and two (8.6 percent), under two years old, showed autistic-like behavior. The scores for six children were compatible to severe autism symptoms according CARS and one child met the criteria for moderate autism symptoms. Among five children with autism, three (60 percent) had positive history of misoprostol exposure during the first trimester of pregnancy and from two cases autistic-like, one (50 percent) had positive history of misoprostol exposure during pregnancy.According to our data, this is the first report of Möbius sequence with autism and positive history of misoprostol use during pregnancy

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