Unequal burden of Zika-associated microcephaly among populations with public and private healthcare in Salvador, Brazil.

OBJECTIVES: To describe the differences in clinical presentation and relative disease burden of congenital Zika syndrome (CZS)-associated microcephaly at 2 large hospitals in Salvador, Brazil that serve patients of different socioeconomic status (SES). METHODS: Clinical and serologic data were collected prospectively from pregnant women and their infants, who delivered at 2 study centers during the 2015-2016 Zika virus (ZIKV) epidemic in Salvador, Brazil. RESULTS: Pregnant women from Salvador, Brazil delivering in a low SES hospital had 3 times higher ZIKV exposure rate than women at a high SES hospital. However, different SES hospitals had similar prevalence of infants with CZS-associated microcephaly (10% vs 6%, p = 0.16) after controlling for ZIKV exposure in their mothers. CONCLUSIONS: Our study supports the positive association between low SES, high maternal ZIKV exposure, and high rates of CZS-associated microcephaly.

Ultrasonographic evaluation of the fetal thymic-thoracic ratio and its association with conotruncal heart defects.

OBJECTIVE: To evaluate the thymic-thoracic ratio (TT ratio) on fetal ultrasound and its association with conotruncal heart defects. METHODS: A case control study was carried out to retrospectively assess the TT ratio on fetal echocardiograms performed between 19 and 39 weeks of gestation, showing congenital heart defects, from January to December 2018. The control group was comprised of fetuses with no echocardiogram evidence of congenital cardiac malformations. Cases of multiple pregnancies and patients where the TT ratio could not be established have been excluded. RESULTS: A total of 338 pregnancies have been analysed. Fifty-two pregnancies were diagnosed with fetal heart defects (15%), 17 of which showed conotruncal heart defects (32.7%). The TT ratio in normal fetuses (286 pregnancies) increased with gestational age, and had an average of 0.43 ± 0.06. Compared to the control group (normal fetuses), fetuses with conotruncal heart defects had significantly lower mean TT ratio (0.33 ± 0.07). Those that were diagnosed with nonconotruncal heart defects did not show any statistically significant difference in the TT ratios compared with the control group (0.40 ± 0.09 vs. 0.43 ± 0.06, respectively). CONCLUSION: The TT ratio was significantly lower in fetuses with conotruncal heart defects compared with both the control group (normal fetuses) and the fetuses with nonconotruncal heart defects.

Cytogenetic abnormalities in couples with a history of primary and secondary recurrent miscarriage: a Brazilian Multicentric Study.

Objective: To evaluate the difference between chromosomal abnormalities between the gender of couples affected by Recurrent miscarriage (RM) and if there is an association between previous obstetric history and chromosomal abnormalities of the parents.Methods: Multicenter, retrospective, observational study from seven different RM clinics between 2006 and 2016. We enrolled 707 couples (1014 participants) with a history of RM. We compared the frequency of chromosomal abnormalities between groups of couples with primary and secondary RM and separated between women and their partners. Furthermore, we compared the prevalence of chromosomal abnormalities between groups based on the number of previous spontaneous abortions.Results: The overall prevalence of all cytogenetic abnormalities was 5.59% (n = 1414, women and their partners). Excluding cases of polymorphism and inversion of chromosome 9, which are considered variants of normality, the prevalence in all individuals was 2.26% (n = 32/1414). The comparative analysis of cases of chromosomal abnormalities among couples with primary and secondary RM based on the number of previous miscarriages (PM) revealed a similar frequency between groups. The statistical analysis of the total cases (primary PM + secondary PM) in these three groups were as follows: (a) couple, 2 pm versus 3 pm vs. ≥4 PM, p = .514; (b) women, 2 pm versus 3 pm vs. ≥4 PM, p = .347; and (3) partner, 2 pm versus 3 pm vs. ≥4 PM, p = .959. Chromosomal abnormalities were significantly more prevalent among women than among their partners (6.9 versus 4.2%; p = .027). Moreover, the distribution of leading chromosomal abnormalities among women was different compared with their partners. Among women, we observed these abnormalities in the following frequency order: mosaicism (38.8%), polymorphism (32.6%), translocation (16.3%), and inversion (12.3%). Among their partners, these abnormalities were polymorphism (73.3%), inversion (13.3%), mosaicism (6.7%), and translocation (6.7%).Conclusion: The number of PM and the history of full-term pregnancy does not correlate with an increase or decrease in the prevalence of cytogenetic abnormalities in couples with RM.

Gestational and perinatal outcomes in recurrent miscarriages couples treated with lymphocyte immunotherapy.

OBJECTIVE: This study aims to elucidate which types of recurrent miscarriage (RM) patients experienced a livebirth after paternal lymphocyte immunotherapy (LIT) and to evaluate the perinatal outcome. STUDY DESIGN: Retrospective analysis of a multicenter, observational study which enrolled 1096 couples with a history of two or more spontaneous miscarriages without any intercalated delivery. We conducted an intention-to-treat analysis of couples with RM treated with or without LIT regarding to gestational and perinatal outcomes. We compared groups by using the Student's t-test or Kruskal-Wallis test, Fisher's exact-test and χ 2 test when appropriate. RESULTS: The success of gestation was significantly higher in the LIT group (60.1% vs. 33.1%; p < 0.001). A sub-analysis of four different immune disorder groups revealed a significantly higher success in the LIT group in all immune categories, except in patients who had autoantibodies positive. We observed no significant differences in perinatal outcomes such as gestational age at birth, preterm and extreme preterm birth, and birth weight in successful pregnancy in both groups. The success rate was significantly higher when LIT was administrated before and during pregnancy and only during pregnancy compared to only before pregnancy (p < 0.01). CONCLUSIONS: Careful laboratory test phenotyping of RM patients may identify subgroups most likely to benefit and exclude those with little likelihood of benefit, and LIT during a pregnancy may significantly improve success rates.

Risk of Zika microcephaly correlates with features of maternal antibodies.

Zika virus (ZIKV) infection during pregnancy causes congenital abnormalities, including microcephaly. However, rates vary widely, and the contributing risk factors remain unclear. We examined the serum antibody response to ZIKV and other flaviviruses in Brazilian women giving birth during the 2015-2016 outbreak. Infected pregnancies with intermediate or higher ZIKV antibody enhancement titers were at increased risk to give birth to microcephalic infants compared with those with lower titers (P < 0.0001). Similarly, analysis of ZIKV-infected pregnant macaques revealed that fetal brain damage was more frequent in mothers with higher enhancement titers. Thus, features of the maternal antibodies are associated with and may contribute to the genesis of ZIKV-associated microcephaly.

Lymphocyte immunotherapy for recurrent miscarriages: Predictors of therapeutic success.

PROBLEM: To evaluate the predictors of successful pregnancies in women with a history of recurrent miscarriages (RMs) having undergone lymphocyte immunotherapy (LIT). METHOD OF STUDY: Retrospective, multicenter, observational study which involved 702 pregnant women with history of RM treated with LIT. Comparative analysis of women with a history of RM having undergone LIT and experienced treatment success vs those having experienced treatment failure along with the analysis of the association between the number of prior miscarriages and the efficacy of LIT. RESULTS: A total of 421 women were able to carry the pregnancy to term, with treatment success rate of 60%. The multivariate analysis showed that age, the association between autoantibodies and thrombophilia, and the number of previous miscarriages were factors associated with LIT failure. Secondary RMs alone were not found to be a factor predictive of LIT success or failure; however, secondary RMs among women with a history of 5 or more RM were found to be a predictor of LIT success (OR: 10.24; 95% CI: 1.9-55.8; P = .007). CONCLUSION: Age, the number of previous miscarriages, and the association between autoantibodies and thrombophilia are associated with LIT failure. A higher number of previous miscarriages in cases of secondary RM resulted in better LIT outcomes.

Acurácia da citologia vaginal e colposcopia para diagnóstico de neoplasia intraepitelial cervical no CICAN-Bahia / Accuracy of vaginal cytology and colposcopy in the diagnosis of cervical intraepithelial neoplasia in CICAN-Bahia / Precisión de la citología vaginal y colposcopia en el diagnóstico de la neoplasia intraepitelial cervical en CICAN-Bahia

O rastreamento do câncer do colo uterino é realizado por meio da citologia cervical e colposcopia. O objetivo deste estudo foi avaliar a acurácia da citologia cervical e da colposcopia para o diagnóstico de neoplasia intraepitelial cervical no do Centro Estadual de Oncologia. Para tanto, utilizou-se os dados das citologias de 351 pacientes e de 378 colposcopias que também realizaram biópsias de lesões suspeitas. Foram estimadas as medidas de acurácia das citologias e das colposcopias. Os valores da sensibilidade e especificidade para citologia foram de 85,04% (Intervalo de Confiança 95% 80,34 ­ 89,01), 40% (Intervalo de confiança 95% 28,47 ­ 52,41), respectivamente; e, para colposcopia, de 97,73% (Intervalo de confiança 95% 95,37 ­ 99,08) e 15,79% (Intervalo de confiança 95% 8,43 ­ 25,96), respectivamente. O valor da Razão de Probabilidade positiva da citologia foi de 1,42 (Intervalo de confiança 95%, 1,16 ­ 1,72) e da Razão de Probabilidade negativa foi de 0,37 (Intervalo de confiança 95%, 0,25 ­ 0,56). Já para colposcopia, o valor da Razão de Probabilidade positiva foi de 1,16 (Intervalo de confiança 95%, 1,05 ­ 1,28); e, a Razão de Probabilidade negativa de 0,14 (Intervalo de confiança 95%, 0,06 ­ 0,36). Assim, sugere-se que a capacidade da citologia e colposcopia de modificar a probabilidade pós-teste de doença no Centro Estadual de Oncologia é pequena, em virtude do baixo valor das Razões de Probabilidade positiva.

Screening for cervical cancer is performed by cervical cytology and colposcopy. The objective of this study was to evaluate the accuracy of cervical cytology and colposcopy in the diagnosis of cervical intraepithelial neoplasia in State Oncology Center. For that it was used cytology data from 351 patients and colposcopy data from 378 patients, which also performed biopsies of suspicious lesions. The measures of accuracy of cytology and colposcopy were estimated. The values of sensitivity and specificity for cytology were 85.04% (95% confidence interval 80,34 - 89.01), 40% (95% confidence interval 28,47 - 52.41), respectively, and for colposcopy were 97.73% (95% confidence interval 95.37 - 99.08) and 15.79% (95% confidence interval, 8.43 - 25,96), respectively. The positive likelihood ratio value of cytology was 1.42 (95% CI, 1.16 to 1.72) and negative Likelihood ratio was 0.37 (95% confidence interval, 0.25 to 0.56). As for colposcopy, the positive likelihood ratio value was 1.16 (95% confidence interval, 1.05 to 1.28) and the negative likelihood ratio, 0.14 (95% confidence interval, 0.06 to 0.36). Thus it is suggested that the capacity of these tests to modify the post-test probability of disease in State Oncology Center is small because of the low value of positive likelihood ratio.

La detección de cáncer de cuello uterino es realizada por medio de citología cervical y por colposcopia. El objetivo de este estudio fue evaluar la precisión de la citología cervical y de la colposcopia en el diagnóstico de la neoplasia intraepitelial cervical in el Centro Estadual de Oncología. Para ello, utilizaronse los datos de citología de 351 pacientes y de 378 colposcopias que también realizaron biopsias de lesiones sospechosas. Fueron estimadas las medidas de precisión de las citologías y de las colposcopias. Los valores de sensibilidad y especificidad para la citología fueron 85,04% (Intervalo de confianza 95%: 80,34 - 89,01), 40% (Intervalo de confianza 95%: 28,47 - 52,41), respectivamente, y, para la colposcopia, de 97,73% (Intervalo de confianza 95% 95,37 - 99,08) y 15,79% (Intervalo de confianza 95%: 8,43 - 25,96), respectivamente. El valor de Razón de probabilidad positivo de la citología fue 1,42 (Intervalo de confianza 95%, 1,16-1,72) y de Razón de Probabilidad negativo fue 0,37 (Intervalo de confianza 95%: 0,25 a 0,56). En cuanto a la colposcopia, el valor de Razón de Probabilidad positivo fue 1,16 (Intervalo de confianza 95%, desde 1,05 hasta 1,28) y de Razón de Probabilidad negativa, 0,14 (Intervalo de confianza 95%, 0,06 hasta 0,36). Así, sugierese que la capacidad de la citología y colposcopia de modificar la probabilidad post test en el Centro Estadual de Oncología es pequeña, debido al bajo valor de las razones de probabilidad positiva.

Acurácia da citologia vaginal e colposcopia para diagnóstico de neoplasia intraepitelial cervical no CICAN-Bahia / Accuracy of vaginal cytology and colposcopy in the diagnosis of cervical intraepithelial neoplasia in CICAN-Bahia

O rastreamento do câncer do colo uterino é realizado por meio da citologia cervical e colposcopia. O objetivo deste estudo foi avaliar a acurácia da citologia cervical e da colposcopia para o diagnóstico de neoplasia intraepitelial cervical no do Centro Estadual de Oncologia. Para tanto, utilizou-se os dados das citologias de 351 pacientes e de 378 colposcopias que também realizaram biópsias de lesões suspeitas. Foram estimadas as medidas de acurácia das citologias e das colposcopias. Os valores da sensibilidade e especificidade para citologia foram de 85,04% (Intervalo de Confiança 95% 80,34 ­ 89,01), 40% (Intervalo de confiança 95% 28,47 ­ 52,41), respectivamente; e, para colposcopia, de 97,73% (Intervalo de confiança 95% 95,37 ­ 99,08) e 15,79% (Intervalo de confiança 95% 8,43 ­ 25,96), respectivamente. O valor da Razão de Probabilidade positiva da citologia foi de 1,42 (Intervalo de confiança 95%, 1,16 ­ 1,72) e da Razão de Probabilidade negativa foi de 0,37 (Intervalo de confiança 95%, 0,25 ­ 0,56). Já para colposcopia, o valor da Razão de Probabilidade positiva foi de 1,16 (Intervalo de confiança 95%, 1,05 ­ 1,28); e, a Razão de Probabilidade negativa de 0,14 (Intervalo de confiança 95%, 0,06 ­ 0,36). Assim, sugere-se que a capacidade da citologia e colposcopia de modificar a probabilidade pós-teste de doença no Centro Estadual de Oncologia é pequena, em virtude do baixo valor das Razões de Probabilidade positiva

Autoimmune endocrine disorders and coeliac disease in children and adolescents with juvenile idiopathic arthritis and rheumatic fever.

OBJECTIVES: There have been few studies on the association between childhood autoimmune and rheumatic diseases. Therefore, this study aims to assess the frequency of autoimmune thyroiditis (AT), coeliac disease (CD) and type 1 diabetes mellitus (T1DM) in children and adolescents with juvenile idiopathic arthritis (JIA) and rheumatic fever (RF). METHODS: This cross-sectional study includes 53 patients with JIA, 66 patients with RF and 40 healthy subjects controls. All subjects were evaluated for thyrotropin (TSH), triiodothyronine (T3), free thyroxine (FT4), antithyroglobulin (Tg) and antiperoxidase antibodies, fasting glucose, C-peptide, anti-glutamic acid decarboxylase (GAD), anti-islet cell (IA) and antitransglutaminase IgA (tTG) antibodies. Patients with thyroid dysfunction, positive anti-thyroid antibodies or tTG underwent thyroid ultrasonography and jejunal biopsy, respectively. RESULTS: In group 1 (n=53), 21 patients presented thyroid disorders (40%; 42% oligoarticular), either subclinical hypothyroidism (13%) or positive anti-thyroid antibodies (26%, 50% oligoarticular), significantly higher than in control group (p<0.009, OR=10.5, CI 1.29-85.2). In group 2 (n=66), thyroid disorders were identified in 11 patients, four (6%) with subclinical hypothyroidism and seven (11%) with positive anti-thyroid antibodies (p=0.06, compared with the control group). There were no cases of clinical overt hypothyroidism, positive anti-GAD or anti-IA, nor changes in serum C-peptide and glycemia. CD was confirmed in one patient from each group. CONCLUSIONS: Patients with JIA (especially the oligoarticular form) and RF should be investigated for thyroid dysfunction. Longitudinal studies could establish screening protocols for CD in patients with JIA and RF. The cost-effectiveness of T1DM screening is not justified in this population.

Quality of life in children with sleep-disordered breathing.

UNLABELLED: Children may present sleep-disordered breathing (SDB) and suffer with adverse effects upon their quality of life. OBJECTIVE: This study assessed the quality of life of children with SDB, compared subjects with obstructive sleep apnea syndrome (OSAS) and primary snoring (PS), and identified which areas in the OSA-18 questionnaire are more affected. METHODS: This is a historical cohort cross-sectional study carried out on a consecutive sample of children with history of snoring and adenotonsillar hyperplasia. The subject's quality of life was assessed based on the answers their caregivers gave in the OSA-18 questionnaire and on diagnostic polysomnography tests. RESULTS: A number of 59 children participated in this study with mean age of 6.7 ± 2.26 years. The mean score of the OSA-18 was 77.9 ± 13.22 and the area most affected were "caregiver concerns" (21.8 ± 4.25), "sleep disturbance" (18.8 ± 5.19), "physical suffering" (17.3 ± 5.0). The impact was low in 6 children (10.2%), moderate in 33 (55.9%) and high in 20 (33.9%). PS was found in 44 children (74.6%), OSAS in 15 (25.6%). OSAS had higher score on "physical suffering" area than PS (p = 0.04). The AI (r = 0.22; p = 0.08) and AHI (r = 0.14; p = 0.26) were not correlated with OSA-18. CONCLUSION: Sleep disordered breathing in childhood cause impairment in quality of life and areas most affected the OSA-18 were: "caregiver concerns", "sleep disturbance" and "physical suffering". OSAS has the domain "physical suffering" more affected than primary snorers.

Qualidade de vida em crianças com distúrbios respiratórios do sono / Quality of life in children with sleep-disordered breathing

Crianças podem apresentar distúrbios respiratórios do sono (DRS) com repercussões na qualidade de vida. OBJETIVO: Avaliar a qualidade de vida de crianças com DRS, comparar crianças com Síndrome da Apneia Obstrutiva do Sono (SAOS) e Ronco Primário (RP) e identificar quais os domínios do OSA-18 estão mais comprometidos. MÉTODOS: Estudo de coorte histórica com corte transversal em crianças com história de ronco e hiperplasia adenotonsilar. Para avaliar qualidade de vida foi aplicado o questionário OSA-18 aos cuidadores e realizado polissonografia para diagnóstico. RESULTADOS: Participaram 59 crianças com média de idade de 6,7 ± 2,26 anos. O escore médio do OSA-18 foi 77,9 ± 13,22 e os domínios mais afetados foram: "preocupação dos responsáveis" (21,8 ± 4,25), "perturbação do sono" (18,8 ± 5,19), "sofrimento físico" (17,3 ± 5,0). O impacto foi pequeno em seis crianças (10,2%), moderado em 33 (55,9%) e grande em 20 (33,9%). RP foi encontrado em 44 crianças (74,6%), SAOS em 15 (25,6%). SAOS tem escore maior no domínio "sofrimento físico" que RP (p = 0,04). CONCLUSÃO: Distúrbios respiratórios do sono na infância causam comprometimento na qualidade de vida e os domínios mais comprometidos do OSA-18 foram: "preocupação dos responsáveis", "perturbação do sono" e "sofrimento físico". SAOS tem o domínio "sofrimento físico" mais afetado que roncadores primários.

Children may present sleep-disordered breathing (SDB) and suffer with adverse effects upon their quality of life. OBJECTIVE: This study assessed the quality of life of children with SDB, compared subjects with obstructive sleep apnea syndrome (OSAS) and primary snoring (PS), and identified which areas in the OSA-18 questionnaire are more affected. METHODS: This is a historical cohort cross-sectional study carried out on a consecutive sample of children with history of snoring and adenotonsillar hyperplasia. The subject's quality of life was assessed based on the answers their caregivers gave in the OSA-18 questionnaire and on diagnostic polysomnography tests. RESULTS: A number of 59 children participated in this study with mean age of 6.7 ± 2.26 years. The mean score of the OSA-18 was 77.9 ± 13.22 and the area most affected were "caregiver concerns" (21.8 ± 4.25), "sleep disturbance" (18.8 ± 5.19), "physical suffering" (17.3 ± 5.0). The impact was low in 6 children (10.2%), moderate in 33 (55.9%) and high in 20 (33.9%). PS was found in 44 children (74.6%), OSAS in 15 (25.6%). OSAS had higher score on "physical suffering" area than PS (p = 0.04). The AI (r = 0.22; p = 0.08) and AHI (r = 0.14; p = 0.26) were not correlated with OSA-18. CONCLUSION: Sleep disordered breathing in childhood cause impairment in quality of life and areas most affected the OSA-18 were: "caregiver concerns", "sleep disturbance" and "physical suffering". OSAS has the domain "physical suffering" more affected than primary snorers.

Perfil clínico-social das gestantes atendidas numa unidade docente-assistencial baseada no modelo de saúde da família / Clinical and social profile of pregnant women attended in a teaching-care unit based on the model of health of the family / Perfil clínico y social de las mujeres embarazadas atendidas en unaunidad docente -asistencial basado en el modelo de salud de la familia

O objetivo do estudo foi traçar o perfil clínico-social das gestantes atendidas numa unidade docente-assistencial baseada no modelo de saúde da família. Foi realizado um estudo descritivo, para o qual se utilizaram prontuários e estabeleceram-se as seguintes variáveis:idade, grau de escolaridade, peso, altura, paridade, exames laboratoriais de pré-natal, doenças identificadas no pré-natal ou anteriores à gestação, tabagismo, alcoolismo, planejamento da gravidez, aceitação da gravidez, apoio familiar, apoio do companheiro e auto imagem. Foram avaliados 104 prontuários e a média de idade das pacientes era de 24,2 maios ou menos 5,9 anos e a mediana de 24 anos. A pressão arterial (PA) tinha uma média de 105,9 mais ou menos 11,2 mmHg na sistólica e67,3 mais ou menos 10,6 mmHg na diastólica. Quanto à vacinação antitetânica, em 44,2por cento dos prontuários não havia o registro sobre a sua realização. Dos prontuários que continham o registro, 41,4por cento das gestantes tinham sido vacinadas havia menos de cinco anos, 22,4por cento entre cinco e 10 anos e 36,2por cento havia mais de 10 anos. A urocultura foi positiva em 22,9por cento. A gravidez foi planejada por 25,3por cento das pacientes, 61,1por cento tinham medo do parto. Concluiu-se que a população tem características de baixo risco gestacional, mas está exposta ao risco de bacteriúria assintomática. A estrutura corporal está com parâmetros normais. Há falhas na vacinação antitetânica. A maiorparte das gestações não foi planejada, as mulheres têm medo de apresentar problemas com o feto e têm medo do parto, contudo são apoiadas pela família.

The objective of the study was to trace the clinical profile of pregnant women from a teaching-care unit based on the model of the familyïs health. A descriptive study was carried out using charts and the following variables were studied: age, level of education, weight, height, parity, pre-natal laboratory tests, diseases identified in pre-natal or prior to pregnancy, smoking, alcoholism, planning of pregnancy, acceptance of the pregnancy, family support, support of companion and self-image. One-hundred and four medical records were evaluated and the average age of the patients was 24.2 more or less 5.9 years and a median of 24years. Blood pressure (BP) was an average of 105.9 more or less 11.2 mmHg for systolic and 67.3 more or less 10.6 mmHg for diastolic blood pressure. There was no record of tetanus vaccination in 44.2percent of the records. Of the medical records that recorded a vaccination, 41.4percent of pregnant women had been vaccinated had records that were less than five years-old, 22.4percent of the records were between five and 10 years-old and 36.2percent were older than 10 years. Urine culture was positive in 22.9percent of cases. Pregnancy was planned by 25.3percent of the patients, 61.1percent were afraid of childbirth. It was concluded that the population has the characteristics of low-risk pregnancy, but is exposed to the risk of asymptomatic bacteriuria. The body structurewas within normal parameters. There are flaws in tetanus vaccination. In large part, the pregnancies were not planned, the women were afraid to present problems with the fetus, and they were afraid of giving birth, however they were supported by a family.

El objetivo del estudio fue trazar el perfil clínicosocial de las mujeresembarazadas atendidas en una unidad escuelaasistencial basada en el modelo de salud de la familia. Estudio de tipo descriptivo, para el cual se utilizaron históricos médicos estableciendo las siguientes variables: edad, nivel de educación, peso, talla, paridad, pruebas de laboratorio, prenatal, enfermedades identificadas en el prenatal o antes del embarazo, tabaquismo, alcoholismo, planificación prenatal, aceptación del embarazo, apoyo familiar, apoyo del compañero y su autoimagen. Fueron evaluados 104 históricos médicos y el promedio de edad de los pacientes era 24,2 más o menos 5,9 años y una mediana de 24 años. La presión arterial (PA) presentó un promedio de 105,9 más o menos 11,2 mmHg para la sistólica y 67,3 más o menos 10,6 mmHg para la diastólica. En cuanto a la vacunación contra el tétanos, en 44,2por ciento de los históricos no había constancia de su aplicación. Los históricos médicos que contienen que contienen dicho registro, 41,4por ciento de las mujeres embarazadas habían sido vacunadas en un periodo menor de cinco años, 22,4por ciento entre 5 y 10 años y 36,2por ciento hacía más de 10 años. El análisis de orina fue positivo en 22,9por ciento. El embarazo fue planeado por 25,3por ciento de las pacientes, 61,1por ciento tenían miedo del parto. Se concluye que la población tiene características de bajo riesgo de preñez, pero está expuesta al riesgo de la bacteriuria asintomática. La estructura corporal está con los parámetros normales. Hay fallas en la vacunación contra el tétanos. La mayor parte de los embarazos no fueron planeados, las mujeres tienen miedo de tener un feto con problemas, así como miedo al parto. Sin embargo, reciben apoyo familiar.

Carcinoma adenóide cístico do seio esfenóide / Sphenoid sinus adenoid cystic carcinoma

Introdução: O carcinoma adenóide cístico do esfenóide é uma neoplasia maligna rara, na cabeça e pescoço, e quando localizado nos seios paranasais, tem origem nas glândulas salivares menores. Apresenta crescimento lento, e é caracterizado por uma grande invasão dos tecidos adjacentes, além de grande capacidade de metástases. A cirurgia associada à radioterapia pós-operatória é utilizada como tratamento. Objetivo: Descrever um caso de carcinoma adenóide cístico do seio esfenóide em um paciente do sexo masculino, negro de 62 anos. Relato do Caso: N. L. B., 62 anos, masculino, apresentava rinorréia sanguinolenta há seis meses associada obstrução nasal bilateral. Na nasofibroscopia mostrava lesão aspecto polipóide em fossa nasal esquerda. Foi submetido à biopsia e o anatomopatológico demonstrou carcinoma adenóide cístico sendo o paciente encaminhado para oncologia. Conclusões: A importância de se realizar o diagnóstico diferencial entre infecção crônica nasossinusal e tumores nasossinusais.

Introduction: The sphenoid adenoid cystic carcinoma is a rare malign neoplasm, in the head and neck and when located in the paranasal sinuses, it is formed in the minor salivary glands. It grows slowly and is characterized by a large invasion of the adjacent tissues, and also has a large capacity of metastasis. The surgery associated with post-operative radiotherapy is used as treatment. Objective: To describe a case of sphenoid sinus adenoid cystic carcinoma in a male, black, 62 year patient. Case Report: N.L.B., 62 years of age, male, had bloody rhinorrhea for 6 months associated with bilateral nasal obstruction. The nasofibroscopy showed lesion of polypoid aspect in the left nasal cavity. He was submitted to biopsy and the anatomopathological exam showed adenoid cystic carcinoma and the patient was forwarded to oncology. Conclusions: The importance of conducting the differential diagnosis between chronic nasosinusal infection and nasosinusal tumors.

Effect of oral contraceptives on vascular endothelial growth factor, Cox-2 and aromatase expression in the endometrium of uteri affected by myomas and associated pathologies.

BACKGROUND: The study was conducted to evaluate vascular endothelial growth factor (VEGF), Cox-2 and aromatase expression in the endometrium of uteri with myomas and other associated pathologies. STUDY DESIGN: Hysteroscopy was performed in 118 women of reproductive age with myomas and menorrhagia, 40 of whom were using a pill containing 75 mcg gestodene+30 mcg ethinylestradiol. Aromatase p450, VEGF and Cox-2 expression was detected using immunohistochemistry. Fisher's Exact Test and the Mann-Whitney test were used in the statistical analysis, with significance established at p<.05. RESULTS: In patients with myomas and menorrhagia, associated pathologies such as adenomyosis, endometrial polyps and endometriosis were found in 32%, 12% and 17% of cases, respectively. Aromatase, Cox-2 and VEGF expression was greater during the proliferative phase compared to the luteal phase of the cycle or following oral contraceptive use. CONCLUSION: Endogenous progesterone or combined oral contraceptives are potent inhibitors of VEGF, aromatase and Cox-2 expression in the endometrium of patients with myomas and menorrhagia.

Estudo da translucência nucal, ducto venoso, osso nasal e idade materna na detecção de cromossomopatia fetal em uma população de alto risco / Study of nuchal translucency, ductus venosus, nasal bone and maternal age for detection of fetal chromosomal disorders in a high-risk population", "_i": "en

OBJETIVO: Avaliar a translucência nucal, o ducto venoso, o osso nasal e a idade materna > 35 anos como testes de rastreamento para aneuploidias entre 12 e 14 semanas de gestação em pacientes de alto risco. MATERIAIS E MÉTODOS: Estudo prospectivo observacional envolvendo 92 gestantes entre 12 e 14 semanas submetidas a biópsia de vilo corial por alto risco de trissomia, baseado na medida da translucência nucal (17,4 por cento) e idade materna >35 anos (78,3 por cento). Antes da biópsia de vilo corial, realizaram-se medida da translucência nucal, avaliação de fluxo no ducto venoso e identificação do osso nasal. Calcularam-se a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo para testes realizados em paralelo e em seqüência. RESULTADOS: Encontrou-se alteração cromossômica em 12 (13,5 por cento) fetos; 7 (58,3 por cento) apresentavam trissomia 21. Osso nasal foi identificado em todos os fetos com trissomia. Translucência nucal, ducto venoso e idade materna isolados mostraram baixa sensibilidade (41,67-58,33 por cento) e baixo valor preditivo positivo (10-45,45 por cento). A associação translucência nucal + ducto venoso + idade materna apresentou o melhor resultado (sensibilidade: 100 por cento; especificidade: 6,49 por cento; valor preditivo positivo: 14,29 por cento; valor preditivo negayivo: 100 por cento). CONCLUSÃO: Em gestantes com idade > 35 anos, a associação translucência nucal + ducto venoso mostra-se como a mais sensível para a indicação de procedimento invasivo.

OBJECTIVE: To evaluate fetal nuchal translucency, ductus venosus, nasal bone and maternal age > 35 years by means of aneuploidy screening between the 12th and 14th gestational weeks in a high-risk population. MATERIALS AND METHODS: Prospective, observational study involving 92 pregnant women at 12-14 gestational weeks, who were submitted to chorionic villus sampling because of high risk for trisomy 21 based on the measurement of nuchal translucency thickness (17.4 percent) or on maternal age > 35 years (78.3 percent). Before the chorionic villus sampling, fetal nuchal translucency thickness was measured, ductus venosus flow was evaluated and the nasal bone was identified. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for tests in parallel and in sequence. RESULTS: Chromosomal abnormalities were found in 12 fetuses (13.5 percent); 7 (58.3 percent) were positive for trisomy 21. The nasal bone was present in all cases with chromosomal abnormalities. Isolated nuchal translucency, ductus venosus or maternal age showed low sensitivity (41.67-58.33 percent) and low positive predictive value (10-45.45 percent). Combined nuchal translucency + ductus venosus + maternal age showed the best results (100 percent sensitivity; 6.49 percent specificity; 14.29 percent positive predictive value; 100 percent negative predictive value). CONCLUSION: In pregnant women with >35 years of age, combined nuchal translucency + ductus venosus have showed the highest sensitivity as an indication for invasive procedure.

The effect of oral contraceptives on aromatase expression in the eutopic endometrium of patients with endometriosis.

OBJECTIVE: To determine the effect of oral contraceptives containing gestodene on aromatase expression in the endometrium of patients diagnosed with endometriosis. PATIENTS AND METHODS: Endometrial biopsies were taken at the time of laparoscopy in 40 patients with endometriosis, 16 of whom were using an oral contraceptive containing gestodene at the time of laparoscopy. The remaining 24 patients were receiving no form of treatment for endometriosis. Endometrial biopsies taken from 23 patients with normal echographic signs and no symptoms were used as controls. Aromatase expression was evaluated in endometrial samples using immunohistochemistry. RESULTS: In the untreated, symptomatic endometriosis patients, aromatase expression was detected during the proliferative phase in 92% of cases, while in the symptom-free control patients aromatase was expressed in only 9% of cases. In patients with endometriosis who were using oral contraceptives, there were significantly fewer cases of positive endometria compared with the untreated patients with endometriosis (6%). CONCLUSION: Oral contraceptives containing gestodene are effective in decreasing aromatase expression in the eutopic endometrium of patients with endometriosis.

Aromatase expression in the eutopic endometrium of myomatous uteri: the influence of the menstrual cycle and oral contraceptive use.

AIMS: To detect aromatase expression in the endometrium of myomatous uteri and to correlate it with the location of the myoma, phase of the menstrual cycle, the presence of menorrhagia and oral contraceptive use. METHOD: Aromatase p450 expression was measured using immunohistochemical methods in the endometrium of 116 patients. Sixty-one patients had menorrhagia associated with intramural/submucous myomas and nine had subserous myomas and no excessive bleeding. Forty-six patients had no uterine pathology and served as controls. Nineteen out of 61 patients with menorrhagia were oral contraceptive users at the time of the examination. Endometrial samples were obtained by hysteroscopy in all cases. RESULTS: Aromatase p450 expression was detected more frequently in the eutopic endometrium of patients with submucous or intramural myomas than in those in the subserous group, and was significantly greater during the proliferative phase than during the luteal phase or following the use of oral contraceptives. In normal uteri, aromatase expression was detected in the endometrium in less than 10% of users. CONCLUSIONS: Aromatase expression in the endometrium was affected by the location of the myoma, the presence of symptoms, and the phase of the menstrual cycle. Oral contraceptives, on the other hand, inhibited aromatase expression in the eutopic endometrium of patients with submucous/intramural myomas.

Complicações materno-fetais da biópsia de vilo corial: experiência de um centro especializado do Nordeste do Brasil / Fetal and maternal complications of chorionic villus sampling: results from a specialized center in the Northeast of Brazil

OBJETIVO: avaliar complicações maternas e fetais após realização de biópsia de vilo corial (BVC) para diagnóstico pré-natal de alterações genéticas, na cidade de Salvador (BA). MÉTODOS: série de 958 gestantes de risco para cromossomopatias, submetidas à BVC realizada entre a nona e a 24ª semanas de gestação, por via transabdominal, utilizando agulha espinhal 18G 3½, guiada por ultra-sonografia, entre 1990 e 2006. As variáveis para a análise de complicações imediatas foram cólicas uterinas, hematoma subcoriônico, punção acidental da cavidade amniótica, dor no local da punção, amniorrexe, desconforto abdominal, bradicardia fetal e sangramento vaginal, e para complicações tardias, dor abdominal, sangramento vaginal, amniorrexe, infecção e abortamento espontâneo. Complicações obstétricas e fetais (parto prematuro, descolamento prematuro de placenta, placenta prévia e malformações anatômicas fetais) foram também estudadas. Para análise estatística, utilizaram-se o chi² e o teste t de Student ou Mann-Whitney; o nível de significância foi 5 por cento. RESULTADOS: a média de idade das gestantes foi 36,3±4,9 anos. Complicações imediatas foram encontradas em 182 (19 por cento) casos (cólica uterina em 14 por cento, hematoma subcoriônico em 1,8 por cento e punção amniótica acidental em 1,3 por cento) e tardias em 32 (3,3 por cento) casos (sangramento vaginal em 1,6 por cento, dor abdominal em 1,4 por cento, amniorrexe em 0,3 por cento e aborto espontâneo em 1,6 por cento). Não foi observado descolamento prematuro de placenta, placenta prévia ou malformação fetal. CONCLUSÕES: a BVC revelou-se procedimento simples e seguro. A BVC pode ser utilizada em gestantes que necessitam de diagnóstico pré-natal devido ao risco de anomalias genéticas.

PURPOSE: to evaluate fetal maternal complications after chorionic villus sampling (CVS) for prenatal diagnosis of genetic disorders in pregnant women of Salvador (BA), Brazil. METHODS: case-series study of 958 pregnancies with high risk for chromosomal abnormality submitted to CVS transabdominal between the ninth to the 24th week of gestation, using an ultrasound-guided 18G 3½ spinal needle, from 1990 to 2006. The variables for the analysis of immediate complications were uterine cramps, subchorionic hematoma, accidental amniotic cavity punction, pain in the punction area, amniotic fluid leakage, abdominal discomfort, fetal arrhythmias and vaginal bleeding, and of late complication, abdominal pain, vaginal bleeding, amniotic fluid leakage, infection and spontaneous miscarriage. Premature labor, obstetrical complications (abruption placenta and placenta previa) and newborn malformation were also studied. Qui-square, Student’s "t" or Mann-Whitney tests were used for the statistical analysis; the significance level was 5 percent. RESULTS: maternal mean age was 36.3±4.9 years old. Immediate complications ware found in 182 (19 percent) cases (uterine cramp in 14 percent, subchorionic hematoma in 1.8 percent and accidental amniotic cavity punction in 1.3 percent). Late complications were found in 32 (3.3 percent) cases (vaginal bleeding in 1.6 percent, abdominal pain in 1.4 percent, amniotic fluid leakage in 0.3 percent and spontaneous miscarriage in 1.6 percent cases). There was no case of abruption placentae, placenta previa or fetal malformation. CONCLUSIONS: CVS is a simple and safe procedure. CVS should be performed in high risk pregnant patients who need prenatal diagnosis of fetal chromosomal abnormalities.

Tibone in the perimenopause for the treatment of androgen deficiency

A tibolona pode ser usada para tratar a deficiência androgênica na mulher na perimenopausa. O mecanismo de ação mais importante da tibolona é a redução dos níveis de SHBG e o aumento da testosterona livre. A tibolona também ativa a COX-2 no endométrio aumentando o risco de formação de pólipos endometriais. O aumento da testosterona livre com o uso da tibolona leva a um aumento de produção tecidual de estrogênios nos tecidos que expressam aromatase

Effect of the menstrual cycle and oral contraceptives on aromatase and cyclooxygenase-2 expression in adenomyosis.

OBJECTIVES: To determine whether aromatase expression in the eutopic endometrium and adenomyotic foci is affected by previous use of oral contraceptives containing gestodene, and to determine whether changes in cyclooxygenase-2 (COX-2) expression occur in adenomyosis during the menstrual cycle. PATIENT AND METHODS: This was a retrospective cohort study carried out in paraffin-embedded endometrial tissue obtained from patients with a histological diagnosis of adenomyosis obtained during the proliferative (n = 25) and luteal (n = 10) phases of the menstrual cycle and following the use of continuous oral contraception with gestodene/ethinyl estradiol (n = 7). COX-2 and aromatase expression were measured in both eutopic endometrium and adenomyotic foci using immunohistochemical methods. RESULTS: Aromatase expression was detected in 80% of the endometrial slices by immunohistochemistry. In positive cases, aromatase was mainly detected in the stromal cells of the eutopic endometrium, whereas in the adenomyotic foci this expression was negative in the majority of the cases. Oral contraceptives containing gestodene, on the other hand, were effective in suppressing aromatase expression in both eutopic and ectopic endometrium. COX-2 expression was detected by immunohistochemistry in the glandular epithelium of both eutopic endometrium and adenomyotic foci and there were no significant changes in its intensity throughout the menstrual cycle. CONCLUSION: Aromatase expression in the eutopic endometrium and adenomyotic foci is suppressed by oral contraceptives containing gestodene. Increased aromatase activity may be responsible for the persistent COX-2 expression during the luteal phase.