Primary Biliary Cholangitis and Chronic Arterial Hypertension in Pregnancy.

This case report presents a woman with a history of adverse obstetric outcomes: two pregnancies complicated by preeclampsia, resulting in a medical termination in the first and fetal demise in the second. Prior to a subsequent pregnancy, she underwent investigations for hypertension, thrombophilia, and autoimmune diseases. These investigations led to a probable diagnosis of primary biliary cholangitis (PBC) and chronic hypertension (CH). She was medicated for both conditions and closely monitored at Unidade Local de Saúde (ULS) Coimbra. Due to severe preeclampsia, she underwent an emergency cesarean section at 33 weeks, delivering a live male infant weighing 1635 g.

From Ovarian Hyperstimulation to the Discovery of a Liver Nodule.

Ovarian hyperstimulation syndrome (OHSS) is a complication of ovulation induction. Deep vein thrombosis (DVT) can occur as a consequence of this syndrome, but it is an infrequent event. The authors describe the case of a woman who became pregnant after ovulation induction and developed severe OHSS and, subsequently, DVT of the right brachiocephalic trunk, internal and external jugular veins, and right subclavian vein. Thrombophilia studies were positive, revealing the presence of four mutations. The pregnancy was bichorionic and biamniotic twins and, during the course of the pregnancy, she developed severe cholestasis. In the follow-up of this situation, she underwent abdominal ultrasound which revealed the presence of liver nodules. Three years after delivery, the patient remains anticoagulated and under surveillance of liver nodules by annual MRI.

Piauí Central Laboratory of Public Health: frequency of mycobacterial species and epidemiological aspects, 2014-2015 / Laboratorio Central de Salud Pública de Piauí: frecuencia de especies micobacterianas y aspectos epidemiológicos, 2014-2015 / Laboratório Central de Saúde Pública do Piauí: frequência de espécies de micobactérias e aspectos epidemiológicos, 2014-2015

Background and Objectives: Knowledge about species diversity of non-tuberculous mycobacteria (NTM) and the frequency of tuberculosis (TB) is an important issue in rural-urban regions such as Piauí (northeast of Brazil), of low incidence rate of TB , can help to improve diagnosis and prevention strategies. The aim of this study is to examine some epidemiological aspects and the frequency of Mycobacterium tuberculosis (Mtb) and NTM isolated at the central public health reference laboratory, Dr. Costa Alvarenga, Piauí (LACEN-PI). Methods: Data records of all mycobacterosis and tuberculosis cases from January 2014 to March 2015 were analyzed. Results : Of the 20% (142/706) positive growths, 70% (99) were Mtb and 10% NTM. The remainde was of inadequate clinical samples, not allowing the identification of even the suspected NTM. The most frequent clinical form was pulmonary with TB patients younger than those infected with NTM (p = 0.001), the majority living in Teresina (52%). NTMs identified were M. abscessus (36%), M. avium, M. intracellulare, Mycobacterium sp. (14% each) and M. asiaticum, M. szulgai, M. kansasii 7% (each). Mtb drug resistance (7.8%) and TB co-infection with the human immunodeficiency virus (HIV-TB) found to be high (49%, 19/39). Conclusion: The frequencies of Mtb infection, drug resistance and HIV-TB co-infection are still underestimated and failures in the identification of NTM may decrease the actual frequency of these infections. Therefore, there is a need for improvements in TB control and in the diagnosis of NTMs in Piauí.(AU)

Justificativa e Objetivos: O conhecimento da diversidade de espécies de micobactérias não tuberculosas (MNT ) e a frequência da tuberculose (TB) é uma questão importante em regiões rurais-urbanas como o Piauí (nordeste do Brasil), com baixa incidência de TB, pode ajudar a melhorar o diagnóstico e estratégias de prevenção. O objetivo deste estudo é examinar alguns aspectos epidemiológicos e a frequência de Mycobacterium tuberculosis (Mtb) e MNT isolados, no Laboratório Central de Referência em Saúde Pública, Dr. Costa Alvarenga, Piauí (LACEN-PI). Métodos: Dados de todo s os casos de micobacterioses e tuberculose de janeiro de 2014 a março de 2015 foram analisados. Resultados: Dos 20% (142/706), de amostras com crescimento positivo 70% (99) foram Mtb e 10% MNT . O restante era de amostras clínicas inadequadas, não permitindo a identificação inclusive de MNT suspeitos. A forma clínica mais frequente foi pulmonar com pacientes TB mais jovens do que os infectados com MNT (p = 0,001), a maioria morando em Teresina (52%). As MNT s identificadas foram M. abscessus (36%), M. avium , M. intracellulare , M. sp. (14%, cada) e M. asiaticum, M. szulgai , M. kansasii 7% (cada). A droga resistência de Mtb (7,8%) e a co-infecção TB e vírus da imunodeficiência humana (HIV-TB) mostraram-se altas (49%, 19/39).Conclusão: As frequências de infecção por Mtb, de resistência a medicamentos e co-infecção HIV-TB ainda são subestimadas e as falhas na identificação de MNT podem diminuir a real frequência destas infecções . Portanto, há necessidade de melhorias no controle da TB e no diagnóstico de MNT s no Piauí.(AU)

Justificacion y objetivos: Conocer la diversidad de especies de micobacterias no tuberculosas (MNT) y la frecuencia de tuberculosis (TB) es tema importante en regiones rurales-urbanas como Piauí (noreste de Brasil) con baja tasa de incidencia de TB, y puede ayudar a mejorar el diagnóstico y las estrategias de prevenció. El objetivo de este estudio es examinar algunos aspectos epidemiológicos y la frecuencia de Mycobacterium tuberculosis (Mtb) y MNT aislado, en el laboratorio central de referencia de salud pública, Dr. Costa Alvarenga, Piauí (LACEN-PI). Métodos: Se analizaron los datos de todos los casos de micobacteriosis de enero de 2014 a marzo de 2015. Resultados: Del 20% (142/706), de las muestras con crecimiento positivo el 70% (99) fueron Mtb y el 10% MNT. El resto fue de muestras clínicas inadecuadas, no permitiendo la identificación de MNT incluso sospechosas. La forma clínica más frecuente fue la pulmonar y los pacientes con TB eran más jóvenes que los infectados con MNT (p = 0.001), la mayoría viviendo en Teresina (52%).Los MNT identificados fueron M.abscessus (36%), M.avium, M.intracellulare, Mycobacterium sp. (14% cada) y M.asiaticum, M.szulgai, M.kansasii 7% (cada ). La resistencia a los medicamentos de Mtb (7,8%) y la coinfección de TB y el virus de la inmunodeficiencia humana (VIH-TB) fueron altas (49%, 19/39 )Conclusión: Las frecuencias aún subestimadas de resistencia a los medicamentos, coinfección por VIH-TB y fallas de identificaciónidentificación de MNT pueden disminuir la frecuencia real de estas infecciones. Consecuentemente, es necesario mejorar el control y diagnóstico de TB y MNT en Piauí.(AU)