Detecção pré-natal de infecção pelo vírus T-linfotrópico humano (HTLV) 1/2 em gestantes / Prenatal detection of human T-lymphotropic virus (HTLV) 1/2 infection in pregnant women

INTRODUÇÃO: O vírus T-linfotrópico humano HTLV-1 e HTLV-2 são retrovírus com potencial oncogênico, sendo particularmente associados à gênese da leucemia de células T do adulto (ATL). Além disso, estes se relacionam a diversas doenças não-neoplásicas de natureza inflamatória, sendo a mielopatia associada ao HTLV/paraparesia espástica tropical (HAM/TSP) e uveíte pelo HTLV-1 (HU) as mais conhecidas. A infecção pelo HTLV-1/2 tem distribuição mundial, com uma estimativa de até 15 a 20 milhões de pessoas afetadas e, uma vez estabelecida, permanece por toda a vida do indivíduo e na maioria dos casos permanece assintomática, tornando estes indivíduos reservatórios virais. Cerca de 4% dos portadores de HTLV-1 desenvolverão ATL, uma malignidade de células T CD4+ altamente agressiva. Por sua vez, a incapacitante HAM, afeta 2 a 3% das pessoas infectadas. As principais formas de transmissão do HTLV-1e 2 são a relação sexual desprotegida, a transmissão vertical, a amamentação e a exposição direta a sangue ou tecidos infectados. Independentemente da região do mundo, a soroprevalência aumenta com a idade, particularmente nas mulheres, tendo em vista a facilidade da transmissão sexual

Improving antenatal engagement for Aboriginal women in Australia: A scoping review.

BACKGROUND: Aboriginal women have an increased risk of poor antenatal engagement in pregnancy in comparison with Caucasian women, due to inequalities in health care provision. The Pregnancy Outcome in South Australia reports Aboriginal women having 10 times the risk of non-attendance of antenatal care throughout their pregnancy, 3 times the risk of attending the initial booking appointment later than recommended in their pregnancy, and Aboriginal women have an increased risk of attending significantly less antenatal appointments than Caucasian women. OBJECTIVE: The primary purpose of the scoping review is to map the body of literature known about Aboriginal women engaging with antenatal care in Australia, and the factors that facilitate or cause barriers to this engagement. Secondary to this, the review will describe how culturally safe care influences antenatal engagement. METHODS: Scoping reviews utilise a broad range of literature, encompassing all types of studies. An online search of 6 databases was conducted to identify and critically analyse sources discussing antenatal engagement for Aboriginal women in Australia. Using the JBI framework for Scoping Reviews, the researcher was able to strengthen the rigour of the methodology. FINDINGS: The search produced 9 articles, relating to 6 studies addressing antenatal engagement for Aboriginal women in Australia. Several themes were prevalent in the research that impact antenatal engagement including: Smoking, Relocation, Continuity of Care, Aboriginal maternity infant care workers, home visits, birthing on country, age, family and culturally safe care. CONCLUSION: Aboriginal women have identified continuity of care, Aboriginal workforce, home visits, family involvement, birthing on country and cultural safety as factors that improve antenatal engagement. Aboriginal women have reported smoking, rural and remote location, cultural incompetence and young age as factors that deter them from engaging with antenatal care. In order to improve antenatal engagement for Aboriginal women in South Australia, culturally safe care is essential. In order to determine the factors that facilitate and/or deter Aboriginal women from antenatal engagement, further research is required.

Low-Cost Fetal Magnetocardiography: A Comparison of Superconducting Quantum Interference Device and Optically Pumped Magnetometers.

Background Fetal magnetocardiography (fMCG) is a highly effective technique for evaluation of fetuses with life-threatening arrhythmia, but its dissemination has been constrained by the high cost and complexity of Superconducting Quantum Interference Device (SQUID) instrumentation. Optically pumped magnetometers (OPMs) are a promising new technology that can replace SQUIDs for many applications. This study compares the performance of an fMCG system, utilizing OPMs operating in a person-sized magnetic shield, to that of a conventional fMCG system, utilizing SQUID magnetometers operating in a magnetically shielded room. Methods and Results fMCG recordings were made in 24 subjects using the SQUID system with the mother lying supine in a magnetically shielded room and the OPM system with the mother lying prone in a person-sized, cylindrical shield. Signal-to-noise ratios of the OPM and SQUID recordings were not statistically different and were adequate for diagnostic purposes with both technologies. Although the environmental noise was higher using the small open-ended shield, this was offset by the higher signal amplitude achieved with prone positioning, which reduced the distance between the fetus and sensors and improved patient comfort. In several subjects, fMCG provided a differential diagnosis that was more precise and/or definitive than was possible with echocardiography alone. Conclusions The OPM-based system was portable, improved patient comfort, and performed as well as the SQUID-based system at a small fraction of the cost. Electrophysiological assessment of fetal rhythm is now practical and will have a major impact on management of fetuses with long QT syndrome and other life-threatening arrhythmias.

Fetal magnetocardiography using optically pumped magnetometers: a more adaptable and less expensive alternative?

Fetal magnetocardiography provides the requisite precision for diagnostic measurement of electrophysiological events in the fetal heart. Despite its significant benefits, this technique with current cryogenic based sensors has been limited to few centers, due to high cost of maintenance. In this study, we show that a less expensive non-cryogenic alternative, optically pumped magnetometers, can provide similar electrophysiological and quantitative characteristics when subjected to direct comparison with the current technology. Further research can potentially increase its clinical use for fetal magnetocardiography. © 2016 John Wiley & Sons, Ltd.

Development of computational pregnant female and fetus models and assessment of radiation dose from positron-emitting tracers.

PURPOSE: Molecular imaging using PET and hybrid (PET/CT and PET/MR) modalities nowadays plays a pivotal role in the clinical setting for diagnosis and staging, treatment response monitoring, and radiation therapy treatment planning of a wide range of oncologic malignancies. The developing embryo/fetus presents a high sensitivity to ionizing radiation. Therefore, estimation of the radiation dose delivered to the embryo/fetus and pregnant patients from PET examinations to assess potential radiation risks is highly praised. METHODS: We constructed eight embryo/fetus models at various gestation periods with 25 identified tissues according to reference data recommended by the ICRP publication 89 representing the anatomy of the developing embryo/fetus. The developed embryo/fetus models were integrated into realistic anthropomorphic computational phantoms of the pregnant female and used for estimating, using Monte Carlo calculations, S-values of common positron-emitting radionuclides, organ absorbed dose, and effective dose of a number of positron-emitting labeled radiotracers. RESULTS: The absorbed dose is nonuniformly distributed in the fetus. The absorbed dose of the kidney and liver of the 8-week-old fetus are about 47.45 % and 44.76 % higher than the average absorbed dose of the fetal total body for all investigated radiotracers. For 18F-FDG, the fetal effective doses are 2.90E-02, 3.09E-02, 1.79E-02, 1.59E-02, 1.47E-02, 1.40E-02, 1.37E-02, and 1.27E-02 mSv/MBq at the 8th, 10th, 15th, 20th, 25th, 30th, 35th, and 38th weeks of gestation, respectively. CONCLUSION: The developed pregnant female/fetus models matching the ICRP reference data can be exploited by dedicated software packages for internal and external dose calculations. The generated S-values will be useful to produce new standardized dose estimates to pregnant patients and embryo/fetus from a variety of positron-emitting labeled radiotracers.

Clinical accuracy of a low cost portable blood pressure device in pregnancy and pre-eclampsia: the Nissei DS-400.

Hypertensive disorders of pregnancy cause significant maternal morbidity and mortality worldwide, particularly in developing countries. This study evaluated the accuracy of the Nissei DS-400, a low cost blood pressure (BP) device, in pregnancy according to the British Hypertension Society protocol. Forty-five pregnant women (15 with pre-eclampsia), were recruited from a large teaching hospital. Nine sequential same-arm BP measurements were taken from each woman by trained observers, alternating between mercury sphygmomanometry and the device. The Nissei DS-400 achieved the highest accuracy grade (A/A) in all subjects (n = 45) and in pregnancy alone (n = 30). The mean difference ± standard deviation between the standard and the device in pregnancy were -1.0 ± 5.1 mmHg and -1.1 ± 5.0 mmHg for systolic and diastolic BP, respectively, and -2.6 ± 5.9 mmHg and -3.4 ± 5.8 mmHg in all subjects. The Nissei-DS 400 can be recommended for clinical use in pregnancy and has potential as a good screening tool for pre-eclampsia in low resource settings.

A transcervical amniotic fluid collector: a new medical device for the assessment of amniotic fluid in patients with ruptured membranes.

AIM: To describe a new device for the transcervical collection of amniotic fluid (AF) in patients with ruptured membranes, and to compare the concentration of proteins in fluid retrieved by transabdominal amniocentesis and the transcervical AF collector. STUDY DESIGN: Paired AF samples were collected in patients with preterm prelabor rupture of membranes (PROM) (n=11) by transabdominal amniocentesis and with the transcervical AF collector (Yoon's AF Collector™). Three proteins known to have high concentrations in AF [α-fetoprotein (AFP), ß-human chorionic gonadotrophin (ß-hCG), and prolactin] were measured. RESULTS: (1) There was a significant correlation between the concentrations of analytes in AF obtained by transabdominal amniocentesis and by the transcervical AF collector (r=0.94, P<0.001 for AFP; r=0.96, P<0.001 for ß-hCG; r=0.72, P<0.05 for prolactin); (2) Bland-Altman plots showed no evidence of heteroscedasticity between transabdominal or transcervical AF concentrations of these markers. CONCLUSIONS: There was a strong correlation between the concentrations of proteins in AF collected by amniocentesis or with the transcervical device.

Preliminary investigations into a new method of functional assessment of the fetal heart using a novel application of 'real-time' cardiac magnetic resonance imaging.

OBJECTIVES: Because of quantitative echocardiographic limitations of fetal ventricular volumes as well as poor windows, we sought to determine if real-time magnetic resonance imaging (MRI) could be used. METHODS: Real-time, functional, true fast imaging with steady-state precession, cardiac MRI was performed on 2 fetuses (one with hypoplastic left heart syndrome and one with ductal constriction). Fetal echocardiography was performed and cardiac index by Doppler was used to validate volume measures by MRI. RESULTS: This technique was able to visualize the beating heart and assess ventricular volumes. Cardiac index and assessment of right ventricular hypertrophy and dilation by echocardiography were consistent with the ventricular volumes and right ventricular hypertrophy obtained by cardiac MRI. CONCLUSION: Real-time, functional fetal cardiac MRI is possible and can be used to quantitatively assess ventricular volumes and cardiac index in utero.

Determination of cholinesterase and acetylcholinesterase in amniotic fluid. Uses in prenatal diagnosis and quality control.

The determination of acetylcholinesterase (AChE) has been shown to be as specific as alphafetoprotein (AFP) for the prenatal detection of open neural tube defects although AFP remains the method of choice. This paper describes a semi-automated technique for the analysis of acetylcholinesterase in amniotic fluid that: A) reduces the cost of the procedure; B) allows for a larger number of samples to be run at a time; and C) provides for more accurate and reproducible procedures and results. Six fetuses with neural tube defects (2 with gastroschisis and 3 where one twin was dead) were detected and found to have elevated AChE, TChE and 2 bands by electrophoresis. Quality control procedures using both pure enzyme and amniotic fluid with low and high levels of the enzyme are described. The analysis of 340 amniotic fluids of normal pregnancies indicates that the normal value for AChE is 5.17 +/- 2.63 mU/ml (97% confidence interval for the mean 4.84-5.49 mU/ml. A group of 27 abnormal pregnancies provides evidence that fetal vomiting and regurgitation, fetal demise, multiple cysts syndrome, idiopathic IUGR, arthrogryposis multiplex, hydrocephaly (stenosis of aqueductus), trisomy 21, trisomy 18, hydronephrosis, pyloric stenosis, heart malformation, ectopia cordis and multiple gestation produce elevated levels of pseudocholinesterase (PChE) in amniotic fluid. The use of pseudocholinesterase levels in amniotic fluid for prenatal diagnosis is proposed and discussed in view of its elevated levels in abnormal pregnancies where AChE is normal. The normal values for PChE are 23.86 mU/ml (mean) and 5.83 for standard deviation. Electrophoretic analysis was performed on all samples with values higher than one standard deviation above the mean.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of fetal lung maturity by a microviscosimeter.

A new method of rapid antenatal assessment of fetal lung maturity was evaluated in relation to the newborn outcome and two other accepted test. This method is based on fluorescence depolarization (FD) technique. The special instrumentation required for this method (the Microviscosimeter) was found to be simple and easy to handle even to nonprofessional personnel. Analysis of 47 samples of amniotic fluid received within 48 hours of delivery demonstrated that lung maturity threshold may be related to a numeric value (P value) measured by this technique. With a P value of less than 0.320 respiratory distress syndrome (RDS) is unlikely to develop. With a P value greater than 0.340, chances for RDS, usually severe, are high. With a P value of less than 0.340 but greater than 0.320, RDS may or may not develop. This method did not prove to be more reliable then the determination of L/S ratio by thin layer chromatography, but its advantage is that it supplies the results in less then an hour. The FD technique proved to be more reliable then the commonly used foam stability test.

Fetal movements in utero: nature, assessment, prognostic value, timing of delivery.

Fetal movements in utero are an expression of fetal well-being. However, a sudden increase of fetal movements is a sign of acute fetal distress, such as in cases of cord complications or abruptio placentae. Decreased fetal movements are seen in cases of chronic fetal distress such as preeclampsia, hypertension in pregnancy, etc. It was shown that in these cases a pronounced decrease up to cessation of fetal movements occurred before fetal death in utero while fetal heart beats were still audible for at least 12 hours. This situation was called "movements alarm signal" (MAS). This sign points to a severely disturbed fetus and indicates impending intrauterine fetal death. Such a development is an indication for immediate delivery of the fetus, provided it is viable. High-risk pregnant women are instructed to assess and record fetal movements daily as a monitor of fetal condition. A special device which records fetal movements is used to confirm the women's assessment of fetal movement. It was shown that fetal movement monitoring was found to be more reliable than the urinary estriol determination in predicting impending fetal death in utero. It was also shown that in cases of MAS, fetal heart rate (FHR) changes will appear 1 to 4 days after the MAS has appeared. Meconium was found in only 50% of these cases. Increased fetal movements are manifested as a response to various stimuli such as sound, light, touch, and ultrasound. Classification of high-risk pregnancies into 3 groups according to the hormone assays, enzyme assays, ultrasonic cephalometry, fetal movements, and FHR is suggested.