Evaluation of the adequacy of reference charts for the accurate identification of fetuses with bone length below the 5th percentile.

AIM: To identify reference charts for femoral and humeral lengths enabling appropriate identification of fetuses <5th percentile in one population. METHODS: Two samples of fetuses aged 14-40 weeks were selected from our institution's ultrasonographic database. Regression analysis was used to construct reference charts of femoral and humeral lengths based on the local population (n=901). Femur and humerus length measurements from a second sample (n=1240) were transformed into Z-scores using local and previously published equations. Z-score distributions were used to assess the appropriateness of reference curves for our population. Fetuses aged 18-24 weeks with measurements <5th percentile were identified using each reference equation. RESULTS: For femoral length, one equation other than the local equation yielded Z-score values within the standard normal distribution (P=0.10), but the histogram was skewed to the right. All Z-score distributions for humeral length fell within the normal distribution (P>0.05), but one was skewed to the right. The numbers of fetuses with femoral and humeral lengths <5th percentile in second-trimester ultrasound examinations varied widely among reference equations used. CONCLUSION: Most reference charts assessed underestimated the number of fetuses with long bone lengths <5th percentile in second-trimester ultrasound examinations and were thus unfit for interpretations of biometric data from the study population.

Association of midtrimester short femur and short humerus with fetal growth restriction.

OBJECTIVE: To investigate the association between the midtrimester presence of short femur and short humerus and intrauterine growth restriction. METHODS: This retrospective study included ultrasound examinations of 1043 fetuses. Fetuses with normal-length bones were compared with fetuses that had femoral or humeral lengths below the 5(th) percentile for gestational age by Student's t-test and the chi-squared test. The association between short bones and fetal growth restriction development was evaluated by Fisher's exact test. Fetuses with estimated weight below the 10(th) percentile for gestational age and abnormal umbilical artery flow were considered to have growth restriction. RESULTS: Femoral and humeral lengths were normal in 974 (93.4%) fetuses; 19 (1.8%) fetuses had short femora, 65 (6.2%) had short humeri, and 15 (1.4%) had short femora and humeri combined. Of fetuses included in the analysis, 603 (57.8%) underwent Doppler examination. Short femur [odds ratio = 9.7, 95% confidence interval = 1.9-50.2, P = 0.03] and short humerus (odds ratio = 13, 95% confidence interval = 4.9-34.6, P < 0.001) were associated with fetal growth restriction. CONCLUSION: Fetuses with midtrimester short femur, short humerus, or short femur and humerus combined require more intensive surveillance for growth restriction development.

A technique for the intra-gastric administration of live larvae of Anisakis simplex in mice.

To understand the mechanisms of infection and to attempt to simulate human infection by the Anisakidae family, many in vivo experimental approaches have been developed. The aim was to develop and present a technique for the induction of an oral infection through the use of an intra-gastric gavage of live Anisakis simplex in mice. A commercial pediatric gastric tube (No. 4) was cut longitudinally to produce a 3-cm slit at the distal end where the larva was placed to then be administered to the stomach of the mouse. There were no abnormal clinical complications before, during or after the procedure. In conclusion oral infection through the direct delivery of larvae in the stomach is simple and effective.

Knowledge about Neonatal Screening among Postpartum Women and Complexity Level of Birthing Facilities.

BACKGROUND: To ascertain the degree of knowledge of postpartum women about important aspects related to the neonatal screening process and whether differences of opinion exist between those who deliver in low-complexity versus high-complexity health facilities (low-risk versus high-risk pregnancies, respectively). METHODS: This was a prospective, cross-sectional, questionnaire-based study. The sample consisted of postpartum women recruited from 2013 to 2015 at public maternity hospitals in the city of Niterói, Brazil. Participants were divided into two groups and completed a questionnaire consisting of Likert-scored items. Continuous variables were analyzed with the Mann-Whitney test, and categorical variables, with Fisher's test. A confirmatory factor analysis of participants' answers was performed. RESULTS: Of 188 women enrolled, 54 (28.7%) had incomplete elementary education; 119 (62.2%) had attended more than six antenatal care visits. The mean age was 25.57 years. Nearly all women (n = 179, 95.2%) were roomed-in with their infants. Knowledge of neonatal screening was very similar in the high-complexity and low-complexity groups. Divergences were limited to items regarding the risks of neonatal screening. CONCLUSIONS: The degree of knowledge among postpartum women was similar among high- and low-complexity facilities. Those who attended high-complexity facilities had longer hospital stays and greater adherence to ethical issues regarding neonatal screening.

Mobile emergency care service: A time-course assessment and characterization of demand.

INTRODUCTION: Prehospital care is defined as any medical attention provided outside the hospital environment. This study aims to study the operation of a regional SAMU by assessing electronic records of cases managed and to evaluate demand patterns over time. METHODS: A retrospective, cross-sectional study was conducted through an analysis of emergency calls handled between the years of 2009 and 2013 by the SAMU Metropolitan 2 Region mobile emergency care service, located in Niterói, Brazil. Nonparametric tests were used to evaluate differences in the variables of interest between the two halves of the 5-year period of analysis and annually. RESULTS: The total call volume during the period of analysis was 590,902 (monthly mean [SD], 9848 [3764]; 95%CI = 8875 to 10,820). Analysis of calls over time revealed a significant decline in call volume (p = 0.008), mainly between the year 2009 and subsequent years (p < 0.001). The vast majority of patients were adults with clinical conditions (average = 2311). Predominantly, calls were made to request prehospital assistance at the patient's home, and the most prevalent age range was 41-50 years. CONCLUSION: The SAMU Metropolitan 2 regional emergency medical service predominantly attended to middle-aged women at their homes. Total call volume has been decreasing, perhaps reflecting a multifactorial phenomenon and improvements in the primary health care network.

Evaluation of the adequacy of Hadlock's reference chart for identification of fetuses with growth restriction.

OBJECTIVE: This study aimed to verify whether Hadlock's reference values for fetal weight identify fetuses below the 10th percentile in our population correctly. METHODS: The fitness of the Hadlock reference range to our study population was tested by assessment of Z scores. We evaluated differences between the reference weight ranges proposed in our study and those recommended by Hadlock. RESULTS: Z scores for Hadlock reference values were non-normally distributed. The difference between the 50th percentile fetal weight proposed by our study model and that proposed by Hadlock was ≤1% at GAs ≥22 weeks and 2-3% at 19-21 weeks. For the 90th percentile level, the maximum difference at GAs ≥17 weeks was 1.5%. For the 10th percentile level, the differences were 2-4% in the third trimester, reaching 8% in week 20 and 13% at a GA of 14 weeks. CONCLUSIONS: The weight reference ranges of this study virtually overlap with the Hadlock ranges. We believe that only at lower gestational ages in the second trimester might some FGR diagnoses be missed in the population study with Hadlock's reference.

Seroreactivity to Anisakis spp. in the perinatal period.

BACKGROUND: This study had sought to assess the seroreactivity to the fish nematode Anisakis spp. in a puerperal population, as well as to ascertain whether a correlation exists between maternal and cord blood levels. METHODS: Blood samples were obtained from puerperal women and cord blood to measure specific anti-Anisakis antigen IgG and IgE by ELISA. Non-parametric tests were used to compare two or more independent and related samples. RESULTS: Of the 99 maternal serum samples assessed, 21 were positive on ELISA (21.2%). There were no significant differences in the mean ranks of IgG optical density levels between women who ate fish and those who did not (p = 0.456), those who ate raw fish and those who did not (p = 0.479), or between those who had allergic complaints and those who did not (p = 0.431). CONCLUSION: Transplacental passage of antibodies occurred, leading to moderate correlation between maternal and cord blood serum levels.

Abdominal lymphadenopathy in an adolescent with Kawasaki disease: a major sign?

In adolescence, Kawasaki disease (KD) may present with varied clinical pictures, and the classic clinical criteria are often insufficient to establish the diagnosis. This report presents a clinical case of KD in an adolescent and a brief review of the relevant literature, based on a PubMed search using the terms "adolescence" and "KD". A 13-year-old girl presented with fever, rash, hepatomegaly, and ultrasonographic evidence of abdominal lymphadenopathy. On week 2 after onset of symptoms, the patient developed desquamation of the extremities and thrombocytosis. Echocardiography was normal during the acute illness and remained unchanged at 2-year follow-up. Clinicians should be aware that, in adolescents, KD poses a diagnostic challenge and rarely corresponds to the classic presentation. On retrospective analysis, we believe that abdominal lymphadenopathy should have been recognized as a substitute manifestation of the classic symptom of cervical lymphadenopathy to establish the diagnosis of this fearsome systemic vasculitis syndrome.

Principal component analysis of factors for sensitization to Anisakis spp. in postpartum women.

INTRODUCTION: Immunoreactivity to Anisakis spp. is believed to be associated with frequency of fish intake. The objective of this study was to evaluate, using principal component analysis, the main factors potentially involved in reactivity to these nematodes in postpartum women. METHODS: Retrospective study conducted on a database of 309 postpartum women. All completed a structured questionnaire and had blood samples collected for ELISA analysis of specific immunoglobulins against total Anisakis spp. antigens and assessment of reactivity. Parametric and nonparametric tests were used to assess factors for sensitization in the reactive and nonreactive groups, and a principal component analysis was performed. A Pearson correlation matrix with varimax rotation was used to assess the variables of interest (place of residence, age, number of prenatal visits, type of birth facility, fish intake and frequency, raw fish intake, fish handling, history of allergies). RESULTS: After exclusions, samples from 203 women were assessed. Of these, 52 (25.6%) were reactive for anti-Anisakis IgG. Most women claimed not to handle fish (n = 121) and eat fish only sporadically (n = 71). Significant differences in age were seen between the reactive and nonreactive groups (p = 0.001). The first two components explained 32.55% and 38.94% of variances in the nonreactive and reactive groups respectively. The adjusted matrix assigned greater probabilistic weight to weekly intake frequency (0.804), followed by raw fish intake (0.759), with differences in relation to the nonreactive group. CONCLUSION: Correlation matrices revealed a direct relationship between seroreactivity to Anisakis spp. and frequency of fish intake in a sample of postpartum women.

Association between immunoreactivity to Anisakis spp. antigens and high-risk pregnancy.

Numerous factors contribute to perinatal risk, many of which remain undefined. This study sought to determine the frequency of fish intake in postpartum women, and to establish a relationship between the rates of immunoreactivity for antigens from Anisakis spp. and high-risk pregnancy. In this prospective noninterventional study, a structured questionnaire was administered and serum was collected from postpartum women at two perinatal centers (a high-risk birth unit [HRBU] and a low-risk birth unit [LRBU]) in the Niteroi municipality of Brazil. Anisakis species-specific IgG and IgE were measured by ELISA. The chisquared test was performed, and odds ratios (ORs) with their 95% confidence intervals were estimated. The t-test or Mann-Whitney test was applied to continuous, normally distributed variables. In total, 309 women (170 from HRBU, 139 from LRBU) between 24.8 and 26.7 years old with a median of 6 to 8 prenatal visits were enrolled. Women in the two units exhibited differences in some variables, including prenatal care (p = 0.01), maternal and fetal risk (p = 0.00; OR = 6.17), and gestational age (p = 0.00), but no differences in fish consumption (p = 0.29), frequency of fish intake (p = 0.40), allergic symptoms (p = 0.51), or frequency of anti-Anisakis reactivity (p = 0.22). Logistic regression analysis revealed that only age was independently associated with postpartum anti-Anisakis reactivity. This study confirmed a low prevalence of fish intake and suggested that Anisakis spp. had no impact on high-risk pregnancies among this postpartum study population.

Use of fetal colon thickness for auxiliary term dating of pregnancy.

OBJECTIVE: To verify whether fetal colon thickness can be used as a marker for estimating, independent of biometrics and fetal weight percentile, the gestational age (GA) of fetuses between 37 and 40 weeks. METHODS: The study group was 1296 fetuses aged between 33 and 40 weeks. The correlation between GA and colon thickness was assessed by the Pearson correlation test. For term fetuses (≥ 37 weeks), comparisons among the mean colon thickness for different weight percentiles at each GA (in weeks) were made with an analysis of variance test. RESULTS: A significant relationship was observed between GA and colon thickness (P < 0.001, r(2) = 0.6). For term fetuses, significant differences were observed among the mean colon thickness values for different weight percentiles at 38 and 39 weeks. Of the 157 term fetuses for which biometrics would have underestimated GA by 2 weeks or more, 126 (80.3%) had a colon thickness equal to, or greater than, 14 mm. This colon thickness was also observed in 52 (70.3%) of term fetuses weighing less than the 10th percentile (n = 74). CONCLUSION: The present study suggested that colon thickness might be a good marker for 37 weeks of gestation, and might identify term fetuses for which biometrics has underestimated the GA.

Prevençäo e controle das infecçöes pós-natais / Prevention and control of the newborn infection

Os autores avaliam vários fatores que favorecem e podem interferir no aumento da infecçäo pós-natal. Comentam sobre o índice de mortalidade no berçário do Hospital Universitário Antonio Pedro, da Universidade Federal Fluminense, em Niterói - RJ. Apresentam medidas importantes de controle para prevençäo das infecçöes pós-natais nos berçários, abrangendo desde a lavagem das mäos, limpeza ambiental, incubadora e instrumentos, até cuidados com o recém-nascido

Nefropatia luética em recém-nascido / Luetic nephropathy in a newborn

Descreve-se um caso de nefropatia luética em recém-nascido, ocorrencia relativamente rara nesta faixa etária. Comentários sobre o quadro clínico, patogenia e evoluçäo