Marcadores clínicos e laboratoriais como preditores de eventos adversos maternos e neonatais em pacientes com diagnóstico de pré-eclâmpsia precoce com critérios de gravidade / Clinical and laboratory markers as predictors of maternal and neonatal adverse events in patients diagnosed with early preeclampsia with severity criteria

Introdução: A pré-eclâmpsia (PE), especialmente em sua forma precoce (antes de 34 semanas), é uma das causas mais importantes de morbimortalidade materna e perinatal no mundo. Assim, é essencial o desenvolvimento de métodos objetivos de predição do risco de eventos adversos, que permitam o direcionamento da abordagem dessas pacientes, garantindo melhor prognóstico. Objetivos: Avaliar um marcador clínico e alguns marcadores laboratoriais como potenciais preditores de desfechos adversos em mulheres portadoras de PE precoce com critérios de gravidade. Pacientes e métodos: Foi realizada uma análise retrospectiva dos prontuários de 97 pacientes com PE precoce com critérios de gravidade, com parto entre 01/01/2014 e 31/12/2017 no Hospital Universitário Risoleta Tolentino Neves, em Belo Horizonte. A partir desse banco de dados, foram construídas curvas de Características de Operação do Receptor (curvas ROC), relacionando Pressão Arterial Média (PAM), Contagem plaquetária, Creatinina sérica e níveis de Aspartato Aminotransferase (AST) com complicações maternas e neonatais. Resultados: Das variáveis avaliadas, apenas a contagem de plaquetas apresentou área sob a curva (Area Under the Curve - AUC) com significância para predição de complicações neonatais. Já para predição de complicações maternas, AST e contagem de plaquetas tiveram AUC com significância. Os demais marcadores não apresentaram bom desempenho para serem usados na predição de desfechos adversos maternos ou neonatais. Conclusão: O estudo atual permite concluir que a AST e a contagem plaquetária podem ser potenciais marcadores do risco de complicações em pacientes com PE precoce com critérios de gravidade.

Introduction: Pre-eclampsia (PE) is still one of the most important causes of maternal and perinatal morbidity and mortality in the word, especially when its early manifestations (before 34 weeks) are considered. Therefore, it is essential to focus on developing objective methods to predict the risk of adverse outcomes in this patients. This enables an individualized clinical approach, potentially assuring better prognosis. Objectives: Evaluate a clinical and some laboratorial markers as potential predictors of adverse outcomes in women with early and severe PE. Patients and Methods: A retrospective analysis of charts was conducted, selecting 97 patients with early and severe PE who gave birth under 34 weeks, between 01/01/2014 and 31/12/2017 in Risoleta Tolentino Neves Hospital, in Belo Horizonte. Using the data collected, Reciever Operating Characteristic (ROC) Curves were developed, relating Medium Arterial Pressure, platelet count, serum creatinin levels, and Aspartate Aminotransferase (AST) levels with maternal adverse outcomes and neonatal adverse outcomes. Results: Amongst evaluated variables, only platelet count presented an Area Under The Curve (AUC) significant enough to predict neonatal complications. For predicting maternal adverse outcomes, AST and platelet count had a significant AUC. However, the other markers did not demonstrate a good performance as predictors of adverse maternal or neonatal outcomes. Conclusion: The present study shows that AST and platelet count can be used as potential markers of the risk of complications in patients with early and severe PE.

Prediction of preeclampsia by means of Doppler flowmetry of uterine artery and flow-mediated dilation of brachial artery / Predição de pré-eclâmpsia por meio da dopplerfluxometria das artérias uterinas e da dilatação fluxo-mediada da artéria braquial

Objective To evaluate the association of Doppler of uterine artery and flow-mediated dilation of brachial artery (FMD) in the assessment of placental perfusion and endothelial function to predict preeclampsia. Materials and Methods A total of 91 patients considered as at risk for developing preeclampsia were recruited at the prenatal unit of the authors' institution. All the patients underwent FMD and Doppler of uterine arteries between their 24th and 28th gestational weeks. Calculations of sensitivity and specificity for both isolated and associated methods were performed. Results Nineteen out of the 91 patients developed preeclampsia, while the rest remained normotensive. Doppler flowmetry of uterine arteries with presence of bilateral protodiastolic notch had sensitivity of 63.1% and specificity of 87.5% for the prediction of preeclampsia. Considering a cutoff value of 6.5%, FMD showed sensitivity of 84.2% and specificity of 73.6%. In a parallel analysis, as the two methods were associated, sensitivity was 94.2% and specificity, 64.4%. Conclusion The association of Doppler study of uterine arteries and FMD has proved to be an interesting clinical strategy for the prediction of preeclampsia, which may represent a positive impact on prenatal care of patients considered as at high-risk for developing such a condition. .

Objetivo Avaliar, para a predição de pré-eclâmpsia, a capacidade associada da dopplerfluxometria de artérias uterinas e da dilatação fluxo-mediada da artéria braquial (FMD), como métodos de avaliação da perfusão placentária e da função endotelial. Materiais e Métodos Um total de 91 pacientes consideradas de risco para o desenvolvimento de pré-eclâmpsia foi recrutado do serviço de pré-natal de nossa instituição. Todas foram submetidas a FMD e a dopplerfluxometria de artérias uterinas entre 24 e 28 semanas de gestação. Cálculos de sensibilidade e especificidade dos dois exames isolados e associados foram realizados. Resultados Do total de 91 pacientes recrutadas, 19 desenvolveram pré-eclâmpsia, sendo que as restantes se mantiveram normotensas. Para a predição de pré-eclâmpsia, a dopplerfluxometria de artérias uterinas, através da presença da incisura protodiastólica bilateral, apresentou sensibilidade de 63,1% e especificidade de 87,5%. Considerando um valor de corte de 6,5%, a FMD apresentou sensibilidade de 84,2% e especificidade de 73,6%. Os dois testes associados, em análise paralela, apresentaram sensibilidade de 94,2% e especificidade de 64,4%. Conclusão A associação entre a dopplerfluxometria de artérias uterinas e a FMD mostrou-se uma estratégia interessante para a predição de pré-eclâmpsia, o que pode representar um impacto positivo no acompanhamento pré-natal das pacientes consideradas de risco para pré-eclâmpsia. .

[Neurofibromatosis type 1: more frequent and severe then usually thought]. / Neurofibromatose tipo 1: mais comum e grave do que se imagina.

OBJECTIVE: To study prevalence of clinical features among Brazilian patients diagnosed with neurofibromatosis type 1(NF1), comparing these features with international data to evaluate the severity and visibility of the disease and quantify less frequent manifestations such as short stature, macrocephaly, muscle strength, voice abnormalities and oral motor disorders. METHODS: 183 patients diagnosed with NF1, attended at the Neurofibromatosis Outpatient Reference Center, were evaluated for clinical manifestations and complications of NF1. Severity and visibility were verified using the Riccardi and Ablon scales respectively. Voice abnormalities and oral motor disorders were quantified using the Vox-Metria software and maximal voluntary muscle strength (MVMS) was quantified using a handgrip dynamometer. RESULTS: Clinical manifestations of NF1 observed were comparable to those described in literature. However, more then 50% of patients presented severity and visibility classified as moderate and severe. The incidence of macrocephaly and short stature was higher among the Brazilian patients. Voice abnormalities and oral motor disorders were quantified for the first time, with hoarseness and oral motor disorders observed in more then 60% the patients. Maximal voluntary muscle strength was found to be reduced in 67% of patients. CONCLUSION: The main clinical features of these patients are similar to those reported in previous studies. More then one-half of the patients presented moderate and severe levels of NF1 (severity and visibility), including short stature, macrocephaly, voice abnormalities and oral motor disorders and decreased muscle strength. These results are in disagreement with the traditional concept that NF1 is a benign disease and also disclosed some clinical aspects not previously reported.

Neurofibromatose tipo 1: mais comum e grave do que se imagina / Neurofibromatosis type 1: more frequent and severe then usually thought

OBJETIVO: Determinar a prevalência das características clínicas da neurofibromatose tipo 1 (NF1), avaliar sua gravidade e visibilidade e quantificar baixa estatura, macrocrania, força muscular e as alterações da motricidade oral e da voz nesta enfermidade. MÉTODOS: 183 pacientes atendidos no Centro de Referência em Neurofibromatose de Minas Gerais (CRNF-MG) foram avaliados quanto à frequência de manifestações clínicas e complicações da NF1. A gravidade e a visibilidade foram avaliadas com o uso de escalas de Riccardi e Ablon respectivamente. As alterações da motricidade oral e da voz foram verificadas com uso do software Vox-Metria, e a medida quantitativa da força muscular realizada com uso de dinamômetro. RESULTADOS: As manifestações clínicas habituais da NF1 observadas neste estudo são semelhantes às descritas na literatura. Entretanto, mais de 50 por cento dos pacientes apresentaram gravidade e visibilidade moderada e grave. A incidência de macrocrania e baixa estatura foi maior nos pacientes do CRNF-MG. As alterações da voz e da motricidade oral foram pela primeira vez quantificadas, com rouquidão e distúrbios da motricidade oral observados em mais de 60 por cento dos pacientes. A força muscular estava reduzida em 67 por cento dos pacientes. CONCLUSÃO: O perfil clínico destes pacientes é semelhante aos relatos prévios da literatura. Mais da metade dos pacientes avaliados apresenta as formas moderada e grave da doença (gravidade e visibilidade), incluindo baixa estatura, macrocrania, distúrbios da voz e da motricidade oral e redução da força muscular. Os resultados desta pesquisa contrariam o conceito tradicional de que a NF1 é uma doença benigna e demonstram alguns aspectos clínicos, ainda não descritos na literatura.

OBJECTIVE: To study prevalence of clinical features among Brazilian patients diagnosed with neurofibromatosis type 1(NF1), comparing these features with international data to evaluate the severity and visibility of the disease and quantify less frequent manifestations such as short stature, macrocephaly, muscle strength, voice abnormalities and oral motor disorders. METHODS: 183 patients diagnosed with NF1, attended at the Neurofibromatosis Outpatient Reference Center, were evaluated for clinical manifestations and complications of NF1. Severity and visibility were verified using the Riccardi and Ablon scales respectively. Voice abnormalities and oral motor disorders were quantified using the Vox-Metria software and maximal voluntary muscle strength (MVMS) was quantified using a handgrip dynamometer. RESULTS: Clinical manifestations of NF1 observed were comparable to those described in literature. However, more then 50 percent of patients presented severity and visibility classified as moderate and severe. The incidence of macrocephaly and short stature was higher among the Brazilian patients. Voice abnormalities and oral motor disorders were quantified for the first time, with hoarseness and oral motor disorders observed in more then 60 percent the patients. Maximal voluntary muscle strength was found to be reduced in 67 percent of patients. CONCLUSION: The main clinical features of these patients are similar to those reported in previous studies. More then one-half of the patients presented moderate and severe levels of NF1 (severity and visibility), including short stature, macrocephaly, voice abnormalities and oral motor disorders and decreased muscle strength. These results are in disagreement with the traditional concept that NF1 is a benign disease and also disclosed some clinical aspects not previously reported.