Prematurity and Low Birth Weight did not Correlate with Anti-Toxoplasma gondii Maternal Serum Profiles--a Brazilian Report.

Gestational Toxoplasma gondii infection is considered a major risk factor for miscarriage, prematurity and low birth weight in animals. However, studies focusing on this topic in humans are scarce. The objective of this study is to determine whether anti-Toxoplasma gondii maternal serum profiles correlate prematurity and low birth weight in humans. The study examined 213 pregnant women seen at the High-Risk Pregnancy Hospital de Base, São José do Rio Preto, São Paulo, Brazil. All serological profiles (IgM-/IgG+; IgM-/IgG-; IgM+/IgG+) were determined by ELISA commercial kits. Maternal age, gestational age and weight of the newborn at birth were collected and recorded in the Statement of Live Birth. Prematurity was defined as gestational age <37 weeks and low birth weight ≤ 2499 grams. The t-test was used to compare values (p < 0.05). The mean maternal age was 27.6±6.6 years. Overall, 56.3% (120/213) of the women studied were IgM-/IgG+, 36.2% (77/213) were IgM-/IgG- and 7.5% (16/213) were IgM+/IgG+. The average age of the women with serological profile IgM+/IgG+ (22.3±3.9 years) was different from women with the profile IgM-/IgG+ (27.9±6.7 years, p = 0.0011) and IgM-/IgG- (27.9±6.4 years, p = 0.0012). There was no statistically significant difference between the different serological profiles in relation to prematurity (p = 0.6742) and low birth weight (p = 0.7186). The results showed that prematurity and low birth weight did not correlate with anti-Toxoplasma gondii maternal serum profiles.

Abscesso Hepático por Osso de Peixe / Liver Abscess Caused by Fish Bone

O abscesso hepático originado por corpo estranho é raro e o quadro clínico apresentado inespecífico. O caso clínico relatado demonstra a evolução de um paciente com quadro de dor abdominal no hipogástrio, irradiada para o hipocôndrio direito e associada à febre diária (39ºC). Ao exame físico foi encontrado abdome dolorosoà palpação no hipocôndrio direito. Exames complementares de entrada revelaram leucocitose, AST, ALT,bilirrubinas e alfa-feto proteína dentro da normalidade. Ao ultra-som, massa compatível com abscesso hepá-tico e tomografia computadorizada (TC) com imagem nodular mal definida, localizada em segmento lateral do lobo hepático esquerdo.O tratamento combinou drenagem percutânea guiada por TC e antibioticoterapia - Ampicilina, Garamicina eMetronidazol. Posteriormente à hemocultura (positiva para S. pneumoniae), a Ampicilina foi substituída por Penicilina G cristalina. Por má evolução do caso, optou-se por laparotomia exploratória, que evidenciou perfuração da região pré-pilórica, bloqueada pelo lobo hepático esquerdo e presença de corpo estranho (osso de peixe). Assim, fez-se uma nova drenagem do abscesso com necrosectomia cirúrgica, rafia simples da perfuração gástrica e mantidos os antibióticos. Atualmente, o paciente encontra-se assintomático.Apesar da TC e da endoscopia digestiva alta (EDA), o diagnóstico foi feito apenas no intra-operatório. Diante da alta mortalidade (8,5) apresentada pelos casos de abscesso hepático, é evidente a relação do abscesso hepático no lobo esquerdo com a presença de corpo estranho.

Liver abscess caused by foreign body is rare and the clinical picture presented is non-specific. The reportedclinical case shows a clinical picture of a patient’s evolution with abdominal pain in the epigastric regionradiating towards the right hypochondrium and associated to daily fever (39°C). On physical examination, itwas found a painful abdomen on palpation in the right hypochondrio. Complementary exams of leucocytosis,aspartate aminotransferase, alanine aminotransferase, bilirubin, and alpha-fetus protein on admission wereconsidered normal. Ultrasonography revealed a compatible mass with hepatic abscess, and the computerizedtomography (CT) showed a poorly defined nodular image located in the left lateral division of left lobe of liver. The treatment combined percutaneous drainage guided by CT and antibioticotherapy - Ampicillin, Garamycinand Metronidazol. After the blood culture (positive for S. pneumoniae), Ampicillin was replaced by Penicillincrystalline G. Because of poor evolution of the case, it was decided to perform an exploratory laparotomy thathighlighted the perforation of the prepyloric region blocked by the left lobe of liver and the presence of aforeign body (fish bone). Thus, a new drainage of the abscess with surgical débridement and a simple surgicalsuture of the gastric perforation were carried out. The antibiotics were continued. Nowadays, the patientbecame asymptomatic. In spite of CT and of high digestive endoscopy (HDE), the diagnosis was only performed intraoperatively.Due to high mortality (8.5%) presented by the cases of liver abscess, the relation of a liver abscess in the leftlobe of liver with the presence of a foreign body is evident.