Placental growth disorders and perinatal adverse outcomes in Brazilian HIV-infected pregnant women.

Fetal and placental growth disorders are common in maternal human immunodeficiency virus (HIV) infection and can be attributed to both the infection and comorbidities not associated with HIV. We describe placental growth disorders and adverse reproductive outcomes in HIV-infected pregnant women whose delivery occurred between 2001-2014 in Vitoria, Brazil. Cases with gestational age (GA) ≥ than 22 weeks validated by ultrasonography, with placental and fetal weight dimensions at birth, were studied. Outcomes were summarized as proportions of small (SGA), appropriate (AGA), and large (LGA) for GA when the z-score values were below -1.28, between -1.28 and +1.28, or above +1.28, respectively. Of 187 fetal attachment requisitions, 122(65.2%) women and their newborns participated in the study. The median maternal age was 28 years and 81(66.4%) underwent ≥ 6 prenatal visits. A total of 81(66.4%) were diagnosed before current pregnancy; 68(55.7%) exhibited criteria for acquired immunodeficiency syndrome (AIDS); 64(52.4%) had detectable viral load; 25(20.5%) cases presented SGA placental weight and 6(4.9%) SGA placental thickness. SGA placental area was observed in 41(33.6%) cases, and among the SGA placental weight cases 12(48%) were also SGA fetal weight. Preterm birth (PTB) occurred in 15.6%(19/122) of cases; perinatal death in 4.1%(5/122) and HIV vertical transmission in 6 of 122 (4.9%). Women, ≥36 years old, were 5.7 times more likely to have PTB than those under 36. Also, patients with AIDS-defining criteria were 3.7 times more likely to have PTB. Prenatal care was inversely associated with PTB. Statistically significant associations were observed between AGA placental area and Protease Inhibitor usage and between SGA placental weight and SGA area. We found a prevalence of placental growth disorders in HIV-infected pregnant women and values higher than international reference values. The restriction of placental growth was a common disorder, possibly attributed to virus effects or a combination of antiretroviral regimens.

Rollet's mixed chancre in Brazilian pregnant women: An unusual case report.

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum and has shown a significant increase in recent decades. It may be associated with other STIs such as soft chancre or chancroid, which is an uncommon infection in Brazil. The presence of ulcerated genital lesions is associated with a higher risk of HIV transmission. An accurate clinical and laboratory diagnosis of genital ulcer disease is essential for the appropriate treatment of pregnant women, in order to avoid congenital syphilis, a severe complication of mother-to-child vertical transmission. We report the case of a woman in the third trimester of pregnancy with Rollet's mixed chancre and describe the clinical and laboratory diagnosis, as well as the treatment of these diseases in pregnancy. We emphasize the importance of training health professionals on early diagnosis and treatment in order to avoid mother-to-child transmission.

Preterm birth and fetal growth restriction in HIV-infected Brazilian pregnant women.

INTRODUCTION: Maternal HIV infection and related co-morbidities may have two outstanding consequences to fetal health: mother-to-child transmission (MTCT) and adverse perinatal outcomes. After Brazilian success in reducing MTCT, the attention must now be diverted to the potentially increased risk for preterm birth (PTB) and intrauterine fetal growth restriction (IUGR). OBJECTIVE: To determine the prevalence of PTB and IUGR in low income, antiretroviral users, publicly assisted, HIV-infected women and to verify its relation to the HIV infection stage. PATIENTS AND METHODS: Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary public university hospital in the city of Vitória, state of Espírito Santo, Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were selected for study, with ultrasound validated gestational age (GA) and data on birth dimensions: fetal weight (FW), birth length (BL), head and abdominal circumferences (HC, AC). The data were extracted from clinical and pathological records, and the outcomes summarized as proportions of preterm birth (PTB, < 37 weeks), low birth weight (LBW, < 2500 g) and small (SGA), adequate (AGA) and large (LGA) for GA, defined as having a value below, between or beyond the ± 1.28 z/GA score, the usual clinical cut-off to demarcate the 10th and 90th percentiles. RESULTS: PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%, 13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were: PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL: 6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA cases. A concomitant presence of, at least, two SGA dimensions in the same fetus was frequent. CONCLUSIONS: The proportions of preterm birth and low birth weight were higher than the local and Brazilian prevalence and a trend was observed for higher proportions of SGA fetal dimensions than the expected population distribution in this small casuistry of newborn from the HIV-infected, low income, antiretroviral users, and publicly assisted pregnant women. A trend for higher prevalence of PTB, LBW and SGA fetal dimensions was also observed in infants born to mothers with AIDS compared to HIV-infected mothers without AIDS.

Preterm birth add fetal growth restriction in hiv-infected Brazilian pregnant women / Nascimento pré-termo e restrição de crescimento fetal em gestantes brasileiras infectadas pelo HIV

Introduction: Maternal HIV infection and related co-morbidities may have two outstanding consequences to fetal health: mother-to-child transmission (MTCT) and adverse perinatal outcomes. After Brazilian success in reducing MTCT, the attention must now be diverted to the potentially increased risk for preterm birth (PTB) and intrauterine fetal growth restriction (IUGR). Objective: To determine the prevalence of PTB and IUGR in low income, antiretroviral users, publicly assisted, HIV-infected women and to verify its relation to the HIV infection stage. Patients and Methods: Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary public university hospital in the city of Vitória, state of Espírito Santo, Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were selected for study, with ultrasound validated gestational age (GA) and data on birth dimensions: fetal weight (FW), birth length (BL), head and abdominal circumferences (HC, AC). The data were extracted from clinical and pathological records, and the outcomes summarized as proportions of preterm birth (PTB, < 37 weeks), low birth weight (LBW, < 2500g) and small (SGA), adequate (AGA) and large (LGA) for GA, defined as having a value below, between or beyond the ±1.28 z/GA score, the usual clinical cut-off to demarcate the 10th and 90th percentiles. Results: PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%, 13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were: PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL: 6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA cases. A concomitant presence of, at least, two SGA dimensions in the same fetus was frequent. Conclusions: ...

Introdução: A infecção materna pelo HIV e comorbidades associadas podem ter duas consequências para a saúde fetal, a transmissão vertical e o desfecho perinatal adverso. Após o sucesso em reduzir a transmissão vertical, deve-se dar atenção ao risco potencial de nascimento pretermo (PRT) e de restrição de crescimento fetal (RCF). Objetivo: Determinar a prevalência de PRT e RCF em gestantes de baixa renda, infectadas pelo HIV, usuárias de terapia antirretroviral atendidas em hospital público terciário e verificar sua relação com o estágio da infecção viral. Casuística e métodos: Dentre os 250 partos de gestantes infectadas pelo HIV, ocorridos em um hospital universitário na cidade de Vitória, estado do Espírito Santo, Sudeste do Brasil, entre novembro de 2001 e maio de 2012, foram selecionadas 74 gestações não-gemelares, com idade gestacional confirmada por ultrassonografia e as dimensões neonatais: peso ao nascer (PN), comprimento (CN) e perímetros cefálico (PC) e abdominal (PA). Os dados foram extraídos dos prontuários clínicos e laboratoriais e o desfecho sumarizado como nascimento pretermo (PRT < 37 semanas), baixo peso ao nascer (BPN < 2500g) e como pequeno (PIG), adequado (AIG) e grande (GIG) para a IG, definido como tendo um menor valor, entre e maior que ± 1.28 z/IG escore, o critério clínico usual para demarcar os percentis 10 e 90. Resultados: PRT foi observado em 17,5%, BPN em 20,2% e PN, CN, PC e PA PIG em 16,2%, 19,1%, 13,8% e 17,4%, respectivamente. As respectivas proporções observadas nos casos de HIV e AIDS foram: PRT: 5,9 versus 27,5%, BPN: 14,7% versus 25,0%, PFN PIG: 17,6% versus 15,0%, CN: 6,0% versus 30,0%, PC: 9,0% versus 17,9% e PA: 13,3% versus 21,2%; somente a diferença de CN PIG foi estatisticamente significativa. Dentre 15 neonatos com BPN, oito (53,3%) eram somente PRT, quatro (26,7%) PIG somente e três (20,0%) PRT e PIG. Concomitância no mesmo caso de pelo menos duas dimensões PIG foi observada frequentemente. ...

Quality evaluation of cone biopsy specimens obtained by large loop excision of the transformation zone.

BACKGROUND: Large loop excision of the transformation zone (LLETZ) has been used for the diagnosis and treatment of precancerous cervical lesions, and it is the first choice of treatment in the majority of cervical pathology services. The aim of this study was to evaluate the presence of thermal artifacts, the need for serial sections, the percentage of clear and involved resection margins and the relationship between endocervical gland involvement and the severity of the lesion in samples resected using LLETZ. METHODS: A retrospective study was performed at Santa Casa de Misericordia School of Science (HSCMV), Vitoria, Espirito Santo, Brazil with a sample of 52 histopathology slides from patients submitted to conization because of abnormal cytology findings and a biopsy result of cervical intraepithelial neoplasia (CIN) 2, CIN 3 and adenocarcinoma in situ. Statistical analysis was performed using Student's t-test. RESULTS: Serial sections were required to confirm diagnosis in four of 52 cases. Thermal artifacts were present in all cases, with grade I being the most common (94.2% of cases). Clear margins were found in 96.2% of cases. No association was found between glandular involvement and CIN 1 (P > 0.05); however, there was an association with CIN 2 and CIN 3 (P < 0.05). CONCLUSION: The amount of excised tissue was sufficient, thermal artifacts were slight, resection margins were clear in most of cases, and a possible association was found between glandular involvement and the severity of the lesion.

Dysphonia as a sign of HPV laryngeal infection: a case report.

BACKGROUND: Voice dysfunction or dysphonia may be associated with several clinical conditions. Among these, laryngeal human papillomavirus (HPV)-induced lesions should be considered as a possible causative factor. We report a case of dysphonia in a patient presenting with an HPV laryngeal lesion. We also discuss the clinical features of the disease, its histopathological findings, and treatment and rigorous follow-up. CASE PRESENTATION: We report a case of laryngeal papilloma in a 29-year-old, Afro-descendant, male patient with dysphonia. He was a non-smoker and was not a drug user. Videolaryngostroboscopy revealed signs suggestive of pharyngolaryngeal reflux. The right vocal fold presented with a papillomatous aspect in the posterior third, which underwent excision. Histopathological examination showed a nodular lesion of the right vocal fold, conclusive of squamous papilloma with absence of malignancy. CONCLUSION: Patients presenting with persistent voice dysfunction or dysphonia should be investigated for possible laryngeal HPV infection. Diagnostic confirmation by HPV genotyping is important for follow-up of potential recurrence.

Endometrial Assessment: When is it Necessary?

BACKGROUND: Endometrial cancer is the fourth most common cancer among women and the most common malignant neoplasm of the female genital tract in the USA. The onset is usually after the age of 50 and prognosis depends on the stage of disease at diagnosis. We aimed at determining the prevalence of high-risk endometrial lesions in women of different ages to establish a protocol for the indication of invasive diagnostic procedures. METHODS: A retrospective study was conducted based on the descriptive and statistical analysis of histopathological records of 2,931 patients who underwent uterine curettage between January 2001 and December 2011 at our institution. RESULTS: The risk of endometrial malignancy was about 10 times higher in patients aged 50 years or older than that in younger women. However, women with abnormal uterine bleeding had a higher prevalence of high-risk conditions, regardless of age. CONCLUSION: Atypical and complex endometrial hyperplasia and carcinoma can affect women of all ages, but are more common in patients 50 years of age or older. Thus, endometrial sampling is recommended as a routine procedure for all women 50 years of age or older with clinical indications of the disease and as a screening procedure for those undergoing hysterectomy.

Zoon vulvitis as a differential diagnosis in an HIV-infected patient: a short report.

Vulvitis circumscripta plasmacellularis or Zoon vulvitis is a rare benign condition that affects the vulva chronically. We herein report a case of Zoon vulvitis in a 52-year-old HIV-infected patient with an uncommon ulcerovegetating lesion diagnosed by histopathologic findings. The patient was treated with clobetasol propionate ointment and oral corticosteroid. Zoon vulvitisis is a rare vulvar disorder that offers a challenging diagnose and therapy. The patient was appropriately treated and remains disease free.

Validation study of a scale of life quality evaluation in a group of pediatric patients infected by HIV.

With the advent of potent antiretroviral therapy and the increase in life expectancy of pediatric patients infected with HIV, the quest for the promotion of enhanced quality of life should currently be the main focus in care of children with HIV/Aids. The scope of this study was to validate the Scale of Children's Quality of Life in a group of children infected with HIV receiving clinical care in Aids Service Units in Rio de Janeiro, Brazil. This scale consists of 26 questions and was tested on 100 children, with ages varying between 4 and 12, and their respective parents or guardians. Statistical analysis was conducted using canonical correlation and confidence interval analysis and the X² test. The results showed that the cut-off point obtained was 49; the internal consistency with Cronbach's alpha was 0.73 for the children and 0.67 for parents or guardians. The response profile revealed marked satisfaction with aspects such as vacations and birthdays, though less satisfaction with items including hospitalization and playing alone. The conclusion was that the scale revealed satisfactory psychometric measurements, proving to be a reliable, consistent, valid and recommended instrument for measuring the quality of life of children infected with HIV.