Cervicogenic-Like Headache as the First Symptom of Acromegaly.

Headache is a frequent symptom in patients with acromegaly; however, it has never been described as a cervicogenic-like headache. This paper reports on an 18-year-old Brazilian man with a four-year history of unilateral headaches characterized as a sensation of tightness or pressure in the right nuchal region spreading across the forehead. An MRI of the brain revealed a pituitary tumor and a transsphenoidal surgical resection of the macroadenoma was performed. During follow-up, he reported a complete relief of headaches after one week of surgery, persisting for six months. This paper shows a cervicogenic-like headache as the first symptom of acromegaly and the improvement of symptoms after surgery.

A Simple, Ecofriendly, and Fast Method for Nitrate Quantification in Bottled Water Using Visible Spectrophotometry.

There are many works associating the presence of nitrate in water and the occurrence of cancer in humans. The most common method for quantifying nitrate in water is based on the use of toxic cadmium as a reductant. In this work, a new approach was developed for the quantification of nitrate in bottled water with indirect spectrophotometry using Zn0 as a reductant. Nitrate is reduced to nitrite using Zn0 in a buffered medium (acetate/acetic acid) and quantified with visible spectrophotometry using the Griess reaction between sulfanilamide and N-(1-naphthyl)-ethylenediamine. The influence of pH, buffer solution (constitution and concentration), Zn0 (mass and granulometry), and agitation time on the efficiency of nitrite generation was evaluated. The optimal conditions were an acetate-acetic acid buffer solution with a concentration and pH of 0.75 mol L-1 and 6.00, respectively, and a Zn0 particle size of 20 MESH and Zn0 mass of 300 mg. The limits of detection and quantification (LoD and LoQ) were 0.024 and 0.08 mg L-1, respectively. The method's accuracy and precision were evaluated using the analysis of commercial bottled water. In conclusion, the use of Zn0 instead of cadmium provided a green method with excellent LoD/LoQ. Further, the method proved to be simple and easy to apply during outdoor analysis.

Prevalence of temporomandibular disorders in the Brazilian population: A systematic review and meta-analysis.

This systematic review aimed to assess the prevalence of temporomandibular disorders (TMD) in the Brazilian population, with studies that used the RDC/TMD or DC/TMD as diagnostic tools. A total of 6365 people from 11 studies were included. Sample mean age ranged from 12 to 69.5 years. The pooled prevalence of TMD was 33.6% (95% CI 31.5-35.8; I2 = 37.2). Prevalence of TMD was higher in females (37.0%) than in males (29.3%). Our results indicate that TMD is a prevalent condition across Brazil's territories. The results from this meta-analysis can help calculate more accurate sample sizes for future studies.

Mesh repair versus non-mesh repair for incarcerated and strangulated groin hernia: an updated systematic review and meta-analysis.

BACKGROUND: Mesh repair in incarcerated or strangulated groin hernia is controversial, especially when bowel resection is required. We aimed to perform a meta-analysis comparing mesh and non-mesh repair in patients undergoing emergency groin hernia repair. METHODS: We performed a literature search of databases to identify studies comparing mesh and primary suture repair of patients with incarcerated or strangulated inguinal or femoral hernias who underwent emergency surgery. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. RESULTS: 1095 studies were screened and 101 were thoroughly reviewed. Twenty observational studies and four randomized controlled trials comprising 12,402 patients were included. We found that mesh-based repair had reduced recurrence (OR 0.36; 95% CI 0.19, 0.67; P = 0.001; I2 = 35%), length of hospital stay (OR - 1.02; 95% CI - 1.87, - 0.17; P = 0.02; I2 = 94%) and operative time (OR - 9.21; 95% CI - 16.82, - 1.61; P = 0.02; I2 = 95%) without increasing surgical site infection, mortality or postoperative complications such as seroma, chronic, ileus or urinary retention. In the subgroup analysis of patients that underwent bowel resection, we found that mesh repair was associated with an increased risk of surgical site infection (OR 1.74; 95% CI 1.04, 2.91; P = 0.04; I2 = 9%). CONCLUSIONS: Mesh repair for incarcerated and strangulated groin hernias reduces recurrence without an increase in postoperative complications and should be considered in clean cases. However, in the setting of bowel resection, mesh repair might increase the incidence of surgical site infection.

The effect of propolis extract on milk production and composition, serum biochemistry, and physiological parameters of heat-stressed dairy cows.

The aim of this study was to evaluate whether feeding propolis extract (PE) influences nutrient intake, milk production and composition, serum biochemistry, and physiological parameters of heat-stressed dairy cows. For this purpose, we used three primiparous Holstein cows with a lactation period of 94 ± 4 days and with 485 ± 13 kg body weight. The treatments were 0 mL/day, 32 mL/day, and 64 mL/day of PE randomly assigned in a 3x3 Latin square design, repeated over time. The experiment lasted a total of 102 days; each Latin square lasted 51 days divided into three 17-day periods (12 days for adaptation and five days for data collection). The PE supply did not influence (P > 0.05) the cows' intake of dry matter (18.96 kg/d), crude protein (2.83 kg/d), and neutral detergent-insoluble fiber (7.36 kg/d), but there was an increase in feeding time with the 64 ml/day PE supply (P < 0.05). Providing 64 ml/day of PE tended (P = 0.06) to increase milk production by 11.64% and improve gross feed efficiency of cows by 12.04%. The PE supply did not influence milk composition and blood parameters of cows (P > 0.05). Offering 32 mL/day of PE decreased (P < 0.05) the rectal temperature and respiratory rate of cows. We recommend a supply of 64 mL/day of PE for heat-stressed dairy cows.

Preoperative Optimization Before Ventral Hernia Repair: A Systematic Review and Meta-analysis.

BACKGROUND: Obesity is associated with an increased risk of ventral hernia development and recurrence rates after ventral hernia repair (VHR). The metabolic derangements caused by obesity can also lead to many postoperative complications. Therefore, it is a common practice to attempt weight loss before VHR. However, there is still no consensus on optimal preoperative management for obese patients with a ventral hernia. This study aims to perform a meta-analysis to evaluate the effect of preoperative weight optimization on VHR outcomes. METHODS: We performed a literature search of PubMed, Scopus, and Cochrane Library databases to identify studies comparing obese patients who underwent surgical or non-surgical weight loss interventions before undergoing hernia repair surgery to obese patients who underwent hernia repair surgery without prehabilitation. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I 2 statistics. RESULTS: One thousand six hundred nine studies were screened and 13 were thoroughly reviewed. Five studies comprising 465 patients undergoing hernia repair surgery were included. No differences in hernia recurrence [odds ratio (OR) 0.66; 95% CI 0.23-1.89; P =0.44; I 2 =20%], seroma (OR 0.70; 95% CI 0.25-1.95; P =0.50; I 2 =5%), hematoma (OR 2.00; 95% CI 0.5-7.94; P =0.45; I 2 =0%), surgical site infection (OR 1.96; 95% CI 0.52-7.40; P =0.32; I 2 =0%), and overall complication (OR 0.80; 95% CI 0.37-1.74; P =0.58; I 2 =40%) rates were noted when comparing patients who underwent a preoperative weight loss intervention (prehabilitation or bariatric surgery) versus those who did not. In the subgroup analysis of patients who underwent bariatric surgery, we found no difference in hernia recurrence (OR 0.64; 95% CI 0.12-3.33; P = 0.59; I 2 =41%) or overall complications (OR 1.14; 95% CI 0.36-3.64; P =0.82; I 2 =64%). In the subgroup analysis of patients who lost weight versus patients who did not, there was no significant difference in overall complication rates (OR 0.86; 95% CI 0.34-2.21; P =0.76; I 2 =55%). CONCLUSIONS: We found similar hernia recurrence, seroma, hematoma, and surgical site infection rates in patients who underwent preoperative optimization. These findings underline the need for prospective studies to define the optimal role of preoperative optimization and weight loss in obese patients undergoing ventral hernia repair.

Physical and chemical characteristics of meat from lambs fed sorghum silage with cashew bagasse.

This study was conducted to evaluate the effects of replacing forage sorghum for dehydrated cashew bagasse (DCB) in the proportions of 0; 8; 16 and 24%, based on the natural matter at the time of ensiling on the physicochemical parameters of meat from feedlot lambs. None of the physical parameters evaluated showed a significant difference between the substitution levels of sorghum forage for DCB. The final pH obtained in this study showed a value above the recommended for freshly slaughtered meat from animals 24 hours in refrigeration, being considered DFD meat (dark, firm and dry). Regarding the chemical parameters, it was observed that there were no significant differences between the levels of substitution of sorghum forage for DCB to variable moisture and ash was perceived negative linear effect for protein and quadratic effect on lipid levels meat. The replacement of forage sorghum up to 24% of dehydrated bagasse cashew the ensilage does not compromise the quality of the meat, however, the substitution of 8% is to be preferred because it provides meats with lower lipid content.

Poly(3-hydroxi-butyrate-co-3-hydroxy-valerate) (PHB-HV) microparticles loaded with holmium acetylacetonate as potential contrast agents for magnetic resonance images.

INTRODUCTION: Biodegradable polymers that contain radioactive isotopes such as Holmium 166 have potential applications as beta particle emitters in tumor tissues. Also, Ho(III) is paramagnetic, which makes it suitable as a contrast agent for magnetic resonance (MR) images. METHODS: Holmium acetylacetonate (Ho(acac)3) loaded poly(3-hydroxy-butyrate-co-3-hydroxy-valerate) microspheres, with 5% or 8% of 3-hydroxy-valerate (HV), were prepared by emulsification/evaporation process within 20-53 µm size. Microspheres characterization was done using scanning electron microscopy, energy-dispersive X-ray, and infrared spectroscopies. The release of holmium(III) in sodium phosphate buffer (pH 7.4) was followed for 9 days with inductively coupled plasma. Finally, T2 and T2* magnetic resonance images (MRI) were acquired and compared with the MRI of the inclusion complex of holmium acetylacetonate in some ß-cyclodextrins. RESULTS: Holmium acetylacetonate loading, evaluated by thermogravimetry, was up to 20 times higher for copolymer with 5% of HV. It was shown that microspheres loaded with Ho(acac)3 exhibited an accumulation of Ho(III) on their surfaces but were stable over time, as no expressive release of holmium(III) was detected in 9-day exposition to sodium phosphate buffer. Holmium acetylacetonate in both microspheres or inclusion complexes was very efficient in obtaining T2 and T2* weighted images in magnetic resonance, thus, might be used as contrast agents. CONCLUSION: This is the first description of the use of inclusion complexes of holmium acetylacetonate in biodegradable polymers as contrast agents. New investigations are underway to evaluate the resistance of PHB-HV polymer microparticles to nuclear activation to assess their potential for use as radiopharmaceuticals for the treatment of liver cancer.

Resistance training improves cardiovascular autonomic control and biochemical profile of rats exposed to Western diet in the perinatal period. / Treinamento resistido melhora controle autonômico cardiovascular e perfil bioquímico de ratos expostos a dieta ocidental no período perinatal.

INTRODUCTION AND OBJECTIVES: Consumption of a Western diet during the perinatal period is associated with development of cardiovascular disease. Resistance training (RT) has been used to treat cardiovascular disorders. The aim of this work was to assess the effect of RT on cardiometabolic disorders in rats exposed to a Western diet in the perinatal period. METHODS: Female Wistar rats were fed with control or Western diet during pregnancy and lactation. The pups were divided into three groups: Control (C), Western Diet Sedentary (WDS) and Western Diet + RT (WDRT). At 60 days of age, all animals started the RT protocol (five times a week for four weeks). At the end, blood pressure was recorded for analysis of heart rate variability and baroreflex sensitivity (BRS). Blood samples were collected for biochemical analysis. RESULTS: RT reduced blood pressure and vascular sympathetic modulation and increased BRS. There were improvements in biochemical profile, with reductions in fasting blood glucose, total cholesterol and low-density lipoprotein, and an increase in high-density lipoprotein. CONCLUSION: RT led to beneficial adaptations in the cardiovascular system, mediated by changes in the mechanisms of autonomic control and biochemical profile of animals exposed to a Western diet in the perinatal period.

Development and characterisation of polymeric microparticle of poly(d,l-lactic acid) loaded with holmium acetylacetonate.

Biodegradable polymers containing radioactive isotopes such as Holmium 166 (166Ho) have potential applications as beta particle emitters in tumour tissues. It is also a gamma ray emitter, allowing nuclear imaging of any tissue to be acquired. It is frequently used in the form of complexes such as holmium acetylacetonate (HoAcAc), which may cause damages in tissues next to the targets cancer cells, as it is difficult to control its linkage or healthy tissues radiotherapy effects. Poly(d,l-lactic acid), PDLLA, was used to encapsulate holmium acetylacetonate (HoAcAc) using an emulsion solvent extraction/evaporation technique. Microspheres with sizes between 20-53 µm were extensively characterised. HoAcAc release from the microspheres was assessed through studies using Inductively Coupled Plasma - Optical Emission Spectroscopy, and the microspheres showed no holmium leakage after a period of 10 half-lives and following gamma irradiation. Thus, HoAcAc loaded microspheres are here presented as a potential system for brachytherapy and imaging purposes.

Exercise leads to unfavourable cardiac remodelling and enhanced metabolic homeostasis in obese mice with cardiac and skeletal muscle autophagy deficiency.

Autophagy is stimulated by exercise in several tissues; yet the role of skeletal and cardiac muscle-specific autophagy on the benefits of exercise training remains incompletely understood. Here, we determined the metabolic impact of exercise training in obese mice with cardiac and skeletal muscle disruption of the Autophagy related 7 gene (Atg7h&mKO). Muscle autophagy deficiency did not affect glucose clearance and exercise capacity in lean adult mice. High-fat diet in sedentary mice led to endoplasmic reticulum stress and aberrant mitochondrial protein expression in autophagy-deficient skeletal and cardiac muscles. Endurance exercise training partially reversed these abnormalities in skeletal muscle, but aggravated those in the heart also causing cardiac fibrosis, foetal gene reprogramming, and impaired mitochondrial biogenesis. Interestingly, exercise-trained Atg7h&mKO mice were better protected against obesity and insulin resistance with increased circulating fibroblast growth factor 21 (FGF21), elevated Fgf21 mRNA and protein solely in the heart, and upregulation of FGF21-target genes involved in thermogenesis and fatty acid oxidation in brown fat. These results indicate that autophagy is essential for the protective effects of exercise in the heart. However, the atypical remodelling elicited by exercise in the autophagy deficient cardiac muscle enhances whole-body metabolism, at least partially, via a heart-brown fat cross-talk involving FGF21.

Ovarian Hormone Deprivation Reduces Oxytocin Expression in Paraventricular Nucleus Preautonomic Neurons and Correlates with Baroreflex Impairment in Rats.

The prevalence of cardiovascular diseases including hypertension increases dramatically in women after menopause, however the mechanisms involved remain incompletely understood. Oxytocinergic (OTergic) neurons are largely present within the paraventricular nucleus of the hypothalamus (PVN). Several studies have shown that OTergic drive from PVN to brainstem increases baroreflex sensitivity and improves autonomic control of the circulation. Since preautonomic PVN neurons express different types of estrogen receptors, we hypothesize that ovarian hormone deprivation causes baroreflex impairment, autonomic imbalance and hypertension by negatively impacting OTergic drive and oxytocin levels in pre-autonomic neurons. Here, we assessed oxytocin gene and protein expression (qPCR and immunohistochemistry) within PVN subnuclei in sham-operated and ovariectomized Wistar rats. Conscious hemodynamic recordings were used to assess resting blood pressure and heart rate and the autonomic modulation of heart and vessels was estimated by power spectral analysis. We observed that the ovarian hormone deprivation in ovariectomized rats decreased baroreflex sensitivity, increased sympathetic and reduced vagal outflows to the heart and augmented the resting blood pressure. Of note, ovariectomized rats had reduced PVN oxytocin mRNA and protein expression in all pre-autonomic PVN subnuclei. Furthermore, reduced PVN oxytocin protein levels were positively correlated with decreased baroreflex sensitivity and negatively correlated with increased LF/HF ratio. These findings suggest that reduced oxytocin expression in OTergic neurons of the PVN contributes to the baroreflex dysfunction and autonomic dysregulation observed with ovarian hormone deprivation.

Increased Nitric Oxide Bioavailability and Decreased Sympathetic Modulation Are Involved in Vascular Adjustments Induced by Low-Intensity Resistance Training.

Resistance training is one of the most common kind of exercise used nowadays. Long-term high-intensity resistance training are associated with deleterious effects on vascular adjustments. On the other hand, is unclear whether low-intensity resistance training (LI-RT) is able to induce systemic changes in vascular tone. Thus, we aimed to evaluate the effects of chronic LI-RT on endothelial nitric oxide (NO) bioavailability of mesenteric artery and cardiovascular autonomic modulation in healthy rats. Wistar animals were divided into two groups: exercised (Ex) and sedentary (SED) rats submitted to the resistance (40% of 1RM) or fictitious training for 8 weeks, respectively. After LI-RT, hemodynamic measurements and cardiovascular autonomic modulation by spectral analysis were evaluated. Vascular reactivity, NO production and protein expression of endothelial and neuronal nitric oxide synthase isoforms (eNOS and nNOS, respectively) were evaluated in mesenteric artery. In addition, cardiac superoxide anion production and ventricle morphological changes were also assessed. In vivo measurements revealed a reduction in mean arterial pressure and heart rate after 8 weeks of LI-RT. In vitro studies showed an increased acetylcholine (ACh)-induced vasorelaxation and greater NOS dependence in Ex than SED rats. Hence, decreased phenylephrine-induced vasoconstriction was found in Ex rats. Accordingly, LI-RT increased the NO bioavailability under basal and ACh stimulation conditions, associated with upregulation of eNOS and nNOS protein expression in mesenteric artery. Regarding autonomic control, LI-RT increased spontaneous baroreflex sensitivity, which was associated to reduction in both, cardiac and vascular sympathetic modulation. No changes in cardiac superoxide anion or left ventricle morphometric parameters after LI-RT were observed. In summary, these results suggest that RT promotes beneficial vascular adjustments favoring augmented endothelial NO bioavailability and reduction of sympathetic vascular modulation, without evidence of cardiac overload.

Obstructive sleep apnea and diabetes mellitus.

BACKGROUND: There is convincing evidence that obstructive sleep apnea (OSA) is highly associated with impaired glucose metabolism. OBJECTIVES: Analyze the prevalence of OSA in type 1 and type 2 diabetes mellitus (DM) patients. Evaluate the influence of OSA on glycemic control. METHODS: The adult patients with diabetes mellitus (DM) followed in the department of internal medicine were referred to our Sleep Unit. A home respiratory polygraphy was then performed on all patients with body mass index (BMI) <40 kg/m(2). The glycemic control was assessed by the value of glycated hemoglobin (Hba1c) in the previous 3 months. RESULTS: A total of 46 patients were studied (20 men and 26 women), the mean age was 50±15 years and mean BMI was 28.6±4.9 kg/m(2). The mean Hba1c was 8.3±1.2. Twenty three patients had type 2 DM and 23 patients had type 1 DM. Twenty nine patients (63.0%) had OSA and 8.7% had severe OSA (AHI>30/h). The mean CT90 was 5.3±12.5 and the mean AHI was 13.6±18.3. The mean AHI was similar between type 1 and type 2 DM (15.7±24.5 Vs 11.6±8.9; p=0.46). The AHI was not correlated with the BMI. Type 2 DM patients with poor glycemic control (HbA1c>7.5%) had a significantly higher mean AHI (14.3±9.0 vs 6.4±6.2; p=0.038). This difference did not remain significant after adjustment for BMI (p=0.151). CONCLUSIONS: The prevalence of OSA in type 1 DM is similar to that found in type 2 DM. We note the high prevalence of OSA in younger patients with type 1 DM.

Tracing tree nut allergens in chocolate: A comparison of DNA extraction protocols.

The present work aimed at comparing different DNA extraction methods, from chocolate matrices, for the effective application in molecular techniques to detect tree nut allergens. For this study, DNA from almond or hazelnut model chocolates was extracted using seven selected protocols: the in-house methods of CTAB-PVP (cetyltrimethylammonium bromide-polyvinylpyrrolidone), Wizard with and without RNase, Wizard-PVP with and without RNase, and the Wizard Magnetic and Nucleospin kits. The extracts were assessed for their suitability for amplification by qualitative PCR and real-time PCR. From the evaluated protocols, Nucleospin presented the best results for almond and hazelnut amplification, achieving a limit of detection of 0.005% (w/w) with high PCR efficiency, linearity and range of amplification. These results highlight the importance of the DNA extraction protocol in the case of food allergens from complex matrices, such as chocolate, in which sensitivity is a key parameter.

ACOMPANHAMENTO TERAPÊUTICO: A PERCEPÇÃO DA FAMÍLIA / THERAPEUTIC MONITORING: THE PERCEPTION OF THE FAMILY

Este estudo, configurado em um modelo de relato de experiência, tem como objetivo investigar a percepção da família acerca das práticas de Acompanhamento Terapêutico (AT), através de uma abordagem qualitativa, que possibilitou a discussão dos aspectos relevantes dentro das categorias construídas. Verificou-se, ao longo da análise das informações obtidas, que a prática do AT tem beneficiado famílias e sujeitos em sofrimento psíquico, portanto, sendo este um estudo valoroso e que deve ser ampliado a fim de contemplar outros estratos populacionais.(AU)

This study, set in an experience report model, aims to investigate the perception of the family about the Therapeutic Monitoring practices, through a qualitative approach that allowed the discussion of the relevant aspects within the constructed categories. It was found, along the data analysis and results, that the practice of Therapeutic Monitoring has benefited families and individuals in psychological distress, therefore, which is a valuable study and should be expanded to include other sections of the population.(AU)

Induction of chronic non-inflammatory widespread pain increases cardiac sympathetic modulation in rats.

Fibromyalgia (FM) is characterized by chronic non-inflammatory widespread pain (CWP) and changes in sympathetic function. In attempt to elucidate the pathophysiological mechanisms of FM we used a well-established CWP animal model. We aimed to evaluate changes in cardiac autonomic balance and baroreflex function in response to CWP induction in rats. CWP was induced by two injections of acidic saline (pH 4.0, n=8) five days apart into the left gastrocnemius muscle. Control animals were injected twice with normal saline (pH 7.2, n=6). One day after the second injection of acidic saline or normal saline, the animals had pulse interval (PI) and systolic arterial pressure (SAP) variability, and spontaneous baroreflex sensitivity (BRS) evaluated. After induction of CWP, there was an increase of power in the low frequency (LF) band of PI spectrum (12.75 ± 1.04 nu), a decrease in the high frequency (HF) band (87.25 ± 1.04 nu) and an increase of LF/HF ratio (0.16 ± 0.01), when compared to control animals (7.83 ± 1.13 nu LF; 92.16 ± 1.13 nu HF; 0.08 ± 0.01 LF/HF). In addition, there was an increase of power in the LF band of SAP spectrum (7.93 ± 1.39 mmHg(2)) when compared to control animals (2.97 ± 0.61 mmHg(2)). BRS was lower in acidic saline injected rats (0.59 ± 0.06 ms/mmHg) when compared to control animals (0.71 ± 0.03 ms/mmHg). Our results showed that induction of CWP in rats shifts cardiac sympathovagal balance towards sympathetic predominance and decreases BRS. These data corroborate findings in humans with FM.

Identification of hare meat by a species-specific marker of mitochondrial origin.

Meat species identification in food has gained increasing interest in recent years due to public health, economic and legal concerns. Following the consumer trend towards high quality products, game meat has earned much attention. The aim of the present work was to develop a DNA-based technique able to identify hare meat. Mitochondrial cytochrome b gene was used to design species-specific primers for hare detection. The new primers proved to be highly specific to Lepus species, allowing the detection of 0.01% of hare meat in pork meat by polymerase chain reaction (PCR). A real-time PCR assay with the new intercalating EvaGreen dye was further proposed as a specific and fast tool for hare identification with increased sensitivity (1pg) compared to end-point PCR (10pg). It can be concluded that the proposed new primers can be used by both species-specific end-point PCR or real-time PCR to accurately authenticate hare meat.

Resultados maternos e perinatais de dez anos de assistência obstétrica a portadoras do vírus da imunodeficiência humana / Maternal and perinatal results in ten years of obstetrical care to human immunodeficiency virus-infected women

Objetivos: avaliar a transmissão vertical do vírus da imunodeficiência humana (HIV) e os fatores de risco associados à infecção perinatal. Métodos: estudo descritivo de 170 gestantes infectadas pelo HIV e seus 188 recém-nascidos, admitidas na Maternidade do Hospital das Clínicas da UFMG, no período de junho de 1994 a setembro de 2004. Foram analisados as características demográficas, o perfil sorológico e a via de parto das gestantes, assim como os resultados perinatais. As crianças foram acompanhadas por período de 18 meses após o nascimento. Os dados foram armazenados e analisados no Epi-Info, Versão 6.0. Estabeleceu-se intervalo de confiança a 95% (p<0,05). Resultados: o diagnóstico da infecção pelo HIV foi confirmado durante a gestação em 84 (45,4%) pacientes. A carga viral era inferior a 1000 cópias/mL em 60,4% das pacientes. O esquema predominante de uso dos anti-retrovirais foi a terapia tríplice (65,5 % ). Foi alta a taxa de cesariana: 79,5 %. A taxa de prematuridade foi 18,2%. Entre os 188 recém-natos houve 184 (97,8%) nativivos e quatro (2,2%) mortes perinatais. Dos nascidos vivos, 97,8% receberam zidovudina após o nascimento. A taxa global de transmissão matemo-fetal global foi 3,8%. As taxas de transmissão vertical do vírus, por período, foram: 60%, até 1996; 28%, entre 1996e 1998; 0,68%, entre 1999 e 2004. Não foram encontrados fatores de risco significativamente associados à infecção perinatal pelo HIV, devido ao pequeno número de recém-nascidos infectados (n=6). Conclusão: houve grande redução da transmissão vertical do HIV no período analisado. A taxa atual de transmissão é zero, confirmando que, adotando-se medidas adequadas, pode-se prevenir a transmissão perinatal do vírus.

Trombastenia de Glanzmann e gravidez: relato de caso / Glanzmann's thrombasthenia and pregnancy: a case report

Os autores relatam um caso extremamente raro de paciente com diagnóstico de Trombastenia de Glanzmann, prévio a gravidez. Paciente de 25 anos, branca, primigesta, proveniente de Divinópolis, Minas Gerais, foi acompanhada durante o período pré-natal, parto e puerpério no Serviço de Assistência à Gestaçäo Alto Risco do Hospital das Clínicas da UFMG. O período pré-natal transcorreu sem complicaçöes. A mesma teve o parto espontâneo. No pós parto imediato desenvolveu grande hematoma no local da episotomia com resoluçäo espontânea em duas semanas sob tratamento clínico. A gestaçäo aumenta o risco de sangramento maciço no parto e a transfusäo de plaquetas pode ser ineficaz em alguns casos