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Campos MAG, Sousa PDS, Cavalcante TB, Takahasi EHM, Costa LC, Ribeiro MRC, Costa EDPF, Amaral GA, Vissoci JRN, Silva AAMD. Continuous epileptiform discharges are associated with worse neurodevelopmental findings in a congenital Zika syndrome prospective cohort. Seizure 2024; 118:148-155. [PMID: 38704883 DOI: 10.1016/j.seizure.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
PURPOSE This study aimed to identify continuous epileptiform discharges (CEDs) on electroencephalograms (EEG) and to determine their clinical significance in children with congenital Zika syndrome (CZS). METHODS This prospective cohort study included 75 children diagnosed with CZS born from March 2015 and followed up until September 2018 (age up to 36 months). EEG was performed to detect CEDs up to 24 months old. Data on obstetric, demographic, and clinical signs; cranial computed tomography (CT); ophthalmology examination; anti-seizure medication; growth; and motor development were collected. Fisher's exact test was used to verify the associations between categorical variables, and the T- test was used to compare the mean z-scores of anthropometric measurements between the groups with and without CED. RESULTS CEDs were identified in 41 (54.67 %) children. The mean age of CEDs identification was 12.24 ± 6.86 months. Bilateral CEDs were shown in 62.89 % of EEGs. CEDs were associated with severe congenital microcephaly, defined by z-score >3 standard deviation of head circumference (HC) below the mean for sex and age (p = 0.025), and worse outcomes, including first seizure before 6 months (p = 0.004), drug-resistant epilepsy (p < 0.001), chorioretinal scarring or mottling (p = 0.002), and severe CT findings (p = 0.002). The CED group had lower mean z-scores of HC up to 24 months of age. CONCLUSION This is the first description of the prevalence and significance of CEDs that also remains during wakefulness in patients with CZS. New investigations may suggest that it is more appropriate to classify the EEG not as a CED, but as a periodic pattern. Anyway, CEDs may be a marker of neurological severity in children with CSZ.
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Affiliation(s)
- Marcos Adriano Garcia Campos
- Clinical Hospital of Botucatu Medical School of São Paulo State University, Professor Mário Rubens Guimarães Montenegro Avenue, Botucatu, São Paulo 18618-687, Brazil.
| | - Patrícia da Silva Sousa
- Department of Medicine of Federal University of Maranhão, Gonçalves Dias Square, São Luís, Maranhão 65020-240, Brazil; Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children/NINAR of Health Secretariat of the State of Maranhão, Borborema Avenue, São Luís, Maranhão 65071-360, Brazil
| | - Tamires Barradas Cavalcante
- Department of Public Health, Programa de Pós-Graduação em Saúde Coletiva, Federal University of Maranhão, Barão de Itapary Street, São Luís, Maranhão 65020-070, Brazil
| | | | - Luciana Cavalcante Costa
- Department of Public Health, Programa de Pós-Graduação em Saúde Coletiva, Federal University of Maranhão, Barão de Itapary Street, São Luís, Maranhão 65020-070, Brazil
| | - Marizélia Rodrigues Costa Ribeiro
- Department of Medicine of Federal University of Maranhão, Gonçalves Dias Square, São Luís, Maranhão 65020-240, Brazil; Department of Public Health, Programa de Pós-Graduação em Saúde Coletiva, Federal University of Maranhão, Barão de Itapary Street, São Luís, Maranhão 65020-070, Brazil
| | - Elaine de Paula Fiod Costa
- Department of Medicine of Federal University of Maranhão, Gonçalves Dias Square, São Luís, Maranhão 65020-240, Brazil
| | - Gláucio Andrade Amaral
- Sarah Network of Neurorehabilitation Hospitals, Governador Luís Rocha Avenue, São Luís, Maranhão 65035-270, Brazil
| | | | - Antônio Augusto Moura da Silva
- Department of Public Health, Programa de Pós-Graduação em Saúde Coletiva, Federal University of Maranhão, Barão de Itapary Street, São Luís, Maranhão 65020-070, Brazil
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Takahasi EHM, Alves MTSSDBE, Ribeiro MRC, Santos AMD, Campos MAG, Simões VMF, Amaral GA, Sousa PDS, Miranda-Filho DDB, Silva AAMD. Decline in head circumference growth and associated factors in congenital Zika syndrome. CAD SAUDE PUBLICA 2022; 38:e00296021. [DOI: 10.1590/0102-311xen296021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
Little is known about the evolution of head circumference (HC) in children with congenital Zika syndrome (CZS). This study aims to evaluate HC growth in children with CZS in the first three years of life and identify associated factors. HC data obtained at birth and in neuropediatric consultations from 74 children with CZS were collected from the Child’s Health Handbook, parents’ reports, and medical records. Predictors of HC z-score were investigated using different mixed-effects models; Akaike’s information criterion was used for model selection. The HC z-score decreased from -2.7 ± 1.6 at birth to -5.5 ± 2.2 at 3 months of age, remaining relatively stable thereafter. In the selected adjusted model, the presence of severe brain parenchymal atrophy and maternal symptoms of infection in the first trimester of pregnancy were associated with a more pronounced reduction in the HC z-score in the first three years of life. The decrease of HC z-score in CZS children over the first three months demonstrated a reduced potential for growth and development of the central nervous system of these children. The prognosis of head growth in the first 3 years of life is worse when maternal infection occurs in the first gestational trimester and in children who have severe brain parenchymal atrophy.
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Cavalcante TB, Ribeiro MRC, Sousa PDS, Costa EDPF, Alves MTSSDBE, Simões VMF, Batista RFL, Takahasi EHM, Amaral GA, Khouri R, Branco MDRFC, Mendes AKT, Costa LC, Campos MAG, Silva AAMD. Congenital Zika syndrome: Growth, clinical, and motor development outcomes up to 36 months of age and differences according to microcephaly at birth. Int J Infect Dis 2021; 105:399-408. [PMID: 33610784 DOI: 10.1016/j.ijid.2021.02.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Little is known regarding the developmental consequences of congenital Zika syndrome (CZS) without microcephaly at birth. Most previously published clinical series were descriptive and they had small sample sizes. STUDY DESIGN We conducted a cohort study to compare the growth, clinical, and motor development outcomes for 110 children with CZS born with and without microcephaly up to their third birthday. Ninety-three had their head circumference (HC) at birth abstracted and they did not have hypertensive hydrocephalus at birth, where 61 were born with microcephaly and 32 without. RESULTS The HC z-scores decreased steeply from birth to six months of age, i.e., from -3.77 to -6.39 among those with microcephaly at birth and from -1.03 to -3.84 among those without. Thus, at 6 months of age, the mean HC z-scores for children born without microcephaly were nearly the same as those for children born with microcephaly. Children born without microcephaly were less likely to have brain damage, ophthalmic abnormalities, and drug-resistant epilepsy, but the differences in many conditions were not statistically significant. CONCLUSIONS Children born without microcephaly were only slightly less likely to present severe neurologic impairment and to develop postnatal-onset microcephaly, and some of the original differences between the groups tended to dissipate with age.
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Affiliation(s)
| | | | - Patrícia da Silva Sousa
- Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children/NINAR - Health Secretariat of the State of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | | | - Eliana Harumi Morioka Takahasi
- Department of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil; Sarah Network of Neurorehabilitation Hospitals, São Luís, Maranhão, Brazil
| | | | - Ricardo Khouri
- Laboratory of Vector-Borne Infectious Diseases, Gonçalo Moniz Institute, Fiocruz-Bahia, and Department of Pathology and Legal Medicine, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
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Takahasi EHM, Alves MTSSDB, Ribeiro MRC, Souza VFP, Simões VMF, Borges MCR, Amaral GA, Gomes LN, Khouri R, da Silva Sousa P, Silva AAMD. Gross Motor Function in Children with Congenital Zika Syndrome. Neuropediatrics 2021; 52:34-43. [PMID: 33111304 DOI: 10.1055/s-0040-1718919] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little information on gross motor function of congenital Zika syndrome (CZS) children is available. OBJECTIVES To evaluate gross motor function in CZS children aged up to 3 years, and its associated factors and changes in a minimum interval of 6 months. METHODS One hundred children with CZS and cerebral palsy (36 with confirmed and 64 with presumed CZS) were evaluated with the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88/GMFM-66). Forty-six were reevaluated. Wilcoxon tests, Wilcoxon tests for paired samples, percentile scores, and score changes were performed. RESULTS Clinical and socioeconomic characteristics (except maternal age), GMFM scores and GMFCS classification of confirmed and probable cases, which were analyzed together, were similar. The mean age was 25.6 months (±5.5); the median GMFM-88 score was 8.0 (5.4-10.8); and the median GMFM-66 score was 20.5 (14.8-23.1); 89% were classified as GMFCS level V. Low economic class, microcephaly at birth, epilepsy, and brain parenchymal volume loss were associated with low GMFM-66 scores. The median GMFM-66 percentile score was 40 (20-55). On the second assessment, the GMFM-66 scores in two GMFCS level I children and one GMFCS level IV child improved significantly. In one GMFCS level III child, one GMFCS level IV child, and the group of GMFCS level V children, no significant changes were observed. CONCLUSIONS Almost all CZS children had severe cerebral palsy; in the third year of life, most presented no improvement in gross motor function and were likely approaching their maximal gross motor function potential.
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Affiliation(s)
- Eliana Harumi Morioka Takahasi
- Sarah Network of Neurorehabilitation Hospitals, São Luís, Maranhão, Brazil.,Public Health Department, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | - Valéria Ferreira Pereira Souza
- Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children - NINAR, State Department of Health of the State of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | - Lillian Nunes Gomes
- Laboratory of Immunology Human, Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Ricardo Khouri
- Laboratory of Vector-Borne Infectious Diseases, Gonçalo Moniz Institute, Salvador, Bahia, Brazil.,Department of Pathology and Legal Medicine, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Patricia da Silva Sousa
- Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children - NINAR, State Department of Health of the State of Maranhão, São Luís, Maranhão, Brazil
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Mendes AKT, Ribeiro MRC, Lamy-Filho F, Amaral GA, Borges MCR, Costa LC, Cavalcante TB, Batista RFL, Sousa PDS, Silva AAMD. Congenital Zika syndrome: association between the gestational trimester of maternal infection, severity of brain computed tomography findings and microcephaly at birth. Rev Inst Med Trop Sao Paulo 2020; 62:e56. [PMID: 32844907 PMCID: PMC7447234 DOI: 10.1590/s1678-9946202062056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 12/25/2022] Open
Abstract
This study analyzed possible associations between the trimester of maternal Zika virus infection (ZIKV) in pregnancy, severity of brain computed tomography (CT) findings and the presence of microcephaly at birth in children with Congenital Zika Syndrome (CZS). It was an analytical study in a cohort of children with CZS. Symptoms of maternal infection were dichotomized into the 1st trimester of pregnancy and other trimesters. Head circumference (HC) at birth was used to calculate the z-score. Mild microcephaly was defined as HC between 2 and ≥3 standard deviations (SD) below the mean for each gestational age and sex, and severe microcephaly when HC <3 SD below average. Brain CT images were evaluated by two radiologists and classified, according to the severity, into mild, moderate and severe. Fisher’s exact, Mann-Whitney and Kruskal-Wallis tests were used to verify the associations between variables. In 108 children, maternal infection in the 1st trimester of pregnancy was associated with more severe brain CT abnormalities (p=0.038), greater severity of microcephaly at birth (p=0.013) and lower HC z-scores at birth (p=0.021). The severity of brain CT lesions was also associated with lower HC z-scores at birth (p<0.001). Maternal ZIKV infection during the first trimester of pregnancy proved to be an important risk factor for a more severe spectrum of CZS, as it is associated with more severe brain CT abnormalities and, consequently, with lower HC z-scores at birth.
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Affiliation(s)
| | | | - Fernando Lamy-Filho
- Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | | | | | - Patrícia da Silva Sousa
- Centro de Referência em Neurodesenvolvimento, Assistência e Reabilitação de Crianças, Secretaria de Saúde do Estado do Maranhão, São Luís, Maranhão, Brazil
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Rubio-Lago L, Amaral GA, Arregui A, González-Vázquez J, Bañares L. Imaging the molecular channel in acetaldehyde photodissociation: roaming and transition state mechanisms. Phys Chem Chem Phys 2012; 14:6067-78. [PMID: 22450696 DOI: 10.1039/c2cp22231k] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The roaming dynamics in the photodissociation of acetaldehyde is studied through the first absorption band, in the wavelength interval ranging from 230 nm to 325 nm. Using a combination of the velocity-map imaging technique and rotational resonance enhanced multiphoton ionization (REMPI) spectroscopy of the CO fragment, the branching ratio between the canonical transition state and roaming dissociation mechanisms is obtained at each of the photolysis wavelengths studied. Upon one photon absorption, the molecule is excited to the first singlet excited S(1) state, which, depending on the excitation wavelength, either converts back to highly vibrationally excited ground S(0) state or undergoes intersystem crossing to the first excited triplet T(1) state, from where the molecule can dissociate over two main channels: the radical (CH(3) + HCO) and the molecular (CO + CH(4)) channels. Three dynamical regions are characterized: in the red edge of the absorption band, at excitation energies below the T(1) barrier, the ratio of the roaming dissociation channel increases, largely surpassing the transition state contribution. As the excitation wavelength is increased, the roaming propensity decreases reaching a minimum at wavelengths ∼308 nm. Towards the blue edge, at 230 nm, an upper limit of ∼50% has been estimated for the contribution of the roaming channel. The experimental results are interpreted in terms of the interaction between the different potential energy surfaces involved by means of ab initio stationary points and intrinsic reaction coordinate paths calculations.
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Affiliation(s)
- L Rubio-Lago
- Departamento de Química Física I, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Amaral GA, Ausfelder F, Izquierdo JG, Rubio-Lago L, Bañares L. Imaging the photodissociation of CH3SH in the first and second absorption bands: The CH3(X̃A12)+SH(XΠ2) channel. J Chem Phys 2007; 126:024301. [PMID: 17228948 DOI: 10.1063/1.2409925] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The CH3(X2A1)+SH(X2Pi) channel of the photodissociation of CH3SH has been investigated at several wavelengths in the first 1 1A"<--X 1A' and second 2 1A"<--X1A' absorption bands by means of velocity map imaging of the CH3 fragment. A fast highly anisotropic (beta=-1+/-0.1) CH3(X2A1) signal has been observed in the images at all the photolysis wavelengths studied, which is consistent with a direct dissociation process from an electronically excited state by cleavage of the C-S bond in the parent molecule. From the analysis of the CH3 images, vibrational populations of the SH(X2Pi) counterfragment have been extracted. In the second absorption band, the SH fragment is formed with an inverted vibrational distribution as a consequence of the forces acting in the crossing from the bound 2 1A" second excited state to the unbound 1 1A" first excited state. The internal energy of the SH radical increases as the photolysis wavelength decreases. In the case of photodissociation via the first excited state, the direct production of CH3 leaves the SH counterfragment with little internal excitation. Moreover, at the longer photolysis wavelengths corresponding to excitation to the 1 1A" state, a slower anisotropic CH3 channel has been observed (beta=-0.8+/-0.1) consistent with a two step photodissociation process, where the first step corresponds to the production of CH3S(X2E) radicals via cleavage of the S-H bond in CH3SH, followed by photodissociation of the nascent CH3S radicals yielding CH3(X2A1)+S(X3P0,1,2).
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Affiliation(s)
- G A Amaral
- Departamento de Quimica Fisica I, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Amaral GA, Aoiz FJ, Bañares L, Barr J, Herrero VJ, Martínez-Haya B, Menéndez M, Pino GA, Tanarro I, Torres I, Verdasco JE. Low-Temperature Rotational Relaxation of CO in Self-Collisions and in Collisions with Ne and He. J Phys Chem A 2005; 109:9402-13. [PMID: 16866388 DOI: 10.1021/jp051766u] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The low-temperature rotational relaxation of CO in self-collisions and in collisions with the rare-gas atoms Ne and He has been investigated in supersonic expansions with a combination of resonance-enhanced multiphoton ionization (REMPI) spectroscopy and time-of-flight techniques. For the REMPI detection of CO, a novel 2 + 1' scheme has been employed through the A(1)Pi state of CO. From the measured data, average cross sections for rotational relaxation have been derived as a function of temperature in the range 5-100 K. For CO-Ne and CO-He, the relaxation cross sections grow, respectively, from values of approximately 20 and 7 A(2) at 100 K to values of approximately 65-70 and approximately 20 A(2) in the 5-20 K temperature range. The cross section for the relaxation of CO-CO grows from a value close to 40 A(2) at 100 K to a maximum of 60 A(2) at 20 K and then decreases again to 40 A(2) at 5 K. These results are qualitatively similar to those obtained previously with the same technique for N(2)-N(2), N(2)-Ne, and N(2)-He collisions, although in the low-temperature range (T < 20 K) the CO relaxation cross sections are significantly larger than those for N(2). Some discrepancies have been found between the present relaxation cross sections for CO-CO and CO-He and the values derived from electron-induced fluorescence experiments.
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Affiliation(s)
- G A Amaral
- Departamento de Química Física, Facultad de Química, Universidad Complutense de Madrid, E-28040 Madrid, Spain
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Amaral SS, Teixeira MG, Brito SL, Amaral GA, Jorge JM, Habr-Gama A, Pinotti HW. [Prevalence of fecal incontinence in diabetic patients: epidemiological study of patients assisted as outpatients at the Clinical Hospital of the Medical School at the University of São Paulo]. Rev Hosp Clin Fac Med Sao Paulo 1997; 52:295-301. [PMID: 9629738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The object of this research was to establish the prevalence of fecal incontinence in those diabetics attended as outpatients at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Individual verbal interviewing was the an adopted method. The classification of diabetes mellitus of World Health Organization was employed (1985). Data was aggregated relative sex, age, color, type of diabetes mellitus, fecal incontinence, duration of diabetes mellitus, peripheral neuropathy, intestinal habits (normal, constipation and diarrhea), urgency to evacuate, sensation of incomplete evacuation, urinary incontinence, vaginal deliveries and its characteristics. The study involved 258 diabetics, 167 of female sex having an average age of 56.2 years (17 to 78 years of age) and 91 of the male sex having average age of 55.8 years (10 to 74 years of age). With relation to color, 57% were white, 28.7% mullato, 11.2% black and 3.1% yellow. Fecal incontinence was prevalent in 18.6% of the cases studied. It occurred also in types I and II diabetics with predominance in the male sex. It also occurred in diabetics having an average history of 10.8 years to onset of illness. Peripheral neuropathy was observed in 8.5% of the diabetics investigated however no association was observed between the peripheral neuropathy and fecal incontinence. Constipation occurred in 29.5% of the patients and diarrhea in 21.3%. Incomplete evacuation was apparent in 15.1% of diabetics and urgency to evacuate in 12.8%. A relationship was identified between fecal incontinence with diarrhea and incomplete evacuation in the group investigated. Total vaginal deliveries was 458 with 70 episiotomies and 25 by forceps. There was no statistical evidence of association between the average number of vaginal deliveries, episiotomies and forceps in diabetics demonstrating or not demonstrating fecal incontinence. Urinary incontinence was more prevalent that fecal incontinence. No relationship was determined between urinary and fecal incontinence for the purpose of the present study.
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Affiliation(s)
- S S Amaral
- Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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