Relationship Between Maternal Age and Macronutrient Content of Colostrum

BACKGROUND

Little is known about the relationship between maternal age and the macronutrient content of colostrum.

RESEARCH AIMS

This study aimed to evaluate the relationship between maternal age and human milk macronutrient content by comparing the concentrations of lactose, proteins, and lipids in the colostrum of women with younger, moderate, and advanced maternal age.

METHODS

An observational, cross-sectional study was designed to compare the macronutrient concentrations in the colostrum of women aged < 20 years, 20 to 34 years, and > 34 years (younger, moderate, and advanced maternal age, respectively; n = 33 per group). For each participant, 3 ml of colostrum was collected by manual extraction from the right breast at 10 am, 39-48 hr after delivery, and analyzed using a Miris Human Milk Analyzer. Macronutrient concentrations were compared between the groups using analysis of variance. P < 0.05 was considered significant.

RESULTS

Mothers with moderate maternal age had a higher colostrum lipid concentration than those with younger or advanced maternal age (2.3 mg, SD = 1.4 mg vs. 1.5 mg, SD = 1.0 mg vs. 1.6 mg, SD = 0.9 mg, respectively; p = 0.007). Lactose and protein contents in the analyzed samples did not differ among the three study groups.

CONCLUSION

This study lends support to the potential variation of lipids in colostrum by maternal age and suggests individual adaptation to the nutritional components of milk to the needs of the infant may be beneficial.

Clinical and serological findings in pregnant women and newborns: patterns of coronavirus disease 2019 placental histopathology

OBJECTIVE

The objective of this study was to evaluate the correlation between clinical and serological findings of pregnant women and newborns with patterns of histopathologic changes of the placenta diagnosed with coronavirus disease 2019.

METHODS

A prospective descriptive study was conducted with pregnant women who were positive for SARS-CoV-2 by reverse transcription polymerase chain reaction or serology (IgG and IgM). Clinical analyses were performed using ELISA to detect anti-SARS-CoV-2 IgG and IgA antibodies using the S1 spike protein domain with the Euroimmun kit. Histopathologic analyses of placentas were performed by two expert pathologists.

RESULTS

Maternal SARS-CoV-2 infection was associated with increased neonatal hospital length of stay (p=0.03), increased preterm birth (p=0.04), and Apgar score<7 at 1st min (p=0.00) and 5th min (p=0.02). Pregnant women with positive IgG and/or IgA at delivery had a higher incidence of placental histopathologic changes in addition to a greater likelihood of having an IgG-positive fetus (p<0.0001). Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion changes (p=0.00).

CONCLUSION

Maternal SARS-CoV-2 infection was associated with adverse perinatal outcomes. Pregnant women with positive IgG at delivery had a higher incidence of placental histopathologic changes. Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion.

Evaluation and monitoring of eye findings in children exposed to Zika virus during gestation: 3 years of follow-up

INTRODUCTION

Congenital Zika syndrome (CZS) is a recently described disease. Our main objective was to evaluate and monitor, over 3 years, the ophthalmoscopic findings in children exposed to zika virus (ZIKV) during gestation.

METHODS

This prospective observational study was conducted in Rio de Janeiro, Brazil, between April 2016 and May 2019. We evaluated two groups with exanthema serving as a proxy for viremia: (i) children whose mothers had exanthema during pregnancy and (ii) children who had microcephaly without maternal exanthema during pregnancy. We performed indirect ophthalmoscopy at recruitment and every 6 months thereafter. We also tested the association between ocular findings with maternal exanthema, microcephaly, CZS and maternal infection confirmed by reverse transcriptase quantitative polymerase chain reaction and gender.

RESULTS

Of the 72 children included, 16 (22.2%) had optic nerve and/or retinal lesions. All 16 had CZS and 15 (93.7%) had microcephaly (14 at birth and 1 postnatally). The child with postnatally acquired microcephaly was born to a mother without exanthema during pregnancy. Fifty-six (77.8%) of the 72 children were followed for a median time of 24 months and none exhibited differences between admission and follow-up examinations. After logistic regression, only microcephaly at birth was associated with eye abnormalities (odds ratio, 77.015; 95% confidence interval, 8.85-670.38; p < 0.001).

CONCLUSION

We observed that there was no progression of the lesions over the follow-up period. We also showed that the eye findings were associated only with microcephaly at birth. Attention should be paid to all children born during a ZIKV epidemic, regardless of maternal exanthema and/or microcephaly at birth.

Incidence of bradycardia during noradrenaline or phenylephrine bolus treatment of postspinal hypotension in cesarean delivery: A randomized double-blinded controlled trial

The treatment of choice for spinal anesthesia-induced hypotension during cesarean section is phenylephrine. As this vasopressor can cause reflex bradycardia, noradrenaline is a suggested alternative. This randomized double-blinded controlled trial included 76 parturients undergoing elective cesarean delivery under spinal anesthesia. Women received noradrenaline in bolus doses of 5 mcg or phenylephrine in bolus doses of 100 mcg. These drugs were used intermittently and therapeutically to maintain systolic blood pressure ≥ 90% of its baseline value. The primary study outcome was bradycardia incidence (<60 bpm) with intermittent bolus administration of these drugs. Secondary outcomes included extreme bradycardia (<40 bpm), number of bradycardia episodes, hypertension (systolic blood pressure > 120% of baseline value), and hypotension (systolic blood pressure < 90% of baseline value and requiring vasopressor use). Neonatal outcomes per the Apgar scale and umbilical cord blood gas analysis were also compared. The incidence of bradycardia in both groups (51.4% and 70.3%, respectively; p = 0.16) were not significantly different. No neonates had umbilical vein or artery pH values below 7.20. The noradrenaline group required more boluses than phenylephrine group (8 vs. 5; p = 0.01). There was no significant intergroup difference in any of the other secondary outcomes. When administered in intermittent bolus doses for the treatment of postspinal hypotension in elective cesarean delivery, noradrenaline, and phenylephrine have a similar incidence of bradycardia. When treating hypotension related to spinal anesthesia in obstetric cases, strong vasopressors are commonly administered, thought these can also have side effects. This trial assessed bradycardia after bolus administration of noradrenaline or phenylephrine, and found no difference in risk for clinically meaningful bradycardia.

Evaluation of the bioimpedance technique in newborns with a focus on electrode positioning: A prospective, randomized, crossover study

BACKGROUND

Bioelectrical impedance analysis (BIA) is a good alternative for assessing total body water in newborns. However, the lack of standardization of the method for its use in the neonatal population raises doubts about its reliability and external validation.

OBJECTIVE

To compare resistance (R) and reactance (Xc) values measured by BIA with electrodes placed in the anatomical position and with electrodes placed at 5-cm intervals.

METHOD

Prospective, randomized, crossover study, in which R and Xc values were measured using monofrequency BIA. The choice of the first position of the electrodes to be analyzed in each NB was performed by a simple randomization, and subsequent measurements were performed in rapid succession. The calculated sample size was 203 evaluations. The paired t test was used to compare the means of R and Xc, and the Bland-Altman plot and linear regression were used to analyze how much the measured values were influenced by the electrode position.

RESULTS

Significant differences were found in the R (855.25 ± 147.79 vs 618.95 ± 93.28 Ω) and Xc (50.94 ± 17.34 vs 39.76 ± 18.35 Ω) values measured with electrodes in the anatomical position and at 5-cm intervals, respectively. The electrodes in the anatomical position produced R and Xc values 37.7% and 16.6%, respectively, higher on average when compared with 5-cm intervals.

CONCLUSIONS

The distance between the electrodes influences the measurement of R and Xc by BIA. These results highlight the importance of defining a standard for the placement of electrodes in newborns for the use of these measures in neonatal clinical practice.

Dietary Intake of Flaxseed Oil since Early Stages of Life Promotes Femur Quality in Male Rats

BACKGROUND

Flaxseed oil (FO) is an alpha linolenic acid source important for growth and body development. However, there is little literature on the role of FO in critical stages of bone development and formation.

OBJECTIVE

This study evaluated the influence of a diet containing FO on rat femurs.

METHODS

After birth, mothers and pups were divided into control and flaxseed groups (n = 6 pups each) fed diets containing 7% soybean oil (C) or 7% FO. At 21 days, pups were weaned and separated from the mothers, and control or experimental diets were continued. At 67 days, the following were analyzed: osteocalcin and osteoprotegerin (OPG) levels, bone mineral density (BMD) and content, and bone area; the dimension, BMD, head radiodensity, and biomechanical proprieties of the right femur; and histomorphometric parameters of the left femur.

RESULTS

Compared to the C group, the FO group presented (p < 0.05) a lower body mass (-3.7%) and medullary area (-10.1%) and higher osteocalcin (+36.7%), OPG (+52.5%), femur width (+3.8%), absolute mass (+2.3%), femur BMD (+3.6%), head radiodensity (+6.1%), maximum force (+7.4%), breaking strength (+17.3), and cortical thickness (+7.0).

CONCLUSION

The FO diet contributed to femur quality in healthy male Wistar rats.

Vaginal collagen I and III changes after carbon dioxide laser application in postmenopausal women with the genitourinary syndrome: a pilot study

OBJECTIVE

The aim of the study was to evaluate the clinical response and collagen remodeling in the vaginal wall after three sessions of carbon dioxide (CO₂) laser application.

METHODS

Fourteen postmenopausal women with vulvovaginal atrophy, aged 45-65 years and sexually active, were evaluated with clinical questionnaires, gynecological examinations and histological techniques before and after 20 weeks of treatment (ClinicalTrials.gov NCT03939078). Treatment consisted of 3-monthly sessions of the CO₂ laser. Clinical questionnaires included the Vaginal Health Index, the Female Sexual Function Index and the International Consultation on Incontinence Questionnaires Short Form. Biopsies were taken from the lateral vaginal wall at week 0 (left wall) and week 20 (right wall). Tissue samples were stained with hematoxylin and eosin, Periodic Acid-Schiff, Picrosirius Red Stain and Orcein dyes. Immunohistochemical study was used to quantify collagens I and III in the samples.

RESULTS

The mean age was 54.4 ± 4.5 years, and the average time of amenorrhea was 7.6 ± 5.1 years. The Female Sexual Function Index and the Vaginal Health Index Score values increased while the International Consultation on Incontinence Questionnaire Short Form score decreased after the programmed treatment. There was no significant change in vaginal pH. Histological studies showed increases in the total and superficial epithelial cell layers, and type III collagen fibers (from 10.86 ± 7.66 to 16.87 ± 3.96, p < 0.05), and immunohistochemical studies confirmed the significant increase in collagen III.

CONCLUSION

Histological findings revealed epithelial atrophy reversal and collagen remodeling of the vaginal wall. Immunohistochemical analysis showed an increase in collagen type III fibers.

Educating diabetic patients through an SMS intervention: a randomized controlled trial at a Brazilian public hospital

Objective

Diabetes mellitus (DM) has a high healthcare system cost worldwide. Educational strategies are important to improve self-care and control this disease. This study aimed to evaluate satisfaction and clinical efficacy of a Short Message Service (SMS) educational intervention in self-care and nutrition at a Brazilian university hospital.

Methods

We conducted a trial of educational intervention and assigned eligible patients with DM to either receive weekly educational SMS for 6 months (intervention group [IG]) or no SMS at all (control group). A satisfaction questionnaire was applied before and after the intervention in both groups. Laboratory (fasting glucose, hemoglobin [Hb] A1c, total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein) and clinical (blood pressure) data were also collected. Data were analyzed using nonparametric tests with the Statistical Package for the Social Sciences.

Results

We included 128 patients (64 in each group). Responses to the satisfaction questionnaire with self-care and healthcare professionals from 112 patients revealed an improvement in the perception of receiving information regarding helpful eating habits and in healthy eating behavior and an improvement in satisfaction with their diabetes care in the IG. In the post-intervention period, improved systolic blood pressure and HbA1c levels were observed in the IG as illustrated by delta % (post-intervention minus pre-intervention data divided by pre-intervention data multiplied by 100) reductions of 2.3% and 3.9%, respectively.

Conclusion

SMS intervention was useful as an educational tool for improving satisfaction and glycemic and blood pressure control of patients with DM observed at a Brazilian university hospital.

Folinic acid rescue during methotrexate treatment for low-risk gestational trophoblastic neoplasia - How much is just right?

OBJECTIVE

To compare the outcomes of patients with low-risk gestational trophoblastic neoplasia (GTN) treated with 8-day methotrexate (MTX) with two different regimens of folinic acid (FA).

METHODS

Retrospective cohort study of low-risk GTN followed at Rio de Janeiro Federal University, from January/2000-December/2019 with 8-day MTX with FA at 0.1 mg/kg versus 15 mg fixed dose.

RESULTS

Among 667 patients with low-risk GTN, 323 were treated with FA at 0.1 mg/kg and 142 with FA at 15 mg fixed dose. The weight-based and fixed dose groups were comparable in terms of clinical profile but did differ in the hCG pretreatment level (8883 versus 5127 IU/L, p < 0.01) and FIGO risk score 5/6 (3.4% versus 18.3%, p < 0.01), respectively. Despite this, there was no difference in the remission rate in first-line treatment (76.8 versus 81%, p = 0.33), although FA at 0.1 mg/kg had a significantly higher number of chemotherapy cycles to remission (5 versus 4, p < 0.01), need to delay chemotherapy due to toxicity (6.8 versus 2.8%, p < 0.01) and time to remission, (12 versus 8 weeks, p < 0.01), respectively. A logistic regression analysis showed that the different FA rescue regimens appeared comparable in terms of achieving remission in first-line chemotherapy for low-risk GTN (OR:5.16, CI95%:0.84-31.64, p = 0.08).

CONCLUSION

FA with 15 mg fixed dose as compared to 0.1 mg/kg of FA was associated with similar primary remission rate, relapse or death among low-risk GTN treated with 8-day MTX. This regimen is highly practical, reduces visits to health facilities, appears equally safe and may be preferable with the 8-day MTX regimen in the treatment of low-risk GTN.

Predictors for single-agent resistance in FIGO score 5 or 6 gestational trophoblastic neoplasia: a multicentre, retrospective, cohort study

BACKGROUND

Patients with gestational trophoblastic neoplasia who have an International Federation of Gynaecology and Obstetrics (FIGO) risk score of 5 or 6 usually receive non-toxic single-agent chemotherapy as a first-line treatment. Previous studies suggest that only a third of patients have complete remission, with the remaining patients requiring toxic multiagent chemotherapy to attain remission. As stratification factors are unknown, some centres offer multiagent therapy upfront, resulting in overtreatment of many patients. We aimed to identify predictive factors for resistance to single-agent therapy to inform clinicians on which patients presenting with a FIGO score of 5 or 6 are likely to benefit from upfront multiagent chemotherapy.

METHODS

We did a multicentre, retrospective, cohort study of patients with gestational trophoblastic neoplasia presenting with a FIGO score of 5 or 6, who received treatment at three gestational trophoblastic neoplasia reference centres in the UK, Brazil, and the USA between Jan 1, 1964, and Dec 31, 2018. All patients who had been followed up for at least 12 months after remission were included. Patients were excluded if they had received a non-standard single-agent treatment (eg, etoposide); had been given a previously established first-line multiagent chemotherapy regimen; or had incomplete data for our analyses. Patient data were retrieved from medical records. The primary outcome was the incidence of chemoresistance after first-line or second-line single-agent chemotherapy. Variables associated with chemoresistance to single-agent therapies were identified by logistic regression analysis. In patient subgroups defined by choriocarcinoma histology and metastatic disease status, we did bootstrap modelling to define thresholds of pretreatment human chorionic gonadotropin concentrations and identify groups of patients with a greater than 80% risk (ie, a positive predictive value [PPV] of 0·8) of resistance to single-agent chemotherapy.

FINDINGS

Of 5025 patients with low-risk gestational trophoblastic neoplasia, we identified 431 patients with gestational trophoblastic neoplasia presenting with a FIGO risk score of 5 or 6. All patients were followed up for a minimum of 2 years. 141 (40%) of 351 patients developed resistance to single-agent treatments and required multiagent chemotherapy to achieve remission. Univariable and multivariable logistic regression revealed metastatic disease status (multivariable logistic regression analysis, odds ratio [OR] 1·9 [95% CI 1·1-3·2], p=0·018), choriocarcinoma histology (3·7 [1·9-7·4], p=0·0002), and pretreatment human chorionic gonadotropin concentration (2·8 [1·9-4·1], p<0·0001) as significant predictors of resistance to single-agent therapies. In patients with no metastatic disease and without choriocarcinoma, a pretreatment human chorionic gonadotropin concentration of 411 000 IU/L or higher yielded a PPV of 0·8, whereas in patients with either metastases or choriocarcinoma, a pretreatment human chorionic gonadotropin concentration of 149 000 IU/L or higher yielded the same PPV for resistance to single-agent therapy.

INTERPRETATION

Approximately 60% of women with gestational trophoblastic neoplasia presenting with a FIGO risk score of 5 or 6 achieve remission with single-agent therapy; almost all remaining patients have complete remission with subsequent multiagent chemotherapy. Primary multiagent chemotherapy should only be given to patients with metastatic disease and choriocarcinoma, regardless of pretreatment human chorionic gonadotropin concentration, or to those defined by our new predictors.

FUNDING

None.

TRANSLATION

For the Portuguese translation of the abstract see Supplementary Materials section.

Effect of glucose and non-nutritive sucking on puncture pain in premature infants: a crossover clinical trial

OBJECTIVE

To compare the effect of non-nutritive sucking, 25% oral glucose and 25% oral glucose combined with non-nutritive sucking in pain relief in premature infants submitted to heel puncture for blood glucose monitoring.

METHOD

This is a randomized crossover clinical trial with 34 preterm infants who randomly received interventions: non-nutritive sucking, 25% oral glucose and the two interventions combined for three consecutive days in heel puncture for blood glucose monitoring. Assessment by the Premature Infant Pain Profile for 30 seconds before the intervention, called the baseline period and for 5 minutes after puncture.

RESULTS

The combination of interventions made the premature infants return to baseline, with 1 minute and 30 seconds after heel puncture, promoting a 2.2% percentage reduction in the scale.

CONCLUSION

Comparing the effect of isolated and combined interventions showed that, when offered in combination, preterm infants were able to return to baseline parameters more quickly. Brazilian Clinical Trials Registry: RBR-3gm6w5.

Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system

The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1 ^st , 2004, to December 1 ^st , 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB.

Fat Mass Ratio in Brazilian HIV-infected Patients Under Antiretroviral Therapy and Its Relationship With Anthropometric Measurents

INTRODUCTION

Human immunodeficiency virus-related lipodystrophy is characterized by a variety of phenotypes and metabolic changes; however, consensus has not yet been reached on its diagnostic criteria. Different cutoff values for fat mass ratio have been proposed for this specific population as an objective diagnostic criterion for lipodystrophy. This study aimed to establish sex-specific reference values for fat mass ratio and to correlate them with anthropometric measurements for the diagnosis of human immunodeficiency virus-related lipodystrophy.

METHODOLOGY

A cross-sectional study was performed on 189 human immunodeficiency virus-infected patients under antiretroviral therapy. Anthropometric measurements were evaluated, and body composition was determined using dual-energy X-ray absorptiometry. Fat mass ratio was calculated as the ratio of the percentage of the trunk fat mass and the percentage of the lower limb fat mass.

RESULTS

One hundred and thirty-two patients (69%) presented lipodystrophy by objective criteria. In men, the cutoff for the fat mass ratio was 1.55 (area under the receiver operating characteristic curve: 0.73 [95% confidence interval: 0.62-0.83], p = 0.000008), with a sensitivity of 62.5%, a specificity of 70.5%, a positive predictive value of 77.8%, and a negative predictive value of 53.4%. In women, the cutoff for the fat mass ratio was 0.959 (area under the receiver operating characteristic curve: 0.70 [95% confidence interval: 0.56-0.85], p = 0.03), with a sensitivity of 83.60%, a specificity of 61.5%, a positive predictive value of 90.2%, and a negative predictive value of 47.1%. Fat mass ratio was positively correlated with waist circumference (men: r = 0.246, p = 0.019; women: r = 0.302, p = 0.014) and neck circumference (men: r = 0.304, p = 0.004; women: r = 0.366, p = 0.003) in both sexes; and body mass index (r = 0.288, p = 0.006) and waist-hip ratio (r = 0.288, p = 0.006) in men.

CONCLUSION

The fat mass ratio evaluated using dual-energy X-ray absorptiometry with the sex-specific cutoffs is an objective tool to define human immunodeficiency virus-related lipodystrophy.

Relationship between sleep disturbances, lipid profile and insulin sensitivity in type 1 diabetic patients: a cross-sectional study

Objective The consequences of sleep deprivation in type 1 diabetes (T1D) patients are poorly understood. Our aim was to determine how sleep disorders influence lipid profile and insulin sensitivity in T1D patients. Materials and methods This was a cross-sectional study at a public university hospital. Demographic information and medical histories were obtained during regular scheduled visit of T1D patients to the outpatient clinic. Insulin sensitivity was obtained using the estimated glucose disposal rate (eGDR) formula. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Berlin Questionnaire. Results The adult participants (n = 66, 62% women) had a median age of 28.0 years (interquartile range 21.8-33.0). Six patients (9%) had metabolic syndrome according to the International Diabetes Federation criteria. Thirty patients (46%) were considered poor sleepers according to the Pittsburgh Sleep Quality Index. The LDL-c and total cholesterol levels of poor sleepers were higher than those of good sleepers (103 v. 81; p = 0.003 and 178.0 v. 159.5 mg/dL; p = 0.009, respectively). Three patients (4%) were at high risk of obstructive sleep apnea syndrome (OSAS) according to the Berlin Questionnaire. The eGDR was lower in the group of patients with high probability of having OSAS (6.0 v. 9.1 mg.kg-1.min-1;p = .03). Conclusions Poor subjective quality of sleep and higher risk of OSAS were correlated with a worsened lipid profile and decreased insulin sensitivity, respectively. Therefore, T1D patients with sleep disturbances might have an increased cardiovascular risk in the future.

Assessment of Fetal Lung Maturity Using Quantitative Ultrasound Analysis in Patients with Prelabor Rupture of Membranes

INTRODUCTION

Prelabor rupture of membranes (PROM) is a frequent clinical situation, and the decision about the best time for delivery remains controversial, mainly due to the risk of neonatal respiratory morbidity (NRM). Assessment of fetal lung maturity using ultrasound, a safe method and widely used in current obstetrical practice, could change this scenario. This study was designed to evaluate the ability of quantitative ultrasound method QuantusFLM® to predict NRM in patients with PROM and whether maternal BMI, gestational age, occurrence of the disease, and presence of oligohydramnios influenced the performance.

METHODS

Patients with singleton gestations, diagnosis of PROM, and gestational age between 24 and 38 weeks and 6 days were included. Fetal lung image was acquired by ultrasound within 48 h prior to delivery and analyzed by QuantusFLM®. The results were then paired with neonatal outcomes to assess the program's ability to predict the NRM in this specific group. A logistic regression model was created to analyze factors that could affect the test results.

RESULTS

Fifty-four patients were included. Mean maternal BMI was 28.99 kg/m2, and in 25 patients (46.2%), oligohydramnios was observed at the time of examination. Mean gestational age at delivery was 35 weeks and 4 days, and the NRM prevalence was of 18.5%. QuantusFLM® predicted NRM with a 60% sensitivity, 79.5% specificity, 40% positive predictive value, 89.7% negative predictive value, and 75.6% accuracy. Maternal BMI, disease occurrence, presence of oligohydramnios, and gestational age did not interfere with the evaluation.

CONCLUSION

This study demonstrates a good accuracy of QuantusFLM® as a NRM predictor in patients with PROM, with particular reliability in identifying that pulmonary maturity has already occurred.

Serological biomarkers for monitoring response to treatment of pulmonary and extrapulmonary tuberculosis in children and adolescents

Key measures to halt the spread of tuberculosis (TB) include early diagnosis, effective treatment, and monitoring disease management. We sought to evaluate the use of serum immunoglobulin levels against antigens present in cell envelope of Mycobacterium tuberculosis to monitor TB treatment response in children and adolescents with pulmonary (PTB) or extrapulmonary TB (EPTB). Blood samples were collected prior to and one, two, and six months following treatment initiation. Serum immunoglobulin levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein were measured by ELISA. Serum from 53 TB patients and 12 healthy participants were analyzed. After six months of successful treatment, there was a significant decrease (p < 0.0001) in IgM levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein and IgG levels against Mce1A protein when compared to baseline immunoglobulin levels. There was no significant variation in antibody levels during follow-up between participants with PTB and EPTB, confirmed and unconfirmed TB diagnosis, and HIV infection status. Antibody levels in control participants without TB did not decrease during follow-up. These results suggest that immunoglobulin responses to mycobacterial cell wall products may be a useful tool to monitor treatment response in children and adolescents with PTB or EPTB.

Gestational trophoblastic neoplasia lethality among Brazilian women: A retrospective national cohort study

OBJECTIVE

To investigate GTN lethality among Brazilian women comparing cases of death by GTN with those who survived, thereby identifying factors associated with GTN lethality.

METHODS

We retrospectively reviewed medical records of women with GTN treated at ten Brazilian GTN Reference Centers, from January 1960 to December 2017. We evaluated factors associated with death from GTN and used Cox proportional hazards regression models to identify independent variables with significant influence on the risk of death.

RESULTS

From 2186 patients with GTN included in this study, 2092 (95.7%) survived and 89 (4%) died due to GTN. When analyzing the relative risk (RR), adjusted for WHO/FIGO score, patients with low risk disease had a significantly higher risk of death if they had choriocarcinoma (RR: 12.40), metastatic disease (RR: 12.57), chemoresistance (RR: 3.18) or initial treatment outside the Reference Center (RR: 12.22). In relation to patients with high-risk GTN, these factors were significantly associated with death due to GTN: the time between the end of antecedent pregnancy and the initiation of chemotherapy (RR: 4.10), metastatic disease (RR: 14.66), especially in brain (RR: 8.73) and liver (RR: 5.76); absence of chemotherapy or initial treatment with single agent chemotherapy (RR: 10.58 and RR: 1.81, respectively), chemoresistance (RR: 3.20) and the initial treatment outside the Reference Center (RR: 28.30).

CONCLUSION

The risk of mortality from low and high-risk GTN can be reduced by referral of these patients to a Reference Center or, if not possible, to involve clinicians in a Reference Center with consultation regarding management.

Association between antioxidant vitamins and oxidative stress among patients with a complete hydatidiform mole

OBJECTIVES

This study aimed to evaluate the potential relationship between oxidative stress, dietary intake, and serum levels of antioxidants in patients with a complete hydatidiform mole (CHM) compared with controls.

METHODS

This was an observational cross-sectional study conducted in Rio de Janeiro, Brazil. A total of 140 women were enrolled in this study and divided into four groups: 43 patients with CHM, 33 women who had had an abortion, 32 healthy pregnant women, and 32 healthy non-pregnant women. All participants underwent blood sampling, assessment using a semiquantitative food frequency questionnaire, and anthropometric measurement. Blood samples were collected after overnight fasting (10-12 h). Vitamin levels (A, C, and E) were determined by ultra-performance liquid chromatography, and gamma-glutamyl transferase levels were assessed using an automated quantitative analysis system (Dimension®, Siemens).

RESULTS

Although all groups showed sufficient serum vitamin A and E levels, the participants had inadequate dietary intake of these vitamins. Conversely, all groups had an insufficient serum level of vitamin C, despite adequate intake. The gamma-glutamyl transferase values did not differ significantly among the groups. However, elevated serum levels of this enzyme were observed in several patients.

CONCLUSIONS

All groups exhibited high levels of oxidative stress, as evaluated by gamma-glutamyl transferase levels, and had inadequate intake of antioxidant vitamins. Therefore, the high exposure to oxidative stress found in our study, even in healthy pregnant and non-pregnant women, may increase the incidence of CHM in this region.

[Aspects related to the use of antiretrovirals in high complexity patients in the state of Rio de Janeiro]

Treatment of AIDS involves the use of the cocktail of drugs that make up the antiretroviral therapy. Its logistic control is monitored by a computerized national system of dispensation, the Logistic Control System of Medication (SICLOM). This study aimed to investigate, by means of SICLOM data, the use of antiretroviral therapy in patients treated at two University Hospitals in the state of Rio de Janeiro. A cross-sectional study was conducted with sociodemographic and dispensation data collected from SICLOM. The evaluation of drug ownership was done by calculating the Proportion of Days Covered (PDC). Five hundred and thirty-eight patients of both genders with active registration in SICLOM and over 18 years of age were included. The ART most used in both hospitals was lamivudine, considering the total of 58 different schemes identified. The mean of possession of groups was 88% (± 0,16). The factor associated with possession of drugs was the ART scheme, with PDC of 91% (p<0,001) for rescue schemes. This study confirmed that SICLOM was a reliable source to establish the profile of the population assisted.

Predictive factors of dengue severity in hospitalized children and adolescents in Rio de Janeiro, Brazil

INTRODUCTION

Dengue is one of the most important mosquito-borne infections. Severe cases are more frequently observed in adults. However, in 2008, the State of Rio de Janeiro, Brazil, experienced a severe dengue epidemic that primarily affected children and caused many cases of dengue hemorrhagic fever (DHF) and death.

METHODS

A cross-sectional analytical study was conducted to examine laboratory diagnosis and clinical epidemiologic factors for confirmed dengue cases in patients aged less than 16 years, from January to June 2008, at a municipal hospital in the City of Rio de Janeiro, Brazil. Variables associated with severe outcomes and P values less than .05 were evaluated by means of a logistic regression model.

RESULTS

Of the 419 dengue cases studied, 296 were classified as DHF and 123 as classical dengue. Six patients who had DHF died. In multivariate analysis, some laboratory and clinical variables were independently associated with DHF: age 5 years or older (odds ratio [OR], 4.94; 95% confidence interval [CI], 1.30-18.71), abdominal pain (OR, 8.59; 95% CI, 3.17-23.27), hepatomegaly (OR, 15.87; 95% CI, 5.38-46.85), and positive tourniquet test (OR, 10.84; 95% CI, 3.96-29.71). Hypoalbuminemia occurred more frequently than hemoconcentration in DHF cases, and high aminotransferase levels were associated with severity.

CONCLUSIONS

Age greater than 5 years, abdominal pain, painful hepatomegaly, and positive tourniquet test were predictors of DHF. The high frequency of hepatic impairment suggests that acetaminophen should be avoided in severe cases of dengue.

Agreement among methods for study estimation of elderly height at the nutrition ambulatory

Abstract Objective: to evaluate methods of elderly height estimation attended at the Nutrition ambulatory. Method: a total of 43 elderly individuals of both genders were evaluated during nutrition consultations. Sociodemographic data were collected from charts and height, knee height, arms wingspan and semi-span were measured. Statistical analysis were made through Bland-Altman test to evaluate concordance among statures estimated by predictive formulas and the height measured. Results: the values found were: height measured in meters 1.53 (±0.08), height estimated by the wingspan 1.60 (±0.10), by the semi-span 1.61 (±0.11) and by the knee height 1.56 (±0.10). According to the Bland-Altman graph, the height estimated by knee height showed a better agreement with the measured height. Conclusion: according to this study results, poor predictive formulas concordance in height estimation in elderly, using the measures: arms wingspan and semi-span with real stature measured were observed. Knee height, using Chumlea formula, presented the best concordance with measured stature and seems to be a good way for stature estimation at the studied population.

Can the indicators of chronic ethanol consumption be minimized by a continuous flaxseed intake?

The aim of this study was to evaluate the use of flaxseed in animals subjected to ethanol-induced hepatotoxicity. Twenty-four male rats were divided into four groups (n = 6): control group (CG) which received a control diet and water ad libitum; flaxseed group (FG) which received control diet with an addition of 25% flaxseed flour and water ad libitum; ethanol control group (ECG) which received control diet and a solution of 10% ethanol (v/v) as the only liquid source; and ethanol flaxseed group (EFG) which received control diet with an addition of 25% flaxseed flour and a solution of 10% ethanol (v/v) as the only liquid source. The animals were euthanized at 60 days, when blood was collected for biochemical analysis and liver was collected for histomorphometric analysis. Rats fed with diets containing flaxseed showed lower values of alkaline phosphatase (P = 0.020) and lower concentration of total bilirubin (P = 0.006), direct bilirubin (P = 0.013) and indirect bilirubin (P = 0.018) compared to ECG and EFG. The groups receiving flaxseed diets demonstrated higher expression of superoxide dismutase (SOD) enzyme (P < 0.001) than CG and ECG but did not affect thiobarbituric acid (TBARS) expression (P = 0.055). Regarding liver analysis, the ECG and EFG showed larger hepatocyte nuclei and paler cytoplasm than the groups who had not received ethanol, and less in fluid accumulation (oedema) in the cytoplasm than was seen in the FG and EFG livers. These latter two groups showed fewer fatty cells than was seen in the groups that had not been given flaxseed, so that the diagnosis of hepatic steatosis was not justified. In conclusion, therefore, this study showed that the indicators of ethanol chronic consumption can be reduced by the introduction of continuous flaxseed dietary intake.

Evaluation of positive and false-positive results in syphilis screening of blood donors in Rio de Janeiro, Brazil

OBJECTIVES

We propose to analyse the positive and false-positive results of treponemal and nontreponemal tests in blood donors from Brazil and to evaluate possible factors associated with the results of treponemal tests.

BACKGROUND

Treponemal tests have been used widely for syphilis screening in blood banks. The introduction of these tests in donor screening has caused an impact and a loss of donors who need to be assessed.

METHODS

This was a retrospective cross-sectional study of syphilis screening and confirmatory test results of blood donors that were obtained before and after adopting a chemiluminescent immunoassay (CLIA). A comparative analysis was performed using a second sample drawn from positive donors. The possible factors associated with CLIA-positive or CLIA-false-positive results were investigated in a subgroup. Statistical tests were used to compare the proportions and adjusted estimates of association.

RESULTS

The reactivity rate increased from 1·01% (N = 28 158) to 2·66% (N = 25 577) after introducing the new test. Among Venereal Disease Research Laboratory (VDRL)- and CLIA-confirmed results, the false-positive rates were 40·5% (N = 180) and 37·4% (N = 359), respectively (P = 0·5266). Older donors (OR = 1·04; P = 0·0010) and donors with lower education levels (OR = 6·59; P = 0·0029) were associated with a higher risk of positivity for syphilis.

CONCLUSIONS

CLIA represents an improvement in blood bank serological screening. However, its use in a healthy population appears to result in high rates of false positives. Identifying which characteristics can predict false positives, however, remains a challenge.

Association of GRIN2B gene polymorphism and Obsessive Compulsive disorder and symptom dimensions: A pilot study

The etiology of OCD is largely unknown, but neuroimaging and pharmacological studies suggest that glutamatergic system plays a significant role on OCD development. We genotyped one polymorphism at GRIN2B (rs1019385) by real time Polymerase Chain Reaction in a sample of Brazilian Obsessive-Compulsive patients and healthy controls, and evaluated its influence on OCD. We found the T-allele and TT genotype to be significantly associated with OCD and ordering dimension. The T-allele was also significantly associated with checking. These preliminary results demonstrated that the GRIN2B gene may confer to some extent the susceptibility to OCD and its symptoms.

Programação fetal e alterações metabólicas em escolares: metodologia de um estudo caso-controle

RESUMO: Objetivo: Descrever a metodologia de um estudo sobre associações entre crescimento intrauterino restrito (CIUR) e prevalência de sobrepeso, obesidade e hipertensão arterial em escolares. Métodos: O estudo, conduzido em dois estágios, foi desenvolvido em 2 escolas municipais de Niterói (RJ) de junho a dezembro de 2010, sendo elegíveis todos os escolares de 6 a 14 anos. O primeiro estágio consistiu em um inquérito nutricional e de potenciais fatores de risco. Foram aplicados questionários aos responsáveis e adolescentes. Concomitantemente, foram selecionados os participantes de um estudo caso-controle, com casos prevalentes definidos como todos os escolares que apresentaram excesso de peso (Z-score de índice de massa corporal -IMC/idade/sexo > +1,00). O grupo controle consistiu em uma amostra aleatória da população de estudo do inquérito, o que permitiu o cálculo de razões de prevalências. Foram realizados bioimpedância elétrica, exames de sangue, ultrassonografia da carótida e entrevistas. As variáveis proxy de CIUR foram definidas a partir de informações sobre peso ao nascer (PN) e idade gestacional (IG). Adicionalmente, foram coletadas informações sobre os dois primeiros anos de vida dos escolares a partir de seus prontuários médicos. Resultado s: Entre os 1.040 escolares elegíveis, participaram do estudo 795 escolares (76,4%). A taxa de retorno do questionário enviado para os responsáveis foi de 85,1%. Para o estudo caso-controle, 62,5% (n = 363) dos selecionados participaram, resultando em uma razão caso:controle de 1:1,8. Foram localizados 55,8% (n = 444) dos prontuários, dos quais em 65,7% (n = 292) foram coletadas informações dos primeiros anos de vida. Conclusão: O presente estudo permitirá a análise de múltiplos desfechos e exposições relacionados ao CIUR e alterações metabólicas.

Maternal exposure to diets containing flaxseed flour or flaxseed oil during pregnancy and lactation protects the aortic remodeling in adult male offspring of diabetic rat dams

BACKGROUND

Diabetes during pregnancy is associated with cardiovascular complications in the fetus and extends into adulthood. Therapeutic applications of flaxseed have been studied in cardiovascular disorders, because its oilseed is the best plant source of omega-3 fatty acid, which is currently considered by researchers to be an essential protective against cardiovascular disease. The aim of this study was to evaluate the influence of flaxseed flour and oil on cardiovascular biochemical parameters and the histoarchitecture of the aorta in adult rats which were offspring of diabetic mothers.

RESULTS

At 100 days of age in offspring it was observed that maternal consumption of a high-fat diet containing flaxseed oil (FOG) and flaxseed flour (FFG) did not affect the serum concentration of monocyte chemoattractant protein-1, vascular endothelial growth factor, cholesterol, triglycerides, high-density-, low-density- or very-low-density-lipoprotein cholesterol. However, the thickness of the intima media layer of the aorta was significantly smaller in FOG and FFG groups; the lumen area was similar among the groups; and a higher percentage of elastic fiber was found in FOG and FFG groups.

CONCLUSION

These data suggest that the use of both flaxseed flour and its oil reduces the remodeling of the aorta; however; it has not been possible to modify the cardiovascular biochemical parameters.

CUTOFF POINT OF THE PHASE ANGLE IN PRE-RADIOTHERAPY CANCER PATIENTS

INTRODUCTION

malnutrition is a common complication for cancer patients. The phase angle (PA), direct measurement of bioelectrical impedance analysis (BIA), has been considered a predictor of body cell mass and prognostic indicator. Cutoff points for phase angle (PA) associated with nutritional risk in cancer patients have not been determined yet.

OBJECTIVES

assess the possibility of determining the cutoff point for PA to identify nutritional risk in pre-radiotherapy cancer patients.

METHODS

sample group: Patients from both genders diagnosed with cancer and sent for ambulatory radiotherapy.

VARIABLES STUDIED

body mass index (BMI), percentage of weight loss (% WL), mid-arm circumference (MAC), triceps skinfold thickness (TST), mid-arm muscle circumference (MAMC), mid-arm muscle area (MAMA), score and categorical assessment obtained using the Patient-Generated Subjective Global Assessment (PG-SGA) form, PA and standardized phase angle (SPA). Kappa coefficient was used to test the degree of agreement between the diagnoses of nutritional risk obtained from several different methods of nutritional assessment. Cutoff points for the PA through anthropometric indicators and PG-SGA were determined by using Receiver Operating Characteristic (ROC) curves, and patient survival was analyzed with the Cox regression method.

RESULTS

the cutoff points with the greatest discriminatory power were those obtained from BMI (5.2) and the categorical assessment of PG-SGA (5.4). The diagnosis obtained using these cutoff points showed a significant association with risk of death for the patients in the sample group.

CONCLUSION

we recommend using the cutoff point 5.2 for the PA as a criterion for identifying nutritional risk in pre-radiotherapy cancer patients.

Correlation between mean body mass index in the population and prevalence of obesity in Brazilian capitals: empirical evidence for a population-based approach of obesity

Background

The purpose of this study was to investigate the association between mean body mass index (BMI) and prevalence of obesity in adult populations living in Brazilian State capitals.

Methods

An ecological study was conducted, using data from the National Household Budget Survey conducted in July 2002 through June 2003, including a representative sample of 48.470 households. Pearson’s correlation and linear regression coefficients were estimated in order to define the relationships of mean BMI and sex-specific, age standardized obesity prevalence (BMI ≥ 30.0 kg/m²) in adults aged 20 to 59 years.

Results

Stronger correlations between BMI and prevalence of obesity were observed in women (r = 0.9; p < 0.001) than in men (r = 0.6; p = 0.001) in all analyzes. A reduction of one unit in mean BMI predicted a decline in the prevalence of obesity of about 4.0% (95% CI: 1.7 - 6.3) in men, and 3.4% (95% CI: 2.6 – 4.3) in women.

Conclusion

We found a correlation between BMI and prevalence of obesity, particularly among women, suggesting that population-based strategies would be effective to reduce the prevalence of obesity in adult populations living in Brazilian state capitals.

Prevalence of metabolic syndrome in elderly and agreement among four diagnostic criteria

BACKGROUND

Metabolic syndrome (MS) is an aggregation of risk factors that increase the incidence of cardiovascular events and diabetes mellitus (DM). Population aging is accompanied by higher prevalence of MS, which varies depending on the population studied and the diagnostic criteria used.

OBJECTIVE

To determine prevalence of MS in the elderly using four diagnostic criteria and agreement between them.

METHODS

Cross-sectional study on 243 patients older than 60 years (180 women) in Niterói, RJ. They were evaluated by clinical examination, fasting glucose, fasting insulin, lipid profile and anthropometric measurements - weight, height, waist circumference and waist/hip ratio. Prevalence of MS was estimated by World Health Organization (WHO) modified, National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF) and Joint Interim Statement (JIS) criteria.

RESULTS

Prevalence was high with the four criteria WHO (51.9%), NCEP-ATPIII (45.2%), IDF (64.1%) and JIS (69.1%), and agreement between criteria by kappa was moderate in almost all comparisons WHO vs. IDF (k = 0.47;95% confidence interval (CI), 0.35 to 0.58); WHO vs. NCEP-ATPIII (k = 0.51; 95% CI, 0.40 to 0.61); WHO vs. JIS (k = 0.45; 95% CI, 0.33 to 0.56); IDF vs. NCEP-ATPIII (k = 0.55; 95% CI, 0.45 to 0.65) and NCEP-ATPIII vs. JIS (k = 0.53; 95% CI, 0.43-0.64), except between IDF vs. JIS (K = 0.89;95% CI, 0.83 to 0.95), which was considered good.

CONCLUSION

Prevalence of MS was high with the four diagnostic criteria, mainly by JIS. There was good agreement between JIS and IDF criteria and moderate among the others.

An upward trend in DNA p16ink4a methylation pattern and high risk HPV infection according to the severity of the cervical lesion

High-risk human papillomavirus (hr-HPV) infection is necessary but not sufficient for cervical cancer development. Recently, P16INK4A gene silencing through hypermethylation has been proposed as an important cofactor in cervical carcinogenesis due to its tumor suppressor function. We aimed to investigate P16INK4A methylation status in normal and neoplastic epithelia and evaluate an association with HPV infection and genotype. This cross-sectional study was performed with 141 cervical samples from patients attending Hospital Moncorvo Filho, Rio de Janeiro. HPV detection and genotyping were performed through PCR and P16INK4A methylation by nested-methylation specific PCR (MSP). HPV frequency was 62.4% (88/141). The most common HPV were HPV16 (37%), HPV18 (16.3%) and HPV33/45(15.2%). An upward trend was observed concerning P16INK4A methylation and lesion degree: normal epithelia (10.7%), low grade lesions (22.9%), high grade (57.1%) and carcinoma (93.1%) (p < 0.0001). A multivariate analysis was performed to evaluate an association between methylation, age, tobacco exposure, HPV infection and genotyping. A correlation was found concerning methylation with HPV infection (p < 0.0001), hr-HPV (p = 0.01), HSIL (p < 0.0007) and malignant lesions (p < 0.0001). Since viral infection and epigenetic alterations are related to cervical carcinoma, we suggest that P16INK4A methylation profile maybe thoroughly investigated as a biomarker to identify patients at risk of cancer.

Reduced plasma zinc levels, lipid peroxidation, and inflammation biomarkers levels in hemodialysis patients: implications to cardiovascular mortality

Despite the fact that low plasma zinc (Zn) levels play important roles in the oxidative stress, the relationships between lipid peroxidation and inflammation biomarkers with low plasma Zn levels have not been investigated in chronic kidney disease (CKD) patients. The aim of this study was to evaluate the Zn plasma levels, electronegative LDL [LDL(-)] levels, and inflammation markers as predictors of cardiovascular (CV) mortality in hemodialysis (HD) patients. Forty-five HD patients (28 men, 54.2 ± 12.7 years, 62.2 ± 51.4 months on dialysis and BMI 24.3 ± 4.1 kg/m(2)) were studied and compared to 20 healthy individuals (9 men, 51.6 ± 15.6 years, BMI 25.2 ± 3.9 kg/m(2)) and followed for 24 months to investigate the risks for CV mortality. LDL(-) levels were measured by ELISA, plasma Zn levels by atomic absorption spectrophotometry, C-reactive protein (CRP) level by immunoturbidimetric method, and tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), and plasminogen activator inhibitor-1 (PAI-1) levels by a multiplex assay kit. HD patients presented low plasma Zn levels (54.9 ± 16.1 μg/dL) and high-LDL(-) (0.18 ± 0.12 U/L) and TNF-α (5.5 ± 2.2 pg/mL) levels when compared to healthy subjects (78.8 ± 9.4μ g/dL, 0.10 ± 0.08U/L, 2.4 ± 1.1 pg/mL, respectively, p < 0.05). Zn plasma levels were negatively correlated to TNF-α (r = -0.49; p = 0.0001) and LDL(-) (r = -0.33; p = 0.008). During the 2 years, 24.4% of the patients died, all due to CV disease. Analysis by the Cox model showed that high CRP, TNF-α, IL-6 levels, and long duration of HD were significant predictors of mortality. In conclusion, reduced Zn levels were associated with lipid peroxidation and inflammation, and we confirm here in a Brazilian cohort of HD patients that inflammation markers are strong predictors of CV death.

Changes in ophthalmic artery Doppler indices in hypertensive disorders during pregnancy

OBJECTIVES

To compare the ophthalmic artery Doppler indices observed in women with singleton pregnancies complicated by hypertension and to correlate the indices observed in hypertensive pregnant women with those observed in healthy pregnant women.

METHODS

Ophthalmic artery Doppler indices were compared between 30 women with mild preeclampsia, 30 women with severe preeclampsia, and 30 women with chronic hypertension at 20 to 40 weeks' gestation. The control group consisted of 289 normotensive pregnant women. The resistive index, pulsatility index, and peak ratio were measured in the right eye. The mean and standard deviation were calculated for each group. Analysis of variance and the Tukey method were used to compare the means of the Doppler indices between groups. Receiver operating characteristic curves were used to determine the predictive power of the Doppler indices for identification of women with severe preeclampsia. P < .05 was considered statistically significant.

RESULTS

Significant differences were found between the resistive index, pulsatility index, and peak ratio in women with severe preeclampsia compared to the other groups. The means ± SDs for the resistive index, pulsatility index, and pulse ratio in women with severe preeclampsia were 0.63 ± 0.09, 1.13 ± 0.31, and 0.89 ± 0.12, respectively. The optimal cutoff values for the resistive index, pulsatility index and the peak ratio for identification of women with severe preeclampsia were determined by the receiver operating characteristic curves to be 0.657, 1.318, and 0.784.

CONCLUSIONS

Doppler imaging of the ophthalmic artery showed central overperfusion among pregnant women with severe preeclampsia. The peak ratio was the best index for discriminating between severe and mild preeclampsia or chronic hypertension.

PP082. Ophthalmic artery doppler for identification of severe preeclampsia in pregnancies complicated by hypertension

INTRODUCTION

Hypertension is the most common disorder that occurs during pregnancy and one of the main causes of maternal mortality worldwide. Among the hypertensive disorders that affect pregnancy, preeclampsia (PE) is the major cause of maternal mortality, maternal morbidity, perinatal death, prematurity and intrauterine growth restriction. The acute cerebral complications in PE account for at least 75% of maternal death. Central nervous system hemodynamic modifications in PE are a controversial issue. Neurological involvement in PE-eclampsia syndrome fulfills the criteria of posterior reversible encephalopathy syndrome (PRES). The pathophysiology of PRES is still under investigation. Assessment of cerebral circulation is challenging. Noninvasive techniques, especially transcranial Doppler sonography, are becoming more widely used to evaluate cerebral flow. Ophthalmic artery Doppler is a noninvasive examination used to study central vascular flow that has been shown to be a promising method in the evaluation of pregnant women with hypertension.

OBJECTIVES

The aim of this study was to compare the ophthalmic artery Doppler indices observed in singleton pregnant women complicated by hypertension (study group) and to correlate the indices observed in hypertensive pregnant women with those observed in normal pregnant women (control group).

METHODS

Ophthalmic artery Doppler indices of 30 mild and 30 severe pre-eclamptic women and 30 pregnant women with chronic hypertension (CH) at 20-40weeks of gestational age (GA) were compared. The control group consisted of 289 healthy pregnant women. Resistance index (RI), pulsatility index (PI), and peak ratio (PR) were determined in the right eye. The mean and SD were calculated for each group. Analysis of variance (ANOVA) was used to compare Doppler indexes means between groups. As significant differences were determined by ANOVA analysis, each group was compared by the Tukey method. Receiver operating characteristics (ROC) curves were used to determine the predictive power of ophthalmic artery Doppler indexes for the identification of severe pre-eclamptic women. P<0.05 was considered statistically significant.

RESULTS

Significant differences were found between the values obtained for RI, PI, and PR in severe PE women compared to the other groups (study and control). The mean and SD for IR, IP and PR in mild PE, severe PE and CH groups were respectively 0.73 (±0.06), 1.63 (±0.35) and 0.65 (±0.10); 0.63 (±0.09), 1.13 (±0.31) and 0.89 (±0.12); 0.73 (±0.07), 1.66 (±0.49) and 0.66 (±0.14). The mean and SD for IR, IP and PR in normotensive pregnant women were 0.75 (±0.05), 1.88 (±0.43), 0.52 (±0.10). The optimal cut-off values for IR, IP and PR for the identification of severe pre-eclamptic women determined by roc curves was 0.657, 1.318, 0.784 (sensitivity and specificity were 0.633 and 0.919, 0.733 and 0.888, 0.833 and 0.974, respectively). The area under the ROC curve for IR was 0.787(95% CI: 0.68-0.89), for IP was 0.797 (95% CI: 0.69-0.90) and for PR was 0.886 (95% CI: 0.80-0.96).

CONCLUSION

Ophthalmic Doppler is a useful method in the identification of severe PE. PR was best ophthalmic Doppler index at discriminating between severe PE and pregnant women with mild PE or chronic hypertension as determined by roc curve.

Doppler velocimetry of the ophthalmic artery: reproducibility of blood flow velocity measurements

OBJECTIVES

The aim of this study was to investigate the interobserver reliability for measuring ophthalmic artery Doppler indices.

METHODS

Healthy women (n = 30) were evaluated. The resistive index, pulsatility index, and peak ratio were determined by two independent observers who were blind to each other. A paired t test was used for the comparison of paired samples in the cases of replication between observers. Pearson product-moment correlation was used to study the relationship between the samples. The Bland-Altman graphic approach was used to investigate the agreement between observers.

RESULTS

No significant differences were found between the values obtained by the two independent observers for the resistive index and pulsatility index. The difference observed between the values obtained by the observers for the peak ratio was 0.02.

CONCLUSIONS

Doppler velocimetry is a reproducible technique for evaluation of the resistive index and pulsatility index. For analysis of the peak ratio, an interval of ±0.02 should be considered for the measurement.

Effects of flaxseed on rat milk creamatocrit and its contribution to offspring body growth

OBJECTIVES

To assess the effect of flaxseed on rat milk creamatocrit and its contribution to offspring weight gain during lactation.

METHODS

The study was conducted with 22 Lister Hooded rats divided into two groups: Control Group (CG, n = 11), which received a casein-based diet with 17% protein, and Flaxseed Group (FG, n = 11), which received a 25% flaxseed diet supplemented with 14% casein, totaling 17% protein. Food consumption was controlled per individual cage and litter size. Maternal milk creamatocrit and offspring weight variation until weaning age were also evaluated.

RESULTS

FG was similar to CG concerning food intake (FG = 76.46±31.87 g; CG = 76.7±33.36 g; p = 0.9613) and equivalent to CG concerning litter size (FG = 4.94±2.34; CG = 5.5±3.19; p = 0.435). The same was found for milk fat content (FG = 18.4±4.76; CG = 15.3±6.03; p = 0.204) and total energy value (FG = 212.92±46.4; CG = 181.1±60; p = 0.1964). FG was similar to CG both in offspring body weight at weaning (FG = 37±6.96 g; CG = 32.6±7.5 g; p = 0.1817) and in weight gain (FG = 31.8±7.0 g; CG = 27.7±7.5 g; p = 0.2104).

CONCLUSION

A total of 25% flaxseed promoted an adequate offspring growth.

Doppler sonography of maternal cerebral arteries in pregnancy: side-to-side differences

BACKGROUND/AIMS

To study side-to-side differences in blood flow of the common and internal carotid arteries, and the vertebral arteries (VAs) in women with uncomplicated pregnancies as a first step to build a reference values chart.

METHODS

A total of 155 healthy pregnant women between 20 and 40 weeks' gestation were included. Doppler sonography of the common and internal carotid arteries and VAs was performed on both sides. Parameters measured included diameter, peak systolic velocity, systolic-diastolic ratio, end-diastolic velocity, pulsatility index and resistance index. Statistical analysis was performed using the S-Plus 8.0 program. Normality was determined using the Kolmogorov-Smirnov test. Differences between sides were tested using Student's paired t test, association using linear correlation, and agreement using the Bland-Altman method.

RESULTS

Mean values were equal between sides for all parameters with the exception of the end-diastolic velocity in the VAs. The association and agreement between the measurements taken from the right and left sides were poor. Bland-Altman plots also indicated low agreement between sides. All parameters showed significant right-to-left differences.

CONCLUSION

Despite the equality between means, right and left flows through the vessels studied differed as there was poor association and agreement.

[Association between Vitamin A deficiency and socioeconomic, nutritional and obstetric variables]

This study verified the night blindness prevalence, the first manifestation of this deficiency, and its association with socioeconomic, nutritionals and obstetric variables of 92 pregnant who were assisted on a health municipal center in Diamantina, Vale do Jequitinhonha. Data was collected through a model interview recommended by WHO (1996) to diagnose night blindness. The statistic analysis used Fisher exact test and Wilcoxon test. The results showed a higher prevalence of night blindness at Diamantina districts and neighbor cities (13.04%). No significant association was found between night blindness and socioeconomic and obstetric variables (p>0.05). It was observed a low vitamin A levels by pregnant with night blindness (4.4). This found shows the necessity of more investigations on vitamin A deficiency in order to help prevent, diagnose and combat this issue.

The influence of an undergraduate scientific initiation programme on the professional profile of new physicians

INTRODUCTION

This paper studies the influence of a Scientific Initiation Programme (SIP) on the professional profile of new doctors from a Brazilian university.

AIM AND METHODS

Evaluate fifty-two new doctors divided into two groups matched by sex, age and academic performance and differing only in participation in the SIP. Professional and socioeconomic data were collected, including schooling of parents; average income before, during and after the medical course; current professional situation; results of exams for civil servant recruitment; and titles and degrees obtained after graduation.

RESULTS

Significant differences were found only in civil servant recruitment exam results (p = 0.0098) and in income after graduation (p = 0.02), which were both higher in the non-SIP group. Only one doctor got a M.Sc. degree after graduation, but many of them in both groups obtained technical titles, and had papers presented at congresses or published.

CONCLUSIONS

Apparently, taking part in a SIP led to lower income and worse civil servant recruitment exam results. However, this may only reflect a transient phase in a long-term process. New research currently under way will answer this remaining question, now that more time has elapsed since graduation.

The Influence of an undergraduate scientific initiation programme onn the professional profile of new physicians

INTRODUCTION

This paper studies the influence of a Scientific Initiation Programme (SIP) on the professional profile of new doctors from a Brazilian university.

AIM AND METHODS

Evaluate fifty-two new doctors divided into two groups matched by sex, age and academic performance and differing only in participation in the SIP. Professional and socioeconomic data were collected, including schooling of parents; average income before, during and after the medical course; current professional situation; results of exams for civil servant recruitment; and titles and degrees obtained after graduation.

RESULTS

Significant differences were found only in civil servant recruitment exam results (p=0.0098) and in income after graduation (p=0.02), which were both higher in the non-SIP group. Only one doctor got a M.Sc. degree after graduation, but many of them in both groups obtained technical titles, and had papers presented at congresses or published.

CONCLUSIONS

Apparently, taking part in a SIP led to lower income and worse civil servant recruitment exam results. However, this may only reflect a transient phase in a long-term process. New research currently under way will answer this remaining question, now that more time has elapsed since graduation. Rev Port Pneumol 2010; XVI (5): 797-808.

Seroepidemiological study of human parvovirus B19 among human immunodeficiency virus-infected patients in a medium-sized city in Rio de Janeiro, Brazil

Parvovirus B19 (B-19) may cause chronic anaemia in immunosuppressed patients, including those infected with human immunodeficiency virus (HIV). We studied single serum samples from 261 consecutive HIV-infected patients using an enzyme immunoassay to detect IgG antibodies to B-19. The seroprevalence of B-19-IgG was 62.8%. The differences in seroprevalence across gender, age, educational categories, year of collection of the serum samples, clinical and antiretroviral therapy characteristics, CD4+ count, CD4+ and CD8+ percentage and CD4+/CD8+ ratios were neither substantial nor statistically significant. There was a non-significant, inverse association between B-19 seropositivity and plasma HIV load and haemoglobin level. Our results indicated that 37.1% of patients might be susceptible to B-19 infection and remained at risk for being infected, mainly during epidemic periods. As B-19 infection can be treated with immune globulin preparations, it may be included in the diagnostic approach toward chronic anaemia in HIV-infected patients.

Doppler velocimetry of the ophthalmic artery in normal pregnancy: reference values

OBJECTIVE

This study aimed at analyzing the correlation between ophthalmic Doppler indices and gestational age (GA) in healthy patients with singleton pregnancies. Intraobserver reproducibility and right-to-left eye correlation were also evaluated.

METHODS

Healthy pregnant women (n = 289) at 20 to 40 weeks' GA were evaluated. The resistive index (RI), pulsatility index (PI), and peak ratio (PR) were determined by 2 measurements in each eye. Comparisons were performed first between the 2 measurements in each eye and later between the right and left eyes. Spearman rank correlation was used to analyze the relationship of the RI, PI, and PR with GA. Linear regression analysis was also performed.

RESULTS

No significant differences were found between the values obtained for the first and the second measurements in each eye and those for the RI, PI, and PR in the right and left eyes. There was a significant decrease in RI and PI values with advancing GA, however (rho = -0.264 and -0.1192, respectively), with low R(2) values for both. Thus, only a small proportion of the variations observed in the RI and PI was associated with changes in GA. No significant difference was found between the PR values with regard to GA intervals.

CONCLUSIONS

Doppler velocimetry is a reproducible technique for evaluation of the RI, PI, and PR in the ophthalmic artery. Unilateral analysis of these indices can be used. Linear regression analysis indicated that other factors were associated with a decrease in the RI and PI values with advancing GA. No significant change was observed in the PR values throughout normal pregnancy.