Fetal Growth Restriction - a 4-Year Case Series

Overview and aims: Fetal growth restriction (FGR) affects 15% of pregnancies and is associated with both increased perinatal and neonatal morbidity and mortality and long-term effects in adult life. Our aim was to describe cases and outcomes of FGR from a tertiary perinatal care centre and identify the predictors of neonatal morbidity and mortality. Study design: retrospective cohort. Population: pregnancies with early or late FGR caused by placental factors followed from 2006 to 2009 in a tertiary perinatal care centre. Methods: we collected data from clinical records on demographics, clinical history and fetal ultrasound parameters. Perinatal and neonatal outcomes were stratiied according to gestational age (above or below 28 weeks) and we used bivariate analysis to identify any associations with clinical and imaging indings. Results: we included 246 pregnancies; hypertension was the most prevalent maternal risk factor (16%). There were 15 cases of early FGR, 11 of which had cesarean delivery due to deterioration of fetal Doppler parameters. Outcomes in this group included one fetal and three neonatal deaths. Of 231 cases of late FGR, 64% were delivered early given a non-reassuring fetal status i.e. due to changes in Doppler evaluation or altered Manning biophysical proile. There were four cases of perinatal death in this group, three of which delivered at 28 weeks. Neonatal morbidity was associated with lower gestational age, lower birthweight and progressive placental dysfunction (p<0.01). Conclusion: there was an association between neonatal morbidity and gestational age, birthweight and Doppler deterioration, particularly for deliveries below 28 weeks. The assessment of vascular changes through Doppler analysis allows anticipation of fetal deterioration and is a helpful tool in deciding the optimum timing of delivery

Ovarian Hyperstimulation Syndrome in a Spontaneous Pregnancy

Introdução: O Síndrome de Hiperestimulação do Ovário (SHO) geralmente é descrito como uma complicação iatrogénica dos tratamentos de indução da ovulação. Raramente, pode estar associado a ciclos ovulatórios espontâneos, sendo mais frequente em gravidez múltipla, patologia molar e hipotiroidismo. A apresentação clínica é variável, podendo nos casos mais graves ser fatal. Caso clínico: Grávida de 13 semanas, nulípara, sem história de tratamentos de infertilidade, referenciada por aumento bilateral do volume ovárico e ascite. Apresentava ligeiro desconforto abdominal, tendo a ecografia revelado ovários aumentados de volume, multiquísticos e ascite ligeira. Os níveis de estradiol estavam aumentados, com hCG e TSH normais. A terapêutica foi expectante, com uma evolução favorável. Discussão: O SHO espontâneo apesar de ser uma entidade rara, deve ser equacionada como hipótese diagnóstica nas situações de massa pélvica na gravidez. Estão descritos 3 possíveis mecanismos para o SHO espontâneo, baseados na permissividade do receptor ovárico da FSH para a hCG e/ou TSH, podendo ocorrer com níveis normais ou elevados de hCG e/ou TSH.

First Trimester Prediction of Pre-Eclampsia in Low Risk Pregnancies: Determining the Cut-Off in a Portuguese Group

Objective:We aimed to identify the cut-off for risk of pre-eclampsia (PE) in Portuguese population by applying the first trimester prediction model from Fetal Medicine Foundation (FMF) in a prospective enrolled cohort of low risk pregnant women. Population and methods: A prospective cohort of low risk singleton pregnancies underwent routine first-trimester scree - ning from 2011 through 2013. Maternal characteristics, blood pressure, uterine artery Doppler, levels of pregnancy-associated plasma protein-A (PAPP-A) and free b-human chorionic gonadotropin were evaluated. The prediction of PE in first trimester was calculated through software Astraia, the outcome obtained from medical records and the cutoff value was subse quently calculated. Results:Of the 273 enrolled patients, 7 (2.6%) developed PE. In first trimester women who developed PE presented higher uterine arteries resistance, represented by higher values of lowest and mean uterine pulsatility index, p <0.005. There was no statistical significance among the remaining maternal characteristics, body mass index, blood pressure and PAPP-A. Using the FMF first trimester PE algorithm, an ideal cut-off of 0.045 (1/22) would correctly detect 71% women who developed PE for a 12% false positive rate and a likelihood ratio of 12.98 (area under the curve: 0.69; confidence interval 95%: 0.39-0.99). By applying the reported cutoff to our cohort, we would obtain 71.4% true positives, 88.3% true negatives, 11.4% false positives and 28.6% false negatives. Conclusion: By applying a first trimester PE prediction model to low risk pregnancies derived from a Portuguese population, a significant proportion of patients would have been predicted as high risk. New larger studies are required to confirm the present findings

Septic Shock Following Hysteroscopy. A Case Report

Introduction: Minimally invasive gynecological surgery such as hysteroscopy has a small risk of complications. These include uterine perforation (with or without adjacent pelvic organ lesion), bleeding and infection, and are more common in the presence of risk factors such as smoking, history of pelvic inflammatory disease (PID) and endometriosis. Case presentation: A patient submitted to a diagnostic hysteroscopy with no immediate complications was admitted five days later to the emergency department in septic shock. The diagnosis of ruptured tubal abscess was made, requiring emergency laparotomy with sub-total hysterectomy and bilateral adnexectomy. Despite multiple organ failure requiring admission to the intensive care unit, the patient made a full recovery. Conclusion: Ascending infection can be a life-threatening complication of hysteroscopy, even in the absence of previously known risk factors.info:eu-repo/semantics/publishedVersio

Pilomatrixoma Recurring As Giant Form

Pilomatrixoma is a benign skin tumor that originates from the hair matrix. It usually appears in children and young adults and is preferably in the head and neck region. It clinically presents as an asymptomatic firm, solitary subcutaneous mass of less than 3 cm. When located in the preauricular area, it is often misdiagnosed as benign or malignant parotids, skin tumors, or sebaceous cysts. Its treatment of choice is surgery, and recurrence is due to incomplete excision. We present a case of a male referred to our hospital with a diagnosis of recurrent pilomatrixoma in its giant form. The lesion was fully excised with no signs of recurrence and no functional impairment.info:eu-repo/semantics/publishedVersio

Relationship Between Coronary Disease and Subclinical Hypothyroidism: an Angiographic Study

INTRODUCTION: The definition of subclinical hypothyroidism (SH) is an asymptomatic state in which free thyroxine (T4) is normal and thyroid-stimulating hormone (TSH) levels are elevated. Its relationship with coronary disease is not clear and has been the subject of recent interest. Current evidence is conflicting and there is a lack of studies supported by coronary angiography. OBJECTIVE: To assess the relationship between SH and the presence and extent of coronary disease diagnosed by angiography. METHODS: We prospectively studied 354 consecutive patients referred for elective coronary angiography. Those with known thyroid disease, documented coronary disease or previous myocardial infarction were excluded. Fasting blood specimens were collected to measure thyroid hormones, lipid profile, high-sensitivity C-reactive protein, fibrinogen and NT-proBNP. Patients with SH were compared with those without to assess differences in clinical characteristics and biochemical and angiographic results. Significant coronary disease was defined as the presence of at least one lesion with > or = 50% luminal stenosis. Lesions with <50% stenosis were considered minimal. RESULTS: SH was diagnosed in 32 (9%) patients. Mean age was similar between the groups. There were more women (66% vs. 39%; p=0.003) and atrial fibrillation was more frequent (25% vs. 11%; p=0.016) in the group of patients with SH. There were no significant differences in the other baseline clinical parameters, and blood biochemistry results were similar in the two groups, with the exception of higher levels of NT-proBNP in SH patients, although without statistical significance. The angiographic results were as follows: significant coronary disease (SH 28.1% vs. non-SH 43.8%; p=0.087); three-vessel disease (9.4% vs. 9.9%; p=0.919); two-vessel disease (12.5% vs. 13.4%; p=0.892); single-vessel disease (6.3% vs. 29.5%; p=0.051); minimal lesions (9.4% vs. 10.9%; p=0.794); and no coronary disease (62.4% vs, 45.3%; p=0.064). CONCLUSION: In this population SH was not associated with the presence or extent of coronary disease diagnosed by coronary angiography

Displasia Cimento Óssea Florida: Apresentação Rara de um Problema Comum

Introdução A displasia cimento-óssea (DCO) é a lesão fibro-óssea mais comum. Pensa-se que a DCO tem origem no ligamento periodontal. Outros acreditam que tem origem num defeito da remodelação óssea desencadeada por lesões locais. Com base nas características clínicas e radiográficas, as DCO dividem-se em focal, periapical e florida. A DCO florida caracteriza-se por um envolvimento multifocal não limitado aos segmentos anteriores. Esta forma afecta sobretudo mulheres melanodérmicas com particular incidência nos adultos de meia-idade e idosos. Caracteriza-se por lesões bilaterais e por vezes simétricas. Normalmente estas lesões são assintomáticas podendo tratar-se de achados radiográficos. Noutros casos pode haver dor ligeira, fístulas alveolares e exposição óssea. Raramente pode haver expansão óssea. Radiograficamente, apresentam um padrão semelhante às outras formas de DCO. Inicialmente as lesões são radiotransparentes, adquirindo um padrão misto e posteriormente tornam-se radiopacas com halo radiotransparente. Caso Clínico Mulher, 53 anos, originária da Índia, com Diabetes Mellitus tipo 2. Vai a consulta de Cirurgia de Cabeça e Pescoço no IPO Lisboa enviada pelo médico de família com a informação de ser seguida em Oncologia na Índia por “neoplasia óssea com atingimento a nível de mandíbula e maxilar superior com destruição óssea progressiva”. Clinicamente refere desde há 20 anos parestesias na hemimandíbula esquerda com instalação de dor há 10 anos. Com recente irradiação da dor para a nuca. À observação tem gengivite tartárica, sem outras alterações. Traz consigo duas TC-Cone Beam (2012 e 2017) que mostram a existência e evolução de cinco lesões junto às regiões de 13-14, 23-25, 33, 36 e 46. As múltiplas lesões eram sugestivas do diagnóstico de DCO florida. Pediu-se TC Maxilofacial e manteve-se a sob vigilância medicando-se sintomaticamente. Discussão e Conclusões Nas DCO periapical e florida, os achados clínicos e radiográficos permitem fazer um diagnóstico presuntivo. As características da DCO focal são menos específicas e por isso a biopsia pode ser necessária. A DCO não tem natureza neoplásica e geralmente não requer remoção sendo que para um paciente assintomático a reavaliação periódica e o controlo da doença periodontal estão indicados. Raramente, estas lesões apresentam um crescimento progressivo (displasia óssea expansiva) com necessidade de remoção. Em geral, o prognóstico é bom. O desenvolvimento de sarcomas em áreas de DCO está relatado mas é muito raro.info:eu-repo/semantics/publishedVersio

Infeção da Cavidade Oral Associada a Ventilação Não Invasiva

info:eu-repo/semantics/publishedVersio

Development and application of a tri-allelic PCR assay for screening Vgsc-L1014F kdr mutations associated with pyrethroid and organochlorine resistance in the mosquito Culex quinquefasciatus

Background: Culex quinquefasciatus has a widespread distribution across tropical and sub-tropical regions, and plays an important role in the transmission of vector-borne diseases of public health importance, including lymphatic filariasis (LF) and multiple arboviruses. Increased resistance to insecticides threatens the efficacy and sustainability of insecticide-based anti-vector interventions which mitigate the burden of mosquito transmitted diseases in endemic regions. In C. quinquefasciatus two non-synonymous voltage gated sodium channel (Vgsc) variants, both resulting in a leucine to phenylalanine change at codon 1014, are associated with resistance to pyrethroids and DDT. This tri-allelic variation has compromised the ability to perform high-throughput single-assay screening. To facilitate the detection and monitoring of the Vgsc-1014 locus in field-caught mosquitoes, an Engineered-Tail Allele-Specific-PCR (ETAS-PCR) diagnostic assay was developed and applied to wild mosquitoes from Brazil, Tanzania and Uganda. Results: This new cost-effective, single-tube assay was compared to two, well-established, genotyping approaches, pyrosequencing and TaqMan. The ETAS-PCR assay showed high specificity for discriminating the three alleles at Vgsc-L1014F, with genotyping results strongly correlated with pyrosequencing and TaqMan results (98.64% and 100% respectively). Conclusions: Our results support the utility of the ETAS-PCR/Vgsc-1014 diagnostic assay, which stands as an effective alternative for genotyping tri-allelic variants