The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study

Aims: To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. Methods: Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. Results: Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59–3.87), large for gestational age (OR 3.99, 95% CI 2.40–6.63), fetal malformation (OR 2.66, 95% CI 1.00–7.18), and respiratory distress (OR 4.33, 95% CI 1.33–14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00–2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04–3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02–2.27) and obesity (OR 1.62, 95% CI 1.04–2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21–2.33 for obese; OR 1.38 95% CI 1.03–1.87 for overweight). Conclusions: A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity

Na mira do olhar: um exercício de análise da fotografia nas revistas ilustradas cariocas, na primeira metade do século XX

This article presents a historical approach for the analysis of photographic images, followed by the application of these theoretical and methodological considerations to a series of photographs issued in two popular magazines, published in the city of Rio de Janeiro between 1900 and 1960. Through the analysis of the photographic message, class behaviour codes are related to their social representations.Este artigo traz considerações sobre a análise histórica de imagens fotográficas, aplicando as propostas teórico-metodológicas apresentadas a uma série fotográfica composta pelas imagens de duas revistas ilustradas, Careta e O Cruzeiro, publicadas na cidade do Rio de Janeiro entre 1900 e 1960. Por meio da análise da mensagem fotográfica relaciona-se a elaboração dos códigos de comportamento de classe às suas representações sociais

A coleção fotográfica de Marcel Gautherot

Considering contemporary Anthropologys debate around photography, there is a\ud keen interest in the understanding of one of the most important open to public consultation\ud photographic collections on 20th Century Brazil, that of Frenchman Marcel Gautherot (1910-\ud 1996). The collection comprises around 25,000 photographs, purchased in 1999 by Instituto\ud Moreira Salles and kept in its fund in the city of Rio de Janeiro. The text comments on the\ud photographers work, linked to documentary projects under the patronage of institutions such as\ud the Musée de l´Homme in Paris, at the end of the 1930s, and both the National Historic and\ud Artistic Patrimony Service and the Brazilian Folklore Defence Campaign, in Brazil, between the\ud years of 1940 -1960. Such commitments and interests define important thematic groupings in\ud the production and organisation of his personal photographic archive. A discussion about criteria and technical procedures adopted by the photographer is attempted, detailing series\ud and visual narratives about Brazilian cultures density. With the photographs purchase by the\ud IMS, the oeuvres aesthetic quality, now as an institutional collection, is highlighted. The collections\ud manners of preservation and conservation, reproduction and circulation are redefined

Acute pontine syndromes following head injury

Patients in the early stage of severe head injuries occasionally present with a clinical picture analogous to that in vascular or neoplastic pontine lesions and they can be identified by careful clinical examination and by repeated electroencephalography (E.E.G.). The commonest features in these cases were preservation of consciousness, constriction of the pupils, disturbances of reflex ocular motility, severe pyramidal deficits, decerebrate rigidity, myoclonic manifestations, irregular breathing, and cranial nerve palsies. An E.E.G. tracing similar to the normal pattern was a common finding. These observations suggest that pontine syndromes may be directly produceg a non-reacting, but conscious, patient for one who is deeply comatose

Intracranial meningiomas in the elderly [Meningiomi endocranici negli anziani: una sfida diagnostica prima che terapeutica].

No abstract availabl

Microsurgical removal of petroclival meningiomas: a report of 33 patients

This is a report of 33 consecutive cases of petroclival meningioma treated surgically at our institution over the last 10 years; there were 21 women and 12 men between the ages of 27 and 68 (mean age, 52). All patients were assessed by computed tomographic scans including coronal sections and bone algorithm studies; in most cases, digital subtraction angiography and magnetic resonance imaging were also done. The largest tumor diameter was between 2 and 3.5 cm in 14 cases, 3.5 to 6 cm in 15 cases, and over 6 cm in 4 cases. Dural attachment predominantly involved the clivus and apical petrous bone on one side only; in 14 cases, however, the tumor grew over the clivus midline or crossed the tentorial notch. Cranial nerve deficit was extant in all cases and was commensurate with tumor size. Cerebellar signs and somatic motor deficits were present in 60 and 30% of cases, respectively. The surgical approaches used were the retromastoid-retrosigmoid in 23 cases, subtemporal in 5 cases, and combined retromastoid subtemporal presigmoid in the remaining 5. Total removal was achieved in 26 cases (79%); incomplete removal occurred in 7 cases (21%). The extent of tumor removal and operative morbidity were not significantly related to tumor size. Brain stem indentation, arterial and cranial nerve encasement, and epidural invasion were the main factors that prevented total tumor removal and influenced operative morbidity. There was no intraoperative mortality, but three patients (9%) died perioperatively. In the postoperative period, most patients went through momentary neurological deterioration, chiefly due to new cranial nerve deficits. The average follow-up was 4.3 years in 27 patients; of these 17 were unchanged and 10 were improved. Before surgery, only 13 patients were self-sufficient; at long-term follow-up, another 6 had achieved independence. Our experience suggests that, even though real petroclival meningiomas still represent a formidable surgical challenge, such tumors can in most cases be removed completely with low attendant mortality and acceptable morbidity