Association of genitourinary infections and cervical length with preterm childbirth

A prospective cohort study was conducted on a convenience sample of 1370 pregnant women with a gestational age of 20 to 25 weeks in the city of Ribeirão Preto. Data on obstetrical history, maternal age, parity, smoking habit, and a history of preterm delivery was collected with the application of a sociodemographic questionnaire. Cervical length was determined by endovaginal ultrasound, and urine and vaginal content samples were obtained to determine urinary tract infection (UTI) and bacterial vaginosis (BV), respectively. The aim of this study was to verify the association of cervical length and genitourinary infections with preterm birth (PTB). Ultrasound showed no association of UTI or BV with short cervical length. PTB rate was 9.63%. Among the women with PTB, 15 showed UTI (RR: 1.55, 95%CI: 0.93-2.58), 19 had BV (RR: 1.22, 95%CI: 0.77-1.94), and one had both UTI and BV (RR: 0.85, 95%CI: 0.13-5.62). Nineteen (14.4%) PTB occurred in women with a cervical length ≤2.5 cm (RR: 2.89, 95%CI: 1.89-4.43). Among the 75 patients with PTB stratified as spontaneous, 10 showed UTI (RR: 2.02, 95%CI: 1.05-3.86) and 14 had a diagnosis of BV (RR: 1.72, 95%CI: 0.97-3.04). A short cervical length between 20 and 25 weeks of pregnancy was associated with PTB, whereas UTI and BV determined at this age were not associated with short cervical length or with PTB, although UTI, even if asymptomatic, was related to spontaneous PTB.

Antiretroviral agents and acid-base balance at delivery of the neonate

Limited evidence is available regarding antiretroviral (ARV) safety for uninfected infants exposed to these drugs in utero. Our objective was to determine if ARV administered to pregnant women is associated with decreasing umbilical arterial pH and base excess in uninfected infants. A prospective study was conducted on 57 neonates divided into three groups: ZDV group, born to mothers taking zidovudine (N = 20), triple therapy (TT) group, born to mothers taking zidovudine + lamivudine + nelfinavir (N = 25), and control group (N = 12), born to uninfected mothers. Umbilical cord blood was used to determine umbilical artery gases. A test was performed to calculate the sample by comparing means by the unpaired one-tailed t-test, with a = 0.05 and ß = 20 percent, indicating the need for a sample of 18 newborn infants for the study groups to detect differences higher than 20 percent. The control and ARV groups were similar in gestational age, birth weight, and Apgar scores. Values of pH, pCO2, bicarbonate, and base excess in cord arterial blood obtained at delivery from the newborns exposed to TT were 7.23, 43.2 mmHg, 19.5 mEq/L, and -8.5 nmol/L, respectively, with no significant difference compared to the control and ZDV groups. We conclude that intrauterine exposure to ARV is not associated with a pathological decrease in umbilical arterial pH or base excess. While our data are reassuring, follow-up is still limited and needs to be continued into adulthood because of the possible potential for adverse effects of triple antiretroviral agents.

Prevalencia de anticuerpos antitiroglobulina y antimicrosomales en enfermedad tiroidea autoinmune / Antithyroglobulin and microsomal antibodies prevalence in autoimmune thyroid disease

Objetivo: Analizar la prevalencia de anticuerpos antitiroideos en enfermedades tiroideas, su relación con variables clínicas y epidemiológicas, y su utilidad diagnóstica. Métodos: Se determinaron anticuerpos antimicrosomales y antitiroglobulina por aglutinación de partículas de gelatina en 32 pacientes sanos (25 mujeres, 7 hombres) y 108 (92 mujeres, 16 hombres) con enfermedad tiroidea; diagnosticados por examen clínico, confirmados por laboratorio y cuando fue necesario por ecografía, pruebas de captación, biopsia y otras. Se consideró la patología, edad y sexo de los pacientes. Resultados: Las enfermedades tiroideas autoinmunitarias predominaron sobre las no autoinmunes en la población estudiada, 64,8 por ciento vs 35,2 por ciento. Los anticuerpos antimicrosomales fueron positivos en altos títulos en la mayoría de los pacientes con enfermedad de Graves y Hashimoto, mientras que pacientes con enfermedades tiroideas no autoinmune presentaron baja frecuencia. La prevalencia de anticuerpos anti tiroglobulina en enfermedades tiroideas autoinmunes fue significativamente menor a la de antimicrosomales, (44,3 por ciento vs 98,6 por ciento p<0,05). Aunque no fue estadísticamente significativo, se encontró cierta asociación entre enfermedades tiroideas autoinmunes y otros desórdenes autoinmunes (Enfermedad de Addison) y no autoinmunes (Diabetes mellitus tipo II). No hubo relación entre parotiditis previa y autoinmunidad tiroidea. Los anticuerpos antimicrosomales mostraron mayor sensibilidad que los antitiroglobulina (98,6 por ciento y 44,3 por ciento), con especificidad comparable (85,7 por ciento y 95,7 por ciento). Conclusiones: Debido a la mayor prevalencia y sensibilidad presentada por los anticuerpos antimocrosomales, el diagnóstico de tiroiditis autoinmune podría basarse en la valoración de dichos anticuerpos, con determinación de anticuerpos antitiroglobulina en casos especiales. Existen factores hereditarios involucrados en el desarrollo de enfermedades autoinmunes tiroideas