Postpartum changes in plasma viral load and CD4 percentage among HIV-infected women from Latin American and Caribbean countries: the NISDI Perinatal Study

The goal of this study was to evaluate changes in plasma human immunodeficiency virus (HIV) RNA concentration [viral load (VL)] and CD4+ percentage (CD4 percent) during 6-12 weeks postpartum (PP) among HIV-infected women and to assess differences according to the reason for receipt of antiretrovirals (ARVs) during pregnancy [prophylaxis (PR) vs. treatment (TR)]. Data from a prospective cohort of HIV-infected pregnant women (National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study) were analyzed. Women experiencing their first pregnancy who received ARVs for PR (started during pregnancy, stopped PP) or for TR (initiated prior to pregnancy and/or continued PP) were included and were followed PP. Increases in plasma VL (> 0.5 log10) and decreases in CD4 percent (> 20 percent relative decrease in CD4 percent) between hospital discharge (HD) and PP were assessed. Of the 1,229 women enrolled, 1,119 met the inclusion criteria (PR: 601; TR: 518). At enrollment, 87 percent were asymptomatic. The median CD4 percent values were: HD [34 percent (PR); 25 percent (TR)] and PP [29 percent (PR); 24 percent (TR)]. The VL increases were 60 percent (PR) and 19 percent (TR) (p < 0.0001). The CD4 percent decreases were 36 percent (PR) and 18 percent (TR) (p < 0.0001). Women receiving PR were more likely to exhibit an increase in VL [adjusted odds ratio (AOR) 7.7 (95 percent CI: 5.5-10.9) and a CD4 percent decrease (AOR 2.3; 95 percent CI: 1.6-3.2). Women receiving PR are more likely to have VL increases and CD4 percent decreases compared to those receiving TR. The clinical implications of these VL and CD4 percent changes remain to be explored.

Captaçäo de células endovervicais colunares na colheita colpocitógica: o estudo comparativo de uma espátula de Ayre modificada / Capture of endocervical columnar cells in the cervical cytology colletion: the study of a modified Ayre spatula

Os autores transformaram a espátula de Ayre Original visando otimizar a colheita endocervical. O estudo verificou se a habilidade da espátula modificada em colher células endocervicais colunares é próxima da obtida pela combinaçäo espátula Ayre-Cytobrush e melhor do que a da espátula de Ayre. Foram avaliados 276 esfregaços. A combinaçäo espátula de Ayre-Cytobrush apresentou o melhor desempenho na produçäo de células endocervicais colunares. Quando comparada à combinaçäo espátula de Ayre-Cytobrush, a espátula modificada produziu menor sangramento (x²=7,98;p=0,004) e näo foi inferior na produçäo de grupos de células endocervicais colunares de escore III (x²=0,26;p=0,6). Quando defrontada com a espátula de Ayre, foi estatisticamente superior na produçäo de densidade celular endocervical (t=5,96;p<0,001) e de grupos de células endocervicais colunares dos escores I, II e III (x²=6,94,p=0,008;x²=24,40,p=0,0000008 e x²=9,59, p=0,002, respectivamente). Conclui-se que a espátula modificada de Ayre, podendo ser utilizada em populaçöes onde o uso do Cytobrush for impossível

Taquicardia ventricular paroxística durante a gravidez após infarto agudo do miocárdio complicado por formaçäo de aneurisma ventricular / Paroxysmal ventricular tachycardia during pregnancy after acute myocardial infarction complicated with formation of ventricular aneurysm

Taquicardia ventricular paroxística durante a gravidez, secundária a infarto agudo do miocárdio complicado por formaçao de aneurisma em ventrículo esquerdo é incomum. É descrito um caso desta perigosa associaçao com ênfase para sua conduçao e as complicaçoes maternas e fetais.