Clinical assessment and brain findings in a cohort of mothers, fetuses and infants infected with ZIKA virus.

BACKGROUND: Congenital Zika virus (ZIKV) infection can be detected in both the presence and absence of microcephaly and manifests as a number of signs and symptoms that are detected clinically and by neuroimaging. However, to date, qualitative and quantitative measures for the purpose of diagnosis and prognosis are limited. OBJECTIVES: Main objectives of this study conducted on fetuses and infants with confirmed congenital Zika virus infection and detected brain abnormalities were (1) to assess the prevalence of microcephaly and the frequency of the anomalies that include a detailed description based on ultrasound and magnetic resonance imaging in fetuses and ultrasound, magnetic resonance imaging, and computed tomography imaging postnatally, (2) to provide quantitative measures of fetal and infant brain findings by magnetic resonance imaging with the use of volumetric analyses and diffusion-weighted imaging, and (3) to obtain additional information from placental and fetal histopathologic assessments and postnatal clinical evaluations. STUDY DESIGN: This is a longitudinal cohort study of Zika virus-infected pregnancies from a single institution in Colombia. Clinical and imaging findings of patients with laboratory-confirmed Zika virus infection and fetal brain anomalies were the focus of this study. Patients underwent monthly fetal ultrasound scans, neurosonography, and a fetal magnetic resonance imaging. Postnatally, infant brain assessment was offered by the use of ultrasound imaging, magnetic resonance imaging, and/or computed tomography. Fetal head circumference measurements were compared with different reference ranges with <2 or <3 standard deviations below the mean for the diagnosis of microcephaly. Fetal and infant magnetic resonance imaging images were processed to obtain a quantitative brain volumetric assessment. Diffusion weighted imaging sequences were processed to assess brain microstructure. Anthropometric, neurologic, auditory, and visual assessments were performed postnatally. Histopathologic assessment was included if patients opted for pregnancy termination. RESULTS: All women (n=214) had been referred for Zika virus symptoms during pregnancy that affected themselves or their partners or if fetal anomalies that are compatible with congenital Zika virus syndrome were detected. A total of 12 pregnant patients with laboratory confirmation of Zika virus infection were diagnosed with fetal brain malformations. Most common findings that were assessed by prenatal and postnatal imaging were brain volume loss (92%), calcifications (92%), callosal anomalies (100%), cortical malformations (89%), and ventriculomegaly (92%). Results from fetal brain volumetric assessment by magnetic resonance imaging showed that 1 of the most common findings associated with microcephaly was reduced supratentorial brain parenchyma and increased subarachnoid cerebrospinal fluid. Diffusion weighted imaging analyses of apparent diffusion coefficient values showed microstructural changes. Microcephaly was present in 33.3-58.3% of the cases at referral and was present at delivery in 55.6-77.8% of cases. At birth, most of the affected neonates (55.6-77.8%) had head circumference measurements >3 standard deviations below the mean. Postnatal imaging studies confirmed brain malformations that were detected prenatally. Auditory screening results were normal in 2 cases that were assessed. Visual screening showed different anomalies in 2 of the 3 cases that were examined. Pathologic results that were obtained from 2 of the 3 cases who opted for termination showed similar signs of abnormalities in the central nervous system and placental analyses, including brain microcalcifications. CONCLUSION: Congenital microcephaly is not an optimal screening method for congenital Zika virus syndrome, because it may not accompany other evident and preceding brain findings; microcephaly could be an endpoint of the disease that results from progressive changes that are related to brain volume loss. Long-term studies are needed to understand the clinical and developmental relevance of these findings.

Asociación entre adiponectina y el síndrome de ovario poliquístico. Revisión de la literatura / Association between adiponectin and polycystic ovary syndrome: review of the literature

Objetivo: evaluar la literatura existente respecto a la asociación entre la adiponectina y el síndrome de ovario poliquístico (SOP). Materiales y métodos: se realizó una búsqueda bibliográfica en las bases de datos electrónicas Scielo, lilacs, PubMed vía ovid, así como de revistas indexadas y sociedades médicas reconocidas tales como Fertility and Sterility, The European Journal of Endocrinology, The Journal of Biological Chemistry, Human Reproduction y Nature Medicine. Resultados: se revisaron 75 títulos, de los cuales 50 cumplían con nuestros criterios de selección, correspondientes a diseños de tipo transversal, casos y controles, y un metaanálisis. Los niveles de adiponectina sérica fueron menores en mujeres con síndrome de ovario poliquístico. Los resultados respecto a los niveles de adiponectina y la obesidad son contradictorios en mujeres con y sin SOP. Es escasa la información respecto a esta asociación en la población latinoamericana. Conclusión: la literatura muestra que hay una asociación entre los niveles bajos de adiponectina y las mujeres que presentan síndrome de ovario poliquístico, independientemente de la presencia o no de obesidad

Objective: To review the existing literature on the association between adiponectin and polycystic ovary syndrome (POS). Materials and methods: A search of the literature was conducted in the Scielo, lilacs and PubMed electronic databases via ovid, as well as in indexed journals and recognized medical societies such as Fertility and Sterility, The European Journal of Endocrinology, The Journal of Biological Chemistry, Human Reproduction and Nature Medicine. Results: Overall, 75 titles were reviewed and 50 were found to meet our selection criteria. They included cross-sectional, case-controls studies and one meta-analysis. Serum adiponectin levels were lower in women with polycystic ovary syndrome. Results regarding adiponectin levels and obesity are conflicting in women with and without POS. There is little information about this association in the Latin American population.Conclusión: The literature shows an association between low adiponectin levels and women with polycystic ovary syndrome, regardless of the presence or absence of obesity

Acretismo diagnóstico prenatal mediante ultrasonido y resonancia magnética y su correlación histopatológica en Barranquilla (Colombia) / Placenta accreta: prenatal diagnosis by ultrasonography and magnetic resonance imaging correlated with histopathological results in Barranquilla, Colombia

Introducción: el acretismo y percretismo se asocian con antecedentes de placentas previas y cesáreas anteriores, las cuales se han incrementado en nuestro medio. Por este motivo, su detección anteparto es fundamental en el propósito de disminuir el riesgo de morbimortalidad materna. Objetivo: evaluar la utilidad del ultrasonido (US) y la resonancia magnética (RM) en el diagnóstico prenatal de este trastorno adherencial placentario. Metodología: el presente es un estudio de cohorte prospectivo que incluyó a once mujeres en tercer trimestre de embarazo con antecedentes de placenta previa y cesárea anterior, a las cuales se les practicó US transabdominal y transvaginal, Doppler color y resonancia magnética, buscando signos de acretismo, los cuales fueron comparados con los hallazgos durante el parto y la histopatología. Resultados: el ultrasonido mostró una sensibilidad de 70% (IC95% 35,4-91,9). En contraste, el Doppler color y la resonancia magnética evidenciaron una sensibilidad de 90% (IC 95% 54,1-99,5). Conclusión: en pacientes con placenta previa y cesárea anterior, el US y el Doppler color surgen como una herramienta útil en la detección de acretismo placentario; sin embargo, se requieren mayores estudios para confirmar su validez diagnóstica.

Introduction: An increased risk of placenta accreta and placenta percreta is associated with patients having had previous caesarean deliveries or placenta previa; such conditions have been increasing of late. Prenatal detection may be helpful in reducing maternal morbidity and mortality. Objective: evaluating the usefulness of ultrasound (US) and magnetic resonance (MR) for prenatal detection of abnormal placental separation. Methodology: this was a prospective study which included 11 patients in the third trimester of pregnancy having a history of previou scaesarean and placenta previa. Transabdominal and transvaginal US, colour Doppler and MR were thus performed, seeking signs of placenta accreta; these were compared to histopathological findings and data from when birth was given. Results: US and MR had 70% sensitivity (95% CI 35.4-91.9) whilst colour Doppler had 90% sensitivity (95%CI 54.1-99.5). Conclusions: US and colour Doppler US might be useful, highly sensitive techniques for detecting abnormal adherence of the placenta in patients having a history of placenta previa and previous caesarean deliveries. Further studies are required for confirming their diagnostic validity.