Follow-up of infants born to mothers with Graves' disease.

INTRODUCTION: The prevalence of neonatal hyperthyroidism (HN) due to maternal Graves Disease (GD) ranges from 0.1 to 2.7%. It may occur in pregnant women with the following: active DG, after treatment with radioactive iodine, anti-thyroid or thyroidectomy or with a previous child with hyperthyroidism. The aim of our observational study was to evaluate the follow-up of infants born to mothers with GD at a Tertiary Hospital prior to the implementation of a follow-up protocol. METHODS: This was a retrospective observational study using data from the medical records of mothers with a diagnosis of GD and their newborns from January 2013 until May 2018. Newborns were divided into two groups: high and low risk for NH according to maternal TRAb, third trimester treatment and signs of fetal hyperthyroidism. RESULTS: We identified 31 newborns, 58% female; 87% high risk. In none of the newborns was umbilical cord blood collected. In the high risk group, 22% had thyroid function evaluation at day-1, one patient presented with hyperthyroidism and 82% were asymptomatic. Considering the cases with an insufficient blood sample for analysis, 9 consultations would have been spared. We found a significant delay in obtaining the high-risk group results which would have spared 10 appointments. A positive correlation was found between age at outpatient clinic discharge and the number of appointments and the maternal TRAb titer. CONCLUSION: The correct surveillance of pregnancy and newborns with identification of those at high risk is essential to avoid unnecessary consultations and blood analyses that increase parental anxiety and hospital costs. Consequently, a multidisciplinary protocol was created to standardize the approach.

Intra- and Extra-Hospital Dissemination of IMP-22-Producing Klebsiella pneumoniae in Northern Portugal: The Breach of the Hospital Frontier Toward the Community.

The emergence of infections (and colonization) with Enterobacteriaceae-producing carbapenemases is a threatening public health problem. In the last decades, we watched an isolated case becoming a brutal outbreak, a sporadic description becoming an endemic problem. The present study aims to highlight the dissemination of IMP-22-producing Klebsiella pneumoniae in the North of Portugal, through the phenotypic and genotypic characterization of isolates collected from hospitalized patients (n=5) and out-patients of the emergency ward of the same acute care hospital (n=2), and isolates responsible for the intestinal colonization of residents in a Long-Term Care Facility (n=4). Pulsed-field gel electrophoresis (PFGE) results, associated with conjugation experiments pointed to a pattern of both vertical and horizontal dissemination. Overall, and complementing other studies that give relevance to IMP-22-producing K. pneumoniae in the clinical settings, here we show for the first time the public health threatening breach of the hospital frontier of this resistance threat, toward the community.

Early Inflammatory Biomarkers as Predictive Factors for Freedom from Infection after Colorectal Cancer Surgery: A Prospective Cohort Study.

PURPOSE: Different biomarkers are useful in diagnosing infections. The aim of this work was to clarify the relation between different inflammatory biomarkers (white blood cell [WBC] count, C-reactive protein [CRP], procalcitonin [PCT], and C-reactive protein-to-albumin ratio [CAR]) and early infectious complications after colorectal surgery. METHODS: This prospective single-center cohort study included 130 patients undergoing elective colorectal surgery. The WBC count, CRP, and PCT were measured at post-operative day one (POD1) and POD3 and albumin on POD3. RESULTS: Patients with surgical site infections (SSI) exhibited significantly higher CRP concentrations on POD1 and CRP and CAR on POD3 than did patients without SSI. According to receiver operating characteristic analysis, the CRP concentration on POD1 and the CRP and CAR on POD3 showed the highest area under the curve (AUC) for predicting SSI (AUC 0.639, 0.736, and 0.729, respectively). Multivariable logistic regression analysis showed that CRP on POD1 and CRP and CAR on POD3 were independent predictors of SSI (odds ratio 7.355, 7.605, and 8.337, respectively). CONCLUSIONS: The CRP concentration on PO1 and CRP and CAR on POD3 can positively identify patients at low risk of SSI. They can be used as a prognostic tool to predict an uneventful post-operative period and therefore have been incorporate into our discharge criteria after elective colorectal resection, improving clinical decision-making.

Alcohol use in adolescence: 5 years admissions at a pediatric emergency department.

Objective To characterize the profile and pattern of alcohol consumption in adolescents, admitted with acute alcoholic intoxication (AAI) at a pediatric emergency department of North Portugal. Methods Retrospective descriptive study of adolescents aged between 10 and 17 years, admitted with AAI between 2012 and 2016. The following variables were evaluated: age, gender, drinking context, quantity and type of alcohol, Glasgow Coma Scale (GCS), previous episodes, associated injuries, transport to the emergency department, other drug consumption, blood alcohol level (BAL), blood glucose level, treatment and orientation. The χ2/Fisher's exact test and t-Student test were performed (p < 0.05). Results A total of 180 adolescents with AAI presented. The majority of adolescents were older than 15 years old (71%) and 3% were younger than 14 years old. The mean age was 15.9 years [standard deviation (SD) 1.1 years] and 65% were males. The most common type of alcohol consumed was distilled drinks (60%). Recurrent alcohol use was identified in 7% and binge drinking was reported in 37% of patients. The mean BAL was 1.58 g/L (SD 0.6 g/L) and there were other drug consumptions (mainly cannabinoids) observed in 11% of patients. After emergency department discharge, 17% were followed at hospital consultation. There was no significant difference between boys and girls or between BAL and injuries or other drugs consumption. Conclusion This study confirms a high rate of alcohol use among adolescents, in particular "heavy episodic drinking", revealing an easy access to alcohol at this age. The integration of alcohol use prevention programs in community and education systems should be encouraged and implemented in every adolescent consultation.

[Hepatitis A virus prevalence: Portuguese first results of low endemicity]. / Prevalência do vírus da hepatite A: primeiros resultados de baixa endemicidade em Portugal.

The prevalence of the hepatitis A virus in a population determines the degree of morbidity associated with this illness, that is, the higher the morbidity, the lower the prevalence. This study aims to obtain the prevalence of total antibody to the hepatitis A virus in children, 5 and 8 years of age, and in adolescents, 14 years of age. The study was based on two samples: the serum of 64 healthy five-year-olds and 76 healthy eight-year-olds living in the proximity of the São Marcos Hospital in Braga and the serum of 311 adolescents, aged 14, from a total population of 536 adolescents attending schools in Braga, North of Portugal. The samples were collected in 1999 for the adolescent group, in 2000 and 2001 for the group of the five-year-olds and in 2002 and 2003 for the group of the eight-year-olds. None of the persons involved had been vaccinated with the hepatitis A virus vaccine. The Enzyme Linked Fluorescent Assay method was used to measure the serum total antibody to the hepatitis A virus. The prevalence of total antibody to the hepatitis A virus was 1.6% at 5 years of age, [95% confidence intervals (CI), 0-4.7%]; 3.9% at 8 years of age, [95% CI, 0-8,4%]; and 32.5% at 14 years of age +/- 6 months, [95% CI, 27.3-37.7%]. The prevalence of total antibody to the hepatitis A virus in this population revealed lower natural immunity. The results obtained for the five and eight-year-olds were the first Portuguese results of low endemicity to the hepatitis A virus.

[Hepatitis B virus vaccination rate with immunization]. / Taxa de cobertura vacinal com imunização para o vírus da hepatite B.

UNLABELLED: The hepatitis B virus is an important cause of morbidity and mortality in humans, thus making it a serious public health issue. The purpose of this study was to determine the hepatitis B virus vaccination rate with immunization, the risk of this population group becoming infected before vaccination and the prevalence of hepatitis B virus infection. The study involved randomly analyzing the serum of 311 adolescents of both sexes aged 14 from a total population of 536 adolescents attending schools in Braga, Portugal. A questionnaire was administered to the adolescents and asked them if they had received the Hepatitis B vaccine, how many doses they received, if they had a history of acute hepatitis, drug abuse, whether or not they had had sexual intercourse and if so, if they had used protection. The determination of the hepatitis B surface antigen (HbsAg), the antibody to HbsAg and the antibody to hepatitis B core antigen was carried out using the chemoluminiscence method. The vaccination rate with immunization was 85.8 %, [95% CI 81.9-89.7%]. The prevalence of hepatitis B virus infection was 0.6%, [95% CI 0-1.5%]. CONCLUSIONS: The prevalence of hepatitis B virus infection was low in this adolescent population of Braga. The vaccination rate with immunization is satisfactory, but does not reach 100%, which means that the risk of transmission is still present in this age group.