Noncompliance to iodine supplementation recommendation is a risk factor for iodine insufficiency in Portuguese pregnant women: results from the IoMum cohort.

PURPOSE: After a recommendation for iodine supplementation in pregnancy has been issued in 2013 in Portugal, there were no studies covering iodine status in pregnancy in the country. The aim of this study was to assess iodine status in pregnant women in Porto region and its association with iodine supplementation. METHODS: A cross-sectional study was conducted at Centro Hospitalar Universitário São João, Porto, from April 2018 to April 2019. Pregnant women attending the 1st trimester ultrasound scan were invited to participate. Exclusion criteria were levothyroxine use, gestational age < 10 and ≥ 14 weeks, non-evolutive pregnancy at recruitment and non-signing of informed consent. Urinary iodine concentration (UIC) was measured in random spot urine by inductively coupled plasma-mass spectrometry. RESULTS: Median UIC was 104 µg/L (IQR 62-189) in the overall population (n = 481) of which 19% had UIC < 50 µg/L. Forty three percent (n = 206) were not taking an iodine-containing supplement (ICS) and median UIC values were 146 µg/L (IQR 81-260) and 74 µg/L (IQR 42-113) in ICS users and non-users, respectively (p < 0.001). Not using an ICS was an independent risk factor for iodine insufficiency [adjusted OR (95% CI) = 6.00 (2.74, 13.16); p < 0.001]. Iodised salt use was associated with increased median iodine-to-creatinine ratio (p < 0.014). CONCLUSIONS: A low compliance to iodine supplementation recommendation in pregnancy accounted for a mild-to-moderately iodine deficiency. Our results evidence the need to support iodine supplementation among pregnant women in countries with low household coverage of iodised salt. Trial registration number NCT04010708, registered on the 8th July 2019.

Shaping efficiency as a function of time of a new heat-treated instrument.

AIM: To assess the shaping ability of the new XP-endo Shaper instrument after different working times. METHODOLOGY: Ten mesial roots of mandibular molars were scanned in a micro-computed tomographic device and prepared using the XP-endo Shaper instrument up to the working length (WL) according to the manufacturer's recommendation. Then, each specimen was subjected to an extra 15, 30 and 45 s of active instrumentation at the WL. Postoperative scans were performed after canal preparation at each time-point. Then, the registered pre- and postoperative datasets were examined to evaluate the percentages of volume and surface area of the instrumented canal, surface area of noninstrumented canal areas and the volume of removed dentine. Repeated measures general linear model was used to compare the differences in either the increase or the reduction of the parameters amongst the time-points. Alpha-error was set at 5%. RESULTS: Extending the period of XP-endo Shaper active instrumentation at WL significantly influenced several parameters such as volume (P < 0.001) and surface area (P < 0.001) of the instrumented canal, surface area of noninstrumented canal areas (P < 0.001), and volume of removed dentine (P < 0.001). CONCLUSIONS: Extending the activation time of XP-endo Shaper instruments at WL resulted in a more comprehensive root canal preparation, increasing the volume and surface area of root canal preparation and the volume of removed dentine.

Revisiting amniotic band sequence: a wide spectrum of manifestations.

OBJECTIVE: To describe the spectrum of clinical deformities related to amniotic band sequence (ABS), ranging from mild to severe. METHODS: Retrospective evaluation of 9 cases of ABS managed during a 4-year period (February 2006 to April 2010) in a tertiary hospital. RESULTS: The median gestational age at prenatal diagnosis was 15 weeks (range 11-26). Only 2 patients had clinical prenatal evidence of amnion rupture. In the other 5 cases the diagnosis of ABS was established prenatally based on fetal structural abnormalities. These abnormalities included: (1) upper limb defects: syndactyly, amputation at the level of phalanges or first metacarpal or forearm; (2) inferior extremities defects: tallus equinovarus and flexed knee, and constriction ring; (3) umbilical cord strangulation, and (4) acrania. CONCLUSION: ABS is a polymorphous syndrome and recognizing its various manifestations can be of help in prenatal identification.

A parallel increase in placental oxidative stress and antioxidant defenses occurs in pre-gestational type 1 but not gestational diabetes.

We aimed to determine the oxidative stress status in placentas obtained from gestational (GDM) and type 1 (T1D) diabetic pregnancies. Malonaldehyde and protein carbonyls, two biomarkers of oxidative damage, were higher in T1D but not in GDM placentas. Also, higher reduced glutathione and lower oxidized glutathione levels and higher glutathione peroxidase activity were found in T1D but not in GDM placentas. These results suggest that T1D placentas may develop a protective antioxidant mechanism to overcome higher oxidative stress levels.

Phenotypic variability in fetuses with down syndrome: a case-control pathological evaluation.

OBJECTIVES: Evaluation of morphological and morphometric characteristics of fetuses with Down syndrome based on a detailed postmortem examination and comparison of these fetuses with a control group of fetuses with normal karyotype to improve the prenatal knowledge of Down syndrome characteristics. MATERIAL AND METHODS: A case-control study was undertaken in a tertiary referral hospital. The Down syndrome fetuses (50) were compared with chromosomally normal fetuses (47) matched for gestational age. Biometric and morphological parameters were compared. RESULTS: The biometry of fetuses with Down syndrome differs from control fetuses only in the occipitofrontal diameter and in the nasal bone length. There were craniofacial anomalies in 96% of fetuses with Down syndrome and in 51% of fetuses with normal karyotype. With the exception of small ears, all craniofacial features analyzed were significantly different between Down syndrome fetuses and control fetuses. All extremity features of fetuses with Down syndrome were significantly different from fetuses without Down syndrome. There were 31 fetuses with Down syndrome (62%) with 55 internal anomalies. Nineteen fetuses (38.8%) showed 27 cardiac anomalies. Six fetuses had more than one anomaly. There were 18 fetuses (36%) with 28 noncardiac anomalies. DISCUSSION: The importance of studying the morphological characteristics of fetuses with Down syndrome is the contribution to a better knowledge of fetal characteristics and probably to optimize prenatal diagnosis.

Systematic fetal autopsy in cases of medical termination of pregnancy due to chromosomal abnormalities: improving the quality of perinatal care?

OBJECTIVES: Evaluation of the clinical utility of systematically performing autopsy after termination of pregnancy (TOP) due to chromosomal abnormalities. METHODS: A retrospective study of cases of TOP due to chromosomal abnormalities was performed between 1 January 2002 and 30 September 2007, in a tertiary referral hospital. A comparative study between prenatal ultrasonographic findings and postmortem findings was performed. RESULTS: There were 57 cases of TOP due to chromosomal abnormalities. The median gestational age at TOP was 17 (range 14-24 weeks). There were 46 trisomies, 4 monosomies, 4 triploidies and 3 cases of structural anomalies. In 25 cases (43.9%) there was at least one major anomaly detected by ultrasound. In 15 cases (26.3%) additional information was obtained after fetal autopsy: in 7 cases further major structural anomalies were detected, and in 8 cases the presence of a major abnormality was not confirmed by the autopsy. CONCLUSION: Fetal autopsy may provide additional information to the ultrasonographic morphological evaluation of the fetus submitted to TOP due to chromosomal abnormalities. The combination of prenatal ultrasound and pathological examination can broaden our knowledge of the natural history of chromosomal anomalies in the earlier stages of development and eventually contribute to improve the quality of perinatal care.

Concordance for bilateral congenital diaphragmatic hernia in a monozygotic dichorionic twin pair - first clinical report.

The authors present a clinical case of concordance for bilateral congenital diaphragmatic hernia in a monozygotic twin pair diagnosed in the early second trimester.

Renal tubular dysgenesis: report of two cases in a non-consanguineous couple and review of the literature.

Renal tubular dysgenesis is a rare congenital abnormality of renal development characterized by short and poorly developed proximal convoluted tubules. It is associated to late-appearing oligohydramnios, Potter's sequence, pulmonary hypoplasia and calvarial bone hypoplasia with enlarged fontanels. The onset of oligohydramnios is delayed and variable, normally later than 22 weeks of gestation, conditioning variation in the expression of the other deformities. We report 2 cases of renal tubular dysgenesis occurring in a non-consanguineous couple.

Procedimiento EXIT en tumefacción cervical voluminosa / Ex utero intrapartum treatment (EXIT) procedure in giant fetal cervical mass

Introducción. La utilización conjunta de la ecografía y la resonancia magnética (RM) ha mejorado el diagnóstico prenatal de las anomalías fetales, permitiendo optimizar la actuación perinatal. Su uso complementario principalmente en masas cervicales fetales voluminosas, con obstrucción de las vías aéreas, ha mejorado el diagnóstico y pronóstico en estas situaciones que pueden tener un desarrollo negativo por la dificultad de la intubación traqueal. Presentamos un caso de tumefacción cervical fetal en el que se recurrió a la utilización del procedimiento EXIT. Caso clínico. Embarazada de 36 años, 2 gesta, para 1, fue referida al Centro de Diagnóstico Prenatal a las 32 semanas por sospecha de tumefacción cervical fetal. La ecografía demostró una masa cervical anterolateral derecha, de 8 cm de diámetro, con contenido heterogéneo y líquido amniótico aumentado. La RM confirmó la presencia de la masa, multilobulada y compleja, en la región cervical derecha, desplazando la vía aérea hacia la izquierda. Debido a la sospecha de obstrucción de vías aéreas se constituyó un equipo multidisciplinario para la realización del procedimiento EXIT. Tras la exteriorización de la cabeza y cuello fetal y con la circulación umbilical mantenida se intentó la intubación endotraqueal por laringoscopia y broncoscopia rígida. Debido a la imposibilidad de la intubación fue necesario proceder a la resección parcial de la masa. La intubación endotraqueal se consiguió y el cordón se clampó 50 minutos después del inicio de la cirugía. El pH de la arteria umbilical fue de 7,26. Discusión. El procedimiento EXIT debe ser utilizado para garantizar el acceso a la vía aérea fetal, manteniendo la circulación fetoplacentaria. Un equipo multidisciplinario (obstetricia, anestesia, neonatología, cirugía pediátrica, otorrinolaringología, radiología) es fundamental para el éxito de la intervención

Introduction. Combined use of ultrasonography and fetal magnetic resonance imaging (MRI) has improved prenatal diagnosis of fetal anatomic malformations, and consequently has optimised the perinatal management and outcome. We present a case in which prenatally a large fetal neck mass was diagnosed and a successful EXIT procedure was performed. Case report. A 36-year-old gravida 2, para 1 was referred to our Prenatal Diagnosis Center at 32 weeks gestation because of a fetal neck mass. Ultrasound examination showed a fetal neck mass of 8 cm diameter (antero-lateral, right) and polyhydramnios. The MRI showed a multiloculated complex mass in the right cervical region, trusted aside the airway. A multidisciplinary team was formed for EXIT procedure realization. Immediately after the delivery of the head, while the feto-placental circulation is preserved, we tried the orotracheal intubation by direct laryngoscopy and rigid broncoscopy. As these procedures were unsuccessful, partial resection of the mass was necessary. The orotracheal intubation was performed and the umbilical cord was clamped 50 min after the begin of surgery. The umbilical artery pH was 7.26. Discussion. The EXIT procedure can be used to obtain a fetal airway while feto-maternal circulation is preserved. A multidisciplinary team (obstetrics, anesthesia, neonatology, pediatric surgery, otorhinolaryngology, imagiology) is required for successful intervention

[Sarcoma of endometrial stroma (SEE). Clinical and pathological prognostic factors]. / Sarcoma do Estroma Endometrial (SEE). Factores de prognóstico clínicos e patológicos.

Endometrial Stromal Sarcomas are rare neoplasms, accounting for 0.2% of female genital tract malignancies. They occur predominantly in post menopausal women, although they can develop during the reproductive years or even in childhood. The most important prognostic factors are the patient's age at diagnosis, FIGO surgical stage, myometrial invasion, mitotic index, DNA index and tumoral necrosis. In this study we try to evaluate the main prognostic factors in the women treated in the Portuguese Oncology Institute in Oporto. From the study of the 14 patients with the diagnosis of endometrial stromal sarcoma, between 1974 and 1995, we can conclude that the main factors influencing the outcome were FIGO surgical staging, mitotic index and myometrial invasion.

Circadian oscillation of nitrate reductase activity in Gonyaulax polyedra is due to changes in cellular protein levels.

A circadian rhythm in the activity of nitrate reductase (NR; EC 1.6.6.1) isolated from the marine dinoflagellate Gonyaulax polyedra is shown to be attributable to the daily synthesis and destruction of the protein. The enzyme was purified in three steps: gel filtration on S-300 Sephacryl, an Affigel-Blue column, and a diethylaminoethyl ion-exchange column. Undenatured protein shows a molecular mass of about 310 kD; based on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, the enzyme appears to be composed of six possibly identical subunits. The amino acid composition of the G. polyedra NR is very similar to that reported for the NR of barley leaves, Chlorella vulgaris, and Ankistrodesmus braunii. The experiments reported indicate that the cellular expression of NR is under circadian control. In extracts of cells grown under either constant dim light or a light-dark cycle, the activity of NR exhibits a daily rhythm, peaking at midday phase, as does photosynthesis. Staining with affinity-purified polyclonal antibodies, raised in rabbits against purified NR, shows that the amount of protein changes by a factor of about 10, with the maximum occurring in midday phase.

[Incidence of and mortality from malignant tumors inthe municipality of++Vila Nova de Gaia: 1981-1987]. / Incidência e mortalidade por tumores malignos no Concelho de Vila Nova de Gaia: 1981-1987.

Data from the population based Cancer Registry of Vila Nova de Gaia for the 1981-1987 period are presented. Cancer is becoming a disease increasingly frequent in Portugal, causing progressively higher mortality rates. Population and geographic characteristics of Vila Nova de Gaia country is presented. Information sources of this Registry are hospitals, pathology labs, Health Authority files and death certificates. Net (229.2, 216.6) and standardized for european population (369.9, 245.9) incidence rates are presented for respectively men and women. Comparisons with registries from other countries (e.s.) are made.

Histiocitose sinusal com linfadenopatia maciça: revisäo e apresentaçäo de um caso / Sinus histiocytosis with massive lymphadenopathy: review and report of a case

Relata-se um caso de Histiocitose Sinusal com Linfadenopatia Maciça (SH ML) diagnosticado em criança de 8 anos. Depois de apresentados aspectos clínicos, säo comentados os resultados de exames laboratoriais e radiográficos, os quais complementam a fundamentaçäo do diagnóstico, que se baseou principalmente na histologia de linfonodos cervical. O processo regrediu paulatinamente e resultou em cura espontânea