Anti-staphylococcal effects of Myracrodruon urundeuva lectins on nonresistant and multidrug resistant isolates.

AIMS: To evaluate the anti-staphylococcal effects of lectins isolated from bark (MuBL), heartwood (MuHL) and leaves (MuLL) of Myracrodruon urundeuva. METHODS AND RESULTS: The lectins were evaluated for: effects on growth, aggregation, haemolytic activity and biofilm-forming ability of Staphylococcus aureus clinical isolates nonresistant (8325-4) and multidrug resistant (LAC USA300); interference with the expression of virulence genes (hla, rnaIII and spa) of the Agr system of S. aureus; and synergistic effect with the antibiotics cefoxitin and cefotaxime. MuBL, MuHL and MuLL reduced growth (minimal inhibitory concentration (MIC): 12·5-50 µg ml-1 ) and viability (minimal bactericidal concentration (MBC): 100 µg ml-1 ) of 8325-4 and LAC USA300 cells. MuLL (at ½MIC and MIC) reduced LAC USA300 agglutination. The lectins did not interfere with haemolytic activity and expression of hla, rnaIII and spa genes. Only MuHL was able to reduce the biofilm production by 8325-4 (50-400 µg ml-1 ) and LAC USA300 (400 µg ml-1 ). CONCLUSION: The M. urundeuva lectins showed antibacterial activity against nonresistant and resistant clinical isolates of S. aureus and synergistic effects with antibiotics in reducing growth and biofilm formation. SIGNIFICANCE AND IMPACT OF THE STUDY: This work reports bioactive molecules capable of acting as anti-staphylococcal agents, since there are increasing reports of multiresistant isolates of this bacterium.

Percutaneous fetoscopic closure of large open spina bifida using a bilaminar skin substitute.

OBJECTIVE: We have described previously our percutaneous fetoscopic technique for the treatment of open spina bifida (OSB). However, approximately 20-30% of OSB defects are too large to allow primary skin closure. Here we describe a modification of our standard technique using a bilaminar skin substitute to allow closure of large spinal defects. The aim of this study was to report our clinical experience with the use of a bilaminar skin substitute and a percutaneous fetoscopic technique for the prenatal closure of large OSB defects. METHODS: Surgery was performed between 24.0 and 28.9 gestational weeks with the woman under general anesthesia, using an entirely percutaneous fetoscopic approach with partial carbon dioxide insufflation of the uterine cavity, as described previously. If there was enough skin to be sutured in the midline, only a biocellulose patch was placed over the placode (single-patch group). In cases in which skin approximation was not possible, a bilaminar skin substitute (two layers: one silicone and one dermal matrix) was placed over the biocellulose patch and sutured to the skin edges (two-patch group). The surgical site was assessed at birth, and long-term follow-up was carried out. RESULTS: Percutaneous fetoscopic OSB repair was attempted in 47 consecutive fetuses, but surgery could not be completed in two. Preterm prelabor rupture of membranes (PPROM) occurred in 36 of the 45 (80%) cases which formed the study group, and the mean gestational age at delivery was 32.8 ± 2.5 weeks. A bilaminar skin substitute was required in 13/45 (29%) cases; in the remaining 32 cases, direct skin-to-skin suture was feasible. There were 12 cases of myeloschisis, of which 10 were in the two-patch group. In all cases, the skin substitute was located at the surgical site at birth. In five of the 13 (38.5%) cases in the two-patch group, additional postnatal repair was needed. In the remaining cases, the silicone layer detached spontaneously from the dermal matrix (on average, 25 days after birth), and the lesion healed by secondary intention. The mean operating time was 193 (range, 83-450) min; it was significantly longer in cases requiring the bilaminar skin substitute (additional 42 min on average), although the two-patch group had similar PPROM rate and gestational age at delivery compared with the single-patch group. Complete reversal of hindbrain herniation occurred in 68% of the 28 single-patch cases and 33% of the 12 two-patch cases with this information available (P < 0.05). In four cases there was no reversal; half of these occurred in myeloschisis cases. CONCLUSIONS: Large OSB defects may be treated successfully in utero using a bilaminar skin substitute over a biocellulose patch through an entirely percutaneous approach. Although the operating time is longer, surgical outcome is similar to that in cases closed primarily. Cases with myeloschisis seem to have a worse prognosis than do those with myelomeningocele. PPROM and preterm birth continue to be a challenge. Further experience is needed to assess the risks and benefits of this technique for the management of large OSB defects. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Comparative analysis of perinatal outcomes among different typesof deliveries in term pregnancies in a reference maternity of Southeast Brazil.

OBJECTIVE: To compare the perinatal outcomes of women undergoing an elective cesarean section (CS) with those who had an emergency CS during the labor. DESIGN: Retrospective cohort study. SETTING: Hospital Estadual Azevedo Lima (HEAL), Niteroi, Brazil. METHODS: We analysed elective CS, emergent CS and vaginal delivery as dependent variables and neonatal data (admission in intensive care unit) as independent variables. Using the Statement of Live Birth during a three-month period, all patients who had their children after 38 complete weeks of pregnancy were selected. χ2 test and Student t-tests were applied to compare the groups. RESULTS: When patients who had vaginal delivery were compared with those who had an elective CS, we observed 219 normal deliveries with 1.8% of hospitalizations in neonatal intensive care units (NICU), and 88 patients of elective CS with 2.3% of admissions in closed units (p = 0.401). We had a sample of 108 newborns delivered by CS during the labor with 8.3% rate of hospitalization in NICU versus 1.8% of 219 newborns delivered vaginally (p = 0.005). CONCLUSION: The worst perinatal outcomes occurred when emergency CS were performed.

Diastasis of rectus abdominis in the immediate puerperium: correlation between imaging diagnosis and clinical examination.

AIM: Diastasis of rectus abdominis is a condition defined as a separation between this muscle and the linea alba, which leads to weakness in the abdominal muscles. Later, such weakness will influence the biomechanical posture causing back pain in women. In the present study, our aim was to assess the accuracy of clinical examination in measuring diastasis of rectus abdominis in the postpartum period. METHOD: Puerperal women (n=106) were selected for this study, including caesarean delivery (62 %) and vaginal delivery (38 %). Diastasis of rectus abdominis was measured in the postpartum period using clinical examination and ultrasonography, at four levels of the anterior sheath of the rectus abdominis, in the region above the umbilical scar. RESULTS: At each level of measurement, the results were statistically analyzed using the Student's t and Pearson tests (confidence interval 95 %), Bland-Altman plot, and Kappa test. The Student t test showed no significant difference between clinical examination and ultrasonography. The Pearson test showed correlation with positive coefficients; moderate correlation (r > 0.5) in the first levels (3, 6, and 9 cm) and a strong correlation (r > 0.75) in the last level (12 cm). In the Kappa test, 65 % of diagnoses given in the clinical examination were confirmed by ultrasonography. CONCLUSIONS: These results show a good agreement between both forms of examination, allowing clinical examination to be used in the diagnosis of rectus muscle diastasis, when ultrasonography is not available.

PP082. Ophthalmic artery doppler for identification of severe preeclampsia in pregnancies complicated by hypertension.

INTRODUCTION: Hypertension is the most common disorder that occurs during pregnancy and one of the main causes of maternal mortality worldwide. Among the hypertensive disorders that affect pregnancy, preeclampsia (PE) is the major cause of maternal mortality, maternal morbidity, perinatal death, prematurity and intrauterine growth restriction. The acute cerebral complications in PE account for at least 75% of maternal death. Central nervous system hemodynamic modifications in PE are a controversial issue. Neurological involvement in PE-eclampsia syndrome fulfills the criteria of posterior reversible encephalopathy syndrome (PRES). The pathophysiology of PRES is still under investigation. Assessment of cerebral circulation is challenging. Noninvasive techniques, especially transcranial Doppler sonography, are becoming more widely used to evaluate cerebral flow. Ophthalmic artery Doppler is a noninvasive examination used to study central vascular flow that has been shown to be a promising method in the evaluation of pregnant women with hypertension. OBJECTIVES: The aim of this study was to compare the ophthalmic artery Doppler indices observed in singleton pregnant women complicated by hypertension (study group) and to correlate the indices observed in hypertensive pregnant women with those observed in normal pregnant women (control group). METHODS: Ophthalmic artery Doppler indices of 30 mild and 30 severe pre-eclamptic women and 30 pregnant women with chronic hypertension (CH) at 20-40weeks of gestational age (GA) were compared. The control group consisted of 289 healthy pregnant women. Resistance index (RI), pulsatility index (PI), and peak ratio (PR) were determined in the right eye. The mean and SD were calculated for each group. Analysis of variance (ANOVA) was used to compare Doppler indexes means between groups. As significant differences were determined by ANOVA analysis, each group was compared by the Tukey method. Receiver operating characteristics (ROC) curves were used to determine the predictive power of ophthalmic artery Doppler indexes for the identification of severe pre-eclamptic women. P<0.05 was considered statistically significant. RESULTS: Significant differences were found between the values obtained for RI, PI, and PR in severe PE women compared to the other groups (study and control). The mean and SD for IR, IP and PR in mild PE, severe PE and CH groups were respectively 0.73 (±0.06), 1.63 (±0.35) and 0.65 (±0.10); 0.63 (±0.09), 1.13 (±0.31) and 0.89 (±0.12); 0.73 (±0.07), 1.66 (±0.49) and 0.66 (±0.14). The mean and SD for IR, IP and PR in normotensive pregnant women were 0.75 (±0.05), 1.88 (±0.43), 0.52 (±0.10). The optimal cut-off values for IR, IP and PR for the identification of severe pre-eclamptic women determined by roc curves was 0.657, 1.318, 0.784 (sensitivity and specificity were 0.633 and 0.919, 0.733 and 0.888, 0.833 and 0.974, respectively). The area under the ROC curve for IR was 0.787(95% CI: 0.68-0.89), for IP was 0.797 (95% CI: 0.69-0.90) and for PR was 0.886 (95% CI: 0.80-0.96). CONCLUSION: Ophthalmic Doppler is a useful method in the identification of severe PE. PR was best ophthalmic Doppler index at discriminating between severe PE and pregnant women with mild PE or chronic hypertension as determined by roc curve.

Coagulant and antibacterial activities of the water-soluble seed lectin from Moringa oleifera.

AIMS: The aim of this work was to analyse the coagulant and antibacterial activities of lectin isolated from Moringa oleifera seeds that are used for water treatment. METHODS AND RESULTS: The water-soluble M. oleifera lectin (WSMoL) was separated from nonhemagglutinating components (NHC) by chitin chromatography. WSMoL fluorescence spectrum was not altered in the presence of ions that are often present in high concentrations in polluted waters. Seed extract, NHC and WSMoL showed coagulant activity on a turbid water model. Both NHC and WSMoL reduced the growth of Staphylococcus aureus, but only WSMoL caused a reduction in Escherichia coli. WSMoL was also more effective in reducing the growth of ambient lake water bacteria. CONCLUSIONS: Data obtained from this study indicate that WSMoL is a potential natural biocoagulant for water, reducing turbidity, suspended solids and bacteria. SIGNIFICANCE AND IMPACT OF THE STUDY: Moringa oleifera seeds are a material effective in the treatment of water.

Three-dimensional ultrasound fetal urinary bladder volume measurement: reliability of rotational (VOCAL) technique using different steps of rotation.

OBJECTIVE: The aim of the study was to investigate the inter- and intraobserver reliability in measuring the fetal bladder volume by 3d ultrasound imaging by VOCAL. In addition a comparison of 15 degrees and 30 degrees rotation steps calculation had been performed. METHODS: Measurements (n = 240) of FB volume were performed in 30 low-risk patients with gestation times ranging from 22 to 39 weeks by two independent observers blind to each other. All fetuses were examined and no ultrasound detectable malformation was found. The volume for each FB was measured twice by the observers who used the Virtual Organ Computed-aided Analysis (VOCAL) technique. Distinct sets of 12 and 6 planes were obtained after sequential rotations of 15 degrees and 30 degrees, respectively. The internal contour of fetal bladder was determined manually and carefully as to exclude adjacent structures from volume calculation. Wilcoxon signed-rank test was used for the comparison of paired samples in the cases of replication within and between observers. Spearman's rank correlation was used to study the relationship among angles. Bland and Altman's graphical approach was used to investigate the agreement between observers. RESULTS: Both techniques were shown to be highly reliable. No significant difference was found between the measurements of FB volume with the VOCAL technique by varying either the steps of rotation or the observers. CONCLUSION: Excellent correlations were found for both observers in the use of rotation angles of 15 degrees and 30 degrees . Since a significantly faster evaluation was obtained by using a 30 degrees rotation step it must be preferred to assess the FB volume. Our results show that the VOCAL technique, with a plane rotation of 30 degrees , can be used in a simple way to estimate fetal urine production.