ABSTRACT
BACKGROUND: Group B Streptococcus (GBS) is one of the most important causative agents of neonatal sepsis. As administration of prophylactic antibiotics during labor can prevent GBS infection, routine screening for this bacterium in prenatal care before the onset of labor is recommended. However, many women present in labor without having undergone such testing during antenatal care, and the turnaround time of detection methods is insufficient for results to be obtained before delivery. METHODS: Vaginal and anorectal specimens were collected from 270 pregnant women. Each sample was tested by Xpert GBS, qPCR, and culture for GBS detection. RESULTS: The overall prevalence of maternal GBS colonization was 30.7% according to Xpert GBS, 51.1% according to qPCR, and 14.3% according to cultures. Considering the qPCR method as the reference, the Xpert GBS had a sensitivity of 53% and specificity of 93%. Positive Xpert GBS results were correlated to marital status (married or cohabitating) and with prematurity as a cause of neonatal hospitalization. Positive cultures were related with ischemic-hypoxic encephalopathy requiring therapeutic hypothermia. CONCLUSIONS: Combined enrichment/qPCR and the Xpert GBS rapid test found a high prevalence of GBS colonization. The Xpert GBS technique gives faster results and could be useful for evaluating mothers who present without antenatal GBS screening results and are at risk of preterm labor, thus allowing institution of prophylactic antibiotic therapy.
Subject(s)
Infectious Disease Transmission, Vertical/prevention & control , Pregnancy Complications, Infectious/diagnosis , Prenatal Diagnosis/methods , Streptococcal Infections/diagnosis , Streptococcus agalactiae/isolation & purification , Adult , Bacteriological Techniques , Female , Humans , Pregnancy , Real-Time Polymerase Chain Reaction , Sensitivity and Specificity , Vagina/microbiology , Young AdultABSTRACT
AIM: Calciuria has been reported to decrease in preeclampsia. We compared calciuria among groups of normal, hypertensive and preeclamptic pregnant women, and assessed its correlation with the severity of the disease. MATERIAL AND METHODS: We conducted a case-control study of mild and severe preeclampsia, chronic hypertension, and normal pregnancy, with 14 patients in each group. The groups were analyzed by one-way anova (variance analysis) for symmetrical distribution and Kruskal-Wallis test for asymmetrical distribution when comparing quantitative variables, and by crossed tables when comparing qualitative variables. RESULTS: There were statistically significant differences between the groups when comparing severe preeclampsia with chronic hypertension, and severe preeclampsia with the control group (P < 0.0001). The calciuria medians were 81.5 mg/24 h for severe preeclampsia, 118 mg/24 h for mild preeclampsia, 226 mg/24 h for chronic hypertension, and 272 mg/24 h for the control group. In a ROC (receiver operating characteristic) curve analysis, the best cutoff point for preeclampsia diagnosis was 167 mg/24 h, with a sensitivity of 75% and a specificity of 85%. The outcomes were more severe as the level of calciuria dropped. CONCLUSION: Measurement of calciuria can differentiate between severe preeclampsia and chronic hypertension, and hypocalciuria is also a marker for disease severity.
Subject(s)
Calcium/urine , Pre-Eclampsia/urine , Adult , Case-Control Studies , Female , Humans , Hypertension/urine , Pregnancy , ROC Curve , Severity of Illness Index , Uric Acid/bloodABSTRACT
OBJECTIVE: To compare the expulsion rates of intrauterine devices (IUDs) inserted in the immediate postpartum after vaginal birth and cesarean section. METHODS: Nineteen patients who had a vaginal birth and 19 patients who had a cesarean section at Hospital de Clínicas de Porto Alegre, Brazil, were selected for copper T 380A IUD insertion. With the aim of detecting clinically unnoticed dislodged devices, ultrasound examinations were performed at 1 month and between 3 and 12 months after delivery. The IUDs were considered completely expelled when found outside the endometrial cavity (e.g., in the cervical canal) or outside the uterus (in the vagina). RESULTS: Expulsion rates were statistically different between the two groups: after a vaginal birth, 50% (ultrasound only) + 27.8% (clinical examination); and post-cesarean section, 0% (p < .001; OR 5.75, 95% CI 2.36-14.01). CONCLUSION: Considering that the contraceptive efficacy of IUDs is associated with their intrauterine location, the high expulsion rates seen when they are inserted immediately after vaginal delivery contraindicate their use in this setting. The use of IUDs immediately after a cesarean section is still a reasonable alternative because its expulsion rate was zero. Ultrasound assessment of IUD positioning performed better than clinical examination, which failed to detect expulsion after postpartum insertion in 75% of the cases (9 from 12 cases).
Subject(s)
Intrauterine Device Expulsion , Postpartum Period , Ultrasonography/methods , Adult , Cesarean Section , Female , Humans , Natural Childbirth , Pilot Projects , PregnancyABSTRACT
O abscesso da mama foi avaliado em 32 pacientes que procuraram o Serviço de Ginecolofia e Obstetrícia em 1990 e 1991. A idade média das pacientes era de 27 anos e 78 por cento delas eram puérperas. O Staphylococcus aureus foi o agente etiológico mais encontrado (90,64 por cento). A penicilina (89,6 por cento) e a ampicilina (75,8 por cento) apresentaram alta resistência. A eritromicina (89,6 por cento), a oxacilina (96,5 por cento), a cefalotina (96,5 por cento), a lincomicina (76,5 por cento), a vancomicina (100 por cento) e o sulfametoxazol-trimetoprim (89,6 por cento) apresentaram alta sensibilidade.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Abscess/drug therapy , Anti-Bacterial Agents/therapeutic use , Corynebacterium/drug effects , Breast Diseases/drug therapy , Escherichia coli/drug effects , Mastitis/drug therapy , Staphylococcus/drug effects , Abscess/etiology , Abscess/prevention & control , Causality , Breast Diseases/etiology , Mastitis/etiology , Microbial Sensitivity Tests , Prospective StudiesABSTRACT
No presente trabalho, relatamos um caso de tumor de células de Merkel (TCM) em uma mulher de 78 anos, localizado na regiäo pré-tibial esquerda, que apresentou comportamento agressivo local e disseminaçäo sistêmica. O diagnóstico baseou-se nos achados achados microscópicos e imuno-histoquímicos, especialmente na positividade a enolase neuronal específica (NSE). Considerando-se os achados clínicos e histopatológicos, incluem-se no diagnóstico diferencial as seguintes neoplasias: neuroblastoma, tumores carcinóide e de células das ilhotas de Langerhans, carcinoma de pequenas células do pulmäo, melanoma, linfomas e carcinoma metastático indiferenciado. O tratamento consistiu primariamente em ressecçäo cirúrgica do tumor. Após recidiva e comprometimento sistêmico, foram utilizados radioterapia e quimioterapia. É feita, também, uma revisäo da literatura