Hura crepitans Seeds for Control of Eimeria spp. in Lambs as an Alternative to Conventional Therapies.

To evaluate the anticoccidial effect of the Hura crepitans seed, 21 cross-breed lambs, 23 ± 3 kg live weight (PV) and 70 ± 6 days old, were used. Animals were housed individually in raised wire-mesh pens, with individual water troughs and feeders. Lambs were randomly divided into three groups (n = 7) that received different doses of Hura crepitans seeds: 4 g/kg B.W. (group 1), 6 g/kg B.W. (group 2) and 0 g/kg B.W. (control group or group 0). The treatment was administered at the beginning of the experiment once orally and the study lasted 21 days. Stool samples were taken for quantitative analysis of oocysts using the McMaster technique and blood for haematological and biochemical analysis. Lambs that received the seeds showed a higher excretion of coccidia oocysts between days 5 and 7 after treatment (p < 0.05) due to the antiparasitic effect of these seeds, without affecting their productive performance (daily feed intake (DFI)- total weight gain (TWG), daily weight gain (DWG)). In addition, the daily feed consumption (DFC) and dry matter intake (DMI) were similar between the groups. The analysed enzymes (ALT, AST, GGT and FA) and creatinine showed reference values. Only the urea and BUN levels were slightly increased, but without statistical difference between the groups. Therefore, the Hura crepitans seed, at doses of 4 and 6 g/kg, favours the expulsion of coccidial oocysts, without affecting either the health or the productive behaviour of lambs.

Improving the compromise between accuracy, interpretability and personalization of rule-based machine learning in medical problems.

One of the key challenges when developing a predictive model is the capability to describe the domain knowledge and the cause-effect relationships in a simple way. Decision rules are a useful and important methodology in this context, justifying their application in several areas, particularly in clinical practice. Several machine-learning classifiers have exploited the advantageous properties of decision rules to build intelligent prediction models, namely decision trees and ensembles of trees (ETs). However, such methodologies usually suffer from a trade-off between interpretability and predictive performance. Some procedures consider a simplification of ETs, using heuristic approaches to select an optimal reduced set of decision rules. In this paper, we introduce a novel step to those methodologies. We create a new component to predict if a given rule will be correct or not for a particular patient, which introduces personalization into the procedure. Furthermore, the validation results using three public clinical datasets suggest that it also allows to increase the predictive performance of the selected set of rules, improving the mentioned trade-off.

Blood Biochemical Variables Found in Lidia Cattle after Intense Exercise.

There are limited published data in the bovine species on blood biological variables in response to intense work or after significant physical exertion. Lidia cattle, in addition to their exercise components, have some behavioral agonistic features that make them more susceptible to stress. The bullfight involves stress and exercise so intense that it causes significant changes in some metabolic variables. The study objective was to evaluate changes in blood biological variables in response to intense exercise and stress. After the fight in the arena, and once the bulls were dead (n = 438), blood samples were taken, and some biochemical and hormonal variables were determined in venous blood. A descriptive analysis was performed using the Statistica 8.0. computer program. The mean (±s.d.) results obtained were: total protein (85.8 ± 10.8 g/dL), albumin (3.74 ± 4.3 g/dL), triglycerides (39.65 ± 0.16 mg/dL), cholesterol (2.44 ± 0.03 mmol/L), glucose (22.2 ± 9.6 mmol/L), uric acid (340 ± 80 µmol/L), creatinine (236.9 ± 0.4 µmol/L), urea (5.93 ± 1.27 mmol/L), LDH (2828 ± 1975 IU/L), CK (6729 ± 10,931 IU/L), AST (495 ± 462 IU/L), ALP (90 ± 33 IU/L), GGT (50 ± 34 IU/L), ALT (59 ± 35 IU/L), cortisol (117.5 ± 46.6 nmol/L), and testosterone (20.2 ± 23.8 nmol/L). Most of the measured variables clearly increased; thus, we found severe hyperglycemia and increases in LDH, AST, GGT, and ALT enzymes, particularly in CK. The increases in all these variables are justified by the mobilization of energy sources, tissue/muscle damage, and dehydration due to continued stress and intense exercise.

Prenatal Diagnosis of Aberrant Right Subclavian Artery: Association with Genetic Abnormalities.

OBJECTIVE: The objective of the present study was to determine the frequency of malformations and chromosomal abnormalities in a population of fetuses with an aberrant right subclavian artery (ARSA). METHODS: This is a 6-year retrospective study of fetuses with a prenatal diagnosis of ARSA conducted during the period between September 2013 and June 2019 at a fetal medicine unit. Data were collected from ultrasound, fetal echocardiograms, genetic studies, and neonatal records. RESULTS: An ARSA was diagnosed in 22 fetuses. An ARSA was an isolated finding in 18 out of 22 cases (82%). Associated abnormal sonographic findings were found in 4 cases. All cases underwent invasive testing. In 1 of the cases, a chromosomal abnormality was detected (mos 45,X [13]/46,X,e(X) (p22.1q22.1)). No cases of congenital heart disease were found in any of these fetuses. There were two cases in which the postnatal evaluation revealed a malformation: one case of hypospadias and 1 case of cleft palate. CONCLUSION: The presence of an isolated ARSA is benign and is not associated with chromosomal abnormalities. The finding of ARSA, however, warrants a detailed fetal ultrasound in order to exclude major fetal abnormalities and other soft markers.

OBJETIVO: O objetivo do presente estudo foi determinar a frequência de malformaçães e anomalias cromossômicas em uma população de fetos com artéria subclávia direita aberrante (ARSA). MéTODOS: Este é um estudo retrospectivo de 6 anos de fetos com diagnóstico pré-natal de ARSA realizado durante o período de setembro de 2013 a junho de 2019 em uma unidade de medicina fetal. Os dados foram coletados de ultrassom, ecocardiograma fetal, estudos genéticos e registros neonatais. RESULTADOS: Um ARSA foi diagnosticado em 22 fetos. Um ARSA foi um achado isolado em 18 dos 22 casos (82%). Achados ultrassonográficos anormais associados foram encontrados em 4 casos. Todos os casos foram submetidos a testes invasivos. Em um dos casos, foi detectada uma anormalidade cromossômica (mos 45, X [13] / 46, X, e (X) (p22.1q22.1)). Nenhum caso de doença cardíaca congênita foi encontrado em qualquer um desses fetos. Houve dois casos em que a avaliação pós-natal revelou a malformação: um caso de hipospádia e 1 caso de fenda palatina. CONCLUSãO: A presença de ARSA isolado é benigna e não está associada a anormalidades cromossômicas. O achado de ARSA, no entanto, justifica uma ultrassonografia fetal detalhada para excluir anormalidades fetais importantes e outros marcadores leves.

Effect of Intense Exercise on Plasma Macrominerals and Trace Elements in Lidia Bulls.

Minerals are inorganic substances present in all body tissues and fluids that directly or indirectly influence the maintenance of multiple metabolic processes and, therefore, are essential for the development of various biological functions. The Lidia bull breed may be considered an athlete, as during a bull fight it displays considerable physical effort of great intensity and short duration in a highly stressful situation. The objective of this study was to assess plasma minerals concentration (macro- and microminerals) in Lidia bulls after intense physical exercise during a bull fight. Plasma Ca, Mg, P, K, Na, Fe, Cr, Co, Ni, Cu, Zn, Se and Mo concentrations were measured in 438 male Lidia bulls. Ca, P and Mg were measured using a Cobas Integra autoanalyzer, while Na and K were determined by ICP-AES, and Fe, Cr, Co, Ni, Cu, Zn, Se and Mo were measured by ICP-MS. All macrominerals, (Ca: 2.96 ± 0.31, Mg: 1.27 ± 0.17, P: 3.78 ± 0.65, K: 7.50 ± 1.58, Na: 150.15 ± 19.59 in mmol/L), and Cr (1.24 ± 0.58), Ni (0.249 ± 1.07), Cu (22.63 ± 4.84) and Zn (24.14 ± 5.59, in µmol/L) showed greater mean values than the reported reference values in the published literature, while Co (0.041 ± 0.07), Se (0.886 ± 0.21) and Mo (0.111 ± 0.08, in µmol/L) values were lower than those reported for other bovine breeds. These increased concentrations could be justified mainly by muscle cell metabolism, hepatic need to provide energy, and intense dehydration and hemoconcentration by losses through sweat glands or urination.

A new approach for interpretability and reliability in clinical risk prediction: Acute coronary syndrome scenario.

INTRODUCTION: The risk prediction of the occurrence of a clinical event is often based on conventional statistical procedures, through the implementation of risk score models. Recently, approaches based on more complex machine learning (ML) methods have been developed. Despite the latter usually have a better predictive performance, they obtain little approval from the physicians, as they lack interpretability and, therefore, clinical confidence. One clinical issue where both types of models have received great attention is the mortality risk prediction after acute coronary syndromes (ACS). OBJECTIVE: We intend to create a new risk assessment methodology that combines the best characteristics of both risk score and ML models. More specifically, we aim to develop a method that, besides having a good performance, offers a personalized model and outcome for each patient, presents high interpretability, and incorporates an estimation of the prediction reliability which is not usually available. By combining these features in the same approach we expect that it can boost the confidence of physicians to use such a tool in their daily activity. METHODS: In order to achieve the mentioned goals, a three-step methodology was developed: several rules were created by dichotomizing risk factors; such rules were trained with a machine learning classifier to predict the acceptance degree of each rule (the probability that the rule is correct) for each patient; that information was combined and used to compute the risk of mortality and the reliability of such prediction. The methodology was applied to a dataset of 1111 patients admitted with any type of ACS (myocardial infarction and unstable angina) in two Portuguese hospitals, to assess the 30-days all-cause mortality risk, being validated through a Monte-Carlo cross-validation technique. The performance was compared with state-of-the-art approaches: logistic regression (LR), artificial neural network (ANN), and clinical risk score model (namely the Global Registry of Acute Coronary Events - GRACE). RESULTS: For the scenario being analyzed, the performance of the proposed approach and the comparison models was assessed through discrimination and calibration. The ability to rank the patients was evaluated through the area under the ROC curve (AUC), and the ability to stratify the patients into low or high-risk groups was determined using the geometric mean (GM) of specificity and sensitivity, the negative predictive value (NPV) and the positive predictive value (PPV). The validation calibration curves were also inspected. The proposed approach (AUC = 81%, GM = 74%, PPV = 17%, NPV = 99%) achieved testing results identical to the standard LR model (AUC = 83%, GM = 73%, PPV = 16%, NPV=99%), but offers superior interpretability and personalization; it also significantly outperforms the GRACE risk model (AUC = 79%, GM = 47%, PPV = 13%, NPV = 98%) and the standard ANN model (AUC = 78%, GM = 70%, PPV = 13%, NPV = 98%). The calibration curve also suggests a very good generalization ability of the obtained model as it approaches the ideal curve (slope = 0.96). Finally, the reliability estimation of individual predictions presented a great correlation with the misclassifications rate. CONCLUSION: We developed and described a new tool that showed great potential to guide the clinical staff in the risk assessment and decision-making process, and to obtain their wide acceptance due to its interpretability and reliability estimation properties. The methodology presented a good performance when applied to ACS events, but those properties may have a beneficial application in other clinical scenarios as well.

Prenatal Diagnosis of Aberrant Right Subclavian Artery: Association with Genetic Abnormalities / Diagnóstico pré-natal de artéria subclávia direita anômala: associação com anormalidades genéticas

Abstract Objective The objective of the present study was to determine the frequency of malformations and chromosomal abnormalities in a population of fetuses with an aberrant right subclavian artery (ARSA). Methods This is a 6-year retrospective study of fetuses with a prenatal diagnosis of ARSA conducted during the period between September 2013 and June 2019 at a fetal medicine unit. Data were collected from ultrasound, fetal echocardiograms, genetic studies, and neonatal records. Results An ARSA was diagnosed in 22 fetuses. An ARSA was an isolated finding in 18 out of 22 cases (82%). Associated abnormal sonographic findings were found in 4 cases. All cases underwent invasive testing. In 1 of the cases, a chromosomal abnormality was detected (mos 45,X [13]/46,X,e(X) (p22.1q22.1)). No cases of congenital heart disease were found in any of these fetuses. There were two cases in which the postnatal evaluation revealed amalformation: one case of hypospadias and 1 case of cleft palate. Conclusion The presence of an isolated ARSA is benign and is not associated with chromosomal abnormalities. The finding of ARSA, however, warrants a detailed fetal ultrasound in order to exclude major fetal abnormalities and other soft markers.

Resumo Objetivo O objetivo do presente estudo foi determinar a frequência demalformaçães e anomalias cromossômicas em uma população de fetos com artéria subclávia direita aberrante (ARSA). Métodos Este é um estudo retrospectivo de 6 anos de fetos com diagnóstico prénatal de ARSA realizado durante o período de setembro de 2013 a junho de 2019 em uma unidade de medicina fetal. Os dados foram coletados de ultrassom, ecocardiograma fetal, estudos genéticos e registros neonatais. Resultados Um ARSA foi diagnosticado em 22 fetos. Um ARSA foi um achado isolado em 18 dos 22 casos (82%). Achados ultrassonográficos anormais associados foram encontrados em 4 casos. Todos os casos foram submetidos a testes invasivos. Em um dos casos, foi detectada uma anormalidade cromossômica (mos 45, X [13] / 46, X, e (X) (p22.1q22.1)). Nenhum caso de doença cardíaca congênita foi encontrado em qualquer um desses fetos. Houve dois casos em que a avaliação pós-natal revelou a malformação: um caso de hipospádia e 1 caso de fenda palatina. Conclusão A presença de ARSA isolado é benigna e não está associada a anormalidades cromossômicas. O achado de ARSA, no entanto, justifica uma ultrassonografia fetal detalhada para excluir anormalidades fetais importantes e outros marcadores leves.

Prenatal diagnosis of isolated frontonasal dysplasia: A case report.

We report a case of mild frontonasal dysplasia, a complex and rare malformation affecting the central portion of the face, especially the eyes, nose, and forehead, which was diagnosed at 20 weeks of gestation. The diagnosis was made by two- and four-dimensional ultrasound and confirmed at autopsy after pregnancy termination. A review of the literature is presented.

Prenatal diagnosis of frontal encephalocele.

Encephalocele is a rare congenital form of neural tube defect characterized by a protrusion of the meninges and cerebral tissue through a skull defect. These defects are classified according to their location: frontal, parietal and occipital, the last one being the most common form of presentation. The prognosis is related to the anatomical site, the volume of the neural contents and the presence of coexisting abnormalities. Most pregnancies are terminated, since the prognosis is poor. We report a case of an isolated fetal frontal encephalocele diagnosed at 21 weeks of gestation.

Relationship between Vitamin B12 and Cobalt Metabolism in Domestic Ruminant: An Update.

Cobalt, as a trace element, is essential for rumen microorganisms for the formation of vitamin B12. In the metabolism of mammals, vitamin B12 is an essential part of two enzymatic systems involved in multiple metabolic reactions, such as in the metabolism of carbohydrates, lipids, some amino acids and DNA. Adenosylcobalamin and methylcobalamin are coenzymes of methylmalonyl coenzyme A (CoA) mutase and methionine synthetase and are essential for obtaining energy through ruminal metabolism. Signs of cobalt deficiency range from hyporexia, reduced growth and weight loss to liver steatosis, anemia, impaired immune function, impaired reproductive function and even death. Cobalt status in ruminant animals can be assessed by direct measurement of blood or tissue concentrations of cobalt or vitamin B12, as well as the level of methylmalonic acid, homocysteine or transcobalamin in blood; methylmalonic acid in urine; some variables hematological; food consumption or growth of animals. In general, it is assumed that the requirement for cobalt (Co) is expressed around 0.11 ppm (mg/kg) in the dry matter (DM) diet; current recommendations seem to advise increasing Co supplementation and placing it around 0.20 mg Co/kg DM. Although there is no unanimous criterion about milk production, fattening or reproductive rates in response to increased supplementation with Co, in some investigations, when the total Co of the diet was approximately 1 to 1.3 ppm (mg/kg), maximum responses were observed in the milk production.

Quality of Sleep among Portuguese Anaesthesiologists: A Cross-Sectional Study.

INTRODUCTION: Sleeping is essential to maintain proper relationships with others, keep alertness, and execute responsibilities, among many other functions. In the medical profession, there are several studies linking sleep deprivation with a decrease in responsiveness, cognition and attention. With this study we intended to characterize the sleep pattern of Portuguese anaesthesiologists and identify independent factors associated with sleep quality in this population. MATERIAL AND METHODS: An observational, cross-sectional study of senior and resident anesthesiologists working in Portugal was carried out through an online questionnaire. Individuals working exclusively in intensive care units, emergency departments or with previously diagnosed sleep disorders were excluded. Socio-demographic data, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Perceived Stress Scale were applied. Statistical significance was assessed using the Mann-Whitney test and the chi-square test. A multivariable analysis was performed to examine the association between the Pittsburgh Sleep Quality Index and certain variables. RESULTS: Among 256 respondents, 46.1% reported "poor" quality of sleep (Pittsburgh Sleep Quality Index > 5). Within these individuals, 77.1% slept less than 7 hours per night (p < 0.001). Excessive daytime sleepiness (Epworth Sleepiness Scale > 10) was present in 41.0% of the sample, and the median Perceived Stress Scale score was 17.0. The independent factors associated with worse quality ofsleep were the number of working hours/week (OR 1.03, 95% CI 1,01 to 1,06), perceived stress (OR 1.18, 95% CI 1.11 to 1.26), taking sleep medication (OR 14.72, 95% CI 5.55 to 39.08), and sleep hours/night (OR 0.25, 95% CI 0.15 to 0.42). DISCUSSION: This fraction of Portuguese anaesthesiologists presented a poorer quality of sleep, with excessive daytime somnolence, perceived stress and higher sedative use compared to previously studied populations. CONCLUSION: Our study characterizes sleep patterns and identifies potential risk factors linked to sleep disturbances in a sample of Portuguese anaesthesiologists. Government and institutional policies can endorse sleep hygiene practices and habits, promoting healthier working environments.

Introdução: O sono é essencial para executar tarefas, manter o estado de alerta, executar tarefas, entre outras funções. Diversos estudos na área médica relacionam a privação de sono com a redução da capacidade de resposta, cognição e nível de atenção. Os objetivos deste estudo foram a caracterização do padrão de sono dos anestesiologistas Portugueses e identificação de fatores de risco independentes para pior qualidade de sono. Material e Métodos: Efetuámos um estudo observacional e transversal em anestesiologistas e internos de formação específica em Anestesiologia a trabalhar em Portugal. Foram excluídos profissionais que trabalham exclusivamente em unidades de cuidados intensivos, serviços de urgência ou com patologias do sono previamente diagnosticadas. Foram colhidos dados sócio-demográficos e aplicadas as escalas de Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) e Perceived Stress Scale (PSS). A significância estatística foi analisada recorrendo aos testes de Mann-Whitney e qui-quadrado. A associação entre o Pittsburgh Sleep Quality Index e demais variáveis foi testada através de uma regressão logística. Resultados: Dos 256 casos admitidos, 46,1% apresentaram "má" qualidade de sono (Pittsburgh Sleep Quality Index > 5). Nestes, 77,1% dormiram menos de 7 horas por noite (p < 0,001). A sonolência diurna excessiva (Epworth Sleepiness Scale > 10) surgiu em 41,0% da amostra e a mediana da Perceived Stress Scale foi 17,0. Os fatores de risco independentes para "má" qualidade de sono foram: número de horas de trabalho semanais (OR 1,03, IC 95% 1,01 a 1,06), stress percecionado (OR 1,18, IC 95% 1,11 a 1,26), toma de medicamentos para dormir (OR 14,72, IC 95% 5,55 a 39,08) e número de horas dormidas por noite (OR 0,25, IC 95% 0,15 a 0,42). Discussão: A nossa amostra de anestesiologistas Portugueses apresentou pior qualidade de sono, com sonolência diurna excessiva, stress percecionado e uso de sedativos superiores a outras populações previamente estudadas. Conclusão: O presente estudo caracteriza o padrão de sono e identifica potenciais factores de risco relacionados com distúrbios do sono, numa amostra de Anestesiologistas Portugueses. Políticas de saúde governamentais e institucionais poderão ser orientadas para a promoção da higiene do sono, levando a ambientes de trabalho mais saudáveis.

Mourning and Takotsubo cardiomyopathy: neuroendocrine implications and nutritional management.

This article aims to make reference to some recent mourning aspects considered risk factors for cardiovascular disease, specifically the Takotsubo cardiomyopathy. The objective was to describe the stress from the death of a loved one combining it to the possibility of occurrence of Takotsubo cardiomyopathy through the perception of a traumatic event by the cortex, which triggers the subcortical brain circuit affecting the endocrine response. Given the growing acknowledgement of this cardiomyopathy, it is possible to contextualize the nutritional behaviours and decisions surrounding it, whose benefits must exceed the condition of temporary cardiac dysfunction and extend to food choices that have some influence in the limbic system. It is a descriptive analysis that aims to problematize the theme into reflections based on this experience, considering the foundation with the science of nutrition.

Mourning and Takotsubo cardiomyopathy: neuroendocrine implications and nutritional management

SUMMARY This article aims to make reference to some recent mourning aspects considered risk factors for cardiovascular disease, specifically the Takotsubo cardiomyopathy. The objective was to describe the stress from the death of a loved one combining it to the possibility of occurrence of Takotsubo cardiomyopathy through the perception of a traumatic event by the cortex, which triggers the subcortical brain circuit affecting the endocrine response. Given the growing acknowledgement of this cardiomyopathy, it is possible to contextualize the nutritional behaviours and decisions surrounding it, whose benefits must exceed the condition of temporary cardiac dysfunction and extend to food choices that have some influence in the limbic system. It is a descriptive analysis that aims to problematize the theme into reflections based on this experience, considering the foundation with the science of nutrition.

RESUMO INTRODUÇÃO: Este artigo busca fazer referência a alguns aspectos do luto recente considerados fatores de risco para a doença cardiovascular, específicamente a cardiomiopatia de Takotsubo. Objetivou-se descrever o estresse proveniente da morte do ente querido aliando-o à possibilidade de ocorrência da cardiomiopatia de Takotsubo, mediante a percepção de um evento traumático pelo córtex que aciona o circuito cerebral subcortical tendo repercussões na resposta endócrina. Dado o crescente reconhecimento dessa cardiomiopatia, torna-se viável contextualizar as condutas nutricionais e as decisões que as norteiam, cujos benefícios devem ultrapassar a condição de disfunção cardíaca temporária e se estender às escolhas alimentares que exercem alguma influência no sistema límbico. Trata-se de uma análise descritiva que objetiva problematizar a temática em reflexões pautadas nessa vivência, considerando o alicerce com a ciência da nutrição.

Chorionic bump in a pregnant patient with a history of infertility.

Chorionic bump is a rare condition in the first trimester of pregnancy. It appears as a bulge from the choriodecidual surface into the gestational sac. So far, there have been no ultrasound or clinical markers that can predict a difference in outcomeWe report a case of a pregnant woman with history of infertility, diagnosed in the first trimester with a chorionic bump. It disappeared spontaneously at 23 weeks of gestation. The pregnancy went well and she delivered a healthy baby.The aetiology and clinical significance of the chorionic bump remains unclear.

Two-Dimensional Identification of Fetal Tooth Germs.

OBJECTIVE: To demonstrate the efficiency and applicability of two-dimensional ultrasonography in the identification of tooth germs and in the assessment of potential pathology. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Prenatal Diagnosis Unit of Centro Hospitalar de Vila Nova de Gaia / Espinho-Empresa Pública in Portugal. PATIENTS: A total of 157 white pregnant women (median age, 32 years; range, 14 to 47 years) undergoing routine ultrasound exams. MAIN OUTCOME MEASURE(S): Description of the fetal tooth germs, as visualized by two-dimensional ultrasonography, including results from prior fetal biometry and detailed screening for malformations. RESULTS: In the first trimester group, ultrasonography identified 10 tooth germs in the maxilla and 10 tooth germs in the mandible in all fetuses except for one who presented eight maxillary tooth germs. This case was associated with a chromosomal abnormality (trisomy 13) with a bilateral cleft palate. In the second and third trimesters group, ultrasonography identified a larger range of tooth germs: 81.2% of fetuses showed 10 tooth germs in the maxilla and 85.0% of fetuses had 10 tooth germs in the mandible. Hypodontia was more prevalent in the maxilla than in the mandible, which led us to use qualitative two-dimensional ultrasonography to analyze the possible association between hypodontia and other variables such as fetal pathology, markers, head, nuchal, face, and spine. CONCLUSIONS: We recommend using this method as the first exam to evaluate fetal morphology and also to help establish accurate diagnosis of abnormalities in pregnancy.