Complicações neonatais do diabetes mellitus gestacional ­ DMG / Neonatal complications of gestacional diabetes mellitus ­ GDM

O diabetes mellitus gestacional (DMG) está associado a um risco aumentado de complicações fetais, neonatais e no desenvolvimento a longo prazo. As taxas de aborto espontâneo, natimorto, mal formações congênitas e morbidade e mortalidade perinatal são maiores em filhos de mães diabéticas. As principais complicações neonatais são: macrossomia, hipoglicemia neonatal, deficiência de ferro, alterações da função cardiorrespiratória, hiperbilirrubinemia, anormalidades neurológicas, hipocalcemia, hipomagnesemia e policitemia. A macrossomia predispõe a lesões do parto, especialmente distócia de ombro, maior risco de lesão do plexo braquial, fraturas de clavícula ou do úmero, asfixia perinatal, e, menos frequentemente, hemorragia subdural e paralisia facial. O controle glicêmico rigoroso pré-concepção e durante a gestação associa-se com menor morbimortalidade perinatal. Assim, o controle do DMG representa tarefa de fundamental importância para impedir sequelas em neonatais. (AU)

The gestational diabetes mellitus (GDM) is associated with an increased risk of fetal, neonatal, and possibly long-term complications. The rates of spontaneous abortion, stillbirth, congenital malformations, and perinatal morbidity and mortality are higher in infants of a diabetic mother than in pregnancies with normal glycemic control. The main neonatal complications are: macrosomia, neonatal hypoglycemia, iron deficiency, changes in cardiac and respiratory function, hyperbilirubinemia, neurological abnormalities, hypocalcemia, hypomagnesemia and polycythemia. Macrosomia predisposes to birth injury, especially shoulder dystocia, increased risk of brachial plexus injury, clavicular or humeral fractures, perinatal asphyxia, and, less often, subdural hemorrhage and facial palsy. Strict glycemic control preconception and during pregnancy is associated with lower perinatal morbidity and mortality. Thus, GDM control is of paramount importance to prevent neonatal harm. (AU)

[Epidemiologic aspects of Cutaneous Leishmaniasis in an endemic area of the state of Paraná, Brazil] / Aspectos epidemiológicos da leishmaniose tegumentar em área endêmica do Estado do Paraná, Brasil.

An epidemiological investigation of cutaneous leishmaniasis (CL) was performed in 1992 and 1993 in an endemic area of Jussara and Terra Boa counties, in the Northern Paraná State. The study covered 684 individuals from a population of approximately 1,400 from six agricultural areas (Fazenda Palmital, Cerâmica Andirá, Fazenda Jussara, Fazenda Lagoa, Destilaria Melhoramentos, and Fazenda Mururê) in Northern Paraná, Brazil. The mean frequency of CL history was 19.9%. The highest frequency was at Fazenda Jussara (40.5%). Based on the indirect immunofluorescence test, 58 (8.5%) presented significant titers of anti-Leishmania antibody, 17 (29.3%) of whom had no history of CL. The Montenegro skin test was applied to 97 individuals with a history of CL and was positive in 80 (82.5%). During the survey, seven individuals presented lesions, four of which were positive for Leishmania sp. The strain isolated was identified as Leishmania (Viannia) braziliensis.

[Serologic survey of dogs in an endemic area of tegumentary leishmaniasis in Paraná State, southern Brazil] / Investigação sorológica em cães de área endêmica de leishmaniose tegumentar, no Estado do Paraná, Sul do Brasil.

Increased reporting of mucocutaneous leishmaniasis in the State of Paraná points to the need for information on both this disease's epidemiology and pertinent control measures. A serological survey was thus performed, with indirect immunofluorescence (IIF) for canine leishmaniasis in farm operations belonging to the Companhia Melhoramentos Norte do Paraná, in Jussara and Terra Boa counties, in northwestern Paraná. IIF was performed on 132 dogs, of which 24 (18.2%) had significant titers (>/=40). Imprints of six dogs with lesions were made and all were negative for Leishmania sp.