False-Positive Ethanol Level in Urine and Plasma Samples of a Resuscitated Infant.

We report the case of an 11-month-old male infant with a complex congenital heart disease who was admitted in the intensive care unit following cardiorespiratory arrest at home. Toxicological urine screening reported an ethanol concentration of 0.65 g/L using an enzymatic assay, without suspicion of alcohol intake; a significant amount of ethanol concentration was found in two plasma samples using the same enzymatic assay. Plasma and urine ethanol concentrations were below the limit of quantification (LOQ) when tested using a gas chromatography method. Urine ethanol level was also below the LOQ when tested by enzymatic assay after an initial urine ultrafiltration. These results confirmed our suspicion of matrix interference due to elevated lactate and lactate dehydrogenase levels interfering in the enzymatic assay. This analytical interference, well-known in postmortem samples, extensively studied in vitro, has been rarely reported in vivo, especially in children. To the best of our knowledge, this case is only the sixth one reported in an infant's plasma and the first initially discovered from urine. Indeed, as for ethanol, this last matrix has not been studied in the context of this artifact that may induce false-positive ethanol results while seeking a diagnosis in life-threatening or fatal situations that are potentially subject to forensic scrutiny. In parallel to a synthetic literature review, we propose a simple, informative decision tree, in order to help health professionals suspecting a false-positive result when performing an ethanol assay.

Determinants of a good perinatal outcome in 588 pregnancies in women with type 1 diabetes.

AIM: This study assessed pregnancy outcomes in women with type 1 diabetes (T1D) over the last 15 years and identified modifiable factors associated with good perinatal outcomes. METHODS: Pregnancy outcomes were prospectively assessed in this cohort study of 588 singleton pregnancies (441 women) managed by standardized care from 2000 to 2014. A good perinatal outcome was defined as the uncomplicated delivery of a normally formed, non-macrosomic, full-term infant with no neonatal morbidity. Factors associated with good perinatal outcomes were identified by logistic regression. RESULTS: The rate of severe congenital malformations was 1.5%, and 0.7% for perinatal mortality. The most frequent perinatal complications were macrosomia (41%), preterm delivery (16%) and neonatal hypoglycaemia (11%). Shoulder dystocia occurred in 2.6% of cases, but without sequelae. Perinatal outcomes were good in 254 (44%) pregnancies, and were associated with lower maternal HbA1c values at delivery [adjusted odds ratio (aOR): 2.78, 95% CI: 2.04-3.70, for each 1% (11mmol/mol) absolute decrease], lower gestational weight gains (aOR: 1.06, 95% CI: 1.02-1.10) and absence of preeclampsia (aOR: 2.63, 95% CI: 1.09-6.25). The relationship between HbA1c at delivery and a good perinatal outcome was continuous, with no discrimination threshold. CONCLUSION: In our study, rates of severe congenital malformations and perinatal mortality were similar to those of the general population. Less severe complications, mainly macrosomia and late preterm delivery, persisted. Also, our study identified modifiable risk factors that could be targeted to further improve the prognosis of pregnancy in T1D.

Alterações neonatais de sífilis congênita em um hospital universitário do município de Niterói, Rio de Janeiro / Congenital syphilis neonatal alterations in a university hospital in Niterói-RJ

A prevalência da infecção pelo Treponema pallidum diminuiu sensivelmente com a penicilina, porém se observa tendência mundial no recrudescimento da sífilis, em particular dos casos de sífilis congênita (SC). Objetivos: Descrever as repercussões neonatais da SC nos recém-nascidos (RN) notificados como caso de SC em um hospital público de Niterói, Rio de Janeiro, no período de janeiro de 2005 a junho de 2006; observar o peso ao nascer e a sorologia dos RN com notificação de SC; descrever o tratamento dos casos de SC. Métodos: Amostra constituída de 35 fichas de notificação de SC do Centro de Vigilância Hospitalar do Hospital Universitário Antônio Pedro (HUAP). Utilizaram-se dados da notificação e realizou-se visita domiciliar para coleta de sangue. esultados: A população foi constituída por 29 pacientes nascidos vivos, 4 nascidos mortos e 2 abortamentos. Apenas dois casos (6,9%) evidenciavam alterações ósseas de SC. O teste Veneral Disease Research Laboratory (VDRL) realizado no líquido cefalorraquidiano (LCR) demonstrou-se não reator para todos os pacientes avaliados. O VDRL do soro dos RN no nascimento foi positivo para 23 (79,31%) pacientes. A penicilina G cristalina (PGC) foi administrada em 26 (89,65%) casos, a penicilina G procaína (PGP) em dois (6,9%) e um individuo utilizou PGC e PGP. Conclusão:O óbito fetal e aborto foram o desfecho mais ominoso como repercussão da SC. A alteração dos ossos longos foi pouco encontrada na amostra. O baixo peso ao nascer foi observado em poucos casos. O VDRL do LCR foi não reator em todos os casos. A utilização de diversos esquemas de antibiótico estava em desacordo com o protocolo proposto pelo Ministério da Saúde.

Syphilis is a sexually transmitted disease caused due to bacterium Treponema pallidum.The prevalence of this infection decreased significantly by the use of penicillin, but it is observed that it reappears particularly in cases of congenital syphilis (CS).Objective:to describe the effects of neonatal CS in newborns (NB) in a public hospital in Niterói - RJ, from January 2005 to June 2006 and to observe the birth weight and serology of newborns with CS notification.The purpose of this study is also to describe the CS treatment in each case.Methods:a sample of 35 CS notifications was recorded from the Center for Hospital Surveillance at the Antonio Pedro University Hospital (HUAP), Niterói - RJ, from January 2005 to June 2006. Data from the notifications was used and homevisit was done to collect blood samples.Results:the study population is comprised of 29 live birth patients, four miscarriages and two stillbirths. Only two cases(6.9%) had evidence of CS bone abnormalities. The VDRL test performed in cerebrospinal fluid (CSF) of the cases proved to be non-reactive for all patients.VDRL serum of newborns at birth was positive for 23 (79.31 %) patients. The crystalline penicillin G was administered in 26 (89.65 % cases,) procaine penicillinG in two (6.9%) and for one individual both crystalline penicillin G and procaine penicillin G was used.Conclusion:fetal death and abortion were the mostominous outcome and impact of CS. Long bones alterations were scarcely found in few samples. Low birth weight was observed in a few cases. CSF VDRL was not reactive in all cases. The use of several antibiotic regimens was in disagreement with the proposed protocol issued by the Ministry of Health.

[Actinomycetoma of the knee due to Nocardia otitidiscaviarum described in the Comoro Islands]. / Actinomycétome du genou àNocardia otitidiscaviarum aux Comores.

BACKGROUND: Mycetoma is a chronic skin and soft tissue infection encountered in the dry tropical regions and are caused by fungi (eumycetoma) or bacteria (actinomycetoma). PATIENTS AND METHODS: A 25-year-old man consulted at the hospital on Mayotte Island for a left knee injury sustained 10 years earlier in a motorcycle accident with broken skin occurring in Anjouan in the Comoro Islands. Clinical and histological diagnosis of mycetoma was made, and in the absence of microbiological diagnosis, empirical antifungal therapy was initiated. Given the poor outcome, new biopsies were performed and resulted in the identification of Nocardia otitidiscaviarum. More than 1 year later, the patient had fully recovered and after administration of several and extended antibiotic courses including cotrimoxazole and linezolid. DISCUSSION: Bacterial mycetomas are usually described in semi-arid regions and the occurrence of this disease is unexpected in humid tropical areas such as the Comoro Islands. N. otitidiscaviarum is rarely involved in this infection, particularly in Africa.

Condiloma acuminado extragenital associado ao intertrigo: relato de caso / Acuminata condyloma extragenital associated to intertrigo: case report

Introdução: papilomavírus humano (HPV) é um vírus de DNA que pode infectar a pele e mucosas, com mais de 100 tipos diferentes descritos, sendo 45 deles considerados sexualmente transmissíveis. Objetivo: relatar o caso de condiloma acuminado extragenital, facilitado pela presença de intertrigo. Métodos: relato de caso de paciente com condiloma acuminado em região hipogástrica. Resultados: mulher atendida no ambulatório de DST/AIDS do setor de Ginecologia da Santa Casa de Misericórdia de Vitória, em 2007, com 46 anos de idade, apresentando lesão condilomatosa extensa associada à intertrigo em região hipogástrica, acima da cicatriz de Pfannestiel e pequenas lesões vulvares compatíveis, clinicamente, com condilomas. Feita a opção pela exérese cirúrgica em lesão de abdome, a qual evidenciou condiloma acuminado e cauterização química de lesões vulvares. Solicitados exames para doenças sexualmente transmissíveis, que foram normais, incluindo citologia oncótica, colposcopia e teste rápido para gonococo e clamídia. Conclusão: a umidade e o calor locais, provocados pelo abdome em avental, com concomitância de área de intertrigo, poderiam justifi car a presença de condiloma acuminado nesta região.

Introduction: the human papillomavirus (HPV) is a DNA virus that can infect skin and mucosa, already described in more than 100 different types,being 45 of those considered to be sexually transmitted. Objective: report the extra-genital case of condyloma acuminata, facilitated by the presenceof intertrigo. Method: report of a case of female patient presenting extensive condylomatous lesions associated to intertrigo in hypogastric region. Results: a 46-year-old female patient assisted in the DST/AIDS Clinic of the Gynecology Sector at Santa Casa de Misericórdia from Vitória in 2007, presenting extensive condylomatous lesions associated to intertrigo in hypogastric region above the Pfannestiel scar and small compatible vulvar verrucosa lesions suggestive of condyloma. Surgical excision was made in the abdomen lesion which evidenced condyloma acuminatum and chemical cauterization of vulvar warts. Tests for sexually transmitted diseases were requested, all of them were normal, including oncotic cytology, colposcopy and fast test for gonococcus and chlamydia. Conclusion: local humidity and heat provoked by abdomen in apron with concurrence of area of intertrigo could justify the presence of condyloma acuminatum in this region.

[Value of contrast-enhanced MR enterography in pediatric Crohn's disease: preliminary study]. / Valeur de l'entéro-IRM avec injection de gadolinium dans la maladie de Crohn en pédiatrie: étude préliminaire.

OBJECTIVE: Feasibility study of contrast enhanced MR enterography without enteroclysis as a new diagnostic tool for children with known or suspected Crohn's disease. METHODS: We prospectively included 15 children, 8-18 years old, with clinical suspicion of Crohn's disease. MR enterography without enteroclysis was performed on a 1,5 T clinical MR system. A total of 1000 ml of mannitol 5% was orally administered 60 minutes prior to MRI. Coronal and axial breath-hold sequences were acquired. The following sequences were obtained: True-FISP, FLASH T1 2D/3D with Fat saturation before and after gadolinium injection. Two radiologists, blinded to patient information, independently reviewed all examinations to record image quality, the degree of distension of the distal ileum, the presence of abnormal bowel segments and the presence of extra-intestinal complications. MRI findings were correlated to sonographic, endoscopic and biological results (sensitivity, specificity, Kappa test). RESULTS: The examinations were considered of satisfactory diagnostic quality in 93.3% of patients. Respiratory artifacts were present in one case. The entire GI tract could be identified on all sequences. Distention of the distal ileum was recorded as good to excellent in 89% of healthy subjects. Five MR examinations were considered abnormal with isolated ileal involvement in 2 cases, ileocolic involvement in 2 cases, and isolated colonic involvement in 1 case. The sensitivity and specificity of MR for the positive diagnosis of Crohn's disease were 100% and 83% respectively. Three extra-intestinal complications were detected: one case of ileo-ileal fistula, not identified on ultrasonography, an asymptomatic anal fistula and a symptomatic inflammatory stricture. CONCLUSION: MR enterography without enteroclysis is a well tolerated, effective non invasive method in the evaluation of known or suspected Crohn's disease. Because of the absence of ionizing radiation, MR enterography should become the gold standard in pediatric patients.

[Importance of urinary methylhistamine measurements during allergy provocation tests]. / Intérêt du dosage de la méthylhistamine urinaire au cours des tests de provocation en allergie.

Methylhistamine, histamine's metabolite, was measured in urine by radio-immuno-assay in 79 provocation test. Six of them were positive with clinical symptoms. All of the six were associated with a significant increase of urinary methylhistamine (UMH). Therefore, there is a good correlation between positive provocation tests and increase of UMH level. In these cases, the severity of clinical symptoms is related to the increase of U.M.H.