Eduardo de Souza

Prevalence of sexual dysfunction during pregnancy

OBJECTIVE This study aims to evaluate the sexual function and to determine the prevalence of sexual dysfunction among teenagers and adult women during pregnancy using the Female Sexual Function Index (FSFI). METHODS A cohort study was conducted with 271 healthy pregnant women presenting a stable relationship with their partners. These women contributed to the survey since the laboratory diagnosis of their present pregnancy. Anonymous questionnaires evaluated aspects of sexual activity and female sexual function. This last item was assessed through the FSFI questionnaire. RESULTS The women sexual function showed a similar pattern during the first and second trimesters; however, it presented a significantly clear decrease in the third trimester. There was a significant difference in the scores of all FSFI domains when comparing the second and third trimesters. The sexual dysfunction among pregnant teenagers was rated 40.8% in the first trimester, 31.2% in the second and 63.2% in the third. For pregnant adults, the dysfunction was rated, respectively, 46.6%, 34.2% and 73.3%. CONCLUSION The sexual function is affected during pregnancy with a significant decrease in all FSFI domains in the third trimester considering both pregnant teenagers and adults. Prevalence of sexual dysfunction is high during pregnancy and reaches higher levels in the third trimester in both age groups; however, teenagers presented better sexual function ratings.

Obstetric and perinatal effects of active and/or passive smoking during pregnancy

CONTEXT Cigarette smoke, whether inhaled voluntarily or not, causes damage to the mother-infant pair. The antenatal period may present the best opportunity for performing effective anti-smoking campaigns. OBJECTIVE To study the obstetric and perinatal effects of smoking on pregnancy and the infant. TYPE OF STUDY Prospective study, interviewing pregnant women who were randomly selected at the maternity hospital as they were being discharged after giving birth. SETTING Hospital Municipal Vereador José Storópolli, São Paulo, Brazil. METHODS 758 patients were interviewed regarding smoke inhalation before being discharged from the maternity hospital. The groups were formed by 42 active smokers, 272 passive smokers, 108 who inhaled smoke both actively and passively, and 336 non-smokers. The groups were compared regarding age, parity, school education, incidence of spontaneous abortion, rate of caesarian births, average gestational age at birth, rate of low birth weight and adequacy of weight in relation to the gestational age of newborn infants. For all variables we considered p < 0.05 as statistically significant. RESULTS There was a high rate (55.7%) of pregnant smokers, including 5.5% active, 35.9% passive and 14.3% active-passive smokers. Active and active-passive smokers were older and had higher parity. Active smokers had lower education levels and higher rates of previous spontaneous abortion. The weights of newborn babies were lower for smoking mothers. DISCUSSION The study was performed among patients that were mostly of low economic, social and cultural levels, thus possibly explaining the high incidence of smokers. Worse still was that 35.9% of the non-smokers were actually passive smokers. These rates we report were similar to those from the literature. The typical receptiveness of teenage girls to unrestricted advertising in the media contributes towards an early start to acquiring the habit of smoking, including during pregnancy in our country. We emphasize the difficulties in quantifying exposure to cigarettes even among active smokers. CONCLUSIONS Cigarette smoke, whether inhaled voluntarily or not, has an unfavorable effect on the mother-infant pair.

Diffuse unilateral subacute neuroretinitis. Report of transvitreal surgical removal of a subretinal nematode.

BACKGROUND The precise identification of nematodes which cause diffuse unilateral subacute neuroretinitis (DUSN) has been unsuccessful. Shape and size are useful in the initial stages of identification, but histopathologic examination usually is necessary for accurate classification. Intact nematodes recovered from patients with DUSN have been mentioned scarcely in the literature. The authors report the first case of DUSN in which a viable nematode was removed successfully via a transvitreal surgical approach and recovered for parasitologic study. METHODS Bimanual pars plana vitrectomy was performed in a 9-year-old Brazilian boy with typical DUSN in its late stage. During surgery, a motile subretinal nematode was confirmed temporal to the macular area. A retinotomy was created adjacent to the nematode. The subretinal material then was aspirated with a 20-gauge soft-tip needle, and parasitologic examination was performed. RESULTS Based on length (630 m x 10(-6)) and width (30 m x 10(-6)) of the nematode and other features such as a small buccal capsule, an esophagus one third of body length, and tapered tail, a morphologic identification of the nematode was made as a third-stage Toxocara larva. Histopathologic examination could not be performed for confirmation because of subsequent deterioration of the specimen. CONCLUSIONS Although direct laser photocoagulation of the nematode is the treatment of choice for DUSN, surgical transvitreal removal of the nematode may be indicated in selected cases. This method for treatment allows removal of the nematode for parasitologic identification.

Inflammatory cytokine gene polymorphisms and spontaneous preterm birth

The objective was to search for an association between spontaneous preterm birth (sPTB) and single and/or combined polymorphisms in genes TNFA -308 G>A, IL10 -1082 G>A, IL10 -819 C>T, IL10 -592 C>A, IL6 -174 G>C, and IFNG +874 A>T. Genotyping was performed on 410 Brazilian ethnically matched women managed at two hospitals (two independent case-control sets). One set consisted of 122 cases and 101 controls, and the other set comprised 82 cases and 105 controls. We compared genotype and genotype-combination frequencies between cases and controls using Fishers exact or the chi(2) tests and confirmed results using logistic regression. Among the six SNPs studied, we found no independent association between any single SNP and sPTB risk. The multi-locus analysis revealed a significant association between sPTB and the TNFA(GG)/IL6(GG)/IFNG(AA) genotype combination (p=0.002), confirmed by logistic regression. Our data suggest that the combination of TNF-alpha, IFN-gamma, and IL-6 maternal gene polymorphisms might contribute to susceptibility to sPTB. This finding could be investigated as a possible genetic marker for the risk of spontaneous preterm birth.

Validação do índice da função sexual feminina em grávidas brasileiras

PURPOSE: to translate and to validate the Female Sexual Function Index (FSFI) for Brazilian pregnant women. METHODS: ninety-two pregnant women attended at a low risk prenatal clinic, with diagnosis of the pregnancy confirmed by precocious ultrasonography, participated in the research. Initially, we translated the FSFI questionnaire for Portuguese language (of Brazil) in agreement with the international criteria. Cultural, conceptual and semantics adaptations of FSFI were accomplished, because of the differences of the language, so that the pregnant women understood the subjects. All the patients answered FSFI twice, in the same day, with two different interviewers, with an hour interval from one to other interview. After 7 to 14 days, the questionnaire was applied again in a second interview. Reliability (internal intra and interobserver consistence) and the validity of the constructo (to demonstrate that questionnaire measures the sexual function) were appraised. RESULTS: Cultural adaptations were necessary for us to obtain the final version. The internal intra-observer (alpha of Chronbach) consistence of the several domains oscillated from moderate to strong (0,791 to 0,911) and the interobserver consistence varied from 0,791 to 0,914. In the validation of the constructo, were obtained moderate correlations to fort among the final scores (general) of FSFI and of Female Sexual Quotient (QS-F) that has the capacity to evaluate the feminine sexual function. CONCLUSIONS: FSFI was adapted to the Portuguese language and to the Brazilian culture, presenting significant reliability and validity; it could be included and used in future studies of the Brazilian pregnant sexual function.

Necessidade de cuidados intensivos em maternidade pública terciária

OBJETIVOS: avaliar os aspectos epidemiologicos e os relacionados ao parto de gestantes e puerperas transferidas para unidades de terapia intensiva (UTIs) e a frequencia com que estas pacientes necessitam de cuidados intensivos. METODOS: estudo observacional e descritivo das transferencias obstetricas para UTIs, entre janeiro de 1999 e dezembro de 2001. A analise incluiu as seguintes variaveis: idade materna, paridade, indicacoes obstetricas e nao-obstetricas para as transferencias, momento em que estas ocorrem no ciclo gravidico-puerperal, tipo de parto, desfecho materno e frequencia com que estas transferencias ocorrem em relacao ao numero total de partos (razao de morte iminente - RMI). A analise estatistica foi realizada pelo teste do c2 ou teste exato de Fisher, com nivel de significância fixado em 5%. RESULTADOS: no periodo de 36 meses, ocorreram 86 transferencias maternas (em 4.560 partos). Entre as pacientes transferidas, 52,3% (n=45) eram nuliparas e 63 (73,2%) tinham idade entre 19 e 35 anos. As sindromes hipertensivas representaram 57,7% (n=41) das indicacoes e as sindromes hemorragicas, 19,7% (n=14). Eclâmpsia (n=23), sindrome HELLP (n=13) e descolamento prematuro da placenta normalmente inserida (n=5) foram as causas obstetricas mais prevalentes na determinacao destas transferencias. As cardiopatias maternas somaram 4 casos entre as indicacoes nao-obstetricas. Houve predominio das transferencias puerperais (82,35%). Cinquenta e cinco pacientes (72,3%) tiveram seus partos realizados atraves de cesarianas. O tempo medio de internacao nas UTIs foi 5,1 dias. A mortalidade materna encontrada neste estudo correspondeu a 24,2%, sendo que as sindromes hipertensivas foram responsaveis por 52,9% (9/17) das mortes obstetricas diretas. Nao houve diferenca significante (p=0,81) entre os decessos maternos e suas causas (sindromes hipertensivas, hemorragicas, infecciosas ou outras) ou entre mortalidade materna e duracao da internacao ( 48 horas) nas UTIs (p=0,08). A RMI encontrada foi de 18,8/1.000 partos. CONCLUSOES: a necessidade de cuidados intensivos estimada pela RMI foi de 18,8/1.000 partos, sendo que as sindromes hipertensivas induzidas pela gestacao foram responsaveis pela maioria das indicacoes para as transferencias maternas.

STRATUSOCT and multifocal ERG in unilateral acute idiopathic maculopathy.

BackgroundUnilateral acute idiopathic maculopathy (UAIM) is a rare entity, in which an inflammatory process involves the macular retinal pigment epithelium (RPE) and outer retina. It represents a wide spectrum of ocular findings not consistently present in all patients, which may lead to difficulties in the recognition of the condition.MethodsThis observational case report presents the third-generation optical coherence tomography (StratusOCT) and multifocal electroretinogram (mfERG) findings in a 31-year-old woman with UAIM in the acute phase as well as two months later, and discusses the role of StratusOCT in the diagnosis.ResultsIn the acute phase, StratusOCT demonstrated abnormal heterogeneous hyperreflectivity and thickening at the level of the outer retina and RPE in the foveal region. Two months after the initial presentation, StratusOCT examination showed a subfoveal area of homogeneous hyperreflectivity that extended from the RPE to the outer retinal layers with posterior shadowing, and sparse points of hyperreflectivity at several different levels of the neurosensory retina, including its superficial layers. The foveal retinal thickness during the acute phase was thicken compared with that after resolution. Seven days after the initial evaluation, mfERG showed severely reduced N1–P1 amplitudes with normal latencies in the region corresponding to the affected area of the papillomacular bundle and fovea. Two months later, mfERG results were normal.ConclusionsStratusOCT provided valuable information, allowing for the exclusion of other disorders that might mimic UAIM. mfERG findings were consistent with transient outer retinal dysfunction as the cause of visual loss. We are unaware of previous reports of UAIM studied by these methods and could find no reference to them in a computerized search using MEDLINE.

Prematuridade e baixo peso entre recém-nascidos de adolescentes primíparas

Abstract Purpose : to compare the incidence of preterm deliveries, and of low birth weight newborns, among primiparous adolescents, from two age groups. Methods : this is a comparative, cross-sectional clinical study composed of 522 primiparous adolescents whose deliveries occurred at the gestational age of 25 to 42 weeks. The adolescents were divided into 2 groups according to their age; Gprec: from 10 to 15 complete years old (n=104); Gtard: from 16 to 19 complete years old (n=418). The research data were obtained by an individualized, confi dential and ethical interview, soon after delivery; and by a written questionnaire with questions about the gestational age in complete weeks, and about the newborns birth weight. The gestational age was calculated at the delivery day, according to the date of the last trustworthy menstrual period, being also confi rmed by the earliest pregnancy scanning or by Capurro’s index, when there were any doubts about the previously described parameters. All newborns with gestational age under 37 weeks at birth were considered preterm babies. The newborn weight was taken by neonatologists immediately after delivery; all newborns with less than 2,500g were considered to be low weight babies. Thus, we compared prematurity rate and low birth weight among newborns from primiparous puerperal adolescents. The χ² test was used for the statistic analysis and the partition χ² test for the found differences.

Expanded clinical spectrum of multiple evanescent white dot syndrome with multimodal imaging

Purpose: To evaluate and characterize multiple evanescent white dot syndrome abnormalities with modern multimodal imaging modalities. Methods: This retrospective cohort study evaluated fundus photography, fluorescein angiography, indocyanine green angiography, optical coherence tomography, enhanced depth imaging optical coherence tomography, short-wavelength autofluorescence, and near-infrared autofluorescence. Results: Thirty-four multiple evanescent white dot syndrome patients with mean age of 28.7 years were studied (range, 14–49 years). Twenty-six patients were women, and eight were men. Initial mean visual acuity was 0.41 logMAR. Final mean visual acuity was 0.03 logMAR. Fluorescein angiography shows a variable number of mid retinal early fluorescent dots distributed in a wreathlike pattern, which correlate to fundus photography, fundus autofluorescence, and indocyanine green angiography. Indocyanine green angiography imaging shows the dots and also hypofluorescent, deeper, and larger spots, which are occasionally confluent, demonstrating a large plaque of deep retinal hypofluorescence. Optical coherence tomography imaging shows multifocal debris centered at and around the ellipsoid layer, corresponding to the location of spots seen with photography, indocyanine green angiography, and fluorescein angiography. Protrusions of the hyperreflectant material from the ellipsoid layer toward the outer nuclear layer correspond to the location of dots seen with photography, indocyanine green angiography, and fluorescein angiography. Conclusion: Multimodal imaging analysis of the retina in patients with multiple evanescent white dot syndrome shows additional features that may help in the diagnosis of the disease and in further understanding its etiology. Multiple evanescent white dot syndrome is predominantly a disease of the outer retina, centered at the ellipsoid zone, but also involving the interdigitation zone and the outer nuclear layer.

Clinical and Tomographic Features of Macular Punctate Outer Retinal Toxoplasmosis

Fuchs endothelial dystrophy had DSAEK in the left eye for bullous keratopathy after cataract surgery and trabeculectomy in 1997. Preoperatively, the BSCVA in this eye was 20/200. On the first postoperative day, characteristic interface wavelike deposit accumulation was visualized on slitlamp examination despite corneal edema (Figure 2). A short trial of intensive steroids (from 4 times initially to 8 times per day) was tried without any evidence of deposit appearance. No evidence of interface fluid was found using anterior segment optical coherence tomography (Visante; Carl Zeiss Meditec, Dublin, California). At the 1-year follow-up examination, interface deposits remained stable. Despite complete resolution of the corneal edema, the patient’s uncorrected and best spectaclecorrected visual acuity did not improve (20/200).