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Objective To describe the immunological and hematological reference intervals of low-risk pregnant women. Methods A cross-sectional retrospective database analysis of a basic and translational study analyzing the hematological evaluation blood counts and immunophenotyping of TCD3 + , TCD4 + , TCD8 + , B, and natural killer (NK) cells of the peripheral blood in 79 low-risk pregnant women and of 30 control women from the state of Pernambuco, Brazil, was performed. Results No significant differences were detected between the hematological profiles of the 2nd and 3rd trimesters. Nevertheless, the median level of B cells decreased significantly in the 2nd (174 x 103 μL; p < 0.002) and 3rd trimesters (160 x 103 μL; p < 0.001), compared with the control group (296 x 103 μL). Similarly, the median level of NK cells was lower in the 2nd (134 x 103 μL; p < 0.0004) and 3rd trimesters (100 x 103 μL, p < 0.0004), compared with the control group (183 x 103 μL). In contrast, relative TCD4+ and TCD8+ levels increased in the 2nd and 3rd trimesters compared with the controls (TCD4 + : 2nd trimester = 59%; p < 0.001; 3rd trimester = 57%; p < 0.01; control = 50%; and TCD8 + : 2nd trimester = 31%; p < 0.001; 3rd trimester = 36%; p < 0.01; control = 24%). Conclusion Low-risk pregnant women have ~ 40% less B and NK cells in the peripheral blood, compared with non-pregnant women. These parameters may improve health assistance for mothers and contribute to define reference values for normal pregnancies. Resumo Objetivo Descrever o intervalo de referência imunológico e hematológico de gestantes de baixo risco. Métodos Realizou-se uma análise retrospectiva, de um estudo básico e translacional, analisando o perfil hematológico e a imunofenotipagem das células TCD3 + , TCD4 + , TCD8 + , B e natural killer (NK) do sangue periférico de 79 gestantes de baixo risco e de 30 mulheres (controles) do estado de Pernambuco, Brasil. Resultados Não observamos diferenças significativas entre os perfis hematológicos do 2° e 3° trimestres. No entanto, houve redução das células B no 2° (média = 174 x 103 μL; p < 0,002) e no 3° trimestres (160 x 103 μL; p < 0,001), comparado como grupo controle (296 x 103 μL). A mediana das células NK foi menor no 2° (134 x 103 μL; p < 0,0004) e no 3° trimestres (100 x 103 μL; p < 0,0004), comparado com o grupo controle (183 x 103 μL). Porém, o percentual de TCD4+ e de TCD8+ aumentou no 2° e 3° trimestres em relação aos controles (TCD4 + : 2° trimestre = 59%; p < 0,001; 3° trimestre = 57%; p < 0,01; controle = 50%; e TCD8 + : 2° trimestre = 31%; p < 0,001; 3° trimestre = 36%; p < 0,01; controle = 24%). Conclusão Mulheres grávidas de baixo risco têm ~ 40% menos células B e NK no sangue periférico em comparação com mulheres não grávidas. Estes parâmetros podem melhorar a assistência à saúde das mães e contribuir para a definição de valores de referência para gestações normais.

Background Repellent use during pregnancy was strongly recommended after uncovering Zika virus (ZIKV) involvement with congenital malformations. In this context, Pernambuco, Brazil played a key role since it was the epicentre for the main studies suggesting ZIKV teratogenicity and one of Brazil's most affected states during the 2014-2016 epidemics. Thus we aimed to identify possible associations between social determinants of health and repellent use in pregnancy during the ZIKV outbreak in Pernambuco. Methods We conducted a cross-sectional study (July-December 2016) with 539 pregnant women residing in Pernambuco and estimated the associations by prevalence ratio and multivariable logistic regression. Results Repellents were associated with pregnant women ≥30 y; graduates, employed, health professionals, private health system users and with a monthly income per person greater than two minimum wages. Women whose domiciles favour mosquitoes (ground-floor houses, intermittent water supply from general distribution or water trucks and for ≤6 d/week, cesspools/open wastewater, indoor household water storage) were less likely to use repellents. There was no association for peridomiciles. Conclusions Repellents were not associated with ZIKV in most vulnerable pregnant women, despite all the general recommendations made during the Pernambuco epidemic. This study observed a demand for public policies focused on health, education and sanitation problems related to deprived social groups along with their co-responsibility rather than focusing on individual attitudes against mosquitoes.

To describe high-resolution anoscopy (HRA) findings and compare them with histopathology results.In a cross-sectional, observational study performed between December 2008 and December 2009, women receiving care at a center in Recife, Brazil, after a histopathologic diagnosis of cervical intraepithelial neoplasia or cervical cancer were screened for anal neoplasia by HRA. Patients with anal lesions were divided into groups A (metaplasia and/or human papillomavirus infection) and B (anal intraepithelial neoplasia [AIN]). Patients with squamous cell atypia in group A and all patients in group B underwent histopathologic analysis. Agreement between HRA and histopathology findings was estimated for group B.HRA was done in 324 women, 204 (63.0%) of whom had anal lesions. Overall, 169 cases (82.8%) were classified as group A and 35 (17.2%) as group B. Histopathologic data were obtained for 28 of the 35 group B cases. Histopathology was suggestive of AIN in 19 (67.9%), resulting in a κ coefficient of 0.45 (95% confidence interval [CI] 0.26-0.65; P0.001). Relative to histopathology, HRA had sensitivity of 57.6% (95% CI 40.8%-72.7%), specificity of 86.1% (95% CI 75.7%-92.5%), positive likelihood ratio of 4.1 (95% CI 3.1-5.5), negative likelihood ratio of 0.5 (95% CI 0.4-0.5), and accuracy of 76.5% (95% CI 67.2%-83.8%).HRA findings can be systematized, reducing the subjectivity of interpretation.

Objectives: to describe altered intrauterine ultrasound, analyze fetal head circumference (HC) growth and neonates' outcomes among presumed cases of congenital Zika syndrome in Brazil. Methods: 30 women were included in the study with suspected history of Zika virus (ZIKV) infection during pregnancy and fetal's brain altered on ultrasound diagnosis. Sociodemographic and obstetric characteristics, prenatal altered ultrasounds, HC and other perinatal outcomes have been described. The relation between HC and gestational age was analyzed by using random regression effects based on polynomials fractions. The Z test was calculated to determine an instant variant mean rate of the HC for each gestational age. Results: the mean gestational age of the ultrasound diagnosis was 33.3 + 4.7 weeks and HC at birth was 28.9 + 1.6 cm. The main altered brain ultrasound was microcephaly (96.7%). The analysis of the fetal head circumference showed an estimated increase of the average HC, as to gestational age, it did not occur in a linear form. The instant HC variation rate increased according to gestational age (p

To compare results of diagnostic hysteroscopy in postmenopausal women using misoprostol for cervical ripening.A randomized, placebo-controlled clinical trial (Canadian Task Force classification Ib).Hospital Barão de Lucena, Instituto Materno Infantil de Pernambuco.One hundred-twenty postmenopausal women.Postmenopausal women received 200 microg of vaginal misoprostol or placebo before hysteroscopy.Variables measured were procedure time, frequency of hysteroscopy carried out in each group (misoprostol and placebo), degree of pain during procedure, need for dilation, side effects, and complications of hysteroscopy. The chi2, Fisher's exact, and Mann-Whitney tests were used and considered significant when alpha error was5%. There were similarities between the groups in age (p = .09), body mass index (p = .55), time since menopause (p = .52), and genital bleeding (p = .52). Pain during the procedure, as measured by visual analog scale, was less severe in the misoprostol group than in the placebo group (median of 05 vs 07, p = .02), but there were similarities in duration (2.4 min vs 2.0 min, p = .3), pain during procedure and biopsy (p = .74 vs p = .19), need for dilation (p = .66), side effects, and complications. There were no differences in severity of post-procedure pain.Previous use of misoprostol reduced pain severity during hysteroscopy.

Study objective To evaluate and determine the main causes for pain occurrence and intensity in outpatients undergoing anesthesia-free hysteroscopy in a medical school hospital. Design Cohort study (Canadian Task Force classification II-2). Setting Diagnosis Center of the Instituto Materno-Infantil de Pernambuco. Patients One hundred seventy-one outpatients undergoing anesthesia-free diagnostic hysteroscopy. Intervention To assess pain occurrence, intensity, and associated factors reported by patients undergoing anesthesia-free diagnostic hysteroscopy. Measurements and main results Pain frequency and intensity were determined by visual analog scale (VAS) at the end of the procedure and at 15-, 30-, and 60-minute intervals. Data analysis of clinical, obstetric, and gynecologic history and its association with pain was performed. Association through χ 2 test (Pearson), risk ratio with 95% CI, and multiple logistic regression were used for statistical analysis. Pain score was higher immediately after the procedure with a median of 6, decreasing to 3, 1, and 0 at 15-, 30-, and 60-minute intervals, respectively. Multiple logistic regression was performed, and the only parameters remaining that were significantly associated with pain were menopause, speculum placement, and the absence of previous vaginal delivery. Conclusion Anesthesia-free diagnostic hysteroscopy is often associated with pain, and it has been determined that menopause, speculum placement, and absence of previous vaginal delivery are factors associated with pain occurrence and intensity.

Fetal hypoxygenation due to the anemia may be an important factor in stimulating the maturation processes of the immune system in the fetus, determining the switch from fetal to adult form. We performed an immunological evaluation in a fetus in the 29th week of gestation with secondary hypoxemia and RhD and C alloimmune anemia. We found normal relative values for total T, TCD4+ and TCD8+, and low levels of B memory and NK cells. NKT cells were absent. There IL-8 serum levels were higher than those of the mother. Fetal anemia was not capable of activating the humoral immune response and differentiation of memory B cells. Our data suggest that NKT cell differentiation may be related to thymus development in humans.

Introduction: several birth defects associated to congenital Zika virus infection have been reported, although the clinical features have not been fully characterized. Description: this is the first case report on unilateral diaphragmatic paralysis diagnosed on a neonate with congenital Zika confirmed by the examination of the amniotic fluid through polymerase chain reaction (ZIKV RT-PCR) and the examination of cerebrospinal fluid by serological test (IgM ZIKV-ELISA) after birth. The main manifestations detected by intrauterine ultrasound were: microcephaly, ventriculomegaly, intracranial calcifications, enlarged cisterna magna, increased amniotic fluid index and fetal akinesia syndrome. The newborn had acute respiratory failure in the first hours of life, requiring mechanical ventila-tion. The X- ray of the chest showed unilateral diaphragmatic paralysis and cardiomegaly. Discussion: diaphragmatic palsy in congenital Zika has not been previously reported, the etiopathogenic mechanisms of this event in congenital Zika virus needs to be elucidated.