IntroductionWe report a very rare case of isolated hypoganglionosis first diagnosed during early pregnancy, which should be discussed from an obstetric and a gastroenterological point of view.Case presentationA pregnant 18-year-old Caucasian woman presented at twelve weeks of gestation with lower abdominal pain, mild constipation and a large abdominal mass. Abdominal and pelvic magnetic resonance imaging demonstrated a megarectum and megasigmoid, and our patient was managed with medical therapy during her pregnancy, which occurred without major incidents. At the onset of labor, a fecaloma obstructing the pelvic outlet was detected, which required manual disimpaction. However, during the procedure a sudden continuous fetal bradycardia was detected. An emergency Cesarean section was performed but the fetus suffered hypoxic ischemic encephalopathy. One year after the delivery, our patient underwent a sigmoid resection. A histopathological analysis revealed a reduction of nerve cells in the myenteric and submucous plexus, suggesting hypoganglionosis.ConclusionAlthough there are some reports of pregnancies complicated by megacolon, they are too few and too old to delineate guidelines for clinical orientation. In our article, we discuss several issues regarding the management of these rare intestinal innervation disorders during pregnancy that we believe will enhance their obstetric and gastroenterological management during pregnancy.
When pharmacological treatment is needed to reach control of gestational diabetes mellitus (GDM), insulin is still first-line agent but metformin has been progressively pointed as an effective alternative. Our aim is to confirm whether metformin is an effective and safe option to insulin, by comparing maternal and foetal outcomes between women with GDM treated with these drugs. Retrospective study including 399 women with GDM, 135 needing pharmacological treatment. Comparison of demographic features, risk factors for GDM, maternal and foetal outcomes between women treated with insulin (G1, 41/135) and those treated with metformin (G2, 94/135). X 2 /Fisher tests were performed. Significance was set at p < 0.05. Both groups showed similar features and risk factors for GDM, except for chronic hypertension, more prevalent in G1. Therapy with insulin showed poorer metabolic control with higher rate of pregnant with HbA1c ≥ 6% (42 mmol/mol) (25.6 vs 4.5%, p = 0.001) and more polihydramnios (14.6% vs 3.2%, p = 0.023). A higher rate of caesarean was observed in G1, however, with no statistical difference (42.5% vs 26.9%, p = 0.076). There were more newborns weighing < 2500 g in women treated with metformin. No other outcome showed difference with statistical significance, namely maternal weight gain, macrosomia or neonatal comorbidities. Metformin allowed a good metabolic control with maternal and foetal outcomes similar to insulin. Metformin has proven effective as a pharmacological option to insulin. Prospective and randomized studies are needed as well as evaluation of long term benefits of metformin.
teinúria (ou a microalbuminúria, nas fases precoces), já que está bem documentado que a sua presença condiciona um pior prognóstico. É discutível a extensão deste rastreio à população geral assintomática e sem doenças relevantes subjacentes. 2,3 Efectuar uma revisão dos principais mecanismos fisiopatológicos de proteinúria e dos métodos actualmente utilizados na sua detecção e quantificação. Discutir a sua importância clínica e apresentar um possível protocolo de abordagem diagnóstica. Rever as terapêuticas específicas
Derivação pericardioperitoneal no tratamento de derrames pericárdicos em doentes neoplásicos Pericardioperitoneal shunt in the treatment of pericardial effusions in neoplasic patients Recebido para publicação/received for publication: 05.09.22 Aceite para publicação/accepted for publication: 06.10.20
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