To identifying spatial patterns in the distribution of perinatal mortality in the state of São Paulo from 2003 to 2012. An ecological and exploratory study with data on perinatal mortality rates of every thousand live births, which were registered on the digital database containing 645 municipalities in the state of São Paulo within the periods of 2003 to 2007 and 2008 to 2012. The spatial analysis provided Moran's index (MI) and thematic maps of rates, and the Moran maps of both periods were drawn. The average rates were compared by Student's test. The TerraView 4.2.2 software (INPE, S. José dos Campos, Brazil) was also used. There were 49,485 perinatal deaths during the first period, at a rate of 17.90 deaths/1,000 live births (standard deviation [SD] = 7.0; MI = 0.14; = 0.01), and 44,582 perinatal deaths during the second period, at a rate of 16.40 deaths/1,000 live births (SD = 11.14; MI = 0.04; = 0.03). These rates are statistically different ( < 0.01). There was a decrease in these rates in 413 municipalities when comparing the two periods. The Moran map has identified 35 municipalities that require special attention, which are located in the Eastern, Southwestern, Western and Northwestern regions of São Paulo state. The study provides municipal managers with subsidies so they can minimize these rates by implementing public policies and taking better care of pregnant women and newborns.

Objectives: to identify spatial pattern on hospitalization rates of children with diarrhea in the counties in São Paulo

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setts General Hospital, 2 MGH. RATIONALE: NRH has been correlated with increased morbidity and mortality in CVID patients. Liver biopsy is the gold standard for NRH diagnosis, however, ideal would be an earlier, noninvasive diagnostic technique. We hypothesized that FibroscanÒ (vibration controlled transient liver elastography) may facilitate the diagnosis of NRH in CVID patients. METHODS: Using a published MGH CVID cohort, we identified CVID patients with biopsy-confirmed NRH ('NRH'), elevated liver biochemistries without biopsy-confirmed NRH ('at risk for NRH'), and non-elevated liver biochemistries ('control'). Patients with chronic viral hepatitis, non-alcoholic steatohepatitis, chronic alcohol use, and/or primary biliary cirrhosis were excluded. We reviewed both clinical Fibroscans, from the electronic medical record, and research-based Fibroscans. Fibroscan-obtained liver stiffness measurements (LSM, kPa) were compared using a two-tailed Student's t-test. RESULTS: Within the MGH CVID cohort, 'control' patients (n53) had a median LSM of 4.9 kPa (range 4.1-5.8 kPa), 'NRH' patients (n54) had a median LSM of 11.2 kPa (range 7.0-26.1 kPa), and 'at risk for NRH' patients (n52) had a median LSM of 11.5 kPa (range 9.8-13.1 kPa). Compared to control CVID, LSMs were significantly elevated in CVID patients with known or suspected NRH (P 5 0.031). CONCLUSIONS: These preliminary data suggest the diagnostic utility of Fibroscan in CVID patients with known or suspected NRH. Elevated liver biochemistries and LSMs may prompt liver biopsy and immediate immunosuppressive intervention. Further studies will extend these findings to the full CVID cohort, correlate Fibroscan reads with NRH disease severity on biopsy, and increase monitoring of liver stiffness following immunosuppressive therapy.

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