A sífilis congênita permanece como um problema de saúde pública no Brasil. Este estudo busca descrever a evolução da incidência da sífilis congênita em Belo Horizonte entre 2001 e 2008 e determinar fatores de risco associados ao diagnóstico da doença. Os dados sobre os casos de sífilis congênita e sobre a população de nascidos vivos foram obtidos do Sistema de Informações de Agravos de Notificação (SINAN) e do Sistema de Informações sobre Nascidos Vivos (SINASC), respectivamente. Análise de regressão logística multivariada utilizou a população de nascidos vivos como grupo de referência para identificar fatores de risco independentes para sífilis congênita. A incidência anual da sífilis congênita apresentou uma tendência crescente, de 0,9 para 1,6 casos por 1.000 nascidos vivos entre 2001 e 2008. Fatores de risco independentes para sífilis congênita incluíram: escolaridade materna < 8 anos (OR: 1,3; IC 95%: 1,2-1,4), cor materna parda ou negra (2,1; 1,5-2,8) e a ausência de realização de pré-natal (11,4; 8,5-15,4). A forte associação entre ausência de pré-natal e ocorrência de sífilis congênita indica que a universalização do pré-natal é crucial para o controle deste agravo. O efetivo controle do agravo no Brasil dependerá também de ações para reduzir as iniquidades sociais em saúde.

Due to the persistence of dengue and other arbovirus infections in Brazil, the government has stepped up measures to combat the Aedes aegypti mosquito vector. The responsibilities of community endemic disease workers (CEDW) and community health workers (CHW) include acting as intermediaries and disseminating knowledge in the community. The aim of this study was to analyze knowledge and practices in dengue control by different social subjects: residents and CEDW/CHW. Interviews were held with residents, field and mobilization CEDW, and CHW in two neighborhoods in Salvador, Bahia State, using focus groups. Residents expressed uncertainty on the form of transmission and hazards of dengue. Field CEDW voiced conflicting feelings due to the need to inform the community on issues over which they lack any control, while expressing personal dissatisfaction with their work and a feeling of underappreciation due to their lack of training. Mobilization CEDW blamed the population and emphasized their own importance as the solution to dengue control. CHW failed to reflect their field experience in their discourse and felt they had no responsibility over vector control. All the groups agreed that government is to blame for dengue and that the solution lies in education. There is an evident need for regular educational interventions, based on dialogue and awareness-raising to deal with residents' daily reality, drawing individuals (residents and CHW) into the knowledge-building process. Under the prevailing methodology, the dissemination of information and knowledge is insufficient to promote community improvements for dengue control.

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Fetal lower urinary tract obstruction (LUTO) is an obstructive uropathy beyond the level of the neck of the bladder for which the main cause is the posterior urethral valve. It shows an incidence of 2.2 per 10 000 births and is associated with high rates of morbidity and mortality as a consequence of pulmonary hypoplasia or renal failure. 1 Lower urinary tract obstruction can be an isolated condition or associated with some syndromes, 2 such as megacystis-microcolon syndrome, megacystismegaureter syndrome, prune-belly syndrome, and trisomy 18. Prenatal diagnosis of LUTO is possible since first trimester by the visualization of megacystics. 3 Prenatal ultrasound (US) provides high rates of detection of LUTO by means the identification of classical "keyhole sign," which represents the dilated posterior urethra. 4 Fetal cystoscopy is an invasive technique that allows direct diagnosis of the cause of the obstructive uropathy and then a specific prenatal therapy. If a membrane-like obstruction of the urethral lumen is seen, the diagnosis of posterior urethral valve will be confirmed, allowing the option of laser fulguration of the valves. However, if the membrane-like is not observed, laser fulguration is not possible, and the prognosis is considerably worse. 4 The imaging fusion of real time US and MRI is feasible and may improve the fetal diagnosis. 5 Three-dimensional (3D) virtual navigation is a model created from overlapping image layers generated of US and/ or magnetic resonance imaging (MRI) scan data. This technology provides an immersive virtual reality that allows for anatomic evaluation of fetal structure similarly to performing a real invasive procedure. 6In the present study, we describe a case of a prenatal diagnosis of LUTO with the 3D virtual cystoscopy that was obtained from MRI scan data. In the present case, this technology allowed a didactical and clear evaluation of the pathology.The patient was a 22-year-old primigravida, referred to our tertiary fetal center, because of fetal US at 29 weeks of gestations that identified fetal renal abnormalities. We saw her in our clinic at 31 weeks of gestation. In our unit, a fetal US was performed using a Voluson E8 apparatus (General Electric Medical System, Milwaukee, Wisconsin), which showed moderate bilateral hydronephrosis, increased kidneys size, dilated bilateral ureters, dilated bladder with thickened wall, and dilated superior portion of urethra keyhole sign ( Figure S1). Three-dimensional US in both conventional and HDlive rendering modes identified clearly the increased kidneys size and hydronephrosis ( Figure S2). To obtain a better assessment of fetal morphology, a fetal MRI examination was performed using a 1.5tesla magnet (Magnetom Aera, Siemens Healthcare, Erlangen, Germany) on the same day of the US examination. The MRI protocol was a T2-weighted sequence in the 3 planes of the fetal body (half-Fourier acquisition single-shot turbo spin echo with repetition time, shortest; echo time, 140 ms; field of view, 300-200 mm; 256 × 256 matrix; slice ...

An artificial beta cell has been used to achieve and maintain a preset plasma glucose concentration in five diabetic patients undergoing surgery. These subjects were compared to control groups of normal subjects receiving either saline or glucose, and diabetics receiving glucose intraoperatively. Hyperglycaemia during surgery was seen in normals (mean plasma glucose +/- SEM: 185 +/- 16 mg/dl) and, to a greater degree, diabetics (247 +/- 36 mg/dl) receiving glucose. Insulin and C-peptide levels did not increase during 2 hours of operation in any of the control groups, suggesting beta cell suppression during surgery. As C-peptide levels declined similarly in normal subjects whether they received saline or glucose, the hyperglycaemia seems to be due to an inability to use exogenous glucose. This is confirmed by a correlation of maximal plasma glucose to glucose infusion rate (r = 0.78, p less than 0.01). The artificial beta cell was able to achieve the same plasma glucose after 2 hours of operation (128 +/- 21 mg/dl) as normal subjects receiving saline (110 +/- 7 mg/dl). The artificial beta cell proved to be a safe, convenient and effective way of monitoring and controlling the hyperglycaemia seen in diabetic patients undergoing surgery.

Congenital dacryocystocele (CD) is a rare condition that presents as a periorbital cyst on prenatal examination. CD has a high rate of spontaneous resolution pre-and postnatally; however, more severe malformations can present as facial cysts, such as encephalocele, venous lymphatic malformation, hemangioma, dermoid cyst, teratoma and rhabdomyosarcoma 1 . In cases of face and neck malformation or tumor, magnetic resonance imaging (MRI) can provide accurate images and may aid in parental counseling 2 . In this report, we demonstrate the application of three-dimensional (3D) reconstruction of magnetic resonance images of the fetal upper airways using virtual navigation (VN) for evaluation of tumor extent and nasal permeability in a case of bilateral CD.A 32-year-old woman, gravida 2 para 1, with normal first-and second-trimester scans, was referred to the Department of Fetal Medicine at CDPI (Rio de Janeiro, Brazil) after bilateral periorbital cystic masses were Figure 1 Coronal (a), sagittal (b) and axial (c) T2-weighted magnetic resonance images (obtained using half-Fourier acquisition single-shot turbo spin echo) of 28-week fetus, showing bilateral periorbital cystic lesions (arrows).observed during a fetal growth evaluation scan at 28 weeks. It was not possible to evaluate the extent of the masses during the ultrasound scan. MRI examination was performed using a 1.5-Tesla scanner (Magnetom Aera, Siemens, Erlangen, Germany), as described previously 3 (Figure 1). 3D reconstruction of the fetal airway was performed by overlapping image layers from the MRI datasets using the software Mimics (Materialize, Leuven, Belgium).The 3D model was acquired successfully. The periorbital swelling on both sides of the fetal face was easily reconstructed and identified. The nasal cavities were individualized and successfully delimited. Intranasal VN, as well as segmentation of the dacryocystocele cysts, was possible. We observed partial compromise of the left nasal cavity resulting from minor protrusion of the cyst; on the right side, the cyst did not reach the nasal cavity (Figure 2, Videoclip S1).

ObjectiveTo generate physical models of fetuses from images obtained with three-dimensional ultrasound (3D-US), magnetic resonance imaging (MRI), and, occasionally, computed tomography (CT), in order to guide additive manufacturing technology.Materials and MethodsWe used 3D-US images of 31 pregnant women, including 5 who were carrying twins. If abnormalities were detected by 3D-US, both MRI and in some cases CT scans were then immediately performed. The images were then exported to a workstation in DICOM format. A single observer performed slice-by-slice manual segmentation using a digital high resolution screen. Virtual 3D models were obtained from software that converts medical images into numerical models. Those models were then generated in physical form through the use of additive manufacturing techniques.ResultsPhysical models based upon 3D-US, MRI, and CT images were successfully generated. The postnatal appearance of either the aborted fetus or the neonate closely resembled the physical models, particularly in cases of malformations.ConclusionThe combined use of 3D-US, MRI, and CT could help improve our understanding of fetal anatomy. These three screening modalities can be used for educational purposes and as tools to enable parents to visualize their unborn baby. The images can be segmented and then applied, separately or jointly, in order to construct virtual and physical 3D models.

Prenatal 3D ultrasound and MRI enabled the identification of all Apert syndrome phenotypes. 3D virtual/physical models provided both the parents and the medical team a better understanding of fetal abnormalities.