Methicillin-resistant Staphylococcus aureus (MRSA) is a major human pathogen worldwide. However, data on MRSA prevalence in the African continent are scarce and nonexistent for São Tomé and Príncipe. In November 2010 and April 2012, a total of 332 individuals (258 patients and 74 health care workers [HCW]) from Hospital Dr. Ayres Menezes in São Tomé and Príncipe, were screened for S. aureus and MRSA carriage. Fifty-two persons (15.7%) were S. aureus nasal carriers out of which 14 (26.9%) were colonized with MRSA. MRSA isolates belonged to three clonal complexes: CC8 (PFGE type B-ST8-t064/t451-IVg/V), CC88 (PFGE E-ST88-t186/t786-IVa), and CC5 (PFGE K-ST5-t105-IVa/PFGE K-ST105-t002-II). A higher genetic diversity was found among methicillin-susceptible S. aureus (MSSA) isolates where 58.5% (n=24) belonged to four major lineages: PFGE type A-ST15-t084; PFGE C-ST508-t861 or related; PFGE D-ST152-t355 or related; and PFGE G-ST121-t159/t2304. Despite the common nonmultiresistant profile, 98% of the isolates harbored two or more virulence factors. Panton-Valentine leukocidine was detected in 36% of the isolates, all MSSA. S. aureus cross-transmission between HCW and patients in the pediatric and medicine wards and the detection of identical MRSA strains among patients in two different wards evidenced the need of implementation of additional infection control measures in this hospital.

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Myasthenia gravis is an autoimmune disorder affecting predominantly women in their reproductive age. The course of the disease during pregnancy is unpredictable, although it is more difficult to manage earlier in the gestation. Myasthenia gravis with antibodies against the muscle-specific receptor tyrosine kinase (anti-MuSK) has been described as a subtype of disease with more localised clinical features and a poorer response to treatment than acetylcholine receptor antibody (anti-AChR)-positive patients. Few cases have been reported in pregnant women, with deliveries being performed mainly by caesarean section. We report a successful case of vaginal delivery and describe our experience providing the first review of the management of this subtype of disease during pregnancy.

SummaryPerinatal morbidity and mortality rates for vasa previa are high when it is not diagnosed antenatally. In this report, a case of vasa previa in a twin pregnancy was diagnosed postnatally, which leads to complications with the first twin. Serial ultrasound during pregnancy did not diagnose a bilobed placenta, a velamentous insertion of the umbilical cord or vasa previa. At 37 weeks, vaginal bleeding was detected in the expulsive stage and vaginal-assisted delivery of both fetuses was undertaken. The first fetus was born pale and anaemic, and required a blood transfusion and therapeutic hypothermia. A high risk of vasa previa is associated with placentas with low-lying insertion, bilobed placentas, velamentous insertions of the umbilical cord, multiple pregnancy and pregnancies conceived after the use of assisted reproductive technologies. Transvaginal ultrasound screening with colour flow Doppler can allow antenatal diagnoses of vasa previa and an improved outcome. BACKGROUND

The accuracy of ultrasound in the prediction of BWD is limited, particularly in pregnancies without fetal growth restriction. Clinical decisions should not rely on BWD alone.

Introduction: The lack of knowledge about the existence, effectiveness, and supply of emergency contraception as well as access to it, its effective duration and the lack of recognition of the need for its use can prevent women from using it. The aim of this study was to ascertain the attitudes, experience, level of knowledge and information sources about emergency contraception of Portuguese female users of healthcare services.Material and Methods: We conducted a multicentre, cross-sectional, observational study among 280 Portuguese women users of health care services through an original and anonymous questionnaire composed of 30 questions.Results: The mean age of the women who replied to the questionnaire was 33.83 ± 8.76 years. Of the observed sample, 27.7% used EC, 50% of whom with no counselling. Despite 92.1% of women claiming knowledge about emergency contraception, only 31.2% of these answered 8 - 10 questions correctly (14 in total). The media were the most frequent source of information (63.4%). Most participants (67.5%) considered that emergency contraception is associated with severe adverse reactions. Furthermore, 76% did not know the time range of effectiveness after unprotected sexual intercourse. Youngest age (p = 0.038), higher education level (p < 0.001), increasing parity (p = 0.051) and previous use of emergency contraception (p = 0.011) were identified as the determinant sociodemographic factors for a higher level of knowledge about emergency contraception.Discussion: The use of emergency contraception after counselling by healthcare professionals was lower than reported in the literature.Conclusion: This study showed that female users of healthcare services were aware of the existence of emergency contraception, but they demonstrated a low level of knowledge about it, especially regarding the correct period of use, place of acquisition and safety issues.

Objective: Rare disease Background: Acute fatty liver of pregnancy is an obstetric emergency characterized by liver dysfunction, which can lead to severe maternal and fetal complications. Case Report: A 34-year-old woman, 37 weeks and 2 days pregnant, reported symptoms of nausea, vomiting, jaundice, and prostration. Laboratory findings revealed liver dysfunction and coagulopathy. A clinical diagnosis of acute fatty liver was made and an emergency cesarean section was performed. The postoperative period was complicated by disseminated intravascular coagulation, acute hepatic and renal insufficiency, and pancreatitis. Conclusions: Early recognition of this pathology, the interruption of pregnancy, and intensive therapy led to a favorable outcome.

Although the nosocomial prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Angola is over 60% and one of the highest in Africa, the extent of MRSA in the community is unknown. To fill this gap, we conducted a hospital-based study in which 158 children attending the emergency ward and ambulatory services of a pediatric hospital in Luanda, the capital of Angola, were screened for S. aureus nasal colonization. Overall, 70 (44.3%) individuals were colonized with S. aureus, of which 20 (28.6%) carried MRSA, resulting in a prevalence of 12.7% (20/158) of MRSA in the population screened. Molecular characterization by pulsed-field gel electrophoresis (PFGE), spa typing, multilocus sequence typing, and SCCmec typing distributed the isolates into two major MRSA clones and one dominant methicillin-susceptible S. aureus (MSSA) lineage, corresponding to the main clones circulating in hospitals in Luanda. The MRSA isolates mainly belonged to clones A (PFGE type A, spa type t105, ST5-IVa-65%) and B (PFGE B, t3869, ST88-IVa-30%), while MSSA isolates mainly belonged to clone L (PFGE type L, t861, ST508-42%). S. aureus isolates showed resistance to penicillin (96%), rifampin (87%), and trimethoprim-sulfamethoxazole (21%). In conclusion, the prevalence of MRSA among children in the community in Luanda is high and seems to originate from hospitals, warranting continuous monitoring and implementation of additional infection control measures.