Resumo Objetivo Recomenda-se o encaminhamento imediato de pacientes com fatores de risco para espectro placentário acreta (PAS, na sigla em inglês) para centros especializados, favorecendo assim o diagnóstico precoce e o manejo interdisciplinar. No entanto, erros diagnósticos são frequentes, mesmo em centros de referência (CRs). Buscou-se avaliar o desempenho do diagnóstico pré-natal para PAS em um hospital latino-americano. Métodos Um estudo descritivo retrospectivo incluindo pacientes encaminhados por suspeita de SAP foi realizado. Os dados dos exames de imagem do pré-natal foram comparados com os diagnósticos finais (intraoperatórios e/ou histológicos). Resultados Foram incluídos 162 pacientes no presente estudo. A idade gestacional mediana no momento da primeira ultrassonografia suspeita de PAS foi de 29 semanas, mas as pacientes chegaram ao CR de PAS com 34 semanas. A frequência de resultados falso-positivos nos hospitais de referência foi de 68,5%. Sessenta e nove pacientes foram operadas com base na suspeita de PAS com 35 semanas e houve 28,9% de falso-positivos no CR. Em 93 pacientes, o diagnóstico de PAS foi descartado no CR, com frequência de falso-negativos de 2,1%. Conclusão O diagnóstico pré-natal de PAS é melhor no CR. Entretanto, mesmo nestes centros, resultados falso-positivos são comuns; portanto, a confirmação intraoperatória do diagnóstico de SAP é essencial.

Abstract Objective The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital. Methods A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological). Results A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency. Conclusion The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.

Abstract Objective: In previous studies, smaller renal volumes were reported in prematurely born infants, however, these renal volumes were not corrected for body surface area, the main determinant of renal size. Given the rapid growth of the renal cortex after premature birth, the authors hypothesized that corrected volumes would not differ from healthy controls. Methods: Ambispective cohort study with prospective follow-up of prematurely born babies in a large specialized center and retrospectively recruited healthy control group. Children were assessed for renal length and renal volumes at age 5 by three independent ultrasonographers. Detailed anthropometry, blood pressure and renal function were also obtained. Age independent z-scores were calculated for all parameters and compared using descriptive statistics. Results: Eighty-nine premature study participants (median 32 weeks gestational age) and 33 healthy controls (median 38 weeks gestational age) were studied. Study participants did not differ in age, sex, Afro-Colombian descent, height, blood pressure, serum creatinine, or new Schwartz eGFR. Premature study participants had a significantly lower weight (17.65 ± 2.93 kg) than controls (19.05 ± 2.81 kg, p = 0.0072) and lower body surface area. The right renal volumes were significantly smaller (39.4 vs 43.4 mL), but after correction for body surface area, the renal volume and renal length z-scores were identical for both kidneys (mean right kidney -0.707 vs -0.507; mean left kidney -0.498 vs -0.524, respectively). Conclusion: Renal volumes need to be corrected to body surface area. After correction for body surface area, 5-year-old healthy and prematurely born children have comparable renal volumes.

Con la finalidad de aportar elementos diferentes a las evidencias geológicas y geomorfológicas que permitan corroborar la existencia de la falla Albarregas, que corta longitudinalmente la terraza de Mérida, y que corre paralela al cauce del río del mismo nombre, se realizaron medidas de la concentración de gas radón en algunos sitios cercanos a su traza. La investigación se justifica por el hecho de que la ciudad ha crecido en torno a la mencionada falla, ocupando el área de afectación en caso de eventualidad sísmica originada por ella. Las medidas se realizaron con un equipo Pylon AB-5 dotado de celdas Lucas, con el que se obtuvieron perfiles transversales al rumbo de la falla. Los resultados muestran anomalías bien definidas en la concentración de gas radón, constituyendo una clara evidencia geoquímica de la existencia de la mencionada falla y permitiendo definir su traza en gran parte de su extensión. La importancia de estos resultados radica en el hecho de que aportan información complementaria sobre la existencia de esta falla, cuya traza fue postulada con base en la necesidad de establecer la existencia del contacto entre dos formaciones y a su control estructural sobre el río Albarregas. De igual forma, los resultados evidencian la factibilidad de aplicar el método de medición de gas radón en centros poblados, aunque sólo bajo ciertas condiciones especiales, pero aun así, podría resultar de mucha utilidad en trabajos de microzonificación sísmica.

The Albarregas fault is an inferred fault running along the Mérida terrace, following the course of the Albarregas river. The city of Mérida has grown around this fault, occupying the possible area that may be affected by an earthquake along it. With the aim of providing new evidence (other than geological or geomorphological) that contribute to demonstrate the existence of the Albarregas fault, radon soil gas has been monitored near its trace. For sampling, a Pylon AB-5 equipment, with Lucas cells (scintillation cells) was used; 11 localities were sampled along transverse paths (transects) to the river course, and anomalous radon high concentrations were obtained indicating the presence of the fault. These results are important because they provide additional geochemical information on the existence of the Albarregas fault, which was postulated assuming a structural control over the Albarregas river, and assuming the geological contact of two formations underneath the terrace. On the other hand, the results also indicate that radon gas monitoring is a suitable method for determining blind or hidden faults in towns, constituting a useful tool in microzonation works.