SAO PAULO, Brazil – Brazilian doctors have decided not to immediately remove nine of the 31 needles found in a toddler’s body because his life is no longer in danger.

Doctor Roque Aras said Tuesday that the remaining needles are small and don’t pose a significant threat. Aras isn’t ruling out future operations, however.

The 2-year-old boy had his third surgery in 10 days on Monday to extract four needles from his neck. Doctors removed 14 more from his intestines, liver and bladder last week, and four from near his heart and lungs earlier.

Police accuse the boy’s stepfather, Roberto Carlos Magalhaes, and his lover of attempted murder, though prosecutors have not yet filed charges.

Magalhaes told Globo TV he wanted to kill the child to spite his wife.

SAO PAULO, Brazil – Surgeons on Friday successfully removed four sewing needles from the lung and near the heart of a Brazilian toddler, allegedly plunged into him by his stepfather during a monthlong series of bizarre rituals.

The surgery lasted nearly five hours and the 2-year-old boy was in stable condition after the procedure, said Susy Moreno, a spokeswoman for the hospital in the northeastern city of Salvador where the boy was in intensive care.

“He’s OK, the surgery was a success, he’s doing fine,” she said in a telephone interview.

Dozens more needles measuring up to 2 inches (5 centimetres) in length remain inside the boy’s body, but the four removed were considered the most life-threatening.

Doctors will evaluate the boy’s recovery before deciding when to perform at least two more surgeries to remove more needles, she said.

Police say the boy’s stepfather, 30-year-old bricklayer Roberto Carlos Magalhaes, confessed to pushing supposedly “blessed” sewing needles deep into the child because his lover told him to while in trances.

The rituals were performed over a period of a month to try to keep the couple together, the stepfather told police. Authorities suspect the woman was trying to take revenge on the wife of her lover by having the man hurt her son.

Magalhaes told detectives the woman would enter into trances and give him commands to insert the needles, police inspector Helder Fernandes Santana said. The stepfather told police the rituals happened every few days for a full month, with him inserting several needles during each session.

The lover, Angelina Ribeiro dos Santos, paid to have the needles blessed by a woman who practiced the Afro-Brazilian religion Candomble, Santana said.

Authorities initially estimated the boy had as many as 50 needles were inside the boy. After batteries of tests were performed, doctors now believe there are closer to 30 needles inside, but they don’t know for sure.

“They haven’t focused on how many there are because they are concentrating on the most dangerous ones,” Moreno said.

The boy was also suffering from an infection from one needle, but received antibiotics and was in stable condition and breathing on his own before going into surgery, she said.

Magalhaes and dos Santos were both arrested, though no charges were filed.

Dos Santos is not believed to be a member of any religious or occult group, and authorities believe she came up with the idea of the rituals on her own, Santana said.

The two were taken to an undisclosed lockup for their own protection after a mob threw stones at the police station where they were being held. It was not immediately clear whether they had legal representation.

Authorities also detained the woman who blessed the needles so she could be questioned, but Santana has said he expects she will be released without charge because she did not know how they were being used.

The boy’s mother, a maid, took him to her hometown hospital in Ibotirama on Dec. 10, saying he was complaining of pain.

After X-rays revealed the cause, the mother told police she didn’t know how the needles got inside her son, whose name was not released because of his age. The boy was later transferred to the much larger hospital in the coastal city of Salvador.

Police and doctors concluded it would have been impossible for the boy to have ingested the needles, which have been found throughout his abdomen, in one leg and in his spine.

Afro-Brazilian religions practiced in Brazil have no ceremonies, rituals or practices involving harm to people, said Nelson Inocencio, director of African-Brazilian studies at the University of Brasilia.

He worried that the incident could hurt the image of the religions, of which Candomble is the most popular, and concentrated most in Bahia state where Ibotirama is located.

MONTREAL – Serious birth defects that strike as many as 2,000 babies each year in Quebec could be avoided, the author of a new study said Tuesday.

Researchers found that more than six per cent of pregnant Quebecers in the study took prescription drugs that are known to be dangerous for fetuses.

The research, led by Universite de Montreal, shows that half of the expectant mothers who consumed the potentially dangerous medications opted for abortions – a rate that was 11 per cent higher than for the rest of the population.

Lead author Anick Berard said these congenital malformations could be prevented with better communication between physicians and patients.

Berard, who believes the statistics are similar for pregnant women across the country, is urging governments to improve monitoring for drugs that pose a risk to embryos.

“Obviously, Canada has been riding on this risk-management program which is very weak, going on the good faith of the prescriber and the user,” said Berard, an epidemiologist from Universite de Montreal’s pharmacy department.

“Well, now we know that it does not work.”

The study, available online and to be published in an upcoming issue of the British Journal of Obstetrics and Gynaecology, examined data from 109,344 Quebec women, aged 15 to 45, who were pregnant between 1998 and 2002.

Researchers found that 6,871 of the pregnant women filled out at least one prescription for medications that are known to threaten fetuses.

Berard said the potentially dangerous substances include drugs to treat anxiety, epilepsy and severe acne.

As an example, she explained that some of the stronger acne medicines can increase the average three-per-cent risk of congenital malformations tenfold.

“You have 30 per cent chance of having a baby with a birth defect – which is huge, it’s one out of three,” Berard said.

She identified major defects as anything from a hole in a baby’s heart to a missing limb.

In the study’s sample, the rate of birth malformations in the general population was seven per cent. For the women who consumed the prescription drugs, it was more than eight per cent.

With roughly 80,000 births per year in Quebec, one percentage point can translate to between 800 and 2,000 birth malformations annually, Berard said.

“One per cent (one percentage point) is a lot of people – a lot of babies,” she said.

Berard believes the majority of these drugs were taken in the first weeks of unplanned pregnancies, when most women still don’t know they’re expecting. About half of Quebec pregnancies are unplanned.

The best way to prevent birth defects caused by prescription drugs? Plan your pregnancy, she said, and take oral contraceptives when necessary.

Berard said one of the major challenges is reaching out to sexually-active teenage girls, who often share acne medication without knowing the potential consequences if they get pregnant.

The Canadian Patient Safety Institute, a not-for-profit organization that advocates safer health-care practices, held a week-long campaign this month promoting communication in the health system.

“Good communication is key and it doesn’t matter whether it’s from the patient’s perspective or from the caregiver’s perspective,” said Paula Beard, the institute’s director of operations.

“Just because we’re talking about health care doesn’t make it any different than any other aspect of our life – good communication is a transferable skill no matter what.”

TORONTO – A significant proportion of HIV-positive women of child-bearing age want to become pregnant at some point in the future, a new study shows, although extra care is needed to prevent transmission of the virus to their babies.

The findings, to be published online Monday by the open access journal PLoS One, point to the need for more services and support for these women so they can have healthy children, researchers say.

The study focused on women in Ontario, and found that 69 per cent of those who responded to a detailed questionnaire expressed a desire to have a baby, while 57 per cent said they actually intend to become pregnant.

Dr. Mona Loutfy, an infectious disease specialist at Women’s College Hospital in Toronto who sees a lot of HIV-positive patients, and her colleagues recruited 490 women from 38 sites across Ontario to complete the survey between October 2007 and April 2009.

“When I was seeing my patients a lot of them were saying that they were interested in pregnancy,” she said in an interview.

“They weren’t being supported either by their family doctors or other doctors, or by the system, including fertility clinics.”

When HIV-AIDS appeared on the scene in North America in the 1980s, life expectancy for those afflicted was short and most HIV-positive women were focused on survival, not contemplating becoming pregnant.

That’s all changed and Loutfy noted that HIV can be “very well managed” today.

“We have 25 anti-HIV drugs, and if we use three of them in combination and the patients take their drugs and don’t miss pills, their life expectancy is now said to be similar to the general population,” she said.

“If a woman’s HIV-positive, we can give her the same drugs and ask her to not breastfeed and the baby has less than one per cent chance of getting infected with HIV.”

Studies involving hundreds of thousands of babies born to HIV-positive women taking antiretroviral drugs in the United States and France found that they had no problems compared to the general population, Loutfy said.

“So putting all that together, I think we’re at a point now where we can support HIV-positive women and men and couples with their pregnancy planning desires.”

A few years ago in British Columbia, a similar survey found only about 30 per cent of HIV-positive women were interested in pregnancy, Loutfy said.

She attributes the higher Ontario numbers to a different demographic that includes many immigrants from Africa and the Caribbean.

“They’re taking their medications, they’re working, while in British Columbia they have more of an intravenous drug-using population and an aboriginal population that gets HIV,” she explained.

There are numerous stumbling blocks for HIV-positive women who wish to become pregnant, according to Dr. Deborah Money, executive director of the Women’s Health Research Institute in British Columbia, and an expert in viral pathogens in women and pregnancy.

“In many cases it’s family members or friends, who if they share that desire with them, are aghast that they would think about having a baby when they have HIV – usually aghast from a position of not understanding what can be done, but there’s often lack of support,” she said.

“And then the medical community, depending on who they connect with, to say I’m positive and I’d like to have a baby, they may not get a positive response, or the right advice as to what can happen or what can be done.”

She said about 200 babies are born each year in Canada to HIV-positive women.

Fertility clinics are only starting to become comfortable in dealing with HIV-positive couples, Money noted, yet they can play a key role in the conception process if one partner is HIV-positive and the other needs to be protected from the virus.

If just the woman is HIV-positive, a syringe or “turkey baster” method can be used for insemination, according to Loutfy, and this can be done at home or with the assistance of a fertility clinic.

Dr. Matt Gysler, medical director of the ISIS Regional Fertility Centre in Mississauga, Ont., said that if a man is HIV-positive, he needs drug therapy to bring the viral count down, and a special technique is used to separate the sperm from fluid so that it’s likely to be non-infectious for insemination. These sperm preparations can cost between $200 and $400, he noted.

“Many of our HIV-positive patients are recent immigrants, some of them are not financially well-to-do … my opinion is that all fertility treatments should be covered,” he said.

“It’s very tough to sit in front of somebody who just can’t afford it.”

It was an “uphill battle” to convince his partners and lab and clinic staff to start taking HIV-positive patients three or four years ago because they feared contracting the virus or that other patients would walk out, he said.

But he won that battle, and now HIV-positive patients even travel from Montreal because they’ve had trouble finding clinics at home to serve them.

“There is a certain amount of fear and the need to set up procedures to deal with infectious patients,” he said. “Fundamentally, you just have to practise excellence in terms of contamination prevention.”

Loutfy said she surveyed 23 of 28 clinics registered with the Canadian Fertility and Andrology Society, and found about half were willing to see HIV-positive patients.

However, she found that only six of the 23 clinics offered the “sperm washing” technique described by Gysler.