The experience of pregnant women and their families who were infected with covid-19 before vaccination: A qualitative approach within a multicenter study in Brazil

BACKGROUND

Pregnant and postpartum women infected by COVID-19 are at increased risk of adverse outcomes, including negative effects on their mental health. Brazilian maternal mortality rate due to COVID-19 is 2.5 times higher than overall mortality rates. This study aimed to understand how pregnant/postpartum women experienced the COVID-19 suspicion/investigation or confirmed infection in different Brazilian cities, the pandemic's consequences to women and their families, and their needs to improve maternal health services during public health emergencies.

METHODS

We conducted a qualitative study with 27 women with COVID-19 and 6 of their family members, as part of a multicenter study among 15 maternity hospitals in Brazil. We applied in-depth interviews through telephone calls when women received the diagnostic or had a suspect infection and after 60 days. Another semi-structured interview was applied to their close family members. The interviews were considered through thematic analysis.

RESULTS

From the thematic content analysis three major themes emerged from the first and second interviews: (Cucinotta and Vanelli, 2020) assistance received by the woman and newborn in the medical services; (World Health Organization (WHO) 2021) stigma/fear of contamination from health workers and from family and friends reported by the women; (Allotey et al., 2020) the COVID-19 pandemic impact.

CONCLUSION

Before the availability of the COVID-19 vaccine, pregnant women experienced fear of death, hospitalization, quarantine, loss of family members, and financial repercussions, resulting in physical, psychological, and socioeconomic impacts on these women's lives.

The effect of body mass index on maternal and perinatal outcomes in COVID-19 infection during pregnancy and postpartum: Secondary analysis from the REBRACO cohort study

OBJECTIVES

To compare maternal and perinatal outcomes among women with obesity, overweight, and normal body mass index, associated with COVID-19 infection during pregnancy and postpartum.

METHOD

Prospective Cohort Study, within the REBRACO (Brazilian Network of COVID-19 in Pregnancy) multicenter initiative. Confirmed positive cases of SARS-CoV-2 were included, and women categorized into three groups according to their pre-pregnancy BMI: obesity (BMI ≥ 30), overweight (BMI <30 but >25), and normal BMI. Sociodemographic, clinical, and obstetric characteristics and different maternal and perinatal outcomes were compared, and a multiple regression analysis was performed to investigate factors independently associated with adverse maternal and perinatal outcomes.

RESULTS

Two hundred eighty-nine women positive for SARS-CoV-2 infection were considered, and 202 had available data on maternal BMI for the current analysis. Overall, 72 (35.6%)obese, 68 (33.6%) overweight, and 60 (29.7%) normal BMI. Obesity was associated with increased adverse clinical outcomes including sepsis (P =  0.02), acute respiratory distress syndrome (P = 0.002), and the need for mechanical ventilation (P = 0.044). Considering perinatal outcomes, a multiple regression model confirmed obesity as an independent factor associated with adverse results (adjusted odds ratio 3.73, 95% CI 1.54-9.08).

CONCLUSION

Obesity and overweight were associated with worse clinical outcomes, severe/critical COVID-19, and adverse perinatal outcomes.

Preeclampsia among women with COVID-19 during pregnancy and its impact on maternal and perinatal outcomes: results from a national multicenter study on COVID in brazil, the REBRACO initiative

Objective

To evaluate the prevalence of preeclampsia among cases of COVID-19 infection during pregnancy and the association between both conditions, in a multicenter cohort of Brazilian women with respiratory symptoms.

Study design

Ancillary analysis of the Brazilian Network of COVID-19 in Obstetrics (REBRACO) study. We performed a nested case-control analysis selecting all women with COVID-19 and compared outcomes between women with and without PE.

Main outcomes

Maternal, gestational, and clinical characteristics and perinatal outcomes.

Measures

Prevalence ratio (PR) and its 95%CI for each of the predictors and outcomes.

Results

A total of 203 women were included: 21 (10.3%) in PE group and 182 (89.7%) in non-PE group. Preeclampsia was not different among women with and without COVID-19 (10.3% vs 13.1%, p-value = 0.41), neither complication such as eclampsia and HELLP syndrome. Chronic hypertension (33.4%) (p < 0.01) and obesity (60.0%) (p = 0.03) were the most frequent comorbidities in PE group, and they were significantly more frequent in this group. Women with PE had more cesarean section (RR 5.54 [1.33 – 23.14]) and their neonates were more frequently admitted to neonatal intensive care unit (PR 2.46[1.06 – 5.69]), most likely due to preterm-birth-related complications.

Conclusion

The prevalence of PE among women with COVID-19 infection during pregnancy was around 10%; women with COVID-19 and a history of chronic hypertension or obesity are more likely to have preeclampsia. Cesarean section is increased among women with PE and COVID-19, with increased rates of neonatal admission to intensive care units, mostly due to prematurity.

Structuring functional groups of aquatic insects along the resistance/resilience axis when facing water flow changes

Understanding how differences in intensity and frequency of hydrological disturbances affect the resistance and resilience of aquatic organisms is key to manage aquatic systems in a fast‐changing world. Some aquatic insects have strategies that improve the permanence (resistance), while others use strategies that favor recolonization (resilience). Therefore, we carried out a manipulative experiment to understand the influence of functional characteristics of aquatic insects in their permanence and recolonization against hydrological disturbances in streams in the biodiversity hotspot of the Cerrado of Brazil. We placed 200 artificial substrates in five streams and submitted them to changing water flow regimes that differed both in frequency and intensity, and we observed the response of the aquatic community for 39 days. We used a hierarchical Bayesian approach to estimate the probabilities of permanence and recolonization of each life strategy group (nine groups). We observed that the most intense changes in the water flow tended to affect the permanence of almost all groups, but the intensity of this effect reduced over time. On the other hand, less frequent disturbances, regardless of intensity, tended to reduce the permanence of most groups of aquatic insects over time. The different effects of disturbance intensity may have been related to a greater recolonization capacity of some groups. The results we present are worrisome in a scenario of reduced riparian vegetation around streams and with the expectation of precipitation becoming more concentrated in shorter periods of time due to climate change in the Cerrado hotspot, reducing the occurrence of many groups of aquatic insects in their habitat, particularly those with traits associated with resistance against hydrological disturbance.

Temporary Shutdown of ERK1/2 Phosphorylation Is Associated With Activation of Adaptive Immune Cell Responses and Disease Progression During Leishmania amazonensis Infection in BALB/c Mice

Leishmania spp. infection outcomes are dependent on both host and parasite factors. Manipulation of host signaling pathways involved in the generation of immune responses is thought to be one of the most common mechanisms used by parasites for persistence within the host. Considering the diversity of pathologies caused by different Leishmania spp., it is plausible that significant differences may exist in the mechanisms of host cell manipulation by each parasite species, which may have implications when developing new vaccine or treatment strategies. Here we show that in L. braziliensis-infection in BALB/c mice, a model of resistance, activation of ERK1/2 coincides with the peak of inflammatory responses and resolution of tissue parasitism. In contrast, in the susceptibility model of L. amazonensis-infection, an early silent phase of infection is observed, detected solely by quantification of parasite loads. At this early stage, only basal levels of P-ERK1/2 are observed. Later, after a brief shutdown of ERK1/2 phosphorylation, disease progression is observed and is associated with increased inflammation, lesion size and tissue parasitism. Moreover, the short-term down-regulation of ERK1/2 activation affected significantly downstream inflammatory pathways and adaptive T cell responses. Administration of U0126, a MEK/ERK inhibitor, confirmed this phenomenon, since bigger lesions and higher parasite loads were seen in infected mice that received U0126. To investigate how kinetics of ERK1/2 activation could affect the disease progression, U0126 was administered to L. amazonensis-infected animals earlier than the P-ERK1/2 switch off time-point. This intervention resulted in anticipation of the same effects on inflammatory responses and susceptibility phenotype seen in the natural course of infection. Additionally, in vitro inhibition of ERK1/2 affected the phagocytosis of L. amazonensis by BMDMs. Collectively, our findings reveal distinct temporal patterns of activation of inflammatory responses in L. braziliensis and L. amazonensis in the same animal background and a pivotal role for a brief and specific shutdown of ERK1/2 activation at late stages of L. amazonensis infection. Since activation of inflammatory responses is a crucial aspect for the control of infectious processes, these findings may be important for the search of new and specific strategies of vaccines and treatment for tegumentary leishmaniasis.

Brazilian network of COVID-19 during pregnancy (REBRACO: a multicentre study protocol)

INTRODUCTION

The aim of this study was to evaluate the clinical, epidemiological and laboratory aspects of SARS-CoV-2 infection during pregnancy and postpartum in 16 maternity hospitals.

METHODS AND ANALYSIS

A prospective multicentre study, with five axes. First, the prevalence of SARS-CoV-2 infection among women admitted for childbirth will be described in a cross-sectional study. Second, maternal and perinatal outcomes will be assessed in a prospective cohort study including pregnant or postpartum women with suspected COVID-19. Third, a cohort of positive COVID-19 cases with sampling of a variety of biological material. Histopathological and viral analysis of biological maternal and neonatal samples will be performed, and the assessment of nutritional variables to evaluate the association between vitamin D and severity of infection. Fourth, a monitoring and evaluation committee to collect relevant healthcare information and plan actions in centres facing the pandemic. Furthermore, qualitative studies will be performed to study pregnant women, their families and health professionals. Fifth, an ecological study will monitor the number of live births, stillbirths and other outcomes to explore any trend among the periods before, during and after the pandemic. Data will systematically be collected in an electronic platform following standardised operational procedures. For quantitative study components, an appropriate statistical approach will be used for each analysis. For qualitative data, in-depth interviews recorded in audio will be transcribed, checking the text obtained with the recording. Subsequently, thematic analysis with the aid of the NVivo programme will be performed.

ETHICS AND DISSEMINATION

Ethical approval was obtained (letters of approval numbers 4.047.168, 4.179.679 and 4.083.988). All women will be fully informed to sign the consent form before enrolment in the study. Findings will be disseminated through peer-reviewed journals and scientific conferences.

Facing the COVID-19 pandemic inside maternities in Brazil: A mixed-method study within the REBRACO initiative

INTRODUCTION

COVID-19 pandemic posed major challenges in obstetric health care services. Preparedness, development, and implementation of new protocols were part of the needed response. This study aims to describe the strategies implemented and the perspectives of health managers on the challenges to face the pandemic in 16 different maternity hospitals that comprise a multicenter study in Brazil, called REBRACO (Brazilian network of COVID-19 during pregnancy).

METHODS

Mixed-method study, with quantitative and qualitative approaches. Quantitative data on the infrastructure of the units, maternal and perinatal health indicators, modifications on staff and human resources, from January to July/2020. Also, information on total number of cases, and availability for COVID-19 testing. A qualitative study by purposeful and saturation sampling was undertaken with healthcare managers, to understand perspectives on local challenges in facing the pandemic.

RESULTS

Most maternities early implemented their contingency plan. REBRACO centers reported 338 confirmed COVID-19 cases among pregnant and post-partum women up to July 2020. There were 29 maternal deaths and 15 (51.8%) attributed to COVID-19. All maternities performed relocation of beds designated to labor ward, most (75%) acquired mechanical ventilators, only the minority (25%) installed new negative air pressure rooms. Considering human resources, around 40% hired extra health professionals and increased weekly workload and the majority (68.7%) also suspended annual leaves. Only one center implemented universal screening for childbirth and 6 (37.5%) implemented COVID-19 testing for all suspected cases, while around 60% of the centers only tested moderate/severe cases with hospital admission. Qualitative results showed that main challenges experienced were related to the fear of the virus, concerns about reliability of evidence and lack of resources, with a clear need for mental health support among health professionals.

CONCLUSION

Study findings suggest that maternities of the REBRACO initiative underwent major changes in facing the pandemic, with limitations on testing, difficulties in infrastructure and human resources. Leadership, continuous training, implementation of evidence-based protocols and collaborative initiatives are key to transpose the fear of the virus and ascertain adequate healthcare inside maternities, especially in low and middle-income settings. Policy makers need to address the specificities in considering reproductive health and childbirth during the COVID-19 pandemic and prioritize research and timely testing availability.

Synthesis of benzoylthiourea derivatives and analysis of their antibacterial performance against planktonic Staphylococcus aureus and its biofilms

Following the appearance of several antimicrobial agents to control the spread of infections, two major challenges have emerged: (i) the occurrence and blowout of multiresistant bacteria and the increase of chronic diseases and (ii) difficult-to-eradicate infections. In this study, we tested five benzoylthiourea derivatives for their ability to inhibit and stop bacterial growth and evaluated the possible influence of 1,2,4-triazolyl-benzoylthiourea derivative 4 on the formation and eradication of Staphylococcus aureus biofilms. Benzoylthiourea derivatives 4, 6, 10, 11 and 13 were obtained in one or two steps with low cost and subjected to tests to identify their minimum inhibitory concentration (MIC) and minimum bactericidal concentration. In vitro tests were also performed to assess their effects on biofilm formation and in preformed biofilms and scanning electron microscopy was used to visualize the effects on biofilm formation. The 1,2,4-triazolyl-benzoylthiourea derivative 4 showed bacteriostatic activity against the S. aureus HU25 clinical strain with an MIC of 16 µg ml^-1 , which is below the toxic concentration (at 2500 µg ml^-1 , 62·25% of the cells remained viable). Compound 4 also effectively prevented biofilm formation at the three subinhibitory concentrations tested (1/2 MIC, 1/4 MIC and 1/8 MIC) as confirmed by scanning electron microscopy. For breakdown of formed biofilms, the main influence was at a subinhibitory concentration (1/2 MIC). These findings make compound 4 a strong candidate for studies on the development of new antimicrobial and antibiofilm agents.

Viability of Staphylococcus aureus and expression of its toxins (SEC and TSST-1) in cheeses using Lactobacillus rhamnosus D1 or Weissella paramesenteroides GIR16L4 or both as starter cultures

Staphylococcus aureus is one of the main causative agents of food poisoning. This bacterium is an important component of cheese microbiota and plays an important role in foodborne diseases. Another important component of the microbiota is the lactic acid bacterium, which actively participates in processes that define the physicochemical, sensorial, and microbiological features of cheese. Of the various microbiological interactions in cheese, the interaction between lactic acid bacteria and Staph. aureus is most relevant. To this end, we evaluated the viability of Staph. aureus strains and the expression of their enterotoxins in cheeses produced experimentally, using Weissella paramesenteroides GIR16L4 or Lactobacillus rhamnosus D1 or both as starter cultures. Over 7 d, we observed that the presence of lactic acid bacteria did not impair Staph. aureus growth. However, via qPCR we observed a change in the gene expression of staphylococcal enterotoxins, suggesting that molecular communication exists between Staph. aureus strains and lactic acid bacteria in cheese.

The Impact of Immunosuppressive Drugs on Human Placental Explants

The use of immunosuppressive drugs guarantees the vitality of the graft and allows gestation in spite of intercurrences such as prematurity and intrauterine growth restriction. However, little is known about the direct effects of immunosuppressive drugs on placental cells. We investigated the effects of immunosuppressive drugs in the chorionic villous explants from human term placentas of healthy gestations. Human placental explants from term gestations (37-39 week gestational age, n = 12) were exposed to cyclosporine A (CSA, 0, 62.5, 125, 1250 ng/mL) or azathioprine (AZA, 0, 5, 10, 100 ng/mL) separately or, in combination for up to 48 hours. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays showed a significant decrease in the explant metabolic activity between AZA and the control group (24 hours, 100 ng/mL, 48 hours, all concentrations, P < .005). Cyclosporin A (CsA) reduced cell activity when associated with AZA (48 hours, P < .005). Fibrinoid deposits increased in AZA-treated explants alone (5 ng/mL, 48 hours; 10 ng/mL, 24-48 hours; P < .005) or when associated with CsA (10 AZA/125 CsA, P < .05), whereas in CsA treatment alone, there was an augment in syncytial knots (24-48 hours, P < .005). The sFLT1 gene (24 hours, P < .05) and protein ( P < .005) expression increased in AZA and CsA-treatments separately or in combination ( P < .05). Placental growth factor increased in AZA (24 hours, 10 ng/mL) and CsA (125 ng/mL; P < .05). In conclusion, our data indicate that AZA primarily acts on the villous metabolism, perturbing placental homeostasis. Since these drugs may alter the balance of angiogenic factors in its selection for clinical application, their impact on the behavior of placental villous should be considered.

Environment and Spatial Influences on Aquatic Insect Communities in Cerrado Streams: the Relative Importance of Conductivity, Altitude, and Conservation Areas

The aquatic insect community is an important element for stream functionality and diversity, but the effects of altitude and conservation areas on the aquatic insect community have been poorly explored in neotropical ecozone. The lack of studies about the relative importance of space and environment on community structure is another obstacle within aquatic insect ecology, which precludes the inclusion of these studies in more current frameworks, like the metacommunity dynamics. We evaluated the relationship between the aquatic insect community structure at 19 streams in the Brazilian Cerrado and spatial and environmental variables, namely geographical distance among sites, stream altitude, chemical variables, and environmental protection areas. We partitioned the variance explained by spatial and environmental components using a partial redundancy analysis. The environment exhibited a strong spatial structure for abundance and number of genera, increasing these community parameters with elevated water conductivity. Only community composition had a large unexplained portion of variance, with a small portion constrained by environmental (altitude and conductivity) and spatial factors. A relevant point in the result was the streams with high conductivity were located outside of the conservation areas. These results suggest that the relationship between number of genera and abundance with environmental conditions is always associated with spatial configuration of streams. Our study shows that altitude is an important determinant of community structure, as it exerts indirect influences, and electrical conductivity directly determines community composition, and that some national parks may be inefficient in maintaining the diversity of aquatic insects in the Cerrado region.

Annexin A1 Is Involved in the Resolution of Inflammatory Responses during Leishmania braziliensis Infection

Leishmaniases are diseases caused by several Leishmania species. Leishmania (Viannia) braziliensis can cause localized cutaneous leishmaniasis (LCL), which heals spontaneously, or mucosal leishmaniasis (ML), characterized by chronic and intense inflammation and scanty parasitism. Annexin A1 (AnxA1) is a protein involved in modulation and resolution of inflammation through multiple mechanisms. In the present study, the role of AnxA1 was investigated in L. braziliensis-infected BALB/c mice. AnxA1 levels increased at the peak of tissue lesion and parasitism in infected mice. AnxA1 increased also after L. braziliensis infection of BALB/c (wild-type [WT]) bone marrow derived macrophages. Despite a lower parasite intake, parasite burden in bone marrow-derived macrophages from AnxA1^-/- mice was similar to WT and associated with an early increase of TNF-α and, later, of IL-10. AnxA1^-/- mice controlled tissue parasitism similarly to WT animals, but they developed significantly larger lesions at later stages of infection, with a more pronounced inflammatory infiltrate and increased specific production of IFN-γ, IL-4, and IL-10. AnxA1^-/- mice also presented higher phosphorylation levels of ERK-1/2 and p65/RelA (NF-κB) and inducible NO synthase expression, suggesting that AnxA1 may be involved in modulation of inflammation in this model of experimental leishmaniasis. Finally, assessment of AnxA1 levels in sera from patients with LCL or ML revealed that ML patients had higher levels of serum AnxA1 than did LCL patients or control subjects. Collectively, these data indicate that AnxA1 is actively expressed during L. braziliensis infection. In the absence of AnxA1, mice are fully able to control parasite replication, but they present more intense inflammatory responses and delayed ability to resolve their lesion size.

Lactic acid microbiota identification in water, raw milk, endogenous starter culture, and fresh Minas artisanal cheese from the Campo das Vertentes region of Brazil during the dry and rainy seasons

Minas artisanal cheese, produced in the Campo das Vertentes region of Brazil, is made from raw milk and endogenous starter cultures. Although this cheese is of great historical and socioeconomic importance, little information is available about its microbiological and physical-chemical qualities, or about its beneficial microbiota. This work was aimed at evaluating the qualities of the cheese and the components used for its production, comparing samples collected during the dry and rainy seasons. We also conducted molecular identification and isolated 50 samples of lactic acid bacteria from cheese (n=21), water (n=3), raw milk (n=9), and endogenous starter culture (n=17). The microbiological quality of the cheese, water, raw milk, and endogenous starter culture was lower during the rainy period, given the higher counts of coagulase-positive Staphylococcus and total and thermotolerant coliforms. Enterococcus faecalis was the lactic acid bacteria isolated most frequently (42.86%) in cheese samples, followed by Lactococcus lactis (28.57%) and Lactobacillus plantarum (14.29%). Lactobacillus brevis (5.88%), Enterococcus pseudoavium (5.88%), Enterococcus durans (5.88%), and Aerococcus viridans (5.88%) were isolated from endogenous starter cultures and are described for the first time in the literature. The lactic acid bacteria identified in the analyzed cheeses may inhibit undesirable microbiota and contribute to the safety and flavor of the cheese, but this needs to be evaluated in future research.

Functional Process Zones Characterizing Aquatic Insect Communities in Streams of the Brazilian Cerrado

Stream ecology studies see to understand ecological dynamics in lotic systems. The characterization of streams into Functional Process Zones (FPZ) has been currently debated in stream ecology because aquatic communities respond to functional processes of river segments. Therefore, we tested if different functional process zones have different number of genera and trophic structure using the aquatic insect community of Neotropical streams. We also assessed whether using physical and chemical variables may complement the approach of using FPZ to model communities of aquatic insects in Cerrado streams. This study was conducted in 101 streams or rivers from the central region of the state of Goiás, Brazil. We grouped the streams into six FPZ associated to size of the river system, presence of riparian forest, and riverbed heterogeneity. We used Bayesian models to compare number of genera and relative frequency of the feeding groups between FPZs. Streams classified in different FPZs had a different number of genera, and the largest and best preserved rivers had an average of four additional genera. Trophic structure exhibited low variability among FPZs, with little difference both in the number of genera and in abundance. Using functional process zones in Cerrado streams yielded good results for Ephemeroptera, Plecoptera, and Trichoptera communities. Thus, species distribution and community structure in the river basin account for functional processes and not necessarily for the position of the community along a longitudinal dimension of the lotic system.

Efficacy and Safety of Celecoxib in the Treatment of Acute Pain due to Ankle Sprain in a Latin American and Middle Eastern Population

Ankle sprains are common acute soft-tissue injuries. This 7-day open-label, multicentre, randomized study compared the efficacy and safety of celecoxib with non-selective non-steroidal antiinflammatory drugs (NSAIDs) in treating acute ankle sprain with moderate-to-severe ankle pain in 278 patients. Patients received either celecoxib (400 mg loading dose followed by 200 mg twice daily) or standard doses of non-selective NSAIDs. The primary endpoint was a change in the patient's assessment of ankle pain on a 0 mm (no pain) −100 mm (worst possible pain) visual analogue scale (VAS) at day 3 compared with baseline. From a baseline of 73 mm, mean VAS pain scores decreased to 29 and 32 mm in the celecoxib and non-selective NSAID groups, respectively. The lower limit of the 95% confidence interval for the treatment difference with regard to change from baseline was greater than the pre-established non-inferiority margin of −10 mm. Using an initial loading dose, celecoxib was at least as efficacious as non-selective NSAIDs in treating acute pain due to ankle sprain.

Pregnancy after renal transplantation ? a five-yr single-center experience

BACKGROUND

There has been an increase in the number of pregnancies in renal transplant recipients. Our aim was to report our experience with a significant casuistic.

METHODS

Fifty-two pregnancies in 52 patients (January 2001 to December 2005), with two patients having a multiple pregnancy, were evaluated and patients were characterized and evaluated as clinical and obstetrical and perinatal outcomes.

RESULTS

Mean patient age was 26.5 yr (range 17-38) with live donors in 34 (65.4%) and cadaver donors in 18 (34.6%). The mean transplantation-pregnancy interval was 3.1 yr. Calcineurin inhibitors (cyclosporine or tacrolimus) comprised the immunosuppressive therapy in 49 pregnancies (94.2%). Pregnancy complications were chronic hypertension in 33 patients (63.5%), anemia in 31 (59.6%), urinary tract infection in 22 (42.3%) and diabetes in four (7.7%). Nine patients (17.3%) received blood transfusion. Preeclampsia was diagnosed in 16 cases (30.7%) and renal dysfunction in 23 (44.2%) with preeclampsia assumed to be the main cause. One patient (1.9%) had graft loss, as a result of hemorrhagic shock after preterm delivery at home. Premature rupture of membranes occurred in four cases (7.7%), and preterm delivery in 20 (38.4%). Sixteen (29.6%) newborn were small for gestational age. One case of neonatal death was registered as a result of excessive prematurity. Cesarean section was performed in 32 patients (61.5%), the main indications being related to hypertension syndromes and fetal distress.

CONCLUSIONS

This group of patients is characterized by a wide range of antenatal and perinatal problems and must be managed in specialized tertiary units to achieve the very best results.

Ephemeroptera, Plecoptera and Trichoptera assemblages from riffles in mountain streams of Central Brazil: environmental factors influencing the distribution and abundance of immatures

The influence of environmental factors on the distribution of Ephemeroptera, Plecoptera and Trichoptera (EPT) immatures was investigated in streams of the Brazilian Center-West (Serra do Pireneus, Pirenópolis, State of Goiás). The insects were sampled by lifting the stones in front of a sieve (0.5 mm mesh) and then removing the insects from both the stone and the sieve. Sampling was carried out for 1 h at 5 collection sites over a period of 14 months. Air and water temperature (degrees C), water velocity (m/s), discharge (m(3)/s), electric conductivity (microS/cm), pH, and rainfall (mm) were also recorded. In general, we may state that altitude, hydrologic classification (order) and vegetation cover were the most important factors explaining the distribution of Ephemeroptera, Plecoptera and Trichoptera immatures. The influence of the rainfall on the temporal variation of the abundance of insects was stronger in stream segments of medium order (3rd, 4th order) compared to smaller streams (first order).

Fish assemblage structure in tributaries of the Meia Ponte River, Goiás, Brazil

This study was conducted in the Meia Ponte River basin, which is located in the Cerrado biome. The objective was to describe the structure of fish assemblages and to evaluate the results with the regard to the position of the tributaries (sampling stations) along the basin. This basin drains 35 municipalities of Goiás State. Springs of the Meia Ponte are located in the district of Itauçu (GO), in the Serra dos Brandões. Two sampling were conducted, one in the rainy season (March/2001) and another in the dry season (August/2001). Thirty sampling sites in tributaries and one in the channel of the Meia Ponte River, in its upper course, were selected to capture fish with dipnets (3 mm mesh) during one hour, along 100-m stretch. Sampling periods (season; rainy and dry) and the categorization according to the distance of the sampling station from the mouth of the Meia Ponte River (position; upper, intermediate and lower) were used to evaluate differences in fish assemblage structure, summarized by a detrended correspondence analysis (DCA), applied on the abundance data matrix, squared root transformed, to eliminate the effect of abundant species. The first two axes were retained for interpretation (eigenvalues = 0.35 and 0.24, for axis 1 and 2, respectively). The two-way ANOVA (factors seasons and positions) identified significant differences (p <0.05) in score averages for axis 1 and 2, for both factors. These results suggest significant differences in fish assemblage structure in the Meia Ponte River basin for the seasons (rainy and dry) and positions (upper, intermediate and lower) studied, in spite of the short spatial scale. These findings demonstrate a great ichthyofauna heterogeneity in the uppermost part of the Paraná River.

Cytokine genotyping in preeclampsia

PROBLEM

Considering that cytokines are involved in preeclampsia (PE) pathogenesis and that cytokine gene polymorphism may affect cytokine production, our purpose was to investigate the association of PE with tumor necrosis factor (TNF)-alpha (-308), transforming growth factor-beta1 (+10; 25), interleukin (IL)-10 (-1082), IL-6 (-174), and interferon-gamma (+874) polymorphisms.

METHOD OF STUDY

Genotyping was performed in women with PE (56 White and 95 non-White women) and in women without obstetric pathology (92 White and 97 non-White women). Data were analyzed by the chi-square or Fisher exact test. We performed a meta-analysis encompassing these and results from other laboratories on the association of TNF-alpha polymorphisms and PE.

RESULTS

We observed a lower frequency of the IL-10 -1082-G/G genotype in White women with PE (PE: 5%; Control (C): 15%, P = 0.02) and no association for all other polymorphisms, including meta-analysis of TNF-alpha results.

CONCLUSION

Our study suggests that PE is associated with IL-10-(1082) polymorphism but not with TNF-(308) polymorphism. On the basis of meta-analysis, we confirm the need for more studies for the evaluation of cytokine genotype in disease.

Patterns of the aquatic macrophyte cover in Cachoeira Dourada Reservoir (GO-MG)

The relationship between the aquatic macrophyte cover in upper segments of tributaries and this cover in these tributaries but near the reservoir's main body was tested. Sixteen taxa belonging to 12 families of aquatic macrophytes were recorded in Cachoeira Dourada Reservoir. The most frequent species were Eichhornia azurea (frequency of occurrence = 92%; n = 37 sites) and E. crassipes (44%). Upper segments of the tributaries were the main areas colonized by these aquatic macrophytes. The positive relationship between the aquatic macrophyte cover between the upper and lower segments of tributaries indicates the importance of dispersion in the colonization of the arms and the reservoir's main body.

Spatial distribution of Plecoptera nymphs in streams of a mountainous area of Central Brazil

In this paper the spatial distribution of Plecoptera nymphs in the Almas' River basin, Pirenópolis, GO, was studied. Two Surber samples, each comprising 20 sampling units and totalling 2 m2, were taken in each of the 13 stations, one during the rainy season (January 1994) and the second during the dry season (July 1994). In 5 of these stations, monthly samplings were made from June 1993 to July 1994; in these, temperature, velocity, discharge, electrical conductivity and pH were measured. Regional rainfall was also obtained. To ascertain the distribution of nymphs in the habitat, a separate sample was taken. Of the factors considered, the most important affecting the spatial distribution of the stonefly nymphs were altitude, stream order, and anthropic influence. Locally, the genera Anacroneuria and Kempnyia showed clumped distributions, but the data for Gripopteryx and Tupiperla were inconclusive due to low numbers.

Classical swine fever virus in plasma and peripheral blood mononuclear cells of acutely infected swine

The distribution of classical swine fever virus (CSFV) in plasma, monocytes, T and B lymphocytes in peripheral blood was monitored during experimentally induced acute classical swine fever infection in piglets. Six piglets were infected with 10(3.8) TCID50 of virus and blood samples taken up to 18 days post-inoculation (p.i.). Infectious virus was detected in monocytes, T and B lymphocytes to similar titres in five of the six infected piglets. Infectious virus was detected earlier in plasma than in any of the mononuclear cell subpopulations. No significant difference was observed in the period of time in which virus could be isolated from the three cell subpopulations. While a progressive lymphopenia developed, a marked B cell depletion was observed. However, B cells were apparently replaced by non-IgM-bearing mononuclear cells, as the proportion 'total lymphocyte/total leucocytes' remained unaltered throughout the experiment. Virus titres in plasma and peripheral blood mononuclear cells showed a tendency to increase as the disease progressed to its outcome.

[Coronary angioplasty in elderly patients. A therapeutic option]

Of 304 consecutive percutaneous transluminal coronary angioplasties (PTCA) performed between March 86 and March 88, 61 patients were 65 years or older. The indications for PTCA were: stable angina, unstable angina and acute myocardial infarction with suitable anatomy. In elderly patients, the female sex, and the calcific deposits, were more frequent than in the younger group (p less than 0.0001). Primary success was achieved in 82%, vs 88% in patients younger than 65 years; complications and mortality were also statistically irrelevant between the two groups. Late clinical follow-up ranging from 3 to 36 months (mean 10) showed that symptomatic improvement was achieved in 86% of elderly patients in whom PTCA was successful (vs 80% in the younger group). These data support the safety and clinical effectiveness of PTCA in elderly symptomatic patients with suitable anatomy.

Histomorphological investigations of coxa femoral ends following double-cup arthroplasty according to Freeman

Of 20 shell prostheses inserted in cases of early coxarthrosis in our clinic during the period from mid-1976 to the end of 1978, three had to be removed. Morphological examinations, employing different techniques, were made of the coxa femoral ends which were removed. The foreign body reaction of the bone tissue beneath the cement within the prosthetic shell and the biomechanical response were investigated on the basis of macroscopic and microscopic structural analyses. Dependent upon the time elapsed, the exposed spongiosa surface was observed to have become remodeled to a thin cortical protective layer. Independent of time between insertion and removal of the prosthetic shell, a continuous wide layer, consisting of cellular and fibrous tissue, was formed between the bone and the cement (which remained intact) even after the formation of the above-mentioned cortical bone substrate.

Six years' experience in treatment of chromomycosis with 5-fluorocytosine,

Twenty-three patients with chromomycosis were treated with oral 5-fluorocytosine for periods ranging from 2 to 67 months. Sixteen were considered cured, after 3 consecutive monthly controls showing healing of the lesions and absence of fungi in mycologic and histopathologic examinations of biopsy specimens. Seven, in spite of initial clinical improvement, showed resistance to treatment. Associated treatment with amphotericin B, calciferol or thiabendazole failed to help patients resistant to 5-fluorocytosine. Resistance seems to occur especially in those with long-standing lesions or widespread involvement.