Expresión de ACE2 en cerebro durante el desarrollo y susceptibilidad de infección cerebral por SARS-COV-2 / ACE2 expression in the brain during development and susceptibility to brain infection by SARS-COV-2

Resumen La pandemia COVID-19 se extendió por todo por a la enorme capacidad del coronavirus SARS-CoV-2 para transmitirse entre humanos. El COVID-19 es una amenaza para la salud pública mundial. La entrada de este virus en las células se ve muy facilitada por la presencia de la enzima convertidora de angiotensina 2 (ACE2) en la membrana celular. Hoy en día no tenemos un conocimiento preciso de cómo se expresa este receptor en el cerebro durante el desarrollo humano y, como consecuencia, no sabemos si las células neurales en desarrollo son susceptibles de ser infectadas a través de la transmisión de madre a feto. Revisamos en este artículo los conocimientos sobre la expresión de ACE2 en el cerebro humano en desarrollo, con especial atención a la etapa fetal. Esta etapa corresponde al periodo de formación de la corteza cerebral. La posibilidad de infección por SARS-CoV-2 durante el periodo fetal puede alterar el desarrollo normal de la corteza cerebral. Así pues, aunque se han publicado pocos casos demostrando la transmisión vertical de la infección por SARS-CoV-2, el gran número de jóvenes infectados puede representar un problema sanitario que necesite seguimiento, por la posibilidad de que se originen alteraciones cognitivas y anomalías en el desarrollo de los circuitos corticales, que pueden representar predisposición a padecer problemas mentales a lo largo de la vida.

Abstract The COVID-19 pandemic spread around the world due to the enormous transmission of the SARS-CoV-2 among humans. COVID-19 represents a threat to global public health. The entry of this virus into cells is greatly facilitated by the presence of angiotensin-converting enzyme 2 (ACE2) in the cell membrane. Today we do not have a precise understanding of how this receptor expresses in the brain during human development and, as a consequence, we do not know whether neural cells in the developing brain are susceptible to infection. We review the knowledge about ACE2 expression in the developing human brain, with special attention to the fetal stage. This stage corresponds to the period of the cerebral cortex formation. Therefore, SARS-CoV-2 infection during the fetal period may alter the normal development of the cerebral cortex. Although few cases have been published demonstrating vertical transmission of SARS-CoV-2 infection, the large number of infected young people may represent a problem which requires health surveillance, due to the possibility of cognitive alterations and abnormalities in the development of cortical circuits that may represent a predisposition to mental problems later in life.

Clinical Efficacy and Mechanism of Erzhi Tiangui Prescription in Treatment of Patients with Repeated Implantation Failure of Kidney Deficiency Syndrome Based on sPD-1 and Th17/Treg Cytokines / 中国实验方剂学杂志

ObjectiveTo investigate the clinical efficacy and possible mechanism of Erzhi Tiangui prescription on repeated implantation failure （RIF） of kidney deficiency syndrome. MethodSeventy patients with RIF of kidney deficiency syndrome who underwent natural cycle frozen-thawed embryo transfer （FET） in the Reproductive and Genetic Center of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine were enrolled and randomly divided into a treatment group （35 cases） and a control group （35 cases）. Patients in the treatment group took oral Erzhi Tiangui prescription from the third day of each menstrual cycle two months before the FET cycle and continued to take it until the day of transplantation from the third day of the menstrual cycle in the month of transplantation. Those in the control group did not accept traditional Chinese medicine （TCM）. In addition，10 patients who successfully achieved clinical pregnancy after the first natural cycle FET were screened from the reproductive medical record bank of this hospital and assigned to the normal group. Peripheral blood samples of patients in the three groups on the day of embryo transfer were collected from the specimen bank of the Reproductive and Genetic Center. Serum soluble programmed death molecule-1 （sPD-1），soluble programmed death molecule-ligand 1 （sPD-L1），transforming growth factor-β （TGF-β），interleukin-17 （IL-17）， and interleukin-10 （IL-10） levels were measured by enzyme-linked immunosorbent assay （ELISA）. The changes in kidney deficiency syndrome scores， the final biochemical pregnancy rates， clinical pregnancy rates， and embryo implantation rates of the treatment group and the control group before and after treatment were observed. ResultCompared with the normal group，the model group showed increased serum levels of sPD-1 and IL-17（r=0.347，P<0.05），decreased levels of IL-10 and TGF-β （P<0.01），and non-significant change in sPD-L1 level. Serum sPD-1 was positively correlated with IL-17 （P<0.05） and negatively correlated with IL-10（r=-0.521，P<0.01） and TGF-β（r=-0.457，P<0.01） in RIF patients with kidney deficiency syndrome. After TCM treatment，compared with the control group， the treatment group showed improved TCM syndrome score （P<0.05） and increased clinical pregnancy rate and embryo transfer rate（P<0.05），but there was no statistically significant difference in the biochemical pregnancy rate between the two groups. ConclusionAbnormal expression of sPD-1 in patients with RIF of kidney deficiency syndrome breaks the balance of T helper 17 （Th17）/regulatory T cell （Treg），which is not conducive to embryo implantation and pregnancy maintenance. Erzhi Tiangui prescription，a TCM for tonifying the kidney，can significantly improve the symptoms of kidney deficiency in patients with RIF of kidney deficiency syndrome，reduce the concentrations of sPD-1 and IL-17 in the peripheral serum，increase the levels of TGF-β and IL-10，regulate the peripheral Th17/Treg immune balance，and increase the implantation rate and clinical pregnancy rate，which has a high clinical value.

Action of enfuvirtide on the pregnancy of albino rats ( Rattus norvegicus albinus, Rodentia, Mammalia ): biological assay and functional and histological analyses of exposed maternal-fetal organs

ABSTRACT Objective To assess the effects of enfuvirtide on pregnancy in albino rats and their fetuses. Methods Forty pregnant EPM 1 Wistar rats were randomly allocated into four groups: control (E) (distilled water twice/day), G1 (4mg/kg/day enfuvirtide), G2 (12mg/kg/day enfuvirtide), and G3 (36mg/kg/day enfuvirtide) groups. On the 20th day of gestation, the rats were anesthetized and subjected to cesarean section. Their blood was collected for laboratory analysis, and they were sacrificed. The offspring's fragments of their kidneys, liver, and placentas and the maternal rats' fragments of their lungs, kidneys, and liver were separated in the immediate postpartum period for light microscopy analysis. Results No maternal deaths occurred. In the second week at the end of pregnancy, the mean weight of the G3 Group was significantly lower than that of the G2 Group (p=0.029 and p=0.028, respectively). Analyzing blood laboratory parameters, the G1 Group had the lowest mean amylase level, and the G2 Group had the lowest mean hemoglobin level and the highest mean platelet count. In the morphological analysis, there were no changes in organs, such as the kidneys and liver, in both the maternal rats and offspring. Three maternal rats in the G3 Group had pulmonary inflammation in the lungs. Conclusion Enfuvirtide has no significant adverse effects on pregnancy, conceptual products, or functional alterations in maternal rats.

Maternal-fetal outcomes of pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion or multiple daily injections during pregnancy - A Brazilian health care referral center cohort study

ABSTRACT Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about the best option during pregnancy are limited. This study's aim was to compare maternal-fetal outcomes among T1D patients treated with CSII or MDI during pregnancy. Subjects and methods: This study evaluated 174 pregnancies of T1D patients. Variables of interest were compared between the groups (CSII versus MDI), and logistic regression analysis was performed (p < 0.05). Results: Of the 174 included pregnancies, CSII was used in 21.3% (37) and MDI were used in 78.7% (137). HbA1c values improved throughout gestation in both groups, with no difference in the first and third trimesters. The frequency of cesarean section was significantly higher in the CSII group [94.1 vs. 75.4%, p = 0.017], but there was no significant difference in the frequency of other complications, such as miscarriage, premature delivery and preeclampsia. The mean birth weight and occurrence of neonatal complications were also similar, except for the proportion of congenital malformations, which was significantly lower in the CSII group [2.9 vs. 15.6%, p = 0.048]. In regression analysis, the association of CSII with cesarean section and malformations lost significance after adjusting for HbA1c and other covariates of interest. Conclusion: In this study, we observed a higher frequency of cesarean section and a lower occurrence of congenital malformations in the CSII group, but the adjusted results might indicate that these associations are influenced by glycemic control.

Sífilis congênita e recusa terapêutica da gestante: análise jurídica e bioética / Congenital syphilis and treatment refusal by pregnant women: a bioethical and legal analysis / Sífilis congénita y rechazo terapéutico por las mujeres embarazadas: análisis legal y bioético

Resumo A infecção congênita pela sífilis é uma doença que, apesar dos esforços públicos, ainda se mantém na rotina do sistema de saúde. Embora haja métodos de prevenção efetivos e muito disseminados, tratamento com alto custo-benefício e disponível no Sistema Único de Saúde, além de assistência pré-natal com alta cobertura, as taxas epidemiológicas da enfermidade continuam relevantes e preocupantes. Umas das barreiras à erradicação desse cenário é a recusa terapêutica da genitora. Com isso, indagações importantes são levantadas, como a responsabilidade médica em relação à recusa, a responsabilidade da gestante para com o nascituro e as implicações jurídicas que perpassam essa problemática. O propósito deste artigo é responder a essas questões e suas repercussões bioéticas e jurídicas.

Abstract Despite public policies, congenital syphilis infection remains a reality in the health system routine. Moreover, its epidemiological rates continue to be relevant and worrisome despite widespread and effective preventive methods, highly cost-effective treatments available in the Unified Health System, and high-coverage pre-natal care. A major obstacle to eradicating this scenario is treatment refusal by the progenitor. Important questions regarding medical responsibility in relation to refusal, the pregnant woman's responsibility towards the unborn child, and the legal implications involved arise from this context. This article seeks to answer these questions and their legal and bioethical repercussions.

Resumen La sífilis congénita es una enfermedad que aún sigue en la rutina del sistema de salud a pesar de los esfuerzos públicos. Aunque existen métodos de prevención efectivos y generalizados, los tratamientos con alto costo-beneficio y disponibles en el Sistema Único de Salud, además de la atención prenatal con alta cobertura, las tasas epidemiológicas de la enfermedad siguen siendo relevantes y preocupantes. Una de las barreras para su erradicación es el rechazo terapéutico de la madre. Por lo tanto, se plantean cuestiones importantes, como la responsabilidad médica con relación al rechazo, la responsabilidad de la mujer embarazada por el feto y las implicaciones legales que impregnan este problema. El propósito de este artículo es responder a estos interrogantes y sus repercusiones bioéticas y legales.

Which social, gestational and mental health aspects are associated to maternal-fetal attachment? / Quais aspectos sociais, gestacionais e de saúde mental materna estão associados ao apego materno-fetal?

Abstract Objectives: this study aimed to explore a set of factors associated with lower maternal-fetal attachment (MFA) in pregnant women. Methods: this is a cross-sectional study corresponding to the second wave of a cohort study with a population-based sample of pregnant women in the South of Brazil. The maternal-fetal attachment scale (MFAS) was used to measure MFA. Bivariate analysis was performed using the t-test and ANOVA. The variables that presented p<0.20 were taken for multivariate analysis, through linear regression, in order to control possible confounding factors. Results: a total of 840 pregnant women were included. Pregnant women who had lower MFA means were those who did not live with a partner (B=-3.8 [CI95%=-6.0; -1.7]), those between the first and second trimester of pregnancy (B=-4.3 [CI95%=-5.9; -2.6]), those who did not have support from their mother during pregnancy (B=-2.4 [CI95%=-4.6; -0.2]), and those with depressive symptoms (B=-4.9 [CI95%=-7.4; -2.5]). Conclusions: the results showed that a higher MFA it is associated with an adequate support network during pregnancy, better maternal mental health, and with an advanced pregnancy. Early evaluation of MFA and effort to promote an adequate prenatal bond, focusing on maternal psychological and emotional aspects are strongly suggested.

Resumo Objetivos: explorar um conjunto de fatores associados ao menor apego materno-fetal (AMF) em gestantes. Métodos: trata-se de um estudo transversal, correspondente à segunda fase de um estudo de coorte com uma amostra de base populacional de gestantes no sul do Brasil. Foi utilizada a Escala de Apego Materno-Fetal (EAMF) para medir o AMF. A análise bivariada foi realizada através do teste t e ANOVA. As variáveis que apresentaram p<0,20 foram levadas para análise multivariada, por meio de regressão linear, a fim de controlar possíveis fatores de confusão. Resultados: foram incluídas 840 gestantes. As gestantes que apresentaram menores médias de AMF foram aquelas que não moravam com um companheiro (B=-3,8 [IC95%=-6,0; -1,7]), que estavam entre o primeiro e o segundo trimestre de gestação (B=-4,3 [IC95%=-5,9; -2,6]), que não tiveram o apoio da mãe durante a gestação (B=-2,4 [IC95%=-4,6; -0,2]) e que apresentaram sintomas depressivos (B=-4,9 [IC95%=-7,4; -2,5]). Conclusões: os resultados mostraram que um maior AMF está associado a presença de uma rede de apoio adequada na gravidez, melhor saúde mental materna e a uma gestação avançada. A avaliação precoce do AMF e a promoção de um vínculo pré-natal adequado, com foco nos aspectos psicológicos e emocionais maternos são fortemente sugeridos.

Procedimiento clínico-quirúrgico en una paciente embarazada con una derivación urológica compleja. Reporte de un caso / Clinical-surgical approach in a pregnant patient with complex urological diversion. A case report

Resumen ANTECEDENTES: El mielomeningocele es el defecto del tubo neural más frecuente; se registra un caso por cada 1000 nacidos vivos. Es más frecuente en mujeres, que resultan con secuelas discapacitantes, entre ellas las urológicas. Pueden subsanarse con diferentes técnicas quirúrgicas y derivaciones urológicas complejas que las predispone a infecciones de vías urinarias de repetición y, cuando hay embarazo, complicaciones materno-fetales y dificultad para el acceso quirúrgico, en caso de cesárea. CASO CLÍNICO: Paciente con 14 semanas de embarazo, 27 años de edad, con diagnóstico de mielomeningocele y vesicoplastia, con múltiples infecciones urinarias y ruptura de membranas pretérmino. Finalización del embarazo por cesárea a las 33 semanas, por indicación de las condiciones fetales. La técnica de la cesárea se modificó para no dañar la cistoplastia y evitar complicaciones con las adherencias en la pelvis. CONCLUSIONES: El mejor pronóstico materno-fetal en pacientes con derivación urológica compleja se consigue con la búsqueda intencionada de infecciones urinarias y tratamiento oportuno y adecuado, además de una planificación multidisciplinaria al momento de la finalización del embarazo.

Abstract BACKGROUND: Myelomeningocele is the most common neural tube defect; one case per 1000 live births is reported. It is more frequent in females, resulting in disabling sequelae, including urological sequelae. They can be corrected with different surgical techniques and complex urological derivations that predispose them to repeated urinary tract infections and, when there is pregnancy, maternal-fetal complications and difficulty for surgical access, in case of cesarean section. CLINICAL CASE: Patient 14 weeks pregnant, 27 years old, diagnosed with myelomeningocele and vesicoplasty, with multiple urinary tract infections and preterm rupture of membranes. Termination of pregnancy by cesarean section at 33 weeks, due to fetal conditions. The cesarean section technique was modified so as not to damage the cystoplasty and to avoid complications with adhesions in the pelvis. CONCLUSIONS: The best maternal-fetal prognosis in patients with complex urologic diversion is achieved with the intentional search for urinary tract infections and timely and adequate treatment, in addition to multidisciplinary planning at the time of termination of pregnancy.

Hemorragia materno-fetal posterior a amniocentesis y cordocentesis

Objetivo . Comparar la frecuencia y cantidad de hemorragia materno-fetal posterior a la amniocentesis y cordocentesis. Diseño . Estudio de casos y controles. Métodos . Gestantes con embarazos simples sin anomalías fetales sometidas a amniocentesis para determinación del cariotipo fetal (16 a 20 semanas de gestación) o cordocentesis (20 a 30 semanas de embarazo) en el periodo de enero de 2017 a mayo de 2022. Principales medidas de estudio. Características generales del procedimiento, resultados de la prueba de Kleihauer-Brown-Betke y concentraciones séricas de alfafetoproteína materna. Resultados . La muestra del estudio fue de 305 pacientes. La amniocentesis se realizó en 165 mujeres y la cordocentesis en 140 casos. La hemorragia materno-fetal de novo se observó en 8 pacientes (4,8%) después de la amniocentesis y en 41 pacientes (29,3%) después de la cordocentesis. Las concentraciones de alfafetoproteína sérica aumentaron en 24 casos (14,5%) después de la amniocentesis y en 55 casos (39,3%) después de la cordocentesis (p < 0,05). Luego de la cordocentesis se observó mayor volumen promedio de hemorragia maternofetal, elevación de valores individuales de volumen e incrementos significativos en la hemorragia materno-fetal severa (más de 5 mL de eritrocitos fetales) y de pérdida del volumen sanguíneo fetoplacentario total (p < 0,05). Conclusión . Estos resultados muestran que tanto la amniocentesis como la cordocentesis aumentan el riesgo de hemorragia materno-fetal. Sin embargo, la amniocentesis guiada por ecografía tiene menor riesgo de producir hemorragia y la isoinmunización Rh resultante, comparada con la cordocentesis.

Objective : To compare the frequency and amount of maternal-fetal hemorrhage following amniocentesis and cordocentesis. Design : Case-control study. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Methods : Pregnant women with singleton pregnancies without fetal anomalies undergoing amniocentesis for fetal karyotyping (16-20 weeks' gestation) or cordocentesis (20- 30 weeks' pregnancy) in the period January 2017-May 2022. Main study outcomes: General characteristics of the procedure, Kleihauer-Brown-Betke test results, and maternal serum alpha-fetoprotein concentrations. Results : The study sample was 305 patients. Amniocentesis was performed in 165 women and cordocentesis in 140 cases. De novo maternal-fetal hemorrhage was observed in 8 patients (4.8%) after amniocentesis and in 41 patients (29.3%) after cordocentesis, de novo maternalfetal hemorrhage was observed in 8 patients (4.8%). Serum alpha-fetoprotein concentrations increased in 24 cases (14.5%) after amniocentesis and in 55 cases (39.3%) after cordocentesis (p < 0.05). After cordocentesis, higher mean maternalfetal hemorrhage volume, elevation of individual volume values and significant increases in severe maternal-fetal hemorrhage (more than 5 mL of fetal erythrocytes) and total fetoplacental blood volume loss were observed (p < 0.05). Conclusion : These results show that both amniocentesis and cordocentesis increase the risk of maternal-fetal hemorrhage. However, ultrasound-guided amniocentesis has a lower risk of producing hemorrhage and resulting Rh isoimmunization compared to cordocentesis.

Crescimento no Primeiro Ano de Vida de Crianças Expostas ao HIV não Infectadas: um Estudo de Coorte Retrospectivo / Growth in the First Year of Life of HIV-Exposed Uninfected Children: a Retrospective Cohort Study

Introdução: O crescimento de crianças expostas ao HIV não infectadas pode ser prejudicado pela exposição intrauterina à terapia antirretroviral. O objetivo deste estudo é descrever o crescimento no primeiro ano de vida de crianças expostas ao HIV não infectadas. Métodos: Estudo de coorte retrospectivo realizado com crianças expostas ao HIV não infectadas nascidas e acompanhadas no Hospital de Clínicas de Porto Alegre. Foram coletados dados referentes a condições socioeconômicas, perinatais, peso e comprimento no primeiro ano de vida. Para avaliação do crescimento, as médias de Escore-Z de peso, comprimento e índice de massa corporal para idade (P/I, C/I e IMC/I, respectivamente) ao nascimento, aos quatro e aos doze meses foram comparadas através da análise de Equações de Estimativas Generalizadas (GEE). Resultados: 39 crianças foram incluídas no estudo. A média de Escore-Z de IMC/I ao nascimento foi 0,03 (-0,24 a 0,30), aos quatro de 0,34 (0,00 a 0,68) e aos 12 meses de 0,73 (0,45 a 1,01). Houve diferença significativa entre o nascimento e aos doze meses (p=0,002). Conclusão: Os resultados sugerem que crianças expostas ao HIV não infectadas apresentam crescimento adequado no primeiro ano de vida e curva ascendente ao longo do tempo.

Introduction: The growth of uninfected HIV-exposed children can be impaired by intrauterine exposure to antiretroviral therapy. The aim of this study is to describe the growth in the first year of life of uninfected HIV-exposed children. Methods: A retrospective cohort study conducted with uninfected HIV-exposed children born and followed up at the Hospital de Clínicas de Porto Alegre. Data regarding socioeconomic status, perinatal information, and weight and length in the first year of life were collected. To assess growth, the Z-score means of weight, length and body mass index for age (W/A, L/A and BMI/A, respectively) at birth, at 4 months and at 12 months were compared through analysis of Generalized Estimating Equations (GEE). Results: Thirty-nine children were included in the study. The mean Z-Score of BMI/A at birth was 0.03 (-0.24 to 0.30), at 4 months 0.34 (0.00 to 0.68) and at 12 months 0.73 (0.45 to 1.01). There was a significant difference between birth and at 12 months (p=0.002). Conclusion: The results suggest that uninfected HIV-exposed children show adequate growth in the first year of life and an ascending curve over time.

Perfil clínico e psiquiátrico de gestantes atendidas em uma unidade de saúde de Criciúma, Santa Catarina / Clinical and psychiatric profile of pregnant women treated at a health unit in Criciúma, Santa Catarina, Brazil

Introdução: A gestação é um período transacional, que faz parte do curso natural do desenvolvimento humano e da renovação geracional. Esse período representa, para a mulher, o enfrentamento de desafios diversos e pode desencadear ou exacerbar transtornos psiquiátricos, podendo ser considerada a fase de maior incidência de alterações psíquicas na mulher. Assim, o objetivo do presente estudo é conhecer o perfil clínico e psiquiátrico de gestantes atendidas em uma unidade de saúde municipal do sul catarinense. Métodos: O presente estudo é do tipo observacional, retrospectivo, transversal, descritivo, com coleta de dados secundários e abordagem quantitativa, com registros que constam em prontuários de gestantes ali atendidas. Resultados: Foram avaliadas 179 gestantes com média de idade de 25,94 (± 6,43) anos e média de IMC pré-gestacional de 27,12 (± 6,01) kg/m² (sobrepeso), casadas (42,9%), escolaridade até o ensino médio (50,5%) e que possuíam alguma comorbidade clínica, principalmente hipertensiva (34,4%) ou diabetes mellitus (34,4%), exceto gestantes de baixo peso, nas quais há maior prevalência de asma. Sobre os transtornos psiquiátricos presentes, eram majoritariamente ansiosos e depressivos, sendo a fluoxetina o psicofármaco predominante. Conclusão: O perfil clínico e psiquiátrico de gestantes do presente estudo é de mulheres jovens, casadas, com sobrepeso, hipertensas ou diabéticas, que estudaram até o ensino médio, já possuem gestação prévia e não desejam a gestação atual. Entre as que possuem transtorno psiquiátrico, a maioria sofre de transtorno depressivo ou ansioso e são tratadas com ISRS. São sugeridos estudos para avaliar o desfecho do binômio mãe-feto e maior atenção à psicoterapia cognitivo-comportamental.

Introduction: Pregnancy, a transactional period, is part of the natural course of human development and generational renewal. This period represents different challenges for women and can trigger or exacerbate psychiatric disorders. It can be considered the phase with the highest incidence of psychiatric changes in women. Thus, this study's objective was to determine the clinical and psychiatric profile of pregnant women treated at a municipal health unit in the southern region of Santa Catarina state. Methods: This cross-sectional, retrospective observational descriptive study involved secondary data and a quantitative approach, assessing medical records of pregnant women treated at the clinic. Results: A total of 179 pregnant women were included, whose mean age was 25.94 (SD, 6.43) years and mean pre-pregnancy BMI was 27.12 (SD, 6.01) kg/m² (ie, overweight). A total of 42.9 % were married and the education level of 50.5% was less than high school. Most had some clinical comorbidity, mainly hypertension (34.4%) or diabetes mellitus (34.4%); there was a higher prevalence of asthma among those with low weight. The psychiatric disorders were mostly anxiety and depression, with fluoxetine being the most prescribed psychotropic drug. Conclusion: The clinical and psychiatric profile of this sample of pregnant women was young, married, overweight, hypertensive or diabetic women, with a less than high school education, previous pregnancies, and an unwanted current pregnancy. Most suffered from depressexualsive or anxiety disorder and were being treated with selective serotonin reuptake inhibitors. Studies are needed to assess the outcome of the mother-fetus pair, focusing on cognitive-behavioral psychotherapy.

Apego materno-fetal e transtornos psiquiátricos em gestantes com fetos malformados / Maternal-fetal attachment and psychiatric disorders in pregnant women with malformed fetuses

OBJETIVO: Determinar a prevalência e os fatores associados aos sintomas de ansiedade e depressão e ao apego materno-fetal em gestantes com diagnóstico de malformações congênitas. MÉTODOS: Estudo prospectivo de corte transversal realizado durante o período de dezembro/2019 a março/2020. Foram incluídas 77 gestantes com diagnóstico de malformação fetal atendidas no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) e excluídas aquelas < 18 anos e as que sabiam o diagnóstico da malformação há menos de três semanas. Aplicou-se um questionário com variáveis sociodemográficas e clínicas, além da Escala Hospitalar de Ansiedade e Depressão e da Escala de Apego Materno-Fetal. Para análise estatística, foi aplicado o modelo de regressão logística multivariado com nível de significância de 5%. RESULTADOS: Entre as gestantes, 46,8% possuíam sintomas ansiosos e 39%, depressivos, sendo o apego materno-fetal médio em 54,5% e alto em 45,5%. Antecedentes de ansiedade e depressão e não possuir religião foram associados a maior risco de sintomas de ansiedade e depressão, e saber da malformação há ≥ 10 semanas associou-se apenas ao risco de ansiedade e ter gestação múltipla associou-se apenas ao risco de depressão. O apego materno-fetal não foi associado a ansiedade ou depressão. CONCLUSÃO: Observou-se alta prevalência de sintomas ansiosos e depressivos em gestantes com fetos malformados, além da presença de apego materno-fetal médio/alto em todas pacientes, porém sem associação com os transtornos psiquiátricos estudados. Diante disso, urge a necessidade da criação de novas linhas de cuidado voltadas à saúde mental dessas mulheres.

OBJECTIVE: To determine the prevalence and factors associated with anxiety and depression symptoms and maternal-fetal attachment in pregnant women diagnosed with congenital malformations. METHODS: Prospective cross-sectional study conducted from December/2019 to March/2020. Seventy-seven managers with a diagnosis of fetal malformation attended at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and those under 18 years of age who did not know the diagnosis of malformation in less than 3 weeks were excluded. Applicable to a questionnaire with clinical and sociodemographic variables, in addition to the Hospital Anxiety and Depression Scale and Maternal- -Fetal Attachment Scale. For statistical analysis, the multivariate logistic regression model was applied with a 5% significance level. RESULTS: Among pregnant women, 46.8% had anxiety symptoms and 39% depressive symptoms, with average maternal-fetal attachment at 54.5% and high at 45.5%. History of anxiety and depression and cannot use religion have been associated with an increased risk of anxiety and depression, whereas malformation saber for ≥ 10 weeks, associated only with risk of anxiety and multiple pregnancy only in depression. Maternal-fetal attachment was not associated with anxiety or depression. CONCLUSION: If there is a high prevalence of anxious and depressive symptoms in pregnant women with malformed fetuses, in addition to the presence of medium maternal-fetal/high attachment in all patients, with no association with the studied psychiatric disorders. Therefore, request the creation of new lines of care aimed at the mental health of these women.

Effects of Toxoplasma gondii infection on mouse and human uterine natural killer cells / 中国血吸虫病防治杂志

Objective To examine the effects of Toxoplasma gondii infection on the proportion, quantity, differentiation and function of mouse and human uterine natural killer cells (uNK cells), so as to explore the role of uNK cells in abortion of early pregnancy caused by T. gondii infection. Methods Pregnant mice were injected intraperitoneally with T. gondii tachyzoites on day 6.5 of pregnancy, and the abortion mouse model caused by T. gondii infections was constructed. Mouse uterine lymphocytes were isolated on day 9.5 of pregnancy. Human uterine lymphocytes were isolated from fresh human decidual specimens after abortion in normal early pregnancy and co-cultured with tachyzoites of the T. gondii RH strain for 48 h at T. gondii/uterine lymphocytes ratios of 0.5:1, 1:1 and 2:1. The phenotypes of mouse uNK cells (CD122, NK1.1, DX5) and human uNK cells (CD3, CD56, CD11b, CD27) and the expression of intracellular cytokines interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) were detected by flow cytometry. Mouse and human uNK cells were sorted by magnetic beads, and the cytotoxicity of uNK cells was tested using the lactate dehydrogenase (LDH) release assay at effector/target cell ratios of 1:1, 5:1, 10:1 and 20:1 with mouse or human uNK cells as effector cells and mouse YAC-1 cells or human K562 cells as target cells. Results On day 9.5 of pregnancy, the mouse abortion rate was significantly higher in the infected group than that in the control group (83.02% vs. 3.51%; χ2 = 71.359, P < 0.001). Significantly lower absolute number of uNK cells [(4 547 ± 1 610) cells/mouse vs. (8 978 ± 3 339) cells/mouse; U = 2.000, P < 0.05], lower NK1.1 expression on uNK cell surface [(74.53 ± 8.37)% vs. (93.00 ± 1.11)%; U = 0.000, P < 0.05], higher proportion of NK1.1-DX5-cells [(20.10 ± 8.03)% vs. (5.04 ± 0.68)%; U = 0.000, P < 0.05], lower proportion of NK1.1+ DX5+ cells [(21.70 ± 12.48)% vs. (45.75 ± 2.26)%; U = 0.000, P < 0.05] and higher IFN-γ expression [(16.74 ± 1.36)% vs. (8.13 ± 1.90)%; U = 0.000, P < 0.05] were detected in the infected group than in the control group, while no significant difference was seen in TNF-α expression between the two groups [(67.98 ± 9.20)% vs. (52.93 ± 10.42)%; U = 2.000, P > 0.05]. The mouse uNK cells showed a strong cytotoxicity in the infected group, and the cytotoxicity gradually increased with the effector/target cell ratio. The cytotoxicity of uNK cells against YAC-1 cells was 2.30%, 4.32%, 8.12% and 12.65% in the infected group and 1.21%, 1.63%, 2.51% and 3.22% in the control group at effector/target cell ratios of 1:1, 5:1, 10:1 and 20:1, respectively. Following co-culture of human uterine lymphocytes and tachyzoites of the T. gondii RH strain for 48 h, the proportion [TOX 2:1 group vs. control group: (6.61 ± 1.75)% vs. (17.48 ± 4.81)%; F = 7.307, P < 0.01], and absolute number of human uNK cells in uterine lymphocytes of human uNK cells in uterine lymphocytes [TOX 2:1 group vs. control group: (12 104 ± 5 726) cells/well vs. (65 285 ± 21 810) cells/well; H = 11.540, P < 0.01] were significantly lower in the infected group than in the control group. A lower proportion of CD56brightCD16- NK cells [TOX 2:1 group vs. control group: (25.25 ± 5.90)% vs. (36.03 ± 4.51)%; F = 3.213, P > 0.05] and higher proportion of CD56dimCD16+ NK cells [TOX 2:1 group vs. control group: (11.15 ± 2.15)% vs. (7.09 ± 2.24)%; F = 2.992, P > 0.05] were detected in uNK cells in the infected group than in the control group, and the ratio of CD56brightCD16- cells/CD56dimCD16+ cells was significantly lower in the infected group than in the control group [TOX2:1 group vs. control group: (2.37 ± 0.92) vs. (5.58 ± 2.39); H = 8.228, P < 0.05]. In addition, the proportion of CD11b+CD27- cells in human uNK cells was significantly higher in the infected group than in the control group [TOX 2:1 group vs. control group: (30.28 ± 6.91)% vs. (17.48 ± 4.67)%; H = 6.556, P < 0.05], while no significant differences were found between the two groups in terms of IFN-γ [TOX 2:1 group vs. control group: (14.13 ± 1.28)% vs. (15.19 ± 1.64)%; F = 1.639, P > 0.05] or TNF-α expression [TOX 2:1 group vs. control group: (54.76 ± 10.02)% vs. (50.33 ± 3.67)%; F = 0.415, P > 0.05]. Human uNK cells presented a strong cytotoxicity in the infected group, and the cytotoxicity gradually increased with the effector/target cell ratio. The cytotoxicity of human uNK cells against K562 cells was 11.90%, 28.11%, 49.91% and 73.35% in the infected group and 12.21%, 21.63%, 33.51% and 48.22% in the control group at effector/target cell ratios of 1:1, 5:1, 10:1 and 20:1, respectively. Conclusions T. gondii infection presents diverse effects on the differentiation and secretion ability of mouse and human uNK cells. However, T. gondii infection causes a reduction in the absolute number and enhances the cytotoxicity of both mouse and human uNK cells.

Abbreviated Version of the Maternal-Fetal Attachment Scale: Evidence of Validity and Reliability / Versão Abreviada da Escala de Apego Materno-Fetal: Evidências de Validade e Confiabilidade / Versión Corta de la Maternal Fetal Attachment Scale: Evidencia de Validez y Fiabilidad

Abstract The Maternal-Fetal Attachment Scale has been widely applied in research on the subject. There are no known studies that have validated a shortened version of this instrument in Brazil. This study aimed to propose a shortened version of the Maternal-Fetal Attachment Scale and examine its evidence of validity and reliability. This methodological study was carried out on a sample of 937 pregnant women in the Primary Health Care of Montes Claros, Minas Gerais - Brazil. Construct validity and reliability were measured. A trifactor version with 15 items was obtained, which presented satisfactory adjustment indexes. Convergent and discriminant validities were close to the recommended ones. The scale differentiated attachment scores according to different sample characteristics. Internal consistency (Cronbach's α = 0.878) and composite reliability (> 0.70) were appropriate. The abbreviated Brazilian version of the Maternal-Fetal Attachment Scale presented satisfactory psychometric attributes for application to pregnant women in Primary Health Care.

Resumo A Escala de Apego Materno-Fetal tem sido amplamente aplicada em pesquisas sobre a temática. Desconhecem-se investigações sobre a validade de uma versão reduzida desse instrumento no Brasil. Este estudo teve por objetivo propor uma versão abreviada da Escala de Apego Materno-Fetal e examinar suas evidências de validade e confiabilidade. Trata-se de um estudo metodológico, realizado com uma amostra de 937 gestantes no âmbito da Atenção Primária à Saúde de Montes Claros, Minas Gerais - Brasil. Obteve-se uma versão trifatorial com 15 itens, que apresentou índices satisfatórios de ajuste. As validades convergente e discriminante foram próximas do recomendado. A escala diferenciou os escores de apego segundo diferentes características da amostra. A consistência interna (α de Cronbach = 0,878) e a confiabilidade composta (> 0,70) foram apropriadas. A versão brasileira abreviada da Escala de Apego Materno-Fetal apresentou atributos psicométricos satisfatórios para aplicação a gestantes na Atenção Primária à Saúde.

Resumen La Maternal Fetal Attachment Scale es ampliamente aplicada en estudios sobre la temática. No existen investigaciones sobre la validez de una versión corta de este instrumento en Brasil. Se pretende proponer una versión corta de esta escala y examinar su validez y fiabilidad. Estudio metodológico, realizado en la Atención Primaria de Salud de Montes Claros, Minas Gerais - Brasil en una muestra de 937 mujeres embarazadas. Se midieron la validez y la fiabilidad del constructo. Se obtuvo una versión de tres factores, con 15 ítems, e índices de ajuste satisfactorios. La validez convergente y discriminante se acercó a lo recomendado. La escala diferenció las puntuaciones de vinculación según las distintas características de la muestra. La consistencia interna (α de Cronbach = 0,878) y la fiabilidad compuesta (> 0,70) fueron adecuadas. La versión corta de Maternal Fetal Attachment Scale para Brasil presentó atributos psicométricos satisfactorios para aplicarse a gestantes en Atención Primaria de Salud.

Feto-maternal outcomes of caesarean delivery in Federal Medical Centre, Asaba: a two year review

Background: The upward trend of caesarean section and its associated morbidity/mortality especially in low- and middle-income areas make regular appraisal of the procedure necessary. Objective: To evaluate caesarean section; its rate, indications, and maternal and fetal outcomes in Asaba. Methods: A retrospective study of all caesarean sections carried out at the obstetrics unit of the Federal Medical Centre, Asaba, between July 1, 2018, and June 31, 2020. Data was analyzed using SPSS version 20. Results: There were 2778 deliveries during the period, out of which 705 had caesarean sections, giving an overall caesarean section rate of 25.4%. There were 456 (64.7%) emergency caesarean sections. The commonest indication for caesarean section was repeat caesarean section 196 (27.8%), while cephalo-pelvic disproportion 87 (12.3%) was the commonest indication for emergency caesarean section. Majority of the babies had low APGAR score at 1min and 5mins, 126 (27.6%) and 50 (11.0%) from emergency than elective caesarean section 16 (6.4%) and 5 (2.0%) at 1min and 5mins respectively (x2=17.963, P<0.001). There were 31 (4.2%) perinatal deaths out of which majority 28 (6.1%) were from emergency caesarean sections (x2=9.412 P=0.002). The commonest post-operative complication was postpartum anemia (140 (19.9%) while caesarean section case fatality was 0.6%. Conclusion: This study showed a caesarean section rate of 25.4% with repeat caesarean section and Cephalopelvic disproportion being the most common indication for elective and emergency caesarean section respectively. Emergency caesarean section accounted for most of the cases and is associated with a higher risk of maternal and perinatal morbidity and mortality

Immune system: development and acquisition of immunological competence

Abstract Objectives: To describe the ontogeny of the immune system and the adaptive mechanisms of the immune system in the neonatal period, with an emphasis on transplacental antibody transport and breastfeeding. Source of data: Non-systematic literature review in the PubMed database. Summary of the findings: The last two decades have witnessed a great advance in the knowledge of the immune system since conception. Several investigation tools have provided insight on phenomena that were previously inadequately understood. Still expanding, the functional and molecular investigation of various aspects of the immune system will make it possible to understand how intra-uterus maternal-fetal exchanges, the maternal microbiota interacting with the fetus and newborn, and the acquisition of immunological competence occur in healthy and disease scenarios. Conclusions: In-depth knowledge of the development of the immune system and of the adaptive mechanisms that allow a safer transition to the extrauterine environment are fundamental components of optimizing maternal and young infant vaccination, as well as the strategies associated with full postnatal development, and the early diagnosis and treatment of innate errors of immunity.

Pregnancy-preserving and maternal-fetal management in a patient with rare large cell neuroendocrine carcinoma of the uterine cervix / 南方医科大学学报

OBJECTIVE@#To explore the strategy of pregnancy-preserving and maternal- fetal management in patients with primary gynecologic neuroendocrine tumors (gNETs) during pregnancy.@*METHODS@#We performed whole genome sequencing (WGS) for analyzing maternal and fetal somatic and germline single nucleotide variations (SNVs) and small insertions and deletions (InDels) for a 29-year-old pregnant woman diagnosed with stage IB2 large cell neuroendocrine carcinoma (LCNEC) and adenocarcinoma in the cervix. A systematic literature review was performed to explore the strategies for treatment of such rare histological type while maintaining pregnancy.@*RESULTS@#Global case analysis of cervical NETs during pregnancy suggested that negative lymph node metastasis and an early FIGO stage were potentially associated with a good prognosis of the patients. In the case presented herein, a pregnancy-preserving strategy was adopted and favorable maternal-fetal outcomes were achieved after neoadjuvant chemotherapy, radical surgery and postoperative systemic chemotherapy. At 35@*CONCLUSIONS@#Although gNETs in pregnancy are rare and highly risky, pregnancy-preserving managements of gNETs can still be considered and favorable maternalfetal outcomes are possible with proper assessment of the clinical indications and implementation of multimodal treatments. Precise treatment and follow-up strategies based on the results of WGS for risk-reducing intervention of cancer recurrence or occurrence can potentially benefit the patient and the neonate.

Educational workshops about bonding with the fetus during pregnancy: a clinical trial / Talleres educativos sobre la vinculación con el feto durante el embarazo: un ensayo clínico / Oficinas educativas sobre vínculo com o feto durante a gestação: um ensaio clínico

ABSTRACT Objective: To verify if participation in educational workshops about bonding with the fetus influences the adoption of practices of interaction with the baby by pregnant women. Method: Randomized clinical trial conducted in a health clinic. The experimental group participated in educational workshops designed for the pregnant couple and the control group received usual care. The practices of interaction with the fetus were evaluated before and after the intervention. Results: 19 pregnant women participated in the study. There was a positive correlation between higher gestational age and the interaction with the fetus (p = 0.016), and between younger mothers and the practice of touching or poking the baby (p = 0.019). There was an increase in the interaction with the fetus in the control and experimental groups (p= 0.024). Conclusion: Educational workshops are strategies for sharing knowledge about fetuses' sensory skills and to foster bonding and child development since pregnancy.

RESUMEN Objetivo: Verificar si la participación en talleres educativos sobre vinculación con el feto influye en la adopción de prácticas de interacción con el bebé por parte de la mujer embarazada. Método: Ensayo clínico aleatorizado realizado en una clínica de salud. El grupo experimental participó en talleres educativos desarrollados para la pareja embarazada y el grupo control recibió monitoreo de salud regular. Las prácticas de interacción con el feto fueron evaluadas antes y después de la intervención. Resultados: 19 mujeres embarazadas participaron en el estudio. Hubo una correlación positiva entre una edad gestacional más alta y la interacción con el feto (p = 0.016), así como entre madres más jóvenes y la práctica de tocar o empujar al bebé (p = 0.019). Hubo un aumento en las prácticas de interacción con el feto tanto en el grupo control como en el experimental (p= 0.024). Conclusión: Los talleres educativos son estrategias para compartir el conocimiento sobre las habilidades sensoriales del feto y las prácticas de fortalecimiento del vínculo y el desarrollo infantil desde el embarazo.

RESUMO Objetivo: Verificar se a participação em oficinas educativas sobre vínculo com o feto influencia a adoção de práticas de interação com o bebê pelas gestantes. Método: Ensaio clínico randomizado realizado em ambulatório de saúde. O grupo experimental participou de oficinas educativas desenvolvidas para o casal grávido, e o grupo controle recebeu acompanhamento de saúde usual. As práticas de interação com o feto foram avaliadas antes e depois da intervenção. Resultados: Participaram do estudo 19 gestantes. Houve correlação positiva entre a maior idade gestacional e a interação com o feto (p=0,016), bem como com a menor a idade materna e a prática de mexer ou cutucar o bebê (p=0,019). Houve aumento das práticas de interação com o feto tanto no grupo controle quanto no experimental (p= 0,024). Conclusão: As oficinas educativas são estratégias de compartilhamento de saberes sobre as competências sensoriais do feto e as práticas fortalecedoras do vínculo e do desenvolvimento infantil desde a gestação.

Atuação da equipe de enfermagem no estabelecimento do apego entre mãe e filho: revisão integrativa / Performance of the nursing team in the establishment of addition between mother and son: integrative review / Desempeño del equipo de enfermería en el establecimiento de la afición entre madre e hijo: revisión integrativa

Objetivo: Demonstrar as evidências científicas disponíveis na literatura atual acerca da atuação da equipe de enfermagem no estabelecimento de relações de apego entre mãe e filho. Método: Revisão integrativa da literatura realizada em abril de 2020 nas bases: Biblioteca Virtual em Saúde, United State National Library of Medicine e Scientific Electronic Library Online. Utilizou-se como descritores: "Relações mãe-filho/motherchild relationships", "enfermagem/nursing" e o descritor não controlado "apego/attachment" combinados pelo operador booleano "AND". Resultados: As dificuldades no estabelecimento de apego entre mãe e filho foram destacadas quando as crianças estão hospitalizadas, quando são deixadas em instituição de ensino ou pessoas externas e quando as mães tiveram hábitos inapropriados durante o período gravídico-puerperal que possa ter afetado o crescimento e desenvolvimento do bebê. A enfermagem facilita o estabelecimento do vínculo mãe e filho, atenua fatores estressores de forma humanística baseada na integralidade. Conclusão: O estabelecimento satisfatório do comportamento de apego é essencial para a saúde mental do ser humano. Envolver-se no cuidado na hospitalização e educação de uma criança requer conhecimento dos seus condicionantes biológicos, psicológicos, sociais, ambientais, para que se compreenda a complexidade da situação de afastamento do meio familiar.

Objective: To demonstrate the scientific evidence available in the current literature about the performance of the nursing team in establishing attachment relationships between mother and child. Method: Integrative literature review conducted in April 2020 on the Virtual Health Library, United State National Library of Medicine and Scientific Electronic Library Online databases. The following descriptors were used: "Relações mãe-filho/motherchild relationships", "enfermagem/ Nursing" and the uncontrolled descriptor "apego/attachment" combined by the Boolean operator "AND". Results: The difficulties in establishing attachment between mother and child were highlighted when the children are hospitalized, when they are left in an educational institution or outside persons and when the mothers had inappropriate habits during the pregnancy-puerperal period that may have affected growth and baby development. Nursing facilitates the establishment of a mother-child bond, mitigating stressors in a humanistic manner based on comprehensiveness. Conclusion: The satisfactory establishment of attachment behavior is essential for human mental health. Getting involved in the care of a child's hospitalization and education requires knowledge of its biological, psychological, social, and environmental conditions, in order to understand the complexity of the situation of distance from the family.

Objetivo: Demostrar la evidencia científica disponible en la literatura actual sobre el desempeño del equipo de enfermería en el establecimiento de relaciones de apego entre madre e hijo. Método: Revisión integrativa de la literatura realizada en abril de 2020 en las bases de datos de la Biblioteca Virtual em Saúde, United State National Library of Medicine y Scientific Electronic Library Online. Se utilizaron los siguientes descriptores: "Relações mãefilho/mother-child relationships", "enfermagem/ nursing" y el descriptor no controlado "apego / attachment" combinado por el operador booleano "AND". Resultados: Se destacaron las dificultades para establecer el vínculo entre madre e hijo cuando los niños son hospitalizados, cuando se les deja en una institución de enseñanza o personas ajenas y cuando las madres tenían hábitos inapropiados durante el período gestacional-puerperal que pueden haber afectado el crecimiento y desarrollo del bebé. La enfermería facilita el establecimiento de un vínculo madre-hijo, mitigando los estresores de manera humanista basada en la integralidad. Conclusión: El establecimiento satisfactorio de la conducta de apego es esencial para la salud mental humana. Involucrarse en el cuidado de la hospitalización y educación de un niño requiere el conocimiento de sus condiciones biológicas, psicológicas, sociales y ambientales, para comprender la complejidad de la situación de distanciamiento de la familia.

COVID-19: aspectos relacionados a la susceptibilidad genética y defectos congénitos / COVID-19: Aspects of genetic susceptibility and congenital defects

RESUMEN Introducción: la COVID-19 (acrónimo del inglés c oronavirus disease 2019) es una enfermedad infecciosa de reciente descripción, causada por el SARS-CoV-2, sin tratamiento efectivo. La identificación de variantes genéticas que intervienen en la respuesta a la COVID-19; así como la posibilidad de trasmisión materno-fetal del SARS-CoV-2 no solo permitirán ampliar los conocimientos sobre su fisiopatología; sino además estratificar los grupos de la población, y según su riesgo, implementar medidas preventivas y tratamientos personalizados, incluida la prioridad en el uso de vacunas. Objetivo: describir aspectos relacionados con la susceptibilidad genética y defectos congénitos en la COVID-19. Material y Métodos: se realizó una investigación tipo revisión bibliográfica; para identificar los documentos que se revisarían se consultó la base bibliográfica PubMed/Medline, incluyendo los trabajos del 2019 y 2020. Se incluyó publicaciones recomendadas por expertos, preferiblemente publicados en los últimos 10 años; luego de una valoración cualitativa, se realizó una síntesis. Desarrollo: están descritas mutaciones de los genes: ACE2, ACE1, TMPRSS2, TLR7, así como haplotipos HLA asociadas a la susceptibilidad genética a la COVID-19. Variantes de los genes: SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6 y XCR1; así como de los que codifican para el receptor de la Vitamina D y las citoquinas pro inflamatorias (como las IL-1, IL-6, IL-12, IFN-γ, y TNT-α), pudieran también estar relacionadas con un incremento de la susceptibilidad al SARS-CoV-2. Ante la posibilidad de trasmisión vertical de la COVID-19 y su posible papel teratogénico, las embarazadas constituyen un grupo de riesgo. Conclusión: variantes genéticas humanas son factores de susceptibilidad genética al virus SARS-CoV-2, que puede ser causa de defectos congénitos(AU)

ABSTRACT Introduction: COVID-19 (acronym for Coronavirus Disease 2019) is a recently described infectious disease caused by SARS-CoV-2, without effective treatment. Identification of genetic variants involved in the response to COVID-19 as well as the possibility of maternal-fetal transmission of SARS-CoV-2 will not only allow us to expand our knowledge of the pathophysiology of COVID-19, but also stratify population groups according to their risks in order to implement preventive measures and personalized treatments, including the priority in the use of vaccines. Objective: To describe aspects related to congenital defects and genetic susceptibility to the SARS-CoV-2 virus. Material and Methods: A bibliographic review was carried out. Medline and PubMed bibliographic databases were searched. Studies published between 2019 and 2020 were included as well the ones recommended by experts, preferably published within the last 10 years. After qualitative evaluation, synthesis was made. Development: Mutations in ACE2, ACE1, TMPRSS2, TLR7 genes, as well as HLA haplotypes associated with genetic susceptibility to COVID-19 are described. Variants in the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6, XCR1 and in those codifying vitamin D receptor and proinflammatory cytokines (IL-1, IL-6, IL-12, IFN-γ, and TNF-α) could be related to an increased susceptibility to SARS-CoV-2. Due to the risk of vertical transmission of COVID-19 and its possible teratogenic effect, pregnant women are included in the risk group. Conclusion: Human genetic variants are factors of genetic susceptibility to the SARS-CoV-2 virus which may cause congenital defects(AU)

Neonatal infection and passive acquisition of serum total IgG and reactive with Streptococcus B, anti-LPS of Klebsiella spp and Pseudomonas spp antibodies in twins

SUMMARY OBJECTIVE To describe the concentration of total and specific IgG antibodies anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella spp, and anti-lipopolysaccharide of Pseudomonas spp in the umbilical cord of newborn(NB) twins and to analyze the association between neonatal infection and antibody concentration in the umbilical cord blood. METHODS A prospective cross-sectional study of a cohort of NB twins admitted during the period of 20 months. Patients with malformations and mothers with infection were excluded. Variables analyzed: gestational age(GA); birth weight(BW); antibody concentrations in umbilical cord blood; infection episodes. We used the paired Student t-test, Spearman correlation, and generalized estimation equation. RESULTS 57 pairs of twins were included, 4 excluded, making the sample of 110 newborns. GA=36±1.65weeks and BW=2304.8±460g(mean±SD). Antibody concentrations in twins(mean±SD): total IgG=835.71±190.73mg/dL, anti-StreptococcusB IgG=250.66±295.1 AU/mL, anti-lipopolysaccharide of Pseudomonas spp IgG=280.04±498.66 AU/mL and anti-lipopolysaccharide of Klebsiella spp IgG=504.75±933.93 AU/mL. There was a positive correlation between maternal antibody levels and those observed in newborns(p <0.005). The transplacental transfer of maternal total IgG and anti-LPS Pseudomonas IgG antibodies was significantly lower at NB GA <34 weeks(p <0.05). Five newborns were diagnosed with an infection. Infants with infection had significantly lower total IgG concentration(p <0.05). CONCLUSION This study showed a positive correlation between maternal and newborn antibodies levels. In infants younger than 34 weeks there is less transfer of total IgG and anti-LPS Pseudomonas IgG. The highest incidence of infection in the newborn group who had significantly lower total IgG serum antibodies reinforces the importance of anti-infectious protection afforded by passive immunity transferred from the mother.

RESUMO OBJETIVOS Descrever o título de anticorpos IgG total e específico anti-Streptococcus B, anti-lipopolissacarídeos(LPS) de Klebsiella e Pseudomonas no cordão umbilical em gêmeos e analisar a possível associação entre os títulos desses anticorpos e a ocorrência de infecção. MÉTODOS Estudo prospectivo transversal de uma coorte de recém-nascidos (RN) gemelares em 20 meses. Excluídos: malformação, infecção congênita ou materna. Variáveis estudadas: idade gestacional(IG); peso de nascimento(PN); título de anticorpos e episódios de infecção. Foram utilizados testes t-Student pareado, correlação de Spearman e equações de estimação generalizadas. RESULTADOS Elegíveis 59 pares de gêmeos, excluídos 4 e incluídos 55 pares (n=110RN). A IG foi 36±1,65semanas e o PN foi 2304,8±460g (média±DP). Concentrações de anticorpos dos RN(média±DP): IgG total=835,71±190,73 mg/dL, IgG anti-Streptococcus B=295,1±250,66 UA/mL, IgG anti-LPS Pseudomonas=280,04±498,66 UA/mL e IgG anti-LPS Klebsiella=504,75± 933,93UA/mL. Houve correlação positiva entre níveis de anticorpos maternos e aqueles observados nos RN (p<0,005). A transferência transplacentária de anticorpos maternos IgG total e IgG anti-LPS Pseudomonas foi significativamente menor em RN IG < 34semanas (p<0,05). Foram diagnosticados 5 RN com infecção. Os RN que apresentaram infecção tinham concentração de IgG total significativamente menor (p<0,05). CONCLUSÕES Na população estudada existe correlação entre os anticorpos maternos e os níveis de anticorpos no RN. Nos gêmeos menores que 34 semanas há menor transferência de IgG total e IgG anti-LPS Pseudomonas. Nos RN com infecção a concentração de IgG total é significativamente menor, o que demonstra a maior vulnerabilidade e risco de infecção dessa população e a importância da imunidade passiva transferida pela placenta.