COVID-19 Treatment: Drug Safety Prior to Conception and During Pregnancy and Breastfeeding.

In December 2019, a new viral respiratory infection known as coronavirus disease 2019 (COVID-19) was first diagnosed in the city of Wuhan, China. COVID-19 quickly spread across the world, leading the World Health Organization to declare it a pandemic on March 11, 2020. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a similar virus to those involved in other epidemics such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Epidemiological studies have shown that COVID-19 frequently affects young adults of reproductive age and that the elderly and patients with chronic disease have high mortality rates. Little is known about the impact of COVID-19 on pregnancy and breastfeeding. Most COVID-19 cases present with mild flu-like symptoms and only require treatment with symptomatic relief medications, whereas other cases with COVID-19 require treatment in an intensive care unit. There is currently no specific effective treatment for COVID-19. A large number of drugs are being used to fight infection by SARS-CoV-2. Experience with this therapeutic arsenal has been gained over the years in the treatment of other viral, autoimmune, parasitic, and bacterial diseases. Importantly, the search for an effective treatment for COVID-19 cannot expose pregnant women infected with SARS-CoV-2 to the potential teratogenic risks of these drugs. Therefore, it is necessary to determine and understand the safety of anti-COVID-19 therapies prior to conception and during pregnancy and breastfeeding.

High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surgery.

INTRODUCTION: Chronic pelvic pain is a disease that directly affects the social and professional lives of women. OBJECTIVE: To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeirão Preto, Brazil. METHODS: A one-year cross-sectional study was conducted in a population sample of 1,278 women over the age of 1,278 women over the age of 14 years. The target population was predominantly composed of women who are treated by the public health system. The questionnaire was administered by interviewers who were not linked to the city health care programs. The prevalence of the morbidity was estimated. First, we identified the significant variables associated with pelvic pain (p<0.10) and then we attributed values of 0 or 1 to the absence or presence of these variables. Logistic regression analysis was used to identify and estimate the simultaneous impact of the independent variables. The results were expressed by odds ratio and their 95% confidence interval with p<0.05. RESULTS: The disease was found in 11.5% (147/1,278) of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level. CONCLUSION: The prevalence of chronic pelvic pain in Ribeirão Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education.

TRPV1 expression on peritoneal endometriosis foci is associated with chronic pelvic pain.

OBJECTIVE: To investigate the expression of capsaicin receptor (transient receptor potential vanilloid type 1 [TRPV1]) in the peritoneal endometriosis foci of women with and without chronic pelvic pain (CPP). METHODS: A case-control study was conducted on 49 women with endometriosis who underwent laparoscopy, 28 of whom had CPP and 21 without CPP. Samples from peritoneum of the rectouterine excavation (2 cm2) were obtained by laparoscopy, fixed in 4% formaldehyde, and underwent immunohistochemistry analysis using rabbit anti-TRPV1 (1:400) polyclonal antibody. RESULTS: Image analysis revealed that the immunoreactivity for TRPV1 was more frequent in specimens (endometriosis foci) from women with CPP (n = 15 of 28, 53.6%), compared to samples from the endometriosis foci of women without CPP (n = 6 of 21, 28.6%; P = .04). There was no correlation with duration, intensity of pain, or stage of the disease (endometriosis). DISCUSSION: The present study shows that TRPV1 expression in peritoneal endometriosis foci is related to CPP in women. However, this association is not related to the endometriosis stage. In view of the immunoreactivity for TRPV1 observed here, we believe that some endometriotic lesions may provide a scenario for TRPV1 to be tonically active and this activity may contribute to the underlying pathology of CPP.

High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surgery

INTRODUCTION: Chronic pelvic pain is a disease that directly affects the social and professional lives of women. OBJECTIVE: To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeirão Preto, Brazil. METHODS: A one-year cross-sectional study was conducted in a population sample of 1,278 women over the age of 1,278 women over the age of 14 years. The target population was predominantly composed of women who are treated by the public health system. The questionnaire was administered by interviewers who were not linked to the city health care programs. The prevalence of the morbidity was estimated. First, we identified the significant variables associated with pelvic pain (p<0.10) and then we attributed values of 0 or 1 to the absence or presence of these variables. Logistic regression analysis was used to identify and estimate the simultaneous impact of the independent variables. The results were expressed by odds ratio and their 95 percent confidence interval with p<0.05. RESULTS: The disease was found in 11.5 percent (147/1,278) of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level. CONCLUSION: The prevalence of chronic pelvic pain in Ribeirão Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education.

Morfologia do primeiro corpúsculo polar e taxas de fertilização, clivagem e qualidade embrionária / First polar body morphology and fertilization rate, cleavage rate, and embryo quality

OBJETIVO: determinar a relação entre a morfologia do primeiro corpúsculo polar (CP) de oócitos humanos e as taxas de fertilização e clivagem e a qualidade embrionária em procedimentos de Injeção Intracitoplasmática de Espermatozóide (ICSI). MÉTODOS: estudo retrospectivo de 582 ciclos consecutivos de ICSI no período de julho de 2003 a julho de 2005. A morfologia do primeiro CP foi avaliada com revisão de 3.177 oócitos em metáfase II, imediatamente antes da realização da ICSI, sempre pelo mesmo observador. O CP foi classificado nas seguintes categorias: CP intacto e de tamanho normal, CP fragmentado ou CP de tamanho aumentado. Avaliamos as taxas de fertilização e de clivagem, o número e a proporção de embriões de boa qualidade em cada um dos três grupos avaliados 48 horas após a ICSI (D2). Foram considerados de boa qualidade os embriões com quatro células, sem fragmentação e com blastômeros simétricos em D2. RESULTADOS: as taxas de fertilização, clivagem e de formação de embriões de boa qualidade resultantes da inseminação de oócitos com o CP aumentado (20,7, 18,7 e 5 por cento, respectivamente) foram significativamente menores que as de oócitos com o CP intacto e de tamanho normal (70,8, 62,5 e 19 por cento, respectivamente) ou CP fragmentado (69,7, 60,5 e 17,1 por cento, respectivamente). CONCLUSÕES: observamos que a presença do primeiro CP aumentado relaciona-se com piores taxas de fertilização, clivagem e de formação de embriões de má qualidade. Entretanto, a fragmentação no primeiro CP parece não interferir nos resultados da ICSI.

PURPOSE: to determine the relationship between the morphology of the first spindle pole of human oocytes and rates of fertilization, fragmentation and embryo quality in procedures of Intracytoplasmic Sperm Injection (ICSI). METHODS: retrospective study of 582 consecutive ICSI cycles, from July 2003 to July 2005. The morphology of the first spindle pole (SP) was assessed through the analysis of 3,177 oocytes in metaphase II, immediately before the ICSI procedure, always by the same observer. SP has been classified in the following categories: normal size intact, fragmented or augmented SP. Fertilization rate and fragmentation, and the number and rate of good quality embryos in each one of the three groups studied have been evaluated, 48 hours after ICSI (D2). Embryos with four cells, without fragmentation and with symmetric blastomeres in D2 were considered as of good quality. RESULTS: rates of fertilization, fragmentation and of good quality embryo formation, resulting from oocyte insemination, with augmented SP (20.7, 16.7 and 5 percent respectively) were significantly lower than the ones from intact and normal size SP (70.8, 62.5 and 19 percent, respectively) or from fragmented SP oocytes (69.7, 60.5 and 17.1 percent, respectively). CONCLUSIONS: it has been observed that the presence of augmented first spindle pole is related to worse rates of fertilization, fragmentation and bad quality embryo formation. Nevertheless, fragmentation in the first spindle pole of the oocyte does not seem to affect ICSI results.

[First polar body morphology and fertilization rate, cleavage rate, and embryo quality]. / Morfologia do primeiro corpúsculo polar e taxas de fertilização, clivagem e qualidade embrionária.

PURPOSE: to determine the relationship between the morphology of the first spindle pole of human oocytes and rates of fertilization, fragmentation and embryo quality in procedures of Intracytoplasmic Sperm Injection (ICSI). METHODS: retrospective study of 582 consecutive ICSI cycles, from July 2003 to July 2005. The morphology of the first spindle pole (SP) was assessed through the analysis of 3,177 oocytes in metaphase II, immediately before the ICSI procedure, always by the same observer. SP has been classified in the following categories: normal size intact, fragmented or augmented SP. Fertilization rate and fragmentation, and the number and rate of good quality embryos in each one of the three groups studied have been evaluated, 48 hours after ICSI (D2). Embryos with four cells, without fragmentation and with symmetric blastomeres in D2 were considered as of good quality. RESULTS: rates of fertilization, fragmentation and of good quality embryo formation, resulting from oocyte insemination, with augmented SP (20.7, 16.7 and 5% respectively) were significantly lower than the ones from intact and normal size SP (70.8, 62.5 and 19%, respectively) or from fragmented SP oocytes (69.7, 60.5 and 17.1%, respectively). CONCLUSIONS: it has been observed that the presence of augmented first spindle pole is related to worse rates of fertilization, fragmentation and bad quality embryo formation. Nevertheless, fragmentation in the first spindle pole of the oocyte does not seem to affect ICSI results.