Characteristics and outcomes of pregnant women with SARS-CoV-2 infection and other severe acute respiratory infections (SARI) in Brazil from January to November 2020.

BACKGROUND: Knowledge about COVID-19 in pregnancy is limited, and evidence on the impact of the infection during pregnancy and postpartum is still emerging. AIM: To analyze maternal morbidity and mortality due to severe acute respiratory infections (SARI), including COVID-19, in Brazil. METHODS: National surveillance data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) was used to describe currently and recently pregnant women aged 10-49 years hospitalized for SARI from January through November, 2020. SARI cases were grouped into: COVID-19; influenza or other detected agent SARI; and SARI of unknown etiology. Characteristics, symptoms and outcomes were presented by SARI type and region. Binomial proportion and 95% confidence intervals (95% CI) for outcomes were obtained using the Clopper-Pearson method. RESULTS: Of 945,460 SARI cases in the SIVEP-Gripe, we selected 11,074 women aged 10-49 who were pregnant (7964) or recently pregnant (3110). COVID-19 was confirmed in 49.4% cases; 1.7% had influenza or another etiological agent; and 48.9% had SARI of unknown etiology. The pardo race/ethnic group accounted for 50% of SARI cases. Hypertension/Other cardiovascular diseases, chronic respiratory diseases, diabetes, and obesity were the most common comorbidities. A total of 362 women with COVID-19 (6.6%; 95%CI 6.0-7.3) died. Mortality was 4.7% (2.2-8.8) among influenza patients, and 3.3% (2.9-3.8) among those with SARI of unknown etiology. The South-East, Northeast and North regions recorded the highest frequencies of mortality among COVID-19 patients. CONCLUSION: Mortality among pregnant and recently pregnant women with SARIs was elevated among those with COVID-19, particularly in regions where maternal mortality is already high.

Heterogeneity of Associations between Total and Types of Fish Intake and the Incidence of Type 2 Diabetes: Federated Meta-Analysis of 28 Prospective Studies Including 956,122 Participants.

The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction (p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01-1.03, I2 = 61%) for total fish, 1.04 (1.01-1.07, I2 = 46%) for fatty fish, and 1.02 (1.00-1.04, I2 = 33%) for lean fish. In men, all associations were null. In women, we observed variation by geographical location: IRRs for total fish were 1.03 (1.02-1.04, I2 = 0%) in the Americas and null in other regions. In conclusion, we found evidence of a neutral association between total fish intake and type 2 diabetes in men, but there was a modest positive association among women with heterogeneity across studies, which was partly explained by geographical location and types of fish intake. Future research should investigate the role of cooking methods, accompanying foods and environmental pollutants, but meanwhile, existing dietary regional, national, or international guidelines should continue to guide fish consumption within overall healthy dietary patterns.

Characteristics and outcomes of pregnant women with SARS-CoV-2 infection and other severe acute respiratory infections (SARI) in Brazil from January to November 2020

ABSTRACT Background: Knowledge about COVID-19 in pregnancy is limited, and evidence on the impact of the infection during pregnancy and postpartum is still emerging. Aim: To analyze maternal morbidity and mortality due to severe acute respiratory infections (SARI), including COVID-19, in Brazil. Methods: National surveillance data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) was used to describe currently and recently pregnant women aged 10-49 years hospitalized for SARI from January through November, 2020. SARI cases were grouped into: COVID-19; influenza or other detected agent SARI; and SARI of unknown etiology. Characteristics, symptoms and outcomes were presented by SARI type and region. Binomial proportion and 95% confidence intervals (95% CI) for outcomes were obtained using the Clopper-Pearson method. Results: Of 945,460 SARI cases in the SIVEP-Gripe, we selected 11,074 women aged 10-49 who were pregnant (7964) or recently pregnant (3110). COVID-19 was confirmed in 49.4% cases; 1.7% had influenza or another etiological agent; and 48.9% had SARI of unknown etiology. The pardo race/ethnic group accounted for 50% of SARI cases. Hypertension/Other cardiovascular diseases, chronic respiratory diseases, diabetes, and obesity were the most common comorbidities. A total of 362 women with COVID-19 (6.6%; 95%CI 6.0-7.3) died. Mortality was 4.7% (2.2-8.8) among influenza patients, and 3.3% (2.9-3.8) among those with SARI of unknown etiology. The South-East, Northeast and North regions recorded the highest frequencies of mortality among COVID-19 patients. Conclusion: Mortality among pregnant and recently pregnant women with SARIs was elevated among those with COVID-19, particularly in regions where maternal mortality is already high.

Nasal Priming with Lactobacillus rhamnosus CRL1505 Stimulates Mononuclear Phagocytes of Immunocompromised Malnourished Mice: Improvement of Respiratory Immune Response.

The effect of Lactobacillus rhamnosus CRL1505 (Lr) on macrophages (Ma) and dendritic cells (DC) in the orchestration of anti-pneumococcal immunity was studied using malnutrition and pneumococcal infection mouse models. Monocytes (Mo), Ma, and DC in two groups of malnourished mice fed with balanced diet (BCD) were studied through flow cytometry; one group was nasally administered with Lr (BCD+Lr group), and the other group was not (BCD group). Well-nourished (WNC) and malnourished (MNC) mice were used as controls.Malnutrition affected the number of respiratory and splenic mononuclear phagocytes. The BCD+Lr treatment, unlike BCD, was able to increase and normalize lung Mo and Ma. The BCD+Lr mice were also able to upregulate the expression of the activation marker MHC II in lung DC and to improve this population showing a more significant effect on CD11b+ DC subpopulation. At post-infection, lung Mo values were higher in BCD+Lr mice than in BCD mice and similar to those obtained in WNC group. Although both repletion treatments showed similar values of lung Ma post-infection, the Ma activation state in BCD+Lr mice was higher than that in BCD mice. Furthermore, BCD+Lr treatment was able to normalize the number and activation of splenic Ma and DC after the challenge.Lr administration stimulates respiratory and systemic mononuclear phagocytes. Stimulation of Ma and DC populations would increase the microbicide activity and improve the adaptive immunity through its antigen-presenting capacity. Thus, Lr contributes to improved outcomes of pneumococcal infection in immunocompromised hosts.

Association of binge eating behavior and psychiatric comorbidity in ELSA-Brasil study: Results from baseline data.

OBJECTIVE: To estimate the association of binge eating behavior (BE) with common mental disorders (CMD). METHOD: Cross sectional investigation of 14,088 adults, aged 35-74years (ELSA-Brasil study). BE was assessed with Structured Clinical Interview for DSM Disorders (SCID - DSM IV) questions, and psychiatric morbidity with CIS-R (CIS R - Clinical Interview Schedule Revised). Poisson regression was used to estimate the association of BE and psychiatric morbidity. RESULTS: Adjusted prevalence ratios (PR) for CMD and BE were: PR=1.60 (1.34-1.91) for a CIS R score 12-18 (presence of CMD with lower clinical severity); PR=2.40 (2.06-2.80) for a CIS R score≥18 (severe symptom profile likely to require treatment); for psychiatric diagnoses: PR=2.24 (1.84-2.73) for depressive episodes; PR=1.77 (1.53-2.04) for anxiety disorders, and PR=1.42 (1.20-1.67) for mixed depressive-anxiety disorder. CONCLUSION: BE was associated with higher prevalence of common mental disorders. Our findings highlight the need to investigate mechanisms involved in the relationship of BE, obesity and psychopathology in low/middle income countries.

Plasminogen activator inhibitor-1 and type 2 diabetes: a systematic review and meta-analysis of observational studies.

An emerging body of evidence has implicated plasminogen activator inhibitor-1 (PAI-1) in the development of type 2 diabetes (T2D), though findings have not always been consistent. We systematically reviewed epidemiological studies examining the association of PAI-1 with T2D. EMBASE, PubMed, Web of Science, and the Cochrane Library were searched to identify studies for inclusion. Fifty-two studies (44 cross-sectional with 47 unique analytical comparisons and 8 prospective) were included. In pooled random-effects analyses of prospective studies, a comparison of the top third vs. bottom third of baseline PAI-1 values generated a RR of T2D of 1.67 (95% CI 1.28-2.18) with moderate heterogeneity (I(2) = 38%). Additionally, of 47 cross-sectional comparisons, 34(72%) reported significantly elevated PAI-1 among diabetes cases versus controls, 2(4%) reported significantly elevated PAI-1 among controls, and 11(24%) reported null effects. Results from pooled analyses of prospective studies did not differ substantially by study design, length of follow-up, adjustment for various putative confounding factors, or study quality, and were robust to sensitivity analyses. Findings from this systematic review of the available epidemiological literature support a link between PAI-1 and T2D, independent of established diabetes risk factors. Given the moderate size of the association and heterogeneity across studies, future prospective studies are warranted.

Antioxidant activity and chemical composition of essential oils of three aromatic plants from La Rioja province.

CONTEXT: The use of many traditional medicinal plants is often hampered by the absence of a proper biochemical characterization, which is essential to identify the bioactive compounds present in it. The essential oils (EOs) of three native species from the La Rioja province were analyzed: Lippia turbinata Griseb and Lippia integrifolia (Griseb.) Hieron (Verbenaceae), and Clinopodium gilliesii (Benth.) Kuntze (Lamiaceae). OBJECTIVE: The aim of this study was to evaluate their EOs antioxidant activity (AA) and their chemical composition. MATERIALS AND METHODS: EOs were analyzed by gas chromatography-mass spectrometry (GC-MS). To enhance the aqueous solubilization of the EOs, EO-water emulsions were prepared (concentration range of 0.1-6 mg mL(-1)). AA was determined using ABTS, DPPH, and peroxyl radical scavenging assays, as well as by the ß-carotene bleaching test. RESULTS: Piperitenone oxide was a major constituent in L. turbinata, pulegone and piperitenone oxide in C. gilliesii, and ß-caryophyllene in L. integrifolia. Lippia turbinata EO was the most active ABTS and DPPH radical scavenger (SC50 values of 0.40 ± 0.14 and 0.74 ± 0.08 mg mL(-1), respectively). Clinopodium gilliesii EO exhibited the highest hydrogen peroxide scavenging activity (SC25 value = 1.52 ± 0.27 mg mL(-1)). In the ß-carotene assay, L. turbinata EO was more effective at inhibiting lipid peroxidation than the other two oils (IC25 value = 0.15 ± 0.04 mg mL(-1)). CONCLUSION: Our results suggest that the AA observed can be justified by the presence of oxygenated monoterpenes, mainly piperitenone oxide. Finally, L. turbinata EO might be used as a safe natural antioxidant and food preservative in the food and cosmetic industries.

Dietary supplementation with Lactobacilli improves emergency granulopoiesis in protein-malnourished mice and enhances respiratory innate immune response.

This work studied the effect of protein malnutrition on the hemato-immune response to the respiratory challenge with Streptococcus pneumoniae and evaluated whether the dietary recovery with a probiotic strain has a beneficial effect in that response. Three important conclusions can be inferred from the results presented in this work: a) protein-malnutrition significantly impairs the emergency myelopoiesis induced by the generation of the innate immune response against pneumococcal infection; b) repletion of malnourished mice with treatments including nasally or orally administered Lactobacillus rhamnosus CRL1505 are able to significantly accelerate the recovery of granulopoiesis and improve innate immunity and; c) the immunological mechanisms involved in the protective effect of immunobiotics vary according to the route of administration. The study demonstrated that dietary recovery of malnourished mice with oral or nasal administration of L. rhamnosus CRL1505 improves emergency granulopoiesis and that CXCR4/CXCR12 signaling would be involved in this effect. Then, the results summarized here are a starting point for future research and open up broad prospects for future applications of probiotics in the recovery of immunocompromised malnourished hosts.

Nasally administered Lactobacillus rhamnosus accelerate the recovery of humoral immunity in B lymphocyte-deficient malnourished mice.

The ability of nasally administered Lactobacillus rhamnosus CRL1505 to accelerate the recovery of respiratory B cell-mediated immunity against pneumococcal infection in replete malnourished mice was evaluated. Weaned mice were malnourished after consumption of a protein-free diet for 21 d. Malnourished mice were fed a balanced conventional diet (BCD) for 7 d (BCD group) or a BCD for 7 d with supplemental L. rhamnosus CRL1505 by the nasal route during the last 2 d (BCD+Lr group). Nonreplete malnourished and normal mice were used as the malnourished (MNC) and the well-nourished (WNC) control groups, respectively. Mice were challenged with Streptococcus pneumoniae at the end of each dietary treatment. The immune response was studied before the challenge and at different times postinfection. The MNC mice had less resistance to pneumococcal infection, fewer mature and immature B cells in lung and spleen, and a reduced production of specific antibodies compared with WNC mice. The BCD treatment did not induce a complete normalization of the number B cell populations and antibody amounts. However, the BCD+Lr group had normal numbers of spleen and lung B cells. Moreover, the BCD+Lr mice had a significantly lower susceptibility to S. pneumoniae infection and higher amounts of anti-pneumococcal antibodies. Although further studies are necessary to clarify the effect of malnutrition and nasally administered lactobacilli in other immune cell populations involved in the protection against respiratory pathogens, this work gives evidence of the importance of using nasal priming with probiotics to accelerate the recovery of respiratory immunity in immunocompromised malnourished hosts.

Psicanálise e antropologia: diálogos possíveis / Psychoanalysis and anthropology: possible dialogues / Psychanalyse et anthropologie: dialogues possibles / Psicoanálisis y antropología: diálogos posibles

A partir de uma experiência concreta de pesquisa, este texto propõe um diálogo entre psicanálise e antropologia, particularmente no que se refere às relações entre pesquisador e pesquisado no trabalho etnográfico: na coleta, na análise e na interpretação dos dados. Essas relações foram pensadas com base na noção de transferência, o que evidenciou a possibilidade do diálogo, tanto no plano analítico quanto metodológico, entre disciplinas que pensam a realidade mediada pela linguagem.

Based on a concrete experience of research, this text proposes a dialogue betweenpsychoanalysis and anthropology, especially in terms of the relationships between research ers and their objects in ethnographical work: in fieldwork, in analyses and inthe interpretation of data. These relationships are seen on the basis of transference.They showed the possibility for dialogue on an analytical and methodological level,between two fields of interest, both of which conceive reality as mediated by language.

À partir d’une expérience concrète de recherche, ce texte propose un dialogue entre la psychanalyse et l’anthropologie en tenant spécialement compte des rapportsentre le chercheur et son objet dans le travail ethnographique, soit le travail de terrain,l’analyse et l’interprétation des données. Ces rapports ont été analysés à l’aide de lanotion de transfert, ce qui a mis en évidence la possibilité du dialogue aux niveauxanalytique et méthodologique entre des disciplines qui pensent la réalité par lamédiation du langage.

Basado en una experiencia concreta de investigación, este texto propone undiálogo entre psicoanálisis y antropología, particularmente en lo que se refiere a las relaciones entre investigador e investigado en el trabajo etnográfico: en la colecta, elanálisis y la interpretación de datos. Esas relaciones fueron pensadas a partir de lanoción de transferencia, lo que posibilitó el diálogo, a nivel analítico y metodológico,entre disciplinas que piensan la realidad mediada por el lenguaje.

Enhanced immune response to pneumococcal infection in malnourished mice nasally treated with heat-killed Lactobacillus casei.

The present study analyzed whether nasal administration of viable and non-viable Lactobacillus casei CRL 431 to immunocompromised mice was capable of increasing resistance against Streptococcus pneumoniae. Weaned mice were malnourished after consuming a PFD for 21 days. Malnourished mice were fed a BCD for 7 days or BCD for 7 days with viable or non-viable L. casei nasal treatments on day 6 and day 7 (BCD+LcV and BCD+LcN, respectively). The MNC group received PFD whereas the WNC mice consumed BCD. MNC mice showed greater lung colonization, more severe lung injuries, impaired leukocyte recruitment and reduced antibodies and cytokine production when compared with WNC mice. Administration of L. casei increased the resistance of malnourished mice to the infection. Both BCD+LcV and BCD+LcN treatments prevented the dissemination of the pathogen to the blood and induced its lung clearance. BCD+LcV or BCD+LcN groups showed improved production of TNF-alpha and activity of phagocytes in the respiratory tract, an effect that was not observed in the BCD control group. In addition, IL-4 and IL-10 were significantly increased in BCD+LcV and BCD+LcN groups, which correlated with the increase in the levels of specific respiratory IgA. The nasal treatments with L. casei were also effective at stimulating the production of specific IgG at both the systemic and the respiratory levels. The comparative study between the viable and the non-viable bacteria demonstrated that viability would be an important factor to achieve maximum protective effects. However, the results from this study suggest that heat-killed lactic acid bacteria are also effective in the immunomodulation of the systemic and respiratory immune system.

Depressão e Envelhecimento na contemporaneidade / Depression and Aging in contemporary times

O presente texto reproduz os trabalhos apresentados em mesa redonda sobre depressão e envelhecimento na contemporaneidade no III Congresso Ibero-americano de Psicogerontologia, realizado em novembro de 2010 em São Paulo. Estes trabalhos são resultado de reflexões precedentes em um grupo de estudos e de discussão de casos clínicos composto por psicanalistas. A depressão é uma figura psicopatológica de presença maciça nos dias de hoje. Na velhice o acúmulo de perdas e a aproximação da morte podem produzir um estado de tristeza, fundo depressivo que caracteriza um momento de recolhimento em que ocorrem os processos de luto. Em alguns sujeitos o que se verifica é a instalação de um episódio depressivo que indica a paralisação destes processos elaborativos e a progressão de um esvaziamento do sentido para a vida, restando, neste contexto, apenas a espera pela morte. Neste trabalho serão discutidos aspectos que concernem a vivência destas duas modalidades de enfrentamento da entrada na velhice, levando-se em conta as maneiras como a cultura pode favorecer a ocorrência destes percursos distintos do envelhecer, e como ela os aloja atualmente em um movimento de desconsideração da subjetividade: desanimo da velhice ou problema neuroquímico? Serão apresentadas hipóteses para a produção da depressão como psicopatologia no envelhecimento e reflexões sobre observações clínicas que derivam destes quadros clínicos, tais como: a crise da percepção da entrada na velhice, o corpo hipocondríaco, a paralisia do tempo, a vivência do desamparo.

This text reproduces the works presented at a "discussion table" about depression and aging in contemporanity in the "III Congresso Ibero-americano de Psicogerontologia", realized on November 2010, in São Paulo. These pieces of work are results of precedents debates in a study and clinic discussion group, composed by psychoanalysts. Nowadays the depression has an intensive presence as a psychopatologique figure. In old age, the accumulation of losses and the proximity of death can produce a state of sadness; a depressive found that characterizes a moment of retiring when the mourning process occurs. At some people, we can verify the installation of depressive episodes that indicates the paralyzation of this elaboration process and the progression of an emptiness of life's sense, being left, in this context, only the death expectation. In this text, aspects related to these two modalities of confronting the entrance in old age will be discussed, considering the ways how culture can collaborate with the occurrence of these two distinct trajectories of oldness, and how culture lodges it in these days, in a movement of desconsideration of subjectivity: discouragement of old age or neurochemical problem. Hypotheses for the production of depression as a psychopathology at oldness and reflections over clinic observations from these kinds of cases will be presented, such as: crisis of entrance in old age perception; the hypocondriaque body, the paralyzation of time, helpless.

Temporalidade e permanência: o eu e o outro de Jorge Luis Borges / Temporality and permanence: the self and the other of Jorge Luis Borges

Este trabalho pretende discorrer sobre aquilo que permanece no ser humano com o passar dos anos, tendo o conto "O outro", de Jorge Luis Borges, como sustentação poética para os assuntos discutidos. Tem o objetivo de contribuir com uma visão da psicanálise, que entende o envelhecimento como constante percurso do sujeito no seu encontro com o outro. O que permanece pode ser compreendido como aquilo que continua sendo investido no cotidiano, que se configura na relação com o mundo, com as pessoas e consigo mesmo.

Trabalho com velhos: algumas reflexões iniciais / Work with the elderly: some initial reflections

Este trabalho tem o intuito de refletir sobre as relações transferenciais que acontecem com o profissional da saúde no contato com idosos. A diferenciação entre os conceitos de velhice e envelhecimento se torna necessária na formulação de uma clínica do envelhecimento, clínica marcada pelo entendimento do idoso como um sujeito que vivencia a finitude de maneira particular