Assessing the risks for stillbirth in São Paulo, Brazil: protocol for a multidisciplinary case-control study - FetRisks.

Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate public policies and protocols to prevent stillbirth, improve maternal care and support bereaved families. METHODS AND ANALYSIS: In this case-control study with stillbirths and live births in 14 public hospitals in São Paulo, mothers are interviewed at hospitals after delivery, and hospital records and prenatal care registries are reviewed. Maternal and umbilical cord blood samples and placentas are collected to analyse angiogenesis and infection biomarkers, and the placenta's anatomopathological exam. Air pollutant exposure is estimated through the participant's residence and work addresses. Traditional and non-invasive autopsies by image-guided histopathology are conducted in a subset of stillbirths. Subsample mothers of cases are interviewed at home 2 months after delivery on how they were dealing with grief. Information contained in the official prenatal care registries of cases and controls is being compiled. Hospital managers are interviewed about the care offered to stillbirth mothers. Data analysis will identify the main risk factors for stillbirth, investigate their interrelations, and evaluate health services care and support for bereaved families. We hope this project will contribute to the understanding of stillbirth's risk factors and related health services in Brazil, providing new knowledge about this central public health problem, contributing to the improvement of public policies and prenatal and puerperal care, helping to prevent stillbirths and improve the healthcare and support for bereaved families. ETHICS AND DISSEMINATION: This study protocol was approved by the Ethics Committee of the Municipal Health Secretary (process no 16509319.0.3012.5551) and of the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (process no 16509319.0.0000.0068). Results will be communicated to the study participants, policy-makers and the scientific community.

Paratrygon aiereba irradiated anti-mucus serum reduce edematogenic activity induced in experimental model.

Accidents by freshwater stingrays are common in northern Brazil, there is no specific therapy for high morbidity and local tissue destruction. The irradiation of venoms and toxins by ionizing radiation has been used to produce appropriate immunogens for the production of antisera. We planned to study the efficacy of stinging mucus irradiation in the production of antisera, with serum neutralization assays of edematogenic activity and quantification of cytokines performed in animal models of immunization with native and irradiated mucus of Paratrygon aiereba, a large freshwater stingray. Antiserum potency and its cross-reactivity with mucus from other freshwater stingrays were detected by ELISA. Immunization models demonstrated the ability to stimulate a strong humoral response with elevated levels of serum IgG detectable by ELISA, and both native and irradiated mucus were immunogenic and capable of recognizing mucus proteins from other freshwater neotropical stingrays. Mucus P. aiereba causes cellular and humoral adaptive immune responses in cells of immunized mice producing antibodies and cytokines such as TNF-α, IL-6 and IL-17. Rabbit antisera immunized with mucus from P. aiereba irradiated at 2 kGy showed a significant reduction of mucus-induced edematogenic activity in mice. Our data suggest that the use of antisera against freshwater stingray mucus show the possibility of specific therapy for these accidents.

Quantitative toxoplasma gondii oocyst detection by a modified Kato Katz test using Kinyoun staining (KKK) in ME49 strain experimentally infected cats / Detecção quantitativa de oocistos de Toxoplasma gondii, por um teste modificado de Kato Katz usando coloração de Kinyoun (KKK), em gatos infectados experimentalmente com a cepa ME49

We detected Toxoplasma gondii oocysts in feces of experimentally infected cats, using a Kato Katz approach with subsequent Kinyoun staining. Animals serologically negative to T. gondii were infected orally with 5x10² mice brain cysts of ME49 strain. Feces were collected daily from the 3rd to the 30th day after challenge. Oocysts were detected by qualitative sugar flotation and the quantitative modified Kato Katz stained by Kinyoun (KKK). In the experimentally infected cats, oocysts were detected from the 7th to 15th day through sugar flotation technique, but oocysts were found in KKK from the 6th to 16th day, being sensitive for a larger period, with permanent documentation. The peak of oocysts excretion occurred between the 8th to 11th days after challenge, before any serological positive result. KKK could be used in the screening and quantification of oocysts excretion in feces of suspected animals, with reduced handling of infective material, decreasing the possibility of environmental and operator contamination.

Detectamos oocistos de Toxoplasma gondii em fezes de gatos experimentalmente infectados, usando a abordagem de Kato Katz, com subseqüente coloração pelo método de Kinyoun. Animais sorologicamente negativos ao T. gondii foram infectados por via oral com 5x10² cistos da cepa ME49 de cérebros de camundongos. Fezes foram colhidas diariamente a partir do 3º até o 30º dia pós-infecção. Oocistos foram detectados por centrífugo-flutuação em sacarose qualitativa e pelo método quantitativo de Kato Katz modificado corado pela técnica de Kinyoun (KKK). Em gatos experimentalmente infectados, oocistos foram detectados do 7º ao 15º dia pela técnica de centrífugo-flutuação em sacarose, mas oocistos foram detectados do 6º ao 16º dia pelo KKK, sendo sensível por um período maior, com documentação permanente. O pico da excreção de oocistos ocorreu entre 8º a 11º dia pós-infecção, antes de resultado sorológico positivo. KKK pode ser utilizado na triagem e quantificação da excreção de oocistos em fezes de animais suspeitos, com redução da manipulação de material infectante, diminuindo a possibilidade de contaminação ambiental e do operador.

Serological survey of antibodies to Toxoplasma gondii in food animals from São Paulo state, Brazil

A toxoplasmose é uma das infecções parasitárias mais prevalentes no homem e no rebanho, e a sua transmissão tem sido usualmente atribuída à ingestão de carnes cruas ou mal cozidas, de animais de produção infectados, sendo que a taxa de infecção destes animais pode ser um importante índice preditivo da doença humana, de alta prevalência no Brasil e no estado de São Paulo. Estudando este aspecto de Saúde Pública, nós testamos amostras séricas de bovinos, caprinos, ovinos e frangos de corte de matadouros do Estado de São Paulo, para a presença de anticorpos IgG anti-Toxoplasma gondii por um ensaio imunoenzimático de fase sólida (ELISA). Nós encontramos anticorpos específicos em 31,00 por cento (62/200) dos ovinos, 17,00 por cento(34/200) dos caprinos e 11,00 por cento (22/200) dos bovinos testados, sem positividade em 185 amostras de frangos de corte. Apesar de diferenças em hábitos alimentares de cada espécie, estas taxas de infecção foram menores em criações intensivas, relacionadas ao tipo de manejo da criação, o que pode reduzir a taxa de infecção por este parasita no rebanho.