COVID-19 during pregnancy and adverse outcomes: Concerns and recommendations from The Brazilian Teratology Information Service.

SARS-CoV-2 virus was first identified in the beginning of 2020 and has spread all over the world, causing the Coronavirus Disease 2019 (COVID-19) pandemic. The virus is a member of the Coronavirus family, which includes viruses that cause common cold, Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). MERS and SARS are known by causing adverse events in pregnancy. Considering that SARS-CoV-2 is a new infection agent, little is known about the risk of its infection to human embryo/fetal development. However, SARS and MERS were associated with negative outcomes, such as miscarriage, preterm birth, intrauterine growth restriction and perinatal death. Here, we raise concerns and possibilities related the harmful potential of SARS-CoV-2 and COVID-19 to pregnancy, discussing symptoms, immunological changes during pregnancy, SARS-CoV-2 mutation rate (and the risks related to it). Finally, we point out recommendations to be performed by the scientific community and health care workers in order to identify and to manage potential risks to pregnant women and their babies.

Fetal Alcohol Spectrum Disorders: Health Needs Assessment in Brazil.

BACKGROUND: Fetal alcohol syndrome (FAS) is a disorder caused by alterations in embryo-fetal development due to prenatal alcohol exposure. It is estimated that between 0.5 and 2 per 1,000 individuals are born with FAS every year. In Brazil, there are few studies addressing the extent of the problem of FAS/fetal alcohol spectrum disorders (FASD); these studies are confined to limited geographic areas. Therefore, we decided to perform a health needs assessment for FAS/FASD in Brazil. METHODS: To estimate the prevalence of FAS and FASD in Brazil, we used information from the literature, which estimates between 0.5 and 2/1,000 births per year for FAS and 10 to 50/1,000 for FASD. RESULTS: We estimated that approximately 1,500 to 6,000 children are born with FAS every year. Considering the whole population, the prevalence would be 95,377 to 380,000 affected people. However, when we consider FASD as a whole, we estimate that between 1,900,000 and 9,500,000 Brazilians might suffer the more severe consequences of alcohol exposure during pregnancy and be living with FASD. CONCLUSION: The results of the current study indicate that FAS and FASD are prevalent disorders in Brazil, and more policies targeting alcohol intake during pregnancy must be developed.

From abortion-inducing medications to Zika Virus Syndrome: 27 years experience of the First Teratogen Information Service in Latin America.

In 1990, the first Teratogen Information Service in Brazil (SIAT) was implemented in the Medical Genetics Service at Hospital de Clinicas de Porto Alegre. SIAT is a free-to-use information service both to health professionals and the general population, especially to women who are pregnant or planning pregnancy. The main objective of this paper is to present the activities of SIAT in its initial years (1990-2006), compared to those in the last decade (2007-2017). In addition we review the scientific contribution of SIAT in the field of human teratogenesis. Since 1990, SIAT received 10,533 calls. Use of medications were the main reason for concern, accounting for 74% of all questions, followed by other chemical exposures (occupational, cosmetics, environmental), and maternal infectious diseases. Among its main contributions to scientific knowledge was the collaboration for the identification of two new human teratogens: misoprostol in the 1990s and Zika virus in 2015/16. In conclusion, SIAT is still evolving, as is the Medical Genetics Service that hosts it. Through its 27 years of existence more than 300 undergraduate and graduate students have rotated at SIAT. Presently, SIAT is expanding the research to experimental teratogenesis and to investigation of molecular mechanisms of teratogens.

Caffeine intake during pregnancy and adverse outcomes: An integrative review.

Caffeine intake during pregnancy is common. Caffeine crosses the placenta, raising concerns about its possible deleterious effects on the developing embryo/fetus. Studies on this subject show conflicting results, and still there is no consensus on the recommended dose of caffeine during pregnancy. We performed an integrative review with studies from six databases, using broad MESH terms to allow the identification of publications that addressed the outcomes of caffeine use during pregnancy, with no date limit for publications, in English and Portuguese language. The research returned 16,192 articles. After removing duplicates, screening by title, abstract and full-text, we evaluated 257 and included 59 articles. We found association between caffeine intake and pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. The effects were often dose dependent. No association with prematurity has been demonstrated, but one study showed a small reduction in gestational age with increasing doses of caffeine intake. Defining a safe dose for caffeine intake during pregnancy is a challenging task due to the heterogeneity in study designs and results, as well as the difficulty of reliably assessing the amount of caffeine consumed. In some studies, exposures below the recommended level of caffeine intake during pregnancy (200 mg/day), as suggested by the guidelines, were associated with pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. Well-designed studies with reliable quantification of caffeine intake are needed to assess the safety of low doses during pregnancy.

Maternal drinking behavior and Fetal Alcohol Spectrum Disorders in adolescents with criminal behavior in southern Brazil.

Prenatal alcohol exposure can have serious and permanent adverse effects. The developing brain is the most vulnerable organ to the insults of prenatal alcohol exposure. A behavioral phenotype of prenatal alcohol exposure including conduct disorders is also described. This study on a sample of Brazilian adolescents convicted for criminal behavior aimed to evaluate possible clinical features of Fetal Alcohol Syndrome (FAS). These were compared to a control group of school adolescents, as well as tested for other environmental risk factors for antisocial behavior. A sample of 262 institutionalized male adolescents due to criminal behavior and 154 male students aged between 13 and 21 years comprised the study population. Maternal use of alcohol was admitted by 48.8% of the mothers of institutionalized adolescents and by 39.9% of the school students. In this sample of adolescents we could not identify individual cases with a clear diagnosis of FAS, but signs suggestive of FASD were more common in the institutionalized adolescents. Social factors like domestic and family violence were frequent in the risk group, this also being associated to maternal drinking during pregnancy. The inference is that in our sample, criminal behavior is more related to complex interactions between environmental and social issues including prenatal alcohol exposure.

Neurodevelopment in Children Exposed to Zika in utero: Clinical and Molecular Aspects.

Five years after the identification of Zika virus as a human teratogen, we reviewed the early clinical manifestations, collectively called congenital Zika syndrome (CZS). Children with CZS have a very poor prognosis with extremely low performance in motor, cognitive, and language development domains, and practically all feature severe forms of cerebral palsy. However, these manifestations are the tip of the iceberg, with some children presenting milder forms of deficits. Additionally, neurodevelopment can be in the normal range in the majority of the non-microcephalic children born without brain or eye abnormalities. Vertical transmission and the resulting disruption in development of the brain are much less frequent when maternal infection occurs in the second half of the pregnancy. Experimental studies have alerted to the possibility of other behavioral outcomes both in prenatally infected children and in postnatal and adult infections. Cofactors play a vital role in the development of CZS and involve genetic, environmental, nutritional, and social determinants leading to the asymmetric distribution of cases. Some of these social variables also limit access to multidisciplinary professional treatment.

Assessment of the epilepsy treatment gap in two cities of south-east of Brazil.

OBJECTIVE: To assess the epilepsy treatment gap in Campinas and São Josédo Rio Preto, two cities in the State of São Paulo, Brazil. METHOD: The treatment gap was estimated using the formula n1-n2/n1x100, where n1 was calculated using 1.86% prevalence and represented the number of individuals with epilepsy, while n2 represented the number of people who could be treated with an adult standard dose for a year utilizing the antiepileptic drugs supplied by the public health system. RESULTS: Our estimates revealed that in 2001, approximately 50% of the population with epilepsy was treated with the recommended antiepileptic medication. CONCLUSION: These results suggest that a relevant percentage of patients with epilepsy are not untreated. Further epidemiological studies are needed to investigate the reasons for this treatment gap so that interventions can reduce this gap and improve the quality of life of patients with epilepsy.

Quality of life in pregnant women with epilepsy versus women with epilepsy.

It is assumed that 25% of patients with epilepsy are women of fertile age and 0.3% to 0.6% of all children are born of mothers with epilepsy. The aim of this study was to evaluate the quality of life on pregnant with epilepsy and compare with non-pregnant women with epilepsy. We evaluated two groups (Experimental Group--29 pregnant women with epilepsy and Control Group--30 women with epilepsy); they were attended at the HC/UNICAMP. The patients had three meetings to carry out and implement the anamnesis and the application of QQV-65. There were no significant differences in the measurement of quality of life when comparing both groups. However, when we analyzed individually in the pre- and post-partum periods, we observed significant differences in health aspects (p=0.0495), physical (p=0.02868) and emotional (p=0.0253) dimensions in QQV-65. This study shows that pregnancy could be interpreted as a stressor. In late pregnancy when this stressor was removed, women with epilepsy had improvement in their quality of life.

Mortalidade evitável: adequado manejo e assistência à saúde podem salvar vidas de pessoas com epilepsia?: [revisão] / Avoidable death: appropriate management and health care can save lives of people with epilepsy?: [review]

INTRODUÇÃO: A mortalidade por epilepsia ainda é uma questão negligenciada e as mortes relacionadas com a epilepsia não são bem compreendidas. Recentemente, alguns estudos têm operacionalizado a metodologia de mortalidade evitável, descrevendo as causas de morte que não devem ocorrer na presença de boa qualidade de serviços e tratamento médico adequado. Esse debate sobre causas de morte evitáveis é amplo e parece promissor para o desenvolvimento do monitoramento e avaliação de desempenho da atenção à saúde de pessoas com epilepsia. OBJETIVO: explorar e selecionar os estudos que priorizaram a epilepsia como evento sentinela ou estudos de mortalidade evitável onde a seleção da epilepsia foi caracterizada dentro do grupo de causas evitáveis de morte. METODOLOGIA: A revisão baseou-se numa pesquisa do banco de dados PubMed, usando os descritores, "mortality", "avoidable", "death" e "epilepsy", sem limites de tempo na data de publicação. Apenas artigos de particular relevância para a compreensão da morte evitável por epilepsia foram recuperados e revistos. RESULTADOS: Encontramos uma variedade de estudos que incluíram a epilepsia dentro do grupo de causas de morte evitáveis e assim, pudemos discorrer a temática que pode nortear as ações e políticas públicas de saúde, facilitando a adoção de mecanismos de monitoramento do desempenho da atenção e da prevenção da saúde dos pacientes com epilepsia. CONCLUSÕES: Diante dos resultados encontrados, sugerimos como estratégias que poderiam ser consideradas pelos órgãos públicos de saúde, a implantação de comitês de mortalidade, que sejam de natureza interinstitucional, multiprofissional e confidencial para a prevenção da mortalidade relacionada à epilepsia. Com isso, medidas de intervenção podem ser realizadas para melhorar o atendimento das pessoas com epilepsia e, consequentemente, reduzir os óbitos relacionados à epilepsia.

INTRODUCTION: The epilepsy avoidable death is a neglected issue. Deaths related to epilepsy are still not fully understood. Recently, some studies have showed the methodology of avoidable death, describing the causes of death should not occur in the presence of good quality services and appropriate medical treatment. The impact of studying the causes of avoidable death is relevant and promising for the monitoring and evaluation of performance of health care system for people with epilepsy. PURPOSE: To explore and select the studies emphasizing epilepsy as avoidable death or avoidable mortality studies where the selection of epilepsy was defined within the group of preventable causes of death. METHODOLOGY: The review was based on a search in the database PubMed, using as key words: "mortality", "avoidable", "death" and "epilepsy", without time limits on the date of publication. RESULTS: We observed a variety of studies of epilepsy in the group of avoidable causes of death. So, we could discuss the topics that could guide the actions and public health policies. CONCLUSIONS: These results suggest strategies involving the establishment of committees of mortality - institutional, multidisciplinary and confidential - to prevent mortality related to epilepsy. So, the adequate intervention' strategies can be performed to improve the management of people with epilepsy and, consequently, to reduce the mortality on epilepsy.

Aspectos sócio-econômicos do parceiro da gestante adolescente / Social-economic aspects of the partner of the pregnant teenager

Objetivo: identificar características sócio-demográficas do parceiro da gestante adolescente e verificar como se estabeleceu o relacionamento do casal. Métodos: participaram deste estudo 309 gestantes com idade até 19 anos que consultaram no Ambulatório de Gestação na Adolescência do Hospital de Clínicas de Porto Alegre. Foi aplicado questionário abordando antecedentes ginecológicos, dados sobre o comportamento sexual da paciente, sobre seu primeiro parceiro e o atual, a forma como se estabeleceu o relacionamento que deu origem à gestação e a intencionalidade em gestar. Resultados: a idade média dos parceiros foi 20 anos, e 4 anos a diferença de idade entre a paciente e seu companheiro. Somente metade dos parceiros era adolescente. A maioria dos parceiros (55,7%) tinha escolaridade entre a 5ª e a 8ª séries do ensino primário; 25,2% permaneciam estudando e 71,2% trabalhavam. Dos casais, 25,2% conheceram-se na vizinhança. Houve relato de parceiros com Doenças Sexualmente Transmissíveis (DSTs) em 2,9% e usuários de drogas ilícitas em 30,4 % do total de entrevistas. Das pacientes, 58,2% relataram mais de 1 ano de namoro com o parceiro atual, com 28,2% do total da amostra referindo mais de 2 anos até a ocorrência da gestação. Conclusões: de modo geral os parceiros são mais velhos que as gestantes adolescentes, já estão inseridos no mercado de trabalho e possuem baixa escolaridade. Observou-se um número expressivo de relações de longo prazo

Objectives: to examine the characteristics of the relationships that originate teenage pregnancy. Methods: 309 pregnant teenagers participated in this study (with ages up to 19 years old); they attended the Ambulatório de Gestação na Adolescência do Hospital de Clínicas de Porto Alegre. A questionnaire was used approaching data on gynecological history and sexual behavior, about her first and the current partner, the way the relationship was established and about intention on pregnancy. Results: the mean age of partners was 20 years and the age difference between the couple was 4 years. Only half of the partners were teenagers. Most partners (55.7%) had among the 5th and 8th grades of school; 25.2% were still in school and 71.2% were in the job market. Of the couples, 25.2% met for the first time in their own neighbourhood. There was information on partners with Sexually Transmitted Diseases (STDs) in 2.9% and illicit drug use in 30.4 % of all interviews. Of the patients, 58.2% mentioned more than 1 year of dating and 28.2% of the sample were together for more than 2 years until the pregnancy occurred. Conclusion: in a general manner, the partners were older than the pregnant teenagers, were already in the job market and had low schooling. Also an expressive number of long term relationships was observed

Machado de Assis's epilepsy

Machado de Assis (1839-1908) é considerado um dos mais importantes escritores brasileiros e uma grande personalidade literária universal. Pouco se sabe sobre sua história médica, pessoal e familiar. Machado referiu ter tido na infância crises epilépticas, caracterizadas como "coisas esquisitas". Ele descrevia suas crises epilépticas como "fenômenos nervosos", "ausências" ou "minha doença". Carlos de Laet assistiu a uma crise e descreveu-a "... quando de nós se acercou o Machado e dirigiu-me palavras em que näo percebi nexo. Encarei-o supreso e achei-lhe demudada a fisionomia. Sabendo que de tempos em tempos o salteavam incômodos nervosos, despedi-me do outro cavalheiro, dei o braço ao amigo enfêrmo, fi-lo tomar um cordial na mais próxima fármacia e só o deixei no bonde das Laranjeiras, quando o vi de todo restabelecido, a proibir-me que o acompanhasse até casa". Mostramos uma fotografia de Machado durante uma crise no Caes Pharoux no dia 1§ de setembro de 1907, documentada pelo fotógrafo Malta. Mário de Alencar escreveu: "A preocupaçäo com a saúde era freqüente: ou havia os efeitos de um acesso do mal terrível ou a iminência dele. Falava-me como a seu próprio médico, confiando-me tudo, consultando-me sobre minúcias da moléstia e o que havia de dizer ao seu facultativo". Parece-nos claro que Machado apresentava epilepsia localizada sintomática com crises parciais complexas secundariamente generalizadas, de etiologia desconhecida. As crises iniciaram na infância, tiveram remissäo na adolescência e recidivaram na terceira década, tornando-se mais freqüentes nos últimos anos. Machado apresentou episódios de depressäo que se acentuaram na útima década. Em nossa opiniäo, a maior conseqüência da epilepsia de Machado de Assis foi o sofrimento psicológico devido ao preconceito vigente. A despeito disto, Machado foi capaz de mostrar toda a sua genialidade, que ainda é atual e cada vez mais reconhecida universalmente

Spontaneous abortion in spouses of greenhouse workers exposed to pesticides

<p><b>OBJECTIVE</b>The aim of this study was to explore the association between exposure to specific pesticides (including endocrine disrupters) of greenhouse workers and spontaneous abortion in their spouses.</p><p><b>METHODS</b>A group of exposed workers was compared with a non-exposed group. The risk of spontaneous abortion was evaluated using a logistic regression model.</p><p><b>RESULTS</b>A significantly higher rate of spontaneous abortion was observed among spouses of workers exposed to specific compounds (atrazine, benomyl-carbendazim, carbaryl and DDT) in comparison with spouses of the unexposed group. The logistic regression model confirmed the increased risk of spontaneous abortion (OR=11.8; 95% CI 2.3-59.6).</p><p><b>CONCLUSIONS</b>These findings suggest that occupational exposure to pesticides might have an adverse effect on the partner's reproductive health.</p>

Cysticidal therapy: impact on seizure control in epilepsy associated with neurocysticercosis

OBJECTIVE: To evaluate the clinical features and seizure control of epilepsy related to neurocysticercosis. METHOD: 18 patients with partial epilepsy and neurocysticercosis were treated with albendazol or praziquantel and followed from 3 months to 12 years. We analyzed results from the CSF exam, interictal electroencephalogram (EEG), head computerized tomography and/or magnetic resonance imaging. RESULTS: The patients' mean age was 36.4 years. The mean duration of epilepsy was 16 years. 83 percent patients had simple partial seizures ; 17 percent had complex partial seizures . All patients underwent routine EEGs: 62 percent had abnormalities and 38 percent were normal. A relationship was observed between focal EEG abnormality and the location of cyst in 28 percent of the patients. The CSF exams showed pleocytosis in 33 percent of the patients, and 28 percent had elevated protein levels. Only 22 percent of patients had positive titer for cysticercosis in the CSF. In all patients who had somatosensory and special sensory seizures there was a relationship between location of the cysts and seizure semiology (n=11). After cysticidal therapy, 83 percent patients had a significant improvement in controlling seizures. CONCLUSION: In this group, we found a predominance of simple partial seizures and a relationship between somatosensory and special sensory seizures and the location of the cysts. Cysticidal therapy was effective in controlling seizures in these patients and should be considered for patients with partial seizures and semiology related to cyst location

Assessment of the epilepsy treatment gap in two cities of south-east of Brazil

OBJETIVO: Estimar a lacuna de tratamento em epilepsia nas cidades de Campinas e São José do Rio Preto, interior do Estado de São Paulo. MÉTODO: Estimamos a lacuna de tratamento através da fórmula n1-n2/n1x100, onde se utiliza o número de pessoas com epilepsia, calculado pela prevalência (n1), e a quantidade de pessoas que podem ser tratadas com a dose padrão para adultos das DAEs, distribuídas no período de um ano na localidade (n2). Usamos a prevalência estimada de 1,86% e consumo de medicação antiepiléptica fornecida pela rede básica de saúde nestas duas cidades. RESULTADOS: Nossas estimativas mostram que somente em torno de metade da população com epilepsia foi tratada em 2001 usando doses preconizadas de medicação antiepiléptica. CONCLUSÃO: A nossa estimativa aponta que uma parcela importante dos pacientes com epilepsia não está sendo tratada no nosso meio. Estudos epidemiológicos futuros devem explorar os motivos desta lacuna de tratamento para que intervenções sejam realizadas para melhorar a qualidade de vida dos pacientes com epilepsia.

A gestante adolescente e seu parceiro: características do relacionamento do casal e aceitação da gravidez / The pregnant adolescent and her partner: characteristics of their relationship and acceptance of pregnancy

A gestação na adolescência é um problema mundial. O conhecimento das características do parceiro da gestante adolescente e a compreensão do tipo de relacionamento são fundamentais para que seja possível atuar de forma preventiva.Objetivos: Avaliar as características do relacionamento que deu origem à gestação, o planejamento ou não dessa gestação e a forma pela qual ela foi recebida pela paciente e seu parceiro.Métodos: Participaram deste estudo 309 gestantes com idade até 19 anos, que consultaramno Ambulatório de Gestação na Adolescência do Hospital de Clínicas de Porto Alegre. Foiaplicado questionário abordando antecedentes ginecológicos, dados sobre o comportamentosexual da paciente, dados sobre o parceiro atual, a forma como se estabeleceu o relacionamento que deu origem à gestação e a intencionalidade da mesma.Resultados: A idade das pacientes foi de 11 a 19 anos, e a dos parceiros foi de 14 a 62 anos. A gestação foi planejada em 22% dos casos. A gestação foi bem recebida pela paciente em 75,1% dos casos e em 78,1% pelos companheiros. Apenas 32,4% dos casais utilizavam regularmente preservativos. Quando a gestante adolescente e seu parceiro moravam juntos, o uso regular de preservativo foi de 23,6%; nos casais que moravam separados, esse percentual foi de 42,9%.Conclusões: Programas de prevenção da gestação na adolescência serão mais efetivos se considerarem que a gestante e seu parceiro nem sempre consideram a gravidez umacontecimento indesejável.

Pregnancy in adolescence is a worldwide problem. Knowing the characteristics of partnersof pregnant adolescents and understanding their type of relationship are essential for thedevelopment of programs to prevent teenage pregnancy.Objectives: To evaluate characteristics of the relationship that resulted in pregnancy, planning status of such pregnancy, and how it was received by the patient and her partner.Methods: We assessed 309 pregnant women aged 19 years or younger, who were attended at Adolescent Pregnancy Outpatient Clinic, Hospital de Clínicas de Porto Alegre. Patients answered a questionnaire about their gynecological history, sexual behavior, current partner, how the relationship was established, and whether pregnancy was planned.Results: Patients were aged 11-19 years, and partners were aged 14-62 years. Pregnancy was planned in 22% of the cases. Pregnancy was well received by the patients and their partners in 75.1 and 78.1% of the cases, respectively. Only 32.4% of the couples regularly used condoms. Regular use of condoms was reported by 23.6% of the pregnant adolescents who lived with their partners and by 42.9% of those who lived separately.Conclusions: Adolescent pregnancy prevention programs will be more effective if they take into account that pregnant women and their partners do not always consider pregnancy to be an undesired event.

Mastectomia: abordagem do papel do cônjuge / Mastectomy: approach to the mate role

Apresenta-se uma revisäo bibliográfica a respeito de um aspecto do Câncer de Mama e Mastectomia, pouco abordado na maioria dos textos: o papel do companheiro da paciente. Aspectos importantes incluem o conhecimento do relacionamento prévio do casal, para o planejamento terapêutico e prognóstico da adaptaçäo conjugal no pós-operatório. É encorajador observar-se o sucesso dos programas de integraçäo dos maridos nas várias etapas do tratamento: decisäo sobre a cirurgia, visualizaçäo da cicatriz operatória e auxílio nos curativos