Epidemiological profile and effectiveness of immediate postpartum contraception in Brazilian women.

Purpose: To determine the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum period and compare the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC. Methods: We analyzed the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum. The data was collected by electronic medical records of postpartum women assisted at the University Hospital of São Bernardo do Campo (HMU-SBC) from January 2016 to December 2020. Also, we compared the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC by identifying women who returned for second delivery during the study period and analyzing the contraceptive method chosen in the first hospitalization. Then the pregnancies interval and the sociodemographic characteristics were analyzed according to contraceptive method type. Results: Data from 20,896 women were collected, of which 8,183 (39%) opted for Cu-IUD, 559 (2.5%) DPMA, and 10,989 (52.5%) chose not to use contraception at the time of hospital discharge. When comparing these groups, women in the DPMA were younger (26.5 ± 7.3, p < 0.05), and NCM showed women with a lower number of pregnancies (2.2 ± 1.3, p < 0.05). Subjects in the TL group (4.6%) had the higher number of pregnancies (3.8 ± 1.2, p < 0.05), and ENG group, the highest number of miscarriages (1.6 ± 1.3, p < 0.05). Of those women who returned pregnant, 5.5% belonged to the DPMA group, 6% to the NCM group, and 2.3% to the Cu-IUD. Conclusions: Women who opted for Cu-IUD insertion were younger, had more pregnancies and vaginal delivery when compared to those who did not choose a method. Of those women who returned, the minority opted for Cu-IUD compared to those that opted for DPMA or no method.

Evaluation of Maternal Fetal Outcomes of Pregnant Women and Mothers with Suspected Infection by SARS-CoV-2 Treated at the Municipal Hospital of São Bernardo do Campo (HMU-SBC), Brazil.

OBJECTIVES: The impact of Covid-19 infection on pregnancy and perinatal outcomes is not fully known. To describe the risk factors and perinatal outcome of pregnant women with suspected COVID-19 infection. METHODS: We evaluated medical records of women with suspected or confirmed SARS-CoV-2 infection who received health care services at the University Hospital of São Bernardo do Campo from March 1 to July 31, 2020, and personal, clinical, and laboratory data of these women and their newborns. RESULTS: Of the 219 women identified, 29% were asymptomatic. Considering the total population, 26% and 17% had obesity and hypertensive syndrome, respectively. Fever measured in the emergency room was the main reason for hospitalization. The presence or not of flu-like symptoms did not impact on perinatal outcomes. Pregnant women requiring hospitalization had newborns with lower birth weight (p < 0.01), shorter length (p = 0.02), and smaller head circumference (p = 0.03), and, in these cases, a higher number of cesarean section deliveries was observed. CONCLUSION: COVID-19 infection did not affect the prognosis of pregnancy and newborns. However, the worst clinical outcome, requiring hospitalization, had an impact on the anthropometric measurements of newborns.

What is already known on this subject?The SARS-CoV-2 infection is not fully undestood, specially during pregnancy and puerperae. There are conflicted information about this in the literature so far. However, it is known that respiratory infections such as influenza and SARS can develop unfavorably in pregnant women, since pregnancy changes the women's physiological condition, including altered immunity to tolerate placenta and fetus proper development.What this study adds?COVID-19 did not affect the prognosis of pregnancy and newborns in this study, but, the worst clinical outcome (hospitalization), impacted the anthropometric measurements of newborns.

Mpox in a Couple Living with HIV: Relapse or Reinfection?

Mpox is caused by a zoonotic orthopoxvirus capable of infecting several animal species, including humans. The analysis of cases in the current outbreak showed that, differently from what happens in the classical disease, mpox has mostly affected men who have sex with men (MSM) and bisexuals, including a high proportion of people living with HIV/AIDS. The role of the immune system in fighting mpox has been discussed in literature and experts believe that immunity conferred by natural infection may be lifelong, advocating against the possibility of reinfection by monkeypox virus. This report presents a MSM couple living with HIV with cycles of mpox lesions after two different risk exposures. The clinical course of both cases, as well as the temporal and anatomical relationship between the second cycle of monkeypox virus lesions and the second exposure, suggests the occurrence of reinfection. The genomic surveillance of monkeypox virus, a better understanding of its interaction with the human host, and knowledge of the postinfection and postvaccine protection correlation are more relevant at this moment, when we observe an intersection of the mpox multicountry outbreak with the HIV/AIDS epidemic, considering the immunosenescence and other immune system issues caused by HIV.

L-lysine: Its antagonism with L-arginine in controlling viral infection. Narrative literature review.

Knowledge about viral characteristics, mechanisms of entry into the host cell and multiplication/dissemination can help in the control and treatment of viral pathologies. Several nutritional factors linked to the host may favour viral multiplication and their control, may lead to new prophylactic alternatives and/or antiviral therapies. The objective of this review is to discuss the relationship between the amino acid L-lysine and the control of viral infections, aiming at a possible therapeutic property. This research used databases such as PubMed, Web of Science, Scielo, Medline and Google Scholar, as well as searching for references cited by journals. The time frame covered the period between 1964 and January 2022. The observed studies have shown that the usual antiviral therapies are not able to interfere with the viruses in their latent state; however, they can interfere with the adhesion and fusion of viral particles or the production of proteins, which play an important role in viral epidemiology and control, particularly in the initial moment and in reactivation. Lysine is an amino acid that can interfere mainly in the formation of capsid proteins and DNA by a competitive antagonism with amino acid arginine, which is an essential amino acid for some viruses, and also by promoting the increase of arginase, increasing the catabolism of arginine. Although there is evidence of the importance of L-lysine in viral control, more studies are needed, with a view to new antiviral therapies.

Pityriasis rosea-like cutaneous eruption as a possible dermatological manifestation after Oxford-AstraZeneca vaccine: Case report and brief literature review.

Pityriasis rosea (PR) has been manifested in patients suffering from COVID-19 as well as after vaccine protocols against SARS-CoV-2. It has a possible association with the HHV-6B virus (roseola infantum) and can be controlled by antivirals such as acyclovir as well as by the amino acid l-Lysine that showed a positive result in reducing the number of lesions and healing time. The aim of this study was to report a case of PR after a second dose of Oxford-AstraZeneca, the adopted therapy and a brief literature review. A 53-year-old woman, phototype II, presented an erythematous lesion in the posterior right thigh 15 days after the second dose of Oxford-AstraZeneca vaccine. Eight days after the initial injury, new injuries appeared in the calf, buttocks and thighs. The diagnosis was PR with a 5-week eruption cycle. The treatment consisted of the use of l-Lysine, 3 grams loading dose and 500 mg for 30 days and moisturizing/healing lotion, starting 14 days after the herald patch. After the 5th week of the disease cycle, there were no new eruptions and the repair cycle continued for up to 8 weeks leaving some residual skin spots. It is concluded that the patient may be a carrier a latent virus, HHV-6, and the vaccine administration with immune system stimulation, would have activated the possible virus causing PR. l-Lysine helped to control the manifestation by limiting the number of lesions and their location, which were restricted to the legs, thighs and buttocks.

Costs and benefits of secrecy: the dilemma experienced by adolescents seropositive for HIV.

This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13-20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other's love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice.

The International development of PROQOL-HCV: An instrument to assess the health-related quality of life of patients treated for Hepatitis C virus.

BACKGROUND: Hepatitis C virus (HCV) compromises Health-related Quality of Life (HRQL) with detriments to Physical, Mental and Social health domains. Treatment with interferon and ribavirin is associated with side effects which further impair HRQL. New treatments appear potent, effective and tolerable. However, Patient Reported Outcomes instruments that capture the impact on HRQL for people with hepatitis C are largely non-specific and will be needed in the new treatment era. Therefore, we developed a conceptually valid multidimensional model of HCV-specific quality of life and pilot survey instrument, the Patient Reported Outcome Quality of Life survey for HCV (PROQOL-HCV). METHODS: HCV patients from France (n = 30), Brazil (n = 20) and Australia (n = 20) were interviewed to investigate HCV-HRQL issues raised in the scientific literature and by treatment specialists. Interviews were recorded, transcribed and translated into English and French. RESULTS: Fifteen content dimensions were derived from the qualitative analysis, refined and fitted to four domains: (1) Physical Health included: fatigue, pain, sleep, sexual impairment and physical activity; (2) Mental Health: psychological distress, psychosocial impact, and cognition; (3) Social Health: support, stigma, social activity, substance use; (4) TREATMENT: management, side effects, and fear of treatment failure. The impact of some dimensions extended beyond their primary domain including: physical activity, cognition, sleep, sexual impairment, and the three treatment dimensions. A bank of 300 items was constructed to reflect patient reports and, following expert review, reduced to a 72-item pilot questionnaire. CONCLUSION: We present a conceptually valid multidimensional model of HCV-specific quality of life and the pilot survey instrument, PROQOL-HCV. The model is widely inclusive of the experience of hepatitis C and the first to include the treatment dimension.

Response predictors and clinical benefits of hepatitis C retreatment with pegylated interferon and ribavirin in HIV/HCV coinfection.

BACKGROUND: Hepatitis C is a leading cause of mortality among HIV-infected individuals. Therefore, eradication of HCV in this population is a priority. There are scarce data regarding retreatment efficacy of HIV/ HCV coinfected patients. The aim of our study was to evaluate efficacy, predictors of response, and long term clinical benefits of sustained virological response (SVR) after hepatitis C retreatment in a population of HIV/HCV coinfected patients. MATERIAL AND METHODS: We evaluated efficacy, safety, and clinical benefits of peginterferon(alfa-2a or alfa-2b) and ribavirin in a restrospective, observational, multicentric study, including 47 HIV/HCV coinfected patients, non-responders to previous treatment with conventional interferon alfa-2a and ribavirin. The primary endpoint of efficacy was SVR, defined as undetectable viral load 24 weeks after end of treatment. Death, liver disease progression, CD4 counts, and AIDS defining illness were the endpoints to access clinical benefits of treatment response. RESULTS: In our analysis, 31.9% patients reached SVR. Genotypes 2/3 had a significant better SVR (66.7%) compared to genotypes 1/4 (33.3%) (p = 0.022). During follow-up, deaths (6.89%) and hepatic decompensation (28.6%) occurred only in the nonresponder group, while there were no cases of death or hepatic decompensation among the responder group(p = 0.037). CONCLUSION: Nearly one third of patients (mainly those with genotypes 2/3) reached SVR after hepatitis C retreatment in this group of HIV/HCV coinfected patients. SVR was protective against hepatic decompensation and death in a two-year follow-up period. Retreatment may be an effective and safe way to eradicate HCV until new anti-HCV drugs become available to this group of patients.

Eliminating vertical transmission of HIV in São Paulo, Brazil: progress and challenges.

BACKGROUND: HIV infection in children is an important public health problem in the world, mainly in poorer countries. If all recommendations are followed, the elimination of HIV vertical transmission is a concrete possibility. This study aims to estimate vertical transmission rates of HIV in São Paulo State, Brazil, based on pregnant women diagnosed and reported in 2006, identifying potentially associated factors. METHODS: This study involves a retrospective cross-sectional analysis of information systems and records of infected pregnant women and children exposed to HIV. The rate of vertical transmission was estimated and variables associated with the antenatal, delivery, and postnatal periods were analyzed by the chi-square test, and Fisher exact test was used for variables with an expected frequency <5. The relative risks were calculated with 95% confidence intervals. RESULTS: The rate of vertical transmission in São Paulo state was 2.7% (95% confidence interval: 1.86 to 3.94) in 2006, decreasing 83.1% in comparison with 1988-1993. The main associated variables were lack of prenatal visits or <6 visits, no antiretroviral prophylaxis during labor or neonatal use for <6 weeks, and maternal breastfeeding. CONCLUSIONS: There is a decreasing trend of HIV vertical transmission in São Paulo with levels approaching elimination, which seems to be associated with antiretroviral policy and interruption of breastfeeding. Although there are serious operational issues, conditions exist to respond effectively. São Paulo state demonstrates that it is possible to achieve advanced levels of control for this mode of HIV transmission.

Prevention of mother-to-child transmission of HIV in São Paulo State, Brazil: an update.

BACKGROUND: São Paulo State has had the largest number of paediatric AIDS cases in Brazil. Since 1996, São Paulo (and Brazil nationally) has implemented an aggressive programme to reduce perinatal transmission. We have gathered available indicators to examine the programme's impact. METHODS: We obtained data on reported AIDS cases from the AIDS surveillance system; data on the number of mother/infant pairs treated with zidovudine from the state logistics office responsible for distributing HIV medication; and the rates of perinatal transmission from a multicity study of the Brazilian Pediatric Society that includes a number of São Paulo facilities, which were compared with an independent study in 1995. The years for which data were available varied according to the source of the indicator. RESULTS: Annual reported cases of AIDS as a result of perinatal transmission fell 58.9% from 1997 to 2002. The number of cases treated with zidovudine increased 73.7% from 1997 to 2004. The rate of perinatal transmission among babies born to HIV-positive mothers fell from 16% in 1995 to 2.4% in 2002 in the reference clinics that participated in the Brazilian Pediatric Society study. CONCLUSION: Both process and outcome indicators point to the effectiveness of efforts to reduce perinatal transmission in São Paulo State.