Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil.

BACKGROUND: The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil. OBJECTIVE: This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria. STUDY DESIGN: This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation-estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated. RESULTS: Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773-0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis. CONCLUSION: In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.

Application of 4 birthweight curves and local reference range at a University Hospital of Rio de Janeiro, Brazil.

BACKGROUND: Numerous fetal growth curves have been developed from various subpopulations and geographic locations worldwide. OBJECTIVE: To determine the birthweight standard at the Maternity School and compare it to currently used standards in the clinical practice services. STUDY DESIGN: Cross-sectional, observational, and descriptive study. Data from infants born between 2011 and 2016 were collected from the Maternity School Hospital of the Federal University of Rio de Janeiro to define the 10th, 25th, 50th, 75th, and 90th percentiles of the birthweight by gestational age. It was determined the performance of the INTERGROWTH-21st, Fenton, Alexander, and Lubchenco for the Maternity School standards. RESULTS: After the 33rd week of pregnancy, the INTERGROWTH standard was similar to the local standard for small-for-gestational-age infants and Fenton for large-for-gestational-age infants at Maternity School Hospital. The INTERGROWTH standard was found to be inadequate to classify small-for-gestational-age infants, which are babies at major risk for morbidity and mortality at the onset of the 33rd week of pregnancy. CONCLUSION: It was possible to define reference values for birthweight for the maternal school hospital considering at least 33 weeks of pregnancy with a 95% confidence interval. The comparison of the INTERGROWTH, Fenton, Alexander, and Lubchenko standards to the maternal school hospital curve showed that the Fenton curve was the most suitable for the diagnosis of small for gestational age.

Erratum: Effect of the Dietary Approaches to Stop Hypertension (DASH) diet on the development of preeclampsia and metabolic outcomes in pregnant women with pre-existing diabetes mellitus: a randomized, controlled, single-blind trial - CORRIGENDUM.

[This corrects the article DOI: 10.1017/jns.2023.54.].

Effect of the Dietary Approaches to Stop Hypertension (DASH) diet on the development of preeclampsia and metabolic outcomes in pregnant women with pre-existing diabetes mellitus: a randomised, controlled, single-blind trial.

Preeclampsia (PE) affects up to five times more women with pre-existing diabetes mellitus (PDM) than women without it. The present study aimed to identify the effect of the DASH diet on PE incidence (primary outcome) and blood pressure, glycated haemoglobin (GH), serum lipids, glutathione peroxidase (GP), C-reactive protein (CRP - secondary outcomes) in pregnant with PDM. This randomised, controlled, single-blind trial studied sixty-eight pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital, Brazil. The standard diet group (SDG) received a diet containing 45-65 % carbohydrates, 15-20 % protein and 25-30 % lipids. The DASH diet group (DDG) received the adapted DASH diet with a similar macronutrient distribution, but with a higher concentration of fibres, unsaturated fats, calcium, magnesium and potassium as well as lower saturated fat. Student's t, Mann-Whitney U and the Chi-square tests were used to compare outcomes. PE incidence was 22⋅9 % in the SDG and 12⋅1 % in the DDG (P = 0⋅25). GP levels significantly increased in the DDG (intra-group analysis; mean difference = 1588 [CI 181, 2994], P = 0⋅03) and tended to be different from the variation in the SDG (mean difference = -29⋅5 [CI -1305; 1⋅365]; v. DDG: 1588 [CI 181; 2994], P = 0⋅09). GH levels decreased significantly and similarly between groups (SDG: -0⋅61 [CI -0⋅26, -0⋅96], P = 0⋅00) v. DDG: -1⋅1 [CI -0⋅57, -1⋅62], P = 0⋅00). There was no evidence of a difference in PE incidence at the end of the intervention between the two diets. The DASH diet seems to favour PE-related biochemical markers.

The prevalence and perinatal repercussions of preeclampsia after the implementation of a prophylaxis protocol with aspirin.

OBJECTIVES: To evaluate the prevalence and perinatal repercussions of preeclampsia (PE) after the implementation of a prophylaxis protocol with aspirin in singleton pregnancy at Maternity School of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (2015-2106). METHODOLOGY: PE prevalence according to gestational age (GA) and the prevalence ratio (PR) between PE and prematurity, small for gestational age (SGA), and fetal death were calculated in patients assisted during 2015 and 2016. RESULTS: PE occurred in 373(10.75%) of 3468 investigated cases, where PE < 37 weeks was of 2.79% and PE greater than 37 weeks was of 7.95%. A total of 413 (11.9%) prematurity cases, 320 SGA (9.22%), and 50 fetal deaths (1.44%) occurred. In the PE group, 97 premature newborns (PR 0.90) and 51 SGA (PR 1.16) were born, and two fetal deaths occurred (PR 7.46). Concerning PE < 37 weeks, 27 SGA cases (PR 1.42) and two fetal deaths (PR 2.62) were observed. Regarding PE greater than 37 weeks, 24 SGA (PR 1.09) were born, and no fetal deaths were observed. Our findings were compared to previously published results. CONCLUSIONS: PE was significantly associated with SGA newborns, especially premature PE. Prescribing aspirin for PE prophylaxis based only on clinical risk factors in a real-life scenario does not appear to be effective but resulted in a PE screening and prophylaxis protocol review and update at ME/UFRJ.

Study of routine metabolism and acute toxicity of mycogenic silver nanoparticles on Palaemon pandaliformis (shrimp)

Palaemon pandaliformis is a shrimp species considered as an important indicator of environmental conditions. In this study, the toxicological effects of mycogenic silver nanoparticles obtained using the fungus Aspergillus tubingensis (AgNP-AT) were evaluated on P. pandaliformis. The AgNP-AT were spherical and homogeneous in size. Compared with the untreated group, at 10 μM AgNP-AT, there was a reduction of 60 and 87% for oxygen consumption and ammonia excretion, respectively. In addition to the untreated group, silver nitrate (AgNO3) was also used as a control, where concentrations at least 10 times lower than those of the AgNPs also reduced the oxygen consumption by 54% and increased the ammonia excretion by 33%, demonstrating its high toxicity. At 24, 48, 72 and 96 h, the AgNP-AT showed lethal concentrations (LC50) of 17.4, 14.4, 12.6 and 0.5 μM, while AgNO3 showed LC50 values of 2.5, 1.0, 0.02 and 0.01 μM, respectively. For all groups exposed to AgNPs, histological analysis showed that, in relation to the untreated group, there was a significant increase in the mean area of the shrimps' gills, indicating hypertrophy. All the changes observed in the hepatopancreatic and gill tissue, mainly for AgNPs at the highest concentration of 10 μM, are described as reversible. The results indicated that the AgNP-AT toxicity to the shrimps increased according to the time of exposure. However, it is important to highlight that the AgNP-AT were less toxic than AgNO3 to the shrimps, probably due to the presence of a protein coat in these AgNPs, which is able to control the release of Ag+ ions, avoiding high toxicity to the shrimps.

Microbiological quality of the water in collection areas and the tissue of Mytella falcata-Cananéia (SP, Brazil).

Changes in fauna and abiotic factors in estuaries are a consequence of their exploitation; thus, bivalve mollusks, as they filter, are widely used as environmental bioindicators. The aim of this study was to analyze the existence of seasonal variation in the concentration of total coliforms (TC) and thermotolerant coliforms (Ct), in addition to correlating the data obtained with the salinity and temperature in collection areas of Mytella falcata and the soft tissue cultivated in the Estuarine Complex of Cananéia. Two biweekly samples of water and tissue were taken, for 12 consecutive months, in nine cultivation areas of M. falcata. The analysis of the water samples showed that the Fisheries Institute, Mosquiteiro, and Itapitangui have high TC densities, with respective annual averages of 772.22, 592.67, and 563.75 most probable number (MPN).100 ml-1 . The highest concentrations of TC and Ct occurred in the summer, in most areas. There was a decrease in both TC and Ct with increasing salinity. However, there was an increase in Ct with increasing temperature. The soft tissue showed TC densities from 9 to 26 MPN.100 ml-1 and Ct densities from 6 to 14 MPN.100 ml-1 , displaying the highest counts in the summer. Places where coliforms were found in high concentrations could indicate contamination, because Ct do not support higher salinities for a long time. PRACTITIONER POINTS: The general mean was 77.64 (total coliforms) and 39.35 (thermotolerant) MPN.100 ml-1 . Annual average (thermotolerant) exceeded the permitted Brazilian limit in five points. Higher concentrations of total and thermotolerant coliforms occurred in the summer. In mollusk's tissue, concentrations of thermotolerant were 6.30 to 26.16 MPN.100 g-1 . Coliforms' MPN varied with increasing salinity and temperature.

External validation of first trimester combined screening for pre-eclampsia in Brazil: An observational study.

OBJECTIVE: To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population. STUDY DESIGN: This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing first-trimester screening for PE involving examination of maternal characteristics, medical history, and biophysical markers were considered eligible. Women were classified as low-or high-risk using a cutoff of 1/200, but the individual risk was not used to dictate management, as aspirin prophylaxis was given to women based solely on clinical risk factors. Receiver-operating characteristics (ROC) curves for PE, preterm PE(PE < 37) and early 34(PE < 34) were constructed and detection rates(DR) and false-positive rates(FPR) were calculated, adjusting for the effect of aspirin. Propensity score analysis was utilized to account for possible confounding by indication. MAIN OUTCOME MEASURES: Screening performance and PE rates. RESULTS: Among 1695 women, 323(19.1%) were classified as high-risk for PE and 1372(80.9%) were considered low-risk. Aspirin use was registered in 62(3.7%) in the high-risk group and 33(1.9%) in the low-risk group. There were 164(9.7%) women who developed PE, including 41(2.4%) with PE < 37 and 18(1.1%) PE < 34.Subgroups with aspirin had higher incidence of PE, suggest confounding by indication. The algorithm had an AUC of 0.87, DR of 72% for PE < 34; an AUC of 0.8, DR of 59% for PE < 37, both with FPR of 18%. Accounting for effect of aspirin, we observed an improvement in DR of PE < 37 to 67%. CONCLUSION: Using combined predictive algorithm for preterm PE prediction is feasible in clinical practice in low/middle-income countries. Aspirin use needs to be accounted for when evaluating the performance of screening.

Use of antenatal corticosteroids in Brazil: data analysis from the National Survey Nascer no Brasil.

OBJECTIVE: To estimate the rate of the use of antenatal corticosteroids (ANC) among pregnant women and to identify the conditions associated with their non-use in Brazil. METHODS: Secondary data analysis from "Birth in Brazil", a national hospital-based survey carried out in 2011-2012 on childbirth and birth. The sample was characterized regarding maternal age, marital status and maternal education, parity, mode of delivery and place of residence. The association of ANC use with gestational age and type of delivery was analyzed. The studied maternal complications were the presence of hypertension, pre-eclampsia/eclampsia, and pyelonephritis, infection by the HIV virus or acquired immune deficiency syndrome. RESULTS: 2,623 pregnant women with less than 37 weeks of gestational age were identified, and, of these, 835 (31.8%) received ANC. The frequency of ANC use was higher among women with gestational ages between 26-34 weeks (481 cases; 48.73%). In pregnancies with less than 37 weeks, the use of ANC was 23.9% in spontaneous deliveries, 20.6% in induced deliveries and 43.8% among those who did not go into labor. The variables vaginal delivery (OR 2.5; 95%CI 1.8-3.4) and living in the countryside were associated with not using ANC, and the occurrence of pre-eclampsia/eclampsia (OR 1.8; 95%CI 1.2-2.9) was associated with the use of ANC. CONCLUSIONS: The use of ANC among Brazilian pregnant women was low. Interventions to increase its use are necessary and can contribute to reduce neonatal mortality and morbidity. ANC should be promoted in pregnancies of less than 37 weeks, especially in cases of vaginal delivery and for those living in the countryside.

Biomonitoring Assessment of Toxic and Trace Elements in Sterechinus neumayeri Sea Urchins from the Comandante Ferraz Station in Antarctica.

In the present study, sea urchin Sterechinus neumayeri tissues were used for the passive biomonitoring of toxic and trace elements at the Comandante Ferraz Station, Antarctica and compared to a pristine region (Botany). As, Ba, Br, Ca, Co, Cr, Fe, K, Na, Rb, Sc, Se and Zn concentrations were determined by instrumental neutron activation analysis (INAA), while toxic metals (Cd, Hg, Ni and Pb), and Cu were determined by atomic absorption spectrometry (GF-AAS). The findings were compared to other organisms commonly applied for biomonitoring purposes and to the sediment concentrations of each sampling region. Urchins from the Ferraz Station area presented higher Br, Co, Cr, Cs, K, Se and Zn levels than the pristine location. The results obtained herein suggest S. neumayeri can be applied to the biomonitoring of Cr and Zn. The present study also contributes to knowledge of the mineral composition of the sea urchin S. neumayeri.

Sublethal effects of propiconazole on the metabolism of lambari Deuterodon iguape (Eigenmann 1907), a native species from Brazil.

The objective of this study was to analyze the sublethal effects of propiconazole on Deuterodon iguape, a native fish common in Brazil, which has potential for aquaculture and use as a bioindicator. The hypothesis was to test whether D. iguape has a metabolism similar to Danio rerio so that its use in bioassays may be validated. Lethal concentration (LC50) and metabolic rates were studied in fish exposed to propiconazole. Specific oxygen consumption and ammonia excretion for D. iguape and D. rerio increased by 0.01 µg L-1 and then decreased as the propiconazole concentration increased. The decrease in the averages of specific oxygen consumption at the concentration of 0.1 µg L-1 represented a reduction in the metabolic rate compared to the control of 71% for D. iguape and 40% D. rerio. For the ammonia excretion, at the same concentration, there was a reduction of 68.7% and 45.4% for D. iguape and D. rerio, respectively. When comparing ammonia excretion of the two species for each concentration of propiconazole, there was a significant difference (p < 0.05) in relation to the control and for the highest concentration (0.1 µg L-1). As for specific oxygen consumption, there was a statistically significant difference only for the concentration of 0.1 µg L-1. D. iguape proved to be a good and useful bioindicator for ichthyologists or ecologists in studies of moderate pesticide contamination in freshwater aquatic environments, as its metabolic response was similar to D. rerio.

Evaluation of fetal medicine foundation algorithm in predicting small-for-gestational-age neonates.

OBJECTIVES: To examine the performance of the Fetal Medicine Foundation (FMF) 2012 predictive model and of isolated biophysical markers (uterine artery pulsatility index and mean arterial pressure) for small-for-gestational-age (SGA), in patients from Rio de Janeiro, Brazil. METHODS: For this cross-sectional study, SGA was diagnosed when a newborn presented birth weight below the fifth percentile for gestational age. FMF2012 algorithm sensitivity and specificity, positive (PPV) and negative (NPV) predictive value, positive likelihood ratio (LR +) and area under the ROC curve (AUC) were calculated to predict total and preterm SGA (SGA < 37). The performance of isolated biophysical markers - mean arterial pressure (MAP) and mean uterine artery pulsatility index (UtAPI) were studied. RESULTS: The final sample consisted of 1480 cases: 69 (4.6%) developed SGA, including 12 patients (0.8%) who were SGA < 37. The AUC showed that the performances of the FMF2012 combined model for SGA prediction was 0.687 and for preterm SGA was 0.824. With risk cutoff of 1:150, SGA screening yielded the following: sensitivity, 47%; specificity, 75%; LR +, 1.88; PPV, 8.66%; NPV, 96.72%. When screening for preterm SGA, we found sensitivity 66.6%, specificity 74.59%, LR +: 2.58, PPV 2%, and NPV 99.63%. CONCLUSIONS: Performance of the FMF2012 algorithm in predicting SGA in our population was similar to that obtained in the reference population, according to sensitivity, but our false positive rate is significantly higher than the reference population.

Effect of Fluoxetine Hydrochloride on Routine Metabolism of Lambari (Deuterodon iguape, Eigenmann, 1907) and Phantom Shrimp (Palaemon pandaliformis, Stimpson, 1871)

HIGHLIGHTS Fluoxetine increases the metabolic rate and excretion of ammonia in both species. O:N ratio in fish showed higher values in the highest concentrations of fluoxetine. The LC50 - 96 hour values of Palaemon pandaliformis represented greater toxicity. Both species are a good biological model for fluoxetine exposure studies.

Abstract Fluoxetine is an emerging pollutant that acts as a selective serotonin reuptake inhibitor (SSRI) and being a hydrolytic molecule that is photolytically stable and accumulaties in biological tissues, its disposal in the aquatic environment can interfere with the physiology of fish and shrimp. Thus, the objective of this study was to analyze the effects of fluoxetine on routine metabolism (metabolic rate, specific ammonia excretion and O:N ratio) of Deuterodon iguape and Palaemon pandaliformis. For this, five groups of each species, were exposed to different concentrations of fluoxetine for 24 hours (D. iguape) and 2 hours (P. pandaliformis). The results demonstrated that in D. iguape exposure to fluoxetine significantly increased both the metabolic rate by 75%, 85%, 55% and 50% for concentrations of 0.05; 0.1; 0.5 and 1.0 mgL-1, respectively, and the specific ammonia excretion by 40%, 48% and 20% for concentrations of 0.05; 0.1 and 0.5 mgL-1, respectively, when compared with their control. The O:N ratio was statistically greater in concentrations of 0.5 and 1.0 mgL-1. Concerning P. pandaliformis, exposure to fluoxetine increased metabolic rate at concentrations 30.0 and 60.0 µgL-1, and also increased specific ammonia excretion at concentrations 10.0, 30.0 and 60.0 µgL-1, when compared with the control group. It was concluded that exposure to fluoxetine increases the routine metabolism of both species and that at the concentration 1.0 mgL-1, Deuterodon iguape required different energy substrates.

Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study.

BACKGROUND: FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. OBJECTIVE: This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. METHODS: This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. RESULTS: A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. CONCLUSIONS: We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

How do maternal factors impact preeclampsia prediction in Brazilian population?

Objective: To evaluate the impacts of maternal risk factors described by the Fetal Medicine Foundation's 2012 algorithm (FMF2012) in a Brazilian population. Methods: All singleton pregnancies submitted to first-trimester preeclampsia (PE) screening using the FMF2012 algorithm were considered for study inclusion. Maternal factors, recorded via a patient questionnaire, were described and compared between PE outcome groups. A Gaussian regression model was derived to measure the effects of maternal factors, and to identify factors that contributed significantly (p < .05) to the alteration of gestational age at delivery, in pregnancies with PE. Results: Of the 1934 cases considered for study inclusion, the final sample consisted of 1531 cases. The sample included 120 (7.8%) cases of PE, of which 26 (1.7%) were preterm PE (PE < 37 weeks) and 11 (0.72%) were early PE (PE < 34 weeks). The PE rate did not differ according to ethnicity, smoking, family history of PE, or use of assisted reproductive technology. Significant differences (p < .05) between the normal and PE groups in maternal age, maternal weight, previous history of PE, chronic hypertension, and types 1 and 2 diabetes were detected. Conclusions: The significance and magnitude of associations of maternal factors in our sample differed from those incorporated in the FMF2012 model, implying the need to derive a fitted model for our population.

Effects of multiwalled carbon nanotubes and carbofuran on metabolism in Astyanax ribeirae, a native species.

The study of the toxic effect of carbofuran and multiwalled carbon nanotubes (MWCNTs) on Astyanax ribeirae metabolism is of paramount importance due to the increasing use of this pesticide in agriculture and in the production of nanotubes within the material industry. This study aimed to evaluate the effects of carbofuran, MWCNT, and the combination of these compounds on specific oxygen consumption and excretion of ammonia in A. ribeirae. Therefore, 65 fish were divided into three groups of treatments at varying concentrations: carbofuran (0.01, 0.05, 0.1, and 0.5 mg/L), MWCNT (0.1, 0.25, 0.5, and 1.0 mg/L), and 0.5 mg/L of MWCNT added to carbofuran concentrations (0.01, 0.05, 0.1, and 0.5 mg/L). The average specific oxygen consumption in the groups exposed to carbofuran, compared to the control, increased 73.49% at the 0.01 mg/L concentration and decreased 63.86% and 91.57% with treatments of 0.1 and 0.5 mg/L, respectively. For groups exposed to the MWCNT, there was an 83.91% drop with the 1.0 mg/L treatment, and the carbofuran + MWCNT groups recorded a decrease of 71.09%, 92.77%, and 93.98% at concentrations of 0.05, 0.1, and 0.5 mg/L, respectively. In relation to specific ammonia excretion, in groups exposed to carbofuran compared to the control, there was an increase of 134.37% and 200% with the 0.1 and 0.5 mg/L treatments, respectively. The group exposed to carbofuran + MWCNT experienced a decrease of 60% and 80% with treatments of 0.1 mg/L carbofuran + 0.5 mg/L MWCNT and 0.5 mg/L carbofuran + 0.5 mg/L MWCNT, respectively. Therefore, it was concluded that carbofuran + MWCNT interact, increasing the effects in Astyanax sp.

Microbiology as an indicator of environmental health of Ilha Comprida lagoons- SP / Microbiologia como indicador da saúde ambiental das lagoas de Ilha Comprida - SP

With an area of 150 Km², the municipality of Ilha Comprida has limited sources of freshwater, sediments and nutrients. However, the sanitary aspects, aiming at Public Health, should be evaluated by determining the densities and the distribution of fecal pollution indicators, mainly bacteria from the group of thermotolerant coliforms. Thus, the objective of this work was to analyze the seasonal variations in the densities of thermotolerant coliforms in the lagoons of the municipality of Ilha Comprida (SP). For that, water samples were collected, in the period between 2014 and 2016, in lagoons of 13 localities (Juruvaúva, City Mar Sul, City Mar Norte, São Januário, Jardim Portugal, Atlântico, Icaraí, Adriana Sul, Adriana Norte, Porto Velho 2, Xandú, Jardim da Barra, Laguna Ponta da Praia) located in the municipality of Ilha Comprida (SP). The results showed that 21.90% of the samples were above the limit established by CONAMA. High densities of bacteria were found in the Icaraí lagoon. The highest averages of thermotolerant coliform densities were recorded in summer and spring. It is concluded that the seasonal variation interferes with the density of thermotolerant coliforms

Com uma área de 150 km², o município de Ilha Comprida tem fontes limitadas de água doce, sedimentos e nutrientes. No entanto, os aspectos sanitários, que visam a Saúde Pública, devem ser avaliados determinando as densidades e a distribuição de indicadores de poluição fecal, principalmente bactérias do grupo de coliformes termotolerantes. Assim, o objetivo deste trabalho foi analisar as variações sazonais nas densidades de coliformes termotolerantes nas lagoas do município de Ilha Comprida (SP). Para isso, foram coletadas amostras de água, no período entre 2014 e 2016, em lagoas de 13 localidades (Juruvaúva, Cidade do Mar do Sul, Cidade do Mar do Norte, São Januário, Jardim Portugal, Atlântico, Icaraí, Adriana Sul, Adriana Norte, Porto Velho 2, Xandú, Jardim da Barra, Laguna Ponta da Praia), localizada no município de Ilha Comprida (SP). Os resultados mostraram que 21,90% das amostras estavam acima do limite estabelecido pelo CONAMA. Foram encontradas altas densidades de bactérias na lagoa de Icaraí. As médias mais elevadas das densidades de coliformes termotolerantes foram registradas no verão e na primavera. Conclui-se que a variação sazonal interfere com a densidade de coliformes termotolerantes

Histopathological Effects on Gills of Nile Tilapia (Oreochromis niloticus, Linnaeus, 1758) Exposed to Pb and Carbon Nanotubes.

The effect of heavy metal in fish has been the focus of extensive research for many years. However, the combined effect of heavy metals and nanomaterials is still a new subject that needs to be studied. The aim of this study was to examine histopathologic alterations in the gills of Nile tilapia (Oreochromis niloticus) to determine possible effects of lead (Pb), carbon nanotubes, and Pb+carbon nanotubes on their histological integrity, and if this biological system can be used as a tool for evaluating water quality in monitoring programs. For this, tilapia were exposed to Pb, carbon nanotubes and Pb+carbon nanotubes for 4 days. The main alterations observed were epithelial structure, hyperplasia and displacement of epithelial cells, and alterations of the structure and occurrence of aneurysms in the secondary lamella. The most severe alterations were related to the Pb+carbon nanotubes. We conclude that the oxidized multi-walled carbon nanotubes enhanced the acute lead toxicity in Nile tilapias. This work draws attention to the implications of carbon nanomaterials released in the aquatic environment and their interaction with classical pollutants.

Preeclampsia: Prevalence and perinatal repercussions in a University Hospital in Rio de Janeiro, Brazil.

Preeclampsia (PE) prevalence studies in Brazil are both scarce and not divided in accordance with gestational age at delivery. We accessed PE prevalence according to delivery before 34, 37 and 42weeks in a cross-sectional study including 4464 single deliveries. PE was diagnosed in 301 cases (6.74%); Prevalence of PE was 0.78%; 1.92% and 6.74% according to deliveries before 34, 37 and 42weeks. PE was associated with fetal death, prematurity and small for gestational age newborns.