It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19).OBJECTIVE To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization

Pre-eclampsia (PE), a syndrome of pregnancy-induced hypertension, continues to be a leading cause of maternal and fetal morbidity and mortality. The aim of this study was to investigate whether changes in oxidative status are correlated with alterations in the L-arginine-nitric oxide pathway and platelet aggregation in PE. Plasma and platelets from women with PE (n=24) or normotensive pregnancy (NP, n=27) recruited in the third trimester of gestation were used to measure oxidative damage assessed by protein carbonyl content, antioxidant activities of superoxide dismutase (SOD), catalase (CAT) and nitrite levels. Transport of L-[(3)H]-arginine, as well as the activities of the nitric oxide (NO) synthase (eNOS and inducible NO synthase (iNOS)) and platelet aggregation, were also evaluated. Plasma nitrite levels and the activities of SOD and CAT were reduced in PE (5.2±2.7, 3.4±0.8, 0.3±0.4, respectively, P<0.05) compared with NP (8.7±2.3, 6.7±3.1, 1.0±0.5, respectively), whereas protein carbonyl content and L-arginine levels were not significantly different between PE and NP groups. In platelets, L-arginine transport was reduced in PE (19.2±10.5, P<0.05) compared with NP (62.0±31.1), whereas the NOS activity, eNOS and iNOS expression, nitrite levels and platelet aggregation were unaffected. Protein carbonyl content was increased, and CAT activity was reduced in platelets from PE (0.03±0.02, 0.55±0.30, respectively, P<0.05), compared with NP (0.005±0.005, 1.01±0.36, respectively). The data suggest that a systemic impairment of antioxidant defense mechanisms is associated with decreased plasma nitrite levels, which may contribute to hypertension in PE. Oxidative stress may contribute to the reduced influx of L-arginine in platelets. Compensatory mechanisms may contribute to the maintenance of NO production and its modulatory role on platelet function.

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Na Paralisia Cerebral (PC), o ideal &eacute; associar o desempenho funcional com caracter&iacute;sticas topogr&aacute;ficas e altera&ccedil;&otilde;es de t&ocirc;nus. Entretanto, grande parte da bibliografia descreve apenas a doen&ccedil;a e suas conseq&uuml;&ecirc;ncias, e, quando se avalia o desempenho funcional, n&atilde;o se consideram as diferen&ccedil;as existentes nos tipos de PC ou se utiliza apenas um tipo. Na literatura, foi encontrada apenas uma refer&ecirc;ncia bibliogr&aacute;fica que diferencia dipar&eacute;ticos e hemipar&eacute;ticos quanto ao seu autocuidado, e nenhuma que compare a mobilidade entre eles. Este trabalho teve por objetivo avaliar a rela&ccedil;&atilde;o do desempenho funcional de crian&ccedil;as com PC dipar&eacute;ticas e hemipar&eacute;ticas. Para tanto, fez-se um estudo transversal com portadores de PC dipar&eacute;ticos e hemipar&eacute;ticos esp&aacute;sticos, de ambos os sexos, de tr&ecirc;s a sete anos, que estavam realizando fisioterapia. Exclu&iacute;ram-se crian&ccedil;as que n&atilde;o andavam e (ou) com d&eacute;ficit cognitivo. Foram realizadas entrevistas com cuidadores, utilizando-se a parte 1 (desempenho funcional nas &aacute;reas de autocuidado e mobilidade) do Invent&aacute;rio de Avalia&ccedil;&atilde;o Pedi&aacute;trica de Incapacidade (PEDI), assim como um question&aacute;rio com dados pessoais das crian&ccedil;as. Utilizou-se programa BioEstat 4.0, e o teste estat&iacute;stico Mann-Whitney, para verifica&ccedil;&atilde;o da associa&ccedil;&atilde;o proposta. Aceitou-se &alpha;  0,05 como infer&ecirc;ncia estat&iacute;stica. A amostra foi composta de 40 crian&ccedil;as, 22 dipar&eacute;ticas e 18 hemipar&eacute;ticas. A maioria era do sexo feminino (53%) e realizava tratamento associado &agrave; fisioterapia (88%). A &aacute;rea de autocuidado (p=0,16) n&atilde;o apresentou diferen&ccedil;a entre os grupos. Todavia mobilidade, (p=0,02) sugere que o grupo hemipar&eacute;tico possui melhor desempenho funcional. Concluiu-se que os hemipar&eacute;ticos possuem melhor mobilidade que os dipar&eacute;ticos, enquanto que, no autocuidado, n&atilde;o se observou diferen&ccedil;a estat&iacute;stica entre os grupos.

1. Pregnancy in rats is characterized by a reduction in arterial pressure that is associated with a decreased response to vasoconstrictors. However, the responses to vasodilators in isolated vessels remain controversial and are not well established in hypertensive pregnant rats. 2. In the present study, we investigated the effect of pregnancy on the bradykinin (BK)-induced vasodilator responses of the isolated mesenteric arterial bed (MAB) from Wistar normotensive and spontaneously hypertensive rats (SHR) and determined the role of nitric oxide (NO), endothelium-derived hyperpolarizing factor (EDHF) and angiotensin-converting enzyme (ACE) in these responses. 3. Mean arterial pressure (MAP) in pregnant normotensive and pregnant hypertensive rats (93 +/- 1 and 122 +/- 2 mmHg, respectively) was lower than in non-pregnant controls (128 +/- 1 and 163 +/- 2 mmHg, respectively; P < 0.05). In MAB isolated from normotensive rats and precontracted with phenylephrine, the effects of bradykinin, acetylcholine (ACh) and nitroglycerine (NG) were not influenced by pregnancy. In contrast, the vasodilator responses to BK were significantly reduced in pregnant compared with non-pregnant SHR and seemed to be specific to BK. 4. The ACE inhibitor captopril potentiated BK vasodilator responses and abolished the differences between pregnant and non-pregnant SHR. Inhibition of nitric oxide (NO) synthase by N(G)-nitro-L-arginine methyl ester (l-NAME) significantly reduced the vasodilator effect of BK in all groups. In the presence of l-NAME plus high K+ solution (47 mmol/L), BK-induced vasodilation was completely blocked. The NO-dependent component of the responses seems to be more important in hypertensive rats and pregnancy does not modify this profile. 5. Our results suggest that increased ACE activity may be involved in the pregnancy associated reduction in vasodilator responses to BK in the MAB of hypertensive rats. Pregnancy does not modify the relative contribution of the EDHF and NO to the vasodilator effect of BK.