SUMMARY OBJECTIVES The outbreak of coronavirus disease (COVID-19) is a public health emergency of international concern. Inflammatory changes are part of COVID-19 pathophysiology and this might generate a higher thromboembolic risk in patients using combined hormonal contraception and menopausal hormone therapy. We aimed to discuss the main aspects related to this issue and propose management strategies for women affected by COVID-19. METHODS This narrative review collected information from several articles published since the beginning of the outbreak of the new coronavirus disease about the pathophysiology, stage of the disease, the occurrence of thrombotic events, and the risk of thromboembolism in users of contraception and hormonal therapy. RESULTS This article consolidates clinical parameters about the risk of venous thromboembolism in users of contraception and menopausal hormone therapy emphasizing the probable increase of that risk in women with suspected or confirmed COVID-19 and bringing safer recommendations. CONCLUSIONS In this scenario, apart from the fundamental orientations of preventive measures, like social isolation and hygiene, it is important that all female health professionals have knowledge of the new rules and adopt safety measures, especially on the prescription of hormonal therapy and contraception.
SUMMARYAlthough elderly populations are more exposed to the risk of getting dengue, the clinical peculiarities of this disease in this age range are not well known. This report is about an 80-year-old woman with dengue complications, self-medicated with salicylate. Literature indicates a more severe clinical condition, high hospitalization rate and significant mortality. This is caused by previous infections by other serotypes of this arbovirus, presence of chronic diseases, immunosenescence and high drug consumption, especially salicylates and the like. Analyses are required in a public health perspective in order to help health professionals that care for patients with dengue in this age range.
Since the development of ART, embryos have been cultured at 37 °C in an attempt to mimic the in vivo conditions and the average body temperature of an adult. However, a gradient of temperatures within the reproductive tract has been demonstrated in humans and several other mammalian species. Therefore, the aim of this study was to evaluate the effects of temperature variation treatments on mouse embryo quality through morphokinetic events, blastocyst morphology, the relative gene expression of Igf2, Bax, Bcl2 and Apaf1 and the metabolomics of individual culture media. Study groups consisted of 2 circadian treatments, T1 with embryos being cultured at 37 °C during the day and 35.5 °C during the night, T2 with 38.5 °C during the day and 37 °C during the night and a control group with constant 37 °C. Our main findings are that the lower-temperature group (T1) showed a consistent negative effect on mouse embryo development with “slow” cleaving embryos, poor-quality blastocysts, a higher expression of the apoptotic gene Apaf1, and a significantly different set of amino acids representing a more stressed metabolism. On the other hand, our higher-temperature group (T2) showed similar results to the control group, with no adverse effects on blastocyst viability.
gráficos Resumo Summary 1. INTRODUÇÃO 2. OBJETIVO 3. REVISÃO DA LITERATURA 3.1 Epidemiologia da infecção pneumocócica 3.2 Panorama da infecção por Streptococcus pneumoniae 3.3 O Streptococcus pneumoniae, agente infeccioso determinante da DPI 3.4 Mecanismos de resistência do Streptococcus pneumoniae à penicilina 3.5 Fatores de mortalidade pelo Streptococcus pneumoniae 3.6 Síndromes clínicas causadas pelo Streptococcus pneumoniae 3.7 Diagnóstico do Streptococcus pneumoniae 3.8 Prevenção ao Streptococcus pneumoniae 3.9 Imunopatogênese da infecção pelo Streptococcus pneumoniae 3.9.1 Complemento 3.9.2 Proteínas surfactantes 3.9.3 Receptores Toll 3.9.4 Células dendríticas 3.9.5 O papel das citocinas 4. MÉTODOS 4.1 Casuística 4.2 Critérios de inclusão e exclusão 4.3 Processamento das amostras 4.4 Métodos imuno-histoquímicos 4.5 Método imuno-histoquímico para citocinas 4.6 Técnica de imunomarcação para determinação de Caspase-3 4.7 Estudos semiquantitativo e quantitativo 4.8 Análise estatística 5. RESULTADOS 5.1 Aspectos clínicos e laboratoriais 5.2 Alterações histopatológicas do pulmão na DPI 5.2.1. Epitélio e luz alveolar 5.2.2 Septos alveolares 5.2.3 Alterações morfológicas brônquicas 5.3 Avaliação imune no pulmão na DPI 5.3.1. Avaliação de linfócitos TCD4, TCD8 e TCD20 na DPI e nos controles 5.3.2 Avaliação dos macrófagos 5.3.3 Avaliação de células Natural Killer (NK) 5.3.4 Avaliação das células dendríticas 5.3.5 Avaliação de complemento, ICAM-1, Toll-2 e SPA 5.3.6 Avaliação da Caspase-3 5.4 Avaliação de citocinas 6. DISCUSSÃO 6.1 Considerações clínico-laboratoriais 6.2 Achados histopatológicos na DPI em comparação com a literatura 6.3 Como se dá a progressão do pneumococo e a reação do tecido pulmonar na DPI? 6.4 Resposta imune 6.4.1 Macrófagos (CD68 e CD14) e pneumococo na DPI 6.4.2 Células Natural Killer (NK) na DPI 6.4.3 Células de Langerhans CD1a na DPI 6.4.4 Células dendríticas S-100 na DPI 6.4.5 Apoptose, citocinas pró-inflamatórias, Toll e SPA na DPI 7. CONCLUSÃO 8. ANEXOS 9. REFERÊNCIAS LISTA DE ABREVIATURAS Ag-Ac Antígeno-anticorpo ADE Antibody dependent enhacement, anticorpos facilitadores APC Antigen presenting cell, célula apresentadora de antígeno BALT Tecido linfoide associado à mucosa brônquica BSA Solução de albumina bovina CAM Cell Adhesion Molecule CD Cluster of differentiation, grupo de diferenciação C3 Fração 3 do complemento DAB Diamino-benzidina DC Dendritic cell, célula dendrítica DPI Doença Pneumocócica Invasiva ELISA Enzime-Linked Immunosorbent Assay et al. E outros gyrA Gene gyrA HE Hematoxilina-eosina HIV Human immunodeficiency vírus, vírus da imunodeficiência adquirida HLA Human leucocyte antigen, antígeno leucocitário humano ICAM Intracellular Cell Adhesion Molecule, molécula de adesão intracelular IFNα Interferon-alpha IFNγ Interferon-gamma Ig Imunoglobulina IL Interleucina IRAK-4 Interkeukin-1receptor-associated kinase 4, Interleucina-1 receptor quinase associada 4 LTA Ácido lipoteicoico LTCD4+ Linfócitos TCD4+ LTCD8+ Linfócitos TCD8+ mefA MIC Concentração inibitória mínima MHC Major h...
Study question Does the analysis of the metabolites of the embryonic culture medium can predict the sex of the embryo? Summary answer The presence and quantity of some metabolites in the culture medium can predict the sex of the human embryos. What is known already Advances in analytical techniques for metabolomics have brought the possibility of better tools for the characterization of molecules. Embryonic metabolism can be used as a good indicator of viability, regardless of the morphology of the blastocysts, since differences were observed in the metabolic activities between the days of embryo development and in the rates of live births. Study design, size, duration 16 patients had their embryos biopsied between the months of January to July 2019 in a human reproduction laboratory. All cases had PGT-A indication and after the biopsy, the embryos were frozen. The culture medium samples were individually prepared for metabolites extraction according to the Bligh and Dyer protocol. Controlled ovarian stimulation and dose adjustments according to the response of each patient. The metabolomics analysis was performed by mass spectrometry. Participants/materials, setting, methods Follicular puncture were performed 35 hours after r-hCG. The eggs were kept in individual culture until the blastocyst stage. The blastocysts biopsy was performed (20). After the culture medium was sent to the 337 metabolites analysis by mass spectrometry. 14 molecules with the highest score on the PLS-Da was submitted to the ROC curves showing the power of metabolic analysis to predict the sex of euploid embryos. Besides, we performed the functional enrichment analysis. Main results and the role of chance After the genetic analysis by PGT-a, we obtain 20 euploid embryos, being 12 female embryos and 08 male embryos. Comparing the quantitative target metabolomic analysis of the 337 metabolites in the embryo culture medium, we observed the Asymmetric dimethylarginine, FAD, Malic Acid, Serotonin, increased in female embryos and Adenosine monophosphate, L-Alanine, L-Arginine, Cysteamine, DL-Dopa, Flavin Mononucleotide, Methionine sulfone, Nicotinic acid, L-Tyrosine, Uracil in male embryos. Through the ROC curve, we can verify AUC = 0.937. This result suggests that the metabolomic analysis of the culture medium is valid to be used as a complement of PGT-A to know embryo sex diagnostic. The functional enrichment analysis shows the Asymmetric dimethylarginine and Malic Sulfone metabolism as the principal function alter by female embryos. Limitations, reasons for caution Small number of samples Wider implications of the findings: Further studies are needed to validate these findings for the diagnostic of sex embryos Trial registration number N/A
Study question Does the metabolomic analysis of the embryonic culture medium predict the embryo aneuploidy? Summary answer The presence and quantity of some metabolites in the culture medium can select euploid embryos for transfer. What is known already Advances in analytical techniques for metabolomics have brought the possibility of better tools for the characterization of molecules. Embryonic metabolism can be used as a good indicator of viability, regardless of the morphology of the blastocysts, since differences were observed in the metabolic activities between the days of embryo development and in the rates of live births. Study design, size, duration 17 patients had their embryos biopsied between January to July 2019 in a human reproduction laboratory. All cases had PGT-A indication and after the biopsy, the embryos were frozen. The culture medium samples were individually prepared for metabolites extraction according to the Bligh and Dyer protocol. Controlled ovarian stimulation and dose adjustments according to the response of each patient. The metabolomics analysis was performed by mass spectrometry. Participants/materials, setting, methods Ovum pick up will be performed 35 hours after r-hCG administration. The embryos were kept in individual 50ul drops until the blastocyst stage. The biopsy was performed in 26 blastocysts. The samples were sent to the 337 metabolites analysis by mass spectrometry. 15 molecules with the highest score on the PLS-Da was submitted the ROC curves to illustrate the power of the metabolic ploidy analysis. Besides, we performed the functional enrichment analysis for each group. Main results and the role of chance After the genetic analysis by PGT-a, 10 aneuploid embryos and 16 euploid embryos were found. Comparing the quantitative target metabolomic analysis of the 337 metabolites in the embryo culture medium, we observed the L-Alanine, Cytosine, Guanosine monophosphate, Homocysteine, Hypoxanthine, and Xanthine hiperrepresented in the aneuploid embryos, and the Citrulline, L-Glutamic acid, Kynurenine, L-Leucine, Methionine, Ornithine, L-Phenylalanine, L-Tyrosine, L-Valine were hiperrepresented in the euploid embryos. Through the ROC curve, we can verify AUC = 0.987. This result suggests that the analysis of euploid embryos through the metabolomic analysis of the culture medium is valid to be used as a noninvasive aneuploid diagnostic. The functional enrichment analysis shows the urea cycle and the glycine and serine metabolism as the principal function alter by aneuploid. Limitations, reasons for caution Small number of samples and not validate sample group. Wider implications of the findings: Further studies are needed to validate these findings for the diagnostic of embryo euploidy. Trial registration number N/A
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