Orbital vascular impedance reduction with orbital hyperperfusion was present in severe pre-eclamptic women compared with mild pre-eclamptic and healthy pregnant women. Ophthalmic Doppler is a novel parameter that may be useful in the diagnosis of severe pre-eclampsia.

No abstract

Because macrophage migration inhibitory factor (MIF) is a key cytokine in pregnancy and has a role in inflammatory response and pathogen defense, the objective of the present study was to investigate the effects of MIF in first-and third-trimester human placental explants infected with Toxoplasma gondii. Explants were treated with recombinant MIF, IL-12, interferon-␥, transforming growth factor-␤1, or IL-10, followed by infection with T. gondii RH strain tachyzoites. Supernatants of cultured explants were assessed for MIF production. Explants were processed for morphologic analysis, immunohistochemistry, and real-time PCR analysis. Comparison of infected and stimulated explants versus noninfected control explants demonstrated a significant increase in MIF release in first-trimester but not third-trimester explants. Tissue parasitism was higher in third-than in first-trimester explants. Moreover, T. gondii DNA content was lower in first-trimester explants treated with MIF compared with untreated explants. However, in third-trimester explants, MIF stimulus decreased T. gondii DNA content only at the highest concentration of the cytokine. In addition, high expression of MIF receptor was observed in first-trimester placental explants, whereas MIF receptor expression was low in third-trimester explants. In conclusion, MIF was up-regulated and demonstrated to be important for control of T. gondii infection in first-trimester explants, whereas lack of MIF up-regulation in third-trimester placentas may be involved in higher susceptibility to infection at this gestational age.

Classical treatment for congenital toxoplasmosis is based on combination of sulfadiazine and pyrimethamine plus folinic acid. Due to teratogenic effects and bone marrow suppression caused by pyrimethamine, the establishment of new therapeutic strategies is indispensable to minimize the side effects and improve the control of infection. Previous studies demonstrated that enrofloxacin and toltrazuril reduced the incidence of Neospora caninum and Toxoplasma gondii infection. The aim of the present study was to evaluate the efficacy of enrofloxacin and toltrazuril in the control of T. gondii infection in human trophoblast cells (BeWo line) and in human villous explants from the third trimester. BeWo cells and villous were treated with several concentrations of enrofloxacin, toltrazuril, sulfadiazine, pyrimethamine, or combination of sulfadiazine+pyrimethamine, and the cellular or tissue viability was verified. Next, BeWo cells were infected by T. gondii (2F1 clone or the ME49 strain), whereas villous samples were only infected by the 2F1 clone. Then, infected cells and villous were treated with all antibiotics and the T. gondii intracellular proliferation as well as the cytokine production were analyzed. Finally, we evaluated the direct effect of enrofloxacin and toltrazuril in tachyzoites to verify possible changes in parasite structure. Enrofloxacin and toltrazuril did not decrease the viability of cells and villous in lower concentrations. Both drugs were able to significantly reduce the parasite intracellular proliferation in BeWo cells and villous explants when compared to untreated conditions. Regardless of the T. gondii strain, BeWo cells infected and treated with enrofloxacin or toltrazuril induced high levels of IL-6 and MIF. In villous explants, enrofloxacin induced high MIF production. Finally, the drugs increased the number of unviable parasites and triggered damage to tachyzoite structure. Taken together, it can be concluded that enrofloxacin and toltrazuril are able to control T. gondii infection in BeWo cells and villous explants, probably by a direct action on the host cells and parasites, which leads to modifications of cytokine release and tachyzoite structure.

BackgroundAlthough Toxoplasma gondii infection is normally asymptomatic, severe cases of toxoplasmosis may occur in immunosuppressed patients or congenitally infected newborns. When a fetal infection is established, the recommended treatment is a combination of pyrimethamine, sulfadiazine and folinic acid (PSA). The aim of the present study was to evaluate the efficacy of azithromycin to control T. gondii infection in human villous explants.MethodsCultures of third trimester human villous explants were infected with T. gondii and simultaneously treated with either PSA or azithromycin. Proliferation of T. gondii, as well as production of cytokines and hormones by chorionic villous explants, was analyzed.ResultsTreatment with either azithromycin or PSA was able to control T. gondii infection in villous explants. After azithromycin or PSA treatment, TNF-α, IL-17A or TGF-β1 levels secreted by infected villous explants did not present significant differences. However, PSA-treated villous explants had decreased levels of IL-10 and increased IL-12 levels, while treatment with azithromycin increased production of IL-6. Additionally, T. gondii-infected villous explants increased secretion of estradiol, progesterone and HCG + β, while treatments with azithromycin or PSA reduced secretion of these hormones concurrently with decrease of parasite load.ConclusionsIn conclusion, these results suggest that azithromycin may be defined as an effective alternative drug to control T. gondii infection at the fetal-maternal interface.

A dopplervelocimetria colorida é uma modalidade do exame ultra-sonográfico que se expandiu rapidamente em todas as áreas da medicina, em virtude da sua riqueza de informações. A dopplervelocimetria colorida das artérias orbitais tem sido empregada no auxílio diagnóstico de doenças oftalmológicas, bem como para o estudo de doenças específicas como a pré-eclâmpsia. O objetivo deste estudo é descrever a anatomia normal da região orbital e detalhar a técnica de exame dopplervelocimétrico colorido, tendo em vista ser este um exame acessível e reprodutível. Acreditamos que surgirão novas aplicações deste método, que deverá ser inserido na prática diária do radiologista, visando à melhoria da qualidade do diagnóstico e seguimento das doenças oculares e sistêmicas.

Objetivos: avaliar os padrões dos índices doplervelocimétricos das artérias oftálmica e central da retina durante o segundo e terceiro trimestres da gestação normal e comparar os valores obtidos do olho direito e esquerdo das gestantes. Métodos: estudo transversal no qual se avaliaram seis índices doplervelocimétricos das artérias central da retina e oftálmica em 51 gestantes normais, com idades gestacionais entre a 20ª e a 38ª semana. As variáveis analisadas foram os índices de resistência e pulsatilidade (IR, IP), os picos de velocidade sistólica e diastólica (PVS, PVD) e a razão entre picos de velocidade (RPV). A análise dos índices doplervelocimétricos dos olhos direito e esquerdo foi realizada utilizando-se a mediana dos valores. Para a comparação dos valores dos índices entre os dois olhos das gestantes, utilizou-se o teste t de Student para dados pareados. A associação entre a idade gestacional e os índices foi testada empregando-se o coeficiente de correlação linear de Pearson. Adotou-se o nível de significância de 5% para os testes estatísticos. Resultados: a mediana dos índices doplervelocimétricos das artérias oftálmica e central da retina foram,

PURPOSE: To determine the pattern of alcohol use before and during pregnancy and associated risk factors in puerperal women hospitalized in a public university hospital in Southeastern Brazil. METHODS: Between June and September 2009, 493 puerperae were consecutively evaluated. Those with cognitive impairment were excluded from the study. The AUDIT and CAGE questionnaires were used to diagnose alcohol use/abuse before pregnancy, in addition to the T-ACE during pregnancy. Another questionnaire was applied to collect sociodemographic data, such as age, educational level, marital status, and household income. The χ 2 test was used in the statistical analysis and the Odds Ratio (OR) and 95% confidence interval (95%CI) were calculated. A p-value <0.05 was considered to be significant. RESULTS: Before pregnancy, the CAGE was positive in 50/405 (12.3%) women and the AUDIT identified alcohol use in 331 (67.1%), which was of low risk in 233 (47.3%), risky in 73 (14.8%), and harmful or indicating possible alcohol dependence in 25 (5%). During pregnancy, the CAGE was positive in 53/405 (13.1%) women and the T-ACE in 84 (17%); the AUDIT identified alcohol use in 114 women, which was of low risk in 73 (14.8%), risky in 27 (5.5%), and harmful or indicating possible alcohol dependence in 14 (2.8%). During pregnancy, alcohol use was more frequent (OR=2.8; 95%CI 1.2-6.2) among women with a lower educational level (8.8 versus 3.3%) and more frequent (OR=3.8; 95%CI 1.3-11.1) among those who did not cohabit with a partner (6 versus 1.7%). Among pregnant women who drank alcohol, 49/114 (43%) were advised to stop drinking. CONCLUSIONS: Alarming alcohol use was observed during pregnancy, especially among pregnant women with a lower educational level and those who did not cohabit with a partner. There was a low frequency of counseling aimed at abstinence and the AUDIT was the instrument that most frequently diagnosed alcohol consumption.