Search

Background: Knowledge about COVID-19 in pregnancy is limited, and evidence on the impact of the infection during pregnancy and postpartum is still emerging., Aim: To analyze maternal morbidity and mortality due to severe acute respiratory infections (SARI), including COVID-19, in Brazil., Methods: National surveillance data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) was used to describe currently and recently pregnant women aged 10-49 years hospitalized for SARI from January through November, 2020. SARI cases were grouped into: COVID-19; influenza or other detected agent SARI; and SARI of unknown etiology. Characteristics, symptoms and outcomes were presented by SARI type and region. Binomial proportion and 95% confidence intervals (95% CI) for outcomes were obtained using the Clopper-Pearson method., Results: Of 945,460 SARI cases in the SIVEP-Gripe, we selected 11,074 women aged 10-49 who were pregnant (7964) or recently pregnant (3110). COVID-19 was confirmed in 49.4% cases; 1.7% had influenza or another etiological agent; and 48.9% had SARI of unknown etiology. The pardo race/ethnic group accounted for 50% of SARI cases. Hypertension/Other cardiovascular diseases, chronic respiratory diseases, diabetes, and obesity were the most common comorbidities. A total of 362 women with COVID-19 (6.6%; 95%CI 6.0-7.3) died. Mortality was 4.7% (2.2-8.8) among influenza patients, and 3.3% (2.9-3.8) among those with SARI of unknown etiology. The South-East, Northeast and North regions recorded the highest frequencies of mortality among COVID-19 patients., Conclusion: Mortality among pregnant and recently pregnant women with SARIs was elevated among those with COVID-19, particularly in regions where maternal mortality is already high., Competing Interests: Conflicts of interest JM is an employee of bioMérieux. The other authors have no competing interests to declare., (Copyright © 2021 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. All rights reserved.)

The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction ( p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01-1.03, I 2 = 61%) for total fish, 1.04 (1.01-1.07, I 2 = 46%) for fatty fish, and 1.02 (1.00-1.04, I 2 = 33%) for lean fish. In men, all associations were null. In women, we observed variation by geographical location: IRRs for total fish were 1.03 (1.02-1.04, I 2 = 0%) in the Americas and null in other regions. In conclusion, we found evidence of a neutral association between total fish intake and type 2 diabetes in men, but there was a modest positive association among women with heterogeneity across studies, which was partly explained by geographical location and types of fish intake. Future research should investigate the role of cooking methods, accompanying foods and environmental pollutants, but meanwhile, existing dietary regional, national, or international guidelines should continue to guide fish consumption within overall healthy dietary patterns.

Objective: To estimate the association of binge eating behavior (BE) with common mental disorders (CMD)., Method: Cross sectional investigation of 14,088 adults, aged 35-74years (ELSA-Brasil study). BE was assessed with Structured Clinical Interview for DSM Disorders (SCID - DSM IV) questions, and psychiatric morbidity with CIS-R (CIS R - Clinical Interview Schedule Revised). Poisson regression was used to estimate the association of BE and psychiatric morbidity., Results: Adjusted prevalence ratios (PR) for CMD and BE were: PR=1.60 (1.34-1.91) for a CIS R score 12-18 (presence of CMD with lower clinical severity); PR=2.40 (2.06-2.80) for a CIS R score≥18 (severe symptom profile likely to require treatment); for psychiatric diagnoses: PR=2.24 (1.84-2.73) for depressive episodes; PR=1.77 (1.53-2.04) for anxiety disorders, and PR=1.42 (1.20-1.67) for mixed depressive-anxiety disorder., Conclusion: BE was associated with higher prevalence of common mental disorders. Our findings highlight the need to investigate mechanisms involved in the relationship of BE, obesity and psychopathology in low/middle income countries., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To explore the issue of gender development and its applications and implications with respect to dynamic psychiatry., Method: Gender study is approached in this paper as a continually evolving process of thinking about male and female attributes, similarities, and differences. The paper reviews a specific thematic area of the extensive literature on the subject., Results: Gendered psychosexual development and identity construction are intertwined and determined by multibiopsychosocial factors. Freud's theory on femininity is briefly reviewed from the perspective of new theoretical developments., Conclusions: The paper highlights the fact that gender is becoming a useful conceptual tool in clinical practice, teaching, and neurosciences.

Objective: Pregnancy involves dynamic changes in the maternal immune system, thus potentially affecting women's response to infection. The aim of this study was to investigate whether gestational age at the time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with mortality and morbidity related to coronavirus disease 2019 (COVID-19) in hospitalized pregnant women.Methods: This was a cohort study of pregnant women with confirmed SARS-CoV-2 infection at any gestational age (categorized into trimesters) who were hospitalized in Brazil from February 2020 to November 2021. Sociodemographic and epidemiological characteristics, signs and symptoms, comorbidities, interventions, vaccination status and type of healthcare establishment were obtained from a nationwide database. Multivariate logistic and Cox regression analyses were used to identify independent risk factors for in-hospital COVID-19-related mortality and morbidity (defined as time from hospital admission to recovery).Results: A total of 7461 SARS-CoV-2-infected pregnant women were included in the study (9.3%, 28.4% and 62.3% in the first, second and third trimesters, respectively). After adjustment for sociodemographic, epidemiological and clinical characteristics, and intervention-related variables, gestational age at infection was found not to be associated with COVID-19-related mortality and morbidity. Women admitted to establishments with an obstetric center, compared to hospitals without, were 38% less likely to die from SARS-CoV-2 infection (adjusted odds ratio, 0.62; 95% CI, 0.48-0.80), while patients who received private not-for-profit healthcare had a 13% shorter time to recovery (adjusted hazard ratio, 1.13; 95% CI, 1.07-1.20) compared to those who received public healthcare.Conclusions: Despite a higher percentage of women being admitted in the third trimester, we found no association between gestational age and COVID-19 mortality and morbidity. The previously reported increase in morbidity and mortality in the third trimester in pregnant women with COVID-19 may be attributable to other gestational-age-affected variables for which adjustment was made in our study. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Individuals with bulimia nervosa and binge eating disorder have greater cardiovascular morbidity than the general population. Longitudinal research on the association between binge eating and metabolic syndrome is limited. We tested the longitudinal association between binge eating and metabolic syndrome and its components in a large population sample of Brazilian adults. Methods: We used data from Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil, N = 15,105). To test for the association between binge eating at baseline (2008–2010) and metabolic syndrome at follow‐up (2012–2014), we used univariable and multivariable logistic regression models progressively adjusting for potential socio‐demographic confounders, number of metabolic syndrome components, and body mass index (BMI) at baseline. Results: In total, 13,388 participants (54.8% female; 52.2% white) had complete data on all variables of interest. Binge eating was associated with increased odds of metabolic syndrome at follow‐up (odds ratio (OR):1.66, 95% confidence intervals (CI): 1.44, 1.75). However, the size of this association was attenuated after including number of metabolic syndrome components at baseline (OR:1.19, 95% CI: 1.05, 1.35) and was no longer present after adjusting for baseline BMI (OR:1.09, 95% CI: 0.96, 1.25). Binge eating was also associated with higher odds of hypertension (OR:1.14, 95% CI: 0.99, 1.37) and hypertriglyceridemia (OR:1.21, 95% CI: 1.06, 1.37) at the follow‐up assessment after adjustment for all confounders. Conclusions: Individuals who binge eat are at increased risk of metabolic syndrome via increased BMI, and of hypertriglyceridemia and hypertension independently of BMI. If these are causal associations, effective interventions for binge eating could also have beneficial effects on metabolic health outcomes. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is characterized by major changes in the coagulation and fibrinolytic system. The study was aimed at assessing the degree of changes in the coagulation and fibrinolytic system in patients with type 2 diabetes mellitus in North-central Nigeria. This was a hospital based comparative Cross-sectional study involving 78 type 2 diabetics and 78 healthy controls. Full blood count was performed using Sysmex XP 300 according to manufacturer's instructions. Prothrombin time was determined using one stage test of Owren. Activated partial thromboplastin time was determined by method of Proctor and Rapaport. Fibrinogen assay was determined using AssayMax Human Fibrinogen ELISA. Plasminogen Activator Inhibitor type-1 was determined using the AssayMax Human PAI-1 ELISA kit. The mean age of the subjects and controls were 60.73 ± 10.8 and 59.65 ± 12.7 years respectively. The mean diastolic blood pressure of subjects with Diabetes was significantly higher than that of the controls (91.84 ± 11.02 vs 87.58 ± 11.3: p-value =0.002). The mean Prothrombin time, Fibrinogen concentration and PAI- 1 level were significantly higher in the subjects than the controls (p = 0.047, 0.031 & 0.020). No significant differences were observed in Platelet count, APTT and INR (P=0.938, 0.664 & 0.059 respectively). This study confirms that diabetes mellitus is a cause of hypercoagulable state as evidenced by the significant alteration in the coagulation and fibrinolytic system. There is need for proper glycaemic control in patients with diabetes. [ABSTRACT FROM AUTHOR]

Metabolic failure is associated with dyslipidemia and coagulation which can result in a higher risk of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). The aim of this study was to assess the effects of choline and magnesium co-supplementation on lipid profile and coagulation parameters in patients with T2DM. In a randomized, double-blind, placebo-controlled trial, supplements of choline bitartrate (1000 mg), magnesium oxide (500 mg), choline plus magnesium, or placebo were administered for 2 months to 96 diabetic participants of both sexes aged 30–60 years. Anthropometric characteristics, dietary intake, physical activity, serum lipids, and coagulation markers were measured in all subjects. Significant differences were observed in plasminogen activator inhibitor-1 (PAI-1) levels in the magnesium and choline-magnesium groups (p < 0.05). Moreover, tissue plasminogen activator (tPA) levels increased in choline-magnesium groups (p < 0.001). When adjusted for potential confounders, a significant decrease in PAI-1 (p = 0.03) and a marginally significant increase in tPA (p = 0.054) were found in the choline-magnesium group compared with the other groups. Compared with baseline values, there were significant differences in serum magnesium, HDL, and triglycerides (TG) following choline-magnesium co-supplementation (p < 0.05); however, there were no significant differences in serum magnesium, HDL, and TG among the groups (p > 0.05). Overall, concurrent supplementation of magnesium and choline is more effective than either magnesium or choline alone to improve coagulation in subjects with T2DM. [ABSTRACT FROM AUTHOR]