Knowledge about COVID-19 in pregnancy is limited, and evidence on the impact of the infection during pregnancy and postpartum is still emerging.
To analyze maternal morbidity and mortality due to ...severe acute respiratory infections (SARI), including COVID-19, in Brazil.
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.
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.
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.
Small-for-gestational-age (SGA) and preterm births are associated with adverse health consequences, including neonatal and infant mortality, childhood undernutrition, and adulthood chronic disease.
...The specific aims of this study were to estimate the association between short maternal stature and outcomes of SGA alone, preterm birth alone, or both, and to calculate the population attributable fraction of SGA and preterm birth associated with short maternal stature.
We conducted an individual participant data meta-analysis with the use of data sets from 12 population-based cohort studies and the WHO Global Survey on Maternal and Perinatal Health (13 of 24 available data sets used) from low- and middle-income countries (LMIC). We included those with weight taken within 72 h of birth, gestational age, and maternal height data (n = 177,000). For each of these studies, we individually calculated RRs between height exposure categories of < 145 cm, 145 to < 150 cm, and 150 to < 155 cm (reference: ≥ 155 cm) and outcomes of SGA, preterm birth, and their combination categories. SGA was defined with the use of both the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) birth weight standard and the 1991 US birth weight reference. The associations were then meta-analyzed.
All short stature categories were statistically significantly associated with term SGA, preterm appropriate-for-gestational-age (AGA), and preterm SGA births (reference: term AGA). When using the INTERGROWTH-21st standard to define SGA, women < 145 cm had the highest adjusted risk ratios (aRRs) (term SGA-aRR: 2.03; 95% CI: 1.76, 2.35; preterm AGA-aRR: 1.45; 95% CI: 1.26, 1.66; preterm SGA-aRR: 2.13; 95% CI: 1.42, 3.21). Similar associations were seen for SGA defined by the US reference. Annually, 5.5 million term SGA (18.6% of the global total), 550,800 preterm AGA (5.0% of the global total), and 458,000 preterm SGA (16.5% of the global total) births may be associated with maternal short stature.
Approximately 6.5 million SGA and/or preterm births in LMIC may be associated with short maternal stature annually. A reduction in this burden requires primary prevention of SGA, improvement in postnatal growth through early childhood, and possibly further intervention in late childhood and adolescence. It is vital for researchers to broaden the evidence base for addressing chronic malnutrition through multiple life stages, and for program implementers to explore effective, sustainable ways of reaching the most vulnerable populations.
We explore new ways to interpret the role played by the deformation
q
-parameter in nonextensive statistics. A generalized polytropic
γ
-index is deduced with basis on the Tsallis distribution. In ...the limit
q
→
1
/
3
, it is shown that the
γ
-index decreases hyperbolically with the increase of the concentration
n
of charged particles in a nonextensive gas. An equation of state of a nonextensive system is derived following the generalized polytropic index. In the limit
q
→
1
/
3
, it is found that a constant and uniform isotropic pressure develops throughout a nonextensive gas of charged particles in the absence of electric and magnetic fields, and in a stationary state of equilibrium of the system. The usual reduction of the Tsallis to Kappa distributions is examined with basis on their corresponding equations of state. It is shown that such a procedure leads to a general proof of the relationship between the
q
-parameter and spectral
κ
-index, and between the
T
-Maxwellian and
Θ
-Kappa temperatures. A generalization of the number of degrees of freedom in a nonextensive gas is provided. It is suggested that a nonextensive polytropic process might characterize a system that shall be something between a monoatomic gas with more than three translational degrees of freedom, and a diatomic gas with less than three translational plus two rotational degrees of freedom. Moreover, it is proved that the restriction of the Tsallis to Kappa distributions requires that the bulk concentration
n
in a nonextensive gas does not exceed 50% of the concentration
n
0
on its boundary, thereby characterizing a low-density system. Possible applications of our theory to anisotropic structures are briefly addressed.
Candida in Solid Organ Transplant Recipients Pappas, P. G.; Silveira, F. P.
American journal of transplantation,
December 2009, 2009-Dec, 2009-12-00, 20091201, Letnik:
9
Journal Article
We aimed to assess the proportion of the population in 133 Brazilian municipalities who - from March to August 2020 - had a health problem but failed to seek care or failed to attend to a health ...service for routine appointment or examination. We conducted a household survey from August 24-27 in 133 Brazilian cities by asking the subjects if, since the beginning of the COVID-19 pandemic in March 2020, they had suffered from a health problem but did not seek care or failed to attend to a routine or screening examination. Poisson regression was used for the analyses. We interviewed 33,250 subjects and 11.8% (95%CI: 11.4-12.1) reported that, since March 2020, they failed to seek care despite being ill, 17.3% (95%CI: 16.9-17.7) failed to attend to a routine or screening examination and 23.9% (95%CI: 23.4-24.4) reported one or both outcomes. Health service closure and fear of the COVID-19 infection were the main reasons for not seeking care. Women and the poorest were more likely to not look for a health service, despite having a health problem or a scheduled routine appointment. On the other hand, those subjects who self-identified as white were less likely to not look for a health service. The COVID-19 pandemic is more critical for the indigenous people and the poorest, and these people are also more likely to not seek care for other health conditions during the pandemic.
Pathogens have evolved mechanisms to modulate host cell functions and avoid recognition and destruction by the host damage response. For many years, researchers have focused on proteins as the main ...effectors used by pathogens to hijack host cell pathways, but only recently with the development of deep RNA sequencing these molecules were brought to light as key players in infectious diseases. Protozoan parasites such as those from the genera
,
,
, and
cause life-threatening diseases and are responsible for 1000s of deaths worldwide every year. Some of these parasites replicate intracellularly when infecting mammalian hosts, whereas others can survive and replicate extracellularly in the bloodstream. Each of these parasites uses specific evasion mechanisms to avoid being killed by the host defense system. An increasing number of studies have shown that these pathogens can transfer non-coding RNA molecules to the host cells to modulate their functions. This transference usually happens via extracellular vesicles, which are small membrane vesicles secreted by the microorganism. In this mini-review we will combine published work regarding several protozoan parasites that were shown to use non-coding RNAs in inter-kingdom communication and briefly discuss future perspectives in the field.
We conducted a retrospective study of 17 transplant recipients with carbapenem‐resistant Klebsiella pneumoniae bacteremia, and described epidemiology, clinical characteristics and strain genotypes. ...Eighty‐eight percent (15/17) of patients were liver or intestinal transplant recipients. Outcomes were death due to septic shock (18%), cure (24%) and persistent (>7 days) or recurrent bacteremia (29% each). Thirty‐ and 90‐day mortality was 18% and 47%, respectively. Patients who were cured received at least one active antimicrobial agent and underwent source control interventions. Forty‐one percent (7/17) of patients had intra‐abdominal infections; all except one developed persistent/recurrent bacteremia despite drainage. Two patients tolerated persistent bacteremia for >300 days. All patients except one were infected with sequence type 258 (ST258), K. pneumoniae carbapenemase (KPC)‐2‐producing strains harboring a mutant ompK35 porin gene; the exception was infected with an ST37, KPC‐3‐producing strain. Seventy‐one percent (12/17) of patients were infected with ST258 ompK36 mutant strains. In two patients, persistent bacteremia was caused by two strains with different ompK36 genotypes. Three ompK36 mutations were associated with significantly higher carbapenem minimum inhibitory concentrations than wild‐type ompK36. Pulse‐field gel electrophoresis identified a single ST258 lineage; serial strains from individual patients were indistinguishable. In conclusion, KPC‐K. pneumoniae bacteremia exhibited highly diverse clinical courses following transplantation, and was caused by clonal ST258 strains with different ompK36 genotypes.
This study describes long‐term outcomes of organ transplant recipients with bacteremia due to carbapenem‐resistant Klebsiella pneumoniae and evaluates the genetic profiles of infecting strains.
Abstract
The temporal analysis of stellar activity evolution is usually dominated by a complex trade-off between model complexity and interpretability, often by neglecting the nonstationary nature of ...the process. Recent studies appear to indicate that the presence of multiple coexisting cycles in a single star is more common than previously thought. The correct identification of physically meaningful cyclic components in spectroscopic time series is therefore a crucial task, which cannot overlook local behaviors. Here we propose a decomposition technique that adaptively recovers amplitude- and frequency-varying components. We present our results for the solar activity as measured both by the sunspot number and the
K
-line emission index, and we consistently recover the Schwabe and Gleissberg cycles as well as the Gnevyshev–Ohl pattern probably related to the Hale cycle. We also recover the known 8 yr cycle for 61 Cygni A, in addition to evidence of a three-cycles-long pattern reminiscent of the Gnevyshev–Ohl rule. This is particularly interesting as we cannot discard the possibility of a relationship between the measured field polarity reversals and this Hale-like periodicity.
This work presents a novel spectral sensing method for the detection of signals presenting nonlinear phase variation over time. The introduced method is based on the angle-time cyclostationarity ...theory, which applies transformations to the signal to be sensed in order to mitigate the effects of nonlinear phase variation. The architecture is employed for sensing binary phase shift keying (BPSK) signals, being also compared with time cyclostationarity. The obtained simulation results clearly demonstrate the efficiency of the proposed approach, while presenting improved performance in terms of the detection rate of primary users increased by about 8 dB.
Common distributional patterns have provided the foundations of our knowledge of Neotropical biogeography. A distinctive pattern is the “circum‐Amazonian distribution”, which surrounds Amazonia ...across the forested lowlands south and east of the basin, the Andean foothills, the Venezuelan Coastal Range, and the Tepuis. The underlying evolutionary and biogeographical mechanisms responsible for this widespread pattern of avian distribution have yet to be elucidated. Here, we test the effects of biogeographical barriers in four species in the passerine family Thamnophilidae by performing comparative demographic analyses of genome‐scale data. Specifically, we used flanking regions of ultraconserved regions to estimate population historical parameters and genealogical trees and tested demographic models reflecting contrasting biogeographical scenarios explaining the circum‐Amazonian distribution. We found that taxa with circum‐Amazonian distribution have at least two main phylogeographical clusters: (1) Andes, often extending into Central America and the Tepuis; and (2) the remaining of their distribution. These clusters are connected through corridors along the Chaco–Cerrado and southeastern Amazonia, allowing gene flow between Andean and eastern South American populations. Demographic histories are consistent with Pleistocene climatic fluctuations having a strong influence on the diversification history of circum‐Amazonian taxa, Refugia played a crucial role, enabling both phenotypic and genetic differentiation, yet maintaining substantial interconnectedness to keep considerable levels of gene flow during different dry/cool and warm/humid periods. Additionally, steep environmental gradients appear to play a critical role in maintaining both genetic and phenotypic structure.
This study found similarities at populational, phylogenetic, and evolutionary levels among four taxonomic groups of passerine birds with a circum‐Amazonian distribution. The presence of Refugia result of climatic oscillations during the Pleistocene was the main drive in the diversification of these circum‐Amazonian taxa.
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