RESUMO
In the emergency of the SARS-CoV-2 pandemic, great efforts were made to quickly provide serology testing to the medical community however, these methods have been introduced into clinical practice without the complete validation usually required by the regulatory organizations. SARS-CoV-2 patient samples (n = 43) were analyzed alongside pre-pandemic control specimen (n = 50), confirmed respiratory infections (n = 50), inflammatory polyarthritis (n = 22) and positive for thyroid stimulating immunoglobulin (n = 30). Imprecision, diagnostic sensitivity and specificity and concordance were evaluated on IgG serologic assays from EuroImmun, Epitope Diagnostics (EDI), Abbott Diagnostics and DiaSorin and a rapid IgG/IgM test from Healgen. EDI and EuroImmun imprecision was 0.02-14.0% CV. Abbott and DiaSorin imprecision (CV) ranged from 5.2%-8.1% and 8.2%-9.6% respectively. Diagnostic sensitivity of the assays was 100% (CI: 80-100%) for Abbott, EDI and EuroImmun and 95% (CI: 73-100%) for DiaSorin at ≥14 days post PCR. Only the Abbott assay had a diagnostic specificity of 100% (CI: 91-100%). EuroImmun cross-reacted in 3 non-SARS-CoV-2 respiratory infections and 2 controls. The DiaSorin displayed more false negative results and cross-reacted in six cases across all conditions tested. EDI had one cross-reactive sample. The Healgen rapid test showed excellent sensitivity and specificity. Overall, concordance of the assays ranged from 76.1% to 97.9%. Serological tests for SARS-CoV-2 showed good analytical performance. The head-to-head analysis of samples revealed differences in results that may be linked to the use of nucleocapsid or spike proteins. The point of care device tested demonstrated adequate performance for antibody detection.
Assuntos
Teste Sorológico para COVID-19/métodos , COVID-19/diagnóstico , SARS-CoV-2/imunologia , Anticorpos Antivirais/sangue , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/imunologia , COVID-19/virologia , Teste Sorológico para COVID-19/tendências , Técnicas de Laboratório Clínico/métodos , Reações Cruzadas , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Pandemias , Sistemas Automatizados de Assistência Junto ao Leito , SARS-CoV-2/isolamento & purificação , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-eclampsia in a previous pregnancy, or body mass index ≥35. DESIGN: Randomised, phase III, double blinded international, multicentre clinical trial. SETTING: 70 obstetrical centres in five countries (Argentina, Australia, Canada, Jamaica, and UK). PARTICIPANTS: 2464 pregnant women with at least one high risk factor for pre-eclampsia were randomised between 2011 and 2015 (1144 to the folic acid group and 1157 to the placebo group); 2301 were included in the intention to treat analyses. INTERVENTION: Eligible women were randomised to receive either daily high dose folic acid (four 1.0 mg oral tablets) or placebo from eight weeks of gestation to the end of week 16 of gestation until delivery. Clinicians, participants, adjudicators, and study staff were masked to study treatment allocation. MAIN OUTCOME MEASURE: The primary outcome was pre-eclampsia, defined as hypertension presenting after 20 weeks' gestation with major proteinuria or HELLP syndrome (haemolysis, elevated liver enzymes, low platelets). RESULTS: Pre-eclampsia occurred in 169/1144 (14.8%) women in the folic acid group and 156/1157 (13.5%) in the placebo group (relative risk 1.10, 95% confidence interval 0.90 to 1.34; P=0.37). There was no evidence of differences between the groups for any other adverse maternal or neonatal outcomes. CONCLUSION: Supplementation with 4.0 mg/day folic acid beyond the first trimester does not prevent pre-eclampsia in women at high risk for this condition. TRIAL REGISTRATION: Current Controlled Trials ISRCTN23781770 and ClinicalTrials.gov NCT01355159.
Assuntos
Suplementos Nutricionais/efeitos adversos , Ácido Fólico/administração & dosagem , Hipertensão/prevenção & controle , Pré-Eclâmpsia/prevenção & controle , Adulto , Argentina/epidemiologia , Austrália/epidemiologia , Canadá/epidemiologia , Diabetes Gestacional/prevenção & controle , Método Duplo-Cego , Feminino , Ácido Fólico/provisão & distribuição , Síndrome HELLP/etiologia , Humanos , Jamaica/epidemiologia , Gravidez , Proteinúria/etiologia , Fatores de Risco , Reino Unido/epidemiologia , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/provisão & distribuição , Adulto JovemRESUMO
BACKGROUND: Nutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic. METHODOLOGY/PRINCIPAL FINDINGS: From February to August 2014, 1010 mother-infant pairs were recruited into a trial aimed at assessing the effectiveness of maternal postpartum deworming on infant and maternal health outcomes. Following delivery, mothers were randomly assigned to receive either single-dose 400 mg albendazole or placebo. Participants were followed-up at 1 and 6 months postpartum. There was no statistically significant difference in mean weight gain between infants in the experimental and control groups (mean difference: -0.02; 95% CI: -0.1, 0.08) at 6 months of age. Further, deworming had no effect on measured infant morbidity indicators. However, ad hoc analyses restricted to mothers who tested positive for STHs at baseline suggest that infants of mothers in the experimental group had greater mean length gain in cm (mean difference: 0.8; 95% CI: 0.1, 1.4) and length-for-age z-score (mean difference: 0.5; 95% CI: 0.2, 0.8) at 6 months of age. CONCLUSIONS/SIGNIFICANCE: In a study population composed of both STH-infected and uninfected mothers, maternal postpartum deworming was insufficient to impact infant growth and morbidity indicators up to 6 months postpartum. Among STH-infected mothers, however, important improvements in infant length gain and length-for-age were observed. The benefits of maternal postpartum deworming should be further investigated in study populations having higher overall prevalences and intensities of STH infections and, in particular, where whipworm and hookworm infections are of public health concern. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01748929).
Assuntos
Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Helmintíase/tratamento farmacológico , Doenças do Recém-Nascido/tratamento farmacológico , Aumento de Peso/efeitos dos fármacos , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Helmintíase/parasitologia , Helmintíase/fisiopatologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/parasitologia , Doenças do Recém-Nascido/fisiopatologia , Masculino , Mães , Peru , Período Pós-Parto , Adulto JovemRESUMO
It is widely accepted that the c-Fos gene has a role in proliferation and differentiation of bone cells. ATP-induced c-Fos activation is relevant to bone homeostasis, because nucleotides that are present in the environment of bone cells can contribute to autocrine/paracrine signalling. Gut hormones have previously been shown to have an effect on bone metabolism. In this study, we used the osteoblastic Saos-2 cell line transfected with a c-Fos-driven reporter stimulated with five gut hormones: glucose inhibitory peptide (GIP), glucagon-like peptide-1 (GLP-1), glucagon-like peptide-2 (GLP-2), ghrelin and obestatin, in the presence or absence of ATP. In addition, TE-85 cells were used to determine the time course of c-Fos transcript induction following stimulation with GLP-1, and GLP-2 with or without ATP, using reverse transcription qPCR. The significant results from the experiments are as follows: higher level of c-Fos induction in presence of GIP, obestatin (p = 0.019 and p = 0.011 respectively), and GIP combined with ATP (p < 0.001) using the luciferase assay; GLP-1 and GLP-2 combined with ATP (p = 0.034 and p = 0.002, respectively) and GLP-2 alone (p < 0.001) using qPCR. In conclusion, three of the gut peptides induced c-Fos, providing a potential mechanism underlying the actions of these hormones in bone which can be directed or enhanced by the presence of ATP.
Assuntos
Trifosfato de Adenosina/farmacologia , Grelina/farmacologia , Peptídeo 1 Semelhante ao Glucagon/farmacologia , Peptídeo 2 Semelhante ao Glucagon/farmacologia , Osteoblastos/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-fos/metabolismo , Linhagem Celular Tumoral , Humanos , Osteoblastos/metabolismoRESUMO
OBJECTIVE: To compare rates of stillbirth among Haitians and non-Haitians in Canada. METHODS: A retrospective cohort study was performed using data on all stillborn and live-born singletons weighing at least 500 g in the province of Quebec, Canada, from 1981 to 2010. Stillbirth rates were computed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for Haitians relative to non-Haitians. The main outcome measure was stillbirth by cause of death. RESULTS: Data for 9657 stillbirths (124 Haitian) and 2 414 751 live births (17 165 Haitian) were included. Stillbirth rates were higher for Haitians than non-Haitians (7.17 [95% CI 5.91-8.43] vs 3.96 [95% CI 3.88-4.04] per 1000 births), particularly for cord prolapse (adjusted HR 1.87, 95% CI 1.10-3.18) and placental abruption (adjusted HR 2.84, 95% CI 1.95-4.15). Haitians had higher risks of stillbirth due to cord prolapse and abruption at every week of pregnancy. Risks were not elevated for stillbirth due to congenital anomaly, a cause less responsive to urgent intervention. CONCLUSION: Stillbirth rates among Haitians are disproportionately high in Canada, particularly fetal death due to cord prolapse and placental abruption. The potential to reduce stillbirth rates through optimal emergency care in vulnerable minorities requires further investigation.
Assuntos
Emigrantes e Imigrantes , Natimorto/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Haiti/etnologia , Humanos , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal , Quebeque/epidemiologia , Estudos Retrospectivos , Natimorto/etnologiaRESUMO
INTRODUCTION: Soil-transmitted helminth infections are endemic in 114 countries worldwide, and cause the highest burden of disease among all neglected tropical diseases. The WHO includes women of reproductive age as a high-risk group for infection. The primary consequence of infection in this population is anaemia. During lactation, anaemia may contribute to reduced quality and quantity of milk, decreasing the duration of exclusive breastfeeding and lowering the age at weaning. To date, no study has investigated the effects of maternal postpartum deworming on infant or maternal health outcomes. METHODS AND ANALYSIS: A single-centre, parallel, double-blind, randomised, placebo-controlled trial will be carried out in Iquitos, Peru, to assess the effectiveness of integrating single-dose 400 mg albendazole into routine maternal postpartum care. A total of 1010 mother-infant pairs will be randomised to either the intervention or control arm, following inhospital delivery and prior to discharge. Participants will be visited in their homes at 1, 6, 12 and 24 months following delivery for outcome ascertainment. The primary outcome is infant mean weight gain between birth and 6 months of age. Secondary outcomes include other infant growth indicators and morbidity, maternal soil-transmitted helminth infection and intensity, anaemia, fatigue, and breastfeeding practices. All statistical analyses will be performed on an intention-to-treat basis. ETHICS AND DISSEMINATION: Research ethics board approval has been obtained from the McGill University Health Centre (Canada), the Asociación Civil Impacta Salud y Educación (Peru) and the Instituto Nacional de Salud (Peru). A data safety and monitoring committee is in place to oversee study progression and evaluate adverse events. The results of the analyses will be published in peer-reviewed journals, and presented at national and international conferences. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov: NCT01748929.
Assuntos
Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Helmintíase/prevenção & controle , Transtornos da Nutrição do Lactente/prevenção & controle , Mães , Adulto , Aleitamento Materno , Análise Custo-Benefício , Método Duplo-Cego , Feminino , Helmintíase/complicações , Helmintíase/tratamento farmacológico , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Lactação , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Peru/epidemiologia , Período Pós-Parto , Gravidez , Solo/parasitologia , Resultado do TratamentoRESUMO
BACKGROUND: Data on cultural groups at risk of stillbirth in high-income countries are scarce. We sought to determine disparities in stillbirth by gestational age for Haitian vs. non-Haitian Canadians. METHODS: We used data on 10,287 stillbirths and 2,482,364 livebirths from 1981-2010 in the province of Quebec, Canada. Stillbirth rates for Haitians were compared with non-Haitians using fetuses at risk denominators, and Cox proportional hazards regression models with gestational age as the time scale. RESULTS: Stillbirth rates were much higher for Haitians than non-Haitians during the study period (7.2 vs. 3.9 per 1000 total births). Disparities between Haitians and non-Haitians were largest at 32-36 weeks of gestation [hazard ratio 2.22, 95% confidence interval 1.61, 3.07]. CONCLUSIONS: Stillbirth rates in Haitian Canadians giving birth in Quebec are exceptionally high. Disparities were greatest during the late preterm period.
Assuntos
Nascido Vivo/etnologia , Resultado da Gravidez , Natimorto/etnologia , Adulto , Escolaridade , Feminino , Idade Gestacional , Haiti/etnologia , Humanos , Nascido Vivo/epidemiologia , Modelos Logísticos , Estado Civil , Gravidez , Modelos de Riscos Proporcionais , Quebeque/epidemiologia , Natimorto/epidemiologia , Adulto JovemRESUMO
Adiponectin is an adipokine that has been related to bone metabolism. Data on adiponectin receptors (AdipoR1, -R2) in osteoclasts have shown discrepancies. In this study we carried out observations of AdipoR1, -R2 in peripheral blood mononuclear cells that were induced to differentiate into osteoclasts. AdipoR1, -R2 were screened using reverse transcription and quantitative PCR and immunofluorescence. Acid phosphatase and Cathepsin-K were evaluated as osteoclastic markers. Results showed that acid phosphatase was expressed from day 1 whereas Cathepsin-K started from day 7. AdipoR1 and -R2 showed expression from day 1, with greater expression for AdipoR1 than AdipoR2. The immunofluorescent patterns were observed in the cells cultured under three different conditions: non-supplemented medium, added M-CSF, or medium with M-CSF, and RANK-L. The non-supplemented control did not display specific fluorescence whereas specific and strong signals were detected in cells cultured with combined M-CSF and RANK-L from day 7. The fluorescence patterns were detected mainly at the periphery of the cells, and in the cytoplasm, showing a localized patchy pattern for both receptors. In contrast, a diffuse fluorescent pattern was detected in the cytoplasm of the cells with M-CSF alone. In summary, AdipoR1 and -R2 were detected by quantitative PCR and immunofluorescence. The immunofluorescence patterns suggest that adiponectin receptors are located, or re-located, in the plasma membrane with distribution in the cytoplasm when mononuclear cells are committed to differentiate to osteoclasts. These findings could be a reasonable explanation for the controversy found in the published literature regarding the role of adiponectin in bone metabolism.