Risk factors for oxygen requirement in hospitalized pregnant and postpartum women with COVID-19

Objective: To identify risk factors for Oxygen (O2) needs in pregnant and postpartum women with COVID-19. Methods: Prospective cohort involving pregnant women hospitalized with COVID-19 from April to October 2020. The oxygen need was analyzed regarding risk factors: demographic characteristics, clinical and laboratory parameters at hospital admission, and chest Computer Tomography (CT) findings. Poisson univariate analysis was used to estimate the Relative Risk (RR) and 95% Confidence Intervals. Results: 145 patients, 80 who used and 65 who did not use O2, were included. Body mass index ≥ 30, smoking, and chronic hypertension increased the risk of O2 need by 1.86 (95% CI 1.10–3.21), 1.57 (95% CI 1.16‒2.12), and 1.46 (95% CI 1.09‒1.95), respectively. Patients who were hospitalized for COVID-19 and for obstetric reasons had 8.24 (95% CI 2.8‒24.29) and 3.44 (95% CI 1.05‒11.31) times more use of O2 than those admitted for childbirth and abortion. Respiratory rate ≥ 24 breaths/min and O2 saturation < 95% presented RR for O2 requirements of 2.55 (1.82‒3.56) and 1.68 (95% CI 1.27–2.20), respectively. Ground Glass (GG) < 50% and with GG ≥ 50%, the risk of O2 use were respectively 3.41-fold and 5.33-fold higher than in patients who haven't viral pneumonia on CT. The combination of C-reactive protein ≥ 21 mg/L, hemoglobin < 11.0 g/dL, and lymphopenia < 1500 mm3 on hospital admission increased the risk of O2 use by 4.97-times. Conclusions: In obstetric patients, clinical history, laboratory, clinical and radiological parameters at admission were identified as a risk for O2 need, selecting the population with the greatest chance of worsening

Impact of SARS-CoV-2 on pregnancy and neonatal outcomes in pregnant women followed up at Hospital das Clínicas da Faculdade de Medicina and Hospital Universitário da USP

Objetivo: Determinar os fatores clínicos e epidemiológicos associados à gravidade do quadro clínico em mulheres gestantes infectadas pelo SARS-CoV-2 e o risco de resultados gestacionais e neonatais adversos de acordo com a gravidade da infecção. Métodos: Análise retrospectiva de dados coletados de forma prospectiva de gestantes testadas para SARS-CoV-2 (ensaios sorológicos e/ou moleculares) durante a gravidez e/ou no parto em dois hospitais de São Paulo no período de 12 de abril de 2020 a 28 de fevereiro de 2021. Cinco grupos foram criados: C0, investigação negativa de SARS-CoV-2 e ausência de sintomas de COVID-19 durante a gravidez ou no parto; C1, investigação positiva e ausência de sintomas; C2, investigação positiva e presença de sintomas leves; C3, internação com COVID-19 moderado; C4, internação com COVID-19 grave. A associação de resultados gestacionais e neonatais com a gravidade da COVID-19 foi determinada por análise multivariada (AMV). Resultados: Foram incluídas 734 gestantes elegíveis, da seguinte forma: C0 (n= 357), C1 (n= 127), C2 (n= 174), C3 (n= 37), C4 (n= 39). Idade materna mais avançada apresentou piora da gravidade clínica (p= 0,044), e a nuliparidade foi menos frequente nos casos moderados e graves (ORa= 0,30; IC 95% 0,12 0,79 e ORa= 0,30; IC 95% 0,12 0,76, respectivamente), enquanto a hipertensão crônica apresentou associação com sintomas moderados (ORa= 5,21; IC 95% 2,09 13,0) e a diabetes pré-existente, com sintomas leves (ORa= 4,27; IC 95% 1,43 11,71). Em comparação com a ausência de infecção por SARS-CoV-2 (grupo C0), os seguintes resultados gestacionais e neonatais foram associados à COVID-19 grave: oligoâmnio (ORa= 6,18; IC 95% 1,87 - 20,39), sofrimento fetal (ORa= 4,01; IC 95% 1,84 - 8,75), parto prematuro (ORa= 5,51; IC 95% 1,47 - 20,61), maior tempo de internação (ORa= 1,66; IC 95% 1,36 - 2,02) e internação em unidade de terapia intensiva neonatal (ORa= 19,36; IC 95% 5,86 - 63,99). Todos os óbitos maternos (n= 6; 15,4%; p< 0,001) e neonatais (n= 5; 12,5%; p<0,001), e a maioria dos óbitos fetais (n= 4; 9,8%; p<0,001) ocorreram nos casos graves de COVID-19. A COVID-19 moderada foi associada a oligoâmnio (ORa= 6,23; IC 95% 1,93 - 20,13) e parto prematuro (ORa= 3,60; IC 95% 1,45 - 9,27). COVID-19 leve foi associada a oligoâmnio (ORa= 3,77; IC 95% 1,56 - 9,07). Conclusão: Progressão da idade materna, multiparidade e antecedentes de hipertensão arterial crônica e de diabetes correlacionaram-se com infecção mais grave. Os resultados gestacionais e neonatais adversos também estiveram associados à gravidade da COVID-19, com aumento do risco com a piora da doençaAim: To determine the factors associated with the severity of the clinical presentation in pregnant women infected with SARS-CoV-2 and the risk of adverse gestational and neonatal outcomes according to the presence and intensity of symptoms. Methods: Retrospective analysis of prospectively collected data on pregnant women tested for SARS-CoV-2 (serological and/or molecular assays) during pregnancy and/or at delivery in two hospitals in Sao Paulo from April 12th, 2020 to February 28th, 2021. Five groups were created: C0, negative SARS-CoV-2 investigation and no COVID-19 symptoms during pregnancy or at delivery; C1, positive investigation and absence of symptoms; C2, positive investigation with mild symptoms; C3, hospital admission with moderate COVID-19; C4, hospital admission with severe COVID-19. The association of pregnancy and neonatal outcomes with COVID-19 severity was determined by multivariate analysis (MVA). Results: 734 eligible pregnant women were enrolled as follows: C0 (n= 357), C1 (n= 127), C2 (n= 174), C3 (n= 37), C4 (n= 39). Incresing maternal age was associated with progressive disease severity (p= 0.044) and nulliparity was less frequent in the moderate and severe groups (aOR= 0.30; 95% CI 0.12 0.79 and aOR= 0.30; 95% CI 0.12 0.76, respectively), while chronic hypertension was associated with moderate symptoms (aOR= 5.21; 95% CI 2.09 13.0) and pre-existing diabetes, with mild symptoms (aOR= 4.27; 95% CI 1.43 11.71). Compared to absence of SARS-CoV-2 infection (group C0), the following pregnancy and neonatal outcomes were associated with severe COVID-19: oligohydramnios (aOR= 6.18; 95%CI 1.87 - 20.39), fetal distress (aOR= 4.01; 95%CI 1.84 - 8.75), preterm birth (aOR= 5.51; 95%CI 1.47 - 20.61), longer hospital stay (aOR= 1.66, 95%CI 1.36 - 2.02), and admission to neonatal intensive care unit (aOR= 19.36, 95%CI 5.86 - 63.99). All maternal (n= 6; 15.4%; p< 0.001) and neonatal (n=5; 12.5%; p< 0.001) and most fetal deaths (n=4; 9.8%; p< 0.001) occurred in the severe COVID-19 maternal group. Moderate COVID-19 was associated with oligohydramnios (aOR= 6.23; 95%CI 1.93 - 20.13) and preterm birth (aOR=3.60; 95%CI 1.45 - 9.27). Mild COVID-19 was associated with oligohydramnios (aOR= 3.77; 95%CI 1.56 - 9.07). Conclusion: Increasing maternal age, multiparity and a history of chronic hypertension and diabetes are related to more serious infection. Adverse pregnancy and neonatal outcomes are also associated with maternal symptomatic COVID-19 status, and the risk increases with disease severit

Evaluation of the expression of metalloproteinases and its inhibitors at the trophoblastic implantation site in ectopic ampullary gestations

OBJETIVOS: O presente estudo objetiva investigar as expressões qualitativa e quantitativa das metaloproteinases (MMPs) e de seus inibidores (TIMPs), no sítio de implantação do trofoblasto, nas gestações ectópicas ampulares, além de correlacioná-las com o grau de invasão tubária. MÉTODOS: estudo prospectivo incluindo 34 pacientes com diagnóstico de gestação tubária ampular, que foram submetidas à salpingectomia, entre 2012 e 2013. Foi realizada avaliação histológica da profundidade da invasão trofoblástica das tubas obtidas. Em seguida, foram avaliadas, por meio de imuno-histoquímica indireta, as expressões dos marcadores MMP-2, MMP-9 e MMP-14, TIMP-1, TIMP-2 e TIMP-3, de forma qualitativa e quantitativa. Por fim, correlacionou-se o grau de invasão trofoblástica com a expressão de cada marcador e com as razões metaloproteinase/inibidor possíveis. RESULTADOS: tanto na avaliação qualitativa, quanto na quantitativa, a MMP-2 (11,23%; 3,58 - 19,52) foi o marcador com maior expressão nos sítios de implantação, enquanto a MMP-9 (2,23%; 0,19 - 5,39) e o TIMP-3 (2,53%; 0,13 - 15,27) estiveram apenas fracamente expressos. Houve ampla variação entre as expressões dos marcadores e das razões metaloproteinase/inibidor estudadas, quando comparadas aos graus de invasão. CONCLUSÃO: há expressão das metaloproteinases e dos inibidores estudados no sítio de implantação trofoblástica nas gestações ectópicas ampulares; entretanto, não há uniformidade de expressão isolada, ou da razão metaloproteinases/inibidor, em relação aos graus de invasão trofoblásticaOBJECTIVES: The present study aims to investigate the qualitative and quantitative expressions of metalloproteinases (MMP) and its inhibitors (TIMP), at the trophoblastic implantation site, in ampullary ectopic pregnancies, and to correlate them with the degree of tubal invasion. METHODS: This was a prospective study including 34 patients diagnosed with ectopic ampullary gestation, who underwent salpingectomy between 2012 and 2013. A histological evaluation of the depth of trophoblastic invasion of the tubes obtained was performed. Next, the local expressions of the markers MMP-2, MMP-9 and MMP-14, TIMP-1, TIMP-2 and TIMP-3 were studied in a qualitative and quantitative manner using indirect immuno histochemistry technique. Finally, the degree of invasion was correlated with the expression of each marker and the possible metalloproteinase/inhibitor ratios. RESULTS: In both qualitative and quantitative evaluations, MMP-2 (11,23%; 3,58 - 19,52) was the marker with the highest expression at the sites of implantation, whereas MMP-9 (2,23%; 0,19 - 5,39) and TIMP-3 (2,53%; 0,13 - 15,27) were only poorly expressed. There was a wide variation between the expressions of the markers and the metalloproteinase/inhibitor ratios when compared with the degrees of invasion. CONCLUSION: There is expression of the studied metalloproteinases and inhibitors at the trophoblastic implantation site in ectopic ampullary gestations; however, there is no uniformity in isolated expression or in the metalloproteinase/inhibitor ratio when compared to the degrees of trophoblastic invasio

Evaluation of the expression of metalloproteinases and its inhibitors at the trophoblastic implantation site in ectopic ampullary gestations

OBJETIVOS: O presente estudo objetiva investigar as expressões qualitativa e quantitativa das metaloproteinases (MMPs) e de seus inibidores (TIMPs), no sítio de implantação do trofoblasto, nas gestações ectópicas ampulares, além de correlacioná-las com o grau de invasão tubária. MÉTODOS: estudo prospectivo incluindo 34 pacientes com diagnóstico de gestação tubária ampular, que foram submetidas à salpingectomia, entre 2012 e 2013. Foi realizada avaliação histológica da profundidade da invasão trofoblástica das tubas obtidas. Em seguida, foram avaliadas, por meio de imuno-histoquímica indireta, as expressões dos marcadores MMP-2, MMP-9 e MMP-14, TIMP-1, TIMP-2 e TIMP-3, de forma qualitativa e quantitativa. Por fim, correlacionou-se o grau de invasão trofoblástica com a expressão de cada marcador e com as razões metaloproteinase/inibidor possíveis. RESULTADOS: tanto na avaliação qualitativa, quanto na quantitativa, a MMP-2 (11,23%; 3,58 - 19,52) foi o marcador com maior expressão nos sítios de implantação, enquanto a MMP-9 (2,23%; 0,19 - 5,39) e o TIMP-3 (2,53%; 0,13 - 15,27) estiveram apenas fracamente expressos. Houve ampla variação entre as expressões dos marcadores e das razões metaloproteinase/inibidor estudadas, quando comparadas aos graus de invasão. CONCLUSÃO: há expressão das metaloproteinases e dos inibidores estudados no sítio de implantação trofoblástica nas gestações ectópicas ampulares; entretanto, não há uniformidade de expressão isolada, ou da razão metaloproteinases/inibidor, em relação aos graus de invasão trofoblásticaOBJECTIVES: The present study aims to investigate the qualitative and quantitative expressions of metalloproteinases (MMP) and its inhibitors (TIMP), at the trophoblastic implantation site, in ampullary ectopic pregnancies, and to correlate them with the degree of tubal invasion. METHODS: This was a prospective study including 34 patients diagnosed with ectopic ampullary gestation, who underwent salpingectomy between 2012 and 2013. A histological evaluation of the depth of trophoblastic invasion of the tubes obtained was performed. Next, the local expressions of the markers MMP-2, MMP-9 and MMP-14, TIMP-1, TIMP-2 and TIMP-3 were studied in a qualitative and quantitative manner using indirect immuno histochemistry technique. Finally, the degree of invasion was correlated with the expression of each marker and the possible metalloproteinase/inhibitor ratios. RESULTS: In both qualitative and quantitative evaluations, MMP-2 (11,23%; 3,58 - 19,52) was the marker with the highest expression at the sites of implantation, whereas MMP-9 (2,23%; 0,19 - 5,39) and TIMP-3 (2,53%; 0,13 - 15,27) were only poorly expressed. There was a wide variation between the expressions of the markers and the metalloproteinase/inhibitor ratios when compared with the degrees of invasion. CONCLUSION: There is expression of the studied metalloproteinases and inhibitors at the trophoblastic implantation site in ectopic ampullary gestations; however, there is no uniformity in isolated expression or in the metalloproteinase/inhibitor ratio when compared to the degrees of trophoblastic invasio

Impact of SARS-CoV-2 on pregnancy and neonatal outcomes: An open prospective study of pregnant women in Brazil.

OBJECTIVES: To determine the incidence and risk of adverse obstetric and neonatal outcomes according to SARS-CoV-2 infection severity in pregnant women. METHOD: Open prospective study of pregnant women tested for SARS-CoV-2 by serological and molecular assays during pregnancy or delivery in two hospitals in Sao Paulo, Brazil from April 12, 2020, to February 28, 2021. Five groups were considered for analysis: C0, negative COVID-19 results and no COVID-19 symptoms; C1, positive COVID-19 results, and no symptoms; C2, positive COVID-19 results with mild symptoms; C3, positive COVID-19 results with moderate symptoms; and C4, positive COVID-19 results with severe symptoms. The association between obstetric and neonatal outcomes and COVID-19 severity was determined using multivariate analysis. RESULTS: 734 eligible pregnant women were enrolled as follows: C0 (n = 357), C1 (n = 127), C2 (n = 174), C3 (n = 37), and C4 (n = 39). The following pregnancy and neonatal outcomes were associated with severe COVID-19: oligohydramnios (adjusted Odds Ratio [aOR] = 6.18; 95% CI 1.87‒20.39), fetal distress (aOR = 4.01; 95% Confidence Interval [CI] 1.84‒8.75), preterm birth (aOR = 5.51; 95% CI 1.47‒20.61), longer hospital stay (aOR = 1.66; 95% CI 1.36‒2.02), and admission to the neonatal intensive care unit (aOR = 19.36; 95% CI, 5.86‒63.99). All maternal (n = 6, 15.4%, p < 0.001) and neonatal (n = 5, 12.5%, p < 0.001) deaths and most fetal deaths (n = 4, 9.8%, p < 0.001) occurred in C4 group. Moderate COVID-19 was associated with oligohydramnios (aOR = 6.23; 95% CI 1.93‒20.13) and preterm birth (aOR = 3.60; 95% CI 1.45‒9.27). Mild COVID-19 was associated with oligohydramnios (aOR = 3.77; 95% CI 1.56‒9.07). CONCLUSION: Adverse pregnancy and neonatal outcomes were associated with maternal symptomatic COVID-19 status, and risk increased with disease severity

Tevatron Combination of Single-Top-Quark Cross Sections and Determination of the Magnitude of the Cabibbo-Kobayashi-Maskawa Matrix Element Vtb\bf V_{tb}

We present the final combination of CDF and D0 measurements of cross sections for single-top-quark production in proton-antiproton collisions at a center-of-mass energy of 1.96 TeV. The data correspond to total integrated luminosities of up to 9.7 fb$^{−1}$ per experiment. The t-channel cross section is measured to be σ$_t$=2.25$_{-0.31}^{+0.29}$ pb. We also present the combinations of the two-dimensional measurements of the s- vs t-channel cross section. In addition, we give the combination of the s+t channel cross section measurement resulting in σ$_{s+t}$=3.30$_{-0.40}^{+0.52}$ pb, without assuming the standard model value for the ratio σ$_s$/σ$_t$. The resulting value of the magnitude of the top-to-bottom quark coupling is |V$_{tb}$|=1.02$_{-0.05}^{+0.06}$, corresponding to |V$_{tb}$|>0.92 at the 95% C.L

Combined Forward-Backward Asymmetry Measurements in Top-Antitop Quark Production at the Tevatron

International audienceThe CDF and D0 experiments at the Fermilab Tevatron have measured the asymmetry between yields of forward- and backward-produced top and antitop quarks based on their rapidity difference and the asymmetry between their decay leptons. These measurements use the full data sets collected in proton-antiproton collisions at a center-of-mass energy of s=1.96  TeV. We report the results of combinations of the inclusive asymmetries and their differential dependencies on relevant kinematic quantities. The combined inclusive asymmetry is AFBtt¯=0.128±0.025. The combined inclusive and differential asymmetries are consistent with recent standard model predictions

Tevatron Run II combination of the effective leptonic electroweak mixing angle

International audienceDrell-Yan lepton pairs produced in the process pp¯→ℓ+ℓ-+X through an intermediate γ*/Z boson have an asymmetry in their angular distribution related to the spontaneous symmetry breaking of the electroweak force and the associated mixing of its neutral gauge bosons. The CDF and D0 experiments have measured the effective-leptonic electroweak mixing parameter sin2θefflept using electron and muon pairs selected from the full Tevatron proton-antiproton data sets collected in 2001-2011, corresponding to 9–10  fb-1 of integrated luminosity. The combination of these measurements yields the most precise result from hadron colliders, sin2θefflept=0.23148±0.00033. This result is consistent with, and approaches in precision, the best measurements from electron-positron colliders. The standard model inference of the on-shell electroweak mixing parameter sin2θW, or equivalently the W-boson mass MW, using the zfitter software package yields sin2θW=0.22324±0.00033 or equivalently, MW=80.367±0.017  GeV/c2