Mast cells (MCs) have relevant participation in inflammatory and vascular hyperpermeability events, responsible for the action of the kallikrein–kinin system (KKS), that affect patients inflicted by the severe form of COVID-19. Given a higher number of activated MCs present in COVID-19 patients and their association with vascular hyperpermeability events, we investigated the factors that lead to the activation and degranulation of these cells and their harmful effects on the alveolar septum environment provided by the action of its mediators. Therefore, the pyroptotic processes throughout caspase-1 (CASP-1) and alarmin interleukin-33 (IL-33) secretion were investigated, along with the immunoexpression of angiotensin-converting enzyme 2 (ACE2), bradykinin receptor B1 (B1R) and bradykinin receptor B2 (B2R) on post-mortem lung samples from 24 patients affected by COVID-19. The results were compared to 10 patients affected by H1N1pdm09 and 11 control patients. As a result of the inflammatory processes induced by SARS-CoV-2, the activation by immunoglobulin E (IgE) and degranulation of tryptase, as well as Toluidine Blue metachromatic (TB)-stained MCs of the interstitial and perivascular regions of the same groups were also counted. An increased immunoexpression of the tissue biomarkers CASP-1, IL-33, ACE2, B1R and B2R was observed in the alveolar septum of the COVID-19 patients, associated with a higher density of IgE⁺ MCs, tryptase⁺ MCs and TB-stained MCs, in addition to the presence of intra-alveolar edema. These findings suggest the direct correlation of MCs with vascular hyperpermeability, edema and diffuse alveolar damage (DAD) events that affect patients with a severe form of this disease. The role of KKS activation in events involving the exacerbated increase in vascular permeability and its direct link with the conditions that precede intra-alveolar edema, and the consequent DAD, is evidenced. Therapy with drugs that inhibit the activation/degranulation of MCs can prevent the worsening of the prognosis and provide a better outcome for the patient.

The inflammasome complex is a key part of chronic diseases and acute infections, being responsible for cytokine release and cell death mechanism regulation. The SARS-CoV-2 infection is characterized by a dysregulated cytokine release. In this context, the inflammasome complex analysis within SARS-CoV-2 infection may prove beneficial to understand the disease’s mechanisms. Post-mortem minimally invasive autopsies were performed in patients who died from COVID-19 (n = 24), and lung samples were compared to a patient control group (n = 11) and an Influenza A virus H1N1 subtype group from the 2009 pandemics (n = 10). Histological analysis was performed using hematoxylin-eosin staining. Immunohistochemical (IHC) staining was performed using monoclonal antibodies against targets: ACE2, TLR4, NF-κB, NLRP-3 (or NALP), IL-1β, IL-18, ASC, CASP1, CASP9, GSDMD, NOX4, TNF-α. Data obtained from digital analysis underwent appropriate statistical tests. IHC analysis showed biomarkers that indicate inflammasome activation (ACE2; NF-κB; NOX4; ASC) were significantly increased in the COVID-19 group (p < 0.05 for all) and biomarkers that indicate cell pyroptosis and inflammasome derived cytokines such as IL-18 (p < 0.005) and CASP1 were greatly increased (p < 0.0001) even when compared to the H1N1 group. We propose that the SARS-CoV-2 pathogenesis is connected to the inflammasome complex activation. Further studies are still warranted to elucidate the pathophysiology of the disease.

Resumo Fundamento A desnutrição é frequente na insuficiência cardíaca com fração de ejeção reduzida (ICFEr) e pode influenciar negativamente o prognóstico. Objetivo Determinar a prevalência de desnutrição em pacientes ambulatoriais com ICFEr, identificar fatores clínicos associados e avaliar seu impacto na mortalidade e em desfechos clínicos em 6 meses. Métodos Estudo observacional, de coorte prospectiva, incluindo 118 pacientes ambulatoriais com ICFEr. A avaliação nutricional foi realizada por meio do Mini Nutritional Assessment (MNA) e da Subjective Global Assessment (SGA). O seguimento de 6 meses documentou mortalidade, hospitalizações e atendimentos emergenciais. Resultados A prevalência de desnutrição foi de 21,2% (25/118). Pacientes desnutridos eram mais idosos (68 ± 12 vs. 60 ± 10 anos; p=0,001), apresentavam maior frequência de classe funcional NYHA III–IV (45% vs. 15%; p=0,002) e fibrilação atrial (44% vs. 25%; p=0,048), além de menor percentual da dose-alvo de betabloqueadores atingida (57,9% vs. 79,8%; p=0,002). Não houve diferença estatisticamente significativa na mortalidade em 6 meses entre os grupos, embora tenha sido numericamente maior no grupo desnutrido (14% vs. 4%; p=0,082). Também não se observou diferença na taxa de hospitalização (p=0,94) ou de atendimentos emergenciais (p=0,97). Conclusão A desnutrição está presente em aproximadamente 1 a cada 5 pacientes ambulatoriais com ICFEr, mais frequente em idosos e portadores de fibrilação atrial e esteve associada a tendência de maior mortalidade em 6 meses.

Introdução: O conhecimento e o acesso a métodos contraceptivos para um planejamento familiar de qualidade no puerpério garantem um intervalo interparto adequado, o que reduz riscos maternos e fetais. Isso deve ser transmitido às pacientes nas consultas de pré-natal, com reforços no internamento para o parto e no puerpério imediato e tardio. Objetivo: Avaliar o impacto das orientações do pré-natal sobre a adesão aos métodos contraceptivos no puerpério, determinar o conhecimento das puérperas sobre métodos contraceptivos que podem ser utilizados no período puerperal e quanto desse conhecimento foi transmitido durante o pré-natal, e relacionar a oferta do método contraceptivo de longa duração ao índice de inserção de DIU no pós-parto e pós-cesárea imediatos no Hospital e Maternidade Alto Maracanã no município de Colombo (PR). Material e Método: Trata-se de um estudo descritivo, transversal e quantitativo. A coleta de dados se deu com aplicação de questionários às puérperas. As respostas foram analisadas por estatística descritiva. Resultados: Apenas 38,7% das gestações foram planejadas na amostra estudada, e não houve relação estatisticamente relevante com fatores como idade, estado civil, escolaridade, religião ou renda familiar mensal. Embora a maior parte das puérperas tenha realizado consultas de pré-natal, menos da metade recebeu orientação sobre planejamento familiar durante as consultas. Um percentual singelo de 19,6% das pacientes teve o DIU oferecido durante o pré-natal e apenas 2,3% do total tiveram de fato o DIU inserido no pós-parto imediato. As gestantes que foram orientadas sobre o DIU durante o pré-natal solicitaram 2,5 vezes mais o DIU durante a internação comparado às mulheres que não foram orientadas sobre contracepção no puerpério. Conclusão: É necessário prestar maior assistência relacionada às questões de planejamento familiar durante as consultas de pré-natal no município de Colombo (PR). A opção de inserção do DIU deve ser ofertada e o método deve ser inserido pelo prestador de cuidados de saúde de Atenção Básica e Especializada. Explicações sobre as opções de contracepção devem ser melhor esclarecidas para que as pacientes possam decidir sobre seu planejamento reprodutivo tendo ciência de suas opções e direitos. Palavras-chave: Contracepção, Período pós-parto, Planejamento familiar, Cuidado pré-natal, Dispositivo intrauterino. ABSTRACT: Introduction: Knowledge and access to contraceptive methods for adequate family planning during puerperium guarantees an appropriate inter-pregnancy interval, which reduces maternal and fetal risks. This must be transmitted to patients during prenatal care, and reinforced during hospitalization for delivery and during immediate and late puerperium. Objective: To evaluate the impact of prenatal orientations over the choice of postpartum women to use contraceptive methods during puerperium; to determine the knowledge of postpartum women about which contraceptive methods can be used during the puerperium period and how much of this knowledge has been transferred during prenatal care; to relate the offering of access to long-term contraceptive methods and the rate of insertion of intrauterine devices (IUDs) during immediate postpartum and post-cesarean section in Alto Maracanã Maternity in the city of Colombo (PR). Method: This is a d scriptive, transversal and quantitative study. Data was collected through the application of a survey form to puerperal women at the maternity in question. The answers were analyzed by descriptive statistics. Results: In our sample, only 38.7% of pregnancies were planned, with no statistically relevant relation shown to factors such as age, marital status, education level, religion or monthly family income. Although most of the puerperal women had attended prenatal routine care, less than 50% received orientation about family planning during their medical appointments. Of the patients, 19.6% had postpartum IUD insertion offered during prenatal care, and only 2.3% of the total sample had the IUD inserted during immediate postpartum. Pregnant women who were informed about the possibility of postpartum IUD insertion during the prenatal period requested it 2.5 more times when compared to women who were not instructed with regard to postpartum contraception. Conclusion: There is a need for better assistance to family planning guidance during prenatal appointments in the city of Colombo (PR). Postpartum IUD insertion must be offered and, if chosen, correctly inserted by health care providers in both basic and specialized care. Explanations about contraceptive methods should be given to patients during prenatal care, so they are aware of their options and rights when they decide their reproductive future. Keywords: Contraception, Postpartum period, Family development planning, Prenatal care, Intrauterine devices.