ABSTRACT Purpose: to investigate the frequency-following response (FFR) for sustained neural activity. Methods: 39 individuals, aged between 20 to 47 months old were divided into 2 groups: (i) 20 individuals without prenatal exposure to the congenital Zika syndrome (CZS) or hydrocephaly, normal development, no risk factors for hearing loss or syndromic hearing impairment and (ii) 19 individuals diagnosed with CZS and microcephaly - based on imaging studies linked to the clinical presentation of the condition. All participants exhibited normal click-ABR tests. FFR waveforms were documented using the /da/ syllable employing the Navigator Pro. The statistical analysis used was ANOVA (p-value <0.05). Results: no distinctions were observed concerning the variables of group, age, or gender with respect to FFR latency values, except for an interaction between gender and group for latency values associated with waves V and F. Children with CZS and microcephaly showed a difference for latency values in wave V for both males and females, when compared to the control group. Conclusion: children presented with CZS and microcephaly showed higher average latencies for waves V, A, C, D and F (male) compared to the control group, whereas, in waves E, F (female) and O they showed higher values in the control group.

Abstract Objective To analyze the follow-up, in specialized outpatient clinics, of infants reported with congenital syphilis during the penicillin shortage. Method A cross-sectional study was carried out in ten public maternity hospitals affiliated with the Brazilian Unified Health System in the city of Fortaleza, state of Ceará. Clinical records of infants reported with congenital syphilis who were born alive in 2015 were used to describe correlates of attendance at recommended clinical follow-up appointments. Results A total of 469 infants reported with CS from January 1/2015 to December 31/2015 were included in the analysis. The results show that most infants did not attend the follow-up visits (368/469, 78.5%) and the main associated factors are that the follow-up clinic is located in a different hospital from that where the infant was born (OR: 3.7; CI: 2.20-6.22; p< 0.001) and the use of illicit drugs by the mother (OR: 3.2; CI: 1.57-6.87; p= 0.002). Only 33.7% (34/101) were followed until discharge. Conclusion The majority of infants with reported congenital syphilis during this period did not attend the follow-up visits. Public health efforts aimed at reaching the parents of infants with CS should be a priority to ensure appropriate clinical identification and management of the associated outcomes of this vertically transmitted infection.

Abstract Introduction The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. Patients and methods This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. Results Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. Conclusion The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t).

ABSTRACT The aim of this work was to evaluate the efficiency of native and exotic isolates of arbuscular mycorrhizal fungi (AMF) in promoting the growth of micropropagated seedlings of Pseudobombax simplicifolium S. Robyns during the acclimatization phase. The experiment was conducted in the greenhouse in an entirely randomized design with three inoculation treatments; Entrophospora etunicata (autochthonous), Acaulospora longula (exotic) and a non-inoculated control group. Seedlings were acclimated in soil and vermiculite (2:1 v/v) in 10 repetitions for each treatment totaling 30 experimental plots. At the end of the experiment, mycorrhized P. simplicifolium seedlings presented better development than those not inoculated. Although the inoculum with native AMF of E. etunicata was more efficient in colonizing the plants, the increments in leaf area, fresh and dry biomass were similar to those provided by the exotic AMF species (A. longula). It is concluded that during the acclimatization phase, P. simplicifolium seedlings present great vegetative development when mycorrhized, regardless of the origin of the fungal isolates tested in this study.

RESUMO O objetivo deste trabalho foi avaliar a eficiência de isolados nativos e exóticos de fungos micorrízicos arbusculares (FMA) na promoção do crescimento de plântulas micropropagadas de Pseudobombax simplicifolium S. Robyns durante a fase de aclimatização. O experimento foi realizado em casa de vegetação em delineamento inteiramente casualizado em três tratamentos de inoculação; Entrophospora etunicata (autóctone), Acaulospora longula (exótico) e um grupo testemunha não inoculado. As plântulas foram aclimatizadas em solo e vermiculita (2:1 v/v) em 10 repetições para cada tratamento totalizando 30 parcelas experimentais. Ao final do experimento, mudas de P. simplicifolium micorrizadas apresentaram melhor desenvolvimento comparado às não inoculadas. Apesar do inóculo com FMA nativo de E. etunicata ter sido mais eficiente em colonizar as plantas, os incrementos na área foliar, biomassa fresca e seca foram similares aos proporcionados pela espécie exótica de FMA (A. longula). Conclui-se que durante a fase de aclimatização, mudas de P. simplicifolium têm o desenvolvimento vegetativo beneficiado pela micorrização, independente da origem dos isolados fúngicos testados nesse estudo.

Abstract Traditionally, Torch Ginger is commercially propagated via rhizomes. Micropropagation (M) is a viable alternative that ensures the genetic and phytosanitary quality of plantlets. However, in vitro cultivation conditions can lead to morphophysiological disorders resulting in death or difficulties in the acclimatization process and establishment of seedlings/plantlets in field conditions. Thus, Arbuscular Mycorrhizal Fungi (AMF) has been used in some crops in order to mitigate the drastic effects during acclimatization and establishment of micropropagated plantlets in the field. In this sense, the objective of this study was to evaluate the implantation forms and efficacy of micropropagation and AMF inoculation on the establishment and production of Torch Ginger plants. The planting was carried in shading screens (50%) and different implantation forms were used; through rhizome (RIZ) and plantlets micropropagated with (M+AMF) and without (M-AMF) inoculation with arbuscular mycorrhizal fungi. Evaluations of growth, phenology and mycorrhizal colonization were carried out for one year. Micropropagation, independently of AMF inoculation, favoured a better development in height and number of tillers when compared to RIZ plants It is concluded that micropropagated plants of E. elatior showed earlier tiller emission, better development and initial establishment in the field. Additionally, the forms of implantation of E. elatior via rhizome and via micropropagation with or without AMF inoculation produce inflorescences with the minimum characteristics required for commercialization.

Resumo Tradicionalmente, a forma de propagação comercial do bastão-do-Imperador é por meio de rizomas. A micropropagação (M) é uma alternativa viável que garante a qualidade genética e fitossanitária das plântulas. No entanto, as condições do cultivo in vitro podem causar distúrbios morfofisiológicos resultando na morte ou dificuldades no processo de aclimatização e estabelecimento das mudas sob condições de campo. Dessa forma, Fungos Micorrízicos Arbusculares (FMA) têm sido utilizados em algumas culturas com o intuito de amenizar os efeitos drásticos durante a aclimatização e estabelecimento de plântulas micropropagadas no campo. Nesse sentido, o objetivo desse estudo foi avaliar as formas de implantação e eficácia da micropropagação e da inoculação com FMA no estabelecimento e produção de plantas de bastão-do-Imperador. O plantio foi realizado em telado com sombreamento (50%) e utilizou-se diferentes formas de implantação; via rizoma (RIZ) e através de plântulas micropropagadas com (M+FMA) e sem (M-FMA) inoculação com fungos micorrízicos arbusculares. Foram realizadas avaliações de crescimento, fenologia e colonização micorrízica ao longo de um ano de cultivo. A micropropagação, independente da inoculação com FMA, favoreceu melhor desenvolvimento em altura e número de perfilhos quando comparada às plantas obtidas de mudas via RIZ. Conclui-se que plantas micropropagadas de E. elatior apresentaram emissão de perfilhos mais precoce, melhor desenvolvimento e estabelecimento inicial no campo. Adicionalmente, as formas de implantação de E. elatior via rizoma e via micropropagação com ou sem inoculação de FMA produzem inflorescências com as características mínimas exigidas para comercialização.

RESUMO Objetivo Caracterizar o consumo alimentar através do grau de processamento industrial dos alimentos consumidos por adolescentes matriculados em escolas públicas. Métodos Estudo transversal com adolescentes de 14 a 19 anos de ambos os sexos matriculados em escolas públicas de Juiz de Fora, MG. O consumo alimentar foi avaliado através de dois recordatórios de 24h. Os alimentos foram classificados em três grupos de acordo com o grau de processamento industrial: (1) alimentos in natura ou minimamente processados, ingredientes culinários e preparações a base desses alimentos; (2) alimentos processados; (3) alimentos ultraprocessados. Ademais, foram coletadas informações de peso e altura dos estudantes, com posterior cálculo de índice de massa corporal/idade para avaliação do estado nutricional conforme o sexo. Foram realizados os testes Qui-quadrado de Pearson, Mann-Whitney e Kruskal-Wallis, adotando o valor de p<0,05. Resultados A amostra foi composta por 804 adolescentes, com predomínio do sexo feminino (57,5%). Entre os adolescentes, 29,9% das meninas e 26,1% dos meninos apresentaram excesso de peso. Observou-se diferença no consumo diário de alimentos prontos de sabor doce, sendo maior no sexo feminino (26,2%) quando comparado ao masculino (18,1%), ao passo que o consumo de refrigerantes de uma a quatro vezes na semana foi de 47,2% e 55,6% nas meninas e meninos, respectivamente (p<0,05). Maior consumo de alimentos ultraprocessados foi observado no sexo feminino (p=0,02) e de alimentos processados no sexo masculino (p=0,008). Conclusão Verificou-se elevada contribuição proveniente do grupo dos alimentos ultraprocessados na dieta dos adolescentes de escolas públicas, com altas prevalências de excesso de peso em ambos os sexos.

ABSTRACT Objective To characterize food consumption, considering the degree of industrial food processing by public schools’ adolescents. Methods Cross-sectional study involving adolescents aged 14 to 19 years, of both genders, attending public schools in Juiz de Fora, MG. Food consumption was assessed using two 24-hour dietary recalls. Foods were classified into three groups according to the degree of industrial processing: (1) unprocessed foods or minimally processed foods, culinary ingredients and preparations based on these foods; (2) processed foods; (3) ultra-processed foods. In addition, weight and height information was collected, with subsequent calculation of body mass index/age to assess the individuals’ nutritional status according to the gender. Pearson’s chi-square, Mann-Whitney and Kruskal-Wallis tests were performed, adopting a value of p<0.05. Results The sample consisted of 804 adolescents, with a predominance of females (57.5%). In the sample, 29.9% and 26.1%, of girls and boys, respectively, were overweight. There was a difference in the daily consumption of ready-made sweet-tasting foods, being higher in females (26.2%) when compared to males (18.1%), whereas the consumption of soft drinks (one to four times a week) was 47.2% and 55.6% in girls and boys, respectively (p<0.05). Higher consumption of ultra-processed foods was observed in females (p=0.02) and processed foods in males (p=0.008). Conclusion There was a high contribution of ultra-processed foods in the diet of adolescents in public schools; a high prevalence of overweight was observed in both genders.

Abstract Objective: To describe systemic manifestations, the characteristics related to tooth eruption, and the occurrence of enamel defects in children with Congenital Zika Virus Syndrome (CZS). Material and Methods: Prospective case series based on nine children with confirmed CZS diagnosis assisted at a reference center in a municipality in the Northeast Region of Brazil. Through a structured interview directed to mothers, information related to prenatal, delivery, and postpartum periods was collected. Tooth eruption was monitored through clinical examinations for 36 months. The modified developmental defect of enamel index (DDE) was used to identify opacities and hypoplasia. Data were presented using descriptive statistics. Results: A high proportion (77.8%) had microcephaly, and 55.5% had low birth weight. Musculoskeletal disorders, swallowing difficulty, and self-injury practices were present in all children. Among the systemic findings, visual impairment (77.8%) and seizures (77.8%) were widely reported. Concerning disorders related to the stomatognathic system, bruxism (66.7%) and difficulty in sucking (33.3%) were present. For most children (77.8%), the deciduous right lower central incisor was the first tooth to erupt (minimum 8 months and maximum 17 months). Enamel defects were diagnosed in only two children (22.2%). Conclusion: A wide range of systemic manifestations was observed in children with CZS, including visual impairment and musculoskeletal disorders. Delayed eruption of the first deciduous tooth was also observed. Enamel defects were present in a small proportion of children.

Abstract In this study, the effect of microbial inoculants and fertilizer application on cowpea (BRS Pujante) growth and on the structure and composition of arbuscular mycorrhizal fungi (AMF) assemblages were evaluated. A completely randomized experiment was set up involving 17 treatments: four with AMF, three with nodulating bacteria, six with AMF + nodulating bacteria, two with phosphorus, one with nitrogen and one control (reference) in five replicates. Plant growth and nutritional content, mycorrhizal colonization, glomerospores number, spore-based AMF assemblages and ecological indices were evaluated. Mycorrhizal inoculants associated with Bradyrhizobium BR3267 strain were more effective than the Microvirga BR3296 strain. Multidimensional scaling analysis showed that Acaulospora longula treatments were more similar among themselves, and distinct from the other treatments. A difference was observed in the structure of AMF community assemblage between treatments with G. albida + Bradyrhizobium BR 3267 and A. longula, with greater Shannon diversity and Pielou equitability indices in the first treatment and greater dominance in the treatment with A. longula only. Long-term studies are required to determine if the successful establishment of A. longula among indigenous species persists over time and if its dominant behavior is not deleterious to the AMF native community.

Abstract This article discusses the interruption of Teaching and learning activities at Brazilian federal universities at the time the Covid-19 pandemic broke out, as well as the extent to which the lack of access to the internet would prohibit remote resumption of those activities. Political-educational strategies for tackling the pandemic that are in line with WHO recommendations are addressed. Then the universities’ immediate responses to the necessary suspension of face-to-face activities are discussed. Finally, official data are reported measuring the size of the problem of internet access among higher education students. Given that 98% are connected, there is an urgent need to enable internet and digital literacy for 2% without access. However, there are no consistent justifications for prolonging the interruption of Teaching and learning activities. Emergency remote Education emerges as an immediate path in the midst of the pandemic, but it is blended learning methodologies that tend to consolidate in the post-pandemic world – which, sooner or later, will require new attitudes and strategies from Brazilian federal universities.

Resumen La interrupción de las actividades docentes en las universidades federales brasileñas se discute en el momento del estallido de la pandemia Covid-19 y hasta qué punto la falta de acceso a internet prohibiría la reanudación de estas actividades de forma remota. Se discuten estrategias políticas y educativas para hacer frente a la pandemia, de acuerdo con las recomendaciones de la OMS. Se analizan las respuestas inmediatas de las universidades cuando es necesario suspender las actividades presenciales. Se presentan datos de Pnad-Contínua, del IBGE, que miden el tamaño del problema de acceso a internet entre los estudiantes de Educación Superior. Dado que el 98% está conectado, existe una necesidad urgente de habilitar internet y la alfabetización digital al 2% sin acceso. Sin embargo, no existen justificaciones consistentes para prolongar la interrupción de las actividades de Enseñanza y aprendizaje. La Educación remota de emergencia surge como un camino inmediato en medio de la pandemia, pero son las metodologías de Enseñanza híbridas las que tienden a consolidarse en el mundo pospandémico, lo que, tarde o temprano, requerirá nuevas actitudes y estrategias de las universidades federales brasileñas.

Resumo Discute-se a paralisação das atividades de Ensino nas universidades federais brasileiras quando da eclosão da pandemia da Covid-19 e em que medida a falta de acesso à internet interditaria a retomada dessas atividades de forma remota. Abordam-se estratégias político-educacionais de enfrentamento à pandemia confluentes às recomendações da OMS. Analisam-se as respostas imediatas das universidades quando as atividades presenciais precisaram ser suspensas. Apresentam-se dados da Pnad-Contínua, do IBGE, que dimensionam o tamanho do problema de acesso à internet entre estudantes da Educação Superior. Dado que 98% estão conectados, urge viabilizar internet e letramento digital aos 2% sem acesso. Não transparecem, todavia, justificativas consistentes para prolongar a interrupção das atividades de Ensino-aprendizagem. O Ensino remoto emergencial surge como caminho imediato em meio à pandemia, mas são as metodologias de Ensino híbrido que tendem a se consolidar no mundo pós-pandemia – o que, cedo ou tarde, exigirá das universidades federais brasileiras novas atitudes e estratégias.

Resumo Objetivos: revisar a literatura disponível sobre os aspectos gerais dainfecção por SARS-CoV-2. Métodos: trata-se de uma revisão narrativa de literatura realizada nos meses de março asetembro de 2020. Resultados: a COVID-19, causada pelo novo coronavírus ou SARS-CoV-2, cresce com efeitos devastadores em todo o mundo. A literetura descreve dados epidemiológicos e sobre grupos de riscos para mortalidade da doença, a qual apresenta uma alta velocidade de trans-missão. A prevenção é a forma mais eficaz de combate à doença, persistindo ausências de fortes evidências sobre o tratamento. Vacinas ainda não estão disponíveis A dexametasona é efetiva para redução da mortalidade nas formas graves. Conclusão: apesar dos grandes esforços, à medida que o número de casos confirmados aumenta, evidências sobre transmissão, incidência, evolução da doença, letalidade, efeitos e os desfechos permanecem limitados e sem grandes níveis de evidência. Estudos ainda são necessários sobre todos os aspectos da doença.

Abstract Objectives: to review the available literature on the general aspects of SARS-CoV-2 infec-tion. Methods: this is a narrative literature review carried out from March to September 2020. Results: COVID-19 caused by the new coronavirus or SARS-CoV-2, grows with devas-tating effects worldwide. The literature describes epidemiological data and mortality risk groups of the disease, which presents a high rate of transmission. Prevention is the most effective way to fight the disease, persisting the absence of strong evidence on the treatment. Vaccines are not yet available. Dexamethasone is effective in reducing mortality in severe forms. Conclusions: despite great efforts, as the number of confirmed cases increases, evidence on transmission, incidence, disease progression, lethality, effects and outcomes remain limited and without any high levels of evidence. Studies are still necessary for all aspects of the disease.

Resumo Objetivos: revisar a literatura disponível sobre a COVID-19 e seus aspectos maternos e perinatais. Métodos: urna revisão narrativa de literatura foi realizada nos meses de março a setembro de 2020, utilizando os descritores, coronavirus, Covid 19, SARS-CoV-2, pregnancy, gravidity, pregnancy complications e pregnancy complications infectius. Foram incluidos todos os desenhos de estudo, revisões, recomendações e notas técnicas, sem distinção de idioma e que trouxessem a abordagem do novo coronavírus no cenárlo gestacional e perinatal. Resultados: a pandemia de COVID-19 vem apresentando efeitos devastadores, acometendo milhões depessoas e ceifando quase um milhão de vidas em todo o mundo. Inicialmente as gestantes não er am vistas como grupo de risco para a doença, porém na medida em que aumentou a proporção de mulheres acometidas durante o ciclo gravídico-puerperal diversos estudos foram publicados demostrando risco aumentado de complicações. Estudos brasileiros também alertaram para um número elevado de mortes maternas, associados à presença de comorbidades, mas, sobretudo, aos determinantes sociais da doença e a falhas graves da assistência. Conclusão: observou-se a necessidade de novos estudos com adequado delineamento de pesquisa, pois muitos estudos são apenas cartas ou pequenas séries de casos, além de recomendações de especialistas, sem o rigor científico necessário.

Abstract Objectives: reviewing the available literature on COVID-19 infection and the maternal and perinatal outcomes. Methods: this is a narrative review of the literature carried out from March to September 2020, usingthe MESH: coronavirus, Covid 19, SARS-CoV-2, pregnancy, gravidity, pregnancy complications and pregnancy complications infectius. All study designs, reviews, recommendations and technical notes were included, without distinction of language and that would bring the approach of the new coronavirus in the gestational and perinatal scenario. Results: the COVID-19 pandemic has had devastating effects, affecting millions of people and claiming almost a million lives worldwide. Initially, pregnant women were not seen as a risk group for the disease, however as the proportion of women affected during the pregnancy-puerperal cycle increased, several studies were published showing an increased risk of complications. Brazilian studies have also warned of a high number of maternal deaths, associated with the presence of comorbidities but, above all, with the social determinants of the disease and serious failures in care. Conclusion: the need for new studies with an adequate research design was observed, as many studies are only letters or small series of cases, in addition expert recommendations, without the necessary scientific rigor.

Resumo Objetivos: avaliar a sobre carga e frequência de sinais e sintomas de ansiedade e depressão em mães de crianças com síndrome congênita do Zika (SCZ) durante pandemia de COVID-19. e o período de isolamento social. Métodos: trata-se de um estudo transversal realizado com mães que cuidam de seus filhos com SCZ. Os dados foram coletados por meio de um formulário online contendo questões referentes as condições socioeconômicas da mãe além da escala de sobrecarga de Zarite dos inventários de Beck de depressão e ansiedade. Para avaliação de fatores relacionados a sobrecarga e saúde mental das mães foram realizados testes de correlação de Spearman e análises de regressão múltipla. Resultados: ao todo foram avaliadas 41 mães das quais 51,2% apresentaram sobrecarga leve, 39% apresentaram ansiedade mínima e 73,2% não apresentaram sinais e sintomas de depressão. Correlações negativas foram observadas entre níveis de sobrecarga e a escolaridade materna (p=0,01), presença de sinais e sintomas de ansiedade e recebimento de auxílio financeiro (p<0,04) assim como da presença de sinais e sintomas de ansiedade e ter filhos com histórico de crises convulsivas (p=0,03). Conclusão: apesar do risco iminente de seus filhos serem novamente vítimas de um vírus epidêmico, mães que cuidam de seus filhos com SCZ não apresentaram comprometimento graves na saúde mental.

Abstract Objectives: to evaluate burden, frequency of anxiety and signs and symptoms of depression in mothers of children with congenital Zika syndrome (CZS) during the COVID-19 pandemic and the social isolation period. Methods: this is a cross-sectional study conducted with mothers who care for their children with CZS. The data were collected by an online form with questions regarding mother's socioeconomic conditions and questions related with Zarit burden scale and Beck's inventories on depression and anxiety. Spearman’s correlation tests and multiple regression analyzes were performed to assess factors related to mothers' burden and mental health. Results: 41 mothers were evaluated, 51.2% had mild burden, 39% had minimal anxiety and 73.2% did not have signs and symptoms of depression. Negative correlations were observed between levels of burden and maternal schooling (p=0.01), presence of signs and symptoms of anxiety and receiving financial aid (p<0.04) as well as the presence of signs and symptoms of anxiety and having children with seizures history (p=0.03). Conclusion: despite the risk of their children again being victims of an epidemic virus, mothers who care for their children with CZS did not present serious mental health impairments.

ABSTRACT Objective: To evaluate the quality of life of mothers of Brazilian children with congenital Zika virus syndrome (CZS) and associated factors. Material and Methods: This cross-sectional study assessed the quality of life (QoL) of 65 mothers of children diagnosed with CZS using the WHOQOL-bref questionnaire. Information related to mothers and children's characteristics and aspects of QoL (physical, psychological, social and environment domains) was collected. Data were presented using descriptive and inferential statistics. Associations between independent variables and quality of life outcome were carried out through bivariate analyses, adopting a 5% significance level. Results: The “physical” domain showed the highest score (65.98 ± 17.62), while the “environment” domain showed the lowest score (48.55 ± 14.75). The quality of life for the physical domain was associated with maternal schooling and child's sex, while the psychological domain was associated with family income and child's sucking difficulty. Conclusion: Socioeconomic characteristics and comorbidities were associated with mothers' QoL. Knowledge of QoL determinants and their impact on different dimensions of life can serve as a guide for interventions aimed at improving the QoL of this population.

BACKGROUND During routine Coronavirus disease 2019 (COVID-19) diagnosis, an unusually high viral load was detected by reverse transcription real-time polymerase chain reaction (RT-qPCR) in a nasopharyngeal swab sample collected from a patient with respiratory and neurological symptoms who rapidly succumbed to the disease. Therefore we sought to characterise the infection. OBJECTIVES We aimed to determine and characterise the etiological agent responsible for the poor outcome. METHODS Classical virological methods, such as plaque assay and plaque reduction neutralisation test combined with amplicon-based sequencing, as well as a viral metagenomic approach, were performed to characterise the etiological agents of the infection. FINDINGS Plaque assay revealed two distinct plaque phenotypes, suggesting either the presence of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains or a productive coinfection of two different species of virus. Amplicon-based sequencing did not support the presence of any SARS-CoV-2 genetic variants that would explain the high viral load and suggested the presence of a single SARS-CoV-2 strain. Nonetheless, the viral metagenomic analysis revealed that Coronaviridae and Herpesviridae were the predominant virus families within the sample. This finding was confirmed by a plaque reduction neutralisation test and PCR. MAIN CONCLUSIONS We characterised a productive coinfection of SARS-CoV-2 and Herpes simplex virus 1 (HSV-1) in a patient with severe symptoms that succumbed to the disease. Although we cannot establish the causal relationship between the coinfection and the severity of the clinical case, this work serves as a warning for future studies focused on the interplay between SARS-CoV-2 and HSV-1 coinfection and COVID-19 severity.

Resumo Objetivo: Avaliar a adiposidade visceral fetal e fatores associados na gestação. Métodos: Análise secundária de dados de coorte prospectiva com 172 pares (gestantes/fetos) atendidas em unidades públicas de saúde. Foram avaliadas nas gestantes na 16a, 28a e 36a semana gestacional: medidas antropométricas, metabólicas (glicose, hemoglobina glicada, insulina, resistência à insulina, colesterol total e frações, triglicerídeos), biometria fetal e adiposidade visceral e subcutânea no binômio (gestantes/feto) por ultrassonografia. Utilizamos o coeficiente de correlação de Pearson e regressão linear múltipla, com nível de significância de 5%. Resultados: Na 16ª semana a média de idade das gestantes foi de 26,6 ± 5,8 anos e peso 62,7 ± 11,5 quilogramas, 47,0% eram eutróficas, 28,3% sobrepeso, 13,3% baixo peso e 11,2% obesas. Na 36a semana, 44,1% tiveram ganho ponderal gestacional insuficiente, 32,5% adequado e 23,3% excessivo. A adiposidade visceral fetal na 36a semana apresentou correlação positiva com variáveis maternas: peso (r = 0,15) e índice de massa corpórea (r = 0,21) na 16a; com peso (r = 0,19), índice de massa corpórea (r = 0,24) e ganho ponderal gestacional (r = 0,21) na 28a; com peso (r = 0,22), índice de massa corpórea (r = 0,26) e ganho ponderal gestacional (r = 0,21) na 36a semana. Após regressão linear múltipla a adiposidade na 28a semana permaneceu associada com variáveis fetais: circunferência abdominal (p < 0,0001), circunferência cefálica (p = 0,01), área (p < 0,0001) e circunferência da coxa (p < 0,001). Na 36a semana com circunferência abdominal da 28a (p = 0,02) e 36a semana (p < 0,001). Conclusão: A adiposidade foi positivamente correlacionada com medidas da gestante, após análise multivariada a persistência da associação deu-se com a circunferência abdominal, medida de adiposidade central, de maior risco metabólico.

Abstract Objective: To assess fetal visceral adiposity and associated factors during pregnancy. Methods: Secondary analysis of prospective cohort data with 172 pairs (pregnant woman/fetus) treated at public health units. Anthropometric data, metabolic (glucose, glycated hemoglobin, insulin, insulin resistance, total cholesterol and fractions, triglycerides) measures, fetal biometry, and visceral and subcutaneous adiposity in the binomial (pregnant woman/fetus) were evaluated at the 16th, 28th and 36th gestational weeks by ultrasonography. Pearson's correlation coefficient and multiple linear regression were used, with a significance level of 5%. Results: At the 16th week, the mean age of the pregnant women was 26.6 ± 5.8 years and mean weight was 62.7 ± 11.5 kg; 47.0% had normal weight, 28.3% were overweight, 13.3% were underweight, and 11.2% were obese. At 36 weeks, 44.1% had inadequate gestational weight gain, 32.5% had adequate gestational weight gain, and 23.3% had excessive gestational weight gain. Fetal visceral adiposity at week 36 showed a positive correlation with maternal variables: weight (r = 0.15) and body mass index (r = 0.21) at the 16th; with weight (r = 0.19), body mass index (r = 0.24), and gestational weight gain (r = 0.21) at the 28th; and with weight (r = 0.22), body mass index (r = 0.26), and gestational weight gain (r = 0.21) at the 36th week. After multiple linear regression, adiposity at the 28th week remained associated with fetal variables: abdominal circumference (p < 0.0001), head circumference (p = 0.01), area (p < 0.0001), and thigh circumference (p < 0.001). At the 36th week, adiposity remained associated with the abdominal circumference of the 28th (p = 0.02) and 36th weeks (p < 0.001). Conclusion: Adiposity was positively correlated with the measurements of the pregnant woman. After the multivariate analysis, the persistence of the association occurred with the abdominal circumference, a central adiposity measurement with a higher metabolic risk.