COVID-19 y embarazo: Una aproximación en tiempos de pandemia / COVID-19 and pregnancy: An approach in times of pandemic

La enfermedad conocida como COVID-19 es causada por el virus SARS-CoV-2 y constituye una emergencia de la salud pública a escala global. Desde el informe sobre el primer caso en diciembre de 2019, en Whuan, provincia china de Hubei, la enfermedad se ha expandido rápidamente por el mundo y fue calificada como pandemia en marzo del presente año. El embarazo es un estado fisiológico que predispone a las mujeres a la infección viral. Más allá del impacto de la infección por la COVID-19 en una embarazada, existen preocupaciones relacionadas con el posible efecto sobre el resultado fetal y neonatal; por tanto, las gestantes constituyen un grupo que requiere atención especial en cuanto a prevención, diagnóstico y atención. En este trabajo se abordan aspectos relacionados con la infección por la COVID-19 y el embarazo.

The well-known disease COVID-19 is caused by SARS-CoV-2 virus and it constitutes an emergency of the public health at global scale. Since the report about the first case on December, 2019, in Whuan, Chinese province of Hubei, the disease has expanded quickly through the world and it was qualified as pandemic on March of the present year. Pregnancy is a physiological state that predisposes women to viral infection. Beyond the impact of the infection due to COVID-19 in a pregnant woman, there are concerns related to the possible effect on the fetal and neonatal result; therefore, the pregnant women constitute a group that requires special care as for prevention, diagnosis and care. Aspects related to the infection due to COVID-19 and pregnancy are approached in this work.

Neonatal lipopolysaccharide exposure induces sexually dimorphic sickness behavior in adult rats

The aim of the present study was to evaluate whether neonatal exposure to lipopolysaccharide (LPS; 50 µg/kg, i.p., on postnatal day 2) induces depressive- and/or anxiety-like effects and sexually dimorphic responses in rats challenged with LPS (100 µg/kg, i.p.) in adulthood. The results revealed that males presented a less depressive state in the forced swim test and exhibited no changes in general motor activity in the open field test. Females exhibited an increase in sickness behavior, revealing different behavioral strategies in response to a bacterial disease. The male rats also exhibited higher cell proliferation, reflected by bone marrow and peripheral blood counts, and female rats exhibited a decrease in corticosterone levels. No changes were observed in the elevated plus maze or peripheral cytokine levels (interleukin-1β and tumor necrosis factor-α). Neonatal exposure to LPS induced sexually dimorphic behavioral, neuroendocrine, and immune effects after an LPS challenge in adulthood, differentially affecting male and female susceptibility to disease later in life...

Prevalence of Hepatitis B Virus Infection among Egyptian Pregnant Women - A Single Center Study.

Background: Hepatitis B virus (HBV) infection still has a relatively high incidence and prevalence worldwide. In the post-vaccination era in developing countries, perinatal vertical transmission remains the most common mode of transmission. Prevention of mother-to-child transmission requires screening for HBV surface antigen (HBsAg) in pregnant women to identify which newborns that must be immunized. Aim: This study aimed to evaluate the prevalence of HBV infection among pregnant mothers who were attending outpatient clinic of the Obstetric Department, and Social and Preventive Medicine Center at Cairo University Hospital Campus, for routine antenatal care. Methods: A cross sectional study included 2,000 pregnant women. A rapid screening test for HBV “One Step HBsAg Rapid Test” was done for all women and all HBsAg-positive cases were confirmed by ELISA for HBsAg. A structured questionnaire for risk factors for HBV acquisition was filled for every pregnant mother positive for HBsAg and a control group of HBsAg negative mothers. Results: Out of 2,000 pregnant women, 35 (1.75%) were positive by the rapid test, out of whom 32/35 cases (91.43) were confirmed to be positive by the confirmatory test representing 1.6% of the study population. Family history of HBV, previous intravenous (IV) injections, medical clinic attendance, hospital admission, and surgeries were the risk factors for acquiring HBV infection (P-value=0.001, 0.003, 0.002, 0.000, and 0.011, respectively). Conclusion: HBV infection is prevalent among pregnant mothers attending our outpatient services. Therefore we recommend screening for HBV in all Egyptian pregnant mothers to prevent neonatal infection by immunoprophylaxis.

Perinatal infection and asthma in the infant / 国际儿科学杂志

Epidemiological and clinical studies have provided compelling evidence that suggests a link between the relative lack of infectious diseases and the increase in allergic disorders. Asthma usually starts early in life. The early occurrence of asthma suggests that prinatal influences are of importance.Prenatal or postnatal exposure to endotoxins and other bacterial products may protect against the development of asthma in the infant. We will briefly outline the current state of the relationship of the perinatal infection and asthma in the infant, and focus our review mainly on possible rneehanism of perinatal infection providing protection against asthma in the infant, such as Th1/Th2 immune system, transcription factors, protection by maternal antibodies, endotoxin tolerance, pulmonary inflammation and genetic influences.

The outcome of perinatal prophylaxis for HBeAg positive mothers according to the maternal HBV-DNA levels at the delivery time / 소아과

PURPOSE: Perinatal hepatitis B viral infection is decreasing; however, 10% of babies to HBeAg positive mothers still become chronic carriers despite perinatal prophylaxis. Although, the cause of prophylaxis failure is still unclear, an importance of maternal HBV-DNA level at the delivery time has been suggested. This study was established to certify if it would be a useful predictable factor for the outcome of perinatal prophylaxis. METHODS: Twenty-nine HBeAg positive mothers whose babies had known outcomes of prophylaxis were selected. To determine the amount of maternal HBV-DNA, a quantitative PCR was performed with the WHO International Standard for HBV DNA NAT assays. RESULTS: The mean logarithm HBV-DNA level of mothers with failed outcomes was significantly higher than that of mothers with succeessful outcomes (7.99 vs. 6.72, P=0.015). The predictable maternal HBV-DNA cut-off level to prophylaxis outcome was 2.83x10(7) copies/mL (100 pg/mL). None out of the case 16 (0%) who had below this level, and 5 out of 13 (38.5%) who had above this level of maternal HBV-DNA failed in perinatal prophylaxis. CONCLUSIONS: Mothers with higher levels of HBV-DNA at delivery time would be prone to a worse outcome of prophylaxis using the conventional approach. Perinatal prophylaxis failure rate can be reduced, if we try to introduce more potent prophylactic treatment into the cases with this risk factor.

Prevention of HIV/AIDS

The prevention of HIV infection is based on strategies that interrupt sexual, blood-borne, and perinatal transmission of the virus. Post-exposure prophylaxis using anti-retroviral therapy is recommended in case of mucosa or injured skin when exposed to blood, semen, vaginal/anal secretion, breast milk, or body fluid containing visible blood within no more than 72 hours. The combination of antiretroviral prophylaxis, elective caesarean delivery, and avoidance of breast feeding has reduced perinatal transmission to less than 2%. Because prophylactic chemotherapy does not guarantee perfect prevention and the adverse effects or toxicity of the drugs are considerably high, a subject who is willing to continue on with the highly risky behavior would not be a proper candidate for post-exposure prophylaxis. There is no evidence that a three-drug regimen is more likely to be effective than a two-drug regimen; however, the recommendation of a three-drug regimen is based on the assumption that the maximal suppression of viral replication will provide the best chance of preventing infection. The most frequently administered regimen is zidovudine (600 mg per day in two or three divided doses) and lamivudine (150 mg orally twice a day) for 4 weeks, with or without the addition of a protease inhibitor in selected cases.

Detección del virus de inmunodeficiencia humana tipo 1 mediante la PCR, en neonatos de madres seropositivas / Detection of type 1 human immunodefficiency virus through the PCR in newborns from seropositive mothers

Resumen El diagnóstico temprano de la infección por el VIH-1 en el recién nacido es importante para su manejo clínico oportuno. Los objetivos de este trabajo fueron la detección del ADN proviral del VIH-1 mediante la técnica de PCR en neonatos de madres seropositivas al VIH-1 y la determinación de los posibles factores de transmisión vertical por VIH-1 en la población estudiada. Se analizaron 214 muestras sanguíneas de niños entre 0 y 18 meses de edad, referidos al INHRR entre Septiembre 2005-Agosto 2006. Todas las muestras se colectaron de manera estéril con EDTA, las células mononucleares de sangre periférica se separaron mediante gradiente de HISTOPAQUE. Posteriormente el ADN proviral fue extraido mediante columnas de silica-gel (QIAGEN). La amplificación del material genético de cada muestra se efectuó por dos ensayos de PCR a dos rondas, utilizando iniciadores conservados de los genes env y gag del VIH-1. Se encontró ADN proviral del VIH-1 en un 8% (17/214 muestras) de la población infantil evaluada, de los cuales el 82,4% mostraron elevados niveles de carga viral (>5.0 log10). Se corroboró la utilidad de la PCR como herramienta molecular en el diagnóstico oportuno de infección perinatal por el VIH-1.

Abstract The early diagnosis of HIV-1 infection is important for the opportune management of these patients. Objectives of this work were detection of proviral HIV-1 DNA through the PCR technique in newborns from HVI-1 seropositive mothers and determination of the possible vertical HIV-1 transmission factors in the population studied. 214 blood samples taken from children aged between 0 and 18 months referred to the INHRR during the September 2005-August 2006 period. All the samples were mixed with EDTA under sterile conditions. Peripheral blood mononuclear cells were separated by an HISTOPAQUE gradient. Later, the proviral DNA was extracted through silica-gel columns (QIAGEN). The amplification of the genetic material of each sample was obtained through two PCR determinations in two stages, using initiators conserved from env and gag HIV-1 genes. Proviral HIV-1 DNA was found in 8% (17/214) of the samples of the child population evaluated, 82.4% of which showed elevated viral load levels (>5.0 log10). The usefulness of PCR as a molecular tool for the opportune diagnosis of perinatal HIV-1 infection is corroborated.

The Incidence Rate of Hepatitis B Virus Surface Gene Variants in Korean Children with Immunoprophylaxis Failure of Perinatal Infection / 대한간학회지

BACKGROUND/AIMS: Perinatal infection with hepatitis B virus (HBV) may occur despite immunoprophylaxis. One of the important mechanisms for perinatal prophylaxis failure, might include HBV surface gene variants. Therefore, we screened Korean children, in whom perinatal prophylaxis failed, for HBV surface gene variants. METHODS: Thirty-one children with perinatal HBV prophylaxis failure were selected. To amplify the major hydrophilic region of the HBV surface gene, nested PCR with primers targeted to nucleotides 237 to 706 was performed, and then sequencing was done. RESULTS: All cases were shown to be PCR positive for HBV-DNA and genotype C. Nine out of 31 (29%) with perinatal prophylaxis failure had a nucleotide substitution at the major hydrophilic region of the gene; but only two cases (6.5%) had an amino acid substitution. One case was infected by wild type and variants of I126S, and the other by wild type and S114A+I126S, respectively. CONCLUSIONS: In Korea, compared to the previous studies of other nations, gene surface variants such as G145R do not appear to play an important role in perinatal immunoprophylaxis failure.

Perinatal Hepatitis B Virus Infection: Viral Factors in the Mechanism of Perinatal Immunoprophylaxis Failure / 소아과

Perinatal hepatitis B virus(HBV) infection may occur despite combined immunoprophylaxis with hepatitis B immunoglobulin and vaccines. Although the mechanism of perinatal prophylaxis still has been obscure, it could be due to:in utero infection; host factors as the personal immunological differences of HLA or cytokine gene; viral factors as a high maternal HBV-DNA level or the presence of surface gene variants; or other factors as the differences of composition, quality, dosage, frequencies, timing and injection site of HBV vaccine or immunoglobulin. To investigate the clinical significance of variant in HBV surface gene in Korea, DNA sequence analysis of the major hydrophilic region was performed and reviewed the related articles. The variant rate observed in perinatal HBV immunoprophylaxis failure children in comparison to other studies was 6.45% versus 14-40%. And perinatal infection could be prevented by immunoprophylaxis in children, even though mothers had infection with variants in HBV surface gene. These findings suggest that the variants on the surface gene are not playing an important role in perinatal immunoprophylaxis failure in Korea. Also, a fact that the higher maternal DNA level was strongly associated with immunoprophylaxis failure was demonstrated. Therefore, the conditions, like maternal viral composition, the degree of maternal DNA level, the status of host immune system should be associated with the outcome of immunoprophylaxis in perinatal infection simultaneously.

The Hepatitis B Carrier Rate in Siblings of Patients with HBV-associated Chronic Liver Disease / 대한간학회지

Backgrounds/Aims: This study aimed to estimate the seroepidemiology of hepatitis B virus (HBV) infection with emphasis on the transmission of HBV infection between mothers and their children. METHODS: For 452 patients with HBV associated chronic liver disease, and 1,098 of their offspring, who visited Korea University Kuro Hospital from February, 2000 to February, 2001, HBsAg was tested by radioimmunoassay. RESULTS: Among siblings whose mothers were HBsAg-positive, the overall prevalence rate of HBV infection was 44.9% (140/312) and decreased with decreasing age (54.7% in > or =20 years old age group, 33.3% in 10-19 years old age group, 7.6% in <10 years old age group). The estimated proportion of perinatal infection out of modes of HBV transmissions in the general population was 38% in <10 years and 63.4% in 10-19 years. CONCLUSION: The present hepatitis B vaccination strategies -especially against perinatal infection- of Korea have performed to their utmost. More effective methods for the prevention of HBV transmission are now needed.

Diagnóstico de infecção congênita e perinatal por citomegalovírus utilizando a reação em cadeia da polimerase / Diagnosis of congenital and perinatal infection by cytomegalovirus using polymerase chain reaction

Aplicou-se uma reação em cadeia da polimerase (PCR) no diagnóstico de infecção congênita e perinatal por citomegalovirus, comparando-a com a técnica de isolamento viral em cultura celular. Foram processadas 305 amostras de urina de crianças de 0 a 6 meses, por ambas as técnicas. Utilizou-se na PCR os primers que amplificam parte do gene codificador do principal antígeno precoce imediato de CMV. Detectou-se virúria em 47 amostras por PCR e comparando os resultados com aqueles obtidos pelo isolamento viral, observou-se copositividade de 89,6% e conegatividade de 98,5%. Estas amostras positivas tiveram o resultado confirmado por PCR utilizando outros primers que amplificam regiões dos genes codificadores das glicoproteínas B e H de CMV. O diagnóstico de infecção congênita e perinatal por CMV pela PCR mostrou sensibilidade comparável à do isolamento viral e o uso de vários primers conferiu alta especificidade ao teste.

The practical application of a polymerase chain reaction (PCR) amplification for the diagnosis of congenital and perinatal cytomegalovirus (CMV) infections was evaluated. Three hundred five urine samples were tested by PCR and conventional virus isolation in cell culture. Viruria was detected in 47 urine samples by PCR using a primer pair which amplifies part of the major immediate-early (MIE) CMV genome. The PCR compared to virus isolation showed 89.6% sensitivity, 98.5% specificity and 91.5% positive predictive value. PCR with primer pairs amplifying parts of the glycoprotein B and glycoprotein H genes of CMV were used for confirmation of the positivity of the 47 urine samples. We concluded that this CMV PCR assay in urine has a suitable sensitivity for the diagnosis of congenital and perinatal infections and its specificity is highly increased by use of more than one pair of primers among the ones we used.

Frecuencia de aislamiento de streptococcus agalactiae en un grupo de embarazadas y sus productos / Frequency of isolation of streptococus agalactiae in pregnant women and their offspring

Se estudiaron 86 madres y 61 de sus recien nacidos con el fin de determinar la frecuencia de aislamiento de Streptococcus agalactiae (esptreptococo beta hemolitico del grupo B); no se aislo el germen de ninguno de los cultivos tomados de las secreciones del cuello uterino pero si a partir de las muestras faringeas, en tres de las madres (3.4%) y en dos de sus hijos. El tercer nino no se estudio porque su nacimiento ocurrio por cesarea. Las cifras encontradas en el presente trabajo estan de acuerdo con lo que relata la literatura, pero el bajo numero de casos estudiado no permite hacer consideraciones epidemiologicas mas profundas

A group of 88 pregnant women and 61 of their newborn Infants was studied In order to determine the frequency of isolation of Streptococcus agalactiae; all genital maternal cultures were negative but 3 mothers and 2 Infants had positive pharyngeal secretions; no evidence of streptococcal disease was found in the colonized Infants. The frequency of colonization found in this study agrees with that reported by other authors but the reduced number of cases does not allow In depth epidemiological considerations.