Mother-to-newborn transmission of mycobacterial L-forms and Vδ2 T-cell response in placentobiome of BCG-vaccinated pregnant women.

The ability of bacteria to exist as a population of self-replicating forms with defective or entirely missing cell wall (L-forms) is an adaptive mechanism for their survival and reproduction under unfavorable conditions. Bacterial mother-to-fetus transfer is a universal phenomenon in the animal kingdom. However, data about vertical transfer of L bacterial forms are extremely scarce. Bacille Calmette-Guérin is an attenuated strain of M. bovis and the only licensed vaccine used for tuberculosis prevention. We already have shown that filterable L-forms of BCG exist freely in the vaccine and are able to reproduce and to form colonies. The present study was focused on the placental microbiome in the context of mother's BCG vaccination. Here we report an isolation of filterable mycobacterial L-form cultures from gestational tissues and blood of healthy newborns delivered by healthy BCG-vaccinated mothers after normal pregnancy. Of note, vertically transmitted mycobacterial L-forms as a part of placentobiome of the pregnant women didn't influence the number of resident pathogen-reactive Vδ2 cells. Placenta colonization with mycobacterial L-forms occurs by maternal blood-to-decidua transfer very early in gestation. Together, these data showed that BCG L-forms have the capacity to pass trans-placental barrier and that maternal BCG vaccination affects the placentobiome.

Differential MS2 Interaction with Food Contact Surfaces Determined by Atomic Force Microscopy and Virus Recovery.

Enteric viruses are recognized as major etiologies of U.S. foodborne infections. These viruses are easily transmitted via food contact surfaces. Understanding virus interactions with surfaces may facilitate the development of improved means for their removal, thus reducing transmission. Using MS2 coliphage as a virus surrogate, the strength of virus adhesion to common food processing and preparation surfaces of polyvinyl chloride (PVC) and glass was assessed by atomic force microscopy (AFM) and virus recovery assays. The interaction forces of MS2 with various surfaces were measured from adhesion peaks in force-distance curves registered using a spherical bead probe preconjugated with MS2 particles. MS2 in phosphate-buffered saline (PBS) demonstrated approximately 5 times less adhesion force to glass (0.54 nN) than to PVC (2.87 nN) (P < 0.0001). This was consistent with the virus recovery data, which showed 1.4-fold fewer virus PFU recovered from PVC than from glass after identical inoculations and 24 h of cold storage. The difference in adhesion was ascribed to both intrinsic chemical characteristics and the substrate surface porosity (smooth glass versus porous PVC). Incorporating a surfactant micellar solution of sodium dodecyl sulfate (SDS) into the PBS reduced the adhesion force for PVC (∼0 nN) and consistently increased virus recovery by 19%. With direct and indirect evidence of virus adhesion, this study illustrated a two-way assessment of virus adhesion for the initial evaluation of potential means to mitigate virus adhesion to food contact surfaces.IMPORTANCE The spread of foodborne viruses is likely associated with their adhesive nature. Virus attachment on food contact surfaces has been evaluated by quantitating virus recoveries from inoculated surfaces. This study aimed to evaluate the microenvironment in which nanometer-sized viruses interact with food contact surfaces and to compare the virus adhesion differences using AFM. The virus surrogate MS2 demonstrated less adhesion force to glass than to PVC via AFM, with the force-contributing factors including the intrinsic nature and the topography of the contact surfaces. This adhesion finding is consistent with the virus recoveries, which were determined indirectly. Greater numbers of viruses were recovered from glass than from PVC, after application at the same levels. The stronger MS2 adhesion onto PVC could be interrupted by incorporating a surfactant during the interaction between the virus and the contact surface. This study increases our understanding of the virus adhesion microenvironment and indicates ways to mitigate virus adhesion onto contact surfaces.

[THE ROLE OF MOTHER'S MILK AND BREAST FEEDING. MEDICAL PROBLEMS DURING THE LACTATION PERIOD LACTOBACILUS FERMENTUM--A NEW APPROACH TOWARDS THE PREVENTION AND THE TREATMENT OF ACUTE AND SUBACUTE MASTITIS].

Breast feeding provides a lot of short and long-term benefits for the mother and the baby. It prevents the baby of gastrointestinal, urinary and respiratory infections, atopical conditions and assures long-term protection of cardiovascular and metabolic diseases. The breast feeding decreases the risk for the mother of ovary and breast carcinoma and creates a positive emotional bond between the mother and the baby Mother's milk is a species specific; its content is relatively stable regardless of mother's age race, way and place of living. Mother's milk is not sterile. There is a 10 year international trial held in Spanish and Finnish universities. It has identified and count all microorganisms in mother's milk (more than 700) and proved that their content and quantity varies according the age of the baby. Mother's milk is a source of lactobacillus for baby's intestines and most of them have probiotic potential. Lactobacillus fermentum Lc40 (hereditum) is isolated from mother's milk. It has a good viability in gastrointestinal system, high level of adhesion to intestinal epithelium cells, produces glutation--strong antioxidant, good antibacterial activity to entero-pathogens and potential of increasing the immunologic response. Clinical trials reveal that Lactobacillus fermentum plays important role to microflora balance of mother's milk in mastitis during lactation. Many trials estimating the efficiency of lactobacillus fermentum in prevention and treatment of acute and subacute mastitis have been carried out. The results of them open a new door in front of us in the treatment of these conditions--treatment with probiotics instead of antibiotics.

[ULTRASOUND OF THE PLACENTA. NORMAL FINDINGS AND PLACENTAL ABNORMALITIES: A REVIEW.]

The placenta has a fundamental role for fetal growth and health throughout pregnancy. Normal placental function is essential for a healthy pregnancy outcome. A complete ultrasound survey at any stage of the pregnancy should include full assessment of the fetus and placenta. Timely detection of placental abnormalities cbn give the clinician the opportunity to make important management decisions. The primary aim is healthy pregnancy outcome. Prenatal diagnosis and correct obstetric managment reduce fetal and maternal morbidity and mortality. Familiarity with the normal and abnormal imaging appearance of the placenta is therefore necessary for the obstetrician. Despite the fundamental role of the placenta for the pregnancy outcome, ultrasound examination of the placenta is often considered secondary to the fetus. Location, size, shape and architecture are easily ascertained with two-dimensional techniques. Three-dimensional techniques and Doppler techniques are more detailed methods for evaluation uteroplacental structure and function.

[VITAMIN D AND PREGNANCY].

This arcicle reviews the role of vitimin D during pregnancy. Adequate intake of vitamin D during pregnancy is very important for the health of mother and infant. A number of epidemiological data worldwide show widespread suboptimal levels of vitamin D in pregnant women. Vitamin D deficiency may be associated with an increased risk of infection, bacterial vaginosis, pre-eclampsia, low serum vitamin D levels in the newborn and others. There are not universal recommendations for dosage and intake of vitamin D for pregnant women in the world. It is recommended that serum level of vitamin D in all pregnant women and its adequate supplementation. Normal maternal vitamin D levels would provide sufficient its accumulation in the fetus.

[Hyperandrogenism in multiple pregnancy].

Hyperandrogenism caused by pregnancy is an extremely rare condition. One of the most common reasons is the hyperreactio luteinalis (LH). The literature describes 51 cases of LH where 8 of them have occurred during spontaneous multiple pregnancy. LH is a result of increased serum concentrations of human chorion gonadotropin (ß-hCG) and increased receptors' sensitivity to ß-hCG. It is characterized by a typical ultrasound image: most often bilaterally massively enlarged ovaries that consist of many of thin-walled small theca-lutein cysts, giving it the appearance of a "spoke wheel". We present a case of a 36 year old woman pregnant for the first time with spontaneously occurred twin pregnancy, who has hyperandrogenism and high blood pressure resistant to therapy. The conducted imaging studies showed enlarged polycystic ovaries resembling cancerous ovarian neoplasia. Recognition of this condition is important as radical surgery, resulting in removal of the ovaries is wrong and incorrect.

[Identification the risk of preterm labor :the role of fetal fibronectin].

UNLABELLED: Fibronectins represent a group of glycoproteins, which form "molecular glue" and are necessary in the interaction between a cell and a cell. The existence of fetal fibronectin in pregnant woman's vagina up to 22 g.w. is normal. In a normally proceeding pregnancy between 22 g.w. and 35 g.w. there is not supposed to be found fetal fibronectin in cervico-vaginal secretion. Its presence is a highly informative biological marker for the risk of premature birth. AIM: The aim of this research was to determine the risk for premature birth through applying fetal fibronectin test as a specific marker to pregnant women with or withthout symptoms of threatened birth. METHODS: A prospective longitudinal study has been carried out. The tests have been applied to hospitalized patients in University hospital "Majchin dom", Clinic of Pathologic pregnancy and Delivery room. Tests have been applied on 116 patients in totally). The pregnant have been separated in two groups depending on the fact of presence or absence of premature birth symptoms. The screening methods used were: the fFN test and the cervical length measurement by transvaginal according to an established protocol. CONCLUSION: From the total of 116 patients, in 78 we have received positive tests for fetal fibronectin; in 38 - negative test. With asymptomatic patients, having higher risk of preterm birth, the percent of positive tests has been lower (14%). With asymptomatic patients with higher percent of risk factors have been: short cervix (38%), multiple pregnancy (29%), followed by patients with diagnosis of preterm birth in the past (25%) and bleeding in earlier terms. Estimating positive and negative predictive rate, we have achieved following results: The test for fetal fibronectin has excellent predictive rate - 97%, which coincides with the great deal of research until this moment in the world. Referring to the positive predictive rate--it is not sufficient--only 19%.

[CASE REPORT OF FETAL ASCITES CAUSED BY PRENATAL PERFORATION OF BOWEL].

The detection of isolated ascites is a rare ultrasound finding. A precise examination should be undertaken in all cases fetal ascites. This include following a systematic protocol for diagnosis. The prognosis of the newborn in case of prenatal diagnosed ascites, depends on the etiology of the ascites. This is a case report of 40 years old pregnant women, at 34 weeks of gestation. During routine ultrasound examination at 33 weeks of gestation fetal ascites, has been diagnosed. The aim of our team was to examine the etiology of the ascites. We performed systematic diagnostic test and series of ultrasound examination, which helped us to diagnose fetal ascites, caused by bowel perforation. The good timing of delivery and postnatal surgical treatment were associated with good neonatal outcome. In cases of prenatal diagnosed ascites, the desirable good neonatal outcome requires multidisciplinary approach and team work of obstetric consultant, fetal medicine consultants, neonatologists and pediatric surgeons. However the parents should be counselled that not all of the associated anomalies could be diagnosed prenatally.

[ACUTE ABDOMEN CAUSED BY COMPLICATED FIBROID IN PREGNANCY. CASE REPORT].

With the advancing maternal age the rate of fibroids in pregnancy is also growing. A small part of fibroids in pregnancy are complicated and in about 2.6% necessitate urgent surgical treatment. We present a clinical case of subserose fibroid at 20 gestational weeks complicated with acute abdomen treated urgently with normal continuation of pregnancy.

[Perinatal mortality of IUGR neonates].

This study was conducted to evaluate the role of intrauterine fetal growth restriction (IUGR) in the perinatale mortality. A prospective study was designed, including 329 consecutive singleton pregnancies between 24 to 40 weeks' gestation, whose body weight is under 10th percentile for the gestational week. The control group consist of 530 appropriate for the gestational week (AGA) in the same period of gestation. The fetuses are without inborn malformations. The results show grater stillbirth rate in the group of hypotrophic than in the eutrophic neonates. In the group under 27th week of gestation is 2.6% forAGA and 8.3% for IUGR, for the group between 28-31 w.g. is 9.6% and 21.1% respectively and for 32-35 wg. is 2.3% against 13.1%. Perinatal mortality rate (stillbirth and demised before discharged) for the group before 27th w.g. is 65.8% for AGA and 72.2% for IUGR (P > 0.05). Between 28-31 w.g. is 28.4% and 50.0%, for 32-35 is 6.9% and 27.8% respectively (P > 0.01). After 37th w.g. perinatal mortality rate is less in AGA than in SGA fetuses. In conclusion the stillbirth rate is more frequent in IUGR fetuses than in AGA and frequencies is more pronounce in late preterm pregnancy. The fetal hypotrophy has deleterious effect on neonatal survival rate.

[Identification of preterm labor: the role of fetal fibronectin in parents with symptoms].

AIM: To determine whether the presence of fetal fibronectin in vaginal secretions of patients with symptoms suggestive of preterm labor predicts preterm delivery. Fetal fibronectin, a large molecular weight glycoprotein produced in the chorion, is expressed in cervical and vaginal secretions in women with disruption of the choriodecidual junction by labor or by inflammation. METHODS: A prospective observational longitudinal study from January 2013 till December 2013 was performed on patients between 24 and 32 weeks of gestation with symptoms of preterm labor, intact membranes, and cervical dilation < 4 cm (total patients = 86). The endpoint was the delivery at 34 weeks or more. The screening methods used were: the fFN test and the cervical length measurement by transvaginal according to an established protocol. CONCLUSION: The presence of FFN in vaginal or cervical secretions before 35 weeks is a is a strong predictor that preterm delivery is unlikely within the next 7 to 14 days. The predictive power of FFN is stronger at earlier gestation ages (24-29 wks) than it is later in pregnancy and is stronger for short-term prediction (7-14 d).

[The pregnancy outcome in patients WITH ß-thalassemia minor].

UNLABELLED: Thalassemia syndromes are heterogenic group hereditary hemoglobinopathies, provoking chronic hemolytic anemia. They affect approximately 100 million people, mostly in the Mediterranean (including Bulgaria), South-eastern Asia and Africa. Thalassemia syndromes are the second reason for hypochromic anemia and anemia in pregnancy after iron deficiency. OBJECTIVE: To determine pregnancy outcome of women with ß-thalassemia minor. MATERIALS AND METHODS: It is an ambispective study in University Hospital of Obstetrics and Gynecology" Maichin dom", Sofia, for a year. Patients are divided in two groups regarding the presence of ß-thalassemia minor. Preeclampsia, gestational diabetes mellitus, olygo- and polyhydramnion, preterm labor intrauterine growth retardation (IUGR), Cesarean section delivery are recorded in study groups. RESULTS: Cases with ß-thalassemia minor have significantly higher prevalence of oligohydramnion and Cesarean section delivery. There is no significant difference regarding Apgar score in 1st and 5th minute, IUGR, gestational diabetes mellitus and preeclampsia between two study groups. CONCLUSION: ß-Thalassemia minor does not significantly influence the pregnancy in negative way.

[The influence of pregnancy on the systemic lupus erythematosus].

Systemic lupus erythematosus (SLE) is an autoimmune disease caused by the interaction between genetic and environment factors which leads to abnormal immune responses. SLE affects more commonly women of childbearing age which raises the following questions--the influence of the disease activity on pregnancy and the influence of pregnancy on disease activity. On the one hand physiological changes occurring during pregnancy could lead to increased SLE activity, on the other hand the latter could mimic SLE activity. Differentiating these manifestations is important for the clinical practice--pregnancy and delivering guidance and SLE therapy.

[Uterine scar after caeserean section- predicting the risk of uterine rupture and decision on the way of delivery].

The Cesarean section rate in University Maternity Hospital 'Maichin dom' is 46 to 48%. The rate of repeated Cesarean section is also increasing. However there is an increasing number of women wishing to deliver vaginally after having had a Cesarean section for their first baby. On the other hand, with postponing pregnancy, increasing number of woman nowadays experience surgeries on their uterus prior to giving birth. With regards to the above-mentioned, pregnancy in scarred uterus is a common thing. Examining the uterine scar gives valuable information for the risk of uterine rupture during pregnancy and the decision making on the safest way of delivery. The current article shows ultrasound pics of uterine scar in pregnant and non-pregnant uterus. Gives recommendations for the timing of the US examination and the reference range for thickness of the uterine scar (residual myometrial thickness) in the view of the risk of rupture and the safest way of delivery. All this information is based on the most recent clinical trials.

[Diagnosis and treatment of lichen sclerosus--review].

UNLABELLED: Lichen sclerosus (LS) is a chronic skin disease of the vulva which affects mostly women in the postmenopausal period. The disease affects also men and children. Its frequency is from 1/70 up to 1/1000, whereas for women it is 10 times more frequently. The disease has unknown etiology. Due to the high frequency of accompanying, autoimmune diseases, it is presumed that this disease is a result of immunological processes. Some of patients diagnosed with LS have vulvar intraepithelial neoplasia, while 0.3% - 4.9% of them have squamous cell carcinoma. The aim of this review is to summarize our knowledge regarding the frequency, clinical features, diagnosis and therapy of LS in view of the prevention of the complications that may occur. MATERIAL AND METHODS: We researched the available literature and Medline on the topic for the period of 1971 until 2014 year. We summarized the most interesting, contemporary and scientifically substantiated facts regarding this disease. DISCUSSION: Early diagnosis, the proper and timely treatment, as well as the continuous follow up the patients with LS is mandatory due to the fact that the spontaneous remission is extremely rare and the complications may lead to significant deterioration of the quality of life.

A study on early-onset neonatal group B streptococcal infection, Bulgaria, 2007-2011.

This study examines neonatal group B streptococcal (GBS) colonization and its relation to early-onset GBS disease (EOGBSD), based upon the experience of leading obstetrics and gynecology centers in Bulgaria. The objectives of the study were to update neonatal colonization rates and to assess relationships between clinically differentiated cases (culture-proven GBS newborns) and risk factors inherent to the infant and mother, using a computerized file. The neonatal GBS colonization rate ranged from 5.48 to 12.19 per 1000 live births. Maternal-fetal infection (MFI, a provisional clinical diagnosis in culture-proven colonized infants with initial signs of infection that is usually overcome with antibiotic treatment) and/or intrapartum asphyxia (IA) have been demonstrated as the most frequent clinical manifestations, with significant correlations for the primary diagnosis, but not affirmative for the final diagnosis at discharge, resulting from adequate treatment of neonates. MFI and IA were significantly related to prematurity, and reciprocally, prematurity was associated with the risk of MFI, indirectly suggesting that preterm birth or PPROM (preterm premature rupture of membranes, an obstetric indication associated with early labor and delivery, one of the major causes of preterm birth) is a substantial risk factor for EOGBSD. The regression analysis indicated that in the case of a newborn with MFI, a birth weight 593.58 g lower than the birth weight of an infant without this diagnosis might be expected. Testing the inverse relationship, i.e., the way birth weight influences a certain diagnosis (logistic regression) established the presence of a relationship between birth weight categories (degree of prematurity) and the diagnosis of MFI. The proportions and odds ratios, converted into probabilities that a baby would develop MFI, indicate the particularly high risk for newborns with extremely low and very low birth weight: extremely low birth weight (≤1000 g), the probability of developing a MFI is 66%; very low birth weight (1001-1500 g), 81%; low birth weight (the birth weight category including premature and small for gestational age term infants: 1501-2500 g), 40%; normal birth weight (term infants) (>2500 g), 32%. In conclusion, the need to introduce separate categories for early- and late-onset GBS disease in the registration nomenclature of neonatal infectious diseases is highlighted by these results. Drawing up intrapartum antibiotic prophylaxis (IAP) guidelines is also strongly recommended.

Prevalence and diagnostic significance of specific IgA and anti-heat shock protein 60 Chlamydia trachomatis antibodies in subfertile women.

The objective of the present study was to evaluate the clinical usefulness of the simultaneous measurement of three serological markers of chlamydial infection in women with tubal factor infertility (TFI) and spontaneous miscarriage. Serum was collected from 87 patients (33 with TFI and 54 with spontaneous miscarriage) and analyzed for the presence of IgG and IgA antibodies against Chlamydia trachomatis MOMP antigen (Dia.Pro) and IgG antibodies to chlamydial heat shock protein 60 (cHSP60) antigen (Medac). We determined a high degree (64.5 %) of seropositivity against chlamydial antigens in our study population. The prevalence of persistent chlamydial infection has tended to be higher in the group of patients with TFI (41.4 %) than in patients with spontaneous miscarriage (21.3 %). The serum level of IgA, as a marker of active infection, was statistically higher in the TFI group with persistent infection than in the corresponding spontaneous miscarriage group (p = 0.008), while the serum level of IgG showed no statistically significant differences compared with the spontaneous miscarriage group with persistent infection (p = 0.227). Also, using the receiver operating characteristic (ROC) curve, we found that the serum level of IgA has the ability to discriminate patients with persistent chlamydial infection between the TFI and miscarriage groups, with a sensitivity and specificity of 74.3 % and 71.4 %, respectively. To the best of our knowledge, the present study is the first study which, besides the already confirmed linkage between serologic evidence of persistent chlamydial infection and TFI, also confirmed associations between spontaneous miscarriage and serologic evidence of persistent chlamydial infection.

[Socio-demographic characteristics and vitamin D status in women born before 32 weeks'].

UNLABELLED: Deficiency of vitamin D (25-OHD) is a health problem among prematurely born women and their newborns independently of the geographical location of the country. OBJECTIVES: To study serum levels of vitamin D in patients born before 32 weeks and their newborns at birth. To analyse the socio-demographic factors, complications of pregnancy and their relationship with vitamin D status of women. PATIENTS AND METHODS: The study has been carried out in the University hospital "Maichin dom" Sofia for the period August 2013-January 2014. 35 women who gave birth before 32 gestational week and their 41 newborns with birth weight < 1500g have been investigated. The serum level of vitamin D (25-OH D) in mother-infant pairs at birth and 8 weeks of age in infants has been investigated. The ECLIA method has been used. Serum levels of vit D (25-OHD) have been estimated as sufficient:(> 30 ng/ml), insufficient (21-29ng/ml) and deficient (< 20 ng/ml). RESULTS: At delivery according to their vit D (25- OHD) serum levels 63% of the mothers are defficient /12.61 ± 4.8 ng/ml/, 28.5% are insufficient/26.66 ± 2.59/and only 8.5%/40.4 ± 8.48/sufficient with normal levels of vitamin D. For newborns data are respectively 32%/ 20.08 ± 3.69/-deficient, 49%/27.39 ± 2.70/- insufficient and 19 %- sufficient/41.6 + 10/ There is a positive correlation between mother's and children's serum levels of vitamin D (25- OHD). Statistical significant differences are observed in the levels of vitamin D and the presence of infection and preeclampsia in the mothers. During the period of the study there were no seasonal variations in vit D (25-OHD) serum levels of mother-baby pairs. All newborns received Vit D3 1334 IU/daily from 20th day of age. At eight weeks of age sufficient levels of vitamin D have 70% of the children, but 30% of the newborns remains with inadequate supplementation/27.09 ng/ml/. CONCLUSION: 91.5% of mothers are with insufficient serum levels of vitamin D (25OHD) at birth, and a deficit is present in 63% of all women. Only in 8.5% of the women had normal values. This implies more effective monitoring and vitamin D prophylaxis during pregnancy.

[Preliminary results of fetal fibronectin testing in twin pregnancies].

OBJECTIVES: Purpose of this study is to investigate accuracy of fetal fibronectin testing (fFN test) as a means to predict preterm birth in twin gestations without symptoms of preterm labour as well as to compare the results with the world trends. MATERIAL AND METHODS: This study is prospective and comparative. It covers a period from December 2012 to May 2013, includes a total of 43 twin pregnancies--34 bichoriotic biamniotic twin pregnancies, 6 monochoriotic biamniotic twin pregnancies and 3 monochoriotic monoamniotic twin pregnancy A measurement of cervical length by transvaginal ultrasonography is used as well. RESULTS: A total of 43 women had cervico-vaginal fetal fibronectin testing obtained from 24 to 34 weeks of gestation. 31 women had negative fFN test and 12 had positive results. In patiens with negative testing delivery began after a period of 30 days average. In most of the women with negative test result labour occurred after more than 14 days, which means that the test has high specificity. Patients with positive test result had delivery after a mean period of 12 days, which demonstrated that the fetal fibronectin test has high sensitivity The shortest period between the positive testing and delivery was one day A transvaginal ultrasound measurement of the cervical length was performed. Four of our patients had positive test result as well as short cervix and delivery occurred at a mean age of 31 w.g. and 5 days after the test. Four women tested positive for fFNA and had normal cervical length. They had labour at 35+3 w.g. and 23 days after the test. Eight patients tested negative for fFN and had short cervical length, but they had labour after 28 days as well. Most of the researched women (19) had negative test result and normal cervical length and they delivered after average 30 days. CONCLUSIONS: Fetal fibronectin testing used in twin pregnancies as well as in singleton pregnancies proves to have high specificity sensitivity, good positive and negative predictive value. It offers the opportunity for adequate tocolytic therapy once the test comes out to be positive. There is a posibility to decrease the use of corticosteroids. The length of stay in the hospital can also be reduced.