Mother-to-child Transmission Research Articles

Outcomes of Fetal Malpresentation Beyond 28 Weeks of Gestation at a Tertiary-Level Hospital

Background: The term malpresentation encompasses any fetal presentation other than vertex, including breech, face, brow, shoulder, and compound presentations. Both fetal and maternal factors contribute to the occurrence of malpresentation. Objective: To determine the outcomes of fetal malpresentation beyond 28 weeks of gestation at a tertiary-level hospital. Material and Methods: It was a cross sectional descriptive type of observational study carried out in the Department of Obstetrics & Gynaecolgy, Mymensingh Medical College Hospital, Mymensingh during the period of March 2019 to August 2019.Structured questionnaire including history and physical examination of pregnant women were included in data collection sheet-and analysis was done by computer software SPSS version 20. Results: This study shows majority of the women 20(40%) were in the age group of 26-30 years. The average age was 29.9 years. The common fetal malpresentation was breech presentation 35(70%) followed by5(10%) was brow presentation, 5(10%) was shoulder presentation and 3(6%) was compound presentation and maximum seen in multiparity 20(40%) Regarding mode of delivery, 15(30%) delivered vaginally and 35(70%) had to do caesarean section. 13(26%) women suffered from complication during labour. Most common fetal morbidity were birth asphyxia 10(20%) and perinatal mortality was 2(4%). Conclusion: It was observed that major fetal morbidities were low birth weight, birth asphyxia and perinatal infection. Majority patients were delivered by caesarean section. Identification of the cases that require caesarean section, and allowing appropriate and safe trial of labour and vaginal delivery (if no contraindication) require clinical experience and technical skill. The obstetricians should acquire and maintain such knowledge through clinical exposure and attending obstetric emergency skill courses.

RISK FACTORS FOR THE DEVELOPMENT OF PLACENTAL DYSFUNCTION ON THE BACKGROUND OF PREGNANT WOMEN GENITAL INFECTIONS

The progress of perinatology revealed new problems related to the gestational process and antenatal protection of the fetus. Among indicators of perinatal morbidity in modern conditions, one of the leading places occupied by placental dysfunction, the frequency of which, according to the data of domestic and foreign scientists ranges from 36% to 60%. It is known that among the many factors that affect the complicated course of pregnancy and perinatal morbidity, infectious factors in modern conditions occupy one of the leading places. Despite certain achievements in elucidating the etiological factors and pathogenesis of the development of placental dysfunction (PD), the issues of diagnosis and treatment of this pathology in pregnant women need further improvement. Thus, the study of links in the pathogenesis of manifestations of placental dysfunction, which develops during pregnancy in the early stages of gestation against the background of genital infections, is relevant and promising.The purpose. To assess the risk factors for the development of placental dysfunction in pregnant women with genital infections.Material and methods. The retrospective comparative study included 55 women who gave birth after involuntary childbirth according to the regional perinatal center of Chernivtsi, who had signs of placental dysfunction and genital infections during pregnancy during the period 2021-2022.Research results. One of the most important factors affecting the fetoplacental system, which leads to the development of chronic PD (CPD), are infections of the TORCH group. Infections during pregnancy, depending on the gestational period, lead to miscarriage, abortion, stillbirth, malformations of the child, cerebral defects, as well as to acute and chronic neonatal diseases. We conducted a retrospective analysis of risk factors, the frequency and structure of obstetric complications based on the data of 55 birth stories of the regional perinatal center in Chernivtsi for 2021-2022. Manifestations of placental dysfunction against the background of genital infections were studied at different gestational periods. Placental dysfunction occurs at different gestational periods in women of different ages. However, in young people (up to 18 years old) it occurs less often at all stages of gestation, compared to other age categories. A significant number of pregnant women with manifestations of placental dysfunction suffered from infectious diseases in childhood (measles, chicken pox, acute respiratory and viral infections, angina, various disorders of menstrual function (hyperpolymenorrhea, hypomenstrual syndrome, algodysmenorrhea) were quite often observed in pregnant women with manifestations of placental insufficiency. More often, placental dysfunction develops during first births than during repeated births. Cases of stillbirth, spontaneous miscarriages, artificial abortions and ectopic pregnancies often occur in the anamnesis. A number of authors [41] indicate that pregnant women with manifestations of placental insufficiency often experience various complications of the current pregnancy. Modern scientific studies show that almost 80% of pregnant women with genital infections show significant changes in the immune, endocrine and coagulation systems, which lead to a violation of the formation of the fetoplacental complex and a violation of adaptation mechanisms in the mother-placenta-fetus system.Conclusion. Clinical and statistical analysis shows the negative impact of manifestations of genital infections in different gestational periods on the course of pregnancy and the state of the fetus and newborn. The conducted studies on this issue give reason to talk about the need to review the system of obstetric tactics for these pregnant women, and further improvement of medical measures for antenatal protection of the fetus with this complication of pregnancy.

Uncommon threads: pneumopericardium complexity following liver catheter removal in pancreatic cancer

Pneumopericardium, the presence of air within the pericardial sac, is a rare but critical condition that can lead to severe complications such as tension pneumopericardium and cardiac tamponade, causing hemodynamic instability and necessitating immediate intervention. Various etiologies include congenital defects, post-surgical complications, infections, and trauma. Malignancies, such as advanced esophageal cancer or lung carcinoma, can also cause pneumopericardium via fistula formation. Multimodal imaging, including chest X-ray, echocardiography, and computed tomography (CT), is essential for diagnosis. This case report discusses a 65-year-old male with advanced pancreatic adenocarcinoma who developed pneumopericardium following the removal of a left lobe liver drainage catheter. Initial CT imaging revealed liver lesions suspicious for metastatic disease or abscess, leading to drainage procedures. Following the removal of the drainage tube, the patient experienced respiratory distress and hypotension, and computed tomography pulmonary angiogram (CTPA) revealed pneumopericardium, likely due to a fistula formed between the abscess and pericardium. Despite no echocardiographic signs of tamponade, the patient’s persistent hypotension warranted CT-guided pericardiocentesis, resulting in gradual blood pressure improvement. This case highlights the intricate interplay between malignancy, infection, and procedural complications in developing pneumopericardium. It emphasizes the need for a multidisciplinary approach and the importance of considering both the quantity and rate of air accumulation when assessing the risk of hemodynamic compromise. The patient’s hemodynamic instability and subsequent improvement following pericardiocentesis underscore the critical role of timely intervention in managing this condition.

Novel 3D human trophoblast culture to explore T. cruzi infection in the placenta.

Human trophoblastic cell lines, such as BeWo, are commonly used in 2D models to study placental Trypanosoma cruzi infections. However, these models do not accurately represent natural infections. Three-dimensional (3D) microtissue cultures offer a more physiologically relevant in vitro model, mimicking tissue microarchitecture and providing an environment closer to natural infections. These 3D cultures exhibit functions such as cell proliferation, differentiation, morphogenesis, and gene expression that resemble in vivo conditions. We developed a 3D culture model using the human trophoblastic cell line BeWo and nonadherent agarose molds from the MicroTissues® 3D Petri Dish® system. Both small (12-256) and large (12-81) models were tested with varying initial cell numbers. We measured the diameter of the 3D cultures and evaluated cell viability using Trypan Blue dye. Trophoblast functionality was assessed by measuring β-hCG production via ELISA. Cell fusion was evaluated using confocal microscopy, with Phalloidin or ZO-1 marking cell edges and DAPI staining nuclei. T. cruzi infection was assessed by microscopy and quantitative PCR, targeting the EF1-α gene for T. cruzi and GAPDH for BeWo cells, using three parasite strains: VD (isolated from a congenital Chagas disease infant and classified as Tc VI), and K98 and Pan4 (unrelated to congenital infection and classified as Tc I). Seeding 1000 BeWo cells per microwell in the large model resulted in comparable cellular viability to 2D cultures, with a theoretical diameter of 408.68 ± 12.65 μm observed at 5 days. Functionality, assessed through β-hCG production, exceeded levels in 2D cultures at both 3 and 5 days. T. cruzi infection was confirmed by qPCR and microscopy, showing parasite presence inside the cells for all three tested strains. The distribution and progression of the infection varied with each strain. This innovative 3D model offers a simple yet effective approach for generating viable and functional cultures susceptible to T. cruzi infection, presenting significant potential for studying the placental microenvironment.

Cytomegalovirus-Specific Hyperimmune Immunoglobulin Administration for Secondary Prevention after First-Trimester Maternal Primary Infection: A 13-Year Single-Center Cohort Study.

Primary cytomegalovirus infection during pregnancy has a high risk of vertical transmission, with severe fetal sequelae mainly associated with first-trimester infections. We conducted a retrospective analysis of 200 IU/kg cytomegalovirus-specific hyperimmune globulin (HIG), used in first-trimester maternal primary infections for congenital infection prevention. The primary outcome was vertical transmission, defined as neonatal viruria or positive amniocentesis if pregnancy was discontinued. HIG, initially administered monthly and since 2019 biweekly, was discontinued in negative amniocentesis cases. Women declining amniocentesis and positive amniocentesis cases with normal sonography were offered monthly HIG until delivery as a treatment strategy. The total transmission rate was 29.9% (32/107; 10 pregnancy terminations with positive amniocentesis, 18 completed pregnancies with positive amniocentesis and 4 declining amniocentesis). Maternal viremia was the only factor associated with fetal transmission (OR 4.62, 95% CI 1.55-13.74). The transmission rate was not significantly different whether HIG was started during the first or second trimester (28.2% vs. 33.3%; p = 0.58), or between monthly and biweekly subgroups (25.7% vs. 37.8%, p = 0.193). Pre-treatment maternal viremia could inform decisions as a predictor of congenital infection.

A multicenter study on the effects of congenital cytomegalovirus infection on hearing loss

Objective: To assess the clinical features and effectiveness of antiviral therapy in newborns with sensorineural hearing loss (SNHL) caused by congenital congenital cytomegalovirus (cCMV) infection, and to speculate the risk factors for poor hearing outcomes. Methods: A multicenter prospective cohort study wasconducted, enrolling 176 newborns diagnosed with cCMV at four research centers in Zhejiang Province from March 1, 2021, to April 30, 2024. Clinical characteristics at birth were recorded and hearing was followed up. The children were divided into groups based on their condition at birth, specifically into asymptomatic, mild symptom, and moderate to severe symptom groups. Additionally, they were divided into SNHL and normal hearing groups based on the results of air conduction brainstem audiometry at birth. And they were also divided into treatment and untreated groups according to antiviral treatment. Mann Whitney U test, and chi square test were used for inter group comparison to analyze the differences in clinical features between different disease groups, and to analyze the effects of clinical features, antiviral therapy, and other factors on hearing improvement. Logistic regression analysis was employed to identify the risk factors influencing hearing outcomes. Results: Among the cohort of 176 children diagnosed infection with cCMV, 90 cases were male and 86 cases were female. Of these, 79 cases were asymptomatic, 12 cases classified as mild cCMV and 85 cases as moderate to severe cCMV. Fifty cases belonged to SNHL group, with different degrees of severity, including 30 cases of mild, 9 cases of moderate, 5 cases of severe, and 6 cases of extremely severe SNHL. Among the 121 cases in the normal hearing group, 2 cases (1.7%) exhibited late-onset hearing loss despite having normal hearing at birth. Among 81 cases (46.0%) who completed the hearing follow-up, 71 cases (87.7%) had good hearing outcomes and 10 cases (12.3%) had poor hearing outcomes. Among the 81 children, 29 cases (35.8%) had SNHL at birth. During follow-up, the hearing threshold improved in 19 cases (65.5%), remained stable in 7 cases (24.1%) and progressed in 3 cases (10.3%). A total of 26 cases in the treatment group and 55 cases in the untreated group completed the hearing follow-up assessment. The rate of hearing improvement in the treatment group was found to be higher compared to the untreated group (13 cases (50.0%) vs. 6 cases (10.9%), χ2=15.00, P<0.01), with individuals in the treatment group having a 4.58 times greater likelihood of experiencing hearing improvement (RR=4.58,95%CI 1.96-10.70, P<0.05). However, no statistically significant difference was observed in hearing outcomes between the antiviral treatment group and the untreated group (RR=0.90, 95%CI 0.57-1.41, P=0.517). Multivariate analysis further confirmed SNHL (OR=11.58, 95%CI 2.10-63.93, P=0.005) and preterm birth (OR=4.98, 95%CI 1.06-23.41, P=0.042) as independent risk factors for poor hearing outcomes. Conclusions: SNHL resulting from cCMV infection presents symptoms at birth and can be improved by antiviral therapy. Poor hearing outcomes are associated with SNHL and prematurity.

Concordance of Cytomegalovirus Saliva and Urine Testing in Infants for the Detection of Congenital Infection.

Congenital cytomegalovirus is a leading cause of neurodevelopmental impairment and sensorineural hearing loss. We evaluated infants ≤21 days postnatal age who had both urine and saliva cytomegalovirus testing and determined concordance between the 2 tests and influence of very low birth weight on concordance. Discordance was low overall between urine and saliva testing; however, discordance was high in very low birth weight infants.

Evaluation of person-centered interventions to eliminate perinatal HIV transmission in Kisumu County, Kenya: A repeated cross-sectional study using aggregated registry data.

Following a decline in perinatal HIV transmission from 20% to 10% between 2010 and 2017 in Kenya, rates have since plateaued with an estimated 8% transmission rate in 2021. Between October 2016 and September 2021, Family AIDS Care & Education Services (FACES) supported HIV care and treatment services across 61 facilities in Kisumu County, Kenya with an emphasis on service strengthening for pregnant and postpartum women living with HIV to reduce perinatal HIV transmission. This included rigorous implementation of national HIV guidelines and implementation of 3 locally adapted evidence-based interventions targeted to the unique needs of women and their infants. We examined whether these person-centered program enhancements were associated with changes in perinatal HIV transmission at FACES-supported sites over time. We conducted a repeated cross-sectional study of annually aggregated routinely collected documentation of perinatal HIV transmission risk through the end of breastfeeding at FACES-supported facilities between October 2016 and September 2021. Data included 12,599 women living with HIV with baseline antenatal care metrics, and, a separate data set of 11,879 mother-infant pairs who were followed from birth through the end of breastfeeding (overlapping with those in antenatal care 2 years prior). FACES implemented 3 interventions for pregnant and postpartum women living with HIV in 2019: (1) high-risk clinics; (2) case management; and (3) a mobile app to support treatment engagement. Our primary outcome was infant HIV acquisition by the end of breastfeeding (18 to 24 months). We compared infant HIV acquisition risk in the final year of the FACES program (2021) to the year before intervention scale-up and following implementation of the "Treat All" policy (2018). Mother-infant pair loss to follow-up was a secondary outcome. Program data were aggregated by year and site, thus in multivariable regression, we adjusted for site-level characteristics, including facility type, urban versus rural, number of women with HIV in antenatal care each year, and the proportion among them under 25 years of age. Between October 2016 and September 2021, 81,172 pregnant women received HIV testing at the initiation of antenatal care, among whom 12,599 (15.5%) were living with HIV, with little variation in HIV prevalence over time. The risk of infant HIV acquisition by 24 months of age declined from 4.9% (101/2,072) in 2018 to 2.2% (48/2,156) in 2021 (adjusted risk difference -2.6% [95% confidence interval (CI): -3.7, -1.6]; p < 0.001). Loss to follow-up declined from 9.9% (253/2,556) in 2018 to 2.5% (59/2,393) in 2021 (risk difference -7.5% [95% CI: -8.8, -6.2]; p < 0.001). During the same period, UNAIDS estimated rates of perinatal transmission in the broader Nyanza region and in Kenya as a whole did not decline. The main limitation of this study is that we lacked a comparable control group. These findings suggest that implementation of person-centered interventions was associated with significant declines in perinatal HIV transmission and loss to follow-up of pregnant and postpartum women.

The prevention of congenital toxoplasmosis using a combination of Spiramycin and Cotrimoxazole: The long-time experience of a tertiary referral centre.

Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii and is responsible for gestational and congenital infections worldwide. The current standard therapy is based on the administration of Spiramycin to prevent trans-placental transmission. Other therapies are being studied to reduce the rates of foetal transmission and symptomatic congenital infection. We report our long-standing experience in maternal toxoplasmosis infection treatment using a combination of Spiramycin-Cotrimoxazole, assessing its effectiveness in preventing vertical transmission compared to the expected incidence of congenital infection. We retrospectively collected cases of pregnant women referred to our centre for suspected toxoplasmosis infection according to Lebech criteria, treated with Spiramycin-Cotrimoxazole. Of 1364 women referred to our centre, postnatal follow-up of primary toxoplasmosis was available in 562 cases (73.9%). The overall vertical transmission rate was 3.4% in women treated immediately with Spiramycin-Cotrimoxazole after the diagnosis of infection. In comparison, it was 7.7% in women undergoing the same therapy but late or with poor compliance. The foetal transmission rate was 71.4% in untreated cases. All the infected newborns of mother treated adequately with Spiramycin-Cotrimoxazole were asymptomatic afterbirth, while 6/21 infected infants of the inadequate Spiramycin-Cotrimoxazole therapy group had postnatal sequelae (28.5%). The incidence of transmission after appropriate Spiramycin-Cotrimoxazole therapy was significantly lower than the expected rate reported in literature. A combination of Spiramycin and Cotrimoxazole is safe and effective in preventing foetal congenital toxoplasmosis and reducing sequelae in case of in-utero infection. The timing and adherence to the therapy are crucial to lowering the risk of congenital infection and neonatal morbidity.

Assessment of blood viral load in asymptomatic and symptomatic cases of congenital cytomegalovirus infection.

This study aimed to retrospectively evaluate the baseline and follow-up viral loads and viral clearance times in cases followed for asymptomatic and symptomatic congenital cytomegalovirus (cCMV) infection between August 2010 and August 2022. Among 93 cases, they had asymptomatic (n: 55) and symptomatic (n: 38). The median baseline blood viral load detected in the symptomatic cCMV (ScCMV) infection (13 054 IU/mL) was significantly higher than that of asymptomatic cCMV (AcCMV) infection (4636 IU/mL) (p < 0.013). There was no difference in median viral clearance times (75 and 90 days, respectively) in baseline viremic cases in the ScCMV and AcCMV infection groups. There were no differences in median baseline blood viral load (6930 IU/mL and 14 268 IU/mL, respectively) and median viral clearance times (75 and 85 days, respectively) between the 6-week and 6-month antiviral treatment group. No correlation was found between baseline blood viral load, clinical severity, and the number of systems involved. However, in initial viremic cases, the viral load threshold for a symptomatic case was 8856 IU/mL, with 85.7% sensitivity and 54.5% specificity.

In utero treatment of congenital cytomegalovirus infection with valganciclovir: an observational study on safety and effectiveness.

The treatment of congenital cytomegalovirus (CMV) infection is usually administered to neonates after birth; however, it can be anticipated during the prenatal period by treating pregnant women in order to reduce the severity of the congenital disease. The most commonly used treatment for CMV during pregnancy is valaciclovir; however, valganciclovir has a higher potency against CMV and is the first choice for neonates with congenital CMV disease. We investigated neonatal and maternal safety of tertiary prevention in infected fetuses showing ultrasound features of infection using valganciclovir. Retrospective cohort study of pregnant women and their symptomatic infected fetuses taking valganciclovir, 3 × 450 mg per day. All fetuses presented at least one prenatal feature on ultrasound. We assessed fetal/neonatal and maternal safety, as well as neonatal efficacy of treatment. The main outcome was neutropenia. Secondary outcomes included other haematological side effects, symptoms at birth and neonatal CMV-PCR was positive. Seventeen women with singleton pregnancies received valganciclovir from a median (IQR) of 27.1 (26.0-30.3) to 11.6 (6.5-12.9) weeks of gestation. No neonatal neutropenia was reported. One pregnancy was terminated for severe features. Three newborns (18%) were asymptomatic at birth, including one with negative CMV-PCR from blood and saliva. CMV-PCR was positive for 12/13 symptomatic newborns, with a median (IQR) log10 viral load of 3.36 (3.30-4.20), 4.03 (1.75-4.27) and 3.04 (0.00-3.40) log10 copies/mL in blood, urine and saliva, respectively. Tertiary prevention by valganciclovir appears to be well tolerated for both fetus and mother. However, more extensive trials accompanied by long-term follow-up are needed.

The Effect of Valacyclovir on Secondary Prevention of Congenital Cytomegalovirus Infection, Following Primary Maternal Infection Acquired Periconceptionally or in the First Trimester of Pregnancy: An Individual Patient Data Meta-analysis

The Effect of Valacyclovir on Secondary Prevention of Congenital Cytomegalovirus Infection, Following Primary Maternal Infection Acquired Periconceptionally or in the First Trimester of Pregnancy: An Individual Patient Data Meta-analysis

Effect of dry period immunization of Salmonella Dublin latent carriers with a commercial live culture vaccine on intrauterine transmission based on the presence of precolostral antibodies in offspring

Salmonella Dublin latent carrier cows represent a high risk for infection of newborn calves via intrauterine transmission and shedding of bacteria in feces and colostrum at calving. Vaccination of these latent carrier dams during late gestation boosts immunity against S. Dublin. This could reduce the activation of the dormant bacteria during the periparturient immune dysfunction period, thereby reducing the risk of early-life infection in the offspring. Thus, the objective of this study was to evaluate the extent to which vaccinating S. Dublin latent carrier cows at dry-off with a commercial live culture vaccine reduces bacterial shedding at calving and intrauterine infection to calves. To identify latent carriers, we screened 1,084 cows in 4 Michigan commercial dairy farms with a history of S. Dublin. Cows were defined as latent carriers when they showed 3 consecutive positive milk antibody ELISA tests conducted every 2 mo. Subsequently, 148 latent carriers were randomly allocated to the vaccine or control group. Vaccine cows received a commercial live culture vaccine subcutaneously (SC) at dry-off and a booster 2 weeks later. Control cows received saline SC at the same times. At calving, we collected fecal and colostrum samples from the dam and a pre-colostral serum sample from the calf. Bacterial shedding was evaluated in feces and colostrum both qualitatively and quantitatively through bacterial culture and qPCR, respectively. Intrauterine transmission was defined when a calf was positive for serum antibody ELISA at birth. Vaccination decreased the likelihood of calves being born S. Dublin seropositive (Relative Risk [95%CI]) = 0.19 [0.04 - 0.84]). However, no S. Dublin positive isolates were identified through either bacteriological culture or qPCR in feces or colostrum. Vaccination of S. Dublin latent-carrier cows at dry-off reduced intrauterine transmission to calves. Further research is warranted into the potential of vaccination to decrease vertical transmission of S. Dublin in dairy farms. Additionally, the absence of S. Dublin positive fecal and colostrum samples warrants further evaluation of the detection methods for identifying latent carriers or S. Dublin isolation, as well as the role of latent carriers in infecting newborn calves in the maternity area at birth.

Awareness and Knowledge of Congenital Cytomegalovirus (cCMV) Among Audiologists and Speech-Language Pathologists in Saudi Arabia: A Cross Sectional Survey.

Congenital cytomegalovirus (cCMV) is the most prevalent congenital infection in the world. It can result in various neurodevelopmental disorders, one of which is environmental hearing loss among children. This study aimed to assess the awareness and knowledge of cCMV among audiologists and speech-language pathologists (SLPs) in Saudi Arabia and to seek their perception of it. An online survey was conducted from May to June 2023, targeting participants through social media, and a descriptive and inferential analysis was performed. A total of 107 participants (31 audiologists and 76 SLPs) were enrolled in this study. Awareness about cCMV was significantly higher among audiologists (84%) compared to SLPs (49%) (p-value < 0.001). However, both groups exhibited poor cCMV knowledge, which was revealed by their low mean knowledge scores (6.8/14 for audiologists and 5.7/14 for SLPs). The difference between their mean scores was non-significant (p-value > 0.05). The majority of SLPs and audiologists agreed that it is crucial for them to learn more about cCMV to enrich their professional backgrounds. This study emphasized the necessity for cCMV education for audiologists and SLPs. Increased awareness and knowledge may allow them to be more mindful of cCMV symptoms and therefore provide enhanced service to their pediatric patients.

Epidemiological Insights into TORCH Infections in the Population of Erbil City

A seroepidemiological study of the TORCH panel was conducted on inhabitants of Erbil City to provide updated baseline data on TORCH prevalence. 508 individuals were included in this study. 218 (42.91%) were females and 290 (57.09%) were males. Their ages ranged from 13 to 63 year, the majority being within the age group (21-30 years), 162 (31.89%), (P &lt; 0.05). 20 individuals (3.94%) tested positive for anti-TOX IgG antibodies. One of the 20 (5%) tested positive for anti-TOX IgM antibodies, who was a 32-year-old female. 128 individuals (25.2%) (all females) tested positive for anti-Rubella IgG antibodies. 40 individuals (7.87%) were positive for anti-CMV IgG antibodies. One of the 40 (2.5%) also tested positive for anti-CMV IgM antibodies, who was a 26-year-old male. 18 individuals (3.54%) tested positive for anti-HSV-1 IgG antibodies. One of the 18 (5.56%) also tested positive for anti-HSV-1 IgM antibodies. One 18-year-old male (0.2%) tested positive for anti-HSV-2 IgG antibodies, and none were positive for anti-HSV-2 IgM antibodies. The results suggest the presence of Toxoplasma, CMV, HSV-1 and HSV-2 infections among the community, the majority (P &lt; 0.05) being CMV followed by TOX and HSV-1 and finally HSV-2. The positive IgG results of Rubella are most probably due to the obligatory vaccination program for females. Despite the fact that the majority of positive cases were for IgG, enhancing vaccination efforts and providing comprehensive health education is crucial for enhancing the well-being of the Erbil population.

Clinical Practice Guidelines for the Management of Congenital Cytomegalovirus Infection in Japan 2023: Executive Summary.

Congenital cytomegalovirus (cCMV) infection is the most common congenital infection in developed countries. Although a standard therapy has not yet been established, evidence for the management of cCMV infection has been accumulating. The first edition of the "Clinical Practice Guidelines for the Management of Congenital Cytomegalovirus Infection" was published in Japan in 2023. This summary outlines the clinical questions (CQs) in the guidelines, with reference to the Japanese Medical Information Distribution Service Manual. Overall, 20 CQs with statements regarding prenatal risk assessment, prevention and management at diagnosis (CQs 1-1-1-3), diagnosis (CQs 2-1-2-6), treatment (CQs 3-1-3-7) and follow-up requirements (CQs 4-1-4-4) have been discussed. For each statement, the levels of recommendation, evidence and consensus rates were determined. These guidelines will assist in the management of patients with cCMV infection.

Investigation of Targeted Genes and Identification of Novel Variants with Next Generation Sequencing Method in Hearing Loss.

Hearing loss is a widespread condition throughout the world. It may affect patients from newborns to the elderly. There are too many reasons for hearing loss, including congenital hearing loss, virus infections, age-related situations, and traumatic situations, which may be related to the immune-mediated system. Fifty percent of hearing loss is related to genetic mutations and defects; genetic causes are highly heterogeneous, so the analysis of new variants are important for diagnosis. We aimed to describe the importance of detected gene variations by using targeted gene panels in the Next-Generation-Sequencing (NGS) platform. Eighty-one hearing loss targeted genes were investigated using Illumina NextSeq550 technology in 100 participants with hearing loss between 2017 and 2022 in our Genetic Diseases Evaluation Center. Targeted genes were performed on 100 patients with hearing loss diagnosis. The total number of detected variants was 77. Forty-seven cases have likely pathogenic/pathogenic variants. Thirty of them have uncertain clinical significance variants, and from the detected variants, 8 are novel. In this research, we highlighted that earlier detection of hearing loss using molecular genetic methods may help us understand the etiology and orient for a better prognosis. Results detected by using the NGS platform can assist and improve the diagnosis. In this study, the diagnostic rate with targeted genes was detected as 35.29%. It has an important role in clinical practice as the recommendation of cochlear implants. Clarifying the genotype and phenotype correlation helps us figure out the etiology of hearing loss and also the worth of genetic counseling in hereditary hearing loss.

Immunoprophylaxis failure and vaccine response in infants born to mothers with chronic hepatitis B infection in Djibouti.

In endemic areas, vertical transmission of hepatitis B virus (HBV) remains a major source of the global reservoir of infected people. Eliminating mother-to-child transmission (MTCT) of HBV is at the heart of World Health Organization's goal of reducing the incidence of HBV in children to less than 0.1% by 2030. Universal screening for hepatitis B during pregnancy and neonatal vaccination are the main preventive measures. To evaluate the efficacy of HBV vaccination combined with one dose of immunoglobulin in children born to hepatitis B surface antigen (HBsAg)-positive mothers in Djibouti city. We conducted a study in a prospective cohort of HBsAg-positive pregnant women and their infants. The study ran from January 2021 to May 2022, and infants were followed up to 7 mo of age. HBV serological markers and viral load in pregnant women were measured using aVidas microparticle enzyme-linked immunosorbent assay (Biomérieux, Paris, France) and the automated Amplix platform (Biosynex, Strasbourg, France). All infants received hepatitis B immunoglobulin and were vaccinated against HBV at birth. These infants were closely monitored to assess their seroprotective response and for failure of immunoprophylaxis. Simple logistic regression was also used to identify risk factors associated with immunoprophylaxis failure and poor vaccine response. All statistical analyses were performed with version 4.0.1 of the R software. Of the 50 pregnant women recruited, the median age was 31 years, ranging from 18 years to 41 years. The MTCT rate in this cohort was 4% (2/50) in HBsAg-positive women and 67% (2/3) in hepatitis B e antigen-positive women with a viral load > 200000 IU/mL. Of the 48 infants who did not fail immunoprophylaxis, 8 (16%) became poor responders (anti-HB < 100 mIU/mL) after HBV vaccination and hepatitis B immunoglobulin, while 40 (84%) infants achieved a good level of seroprotection (anti-HB > 100 mIU/mL). Factors associated with this failure of immunoprophylaxis were maternal HBV DNA levels (> 200000 IU/mL) and hepatitis B e antigen-positive status (odds ratio = 158, 95% confidence interval: 5.05-4958, P < 0.01). Birth weight < 2500 g was associated with a poor immune response to vaccination (odds ratio = 34, 95% confidence interval: 3.01-383.86, P < 0.01). Despite a failure rate of immunoprophylaxis higher than the World Health Organization target, this study showed that the combination of immunoglobulin and HBV vaccine was effective in preventing MTCT of HBV. Therefore, further studies are needed to better understand the challenges associated with immunoprophylaxis failure in infants in Djibouti city.

Association of maternal infection of SARS-CoV-2 and neonatal susceptibility: A retrospective cohort study

ObjectiveThis study aims to assess the risk of neonatal susceptibility to COVID-19 among pregnant women. MethodsWe conducted a retrospective cohort study involving 1089 pregnant women ≥28 weeks of gestational age, who were categorized into infected and uninfected groups. Data for all participants were collected through a comprehensive review of electronic medical records and follow-up phone calls. The primary outcome was neonatal infection with SARS-CoV-2, while secondary outcomes included delivery patterns and gestational age at delivery. ResultsMaternal vaccination (OR 95%CI:0.63[0.46, 0.85]) and maternal infection with SARS-CoV-2 (OR 95%CI: 0.45[0.34, 0.60]) were found to be associated with a decreased risk of neonatal infection. The infected group exhibited a lower neonatal SARS-CoV-2 infection rate (25.93%) compared to the uninfected group (45.15%). Logistic regression analysis identified several risk factors associated with an increased risk of neonatal infection, including pregnancy BMI (OR 95%CI: 1.04[1.01, 1.08]), age at first pregnancy (OR 95%CI: 1.05[1.01, 1.10]), age at menarche (OR 95%CI: 1.13[1.02, 1.26]), and parturition (Yes vs. No) (OR 95%CI:1.4 [1.04,1.88]). ConclusionMaternal vaccination and perinatal infection with SARS-CoV-2 play a protective role in preventing neonatal SARS-CoV-2 infection.

Group B Streptococcus colonization status and antibiotic use during labour - a single-centre observational study.

Group B streptococcus (GBS) colonization among pregnant women is the leading cause of neonatal infection. Intrapartum antibiotic prophylaxis (IAP) is the most effective method to reduce the incidents of neonatal sepsis. We describe compliance with GBS management and the implementation of IAP in the context of the long-term effect of antibiotics. The study was conducted among 249 childbearing women hospitalized between January 2022 and February 2022 at University Clinical Center in Gdansk, Poland. The data were obtained from the questionnaire and medical records. We analyzed maternal colonization with GBS, compliance with GBS screening and treatment guidelines, risk factors contributing to GBS colonization, IAP administration, and neonatal congenital infection occurrence. Of all patients, 240 (96.4%) were screened for GBS, 215 (89.6%) between 35-37 weeks of gestation. Fifty (20%) were GBS-positive, 184 (74%) negative, 15 (6%) had unknown GBS status. There were no significant differences between the GBS-positive and GBS-negative groups in maternal age, mode of delivery, gestational age at birth, maternal comorbidities, parity, GBS status in previous pregnancies, and the development of infection among infants of both groups, regardless of IAP administration. Of all the studied women, 158 (63.5%) received antibiotics, 91 (36.5%) did not. The study showed the low positive and the high negative predictive value of the antenatal GBS screening test. We found that compliance with the universal GBS screening is widespread. The management of women with absent or only partial screening test requires assessing the risk factors before administering IAP.