The role of trophoblast cell receptor expression in HIV-1 passage across the placenta in pre-eclampsia: an observational study.

OBJECTIVE: To compare expression of markers of HIV and associated receptors (p24, CD4, CCR5 and ICAM-2) in placentae and umbilical cords of HIV-associated and pre-eclamptic pregnancies to elucidate any association between these conditions in mother-to-child transmission. DESIGN: Cross-sectional immunohistochemical analysis of target receptor expression. SETTING: Laboratory-based study of primigravidae attending a district hospital in South Africa. POPULATION OR SAMPLE: Retrospectively collected placental tissue (stratified into four groups according to HIV status of normotensive and pre-eclamptic participants (n = 20/group). METHOD: Immunohistochemistry utilising CD4 (1:1), p24 (1:10), CCR5 (1:80) and ICAM-2 (1:100) antibodies was performed using light microscopy for image acquisition and analysis. MAIN OUTCOME MEASURES: Evaluate the expression of receptors on syncytiotrophoblast involved in in utero transmission of HIV. RESULTS: Syncytiotrophoblast was immunopositive for CD4 and CCR5 antibody with greater expression of CCR5 in HIV-positive versus HIV-negative groups (F1,159  = 6.979, P = 0.009) and normotensive versus pre-eclamptic groups (F1,159  = 8.803, P = 0.003). p24 was present in both placentae and umbilical cords of babies that were HIV-negative at 6 weeks. ICAM-2 immunostaining was observed in the syncytiotrophoblast across study groups and was significantly higher in the HIV-negative pre-eclamptic group (χ2 (3)  = 45.3; P < 0.001). CONCLUSION: Concurrent CD4 and CCR5 receptor expression demonstrates possible in utero viral entry routes across the placental barrier. ICAM-2 expression may influence HIV passage across the placenta or restoration of risk of pre-eclampsia in HAART-treated mothers. HIV was found in fetal circulation regardless of antiretroviral treatment. Further confirmatory ultrastructural and molecular work is warranted. TWEETABLE ABSTRACT: CD4, CCR5 and ICAM-2 on syncytiotrophoblast may facilitate HIV infection of passage across the placenta.

Factors causing stress among first-year students attending a nursing college in KwaZulu-Natal, South Africa

Background. In South Africa (SA), there is a high failure rate of students in the first year of nursing and many drop out after this year, a precarious situation considering the shortage of professional nurses faced by the country. Academic success does not entirely comprise one's application of intellectual capacity. Other factors may affect academic success, which could lead to stress, in turn hindering students' academic potential.Objectives. To determine the stressors experienced by first-year nursing students who attended a college of nursing in SA and to ascertain the stress-relieving mechanisms used by these students.Methods. Student nurses (n=248) at a college of nursing in KwaZulu-Natal Province, SA, were required to complete a quantitative questionnaire. Data were collected between September and November 2013.Results. Long working hours, difficulty of academic work, poor study methods and family illness caused considerable stress. Family pressure to pay for necessities at home was also a factor that caused stress among the students. There was insufficient money to pay for textbooks for their studies. Stress-relieving mechanisms included playing with cell phones and socialising with friends. Lecturers, parents and fellow nursing students' friends were a source of support.Conclusion. First-year nursing students experience a variety of stressors not directly related to their studies. Stress- and time-management workshops would be beneficial to these students. We also suggest that institutional support units be created to assist students in adjusting to the tertiary environment