Evaluation of intermittent preventive treatment of malaria against group B Streptococcus colonization in pregnant women: a nested analysis of a randomized controlled clinical trial of sulfadoxine/pyrimethamine versus mefloquine.

OBJECTIVES: Streptococcus agalactiae constitutes an important cause of neonatal infections in sub-Saharan Africa. Sulfadoxine/pyrimethamine-the current intermittent preventive treatment of malaria in pregnancy (IPTp)-has proven in vitro activity against group B Streptococcus (GBS). Because of specific drug resistance to sulfadoxine/pyrimethamine, mefloquine-an antimalarial without in vitro activity against GBS-was evaluated as a potential alternative. This study assessed the potential of sulfadoxine/pyrimethamine-IPTp to reduce the prevalence of GBS colonization in pregnant women in Gabon when compared with the inactive control mefloquine-IPTp. METHODS: Pregnant women participating in a randomized controlled clinical trial evaluating mefloquine-IPTp versus sulfadoxine/pyrimethamine-IPTp were invited to participate and recto-vaginal swabs were collected at delivery for detection of GBS colonization. Prevalence of recto-vaginal GBS colonization was compared between IPTp regimens and risk factor and birth outcome analyses were computed. RESULTS: Among 549 participants, 106 were positive for GBS colonization at delivery (19%; 95% CI = 16%-23%). Prevalence of maternal GBS colonization showed no significant difference between the two IPTp regimens (mefloquine-IPTp: 67 of 366 women = 18%; 95% CI = 14%-22%; sulfadoxine/pyrimethamine-IPTp: 39 of 183 women = 21%; 95% CI = 15%-27%). Risk factor analysis for GBS colonization demonstrated a significant association with illiteracy (adjusted OR = 2.03; 95% CI = 1.25-3.30). GBS colonization had no impact on birth outcome, anaemia at delivery, gestational age and birth weight. CONCLUSIONS: Sulfadoxine/pyrimethamine did not reduce colonization rates when used as the IPTp drug during pregnancy. Illiteracy was associated with GBS colonization.

Focus gender - medical students' gender-specific perception and attitudes towards the burdens of everyday student life.

Introduction: The aim of this study was to investigate if female and male medical students perceive burdens differently and if students of both sexes assess their capability to stand performance pressure differently. Material and Methods: In 2017, 2nd (n=424, 53% female) and 6th (n=161, 46.6% female) year students at the medical university of Vienna were surveyed using a fully structured questionnaire. Results: In 2nd year, female students felt significantly more often that they could not measure up to study requirements than male students (87,5% vs. 94,4%). Performance pressure was perceived as major problem by male (45,5%) and female (50,9%) students while in 6th year the number was only half as high than in 2nd (24%, 18,4%). In 6th year significantly more female than male students were complaining about competition between students (33,3% vs. 8%). Half of the students shared the view that there is no difference between men and women in the capability to deal with performance pressure. Most of the other half state that men are superior to women in handling performance pressure. In both groups significantly more male than female students were convinced that they are superior to the other sex in handling performance pressure. Conclusion: Perception of problems is similar in male and female students. While in objective assessments female students perform equally to male students they consider themselves less competent and are more inclined to doubt their capability.

Knowledge, application and how about competence? Qualitative assessment of multiple-choice questions for dental students.

Background: Many medical schools train their faculty members to construct high cognitive level multiple choice questions (MCQs) that demand a great deal of analytical and critical thinking, application, and competence. The purpose of this study is to determine the cognitive levels of MCQs by using Moore's Expanded Outcomes Framework and to understand whether the quality of MCQs has an effect on students' assessment performance.Methods: Four trained faculty members analysed 100 randomly selected questions developed at the University Clinic of Dentistry (UCD) and 100 questions developed by the National Board of Dental Examinations (NBDE). Moore's framework was applied to assist the review process.Results: The majority of questions was at the level of declarative knowledge followed by questions at the level of procedural knowledge. The cognitive level of UCD questions from 2002 to 2009 was significantly lower than that of NBDE questions but increased in questions written from 2010 to 2018. The improvement of quality of MCQs had no impact on assessment performance of students.Conclusion: The enhanced cognitive levels of UCD MCQs written 2010-2018 coincides with the implementation of a faculty training program for writing high-ordered MCQs. In addition, this study shows that the use of Moore's expanded framework is on par with other known taxonomies in supporting educators in writing items and reviewing the process.Abbreviations: MCQs: Multiple Choice Questions; UCD: University Clinic of Dentistry; NBDE: National Board of Dental Examinations.

Streptococcus agalactiae Serotype Distribution and Antimicrobial Susceptibility in Pregnant Women in Gabon, Central Africa.

Neonatal invasive disease due to Streptococcus agalactiae is life threatening and preventive strategies suitable for resource limited settings are urgently needed. Protective coverage of vaccine candidates based on capsular epitopes will relate to local epidemiology of S. agalactiae serotypes and successful management of critical infections depends on timely therapy with effective antibiotics. This is the first report on serotype distribution and antimicrobial susceptibility of S. agalactiae in pregnant women from a Central African region. Serotypes V, III, and Ib accounted for 88/109 (81%) serotypes and all isolates were susceptible to penicillin and clindamycin while 13% showed intermediate susceptibility to erythromycin.

Epidemiology of Human Herpes Virus 8 in Pregnant Women and their Newborns--A cross-sectional delivery survey in Central Gabon.

OBJECTIVES: On the background of a high prevalence of HHV-8 infection in pre-pubertal Central African children, this study investigated the potential for in utero transmission of HHV-8. PATIENTS: Gabonese pregnant women were invited to provide peripheral and cord blood samples for serological and PCR diagnostics of HHV-8 infection at delivery for this cross-sectional survey. RESULTS: Out of 344 participants 120 (35%, 95% CI: 30-40%) were serologically positive for HHV-8. 31% (95% CI: 22-40%) of cord blood samples of seropositive women had detectable IgG antibodies. Among all seropositive participants HHV-8 was detected by PCR in one maternal peripheral blood sample at delivery (1%, 95% CI: 0.2-7%) and in none of cord blood samples. There was no association between demographic characteristics and infection status. Similarly, there was no difference in risk for premature delivery, low birth weight, and maternal anaemia in HHV-8 seropositive women. DISCUSSION: These data suggest a high seroprevalence of HHV-8 infection in pregnant women, however viraemia at delivery does not commonly occur in Central Africa. Based on these observations it may be speculated that infection of children may occur more commonly either antepartum or later on in infancy and childhood.