Hepatitis E virus infection in pregnant women, Argentina.

BACKGROUND: Hepatitis E virus (HEV) infection is an important cause of acute hepatitis worldwide. In pregnant women, HEV can cause more severe symptoms, with high rates of fatal hepatic failure in endemic countries. However, HEV prevalence and circulation among pregnant women from South America is almost unknown. We aimed to investigate HEV infection in pregnant women for the first time in Argentina. METHODS: IgG and IgM anti-HEV antibodies and RNA-HEV were investigated (by ELISA assays and RT-Nested-PCR, respectively) in 202 serum samples from pregnant women collected in the central region of Argentina between 2015 and 2017. A control group of 155 non-pregnant women was included (year 2018). RESULTS: The IgG anti-HEV positivity rate was 8.4% (17/202), higher than the 2.6% (4/155) obtained for the non-pregnant women control group, and showing association between pregnancy and HEV infection (p = 0.023, OR = 3.5, CI95% = 1.1-10.5). Women younger than 25 years old presented higher levels of antibodies, and there were no differences in the prevalences between trimesters of pregnancy. Two samples were reactive for IgM anti-HEV, showing recent infections, although no symptoms were registered in these patients. All samples were negative for RNA-HEV amplification. CONCLUSIONS: HEV produces infections in pregnant women from Argentina, alerting health teams to consider it as a possible cause of liver disease.

Krüppel-like factor 6 (KLF6) requires its amino terminal domain to promote villous trophoblast cell fusion.

INTRODUCTION: Villous cytotrophoblast (vCTB) cells fuse to generate and maintain the syncytiotrophoblast layer required for placental development and function. Krüppel-like factor 6 (KLF6) is a ubiquitous transcription factor with an N-terminal acidic transactivation domain and a C-terminal zinc finger DNA-binding domain. KLF6 is highly expressed in placenta, and it is required for proper placental development. We have demonstrated that KLF6 is necessary for cell fusion in human primary vCTBs, and in the BeWo cell line. MATERIALS AND METHODS: Full length KLF6 or a mutant lacking its N-terminal domain were expressed in BeWo cells or in primary vCTB cells isolated from human term placentas. Cell fusion, gene and protein expression, and cell proliferation were analyzed. Moreover, Raman spectroscopy and atomic force microscopy (AFM) were used to identify biochemical, topography, and elasticity cellular modifications. RESULTS: The increase in KLF6, but not the expression of its deleted mutant, is sufficient to trigger cell fusion and to raise the expression of ß-hCG, syncytin-1, the chaperone protein 78 regulated by glucose (GRP78), the ATP Binding Cassette Subfamily G Member 2 (ABCG2), and Galectin-1 (Gal-1), all molecules involved in vCTB differentiation. Raman and AFM analysis revealed that KLF6 reduces NADH level and increases cell Young's modulus. KLF6-induced differentiation correlates with p21 upregulation and decreased cell proliferation. Remarkable, p21 silencing reduces cell fusion triggered by KLF6 and the KLF6 mutant impairs syncytialization and decreases syncytin-1 and ß-hCG expression. DISCUSSION: KLF6 induces syncytialization through a mechanism that involves its regulatory transcriptional domain in a p21-dependent manner.

[Group B streptococcus colonization during pregnancy and prevention of early onset of disease]. / Colonizacion por estreptococo beta hemolitico del grupo B durante el embarazo y prevencion de enfermedad neonatal.

Group B Streptococcus (GBS) is the most frequent cause of early onset of neonatal sepsis. Case-fatality rate is 6-20% for newborns. Neurological sequel occurs in 30% of survivors. In 1996, the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommended that obstetrics providers should adopt either a culture-based or a risk-based approach for the prevention of this disease. The aim of this prospective study was to determine the colonization rate of GBS in our population of pregnant women between July 1st 2001 and December 31st 2002, and to introduce a culture-based strategy to prevent early onset neonatal GBS disease. From a population of 1756 pregnant women, 1228 were screened with rectal and vaginal swabs (69.9%). Maternal colonization rate was 1.4% (17 patients). There was one case of early-onset neonatal sepsis consistent with GBS disease (0.6%) in a patient with negative cultures. From the colonized patients, only one presented risk factors. Because most of the colonized women did not present intrapartum risk factors, the results of this study suggest that the culture-based approach should be used for the prevention of early-onset GBS disease in our population. Cost-benefit studies are needed in our country to determine if this prevention strategy is able to be implemented in all the settings of Argentina.

[Nine cases of HELLP syndrome (hemolysis, elevated liver enzymes and low platelets]. / Nueve casos del síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia).

HELLP syndrome (Hemolysis, Elevated Liver Enzymes and Low Platelets) was described by Weinstein in 1982. It has a high maternal and perinatal morbi-mortality rate. We undertook this study to evaluate perinatal outcome in patients with HELLP syndrome. Patients with HELLP syndrome were identified in a retrospective study between March 1998 and March 2001 at the Hospital Privado de Córdoba. Maternal and neonatal variables were analyzed. Nine patients with HELLP syndrome were identified (incidence 2.3@1000). Mean maternal age was 24.5 (15-36) years. Five patients were nuliparous. The mean gestational age was 34.5 weeks (29-40). The main symptom was epigastric pain (77.7%). In seven women delivery was made by cesarean section. Three patients had postpartum HELLP syndrome. Three patients had difficult control hypertension; one had eclampsia and another one had disseminated intravascular coagulopathy with acute renal failure and died. Three women needed blood products transfusions. The average admission time was 4.4 days. There were six preterm infants (75%). Mean birth weight was 2030 g (736-3200). Four neonates had Apgar score < 7 at the first minute, all had > 7 at 5 minutes. Three neonates had alimentary disorders, one had hypoglucemia and another hyaline membrane disease, patent ductus arteriosus, sepsis and thrombocytopenia. The high maternal and perinatal morbi-mortality of HELLP syndrome requires management in a centre where intensive maternal and neonatal care are available.

Longitud cervical mediante ecografía transvaginal en el segundo trimestre del embarazo para predecir el parto prematuro / Cervical length by transvaginal ultrasound in second trimester of pregnacy for predicting preterm delivery

Siendo que la prematurez es la principal causa de morbi-mortalidad neonatal, se realizó un estudio para predecir parto prematuro en una población de bajo riesgo, valorando la longitud cervical entre las 19 y 23 semanas de gestación, a través de ecografía transvaginal en 604 pacientes.

Nueve casos del sindrome hellp (hemolisis, enzimas hepaticas elevadas y plaquetopenia) / Nine cases of Hellp syndrome (hemolysis, elevated liver enzymes and low platelets)

El síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia) descripto por Weinstein en 1982, se asocia a alta morbi mortalidad materna y perinatal. Se evaluaron retrospectivamente Ias pacientes que presentaron síndrome HELLP entre marzo 1998 y marzo 2001 en el Hospital Privado de Córdoba. Se identificaron nueve pacientes con Síndrome HELLP (incidencia 2.3%o). La edad media de Ias pacientes fue 24.5 anos (15 36) con una edad gestacional media de 34.5 semanas (29 40). Cinco pacientes fueron nulíparas. El síntoma principal fue epigastralgia (77.7%). El parto fue por cesárea en siete pacientes y tres tuvieron síndrome HELLP post parto. Tres pacientes resentaron hipertensión de difícil manejo, una eclampsia y otra coagulación intravascular diseminada, insuficiencia renal aguda y muerte. Tres requirieron transfusión de derivados sanguíneos y el promedio de internación fue 4.4 días. Seis (75%) neonatos fueron pretérmino. El peso medio de nacimiento fue 2030 gramos (736 3200). Cuatro recién nacidos tuvieron un score de Apgar menor de 7 ai minuto y todos mayor de 7 a los cinco minutos. Tres neonatos presentaron trastomos alimentarios, uno hipoglucemia y otro enfermedad de membrana hialina, ductus arterioso permeable, sepsis y plaquetopenia. Debido a Ia morbi mortalidad materna yperinatal el síndrome HELLP requiere atención en un centro de alta complejidad mediante un equipo multidisciplìnario.