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Obstet Gynecol Surv ; 77(1): 45-62, 2022 Jan.
Article En | MEDLINE | ID: mdl-34994394

Importance: Thyroid disorders represent one of the most frequent complications of pregnancy associated with adverse obstetric, fetal, and neonatal outcomes, especially in case of delayed diagnosis and suboptimal management. Objective: The aim of this study was to review and compare the recommendations of the most recently published guidelines on the diagnosis and management of these common conditions. Evidence Acquisition: A descriptive review of guidelines from the Endocrine Society, the European Thyroid Association, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the American Thyroid Association, and the American College of Obstetricians and Gynecologists on thyroid disease in pregnancy was carried out. Results: There is an overall consensus regarding the diagnosis of overt and subclinical hypothyroidism and hyperthyroidism in pregnancy using the pregnancy-specific reference ranges and the definition of postpartum thyroiditis. The reviewed guidelines unanimously discourage universal screening for thyroid function abnormalities before and during pregnancy and support targeted screening of high-risk patients by measuring serum thyroid-stimulating hormone levels. Moreover, they all highlight the need of treating overt hypothyroidism and hyperthyroidism, not only during pregnancy, but also before conception, suggesting similar management policies and treatment targets. There is also agreement regarding the management of gestational transient hyperthyroidism with hyperemesis gravidarum, suspected fetal thyrotoxicosis, postpartum thyroiditis, and thyroid malignancy. Scanning or treating with radioactive iodine is contraindicated during pregnancy and breastfeeding. On the other hand, there is controversy on the management of subclinical thyroid disease, thyroid function surveillance protocols, and iodine nutrition recommendations. Of note, the American College of Obstetricians and Gynecologists makes some specific recommendations on the treatment of thyroid storm and thyrotoxic heart failure in pregnant women, whereas the American Thyroid Association makes a special reference to the management of women with thyroid cancer. Conclusions: As the disorders of the thyroid gland affect a significant proportion of pregnant women, it is of paramount importance to develop uniform international evidence-based protocols for their accurate diagnosis and optimal management, in order to safely guide clinical practice and eventually improve perinatal outcomes.

Hyperemesis Gravidarum , Pregnancy Complications , Thyroid Diseases , Thyroid Neoplasms , Australia , Female , Humans , Infant, Newborn , Iodine Radioisotopes , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Thyroid Diseases/diagnosis , Thyroid Diseases/therapy
BMC Health Serv Res ; 22(1): 40, 2022 Jan 07.
Article En | MEDLINE | ID: mdl-34996445

BACKGROUND: Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda. METHODS: We analyzed data from the women's questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance. RESULTS: Overall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), - 16.1, - 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions. CONCLUSION: Besides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.

Measles Vaccine , Vaccination , Child , Demography , Female , Health Surveys , Humans , Immunization Programs , Infant , Infant, Newborn , Pregnancy , Uganda
BMJ Case Rep ; 15(1)2022 Jan 07.
Article En | MEDLINE | ID: mdl-34996767

As an X linked disorder, the presence of severe symptomatic haemophilia A is an extremely rare disorder in women. Therefore there are no high-level evidence-based guidelines when it comes to pregnancy. Although there have been advances in the fields of prenatal counselling and maternal-fetal care, the management of these gestations continues to embody a challenge for any medical team. We report the successful management of a pregnant woman with symptomatic haemophilia A, from pregnancy to the postpartum period. Our aim is to enhance knowledge on this topic, and further improve outcomes for these mothers and their offspring.

Hemophilia A , Female , Hemophilia A/diagnosis , Hemophilia A/therapy , Humans , Mothers , Postpartum Period , Pregnancy , Prenatal Care
BMJ Glob Health ; 7(1)2022 01.
Article En | MEDLINE | ID: mdl-35012970

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

COVID-19 , Maternal Health Services , Developing Countries , Female , Health Facilities , Humans , Pandemics/prevention & control , Pregnancy , SARS-CoV-2
J Int Med Res ; 50(1): 3000605211070753, 2022 Jan.
Article En | MEDLINE | ID: mdl-35014555

OBJECTIVE: This study aimed to determine the risk factors associated with the necessity of laparoscopic scar defect repair for cesarean scar pregnancy (CSP). METHODS: We retrospectively analyzed 237 patients with CSP who were treated by ultrasound-guided suction curettage and/or laparoscopy in our hospital from April 2012 to November 2019. A total of 199 of these patients underwent ultrasound-guided suction curettage without uterine scar defect repair, while 38 of these patients underwent laparoscopic resection and uterine scar defect repair. We analyzed various clinical variables and compared the efficacy of treatment between the two groups. RESULTS: Gestational age, the maximum transverse diameter (MTD) of the gestational sac, myometrial thickness, the operation time, intraoperative blood loss, and the duration of the hospital stay were significantly different between the two groups. Gestational age, the MTD of the gestational sac, and myometrial thickness were independent risk factors for laparoscopic repair. CONCLUSIONS: Gestational age, the MTD of the gestational sac, and myometrial thickness are important factors associated with the necessity for laparoscopic repair of a uterine scar defect.

Laparoscopy , Pregnancy, Ectopic , Cesarean Section , Cicatrix , Female , Humans , Pregnancy , Pregnancy, Ectopic/surgery , Retrospective Studies , Treatment Outcome
BMC Res Notes ; 15(1): 16, 2022 Jan 11.
Article En | MEDLINE | ID: mdl-35016699

OBJECTIVE: To ensure the health of newborns, it is necessary to perform high-quality diagnostic tests. The TORCH panel is a set of tests that identifies infectious pathogens such as Toxoplasma (Toxo) and Cytomegalovirus (CMV) that are common in low-setting populations. We performed TORCH panel quality planning using six sigma in a reference laboratory at Peru. RESULTS: This was a cross-sectional study. TORCH tests include Toxo, Rubella, CMV, and Herpes. We processed all samples by fourth-generation ELISA on the GEMINI XCR200 analyzer (Diatron, Budapest, Hungary). We obtained the imprecision from the annual data of the external quality assessment plan and we used the CLSI EP12-A3 guideline. In a total of 44,788 analyses, the average imprecision was 3.69 ± 1.47%, and CMV had lower imprecision (2.3 and 2.6% for IgM and IgG, respectively). Quality planning of the TORCH panel allowed estimating the sigma value that ranged from 4 to 10 (average 7 ± 2 sigma), where rubella had the highest values (10 for IgM and 8 for IgG) while HSV2 had the lowest values (4 for IgM and 5 for IgG). Our results suggest the optimal performance of half of the markers including Toxoplasma, Rubella, and CMV in the Peruvian population.

Pregnancy Complications, Infectious , Rubella , Toxoplasma , Toxoplasmosis , Cross-Sectional Studies , Female , Humans , Immunoglobulin M , Infant, Newborn , Peru , Pregnancy , Rubella/diagnosis , Total Quality Management
BMC Pregnancy Childbirth ; 22(1): 14, 2022 Jan 06.
Article En | MEDLINE | ID: mdl-34986833

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is predominately known as a respiratory disease associated with pneumonia, acute respiratory distress syndrome and multiorgan failure. However, extra-pulmonary complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly being recognized. In this regard, some studies implied the hemostatic and vascular involvements in patients with SARS-CoV-2 infection. CASE PRESENTATION: We describe a case of spontaneous Intracerebral Hemorrhage (ICH) in a pregnant patient with COVID-19 and history of cesarean section a week before the occurrence of ICH. The patient underwent emergent craniotomy with acceptable outcome. Hemorrhagic events, including ICH, may happen during COVID-19 infection with several possible mechanisms. CONCLUSION: COVID-19 patients, especially high-risk groups, are at a risk of intracranial hemorrhage. Therefore, close follow-up must be maintained and hemorrhagic events must be kept in mind in these cases.

COVID-19/complications , Cerebral Hemorrhage/virology , Pregnancy Complications, Cardiovascular/virology , Pregnancy Complications, Infectious , SARS-CoV-2 , Adult , Cerebral Hemorrhage/pathology , Cerebral Hemorrhage/surgery , Craniotomy , Critical Care , Female , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/pathology , Pregnancy Complications, Cardiovascular/surgery , Pregnancy Complications, Infectious/virology , Treatment Outcome
Trials ; 23(1): 5, 2022 Jan 03.
Article En | MEDLINE | ID: mdl-34980212

BACKGROUND: Breastfeeding offers many medical and neurodevelopmental advantages for birthing parents and infants; however, the majority of parents stop breastfeeding before it is recommended. Professional lactation support by the International Board Certified Lactation Consultants (IBCLCs) increases breastfeeding rates; however, many communities lack access to IBCLCs. Black and Latinx parents have lower breastfeeding rates, and limited access to professional lactation support may contribute to this disparity. Virtual "telelactation" consults that use two-way video have the potential to increase access to IBCLCs among disadvantaged populations. We present a protocol for the digital Tele-MILC trial, which uses mixed methods to evaluate the impact of telelactation services on breastfeeding outcomes. The objective of this pragmatic, parallel design randomized controlled trial is to assess the impact of telelactation on breastfeeding duration and exclusivity and explore how acceptability of and experiences with telelactation vary across Latinx, Black, and non-Black and non-Latinx parents to guide future improvement of these services. METHODS: 2400 primiparous, pregnant individuals age > 18 who intend to breastfeed and live in the USA underserved by IBCLCs will be recruited. Recruitment will occur via Ovia, a pregnancy tracker mobile phone application (app) used by over one million pregnant individuals in the USA annually. Participants will be randomized to (1) on-demand telelactation video calls on personal devices or (2) ebook on infant care/usual care. Breastfeeding outcomes will be captured via surveys and interviews and compared across racial and ethnic groups. This study will track participants for 8 months (including 6 months postpartum). Primary outcomes include breastfeeding duration and breastfeeding exclusivity. We will quantify differences in these outcomes across racial and ethnic groups. Both intention-to-treat and as-treated (using instrumental variable methods) analyses will be performed. This study will also generate qualitative data on the experiences of different subgroups of parents with the telelactation intervention, including barriers to use, satisfaction, and strengths and limitations of this delivery model. DISCUSSION: This is the first randomized study evaluating the impact of telelactation on breastfeeding outcomes. It will inform the design and implementation of future digital trials among pregnant and postpartum people, including Black and Latinx populations which are historically underrepresented in clinical trials. TRIAL REGISTRATION: NCT04856163. Registered on April 23, 2021.

Breast Feeding , Telemedicine , Adult , Female , Humans , Infant , Middle Aged , Parents , Postnatal Care , Postpartum Period , Pregnancy , Randomized Controlled Trials as Topic
Curr Microbiol ; 79(2): 44, 2022 Jan 04.
Article En | MEDLINE | ID: mdl-34982235

Hepatitis E contributes to 3.3 million acute hepatitis cases worldwide with 30% mortality in pregnant women. Pathogenesis of Hepatitis E is complex; thus, the present study was aimed at inflammasomes and associated cytokines in the immunopathogenesis of viral hepatitis E. PBMCs were isolated from 45 HEV IgM/HEV RNA-positive AVH/ALF and 19 healthy individuals and processed for mRNA expressions of NLRs, RLRs, and cytokines. PBMCs were cultured and stimulated with HEV-pORF-2 peptide in vitro for mRNA expression by RT-PCR and cytokines levels in serum/culture supernatant by ELISA. siRNA transfection and post-silencing effect in AVH PBMCs were also assessed by NLRP3 gene expression and IL-1ß and IL-18 levels by ELISA. The results demonstrated high viral load in ALF than AVH cases. mRNA expression of NLRP3 in AVH patients was found to be positively correlated with IL-18 (r = 0.74) and IL-1ß (r = 0.68); P < 0.0001***. Significant levels of serum IL-1ß and IL-18 cytokines were observed in AVH as compared to ALF patients. The levels of IL-1ß in the culture supernatant in mock and stimulated conditions were significantly higher in AVH than in ALF patients. Significant downregulation in NLRP3 gene expression was correlated with the reduced levels of IL-1ß and IL-18 cytokines in NLRP3-siRNA-transfected PBMCs. This study highlighted the significance of upregulated NLRP3 inflammasome leading to increased production of IL-18 and IL-1ß cytokines in sera of AVH patients. Thus, it indicated the role of Th1 response acting through the NLRP3 pathway which might have been helpful in the recovery of AVH patients. These promising results open multiple treatment avenues where specific inhibitors can be designed to modulate the progress of disease and its pathogenicity.

Hepatitis E , Inflammasomes , NLR Family, Pyrin Domain-Containing 3 Protein/immunology , Cells, Cultured , Cytokines/immunology , Female , Hepatitis E/immunology , Humans , Inflammasomes/immunology , Pregnancy , Prognosis , T-Lymphocytes/immunology , Viral Load
J Coll Physicians Surg Pak ; 32(1): 46-50, 2022 Jan.
Article En | MEDLINE | ID: mdl-34983147

OBJECTIVE: To investigate whether the duration between breastfeeding and heel lance has an effect on babies' pain perception. STUDY DESIGN: A randomised trial. PLACE AND DURATION OF STUDY: Obstetrics & Gynecology Unit, Yenimahalle Training and Research Hospital, Ankara, Turkey between August 2019 and February 2020. METHODOLOGY: Healthy term newborns who were scheduled for a heel lance blood collection for newborn screening were included in the study. Healthy term babies were randomised into three groups, according to their heel lance time. The procedure was performed immediately after breastfeeding (group 1), one hour after breastfeeding (group 2), and two hours after breastfeeding (group 3). The magnitude of pain was measured by the neonatal pain, agitation and sedation scale (N-PASS) one minute before intervention, at the time of intervention, and at 1, 2 and 5 minutes after the intervention. Total crying times of the babies was recorded as well. RESULTS: Ninety-one babies were included in the study. The pain scores during heel lance and one and two minutes after heel lance were significantly higher in group 3 than in group 1 and group 2. Total crying time of the babies in group 3 was also significantly longer than the total crying time of the babies in group 1 and group 2. However, there was no significant difference between group 1 and 2 in terms of pain scores. CONCLUSION: The duration between breastfeeding and heel lance may influence the perception of pain in newborns. Keeping this period short, may reduce the perception of pain. Key Words: Breastfeeding, Breast milk, Newborn, Pain.

Breast Feeding , Heel , Female , Humans , Infant, Newborn , Milk, Human , Pain/etiology , Perception , Pregnancy
BMC Infect Dis ; 22(1): 5, 2022 Jan 04.
Article En | MEDLINE | ID: mdl-34983412

BACKGROUND: The increasing number of dengue cases worldwide implies a greater exposure of at-risk groups, such as pregnant women. DENV infection during pregnancy has been increasingly associated with unfavorable outcomes, but the evolution of the disease and its clinical outcomes remain unclear. The objective of this study was to characterize dengue cases in reproductive aged women by comparing the development of the disease in pregnant and non-pregnant women. METHODS: A population based retrospective cohort study that used data reported in the Brazilian Mandatory Notifiable Diseases Information System from 2016 to 2019 in Paraná, Brazil. We compared sociodemographic, clinical, and laboratory variables between pregnant and non-pregnant women. Hospitalization and disease severity classification (Dengue, Dengue with warning signs, Severe Dengue) were considered outcome variables. RESULTS: The two groups had differences in the year of notification, age distribution, and region of residence. Laboratory investigation was more frequent among pregnant women, and DENV-2 prevailed in both groups. The risks of hospitalization and development of Severe Dengue were higher in pregnant women. There were no deaths observed among pregnant women. CONCLUSION: This study identified pregnancy as a risk factor for an increase in the severity of DENV infection. It reinforces the importance of identifying early signs of complication, close monitoring, and adequate treatment for pregnant women.

Dengue , Pregnant Women , Adult , Brazil/epidemiology , Cohort Studies , Dengue/epidemiology , Female , Humans , Pregnancy , Retrospective Studies
J Synchrotron Radiat ; 29(Pt 1): 247-253, 2022 Jan 01.
Article En | MEDLINE | ID: mdl-34985442

Virtual histology is increasingly utilized to reconstruct the cell mechanisms underlying dental morphology for fragile fossils when physical thin sections are not permitted. Yet, the comparability of data derived from virtual and physical thin sections is rarely tested. Here, the results from archaeological human deciduous incisor physical sections are compared with virtual ones obtained by phase-contrast synchrotron radiation computed microtomography (SRµCT) of intact specimens using a multi-scale approach. Moreover, virtual prenatal daily enamel secretion rates are compared with those calculated from physical thin sections of the same tooth class from the same archaeological skeletal series. Results showed overall good visibility of the enamel microstructures in the virtual sections which are comparable to that of physical ones. The highest spatial resolution SRµCT setting (effective pixel size = 0.9 µm) produced daily secretion rates that matched those calculated from physical sections. Rates obtained using the lowest spatial resolution setup (effective pixel size = 2.0 µm) were higher than those obtained from physical sections. The results demonstrate that virtual histology can be applied to the investigated samples to obtain reliable and quantitative measurements of prenatal daily enamel secretion rates.

Fossils , Synchrotrons , Dental Enamel/diagnostic imaging , Female , Humans , Pregnancy , X-Ray Microtomography , X-Rays
Agri ; 34(1): 63-66, 2022 Jan.
Article En | MEDLINE | ID: mdl-34988959

We aimed to inform transient neurological symptoms after spinal anesthesia and to review postpartum neurological deficits of regional anesthesia. A previously healthy 25-year-old primigravid woman underwent an elective cesarean section. Hypotension and bradycardia were not observed during the operation. On the 25th day postpartum, the patient suffered from numbness and weakness at the lower extremity. On neurological assessment, the muscle strengths in the gastrocnemius and quadriceps bilaterally were 2/5 (+) and 3/5 (+), respectively. The muscle strength at foot dorsiflexion and plantar flexion were 2/5 (+) bilaterally. The patient was unable to walk on toes and walked on heels, and the lower extremities were hypoesthetic. The patellar and the Achilles tendon reflexes were bilaterally negative. No pathological findings could be detected on lumbosacral magnetic resonance imaging (MRI). Electromyography revealed a mixed type of polyneuropathy. The symptoms relieved partially at the end of the 2nd month and regressed completely at the end of the 3rd month. To prevention of irreversible postpartum permanent neurologic deficits, the diagnosis should be made using a detailed neurologic examination along with MRI or computed tomography.

Cesarean Section , Muscle, Skeletal , Adult , Electromyography , Female , Humans , Magnetic Resonance Imaging , Pregnancy , Ropivacaine
BMC Bioinformatics ; 23(1): 12, 2022 Jan 05.
Article En | MEDLINE | ID: mdl-34986802

BACKGROUND : Construction of networks from cross-sectional biological data is increasingly common. Many recent methods have been based on Gaussian graphical modeling, and prioritize estimation of conditional pairwise dependencies among nodes in the network. However, challenges remain on how specific paths through the resultant network contribute to overall 'network-level' correlations. For biological applications, understanding these relationships is particularly relevant for parsing structural information contained in complex subnetworks. RESULTS: We propose the pair-path subscore (PPS), a method for interpreting Gaussian graphical models at the level of individual network paths. The scoring is based on the relative importance of such paths in determining the Pearson correlation between their terminal nodes. PPS is validated using human metabolomics data from the Hyperglycemia and adverse pregnancy outcome (HAPO) study, with observations confirming well-documented biological relationships among the metabolites. We also highlight how the PPS can be used in an exploratory fashion to generate new biological hypotheses. Our method is implemented in the R package pps, available at . CONCLUSIONS: The PPS can be used to probe network structure on a finer scale by investigating which paths in a potentially intricate topology contribute most substantially to marginal behavior. Adding PPS to the network analysis toolkit may enable researchers to ask new questions about the relationships among nodes in network data.

Blood Glucose , Hyperglycemia , Cross-Sectional Studies , Female , Humans , Normal Distribution , Pregnancy , Pregnancy Outcome
BMC Res Notes ; 15(1): 3, 2022 Jan 05.
Article En | MEDLINE | ID: mdl-34986872

OBJECTIVE: To study the change in trend of antenatal mental health and associated factors among a cohort of pregnant women during the second wave of COVID-19 using Hospital Anxiety and Depression Scale (HADS). Previous study using the same scale, during the first wave reported a higher prevalence of anxiety and depression. RESULTS: A descriptive cross-sectional study was carried out at the two large maternity hospitals in Colombo, Sri Lanka: Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW). Consecutively recruited 311 women were studied. Out of which, 272 (87.5%) were having uncomplicated pregnancies at the time of the survey and 106 (34.1%) were either anxious, depressed, or both. Prevalence of anxiety was 17.0% and depression 27.0%. Overall, continuing COVID-19 pandemic increased antenatal anxiety and depression. The trend was to aggravate depression more intensively compared to anxiety in this cohort of women studied. Special support is needed for pregnant mothers during infectious epidemics taking more attention to antenatal depression.

COVID-19 , Pregnant Women , Anxiety/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Female , Humans , Mental Health , Pandemics , Pregnancy , SARS-CoV-2 , Sri Lanka/epidemiology
J Med Case Rep ; 16(1): 5, 2022 Jan 06.
Article En | MEDLINE | ID: mdl-34986884

INTRODUCTION: Patients with chikungunya virus infection commonly present with fever, skin rash, and severe joint pain. The vesiculobullous rash is rare in adults but common in infants. In addition, septic shock and acute respiratory distress syndrome are rare complications of atypical and severe acute chikungunya infection. CASE PRESENTATION: We report the presence of an 18-year-old Thai female, at 31 weeks gestation, with fever, maculopapular rash, and polyarthritis. The rash later progressed to a vesiculobullous pattern, and she developed septic shock and acute respiratory distress syndrome. Skin biopsy and blood were positive for chikungunya virus RNA. The patient was intubated with a mechanical ventilator and subsequently fully recovered. CONCLUSION: Atypical skin manifestation and severe acute disease is likely due to immune response attenuation in pregnancy. The possibility of progression to severe or atypical disease in pregnant women suffering chikungunya should always be considered.

Chikungunya Fever , Exanthema , Skin Diseases , Adolescent , Adult , Chikungunya Fever/complications , Chikungunya Fever/diagnosis , Exanthema/etiology , Female , Fever , Humans , Infant , Pregnancy , Pregnant Women
Genet Sel Evol ; 54(1): 1, 2022 Jan 03.
Article En | MEDLINE | ID: mdl-34979897

BACKGROUND: The genetic background of trait variability has captured the interest of ecologists and animal breeders because the genes that control it could be involved in buffering various environmental effects. Phenotypic variability of a given trait can be assessed by studying the heterogeneity of the residual variance, and the quantitative trait loci (QTL) that are involved in the control of this variability are described as variance QTL (vQTL). This study focuses on litter size (total number born, TNB) and its variability in a Large White pig population. The variability of TNB was evaluated either using a simple method, i.e. analysis of the log-transformed variance of residuals (LnVar), or the more complex double hierarchical generalized linear model (DHGLM). We also performed a single-SNP (single nucleotide polymorphism) genome-wide association study (GWAS). To our knowledge, this is only the second study that reports vQTL for litter size in pigs and the first one that shows GWAS results when using two methods to evaluate variability of TNB: LnVar and DHGLM. RESULTS: Based on LnVar, three candidate vQTL regions were detected, on Sus scrofa chromosomes (SSC) 1, 7, and 18, which comprised 18 SNPs. Based on the DHGLM, three candidate vQTL regions were detected, i.e. two on SSC7 and one on SSC11, which comprised 32 SNPs. Only one candidate vQTL region overlapped between the two methods, on SSC7, which also contained the most significant SNP. Within this vQTL region, two candidate genes were identified, ADGRF1, which is involved in neurodevelopment of the brain, and ADGRF5, which is involved in the function of the respiratory system and in vascularization. The correlation between estimated breeding values based on the two methods was 0.86. Three-fold cross-validation indicated that DHGLM yielded EBV that were much more accurate and had better prediction of missing observations than LnVar. CONCLUSIONS: The results indicated that the LnVar and DHGLM methods resulted in genetically different traits. Based on their validation, we recommend the use of DHGLM over the simpler method of log-transformed variance of residuals. These conclusions can be useful for future studies on the evaluation of the variability of any trait in any species.

Genome-Wide Association Study , Quantitative Trait Loci , Animals , Female , Genomics , Litter Size/genetics , Phenotype , Polymorphism, Single Nucleotide , Pregnancy , Sus scrofa/genetics , Swine/genetics
BMC Pregnancy Childbirth ; 22(1): 5, 2022 Jan 03.
Article En | MEDLINE | ID: mdl-34979990

BACKGROUND: The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery. METHODS: We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country. RESULTS: Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (ß = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (ß = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group. CONCLUSIONS: Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.

Delivery, Obstetric , Health Promotion , Health Services Accessibility , Maternal Health Services , Prenatal Care , Adolescent , Adult , Female , Guatemala , Health Facilities , Honduras , Humans , Middle Aged , Nicaragua , Pregnancy , Pregnancy Outcome , Young Adult
Trials ; 23(1): 3, 2022 Jan 03.
Article En | MEDLINE | ID: mdl-34980220

BACKGROUND: In previous retrospective studies, low serum progesterone level on the embryo transfer day is associated with lower clinical pregnancy and ongoing pregnancy rates. Whether adding progesterone in low serum progesterone patients can rescue the outcome, there is no sufficient evidence from randomized controlled studies. METHODS: This trial is a clinical randomized controlled study (high serum progesterone vs low serum progesterone 1:1, 1:1 randomization ratio of intervention vs the control group with low serum progesterone). The eligible hormone replacement therapy-frozen embryo transfer (HRT-FET) cycles, will be recruited and randomly assigned to two parallel groups when serum progesterone is < 7.24µg/l on the day of embryo transfer for D3. The intervention group will be extrally given intramuscular progesterone 40 mg per day from D3 to 8 weeks of gestation if clinical pregnancy. The primary outcome is the ongoing pregnancy (beyond 12 weeks of gestation) rate. DISCUSSION: The findings of this study will provide strong evidence for whether the progesterone addition from the D3 in low serum progesterone patients can improve the outcome in the HRT-FET cycle. TRIAL REGISTRATION: NCT04248309 . Registered on January 28, 2020.

Live Birth , Progesterone , Embryo Transfer , Female , Humans , Pregnancy , Pregnancy Rate , Randomized Controlled Trials as Topic , Retrospective Studies
Trials ; 23(1): 2, 2022 Jan 03.
Article En | MEDLINE | ID: mdl-34980232

BACKGROUND: Maternal undernutrition is critical in the etiology of poor perinatal outcomes and accounts for 20% of small-for-gestational-age (SGA) births. High levels of food insecurity, antenatal undernourishment, and childhood undernutrition necessitate the supplementation of fortified balanced energy protein (BEP) during pregnancy in low-income settings especially with scarce literature available in this subject. Hence, this paper extensively covers the protocol of such a trial conducted in an urban slum of Karachi, Pakistan. METHODS: The trial is community-based, open-labelled, four-arm, and randomized controlled that will include parallel group assignments with a 1:1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. All pregnant women (PW), if identified between > 8 and < 19 weeks of gestation based on ultrasound, will be offered routine antenatal care (ANC) counseling and voluntary participation in the trial after written informed consent. A total number of 1836 PW will be enrolled with informed consent and randomly allocated to one of the four arms receiving: (1) ANC counseling only (control group), (2) ANC counseling plus BEP supplement (intervention arm 1), (3) ANC counseling plus BEP supplement plus 2 doses azithromycin (intervention arm 2), or (4) ANC counseling plus BEP supplement plus daily single dose of nicotinamide and choline (intervention arm 3). TRIAL REGISTRATION: NCT04012177 . Registered on July 9, 2019.

Azithromycin , Nutritional Support , Poverty Areas , Pregnancy Outcome , Azithromycin/therapeutic use , Female , Humans , Infant, Newborn , Pakistan , Pregnancy , Pregnant Women , Randomized Controlled Trials as Topic