Modelling the Unidentified Abortion Burden from Four Infectious Pathogenic Microorganisms (Leptospira interrogans, Brucella abortus, Brucella ovis, and Chlamydia abortus) in Ewes Based on Artificial Neural Networks Approach: The Epidemiological Basis for a Control Policy.

Unidentified abortion, of which leptospirosis, brucellosis, and ovine enzootic abortion are important factors, is the main cause of disease spread between animals and humans in all agricultural systems in most developing countries. Although there are well-defined risk factors for these diseases, these characteristics do not represent the prevalence of the disease in different regions. This study predicts the unidentified abortion burden from multi-microorganisms in ewes based on an artificial neural networks approach and the GLM. METHODS: A two-stage cluster survey design was conducted to estimate the seroprevalence of abortifacient microorganisms and to identify putative factors of infectious abortion. RESULTS: The overall seroprevalence of Brucella was 70.7%, while Leptospira spp. was 55.2%, C. abortus was 21.9%, and B. ovis was 7.4%. Serological detection with four abortion-causing microorganisms was determined only in 0.87% of sheep sampled. The best GLM is integrated via serological detection of serovar Hardjo and Brucella ovis in animals of the slopes with elevation between 2600 and 2800 meters above sea level from the municipality of Xalatlaco. Other covariates included in the GLM, such as the sheep pen built with materials of metal grids and untreated wood, dirt and concrete floors, bed of straw, and the well water supply were also remained independently associated with infectious abortion. Approximately 80% of those respondents did not wear gloves or masks to prevent the transmission of the abortifacient zoonotic microorganisms. CONCLUSIONS: Sensitizing stakeholders on good agricultural practices could improve public health surveillance. Further studies on the effect of animal-human transmission in such a setting is worthwhile to further support the One Health initiative.

Bioinformatic Approach of B and T Cell Epitopes of PLD and CP40 Proteins of Corynebacterium pseudotuberculosis ovis Mexican Isolate 2J-L towards a Peptide-Based Vaccine.

Mapping B and T cell epitopes constitutes an important action for peptide vaccine design. PLD and CP40 virulence factors of Corynebacterium pseudotuberculosis biovar ovis, a causal agent of Caseous Lymphadenitis, have been evaluated in a murine model as good candidates for vaccine development. Therefore, the goal of this work was to in silico analyze B and T cell epitopes of the PLD and CP40 proteins of a Mexican isolate of Corynebacterium pseudotuberculosis ovis. The Immune Epitope Data Base and Resource website was employed to predict the linear and conformational B-cell, T CD4+, and T CD8+ epitopes of PLD and CP40 proteins of Corynebacterium pseudotuberculosis ovis Mexican strain 2J-L. Fifty B cell epitopes for PLD 2J-L and forty-seven for CP40 2J-L were estimated. In addition, T CD4+ and CD8+ cell epitopes were predicted for PLD 2J-L (MHC I:16 epitopes, MHC II:10 epitopes) and CP40 2J-L (MHC I: 15 epitopes, MHC II: 13 epitopes). This study provides epitopes, paying particular attention to sequences selected by different predictor programs and overlap sequences as B and T cell epitopes. PLD 2J-L and CP40 2J-L protein epitopes may aid in the design of a promising peptide-based vaccine against Caseous Lymphadenitis in Mexico.

Associations between prenatal serum levels of leptin, IGF-I, and estradiol and adolescent mothers' height gain during and after pregnancy.

Mexico is within the top three Latin American countries with the highest proportion of adolescent pregnancies while being in the lowest ten Latin American countries in terms of height. It is still unclear how much growth in adolescence is affected by pregnancy; therefore, this study was designed to study the association between prenatal serum concentrations of leptin, IGF-I, and estradiol and the increase in the height of a group of pregnant adolescents between the 28th week of gestation to one year postpartum. We conducted a cohort study from 2009 to 2017 in pregnant adolescents in their third trimester of pregnancy receiving prenatal care at Mexico's National Institute of Perinatology. Data on hormones, other covariates, and confounding variables were analyzed through bivariate analysis and then a linear univariate analysis. Our patients were an average of 15.5±1 years and gained an average of 9.5 mm during the study period. A Pearson's correlation showed a positive and significant height increase between height and leptin and IGF-I, and negative between height and estradiol. The general linear model (adjusted by age, bone age, gynecological age, parent's stature, breastfeeding, body fat, energy intake, and BMI) found that leptin and estradiol serum concentrations explained 39.6% of height increase; IGF-I did not have any predictive effect. Leptin and estradiol concentrations in the third trimester of pregnancy are associated with increased height in our group of teenage mothers. No effect association was observed between height and IGF-I concentrations.

A randomized controlled trial comparing isosorbide dinitrate-oxytocin versus misoprostol-oxytocin at management of foetal intrauterine death.

BACKGROUND: The metabolic activity of endogenous nitric oxide (NO) and the medical use of nitrovasodilatory drugs like isosorbide dinitrate have been shown to be potential inducers inducers of cervical ripening prior to surgical evacuation of the uterus. OBJECTIVE: To assess the therapeutic efficacy and safety of combined isosorbide dinitrate-oxytocin in the management of intrauterine foetal death (IUFD). METHODS: Sixty women with IUFD after 20 weeks of gestation requesting uterine evacuation were randomly selected to receive isosorbide dinitrate gel solution (80 mg/1.5 mL; n = 30) or misoprostol gel solution (100 mcg/1.5 mL; n = 30) every 3 h with a maximum of four doses or until a Bishop score >7 was reached. Subsequently, patients received a high dose of intravenous oxytocin until complete uterus evacuation was achieved. Therapeutic efficacy was evaluated by mean the relative risk of the foetal expulsion based on comparison of event rates, and the proportion of women induced to labor at 7, 10 and 15 h after the administration of isosorbide dinitrate or misoprostol. Safety was assessed on the basis of woman´s vital signs and evaluation of adverse effects, including headache, abdominal pain, pelvic pain, lower back pain, nausea, dizziness and vomiting. RESULTS: The foetal expulsion rate using the isosorbide dinitrate-oxytocin combination was approximately 4.4 times, and at least 2.1 times, the foetal expulsion rate with the misoprostol-oxytocin regimen at any given point in time. The proportion of women achieved vaginal delivery at 15 hours was 100% for the isosorbide dinitrate-oxytocin group and 86.7% for the misoprostol-oxytocin group. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 ± 3.1 h) than when misoprostol-oxytocin (11.9 ± 3.1 h) was used. A total of 20% of patients in the isosorbide dinitrate-oxytocin group recorded headache, and no cases of uterine tachysystole, haemorrhage or coagulopathy were recorded. CONCLUSION: This study indicates that intravaginal isosorbide dinitrate followed by intravenous oxytocin was more effective than the conventional method used to induce labour in the medical management of foetal death in pregnancies after 20 weeks of gestation. TRIAL REGISTRATION: Clinicaltrials.gov NCT02488642.

Differential Immune Profiles in Two Pandemic Influenza A(H1N1)pdm09 Virus Waves at Pandemic Epicenter.

BACKGROUND AND AIMS: Severe influenza A(H1N1)pdm2009 virus infection cases are characterized by sustained immune activation during influenza pandemics. Seasonal flu data suggest that immune mediators could be modified by wave-related changes. Our aim was to determine the behavior of soluble and cell-related mediators in two waves at the epicenter of the 2009 influenza pandemic. METHODS: Leukocyte surface activation markers were studied in serum from peripheral blood samples, collected from the 1(st) (April-May, 2009) and 2(nd) (October 2009-February 2010) pandemic waves. Patients with confirmed influenza A(H1N1)pdm2009 virus infection (H1N1), influenza-like illness (ILI) or healthy donors (H) were analyzed. RESULTS: Serum IL-6, IL-4 and IL-10 levels were elevated in H1N1 patients from the 2(nd) pandemic wave. Additionally, the frequency of helper and cytotoxic T cells was reduced during the 1(st) wave, whereas CD69 expression in helper T cells was increased in the 2(nd) wave for both H1N1 and ILI patients. In contrast, CD62L expression in granulocytes from the ILI group was increased in both waves but in monocytes only in the 2(nd) wave. Triggering Receptor Expressed on Myeloid cells (TREM)-1 expression was elevated only in H1N1 patients at the 1(st) wave. CONCLUSIONS: Our results show that during the 2009 influenza pandemic a T cell activation phenotype is observed in a wave-dependent fashion, with an expanded activation in the 2(nd) wave, compared to the 1(st) wave. Conversely, granulocyte and monocyte activation is infection-dependent. This evidence collected at the pandemic epicenter in 2009 could help us understand the differences in the underlying cellular mechanisms that drive the wave-related immune profile behaviors that occur against influenza viruses during pandemics.

Pregnant women infected with pandemic H1N1pdm2009 influenza virus displayed overproduction of peripheral blood CD69+ lymphocytes and increased levels of serum cytokines.

The first pandemic of the 21st century occurred in 2009 and was caused by the H1N1pdm influenza A virus. Severe cases of H1N1pdm infection in adults are characterized by sustained immune activation, whereas pregnant women are prone to more severe forms of influenza, with increased morbi-mortality. During the H1N1pdm09 pandemic, few studies assessed the immune status of infected pregnant women. The objective of this study was to evaluate the behavior of several immune markers in 13 H1N1pdm2009 virus-infected pregnant (PH1N1) women, in comparison to pregnant women with an influenza-like illness (ILI), healthy pregnant women (HP) and healthy non-pregnant women (HW). The blood leukocyte phenotypes and the serological cytokine and chemokine concentrations of the blood leukocytes, as measured by flow cytometry, showed that the CD69+ cell counts in the T and B-lymphocytes were significantly higher in the PH1N1 group. We found that pro-inflammatory (TNF-α, IL-1ß, IL-6) and anti-inflammatory (IL-10) cytokines and some chemokines (CXCL8, CXCL10), which are typically at lower levels during pregnancy, were substantially increased in the women in the ILI group. Our findings suggest that CD69 overexpression in blood lymphocytes and elevated levels of serum cytokines might be potential markers for the discrimination of H1N1 disease from other influenza-like illnesses in pregnant women.

Genotyping of Chlamydia trachomatis from endocervical specimens of infertile Mexican women.

INTRODUCTION: It has been reported in several countries that Chlamydia trachomatis genotypes D, E, and F are the ones more frequently associated with urogenital infections. In Mexico, the prevalence of serovars and genotypes is unknown. MATERIAL AND METHODS: One hundred and fifty-two endocervical swabs were collected from infertile women to test for C. trachomatis. The PCR-based RFLP and automated-sequencing methods of ompA gene was used to identify the C. trachomatis genotypes. Sequences of 891 pb obtained were aligned with currently available chlamydial sequences from GenBank to identify the corresponding genotype. RESULTS: Twenty-four women with infertility (15.8%) were positive for C. trachomatis. According to the RFLP and nucleotide sequences results the most prevalent ompA genotype corresponded to serovar F (n=13 [54.2%]), followed by serovars E (n=2 [8.7%]), G (n=2 [8.7%]), K (n=2 [8.7%]) and LGV (n=2 [8.7%]), while serovars D, H and Ia were less prevalent (all n=1 [4.2%]). None of the patients who were positive to genovar L2 had symptoms of lymphogranuloma venereum (LGV). Nucleotide sequences analysis showed a new genovariant of L2, which was different to L2b to L2f. Mutation points were observed in VS1 domain of Omp A. CONCLUSIONS: In this study the most common genotypes were F. Furthermore, the L2 genovariants were demonstrated in infertile women without signs and symptoms of LGV disease. Presence of point mutations in L2 genotype sequences were seen by which there is a need for further research in order to identify new L2 genetic variants that exist in Latin America.

[Anti-C. trachomatis IgG antibodies levels in serum to identify infertility caused by tubal damage]. / Evaluación de los niveles séricos de anticuerpos IgG anti-Chlamydia trachomatis para el diagnóstico de infertilidad por factor tubario.

OBJECTIVE: To identify the serologic titers of anti-Chlamydia trachomatis IgG (Ab) antibodies that could be used to differentiate tubal damage infertility from other causes of subfertility in a group of Mexican women. MATERIAL AND METHODS: This was a prospective, longitudinal and analytical study of 147 women selected in a non-random way. The women were classified into three sub-groups: 1) infertile women with tubal occlusion detected by laparoscopy (n = 58); 2) infertile women with alternative causes of subfertility (n = 50), and 3) fertile women for the control group (n = 39). An assay of indirect immunofluorescence was performed on all infertile women (n = 108). The results obtained were compared with the laparoscopic and hormonal analyses carried out on the 108 infertile women. The statistical analysis included a model in ROC Curve and Logistical Regression. RESULTS: The results showed that the titer 1:256 is able to differentiate fertile women from infertile women. Moreover, in the adjusted analysis, the titer 1:512 was able to identify infertile women with tubal occlusion (OR 2.6, CI 95% 1.24, 5.4), with a sensibility of 40% and a specificity of 90%. Positive and negative predictive values were 85% and 50%, respectively and the positive and negative likelihood ratios were 3.85 and 0.67, respectively. The pattern of the ROC curve confirmed a court value of 1:512, with an area under the curve of 62.2% (CI 95%: 53.4-72%). CONCLUSION: A titer greater or equal to 1:512 of anti-C. trachomatis IgG antibodies is useful in the identification of tubal factor infertility.

Evaluation of endocytic capacity and NADPH-oxidase activity from armadillo (Dasypus novemcinctus) eosinophils infected with microfilariae.

Endocytic activity of phagocytic cells from armadillos infected with viruses, parasites or bacteria is unknown. This report shows that eosinophils from armadillos infected with microfilaria act against these helmintic parasites but have deficiencies in their oxygen-dependent bacteriocidal mechanisms and also in endocytic capacity against yeast.

Intracervical application of the nitric oxide donor isosorbide dinitrate for induction of cervical ripening: a randomised controlled trial to determine clinical efficacy and safety prior to first trimester surgical evacuation of retained products of conception.

OBJECTIVE: To determine the therapeutic efficacy and safety of a nitric oxide (NO) isosorbide dinitrate donor to induce cervical ripening of women with missed abortions before surgical evacuation of the uterus. DESIGN: A prospective, randomised, double-blind controlled trial. SETTING: Tertiary referral maternity teaching hospital. Population Sixty women with missed abortions and no cervical dilation. METHODS: Women requesting surgical evacuation of the uterus were randomly selected to receive endocervical 80 mg/1.5 mL isosorbide dinitrate gel solution (n= 30) or 400 mug/1.5 mL misoprostol gel solution (n= 30) every 3 hours to a maximum of four doses or until reaching cervical ripening. Vital signs and symptoms were recorded at baseline and then every 3 hours until finishing therapy. Adverse events, such as headache, abdominal pain, pelvic pain, backache, nausea and vomiting, were evaluated. MAIN OUTCOME MEASURES: Probability of reaching cervical ripening >8 mm Hegar dilator; evaluated at 3, 6, 9 and 12 hours after application of isosorbide dinitrate or misoprostol. RESULTS: The probabilities of induction of cervical ripening by isosorbide dinitrate and misoprostol after four repeated doses at 3-hour intervals were significantly different (P<0.001). Efficacy of therapy after 12 hours was 97% for the isosorbide dinitrate group and 70% for the misoprostol group. Systolic and diastolic blood pressures were lower after administration of isosorbide dinitrate than prostaglandin analogues. The difference in the mean systolic and diastolic blood pressure between treatment groups was greatest at 3 hours, with a difference of 7.7 mmHg (P<0.001) and 5.9 mmHg (P<0.003), respectively. The most frequent side effect associated with isosorbide dinitrate administration was headache, which occurred in 18 out of 30 patients, compared with only 5 out of 30 women in the misoprostol group [relative risk (RR) 2.41, 95% confidence interval (CI) 1.45-4.03, P<0.001). Women treated with misoprostol reported mainly pelvic pain (RR 3.24, 95% CI 1.99-5.27, P<0.001). CONCLUSIONS: Intracervical administration of 80 mg isosorbide dinitrate in women with missed abortions appears to be effective for cervical ripening prior to surgical evacuation of the uterus. Differences in the incidence of non-serious adverse events are not likely to be clinically significant.

Ultrastructural alterations in human blood leukocytes induced by porcine circovirus type 1 infection.

BACKGROUND: Swine infectious pathogens, especially viruses, represent a potential public health risk associated with the use of pig tissues for xenotransplantation in humans. We hypothesized that porcine circovirus type I (PCV-1) may infect human mononuclear cells, resulting in ultrastructural alterations of the target cells. METHODS: Transmission electron microscopy was used for evaluating ultrastructural alterations of human cells exposed to a PCV-infected PK15 cell line. A polymerase chain reaction (PCR) assay and fluorescence in situ hybridization (FISH) were developed for detecting PCV-1 in human mononuclear cells. RESULTS: Morphological alterations of the human T cells exposed to PCV PK15 showed ''boomerang-shaped'' intracytoplasmic inclusions. Nucleocapsids appeared free, close to the nucleus, or contained into cytoplasmic vacuoles. Virions were observed near the surface of the human cells. A considerable number of mature virions and immature forms could be observed in the human cells that had a completely intact nuclear membrane with no alteration in the disposition of chromatin. PCV-1 particles were identified budding into typical Golgi saccules and vacuoles. Virions sized up to 23 nm in diameter, and appeared in the nucleus and in the periphery of the cellular core. PCV-1 infection was detected on CD4+, CD8+, CD14+, CD19+, and CD56+ human cells by PCR assay and FISH. CONCLUSIONS: These results suggest that PCV has the capability of infecting human leukocytes in vitro, and should be considered a potential risk of viral transmission during xenotransplantation.

[Risk factors and reproductive sequelae associated with Chlamydia trachomatis infection in infertile women]. / Factores de riesgo y secuelas reproductivas asociados a la infección por Chlamydia trachomatis en mujeres infértiles.

OBJECTIVE: To assess the clinical and sexual lifestyle characteristics associated with Chlamydia trachomatis infection among women diagnosed with infertility. MATERIAL AND METHODS: Study subjects were women with an infertility diagnosis attending the infertility clinic at the National Institute of Perinatology. Endocervical specimens from 309 women were examined for Chlamydia trachomatis using the direct immunofluorescence method. Vaginal culture samples were taken before initiating treatment. The presence of other sexually-transmitted infections was also assessed. Demographic, sexual behavioral, historical, and clinical data were collected for each subject. RESULTS: Seventy-seven women (24.9%) were infected with C trachomatis. Of these women, 70 (90.9%) had only one sexual partner, 58 (75.3%) were married, and 19 (24.7%) were single or had a common-law sex partner. Intrauterine device (IUD) was the main contraceptive method used in 15 women (19.5%). A coinfection with other sexually-transmitted microorganisms was detected in 41 of these patients (53.2%). Nineteen (24.7%) women had undergone tubal ligation. Among women with C trachomatis infection, reproductive sequelae were found: 24 (31.2%) women had had abortions and 50 (64.9%) had had a miscarriage. In 26 women cervical abnormalities were detected (33.8%); 50 (64.9%) had purulent vaginal discharge and 14 (18.1%) had pelvic pain. Bivariate analysis revealed that the risk factors for C trachomatis infection in women with infertility were: having a sex partner (OR = 2.96, 95% CI 1.22-7.5, p = 0.008), common-law union (OR = 3.68, p = 0.03), and IUD use (OR = 2.42, p = 0.01). CONCLUSIONS: A consistent relationship between C trachomatis infection and infertility was found. Infection with C trachomatis in women with infertility was associated with having one single sexual partner, marital status, and IUD use. The presence of ectropion and friability of the cervix may signal C trachomatis infection. Identification and presumptive therapy should be evaluated as measures to prevent and control C trachomatis infection in patients at risk. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Factores de riesgo y secuelas reproductivas asociados a la infección por Chlamydia trachomatis en mujeres infértiles / Risk factors and reproductive sequelae associated with Chlamydia trachomatis infection in infertile women

OBJETIVO: Comparar la información clínica y el estilo de vida sexual en dos grupos de mujeres con y sin infección por Chlamydia trachomatis que asisten a la clínica de infertilidad del Instituto Nacional de Perinatología, de la Ciudad de México. MATERIAL Y MÉTODOS: De febrero a noviembre de 1998, se realizó un estudio prospectivo en pacientes con diagnóstico de infertilidad. En el estudio se incluyó a pacientes con diagnóstico de infertilidad, tratados en el Instituto Nacional de Perinatologia, de la Ciudad de México, durante 1988. Las muestras endocervicales de 309 mujeres, que incluyeron a 77 con infección y a 232 sin infección, fueron examinadas para Chlamydia trachomatis, usando inmunofluorescencia directa. Los cultivos vaginales fueron obtenidos antes de iniciar el tratamiento. También se investigó la presencia de otros agentes infecciosos de transmisión sexual y la información demográfica, de conducta sexual, histórica y clínica fue recopilada de cada paciente. Los datos clínicos y ginecológicos de ambos grupos fueron comparados por ji2. La magnitud de las asociaciones fueron establecidas por razón de momios en análisis bivariados. Se realizó un análisis de regresión logística para establecer los efectos confusores en relación con los factores analizados. Las diferencias fueron consideradas estadísticamente significativas si p<0.05. RESULTADOS: Para el estudio 309 mujeres fueron elegibles, 77 (24.9 por ciento) cursaron con infección por C trachomatis, de éstas, 70 (90.9 por ciento) mencionaron tener un compañero sexual, 58 (75.3 por ciento) estaban casadas, 19 (24.7 por ciento) eran solteras o vivían en concubinato, 15 (19.5 por ciento) utilizaron el dispositivo intrauterino para el control de la natalidad, 41 (53.2 por ciento) presentaron coinfección con otros agentes infecciosos de transmisión sexual, y 19 (24.7 por ciento) cursaron con infertilidad por obstrucción tubárica. Las secuelas reproductivas observadas en las pacientes con infección por C trachomatis mostraron que 24 (31.2 por ciento) tuvieron abortos, 50 (64.9 por ciento), gestaciones previas, 26 (33.8 por ciento) anormalidades en el cérvix y 50 (64.9 por ciento) secreciones vaginales purulentas, con dolor (18.1 por ciento). El análisis bivariado mostró que los factores de riesgo asociados significativamente con la infección por C trachomatis fueron la presencia de un compañero sexual (OR= 2.96, IC 95 por ciento 1.22-7.5, p=0.008), concubinato (RM=3.68, p=0.03) y uso de...