Emergence of Thelaziosis Caused by Thelazia callipaeda in Dogs and Cats, United States.

We report 2 autochthonous feline thelaziosis cases caused by the eyeworm Thelazia callipaeda and discuss the spread among dogs in the northeastern United States. Phylogenetic analysis suggests the parasite was introduced from Europe. Adopting a One Health approach is needed to limit further spread of T. callipaeda eyeworms in North America.

Cholestasis: A Prospective Study of Perinatal Outcomes and Time to Symptom Improvement.

OBJECTIVE: Although intrahepatic cholestasis of pregnancy (ICP) remains poorly understood, there are several perinatal complications associated with this condition. This study aimed to examine perinatal outcomes of women with ICP, evaluate outcomes according to severity of disease, and monitor time to symptom improvement following diagnosis. STUDY DESIGN: It involves a prospective, observational study of women with ICP at a single institution. Women with new-onset pruritus without rash were referred to a high-risk obstetrics clinic and evaluated with fasting total bile acids (TBA). Laboratory-confirmed ICP was defined as fasting TBA ≥10 µmol/L. Following diagnosis, a standardized protocol was utilized, including treatment with ursodeoxycholic acid (UDCA). Perinatal outcomes were compared amongst those with and without ICP, and to the general population. Women with ICP were further analyzed based on maximum TBA: 10 to 39, 40 to 99, and ≥100 µmol/L. A Kaplan-Meier survival curve was used to analyze time to symptom improvement. RESULTS: A total of 404 patients were evaluated and 212 (52%) were diagnosed with ICP. The mean gestational age at diagnosis was 34.1 ± 3.3 weeks. When comparing those with ICP to those not confirmed, and to the general population, there were no differences in age, parity, mode of delivery, preeclampsia, or stillbirth (p > 0.05). Preterm birth was significantly associated with ICP (p < 0.01). This relationship was significant across increasing severity of TBA (p < 0.01) and persisted when examining rates of spontaneous preterm birth (p < 0.01). All women with fasting TBA ≥40 µmol/L delivered preterm due to premature rupture of membranes or spontaneous labor. Time to symptom improvement after diagnosis was over 2 weeks on average; however, this time increased with worsening severity of disease. CONCLUSION: Despite treatment with UDCA, women with ICP are at increased risk for spontaneous preterm birth, and this risk significantly increased with severity of disease. Although not significant, a trend exists between increasing time to symptom improvement and worsening severity of disease. KEY POINTS: · Preterm birth is significantly increased in patients diagnosed with intrahepatic cholestasis of pregnancy.. · The risk of preterm birth in women with ICP increases across increasing strata of disease.. · Following initiation of treatment in patients with ICP, symptom improvement takes more than 2 weeks..

Acculturation, depressive symptoms, estriol, progesterone, and preterm birth in Hispanic women.

We examined the effects of acculturation, depressive symptoms, progesterone, and estriol (E3) as predictors of preterm birth (PTB) in pregnant Hispanic women. This cross-sectional study recruited a sample of 470 Hispanic women between 22- and 24-week gestation from physician practices and community clinics. We used the CES-D to measure maternal depressive symptoms. We measured acculturation by English proficiency on the Bidimensional Acculturation Scale, residence index by years in the USA minus age, nativity, and generational status. Serum progesterone and E3 were analyzed by EIA. Ultrasound and medical records determined gestational age after delivery. In χ (2) analysis, there were a significantly greater percentage of women with higher depressive scores if they were born in the USA. In a structural equation model (SEM), acculturation (English proficiency, residence index, and generational status) predicted the estriol/progesterone ratio (E/P), and the interaction of depressive symptoms with the E/P ratio predicted PTB. Undiagnosed depressive symptoms during pregnancy may have biological consequences increasing the risk for PTB.

The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics.

OBJECTIVE: To examine the Hispanic acculturation paradox by identifying the effect of acculturation on serum progesterone and estriol levels, the progesterone/estriol ratio, and preterm birth. METHODS: We used an observational, prospective design with 468 self-identified, low-income, pregnant Hispanic women. We used the Language Proficiency Subscale (from the Bidimensional Acculturation Scale for Hispanics) to measure acculturation. We measured progesterone and estriol in maternal serum at 22-24 weeks of pregnancy. We defined preterm birth as birth before 37 weeks of gestation. Statistical analysis was by Wilcox-Mann-Whitney and Kruskal-Wallis tests, analysis of variance, t tests, logistic regression, and structural equation modeling. RESULTS: English proficiency had an adjusted odds ratio of 4.03 (95% confidence interval 1.44-11.25), P<.001, and the lowest quartile of the progesterone/estriol ratio had an adjusted odds ratio of 2.93 (95% confidence interval 1.25-6.89), P<.001, to predict preterm birth. English proficiency was associated with a decrease in progesterone/estriol ratio and an increase in preterm birth. In structural equation modeling, the progesterone/estriol ratio mediated the relationship between acculturation and preterm birth. CONCLUSION: Hispanic woman have four times the risk of a preterm birth if they are more acculturated (ie, proficient in English). These findings demonstrate another possible aspect of obstetric risk, that of acculturation. Further refinement of the risk of acculturation is essential to clarify how we can adjust our clinical care to prevent increasing preterm birth with the increasing Hispanic population. LEVEL OF EVIDENCE: III.

Frequencies of polymorphisms associated with BSE resistance differ significantly between Bos taurus, Bos indicus, and composite cattle.

BACKGROUND: Transmissible spongiform encephalopathies (TSEs) are neurodegenerative diseases that affect several mammalian species. At least three factors related to the host prion protein are known to modulate susceptibility or resistance to a TSE: amino acid sequence, atypical number of octapeptide repeats, and expression level. These factors have been extensively studied in breeds of Bos taurus cattle in relation to classical bovine spongiform encephalopathy (BSE). However, little is currently known about these factors in Bos indicus purebred or B. indicus x B. taurus composite cattle. The goal of our study was to establish the frequency of markers associated with enhanced susceptibility or resistance to classical BSE in B. indicus purebred and composite cattle. RESULTS: No novel or TSE-associated PRNP-encoded amino acid polymorphisms were observed for B. indicus purebred and composite cattle, and all had the typical number of octapeptide repeats. However, differences were observed in the frequencies of the 23-bp and 12-bp insertion/deletion (indel) polymorphisms associated with two bovine PRNP transcription regulatory sites. Compared to B. taurus, B. indicus purebred and composite cattle had a significantly lower frequency of 23-bp insertion alleles and homozygous genotypes. Conversely, B. indicus purebred cattle had a significantly higher frequency of 12-bp insertion alleles and homozygous genotypes in relation to both B. taurus and composite cattle. The origin of these disparities can be attributed to a significantly different haplotype structure within each species. CONCLUSION: The frequencies of the 23-bp and 12-bp indels were significantly different between B. indicus and B. taurus cattle. No other known or potential risk factors were detected for the B. indicus purebred and composite cattle. To date, no consensus exists regarding which bovine PRNP indel region is more influential with respect to classical BSE. Should one particular indel region and associated genotypes prove more influential with respect to the incidence of classical BSE, differences regarding overall susceptibility and resistance for B. indicus and B. taurus cattle may be elucidated.

Managing Gestational Weight Gain: Obstetricians' Perceived Barriers and Interventions.

To support optimal health outcomes during pregnancy, understanding obstetricians' (OBs) recommendations for and barriers to managing gestational weight gain (GWG) can benefit childbirth educators. This mailed survey examined OBs' practices (n = 63) for managing GWG along with perceived barriers. The most frequent recommendations were (a) increase activity (76.2%), (b) aerobic activity (63.5%), (c) patient education about weight management (61.9%), (d) increase fiber intake (61.3%), and (e) use of guidelines for weight gain (58.7%). Self-tracking weight gain charts were the least used. Greatest barriers to GWG management were (a) patients not interested in changing behavior (77.8%), (b) high relapse rates (66.7%), (c) lack of community resources (60.3%), (d) patients cannot afford referrals (58.7%), and (e) lack of time (53.9%).

An evaluation of preparation methods and storage conditions of tribromoethanol.

This reports the in vitro portion of a study designed to establish guidelines for the preparation, storage, and use of tribromoethanol (TBE). We evaluated: 1) the purity of TBE powder from three suppliers; 2) nine methods of preparation of a 25-mg/ml (working) solution for formation of particulates and breakdown products; 3) formation of particulates and breakdown products and pH change in 1-g/ml (stock) solutions and working solutions stored under four conditions (25 degrees C and 5 degrees C in light and in dark); and 4) stock and working solutions of TBE that caused lethal effects in mice. These objectives were met by using nuclear magnetic resonance spectroscopy, gas chromatography-mass spectroscopy, particle-size and turbidity analyses, and pH strips. TBE powder from three suppliers varied in purity. No significant differences in breakdown product formation, particle size, or turbidity were noted between the nine preparation methods evaluated. Stock solutions and the working solution stored at 5 degrees C in the dark maintained a pH of 6.5 to 7.0, whereas the pH dropped for all other working solutions. A low level of dibromoacetaldehyde (DBA), a potential breakdown product reported to cause toxic effects, was detectable in all newly prepared solutions. Regardless of the storage condition or pH, DBA concentration did not increase measurably in any of the solutions after 8 weeks. The stock and working solutions that demonstrated lethal effects in mice had a pH of 6.5 and did not differ notably from newly prepared, non-lethal solutions, when evaluated for DBA. A decrease in pH could not be correlated to an increase in DBA or potential lethality, as suggested in the literature. The toxicity associated with the lethal TBE in this study appears to be a result of a chemical reaction or breakdown product that has not yet been reported.

Predicting risk of preterm birth: the roles of stress, clinical risk factors, and corticotropin-releasing hormone.

The relationships and predictive abilities of perceived stress, selected clinical risk factors, and corticotropin-releasing hormone (CRH) levels in maternal plasma were investigated for their association with preterm labor (PTL), preterm birth, and gestational age at delivery. An exploratory, prospective, longitudinal research design was used to measure CRH 4 times over pregnancy, perceived stress at 24 and 32 weeks of pregnancy, clinical risk factors, and genitourinary infections in low-income women. Multiple regression analyses revealed that a model of measurement ofperceived stress at 24 or 32 weeks, CRH at 24 or 32 weeks, and PTL (indicated by a diagnosis by the physicians on the medical record and greater than 5 contractions per hour on the fetal monitor) was predictive of as much as 0.23 to 0.27 of the variance in gestational age at birth. Entering ethnicity as a variable into a model did not improve the predictive value. An analysis of variance between Caucasian and Hispanic ethnic groups revealed differences in CRH levels. However, simple regression analysis of ethnicity as a predictor showed a weak r2 with no significance for prediction. There was some evidence of an association of smoking with stress and both PTL and preterm birth. The measurement of stress combined with the measurement of CRHfrom maternal plasma may improve the prediction of which pregnant women are at riskfor pretern birth. The measurement of CRH has potential as an early biological marker of preterm birth.

The utility of fFN for the prediction of preterm birth in twin gestations.

OBJECTIVE: To determine the sensitivity, specificity, and positive predictive value (PPV) of fetal fibronectin (fFN) and to determine its usefulness, in conjunction with selected other clinical assessment measures, in the prediction of preterm birth for women with twin gestations. DESIGN: A prospective, descriptive, longitudinal design. SETTING: An obstetrical high-risk clinic that received patient referrals from several surrounding communities in central Texas. PATIENTS/PARTICIPANTS: Forty-eight women identified with twin gestations prior to the 22nd week of pregnancy; primarily of Hispanic ethnicity. MAIN OUTCOME MEASURES: A substantial number of outcome variables were assessed in this study. In the present report, data derived from weekly assessments for the identification of the presence of fFN, the diagnosis of bacterial vaginosis, and the measurement of cervical length were reviewed for their relationship to prematurity, birth weight, birth weight discordancy and placental chorionicity. RESULTS: The relative risk of birth prior to 35 weeks gestation, fetal death, or discordance of twin birth weights of greater than 20% was 2.22 (CI: 1.09, 4.55, P < 0.015) when fFN was found to be positive at any weekly testing after 22 to 24 weeks gestation (sensitivity 76.82%, specificity 58.33%, PPV 66.7%). The presence of fFN was most highly predictive of preterm birth when performed during the 24th to 28th gestational week. Shorter cervical lengths were highly correlated with preterm birth (r = -0.6). An association between bacterial vaginosis and preterm birth was not demonstrated in this sample. CONCLUSION: Sampling for the presence of fetal fibronectin can be easily accomplished by RNs in labor triage units and by advanced practice nurses in outpatient settings. The identification of fFN, particularly during the 24 to 28 weeks gestational time frame, is highly predictive of preterm birth, and particularly so for women with twin gestations.

Interleukin-10 predicts preterm birth in acculturated Hispanics.

OBJECTIVE: Among Hispanics living in the United States, acculturation is associated with an increased risk for preterm birth. Inflammatory pathways are also associated with preterm birth. As such, the current study sought to investigate the potential relationships among preterm birth, acculturation of Hispanic women, and inflammatory markers. STUDY DESIGN: The authors performed an observational study on pregnant Hispanic women in Texas at 22-24 weeks' gestation (n = 470). The authors obtained demographic data prenatally as well as birth outcome data from the medical chart after delivery. The authors obtained venous blood and used plasma to assay interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), and interleukin-10 (IL-10). The authors used logistic regression to understand whether the presence or the absence of IL-10 levels was related to acculturation and the risk of preterm birth. RESULTS: The authors observed interactions between undetectable IL-10 levels and years in the United States and undetectable IL-10 levels and being born in the United States in models predicting preterm birth. Follow-up probes of these interactions suggested that when IL-10 was undetectable, preterm birth became more likely as time living in the United States increased, χ(2) = 5.15 (1, 416), p = .020, odds ratio (OR) = 3.17, and was more likely in participants born in the United States than in those born elsewhere, χ(2) = 5.35 (1, 462), p = .020, OR = 16.78. The authors observed no interactions among acculturation, preterm birth, and IL-1RA and IL-6 levels. CONCLUSION: Acculturated Hispanics who lack the protective effects of IL-10 experience a markedly higher risk of preterm birth than nonacculturated Hispanics.

Fetal chromosomal abnormalities: antenatal screening and diagnosis.

Pregnant women of all ages should be offered screening and invasive diagnostic testing for chromosomal abnormalities before 20 weeks' gestation. New developments in screening methods have increased the number of options for patients. Diagnostic options include chorionic villus sampling in the first trimester and amniocentesis in the second trimester. Screening options in the first trimester include nuchal translucency testing in combination with measurement of pregnancy-associated plasma protein A and human chorionic gonadotropin. Nuchal translucency testing alone is not as effective. Screening options in the second trimester include serum screening using triple or quadruple screening, and ultrasonography. Patients may also choose a combination of first- and second-trimester screening in an integrated, stepwise sequential, or contingent sequential fashion. These options include an analysis of pregnancy-associated plasma protein A, with or without nuchal translucency testing, in combination with quadruple screening. An integrated test with nuchal translucency testing is the most effective method for women who present in the first trimester. If nuchal translucency testing is unavailable, the maternal serum-integrated test is safest and most effective. For women who do not present until the second trimester, the quadruple screen is recommended. Comprehensive counseling should be available to all pregnant women. Specific screening tests will depend on availability of the procedure and patient preference.