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Is parvovirus B19 infection upsurge in 2023–2024 associated with adverse pregnancy outcome?
Full text linkObjective
A surge in parvovirus B19 infections has been reported in 2023–2024 across Europe and the USA, raising concerns about the associated perinatal risks. The aim of this study was to compare perinatal outcomes following maternal parvovirus B19 infection during the 2023–2024 period with those from a pre‐2023 cohort.
Methods
This multicenter, retrospective cohort study compared perinatal outcomes in women with maternal parvovirus B19 infection according to whether infection occurred pre‐2023 (2012–2022) or between 2023 and 2024. Pregnant women with confirmed parvovirus B19 infection were eligible for inclusion. Cases were excluded if they had incomplete records, an ongoing pregnancy, coinfection with cytomegalovirus or Epstein–Barr virus, pre‐existing structural or genetic abnormality, immune fetal hydrops or a maternal serology result not indicative of parvovirus B19 infection. The primary outcome was perinatal mortality, which was defined as intrauterine fetal death ≥ 20 weeks' gestation or neonatal death ≤ 28 days after delivery. The secondary outcomes were persistent fetal anemia requiring more than one intrauterine transfusion (IUT) and a composite adverse perinatal outcome (CAPO), defined as the presence of one or more adverse outcomes, including perinatal mortality, pregnancy loss < 20 weeks, new‐onset structural anomaly and termination of pregnancy owing to parvovirus‐related morbidity. Differences between the two groups were assessed using standard statistical tests, and a generalized linear mixed model was used to identify predictors of perinatal mortality in the 2023–2024 cohort.
Results
Following exclusions, 140 cases from pre‐2023 and 175 cases from 2023–2024 were analyzed. The rate of fetal hydrops at presentation was similar across the two groups (22.9% in pre‐2023 vs 23.4% in 2023–2024; P = 0.905). The rates of perinatal mortality (6.4% in pre‐2023 vs 8.0% in 2023–2024; P = 0.294) and CAPO (17.9% in pre‐2023 vs 21.7% in 2023–2024; P = 0.395) were not significantly different between groups, but the proportion of fetuses with persistent fetal anemia requiring a second IUT was significantly higher in the 2023–2024 cohort (46.0% vs 19.4%; P = 0.011). For the 2023–2024 cohort, fetal hydrops at presentation was an independent predictor of perinatal mortality (adjusted odds ratio, 10.91 (95% CI, 1.89–63.07); P = 0.007).
Conclusion
In this multicenter collaboration, we report perinatal outcomes following maternal parvovirus B19 infection during the recent upsurge and compare them with those of a historical cohort. Although perinatal mortality and CAPO rates were similar between cohorts, cases in the recent surge (2023–2024) required more prenatal interventions, including the need for more than one IUT. Early identification and monitoring remain essential to mitigate adverse perinatal outcomes following maternal parvovirus B19 infection. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology
Regulation of Kv7 Channel Function in Rat Bladder by ERα and GPER1 Estrogen Receptors
Full text linkThis study investigated the sex and oestrous-stage dependent effects on voltage-gated potassium channels encoded by KCNQ genes (Kv7) channels in the rat bladder, focusing on the roles of different estrogen receptors (ERs). We hypothesized that ERα and G-protein-coupled estrogen receptor (GPER1) play distinct roles in modulating Kv7.4 and Kv7.5 channel functionality and localization. Using bladder tissues from male and female Wistar rats at different oestrous stages, we performed myography, RT-qPCR, immunocytochemistry, and western blot analyses. Our results showed that ML213, a Kv7.2–7.5 activator, was more effective in male bladders, correlating with higher membrane localization of Kv7.4 and Kv7.5. In contrast, female rats in the proestrous and oestrous stages exhibited reduced sensitivity to ML213, associated with decreased Kv7.5 membrane abundance. In this group, ERα attenuated both the Kv7 functional response to ML213 and the membrane localization of Kv7.5, whereas GPER1 was associated with reducing the membrane abundance of the channel without affecting functionality. In diestrous and metestrous rat bladders, ERα was not active in baseline conditions. Instead, GPER1 induced a removal of Kv7.5 from the membrane, without exerting any effect on the Kv7 functional response to ML213. These findings highlight a complex interplay between sex hormones and ERs in bladder smooth muscle cells, offering insights into sex-specific differences in bladder function and potential therapeutic targets for bladder disorders
mGem: Sepsis and antimicrobial resistance in the context of advanced HIV disease
Full text linkSepsis triggered by bloodstream infections (BSI) is a significant driver of HIV-related mortality, particularly among in-patients with advanced HIV disease (AHD). Currently, the incidence, etiology, and outcomes of BSI in this population are poorly defined. We review the existing evidence, which shows an increased risk of BSI, particularly with antimicrobial-resistant (AMR) organisms, and higher BSI-associated mortality in patients with AHD. Causative bacterial and fungal pathogens are often unknown, but when identified, limited data show etiology has shifted probably owing to increasing coverage of antiretroviral treatment, antimicrobial prophylaxis, and rising global AMR trends. Further research is crucial to design and refine interventions before, during, and after hospital admission to reduce sepsis-related mortality in patients with AHD
Clinical and Microbiological Characteristics of Meningococcal Eye Infections: Retrospective National Surveillance in England, 2010–2022
No full textObjectives: Neisseria meningitidis is primarily associated with severe systemic infections but can infect the eye and periocular tissues. Most meningococcal eye infections have a mild prognosis, but there is a significant increase in the risk of invasive disease. UK public health guidelines recommend chemoprophylaxis for meningococcal eye infection cases and contacts. This study involved a clinical and microbiological analysis of meningococcal eye infections in England over a 13-year period.
Methods: The analysis included all English cases of eye infection with confirmed isolation of N. meningitidis from ocular samples between 2010 and 2022. Microbiological data were integrated with clinical information collected by public health professionals, including age, clinical presentation, and treatment.
Results: Among 263 meningococcal eye infection cases, nearly half were observed in infants, with the highest risk in neonates. Conjunctivitis was the most common presentation, and most cases resolved without complications following treatment. Young children were more likely to receive intravenous antibiotics compared to older age groups. Around 3% of cases progressed to invasive disease (groups B, Y, or W); however, all patients survived. Most eye-derived isolates were non-groupable and reflected the profile of carriage strains in the UK, indicating an incidental infection not requiring encapsulation.
Conclusions: Meningococcal eye infections typically reflect strains circulating within the population suggesting they arise from exposure to respiratory secretions. Although cases often present with mild symptoms, the risk of invasive disease shortly after onset highlights the need for prompt recognition, systemic treatment, and a swift public health response
Noncredible Complaints and Symptom Validity in Patients With Chronic Pain
Full text linkIntroduction: The multifactorial nature of pain complicates assessment of the validity of presenting symptoms and behaviours in people with chronic pain. Recently, the Personal Problems Questionnaire (PPQ) was developed to assess genuine and noncredible cognitive, emotional and physical complaints. Here, the PPQ was used to investigate the extent to which patients with chronic pain report noncredible complaints and the relationship with pain severity and measures of cognitive performance validity and symptom over‐reporting.
Materials and Methods: Seventy‐five participants with chronic pain recruited from outpatient and pain management programme clinics completed the clinical and validity scales of the PPQ, the short‐form McGill Pain Questionnaire (SF‐MPQ) subscales and the Medical Symptom Validity Test (MSVT), and a subsample (n = 27) completed the Personality Assessment Inventory (PAI).
Results: Significant mean (T‐score±SD) elevations were observed across the PPQ cognitive (64.5 ± 13.1), emotional (65.1 ± 13.2) and physical (77.4 ± 11.0) clinical domains. Endorsement of implausible complaints on the PPQ was common; 35.6% of patients endorsed noncredible pain/physical complaints, while 19.2% and 33.3%, respectively, reported implausible cognitive and emotional difficulties. Multivariate analyses indicated that the odds of likely noncredible responding significantly increased in cognitive (34%) and emotional domains (26%) and in the physical domain (12%) for every point increase on the SF‐MPQ affective and sensory pain subscales, respectively. Noncredible symptom reporting was elevated in those receiving disability benefits/involved in litigation (n = 27), but not significantly after controlling for pain severity. Negative impression management on the PAI was associated with implausible cognitive and emotional symptom endorsement, but there was a limited relationship between PPQ validity scales and MSVT underperformance.
Conclusion: The PPQ is a potentially useful tool in the assessment of chronic pain patients, with implausible symptom endorsement found in a significant proportion, although this may not reflect intentional exaggeration
Uptake rates of influenza vaccination in over 65s in Denmark: a comparison between Danish-born and migrant populations, 2015–21
Full text linkWHO’s Immunization Agenda 2030 has placed renewed focus on life-course vaccination, including among migrants. Despite the availability of a seasonal vaccine, influenza remains a key contributor to winter excess mortality in Northern Europe, yet limited data on influenza vaccination uptake in migrants has been published. We analyzed Danish national registry data to determine influenza vaccine uptake across six flu seasons (2015/16–2020/21) among migrants (asylum-pathway and quota refugees, family reunified migrants) ≥65 years matched 1:6 on age and gender to Danish-born individuals. We used multivariate logistic regression models controlling for migrant status (immigration status, time in Denmark) and other sociodemographic variables (age, gender, nationality, urban/rural residence) to identify factors associated with influenza vaccination uptake. All analyses were done in R v4.2.1. Across all six seasons, overall flu vaccination uptake was 49.3% (Danish-born: 50.9%; migrant cohort: 39.4%). Migrants were less likely [odds ratio (OR): 0.66; 95% confidence interval (CI): 0.64–0.67] to receive an influenza vaccine across all seasons, with this gap widening from 2015/16 (OR: 0.78; 95% CI: 0.74–0.84) to the 2020/21 season (OR: 0.44; 95% CI: 0.42–0.46). Family-reunified migrants were less likely to receive an influenza vaccine across the study period than asylum-pathway and quota refugees and those from the Sub-Saharan Africa region had the lowest uptake in terms of area of origin. This large and unique dataset shows that migrant groups have lower uptake rates for influenza vaccination compared with Danish-born individuals, with the gap widening over time. Going forward, developing tailored interventions, co-developed in collaboration with communities themselves, will be key
Untargeted Plasma Metabolomics Extends the Biomarker Profile of Mitochondrial Neurogastrointestinal Encephalomyopathy
Full text linkMitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is caused by pathogenic mutations in the nuclear TYMP gene, which encodes the cytosolic enzyme thymidine phosphorylase. In addition to the systemic accumulation of thymidine and deoxyuridine, several case studies have reported abnormalities in a range of other metabolites in patients with MNGIE. Since metabolites are intermediates or end-products of numerous biochemical reactions, they serve as highly informative indicators of an organism’s metabolic activity. This study aimed to perform an untargeted metabolomic profiling to determine whether individuals with MNGIE exhibit a distinct plasma metabolic signature compared to 15 age- and sex-matched healthy controls. Metabolites were profiled using Ultra-High-Performance Liquid Chromatography–Mass Spectrometry (UHPLC-MS). A total of 160 metabolites were found to be significantly upregulated and 260 downregulated in patients with MNGIE. KEGG pathway enrichment analysis revealed disruptions in 20 metabolic pathways, with arachidonic acid metabolism and bile acid biosynthesis being the most significantly upregulated. Univariate receiver operating characteristic (ROC) curve analyses identified 23 individual metabolites with diagnostic potential, each showing an area under the curve (AUC) ≥ 0.80. We propose that an impaired resolution of inflammation contributes to a chronic inflammatory state in MNGIE, potentially driving disease progression. Additionally, we suggest that the gut–liver axis plays a central role in MNGIE pathophysiology, with hepatic function being bidirectionally influenced by gut-derived factors
Response to: “Response to “2024 Global Statement Defining Interventional Radiology: Have we Reached the Tipping Point?””
No full textPsychosis in Huntington's disease: a review and comparison with schizophrenia
No full textPsychosis is a relatively rare phenomenon in Huntington's disease (HD) yet it occurs more commonly amongst individuals with HD than in the general population. Its presence is associated with significant distress and caregiver burden. This review evaluates the epidemiology, aetiology, phenomenology, neurobiology and treatment of psychosis in HD, drawing comparisons with schizophrenia as an archetypal psychotic disorder. We conducted a detailed literature search and narrative synthesis and found that prevalence estimates of psychosis in HD varied widely (4.1-17.6 %). While generally more common in those with established motor symptoms, psychosis occurred throughout the HD course. Its presence conferred a poorer prognosis, including greater functional and cognitive decline. No distinct phenomenology of psychosis in HD emerged; paranoid ideation was common whereas formal thought disorder was rarely reported. Like schizophrenia, psychosis in HD is associated with depression, suicidality, apathy, executive and social cognitive dysfunction. The neurobiology of psychosis in HD is not well understood however HD neurobiology shares some overlap with schizophrenia. Despite the absence of mesostriatal hyperdopaminergic transmission, frontostriatal network dysfunction, glutamatergic dysregulation and medium spiny neuron pathology could contribute to psychosis manifestation. The development of psychosis in HD is conceptualised within a stress-diathesis framework, involving an interaction between genetic risk (with some shared vulnerability to schizophrenia), neuronal changes and psychosocial stressors. Clinically, this implies a rationale for utilising therapeutic approaches trialled in schizophrenia, as there is no evidence that psychosis in HD requires fundamentally different treatment, except for an awareness of the antipsychotic effects on HD motor symptoms
Association of British Clinical Diabetologists and UK Kidney Association Joint Clinical Practice Guidelines for the Pharmacological Management of Hyperglycemia in Adults With Type 2 Diabetes Mellitus and CKD
Full text linkA growing and significant number of people with diabetes develop chronic kidney disease (CKD), and diabetes-related CKD is a leading cause of end-stage kidney disease (ESKD). People with diabetes and CKD have high morbidity and mortality, predominantly related to cardiovascular disease (CVD).
Hyperglycemia and hypertension are modifiable risk factors to prevent the onset and progression of CKD and related CVD. Recent clinical trials of people with type 2 diabetes mellitus (T2DM) and CKD have demonstrated reduction in composite kidney end point events (significant decline in kidney function, need for kidney replacement therapy, and kidney-related death) and cardiovascular risk with sodium-glucose cotransporter 2 (SGLT-2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) and glucagon-like peptide 1 (GLP-1) receptor agonists (RAs).
The Association of British Clinical Diabetologists and UK Kidney Association Diabetic Kidney Disease Clinical Speciality Group have previously undertaken a narrative review and critical appraisal of the available evidence to inform clinical practice guidelines for the pharmacological management of hyperglycemia in adults with T2DM and CKD. This 2025 abbreviated updated guidance by a multidisciplinary group of health care professionals from primary and secondary care settings summarizes the key recommendations, clinical considerations and recent evidence that has implications for clinical practice for health care professionals who treat people with T2DM and CKD
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