1,168 research outputs found
Placental enlargement in women with primary maternal cytomegalovirus infection is associated with fetal and neonatal disease
No full textBackground. Serological testing for primary maternal cytomegalovirus (CMV) infection during pregnancy is not routine, but ultrasound studies are routine. Therefore, we evaluated placental thickening in women with primary CMV infection during pregnancy. Methods. The study included 92 women with primary CMV infection during pregnancy and 73 CMV-seropositive pregnant women without primary CMV infection. Neonatal CMV transmission was determined by CMV culture of urine samples. Thirty-two women were treated with CMV hyperimmune globulin to either prevent or treat intrauterine CMV infection. Maximal placental thickness was measured by longitudinal (nonoblique) scanning with the ultrasound beam perpendicular to the chorial dish. Programmed placental ultrasound evaluations were performed from 16 to 36 weeks of gestation. Results. At each measurement between 16 and 36 weeks of gestation, women with primary CMV infection who had a fetus or newborn with CMV disease had placentas that were significantly thicker than those of women with primary CMV infection who did not have a diseased fetus or newborn (P <.0001); the latter group, in turn, P <.0001 had placentas that were significantly thicker than those of seropositive control subjects (P <.0001). For both women P <.0001 with and women without diseased fetuses or newborns, receipt of hyperimmune globulin after primary CMV infection was associated with statistically significant reductions in placental thickness (P <.001). Placental vertical P <.001 thickness values, which are predictive of primary maternal infection, were observed at each measurement from 16 to 36 weeks of gestation, and cutoff values ranged from 22 mm to 35 mm, with the best sensitivity and specificity at 28 and 32 weeks of gestation. Conclusions. Primary maternal CMV infection and fetal or neonatal disease are associated with sonographically thickened placentas, which respond to administration of hyperimmune globulin. These observations suggest that many of the manifestations of fetal and neonatal disease are caused by placental insufficiency
Fetal hyperechogenic bowel may indicate congenital cytomegalovirus disease responsive to immunoglobulin therapy
No full textObjective: To determine whether fetal hyperechogenic bowel is associated with a poor outcome with or without immunoglobulin therapy. Methods: Sixteen pregnant women whose 17 fetuses had hyperechogenic bowel were followed by a protocol of offering additional serologic testing, amniocentesis, hyperimmunoglobulin (HIG), serial ultrasounds, and evaluation of their children. Results: Of 17 fetuses with hyperechogenic bowel, 13 showed hyperechogenic bowel as a single or first ultrasound sign compared to four who showed it concomitantly or after other ultrasound abnormalities appeared (P = 0.02). Of the 17 fetuses with hyperechogenic bowel, nine were treated with HIG. Eight of the nine were normal at birth and during a follow-up of 38 years. One treated fetus is deaf at 4 years of age. A significantly different result (P < 0.0004) occurred among seven untreated fetuses who were each severely affected at 27 years of age, and the remaining one died soon after preterm birth. Among seven of nine fetuses (77.8%) of treated mothers the fetal hyperechogenic bowel resolved after HIG administration. There were no significant differences between treated and untreated fetuses for gestational age at maternal infection, gestational age at birth, and birth weight. Conclusion: Hyperechogenic bowel may be a marker of congenital cytomegalovirus (CMV) disease, which may be prevented by HIG. © 2012 Informa UK, Ltd
sj-docx-1-rcp-10.1177_14782715221147969 – Supplemental material for An unusual case of neurocardiogenic syncope: A case report and systematic review
No full textSupplemental material, sj-docx-1-rcp-10.1177_14782715221147969 for An unusual case of neurocardiogenic syncope: A case report and systematic review by Wei Wen Tan, Maciej Adler, Stuart Rochow and Phyo Kyaw Myint in Journal of the Royal College of Physicians of Edinburgh</p
sj-png-3-rcp-10.1177_14782715221147969 – Supplemental material for An unusual case of neurocardiogenic syncope: A case report and systematic review
No full textSupplemental material, sj-png-3-rcp-10.1177_14782715221147969 for An unusual case of neurocardiogenic syncope: A case report and systematic review by Wei Wen Tan, Maciej Adler, Stuart Rochow and Phyo Kyaw Myint in Journal of the Royal College of Physicians of Edinburgh</p
sj-docx-2-rcp-10.1177_14782715221147969 – Supplemental material for An unusual case of neurocardiogenic syncope: A case report and systematic review
No full textSupplemental material, sj-docx-2-rcp-10.1177_14782715221147969 for An unusual case of neurocardiogenic syncope: A case report and systematic review by Wei Wen Tan, Maciej Adler, Stuart Rochow and Phyo Kyaw Myint in Journal of the Royal College of Physicians of Edinburgh</p
Alfred Adler Revisited
No full textAlfred Adler was one of the most influential thinkers in psychotherapy – a physician, psychiatrist, author, and professor who wanted to answer the questions that plagued people during a significant time in history. His original ideas serve as a foundation for most modern theories of counseling and psychotherapy, ideas and writings that are brought back to life in this volume. Within, contemporary experts comment and introduce Adler\u27s work through the lens of the 21st century. In doing so, they pay tribute to, analyze, and disseminate his classic, seminal papers that have significantly impacted the therapy field. The 23 papers included were chosen because of their relevance to today\u27s issues, and their importance in Adlerian theory and practice. They detail the core elements of his theory, the tactics he used to advocate change in individuals and systems, and emphasize how contemporary his ideas are. Alfred Adler Revisited not only plays homage to a great professional, it revives his ideas and encourages debate over fundamental human issues.https://opus.govst.edu/faculty_books/1025/thumbnail.jp
Passive immunization during pregnancy for congenital cytomegalovirus infection
No full textBACKGROUND: Currently, there is no effective intervention for a primary cytomegalovirus (CMV) infection during pregnancy. METHODS: We studied pregnant women with a primary CMV infection. The therapy group comprised women whose amniotic fluid contained either CMV or CMV DNA and who were offered intravenous CMV hyperimmune globulin at a dose of 200 U per kilogram of maternal weight. A prevention group, consisting of women with a recent primary infection before 21 weeks' gestation or who declined amniocentesis, was offered monthly hyperimmune globulin (100 U per kilogram intravenously). RESULTS: In the therapy group, 31 women received hyperimmune globulin, only 1 (3 percent) of whom gave birth to an infant with CMV disease (symptomatic at birth and handicapped at two or more years of age), as compared with 7 of 14 women who did not receive hyperimmune globulin (50 percent). Thus, hyperimmune globulin therapy was associated with a significantly lower risk of congenital CMV disease (adjusted odds ratio, 0.02; 95 percent confidence interval, -infinity to 0.15; P<0.001). In the prevention group, 37 women received hyperimmune globulin, 6 (16 percent) of whom had infants with congenital CMV infection, as compared with 19 of 47 women (40 percent) who did not receive hyperimmune globulin. Thus, hyperimmune globulin therapy was associated with a significantly lower risk of congenital CMV infection (adjusted odds ratio, 0.32; 95 percent confidence interval, 0.10 to 0.94; P=0.04). Hyperimmune globulin therapy significantly (P<0.001) increased CMV-specific IgG concentrations and avidity and decreased natural killer cells and HLA-DR+ cells and had no adverse effects. CONCLUSIONS: Treatment of pregnant women with CMV-specific hyperimmune globulin is safe, and the findings of this nonrandomized study suggest that it may be effective in the treatment and prevention of congenital CMV infection. A controlled trial of this agent may now be appropriate
Regression of fetal cerebral abnormalities by primary cytomegalovirus infection following hyperimmunoglobulin therapy
No full textObjective To assess the effects of maternal and intra-amniotic hyperimmunoglobulin (HIG) infusions among cytomegalovirus (CMV) infected fetuses with ultrasound abnormalities following a primary CMV infection. Patients and Methods The subjects were fetuses with CMV-associated cerebral and other ultrasound abnormalities. Three mothers were treated with HIG infusions during pregnancy and two were untreated. Fetal ventricle size, organ echodensity and placental thickness were measured by ultrasound before and after HIG infusions. The children were evaluated between 3 and 7 years of age. Results The ventriculomegaly of all three fetuses of HIG-treated mothers regressed and the ascites, hepatic echodensities, periventricular echodensities, and intestinal echodensities disappeared. Their sensorial, mental and motor development was normal at 4, 4.7, and 7 years of age. In contrast, both infants born of untreated mothers had signs and symptoms of severe CMV cerebropathy. Conclusion The outcomes of the infants born to HIG-treated mothers support the efficacy of HIG as a treatment for CMV-infected fetuses with ultrasound cerebral abnormalities. Copyright (C) 2008 John Wiley & Sons, Ltd
Cytomegalovirus and Child Day Care
No full textAbstract
To determine whether day-care workers acquire cytomegalovirus infection from the children they care for, we studied 610 women employed at 34 day-care centers over two years.
Forty-one percent of the caretakers were seropositive for cytomegalovirus. After adjustment for the effects of race, marital status, and age on seropositivity, the women who cared for children younger than two years of age had a significantly higher seropositivity rate (46 percent) than the women who cared for children older than two years of age (35 percent) (relative risk, 1.29; 95 percent confidence interval, 1.05 to 1.57; P\u3c0.02).
Of 202 initially seronegative caretakers (observed for an average of 305 days per woman), 19 seroconverted, for an annual seroconversion rate of 11 percent. This rate was significantly higher than the 2 percent annual rate of seroconversion among 229 seronegative women (11 of whom seroconverted) in a comparison group of female hospital employees observed for an average of 781 days per woman (relative risk, 5.0; 95 percent confidence interval, 2.4 to 10.5; P
We conclude that workers in day-care centers may acquire cytomegalovirus infection from the children in their care and that this risk is significantly greater among those who care for children less than two years of age. (N Engl J Med 1989;321:1290–6.
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