Cytomegalovirus infection (CMV) in solid organ transplant recipients is a major clinical problem. The aim of this study was to evaluate the incidence of CMV infection and its association with mortality during the first year after transplantation in a large solid organ transplant cohort at the Royal Infirmary of Edinburgh between January 2006 and April 2009. Data including the use of CMV prophylaxis, nature of CMV disease, treatment and deceased date (when appropriate) was collected retrospectively using hospital databases and patient notes for all transplanted patients with detectable CMV viraemia. The outcomes between recipients of kidney and liver transplants in the four CMV donor/recipient serostatus categories (D+R+, D-R-, D+R-, D-R+) were compared. A total of 428 individuals were included. Despite the administration of valganciclovir prophylaxis, CMV disease (syndrome or end-organ involvement) was diagnosed within the year of transplantation in the D+R--group in 31.3% of liver and 19.2% of kidney recipients. All D+R- transplant recipients that received CMV-prophylaxis presented with late-onset CMV disease. Furthermore, the rate of CMV disease in the D+R+-group was markedly higher in renal graft recipients compared to liver recipients (22% vs. 5%). The highest mortality was observed among the D+R+ liver and kidney graft recipients with CMV infection. The high incidence of late-onset CMV disease in D+R- transplant recipients receiving CMV prophylaxis demonstrates that CMV disease remains an important problem after organ transplantation. Furthermore, the surprisingly high mortality in the D+R+-transplant patients with CMV viraemia highlights the need for proactive monitoring of this group.

The cause, and therefore the prognosis, was identified in 82% of cases of fetal ascites. The prognosis for prenatally diagnosed ascites was poor; however, a few patients did well, which has important implications for genetic counseling.

Objective: To describe risk factors and outcomes of pregnant women infected with SARS-CoV-2 admitted to South African healthcare facilities. Methods:A population-based cohort study was conducted utilizing an amended International Obstetric Surveillance System protocol. Data on pregnant women with SARS-CoV-2 infection, hospitalized between April 14, 2020, and November 24, 2020, were analyzed.Results: A total of 36 hospitals submitted data on 673 infected hospitalized pregnant women; 217 (32.2%) were admitted for COVID-19 illness and 456 for other indications. There were 39 deaths with a case fatality rate of 6.3%: 32 (14.7%) deaths occurred in women admitted for COVID-19 illness compared to 7 (1.8%) in women admitted for other indications. Of the women, 106 (15.9%) required critical care.Maternal tuberculosis, but not HIV co-infection or other co-morbidities, was associated with admission for COVID-19 illness. Rates of cesarean delivery did not differ significantly between women admitted for COVID-19 and those admitted for other indications. There were 179 (35.4%) preterm births, 25 (4.7%) stillbirths, 12 (2.3%) neonatal deaths, and 162 (30.8%) neonatal admissions. Neonatal outcomes did not differ significantly from those of infected women admitted for other indications. Conclusion:The maternal mortality rate was high among women admitted with SARS-CoV-2 infection and higher in women admitted primarily for COVID-19 illness with tuberculosis being the only co-morbidity associated with admission.

Down syndrome (DS) is the most common genetic cause of intellectual disability. Evidence suggests that live-birth prevalence of DS is high in South Africa: 1.33 -1.8 per 1 000 live births in two urban areas, 1,2 and 2.1 per 1 000 in a rural area. 3 Prenatal screening for DS was established in the 1970s using advanced maternal age (AMA) as a risk factor, and this remains the standard of care in the public health sector of South Africa. National policy provides for free amniocentesis to be offered to AMA women, whereas biochemical screening is not offered and access to fetal ultrasound is limited.Cape Town's public health services are among the best developed in South Africa. Although access to fetal ultrasound has increased in recent years, AMA remains a frequent indication for prenatal genetic counselling. The study focused on the Cape Town Metropole West health district (CT West) to obtain evidence regarding the effectiveness of age-based screening for the prevention of DS, and preliminary evidence regarding factors affecting utilisation of prenatal diagnosis. We assessed (i) laboratory trends in prenatal diagnostic testing over a 30-year period, (ii) trends in uptake of prenatal diagnostic testing among women receiving genetic counselling and (iii) the referral pathway from primary care to tertiary care. MethodsStudy population. Women attending state antenatal health care services in CT West, which comprises a large and diverse urban population, with a majority coloured population, and minorities of whites and blacks. The district has experienced rapid urbanisation and considerable demographic changes. In 2005, there were approximately 34 000 deliveries in the district (Patel, unpublished data).Study sites and services. The antenatal health service and cytogenetic laboratory service in CT West have been stable since the 1970s. The health service includes several primary and secondary level facilities, and tertiary level fetal medicine and pregnancy counselling services at Groote Schuur Hospital (GSH). The University of Cape Town (UCT) Cytogenetic Laboratory (CL) has provided prenatal and postnatal diagnostic laboratory services to CT West throughout the period. Prenatal diagnostic testing is almost exclusively by amniocentesis, and indications have included increased risk of DS (most commonly AMA, but more recently also based on ultrasound markers (first trimester nuchal translucency thickness and second trimester soft markers) and fetal anomalies detected on ultrasound. The age cut-off for AMA counselling has varied over the years.UCT CL database. The laboratory has maintained a database of samples received since the early 1970s. Initially this was a written record but all records were transferred to Microsoft Access in the mid-1990s, and a parallel written and computerised database was maintained. To improve data quality, the database was cleaned by cross-referencing blank or unclear computer data fields with the written records -the remaining missing data represented less than 5% of data points per category...