Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.
The incidence of chronic middle ear disease is falling in Britain, and in adults, is currently approximately 2.6% (inactive) and 1.5% (active). The incidence of HIV and hepatitis C is, however, rising. With this in mind, the chances of operating on a patient with undiagnosed infection is increasing. Operations involving the drilling or cutting of bone in patients with bloodborne communicable diseases are inherently dangerous to surgeons. In the pre-antibiotic era, many orthopaedic surgeons succumbed to infection and septicemia after being pierced with a spicule of bone during the execution of their duty. With the advent of the antibiotic era, the phenomenon is no longer life threatening where a bacterium is the offending microorganism. The principle, however, may be just as valid today with regard to viral communicable diseases. The world medical literature is full of reports of transmission of HIV from doctor to patient or dentist to patient. Very little is written about the reverse. This study attempted to address the apparent imbalance in the debate over exactly who is most at risk of iatrogenic transmission of potentially lethal viruses. We took fish eyes and held them in place around a mastoid cavity during drilling of a temporal bone. The eyes were then stained with fluorescein and a blue light shone over them to identify any spicules and corneal tears. Also, during this study, the maximum distance of bone dust scatter from an in vivo mastoid operation was measured from the cavity in all directions and documented. The HIV and hepatitis C virus are discussed and the importance of protection to staff highlighted.
Human cytomegalovirus (HCMV) strains may be genotyped based on polymorphisms that exist within the UL144 gene, which is one of 19 viral genes lost in attenuated laboratory strains. In the present study, UL144 genotypes in congenitally infected babies (congenital cytomegalovirus [cCMV]) were determined, and the relationship between the genotype, viral load, cytokine profile, and patient developmental outcome was investigated. All cCMV infections identified during 2006 and 2007 were included (n ؍ 29). A portion of the infants were clinically assessed at birth and at 12 to 18 months postinfection for cCMV clinical sequelae (n ؍ 18/29). The plasma viral load (PVL) was requested for 23/29 patients, and the UL144 genotype was determined (n ؍ 27/29). The cytokine profile in patient plasma or serum was assessed (n ؍ 20/29). UL144 genotypes A, B, and C were detected within the cCMV population at 33.3%, 29.6%, and 25.9%, respectively. UL144 A and C were associated with a high PVL (P < 0.04). Furthermore, a significant association between the developmental outcome and UL144 A and C was observed (P < 0.04). Only patients infected with UL144 B and A/B were described as having a normal clinical outcome. In addition, a significant correlation between interleukin 10 (IL-10) levels and the PVL was observed (P < 0.04); however, there was no association between the genotype and the cytokine profile. The present study determined that the specific detection of UL144 genotypes A and C was indicative of serious cCMV infection and more likely to lead to long-term cCMV-associated clinical manifestations. The inclusion of HCMV UL144 genotyping along with the recommended PVL monitoring following cCMV diagnosis may aid prediction of the clinical outcome.
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