Breastfeeding Initiation, Duration, and Associated Factors Among People With Hepatitis C Virus Infection

OBJECTIVE: To characterize breastfeeding behaviors and identify factors associated with breastfeeding initiation among people with hepatitis C virus (HCV) infection. METHODS: We conducted a secondary analysis of a multicenter observational cohort of pregnant people with singleton gestations and HCV seropositivity. This analysis includes individuals with data on breastfeeding initiation and excludes those with human immunodeficiency virus (HIV) co-infection. The primary outcome was self-reported initiation of breastfeeding or provision of expressed breast milk. Secondary outcomes included duration of breastfeeding. Demographic and obstetric characteristics were compared between those who initiated breastfeeding and those who did not to identify associated factors. Univariable and multivariable analyses were performed. RESULTS: Overall, 579 individuals (75.0% of participants in the parent study) were included. Of those, 362 (62.5%) initiated breastfeeding or provided breast milk to their infants, with a median duration of breastfeeding of 1.4 months (interquartile range 0.5-6.0). People with HCV viremia , defined as a detectable viral load at any point during pregnancy, were less likely to initiate breastfeeding than those who had an undetectable viral load (59.4 vs 71.9%, adjusted odds ratio [aOR] 0.61, 95% CI, 0.41-0.92). People with private insurance were more likely to initiate breastfeeding compared with those with public insurance or no insurance (80.0 vs 60.1%; aOR 2.43, 95% CI, 1.31-4.50). CONCLUSION: Although HCV seropositivity is not a contraindication to breastfeeding regardless of viral load, rates of breastfeeding initiation were lower among people with HCV viremia than among those with an undetectable viral load

Periodontitis to placenta: An awareness-based survey

Introduction: Surprising how a small part of our body, the mouth, can alter and result in a variety of systemic complications if not taken care of. The primary factor for maternal and newborn morbidity and mortality is thought to be periodontitis. Gynecologists have a crucial role in educating their patients about the need of keeping good dental health because it can improve the success of pregnancies and reduce mouth pain. Objective: The objective of this study was to understand the awareness of gynecologists practicing in Pune, Maharashtra, about periodontal status and its outcome in pregnant women. Materials and Methods: A questionnaire-based study was conducted on 60 gynecologists. We evaluated people's knowledge of the negative effects of female sex hormones on periodontal health. Results: Eighty percent were aware of the correlation between periodontal health and female sex hormones. 56.7% agreed that periodontal microorganisms can pass through the placenta and harm the fetus. 76.7% were unaware that the possibility of prenatal growth restriction has increased. Most participants did not motivate pregnant women for an oral health checkup. Conclusion: It can be inferred that gynecologists are not aware of the connection between mouth findings and worse pregnancy outcomes

Variation of pneumococcal Pilus-1 expression results in vaccine escape during Experimental Otitis Media [EOM].

The pneumococcal Pilus-1 enhances attachment to epithelial cells in the respiratory tract and subsequent invasion. Pilus-1 expression is bi-stable and positively regulated by the RlrA transcriptional regulator. To delineate the role of pilus-1 in Experimental Otitis Media (EOM), we evaluated colonization and disease due to a Streptococcus pneumoniae (SP) wild type strain (Taiwan19F-14 wt) and its otherwise isogenic pilus-1 and pilus-2 deficient mutant (Taiwan19F-14 ΔPI-1/PI-2-) as well as potential for a chimeric protein (RrgB321) vaccine candidate for prevention of middle ear (ME) disease.Chinchillas were challenged intranasally with either Taiwan19F-14 wt or Taiwan19F-14PI-1/PI-2 deficient mutant. ME status was assessed and direct cultures performed. New cohorts of animals were immunized with RrgB321 or alum. Intranasal challenge with Taiwan19F-14 wt [erythromycin susceptible E(S)] was performed. Subsequently, a second cohort of animals was immunized and challenged with either Taiwan19F-14 wt or a Pilus-1 over-expressing mutant [Taiwan19F-14+pMU1328_Pc-rlrA mutant; E resistant (R)] strain. Pilus-1 expression was analyzed in SP isolated from nasopharynx (NP) and ME fluids by flow cytometry.Culture positive EOM developed following challenge with either wild type SP (Taiwan19F-14) or its pilus-1 deficient mutant. Culture positive EOM developed following challenge with wild type in both RrgB321 immunized and control animals. Pilus-1 expression in ME fluids was significantly higher in controls compared to immunized chinchillas. In second cohort of immunized and control animals challenged with the over-expressing Pilus-1 mutant, delayed development of EOM in the immunized animals was observed. Pneumococci recovered from ME fluid of immunized animals were no longer E(R) signifying the loss of the pMU1328_Pc-rlrA plasmid.Pneumococcal pilus-1 was not essential for EOM. Regulation of Pilus-1 expression in ME fluids in the presence of anti RrgB321 antibody was essential for survival of S. pneumoniae. Pneumococci have evolved mechanisms of regulation of non-essential surface proteins to evade host defenses

ISOM 2023 Research Panel 5: Interventions- Vaccines and prevention, medical and surgical treatment, and impact of COVID-19 pandemic

OBJECTIVES: To identify and synthesize key research advances from the literature published between 2019 and 2023 on the advances in preventative measures, and medical and surgical treatment of uncomplicated otitis media (OM) including the impact of the COVID-19 pandemic on OM management. DATA SOURCES: Medline (PubMed), Embase, and the Cochrane Library. REVIEW METHODS: All relevant original articles published in English between June 2019 and February 2023 were identified. Studies related to guideline adherence, impact of treatment on immune response and/or microbiology, tympanoplasty, Eustachian tube balloon dilatation, mastoidectomy procedures, and those focusing on children with Down's syndrome or cleft palate were excluded. MAIN FINDINGS: Of the 9280 unique records screened, 64 were eligible for inclusion; 23 studies related to medical treatment, 20 to vaccines, 13 to surgical treatment, 6 to prevention (excl. vaccines) and 2 to the impact of COVID-19 on OM management. The level of evidence was judged 2 in 11 studies (17.2 %) and 3 or 4 in the remaining 53 studies (82.8 %) mainly due to the observational design, study limitations or low sample sizes. Some important advances in OM management have been made in recent years. Video discharge instructions detailing the identification and management of pain and fever for parents of children with acute otitis media (AOM) was more effective than paper instructions in reducing symptomatology; compared to placebo, levofloxacin solution was more effective for treating chronic suppurative otitis media, whereas AOM recurrences during two years of follow-up did not differ between children with recurrent AOM who received tympanostomy tube (TT) insertion or medical management. Further, novel pneumococcal conjugate vaccines (PCV) schedules for preventing OM in Aboriginal children appeared ineffective, and a protein-based pneumococcal vaccine had no added value over PCV13 for preventing AOM in native American infants. During the COVID-19 pandemic, a decline in OM and TT case volumes and complications was observed. IMPLICATION FOR PRACTICE AND FUTURE RESEARCH: Whether the observed impact of the COVID-19 pandemic on OM management extends to the post-pandemic era is uncertain. Furthermore, the impact of the pandemic on the conduct of urgently needed prospective methodologically rigorous interventional studies aimed at improving OM prevention and treatment remains to be elucidated since the current report consisted of studies predominantly conducted in the pre-pandemic era

Formulations for trans-tympanic antibiotic delivery

We have developed a drug delivery system for prolonged trans-tympanic antibiotic delivery from a single dose administration. Increased permeability to ciprofloxacin of the intact tympanic membrane (TM) was achieved by chemical permeation enhancers (CPEs - bupivacaine, limonene, sodium dodecyl sulfate); this was also seen by CPEs contained within a hydrogel (poloxamer 407) to maintain the formulation at the TM. The CPE-hydrogel formulation had minimal effects on auditory thresholds and tissue response in vivo. CPE-hydrogel formulations have potential for ototopical delivery of ciprofloxacin for the treatment of acute otitis media (AOM) and other middle ear diseases. ©2012 Elsevier Ltd.National Institute of Deafness andCommunicative Disorders - NIDCD (Grant Number R21DC009986

Outcome of challenge with SP Pilus-1 overexpressing mutant in RrgB321 immunized animals.

<p>Density of colonization in middle ear fluid in RrgB321 immunized and control chinchillas challenged with SP Taiwan19F-14 pMU1328_<i>Pc-rlrA</i> (100% pilus +).</p

Pilus expression of SP Taiwan19F-14 wt in nasal and middle ear washes compared to inoculum.

<p>Flow cytometry analysis of Pilus-1 expression in nasal wash (NW) [A] and middle ear Fluid (MEF) [B] following challenge with SP Taiwan19F-14 wt.</p

Nasopharyngeal colonization and middle ear challenge with SP Taiwan19F-14 wt and PI-1/PI-2 mutant.

<p>Density of colonization in nasopharynx (A) and middle ear fluid (B) in chinchillas challenged with SP Taiwan19F-14 wt (pilus +) or with Taiwan19F-14 ΔPI-1/PI-2 mutant.</p

Pilus expression of SP Taiwan19F-14 wt in nasal and middle ear washes of RrgB321 immunized and control animals.

<p>Flow cytometry analysis of Pilus-1 expression in nasal wash (NW) [A] and middle ear Fluid (MEF) [B] in RrgB321 immunized and control animals following challenge with SP Taiwan19F-14 wt.</p

Evaluation of pilus expression on surface of <i>Streptococcus pneumoniae</i>.

<p>Flow cytometry on SP Taiwan19F-14 wt and its derivatives (ΔPI-1/PI-2 mutant and pMU1328_<i>Pc-rlrA</i> + strain) performed with pAb against RrgB. The percentage of pilus positive and negative bacteria for each strain was reported.</p