Invasive Obstetric Procedures and Cesarean Sections in Women With Known Herpes Simplex Virus Status During Pregnancy.

BackgroundNeonatal herpes is a potentially devastating infection that results from acquisition of herpes simplex virus (HSV) type 1 or 2 from the maternal genital tract at the time of vaginal delivery. Current guidelines recommend (1) cesarean delivery if maternal genital HSV lesions are present at the time of labor and (2) antiviral suppressive therapy for women with known genital herpes to decrease HSV shedding from the genital tract at the time of vaginal delivery. However, most neonatal infections occur in infants born to women without a history of genital HSV, making current prevention efforts ineffective for this group. Although routine serologic HSV testing of women during pregnancy could identify women at higher risk of intrapartum viral shedding, it is uncertain how this knowledge might impact intrapartum management, and a potential concern is a higher rate of cesarean sections among women known to be HSV-2 seropositive.MethodsTo assess the effects of prenatal HSV-2 antibody testing, history of genital herpes, and use of suppressive antiviral medication on the intrapartum management of women, we investigated the frequency of invasive obstetric procedures and cesarean deliveries. We conducted a retrospective cohort study of pregnant women delivering at the University of Washington Medical center in Seattle, Washington. We defined the exposure of interest as HSV-2 antibody positivity or known history of genital herpes noted in prenatal records. The primary outcome was intrapartum procedures including fetal scalp electrode, artificial rupture of membranes, intrauterine pressure catheter, or operative vaginal delivery (vacuum or forceps). The secondary outcome was incidence of cesarean birth. Univariate and multivariable logistic regressions were performed.ResultsFrom a total of 449 women included in the analysis, 97 (21.6%) were HSV-2 seropositive or had a history of genital herpes (HSV-2/GH). Herpes simplex virus-2/GH women not using suppressive antiviral therapy were less likely to undergo intrapartum procedures than women without HSV-2/GH (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.25-0.95; P = .036), but this relationship was attenuated after adjustment for potential confounders (adjusted OR, 0.69; 95% CI, 0.34-1.41; P = .31). There was no difference in intrapartum procedures for women on suppressive therapy versus women without HSV-2/GH (OR, 1.17; 95% CI, 0.66-2.07; P = .60). Similar proportions of cesarean sections were performed within each group of women: 25% without history of HSV-2/GH, 30% on suppressive treatment, and 28.1% without suppressive treatment (global, P = .73).ConclusionsIn this single-site study, provider awareness of genital herpes infection either by HSV serotesting or history was associated with fewer invasive obstetric procedures shown to be associated with neonatal herpes, but it was not associated with an increased rate of cesarean birth

Predictors Of Non-Escherichia Coli Urinary Tract Infection

We aimed to determine which children are prone to non-Escherichia coli coli UTIs. We included 769 children with UTI. We found that circumcised males, Hispanic children, children without fever, and children with Grade 3–4 VUR were more likely to have a UTI caused by organisms other than E. coli. This information may guide clinicians in their choice of antimicrobial therapy

Predictors of Antimicrobial Resistance among Pathogens Causing Urinary Tract Infection in Children

To determine which children with urinary tract infection (UTI) are likely to have pathogens resistant to narrow-spectrum antimicrobials

Estimate of the incidence of PANDAS and PANS in 3 primary care populations

ObjectivePediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) and Pediatric Acute-Onset Neuropsychiatric syndrome (PANS) are presumed autoimmune complications of infection or other instigating events. To determine the incidence of these disorders, we performed a retrospective review for the years 2017–2019 at three academic medical centers.MethodsWe identified the population of children receiving well-child care at each institution. Potential cases of PANS and PANDAS were identified by including children age 3–12 years at the time they received one of five new diagnoses: avoidant/restrictive food intake disorder, other specified eating disorder, separation anxiety disorder of childhood, obsessive-compulsive disorder, or other specified disorders involving an immune mechanism, not elsewhere classified. Tic disorders was not used as a diagnostic code to identify cases. Data were abstracted; cases were classified as PANDAS or PANS if standard definitions were met.ResultsThe combined study population consisted of 95,498 individuals. The majority were non-Hispanic Caucasian (85%), 48% were female and the mean age was 7.1 (SD 3.1) years. Of 357 potential cases, there were 13 actual cases [mean age was 6.0 (SD 1.8) years, 46% female and 100% non-Hispanic Caucasian]. The estimated annual incidence of PANDAS/PANS was 1/11,765 for children between 3 and 12 years with some variation between different geographic areas.ConclusionOur results indicate that PANDAS/PANS is a rare disorder with substantial heterogeneity across geography and time. A prospective investigation of the same question is warranted

Spatial limits of visuotactile interactions in the presence and absence of tactile stimulation

The presence of a light flash near to the body not only increases the ability to detect a weak touch but also increases reports of feeling a weak touch that did not occur. The somatic signal detection task (SSDT) provides a behavioural marker by which to clarify the spatial extent of such visuotactile interactions in peripersonal space. Whilst previous evidence suggests a limit to the spatial extent over which visual input can distort the perception of tactile stimulation during the rubber hand illusion, the spatial boundaries of light-induced tactile sensations are not known. In a repeated measures design, 41 participants completed the SSDT with the light positioned 1 cm (near), 17.5 cm (mid) or 40 cm (far) from the tactile stimulation. In the far condition, the light did not affect hit, or false alarm rates during the SSDT. In the near and mid conditions, the light significantly increased hit rates and led to a more liberal response criterion, that is, participants reported feeling the touch more often regardless of whether or not it actually occurred. Our results demonstrate a spatial boundary over which visual input influences veridical and non-veridical touch perception during the SSDT, and provide further behavioural evidence to show that the boundaries of the receptive fields of visuotactile neurons may be limited to reach space

Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection

Knowledge of prevalent RV types, antibody responses, and populations at risk based on age and genetics may guide the development of vaccines or other novel therapies against this important respiratory pathogen.Longitudinal data from the Childhood Origins of ASThma (COAST) birth cohort study were analyzed to determine relationships between age and RV-C infections. Neutralizing antibodies specific for rhinovirus A (RV-A) and RV-C (3 types each) were determined using a novel polymerase chain reaction-based assay. We pooled data from 14 study cohorts in the United States, Finland, and Australia and used mixed-effects logistic regression to identify factors related to the proportion of RV-C versus RV-A detection.In COAST, RV-A and RV-C infections were similarly common in infancy, while RV-C was detected much less often than RV-A during both respiratory illnesses and scheduled surveillance visits (pRhinovirus C (RV-C) can cause asymptomatic infection and respiratory illnesses ranging from the common cold to severe wheezing.To identify how age and other individual-level factors are associated with susceptibility to RV-C illnesses.</div

The United States, Great Britain and the middle-eastern oil industry, 1945-1960

Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.In 1943, the U.S. government tried to purchase the controlling share of an American oil company with holdings in Saudi Arabia. Owning an oil company would ensure future access to petroleum resources in the Middle East when domestic stores inevitably proved inadequate to meet demand. When this endeavor failed and the oil company instead sold those shares to two other major American oil companies, the government was left to forge a new foreign oil policy that relied on private oil companies to extract, refine and transport petroleum products from the Middle East to satisfy U .S. and Allied needs. This policy coincided neatly with the interests of American oil companies keen to exploit recently discovered deposits in the Middle East. Both the United States and the oil companies faced risks associated with an area as politically unstable and technologically backward as the Middle East. To mitigate these risks, the government helped secure and maintain the companies' legal, financial, political and diplomatic positions. On the other side, the oil companies provided access to stable, ample and additional supplies of petroleum in support of U.S. economic, political and foreign policies. The relationship between public and private that emerged, termed "mutual insurance," was of a symbiotic, rather than exploitative nature. This affiliation grew organically, based on the convergent goal of accessing Middle East oil, even though each side maintained its own, discrete objectives. The dissertation explores the development, creation, implementation and eventual termination of this distinct relationship between 1945 and 1960. It utilizes the records of the administrative bureaucracies tasked with designing and implementing U.S. foreign oil policy, the U.S. State Department, the British Foreign Office and the American and British oil companies involved in the Middle East. These sources reveal the government and corporate motivations that shaped this relationship in the Middle East during the early Cold War. Ultimately, this model of mutual insurance led to American economic and political ascendancy over the British in the Middle East, providing fuel for the American century

Listeriosis

Listeria monocytogenes, a small, facultative anaerobic, Gram-positive motile bacillus, is an important cause of foodborne illness which disproportionately affects pregnant women and their newborns. Listeria infects many types of animals and contaminates numerous foods including vegetables, milk, chicken and beef. This organism has a unique proclivity to infect the fetoplacental unit with the ability to invade cells, multiply intracellularly and be transmitted cell-to-cell. The organism possesses several virulence factors, including internalin A and internalin B, which facilitate the direct invasion of cells. Cell-to-cell transmission is promoted by the bacterial surface protein ActA which is regulated by a transcriptional activator known as positive regulatory factor A. Both innate and adaptive immune responses enable the host to eliminate this pathogen. Clinical manifestations of infection in the newborn fall into the traditional categories of early- and late-onset sepsis. Therapeutic recommendations include ampicillin and gentamicin for 14-21 days