NSIDRC Journal Article Alert — October 24, 2008
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
This journal article alert provides selected items added to the National Library of Medicine's PubMed database in the last week.
Past issues of Resource Center journal alerts are available at http://www.sidscenter.org. Availability of full-text journal articles is often limited to subscribers or through inter-library loan. Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article for more details.
Sudden Infant Death
1. Tester DJ, Ackerman M Cardiomyopathic and Channelopathic Causes of Sudden, Unexpected Death in Infants and Children Annu Rev Med. 2008 Oct 17. [Epub ahead of print]
Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905.
In the past decade there has been an increasing awareness of distinct, potentially lethal heritable cardiomyopathic and channelopathic syndromes as they pertain to sudden cardiac death in infants and children. This review highlights current clinical and molecular findings of two highly relevant structural cardiac abnormalities evident at autopsy, namely hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, as well as the cardiac channelopathies of long QTsyndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome, and short QT syndrome, which may account for one third of autopsy-negative sudden unexplained deaths (SUDs) during childhood and adolescence. We also explore the role of postmortem genetic analysis (molecular autopsy) in cases of SUD, provide a critical analysis of the current spectrum and prevalence of channelopathies as the pathogenic basis for sudden infant death syndrome (SIDS), and provide a brief synopsis on genetic testing for such potentially lethal cardiac disorders. Expected final online publication date for the Annual Review of Medicine Volume 60 is January 07, 2009. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Bereavement
1. Arnold J, Gemma PB The continuing process of parental grief Death Stud. 2008;32(7):658-73
School of Nursing, College of New Rochelle, New Rochelle, New York and St. Luke's-Roosevelt Hospital Center, New York, 29 Castle Place, New Rochelle, NY 10805, USA. jarnold@aol.com
The death of a child is an incomprehensible and devastating loss. Grief for parents is lifelong, becoming the connection between parent and child. To extend and deepen current understanding of parental grief, a new survey instrument was developed, combining quantitative and qualitative measures. The qualitative findings from this combined methodological study are presented. Parental grief themes are derived from the respondents' descriptions of their grief resulting in a reformulation of parental grief.
Miscarriage/Stillbirth/Prenatal Issues
1. O'Donnell CI, Glueck CJ, Fingerlin TE, Glueck DH A Likelihood Model That Accounts for Censoring Due to Fetal Loss Can Accurately Test the Effects of Maternal and Fetal Genotype on the Probability of Miscarriage Hum Hered. 2008 Oct 17;67(1):57-65. [Epub ahead of print]
Department of Preventive Medicine and Biometrics, University of Colorado Denver, Denver, Colo., USA.
Objective: Heritable maternal and fetal thrombophilia and/or hypofibrinolysis are important causes of miscarriage. Under the constraint that fetal genotype is observed only after a live birth, estimating risk is complicated. Censoring prevents use of published statistical methodology. We propose techniques to determine whether increases in miscarriage are due to the fetal genotype, maternal genotype, or both. Methods: We propose a study to estimate the risk of miscarriage contributed by an allele, expressed in either dominant or recessive fashion. Using a multinomial likelihood, we derive maximum likelihood estimates of risk for different genotype groups. We describe likelihood ratio tests and a planned hypothesis testing strategy. Results: Parameter estimation is accurate (bias <0.0011, root mean squared error <0.0780, n = 500). We used simulation to estimate power for studies of three gene mutations: the 4G hypofibrinolytic mutation in the plasminogen activator inhibitor gene (PAI-1), the prothrombin G20210A mutation, and the Factor V Leiden mutation. With 500 families, our methods have approximately 90% power to detect an increase in the miscarriage rate of 0.2, above a background rate of 0.2. Conclusion: Our statistical method can determine whether increases in miscarriage are due to fetal genotype, maternal genotype, or both despite censoring. Copyright (c) 2008 S. Karger AG, Basel.
2. Villadsen SF, Mortensen LH, Nybo Andersen AM Ethnic disparity in stillbirth and infant mortality in Denmark 1981-2003 J Epidemiol Community Health. 2008 Oct 17. [Epub ahead of print]
Denmark.
OBJECTIVE: Ethnic minorities constitute a growing part of the Danish population but little is known about ethnic disparity in early life mortality in this population. The aim of this study was to investigate ethnic disparities in stillbirth risk and infant mortality in Denmark from 1981 to 2003. Design and settings: From population-covering registries we identified all live and stillbirths of women from the five largest ethnic minority groups and of women from the (Danish) majority population (n=1 333 452). The live born were followed-up for vital status to the age of 1 year. Log-binomial regression was used to estimate relative risks according to ethnic group. MAIN OUTCOME MEASURE: Stillbirth and infant death. RESULTS: Compared to the majority population, the relative risks of stillbirth were 1.28 (95% confidence interval: 1.07-1.53) for Turkish, 1.62 (1.25-2.09) for Pakistani, and 2.11 (1.60-2.77) for Somali women. The relative risks of infant mortality were 1.41 (1.22-1.63), 1.88 (1.53-2.30), 1.39 (1.03-1.89) for children born of Turkish, Pakistani, and Somali mothers, respectively. The fetal and infant mortality in offspring of Lebanese and Former Yugoslavian women was not different from the mortality in the Danish group. The differences found were, in general, not attributable to ethnic differences in socioeconomic position. Turkish, Pakistani, and Somali children had an excess relative risk of infant death due to congenital malformations and the risk of death of perinatal causes was increased among the Pakistani offspring. CONCLUSION: Among the five largest ethnic minorities, the Turkish. Pakistani, and Somali population had substantially higher fetal and infant mortality compared to the Danish majority population, while the Lebanese and Former Yugoslavian minorities were at the same level as the majority population. The excess risk was not attributable to socioeconomic conditions.
3. Johansson S, Buchmayer S, Harlid S, Iliadou A, Sjöholm M, Grillner L, Norman M, Sparen P, Dillner J, Cnattingius S Infection with Parvovirus B19 and Herpes viruses in early pregnancy and risk of second trimester miscarriage or very preterm birth Reprod Toxicol. 2008 Oct 9. [Epub ahead of print]
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
We investigated whether infections with Parvovirus B19 and Herpes viruses in early pregnancy increase risks of second trimester miscarriage or delivery before 32 gestational weeks. Blood samples taken in early pregnancy were analyzed for Parvovirus B19 or Herpes viruses. Viremia was found in blood samples of 11 (4.7%) women with second trimester miscarriage and 10 (3.7%) women with very preterm birth, compared to 5 (1.7%) women who delivered at term, corresponding to adjusted odds ratios [95% CI] of 3.32 [0.93, 11.8] and 2.21 [0.71, 6.84], respectively. In stratified analyses, Parvovirus B19 viremia was associated with adjusted odds ratios of 3.76 [0.77, 12.0] for second trimester miscarriage and 2.66 [0.64, 11.1] for very preterm birth. Corresponding odds ratios for human Herpes virus 6 viremia was 2.52 [0.33, 19.5] and 1.08 [0.14, 8.08], respectively. In conclusion, this study lends some support to the hypothesis that women with viremia in early pregnancy may face an increased risk of second trimester miscarriage or very preterm birth. Studies with larger sample sizes are needed.
4. Costa SL, Proctor L, Dodd JM, Toal M, Okun N, Johnson JA, Windrim R, Kingdom JC Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better? Placenta. 2008 Oct 17. [Epub ahead of print]
Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
OBJECTIVE: To compare a profile of placental function between the first and second trimesters in pregnancies at high risk of adverse perinatal outcomes attributable to placental insufficiency. STUDY DESIGN: Prospective cohort study in 61 singleton pregnancies. Uterine artery Doppler and placental morphology (shape and texture) were determined at 11-13(+6) weeks and at 18-23(+6) weeks. First trimester (pregnancy-associated placental protein-A [PAPP-A]) and second trimester (total hCG and alpha fetoprotein [AFP]) serum biochemistry were determined. The two screening periods were compared for the prediction of a range of severe adverse perinatal outcomes (intrauterine growth restriction [IUGR], abruption, severe pre-eclampsia/HELLP syndrome, delivery<32 weeks, or stillbirth). RESULTS: Adverse perinatal outcomes occurred in 14 (23%) women; 3 (4.9%) losses<20 weeks, 2 (3.3%) stillbirths>20 weeks, 4 (6.6%) IUGR, 7 (11.5%) severe pre-eclampsia/HELLP syndrome, and 10 (16.4%) deliveries<32 weeks. Abnormal second trimester placental morphology was significantly associated with adverse outcome [+LR: 3.6, 95% CI: 1.3-8.5; -LR: 0.63, 95% CI: 0.36-0.93; p=0.025], as was >/=1 abnormal second trimester tests [+LR: 5.9, 95% CI: 1.6-24; -LR: 0.68, 95% CI: 0.59-0.89; p=0.005] or >/=2 abnormal second trimester tests [+LR: 3.6, 95% CI: 1.3-7.7; -LR: 0.58, 95% CI: 0.27-0.94; p=0.035]. No combination of first trimester tests significantly predicted severe adverse perinatal outcomes. A study sample size of 822 women with similar high-risk characteristics would be needed in order to refute the conclusion that present methods of first trimester screening are not inferior to second trimester screening for severe placental insufficiency (p=0.05, power 80%, z-test). CONCLUSIONS: In clinically high-risk pregnancies, prediction of adverse perinatal outcomes using placental function testing is more effective in the second compared with the first trimester.
5. Gordts S, Campo R, Puttemans P, Gordts S Clinical factors determining pregnancy outcome after microsurgical tubal reanastomosis Fertil Steril. 2008 Oct 16. [Epub ahead of print]
Leuven Institute for Fertility and Embryology, Leuven, Belgium.
OBJECTIVE: To evaluate pregnancy rates after tubal microsurgical anastomosis. DESIGN: Retrospective study. SETTING: Private tertiary care center. PATIENT(S): Two hundred sixty-one women undergoing tubal microsurgical anastomosis. INTERVENTION(S): Tubal anastomoses were performed by minilaparotomy using microsurgical principles and approximating proximal and distal tubal ends in a two-layer technique with 8-0 ethylon. MAIN OUTCOME MEASURE(S): Pregnancy outcome was analyzed for the technique of sterilization, location of anastomosis, tubal length, age, and semen parameters. RESULT(S): After exclusion of 89 patients lost to follow-up (34%) and 8 who did not attempt to conceive, 164 of the 261 patients were analyzed.The overall intrauterine pregnancy rate was 72.5%, with a miscarriage rate of 18% and a tubal pregnancy rate of 7.7%. Related to age, the cumulative intrauterine pregnancy rate was, respectively, 81%, 67%, 50%, and 12.5% for patients <36, 36-40, 40-43, and >43 years. Mean time to pregnancy was respectively 6.9, 6.2, and 12.7 months, respectively, for patients aged <36, 36-39, and 40-43 years According to the type of sterilization, intrauterine pregnancies occurred in 72% after ring sterilization, 78% after clip sterilization, 68% after coagulation, and 67% after Pomeroy sterilization. Intrauterine pregnancies and ectopic pregnancies, respectively, occurred in 80% and 3.4% in the isthmo-isthmic, 63% and 18% in the isthmo-ampullar, 75% and 8.3% in the isthmo-cornual, 100% and 0% in the ampullo-ampullar, and 60% and 0% in the ampullo-cornual anastomosis groups. Tubal length after anastomosis did not influence the pregnancy rate. In case of fertile sperm, the pregnancy rate was found to be 80%, and it decreased to 50% in case of subfertile semen. CONCLUSION(S): Our results clearly demonstrate the validity of tubal microsurgical anastomosis, establishing a quasinormalization of the fertility potential and offering the opportunity for a spontaneous conception.
6. Christiansen OB, Nielsen HS, Lund M, Steffensen R, Varming K Mannose-binding lectin-2 genotypes and recurrent late pregnancy losses Hum Reprod. 2008 Oct 16. [Epub ahead of print]
Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
BACKGROUND Low levels of mannose-binding lectin (MBL) predispose to various infectious and inflammatory disorders and have been reported to be associated with recurrent early miscarriages. Recurrent late pregnancy losses (RLPL) in the second trimester is a rare but devastating syndrome where maternal rather than fetal causes are likely to play a stronger role than in early recurrent miscarriage. METHODS We identified 75 patients with at least two late losses of pregnancies with apparently normal fetuses between gestational week 14 and 30 among patients with recurrent pregnancy losses referred to our clinic. Polymorphisms in the MBL2 gene associated with plasma MBL levels were investigated in all patients and in 104 women with two or more children and no miscarriages. The patients were divided into three groups: one with clinical signs of cervical insufficiency, one positive for the lupus anticoagulant (LAC) and an idiopathic group. RESULTS Among all patients with RLPL, 26.7% had MBL2 genotypes associated with MBL deficiency compared with 12.5% in controls [odds ratio (OR) 2.55; 95% confidence interval (CI) 1.17-5.52; P < 0.02]. Among patients with clinical signs of cervical insufficiency or the LAC, the frequency of genotypes associated with MBL deficiency was not significantly increased. However, among 38 patients with idiopathic RLPL, 36.8% carried low-producing MBL2 genotypes, which was significantly more than in controls (OR 4.08, 95% CI 1.70-9.83, P = 0.001). CONCLUSIONS MBL deficiency is strongly associated with idiopathic RLPL. This may point towards a role for excessive inflammatory disturbances as a cause of the syndrome.
7. Waylen AL, Metwally M, Jones GL, Wilkinson AJ, Ledger WL Effects of cigarette smoking upon clinical outcomes of assisted reproduction: a meta-analysis Hum Reprod Update. 2008 Oct 15. [Epub ahead of print]
University of Sheffield School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S10 2RX, UK.
BACKGROUND The aim of this meta-analysis was to investigate whether any difference exists in success rate of clinical outcomes of assisted reproductive technologies (ART) between women who actively smoke cigarettes at the time of treatment and those who do not. METHODS An intensive computerized search was conducted on published literature from eight databases, using search terms related to smoking, assisted reproduction and outcome measures. Eligible studies compared outcomes of ART between cigarette smoking patients and a control group of non-smoking patients and reported on live birth rate per cycle, clinical pregnancy rate per cycle, ectopic pregnancy rate per pregnancy or spontaneous miscarriage rate per pregnancy, and 21 studies were included in the meta-analyses. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for the data, and statistical heterogeneity was tested for using chi(2) and I(2) values. A systematic review examined the effect of smoking upon fertilization rates across 17 studies. RESULTS Smoking patients demonstrated significantly lower odds of live birth per cycle (OR 0.54, 95% CI 0.30-0.99), significantly lower odds of clinical pregnancy per cycle (OR 0.56, 95% CI 0.43-0.73), significantly higher odds of spontaneous miscarriage (OR 2.65, 95% CI 1.33-5.30) and significantly higher odds of ectopic pregnancy (OR 15.69, 95% CI 2.87-85.76). A systematic literature review revealed that fertilization rates were not significantly different between smoking and non-smoking groups in most studies. CONCLUSIONS This meta-analysis provides compelling evidence for a significant negative effect of cigarette smoking upon clinical outcomes of ART and should be presented to infertility patients who smoke cigarettes in order to optimize success rates.
8. Brady G, Brown G, Letherby G, Bayley J, Wallace LM Young women's experience of termination and miscarriage: A qualitative study Hum Fertil (Camb). 2008 Sep;11(3):186-90
Applied Research Centre for Sustainable Regeneration, Coventry University, Coventry, UK.
In Britain, teenage pregnancy is seen as both a cause and a consequence of social exclusion. The emphasis on 'prevention' of teenage pregnancy and a limited conception of 'support' within the Teenage Pregnancy Strategy (Social Exclusion Unit, 1999) positions parenthood for young people as a negative choice; this dominant discourse is likely to influence young people's reproductive decisions and experiences. With this in mind, this article focuses on a key finding from a multidisciplinary empirical research study, conducted in a city in the West Midlands of England, which considered and explored young people's experience of support before and following termination and miscarriage. Data were collected via in-depth interviews with professionals and practitioners (n = 15), young mothers (n = 4) and one young father. Although termination and miscarriage are generally perceived as distinct and different issues, the data suggest that the issues become more blurred where younger women are concerned. The experiences of young, 'inappropriately pregnant teenagers' often remain unacknowledged and devalued. This analysis highlights the social and political context in which young women experience termination and miscarriage, and suggests that termination and miscarriage should be acknowledged as significant medical, social and emotional events in the lives of young people.
9. Chigbu CO, Okezie OA, Odugu BU Intrapartum stillbirth in a Nigerian tertiary hospital setting Int J Gynaecol Obstet. 2008 Oct 13. [Epub ahead of print]
Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
OBJECTIVE: To examine the nonmedical events contributing to intrapartum stillbirths in an African setting. METHODS: Retrospective analysis of the records of women who had intrapartum stillbirths at the University of Nigeria Teaching Hospital, Enugu, from January 1999 to December 2007. The events surrounding the delivery of these women were critically analyzed and statistically compared with those who had live births to determine the nonmedical factors contributing to the stillbirths. RESULTS: The overall stillbirth rate was 89 per 1000 births. The intrapartum stillbirth rate was 52.1 per 1000 births. Nonmedical factors contributing to stillbirths included delays in receiving appropriate management, inadequate intrapartum monitoring, inappropriate interventions, and wrong diagnosis. All 3 types of delay were significantly associated with intrapartum stillbirth (P=0.0001). CONCLUSION: Intrapartum stillbirth accounts for the majority of stillbirths in this setting. Avoidable delays, suboptimal intrapartum monitoring, and inappropriate interventions contribute to the majority of intrapartum stillbirths in Nigeria.
10. Kondrackiene J, Kupcinskas L Intrahepatic cholestasis of pregnancy-current achievements and unsolved problems World J Gastroenterol. 2008 Oct 14;14(38):5781-8
Department of Gastroenterology, Kaunas University of Medicine, Eiveniu Street 2, Kaunas 50009, Lithuania. jukond@takas.lt.
Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disorder. Maternal effects of ICP are mild; however, there is a clear association between ICP and higher frequency of fetal distress, preterm delivery, and sudden intrauterine fetal death. The cause of ICP remains elusive, but there is evidence that mutations in genes encoding hepatobiliary transport proteins can predispose for the development of ICP. Recent data suggest that ursodeoxycholic acid is currently the most effective pharmacologic treatment, whereas obstetric management is still debated. Clinical trials are required to identify the most suitable monitoring modalities that can specifically predict poor perinatal outcome. This article aims to review current achievements and unsolved problems of ICP.
11. Smith B, Kemp M, Ethelberg S, Schiellerup P, Bruun BG, Gerner-Smidt P, Christensen JJ Listeria monocytogenes: Maternal-foetal infections in Denmark 1994-2005 Scand J Infect Dis. 2008 Oct 14:1-5. [Epub ahead of print]
From the Department of Bacteriology, Mycology, and Parasitology, Statens Serum Institut, Copenhagen.
Maternal-foetal infection by Listeria monocytogenes is a rare complication in pregnancy. In the period 1994-2005, 37 culture-confirmed cases of maternal-foetal Listeria monocytogenes infections were reported in Denmark. We examined 36 patients' files in order to evaluate risk factors, clinical and laboratory findings, response to therapy, and outcome for maternal-foetal listeriosis. Patient data and bacteriological findings were divided into 2 groups for comparison: 1 group with children born alive (n=24) and another group with abortion or stillbirth (n=12). 23 of the 36 children survived the acute infection, as did all the mothers. The mothers were generally only mildly affected by the infection. In contrast, among the children born alive, 15 were diagnosed with bacteraemia/septicaemia, 3 children with pneumonia, 3 with neonatal meningitis, and 3 were unaffected. Despite the high frequency of illness only 1 of the live-born children died from the infection and none of the surviving children showed signs of permanent damage at the time they were discharged from hospital. Listeriosis during pregnancy is a serious threat to the unborn child. One-third of culture-confirmed cases of maternal-foetal infections resulted in abortion or stillbirth; however, the prognosis for live-born children is good, even in severely ill newborns.
12. Plaisier M, Dennert I, Rost E, Koolwijk P, van Hinsbergh VW, Helmerhorst FM Decidual vascularization and the expression of angiogenic growth factors and proteases in first trimester spontaneous abortions Hum Reprod. 2008 Oct 14. [Epub ahead of print]
Department Biomedical Research, Gaubius Laboratory TNO-Quality and Life, PB Box 2215, Leiden 2301 CE, The Netherlands.
BACKGROUND Decidual vascular development is important for implantation. This study analysed decidual vascular adaptation to implantation in correlation with miscarriage in decidual secretory endometrium (DSE), decidua parietalis (DP) and decidua basalis (DB) of miscarriage patients and matched controls. METHODS Decidua was obtained during first trimester termination of pregnancy (controls) and vacuum aspiration in case of missed abortion (cases). Vascularization and the expression of VEGF-A, placental growth factor, Flt-1, KDR, angiopoietin (Ang)-1, Ang-2, TIE-2, and membrane-type matrix metalloproteinases MT1-, MT2-, MT3- and MT5-MMP were determined at mRNA and protein level. Uterine natural killer cells (CD56), macrophages (CD68), proliferation (Ki67) and apoptosis (activated caspase-3) were evaluated in consecutive sections. RESULTS Decidual vascularization showed differences between cases and controls, i.e. fewer vessels with larger circumference in cases. This correlated with the differential expressions of various factors at mRNA/antigen level and with increased endothelial flt1, KDR, MT2- and MT5-MMP expression in miscarriage patients. The differences between cases and controls were probably not based on altered proliferation and/or apoptosis, since Ki67 and active Caspase-3 showed comparable expression levels in both groups. Although DB of cases and controls showed similar amounts of CD56- and CD68-positive cells, the case group did show elevated levels of CD56 in DSE (P < 0.05) and of CD68 in DP compared with the control group (P < 0.05). CONCLUSIONS The differences in vascularization and in the expression of angiogenic factors and proteases between groups suggest a correlation between decidual vascularization and the occurrence of miscarriages.
13. Esinler I, Bozdag G, Yarali H Impact of isolated obesity on ICSI outcome Reprod Biomed Online. 2008 Oct;17(4):583-7
Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
The aim of this study was to assess the impact of isolated obesity on the outcome of intracytoplasmic sperm injection (ICSI). A total of 775 patients undergoing 1113 ICSI cycles were categorized on the basis of body mass index (BMI): group 1 (BMI 18.5-24.9 kg/m(2); normal weight; n = 627 cycles), group 2 (BMI 25.0-29.9 kg/m m(2); overweight; n = 339 cycles) and group 3 (BMI >or=30 kg/m(2); obese; n = 147 cycles). Sixty-three (10.0%) cycles in group 1, 53 (15.6%) cycles in group 2 and 26 cycles (17.7%) in group 3 were cancelled (P < 0.05 for group 1 versus groups 2 and 3). Despite the significantly higher total gonadotrophin consumption in groups 2 and 3 compared with group 1, the mean serum oestradiol level on the day of human chorionic gonadotrophin administration was significantly higher in group 1 (P < 0.05). The number of cumulus-oocyte complexes, metaphase II oocytes, and two-pronucleated oocytes were significantly lower in group 3 compared with group 1 (P < 0.05). However, fertilization rate, the mean number of embryos transferred, the mean number of grade 1 embryos transferred, clinical pregnancy, implantation, multiple pregnancy and miscarriage rates were comparable among the three groups. The rate of cycles with cryopreservable embryos was significantly lower in groups 2 and 3 compared with group 1 (P < 0.05).
14. Elwakil HS, Abdel Hameed DM, Thabet HS, Ahmed MA Detection of molecular markers of toxoplasmosis among Egyptian patients with miscarriage using avidity IgG-ELISA and Western blotting J Egypt Soc Parasitol. 2008 Aug;38(2):537-46
Department of Parasitology, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
A total of 54 miscarriage patients were divided into 3 groups. GI: 10 toxoplasmosis patients with +ve IgM-ELISA; GII: 24 toxoplasmosis patients with +ve IgG-ELISA, and GIII: 20 non-toxoplasmosis cross-matched females as a control. All groups were subjected to IgG-avidity ELISA & IgG-avidity immunoblotting. Avidity Indices (AI) by ELISA ranged from 22.6% to 73.3% in GI and from 9.6%-75.6% in GII. AI were high (>40%) in 3 (30%) patients in G I and in 8 (33.3%) patients in G II. Sera of GI recognized the 20, 28, 32, 60, 93 & 100 Kda bands with 55% reduction in the 38 and 60 Kda bands after treatment with 6 M urea solutions. Sera of GII recognized the 20, 28, 32, 38, 45, 95-97 & 106 Kda bands. There was 12.5%, 16.6% & 16.7% reduction in the 20, 32, & 106 Kda bands, respectively, after urea. The 38 & 60 Kda bands were identified as good diagnostic markers for the recent toxoplasmosis infection (GI). The 20, 32 & 106 Kda bands were good markers of high avidity antibodies during the chronic toxoplasmosis (GII).
15. Abdel-Hameed DM, Hassanein OM Genotyping of Toxoplasma gondii strains from female patients with toxoplasmosis J Egypt Soc Parasitol. 2008 Aug;38(2):511-20
Department of Parasitology, Faculty of Medicine, Ain-Shams University, Cairo 11566, Egypt.
Thirty-eight female patients with abortion and intrauterine fetal death were selected from the Obstetric and Gynecology Emergency, Ain Shams University Hospitals, with positive PCR results for toxoplasmosis in previous study. In this study, a rapid and efficient procedure was used for genotyping of T. gondii isolates based on PCR-RFLP assay at SAG2 locus. On the basis of the alleles identified at SAG2 locus, the isolates were grouped into three lineages. Type I was determined by resistance of the 3' & 5' end nested product of the SAG2 locus to cleavage by HhaI & Sau3AI respectively. Resistance of 5' end of SAG2 locus to cleavage by HhaI determined type II. Type III was determined by resistance of the 3' end nested-PCR products of SAG2 locus to cleavage by Sau3AI. Of the 38 isolates, type II was the most prevalent genotype found in 33 (87%). Type I was found in 5 (13%) of the isolates, whereas genotype III was not never found.
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center Georgetown University 2115 Wisconsin Avenue, N.W., Suite 601 Washington, DC 20007 (866) 866-7437 toll free (202) 687-7466 local (202) 784-9777 fax info@sidscenter.org http://www.sidscenter.org
