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      Despistaje de infecciones de transmisión vertical durante el embarazo: Toxoplasmosis, VIH, Hepatitis B y C, Sífilis Translated title: Screening vertical transmission of infections during pregnancy: Toxoplasmosis, HIV, Hepatitis B and C, Syphilis

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          Abstract

          El despistaje de infecciones mediante pruebas de laboratorio permite disminuir el riesgo de morbimortalidad perinatales y maternas. El objetivo del estudio fue identificar la presencia de infecciones de transmisión vertical: toxoplasmosis, VIH, sífilis, Hepatitis B y C, durante el periodo noviembre 2013 a mayo 2014. Estudio descriptivo, muestra conformada por 175 embarazadas entre 14 a 43 años, a las cuales se les descarto Toxoplasmosis, Anticuerpos Reagínicos por VDRL cualitativa, VIH, hepatitis B (Anti-HBsAg, HBsAg, anti-Core); hepatitis C (Anticuerpos totales), a través de ultramicroELISA (UMELISA). Los resultados arrojaron Anticuerpos Anti Toxoplasma gondii positivas en 27,4%, donde el 31,2% de estas embarazadas presentaron títulos de anticuerpos de 1/512. Los Anticuerpos Anti-VIH resultaron positivos en 0,6%. El 99,4% mostraron un VDRL No Reactivo. El 38,9% tuvo un resultado positivo para anticuerpos contra el antígeno de superficie de la hepatitis B, los marcadores HBsAg y Anti-Core resultaron negativos en un 100%; el 1,7% fue positivo para anticuerpos totales contra el virus de la Hepatitis C. Se concluye que el despistaje de enfermedades infecciosas que representan factores de riesgo de transmisión vertical en embarazadas, constituye uno de los medios más oportuno para diagnosticar estas patologías y prevenir la morbimortalidad materna e infantil.

          Translated abstract

          The screening for infection diseases in pregnancy by laboratory tests can reduce the risk of perinatal and maternal morbidity and mortality. The objective of this study was to identify the presence of vertically transmitted infections: toxoplasmosis, HIV, syphilis, hepatitis B and C, for the period November 2013 to May 2014. Descriptive study, the sample consisted of 175 pregnant women between 14 to 43 years, women who were discarded for Toxoplasmosis, Reaginic Antibodies by qualitative VDRL, HIV, hepatitis B (Anti-HBsAg Anti-HBsAg, anti-Core); hepatitis C (Total antibodies), through ultramicroELISA (UMELISA). The results showed 27.4% positive for Anti- Toxoplasma gondii antibodies, with 31.2% of these pregnant women having antibody titers of 1/512. Anti-HIV antibodies were positive by 0.6%. 99.4% showed Nonreactive VDRL. 38.9% were positive for antibodies against the hepatitis B surface antigen, the markers HBsAg and anti-Core were negative by 100%; 1.7% were positive for total antibodies against Hepatitis C. It is concluded that the screening of infectious diseases that represent risk factors for vertically transmission infections during pregnancy, is one of the most appropriate tools to diagnose these diseases and prevent maternal and infant morbidity and mortality.

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          A novel point-of-care testing strategy for sexually transmitted infections among pregnant women in high-burden settings: results of a feasibility study in Papua New Guinea

          Background Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is feasible in the high-burden, low-income setting of Papua New Guinea. Methods Women attending their first antenatal clinic visit were invited to participate. CT/NG and TV were tested using the GeneXpert platform (Cepheid, USA), and BV tested using BVBlue (Gryphus Diagnostics, USA). Participants received same-day test results and antibiotic treatment as indicated. Routine antenatal care including HIV and syphilis screening were provided. Results Point-of-care testing was provided to 125/222 (56 %) of women attending routine antenatal care during the three-month study period. Among the 125 women enrolled, the prevalence of CT was 20.0 %; NG, 11.2 %; TV, 37.6 %; and BV, 17.6 %. Over half (67/125, 53.6 %) of women had one or more of these infections. Most women were asymptomatic (71.6 %; 47/67). Women aged 24 years and under were more likely to have one or more STI compared with older women (odds ratio 2.38; 95 % CI: 1.09, 5.21). Most women with an STI received treatment on the same day (83.6 %; 56/67). HIV prevalence was 1.6 % and active syphilis 4.0 %. Conclusion Point-of-care STI testing and treatment using a combination of novel, newly-available assays was feasible during routine antenatal care in this setting. This strategy has not previously been evaluated in any setting and offers the potential to transform STI management in pregnancy and to prevent their associated adverse health outcomes.
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            Antiviral therapy for hepatitis C: Has anything changed for pregnant/lactating women?

            Hepatitis C virus (HCV) affects about 3% of the world's population, with the highest prevalence in individuals under 40. The prevalence in pregnant women varies with geographical distribution (highest in developing countries). Prevalence also increases in sub-populations of women at high risk for blood-transmitted infections. HCV infection in pregnancy represents a non-negligible problem. However, most of the past antiviral regimens cannot be routinely offered to pregnant or breastfeeding women because of their side effects. We briefly reviewed the issue of treatment of HCV infection in pregnant/breastfeeding women focusing on the effects of the new direct-acting antivirals on fertility, pregnancy and lactation in animal studies and on the potential risk for humans based on the pharmacokinetic properties of each drug. Currently, all new therapy regimens are contraindicated in this setting because of lack of sufficient safety information and adequate measures of contraception are still routinely recommended for female patients of childbearing potential.
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              Vertically acquired hepatitis C virus infection: Correlates of transmission and disease progression.

              The worldwide prevalence of hepatitis C virus (HCV) infection in children is 0.05%-0.4% in developed countries and 2%-5% in resource-limited settings, where inadequately tested blood products or un-sterile medical injections still remain important routes of infection. After the screening of blood donors, mother-to-child transmission (MTCT) of HCV has become the leading cause of pediatric infection, at a rate of 5%. Maternal HIV co-infection is a significant risk factor for MTCT and anti-HIV therapy during pregnancy seemingly can reduce the transmission rate of both viruses. Conversely, a high maternal viral load is an important, but not preventable risk factor, because at present no anti-HCV treatment can be administered to pregnant women to block viral replication. Caution is needed in adopting obstetric procedures, such as amniocentesis or internal fetal monitoring, that can favor fetal exposure to HCV contaminated maternal blood, though evidence is lacking on the real risk of single obstetric practices. Mode of delivery and type of feeding do not represent significant risk factors for MTCT. Therefore, there is no reason to offer elective caesarean section or discourage breast-feeding to HCV infected parturients. Information on the natural history of vertical HCV infection is limited. The primary infection is asymptomatic in infants. At least one quarter of infected children shows a spontaneous viral clearance (SVC) that usually occurs within 6 years of life. IL-28B polymorphims and genotype 3 infection have been associated with greater chances of SVC. In general, HCV progression is mild or moderate in children with chronic infection who grow regularly, though cases with marked liver fibrosis or hepatic failure have been described. Non-organ specific autoantibodies and cryoglobulins are frequently found in children with chronic infection, but autoimmune diseases or HCV associated extrahepatic manifestations are rare.
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                Author and article information

                Contributors
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                Role: ND
                Role: ND
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                Role: ND
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                Journal
                km
                Kasmera
                Kasmera
                Universidad del Zulia (Maracaibo, Zulia, Venezuela )
                0075-5222
                December 2016
                : 44
                : 2
                : 77-87
                Article
                S0075-52222016000200002
                fd13ad7c-9cc5-41e0-9055-06c1ba931b36

                http://creativecommons.org/licenses/by/4.0/

                History
                : 21 October 2016
                : 29 September 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 11
                Product

                SciELO Venezuela


                toxoplasmosis,hepatitis B y C,sífilis,Pregnancy,HIV,syphilis,Embarazo,VIH

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