Zika virus detection in amniotic fluid and Zika-associated birth defects.
- 作者列表："Mercado M","Ailes EC","Daza M","Tong VT","Osorio J","Valencia D","Rico A","Galang RR","González M","Ricaldi JN","Anderson KN","Kamal N","Thomas JD","Villanueva J","Burkel VK","Meaney-Delman D","Gilboa SM","Honein MA","Jamieson DJ","Ospina ML
BACKGROUND:Zika virus infection during pregnancy can cause serious birth defects, which include brain and eye abnormalities. The clinical importance of detection of Zika virus RNA in amniotic fluid is unknown. OBJECTIVE:The purpose of this study was to describe patterns of Zika virus RNA testing of amniotic fluid relative to other clinical specimens and to examine the association between Zika virus detection in amniotic fluid and Zika-associated birth defects. Our null hypothesis was that Zika virus detection in amniotic fluid was not associated with Zika-associated birth defects. STUDY DESIGN:We conducted a retrospective cohort analysis of women with amniotic fluid specimens submitted to Colombia's National Institute of Health as part of national Zika virus surveillance from January 2016 to January 2017. Specimens (maternal serum, amniotic fluid, cord blood, umbilical cord tissue, and placental tissue) were tested for the presence of Zika virus RNA with the use of a singleplex or multiplex real-time reverse transcriptase-polymerase chain reaction assay. Birth defect information was abstracted from maternal prenatal and infant birth records and reviewed by expert clinicians. Chi-square and Fisher's exact tests were used to compare the frequency of Zika-associated birth defects (defined as brain abnormalities [with or without microcephaly, but excluding neural tube defects and their associated findings] or eye abnormalities) by frequency of detection of Zika virus RNA in amniotic fluid. RESULTS:Our analysis included 128 women with amniotic fluid specimens. Seventy-five women (58%) had prenatally collected amniotic fluid; 42 women (33%) had amniotic fluid collected at delivery, and 11 women (9%) had missing collection dates. Ninety-one women had both amniotic fluid and other clinical specimens submitted for testing, which allowed for comparison across specimen types. Of those 91 women, 68 had evidence of Zika virus infection based on detection of Zika virus RNA in ≥1 specimen. Testing of amniotic fluid that was collected prenatally or at delivery identified 39 of these Zika virus infections (57%; 15 [22%] infections were identified only in amniotic fluid), and 29 infections (43%) were identified in other specimen types and not amniotic fluid. Among women who were included in the analysis, 89 had pregnancy outcome information available, which allowed for the assessment of the presence of Zika-associated birth defects. Zika-associated birth defects were significantly (P<.05) more common among pregnancies with Zika virus RNA detected in amniotic fluid specimens collected prenatally (19/32 specimens; 59%) than for those with no laboratory evidence of Zika virus infection in any specimen (6/23 specimens; 26%), but the proportion was similar in pregnancies with only Zika virus RNA detected in specimens other than amniotic fluid (10/23 specimens; 43%). Although Zika-associated birth defects were more common among women with any Zika virus RNA detected in amniotic fluid specimens (ie, collected prenatally or at delivery; 21/43 specimens; 49%) than those with no laboratory evidence of Zika virus infection (6/23 specimens; 26%), this comparison did not reach statistical significance (P=.07). CONCLUSION:Testing of amniotic fluid provided additional evidence for maternal diagnosis of Zika virus infection. Zika-associated birth defects were more common among women with Zika virus RNA that was detected in prenatal amniotic fluid specimens than women with no laboratory evidence of Zika virus infection, but similar to women with Zika virus RNA detected in other, nonamniotic fluid specimen types.
背景: 妊娠期感染寨卡病毒可导致严重的出生缺陷，包括脑部和眼部异常。检测羊水中寨卡病毒RNA的临床重要性尚不清楚。 目标: 本研究的目的是描述相对于其他临床标本的羊水进行寨卡病毒RNA检测的模式，并检查羊水中寨卡病毒检测与寨卡相关出生缺陷之间的相关性。。我们的零假设是羊水中寨卡病毒检测与寨卡相关出生缺陷无关。 研究设计: 我们对 2016 年 1 月至 2017 年 1 月作为国家寨卡病毒监测的一部分提交给哥伦比亚国家卫生研究所的羊水标本的妇女进行了回顾性队列分析。标本 (母体血清、羊水、脐带血、脐带组织和胎盘组织) 使用单链或多重实时逆转录酶-聚合酶链反应检测寨卡病毒RNA的存在。从产妇产前和婴儿出生记录中提取出生缺陷信息，并由专家临床医生进行审查。卡方检验和Fisher精确检验用于比较寨卡相关出生缺陷 (定义为脑异常 [伴或不伴小头畸形，但通过检测羊水中寨卡病毒RNA的频率排除神经管缺陷及其相关发现] 或眼部异常)。 结果: 我们的分析包括 128 例羊水标本的妇女。75 例妇女 (58%) 在产前采集羊水; 42 例妇女 (33%) 在分娩时采集羊水，11 例妇女 (9%) 丢失采集日期。91 名妇女同时提交了羊水和其他临床标本进行检测，这允许跨标本类型进行比较。这些 91 名妇女，68 有证据表明寨卡病毒感染基于检测寨卡病毒RNA ≥ 1 的样本.测试羊水收集产前或分娩时确定 39 的寨卡病毒感染 (57% [22%] 15 感染中鉴定出只羊水中)，29 感染 (43%) 在其他标本类型而不是羊水中鉴定。在纳入分析的妇女中，有 89 人获得了妊娠结局信息，这使得可以评估寨卡相关出生缺陷的存在。寨卡相关出生缺陷在产前采集的羊水标本中检测到寨卡病毒RNA的孕妇中显著 (P<.05) 更常见 (19/32 份标本; 59% 份) 比那些没有的实验室证据寨卡病毒感染任何试样 (6/23 份标本中，26% ml)，但妊娠中仅在羊水以外的标本中检测到寨卡病毒RNA的比例相似 (10/23 份标本; 43%)。虽然寨卡相关出生缺陷在羊水标本中检测到任何寨卡病毒RNA的妇女中更常见 (即，产前或分娩时收集; 21/43 标本; 49%) 比那些没有的实验室证据寨卡病毒感染标本 6/23 例，26%)，这种比较无统计学意义 (P =.07). 结论: 检测羊水提供额外证据产妇诊断寨卡病毒感染.寨卡病毒相关出生缺陷更常见于妇女寨卡病毒RNA检测产前羊水标本比女性没有实验室证据寨卡病毒感染，但与其他非羊水标本类型中检测到的寨卡病毒RNA的女性相似。
METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.
METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.
METHODS:INTRODUCTION:Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease. METHODS:This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. TPO was performed on 22 patients by the senior author. The first 10 patients underwent TPO through a single-incision anterolateral approach. The last 12 patients underwent TPO using the direct lateral approach. Preoperative and postoperative pelvic radiographs were reviewed for each patient, and the migration index and center-edge angle were recorded. RESULTS:The migration index and center-edge angle were evaluated and were not found to be significantly different between the anterolateral and direct lateral groups. The direct lateral approach is described. CONCLUSION:The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve.