bluuebunny/crossref_metadata_2025_split huggingface dataset:
Care of HIV‐Infected Pregnant Women in Maternal–Fetal Medicine Programs
Authors: Sklar Peter A. , Bathgate Susanne L. , Young Heather A. , Parenti David M. 
Published: March 2007

Objective: To survey the evolution over the past decade of attitudes and practices of obstetricians in maternal–fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV)‐infected
pregnant women.Methods: Directors of all 65 approved maternal–fetal medicine training programs were sent questionnaires,
responses to which were to reflect the consensus among members of their faculties. Programs were stratified
based upon the number of HIV‐infected pregnant patients cared for in the previous year.Results: Responses reflect experience with over 1000 infected pregnantwomen per year, nearly one‐quarter with
advanced disease. Combination antiretroviral therapy was prescribed by all respondents, universally in the 2nd and
3rd trimesters. A three‐drug regimen (often containing a protease inhibitor) was used more often by those who
treated at least 20 HIV‐infected pregnant patients per year than by those programs seeing a lower number of
patients (80 vs 59%).Despite the known and unknown risks of the use of antiretrovirals during pregnancy, only half
of all responding programs report adverse events to the Antiretroviral Pregnancy Registry; reporting was more
common among the institutions seeing a higher number of patients (61 vs 45%). Seventy‐eight percent of higher
volume programs enroll their patients in clinical studies, usually multicenter, versus 35% of lower volume
programs.Conclusions: Care for HIV² pregnant women has dramatically changed over the past decade. Antiretroviral
therapy is now universally prescribed by physicians involved in maternal–fetal medicine training programs.
Given limited experience with these agents in the setting of pregnancy, it is essential for maternal–fetal medicine
practitioners to actively report on adverse events and participate in clinical trials.
Human Papillomavirus Typing in HIV‐Positive Women
Authors: Hameed Meera , Fernandes Helen , Skurnick Joan , Moore Dorothy , Kloser Patricia , Heller Debra 
Published: March 2007

Objective: Human papillomavirus (HPV) is the major cause of cervical carcinoma and cervical intraepithelial neoplasia worldwide. Certain HPV types have a strong association with and probably a causative role in the
pathogenesis of premalignant cervical lesions. Epidemiologic studies in women infected by the human immunodeficiency
virus (HIV) have shown an increased incidence of squamous intraepithelial lesions (SILs), whichwere predominantly
high‐grade. Six to 30 per cent of women diagnosed with atypical squamous cells of undetermined
significance (ASCUS) on a Papanicolaou (Pap) smear harbor SIL in normal screening populations. This study was
undertaken to determine the presence of low‐ and high‐risk HPV types in women infected by HIV and to correlate
the results to those of the Pap smear.Study design: HPV DNA typing (low‐ and high‐risk) by Digene™ (Digene Corporation, Gathesburg, MD) hybrid capture methodology was performed on cervical swabs from 209 HIV‐positive women. The results of HPV typing
were correlated with those of the Pap smear in a retrospective analysis.Results: One hundred and one women (48%) tested positive for HPV subtypes by DNA typing by the hybrid capture method. Of these, 64 patients (63%) had Pap smears whichwere read as being normal, having benign cellular
changes, or having ASCUS (favor reactive process). Of these, 19 patients tested positive for both high‐risk and
low‐risk subtypes, 32 patients tested positive only for high‐risk subtypes, and 13 patients tested positive only for
low‐risk subtypes.Conclusion: HPV subtyping identifies a significant group of HIV‐positive women who are at risk for developing cervical intraepithelial neoplasia, although they may not show significant abnormalities on their Pap smears.
Production of Interferons and ß‐Chemokines by Placental Trophoblasts of HIV‐1‐Infected Women
Authors: Lee Bang-Ning , Hammill Hunter , Popek Edwina J. , Cron Stanley , Kozinetz Claudia , Paul Mary , Shearer William T. , Reuben James M. 
Published: March 2007

Objective: The mechanism whereby the placental cells of a human immunodeficiency virus (HIV)‐1‐infected mother protect the fetus from HIV‐1 infection is unclear. Interferons (IFNs) inhibit the replication of viruses by
acting at various stages of the life cycle and may play a role in protecting against vertical transmission of HIV‐1. In
addition the ß‐chemokines RANTES (regulated on activation T cell expressed and secreted), macrophage inflammatory
protein‐1‐a (MIP‐1a), and MIP‐1ß can block HIV‐1 entry into cells by preventing the binding of the
macrophage‐trophic HIV‐1 strains to the coreceptorCCR5. In this study the production of IFNs and ß‐chemokines
by placental trophoblasts of HIV‐1‐infected women who were HIV‐1 non‐transmitters was examined.Methods: Placental trophoblastic cells were isolated from 29 HIV‐1‐infected and 10 control subjects. Supernatants
of trophoblast cultures were tested for the production of IFNs and ß‐chemokines by enzyme
linked immunosorbent assay (ELISA). Additionally, HIV‐1‐gag and IFN‐ß transcripts were determined by a
semi‐quantitative reverse transcription polymerase chain reaction (RT‐PCR) assay.Results: All placental trophoblasts of HIV‐1‐infected women contained HIV‐1‐gag transcripts. There were no
statistical differences in the median constitutive levels of IFN‐a and IFN‐? produced by trophoblasts of HIV‐1‐
infected and control subjects. In contrast, trophoblasts of HIV‐1‐infected women constitutively produced significantly
higher levels of IFN‐ß protein than trophoblasts of control subjects. Furthermore, the median levels of
ß‐chemokines produced by trophoblasts of HIV‐infected and control women were similar.Conclusions: Since there was no correlation between the placental HIV load and the production of interferons or
ß‐chemokines, the role of trophoblast‐derived IFNs and ß‐chemokines in protecting the fetus from infection with
HIV‐1 is not clear.
The Classic Approach to Diagnosis of Vulvovaginitis: A Critical Analysis
Authors: Bornstein Jacob , Lakovsky Yaniv , Lavi Idit , Bar-Am Amiram , Abramovici Haim 
Published: March 2007

Objective: To correlate the symptoms, signs and clinical diagnosis in women with vaginal discharge, based on the combined weight of the character of the vaginal discharge and bedside tests, with the laboratory diagnosis.Methods: Women presenting consecutively to the women′s health center with vaginal discharge were interviewed and examined for assessment of the quantity and color of the discharge. One drop of the material was then examined for pH and the whiff test was done; a wet mount in saline and in 10% KOH was examined microscopically. The clinical diagnosis was based on the results of these assessments. Gram stain and cultures of the discharge were sent to the microbiology laboratory.Results: One hundred and fifty‐threewomen with vaginal discharge with a clinical diagnosis of vulvovaginitis participated in the study. Fifty‐five (35.9%) had normal flora and the other 98 (64.1%) had true infectious vulvovaginitis (k agreement = 18%). According to the laboratory, the principal infectious micro‐organism causing the vulvovaginitis was Candida species. Candida infection was associated with pH levels of less than 4.5 (p < 0.0001, odds ratio = 4.74, 95% confidence interval: 2.35–9.5, positive predictive value 68.4%). The whiff test was positive in only a small percentage of bacterial vaginosis (BV) (p = not significant (NS)). Clue cells were documented in 53.3% of patients with a laboratory diagnosis of BV (p < 0.02, positive predictive value 26.7%).Conclusions: The current approach to the diagnosis of vulvovaginitis should be further studied. The classical and time‐consuming assessments were shown not to be reliable diagnostic measures.
Differences in Innate Immunologic Response to Group BStreptococcus Between Colonized and Noncolonized Women
Authors: Smith Jennifer M. , Respess Rachel H. , Chaffin David G. , Larsen Bryan , Jackman Susan H. 
Published: March 2007

Objective: To evaluate the functional capacity of granulocytes and monocytes from pregnant and nonpregnant
women in relation to group B streptococcus (GBS) colonization status.Methods: Engulfment of fluorescent GBS by peripheral blood phagocytes from GBS‐colonized and noncolonized
women was measured by flow cytometry. Intracellular superoxiode generated in response to GBS challenge to
monocytes and granulocytes enriched from peripheral blood of these women was also measured by flow
cytometry, and extracellular superoxide was determined by colorimetric assay.Results: Monocytes and granulocytes from pregnant, GBS‐colonized women engulfed significantly greater
numbers of GBS than phagocytes from pregnant, noncolonized women. No difference in intracellular superoxide
production was detected between any of the groups of women; however, monocytes from pregnant, colonized
women released significantly more superoxide into the extracellular milieu than did granulocytes from the same
women. No differences in extracellular release of superoxide were observed among noncolonized women
whether they were pregnant or not.Conclusions: Monocytes from pregnant, colonized women engulf more GBS and release more of the superoxide
into the extracellular environment, where it is unlikely to be an effective defense mechanism against intracellular
bacteria. This suggests that components of the innate immune system that should serve in a protective role may
function suboptimally, thereby contributing to the colonization process by GBS.
Virulence Factors of Escherichia coli Isolated From FemaleReproductive Tract Infections and Neonatal Sepsis
Authors: Cook Susan W. , Hammill Hunter A. , Hull Richard A. 
Published: March 2007

Objective: The presence of enterobacteria such as Escherichia coli in the vagina of normal women is not synonymous
with infection. However, vaginal E. coli may also cause symptomatic infections. We examined bacterial
virulenceproperties that may promote symptomatic female reproductive tract infections (RTI) and neonatal sepsis.Methods: E. coli isolated as the causative agent from cases of vaginitis (n = 50), tubo‐ovarian abscess (n = 45) and
neonatal sepsis (n = 45) was examined for selected phenotypic and genetic virulence properties. Results were
compared with the frequency of the same properties among fecal E. coli not associated with disease.Results: A significantly greater proportion of infection E. coli exhibited D‐mannose resistant hemagglutination
compared with fecal E. coli (p < 0.01). This adherence phenotype was associated with the presence of P fimbriae
(pap) genes which were also significantly more prevalent among isolates from all three infection sites (p < 0.01).
The majority of pap+
isolates contained the papG3 allele (Class II) regardless of infection type. Increased frequency
of Type 1C genes among vaginitis and abscess isolates was also noted. No significant differences in frequency of
other bacterial adherence genes, fim, sfa, uca (gaf) or dra were observed.
E. coli associated with vaginitis was significantly more likely to be hemolytic ( HIY +)
than were fecal isolates
(p < 0.05). The HIY + phenotype was also more prevalent among tubo‐ovarian abscess and neonatal sepsis isolates
(p < 0.08).Conclusions:E. coli isolated from female RTI and neonatal sepses possess unique properties that may enhance
their virulence. These properties are similar to those associated with other E. coli extra‐intestinal infections,
indicating that strategies such as vaccination or bacterial interference that may be developed against urinary tract
infections (UTI) and other E. coli extra‐intestinal infections may also prevent selected female RTI.
Performance Characteristics of Putative Tests for Subclinical Chorioamnionitis
Authors: Edwards Rodney K. , Clark Penny , Locksmith Gregory J. , Duff Patrick 
Published: March 2007

Objective: To evaluate amniotic fluid glucose, matrix metalloproteinase (MMP)‐9, interleukin (IL)‐6, and IL‐12 for
diagnosing subclinical chorioamnionitis in women with preterm labor.Methods: Forty‐four women in preterm labor at 22–35 weeks gestation with suspected subclinical
chorioamnionitis underwentamniocentesis.Amniotic fluid analysis included Gram stain, culture, and determination
of glucose, MMP‐9, IL‐6, and IL‐12 concentrations. Median values of these analytes were compared using the
Mann‐Whitney U test. Sensitivity, specificity, and positive and negative predictive values were calculated for tests
using a positive amniotic fluid culture or delivery within 24 hours as the key outcome variablesResults: Amniotic fluid concentrations of glucose, MMP‐9, and IL‐6 correlated closely with positive culture or
delivery within 24 hours. IL‐12 concentrations did not correlate with either a positive culture or delivery within
24 hours.Conclusions: Amniotic fluid glucose, MMP‐9, and IL‐6 reliably predict microbial invasion of the amniotic cavity or
imminent delivery. IL‐12 values did not correlate with amniotic fluid culture results or imminent delivery.
Prevalence of Human Immunodeficiency Virus, Hepatitis B andHepatitis C Virus Antibodies and Hepatitis B Antigen AmongCommercial Sex Workers in Japan
Authors: Ishi Kazuhisa , Suzuku Fujihiko , Saito Akira , Yoshimoto Shinsaku , Kubota Takeyoshi 
Published: March 2007

Objective: To investigate the prevalence of antibodies to human immunodeficiency virus (HIV), hepatitis B virus
(HBV) and hepatitis C virus (HCV), and of hepatitis B surface (HBs) antigen in commercial sex workers (CSW) who
attended a sexually transmitted disease (STD) clinic in Tokyo.Methods: Surveys were conducted on 308 CSW and 384 control subjects for HIV antibody or 241 control subjects
for HBs antibody and antigen and HCV antibody.Results: HIV antibodywas not detected in either CSW or control subjects. The positive rates for HBs antigen and
antibody were 0.6 and 23.4%, respectively, in the CSW group, and 0.4 and 71.8% in the control group. The HCV
antibody positive rate was 3.2% in the CSW group and 0.4% in the control group.Conclusion: A statistically significant difference between the two groups was observed only in HCV antibody
positive rate. STD checkup for CSW alone is inadequate – STD health education and screening for the general
public are also required.
Impaired Whole‐Blood Polymorphonuclear Leukocyte Migration as a Possible Predictive Marker for Infections in Preterm Premature Rupture of Membranes
Authors: Glasner Andreas , Egger Gerd , Winter Raimund 
Published: March 2007

Objectives: Steroids, used in pretermpremature rupture of membranes (pPROM), to reduce the risk of morbidity and mortality of the preterm neonate, impair the maternal polymorphonuclear leukocyte (PMN)‐based immune system. In spite of combination with antibiotics, prenatal and postnatal bacterial infections of mother and child are frequent. This pilot study focuses on the influence of steroids in pPROM on maternal PMN functional capacity and subsequent infections.Methods: After opting for expectant management, eight women with pPROM and no signs of infection were treated by steroids (betamethasone 5.7 mg, i.m. every 24 hours, for three days) and antibiotic therapy with either amoxicillin and clavulanic acid, piperacillin or ampicillin i.v. up to delivery. The conventional inflammation parameters of PMN blood count and C‐reactive protein (CRP) were measured daily in parallel with PMN migratory capacity towards N‐formyl‐methionyl‐leucyI‐phenylalanine stimulation and under blank conditions, estimated by a whole blood membrane filter assay.Results: In all patients PMN migration decreased during the application of steroids. Three patients showed a decrease in PMN migration below critical values and in spite of antibiotic prophylaxis acute pyelonephritis developed 2–6 days later. PMN count and CRP were not predictive of maternal infection.Conclusion: Reduced PMN function, caused by steroid treatment in pPROM, is suggested to be a reason for serious bacterial infections in spite of antibiotic prophylaxis. PMN migration reflects individual PMN defensive capacity.
A Randomized Controlled Trial of Interleukin‐1 ReceptorAntagonist in a Rabbit Model of Ascending Infection in Pregnancy
Authors: McDuffie Robert S. , Davies Jill K. , Leslie Kimberly K. , Lee Scott , Sherman Michael P. , Gibbs Ronald S. 
Published: March 2007

Objective: To determinewhether treatment with interleukin‐1 receptor antagonist (IL1‐ra) would affect amniotic
fluid concentrations of tumor necrosis factor alpha (TNF‐α) and prostaglandins or clinical or microbiological outcomes
in a model of ascending bacterial infection in pregnancy.Methods: Timed pregnant New Zealand white rabbits at 70% of gestation underwent endoscopic inoculation of
the cervices with 106
– 107cfu Escherichia coli . Animals were randomly assigned in a blinded manner to a 5‐h intravenous
infusion of human IL1‐ra (10 mg/kg) or placebo beginning 1 – 2 h after inoculation. Blood was drawn fromthe
does for assay of serum IL1‐ra concentration before inoculation, at mid‐infusion, after the infusion ended and at
necropsy. At necropsy, temperature and cultures were taken, and aspirated amniotic fluid was pooled for assays of
TNF‐α, prostaglandin E 2
( PGE 2) and IL1‐ra.Results: Serum IL1‐ra concentrations rose to a mean of 2 mg/ml at mid‐infusion and fell markedly after the infusion
to concentrations barely detectable at necropsy. Between the two groups, there were no significant differences in
the rates of fever or positive cultures or in amniotic fluid concentrations of PGE 2 or TNF‐α.One unique finding was
the demonstration that administration of human IL1‐ra to the does resulted inmeasurable concentrationsof human
IL1‐ra in the amniotic fluid.Conclusions: Treatment with an intravenous infusion of human IL1‐ra after cervical inoculation with E. coli did not
affect clinical or microbiological outcomes or amniotic fluid concentrations of TNF‐α or PGE 2. This experiment
provides the first demonstration of passageof human IL1‐ra from the maternal bloodstreamto the amniotic fluid.
Acyclovir Suppression to Prevent Recurrent Genital Herpesat Delivery
Authors: Scott L. L. , Hollier L. M. , McIntire D. , Sanchez P. J. , Jackson G. L. , Wendel G. D. 
Published: March 2007

Objective: To determine if suppressive acyclovir near term decreased the frequency of clinical recurrences at
delivery in women with recurrent genital herpes simplex virus (HSV) infection.Methods: We conducted a prospective, double‐blind, randomized trial in 234 women with recurrent genital
herpes. Women with genital infection of any frequency were enrolled. Patients received either suppressive oral
acyclovir 400 mg three times daily or an identical placebo after 36 weeks’ gestation.Clinical lesions were identified,
and HSV cultures were obtained at delivery. The frequencies of clinical and subclinical HSV recurrences at delivery
were evaluated.Results: Six percent of patients treated with acyclovir, and 14% of patients treated with placebo had clinicalHSV at
delivery (p = 0.046). No patients in the acyclovir group had positive HSV cultures, compared with 6% of
placebo‐treated patients (p = 0.029). There was no significant difference in subclinical HSV shedding in the
acyclovir group (0%) compared with the placebo‐treated group (3%) (p = 0.102).Conclusions: Suppressive acyclovir therapy significantly decreased the incidence of clinical genital herpes and the
overall incidence of HSV excretion at delivery in patients with previous herpes infection. Conclusions: Suppressive acyclovir therapy significantly decreased the incidence of clinical genital herpes and the
overall incidence of HSV excretion at delivery in patients with previous herpes infection.
Risk of Perinatal Transmission of Hepatitis B Virus in Jordan
Authors: Batayneh Naji , Bdour Salwa 
Published: March 2007

Objectives: To determine the risk of perinatal transmission of hepatitis B virus (HBV) in Jordan.Methods: Plasma samples from 1000 pregnant Jordanian women were screened by ELISA for HBV markers
(HBsAg, HBeAg, anti‐HBe, anti‐HBc and anti‐HBs).Results: HBsAg and HBeAg were detected in 4.3% and 0.1% of the pregnant women, respectively. The overall
prevalence of antibodies was 6%, 11.1% and 7.5% for anti‐HBe, anti‐HBc and anti‐HBs, respectively. Women
were assignedto four groups according to the serological patternsofHBV markers: susceptible (85.9%), with acute
infection (2.9%), with chronic infection (1.4%) and previously infected (9.8%). Most women were at the third
trimester of pregnancy, therefore women with acute and chronic hepatitis at this gestational age were at risk of
transmitting HBV infection to their newborns. Women who belonged to the low socio‐economic class were
at higher risk of HBV infection.Conclusions: Based on the results, we recommend screening women for HBV during pregnancy in order to
identify HBV carriers. All newborns born to carriers should be vaccinated immediately after birth, both passively
and actively. Also vaccination of HBV seronegative pregnant women is recommended.
Haemophilus influenzae Septic Abortion
Authors: Cherpes Thomas L. , Kusne Shimon , Hillier Sharon L. 
Published: March 2007

Background: Haemophilus influenzae septic abortion is typically caused by nontypeable strains of the organism.
Furthermore, nontypeable species with a special affinity for the genital tract are the most frequent isolates encountered,
and an ascending vaginal or cervical infection is often the suspected route of transmission.Case: A 39‐year‐old woman at 8 weeks gestation who underwent dilation, evacuation, and curettage for embryonic
demise had clinical evidence for sepsis and isolation of a nontypeable, ampicillin resistant H. influenzae
from blood cultures. Although an ascending vaginal infection was suspected, the route of transmission was not
determined.Conclusion: Nontypeable strains of. H. influenzae have demonstrated increased beta‐lactamase activity, and
ampicillin, formerly the treatment of choice, should be used only if isolate susceptibility is known.
Compliance With a Protocol for Intrapartum AntibioticProphylaxis Against Neonatal Group B Streptococcal Sepsis in Women With Clinical Risk Factors
Authors: Sanders Toni R. , Roberts Christine L. , Gilbert Gwendolyn L. 
Published: March 2007

Objective: The aim of this study was to determine the prevalence of clinical risk factors (CRF) for neonatal sepsis
in laboring women and to evaluate clinician compliance with a CRF‐based protocol for intrapartum antibiotic
prophylaxis (IAP).Methods: A retrospective chart audit was undertaken at a district hospital (A) and a tertiary obstetric hospital (B)
in Sydney, Australia between 1996 and 1998, to determine compliance with IAP in women with defined CRF.Results: Eighty‐five (12%) women at Hospital A and 117 (19%) at Hospital B had one or more CRF. Overall
compliance rates with the IAP protocols were 65 and 50%at Hospitals A and B respectively, but varied according to
maternal, obstetric and sepsis‐related risk factors. We postulate that differences between the hospitals were
related to protocol implementation.Conclusions: Compliance with a CRF‐based protocol was lower than previously reported. Improvements in
protocol development, implementation and maintenance are required to enhance compliance with IAP based
on CRF.