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Summary: Diagnostic tests for toxoplasmosis are based on serological techniques due to their high sensitivity. Some IgG subclasses are related to clinical outcome in the congenital form. In this work, we determined the levels of IgG, IgA, IgG1, IgG2, IgG3 and IgG4 anti‐Toxoplasma gondii antibodies in paired saliva and serum samples from 91 women by indirect ELISA using a crude extract of the RH strain. The levels of IgA, IgG2, IgG3 and IgG4 antibodies and, to a lesser extent, IgG1 did not correlate between saliva and serum, that is, most cases that were positive for one Ig class in a sample were negative or very low in the other, and vice versa. We also observed that most samples of saliva that were positive for one IgG subclass were also positive for at least 2 of the other 3; this contrasted with findings in serum, wherein each person was positive almost exclusively for one subclass, as demonstrated before by us and other researchers. Although these findings are disappointing for the use in diagnosis, the richer response in saliva might indicate local exposure to T. gondii antigens without systemic infection; thus, saliva might be reflecting a local (protective?) response against this protozoan. [ABSTRACT FROM AUTHOR]

OBJETIVO: Identificar los factores asociados a la aceptación de salpingoclasia entre mujeres infectadas por el virus de inmunodeficiencia humana (VIH), después de finalizar su embarazo. MATERIAL Y MÉTODOS: Se realizó un estudio de casos y controles con 72 pacientes embarazadas seropositivas al VIH, en el Instituto Nacional de Perinatología (INPer), entre marzo de 1988 y febrero de 1999. Se consideraron casos a 49 mujeres que al finalizar el embarazo aceptaron la realización de salpingoclasia, 23 pacientes que rechazaron este procedimiento conformaron los controles. En cada paciente se investigaron antecedentes demográficos, historia sexual y reproductiva y condiciones relacionadas con la infección por el VIH. Se realizó estadística descriptiva, las variables categóricas se compararon con ji² o prueba exacta de Fisher y las continuas con t de Student, se hizo cálculo de razón de momios (RM), con intervalo de confianza al 95% y se realizó análisis estratificado mediante ji² de Mantel Haenszel para variables potencialmente confusoras. RESULTADOS: La edad promedio de las pacientes seropositivas fue de 25.5 ± 5.5 años. Estas ingresaron al hospital con una mediana de 27 semanas de gestación (intervalo de 7 a 40 semanas); 16 (22.2%) no tuvieron control prenatal en el INPer. La mediana de tiempo de conocerse infectadas fue de nueve meses (intervalo 1 a 108). Las variables que se asociaron con la aceptación de salpingoclasia fueron: el antecedente de hijos previos, con una RM de 11.1 (IC 95% 3.4 a 36); la atención a partir del año de 1995, con una RM de 4.7 (IC 95% 1.7 a 13.3) y el tener cuando menos un hijo previo infectado, con una RM de 4.6 (IC 95% 1.1 a 23.1). El análisis estratificado no mostró modificación en la fuerza de asociación de estas variables con la aceptación de salpingoclasia. CONCLUSIONES: El tener hijos previos fue el factor que más influyó en la aceptación de salpingoclasia. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

OBJETIVO: Identificar las complicaciones médicas de las embarazadas infectadas por el virus de la inmunodeficiencia humana (VIH) y asintomáticas, y determinar el riesgo que el virus representa para el desarrollo de las mismas. MATERIAL Y MÉTODOS: Se comparó la evolución del embarazo y el resultado perinatal de 44 embarazadas seropositivas al VIH, asintomáticas y que presentaron más de 200 linfocitos CD4/mm³, con embarazadas control no infectadas; las pacientes se parearon por edad y nivel socioeconómico. RESULTADOS: En 42 (95.4%) pacientes la vía de contagio fue sexual; 35 (79.5%) tenían menos de un año de saber que estaban infectadas y 15 (34%) recibieron tratamiento antiviral durante la gestación. Las mujeres infectadas por el VIH presentaron un riesgo mayor de complicaciones infecciosas (RR3.1, IC95% 1.9-52), cervicovaginitis (RR2.2, IC95% 1- 48) y enfermedades de transmisión sexual (RR18, IC95% 2.3-137). El promedio de peso y talla de los recién nacidos y el número de complicaciones neonatales fueron similares entre los grupos comparados. El análisis estratificado mostró que la ausencia de tratamiento antirretroviral y el antecedente de tres o más parejas sexuales incrementaron el riesgo de complicaciones infecciosas. CONCLUSIONES: Las embarazadas seropositivas al VIH y asintomáticas no tuvieron un riesgo mayor de complicaciones médicas del embarazo, con excepción de problemas infecciosos.

OBJETIVO. Describir la experiencia del manejo de embarazadas con rubéola, evaluando el resultado perinatal. MATERIAL Y MÉTODOS. Del 1 de enero de 1990 al 31 de octubre de 1997 se incluyeron 67 embarazadas con diagnóstico de rubéola, corroborada con la determinación de anticuerpos séricos IgM. Se dio seguimiento hasta la resolución del embarazo en 66 de estas mujeres: en cuatro se realizó un aborto electivo y una tuvo un embarazo molar. En 61 pacientes se pudo evaluar el efecto de la rubéola sobre el producto y la gestación. A los productos con determinación positiva de IgM contra rubéola se les realizó ecocardiograma, estudio oftalmológico y potenciales provocados auditivos del tallo cerebral (PPATC). RESULTADOS. El promedio de edad de las embarazadas fue de 24.7±5.5 años; 28 pacientes cursaban su primer embarazo. Ninguna de las embarazadas presentó alguna complicación del episodio de rubéola. En 35 casos (52.2%) la infección viral se presentó durante el primer trimestre de gestación; en 23 (34.5%) sucedió durante el segundo trimestre, y en nueve (13.3%) ocurrió en el último trimestre. De los casos de infección materna durante el primer trimestre gestacional, 71% de los productos se infectaron y 51.6% desarrollaron un síndrome de rubéola congénita. Las manifestaciones de rubéola congénita más frecuentes fueron prematurez, bajo peso al nacimiento y alteración de los PPATC. CONCLUSIONES. En México la rubéola continúa causando daño fetal, de tal manera que es necesario establecer medidas de prevención, como la vacunación universal, para evitar la infección por rubéola.

Background: The incidence of Late-Onset Sepsis (LOS) increases as gestational age decreases in newborns. The clinical signs of neonatal sepsis are not specific for diagnosis in preterm infants. The gold standard for its diagnosis is the blood culture test, which requires more than 24 h to obtain results, with positive results obtained in 10-3 % of cases analysed. As the molecular markers on the lymphocyte surface CD64 and CD69 are involved in early innate immune activation, they may be helpful for faster diagnosis., Aim: Measure the expression of CD64 and CD69 on lymphocytes in clinical and confirmed sepsis patients and compared to that in infants without sepsis., Methodology: We used peripheral blood samples from three groups of preterm babies with suspected sepsis (n = 31), confirmed sepsis (n = 10) and without sepsis (n = 47). Using flow cytometry, we measure the expression of CD64 on neutrophils and CD69 on NK cells., Results: Expression of CD64 on neutrophils and CD69 on NK cells did not increase in the clinical or confirmed sepsis groups compared to the without sepsis group., Conclusions: Leukocytes from infants born prematurely may have tightly regulated mechanisms that control their activation phenotype, rendering them unsuitable for diagnosing sepsis., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2025. Published by Elsevier España, S.L.U.)

Objective To evaluate the sterilization efficacy of hysteroscopy instruments using ultraviolet C (UV-C) light at a wavelength of 259 nm in the Endoscopic Diagnostic Center of the National Institute of Perinatology. Methods Consecutive patients undergoing office hysteroscopy via the Bettochi vaginoscopy technique were included, excluding those with conditions such as viable intrauterine pregnancy or acute pelvic infection. Samples were collected from six designated sites of the hysteroscope, including the inner sheath, internal holes of the inner sheath, lens, graspers, scissors, and outer sheath. Initially, samples were taken after the first sterilization using a LAOKEN LK/MJG-150 Plasma Sterilizer (Chengdu, China). Next, samples were collected after the routine use of the hysteroscope in the office setting to confirm contamination. Subsequently, a new set of samples were taken after a 20-minute UV-C sterilization cycle with the EsteriUV device. Results The initial sterilization achieved a 96.73% sterilization rate, with ten samples testing positive for  Staphylococcus   coagulase -negative. Post-hysteroscopy, contamination increased significantly. Afterward, UV-C sterilization achieved a 96.08% sterilization rate, with 11 samples positive for  Staphylococcus   coagulase -negative and one for  Streptococcus anginosus  (p=0.66). No clinical infections were reported in any patient within one-month post-procedure. Conclusion UV-C light is a viable alternative for hysteroscopy instrument sterilization, demonstrating comparable efficacy to conventional methods. Further studies are recommended to optimize UV-C parameters for enhanced sterilization efficiency., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mora-Galván et al.)

Pregnancy in women living with human immunodeficiency virus (WLWH) represents an important challenge for maternal-fetal health. Besides, they can also present anxiety (Anx) and depression (Dep). Imbalances in serotonin (5-HT), dehydroepiandrosterone sulfate (DHEA-S), and cortisol (CORT) levels can contribute to Anx and Dep manifestations. Currently, there is not enough data about the neuroendocrine and neurochemical changes in pregnant WLWH with affective disorders. This study aimed to characterize 5-HT, DHEA-S, and CORT plasma levels in Mexican pregnant WLWH presenting Anx/Dep. Forty-two adult pregnant women were recruited during the third trimester of gestation at the National Institute of Perinatology in Mexico during 2019-2022. These patients were divided into three groups: (1) pregnant WLWH with Anx/Dep (n = 16), (2) pregnant without HIV but with Anx/Dep (n = 12), and (3) healthy pregnant women without Anx/Dep (n = 14). WLWH presented a marked reduction in 5-HT (41.33 ± 39.37 ng/dL) compared to non-infected pregnant women with Anx/Dep (220.2 ± 151.8 ng/dL) and the healthy group (370.0 ± 145.3 ng/dL). Anx/Dep infected and uninfected pregnant women showed a significant reduction in DHEA-S levels (86.58 ± 30.59 and 76.9 ± 36.7 µg/dL, respectively) compared to healthy subjects (149.7 ± 44.6 µg/dL). Anx and Dep symptoms were inversely correlated with 5-HT and DHEA-S levels. No significant differences were observed in CORT levels among the three groups (p = 0.094). Our results suggest the presence of a disbalance in 5-HT and DHEA-S levels in pregnant WLWH with affective symptoms., (© 2024. The Author(s).)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

(1) This study aimed to evaluate characteristics, perinatal outcomes, and placental pathology of pregnant women with or without SARS-CoV-2 infection in the context of maternal PCR cycle threshold (C T ) values. (2) This was a retrospective case-control study in a third-level health center in Mexico City with universal screening by RT-qPCR. The association of COVID-19 manifestations, preeclampsia, and preterm birth with maternal variables and C T values were assessed by logistic regression models and decision trees. (3) Accordingly, 828 and 298 women had a negative and positive test, respectively. Of those positive, only 2.6% of them presented mild to moderate symptoms. Clinical characteristics between both groups of women were similar. No associations between C T values were found for maternal features, such as pre-gestational BMI, age, and symptomatology. A significantly higher percentage of placental fibrinoid was seen with women with low C T s (<25; p < 0.01). Regarding perinatal outcomes, preeclampsia was found to be significantly associated with symptomatology but not with risk factors or C T values ( p < 0.01, aOR = 14.72). Moreover, 88.9% of women diagnosed with COVID-19 at <35 gestational weeks and symptomatic developed preeclampsia. (4) The data support strong guidance for pregnancies with SARS-CoV-2 infection, in particular preeclampsia and placental pathology, which need further investigation.

Formalin-fixed paraffin-embedded (FFPE) tissues are a source of biological material for molecular studies; several methods to extract DNA from FFPE tissues have been reported. This process is challenging because of formaldehyde-induced cross-linking between proteins and DNA as well as molecule fragmentation when unbuffered formalin is used for fixation. Here, 2 methods for DNA extraction from FFPE tissues, based on a chelating resin and silica membrane columns, were modified and compared in their capacity to detect human cytomegalovirus (HCMV) in congenital infections. Both methods were tested on 121 samples of brain, lung, spleen, and liver derived from 36 deceased preterm newborns. Twelve patients were selected, and UL55 and UL75 HCMV genes were detected by polymerase chain reaction in 16/36 samples. These 2 methods represent a useful tool for DNA recovery from FFPE tissues and HCMV molecular identification with the advantage of low cost, minimal steps, minimal sample use, being solvent-free, and being easy to implement in the laboratory., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Simultaneous therapeutic drug monitoring (TDM) of combination antiretroviral therapy (cART) is critical during pregnancy in order to improve clinical follow-up, monitor viral load, and patient adherence to treatment.A modified simple and fast ultra-high performance liquid chromatography coupled with tandem mass spectrometry and electrospray ionization (UPLC-ESI-MS/MS) method was developed and validated according to national and international guidelines for the simultaneous determination of lamivudine (LMV), zidovudine (ZDV), lopinavir (LPV), and ritonavir (RTV) concentrations in 100-μL plasma sample of Human Immunodeficiency Virus (HIV)-positive pregnant women. Protein precipitation using 0.1% formic acid in cold acetonitrile was used for sample preparation. The chromatographic separation was achieved with a run-time of 3.0 minutes and 3-μL injection on an ethylene bridged hybrid C18 column (2.1 μm × 50 mm, 1.7 μm), under gradient conditions using acetonitrile and formic acid (0.1%).The chromatographic method was used to analyze 10 plasma samples from 8 HIV pregnant women as a clinical patient routinely follow-up by applying TDM criteria.The protonated precursor/product ion transitions for LMV (230.18/112.08), ZDV (268.22/127.10), LPV (629.55/447.35), and RTV (721.50/296.20) were recorded in multiple-reaction-monitoring (MRM) mode. The calibration curve was linear in the range of 50-3,000, 75-4,500, 250-15,000, and 25-1,500-ng/mL for LMV, ZDV, LPV, and RTV, respectively. The range of accuracy was 97.2% to 100.1% and precision 3.4% to 12.7%. The method showed specificity and matrix effect values of < 15%. Minimum absolute recovery percentages (%CV) were 90.5 (5.4), 90.8 (5.0), 95.4 (3.5), and 93.7 (6.9), for LMV, ZDV, LPV, and RTV, respectively. Drug concentrations in patient samples had high inter-individual variability with %CV of 91.98%, 77.54%, 53.80%, and 92.16% for ZDV, LMV, LPV, and RTV, respectively. Two of the 8 patients showed no adherence due to the absence of Protease Inhibitors (PIs) levels in plasma.This technique demonstrated to be effective in therapeutic drug monitoring and is intended to be used in population pharmacokinetics specifically for HIV-positive pregnant women.

Toxoplasma gondii is the etiological agent of toxoplasmosis. Mother-to-child transmission of this parasite can occur during pregnancy. Newborns with congenital toxoplasmosis may develop central nervous system impairment, with severity ranging from subclinical manifestations to death. A proinflammatory/regulated specific immune profile is crucial in the defense against the parasite; nevertheless, its role in the infected pregnant women and the congenitally infected offspring has been poorly explored, and there is still no consensus about its relation to parasite vertical transmission or to severity and dissemination in the congenitally infected newborns. This work aimed to characterize these relations by means of principal component and principal factor analyses. For this purpose, we determined the specific production of the four immunoglobulin G antibody subclasses, cytokines, and lymphocyte proliferation in the T. gondii- infected pregnant women-10 who transmitted the infection to their offspring and seven who did not-as well as in 11 newborns congenitally infected and grouped according to disease severity (five mild and six moderate/severe) and dissemination (four local and seven disseminated). We found that the immune response of nontransmitter women differed from that of the transmitters, the latter having a stronger proinflammatory response, supporting a previous report. We also found that newborns who developed moderate/severe disease presented higher levels of lymphocyte proliferation, particularly of CD8 + and CD19 + cells, a high proportion of tumor necrosis factor α producers, and reduced expression of the immune modulator transforming growth factor β, as opposed to children who developed mild clinical complications. Our results suggest that a distinctive, not regulated, proinflammatory immune response might favor T. gondii vertical transmission and the development of severe clinical manifestations in congenitally infected newborns., (Copyright © 2020 Gómez-Chávez, Cañedo-Solares, Ortiz-Alegría, Flores-García, Figueroa-Damián, Luna-Pastén, Gómez-Toscano, López-Candiani, Arce-Estrada, Bonilla-Ríos, Mora-González, García-Ruiz and Correa.)

Background: During pregnancy, the Zika virus (ZIKV) replicates in the placenta and central nervous system (CNS) of infected fetuses; nevertheless, the ability of ZIKV to replicate in other fetal tissues has not been extensively characterized., Methods: We researched whether dissemination of congenitally-acquired ZIKV outside the CNS exists by searching for the accumulation of the viral envelope protein, ZIKV ribonucleic acid (RNA), and infectious viral particles in different organs of a deceased newborn with Congenital Zika Syndrome. A real-time qualitative polymerase chain reaction (qPCR) was used to detect ZIKV RNA in the brain, thymus, lungs, kidneys, adrenal glands, spleen, liver, and small intestine. The same tissues were analyzed by indirect immunofluorescence and immunoperoxidase assays using the monoclonal antibody 4G2 to detect ZIKV envelope antigens. Isolation of infectious ZIKV in a cell culture was carried out using brain and kidney samples., Results: A postmortem, virological analysis of multiple organs, such as the kidneys (epithelial cells in the renal tubules), lungs (bronchial epithelia), thymus (epithelial cells inside the Hassall's corpuscles), and brain (neurons, ependymal cells, and macrophages) revealed the presence of ZIKV RNA and envelope antigens. Other tissues of the deceased newborn tested positive by qPCR for Epstein-Barr virus and human herpesvirus 6, including the brain cortex (Epstein-Barr) and the thymus, kidneys, and adrenal glands (human herpesvirus 6). The kidneys were identified as a significant niche for viral replication, given that infectious particles were successfully isolated from renal tissues., Conclusions: Our findings demonstrate the ability of congenitally-acquired ZIKV to produce disseminated infections and the viral tropism towards epithelial cells., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.)

Toxoplasmosis is a parasitic zoonosis distributed worldwide, caused by the ingestion of contaminated water/food with the parasite Toxoplasma gondii . If a pregnant woman is infected with this parasite, it may be transmitted to the fetus and produce ocular, neurological, or systemic damage with variable severity. The strength and profile of mother's immune response have been suggested as important factors involved in vertical transmission rate and severity of clinical outcome in the congenitally infected fetus. The aim of this work was to evaluate a possible relation between the mother's immune response during pregnancy and congenital transmission to the fetus. We obtained peripheral blood from T. gondii infected pregnant woman and tested it for anti T. gondii (IgG1, IgG2, IgG3, IgG4, and IgA) in serum. Peripheral blood mononuclear cells (PBMCs) were isolated to analyze the in vitro effect of soluble T. gondii antigens on proliferation and production of cytokines. We found that IgG2-4 and IgA antibodies and lymphocytes proliferation, especially CD4 + , CD8 + , and CD19 + were positive in a higher proportion of cases in transmitter than in non-transmitter women. Furthermore, IgG2-3 and IgA anti- Toxoplasma antibody levels were higher in those mothers who transmitted the infection than in those who did not. Interestingly, a higher proportion of positive cases to IFN-γ and negatives to the immunoregulatory cytokine TGF-β, were related to T. gondii vertical transmission. Our descriptive results are consistent with the paradoxical previous observations in murine models of congenital toxoplasmosis, which suggest that an increased immune response that protects the mothers from a disseminated or severe disease, and should protect the fetus from infection, is positively related to parasite transmission.

Mexico presents high prevalence of Toxoplasma gondii infection, including the congenital form, but there are few data about the genetic diversity of the parasite, so we attempted parasite isolation and genotyping in nine mother/children pairs with congenital toxoplasmosis (CT), living in the Valley of Mexico, who were part of a 30 cases cohort that started 12 years ago. They were recruited through research projects which included pre- and postnatal screening of congenital infections or directly CT, and cases referred to INP for management because they had clinical abnormalities. Genotyping was performed by PCR-RFLP of SAG1, SAG2, SAG3, BTUB GRA6, c22-8, c29-2, L358, PK1 and Apico markers, followed by sequencing. Sixty seven percent of samples were typed for the SAG3 locus, 39% for Apico and 33% for BTUB, while Alt. SAG2, GRA6 and c29-2 types could be labelled in less cases. Type I alleles predominated, followed by II and III. We isolated the first strain obtained from humans in Mexico and found three genotypes not previously found in the world. The presence of ToxoDB#10 clonal type was documented in one pair, as well as mixed infections in five mothers. No relation of genotype or parasite load with clinical signs was found. In conclusion, we encountered great genetic diversity and mixed T. gondii infections among mother/children pairs with congenital toxoplasmosis in the mega-metropolis of the Valley of Mexico., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The primary strategy to avoid mother-to-child transmission of human immunodeficiency virus (HIV) through breastfeeding is administration of highly active antiretroviral therapy (HAART) to HIV-positive pregnant women. Because significant changes in the pharmacokinetics of antiretroviral (ARV) drugs occur during pregnancy, quantifying HAART and the viral load in breast milk in this population is essential. Here, we developed an analytical assay for the simultaneous quantification of four ARV drugs in breast milk using ultra-performance liquid chromatography coupled to tandem mass spectrometry. We validated this method following Mexican and international guidelines. ARV drugs. We extracted the ARV drugs from 200 μL samples of breast milk and detected these drugs in a triple quadrupole mass spectrometer with positive electrospray ionization. The validated concentration ranges (ng/mL) for zidovudine, lamivudine, lopinavir, and ritonavir were 12.5-750, 50-2500, 100-5000 and 5 to 250, respectively. Additionally, the absolute recovery percentages (and matrix effects) were 91.4 (8.39), 88.78 (28.75), 91.38 (11.77) and 89.78 (12.37), respectively. We determined that ARV drugs are stable for 24 h at 8°C and 24°C for 15 days at -80°C. This methodology had the capacity for simultaneous detection; separation; and accurate, precise quantification of ARV drugs in human breast milk samples according to Mexican standard laws and United States Food and Drug Administration guidelines.

The first pandemic of the 21st century occurred in 2009 and was caused by the H1N1pdm influenza A virus. Severe cases of H1N1pdm infection in adults are characterized by sustained immune activation, whereas pregnant women are prone to more severe forms of influenza, with increased morbi-mortality. During the H1N1pdm09 pandemic, few studies assessed the immune status of infected pregnant women. The objective of this study was to evaluate the behavior of several immune markers in 13 H1N1pdm2009 virus-infected pregnant (PH1N1) women, in comparison to pregnant women with an influenza-like illness (ILI), healthy pregnant women (HP) and healthy non-pregnant women (HW). The blood leukocyte phenotypes and the serological cytokine and chemokine concentrations of the blood leukocytes, as measured by flow cytometry, showed that the CD69+ cell counts in the T and B-lymphocytes were significantly higher in the PH1N1 group. We found that pro-inflammatory (TNF-α, IL-1β, IL-6) and anti-inflammatory (IL-10) cytokines and some chemokines (CXCL8, CXCL10), which are typically at lower levels during pregnancy, were substantially increased in the women in the ILI group. Our findings suggest that CD69 overexpression in blood lymphocytes and elevated levels of serum cytokines might be potential markers for the discrimination of H1N1 disease from other influenza-like illnesses in pregnant women.

Toxoplasma gondii congenital transmission depends partially on parasite load and genotype. Both factors were examined in 4 mother/newborn pairs with perinatal infection acquired in central Mexico. Type I and type I-related strains were identified. These results add information regarding T. gondii strains prevailing in humans, although neither the genotype nor the load were related to vertical transmission or damage.

Objective: To identify the microbiota communities in the vaginal tracts of healthy Mexican women across the pregnancy., Methods: Vaginal swabs were obtained during the prenatal visit of women from all trimesters (n = 64) of healthy pregnant women of Mexico City. DNA was isolated from each sample, and PCR-DGGE and sequencing of 16S rRNA gene fragments were used to identify the bacterial communities., Results: 21 different microorganisms were identified in the vaginal samples. Lactobacillus genus was present in 98% of women studied. Four lactobacilli species were identified in vaginal samples. L. acidophilus was the predominant (78%) followed by L. iners (54%), L. gasseri (20%), and L. delbrueckii (6%). 17 different microorganisms related to bacterial vaginosis conditions were identified. Ureaplasma urealyticum was the predominant (21%) followed by BVAB1 (17%) and Gemella bergeriae (7.8%)., Conclusions: Lactobacillus genus predominates in the vaginal samples of Mexican pregnant women associated with different microorganisms related to bacterial vaginosis conditions.

Epidemiology and statistics play an important role in clinical practice. Evidence based medicine is a systematic approach of basic concepts in this areas. It offers a useful framework to enhance the physician ability in clinical research selection and in the same way improves communication between researchers and clinicians. In order to improve patient care in obstetrics and gynecology, this review focuses in general aspects of diagnosis from clinical epidemiology point of view.

Anti-Toxoplasma gondii antibodies of all IgG subclasses were studied in mother/newborn pairs. IgG1 in the mothers and IgG3 in the newborns were related to offspring clinical problems; IgG2 and IgG3 in the babies were markers of vertical transmission, and IgG4 in mothers or children were associated to clinical problems. IgG subclasses may be markers of congenital infection or clinical outcome.

Objective: To compare the bacteriological and clinical efficacy of three treatments for uncomplicated cystitis in ambulatory pre-menopausal women: ciprofloxacin 250 mg orally twice daily for 3 days, trimethoprim/sulfamethoxazole 160/800 mg orally twice daily for 7 days, and norfloxacin 400 mg orally twice daily for 7 days., Materials and Methods: A total of 455 women were randomly assigned to three treatment groups: 151 received ciprofloxacin, 150 received trimethoprim/sulfamethoxazole, and 154 received norfloxacin. Bacteriological cure and clinical resolution were evaluated 5-9 days and 4-6 weeks after completion of treatment., Results: There was no significant difference among the three treatment groups: overall efficacy ranged from 78.5% for the trimethoprim/sulfamethoxazole group, to 84.5% for the ciprofloxacin group. The highest overall incidence of drug-related adverse effects occurred in the trimethoprim/sulfamethoxazole patients., Conclusions: These data indicate that a 3 day treatment with ciprofloxacin is at least as clinically and bacteriologically effective as 7 day treatments with trimethoprim/sulfamethoxazole and norfloxacin for uncomplicated lower urinary tract infections.

A prospective and descriptive study was done in pregnant women diagnosed with herpes zoster, to know the demographic characteristics and clinical manifestations as well as maternal and/or neonatal complications to cause by this viral infection during pregnancy. The study included all pregnant women diagnosed with herpes zoster at the Department of Infectious Diseases of the Instituto Nacional de Perinatologia México, between 1994 and 2002. A total of 17 women were included in the study. All were given clinical and ultrasound follow-up to discard any maternal or fetal complications also at the moment of birth. A review in the newborn was made to establish the demographic, anthropometric and clinical characteristics; also the data collected included mother's age, gestational age at the moment of diagnosis with herpes zoster, anatomical lesion site, treatments administered, ultrasound characteristics, newborn's gestational age, weight, height, Apgar at birth and type of delivery. The most frequent site (58.8%) for herpes zoster lesions on the mother was the intercostal area, followed by the scapular region, the lumbar region and the limbs. None of the patients experienced complications during pregnancy, including post-herpetic pain. Sixteen of the newborns had no complications and one was a stillborn due to 60% of placental separation. These findings suggest a benign evolution of herpes zoster during pregnancy, supporting similar findings in the literature. No complications during pregnancy are suggested, and no phenotypical alterations occurred in the child at the moment of birth.

Long-term in utero adverse effects of infants exposed perinatally to antiretroviral drugs are still unknown. The purpose of this study was to determine whether there were differences in Brainstem Auditory Evoked Potential (BAEP) waves and interval interwaves in a group of Zidovudine (AZT) alone or AZT plus Lamivudine (3TC) prenatally exposed infants as the result of a mother with Human Immunodeficiency Virus (HIV) infection; compared with a group of infants not exposed to antiretroviral drugs. Results couls provide an index of neurotoxicity in newborns. Pregnant women were recruited at the first trimester of pregnancy, when they were diagnosed with HIV syndrome. Infants were included in the study if they were exposed prenatally to AZT alone or AZT plus 3TC. BAEP recordings were blinded from each investigator and results compared with a cephalic perimeter-matched control group of non-exposed infants. Comparison of wave latencies showed significant delay of wave I and I-III interwave interval in the AZT-3TC-treated group. The present findings suggest that prenatal exposure to the antiretroviral drugs AZT and/or 3TC is related to increased latencies in wave I and I-III interwave interval. This finding may provide an index of toxicity in lower regions of the brainstem in exposed infants.

Objective: To identify the frequency and type of microorganisms isolated from infected surgical wounds at the Instituto Nacional de Perinatología, and identify the association among the microorganisms isolated and the outcome of the infected patients., Methodology: Observational, descriptive and cross-sectional study carried out between January 1999 and January 2001. Postoperative patients of an obstetric or gynecologic procedure, complicated with a surgical wound infection and with a culture and smear of the wound, were included., Results: During the study period 41 surgical wound infections were identified. The general incidence of surgical infections was 3.9 infections per 1,000 surgical procedures. The incidence of infections after abdominal hysterectomy was 12.4 per 1,000, after vaginal hysterectomy 6.5 per 1,000, postcesarean section 5.3 per 1,000 and after episiotomy 1 per 1,000 procedures. The comparison among bacterial isolates in 1988 with 1999-2000 period showed a high frequency of gram negative bacteria isolation in the second period., Conclusions: In this study the incidence of surgical infections was less than the incidence reported in the medical literature, but the type of bacteria isolated was similar to other studies.

Objective: To describe demographics and clinical features in women with vaginal colonization with Streptococcus agalactiae attended in a gyneco-obstetric hospital., Methods: Descriptive study of 118 women with isolation of Streptococcus agalactiae in cervical swab during January 1992 to December 1998. Major patient features were obtained in retrospective revising their chart and were classified in demographic, gyneco-obstetrical and clinical characteristics. Statistical analyses were performed with descriptive statistics using central tendency measurements and dispersion, frequencies, rates and proportions with all different variables., Results: Mean age was 31 +/- 11 years; 44 (37.3%) received attention because of sterility, 37 (31.4%) were pregnant, 26 (22%) had any other gynecological disease and, 11 (9.3%) were in a group of high pregestational risk. One hundred eleven (94.1%) were sexually active, starting at a mean age of 20.9 +/- 4.3. GBS was the only microorganism isolated in 70 patients (59.3%). A concomitant cervicovaginal infection was identified in 22 (18.6%) patients. A sexual transmitted disease was present in 25 (21.2%) patients, with isolation of human papilomavirus (HPV), M. hominis, C. trachomatis y T. vaginalis. Fifty-five patients had a concomitant illness: 24 with endocrine disease, 12 cardiovascular pathology and 10 with oncologic disease., Conclusions: Vaginal colonization of mexican women by GBS is low. However, clinical and demographics characteristics are required to identify these women easily, because of the importance of maternal and infant infection by this organism.

Objective: To identify the factors associated with the acceptance of tubal ligation after childbirth among HIV-infected patients., Material and Methods: A case-control study was conducted from March 1988 to February 1999, at Mexico's National Institute of Perinatology (INPer), in 72 HIV-positive pregnant women. Cases were 49 women who accepted postpartum tubal ligation after childbirth, and controls were 23 women who refused this birth control method. Data collected for each patient were demographic characteristics, sexual and reproductive history, and HIV status. Statistical analysis consisted of descriptive measures, Chi 2 or Fisher's exact test for categorical variables, and Student's t test for continuous variables. Odds ratios (OR) with 95% CI were used to compare groups and potential confounders were assessed by stratified analysis with the Mantel-Haenszel method., Results: The patients' mean age was 25.5 +/- 5.5 years. The median gestation period was 27 weeks (range 7 to 40 weeks); 16 women (22.2%) had no prenatal care visits at INPer. The median time of HIV positivist awareness was 9 months (range 1 to 108). Variables associated with acceptance of tubal ligation were: having a prior childbirth (OR 11.1, 95% CI 3.4 to 36), pregnancy care from 1995 onward (OR 4.7, 95% CI 1.7 to 13.3), and having given birth to an HIV-infected child (OR 4.6, 95% CI 1.05 to 23.1). Stratified analysis showed no modification of the strength of association of these variables with acceptance of tubal ligation., Conclusions: A prior childbirth was the most important predictor of tubal ligation acceptance. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Background: As the incidence of tuberculosis (TB) has increased worldwide, it is expected that pregnant women will acquire this infection more frequently. Mycobacterium tuberculosis infection during pregnancy may represent a risk for maternal and neonatal complications., Methods: We studied the perinatal events of 35 consecutive pregnancies complicated by TB from March 1990 to June 1998; 105 apparently healthy pregnant women were included as controls, matched in age, gestational age upon arrival at the Institute, and socioeconomic status. Frequency and type of neonatal complications were recorded. Relative risk (RR) with 95% confidence interval (CI) was calculated. To control potentially confounding variables, a stratified analysis was performed., Results: Seventeen (48.5%) tuberculous mothers had a pulmonary infection and 18 (51.5%), an extrapulmonar localization of the TB. The neonatal morbidity rate in children born to women with TB was 23% against 3.8% of the children of the control cohort (p <0.05). Average weight of newborn infants of tuberculous mothers was 2,859 +/- 78.5 g, while average weight at birth of control neonates was 3,099 +/- 484 g (p = 0.03). Newborns of women with TB had a higher risk of prematurity (RR 2.1; 95% CI 1-4.3), perinatal death (RR 3.1; 95% CI 1.6-6), and weight at birth less than 2,500 g (RR 2.2; 95% CI 1.1-4.9). Pulmonary localization of the TB and late start of the treatment in the mothers increase the risk of perinatal death and neonatal morbidity., Conclusions: Children born to women with TB have an increased risk of morbidity and mortality in the neonatal period.

Objective: To describe the clinical manifestations, treatment and lethality of a series of patients with descending necrotizing mediastinitis (DNM)., Design: Retrospective study of a series of cases. SITE OF STUDY: The Infectious Diseases Hospital (IDH) of the Mexican Social Security Institute, Mexico City; a national reference hospital., Patients and Methods: From January 1996 through December 1998, 18 consecutive patients with diagnostic criteria for DNM were treated in the IDH. Demographic variables, precedents, clinical manifestations, characteristics of paraclinical studies, and treatment results were recollected from the chart of each patient. We made a comparison between patients who survived and the patients who died., Results: The mean age of the patients was 48.8 +/- 19.1 years; 13 (72.5%) were men. Nine (50%) had an underlying disease, being diabetes mellitus the most frequent one. In 13 (72.5%) cases an odontogenic abscess was the original infection; three (16.6%) patients had retropharyngeal abscesses. The mean time between the beginning of symptoms and admission to the hospital was 10.6 +/- 6.7 days. The most frequent symptoms were fever, dyspnea, dysphagia, and hypotension. The treatment was medical and surgical in all cases, with antibiotics, thoracotomy, drainage and debridement. The most frequent complications were septic shock, nosocomial pneumonia and ARDS. Nine patients died, the lethality rate was 50%. Patients who died had, at admission lower leukocytes and platelets counts; higher glycemia, and developed more frequently cardiovascular complications and septic shock., Conclusions: Odontogenic abscesses are the most frequent primary infections in patients with DNM. This is an infectious problem with high lethality. Septic shock is the principal cause of death.

Objective: To identify the medical complications in a cohort of HIV-infected, pregnant women and to determine the risk of having the virus in the development of these complications., Material and Methods: A cohort study of 44 HIV-infected and 88 seronegative pregnant women was performed. Pregnancy was followed and perinatal results were compared. HIV-infected women were asymptomatic with CD4 count > 200 mm3. Patients were matched for age and socioeconomic status., Results: In 42 (95.4%) of HIV patients the disease had been transmitted sexually; 35 (79.5%) had been infected for less than one year and 15 (34%) received antiviral treatment during pregnancy. HIV-infected patients showed greater risk of infectious disorders (RR3.1, CI95% 1.9-52), cervical infections (RR 2.2, CI95% 1-48) and sexually transmitted diseases (RR 18, CI95% 2.3-137). Newborns showed low birth weight and were premature, and neonatal affections were similar in the two groups compared. Stratified analysis showed that no antiretroviral treatment and more than three sexual partners increase the risk of infections., Conclusions: HIV-seropositive, asymptomatic, pregnant women with > 200/mm3 CD4 count did not show greater medical risk along pregnancy and birth, although higher incidence of infections was detected.

Objective: To describe the experience of management of pregnant women complicated with rubella and to evaluate the perinatal outcome., Material and Methods: A total of 67 pregnant women with positive IgM test for rubella were studied in the period from January 1st, 1990 to October 31st, 1997. Sixty-six of these women were followed until the end of gestation, in 4 patients an elective abortion was performed and 1 patient had a molar pregnancy. The effects of rubella on gestation and on the product were evaluated in sixty-one of the patients. Anti-rubella IgM was determined at birth and positive infants were subjected to evaluation by echocardiogram, brainstem auditory evoked potentials (BAEP) and ophthalmological study., Results: Mean age of the patients was 24.7 +/- 5.5 years; 28 patients were primigravidae. Pregnancies were normal showing no complications due to the rubella episode. In 35 cases (52.2%), the viral infection occurred during the first trimester of pregnancy, in 23 cases (34.5%) during the second and in 9 (13.3%) during the third. Seventy-one percent of infants born to mothers infected during the first trimester of pregnancy were also infected, and 51.6% developed congenital rubella syndrome. The most frequent manifestations of CRS were: prematurity, low birth weight and alterations of the BAEP., Conclusions: In Mexico, rubella is still a cause of fetal damage, which shows the need for preventive strategies, such as universal vaccination, to avoid rubella infection during pregnancy.

Background: High concentrations of interleukin-6 (IL-6) have been demonstrated in amniotic fluid (AF) from women with intra-amniotic infection. Recent studies have reported that IL-6 levels in AF were related to an increase in neonatal morbidity; moreover, higher IL-6 plasma levels have been observed in neonates with sepsis., Methods: A cohort study was carried out at the National Institute of Perinatology in Mexico City. Inclusion criteria were the following: 1) preterm singleton pregnancy; 2) intact membranes at time of enrollment, and 3) written informed consent. Women with other complications of pregnancy were excluded. Newborn sepsis during the first 72 h was defined as early-onset sepsis. Amniotic fluid was obtained at the moment of delivery. Amniotic fluid IL-6 (AF IL-6) was determined by enzyme-linked immunoassays., Results: Ninety-three women met the criteria for enrollment in the study and 31 (33%) of their newborns had early-onset neonatal sepsis. The mean AF IL-6 in mothers of septic newborns was 5779 +/- 2804 pg/ml compared to 729 +/- 382 pg/ml in mothers with non-infected neonates (p < 0.001). AF IL-6 concentrations higher than 1250 pg/ml were significantly associated with early-onset sepsis (OR 33.3; 95% CI 9.4-117.3) (p < 0.001). Gestational age under 32 weeks was also associated with neonatal sepsis (OR 2.56; 95% CI 1.2-9) (p = 0.002). Women whose infants developed neonatal sepsis had a higher frequency of clinical chorioamnionitis (p = 0.02)., Conclusions: IL-6 determination in AF may be a useful indicator to identify neonates with higher risk of in utero bacterial infection.

In obstetric patients transfusion is a common procedure, it has many advantages but it also has severe risks. Since the observation that human immunodeficiency virus (HIV) infection is transmitted by transfusion, the number of preventive measures to reduce the infectious diseases transmission by this procedure has increased. The microorganisms that can be transmitted through transfusion include: human T lymphotropic virus (HTLV) I and II, hepatitis B virus, hepatitis C virus, hepatitis D virus, hepatitis G virus, HIV, cytomegalovirus, Treponema pallidum, Barucella sp, Toxoplasma gondii, Plasmodium sp, and Trypanosoma cruzi. The most important measure for reduce transfusion risks is the appropriate and careful use of this procedure. This article review transfusion's indication, describe the infectious diseases commonest transmitted by transfusion and analyze the preventive measures to put in practice.

Near 70 per cent of Mexican women infected by the Human Immunodeficiency virus (HIV) are between 15 and 44 years old, in this women sexual transmission are the most frequent route of infection. The objective of this article was to describe the obstetric course and perinatal repercussion of the HIV-Positive pregnant women with medical care at the Instituto Nacional de Perinatología, Mexico city between January 1994 to December 1996. Nineteen women were studied, sexual transmission was the route of infection in 16 of them. One had diagnostic criteria for AIDS, the others 18 had HIV asymptomatic infection. At delivery 18 a term products were born. The mean of the newborn weight was 3159 g. At moment of this report 4 children (22%) have been diagnosed as HIV infected, all of them dead during their first year of life.

The diagnosis of intraamniotic infection (IAI) is not difficult when clinical manifestations are present, but there are patients with subclinical infections, in these cases the examination of the amniotic fluid is the most important diagnostic procedure. We made a critical review of the medical literature of diagnostic tests of IAI, according to the analysis criterion of the medical articles of the Department of Clinical Epidemiology of the McMaster University. The articles were identified looking for in the MEDLINE-CD ROOM and INDEX MEDICUS from 1991 to 1995. We identified 19 articles, none of them complied with all of the analysis criterion, none of the studies were blinded nor independently compared with a gold standard test and only five articles studied a full spectrum of patients. The articles with better methodologic design were those that studied the interleukin-6 role as diagnostic test for IAI; they showed a sensibility between 75 to 89% and a specificity of 97 to 100%; nevertheless it is still necessary to standardize the cut-off point of the interleukin-6 levels.

Hemorrhagic cystitis is generally a benign self-limited disorder, however there are some severe cases which are associated to a significant blood loss. The etiology may be either bacterial, viral or chemical in origin; though the cause is not identified in most of the cases. Immunocompromised patients or patients who have undergone chemotherapy or radiation constitute the highest risk group. There are only a few articles about hemorrhagic cystitis in pregnancy, that is the reason why the therapy for this disorder is not uniform. Hemorrhagic cystitis in pregnant women frequently is associated with preterm labor. We describe one patient with a clinical status of hematuria, dysuria, frequency, urgency and premature labor. The cystoscopic study showed data that suggest hemorrhagic cystitis. The various treatment used in this disorder are reviewed here.

Measles is a highly infectious disease. In Mexico, nevertheless the postvaccine era, continue being an endemic disease. It has been described that measles increase the maternal mortality, because pregnant women have a more severe clinical course of the disease; measles also has negative repercussion on pregnancy, increasing the frequency of premature labor. We report two pregnant women complicated with measles, both of them had a clinical course of the disease and they didn't have obstetric or neonatal complications.

Objective: To determine the seroprevalence of hepatitis A, B, C and D virus infection among pregnant women attending a perinatal care hospital., Material and Methods: A prospective study was carried out to determine the seroprevalence of hepatitis A virus IgG antibodies (anti-HAV), hepatitis B virus markers (anti-HBcAg and HBsAg) and hepatitis C virus antibodies (anti-HCV) in pregnant women. In HBsAg positive cases. HBeAg and hepatitis D virus antibodies (anti-HDV) were investigated. All analyses were performed with the ELISA technique., Results: Of the 1500 pregnant women studied. 93.3% were positive for anti-HAV IgG. The HBsAg seroprevalence was 0.26% and anti-HCV seroprevalence was 0.53%. There were no patients with HBeAg or anti-HDV., Conclusions: A higher seroprevalence of HBsAg was found in this study than in other studies of pregnant Mexican women. We propose that HBsAg screening become a routine prenatal test.

Vaccination is one of the most important methods to prevent infectious diseases, it consist of application of an inactive but immunogenic antigen, with the objective of simulating a natural infection and originate an immunological response. Important vaccines used in women's reproductive age are: 1) antirubella, if the woman has not serum antibodies against rubella virus; 2) tetanus toxoid is indicated in all pregnant women which had not been vaccinated against tetanus in the last ten years; 3) hepatitis B vaccine, to be applicated in newborns of women with positive serological indicators of chronic hepatitis B infection; 4) antirabies vaccine and gamaglobulin hiperimmune must be used in women with a recent exposure to rabies virus.

The cesarean section is associated with a high incidence of puerperal infections. The antibiotic prophylaxis in obstetric surgery may reduce infectious complications, nevertheless antibiotic prophylaxis only has proved to be effective in women with risk factors for the occurrence of infection. We made a comparative study of the prophylactic efficacy of the ceftriaxone a single dose versus cefazolin three doses, in women with risk factor for infection. There were enrolled 100 patients, 50 in each group. Six percent of the ceftriaxone group patients developed puerperal infections while 12% of the cefazolin group women developed this complication. The statistic analysis don't show difference between the groups. We consider the single dose prophylactic schema is better because its application is easier, administration is safety and reduces the risk of adverse reactions.