Keimari Mendez

Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer

Exposure of newborns to the maternal vaginal microbiota is interrupted with cesarean birthing. Babies delivered by cesarean section (C-section) acquire a microbiota that differs from that of vaginally delivered infants, and C-section delivery has been associated with increased risk for immune and metabolic disorders. Here we conducted a pilot study in which infants delivered by C-section were exposed to maternal vaginal fluids at birth. Similarly to vaginally delivered babies, the gut, oral and skin bacterial communities of these newborns during the first 30 d of life was enriched in vaginal bacteria—which were underrepresented in unexposed C-section–delivered infants—and the microbiome similarity to those of vaginally delivered infants was greater in oral and skin samples than in anal samples. Although the long-term health consequences of restoring the microbiota of C-section–delivered infants remain unclear, our results demonstrate that vaginal microbes can be partially restored at birth in C-section–delivered babies.

Erratum to: The first microbial environment of infants born by C-section: the operating room microbes

After publication of this article [1], the authors noticed one of the collaborator’s names had been misspelled in the ‘Acknowledgements’ section. “Dr. Tsei Ming” is incorrect and should be “Dr. Ming C. Tsai”. The correct version of the ‘Acknowledgements’ section is included below and has been updated in the original article [1].

Human papillomavirus infection in women in Puerto Rico: agreement between physician-collected and self-collected anogenital specimens.

Objective This study aimed to describe the prevalence and concordance between cervical and anal human papillomavirus (HPV) infection and compare cervicovaginal and anal self-collection methods for HPV testing between physician and self-collected specimens in women in Puerto Rico. Materials and Methods Specimens for HPV-DNA testing were obtained from 100 women aged 18 to 34 years attending a general gynecology clinic for a routine Pap smear. Human papillomavirus testing was performed using polymerase chain reaction MY09/MY11 primers. Positive samples were typed for 39 genotypes. Agreement between sampling methods was determined by percent agreement and the &kgr; statistic. Results For the 39 genotypes evaluated, 38.4% (38/99) of cervicovaginal and 33.7% (30/89) of anal physician-collected samples were HPV+, whereas 35.1% (34/97) of cervicovaginal and 32.0% (31/97) of anal self-collected samples were positive. Human papillomavirus type 16 was the most common type identified in the cervix (8.3%, 8/97) and the anus (5.6%, 5/89) of physician-collected samples, with similar prevalence in self-collected samples. Concordance between cervical and anal HPV infection was high (>90%) for all types evaluated. There was a strong percent agreement between physician- and self-collected cervicovaginal and anal samples (>95% for all HPV types) and good to excellent agreement (&kgr; > 0.60) for most HPV types. Conclusions The clinic-based prevalence of anal and cervicovaginal HPV infection was high, with a strong concordance between cervical and anal infection and good to excellent agreement between physician- and self-collected samples. This study supports the feasibility of using cervical and anal self-sampling methods in future population-based studies of HPV infection in Puerto Rico and as an HPV screening method in women.

Molecular Triage of Premalignant Lesions in Liquid-Based Cervical Cytology and Circulating Cell-Free DNA from Urine, Using a Panel of Methylated Human Papilloma Virus and Host Genes

Clinically useful molecular tools to triage women for a biopsy upon referral to colposcopy are not available. We aimed to develop a molecular panel to detect cervical intraepithelial neoplasia (CIN) grade 2 or higher lesions (CIN2+) in women with abnormal cervical cytology and high-risk HPV (HPV+). We tested a biomarker panel in cervical epithelium DNA obtained from 211 women evaluated in a cervical cancer clinic in Chile from 2006 to 2008. Results were verified in a prospective cohort of 107 women evaluated in a high-risk clinic in Puerto Rico from 2013 to 2015. Promoter methylation of ZNF516, FKBP6, and INTS1 discriminated cervical brush samples with CIN2+ lesions from samples with no intraepithelial lesions or malignancy (NILM) with 90% sensitivity, 88.9% specificity, 0.94 area under the curve (AUC), 93.1% positive predictive value (PPV), and 84.2% negative predictive value (NPV). The panel results were verified in liquid-based cervical cytology samples from an independent cohort with 90.9% sensitivity, 60.9% specificity, 0.90 AUC, 52.6% PPV, and 93.3% NPV, after adding HPV16-L1 methylation to the panel. Next-generation sequencing results in HPV+ cultured cells, and urine circulating cell-free DNA (ccfDNA) were used to design assays that show clinical feasibility in a subset (n = 40) of paired plasma (AUC = 0.81) and urine (AUC = 0.86) ccfDNA samples obtained from the prospective cohort. Viral and host DNA methylation panels can be tested in liquid cytology and urine ccfDNA from women referred to colposcopy, to triage CIN2+ lesions for biopsy and inform personalized screening algorithms. Cancer Prev Res; 9(12); 915–24. ©2016 AACR.

Urine-based human papillomavirus DNA testing as a screening tool for cervical cancer in high-risk women

To test the hypothesis that self‐collected urine could be used to detect high‐risk human papillomavirus (HPV) DNA with sensitivity and specificity comparable to those of standard cervical testing.

Cost Savings Related to Decreased Preterm Birth in a Program of Centering Pregnancy for Hispanic Women

Preterm birth (PTB) is one of the most important causes of perinatal mortality and morbidly in the developed world.1 The birth of a preterm infant results in significant health consequences to the infant and emotional and economic costs for families and communities.2 PTB is defined as a birth before 37weeks of gestational age. In 2015, preterm birth affected about 1 of every 10 infants born in the United States.3 The National Center for Health Statistics has reported that about 500,000 premature live births occur annually in the United States alone.4 In addition to the health problems associated with preterm birth, there is a broad of emotional and financial costs and lost opportunities for families.3 In a 2006 report, the Institute of Medicine described the high rate of premature births in the United States as “a public health concern that costs society at least

Abstract B11: Viral and host gene methylation in liquid prep: novel molecular screening and triage tools to reduce cervical cancer disparities

26billion a year,5 or

The first microbial environment of infants born by C-section: the operating room microbes.

51,600 per infant born preterm.3 The March of Dimes has described these costs as follows:

Cervical Human Papillomavirus Infection in a Sample of Hispanic Women Living in Puerto Rico: Comparison with Cervical Cytology Reports

16.9billion in medical and health care costs for the baby,

Lifestyle modification intervention for overweight and obese Hispanic pregnant women: Development, implementation, lessons learned and future applications

1.9 billion in labor and delivery costs for mom,