Pannee Sirivatanapa

Pregnancy outcomes among chronic carriers of hepatitis B virus

To compare pregnancy outcomes of women with chronic HBV infection with those of HBV‐negative women.

One-day compared with 7-day nitrofurantoin for asymptomatic bacteriuria in pregnancy: a randomized controlled trial.

OBJECTIVE: To evaluate whether a 1-day nitrofurantoin regimen is as effective as a 7-day regimen in eradicating asymptomatic bacteriuria during pregnancy. METHODS: A multicenter, double-blind, randomized, placebo controlled noninferiority trial was conducted in antenatal clinics in Thailand, the Philippines, Vietnam, and Argentina. Pregnant women seeking antenatal care between March 2004 and March 2007 who met the inclusion and exclusion criteria were invited to participate in the study. Those who consented were randomly allocated to receive either a 1-day or a 7-day course of 100 mg capsules of nitrofurantoin, which was taken twice daily. The primary outcome was bacteriologic cure on day 14 of treatment. RESULTS: A total of 1,248 of 24,430 eligible women had asymptomatic bacteriuria, making the overall prevalence of 5.1%. Of these 1,248 women, 778 women were successfully recruited, and 386 and 392 women were randomly allocated to 1-day and 7-day regimens, respectively. Escherichia coli was the most common potentially pathogenic bacteria detected, its prevalence approaching 50%. Bacteriologic cure rates at treatment day 14 were 75.7% and 86.2% for 1-day and 7-day regimens, respectively. The cure rate difference was –10.5% (95% confidence interval −16.1% to −4.9%). Mean birth weight and mean gestational age at delivery were significantly lower in the 1-day regimen group. There were fewer adverse effects in the 1-day regimen group, but the differences were not statistically significant. CONCLUSION: A 1-day regimen of nitrofurantoin is significantly less effective than a 7-day regimen. Women with asymptomatic bacteriuria in pregnancy should receive the standard 7-day regimen. CLINICAL TRIAL REGISTRATION: ISRCTN, isrctn.org, ISRCTN11966080 LEVEL OF EVIDENCE: I

Chorioamnionitis is associated with placental transmission of human immunodeficiency virus-1 subtype E in the early gestational period.

The frequency and the cellular basis for HIV-1 transmission from mother to child in the early gestational period are poorly understood. We compared the placentas of 24 women seropositive for HIV-1 subtype E and who had not received any antiretroviral drugs, to placentas of 25 seronegative women. All placentas were obtained during therapeutic abortion at 6–23 weeks gestation. Placentas and fetal organs were examined by routine light microscopy, immunostaining for p24 capsid protein, and in situ PCR to localize which cells were infected with HIV-1 subtype E. The number of previous abortions was not a factor in placental HIV infection since this number was higher in seronegative women (P<0.01). There were no significant differences between the placentas of the two groups with respect to presence of chorioamnionitis, villitis, villous stromal fibrosis, infarction, abnormal villous maturation, deciduitis or decidual necrosis. HIV-1 subtype E was detected in up to 83% of placentas, either by immunostaining or in situ PCR, in trophoblast, villous stromal cells, Hofbauer cells, decidual and decidual glandular epithelium. Fetal organs were positive for HIV in 30% (6/20) of cases. There was a significant association between transmission of HIV to the fetus and the histologic findings of chorioamnionitis, plasmacellular deciduitis and decidual cell necrosis. This is the first report showing an association of chorioamnionitis with early in utero transmission of HIV-1 subtype E. This may help explain the cases of in utero transmission that persist despite antiretroviral prophylaxis, given that therapy is started in the late gestational period.

Prenatal strategies for reducing severe thalassemia in pregnancy

Objective: To describe the prenatal strategy in reducing new cases of severe thalassemia at Maharaj Nakorn Chiang Mai Hospital. The study design involved a prospective descriptive analysis set in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. Subjects: Pregnant women attending antenatal clinic. Methods: The strategy included: (1) carrier identification by retrospective (history review) and prospective screening program; (2) the couples at risk were counseled and offered cordocentesis; (3) analysis of fetal blood with high performance liquid chromatography (HPLC) or electrophoresis; and (4) counseling for termination of pregnancy in case of affected fetus. The prospective screening consisted of testing for a carrier by a simple erythrocyte osmotic fragility test (EOFT) in women with no risk and testing the husbands of the women with abnormal tests. A pregnancy in which both of the couple were carriers was considered a risk. Results: Cordocentesis was performed in 554 pregnancies at risk, 252 and 302 from retrospective and prospective screening, respectively. Sixty of 252 of the first group had severe thalassemia. In the prospective screening program of 12 680 women, 459 risk couples were identified, 302 pregnancies underwent cordocentesis and 53 (17.5%) had severe thalassemia. This strategy enabled us to identify 113 cases of severe thalassemia (Hb Barts; 60, β‐thal entities; 53) from 554 cases at risk. Conclusion: The strategy proves valuable in the control of severe thalassemia. This extensive experience suggests the strategy be considered an effective way in the control of severe thalassemia in high prevalence areas.

One-Day Compared With 7-Day Nitrofurantoin for Asymptomatic Bacteriuria in Pregnancy: A Randomized Controlled Trial

ABSTRACTOver 20% of culture-positive untreated pregnant women develop pyelonephritis and other symptomatic disease. The risk of pyelonephritis in pregnant women with asymptomatic bacteriuria is reduced by treatment with antibiotics. It is unclear whether 1-day antibiotic therapy or treatment for sev

Prenatal sonographic diagnosis of ectopia cordis

We present a small series of prenatally diagnosed cases of ectopia cordis.

Effectiveness of the model for prenatal control of severe thalassemia

The aim of the research was to determine effectiveness of the model for prenatal control in reducing new cases of severe thalassemia.

Higher Placental Anti-Inflammatory IL-10 Cytokine Expression in HIV-1 Infected Women Receiving Longer Zidovudine Prophylaxis Associated with Nevirapine

Placental cytokine balance may be critical for the control of mother-to-child transmission (MTCT) of HIV. We assessed whether the type and duration of antiretrovirals used for prevention of HIV-1-MTCT modified the inflammatory cytokine profile. We investigated the levels of cytokine expression in the placentas of 61 HIV-1-infected women who received zidovudine (ZDV) plus single dose nevirapine (SD-NVP) or ZDV only for prevention of MTCT. Placentas of 38 HIV-1-uninfected women were included as controls. All placentas were obtained after vaginal delivery. Levels of mRNA and cytokine expression were quantified using real-time PCR and ELISA, respectively, in placental explants and 24-hour culture supernatants and analyzed in relation to the womens characteristics and the type and duration of antiretroviral prophylaxis. HIV-1-infected and uninfected women did not show any differences in the expression of placental cytokine secretion except for a trend toward lower TNF-alpha mRNA levels in HIV-1-infected women. Within the HIV-1-infected group, women who were exposed to a long duration of ZDV (>72 days) or received SD-NVP less than 5h prior to delivery, more frequently expressed detectable levels of IL-10 in their placentas (32% versus 7% (p = 0.01) and 32% versus 5% (p = 0.02), respectively). No infant was found to be HIV-1-infected. Our results showed a normalization of the placental cytokine balance in HIV-1-infected women receiving antiretroviral prophylaxis. Furthermore, the type and duration of antiretroviral prophylaxis have an impact on the placental anti-inflammatory IL-10 expression level, which may contribute to controlling HIV replication at the placental level, thus reducing MTCT of HIV-1.

Hematological alterations and thymic function in newborns of HIV-infected mothers receiving antiretroviral drugs

ObjectivesTo investigate the effects of antiretroviral (ARV) drugs on hematological parameters and thymic function in HIVuninfected newborns of HIV-infected mothers.Study designCross sectional study.SettingChiang-Mai University Hospital, Chiang-Mai, Thailand.Participants/Patients49 HIV-uninfected and 26 HIV-infected pregnancies.MethodsCord blood samples of newborns from HIV-uninfected and HIV-infected mothers were collected. Hematological parameters were measured using automatic blood cell count. T-cell receptor excision circles (TRECs) levels in cord blood mononuclear cells (CBMCs), CD4+ and CD8+ T-cells were quantified using real-time PCR.Main Outcome MeasuresHemotological parameters and thymic function.ResultsNewborn of HIV-infected mother tended to have lower mean levels of hemoglobin than those of HIV-uninfected mother (137 ± 22 vs 146 ± 17 g/L, P = 0.05). Furthermore, mean of red blood cell (RBC) counts and hematocrit and median of TRECs in CD4+ T-cells in the newborns of the former were significantly lower than those of the latter [3.6 ± 0.7 vs 4.8 ± 0.6 × 1012 cells/L, P <0.001; 0.40 ± 0.07 vs 0.46 ± 0.05 L/L, P <0.001 and 0.53 (IQR: 0.03–5.76) vs 13.20 (IQR: 2.77–27.51) × 10−3 pg/μL, P = 0.02, respectively].ConclusionARV drugs altered hematological parameters and thymic function (TRECs CD4+ T-cells) in HIV-uninfected newborns of HIV-infected mothers.

Development of an ELISA strip for the detection of α thalassemias

α thalassemia is probably the most common of all single-gene disorders throughout the world. Most incidences of α thalassemia arise from the deletion of one (-α) or both (--) of the α globin genes, which are known as α+ thalassemia (-α/αα) or α thalassemia (--/αα), respectively.[1][1] The