HIV and Pregnancy in Resource-Poor Settings

There are 33.4 million people living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome. Globally, HIV/AIDS is the leading cause of death among women of reproductive age. In the United States and other developed countries, aggressive efforts to treat HIV-positive pregnant women with highly active antiretroviral therapy have decreased the maternal-to-child transmission (MTCT) from over 20% to less than 2%. However, in resource-poor settings, access to antiretroviral therapy (ART) is not readily available, and perinatal transmission rates remain as high as 45%. Women are at greater risk of heterosexual transmission of HIV, which is compounded by lack of condom use, imbalance of social power, and the high fertility rate. Prevention programs are needed to empower and educate women and engender community awareness for condom use. Prenatal screening and treatment, intrapartum ART, and postpartum prophylaxis must be made available to all women and children to prevent MTCT.Key Words: Human immunodeficiency virus, AIDS, Antiretroviral therapy, Pregnancy, Perinatal transmissionHuman immunodeficiency virus (HIV) and AIDS are recognized as major contributors to maternal mortality worldwide. Of the 33.4 million people affected with HIV/AIDS, 22.4 million live in sub-Saharan Africa, 3.8 million live in Southeast Asia, and 2 million live in Latin America (Figure 1). Almost 16 million (47%) are women, and 2.7 million (6.2%) are children.¹ According to the World Health Organization (WHO), approximately 60,000 fewer maternal deaths would have occurred in 2008 in the absence of HIV, and the maternal mortality rate from 1980 to 2008 would have dropped much more significantly if it had not been for the introduction of the HIV epidemic.²Open in a separate windowFigure 1Adults and children estimated to be living with human immunodeficiency virus (2008). Reproduced with permission from UNAIDS/World Health Organization.¹ © UNAIDS.     

Schistosomiasis: Health Effects on Women

Schistosomiasis is a parasitic infection endemic in 74 resource-poor nations that affects approximately 200 million people. Schistosomes are water-borne flatworms or blood flukes that enter the human body through the skin. Some symptoms of schistosomiasis include fever, arthralgias, abdominal pain, bloody diarrhea, and hematuria. Ultimately, patients develop heptosplenomegaly, ascites, and lymphadenopathy. Schistosomiasis is a neglected tropical disease, and its global health impact is grossly underestimated. Women suffer considerably from female genital schistosomiasis that causes infertility, preterm labor, anemia, menstrual disorders, and dyspareunia. More effort is needed to prevent schistosomiasis. Treating pregnant and lactating women decreases the disease burden and improves maternal and fetal outcome.Key words: Schistosomiasis, Praziquantel, Female genital schistosomiasisSchistosomiasis, also known as, bilharzia, bilharziasis, or snail fever, affects approximately 200 million people worldwide. Theodor Bilharz, a German surgeon who worked in Cairo, discovered schistosomiasis in 1851. Today, 120 million people are symptomatic.¹ Over 80% of the disease is currently found in sub-Saharan Africa (Figure 1). According to the World Health Organization (WHO), approximately 652 million people are at risk with an estimated 200,000 deaths occurring annually. Forty million women of childbearing age are infected.² WHO has placed schistosomiasis as the third most devastating tropical disease, following malaria and intestinal helminthiasis.³Open in a separate windowFigure 1Countries and areas at risk for schistosomiasis (2008). Available at http://gamapserver.who.int/mapLibrary/Files/Maps/Global_ShistoPrevalence_ITHRiskMap.png. Reprinted with permission.There are 5 species of schistosomiasis. These water-borne flatworms or blood flukes are schistosomes. The most common are Schistosoma mansoni, S japonicum, and S haematobium. The rarer forms are S intercalatum and S mekongi. S mansoni occurs in Africa, the Caribbean, South America, and the Eastern Mediterranean. S japonicum and S mekongi are found in Southeast Asia and the Western Pacific. S intercalatum is endemic in central Africa and S haematobium occurs throughout Africa and the Eastern Mediterranean. S haematobium affects both the urinary and reproductive tract systems, whereas the 4 other species impact the hepatic and gastrointestinal systems.⁴     

A Comparison of group A Streptococcus versus Streptococcus pneumoniae pneumonia

BACKGROUND: St reptococcus pyogenes is an uncommon cause of community-acquired pneumonia in children. Further, its clinical course in comparison to pneumonia caused by Streptococcus pneumonia has not been previously highlighted. METHODS: We reviewed medical records of children 0-18 years of age from April 1983 to April 2005, with discharge diagnoses of invasive disease caused by group A streptococcus (GAS) (Streptococcus pyogenes), or Streptococcus pneumonia (SP) or pneumonia. Data were extracted from the charts, and a comparison of clinical characteristics between the 2 etiologies was performed. Confirmed disease required blood or pleural fluid isolates. Patients with single isolates of GAS in tracheobronchial secretions or sputum were classified as having presumed disease caused by GAS. Patients with confirmed disease due to GAS and SP were compared with respect to clinical characteristics. RESULTS: Of 103 patients with invasive GAS disease, 12 (11.6%) had confirmed GAS lobar pneumonia. In addition 7 patients had presumed GAS pneumonia. There were 54 patients with confirmed SP pneumonia. Most children who had GAS pneumonia were healthy and recovered completely. Compared with patients with confirmed SP pneumonia, those with confirmed GAS pneumonia had more frequent and larger effusions, more culture positive effusions, had prolonged fever, and had longer hospitalizations. There was not an increasing trend to GAS pneumonia over the 22-year period. There was not a predominant serotype responsible for the pneumonias. CONCLUSIONS: Lobar GAS pneumonia represents approximately 11% of all cases of invasive disease in this institution during a 22-year period. Compared with patients with SP pneumonia, it appears to cause more effusions and morbidity. The organism is also more frequently recovered from pleural fluid.     

Cervical Cancer: A Preventable Death

Cervical cancer kills 260,000 women annually, and nearly 85% of these deaths occur in developing nations, where it is the leading cause of cancer deaths in women. Disparities of health and poverty play a large role in this high mortality rate. Whereas routine Papanicolaou and human papillomavirus (HPV) testing has dramatically reduced cervical cancer deaths in Western nations, without proper infrastructure, facilities, and medical training, the rates of cervical cancer in developing nations will remain high. Studies on HPV DNA testing and the low-technology method of “screen and treat” are promising. In addition, reducing the cost and increasing the availability of HPV vaccines in developing nations brings hope and promise to the next generation of women.Key words: Cervical cancer, Human papillomavirus, Human papillomavirus DNA testing, Human papillomavirus vaccineIn the 1970s, Harald zur Hausen detected the human papillomavirus (HPV) in warts and cervical cancer, and he subsequently isolated and cloned different strains of HPV. His research concluded that patients infected with HPV types 16 and 18 were at an increased risk of developing cancer. In 2008, Dr. Hausen received the Nobel Prize for his groundbreaking work on HPV.¹Human papillomavirus can cause cancer of the cervix, vagina, vulva, penis, and anus, as well as some head and neck cancers, anogenital warts, and recurrent respiratory papillomatosis. The World Health Organization (WHO) estimates that of the 500,000 new cases annually, 80% affect women between the ages of 15 and 45 years who live in developing nations. It predominantly impacts women living in Latin America and the Caribbean, sub-Saharan Africa, and Southeast Asia (Figure 1). Only 5% of women in these regions have been screened for cervical disease in the past 5 years.Open in a separate windowFigure 1Global burden of cervical cancer greatest in developing countries. Reproduced with permission from Women Deliver. http://www.womendeliver.org/blog/wp-content/uploads/2009/08/cervicalcancer1.jpg.     

Unsafe Abortion: Unnecessary Maternal Mortality

Every year, worldwide, about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 20 million, are unsafe. Some 68,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer long-term health complications. Unsafe abortion is thus a pressing issue. Both of the primary methods for preventing unsafe abortion—less restrictive abortion laws and greater contraceptive use—face social, religious, and political obstacles, particularly in developing nations, where most unsafe abortions (97%) occur. Even where these obstacles are overcome, women and health care providers need to be educated about contraception and the availability of legal and safe abortion, and women need better access to safe abortion and postabortion services. Otherwise, desperate women, facing the financial burdens and social stigma of unintended pregnancy and believing they have no other option, will continue to risk their lives by undergoing unsafe abortions.Key words: Unsafe abortions, Maternal mortality, Postabortion careAccording to the World Health Organization (WHO), every 8 minutes a woman in a developing nation will die of complications arising from an unsafe abortion. An unsafe abortion is defined as “a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.”¹ The fifth United Nations Millennium Development Goal recommends a 75% reduction in maternal mortality by 2015. WHO deems unsafe abortion one of the easiest preventable causes of maternal mortality and a staggering public health issue.     

Morinda Citrifolia (Noni) Reduces Cancer Risk in Current Smokers by Decreasing Aromatic DNA Adducts

Quantitative determination of aromatic DNA adducts in peripheral blood lymphocytes (PBLs) of current smokers is an useful surrogate biomarker for the evaluation of environmental carcinogen exposure or chemopreventive intervention. In this study, we examined the impact of Tahitian Noni Juice (TNJ) on the aromatic DNA adducts of PBLs, before and after a 1-mo intervention, using ³²P postlabeling assay. Of 283 enrolled, 203 smokers completed the trial. Aromatic DNA adducts levels in all participants were significantly reduced by 44.9% (P < 0.001) after drinking 1 to 4 oz of TNJ for 1 mo. Dose-dependent analyses of aromatic DNA adduct levels showed reductions of 49.7% (P < 0.001) in the 1-oz TNJ group and 37.6% (P < 0.001) in the 4-oz TNJ group. Gender-specific analyses resulted in no significant differences in the 4-oz TNJ groups. Interestingly, the 1-oz TNJ group showed a reduction of 43.1% (P < 0.001) in females compared with 56.1% (P < 0.001) in males. The results suggest that drinking 1 to 4 oz of TNJ daily may reduce the cancer risk in heavy cigarette smokers by blocking carcinogen-DNA binding or excising DNA adducts from genomic DNA.     

Kinetics of palmitic acid transport in insulin-dependent diabetic pregnancies: In vitro study

BACKGROUND: The paucity of data relating to transport kinetics of free fatty acids (FFA) in pregnant diabetic women prompted the undertaking of the present study. METHODS: Transport kinetics of a model FFA, palmitic acid, have been investigated in Type I diabetic pregnancies, using in vitro perfusion of isolated placental lobules. National Cancer Tissue Culture medium diluted with Earle's buffered salt solution was used as the perfusate and control placental lobules were perfused for comparison. RESULTS: In five Type I diabetic women, the palmitic acid transport fraction (TF) averaged 5.6 +/- 0.42% of injected maternal bolus dose, representing 11.8 +/- 2.1% that of tritiated water used as reference. In control perfusions (n = 5), the palmitic acid TF represented 10.2 +/- 1.3% of tritiated water TF. Differential transport rates of palmitic acid for 10, 25, 50, 75 and 90% of efflux in fetal veins differed significantly from the corresponding values for tritiated water in both study and control series. However, palmitic acid transport rates for the various efflux fractions in the two series were not significantly different. For kinetic parameters, such as area under the curve, clearance, elimination constant, time for maximum response, absorption rate and elimination rate, the values for palmitic acid in the diabetic and control series also did not differ significantly. CONCLUSION: Transport kinetics of palmitic acid in Type I human diabetic pregnancies in in vitro conditions do not differ significantly from those observed in normal pregnancies.