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27 Nov 2017
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Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 01 Aug 2013

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1

Malaria variant ups risk of low birth weight, small for gestational age

Tristan Manalac
28 Aug 2017
The first attempt to eradicate malaria globally was in 1955 – by WHO, through The Global Malaria Eradication programme.

Infection with different malaria strains results in differential adverse pregnancy and birth weight outcomes in malaria-endemic African populations, a new study has shown. Specifically, parasites that carry 3D7-like variant of the VAR2CSA Plasmodium falciparum protein cause poorer birth outcomes.

“This is the first study investigating effects of specific genetic variants of var2csa on clinical outcomes. We employed an integrative approach, using molecular epidemiology, next-generation sequencing and population genetics,” said researchers.

“The results from our study provide strong support for the development of polyvalent VAR2CSA-based vaccines against pregnancy-associated malaria,” they added.

The study included P. falciparum-infected placental samples from 101 pregnant women, of which 56 were from Malawi (mean maternal age 20.5±4.6 years) and 45 were from Benin (mean maternal age 24±6.3 years). Maternal age (p=0.013) and gestational age at delivery (p<0.001) were significantly higher in the Benin cohort. [Sci Rep 2017;7:7768]

The placental samples were then subjected to amplicon deep-sequencing and subsequent clustering to determine the sequence diversity of the ID1-DBL2X region of the VAR2CSA. This resulted in five distinct clades, two of which, the FCR-3- and 3D7-like variants, were common to both Malawi and Benin cohorts.

“Our study shows that the ID1-DBL2x epitope in the N-terminus region is highly diverse among P. falciparum-infected pregnant women in Malawi and Benin. There were 152 variants found among 101 women, and they clustered phylogenetically into five distinct clades,” the researchers reported.

In the Malawi cohort, mothers infected with the 3D7-like and FCR-3-like variant had median infant birth weight of 2,450 and 2,800 g, respectively. By comparison, those in the Benin cohort had median infant birth weight of 2,710 and 2,720 g, respectively.

Regression models of pooled data showed that mothers infected with the 3D7-like clade birthed infants with lower birth weight (difference, -267.99 g; 95 percent CI, -466.43 to -69.55) after adjusting for parity and country.

Moreover, this trend persisted when data were analysed by country. Infant birth weight was significantly lower in 3D7-like variant-infected mothers from Malawi (adjusted difference, -330.97 g; -628.44 to -33.49) and Benin (adjusted difference, -147.88 g; -530.06 to 234).

The unadjusted prevalence of low birth weight (LBW) was higher in 3D7-like variant-infected women from Malawi (47.6 vs 4.6 percent) and Benin (25 vs 15.4 percent) than in those infected with the FCR-3-like variant. The odds of LBW were also higher in those infected with the 3D7-like variant (odds ratio [OR], 5.41; 0.99 to 29.52).

Similarly, the unadjusted prevalence of small-for-gestational-age (SGA) was higher in Malawi (28.1 vs 9.1 percent) and Benin (50 vs 23.1 percent) women infected with the 3D7-like variant than in those with the FCR-3-like variant (OR, 3.65; 1.01 to 13.38).

“[V]ariants from the 3D7-like clade were associated with adverse birth outcomes including newborns with lower birth weight,” noted researchers.

“Taken together, the intrinsic diversity of this VAR2CSA region along with the association of a specific P. falciparum genotype with more severe clinical consequences suggest that an effective VAR2CSA-based vaccine aimed to prevent placental malaria and its sequelae will require multivalent activity,” they added.

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Most Read Articles
27 Nov 2017
Transdermal oestradiol added to progesterone reduces menopause-related depression, researchers reported at the annual meeting of The North American Menopause Society in Philadelphia, US.
5 days ago
Intravenous (IV) iron is less toxic and more effective compared to oral iron, making it a potential frontline therapy for neonatal iron deficiency anaemia, suggests a recent study.
Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 01 Aug 2013

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1