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Objective: To investigate intrafamilial and interspousal transmission of hepatitis C virus., Methods: The incidence of anti-hepatitis C virus antibodies in 224 family members of 65 index patients was studied. Sixty-five of the 94 index patients were asymptomatic, apparently healthy parturient Egyptian women, who were detected to be anti-hepatitis C virus positive at routine antenatal screening and whose spouses resided in the United Arab Emirates. The serologic status of family members of seropositive index patients was compared with that of 218 family contacts of 65 matched healthy anti-hepatitis C virus-negative parturient Egyptian women (control group). To determine interspousal transmission, hepatitis C virus genotype was determined in 35 of 36 hepatitis C virus-RNA positive index patient-spouse pairs and 22 of 25 nonrelated RNA positive pairs by polymerase chain reaction. Subsequently nucleotide sequencing of the hepatitis C virus genome was done., Results: In comparison with the control group, a significantly greater number of family members of the index patients were anti-hepatitis C virus positive (five of 218 versus 60 of 224; P < .004). Husbands of index patients had the highest prevalence of anti-hepatitis C virus (74%), with longer duration of marriage being an important risk factor. Of the 35 index patient-spouse pairs analyzed, 33 (94%) had the same hepatitis C virus genotype. On nucleotide sequencing, 30 (91%) couples showed 100% homology, and two had a high (> 97%) homology. Among nonspouse pairs, six pairs (27%) had the same hepatitis C virus genotype; however, low nucleotide sequence homologies (less than 88%) were noted., Conclusion: These data suggest that interspousal transmission of hepatitis C virus occurs and that this may be an important route of intrafamilial spread of hepatitis C virus infection.

Background: The advantages of non-closure of the visceral and parietal peritoneum at lower segment cesarean section seems to be evident but in the reports published so far, the number of patients studied has been relatively small and the follow-up periods short. It is obviously of value to reconfirm such important observation in several institutions and therefore, in 1991, we decided to study non-closure of the peritoneum in lower segment cesarean section in a large series of patients with long-term follow-up of at least one year., Methods: A prospective randomized study of 361 patients undergoing lower segment cesarean section in a University Affiliated Hospital, Al-Ain, United Arab Emirates. The operative technique was randomized to include either non-closure of both visceral and parietal peritoneum (study group, n = 179) or closure of both layers (control group, n = 182). Patients were followed up according to a study protocol. The nursing staff and the obstetricians responsible for data collection were unaware as to which of the two groups the patients belonged to. Student-t test and Chi-square test were used for statistical analysis of the results, where appropriate, with a p < 0.05 considered probability level to reflect significant differences., Results: Postoperative febrile morbidity and wound infection were significantly lower in the study group as compared to the control group (p < 0.001 and p < 0.05 respectively). The incidence of wound dehiscence, urinary tract infection and the time to opening of the bowels postoperatively were similar in the two groups. In the non-closure group, the average operating time was significantly shorter by 7.9 minutes (p < 0.01) and the hospital stay was one day less (p < 0.01). There were no patients with late postoperative complications or readmissions during 2-5 years of follow-up that could be attributed to complications associated with lower segment cesarean section., Conclusion: Non-closure of the visceral and parietal peritoneum at lower segment cesarean section is associated with fewer postoperative complications, is more cost effective and is simpler than the traditional operative technique of closing both peritoneal layers.

Objectives: In this study, we sought to determine (1) the prevalence of hepatitis C virus (HCV) RNA, or its antibodies, in a healthy parturient Egyptian population and (2) the risk of mother-to-infant transmission in this population., Method: The serum of 499 pregnant Egyptian women was tested for anti-HCV with ELISA-3 and for HCV RNA by polymerase chain reaction (PCR). Neonatal cord blood and infant blood were similarly tested for anti-HCV and HCV RNA., Results: Recombinant immunoblot assay (RIBA) detected anti-HCV in 65/499 (13%) women; of these, 20/65 (31%) were PCR-positive. The total number of babies born was 499. Of the original group, 97 mothers and infants (HCV-negative) were lost to follow up and were excluded. Sixty-five anti-HCV-positive infants were born vaginally to the 65 anti-HCV-positive mothers, of which twenty (31%) corresponding mothers and babies were also positive for HCV RNA. Of these twenty babies, three died of hepatocellular disease by six months of age; sixteen developed chronic liver disease; the remaining nine remained asymptomatic but were serologically and PCR-positive. The mother-to-infant transmission rate was significantly increased (5%; P < 0.0001). Of the seropositive children, 45/65 (69%; P < 0.0001) seroreverted by eighteen months of age., Conclusion: There is a high prevalence of anti-HCV in healthy pregnant Egyptian women and vertical transmission is a major risk for chronic HCV carriers.

Objective: To assess the impact of pregnancy on maternal acquired immunodeficiency syndrome (AIDS) among tribal women in India., Study Design: From February 1992 to February 1996, 71 tribal women from Manipur, India, with AIDS (Centers for Disease Control stage iii/iv), matched for age, parity, CD4 lymphocyte count and demographic characteristics, were recruited into a prospective study. Thirty-two (49%) of these women were pregnant (8-10 weeks) (group A) and 38 (51%) nonpregnant (group B)., Results: Pneumocystis carinii pneumonia followed by miliary tuberculosis and wasting disease were the most common AIDS-defining illness and cause of maternal death in both groups. A total of 28 (39%) women died as a direct result of their AIDS-defining illness; 10 (27%) of them were among the nonpregnant women as compared to 18 (56%) deaths among the pregnant women (P = .17, odds ratio 3.7285, 95% confidence interval 1.23, 11.58). Three (16%) of these 18 deaths occurred within 14 weeks of an uneventful first-trimester medical termination of pregnancy. Thirteen women (41%) died undelivered at 30-34 weeks' gestation, and two died within 3 weeks of delivery. Fourteen (44%) women vaginally delivered 14 preterm infants, between 28 and 35 weeks' gestation. Eleven of these infants died within six weeks; nine deaths were a direct result of prematurity and clinical diagnosis of an AIDS-defining illness. The mean survival time was 9.72 months for the pregnant women and 22.6 months for the nonpregnant women (P = .066)., Conclusion: Pregnancy increased maternal and fetal mortality in these AIDS-infected women.

Objective: To conduct a study of maternal and fetal outcome in pregnant women with transfusion-dependent beta-thalassemia major., Study Design: The course and outcome of pregnancy were studied prospectively in 32 pregnant women with transfusion-dependent beta-thalassemia major, of which 10 were HIV 1 positive, at Sanjay Gandhi Hospital, Manipur, India, from January 1990 to July 1996., Results: Over a period of six years, 32 women with transfusion-dependent beta-thalassemia major conceived. Twenty conceptions were spontaneous (63%), and 12 (37%) followed induction of ovulation. There were 24 (75%) singleton vaginal deliveries, all of which were term. At term, eight (25%) women delivered by elective cesarean section due to cephalopelvic disproportion. All the women remained well throughout pregnancy. Despite increased blood transfusion requirements during pregnancy to maintain the hemoglobin level > 10 g/dL, serum ferritin levels remained stable in all patients., Conclusion: Successful outcomes of pregnancy occurred in some women with transfusion-dependent beta-thalassemia major.

Eighty under-five children admitted in the pediatric ward with acute respiratory distress requiring oxygen inhalation were prospectively studied. Oxygen was administered to all the children by head box, face mask, nasopharyngeal catheter, and twin-holed prenasal catheter in a predetermined sequence. Oxygen was delivered at a flow rate of 4 l/min in the head box and by face mask and at a rate of 1 l/min for nasopharyngeal catheter and twin-holed prenasal catheter. There was a significant rise in paO2 and SaO2 values with all the oxygen delivery methods. The number of children who achieved paO2 of > 90 mmHg with oxygen delivered by head box was 53 (69 per cent), with face mask 37 (57 per cent), with nasopharyngeal catheter 13 (26 per cent), and with twin-holed prenasal catheter 18 (25 per cent). In view of high acceptability of twin-holed prenasal catheter, a further pilot study involving 10 children was carried out to compare the efficacy of head box and twin-holed prenasal catheter at an identical oxygen flow rate of 4 l/min. The number of children achieving paO2 of > 90 mmHg were comparable, i.e. seven (70 per cent) and eight (80 per cent) when the oxygen was delivered by head box and twin-holed prenasal catheter, respectively. It is concluded that both head box and twin-holed prenasal catheter are equally effective, acceptable and safe methods for administration of oxygen to children with acute respiratory disorders. In view of the cost-effectiveness, and easy availability and affordability of twin-holed prenasal catheter, it should be popularized in the small hospitals in the community, while head box should be reserved for use in the referral hospitals.

Objective: Investigation of human oocyte chromosomes that fail to fertilize may provide data essential to the assessment of reproductive failure. In view of this, 121 uncleaved human oocytes were analyzed cytogenetically to assess the type and frequency of chromosomal abnormality., Methods: Oocyte recovery was done from patients undergoing in vitro fertilization (IVE) procedures. Then, these oocytes were preincubated and inseminated in vitro. Karyotyping was attempted in 121 oocytes lacking signs fertilization 50 h after insemination., Results: Sixty-nine oocytes were adequately karyotyped. The overall frequency of chromosomal aberration was 47.6%. Amongst these, 34.8% were aneuploidy, the frequency of which was significantly higher (p < 0.05) in patients > 35 years of age. Diploidy and hyperploidy was noted in 7.2% and 2.8% respectively. Translocation were noted in 2.8% and in 18.8% of human oocytes sperm chromosome condensation appeared prematurely in the G1 phase. No correlation was a found between specific chromosomal aberrations and type of fertility, stimulation treatment or gonadotropin levels., Conclusion: The high rate of chromosomal disorders (47.6%) in human oocytes may contribute significantly towards their failure to fertilize in vitro.

Background: Ligand molecules conjugated to polylysine can be electrostatically bound to DNA and can bind receptors or antigens on the surface of cells, delivering the DNA into specific cells and tissues. Several researchers have used this approach to generate non-viral vehicles for the efficient delivery of DNA to specific cells. We have attempted to adopt this general approach to the cell-specific delivery of magnetic contrast agents for use in magnetic resonance imaging (MRI)., Results: We have synthesized a new class of agents capable of both transfecting genes into cells and enhancing the contrast of the targeted cells for MRI. DNA is used both to encode a marker gene and as a molecular scaffold, which electrostatically binds polylysine conjugated to transferrin, an iron uptake protein, and polylysine modified with gadolinium chelated to diethylenetriaminepetaacetic acid. When cells displaying the transferrin receptor are treated with these particles, high levels of gene expression are observed, higher than with control particles composed only of transferrin, polylysine and DNA. The treated cells show specific MRI contrast enhancement, which did not require expression of the marker gene., Conclusions: The development of this class of particles permits the use of novel protocols by which genes for genetic therapy and agents for MRI contrast are co-transported. These protocols may allow non-invasive MRI monitoring of DNA delivery for gene therapy in real time.

The transmission of human immunodeficiency virus type 1 from infected mothers to their babies was assessed by serologic, virologic, and clinical means. Of the 160 antibody-positive women enrolled at the beginning of the study, 13 had overt clinical symptoms (CDC stage III/IV). Termination of pregnancy was done, on request, in seven of these cases. The rest delivered prematurely. A total of 143 parturient women and their infants were followed prospectively until the babies were 18 months of age. Fifteen infants (9%) died of AIDS before 14 months of age. The remaining 128 children (91%) were alive at the end of the study period. Seventy-four seropositive children (46%) became seronegative and were considered noninfected. None of the seronegative children reverted to seropositive status despite the fact that they were breast-fed. The majority of the seropositive children (63%) became symptomatic and clinically ill during infancy. The overall mother-to-infant vertical transmission rate was 48%.

Objectives: To study the impact of HIV-1 infection on pregnancy and maternal and early fetal outcome., Method: From January 1992 to January 1993, 160 HIV-1 seropositive women and 164 HIV-1 seronegative age- and parity-matched pregnant tribal women from Manipur, India, were recruited into a prospective study. Mother and infant were followed until 6 weeks postpartum., Results: Nine percent (15/160) of subjects had AIDS (CDC IV), 38% (60/160) were symptomatic (CDC III) and 53% (85/160) were asymptomatic (CDC I/II). Symptomatic (CDC III/IV) HIV-1 infection is associated with a significantly increased rate of miscarriage, low birth weight, intrauterine fetal death and preterm delivery. Perinatal, infant and maternal deaths were limited to symptomatic women. HIV-1 infected women were significantly younger than their HIV-1 negative counterparts both in age and age at sexual debut. Placental membrane inflammation was significantly higher in the seropositive group and this correlated well with a higher risk of preterm delivery and postpartum endometritis. Asymptomatic HIV-1 infection was not associated with adverse pregnancy outcome., Conclusion: Symptomatic (CDC III/IV) HIV-1 infection in Indian tribal women is associated with adverse maternal and fetal outcome.

As more women of childbearing age are being identified as HIV infected, vertical transmission to the fetus and/or neonate is an increasingly significant therapeutic problem. Currently the use of zidovudine is one of the few specific measures available, and as a potentially teratogenic and fetotoxic agent, any decision for its use requires evaluation of the potential for fetal damage. In a series of 104 cases of intentional or inadvertent use of zidovudine at differing gestations in pregnancy, there were eight spontaneous first trimester abortions, eight therapeutic terminations, and eight cases of fetal abnormality occurring among a total of 88 cases where the pregnancy progressed. Analysis and correlation of antenatal data and drug therapy with individual cases failed to show any specific abnormality that could reasonably be attributed to zidovudine therapy. While not proving safety, these data add to previous smaller series with similar findings, thus lending tenuous support to the use of this agent. Continuing studies are required, particularly to clarify the possibility of long-term developmental defects.

Four hundred and six multitransfused thalassaemic children attending the paediatric clinic in Manipur, India, were screened for HIV antibodies. There were 46 (8.9%) ELISA antibody-positive children and the diagnosis was reaffirmed by Western blot assay. The immunologic status of the seropositive children was evaluated by a) absolute lymphocyte count, b) percentage of ratio of T helper (CD4+) and T suppressor (CD8+) cells, c) quantitative Ig, G, M and A levels and d) delayed-type cutaneous hypersensitivity (DTH) testing. Twelve of the 36 seropositive children were clinically symptomatic with AIDS. The clinical and immunological status of seropositive children are compared with matched seronegative thalassaemic control groups. Five of the 12 symptomatic seropositive children had received continued antiretroviral treatment. The mortality rate at the end of 36 weeks of itinerary was 20% in contrast to 50% in the untreated children. This report highlights the value of early recognition and therapeutic intervention in a selected high risk paediatric population.

The peripheral lymphocytes of 11 male and seven female workers occupationally exposed to textile dyes were studied for cytogenetic change. A significant increase in the frequency of chromosomal aberrations and sister chromatid exchanges were recorded regardless of the duration of the workers' exposure to the dyes.