Bacterial pneumonia infection in pregnancy

Maternal Infections, Antibiotics, Steroid Use, and Diabetes Mellitus Increase Risk of Early-Onset Sepsis in Preterm Neonates: A Nationwide Population-Based Study

The global evolution of pathogens causing early-onset sepsis (EOS), a critical condition in preterm infants, necessitates a re-evaluation of risk factors to develop updated prevention and treatment strategies. This nationwide case-control study in Taiwan analyzed data from the National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database from 2010 to 2019. The study included 176,681 mother-child pairs with preterm births. We identified 2942 clinical EOS cases from 5535 diagnosed sepsis cases, excluding unlikely cases. A control group of 14,710 preterm neonates without EOS was selected at a 1:5 ratio. Clinical EOS increased since 2017. Adjusted logistic regression identified significant EOS risk factors in preterm infants, including maternal fever, chorioamnionitis, maternal diabetes mellitus, maternal antibiotic usage, very preterm birth, birth weight (all with p < 0.001), maternal pneumonia (p = 0.002), and maternal CS (p = 0.004). Effective treatment of maternal conditions like diabetes, fever, and infections is essential to prevent EOS in preterm infants. Key measures include reducing unnecessary antibiotics or steroids, minimizing unnecessary cesarean sections, avoiding premature or prolonged rupture of membranes (PPROM), and increasing gestational age and neonatal birth weight. High-risk preterm neonates should be closely monitored for EOS and considered for antibiotics when warranted.

Pregnancy and Infant Outcomes in Women With Multiple Sclerosis Treated With Ocrelizumab

BACKGROUND AND OBJECTIVES

Ocrelizumab labeling advises contraception for women during treatment and for 6-12 months thereafter. Because pregnancies may occur during this time, it is critical to understand pregnancy and infant outcomes in women with multiple sclerosis (MS) after ocrelizumab exposure.

METHODS

Pregnancy cases reported to Roche global pharmacovigilance until 12 July 2023 were analyzed. In utero exposure was defined if the last ocrelizumab infusion occurred in the 3 months before the last menstrual period or during pregnancy. Breastfeeding exposure was defined if at least one infusion occurred while breastfeeding. Fetal death was termed spontaneous abortion (SA) if < 22 complete gestational weeks (GWs) and stillbirth if later. Live births (LBs) were preterm if < 37 complete GWs. Major congenital anomalies (MCAs), infant outcomes, and maternal complications were also analyzed.

RESULTS

In total, 3,244 pregnancies were reported in women with MS receiving ocrelizumab. The median maternal age was 32 years (Q1-Q3: 29-35 years), and most women had relapsing MS (65.6%). Of 2,444 prospectively reported pregnancies, 855 were exposed to ocrelizumab in utero (512 with a known outcome), 574 were nonexposed, and the remaining 1,015 had unknown timing of exposure. Most (83.6%; 956/1,144) of the pregnancies with a known outcome resulted in LBs (exposed, 84.2%; nonexposed, 88.3%). The exposed and nonexposed groups had similar proportions of other important pregnancy outcomes (preterm births, 9.5% vs 8.7%; SA, 7.4% vs 9.1%). Elective abortions were more frequent in the exposed group (7.4%, vs 1.7% in the nonexposed group). The proportion of LBs with MCAs was similar between the exposed and nonexposed groups (2.1% vs 1.9%) and within epidemiologic background rates. In the exposed group, one stillbirth and one neonatal death were prospectively reported.

DISCUSSION

In this analysis of a large pregnancy outcome dataset for an anti-CD20 in MS, in utero exposure to ocrelizumab was not associated with an increased risk of adverse pregnancy or infant outcomes. These data will enable neurologists and women with MS to make more informed decisions around family planning, balancing safety risks to the fetus/infant against the importance of disease control in the mother.

A novel Bacillus aerolatus CX253 attenuates inflammation induced by Streptococcus pneumoniae in childhood and pregnant rats by regulating gut microbiome

Streptococcus pneumoniae (Spn) is the predominant pathogen responsible for community-acquired pneumonia (CAP) in children under five years old, and it can induce over 17% of pregnant women. However, no more effective measures exist to prevent infection induced by Spn in these two special populations. The beneficial microbes can antagonize Spn and provide new targets for preventing pneumococcal infections. This study used 16S rRNA gene sequencing and targeted metabolomics to evaluate the role of the Bacillus aerolatus CX253 (CX253) in alleviating Spn infection. Additionally, the colonization of CX253 was observed in nose, trachea, and lung by using confocal laser scanning microscopy and fluorescent labeling techniques. Compared with the model group, the expression level of interleukin-1β was dropped 1.81-fold and 2.22-fold, and interleukin-6 was decreased 2.39-fold and 1.84-fold. The express of tumor necrosis factor-α was down 2.30-fold and 3.84-fold in prevention group of childhood and pregnant rats, respectively. The 16S rRNA sequencing results showed that CX253 administration alone significantly increased the abundance of Lactobacillus, Limosilactobacillus, and Prevotella in the gut of childhood and pregnant rats. Furthermore, the CX253 increased propionate in the gut of childhood rats and increased propionate and butyrate in the gut of pregnant rats to inhibit pulmonary inflammation. In summary, CX253 attenuated Spn-induced inflammation by regulating the gut microbiota and SCFAs. The research provides valuable information for the prevention of pneumonia.

Diterpenes of Pinus pinaster aiton with anti-inflammatory, analgesic, and antibacterial activities

ETHNO-PHARMACOLOGICAL RELEVANCE

The P. pinaster species, known as 'Pino nigral or rodeno', is used in the treatment of colds, asthma, flu, and tuberculosis.

AIM OF THE STUDY

This study determined the anti-inflammatory, analgesic, and antibacterial activities of the P. pinaster resin, identifying the compounds with higher biological activity.

MATERIALS AND METHODS

A bio-guided isolation of the compounds of P. pinaster was carried out by selecting the most active extracts with anti-inflammatory and analgesic effects in the HBEC3-KT, MRC-5, and THP-1 cell lines. The antibacterial activity was determined against the S. aureus, S. pneumoniae, K. pneumoniae and P. aeruginosa strains.

RESULTS

The following compounds were identified by NMR: dehydroabietic acid (1), ( + )-cis-abienol (2), pimaric acid (3), isopimaric acid (4), 7α-hydroxy-dehydroabietic acid (5), 7-oxo-dehydroabietic acid (6), 15-hydroxy-abietic acid (7), 7-oxo-15-hydroxy-dehydroabietic acid (8), 13-oxo-8 (14)-podocarpen-18-oic acid (9), and pinyunin A (10). Regarding their anti-inflammatory activity, all compounds inhibited NF-κB. Compound 9 was the most active (IC50 = 3.90-12.06 μM). Concerning the analgesic activity, all the compounds inhibited NK-1, yet compound 9 was the most active (IC50 = 0.28-0.33 μM). Finally, compounds 6 (MIC = 12.80-25.55 μM) and 9 (MIC = 9.80-24.31 μM) were the most promising antibacterial compounds in all strains.

CONCLUSION

This study managed to identify, for the first time, six diterpenes from the resin of P. pinaster, with anti-inflammatory, analgesic, and antibacterial activity. Among the identified compounds, compound 9 was the most active, being considered a promising candidate as an antagonist of the tachykinin NK-1 receptor and as an analgesic agent against inflammation and neuropathic pain. It also had an antibacterial effect against Gram negative bacteria.

Treatable traits in asthma during pregnancy: a call for a shift towards a precision-based management approach

Asthma is the most common chronic medical condition in pregnancy. Asthma exacerbations in pregnancy are unpredictable, and are associated with adverse maternal and fetal perinatal outcomes such as preterm birth and low birthweight. Goals of asthma management in pregnancy are to establish effective asthma control and prevent exacerbations. Optimising the management of asthma in pregnancy is an important goal of practice and future research.Treatable traits is a precision medicine paradigm proposed for the management of airways diseases, which holistically addresses the complexity and heterogeneity of airways disease. It is an individualised treatment approach that aims to improve outcomes. This makes treatable traits well suited for pregnant women with asthma, who have a high prevalence of obesity, mental health conditions, poor symptom perception and suboptimal asthma management skills including low treatment adherence. These traits are measurable and treatable. In this review, we explore current knowledge on the burden of asthma, maternal and perinatal consequences of asthma during pregnancy, the treatable traits paradigm, the prevalence of treatable traits in pregnant women with asthma, and consider how the treatable traits paradigm can be integrated into the management of asthma in pregnancy.

Modular Design in Triboelectric Sensors: A Review on the Clinical Applications for Real-Time Diagnosis

Triboelectric nanogenerators (TENGs) have garnered considerable interest as a promising technology for energy harvesting and stimulus sensing. While TENGs facilitate the generation of electricity from micro-motions, the modular design of TENG-based modular sensing systems (TMSs) also offers significant potential for powering biosensors and other medical devices, thus reducing dependence on external power sources and enabling biological processes to be monitored in real time. Moreover, TENGs can be customised and personalized to address individual patient needs while ensuring biocompatibility and safety, ultimately enhancing the efficiency and security of diagnosis and treatment. In this review, we concentrate on recent advancements in the modular design of TMSs for clinical applications with an emphasis on their potential for personalised real-time diagnosis. We also examine the design and fabrication of TMSs, their sensitivity and specificity, and their capabilities of detecting biomarkers for disease diagnosis and monitoring. Furthermore, we investigate the application of TENGs to energy harvesting and real-time monitoring in wearable and implantable medical devices, underscore the promising prospects of personalised and modular TMSs in advancing real-time diagnosis for clinical applications, and offer insights into the future direction of this burgeoning field.

Adaptive Triboelectric Nanogenerators for Long-Term Self-Treatment: A Review

Triboelectric nanogenerators (TENGs) were initially invented as an innovative energy-harvesting technology for scavenging mechanical energy from our bodies or the ambient environment. Through adaptive customization design, TENGs have also become a promising player in the self-powered wearable medical market for improving physical fitness and sustaining a healthy lifestyle. In addition to simultaneously harvesting our body's mechanical energy and actively detecting our physiological parameters and metabolic status, TENGs can also provide personalized medical treatment solutions in a self-powered modality. This review aims to cover the recent advances in TENG-based electronics in clinical applications, beginning from the basic working principles of TENGs and their general operation modes, continuing to the harvesting of bioenergy from the human body, and arriving at their adaptive design toward applications in chronic disease diagnosis and long-term clinical treatment. Considering the highly personalized usage scenarios, special attention is paid to customized modules that are based on TENGs and support complex medical treatments, where sustainability, biodegradability, compliance, and bio-friendliness may be critical for the operation of clinical systems. While this review provides a comprehensive understanding of TENG-based clinical devices that aims to reach a high level of technological readiness, the challenges and shortcomings of TENG-based clinical devices are also highlighted, with the expectation of providing a useful reference for the further development of such customized healthcare systems and the transfer of their technical capabilities into real-life patient care.