scholarly journals Configuration of Primary and Recurrent Aggressive Fibromatosis on Contrast-Enhanced MRI with an Evaluation of Potential Risk Factors for Recurrences in MRI Follow-Up

2019 ◽  
Vol 192 (05) ◽  
pp. 448-457
Author(s):  
Sam Sedaghat ◽  
Alexey Surov ◽  
Sebastian Krohn ◽  
Maya Sedaghat ◽  
Benjamin Reichardt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Contrast Enhancement ◽  
Potential Risk ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Aggressive Fibromatosis ◽  
Primary Tumor Resection ◽  
Potential Risk Factors ◽  
Muscle Edema

Purpose To analyze the appearance of primary and recurrent aggressive fibromatosis (AF) on MRI with a focus on configuration and to determine potential risk factors for recurrences detected on MRI follow-up scans. Methods From 79 consecutive patients with histologically proven diagnosis of AF, 39 patients underwent a minimum of four 1.5 T MRI follow-up scans after resection of primary AF between 2008 and 2018. The primary and recurrent tumors were radiographically examined for configuration, limitation and extent on MRI. Epidemiological data and loco-regional subcutaneous edema, muscle edema and post-operative seroma were included. Results The mean age of the patients was 39 ± 2.6 years. Primary and recurrent AF most often occurred in the thigh. The main appearance of primary AF was significantly most often fascicular (p = 0.001–0.01) with heterogeneous and marked contrast enhancement. 21 % (n = 8) of the patients developed recurrences of AF. A fascicular configuration with homogeneous/heterogeneous contrast enhancement was the main appearance of recurrent AF, but recurrent AF appeared nodular, polycyclic, ovoid or streaky/flat as well. Recurrent AF significantly most often occurred within the first 9 months after primary tumor resection (p = 0.009), especially in patients up to 25 years of age (RR = 6.1; 95 % CI: 1.8–20.9; p = 0.004). The cases of recurrent AF were altogether significantly smaller than the primary tumors (p = 0.001). Post-treatment subcutaneous and muscle edema were present in 77 % and 56 %, respectively. Patients with muscle edema after primary tumor resection had a significantly higher risk for AF recurrences (relative risk ratio (RR) = 1.8; 95 % CI: 1.16–2.8; p = 0.0096). There was no significant difference detected in patients with complete or incomplete resection of the primary tumor. Conclusion Primary and recurrent aggressive fibromatosis has a mostly fascicular configuration, but may appear ovoid, nodular, streaky/flat or polycyclic as well. High risks for tumor recurrences are detected for patients up to 25 years of age, patients within the first 9 post-operative months and patients with muscle edema after primary tumor resection. Key points:  Citation Format

Risk factors for gastrointestinal perforations in patients with metastatic colorectal cancer receiving bevacizumab plus chemotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3535-3535 ◽  
Author(s):  
M. Sugrue ◽  
M. Kozloff ◽  
J. Hainsworth ◽  
S. Badarinath ◽  
A. Cohn ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Metastatic Colorectal Cancer ◽  
Potential Risk ◽  
Primary Tumor ◽  
Phase Iii ◽  
Community Based ◽  
Large Community ◽  
Significant Difference ◽  
Potential Risk Factors

3535 Background: Bevacizumab (BV) prolongs overall survival and progression-free survival when added to standard chemotherapy in patients (pts) with metastatic colorectal cancer (mCRC). BRiTE is a large, community-based observational registry of pts with mCRC receiving BV plus first-line chemotherapy (CT). Incidence rate, temporal pattern, and potential risk factors associated with gastrointestinal perforation (GIP) were explored. Methods: Baseline patient characteristics (BC), including prospectively identified potential risk factors for GIP, were collected at study entry. Safety data were collected every 3 months (mo). Logistic regression models, adjusted and unadjusted for treatment assignment, were used to identify BC potentially associated with GIP. Results: 1968 pts were enrolled between Feb 2004 and Jun 2005. Median study follow-up was 10 mo as of Nov 4, 2005. GIPs were observed in 34 pts (1.7%). For pts with GIP, median time to first event was 2.1 mo; the majority of events were non-fatal and occurred within the first 3 mo after starting BV. BC including GI medical history (chronic aspirin or NSAID use, peptic ulcer disease, diverticulosis) were similar in pts with or without GIP and with earlier or later GIP onset (≤ or >3 mo from start of BV). Although adjusted models did not show any significant BC, GIP rates were numerically higher in pts with primary tumor intact (2.6%) vs. resected (1.6%). Furthermore, univariate analyses revealed a significant difference between intact (2.3%) and resected (0.8%) primary tumor for earlier GIP (≤3 mo from start of BV). The majority of pts with GIP had at least one of the following: acute diverticulitis, intra-abdominal abscess, gastrointestinal obstruction, tumor at GIP site, abdominal carcinomatosis, prior abdominal or pelvic radiation therapy. Conclusions: Preliminary analyses indicate the incidence of GIP in this large, community-based observational registry is similar to that previously reported in phase III mCRC trials with BV. No associations between specific BCs and an increased risk of GIP were identified. Patients with primary tumor intact were more likely to incur a GIP within the first 3 mo of starting BV and CT. [Table: see text]

scholarly journals Incidence of Anxiety in Latest Life and Risk Factors. Results of the AgeCoDe/AgeQualiDe Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12786
Author(s):  
Franziska Dinah Welzel ◽  
Melanie Luppa ◽  
Alexander Pabst ◽  
Michael Pentzek ◽  
Angela Fuchs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Depressive Symptoms ◽  
Potential Risk ◽  
Oldest Old ◽  
Anxiety Symptoms ◽  
Subjective Memory Complaints ◽  
Subjective Memory ◽  
Memory Complaints ◽  
Potential Risk Factors

Research on anxiety in oldest-old individuals is scarce. Specifically, incidence studies based on large community samples are lacking. The objective of this study is to assess age- and gender-specific incidence rates in a large sample of oldest-old individuals and to identify potential risk factors. The study included data from N = 702 adults aged 81 to 97 years. Anxiety symptoms were identified using the short form of the Geriatric Anxiety Inventory (GAI-SF). Associations of potential risk factors with anxiety incidence were analyzed using Cox proportional hazard models. Out of the N = 702 older adults, N = 77 individuals developed anxiety symptoms during the follow-up period. The incidence rate was 51.3 (95% CI: 41.2–64.1) per 1000 person-years in the overall sample, compared to 58.5 (95% CI: 43.2–72.4) in women and 37.3 (95% CI: 23.6–58.3) in men. Multivariable analysis showed an association of subjective memory complaints (HR: 2.03, 95% CI: 1.16–3.57) and depressive symptoms (HR: 3.20, 95% CI: 1.46–7.01) with incident anxiety in the follow-up. Incident anxiety is highly common in late life. Depressive symptoms and subjective memory complaints are major risk factors of new episodes. Incident anxiety appears to be a response to subjective memory complaints independent of depressive symptoms.

Neurosurgical treatment of pediatric pleomorphic xanthoastrocytomas: long-term follow-up of a single-institution, consecutive series of 12 patients

2019 ◽  
Vol 23 (4) ◽  
pp. 512-516
Author(s):  
Tryggve Lundar ◽  
Bernt Johan Due-Tønnessen ◽  
Radek Frič ◽  
Bård Krossnes ◽  
Petter Brandal ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Primary Tumor ◽  
Barthel Index ◽  
Tumor Resection ◽  
Long Term Results ◽  
Primary Tumor Resection ◽  
Low Grade ◽  
Initial Operation

OBJECTIVEThe authors conducted a study to delineate the long-term results of the surgical treatment of pediatric pleomorphic xanthoastrocytomas (PXAs).METHODSAll consecutive children and adolescents (0–20 years) who underwent primary tumor resection for a PXA during the years 1972–2015 were included in this retrospective study on surgical morbidity, mortality rate, academic achievement, and/or work participation. Gross motor function and activities of daily living were scored according to the Barthel Index.RESULTSOf the 12 patients, 8 patients were in the 1st decade of life and 4 in the 2nd. The male/female ratio was 6:6. No patient was lost to follow-up. One patient presented with severe progressive tumor disease and died within 3 months after repeated resection. Another child died 3 days following a second surgical procedure involving gross-total resection (GTR) 8 years after the initial operation. The other 10 patients were alive at the latest follow-up when they reached the median age of 34 years (range 11–60 years). The median follow-up duration was 22 years (range 2–41 years). Barthel Index score was 100 in all 10 survivors. A total 18 tumor resections were performed. Five patients underwent a second tumor resection after MRI/CT confirmed recurrent tumor disease, from 6 months up to 17 years after the initial operation. Only one of our patients received adjuvant therapy: a 19-year-old male who underwent resection (GTR) for a right-sided temporal tumor in 1976. This particular tumor was originally classified as astrocytoma WHO grade IV, and postoperative radiotherapy (54 Gy) was given. The histology was reclassified to that of a PXA. Seven of 8 children whose primary tumor resection was performed more than 20 years ago are alive as of this writing—i.e., 88% observed 20-year survival. These are long-term survivors with good clinical function and all are in full- or part-time work.CONCLUSIONSPediatric patients with PXA can be treated with resection alone with rewarding results. Recurrences are not uncommon, but repeated surgery is well tolerated and should be considered in low-grade cases before adjuvant therapy is implemented. Follow-up including repeated MRI is important during the first postoperative years, since individual patients may have a more aggressive tumor course.

Primary tumor resection to improve survival and local disease control in stage IV inflammatory breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1102-1102
Author(s):  
Catherine Liebig Akay ◽  
Naoto T. Ueno ◽  
Gary B. Chisholm ◽  
Gabriel N. Hortobagyi ◽  
Wendy A. Woodward ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Breast Cancer ◽  
Systemic Therapy ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Skin Involvement ◽  
Distant Disease

1102 Background: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer typically presenting with early metastasis. Optimal outcomes are achieved with multimodality treatment strategies in the non-metastatic setting. Data is limited, however, on the benefit of surgery in patients with metastatic IBC. We evaluated the effect of primary tumor resection on outcomes in patients with newly diagnosed stage IV IBC. Methods: We reviewed records of 172 patients with metastatic IBC treated at our institution from 1994 - 2009. All patients received systemic therapy with or without locoregional therapy (LRT). Patient demographics, receptor (ER) and HER2-neu status, grade, histology, presence of lymphovascular invasion, margin status, number of distant disease sites, pathologic response of primary tumor and clinical response to systemic therapy (CRS) at distant disease sites were recorded. Overall survival (OS), distant progression-free survival (DPFS), and chest/skin involvement at last follow-up were evaluated. Kaplan-Meier survival analyses, univariate (UV) and multivariate (MV) logistic regression models were used. Chest/skin involvement was compared between groups using Kruskal-Wallis test. Results: Seventy-nine (45%) patients underwent primary tumor resection. Average age was 51 (22-78). Median live-patient follow-up was 33 months. OS and DPFS were significantly better for patients who underwent LRT versus none (p<0.0001). Factors associated significantly for improved DPFS on MV analysis were ER and HER2-neu status (HR 0.61,0.60 p=0.02,0.05 ,respectively), LRT (HR .38, p=0.002) and CRS (HR 0.62, p=0.03). ER status (HR .45, p<0.001), LRT (HR .30, p<0.001) and CRS (HR 0.54, p=0.02) were significant predictors for higher OS on MV analysis. At last follow up, chest/skin involvement was moderate/severe in 11% of patients in LRT group versus 35% of patients in no LRT group (p<0.0001). Conclusions: This latest retrospective study demonstrates metastatic IBC patients who undergo LRT in addition to systemic therapy may have improved survival and local control outcomes. CRS may be used to guide LRT. A prospective randomized trial is needed to validate these findings.

Risk factors for significant prostate cancer in radical cystoprostatectomy specimen: A retrospective analysis.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 136-136
Author(s):  
Andrea Katharina Thissen ◽  
Daniel Porres ◽  
David J. K. P. Pfister ◽  
Axel Heidenreich
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Bladder Cancer ◽  
Retrospective Analysis ◽  
Potential Risk ◽  
Common Finding ◽  
Considerable Proportion ◽  
Radical Cystoprostatectomy ◽  
Potential Risk Factors

136 Background: Prostate cancer (Pca) has been found incidentally in radical cystoprostatectomy (RCP) specimens in 27-70%. We evaluated histopathological features and clinical outcome of patients with incidental Pca undergoing RCP for urothelial bladder cancer and identified potential risk factors for the presence of significant Pca, being defined as Gleason Score ≥7b, primary tumor ≥T2c or Pca volume ≥0.5cm3. Methods: A retrospective analysis of patients who underwent RCP between 01/2005-03/2015 was performed with regard to clinical data and pathohistological features. Whole mount serial sections of specimens were examined in the same urological and pathological institution. Pca grade, p-stage, cancer volume and surgical margins were recorded. Preoperative PSA values and follow-up were analysed. Results: We identified 71 patients with incidental Pca with a mean age of 71.7 years (47-84 years). 33/71 patients (46.5%) had significant Pca (28.2% ≥T2c, 4.2% GS ≥7b [+≥T2c], 14.1% cancer volume ≥0.5cm3[+≥T2c]). Other features were as follows: pT2a, n=36 (50.7%); pT2b, n=2 (2.8%); GS 6, n=50 (70.4%); GS 7a, n=18 (25,3%). All patients were R0 and N0 for Pca. Mean preoperative PSA level was 2.7ng/ml. None of the patients developed biochemical recurrence (median follow-up: 29.5 [1-124 months]). Patients with significant Pca were older than those with insignificant Pca (median age 71.2 years vs 70.1 years) and had higher preoperative PSA levels: 90% of patients with a PSA level of 4-10ng/ml had a ≥T2c Pca, while 81.5% of patients with PSA levels of 0-1ng/ml had a pT2a Pca. P-stages in patients with PSA values between 1-4ng/ml were found to be equally distributed between pT2a-pT2c. Conclusions: The occurence of incidental Pca is a common finding in patients undergoing RCP, with a considerable proportion having the characteristics of significant Pca. Potential risk factors for significant Pca are older age and PSA levels >4ng/ml. However, none of the patients experienced biochemical relapse or Pca-related death during the follow-up. In line with published data, incidental Pca does not impact on the oncological outcome of patients undergoing RCP. The prognosis is primarily determined by bladder cancer.

scholarly journals The lack of retropatellar resurfacing at index surgery is significantly associated with failure in patients following patellofemoral inlay arthroplasty: a multi-center study of more than 260 patients

2021 ◽  
Author(s):  
Andreas B. Imhoff ◽  
Eva Bartsch ◽  
Christoph Becher ◽  
Peter Behrens ◽  
Gerrit Bode ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Potential Risk ◽  
Young Patients ◽  
Womac Score ◽  
Potential Risk Factors ◽  
Multi Center Study ◽  
Center Study

Abstract Purpose To evaluate the clinical outcomes of patients with a minimum 2-year follow-up following contemporary patellofemoral inlay arthroplasty (PFIA) and to identify potential risk factors for failure in a multi-center study. Methods All patients who underwent implantation of PFIA between 09/2009 and 11/2016 at 11 specialized orthopedic referral centers were enrolled in the study and were evaluated retrospectively at a minimum 2-year follow-up. Clinical outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Scale, the visual analogue scale (VAS) for pain, and subjective patient satisfaction. Pre- and perioperative risk factors were compared among failures and non-failures to determine potential risk factors. Results A total of 263 patients (85% follow-up rate) could be enrolled. The mean age at the time of index surgery was 49 ± 12 years with a mean postoperative follow-up of 45 ± 18 months. The overall failure rate was 11% (28 patients), of which 18% (5 patients) were patients with patella resurfacing at index surgery and 82% (23 patients) were patients without initial patella resurfacing. At final follow-up, 93% of the patients who did not fail were satisfied with the procedure with a mean transformed WOMAC Score of 84.5 ± 14.5 points, a mean KOOS Score of 73.3 ± 17.1 points, a mean Tegner Score of 3.4 ± 1.4 points and a mean VAS pain of 2.4 ± 2.0 points. An increased BMI was significantly correlated with a worse postoperative outcome. Concomitant procedures addressing patellofemoral instability or malalignment, the lack of patellofemoral resurfacing at the index surgery and a high BMI were significantly correlated with failure in our patient cohort. Conclusion Patellofemoral inlay arthroplasty shows high patient satisfaction with good functional outcomes at short-term follow-up and thus can be considered a viable treatment option in young patients suffering from isolated patellofemoral arthritis. Patellar resurfacing at index surgery is recommended to decrease the risk of failure. Level of evidence Retrospective case series, Level IV.

scholarly journals Le ulcere flebostatiche recidive degli arti inferiori: analisi di un’esperienza/Recurrent venous leg ulcers: clinical analysis of an experience

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Alberto Garavello ◽  
Margherita Lo Ponte ◽  
Stefania Gilardi ◽  
Paola Fiamma ◽  
Massimo Tozzi
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Wound Care ◽  
Lower Limbs ◽  
Orthopedic Procedures ◽  
Ulcer Recurrence ◽  
Venous Ulcers ◽  
Potential Risk Factors ◽  
Fattori Di Rischio

Nonostante i recenti progressi in tema di wound care, le ulcere varicose degli arti inferiori restano un problema frequente, con un alto tasso di recidiva. In questo lavoro abbiamo esaminato la storia clinica, la storia chirurgica e le patologie associate di 133 pazienti affetti da ulcera varicosa degli arti inferiori, di cui 56 da ulcera recidiva o plurirecidiva. L’analisi dei fattori di rischio potenziale per recidiva ha evidenziato come la presenza di varici recidive, una pregressa trombosi venosa profonda, problemi ortopedici, interventi ortopedici, l’obesità e un’età inferiore a 60 anni siano fattori di rischio potenziale per una recidiva dell’ulcera. La combinazione di uno più fattori di rischio assume significatività per la possibilità di una recidiva; si passa dal 22,7% in assenza di fattori di rischio al 33% per i pazienti che ne presentano due, fino al 57,5% in presenza di tre fattori di rischio e all’81,3% per quattro o più. L’ulcera varicosa richiede un follow-up stretto del paziente e una terapia elastocompressiva continua, che deve vedere una stretta collaborazione del paziente e un’attenzione specifica ai fattori di rischio. Despite recent advances in wound care, varicose ulcers of lower limbs remain frequent and display a high rate of recurrence. In this paper, we examined the clinical, surgical histories and associated diseases of 133 patients with venous ulcers of the lower limbs, which were recurrent in 56 cases. The analysis of potential risk factors for recurrence showed that the presence of recurrent varicose veins, a previous deep venous thrombosis, orthopedic problems, previous orthopedic procedures, obesity and age lower than 60 are potential risk factors for ulcer recurrence. Furthermore, the association of one or more risk factors increased the likelihood of relapse, from 22.7% with no risk factors to 33% with 2 risk factors, up to 57.5% with 3 risk factors, and up to 81.3% with 4 risk factors or more. Venous ulcers require close follow-up and continuous elastic compression, close collaboration by the patient and specific focus on risk factors.

scholarly journals Potential risk factors for reactive arthritis and persistence of symptoms at 2 years: a case-control study with longitudinal follow-up

2017 ◽  
Vol 37 (2) ◽  
pp. 415-422 ◽  
Author(s):  
Helga Raquel Garcia Ferrer ◽  
Alexander Azan ◽  
Isa Iraheta ◽  
Joan Von Feldt ◽  
Luis R. Espinoza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Reactive Arthritis ◽  
Case Control Study ◽  
Case Control ◽  
Potential Risk Factors ◽  
Control Study

Blastocystis: unravelling potential risk factors and clinical significance of a common but neglected parasite

2009 ◽  
Vol 137 (11) ◽  
pp. 1655-1663 ◽  
Author(s):  
C. R. STENSVOLD ◽  
H. C. LEWIS ◽  
A. M. HAMMERUM ◽  
L. J. PORSBO ◽  
S. S. NIELSEN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Irritable Bowel Syndrome ◽  
General Population ◽  
Clinical Significance ◽  
Potential Risk ◽  
Factors Associated ◽  
Potential Risk Factors ◽  
Intestinal Symptoms ◽  
Irritable Bowel

SUMMARYTwo independent studies were conducted to describe symptoms and potential risk factors associated withBlastocystisinfection. Isolates were subtyped by molecular analysis. In the NORMAT study (126 individuals randomly sampled from the general population) 24 (19%) were positive forBlastocystis.Blastocystiswas associated with irritable bowel syndrome (P=0·04), contact with pigs (P<0·01) and poultry (P=0·03). In the Follow-up (FU) study (follow-up of 92Blastocystis-positive patients), reports on bloating were associated with subtype (ST) 2 (P<0·01), and blood in stool to mixed subtype infection (P=0·06). ST1 was more common in FU individuals (32%) than in NORMAT individuals (8%), whereas single subtype infections due to ST3 or ST4 were seen in 63% of the NORMAT cases and 28% of the FU cases. Only FU individuals hosted ST7, and ST6/7 infections due to ST7 or ST9 were characterized by multiple intestinal symptoms. The data indicate subtype-dependent differences in the clinical significance ofBlastocystis.

scholarly journals Clinical profiles of neonates born to mothers with COVID-19

2021 ◽  
Vol 61 (5) ◽  
pp. 277-82
Author(s):  
Ambili Susan Jacob ◽  
Mohammed MTP ◽  
Reetha Gopinath ◽  
Binoo Divakaran ◽  
Tariq Harris
Keyword(s):  
Risk Factors ◽  
Vertical Transmission ◽  
Potential Risk ◽  
Disease Transmission ◽  
Horizontal Transmission ◽  
Tertiary Care ◽  
Increased Risk ◽  
Hygiene Measures ◽  
Potential Risk Factors

Background The risk of congenital infections in neonates born to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected mothers and those breastfed by infected mothers remains largely unknown. Objective To describe the outcomes and clinical features of neonates born to mothers infected with SARS-CoV-2 during pregnancy, to follow up neonates who were positive for SARS-CoV-2 at the time of delivery for a period of 1 month, and to identify potential risk factors associated with disease transmission. Methods This prospective observational study on neonates born to SARS-CoV-2-infected mothers between June 2020 and January 2021 was carried out after getting written informed consent in a tertiary care government hospital (Government Medical college Kannur, North Kerala, India). The clinical and demographic characteristics of infected mothers were reviewed. Neonates were tested for SARS-CoV-2 infection within 24 hours of birth, with repeat testing on day 5 for those who were negative at birth.  The demographic and clinical characteristics as well as potential risk factors for disease transmission in these neonates were evaluated. Results A total of 342 neonates (95.3%) were tested for SARS-CoV-2 infection at birth. Rooming-in and breastfeeding was practiced in 75% of at-risk neonates. Fifty neonates tested positive for SARS-CoV-2 infection at birth (14.3%); 293 neonates who tested negative at birth remained so on day 5, except one baby isolated with a caretaker who also tested positive, indicating postnatal infection. There was no statistically significant increased risk of infection in neonates born to SARS-CoV-2-positive mothers compared to those born to mothers who had already become negative at delivery. Mild symptoms were present in 8% of positive neonates. On one-month follow up, all neonates were well and gaining weight. Conclusion Vertical transmission, in particular transplacental, may be possible in SARS-CoV-2-infected mothers. Maternal infection at the time of delivery is not a predictor for increased vertical transmission compared to mothers whose infections had resolved prior to delivery. Breastfeeding with appropriate hygiene measures is not a risk factor for horizontal transmission.

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