Early Predictors of Poor Neurologic Outcomes in a Prospective Cohort of Infants With Antenatal Exposure to Zika Virus

Background. Prognosis of therapy results of patients with the juvenile idiopatic arthritis (JIA) without systematic manifestations is the precondition of their treatment efficiency enhancement.Objective. Our aim was to establish early predictors for remission achievement in patients with JIA without systematic manifestations who received Etanercept therapy.Methods. In prospective cohort study the therapy results of patients with JIA without systematic manifestations hospitalized from December, 2009 to August, 2014 and administrated with Etanercept are analysed. The association of initial demographic indicators as well as initial and registered after a month of treatment clinical and laboratory indicators with remission achievement after a year of treatment according to the Wallace criteria is estimated.Results. The research included 197 patients with JIA without systematic manifestations who received Etanercept in 0.4 mg/kg dose twice a week subcutaneously (the maximum single dose — 25 mg). In addition to Etanercept 136 (69%) patients received Methotrexat, 121 (61%) — non-steroidal anti-inflammatory drugs, 10 (5%) — glucocorticosteroids, 6 (3%) — Sulfasalazine. After a year of treatment remission was recorded in 77 out of 197 (39.1%) patients. According to multivariate analysis the remission predictors are the following: tender joint count 4 (odds ratio (OR) 4.38; 95% confidential interval (CI) 2.33–8.55), duration of illness before Etanercept therapy 2 years (OR 1.28; 95% CI 1.02–2.15), disease activity decline according to JADAS71 index 10 points in a month of the therapy including Etanercept (OR 2.59; 95% CI 1.38–5.03). Model sensitivity was 32% (all three criteria in 25/77 patients with remission), specificity — 94% (lack of even one criteria in 113/120 patients who did not achieve remission).Conclusion. The predictors of remission in patients with JIA without systematic manifestations in 1 year of Etanercept therapy are smaller tender joint count prior to therapy, smaller duration of illness as well as significant disease activity decline in a month of the therapy.

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Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz629 ◽

2019 ◽

Vol 221 (11) ◽

pp. 1838-1845 ◽

Cited By ~ 1

Author(s):

Nasim C Sobhani ◽

Elyzabeth Avvad-Portari ◽

Aline C M Nascimento ◽

Heloisa N Machado ◽

Daniel S S Lobato ◽

...

Keyword(s):

Zika Virus ◽

Prospective Cohort ◽

Neonatal Outcome ◽

Infant Outcomes ◽

Long Term Follow Up ◽

History Of ◽

Virus Exposure ◽

Twin Pregnancies

Abstract Background There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. Methods This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. Results Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16–33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. Conclusions Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission.

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