Association between maternal Herpesvirus infections and congenital malformations

Counselling for physical activity, life-space mobility and falls prevention in old age (COSMOS): protocol of a randomised controlled trial

INTRODUCTION

The most promising way to promote active life years in old age is to promote regular participation in physical activity (PA). Maintaining lower extremity muscle function with good balance has been associated with fewer falls and the need of help from others. This article describes the design and intervention of a randomised controlled trial (RCT) investigating the effectiveness of a health and PA counselling programme on life-space mobility and falls rates in community-dwelling older adults at the Health Kiosk and/or Service Centre.

METHODS AND ANALYSIS

Community-dwelling men and women (n=450) aged 65 years and over with early phase mobility limitation will be recruited to a 24-month RCT with a 24-month follow-up. Participants will be randomly allocated into either a health and PA counselling group (intervention) or relaxation group (control intervention). All participants will receive five group specific face-to-face counselling sessions and 11 phone calls. The counselling intervention will include individualised health counselling, strength and balance training, and guidance to regular PA. The control group will receive relaxation exercises. Outcomes will be assessed at baseline, 12, 24 and 48 months. Primary outcomes are average life-space mobility score and falls rates. Life-space mobility will be assessed by a validated questionnaire. Falls rates will be recorded from fall diaries. Secondary outcomes are data on fall-induced injuries and living arrangements, number of fallers, fracture risk, mean level of PA, physical performance, quality of life, mood, cognition, balance confidence and fear of falling. Data will be analysed using the intention-to-treat principle. Cost-effectiveness of the programme will be analysed. Ancillary analyses are planned in participants with greater adherence.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Ethics Committee of the Tampere University Hospital (R15160). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences.

TRIAL REGISTRATION

ISRCTN65406039; Pre-results.

Heartbeat-enhanced immersive virtual reality to treat complex regional pain syndrome

Objectives

To develop and test a new immersive digital technology for complex regional pain syndrome (CRPS) that combines principles from mirror therapy and immersive virtual reality and the latest research from multisensory body processing.

Methods

In this crossover double-blind study, 24 patients with CRPS and 24 age- and sex-matched healthy controls were immersed in a virtual environment and shown a virtual depiction of their affected limb that was flashing in synchrony (or in asynchrony in the control condition) with their own online detected heartbeat (heartbeat-enhanced virtual reality [HEVR]). The primary outcome measures for pain reduction were subjective pain ratings, force strength, and heart rate variability (HRV).

Results

HEVR reduced pain ratings, improved motor limb function, and modulated a physiologic pain marker (HRV). These significant improvements were reliable and highly selective, absent in control HEVR conditions, not observed in healthy controls, and obtained without the application of tactile stimulation (or movement) of the painful limb, using a readily available biological signal (the heartbeat) that is most often not consciously perceived (thus preventing placebo effects).

Conclusions

Next to these specific and well-controlled analgesic effects, immersive HEVR allows the application of prolonged and repeated doses of digital therapy, enables the automatized integration with existing pain treatments, and avoids application of painful bodily cues while minimizing the active involvement of the patient and therapist.

Classification of evidence

This study provides Class III evidence that HEVR reduces pain and increases force strength in patients with CRPS.

Unusual concurrence of heterotopic glial nodule of the scalp and congenital herpes simplex virus type-2 infection

Heterotopic glial nodules are rare congenital cutaneous lesions; only 13 cases of scalp localized lesions of this kind are reported in the English medical literature. Herpes simplex virus is a rare cause of neonatal morbidity and mortality and is a rare cause of intrauterine infection. We report the first case of concurrent presence of a heterotopic glial nodule of the scalp and neonatal, in utero-acquired, fatal herpes simplex virus type-2 infection.

Mothers of children with Down syndrome have higher herpes simplex virus type 2 (HSV-2) antibody levels

The antibody response to herpes simplex virus (HSV) was studied in 53 mothers of children with Down syndrome (Ds) and compared with that in 154 controls, using sera sampled during pregnancy or at delivery. Conventional analysis of HSV complement fixing antibodies showed the same frequency of positivity for the two groups (70%). When the levels of IgG antibodies to an HSV-1 and an HSV-2 antigen preparation were determined by an enzyme-linked immunosorbent assay (ELISA) technique, it was found that the Ds and control mothers had similar levels of IgG antibodies to HSV-1, whereas the level of IgG antibodies to HSV-2 was significantly (P less than 0.001) higher in Ds mothers. The ratio of HSV-2 to HSV-1 ELISA IgG was calculated for each mother and the distribution of these ratios also differed significantly between the control and Ds mothers. The differences found were not due to differences in age distribution in the control and Ds groups. For comparison a third procedure, measurement of thymidine kinase blocking antibody (TK ab), was used. With this procedure the mothers were divided into groups estimated to be positive for HSV-1, HSV-2, or both. Statistical analyses showed a good correlation between the type found in TK ab analyses and the ratio found in the ELISA HSV test. The results clearly demonstrated an overrepresentation of HSV-2 antibody positivity among Ds mothers, though not of sufficient magnitude to imply that HSV-2 can be the major cause of Ds. It is discussed whether HSV-2 might be related to the recently increased birthrate of children with Ds among young mothers in Sweden or to localized geographical clustering of Ds births, or whether the increased HSV-2 antibody positivity merely indicates that factors following the same epidemiological pattern are involved in the aetiology of Ds.

Epidemiology of cytomegalovirus infections during pregnancy and infancy. A prospective study

The occurrence and possible consequences of cytomegalovirus (CMV) infections were studied in 200 mothers and their children by means of immunofluorescent antibody assays in serum, virus isolation from urine and regular clinical and neurological examinations. The prospective study covered the time from early pregnancy to 1 year post partum. The frequency of intrauterine infections was 2%, while 30% of the children became perinatally infected as indicated by the onset of virus excretion and an antibody response at the age of 2--4 months. Later on the occurrence of CMV infections declined sharply. 23 mothers had no CMV antibodies and none of their children contracted CMV during the first year of life. Maternal antibodies seemed unable to protect the child from CMV infections or to delay the onset of virus excretion in perinatally infected children. Intrauterine infections did not correlate with significant increases in the antibodiy titres of the mothers or the presence of IgM antibodies either in the mother's sera or in the cord sera. Perinatal infections were often associated with the presence of IgM antibodies both in the child and in the mother and in these mothers significant increases in CMV antibody titres were frequently seen, probably indicating an activated latent infection. Immunofluorescent antibody assay correlated well with virus isolations and was more sensitive than complement-fixing antibody assay.

Spina bifida and anencephaly: miscarriage as possible cause

In two retrospective Liverpool surveys the domestic, family, dietary, and medical environments of the mothers of children affected by anencephaly or spina bifida, or both (ASB) were examined. None seemed to be of more than minor importance and the findings of others were therefore examined to see if they suggested a major factor. The most promising lead came from the hypothesis that ASB is usually due to an interaction between twin fetuses or between a fetus and residual trophoblastic material from the previous normal pregnancy, particularly when this is of the opposite sex to the propositus. The sex finding was not confirmed. It was noted that hydatidiform moles, like children with ASB, were usually female and that moles and choriocarcinomas on the one hand and children with ASB on the other occurred in mothers of similar ages, but were to some extent reciprocal in geographical incidence. This suggested that trophoblastic disease might be a factor common to all three and if so then one would expect the frequency of miscarriages to be higher immediately before than immediately after the birth of an ASB child, since mole and choriocarcinoma seldom follow a normal pregnancy. An analysis of published data confirmed that this was almost certainly so. Hence residual pathological trophoblastic material from either a previous miscarriage or a co-twin may interact unfavourably with another fetus to produce ASB and this may be the primary cause of the condition. The hypothesis is consistent with the observed lack of concordance in twins, the high incidence in females, the maternal age effect, and the greater prevalence in social classes IV and V.

Risk indicators in childhood malignancies

A series of 972 childhood malignancies was compared with a control series of healthy children matched for date and place of birth. Several variables were tested for possible aetiological significance. The information was obtained from the Finnish Cancer Registry and from the antenatal records of the mothers. No significant associations were found between the various types of malignancies and the variables studied. In the group consisting of all malignancies, a risk ratio of 2.0 could be significantly excluded for most variables. In the leukaemia group, both pelvic X-ray and polio vaccination were associated with slightly elevated risk ratios, but the differences between this group and the match controls were not statistically significant. BCG vaccination was performed during the perinatal period in 90% of the children, but the proportion was the same in the study and control groups, and hence the hypothesis that this vaccination confers protection was not supported. The information is considered prospective and relatively reliable, and the authors suggest that these data may be useful when more extensive series are compiled from various sources.