Background: Pregnancy simulates a metabolic syndrome-like state and predisposes to iodine deficiency and hypothyroidism through increased iodine renal loss and transplacental transfer to the fetus. Iodine deficiency is thought to predispose to dyslipidemia through elevation of serum TSH. Obesity, dyslipidemia, and hypothyroidism are established risk factors of preeclampsia. Hence, pregnant women with iodine deficiency are likely to be at increased risk of dyslipidemia and preeclampsia. We investigated the pattern of dyslipidemia among preeclamptic and normotensive pregnant women with and without iodine deficiency. Methods: The pathophysiological mechanisms linking iodine deficiency and dyslipidemia were delineated using bivariate correlations, logistic regression, and exploratory factor analysis of anthropometric, lipid profile, urine iodine concentration (UIC), and thyroid function data from 240 women with preeclampsia and 120 normotensive pregnant controls at term who attended Lomo Medical Centre, Democratic Republic of Congo (DRC). Results: Preeclamptic women with iodine deficiency had significantly lower HDL-C but higher triglyceride levels than those with sufficient iodine intake. Both normotensive and preeclamptic participants with elevated TSH had high serum oxidized LDL-C but low NO, p < 0.001. Conclusions: SCH, secondary to iodine deficiency, is associated with elevated serum oxidized LDL and decreased Nitric Oxide (NO) among both normotensive and preeclamptic women, while insufficient iodine nutrition among preeclamptic women predisposes to reduced HDL-C and increased serum Triglycerides, which are risk factors of atherosclerosis and cardiovascular disease.

Background and Objectives: Several micro- and macro-nutrient malnutrition states that are routinely assessed during clinical care of women in the antenatal period have been proposed as risk factors for preeclampsia. However, there is a paucity of data on the potential use of these biomarkers for detection of preeclampsia. The aim of this case-control study was to investigate the association of biomarkers from routine clinical tests, and those specific to micro- and macro-nutrient malnutrition, with the risk of preeclampsia. Materials and Methods: Venous blood samples of 250 participants with preeclampsia and 150 pregnant women without preeclampsia were collected and assayed immediately for the full blood count, urea and electrolytes, high-density cholesterol (HDL), total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL), oxidized low-density lipoprotein cholesterol (OxLDL), and selenium, in addition to urine iodine concentration (UIC). Results: The serum potassium/magnesium ratio (K+/Mg2+), UIC, fasting plasma glucose (FPG), thyroid stimulating hormone (TSH), lymphocyte percentage (L/WBC%), and the oxidized LDL/albumin ratio (OxLDL/Alb) were identified as independent predictors of preeclampsia. Conclusions: Serum potassium/magnesium ratio and other analytes essential for various biological processes, some of which are assayed during routine care, were significantly associated with preeclampsia, warranting further exploration as potential screening biomarkers in low-resource settings.

Background: This commentary analyzes demographic, clinical, and occupational characteristics associated with Ebola virus disease (EVD) outcomes during the 2018-2020 outbreak in the Democratic Republic of Congo (DRC). Methods: A total of 3477 EVD cases were included. Descriptive statistics and univariate and multivariate Cox regression analyses were performed to evaluate associations between clinical outcomes and patient characteristics. Comorbidity estimates and healthcare worker (HCW) occupational exposure data were incorporated based on the literature. Results: The median age was 26.5 years (SD = 16.1), with the majority (59.7%) aged 20-59. Males represented 51.3% of the cohort. Most patients (81.8%) worked in occupations that were not disease-exposing. Overall, 450 patients (12.9%) died. Although comorbidities initially appeared predictive of mortality (unadjusted HR: 3.05; 95% CI: 2.41-3.87), their effect was not statistically significant after adjustment (adjusted HR: 1.17; 95% CI: 0.87-1.59; p = 0.301). The strongest predictor of death was clinical status at admission: patients classified as "very sick" had an alarmingly high adjusted hazard ratio (HR) of 236.26 (95% CI: 33.18-1682.21; p < 0.001). Non-disease-exposing occupations were also associated with increased mortality (adjusted HR: 1.75; 95% CI: 1.33-2.31; p < 0.001). Conclusions: Despite improvements in outbreak response, mortality remains disproportionately high among patients presenting in critical condition and those outside the health sector. These findings underscore the importance of early detection strategies and enhanced protection for all occupational groups during EVD outbreaks.

Caesarean section (C-S), a common life-saving obstetric intervention, can result in immediate life-threatening or long-term complications for the mothers and their babies. Hence, C-S should be done only when medically indicated and in a timely and safe manner. The risk of complications is heightened by unnecessary C-S deliveries and the inappropriate timing and conduct of the procedure, especially in LMIC. In both HIC and LMIC settings, women with low socio-economic status are more at risk due to upstream structural factors that propagate health inequity during the reproductive age and downstream health system factors that preclude access to quality maternity care. Effective interventions ought to address social inequality, promote healthy lifestyles, and increase access to quality maternity care as an integral part of a multisectoral approach to primary health care. These interventions should address the risk factors along a continuum of care from preconception and antenatal periods which operate mainly at the community level; antenatal and intrapartum factors at the primary health facility levels; and intraoperative and post-operative factors mainly at the secondary level and tertiary level facilities. The scale of the interventions at the various levels will depend on the magnitude of the risk, which varies by HIC and LIC status and from one country to another and within countries. The rapidly increasing information technology and access to other medical technologies like point-of-care ultrasound, AI, and the use of evidence-based protocols have started positively impacting maternity care and may further improve C-S outcomes when accessible and properly utilised.

Introduction Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal morbidity and mortality. The risk of developing cardiovascular diseases following HDP is high. Arterial stiffness is a prognostic indicator for cardiovascular disease in the general population, and it is elevated during pregnancy in women with HDP. No systematic reviews have been conducted to determine if arterial stiffness remains elevated beyond puerperium in these women with HDP.Methods and analysis We will conduct a systematic literature search in the following electronic databases: Medline, PubMed, Embase, Cochrane Library, Google Scholar, Web of Science and CINAHL. The review will consider studies that investigate arterial stiffness in women who had HPD and are between 43 days and 10 years postdelivery and under 60 years of age. This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. Estimates of mean ± SD for arterial stiffness indices (cfPWV, AIx and AIx@75) for the women in the included studies will be obtained. For studies where the estimates were reported as the median and IQR, approximate estimates of mean ± SD will be calculated by using the low and high end of the range, median and sample size. Data from the individual studies will be pooled by use of a random-effects model. The risk of bias assessment will be assessed using the Cochrane Collaboration tool and the Newcastle-Ottawa Quality Assessment Scale as appropriate. Sources of heterogeneity will be explored by sensitivity and subgroup analyses.Ethics and dissemination No ethics approval is required as only published data will be used in this study. The research study’s outcomes will be shared through scientific conferences and peer-reviewed publications.PROSPERO registration number CRD42023461867.

Human papillomavirus (HPV) is a sexually transmitted infection associated with the development of cervical cancer. This study investigated cervical HPV prevalence, characteristics, and distribution according to age and human immunodeficiency virus (HIV) status among women attending a public community health facility in the Eastern Cape Province of South Africa. A total of 325 participants (aged 18 to 60) visiting a community health facility for any reason were recruited. Cervical HPV infection was detected using the Seegene Anyplex™ II HPV28 assay (Seegene Inc., Seoul, South Korea). Overall HPV prevalence was 65.2% (95% CI: 59.9–70.2%), with the highest prevalence of 80.9% (95% CI: 67.2–89.8%) observed in the 18–25-year-old age group and the lowest prevalence of 46.3% (95% CI: 35.8–57.1%) in the 46–60-year-old age group. HR-HPV infection was found to decrease with increasing age (p < 0.001) in the overall population and according to HIV status. In contrast, LR-HPV infection was found to significantly decrease with age among HIV-negative women (p = 0.001) but not for the overall population and HIV-positive women. A proportion of 12.9% were infected with one or more HPV types covered by the Cervarix® HPV vaccine (HPV-16 and/or -18), 18.8% (by those covered by Gardasil®4 (HPV-6, -11, -16 and/or -18), and 42.2% by those covered by Gardasil®9 (HPV-6, -11, -16, -18, -31, -33, -45, -52 and/or -58). The alpha-9 HPV species was the most dominant species (40.6%), followed by the alpha-7 species (29.8%). High overall HPV, HR-HPV, and alpha-9 species prevalence were observed among the women attending the public health facility. These findings contribute to the limited HPV distribution data among the Eastern Cape women, which could be used to improve HPV-related policy and assess the effectiveness of the HPV vaccination.

Graves’ disease and nodular toxic thyroid disease are the leading causes of hyperthyroidism. Iodine fortification (IF) among mild-to-moderate iodine deficiency populations is associated with transient increase in incident thyrotoxic nodular disease that may last up to 10 years. A rise in incident Graves’ disease and other autoimmune thyroid conditions has also been associated with IF. Epidemiological studies from different geographical settings around the globe suggest increased incidence even among reproductive age groups in affected populations. Recurrent iodine deficiency in iodine replete populations in developed countries may also predispose them to a similar phenomenon. The prevalence and consequences of hyperthyroidism in pregnancy may be higher than previously reported. We intend to describe the aetiopathology and epidemiology of hyperthyroidism, the mechanisms through which hyperthyroidism predisposes to infertility; the impact of hyperthyroidism on fertility treatment, pregnancy in general and among women with infertility; as well as the effects of hyperthyroidism or agents used in the treatment of hyperthyroidism on perinatal outcomes and adult life for those exposed in utero.

Cervical cancer knowledge and awareness is low among South Africans despite high cervical cancer prevalence. This study aimed to investigate knowledge about the symptoms, signs, risk factors, and methods of prevention of cervical cancer among women and men in the rural Eastern Cape province, South Africa. This cross-sectional analytical study was conducted in the rural community of the OR Tambo municipality in the Eastern Cape province. 252 women and men aged ≥ 25 years were randomly recruited. Data were collected using semi-structured questionnaires. A knowledge score was categorized as “good” if it was ≥65%. The majority of participants (69.8%) were women. Only a proportion of 25.6% (51/199) of the participants had good overall knowledge about cervical cancer, and the majority of these (84.3%) were women. Women previously screened for cervical cancer had a significantly higher median cervical knowledge score than those who had never been screened (p = 0.002). Only among women, good knowledge about cervical cancer was associated with a tertiary education level (OR: 3.17, 95% CI: 1.08–9.57, p = 0.044) and high household income (OR: 3.40, 95% CI: 1.24–9.75, p = 0.027). Both women and men in rural Eastern Cape had limited knowledge about the risk factors and prevention methods of cervical cancer. Public health strategies to improve knowledge and awareness of cervical cancer among both men and women are necessary.

Hyperthyroidism is a condition caused by physiological, biological, and clinical findings that cause hypermetabolism as a result of the excessive elevation of thyroid hormones in the blood and the surrounding tissues under the influence of high levels of hormones. There is a general acceleration in metabolism. There are a wide variety of methods in the treatment of hyperthyroidism, such as antithyroid drugs, lithium carbonate, radioactive iodine, and dexamethasone. This comprehensive book, with contributions from various researchers on thyroid hormones and hyperthyroidism, offers a wide range of expert reviews on the release of thyroid hormones, their physiological effects, and the occurrence of hyperthyroidism as well as its types, effects, and treatment options.

BACKGROUND: Autoimmune thyroid disease, one of the main risk factors for hypothyroidism, is associated with adverse pregnancy outcomes. The burden of autoimmune thyroid disease in pregnancy and its association with thyroid function among normotensive pregnant women and pregnant women with hypertension in South Africa are not known. OBJECTIVE: This study aimed to establish the magnitude of thyroid peroxidase autoantibodies in pregnancy in the Eastern Cape of South Africa and its relationship with iodine nutrition status and preeclampsia. STUDY DESIGN: Overall, 60 randomly selected normotensive pregnant controls at term and 120 pregnant participants with preeclampsia in the third trimester of pregnancy going to the Mthatha Regional Hospital and the Nelson Mandela Academic Hospital in the Eastern Cape Province who had complete data on thyroid peroxidase antibody titers, urinary iodine concentrations, serum thyroid-stimulating hormones, and free triiodothyronine, free thyroxine, and thyroglobulin levels were enrolled in this unmatched case-control study. RESULTS: The cases and controls had similar mean chronological age (23.8 vs 24.0 years), body mass index (29.4 vs 28.8 kg/m2), and median parity (both 1) (P>.05). The controls had a higher mean gestational age than participants with preeclampsia (38.5 vs 33.7 weeks, respectively; P<.001). Both participants with preeclampsia and normotensive participants had median thyroid peroxidase antibody levels consistent with a negative thyroid autoimmune status. Participants with preeclampsia had higher but nonstatistically significant median thyroid peroxidase antibody (2.14 vs 1.77 IU/L), thyroglobulin (25.9 vs 21.3 µg/L), and thyroid-stimulating hormone (2.4 vs 2.3 mIU/L) levels (P>.05) and significantly lower median urinary iodine concentration (123.4 vs 188.6 µg/L), free thyroxine (13.2 vs 14.1 pmol/L), and free triiodothyronine (4.3 vs 4.6 pmol/L) levels (P<.05) than normotensive controls. Thyroid peroxidase antibodies were positively correlated with thyroglobulin, urinary iodine concentration, and thyroid-stimulating hormone. CONCLUSION: In the rural Eastern Cape of South Africa, pregnant women in the third trimester of pregnancy have thyroid peroxidase antibody titers that show negative thyroid autoimmune status. Insufficient iodine intake, other than thyroid autoimmune disease, seems to be the underlying cause of the lower free triiodothyronine and free thyroxine levels observed among women with preeclampsia.

Human papillomavirus (HPV) prevalence and genotype distribution data is important for HPV vaccine monitoring. This study investigated the prevalence and distribution of HPV genotypes in cervical lesions of unvaccinated women referred to Nelson Mandela Academic Hospital Gynaecology Department due to different abnormal cervical conditions. A total of 459 women referred to the Nelson Mandela Academic Hospital Gynaecology department were recruited. When the cervical biopsy was collected for histopathology, an adjacent biopsy was provided for HPV detection. Roche Linear Array HPV genotyping assay that detects 37 HPV genotypes was used to detect HPV infection in cervical biopsies. HPV infection was detected in 84.2% (383/455) of participants. The six most dominant HPV types were HPV-16 (34.7%), followed by HPV-35 (17.4%), HPV-58 (12.1%), HPV-45 (11.6%), HPV-18 (11.4%) and HPV-52 (9.7%). HPV-35 was the third most dominant type among women with cervical intraepithelial lesion (CIN)-2 (12.6%; single infection: 5.7% and multiple infection: 6.9%), the second most dominant type among women with CIN3 (22.2%; single infection: 8.0% and multiple infection: 14.2%); and the fourth most dominant type among women with cervical cancer (12.5%; single infection: 7.1% and multiple infection: 5.4%). A proportion of 41.1% (187/455) was positive for HPV types targeted by the Cervarix®, 42.4% (193/455) by Gardasil®4, and 66.6% (303/455) by Gardasil®9. There was a statistically significant increase when the prevalence of women infected with HPV-35 only or with other HPV types other than Gardasil®9 types was included to those infected with Gardasil®9 HPV types (66.6%, 303/455 increase to 76.0%, 346/455, p = 0.002). High HPV-35 prevalence in this population, especially among women with CIN3 warrants attention since it is not included in current commercially available HPV vaccines.

Background: There is paucity of data on the relationship between thyroid hormones, potassium and eclampsia. Moderate-to-severe iodine deficiency that worsens during pregnancy leads to decreased thyroid hormone output and bioavailability to the brain. Apart from metabolic functions, T3 and T4 are essential fast acting cytosolic and synaptosomal neural transmitters that also regulate neuronal excitatory-inhibitory mechanisms. T3 also regulates the Na + -K + -ATPase pump that maintains the membrane ionic gradient. Hence altered serum potassium, thyroxine and triiodothyronine levels could increase the risk of eclamptic seizures. Methods: Forty-five women with eclampsia, 45 severe preeclampsia and 90 normotensive pregnant controls were enrolled into this study. Levels of thyroid hormones, thyroglobulin and urine iodine concentration (UIC) were measured and compared between the three groups. Results: Eclamptic participants had significantly lower median serum potassium (K), triiodothyronine (FT3), urinary iodine concentration (UIC) but higher serum thyroglobulin (Tg) (K = 3.7 mmol/L; FT3 = 3.8 pmol/L; UIC = 69.5 μg/L; Tg = 39.0 μg/L) than normotensive pregnant controls (K = 4.3 mmol/L; T3 = 4.7 pmol/L; UIC = 169.5 μg/L; Tg = 19.5 μg/L) and participants with severe preeclampsia (K = 4.2 mmol/L; T3 = 4.4 pmol/L; UIC = 95.7 μg/L; Tg = 22.4 μg/L), p < 0.05. Low UIC, low serum T3 and potassium and elevated Tg were independent predictors of eclampsia. Conclusions: Women with iodine deficiency in pregnancy may be at increased risk of eclampsia secondary to the ensuing rapid peripheral turnover of thyroid hormones leading to hypothyroxinaemia and reduced triiodothyronine bioavailability to the central nervous system that can be exacerbated by hypokalaemia.

Bacterial vaginosis (BV), whose etiology remains a matter of controversy, is a common vaginal disorder among reproductive-age women and can increase the risk for sexually transmitted infections (STIs). African women bear a disproportionately high burden of STIs and BV.

South African women have a high rate of cervical cancer cases, but there are limited data on human papillomavirus (HPV) genotypes in cervical intraepithelial neoplasia (CIN) in the Eastern Cape province, South Africa. A total of 193 cervical specimens with confirmed CIN from women aged 18 years or older, recruited from a referral hospital, were tested for HPV infection. The cervical specimens, smeared onto FTA cards, were screened for 36 HPV types using an HPV direct flow kit. HPV prevalence was 93.5% (43/46) in CIN2 and 96.6% (142/147) in CIN3. HIV-positive women had a significantly higher HPV prevalence than HIV-negative women (98.0% vs. 89.1%, p = 0.012). The prevalence of multiple types was significantly higher in HIV-positive than HIV-negative women (p = 0.034). The frequently detected genotypes were HPV35 (23.9%), HPV58 (23.9%), HPV45 (19.6%), and HPV16 (17.3%) in CIN2 cases, while in CIN3, HPV35 (22.5%), HPV16 (21.8%), HPV33 (15.6%), and HPV58 (14.3%) were the most common identified HPV types, independent of HIV status. The prevalence of HPV types targeted by the nonavalent HPV vaccine was 60.9% and 68.7% among women with CIN2 and CIN3, respectively, indicating that vaccination would have an impact both in HIV-negative and HIV-positive South African women, although it will not provide full protection in preventing HPV infection and cervical cancer lesions.

Normal pregnancy is characterized by a mild systemic inflammatory response and progressive increase in serum inflammatory cytokines that peak in the third trimester. During pregnancy pre-existing inflammatory conditions, acquired oxidative stress arising from the placenta malfunction and nutritional deficiencies can trigger intense systemic responses that lead to endothelial activation, dysfunction and preeclampsia. We investigated the principal nutritional, oxidative and inflammatory pathways that trigger the clinical manifestation of preeclampsia. This case-control study included 250 women with preeclampsia and 150 normotensive pregnant women. Urinary Iodine concentration (IUC) and serum levels of Ferritin, Thyroid-stimulating Hormone (TSH), selenium, Nitric Oxide (NO) gamma glutamyl transferase (GGT), Rheumatoid factor, and high sense C-reactive protein (hs-CRP) of cases and controls were compared using the student’s t and the Mann-Whitney U tests. Principal component analysis was carried out to delineate the patterns of association between nutritional, inflammatory and oxidative markers and preeclampsia. The main pathophysiological pathways identified were the interactions between selenium/iodine deficiency and elevated serum TSH (endothelial dysfunction); serum ferritin, GGT, CRP and low urinary iodine concentration (inflammatory oxidative stress); elevated serum hs-CRP and Rheumatoid factor subclinical inflammation and immune cell activation) and high T3/T4 ratio (acute TSH stimulation of thyroid with low thyroid iodine stores) Combined selenium and iodine deficiency resulting into elevated TSH, low NO and preferential T3 secretion; acute inflammatory conditions associated with elevated serum GGT, CRP, and Ferritin; and subclinical inflammatory conditions characterized by autoimmunity are some of the major oxidant and inflammatory pathways associated with increased risk of preeclampsia.

Background South African women of reproductive age have a high burden of sexually transmitted infections (STIs), including human papillomavirus (HPV) infection. However, there is limited information on the prevalence of sexually transmitted pathogens in women from rural Eastern Cape Province, South Africa. The study aims at determining the prevalence of sexually transmitted pathogens and co-infection with high-risk (HR) HPV among women from rural Eastern Cape Province, South Africa. Methods A total of 205 cervical specimens were collected from women aged ≥ 30 years from a rural community-based clinic. The samples were tested for a panel of pathogenic STIs [Chlamydia trachomatis (serovars A-K & L1-L3), Haemophilus ducreyi, Herpes Simplex Virus (Types 1 & 2), Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis (TV), and pathobionts [Mycoplasma genitalium (MG), Mycoplasma hominis (MH) and Ureaplasma spp. (UP)] using a multiplex PCR STD direct flow chip assay through a manual Hybrispot platform (Master Diagnostica, Granada, Spain). HR-HPV detection was performed by Hybrid Capture-2 assay. Results High-risk HPV prevalence was 32.2% (66/205) and HIV-1 prevalence was 38.5% (79/205). The overall prevalence of six pathogenic STIs was 22.9% (47/205), with TV having the highest prevalence (15.6%; 32/205). UP (70.2%, 144/205) and MH (36.6%, 75/205) were the most frequently detected pathobionts. Co-infection with ≥ 2 pathogens pathobionts was observed among 52.7% (108/205) participants. Of the six pathogenic STIs, three participants had more than one STI (1.46%) with the presence of MH and UP. HSV-2 (OR: 4.17, CI [1.184–14.690]) and HIV infection (OR: 2.11, CI [1.145–3.873]) were independent STIs associated with HR-HPV infection. Conclusions The high prevalence of pathogenic STIs underscores the need to improve syndromic management policy by implementing effective strategies of prevention, screening tests, and management. HSV-2 and HIV positive remain strongly associated with HR-HPV infection.

BACKGROUND:Preeclampsia and hypothyroidism are associated with endothelial dysfunction. Iodine deficiency is a risk factor for subclinical hypothyroidism in pregnancy. However, there is a paucity of data on the relationship between iodine nutrition state in pregnancy, the degree of endothelial dysfunction, and the risk of preeclampsia. METHODS:Ninety-five normotensive pregnant women, 50 women with preeclampsia with no severe features, and 50 women with severe preeclampsia were enrolled into the current study from the maternity units of Nelson Mandela Academic Hospital and Mthatha Regional Hospitals in Eastern Cape Province, South Africa. Urinary iodine concentration (UIC), serum markers of thyroid function, aortic augmentation index, and pulse wave velocity (PWV) were compared. RESULTS:Median UIC was 167.5, 127.7, and 88.5 µg/L, respectively for normotensive pregnant women, those with preeclampsia and severe preeclampsia (p = .150). Participants with severe preeclampsia had significantly higher median thyroid-stimulating hormone (TSH) and oxidized LDL than normotensive and preeclamptic women without severe features (respectively 3.0, 2.3, and 2.3 IU/L; 1.2, 1.0, and 1.0 IU/L, p < .05). The median Aortic augmentation index was 7.5, 19.0, and 21.0 (p < .001), and the pulse wave velocity 5.1, 5.7, and 6.3, respectively for normotensive, preeclampsia, and severe preeclampsia participants (both p < .001). In linear regressions, TSH, age, and hypertensive disease were independent predictors of elevated PWV. CONCLUSION:Upper normal-range TSH levels in women with severe preeclampsia were associated with markers of endothelial dysfunction. The low UIC and trend towards the elevation of thyroglobulin suggest that inadequate iodine intake may have increased TSH levels and indirectly caused endothelial dysfunction.

Supplemental Digital Content is available in the text Objective: The cervical mucus plugs are enriched with proteins of known immunological functions. We aimed to characterize the anti-HIV-1 activity of the cervical mucus plugs against a panel of different HIV-1 strains in the contexts of cell-free and cell-associated virus. Design: A cohort of consenting HIV-1-negative and HIV-1-positive pregnant women in labour was recruited from Mthatha General Hospital in the Eastern Cape province of South Africa, from whom the cervical mucus plugs were collected in 6 M guanidinium chloride with protease inhibitors and transported to our laboratories at −80 °C. Methods: Samples were centrifuged to remove insoluble material and dialysed before freeze--drying and subjecting them to the cell viability assays. The antiviral activities of the samples were studied using luminometric reporter assays and flow cytometry. Time-of-addition and BlaM-Vpr virus-cell fusion assays were used to pin-point the antiviral mechanisms of the cervical mucus plugs, before proteomic profiling using liquid chromatography-tandem mass spectrometry. Results: The proteinaceous fraction of the cervical mucus plugs exhibited anti-HIV-1 activity with inter-individual variations and some degree of specificity among different HIV-1 strains. Cell-associated HIV-1 was less susceptible to inhibition by the potent samples whenever compared with the cell-free HIV-1. The samples with high antiviral potency exhibited a distinct proteomic profile when compared with the less potent samples. Conclusion: The crude cervical mucus plugs exhibit anti-HIV-1 activity, which is defined by a specific proteomic profile.

AbstractObjective:To assess the burden of iodine deficiency in pregnancy in Africa using estimated pregnancy median urinary iodine concentration (pMUIC).Design:pMUIC for each African country was estimated using a regression equation derived by correlating the school-age children (SAC) median UIC (mUIC) and pMUIC from countries around the globe, and the SAC mUIC data for African countries obtained from the Iodine Global Network (IGN) 2017 and 2019 Score cards.Setting:Iodine deficiency was endemic in many African countries before the introduction of iodine fortification, mainly through universal salt iodisation programmes about 25 years ago. There is a scarcity of data on the level of iodine nutrition in pregnancy in Africa. Women living in settings with pMUIC below 150 µg/l are at risk of iodine deficiency-related pregnancy complications.Participants:Fifty of the fifty-five African countries that had data on iodine nutrition status.Results:A cut-off school age mUIC ≤ 175 µg/l is correlated with insufficient iodine intake in pregnancy (pregnancy mUIC ≤ 150 μg/l). Twenty-two African countries had SAC mUIC < 175 μg/l, which correlated with insufficient iodine intake during pregnancy (pMUIC < 150 μg/l). However, nine of these twenty-two countries had adequate iodine intake based on SAC mUIC.Conclusions:There is likely a high prevalence of insufficient iodine intake in pregnancy, including in some African countries classified as having adequate iodine intake in the general population. A SAC mUIC ≤ 175 µg/l predicts insufficient iodine intake among pregnant women in these settings.