A retrospective case study in Brazil examines whether the Zika virus has ties to a birth defect other than microcephaly. Also, the USPSTF issues recommendations on screening for genital herpes. Plus: Does soy reduce the risk of diabetes and heart disease in women with PCOS?
In addition to microcephaly, the Zika virus’s impact on the fetal brain may be linked to arthrogryposis, congenital contracture of joints, according to results of a small new study published in the BMJ.
For the retrospective case series, researchers reviewed records from children seen at the Association for Assistance of Disabled Children in the Pernambuco state in Brazil. Seven children with arthrogryposis and a diagnosis of a congenital infection, which was presumed to be Zika virus contracted during the Brazilian microcephaly epidemic, were identified. Clinical, radiologic, and electromyographic findings were assessed for likely correlations between clinical and primary neurologic abnormalities.
In all 7 children, brain images were consistent with congenital infection and arthrogryposis. In 2 children, testing of cerebrospinal fluid was positive for immunoglobulin M to Zika virus. Arthrogryposis was present in the arms and legs of 6 children and in 1 child’s legs. All 7 children had bilateral dislocation on radiography and 3 children had subluxation of the knee, which was bilateral in 2 of them. No evidence of joint abnormalities was found on high-definition ultrasonography.
Computed tomography (CT) and magnetic resonance imaging (MRI) were performed on 5 of the children’s brains and the other 2 received CT brain scans. Each child had calcifications, predominantly in the cortex and subcortical white matter, reduction in brain volume, ventriculomegaly, hypoplasia of the brainstem and cerebellum, and malformations of cortical development. Spine MRIs of 4 children showed apparent thinning of the cord and reduced ventral roots.
The researchers concluded that congenital Zika infection should be added to the differential diagnosis for arthrogryposis. The findings showed that the arthrogryposis was not related to abnormalities in the joints themselves, but rather, to tropism of neurons or to vascular disorders.
USPSTF recommends against genital herpes screening
The US Preventive Services Task Force (USPSTF) has issued draft recommendations that advocate against routinely screening asymptomatic adolescents and adults for genital herpes. Harms of the screening, the panel says, outweigh benefits in this population-including pregnant women.
The public is encouraged to comment online on the draft, which is consistent with and updates USPSTF’s 2005 recommendation, through 8 p.m. on August 29. The findings are based on a systematic evidence review of the accuracy, benefits, and harms of serologic screening for HSV-2 in asymptomatic adolescents and adults. The panel also considered the effectiveness and harms of preventive medications and behavioral interventions in this population as a way to reduce symptomatic episodes and transmission to sexual partners and infants.
Examining the accuracy of screening tests for HSV-2, USPSTF found that HerpeSelect, the most widely available US Food and Drug Administration-approved test, has sensitivity of 99% (95% CI, 97 to 100) and specificity of 83% (95% CI, 72 to 91). BioKit, the second test, has sensitivity of 84% (95% CI, 73 to 91) and specificity of 95% (95% CI, 93 to 97). The positive predictive value of HerpeSelect may be as low as 50% and for BioKit may be as low as 75%. One out of 2 positive results on the tests, noted USPSTF, may be false-positive.
The randomized, double-blind, placebo-controlled trial included 70 women aged 18 to 40 who had been diagnosed with PCOS according to Rotterdam criteria. They were randomized to receive either 50 mg/d of soy isoflavones (n = 35) or placebo (n = 35) for 12 weeks. At baseline and after the 12 weeks, oxidative stress, inflammation, endocrine, and metabolic biomarkers were quantified.
The researchers found that those in the soy isoflavone group had significantly decreased circulating serum levels of insulin (−1.2 ± 4.0 vs +2.8 ± 4.7 μ IU/mL; P < .001) and insulin resistance (−0.3 ± 1.0 vs +0.6 ± 1.1; P < .001) and increased quantitative insulin sensitivity (+0.0009 ± 0.01 vs −0.01 ± 0.03; P = .01). In addition, soy significantly reduced the free androgen index (−0.03 ± 0.04 vs +0.02 ± 0.03; P < .001) and levels of serum triglycerides (−13.3 ± 62.2 vs +10.3 ± 24.5 mg/dL; P = .04) when compared to placebo. Taking soy also was associated with a significant increase in plasma total glutathione (+96.0 ± 102.2 vs +22.7 ± 157.8 μ mol/L; P = .04) and a decrease in malondialdehyde levels (−0.7 ± 0.8 vs +0.8 ± 2.3 μ mol/L; P = .001). Soy was not observed to have a significant effect on other lipid profiles or inflammatory and oxidative stress markers.
The researchers concluded that soy isoflavone consumption in women with PCOS can significantly improve markers linked to diabetes and heart disease.