Primary human cytomegalovirus (HCMV) infection occurring in pregnant women within 3 months before (preconceptional) or within 4 weeks after (periconceptional) the last menstrual period represents an as-yet-undefined risk to the fetus. One (9.1%) of 11 newborns born to 12 women with preconceptional infection was subclinically infected (1 aborted fetus was not examined for infection). Of 20 pregnancies in women with periconceptional infection, 7 were terminated before 12 weeks of gestation (aborted fetus was not examined), 1 was terminated at 23 weeks after prenatal diagnosis of congenital infection, and 12 continued to term. Of those 12, 3 resulted in newborns who were congenitally infected. Thus, in the periconceptional group, intrauterine transmission occurred in 4 (30.8%) of 13 pregnancies for which the virologic outcome was known. One newborn was symptomatic at birth, and disseminated HCMV infection was diagnosed in an aborted fetus. Periconceptional primary HCMV infection seems to bear a higher risk of unfavorable outcome than preconceptional infection, and counseling should be adjusted accordingly.

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Although a hypertension-related hypalgesia has been described, the relation between pain perception and the 24-hour blood pressure trend is still unknown. The ambulatory blood pressure monitoring parameters and dental pain sensitivity were correlated in 67 male subjects. The pulpar test (graded increase of test current of 0 to 0.03 mA) was performed on three healthy teeth, and mean dental pain threshold (occurrence of pulp sensation) and pain tolerance (time when the subjects asked for the test to be stopped) were evaluated. Three groups of subjects with normal (n = 34), intermediate (n = 13), and high (n = 20) blood pressure values were identified according to ambulatory monitoring results. Pain threshold differed among the three groups (P < .02), being higher in the group with highest blood pressure. The groups of hypertensive subjects showed higher pain tolerance than the normotensive group (P < .02). Pain threshold was correlated with 24-hour, diurnal, and nocturnal blood pressure values. Pain tolerance was also related to 24-hour blood pressure and to diurnal and nocturnal diastolic and mean arterial pressure values. Systolic and diastolic blood pressure loads were significantly associated with pain threshold, and diastolic load was also associated with tolerance. The blood pressure variability (SD) did not relate to pain perception. The 24-hour arterial pressure was more closely associated with pain perception than the blood pressure values obtained before the pulpar test. A close correlation between pain perception and 24-hour ambulatory blood pressure was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical evaluation of a novel fully automated chemiluminescence immunoassay for determination of immunoglobulin G avidity to human cytomegalovirus (HCMV) showed 92.8% sensitivity and 84.7% specificity in detecting a recent (<90 days) primary HCMV infection. The assay appears useful for accurately diagnosing recent primary HCMV infections.Human cytomegalovirus (HCMV) is the leading infectious agent causing mental retardation and deafness in newborns (14). Since symptomatic congenital infections are mostly due to intrauterine transmission following primary maternal infection (4), differential diagnosis of primary versus recurrent infection (or persistence of HCMV-specific immunoglobulin M [IgM] antibody) is crucial for correct counseling and management of pregnancy. The determination of IgG avidity has been shown to help in distinguishing primary from nonprimary HCMV infection (1,8,10), as low avidity values have been shown to be associated to recent primary HCMV infections. Indeed, determination of IgG avidity has become a key step in the algorithm for the interpretation of a positive IgM result in pregnant women (10).The aim of the study was the clinical evaluation of a fully automated chemiluminescence immunoassay for the determination of HCMV-specific IgG avidity (Liaison CMV IgG avidity assay) developed by DiaSorin, Saluggia, Italy.For this purpose, 413 sera obtained from 212 subjects were examined. The sera had been characterized previously and divided into the following groups: group A, including 167 sequential serum samples from 78 patients collected Յ90 (n ϭ 112), 91 to 180 (n ϭ 38), and Ͼ180 (n ϭ 17) days after the onset of primary HCMV infection; group B, including 56 serum samples from 17 pregnant women with persistent HCMVspecific IgM antibody; group C, including 87 sequential serum samples from 14 solid organ transplant recipients with recurrent HCMV infection; and group D, including 103 HCMV IgG-positive, IgM-negative serum samples from 49 pregnant women and 54 transplanted patients with past HCMV infection.Diagnosis of primary HCMV infection was based on the following criteria: seroconversion, decreasing levels of HCMVspecific IgM antibody, increasing levels of IgG antibody avidity, and detection of HCMV and HCMV products in blood. Dating of the onset was based on the presence of abnormal laboratory findings and/or clinical symptoms (10). Persistent IgM antibody was defined as stable IgM values for Ն3 months in the absence of serologic, virologic, or clinical data indicative of a recent primary HCMV infection in the mothers and of congenital infection in the relevant newborn babies. Congenital HCMV infection was diagnosed within the first 2 weeks of life by virus isolation from urine and virus detection in blood (7,12). Recurrent HCMV infection in transplanted patients was diagnosed by quantitative determination of pp65 antigenemia in peripheral blood leukocytes (5).Sera examined in the present study had been previously characterized for HCMV-specific IgG and IgM antibody by in-house-developed enz...