Non-invasive perinatal postmortem examination

Aim To evaluate the efficiency of non-invasive perinatal postmortem examination as an alternative option in Middle East countries where full autopsy is denied. The study prospectively compared the results obtained by the non-invasive postmortem techniques with that obtained by full autopsy. Subjects and methods Initially, there was an extensive literature review of the available methods of non-invasive postmortem examination as well as the different causes of fetal and perinatal deaths. The usefulness of these ideas and points were evaluated for the possibility of using them in Middle East Region. Fifty five cases of perinatal and fetal deaths, including cases terminated because of congenital abnormalities, were studied. The efficiency of non¬invasive techniques was assessed: these included review of the clinical record, external examination, body weight and measurements, radiological examination, placenta, cord, and membranes examination, as well as microscopic examination (fine needle aspiration, needle biopsy). Results In 50 out of 55 (91%) cases, full autopsy did not alter the specific diagnosis made by the non-invasive techniques. In the remaining 5 cases, full autopsy did provide extra information by disclosing further internal malformations and lesions that might have affected genetic counselling. For non-invasive microscopic examination, needle biopsy was superior to fine needle aspiration, and its validity could have been increased by using ultrasound needle biopsy guidance. Although full autopsy remains the method of choice for evaluating fetal and perinatal deaths, particularly in malformed cases, non-invasive perinatal postmortem techniques are collectively an excellent option, particularly in Middle East societies where full autopsy is restricted. Conclusion In Middle East countries, basic steps need to be taken in order to establish and promote a standardised protocol for perinatal postmortem examination. This will facilitate the identification of different causes of fetal and perinatal deaths in this region, so that prevention and proper counselling can be provided for the family

UWOMJ Volume 26, No 1, January 1956

Schulich School of Medicine & Dentistryhttps://ir.lib.uwo.ca/uwomj/1039/thumbnail.jp

LABRAD : Vol 47, Issue 1 - June 2022

Content From the Editor’s Desk LABRAD Star Contributors for the Year 2021 Clinical Relevance of Measuring Thyroid Stimulating Hormone Receptor Antibodies in Pregnancy and Newborns Aromatic l-amino Acid Decarboxylase (AADC) Deficiency- An Ultra-rare and Underdiagnosed Neurometabolic Disorder Role of Flowcytometry & Kleihauer - Betke Test in Detection and Quantification of Fetomaternal Hemorrhage Gestational Trophoblastic Diseases: An Overview Acrania-Exencephaly-Anencephaly Sequence/ Spectrum: Radiological Features on Antenatal Screening Minimally Invasive Tissue Sampling (MITS) A New Way to Investigate Cause of Death In Resource-constrained Countries Laboratory Guideline for Detection, Interpretation and Reporting of Maternal Cell Contamination (MCC) in Prenatal Analysis Molecular Analysis of Alpha Thalassemia by MLPA Study of DMD Gene for Exon/s Deletion/ Duplications by Multiplex Ligation-Dependent Probe Amplification in Prenatal Samples Best of the Recent Past New Tests in Clinical Laboratoryhttps://ecommons.aku.edu/labrad/1037/thumbnail.jp

Current issues in postmortem imaging of perinatal and forensic childhood deaths

Perinatal autopsy practice is undergoing a state of change with the introduction of evidence-based cross-sectional imaging, driven primarily by parental choice. In particular, the introduction of post mortem magnetic resonance imaging (PMMR) has helped to advance less-invasive perinatal autopsy in the United Kingdom (UK) and Europe. However, there are limitations to PMMR and other imaging techniques which need to be overcome, particularly with regard to imaging very small fetuses. Imaging is also now increasingly used to investigate particular deaths in childhood, such as suspected non-accidental injury (NAI) and sudden unexpected death in infancy (SUDI). Here we focus on current topical developments the field, with particular emphasis on the application of imaging to perinatal autopsy, and pediatric forensic deaths. Different imaging modalities and their relative advantages and disadvantages are discussed, together with other benefits of more advanced cross-sectional imaging which currently lie in the research domain. Whilst variations in local imaging service provision and need may determine different practice patterns, and access to machines and professionals with appropriate expertise and experience to correctly interpret the findings may limit current practices, we propose that gold standard perinatal and pediatric autopsy services would include complete PMMR imaging prior to autopsy, with PMCT in suspicious childhood deaths. This approach would provide maximal diagnostic yield to the pathologist, forensic investigator and most importantly, the parents

Digital Infrared Thermal Imaging and its use in Domestic and Non-Domestic Species

Digital infrared thermal imaging (DITI) is a non-invasive diagnostic technique that is used to detect symmetry and asymmetry of surface temperature gradients. DITI can examine many different aspects of thermal physiology and diagnose injury and disease. The objectives of this study were (1) to investigate the use of DITI to determine whether differences in temperature gradients exist between late gestation and non-pregnant mares, (2) to evaluate whether velvet antler (VA) temperature gradients, as measured by DITI would pattern VA growth, and (3) to determine if “normal” temperature gradients of the foot exist among elephants as detected using DITI. To investigate these objectives, three experiments were conducted to determine the value of DITI for research on mammals. Results obtained from the first study indicate DITI was able to detect pregnancy in the horse during late gestation. In the second study DITI successfully patterned the growth and hardening of VA. While in the third study DITI demonstrated its value as a tool to increase overall welfare for captive elephants. In summary these studies suggests that DITI may have value in conducting research with domestic and non-domestic species that are not able to be restrained

Digital Infrared Thermal Imaging and its use in Domestic and Non-Domestic Species

Digital infrared thermal imaging (DITI) is a non-invasive diagnostic technique that is used to detect symmetry and asymmetry of surface temperature gradients. DITI can examine many different aspects of thermal physiology and diagnose injury and disease. The objectives of this study were (1) to investigate the use of DITI to determine whether differences in temperature gradients exist between late gestation and non-pregnant mares, (2) to evaluate whether velvet antler (VA) temperature gradients, as measured by DITI would pattern VA growth, and (3) to determine if “normal” temperature gradients of the foot exist among elephants as detected using DITI. To investigate these objectives, three experiments were conducted to determine the value of DITI for research on mammals. Results obtained from the first study indicate DITI was able to detect pregnancy in the horse during late gestation. In the second study DITI successfully patterned the growth and hardening of VA. While in the third study DITI demonstrated its value as a tool to increase overall welfare for captive elephants. In summary these studies suggests that DITI may have value in conducting research with domestic and non-domestic species that are not able to be restrained

Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008

<p>Abstract</p> <p>Background</p> <p>Over the last decade, utilization of ultrasound technology by non-radiologist physicians has grown. Recent advances in affordability, durability, and portability have brought ultrasound to the forefront as a sustainable and high impact technology for use in developing world clinical settings as well. However, ultrasound's impact on patient management plans, program sustainability, and which ultrasound applications are useful in this setting has not been well studied.</p> <p>Methods</p> <p>Ultrasound services were introduced at two rural Rwandan district hospitals affiliated with Partners in Health, a US nongovernmental organization. Data sheets for each ultrasound scan performed during routine clinical care were collected and analyzed to determine patient demographics, which ultrasound applications were most frequently used, and whether the use of the ultrasound changed patient management plans. Ultrasound scans performed by the local physicians during the post-training period were reviewed for accuracy of interpretation and image quality by an ultrasound fellowship trained emergency medicine physician from the United States who was blinded to the original interpretation.</p> <p>Results</p> <p>Adult women appeared to benefit most from the presence of ultrasound services. Of the 345 scans performed during the study period, obstetrical scanning was the most frequently used application. Evaluation of gestational age, fetal head position, and placental positioning were the most common findings. However, other applications used included abdominal, cardiac, renal, pleural, procedural guidance, and vascular ultrasounds.</p> <p>Ultrasound changed patient management plans in 43% of total patients scanned. The most common change was to plan a surgical procedure. The ultrasound program appears sustainable; local staff performed 245 ultrasound scans in the 11 weeks after the departure of the ultrasound instructor. Post-training scan review showed the concordance rate of interpretation between the Rwandese physicians and the ultrasound-trained quality review physicians was 96%.</p> <p>Conclusion</p> <p>We suggest ultrasound is a useful modality that particularly benefits women's health and obstetrical care in the developing world. Ultrasound services significantly impact patient management plans especially with regards to potential surgical interventions. After an initial training period, it appears that an ultrasound program led by local health care providers is sustainable and lead to accurate diagnoses in a rural international setting.</p

Covid-19: Pulmonary and Extra-Pulmonary Manifestations

Introduction: The coronavirus disease-2019 (COVID-19) pandemic has been the most significant event in 2020, with ~86.8 million cases and 1.88 million deaths worldwide. It is a highly infectious disease, wherein the virus (severe acute respiratory syndrome coronavirus 2) rapidly multiplies and spreads to all parts of the body. Therefore, COVID-19 is not only respiratory disease but also a multisystem disease. Many people, including physicians, incorrectly believe that the disease affects only the respiratory tract. In this study, we aimed to describe COVID-19 manifestations and the underlying pathophysiology to provide the readers with a better understanding of this disease to achieve good management and to control the spread of this disease. Methods: Secondary data were obtained from PubMed, Google Scholar, and Scopus databases. The keywords used for the search were as follows: COVID-19, COVID-19 pulmonary manifestations, COVID-19 extra pulmonary manifestations, and pathophysiology of COVID-19. We collected secondary data from systemic reviews, metaanalyses, case series, and case reports in the form of public data that was published on websites of the government, medical corporations, medical peer-reviewed journals, and medical academies, all of which were indexed in PubMed, Google Scholar, or Scopus. Our questions were as follows: Is COVID-19 a respiratory disease only? and What are the extrapulmonary manifestations of COVID-19? Results: From our data, we found that a patient with COVID-19 may be either asymptomatic or symptomatic. Symptomatic cases may have either pulmonary or extrapulmonary manifestations. Pulmonary manifestations occur as mild, moderate, or severe cases. In mild and moderate cases, extrapulmonary manifestations such as gastroenteritis, fever, or vomiting may present alone. Some of these cases may be missed for diagnosis, and the patient may receive symptomatic treatment without a COVID-19 diagnosis, leading to increased spread of the infection. Extrapulmonary manifestations may occur in severe and critical cases as complications of severe infections (high viral overload) or the cytokine storm, such as in acute kidney injury (AKI), heart failure (HF), and venous thromboembolic (VTE) manifestation. Conclusion: COVID-19 is not a respiratory disease alone; rather, it is a multisystem disease. Pulmonary and extrapulmonary manifestations should be considered for early diagnosis and to control the spread of the infection

Maternal Intuition of Fetal Gender

Purpose: Fetal gender speculation is a preoccupation of many expecting parents, and pregnant women commonly profess to intuitively know the gender of their unborn babies. This study objectively compared pregnant mothers’ perceptions of fetal gender to sonographically proven gender determinations. Also, success rates from previously published studies, noninvasive prenatal testing and a myriad of gender determination methods were observed and reported for context. Methods: All pregnant women presenting for second-trimester screening ultrasound (at 17–23 weeks gestation) in the obstetrics department of a single health center were asked to participate. A medical sonographer described the ultrasound examination, obtained appropriate consent and medical history. Each mother was asked if she had any perception as to the fetal gender and her answer documented. Mothers who had foreknowledge of fetal gender were excluded. Frequencies of actual gender were compared with observed frequencies of the maternal prediction using chi-squared test. Results: Approximately 40% (n = 411) of our study population (N = 1,026) indicated having an intuition or perception of fetal gender. These women correctly predicted the gender of their babies 51% of the time (P = 0.6571). Women who expressed a “strong” degree of intuition (n = 53) fared better, accurately predicting fetal gender at a rate of 62%, though the difference in this smaller subcohort also failed to demonstrate statistical significance (P = 0.0741). Conclusions: Intuition of fetal gender is professed by almost half of mothers though, when present, is no better at accurately predicting fetal gender than flipping a coin

Association between preterm brain injury and exposure to chorioamnionitis during fetal life

Preterm infants are susceptible to inflammation-induced white matter injury but the exposures that lead to this are uncertain. Histologic chorioamnionitis (HCA) reflects intrauterine inflammation, can trigger a fetal inflammatory response, and is closely associated with premature birth. In a cohort of 90 preterm infants with detailed placental histology and neonatal brain magnetic resonance imaging (MRI) data at term equivalent age, we used Tract-based Spatial Statistics (TBSS) to perform voxel-wise statistical comparison of fractional anisotropy (FA) data and computational morphometry analysis to compute the volumes of whole brain, tissue compartments and cerebrospinal fluid, to test the hypothesis that HCA is an independent antenatal risk factor for preterm brain injury. Twenty-six (29%) infants had HCA and this was associated with decreased FA in the genu, cingulum cingulate gyri, centrum semiovale, inferior longitudinal fasciculi, limbs of the internal capsule, external capsule and cerebellum (p < 0.05, corrected), independent of degree of prematurity, bronchopulmonary dysplasia and postnatal sepsis. This suggests that diffuse white matter injury begins in utero for a significant proportion of preterm infants, which focuses attention on the development of methods for detecting fetuses and placentas at risk as a means of reducing preterm brain injury