Pregnancy and COVID-19: The Possible Contribution of Vitamin D

Background: Vitamin D deficiency has been associated with the severity of COVID-19. The role of vitamin D in pregnant women with COVID-19 has been poorly investigated to date. The aim of this study was to evaluate the influence of vitamin D in affecting some clinical features in pregnancy between SARS-CoV-2 positive and negative patients. Methods: Vitamin D pathway related polymorphisms and 25-hydroxyvitamin D levels were quantified in pregnant women followed from the first to the third trimester of pregnancy. Vitamin D deficiency was considered with values ≤ 30 ng/mL. Results: In total, 160 women were enrolled: 23 resulted positive for at least one SARS-CoV-2 related test (molecular swab or antibody tests). Vitamin D-associated polymorphisms were able to affect vitamin D levels in SARS-CoV-2 negative and positive subjects: remarkably, all the VDR TaqICC genotype patients were negative for SARS-CoV-2. In a sub-population (118 patients), vitamin D levels correlated with pregnancy-related factors, such as alpha-fetoprotein levels. Third-trimester vitamin D levels were lower in preterm births compared to full-term pregnancy: this trend was highlighted for SARS-CoV-2 positive patients. Conclusions: This is the first study demonstrating a role of vitamin D in affecting the clinical characteristics of pregnant women during the COVID-19 era. Further studies in larger and different cohorts of patients are required to confirm these findings

Sulfatase modifying factor 1–mediated fibroblast growth factor signaling primes hematopoietic multilineage development

Self-renewal and differentiation of hematopoietic stem cells (HSCs) are balanced by the concerted activities of the fibroblast growth factor (FGF), Wnt, and Notch pathways, which are tuned by enzyme-mediated remodeling of heparan sulfate proteoglycans (HSPGs). Sulfatase modifying factor 1 (SUMF1) activates the Sulf1 and Sulf2 sulfatases that remodel the HSPGs, and is mutated in patients with multiple sulfatase deficiency. Here, we show that the FGF signaling pathway is constitutively activated in Sumf1−/− HSCs and hematopoietic stem progenitor cells (HSPCs). These cells show increased p-extracellular signal-regulated kinase levels, which in turn promote β-catenin accumulation. Constitutive activation of FGF signaling results in a block in erythroid differentiation at the chromatophilic erythroblast stage, and of B lymphocyte differentiation at the pro–B cell stage. A reduction in mature myeloid cells and an aberrant development of T lymphocytes are also seen. These defects are rescued in vivo by blocking the FGF pathway in Sumf1−/− mice. Transplantation of Sumf1−/− HSPCs into wild-type mice reconstituted the phenotype of the donors, suggesting a cell autonomous defect. These data indicate that Sumf1 controls HSPC differentiation and hematopoietic lineage development through FGF and Wnt signaling

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6+/-9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; pPeer reviewe

Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection.

OBJECTIVES: To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS-CoV-2 infection. METHODS: This was a multinational retrospective cohort study including women with a singleton pregnancy and laboratory-confirmed SARS-CoV-2 infection, conducted in 72 centers in 22 different countries in Europe, the USA, South America, Asia and Australia, between 1 February 2020 and 30 April 2020. Confirmed SARS-CoV-2 infection was defined as a positive result on real-time reverse-transcription polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit (ICU), use of mechanical ventilation and death. RESULTS: In total, 388 women with a singleton pregnancy tested positive for SARS-CoV-2 on RT-PCR of a nasopharyngeal swab and were included in the study. Composite adverse maternal outcome was observed in 47/388 (12.1%) women; 43 (11.1%) women were admitted to the ICU, 36 (9.3%) required mechanical ventilation and three (0.8%) died. Of the 388 women included in the study, 122 (31.4%) were still pregnant at the time of data analysis. Among the other 266 women, six (19.4% of the 31 women with first-trimester infection) had miscarriage, three (1.1%) had termination of pregnancy, six (2.3%) had stillbirth and 251 (94.4%) delivered a liveborn infant. The rate of preterm birth before 37 weeks' gestation was 26.3% (70/266). Of the 251 liveborn infants, 69/251 (27.5%) were admitted to the neonatal ICU, and there were five (2.0%) neonatal deaths. The overall rate of perinatal death was 4.1% (11/266). Only one (1/251, 0.4%) infant, born to a mother who tested positive during the third trimester, was found to be positive for SARS-CoV-2 on RT-PCR. CONCLUSIONS: SARS-CoV-2 infection in pregnant women is associated with a 0.8% rate of maternal mortality, but an 11.1% rate of admission to the ICU. The risk of vertical transmission seems to be negligible. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

Is it possible to combine a career in sport with the mother role?

reservedNella mia tesi parlerò di come le atlete di alto livelllo (che fanno del loro sport il loro lavoro) riescano a gestire il loro ruolo di madre e di come questo possa essere visto o come un arriccimento della loro carriera o come un impedimento. La parte iniziale sarà incentrata maggiormente sulle definizioni che si sono susseguite nel tempo di "lavoratore sportivo" e di come venga gestita la maternità delle atlete a livello normativo. Nella seconda parte, di stampo più psicologico, mi concentrerò sul definire il concetto di materità e di come le atlete vivano la maternità o l'idea di diventare madri in base al tipo di sport che praticano. Nell'ultima parte cercherò di parlare di alcuni casi specifici "lavoratrici sportive".In this article I will talk about how high-level athletes (who make their sport their job) can manage their role as a mother and how this can be seen or as an enrichment of their career or as an impediment. The initial part will focus more on the definitions that have followed in the time of "sports worker" and how the motherhood of athletes is managed at the regulatory level. In the second part, more psychological, I will focus on defining the concept of materiality and how athletes live motherhood or the idea of becoming mothers according to the type of sport they practice. In the last part I will try to talk about some specific cases "sports workers"

No association between the degree of liver steatosis and early signs of vasculopathy in T2DM.

Non alcoholic fatty liver disease (NAFLD) is both an independent and an associated risk factor for cardiovascular (CV) disease in the general population [1]. Whereas the association between NAFLD, and early signs of vasculopathy, such as an increased intima-media thickness (IMT) and a decreased flow-mediated vasodilation (FMD), has been reported in the general population, such an association in type 2 diabetes mellitus (T2DM) is controversial. In T2DM patients with NAFLD FMD was decreased [2], whereas IMT was not different, with respect to patients without liver steatosis [3]. Should a (causative) relationship between hepatic steatosis and early signs of vasculopathy exists, the degree of liver fat should be associated with a worse endothelial function and morphology. However, despite the bulk of data generated on this complex association, insufficient reports exist on T2DM. To this aim, we measured the extent of liver fat, average IMT, the presence and type of carotid plaques, and FMD, in sixty consecutive T2DM patients largely affected by features of the MS. Liver steatosis, IMT, and presence and types of carotid plaques, were evaluated by ultrasonography (using an HDI 5000 Philips Medical Systems apparatus, Bothell, WA, USA), with a broad-band width phased array transducer (2–5 MHz). Steatosis was divided into four classes following the traditional US classification (class 0: absence; classes 1–3: increasing degrees, of steatosis) [4]. IMT was assessed using standard procedures [5]. FMD was evaluated in 45 patients using an internationally validated approach [6]. Only six patients were current smokers, and seven had a positive history for CV disease (five for ischemic heart disease, and two for cerebrovascular disease). No subject was positive for hepatitis C virus infection. The overall prevalence of steatosis was 88% (34% mild, 34% moderate e 20% severe). Average IMT was 0.88 ± 0.03 mm (Mean ± SE), significantly greater (p < 0.0001) than the mean value of a healthy, age- and sex matched population at our Institution (0.72 ± 0.03 mm). Fifty-eight percent of patients had carotid plaques. Average FMD in the patients (5.02 ± 0.81%) was lower (p < 0.001) than the normal values of healthy, age- and sex matched individuals from our Institution (6.56 ± 0.60%). Nevertheless, there was no difference, among the four classes of steatosis, in either FMD (class 0: 5.10 ± 0.89%; class 1: 4.97 ± 0.46%; class 2: 4.73 ± 0.40%; class 3: 5.25 ± 0.17%) (p = 0.543 by ANOVA), average IMT (0.82 ± 0.08; 0.93 ± 0.05; 0.85 ± 0.05; and 0.85 ± 0.06 mm, respectively; p = 0.760 by ANOVA), or the prevalence of carotid plaques (43; 70; 60 and 69% respectively, p = 0.644). In conclusion, in T2DM patients largely exhibiting features of the MS, the degree of liver steatosis is not associated with early signs of (sub)clinical atherosclerosis and altered vascular function. These data question the role of liver fat as a direct determinant of early signs of vasculopathy in T2DM. Alternatively, it is possible that the burden of cardiovascular risk factors already present in these T2DM patients, obscure the possible contribution given by the degree of steatosis, on early signs of arteriosclerosis

Immunofluorescence vs immunochemiluminescent methods: AIA 2000 vs Immulite 2000

The aim of this study was to evaluate the measurement of C-peptide, insulin, sex hormone binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEAS), tests of specific clinical value that are not frequently measured in routine clinical laboratories, carried out using an automated system, AIA 2000 (Tosoh). The obtained data demonstrated that the evaluated system, characterized by fluorescence system detector provides satisfactory analytical performance comparable to those of different instrument that use the well known and widely diffused chemiluminescent principle (Immulite 2000). These characteristics allow an excellent comparability between methods for the measurement of same specific hormones not frequently used in clinical practice