Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Influence of metal-support interaction on nitrate hydrogenation over Rh and Rh-Cu nanoparticles dispersed on Al2O3 and TiO2 supports

Well-defined Rh and Rh-Cu nanoparticles (NP's) of 1.6 nm and 1.3 nm, respectively, were synthesized by alkaline polyol method and then dispersed on insulating (Al2O3) and semiconducting (TiO2) supports. Both colloidal NP's and supported NP's were characterized using various experimental methods (TEM, XPS, XRD, etc.) to gather information about their specific morphology, structure and chemical state. The effects of size and support on the catalytic behavior of NP's for nitrate hydrogenation reaction were analyzed. Oxide supports, especially TiO2, were found to have a strong positive effect on the catalytic activity of metallic NP's. The non-supported, colloidal, Rh and Rh-Cu NP's are either inactive or posses very low hydrogenation activity. For supported materials, the intimate contact between two metals (i.e. Rh-Cu) is required to attain good hydrogenation activity. The strong metal-support interaction, induced by hydrogen spillover, is a key point in determining hydrogenation activity. The Rh-Cu NP's dispersed on TiO2 are extremely active for NO3− and NO2− (intermediate) deep hydrogenation, with high selectivity for NH4+. The hydrogenation activity of Rh-Cu NP's supported on Al2O3 is hindered considerably, the main products of NO3− hydrogenation being NO2− intermediate

ARRHYTHMIAS IN ACUTE AND PERSISTENT DEPRESSION IN PATIENTS WITH MYOCARDIAL INFARCTION

ABSTRACT. Acute and persistent depression is recognized as a risk factor for coronary artery disease. Significant depressive symptoms are found in 40-65 percent of patients with myocardial infarction. Depression is often persistent and exacerbates cardiac symptoms. It increases the frequency of arrhythmias, angina, morbidity and mortality (through sudden cardiac death). The therapy with serotonin reuptake inhibitor antidepressants improves depression and has favorable effects on the severity of cardiovascular symptoms, on morbidity and mortality. Keywords: acute and persistent depression, arrhythmias, myocardial infarction. REZUMAT. Depresia acută și persistentă este recunoscută ca un factor de risc pentru boala coronariană. La aproximativ 40-65% dintre pacienţii cu infarct miocardic, identificăm simptome semnificative de depresie. Depresia este frecvent persistentă și exacerbează simptomele cardiace. Crește frecvenţa aritmiilorși a anginei, morbiditatea și mortalitatea (prin moarte subită). Terapia cu antidepresive, de tipul inhibitorilor recaptării serotoninei, ameliorează depresia și are efect favorabil asupra simptomelor cardiovasculare, a morbidităţii și a mortalităţii. Cuvinte cheie: depresie acută și pesistentă, aritmii, infarct miocardic