Amniotic Fluid Embolism. Is a New Pregnancy Possible? Case Report.

Amniotic fluid embolism (AFE) is a rare but potentially catastrophic clinical condition, characterized by a combination of signs and symptoms that reflect respiratory distress, cardiovascular collapse and disseminated intravascular coagulation (DIC). Its pathogenesis is still unclear. More recently, the traditional view of obstruction of pulmonary capillary vessels by amniotic fluid emboli as the main explanation for the etiology has been ruled out, and immunologic factors and the activation of the inflammatory cascade took on an important role. Amniotic fluid embolism has an unpredictable character, its diagnosis is exclusively clinical, and the treatment consists mainly of cardiovascular support and administration of blood products to correct the DIC. No diagnostic test is recommended until now, though multiple blood markers are currently being studied. The authors present a case report of a woman who had survived AFE in her previous pregnancy and had a subsequent pregnancy without recurrence, providing one more clinical testimony of the low risks for the pregnancy after AFE.info:eu-repo/semantics/publishedVersio

Prolonged Thrombocytopenia in a Child with Severe Neonatal Alloimmune Reaction and Noonan Syndrome

Fetomaternal alloimmune thrombocytopenia (FMAIT) caused by maternal antibodies is the leading cause of severe neonatal thrombocytopenia. A 1-month-old Caucasian girl was referred to our Hematology Clinic for persistent thrombocytopenia diagnosed after a bleeding episode. Diagnostic tests suggested FMAIT. Mild thrombocytopenia persisted for 18 months, and subsequent findings of dysmorphic facies, short stature and mild pulmonary stenosis led to the hypothesis of Noonan syndrome (NS), which was confirmed by genetic test. Other hematological abnormalities were excluded and she had no further bleeding episodes. This case illustrates the possibility of different diagnoses with the same clinical manifestations. The persistence of thrombocytopenia longer than expected associated with typical physical features led to the diagnosis of NS.info:eu-repo/semantics/publishedVersio

Importance of Primary Indications for Fetal Echocardiography Proposed by the Portuguese Health Department

Introdução: A malformação congénita mais frequente é a cardíaca, afectando cerca de 5-8 recém-nascidos/mil nados vivos. Actualmente é possível obter um diagnóstico pré-natal destas anomalias através do ecocardiograma fetal (EcoF), porém, porque os recursos em Saúde são limitados, este exame deve ser pedido de acordo com os critérios estabelecidos pela Direcção Geral de Saúde (DGS). Objectivos: Avaliar a importância dos critérios de referenciação propostos pela DGS para detecção de anomalias cardíacas. Determinar as taxas de prevalência e mortalidade nos fetos com doença cardíaca. Material e Métodos: Revisão casuística de uma amostra de 733 fetos aos quais foi realizado EcoF em consulta de Cardiologia Pré-natal num centro terciário de Cardiologia Pediátrica, no período de 2006 a 2008. Foram avaliados dados demográficos, motivo de referenciação (MR), resultados da EcoF e evolução. Classificámos os MR em dois grupos: (I) concordantes com as indicações da DGS- causas major (familiar, materna, fetal) e causas minor (outras situações); (II) não concordantes. Resultados: Realizaram-se 871 EcoF a 705 grávidas. A mediana da idade materna foi de 32 anos (15-45 anos) e a média da idade gestacional foi de 26 semanas (±4 sem). O grupo I incluiu 89% das grávidas. Identificaram-se 52 fetos (7%) com anomalias cardíacas: 42 estruturais, 8 de ritmo e 2 derrames pericárdicos. Estas anomalias distribuíram-se da seguinte forma: grupo I - causa familiar (3), causa materna (3), causa fetal (39), causas minor (5) e no grupo II (2). Observou-se um maior número de anomalias cardíacas no grupo I (6,8% vs 0,3%) (p> 0.05), sobretudo nos fetos referenciados por causa fetal (p<0,05). Perderam-se no controlo evolutivo 10 casos positivos, realizaram-se 3 interrupções médicas da gravidez e ocorreram 3 mortes. Mantêm-se em seguimento na consulta de Cardiologia Pediátrica 11 casos positivos. Conclusões: Na maioria dos casos cumpriram-se os critérios de referenciação da DGS, no entanto não se observou uma diferença estatisticamente significativa na prevalência de anomalias cardíacas fetais nas grávidas com e sem factores de risco. A causa fetal foi a que melhor se correlacionou com a presença de anomalia cardíaca. A prevalência destas anomalias e a taxa de mortalidade aferida na amostra pode estar subestimada por perda de casos positivos no controlo evolutivo

Accidents in Children and Adolescents: What Context and What Approach? A Nine-Month Experience at the Emergency Department of a Level II Hospital

Introdução: Os acidentes constituem uma importante causa de morbimortalidade infantil e de recurso ao serviço de urgência pediátrica. A nível nacional conhecem-se apenas alguns dados epidemiológicos. Métodos: Estudo observacional transversal com análise da coorte das crianças observadas no serviço de urgência pediátrica de um hospital nível II por motivo de acidente, durante um período de nove meses, com dados obtidos através de um inquérito e submetidos a análise estatística. Resultados: Das 22502 admissões de crianças até aos 14 anos registadas, 1746 (7,8%) foram por acidentes. A maioria era do sexo masculino e tinha mais de 5 anos. Os acidentes ocorreram maioritariamente no exterior da escola (29,1%) e interior de casa (25%), predominando a queda como tipo de acidente (55,5%) e a contusão como mecanismo de lesão (54,2%). A maioria das crianças (77,3%) foi submetida a exames complementares de diagnóstico destacando-se os radiológicos. Os diagnósticos mais frequentes foram os traumatismos superficiais (47,9%) e os ferimentos (24,8%). Em 6,6% (115) dos casos os acidentes foram considerados graves. Estas admissões por acidentes associaram-se a uma despesa imediata estimada de 124 mil euros. Discussão: A frequência elevada e o local de ocorrência dos acidentes coincidiram com a literatura. Apesar do predomínio das lesões minor superficiais (47,9%) verificou-se um número significativo de crianças com necessidade de cuidados hospitalares. Não foram registados óbitos. Os autores concluem que os acidentes em crianças foram um motivo frequente de ida ao serviço de urgência pediátrica com importante consumo de recursos. A sensibilização dos cuidadores é essencial na prevenção dos acidentes

Minimizing follow-up for space-based transit surveys using full lightcurve analysis

One of the biggest challenges facing large transit surveys is the elimination of false-positives from the vast number of transit candidates. We investigate to what extent information from the lightcurves can identify blend scenarios and eliminate them as planet candidates, to significantly decrease the amount of follow-up observing time required to identify the true exoplanet systems. If a lightcurve has a sufficiently high signal-to-noise ratio, a distinction can be made between the lightcurve of a stellar binary blended with a third star and the lightcurve of a transiting exoplanet system. We perform simulations to determine what signal-to-noise level is required to make the distinction between blended and non-blended systems as function of transit depth and impact parameter. Subsequently we test our method on real data from the first IRa01 field observed by the CoRoT satellite, concentrating on the 51 candidates already identified by the CoRoT team. About 70% of the planet candidates in the CoRoT IRa01 field are best fit with an impact parameter of b>0.85, while less than 15% are expected in this range considering random orbital inclinations. By applying a cut at b<0.85, meaning that ~15% of the potential planet population would be missed, the candidate sample decreases from 41 to 11. The lightcurves of 6 of those are best fit with such low host star densities that the planet-to-star size ratii imply unrealistic planet radii of R>2RJup. Two of the five remaining systems, CoRoT1b and CoRoT4b, have been identified as planets by the CoRoT team, for which the lightcurves alone rule out blended light at 14% (2sigma) and 31% (2sigma). We propose to use this method on the Kepler database to study the fraction of real planets and to potentially increase the efficiency of follow-up.Comment: 13 pages, 11 figures, 2 tables. Accepted for publication in A&

The Photoeccentric Effect and Proto-Hot Jupiters I. Measuring photometric eccentricities of individual transiting planets

Exoplanet orbital eccentricities offer valuable clues about the history of planetary systems. Eccentric, Jupiter-sized planets are particularly interesting: they may link the "cold" Jupiters beyond the ice line to close-in hot Jupiters, which are unlikely to have formed in situ. To date, eccentricities of individual transiting planets primarily come from radial velocity measurements. Kepler has discovered hundreds of transiting Jupiters spanning a range of periods, but the faintness of the host stars precludes radial velocity follow-up of most. Here we demonstrate a Bayesian method of measuring an individual planet's eccentricity solely from its transit light curve using prior knowledge of its host star's density. We show that eccentric Jupiters are readily identified by their short ingress/egress/total transit durations -- part of the "photoeccentric" light curve signature of a planet's eccentricity --- even with long-cadence Kepler photometry and loosely-constrained stellar parameters. A Markov Chain Monte Carlo exploration of parameter posteriors naturally marginalizes over the periapse angle and automatically accounts for the transit probability. To demonstrate, we use three published transit light curves of HD 17156 b to measure an eccentricity of e = 0.71 +0.16/-0.09, in good agreement with the discovery value e = 0.67+/-0.08 based on 33 radial-velocity measurements. We present two additional tests using actual Kepler data. In each case the technique proves to be a viable method of measuring exoplanet eccentricities and their confidence intervals. Finally, we argue that this method is the most efficient, effective means of identifying the extremely eccentric, proto hot Jupiters predicted by Socrates et al. (2012).Comment: ApJ, 756, 122. Received 2012 April 5; accepted 2012 July 9; published 2012 August 2

Possible Disintegrating Short-Period Super-Mercury Orbiting KIC 12557548

We report here on the discovery of stellar occultations, observed with Kepler, that recur periodically at 15.685 hour intervals, but which vary in depth from a maximum of 1.3% to a minimum that can be less than 0.2%. The star that is apparently being occulted is KIC 12557548, a K dwarf with T_eff = 4400 K and V = 16. Because the eclipse depths are highly variable, they cannot be due solely to transits of a single planet with a fixed size. We discuss but dismiss a scenario involving a binary giant planet whose mutual orbit plane precesses, bringing one of the planets into and out of a grazing transit. We also briefly consider an eclipsing binary, that either orbits KIC 12557548 in a hierarchical triple configuration or is nearby on the sky, but we find such a scenario inadequate to reproduce the observations. We come down in favor of an explanation that involves macroscopic particles escaping the atmosphere of a slowly disintegrating planet not much larger than Mercury. The particles could take the form of micron-sized pyroxene or aluminum oxide dust grains. The planetary surface is hot enough to sublimate and create a high-Z atmosphere; this atmosphere may be loaded with dust via cloud condensation or explosive volcanism. Atmospheric gas escapes the planet via a Parker-type thermal wind, dragging dust grains with it. We infer a mass loss rate from the observations of order 1 M_E/Gyr, with a dust-to-gas ratio possibly of order unity. For our fiducial 0.1 M_E planet, the evaporation timescale may be ~0.2 Gyr. Smaller mass planets are disfavored because they evaporate still more quickly, as are larger mass planets because they have surface gravities too strong to sustain outflows with the requisite mass-loss rates. The occultation profile evinces an ingress-egress asymmetry that could reflect a comet-like dust tail trailing the planet; we present simulations of such a tail.Comment: 14 pages, 7 figures; submitted to ApJ, January 10, 2012; accepted March 21, 201

ACME Stellar Spectra. I. Absolutely Calibrated, Mostly Empirical Flux Densities of 55 Cancri and its Transiting Planet 55 Cancri e

The ACME Spectra project provides absolutely calibrated, mostly empirical spectra of exoplanet host stars for use in analysis of the stars and their planets. Spectra are obtained from ground-based telescopes and are tied directly to calibrated ground- and space-based photometry. The spectra remain only "mostly" empirical because of telluric absorption, but interpolation of stellar models over the gaps in wavelength coverage provides continuous stellar spectra. Among other uses, the spectra are suitable for precisely converting observed secondary eclipses (occultations) into absolute flux units with minimal recourse to models. In this letter I introduce ACME's methods and present a calibrated spectrum of the nearby, super-Earth hosting star 55 Cancri that spans the range from 0.81-5.05 micron. This spectrum is well-suited for interpreting near- and thermal-infrared eclipse observations. With this spectrum I show that the brightness temperature of the small, low-mass transiting planet 55 Cnc e is 1950 +260/-190 K at 4.5 micron (cooler than previously reported), which corresponds to a planetary flux of 0.44 +0.12/-0.08 mJy. This result suggests the planet has some combination of a nonzero albedo, a moderately efficient redistribution of absorbed stellar irradiation, and/or an optically thick atmosphere, but more precise eclipse measurements are required to distinguish between these scenarii.Comment: Accepted to A&A. 6 pages, 1 figure, 1 electronic table. See http://irtfweb.ifa.hawaii.edu/~spex/IRTF_Spectral_Library/ for an alternative spectru

A transiting companion to the eclipsing binary KIC002856960

We present an early result from an automated search of Kepler eclipsing binary systems for circumbinary companions. An intriguing tertiary signal has been discovered in the short period eclipsing binary KIC002856960. This third body leads to transit-like features in the light curve occurring every 204.2 days, while the two other components of the system display eclipses on a 6.2 hour period. The variations due to the tertiary body last for a duration of \sim1.26 days, or 4.9 binary orbital periods. During each crossing of the binary orbit with the tertiary body, multiple individual transits are observed as the close binary stars repeatedly move in and out of alignment with the tertiary object. We are at this stage unable to distinguish between a planetary companion to a close eclipsing binary, or a hierarchical triply eclipsing system of three stars. Both possibilities are explored, and the light curves presented.Comment: Accepted into A&A Letters (5 pages & 3 figures

Variability of Southern T Tauri Stars I: The Continuum and the Hβ\beta Inverse PCygni Profile of GQ LUPI

We present time series spectrophotometric observations of GQ Lupi, a typical representative of the YY Ori subgroup of T Tauri stars that show conspicuous inverse PCygni profiles. The data set consists of 32 exposures taken over 5 and 8 consecutive nights of May and July 1998, respectively, and covers the spectral range of 3100 \AA~ $< \lambda < 5100$ \AA. The region redward and next to the Balmer jump varies significantly on a night-to-night basis and the amplitude of such variability decreases sharply at $\lambda >$ 4600 \AA. The Balmer continuum slope indicates that the spectral energy distribution is governed by a gas of temperature greater than that of the stellar photosphere. We find an anticorrelation between the veiling and the observed Balmer jump. The time series of the redward absorption component behaves similarly to the veiling time series. We model the emitting region by a gas of uniform temperature and density. The models indicate that the gas densities and the respective temperatures are strongly anticorrelated. In addition, the model time series show that the increase in the gas density is mirrored by an increase of the projected emitting area (filling factor). Large/small gas densities and filling factors are characterized by high/low observed veiling. As the accretion rate fades from night-to-night, the observed veiling decreases, as does the gas density and the total projected emitting area.Comment: 26 pages, 14 postscript figures, ApJ accepte