Hidropesía y muerte fetal intraútero asociada a infección por parvovirus B19. Reporte de un caso

Human parvovirus B19/B19V infection in pregnant women can be transmitted to the fetus and cause anemia, hydrops and fetal death in situations that are still poorly understood. Its clinical suspicion is important to request opportune studies in the mother and the fetus that can confirm the diagnosis (specific antibodies and viral DNA). A fatal case of hydrops fetalis associated with B19V infection is reported. A 40-year-old patient with a controlled pregnancy (30 weeks of gestation). Consultation for not perceiving fetal movements. History of rheumatoid arthritis in remission (without treatment during pregnancy) and previous abortion (attributed to cytomegalovirus); receives alpha-methyldopa for pregnancy-induced hypertension with good evolution. Family history of systemic lupus erythematosus and scleroderma. She did not report rashes or previous parvoviral symptoms. Blood group 0 Rh+. Physical examination: blood pressure/BP 140-90mmHg, afebrile. Negative uterine dynamics (10 minutes), negative fetal heartbeat (doppler), closed cervix, intact amniotic membranes, negative genitorrhagia. Ultrasound: "single fetus died in utero, with pleural effusion, ascites and hydropic signs". A cesarean section was performed extracting a dead male fetus, with signs of maceration, weighing 1500g. Postoperative with good evolution. Discharge with analgesia and controls by obstetrics office, medical clinic and rheumatology. Pathological anatomy: "900g placenta, edematous chorionic villi, decreased villous capillaries with signs of moderate obliterative endarteritis; generalized edema attributable to hydrops." negative genetics. Maternal serum studies (2 months post-cesarean): indeterminate IgM-B19V=24.8IU/mL(cutoff/25), positive IgG-B19>50IU/mL(cutoff/3), positive PCR/B19V (limit detection) . Other negative TORCH results. IgM-CMV negative, IgG-CMV positive=709.5AU/mL(cutoff/6). In placenta: PCR/B19V negative. A case of hydrops with fetal death related to B19V is reported. The timely collection of samples could improve the efficiency of diagnostic methods and the interpretation of results in cases of such great impact on health.La infección por parvovirus humano B19/B19V en la embarazada puede transmitirse al feto y provocar anemia, hidropesía y muerte fetal en situaciones aún poco conocidas. Su sospecha clínica es importante para solicitar estudios oportunos en la madre y el feto que puedan confirmar el diagnóstico (anticuerpos específicos y ADN viral). Se reporta un caso fatal de hidropesía fetal asociado a infección por B19V.  Paciente de 40 años con embarazo controlado (30 semanas de gestación). Consulta por no percibir movimientos fetales. Antecedente de artritis reumatoidea en remisión (sin tratamiento durante el embarazo) y aborto previo (atribuido a citomegalovirus); recibe alfa-metildopa por hipertensión-inducida-embarazo con buena evolución. Antecedentes familiares de lupus eritematoso sistémico y esclerodermia. No refiere exantemas o sintomatología parvoviral previa. Grupo sanguíneo 0 Rh+. Examen físico: tensión arterial/TA 140-90mmHg, afebril. Dinámica uterina negativa (10 minutos), latidos cardiacos fetales negativos (doppler), cérvix cerrado, membranas amnióticas íntegras, genitorragia negativa. Ecografía: "feto único muerto in útero, con derrame pleural, ascitis y signos hidrópicos”. Se realiza operación cesárea extrayendo feto masculino muerto, con signos de maceración, peso 1500g. Postoperatorio con buena evolución. Alta con analgesia y controles por consultorio de obstetricia, clínica médica y reumatología. Anatomía patológica: "placenta de 900g, vellosidades coriales edematosas, disminución de capilares vellosos con signos de endarteritis obliterativa moderada; edema generalizado atribuible a hidropesía". Genética negativa. Estudios en suero materno (2 meses post-cesárea): IgM-B19V indeterminado=24,8UI/mL(cutoff/25), IgG-B19 positiva>50UI/mL(cutoff/3), PCR/B19V positiva (límite detección). Resto de resultados TORCH negativos. IgM-CMV negativa, IgG-CMV positiva=709,5UA/mL(cutoff/6). En placenta: PCR/B19V negativa.  Se reporta un caso de hidropesía con muerte fetal relacionada a B19V. La obtención oportuna de muestras podría mejorar la eficiencia de los métodos diagnósticos y la interpretación de resultados en casos de tanto impacto para la salud. &nbsp

Comparison of quantitative flow ratio, Pd/Pa and diastolic hyperemia-free ratio versus fractional flow reserve in non-culprit lesion of patients with non ST-segment elevation myocardial infarction

Objectives: To investigate the correlation between quantitative flow ratio (QFR), Pd/Pa, diastolic hyperemia-free ratio (DFR) and fractional flow reserve (FFR, gold standard) in non-culprit lesion (NCL) of patients with non ST-segment elevation myocardial infarction (NSTEMI). Background: The non-hyperemic pressure ratio (NHPR) and the angiography-based indexes have been developed to overcome the limitation of the use of the FFR. Methods: Between January and December 2019, 184 NCL from 116 NSTEMI patients underwent physiologic assessment and were included in the study. NCLs were investigated with QFR, Pd/Pa, DFR, and FFR. Mean values of QFR, Pd/Pa, DFR and FFR were 0.85 ± 0.10, 0.92 ± 0.07, 0.93 ± 0.05 and 0.84 ± 0.07, respectively. According to established cut-offs of QFR, Pd/Pa, DFR, FFR, 42 (23%), 60 (33%), 55 (30%) and 58 (31.5%) lesions resulted flow-limiting. Results: DFR and FFR showed a good correlation (r = 0.76). Bland and Altman plot showed a mean difference of 0.080. DFR Diagnostic accuracy was 88%. The area under the ROC curve (AUC) for DFR was 0.946 (95%CI 0.90–0.97, p =.0001). Similar findings were reported for Pd/Pa (r = 0.73; mean difference 0.095, diagnostic accuracy 84%, AUC 0.909 [95%CI 0.85–0.94, p =.0001]) and QFR (r = 0.68; mean difference 0.01; diagnostic accuracy 88%, AUC 0.964 [95% CI 0.91–0.98, p =.0001]). FFR, QFR, Pd/Pa and DFR identified 31%, 32%, 30% and 32% potentially flow-limiting lesions, respectively. Conclusions: In NSTEMI patients, QFR, Pd/Pa and DFR showed equivalence as compared to gold standard FFR in the discrimination of non-culprit lesions requiring revascularization

Shaping childhood obesity: behavioral and environmental risk factors associated with body mass index trajectories between 2 and 9 years in Samoan children

Background/Objective: Pacific children are at high obesity risk, yet the behavioral and environmental factors that contribute to obesity development in this setting remain poorly understood. We assessed associations between childhood risk factors for obesity with body mass index (BMI) trajectories between ages 2-9 years in Samoa.Subjects/Methods: In a prospective cohort of 485 children from ‘Upolu, we measured weight and height at ages 2-4 (2015), 3.5-8 (2017-18), and 5.5-11 years (2019-20). Modern dietary pattern adherence was assessed using factor analysis of primary caregiver-reported food frequency questionnaire data. Physical activity was estimated with the Netherlands Physical Activity Questionnaire. Socioeconomic resources were assessed using an 18-item household asset score. Urbanicity was based on village residence. Associations of these risk factors with predicted weight, height, and BMI (at 1-year intervals and velocity) were assessed using multilevel cubic spline regressions.Results: Females had greater adjusted weight velocity with high modern dietary pattern adherence compared to low (p-value for interaction with age spline term 1=0.028 and age spline term 2=0.007). Starting at age 3 years, children with higher physical activity had higher BMI, but this association was not meaningful up to age 9 (all p-value>0.05). Males with very high compared to low household assets had higher BMI from age 2 to 4 years (95% CI: 0.26-1.53 kg/m2, p=0.006) and greater BMI velocity (p-value for interaction with age spline term 2=0.001). Males in the urban region had the greatest BMI gain after age 5 compared to the rural region (p-value for interaction with age spline term 2=0.014).Conclusions: High, centile-crossing BMI trajectories suggest that obesity prevention and intervention are needed among Samoan children before age 9 years. Positive associations between high modern dietary pattern adherence, greater asset ownership, and urbanization offer initial insights into who, and which behavioral risk factors, should be prioritized in implementing public health solutions.</p

The ASTRI SST-2M prototype for the Cherenkov Telescope Array: prototype technologies goals and strategies for the future SSTGround-based and Airborne Telescopes V

The Cherenkov Telescope Array (CTA) observatory will represent the next generation of Imaging Atmospheric Cherenkov Telescope. Using a combination of large-, medium-, and small-scale telescopes (LST, MST, SST, respectively), it will explore the Very High Energy domain from a few tens of GeVup to about few hundreds of TeV with unprecedented sensitivity, angular resolution and imaging quality. In this framework, the Italian ASTRI program, led by the Italian National Institute of Astrophysics (INAF) developed a 4-meter class telescope, which will adopt an aplanatic, wide-field, double-reflection optical layout in a Schwarzschild- Couder configuration. Within this program INAF assigned to the consortium between Galbiati Group and EIE Group the construction, assembly and tests activities of the prototype named ASTRI SST-2M. On the basis of the lesson learnt from the prototype, other telescopes will be produced, starting from a re-design phase, in order to optimize performances and the overall costs and production schedule for the CTA-SST telescope. This paper will firstly give an overview of the concept for the SST prototype mount structure. In this contest, the technologies adopted for the design, manufacturing and tests of the entire system will be presented. Moreover, a specific focus on the challenges of the prototype and the strategies associated with it will be provided, in order to outline the near future performance goals for this type of Cherenkov telescopes employed for Gamma ray science

Associations of childhood BMI traits with blood pressure and glycated haemoglobin in 6–9-year-old Samoan children

Introduction: Prevalence and risk factors for elevated glycated haemoglobin (HbA1c) and blood pressure (BP) are poorly understood among Pacific children. We examined associations of HbA1c and BP in 6–9 year-olds with body mass index (BMI) at ages 2, 5, and BMI velocity between 2–9 years in Samoa.Methods: HbA1c (capillary blood) and BP were measured in n = 410 Samoan children who were part of an ongoing cohort study. Multilevel models predicted BMI trajectory characteristics. Generalized linear regressions assessed associations of childhood characteristics and BMI trajectories with HbA1c and BP treated as both continuous and categorical outcomes. Primary caregiver-reported childhood characteristics were used as covariates.Results: Overall, 12.90% (n = 53) of children had high HbA1c (≥5.7%) and 33.17% (n = 136) had elevated BP. BMI at 5-years and BMI velocity were positively associated with high HbA1c prevalence in males. A 1 kg/m2 per year higher velocity was associated with a 1.71 (95% CI: 1.07, 2.75) times higher prevalence of high HbA1c. In females, higher BMI at 5-years and greater BMI velocity were associated with higher BP at 6–9 years (95% CI: 1.12, 1.40, and 1.42, 2.74, respectively).Conclusion: Monitoring childhood BMI trajectories may inform cardiometabolic disease screening and prevention efforts in this at-risk population.</p

Associations of childhood BMI traits with blood pressure and glycated haemoglobin in 6–9-year-old Samoan children

Introduction: Prevalence and risk factors for elevated glycated haemoglobin (HbA1c) and blood pressure (BP) are poorly understood among Pacific children. We examined associations of HbA1c and BP in 6–9 year-olds with body mass index (BMI) at ages 2, 5, and BMI velocity between 2–9 years in Samoa.Methods: HbA1c (capillary blood) and BP were measured in n = 410 Samoan children who were part of an ongoing cohort study. Multilevel models predicted BMI trajectory characteristics. Generalized linear regressions assessed associations of childhood characteristics and BMI trajectories with HbA1c and BP treated as both continuous and categorical outcomes. Primary caregiver-reported childhood characteristics were used as covariates.Results: Overall, 12.90% (n = 53) of children had high HbA1c (≥5.7%) and 33.17% (n = 136) had elevated BP. BMI at 5-years and BMI velocity were positively associated with high HbA1c prevalence in males. A 1 kg/m2 per year higher velocity was associated with a 1.71 (95% CI: 1.07, 2.75) times higher prevalence of high HbA1c. In females, higher BMI at 5-years and greater BMI velocity were associated with higher BP at 6–9 years (95% CI: 1.12, 1.40, and 1.42, 2.74, respectively).Conclusion: Monitoring childhood BMI trajectories may inform cardiometabolic disease screening and prevention efforts in this at-risk population.</p