Impaired placental perfusion and major fetal cardiac defects

Objectives: To investigate the relationship between fetal congenital heart defects (CHD) and placental perfusion assessed by uterine artery pulsatility index (UtA-PI) in relation to development of preeclampsia (PE). Methods: This was a prospective screening study in singleton pregnancies at 19-24 weeks’ gestation. Transvaginal ultrasound was used to measure the UtA-PI and the values were converted into multiples of the normal median (MoM). Median MoM values in pregnancies with fetuses with isolated major CHD were compared to those without CHD in relation to development of PE. Results: The 91,407 singleton pregnancies fulfilling the entry criteria included 206 (0.23%) with isolated major fetal CHD and 91,201 without CHD. The prevalence of PE was 4.4% in those with CHD and 2.7% in those without CHD (RR 1.6, 95% CI 0.84-3.04; p=0.150); the respective values for preterm-PE, with delivery at <37 weeks’ gestation, were 2.4% and 0.7%, (RR 3.4, 95% CI 1.42-8.09; p=0.006). In the total population, the median UtA-PI MoM was significantly higher in those that developed PE compared to those without PE (1.22, IQR 0.94-1.57 vs. 1.00, IQR 0.84-1.19; p<0.0001) and in the PE group the median UtA-PI MoM was inversely related to gestational age at delivery (r=-0.458; p<0.0001). The same pattern of inverse relationship between UtA-PI MoM and gestational age at delivery with PE was observed in pregnancies with and without CHD, but in the CHD group, compared to those without CHD, UtA-PI was significantly higher both in pregnancies with and in those without PE. Conclusions: In both pregnancies with and without fetal CHD that develop PE impedance to flow in the uterine arteries is increased and this increase is particularly marked in those with preterm-PE. The prevalence of preterm-PE is more than 3 times higher in pregnancies with than without fetal major CHD and the prevalence of major CHD in pregnancies with preterm-PE is also more than 3 times higher than in those without PE. However, >97% of pregnancies with fetal CHD do not develop preterm-PE and >99% of pregnancies with preterm-PE are not associated with fetal CHD

Fetal major cardiac defects and placental dysfunction at 11-13 weeks' gestation

Objectives: To investigate the relationship between fetal major cardiac defects and markers of placental perfusion and function. Methods: This was a prospective screening study in singleton pregnancies at 11-13 weeks’ gestation. Uterine artery pulsatility index (UTPI), serum pregnancy associated plasma protein-A (PAPP-A) and placental growth factor (PLGF) were measured and the values were converted into multiples of the normal median (MoM). Median MoM values in fetuses with isolated major cardiac defects were compared to those in fetuses without major defects. Results: The 50,094 singleton pregnancies fulfilling the entry criteria included 49,898 pregnancies with a normal cardiac anatomy and 196 (0.39%) with major congenital cardiac defects; 73 (37.2%) with conotruncal defects, 63 (32.1%) with left ventricular outflow tract (LVOT) defects and 60 (30.6%) with valvular defects. In the group of cardiac defects, compared to controls, there was lower median PAPP-A MoM (0.81 vs 1.00, p<0.0001) and PLGF MoM (0.78 vs 1.00, p<0.0001) but no significant difference in UTPI MoM (1.01 vs 1.00, p=0.162). Conclusions: In pregnancies with isolated major cardiac defects there is evidence of placental dysfunction in the absence of impaired placental perfusion

One-step determination of total iron using deferiprone or kojic acid as colorimetric reagents

The role of iron, one of the most common metals in the environment, is fundamental in many biological and geochemical processes, which determine its availability in the two main oxidation states Fe2+ and Fe3+. Its relevance in the environment, industrial applications, and human physiology, as well as in many other fields has constantly encouraged the development of analytical techniques for its accurate determination. Spectrophotometric methods are those most frequently applied for iron determination in real samples, with specific reagents for the two existing oxidation state right now. In the present work, two low-cost, non-toxic, colorimetric reagents are proposed: deferiprone and kojic acid. These compounds present peculiar features, in particular the formation of 1:3 complexes with Fe3+ of extremely high stability and absorptivity in a wide operative pH range. In this study, we show that both reagents can be used to measure the total iron content. Actually, the extremely low redox potential characterizing the FeL3 complexes permits to determine the total concentration of iron independently from the starting oxidation state, and assures the complete oxidation in presence of oxygen of any amount of Fe2+ to Fe3+ complexes. These features constitute a novelty in the analytical determination of total iron not requiring any pretreatment of the sample, contrary to the methods in use, devoted either to Fe3+ or to Fe2+, necessitating awkward and error generating oxidative or reductive processes. The analytical performance of the proposed spectrophotometric method has been evaluated for the full compliance with the Lambert-Beer law, the operative range of iron concentration, the influence of pH, and the interfering effects of other metal ions. Finally, it has been validated in terms of LoD, LoQ, linearity, precision, and trueness, and has been tested on total iron determination in natural water certified material and in two biological reference materials, human urine and serum

Non-responsive Dihydropteridine Reductase Deficiency

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Laryngeal myxoma: a case report and review of the literature

Myxomas are a rare benign neoplasm of uncertain mesenchymal cell origin, typically involving the heart. Laryngeal myxomas are uncommon, and are usually misdiagnosed as laryngeal polyp. To the best of our knowledge, there are only nine reported cases in the English literature. We report a case of a laryngeal myxoma presenting clinically as a left vocal cord polyp in a 77 year old male, and review the literature related to this rare entity

A family of kojic acid derivatives aimed to remediation of Pb2+ and Cd2+

The present work analyzes the complex formation ability towards Pb2+ and Cd2+ of a series of kojic acid derivatives that join the chelating properties of the pyrone molecules and those of polyamines, with the aim of evaluating how the different effects of oxygen and nitrogen coordinating groups act on the stability of metal complexes. Experimental research is carried out using potentiometric and spectrophotometric techniques supported by 1H and 13C NMR spectroscopy and DFT calculations. Actually, a different coordination mechanism toward Pb2+ and Cd2+ was proved: in the case of Pb2+, coordination takes place exclusively via the oxygen atoms, while the contribute of the nitrogen atoms appears relevant in the case of Cd2+. Lead complexes of all the studied ligands are characterized by significantly stronger stability than those of cadmium. Finally, on the basis of the measured complex formation stabilities, some of the proposed molecules seems promising effective ligands for lead and cadmium ion decorporation from polluted soils or waste waters

Intrauterine versus post-mortem magnetic resonance in second trimester termination of pregnancy for central nervous system abnormalities

Objective: To evaluate if limiting factors of intrauterine magnetic resonance imaging (iuMRI) performed in the early second trimester of pregnancy (19\u201323 weeks) affect its accuracy in comparison to post-mortem MRI (pmMRI) in fetuses that underwent termination of pregnancy (TOP) for central nervous system (CNS) defects. Study design: This is a secondary analysis of a 10 years prospective observational study. Cases of TOP < 23 weeks for CNS malformation that had undergone neurosonography (NSG), iuMRI, pmMRI and autopsy were included. The agreement between iuMRI and pmMRI was calculated. The autopsy represented the gold-standard. Results: Overall, 143 TOPs for fetal congenital anomaly underwent the post-mortem diagnostic protocol. Of these, 31 cases underwent iuMRI and pmMRI for CNS abnormality. Three cases were excluded due to brain autolysis at autopsy. Corpus callosum defects were the most represented (16/28; 57 %). In only one case of posterior fossa defect, pmMRI identified the presence of vermian hypoplasia not diagnosed at iuMRI. In 2 cases (7%), iuMRI added clinically relevant additional findings to NSG, that were posteriorly confirmed by pmMRI. Conclusions: The study shows that, at 19\u201323 weeks and for CNS defects, limiting factors that might influence the performance of iuMRI have little influence on iuMRI accuracy. This finding is particularly important for professionals who work in countries with legal bound for TOP in the early second trimester