The peripartum management of a 32-year-old patient presenting at 34 weeks’ gestation with unrepaired cyanotic heart disease

CITATION: Rossouw, J. N., et al. 2018. The peripartum management of a 32-year-old patient presenting at 34 weeks’ gestation with unrepaired cyanotic heart disease. South African Journal of Obstetrics and Gynaecology, 24(2):36-39, doi:10.7196/sajog.1265.The original publication is available at http://www.sajog.org.zaENGLISH ABSTRACT: Unrepaired cyanotic heart disease is considered a high-risk lesion owing to the consequent increase in maternal and fetal complications. In the presence of pulmonary hypertension, maternal mortality approaching 50% has been reported, and pregnancy is therefore considered contraindicated. We present a case of a 32-year-old woman presenting at 34 weeks’ gestation in heart failure due to newly diagnosed cyanotic complex cardiac disease. The diagnosis of left atrial isomerism with a common atrium, single atrioventricular valve, and a restrictive ventricular septum defect was made. Cyanosis was due to mixing at atrial level, without features of Eisenmenger’s syndrome. Her intrapartum multidisciplinary management is described in detail. The patient was discharged home in a condition similar to her baseline, together with her healthy neonate.http://www.sajog.org.za/index.php/SAJOG/article/view/1265Publisher's versio

Production of the neutral top-pion πt0\pi_{t}^{0} in association with a high-pTp_{T} jet at the LHCLHC

In the framework of the topcolor-assisted technicolor $(TC2)$ model, we study production of the neutral top-pion $\pi_{t}^{0}$ in association with a high-$p_{T}$ jet at the $LHC$, which proceeds via the partonic processes $gg\longrightarrow \pi_{t}^{0}g$, $gq\longrightarrow \pi_{t}^{0}q$, $q\bar{q}\longrightarrow \pi_{t}^{0}g$, $gb(\bar{b})\longrightarrow \pi_{t}^{0}b(\bar{b})$, and $b\bar{b}\longrightarrow \pi_{t}^{0}g$. We find that it is very challenging to detect the neutral top-pion $\pi_{t}^{0}$ via the process $pp\longrightarrow \pi_{t}^{0}+jet+X\to t\bar{t}+jet+X$, while the possible signatures of $\pi_{t}^{0}$ might be detected via the process $pp\longrightarrow \pi_{t}^{0}+jet+X\to(\bar{t}c+t\bar{c})+jet+X$ at the $LHC$.Comment: 13 pages, 4 figures; typos correcte

Evidence of neuroinflammation and blood–brain barrier disruption in women with preeclampsia and eclampsia

Cerebral complications in preeclampsia are leading causes of maternal mortality. Animal models suggest that an injured blood–brain barrier and neuroinflammation may be important but there is paucity of data from human studies. Therefore, we aimed to evaluate this in women with preeclampsia and eclampsia. We included women recruited to the South African Preeclampsia Obstetric Adverse Events (PROVE) biobank. Blood and cerebrospinal fluid (CSF) were collected around delivery. CSF was analyzed for neuroinflammatory markers interleukin 1β, interleukin 6, interleukin-8 and tumor necrosis factor alpha (TNF-alpha). The CSF to plasma albumin ratio was measured to assess blood–brain barrier function. Women with eclampsia (n = 4) showed increased CSF concentrations of all pro-inflammatory cytokines and TNF-alpha compared to women with normotensive pregnancies (n = 7) and also for interleukin-6 and TNF-alpha compared to women with preeclampsia (n = 4). Women with preeclampsia also showed increases in pro-inflammatory cytokines IL-6 and IL-8 but not TNF-alpha in the CSF compared to women with normotensive pregnancies. In particular, women with eclampsia but also women with preeclampsia showed an increase in the CSF to plasma albumin ratio compared to normotensive women. In conclusion, women with preeclampsia and eclampsia show evidence of neuroinflammation and an injured blood–brain barrier. These findings are seen in particular among women with eclampsia

Linear Peptides-A Combinatorial Innovation in the Venom of Some Modern Spiders

In the venom of spiders, linear peptides (LPs), also called cytolytical or antimicrobial peptides, represent a largely neglected group of mostly membrane active substances that contribute in some spider species considerably to the killing power of spider venom. By next-generation sequencing venom gland transcriptome analysis, we investigated 48 spider species from 23 spider families and detected LPs in 20 species, belonging to five spider families (Ctenidae, Lycosidae, Oxyopidae, Pisauridae, and Zodariidae). The structural diversity is extraordinary high in some species: the lynx spider Oxyopes heterophthalmus contains 62 and the lycosid Pardosa palustris 60 different LPs. In total, we identified 524 linear peptide structures and some of them are in lycosids identical on amino acid level. LPs are mainly encoded in complex precursor structures in which, after the signal peptide and propeptide, 13 or more LPs (Hogna radiata) are connected by linkers. Besides Cupiennius species, also in Oxyopidae, posttranslational modifications of some precursor structures result in the formation of two-chain peptides. It is obvious that complex precursor structures represent a very suitable and fast method to produce a high number and a high diversity of bioactive LPs as economically as possible. At least in Lycosidae, Oxyopidae, and in the genus Cupiennius, LPs reach very high Transcripts Per Kilobase Million values, indicating functional importance within the envenomation process

The Physics of Heavy Flavours at SuperB

This is a review of the SuperB project, covering the accelerator, detector, and highlights of the broad physics programme. SuperB is a flavour factory capable of performing precision measurements and searches for rare and forbidden decays of $B_{u,d,s}$, $D$, $\tau$ and $\Upsilon({\mathrm{nS}})$ particles. These results can be used to test fundamental symmetries and expectations of the Standard Model, and to constrain many different hypothesised types of new physics. In some cases these measurements can be used to place constraints on the existence of light dark matter and light Higgs particles with masses below $10GeV/c^2$. The potential impact of the measurements that will be made by SuperB on the field of high energy physics is also discussed in the context of data taken at both high energy in the region around the \Upsilon({\mathrm{4S}})$, and near charm threshold.Comment: 49 pages, topical review submitted to J. Phys

Maternal and neonatal outcomes of COVID-19 in a high-risk pregnant cohort with and without HIV

Background. The impact of SARS-CoV-2 infection in pregnant women living with HIV (PLHIV) has not been described previously.Objectives. To describe the clinical presentation and outcomes of a cohort of women with high-risk pregnancies with confirmed COVID-19 to determine whether risk factors for disease severity and adverse outcomes of COVID-19 differed in pregnant women without HIV compared with PLHIV.Methods. We prospectively enrolled pregnant women with COVID-19 attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, South Africa, from 1 May to 31 July 2020, with follow-up until 31 October 2020. Women were considered high risk if they required specialist care for maternal, neonatal and/or anaesthetic conditions. Common maternal or obstetric conditions included hypertensive disorders, morbid obesity (body mass index (BMI) ≥40 kg/m2) and diabetes. Information on demographics, clinical features, and maternal and neonatal outcomes was collected and compared for PLHIV v. pregnant women without HIV.Results. One hundred women (72 without HIV and 28 PLHIV) with high-risk pregnancies had laboratory-confirmed COVID-19. Among the 28 PLHIV, the median (interquartile range) CD4 count was 441 (317 - 603) cells/µL, and 19/26 (73%) were virologically suppressed. COVID-19 was diagnosed predominantly in the third trimester (81%). Obesity (BMI ≥30 in n=61/81; 75%) and hypertensive disorders were frequent comorbidities. Of the 100 women, 40% developed severe or critical COVID-19, 15% required intensive care unit admission and 6% needed invasive ventilation. Eight women died, 1 from advanced HIV disease complicated by bacteraemia and urosepsis. The crude maternal mortality rate was substantially higher in women with COVID-19 compared with all other deliveries at our institution during this period (8/91 (9%) v. 7/4 058 (0.2%); p<0.001). Neonatal outcomes were favourable. No significant differences in COVID-19 risk factors, disease severity, and maternal/neonatal outcome were noted for PLHIV v. those without HIV.Conclusions. In this cohort of high-risk pregnant women, the impact of COVID-19 was severe, significantly increasing maternal mortality risk compared with baseline rates. Virally suppressed HIV infection was not associated with worse COVID-19 outcomes in pregnancy

Heavy-quark mass effects in Higgs boson production at the LHC

We study the impact of heavy-quark masses in Higgs boson production through gluon fusion at the LHC. We extend previous computations of the fully differential cross section and of the transverse momentum spectrum of the Higgs boson by taking into account the finite top- and bottom-quark masses up to O(alpha_S^3). We also discuss the issues arising when the heavy-quark mass is much smaller than the Higgs mass. Our results are implemented in updated versions of the HNNLO and HRes numerical programs.Comment: Minor modifications, results unchanged. Discussion on uncertainties added. Version published on JHE

Investigations on incidence and histopathology of toxoplasmosis in domestic mammals (dogs and rabbits) in Brazil

As observações foras realizadas nas cidades do Rio de Janeiro e Niterói e no Distrito de Seropédica (Univ. Fed. Rural do Rio de Janeiro, Itaguaí, Estado do Rio de Janeiro). A doença foi sempre diagnosticada pelo exame histopatológico de órgãos toráxicos e abdominais, após a execução das respectivas necrópsias. Dos mamíferos domésticos observados, apenas cães e coelhos se mostravam infectados pelo Taxoplasma gondii. De 873 cães necropsiados, 16 exibiam a infecção (1,8%). Dentre 499 coelhos necropsiados, 6 tinham a infecção (1,2%). Dos órgãos examinados, eram mais constantemente lesados o fígado, o baço e os pulmões. A infecção determinava necrose miliar nos órgãos. Microscòpicamente, os focos necróticos tinham um aspecto filamentoso, lembrando o da fibrina; havia pouca reação inflamatória perifocal. Em dois coelhos, uma necrose maciça dos gânglios mesentéricos foi observada; lesões do mesmo tipo foram evidenciadas, igualmente, duas vezes no baço de tais roedores. Aparentemente, o toxoplasmose consistiu sempre a causa da morte dos animais infectados, exceto a de um coelho que morreu em consequência de uma neoplasia maligna uterina. Durante o exame histopatológico de idênticos órgãos no mesmo período, a toxoplasmose não foi observada nos seguintes animais domésticos: bovinos, suínos, ovinos, caprinos, equinos, asininos, muares, gatos, cobaios, ratos e camundongos. As observações foram realizadas entre janeiro de 1933 e agosto de 1966.Toxoplasmosis - caused by the parasite Toxoplasma gondii - has been diagnosed in Brazil following post-mortem examination of thoracic and abdominal organs in dogs and rabbits but not in cattle, swine, sheep, goats, horses, asses, mules, cats, guinea-pigs, rats and mice. During the period 1933 lo 1966 out of a total of 873 dogs autopsied 16 (1.8%) had the infection and of 499 rabbits examned 6 (1.2%) were infected. Of the organs examined lesions were most commonly found in the liver, spleen and lungs. The histopathologic lesions consisted of necrosis, which had a filamentous aspect and very acidophilic necrotic material; practically there was little inflammatory reaction around the necrotic lesions. In two rabbits the disease caused extensive necrosis of the mesenteric lymph nodes and the same type of lesions in the spleen. Apparently the toxoplasmosis was always the cause of the death of the animals with the infection, with exception of one rabbit which died due to an malignant uterine neoplasm