La tele-ecografia wireless in telemedicina prenatale

La tele-ecografia è una applicazione della telemedicina alla diagnostica ecografica che attualmente si avvale di molteplici sistemi, più o meno complessi, finalizzati all’acquisizione di scansioni ecografiche di qualità tale da poter essere interpretate da un esperto a distanza, a cui si richiede di formulare una diagnosi o di fornire una second opinion. Una delle più recenti aree di applicazione delle nuove tecnologie è la tele-ecografia con sistemi wireless, allo scopo di migliorare la portabilità delle apparecchiature e di semplificare la trasmissione a distanza delle immagini, con una sensibile riduzione dei costi. Recentemente, il sistema TOCOMAT di telemedicina prenatale, attivo in Campania dal 1998, è stato aggiornato con un’applicazione di tele-ecografia wireless per il monitoraggio ecografico a distanza delle pazienti a rischio residenti in aree rurali o decentrate. Il sistema si basa su un ecografo portatile di ultima generazione in grado di trasferire le immagini acquisite ad un palmare, che poi le trasmette alla Centrale Operativa attraverso la connessione ad una rete internet wireless. I risultati ottenuti nel corso dei primi sei mesi di attività con il nuovo sistema dimostrano come esso sia tecnicamente di facile applicazione e ben accetto dai medici e dalle pazienti, ed in grado di favorire la riduzione del divario nel livello di assistenza sanitaria tra la periferia ed il centro

Il nuovo sistema TOCOMAT wireless di telecardiotocografia convenzionale e computerizzata

La rete TOCOMAT di telecardiotocografia convenzionale e computerizzata ha l’obiettivo di migliorare la qualità dell’assistenza sanitaria alle gravide a rischio della Campania, offrendo la possibilità del monitoraggio cardiotocografico computerizzato anche intensivo dei feti senza richiedere frequenti spostamenti delle pazienti o ricoveri prolungati in centri nascita di terzo livello. Recentemente, il sistema, attivo già dal 1998, è stato aggiornato con l’impiego di una tecnologia wireless, che consente la trasmissione dei dati dalle unità remote alla Centrale Operativa attraverso un palmare in grado di collegarsi ad internet attraverso una rete wireless. La nuova versione del sistema TOCOMAT consente di superare i limiti di mobilità, flessibilità e portabilità della telemedicina convenzionale, migliorando ulteriormente la facilità di accesso delle gravide alle cure prenatali e contribuendo ad un’ulteriore razionalizzazione della spesa sanitaria

Brugada Pattern in a Child with Severe SARS-CoV-2 Related Multisystem Inflammatory Syndrome

This report presents the first case of Brugada pattern complicated by a supraventricular arrhythmia in a child with SARS-CoV-2 related Multisystem Inflammatory Syndrome in Children (MIS-C). A 7-year-old boy came to our Emergency Department with 7 days of abdominal pain and fever. MIS-C was diagnosed on the basis of the clinical, laboratory and instrumental tests. On admission, ECG showed type 1 Brugada pattern in the right precordial leads. During hospitalization the onset of supraventricular arrhythmias complicated the clinical picture. This case underlines management complexity of supraventricular arrhythmic events, different from atrial fibrillation, in patients with Brugada pattern in the context of a systemic inflammatory condition with significant cardiac involvement. All potential therapeutic choices should be considered to ensure the best outcomes

The diagnostic and therapeutic challenge of atrial flutter in children: a case report

Background: Palpitations represent a common cause for consultation in the pediatric Emergency Department (ED). Unlike adults, palpitations in children are less frequently dependent from the heart, recognizing other causes. Case presentation: A 11-year-old male came to our pediatric ED for epigastric pain, vomiting and palpitations. During the previous 6 month the patient was affected by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus). Electrocardiogram (ECG) revealed supraventricular tachycardia. Therefore, adenosine was administered unsuccessfully. The administration of adenosine, however, allowed us to make diagnosis of atypical atrial flutter. Multiple attempts at both electrical cardioversion, transesophageal atrial overdrive, and drug monotherapy were unsuccessful in our patient. Consequently, a triple therapy with amiodarone, flecainide, and beta-blocker was gradually designed to control the arrhythmic pattern with the restoration of a left upper atrial rhythm. There was not any evidence of sinus rhythm in the patient clinical history. Conclusions: The present study underlines the rarity of this type of dysrhythmia in childhood and the difficulties in diagnosis and management, above all in a patient who has never showed sinus rhythm. Raising awareness of all available treatment options is essential for a better management of dysrhythmia in children

Human Polyomavirus JC monitoring and noncoding control region analysis in dynamic cohorts of individuals affected by immune-mediated diseases under treatment with biologics: an observational study.

Background: Progressive multifocal leukoencephalopathy (PML) onset, caused by Polyomavirus JC (JCPyV) in patients affected by immune-mediated diseases during biological treatment, raised concerns about the safety profile of these agents. Therefore, the aims of this study were the JCPyV reactivation monitoring and the noncoding control region (NCCR) and viral protein 1 (VP1) analysis in patients affected by different immunemediated diseases and treated with biologics. Methods: We performed JCPyV-specific quantitative PCR of biological samples collected at moment of recruitment (t0) and every 4 months (t1, t2, t3, t4). Subsequently, rearrangements' analysis of NCCR and VP1 was carried out. Data were analyzed using chi(2) test. Results: Results showed that at t0 patients with chronic inflammatory rheumatic diseases presented a JCPyV load in the urine significantly higher (p <= 0.05) than in patients with multiple sclerosis (MS) and Crohn's disease (CD). It can also be observed a significant association between JC viruria and JCPyV antibodies after 1 year of natalizumab (p=0.04) in MS patients. Finally, NCCR analysis showed the presence of an archetype-like sequence in all urine samples, whereas a rearranged NCCR Type IR was found in colon-rectal biopsies collected from 2 CD patients after 16 months of infliximab. Furthermore, sequences isolated from peripheral blood mononuclear cells (PBMCs) of 2 MS patients with JCPyV antibody at t0 and t3, showed a NCCR Type IIR with a duplication of a 98 bp unit and a 66 bp insert, resulting in a boxB deletion and 37 T to G transversion into the Spi-B binding site. In all patients, a prevalence of genotypes 1A and 1B, the predominant JCPyV genotypes in Europe, was observed. Conclusions: It has been important to understand whether the specific inflammatory scenario in different immune-mediated diseases could affect JCPyV reactivation from latency, in particular from kidneys. Moreover, for a more accurate PML risk stratification, testing JC viruria seems to be useful to identify patients who harbor JCPyV but with an undetectable JCPyV-specific humoral immune response. In these patients, it may also be important to study the JCPyV NCCR rearrangement: in particular, Spi-B expression in PBMCs could play a crucial role in JCPyV replication and NCCR rearrangement

JC VIRAL REACTIVATION IN A PEDIATRIC PATIENT WITH CROHN'S DISEASE

This is a report concerning human polyomavirus JC (JCV) reactivation in a pediatric patient with Crohn's disease (CD) during the treatment with 5-aminosalicylic acid (5-ASA), a non-steroidal anti-inflammatory drug (NSAID). We examined 9 bioptic samples from three different bowel districts (ileum, cecum, rectum) of this child. These samples were analyzed by Quantitative PCR (Q-PCR) to investigate the presence of JCV DNA. JCV DNA was detected in one rectum biopsy taken two months after 5-ASA treatment. Although our result must be validated in a larger group of subjects and with a longer follow-up period, it underlines the importance of JCV monitoring in CD patients