Case Report: SARS-CoV-2 Infection in a Child With Suprasellar Tumor and Hypothalamic-Pituitary Failure

In early 2020, a novel coronavirus leading to potentially death was discovered. Since then, the 2019 coronavirus disease (COVID-19) has spread to become a worldwide pandemic. Beyond the risks strictly related to the infection, concerns have been expressed for the endocrinological impact that COVID-19 may have, especially in vulnerable individuals with pre-existing endocrinological health conditions. To date new information is emerging regarding severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in children but the literature is still scarce concerning this infection in patients with intracranial malignant neoplasms. We report a 9-year-old child infected with SARS-CoV-2 and recent diagnosis of suprasellar non-germinomatous germ cell tumor also suffering from diabetes insipidus and hypothalamic-pituitary failure (hypothyroidism, adrenal insufficiency, hypothalamic obesity and growth hormone deficiency) and its clinical course. The patient remained asymptomatic for the duration of the infection without requiring any change in the replacement therapeutic dosages taken before the infection. We then discuss the proposed approach to treat a pediatric patient with SARS-CoV-2 infection and hypothalamic-pituitary failure and we include a review of the literature. Our report suggests that SARS-CoV-2 infection is usually mild and self-limiting in children even those immunocompromised and with multiple endocrinological deficits. Patients are advised to keep any scheduled appointments unless informed otherwise

Transmitter made up of a Silicon Photonic IC and its Flip-Chipped CMOS IC DriverTargeting implementation in FDMA-PON

We report on the design, fabrication and characterization of a reflective transmitter targeting implementation in Passive Optical Networks (PON) with Frequency Division Multiplexed Access (FDMA). It is made up of a Silicon Photonic Integrated Circuit (Si-PIC) comprising a Reflective Mach Zehnder Modulator (R-MZM) and its flip chipped CMOS Electronic Integrated Circuit (EIC) driver, the two ICs being interconnected by means of high density and low parasitic copper micro pillars. Several transmissions, in an FDMA PON context, are successfully demonstrated using 500MBaud QPSK and 16-QAM modulated subcarriers, achieving Bit Error Rate (BER) below 2.10-3. For QPSK-modulated subcarriers (respectively 16-QAM), the available access frequency bandwidth is measured to be [1-7GHz] (respectively [2-4GHz]) with an available loss budget of 9dB (respectively 5dB). Improvements of the Si-PIC are further identified to achieve compliancy with 31dB ODN loss

Demonstration of a partially integrated silicon photonics ONU in a self-coherent reflective FDMA PON

We report about the final results of the FABULOUS European project, demonstrating the feasibility of real-time Ethernet transmission on a self-coherent reflective passive optical network, using an optical network unit (ONU) whose main optical functions are performed by a silicon-photonics device; 500 Mbps per user with a power budget of 24 dB in offline processing and 21 dB in real time is shown. We also report details about the packaging process and the special technique developed for the flip-chipping of a CMOS electrical driver, used for driving the ONU with low voltage, onto a silicon Mach-Zehnder modulator

Pure Red Cell Aplasia (PRCA) and Cerebellar Hypoplasia as Atypical Features of Polyglandular Autoimmune Syndrome Type I (APS-1): Two Sisters With the Same AIRE Mutation but Different Phenotypes

The polyglandular autoimmune syndrome type I is a rare hereditary autosomal recessive disease. We describe a child with the classic triad of the disease and her sister with pure red cell aplasia and cerebellar hypoplasia. The latter received two haematopoietic stem cell transplantations, complicated by an acute disseminated encephalomyelitis

Images from 18F-DOPA Scan in Congenital Hyperinsulinism: Not Always a Clue for Diagnosis

Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycaemia in childhood (Horm Res 70:65-72, 2008; J Clin Endocr Metab 93:869-875, 2008). 18-Fluoro-L-dihydroxy-phenylalanine (18F-DOPA) positron emission tomography (PET) can detect areas of increased activity in the pancreas and may differentiate focal from diffuse CHI (J Clin Endocr Metab 93:869-875, 2008; Radiology 253:216-222, 2009). We here report the case of a girl who complained of recurrent episodes of severe hypoglycaemia despite previous partial pancreatectomy. To evaluate the need for additional surgical intervention, we performed 18F-DOPA PET/computed tomography (CT), which showed a focal lesion corresponding to the anatomical region of the pancreatic tail. On the other hand, abdominal magnetic resonance imaging (MRI) clearly demonstrated that the 18F-DOPA uptake was in a loop of bowel occupying the previous surgical bed. Our case highlights that bowel uptake can be a possible pitfall in the interpretation of 18F-DOPA PET/CT in children affected by CHI, suggesting that when 18F-DOPA PET/CT results do not fit the clinical picture, magnetic resonance imaging (MRI) may allow a more accurate correlation of the radiotracer activity with the underlying anatomical or pathological structure

The effect of surgical versus transcatheter aortic valve replacement on endothelial function. An observational study

Background: The effects of surgical aortic valve replacement versus transcatheter aortic valve replacement on endothelial function are unknown. We investigated the effects of surgical and transcatheter aortic valve replacement on early and 90-day endothelial function measured by brachial flow mediated dilation and apoptotic rate in the human umbilical vein endothelial cells in patients with significant aortic stenosis, intermediate risk of surgery, and no coronary artery disease. Methods: We conducted a prospective observational case control single-blind study at a single tertiary center. Endothelial function was measured at baseline, early post-procedure (4 days), and follow-up (90 days). A blood pressure cuff was used to elicit reactive hyperemia for measuring brachial wall shear stress and flow mediated dilation. The apoptosis rate was observed in the human umbilical vein endothelial cells after 48-h incubation with 20% serum from patients. The rate of apoptosis was assessed by determining the number of annexin V and propidium iodide positive cells by flow cytometry. Results: Early post-procedure flow dilation was significant lower in the surgical group (p < 0.003). At follow-up, both groups showed incremental increases in flow mediated dilation. Surgical group apoptotic rate did not significantly change, while transcatheter apoptotic rate steadily decreased, suggesting a trend toward improved endothelial function. Conclusions: The data suggest that conventional surgical aortic valve replacement may be associated with an early and transient decrease in endothelial function, likely due to the use of cardio-pulmonary bypass

Transmitter Made up of a Silicon Photonic IC and its Flip-Chipped CMOS IC Driver Targeting Implementation in FDMA-PON

We report on the design, fabrication and characterization of a reflective transmitter targeting implementation in Passive Optical Networks (PON) with Frequency Division Multiplexed Access (FDMA). It is made up of a Silicon Photonic Integrated Circuit (Si-PIC) comprising a Reflective Mach Zehnder Modulator (R-MZM) and its flip chipped CMOS Electronic Integrated Circuit (EIC) driver, the two ICs being interconnected by means of high density and low parasitic copper micro pillars. Several transmissions, in an FDMA PON context, are successfully demonstrated using 500MBaud QPSK and 16-QAM modulated subcarriers, achieving Bit Error Rate (BER) below 2.10-3. For QPSK-modulated subcarriers (respectively 16-QAM), the available access frequency bandwidth is measured to be [1-7GHz] (respectively [2-4GHz]) with an available loss budget of 9dB (respectively 5dB). Improvements of the Si-PIC are further identified to achieve compliancy with 31dB ODN loss

Mortality Predictors in Elderly Patients With Cardiogenic Shock on Venoarterial Extracorporeal Life Support. Analysis From the Extracorporeal Life Support Organization Registry

Objectives: Because significantly higher mortality is observed in elderly patients undergoing venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock, decision-making in this setting is challenging. We aimed to elucidate predictors of unfavorable outcomes in these elderly ( 65 70 yr) patients. Design: Analysis of international worldwide extracorporeal life support organization registry. Setting: Refractory cardiogenic shock due to various etiologies (cardiac arrest excluded). Patients: Elderly patients ( 65 70 yr). Interventions: Venoarterial extracorporeal membrane oxygenation. Measurements and main results: Three age groups (70-74, 75-79, 6580 yr) were in-depth analyzed. Uni- and multivariable analysis were performed. From January 1997 to December 2018, 2,644 patients greater than or equal to 70 years (1,395 [52.8%] 70-74 yr old, 858 [32.5%] 75-79 yr, and 391 [14.8%] 65 80 yr old) were submitted to venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock with marked increase in the most recent years. Peripheral access was applied in majority of patients. Median extracorporeal membrane oxygenation support duration was 3.5 days (interquartile range: 1.6-6.1 d), (3.9 d [3.7-4.6 d] in patients 65 80 yr) (p &lt; 0.001). Weaning from extracorporeal membrane oxygenation was possible in 1,236 patients (46.7%). Overall in-hospital mortality was estimated at 68.3% with highest crude mortality rates observed in 75-79 years old subgroup (70.1%). Complications were mostly cardiovascular and bleeding, without apparent differences between subgroups. Airway pressures, 24-hour pH after extracorporeal membrane oxygenation start, extracorporeal membrane oxygenation duration, and renal replacement therapy were predictive of higher mortality. In-hospital mortality was lower in heart transplantation recipients, posttranscatheter aortic valve replacement, and pulmonary embolism; conversely, higher mortality followed extracorporeal membrane oxygenation institution after coronary artery bypass + valve and in decompensated chronic heart failure, and nearly 100% mortality followed in extracorporeal membrane oxygenation for sepsis. Conclusions: This study confirmed the remarkable increase of venoarterial extracorporeal membrane oxygenation use in elderly affected by refractory cardiogenic shock. Despite in-hospital mortality remains high, venoarterial extracorporeal membrane oxygenation should still be considered in such setting even in elderly patients, since increasing age itself was not linked to increased mortality, whereas several predictors may guide indication and management