Prenatal MRI Findings of Fetuses with Congenital High Airway Obstruction Sequence

Carolina V. A. Guimaraes,Leann E. Linam,Beth M. Kline-Fath,Lane F. Donnelly,Maria A. Calvo-Garcia,Eva I. Rubio,Jeffrey C. Livingston,Robert J. Hopkin,Elizabeth Peach,Foong-Yen Lim,Timothy M. Crombleho 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.2

Objective: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. Materials and Methods: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. Results: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. Conclusion: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction. Objective: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. Materials and Methods: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. Results: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. Conclusion: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.

Dengue virus serological prevalence and seroconversion rates in children and adults in Medellin, Colombia: implications for vaccine introduction

Carabali, Mabel,Lim, Jacqueline Kyungah,Velez, Diana Carolina,Trujillo, Andrea,Egurrola, Jorge,Lee, Kang Sung,Kaufman, Jay S.,DaSilva, Luiz Jacinto,Velez, Ivan Dario,Osorio, Jorge E. Elsevier 2017 INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES Vol.58 No.-

<▼1><P><B>Highlights</B></P><P>•<P>A total of 3684 individuals between 1 and 65 years old participated in the survey.</P>•<P>The overall seroprevalence by IgG Indirect ELISA was 61%.</P>•<P>The overall seroconversion rate was 8.7% per 1000 person-months over 2.5 years.</P>•<P>The highest rate of infection was observed during the fifth visit (February 2014).</P></P></▼1><▼2><P><B>Summary</B></P><P><B>Background</B></P><P>Dengue is an important public health problem worldwide. A vaccine has recently been licensed in some countries of Latin America and Asia. Recommendations for dengue vaccine introduction include endemicity and a high serological prevalence of dengue in the territories considering its introduction.</P><P><B>Methods</B></P><P>A community-based survey was conducted to estimate dengue seroprevalence and age-specific seroconversion rates in a community in Medellin, Colombia, using a dengue serological test (IgG indirect ELISA). Residents were selected at random and were first screened for dengue infection; they were then followed over 2.5 years.</P><P><B>Results</B></P><P>A total of 3684 individuals aged between 1 and 65 years participated in at least one survey. The overall dengue seroprevalence was 61%, and only 3.3% of seropositive subjects self-reported a past history of dengue. Among dengue virus (DENV)-naïve subjects with more than two visits (<I>n</I> = 1002), the overall seroconversion rate was 8.7% (95% confidence interval 7.3–10.4) per 1000 person-months, over the study period. Overall, the mean age of DENV prevalent subjects was significantly higher than the mean age of seroconverted subjects. Specifically, DENV seropositivity over 70% was observed in participants over 21 years old. Serotype-specific plaque-reduction neutralization tests (PRNT) revealed that all four dengue serotypes were circulating, with DENV4 being most prevalent.</P><P><B>Conclusions</B></P><P>These laboratory-based findings could inform dengue vaccine decisions, as they provide age-specific seroprevalence and seroconversion data, evidencing permanent and ongoing dengue transmission in the study area. This study provides evidence for the existing rates of secondary and heterotypic responses, presenting a challenge that must be addressed adequately by the new vaccine candidates.</P></▼2>

Improvement of Bone Mineral Density and Markers of Proximal Renal Tubular Function in Chronic Hepatitis B Patients Switched from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide

( Tse-ling Fong ),( Brian Lee ),( Andy Tien ),( Mimi Chang ),( Carolina Lim ),( Ho S. Bae ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Tenofovir alafenamide (TAF) is a novel prodrug that re-duces tenofovir plasma levels by 90% compared to tenofovir disoproxil fumarate (TDF), resulting in decreased bone mineral density (BMD) loss and renal toxicity. We aimed to study changes in BMD and markers of renal function of chronic hepatitis B (CHB) patients previously treated with TDF who were switched to TAF. Methods: This was a prospective single-arm open-label study of 75 CHB patients treated with TDF 300 mg daily who were switched to TAF 25 mg daily and followed for 24 weeks. All patients had been treated with TDF for at least 12 months and had HBV DNA < 21 IU/mL at the time of switch. BMD and markers of renal function were taken on the day of switch and repeated after 12 and 24 weeks of TAF treatment. Results: BMD significantly increased after switch from TDF to TAF from baseline to week 12 and remained stable at week 24. Mean percent changes from baseline to week 12 in hip and spine BMDs significantly increased (+ 12.9% and +2.4%, respectively). There were significantly more patients with gains in hip (86%) or spine (76%) BMD than patients who experienced loss (11% and 25%, respectively). No significant change in BMD was seen between week 12 and 24. There was no significant difference in eGFR_CG from baseline to week 24. Significant improvement was observed in urinary beta-2 micro globulin/creatinine ratio between baseline and week 12 that remained through week 24 (median change from baseline to week 12 and 24; 1.5, 1.0 and 1.1 mcg/g respectively; P<0.01). Similar changes were observed with retinol binding protein/creatinine ratio at from baseline to week 12 and 24 (median change from baseline to week 12 and 24; 1.7, 1.3 and 1.4 mcg/g respectively; P<0.01). There was significant increase in fractional excretion of phosphate from baseline to week 24 (11.9 to 14.0; P<0.05). Phosphate threshold for renal tubular reabsorption decreased from baseline to week 12 (2.8 to 2.6 mg/dL). Conclusions: Switching from long-term TDF to TAF among CHB patients was associated with significant improvement in BMD and some markers of proximal renal tubular function. There was no improvement in urinary phosphate handling after the switch which suggests TDF has a direct effect on bone metabolism that is reversible. Longer term and larger studies are needed to confirm these findings.