Fetal Hemodynamic Response to Anemia in Early Gestation: Using Hemoglobin Bart’s Disease as a Study Model

2021 ◽  
Author(s):  
Suchaya Luewan ◽  
Fuanglada Tongprasert ◽  
Kasemsri Srisupundit ◽  
Kuntharee Traisrisilp ◽  
Phudit Jatavan ◽  
...  
Keyword(s):  
At Risk ◽  
Peak Systolic Velocity ◽  
Invasive Procedure ◽  
Doppler Velocity ◽  
Early Gestation ◽  
Volume Load ◽  
Sphericity Index ◽  
The Right ◽  
A Prospective Study ◽  
Hb Bart's

Abstract Objective To assess fetal hemodynamic changes in response to anemia in early gestation, using fetal Hb Bart’s disease as a study model. Methods A prospective study was conducted on pregnancies at risk for fetal Hb Bart’s disease at 12–14 weeks of gestation. Fetal hemodynamics were comprehensively assessed by 2D ultrasound, Doppler velocity, and cardio-STIC just prior to the invasive procedure for diagnosis. The various hemodynamic parameters of the affected and unaffected fetuses were compared. Results Of 56 fetuses at risk, 17 had Hb Bart’s disease and 39 were unaffected. The right and combined ventricular cardiac outputs (CO) were significantly higher in the affected fetuses (0.993 vs. 1.358; p < 0.001 and 1.010 vs. 1.236; p < 0.001, respectively), whereas the left CO tended to be higher but not significantly (1.027 vs. 1.113; p = 0.058). Cardiac dimensions, middle-cerebral artery peak systolic velocity, Tei index, and isovolemic contraction time were significantly increased, while the global sphericity index was significantly decreased. Interestingly, cardiac preload, ventricular wall thickness, shortening fraction, isovolemic relaxation time, and fetal heart rate were unchanged. Four fetuses had hydropic changes, but all cardiac functions were normal. Conclusion Fetal anemia induces hypervolemia and increases cardiac output to meet the tissue oxygen requirement, resulting in an increase in size without hypertrophy, volume load without pressure load, and a decrease in the globular sphericity index. The heart works very well but works harder, especially systolic ventricular load. Hydrops fetalis due to anemia appears not to be caused by heart failure as previously believed but rather by volume load with high vascular permeability at least in early pregnancy.

Comparison of the Performances of Middle Cerebral Artery Peak Systolic Velocity and Cardiothoracic Diameter Ratio in Predicting Fetal Anemia: Using Fetal Hemoglobin Bart’s Disease as a Study Model

2021 ◽  
pp. 1-8
Author(s):  
Wisit Chankhunaphas ◽  
Theera Tongsong ◽  
Fuanglada Tongprasert ◽  
Kasemsri Srisupundit ◽  
Suchaya Luewan ◽  
...  
Keyword(s):  
At Risk ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Gestational Age ◽  
Peak Systolic Velocity ◽  
Fetal Hemoglobin ◽  
Diameter Ratio ◽  
Fetal Anemia ◽  
Receiver Operating Characteristic Curves ◽  
Hb Bart's

<b><i>Objective:</i></b> The aim of the study was to compare the performances of cardiothoracic diameter ratio (CTR) and middle cerebral artery peak systolic velocity (MCA-PSV) in predicting fetal hemoglobin (Hb) Bart’s disease and identify the best CTR cut-off for each gestational period. <b><i>Methods:</i></b> Pregnancies at risk of fetal Hb Bart’s disease (gestational ages of 12–36 weeks) were prospectively recruited to undergo ultrasound examination. The measurements of CTR and MCA-PSV were performed and recorded before invasive diagnosis. <b><i>Results:</i></b> During the study period (2005–2019), a total of 1,717 pregnancies at risk of fetal Hb Bart’s disease met the inclusion criteria and were available for analysis, including 329 (19.2%) fetuses with Hb Bart’s disease. The mean gestational age at the time of diagnosis was 19.30 ± 5.6 weeks, ranging from 12 to 36 weeks. The overall performance of CTR <i>Z</i>-scores is superior to that of MCA-PSV multiple of median (MoM) values; area under curve of 0.866 versus 0.711, <i>p</i> value &#x3c;0.001. The diagnostic indices of CTR and MCA-PSV are increased with gestational age. Based on receiver operating characteristic curves of CTR <i>Z</i>-scores, the best cut-off points of CTR at 12–14, 15–17, 18–20, 21–23, and ≥24 weeks are 0.48, 0.49, 0.50, 0.51, and 0.54, respectively. The best cut-off of MCA-PSV is 1.3 MoM, giving the best performance at 21–23 weeks with a sensitivity of 91.8% and specificity of 85.5%. <b><i>Conclusion:</i></b> The performance of CTR is much better than MCA-PSV in predicting fetal anemia caused by Hb Bart’s disease. Nevertheless, whether this can be reproduced in anemia due to other causes, like isoimmunization, is yet to be explored.

Appearance of Abnormal Cardiothoracic Ratio of Fetuses with Hemoglobin Bart’s Disease: Life Table Analysis

2017 ◽  
Vol 38 (05) ◽  
pp. 544-548 ◽  
Author(s):  
Chanane Wanapirak ◽  
Supatra Sirichotiyakul ◽  
Suchaya Luewan ◽  
Kasemsri Srisupundit ◽  
Fuanglada Tongprasert ◽  
...  
Keyword(s):  
At Risk ◽  
Life Table ◽  
Peak Systolic Velocity ◽  
First Trimester ◽  
Life Table Analysis ◽  
Prospective Longitudinal Study ◽  
Cardiothoracic Ratio ◽  
Table Analysis ◽  
Prospective Longitudinal ◽  
Hb Bart's

Abstract Objective To determine the timeline of the first appearance of an increased CT ratio of fetuses with hemoglobin (Hb) Bart’s disease. Materials and Methods A prospective longitudinal study was conducted on pregnancies at risk for fetal Hb Bart’s disease. Sonographic markers including cardiothoracic (CT) ratio and middle cerebral artery peak systolic velocity (MCA-PSV) were serially assessed and recorded from the first trimester. The definite diagnosis of fetal Hb Bart’s disease based on DNA analysis (CVS), or fetal Hb typing (HPLC; cordocentesis) was performed at the first appearance of an increased CT ratio. Results Of 275 pregnancies at risk, 64 fetuses were finally proven to be affected and life table analysis was performed. Most affected fetuses showed an increased CT ratio in late first trimester and early second trimester, with median time of the first appearance at 13 weeks and all affected fetuses were detected at 23 weeks or less. The CT ratio yielded a sensitivity of 100 % at a gestational age of 23 weeks with a false-positive rate of 8 %. MCA-PSV appeared later than CT ratio. Only 9.4 % of affected cases developed abnormal MCA-PSV before an increased CT ratio. Conclusion The timeline of the first appearance of an increased CT ratio of fetuses with Hb Bart’s disease was established. This may help us identify Hb Bart’s disease among fetuses at risk in earlier gestation and proper schedules for serial ultrasound could be made more effectively.

scholarly journals Performance of Fetal Cardiac Volume Derived from VOCAL (Virtual Organ Computer-Aided AnaLysis) in Predicting Hemoglobin (Hb) Bart’s Disease

2021 ◽  
Vol 10 (20) ◽  
pp. 4651
Author(s):  
Keooudone Thammavong ◽  
Suchaya Luewan ◽  
Theera Tongsong
Keyword(s):  
At Risk ◽  
High Performance ◽  
Peak Systolic Velocity ◽  
Cardiac Volume ◽  
Vocal Technique ◽  
Computer Aided Analysis ◽  
The Mean ◽  
Hb Bart's ◽  
Very High ◽  
Better Than

Objective: To determine the performance of fetal cardiac volume (CV) in the detection of fetal Hb Bart’s disease among fetuses at risk at 18–22 weeks of gestation and to compare the performance with those of cardiothoracic diameter ratio (CTR) and middle cerebral artery peak systolic velocity (MCA-PSV). Methods: Fetuses at risk of Hb Bart’s disease between 18 and 22 weeks of gestation prospectively underwent echocardiography with acquisition of the volume datasets (VDS) of fetal heart, using 4D-cardiac STIC. Subsequently, off-line analysis was blindly performed to measure cardiac volume using the VOCAL technique. Results: A total of 502 fetuses at risk meeting the inclusion criteria were included in the analysis, consisting of 117 (23.3%) fetuses with Hb Bart’s disease and 385 (76.7%) unaffected fetuses. The mean (±SD) gestational age at the time of ultrasound examination was 19.70 ± 1.3 weeks. In predicting fetal Hb Bart’s disease, CV, using a cut-off Z-score of 1.7, had a sensitivity of 94.9% and specificity of 94.0%. The performance of CV was slightly better than that of CTR but very superior to that of MCA-PSV (areas under curve: 0.988, 0.974 and 0.862, respectively). Conclusions: Fetal CV has a very high performance in predicting fetal Hb Bart’s disease at mid-pregnancy, comparable with CTR and much better than MCA-PSV.

IMAGERY AND EMOTIONS IN THE PIANO PIECE „THE SICK DOLL“ FROM CHILDREN’S ALBUM OF P . I TCHAIKOVSKY

2020 ◽  
Vol 11 (1) ◽  
pp. 110-113
Author(s):  
Smilena Smilkova ◽  
Keyword(s):  
At Risk ◽  
Social Work ◽  
Short Story ◽  
Special Educational Needs ◽  
Social Pedagogy ◽  
Sound Image ◽  
The Individual ◽  
The Right ◽  
The University ◽  
Art Pedagogy

The proposed material examines the creative task of students majoring in Social Pedagogy at the University „Prof. Dr. Assen Zlatarov“ in Burgas, and studying the discipline Art Pedagogy – Part 1 – Music. In the course of the lecture course students get acquainted with the elements of musical expression, as a means of figurative representations and impact of music, with different techniques concerning individual musical activities, with the endless and diverse opportunities that music provides in the use of art pedagogy for social work teachers.Verbal interpretation of music is a necessary component when working with children with special educational needs, at risk and in the norm. Looking at Tchaikovsky’s short and extremely figurative piano piece „The Sick Doll“ from his charming „Children’s Album“, in the form of a short story, tale or essay, students express their personal vision, feeling and transformation of the musical image. The aim of the task is to transcribe the sound image into a verbal one. This requires speed, flexibility and logic in thinking, through imagination and creativity in its manifestation. Children love to listen, especially when they are involved. In search of the right way to solve problems and situations, future social educators could successfully benefit from the conversion of sound into words, according to the needs and deficits of the individual or group.

Un Kilo de Ayuda

2018 ◽  
Author(s):  
Mary Kay Gugerty ◽  
Dean Karlan
Keyword(s):  
At Risk ◽  
Impact Evaluation ◽  
Health Problems ◽  
Health Data ◽  
Outcome Data ◽  
Monitoring Data ◽  
Program Monitoring ◽  
At Risk Children ◽  
The World ◽  
The Right

This case explores two common challenges facing organizations around the world: how to collect the right amount of data, and how to credibly use outcome data collected during program monitoring. Health promoters at Un Kilo de Ayuda (UKA) in Mexico use regularly collected health data on more than 50,000 children to structure their work, track their progress, and identify at-risk children in time to treat health problems. In this case, readers will assess the tradeoffs between actionability and responsibility that UKA faces in determining how much data to collect. They will also examine the challenges of monitoring data on a program’s outcomes instead of outputs, particularly when it comes to asserting a program’s impact on those outcomes. Finally, readers will propose ways to generate credible data on one of the organization’s programs when plans for an impact evaluation fall through.

scholarly journals Resting state alpha oscillatory activity is a valid and reliable marker of schizotypy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jelena Trajkovic ◽  
Francesco Di Gregorio ◽  
Francesca Ferri ◽  
Chiara Marzi ◽  
Stefano Diciotti ◽  
...  
Keyword(s):  
At Risk ◽  
Resting State ◽  
Right Hemisphere ◽  
Normal Population ◽  
Alpha Activity ◽  
Oscillatory Activity ◽  
Loop Current ◽  
Clinical Tool ◽  
Reliable Marker ◽  
The Right

AbstractSchizophrenia is among the most debilitating neuropsychiatric disorders. However, clear neurophysiological markers that would identify at-risk individuals represent still an unknown. The aim of this study was to investigate possible alterations in the resting alpha oscillatory activity in normal population high on schizotypy trait, a physiological condition known to be severely altered in patients with schizophrenia. Direct comparison of resting-state EEG oscillatory activity between Low and High Schizotypy Group (LSG and HSG) has revealed a clear right hemisphere alteration in alpha activity of the HSG. Specifically, HSG shows a significant slowing down of right hemisphere posterior alpha frequency and an altered distribution of its amplitude, with a tendency towards a reduction in the right hemisphere in comparison to LSG. Furthermore, altered and reduced connectivity in the right fronto-parietal network within the alpha range was found in the HSG. Crucially, a trained pattern classifier based on these indices of alpha activity was able to successfully differentiate HSG from LSG on tested participants further confirming the specific importance of right hemispheric alpha activity and intrahemispheric functional connectivity. By combining alpha activity and connectivity measures with a machine learning predictive model optimized in a nested stratified cross-validation loop, current research offers a promising clinical tool able to identify individuals at-risk of developing psychosis (i.e., high schizotypy individuals).

scholarly journals 109 Game Changing Magnetic Experience in Rural and Urban Wirral Peninsula - Our Experience with Magseed Localisation of Impalpable Breast Tumours and Axillary Nodes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Arif ◽  
R Vinayagam ◽  
J M Lund ◽  
S Poonawala
Keyword(s):  
Incidental Finding ◽  
Breast Tumour ◽  
Axillary Node ◽  
Reliable Technique ◽  
Breast Tumours ◽  
Rural And Urban ◽  
Mean Size ◽  
The Right ◽  
A Prospective Study ◽  
Mean Time

Abstract Introduction Magseed is a novel localization technology in which a tiny seed is inserted to accurately mark the site of breast tumour. These can be detected intra-operatively by sentimag localization system. It aids localization of impalpable breast lesions improving margin clearance rates. Method A prospective study of first fifty Magseed localised breast tumour and axillary node excisions in Clatterbridge General Hospital. Results A total of 50 patients had 52 Magseed inserted. n = 14 was symptomatic, n = 35 was screen detected and n = 1 was an incidental finding on surveillance mammogram for a B3 lesion. 30 seeds were inserted on the right and 22 were inserted on the left (two were bilateral). 44 seeds were inserted under ultrasound guidance and the rest were targeted under stereo guidance (n = 8). Deployment of two resulted in malposition requiring wire localization. Mean age of subjects was 59.76 (range 31-81) years. Mean time to surgery after magseed insertion was 8.04 (range 1-27) days. Mean weight of the specimen was 48.57(range 10-264) gm. Mean size of the lesions was 20.32 (range 8-65) mm. Redo surgery for margin clearance was performed bringing the re-excision rate to 15.38% (n = 8). Conclusions We conclude that Magseed localization of breast tumours is a safe and reliable technique

scholarly journals A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

2011 ◽  
Vol 69 (2a) ◽  
pp. 221-226 ◽  
Author(s):  
Wuilker Knoner Campos ◽  
Marcelo N. Linhares
Keyword(s):  
Trigeminal Neuralgia ◽  
Female Gender ◽  
Safe Procedure ◽  
Approval Ratings ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
The Face ◽  
The Right ◽  
A Prospective Study

OBJECTIVE: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC), which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. METHOD: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. RESULTS: There was predominance of the female gender (54%), the right side of the face (84%) and V2V3 roots of trigeminal nerve (33%). The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02). Most patients (80%) were pain-free after 50 months with a 90% satisfaction rate. CONCLUSION: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life.

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