Abstract 17180: Complications Of A Severe Case Of Multisystem Inflammatory Syndrome In Children

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Danielle Sganga ◽  
Shiraz A Maskatia
Keyword(s):  
Cardiac Function ◽  
Brain Mri ◽  
Severe Case ◽  
Coronary Aneurysm ◽  
Laboratory Evaluation ◽  
Av Block ◽  
Cardiorespiratory Failure ◽  
Wide Range ◽  
Va Ecmo ◽  
Inflammatory Syndrome

Case Presentation: A 10 year old male with prior COVID-19 exposure presented with 7 days of fever, rash, cough, vomiting, and hypotension. Laboratory evaluation was notable for SARS-CoV2 antibodies, elevated cardiac enzymes, BNP, and inflammatory markers. Initial echocardiogram showed normal cardiac function and a small LAD coronary aneurysm. He was diagnosed with Multisystemic Inflammatory Syndrome in Children (MIS-C) and given methylprednisolone and IVIG. Within 24 hours, he developed severe LV dysfunction and progressive cardiorespiratory failure requiring VA-ECMO cannulation and anticoagulation with bivalirudin. Cardiac biopsy demonstrated lymphocytic infiltration consistent with myocarditis. On VA-ECMO, he had transient periods of complete AV block. With immunomodulator treatment (anakinra, infliximab) and 5 days of plasmapheresis, inflammatory symptoms and cardiac function improved. He weaned off ECMO, and anticoagulation was transitioned to enoxaparin. He had left sided weakness 5 days later, and brain MRI revealed an MCA infarct. Ten days later, he had focal right sided weakness and repeat MRI showed multiple hemorrhagic cortical lesions, thought to be thromboembolic with hemorrhagic conversion secondary to an exaggerated inflammatory response to an MSSA bacteremia in the setting of MIS-C. Enoxaparin was discontinued. After continued recovery and a slow anakinra and steroid wean, he has normal coronary arteries, cardiac function, and baseline ECG but requires ongoing neurorehabilitation. Discussion: COVID-19 infection in children is often mild, but MIS-C is an evolving entity that can present with a wide range of features and severity. This case highlights two concepts. While first degree AV block is often reported in MIS-C, there is potential for progression to advanced AV block. Close telemetry monitoring is critical, especially if there is evidence of myocarditis. MIS-C shares features with Kawasaki disease, with a notable difference being a higher likelihood of shock and cardiac dysfunction in MIS-C. In MIS-C patients with cardiovascular collapse requiring ECMO, there is a risk for stroke. There should be a low threshold for neuroimaging and multidisciplinary effort to guide anticoagulation in these complex cases.

Effect of human urotensin-II infusion on hemodynamics and cardiac function

2003 ◽  
Vol 81 (2) ◽  
pp. 125-128 ◽  
Author(s):  
Ghada S Hassan ◽  
Fazila Chouiali ◽  
Takayuki Saito ◽  
Fu Hu ◽  
Stephen A Douglas ◽  
...  
Keyword(s):  
Cardiac Function ◽  
Diastolic Pressure ◽  
Cardiac Contractility ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Urotensin Ii ◽  
Ventricular Systolic Pressure ◽  
Wide Range ◽  
Dose Dependent Decrease

Recent studies have shown that the vasoactive peptide urotensin-II (U-II) exerts a wide range of action on the cardiovascular system of various species. In the present study, we determined the in vivo effects of U-II on basal hemodynamics and cardiac function in the anesthetized intact rat. Intravenous bolus injection of human U-II resulted in a dose-dependent decrease in mean arterial pressure and left ventricular systolic pressure. Cardiac contractility represented by ±dP/dt was decreased after injection of U-II. However, there was no significant change in heart rate or diastolic pressure. The present study suggests that upregulation of myocardial U-II may contribute to impaired myocardial function in disease conditions such as congestive heart failure.Key words: urotensin-II, rat, infusion, heart.

Brain abnormality detection using template matching

2018 ◽  
Vol 14 (4) ◽  
Author(s):  
G.B. Praveen ◽  
Anita Agrawal ◽  
Shrey Pareek ◽  
Amalin Prince
Keyword(s):  
Magnetic Resonance ◽  
Template Matching ◽  
Imaging Modality ◽  
Brain Mri ◽  
Tumor Segmentation ◽  
Processing Unit ◽  
Brain Disorders ◽  
Brain Tumor Segmentation ◽  
Central Processing ◽  
Wide Range

Abstract Magnetic resonance imaging (MRI) is a widely used imaging modality to evaluate brain disorders. MRI generates huge volumes of data, which consist of a sequence of scans taken at different instances of time. As the presence of brain disorders has to be evaluated on all magnetic resonance (MR) sequences, manual brain disorder detection becomes a tedious process and is prone to inter- and intra-rater errors. A technique for detecting abnormalities in brain MRI using template matching is proposed. Bias filed correction is performed on volumetric scans using N4ITK filter, followed by volumetric registration. Normalized cross-correlation template matching is used for image registration taking into account, the rotation and scaling operations. A template of abnormality is selected which is then matched in the volumetric scans, if found, the corresponding image is retrieved. Post-processing of the retrieved images is performed by the thresholding operation; the coordinates and area of the abnormality are reported. The experiments are carried out on the glioma dataset obtained from Brain Tumor Segmentation Challenge 2013 database (BRATS 2013). Glioma dataset consisted of MR scans of 30 real glioma patients and 50 simulated glioma patients. NVIDIA Compute Unified Device Architecture framework is employed in this paper, and it is found that the detection speed using graphics processing unit is almost four times faster than using only central processing unit. The average Dice and Jaccard coefficients for a wide range of trials are found to be 0.91 and 0.83, respectively.

scholarly journals Severe Plane-Form Enamel Hypoplasia in a Dentition from Roman Britain

2018 ◽  
Vol 30 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Ian Towle ◽  
Eleanor R. Dove ◽  
Joel D. Irish ◽  
Isabelle De Groote
Keyword(s):  
Life Histories ◽  
Dna Analysis ◽  
Severe Case ◽  
Enamel Hypoplasia ◽  
Life Threatening Illness ◽  
Molar Incisor Hypomineralization ◽  
Wide Range ◽  
Pathogen Dna ◽  
Insight Into ◽  
Plane Form

Enamel defects can provide insight into the life histories of past individuals and populations, in-cluding information on a wide range of disturbances during childhood. This study investigates a particularly severe case of plane-form enamel hypoplasia from a Roman site in Gloucester, UK. Dentine protrudes above the occlusal enamel of upper central incisors, both upper canines, the lower left canine, lower right central incisor, and all four first molars. Given the morphology and location of these defects, along with the developmental tim-ing of the affected teeth, such factors as molar-incisor hypomineralization, amelogenesis imperfecta, and congen-ital syphilis can likely be ruled out. The defects resulted from a nonspecific but severe physiological disturbance during the second year of life. Severe plane-form defects of this kind, where enamel formation has completely ceased, are extremely rare in premodern populations, and this example is one of the earliest reported cases. It has been suggested that these defects generally occur only in individuals that survived a life-threatening illness, which would explain the scarcity in the archaeological record, i.e., the afflicted individual would not have lived long enough for the defects to manifest. Comparisons with clinical examples and pathogen DNA analysis may provide further insight into the etiology of these defects.

505: Survival and cardiac function in children with isoimmune AV block treated in utero with transplacental dexamethasone

2007 ◽  
Vol 197 (6) ◽  
pp. S148 ◽  
Author(s):  
Naveen Imram ◽  
James Huhta ◽  
Marcjoseph Ovadia ◽  
Alisa Niksch ◽  
Jenny Leshko ◽  
...  
Keyword(s):  
Cardiac Function ◽  
In Utero ◽  
Av Block

Abstract 28: In Vivo Knockdown of Mirna-15b Results in Increased Cardiac Hypertrophy and Fibrosis in Response to Pressure Overload of the Mouse Heart

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Anke J Tijsen ◽  
Ingeborg van der Made ◽  
Elza D van Deel ◽  
Monika Hiller ◽  
Yolan J Reckman ◽  
...  
Keyword(s):  
Transgenic Mice ◽  
Cardiac Function ◽  
Cardiac Fibrosis ◽  
Negative Control ◽  
Heart Weight ◽  
Mouse Heart ◽  
Hypertrophic Response ◽  
Wide Range ◽  
Tgfβ Pathway

MiRNAs play an important role in the control of diverse aspects of cardiac function. MiR-15b is highly expressed in the heart and is found consistently upregulated in hypertrophic and failing hearts. To investigate the function of miR-15b in the heart we set out two experiments. In the first experiment we generated two independent transgenic mouse lines that drive miR-15b expression under the αMHC-promotor and show a three and four fold overexpression of miR-15b. Strikingly, both lines show a decrease in heart weight/tibia length of 20% in adult and aged mice when compared to littermate controls. We investigated the response of these transgenic mice to thoracic aorta constriction (TAC) and found no differences in the hypertrophic response or in cardiac function measured by echocardiography between wild-type and transgenic mice. In a second experiment, we inhibited miR-15b using LNA-based antimiRs. In these mice, TAC resulted in an increased hypertrophic response and increased cardiac fibrosis when compared to a negative control antimiR. A wide range of predicted targets of miR-15 belong to the pathways of the TGFβ-superfamily and using a smad-dependent reporter we show that miR-15b inhibits TGFβ-induced Smad activity in HepG2 cells. One of the predicted targets in the TGFβ pathway is TGFβ receptor 1 (TGFβR1), of which the 3’UTR contains six predicted miR-15 binding sites. This suggests that the phenotype in the transgenic mice and after knockdown of miR-15b may be (partly) mediated by repression of TGFβR1. Indeed, in the adult miR-15b transgenic hearts we found a downregulation of TGFβR1 mRNA and protein and we confirmed binding of miR-15 to the TGFβR1 3’UTR by luciferase assays. In conclusion, miR-15b causes a cardiac hypotrophic phenotype at baseline in transgenic mice and inhibition of miR-15b leads to a stronger hypertrophic and fibrotic response after TAC. Furthermore miR-15b inhibits the TGFβ pathway by targeting the TGFβR1 and possibly other targets in this pathway. This research is funded by the Dutch Heart Foundation (NHF grant #2007B077).

scholarly journals Performance of a Commercial Polymerase Chain Reaction Test for EndocervicalChlamydia trachomatisInfection in a University Hospital Population

1998 ◽  
Vol 6 (5) ◽  
pp. 224-229
Author(s):  
C. H. Livengood III ◽  
K. A. Boggess ◽  
J. W. Wrenn ◽  
A. P. Murtha
Keyword(s):  
Polymerase Chain Reaction ◽  
Polymerase Chain Reaction Test ◽  
Laboratory Evaluation ◽  
Clinical Samples ◽  
Chain Reaction ◽  
Predictive Values ◽  
Target Dna ◽  
Wide Range ◽  
Polymerase Chain ◽  
Pcr Test

Objectives:To examine the accuracy of a commercial polymerase chain reaction (PCR) test (Amplicor CTR, Roche Diagnostic Systems, Branchburg NJ) for identification of endocervical chlamydial infections through both laboratory evaluation and among a diverse teaching hospital patient population.Methods:Testing of reliable threshold inocula and reproducibility were carried out using laboratory stock organisms. Paired endocervical samples from patients with a wide range of indications were tested by PCR and an established culture procedure, and discrepant pairs were further analyzed to determine true results.Results:Laboratory evaluation suggested that one copy of target DNA from a viable organism consistently yielded a positive result, and test reproducibility was very good, with an overall coefficient of variation of 15%. Compared to true results in 1,588 paired clinical samples from 1,489 women with a 10% prevalence of infection, the PCR test and culture yielded respective sensitivities of 87.4% and 78.0%, and negative predictive values of 98.6% and 97.6%. Specificity and positive predictive value for both tests were 100%. Cost per specimen was nearly identical at $18.84 and $18.88 respectively. Polymerase inhibitors and organisms lacking target DNA were not found in false-negative PCR samples.Conclusion:This commercial PCR test is accurate, cost-competitive, and much faster than culture for diagnosis of endocervical chlamydia infections in our population of intermediate prevalence of chlamydial infection.

scholarly journals Increase of a wide range of bioactive substances in an active phase of neuro-Sweet disease

2020 ◽  
Vol 13 (4) ◽  
pp. e233457
Author(s):  
Hiroi Kusaka ◽  
Katsuya Nagatani ◽  
Takeo Sato ◽  
Seiji Minota
Keyword(s):  
Brain Mri ◽  
Active Phase ◽  
Hla Typing ◽  
Microbial Infection ◽  
Bioactive Substances ◽  
Neurological Sequelae ◽  
Consciousness Disturbance ◽  
Wide Range ◽  
Old Japanese ◽  
Cytokine Assay

We present the case of a patient whose skin findings and human leucocyte antigen (HLA) typing were key findings for the diagnosis of his neuro-Sweet disease. A 55-year-old Japanese man with skin rashes and high fever suddenly developed consciousness disturbance, and brain MRI showed encephalitis and leptomeningitis. Neuro-Behçet disease or microbial infection was initially suspected, but he was eventually diagnosed with neuro-Sweet disease based on his skin rashes and pathology and the presence of HLA-B54 and Cw1. He responded to glucocorticoid and recovered without neurological sequelae. The involvement of cytokines has been implicated in the pathogenesis of Sweet disease, but the number of cytokines assayed in each case report is limited. In our patient’s case, the result of a 27-cytokine assay showed increases in a wide range of bioactive substances including inflammatory cytokines, growth factors and chemoattractants in the active phase, indicating the involvement of multiple cytokines in the pathogenesis of Sweet disease.

scholarly journals Denoising of Images Using Deep Convolutional Autoencoders for Brain Tumor Classification

2021 ◽  
Vol 35 (6) ◽  
pp. 489-496
Author(s):  
Revathi Vankayalapati ◽  
Akka Lakshmi Muddana
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Mri ◽  
Model Performance ◽  
The Body ◽  
Resonance Imaging ◽  
Forming Process ◽  
Medical Sector ◽  
Proposed Model ◽  
Wide Range

In the acquisition of images of the human body, medical imaging devices are crucial. The Magnetic Resonance Imaging (MRI) system detects tissue anomalies and tumours in the body of people. During the forming process, the MRI images are degraded by different kind of noises. It is difficult to remove certain noises, accompanied by the segmentation of images in order to classify anomalies. The most commonly explored areas of this period are automatic tumour detection systems using Magnetic Resonance Imaging. In the medical sector, timely and exact identification of frequencies is a problem. Automated systems are efficient that reduce human errors when tumour is detected. In recent years, many approaches have been proposed to do this, but there are still several drawbacks and a wide range of improvements on these methodologies are still needed. The image processing mechanism is widely used to improve early detection and treatment stages in the field of medical sciences. Sometimes the doctor can misdiagnose the image of MRI because of noise levels. To date, Deep Convolution Neural Networks (DCNN) have demonstrated excellent classification and segmentation efficiency. This paper proposes a technique for the image denoising using DCNN based Auto Encoders (DCNNAE) for achieving better accuracy rates in brain tumour prediction. In this paper we propose a deep convolution denoising auto encoder to remove noise from images and over fit the model problem by developing a deep convolution neural network for brain MRI image tumour prediction. The proposed model is compared with the existing methods and the results exhibits that the proposed model performance levels are better than the existing ones.

scholarly journals Clinical Characteristics and Factors Associated with Unfavorable Outcomes of Pediatric Inflammatory Multisystem Syndrome Related to COVID-19 in Lima-Peru

2021 ◽  
Author(s):  
Olguita del Aguila ◽  
Jesús Dominguez-Rojas ◽  
Kenny Chonlon-Murillo ◽  
Aida Borcic ◽  
Sandra Sánchez ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Myocardial Injury ◽  
Coronary Aneurysm ◽  
C Reactive Protein ◽  
Factors Associated ◽  
Reactive Protein ◽  
Robust Variance ◽  
Organic Dysfunction ◽  
Epidemiological Profile ◽  
Inflammatory Syndrome

Abstract Objective: Describe the clinical-epidemiological profile and determine the factors associated with unfavorable outcomes of pediatrics multisystemic inflammatory syndrome (SIM-P) related to COVID-19 at Edgardo Rebagliati Martins National Hospital (HNERM), Lima-Perú, from April to September 2020. Materials and methods: Retrospective cohort in children under 14 years of age. The current criteria were used for the diagnosis of SIM-P. The effect size was estimated with relative risk (RR) and 95% confidence intervals, using a generalized linear Poisson family model with robust variance. Results: 43 patients were included, 22 (51.2%) Kawasaki Disease (EK), 10 (23.3%) shock, and 11(25.6%) fever with inflammatory markers. The median age was 8 years, most men, without comorbidity, with negative molecular test and positive IgG. Gastrointestinal and mucocutaneous manifestations predominated, with altered inflammatory markers and myocardial injury. Most required intravenous immunoglobulin (IVIG), aspirin (AAS), corticosteroids and antibiotics. More than a third required VMI, ICU and developed organic dysfunction, with a lethality of 4.6% (2/43). Increasing lethality to 20% (2/10) in the shock subgroup. Five were found (14.7%) coronary aneurysm. Having some comorbidity (RR 1.79; IC95%1.02-3.14), C-reactive protein ≥ 10 mg/dL (RR 2.09; IC95%1.15-3.79), and SatO2 ≤92 in emergency (RR 2.84; IC95%1.47-5.50) was morelikely to betransferred to ICU. In addition, those with some comorability (RR 2.23; IC95%1.04-4.79), with lymphopenia <500cel/mL (RR 2.8; IC95%1.24-6.30), and with d≥ 3 mg/L (RR 3.57; IC95%1.23-10.38) were more likely to require VMI. Conclusion: Active monitoringis an eye to make early diagnosis and management in order to improve the prognosis.

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