Placental histopathology provides insights, or “snapshots”, into relevant antenatal factors that could elevate the risk of perinatal brain injury. We present a systematic review and meta-analysis comparing frequencies of adverse neurological outcomes in infants born to women with placental abruption versus without abruption. Records were sourced from MEDLINE, Embase, and the CENTRAL Trials Registry from 1946 to December 2019. Studies followed the PRISMA guidelines and compared frequencies of neurodevelopmental morbidities in infants born to pregnant women with placental abruption (exposure) versus women without placental abruption (comparator). The primary endpoint was cerebral palsy. Periventricular and intraventricular (both severe and any grades of IVH) and any histopathological neuronal damage were the secondary endpoints. Study methodologic quality was assessed by the Ottawa–Newcastle scale. Estimated odds ratios (OR) and hazards ratio (HR) were derived according to study design. Data were meta-analyzed using a random effects model expressed as pooled effect sizes and 95% confidence intervals. We included eight observational studies in the review, including 1245 infants born to women with placental abruption. Results of the random effects meta-analysis show that the odds of infants born to pregnant women with placental abruption who experience cerebral palsy is higher than in infants born to pregnant women without placental abruption (OR 5.71 95% CI (1.17, 27.91); I2 = 84.0%). There is no statistical difference in the odds of infants born to pregnant women with placental abruption who experience severe IVH (grade 3+) (OR 1.20 95% CI (0.46, 3.11); I2 = 35.8%) and any grade of IVH (OR 1.20 95% CI (0.62, 2.32); I2 = 32.3%) vs. women without placental abruption. There is no statistically significant difference in the odds of infants born to pregnant women with placental abruption who experience PVL vs. pregnant women without placental abruption (OR 6.51 95% CI (0.94, 45.16); I2 = 0.0%). Despite our meta-analysis suggesting increased odds of cerebral palsy in infants born to pregnant women with placental abruption versus without abruption, this finding should be interpreted cautiously, given high heterogeneity and overall poor quality of the included studies.
Organizing pneumonia (OP) is a lung pathology mainly affecting distal lung structures. Its etiology is often unknown, in which case it is termed cryptogenic organizing pneumonia (COP). Of those cases of OP with an identified cause, the usual culprits include infections, medications, and radiation therapy. In this report, we present the case of a 73-year-old female on azacitidine –a pyrimidine analogue– used for treatment of myelodysplastic syndrome (MDS). The patient presented with fever, productive cough, and pleuritic chest pain. A CT of the chest, a bronchoalveolar lavage and a transthoracic biopsy were performed, and findings were consistent with OP, thought to be induced by azacitidine. The patient was treated with prednisone and subsequently showed significant improvement. Although rare, this case underlines the importance of considering OP in the context of non-resolving pulmonary infiltrates, particularly when there is a potentially relevant exposure, such as azacitidine.
Medical museums around the world have many specimens of historical and teaching value in their collections. Some of these are bones that have been prepared to illustrate normal anatomy. Others consist of organs preserved in liquid fixative (“wet” specimens) and mounted in glass or plexiglass containers that demonstrate the pathology of disease. Digitization of these specimens has the advantage of making them available for viewing by more students or website visitors than is possible in the museum itself. Photogrammetry is one method for doing this that enables the reconstruction of high-quality 3D models using standard specimen photographs. However, although relatively easy to perform on bones, its use with “wet” objects is more difficult and special steps are required to achieve optimal results. Using specimens from the Sir William Osler aortic aneurysm collection at the Maude Abbott Medical Museum, we developed a relatively simple and cost-effective photogrammetry process that gave good reconstructions of most specimens. We expect that future developments, such as the use of artificial intelligence-based techniques, may improve this result.
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