We conclude that fludarabine-based conditioning regimens are safe and effective in patients with IMO, improving morbidity and mortality related to HSCT.

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Congenital toxoplasmosis represents the second most commonly recognized congenital infection. Ocular and neurological abnormalities are considered the most frequent sequelae. Endocrinological manifestations are rare and have received little attention. We report a 3.5-month-old female infant who presented with failure to thrive and recurrent hypoglycemic attacks, diagnosed as growth hormone deficiency due to sequelae of congenital toxoplasmosis. Although endocrinological sequelae of congenital toxoplasmosis are uncommon, they represent potentially treatable conditions. Here, we stress on the importance of monitoring pituitary function and growth in children in particular, with congenital toxoplasmosis, keeping in mind other possible, potentially treatable, endocrinological manifestations.

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Background/aimOrganophosphate Pesticides (OP) aim to target the nervous system. Associations between maternal urinary levels of dialkyl metabolites of OP (DAP) and adverse outcomes in neonates and children were reported. Between 2012 and 2014, the Israeli Ministry of Agriculture restricted or banned eighteen active ingredients. We studied trends in OP exposure among pregnant women in the era of new regulation.MethodsAn ongoing cohort study of pregnant women recruited at 11–18 weeks of gestation, who were interviewed and gave a urine sample upon recruitment. Soon after birth, data collection included maternal interview and neonatal examination and urine sample collection. Urine specimens of 273 mothers and 107 offspring were sent for DAPs analysis in the Institute for Occupational, Social and Environmental Medicine of the University Erlangen-Nürnberg, Germany. Trends in DAP metabolites were tested using spearman correlation and linear regression models to estimate the association between time in months and DAP level over the period between September 2012 and March 2016.ResultsOver the study period, the median maternal DAP level decreased from 250 nmol/L to 148 nmol/L. Time of recruitment was inversely significantly correlated with total DAPs metabolites(r=-0.237, p<0.0001) and remained significant in linear regression model after controlling for maternal fruit consumption(β=-21, p<0.05). Similar trend was found for DAP metabolites in neonatal urine. The median total DAP exposure decreased from 49 nmol/L to 21 nmol/L and was inversely significantly correlated with birth month(r=-0.326, p<0.001). In linear regression model adjusting for urinary creatinine and birthweight, neonatal DAP levels decreased significantly over time (β=-5, p<0.05). Compared to other studies, pregnant women in Jerusalem had higher OP exposure, even at the end of the study period.ConclusionWe observed a reduction in maternal and neonatal DAP urinary level during the period of 2012–2016. Regulations restricting the use of OP in agriculture are probably responsible and seem to be effective in reducing the exposure of the population to OP. Yet, exposure levels are still higher than the reported levels in other Western countries.

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Background/aimLittle is known about the association between maternal exposure during pregnancy to organophosphate pesticides (OP) and fetal growth. We aimed to study whether maternal exposure to the dialkyl phosphate (DAP) metabolites during the first half of pregnancy was associated with fetal growth as estimated by ultrasonographic prenatal examinations (US).MethodsAn ongoing cohort study of pregnant women recruited at 11–18 weeks of gestation, who were interviewed and gave a urine specimen upon recruitment. In order to analyse the fetal growth, we used repeated US fetal measurements of head circumference (HC), femur length (FL), abdominal circumference (AC) and biparietal diameter (BPD). Urine specimens were analysed for DAP metabolites in the Institute for Occupational, Social and Environmental Medicine of the University Erlangen-Nürnberg, Germany. Linear and mixed linear models (with DAP, gestational age and gender as fixed effects and mothers as random effects) were constructed to study the associations between OP exposure and US measurements.ResultsA total of 826 US measurements were conducted in 211 women for each of the four US parameters. 165 women had more than two US measurements and 99 women had 4–7 measurements during pregnancy. Linear regression models for the association between DAP and the last US measurement adjusting for gender, suggested negative associations; HC (ß=-15.3, p=0.07), FL (ß=-3.8, p=0.07), AC (ß=-15.3, p=0.08), BPD(ß=-4.06, p=0.08). Mixed linear models with all US data did not support any association between maternal DAP level and fetal growth (HC: ß=-0.21, std=1.03, p=0.8; FL: ß=-0.01, std=0.23, p=0.9; AC: ß=-0.03, std=1.23, p=0.9; and BPD: ß=0.05, std=0.31, p=0.8).ConclusionIn this preliminary analysis, there was a suggested inverse association between DAP exposure and fetal growth. To our knowledge, this analysis is the first to use repeated fetal measurements and early maternal DAP levels. Further analyses controlling for gestational age will be conducted.