Objectives: Evaluation of clinical course of COVID-19 during pregnancy and maternal and perinatal outcomes of this pregnancy. Methods: 66 women with polymerase chain reaction (PCR)confirmed SARS-CoV-2 and their 42 neonates were included in the prospective observational study. Demographic, epidemiological, clinical, laboratory and instrumental data of pregnancy, delivery, postpartum period, including pharmacotherapy and neonatal outcomes were analyzed. Results: 15 (22.7%) women were asymptomatic, 25 (38%) had mild disease, while moderate and severe forms were detected in 20 (30.2%) and 6 (9.1%) cases, respectively. Additional oxygenation was required in 6 (9%) cases: 4 (6%) received CPAP therapy and 2 (3%)mechanical ventilation. Main clinical symptoms were cough (51.5%), anosmia (34.9%), and hyperthermia (33.3%). Laboratory changes included increased levels of lactate dehydrogenase (LDH), creatinine, D-dimer, and C-reactive protein (CRP), anemia, and leukopenia. All pregnant women received low molecular weight heparin and interferon alfa-2b according to the National clinical recommendations. Antimicrobial drugs included Amoxicillin/Clavulanic acid (46%) and macrolides (28%) or carbapenems in severe cases of disease. Spontaneous abortion was reported in 6.1% of cases. Eight preterm (19%) and 34 term deliveries (81%) occurred. The mean weight of neonates was (3283 ± 477) g, 1-and 5-min Apgar score was (7.8 ± 0.6) and (8.7 ± 0.5), respectively. No cases of neonatal COVID-19 infection were reported. Conclusions: Mostly, the manifestations of COVID-19 were mild. However, 9% of cases were severe, and could contribute to preterm delivery or maternal morbidity. Main predictors of severe COVID-19 course in pregnant women were a decrease in the levels of erythrocytes and lymphocytes and increase in the levels of alanine aminotransferase and CRP. Elimination of the virus in pregnant women required more time due to altered immunity. No evidence of vertical transmission during pregnancy and delivery was found. However, the possibility of this cannot be excluded.
55-62. DOI: 10.21508/102755-62. DOI: 10.21508/ -4065-2017 Abstract: The article reports clinical case of early neonatal manifestation of a rare genetic disease -mitochondrial DNA depletion syndrome, confirmed in laboratory in Russia. Mutations of FBXL4, which encodes an orphan mitochondrial F-box protein, involved in the maintenance of mitochondrial DNA (mtDNA), ultimately leading to disruption of mtDNA replication and decreased activity of mitochondrial respiratory chain complexes. It's a reason of abnormalities in clinically affected tissues, most of all the muscular system and the brain. In our case hydronephrosis on the right, subependimal cysts of the brain, partial intestinal obstruction accompanied by polyhydramnios were diagnosed antenatal. Baby's condition at birth was satisfactory and worsened dramatically towards the end of the first day of life. Clinical presentation includes sepsis-like symptom complex, neonatal depression, muscular hypotonia, persistent decompensated lactic acidosis, increase in the concentration of mitochondrial markers in blood plasma and urine, and changes in the basal ganglia of the brain. Imaging of the brain by magnetic resonance imaging (MRI) demonstrated global volume loss particularly the subcortical and periventricular white matter with significant abnormal signal in bilateral basal ganglia and brainstem with associated delayed myelination. Differential diagnosis was carried out with hereditary diseases that occur as a «sepsis-like» symptom complex, accompanied by lactic acidosis: a group of metabolic disorders of amino acids, organic acids, β-oxidation defects of fatty acids, respiratory mitochondrial chain disorders and glycogen storage disease. The diagnosis was confirmed after sequencing analysis of 62 mytochondrial genes by NGS (Next Generation Sequencing). Reported disease has an unfavorable prognosis, however, accurate diagnosis is very important for genetic counseling and helps prevent the re-birth of a sick child in the family.
Посмертная МРТ для диагностики врожденной пневмонииPostmortem magnetic resonance imaging in the diagnosis of congenital pneumonia Врожденная пневмония -одна из основных причин гибели детей в неонатальном периоде. В работе оценена возможность применения посмертной магнитно-резонансной томографии для диагностики врожденной пнев-монии на аутопсийном материале. Исследовали тела 21 умершего новорожденного. До аутопсии проводили МРТ-исследование на аппарате 3T Magnetom Verio (Siemens, Германия) в стандартных Т1 и Т2 режимах. На томограм-мах анализировали интенсивность сигнала от ткани легких, плевральной жидкости и воздуха и рассчитывали по-казатель воздушности -отношение интенсивности сигнала от жидкости в плевральной полости к интенсивности сигнала от ткани легких. Затем проводили патологоанатомическое вскрытие и по результатам изучения гистоло-гических препаратов все наблюдения разделили на две группы: в основную группу включили тела 9 новорожден-ных, умерших от врожденной пневмонии, в группу сравнения -тела 12 умерших новорожденных без признаков пневмонии. Интенсивность сигнала от ткани легких новорожденных с врожденной пневмонией была выше анало-гичного показателя в группе сравнения: на 26,5 и 12,9 % в левом и правом легком соответственно на Т1-взве-шенных изображениях (p >0,05) и на 23,7 и 31,2 % -на Т2-взвешенных изображениях (p >0,05). Чувствитель-ность описанного метода составила 77,8 %, специфичность -75,0 %, диагностическая эффективность -76,2 %.Congenital pneumonia is one of the leading causes of neonatal deaths. In this work we assess the possibility of using postmortem magnetic resonance imaging for the diagnosis of congenital pneumonia. The study was conducted on 21 neonate bodies. Before the autopsy, MRI scanning was performed on the Magnetom Verio 3T system (Siemens, Germany) in T1 and T2 standard modes. The resulting images were used to analyze signal intensities of lung tissue, pleural fluid and air. Airiness index was computed as the ratio of pleural fluid signal intensity to lung tissue signal intensity. Then, the autopsy was performed. Based on the histological analysis results, the main and the control groups were formed. The bodies of 9 neonates who had died from congenital pneumonia were included into the main group; the control group consisted of 12 dead neonates with no signs of pneumonia. On T1-weighted images, the signal intensity from the lungs of the infants with congenital pneumonia was higher by 26.5 % in the left lung and 12.9 % in the right lung, compared to the controls (p >0.05). On T2-weighted images, the corresponding figures were 23.7 and 31.2 % (p >0.05). The sensitivity of the method is 77.8 %, specificity is 75.0 % and diagnostic efficacy is 76.2 %.Ключевые слова: врожденная пневмония, легкое, посмертная магнитно-резонансная томография, аутопсия, пока-затель воздушности Keywords: congenital pneumonia, lung, postmortem magnetic resonance imaging, autopsy, airiness index Congenital pneumonia is an acute inflammatory condition of the respiratory zone caused by an antenatal or/an...
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