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Esmel-Vilomara R, Dolader P, Giralt G, Ferrer Q, Gran F. Coxsackievirus-induced myocarditis. An Pediatr (Barc) 2022; 97:354-356. [PMID: 35995700 DOI: 10.1016/j.anpede.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Roger Esmel-Vilomara
- Cardiología Pediátrica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cardiología Pediátrica, Vall d'Hebron Hospital Campus, Barcelona, Spain.
| | - Paola Dolader
- Cardiología Pediátrica, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Gemma Giralt
- Cardiología Pediátrica, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Queralt Ferrer
- Cardiología Pediátrica, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Ferran Gran
- Cardiología Pediátrica, Vall d'Hebron Hospital Campus, Barcelona, Spain
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Grasa CD, Fernández-Cooke E, Domínguez-Rodríguez S, Aracil-Santos J, Barrios Tascon A, Sánchez-Manubens J, Mercader B, Antón J, Nuñez E, Villalobos E, Bustillo M, Camacho M, Oltra Benavent M, Giralt G, Bello Naranjo AM, Rocandio B, Calvo C. Risk scores for Kawasaki disease, a management tool developed by the KAWA-RACE cohort. Clin Rheumatol 2022; 41:3759-3768. [PMID: 35939163 DOI: 10.1007/s10067-022-06319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVES Asian scores developed to predict unresponsiveness to intravenous immunoglobulin (IVIG) or development of coronary artery aneurysms (CAA) in patients with Kawasaki disease (KD) are not appropriate in Western populations. The purpose of this study is to develop 2 scores, to predict unresponsiveness to IVIG and development of CAA, appropriate for Spanish population. METHOD Data of 625 Spanish children with KD collected retrospectively (2011-2016) were used to identify variables to develop the 2 scores of interest: unresponsiveness to IVIG and development of CAA. A statistical model selected best variables to create the scores, and scores were validated with data from 98 patients collected prospectively. RESULTS From 625 patients of the retrospective cohort, final analysis was performed in 439 subjects: 37 developed CAA, and 212 were unresponsive to IVIG. For the score to predict CAA, a cutoff ≥ 8 was considered for high risk, considering a score system with a different weight for each of the eight variables. External validation showed a sensitivity of 22% and a specificity of 75%. The score to predict unresponsiveness to IVIG established a cutoff ≥ 8 for high risk, considering a score system with a different weight for each of the nine variables. External validation showed a sensitivity of 78% and a specificity of 50%. CONCLUSIONS Two risk scores for KD were developed from Spanish population, to predict development of CAA and unresponsiveness to IVIG; validation in other cohorts could help to implement these tools in the management of KD in other Western populations.
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Affiliation(s)
- Carlos D Grasa
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
- IdiPaz, Institute for Health Research from La Paz Hospital, Madrid, Spain
- CIBERINFEC, CIBER of Infectious Diseases in Spain (Instituto de Salud Carlos III - ISCIII), Seville, Spain
| | - Elisa Fernández-Cooke
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trial Unit (UPIC), Department of Pediatrics, Hospital Universitario 12 Octubre, Avda. Córdoba s/n., 28041, Madrid, Spain.
- imas12, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain.
- RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain.
| | - Sara Domínguez-Rodríguez
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trial Unit (UPIC), Department of Pediatrics, Hospital Universitario 12 Octubre, Avda. Córdoba s/n., 28041, Madrid, Spain
- imas12, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Javier Aracil-Santos
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
| | - Ana Barrios Tascon
- Department of Pediatrics, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
| | - Judith Sánchez-Manubens
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
- Department of Pediatric Rheumatology, Hospital Parc Tauli, Sabadell, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Jordi Antón
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | - Esmeralda Nuñez
- Pediatric Rheumatology Unit, Department of Pediatrics, Hospital Regional Universitario, Malaga, Spain
| | | | - Matilde Bustillo
- Department of Pediatric Infectious Diseases, Hospital Miguel Servet, Zaragoza, Spain
| | - Marisol Camacho
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Department of Pediatrics, Hospital Virgen del Rocio, Sevilla, Spain
| | - Manuel Oltra Benavent
- Department of Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Giralt
- Department of Pediatric Cardiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ana Maria Bello Naranjo
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Canarias, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario Donostia, San Sebastian, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
- IdiPaz, Institute for Health Research from La Paz Hospital, Madrid, Spain
- CIBERINFEC, CIBER of Infectious Diseases in Spain (Instituto de Salud Carlos III - ISCIII), Seville, Spain
- RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain
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Esmel-Vilomara R, Dolader P, Giralt G, Ferrer Q, Gran F. Miocarditis agudas por virus coxsackie. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Grasa CD, Fernández-Cooke E, Sánchez-Manubens J, Carazo-Gallego B, Aracil-Santos J, Anton J, Lirola MJ, Mercader B, Villalobos E, Bustillo M, Giralt G, Rocandio B, Escribano LM, Domínguez-Rodríguez S, Calvo C. Kawasaki disease in children younger than 6 months of age: characteristics of a Spanish cohort. Eur J Pediatr 2022; 181:589-598. [PMID: 34459958 DOI: 10.1007/s00431-021-04215-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/20/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
A retrospective study that compared children younger than 6 months versus older children of a Spanish cohort of patients diagnosed with Kawasaki disease between 2011 and 2016 (Kawa-Race study). From the 598 patients recruited, 42 patients were younger than 6 months (7%) and presented more frequently with an incomplete diagnosis of Kawasaki disease (52.4 vs 27.9%, p = 0.001). Cardiac abnormalities detected by echocardiography were more common in younger patients (52.4 vs 30%, p = 0.002). These younger patients presented with a higher proportion of coronary aneurysms as well (19 vs 8.6%, p < 0.001). Shock at diagnosis (9.5 vs 1.9%, p = 0.016) and admission to intensive care units (17.7 vs 4.1%, p = 0.003) were more frequent in patients younger than 6 months. There were no statistically significant differences in relation to infections, non-response to IVIG, or mid- or long-term outcomes.Conclusion: Data of the Spanish cohort are consistent with other American and Asian studies, although Spanish children younger than 6 months had a lower rate of non-response to IVIG and better clinical outcomes. A high index of suspicion should be considered for this population due to a higher risk of coronary abnormalities, presentation of shock, and admission to the intensive care unit. What is Known: •Children below 6 months of age with Kawasaki disease (KD) have different features compared to older. •Younger patients usually have an incomplete form of KD and coronary artery abnormalities. What is New: •Younger than 6 months with KD presented with shock and required admission to PICU more frequently compared to older. •Infections play a similar role in KD despite the age of the patients.
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Affiliation(s)
- Carlos D Grasa
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain.
| | - Elisa Fernández-Cooke
- Pediatric Research and Clinical Trial Unit (UPIC), Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario, 12 Octubre, Madrid, Spain.,imas2, Instituto de Investigación Sanitaria Hospital, 12 de Octubre, Madrid, Spain.,RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain
| | | | - Begoña Carazo-Gallego
- Department of Pediatric Infectious Diseases, Hospital Regional Universitario, Malaga, Spain
| | - Javier Aracil-Santos
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - María José Lirola
- Department of Pediatric Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Virgen de La Arrixaca, Murcia, Spain
| | | | - Matilde Bustillo
- Department of Pediatric Infectious Diseases, Hospital Miguel Servet, Zaragoza, Spain
| | - Gemma Giralt
- Department of Pediatric Cardiology, Hospital Vall D'Hebron, Barcelona, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario Donostia, San Sebastián, Spain
| | - Lucía M Escribano
- Department of Pediatric Cardiology, Hospital General de Albacete, Albacete, Spain
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trial Unit (UPIC), Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario, 12 Octubre, Madrid, Spain.,imas2, Instituto de Investigación Sanitaria Hospital, 12 de Octubre, Madrid, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain.,RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain.,IdiPaz, Institute for Health Research From La Paz Hospital, Madrid, Spain
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Esmel-Vilomara R, Ferrer Q, Giralt G. Cor triatriatum sinister: out of the Lucas-Schmidt classification. Rev Esp Cardiol (Engl Ed) 2021; 74:983. [PMID: 33958313 DOI: 10.1016/j.rec.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Roger Esmel-Vilomara
- Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Queralt Ferrer
- Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Gemma Giralt
- Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Esmel-Vilomara R, Ferrer Q, Giralt G. Cor triatriatum sinister: fuera de la clasificación de Lucas-Schmidt. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Siurana JM, Ventura PS, Yeste D, Riaza-Martin L, Arciniegas L, Clemente M, Torres M, Amigó N, Giralt G, Roses-Noguer F, Sabate-Rotes A. Myocardial Geometry and Dysfunction in Morbidly Obese Adolescents (BMI 35-40 kg/m 2). Am J Cardiol 2021; 157:128-134. [PMID: 34392890 DOI: 10.1016/j.amjcard.2021.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
This study evaluated the preclinical effect of obesity on the ventricular remodeling in adolescents with morbid obesity, and determined if subjects labelled as metabolically healthy obesity (MHO) presented better heart index than those with metabolically unhealthy obesity (MUO). Prospective case-control research of 45 adolescents (14-year-old) with morbid obesity and 25 normal weight adolescents' gender- and age-matched with Tanner stage 4-5. Left ventricle (LV) was evaluated by conventional Doppler echocardiography, tissue Doppler imaging and two-dimensional speckle tracking echocardiography. Compared to normal-weight subjects, adolescents with morbid obesity presented a high percentage of pathological LV geometry (87%; p<0.01), and systolic and diastolic dysfunctions only detected by E/A ratio (2.0 vs 1.7, p<0.01), global longitudinal strain (-21.0% vs -16.5%, p<0.01), and early diastolic strain rate (3.2 vs 2.2, p<0.01). A correlation was found between impaired cardiac index and body mass index (BMI), high blood pressure, hyperglycemia, low HDL-cholesterol and hypertriglyceridemia. BMI and HDL-cholesterol were the most significant independent variables. No significant differences were found in structural and functional cardiac index when MHO and MUO subjects were compared (global longitudinal strain: -17.0% vs -16.4%, p0.79). Morbidly obese adolescents have an abnormal LV geometry, closely related to BMI, and systolic and diastolic LV dysfunctions. Adolescents labelled as MHO, despite exhibiting better BMI and insulin-resistance values, present the same pathological heart changes as MUO.
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Affiliation(s)
- Jose M Siurana
- Hospital HM Nens. HM Hospitales, Barcelona, Spain; Autonomous University of Barcelona, Spain.
| | - Paula S Ventura
- Hospital HM Nens. HM Hospitales, Barcelona, Spain; Autonomous University of Barcelona, Spain
| | - Diego Yeste
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; CIBER of Rare Diseases (CIBERER) ISCIII, Spain
| | | | | | - Maria Clemente
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; CIBER of Rare Diseases (CIBERER) ISCIII, Spain
| | | | - Núria Amigó
- Biosfer Teslab - Metabolomics Platform, Rovira i Virgili University, Tarragona, Spain
| | - Gemma Giralt
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ferran Roses-Noguer
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain
| | - Anna Sabate-Rotes
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain
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Costa-Borges N, Giralt G, Albó E, Alvarez A, Ramos J, Hernandez I, Luis M, Calderón G, Munne S. O-122 ICSI in a box: development of a successful automated sperm injection robot with external supervision and minimal manual intervention. Hum Reprod 2021. [DOI: 10.1093/humrep/deab126.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is it possible to automate the way sperm is injected in an oocyte and improve ICSI consistency between embryologists?
Summary answer
The developed ICSI robot demonstrated a high degree of consistency and operator skill independence, allowing human supervision and external control, but minimal manual intervention.
What is known already
ICSI is a clinical procedure that is currently performed worldwide in most IVF centers and its use will only increase with more utilization of egg freezing. Since its implementation, the technique has been conducted manually by highly skilled embryologists. However, success rates can vary significantly depending on the experience of the operator. We leverage our experience in robotics, AI algorithms and embryology to develop an automated ICSI robot that requires minimal manual intervention with the aim to standardize the consistency of the procedure and, ultimately, improve overall results maintaining embryologist oversight.
Study design, size, duration
The ICSI robot was developed to have supervised automated control on critical steps of the injection procedure, including injection pipette advancement, zona pellucida and oolemma penetration with piezo-pulses, and pipette removal after injection. Manual intervention is required only for immobilization and capture of spermatozoa with a joystick gamepad and to release the sperm in the ooplasm, without the need for micromanipulation skills. In parallel, piezo-ICSI was performed in a conventional micromanipulation station as a control.
Participants/materials, setting, methods
Hamster and mouse oocytes were collected from superovulated females. For testing the efficiency of the automated system, hamster oocytes were injected with human donor sperm, as historically used in manual ICSI training programs, and survival rates evaluated after overnight culture. Mouse oocytes were injected with mouse sperm heads and subsequently cultured in vitro for five days. Blastocysts obtained were vitrified and embryo transfers are ongoing to evaluate term developmental rates.
Main results and the role of chance
The technical components of the ICSI robot were engineered to integrate AI algorithms, optics, cell microinjectors and mechatronics. AI algorithms were developed to identify the morphological structures of MII oocytes, including the zona pellucida, perivitelline space and polar body, both in the hamster and mouse models. The system detects and analyzes both the pipette and the oocyte and chooses the best area and plane for injection, allowing automated control of the subsequent injection steps. Using the hamster oocyte-human sperm model, a survival rate of 91% (n = 110) was achieved with the robot, which was statistically similar (p = 0.335) to the results obtained in the controls injected manually (96%, n = 28). The average time spent in each injection cycle, which includes scanning of the oocyte and injection pipette, and injection of the sperm into the oocyte, was approximately two minutes per ICSI operation. This time was comparable to the time required by highly experienced operators with manual piezo-injection. In the mouse, 91% (n = 53) of the oocytes injected survived the procedure, of which, 92% developed to two-cells and 87% to the blastocyst stage. No statistical differences were found when compared these efficiencies with manual controls (n = 40, 98%, 97% and 92%, respectively).
Limitations, reasons for caution
The developed ICSI robot has shown highly consistent results, independently of operator skills, both in hamster and mouse oocytes. However, additional validations should be performed to enlarge the sample size of injected oocytes and to evaluate the efficiency of the system in other oocyte species, including translational studies to humans.
Wider implications of the findings
The combination of multidisciplinary teams allows the development of automated processes that can reduce variability in certain IVF procedures, while supervised and assisted by experienced embryologists. It is expected that other laboratory procedures can be automated in the field of assisted reproductive treatments in a near future.
Trial registration number
N/A
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Affiliation(s)
- N Costa-Borges
- Embryotools S.L., Research and Development, Barcelona, Spain
| | - G Giralt
- Overture, Research and Development, Barcelona, Spain
| | - E Albó
- Overture, Research and Development, Barcelona, Spain
| | - A Alvarez
- Overture, Research and Development, Madrid, Spain
| | - J Ramos
- Overture, Research and Development, Madrid, Spain
| | - I Hernandez
- Overture, Research and Development, Madrid, Spain
| | - M Luis
- Overture, Research and Development, Barcelona, Spain
| | - G Calderón
- Embryotools S.L., Research and Development, Barcelona, Spain
| | - S Munne
- Overture, Research and Development, Barcelona, Spain
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Laín A, Giralt G, Giné C, García Martínez L, Villaverde I, López M. Transesophageal echocardiography during pectus excavatum correction in children: What happens to the heart? J Pediatr Surg 2021; 56:988-994. [PMID: 32660778 DOI: 10.1016/j.jpedsurg.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Cardiac compression in pectus excavatum remains difficult to evaluate. We describe the findings with intraoperative transesophageal echocardiography during pectus excavatum correction in pediatric patients. METHODS We studied right heart changes during surgical correction of pectus excavatum by transesophageal echocardiograph. Four-D echo was associated to assess morphology of the tricuspid annulus. RESULTS Twenty patients were included, mean age 13.5 (+/- 2.9). Mean preoperative Haller Index was 6.3 (+/- 2.63) and mean Correction Index 47.63% (+/- 12.4%). Preoperative transthoracic echocardiography at rest showed mild right heart compression in 6. Correction was gained by Nuss technique in 19, and Taulinoplasty in one. Initial transesophageal echocardiography showed compression of the right heart and deformation of the tricuspid annulus in all. During the sternal elevation, diameters of right atrium, ventricle and tricuspid annulus significantly improved: mean augmentation of right ventricle was 5.78 mm (+/- 3.56 p < 0.05), right atrium 6.64 mm (+/- 5.55 p < 0.05) and tricuspid annulus 6.02 mm (+/- 3.29 p < 0.05). The morphology of the tricuspid annulus in 4D normalized. CONCLUSIONS Preoperative transthoracic echocardiography at rest underestimates right chamber compression in pediatric patients with pectus excavatum. Surgical correction improves diameters of the right ventricle, right atrium and tricuspid annulus and normalizes the morphology of the tricuspid annulus (4D). LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ana Laín
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
| | - Gemma Giralt
- Pediatric Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Giné
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain
| | | | - Iván Villaverde
- Pediatric Anesthesiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Manuel López
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain
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Fernández-Cooke E, Grasa CD, Domínguez-Rodríguez S, Barrios Tascón A, Sánchez-Manubens J, Anton J, Mercader B, Villalobos E, Camacho M, Navarro Gómez ML, Oltra Benavent M, Giralt G, Bustillo M, Bello Naranjo AM, Rocandio B, Rodríguez-González M, Núñez Cuadros E, Aracil Santos J, Moreno D, Calvo C. Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain. Front Pediatr 2020; 8:617039. [PMID: 33537269 PMCID: PMC7849209 DOI: 10.3389/fped.2020.617039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.
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Affiliation(s)
- Elisa Fernández-Cooke
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Carlos D Grasa
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Ana Barrios Tascón
- Department of Pediatrics, Hospital Universitario Infanta Sofia, Madrid, Spain
| | - Judith Sánchez-Manubens
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Anton
- Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Enrique Villalobos
- Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marisol Camacho
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Department of Pediatrics, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Manuel Oltra Benavent
- Department of Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Giralt
- Pediatric Cardiology Unit, Department of Pediatrics, Hospital Universitario Vall d'Hebron Barcelona, Barcelona, Spain
| | - Matilde Bustillo
- Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ana María Bello Naranjo
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Canarias, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario de Donostia, Guipuzcoa, Spain
| | | | | | - Javier Aracil Santos
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - David Moreno
- Department of Pediatrics, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Cristina Calvo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
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Dolader P, Gran F, Giralt G, Ferrer Q, Rosés-Noguer F, Albert DC. Evolución ondulante de la miocardiopatía no compactada. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dolader P, Gran F, Giralt G, Ferrer Q, Rosés-Noguer F, Albert DC. Undulating Clinical Course of Noncompaction Cardiomyopathy. Rev Esp Cardiol (Engl Ed) 2018; 71:1077-1079. [PMID: 29221698 DOI: 10.1016/j.rec.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Paola Dolader
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ferran Gran
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Gemma Giralt
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Queralt Ferrer
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ferran Rosés-Noguer
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Dimpna C Albert
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Valenzuela I, Fernández-Alvarez P, Munell F, Sanchez-Montanez A, Giralt G, Vendrell T, Tizzano EF. Arthrogryposis as neonatal presentation of Loeys-Dietz syndrome due to a novel TGFBR2 mutation. Eur J Med Genet 2017; 60:303-307. [PMID: 28344185 DOI: 10.1016/j.ejmg.2017.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/10/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Abstract
Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder characterized mainly by cardiovascular, craniofacial and skeletal features. We report on a patient with LDS, whose prenatal examination was compatible with the diagnosis of arthrogryposis multiplex congenita. Neonatal assessment showed craniofacial and cardiovascular findings suggestive of LDS whose diagnosis was confirmed by the detection of a novel mutation (HGVN: NM_003242.5 (TGFBR2): c.1381T > C (p.(Cys461Arg))) in the TGFBR2 gene. Few prenatal and neonatal cases of LDS have been reported in the literature. We reviewed all cases reported to date with perinatal onset to delineate the clinical manifestations that allow us to prompt diagnosis of this syndrome at an early stage to prevent fatal cardiovascular complications. Furthermore we discuss the multidisciplinary follow up required in these patients.
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Affiliation(s)
- Irene Valenzuela
- Department of Clinical and Molecular Genetics and Rare Disease Unit, University Hospital Vall d'Hebron, CIBERER, Barcelona, Spain
| | - Paula Fernández-Alvarez
- Department of Clinical and Molecular Genetics and Rare Disease Unit, University Hospital Vall d'Hebron, CIBERER, Barcelona, Spain
| | - Francina Munell
- Neuropediatrics Service, University Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Gemma Giralt
- Pediatric Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Teresa Vendrell
- Department of Clinical and Molecular Genetics and Rare Disease Unit, University Hospital Vall d'Hebron, CIBERER, Barcelona, Spain
| | - Eduardo F Tizzano
- Department of Clinical and Molecular Genetics and Rare Disease Unit, University Hospital Vall d'Hebron, CIBERER, Barcelona, Spain.
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Martínez-Villar M, Gran F, Ferrer Q, Giralt G, Sabaté-Rotés A, Albert DC. Vena cava superior izquierda persistente con agenesia de la vena cava superior derecha. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Martínez-Villar M, Gran F, Ferrer Q, Giralt G, Sabaté-Rotés A, Albert DC. Persistent Left Superior Vena Cava With Absent Right Superior Vena Cava. ACTA ACUST UNITED AC 2015; 69:220-1. [PMID: 26708343 DOI: 10.1016/j.rec.2015.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/09/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ferran Gran
- Unidad de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Queralt Ferrer
- Unidad de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Gemma Giralt
- Unidad de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Anna Sabaté-Rotés
- Unidad de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Dimpna C Albert
- Unidad de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Giralt G, Gran F, Betrian P, Ferrer Q. Infarto agudo de miocardio en un neonato causado por trombosis coronaria: un gran reto diagnóstico y terapéutico. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Giralt G, Gran F, Betrian P, Ferrer Q. Acute Myocardial Infarction in a Neonate Caused by a Coronary Thrombosis: a Considerable Diagnostic and Therapeutic Challenge. Rev Esp Cardiol (Engl Ed) 2015; 68:903-4. [PMID: 26297178 DOI: 10.1016/j.rec.2015.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Gemma Giralt
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Ferran Gran
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pedro Betrian
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Queralt Ferrer
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Giralt G, Madrid Á, Garrido M, Albert DC, Betrian P, Girona J. Reversal of hyperoxaluric cardiomyopathy with severe cardiac dysfunction after combined liver and kidney transplantation. ACTA ACUST UNITED AC 2014; 66:224-5. [PMID: 24775460 DOI: 10.1016/j.rec.2012.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/21/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Gemma Giralt
- Servicio de Cardiología Pediátrica, Área del Cor, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Álvaro Madrid
- Servicio de Nefrología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Marta Garrido
- Servicio de Anatomía Patológica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Dimpna C Albert
- Servicio de Cardiología Pediátrica, Área del Cor, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Pedro Betrian
- Servicio de Cardiología Pediátrica, Área del Cor, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Josep Girona
- Servicio de Cardiología Pediátrica, Área del Cor, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Manso B, Gran F, Pijuán A, Giralt G, Ferrer Q, Betrián P, Albert D, Rosés F, Rivas N, Parra M, Girona J, Farrán I, Casaldáliga J. Embarazo y cardiopatías congénitas. Rev Esp Cardiol 2008. [DOI: 10.1157/13116650] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Manso B, Gran F, Pijuán A, Giralt G, Ferrer Q, Betrián P, Albert D, Rosés F, Rivas N, Parra M, Girona J, Farrán I, Casaldáliga J. [Pregnancy and congenital heart disease]. Rev Esp Cardiol 2008; 61:236-243. [PMID: 18361896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION AND OBJECTIVES Since the creation of the Adult Congenital Heart Disease Units and of the High Obstetric Risk Units, there has been increasing interest in hemodynamic and obstetric outcomes in pregnant woman with congenital heart disease. METHODS Retrospective descriptive study of 56 women with congenital heart disease aged (mean [range]) 25 (18-40) years, who experienced a total of 84 pregnancies between January 1992 and August 2006. The women were divided into three pregnancy risk groups: A, low-risk; B, moderate-risk, and C, high-risk. RESULTS The incidence of complications during pregnancy was 1.6%, 15%, and 20% in groups A, B, and C, respectively; the incidence during the puerperium was 2%, 23%, and 50%, respectively; and maternal mortality was 0%, 7.6%, and 25%, respectively. Overall, 69 children were born, and the prematurity rates in the three groups were 11%, 15%, and 100%, respectively. The following risk factors were studied: pulmonary hypertension, cyanosis, arrhythmia, left ventricular outflow tract obstruction, right ventricular dilatation, systemic right ventricle, and anticoagulation therapy. The risk factor most significantly associated with maternal or fetal morbidity or mortality was found to be pulmonary hypertension. CONCLUSIONS Risk stratification in pregnant women with congenital heart disease provides prognostic information that can help multidisciplinary teams to target care to achieve the best results.
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Affiliation(s)
- Begoña Manso
- Unidad de Cardiopatías Congénitas del Adolescente y del Adulto, Unidad de Embarazo de Alto Riesgo Obstétrico, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
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