Fatal pulmonary embolism in a premature neonate after twin-to-twin transfusion syndrome

Thrombotic events are being increasingly recognized during the neonatal period. An infant girl was born at 29 weeks' gestation after a pregnancy complicated by twin-to-twin transfusion syndrome. After an initial uncomplicated clinical course, her oxygen requirement increased, which was interpreted as an early sign of bronchopulmonary dysplasia. At 3 weeks of age, she suddenly collapsed and died of severe pulmonary hypertension. At autopsy, multiple pulmonary artery emboli and several older renal vein thromboses were found. Results of genetic analyses of the infant and her family were negative for thrombophilia. Although embolism represents a frequent emergency in adults, fatal pulmonary embolism has never, to our knowledge, been described for premature infants. This case suggests that thrombotic events are underdiagnosed and that additional studies are needed to define infants at risk and optimal treatment strategies.

[Complex umbilical cord vein pulsations in cases with twin-twin transfusion syndrome: prognostic implications]

Umbilical vein pulsations (UV-P) are due to various etiologies. The aim of the present study was to investigate the incidence and type of UV-P in monochorionic twins with twin-twin transfusion syndrome (TTTS).

Single umbilical artery in twin pregnancies

Our purpose was to evaluate the antenatal incidence of single umbilical artery (SUA) in twin pregnancies according to chorionicity and to assess its relationship with outcome.

Carbon pools and poverty peaks in Lao PDR

Reducing Emissions from Deforestation and forest Degradation and enhancing forest carbon stocks in developing countries (REDD+) is heavily promoted in Laos. REDD+ is often perceived as an opportunity to jointly address climate change and poverty and, therefore, could come timely for Laos to combine its prominent national target of poverty eradication with global climate mitigation efforts. Countrywide planning of the right approaches to REDD+ combined with poverty alleviation requires knowledge of the spatial combination of poverty and carbon stocks at the national level. This study combined spatial information on carbon stored in vegetation and on poverty and created carbon-poverty typologies for the whole country at the village level. We found that 11% of the villages of Laos have high to very high average village-level carbon stock densities and a predominantly poor population. These villages cover 20% of the territory and are characterized by low population density. Shifting cultivation areas in the northwestern parts of the country have a higher carbon mitigation potential than areas in the central and eastern highlands due to a more favorable climate. Finally, we found that in Laos the majority (58%) of poor people live in areas with low carbon stock densities without major potential to store carbon. Accordingly, REDD+ cannot be considered a core instrument for poverty alleviation. The carbon-poverty typologies presented here provide answers to basic questions related to planning and managing of REDD+. They could serve as a starting point for the design of systems to monitor both socioeconomic and environmental development at the national level.

Novel mutation in OTC gene causes neonatal death in twin brothers

Ornithine transcarbamylase (OTC) deficiency is the most common inborn error of the urea cycle. OTC locus is located in the short arm of X-chromosome. Authors report a case of a woman who gave birth to monozygotic male twins who later died because of severe neonatal-onset hyperammonaemic encephalopathy caused by a novel mutation of OTC gene. Post-mortem liver biopsy was taken from the second twin; afterwards, blood was drawn from the mother for examination. DNA sequence data showed that the mother was a carrier of the same novel mutation that was previously detected in the case of her son. In OTC deficiency, detection of female carriers is important for genetic counselling and eventual prenatal diagnosis.

A twin spiral planar antenna for UWB medical radars

A planar-spiral antenna to be used in an ultrawideband (UWB) radar system for heart activity monitoring is presented. The antenna, named “twin,” is constituted by two spiral dipoles in a compact structure. The reflection coefficient at the feed point of the dipoles is lower than −8 dB over the 3–12 GHz band, while the two-dipoles coupling is about −20 dB. The radiated beam is perpendicular to the plane of the spiral, so the antenna is wearable and it may be an optimal radiator for a medical UWB radar for heart rate detection. The designed antenna has been also used to check some hypotheses about the UWB radar heart activity detection mechanism. The radiation impedance variation, caused by the thorax vibrations associated with heart activity, seems to be the most likely explanation of the UWB radar operation.

Prenatal management of monoamniotic twin pregnancies

OBJECTIVE To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic twin pregnancies. METHODS Obstetric and perinatal outcomes were retrospectively retrieved for 193 monoamniotic twin pregnancies. Fetal and neonatal outcomes were compared between fetuses followed in an inpatient setting and those undergoing intensive outpatient follow-up from 26 to 28 weeks of gestation until planned cesarean delivery between 32 and 35 weeks of gestation. The risk of fetal death was compared with the risk of neonatal complications. RESULTS Fetal deaths occurred in 18.1% of fetuses (70/386). Two hundred ninety-five neonates from 153 pregnancies were born alive after 23 weeks of gestation. There were 17 neonatal deaths (5.8%), five of whom had major congenital anomalies. The prospective risk of a nonrespiratory neonatal complication was lower than the prospective risk of fetal death after 32 4/7 weeks of gestation (95% confidence interval 32 0/7-33 4/7). The incidence of death or a nonrespiratory neonatal complication was not significantly different between fetuses managed as outpatients (14/106 [13.2%]) or inpatients (15/142 [10.5%]; P=.55). Our statistical power to detect a difference in outcomes between these groups was low. CONCLUSIONS The in utero risk of a monoamniotic twin fetus exceeds the risk of a postnatal nonrespiratory complication at 32 4/7 weeks of gestation. If close fetal surveillance is instituted after 26-28 weeks of gestation and delivery takes place at approximately 33 weeks of gestation, the risk of fetal or neonatal death is low, no matter the surveillance setting. LEVEL OF EVIDENCE II.