@article {10815, title = {Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage.}, journal = {Ther Clin Risk Manag}, volume = {14}, year = {2018}, month = {2018}, pages = {1671-1675}, abstract = {

Background/aim: Clinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population.

Patients and methods: A retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively.

Results: A total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95\% CI: 1.2-1.5, <0.001 and OR=2.5, 95\% CI: 1.5-4.2, <0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95\% CI: 1.0-2.2, =0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal-perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates.

Conclusion: To the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF.

}, issn = {1176-6336}, doi = {10.2147/TCRM.S150049}, author = {Bouch{\`e}, Carlo and Wiesenfeld, Uri and Ronfani, Luca and Simeone, Roberto and Bogatti, Paolo and Skerk, Kristina and Ricci, Giuseppe} } @article {10852, title = {Total body irradiation and iron chelation treatment are associated with pancreatic injury following pediatric hematopoietic stem cell transplantation.}, journal = {Oncotarget}, volume = {9}, year = {2018}, month = {2018 Apr 13}, pages = {19543-19554}, abstract = {

Whereas many studies have addressed the risk of organ dysfunction following hematopoietic stem cell transplantation (HSCT), little is known about pancreatic susceptibility in this setting. We aimed to investigate the effect of iron overload (IO) and total body irradiation (TBI) on pancreatic function of children undergoing HSCT. We retrospectively evaluated children admitted between 2012-2016 fulfilling the following criteria: normal pancreatic iron concentration (PIC), regular pancreatic function before HSCT, availability of abdominal magnetic resonance imaging with gradient-recalled-echo sequences and a full set of biochemical markers of IO and pancreatic function performed before HSCT and at discharge. We divided the patients according to the use of TBI or myeloablative chemotherapy (MCHT) in the conditioning regimen. All patients with severe IO or moderate IO with a high risk of engraftment delay or transplantation-related complications underwent chelation therapy with deferoxamine (DFO) from the first day of conditioning to discharge. 63 patients had a HSCT in the study period, 13 did not fulfill the inclusion criteria; 50 (25 in each group) are included in the analysis, and did not show differences at baseline evaluation. At follow up testing the TBI group showed a significantly higher PIC (107,8{\textpm}100,3 μmol/g vs 28,4{\textpm}37,9 in MCHT group, p<0,0001). In the TBI group the patients who had DFO treatment had higher PIC (223,2{\textpm}48,8 μmol/g vs 55,7{\textpm}10,5 without DFO treatment, p<0,0001), and all patients having PIC >100 μmol/g at follow up had DFO-based chelation therapy, versus 26\% of those with lower PIC (p<0,0001). The number of patients presenting exocrine pancreatic dysfunctions one month after transplantation was significantly higher in the TBI group (48\% vs 4\%; p<0.0001). The mean pancreatic volume reduction was significantly greater in the TBI group (39,1\% vs 0,9\% in the MCHT group; p<0,05), and was significantly worse on those who received DFO therapy. Based on our data, we suggest that TBI is detrimental for pancreatic functions, and speculate that DFO may contribute to the rapid pancreatic IO observed in these patients.

}, issn = {1949-2553}, doi = {10.18632/oncotarget.24646}, author = {Maximova, Natalia and Gregori, Massimo and Simeone, Roberto and Sonzogni, Aurelio and Zanon, Davide and Boz, Giulia and D{\textquoteright}Antiga, Lorenzo} } @article {10537, title = {Comparison of Efficacy and Safety of Caspofungin Versus Micafungin in Pediatric Allogeneic Stem Cell Transplant Recipients: A Retrospective Analysis.}, journal = {Adv Ther}, volume = {34}, year = {2017}, month = {2017 05}, pages = {1184-1199}, abstract = {

INTRODUCTION: The high morbidity and mortality associated with invasive fungal infections (IFIs) provide the rationale for antifungal prophylaxis in immuno-compromised pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Caspofungin and micafungin are antifungal agents of interest for prophylaxis of IFIs because of their potency against Candida and minimal toxicity or interactions with other drugs. Few studies have demonstrated the safety and efficacy of such echinocandins as prophylaxis for IFIs in patients undergoing HSCT.

METHODS: This retrospective cohort study compared caspofungin and micafungin for prevention of IFIs in 93 pediatric patients undergoing HSCT for oncological or non-oncological disease. The observation began with the first dose of antifungal agent and ended 3~months after transplantation.

RESULTS: Patients in the micafungin group had a higher overall treatment success rate of 87.2 versus 84.8\% in the caspofungin group, but the difference was not significant. There were no statistically significant differences in the incidence or type of proven/probable IFIs between the 2 groups. The low incidence of death did not differ statistically between the groups. Patients in the caspofungin group presented more frequently with fever, during and after neutropenia. In both groups, we observed an expected worsening of blood chemistry parameters. There were no adverse events definitely attributable to the two antifungal agents.

CONCLUSION: These results demonstrate good efficacy and tolerability for caspofungin and micafungin. However, better results with respect to the incidence and resolution of fever in the micafungin group may suggest its use in preference to that of caspofungin.

}, keywords = {Adolescent, Antifungal Agents, Caspofungin, Child, Child, Preschool, Cohort Studies, Echinocandins, Female, Hematopoietic Stem Cell Transplantation, Humans, Infant, Infant, Newborn, Lipopeptides, Male, Micafungin, Mycoses, Neutropenia, Retrospective Studies}, issn = {1865-8652}, doi = {10.1007/s12325-017-0534-7}, author = {Maximova, Natalia and Schillani, Giulia and Simeone, Roberto and Maestro, Alessandra and Zanon, Davide} } @article {10487, title = {Thrombogenesis in Thrombophilic Pregnancy: Evaluation of Low-Molecular-Weight Heparin Prophylaxis.}, journal = {Acta Haematol}, volume = {137}, year = {2017}, month = {2017}, pages = {201-206}, abstract = {

The aim of this study is to investigate thrombogenesis and the hypercoagulable changes in pregnant women affected by thrombophilia who received low-molecular-weight heparin (LWMH) prophylaxis. We included 21 pregnant women affected by thrombophilia treated with LWMH and 20 nontreated normal pregnant women as the control group. The sample group of thrombophilic pregnant women included different conditions (factor V Leiden mutation, protein C deficiency, protein S deficiency, antiphospholipid antibodies syndrome, and combined defects). Three blood samples were collected during pregnancy (i.e., at 16, 20, and 24 weeks) and tested for activated partial thromboplastin time and prothrombin fragment F1 + 2 (F1 + 2); anti-FXa activity was tested only in treated thrombophilic pregnant women. F1 + 2 levels progressively increased during pregnancy in both study groups. However, the F1 + 2 increase in women exposed to heparin prophylaxis was significantly lower than that in normal pregnant women in all 3 measurements carried out during gestation (p < 0.05); a statistically significant inverse correlation between F1 + 2 levels and anti-Xa activity (R = -0.8575, p < 0.05) was observed in treated women during pregnancy. Our findings suggest that F1 + 2 in addition to anti-Xa measurement could be used to adjust LWMH prophylaxis, at least in high-risk pregnant women.

}, keywords = {Adult, Anticoagulants, Case-Control Studies, Factor Xa Inhibitors, Female, Heparin, Low-Molecular-Weight, Humans, Nadroparin, Partial Thromboplastin Time, Peptide Fragments, Pilot Projects, Pregnancy, Pregnancy Complications, Hematologic, Prothrombin, Thrombophilia, Thrombosis}, issn = {1421-9662}, doi = {10.1159/000467385}, author = {Simeone, Roberto and Giacomello, Roberta and Bruno, Germano and Parco, Sergio and Maximova, Natalia and Martinelli, Monica and Zito, Gabriella and Luppi, Stefania and Cervi, Gina and Ricci, Giuseppe} } @article {8510, title = {Hepatic Gadolinium Deposition and Reversibility after Contrast Agent-enhanced MR Imaging of Pediatric Hematopoietic Stem Cell Transplant Recipients.}, journal = {Radiology}, year = {2016}, month = {2016 Jun 8}, pages = {152846}, abstract = {

Purpose To determine if hepatic gadolinium deposition occurs in pediatric patients with iron overload but normal renal and hepatic function who undergo gadolinium-based contrast agent (GBCA)-enhanced magnetic resonance (MR) imaging. Materials and Methods Design and execution of this study was approved by the Ethical Committee of Institute for Research in Maternal and Child Health Burlo Garofolo of Trieste (reference no. 1105/2015). Because of the retrospective nature of the study, the requirement to obtain informed consent was waived. Twenty-one recipients of allogeneic hematopoietic stem cell transplants who underwent GBCA-enhanced MR imaging for suspected infection or relapse followed by liver biopsy comprised the study group. The number of GBCA-enhanced MR examinations and cumulative gadolinium dose for each patient was analyzed by comparing liver histologic analysis and iron and gadolinium liver concentration (GLC). Eight patients had siderosis and underwent chelation therapy. The study group was compared with four control patients who were never exposed to GBCA. Statistical analysis was performed with Spearman rank coefficient for correlation. Results All 21 patients had positive correlations between GLC and total GBCA dose (r = 0.4486; P < .05) and between GLC and liver iron concentration (r = 0.56; P < .05). Patients who underwent deferoxamine therapy had a significant reduction of GLC (from 0.64 μg/g {\textpm} 0.29 to 0.20 μg/g {\textpm} 0.17 [standard deviation]; P < .05). Conclusion In the presence of siderosis, a transmetallation mechanism may be set off between ferric ion and gadoterate meglumine. Deferoxamine appears capable of binding to gadolinium ion. Further studies of the safety of GBCAs in severe siderosis are needed. Chelation should be considered in patients with iron overload and a history of GBCA exposure. ({\textcopyright}) RSNA, 2016.

}, issn = {1527-1315}, doi = {10.1148/radiol.2016152846}, author = {Maximova, Natalia and Gregori, Massimo and Zennaro, Floriana and Sonzogni, Aurelio and Simeone, Roberto and Zanon, Davide} } @article {8325, title = {Thromboprophilaxis in neurological conditions in pregnancy. A clinical dilemma or a methods dilemma?}, journal = {Minerva Ginecol}, volume = {68}, year = {2016}, month = {2016 Feb}, pages = {95-6}, issn = {1827-1650}, author = {Parco, Sergio and Vascotto, Fulvia and Simeone, Roberto} }