Term Follow-up Study Research Articles

Comparison of traditional growth rods and magnetically controlled growing rods in early-onset scoliosis: a case-matched mid term follow-up study.

Early-onset scoliosis (EOS) has always been a challenging situation for spine surgeons. The aim of treatment is to control the direction of curve progression to allow for the complete development of lungs. Among all the growth constructs available, traditional growth rods (TGR) and magnetically controlled growth rods (MCGR) are most widely used. The MCGR has been introduced a few years back and there is a dearth of long-term follow-up studies. The purpose of this study is to compare the effectiveness of TGR and MCGR for the treatment of EOS. All patients of EOS managed with either TGR or MCGR were included in the study. The patients managed with other methods or having follow-up < 2-years were excluded from the study. A total of 20 patients were recruited in the MCGR group and 28 patients were recruited in the TGR group. Both groups were matched by etiology, gender, pre-operative radiological parameters, and complications including unplanned surgeries. The mean age in our study was 7.90years in the MCGR group and 7.46years in the TGR group. The mean duration of follow-up in the MCGR group was 50.89months and in the TGR group 94.2months. Pre-operative cobb's angle in the coronal plane and T1-S1 were comparable in both groups with a mean cobb's angle of 65.4 in MCGR and 70.5 in TGR. The mean T1-S1 length in the MCGR group was 36.1cms and in the TGR group was 35.2cms (p = 0.18). The average increase in T1-S1 length was 1.3cm/year in the TGR group and 1.1cm/year in the MCGR group (p > 0.05). The TGR patients underwent 186 open lengthening surgeries and 11 unplanned surgeries for various complications. The MCGR group has 180 non-invasive lengthening with only 4 unplanned returns to OT for various causes. The curve correction was similar in both TGR and MCGR groups. The average T1-S1 length achieved on final follow-up was similar in both groups. The MCGR patients have attained similar correction with fewer invasive procedures and lesser complications compared to the TGR group.

MP06-20 Long term follow-up study of polytetrafluoroethylene (PTFE) coated self-expandable metallic urethral stents a management modality for recurrent bulbar urethral stricture

MP06-20 Long term follow-up study of polytetrafluoroethylene (PTFE) coated self-expandable metallic urethral stents a management modality for recurrent bulbar urethral stricture

Outcomes and Trends of Surgical Ventricular Septal Defect Repair in a Tertiary Care Hospital in Pakistan: a Retrospective Study

Background: Ventricular septal defect is the most common congenital heart malformation in newborns. About 77% of newborns diagnosed with congenital heart disease had ventricular septal defect in Pakistan. VSD closure is one of the commonest procedure performed by pediatric cardiac surgeons. With advancement in preoperative and postoperative management, VSD closure has a very low incidence of postoperative complications. Methodology: Patients who underwent VSD closure at our center from 2017 to 2021 were reviewed in the database. Patients with a simple VSD were included and those with a concomitant complex congenital cardiac anomaly were excluded. Data was analyzed in SPSS 23. Results: Among the patients, 62.8% were males and 37.2% were females. Mean age was 10.36 + 9.69 years, with 39.7% of the subjects below the age of 5. Increased ICU stay was defined as stay in the ICU for more than 48 hours and increased hospital stay was described as postoperative stay of more than 7 days. Nine patients had a prolonged hospital stay and four patients had a prolonged ICU stay. One patient went under reopening due to bleeding tamponade and one had a deep sternum infection. In hospital mortality rate was 2.4%. Conclusion: VSD has a very low mortality rate in our center. Further studies are required to identify risk factors for morbidity and mortality. Long term follow-up studies should be conducted to identify rate of long term complications.

Health related quality of life, physical function, and cognitive performance in mechanically ventilated COVID-19 patients: A long term follow-up study

BackgroundSurvivors of severe COVID-19 related respiratory failure may experience durable functional impairments. We aimed at investigating health-related quality of life (HR-QoL), physical functioning, fatigue, and cognitive outcomes in COVID-19 patients who received invasive mechanical ventilation (IMV). MethodsCase-series, prospective, observational cohort study at 18 months from hospital discharge. Patients referring to the Intensive Care Unit (ICU) of Humanitas Research Hospital (Milan, Italy) were recruited if they needed IMV due to COVID-19 related respiratory failure. After 18 months, these patients underwent the 6-min walking test (6MWT), the Italian version of the 5-level EQ-5D questionnaire (EQ-5D-5L), the Functional Assessment of Chronic Illness Therapy – Fatigue questionnaire (FACIT-F), the Trail Making Test-B (TMT-B) and the Montreal Cognitive Assessment-BLIND test (MoCA-BLIND). Results105 patients were studied. The population's age was 60 ± 10 years on average, with a median Frailty Scale of 2 (Hodgson et al., 2017; Carenzo et al., 2021a [2,3]). EQ-VAS was 80 [70–90] out of 100, walked distance was 406 [331–465] meters, corresponding to about 74 ± 19,1% of the predicted value. FACIT-F score was 43 [36–49] out of 52, and MoCa-BLIND score was 19 (DeSalvo et al., 2006; von Elm et al., 2008; Herdman et al., 2011; Scalone et al., 2015 [16-20]) out of 22. The median TMT-B time was 90 [62–120] seconds. We found a possible age and gender specific effect on HR-QoL and fatigue. ConclusionsAfter 18 months from ICU discharge, survivors of severe COVID-19 respiratory failure experience a moderate reduction in HR-QoL, and a severe reduction in physical functioning. Fatigue prevalence is higher in younger patients and in females. Finally, cognitive impairment was present at a low frequency.

COVID mRNA Vaccination Responses in Individuals with Sickle Cell Disease: An ASH Research Collaborative Clinical Trial Network Study

A multi-state, long term follow-up study of individuals with sickle cell disease (SCD) demonstrated an increase in mortality and morbidity in children and adults with COVID. mRNA vaccines are recommended for all SCD patients. Vaccination in individuals with SCD for other infections may be associated with impaired antibody responses. Concern has also been raised about whether mRNA vaccines, through a unique mechanism, may induce disease-related-complications in patients with SCD resulting in a suboptimal immunization rate. The ASH Research Collaborative Clinical Trial Network (ASH RC CTN) performed a mRNA vaccine trial to assess whether antibody responses following COVID vaccination were adequate to induce immunity and whether mRNA vaccination precipitated any toxicity unique to SCD patients. We prospectively studied patients at 8 of the ASH RC CTN sites: Johns Hopkins, Prisma, Duke, UT Southwestern, Medical College of Wisconsin, UCSF, Children's National, and Montefiore. Eligible patients with SCD had not yet received the COVID vaccine. We enrolled 59 patients and 47 received at least one vaccination. All vaccinated patients received the monovalent Pfizer vaccine. Forty-two patients received two vaccinations and provided baseline blood samples prior to vaccination and 2 months after the initial vaccination. For this report, data for 41 paired samples were available for analysis of IgG reactivity against the receptor binding domain (RBD) of the SARS-CoV-2 spike protein. Samples were taken from 7 patients (17%) under 3 years of age, 17 (41%) from older children (3-17 years of age), and 17 (41%) from adults (18-53 years of age). The majority of patients had HbSS (73%) or HbSC (22%), and one of each had either HbS beta 0 (2%) or HbS beta+ (2%). Concurrent therapies included hydroxyurea (59%), voxelotor (17%), crizulizumab (2%), intravenous immunoglobulin (2%), and chronic transfusions (2%). Five had a history of splenectomy (12%). Seventy-five percent of patients received their initial vaccination within 10 days of the baseline visit, and the median time between initial vaccination and post vaccination blood draw was 62 days. One patient experienced a COVID infection 5 days after the baseline visit, but prior to vaccination. This individual later received two vaccinations and submitted blood samples for analysis. Post-vaccination fever/chills, arthralgias, emesis, or local vaccination pain/erythema were reported in 49% of the patients. None reported fever that required inpatient admission. Seven patients (17%) reported a total of 8 episodes of vaso-occlusive pain within 14 days of the 1st vaccination. Of these, three required evaluation and treatment at a medical facility, and one patient was admitted for inpatient care. Antibody responses are shown in the Figure. Fourteen patients (34%) were seronegative at baseline, all with IgG ≤ 0.48 arbitrary units (AU). Twenty-seven patients (66%) were seropositive at baseline with a median IgG = 4.59 AU. Post-vaccination demonstrated a median IgG = 32.2 AU for the initially seronegative patients, and IgG = 102 AU for those initially seropositive. All initially seronegative patients converted to seropositive post vaccination; although post-vaccination IgG levels were lower than in the patients who were initially seropositive (Wilcoxon rank sum test, p-value = 0.0062). Overall, patients with sickle cell disease had side effects similar to those in the general population, and patients with SCD also responded to the COVID mRNA vaccination as expected after 2 months. The 6-month titers will be analyzed in the early fall. To our knowledge, this is the largest mRNA vaccine efficacy and safety trial in individuals with SCD, and it also marks the first evaluation of vaccine safety and antibody response in very young children with SCD.

Long Term Follow-Up Study of a Randomized, Open-Label, Uncontrolled, Phase I/II Study to Assess the Safety and Immunogenicity of Intramuscular and Intradermal Doses of COVID-19 DNA Vaccine (AG0302-COVID19).

Pharmacological studies have demonstrated antibody production and infection prevention with an intradermal coronavirus disease 2019 (COVID-19) DNA vaccine (AG0302-COVID-19). This clinical trial aimed to investigate the safety and immunogenicity of high doses of AG0302-COVID19 when injected intramuscularly and intradermally. Healthy adults were randomly divided into three intramuscular vaccination groups (2 mg, three times at 2-week intervals; 4 mg, twice at 4-week intervals; and 8 mg, twice at 4-week intervals) and two intradermal groups (1 mg, three times at 2-week intervals or twice at 4-week intervals). After a one-year follow-up, no serious adverse events were related to AG0302-COVID-19. At Week 52, the changes in the geometric mean titer (GMT) ratios of the anti-S antibodies were 2.5, 2.4, and 3.2 in the 2, 4, and 8 mg intramuscular groups, respectively, and 3.2 and 5.1 in the three times and twice injected intradermal groups, respectively. The number of INF-γ-producing cells responsive to S protein increased after the first dose and was sustained for several months. AG0302-COVID-19 showed an acceptable safety profile, but the induction of a humoral immune response was insufficient to justify progressing to a Phase 3 program.

Mid-Term Survivorship, Radiographic and Functional Outcomes of Robotic-Assisted Unicompartmental Knee Arthroplasty.

The use of robotic-arm assistance for medial unicompartmental knee arthroplasty (RAUKA) has become an area of interest to overcome technical challenges, improve accuracy, and optimize patient outcomes. Due to the rise in osteoarthritis (OA) and robotic assistance, well-powered long-term studies are warranted. The aim of this study was to analyze midterm survivorship, radiographic changes, range of motion (ROM), and patient-reported outcome measurements (PROMs) of RAUKA. Patients who underwent RAUKA for medial compartmental OA were identified from April 2009 to May 2014. The query yielded 162 knees with a mean follow up of 6.5 years. Primary endpoints were to compare survivorship, final mechanical axis alignment, radiographic changes, mean ROM, and changes to the following PROMs: Knee Society Score (KSS), International Knee Documentation Committee (IKDC), and Oxford Knee Score (OKS). Statistical analyses were primarily descriptive. A p-value less than 0.05 was considered statistically significant. There were no revisions of the primary implant, one case required exchange of polyethylene bearing and debridement for deep infection, and five cases required additional surgical intervention with implant retention. Overall survivorship was 100%. Radiographic assessment demonstrated no mechanical loosening or osteolysis surrounding the implant. Mean ROM was 3 to 121.9º. Patients demonstrated a mean functional KSS of 78.55, IKDC of 78.22, and OKS of 43.94. The study supports excellent mid-term outcomes in patients undergoing RAUKA for medial compartment OA. Longer term follow-up studies are necessary to determine the efficacy of this technology for patients undergoing RAUKA for medial compartment OA.

Assessment of Pulmonary Functions in COVID-19 Survivors and their Clinical Correlation at 6-month Follow-up

Background: Long term impact of COVID-19 on pulmonary functions is still an area of active research. Objective: To assess pulmonary functions and their relationship with clinical severity of disease among COVID-19 survivors at six-month follow-up after being discharged from the hospital. Methods: It was a hospital based prospective observational six-month follow-up study. After fulfillment of all inclusion and exclusion criteria, subjects underwent spirometry and diffusion capacity of lung for carbon monoxide (DLco). Ninety-six subjects had completed the tests and were enrolled for the study. Categorization of subjects was made based on their clinical disease severity profile according to Government of India guidelines. Test results were correlated with clinical severity of disease. Results: Of 96 subjects, 46 were mild, 28 were moderate, 18 were severe and 4 were critical cases. Majority of subjects had normal spirometry (65.6 %) and DLco (66.6 %). Among abnormal lung functions, the commonest was reduced DLco (33.3%) followed by restrictive (18.7%), small airway disease (10.4 %), obstructive (3.1 %) and mixed (2%) spirometry patterns. With the advancement of clinical disease severity, the frequency of restrictive pattern (P&lt;0.01) and reduced DLco increases significantly (P&lt;0.05). Conclusion: After six months, few COVID-19 survivors had residual lung function impairment in terms of reduced DLco and restrictive spirometry pattern. Hence, we recommend regular lung function assessment with various methods such as spirometry and DLco in COVID-19 survivors and advocate more large scale - long term follow-up studies to investigate the further progression or resolution in these abnormalities over the time.

Burosumab - new potent treatment for X-linked hypophosphatemia and tumor-induced osteomalacia

Introduction and purpose: Elevated FGF23 in X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia (TIO) leads to systemic hypophosphatemia, several musculoskeletal manifestations and rickets in children. In this review we describe advances in the management of XLH and TIO using burosumab, which is a new therapeutic option approved both for adults and children. A search was conducted using PubMed and Google Scholarship databases. Brief description of the state of knowledge: Patients with XLH and TIO exhibit a similar clinical picture and way of treatment. Although in TIO surgery is the only definitive treatment, some tumors cannot be removed due to their location. In this case oral conventional therapy is used in treating both in TIO and XLH. Another approved treatment option is the use of burosumab, which is a fully humanised FGF23-antibody. This therapy led to normalisation of phosphate homoeostasis and resulted in improvement of bone turnover, fracture healing, subjective pain, and physical function. Compared to conventional, oral therapy burosumab has been shown to be superior for treatment of XLH and TIO.Conclusions: While burosumab appears to improve treatment outcomes, the effects of chronic or lifelong use have yet to be established. Long term follow-up studies would be necessary to assess especially the potential risk of nephrocalcinosis and cardiac calcification.

Transcaval Coil Embolization of Type 2 Endoleak After Endovascular Aortic Repair: An Institutional Review.

Endovascular aortic repair may be complicated by type 2 endoleaks. Intervention is generally recommended when the native sac continues to grow more than 5mm. Transcaval coil embolization (TCE) of the native aneurysm sac is an emerging technique for repair of type 2 endoleaks. The objective of this study is to report an institutional review of our experience with this technique. 11 patients underwent TCE during the study period. Data were gathered on demographics, size increase of native aneurysm sac, operative details, and outcomes. Technical success was defined as resolution of the endoleak during completion sac angiogram at end of the procedure. Clinical success was defined as no growth in the aneurysm sac at interval follow-up. Coils were the embolant of choice in all cases. Technical success was achieved in all cases except 1 resulting in a 91% technical success rate. Median follow-up was 25months (range, 3-33). Of the ten patients that had technically successful embolization, 8 patients had repeat computed tomography (CT) scans which showed no further expansion of the native sac resulting in a 80% clinical success rate. No complications were noted immediately post-op or at interval follow-up. This institutional retrospective review demonstrates that TCE is an effective and safe option for type 2 endoleaks after endovascular aortic repair (EVAR) in selected patients with favorable anatomy. Longer term follow-up, more patients, and comparison studies are needed to further define durability and efficacy.

A Long Term Follow-Up Study of the Reconstruction of the Oral Cavity at a Tertiary Care Center: An Original Research.

In the subcontinent of India as well as for the other nations, the most usual cancer that affects the oral cavity the "squamous cell carcinoma". The main side effects of the intervention of the SCC are the large defect and disfigurement. This study sought to investigate the various interventions of the SCC in a designated cancer institute. A retrospective clinical study of the records was done between 2000-2020 years. The operated cases were analysed for various patient demographics as well as the site of the lesion and number distributions. The change in the techniques and the preference flaps over the periods was noted, and the values were compared for every 5 years. A1001 patients were treated between the intended periods. Though there were larger number of men, the variation was not significant. Common sites were floor of the mouth (FOM) and tongue. The common interventions were primary closure, soft tissue free flaps and bone flaps. The shift was seen towards the free flaps. The Free flaps were the common applications in the constructions. Bone free flaps overtook the other procedures that were commonly applied. The quality of life and the aesthetics are seen to be better with the free flaps.

The effects of combination treatment with LT4 and LT3 on diastolic functions and atrial conduction time in LT4-treated women with low T3: a short term follow-up study.

To investigate the effects of combination treatment with levothyroxine (LT4) and l- triiodothyronine (LT3) on left atrial volume (LAV), diastolic functions, and atrial electro-mechanical delays in LT4-treated women with low triiodothyronine (T3) levels. This prospective study consisted of 47 female patients between 18 and 65 years old treated at an Endocrinology and Metabolism outpatient clinic between February and April 2022 due to primary hypothyroidism. The study included patients with persistently low T3 levels in at least three measurements, despite LT4 treatment (1.6-1.8 mcg/kg/m2) for 23.13 ± 6.28 months with normal thyrotropin (TSH) and free tetraiodothyronine (fT4) levels. The combination therapy dose was as follows: the fixed LT4 dose (25 mcg) was removed from patients' usual LT4 treatment [100 mcg (min-max, 75-150)], and a fixed LT3 dose (12.5 mcg) was added. Biochemical samples were taken, and an echocardiographic assessment was performed for patients upon their first admission, and after 195.5 ± 12.8 days of receiving LT3 (12.5 mcg) treatment. There was a statistically significant reduction at left ventricle (LV) end-systolic diameter (27.69 ± 3.14, 27.13 ± 2.89, p = 0.035), left atrial (LA) maximum volume (14.73 ± 3.22, 13.94 ± 3.15, p = 0.009), LA minimum volume (7.84 ± 2.45, 6.84 ± 2.30, p < 0.001), LA vertical diameter (44.08 ± 6.92, 34.60 ± 4.31, <0.001), LA horizontal diameter (45.65 ± 6.88, 33.43 ± 4.51, p < 0.001), LAVI (50.73 ± 18.62, 41.0 ± 13.02, p < 0.001), total conduction time (103.69 ± 12.70, 79.82 ± 18.40, p < 0.001) after LT3 replacement (respectively pre-post- treatment and p value). In conclusion, the findings of this study suggest that the addition of LT3 to LT4 treatment may lead to improvements in LAVI and atrial conduction times in patients with low T3. However, further research with larger patient groups and exploration of different LT4 + LT3 dose combinations is needed to better understand the effects of combined hypothyroidism treatment on cardiac functions.

Developments in the management of psychosis: key evidence from 2022

Abstract The field of treatment and understanding in psychosis is evolving at an unprecedented pace with advances in neuroscience. It takes time before research findings are translated to clinical practice. Daunting as it is, clinicians need to keep up with findings which change our practice straightaway (new medication), findings which suggest that changes are expected in future (new theories about how illness develops and can be predicted) and findings which remind us of continuing practice and the evidence behind them (long term follow-up studies which give no big surprises but consolidate existing knowledge). In a snap shot, I bring to you a range of five papers published in 2022 which enrich our understanding of psychosis, its development and treatment. Disclosure of Interest None Declared

Mid-Term Survivorship, Radiographic and Functional Outcomes of Robotic-Assisted Unicompartmental Knee Arthroplasty.

The use of robotic-arm assistance for medial unicompartmental knee arthroplasty (RAUKA) has become an area of interest to overcome technical challenges, improve accuracy, and optimize patient outcomes. Due to the rise in osteoarthritis (OA) and robotic assistance, well-powered long-term studies are warranted. The aim of this study was to analyze midterm survivorship, radiographic changes, range of motion (ROM), and patient-reported outcome measurements (PROMs) of RAUKA. Patients who underwent RAUKA for medial compartmental OA were identified from April 2009 to May 2014. The query yielded 162 knees with a mean follow up of 6.5 years. Primary endpoints were to compare survivorship, final mechanical axis alignment, radiographic changes, mean ROM, and changes to the following PROMs: Knee Society Score (KSS), International Knee Documentation Committee (IKDC), and Oxford Knee Score (OKS). Statistical analyses were primarily descriptive. A p-value less than 0.05 was considered statistically significant. There were no revisions of the primary implant, one case required exchange of polyethylene bearing and debridement for deep infection, and five cases required additional surgical intervention with implant retention. Overall survivorship was 100%. Radiographic assessment demonstrated no mechanical loosening or osteolysis surrounding the implant. Mean ROM was 3 to 121.9º. Patients demonstrated a mean functional KSS of 78.55, IKDC of 78.22, and OKS of 43.94. The study supports excellent mid-term outcomes in patients undergoing RAUKA for medial compartment OA. Longer term follow-up studies are necessary to determine the efficacy of this technology for patients undergoing RAUKA for medial compartment OA.

Bone Transport in the Management of Post-Osteomyelitis Tibial Defects in Pediatric Population. A Long Term Follow-up Study in Uganda

Background: This study was designed to evaluate the long-term results and complications of using the bone transport technique in the management of post-osteomyelitis tibial defects in a low income country. Design: Retrospective study in a cohort of pediatric patients. Methods: Twenty-two patients were included in the study; all patients were treated between 2005 and 2014. The mean age at time of surgery was 9.5 years. The mean bone defect was 8.2 cm. Transport was done using both ring and monolateral external fixators; the fixator stayed in place for 290 days on average. Clinical and radiological evaluations were performed after a minimum follow-up period of 7 years. Patients were interviewed by social workers with focus on the psychosocial and economic costs of the procedure. Results: The bone and soft tissues management required a total of ninety-one surgeries, with an average of four surgeries per child. Eradication of infection was obtained in all patients. Bone results were graded as excellent in 10, good in 7, fair in 2 and poor in 3. Functional results were graded as excellent in 8, good in 6, fair in 7 and poor in 1. Major and minor complications were numerous during the bone transport procedure. Three cases of non-union at the docking point were observed. Twelve patients had a limb length discrepancy, four had slight angular deformities. Reduced range of motion was observed both in the ankle (n=4) and knee (n=2). Seven joint fusions were noted, two knees and five ankles. Conclusion: Bone transport is a valid option in the management of bone defects in children, providing satisfactory long-term outcomes. Bone gaps, soft tissue defects, limb discrepancy and joint disorders can be managed concurrently. The procedure is lengthy and prone to complications.

20 Years of the isat (international subarachnoid aneurysm trial) study. End of argument

20 years have past since the publication of the results of the International Subarachnoid Aneurysm Trial (ISAT), which changed the worldwide clinical practice of the treating of ruptured cerebral aneurysms. ISAT lasted almost 8 years until May 30, 2002, in many centers all around the world and included 2143 patients. This first prospective randomized multi-center study confirmed the superiority of endovascular treatment for ruptured cerebral aneurysms. Further, long term follow-up study of ISAT groups confirmed these results. Development of the endovascular method was possible due to pioneers in this field, including professor V.I. Shchehlov, founder of the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine», who made his first endovascular procedure using detachable latex balloons for the treatment of aneurysm on November 27, 1974 at the Kiev Institute of Neurosurgery. His contribution in development of endovascular neurosurgery was highly appreciated by the author of the ISAT study, Andrew Molyneux, during his lecture at the world congress of the European Society of Minimally Invasive Neurological Therapy.

A Comparative Study between Single Dose Intralesional Corticosteroid and PRP Injection in Chronic Plantar Fascitis - A Long Term Follow-Up Study

A Comparative Study between Single Dose Intralesional Corticosteroid and PRP Injection in Chronic Plantar Fascitis - A Long Term Follow-Up Study

Surgical-PEARL protocol: a multicentre prospective cohort study exploring aetiology, management and outcomes for patients with congenital anomalies potentially requiring surgical intervention

IntroductionCongenital anomalies affect over 2% of pregnancies. Surgical advances have reduced mortality and improved survival for patients with congenital anomalies potentially requiring surgical (CAPRS) intervention. However, our understanding of aetiology,...

Impact of COVID-19 Related Maternal Stress on Fetal Brain Development: A Multimodal MRI Study.

Disruptions in perinatal care and support due to the COVID-19 pandemic was an unprecedented but significant stressor among pregnant women. Various neurostructural differences have been re-ported among fetuses and infants born during the pandemic compared to pre-pandemic counterparts. The relationship between maternal stress due to pandemic related disruptions and fetal brain is yet unexamined. Pregnant participants with healthy pregnancies were prospectively recruited in 2020-2022 in the greater Los Angeles Area. Participants completed multiple self-report assessments for experiences of pandemic related disruptions, perceived stress, and coping behaviors and underwent fetal MRI. Maternal perceived stress exposures were correlated with quantitative multimodal MRI measures of fetal brain development using multivariate models. Increased maternal perception of pandemic related stress positively correlated with normalized fetal brainstem volume (suggesting accelerated brainstem maturation). In contrast, increased maternal perception of pandemic related stress correlated with reduced global fetal brain temporal functional variance (suggesting reduced functional connectivity). We report alterations in fetal brainstem structure and global functional fetal brain activity associated with increased maternal stress due to pandemic related disruptions, suggesting altered fetal programming. Long term follow-up studies are required to better understand the sequalae of these early multi-modal brain disruptions among infants born during the COVID-19 pandemic.

Disease activity at conception predicts lupus flare up to two years after birth: A multicentre long term follow-up study

ObjectiveTo assess predicting factors that might influence systemic lupus erythematosus (SLE) disease activity in women in an extended follow-up period of two years after giving birth with clinical assessments every three months. MethodsThe study was design as an international retrospective study, enrolling 119 women with a first birth and with a two years follow-up. ResultsJoint involvement was present in 80% of patients, acute cutaneous in 64%, haematological in 54%, renal in 41% and 75% of patients were positive for anti-dsDNA. The mean SLE disease activity index 2000 (SLEDAI-2K) at diagnosis was 13.5±6.8 and at first birth was 2.8±4.4.At follow-up, 51.3% of patients had at least one flare after a mean time after birth of 9±6.3 months (mean flare per patient 0.94±1.1). The most frequent flare manifestations were joint involvement (48%), renal (33%), cutaneous (28%) and haematologic (20%).Patients with remission of disease (SLEDAI-2K=0; no clinical or laboratory manifestations of SLE) at conception had significantly lower rates of flares (18/49–37% vs. 43/70–61%; p=0.008).Patients who experienced a flare during pregnancy (17 patients) had higher rates of flares during follow-up (76% vs. 47%; p=0.019), lower time for first flare (4.4±2.3 months vs. 10.3±6.5; p<0.001), lower rate of remission of disease at conception (12% vs. 46%; p<0.001), lower rates of SLEDAI-2K at conception (5.9±5.6 vs. 2.3±4; p<0.001) and lower rates of exclusive breastfeeding (24% vs. 57%: p=0.009). Results were confirmed after performing multivariate analysis. ConclusionRemission at conception can influence SLE disease positively, even at long-term. Planned pregnancy counseling is fundamental when managing SLE patients.