Giorgio Bartolozzi

Atrial septal aneurysm, ectasia of a sinus of valsalva and mitral valve prolapse in Marfan's syndrome

Abstract Cases of primary atrial septal aneurysm (ASA) have been recently reported. 1–5 ASA is considered primary when it is not associated with congenital heart disease, causing a significant pressure gradient between the 2 atria. These reported cases of primary ASA were usually associated with atrioventricular valve prolapse, especially mitral valve prolapse. 4 Although the cause of primary ASA formation is unclear, it is believed that a congenital disorder of the connective tissue is the basis of these anomalies. The reported cases, including those detected at necropsy, were in both young and old persons. 5 The virtual absence of primary ASA during childhood suggests that some time is required for the malformation to become apparent, as with mitral valve prolapse. 5 To our knowledge, primary ASA in Marfans syndrome has not been previously reported.

Can Hexavalent Vaccines Be Simultaneously Administered with Pneumococcal or Meningococcal Conjugate Vaccines

Background Local immunization programs may include hexavalent and conjugate pneumococcal or meningococcal vaccines administered in the same vaccination visit. Information based on evidence is necessary for correctly planning schedules and for parents who often fear the administration of too many vaccines. We reviewed the available literature to assess the effects on immunogenicity and safety of simultaneous administration of hexavalent and conjugate pneumococcal and meningococcal C vaccines in healthy children. Methods We searched for papers including a comparison of coadministration and single administration of hexavalent with conjugate pneumococcal or meningococcal C vaccines. Data sources included Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Immunogenicity and safety results were extracted and compared. We calculated the absolute risk increase of being a non responder to any antigen and of experiencing common adverse events. Results Four relevant articles were included in the review. Immunogenicity of components included in the hexavalent vaccines was maintained with coadministration of conjugate pneumococcal and meningococcal C vaccines. However individuals who received hexavalent vaccine with conjugate pneumococcal vaccines were 18% more likely to have anti-PRP < 1 μg/mL after the third dose although this difference disappeared after the fourth dose, and titres against meningococcal C antigens were higher when vaccines were administered separately. Children who received simultaneous administration of hexavalent vaccines with conjugate pneumococcal vaccines had a 13-17% additional risk of experiencing fever compared with single administration. Conclusion Few studies deal with coadministration of vaccines. Hexavalent and conjugate pneumococcal or meningococcal vaccines may however be administered simultaneously without noteworthy negative effects on immunogenicity or safety profile. Parents of vaccinees should be appropriately informed on the effects of coadministration to improve their compliance. Studies on vaccine coadministration should be promoted and unpublished studies realized for vaccine registration should be made available.

Cross-sectional echocardiography with pulsed and continuous wave Doppler in the management of ventricular septal defects

We designed this study in order to evaluate those cross-sectional echocardiographic projections of most value in the diagnosis of ventricular septal defects and to compare the techniques of cross-sectional and Doppler echocardiography in these lesions. We studied 71 cases with ventricular septal defects confirmed by cross-sectional and/or pulsed Doppler echocardiography. The defect was imaged by cross-sectional echocardiography in 49 patients but not imaged in 22. In the group of 49 patients, except two with pulmonary hypertension, pulsed Doppler enabled us to detect a left-to-right shunt at ventricular level. In the second group of 22 patients, a positive pulsed Doppler signal was detected in the ventricles although no defect was visualized. Pulsed Doppler examination supplemented the information detectable from cross-sectional echocardiography in small defects; in the diagnosis of multiple septal defects; in the presence of aortic valve regurgitation in doubly committed and subarterial defects; in those having residual shunts after surgical correction; and in those with tricuspid valve regurgitation in the setting of perimembranous defects. Continuous wave Doppler cannot always be reliably employed in the evaluation of transventricular pressure gradient because of a failure to align with the jet in the presence of poor signals. The sub-costal oblique projections and the introduction of the right oblique sub-costal view proved, in our hands, to be the most important tools for identifying and classifying the various types of ventricular septal defect.

West nile virus infections in children: A disease pediatricians should think about

West Nile Virus (WNV)—Flaviviridae family, genus Flavivirus—causes an emerging vector-borne disease transmitted mainly by mosquitoes (mostly Culex pipiens genus). WNV is maintained in nature by a mosquito-bird-mosquito cycle in which humans and other mammals (eg, horses) are accidental hosts. Most human infections are due to mosquito bites; other possible, if less common, routes of transmission include blood transfusion and organ transplantation from infected donors. Rarely, congenital infections and transmission through human milk have been reported. Since its isolation in 1937 in the West Nile province of Uganda, WNV has become one of the most widely distributed arboviruses. In temperate areas, it causes seasonal outbreaks; its activity peaking from midsummer to late fall. Until 1996, WNV was only known to cause sporadic outbreaks of mild febrile disease in humans with an extensive distribution in the Old World and was therefore considered of minor public health importance. Since then, several WNV outbreaks were described throughout Africa, in parts of Eastern Europe and the Middle East, particularly in Romania, Russia, and Israel. In the Americas, WNV was first isolated during the 1999 New York City outbreak, and associated with serious neurologic disease in humans. It is unknown how WNV arrived in the United States. The WNV variant responsible for the US outbreak was more virulent then other strains known in the Old World and was closely related to a virus identified in Israel, suggesting a possible importation from the Middle East. Since that time, the virus has dramatically spread in the US; it is ubiquitous in almost every Southern state and in Canada. In the 2000s, WNV became a major public health problem in Europe as outbreaks occurred in previously unaffected countries and human cases of WNV neuroinvasive disease (WNND) were reported in Western Europe. In Italy, 18 cases with 4 deaths occurred in 2009 (ranging from 62 to 82 years of age), with a westward expansion of WNV activity in the Country. In Portugal, one autoctonous probable case was detected in 2010. Several outbreaks were also recently reported in Greece, Russia, Israel, and Romania, with more than 100 confirmed human WNND cases. In the last decade, awareness of WNV disease (WNVD) has increased due to heightened epidemiologic surveillance in human and animals, availability of new and simple laboratory confirmation tests, and screening of blood donors and transplant individuals in affected countries. However, due to the different clinical presentations of WNV infection in humans, it is still very difficult to estimate the effective disease burden. Although WNVD affects mainly young adults and elderly, cases can occur in children. In the US, between 1999–2007, 1478 WNVD cases occurred in children ( 18 years), and 443 presented as WNND (5% of WNVD and 4% of WNND reported in all age-groups).