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Manvelyan E, Millington KA, Abittan BS, Blitz MJ, Kwait B, Shan W, Goldman RH. Histopathologic evaluation of dichorionic twin placentas in unassisted and in vitro fertilized pregnancies affected by preeclampsia. J Matern Fetal Neonatal Med 2022; 35:10262-10270. [PMID: 36167346 DOI: 10.1080/14767058.2022.2121645] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Pregnancies achieved with assisted reproductive technology have an increased risk of multiple gestations, preeclampsia, and placental morphologic abnormalities. Inflammatory processes affect dichorionic twin pregnancies disproportionately more than singleton gestations and have been associated with adverse pregnancy outcomes, such as fetal growth restriction and preeclampsia. Our objective is to investigate the placental morphology of dichorionic twin pregnancies complicated by preeclampsia conceived with in vitro fertilization (IVF) versus unassisted. METHODS This is a retrospective analysis of placentas from dichorionic twin pregnancies affected by preeclampsia conceived with IVF versus without assistance from 2010 to 2016 at a tertiary care university hospital. Placental pathology findings were analyzed both independently and in aggregate stratified into composite outcome scores using a modified placental synoptic framework. Individual placental abnormalities were grouped into composite categories based on the site of origin: anatomic placental abnormalities; maternal vascular malperfusion; placental villous maldevelopment; fetal vascular malperfusion; chronic utero-placental separation; maternal-fetal interface disturbance; inflammation of infectious etiology; and inflammation of idiopathic etiology. Placental histopathological statistical analysis was performed using Fisher's exact test. Demographic variables and pregnancy outcomes were compared between groups using the Student's t test or Mann-Whitney U test, where appropriate. p < .05 defined statistical significance. RESULTS Of 117 dichorionic twin pregnancies, 60 resulted from IVF (Group A) and 57 were conceived without assistance (Group B). Patients in Group A were older (36 [29-37] vs. 33 [32-38] respectively; p = .042) and less parous (18.3% vs. 38.6% percent parous in Group A and Group B, respectively p = .009) than Group B, respectively. No differences were found between groups regarding mode of delivery, gestational age at delivery, placental weight/birthweight, fetal growth restriction, and discordance of fetal growth. There were significantly more inflammatory changes of unknown etiology and composite inflammatory abnormalities in Group A versus Group B (26.7% vs. 10.5%, p = .02). The cumulative number of inflammatory abnormalities per patient had a significantly different distribution among groups (p = .005), and Composite Chronic Inflammation and Infection were found to be significantly more abundant in Group A versus Group B (p = .02). The distribution of placental composite anatomic placental abnormalities, maternal vascular malperfusion, placental villous maldevelopment, fetal vascular malperfusion, chronic utero-placental separation, or maternal-fetal interface disturbance was not statistically different between groups. The distribution of placental abnormalities was not different between groups for any individually analyzed pathological condition. Due to the relatively small sample size, adjustment for potential confounders was not performed. CONCLUSION Dichorionic twin pregnancies affected by preeclampsia are associated with more placental inflammatory abnormalities if conceived with IVF versus unassisted. Further research is needed to ascertain the underlying mechanisms of these observed differences.
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Affiliation(s)
- Evelina Manvelyan
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell South Shore University Hospital, Bay Shore, NY, USA
| | - Karmaine A Millington
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Baruch S Abittan
- Department of Obstetrics & Gynecology Division of Reproductive Endocrinology and Infertility Zucker School of Medicine at, Hofstra/Northwell. Manhasset, New York, NY, USA
| | - Matthew J Blitz
- Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine Zucker School of Medicine at, Hofstra/Northwell, Bay Shore, NY, USA
| | - Brittany Kwait
- Donald and Barbara Zucker School of Medicine at, Hofstra/Northwell, Manhasset, NY, USA
| | - Weiwei Shan
- Department of Obstetrics & Gynecology, Biostatistics Unit at The Feinstein School of Medical Research, New York, NY, USA
| | - Randi H Goldman
- Department of Obstetrics & Gynecology Division of Reproductive Endocrinology and Infertility Zucker School of Medicine at, Hofstra/Northwell. Manhasset, New York, NY, USA
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Perveen S, Millington KA, Acharya S, Garg A, Boyar V. Neonate born with ischemic limb to a COVID-19 positive mother: management and review of literature. Case Reports in Perinatal Medicine 2020. [DOI: 10.1515/crpm-2020-0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
To describe challenges in diagnosis and treatment of congenital neonatal gangrene lesions associated with history of maternal coronavirus disease 2019 (COVID-19) infection.
Case presentation
A preterm neonate was born with upper extremity necrotic lesions and a history of active maternal COVID-19 infection. The etiology of his injury was challenging to deduce, despite extensive hypercoagulability work-up and biopsy of the lesion. Management, including partial forearm salvage and hand amputation is described.
Conclusions
Neonatal gangrene has various etiologies, including compartment syndrome and intrauterine thromboembolic phenomena. Maternal COVID-19 can cause intrauterine thrombotic events and need to be considered in a differential diagnosis.
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Affiliation(s)
- Shahana Perveen
- Division of Neonatal-Perinatal Medicine , Cohen Children’s Medical Center of NY, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
| | - Karmaine A. Millington
- Department of Pathology and Laboratory Medicine , Cohen Children’s Medical Center of NY/Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
| | - Suchitra Acharya
- Pediatrics Hematology Oncology and Stem Cell Transplantation , Cohen Children Medical Center of NY, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
| | - Amit Garg
- Department of Dermatology , Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
| | - Vita Boyar
- Division of Neonatal-Perinatal Medicine , Cohen Children’s Medical Center of NY, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell , New York , NY , USA
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Gulersen M, Prasannan L, Tam Tam H, Metz CN, Rochelson B, Meirowitz N, Shan W, Edelman M, Millington KA. Histopathologic evaluation of placentas after diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection. Am J Obstet Gynecol MFM 2020; 2:100211. [PMID: 32838277 PMCID: PMC7428686 DOI: 10.1016/j.ajogmf.2020.100211] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/22/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
Background The impact of maternal severe acute respiratory syndrome coronavirus 2 infection on placental histopathology is not well known. Objective To determine if any significant placental histopathologic changes occur after the diagnosis of severe acute respiratory syndrome coronavirus 2 infection during pregnancy and whether these changes are correlated with the presence or absence of symptoms associated with the infection. Study Design A retrospective cohort study of women diagnosed as having severe acute respiratory syndrome coronavirus 2 infection who delivered at a single center from April 9, 2020 to April 27, 2020, and had placental specimens reviewed by the Department of Pathology. Women with singleton gestations and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for inclusion. Historical controls selected from a cohort of women who delivered 6 months before the study period were matched in a 1:1 fashion by weeks of gestation at delivery. Histopathologic characteristics were evaluated in each placenta, and the incidence of these findings was compared between placentas of those who received a diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection and historical controls, and between placentas from patients with or without typical symptoms related to the infection. Statistical analyses included the use of Wilcoxon rank-sum test and Fisher's exact test for the comparison of categorical and continuous variables. Statistical significance was defined as a P value of <.05. Results A total of 50 placentas after the diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection and 50 historical controls were analyzed. Among the placentas from patients diagnosed with severe acute respiratory syndrome coronavirus 2 infection, 3 (6%) were preterm (33 3/7, 34 6/7, and 36 6/7 weeks of gestation), 16 (32%) were from patients with typical symptoms related to the infection, and 34 (68%) were from patients without typical symptoms related to the infection. All patients had received a diagnosis of severe acute respiratory syndrome coronavirus 2 infection in the third trimester. Decidual vasculopathy was not visualized in any of the placentas from patients diagnosed as having severe acute respiratory syndrome coronavirus 2 infection. There was no statistically significant difference in placental histopathologic characteristics between the groups. Severe acute respiratory syndrome coronavirus 2 test results for all neonates at 24 hours of life were negative. Conclusion Based on the results of this study, there are no significant placental histopathologic changes that occur after the diagnosis of severe acute respiratory syndrome coronavirus 2 infection in women during the third trimester of pregnancy compared with a gestational age-matched historical control group. Similar incidences of histopathologic findings were also discovered when comparing placentas from patients with severe acute respiratory syndrome coronavirus 2 infection with or without the presence of symptoms typically related to the infection.
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Affiliation(s)
- Moti Gulersen
- Department of Obstetrics and Gynecology, North Shore University Hospital, Northwell Health, Manhasset, NY
| | - Lakha Prasannan
- Department of Obstetrics and Gynecology, North Shore University Hospital, Northwell Health, Manhasset, NY
| | - Hima Tam Tam
- Department of Obstetrics and Gynecology, North Shore University Hospital, Northwell Health, Manhasset, NY
| | - Christine N Metz
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | - Burton Rochelson
- Department of Obstetrics and Gynecology, North Shore University Hospital, Northwell Health, Manhasset, NY
| | - Natalie Meirowitz
- Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Northwell Health, Queens, NY
| | - Weiwei Shan
- Biostatistics Unit, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Morris Edelman
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Karmaine A Millington
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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Curtin WM, Hill JM, Millington KA, Hamidi OP, Rasiah SS, Ural SH. Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case-control study. Int J Womens Health 2019; 11:169-176. [PMID: 30881146 PMCID: PMC6417011 DOI: 10.2147/ijwh.s189718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Our objective was to determine the accuracy of ultrasound at the time of the fetal anatomy survey in the diagnosis of velamentous cord insertion (VCI). Study design This retrospective case–control study identified placentas with VCI (cases) and randomly selected placentas with normal placental cord insertion (PCI) (controls) as documented by placental pathology for mothers delivered from 2002 through 2015. Archived ultrasound images for PCI at the time of the fetal anatomy survey were reviewed. Data analysis was by calculation of sensitivity, specificity, and accuracy and their 95% CI for the ultrasound diagnosis of VCI. Results The prevalence of VCI was 1.6% of placentas submitted for pathologic examination. There were 122 cases of VCI and 347 controls with normal PCI. The performance criteria calculated for the diagnosis of VCI at the time of fetal anatomy survey were as follows: sensitivity 33.6%; 95% CI: 25.3, 42.7; specificity 99.7%; 95% CI: 98.4, 99.9 and accuracy 82.5; 95% CI: 80.5, 82.9. Conclusion The identification of a VCI at the time of fetal anatomy survey is highly specific for the presence of a VCI as documented by placental pathology. The sensitivity in this study was less than expected. Sensitivity could be improved by reducing the number of nonvisualized PCIs, creating an awareness of risk factors for VCI, and obtaining more detailed images in the case of an apparent marginal PCI.
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Affiliation(s)
- William M Curtin
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, USA, .,Department of Pathology & Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA,
| | - Jennifer M Hill
- Pennsylvania State University College of Medicine, Hershey, PA, USA.,Department of Obstetrics & Gynecology, St Francis Hospital and Medical Center, Hartford, CT, USA
| | - Karmaine A Millington
- Department of Pathology & Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA,
| | - Odessa P Hamidi
- Department of Obstetrics & Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Stephen S Rasiah
- Department of Obstetrics & Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Serdar H Ural
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, USA, .,Department of Radiology, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Ohanessian SE, Rocourt DV, Millington KA. Mimics of duplication cysts: intraperitoneal nodules in a 14-year-old boy. Clin Med Insights Pediatr 2015; 9:49-53. [PMID: 25922589 PMCID: PMC4395037 DOI: 10.4137/cmped.s15683] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 11/30/2014] [Accepted: 12/02/2014] [Indexed: 11/05/2022]
Abstract
Hemangiomas are the most common primary hepatic tumors, but there are few reports of their occurrence elsewhere in the abdomen. The concurrent existence of multiple fibrous nodules of the omentum, mesentery, and porta hepatis, along with a gastric hemangioma, in a child raises the question of syndromic association. Our search of the English literature revealed only rare mentions of hemangiomas involving the stomach and mesentery or omentum. These lesions have attracted clinical attention by symptoms of obstruction, gastrointestinal bleeding, intussusception, infection, perforation, or vague abdominal pain. Although some tumors exist unnoticed for many decades and are identified only incidentally, others present emergently and require immediate surgical attention. We report the case of a 14-year-old boy who presented with symptoms similar to those for appendicitis or duplication cyst, who was found to have a torsed gastric hemangioma and multiple benign fibrous nodules in the abdomen. The presence of multiple vascular or fibrous lesions is associated with genetic syndromes that can have lifelong and reproductive repercussions; so it is imperative that these tumors be recognized by diagnosticians.
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Affiliation(s)
- Sara E Ohanessian
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Dorothy V Rocourt
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Karmaine A Millington
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Abstract
Type 2 congenital pulmonary airway malformation (CPAM) has been reported in association with many other congenital anomalies. To the best of our knowledge, however, an association of type 2 CPAM with congenital nephrotic syndrome has not been heretofore reported. We present the 1st report of such an association in a boy who had a prenatal diagnosis of cystic lung malformation and was found to have congenital nephrotic syndrome (diffuse mesangial sclerosis) at 1 month of age. A prenatal ultrasonogram had also shown oligohydramnios, and additionally the child had cleft lip and palate. There was no family history of childhood renal or pulmonary disease, and genetic testing for genes mutated in congenital nephrotic syndrome was negative.
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Affiliation(s)
- Karmaine A Millington
- Department of Pathology, Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA, USA.
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Saini AP, Wolfe LT, Millington KA, Myers JL, Clark JB. Occult Coronary Ostial Obstruction Late after Arterial Switch Operation. J Card Surg 2013; 28:308-11. [DOI: 10.1111/jocs.12083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ashish P. Saini
- Department of Pediatrics; Penn State College of Medicine; Hershey, Pennsylvania
| | - Lewis T. Wolfe
- Department of Pediatrics; Penn State College of Medicine; Hershey, Pennsylvania
| | | | - John L. Myers
- Department of Pediatrics; Penn State College of Medicine; Hershey, Pennsylvania
- Department of Surgery; Penn State College of Medicine; Hershey, Pennsylvania
| | - Joseph B. Clark
- Department of Pediatrics; Penn State College of Medicine; Hershey, Pennsylvania
- Department of Surgery; Penn State College of Medicine; Hershey, Pennsylvania
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Ntinginya EN, Squire SB, Millington KA, Mtafya B, Saathoff E, Heinrich N, Rojas-Ponce G, Kowuor D, Maboko L, Reither K, Clowes P, Hoelscher M, Rachow A. Performance of the Xpert® MTB/RIF assay in an active case-finding strategy: a pilot study from Tanzania. Int J Tuberc Lung Dis 2012; 16:1468-70. [PMID: 22964006 DOI: 10.5588/ijtld.12.0127] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In this pilot study, we evaluated the Xpert® MTB/RIF assay in an active case-finding strategy, using two spot sputum samples collected within a 1-hour interval from household contacts of smear-positive TB index cases. Tuberculosis (TB) confirmed by culture served as the reference standard. Among 219 enrolled contacts, the yield of active TB was 2.3%. While the sensitivity of smear microscopy was 60% (95%CI 14.7-94.7), Xpert MTB/RIF achieved a sensitivity of 100% (95%CI 47.81-100.0). All culture-confirmed cases tested positive by Xpert MTB/RIF on the first submitted sample, suggesting that the evaluation of only one sample could be sufficient for TB diagnosis in this context.
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Affiliation(s)
- E N Ntinginya
- National Institute for Medical Research, Mbeya Medical Research Programme, Mbeya, Tanzania.
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Lalvani A, Meroni PL, Millington KA, Modolo ML, Plebani M, Tincani A, Villalta D, Doria A, Ghirardello A. Recent advances in diagnostic technology: applications in autoimmune and infectious diseases. Clin Exp Rheumatol 2008; 26:S62-S66. [PMID: 18570756] [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
Biomarkers are used ubiquitously as indicators of biological health. The development of genomic and proteomic multiplex technologies have enormously amplified biomarker discovery and application to diagnostic and therapeutic decisions in clinical practice. New technologies are now available that simultaneously identify a wide spectrum of biomarkers and save time and costs. Multiplexed assays can be coupled to other disease specific indicators (i.e., cytokines, single nucleotide polymorphisms) in order to get more powerful information. However, there is an urgent need for validation/standardization of the new assays before they are adopted into clinical diagnostics. It is worthy to note a new assay, T cell interferon gamma release (TIGRAs), which has recently been introduced in the diagnosis of latent tuberculosis infection. It seems to perform better than tuberculin skin test in patients with inflammatory rheumatic diseases. In this review, we focus on advantages and limits of novel approaches to the detection of autoantibody profiles in autoimmune diseases or pathogen signatures in microbiology.
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Affiliation(s)
- A Lalvani
- Department of Respiratory Medicine, Faculty of Medicine, Imperial College London, London, UK
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Richeldi L, Luppi M, Losi M, Luppi F, Potenza L, Roversi P, Cerri S, Millington KA, Ewer K, Fabbri LM, Torelli G, Lalvani A. Diagnosis of occult tuberculosis in hematological malignancy by enumeration of antigen-specific T cells. Leukemia 2005; 20:379-81. [PMID: 16357840 DOI: 10.1038/sj.leu.2404053] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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