Diagnostic Limitations in Congenital Zika Virus Infection.

This is the first documented case of an infant with congenital Zika virus infection (ZVI) born in Ireland. A term infant was delivered with an antenatal diagnosis of severe microcephaly. First trimester bloods confirmed maternal ZVI and although the infant did not have Zika virus RNA or Zika-specific IgM in her blood or urine, she had multiple clinical features of congenital ZVI and Zika virus RNA was present in the placenta.

Variations in parathyroid hormone concentration in patients with low 25 hydroxyvitamin D.

UNLABELLED: Although 25 hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) levels are inversely related, less than half of the patients with a low vitamin D level have an elevated PTH, and, in most of these patients, the PTH does not immediately normalize with correction of the vitamin D. INTRODUCTION: Despite the inverse relationship between 25OHD and PTH, patients with vitamin D deficiency seen in clinical practice do not always have an elevated PTH, and, in those with secondary hyperparathyroidism, the PTH does not always normalize with correction of vitamin D deficiency. We examined variations in PTH concentrations in patients with low 25OHD and studied changes in the PTH concentration with restoration of vitamin D sufficiency. METHODS: This was a retrospective cohort study of patients with a 25OHD < 30 ng/mL and a concomitant PTH measurement seen at the Metabolic Bone Disease Clinic at a tertiary care center between July 1, 2007 and May 31, 2011. Patients with conditions associated with alterations in PTH were excluded. RESULTS: The study population consisted of 104 patients. The mean age was 55.5 years, and 83 % were female. The 25OHD and PTH were negatively correlated, but only 30 % of patients with a 25OHD < 30 ng/mL and 40 % of those with a 25OHD < 20 ng/mL had an elevated PTH. As the 25OHD increased to 30 ng/mL or higher, the PTH decreased significantly in the group of patients who had an elevated PTH at baseline, but only 44 % reached a normal PTH. Of patients with a normal PTH at baseline, 59 % experienced a drop in their PTH while the PTH remained unchanged or increased in 41 %. CONCLUSIONS: PTH has a limited role in defining vitamin D status in individual patients and in guiding vitamin D therapy in clinical practice.

Effects of antioxidant MnTBAP on angiogenesis in newborn mice with hyperoxic lung injury.

BACKGROUND: Oxygen toxicity mediated by reactive oxygen species (ROS) plays an essential role in the development of bronchopulmonary dysplasia in premature infants. By reducing oxidative stress, antioxidants protect the immature lung. We studied the effects of MnTBAP, a catalytic antioxidant on angiogenesis and alveolar growth following neonatal hyperoxia. METHODS: Newborn mouse litters randomized to room air (RA) or >95% O2 for 72 hours from day 4 (D4) to D7 to receive either MnTBAP (10 mg/kg/d) or saline intraperitoneally (every 24 h for three doses). Lungs harvested for angiogenic gene expression, protein expression, and histopathology post-hyperoxia exposure. Radial alveolar count (RAC), mean linear intercept (MLI) and vessel density assessed by histopathology. RESULTS: Angiogenic gene expression was significantly lower in the hyperoxia group compared to the RA group. The protein expression for VEGF and its receptor, VEGFR1, was significantly lower following treatment with MnTBAP compared to hyperoxia alone. Expression of VEGFR2, Angiopoietin-1 and TIE2, were substantially higher in the RA groups compared to hyperoxia groups with or without MnTBAP. Hyperoxia groups demonstrated alveolar simplification. MnTBAP reduced vessel density and failed to improve alveolar growth following hyperoxia. CONCLUSIONS: MnTBAP, a catalytic antioxidant, does not offer protection from hyperoxia-induced alveolar impairment. The lack of angiogenic upregulation by MnTBAP may contribute to alveolar simplification in newborn mice.

Galactorrhea with metoclopramide use in the neonatal unit.

We report a 3(1/2)-month-old infant with trisomy 21 presenting with galactorrhea in the neonatal intensive care unit (NICU). Endocrine work-up showed a high prolactin level (64.4 ng ml(-1)--normal: 0.5 to 30 ng ml(-1)). Cessation of therapy with metoclopramide (0.2 mg kg(-1) per dose q 6 h) resulted in the resolution of galactorrhea with a decrease in serum prolactin level (20.1 ng ml(-1)). We present this case to highlight this uncommon side effect of a commonly used medication in the NICU.