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Alvin Zipursky - One of the best experts on this subject based on the ideXlab platform.
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hemolytic Disease of the fetus and newborn due to Rh d incompatibility a preventable Disease that still produces significant morbidity and mortality in children
PLOS ONE, 2020Co-Authors: Valeria Pegoraro, Alvin Zipursky, Ducciocompet Urbinati, Gerard H A Visser, Gian Carlo Di Renzo, Brie A Stotler, Steven L SpitalnikAbstract:In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., "Rh Disease"), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh Disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is ~99% effective at preventing maternal sensitization to Rh(D). To investigate global compliance with this therapeutic intervention, we used an epidemiological approach to estimate the current annual number of pregnancies worldwide involving an Rh(D)-negative mother and an Rh(D)-positive fetus. The annual number of doses of anti-Rh(D) IgG required for successful immunoprophylaxis for these cases was then calculated and compared with an estimate of the annual number of doses of anti-Rh(D) produced and provided worldwide. Our results suggest that ~50% of the women around the world who require this type of immunoprophylaxis do not receive it, presumably due to a lack of awareness, availability, and/or affordability, thereby putting hundreds of thousands of fetuses and neonates at risk for Rh Disease each year. The global failure to provide this generally acknowledged standard-of-care to prevent Rh Disease, even 50 years after its availability, contributes to an enormous, continuing burden of fetal and neonatal Disease and provides a critically important challenge to the international health care system.
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Infants affected by Rh sensitization: A 2-year Canadian National Surveillance Study
Paediatrics & Child Health, 2020Co-Authors: Jillian M. Baker, Alvin Zipursky, Vinod K. Bhutani, Michael Sgro, Douglas M Campbell, Katerina Pavenski, Aasha Gnanalingam, Kathleen Hollamby, Thivia Jegathesan, NeohbcAbstract:Abstract Introduction Rh sensitization occurs when Rh(D)-negative women develop anti-Rh(D) antibodies following exposure through pregnancy or transfusion. Rh Disease may cause jaundice, anemia, neurological impairment, and death. It is rare in countries where Rh Immune Globulin (RhIg) is used. Canadian Rh sensitization and Disease rates are unknown. Methods This survey-based study was conducted using a Canadian Paediatric Surveillance Program questionnaire sent to Canadian paediatricians and paediatric subspecialists to solicit Rh Disease cases from May 2016 to June 2018. Paediatricians reported Rh-positive infants ≤ 60 days of age, born to Rh-negative mothers with RhD sensitization. Results Sixty-two confirmed cases of infants affected by Rh(D) sensitization were reported across Canada. The median gestational age of neonates was term, age at presentation was 2 hours, and hemoglobin at presentation was 137.5 g/L (33 to 203 g/L). The median peak bilirubin and phototherapy duration were 280 µmol/L (92 to 771 µmol/L), and 124 hours, respectively. Thirty (48%) infants received Intravenous immune globulin (IVIG) (median two doses). Seventeen (27%) received one to three simple transfusions; 10 (16%) required exchange transfusions. Six (10%) infants presented with acute bilirubin encephalopathy, and less than five presented with seizures. Fourteen mothers with affected infants were born outside of Canada. Discussion Rh Disease continues to exist in Canada. Additional efforts are needed to raise awareness of Rh Disease, prevent Disease, and minimize sequelae when it does occur. The ongoing global burden of Rh Disease, as well as the possibility of emerging Rh immunoglobulin refusal are among factors that could be taken into consideration in future prevention efforts.
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impact of Rhesus Disease on the global problem of bilirubin induced neurologic dysfunction
Seminars in Fetal & Neonatal Medicine, 2015Co-Authors: Alvin Zipursky, Vinod K. BhutaniAbstract:Clinical experience with Rhesus (Rh) Disease and its post-icteric sequelae is limited among high-income countries because of nearly over four decades of effective prevention care. We hypothesized that Rh Disease is prevalent in other regions of the world because it is likely that protection is limited or non-existent. Following a worldwide study, it has been concluded that Rh hemolytic Disease is a significant public health problem resulting in stillbirths and neonatal deaths, and is a major cause of severe hyperbilirubinemia with its sequelae, kernicterus and bilirubin-induced neurologic dysfunction. Knowing that effective Rh-Disease prophylaxis depends on maternal blood-type screening, healthcare afforded to the high-risk mothers needs to be free of bottlenecks and coupled with unfettered access to effective Rh-immunoglobulin. Future studies that match the universal identification of Rh-negative status of women and targeted use of immunoprophylaxis to prevent childhood bilirubin neurotoxicity are within reach, based on vast prior experiences.
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The global burden of Rh Disease
Archives of disease in childhood. Fetal and neonatal edition, 2010Co-Authors: Alvin Zipursky, Vinod K. PaulAbstract:Rh negative women who deliver an Rh positive baby are at risk of developing anti-Rh antibodies.1 Rh positive babies born of these mothers will develop Rh haemolytic Disease. This is a severe condition responsible for death in utero or in the neonatal period or severe jaundice with ensuing brain damage. The natural history of the Disease has not been described in recent literature. Walker,1 in 1971, reviewed a series of cases from his community. It was found that 14% of affected pregnancies resulted in stillbirths. Of the survivors, 30% had severe Disease almost certainly fatal without treatment, while an additional 30% had moderate Disease which would manifest as severe hyperbilirubinaemia that untreated may result in brain damage and/or death. Forty per cent of cases would require no treatment. Therefore, it can be estimated that approximately 50% of children with untreated haemolytic Disease of the newborn (HDN) will die of the Disease or develop brain damage. Similar observations were made in Manitoba, Canada.2 Over 30 years ago it was established that Rh isoimmunisation could be prevented by passive immunisation with anti-Rh (anti-D) γ globulin.3 4 Thereafter, prevention of Rh Disease was instituted using postpartum injections of anti-Rh (anti-D) γ globulin; this has been proven to be highly effective.5 In most developed, high income countries, all Rh negative postpartum women whose babies are Rh positive …
Lluis Palou - One of the best experts on this subject based on the ideXlab platform.
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evaluating food additives as antifungal agents against monilinia fructicola in vitro and in hydroxypropyl methylcellulose lipid composite edible coatings for plums
International Journal of Food Microbiology, 2014Co-Authors: Hakan Karaca, Maria B Perezgago, V Taberner, Lluis PalouAbstract:Common food preservative agents were evaluated in in vitro tests for their antifungal activity against Monilinia fructicola, the most economically important pathogen causing postharvest Disease of stone fruits. Radial mycelial growth was measured in Petri dishes of PDA amended with three different concentrations of the agents (0.01-0.2%, v/v) after 7 days of incubation at 25 °C. Thirteen out of fifteen agents tested completely inhibited the radial growth of the fungus at various concentrations. Among them, ammonium carbonate, ammonium bicarbonate and sodium bicarbonate were the most effective while sodium acetate and sodium formate were the least effective. The effective agents and concentrations were tested as ingredients of hydroxypropyl methylcellulose (HPMC)-lipid edible coatings against brown rot Disease on plums previously inoculated with M. fructicola (curative activity). 'Friar' and 'Larry Ann' plums were inoculated with the pathogen, coated with stable edible coatings about 24h later, and incubated at 20 °C and 90% Rh. Disease incidence (%) and severity (lesion diameter) were determined after 4, 6, and 8 days of incubation and the 'area under the Disease progress stairs' (AUDPS) was calculated. Coatings containing bicarbonates and parabens significantly reduced brown rot incidence in plums, but potassium sorbate, used at 1.0% in the coating formulation, was the most effective agent with a reduction rate of 28.6%. All the tested coatings reduced Disease severity to some extent, but coatings containing 0.1% sodium methylparaben or sodium ethylparaben or 0.2% ammonium carbonate or ammonium bicarbonate were superior to the rest, with reduction rates of 45-50%. Overall, the results showed that most of the agents tested in this study had significant antimicrobial activity against M. fructicola and the application of selected antifungal edible coatings is a promising alternative for the control of postharvest brown rot in plums.
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antifungal activity of food additives in vitro and as ingredients of hydroxypropyl methylcellulose lipid edible coatings against botrytis cinerea and alternaria alternata on cherry tomato fruit
International Journal of Food Microbiology, 2013Co-Authors: Cristiane Fagundes, Maria B Perezgago, Alcilene Rodrigues Monteiro, Lluis PalouAbstract:Abstract The antifungal activity of food additives or ‘generally recognized as safe’ (GRAS) compounds was tested in vitro against Botrytis cinerea and Alternaria alternata . Radial mycelial growth of each pathogen was measured in PDA Petri dishes amended with food preservatives at 0.2, 1.0, or 2.0% (v/v) after 3, 5, and 7 days of incubation at 25 °C. Selected additives and concentrations were tested as antifungal ingredients of hydroxypropyl methylcellulose (HPMC)-lipid edible coatings. The curative activity of stable coatings was tested in in vivo experiments. Cherry tomatoes were artificially inoculated with the pathogens, coated by immersion about 24 h later, and incubated at 20 °C and 90% Rh. Disease incidence and severity (lesion diameter) were determined after 6, 10, and 15 days of incubation and the ‘area under the Disease progress stairs’ (AUDPS) was calculated. In general, HPMC-lipid antifungal coatings controlled black spot caused by A. alternata more effectively than gray mold caused by B. cinerea . Overall, the best results for reduction of gray mold on cherry tomato fruit were obtained with coatings containing 2.0% of potassium carbonate, ammonium phosphate, potassium bicarbonate, or ammonium carbonate, while 2.0% sodium methylparaben, sodium ethylparaben, and sodium propylparaben were the best ingredients for coatings against black rot.
Arsen D Ristic - One of the best experts on this subject based on the ideXlab platform.
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practical aspects of the management of pericardial Disease
Heart, 2003Co-Authors: Bernhard Maisch, Arsen D RisticAbstract:The aetiology based classification of pericardial Disease comprises: infectious pericarditis; pericarditis in systemic autoimmune Diseases; type 2 (auto)immune pericarditis; metabolic disorders; trauma; tumours; pericardial cysts; and congenital defects.1 This classification has major therapeutic consequences that will be elaborated upon in this article, with the focus on practical management of pericardial syndromes and specific underlying Diseases. ### Pericardial syndromes The diagnosis of acute pericarditis relies on clinical findings, ECG changes, and echocardiography (table 1).2,3 Chronic pericardial inflammation includes effusive, adhesive, and constrictive forms, lasting three months or more. Recurrent pericarditis may be intermittent (symptom-free interval without treatment) or incessant (discontinuation of anti-inflammatory treatment always ensures a relapse). View this table: Table 1 Diagnostic pathway and sequence of performance in acute pericarditis.2,3 Pericardial effusion occurs as transudate (hydropericardium), exudate, pyopericardium or haemopericardium, or a mixture of these. Large effusions generally indicate more serious Disease and are common with neoplasia, tuberculosis, hypercholesterolaemia, uraemic pericarditis, myxoedema, and parasitoses.2,4 Patients can be asymptomatic if effusion develops slowly. Many pregnant women develop a minimal to moderate clinically silent hydropericardium by the third trimester. Fetal pericardial fluid can be detected by echocardiography after 20 weeks’ gestation and is normally 2 mm or less in depth. More fluid should raise questions of hydrops fetalis, Rh Disease, hypoalbuminaemia, and immunopathy or maternally transmitted mycoplasmal or other infections, and neoplasia.3 Echocardiography reveals the size of effusions: (1) small (echo-free space in diastole < 10 mm); (2) moderate (at least ⩾ 10 mm posteriorly); (3) large (⩾ 20 mm); or (4) very large (⩾ 20 mm with compression of the heart).2 Presence of fibrin, clot, tumour, air, and calcium can also be detected. Pericardial effusion must be differentiated from pleural fluid, ascites, atelectasis, or epicardial fat. Transoesophageal echocardiography is useful in loculated pericardial effusions, intrapericardial clots, metastases, and pericardial thickening. …
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pericardial Disease in pregnancy
Herz, 2003Co-Authors: Arsen D Ristic, G G Ristic, Sabine Pankuweit, Miodrag Ostojic, Petar M Seferovic, Ida Jovanovic, Aleksandar Ljubic, Bernhard MaischAbstract:Background: There is no evidence that pregnancy affects susceptibility to pericardial Disease. However, when such a condition occurs, its proper diagnosis and management may be crucial for the outcome of the pregnancy. Incidence and Diagnosis: Hydropericardium is the most frequent form of pericardial involvement in pregnancy. It is typically a small, clinically silent pericardial effusion present in the third trimester in approximately 40% of healthy pregnant women. Small amounts of fetal pericardial fluid (< 2 mm in echocardiography, in diastole) can be detected after 20 weeks of gestation. Larger effusions should raise clinical concern for hydrops fetalis, Rh Disease, hypoalbuminemia, and infectious or autoimmune disorder. Wide varieties of etiologic forms of pericardial Diseases occur sporadically in pregnant women. Significant symptoms, electrocardiographic changes, or physiologic impairment warrant hospitalization. Treatment: Most pericardial disorders are managed during pregnancy as in nonpregnant patients (i.e., nonsteroidal antiinflammatory drugs for acute, antibiotics and drainage for purulent pericarditis, and corticosteroids for systemic autoimmune disorders). However, colchicine is contraindicated in pregnancy, and pericardiocentesis should be performed only for very large effusions causing clinical signs of cardiac tamponade or if presence of suppurative, tuberculous or neoplastic pericardial effusion is suspected. Echocardiographic guidance of pericardiocentesis is preferred to fluoroscopic guidance in order to avoid fetal X-ray exposure. Pericardiectomy should be reserved for significant pericardial constriction and resistant bacterial infections. Delivery of normal infants in term after pericardiocentesis or pericardiectomy is expected, whenever natural history of causative Disease allows. Pericardiectomy itself is not a contraindication for subsequent successful pregnancies.
Palou L - One of the best experts on this subject based on the ideXlab platform.
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edible coatings for plums
'Elsevier BV', 2014Co-Authors: Karaca H, Mb Perez-gago, Palou LAbstract:Common food preservative agents were evaluated in in vitro tests for their antifungal activity against Monilinia fructicola, the most economically important pathogen causing postharvest Disease of stone fruits. Radial mycelial growth was measured in Petri dishes of PDA amended with three different concentrations of the agents (0.01-0.2%, v/v) after 7 days of incubation at 25 degrees C. Thirteen out of fifteen agents tested completely inhibited the radial growth of the fungus at various concentrations. Among them, ammonium carbonate, ammonium bicarbonate and sodium bicarbonate were the most effective while sodium acetate and sodium formate were the least effective. The effective agents and concentrations were tested as ingredients of hydroxypropyl methylcellulose (HPMC)-lipid edible coatings against brown rot Disease on plums previously inoculated with M. fructicola (curative activity). 'Friar' and 'Larry Ann' plums were inoculated with the pathogen, coated with stable edible coatings about 24 h later, and incubated at 20 degrees C and 90% Rh. Disease incidence (%) and severity (lesion diameter) were determined after 4, 6, and 8 days of incubation and the 'area under the Disease progress stairs' (AUDPS) was calculated. Coatings containing bicarbonates and parabens significantly reduced brown rot incidence in plums, but potassium sorbate, used at 1.0% in the coating formulation, was the most effective agent with a reduction rate of 28.6%. All the tested coatings reduced Disease severity to some extent, but coatings containing 0.1% sodium methylparaben or sodium ethylparaben or 0.2% ammonium carbonate or ammonium bicarbonate were superior to the rest, with reduction rates of 45-50%. Overall, the results showed that most of the agents tested in this study had significant antimicrobial activity against M. fructicola and the application of selected antifungal edible coatings is a promising alternative for the control of postharvest brown rot in plums. (C) 2014 Elsevier B.V. All rights reserved
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Evaluating food additives as antifungal agents against Monilinia fructicola in vitro and in hydroxypropyl methylcellulose-lipid composite edible coatings for plums
'Elsevier BV', 2014Co-Authors: Karaca H, Pérez-gago M.b., Palou LAbstract:Common food preservative agents were evaluated in in vitro tests for their antifungal activity against Monilinia fructicola, the most economically important pathogen causing postharvest Disease of stone fruits. Radial mycelial growth was measured in Petri dishes of PDA amended with three different concentrations of the agents (0.01-0.2%, v/v) after 7. days of incubation at 25. °C. Thirteen out of fifteen agents tested completely inhibited the radial growth of the fungus at various concentrations. Among them, ammonium carbonate, ammonium bicarbonate and sodium bicarbonate were the most effective while sodium acetate and sodium formate were the least effective. The effective agents and concentrations were tested as ingredients of hydroxypropyl methylcellulose (HPMC)-lipid edible coatings against brown rot Disease on plums previously inoculated with M. fructicola (curative activity). 'Friar' and 'Larry Ann' plums were inoculated with the pathogen, coated with stable edible coatings about 24. h later, and incubated at 20. °C and 90% Rh. Disease incidence (%) and severity (lesion diameter) were determined after 4, 6, and 8. days of incubation and the 'area under the Disease progress stairs' (AUDPS) was calculated. Coatings containing bicarbonates and parabens significantly reduced brown rot incidence in plums, but potassium sorbate, used at 1.0% in the coating formulation, was the most effective agent with a reduction rate of 28.6%. All the tested coatings reduced Disease severity to some extent, but coatings containing 0.1% sodium methylparaben or sodium ethylparaben or 0.2% ammonium carbonate or ammonium bicarbonate were superior to the rest, with reduction rates of 45-50%. Overall, the results showed that most of the agents tested in this study had significant antimicrobial activity against M. fructicola and the application of selected antifungal edible coatings is a promising alternative for the control of postharvest brown rot in plums. © 2014 Elsevier B.V
Steven L Spitalnik - One of the best experts on this subject based on the ideXlab platform.
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hemolytic Disease of the fetus and newborn due to Rh d incompatibility a preventable Disease that still produces significant morbidity and mortality in children
PLOS ONE, 2020Co-Authors: Valeria Pegoraro, Alvin Zipursky, Ducciocompet Urbinati, Gerard H A Visser, Gian Carlo Di Renzo, Brie A Stotler, Steven L SpitalnikAbstract:In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., "Rh Disease"), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh Disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is ~99% effective at preventing maternal sensitization to Rh(D). To investigate global compliance with this therapeutic intervention, we used an epidemiological approach to estimate the current annual number of pregnancies worldwide involving an Rh(D)-negative mother and an Rh(D)-positive fetus. The annual number of doses of anti-Rh(D) IgG required for successful immunoprophylaxis for these cases was then calculated and compared with an estimate of the annual number of doses of anti-Rh(D) produced and provided worldwide. Our results suggest that ~50% of the women around the world who require this type of immunoprophylaxis do not receive it, presumably due to a lack of awareness, availability, and/or affordability, thereby putting hundreds of thousands of fetuses and neonates at risk for Rh Disease each year. The global failure to provide this generally acknowledged standard-of-care to prevent Rh Disease, even 50 years after its availability, contributes to an enormous, continuing burden of fetal and neonatal Disease and provides a critically important challenge to the international health care system.
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The continuing burden of Rh Disease 50 years after the introduction of anti-Rh(D) immunoglobin prophylaxis: call to action.
American journal of obstetrics and gynecology, 2019Co-Authors: Gerard H A Visser, Gian Carlo Di Renzo, Steven L Spitalnik, Diogo Ayres-de-campos, Maria Fernanda Escobar, Eytan R. Barnea, P.k. Shah, Anwar Nasser, Luc De Bernis, Luming SunAbstract:Severe morbidity and death because of Rh Disease have only been reduced by approximately 50% globally during the last 50 years, despite the advent of anti-Rh(D) immunoglobin prophylaxis, which has resulted in >160,000 perinatal deaths and 100,000 disabilities annually. This apparent failure to take appropriate preventive measures is of great concern. Thus, there is a great need to do much better. We wish to draw attention to the unnecessary continuing burden of Rh Disease, to discuss some of the reasons for this failure, and to provide suggestions for a better way forward.