Kawasaki disease and giant coronary artery aneurysms: the role of echocardiography from diagnosis through follow‐up

Kawasaki disease is an acquired vasculitis that can affect the coronary arteries placing the patient at risk for coronary artery thrombosis, myocardial ischemia and infarction. The risk of complications related to coronary artery involvement persists for years despite recovery from the acute illness phase. The risk of late coronary disease progression necessitates long term follow‐up generally accomplished by non‐invasive echocardiography in pediatric patients. We review the utility of echocardiography in patients with Kawasaki disease as it relates to initial management, risk stratification and follow‐up of these children.     

Development and preliminary validation of the PC‐SAD5, a screener‐derived short depression severity measure

Background The prevalence of depressive disorders is high among patients with skin disease. The PC‐SAD is a 37‐item self‐administered depression screening questionnaire that has been validated in dermatological patients. Objective The aim of this study was to develop and validate a brief depression severity instrument derived from the PC‐SAD that can be used to assess severity and monitor ongoing clinical course. Methods Two patient samples participated in the study: 72 adult dermatological inpatients and 73 adults attending six primary care practices. Psychiatric assessment included the Structured Clinical Interview for DSM‐IV and an 18‐item version of the PC‐SAD; moreover, dermatological patients completed the Patient Health Questionnaire depression scale (PHQ‐9), while primary care patients were administered the Montgomery‐Asberg Depression Rating Scale (MADRS). A subset of five PC‐SAD items showing the best psychometric properties were selected, and the reliability and validity of the resulting instrument (PC‐SAD5) were examined. Results The PC‐SAD5 showed satisfactory internal consistency in both samples. There was a high correlation between PC‐SAD5 and PHQ‐9 and MADRS scores. Multiple regression analysis revealed a gradient of PC‐SAD5 scores from patients with no mental disorder, those with milder forms of depression, to those with Major Depressive Disorder. Similar results were observed for the 18‐item version of the PC‐SAD. Conclusion The availability of valid and reliable continuous measures of depression severity derived from the PC‐SAD extends its field of application from depression screening to use as a follow‐up measure of depression severity in routine clinical practice. A validated very short instrument such as the PC‐SAD5 may have substantial clinical value.     

HCMV Infection of Human Trophoblast Progenitor Cells of the Placenta Is Neutralized by a Human Monoclonal Antibody to Glycoprotein B and Not by Antibodies to the Pentamer Complex

Human cytomegalovirus (HCMV) is the major viral cause of congenital infection and birth defects. Primary maternal infection often results in virus transmission, and symptomatic babies can have permanent neurological deficiencies and deafness. Congenital infection can also lead to intrauterine growth restriction, a defect in placental transport. HCMV replicates in primary cytotrophoblasts (CTBs), the specialized cells of the placenta, and inhibits differentiation/invasion. Human trophoblast progenitor cells (TBPCs) give rise to the mature cell types of the chorionic villi, CTBs and multi-nucleated syncytiotrophoblasts (STBs). Here we report that TBPCs are fully permissive for pathogenic and attenuated HCMV strains. Studies with a mutant virus lacking a functional pentamer complex (gH/gL/pUL128-131A) showed that virion entry into TBPCs is independent of the pentamer. In addition, infection is blocked by a potent human neutralizing monoclonal antibody (mAb), TRL345, reactive with glycoprotein B (gB), but not mAbs to the pentamer proteins pUL130/pUL131A. Functional studies revealed that neutralization of infection preserved the capacity of TBPCs to differentiate and assemble into trophospheres composed of CTBs and STBs in vitro. Our results indicate that mAbs to gB protect trophoblast progenitors of the placenta and could be included in antibody treatments developed to suppress congenital infection and prevent disease.