Catastrophic antiphospholipid syndrome during pregnancy Fuentes Carrasco, Marta; Mayoral Triana, Alejandra; Cristóbal García, Ignacio Cristóbal ...
European journal of obstetrics & gynecology and reproductive biology,
09/2021, Letnik:
264
Journal Article
Recenzirano
Odprti dostop
Catastrophic antiphospholipid syndrome (CAPS) is an uncommon and the most severe form of antiphospholipid syndrome (APS). A 33-week pregnant patient with Klippel-Trenaunay syndrome, past SARS-CoV-2 ...infection and type I fetal growth restriction with shortening of the fetal long bone was diagnosed in our center with a probable CAPS. Cesarean section was performed four days after the diagnosis due to the torpid evolution of the patient. Clinical improvement was noted a few days later and the mother and baby were discharged within a week. We review the current literature on CAPS during pregnancy and provide an updated view.
Studies focused on dermoscopic aspects of pigmented Bowen disease (pBD) in Latin American population are scarce and limited to only case reports or small series.
To report dermoscopic findings in a ...large series of 147 pBD diagnosed in Ibero-Latin American population.
We conducted a multicentric, retrospective study on 147 histologically proven pBD under the auspices of the Dermoscopy Chapter of the Ibero-Latin American College of Dermatology.
The study population consisted of 77 females (52%) and 70 males (48%) with a mean age of 68.6 years. 70.1% of patients had skin phototype 3, 15.6% to skin phototype 2, and 14.3% to skin phototype 4. On clinical examination, near 60% of pBD were flat, 70% presented with scales, and 90% were asymmetric. Under dermoscopy, structureless hypopigmented areas, dots brown and pink color were the most frequently observed. Regarding specific dermoscopic clues to pBD, the most prevalent were structureless hypopigmented areas, vessels arranged in linear fashion at the periphery, and pigmented lines or pigmented dots distributed in a linear fashion. Clustered, coiled, and dotted vessels were observed in 55.8%, 45.6%, and 45.6% of the cases, respectively.
We report a large series of cases of pBD in Latin American patients, with most patients being skin phototype 3 and 4. Distinctively in our study, the pigmented structures and the clues derived from the presence of melanin were much more frequent than in previous reports in fair skin.
•Our work opens a path of study and a therapeutic possibility in patients with chronic lung allograft dysfunction (CLAD) (the leading cause of death from the first year of transplant) who do not ...respond to other treatments.•We have shown an improvement or stabilization on half of the patients who received antithymocyte globulin.•We described a trend toward better survival in patients in early stage 1 to 2 CLAD who received antithymocyte globulin.•We reported little effects of antithymocyte globulin, and the risk of infection is relatively low if we rule it out prior the treatment and use prophylaxis.
Chronic lung allograft dysfunction (CLAD) is the leading cause of mortality after the first year of transplantation and treatments can have little impact on CLAD progression in some cases. The objective of this study was to evaluate the effectiveness and safety of antithymocyte globulin (ATG) in lung transplant recipients with CLAD.
We reviewed all patients from our center that had undergone a lung transplant between 2008 and 2019 and selected those with CLAD who were treated with ATG. The closest lung function (forced expiratory volume in the first second) to the ATG administration was recorded, as well as the values 3, 6, and 12 months before and after treatment. We followed and recorded survival during the 12 months after treatment.
A total of 13 patients with CLAD received ATG treatment. A favorable positive response to treatment (improvement or stabilization on lung function) was achieved in half of the patients. Most patients (71%) who responded well to ATG were in CLAD stage 1 to 2. The fall slope of forced expiratory volume in the first second is better after treatment. The median survival was 27 months, and we found a trend toward better survival in early CLAD stages 1 to 2. There were also differences in survival between rapid decliners and nonrapid decliners.
ATG treatment could play a role in patient with CLAD who do not respond to conventional therapies. The effect of cytolytic therapy with ATG is clearly better in those patients in early stages, with little effect in those in CLAD stage 3.
Home non-invasive ventilation (NIV) is recommended in patients with COPD and hypercapnic chronic respiratory failure (HCRF). The mechanism by it can improve alveolar ventilation during spontaneous ...breathing is not yet completely explained. Our aim is to evaluate the impact of on diaphragm muscle function in a series of patients with HCRF.
Observational, longitudinal, prospective study of a series of patients with very severe chronic obstruction to airflow treated with home high imntensity NIV (HINIV). Patients underwent a baseline and after 12 months assessment including adherence to treatment, quality of life, respiratory function tests and diaphragmatic ultrasound. SPSS v.26 software was used for statistical analysis.
We studied 30 patients, 63% male, the mean age was 60.8 (±6.4) years old. Patients had a severe obstructive ventilatory pattern FEV1 21.8 (±6.1)% and hypercapnia pCO2 56.4 (±7.2) mmHg. After 12 months of HINIV, we observed significant increases in FVC of 9.2% (p = 0.002), FEV1 of 3.5% (p = 0.04), MIP of 9.4% (p = 0.006), and 6-minute-walking test (6MWT) of 31.9 m (p = 0.001), as well as decreases in paCO2 of 12.5 mmHg (p = 0.001), HCO3 of 4.7 mmol/L (p = 0.001) and BODE index from 7 to 6. Diaphragmatic ultrasound demonstrated an increase in the thickening fraction of 14% (p = 0.002). Respiratory symptoms (p = 0.04), physical function (p = 0.03), and sleep (p = 0.04) also improved.
In patients with HCRF due to very severe chronic obstruction to airflow, long-term HINIV can improve respiratory performance by improving the function of the diaphragmatic musculature. Larger multicenter clinical trials are needed to confirm the results suggested in this study.
Spectral differences (range: 350-2500 nm) between the three alteration phases related to low and high sulfidation epithermal mineralization has been studied in the Jacinto deposit (Beatriz, Sur de ...Elena, and El Limon Nuevo veins) and the Big Golden Hill sector, respectively, located in the Cuban Cretaceous volcanic, Camagüey and Las Tunas provinces. This study has revealed the following differences between the phases: (a) Phase I: associated with the lithological type of quartz with massive and/or brecciated texture, where gold mineralization develops. At 600-800 nm, the signals identified responds with goethite and at 1400, 1900 y 2200 nm, as montmorillonite and nontronite. The reflectance value is 30 -50%, although in the El Limón Nuevo vein is 30-40%. (b) Phase II: Related to the argillic alteration zone composed by sericitic or silicified quartz and ferrous minerals such as limonite and hematite. It only occurs in Beatriz and Sur de Elena veins. At 600-800 nm, the signal is associated with ferrous minerals and at 1400, 1900, and 2200 nm, to clays minerals as montmorillonite, halloysite, and nontronite. The reflectance value is 30 – 50%. The difference between both Phases is in the amplitude and shape of the absorption feature at 1400 nm. (c) Phase III: it is located near the volcanic rock, composed by illite-smectite-quartz, without gold content and nearby to propylitic zone. At 600-800 nm, the feature indicates the presence of goethite and at 1400, 1900, and 2200 nm, to montmorillonite, illite, and nontronite. The reflectance value is 30 - 40%. The Big Golden Hill sector is characterized by peaks related to goethite and nontronite at 600-800 nm and pyrophyllite at 1400, 1950 and 2165 nm, typical of advanced argillic alteration. The reflectance value reaches 55%. This study represents one of the first applications of reflectance spcetroscopic techniques in Cuban mineral deposits.
Specific anatomical structures from the female body, such as the axillary slope, armpit, pectoral muscle, or abdominal tissue, can be present in mammograms and might affect the proper mammogram ...analysis, especially in female populations with overweight issues, as is the case in Mexico. This work aims to determine if better results can be obtained in an automatic mammogram analysis by removing the abdominal and axillary fatty tissues as a preprocessing step. The experimentation is carried out by applying a pectoral muscle segmentation technique in a Mexican mammogram dataset and comparing the results by removing the fatty tissues from the same mammograms. Furthermore, the same experimentation is performed using the Portuguese public datasets, INbreast and BCDR. The conducted experiment will allow us to determine the differences in results across different populations. The fat removal method is based on the breast contour-edge from which points of interest are detected to cut the fat tissue. Our results suggest that the proposed method is suitable as a preprocessing technique, obtaining a 94.18% of acceptance, according to the qualitative analysis performed, and showed that removing the fatty tissue yields better results if the mammogram contains significant fatty tissue such as in the mammograms of Mexican patients.
Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) ...after lung transplantation.
We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05.
There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326).
SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.
NIR spectroscopy was used as a non-destructive technique for the assessment of chemical changes in the main internal quality properties of wine grapes (Vitis vinifera L.) during on-vine ripening and ...at harvest. A total of 363 samples from 25 white and red grape varieties were used to construct quality-prediction models based on reference data and on NIR spectral data obtained using a commercially-available diode-array spectrophotometer (380-1,700 nm). The feasibility of testing bunches of intact grapes was investigated and compared with the more traditional must-based method. Two regression approaches (MPLS and LOCAL algorithms) were tested for the quantification of changes in soluble solid content (SSC), reducing sugar content, pH-value, titratable acidity, tartaric acid, malic acid and potassium content. Cross-validation results indicated that NIRS technology provided excellent precision for sugar-related parameters (r(2) = 0.94 for SSC and reducing sugar content) and good precision for acidity-related parameters (r(2) ranging between 0.73 and 0.87) for the bunch-analysis mode assayed using MPLS regression. At validation level, comparison of LOCAL and MPLS algorithms showed that the non-linear strategy improved the predictive capacity of the models for all study parameters, with particularly good results for acidity-related parameters and potassium content.
On March 2020, World Health Organization (WHO) declared COVID-19 to be a pandemic disease. Interactions between allergy-related inflammatory and psychiatric disorders including depression, anxiety, ...and post-traumatic stress disorder (PTSD) have been documented. Therefore, those who have pre-existing allergic conditions may have an increased psychiatric reaction to the stresses of the COVID-19 pandemic.
Identify the psychological impact of COVID-19 in patients with allergic diseases and determine if these individuals have a greater risk of presenting with post-traumatic stress disorder (PTSD).
It is a cross-sectional, survey-based study designed to assess the degree of symptoms of depression and the risk of PTSD using the Patient Health Questionnaire (PHQ-9) and the Impact of Event Scale–Revised (IES-R), respectively, in allergic patients.
A total of 4106 surveys were evaluated; 1656 (40.3%) were patients with allergic disease, and 2450 (59.7%) were non-allergic (control) individuals. Of those with allergies, 76.6% had respiratory allergic disease including asthma and allergic rhinitis. Individuals with allergic disease reported higher scores regarding symptoms of PTSD on the IES-R scale (p = 0.052, OR 1.24 CI 0.99–1.55) as well as a higher depression risk score in the PHQ-9 questionnaire (mean 6.82 vs. 5.28) p = 0.000 z = −8.76.
The allergy group presented a higher score in the IES-R questionnaire (mean 25.42 vs. 20.59), being more susceptible to presenting PTSD (p = 0.000, z = −7.774).
The individuals with allergic conditions were further divided into subgroups of those with respiratory allergies such as allergic rhinitis and asthma vs those with non-respiratory allergies such as drug and food allergy, urticaria and atopic dermatitis. This subgroup analysis compares respiratory versus non-respiratory allergic patients, with similar results on the IES-R (mean 25.87 vs 23.9) p = 0.0124, z = −1.539. There was no significant difference on intrusion (p = 0.061, z = −1.873) and avoidance (p = 0.767, z = −0.297), but in the hyperarousal subscale, patients with respiratory allergy had higher scores (mean 1.15 vs. 0.99) p = 0.013 z = −2.486.
Psychological consequences such as depression and reported PTSD are present during the COVID-19 pandemic causing an impact particularly in individuals with allergic diseases. If we acknowledge the impact and how it is affecting our patients, we are able to implement interventions, follow up, and contribute to their overall well-being.
Abstract
There is a paucity of reports on the characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in infants, because most studies have grouped infants with ...older children. We analyzed the viral loads of 45318 SARS-CoV-2–positive nasopharyngeal swab samples obtained in Buenos Aires, Argentina. Infants younger than 6 months presented higher viral loads than any other age group. Children older than 6 months showed significantly lower viral loads, similar to those founds in adults. This observation raises new questions regarding the role of infants in the spreading of SARS-CoV-2 infection.
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