Preventing adverse obstetric outcome in women with thrombophilia

Thrombophilia may represent a new risk factor for placental vascular disorders. Thromboprophylaxis with low doses of heparin and aspirin may be discussed in order to reduced adverse obstetric outcomes. No randomized controlled trials are currently published in the literature. Thromboprophylaxis may be unwarranted in asymptomatic women because of the lack for an association between thrombophilia and pregnancy outcome. Women with antiphospholipid syndrome are at high risk for pregnancy loss and maternal complications. Pregnancy in women with antiphospholipid syndrome appears to be improved by thromboprophylaxis, but adverse obstetric outcome may occur despite treatment. Thromboprophylaxis is recently reported in women with previous poor obstetric outcomes. These preliminary observational studies are still insufficient to recommend a large diffusion for thromboprophylaxis. Prevention for adverse outcomes with a low fixed dose of heparin may only be discussed in women with previous late fetal loss or intrauterine fetal death.     

A follow-up analysis of cardiac function and complications in pediatric patients with permanent epicardial pacing

Background Nowadays, the number of pediatric patients receiving permanent pacemaker implantations is increasing. However, there is very little relevant, long-term follow-up analysis carried out in China. Methods Clinical information from pediatric patients who underwent epicardial permanent pacemaker implantation from January 1, 2005 to December 31, 2017 in Guangdong Provincial People's Hospital was collected. Eligible patients received 12-lead electrocardiograms and echocardiography preoperatively and postoperatively, as well as programming control during their follow-up. Meanwhile, complications were treated and analyzed. Results A total of98 pediatric patients with permanent epicardial pacing were included in the study, including 60 males and 38 females. The age of patients who underwent surgery for the first time ranged from 8 days to 14 years old( the median age of these patients was 3 years old). The weight of these patients ranged from 2.7 kg to 52 kg(the median weight of these patients was 12 kg). Three patients died while they were getting treatment. The follow-up was carried out on eighty-seven out of ninety-five patients(91.6%) and lasted 5 months to 13 years( average 3.79±3.06 years). One patient with single-chamber right ventricular pacing was found to have cardiac insufficiency in the second year after operation. There were 6 patients with cardiac insufficiency whose ejection fractions were less than 55%. All these patients had a single-chamber left ventricular pacing implant or double-chamber right atrial left ventricular pacing implant. Paired T-test was used to compare the preoperative LVEF with the last echocardiographic LVEF(45%±7% vs.67%±7%, P 0.05),which indicated statistical differences. Conclusion A permanent epicardial pacemaker is safe and effective and reasonable pacing mode can protect cardiac function.[S Chin J Cardiol 2019;20(1):10-14]     

Anti-TNF therapies: a comprehensive analysis of adverse effects associated with immunosuppression

Knowledge and understanding about the immunosuppressive properties of anti-TNF therapies and the adverse effects these causes have advanced over the last 10 years since the first of these drugs was approved. These drugs work by inhibiting tumour necrosis factor (TNF) in the body, which plays an essential role in the immune response to invading pathogens. Anti-TNF drugs have therapeutic value because high levels of TNF are thought to be part of the pathophysiology of many chronic inflammatory disorders such as rheumatoid arthritis and Crohn’s disease. Anti-TNF drugs are usually well-tolerated, however, there have been reports of many potentially serious adverse effects. This article will comprehensively analyse these adverse effects; the incidence, symptoms and mechanisms will be discussed. In addition, the contraindications of this class of drugs will be explored and the detection and prevention methods that should be put in place by health care professionals who treat patients on these drugs will be described.     

Seroprevalence of cytomegalovirus infection in pregnant women and associated role in obstetric complications: a preliminary study

The objective of this study was to determine the seroprevalence of cytomegalovirus (CMV) infections through antenatal screening data and the association of this virus with obstetric complications. Serum samples from 125 apparently healthy pregnant women sent for antenatal screening from various hospitals in Malaysia between January 2007 and December 2008, were examined for CMV specific IgM and IgG antibodies using an enzyme-linked immunosorbent assay method. Of the 125 pregnant women tested, anti-CMV IgG antibody was found in 105 (84%) of the cases and anti-CMV IgM in 9 cases (7.2%). Both CMV IgM and IgG were also found in another 37 women whose serum samples were sent for investigation of various obstetric complications: 17 cases of spontaneous abortions, 15 cases of fetal anomalies detected during ultrasound examination, 1 case of incomplete abortion, 3 cases with premature delivery of infant with congenital anomalies and 1 case of infertility. Our preliminary data which only represented a small study group has shown the prevalence of CMV infection among the local population and the association of CMV in obstetric complications.     

A cost-effectiveness threshold analysis of a multidisciplinary structured educational intervention in pediatric asthma

Objective: Asthma educational interventions have been shown to improve several clinically and economically important outcomes. However, these interventions are costly in themselves and could lead to even higher disease costs. A cost-effectiveness threshold analysis would be helpful in determining the threshold value of the cost of educational interventions, leading to these interventions being cost-effective. The aim of the present study was to perform a cost-effectiveness threshold analysis to determine the level at which the cost of a pediatric asthma educational intervention would be cost-effective and cost-saving. Methods: A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a single uncontrolled before-and-after study performed with Colombian asthmatic children. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable “quality-adjusted life-years” (QALYs). Results: A deterministic threshold sensitivity analysis showed that the asthma educational intervention will be cost-saving to the health system if its cost is under US$513.20. Additionally, the analysis showed that the cost of the intervention would have to be below US$967.40 in order to be cost-effective. Conclusions: This study identified the level at which the cost of a pediatric asthma educational intervention will be cost-effective and cost-saving for the health system in Colombia. Our findings could be a useful aid for decision makers in efficiently allocating limited resources when planning asthma educational interventions for pediatric patients.     

Toxoplasma antibody prevalence in Nepalese pregnant women and women with bad obstetric history

Sera from randomly selected 345 pregnant Nepalese women aged 16-36 years and 13 women with bad obstetric history (BOH) were tested for the presence of Toxoplasma antibodies using microlatex agglutination (MLA) and ELISA methods. The overall prevalence was 55.4% (191/345). Prevalence was slightly higher (59.0%) in older age-group (27-36 years) compared with younger age-group (16-26 years) (52.2%). No significant difference in antibody prevalence in women belonging to two different ethnic-groups (Tibeto-Burmans 57.8%, Indo-Aryans 52.7%) was observed (p>0.05). MLA antibody titer ranged from 1:16 to 1:2,048. Over three-fourth of the women showed either high (1:510 or over) or low (1:16 or 1:32) antibody titer. Three percent (6/191) of MLA antibody positive subjects had Toxoplasma IgM antibodies by IgM-ELISA. All six IgM antibody positive pregnant women had MLA antibody titer of over 1:510. Of the total 13 women with BOH, 5 (38.5%) had Toxoplasma antibodies of which 2 (40.0%) were positive for Toxoplasma-IgM antibodies.     

A comprehensive review of vascular complications in COVID-19

Journal of Thrombosis and Thrombolysis - This study aims to review the available literature pertinent to vascular complications in COVID-19. A systematic search was performed using PubMed and...     

Outcomes in pediatric asthma

Pediatric asthma is one of the most common chronic conditions seen in children throughout the world. Even with our better understanding of the pathology of pediatric asthma and improved pharmaceutical management for this disorder, we are still far from reaching the goals of optimal asthma outcomes as outlined by the National Heart, Lung, and Blood Institute of the National Institutes of Health. What we mean by outcomes is the change in the patient’s current and future health due to the care given. The outcomes in pediatric asthma can be divided into three categories: clinical, humanistic, and economic. This article provides information regarding the different components of outcomes in pediatric asthma and how one can use outcomes to improve asthma control for the child.     

不同青霉素治疗妊娠梅毒患者的妊娠不良结局及随诊情况

目的探讨普鲁卡因青霉素与苄星青霉素治疗妊娠梅毒患者的妊娠结局不良率及随诊率有无差异。方法收集2009年3月至2011年3月门诊159例妊娠梅毒患者,根据患者处理方式的不同,分组进行比较。结果 A组为普鲁卡因青霉素治疗组,有效病例53例,普鲁卡因青霉素80万单位肌肉注射,每日1次,连续15日;B组为苄星青霉素治疗组,有效病例75例,苄星青霉素240万单位肌肉注射,每周1次,连续3周;C组为未治疗组,有效病例9例,D组为快速血浆反应素环状卡片试验（RPR）及梅毒螺旋体血球凝集试验（TPHA）均阴性的正常孕妇159例。A、B、C、D组妊娠结局异常率分别为18.87%（10/53）、17.33%（13/75）、66.67%（6/9）、15.72%（25/159）,C、D组间,A、C组间,B、C组间差异均有统计学意义;A、D组间,B、D组间,A、B组间,差异均无统计学意义。A、B组随诊率分别为76.81%、92.59%,两组间随诊率差异有统计学意义。结论未治疗组妊娠梅毒的妊娠结局不良率远高于治疗组及正常孕妇组,治疗组的妊娠结局不良率与正常孕妇组无明显差异,且2种青霉素治疗组间无明显差异,但2治疗组间随诊率有差异。     

Relevance of chest radiography in pediatric inpatients with asthma

Introduction: The goals of this study are to identify factors associated with ordering of chest radiographs (CXR’s) in children hospitalized with acute asthma exacerbations and determine the overall clinical impact of these CXR’s. Methods: A retrospective study was performed with children?≥?2 years of age admitted from our emergency department (ED) between 6/1/2011 and 5/31/2012 with a primary diagnosis of acute asthma exacerbation or status asthmaticus. Patients were excluded if they had been on antibiotics prior to the emergency visit, received continuous albuterol or intravenous magnesium during the hospitalization, or had another chronic disease affecting lung function. Results: 180 of the 405 children in the study (44%) had CXR’s ordered, of which 18 (10%) had imaging that altered the patient’s treatment plan. There were six cases of radiologist-diagnosed pneumonia, nine cases of atelectasis treated with antibiotics and three cases of pneumothorax. Factors associated with CXR ordering were: fever at home or in the ED (OR 4.5, 95% CI 2.8–7.4), triage oxygen saturation less than or equal to 92% (OR 1.8, 95% CI 1.2–2.7) and age 4 years or less (OR 2.3, 95% CI 1.4–3.7). Patients with treatment-altering CXR’s were more likely to have oxygen saturations less than or equal to 92% (OR 4.2, 95% CI 1.4–13.0; p?=?0.006) or fever in the ED (OR 3.8, 95% CI 1.0–13.6; p?Conclusions: The majority of CXR’s ordered in pediatric inpatients with asthma exacerbation do not provide clinically relevant information.     

A systematic review of the adverse events and economic impact associated with oral corticosteroids in asthma

Background: Oral corticosteroids (OCSs) are often used to achieve asthma control. OCS-related comorbidities increase the burden of disease for patients and healthcare providers. Most studies characterizing OCS use and risk of adverse events (AEs) are in non-asthma patients. We sought to systematically review the literature on the burden of OCS use among adults with asthma. Methods: We systematically reviewed the literature including MEDLINE (1946–May 2017), EMBASE (1974–May 2017), and the Cochrane Library (2005–May 2017) to identify studies that considered AEs due to OCS treatment of adults with asthma, their burden on healthcare utilization, and costs. Results: We retrieved 9,589 citations; and 15 studies were included. AEs were significantly higher among OCS-users compared with non-OCS users with pooled adjusted odds ratio (OR) 1.68 (95% CI 1.15–2.46) for diabetes mellitus and 1.34 (95% CI 1.23–1.46) for hypertension. Among high dose OCS-users (>10 mg) compared with non-OCS users, the pooled adjusted ORs for development of any complication was 3.35 (95% CI 2.94–3.82), and bone and muscle complications 2.30 (95% CI 2.18–2.42). The risk of any complication increased with higher doses of OCS, with pooled adjusted OR from 2 studies of 2.26 (95% CI 1.37–3.72), 2.94 (95% CI 2.62–3.29) and 3.35 (95% CI 2.94–3.82) for low dose (<6 mg), medium dose (5–12 mg) and high dose (>10 mg) respectively compared with no OCS use. Conclusions: The use of OCS in the management of asthma is associated with a higher risk of complications. This risk is higher as the OCS dose increases.     

空气污染与儿童哮喘

工业化导致的空气污染是儿童哮喘发生、发展的高危因素之一。常见的空气污染物种类繁多,如交通相关空气污染物、多环芳香烃、香烟烟雾、尘埃颗粒及细颗粒物 PM 2.5等,均与儿童哮喘密切相关。它们通过各种相关信号通路,从而调节哮喘进程;同时空气污染导致的哮喘相关基因表观遗传学改变、上皮间充质转化及遗传多态性等亦影响儿童哮喘个体异质性及诊疗个体化。目前,空气污染与儿童哮喘研究已取得一定进展,但其确切机制仍需进一步研究。本文就常见的空气污染物参与儿童哮喘的发生、发展及其机制进行阐述。     

Profile of women with abortion complications in Ghana

A cross-sectional study of 150 women was performed at the gynaecology department of the Korle-BuTeaching Hospital to describe the characteristics of patients with complications of induced or spontaneous abortions, and to find out the reasons behind induced abortions. In all, 31% of the study sample presented with complications of induced abortions. This group was younger, of lower parity, more educated, with lower economic potential, in less stable relationships and with a higher knowledge of modern contraceptive methods than the group with spontaneous abortions. The chief reason for procuring an induced abortion was the presence of relationship problems with the subject's partner. We conclude that measures to prevent induced abortions and their subsequent problems will yield major results if directed at women in their early 20s with at least primary education, no children, low economic potential, not in a stable relationship and who have had a previous induced abortion.     

Risk factors for adverse maternal and perinatal outcomes in women with preeclampsia: analysis of 1396 cases

Preeclampsia is a major cause of adverse maternal and perinatal outcomes, but how to identify women and fetuses at increased risk for later adverse events is a challenge. This study aimed to investigate the risk factors for adverse maternal and perinatal outcomes in women with preeclampsia. Data from 1396 women with preeclampsia were retrospectively collected and analyzed. Eighteen candidate risk factors and 12 adverse outcomes were investigated. The following factors were found to be significantly associated with at least one adverse outcome: maternal age 35 years or older, multiple birth, the usage of assisted reproductive technology, living in a rural area, history of pregnancy‐induced hypertension, male fetus, multigravida, or having polycystic ovary syndrome, hemolysis, elevated liver enzymes, and low platelet count syndrome, intrahepatic cholestasis of pregnancy, cardiovascular disease, gestational diabetes mellitus, systemic lupus erythematosus, thyroid disease, or liver disease. Compared with patients without any identified risk factors, patients with preeclampsia with three or more risk factors were at increased risk for severe adverse outcomes. Those findings demonstrated that maternal risk factors could be used as indicators supplementary to clinical symptoms and laboratory test results for the risk assessment in women with preeclampsia.     

Rhinitis in pregnant women with asthma is associated with poorer asthma control and quality of life

Objective: To describe the pattern and severity of rhinitis in pregnancy and the impact rhinitis has on asthma control and quality of life (QoL) in pregnant women with asthma. Methods: Two hundred and eighteen non-smoking pregnant women with asthma were participants in a randomised controlled trial of exhaled nitric oxide guided treatment adjustment. Rhinitis was assessed using a visual analogue scale (VAS) scored from 0 to 10 and classified as current (VAS?>?2.5), moderate/severe versus mild (VAS?>?6 vs <5), atopic versus non-atopic and pregnancy rhinitis. At baseline, women completed the 20-Item Sino-Nasal Outcome Test (SNOT20), asthma-specific (AQLQ-M) QoL questionnaires and the Six-Item Short-Form State Trait Anxiety Inventory (STAI-6). Asthma control was assessed using the asthma control questionnaire (ACQ). Perinatal outcomes were collected after delivery. Results: Current rhinitis was present in 142 (65%) women including 45 (20%) women who developed pregnancy rhinitis. Women with current rhinitis had higher scores for ACQ (p?=?0.004), SNOT20 (p?<?0.0001) and AQLQ-M (p?<?0.0001) compared to women with no rhinitis. Current rhinitis was associated with increased anxiety symptoms (p?=?0.002), rhinitis severity was associated with higher ACQ score (p?=?0.004) and atopic rhinitis was associated with poorer lung function (p?=?0.037). Rhinitis symptom severity improved significantly during gestation (p?<?0.0001). There was no impact on perinatal outcomes. Improved asthma control was associated with improvement in rhinitis. Conclusion: Rhinitis in pregnant women with asthma is common and associated with poorer asthma control, sino-nasal and asthma-specific QoL impairment and anxiety. In the context of active asthma management there was significant improvement in rhinitis symptoms and severity as pregnancy progressed.