妊娠合并肺结核55例临床分析

目的：分析妊娠合并肺结核的临床特征。方法对我院2012年1月~2013年12月收治的55例妊娠期、产褥期肺结核患者的临床资料进行回顾性分析。结果妊娠期发病占36.36%(20/55),合并肺外结核占29.09%(16/55),危重症比例高16.36%(9/55),死亡率高达7.27%(5/55)。结论妊娠合并结核病应引起重视,尽早诊断,予以正规治疗,把握好终止妊娠的时机,提高妊娠合并肺结核患者的治愈率和新生儿存活率。     

亚临床甲状腺功能减退合并妊娠期糖尿病对妊娠影响的研究

目的 研究妊娠期亚临床甲状腺功能减退(SCH)合并妊娠期糖尿病(GDM)的孕期并发症及妊娠结局.方法 选择140例妊娠合并SCH及122例甲状腺功能正常孕妇,常规进行妊娠期糖尿病筛查,分成SCH合并GDM组、SCH组、GDM组、正常组,观察记录4组孕妇孕期情况及妊娠结局.结果 妊娠合并SCH组的自然流产率及妊娠期糖尿病的发生率明显高于甲功正常组;SCH合并GDM组孕期胎儿生长受限、羊水过少、早产的发生率明显高于甲功正常组,且妊娠结局中胎儿窘迫、剖宫产、新生儿窒息的发生率亦明显高于甲功正常组,差异均有统计学意义(P＜0.05).结论 妊娠期SCH合并GDM对母儿造成的危害较大,应该尽早筛查进行治疗.     

妊娠合并糖尿病诊治现状

妊娠合并糖尿病是孕期最常见的并发症之一。未能得到及时诊断和妥善处理的妊娠合并糖尿病可引起巨大儿、胎儿畸形等 ,并使难产发生率及母婴围生死亡率增加 ,是常见的产科高危因素之一 ,并常提示孕妇在以后可能发生糖尿病。妊娠期及时对妊娠合并糖尿病者做出诊断 ,加以正确管理 ,不仅能减少孕期母儿合并症 ,也能够降低孕期糖尿病的发生率。近年来 ,随着国内学者对妊娠合并糖尿病认识的提高 ,重视了孕期糖尿病筛查 ,该病检出率逐年升高。对妊娠合并糖尿病的处理 ,原则上以饮食控制为止 ,适量运动、密切监测 ,必要时与药物结合结合治疗 ,同时重视产时、产褥期处理。目前研究表明 ,糖尿病对妊娠的影响与糖尿病病情程度与孕产期血糖控制情况密切相关 ,而对妊娠合并糖尿病的正确处理 (包括妊娠期、产时及产褥期 )可以明显改善妊娠合并糖尿病之结果和预后     

青霉素治疗妊娠合并梅毒患者与妊娠结局

目的 探讨妊娠合并梅毒患者的抗梅毒治疗对妊娠结局的影响.方法 对韶关市妇幼保健院2000年1月至2006年12月间,妊娠合并梅毒患者进行回顾性临床分析.根据是否行抗梅毒治疗,将妊娠合并梅毒患者分为治疗组与非治疗组,治疗组患者行青霉素治疗,非治疗组患者未行青霉素治疗.结果 7年间医院分娩总人数12650例,接受梅毒筛查者8942例,妊娠合并梅毒患者82例,发生率9.2‰,治疗组与非治疗组新生儿死亡率分别为0及12.5%,先天梅毒分别为24.1%及56.30%,死胎发生率为3.1%及23.3%.结论 妊娠期梅毒是危害围产儿的严重合并症孕期梅毒筛查是乔诊断的必要手段.孕期有效的青霉素治疗,将降低围产儿死亡率及先天梅毒的发生.     

妊娠期急性胰腺炎与普通人群急性胰腺炎诊治分析

目的 探讨妊娠期急性胰腺炎与正常人群急性胰腺炎的发病机制、对母婴的影响、诊治特点及治疗效果.方法 回顾性分析我院近2年来收治的20例妊娠期合并急性胰腺炎患者的临床资料,根据病因不同分为胆石症组(A组)与高脂血症组(B组),分析比较A组与B组急性胰腺炎的治疗特点及治疗效果,并从我院近2年来收治的普通人群组(C组)急性胰腺炎病例中随机选取20例,与妊娠组(D组)急性胰腺炎做对照,观察其治疗特点及疗效.结果 妊娠期急性胰腺炎患者A组与B组各临床观察指标比较有显著差异性(P＜0.05),普通人群组与妊娠组急性胰腺炎治愈率无明显差异,各个临床观察指标无明显差异性(P＞0.05).结论 早期及时诊断妊娠合并急性胰腺炎并适时终止妊娠,可降低母婴死亡率;内镜下鼻胆管置入术可显著缩短治疗时间,需合理选择药物,加贝酯与生长抑素对胎儿有不良影响应慎用.     

妊娠期糖尿病的护理

妊娠期合并糖尿病是指在原有糖尿病基础上合并妊娠者或妊娠前为隐性糖尿病,妊娠后发展为糖尿病者,或妊娠期出现糖尿病3种情况的孕妇.其发生率为1‰～6.6‰,国内发生率约为1‰[1].     

妊娠期糖尿病对母婴影响的分析

目的探讨妊娠期糖尿病对妊娠结局和新生儿结局的影响。方法回顾性分析我院产科住院分娩的妊娠期糖尿病及健康孕妇各903例的妊娠结局及新生儿结局。结果妊娠期糖尿病组中妊娠期高血压、妊娠肝内胆汁淤积症、胎儿窘迫、剖宫产率、巨大胎儿、早产儿发生率均高于对照组。结论妊娠期糖尿病对母婴危害大,应及早诊断和控制血糖,以降低母婴并发症,降低围产儿死亡率。     

妊娠期肝内胆汁淤积症合并乙型肝炎病毒感染对母婴结局的影响

目的探讨妊娠期肝内胆汁淤积症(ICP)合并乙型肝炎病毒感染的妊娠结局。方法回顾性总结2006年1月-2007年12月陕西省妇幼保健院86例ICP合并乙型肝炎病毒感染者(研究组),同期住院治疗的单纯ICP孕妇118例(对照组)的妊娠结局,比较两组的早产率、新生儿窒息率、产后出血率等并发症的发生情况。结果妊娠期肝内胆汁淤积症合并乙型肝炎病毒感染各并发症的发生情况:早产76例、妊娠期高血压疾病17例、产后出血8例。与对照组并发症的发生差异有显著性(P<0.05)。结论妊娠期肝内胆汁淤积症合并乙型肝炎病毒感染对母婴结局产生更严重的影响。加强母婴监护,药物治疗同时适时终止妊娠可有效改善妊娠结局。     

妊娠合并子宫腺肌病并二例分析

近年来子宫腺肌病的发病率越来越高，而妊娠合并子宫腺肌病及其发生妊娠期并发症报道不多。本文总结妊娠合并子宫腺肌病并发胎膜早破引产失败1例、中期妊娠子宫破裂1例，探讨妊娠期合并子宫腺肌病的诊断以及并发症的治疗。     

脑肠肽Obestatin、Ghrelin与妊娠期糖尿病的研究进展

妊娠合并糖尿病,包括糖尿病（DM）合并妊娠、妊娠期糖尿病（GDM）。前者指在原有DM基础上合并妊娠。GDM系指妊娠期首次发生或发现的任何程度的糖耐量异常。随着经济的发展、生活方式的改变,近年来GDM的发病率正逐年上升。GDM可导致一系列母婴并发症。妊娠期胰岛素抵抗（IR）增加是GDM公认的主要病理生理机制,但GDM发生的具体机理不详。     

Tuberculosis and female reproductive health

Tuberculosis (TB) is an important cause of mortality and morbidity all over the world and is particularly relevant in developing countries like India where the disease is endemic. Female reproductive system is very vulnerable to this infection and clinical presentation of this disease in female reproductive tract is protean in nature and in a large majority of patients could be completely silent. This disease is an important cause of infertility, menstrual irregularity, pregnancy loss, and in association with pregnancy, morbidity to both the mother and child increases. Some of the effects of TB infection on female genital tract could be remote in nature due to infection elsewhere. Medicines used to treat TB infection can also have adverse effects on contraception and other areas of female reproductive health. HIV coinfection and multidrug-resistant tuberculosis (MDR-TB) and increased population migration from developed to developing countries have now added a whole new dimension to this infection. Though new, finer diagnostic tools of detection of TB are increasingly available in the form of bacterial cultures and polymerase chain reaction (PCR) based diagnostics, suspicion by clinicians remains the main tool for diagnosis of the condition. Hence, doctors need to be properly trained to become "Tuberculosis Minded".     

妊娠急性脂肪肝10例及其相关资料临床分析

目的 探讨妊娠期急性脂肪肝（AFLP）的临床特点,以便早期诊断和及时治疗,降低孕产妇及围生儿的死亡率.方法 对近4年我院收治的10例妊娠期急性脂肪肝患者的临床资料进行回顾性分析.结果 9例患者为初产妇,平均发病孕周为36＋6周,单胎8例,双胎2例.4例存活孕妇均行剖宫产结束分娩,3例入院时出现凝血功能障碍行剖宫产加子宫全切.孕产妇共存活4例,死亡率为60%;围生儿死亡9例,死亡率为75%.结论 妊娠急性脂肪肝是发生在妊娠晚期的一种严重并发症,早期诊断、尽快终止妊娠是提高母儿预后的关键;对于AFLP患者的分娩方式选择我们主张以剖宫产尽快结束分娩为宜;对于出现凝血功能障碍者,就在剖宫产的同时行子宫全切,以挽救患者生命.     

Host-directed therapy targeting the <Emphasis Type="Italic">Mycobacterium tuberculosis</Emphasis> granuloma: a review

Infection by the intracellular bacterial pathogen Mycobacterium tuberculosis (Mtb) is a major cause of morbidity and mortality worldwide. Slow progress has been made in lessening the impact of tuberculosis (TB) on human health, especially in parts of the world where Mtb is endemic. Due to the complexity of TB disease, there is still an urgent need to improve diagnosis, prevention, and treatment strategies to control global spread of disease. Active research targeting avenues to prevent infection or transmission through vaccination, to diagnose asymptomatic carriers of Mtb, and to improve antimicrobial drug treatment responses is ongoing. However, this research is hampered by a relatively poor understanding of the pathogenesis of early infection and the factors that contribute to host susceptibility, protection, and the development of active disease. There is increasing interest in the development of adjunctive therapy that will aid the host in responding to Mtb infection appropriately thereby improving the effectiveness of current and future drug treatments. In this review, we summarize what is known about the host response to Mtb infection in humans and animal models and highlight potential therapeutic targets involved in TB granuloma formation and resolution. Strategies designed to shift the balance of TB granuloma formation toward protective rather than destructive processes are discussed based on our current knowledge. These therapeutic strategies are based on the assumption that granuloma formation, although thought to prevent the spread of the tubercle bacillus within and between individuals contributes to manifestations of active TB disease in human patients when left unchecked. This effect of granuloma formation favors the spread of infection and impairs antimicrobial drug treatment. By gaining a better understanding of the mechanisms by which Mtb infection contributes to irreversible tissue damage, down regulates protective immune responses, and delays tissue healing, new treatment strategies can be rationally designed. Granuloma-targeted therapy is advantageous because it allows for the repurpose of existing drugs used to treat other communicable and non-communicable diseases as adjunctive therapies combined with existing and future anti-TB drugs. Thus, the development of adjunctive, granuloma-targeted therapy, like other host-directed therapies, may benefit from the availability of approved drugs to aid in treatment and prevention of TB. In this review, we have attempted to summarize the results of published studies in the context of new innovative approaches to host-directed therapy that need to be more thoroughly explored in pre-clinical animal studies and in human clinical trials.     

Influenza pathogenicity during pregnancy in women and animal models

Pregnant women are at the highest risk to develop severe and even fatal influenza. The high vulnerability of women against influenza A virus infections during pregnancy was repeatedly highlighted during influenza pandemics including the pandemic of this century. In 2009, mortality rates were particularly high among otherwise healthy pregnant women. However, our current understanding of the molecular mechanisms involved in severe disease development during pregnancy is still very limited. In this review, we summarize the knowledge on the clinical observations in influenza A virus-infected pregnant women. In addition, knowledge obtained from few existing experimental infections in pregnant animal models is discussed. Since clinical data do not provide in-depth information on the pathogenesis of severe influenza during pregnancy, adequate animal models are urgently required that mimic clinical findings. Studies in pregnant animal models will allow the dissection of involved molecular disease pathways that are key to improve patient management and care.     

Using machine learning methods for predicting inhospital mortality in patients undergoing open repair of abdominal aortic aneurysm

An abdominal aortic aneurysm is an abnormal dilatation of the aortic vessel at abdominal level. This disease presents high rate of mortality and complications causing a decrease in the quality of life and increasing the cost of treatment. To estimate the mortality risk of patients undergoing surgery is complex due to the variables associated. The use of clinical decision support systems based on machine learning could help medical staff to improve the results of surgery and get a better understanding of the disease. In this work, the authors present a predictive system of inhospital mortality in patients who were undergoing to open repair of abdominal aortic aneurysm. Different methods as multilayer perceptron, radial basis function and Bayesian networks are used. Results are measured in terms of accuracy, sensitivity and specificity of the classifiers, achieving an accuracy higher than 95%. The developing of a system based on the algorithms tested can be useful for medical staff in order to make a better planning of care and reducing undesirable surgery results and the cost of the post-surgical treatments.     

Evaluation and management of systemic lupus erythematosus and rheumatoid arthritis during pregnancy

Women of childbearing age are at risk for developing systemic rheumatic diseases. Pregnancy can be challenging to manage in patients with rheumatic diseases for a variety of reasons including the impact of physiological and immunological changes of pregnancy on underlying disease activity, the varied presentation of rheumatic disease during pregnancy, and the limited treatment options. Previously, patients with rheumatic disease were often advised against pregnancy due to concerns of increased maternal and fetal morbidity and mortality. However, recent advancements in the understanding of the interaction between pregnancy and rheumatic disease have changed how we counsel patients. Patients with rheumatic disease can have successful pregnancy outcomes, particularly when a collaborative approach between the rheumatologist and obstetrician is applied. This review aims to discuss the effect of pregnancy on patients with the most common rheumatic diseases, the effect of these diseases on the pregnancy itself, and the management of these patients during pregnancy.     

Primary pulmonary hypertension in pregnancy: case report

Primary pulmonary hypertension (PPH) is a rare, progressive and currently incurable disease characterised by an increase in pulmonary artery pressure without a demonstrable cause. When associated with pregnancy, the maternal mortality ranges from 30 to 50%. In this report we present a 26-year old patient diagnosed with primary pulmonary hypertension during her twenty-first week of gestation. She was treated with a low-molecular-weight heparin and sedatives and underwent pregnancy termination without complications. Although cases have been reported with positive maternal and fetal outcome, the available evidence suggests that pregnancy with primary pulmonary hypertension should be avoided. Thus, in cases of pregnancy occurring, a therapeutic abortion is indicated.     

Host versus pathogen: Two sides of the same challenge in the TB world

Humans have studied tuberculosis for many thousands of years. For most of this time investigations were focused on describing patient symptoms with the hope of ameliorating them and perhaps limiting the spread of disease. At the end of the 19th century, however, the association between the bacterium and disease was demonstrated 1 – a discovery recognized annually on 24 March by World TB Day, a day that also highlights efforts to eliminate the disease. Following the discovery, the study of the disease split in two directions: the nature of the pathogen and the nature of the host response. A key advance to be celebrated this World TB Day 2009 is that we are now in a position to integrate the study of the bacteria with that of the host response and thereby create a more complete understanding of how this pervasive disease develops. With this improved understanding more efficient and targeted intervention will be forthcoming.     

Inflammatory bowel disease and pregnancy: an update

Women with inflammatory bowel disease have similar rates of conception to the general population unless they have had pelvic surgery. Once pregnant, regardless of disease activity, they have an increased risk of adverse pregnancy outcome and should be followed as high-risk obstetric patients. Most medications are compatible with pregnancy and lactation, as described in this article. Ideally, women should discuss their plans for pregnancy with their physician prior to conception so that risks and benefits can be reviewed, medications adjusted and healthcare maintenance updated. Once pregnant, a multidisciplinary team of gastroenterologists, obstetricians and pediatricians should help to ensure the best care for the mother and child.     

Combining PMTCT with active case finding for tuberculosis

Tuberculosis (TB) is the preeminent manifestation of HIV infection and has become a leading cause of maternal mortality and morbidity in high HIV-prevalence settings. Active TB in pregnant women has potentially serious consequences for fetuses and newborns. In Soweto, South Africa, there is a more than 90% uptake of voluntary counseling and HIV testing during routine antenatal care, and almost one third of pregnant women are HIV-infected. The posttest counseling session of the prevention of mother-to-child transmission program provides an opportunity to screen HIV-infected pregnant women for TB. In this study, 370 HIV-infected pregnant women were screened for symptoms of active TB by lay counselors at the posttest counseling session. If symptomatic, they were referred to nurses who investigated them further. Eight women were found to have previously undiagnosed, smear-negative, culture-confirmed TB (2160/100,000). The mean CD4 count in those with active TB compared to those without TB was 276 x 10(6) cells per liter vs 447 x 10(6) cells per liter (P = 0.051). Symptoms most associated with active TB were hemoptysis and fever. We conclude that rates of TB in HIV-infected pregnant women are high, and screening for TB during routine antenatal care should be implemented in high HIV-prevalence settings.