Pregnancy outcome in patients with Takayasu’s arteritis: cohort study and review of the literature

Objective: The objective of this study is to investigate the clinical features of pregnancy in women with Takayasu’s arteritis managed in a tertiary medical center and review the literature in order to establish the course and recommended follow up and treatment for these pregnancies.

Materials and methods: Retrospective analysis of 20 pregnancies in 6 women with Takayasu’s arteritis. Patients were recruited from the high risk pregnancy clinics at Sheba Medical Center, where follow up included strict control of blood pressure and treatment of obstetric and disease-related complications.

Results: Mean maternal age was 29.3?±?3 years. Thirty-six patients had both supra and infradiaphragmatic arterial disease, of them two had an abdominal aorta involvement and three out of six patients had an isolated supradiaphragmatic disease. Of 20 pregnancies, six pregnancies (30%) resulted in early spontaneous miscarriages, and one pregnancy was terminated at 17 weeks due to fetal anomalies. The remaining 13 pregnancies (65%) resulted in live births. Three out of 13 (23%) neonates were small-for-gestational-age. The most common complication was maternal hypertension affecting 8/13 (61.5%) pregnancies. Preeclampsia occurred in one pregnancy. Four out of 13 (30.7%) pregnancies necessitated preterm induction of labor due to obstetric indications or uncontrolled disease.

Conclusions: Although Takayasu’s arteritis is associated with pregnancy complications, tight preconception disease control, strict follow up, and targeted treatment of high blood pressure can result in positive pregnancy outcome.     

Association Between Prediagnostic Serum 25-Hydroxyvitamin D Concentration and Glioma

There are no previous studies of the association between prediagnostic serum vitamin D concentration and glioma. Vitamin D has immunosuppressive properties; as does glioma. It was, therefore, our hypothesis that elevated vitamin D concentration would increase glioma risk. We conducted a nested case-control study using specimens from the Janus Serum Bank cohort in Norway. Blood donors who were subsequently diagnosed with glioma (n = 592), between 1974 and 2007, were matched to donors without glioma (n = 1112) on date and age at blood collection and sex. We measured 25-hydroxyvitamin D [25(OH)D], an indicator of vitamin D availability, using liquid chromatography coupled with mass spectrometry. Seasonally adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated for each control quintile of 25(OH)D using conditional logistic regression. Among men diagnosed with high grade glioma >56, we found a negative trend (P = .04). Men diagnosed ≤ 56 showed a borderline positive trend (P = .08). High levels (>66 nmol/L) of 25(OH)D in men >56 were inversely related to high grade glioma from ≥2 yr before diagnosis (OR = 0.59; 95% CI = 0.38, 0.91) to ≥15 yr before diagnosis (OR = 0.61; 95% CI = 0.38,0.96). Our findings are consistent long before glioma diagnosis and are therefore unlikely to reflect preclinical disease.     

The Effect of Residential Aged Care Size,Ownership Model,and Multichain Affiliation on Resident Comfort and Symptom Management at the End of Life

Context

In most resource-rich countries, a large and growing proportion of older adults with complex needs will die while in a residential aged care (RAC) facility.

Genetic variation associated with chromosomal aberration frequency: A genome-wide association study

Chromosomal aberrations (CAs) in human peripheral blood lymphocytes (PBL) measured with the conventional cytogenetic assay have been used for human biomonitoring of genotoxic exposure for decades. CA frequency in peripheral blood is a marker of cancer susceptibility. Previous studies have shown associations between genetic variants in metabolic pathway, DNA repair and major mitotic checkpoint genes and CAs. We conducted a genome-wide association study on 576 individuals from the Czech Republic and Slovakia followed by a replication in two different sample sets of 482 (replication 1) and 1288 (replication 2) samples. To have a broad look at the genetic susceptibility associated with CA frequency, the sample sets composed of individuals either differentially exposed to smoking, occupational/environmental hazards, or they were untreated cancer patients. Phenotypes were divided into chromosome- and chromatid-type aberrations (CSAs and CTAs, respectively) and total chromosomal aberrations (CAtot). The arbitrary cutoff point between individuals with high and low CA frequency was 2% for CAtot and 1% for CSA and CTA. The data were analyzed using age, sex, occupation/cancer and smoking history as covariates. Altogether 11 loci reached the P-value of 10⁻⁵ in the GWAS. Replication 1 supported the association of rs1383997 (8q13.3) and rs2824215 (21q21.1) in CAtot and rs983889 (5p15.1) in CTA analysis. These loci were found to be associated with genes involved in mitosis, response to environmental and chemical factors and genes involved in syndromes linked to chromosomal abnormalities. Identification of new genetic variants for the frequency of CAs offers prediction tools for cancer risk in future. Environ. Mol. Mutagen. 60:17–28, 2019. © 2018 Wiley Periodicals, Inc.     

Culture,causal attributions to visual impairments,and stigma: A mediation model

BackgroundCausal attributions are central to the understanding of public reactions to disability (that is, disability-related stigma). Research shows that culture and ethnicity were found to play a significant role in both causal attributions of disability and disability-related stigma.Disability-related stigma was found to influence physical and mental health. Nevertheless, to the best of our knowledge, the relationships linking culture, causal attributions of disability and disability-related stigma, have not been previously examined.ObjectiveThe study examined whether causal attributions (natural, mystic, punitive and emotional) to a specific disability-visual impairments - mediate the relationship between culture and stigma towards individuals with visual impairments.MethodsA quota sample comprised of 305 university and college students was drawn. Data were collected via a self-reported questionnaire.ResultsThe main findings indicated that emotional and punitive causal attribution to visual impairments mediated the relationship between culture and visual impairments-stigma; Israeli Arab-Palestinians had a higher tendency to attribute higher levels of punitive and emotional causes to visual impairments compared to Israeli Jews. Higher levels of punitive and emotional attributed causes for visual impairments were correlated with higher levels of visual impairments-stigma. Israeli Arab-Palestinians have a higher tendency to attribute visual impairments to mystic causes compared to Israeli Jews. However, this type of perceived causation was unrelated to visual impairments-stigma.ConclusionsInterventions to reduce visual impairments-stigma should focus on misconceptions concerning causation. It is especially important to design culturally sensitive interventions for visual impairments stigma reduction among Israeli Arab-Palestinians, which will focus on de-psychologizing visual impairments.     

Paravaginal defect: A new classification of fascial and muscle tears in the paravaginal region

The lateral support of the vaginal wall depends on the integrity of the paravaginal section of the visceral pelvic fascia, levator ani, and their connection. Various defects of the muscle and fascia can result in identical clinical findings—ie, the descent of the lateral vaginal sulcus. In this study, we created a realistic scheme for classifying paravaginal defects, based on the complex relationship of the pelvic fascia with the levator ani. Surgical observations, cadaver examinations, and a complex magnetic resonance imaging (MRI)‐based 3‐dimensional (3D) model were used to analyze the spatial relationships of normal and defective anatomy of the female pelvic floor. Descent of the lateral vaginal sulcus can result from a defect in the paravaginal visceral pelvic fascia, levator ani, or both. The fascial defect can be partial or complete, and the muscle defect can vary in location. A detailed illustrated classification is presented. We present a new model of the pathology that underlies a common clinical finding. Clin. Anat. 29:524–529, 2016. © 2016 Wiley Periodicals, Inc.     

Glucose Control in the ICU: Is There a Time for More Ambitious Targets Again?

During the last 2 decades, the treatment of hyperglycemia in critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of blood glucose levels in critically ill patients using intensive intravenous insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for glucose control in critically ill patients is generally accepted yet the target glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight glucose control in critically ill patients focusing on the novel technological approaches including continuous glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight glucose control. Since increased risk of hypoglycemia appears to be the major obstacle of tight glucose control, we try to put forward novel approaches that may help to achieve optimal glucose control with low risk of hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight glucose control may need to be revisited.