Serum neopterin levels in women with preeclampsia: a systematic review

ABSTRACT

Objective: Neopterin is a pteridine that is produced following activation of human macrophages upon stimulation with the cytokine interferon-gamma. Several studies suggest its association with preeclampsia and the purpose of the present study is to evaluate this assumption. Methods: We searched the Medline (1992–2018), Scopus (1993–2018) and Google Scholar (1993–2018) databases. All articles that evaluated serum neopterin levels in patients with preeclampsia were held eligible for inclusion, regardless of the trimester of pregnancy in which the measurement was performed. Case reports, animal studies and previous reviews were excluded. Results: A total of 10 studies were finally included in the present review, with a total number of 3,529 pregnant women. Among them 446 were diagnosed with preeclampsia. The majority of included studies reported that serum neopterin was significantly higher in patients with preeclampsia, compared to normotensive pregnant women (p < .05). One study reported that serum levels seem to correlate with the severity of the disease; as patients with HELLP had significantly higher values of neopterin compared to patients with mild and severe preeclampsia. None of the included studies proposed a cut-off value that would help assess the predictive accuracy of this protein for the detection of preeclampsia. Conclusion: Although current data seem to be promising, neopterin remains far from being used in current clinical practice as a biomarker that would help predict and follow-up patients that develop preeclampsia. Future studies are needed, to determine the optimal timing for its measurement and to propose potential cut-off values that would help in this direction.     

Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta-analysis of observational studies

Objective: The pathophysiologic processes that result in wound healing are the same regardless of the tissue involved. The purpose of the present meta-analysis is to evaluate whether cesarean scar characteristics may predict the presence of pelvic adhesions.

Materials and methods: We conducted a systematic review searching the Medline (1966–2016), Scopus (2004–2016), ClinicalTrials.gov (2008–2016), Cochrane Central Register of Controlled Trials CENTRAL (1999–2016) and Google Scholar (2004–2016) databases together with reference lists from included studies. All prospective and retrospective observational cohort studies were included. Statistical meta-analysis was performed using the RevMan 5.1 software.

Results: Current evidence suggests that depressed scars are positively associated with intra-abdominal adhesions (ΟR 2.79, 95%CI 1.74–4.46). Elevated scars might also correlate with the presence of adhesions, however, this association did not reach statistical significance (OR 1.61, 95%CI 0.91–2.85, p?=?0.10). The same was reported in the case of scar pigmentation (REM, OR 1.68, 95%CI 0.86–3.26, p?=?0.13). Flat scars were predictive of the absence of adhesions (899 patients, REM, OR 0.33, 95%CI 0.23-0.54, p?Conclusion: According to our meta-analysis, abdominal wound characteristics following cesarean section can predict the presence of adhesions. However, given the small number of published studies, further research is needed to corroborate our findings.     

Takotsubo cardiomyopathy: A known unknown foe of asthma

Introduction: Patients with uncontrolled asthma are at a greater risk of asthma attacks requiring emergency room visits or hospital admissions. Takotsubo cardiomyopathy is potentially a significant complication in a course of status asthmaticus. Case study: We describe a 43-year-old female patient who presented with status asthmaticus that was further complicated with takotsubo cardiomyopathy. Results: Recognizing apical ballooning syndrome is challenging in patients with a history of respiratory disease because the symptoms of the last entity may complicate the diagnostic approach. It is difficult to distinguish clinically apical ballooning syndrome from the acute airway exacerbation itself. Both asthma and takotsubo cardiomyopathy share the same clinical presentation with dyspnea and chest tightness. In our patient, the electrocardiographic abnormalities, the rapidly reversible distinctive characteristics of echocardiography, and the modest elevation of serum cardiac biomarkers levels, in combination with the presence of a stress trigger (severe asthma attack), strongly supported the diagnosis of broken heart syndrome. Conclusions: Clinicians should re-evaluate asthma management and be aware of the complications associated with asthma attacks such as stress-induced cardiomyopathy.     

Quality of life in children with chronic kidney disease

Background

Progressive chronic kidney disease (CKD), irrespective of the underlying etiology, affects the quality of life (QoL) of children due to the need for regular follow-up visits, a strict medication program and diet intake.

Methods

The Greek version of the KIDSCREEN-52 multidimensional questionnaire was used in children with CKD, renal transplantation (RT) and in a control group (CG) of healthy children.

Results

Fifty-five patients between 8 and 18 years, with CKD (n?=?25), RT (n?=?16) and with end-stage renal disease (ESRD) on peritoneal dialysis (PD) (n?=?14) were included. Each group of studied children was compared with the CG (n?=?55), the validation sample (VS) (n?=?1200) and the parent proxy scores. Physical well-being of all studied children was significantly lower compared to CG (p?=?0.004). In contrast, all studied children between 8 and 11 years showed better social acceptance compared to VS (p?=?0.0001). When QoL of children with CKD was compared with parent proxy QoL, conflicting opinions were observed in several dimensions, such as self-perception (p?=?0.023), autonomy (p?=?0.012), school environment (p?=?0.012) and financial resources (p?=?0.03).

Conclusions

QoL and mainly the dimension of physical well-being, may be affected dramatically in children with CKD unrelated to disease stage. In early school years children with CKD seem to feel higher social acceptance than the healthy controls, exhibiting better score in this dimension. Optimal care requires attention not only to medical management, but also to an assessment of QoL factors, that may help promote pediatric patient’s health.

     

Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement

Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.     

Epidemiology and molecular analysis of intestinal colonization by vancomycin-resistant enterococci in greek hospitals

From 1,246 specimens collected from 13 Greek hospitals, 266 vancomycin-resistant enterococci strains were isolated from 255 patients (20.5%). The VanA phenotype was present in 82 (30.8%) strains, the VanB phenotype in 17 (6.4%) strains, the VanC1 phenotype in 152 (57.1%) strains, and the VanC2/C3 phenotypes in 15 (5.6%) strains. When only VanA and VanB phenotypes were considered, the overall prevalence was 7.5%. Eighty-six isolates exhibiting the VanA or VanB phenotype were analyzed by pulsed-field gel electrophoresis (PFGE), and 46 PFGE groups were found.