scholarly journals Complete molar pregnancies with a coexisting fetus: Pregnancy outcomes and review of literature

2021 ◽  
Author(s):  
Roxanna A Irani ◽  
Kerry Holliman ◽  
Michelle Debbink ◽  
Lori Day ◽  
Krista Maree Mehlhaff ◽  
...  
Keyword(s):  
Data Transfer ◽  
Case Series ◽  
First Trimester ◽  
The United States ◽  
Obstetric Outcomes ◽  
Neoplastic Disease ◽  
Surveillance Period ◽  
Retrospective Case ◽  
Medicine Physician ◽  
Fetal Complications

To review obstetric outcomes of complete hydatidiform molar pregnancies with a coexisting fetus (CHMCF), a rare clinical entity, we performed a retrospective case series of pathology-confirmed HMCF. The cases were collected via a private Maternal-Fetal Medicine physician group on social media. Each contributing institution from across the United States obtained informed consent and institutional data transfer agreements as required, then transmitted the data using a HIPAA-compliant modality. Data collected included maternal, fetal/genetic, placental and delivery characteristics. Nine institutions contributed 14 cases. We found that the median gestational age at diagnosis was 12 weeks 2 days (9w0d - 19w4d), and over half were diagnosed in the first trimester. Sixty-four percent of CHMCF cases were a product of assisted reproductive technology. Placental mass size universally enlarged over the surveillance period. When invasive testing was performed, insufficient sample or no growth was noted in 40% of the sampled cases. Antenatal complications occurred in all delivered patients. Four patients developed gestational trophoblastic neoplasia. This is the largest reported series of obstetric outcomes for CHMCF, and highlights the need to counsel patients about the severe maternal and fetal complications in continuing pregnancies, including progression to gestational trophoblastic neoplastic disease.

scholarly journals The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

2018 ◽  
Vol 45 (12) ◽  
pp. 1651-1655 ◽  
Author(s):  
Mark Berman ◽  
Devy Zisman ◽  
Jonathan Wollman ◽  
David Levartovsky ◽  
Eli Rimon ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Postpartum Period ◽  
Case Series ◽  
First Trimester ◽  
Reproductive Age ◽  
Retrospective Case ◽  
Medical Centers ◽  
Stopping Treatment ◽  
Significant Change

Objective.To evaluate the effect of pregnancy on disease activity in psoriatic arthritis (PsA).Methods.This is a retrospective case series. Review of the medical files of all female patients followed at the PsA clinic of 2 medical centers identified those with at least 1 pregnancy during followup and 1 visit during or soon after pregnancy.Results.Twenty-five women with PsA (out of 107 women of reproductive age followed up in our PsA clinics) and 35 pregnancies were enrolled. Thirty-three pregnancies resulted in live healthy babies. In the whole group, there was no significant change in disease activity throughout pregnancy, while in 16 (48%) of pregnancies, patients worsened during the first postpartum year. In 15 out of 21 pregnancies, in which the women had been treated before conception with biologics, treatment was discontinued close to pregnancy or during the first trimester. Five of those 15 patients had been classified as having mild to severe PsA activity prior to pregnancy. That number increased to 8, 9, and 14 during the first and second trimesters and postpartum period, respectively. There was no significant change in degree of disease activity in 6 patients whose biologics were continued beyond the first trimester. Improvement in disease activity was observed during pregnancy among the nonbiologics-treated patients. Corticosteroids were initiated or the dosage was increased during 6 pregnancies, all involving patients whose biologics were stopped before pregnancy.Conclusion.Continuation of biologics therapy was associated with a low level of disease activity and a low probability of flare during pregnancy. Stopping treatment with biologics before pregnancy is associated with flare during pregnancy and the postpartum period.

scholarly journals The Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in a Pediatric Healthcare Network in the United States

2020 ◽  
Vol 9 (5) ◽  
pp. 523-529 ◽  
Author(s):  
William R Otto ◽  
Sarah Geoghegan ◽  
Leila C Posch ◽  
Louis M Bell ◽  
Susan E Coffin ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
Healthcare Providers ◽  
Case Series ◽  
The United States ◽  
Retrospective Case ◽  
White Children ◽  
Healthcare Network ◽  
Pediatric Healthcare

Abstract Background Understanding the prevalence and clinical presentation of coronavirus disease 2019 in pediatric patients can help healthcare providers and systems prepare and respond to this emerging pandemic. Methods This was a retrospective case series of patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across a pediatric healthcare network, including clinical features and outcomes of those with positive test results. Results Of 7256 unique children tested for SARS-CoV-2, 424 (5.8%) tested positive. Patients aged 18–21 years had the highest test positive rate (11.2%), while those aged 1–5 years had the lowest (3.9%). By race, 10.6% (226/2132) of black children tested positive vs 3.3% (117/3592) of white children. By indication for testing, 21.1% (371/1756) of patients with reported exposures or clinical symptoms tested positive vs 3.8% (53/1410) of those undergoing preprocedural or preadmission testing. Of 424 patients who tested positive for SARS-CoV-2, 182 (42.9%) had no comorbidities, 87 (20.5%) had asthma, and 55 (13.0%) were obese. Overall, 52.1% had cough, 51.2% fever, and 14.6% shortness of breath. Seventy-seven (18.2%) SARS-CoV-2–positive patients were hospitalized, of whom 24 (31.2%) required respiratory support. SARS-CoV-2-targeted antiviral therapy was given to 9 patients, and immunomodulatory therapy to 18 patients. Twelve (2.8%) SARS-CoV-2-positive patients required mechanical ventilation, and 2 patients required extracorporeal membrane oxygenation. Two patients died. Conclusions In this large cohort of pediatric patients tested for SARS-CoV-2, the rate of infection was low but varied by testing indication. The majority of cases were mild and few children had critical illness.

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

2017 ◽  
Vol 01 (02) ◽  
pp. 112-117
Author(s):  
Omri Merose ◽  
Erik Zachwieja ◽  
Samuel Rosas ◽  
Jennifer Kurowicki ◽  
Luis Grau ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Patient Population ◽  
Case Series ◽  
The United States ◽  
Resection Arthroplasty ◽  
Annual Incidence ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Medicare Patient ◽  
Retrospective Case Series

AbstractHip resection arthroplasty (HRA) is a relatively uncommon, yet viable surgical procedure originally developed by Girdlestone for osteomyelitis of the proximal femur. Currently, HRA is primarily indicated as a salvage procedure after a failed total hip arthroplasty. Despite a continuous rise in the rates of primary and revision hip arthroplasty, there is a lack of published evidence regarding the extent of HRA's current use and its recent trends. We sought to provide an epidemiological description of the recent utilization patterns of HRA in the United States. A level of evidence IV, retrospective case series review of the entire Medicare files between 2005 and 2012 was conducted through the use of current procedural terminology codes and International Classification of Disease ninth edition codes. Linear regressions and chi-square tests were used for analysis. Subgroup analysis was performed by patient age. The total number of HRAs performed between 2005 and 2012 significantly decreased from 4,248 to 3,872 (p = 0.025). There was a significant increase in the annual incidence of HRA among patients younger than 65 years (p = 0.027; 9% increase) and patients 65 to 69 years old (p = 0.007; 22% increase), constituting 43% of the total patients. There was a significant decrease in HRA incidence among patients 80 to 84 years old (p = 0.001; 32% decrease) and patients 85 years old and over (p = 0.002; 24% decrease). Geographic analysis demonstrated the most HRA procedures were performed in the South, whereas gender focused analysis demonstrated a statistically significant decrease in HRA incidence for females (p = 0.003; 6% decrease) and a significant increase in incidence for males (p = 0.003; 7% increase). The overall annual incidence of HRA performed in the Medicare patient population has significantly decreased in recent years. However, this conceals an increased incidence among the relatively younger patient population. Potential causes for these opposing trends include changes in rates of revision surgery, alternative indications for surgery, advances in hardware, and surgeon expertise. This was a level of evidence IV, retrospective case series study.

scholarly journals Feline and Canine Cutaneous Lymphocytosis: Reactive Process or Indolent Neoplastic Disease?

2022 ◽  
Vol 9 (1) ◽  
pp. 26
Author(s):  
Francesco Albanese ◽  
Francesca Abramo ◽  
Michele Marino ◽  
Maria Massaro ◽  
Laura Marconato ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Clinical Signs ◽  
Case Series ◽  
Response To Treatment ◽  
Neoplastic Disease ◽  
Retrospective Case ◽  
Term Survival ◽  
Dermal Infiltrate

Cutaneous lymphocytosis (CL) is an uncommon and controversial lymphoproliferative disorder described in dogs and cats. CL is generally characterized by a heterogeneous clinical presentation and histological features that may overlap with epitheliotropic lymphoma. Therefore, its neoplastic or reactive nature is still debated. Here, we describe clinicopathological, immunohistochemical, and clonality features of a retrospective case series of 19 cats and 10 dogs with lesions histologically compatible with CL. In both species, alopecia, erythema, and scales were the most frequent clinical signs. Histologically, a dermal infiltrate of small to medium-sized lymphocytes, occasionally extending to the subcutis, was always identified. Conversely, when present, epitheliotropism was generally mild. In cats, the infiltrate was consistently CD3+; in dogs, a mixture of CD3+ and CD20+ lymphocytes was observed only in 4 cases. The infiltrate was polyclonal in all cats, while BCR and TCR clonal rearrangements were identified in dogs. Overall, cats had a long-term survival (median overall survival = 1080 days) regardless of the treatment received, while dogs showed a shorter and variable clinical course, with no evident associations with clinicopathological features. In conclusion, our results support a reactive nature of the disease in cats, associated with prolonged survival; despite a similar histological picture, canine CL is associated with a more heterogeneous lymphocytic infiltrate, clonality results, and response to treatment, implying a more challenging discrimination between CL and CEL in this species. A complete diagnostic workup and detailed follow-up information on a higher number of cases is warrant for dogs.

scholarly journals COVID-19 hospitalizations in five California hospitals: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miriam Nuño ◽  
Yury García ◽  
Ganesh Rajasekar ◽  
Diego Pinheiro ◽  
Alec J. Schmidt
Keyword(s):  
Mortality Rate ◽  
Hospital Admissions ◽  
Large Population ◽  
Case Series ◽  
The United States ◽  
Composite Outcome ◽  
Retrospective Case ◽  
Hospital System ◽  
Icu Admission ◽  
Increased Risk

Abstract Background The novel coronavirus pandemic has had a differential impact on communities of color across the US. The University of California hospital system serves a large population of people who are often underrepresented elsewhere. Data from hospital stays can provide much-needed localized information on risk factors for severe cases and/or death. Methods Patient-level retrospective case series of laboratory-confirmed COVID-19 hospital admissions at five UC hospitals (N = 4730). Odds ratios of ICU admission, death, and a composite of both outcomes were calculated with univariate and multivariate logistic regression based on patient characteristics, including sex, race/ethnicity, and select comorbidities. Associations between comorbidities were quantified and visualized with a correlation network. Results Overall mortality rate was 7.0% (329/4,730). ICU mortality rate was 18.8% (225/1,194). The rate of the composite outcome (ICU admission and/or death) was 27.4% (1298/4730). Comorbidity-controlled odds of a composite outcome were increased for age 75–84 (OR 1.47, 95% CI 1.11–1.93) and 85–59 (OR 1.39, 95% CI 1.04–1.87) compared to 18–34 year-olds, males (OR 1.39, 95% CI 1.21–1.59) vs. females, and patients identifying as Hispanic/Latino (OR 1.35, 95% CI 1.14–1.61) or Asian (OR 1.43, 95% CI 1.23–1.82) compared to White. Patients with 5 or more comorbidities were exceedingly likely to experience a composite outcome (OR 2.74, 95% CI 2.32–3.25). Conclusions Males, older patients, those with multiple pre-existing comorbidities, and those identifying as Hispanic/Latino or Asian experienced an increased risk of ICU admission and/or death. These results are consistent with reported risks among the Hispanic/Latino population elsewhere in the United States, and confirm multiple concerns about heightened risk among the Asian population in California.

scholarly journals Role of the Infectious Disease Consultant in Management of Patients With Tuberculosis-Associated Ocular Inflammation

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Marjorie M. Conant ◽  
Chuck R. Vrasich ◽  
Jeff V. Wongskhaluang ◽  
Kevin Ferenchak ◽  
Matthew K. Asano ◽  
...  
Keyword(s):  
Infectious Disease ◽  
United States ◽  
Case Series ◽  
The United States ◽  
Positive Tuberculin Skin Test ◽  
Ocular Inflammation ◽  
Ocular Involvement ◽  
Foreign Born ◽  
Retrospective Case

Abstract Background.  Tuberculosis is a disease with continued worldwide prevalence, morbidity, and mortality. Tuberculosis-associated ocular inflammation (TB-AOI) is a manifestation that can occur with pulmonary or extrapulmonary TB. Evaluation of these ocular presentations and treatment in the United States are limited. Our objective was to describe cases in an urban area and assess the role of the infectious diseases specialist in managing these complex patients. Methods.  We performed a retrospective case series of all patients referred to our infectious disease clinic for presumed TB-AOI from 2005 through 2013. Patients with ocular inflammation were determined to have presumed TB-AOI based on clinical presentation with correlative positive tuberculin skin test and/or QuantiFERON-TB Gold. Attempts were made to exclude other diagnoses. Data were collected and analyzed with respect to demographics, ocular manifestations, and treatment. Results.  Sixty eyes of 42 patients were included in the study; anterior uveitis was the most common site of involvement. The median age was 46 years, and 33 patients (79%) were foreign born. Forty patients (95%) received a course of antituberculous therapy with 38% experiencing treatment-related side effects. A 6-month duration was recommended in 78% cases. There was improvement or stability of the vision in 42 eyes (74%) of those treated. Conclusions.  Ocular involvement is an uncommon but important manifestation of TB. Our data further characterize TB-AOI cases in the United States. Treatment provides significant benefit to properly selected patients. A multidisciplinary approach, with care provided by ophthalmology and infectious disease providers, should be used to allow for the most efficacious treatment.

scholarly journals Chemotherapy for Breast Cancer During Pregnancy: An 18-Year Experience From Five London Teaching Hospitals

2005 ◽  
Vol 23 (18) ◽  
pp. 4192-4197 ◽  
Author(s):  
Alistair E. Ring ◽  
Ian E. Smith ◽  
Alison Jones ◽  
Catherine Shannon ◽  
Eleni Galani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Palliative Chemotherapy ◽  
Case Series ◽  
First Trimester ◽  
Fetal Outcome ◽  
Teaching Hospitals ◽  
Published Data ◽  
Retrospective Case ◽  
Rare Association

Purpose The rare association between breast cancer and pregnancy means that few oncologists gain an expertise in this area. In particular, there are few published data concerning the use of chemotherapy for breast cancer during pregnancy. In this retrospective case series, we describe the experiences of five hospitals in London, United Kingdom, and how they manage this condition. Patients and Methods Retrospective searches were performed at five London hospitals in order to identify women who received chemotherapy for breast cancer while pregnant. Results Twenty-eight women were identified who had received chemotherapy for breast cancer during pregnancy. Twenty-four women received adjuvant or neoadjuvant chemotherapy for early breast cancer, and four women received palliative chemotherapy for metastatic disease. A total of 116 cycles of chemotherapy were administered during pregnancy. Sixteen women were treated with anthracycline-based chemotherapy and 12 received cyclophosphamide, methotrexate, and fluorouracil. All but one of the women were treated after the first trimester. One spontaneous abortion occurred in the woman treated during her first trimester; otherwise, there were no serious adverse consequences for the mothers or neonates. Conclusion These data provide evidence that in terms of peripartum complications and immediate fetal outcome, chemotherapy can be safely administered to women during the second and third trimesters of pregnancy.

Differing Clot Distribution in Black Compared to White Patients Presenting with Acute Lower Extremity Deep Venous Thrombosis

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3819-3819
Author(s):  
Tyler W Buckner ◽  
Soham Puvvada ◽  
Chirag Amin ◽  
Nigel S. Key
Keyword(s):  
Lower Extremity ◽  
Case Series ◽  
Factor V Leiden ◽  
Case Fatality ◽  
The United States ◽  
Factor V ◽  
Racial Groups ◽  
Retrospective Case ◽  
Black Patients ◽  
Incidence And Mortality

Abstract Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the United States. There is growing evidence that VTE incidence and mortality rates differ among ethnic/racial groups. Specifically, it has been demonstrated previously that blacks with VTE have a higher proportional rate of pulmonary embolism (PE), as well as a higher case fatality rate from PE compared to whites (Arch Int Med2003;163(15):1843–8). We therefore compared the location of DVT (proximal vs. distal) in blacks and whites at the time of diagnosis. The null hypothesis was that there is no difference in the location of DVT between white and black patients at the time of diagnosis. We reviewed all lower extremity Doppler ultrasound studies that were positive for acute DVT at our Institution over a 3-year period to create a retrospective case series of 941 patients. Subjects were further classified by self-reported race (black or white), disposition at diagnosis (inpatient or outpatient), and clot location (proximal or distal). Distal DVT was defined as thrombus in one or more deep veins distal to -- but not including -- the popliteal vein. Results were analyzed using Stata version 10. We found that the rate of any proximal (proximal or both proximal and distal) DVT compared with distal only was significantly higher in black patients (OR = 1.4; 95%CI: 1.03, 1.8; P = 0.032), both for 637 inpatients (OR = 1.3; (0.94, 1.9); P = 0.11) and for 304 outpatients (OR = 2.0; (1.01, 3.8); P = 0.048). These differences persisted after controlling for sex and age. We conclude that blacks with acute lower extremity DVT are more likely to present with proximal DVT than whites. These results confirm earlier suggestions that the proportion of proximal lower extremity DVT is higher in blacks, which might account in part for the higher rate of PE (Arch Int Med2004;164(12):1348–9). We are further examining the possible causes of this disparity. Possibilities include genetic factors (such as factor V Leiden which is associated with more distal DVT presentation and is rare in blacks), co-morbid conditions (such as diabetes which is more prevalent in blacks), and access to healthcare and diagnostic services, which may lead to more delayed evaluation. Efforts will also be made to determine rates of idiopathic and provoked DVT in these sub-groups.

Micronized Dehydrated Human Amnion Chorion Membrane Injection in the Treatment of Knee Osteoarthritis—A Large Retrospective Case Series

2019 ◽  
Author(s):  
Kris J. Alden ◽  
Stan Harris ◽  
Brandon Hubbs ◽  
Kimberly Kot ◽  
Niki B. Istwan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Intervention ◽  
Case Series ◽  
The United States ◽  
Common Adverse Event ◽  
Human Amniotic Membrane ◽  
Retrospective Case ◽  
Human Amnion ◽  
Knee Oa

AbstractOsteoarthritis (OA) of the knee is a leading cause of chronic pain and disability in the United States. Current treatment options primarily target OA symptoms reserving surgical intervention and knee replacement for those who fail conservative measures. With average age of patients with knee OA decreasing, regenerative treatment approaches to reduce symptoms, increase quality of life, and delay the need for surgical intervention are increasingly sought. Human amniotic membrane contains growth factors and cytokines, which promote epithelial cell migration and proliferation, stimulate metabolic processes leading to collagen synthesis, and attract fibroblasts, while also reducing pain and inflammation. Micronization of the tissue allows for suspension in normal saline and injection. We conducted a retrospective review of 100 knees treated for symptomatic OA with micronized dehydrated human amnion/chorion membrane (mdHACM) and followed for 6 months. Our purpose is to present our experience and patient outcomes. Data were abstracted from electronic medical records of 82 consecutive OA patients (100 knees) injected with 100 mg mdHACM. Patient age, gender, adverse events and routinely collected Knee Injury and Osteoarthritis Outcome Score (KOOS) were evaluated. Effectiveness of mdHACM treatment was measured by serial KOOS at baseline, and posttreatment at 6 weeks, 3, and 6 months. Overall mean KOOS for the cohort was 40 at baseline, improving to 52, 62, and 65 at 6 weeks, 3 months, and 6 months post-mdHACM injection. Percent increases were 32, 56, and 65%, respectively. Quality of life and sports/recreation domains improved by 111 and 118%, respectively, at 6 months. Pain scores improved by 67% at 6 months. All scores improved throughout the observation period. The most common adverse event was pain after injection lasting 2 to 7 days, observed in 68% of cases. This represents the largest single-physician experience with mdHACM for treatment of knee OA reported to date. Injectable mdHACM appears to be a potentially useful treatment option for knee OA patients. Controlled studies are underway to confirm these observations.

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