Diagnosis of dengue fever in a patient with early pregnancy loss

2021 ◽  
Vol 14 (8) ◽  
pp. e243968
Author(s):  
Naomi N Adjei ◽  
Anna Y Lynn ◽  
Ernest Topran ◽  
Oluwatosin O Adeyemo
Keyword(s):  
Neonatal Death ◽  
Vaginal Bleeding ◽  
Pregnancy Loss ◽  
Clinical Evidence ◽  
Adverse Outcomes ◽  
Intravenous Fluids ◽  
Early Pregnancy Loss ◽  
Orbital Pain ◽  
History Of

Dengue is a mosquito-borne virus that causes an influenza-like illness ranging in severity from asymptomatic to fatal. Dengue in pregnancy has been associated with adverse outcomes including miscarriage, preterm birth and fetal and neonatal death. We present the case of a multiparous woman who presented at 9 weeks’ gestation with vaginal bleeding and abdominal cramping after a 1 month stay in Mexico. She was initially diagnosed with miscarriage with plan for outpatient follow-up. She was readmitted 3 days later with fever, retro-orbital pain, arthralgia, rash, pancytopenia and transaminitis and managed with intravenous fluids and acetaminophen. Of note, dengue serology was initially negative but retesting 2 days later was positive. It is imperative that clinicians have heightened suspicion for dengue in pregnant women with history of travel to or residence in a dengue-endemic area and consistent clinical evidence.

The Natural History and Management of Intracranial Dural Arteriovenous Fistulae

1997 ◽  
Vol 3 (4) ◽  
pp. 303-311 ◽  
Author(s):  
M.A. Davies ◽  
K. ter Brugge ◽  
R. Willinsky ◽  
M.C. Wallace
Keyword(s):  
Natural History ◽  
Venous Drainage ◽  
Treated Group ◽  
Adverse Outcomes ◽  
Arteriovenous Fistulae ◽  
Surgical Access ◽  
History Of ◽  
Grade Ii ◽  
Intracranial Dural Arteriovenous Fistulae

The natural history of aggressive intracranial dural arteriovenous fistulae (ICDAVF) is unknown. Despite this, the recently proposed classification scheme of Borden et al (Borden*) has the potential to predict aggressive lesion behavior after presentation for any lesion, but has so far been untested. In addition, they discuss a new but logical treatment strategy for aggressive ICDAVF based on the elimination of retrograde leptomeningeal venous drainage (RLVD). Our similar philosophy and substantial experience with these lesions, provides a unique opportunity to test these hypotheses. A cohort of 46 Borden* grade II and III ICDAVF was selected from a series of 102 ICDAVF seen at a single institution between 1984 and 1995. Patients with these lesions, presumed to have an aggressive course were all offered treatment. Conservative therapy was chosen by 14 (30%) patients, 22 (47%) had surgery, and 20 (43%) had embolisation either as sole treatment or prior to surgery. During the follow-up period (249 lesion months) for the conservatively treated group, four (29%) patients died. Excluding presentation, these patients were observed to have interval rates of intracranial hemorrhage (ICH), non haemorrhagic neurological deficit (NHND), and mortality, of 19.2%, 10.9%, and 19.3% / lesion year respectively. The 11 patients who had embolisation alone were followed for a total of 344 months after treatment. All nine patients who had lesion obliteration, or subtotal obliteration with elimination of RLVD, as confirmed by angiography, experienced improvement or complete clinical recovery. Two patients had subtotal obliteration without elimination of RLVD. One died from interval ICH and the other experienced a delayed NHND. Twenty-five surgical operations were performed on 23 ICDAVF in 22 patients. Resection of the ICDAVF was performed in 9 patients, and 16 patients were treated with surgical disconnection alone. Complications occurred in 3/9 (33%) patients who had their lesions resected and none of the disconnected group. Failure to achieve angiographic obliteration of RLVD in 2 patients treated with resection was associated with an adverse outcome in both cases (death, and interval NHND). All 16 (100%) of the disconnected group were shown to have undergone angiographic obliteration with excellent clinical outcome. Untreated, Borden* grade II and III ICDAVF have a poor natural history. Also, persistence of RLVD after inadequate treatment results in adverse outcomes. Embolisation usually improves the safety of surgical access and may lead to obliteration on its own in some cases. For the aggressive ICDAVF, surgery is required in most cases, and our data confirm that surgical disconnection alone results in cure of all Borden* grade III ICDAVF, and in grade II lesions, if not cure, conversion to a benign grade I lesion.

Abstract P179: Comparison of Earlier versus Later Orthostatic Hypotension Assessment Times in Middle-Age Adults of the Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Stephen P Juraschek ◽  
Natalie Daya ◽  
Andreea M Rawlings ◽  
Lawrence J Appel ◽  
Edgar R Miller ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Standing Position ◽  
Adverse Outcomes ◽  
Cox Models ◽  
Atherosclerosis Risk In Communities ◽  
Adverse Health Outcomes ◽  
History Of ◽  
Risk Of Fall

Background: Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. Hypothesis: Measurements performed immediately after standing will be as informative as measurements performed closer to 3 minutes after standing with regards to symptoms of dizziness or risk of adverse outcomes. Methods: OH, defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, was measured up to five times at 25 seconds intervals in middle-aged (range 44 to 66 years) ARIC participants (1987-1989). Associations between each measurement and history of dizziness upon standing were examined via logistic regression. We used Cox models to examine the association between each of five measurements with risk of fall, fracture, syncope, and all-cause mortality over a median follow-up of 23 years. Results: In 11,449 participants (mean age 54 years, 54% women, 26% black) 10% reported a history of dizziness upon standing. OH assessed at measurement 1 (performed at a mean of 28 seconds after standing) was associated with risk of fall ( P = 0.03), fracture ( P = 0.05), syncope ( P <0.001), and mortality ( P < 0.001) ( Table ). Furthermore, measurement 1 was the only measurement associated with higher odds of dizziness upon standing (OR: 1.5; P = 0.001). Measurement 2 (performed on average 53 seconds after standing) was associated with all long-term outcomes. Measurements 4 and 5 (mean 100 and 116 seconds after standing) were generally less informative with regards to prospective outcomes than earlier measurements and were not statistically associated with history of dizziness. Conclusions: OH measurements obtained, on average, within the first 30 seconds of standing were predictive of long-term adverse health outcomes and were the most strongly related to symptoms of dizziness compared to later measurements. These findings suggest that BP measurements for determining orthostatic hypotension should be performed immediately after standing.

scholarly journals Pregnancy, pregnancy loss and the risk of diabetes in Chinese women: findings from the China Kadoorie Biobank

2019 ◽  
Vol 35 (3) ◽  
pp. 295-303
Author(s):  
Sanne A. E. Peters ◽  
◽  
Ling Yang ◽  
Yu Guo ◽  
Yiping Chen ◽  
...  
Keyword(s):  
Pregnancy Loss ◽  
Cox Regression ◽  
Chinese Women ◽  
Later Life ◽  
Induced Abortion ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of ◽  
Incident Cases

AbstractPregnancy and pregnancy loss may be associated with increased risk of diabetes in later life. However, the evidence is inconsistent and sparse, especially among East Asians where reproductive patterns differ importantly from those in the West. We examined the associations of pregnancy and pregnancy loss (miscarriage, induced abortion, and still birth) with the risk of incident diabetes in later life among Chinese women. In 2004–2008, the nationwide China Kadoorie Biobank recruited 302 669 women aged 30–79 years from 10 (5 urban, 5 rural) diverse localities. During 9.2 years of follow-up, 7780 incident cases of diabetes were recorded among 273,383 women without prior diabetes and cardiovascular disease at baseline. Cox regression yielded multiple-adjusted hazard ratios (HRs) for the risk of diabetes associated with pregnancy and pregnancy loss. Overall, 99% of women had been pregnant, of whom 10%, 53%, and 6% reported having a history of miscarriage, induced abortion, and stillbirth, respectively. Among ever pregnant women, each additional pregnancy was associated with an adjusted HR of 1.04 (95% CI 1.03; 1.06) for diabetes. Compared with those without pregnancy loss, women with a history of pregnancy loss had an adjusted HR of 1.07 (1.02; 1.13) and the HRs increased with increasing number of pregnancy losses, irrespective of the number of livebirths; the adjusted HR was 1.03 (1.00; 1.05) for each additional pregnancy loss. The strength of the relationships differed marginally by type of pregnancy loss. Among Chinese women, a higher number of pregnancies and pregnancy losses were associated with a greater risk of diabetes.

Endometrial expression of leukemia inhibitory factor in women with different estrogen/progesterone receptor status of the endometrium

2019 ◽  
Vol 13 (2) ◽  
pp. 85-94
Author(s):  
S. S. Aganezov ◽  
V. N. Ellinidi ◽  
A. V. Morotskaya ◽  
A. S. Artemyeva ◽  
A. O. Nyuganen ◽  
...  
Keyword(s):  
Progesterone Receptor ◽  
Hormone Receptor ◽  
Leukemia Inhibitory Factor ◽  
Pregnancy Loss ◽  
Control Group ◽  
Luminal Epithelium ◽  
Progesterone Receptor Status ◽  
Early Pregnancy Loss ◽  
Receptor Interactions ◽  
History Of

Aim: to analyze the endometrial expression of leukemia inhibitory factor (LIF) related to the estrogen/progesterone receptor endometrial status in women with the history of reproductive dysfunctions.Materials and methods. The main group consisted of patients with the history of infertility (n = 81) or early pregnancy loss (n = 40). The control group included 16 women with normal fertility. At days 6–8 after ovulation, endometrial biopsy was performed and peripheral blood samples were taken to assess the estradiol and progesterone levels. Histological and immunohistochemical (to quantify the estrogen (ER)/progesterone (PR) receptors and LIF expression) examinations of the endometrium biopsy materials were carried out.Results. In the middle phase of the secretion, women of the control group showed higher levels of LIF expression in the endometrial glands (94%; n = 15) and stroma (88 %; n = 14) significantly more often than patients with reproductive dysfunctions – 69 % (n = 84) and 44 % (n = 53) respectively (p < 0.05). There was no difference in the endometrial LIF expression between women with infertility and those with early pregnancy loss. In women with a sizable hormone-receptor 'response', a pronounced expression of LIF in the luminal epithelium (87 %; n = 52 out of 60) and stroma (68 %; n = 47 out of 69) was detected more often (p < 0.01) than that in patients with impaired hormone-receptor interactions (61 %, n = 27 of 44; 29 %, n = 20 of 68). High PR expression in the endometrial glands (H-score > 105) indicates the risk of impaired LIF expression in the luminal epithelium (OR =2.6) and stroma (OR = 2.5). Overexpression of ER (H-score > 155) in the endometrial stroma is associated with the risk of sub-normal LIF expression in the endometrial glands (OR = 2.5) and stroma (OR = 2.8).Conclusion. A meaningful connection has been found between the endometrial estrogen/progesterone receptor status and the expression of LIF. Women with well-pronounced endometrial hormone-receptor interactions show high levels of endometrial LIF expression more often. The stromal ER and glandular PR expression levels are considered to be prognostic factors of reduced endometrial LIF expression in the uterine body mucosa.

scholarly journals Vitamin D Intoxication in An Elderly: A Case Report

2019 ◽  
Vol 3 (4) ◽  
pp. 147-149
Author(s):  
Sahil Singh ◽  
Prernika Mittal ◽  
Ajay Sharma
Keyword(s):  
Vitamin D ◽  
Serum Vitamin ◽  
High Serum ◽  
Intravenous Fluids ◽  
Serum Vitamin D ◽  
Replacement Surgery ◽  
Vitamin D Intoxication ◽  
History Of ◽  
Very High

Vitamin D is a very common prescribed drug for numerous indications. Due to scarce knowledge and poor awareness of the various formulations, preparations and dosages of Vitamin D, there are many chances of prescription errors, medication errors, product use issue and undesirable adverse drug reactions. We hereby detail case of 70-year-old ex-army gentleman reported to us with a history of lethargy, confusion, reduced appetite and gait imbalance since few days with a history of knee replacement surgery 2 years back. Medical history was not of much relevance before it was revealed that he was getting cholecalciferol injection with a strength of 600000 IU once a week for few months. He was detected to have very high serum vitamin D level and hypercalcemia. He was started on intravenous fluids, diuretics and glucocorticoids. In a few days, after effective treatment, the patient was discharged in a recovering stage and advised to stop intake calcium and vitamin D in any form. At his last follow up, after a few months of discharge, he had totally recovered.

scholarly journals P024: Obtaining consensus on optimal management and follow-up of patients presenting to the emergency department with early pregnancy complications – a modified Delphi study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S71-S72
Author(s):  
A. Cornelis ◽  
R. Clouston ◽  
P. Atkinson
Keyword(s):  
Emergency Department ◽  
Family Medicine ◽  
Nurse Practitioners ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Delphi Study ◽  
Pregnancy Loss ◽  
Early Pregnancy Loss ◽  
Modified Delphi

Introduction: Complications in early pregnancy are common and have many physical and emotional consequences. Locally, there is no early pregnancy loss clinic or standardized guide in the emergency department (ED) for referral and follow-up decisions, and both initial management of patients and follow up can be inconsistent. This study aimed to obtain consensus on the best approach to initial work-up, management, and follow up for patients who present to the ED with early pregnancy complications, with the goal of using this consensus to produce a standardized guide for emergency provider use. Methods: A literature review was completed to produce evidence-based recommendations which were used to initiate a modified Delphi consensus process. A survey was distributed, with three rounds completed. Participants included emergency providers, obstetrician-gynecologists, a radiologist, a sample of family medicine physicians including some involved in primary care obstetrics, and nurse practitioners. An obstetric specialist from outside the local region was also involved. Results: Consensus was reached on several key recommendations, however some areas remained without clear accepted best practice. There was consensus that physical components of early pregnancy complications are addressed well, but that we could improve on patient flow and more consistent follow up. Important investigations to be done for patients were identified. The timing of formal ultrasound, necessity and timing of obstetrician consultation, and safety of discharge was addressed for various patient scenarios including stable and unstable patients, with and without adnexal pain, with intrauterine pregnancy of uncertain viability, and with pregnancy of unknown location. Management of confirmed early pregnancy loss in the ED and family medicine clinics was addressed. Barriers to an early pregnancy loss clinic included lack of funding, space, and staffing as well as lack of resources and uncertain patient volumes. A feasible alternative to an early pregnancy loss clinic was for willing providers to keep appointment times available to facilitate confirmation of follow-up prior to discharge. Other suggested alternatives included an early pregnancy loss clinic, a nurse educator, and having a standardized guideline in the ED. Conclusion: Through a consensus approach, several recommendations were agreed upon for improving care for patients presenting to the ED with early pregnancy complications.

Abstract 11420: Long-Term Mortality, MACE, and Angina Among Patients With Diabetes and Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Suzanne V Arnold ◽  
John A Spertus ◽  
Darren K McGuire ◽  
Kasia J Lipska ◽  
Yan Li ◽  
...  
Keyword(s):  
Prediction Models ◽  
Adverse Outcomes ◽  
Risk Levels ◽  
Patients With Diabetes ◽  
History Of ◽  
Event Rates ◽  
High Risk Cohort ◽  
Long Term Mortality

Background: Patients with diabetes mellitus (DM) are at higher risk for adverse events after MI, including death and recurrent ischemia. As such, we sought to develop prediction models to identify DM patients at highest risk for these outcomes. Methods: We examined 3 adverse outcomes (3-year mortality, 1-year angina, 1-year MACE [mortality, MI, stroke, urgent revascularization]) among patients with DM discharged alive after MI from 24 US hospitals. Using Harrell’s backward selection, we developed hierarchical multivariable models with a parsimonious set of covariates for each outcome. The mortality and angina models were validated in a separate 19-site US MI registry. Results: Among 1626 DM patients, event rates were 19% for 3-year mortality, 11% for 1-year MACE, and 27% for 1-year angina. The models had good discrimination, with c-indices of 0.80, 0.72, and 0.73, respectively, and excellent calibration. The strongest predictors (in terms of F-value) were age, hemoglobin, and creatinine for mortality; depression, hemoglobin, and history of heart failure for MACE; and angina prior to MI, age, and prior CABG for angina (Table). The observed rates of outcomes in the lowest to highest decile of predicted risk ranged broadly for all 3 outcomes, with ranges of 1-58% for mortality, 1-38% for MACE, and 8-62% for angina. The mortality and angina models performed well in the validation cohort, although they tended to over-predict mortality at higher levels of risk and under-predict angina at lower levels of risk. Conclusion: Patients with DM and MI represent a particularly high-risk cohort, with increased mortality, MACE, and angina. However, patients with DM are not a homogenous group, as there is a broad range of risk levels for adverse outcomes within the DM population. We have developed and validated models so as to identify the highest-risk DM patients for whom closer follow-up and secondary prevention strategies can be targeted most aggressively.

Circulating Procoagulant Microparticles in Women with Unexplained Pregnancy Loss: a New Insight

2001 ◽  
Vol 85 (01) ◽  
pp. 18-21 ◽  
Author(s):  
I. Laude ◽  
C. Rongières-Bertrand ◽  
C. Boyer-Neumann ◽  
M. Wolf ◽  
V. Mairovitz ◽  
...  
Keyword(s):  
Pregnancy Loss ◽  
Cell Activation ◽  
Fetal Death ◽  
Late Pregnancy ◽  
Clinical Settings ◽  
Thrombotic Risk ◽  
High Prevalence ◽  
Circulating Microparticles ◽  
History Of

SummaryOne of the frequently proposed mechanisms for pregnancy losses refers to uteroplacental thrombosis. However the contribution of classical thrombotic risk factors remains questionable and, if real, does not account for a large number of pregnancy losses. The aim of this study was to investigate the presence of circulating procoagulant microparticles, a new marker of cell activation already associated with various prothrombotic clinical settings. Microparticles were assessed by an original prothrombinase assay on platelet depleted plasma obtained from 74 women with a history of pregnancy loss without apparent cause and 50 controls. Patients were studied at least 2 months after the last obstetrical event and were classified into 2 groups: 49 women with at least 3 consecutive spontaneous abortions at or before the 10th postmenstrual week and 25 with at least one fetal death beyond the 10th postmenstrual week. Among the 74 patients, 41 had increased levels of circulating microparticles, 29 belonging to the group of early pregnancy loss (59%) and 12 to the group of late pregnancy loss (48%). The high prevalence of increased levels of procoagulant microparticles in both groups makes this new marker very promising for the understanding, follow up and therapeutical handling of pregnancy loss.

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