Clinical presentation and maternal-fetal outcomes of mirror syndrome: A case series of 10 affected pregnancies

2021 ◽  
pp. 1753495X2110580
Author(s):  
Hussain Mogharbel ◽  
Jennifer Hunt ◽  
Rohan D’Souza ◽  
Sebastian R Hobson
Keyword(s):  
Case Series ◽  
Perinatal Outcomes ◽  
Retrospective Chart Review ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Clinical Findings ◽  
Maternal Body Mass Index ◽  
Maternal Condition ◽  
Fetal Hydrops ◽  
Laboratory Findings

Background Mirror Syndrome, also known as Ballantyne syndrome, is a rare condition with fewer than 120 cases described in the literature. A simultaneous edematous state of the mother, fetus and placenta is pathognomonic, with the maternal condition frequently presenting with signs and symptoms similar to that of preeclampsia. Objective Our aim was to add to the international body of literature through identification of all cases of Mirror Syndrome at two Canadian tertiary obstetric centres and characterize the maternal presentation, laboratory findings, and perinatal outcomes. Methodology We performed a retrospective chart review of all cases of fetal hydrops from two tertiary centres in Winnipeg (Manitoba, Canada) between 2000 and 2019. There were 276 cases of fetal hydrops during this period, of which 10 cases satisfied the diagnostic criteria for Mirror Syndrome where maternal and perinatal outcomes were analysed. Results The median gestational age at diagnosis with Mirror Syndrome was 23weeks and 3 days of gestation and at birth was 25 weeks and 0 days of gestation. The majority of women were multiparous (80%) and had elevated maternal body mass index (median 33 kg/m2). The most common maternal clinical findings included weight gain (100%) and hypertension (90%). The most common laboratory findings included low hematocrit (100%), hypoalbuminemia (80%), anemia (70%) and hyperuricemia (70%). Structural anomalies were observed in 50% of cases, over half of the fetuses were stillborn (66.7%) and one quarter of pregnancies resulted in neonatal deaths (25%). The median time until maternal improvement of Mirror Syndrome was 2 days postpartum. Conclusion Mirror Syndrome affected 3.6% of all cases of fetal hydrops in our cohort, and showed associations with multiparity, elevated BMI, hemodilution, hypoalbuminemia, anemia and hyperuricemia. Delivery is frequently required for fetal and/or maternal indications and symptoms usually improved rapidly after delivery.

The utility of clinical findings to predict laboratory values in hypertensive disorders of pregnancy

2016 ◽  
Vol 44 (3) ◽  
Author(s):  
Jane So ◽  
Elizabeth Young ◽  
Natalie Crnosija ◽  
Joseph Chappelle
Keyword(s):  
Severe Disease ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Clinical Findings ◽  
Bivariate Analysis ◽  
Test Results ◽  
Quadrant Pain ◽  
Laboratory Findings ◽  
Abnormal Laboratory ◽  
Laboratory Test Results

AbstractPreeclampsia is the 2A retrospective chart review of women who presented for evaluation of hypertension in pregnancy during 2010. Demographic information, medical history, symptoms, vital signs, and laboratory results were collected. Bivariate analysis was used to investigate associations between predictors and the outcome.Of the 481 women in the sample, 22 were identified as having abnormal laboratory test results (4.6%). Women who reported right upper quadrant pain or tenderness had significantly increased likelihood of having laboratory abnormalities compared to those without the complaint.Only a small percentage of women evaluated were determined to have abnormal laboratory findings, predominantly among women with severe preeclampsia. Right upper quadrant pain or tenderness was positively correlated with laboratory abnormalities. The restriction of laboratory analysis in women with clinical evidence of severe disease may be warranted – a broader study should, however, first be used to confirm our findings.

scholarly journals Risk factors associated with COVID-19 Intensive Care Unit hospitalisation in Guyana: A cross-sectional study

2021 ◽  
Author(s):  
Steven A. Seepersaud
Keyword(s):  
Risk Factors ◽  
Retrospective Chart Review ◽  
Binary Logistic Regression ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Factors Associated ◽  
Independent Variables ◽  
Icu Admission

Objective The purpose of the study was to determine risk factors associated with COVID-19 ICU hospitalisation at Georgetown Public Hospital Corporation (GPHC), Guyana. Methods A retrospective chart-review was conducted on all COVID-19 admissions from March to September 2020. The predictive factors were demographics, comorbidities, signs and symptoms of COVID-19 and laboratory findings on admission. Descriptive frequency analysis was done for all independent variables and the Chi-square test was used to compare differences between groups where suitable. Univariate and multivariate binary logistic regression was used to examine the association between the independent variables and the risk for ICU hospitalisation. Results There were 136 patients with COVID-19 at GPHC during March to September 2020 and after exclusion, 135 patients were used in the study. There were 72 (53.4%) patients who required non-ICU care, while 63 (46.6%) ICU care and average age ± SD (median) was 51 ±16 (n= 49) and 56 ±18 (n= 60), respectively. In the multivariate regression model, the odds of ICU admission for those aged 40-65 was 0.14 (p <.01) compared to those > 65 years. Patients with class 2 and above obesity had higher odds of ICU admission compared to non-obese patients OR 11.09 (p= .006). Patients with 2 and 3 or more comorbidities also had higher odds of ICU admission compared to those with no comorbidities OR 7.83 (p= .03) and 132 (p <.001), respectively. Patients with LDH 228-454 U/L and > 454 U/L on admission had higher odds of ICU admission compared to those with normal LDH OR 19.88 (p= .001) and 23.32 (p= .001), respectively. Patients with albumin < 3.50 mg/dL on admission also had higher odds of ICU admission compared to those with normal albumin OR 5.78 (p= .005). Conclusion Risk factors associated with ICU hospitalisation were advanced age, obesity, multiple comorbidities, elevated LDH and low albumin. Protecting the population at risk for ICU admission and prioritizing them for vaccination is recommended to reduce the risk of running out of ICU capacity.

scholarly journals Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

2020 ◽  
Vol 148 ◽  
Author(s):  
Setareh Mamishi ◽  
Zahra Movahedi ◽  
Mohsen Mohammadi ◽  
Vahid Ziaee ◽  
Mahmoud Khodabandeh ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Case Series ◽  
Signs And Symptoms ◽  
Case Definition ◽  
Laboratory Findings ◽  
Duration Of Symptoms ◽  
Presenting Symptoms ◽  
Hands And Feet ◽  
Inflammatory Syndrome ◽  
D Dimer

Abstract During the coronavirus disease 2019 (COVID-19) pandemic, a new phenomenon manifesting as a multisystem inflammatory syndrome in children (MIS-C) which has a similar clinical presentation to Kawasaki disease, toxic shock syndrome and severe sepsis has emerged. Although the number of MIS-C reports is increasing, rare reports in Asia is still available. To our knowledge, this study is the largest series of published MIS-C cases in Iran. We performed a retrospective study of all patients with case definition for MIS-C admitted to the three paediatric hospitals in Iran. All of these hospitals are located within the most active COVID-19 pandemic areas (Tehran, Qom and Mazandaran) in Iran. Demographic characteristics, clinical data, laboratory findings, imaging and echocardiographic findings, treatment and outcomes were collected. Between 7 March and 23 June 2020, 45 children were included in the study. The median age of children was 7 years (range between 10 months and 17 years). Common presenting symptoms include fever (91%), abdominal pain (58%), nausea/vomiting (51%), mucocutaneous rash (53%), conjunctivitis (51%) and hands and feet oedema (40%) with median duration of symptoms prior to presentation of 5 (interquartile range (IQR) 3, 7) days. Fifty-three percent of children showed lymphopaenia. Overall, the majority of cases at admission had markedly elevated inflammatory markers erythrocyte sedimentation rate (ESR) (95.5%) and C-reactive protein (CRP) (97%). Ferritin was abnormal in 11 out of 14 tested patients (73%), and it was highly elevated (>500 ng/ml) in 47% of cases. Median fibrinogen level was 210 (IQR 165, 291) mg/dl, D-dimer was 3909 (IQR 848, 4528) ng/ml and troponin was 0.6 (IQR 0.1, 26) ng/ml, respectively. Twenty out of 31 patients (64.5%) had hypoalbuminaemia. In addition, hyponatraemia was found in 64% of cases. Twenty-five patients (56%) presented with cardiac involvement and acute renal failure was observed in 13 cases (29%). Pleural, ascitic, ileitis and pericardial effusions were found in 18%, 11%, 4% and 2% of cases, respectively. In conclusion, this is a first large case series of hospitalised children who met criteria for MIS-C in Iran. There was a wide spectrum of presenting signs and symptoms; evidence of inflammation with abnormal values of CRP, ESR, D-dimer, ferritin and albumin; and multi-organ involvement.

scholarly journals Mucopolysaccharidosis VII in Brazil: natural history and clinical findings

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Roberto Giugliani ◽  
Anneliese Lopes Barth ◽  
Melissa Rossi Calvão Dumas ◽  
José Francisco da Silva Franco ◽  
Liane de Rosso Giuliani ◽  
...  
Keyword(s):  
Natural History ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Signs And Symptoms ◽  
Epidemiological Data ◽  
Clinical Findings ◽  
Compound Heterozygous ◽  
Novel Variant ◽  
Almost All ◽  
Mps Vii

Abstract Background Mucopolysaccharidosis type VII (MPS VII), also known as Sly syndrome, caused by deficiency of the lysosomal enzyme β-glucuronidase, is an ultra-rare disorder with scarce epidemiological data and few publications about natural history and clinical spectrum. Methods We conducted a case series report which included retrospective data from all MPS VII patients diagnosed through the “MPS Brazil Network” who were known to be alive in 2020 in Brazil (N = 13). Clinical data were obtained from a review of the medical records and descriptive statistics and variables were summarized using counts and percentages of the total population. Results The majority of the patients were from the Northeast region of Brazil. Among the signs and symptoms that raised the clinical suspicion of MPS, coarse face was the most frequent; 58% of the patients had a history of non-immune hydrops fetalis. All the subjects presented short neck and trunk. The majority presented typical phenotypical signs of MPS disorders. They all presented neurodevelopmental delay and cognitive impairment. About half of this cohort had knees deformities. Dysostosis multiplex was identified in almost all patients and cardiomyopathy was less frequent than observed in other types of MPSs. The mean age at diagnosis was 5 years, ranging from 1 to 14 years. Almost all patients (12/13) were homozygous for the c.526C>T (p.Leu176Phe) mutation. A novel variant of the GUSB gene was found, the c.875T>C (p.Leu292Pro), in a compound heterozygous with the c.526C>T (p.Leu176Phe) variant. Conclusions This case series is the biggest data collection of MPS VII patients alive in Latin America. The overall clinical picture of the MPS VII patients is very similar to other MPS disorders, including a spectrum of severity and delayed diagnosis.

scholarly journals Is Allogeneic Stem Cell Transplantation a Good Option for Paroxysmal Nocturnal Haemoglobinuria?

2020 ◽  
Author(s):  
Fatma Keklik Karadağ ◽  
Güray Saydam ◽  
Fahri Sahin
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Haemolytic Anaemia ◽  
Case Series ◽  
Clinical Findings ◽  
Paroxysmal Nocturnal Haemoglobinuria ◽  
Haematopoietic Stem Cell ◽  
Laboratory Findings ◽  
Curative Therapy

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, nonmalignant, haematopoietic clonal disorder that manifests with haemolytic anaemia, thrombosis, and peripheral blood cytopenias. The diagnosis is based on laboratory findings of intravascular haemolysis and flow cytometry. Clinical findings in PNH include haemolytic anaemia, thrombosis in atypical sites, or nonspecific symptoms attributable to the consequences of haemolysis. Thrombosis is the leading cause of death in PNH. Terminal complement pathway inhibition with eculizumab controls most of the symptoms of haemolysis and the life-threatening complications of PNH. However, there is still no consensus about haematopoietic stem cell transplantation (HSCT) in the management of PNH; it is the only potentially curative therapy for PNH. There are limited data and few case series about both the long-term outcomes of HSCT for PNH and the impacts of conditioning regimens on PNH clones. The authors have reviewed the findings of these studies which report on HSCT for the treatment of PNH.

scholarly journals Spontaneous Transethmoidal Meningoceles in Adults: Case Series with Emphasis on Surgical Management

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
G. Ziade ◽  
A. L. Hamdan ◽  
M. T. Homsi ◽  
I. Kazan ◽  
U. Hadi
Keyword(s):  
Chart Review ◽  
Adult Population ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Rare Condition ◽  
Surgical Reconstruction ◽  
Fascia Graft ◽  
Csf Leakage ◽  
Diagnostic Modalities ◽  
Reported Data

Background.Spontaneous onset transethmoidal meningocele is a rare entity among the adult population.Methods.A retrospective chart review was performed and cases of adults diagnosed with spontaneous transethmoidal meningoceles from November 2000 till February 2014 were reported. Data collected included demographics, clinical presentation, diagnostic modalities, and results. Intraoperative findings, the type of surgical reconstruction performed, and the percentage of recurrence, if present, were also reported.Results.Ten cases of spontaneous transethmoidal meningoceles in adults were diagnosed. Eight were females and two males with a mean age of 47.5 years. All patients presented with CSF leakage with or without meningitis. They underwent a reconstruction of the base of skull defect using the temporalis fascia graft in addition to fibrin glue (Tissucol) and Surgicel (Ethicon). In two cases with a larger defect, a piece of septal bone and turbinate mucosa were applied achieving a watertight seal in all cases.Conclusion.Spontaneous transethmoidal meningocele in adults is a rare condition. It usually presents with clear rhinorrhea with or without meningitis and an endoscopic multilayer reconstruction is advocated for treatment of such conditions.

scholarly journals P.127 Management and outcome of spontaneous sub-aponeurotic fluid collections in infants: the Hospital for Sick Children experience and review of literature

2016 ◽  
Vol 43 (S2) ◽  
pp. S49-S49
Author(s):  
S Wang ◽  
AV Kulkarni ◽  
J Drake
Keyword(s):  
Fluid Collection ◽  
Case Series ◽  
Rare Condition ◽  
Infectious Complications ◽  
Unknown Etiology ◽  
Laboratory Findings ◽  
Imaging Characteristics ◽  
History Of ◽  
And Gender ◽  
Sick Children

Background: Spontaneous sub-aponeurotic fluid collection (SSFC) is an uncommon and newly described entity of unknown etiology, observed in infants less than one year of age. In this paper, we report a series of 9 infants who presented to the Hospital for Sick Children with SSFC over the 2004 to 2015 period, focusing on the natural history of this rare condition. Methods: Data from the HSC was retrospectively reviewed. Patient age and gender, birth history, past medical history, laboratory findings, imaging characteristics, management, and outcome were analyzed. Results: Our case series consists of 4 males and 5 females, ranging from 5 weeks to 11 months of age. All cases of SSFC developed spontaneously over a period of days, and the infants had no history of injuries or hair manipulation. Six patients had a remote history of forceps or vacuum-assisted births. One patient experienced fluctuating fluid collection size over 4 months, but in all the cases, the collections resolved spontaneously without structural or infectious complications. Conclusions: This is the largest series describing SSFC to date, and summarizes the experience of a large academic neurosurgical center. SSFCs develop spontaneously without immediate preceding trauma, and an extensive hematology or child abuse workup is not necessary. A conservative approach with outpatient follow-up is advocated.

scholarly journals Mucopolysaccharidosis VII in Brazil: Natural History and Clinical Findings

2021 ◽  
Author(s):  
Roberto Giugliani ◽  
Anneliese Lopes Barth ◽  
Melissa Rossi Calvão Dumas ◽  
José Francisco da Silva Franco ◽  
Liane de Rosso Giuliani ◽  
...  
Keyword(s):  
Natural History ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Signs And Symptoms ◽  
Epidemiological Data ◽  
Clinical Findings ◽  
Compound Heterozygous ◽  
Novel Variant ◽  
Almost All ◽  
Mps Vii

Abstract Background: Mucopolysaccharidosis type VII (MPS VII), also known as Sly syndrome, caused by deficiency of the lysosomal enzyme β-glucuronidase, is an ultra-rare disorder with scarce epidemiological data and few publications about natural history and clinical spectrum. Methods: We conducted a case series report which included retrospective data from all MPS VII patients diagnosed through the “MPS Brazil Network” who were known to be alive in 2020 in Brazil (N=13). Clinical data were obtained from a review of the medical records and descriptive statistics and variables were summarized using counts and percentages of the total population.Results: The majority of the patients were from the Northeast region of Brazil. Among the signs and symptoms that raised the clinical suspicion of MPS, coarse face was the most frequent; 58% of the patients had a history of non-immune hydrops fetalis. All the subjects presented short neck and trunk. The majority presented typical phenotypical signs of MPS disorders. They all presented neurodevelopmental delay and cognitive impairment. About half of this cohort had knees deformities. Dysostosis multiplex was identified in almost all patients and cardiomyopathy was less frequent than observed in other types of MPSs. The mean age at diagnosis was 5 years, ranging from 1 to 14 years. Almost all patients (12/13) were homozygous for the c.526C>T (p.Leu176Phe) mutation. A novel variant of the GUSB gene was found, the c.875T>C (p.Leu292Pro), in a compound heterozygous with the c.526C>T (p.Leu176Phe) variant.Conclusions: This case series is the biggest data collection of MPS VII patients alive in Latin America. The overall clinical picture of the MPS VII patients is very similar to other MPS disorders, including broad spectrum of severity and delayed diagnosis.

scholarly journals Fatal Association of Mirror and Eisenmenger Syndrome during the COVID-19 Pandemic

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1031
Author(s):  
Viorica Radoi ◽  
Lucian Gheorghe Pop ◽  
Nicolae Bacalbasa ◽  
Anca Maria Panaitescu ◽  
Anca Marina Ciobanu ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
Eisenmenger Syndrome ◽  
Maternal Condition ◽  
Fetal Hydrops ◽  
Maternal Fetal Medicine ◽  
Fetal Medicine ◽  
Recent Advances ◽  
Life Threatening

Mirror syndrome (MS) or Ballantyne’s syndrome is a rare maternal condition that can be life-threatening for both mother and fetus. The condition is characterized by maternal signs and symptoms similar to those seen in preeclampsia in the setting of fetal hydrops. Despite recent advances in the field of maternal-fetal medicine, the etiopathogenesis of MS remains elusive. For patients and doctors, the COVID-19 pandemic has become an extra hurdle to overcome. The following case illustrates how patients’ non-compliance associated with mirror syndrome and SARS-CoV-2 infection led to the tragic end of a 19-year-old patient. Therefore, knowledge of the signs and symptoms of mirror syndrome should always be part of the armamentarium of every obstetrician.

scholarly journals Socio-demographic Characteristics of Patients Diagnosed with Advanced Chronic Venous Insufficiency (C4-C6) Correlated with Clinical and Para-clinical Findings

2015 ◽  
Vol 61 (2) ◽  
pp. 94-99
Author(s):  
Imre Eniko Reka ◽  
M Imre
Keyword(s):  
Risk Factors ◽  
Therapeutic Approach ◽  
Venous Insufficiency ◽  
Metabolic Diseases ◽  
Demographic Data ◽  
Clinical Stage ◽  
Signs And Symptoms ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Peripheral Arterial Diseases

Abstract Chronic venous insufficiency’s frequency reaches almost 25% in European countries. The aim of this present study was to assess the correlation between sociodemographic characteristics as well as clinical findings and para-clinical findings of aCVI patients. A total number of 2636 patients diagnosed with CVI were evaluated for over an 8 year time period (2006-2013). In case of 795 of them, diagnosis of aCVI (C4-C6) has been established. The following variables have been evaluated: demographic data, etiology, risk factors, chronic diseases as risk factors, signs and symptoms, laboratory findings and even the therapeutic approach. All the assessed data has been evaluated using descriptive statistics, t-Student test, and chi square test. Also the relative risk (RR) and Odds ratio (OR) has been calculated. The mean age of aCVI patients was significantly higher (p=0.001) than the age of patients with stage C1-3 CVI. A positive correlation (p<0.0001) between combined venous disorders and clinical stage of CVI has been found. Deep vein thrombosis proved to be correlated (p=0.02) with evolution of CVI to venous ulcer (stage C6). Worsening of advanced venous insufficiency was also correlated with presence of peripheral arterial diseases, and/or metabolic diseases (p<0.0001, and p=0.02). Based on our results, the typical profile of a patient with aCVI has been outlined. Using this profile, the general practitioner and even the internal medicine specialist can recognize in advance patients with an elevated risk of developing aCVI, and accordingly can choose a more appropriate therapeutic approach.

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