scholarly journals Management of Ruptured Arteriovenous Malformation During Pregnancy- Case Report.

2021 ◽  
Author(s):  
Maciej W. Socha ◽  
Magdalena Grześk ◽  
Szymon Kaczyński ◽  
Piotr Bernard
Keyword(s):  
Pregnant Woman ◽  
Arteriovenous Malformation ◽  
Case Reports ◽  
Elective Caesarean Section ◽  
Interdisciplinary Treatment ◽  
Left Frontal Lobe ◽  
Severe Condition ◽  
Increased Risk ◽  
Close Supervision ◽  
Mother And Child

Abstract Background: Over the years care of pregnant woman has improved all over the world. However, still a significant percentage of the causes of pregnant mortality are subarachnoid haemorrhages due to rupture of arteriovenous malformation (AVM). According to available data, the percentage is as high as 5-12%. Neurosurgical operations in pregnant women require the cooperation of doctors of many specializations and are associated with close supervision of the patient due to the increased risk of complications. There are no guidelines regarding brain hemorrhages in pregnancy. This is the reason why case reports in this field are valuable as source of medical knowledge.Case presentation: A 28-year-old patient was admitted in a severe condition, GCS: 3, to the ICU due to massive intracerebral bleeding with a puncture into the ventricular system from the AVM in left frontal lobe. The family informed about the possibility of patient’s pregnancy, TVUS was performed and the sixth week fetus was visualized in the uterus. After gynaecological and neurosurgical consultation the successful surgery was made.The patient was hospitalized for 5 months at the ICU. The stay was complicated by pneumonia and an urinary tract infection that were successfully cured. The patient was under supervision of gynaecologists, the pregnancy was developing properly, tests were carried out as recommended. The patient underwent psychotherapy, rehabilitation and music therapy.At 35th week of gestation elective caesarean section was performed. A female infant of 2400 g was born, on the Apgar scale in 1st, 3rd, 5th minutes, 6,10,10 points respectively. Labour was complicated by mothers seizures and respiratory distress. After three days the patient's condition improved. Currently patient is rehabilitated as an outpatient.Conclusions: The above case emphasizes the need for cooperation between many specialties, physiotherapists and midwives, which enabled effective therapy of a pregnant woman and saving her life in such a critical situation. In addition interdisciplinary treatment ended positively for both mother and child.

scholarly journals Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Rosner-Tenerowicz ◽  
Tomasz Fuchs ◽  
Aleksandra Zimmer-Stelmach ◽  
Michał Pomorski ◽  
Martyna Trzeszcz ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Pregnant Women ◽  
Elective Caesarean Section ◽  
Good Condition ◽  
Intrauterine Infection ◽  
Coagulation System ◽  
Multidrug Therapy ◽  
Plasma Therapy ◽  
Severe Condition ◽  
Ecmo Treatment

Abstract Background Infection with SARS-CoV-2 during pregnancy can lead to a severe condition in the patient, which is challenging for obstetricians and anaesthesiologists. Upon severe COVID-19 and a lack of improvement after multidrug therapy and mechanical ventilation, extracorporeal membrane oxygenation (ECMO) is introduced as the last option. Such treatment is critical in women with very preterm pregnancy when each additional day of the intrauterine stay is vital for the survival of the newborn. Case presentation We report a case of a 38-year-old woman at 27 weeks of gestation treated with multidrug therapy and ECMO. The woman was admitted to the intensive care unit (ICU) with increasing fever, cough and dyspnoea. The course of the pregnancy was uncomplicated. She was otherwise healthy. At admission, she presented with severe dyspnoea, with oxygen saturation (SpO2) of 95% on passive oxygenation, heart rate of 145/min, and blood pressure of 145/90. After confirmation of SARS-CoV-2 infection, she received steroids, remdesivir and convalescent plasma therapy. The foetus was in good condition. No signs of an intrauterine infection were visible. Due to tachypnea of 40/min and SpO2 of 90%, the woman was intubated and mechanically ventilated. Due to circulatory failure, the prothrombotic activity of the coagulation system, further saturation worsening, and poor control of sedation, she was qualified for veno-venous ECMO. An elective caesarean section was performed at 29 weeks on ECMO treatment in the ICU. A preterm female newborn was delivered with an Apgar score of 7 and a birth weight of 1440 g. The newborn had no laboratory or clinical evidence of COVID-19. The placenta showed the following pathological changes: large subchorionic haematoma, maternal vascular malperfusion, marginal cord insertion, and chorangioma. Conclusions This case presents the successful use of ECMO in a pregnant woman with acute respiratory distress syndrome in the course of severe COVID-19. Further research is required to explain the aetiology of placental disorders (e.g., maternal vascular malperfusion lesions or thrombotic influence of COVID-19). ECMO treatment in pregnant women remains challenging; thus, it should be used with caution. Long-term assessment may help to evaluate the safety of the ECMO procedure in pregnant women.

scholarly journals Switching treatments in clinically stable relapsing remitting multiple sclerosis patients planning for pregnancy

2021 ◽  
Vol 7 (1) ◽  
pp. 205521732110015
Author(s):  
Lubna Almouzain ◽  
Fiona Stevenson ◽  
Declan Chard ◽  
Nur Abdul Rahman ◽  
Fiona Hamilton
Keyword(s):  
Multiple Sclerosis ◽  
Case Reports ◽  
Controlled Trial ◽  
Current Evidence ◽  
Cochrane Library ◽  
Disease Modifying Drugs ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Mother And Child ◽  
Multiple Sclerosis Patients

Background The decision to have children can be complex, particularly for people with multiple sclerosis (MS). A key concern is the use of disease modifying drugs (DMDs) during pregnancy, and how continuing, stopping or switching them may affect the mother and child. In people with active MS, stopping medications puts the mother at risk of relapse and disease rebound. Objectives Review evidence on the effect of different switching strategies in people with stable relapsing remitting MS (RRMS). Methods We searched MEDLINE, EMBASE, EMCARE, CINAHL, SCOPUS, Cochrane Library up to March 2020. Only papers in English were included and no other limits were applied. Seven articles were included: four cohorts, two case reports and one randomized controlled trial (RCT). Results Two strategies were found: de-escalating, which was associated with an increased risk of relapses, and switching between first line injectables, with no change in relapse rate observed. Conclusion Evidence on the effect of switching strategy on disease course in stable RRMS patients planning for pregnancy is scarce, but when switching, current evidence suggests the risk of relapses mirrors known medication efficacy.

scholarly journals THE ROLE OF BIOCHEMICAL MARKERS IN THE RISK STRATIFICATION FOR DEVELOPMENT OF PREECLAMPSIA: THE CLINICIAN’S VIEW

2017 ◽  
Vol 4 (4) ◽  
pp. 181-186
Author(s):  
I. V Ignatko ◽  
Violetta S. Florova ◽  
A. C Kuznetsov ◽  
E. Yu Kuzina
Keyword(s):  
Pregnant Woman ◽  
Biochemical Markers ◽  
Well Being ◽  
Correct Interpretation ◽  
Third Trimester ◽  
The Third ◽  
Increased Risk ◽  
The World ◽  
Mother And Child

Preeclampsia is one of the main causes of maternal mortality and leads to 50-60 thousand deaths annually worldwide, its prevalence in the world is 5-8%. Moreover, this complication is associated with an increased risk of the development of cardiovascular diseases and diabetes in the mother and child. Preeclampsia is a multi-systemic syndrome including hereditary and environmental factors in its pathogenesis and pathophysiology, and the only effective method of the treatment is still delivery. Regardless of the time of debut, preeclampsia is often characterized by the relative well-being of a pregnant woman, right up to the development of severe pre-eclampsia. This review is devoted to biochemical markers of the high risk of pre-eclampsia. Of particular interest there is the balance of proangiogenic (PIGF) and anti-angiogenic (sFlt) growth factors at different gestational ages; both the correct interpretation of the sFlt/PIGF balance and the correlation with the history data already allow us to expand the criteria for the prevention of preeclampsia and open up prospects for optimizing obstetric tactics in the third trimester of pregnancy.

Bowel ischaemia after endovascular aneurysm repair

VASA ◽  
2018 ◽  
Vol 47 (4) ◽  
pp. 273-277
Author(s):  
Christopher Lowe ◽  
Oussama El Bakbachi ◽  
Damian Kelleher ◽  
Imran Asghar ◽  
Francesco Torella ◽  
...  
Keyword(s):  
Case Reports ◽  
Endovascular Aneurysm Repair ◽  
Artery Occlusion ◽  
Bibliographic Databases ◽  
Bowel Ischaemia ◽  
Prophylactic Measures ◽  
Increased Risk ◽  
Prisma Statement ◽  
Meta Analyses ◽  
Aneurysm Repair

Abstract. The aim of this review was to investigate presentation, aetiology, management, and outcomes of bowel ischaemia following EVAR. We present a case report and searched electronic bibliographic databases to identify published reports of bowel ischaemia following elective infra-renal EVAR not involving hypogastric artery coverage or iliac branch devices. We conducted our review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. In total, five cohort studies and three case reports were included. These studies detailed some 6,184 infra-renal elective EVARs, without procedure-related occlusion of the hypogastric arteries, performed between 1996 and 2014. Bowel ischaemia in this setting is uncommon with an incidence ranging from 0.5 to 2.8 % and includes a spectrum of severity from mucosal to transmural ischaemia. Due to varying reporting standards, an overall proportion of patients requiring bowel resection could not be ascertained. In the larger series, mortality ranged from 35 to 80 %. Atheroembolization, hypotension, and inferior mesenteric artery occlusion were reported as potential causative factors. Elderly patients and those undergoing prolonged procedures appear at higher risk. Bowel ischaemia is a rare but potentially devastating complication following elective infra-renal EVAR and can occur in the setting of patent mesenteric vessels and hypogastric arteries. Mortality ranges from 35 to 80 %. Further research is required to identify risk factors and establish prophylactic measures in patients that have an increased risk of developing bowel ischaemia after standard infra-renal EVAR.

Hyperbaric oxygen therapy in the treatment of malign edema complication after arteriovenous malformation radiosurgery

2019 ◽  
pp. 713-717
Keyword(s):  
Arteriovenous Malformation ◽  
Hyperbaric Oxygen ◽  
Vasogenic Edema ◽  
Mass Effect ◽  
Radiological Examination ◽  
Temporal Region ◽  
Left Frontal Lobe ◽  
Steroid Resistant ◽  
Alternative Treatment Option ◽  
Martin Grade

A 16-year-old female patient with headache was admitted to our hospital. Radiological examination showed a Spetzler- Martin Grade III arteriovenous malformation (AVM) located at the left frontal lobe. Volume-staged stereotactic radiosurgery (SRS) treatment performed in two fractions at three-month intervals and post-procedural period were uneventful. Eight months later the patient was admitted to our hospital with headache, vomiting, right-sided facial palsy and right upper extremity paresthesia. Radiological examination demonstrated severe vasogenic edema in the left centrum semiovale and temporal region. Due to severe and steroid-resistant malign edema, hyperbaric oxygen (HBO2) therapy was performed as an alternative treatment option. Neurological symptoms resolved completely after HBO2. Radiological examination demonstrated serious improvement of brain edema and mass effect.

scholarly journals Haemostatic and thrombo-embolic complications in pregnant women with COVID-19: a systematic review and critical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juliette Servante ◽  
Gill Swallow ◽  
Jim G. Thornton ◽  
Bethan Myers ◽  
Sandhya Munireddy ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Pregnant Women ◽  
Clinical Evidence ◽  
Case Reports ◽  
Standard Form ◽  
Test Results ◽  
Maternal Deaths ◽  
High Clinical Suspicion ◽  
Increased Risk ◽  
Definition Of

Abstract Background As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. Methods Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. Results One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. Conclusions Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.

scholarly journals Risk Factors, and Clinical and Etiological Characteristics of Ischemic Strokes in COVID-19-Infected Patients: A Systematic Review of Literature

2021 ◽  
pp. 1-4
Author(s):  
Simone Vidale
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Clinical Features ◽  
Case Reports ◽  
Clinical Severity ◽  
Large Artery ◽  
Causal Association ◽  
Review Of Literature ◽  
Increased Risk ◽  
Long Time

<b><i>Background and Purpose:</i></b> Coronavirus disease 2019 (CO­VID-19) infection is an ongoing pandemic and worldwide health emergency that has caused important changes in healthcare systems. Previous studies reported an increased risk of thromboembolic events, including stroke. This systematic review aims to describe the clinical features and etiological characteristics of ischemic stroke patients with CO­VID-19 infection. <b><i>Method:</i></b> A literature search was performed in principal databases for studies and case reports containing data concerning risk factors, clinical features, and etiological characteristics of patients infected with COVID-19 and suffering from stroke. Descriptive and analytical statistics were applied. <b><i>Results:</i></b> Overall, 14 articles were included for a total of 93 patients. Median age was 65 (IQR: 55–75) years with prevalence in males. Stroke occurred after a median of 6 days from COVID-19 infection diagnosis. Median National of Institute of Health Stroke Scale (NIHSS) score was 19. Cryptogenic (Cry) strokes were more frequent (51.8%), followed by cardioembolic etiology, and they occurred a long time after COVID-19 diagnosis compared with large-artery atherosclerosis strokes (<i>p</i><sub>trend</sub>: 0.03). The clinical severity of stroke was significantly associated with the severity grade of COVID-19 infection (<i>p</i><sub>trend</sub>: 0.03). <b><i>Conclusions:</i></b> Ischemic strokes in COVID-19-infected patients were clinically severe, affecting younger patients mainly with Cry and cardioembolic etiologies. Further multicenter prospective registries are needed to better describe the causal association and the effect of COVID-19 infection on stroke.

Treatment of attention deficit/hyperactivity disorder in children with CHD

2021 ◽  
pp. 1-4
Author(s):  
Alyson R. Pierick ◽  
Melodie Lynn ◽  
Courtney M. McCracken ◽  
Matthew E. Oster ◽  
Glen J. Iannucci
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
General Population ◽  
Adverse Events ◽  
Supraventricular Tachycardia ◽  
Medical Therapy ◽  
Attention Deficit ◽  
Case Reports ◽  
Single Centre ◽  
Hyperactivity Disorder ◽  
Increased Risk

Abstract Introduction: The prevalence of attention deficit/hyperactivity disorder in the general population is common and is now diagnosed in 4%–12% of children. Children with CHD have been shown to be at increased risk for attention deficit/hyperactivity disorder. Case reports have led to concern regarding the use of attention deficit/hyperactivity disorder medications in children with underlying CHD. We hypothesised that medical therapy for patients with CHD and attention deficit/hyperactivity disorder is safe. Methods: A single-centre, retrospective chart review was performed evaluating for adverse events in patients aged 4–21 years with CHD who received attention deficit/hyperactivity disorder therapy over a 5-year span. Inclusion criteria were a diagnosis of CHD and concomitant medical therapy with amphetamines, methylphenidate, or atomoxetine. Patients with trivial or spontaneously resolved CHD were excluded from analysis. Results: In 831 patients with CHD who received stimulants with a mean age of 12.9 years, there was only one adverse cardiovascular event identified. Using sensitivity analysis, our median follow-up time was 686 days and a prevalence rate of 0.21% of adverse events. This episode consisted of increased frequency of supraventricular tachycardia in a patient who had this condition prior to initiation of medical therapy; the condition improved with discontinuation of attention deficit/hyperactivity disorder therapy. Conclusion: The incidence of significant adverse cardiovascular events in our population was similar to the prevalence of supraventricular tachycardia in the general population. Our single-centre experience demonstrated no increased risk in adverse events related to medical therapy for children with attention deficit/hyperactivity disorder and underlying CHD. Further population-based studies are indicated to validate these findings.

scholarly journals Bittersweet: infective complications of drug-induced glycosuria in patients with diabetes mellitus on SGLT2-inhibitors: two case reports

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caroline Bartolo ◽  
Victoria Hall ◽  
N. Deborah Friedman ◽  
Chloe Lanyon ◽  
Andrew Fuller ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Fungal Infections ◽  
Case Reports ◽  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
Urogenital Tract ◽  
Hypoglycemic Agents ◽  
Drug Induced ◽  
First Case ◽  
Increased Risk

Abstract Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in significant glycosuria and increased risk of genital mycotic infections (GMI). These infections are typically not severe as reported in large systematic reviews and meta-analyses of the medications. These reviews have also demonstrated significant cardiovascular benefits through other mechanisms of action, making them attractive options for the management of Type 2 diabetes mellitus (T2DM). We present two cases with underlying abnormalities of the urogenital tract in which the GMI were complicated and necessitated cessation of the SGLT2 inhibitor. Case presentations Both cases are patients with T2DM on empagliflozin, an SGLT2 inhibitor. The first case is a 64 year old man with Candida albicans balanitis and candidemia who was found to have an obstructing renal calculus and prostatic abscess requiring operative management. The second case describes a 72 year old man with Candida glabrata candidemia who was found to have prostatomegaly, balanitis xerotica obliterans with significant urethral stricture and bladder diverticulae. His treatment was more complex due to fluconazole resistance and concerns about urinary tract penetration of other antifungals. Both patients recovered following prolonged courses of antifungal therapy and in both cases the SGLT2 inhibitor was ceased. Conclusions Despite their cardiovascular benefits, SGLT2 inhibitors can be associated with complicated fungal infections including candidemia and patients with anatomical abnormalities of the urogenital tract may be more susceptible to these infections as demonstrated in these cases. Clinicians should be aware of their mechanism of action and associated risk of infection and prior to prescription, assessment of urogenital anatomical abnormalities should be performed to identify patients who may be at risk of complicated infection.

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