scholarly journals Clinical Characteristics and Outcomes of Childbearing-Age Women With COVID-19 in Wuhan: Retrospective, Single-Center Study (Preprint)

2020 ◽  
Author(s):  
Lijie Wei ◽  
Xuan Gao ◽  
Suhua Chen ◽  
Wanjiang Zeng ◽  
Jianli Wu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Influenza A ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Outcome Data ◽  
Fetal Movement ◽  
Adverse Outcomes ◽  
Elevated Concentration ◽  
Childbearing Age ◽  
Childbearing Age Women

BACKGROUND Since December 2019, an outbreak of the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly in Wuhan and worldwide. However, previous studies on pregnant patients were limited. OBJECTIVE The aim of this study is to evaluate the clinical characteristics and outcomes of pregnant and nonpregnant women with COVID-19. METHODS This study retrospectively collected epidemiological, clinical, laboratory, imaging, management, and outcome data of 43 childbearing-age women patients (including 17 pregnant and 26 nonpregnant patients) who presented with laboratory-confirmed COVID-19 in Tongji Hospital, Wuhan, China from January 19 to March 2, 2020. Clinical outcomes were followed up to March 28, 2020. RESULTS Of the 43 childbearing-age women in this study, none developed a severe adverse illness or died. The median ages of pregnant and nonpregnant women were 33.0 and 33.5 years, respectively. Pregnant women had a markedly higher proportion of history exposure to hospitals within 2 weeks before onset compared to nonpregnant women (9/17, 53% vs 5/26, 19%, <i>P</i>=.02) and a lower proportion of other family members affected (4/17, 24% vs 19/26, 73%, <i>P</i>=.004). Fever (8/17, 47% vs 18/26, 69%) and cough (9/17, 53% vs 12/26, 46%) were common onsets of symptoms for the two groups. Abdominal pain (n=4, 24%), vaginal bleeding (n=1, 6%), reduced fetal movement (n=1, 6%), and increased fetal movement (n=2, 13%) were observed at onset in the 17 pregnant patients. Higher neutrophil and lower lymphocyte percent were observed in the pregnant group compared to the nonpregnant group (79% vs 56%, <i>P</i><.001; 15% vs 33%, <i>P</i><.001, respectively). In both groups, we observed an elevated concentration of high-sensitivity C-reactive protein, erythrocyte sedimentation rate, aminotransferase, and lactate dehydrogenase. Concentrations of alkaline phosphatase and D-dimer in the pregnant group were significantly higher than those of the nonpregnant group (119.0 vs 48.0 U/L, <i>P</i><.001; 2.1 vs 0.3μg/mL, <i>P</i><.001, respectively). Both pregnant (4/10, 40%) and nonpregnant (8/15, 53%) women tested positive for influenza A virus. A majority of pregnant and nonpregnant groups received antiviral (13/17, 76% vs 25/26, 96%) and antibiotic (13/17, 76% vs 23/26, 88%) therapy. Additionally, both pregnant (2/11, 18%) and nonpregnant (2/19, 11%) recovered women redetected positive for SARS-CoV-2 after discharge. CONCLUSIONS The epidemiology and clinical and laboratory features of pregnant women with COVID-19 were diverse and atypical, which increased the difficulty of diagnosis. Most pregnant women with COVID-19 were mild and moderate, and rarely developed severe pneumonia or severe adverse outcomes.

scholarly journals Clinical Characteristics and Outcomes of Childbearing-Age Women With COVID-19 in Wuhan: Retrospective, Single-Center Study

10.2196/19642 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e19642
Author(s):  
Lijie Wei ◽  
Xuan Gao ◽  
Suhua Chen ◽  
Wanjiang Zeng ◽  
Jianli Wu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Influenza A ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Outcome Data ◽  
Fetal Movement ◽  
Adverse Outcomes ◽  
Elevated Concentration ◽  
Childbearing Age ◽  
Childbearing Age Women

Background Since December 2019, an outbreak of the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly in Wuhan and worldwide. However, previous studies on pregnant patients were limited. Objective The aim of this study is to evaluate the clinical characteristics and outcomes of pregnant and nonpregnant women with COVID-19. Methods This study retrospectively collected epidemiological, clinical, laboratory, imaging, management, and outcome data of 43 childbearing-age women patients (including 17 pregnant and 26 nonpregnant patients) who presented with laboratory-confirmed COVID-19 in Tongji Hospital, Wuhan, China from January 19 to March 2, 2020. Clinical outcomes were followed up to March 28, 2020. Results Of the 43 childbearing-age women in this study, none developed a severe adverse illness or died. The median ages of pregnant and nonpregnant women were 33.0 and 33.5 years, respectively. Pregnant women had a markedly higher proportion of history exposure to hospitals within 2 weeks before onset compared to nonpregnant women (9/17, 53% vs 5/26, 19%, P=.02) and a lower proportion of other family members affected (4/17, 24% vs 19/26, 73%, P=.004). Fever (8/17, 47% vs 18/26, 69%) and cough (9/17, 53% vs 12/26, 46%) were common onsets of symptoms for the two groups. Abdominal pain (n=4, 24%), vaginal bleeding (n=1, 6%), reduced fetal movement (n=1, 6%), and increased fetal movement (n=2, 13%) were observed at onset in the 17 pregnant patients. Higher neutrophil and lower lymphocyte percent were observed in the pregnant group compared to the nonpregnant group (79% vs 56%, P<.001; 15% vs 33%, P<.001, respectively). In both groups, we observed an elevated concentration of high-sensitivity C-reactive protein, erythrocyte sedimentation rate, aminotransferase, and lactate dehydrogenase. Concentrations of alkaline phosphatase and D-dimer in the pregnant group were significantly higher than those of the nonpregnant group (119.0 vs 48.0 U/L, P<.001; 2.1 vs 0.3μg/mL, P<.001, respectively). Both pregnant (4/10, 40%) and nonpregnant (8/15, 53%) women tested positive for influenza A virus. A majority of pregnant and nonpregnant groups received antiviral (13/17, 76% vs 25/26, 96%) and antibiotic (13/17, 76% vs 23/26, 88%) therapy. Additionally, both pregnant (2/11, 18%) and nonpregnant (2/19, 11%) recovered women redetected positive for SARS-CoV-2 after discharge. Conclusions The epidemiology and clinical and laboratory features of pregnant women with COVID-19 were diverse and atypical, which increased the difficulty of diagnosis. Most pregnant women with COVID-19 were mild and moderate, and rarely developed severe pneumonia or severe adverse outcomes.

scholarly journals Is it time to administer acellular pertussis vaccine to childbearing age/pregnant women in all areas using whole-cell pertussis vaccination schedule?

2021 ◽  
Vol 9 ◽  
pp. 251513552110158
Author(s):  
Abdoulreza Esteghamati ◽  
Shirin Sayyahfar ◽  
Yousef Alimohamadi ◽  
Sarvenaz Salahi ◽  
Mahmood Faramarzi
Keyword(s):  
Pregnant Women ◽  
Age Groups ◽  
Vaccination Schedule ◽  
Immunoglobulin M ◽  
Enzyme Linked Immunosorbent Assay ◽  
Childbearing Age ◽  
Cross Sectional ◽  
Whole Cell ◽  
Childbearing Age Women ◽  
The Mean

Background: Whole-cell pertussis (wP) vaccine administration is still advocated for children under 7 years of age in Iran. However, there is no recommendation for the administration of a dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to childbearing age/pregnant women in the Iranian vaccination program and it has increased the risk of infection through waning immunity during women’s childbearing age life. The study aimed to assess the levels of anti- Bordetella pertussis antibodies in childbearing age women of different ages in Iran. Methods: A cross-sectional study was conducted on a total number of 360 childbearing age women divided into six age groups, with 5-year intervals from 15 to 45 years old, in 2018–2019. Then, the levels of immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) antibodies against B. pertussis were evaluated using enzyme-linked immunosorbent assay (ELISA). The IBM SPSS Statistics software (version 16.0) (SPSS Inc., Chicago, IL, USA) was used for data analysis. Results: The mean age of the participants was 30.01 ± 8.35 years (range 14–45 years). All the cases were IgM negative, but two IgA-positive individuals (in the age groups of 14–19 and 30–34 years) were reported. Overall, 239 (66.4%) cases were IgG positive. The mean age of IgG-positive cases was 30.37 ± 8.37 years. The IgG-positive cases were mostly in the age groups of 30–34 and 35–39 years [43 (71.1%)]. The odds of IgG positivity were 1.97. The highest odds of IgG positivity were seen in 30–34 and 35–39 years groups (2.52) and the lowest odds were seen in the 20–24 and 25–29 years groups (1.60). Using the Jonckheere–Terpstra test, the increasing trend of IgG changes in different age groups was not statistically significant (Tπ=5.78, p = 0.09). Conclusion: The infants of women of childbearing age might be prone to pertussis in countries using the wP vaccination schedule. It is suggested to administer a dose of Tdap to women before or during pregnancy to increase the immunity of their infants against this disease during early infancy.

scholarly journals Seroprevalence of anti-Parvovirus B19 IgG in childbearing age women in Pleven region (Bulgaria)

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
T Petkova ◽  
S Pachkova ◽  
T z Doichinova ◽  
S Aleksandrova-Yankulovska
Keyword(s):  
Pregnant Women ◽  
Parvovirus B19 ◽  
Specific Treatment ◽  
Case Report Form ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Active Monitoring ◽  
Populations At Risk ◽  
Parvovirus B19 Infection ◽  
Childbearing Age Women

Abstract Background Parvovirus B19 is a widespread infection in childhood. Seroprevalence of anti-Parvovirus B19 increases with age and about 60% to 70% of women of childbearing age have serological evidence of past exposure to virus. Diaplacental Parvovirus B19 infection in pregnant women can lead to anaemia, non-immune hydrops fetalis and foetal death. The aim of the study is determining the susceptibility to Parvovirus B19 in childbearing age women. Methods We conducted a prospective seroepidemiological study in which 90 healthy women of childbearing age (19 to 40 years) were tested during the period September-October 2018 in Medical Center “Clinical Institute for Reproductive Medicine”- Pleven, Bulgaria. Participants were surveyed on a voluntary basis. The exclusion criteria were: presence of autoimmune disorder, immunosuppressive states, malignancy and populations at risk such as persons under 18 years of age and pregnant women. The presence of specific Parvovirus B19 IgG was detected using a standardized anti-Parvovirus B19 (IgG) ELISA kit. The demographic and anamnestic data were collected for each participant in Case Report Form. Results The average age of the women was 31.4 ± 4.9 years. Dominating were women with higher education (52.2%) living in urban areas (92.2%). The survey results showed that 37.8% of women were positive for anti-Parvovirus B19 IgG, 61.1% were negative and 1.1% equivocal. Immunty to the virus increased from 27.3% to 45% with age. There was no significant correlation between the presence of antibodies and the demographic factors (living area, education and number of family members). Conclusions The results of this study imply that 61.1% of the childbearing age women in Pleven region are susceptible to infection with Parvovirus B19. Because of the high susceptibility to Parvovirus B19, active monitoring of risk groups pregnant women for the prevention of fetal complications is recommended. Key messages There is no specific treatment or prophylaxis against Parvovirus B19 infection and epidemiological surveillance requires the introduction of effective preventive measures at the public health level. Active monitoring in childbearing age women is necessary to reduce the risk of fetal damage and the cost of healthcare associated with the infection.

scholarly journals Prevalence ofChlamydia trachomatisamong Childbearing Age Women in India: A Systematic Review

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Kalpana Betha ◽  
Jamie M. Robertson ◽  
Gong Tang ◽  
Catherine L. Haggerty
Keyword(s):  
Chlamydia Trachomatis ◽  
General Population ◽  
Risk Groups ◽  
Adverse Outcomes ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Sexually Transmitted ◽  
Screening Programs ◽  
Childbearing Age Women ◽  
Women In India

Background. Infection withChlamydia trachomatis(CT) can lead to reproductive sequelae. Information on the general population of childbearing age women in India is sparse. We reviewed the literature on CT prevalence within the general population of reproductive aged women in order to improve the efforts of public health screening programs and interventions.Objective. To conduct a literature review to determine the prevalence ofChlamydia trachomatisamong childbearing age women in India.Search Strategy. Ovid Medline and PubMed databases were searched for articles from January 1, 2003, through December 31, 2014. Search terms included “Chlamydia trachomatis”, “CT”, “prevalence”, “India”, and “sexually transmitted infections”.Selection Criteria. Studies on prevalence data for CT among women of childbearing age (15–45) living in India were included.Data Collection and Analysis. Articles that met the inclusion criteria were extracted by two readers and discrepancies solved through discussion.Results. Reported prevalence of active CT infection among lower risk groups ranged from 0.1% to 1.1% and in higher risk group from 2.7% to 28.5%.Conclusion.CT prevalence among women in India is comparable to other countries. Screening programs to prevent adverse outcomes among Indian women of childbearing age and their offspring are warranted.

scholarly journals Prevalence of Chlamydia Trachomatis among Pregnant Women, Gynecology Clinic Attendees, and Subfertile Women in Guangdong, China: A Cross-sectional Survey

2021 ◽  
Author(s):  
Changchang Li ◽  
Weiming Tang ◽  
Hung Chak Ho ◽  
Jason J Ong ◽  
Xiaojing Zheng ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Pregnant Women ◽  
Chinese Women ◽  
Birth Outcome ◽  
Nucleic Acid Amplification ◽  
Childbearing Age ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
First Sex ◽  
Childbearing Age Women

Abstract Background Chlamydia trachomatis (CT) is a major cause of infertility and adverse birth outcome, but its epidemiology among childbearing-age women remains unclear in China. This study investigated the prevalence of CT and associated factors among Chinese women aged 16-44 years who were either 1) pregnant; 2) attending gynaecology clinics; or 3) subfertile. Methods We conducted a cross-sectional survey and recruited participants from obstetrics, gynaecology, and infertility clinics in Guangdong, between March to December, 2019. We collected information on individuals' socio-demographic characteristics, previous medical conditions, and sexual behaviours. First-pass urine and cervical swabs were tested using nucleic acid amplification testing. We calculated the prevalence in each population and subgroup by age, education, and age at first sex. Multivariable binomial regression models were used to identify factors associated with CT. Results We recruited 881 pregnant women, 595 gynaecology clinic attendees, and 254 subfertile women. The prevalence of CT was 6.7% (95% Confidence Interval (CI): 5.2%-8.5%), 8.2% (95%CI: 6.2%-10.7%), 5.9% (95%CI: 3.5%-9.3%) for the above three populations, respectively. The subgroup-specific prevalence was highest among those who had the first sex before 25 years and older pregnant women (&gt;35 years). The proportion of asymptomatic CT was 84.8%, 40.0%, and 60.0% among pregnant women, gynaecology clinic attendees, and subfertile women, respectively. Age at first sex (&lt;25 years), multipara, and ever having more than one partner increased the risk of CT. Conclusion Childbearing age women in China have a high prevalence of CT. As most women with CT were asymptomatic, more optimum prevention strategies are urgently needed in China.

Presumed tuberculosis-related scleritis

2021 ◽  
pp. bjophthalmol-2021-319799
Author(s):  
Maite Sainz de La Maza ◽  
Ines Hernanz ◽  
Aina Moll-Udina ◽  
Marina Mesquida ◽  
Alfredo Adan ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Remission Rate ◽  
Retrospective Chart Review ◽  
Unknown Origin ◽  
Outcome Data ◽  
Therapeutic Outcome ◽  
Posterior Scleritis ◽  
Ocular Surgery ◽  
Systemic Corticosteroids

AimsTo evaluate the clinical characteristics and therapeutic outcome of patients with recurrent scleritis of unknown demonstrable aetiology and positive QuantiFERON-TB Gold In-Tube test (QFT).MethodsRetrospective chart review of the demographic, clinical, laboratory and therapeutic outcome data of 15 patients. Clinical characteristics as well as remission rate after standard antituberculous therapy (ATT) were assessed.ResultsThere were 9 men and 6 women with a mean age of 48.9 years (range, 32–73). Scleritis was diffuse in 10 patients (66.6%) and nodular in 5 patients (33.3%), 1 of them with concomitant posterior scleritis. It was bilateral in 7 patients (46.6%) and recurrent in all of them. Scleritis appeared after prior uveitis (10 patients, 66.6%) and/or with concomitant uveitis (5 patients, 33.3%) or peripheral keratitis (5 patients, 33.3%). Previous ocular surgery was found in 7 patients (46.6%). Previous extraocular tuberculosis (TB) infection or previous TB contact was detected in 11 patients (73.3%). No radiologic findings of active extraocular TB were detected. ATT was used in 15 patients, sometimes with the addition of systemic corticosteroids (5 patients) and methotrexate (1 patient); 14 patients achieved complete remission (93.3%).ConclusionPresumed TB-related scleritis may appear in recurrent scleritis of unknown origin and positive QFT. It may occur after prior uveitis and/or concomitantly with uveitis or peripheral keratitis, and it may be triggered by previous ocular surgery. No patients had evidence of concurrent active extraocular infection, although many had previous TB infection or TB contact. ATT was effective, sometimes with the addition of systemic corticosteroids and methotrexate.

scholarly journals Intravenous Iron Treatment in Pregnancy: Ferric Carboxymaltose for Correction of Iron Deficiency Anaemia

2017 ◽  
Vol 12 (2) ◽  
pp. 54-57
Author(s):  
Dilruba Zeba ◽  
Parvin Akter Khanam ◽  
Mansur Ahamed ◽  
Md Abul Khair
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Intravenous Iron ◽  
Adverse Outcomes ◽  
Ferric Carboxymaltose ◽  
Childbearing Age ◽  
Deficiency Anaemia ◽  
New Treatment ◽  
A Prospective Study

Iron deficiency is the most common nutritional deficiency state of women in childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. An effective management is needed to prevent adverse outcomes. Current options for treatment are limited; these include oral iron supplements, which are usually ineffective and poorly tolerated, and whole blood transfusion, which carries an inherent risk, should be avoided during pregnancy. Intravenous ferric carboxymaltose is a new treatment option and it is better tolerated with a good result. The study was designed to assess the safety and efficacy of intravenous ferric carboxymaltose for correction of IDA in pregnant women in third trimester. It was a prospective study; 260 anaemic pregnant women received Injection ferric carboxymaltose, as a total dose of 500-1000 mg between 28 to 36 weeks of pregnancy. Safety was assessed by analyzing adverse drug reactions. Ferric carboxy maltose significantly increased Hb level (p<0.001) in all women in this study group. Increased Hb value was observed 3-4 weeks after infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 34(13%) patients.Our study revealed that the Hb level increased significantly, was well tolerated and without significant side effects.Faridpur Med. Coll. J. Jul 2017;12(2): 54-57

scholarly journals Clinical Characteristics and Neonatal Outcomes of Pregnant Patients With COVID-19: A Systematic Review

2020 ◽  
Vol 7 ◽  
Author(s):  
Md. Mohaimenul Islam ◽  
Tahmina Nasrin Poly ◽  
Bruno Andreas Walther ◽  
Hsuan Chia Yang ◽  
Cheng-Wei Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Clinical Manifestations ◽  
Fetal Distress ◽  
Neonatal Outcomes ◽  
Published Evidence ◽  
General Populations

Background and Objective: Coronavirus disease 2019 (COVID-19) characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created serious concerns about its potential adverse effects. There are limited data on clinical, radiological, and neonatal outcomes of pregnant women with COVID-19 pneumonia. This study aimed to assess clinical manifestations and neonatal outcomes of pregnant women with COVID-19.Methods: We conducted a systematic article search of PubMed, EMBASE, Scopus, Google Scholar, and Web of Science for studies that discussed pregnant patients with confirmed COVID-19 between January 1, 2020, and April 20, 2020, with no restriction on language. Articles were independently evaluated by two expert authors. We included all retrospective studies that reported the clinical features and outcomes of pregnant patients with COVID-19.Results: Forty-seven articles were assessed for eligibility; 13 articles met the inclusion criteria for the systematic review. Data is reported for 235 pregnant women with COVID-19. The age range of patients was 25–40 years, and the gestational age ranged from 8 to 40 weeks plus 6 days. Clinical characteristics were fever [138/235 (58.72%)], cough [111/235 (47.23%)], and sore throat [21/235 (8.93%)]. One hundred fifty six out of 235 (66.38%) pregnant women had cesarean section, and 79 (33.62%) had a vaginal delivery. All the patients showed lung abnormalities in CT scan images, and none of the patients died. Neutrophil cell count, C-reactive protein (CRP) concentration, ALT, and AST were increased but lymphocyte count and albumin levels were decreased. Amniotic fluid, neonatal throat swab, and breastmilk samples were taken to test for SARS-CoV-2 but all found negativ results. Recent published evidence showed the possibility of vertical transmission up to 30%, and neonatal death up to 2.5%. Pre-eclampsia, fetal distress, PROM, pre-mature delivery were the major complications of pregnant women with COVID-19.Conclusions: Our study findings show that the clinical, laboratory and radiological characteristics of pregnant women with COVID-19 were similar to those of the general populations. The possibility of vertical transmission cannot be ignored but C-section should not be routinely recommended anymore according to latest evidences and, in any case, decisions should be taken after proper discussion with the family. Future studies are needed to confirm or refute these findings with a larger number of sample sizes and a long-term follow-up period.

scholarly journals Older adults hospitalized with Covid-19: Clinical characteristics and early outcomes from a single center in Istanbul, Turkey

2020 ◽  
Author(s):  
Alpay Medetalibeyoğlu ◽  
Naci Senkal ◽  
Murat Kose ◽  
Yunus Catma ◽  
Emine Bilge Caparali ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Mortality ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Severe Pneumonia ◽  
Pulmonary Involvement ◽  
Adverse Outcomes ◽  
Younger Patients ◽  
Presenting Symptoms

Abstract Objective: Older adults have been continuously reported to be at higher risk for adverse outcomes of Covid-19. We aimed to describe clinical characteristics and early outcomes of the older Covid-19 patients hospitalized in our center comparatively with the younger patients, and also to analyze the triage factors that were related to the in-hospital mortality of older adults.Design: Retrospective; observational studySetting: Istanbul Faculty of Medicine hospital, TurkeyParticipants: 362 hospitalized patients with laboratory-confirmed Covid-19 from March 11 to May 11, 2020.Measurements: The demographic information; associated comorbidities; presenting clinical, laboratory, radiological characteristics on admission and outcomes from the electronic medical records were analyzed comparatively between the younger (<65 years) and older (≥65 years) adults. Factors associated with in-hospital mortality of the older adults were analyzed by multivariate regression analyses.Results: The median age was 56 years (interquartile range [IQR], 46-67), and 224 (61.9%) were male. There were 104 (28.7%) patients ≥65 years of age. More than half of the patients (58%) had one or more chronic comorbidity. The three most common presenting symptoms in the older patients were fatigue/myalgia (89.4%), dry cough (72.1%), and fever (63.5%). Cough and fever were significantly less prevalent in older adults compared to younger patients (p=0.001 and 0.008, respectively). Clinically severe pneumonia was present in 31.5% of the study population being more common in older adults (49% vs. 24.4%) (p<0.001). The laboratory parameters that were significantly different between the older and younger adults were as follows: the older patients had significantly higher CRP, D-dimer, TnT, pro-BNP, procalcitonin levels, higher prevalence of lymphopenia, neutrophilia, increased creatinine, and lower hemoglobin, ALT, albumin level (p<0.05). In the radiological evaluation, more than half of the patients (54.6%) had moderate-severe pneumonia, which was more prevalent in older patients (66% vs. 50%) (p=0.006). The adverse outcomes were significantly more prevalent in older adults compared to the younger patients (ICU admission, 28.8% vs. 8.9%; mortality, 23.1% vs. 4.3%, p<0.001). Among the triage evaluation parameters, the only factor associated with higher mortality was the presence of clinically severe pneumonia on admission (Odds Ratio=12.3, 95% confidence interval=2.7-55.5, p=0.001).Conclusion: Older patients presented with more prevalent chronic comorbidities, less prevalent symptomatology but more severe respiratory signs and laboratory abnormalities than the younger patients. Among the triage assessment factors, the clinical evaluation of pulmonary involvement came in front to help clinicians to stratify the patients for mortality risk.

scholarly journals Ivabradine use in pregnant women—treatment indications and pregnancy outcome: an evaluation of the German Embryotox database

2021 ◽  
Author(s):  
Maria Hoeltzenbein ◽  
Marie-Louise Lehmann ◽  
Evelin Beck ◽  
Katarina Dathe ◽  
Christof Schaefer
Keyword(s):  
Pregnant Women ◽  
Animal Studies ◽  
Chronic Stable Angina ◽  
Case Series ◽  
Adverse Outcomes ◽  
Close Monitoring ◽  
Childbearing Age ◽  
Fetal Ultrasound ◽  
Treatment Indications ◽  
Treatment Alternatives

Abstract Purpose Ivabradine has been approved for the treatment of chronic heart failure and chronic stable angina pectoris in Europe. Based on adverse outcomes of reproductive animal studies and the lack of human data, ivabradine is considered contraindicated during pregnancy. The aim of this observational study is to analyse ivabradine use before and during pregnancy. Methods We evaluated all ivabradine-related requests to the German Embryotox Institute from 2007 to 2019. Exposed pregnancies were analysed as to their outcome. Results Off-label use for supraventricular tachycardia was frequent in women of childbearing age. Of 38 prospectively ascertained pregnancies with ivabradine exposure and completed follow-up, 32 resulted in live births, 3 in spontaneous abortions, and 3 were electively terminated. One neonate presented with major birth defects (atrial septal defect and cleft palate). In 33/38 patients, ivabradine was discontinued after confirmation of pregnancy without cardiac deterioration and 5/38 women continued ivabradine throughout pregnancy. In addition, there were 3 retrospectively reported pregnancies including one major birth defect (tracheal atresia). Conclusion This case series represents the largest cohort of ivabradine-exposed pregnancies, published so far. According to our findings, ivabradine appears not to be a major teratogen. However, established drugs of choice with strong evidence of low risk for the unborn should be preferred in women planning pregnancy. After inadvertent exposure during pregnancy or lack of treatment alternatives, fetal ultrasound for structural anomalies and growth restriction is recommended. In addition, close monitoring is necessary in pregnant women with supraventricular arrhythmias or cardiac disease.

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