Indirect bypass for maternal symptomatic moyamoya in the first trimester of pregnancy: case report

2020 ◽  
Vol 25 (2) ◽  
pp. 138-143
Author(s):  
Katie P. Fehnel ◽  
Craig D. McClain ◽  
Edward R. Smith
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Index Patient ◽  
First Trimester ◽  
Childbearing Age ◽  
Surgical Revascularization ◽  
First Case ◽  
Risk Period ◽  
First Trimester Of Pregnancy ◽  
Term Baby

There are no practice guidelines for the treatment of moyamoya disease in pregnant women. The need for such guidelines, however, is evidenced by the numerous case reports, case series, and systematic reviews in the literature highlighting an at-risk period for female moyamoya patients of childbearing age. Here the authors review and interpret the existing literature as it applies to their index patient and expand the literature in support of treating select patients during pregnancy. The authors describe what is to their knowledge the first case reported in the literature of a patient successfully treated with indirect surgical revascularization during the first trimester, who went on to deliver a healthy term baby without complications.

scholarly journals Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management

2019 ◽  
Vol 58 (3) ◽  
pp. 282-292
Author(s):  
Katelyn A Pastick ◽  
Elizabeth Nalintya ◽  
Lillian Tugume ◽  
Kenneth Ssebambulidde ◽  
Nicole Stephens ◽  
...  
Keyword(s):  
Survival Rate ◽  
Pregnant Women ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Case Series ◽  
First Trimester ◽  
Secondary Prophylaxis ◽  
Fetal Survival

Abstract Cryptococcal meningitis causes 15% of AIDS-related deaths. Optimal management and clinical outcomes of pregnant women with cryptococcosis are limited to case reports, as pregnant women are often excluded from research. Amongst pregnant women with asymptomatic cryptococcosis, no treatment guidelines exist. We prospectively identified HIV-infected women who were pregnant or recently pregnant with cryptococcosis, screened during a series of meningitis research studies in Uganda from 2012 to 2018. Among 571 women screened for cryptococcosis, 13 were pregnant, one was breastfeeding, three were within 14 days postpartum, and two had recently miscarried. Of these 19 women (3.3%), 12 had cryptococcal meningitis, six had cryptococcal antigenemia, and one had a history of cryptococcal meningitis and was receiving secondary prophylaxis. All women with meningitis received amphotericin B deoxycholate (0.7–1.0 mg/kg). Five were exposed to 200–800 mg fluconazole during pregnancy. Of these five, three delivered healthy babies with no gross physical abnormalities at birth, one succumbed to meningitis, and one outcome was unknown. Maternal meningitis survival rate at hospital discharge was 75% (9/12), and neonatal/fetal survival rate was 44% (4/9) for those mothers who survived. Miscarriages and stillbirths were common (n = 4). Of six women with cryptococcal antigenemia, two received fluconazole, one received weekly amphotericin B, and three had unknown treatment courses. All women with antigenemia survived, and none developed clinical meningitis. We report good maternal outcomes but poor fetal outcomes for cryptococcal meningitis using amphotericin B, without fluconazole in the first trimester, and weekly amphotericin B in place of fluconazole for cryptococcal antigenemia.

scholarly journals Spontaneous rupture of an unscarred uterus in early pregnancy: a rare but life-threatening emergency

2019 ◽  
Vol 12 (5) ◽  
pp. e228493 ◽  
Author(s):  
Bedayah Amro ◽  
Ghassan Lotfi
Keyword(s):  
Early Pregnancy ◽  
Uterine Rupture ◽  
Laparoscopic Approach ◽  
First Trimester ◽  
Rare Occurrence ◽  
Spontaneous Uterine Rupture ◽  
First Case ◽  
Life Threatening ◽  
First Trimester Of Pregnancy ◽  
Underlying Risk

Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.

scholarly journals Safety of Antimicrobials During Pregnancy: A Systematic Review of Antimicrobials Considered for Treatment and Postexposure Prophylaxis of Plague

2020 ◽  
Vol 70 (Supplement_1) ◽  
pp. S37-S50 ◽  
Author(s):  
Patricia A Yu ◽  
Emmy L Tran ◽  
Corinne M Parker ◽  
Hye-Joo Kim ◽  
Eileen L Yee ◽  
...  
Keyword(s):  
Spontaneous Abortion ◽  
Case Reports ◽  
Case Series ◽  
First Trimester ◽  
Neonatal Outcomes ◽  
Primary Sources ◽  
Limited Data ◽  
Postexposure Prophylaxis ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract Background The safety profile of antimicrobials used during pregnancy is one important consideration in the decision on how to treat and provide postexposure prophylaxis (PEP) for plague during pregnancy. Methods We searched 5 scientific literature databases for primary sources on the safety of 9 antimicrobials considered for plague during pregnancy (amikacin, gentamicin, plazomicin, streptomycin, tobramycin, chloramphenicol, doxycycline, sulfadiazine, and trimethoprim-sulfamethoxazole [TMP-SMX]) and abstracted data on maternal, pregnancy, and fetal/neonatal outcomes. Results Of 13 052 articles identified, 66 studies (case-control, case series, cohort, and randomized studies) and 96 case reports were included, totaling 27 751 prenatal exposures to amikacin (n = 9), gentamicin (n = 345), plazomicin (n = 0), streptomycin (n = 285), tobramycin (n = 43), chloramphenicol (n = 246), doxycycline (n = 2351), sulfadiazine (n = 870), and TMP-SMX (n = 23 602). Hearing or vestibular deficits were reported in 18/121 (15%) children and 17/109 (16%) pregnant women following prenatal streptomycin exposure. First trimester chloramphenicol exposure was associated with an elevated risk of an undescended testis (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.2–28.7). Doxycycline was associated with cardiovascular malformations (OR 2.4, 95% CI 1.2–4.7) in 1 study and spontaneous abortion (OR 2.8, 95% CI 1.9–4.1) in a separate study. First trimester exposure to TMP-SMX was associated with increased risk of neural tube defects (pooled OR 2.5, 95% CI 1.4–4.3), spontaneous abortion (OR 3.5, 95% CI 2.3–5.6), preterm birth (OR 1.5, 95% CI 1.1–2.1), and small for gestational age (OR 1.6, 95% CI 1.2–2.2). No other statistically significant associations were reported. Conclusions For most antimicrobials reviewed, adverse maternal/fetal/neonatal outcomes were not observed consistently. Prenatal exposure to streptomycin and TMP-SMX was associated with select birth defects in some studies. Based on limited data, chloramphenicol and doxycycline may be associated with adverse pregnancy or neonatal outcomes; however, more data are needed to confirm these associations. Antimicrobials should be used for treatment and PEP of plague during pregnancy; the choice of antimicrobials may be influenced by these data as well as information about the risks of plague during pregnancy.

scholarly journals Case series of coronavirus (SARS-CoV-2) in a military recruit school: clinical, sanitary and logistical implications

2020 ◽  
pp. bmjmilitary-2020-001482 ◽  
Author(s):  
Sascha J Baettig ◽  
A Parini ◽  
I Cardona ◽  
G B Morand
Keyword(s):  
Close Contact ◽  
Case Series ◽  
Armed Forces ◽  
Index Patient ◽  
Confined Space ◽  
Serological Testing ◽  
Military Recruit ◽  
First Case ◽  
Asymptomatic Patients ◽  
The Impact

IntroductionA new coronavirus, called Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2), has emerged from China in late 2019 and has now caused a worldwide pandemic. The impact of COVID-19 has not been described so far in a military setting. We therefore report a case series of infected patients in a recruit school in Switzerland and the herein associated challenges.MethodsRetrospective review of COVID-19 cases among Swiss Armed Forces recruits in the early weeks of SARS-CoV-2 pandemic in the canton of Ticino, the southernmost canton of Switzerland. Positive cases were defined with two positive PCR testing for SARS-CoV-2 from nasopharyngeal swabs. Serological testing was performed with a commercially available kit according to manufacturers’ instructions.ResultsThe first case was likely contaminated while skiing during weekend permission. He became symptomatic 4 days later, tested positive for SARS-CoV-2 and was put into isolation. He showed complete symptom resolution after 48 hours. Quarantine was ordered for all recruits with close contact in the past 2 days, a total of 55 persons out of 140 in the company. Seven out of nine recruits in one particular quarantine room became mildly symptomatic. SARS-CoV-2 PCR was positive in one of them. Seven days after initial diagnosis, the index patient and the other one from the quarantine retested positive for SARS-CoV-2, although they had been completely asymptomatic for over 96 hours. Serological testing revealed positive for both patients. All others showed negative IgM and IgG.ConclusionsYoung healthy recruits often showed a mild course of COVID-19 with rapid symptom decline but were persistent SARS-CoV-2 carriers. This illustrates how asymptomatic patients may be responsible for covert viral transmission. An early and prolonged establishment of isolation and quarantine for patients and close contacts is essential to slow down the spread of SARS-CoV-2, especially in the confined space of a military environment.

scholarly journals Ingresos en UCI por causas obstétricas

2018 ◽  
Vol 18 (1) ◽  
pp. 304-345 ◽  
Author(s):  
Luana Feitosa Mourão ◽  
Igor Cordeiro Mendes ◽  
Antonio Dean Barbosa Marques ◽  
Virna Ribeiro Feitosa Cestari ◽  
Roussana Maria Barreto de Brito Braga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
First Trimester ◽  
Lung Edema ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Cross Sectional ◽  
First Trimester Of Pregnancy ◽  
Terapia Intensiva ◽  
Las Mujeres

Objetivou-se analisar as internações de mulheres em idade fértil em uma Unidade de Terapia Intensiva Obstétrica. Estudo transversal, documental e retrospectivo, realizado em uma Unidade de Terapia Intensiva Obstétrica, localizada em Fortaleza/Ceará, com a presença de mulheres em idade fértil admitidas na unidade no ano de 2016. Os dados foram coletados dos prontuários que atenderam aos critérios de inclusão, durante o mês de abril de 2017, mediante um formulário semiestruturado e analisados por meio de estatística descritiva, sendo incluídos 106 prontuários. A maioria das mulheres tinham faixa etária entre 20 a 29 anos, pardas, em união estável, com ensino médio completo, primíperas, com início do pré-natal no 1º trimestre gestacional, com 4 a 6 consultas. Dentre as causas obstétricas diretas (61,1%) as principais foram Eclâmpsia (34,4%), Síndrome de Hellp (15,1%) e Pré-eclâmpsia grave (11%) e para as causas obstétricas indiretas (38,9%) destacam-se Insuficiência renal (13,5%), Edema agudo de pulmão (11,5%) e Cardiopatia (9,6%). Os dados revelam uma linha ténue no que concerne a atenção a saúde da mulheres dentro do ciclo gravídico-puerperal. Su objetivo es analizar los ingresos de mujeres en edad fértil en una Unidad de Cuidados Intensivos Obstétrica. Estudio transversal, documental y retrospectivo, realizado en una Unidad de Cuidados Intensivos Obstétrica, ubicada en Fortaleza / Ceará, con la presencia de mujeres en edad fértil admitidas en la unidad en el año 2016. Los datos fueron recolectados de los registros que atendieron a los criterios de inclusión. Durante el mes de abril de 2017, mediante un formulario semiestructurado y analizado por medio de estadística descriptiva, siendo incluidos 106 registros. La mayoría de las mujeres tenía un grupo de edad entre 20 y 29 años, pardas, en unión estable, con enseñanza media completa, primíperas, con inicio del prenatal en el primer trimestre gestacional, con 4 a 6 consultas. Entre las causas obstétricas directas (61,1%) las principales fueron Eclampsia (34,4%), Síndrome de Hellp (15,1%) y Pre-eclampsia grave (11%) y para las causas obstétricas indirectas (38,9 (%), Se observan las siguientes: Insuficiencia renal (13,5%), Edema agudo de pulmón (11,5%) y Cardiopatía (9,6%). Los datos revelan una línea tenue en lo que concierne a la atención a la salud de las mujeres dentro del ciclo gravídico-puerperal. The objective was to analyze the admission of women of childbearing age to an Obstetric Intensive Care Unit. A cross-sectional, documentary and retrospective study was carried out in an Obstetric Intensive Care Unit, located in Fortaleza/Ceará, with women of childbearing age admitted to the unit in 2016. Data were collected from 106 medical records that met the inclusion criteria during the month of April 2017, using a semi-structured form, and analyzed by means of descriptive statistics. The majority of the women were between 20 and 29 years old, common-law married, with complete secondary education, primiparous, had initiated prenatal care in the first trimester of pregnancy, and attended 4 to 6 consultations. Among the direct obstetric causes (61.1%), the most frequent were Eclampsia (34.4%), HELLP syndrome (15.1%) and Severe preeclampsia (11%). The indirect obstetric causes (38.9%) included Renal insufficiency (13.5%), Acute lung edema (11.5%) and Heart disease (9.6%). Data revealed a fragile health care for women within the pregnant-puerperal cycle.

Endovascular intervention for acute stroke due to infective endocarditis

2012 ◽  
Vol 32 (2) ◽  
pp. E1 ◽  
Author(s):  
Haitham Dababneh ◽  
V. Shushrutha Hedna ◽  
Jenna Ford ◽  
Ziad Taimeh ◽  
Keith Peters ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Acute Stroke ◽  
Case Reports ◽  
Case Series ◽  
Standard Of Care ◽  
Clinical Decision ◽  
Neurological Complications ◽  
Endovascular Interventions ◽  
First Case ◽  
Risk Of Hemorrhage

The overall incidence of neurological complications due to infective endocarditis is as high as 40%, with embolic infarcts more common than hemorrhagic strokes. The standard of care for typical strokes does not apply to infective endocarditis because there is a substantial risk of hemorrhage with thrombolysis. In the last decade there have been multiple case reports of intravenous and intraarterial thrombolysis with successful outcomes for acute strokes with related infective endocarditis, but successful endovascular interventions for acute strokes associated with infective endocarditis are rarely reported. To the authors' knowledge, this report is the first case in the literature to use a mechanical retrieval device in successful vegetation retrieval in an infective endocarditis acute stroke. Although an interventional approach for treatment of acute stroke related to infective endocarditis is a promising option, it is controversial and a cautious clinical decision should be made on a case-by-case basis. The authors conclude that this approach can be tested in a case series with matched controls, because this condition is rare and a randomized clinical trial is not a realistic option.

scholarly journals Emergence of evidence during disease outbreaks: lessons learnt from the Zika virus outbreak

2020 ◽  
Author(s):  
Michel J Counotte ◽  
Kaspar W Meili ◽  
Nicola Low
Keyword(s):  
Infectious Diseases ◽  
Study Design ◽  
Zika Virus ◽  
Case Reports ◽  
Emerging Infectious Diseases ◽  
Case Series ◽  
Disease Outbreaks ◽  
Basic Research ◽  
First Case ◽  
Over Time

AbstractIntroductionOutbreaks of infectious diseases trigger an increase in scientific research and output. Early in outbreaks, evidence is scarce, but it accumulates rapidly. We are continuously facing new disease outbreaks, including the new coronavirus (SARS-nCoV-2) in December 2019.The objective of this study was to describe the accumulation of evidence during the 2013-2016 Zika virus (ZIKV) outbreak in the Pacific and the Americas related to aetiological causal questions about congenital abnormalities and Guillain-Barré syndrome.MethodsWe hypothesised that the temporal sequence would follow a pre-specified order, according to study design. We assessed 1) how long it takes before findings from a specific study design appear, 2) how publication of preprints could reduce the time to publication and 3) how time to publication evolves over time.ResultsWe included 346 publications published between March 6, 2014 and January 1, 2019. In the 2013-–2016 ZIKV outbreak, case reports, case series and basic research studies were published first. Case-control and cohort studies appeared between 400–700 days after ZIKV was first detected in the region of the study origin. Delay due to the publication process were lowest at the beginning of the outbreak. Only 4.6% of the publications was available as preprints.DiscussionThe accumulation of evidence over time in new causal problems generally followed a hierarchy. Preprints reduced the delay to initial publication. Our methods can be applied to new emerging infectious diseases.

scholarly journals Successful Treatment of Pityriasis Rubra Pilaris with Brodalumab

2020 ◽  
Vol 4 (2) ◽  
pp. 139
Author(s):  
Umair Khan ◽  
Nahla Shihab ◽  
Robert G Phelps ◽  
Mark Lebwohl
Keyword(s):  
Combination Therapy ◽  
Successful Treatment ◽  
Skin Disease ◽  
Case Reports ◽  
Case Series ◽  
Inflammatory Skin Disease ◽  
Clinical Appearance ◽  
Pityriasis Rubra Pilaris ◽  
First Case ◽  
Inflammatory Skin

Pityriasis Rubra Pilaris (PRP) is a rare inflammatory skin disease with highly variable clinical appearance. Treatment of PRP remains a challenge and has been mostly guided by case reports and case series. We report the first case of pityrisis rubra pilaris that is successfully treated with combination therapy of brodalumab and methotrexate.

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