Maternal Perinatal Characteristics in Patients with Severe Preeclampsia: A Case-Control Nested Cohort Study

Preeclampsia is one of the most worrisome complications during pregnancy, affecting approximately 1 out of 20 women worldwide. Preeclampsia is mainly characterized by a sustained hypertension, proteinuria, also involving a significant organ dysfunction. Moreover, 25% of the cases could be classified as severe preeclampsia (SP), a serious condition that could be life-threatening for both the mother and fetus. Although there are many studies focusing on preeclampsia, less efforts have been made in SP, frequently limited to some specific situations. Thus, the present study aims to conduct a comparative analysis of risk factors, maternal characteristics, obstetric and neonatal outcomes and maternal complications in patients with severe preeclampsia versus patients without severe preeclampsia. Hence, 235 cases and 470 controls were evaluated and followed in our study. We described a set of variables related to the development of severe preeclampsia, including maternal age > 35 years (69.8%), gestational (26.8%) or chronic arterial hypertension (18.3%), obesity (22.6%), use of assisted reproduction techniques (12.3%), prior history of preeclampsia (10.2%) and chronic kidney disease (7.7%) All patients had severe hypertension (>160 mmHg) and some of them presented with additional complications, such as acute renal failure (51 cases), HELLP syndrome (22 cases), eclampsia (9 cases) and acute cerebrovascular accidents (3 cases). No case of maternal death was recorded, although the SP group had a higher cesarean section rate than the control group (60% vs. 20.9%) (p < 0.001), and there was a notably higher perinatal morbidity and mortality in these patients, who had a prematurity rate of 58.3% (p < 0.001) and 14 perinatal deaths, compared to 1 in the control group. Overall, our study recognized a series of factors related to the development of SP and related complications, which may be of great aid for improving the clinical management of this condition.

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Factors Influencing Maternal Mortality from Severe Preeclampsia and Eclampsia

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v36i2.293 ◽

2016 ◽

Author(s):

Denny Khusen

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Maternal Mortality ◽

Maternal Death ◽

Gestational Age ◽

Post Partum ◽

Severe Preeclampsia ◽

Maternal Complications ◽

History Of ◽

Post Partum Bleeding

Objective: To analyze risk factor, both clinical and laboratory findings, associated with maternal mortality from severe preeclampsia and eclampsia in Atma Jaya Hospital. Methods: This was a retrospective case control study. All medical records of maternal death associated with severe preeclampsia and eclampsia between 1st January 2009 and 31st December 2011 were obtained and then information about risk factors were collected and tabulated. Risk factor analyzed were maternal age, gestational age, parity, coexisting medical illness (hypertension), antenatal examination status, maternal complications, systolic and diastolic blood pressure at admission, and admission laboratory data. Results: There were 19 maternal deaths associated with severe preeclampsia and eclampsia during period of study (Consisted of 6 cases of eclampsia and 13 cases of severe preeclampsia). Maternal mortality rate for severe preeclampsia and eclampsia were 16.7% and 33.3% respectively. Multivariate analysis identified the following risk factors associated with maternal death: gestation age <32 week, history of hypertension, thrombocyte count < 100.0000/Î¼l, post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. Conclusion: In this study, we found that gestational age, history of hypertension, and platelet count are the cause of maternal mortality. Maternal complications associated with maternal mortality are post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. [Indones J Obstet Gynecol 2012; 36-2: 90-4] Keywords: eclampsia, maternal mortality, preeclampsia

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Abstract 18516: Regional Dysfunction of Left Atrial Appendage and its Association with Stroke in Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.18516 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Abdullah A Alissa ◽

Yuko Inoue ◽

Jochen Cammin ◽

Qiulin Tang ◽

Elliot Fishman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Control Group ◽

Prior History ◽

Area Change ◽

Increased Risk ◽

History Of ◽

Regional Dysfunction

Background: Atrial Fibrillation (AF) is associated with an increased risk of cardioembolic stroke. Previous studies demonstrate that the Left atrial appendage (LAA) is the most common site of intracardiac thrombus, and the LAA morphology alone may determine the risk of stroke. We aimed to determine the association between LAA regional dysfunction using novel, noninvasive, image-based motion-estimation CT (iME) and prior history of stroke in patients with AF. Methods: Among the patients with history of AF referred for ablation who underwent pre-ablation CT with retrospective ECG gating, we identified 18 patients with a prior history of stroke or TIA, and 18 age- and gender-matched controls. The patients in AF at the time of CT were excluded. Four-dimensional motion vector field was estimated from reconstructed CT images using iME at every 5% RR interval. To assess myocardial deformation, area change ratio and area change rate were calculated over the endocardial surface of the LA and LAA. Univariate and multivariate comparisons were made by using binary logistic regression model. Results: A total of 36 patients (mean age 67.6 ± 8.1 years, 66.7% male, 16.7% persistent AF) were included in the study. Univariate analysis showed that the LA pre-atrial contraction area change ratio and LAA maximum area change ratio were significantly lower (P= 0.02 and 0.04, respectively) in the stroke/TIA group compared to the control group. These changes remained statistically significant in multivariate analysis (P=0.03 and 0.04, respectively) after adjusting for age, sex, body mass index, LV ejection fraction, type of AF, and CHADS score. Conclusions: LAA regional dysfunction is associated with stroke/TIA in patients with AF. LAA regional dysfunction detected by iME could represent a marker for stroke and a possible therapeutic target.

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The Investigation of Tramadol Dependence with No History of Substance Abuse: A Cross-Sectional Survey of Spontaneously Reported Cases in Guangzhou City, China

BioMed Research International ◽

10.1155/2013/283425 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Haoran Zhang ◽

Zhimin Liu

Keyword(s):

Substance Abuse ◽

Physical Dependence ◽

Abuse Potential ◽

Opiate Withdrawal ◽

Control Group ◽

Prior History ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Healthy Men ◽

History Of

The study was to survey and assess the drug dependence and abuse potential of tramadol with no history of substance abuse. Subjects of tramadol dependence with no prior history of substance abuse were surveyed by interview. Physical dependence of tramadol was assessed using 10 items opiate withdrawal scale (OWS), and psychological dependence was assessed by Addiction Research Center Inventory—Chinese Version (ARCI-CV). Twenty-three male subjects (the median age was23.4±4.1years) referred to the addiction unit in Medical Hospital of Guangzhou with tramadol abuse problems were included in this cross-sectional study. The control group included 87 heroin addicts, 60 methamphetamine (MA) abusers, and 50 healthy men. The scores of OWS of tramadol were 0.83–2.30; the mean scores of identifying euphoric effects–MBG, sedative effects–PCAG, and psychotomimetic effects–LSD of ARCI were8.96±3.08,6.52±3.25, and6.65±2.50, respectively,F= 4.927,P<0.001. Scores of MBG scale in tramadol did not differ from those in heroin and MA groups (P>0.05) but were higher than those in healthy men (P<0.05). Tramadol with no history of substance abuse has a clear risk of producing high abuse potential under the long-term infrequent abuse and the high doses.

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The History of 34 Errors Identified in 874 Patients Analyzed at Weekly Clinical-Pathological Meetings in Two Institutions over 22 Years (1982–2004).

Blood ◽

10.1182/blood.v104.11.5287.5287 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5287-5287 ◽

Cited By ~ 1

Author(s):

Evarist Feliu ◽

Blanca Xicoy ◽

Maria Rozman ◽

Fuensanta Milla ◽

Josep-Lluis Aguilar ◽

...

Keyword(s):

Improve Patient Care ◽

Good Method ◽

Chi Square ◽

Acute Leukemias ◽

Chi Square Test ◽

Life Threatening ◽

History Of ◽

The Difference ◽

Logistic Support ◽

Made In

Abstract Clinical-pathological sessions are a good method for solving diagnostic and/or therapeutic problems in patients with hemopathies. In these sessions, errors made during health care given to the patient can be detected. By analyzing how and why these errors are made, we can improve patient care and prevent further mistakes. The objective of this study is to describe 34 errors identified in 874 patients with hemopathies at clinical-pathological meetings in two centers, performed with the aim of solving a diagnostic problem and/or a therapeutic decision or due to a great interest of the case, in two institutions, over 22 years (1982–2004). An intererdisciplinary team of hematology specialists gathered every week at interactive sessions of about 45 minutes each, in both institutions. The methodology of sessions was: a description of the medical history of a patient in a one or two-page report and a revision of the different samples (peripheral blood, bone marrow and lymph node morphology, immunocytochemistry, flow-cytometry, cytogenetic and molecular studies) with the aid of a microscope and a TV monitor. A diagnostic and/or treatment were proposed at the end of the session. Eight-hundred and seventy-four reports were analyzed. All the diagnostics were classified: chronic lymphoproliferatives disorders (445), myeloproliferative and myelodysplastic syndromes (136), acute leukemias (136), other haematological diseases (74), non-haematological diseases (31), without a diagnosis after the meeting (52). We identified diagnostic (D) and therapeutic (T) mistakes and considered as the main causes of the medical error (mistake in the diagnosis and/or treatment): lack of expertise (LE), malpractice (MP), impetuosity (IM), bad logistic support (LS), inexplicable (IN). We divided the 22 years into two decades and each error was classified in one of these two groups. Our own mistakes (OM) and the errors made in other institutions (OI) were identified. A comparison between number of errors made in the first 11 years and the second 11 years was made using a Chi-square test. P<0.05 was considered statistically significant. Thirty-four errors (4 %) were detected, being more D and T (20) rather than only D (14). The type of error detected was: 17 LE, 7 MP, 5 IM, 3 LS, 2 IN. Twenty errors were OM and 14 were made in OI. The difference in the proportion of errors detected during the first and the second decade (6.6 % vs 2.8 %, respectively) was statistically significant (p=0.05). No error led to the death of any patient or were life-threatening in any way. Errors may be made in the diagnosis and treatment of hematologic patients. Although the rate of error found appears to be high, it can be considered as low, since the cases were presented in scientific sessions because of diagnostic and/or therapeutic problems. One of the best ways of improving how to care for future patients is to detect and analyze the errors made. Many lessons can be learnt in this way.

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Risperidone-Induced Neuroleptic Malignant Syndrome: A Case Report and Review

The Canadian Journal of Psychiatry ◽

10.1177/070674379604100112 ◽

1996 ◽

Vol 41 (1) ◽

pp. 52-54 ◽

Cited By ~ 21

Author(s):

Gb Meterissian

Keyword(s):

Case Report ◽

Side Effects ◽

Neuroleptic Malignant Syndrome ◽

Clinical Features ◽

Prior History ◽

Extrapyramidal Side Effects ◽

Life Threatening ◽

History Of ◽

Life Threatening Complication ◽

The One

Objectives: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) — a rare but potentially life-threatening complication of neuroleptic therapy — 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone. Methods: A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone. Results: Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance. Conclusions: These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.

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A rare case scenario: spontaneous diaphragmatic rupture during labor

International Surgery Journal ◽

10.18203/2349-2902.isj20212748 ◽

2021 ◽

Vol 8 (7) ◽

pp. 2241

Author(s):

Shambhu Nath Agrawal ◽

Amit Verma ◽

Sunil Kedia ◽

Amol Padegaonkar ◽

Hari Shankar Mahobia

Keyword(s):

Surgical Intervention ◽

Hepatic Flexure ◽

Diaphragmatic Rupture ◽

Prior History ◽

Case Scenario ◽

Term Delivery ◽

Life Threatening ◽

History Of ◽

Full Term Delivery ◽

Complications And Mortality

Diaphragmatic rupture during labor is not a very common presentation and usually occurs in patients with prior history of traumatic chest or abdominal injury or any congenital abnormality. We presented a case of a 29 year old woman who presented with sudden breathing difficulty two days after a full-term delivery by caesarean section. e-FAST scan suggested the presence of a massive pleural effusion over right side. CT scan of chest revealed large rent in right diaphragm with superior migration of liver and hepatic flexure. Patient was taken for emergent surgical intervention, inter coastal drainage (ICD) tube was placed and surgical repair was performed, patient was further treated in critical care unit, the patient recovered well and was discharged. Though diaphragmatic hernia rupture during labor are not reported often it is life threatening complication that requires immediate surgical intervention to prevent major complications and mortality.

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Under the Radar: A Case Report of a Missed Aortoenteric Fistula

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.4.51791 ◽

2021 ◽

Vol 5 (3) ◽

pp. 312-315

Author(s):

Blake Briggs ◽

David Manthey

Keyword(s):

Case Report ◽

Surgical Intervention ◽

Imaging Modality ◽

Aortic Surgery ◽

Aortoenteric Fistula ◽

Prior History ◽

Gi Bleeding ◽

Life Threatening ◽

History Of ◽

Widespread Availability

Introduction: An aortoenteric fistula (AEF) is an abnormal connection between the aorta and the gastrointestinal tract that develops due to a pathologic cause. It is a rare, but life-threatening, cause of gastrointestinal (GI) bleeding. Although no single imaging modality exists that definitively diagnoses AEF, computed tomography angiography (CTA) of the abdomen and pelvis is the preferred initial test due to widespread availability and efficiency. Case Report: Many deaths occur before the diagnosis is made or prior to surgical intervention. We describe a case of a patient with a history of aortic graft repair who presented with active GI bleeding. Conclusion: Although CTA can make the diagnosis of AEF, it cannot adequately rule it out. In patients with significant GI bleeding and prior history of aortic surgery, vascular surgery should be consulted early on, even if CTA is equivocal.

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Sports education an element of academic development

ECORFAN Journal Spain ◽

10.35429/ejs.2020.13.7.1.6 ◽

2020 ◽

pp. 1-6

Author(s):

Brenda Ivonne MORALES-BENÍTEZ ◽

Ramiro MORALES-HERNÁNDEZ ◽

Ramsés Josafath ALCARAZ-GONZÁLEZ

Keyword(s):

Positive Influence ◽

Point Of View ◽

The Body ◽

Middle Level ◽

Control Group ◽

Participation Decision ◽

History Of ◽

Academic Competencies ◽

Middle Level Students ◽

Made In

Sport is regularly seen as one of the forms of activation of the body that provide motor skills and contribute to healthy health, however it is important to appreciate it from the point of view of knowledge, so its contribution in aspects of academic competencies in students was analyzed upper middle level. In the first part, the history of sport was discussed, as well as the contributions of authors about educational sport and the learning generated. Subsequently, a comparison was made in young upper-middle-level students divided into two groups: the experiential group (they practice and perform exercise, sport and physical activity) and the control group (individuals who are totally sedentary), in order to observe performance. in school performance, class participation, decision making as well as knowing how influential or manipulable their peers can be to analyze and solve problems, in the study a questionnaire was applied to both groups using the Likert scale to know these results. The information obtained shows the positive influence that sport has on the development of educational capacities in students.

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Past SARS-CoV-2 infection elicits a strong immune response after a single vaccine dose

10.1101/2021.03.14.21253039 ◽

2021 ◽

Author(s):

Rossana Elena Chahla ◽

Rodrigo Hernan Tomas-Grau ◽

Silvia Ines Cazorla ◽

Diego Ploper ◽

Esteban Vera Pingitore ◽

...

Keyword(s):

Immune Response ◽

Health Personnel ◽

Vaccine Dose ◽

Antibody Responses ◽

Control Group ◽

Prior History ◽

Secondary Antibody ◽

Strong Immune Response ◽

History Of Disease ◽

History Of

We hypothesized that in individuals with previous SARS-CoV-2 infection, the first vaccine dose would work as a booster, eliciting a faster and more intense immune response. We herein describe antibody responses to the first and second doses of Gam-COVID-Vac (SPUTNIK V) vaccine in health personnel of Tucuman, Argentina, with previous COVID-19 and compared it with uninfected personnel. Individuals with anti-SARS-CoV-2 titers at baseline showed significantly higher responses to the first dose than people with no prior history of disease (p <0.0001), with titers higher to those registered after the second dose in the control group, representing a clear secondary antibody response. This suggests that a single dose of SPUTNIK V for people with previous SARS-CoV-2 infection could contribute to a better use of available doses.

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Pathophysiology and causes of acute hepatic failure

10.1093/med/9780199600830.003.0194 ◽

2016 ◽

Author(s):

Sameer Patel ◽

Julia Wendon

Keyword(s):

Liver Failure ◽

Cerebral Oedema ◽

Acute Hepatic Failure ◽

Clinical Syndrome ◽

Prior History ◽

Drug Induced ◽

Disease Mortality ◽

Haemodynamic Changes ◽

Life Threatening ◽

History Of

Acute liver failure (ALF) is a rare, life-threatening clinical syndrome, resulting in loss of hepatic metabolic and immunological function, in a person with no prior history of liver disease. Mortality can still exceed 50%. ALF is characterized by hepatic encephalopathy (HE) and coagulopathy, occurring within days or weeks. Establishing aetiology is essential for treatment, prognostication, and liver transplantation consideration. Viral hepatitis and drug-induced liver failure are the two commonest causes worldwide. Aetiology and time of onset of encephalopathy determines prognosis. Disease progression can rapidly result in multi-organ failure. Ammonia has been postulated in the development of HE, cerebral oedema and intracranial hypertension. Coagulopathy can be highly variable, with some patients prothrombotic, or exhibiting balanced coagulation disorders. Systemic inflammatory response syndrome (SIRS) and associated infection are frequently observed. Significant haemodynamic changes are common while renal failure is an independent risk factor for mortality. Respiratory failure is less common. Deranged homeostasis results in severe hypoglycaemia, and metabolic disturbance.

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