scholarly journals Fetal Surveillance in Pregnancies with Myasthenia Gravis

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1277
Author(s):  
Brîndușa Ana Cimpoca-Raptis ◽  
Anca Marina Ciobanu ◽  
Nicolae Gica ◽  
Gheorghe Peltecu ◽  
Dan Mitrea ◽  
...  

Myasthenia gravis (MG) is an autoimmune condition, that commonly impacts adult women of reproductive age. Myasthenia gravis in pregnancy is rare, but the incidence is higher in different geographical areas. Pregnancies in mothers with MG can have an unfortunate outcome. Acetylcholine receptor antibodies may pass into the fetal circulation and can affect the fetal neuromuscular junction, generating transient MG or even fetal arthrogryposis. The 2016 and 2021 International Consensus Guidance for Management of Myasthenia Gravis issued by Myasthenia Gravis Foundation of America is lacking in recommendation for fetal surveillance for pregnancies in women with MG. The aim of this paper is to highlight fetal and neonatal complications in mothers with MG and to offer antenatal care insights. Close maternal and pregnancy monitoring can improve pregnancy outcome. Patients with MG should be encouraged to conceive, to avoid triggers for exacerbations of the disease during pregnancy and a multidisciplinary team should be established to ensure the optimal support and therapy.

PLoS ONE ◽  
2020 ◽  
Vol 15 (7) ◽  
pp. e0235967
Author(s):  
Lucia Hernández-Barrera ◽  
Belem Trejo Valdivia ◽  
Martha Maria Téllez-Rojo ◽  
Simón Barquera ◽  
Cinthya Muñoz-Manrique

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Oyinkansola Islamiyat Lawal ◽  
Jameelu-deen Omokunmi Yusuff

Abstract Background Anti-Müllerian hormone is a dimeric glycoprotein produced by the granulosa cells of preantral and small antral follicles of the ovaries. It is a reliable biomarker of ovarian reserve, ageing, and response in the management of women with infertility. However, there are few studies on the determinants of serum anti-Müllerian hormone in Nigerian women. This study aimed to investigate determinants of serum anti-Müllerian hormone among adult women of reproductive age. The study was a hospital-based cross-sectional study involving 161 women of reproductive age attending the gynaecology clinic and immunisation clinic of a Nigerian tertiary hospital. Baseline characteristics were collected using a semi-structured questionnaire. Serum anti-Müllerian hormone was quantified using enzyme-linked immunosorbent assay. Results In univariate analysis, age (B = − 0.035, P = 0.000), parity (B = − 0.080, P = 0.001), and infertility duration (B = − 0.050, P = 0.011) had a negative relationship with serum anti-Müllerian hormone, while ethnicity (B = 0.180, P = 0.040), body mass index (B = 0.015, P = 0.010), and cycle length (B = 0.042, P = 0.000) had a positive relationship with serum anti-Müllerian hormone. In multivariable analysis, all relationships except infertility duration persisted. Conclusion We found that age, ethnicity, parity, infertility duration, body mass index, and cycle length were associated with serum anti-Müllerian hormone. A large prospective population-based study is required to better understand factors that are associated with serum anti-Müllerian hormone in an ethnically diverse country like Nigeria.


2021 ◽  
Vol 81 (12) ◽  
pp. 1301-1306
Author(s):  
Maritta Kühnert ◽  
Markus Schmidt ◽  
Bettina Kuschel ◽  
Ute Margaretha Schäfer-Graf

AbstractMyasthenia gravis is an autoimmune disease with a range of clinical presentations which manifest as combinations of weakness of the ocular, bulbar, and respiratory muscle groups and muscles of the extremities. Young women of reproductive age are most commonly affected. Preconception planning, the impact of pregnancy, prepartum management, drug therapy in pregnancy, myasthenic and cholinergic crises, fetal monitoring, peripartum management including analgesia and anesthesia during labor and cesarean section as well as neonatal management and neonatal myasthenia gravis are described here and the appropriate recommendations are given.


2020 ◽  
Author(s):  
Alick Sixpence ◽  
Owen Nkoka ◽  
Gowokani C. Chirwa ◽  
Edith B. Milanzi ◽  
Charles Mangani ◽  
...  

Abstract Background: Malawi is a malaria-endemic country and approximately 6 million cases are reported annually. Improving knowledge of malaria causes and symptoms, and the overall perception towards malaria and its preventive measures is vital for malaria control. Thus, the current study investigated the levels of knowledge of the causes, symptoms, and prevention of Malaria among Malawian women. Methods: We analyzed data from the 2017 wave of the Malawi Malaria Indicator Survey (MIS). In total, 3,422 women of reproductive age (15–49 years) were sampled and analyzed. We assessed the levels of women’s knowledge about 1), causes of malaria 2) symptoms of malaria and 3) preventive measures. The tertiles of the composite score were used as the cut-offs to categorize the levels of knowledge as ‘‘low”, ‘‘medium” and ‘‘high”. Multinomial logistic regression models were constructed to assess the independent factors while taking into account the complex survey design. Results : All in all, 49.74% of all respondents had high levels of knowledge of causes, symptoms, and preventive measures. The high level of knowledge was 45% for rural women and 55% for urban dwellers. After adjustment for independent factors, women of age group 15–19 years adjusted odds ratio ([aOR]: 2.58; 95% Confidence Interval [CI]: 1.69–3.92), women with no formal education (aOR: 3.73; 95% CI: 2.20–6.33), women whose household had no television (aOR: 1.50; 95% CI: 1.02–2.22), women who had not seen/heard malaria message (aOR: 1.53; 95% CI: 1.20–1.95), women of Yao tribe (aOR: 1.95; 95% CI: 1.10–3.46) and women from rural areas had low levels of knowledge about the causes of malaria, symptoms of malaria, and preventive measures. Additionally, the results also showed that women aged 15–19 years (beta [β] = -0.73, standard error [SE] = 0.12); P <.0001, women with no formal education (β = -1.17, SE = 0.15); P <.0001, women whose household had no radio (β = -0.15, SE = 0.0816); P =0.0715 and women who had not seen or heard malaria message (β = -0.41, SE = 0.07); P <.0001 were likely to have a lower knowledge score. Conclusions: The levels of malaria knowledge were reported to be unsatisfactory among adult women, underscoring the need to scale up efforts on malaria education. Beside insecticide-treated bed nets (ITNs) and prompt diagnosis, malaria can be best managed in Malawi by increasing knowledge of malaria causes, and symptoms especially for younger women, women with no formal education, women whose households have no media, women from Yao tribes and rural dwellers.


2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ying Zhang ◽  
Hongmei Yu ◽  
Rui Dong ◽  
Xuan Ji ◽  
Fujun Li

Myasthenia gravis (MG) is a chronic autoimmune disease of the nervous system, which is still incurable. In recent years, with the progress of immunosuppressive and supportive treatment, the therapeutic effect of MG in the acute stage is satisfactory, and the mortality rate has been greatly reduced. However, there is still no consensus on how to conduct long-term management of stable MG, such as guiding patients to identify relapses, practice exercise, return to work and school, etc. In the international consensus guidance for management of myasthenia gravis published by the Myasthenia Gravis Foundation of America (MGFA) in 2020, for the first time, “the role of physical training/exercise in MG” was identified as the topic of discussion. Finally, due to a lack of high-quality evidence on physical training/exercise in patients with MG, the topic was excluded after the literature review. Therefore, this paper reviewed the current status of MG rehabilitation research and the difficulties faced by stable MG patients in self-management. It is suggested that we should take advantage of artificial intelligence (AI) and leverage it to develop the data-driven decision support platforms for MG management which can be used for adverse event monitoring, disease education, chronic management, and a wide variety of data collection and analysis.


Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011124 ◽  
Author(s):  
Pushpa Narayanaswami ◽  
Donald B. Sanders ◽  
Gil Wolfe ◽  
Michael Benatar ◽  
Gabriel Cea ◽  
...  

ObjectiveTo update the 2016 formal consensus-based guidance for the management of myasthenia gravis (MG) based on the latest evidence in the literature.MethodsIn October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness method was used to develop consensus recommendations pertaining to 7 treatment topics. In February 2019, the international panel was reconvened with the addition of one member to represent South America. All prior recommendations were reviewed for currency, and new consensus recommendations were developed on topics that required inclusion or updates based on recent literature. Up to 3 rounds of anonymous e-mail votes were used to reach consensus, with modifications to recommendations between rounds based on panel input. A simple majority vote (80% of panel members voting “yes”) was used to approve minor changes in grammar and syntax to improve clarity.ResultsThe previous recommendations for thymectomy were updated. New recommendations were developed for the use of rituximab, eculizumab and methotrexate as well as for the following topics: early immunosuppression in ocular MG and MG associated with immune checkpoint inhibitor treatment.ConclusionThis updated formal consensus guidance of international MG experts, based on new evidence, provides recommendations to clinicians caring for MG patients worldwide.


Neurology ◽  
2016 ◽  
Vol 87 (4) ◽  
pp. 419-425 ◽  
Author(s):  
Donald B. Sanders ◽  
Gil I. Wolfe ◽  
Michael Benatar ◽  
Amelia Evoli ◽  
Nils E. Gilhus ◽  
...  

2017 ◽  
Vol 4 (3) ◽  
pp. 54
Author(s):  
Wei-Bin Liu ◽  
Hao Ran ◽  
Chuang-Yi Ou ◽  
Li Qiu ◽  
Zhi-Dong Huang ◽  
...  

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