scholarly journals Takayasu arteritis in pregnancy: A case series

2020 ◽  
Vol 8 (2) ◽  
pp. 109-113
Author(s):  
Ipsita Mohapatra ◽  
Subha Ranjan Samantaray ◽  
priyanka G ◽  
Vivekananda Achanta
Keyword(s):  
Takayasu Arteritis ◽  
Neonatal Outcome ◽  
Systemic Vasculitis ◽  
Case Series ◽  
Fetal Outcome ◽  
Chronic Inflammatory Disease ◽  
Unknown Etiology ◽  
Primary Systemic Vasculitis ◽  
Sparing Effect ◽  
In Pregnancy

Takayasu arteritis is a disease of unknown etiology which is a primary systemic vasculitis leading to stenotic and occlusive changes. Takayasu arteritis is a chronic inflammatory disease in progressive pattern which chiefly affects the aorta and its main branches. The diagnosis of the disease is mainly based on the clinical suspicion, history, physical examination and vascular imaging. We present here three cases of takayasu arteritis in pregnancy that were treated at our institute in the last 5 years. 1st case had complications like severe preeclampsia, abruption, temporary loss of vision, and intra uterine death of fetus. In 2nd case there was brain sparing effect of fetus, but other than that she did not have any other complications and neonatal outcome was also good without any neonatal complications. In the 3rd case antenatal and postnatal periods were uneventful and with good neonatal outcome. Pregnancy with takayasu arteritis needs to be timely diagnosed and treated for best maternal and fetal outcome.

scholarly journals AB1009 THE EFFICACY OF TOCILIZUMAB ON THE TREATMENT OF TAKAYASU ARTERITIS IN CHINESE CHILDREN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1798.2-1798
Author(s):  
C. Wang ◽  
H. Song ◽  
Z. Yu ◽  
M. Quan
Keyword(s):  
Takayasu Arteritis ◽  
Case Series ◽  
Large Vessel Vasculitis ◽  
Chinese Children ◽  
Large Vessel ◽  
Efficacy And Safety ◽  
Imaging Data ◽  
Eular Recommendations ◽  
Interleukin 6 Receptor ◽  
Sparing Effect

Background:Takayasu arteritis (TA) is the most prevalent large-vessel vasculitis in children. Patients with TA have a high mobidity and mortality.It remains a therapeutic challenge because corticosteroids monotherapy can rarely cure TAK and the relapse rate is high during GC tapering.Objectives:The aim of this study is to investigate the efficacy and safety of tocilizumab (TCZ)in Chinese children with Takayasu arteritis(TAK).Methods:We retrospectively studied 6 TAK children treated with TCZ in our hospital from July 2017 to October 2018. The demographic and clinical data, laboratory examination results and vascular imaging data were collected.Results:Six pediatric patients with critical or refractory TAK treated with TCZ were analyzed, including 3 males and 3 females.The diagnosis age was ranging in age from 2 to 13 years(median age:7 years).Three patients were initially treated with TCZ and Mycophenolate Mofetil(MMF) as the first-line regimen without corticosteroid or with a quite rapid GC taper duration,two of which had lifte-threatening coronary arteries involved and heart failure.The other three paitients were swcithed to TCZ from conventional disease modifying anti-rheumatic drugs (DMARDs) or other biologics due to being refractory to them and recurrent relapses.Four patients were given TCZ at 4 weeks regular intervals for 10 to 22 months,while two patients withdrew TCZ because of disease deterioration and unbearable abdominal or chest pain after the second dose.After 6 months follow-up,four patients experienced significant clinical and biological improvement with angiographically progression in one patient. A corticosteroid-sparing effect is obvious. Drug-related side effects occur in 1 patients manifesting as a mild elevated liver fuction. Neither neutropenia nor infection was observed.Conclusion:Our study shows a clinical, biological, and radiological response in patients with refractory TAK treated with TCZ.References :[1]Hellmich B, Agueda A, Monti S,et al.2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2019;0:1–12. doi:10.1136/annrheumdis-2019-215672.[2]BravoMancheño B, Perin F, Guez Vázquez Del ReyMDMR, García Sánchez A, Alcázar Romero PP. Successful tocilizumab treatment in a child with refractory Takayasu arteritis.Pediatrics 2012;130(6):e1720-724.[3]Goel R, Danda D, Kumar S, Joseph G. Rapid control of disease activity by tocilizumab in 10 «difficult-to-treat» cases of Takayasu arteritis. Int J Rheum Dis 2013;16(6):754–61.[4]Cañas CA, Cañas F, Izquierdo JH, Echeverri A-F, Mejía M, Bonilla-Abadía F, et al. Efficacy and safety of anti-interleukin 6 receptor monoclonal antibody (tocilizumab) in Colombian patients with Takayasu arteritis. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 2014;20(3):125–9.[5]Batu ED, Sönmez HE, Hazirolan T, Özaltin F, Bilginer Y, Özen S. Tocilizumab treatment in childhood Takayasu arteritis: case series of four patients and systematic review of the literature. Semin Arthritis Rheum 2017 Feb;46(4):529–35.Disclosure of Interests:None declared

scholarly journals A CASE REPORT ON TAKAYASU ARTERITIS

2020 ◽  
Vol 8 (10) ◽  
pp. 167-171
Author(s):  
Hari Chandana Punukula ◽  
◽  
Bospali Kavya Sree ◽  
Vaka Pratyusha ◽  
Swetha Bospali
Keyword(s):  
Young Women ◽  
Takayasu Arteritis ◽  
Systemic Vasculitis ◽  
Signs And Symptoms ◽  
Current Case ◽  
Systemic Arterial Hypertension ◽  
Bilateral Renal Artery Stenosis ◽  
Primary Systemic Vasculitis ◽  
Bilateral Renal Artery ◽  
Type V

Takayasus arteritis primarily affects young women. Takayasu arteritis (TA) is a type of primary systemic vasculitis mainly affecting the medium and large arteries. The signs and symptoms are due to systemic inflammation or ischemia of an organ or limb and include angiodynia, claudication, peripheral pulselessness, murmurs, ischemic stroke, myocardial infarction and severe systemic arterial hypertension. The disease tends to affect more women than men.The current case of Takayasu arteritis type V focuses on a 21 year female who complained of cold, cough, fever, facial puffiness since 2 months, along with bilateral renal artery stenosis, and resistant hypertension.

scholarly journals Fetal and maternal outcomes after maternal biologic use during conception and pregnancy: a systematic review and meta-analysis.

2021 ◽  
Author(s):  
Laura O'Byrne ◽  
Safi Alqatari ◽  
Gillian Maher ◽  
Aoife O'Sullivan ◽  
Ali Khashan ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
English Language ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Linear Regression Analysis ◽  
Case Series ◽  
Neonatal Infection ◽  
Chronic Inflammatory Disease ◽  
Cross Sectional ◽  
In Pregnancy

Background: Biologic medications, specifically the TNF-α inhibitors, have become increasingly prevalent in the treatment of chronic inflammatory disease (CID) in pregnancy. Objective: To determine pregnancy outcomes in women with CID exposed to biologics during pregnancy. Search strategy: PubMed and EMBASE databases were searched through January 1998-July 2021. Selection criteria: Peer reviewed, English language cohort, case-control, cross-sectional studies, and case series which contained original data. Data collection and analysis: Two authors independently conducted data extraction and assessed study quality. A meta-analysis of proportions using a random-effects model was used to pool outcomes. Linear regression analysis was used to compare the mean of proportions of outcomes across exposure groups using the ‘treated’ group as the reference category. All studies were evaluated using an appropriate quality assessment tool described by McDonald et al. Main Results: 35 studies, 11172 pregnancies, were eligible for inclusion. Analysis showed pooled proportions for congenital malformations: treated 4%(95% CI 0.03-0.4) vs disease matched 4%(0.03-0.05).Preterm delivery treated 12%(0.10-0.14) vs disease matched 10%(0.09-0.12) Severe neonatal infection: treated 5%(0.03-0.07) vs disease matched 5%(0.02-0.07) Low birth weight: treated 10%(0.07-0.12) vs disease matched 8%(0.07-0.09) The pooled Miscarriage: treated 13%(0.10-0.15) vs disease matched 8%(0.04-0.11) Pre-eclampsia; treated 1%(0.01-0.02) vs disease matched 1%(0.00-0.01). No statistical differences in proportions were observed. Conclusion: We demonstrated comparable pregnancy outcomes in pregnancies exposed to biologics, disease matched controls and CID free pregnancies. Overall, women receiving biologics in pregnancy may be reassured regarding their safety.

Challenges of Takayasu Arteritis in Pregnancy: A Case Report

2017 ◽  
Vol 51 (4) ◽  
pp. 195-198 ◽  
Author(s):  
Sarah Soo-Hoo ◽  
Jenny Seong ◽  
Brandon R. Porten ◽  
Nedaa Skeik
Keyword(s):  
Heart Failure ◽  
Takayasu Arteritis ◽  
Cardiovascular Complications ◽  
Unknown Etiology ◽  
Optimal Management ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Clinical Challenge ◽  
Increased Risk ◽  
In Pregnancy

Takayasu arteritis is a rare, chronic vasculitis of unknown etiology characterized by inflammation of the aorta and its main branches. Although Takayasu arteritis mostly affects women of childbearing age, there is a paucity in the literature on pregnancy associated with Takayasu arteritis. Pregnant patients are at increased risk of cardiovascular complications, including hypertension and congestive heart failure, which may jeopardize both maternal and fetal outcomes. Furthermore, optimal management has not yet been established for pregnant patients with Takayasu arteritis, posing a clinical challenge. We present a case of a young woman with Takayasu arteritis whose symptoms and disease activity improved during 2 pregnancies. Although her first pregnancy was complicated with preeclampsia, gestational diabetes, and preterm vaginal delivery, her second pregnancy was uneventful. This case provides a rare glimpse of Takayasu arteritis in pregnancy and highlights the challenges of medical management in gravid patients.

scholarly journals ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

2017 ◽  
Vol 177 (2) ◽  
pp. R49-R58 ◽  
Author(s):  
K van der Weerd ◽  
C van Noord ◽  
M Loeve ◽  
M F C M Knapen ◽  
W Visser ◽  
...  
Keyword(s):  
Early Recognition ◽  
Case Series ◽  
Fetal Outcome ◽  
Fetal Mortality ◽  
Tertiary Referral Hospital ◽  
Common Causes ◽  
Alpha Blockade ◽  
Receptor Blockers ◽  
Dedicated Team ◽  
In Pregnancy

Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.

scholarly journals Compassionate use of remdesivir in pregnancy: a case series

2021 ◽  
Vol 10 (10) ◽  
pp. 3950
Author(s):  
Jui R. Shah ◽  
Khushali P. Parikh ◽  
Aayushi A. Suthar ◽  
Sushma R. Shah ◽  
Supriya D. Malhotra
Keyword(s):  
Pregnant Women ◽  
Birth Defects ◽  
Treatment Options ◽  
Antiviral Drug ◽  
Case Series ◽  
Fetal Outcome ◽  
Limited Data ◽  
Compassionate Use ◽  
Healthcare Crisis ◽  
In Pregnancy

Coronavirus disease 2019 (COVID-19) has resulted in an unprecedented global healthcare crisis. One special population that poses a challenge is pregnant women with COVID-19. However, there is limited data on treatment options for severe coronavirus disease in pregnancy. Remdesivir, an antiviral drug, is currently being studied as a potential treatment of COVID-19 pneumonia. Nevertheless, pregnant women are also being excluded from various clinical trials for the disease. There are some studies mentioned in the literature which have shown no adverse effects of remdesivir during pregnancy. In this study, we present four serial cases of COVID-19 in pregnant women with moderate to severe symptoms who were treated with remdesivir. All of the them showed positive fetal outcome without any birth defects or malformations. However, further studies are necessary to evaluate the biosafety and effects of remdesivir in pregnant women.

scholarly journals Clinical characteristics, management, maternal and neonatal outcome among seven severe and critically ill pregnant women with COVID-19 pneumonia

2020 ◽  
Vol 3 (2) ◽  
pp. 158-166
Author(s):  
Hazari Komal Sundeep ◽  
Paulose Litty ◽  
Kurien Nimmi ◽  
Mohammad Hozaifah ◽  
A Elgergawi Taghrid Faek ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Clinical Characteristics ◽  
Case Series ◽  
Fetal Outcome ◽  
World Health ◽  
Investigational Therapies ◽  
Serious Disease ◽  
Novel Coronavirus ◽  
Health Organization ◽  
In Pregnancy

Pneumonia caused by the Novel coronavirus disease 2019 (COVID-19) is a highly infectious disease and the ongoing outbreak has been declared as a Pandemic by the World health organization. Pneumonia is a serious disease in pregnancy and requires prompt attention. Viral pneumonia has higher morbidity and mortality compared to bacterial pneumonia in pregnancy. All efforts are well exerted to understand the newly emerged disease features but still some areas are gray. The treatment is primarily supportive with antivirals, steroids, anticoagulation and antibiotics for secondary bacterial infection. Severe cases require intensive care monitoring with oxygen support, mechanical ventilation. Investigational therapies include convalescent plasma, cytokine release inhibitors and other immunomodulatory agents like interferons. The mortality appears driven by the presence of severe Adult Respiratory Syndrome (ARDS) and organs failure. COVID pandemic is a challenging and stressful socio-economic situation with widespread fear of infection, disease and death. In the specialty of obstetrics and gynecology, studies are being conducted to ascertain the manifestation of disease in pregnant women and the fetal outcome. The aim of our case series is to describe the demographics, clinical characteristics, laboratory and radiological findings, feto- maternal outcome of severe and critical COVID pneumonia in pregnant women in Latifa Hospital.

scholarly journals A CASE REPORT ON TAKAYASU ARTERITIS

2020 ◽  
Vol 8 (9) ◽  
pp. 1289-1293
Author(s):  
Harichandana Punukula ◽  
◽  
Bospali Kavya Sree ◽  
Vaka Pratyusha ◽  
Swetha Bospaly
Keyword(s):  
Young Women ◽  
Takayasu Arteritis ◽  
Systemic Vasculitis ◽  
Signs And Symptoms ◽  
Current Case ◽  
Systemic Arterial Hypertension ◽  
Bilateral Renal Artery Stenosis ◽  
Primary Systemic Vasculitis ◽  
Bilateral Renal Artery ◽  
Type V

Takayasus arteritis primarily affects young women. Takayasu arteritis (TA) is a type of primary systemic vasculitis mainly affecting the medium and large arteries. The signs and symptoms are due to systemic inflammation or ischemia of an organ or limb and include angiodynia, claudication, peripheral pulselessness, murmurs, ischemic stroke, myocardial infarction and severe systemic arterial hypertension. The disease tends to affect more women than men.The current case of Takayasu arteritis type V focuses on a 21 year female who complained of cold, cough, fever, facial puffiness since 2 months, along with bilateral renal artery stenosis, and resistant hypertension.

scholarly journals Successful maternal and fetal outcome in a patient with chronic myeloid leukemia on chemotherapy

2020 ◽  
Vol 9 (2) ◽  
pp. 832
Author(s):  
Nishtha Jaiswal ◽  
Harsha Khullar ◽  
Geeta Mediratta ◽  
Sharmistha Garg
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Philadelphia Chromosome ◽  
Myeloproliferative Neoplasm ◽  
Case Series ◽  
Fetal Outcome ◽  
Total Leucocyte Count ◽  
Term Survival ◽  
Drug Of Choice ◽  
In Pregnancy

Chronic myeloid leukemia (CML) is a myeloproliferative-neoplasm accounting for 15% of adult leukemias. Management of leukemia in pregnancy and effect of anti-neoplastic agents on pregnancy outcomes is not well investigated. Management of pregnancy in CML is complicated by the fact that drug used in its treatment i.e. imatinib can lead to teratogenicity in fetus, whereas withholding the drug may lead to relapse of disease. However, pregnancy itself does not alter course of CML. A 19-year-old female, was diagnosed with CML at 15 years of age. She was positive for Philadelphia chromosome. She was on imatinib and had achieved clinical, hematologic and molecular remission. Patient was on regular follow-up till 18 years of age. 45 months post diagnosis she presented with 8 weeks amenorrhoea. Ultrasound (USG) done at 5 weeks gestation showed a single live intrauterine fetus. She took imatinib during this period of organogenesis, so she was advised medical termination of pregnancy (MTP) by treating oncologist. However, patient denied MTP, so her imatinib was stopped and pregnancy continued. The quantitative Bcr/Abl PCR transcript levels at 16, 20 and 28 weeks of gestation were not detectable. The patient did not develop any symptoms or signs suggestive of CML and total leucocyte count remained normal throughout pregnancy. Patient went into preterm-labor at 36 weeks gestation and delivered a healthy male baby weighing 3.1 kg. The baby was well and had a normal examination. USG abdomen of baby was also normal. CML in pregnancy is rare and imatinib is the drug of choice with which long term survival is possible. Imatinib in large case series has been known to be associated with adverse fetal outcomes although evidence to the contrary also exists. Further studies are needed to draw a conclusion on this debatable issue.

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