scholarly journals Spotted Fever Rickettsial Infection in Pregnancy Causing Acute Hepatitis, Fatal Postpartum Hemorrhage and Possible Vertical Transmission

2021 ◽  
pp. 1-5
Author(s):  
R. M. C. J. Ratnayake ◽  
W. M. M. P. B. Wanasinghe ◽  
P. Dissanayake ◽  
S. A. M. Kularatne ◽  
M. V. G. Pinto ◽  
...  
Keyword(s):  
Acute Hepatitis ◽  
Vertical Transmission ◽  
Epigastric Pain ◽  
Post Partum ◽  
Spotted Fever ◽  
Clinical Manifestations ◽  
Pulmonary Hemorrhage ◽  
Rickettsial Infection ◽  
History Of ◽  
In Pregnancy

We present a rare case of a 31-year-old pregnant mother in 37 weeks of gestation who presented with a 3-day history of vomiting, epigastric pain, and icterus, subsequently diagnosed as a rickettsial disease in pregnancy (with positive IgG titer for SFG) complicated with hepatitis, coagulopathy, pulmonary hemorrhage, and post-partum hemorrhage, who expired despite intensive care management. The newborn baby also had high IgG titer for SFG suggesting a vertical transmission of the disease and recovered following treatment with chloramphenicol. The SFG rickettsial infection can cause diverse clinical manifestations in pregnancy including acute hepatitis and coagulopathy. Therefore, the possibility of SFG rickettsial infection needs to be considered in diagnostic workup in obscure clinical presentations. We postulate possible vertical transmission of SFG to newborns which needs further confirmation. 

scholarly journals Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases

2015 ◽  
Vol 172 (3) ◽  
pp. K11-K17 ◽  
Author(s):  
Giuseppe Bellastella ◽  
Antonio Bizzarro ◽  
Ernesto Aitella ◽  
Mariluce Barrasso ◽  
Domenico Cozzolino ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Arginine Vasopressin ◽  
Post Partum ◽  
Central Diabetes Insipidus ◽  
Pituitary Function ◽  
Unsuccessful Attempt ◽  
Function Recovery ◽  
History Of ◽  
In Pregnancy

Recently, an increased incidence of central diabetes insipidus (CDI) in pregnancy, and less frequently in thepost partumperiod, has been reported, most probably favoured by some conditions occurring in pregnancy. This study was aimed at investigating the influence of pregnancy on a pre-existing potential/subclinical hypothalamic autoimmunity. We studied the longitudinal behaviour of arginine–vasopressin cell antibodies (AVPcAbs) and post-pituitary function in two young women with a positive history of autoimmune disease and presence of AVPcAbs, but without clinical CDI, and who became pregnant 5 and 7 months after our first observation. The behaviour of post-pituitary function and AVPcAbs (by immunofluorescence) was evaluated at baseline, during pregnancy and for 2 years after delivery. AVPcAbs, present at low/middle titres at baseline in both patients, showed a titre increase during pregnancy in one patient and after delivery in the other patient, with development of clinically overt CDI. Therapy with 1-deamino-8-d-arginine vasopressin (DDAVP) caused a prompt clinical remission. After a first unsuccessful attempt of withdrawal, the therapy was definitively stopped at the 6th and the 7th month ofpost partumperiod respectively, when AVPcAbs disappeared, accompanied by post-pituitary function recovery, persisting until the end of the follow-up. The determination of AVPcAbs is advisable in patients with autoimmune diseases planning their pregnancy, because they could be considered good predictive markers of gestational orpost partumautoimmune CDI. The monitoring of AVPcAb titres and post-pituitary function during pregnancy in these patients may allow for an early diagnosis and an early replacement therapy, which could induce the disappearance of these antibodies with consequent complete remission of CDI.

scholarly journals An Unusual Case of Gastric Gnathostomiasis Caused by Gnathostoma spinigerum Confirmed by Video Gastroscopy and Morphological and Molecular Identification

2021 ◽  
Author(s):  
Kookwan Sawadpanich ◽  
Nitiwat Chansuk ◽  
Patcharaporn Boonroumkaew ◽  
Lakkhana Sadaow ◽  
Rutchanee Rodpai ◽  
...  
Keyword(s):  
Molecular Identification ◽  
Unusual Case ◽  
Epigastric Pain ◽  
Parasitic Infection ◽  
Clinical Manifestations ◽  
Surgical Removal ◽  
Its2 Region ◽  
Serological Tests ◽  
Gnathostoma Spinigerum ◽  
History Of

Human gnathostomiasis is a harmful foodborne parasitic infection caused by nematodes of the genus Gnathostoma. Here, we report an unusual case of gastric gnathostomiasis seen in a hospital in Thailand along with the clinical characteristics, treatment, and outcome. A 39-year-old man presented with complaints of epigastric pain, dizziness, and history of passing dark, tarry stools for 2 days. The patient had a history of consuming raw freshwater fish. Supplementary differential diagnosis was performed via rapid serological testing, and presence of the causative agent was confirmed based on video gastroscopy, morphology of the removed parasite, and molecular identification. After its surgical removal from the stomach, the parasite was morphologically identified as Gnathostoma species. Molecular identification was performed via DNA extraction from the recovered worm, and amplification and sequencing of the second internal transcribed spacer (ITS2) region and partial cytochrome c oxidase subunit I (cox1) gene. The ITS2 and cox1 sequences were consistent with those of Gnathostoma spinigerum. Clinicians in endemic areas should therefore be aware of the rare clinical manifestations and use of supplementary serological tests to facilitate early diagnosis and treatment of gastric gnathostomiasis.

scholarly journals Acceptability of HCV screening and potential use of DAAs during pregnancy in women attending antenatal care in Egypt, Pakistan and Ukraine

2021 ◽  
Author(s):  
Karen Scott ◽  
Elizabeth Chappell ◽  
Aya Mostafa ◽  
Alla Volokha ◽  
Nida Najmi ◽  
...  
Keyword(s):  
Vertical Transmission ◽  
Post Partum ◽  
Hiv Status ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Safety And Efficacy ◽  
Maternity Hospitals ◽  
Hcv Screening ◽  
The Uk ◽  
In Pregnancy

AbstractBackgroundThe risk of vertical transmission of hepatitis C virus (HCV) is ≈6%, and evidence suggests HCV negatively affects pregnancy and infant outcomes. Despite this, universal antenatal HCV screening is not available in most settings, and direct acting antivirals (DAA) are yet to be approved for use in pregnancy or breastfeeding period. Larger safety and efficacy trials are needed. At current there is limited understanding of the acceptability of routine HCV screening and use of DAAs in pregnancy but only among women in high HCV burden countries.MethodsWe conducted a cross-sectional survey of pregnant or post-partum (<6 months since delivery) women attending antenatal clinics or maternity hospitals in Egypt, Pakistan and Ukraine. In Ukraine, this included one HIV clinic. Acceptability of free universal antenatal HCV screening and potential uptake of DAA treatment in the scenario of DAAs being approved for use in pregnancy was assessed. Results were stratified by HCV status and in Ukraine by HIV status. Descriptive statistics were used to explore differences in acceptability of treatment in pregnancy by country.FindingsAmong 630 women (n=210 per country) who participated, the median age was 30 [interquartile range (IQR) 26, 34] years, 73% were pregnant and 27% postpartum, and 27% ever HCV antibody or PCR positive. 40% of women in Ukraine were living with HIV. Overall 93% of women supported free universal HCV screening in pregnancy, with no difference by country. 88% would take DAAs in pregnancy if approved for use: 92%, 98% and 73% among women in Egypt, Pakistan and Ukraine, respectively. Motivation for use of DAAs in pregnancy (to avert vertical transmission or for maternal HCV cure) varied by country, HCV status and HIV status (in Ukraine). No predictors for acceptability of DAAs were identified.InterpretationOur survey across 3 high burden countries found very high acceptability of free universal HCV screening and DAAs if approved for use in pregnancy. Clinical trials to evaluate the safety and efficacy of DAAs during pregnancy and breastfeeding are urgently required.FundingThis survey was conducted as part of the “HCVAVERT” study, funded by the UK Medical Research Council (ref MR/R019746/1).

scholarly journals Antiphospholipid Syndrome

2019 ◽  
Vol 9 (4) ◽  
pp. 37-42
Author(s):  
Thaís da Silva Santos ◽  
Izabel Galhardo Demarchi ◽  
Tatiane França Perles Mello ◽  
Jorge Juarez Vieira Teixeira ◽  
Maria Valdrinez Campana Lonardoni
Keyword(s):  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Binding Proteins ◽  
Clinical Manifestations ◽  
Cellular Activation ◽  
Pathophysiological Mechanisms ◽  
Individual Character ◽  
History Of ◽  
Autoimmune Condition ◽  
In Pregnancy

Antiphospholipid syndrome (APS) was characterized as an autoimmune condition with the production of antiphospholipid antibodies (aPL) associated with thrombosis and morbidity in pregnancy. The prevalence of aPL in the population ranges from 1% to 5% in patients with APS. The hypotheses regarding pathophysiological mechanisms are strongly related to binding proteins and antiphospholipid antibodies. The exact mechanisms by which they lead to clinical manifestations appear to be heterogeneous, but it is believed which aPL contribute to the cellular activation/coagulation, and so cause the thrombotic events. The treatment of APS should be an individual character and several factors should be taken into accounts, such as a number of antibodies, the age of the patient and the history of thrombotic events.

scholarly journals Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

Pathogens ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. 832
Author(s):  
Claudia Minosse ◽  
Elisa Biliotti ◽  
Daniele Lapa ◽  
Alessia Rianda ◽  
Mauro Marchili ◽  
...  
Keyword(s):  
Viral Load ◽  
Acute Hepatitis ◽  
Epigastric Pain ◽  
Clinical Manifestations ◽  
Clinical Information ◽  
Hepatitis E ◽  
International Normalized Ratio ◽  
Genotype 3 ◽  
Lazio Region ◽  
Acute Hepatitis E

Genotype 3 (GT3) is responsible for most European autochthonous hepatitis E virus (HEV) infections. This study analyzed circulating genotypes and GT3 subtypes in the Lazio region, Italy, between 2011 and 2019, as well as their pathogenic characteristics. Of the 64 evaluable HEV GT3 patient-derived sequences, identified subtypes included GT3f (n = 36), GT3e (n = 15), GT3c (n = 9), GT3a (n = 1) and three unsubtyped GT3 sequences. GT3c strains were similar to Dutch sequences (96.8–98.1% identity), GT3e strains showed high similarity (96.8%) with a United Kingdom sequence, while the most related sequences to GT3f Italian strains were isolated in France, Belgium and Japan. One sequence was closely related to another Italian strain isolated in raw sewage in 2016. The liver functioning test median values for 56 evaluable GT3 patients were: alanine aminotransferase (ALT), 461 (range 52–4835 U/L); aspartate aminotransferase (AST), 659 (range 64–6588 U/L); and total bilirubin, 3.49 (range 0.4–33 mg/dL). The median HEV RNA viral load for 26 evaluable GT3 patients was 42,240 IU/mL (range 5680–895,490 IU/mL). Of the 37 GT3 patients with available clinical information, no correlation was observed between HEV clinical manifestations and GT3 subtype. HEV symptoms were comparable among GT3c/e/f patients across most analyzed categories except for epigastric pain, which occurred more frequently in patients with HEV GT3e (75%) than in patients with GT3c (50%) or GT3f (19%) (p = 0.01). Additionally, patients with HEV GT3c exhibited significantly higher median international normalized ratio (INR) than patients with GT3e and GT3f (p = 0.033). The severity of GT3 acute hepatitis E was not linked to HEV RNA viral load or to the GT3 subtype.

Prophylactic Low Molecular Weight Heparin (LMWH) during Pregnancy Is Not Associated with a Decrease in Bone Mineral Density (BMD). The TIPPS (Thrombophilia in Pregnancy Prophylaxis Study) BMD Substudy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 548-548 ◽  
Author(s):  
Marc A. Rodger ◽  
Alejandro Lazo-Langner ◽  
Susan Kahn ◽  
Michael Kovacs ◽  
Sue Robinson ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Pregnant Women ◽  
Post Partum ◽  
Ctrl Group ◽  
T Score ◽  
History Of ◽  
Post Hoc ◽  
In Pregnancy

Abstract Background: Decreased BMD is a relatively common serious complication of long-term heparin use, however there have not been adequately powered randomized controlled trials addressing its risk in association with long-term use of LMWH. The TIPPS study is an ongoing multi-center randomized trial designed to compare the effect of LMWH prophylaxis vs. no prophylaxis on pregnancy outcomes in thrombophilic pregnant women. A separate sub-study was planned a priori to assess the effect of LMWH on BMD. Methods: Pregnant women (&lt;20 weeks) were included if they had history of: pregnancy complications or were at moderate risk of venous thrombosis, and had a confirmed thrombophilia. They were excluded if they had history of underlying bone or thyroid disease, long-term use of corticosteroids, metabolic bone agents or anticonvulsants, or &gt;100 kg wt. Patients (pts) were randomized to either LMWH (dalteparin [dalt] 5,000 U qd until 20 wks and then 10,000 qd until term) or control (ctrl) group. All participants received post-partum dalt 5,000 U qd from postpartum d1 to d42. BMD (hip and lumbar spine) was performed 6 wk post-partum. A sample size of 26 pts per group was calculated to detect a 10% difference in absolute BMD (α=0.05, β=0.10). Primary outcome was absolute spine BMD compared using an unpaired t-test. Results were analyzed as-treated; 31 pts received dalt and 22 did not (4 pts randomized to ctrl group crossed over). BMD and T-score results in treatement groups Dalteparin1 No dalteparin1 p Value 1Mean (SD) BMD (spine) 1.12 (0.26) 1.21 (0.14) 0.115 T-score (spine) −0.32 (1.25) 0.13 (1.15) 0.196 BMD (hip) 0.97 (0.21) 1.02 (0.12) 0.319 T-score (hip) 0.17 (0.96) 0.36 (1.01) 0.479 Duration of dalt treatment was 214.5±41.9d for dalt group and 47±38.6d for ctrl (p&lt;0.001). Two cases of osteoporosis (Opo) and 7 cases of osteopenia (Ope) were documented in the dalt group vs 0 of Opo and 3 of Ope in the ctrl group respectively. Results of post-hoc logistic regression analysis examining the odds of obtaining an abnormal (Opo or Ope) spine or hip BMD result in both treatment groups were non significant (Crude OR 2.59; 95%CI 0.61, 10.97; p=0.20; Adjusted OR 6.83; 95%CI 0.17, 272.33; p=0.307) as well as results of post-hoc multiple linear regression to predict changes in BMD and T-scores. Multiple linear regression analysis predicting BMD and T-score in patients receiving dalteparin Unadjusted Adjusted Beta (SE) p Beta (SE) p BMD (spine) −0.099(0.06) 0.12 −0.226(0.16) 0.16 BMD (hip) −0.051(0.05) 0.32 −0.190(0.13) 0.15 T-score (spine) −0.444(0.34) 0.66 −0.641(0.87) 0.47 T-score (hip) −0.195(0.27) 0.48 −0.661(0.68) 0.34 Conclusion: Our results suggest that the use of long term prophylactic dalteparin in pregnancy is not associated with a significant decrease in BMD.

P01-204-Predictors of recurrence of bipolar disorder during pregnancy and postpartum period in a sample of egyptian women

2011 ◽  
Vol 26 (S2) ◽  
pp. 205-205 ◽  
Author(s):  
M.A. Abd El-Hay ◽  
H.F. El Sawy ◽  
A.A. Badawy
Keyword(s):  
Bipolar Disorder ◽  
Age Of Onset ◽  
Unplanned Pregnancy ◽  
Post Partum ◽  
Bipolar I Disorder ◽  
Duration Of Illness ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
History Of ◽  
In Pregnancy

IntroductionPregnancy and the postpartum are times of increased risk for women with bipolar disorder to develop new episodes.ObjectiveTo evaluate factors that are supposed to be associated with recurrence of bipolar I disorder among euthymic women with a history of bipolar I disorder, which could be used as a predictors of bipolar I disorder in that period.MethodEighty-three pregnant women with history of bipolar I disorder were followed through pregnancy and post-partum periods for possible recurrence of a new episode. All women were assessed using the MINI International Neuropsychiatric Interview. Factors that may contribute to recurrence were assessed prospectively; these included age of patients, age of onset of bipolar disorder, duration of illness, number of previous attacks, number of previous pregnancies, prior episodes in pregnancy or postpartum, complications during pregnancy and labor, pregnancy type, prior hospitalization, prior suicidal attempts, time since last episode in months, and continuation of medications.ResultsSixty five % of euthymic bipolar females had recurrence of a new episode, either during pregnancy (33.73%) or 4 weeks postpartum (31.32%). Discontinuation of medications, longer duration of illness, more number of previous attacks, more number of previous pregnancies, more prior episodes in pregnancy, more complication during pregnancy, more complication during labor, unplanned pregnancy type, prior hospitalization, were associated with recurrence of bipolar disorder during pregnancy and postpartum.ConclusionsMultiple factors were associated with risk of recurrence of bipolar I disorder during pregnancy and postpartum, which should be while planning treatment for such women.

Syphilis gastritis: a case report

2017 ◽  
Vol 29 (7) ◽  
pp. 723-725
Author(s):  
Kuan Lai ◽  
Nicolas Pinto-Sander ◽  
Daniel Richardson ◽  
Shanshan Wei ◽  
Kang Zeng
Keyword(s):  
Gastric Mucosa ◽  
Histopathological Examination ◽  
Epigastric Pain ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Maculopapular Rash ◽  
Skin Lesions ◽  
Lymphoplasmacytic Infiltrate ◽  
Assay Result ◽  
History Of

Awareness of the spectrum of clinical manifestations of syphilis, especially uncommon changes, is essential for diagnosis and effective management of patients. A 48-year-old Han businessman presented to the ear, nose and throat surgeons with an eight-week history of epigastric pain, a four-week history of a widespread non-itchy rash including the scrotal skin and a one-week history of tinnitus and dizziness. On examination, he was afebrile with widespread lymphadenopathy and a maculopapular rash affecting his trunk and scrotum. His abdomen was soft but tender in the epigastrium. The Treponema pallidum particle agglutination assay result was positive, and the rapid plasma reagin was 1:2. Gastroscopy showed ulcers in the gastric antrum and pylorus. Histopathological examination of gastric mucosa lesions showed a large amount of lymphoplasmacytic infiltrate detected in the lamina propria of the gastric mucosa. The T. pallidum Liferiver real time polymerase chain reaction kit assay performed on specimens from skin lesions and gastric mucosal tissue were positive. The patient was treated with intravenous sodium penicillin followed by intramuscular benzathine penicillin. On the fourth day of the treatment, the rash, epigastric pain and lymphadenopathy subsided. Two weeks after treatment, the tinnitus alleviated and vertigo disappeared.

scholarly journals Pregnancy outcomes of mothers with immune thrombocytopenia

2020 ◽  
Vol 9 (11) ◽  
pp. 4535
Author(s):  
Shashikala Karanth ◽  
Christy Vijay ◽  
Chaitanya Harita ◽  
Jaya S. Mol
Keyword(s):  
Pregnancy Outcomes ◽  
Immune Thrombocytopenia ◽  
Post Partum ◽  
Treatment Modalities ◽  
Care Hospital ◽  
Chronic Itp ◽  
Age Of Diagnosis ◽  
History Of ◽  
Itp In Pregnancy ◽  
In Pregnancy

Background: It has been proposed that, thrombocytopenia is the most common haematological abnormality in pregnancy after anaemia. The incidence of severe immune thrombocytopenia (ITP) in pregnancy has been difficult to report because of the rarity of the disease. Objectives were to determine the prevalence, pregnancy outcomes, treatment modalities of ITP mothers over five years in a tertiary health care hospital in South India.Methods: Our study was a retrospective record study, which looked into various aspects of obstetrical outcomes and complications in ITP mothers. Records of the in-patient medical record department (MRD) folders of patients with ITP who delivered at St. Johns Medical Hospital, Bangalore were studied.Results: We identified 53 patients with ITP with a mean age of 25.6+4.6 years, age of diagnosis of ITP at 21.1+5.9 years and gestational age of 36.2+3 weeks. In our study 17 (32%) were acute and 36 (67.1%) were chronic ITP. In our study 39.6% had history of at least one prior pregnancy loss. Patients with ITP at 35-37 weeks were induced with PGE1 (35.7%) in comparison to those with PGE2 (p≤0.001). Post-partum haemorrage (PPH) was seen in 7.5% of the pregnancies and all four were mothers with chronic ITP. Severe preeclampsia in ITP mothers was seen in 2 (66.7%).Conclusions: Chronic ITP in pregnancy poses more risks to mother and foetus as seen with the higher chance of PPH etc. Mothers with ITP should be screened antenatally as the chances of anomalies are high in the foetus. 

scholarly journals A Model Example: Coexisting Superior Mesenteric Artery Syndrome and the Nutcracker Phenomenon

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Rebecca Nunn ◽  
Jaimie Henry ◽  
Alistair A. P. Slesser ◽  
Rukshan Fernando ◽  
Nebil Behar
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Epigastric Pain ◽  
Left Renal Vein ◽  
Clinical Manifestations ◽  
External Compression ◽  
Nutcracker Phenomenon ◽  
Narrow Angle ◽  
Sma Syndrome ◽  
History Of

Superior mesenteric artery (SMA) syndrome is a rare cause of gastrointestinal obstruction, caused by external compression of the third part of the duodenum by the SMA. It may be associated with the Nutcracker phenomenon: external compression of the left renal vein. To our knowledge, there are few reports in the literature describing the coexistence of these two conditions and so we take this opportunity to highlight a rare cause of the acute abdomen that might otherwise be overlooked in cases of nonspecific abdominal findings and potentially unremarkable initial investigations. We report a case of SMA syndrome and Nutcracker phenomenon in a 19-year-old female who presented to our emergency department with a short history of epigastric pain and emesis. The SMA syndrome is thought to develop as the result of an abnormally narrow angle between the proximal SMA and the aorta, for which a number of predisposing factors have been described. Surgical options exist; however, the SMA syndrome is typically managed conservatively in the first instance, consistent with the approach described in this case. The Nutcracker phenomenon may give rise to the Nutcracker syndrome in the presence of typical clinical manifestations; however, these did not feature in this case.

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