Clinical characteristics, management, maternal and neonatal outcome among seven severe and critically ill pregnant women with COVID-19 pneumonia
Published on: 30th November, 2020
OCLC Number/Unique Identifier: 8812298810
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.
Atherogenic risk assessment of naive HIV-infected patients attending Infectious Diseases Service of Kinshasa University Teaching Hospital, Democratic Republic of the Congo (DRC)
Published on: 13th October, 2020
OCLC Number/Unique Identifier: 8689021635
Background and aim: Metabolic abnormalities are common in HIV/AIDS. Increasingly, lipid ratios are used as screening tools for dyslipidaemia in these medical conditions. The aim of this study was to assess the ability of 4 lipid ratios to predict cardiovascular risks.
Methods: This is a cross-sectional and analytical study included 105 HIV+ patients followed in Kinshasa University Teaching Hospital (KUTH). Four indices [Atherogenic Index of Plasma (AIP), Castelli Risk Index (CRI) I and II, Atherogenic coefficient (AC)] were compared. Statistical analyzis consisted of measuring frequencies and means, Student’s t-tests, ANOVA and Ficher’s exact test, and the calculation of the Kappa value.
Results: Lipid ratios predicted respectively the risk in 62% (AIP), 28.6% (CRI-I) and 23.8% (CRI-II). CRI-I and II were elevated, especially in women. The AIP appeared to be a better predictor than CRI-I and II to assess dyslipidaemia in general and the high-risk frequency. The cholesterol detected risk in 66.7% (Low HDL-C), 50% (High LDL-C), 38.9% (High TC and/or TG).
The atherogenic risk was higher with age, advanced WHO stage, HIV-TB, HBV-HCV co-infections, smoking and alcohol intake. Haemoglobin (Hb) and CD4 counts were low when the risk was high. Age ≥ 50 years, stage 4 (WHO), CD4s+ ≤ 200 cells/µL were independent factors associated with atherogenic risk.
Conclusion: Lipid ratios can be used as reliable tools for assessing cardiovascular risk of naïve HIV-infected patients who received HAART.
Estimating global case fatality rate of coronavirus disease 2019 (COVID-19) pandemic
Published on: 11th August, 2020
OCLC Number/Unique Identifier: 8646216717
Background: There is a huge global loss of lives due to COVID-19 pandemic, the primary epicentre of which is China, where the causative agent of the disease, SARS-CoV-2 was first emerged in December 2019. This study aims to explore the severity, in terms of case fatality rate (CFR), of COVID-19 pandemic.
Methods: Data of ongoing COVID-19 global pandemic were retrieved from website of the WHO, and processed for the estimation of global (both including and excluding China) CFRs of COVID-19. CFRs were explored following the naive estimates, 14-day delay estimates, and linear regression model analysis, during January 25, 2020 to April 25, 2020, on weekly basis. To explore the current situation, in terms of CFR, data for the next 13 weeks (May 2, 2020 through July 25, 2020), were processed by naive and linear regression model analysis.
Results: Mean CFRs, in naive estimates, were 4.59% for the world including China, and 3.62% for the world excluding China. The 14-day delay estimates of CFRs were 15.6% globally, and 21.65% in countries outside China. Following statistical model, global (both including and excluding China) CFRs were 6.81%, by naive estimates, and ~13%, by 14-day delay estimates. Global CFRs of COVID-19 during May 2, 2020 to July 25, 2020, ranged 4.1% – 7.04%, by naive estimates, and by statistical regression analysis the CFR was 3.19%.
Conclusion and recommendations: The CFR might help estimate the need of up-to-date hospital supplies and other mitigation measures for COVID-19 ongoing pandemic, and therefore, instantaneous CFR estimations are recommended.
Complete recovery of chronic Osmotic Demyelination Syndrome with plasma exchange
Published on: 8th March, 2018
OCLC Number/Unique Identifier: 7877940509
A 50-years old female presented with dysarthria, inability to swallow and quadriparesis for three weeks. She had rapid correction of her serum sodium (Na) from 99meq/l to 138meq/l within 24 hours 1 week prior to development of these symptoms. She was diagnosed as a case of Osmotic demyelination syndrome (ODS) formerly known as central pontine myelinolysis (CPM) which was confirmed by MRI. She underwent Plasma Exchange (PE) on the 20th day since her symptoms started and underwent 7 cycles of PE with complete neurological recovery. Pt was discharged with ability to ambulate independently and complete recovery of speech and swallowing. Hence, we report that PE is beneficial in chronic ODS.
Overview on current approach on recurrent miscarriage and threatened miscarriage
Published on: 30th November, 2020
OCLC Number/Unique Identifier: 8875583329
Miscarriage is a frequent outcome of pregnancy, with major emotional implications to the couple experiencing such an event. Threatened miscarriage is the commonest complication of early pregnancy and affects about 20% of pregnancies. It presents with vaginal bleeding with or without abdominal cramps. On the other hand recurrent miscarriages are post implantation failures in natural conception. Increasing age of women, smoking, obesity or polycystic ovary syndrome (PCOS) and a previous history of miscarriage are risk factors for threatened miscarriage. The pathophysiology has been associated with changes in levels of cytokines or maternal immune dysfunction. Clinical history and examination, maternal serum biochemistry and ultrasound findings are important to determine the treatment options and provide valuable information for the prognosis. Many surgical and non-surgical interventions are used in the management of threatened and recurrent miscarriages. In this review, we present available evidence-based guidance on the incidence, pathophysiology, investigation and clinical management of recurrent miscarriage and threatened miscarriage, focusing mainly on the first trimester of pregnancy and primary healthcare settings. The review is structured to be clinically relevant. We have critically appraised the evidence to produce a concise answer for clinical practice.
Detection of IDH mutations in cerebrospinal fluid: A discussion of liquid biopsy in neuropathology
Published on: 17th September, 2020
OCLC Number/Unique Identifier: 8873201615
Isocitrate dehydrogenase (IDH) mutations are a common event in secondary glioblastoma multiforme and lower-grade adult infiltrative astrocytomas and independently confer a better prognosis [1,2]. These are highly conserved mutations during glioma progression and thus also a useful diagnostic marker amenable to modern molecular sequencing methods. These mutations can even be detected in sites distant from the primary tumour. We use an illustrative case of a patient with radiologically suspected recurrent astrocytoma and negative histology, but positive IDH-mutated tumour DNA detected within CSF. Our results demonstrated the usefulness of liquid biopsy for recurrent glioma within the context of equivocal or negative histopathological results, whilst also showing the ability to detect a de-novo IDH-2 mutation not present in the previous resection. Building on this ‘proof-of-concept’ result, we also take the opportunity to briefly review the current literature describing the various liquid biopsy substrates available to diagnose infiltrative gliomas, namely the study of circulating tumour DNA, circulating tumour cells, and extracellular vesicles. We outline the current challenges and prospects of liquid biopsies in these tumours and suggest that more studies are required to overcome these challenges and harness the potential benefits of liquid biopsies in guiding our management of gliomas
4-year recurrence risk factors after tension-free vaginal tape-obturator as a treatment of stress urinary incontinence
Published on: 4th November, 2020
OCLC Number/Unique Identifier: 8875587752
Objectives: Tension-free vaginal tapes are the gold standard of the surgical treatment of stress urinary incontinence (SUI); however, long-term recurrence of SUI after this surgery has been a matter of problem. Here, we attempted to determine the incidence of its recurrence and to identify the risk factors of 4-year-recurrence of SUI after this surgery.
Methods: Of all patients undergoing this surgery (n = 341, 2015-2019), 71 patients were met the study inclusion criteria. Of 71, SUI recurred in 8 patients, with the recurrence rate being 11.3%. The following three were identified to be independent risk factors: older age, history of delivery of macrosomic baby (>4 kg), and the presence of mixed urinary incontinence. The frequency of recurrence in cases with mixed incontinence amounted for 19.5%. Recurrence was 22 and 50% for women with macrosomic delivery once and more than twice, respectively.
Conclusion: Advanced age, macrosomic delivery and mixed urinary incontinence have shown to be independent risk factors of recurrence of SUI after tension-free vaginal tape-obturator at 4 years.
Key message: Stress urinary incontinence can recur so investigate possible risk factors is a priority. Our paper relates recurrence with: advanced age, fetal macrosomia and mixed incontinence.
Posterior Reversible Leukoencephalopathy Syndrome in a patient after second dose of Rituximab for treatment of resistant Thrombotic Thrombocytopenic Purpura
Published on: 16th February, 2018
OCLC Number/Unique Identifier: 7347066275
Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome with clinical features of altered sensorium, headaches, visual problems and seizures. It has been associated with uncontrolled hypertension (HTN), thrombotic thrombocytopenic purpura (TTP) and immunosuppressive drugs. Rituximab has also been implicated as a cause of PRES that usually occurs after the first dose. We report a case of PRES that occurred after the second dose of Rituximab. A twenty three years old female known case of resistant TTP treated with multiple courses of steroids and plasmapharesis was admitted with renal failure, severe volume overload ad lower respiratory tract infection. She was treated with hemodialysis, intravenous antibiotics, steroids and plasma exchange (PEX).
Experiment of a novel four-spherical intrauterine contraceptive device with nickel-titanium
Published on: 20th October, 2020
OCLC Number/Unique Identifier: 8691260293
The aim of this study was to develop a novel four-spherical intrauterine contraceptive device (4-SIUD) with nickel-titanium (Ni-Ti) for human, and to evaluate the contraceptive effect. The 4-SIUD composed of 4 mesh spheres and 5 support arms. The shape of 4-SIUD was like a “T”. The height (H), upper width (D) and thickness of the 4-SIUD for macaques were 0.8 cm, 0.5 cm and 0.3 cm, and for human were 4.5 cm, 4.0 cm and 0.8 cm, respectively. The 4-SIUD was inserted into 5 macaques and pregnancy was not observed at 12 months. Three women used the 4-SIUD for 12 months, uterine perforations, expulsion, pain, and pelvic inflammatory did not occur. The results suggested that the 4-SIUD is appropriate for rhesus macaques and human use, and has a good contraceptive effect.
Association between bh4/bh2 ratio and Albuminuria in Hypertensive Type -2 Diabetic patients
Published on: 29th December, 2017
OCLC Number/Unique Identifier: 7338866036
Endothelial dysfunction and inflammation play a key role in the pathophysiology of diabetic nephropathy; Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase, when BH4 is reduced to dihydrobiopterin (BH2), endothelial dysfunction is induced.
Purpose: The aim of this study is to evaluate the relationship between the levels of biopterins with albuminuria in type-2 diabetic hypertensive patients.
Methods: We studied 30 hypertensive type-2 diabetic patients in whom biopterins levels were measured by reverse phase high performance liquid chromatography with fluorescence detection. Additionally, 24 h urinary albumin excretion was also measured (nephelometry). The levels of biopterins and albuminuria were correlated with the Pearson correlation coefficient.
Results: We did not find a significantly correlation between biopterins levels and albuminuria, However, we found a significantly inverse correlation (R= -0.498, p<0.005) between the BH4/BH2 ratio and albuminuria.
Conclusion: Our results suggest that the BH4/BH2 ratio instead of biopterins levels may be a marker of nephropathy in hypertensive type-2 diabetic patients.
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