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Autoimmune, obstetrics

Pedro Pallangyo, Isaac Mawenya, Paulina Nicholaus, Henry Mayala, Amida Kalombola, Godwin Sharau, Naiz Majani, Mohamed Janabi
BACKGROUND: Congenital complete heart block is a life-threatening condition which is highly associated with autoimmune and connective tissue disorders. Presence of maternal autoantibodies for associated conditions increases the risk of delivering a child with congenital complete heart block, however, less than a half of all women with such antibodies are symptomatic even after delivery. Mortality rate is highest during the neonatal period (45 %) and about two-thirds of all cases will require permanent pacing at some point in their lives...
October 19, 2016: Journal of Medical Case Reports
Marie-Pierre Piccinni, Letizia Lombardelli, Federica Logiodice, Ornela Kullolli, Paola Parronchi, Sergio Romagnani
Autoimmune disorders are characterized by tissue damage, caused by self-reactivity of different effectors mechanisms of the immune system, namely antibodies and T cells. Their occurrence may be associated with genetic and/or environmental predisposition and to some extent, have implications for fertility and obstetrics. The relationship between autoimmunity and reproduction is bidirectional. This review only addresses the impact of pregnancy on autoimmune diseases and not the influence of autoimmunity on pregnancy development...
2016: Clinical and Molecular Allergy: CMA
Omar Laghzaoui
The influence of hormonal status during the autoimmune disease is clearly established, with peak prevalence during the reproductive years where the interest of our retrospective study of 32 cases of pregnant patients with autoimmune pathologies. Relapses of the disease during pregnancy are especially observed in pregnant with lupus erythematosus and Behçet's disease while in post-partum complications were observed in cases of rheumatoid arthritis, multiple sclerosis and scleroderma. The fetal complications depend on the stage and type of autoimmune disease and the association with other pathologies...
2016: Pan African Medical Journal
Jyothis Purushothaman, Kochuthresia J Puthumana, Aswath Kumar, Susheela J Innah, Sareena Gilvaz
Immune thrombocytopenic purpura is a common acquired autoimmune disorder defined by a low platelet count secondary to accelerated platelet destruction or impaired thrombopoesis by anti-platelet antibodies. Thrombopoietin (TPO)-mimetic drugs such as eltrombopag and romiplostim have been used successfully in many nonpregnant individuals with immune thrombocytopenia (ITP) but studies based on its effects in pregnancy are limited. A 27-year-old multigravida who is a known case of ITP with bad obstetric history was referred to the Department of Obstetrics and Gynecology at 26 weeks of gestation with complaints of mucosal bleeding and recurrent abortions...
July 2016: Asian Journal of Transfusion Science
Alberta Y Hoi, Laura Ross, Jessica Day, Russell Rc Buchanan
Antiphospholipid syndrome (APS) is an autoimmune condition, characterized by the persistent presence of antiphospholipid antibodies (aPL) and either thrombosis or obstetric morbidity. The cornerstone of therapy is long-term anticoagulation to reduce morbidity and mortality; however, better understanding of the immunological pathways may direct us to develop future therapeutic strategies. We provide an overview of the current understanding of the immunopathogenesis of this perplexing condition and its associated morbidities and current evidence for some of the immunotherapeutic strategies...
August 30, 2016: Internal Medicine Journal
Frank Bienaimé, Christophe Legendre, Fabiola Terzi, Guillaume Canaud
The antiphospholipid syndrome is a common autoimmune disease caused by pathogenic antiphospholipid antibodies, leading to recurrent thrombosis and/or obstetrical complications. Importantly for nephrologists, antiphospholipid antibodies are associated with various renal manifestations including large renal vessel thrombosis, renal artery stenosis, and a constellation of intrarenal lesions that has been termed antiphospholipid nephropathy. This last condition associates various degrees of acute thrombotic microangiopathy, proliferative and fibrotic lesions of the intrarenal vessels, and ischemic modifications of the renal parenchyma...
August 20, 2016: Kidney International
Pier Luigi Meroni
Pregnancy morbidity is part of the clinical spectrum of the anti-phospholipid syndrome (APS), with an important social and economical cost. Antiplatelet and anticoagulant agents are effective in preventing the clinical manifestations in the majority of the patients. However, a consistent proportion of the pregnant women present recurrences in spite of the standard therapy. Observational studies and anecdotal reports raised the issue of additional therapeutic strategies in these refractory cases. Among these, anti-malarials (AMs) and in particular hydroxychloroquine (HCQ) are becoming more and more popular in APS as well as in other systemic autoimmune rheumatic conditions...
August 2, 2016: Journal of Autoimmunity
Guie Yong Lee, Sooyoung Cho
Systemic sclerosis or scleroderma is a rare autoimmune disorder characterized by excessive fibrosis and, vasculopathy, with multiorgan involvement. Anesthetic considerations in patients with systemic sclerosis must take into account the degree of organ dysfunction as well as airway management. Regional anesthesia is a preferable alternative to general anesthesia despite the reports of prolonged sensory block. Spinal anesthesia in patients with systemic sclerosis has been reported for only one patients undergoing cesarean section...
August 2016: Korean Journal of Anesthesiology
António Costa Braga, Carlos Vasconcelos, Jorge Braga
AIM: The aim of this study was to review our experience with gestations in autoimmune hepatitis patients. BACKGROUND: There are only limited data describing pregnancy in patients with autoimmune hepatitis. PATIENTS AND METHODS: Retrospective analysis of pregnancies with autoimmune hepatitis followed in Centro Hospitalar do Porto, Portugal in the last ten years. RESULTS: We reported nine pregnancies in seven patients with autoimmune hepatitis...
2016: Gastroenterology and Hepatology From Bed to Bench
Flora Veltri, Sarah Decaillet, Pierre Kleynen, Lidia Grabczan, Julie Belhomme, Serge Rozenberg, Thierry Pepersack, Kris Poppe
OBJECTIVE: Thyroid disorders and iron deficiency (ID) are associated with obstetrical and fetal complications. Iron is essential for the normal functioning of thyroid peroxidase (TPO-abs) and ID is frequent during pregnancy. The aim of this study was to compare the prevalence of thyroid autoimmunity (TAI) and dysfunction during the first trimester of pregnancy in women with and without ID. DESIGN: Cross-sectional data analysis of 1900 pregnant women nested within an ongoing prospective collection of pregnant women's data...
September 2016: European Journal of Endocrinology
Anush Martirosyan, Martin Petrek, Amit Kishore, Gayane Manukyan
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by thrombosis and recurrent fetal loss, with the persistent presence of antiphospholipid antibodies (aPLs). aPLs exert their pathogenic effect via the overproduction of tissue factor and activation of complement and several cell types, including endothelial cells, platelets and notably monocytes. As a result, a hypercoagulable state develops leading to APS-associated obstetric complications and fetal loss. Despite being far from optimal, treatment of APS usually includes heparin and low dose aspirin...
August 2016: Experimental and Therapeutic Medicine
M Khamashta, M Taraborelli, S Sciascia, A Tincani
Antiphospholipid syndrome (APS) is an autoimmune condition characterized by the occurrence of thrombosis (arterial and/or venous), often multiple, and/or pregnancy morbidity. Thrombosis is one of the major disease mechanisms, mainly caused by activating endothelial cells, monocytes, and platelets. At present, the management of APS patients with a history of thrombosis is based on long-term antithrombotic therapy, due to the high rate of recurrent thrombosis (29% per year without treatment). Obstetrical APS includes heterogeneous pregnancy complications whose pathogenesis has been increasingly elucidated in the past years...
February 2016: Best Practice & Research. Clinical Rheumatology
A H James, J Eikenboom, A B Federici
The State of the Art in von Willebrand disease (VWD) has been impacted not only by discoveries in the field of haemostasis, but also by changes in practice in other fields. The development of bleeding assessment tools has led to the clarification of bleeding symptoms and phenotype in VWD. New discoveries in the biology and genetics of von Willebrand factor (VWF) are challenging our existing diagnostics and classification(s). An improved understanding of reproductive physiology and the pathology of VWD along with changing obstetric, gynaecologic and haemostatic therapies necessitate an evolving response to the care of women with VWD...
July 2016: Haemophilia: the Official Journal of the World Federation of Hemophilia
Mirjana Bećarević, Svetlana Ignjatović
The latest classification criteria for the diagnosis of the antiphospholipid syndrome (APS, an autoimmune disease characterized by thromboses, miscarriages and presence of antiphospholipid antibodies (Abs)) emphasized that thrombotic manifestations of APS should be without any signs of an inflammatory process. However, atherosclerosis (a chronic inflammatory response to the accumulation of lipoproteins in the walls of arteries) and APS are characterized by some similar features. We evaluated whether proinflammatory proteins were associated with the features of the primary APS (PAPS)...
October 2016: Clinical Rheumatology
Andrea Busnelli, Alessio Paffoni, Luigi Fedele, Edgardo Somigliana
BACKGROUND: Thyroid autoimmunity (TAI) is the most frequent autoimmune condition and the first cause of thyroid dysfunction among women of reproductive age. Notably, it has been associated with adverse obstetric outcomes during all trimesters of pregnancy. Furthermore, since most studies show an increased prevalence of TAI among women attending infertility clinics, a detrimental impact of this condition on natural fertility and on the rate of success of assisted reproductive techniques has been suggested...
June 20, 2016: Human Reproduction Update
Dulce María Albertina Camarena Cabrera, Claudia Rodriguez-Jaimes, Sandra Acevedo-Gallegos, Juan Manuel Gallardo-Gaona, Berenice Velazquez-Torres, José Antonio Ramírez-Calvo
Antiphospholipid antibody syndrome is a non-inflammatory autoimmune disease characterized by recurrent thrombotic events and/or obstetric complications associated with the presence of circulating antiphospholipid antibodies (anticardiolipin antibodies, anti-β2 glycoprotein-i antibodies, and/or lupus anticoagulant. Antiphospholipid antibodies are a heterogeneous group of autoantibodies associated with recurrent miscarriage, stillbirth, fetal growth restriction and premature birth. The diversity of the features of the proposed placental antiphospholipid antibodies fingerprint suggests that several disease processes may occur in the placentae of women with antiphospholipid antibody syndrome in the form of immune responses: inflammatory events, complement activation, angiogenic imbalance and, less commonly, thrombosis and infarction...
June 9, 2016: Reumatología Clinica
Marília Rodrigues, Laura Andreoli, Angela Tincani
Autoimmune rheumatic diseases (ARD) affect mainly young women during their reproductive years. Fertility is usually not diminished but the time it takes to conceive is usually longer. Factors related to an ARD or to its treatment are responsible for this effect. In addition, contraception counseling is required to prevent negative fetal outcome and exacerbation of disease symptoms. In recent years, advances in therapies, clarification of risk factors for adverse pregnancy outcomes, and a multidisciplinary approach have vastly improved obstetric management, increasing the possibility of successful pregnancy with a high likelihood of favorable outcome...
March 2016: Israel Medical Association Journal: IMAJ
Álvaro Danza, Guillermo Ruiz-Irastorza, Munther Khamashta
Systemic autoimmune diseases especially affect young women during childbearing age. The aim of this review is to update systemic lupus erythematosus, antiphospholipid syndrome and systemic sclerosis management during pregnancy. These diseases present variable maternal and fetal risks. Studies show that an appropriate disease control and a reasonable remission period prior to pregnancy are associated with satisfactory obstetric outcomes. Antiphospholipid autoantibodies profile, anti-Ro/anti-La antibodies, pulmonary pressure and activity evaluation are crucial to assess the pregnancy risk...
October 7, 2016: Medicina Clínica
Eric Mariotte, Elie Azoulay, Lionel Galicier, Eric Rondeau, Fouzia Zouiti, Pierre Boisseau, Pascale Poullin, Emmanuel de Maistre, François Provôt, Yahsou Delmas, Pierre Perez, Ygal Benhamou, Alain Stepanian, Paul Coppo, Agnès Veyradier
BACKGROUND: Thrombotic thrombocytopenic purpura is a thrombotic microangiopathy related to a severe deficiency of ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13; activity <10%). We aimed to investigate the association between mechanisms for ADAMTS13 deficiency and the epidemiology and pathophysiology of thrombotic thrombocytopenic purpura at initial presentation. METHODS: Between Jan 1, 1999, and Dec 31, 2013, we did a cross-sectional analysis of the French national registry for thrombotic microangiopathy to identify all patients with adult-onset thrombotic microangiopathy (first episode after age 18 years) who had severe ADAMTS13 deficiency at presentation...
May 2016: Lancet Haematology
Yan-Ting Lu, Che-Wei Hsu, Wan-Chen Tsai, Mei-Yun Cheng, Fu-Yuan Shih, Ting-Ying Fu, Yao-Chung Chuang, Meng-Han Tsai
BACKGROUND: Status epilepticus (SE) is a neurological emergency associated with a high mortality rate and long-term cognitive sequelae. Status epilepticus in pregnancy poses a tremendous threat to both mother and fetus, making a correct diagnosis and treatment a challenging task for clinicians. The prevalence, underlying etiology, and outcomes of pregnancy-related SE remain largely unknown. METHODS: We retrospectively studied all SE episodes (n=366) in patients admitted to our neurological ICU over a period of 8...
June 2016: Epilepsy & Behavior: E&B
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