Purpose: To investigate the impact of thyroid hormone treatment (LT4) on maternal pregnancy outcomes in women with subclinical hypothyroidism (SCH) without thyroid peroxidase antibodies (TPOAb) positivity.
Design/Methods: Single centre, cross-sectional study in 1460 women screened for TSH, free T4 and TPOAb at median 13 (11-17) weeks of gestation during the period 2013-2014. Exclusion criteria were twin- and assisted reproduction pregnancies, TPO positivity, overt hyperthyroidism, and treatment with LT4 before screening. The impact of LT4 on maternal pregnancy outcomes was investigated in a group of 53 women with SCH (TSH >3.74 mIU/L) in which LT4 was initiated at median 13 (10-22) weeks (treated group). The control group included 18 women with SCH (TSH >3.74 mIU/L; untreated group). The prevalence of pregnancy complications in these two groups was compared with that in a reference group of 1389 women (TSH £3.74 mIU/L and no TPOAb; REF group).
Results: The prevalence of pre-eclampsia and gestational diabetes (GDM) was higher in the control group vs that in the REF group (16.7% vs 5.0% and 27.8% vs 18.9%; p=0.017 and p=0.016, respectively), but comparable in the LT4 treated SCH group vs the REF group (7.6% vs 5.0% and 22.6% vs 18.9%; p=0.918 and 0.676, respectively). The prevalence of iron-deficiency anaemia was lower in the LT4 treated vs the REF group (17.0% vs 32.5%; p=0.017).
Conclusions: Pregnant women with SCH and without TPOAb positivity who were LT4 untreated had a higher prevalence of pre-eclampsia and GDM compared with euthyroid women, while this was not the case when SCH women were treated with LT4, even when it was initiated after the first trimester.
In this era of Highly Active Antiretroviral Therapy (HAART), we see that incidence of neoplasic diseases among patients affected by Human Immonudeficiency Virus (HIV) is increasing. Plasmablastic lymphoma (PBL) is an example of neoplastic condition specific to HIV patients. It is a subtype of diffuse large B-cell lymphoma (DLBCL) recently described in the 2008 WHO classification of lymphoproliferative disorder. PBL is characterized by its aggressive nature and plasmacytic differentiation and usually occurs in the oral cavity or jaw of HIV-infected individuals. However, several cases of PBL involving extraoral sites have been reported in immunocompetent individuals. This entity is a diagnostic challenge and need integration of clinical, pathological, genetic and microbiologic features. Several types of lymphoma present with plasmablastoid differenciation and may give rise to some difficulties for a differential diagnosis. We give some anatomopathological, molecular and genetic details for each subtype and we will illustrate the difficulty for the diagnosis with two cases. The first case is a patient with plasmablastic lymphoma that present with unusual negative immunoreactivity for CD 138 (10% of PBL cases). The second case has clinical, epidemiological and pathological characteristic of plasmablastic lymphoma but HHV8 positivity is a criteria for considering extra-cavitary PEL as the most relevant diagnosis.
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