Importance Preeclampsia is a devastating disease of pregnancy associated with increased risk of fetal and maternal complications. African American pregnant women have a high prevalence of preeclampsia, but there is a need of systemic analyses of this high-risk group regarding complications, etiology, and biomarkers. Objective The aim of this study was to provide a synopsis of current research of preeclampsia specifically related to African American women. Evidence Acquisition A comprehensive search was performed in the bibliographic database PubMed with keywords “preeclampsia” and “African American.” Results African American women with preeclampsia were at an increased risk of preterm birth, which resulted in low-birth-weight infants. Intrauterine fetal death among African American preeclamptic patients occurs at twice the rate as in other races. On the maternal side, African American mothers with preeclampsia have more severe hypertension, antepartum hemorrhage, and increased mortality. Those who survive preeclampsia have a high risk of postpartum cardiometabolic disease. Preexisting conditions (eg, systemic lupus erythematosus) and genetic mutations (eg, sickle cell disease in the mother, FVL or APOL1 mutations in the fetus) may contribute to the higher prevalence and worse outcomes in African American women. Many blood factors, for example, the ratio of proteins sFlt/PlGF, hormones, and inflammatory factors, have been studied as potential biomarkers for preeclampsia, but their specificity needs further investigation. Conclusions Further studies of preeclampsia among African American women addressing underlying risk factors and etiologies, coupled with identification of preeclampsia-specific biomarkers allowing early detection and intervention, will significantly improve the clinical management of this devastating disease. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to describe the difference in prevalence of fetal and maternal complications among African American women with preeclampsia versus women of other races; explain updated genetic studies of preeclampsia specifically related to African American women; and analyze current research of biomarkers for prediction of status and progress of preeclampsia.
Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder that primarily affects synovial joints. Approximately 18-41% of patients with RA develop extra-articular manifestations [1]. However, extra-articular manifestations preceding or occurring without articular symptoms in RA have rarely been reported. Such atypical presentations of RA pose a diagnostic challenge to the clinician and may delay treatment. Case presentation: A 57-year-old female with long standing diabetes, hypertension, hyperlipidemia and Raynaud's phenomenon presented shortness of breath, cough and new subcutaneous nodules. Four years before, she had been diagnosed with non specific interstitial pneumonia but had declined treatment. The physical exam did not reveal any signs suggestive of RA however, she was seropositive for rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA). Treatment for RA-associated interstitial lung disease was discussed. Conclusion: Extra-articular involvement of RA can be observed as initial presentation of the disease in a handful of cases. However, RA diagnosis must be achieved to correctly manage these patients which can at that time receive targeted therapeutic interventions. From our literature review, pulmonary involvement was seen in over half of the cases in seropositive RA patients who lacked articular involvement at initial presentation.
Background: Chemotherapy-induced cardiomyopathy and heart failure are major complications of cancer therapy and can result in significant morbidity and mortality. Unfortunately, there is a high risk of poor compliance and loss to follow-up in underserved areas. Objective: Create a pathway to improve detection and management of chemotherapy-induced cardiotoxicity and heart failure in patients undergoing chemotherapy treatment in an urban underserved hospital. Description: The project is performed at Kings County Hospital, a major cancer treatment center in Brooklyn, NY. Our findings indicate that over the past five years, patients with chemotherapy-induced cardiomyopathy were lost to follow-up with outpatient cardiology services. Therefore, we developed and applied a new collaborative protocol for patients who were diagnosed with any cancer undergoing treatment complicated by cardiomyopathy. The protocol is as follows; Firstly, patients are sent for a multigated acquisition (MUGA) scan prior to beginning chemotherapy, and every three months thereafter over the course of their chemotherapy treatment. The reading physician then identifies all patients with a 10% or more reduction in ejection fraction between MUGA scans, and notifies the Heart Health Center at Kings County Hospital to contact the patient with an appointment with cardiology services. At the Heart Health Center, the patient is then counseled on guideline-recommended treatment for heart failure. Further follow up with the nurse practitioner is done for medication reconciliation, education regarding activity, weight monitoring, dietary intake, and warning symptoms for heart failure exacerbations. The patient will receive follow-up with a nutritionist for guideline directed dietary recommendations for heart failure and social work services to ensure appropriate social conditions and support. The oncology service will monitor if the patient has followed up with outpatient cardiology before continuing chemotherapy. If the patient was lost to follow up, oncology will notify the Heart Health Center and assist with providing the patient with an appointment. Conclusions: We aim to improve compliance for follow up and guideline directed management for chemotherapy-induced heart failure in an urban underserved tertiary hospital.
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