Abnormalities of corpus callosum are one of the most common brain anomalies. Fetuses with isolated corpus callosum agenesis (CCA) have a better prognosis than those with additional anomalies. However, unpredictable neurodevelopmental outcomes of truly isolated CCA make prenatal counseling a challenge. The aim of this review is to evaluate neurodevelopmental outcomes in children with prenatal diagnosis of isolated CCA. Controlled clinical trials published between May 23, 2009, and May 23, 2019, using the MeSH term “agenesis of corpus callosum” were reviewed. A total of 942 articles were identified, and 8 studies were included in the systematic review depending on the inclusion criteria. These studies included 217 fetuses with isolated CCA and no other anomalies at prenatal assessment. Neurodevelopmental outcome was reported to be normal in 83 children with a prenatal diagnosis of isolated CCA confirmed at birth within 128 completed assessments. About 45 children presented borderline, moderate, or severe neurodevelopmental outcome. In this review, neurodevelopment was favorable in two-thirds of the cases, but mild disabilities emerged in older children. Despite this, disabilities can occur later beyond school age and a low risk of severe cognitive impairment exists. Our study highlights the essential early diagnosis and proper supportive therapy.
Introduction: Inflammatory bowel disease is a chronicidiopathic condition involving the gastrointestinal tract.The disease prevalence is increasing worldwide, affectingwomen in childbearing age. Objective: Clinical and practicalreview of the women´s sexual and reproductive health ininflammatory bowel disease with focus in gynaecologicaland obstetrical management. Materials and Methods: In thisarticle we review sexual and reproductive health issues inwomen with inflammatory bowel disease in all life stagesand the main particularities of the approach of inflammatorybowel disease in pregnancy and breastfeeding. Results andConclusion: Fertility in women without disease activity isnot decreased comparing to general population, but despiteresearch is inconsistent there are reports of increased risk ofsmall for gestational age, preterm delivery, low Apgar score,congenital anomalies, intrauterine death, miscarriage, venousthromboembolism and preeclampsia. To improve obstetricoutcomes, a period of 3 to 6 months of disease remission isrecommended before conception. Medication adjustmentmay be necessary, and supplementation should be adapted. Amultidisciplinary approach and a comprehensive knowledgeof the disease through all women life stages allows a betterhealth care.Keywords: Inflammatory bowel disease, Sexual health,Reproduction, Pregnancy, Breastfeeding.
Introduction: Hospital readmissions are associated with increased healthcare expenses and with higher hospital fatality rates. We aim to characterize unplanned hospital readmissions occurred within 30 days after discharge, according to its Major Diagnosis Category, hospital type and location, and patients’ demographic attributes. We also intend to estimate the hospital fatality rates associated to those readmissions, as well as to study the evolution of hospital readmissions rates in the last decade (2000-2008). Moreover, we aim to characterize heart failure readmissions.Material and Methods: We analysed a database (provided by Autoridade Central do Sistema de Saúde) containing all hospital admissions occurred in Portuguese public hospitals. In order to compare readmissions rates, we performed chi-square tests and linear-bylinear association tests.Results: Between 2000 and 2008, there were 5 514 331 unplanned admissions, of which 4.1% corresponded to hospital readmissions, classified with the same Major Diagnosis Category of the first admission. Between 2000 and 2008, hospital readmissions rate increased continuously from 3.0% to 4.7%. Hospital fatality rate was significantly higher among readmitted cases (9.5 versus 5.6%, p < 0.001). Readmissions rates were also significantly higher among episodes involving older patients (2.6% in children versus 5.3% in the elderly) and males (4.5% versus 3.9% in females, p < 0.001), being lower in Lisbon region (2.7%) and in central hospitals (3.0%, p < 0.001). For episodes of heart failure, we found a readmissions rate of 6.7%.Discussion and Conclusion: Most of the differences found are consistent with those described in other Western countries. Readmission episodes, whose rates have been increasing in Portugal, are associated with higher hospital fatality rates.
Objectives Fetal and neonatal alloimmune thrombocytopenia is a rare condition associated with fetal and neonatal morbimortality. Prevention of recurrence includes intravenous immunoglobulin. One challenge in pregnancy surveillance remains the fact that maternal intravenous immunoglobulins therapy can result in false-positive infectious markers. The goal of this case report is to highlight the possible serological misdiagnosed infection associated with intravenous immunoglobulins therapy in pregnancy, and the difficulty of management in this time of a women’s life. Case presentation We report a case of a 38-year-old pregnant woman, with a previous affected child with fetal neonatal alloimmune thrombocytopenia. To prevent recurrence, intravenous immunoglobulin treatment was administered in early second trimester. In the second trimester routine analysis, a positive anti-treponemal test and a toxoplasmosis seroconversion occurred. Infection suspicion based on test positivity of some infectious agents, after passive acquired antibodies, can lead to anxiety and subsequent unnecessary treatment. Conclusions Clinicians and pathologists must be aware of the possible acquisition of these antibodies during treatment and be able to counsel patients receiving intravenous immunoglobulin. Managing possible infectious intercurrences in pregnancy remains a challenge.
Some studies associated metformin with a slight increase in the risk of prematurity and lower birth weight. 3 Methods Results ConclusionsProblem statement
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