No abstract

CONCLUSION:The present results indicate bad environmental hygienic conditions and close intra-familial relationships are important in H pylori contamination.

No abstract

Background Pregnant women are at increased risk of mortality and morbidity due to coronavirus disease 2019 (COVID-19). Many studies reported on the association of COVID-19 with pregnancy specific adverse outcomes but prediction models utilizing large cohort of pregnant women are still lacking for estimating the risk of maternal morbidity and other adverse events. Objective The main aim of this study was to develop a prediction model to quantify the risk of progression to critical COVID-19 and intensive care unit admission in pregnant women with symptomatic infection. Study design This was a multicenter retrospective cohort study including eight hospitals from four countries (UK, Austria, Greece and Turkey). Data extraction was from February 2020 until May 2021. Included were consecutive pregnant and early postpartum women (within 10 days of birth), reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. The primary outcome was progression to critical illness requiring intensive care. Secondary outcomes included maternal death, preeclampsia and stillbirth. The association between the primary outcome and 12 candidate predictors with known association with severe COVID-19 in pregnancy, was analyzed with log-binomial mixed-effects regression and reported as adjusted risk ratios (aRR). All potential predictors were evaluated in one model and only baseline factors in another. Predictive accuracy were assessed by the area under the receiver operating characteristic curves (AUROC). Results Of 793 pregnant women positive for SARS-CoV-2 and symptomatic, 44 (5.5%) were admitted to intensive care, of whom 10 died (1.3%). The ‘mini-COvid Maternal Intensive Therapy’ model included demographic and clinical variables available at disease onset: maternal age (aRR: 1.45, 95% CI: 1.07–1.95, P=0.015); body-mass index (aRR: 1.34, 95% CI: 1.06–1.66, P=0.010); and diagnosis in the third trimester of pregnancy (aRR: 3.64, 95% CI: 1.78–8.46, P=0.001). The optimism-adjusted AUROC was 0.73. The ‘full-COvid Maternal Intensive Therapy’ model included body-mass index (aRR: 1.39, 95% CI: 1.07–1.95, P=0.015), lower respiratory symptoms (aRR: 5.11, 95% CI: 1.81–21.4, P=0.007), neutrophil/lymphocyte ratio (aRR: 1.62, 95% CI: 1.36–1.89, P<0.001); and serum C-reactive protein (aRR: 1.30, 95% CI: 1.15–1.44, P<0.001), with an optimism-adjusted AUROC 0.85. Neither model showed signs of poor fit (P>0.05). Categorization as high risk by either model was associated with a shorter diagnosis to ICU admission interval (log-rank test P<0.001, both), higher maternal death (5.2% vs. 0.2%; P<0.0001) and preeclampsia (5.7% vs. 1.0%; P=0.0003). A spreadsheet calculator is available for risk estimation. Conclusion At presentation with symptomatic COVID-19, pregnant and recently postpartum women can be stratified into high and low-risk for progression to critical disease, even where resources are limited. This ...

We present two cases of fetal hypothyroidism with goiter which were successfully diagnosed and treated in utero. In both cases, ultrasonographic examination demonstrated a bilobed solid anterior neck mass with increased vascularity compatible with enlarged thyroid gland. Fetal blood sampling revealed hypothyroidism. Intra-amniotic injection of L-thyroxin caused a reduction in thyroid gland size and enabled vaginal delivery without complication. In the first case, maternal thyroid hormone levels and autoantibodies were normal and the neonate had hypothyroidism suggesting the diagnosis of dyshormonogenesis. In the second case, the fetus had transient hypothyroidism, which resolved spontaneously after delivery. Maternal thyroid function tests and autoantibodies were normal and both the mother and neonate had normal urinary iodine, excluding the diagnosis of iodine deficiency or excess. Thus, we believe that transplacental transfer of undetermined factors might be a cause of transient congenital hypothyroidism. Also, we reviewed the literature and described controversial issues regarding the management of fetal goiter.