Background: Ocular involvement in pregnancy-induced hypertension (PIH) is common.Objective: To study the association between pregnancy-induced hypertensive fundus changes and fetal outcomes. Subjects and methods:A prospective cohort study was carried out including 153 subjects with the diagnosis of PIH. The subjects were evaluated for hypertensive fundus changes. Fetal outcomes were assessed in terms of gestational age, birth weight, 1 minute Apgar score, stillbirth and neonatal death. Statistics:The chi 2 test was used to evaluate the association between the various fundus changes and fetal outcomes using SPSS version 10 software program.Results: Fundus changes were found in 13.7 % of the subjects. The means of systolic and diastolic BP of the subjects with hypertensive fundus changes were 182.86 ± 33.64 and 125.24 ± 21.36 respectively, whereas those values without fundus changes were 150.72 ± 12.86 and 100.07 ± 9.51.Vitreous hemorrhage, serous retinal detachment and macular star were not found in this study. Fetal outcomes in PIH patients with vascular changes alone were similar to those with no fundus changes. Retinal and optic nerve head changes were found to be associated (p =0.016) with low birth weight (<2.5 kg). Choroidal changes and optic nerve head changes were associated with low Apgar score. Conclusion:Retinal and optic nerve head changes are associated with low birth weight. Choroidal changes and optic nerve head changes are associated with low Apgar score. Fundus evaluation in patients with PIH is an important procedure to predict adverse fetal outcomes.
ImportanceIn patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.ObjectiveTo report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.Design, Setting, and ParticipantsSURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021.InterventionPatients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis.Main Outcomes and MeasuresThe prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years.ResultsA total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P = .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P &lt; .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm2 vs 1.8 [0.6] cm2; P &lt; .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%]; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%]; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P &lt; .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%]; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention.Conclusions and RelevanceAmong intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.
Background: Powassan virus is a tick borne virus which can lead to encephalitis. Methods: 63 year old woman with history of migraine presented with 2 days of fever, headache, language difficulty and right sided facial droop. Her examination revealed right upper motor neuron type facial weakness and expressive aphasia. She rapidly deteriorated within 24 hours becoming non verbal and ultimately comatose. Results: MRI brain revealed T2 hyperintensities in bilateral caudate and putamen. Subsequent MRI brain showed progression of the caudate and basal ganglia changes and new T2 hyperintensities in bilateral thalami and midbrain with no abnormal enhancement. CSF revealed lymphocytic pleocytosis with normal protein and glucose. Viral Encephalitis was suspected and she was continued on Acyclovir until Varicella zoster and Herpes simplex virus serology in CSF returned negative. Prolonged video EEG showed near continuous generalized triphasic pattern without any evolution or seizure pattern. There was no improvement in clinical status or EEG with antiepileptic treatment. Paraneoplastic panel , serum HIV, Lyme and 14-3-3 protein were negative. Extensive viral serologies were sent and ultimately Powassan serology came back positive. Conclusions: This case highlights powassan virus as a cause of encephalitis and occurrence of triphasic waves in non metabolic causes of encephalopathy such as infectious encephalitis.
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