scholarly journals Maternal Near Miss in Patients with Systemic Lupus Erythematosus

2021 ◽  
Author(s):  
Arlley Cleverson Belo Silva ◽  
Sue Yazaki Sun ◽  
Felipe Favorette Campanharo ◽  
Letícia Tiemi Morooka ◽  
José Guilherme Cecatti ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Maternal Death ◽  
Lupus Erythematosus ◽  
Neonatal Death ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Control Group ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Life Threatening

Abstract Introduction: Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with coexisting SLE may have severe life-threatening risks. Severe maternal morbidities (SMM) include maternal death, maternal near miss (MNM), and potentially life-threatening conditions (PLTC). This study aimed to determine the prevalence of SMM in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods: This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at São Paulo Hospital , Brazil, from 2005 to 2015. The pregnant women were divided in control group without complications, group with PLTC, and group with MNM. Results: Out of 149 pregnancies, there were 14 cases of MNM (9.4%), 56 cases of PLTC (37.6%), and no maternal death. The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with control group [p=0.0042; OR (95% CI): 12.05 (1.5-96.6) for MNM group and p=0.0001; OR (95% CI): 4.84 (2.2-10.8) for PLTC group]. SMM increases the risk of longer hospitalization [p<0,0001; OR (95% CI): 18.8 (7.0-50.6) and p <0.0001; OR (95% CI): 158.17 (17.6-1424,2) for PLTC and MNM, respectively], newborns with low birth weight [p=0.0006; OR (95% CI): 3.67 (1.7-7.9) and p=0.0009; OR (95% CI): 17.68 (2-153.6) for PLTC and MNM group, respectively] as well as renal diseases [PLTC (58.9%, 33/56; p = 0.0069) and MNM (78.6%, 11/14; p = 0.0026)]. MNM cases presented increased risk for neonatal death [p=0.0128; OR (95% CI): 38.4 (3.3-440.3)], stillbirth and miscarriage [p=0.0011; OR (95% CI): 7.68 (2.2-26.3)]. Conclusion: SLE was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes, such as prematurity, neonatal death, miscarriage and fetal loss.

scholarly journals Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Rochelle Hardie ◽  
Tracian James-Goulbourne ◽  
Monsoon Rashid ◽  
Jeremy Sullivan ◽  
Yamen Homsi
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Respiratory Failure ◽  
Lupus Erythematosus ◽  
Opportunistic Infections ◽  
Immunocompromised Patient ◽  
Shortness Of Breath ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Life Threatening ◽  
Disseminated Aspergillosis

Patients with systemic lupus erythematosus (SLE) are at increased risk for infection including opportunistic infections. Fungal infection in particular can be difficult to diagnose and treat and often can be life-threatening in the immunocompromised patient. We present a case in which a patient with SLE presented to the hospital with shortness of breath and cough. Throughout the hospital course, the patient’s condition continued to decline leading to acute respiratory failure, and eventually, the patient expired. Postmortem autopsy revealed invasive fungal aspergillosis infection involving the heart, lungs, and brain. Earlier diagnosis and treatment with empiric antifungals may improve survival in these patients.

The Potential Role of Interferon-regulatory Factor 7 Among Taiwanese Patients with Systemic Lupus Erythematosus

2011 ◽  
Vol 38 (9) ◽  
pp. 1914-1919 ◽  
Author(s):  
LI-HSIN LIN ◽  
PIN LING ◽  
MING-FEI LIU
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Control Group ◽  
Type I ◽  
Mrna Levels ◽  
Regulatory Factor ◽  
Systemic Lupus ◽  
Increased Risk

Objective.Type I interferons (IFN), especially IFN-α, have been proposed to underlie the pathogenesis of systemic lupus erythematosus (SLE). Members of the IFN regulatory factor (IRF) family, which regulate IFN expression, have been implicated as risk factors for SLE. Our aims were to investigate the expression of IRF7 and its correlation with disease activity and to explore the association in Taiwanese patients between 2 genetic single-nucleotide polymorphisms (SNP) of IRF7 and SLE.Methods.IRF7 messenger RNA (mRNA) levels were measured in peripheral blood mononuclear cells by real-time reverse transcription polymerase chain reaction in 51 adult patients with SLE and 65 age-matched and sex-matched controls. Their serum IFN-α levels were determined by ELISA and the clinical manifestations were recorded at the same time. Two IRF7 SNP, rs1061501 and rs1061502, were examined by genotyping across 92 patients with SLE and 92 age and sex-matched healthy control subjects.Results.Compared with controls, the expression of IRF7 mRNA was significantly increased in patients with SLE and was positively correlated with both the serum level of IFN-α and lupus disease activity. The distribution of SNP rs1061501 by genotype (CC, CT, and TT) and by allele (C, T) was significantly different between the SLE and the control group (p = 0.028 for genotype and p = 0.009 for allele). There were no significant differences for SNP rs1061502.Conclusion.The results suggest that dysregulation of IRF7 might mediate an excessive production of IFN-α, which then exerts a crucial effect on the pathogenesis of human SLE. The IRF7 SNP rs1061501 TT genotype and T allele are enriched in Taiwanese patients with SLE and thus would seem to be associated with an increased risk of developing SLE.

scholarly journals Association of STAT4 rs7582694 with susceptibility to systemic lupus erythematosus in population of Lorestan province, Iran

2018 ◽  
Vol 21 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Gholam Reza Izadkhasti ◽  
Seyed Reza Kazeminezhad ◽  
Mohammad Reza Akhoond
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Single Nucleotide Polymorphism ◽  
Lupus Erythematosus ◽  
Control Group ◽  
Amplification Refractory Mutation System ◽  
Sample Population ◽  
Nucleotide Polymorphism ◽  
Systemic Lupus ◽  
Single Nucleotide ◽  
Increased Risk

Background and aims: Systemic lupus erythematosus (SLE) is a polygenic, inflammatory disease with a complex genetic inheritance that affects almost all the organs and systems of the host body. According to studies, STAT4 is a susceptible gene that can participate in the development of SLE in different populations. The aim of this study was to show the association between rs7582694 single nucleotide polymorphism with increased risk of SLE disease and two serological symptoms of the disease (i.e., anti-dsDNA and ANA) in the population residing in Lorestan province. Methods: The present study was conducted as a case control research. In this study, the prevalence of STAT4 gene G/C (rs7582694) single nucleotide polymorphism (SNP) in the patients with SLE (n=122) and in control group (n=127) was investigated among a sample population from Lorestan province. This SNP was genotyped based on using two methods including PCR-RFLP (polymerase chain reactionrestriction fragment length polymorphism) and tetra-primer ARMS-PCR (amplification-refractory mutation system) methods. Results: According to the obtained results, the frequency of minor allele C from this SNP (related allele with the disease) as compared to the major allele G (normal allele) was significantly higher in SLE patients than the controls. In addition, it showed a significant association (odds ratio [OR] = 1.623, 95% CI = 1.111-2.370, P = 0.012) with susceptibility to SLE. Moreover, a significant correlation (OR = 2.249, 95% CI = 1.031–4.904, P = 0.042) was found between the rs7582694 CC genotype and the risk of SLE in the population of Lorestan. Conclusion: Overall, based on the results it can be concluded that there was a relationship between the STAT4 gene G/C (rs7582694) SNP and the increased risk of SLE. However, no association was observed between the above-mentioned gene and anti-dsDNA or ANA that are some of the symptoms of SLE.

scholarly journals Incidence and risk factors of osteomyelitis in adult and pediatric systemic lupus erythematosus: a nationwide, population-based cohort study

Lupus ◽  
2018 ◽  
Vol 28 (1) ◽  
pp. 19-26
Author(s):  
Y.F. Huang ◽  
Y.S. Chang ◽  
W.S. Chen ◽  
Y.P. Tsao ◽  
W.H. Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Incidence Rate ◽  
Bone Fracture ◽  
Lupus Erythematosus ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
Systemic Lupus ◽  
Increased Risk

Objective The objective of this paper is to investigate the incidence rate, risk factors and outcome of osteomyelitis among patients with systemic lupus erythematosus (SLE). Materials and methods We conducted a cohort study using data for patients enrolled in the Taiwan National Health Insurance Database from 2000 to 2012. Patients with SLE and age- and sex-matched controls without SLE were enrolled. Primary endpoint was the first occurrence of osteomyelitis. Risks of osteomyelitis in SLE patients were analyzed with Cox proportional hazards regression models, including age, sex, comorbidities and medications. Results Among 24,705 SLE patients (88.4% women, mean age 35.8 years) with a median follow-up of 9.1 years, 386 patients had osteomyelitis. The incidence rate ratio (IRR) of osteomyelitis in the SLE group vs the control group was 8.52 (95% confidence interval (CI) 7.24–10.05). The SLE group had higher incidence rates of osteomyelitis than the control group, especially in pediatric subgroups (IRR 41.1 95% CI 18.57–107.35). Compared to controls, SLE patients experienced osteomyelitis at a younger age (42.3 vs 58.1 years) but did not have an increased risk of mortality (hazard ratio 0.7; 95% CI 0.21–2.38). Age >60 years, male gender, malignancy within five years, prior bone fracture and higher daily prednisolone dose (>7.5 mg) cumulatively for >180 days increased risk for osteomyelitis. Conclusions SLE patients have a higher IRR of osteomyelitis than controls. Pediatric and elder SLE patients, patients with a history of bone fracture, malignancy within five years and higher-dose glucocorticoid use have a higher risk of osteomyelitis and should be carefully monitored.

Systemic lupus erythematosus and risk of sexual dysfunction: A systematic review and Meta-Analysis

Lupus ◽  
2020 ◽  
pp. 096120332097408
Author(s):  
Zhao Jin ◽  
Cong Yang ◽  
Chu Xiao ◽  
Zizhen Wang ◽  
Suxin Zhang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Sexual Dysfunction ◽  
Lupus Erythematosus ◽  
Web Of Science ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Systemic Lupus ◽  
Increased Risk

Objective To systematically review and summarize the available literature regarding the association between systemic lupus erythematosus (SLE) and sexual dysfunction (SD) in both sexes. Methods We retrieved relevant studies from the following databases: PubMed, Embase, Cochrane Library, and Web of Science. Two reviewers independently reviewed the studies in our sample, assessed their validity, and extracted relevant data. Sensitivity and subgroup analyses were performed to distinguish sources of heterogeneity. Results Our search resulted in a sample of eight eligible studies, which involved 758 patients in the SLE group and 1724 individuals in the control group. The pooled RR for the increased risk for SD compared to those in the control group was 1.80 (95%CI 1.12-2.87). Subgroup analysis by sex revealed that males (pooled RR = 2.98, 95%CI 2.41-3.68) had a higher risk of SD compared to females (pooled RR = 1.56, 95%CI 0.99-2.48). Females with SLE had significantly lower values in FSFI compared to the healthy individuals (WMD=-0.224, 95%CI -0.441 to -0.078). Age of participants and the quality of studies might influence the results. Conclusions Our meta-analysis suggests that SLE is significantly associated with an increased risk of sexual dysfunction. It is of great urgency to implement for active interventions that aimed to treat or prevent SD among SLE patients.

scholarly journals Spontaneous perirenal hemorrhage in systemic lupus erythematosus: a rare case report and literature review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Youlu Zhao ◽  
Xiaoyu Jia ◽  
Xiaoqiang Tong ◽  
Guochen Niu ◽  
Rui Wang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Kidney Injury ◽  
Left Renal Artery ◽  
Systemic Lupus ◽  
Abdominal Ultrasonography ◽  
Selective Embolization ◽  
Increased Risk ◽  
Life Threatening ◽  
Perirenal Hemorrhage

Abstract Background Spontaneous perirenal hemorrhage is relatively uncommon but may be life-threatening. There are some challenges in early diagnosis due to the lack of specific presentations. Case presentation We report a case of spontaneous perirenal hemorrhage in a newly diagnosed systemic lupus erythematosus patient who initially presented with non-specific flank pain. Weakness and unstable vital signs were noted on admission. Abdominal ultrasonography and computed tomography revealed a sizable perirenal hematoma over the left retroperitoneal cavity. Renal arteriography identified active extravasation of contrast media from a distant branch of the left renal artery, and selective embolization effectively obliterated the bleeding spot. After cessation of bleeding, the patient received intensive immunosuppressive therapy for acute kidney injury and encephalopathy due to lupus. Her mental status recovered successfully, and she was withdrawn from short-term hemodialysis. Conclusions Spontaneous perirenal hemorrhage in the condition of systemic lupus erythematosus was a rare clinical entity with life-threatening potential. Early accurate diagnosis of spontaneous renal hemorrhage requires both detailed clinical examination and radiologic studies. Interventional embolization is essential and effective for both diagnosis and treatment. A high index of suspicion is necessary to avoid missing this potentially fatal syndrome, especially in patients with an increased risk of bleeding.

scholarly journals Effect of Delay in Postpartum Hemorrhage Management on the Rate of Near-Miss and Maternal Death Cases

2018 ◽  
pp. 177
Author(s):  
Risanto Siswosudarmo
Keyword(s):  
Multivariate Analysis ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Postpartum Hemorrhage ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Control Group ◽  
Increased Risk ◽  
Death Cases

Objective: To recognize the effect of delay in the management of postpartum bleeding to the occurrence of near-miss and maternal death cases. Method: Prospective cohort. The study population was patients with postpartum hemorrhage. All PPH cases from thirteen hospitals (Sardjito and 12 affiliated hospitals) were recorded. The study was carried out from January 1st to June 30th 2009. The study group was those who experienced delay and the control group was those withoutdelay. The outcome was measured as the number of near-miss and death cases. Near-miss was defined as those who experienced severe shock, demonstrated by systolic blood pressure 90 mmHg or less. Chi square test, t-test and logistic regressions were used to analyze our data.Result: From January 1st to June 30th 2009 we identified 139 cases of PPH from 8,924 deliveries (1.6%). From the 80 referred cases, as much as 22 cases (27.5%) were delayed, and 12 from 139 (8.6%) experienced delay in the hospital. A total of 30 cases among 139 (21.6%) experienced delay both outside and in the hospital. There were 74 near-miss cases, 9 of which ended in death of the patient. This means the real occurrence of near-miss cases is 65 from 139 cases or 46.8% while the occurrence of maternal death was 9 out of 139, or 6.47%. Case fatality rate was 9 from 139 or 6.47%; maternal near-miss ratio was 6.22; mortality index was 13.84% and maternal mortality ratio is estimated as 103/100.000 live births. Multivariate analysis showed delay in referral increased the risk of near-miss cases as much as 8.37 folds, while bleeding >1500 ml increased risk of near-miss by 12.12 folds. Delay in both referral and management in the hospital increased the risk of maternal death rate as much as 25.34 folds, hemoglobin <6 g/dl and unavailability of blood increase maternal death by 31.58 folds and 13.39 folds, respectively.Conclusion: Delay in referral and delay of in-hospital management ncreased the occurrence of near-miss and maternal mortality cases significantly. Multivariate analysis showed that the amount of bleeding, hemoglobin level and lack of blood availability influenced the occurrence of near-miss and maternal death more than the delay itself.Keywords: delay, maternal death, maternal near-miss, PPH

scholarly journals Impact of COVID-19 infection on maternal near miss cases in tertiary care centre

2021 ◽  
Vol 10 (7) ◽  
pp. 2671
Author(s):  
Niranjan Chavan ◽  
Shalini Mahapatra ◽  
Sneha Venkateswaran ◽  
Jui Ponkshe ◽  
Arun H. Nayak
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Pregnant Women ◽  
Maternal Death ◽  
Tertiary Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Control Group ◽  
Tertiary Referral Hospital ◽  
Health Crisis ◽  
Increased Risk

Background: The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to a health crisis. Since the beginning of the severe acute respiratory syndrome (SARS-CoV-2) or COVID-19 outbreak, it has been argued whether pregnant women are at increased risk of severe infection.1 The objective of this study was to summarize the effect of COVID-19 on maternal near miss cases.Methods: This single-centre prospective observational study, included all consecutive pregnant women with COVID-19 infection admitted to Lokmanya Tilak Municipal Medical College and General Hospital (Mumbai, India), a tertiary referral hospital, from 1 April 2020, to 20 December 2020. In this study, a total of 46 patients were included in near miss cases, who required ICU admission with severe morbidity. Of these, 8 patients were COVID-19 positive and remaining 38 patients were included in control group (COVID-19 negative). The course of each of their stay in ward was noted and findings were compared in both the groups. Results: During their course in ICU it was found that 6 COVID-19 patients had maternal death representing 75% and 12 non-COVID-19 patients had maternal death representing 31.57%.  Conclusions: The mortality rate from the above results concludes that in this study mortality appeared to be higher in COVID-19 infection. Multi-centre retrospective analysis with larger population size is required in order for this to be statistically significant.

Pancreatitis in Systemic Lupus Erythematosus: Frequency and Associated Factors — A Review of the Hopkins Lupus Cohort

2009 ◽  
Vol 37 (2) ◽  
pp. 341-345 ◽  
Author(s):  
ASHIMA MAKOL ◽  
MICHELLE PETRI
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Multivariate Model ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Large Prospective Cohort ◽  
Strong Associate

Objective.Pancreatitis is a rare but potentially life-threatening complication of systemic lupus erythematosus (SLE). Vasculitis of the gastrointestinal tract is the most commonly proposed mechanism. We determined the frequency of SLE-related pancreatitis in the Hopkins Lupus Cohort.Methods.A large prospective cohort of 1811 patients with SLE was reviewed and clinical and laboratory measures of SLE patients who developed pancreatitis were compared to patients who did not develop pancreatitis.Results.Four percent of patients with SLE had pancreatitis due to SLE. The best multivariate model of clinical and laboratory associations included hypertriglyceridemia, psychosis, pleurisy, gastritis, and anemia.Conclusion.Hypertriglyceridemia appears to be a strong associate of pancreatitis in SLE, but antiphospholipid antibodies are not. SLE patients with psychosis and pleurisy are at increased risk for pancreatitis.

Impact of markers of endothelial injury and hypercoagulability on systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (2) ◽  
pp. 182-190
Author(s):  
W Batista Cicarini ◽  
R C Figueiredo Duarte ◽  
K Silvestre Ferreira ◽  
C de Mello Gomes Loures ◽  
R Vargas Consoli ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Activity Index ◽  
Endothelial Injury ◽  
Control Group ◽  
Systemic Lupus ◽  
Low Concentrations ◽  
The Relationship

We have explored the relationship between possible hemostatic changes and clinical manifestation of the systemic lupus erythematosus (SLE) as a function of greater or lesser disease activity according to Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) criteria. Endothelial injury and hypercoagulability were investigated in patients with SLE by measuring thrombomodulin (TM), D-dimer (DDi) and thrombin generation (TG) potential. A total of 90 participants were distributed into three groups: 1) women with SLE presenting with low disease activity (laSLE) (SLEDAI-2K ≤ 4), 2) women with SLE presenting with moderate to high disease activity (mhaSLE) (SLEDAI-2K > 4), and 3) a control group comprising healthy women. Levels of TM and DDi were higher both in the laSLE and mhaSLE groups compared to controls and in mhaSLE compared to the laSLE group. With respect to TG assay, lagtime and endogen thrombin potential, low concentrations of tissue factor provided the best results for discrimination among groups. Analysis of these data allow us to conclude that TM, DDi and TG are potentially useful markers for discriminating patients with very active from those with lower active disease. Higher SLE activity may cause endothelial injury, resulting in higher TG and consequently a hypercoagulability state underlying the picture of thrombosis common in this inflammatory disease.

Sign in / Sign up

Export Citation Format

Share Document