[A case study of anaphylaxis in a pregnant woman]. / Choque anafiláctico en una gestante en el tercer trimestre de embarazo.

We report a case of anaphylaxis in a 35+5 week of pregnancy patient who came to the Emergency Room with shortness of breath, hypotension and loss on fetal wellbeing. Due to her medical history and given the clinical picture at that time, an anaphylactic shock was suggested as the most probable diagnose. The administration of dexchlorpheniramine and methylprednisolone resulted in an immediate and positive reaction. Simultaneously, an improvement in the fetus cardiotocographic record was objectified. The patient was hospitalized for 48 hours, after which she was discharged. In case of suspicion of anaphylaxis in a pregnant woman, four aspects should be handled: the severity of the anaphylaxis chart, individual complications regarding a pregnant woman, unfavorable effects of the regularly used treatment during that specific gestation, and the need of fetal extraction based of gestational age.

Importance of the cytomegalovirus seropositive recipient as a contributor to disease burden after solid organ transplantation.

BACKGROUND: The incidence of cytomegalovirus (CMV) syndrome/disease after adult solid organ transplantation in the era effective antiviral therapy has not been fully assessed. OBJECTIVE: To determines the incidence of CMV syndrome/disease after solid organ transplantation in the UK. STUDY DESIGN: A retrospective analysis of 1807 solid organ transplants from 12 UK solid organ transplant centres representing 32.7% of all transplant activity occurring in the UK between 1/04/2004 and 31/03/2006. Patients were categorised into those experiencing an episode of symptomatic CMV infection after transplant or those who remained free of symptoms. All patients were followed up for 2 years for the occurrence of CMV syndrome/disease. RESULTS: The majority of the transplant centres used valganciclovir prophylaxis in the high risk D+R- patients (91.6%) whereas management of the lower risk D+R+ and D-R+ patients was more variable with deployment of both prophylactic and pre-emptive strategies in ∼50% of centres. CMV syndrome/disease occurred in 20.5% of the D+R- patients representing 55 cases whereas the incidence was only 8.1% and 9% in the D+R+ and D-R+ group, respectively (p<0.001 compared to the D+R- group), but representing a further 58 cases of CMV syndrome/disease. CMV viraemia in the D+R- group was associated with a high probability (65%) of CMV syndrome/disease in renal transplant recipients whereas this was less apparent in the intermediate risk groups. CONCLUSIONS: CMV syndrome/disease remains an important healthcare burden after solid organ transplantation with the intermediate risk groups contributing similar numbers of cases as the high risk group.

Genomic location and characterisation of MIC genes in cattle.

Major histocompatibility complex (MHC) class I chain-related (MIC) genes have been previously identified and characterised in human. They encode polymorphic class I-like molecules that are stress-inducible, and constitute one of the ligands of the activating natural killer cell receptor NKG2D. We have identified three MIC genes within the cattle genome, located close to three non-classical MHC class I genes. The genomic position relative to other genes is very similar to the arrangement reported in the pig MHC region. Analysis of MIC cDNA sequences derived from a range of cattle cell lines suggest there may be four MIC genes in total. We have investigated the presence of the genes in distinct and well-defined MHC haplotypes, and show that one gene is consistently present, while configuration of the other three genes appears variable.