De novo antineutrophil cytoplasmic antibody-associated vasculitis in pregnancy: a systematic review on maternal, pregnancy and fetal outcomes.

BACKGROUND: De novo antineutrophil cytoplasmic antibody-associated vasculitis typically arises in post-reproductive years, but can occur during pregnancy. Concerns of treatment-related teratogenicity persist, while efficacy and safety of new therapies including intravenous immunoglobulin (IVIG) and rituximab are uncertain. There remains a paucity of maternal, fetal and pregnancy outcome data in these women, and therefore a lack of guidance on safe treatment for clinicians. METHODS: We conducted a systematic review of the literature and a local, retrospective chart review of women with de novo antibody-associated vasculitis (AAV) in pregnancy. Cochrane, Embase and PubMed databases and relevant conference abstracts were searched. Patient demographics, clinical presentation, management and outcomes (maternal, fetal and pregnancy-related) were analyzed. RESULTS: Twenty-seven cases of de novo AAV in pregnancy were included. Women presented were from 5 to 39 weeks' gestation, of which a majority were in the second trimester (median 20 weeks). The median gravida of women was 2 and the median parity was 1. Women were treated with steroids (89%), cyclophosphamide (CYC) (37%), other immunosuppressive agents [azathioprine (AZA), IVIG, plasma exchange (PLEX)] or no therapy (11%). High rates of serious complications, including preeclampsia (29%) and maternal death (7%), were reported; however, most pregnancies resulted in live birth (73%). Prematurity was common; 73% of live births occurred prior to 37 weeks' gestation and 40% prior to 34 weeks' gestation. The majority of infants were born in the third trimester (median 34.5 weeks). Rates of pregnancy termination were high (23%) and only one intrauterine death was reported, shortly after initiation of therapy (4%). Congenital abnormalities were rare, with one infant having a solitary, pelvic kidney (6%) after maternal treatment with steroids, CYC and PLEX. Use of PLEX, IVIG and AZA increased after 2005, whereas CYC use decreased. Remission often occurred postpartum (60%). CONCLUSIONS: De novo AAV in pregnancy can result in uncomplicated pregnancies; however, serious maternal risks exist. Further data on potentially pregnancy compatible therapies such as IVIG and rituximab are needed in this population.

Patient characteristics, menopause symptoms, and care provided at an interdisciplinary menopause clinic: retrospective chart review.

OBJECTIVE: The goal of this study was to describe the characteristics, menopause symptoms, and treatment progressions in women cared for at an interdisciplinary menopause clinic. METHODS: We conducted a retrospective review of patient charts from women attending a multidisciplinary menopause clinic. Data collected from the charts included patient demographics, menopause symptoms, other concurrent medical conditions, and treatment recommendations. Data were entered into Research Electronic Data Capture database and analyzed descriptively. Generic symptom severity questionnaires were used to compare severity scores from initial to follow-up visits. RESULTS: Among the 198 women (mean age 52.1 y [±SD 6.3], 63.6% postmenopausal), the most common moderate/severe menopause symptoms were as follows: difficulty staying asleep or waking frequently (76.3%), tiredness (73.7%), and lack of interest in sex (60.1%). Women tended to have complex chronic medical conditions, with 54.5% suffering from four or more concurrent medical conditions. The majority of women (70.2%) were recommended various forms of hormone therapy. Women with a follow-up visit at 3 to 4 months reported a reduction in symptom severity. CONCLUSIONS: Our study addresses a gap in published information on patient characteristics and treatment in menopause-specific interdisciplinary clinics. The chart review highlights the variety of symptom experience and complexity of care faced in a menopause clinic. Rigorous prospective studies including standardized data collection and follow-up are needed to help guide clinicians in managing complex menopause patients.

Tuning light absorption in pyrene: synthesis and substitution effects of regioisomeric donor-acceptor chromophores.

Three isomeric donor-acceptor (DA) chromophores based on pyrene were synthesized to study the effects of substitution pattern on intramolecular charge-transfer absorption through pyrene. These chromophores are nonfluorescent and absorb light in the long-wavelength region approaching 700 nm, making them promising light-harvesters. Their optical properties depend greatly on the substitution pattern of the donor, but their electrochemical properties are relatively unaffected.