Implications of fetal premature atrial contractions: systematic review.

OBJECTIVE: Fetal heart-rate irregularities occur in 1-2% of pregnancies and are usually caused by premature atrial contractions (PAC). Although PAC are considered benign, they may be associated with cardiac defects and tachyarrhythmia. We aimed to determine the incidence of congenital heart defects (CHDs) and complications in fetuses with PAC. METHODS: This was a systematic review and meta-analysis conducted in accordance with the PRISMA statement for reporting items for systematic reviews and meta-analyses. MEDLINE and EMBASE were searched from 1990 to June 2021 to identify studies on fetuses with PAC. The primary outcome was CHD; secondary outcomes were complications using the endpoints supraventricular tachyarrhythmia (SVT), cardiac failure and intrauterine fetal demise. Meta-analysis of proportions was performed, subdivided into high-risk and low-risk populations based on reason for referral. Pooled incidences with 95% CIs were calculated. RESULTS: Of 2443 unique articles identified, 19 cohort studies including 2260 fetuses were included. The pooled incidence of CHD in fetuses with PAC was 2.8% (95% CI, 1.5-4.1%), when 0.6% is the incidence expected in the general population. The pooled incidence of CHD was 7.2% (95% CI, 3.5-10.9%) in the high-risk population and 0.9% (95% CI, 0.0-2.0%) in the low-risk population. SVT occurred in 1.4% (95% CI, 0.6-3.4%) of fetuses diagnosed with PAC. Cardiac failure was described in 16 fetuses (1.4% (95% CI, 0.5-3.5%)), of which eight were CHD-related. Intrauterine fetal demise occurred in four fetuses (0.9% (95% CI, 0.5-1.7%)) and was related to CHD in two cases. CONCLUSIONS: Our findings suggest that the risk of CHD in fetuses with PAC is 4-5 times higher than that in the general population. CHD was present more frequently in the high-risk population. Consequently, an advanced ultrasound examination to diagnose PAC correctly and exclude CHD is recommended. Complications of PAC are rare but can result in fetal demise, thus weekly fetal heart-rate monitoring remains advisable to enable early detection of SVT and to prevent cardiac failure. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Autoimmune Encephalitis With mGluR1 Antibodies Presenting With Epilepsy, but Without Cerebellar Signs: A Case Report.

OBJECTIVE: To describe the unique case history of a patient with mGluR1 antibodies, with mainly limbic and without cerebellar symptoms. METHODS: A 50-year-old woman initially presented with focal seizures with epigastric rising and déjà-vu sensations, next to cognitive complaints, and musical auditory hallucinations. MRI, EEG, and neuronal autoantibody tests were performed. RESULTS: EEG findings showed slow and sharp activity (sharp waves and sharp-wave-slow-wave complex) in the left temporal lobe. A test for autoantibodies was negative initially. Because of persistent symptoms, serum and CSF were tested 4 years later and found positive for mGluR1 antibodies. Treatment started with monthly IV immunoglobulins and azathioprine that was replaced by mycophenolate mofetil later. Especially cognitive symptoms and hallucinations did not respond well to the treatment. During treatment, mGluR1 antibodies remained present in CSF. DISCUSSION: Whereas cerebellar symptoms are present in 97% of mGluR1-positive cases, our patient presented without ataxia. Therefore, we suggest that the clinical presentation of patients with mGluR1 antibodies is probably more diverse than previously described. Testing for mGluR1 antibodies should be considered in patients with limbic encephalitis and epilepsy, especially when negative for more common antibodies.

Fatigue in neuromuscular disorders: focus on Guillain-Barré syndrome and Pompe disease.

Fatigue accounts for an important part of the burden experienced by patients with neuromuscular disorders. Substantial high prevalence rates of fatigue are reported in a wide range of neuromuscular disorders, such as Guillain-Barré syndrome and Pompe disease. Fatigue can be subdivided into experienced fatigue and physiological fatigue. Physiological fatigue in turn can be of central or peripheral origin. Peripheral fatigue is an important contributor to fatigue in neuromuscular disorders, but in reaction to neuromuscular disease fatigue of central origin can be an important protective mechanism to restrict further damage. In most cases, severity of fatigue seems to be related with disease severity, possibly with the exception of fatigue occurring in a monophasic disorder like Guillain-Barré syndrome. Treatment of fatigue in neuromuscular disease starts with symptomatic treatment of the underlying disease. When symptoms of fatigue persist, non-pharmacological interventions, such as exercise and cognitive behavioral therapy, can be initiated.

Trends and determinants of end-of-life practices in ALS in the Netherlands.

BACKGROUND: In the Netherlands, the proportion of patients with amyotrophic lateral sclerosis (ALS) who choose the option of euthanasia or physician-assisted suicide (PAS) is relatively high (20%). The objective of this study was to determine which factors influence end-of-life practices in ALS and whether rates are changing over time. METHODS: In a cohort survey, 204 physicians and 198 informal caregivers (response rates 75% and 80%) of patients with ALS who died between 2000 and 2005 filled out questionnaires of the end-of-life circumstances of the patient. Results were compared with those of a similar study performed during the period 1994-1998. RESULTS: In 2000-2005, 16.8% of the patients decided on euthanasia or PAS compared to 20.2% in 1994-1998. Thirty-one (14.8%) patients died during continuous deep sedation (CDS) in 2000-2005. Euthanasia or PAS, but not CDS, were significantly associated with religion not being important to the patient, being more educated, and dying at home. Euthanasia or PAS were not associated with quality of care items or symptoms of depression. Loss of function was similar in both groups. Informal caregivers of patients who died after euthanasia or PAS more frequently reported fear of choking (p = 0.003), no chance of improvement (p = 0.001), loss of dignity (p = 0.02), being dependent on others (p = 0.002), and fatigue (p = 0.018) as reasons for shortening life. Hopelessness was associated with euthanasia or PAS, as with CDS. CONCLUSION: The frequency of euthanasia or physician-assisted suicide (PAS) in amyotrophic lateral sclerosis (ALS) appeared stable over time and 1 in 7 patients died during CDS. CDS is relatively common in ALS, but appears to have other determinants than euthanasia or PAS. Subjective factors may be important in explaining euthanasia or PAS in ALS.

Meiotic multivalent orientation and cell developmental delay.

In the heterozygote for the combination of an interchange (662W;3R/6R) and a Robertsonian split (3R) of rye, one type of adjacent orientation leads to trisomy in the progeny. Pollen mother cells with adjacent orientation of the translocation quinquivalent or with a trivalent and a bivalent were delayed in their development and appeared at prometaphase and metaphase later than cells with alternate quinquivalents. Delay in cell development is ascribed to unfavorable (early) prophase positioning of chromosomes.

Identification of rye chromosomes: the Giemsa banding pattern and the translocation tester set.

The Giemsa banding pattern is given for eleven reciprocal translocations of rye, Secale cereale L., together involving all chromosomes at least once, and one telocentric substitution. It is possible to correlate the identification system based on the Giemsa pattern with that based on the translocation tester set. The location of the translocation break points could be determined very exactly for a number of translocations, somewhat less exactly for others. The variations in the banding pattern, resulting from genetic, environmental and technical variation, make definite identification with the nomenclature system of the different rye additions to wheat difficult. An attempt is made, but some caution is necessary.

Oral dose and faecal concentration of antibiotics during antibiotic decontamination in mice and in a patient.

In both mice and one patient, a similar correlation was found between the oral dose of a ;nonabsorbable' aminoglycoside antibiotic selected for antibiotic decontamination of the digestive tract and the resultant faecal concentration. In mice, absorption of the orally-given antibiotics could only be demonstrated in animals treated with extremely high doses of 1440 mg. per kg. body weight per day. Evidence of absorption of gentamycin was found to occur in a patient after doses as low as 70 mg. per kg. per day.

Selective elimination of Enterobacteriaceae species from the digestive tract in mice and monkeys.

In mice and in monkeys, ;selective' elimination of Enterobacteriaceae species from the digestive tract of animals with a sensitive flora was accomplished by oral treatment with nalidixic acid (1 mg./g. body weight in mice and 0.4 mg./g. body weight in monkeys). During treatment, the concentration of enterococci (and also of Candida albicans in the monkey) remained unaltered. This indicates that the fraction of the anaerobic microflora which is responsible for the colonization resistance of the digestive tract is not affected by the treatment. An important consequence seems to be, that elimination of yeast and fungi with fungistatic drugs can be started at the same time as elimination of Enterobacteriaceae is attempted.

Colonization resistance of the digestive tract and the spread of bacteria to the lymphatic organs in mice.

After oral contamination of conventional mice with high doses of Escherichia coli, Klebsiella pneumoniae or Pseudomonas aeruginosa the contaminant was recovered in abnormally high concentrations from the duodenum and caecum during the first few days. In this initial colonization phase, evidence of spread was obtained by culturing the cervical and mesenteric lymph nodes and spleen. Longer after contamination the intestinal concentration decreased to normal and spread stopped. In orally antibiotic-treated mice, the situation seen during the initial colonization phase in conventional mice occurred after a much lower oral contamination dose and persisted during the entire observation period of 2 weeks.

Colonization resistance of the digestive tract in conventional and antibiotic-treated mice.

The effect of oral administration of antibiotics on the intestinal flora of conventional mice and their resistance to colonization by orally introduced Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa was studied. Colonization resistance (CR) was expressed as the log of the oral bacterial dose followed by a persistent take in 50% of the contaminated animals. The intestinal flora was virtually eliminated by the antibiotics and this elimination was accompanied by a precipitous fall of CR. CR gradually returned to normal values during the period of repopulation of the intestinal tract by the organisms surviving the treatment. Antibiotic treatment resulted in the disappearance of Enterobacteriaceae, enterococci, staphylococci and yeasts and, under appropriate housing conditions, the animals remained free of these organisms indefinitely. Germ-free mice contaminated with the intestinal flora of an antibiotic-treated animal and their offspring housed in a germ-free isolator showed high values of CR. Their intestinal flora consisted of anaerobic bacteria only. Apparently, these anaerobes are responsible for CR in these and in conventional mice.