Unknown rheumatic cardiac disease as cause of acute onset post-partum dyspnea: a case report.

BACKGROUND: Acute post-partum dyspnea configures an obstetric challenge with multiple differential diagnosis. CASE PRESENTATION: We present a case of a previous healthy woman with preeclampsia who developed severe dyspnea 30 h after delivery. She complained of cough, orthopnea, and bilateral lower extremities oedema. She denied headaches, blurry vision, nausea, vomiting, fever or chills. Auscultation revealed a diastolic murmur, and was compatible with pulmonary oedema. A timely bedside echocardiogram showed moderate dilated left atrium with severe mitral insufficiency suggestive of an unknown rheumatic disease. She was managed with noninvasive ventilation, loop diuretics, vasodilators, thromboprophylaxis, head-end elevation, and fluid restriction with progressive improving. CONCLUSIONS: Hemodynamic changes in pregnant patients with previously silent cardiac disease may pose a challenge and cause post-partum dyspnea. This scenario requires a timely and multidisciplinary approach.

COVID-19 and Hypertensive Disorders of Pregnancy (HDP): A Portuguese Multicentric Retrospective Cohort Study of HDP in SARS-CoV-2 Infected Patients.

BACKGROUND:  An increased incidence of hypertensive disorders of pregnancy (HDP) has been reported among pregnant women infected by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the pathogen behind coronavirus disease-19 (COVID-19). Although it is primarily a respiratory infection, the extra-pulmonary manifestations of COVID-19 mimic those found in preeclampsia (PE). Moreover, the two conditions share common risk factors and pathological mechanisms, hindering the ability to understand the interaction between them. Current literature on this topic is controversial and as there is an overlap of clinical and laboratory findings, HDP can be an overreported outcome in pregnant women with COVID-19. The aim of our study is to assess whether there is an association between maternal SARS-CoV-2 infection and HDP. METHODS: We designed a multicenter retrospective cohort study with data collected from five maternity hospitals in Almada, Porto, Lisboa, Penafiel and Coimbra, Portugal, between March 2020 and March 2021. We obtained a sample of 789 pregnant women who were followed up or delivered their babies in one of the participating centers. Each pregnant woman who tested positive for SARS-CoV-2 on a real-time polymerase chain reaction test -- exposure group (n= 263), was paired with two negative pregnant women (1:2), who received the same antenatal care and had similar gestational age and parity -- control group (n=526). Data were collected on maternal characteristics, medical history, obstetric outcomes, and delivery.  Outcomes: The primary outcome of our study is to assess the incidence of HDP in pregnant women infected and not infected by SARS-CoV-2. The secondary outcomes of our study are to assess the incidence of HDP across all COVID-19 severity subgroups and to assess whether SARS-CoV-2 infection in pregnancy modified the odds of a set of risk factors developing HDP.  Results: There was a slightly increased, but not statistically significant, incidence of PE (relative risk, RR, 1.33; 95% confidence interval, CI 0.68-2.57) in the SARS-CoV-2 positive group. There was no statistically significant association between having COVID-19 in pregnancy and developing PE/eclampsia/ hemolysis, elevated liver enzymes, and low platelets, HELLP syndrome [X2(1) = 0.732; p = 0.392] as well as developing gestational hypertension (GH) [X2(1) = 0.039; p = 1]. There was no statistically significant association [X2(2) = 0.402; p = 0.875), [X2(2) = 1.529; p = 0.435] between COVID-19 severity and incidence of HDP. The SARS-CoV-2 infection did not modify the odds of each maternal risk factor causing HDP.  Conclusion: Our study did not demonstrate an association between maternal COVID-19 and HDP. We did not observe a significantly increased incidence of HDP in pregnant women infected by SARS-CoV-2. As current literature is controversial on this topic, clinicians should be aware that HDP is a possible complication of maternal SARS-CoV-2 infection and further research studies urge to better assess the association between COVID-19 in pregnancy and HDP.

ROPA - Lesbian shared in vitro fertilization - Ethical aspects.

Recently, a technique of assisted reproduction was developed to allow lesbian women to share biological motherhood of their offspring - the ROPA method (in Spanish - Recepción de Ovocitos de Pareja; in English - Reception of Partner's Oocytes), also known as lesbian shared in vitro fertilization. One mother provides the oocytes (genetic mother) and the other receives the embryo and gets pregnant (gestational mother). As for most issues related to medically assisted reproduction, this technique raises a lot of ethical questions in respect to patients, future offspring, gametes, and embryos. Furthermore, the fact that it is directed to homosexual women poses its own issues, both biological and social in nature. This is a state-of-the-art review of the main ethical dilemmas related to this technique, primarily focusing on the basic principles of bioethics, but also specific concerns directly related to this kind of treatments.

Ulipristal Acetate in Adenomyosis.

Adenomyosis is defined as the invasion of the basal endometrium (stroma and glands) into the underlying myometrium. It may lead to abnormal uterine bleeding (AUB), pelvic pain, and infertility. The definitive treatment is hysterectomy. Some conservative measures have been used in patients willing to procreate. Ulipristal acetate is a selective progesterone receptor modulator used to treat AUB caused by leiomyomas. This is a systematic review on the use of ulipristal to treat adenomyosis. Eight eligible articles were retrieved from PubMed, SCOPUS, and Cochrane Library. Only one randomized clinical trial was published until date concerning this matter. It seems that ulipristal acetate induces partial or complete remission of AUB caused by adenomyosis, but the evidence concerning its effect on pelvic pain and the radiologic findings of the disease is conflicting. Nevertheless, given the paucity of data, it is still preliminary to draw any conclusion about the subject.

The 15d­PGJ2 hydrogel ameliorates atopic dermatitis through suppression of the immune response.

The present study examined the efficacy of the topical 15d­PGJ2­poloxamer 407 hydrogel in an atopic dermatitis (AD) animal model. The 15d­PGJ2 hydrogel was prepared and characterized. The examined rats possessed AD­Like cutaneous lesions, which were induced using 2,4­dinitrochlorobenzene, the rats were then treated with a hydrogel vehicle, 15d­PGJ2 hydrogel or tacrolimus for 14 days. The rats were sacrificed and blood samples were collected to quantify the IgE levels. Subsequently, skin biopsies were stained with toluidine blue to identify mast cells and immunohistochemistry was performed for ROR­Î³t and TNF­α. Histological analyses demonstrated that 15d­PGJ2 hydrogel significantly decreased mast cell infiltration (P<0.05) when compared with the AD­group. Tacrolimus at 0.1% exhibited decreased mast cell infiltration; however, this difference was not statistically significant from the AD­group. Topical 15d­PGJ2 hydrogel and Tacrolimus 0.1% significantly reduced the serum levels of IgE (P<0.05) compared with the AD­group. Immunohistochemistry revealed a significant decrease in ROR­Î³t and TNF­α positive cell expression (P<0.05) in the 15d­PGJ2 hydrogel group compared with the AD­group. In summary, topical administration of 15d­PGJ2 hydrogel had a beneficial effect on AD symptoms, suggesting that this formulation may be a useful strategy for the treatment of AD.

Increased serum levels of interleukin-8 in polyarteritis nodosa and Behçet's disease.

The pathogenesis of Behçet's disease (BD) and polyarteritis nodosa (PAN) is not yet well established. Endothelial cells have been shown to express chemokines that are involved in inflammatory processes. Interleukin-8 (IL-8) is a potent chemoattractant and activator of neutrophils. We evaluated serum IL-8 levels in patients with PAN and BD. We measured serum IL-8 levels in 21 patients with BD and 16 with PAN. Sera from 30 age-matched healthy blood donors were used as normal controls. Serum IL-8 levels were measured by an enzyme-linked immunosorbent assay (ELISA). The mean serum IL-8 level of the active BD (1522.31 pg/ml) and that of the active PAN (654.8 pg/ml) was significantly higher than that of the normal controls (40.39 pg/ml, P <0.05). There was no difference in mean serum IL-8 levels between patients with inactive disease and normal controls. We found higher serum levels of IL-8 in those patients with more severe disease. These results suggest that IL-8 may play a role in the pathogenesis of PAN and/or BD. Our study also suggests a possible relation between serum IL-8 levels and the severity of these diseases.

Comparison of house dust mites found on different mattress surfaces.

BACKGROUND: House dust mites have been considered the most important source of allergens for humans. These allergens have been encountered at different indoor sites, mainly on mattresses and pillows. OBJECTIVE: To evaluate the number and different specimens of mites on Brazilian bunk-bed mattresses. METHODS: Dust samples were collected once using a standardized method on the upper mattress surface (US) and lower mattress surface (LS) (bed frame also included in the latter) of 58 mattresses. RESULTS: The total number of mite bodies on the LS was 3.5-fold higher than on the US, with a mean concentration of 932 mites per gram of fine dust (mites/g) on the US (range, 0-3,375 mites/g) and 3,254 mites/g on the LS (range, 125-14,500 mites/g) (P < .001). Additionally, the number of house dust mite bodies on the LS was 2.4 higher than on the US (P < .001); the mean concentration was 750 mites/g on the US (range, 0-2,875 mites/g) and 1,816 mites/g on the LS (range, 0-10,875 mites/g). Approximately 91% (n = 52) of the US and all LS dust samples had more than the limit of 100 mites/g. The most frequent family was Pyroglyphidae in both mattress surfaces, with Dermatophagoides pteronyssinus the most important species found. Storage mites, including Glycyphagidae (P < .001), Acaridae (P < .001), and other families (P < .001), also showed significant differences in the number of mites between both sample counts. CONCLUSIONS: This study shows a significant difference in US and LS mite counts, with higher counts on the LS. Mite allergen avoidance should include the LS and bed frame as potential targets.