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Shetty A, Gupta S, Weber M, Molnarfi N, Forsthuber T, Sobel R, Bernard C, Slavin A, Zamvil S. T Cell Epitope 119-132, but Not 35-55, Is the Immunodominant Encephalitogenic Determinant of the CNS Autoantigen, Myelin Oligodendrocyte Glycoprotein (P05.118). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Schulze Topphoff U, Shetty A, Varrin-Doyer M, Molnarfi N, Sagan S, Sobel R, Nelson P, Zamvil S. Laquinimod Promotes T Cell Immune Modulation in Central Nervous System Autoimmunity Via Type II (M2) Myeloid APC (P02.105). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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78
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Duckett SG, Ginks M, Shetty A, Kirubakaran S, Bostock J, Kapetanakis S, Gill J, Carr-White G, Razavi R, Rinaldi CA. Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position. J Interv Card Electrophysiol 2012; 33:151-60. [PMID: 22127378 DOI: 10.1007/s10840-011-9630-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 09/28/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Myocardial scar is an adverse factor when considering which patients are likely to respond to cardiac resynchronisation therapy (CRT). We hypothesized that septal scarring on magnetic resonance imaging (MRI) may be associated with a poor outcome from CRT, which may relate to the inability to place the right ventricular (RV) lead in the septum. METHODS Fifty patients (ejection fractions, 25 ± 8%; 45 men, 62.8 ± 14 years; 26 dilated cardiomyopathy; and 24 ischaemic cardiomyopathy (ICM)) receiving CRT underwent delayed enhancement cardiac MRI to assess location and burden of myocardial scar. Acute hemodynamic response (AHR) was evaluated at implant with a pressure wire in the left ventricular (LV) cavity. LV remodelling was determined by reduction in LV end-systolic volume at 6 months. RESULTS The presence of ICM with septal scar was associated with a poor acute and chronic response to CRT. This was predominantly due to a worse response in patients with septal scar. Patients without septal scar had a better AHR with a 26.7 ± 28.9% rise in LV dP/dt (max) from baseline vs. -2.8 ± 14.5% for patients with septal scar (P = 0.01) with Biventricular (BIV) pacing. A greater proportion remodelled (56% vs. 20% (P = 0.02)). Furthermore, only 33% of patients with septal scar had an RV septal lead compared with 66% with no septal scar (P = 0.03). CONCLUSIONS The presence of septal scar was associated with a poor acute and chronic response to CRT. This may relate to the inability to achieve a RV septal lead placement.
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Vadwai V, Shetty A, Rodrigues C. Using likelihood ratios to estimate diagnostic accuracy of a novel multiplex nested PCR in extra-pulmonary tuberculosis. Int J Tuberc Lung Dis 2012; 16:240-7. [DOI: 10.5588/ijtld.11.0322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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80
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Arujuna A, Williams S, Whittaker J, Shetty A, Roy D, Bostock J, Kirubakaran S, O'Neill M, Gill J, Cooklin M, Patel N, Blauth C, Bucknall C, Hamid S, Rinaldi CA. Trends, indications and outcomes of cardiac implantable device system extraction: a single UK centre experience over the last decade. Int J Clin Pract 2012; 66:218-25. [PMID: 22257047 DOI: 10.1111/j.1742-1241.2011.02863.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The rising number of device implantation has seen a parallel in the rising numbers of lead extraction. Herein we have analysed our experience in cardiac device and lead extraction in a single tertiary centre over the last decade. METHOD Retrospective analysis of all consecutive patients undergoing lead extractions performed between 2001 and 2010. Procedural success and complications as defined by the Heart Rhythm Society policy. RESULTS A total of 745 leads were extracted with a procedural success of 98.9% [382 cases; partial success in 6.9% (26) cases] and failure in 1.1% (4). Major complication rate was 1% (four cases) and minor complication rate was 3.6%. By both univariate and multivariate analysis only duration of lead implantation was an indicator for success (p < 0.0001). The mean implantation time for failed lead extraction was 203 ± 64 months compared with 71.8 ± 16.5 months in the successful cohort (p < 0.0001). Laser-assisted extraction was required in 176 cases. With regard to extraction indication, lead malfunction/recall showed a significant increase during the study period (p = 0.03). On time trend analysis the rise in coronary sinus (CS) lead extraction over time was significant. (p = 0.02) Despite a trend for increased laser use over time this did not achieve statistical significance, p = 0.06. CONCLUSIONS A decade's experience of percutaneous lead extraction suggests that a high procedural success rate with a low complication rate is achieved in a high-volume centre. During this time, an increase in both defibrillator and CS lead explantation and a rising trend in laser assistance with almost 50% of cases needing laser usage were observed.
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Deshpande P, Vadwai V, Shetty A, Dalal R, Soman R, Rodrigues C. No NDM-1 carriage in healthy persons from Mumbai: reassuring for now. J Antimicrob Chemother 2012; 67:1046-7. [DOI: 10.1093/jac/dkr580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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82
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Bhandary N, Shetty A. P-841 - Service users and carers as educators. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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83
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Deshpande P, Shetty A, Mehta A, Kapadia F, Hedge A, Soman R, Rodrigues C. Standardization of fungal polymerase chain reaction for the early diagnosis of invasive fungal infection. Indian J Med Microbiol 2011; 29:406-10. [PMID: 22120803 DOI: 10.4103/0255-0857.90179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND An early initiation of antifungal therapy in invasive fungal infections (IFIs) is critical in reducing the high mortality rate. Current diagnosis of fungal infection relies on microscopy, culture, antigen, antibody specific tests and histological diagnosis. However, these tests either lack sensitivity or specificity. There is thus the need for a rapid, specific and accurate diagnostic method. OBJECTIVE The aim of our study was to establish PCR for the rapid detection of Candida and Aspergillus species in clinical specimens with improved sensitivity and specificity. MATERIALS AND METHODS A total of 71 proven cases of IFI (confirmed by culture) were collected. A total of 15 healthy, 15 patients suffering from bacterial sepsis and 15 patients with HIV, HBV viral infections were included as controls. Clinical specimens were subjected to a standardized nested amplification to produce Round I (504 bp) and Round II (150 bp) amplicons. Restriction digestion was performed on these products for further identification. RESULTS Analytical sensitivity was determined using 10⁶-10 CFU/ml of cell suspension. The lower detection limit of the assay was 10 CFU/ml of blood. This test was 100% sensitive and specific with a positive predictive value of 100% and a negative predictive value of 96.7%. CONCLUSION The assay was found to be effective for the rapid detection of Candida and Aspergillus in clinical specimens.
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84
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Ginks MR, Duckett SG, Kapetanakis S, Bostock J, Hamid S, Shetty A, Ma Y, Rhode KS, Carr-White GS, Razavi RS, Rinaldi CA. Multi-site left ventricular pacing as a potential treatment for patients with postero-lateral scar: insights from cardiac magnetic resonance imaging and invasive haemodynamic assessment. Europace 2011; 14:373-9. [PMID: 22045930 DOI: 10.1093/europace/eur336] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Multi-site left ventricular (LV) pacing may be superior to single-site stimulation in correcting dyssynchrony and avoiding areas of myocardial scar. We sought to characterize myocardial scar using cardiac magnetic resonance imaging (CMR). We aimed to quantify the acute haemodynamic response to single-site and multi-site LV stimulation and to relate this to the position of the LV leads in relation to myocardial scar. METHODS Twenty patients undergoing cardiac resynchronization therapy had implantation of two LV leads. One lead (LV1) was positioned in a postero-lateral vein, the second (LV2) in a separate coronary vein. LV dP/dtmax was recorded using a pressure wire during stimulation at LV1, LV2, and both sites simultaneously (LV1 + 2). Patients were deemed acute responders if ΔLV dP/dtmax was ≥ 10%. Cardiac magnetic resonance imaging was performed to assess dyssynchrony as well as location and burden of scar. Scar anatomy was registered with fluoroscopy to assess LV lead position in relation to scar. RESULTS LV dP/dtmax increased from 726 ± 161 mmHg/s in intrinsic rhythm to 912 ± 234 mmHg/s with LV1, 837 ± 188 mmHg/s with LV2, and 932 ± 201 mmHg/s with LV1 and LV2. Nine of 19 (47%) were acute responders with LV1 vs. 6/19 (32%) with LV2. Twelve of 19 (63%) were acute responders with simultaneous LV1 + 2. Two of three patients benefitting with multi-site pacing had the LV1 lead positioned in postero-lateral scar. CONCLUSION Multi-site LV pacing increased acute response by 16% vs. single-site pacing. This was particularly beneficial in patients with postero-lateral scar identified on CMR.
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Kulothungan K, Kondagunta N, Shetty A, Kamath A. SP3-9 An epidemiological study on health provider practices and the factors influencing them in rural area of Udupi taluk, Karnataka, India. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976o.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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86
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Beattie T, Bradley J, Vanta UD, Shetty A, Lowndes CM, Alary M. O2-S1.05 Vulnerability re-assessed: the changing face of sex work in Guntur District, Andhra Pradesh. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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87
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Shetty A, Duckett S, Ginks M, Ma Y, Sohal M, Mehta P, Hamid S, Bostock J, Carr-White G, Rhode K, Razavi R, Rinaldi CA. 152 Real-time cardiac MR anatomy and dyssynchrony overlay to guide left ventricular lead placement in CRT. BRITISH HEART JOURNAL 2011. [DOI: 10.1136/heartjnl-2011-300198.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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88
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Duckett SG, Ginks M, Shetty A, Bostock J, Gill JS, Hamid SG, Kapetanakis S, Cunliffe E, Razavi RS, Carr-White G, Rinaldi CA. 90 Invasive acute haemodynamic response to guide LV lead implantation predicts chronic remodelling in patients undergoing cardiac resynchronisation therapy. BRITISH HEART JOURNAL 2011. [DOI: 10.1136/heartjnl-2011-300198.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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90
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Pieper D, Huang J, Wang A, Yan D, Maitz A, Shetty A, Doyle D, Park S, Chen P, Grills I. Comparison of MR Spectroscopy, MR perfusion, and Volume Modeling in Distinguishing Brain Tumor Recurrence from Radiation Necrosis. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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91
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Cutress R, McDowell A, Gabriel F, Brown V, Shetty A, Jeffrey M, Agrawal A, Wise M, Raftery J, Cree I, Yiangou C. Health economic analysis of the implementation of a molecular method for intra-operative breast cancer sentinel node (SLN) analysis. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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92
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Simoes T, Brown V, Shetty A, Yiangou C. Extent of Intraoperative Molecular Analysis (IMA) of the Axilla in Breast Cancer. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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93
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Shetty A, Fishwick KT, Rambani R, Acharya S. An unusual case of post-traumatic endometriosis involving the sciatic nerve in the right greater sciatic notch. J OBSTET GYNAECOL 2010; 30:642. [DOI: 10.3109/01443615.2010.491568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE To examine the risk of recurrence of stillbirth in a second pregnancy. DESIGN Retrospective cohort study. SETTING Scotland, UK. POPULATION All women who delivered their first and second pregnancies in Scotland between 1981 and 2005. METHODS All women delivering for the first time between 1981 and 2000 were linked to records of their second pregnancy using routinely collected data from the Scottish Morbidity Returns. Women who had an intrauterine death in their first pregnancy formed the exposed cohort, whereas those who had a live birth formed the unexposed cohort. MAIN OUTCOME MEASURE Stillbirth in a second pregnancy. RESULTS After adjusting for confounding factors, the odds of recurrence of stillbirth in a second pregnancy were found to be 1.94 (99% CI 1.29-2.92) compared with women who had had a live birth in their first pregnancy. Other factors associated with recurrence of stillbirth in a second pregnancy included placental abruption (adjusted OR 1.96; 99% CI 1.60-2.41), preterm delivery (adjusted OR 7.45; 99% CI 5.91-9.39) and low birthweight (adjusted OR 6.69; 99% CI 5.31-8.42). A Bayesian analysis using minimally informative normal priors found the risk of recurrence of stillbirth in a second pregnancy to be 1.59 (99% CI 1.10-2.33). CONCLUSIONS Women who have stillbirth in their first pregnancy have a higher risk of recurrence in their next pregnancy.
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Duckett SG, Ginks MR, Knowles BR, Chiribiri A, Sinclair S, Shetty A, Carr-white G, Rinaldi CA, Razavi R, Nagel E, Schaeffter T. 083 Coronary vein and myocardial scar imaging with a single cardiac MRI examination using a high relaxivity contrast agent in patients with severe heart failure awaiting CRT implantation. BRITISH HEART JOURNAL 2010. [DOI: 10.1136/hrt.2010.196071.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ginks MR, Duckett S, Hamid S, Shetty A, Bostock J, Razavi R, Rinaldi CA. 142 Cardiac resynchronisation therapy: are two left ventricular leads better than one? BRITISH HEART JOURNAL 2010. [DOI: 10.1136/hrt.2010.196113.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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97
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Naik V, Kini R, Shetty A. Rapidly Proliferating Nodular Fasciitis of the Maxillary Alveolus Extending into Antrum. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2010. [DOI: 10.4103/0972-1363.166989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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98
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Lee W, Krisko A, Shetty A, Yeo L, Hassan SS, Gotsch F, Mody S, Gonçalves LF, Romero R. Non-invasive fetal lung assessment using diffusion-weighted imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:673-7. [PMID: 19859908 PMCID: PMC2789899 DOI: 10.1002/uog.7446] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/03/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The main goal was to develop a reproducible method for estimating the diffusion of water in human fetal lung tissue using diffusion-weighted imaging (DWI). A secondary objective was to determine the relationship of the apparent diffusion coefficients (ADCs) in the fetal lung to menstrual age and total lung volume. METHODS Normal pregnant volunteers were scanned on a 1.5-Tesla (T) magnetic resonance imaging (MRI) system. The MRI system was equipped with 40-mT/m gradients (slew rate 200 T/m/s, rise time 0.2 ms). A six-channel body array coil was used for signal reception. Single-shot DWI utilized TE/TR 125/3400 ms, slice thickness 4 mm, field of view 280 mm x 280 mm, interslice gap 0.8 mm and a matrix of 128 x 128. The voxel size was 2.5 mm x 2.5 mm x 4.0 mm. Two b-values (0 and 1000) were chosen along three orthogonal directions. ADC maps were created using assigned b-values. Simple linear regression was performed with Pearson correlation coefficient. Interexaminer and intraexaminer bias, and 95% limits of agreement (LOA) were determined using Bland-Altman plots. RESULTS Forty-seven scans were performed at a mean +/- SD of 29.2 +/- 4.5 weeks. The median coefficient of variation for ADC was 5.6% (interquartile range, 4.0-8.1%). No differences in ADC values were found between right and left lungs. Normally distributed ADC measurements were not significantly correlated with either total lung volume (r(2) = 0.0001, P = 0.94) or menstrual age (r(2) = 0.003, P = 0.70). The mean ADC value was 1.75 (95% CI, 1.63-1.86). Mean +/- SD intraexaminer bias was -0.15 +/- 2.3 (95% LOA, -4.7 to + 4.4) and interexaminer bias was 2.2 +/- 3.5 (95% LOA, -4.7 to + 9.1). CONCLUSIONS Our findings suggest that ADC measurements of the fetal lung are reproducible between blinded examiners and are independent of menstrual age, as well as lung volume.
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Haque L, Mathur M, Shetty A. O375 Management of HIV-positive patients in pregnancy in the Grampian region of Scotland (1997-2008). Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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100
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Milingos DS, Madhuvrata P, Dean J, Shetty A, Campbell DM. Hereditary angioedema and pregnancy: successful management of recurrent and frequent attacks of angioedema with C1-inhibitor concentrate, danazol and tranexamic acid - a case report. Obstet Med 2009; 2:123-5. [PMID: 27582827 DOI: 10.1258/om.2009.090003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2009] [Indexed: 11/18/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare but potentially life-threatening condition caused by deficiency of C1 esterase inhibitor. It is characterized by subcutaneous swelling in any part of the skin, gastrointestinal and respiratory tracts. We present the case of a pregnant woman with known HAE that deteriorated during pregnancy with frequent attacks that were managed successfully with danazol, tranexamic acid and regular intravenous administration of C1 esterase inhibitor.
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