1
|
Doss JD, Diveley E, Zhang F, Scheffer A, Huang R, Jackson D, Raghuraman N, Carter EB, Mysorekar IU, Kelly JC. A prospective cohort study of pregnancy outcomes following antepartum infection with SARS-CoV-2. Pregnancy Hypertens 2024; 37:101152. [PMID: 39213820 DOI: 10.1016/j.preghy.2024.101152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 08/11/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Our study aimed to explore the impact of COVID-19 infection on pregnancy outcomes, accounting for the progression of variants, vaccines, and treatment modalities. STUDY DESIGN We performed a prospective longitudinal cohort study at two urban tertiary centers enrolling patients with a confirmed intrauterine singleton pregnancy from December 23, 2020 to July 18, 2022. Patients were evaluated for SARS-CoV-2 infection at enrollment and every trimester using serum antibody testing. The primary outcome was preterm birth. Symptom and treatment data were collected from pregnant patients with COVID-19 infections. Variant strain infection status was determined from local wastewater analysis. RESULTS 448 patients were enrolled, and 390 patients were retained through delivery with 159 unexposed and 231 exposed patients, of whom 56 patients (26.0 %) crossed over after enrollment to the exposed cohorts during pregnancy. There was no difference in rates of preterm birth between exposed and unexposed cohorts (14.6 % vs 11.3 %), in deliveries < 34 weeks (1.5 % vs 2.7 %), PPROM, (0.4 % vs 1.3 %), or gestational age at delivery (38.1 vs 38.2). Exposed patients were significantly more likely to be diagnosed with a hypertensive disorder (aOR 2.3, 95 % CI 1.2-4.1), specifically gestational hypertension (aOR 2.8, 95 % CI 1.3--6.0), but not preeclampsia/eclampsia. There were no differences in individual or composite neonatal outcomes. CONCLUSIONS Our study contributed to the understanding of the effects of SARS-CoV-2 infection on pregnancy outcomes, with increased risk of hypertensive disorders of pregnancy but overall, no differences in adverse neonatal outcomes. Regular antenatal PCR and antibody screening allowed for higher detection and inclusion of patients with asymptomatic SARS-CoV-2 infection and effects on maternal and neonatal outcomes.
Collapse
Affiliation(s)
- James D Doss
- Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO, USA.
| | - Emily Diveley
- Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO, USA
| | - Fan Zhang
- Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO, USA
| | - Amy Scheffer
- Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO, USA
| | - Ruizhi Huang
- Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO, USA
| | - Daniel Jackson
- Missouri Baptist Medical Center, Department of Obstetrics and Gynecology, St. Louis, MO, USA
| | - Nandini Raghuraman
- Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO, USA
| | - Ebony B Carter
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Indira U Mysorekar
- Baylor College of Medicine, Department of Medicine, Infectious Disease, Department of Molecular Virology and Microbiology, Houston, TX, USA
| | - Jeannie C Kelly
- Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO, USA
| |
Collapse
|
2
|
Pokharel G, Rosales S, Morrison J, Kim C. A Case of Adrenal Insufficiency Secondary to Bilateral Adrenal Hemorrhage in a Patient With Antiphospholipid Antibody Syndrome and Epstein-Barr Virus Infection. Cureus 2024; 16:e63544. [PMID: 39086776 PMCID: PMC11289495 DOI: 10.7759/cureus.63544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
Bilateral adrenal hemorrhage (AH) is linked to various causes, including bacterial and viral infections, coagulopathies, and postoperative states. Symptoms can range from mild adrenal insufficiency to shock from Waterhouse-Friedrichsen syndrome. We present a case of a 47-year-old male with antiphospholipid antibody syndrome (APS) on warfarin who presented to the emergency department (ED) with bilateral flank pain and was found to have bilateral AH. On exam, he was hypertensive, mildly tachycardic, and in severe pain. The abdomen was tender over the bilateral flank and costovertebral regions. Labs showed thrombocytopenia but normal international normalized ratio (INR) and fibrinogen. The CT and MRI confirmed bilateral AH. Further investigations revealed low ante meridiem (AM) cortisol and elevated adrenocorticotropic hormone (ACTH). The antinuclear antibody (ANA) test was negative, but the antiphospholipid antibody panel was positive. In addition, the patient had a positive Epstein-Barr virus (EBV) nuclear antigen with a significant IgM titer. He was treated with low-dose steroids and was placed on a prophylactic dose of enoxaparin with the resolution of symptoms. At discharge, he was advised to follow up with a hematologist in six weeks to restart full-dose anticoagulation, allowing time for the bleeding to resolve. This case highlights EBV infection as a possible trigger of adrenal insufficiency from adrenal bleeding in a patient with preexisting coagulopathy, necessitating prompt recognition and treatment.
Collapse
Affiliation(s)
- Grishma Pokharel
- Internal Medicine, Englewood Hospital and Medical Center, Englewood, USA
| | - Stephanie Rosales
- Internal Medicine, Englewood Hospital and Medical Center, Englewood, USA
| | - Jill Morrison
- Hematology and Oncology, Englewood Hospital and Medical Center, Englewood, USA
| | - Christian Kim
- Endocrinology, Hackensack University and Medical Center, Hackensack, USA
| |
Collapse
|
3
|
Qiu X, Liu M, Wang Q, Zhang Y, Kong L, Zhou L. Thrombosis in Critically Ill Influenza Patients: Incidence and Risk Factors. Clin Appl Thromb Hemost 2024; 30:10760296241278615. [PMID: 39183536 PMCID: PMC11348485 DOI: 10.1177/10760296241278615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/24/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024] Open
Abstract
Influenza infection is associated with a risk of thrombosis. Whether factors associated with reduced thrombosis might also be associated with reduced risk in patients with severe influenza is unknown. To investigate risk factors associated with thrombosis in patients with severe influenza. We used a cohort data set to identify adults diagnosed with severe influenza. Univariable and multivariable logistic regression models explored potential risk factors for thrombosis events in patients with severe influenza. Cox regression analysis was used to examine the risk factors for mortality in patients with severe influenza. A total of 854 patients with severe influenza were included in the analysis. The incidence of VTE was 9.37% (80/854). Multivariable regression analysis showed that previous aspirin medication (OR: 0.37; 95%CI: 0.14-0.84; P = .029) could reduce the risk factor of thrombosis in patients with severe influenza. Compared with patients in the non-thrombosis group, patients in the thrombosis group required more mechanical ventilation (P < .001), tracheostomy (P < .001), ECMO (P = .046), and high-frequency ventilation (P = .004). The incidence of co-infection was higher in the thrombosis group compared to the non-thrombosis group (P = .025). Univariable Cox regression analysis showed that previous aspirin medication (HR 0.52, 95%CI: 0.33-0.82, P = .005) and previous statin medication (HR 0.54, 95%CI: 0.34-0.87, P = .011) were risk factors for 60-day mortality in patients with severe influenza. Patients with severe influenza are at high risk for thrombosis. The effect of aspirin on thrombosis in patients with severe influenza needs further investigation.
Collapse
Affiliation(s)
- Xianming Qiu
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Respiratory Diseases, Jinan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Mingjie Liu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Quanzhen Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Respiratory Diseases, Jinan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yuke Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Respiratory Diseases, Jinan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Li Kong
- Department of Emergency Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Lei Zhou
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Respiratory Diseases, Jinan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| |
Collapse
|
4
|
Skripchenko NV, Alekseeva LA, Zheleznikova GF, Skripchenko EY, Bessonova TV, Zhirkov AA. [Factors of the hemostasis system as biomarkers of severe course of acute viral infections]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:63-74. [PMID: 38529865 DOI: 10.17116/jnevro202412403163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The authors give literature review of hemostasis and immune system factors intraction as main biomarkers of a severe cause of viral infectious diseases. Pro-inflamatory cytokines as the main markers of inflammation, can serve both as biomarkers of the clinical severity of the infectious process and reflect the state of the hemostatic and fibrinolytic systems, since components of these systems are present in various structures of the central nervous system and affect the development of neurons and synaptic plasticity. An inverse correlation has been proven between the concentration of D-dimer and the oxygenation index, and the development of DIC is not associated with the presence of respiratory failure in patients with influenza type A, while the ferritin concentration directly reflects the severity of the disease. One of the markers of endothelial damage may be soluble thrombomodulin, which, however, is rarely used in routine clinical practice. Cytoflavin is a highly effective pathogenetic drug that affects various parts of the hemostasis system, has anti-ischemic, antioxidant, antihypoxic, immunocorrective effect, which is indicated for any generalized infectious disease since its debut.
Collapse
Affiliation(s)
- N V Skripchenko
- Pediatric Research and Clinical Center for Infectious Diseases, St. Petersburg, Russia
- Saint Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - L A Alekseeva
- Pediatric Research and Clinical Center for Infectious Diseases, St. Petersburg, Russia
| | - G F Zheleznikova
- Pediatric Research and Clinical Center for Infectious Diseases, St. Petersburg, Russia
| | - E Yu Skripchenko
- Pediatric Research and Clinical Center for Infectious Diseases, St. Petersburg, Russia
- Saint Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - T V Bessonova
- Pediatric Research and Clinical Center for Infectious Diseases, St. Petersburg, Russia
| | - A A Zhirkov
- Pediatric Research and Clinical Center for Infectious Diseases, St. Petersburg, Russia
| |
Collapse
|
5
|
Zaher EA, Ebrahim MA, Patel P, Eshan SH, Alvi MS. A Rare Association of Epstein-Barr Virus and Budd-Chiari Syndrome. Cureus 2024; 16:e52323. [PMID: 38361703 PMCID: PMC10867698 DOI: 10.7759/cureus.52323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Budd-Chiari syndrome (BCS) is a rare hepatic venous outflow obstruction typically associated with hypercoagulable states. We present a unique case of a 29-year-old male with BCS triggered by a recent Epstein-Barr virus (EBV) infection. Workup unveiled antiphospholipid antibody syndrome as an underlying prothrombotic condition. Diagnostic challenges included inconclusive ultrasound findings, necessitating magnetic resonance imaging for confirmation. This case underscores the importance of considering infectious triggers for venous thromboembolism in BCS. Understanding the potential link between EBV and thrombosis warrants further investigation.
Collapse
Affiliation(s)
- Eli A Zaher
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | | | - Parth Patel
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | | | | |
Collapse
|
6
|
Guillen-Grima F, Guillen-Aguinaga S, Guillen-Aguinaga L, Alas-Brun R, Onambele L, Ortega W, Montejo R, Aguinaga-Ontoso E, Barach P, Aguinaga-Ontoso I. Evaluating the Efficacy of ChatGPT in Navigating the Spanish Medical Residency Entrance Examination (MIR): Promising Horizons for AI in Clinical Medicine. Clin Pract 2023; 13:1460-1487. [PMID: 37987431 PMCID: PMC10660543 DOI: 10.3390/clinpract13060130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023] Open
Abstract
The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. MATERIAL AND METHODS We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4's new image analysis capability. RESULTS GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as "error requiring intervention to sustain life" and "error resulting in death", had a 0% rate. CONCLUSIONS GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implications for patient safety.
Collapse
Affiliation(s)
- Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Preventive Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Laura Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Department of Nursing, Kystad Helse-og Velferdssenter, 7026 Trondheim, Norway
| | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1100, Cameroon;
| | - Wilfrido Ortega
- Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28871 Alcalá de Henares, Spain;
| | - Rocio Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden
| | | | - Paul Barach
- Jefferson College of Population Health, Philadelphia, PA 19107, USA;
- School of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, 1020 Vienna, Austria
- Department of Surgery, Imperial College, London SW7 2AZ, UK
| | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
| |
Collapse
|
7
|
Rodrigues WF, Miguel CB, de Abreu MCM, Neto JM, Oliveira CJF. Potential Associations between Vascular Biology and Hodgkin's Lymphoma: An Overview. Cancers (Basel) 2023; 15:5299. [PMID: 37958472 PMCID: PMC10649902 DOI: 10.3390/cancers15215299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Hodgkin's lymphoma (HL) is a lymphatic neoplasm typically found in the cervical lymph nodes. The disease is multifactorial, and in recent years, the relationships between various vascular molecules have been explored in the field of vascular biology. The connection between vascular biology and HL is intricate and the roles of several pathways remain unclear. This review summarizes the cellular and molecular relationships between vascular biology and HL. Proteins associated with various functions in vascular biology, including cytokines (TNF-α, IL-1, IL-13, and IL-21), chemokines (CXCL10, CXCL12, and CCL21), adhesion molecules (ELAM-1/VCAM-1), and growth factors (BDNF/NT-3, platelet-derived growth factor receptor-α), have been linked to tumor activity. Notable tumor activities include the induction of paracrine activation of NF-kB-dependent pathways, upregulation of adhesion molecule regulation, genome amplification, and effective loss of antigen presentation mediated by MHC-II. Preclinical study models, primarily those using cell culture, have been optimized for HL. Animal models, particularly mice, are also used as alternatives to complex biological systems, with studies primarily focusing on the physiopathogenic evaluation of the disease. These biomolecules warrant further study because they may shed light on obscure pathways and serve as targets for prevention and/or treatment interventions.
Collapse
Affiliation(s)
- Wellington Francisco Rodrigues
- Postgraduate Course in Tropical Medicine and Infectious Diseases, Federal University of Triangulo Mineiro, UFTM, Uberaba 38025-440, MG, Brazil; (C.B.M.); (C.J.F.O.)
- University Center of Mineiros, Unifimes, Mineiros 75833-130, GO, Brazil; (M.C.M.d.A.); (J.M.N.)
| | - Camila Botelho Miguel
- Postgraduate Course in Tropical Medicine and Infectious Diseases, Federal University of Triangulo Mineiro, UFTM, Uberaba 38025-440, MG, Brazil; (C.B.M.); (C.J.F.O.)
- University Center of Mineiros, Unifimes, Mineiros 75833-130, GO, Brazil; (M.C.M.d.A.); (J.M.N.)
| | | | - Jamil Miguel Neto
- University Center of Mineiros, Unifimes, Mineiros 75833-130, GO, Brazil; (M.C.M.d.A.); (J.M.N.)
| | - Carlo José Freire Oliveira
- Postgraduate Course in Tropical Medicine and Infectious Diseases, Federal University of Triangulo Mineiro, UFTM, Uberaba 38025-440, MG, Brazil; (C.B.M.); (C.J.F.O.)
| |
Collapse
|