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Violette CJ, Aberle LS, Anderson ZS, Komatsu EJ, Song BB, Mandelbaum RS, Matsuzaki S, Ouzounian JG, Matsuo K. Pregnancy with endometriosis: Assessment of national-level trends, characteristics, and maternal morbidity at delivery. Eur J Obstet Gynecol Reprod Biol 2024; 299:1-11. [PMID: 38815411 DOI: 10.1016/j.ejogrb.2024.05.011] [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: 02/27/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To examine pregnancy characteristics and maternal morbidity at delivery among pregnant patients with a diagnosis of endometriosis. STUDY DESIGN This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. Study population was 17,796,365 hospital deliveries from 2016 to 2020, excluded adenomyosis and uterine myoma. The exposure was endometriosis diagnosis. Main outcome measures were clinical and pregnancy characteristics and severe maternal morbidity at delivery related to endometriosis, assessed with multivariable regression model. RESULTS Endometriosis was diagnosed in 17,590 patients. The prevalence of endometriosis increased by 24 % from one in 1,191 patients in 2016 to one in 853 patients in 2020 (adjusted-odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.19-1.30). Clinical and pregnancy characteristics that had greater than two-fold association to endometriosis included polycystic ovary syndrome, placenta previa, cesarean delivery, maternal age of ≥30 years, prior pregnancy loss, and anxiety disorder. Pregnant patients with endometriosis were more likely to have the diagnosis of measured severe maternal morbidity during the index hospitalization for delivery (47.8 vs 17.3 per 1,000 deliveries, aOR 1.91, 95%CI 1.78-2.06); these associations were more prominent following vaginal (aOR 2.82, 95%CI 2.41-3.30) compared to cesarean (aOR 1.85, 95%CI 1.71-2.00) deliveries. Among the individual morbidity indicators, endometriosis was most strongly associated with thromboembolism (aOR 5.05, 95%CI 3.70-6.91), followed by sepsis (aOR 2.39, 95%CI 1.85-3.09) and hysterectomy (aOR 2.18, 95%CI 1.85-2.56). When stratified for endometriosis anatomical site, odds of thromboembolism was increased in endometriosis at distant site (aOR 9.10, 95%CI 3.76-22.02) and adnexa (aOR 7.37, 95%CI 4.43-12.28); odds of sepsis was most increased in endometriosis at multi-classifier locations (aOR 7.33, 95%CI 2.93-18.31) followed by pelvic peritoneum (aOR 5.54, 95%CI 2.95-10.40); and odds of hysterectomy exceeded three-fold in endometriosis at adnexa (aOR 3.00, 95%CI 2.30-3.90), distant site (aOR 5.36, 95%CI 3.48-8.24), and multi-classifier location (aOR 4.46, 95%CI 2.11-9.41). CONCLUSION The results of this nationwide analysis suggest that pregnancy with endometriosis is uncommon but gradually increasing over time in the United States. The data also suggest that endometriosis during pregnancy is associated with increased risk of severe maternal morbidity at delivery, especially for thromboembolism, sepsis, and hysterectomy. These morbidity risks differed by the anatomical location of endometriosis.
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Affiliation(s)
- Caroline J Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Laurel S Aberle
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Zachary S Anderson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Emi J Komatsu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Bonnie B Song
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Solela G, Aschenek A, Amsalu C. Recurrent deep vein thrombosis in a young patient of African descent: challenging the prevailing stance on the significance of MTHFR C677T mutation. Oxf Med Case Reports 2023; 2023:omad132. [PMID: 38145269 PMCID: PMC10735354 DOI: 10.1093/omcr/omad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 12/26/2023] Open
Abstract
Background Although numerous gene variations, such as those in the methylenetetrahydrofolate reductase (MTHFR) gene, have been implicated in an increased risk of venous thrombosis, current recommendations do not advocate genetic testing if there is no clinically meaningful association with thrombosis. Case Presentation A 30-year-old male patient presented with left lower limb swelling of two days with prior history of deep vein thrombosis and superficial thrombophlebitis. His left lower limb was grossly swollen. Doppler study showed thrombosis of left common femoral, superficial femoral and iliac veins and work up for inherited thrombophilia was negative except detection of MTHFR C677T mutation. Conclusion In spite of the great controversy regarding the strong association between MTHFR C677T mutation and venous thromboembolism, it is worth considering genetic testing as part of work-up for inherited thrombophilia in young patients, particularly of African descent, if they have recurrent deep vein thrombosis with no obvious risk factors.
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Affiliation(s)
- Gashaw Solela
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Addis Aschenek
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Chali Amsalu
- College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Lee S, Lee CH, Seo MS, Yoo JI. Integrative analyses of genes about venous thromboembolism: An umbrella review of systematic reviews and meta-analyses. Medicine (Baltimore) 2022; 101:e31162. [PMID: 36316870 PMCID: PMC9622592 DOI: 10.1097/md.0000000000031162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, many studies have found possible links between gene polymorphisms and venous thromboembolism (VTE). By identifying genetic risk factors before facing environmental risk factors such as surgical interventions and COVID-19 vaccination, we could rapidly respond to the risk of VTE. The aim of this study was to perform an umbrella review of genetic variants related to VTE. Integrative gene analysis of VTE was performed to identify critical genetic variations. METHODS This study conducted an umbrella review of systematic reviews and meta-analyses. All included studies were selected from the PubMed/MEDLINE database. To select eligible studies, the following variables were extracted: first author name; effect size of each study genetic variant; year of publication; the number of studies included in each article; ethnicity, sample size, P values, and heterogeneity estimates. To assess cumulative evidence in genetic epidemiology about effects of gene polymorphisms on VTE, Human Genome Epidemiology Network's Venice criteria were used. Methodological quality assessment was conducted with JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. RESULTS Genes provided in the present study with genetic variants associated with VTE were FVL (G1691A), Prothrombin (G20210A), MTHFR (C677T, A1298C), PAI-1 (4G/5G), factor VII activating protease (1601G > A), and endothelial protein C receptor (g.6936A_G, c.4600A_G). Among them, variants in FVL, Prothrombin, MTHFR, and PAI-1 showed high significance. Particularly, variants in Prothrombin (G20210A), MTHFR (C677T), and PAI-1 (4G/5G) had more than 2 types of model significance. CONCLUSION The present study performed a systematic review of genetic variants associated with VTE. Our results could lead to a more comprehensive understanding of VTE etiology. These results could give a strategy of prediagnosis about evaluating individual risks of VTE who might be exposed to environmental risk factors.
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Affiliation(s)
- Sangyeob Lee
- Department of Biomedical Research Institute, Gyeongsang national university hospital, Jinju, South Korea
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Gyeongsang National University, Jinju, South Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Min Seok Seo
- Department of Orthopaedic Surgery, Gyeongsang national university hospital, Jinju, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang national university hospital, Jinju, South Korea
- * Correspondence: Jun-Il Yoo, Department of Orthopaedic Surgery, Gyeongsang National University Hospital, 90 Chilamdong, Jinju, Gyeongnamdo 660-702, Republic of Korea (e-mail: )
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Spiriev TY, Milev M, Laleva L, Stoyanov S, Plachkov I, Staneva M, Nakov V. A rare case of carotid body tumor associated with near complete cerebral sinus thrombosis and idiopathic intracranial hypertension. Management strategy and review of the literature. Surg Neurol Int 2021; 12:262. [PMID: 34221593 PMCID: PMC8247744 DOI: 10.25259/sni_170_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022] Open
Abstract
Background Carotid body tumors (CBTs) are rare hypervascular lesions with critical location which makes them very challenging to treat. In rare occasions, compression of the jugular vein from the tumor mass could predispose to progressive thrombosis of intracranial venous sinuses. The latter consequently leads to intracranial hypertension (pseudotumor cerebri) with the accompanying danger to the vision. Herewith, we present our management strategy for this rare presentation of CBTs. Case Description A 38-year-old woman, with no medical history, was admitted in the emergency unit with acute onset of headache, dizziness, and vomiting. On the diagnostic imaging studies (CT venography and MRI) a near total occlusion of all cerebral venous sinuses and a large CBT (Shambin Type II) were diagnosed. Initially, the patient was treated with anticoagulants for the thrombosis and with lumbo-peritoneal (LP) shunt for the management of pseudotumor cerebri. At a second stage, after resolution of the cerebral sinus thrombosis, the CBT was completely resected under electrophysiological monitoring, without preoperative embolization. At 1-year follow-up, the patient is neurologically intact with functioning LP shunt, patent cerebral venous sinuses, without tumor recurrence. Conclusion We present a rare case of CBT with intracranial complications, which was managed successfully by staged treatment. Careful study of the preoperative radiological and laboratory data, thorough preoperative planning of the tridimensional lesion anatomy, as well as meticulous microsurgical technique under intraoperative electrophysiological monitoring was essential for the successful outcome of the case.
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Affiliation(s)
- Toma Yuriev Spiriev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Milko Milev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Stoicho Stoyanov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Ivan Plachkov
- Department of Imaging Diagnostics Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Milena Staneva
- Department of Angiology, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
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Dick-Guareschi J, Fontana JC, Sanseverino MTV, Kubaski F, Sekine L, Mesquita NF, Onsten TGH, Leistner-Segal S. Prevalence of thrombophilia-associated genetic risk factors in blood donors of a regional hospital in southern Brazil. Hematol Transfus Cell Ther 2021; 44:379-385. [PMID: 33775585 PMCID: PMC9477773 DOI: 10.1016/j.htct.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/02/2021] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Thromboembolic events occur due to an imbalance in the hemostasis and some factors associated with this condition can be inherited. In order to evaluate the frequency of genotypes considered to be common hereditary risk factors for thrombophilia associated with venous thrombosis (g.1691G > A and g.20210G > A) and hyperhomocysteinemia (g.677C > T and g.1298A > C), samples from voluntary healthy blood donors at the Hospital de Clínicas de Porto Alegre were tested. Methods We examined 325 blood samples from blood donors collected from October 2017 to July 2018. Blood was collected on filter paper and the DNA was extracted for single nucleotide polymorphisms (SNPs) analysis using the qualitative real time polymerase chain reaction. Results The calculated frequencies of each genetic variant in heterozygosity were 4% for the FV gene (g.1691G > A), 4% for the F2 gene (g.20210G > A) and 42% and 39% for methylenetetrahydrofolate reductase (MTHFR), g.677C > T and g.1298A > C, respectively. Only the genetic variants of MTHFR were found in homozygosity, with frequencies of 14% and 6% (g.677C > T and g.1298A > C), respectively. Discussion Altogether, these results describe the frequencies of genetic variants associated with venous thrombosis and hyperhomocysteinemia in the analyzed group and are important to enhance our current knowledge about the genetic profiles of Brazilian blood donors.
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Affiliation(s)
- Jéssica Dick-Guareschi
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | | | - Francyne Kubaski
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Leo Sekine
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Tor Gunnar Hugo Onsten
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Sandra Leistner-Segal
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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