Microangiopathic antiphospholipid antibody syndrome due to anti-phosphatidylserine/prothrombin complex IgM antibody

Serum parabens and its correlations with immunologic and cellular markers in Southern Taiwan industrialized city systemic lupus erythematosus patients

BACKGROUND

Although the immune systems of patients with systemic lupus erythematosus (SLE) are affected by both personal characteristics and environmental factors, the effects of parabens on patients with SLE have not been well studied. We investigated the indirect effects of four parabens-methylparaben (MP), ethylparaben (EP), propylparaben (n-PrP), and butylparaben (n-BuP)-on several immunological markers.

METHODS

We assessed the serum levels of MP, EP, n-PrP, and n-BuP in 25 SLE patients and correlated the concentration of each paraben with available clinical and laboratory markers, including intracellular markers of antiviral immunity and apoptosis.

RESULTS

The expression of aryl hydrocarbon receptor (AhR) was significantly negatively correlated with n-PrP levels (p = 0.03, r = -0.434). In monocytes, APO2.7 was significantly positively correlated with n-BuP levels (p = 0.019, r = 0.467). Glutathione levels were significantly negatively correlated with n-BuP levels (p = 0.019, r = -0.518). Anti- β2 glycoprotein I IgM was significantly positively correlated with both MP (p = 0.011, r = 0.585) and EP levels (p = 0.032, r = 0.506). Anti-cardiolipin IgA was significantly positively correlated with both MP (p = 0.038, r = 0.493) and n-PrP levels (p = 0.031, r = 0.508). On CD8 T cells, the early apoptotic marker annexin V was significantly negatively correlated with both MP (p < 0.05, r = -0.541) and n-BuP levels (p = 0.02, r = -0.616), and L-selectin was significantly positively correlated with both MP (p < 0.05, r = 0.47) and n-PrP levels (p = 0.02, r = 0.556).

CONCLUSION

Our findings suggest that higher parabens levels were associated with lower AhR expression in leukocytes, increased monocyte apoptosis, lower serum glutathione levels, reduced annexin V expression on CD8 T cells, and higher L-selectin levels on leukocytes.

Effects of Comprehensive Nursing Based on Orem's Self-Care Theory on Symptom Improvement and Pregnancy Outcome in Patients with Antiphospholipid Syndrome: A Retrospective Cohort Study

Objective

A retrospective cohort study was conducted to explore the effects of comprehensive nursing based on Orem's self-care theory on symptom improvement and pregnancy outcomes in patients with antiphospholipid syndrome (APS).

Methods

Sixty patients with antiphospholipid antibody syndrome treated in our hospital from February 2019 to April 2021 were enrolled. The control group received comprehensive nursing, while the study group received comprehensive nursing based on Orem's self-care theory. Nursing satisfaction, self-nursing ability, anxiety score, social support status, pregnancy outcome, and the score of life quality were compared between the two groups.

Results

First of all, we compared the nursing satisfaction, the study group was very satisfied in 23 cases, satisfactory in 5 cases, general in 2 cases, the satisfaction rate was 100.00%. While in the control group, 11 cases were very satisfied, 10 cases were satisfied, 4 cases were general, and 5 cases were dissatisfied, the satisfaction rate was 83.33%. The nursing satisfaction in the study group was higher compared to the control group (P < 0.05). Secondly, the self-concept, sense of self-care responsibility, self-nursing skills, health knowledge, and total score of the study group were higher compared to the control group (P < 0.05). After intervention, the anxiety scores of the two groups decreased. Compared between the two groups, the anxiety scores of the study group before intervention and 1 week, 2 weeks, 3 weeks, and 4 weeks after intervention were lower compared to the control group (P < 0.05). The comparison of social support showed that the scores of objective support, subjective support, utilization of support, and total score of social support in the study group were higher compared to the control group (P < 0.05). The number of abortions in the control group was lower compared to the control group, and the number of full-term deliveries was higher compared to the control group (P < 0.05). Finally, we compared the scores of life quality. After nursing, the scores of life quality of the two groups increased. Of note, the scores of physiological function, psychological function, social function, and health self-cognition in the study group were lower compared to the control group (P < 0.05).

Conclusion

Comprehensive nursing for patients with APS based on Orem's self-care theory can effectively improve clinical symptoms and pregnancy outcome and play a positive role in facilitating patients' nursing satisfaction and self-nursing ability, which can also effectively strengthen mental health and social support, this nursing model is worth popularizing in clinic.

Pediatric antiphospholipid syndrome: clinical features and therapeutic interventions in a single center retrospective case series

BACKGROUND/PURPOSE

Pediatric antiphospholipid syndrome (APS) is a thromboinflammatory disease characterized by the presence of circulating antiphospholipid antibodies and either thrombotic events or pregnancy morbidity. The objective of this study was to review a large institution's experience to better understand the characteristics of children with APS.

METHODS

We conducted a retrospective review of pediatric APS at a tertiary referral center. The electronic medical record system was queried from 2000 through 2019, and 21 cases were included based on meeting the revised Sapporo Classification criteria by age 18 or younger. Comparisons between primary and secondary APS patients were made with two-tailed t-tests.

RESULTS

Twenty-one patients were included with a median age at diagnosis of 16 years and median follow-up of 5.8 years. Secondary APS was slightly more common than primary APS (11 vs. 10 cases) and was primarily diagnosed in the context of systemic lupus erythematosus. Two thirds of patients (67%) also had "non-criteria" manifestations of APS including thrombocytopenia, autoimmune hemolytic anemia, and livedo reticularis/racemosa. Almost half of patients (43%) had recurrent thrombosis, typically when patients were subtherapeutic or non-adherent with anticoagulation. Damage Index in Patients with Thrombotic APS (DIAPS) scores indicated a chronic burden of disease in both primary and secondary APS patients.

CONCLUSION

This case series of pediatric APS provides important context regarding disease phenotypes displayed by children with APS. High prevalence of non-criteria clinical manifestations highlights the need to consider these characteristics when developing pediatric-specific classification criteria and when considering this relatively rare diagnosis in pediatric practice.