Annals of medicine
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COVID-19 counts 46 million people infected and killed more than 1.2 million. Hypoxaemia is one of the main clinical manifestations, especially in severe cases. HIF1α is a master transcription factor involved in the cellular response to oxygen levels. The immunopathogenesis of this severe form of COVID-19 is poorly understood. ⋯ The up-regulation and participation of HIF1α in events such as inflammation, immunometabolism, and TLR make it a potential molecular marker for COVID-19 severity and, interestingly, could represent a potential target for molecular therapy. Key messages Critically ill COVID-19 patients show emergency myelopoiesis. HIF1α and its transcriptionally regulated genes are expressed in immature myeloid cells which could serve as molecular targets. HIF1α and its transcriptionally regulated genes is also expressed in lung cells from critically ill COVID-19 patients which may partially explain the hypoxia related events.
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Observational Study
Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients.
Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment. ⋯ Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients. KEY MESSAGE Critically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended. Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases. An incidence of 7.6 cases per 1000 admission of IPHs was reported. Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.
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The main risk factor for uterine scar dehiscence is a previous caesarean section. Better characterisation of the ultrasonographic features of uterine scar dehiscence may improve preoperative diagnostic accuracy in pregnant women with a caesarean scar. This study aimed to evaluate the ultrasonographic features of uterine scar dehiscence in pregnant women and maternal and neonatal outcomes. ⋯ Preoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality. However, the maximum benefit can only be obtained by scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence.KEY MESSAGESPreoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality.Scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence could be beneficial.Even when uterine dehiscence is detected by ultrasound during the second trimester, conservative management via strict observation alone is also feasible.
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This study aimed to investigate the effects of PPM1K rs1440581 and rs7678928 single nucleotide polymorphisms (SNPs) on the serum branched-chain amino acids (BCAAs) levels and cardiovascular disease (CVD) risk. ⋯ Allele C of PPM1K rs1440581 was associated with elevated serum Val, total BCAAs and CVD risks. rs1440581 CC genotype may be a better marker than baseline serum BCAAs in predicting the risk for CVD.
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To provide the reference biometric measurements of the normal foetal brain by prenatal MRI and describe the distribution of measurements in the foetuses with ventricular septal defect (VSD). ⋯ We have presented reference linear biometry of the foetal brain by prenatal MRI from 18 to 37 gestational weeks, which could help us to interpret and monitor the brain development for foetuses with VSD and other congenital heart diseases.Key messages:We have presented reference linear biometry of the foetal brain by prenatal MRI from 18 to 37 gestational weeks in multiple statistical methods: mean and standard deviation; 95% predicted confidence intervals and the 3rd, 10th, 25th, 50th, 75th, 90th, 97th centiles.Our data showed that the involvement of the brain in VSD may be not globally, but regionally, and the cerebellum may be more possible to be involved.We speculated that the earlier the VSD diagnosed the worse the brain involved, which might suggest a poor outcome and necessary follow-up.