Aaenemborg2918

OBJECTIVE To validate the performance of a first-trimester simple risk score based on the ASPRE trial algorithm for pre-eclampsia. DESIGN Multicentric retrospective cohort analysis. SETTING Four Italian hospitals. POPULATION Unselected nulliparous women at 11-13 weeks gestation from January 2014 through January 2018. METHODS Model performance was evaluated based on discrimination and calibration. MAIN OUTCOME MEASURES Delivery before 37 weeks gestation with a diagnosis of pre-eclampsia. RESULTS Based on 73 preterm pre-eclampsia cases, and 7,546 controls (including 101 cases of late pre-eclampsia) , the area under the ROC curve was 0.659 (95% CI 0.579-0.726). The sensitivity was 32.9% (95% CI 22.1-43.7) at a false positive rate of 8.8%. The LR+ was 3.74 (95% CI 2.67-5.23), the PPV was 3.49% (95% CI 2.12-4.86%) and the NPV 99.3% (99.1-99.5%). The sensitivity and LR+ were approximately 40% lower than in the original study. The calibration analysis showed a good agreement between observed and expected risks (p=0.037). Comparison with the Fetal Medicine Foundation (FMF) algorithm yielded a difference in the Area Under the Curve (AUC) of 0.084 (p =0.007). CONCLUSIONS In our Italian population, the simple risk score had a lower performance than expected for the prediction of preterm pre-eclampsia in nulliparous women. The FMF algorithm applied to the same data set resulted in a better prediction. This article is protected by copyright. All rights reserved.Discoid lupus erythematosus (DLE) is a chronic inflammatory erythematous skin disease that can be triggered by several factors. Rosacea is another skin disease that causes facial redness and tenderness. Demodex mites have been reported in rosacea and DLE patients commonly in the literature. These two diseases can be seen concomitant, mimic each other clinically and share common possible etiologic factors. To assess Demodex mite infestation in both clinical and histopathological findings in DLE patients. We retrospectively evaluated the files of 42 patients with DLE who had been diagnosed DLE based on clinical and histopathological findings between August 2018 and August 2019. Demodex positivity was detected 50% of patients (n = 21). Neutrophile percentages in the dermal and perivascular area were higher in the demodex positive patients (4,43%) than in the Demodex negative patients (2,19%). The intensity of demodex mites correlated positively with dermal neutrophile percentages. ANA was negative in 29 patients (69%) and positive in 13 patients (31%). Anti-dsDNA was negative in serology and follicular plugging was positive in histopathology in all 42 patients (100%). This was a retrospective study. DLE and rosacea share common features in etiopathogenesis and clinical presentation. Inflammation and exacerbations caused by the demodex mites may increase the clinical severity of DLE. Although the position of demodex mites in DLE etiopathogenesis is not known exactly, the presence of high demodex in DLE patients has been determined. Standard skin surface biopsy can be a routine procedure for the evaluation of DLE patients in daily clinical practice. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.BACKGROUND The prevalence of anaemia in the South African paediatric surgical population is unknown. Anaemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs). AIM The primary aim of this study was to describe the association between preoperative anaemia and 26 defined postoperative complications, in noncardiac paediatric surgical patients. Secondary aims included describing the prevalence of anaemia and risk factors for intraoperative blood transfusion. METHOD This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and less then 16 years, presenting to participating centres during the study period who underwent elective and non-elective noncardiac surgery and had a pre-operative haemoglobin recorded. Exclusion criteria were patients agoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anaemia reduces morbidity and mortality in children undergoing noncardiac surgery. This article is protected by copyright. All rights reserved.The authors of "COVID-19 and Urology A Comprehensive Review of Literature" have written a perceptive article which clearly outlines the complex challenges that COVID-19 is posing to urological surgeons and, indeed, the global surgical community at-large. 1. This article is protected by copyright. All rights reserved.Pre-clinical evidence has shown all common anesthetic drugs are toxic to the developing brain1 . Despite numerous cohort studies and one randomised control trial (RCT)2 , it remains unclear whether anesthetic-induced neurotoxicity exists and if intraoperative physiological disturbance plays a role. Well-designed RCTs with long-term follow-up are required to examine this. Infants requiring repair of oral cleft may provide an optimal clinical model; they often undergo multiple surgeries and have routine, nationally agreed, long-term speech and language assessments which extend into early adulthood. This article is protected by copyright. All rights reserved.Since the first report of coronavirus commonly termed as COVID-19 in China, it has progressed into a pandemic and Italy has been one of the countries worst hit. Deoxycytidine Coronaviruses are enveloped ribonucleic acid (RNA) viruses that cause respiratory, entero-hepatic, and neurologic diseases in humans and mammals. More specifically the coronavirus causing the current pandemic is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The common symptoms include a dry continuous cough, fever and shortness of breath; severe cases involve pneumonia which may require ventilatory support. This article is protected by copyright. All rights reserved.Chronic viral infections disrupt the ability of the humoral immune response to produce neutralising antibody or form effective immune memory, preventing viral clearance and making vaccine design difficult. Multiple components of the B cell response are affected by pathogens that are not cleared from the host. Changes in the microenvironment shift production of B cells to short-lived plasma cells early in the response. Polyclonal B cells are recruited into both the plasma cell and germinal centre compartments, inhibiting the formation of a targeted, high-affinity response. Finally, memory B cells shift towards an 'atypical' phenotype, which may in turn result in changes to the functional properties of this population. While similar properties of B cell dysregulation have been described across different types of persistent infections, key questions about the underlying mechanisms remain. This review will discuss the recent advances in this field, as well as highlight the critical questions about the interplay between viral load, microenvironment, the polyclonal response and atypical memory B cells that are yet to be answered. Design of new preventative treatments will rely on identifying the extrinsic and intrinsic modulators that push B cells towards an ineffective response, and thus identify new ways to guide them back onto the best path for clearance of virus and formation of effective immune memory. This article is protected by copyright. All rights reserved.BACKGROUND Studies suggest that a diet rich in omega-3 essential fatty acids may have beneficial anti-inflammatory effects for chronic conditions such as cystic fibrosis. This is an updated version of a previously published review. OBJECTIVES To determine whether there is evidence that omega-3 polyunsaturated fatty acid supplementation reduces morbidity and mortality and to identify any adverse events associated with supplementation. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of last search 01 April 2020. We also searched online study registries and contacted authors. Date of last search 12 February 2020. SELECTION CRITERIA Randomised controlled trials in people with cystic fibrosis comparing omega-3 fatty acid supplements with placebo. DATA COLLECTION AND ANALYSIS Two authors indepen a decrease in AA levels in the treatment arm compared to placebo. AUTHORS' CONCLUSIONS This review found that regular omega-3 supplements may provide some limited benefits for people with cystic fibrosis with relatively few adverse effects however, the quality of the evidence across all outcomes was very low. The current evidence is insufficient to draw firm conclusions or recommend routine use of these supplements in people with cystic fibrosis. A large, long-term, multicentre, randomised controlled study is needed to determine any significant therapeutic effect and to assess the influence of disease severity, dosage and duration of treatment. Future researchers should note the need for additional pancreatic enzymes when providing omega-3 supplementation or olive oil placebo capsules. More research is required to determine the exact dose of pancreatic enzyme required. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.OBJECTIVE Systematic approach to myelolipoma remains poorly defined. We aimed to describe clinical course of myelolipoma and to identify predictors of tumor growth and need for surgery. link2 METHODS We conducted a retrospective study of consecutive patients with myelolipoma. RESULTS A total of 321 myelolipomas (median size, 2.3 cm) were diagnosed in 305 patients at median age of 63 years (range, 25-87). Median follow-up was 54 months. Most myelolipomas were incidentally detected (86%), whereas 9% were discovered during cancer staging, and 5% during workup of mass effect symptoms. Thirty seven (12%) patients underwent adrenalectomy. Compared to myelolipomas less then 6 cm, tumors ≥6 cm were more likely to be right-sided (59% vs 41%, P=0.02), bilateral (21% vs 3%, P less then .0001), cause mass effect symptoms (32% vs 0%, P less then .0001), have hemorrhagic changes (14% vs 1%, P less then .0001), and undergo adrenalectomy (52% vs 5%, P less then .0001). Among patients with ≥6 months of imaging follow-up, median size change was 0 mm (-10, 115) and median growth rate was 0 mm/year (-6, 14). Compared to less then 1 cm growth, ≥1 cm growth correlated with larger initial size (3.6 vs 2.3 cm, P=0.02), hemorrhagic changes (12% vs 2%, P=0.007), and adrenalectomy (35% vs 8%, P less then .0001). CONCLUSIONS Most myelolipomas are incidentally discovered on cross-sectional imaging. Myelolipomas ≥6 are more likely to cause mass effect symptoms, have hemorrhagic changes, and undergo resection. Tumor growth ≥1 cm is associated with larger myelolipoma and hemorrhagic changes. Adrenalectomy should be considered in symptomatic patients with large tumors and when there is evidence of hemorrhage or tumor growth. link3 This article is protected by copyright. All rights reserved.