scholarly journals Selenium Deficiency Due to Diet, Pregnancy, Severe Illness, or COVID-19—A Preventable Trigger for Autoimmune Disease

2021 ◽  
Vol 22 (16) ◽  
pp. 8532
Author(s):  
Lutz Schomburg
Keyword(s):  
Autoimmune Disease ◽  
Health Risks ◽  
Treatment Options ◽  
Severe Illness ◽  
Autoimmune Thyroid ◽  
Positive Effects ◽  
Increased Risk ◽  
Se Deficiency ◽  
In Pregnancy ◽  
Se Status

The trace element selenium (Se) is an essential part of the human diet; moreover, increased health risks have been observed with Se deficiency. A sufficiently high Se status is a prerequisite for adequate immune response, and preventable endemic diseases are known from areas with Se deficiency. Biomarkers of Se status decline strongly in pregnancy, severe illness, or COVID-19, reaching critically low concentrations. Notably, these conditions are associated with an increased risk for autoimmune disease (AID). Positive effects on the immune system are observed with Se supplementation in pregnancy, autoimmune thyroid disease, and recovery from severe illness. However, some studies reported null results; the database is small, and randomized trials are sparse. The current need for research on the link between AID and Se deficiency is particularly obvious for rheumatoid arthritis and type 1 diabetes mellitus. Despite these gaps in knowledge, it seems timely to realize that severe Se deficiency may trigger AID in susceptible subjects. Improved dietary choices or supplemental Se are efficient ways to avoid severe Se deficiency, thereby decreasing AID risk and improving disease course. A personalized approach is needed in clinics and during therapy, while population-wide measures should be considered for areas with habitual low Se intake. Finland has been adding Se to its food chain for more than 35 years—a wise and commendable decision, according to today’s knowledge. It is unfortunate that the health risks of Se deficiency are often neglected, while possible side effects of Se supplementation are exaggerated, leading to disregard for this safe and promising preventive and adjuvant treatment options. This is especially true in the follow-up situations of pregnancy, severe illness, or COVID-19, where massive Se deficiencies have developed and are associated with AID risk, long-lasting health impairments, and slow recovery.

COVID-19 IN PREGNANCY AND LITERATURE REVIEW

2021 ◽  
pp. 9-11
Author(s):  
Hari Kishan Boorugu
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Literature Review ◽  
Pregnant Women ◽  
Congenital Anomalies ◽  
Severe Illness ◽  
Increased Risk ◽  
Pregnancy And Lactation ◽  
In Pregnancy

COVID-19 pandemic has affected humankind in a major way. Pregnant women are as susceptible to SARS-COV-2 infection as non-pregnant population. Infections prevention is paramount as pregnancy is associated with increased risk of severe illness, admission to intensive care and mechanical ventilation. Pregnancy poses unique challenges in view of paucity of information regarding safety of drugs used in management of patients with COVID-19 infection. Fortunately SARS-COV-2 infection during pregnancy does not appear to cause congenital anomalies. Vaccination should not be withheld based on pregnancy and lactation status.

scholarly journals Influence of Rapid Urbanization on Thyroid Autoimmune Disease in China

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yingchao Chen ◽  
Bing Han ◽  
Jie Yu ◽  
Yi Chen ◽  
Jing Cheng ◽  
...  
Keyword(s):  
Autoimmune Disease ◽  
Genetic Factors ◽  
Autoimmune Thyroid Diseases ◽  
Rapid Urbanization ◽  
Autoimmune Thyroid ◽  
Locus Model ◽  
Thyroid Autoimmune Disease ◽  
Increased Risk ◽  
The World ◽  
The Relationship

Background. The prevalence of autoimmune thyroid diseases (AITDs), especially Hashimoto’s thyroiditis (HT), has increased dramatically in China. Moreover, China is experiencing the largest scale of urbanization in the world. We intended to explore the relationship between rapid urbanization and HT. Methods. A total of 2946 subjects in Zhejiang Shangyu (SY) (n = 1546) and Jiangsu Nanjing (NJ) (n = 1400) were enrolled in this study. Serum TPOAb, TGAb, and thyrotropin (TSH) were measured, and ultrasonography of the thyroid was performed in all subjects. DNA was extracted from all subjects, and four SNPs were selected for genotyping. Generalized multifactor dimensionality reduction (GMDR) was used to screen the best interaction between genetic factors and environment factors. Results. TPOAb and TGAb concentrations were higher in NJ than in SY (34.60 vs. 14.00 IU/ml and 21.05 vs. 7.50 IU/ml). People in NJ also had higher TPOAb and TGAb positivity rates than those in SY (7.8% vs. 12.7% and 8.7% vs. 16.3%). Logistic regression analysis indicated that rapid urbanization was an independent risk factor for TPOAb (OR = 1.473) and TGAb (OR = 1.689). Genotype TT in rs11675434 was associated with an increased risk of TPOAb positivity both in SY (OR = 2.955) and in NJ (OR = 1.819). GMDR analysis showed a two-locus model (SNP2 × urbanization) and a three-locus model (SNP2 × SNP3 × urbanization), which had testing accuracies of 56.88% and 57.25%, respectively ( P values were 0.001 and 0.001). Conclusion. Rapid urbanization influences the incidence of TPOAb and TGAb positivity. We should pay more attention to thyroid autoimmune disease in areas of China experiencing rapid urbanization.

scholarly journals Systemic Lupus Erythematosus and Virus C Infection - Diagnosis, Evolution and Treatment Particularities

2020 ◽  
Vol 17 (5) ◽  
pp. 15-33
Author(s):  
Delia-Georgiana Tudorovici Rotariu ◽  
Mircea Penescu
Keyword(s):  
Autoimmune Disease ◽  
Lupus Erythematosus ◽  
De Novo ◽  
Treatment Options ◽  
Immunosuppressive Drug ◽  
Lower Survival Rate ◽  
Increased Risk ◽  
Virus C ◽  
Stage Renal Disease ◽  
Direct Acting

Abstract Lupus erythematosus (SLE) is an autoimmune disease with a broad spectrum of clinical and immunologic manifestations. Hepatitis C virus (HCV) has been postulated as a potential etiologic or triggering agent among other viruses and it appears to be associated with the presence of autoimmune disorders, even mimicking SLE clinically and serologically. Data on the association between HCV infection and SLE are scarce, but an interaction between these two conditions seems possible. As for treatment options, it is well known that the classic antiviral therapy with interferon may aggravate preexisting autoimmunity, unmask previously silent autoimmune processes, or even cause the emergence of de novo autoimmune disease, including SLE. Interferon-free treatment seems to be more efficacious, safer and more tolerable. However, it is important that clinicians be aware that DAAs (direct acting antivirals) can also trigger lupus-like immune complex-mediated glomerulonephritis. There is scant data on the use of immunosuppressive drug therapy in HCV patients. It seems that enhanced HCV replication due to immunosuppression does not lead to clinically significant sequelae and growing evidence has been reported that supports its efficacy and safety. Patients with SLE and virus C infection are a special category, a fact that the clinician needs to take in consideration in order to a better approach, all the more as these patients are at increased risk for developing end-stage renal disease and have a lower survival rate than general population.

scholarly journals An Unusual Presentation of COVID-19 Associated Multisystem Inflammatory Syndrome in Adults (MIS-A) in a Pregnant Woman

2022 ◽  
Vol 2022 ◽  
pp. 1-5
Author(s):  
Mohamed Rishard ◽  
Suren Perera ◽  
Kushan Jayasinghe ◽  
Amila Rubasinghe ◽  
Sanjaya Athapaththu ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Pregnant Women ◽  
Respiratory Illness ◽  
Severe Illness ◽  
Obstetric Outcomes ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Increased Risk ◽  
Inflammatory Syndrome ◽  
In Pregnancy

Based on available literature, pregnant women are at an increased risk of severe illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, compared to nonpregnant women. Consequences of coronavirus disease 2019 (COVID-19) in pregnancy have many implications in women’s lives other than unfavorable obstetric outcomes. In addition to managing acute respiratory illness and symptoms, caregivers should be equipped to detect and manage the short-term, intermediate, and long-term consequences of SARS-CoV-2 infection as well. Many pregnant women can remain asymptomatic and continue their pregnancy without being diagnosed. Pregnancy outcomes and consequences of SARS-CoV-2 infected yet asymptomatic mothers have not been very well explained. Reports of a new multisystem inflammatory syndrome in children (MIS-C) and multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 have been described. However, MIS-A in pregnancy is an extremely rare presentation that can cause a huge diagnostic dilemma to caregivers. We describe the successful management of a pregnant woman with MIS-A following SARS-CoV-2 infection.

scholarly journals Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 667
Author(s):  
Kjerstine Breintoft ◽  
Regitze Pinnerup ◽  
Tine Brink Henriksen ◽  
Dorte Rytter ◽  
Niels Uldbjerg ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Cesarean Section ◽  
Placental Abruption ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcome ◽  
Placenta Previa ◽  
Meta Analysis ◽  
Increased Risk ◽  
Spontaneous Hemoperitoneum ◽  
In Pregnancy

Background: This systematic review and meta-analysis summarizes the evidence for the association between endometriosis and adverse pregnancy outcome, including gestational hypertension, pre-eclampsia, low birth weight, and small for gestational age, preterm birth, placenta previa, placental abruption, cesarean section, stillbirth, postpartum hemorrhage, spontaneous hemoperitoneum in pregnancy, and spontaneous bowel perforation in pregnancy. Methods: We performed the literature review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), by searches in PubMed and EMBASE, until 1 November 2020 (PROSPERO ID CRD42020213999). We included peer-reviewed observational cohort studies and case-control studies and scored them according to the Newcastle–Ottawa Scale, to assess the risk of bias and confounding. Results: 39 studies were included. Women with endometriosis had an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth, compared to women without endometriosis. These results remained unchanged in sub-analyses, including studies on spontaneous pregnancies only. Spontaneous hemoperitoneum in pregnancy and bowel perforation seemed to be associated with endometriosis; however, the studies were few and did not meet the inclusion criteria. Conclusions: The literature shows that endometriosis is associated with an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth.

A case of minimal change disease during pregnancy – Benefits of early diagnosis and use of corticosteroids

2021 ◽  
pp. 1753495X2199021
Author(s):  
Priyanka S Sagar ◽  
Eddy Fischer ◽  
Muralikrishna Gangadharan Komala ◽  
Bhadran Bose
Keyword(s):  
Nephrotic Syndrome ◽  
Early Diagnosis ◽  
Renal Biopsy ◽  
Early Pregnancy ◽  
Minimal Change Disease ◽  
Minimal Change ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Prompt Diagnosis ◽  
In Pregnancy

Nephrotic syndrome presenting in pregnancy is rare and poses a diagnostic and therapeutic challenge. Timing of renal biopsy is important given the increased risk of bleeding and miscarriage, and the choice of immunosuppression is limited due to the teratogenicity profiles of standard drugs. We report and discuss a case of minimal change disease diagnosed by renal biopsy during early pregnancy and treated with corticosteroids throughout the pregnancy. Prompt diagnosis and treatment of glomerular disease in pregnancy are vital to prevent poor maternal and fetal outcomes.

scholarly journals Educational aspects of rare and orphan lung diseases

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tiago M. Alfaro ◽  
Marlies S. Wijsenbeek ◽  
Pippa Powell ◽  
Daiana Stolz ◽  
John R. Hurst ◽  
...  
Keyword(s):  
Lung Diseases ◽  
Healthcare Professionals ◽  
Treatment Options ◽  
Delayed Diagnosis ◽  
Reference Network ◽  
Delay In Diagnosis ◽  
Positive Effects ◽  
European Reference Network ◽  
Patient Representatives ◽  
Rare Lung Diseases

AbstractPeople with rare lung diseases often suffer the burden of delayed diagnosis, limited treatment options, and difficulties in finding expert physicians. One of the reasons for the delay in diagnosis is the limited training for healthcare practitioners on rare diseases. This review explores the main concerns and needs for education on rare lung diseases from the perspectives of both patients and professionals. Despite the increasing interest in rare lung disorders and some recent breakthrough developments on the management of several diseases, healthcare professionals, including general practitioners and hospital workers, receive little education on this topic. Nonetheless, many healthcare professionals show much interest in receiving further training, especially on diagnosis. Patients and families want easier access to high-quality education materials to help them manage their own disease. Well-educated patients are better equipped to deal with chronic diseases, but patient education can be challenging as patients’ individual health issues, and diverse backgrounds can create significant barriers. Raising more awareness for rare lung diseases and further development of patient-centred international expert networks like the European Reference Network on Rare Lung Diseases (ERN-LUNG), which includes both experts and patient representatives, are essential for improving care and education on rare lung diseases. Initiatives such as the Rare Disease Day, have been successful in increasing awareness for rare conditions. The development of online tools for accessing information has had positive effects and should be further supported and extended in the future.

scholarly journals Psychosocial interventions to support the mental health of informal caregivers of persons living with dementia – a systematic literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henrik Wiegelmann ◽  
Sarah Speller ◽  
Lisa-Marie Verhaert ◽  
Liane Schirra-Weirich ◽  
Karin Wolf-Ostermann
Keyword(s):  
Mental Health ◽  
Informal Caregivers ◽  
Psychosocial Interventions ◽  
Health Interventions ◽  
Subjective Burden ◽  
Dementia Caregivers ◽  
Targeted Interventions ◽  
Positive Effects ◽  
Increased Risk ◽  
Mental Health Interventions

Abstract Background Informal caregivers of persons living with dementia have an increased risk of adverse mental health effects. It is therefore important to systematically summarize published literature in order to find out which mental health interventions generate effective support for informal caregivers of persons living with dementia. The objective of this study is to conduct a systematic review of intervention content, effectiveness and subgroup differentiation of mental health interventions for informal caregivers of persons with dementia living at home. Method We searched four electronic databases (PubMed, PsychINFO, Scopus and CINAHL) and included only methodically high-quality randomized controlled trials (RCTs), published in English or German language between 2009 and 2018. The intervention programmes focused on mental health of family caregivers. A narrative synthesis of the included studies is given. Results Forty-eight publications relating to 46 intervention programmes met the inclusion criteria. Burden, depression and quality of life (QoL) are the predominant parameters that were investigated. Twenty-five of forty-six interventions (54.3%) show positive effects on at least one of the outcomes examined. Most often, positive effects are reported for the outcome subjective burden (46.2%). Only six studies explicitly target on a certain subgroup of informal dementia caregivers (13%), whereas all other interventions (87%) target the group as a whole without differentiation. Conclusion The most beneficial results were found for cognitive behavioural approaches, especially concerning the reduction of depressive symptoms. Besides this, leisure and physical activity interventions show some good results in reducing subjective caregiver burden. In order to improve effectiveness, research and practice may focus on developing more targeted interventions for special dementia informal caregiver subgroups.

scholarly journals Considerations in the provision of teleconsultations for outpatient obstetric anaesthesia care during the Covid-19 pandemic

2021 ◽  
pp. 201010582199117
Author(s):  
Leonard Wei Wen Loh ◽  
Yingke He ◽  
Hairil Rizal Abdullah ◽  
Kai Lee Ng ◽  
Un Sam Mok
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Illness ◽  
Continuing Care ◽  
Short Report ◽  
Obstetric Anaesthesia ◽  
Increased Risk ◽  
Process And Outcome ◽  
Risk Of Exposure ◽  
Anaesthesia Care

Evidence has emerged that pregnant women who contract coronavirus disease 2019 (Covid-19) are at increased risk of certain forms of severe illness as well as complications requiring intensive care unit admission and resultant mortality. Teleconsultations can facilitate continuing care for obstetric patients during the Covid-19 pandemic while reducing their risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this short report, we share our experience in the provision of teleconsultations for ambulatory obstetric anaesthesia patients in our high-risk obstetric anaesthesia clinic during the Covid-19 pandemic. Appropriate labour analgesia or anaesthesia plans were able to be formulated and communicated to the patients by teleconsultation, resulting in no delay or compromise in their peripartum care. Both patients and clinicians reported satisfaction with the teleconsultation process and outcome. The considerations and challenges in setting up a teleconsultation service as well as the factors in favour of teleconsultation are also explored.

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