Psoriasis in pregnancy: A review

Psoriasis is a complex autoimmune disease, most commonly characterized by silvery scale erythematous plaque. During pregnancy, there is a physiologic change of immunology status, which shifts from an inflammatory state to an anti-inflammatory state, in order to avoid fetal rejection. As a result of this immunomodulatory changes, the majority of pregnant patients experience improvement of their psoriasis. The treatment of psoriasis in pregnancy can be challenging, mainly because there is only a few evidence-based studies. The objective of this paper is to review the relevant data on psoriasis in pregnancy and its treatment.

Moderate Adverse Events

The incidence of sedation-related adverse events depends on (1) the medications used; (2) the type, duration, invasiveness, and location of the procedure; and (3) patient factors (e.g., age, medical condition, psychological factors). For the purposes of this chapter, moderate adverse sedation-related events represent physiologic change that is extremely likely to lead to significant patient harm if unnoticed or responded to ineffectively by the sedationist. Apnea, airway obstruction, and laryngospasm are examples. The relative likelihood of events of this type (1 of every 400 sedation episodes) provides significant impetus for effective preparation and training so that sedationists can effectively respond to these adverse events or preempt them. Even though they are categorized as “moderate” and may not be associated with harm in and of themselves, these events may certainly progress to produce significant harm.

Neurosurgery in Pregnancy

Pregnancy is a time of significant physiologic change that affects the vast majority of organ systems. Pregnant patients occasionally present for nonobstetric surgery, with complication rates of the procedure increased as well as the potential for fetal loss or damage as a result of the underlying disease process. Typical steps in diagnosis (such as imaging modalities) often need to be adjusted in pregnancy, and the medical or surgical treatment of neurologic disease will often change as well. A thorough understanding of pregnancy physiology, pharmacology, and teratogenicity will be important in caring for the pregnant neurosurgical patient.

Major Adverse Events

The incidence of sedation-related adverse events depends on medication characteristics, procedure conditions, and preexisting patient physiologic and psychological conditions. Major adverse sedation-related events represent extreme physiologic change causing significant patient harm that may be long-lasting or permanent, particularly if responded to ineffectively by the sedationist. Large safety studies of pediatric sedation events suggest that events of this type occur very rarely when well-organized, equipped, and trained sedation teams are present. However, sporadic reports of death during pediatric sedation continue to surface, providing significant impetus for effective preparation and training for sedationists. Major adverse sedation-related events discussed here are aspiration, cardiovascular collapse, respiratory failure, and death.

The Long-Term Stability of the Human Gut Microbiota

A low-error 16S ribosomal RNA amplicon sequencing method, in combination with whole-genome sequencing of >500 cultured isolates, was used to characterize bacterial strain composition in the fecal microbiota of 37 U.S. adults sampled for up to 5 years. Microbiota stability followed a power-law function, which when extrapolated suggests that most strains in an individual are residents for decades. Shared strains were recovered from family members but not from unrelated individuals. Sampling of individuals who consumed a monotonous liquid diet for up to 32 weeks indicated that changes in strain composition were better predicted by changes in weight than by differences in sampling interval. This combination of stability and responsiveness to physiologic change confirms the potential of the gut microbiota as a diagnostic tool and therapeutic target.