The Risk of Obstetric Complications and the Effects of Treatment in Women with Low Titer and Medium-High Titer Anti-Phospholipid Antibodies

Background/Purpose: The association of low titer anti-phospholipid antibodies (aPL) with obstetric anti-phospholipid syndrome (APS) is increasingly acknowledged, even though some studies have showed conflicting results. To raise further evidence on the relevance of low titer aPL in pregnancy morbidity (PM), we retrospectively reviewed the clinical records of pregnant women attending a joint obstetric/rheumatology clinic over the years 2009-2016. Methods: Patients were included when positive in at least one criteria aPL assay, at any titer, in two occasions minimum 12 weeks apart. Statistical analysis was performed using R package. Results: 111 women (338 pregnancies) were identified. 51 women displayed low-titer aPL, with 160 pregnancies. 60 patients carried aPL at medium-high titers, with 178 pregnancies. 4 patients (4%) had thrombotic APS, 27 (24%) obstetric APS, 7 (6%) thrombotic and obstetric APS, 15 (14%) medium-high titer aPL and non criteria PM, 7 (6%) medium-high titer aPL and no PM, 18 (16%) low titer aPL and non criteria PM and 15 (14%) low titer aPL and no PM. Low-titer aPL were significantly associated with pregnancy complications (c2=8.82, p=0.003). Considering 245 untreated pregnancies, a significant difference in PM distribution was noted for low titer and medium-high titer aPL (p=0.003, Table 1). Among patients with low titer aPL, treatment with low molecular weight heparin [LMWH] + low-dose aspirin [LDASA] significantly improved pregnancy outcomes (p<<0.001, odds ratio [OR]=0.07, 95% CI=0.007\u20130.300), leading to a 14.3-fold reduction of obstetric complications. Hydroxychloroquine [HCQ] was not associated with a significant improvement in live birth rate (p=0.079). Among women with medium-high titer aPL, the standard therapeutic approach with LMWH+LDASA resulted in a significant improvement of obstetric outcome (p<<0.001, OR=0.20, 95% CI=0.100\u20130.400). HCQ treatment significantly improved obstetric outcome, carrying a 3-fold increase in the live birth rate (p=0.025, OR=0.34, 95% CI=0.117\u20130.894). Conclusion: According to our data, low titer aPL are significantly associated with aPL-associated obstetric complications, with a lower prevalence of premature birth compared to medium-high titer aPL. Treatment with LDASA+LMWH led to a higher increase of live birth rate in women with low titer aPL compared to those with medium-high titer aPL. Additional treatment such as HCQ were effective in women with medium-high titer aPL but not those with low titer aPL. Table 1. Obstetric outcomes (defined according to Miyakis et al, 2006) in 245 untreated pregnancies in women with low titer and medium-high titer anti-phospholipid antibodies

Providing high-quality care remotely to patients with rare bone diseases during COVID-19 pandemic

During the COVID-19 outbreak, the European Reference Network on Rare Bone Diseases (ERN BOND) coordination team and Italian rare bone diseases healthcare professionals created the "COVID-19 Helpline for Rare Bone Diseases" in an attempt to provide high-quality information and expertise on rare bone diseases remotely to patients and healthcare professionals. The present position statement describes the key characteristics of the Helpline initiative, along with the main aspects and topics that recurrently emerged as central for rare bone diseases patients and professionals. The main topics highlighted are general recommendations, pulmonary complications, drug treatment, trauma, pregnancy, children and elderly people, and patient associations role. The successful experience of the "COVID-19 Helpline for Rare Bone Diseases" launched in Italy could serve as a primer of gold-standard remote care for rare bone diseases for the other European countries and globally. Furthermore, similar COVID-19 helplines could be considered and applied for other rare diseases in order to implement remote patients' care

Instrument for long-path spectral extinction measurements in air: application to sizing of airborne particles

A novel instrument that is capable of taking spectral extinction measurements over long optical paths (approximately 1\u2013100 m) in the UV, visible, and IR ranges is described. The instrument is fully automated, and the extinction spectrum is acquired in almost real time (approximately 5\u201310 s) with a resolution of \u2dc3 nm. Its sensitivity and accuracy were estimated by tests carried out in a clean room that showed that, for optical paths between 50 and 100 m, the extinction coefficient can be detected at levels of \u2dc1025 m-1. Tests carried out on calibrated latex particles showed that, when it was combined with an appropriate inversion method, the technique could be profitably applied to characterize airborne particulate distributions. By carrying out measurements over optical paths of \u2dc100 m, the instrument is also capable of detecting extinction coefficients that are due to aerosol concentrations well below the limits imposed by the European Economic Community for atmospheric pollution (150 \u3bcg/m3). Scaled over optical paths of;10 m, the limit imposed for particle emissions from industrial plants (10 \u3bcg/m3) can also be detected sensitively. \ua9 2001 Optical Society of America

Determination of size and concentration of particles in air by using long path optical extinction measurements

Atmospheric particle pollution and particles emitted by industrial plants are extremely dangerous for human health. Indeed, they have diameters in such a range (approximately 0.1-5 \u3bcm) that they can penetrate our respiratory system, but cannot be expelled during exhalation. Therefore, it is extremely important to detect them and characterize their size distribution. In this paper we propose the use of a novel instrument recently developed by the authors for the monitoring of airborne particulate at concentration levels so to comply with the current European Economic Community (EEC) regulations. The instrument is based on spectral extinction measurements over long optical paths and is able to recover, almost in real time, both concentration and size distribution of particles with diameters in the range of interest. The sensitivity and accuracy of the instrument were estimated by means of measurements in a clean room and by using calibrated particles dispersed in water. Our results show that, by carrying out measurements over optical paths of approximately \u25a1100 m, the instrument is able to detect concentration levels well below the ECC limit imposed for the atmospheric pollution. Scaled over shorter optical paths (approximately 10 m), the limit imposed for particle emissions by industrial plants can also be detected very accurately

Disturbi del comportamento alimentare e gravidanza

Society today presents a decidedly rising incidence and prevalence of feeding behaviour disturbances. Fertility-related symptoms stand out among the medical complications associated with these. Moreover, owing to psycho-pathological aspects of patients and diagnostic difficulty it often time to reach an evaluation and a decision on adequate treatment for these patients. The literature on feeding behaviour disturbances is reviewed with special regard to the effects they have in pregnancy, with an evaluation of their omplications in clinical practic

Treatment with a gonadotrophin releasing hormone agonist before endometrial resection: a multicentre, randomised controlled trial

To ascertain whether treatment with a gonadotrophin releasing hormone agonist before endometrial resection reduces absorption of distension fluid and operating time and facilitates the procedure

Tumor necrosis factor in plasma and peritoneal fluid of women with and without endometriosis

To determine whether in vivo levels of tumor necrosis factor a in plasma and peritoneal fluid differ in infertile subjects with and without endometriosis, peripheral blood and peritoneal fluid samples were collected in 94 women undergoing laparoscopy for infertility. Quantitative determinations of tumor necrosis factor a were performed by an enzyme immunoassay test. Tumor necrosis factor a levels were below the detection limit (10 pg/ml) in plasma and peritoneal fluid of 42 (91%) and 30 (90%) patients with endometriosis and 40 (83%) and 31 (91%) subjects without the disease, respectively. In our series, plasma and tumor necrosis factor a levels were not different in infertile women with and without endometriosis

Gonadotropin releasing hormone agonist treatment before hysteroscopic endometrial resection

To evaluate the effects of treatment with the gonadotropin releasing hormone (GnRH) agonist goserelin before endometrial resection on absorption of distension medium fluid and technical feasibility of the surgical procedure

Very low dose danazol for relief of endometriosis-associated pelvic pain: a pilot study

To evaluate the efficacy and safety of very low dose danazol in improving pelvic pain in women with endometriosis, the benefit of preceding the treatment by a short course of a GnRH agonist, symptoms recurrence after drug withdrawal, and variations in menstrual pattern

Endometriosis and pelvic pain: relation to disease stage and localization

To determine whether prevalence and severity of pain symptoms are related to endometriosis stage and site, with particular reference to deep infiltrating vaginal lesions