Clinical and serological risk factors of systemic lupus erythematosus outcomes during pregnancy

SLE is an important risk factor for mother and fetus during pregnancy. To identify clinical and serological risk factors that may cause poor maternal and fetal outcomes in pregnant systemic lupus erythematosus [SLE] patients. Forty selected SLE pregnant women [group A] versus 35 non-pregnant SLE patients [group B]. SLE disease activity index [SLEDAI] and flares were evaluated for both groups. Laboratory investigations included double stranded DNA, anticardiolipin antibodies [aCL], and complements [C3 and C4]. SLE pregnant patients were followed up in the second and third trimesters by ultrasonography and fetal Doppler were done to assess fetal outcome. Risk factors for poor maternal and fetal outcome were recorded. SLEDAI was increased in both groups more in group A. Lupus flares were increased during pregnancy as it occurred in [62.5%] of group A compared to [37.14%] in group B where severe flares were more frequent in group A. Gestational hypertension and active SLEDAI were found statistically significant for poor maternal outcome. Fetal outcome included full term 37.5%, prematurity 25%, intra-uterine growth retardation [IUGR] 22.5%, stillbirth 12.5%, abortion 7.5% and congenital heart block [CHB] 2.5%. Factors significantly associated with poor fetal outcome were severe flares and active renal disease where fetal loss significantly associated with aCL antibodies. Full term was more common in patients with no flares. These data demonstrate that pregnancy in SLE patients should be considered as a high-risk pregnancy and conception should be planned during a quiescent period. Close monitoring for optimal disease control of flares, lupus nephritis, gestational hypertension and aCL antibodies is recommended

Anorectal varices in liver cirrhosis

The study comprised 135 patients with liver cirrhosis and portal hypertension. They were classified into three groups: Group A [55 patients with no history of esophageal bleeding], group B [70 patients undergone endoscopic infection for bleeding esophageal varices], and group C [10 patients undergone splenectomy vasoligation]. The prevalence of hemorrhoids and anorectal varices was studied in the three groups. Only anorectal varices showed significant increase in their incidence after esophageal sclerotherapy [p <0.005], but both hemorrhoids and anorectal varices, increase significantly with the increase in severity of liver disease [p <0.001]. Significant increase of hemorrhoids and anorectal varices was found with the increase in grading of esophageal varices with tendency to more significant increase in frequency of anorectal varices [x2 = 9.3 p <0.01]. Anorectal varices also showed significant increase with the increase in the number of sessions of sclerotherapy [x2 = 9.3 p = 5.601 p = 0.07]. Finally, it was found that, in all three groups, the presence or absence of hemorrhoids has no relation to the incidence of anorectal varices [x2 = 1.3 p <0.05]