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Int J Gynaecol Obstet ; 155(3): 524-531, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1562319


OBJECTIVE: To compare the outcomes of adolescent versus adult women during pregnancy and puerperium admitted to a dedicated intensive care unit (ICU) in Manaus, Amazonas, Brazil. METHODS: In a retrospective cohort study, we retrieved data from the medical charts of 557 adolescent (<20 years) and adult (≥20 years) women. The association between demographic and clinical variables and the outcomes were compared in univariate and multivariate analyses. RESULTS: The maternal severity index (MSI) of adult women was significantly higher than in adolescents. In univariate log-binomial regression analysis, pneumothorax and circulatory dysfunction were positively associated with the composite primary outcome of death or transfer (for more complex care), whereas eclampsia was negatively associated. Being an adolescent was not associated with this outcome, not even when adjusting for potential confounders. Conversely, being an adolescent was associated with fewer complications (secondary outcome) even after adjusting for potential confounders (type of admission, eclampsia, pre-eclampsia, surgical site infection, abdominal hemorrhage, drug abuse, metabolic syndrome, malnutrition, pneumothorax, or circulatory dysfunction). CONCLUSION: In Manaus, Amazonas, Brazil, adult women admitted to the ICU because of gestational or birth complications had worse outcomes compared with adolescents.

Eclampsia , Intensive Care Units , Adolescent , Adult , Brazil/epidemiology , Eclampsia/epidemiology , Female , Humans , Pregnancy , Pregnant Women , Retrospective Studies
Curr Pain Headache Rep ; 25(3): 19, 2021 Feb 25.
Article in English | MEDLINE | ID: covidwho-1100995


PURPOSE OF REVIEW: This review provides an updated discussion on the clinical presentation, diagnosis and radiographic features, mechanisms, associations and epidemiology, treatment, and prognosis of posterior reversible encephalopathy syndrome (PRES). Headache is common in PRES, though headache associated with PRES was not identified as a separate entity in the 2018 International Classification of Headache Disorders. Here, we review the relevant literature and suggest criteria for consideration of its inclusion. RECENT FINDINGS: COVID-19 has been identified as a potential risk factor for PRES, with a prevalence of 1-4% in patients with SARS-CoV-2 infection undergoing neuroimaging, thus making a discussion of its identification and treatment particularly timely given the ongoing global pandemic at the time of this writing. PRES is a neuro-clinical syndrome with specific imaging findings. The clinical manifestations of PRES include headache, seizures, encephalopathy, visual disturbances, and focal neurologic deficits. Associations with PRES include renal failure, preeclampsia and eclampsia, autoimmune conditions, and immunosuppression. PRES is theorized to be a syndrome of disordered autoregulation and endothelial dysfunction resulting in preferential hyperperfusion of the posterior circulation. Treatment typically focuses on treating the underlying cause and removal of the offending agents.

Endothelium/physiopathology , Headache/physiopathology , Posterior Leukoencephalopathy Syndrome/physiopathology , Seizures/physiopathology , Vision Disorders/physiopathology , Acute Chest Syndrome/epidemiology , Aminolevulinic Acid/analogs & derivatives , Anemia, Sickle Cell/epidemiology , Autoimmune Diseases/epidemiology , Blood-Brain Barrier/metabolism , Brain Edema/diagnostic imaging , Brain Edema/physiopathology , COVID-19/epidemiology , Cerebrovascular Circulation/physiology , Cytokines/metabolism , Eclampsia/epidemiology , Female , Homeostasis/physiology , Humans , Hypertension/physiopathology , Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/epidemiology , Posterior Leukoencephalopathy Syndrome/therapy , Pre-Eclampsia/epidemiology , Pregnancy , Prognosis , Renal Insufficiency/epidemiology , SARS-CoV-2 , Vasospasm, Intracranial/physiopathology