Catatonic postpartum paternal depression as a first debut of a bipolar disorder: a case report.

Paternal postpartum depression (PD) is considered an affective disorder that affects fathers during the months following childbirth. Interestingly, it has been observed that during these months the chances of a male parent suffering from depression are double that for a non-parent male counterpart. We present the case of a 34-year-old man with no relevant medical history in who, overlapping her daughter's birth, several depressive symptoms emerged, such as fatigue, lack of concentration, sleeping disturbances and abandonment of care of the newborn. Prior to consultation, patient refused to eat and open his eyes, and his speech became progressively more parsimonious until reaching mutism. The patient was diagnosed with a severe depressive disorder with catatonia. Given the lack of improvement with pharmacological treatment and due to the evidence of electroconvulsive therapy (ECT)'s effectiveness on patients with catatonia, acute ECT treatment was indicated and started. It should be noted that PD is an important entity to consider in our differential diagnosis of young parents who present a depressive episode. Few cases of relatively young patients presenting with such clinical presentation have been described and, although this case presents some of the characteristics described in the epidemiology of PD, other clinical aspects are not typical of this entity. Informed consent was obtained from the patient for the purpose of publication.

Placental and Doppler ultrasound findings in pregnant women with SARS-CoV-2 infection.

BACKGROUND: Several viral infections cause changes in the placenta. Cytomegalovirus, herpes viruses, and HIV cause increased placental thickness; Zika virus induces focal regions of necrosis; parvovirus B19 causes a structural injury. Umbilical flow can be considered a direct measurement of vascular placental function. OBJECTIVE: This study aimed to compare placental ultrasound and umbilical Doppler findings in pregnant women who tested positive or negative for SARS-CoV-2. Our work aimed to confirm the suspicion of placental infection and the consequence in fetal physiopathology. STUDY DESIGN: Fifty-seven pregnant women who tested positive for SARS-CoV-2 at the time of or 1 month before the ultrasound scan were evaluated. Cases included 9 first trimester, 16 second trimester, and 32 third trimester ultrasound scans. For comparison, 110 pregnant women (controls) were evaluated. They included 19 women in their first trimester, 43 in their second trimester, and 48 in the third trimester. Controls were asymptomatic and tested negative for SARS-CoV-2 infection in the last 72 hours before the ultrasound scan. Fetal biometry, placental thickness, placental lakes and Doppler umbilical vein parameters, including venous cross-sectional area (mean transverse diameter and radius of umbilical vein, mean velocity of umbilical vein), and umbilical vein blood flow were evaluated. RESULTS: Placental thickness (in millimeter) was significantly higher in the group of pregnant women with SARS-CoV-2 infection (53.82 [10-115]) than in the control group (33.82 [12-66]; P<.001) in their second and third trimesters. The frequency of >4 placental lakes was significantly higher in the group of pregnant women with SARS-CoV-2 infection (28/57 [50.91%]) than in the control (7/110 [6.36]; P<.001) in all 3 trimesters. The mean velocity of umbilical vein was significantly higher in the group of pregnant women with SARS-CoV-2 infection (12.45 [5.73-21]) than in the control group (10.81 [6.31-18.80]; P=.001) in all 3 trimesters. Umbilical vein blood flow (in milliliter per minute) was significantly higher in the group of pregnant women with SARS-CoV-2 infection (389.9 [6.52-1496.1]) than in the control group (305.05 [3.11-1441]; P=.05) in all 3 trimesters. CONCLUSION: Significant differences in placental and venous Doppler ultrasound were documented. Placental thickness, placental venous lakes, mean velocity of umbilical vein, and umbilical vein flow were significantly higher in the group of pregnant women with SARS-CoV-2 infection in all 3 trimesters.

Prolonged remission in SLE is possible by using reduced doses of prednisone: An observational study from the Lupus-Cruces and Lupus-Bordeaux inception cohorts.

OBJECTIVE: The aim of this study is to compare the frequency of remission, according to DORIS definitions, of inception patients from two European SLE cohorts, with a special focus on the differences between the therapeutic schemes of both Units. METHODS: Inception patients enrolled after 2000 from the longitudinal Cruces Lupus Cohort (CC) and Bordeaux Lupus Cohort (BC) were included. The main endpoint was the achievement of clinical remission on treatment (ClinROnT). ClinROnT was assessed yearly from the 1st until the 5th year following the diagnosis of SLE. RESULTS: 173 patients, 92 CC and 81 BC, were studied. The clinical presentation of both cohorts was similar, with no significant differences in the mean SLEDAI score at diagnosis (6.6 vs. 8.1, p = 0.06). Patients from CC were treated more frequently with hydroxychloroquine (mean 57 vs. 43 months), methotrexate (24% vs. 11%) and pulse methyl-prednisolone (42% vs. 26%), and received lower doses of oral prednisone (average dose during the follow up 2.3 vs. 7.2 mg/d, p < 0.001). Patients in CC were more likely to achieve ClinROnT at year one, 84% vs. 43% (p < 0.001). Prolonged ClinROnT during the 5 years of follow up was more frequent in CC: 70% vs. 28%, p < 0.001. Patients in CC were also more likely to achieve ClinROnT after controlling for baseline SLEDAI (adjusted HR 1.69, 95%CI 1.21-2.35) and for the presenting clinical manifestations (adjusted HR 1.72, 95% CI 1.2-2.4). CONCLUSION: Prolonged ClinROnT was achievable by using a therapeutic regime consisting of lower doses of oral prednisone and maximizing the use of hydroxychloroquine, pulse methyl-prednisolone and methotrexate.

Prevalence and predictors of valvular heart disease in patients with systemic lupus erythematosus.

OBJECTIVES: We aimed to study the frequency, severity and predictors of valvular heart disease (VHD) in our lupus cohort. MATERIAL AND METHODS: 211 patients were included. A transthoracic echocardiogram was used for this study. Significant valvular lesions were classified into two groups: valvular thickening and valvular dysfunction. Univariate logistic regression was performed in order to find associations with valvular thickening and dysfunction. Those variables with a p value ≤0.1 in the univariate analysis were subsequently included in multiple logistic regression models. RESULTS: Significant valve lesions were found in 53 patients (25%). The independent predictors of valvular thickening were the age at the time of the echocardiogram (OR 1.05, 95% CI 1.02-1.7), lymphopenia (OR 3.6, 95%CI 1.4-9.5), thrombocytopenia (OR 2.65, 95%CI 1.24-5.72), and anti-Sm antibodies (OR 3.28, 95%CI 1.44-7.33). The independent predictors of valvular dysfunction were age at the time of the echocardiogram (OR 1.045, 95%CI 1.009-1.083), thrombocytopenia (OR 5, 95%CI 1.66-14.86), hypertension (OR 6.2, 95%CI 2.1-18.4) and aPL (OR 6.2, 95%CI 2.1-18.4). Regarding the latter, the independent relation with valvular dysfunction was only seen for the double positivity aCL/LA, (OR 13.2, 95%CI 3.8-45.2, p<0.0001). CONCLUSIONS: Our study confirms the high prevalence of significant VHD in SLE patients. Clinical variables related with persistent inflammatory activity were associated with VHD. The association between VHD and aPL positivity was confirmed. Double-positive aCL/LA patients were most likely to suffer from valvular dysfunction.