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Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
HELLP syndrome can have an antepartum or postpartum onset and it is associated with increased maternal morbidity and mortality. For HELLP syndrome to be diagnosed, there must be micro-angiopathic hemolysis, thrombocytopenia, and abnormalities of liver function. There is no consensus, however, on the classification criteria and the specific thresholds of hematologic and biochemical values to use in establishing the diagnosis of HELLP syndrome. The following criteria are most commonly used (Tennessee Classification): Hemolysis as evidenced by an abnormal peripheral smear in addition to either serum lactate dehydrogenase (LDH) >600 IU/L, or total bilirubin ≥1.2 mg/dL (≥20.52 μmol/L); elevated liver enzymes, (AST and/or ALT) two times of the upper limit of normal concentration at a particular laboratory, and platelets <100,000 cells/mm3 [44]. If all the criteria are met, the syndrome can be also called “complete”; if only one or two criteria are present, the term “partial HELLP” is preferred.
Infections and Their Mimics in Returning Travelers in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Elise Kochoumian, Jonathon Moore, Bushra Mina, Kevin Cahill
Pathology related to TB does not necessarily only arise from direct infection with M. tuberculosis but can also come as a result of the adverse effects of the anti-TB drug regimen leading to drug-induced liver injury. This typically manifests as laboratory studies showing elevated liver enzymes greater than three times normal values, as well as clinical signs of liver dysfunction, which include right upper quadrant pain, jaundice, coagulopathy, hypoglycemia, and encephalopathy in its severe form. Management involves replacement of first-line drugs with second-line agents [72].
Neurological manifestations of West Nile virus
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Daniel E. Smith, J. David Beckham, Daniel M. Pastula, Kenneth L. Tyler
With regards to systemic laboratory workup, patients with WNV typically have a normal CBC or a mild leukocytosis. Hyponatremia can be seen and is more common in those with encephalitis. Some patients may have mildly elevated liver enzymes [61].
Successful Treatment of Covid-19 Associated Cytokine Release Syndrome with Colchicine. A Case Report and Review of Literature
Published in Immunological Investigations, 2021
Nahal Mansouri, Majid Marjani, Payam Tabarsi, Christophe von Garnier, Davood Mansouri
This presentation was associated with a fever of 40°C with shaking chills, headache, severe myalgia, and a decrease in his urine output. On physical exam he had a blood pressure of 118/72 mm Hg, pulse rate of 95 beats per minute, and respiratory rate of 14 breaths per minutes with a normal oxygen saturation while breathing ambient air (95%). Lung auscultation was normal. Laboratory tests showed mild acute kidney injury (Creatinine, 1.4 mg per deciliter), leukocytosis (WBC, 10,100 per cubic millimiter) with a neutrophil count of 75% and a lymphocyte count of 21%, and thrombocytosis (platelet 407,000 per cubic millimiter). Other markers of inflammation were elevated as well: CRP (75 mg per deciliter), ESR (62 mm per hour), ferritin (3200 ng per milliliter), fibrinogen (520 mg per deciliter), lactate dehydrogenase (1200, LDH) and D-dimer level (7123 ng per milliliter). IL-6 level was elevated to 71 pg per millilitre. Liver function tests showed slightly elevated liver enzymes. Uric acid was as high as 8.8 mg per deciliter (normal on routine laboratory tests performed prior to the initial presentation). Blood and urine cultures were negative. Nasopharyngeal swab was again positive for Covid-19, and a repeat chest CT showed significant improvement in alveolar infiltrates (Figure 2). A bilateral lower extremity doppler study did not show any deep vein thrombosis.
Real-world treatment patterns and outcomes of abemaciclib for the treatment of HR+, HER2− metastatic breast cancer
Published in Current Medical Research and Opinion, 2021
Gebra Cuyun Carter, Kristin M. Sheffield, Anala Gossai, Yu-Jing Huang, Yajun Emily Zhu, Lee Bowman, Emily Nash Smyth, Raina Mathur, Aaron B. Cohen, Erik Rasmussen, Shreya Balakrishna, Claudia Morato Guimaraes, Sarah Rybowski, Andrew D. Seidman
RwAE diarrhea incidence was lower than clinical trials (∼85%)6,7,10,11; however, abemaciclib discontinuation due to diarrhea was higher in the real-world, occurring in 11.9% of this cohort compared to <3.0% in MONARCH 2 and 320. Anti-diarrheal medication use among all patients with diarrhea was consistent with clinical trial results (∼70%)21. Median time-to-onset of diarrhea symptoms was longer in the real-world (27 days versus 6–8 days in clinical trials)20. Differences in abemaciclib discontinuation due to diarrhea and median time-to-onset of diarrhea symptoms may be due to heterogeneity in side effect management; clinical trial physicians follow a strict protocol and monitor patients in pre-specified ascertainment windows, which is not done in the real-world setting. Since grading is not typically used in a clinical practice setting, grade was not available for the rwAE of diarrhea or VTE, unlike CTCAE grade information available in clinical trials. RwAE incidence of any grade and grade ≥3 neutropenia was lower (36% and 8%, respectively) than in MONARCH 2 (46% and 27%) and 3 (44% and 24%)21; this may be due to laboratory measurement occurring at a different frequency in clinical trials versus the real-world setting, or due to applied derivation rules. Elevated liver enzymes occurred at lower rates in the real world than in clinical trials. Incidence of any-grade VTEs was consistent with clinical trials.
No association between COVID-19 related liver injury and the course of disease: a retrospective study
Published in Scandinavian Journal of Gastroenterology, 2021
B. J (Barend) Sikkema, J. (Jerome) Sint Nicolaas, P. (Peter) van Wijngaarden
Different factors can contribute to liver injury during the course of COVID-19, especially in severe cases such as hypoxemia in patients with shock as well as the administration of certain antibiotics and other treatments [3,5,9,10,12,13,15]. For example, in the aforementioned study by Phipps et al. many patients with severe liver injury received several drugs as vasopressors and different antiviral agents like remdesevir and IL-6 inhibitors [15]. Other potential mechanisms for liver injury include direct liver tissue damage by SARS-CoV-2 infecting liver cells via the ACE2 receptor and inflammation-mediated liver injury [3,5,9,10,12,13,15]. To increase the likelihood that existing liver injury in the present study was related to the virus itself or the immune response to SARS-CoV-2, we evaluated the presence of liver injury at the time when the first positive COVID-19 sample was obtained. Furthermore, we excluded patients in which other factors could have contributed to the elevated liver enzymes levels such as harmful alcohol consumption, pre-existing liver disease and possible hepatotoxic antibiotics like amoxicillin-clavulanate.