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ARP Rheumatology Jul 2022Serositis is seen in approximately 12% of patients with systemic lupus erythematosus (SLE), usually in the form of pleuritis or pericarditis. Peritoneal serositis with...
Serositis is seen in approximately 12% of patients with systemic lupus erythematosus (SLE), usually in the form of pleuritis or pericarditis. Peritoneal serositis with ascites is an extremely rare manifestation of SLE and ascites as initial manifestation of SLE is even rarer. Here, we describe a previously healthy 48-year-old female with periumbilical abdominal pain, constitutional symptoms, ascites, pleural effusions and raised CA-125 level as an initial manifestation of SLE, which led up to the diagnosis of pseudo-pseudo Meigs syndrome. PPMS is a rare manifestation of SLE and awareness of this entity among clinicians is crucial to ensure an early recognition and prompt treatment.
PubMed: 36056947
DOI: No ID Found -
F1000Research 2022Meigs's syndrome is characterized by a triad of ovarian fibroma, ascites, and pleural effusion which can be managed surgically. Pleural effusion and ascites are usually...
Meigs's syndrome is characterized by a triad of ovarian fibroma, ascites, and pleural effusion which can be managed surgically. Pleural effusion and ascites are usually transudative. Ovarian fibroma is an uncommon tumor. We herein report a case of Meigs's syndrome in a 61-year-old woman who presented with complaints of abdominal pain for two-three months along with decreased appetite and constipation. On examination, there was decreased air entry in the right side of the chest, generalized abdominal distention, and a firm irregular mass was felt which was mobile and extending from upper border of symphysis pubis to just above the umbilicus on abdominal palpation. Chest X ray showed right sided pleural effusion, ultrasonogram (USG) abdominal and pelvis showed gross ascites, and a very large complex right ovarian cyst was confirmed by computed tomography (CT) scan. She underwent staging laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy and omental resection for biopsy. Biopsy showed right ovarian fibroma.
PubMed: 38817953
DOI: 10.12688/f1000research.122368.1 -
American Journal of Respiratory and... Nov 2022A common gene polymorphism, rs35705950-T, is associated with idiopathic pulmonary fibrosis (IPF), but its role in severe acute respiratory syndrome coronavirus 2... (Meta-Analysis)
Meta-Analysis
A common gene polymorphism, rs35705950-T, is associated with idiopathic pulmonary fibrosis (IPF), but its role in severe acute respiratory syndrome coronavirus 2 infection and disease severity is unclear. To assess whether rs35705950-T confers differential risk for clinical outcomes associated with coronavirus disease (COVID-19) infection among participants in the Million Veteran Program (MVP). The rs35705950-T allele was directly genotyped among MVP participants; clinical events and comorbidities were extracted from the electronic health records. Associations between the incidence or severity of COVID-19 and rs35705950-T were analyzed within each ancestry group in the MVP followed by transancestry meta-analysis. Replication and joint meta-analysis were conducted using summary statistics from the COVID-19 Host Genetics Initiative (HGI). Sensitivity analyses with adjustment for additional covariates (body mass index, Charlson comorbidity index, smoking, asbestosis, rheumatoid arthritis with interstitial lung disease, and IPF) and associations with post-COVID-19 pneumonia were performed in MVP subjects. The rs35705950-T allele was associated with fewer COVID-19 hospitalizations in transancestry meta-analyses within the MVP (N = 4,325; N = 507,640; OR = 0.89 [0.82-0.97]; = 6.86 × 10) and joint meta-analyses with the HGI (N = 13,320; N = 1,508,841; OR, 0.90 [0.86-0.95]; = 8.99 × 10). The rs35705950-T allele was not associated with reduced COVID-19 positivity in transancestry meta-analysis within the MVP (N = 19,168/N = 492,854; OR, 0.98 [0.95-1.01]; = 0.06) but was nominally significant ( < 0.05) in the joint meta-analysis with the HGI (N = 44,820; N = 1,775,827; OR, 0.97 [0.95-1.00]; = 0.03). Associations were not observed with severe outcomes or mortality. Among individuals of European ancestry in the MVP, rs35705950-T was associated with fewer post-COVID-19 pneumonia events (OR, 0.82 [0.72-0.93]; = 0.001). The variant rs35705950-T may confer protection in COVID-19 hospitalizations.
Topics: Humans; COVID-19; Mucin-5B; Polymorphism, Genetic; Idiopathic Pulmonary Fibrosis; Genotype; Hospitalization; Genetic Predisposition to Disease
PubMed: 35771531
DOI: 10.1164/rccm.202109-2166OC -
Journal of Surgical Case Reports Jun 2022Ascites, pelvic mass and elevated CA-125 in females carry a grim prognosis, likely an ovarian carcinoma. However, more benign etiologies such as Meigs' and pseudo-Meigs'...
Ascites, pelvic mass and elevated CA-125 in females carry a grim prognosis, likely an ovarian carcinoma. However, more benign etiologies such as Meigs' and pseudo-Meigs' syndrome must be considered. Pseudo-Meigs' syndrome presenting with an elevated CA-125 is rare and presents a diagnostic challenge. Medline and PubMed were queried for pseudo-Meigs' syndrome cases. We present a 35-year-old female patient who presented with abdominal swelling and weight gain. Imaging demonstrated a 29-cm large intraabdominal mass with significant ascites with elevation of CA-125. Surgical resection was performed, and pathology identified uterine leiomyoma. Twenty-one cases of pseudo-Meigs' syndrome were identified in the literature. Most patients presented with abdominal distention, and some also reported dyspnea. All patients, including our case, were treated surgically. No recurrence reported among these cases. Surgery is the mainstay for radical treatment in pseudo-Meigs' syndrome. Resolution of the ascites and hydrothorax occurs following resection of the tumor.
PubMed: 35685293
DOI: 10.1093/jscr/rjac253 -
Science Advances May 2022The nonstructural protein 3 (NSP3) macrodomain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Mac1) removes adenosine diphosphate (ADP) ribosylation...
The nonstructural protein 3 (NSP3) macrodomain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Mac1) removes adenosine diphosphate (ADP) ribosylation posttranslational modifications, playing a key role in the immune evasion capabilities of the virus responsible for the coronavirus disease 2019 pandemic. Here, we determined neutron and x-ray crystal structures of the SARS-CoV-2 NSP3 macrodomain using multiple crystal forms, temperatures, and pHs, across the apo and ADP-ribose-bound states. We characterize extensive solvation in the Mac1 active site and visualize how water networks reorganize upon binding of ADP-ribose and non-native ligands, inspiring strategies for displacing waters to increase the potency of Mac1 inhibitors. Determining the precise orientations of active site water molecules and the protonation states of key catalytic site residues by neutron crystallography suggests a catalytic mechanism for coronavirus macrodomains distinct from the substrate-assisted mechanism proposed for human MacroD2. These data provoke a reevaluation of macrodomain catalytic mechanisms and will guide the optimization of Mac1 inhibitors.
PubMed: 35622909
DOI: 10.1126/sciadv.abo5083 -
Journal of the Formosan Medical... Dec 2022Pseudo-pseudo Meigs' syndrome (PPMS) exhibits patients with ascites, pleural effusion, elevated CA-125, and diagnosed of systemic lupus erythematosus (SLE) eventually... (Review)
Review
Pseudo-pseudo Meigs' syndrome (PPMS) exhibits patients with ascites, pleural effusion, elevated CA-125, and diagnosed of systemic lupus erythematosus (SLE) eventually without evidence of ovarian or pelvic tumor. It's a rare diagnosis but it has a good response to treatment. We here present an 82-year-old female, who was found to have ascites, pleural effusion, and elevated CA-125. CT of abdomen revealed absence of pelvic tumor. However, a rapid decline in renal function and progressive proteinuria were also observed. We performed an autoimmune-associated investigation. A diagnosis of late-onset SLE was made due to meeting the criteria of serositis, hemolytic anemia, thrombocytopenia, renal disease, and positive anti-smith antibody. We gave this patient a regimen with steroids and hydroxychloroquine. Both ascites and pleural effusion resolved in one month. PPMS is an important differential diagnosis in female patients with ascites, pleural effusion, and elevated CA-125. A survey of the pelvic tumor should be done first to exclude Meigs' syndrome or pseudo-Meigs' syndrome. SLE flare-up should be kept in mind even in the elderly.
Topics: Aged; Humans; Female; Aged, 80 and over; Meigs Syndrome; Ascites; Pelvic Neoplasms; Taiwan; Pleural Effusion; Lupus Erythematosus, Systemic; Diagnosis, Differential
PubMed: 35459608
DOI: 10.1016/j.jfma.2022.03.020 -
JPMA. the Journal of the Pakistan... Mar 2022Meigs Syndrome is a rare condition characterised by Ovarian fibroma, ascites and pleural effusion. Pseudo Meigs is called so because it mimics Meigs but occurs with...
Meigs Syndrome is a rare condition characterised by Ovarian fibroma, ascites and pleural effusion. Pseudo Meigs is called so because it mimics Meigs but occurs with tumours other than fibromas. The objective of this case report is to shed light on the diverse presentations of Ovarian carcinomas. We herein report a rare case of Pseudo Meigs syndrome in a 32-year-old female patient parity one and no miscarriage and who had right-sided ovarian mass, gross ascites and right-sided pleural effusion with cancer antigen 125 value of 518.5 IU/L. Clinical Diagnosis was that of Meigs Syndrome. The patient underwent laparotomy for surgical staging and large right-sided ovarian mass with draining of nine litres of ascitic fluid and total abdominal hysterectomy and bilateral salpingo-oophorectomy. The histopathology report showed that it was Endometroid Adenocarcinoma FIGO Grade 3. Definitive diagnosis was that of Pseudo Meigs Syndrome. The case was a diagnostic challenge and difficult to manage. The diverse presentation of ovarian carcinomas makes them difficult to diagnose and clinicians should have a high index of suspicion while managing such cases.
Topics: Adult; Ascites; CA-125 Antigen; Female; Fibroma; Humans; Meigs Syndrome; Pleural Effusion
PubMed: 35320242
DOI: 10.47391/JPMA.128 -
SAGE Open Medical Case Reports 2022Demons syndrome is defined by hydrothorax and ascites associated with a benign genital tumor that resolves after resection of the tumor. However, Demons syndrome with...
Demons syndrome is defined by hydrothorax and ascites associated with a benign genital tumor that resolves after resection of the tumor. However, Demons syndrome with pericardial effusion has never been reported. Intensive care unit-acquired weakness is a neurological sequela to sepsis/systemic inflammatory response syndrome, or multi-organ failure. A 47-year-old, nulligravid, Japanese woman, was transferred to our hospital for refractory heart failure and a ruptured ovarian tumor. She had an 11-cm left ovarian tumor with ascites, hydrothorax, and pericardial effusion; she was intubated for pulmonary hypertension and admitted to the intensive care unit for septic shock. Four days later, a left salpingo-oophorectomy was performed for Demons syndrome with pericardial effusion. The histological diagnosis indicated a serous cystadenoma with fibrotic changes. Following surgery, ventilator weaning was delayed due to intensive care unit-acquired weakness. The association between Demons syndrome and pericardial effusion should be recognized to ensure early treatment and for preventing sequalae from the disease.
PubMed: 35083047
DOI: 10.1177/2050313X211069315 -
Taiwanese Journal of Obstetrics &... Nov 2021Adult-type granulosa cell tumors (GCT) are sex cord-stromal tumors and often accompanied with abdominal distention and hyperestrogenism-related symptoms. Adult-type...
OBJECTIVE
Adult-type granulosa cell tumors (GCT) are sex cord-stromal tumors and often accompanied with abdominal distention and hyperestrogenism-related symptoms. Adult-type GCT-presenting ascites and pleural effusion is extremely rare.
CASE REPORT
A 56-year-old perimenopausal woman presented with abdominal distention and abnormal vaginal spotting. Ultrasound and abdominal computed tomography showed a complex cystic mass in the left ovary accompanied with bilateral pleural effusion and ascites. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, left pelvic lymph node dissection, omentectomy and appendectomy. Final histopathological diagnosis was adult-type GCT. The patient had postoperative hormone and anti-angiogenesis agent therapy with free of disease.
CONCLUSION
Ovarian cystic complex mass accompanied with ascites and pleural effusion often results from malignant ovarian tumors or benign ovarian fibroma. Based on the aforementioned report, the rare types of ovarian tumors, such as adult-type granulosa cell tumor of the ovary should be taken into consideration.
Topics: Antineoplastic Agents, Hormonal; Ascites; Bevacizumab; Cytoreduction Surgical Procedures; Female; Gonadotropin-Releasing Hormone; Goserelin; Granulosa Cell Tumor; Humans; Laparotomy; Meigs Syndrome; Middle Aged; Ovarian Neoplasms; Ovary; Pleural Effusion; Salpingo-oophorectomy; Treatment Outcome
PubMed: 34794749
DOI: 10.1016/j.tjog.2021.09.028 -
The Journal of Clinical Endocrinology... Jan 2022Obesity is an established risk factor for severe COVID-19 outcomes. The mechanistic underpinnings of this association are not well-understood. (Observational Study)
Observational Study
BACKGROUND
Obesity is an established risk factor for severe COVID-19 outcomes. The mechanistic underpinnings of this association are not well-understood.
OBJECTIVE
To evaluate the mediating role of systemic inflammation in obesity-associated COVID-19 outcomes.
METHODS
This hospital-based, observational study included 3828 SARS-CoV-2-infected patients who were hospitalized February to May 2020 at Massachusetts General Hospital (MGH) or Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP). We use mediation analysis to evaluate whether peak inflammatory biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], D-dimer, ferritin, white blood cell count and interleukin-6) are in the causal pathway between obesity (BMI ≥ 30) and mechanical ventilation or death within 28 days of presentation to care.
RESULTS
In the MGH cohort (n = 1202), obesity was associated with greater likelihood of ventilation or death (OR = 1.73; 95% CI = [1.25, 2.41]; P = 0.001) and higher peak CRP (P < 0.001) compared with nonobese patients. The estimated proportion of the association between obesity and ventilation or death mediated by CRP was 0.49 (P < 0.001). Evidence of mediation was more pronounced in patients < 65 years (proportion mediated = 0.52 [P < 0.001] vs 0.44 [P = 0.180]). Findings were more moderate but consistent for peak ESR. Mediation by other inflammatory markers was not supported. Results were replicated in CUIMC/NYP cohort (n = 2626).
CONCLUSION
Findings support systemic inflammatory pathways in obesity-associated severe COVID-19 disease, particularly in patients < 65 years, captured by CRP and ESR. Contextualized in clinical trial findings, these results reveal therapeutic opportunity to target systemic inflammatory pathways and monitor interventions in high-risk subgroups and particularly obese patients.
Topics: Adult; Aged; Aged, 80 and over; Aging; Blood Sedimentation; C-Reactive Protein; COVID-19; Female; Ferritins; Fibrin Fibrinogen Degradation Products; Humans; Interleukin-6; Leukocyte Count; Male; Middle Aged; Obesity; Risk Factors; Systemic Inflammatory Response Syndrome; Treatment Outcome; United States
PubMed: 34473294
DOI: 10.1210/clinem/dgab629