Our findings indicate that despite its beneficial hemodynamic actions, long-term therapy with oral milrinone increases the morbidity and mortality of patients with severe chronic heart failure. The mechanism by which the drug exerts its deleterious effects is unknown.

In patients with early, relapsing-remitting multiple sclerosis, alemtuzumab was more effective than interferon beta-1a but was associated with autoimmunity, most seriously manifesting as immune thrombocytopenic purpura. The study was not powered to identify uncommon adverse events. (ClinicalTrials.gov number, NCT00050778.)

Malnutrition is an independent risk factor for patient morbidity and mortality and is associated with increased healthcare-related costs. However, a major dilemma exists due to lack of a unified definition for the term. Furthermore, there are no standard methods for screening and diagnosing patients with malnutrition, leading to confusion and varying practices among physicians across the world. The role of inflammation as a risk factor for malnutrition has also been recently recognized. Historically, serum proteins such as albumin and prealbumin (PAB) have been widely used by physicians to determine patient nutritional status. However, recent focus has been on an appropriate nutrition-focused physical examination (NFPE) for diagnosing malnutrition. The current consensus is that laboratory markers are not reliable by themselves but could be used as a complement to a thorough physical examination. Future studies are needed to identify serum biomarkers in order to diagnose malnutrition unaffected by inflammatory states and have the advantage of being noninvasive and relatively cost-effective. However, a thorough NFPE has an unprecedented role in diagnosing malnutrition.

SummaryBackgroundThe effect of inflammatory bowel disease (IBD) on pregnancy‐related outcomes remains unknown.AimTo determine the risk of adverse maternal, placental and obstetric outcomes in IBDMethodsWe searched Medline, Embase and Cochrane library through May 2019 for studies reporting adverse maternal, placental and obstetric outcomes in patients with IBD. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for these outcomes in patients with IBD compared to healthy controls.ResultsFifty‐three studies were included (7917 IBD pregnancies and 3253 healthy control pregnancies). Caesarean delivery was more common in patients with IBD compared to healthy controls (OR 1.79, 95% CI, 1.16‐2.77). This remained significant for UC (OR 1.80, 95% CI, 1.21‐2.90) but not CD (OR 1.48, 95% CI, 0.94‐2.34). Similarly, gestational diabetes occurred more commonly in IBD (OR 2.96, 95% CI, 1.47‐5.98). The incidences of placental diseases were 2.0% (95% CI, 0.9%‐3.1%) for pre‐eclampsia, 3.3% (95% CI, 0%‐7.2%) for placental abruption, 0.5% (95% CI, 0.2%‐0.9%) for placenta previa and 0.3% (95% CI, 0%‐0.5%) for chorioamnionitis. Patients with IBD were more likely to experience preterm prelabour rupture of membranes (OR 12.10, 95% CI, 2.15‐67.98), but not early pregnancy loss (OR 1.63, 95% CI 0.49‐5.43). Anti‐tumour necrosis factor therapy was not associated with chorioamnionitis (OR 1.12, 95% CI, 0.16‐7.67), early pregnancy loss (OR 1.49, 95% CI, 0.83‐2.64) or placenta previa (OR 1.58, 95% CI, 0.30‐8.47).ConclusionsGestational diabetes and preterm prelabour rupture of membranes occurs more commonly in patients with IBD, although the incidence of placental diseases remains low.