Antibiotic use during pregnancy and neurodevelopmental outcomes of offspring in early childhood

There is limited research on the effects of antibiotic use during pregnancy on neurodevelopmental outcomes of offspring in early childhood. The aim of this study was to investigate associations between antibiotic use during early pregnancy and neurodevelopmental outcomes, both behavioral and cognitive, in the offspring during early childhood. This thesis examined a longitudinal study of 570 mother-child pairs where prenatal exposures and at least one neurodevelopment outcome assessment were recorded. An interview was conducted with mothers on average one year after delivery to collect information on prenatal exposures. Neurodevelopmental outcomes were assessed between the ages 5–11 years using the cognitive-based outcomes of Peabody Picture Vocabulary Test (PPVT-III) and the Beery-Buktenica Test of Visual Motor Integration-Fifth Edition (VMI-5) and behavioral-based outcomes of the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF). Adjusted mean differences (adjMD) in outcome measures were calculated between mothers reporting antibiotics use and mothers reporting treated infections. Antibiotic use during pregnancy was not significantly associated with the two cognitive measures but was associated with increased total behavioral problems reported by mothers (adjMD: 2.60; CI: 0.50, 4.69) and teachers (adjMD 2.60; 95% CI 0.44, 4.76). Overall, antibiotics use during pregnancy was not associated with differences in childhood cognition but may be associated with greater behavior problems

Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study

Objective: To investigate the association between antidepressant use in late gestation and postpartum haemorrhage (PPH). Design: Retrospective cohort study. Tertiary teaching hospital in Adelaide, Australia. Population: A total of 30 198 women delivering between 2002 and 2008. Methods: Relative risks adjusted for maternal sociodemographics and comorbidities (aRRs) were calculated for PPH, comparing women with late-gestation exposure to antidepressants (n = 558), women with a psychiatric illness but no antidepressant use (n = 1292), and women with neither antenatal exposures (n = 28 348). Additional sensitivity analyses were undertaken, examining associations with severe PPH and postpartum anaemia. Main Outcome Measures: The primary outcome was PPH, defined as a recorded blood loss of ≥500 mL for vaginal deliveries and ≥1000 mL for caesarean sections. Secondary outcomes included severe PPH (≥1000 mL blood loss, irrespective of method of delivery), and the presence of postpartum anaemia (identified from hospital medical records). Results: Compared with unexposed controls, women exposed to antidepressants had an increased risk of PPH (aRR 1.53; 95% confidence interval, 95% CI 1.25-1.86), whereas no increased risk was observed for women with a psychiatric illness but no antidepressant use (aRR 1.04; 95% CI 0.89-1.23). In sensitivity analyses, late gestation antidepressant exposure was associated with an increased risk of severe PPH (aRR 1.84; 95% CI 1.39-2.44), as well as postpartum anaemia (aRR 1.80; 95% CI 1.46-2.22). Conclusions: Exposure to antidepressants in late gestation was associated with a significantly increased risk of PPH. Although potential confounding by unmeasured factors cannot be ruled out, these findings suggest a direct effect of antidepressant exposure on PPH.LE Grzeskowiak, R McBain, GA Dekker, VL Clifto

Herbal Supplements (Haematanics) and their Interactions with Medications: An Overview

Herbal supplements, if taken at the same time as prescription medicines, can create potential problems for the user. Unfortunately, there is very little scientific information available about the way herbs and drugs interact. The present paper deals with various herbal supplements and their interactions with medications

Prescription and Other Medication Use in Pregnancy

OBJECTIVE: To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy. METHODS: In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined. RESULTS: Of the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication). CONCLUSION: In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common

Combined lymphangioma and hemangioma of the spleen in a patient with Klippel–Trénaunay syndrome

Introduction. Klippel–Trénaunay syndrome (KTS) is a very rare congenital anomaly of blood vessels, characterized by the following clinical triad: varicose superficial veins, port-wine stain and usually bony and soft tissue hypertophy of extremities, most often located in the lower extremities. It is often accompanied by visceral manifestations, and rarely combined with splenomegaly. Case Outline. A 30-year-old female patient came to the Surgery Clinic because of occasional left hypochondrial pain. After she was diagnosed with KTS combined with splenomegaly, splenectomy was performed. Macroscopic and microscopic spleen examination indicated the presence of tumor of vascular origin, presenting a combination of lymphangioma and hemangioma. Conclusion. Diagnosed KTS demands a thorough clinical examination of the patient because of the potential presence of visceral manifestations. When splenomegaly is present, even though being often benign, splenectomy is usually performed to alleviate accompanying symptoms which occur as a result of organ enlargement and compression, to prevent rupture and consequential bleeding when the vascular spleen tumor is large, and finally to avoid a possibility of malignant transformation

A Social Controversy: Autism Spectrum Disorder\u27s Correlation to the Measles-Mumps-Rubella Vaccination

A 1998 research study lead by Dr. Andrew Wakefield linked the measles-mumps-rubella (MMR) vaccination as a probable cause to autism spectrum disorder. This publication has started a significant debate among healthcare professionals and instigated an anti-vaccination movement within the general population. This vaccination controversy was started by parents who readily accepted Wakefield’s findings as truth and frequently would choose to withdrawal the administration of vaccinations from their children’s care plans. There has also been disapproval by healthcare professionals over Wakefield’s study since numerous research teams have been unable to replicate his findings. This disagreement surrounding the MMR vaccination is likely putting millions of people, mostly children, at risk of contracting horrific diseases. Brian Deer established the fraud in Wakefield’s original study and rejected Wakefield’s null hypothesis. Deer’s seven years of investigation affirmed the countless research studies that rejected Wakefield’s null hypothesis. Deer’s analysis of Dr. Wakefield’s study demonstrates how the public and the media can be blindly misled by scientific studies. When information has reached people’s grasp, it is hard to retract false information once it has permeated millions of households, which is what needs to be accomplished regarding the truth behind the relationship between the MMR vaccination and autism. The medical world could benefit from knowing the cause of this detrimental disorder, in an effort to treat patients better and possibly someday cure them

Focal Spot, Winter 2008/2009

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Jefferson Digital Commons quarterly report: October-December 2018

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Leukocyte adhesion deficiency type I - a focus on oral disease in a young child

This paper presents a case of the moderate form of Leukocyte adhesion deficiency type 1 (LAD-1) in a 4 year-old boy. LAD-1 is a rare, inherited immunodeficiency that affects 1 in 1 million people yearly. Affected patients are susceptible to recurrent bacterial and fungal infections, impaired pus formation and delayed wound healing. In the oral clinical finding, more important is a generalized prepuberal periodontitis that can affect the primary and permanent dentitions. For this reason cooperation between dentists and pediatricians is essential in these patients. Evaluating immune system in these patients included peripheral blood leukocyte counts, measurement of serum immunoglobulin levels, assessment of complement level and function, flow cytometric analysis of lymphocyte subsets, and tests of phagocytic function (nitrobluetetrazolium test (NBT)). In families with known molecular defect, an earlier prenatal diagnosis is possible by chorionic villi biopsy. The most important focus should be to control infections. Treatment includes systemic antibiotics and in many cases bone marrow transplantation