WHAT IF DEPRESSED AND PREGNANT?

Depression is the most prevalent mood disorder among pregnant women. Only 50% of women seek intervention during gestation. Untreated during pregnancy, depression can induce obstetric and neonatal complications, most commonly, anhedonia, suboptimal weight gain, suicidal behavior, pre-term birth, and/or spontaneous miscarriage. The babies more often suffer cognitive deficits, low birth weight, and growth delay. The mothers subsequently also experience an increased risk for significant degrees of postpartum depression. Those with relatively milder cases of depression should initially receive psychotherapy. Otherwise, there are many antidepressant medications available for the pharmacotherapy of depression. However, treating pregnant females with depression is a challenge because of potential teratogenic effects caused by many pharmaceuticals. Physicians should know the recommended guidelines for treating depressed women during a time of gestation. It is crucial to identify women suffering from depression during pregnancy, and electing those that warrant pharmacotherapy while picking the best and safest medication is a complex process with paramount significance. Before prescribing an antidepressant drug, explain the advantages and disadvantages of the interventions. Whenever prescribing during these circumstances, more than conventionally close obstetric, emotional, and medication monitoring is to be provided. This would also include an emphasis on diet, exercise, psychotherapy, and avoidance of any non-critical medicinal or other substance exposures

Comparing Outcomes for Community-Acquired Pneumonia Between Females and Males: Results from the University of Louisville Pneumonia Study

Introduction: Male sex is currently considered to be a risk factor for worsened community-acquired pneumonia (CAP) outcomes compared to female sex; hence, female sex equates to a lower score on the Pneumonia Severity Index. There is no recent update on sex-based outcomes of patients with CAP. The objective of this study was to compare the outcomes of CAP between females and males. Methods: This was a secondary analysis of the University of Louisville Pneumonia Study database. It was a prospective population-based cohort study of all hospitalized adults with CAP who were residents of Jefferson County in the city of Louisville, Kentucky. The study included data from June 1, 2014, to May 31, 2016, and data from October 1, 2016, to May 31, 2017. The study population was divided into two groups: females and males. Results: Female patients had a 13% lower mortality at one year compared to males (aHR 1.13 [95% CI 1.05–1.23], P=0.002). There was no significant difference in mortality between the two groups during hospitalization or at 30-day or six-month follow-up. The median time to discharge for both female and male patients hospitalized with CAP was five days (interquartile range [IQR] 3, 9 days). The median time to clinical stability for both female and male patients hospitalized with CAP was two days (IQR 1, 4 days). Conclusion: This study shows that female patients had significantly lower one-year mortality compared to males. There was no significant difference between females and males in time to clinical stability or length of stay. Further investigation is needed to examine whether risk factors associated with female and male sex predict outcomes among hospitalized patients due to CAP

Opioid Crisis

Deaths from opioid overdose in the United States doubled between 2000-2014. An increase in prescription opioid drug-induced fatalities parallels a rise in the frequency of these medications being prescribed. Although the number of legal narcotics sold in this country has nearly quadrupled, there is no change reported in the degree of pain Americans experience. Deaths are most common among those opioid users who are drug dependent, even though overdoses occur in medical and non-medical narcotic users who are not addicted.Public health efforts have focused on providing patients with chronic pain appropriate access to opioid pain relievers, while reducing non-medical usage. However, that alone has been insufficient to curb opioid overdoses. There remains a high opioid-related morbidity and mortality among people with pain, even for those receiving these analgesics for legitimate clinical reasons. Research results demonstrating the safety and efficacy of narcotics for chronic, non-cancer pain are not evident. Surveys of patients prescribed opioids over the long-term indicate that most of them continued to experience significant distress; yet, some of them, also experience greater comfort and were without abuse of medication.&nbsp;Physicians should avoid unnecessary opioid prescribing for some people with chronic conditions, although it is difficult to predict which patients might be vulnerable to addiction versus who might benefit from these pharmaceuticals. Because of such uncertainty, it is helpful when doctors screen personal and family&nbsp; histories for substance abuse and provide careful, regular monitoring. Strategies for reducing abuse of prescription analgesic drugs focus on physician prescribing regulations that are thus far not consistently effective.</p