Prepartum, postpartum, and chronic depression effects on newborns

In order to assess the effects of the onset and chronicity of maternal depression on neonatal physiology, eighty pregnant women were assessed for depression during mid-pregnancy (M gestational age = 25.9 weeks) and shortly after delivery. The women were classified as reporting depressive symptoms 1) only during the prepartum assessment; 2) only during the postpartum assessment; 3) during both the prepartum and postpartum assessments; or 4) reporting no depressive symptoms at either the prepartum or the postpartum assessment. Maternal mood and biochemistry were assessed during pregnancy, and the EEG and biochemical characteristics of their 1-week-old infants were assessed shortly after birth. As predicted, the newborns of the mothers with prepartum and postpartum depressive symptoms had elevated cortisol and norepinephrine levels, lower dopamine levels, and greater relative right frontal EEG asymmetry. The infants in the prepartum group also showed greater relative right frontal EEG asymmetry and higher norepinephrine levels. These data suggest that effects on newborn physiology depend more on prepartum than postpartum maternal depression but may also depend on the duration of the depressive symptoms.     

Palliative endoscopic treatment of pancreatic cancer

Pancreatic cancer has a very poor chance of being radically resected (20-25%) at the time of diagnosis. Palliation has thus proved to be the mode of treatment adopted in the majority of cases. When a radical surgical resection is not feasible, the endoscopic approach is one of the most common options among the therapeutic methods available. Endoscopic palliation for the treatment of jaundice is regarded as the best choice. It is associated with very low morbidity and no mortality. Hospitalization is short and the treatment is also inexpensive compared to other procedures. The authors report on their experience with endoscopic palliation for the treatment of inoperable pancreatic cancer.     

Flu vaccination in patients with acute coronary syndromes: treatment benefit in prespecified subgroups

BACKGROUND: The first prospective clinical Flu Vaccination in Acute Coronary Syndromes (FLUVACS) Trial has provided some evidence that flu vaccination together with standard therapy may be useful during the winter season to reduce the risk of death and major cardiac events in patients with acute myocardial infarction. PATIENTS AND METHOD: Information available in the FLUVACS database was analyzed to evaluate the efficacy of flu vaccination in different subgroups. Logistic regression was used to identify features related with better therapeutic results. RESULTS: Flu vaccination was effective in reducing the incidence of the composite endpoint (death, nonfatal myocardial reinfarction or recurrent angina prompting urgent revascularization) in most subgroups at 6 months after inclusion. The regression model showed a greater benefit of flu vaccination in patients with no ST-segment elevation or older than 65 years, nonsmokers and patients with a TIMI risk score higher than 6. CONCLUSIONS: Our data suggest that vaccination for secondary prevention of flu during the acute phase of myocardial infarction may be effective in a broad range of patients with acute coronary artery disease, regardless of their initial clinical risk.     

Vestibular surgical access to the palatine root of the superior first molar: "low-dose cone-beam" CT analysis of the pathway and its anatomic variations

Apicoectomy of the superior first molar palatine root until recently involved relatively destructive and laborious surgery because of the palatal access route, which not only necessitates an extensive flap, but also the readying of procedures required to deal with a possible hemorrhage from the palatine artery. With the advent of operative microscopy, endodontic surgery has become more precise and less invasive and its technical potential has increased; a possible innovative surgical technique may entail vestibular root access. The possibility of using low-dose, low-cost computed tomography (CT) dedicated to the jaw to obtain anatomic information to plan apicoectomy via the vestibular approach was evaluated; 31 patients were referred to CT with the NewTom apparatus. In 43 superior first molars, the mean distance of the palatine root from the external vestibular cortex was measured, and the frequency that the maxillary sinus lateral recess lay between the roots was determined. The mean root apex-vestibular cortex distance was 9.73 mm. In 25% of cases the maxillary sinus recessus lay between vestibular and palatine roots. CT may play an important role in optimizing palatine root apicoectomy through vestibular access, with regard to precision and preventing complications, with relatively low biological and economic cost, also possibly contributing to the affirmation of this new surgical procedure.     

Attitudes toward prenatal diagnosis,termination of pregnancy,and reproduction by parents of children with nonsyndromic oral clefts in Argentina

OBJECTIVE: To investigate the attitudes of Argentine parents of children with nonsyndromic oral clefts with respect to prenatal diagnosis, termination of pregnancy, and reproduction and to assess the variables that might influence their responses. DESIGN: One hundred and sixty-five parents of children with oral clefts, ascertained from a craniofacial clinic in the suburbs of Buenos Aires, answered a 151-item semistructured questionnaire. The questionnaire included sections covering sociodemographic information, level of religiousness, characteristics of the child's cleft, parental perception of their child's cleft, pregnancy history, recurrence risk, access to health care, attitudes in regard to abortion, and family environment. RESULTS: Most parents (60%) believe their child's cleft is not a serious condition. None of the respondents would terminate a pregnancy because the ultrasound reveals an oral cleft. Similarly, very few (6.1%) would terminate the pregnancy if there were an early diagnosis of Down syndrome. Half of the respondents believe that abortion should not be an option for any couple expecting a child. CONCLUSIONS: Most respondents do not perceive oral clefts as a severe condition. Parents would not choose to terminate the pregnancy over delivery of such an affected newborn.