Severe liver dysfunction possibly caused by the combination of interferon beta‐1b therapy and melilot (sweet clover) supplement

What is known and objective: We report a case of severe liver dysfunction exacerbated after interferon beta (IFNB)‐1b injection in a patient with multiple sclerosis (MS) who had been taking a melilot (sweet clover) supplement. Although IFNB‐1b therapy for MS can cause mild liver dysfunction, severe hepatotoxicity attributable to supplement use has been reported. Case summary: A 23‐year‐old Japanese woman taking a melilot supplement containing coumarin at 10 mg/day for 3 years was admitted to our hospital to receive IFNB‐1b therapy for MS. Fourteen days after subcutaneous injection of IFNB‐1b every other day, her aspartate transaminase (AST) and alanine aminotransferase (ALT) levels were elevated at 235 and 681 IU/L, respectively. After the discontinuation of IFNB‐1b therapy and supplement intake, AST and ALT returned to normal levels. Later, she started receiving an intramuscular injection of IFNB‐1a weekly without supplement intake. She was able to continue IFNB‐1a therapy this time, showing a slight elevation of AST level at 61 IU/L. What is new and conclusion: The combination of IFNB‐1b therapy and melilot supplement intake may cause severe liver dysfunction in patients with MS. Given the doubtful value of the supplement, we suggest that it should be avoided by patients receiving interferon therapy.     

Co-Occurring Psychiatric Symptoms in Opioid-Dependent Women: The Prevalence of Antenatal and Postnatal Depression

Background: Despite the high prevalence of psychiatric symptoms in substance-dependent women, little evidence is available on postpartum depression in this population. Objectives: To determine whether demographic variables and prenatal depression predict postpartum depression and select substance abuse treatment outcomes in a sample of pregnant women. Methods: A retrospective chart review was conducted on 125 pregnant women enrolled in a comprehensive substance abuse treatment program. Data on demographic variables, prenatal care attendance, urine drug screen (UDS) results, and psychiatric symptoms were abstracted from patient medical and substance abuse treatment charts. The Postpartum Depression Screening Scale (PDSS) was administered 6 weeks post-delivery. Multiple linear regression was conducted to identify predictors of prenatal care attendance and total PDSS scores at 6 weeks postpartum. Multiple logistic regression was used to examine predictors of positive UDS at delivery. Results: Nearly one-third (30.4%) of the sample screened positive for moderate or severe depression at treatment entry. Psychiatric symptoms did not predict either prenatal care compliance or UDS results at delivery. Almost half of the sample (43.7%) exhibited postpartum depression at 6 weeks post-delivery. No demographic variables correlated with incidence of postnatal depression. Only antenatal depression at treatment entry predicted PDSS scores. Conclusion: Prevalence of antenatal psychiatric disorders and postpartum depression was high in this sample of women seeking substance abuse treatment. Results support prior history of depression as a predictor of risk for developing postpartum depression. Scientific Significance: Routine screening for perinatal and postpartum depression is indicated for women diagnosed with substance abuse disorders.     

Validation of the Fitbit Zip and Fitbit Flex with pregnant women in free-living conditions

Physical activity (PA) is a part of a healthy pregnancy. To date, no consumer-based activity monitors have been validated with this population. The aim of this study was to validate the Fitbit Zip and Fitbit Flex monitors in free-living conditions with pregnant women using the ActiGraph GT3X as the ?gold standard?. We compared the accuracy of the Fitbit Zip and Fitbit Flex devices in measuring steps, sedentary time and time spent in different activity intensities. Sixteen women in their third trimester of pregnancy wore the ActiGraph GT3X (hip) plus one Fibit Zip (hip) and one Fitbit Flex (wrist) during seven consecutive days. The validity of Fitbit Zip and Fitbit Flex is good, depending on measured parameters. Fitbit Zip is accurate to measure steps whereas Fitbit Flex is precise for MVPA. When choosing between Fitbit Zip and Fitbit Flex monitors, pregnant women should take into account their preferred PA and the parameters they want to measure..     

Compound Heterozygosity for Hb Adana (HBA2: c.179G>A) and the –α3.7/αα Thalassemia Deletion in Greece: Clinical Phenotype and Genetic Counseling

Hb Adana (HBA2: c.179G>A) is found worldwide but is extremely rare and carriers are asymptomatic, with red cell indices similar to α⁺-thalassemia (α⁺-thal) carriers. First line screening tests are unable to detect the unstable hemoglobin (Hb). Coinheritance with the α-thal (–α^3.7) deletion is herein presented and the challenges involving genetic counseling of couples carrying the mutations are discussed.     

Sexual function may be impaired during pregnancy in adolescent women

Prevalence of sexual dysfunctions is reported as high as 70% during pregnancy. However, there are limited data about the burden of sexual dysfunction in pregnant adolescents. This cross-sectional study was conducted in the outpatient antenatal clinic of our institution between October and December 2014. The total female sexual function index scores and domain scores were compared between adolescent and adult pregnant women. A total of 121 pregnant women participated in the study. Of those women, 29 (24.0%) were 21 years old or younger (Group 1), whereas the remaining were older (Group 2). The sexual dysfunction ratios were 41.4% and 23.9% in Groups 1 and 2, respectively (p = 0.068). The desire (3.29 vs. 2.79, p = 0.024) and arousal (3.48 vs. 2.71, p = 0.008) domain scores of adolescent pregnant women were significantly higher whereas the remaining domain scores (i.e. lubrication, orgasm, satisfaction and pain) were not significantly different. The adolescent women seem to be more prone to sexual dysfunctions during the course of pregnancy, especially in the third trimester. The health care providers should consider discussing the sexual life during pregnancy as a part of routine antenatal visit to improve sexual function and quality of life, especially among adolescent pregnant population.     

彩色多普勒超声多参数预测孕晚期妊娠结局的临床意义

目的：探讨胎儿脐动脉(UA)、大脑中动脉(MCA)搏动指数(PI)/脐动脉(UA)搏动指数(PI)比值、脐静脉(UV)和静脉导管(DV)血流的多普勒特征性改变与孕晚期(30～41周)妊娠结局的相关性及其临床意义。方法：应用彩色多普勒超声综合检测指标：脐动脉S/D值、PI_MCA/PI_UA比值、脐静脉频谱波形和静脉导管血流频谱波形的改变,判断胎儿宫内缺血缺氧情况。结果：2015年1月～2016年12月共发现227例孕晚期胎儿存在不同程度的脐动脉S/D值,脐静脉频谱,静脉导管频谱以及PI_MCA/PI_UA比值异常,227例胎儿出生后有15例出现新生儿Apgar评分异常。脐动脉S/D值,静脉导管频谱以及PI_MCA/PI_UA比值差异性具有统计学意义(P<0.05),脐静脉频谱差异不具有统计学意义(P>0.05)。结论：孕晚期胎儿出现脐动脉S/D值增高、PI_MCA/PI_UA比值异常、脐静脉和静脉导管血流频谱波形的改变,与围生儿不良妊娠结局有一定的因果关系。应用彩色多普勒综合检测晚孕期脐动脉S/D值、PI_MCA/PI_UA比值、脐静脉和静脉导管血流频谱波形的改变,能早期发现胎儿宫内缺血缺氧情况,为临床早期预防和诊治宫内胎儿缺氧、加强围生期管理具有重要的临床意义。