First, hepatitis B in pregnancy may vary in prevalence, behavior of the virus, prenatal transmission, and pregnancy outcome. This article discusses hepatitis B in pregnancy, which may vary in prevalence, viral behavior, prenatal transmission, screening, and pregnancy outcome. The safety of drugs during pregnancy and lactation, the effect of the drug of choice, resistance to treatment, side effects and duration of treatment are factors that must be considered in the treatment of pregnant women with hepatitis B.
CONCLUSION
Monitoring the health status of the fetus and determining next prenatal visits based on the patient's condition are among the other prenatal care needed. Although nutritional knowledge attempts to identify the ideal amount of food groups for pregnant women, people directly responsible for caring for mothers with hepatitis B can best perform their duties[54-56]. The World Health Organization recommends that all mothers who are hepatitis B positive breastfeed their children and that their children be immunized at birth[57].
A recent meta-analysis shows that breastfeeding after adequate immunoprophylaxis does not contribute to mother-to-child transmission of HBV[58]. Mothers with hepatitis B are advised to pay close attention and check the nipples before each feeding. In case of cracks, bleeding or blood on the nipples, temporarily stop breastfeeding and express and discard all milk. If the nipples are healthy and free of cracks, the milk should be expressed, kept in good condition and given to the child at the time of cessation of breastfeeding.
The mother should learn the correct way to breastfeed and embrace the infant so that an uncomfortable position does not cause the infant to refuse to breastfeed. During teething, care must be taken so that the nipple is not injured, and a milk bottle can be used at this time.
An algorithm for risk assessment and intervention of mother-to-child transmission of hepatitis B virus. Clinical significance of hepatitis B surface antigen in umbilical cord blood from hepatitis B e-antigen-negative chronic hepatitis B virus-infected mothers. Presence of HBV DNA in umbilical cord blood is associated with spontaneous preterm birth in pregnant women with HBeAg-negative chronic hepatitis B virus infection.
Assessing completeness of perinatal reporting of hepatitis B virus infection by comparing immunization program and surveillance data - United States. Follow-up study of the efficacy of hepatitis B immunoglobulin combination vaccine in infants born to HBsAg-positive mothers. Hepatitis B immunoglobulin injection in pregnancy to interrupt mother-to-child transmission of hepatitis B virus - a meta-analysis.
A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2008 update. Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis.
High prevalence of post-partum depression in women with coeliac disease
Abstract
INTRODUCTION
MATERIALS AND METHODS
The screening for PPD was performed by an interviewer using the EPDS score with a ≥ 10 cutoff and a clinical interview performed by an expert psychiatrist according to the DSM IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) ). The SF-36 survey consists of a 36-item questionnaire that includes eight components: physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional and mental health issues. The SF-36 subscales and composite scores can be summarized by means ± SD, with higher scores indicating better health and well-being.
Low PC scores indicate limitations in physical function and general health, and/or physical pain, whereas higher scores suggest no physical limitations, disabilities, or reduced well-being. Similarly, low scores on the MCS suggest frequent experience of psychosocial health difficulties, emotional problems, and reduced vitality, while high scores indicate frequent positive affect and vitality, lack of psychological distress, and reduced or no limitations in activities. daily social[26-29. ]. We estimated that a sample size of 67 participants would be able to provide an 80% power to detect a 20% difference between the two groups (assuming a known PPD prevalence of 13% in the general population)[10, 11].
Statistical analysis was performed using χ2, Mann Whitney U test and odd ratio (OR) calculation when indicated; differences were considered significant with a p < 0.05.
RESULTS
The majority of patients with mild PPD received only active psychological support; only 6 patients (16%) required antidepressants and long-term psychiatric follow-up. Regarding the conditions of delivery, no significant differences were observed between the two groups regarding the type of delivery (group A: cesarean section 51.4%; vaginal delivery 48.6%; group B: cesarean section 44.3%; vaginal delivery 55.7%; p = NS) and birth outcomes (live birth: group A 100%; group B 100%; congenital anomalies: group A 0%; group B 1.5%; p = NS). On the contrary, a significant association was observed between the onset of PPD and previous menstrual disorder in women suffering from CD.
DISCUSSION
In our CD population, the occurrence of PPD was significantly correlated with the presence of previous menstrual disorders[37]. Therefore, in order to recruit a homogeneous population for the study, we decided to exclude patients who had recently been diagnosed with CD and were on a free diet. However, thanks to the composition of our sample, we were able to document that PPD in patients suffering from CD is not directly related to active gluten intake.
Further studies (ideally multicenter) are needed to determine the prevalence of PPD in women with CD on a free diet (eg, diagnosed with CD during pregnancy or immediately postpartum). This methodological approach is necessary to demonstrate the actual increase in PPD in CD patients compared to the general population; however, it does not determine whether the high prevalence of PPD is related specifically to CD or to a non-specific "disease status". Accordingly, only a study directly comparing the prevalence of PPD in CD patients with that in patients with other diseases (eg, inflammatory bowel diseases, rheumatological diseases) could clarify this aspect.
However, the high prevalence of PPD in patients with CD and the clinical significance of this psychiatric condition warrant the routine use of the EPDS questionnaire in women with CD who have recently given birth. We suggest screening for PPD in all women with CD for early detection and prompt treatment of this condition.
ACKNOWLEDGMENTS
Stratified subgroup analysis by class of antidepressants indicated that serotonin reuptake inhibitors can reduce levels of IL-6 and TNFα[ 36 ]. All of these considerations could be considered an indirect demonstration of the central role inflammation plays in determining depression (and PPD) symptoms. This result could be an expression of a pre-existing underlying hormonal change, which may also influence and/or contribute to the occurrence of mental disorders[38,39].
In our control population, such an association was not evident, probably due to the small number of controls with PPD (10 patients). Nevertheless, it could be hypothesized that this association may be related to a series of changes that characterize the spectrum of gynecological diseases. Regarding this question, our work confirmed once again the very high percentage of cesarean delivery in southern Italy [43,44].
First of all, we included all CD patients on GFD in our study; Full compliance with the GFD was confirmed by the negative level of anti-transglutaminase antibodies in all CD patients. We decided to exclude patients with a new/recent diagnosis of CD (who would be free diet patients) because the majority of patients followed at our Center consisted of individuals with a previous diagnosis of CD and already on a GFD.
COMMENTS
In fact, as mentioned earlier[32], adults affected by CD do not differ substantially in terms of the prevalence of depression from those with other types of physical illnesses and the. Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality "trait" or a reactive disease. The use of the Antenatal Psychosocial Health Assessment (ALPHA) instrument in the detection of psychosocial risk factors for postpartum depression: a randomized controlled trial.
Depressive and anxiety symptoms throughout late pregnancy and the first year postpartum: Examining prospective relationships. Italian translation of the celiac disease-specific quality of life scale in celiac disease patients on a gluten-free diet. Quality of life in screen-detected and typical celiac disease and the effect of gluten exclusion in the diet.
Hepatoma-derived growth factor expression as a prognostic marker in cervical cancer
However, the prognostic significance of HDGF index was observed in the pT2-4 patient group, in which the mortality rates of patients with HDGF index level 2 CC and those with level 0 or 1 CC differed significantly (P = 0.0463). Hepatoma-derived growth factor (HDGF) is a heparin-binding protein purified from the conditioned medium of the hepatocellular carcinoma (HCC) cell line HuH-7, which can proliferate autonomously in a chemically defined medium without serum[14,15]. Eleven cases with HDGF expression in either the nucleus or the cytoplasm were classified as HDGF index level 1.
However, prognostic significance of the HDGF index was observed in the pT2-4 patient group, in which a significant difference in mortality was present between patients with HDGF index level 2 CC and those with level 0 or 1 CC (Figure 2B). In addition, patients with HDGF index level 2 CC showed a higher mortality rate compared to those with level 0 or 1. Although patients with HDGF index level 0 or 1 can expect a favorable outcome after surgery, the incidence of lymph node metastasis varied between the two groups.
As patients with HDGF index level 0 CC did not show lymph node metastasis, they may be suitable for fertility-sparing surgery. In contrast, patients with HDGF index level 1 or 2 showed a higher risk of lymph node metastases; therefore, standard operations such as radical hysterectomy are more preferable when the FIGO stage is higher than IA. Patients with HDGF index level 0 CC showed no lymph node metastases, they are suitable for fertility-sparing surgery.
In contrast, patients with HDGF index levels of 1 or 2 have a higher risk of lymph node metastases; therefore, standard operations such as radical hysterectomy are more preferable when the FIGO stage is higher than IA.