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Animal : An International Journal of... May 2023This paper reviews recent data and concepts on metritis, purulent vaginal discharge (PVD), and endometritis in dairy cows and the ways in which these diseases affect... (Review)
Review
This paper reviews recent data and concepts on metritis, purulent vaginal discharge (PVD), and endometritis in dairy cows and the ways in which these diseases affect reproductive performance. Metritis is characterized by fetid discharge from the uterus, with or without fever. Purulent vaginal discharge describes exudate that is >50% pus that may be attributable to uterine infection or cervicitis. Endometritis is inflammation of the uterus diagnosed by endometrial cytology with a proportion of neutrophils (typically ≥5%) that is associated with impaired fertility. Metritis and PVD are associated with uterine bacterial dysbiosis: changes in the microbiota to lesser diversity and greater abundance of pathogens, especially Gram-negative anaerobic bacteria, and Trueperella pyogenes in the case of PVD. Metritis is justifiably treated with approved antibiotics but criteria for more selective treatment without loss of performance are emerging. Purulent vaginal discharge is not synonymous with clinical endometritis, and greater precision in terminology is warranted. PVD is likely under-diagnosed and represents an opportunity for improved management in many herds. Endometritis seems in many cases to reflect persistent, dysregulated inflammation, for which the inciting cause is unclear. Postpartum uterine infection and inflammation have harmful effects on oocytes, embryo development, and the endometrium for at least three months, even if the disease is apparently resolved. Emerging concepts of the resolution and regulation of inflammation are promising for the improvement of prevention and therapy of endometritis.
Topics: Female; Cattle; Animals; Endometritis; Vaginal Discharge; Postpartum Period; Fertility; Puerperal Disorders; Inflammation; Cattle Diseases
PubMed: 37567665
DOI: 10.1016/j.animal.2023.100781 -
European Journal of Obstetrics,... Oct 2023Pregnancy and postpartum period are associated with stress and pain. Chronic medical conditions can aggravate depressive and psychotic mental illnesses in the peripartum...
BACKGROUND
Pregnancy and postpartum period are associated with stress and pain. Chronic medical conditions can aggravate depressive and psychotic mental illnesses in the peripartum period.
AIM
The study aimed to investigate the association between different chronic medical conditions and mental illnesses during pregnancy and the postpartum period using the National Inpatient Sample (NIS).
METHODS
Pregnant women or women in the postpartum period were retrieved from the NIS 2016-2019 database using the International Classification of Diseases (ICD)-10 and set as our targeted population. Postpartum depression, puerperal psychosis, and mental illnesses related to pregnancy were also retrieved as our outcomes of interest. STATA 15 was used to analyze the data and investigate the relationship between chronic medical conditions and pregnancy-related mental illnesses.
RESULTS
2,854,149 admissions were retrieved from the database with a mean age of 29 ± 6 years old. Univariate and multivariate analyses showed a significant association between chronic medical conditions and postpartum depression, puerperal psychosis, and other mental illnesses. On univariate analysis, heart failure (odds ratio [OR] = 13.9; 95% confidence interval [CI] = 3.5-55.88; P < 0.001), alcohol misuse (OR = 5.3; 95% CI = 1.7-16.4; P = 0.004), and migraine (OR = 3.9; 95% CI = 2.8-5.3; P < 0.001) showed high association with postpartum depression. Epilepsy (OR = 54.37; 95% CI = 7.4-399.34; P < 0.001), systemic lupus erythematosus (OR = 24.66; 95% CI = 3.36-181.1; P = 0.002), and heart diseases (OR = 15.26; 95% CI = 3.6-64.5; P < 0.001) showed the highest association with puerperium psychosis. Alcohol misuse (OR = 8.21; 95% CI = 7.4-9.12; P < 0.001), osteoarthritis (OR = 6.02; 95% CI = 5.41-6.70; P < 0.001), and migraine (OR = 5.71; 95% CI = 5.56-5.86; P < 0.001) showed the highest association with other mental illnesses during pregnancy and the postpartum period.
CONCLUSION
Heart diseases, alcohol misuse, migraine, systemic lupus erythematosus, and epilepsy were the most important chronic medical conditions associated with mental diseases during pregnancy and the postpartum period. This investigation recommends integrating management of chronic diseases and mental health care together. Specifically, screening for mental illnesses should be a routine part of care for patients with chronic medical conditions, especially during pregnancy and early postpartum. By identifying and addressing mental health issues early on, healthcare providers can improve the overall health and well-being of these patients, ultimately leading to better maternal and fetal outcomes.
Topics: Pregnancy; Female; Humans; Young Adult; Adult; Depression, Postpartum; Mental Health; Inpatients; Alcoholism; Postpartum Period; Puerperal Disorders; Lupus Erythematosus, Systemic; Chronic Disease; Heart Diseases
PubMed: 37632994
DOI: 10.1016/j.ejogrb.2023.08.011 -
Journal of Affective Disorders Oct 2023Suicidal behavior is strongly associated with major affective disorders, but there is a need to quantify and compare specific risk and protective factors in bipolar...
BACKGROUND
Suicidal behavior is strongly associated with major affective disorders, but there is a need to quantify and compare specific risk and protective factors in bipolar disorder (BD) and major depressive disorder (MDD).
METHODS
In 4307 extensively evaluated major affective-disorder participants with BD (n = 1425) or MDD (n = 2882) diagnosed by current international criteria, we compared characteristics among those with versus without suicidal acts from illness-onset through 8.24 years of follow-up.
RESULTS
Suicidal acts were identified in 11.4 % of participants; 25.9 % were violent and 6.92 % (0.79 % of all participants) were fatal. Associated risk factors included: diagnosis (BD > MDD), manic/psychotic features in first-episodes, family history of suicide or BD, separation/divorce, early abuse, young at illness-onset, female sex with BD, substance abuse, higher irritable, cyclothymic or dysthymic temperament ratings, greater long-term morbidity, and lower intake functional ratings. Protective factors included marriage, co-occurring anxiety disorder, higher ratings of hyperthymic temperament and depressive first episodes. Based on multivariable logistic regression, five factors remained significantly and independently associated with suicidal acts: BD diagnosis, more time depressed during prospective follow-up, younger at onset, lower functional status at intake, and women > men with BD.
LIMITATIONS
Reported findings may or may not apply consistently in other cultures and locations.
CONCLUSIONS
Suicidal acts including violent acts and suicides were more prevalent with BD than MDD. Of identified risk (n = 31) and protective factors (n = 4), several differed with diagnosis. Their clinical recognition should contribute to improved prediction and prevention of suicide in major affective disorders.
Topics: Male; Humans; Female; Depressive Disorder, Major; Prospective Studies; Suicidal Ideation; Protective Factors; Suicide; Temperament; Risk Factors; Puerperal Disorders
PubMed: 37301296
DOI: 10.1016/j.jad.2023.06.018 -
La Revue de Medecine Interne Jun 2020Thyroiditis is a frequent and mostly benign disease that can sometimes disrupt the thyroid balance. Their diagnosis, as well as their aetiology, is a necessary step in... (Review)
Review
Thyroiditis is a frequent and mostly benign disease that can sometimes disrupt the thyroid balance. Their diagnosis, as well as their aetiology, is a necessary step in the management of the patients. Painful thyroiditis includes acute thyroiditis of infectious origin and subacute thyroiditis. The first one can be treated by antibiotics or antifungals depending on the germ found. The second one will be treated with non-steroidal anti-inflammatory drugs or corticosteroids. In cases of Hashimoto's thyroiditis with overt hypothyroidism, replacement therapy with L-thyroxine will be adapted to the TSH level. As amiodarone treatment provides dysthyroidism, the thyroid status should be monitored regularly. Hypothyroidism will be treated using thyroid replacement therapy. Hyperthyroidism imposes a stop of amiodarone when it is possible. Treatment with synthetic antithyroid drugs (propyl-thio-uracil) or corticosteroids could be used whether there is an underlying thyroid disease or not. Immunotherapies with anti-PD-1/PDL1 or anti-CTLA-4 can also provide dysthyroidism. A monitoring of the thyroid assessment needs to be done in these patients, even if there are no clinical signs, which are not very specific in this context. The treatment of hypothyroidism will be based on thyroid replacement therapy according to the TSH level and the presence or absence of anti-TPO antibodies. Treatment of symptomatic hyperthyroidism may involve a prescription of beta-blockers, or synthetic antithyroid drugs in case of positive anti-TSH receptor antibodies. In all cases, it is desirable to contact an endocrinologist to confirm the diagnosis hypothesis and to decide on a suitable treatment.
Topics: Acute Disease; Adult; Female; History, 21st Century; Humans; Iatrogenic Disease; Immunotherapy; Interferon-alpha; Iodine; Male; Pregnancy; Puerperal Disorders; Thyroiditis; Thyroiditis, Autoimmune
PubMed: 32107053
DOI: 10.1016/j.revmed.2020.02.003 -
Optimizing Mental Health for Women: Recognizing and Treating Mood Disorders Throughout the Lifespan.The Journal of Clinical Psychiatry Sep 2023Mood disorders can come and go during the reproductive stages of a woman's life and beyond and can include premenstrual-related mood disorders, depression and other...
Mood disorders can come and go during the reproductive stages of a woman's life and beyond and can include premenstrual-related mood disorders, depression and other psychiatric disorders during pregnancy, postpartum mood disorders, and depression during menopause, as well as comorbid psychiatric conditions. Women may have regular contact with health care providers at these various stages in their lives, providing an opportunity for treatment intervention. However, clinicians struggle to effectively identify and manage these disorders, leaving women's mental health issues unaddressed and causing unnecessary suffering, multiple comorbidities, and unwanted outcomes. Context is essential for diagnoses and treatment, and spending time with patients, taking a full history, and taking the time to understand each patient's perspective during these complex periods lead to more accurate diagnoses, ultimately facilitating more effective treatment plans. An array of options is available for treating women's mental health, including antidepressants, oral contraceptives, hormones and recently approved neurosteroids, and nonpharmacological approaches. Clinicians need to be aware of which treatment options are available and evidence-based, guideline-directed solutions to help women manage their mental health. Creating patient-centered, individualized, evidence-based treatment plans is key to optimizing outcomes for women across their lifespan.
Topics: Pregnancy; Humans; Female; Mood Disorders; Mental Health; Longevity; Affect; Awareness; Puerperal Disorders
PubMed: 37728480
DOI: 10.4088/JCP.vtsmdd2136ahc -
American Family Physician Oct 2020
Review
Topics: Adult; Antibiotic Prophylaxis; Extraction, Obstetrical; Female; Humans; Obstetrical Forceps; Pregnancy; Prenatal Care; Puerperal Disorders; Randomized Controlled Trials as Topic; Surgical Wound Infection; Vacuum Extraction, Obstetrical
PubMed: 32996760
DOI: No ID Found -
Gynecologie, Obstetrique, Fertilite &... Mar 2022Peripartum cardiomyopathy is a rare and unpredictable pregnancy-related pathology. Idiopathic cardiomyopathy is characterized by a heart failure secondary to left... (Review)
Review
Peripartum cardiomyopathy is a rare and unpredictable pregnancy-related pathology. Idiopathic cardiomyopathy is characterized by a heart failure secondary to left ventricular systolic dysfunction appearing towards the end of pregnancy or in the months following delivery with a non-specific clinic presentation. Through reviewing previous research, our critical literature review wishes to bring a concise and objective summarize for a better understanding of physiopathology, evocative symptoms and knowing of factors influencing prognosis in order to standardize peripartum management. The treatment remains mainly symptomatic but other promising treatments are still in development. In conclusion, early detection and treatment allow a better cardiac function recovery reducing cardiac transplantation.
Topics: Cardiomyopathies; Female; Humans; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Ventricular Dysfunction, Left
PubMed: 34481099
DOI: 10.1016/j.gofs.2021.08.004 -
The Lancet. Psychiatry Dec 2021
Topics: Female; Humans; Psychotic Disorders; Puerperal Disorders
PubMed: 34801113
DOI: 10.1016/S2215-0366(21)00440-5 -
Best Practice & Research. Clinical... Dec 2019Autoimmune diseases represent a complex heterogeneous group of disorders that occur as a results of immune homeostasis dysregulation and loss of self-tolerance.... (Review)
Review
Autoimmune diseases represent a complex heterogeneous group of disorders that occur as a results of immune homeostasis dysregulation and loss of self-tolerance. Interestingly, more than 80% of the cases are found among women at reproductive age. Normal pregnancy is associated with remarkable changes in the immune and endocrine signaling required to tolerate and support the development and survival of the placenta and the semi-allogenic fetus in the hostile maternal immune system environment. Gravidity and postpartum represent an extremely challenge period, and likewise the general population, women suffering from autoimmune disorders attempt pregnancy. Effective preconception counseling and subsequent gestation and postpartum follow-up are crucial for improving mother and child outcomes. This comprehensive review provides information about the different pathways modulating autoimmune diseases activity and severity, such as the influence hormones, microbiome, infections, vaccines, among others, as well as updated recommendations were needed, in order to offer those women better medical care and life quality.
Topics: Autoimmune Diseases; Disease Progression; Female; Humans; Infant, Newborn; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care; Puerperal Disorders; Severity of Illness Index
PubMed: 31564626
DOI: 10.1016/j.beem.2019.101321 -
Best Practice & Research. Clinical... Mar 2024Peripartum cardiomyopathy (PPCM) causes pregnancy-associated heart failure, typically during the last month of pregnancy, and up to 6 months post-partum, in women... (Review)
Review
Peripartum cardiomyopathy (PPCM) causes pregnancy-associated heart failure, typically during the last month of pregnancy, and up to 6 months post-partum, in women without known cardiovascular disease. PPCM is a global disease, but with a significant geographical variability within and between countries. Its true incidence in Africa is still unknown because of the lack of a PPCM population-based study. The variability in the epidemiology of PPCM between and within countries could be due to differences in the prevalence of both genetic and non-genetic risk factors. Several risk factors have been implicated in the aetiopathogenesis of PPCM over the years. Majority of patients with PPCM present with symptoms and signs of congestive cardiac failure. Diagnostic work up in PPCM is prompted by strong clinical suspicion, but Echocardiography is the main imaging technique for diagnosis. The management of PPCM involves multiple disciplines - cardiologists, anaesthetists, intensivists, obstetricians, neonatologists, and the prognosis varies widely.
Topics: Pregnancy; Humans; Female; Peripartum Period; Developing Countries; Cardiomyopathies; Heart Failure; Puerperal Disorders; Pregnancy Complications, Cardiovascular
PubMed: 38395024
DOI: 10.1016/j.bpobgyn.2024.102476