The correlation between quality of recovery and parturient outcomes after Cesarean delivery: a cohort study.

PURPOSE: Recent studies have reported the use of the obstetric-specific quality of recovery tool (ObsQoR-10) to assess the quality of recovery in parturients after childbirth; however, the correlation between ObsQoR-10 scores and important postpartum outcomes are unclear. The primary aim of the present study was to investigate the correlations between ObsQoR-10 scores at 24 hr after Cesarean delivery and breastfeeding, depressive symptomatology, overall health, and pain at seven days postpartum. METHODS: We recruited parturients who underwent elective Cesarean delivery at KK Hospital in Singapore. Parturients provided responses to post-Cesarean questionnaires at 1) 24 hr (ObsQoR-10, EuroQol EQ-Visual Analogue Scale, Edinburgh Postnatal Depression Scale), 2) 48 hr (ObsQoR-10, EQ-Visual Analogue Scale), and 3) seven days after Cesarean delivery (ObsQoR-10, Breastfeeding Self-Efficacy Scale-Short form, EQ-Visual Analogue Scale, Edinburgh Postnatal Depression Scale, pain survey). RESULTS: We enrolled 222 participants, 200 (90%) of whom completed the seven-day follow-up between September 2022 and April 2023. There was limited correlation between ObsQoR-10 at 24 hr with the Edinburgh Postnatal Depression Scale (r = 0.135), EQ-Visual Analogue Scale (r = 0.158), Breastfeeding Self-Efficacy Scale-Short form (r = 0.225), and averaged pain scores (r = -0.107) at seven days postpartum. ObsQoR-10 breastfeeding sub-score at 24 hr was weakly correlated with Breastfeeding Self-Efficacy Scale-Short form at seven days postpartum (r = 0.307). CONCLUSION: ObsQoR-10 at 24 hr postpartum had limited correlation with breastfeeding, depressive symptomatology, overall health, and pain at seven days. STUDY REGISTRATION: ClinicalTrials.gov ( NCT04989894 ); first submitted 4 July 2021.

RéSUMé: OBJECTIF: Des études récentes ont rapporté l'utilisation de l'outil de qualité de récupération spécifique à l'obstétrique (ObsQoR-10) pour évaluer la qualité de la récupération chez les personnes parturientes après l'accouchement; cependant, la corrélation entre les scores sur l'outil ObsQoR-10 et les devenirs post-partum importants n'est pas claire. L'objectif principal de la présente étude était d'examiner les corrélations entre les scores ObsQoR-10 obtenus 24 heures après l'accouchement par césarienne et l'allaitement, la symptomatologie dépressive, l'état de santé général et la douleur sept jours après l'accouchement. MéTHODE: Nous avons recruté des personnes parturientes qui ont bénéficié d'un accouchement par césarienne programmée à l'Hôpital KK de Singapour. Les personnes parturientes ont répondu aux questionnaires post-césarienne à 1) 24 heures (ObsQoR-10, échelle visuelle analogique EuroQol EQ-Visual Analogue Scale, Échelle de dépression postnatale d'Édimbourg), 2) 48 heures (ObsQoR-10, EQ-Visual Analogue Scale), et 3) sept jours après la césarienne (ObsQoR-10, Échelle abrégée d'auto-efficacité de l'allaitement [Breastfeeding Self-Efficacy Scale-Short form], EQ-Visual Analogue Scale, Échelle de dépression postnatale d'Edimbourg, enquête sur la douleur). RéSULTATS: Nous avons recruté 222 participant·es, dont 200 (90 %) ont terminé le suivi de sept jours entre septembre 2022 et avril 2023. Il y avait une corrélation limitée entre l'ObsQoR-10 à 24 heures et l'Échelle de dépression postnatale d'Édimbourg (r = 0,135), l'échelle EQ-Visual Analogue Scale (r = 0,158), l'échelle d'auto-efficacité de l'allaitement maternel forme courte (r = 0,225) et les scores moyens de douleur (r = -0,107) sept jours après l'accouchement. Le sous-score d'allaitement ObsQoR-10 à 24 heures était faiblement corrélé à l'échelle d'auto-efficacité de l'allaitement maternel à sept jours après l'accouchement (r = 0,307). CONCLUSION: L'ObsQoR-10 à 24 heures après l'accouchement avait une corrélation limitée avec l'allaitement, la symptomatologie dépressive, l'état de santé général et la douleur à sept jours. ENREGISTREMENT DE L'éTUDE: ClinicalTrials.gov ( NCT04989894 ); première soumission le 4 juillet 2021.

Anesthetic Implications for Cesarean Section in a Parturient with Complex Congenital Cyanotic Heart Disease.

The discordance between increased physiological demand during pregnancy and congenital cardiac pathology of a parturient is a perilous threat to the maternal-fetal well-being. Early involvement of a multidisciplinary team is essential in improving peripartum morbidity and mortality. Designing the most appropriate anesthetic care will require a concerted effort, with inputs from the obstetricians, obstetric and cardiac anesthesiologists, cardiologists, neonatologists, and cardiothoracic surgeons. We report the multidisciplinary peripartum care and anesthetic management for cesarean section (CS) of a 28-year-old primigravida who has partially corrected transposition of the great arteries, atrial and ventricular septal defect, dextrocardia, right ventricle hypoplasia, and tricuspid atresia.

The negative impact of rebate contracts on the health care of patients with depression in Germany.

BACKGROUND: Aim of this study was to show the negative consequences of rebate contracts on health care of patients with depression. Negative consequences were defined as therapy withdrawal, increased resource utilization and the frequency of switch-back to initial pharmaceutical product in patients with conversion to a rebate pharmaceutical. METHODS: This retrospective analysis was performed combining the information of 3 databases including information about 20 millions patients and 80% of all prescriptions in Germany. The time period of observation started 1 year before the initiation of rebate contracts. Observation time was 2 years. This study included adults (> 18 years) with an antidepressive drug therapy and who had a statutory health insurance with rebate contracts on antidepressive pharmaceuticals. RESULTS: The mean persistence was 329 days for patients, who were switched to a rebate product compared to 365 days for patients who stayed on the initial drug therapy (p < 0.0001). 29.9% of the patients who were converted to a rebate product switched back to the initial antidepressive drug therapy within 1 year. 1,871 additional patients would be hospitalized due to the conversion to a rebate pharmaceutical that caused direct inpatient costs amounting to 19.9 million EUR per year in Germany. CONCLUSIONS: Despite the above limitations this analysis presents a clear association between the initiation of rebate contracts and a negative impact on health care of patients with an antidepressive drug therapy.

Mitral valve reconstruction with unusual bleeding complications.

With the surgical techniques used nowadays, bleeding complications after heart surgery have become less common. We report the case of a 72-year-old male patient who underwent mitral valve reconstruction and suffered from serious bleeding complications. The patient needed repeated blood transfusions (30 red blood cell concentrates and 12 units of fresh frozen plasma) until a final diagnosis of hemophilia A was made and substitution of the depleted factor VIII was begun.

Abraham's discovery of the 'bad mother'. A contribution to the history of the theory of depression.

The author shows how, after Freud struggled in vain from the 1890s to develop a theory of depression, Abraham succeeded for the first time in finding an approach to the understanding of depression a few years before the publication of Freud's 'Mourning and melancholia'. It is contained in his study of the painter Giovanni Segantini (1911), which also includes a description, imbued with a new atmospheric quality, of the mother-son relationship that centres on the concept of the 'bad mother'. The author points out that Abraham's 'good/bad' dimension is effectively absent from Freud's published work up to 1911 and is also at variance with his view of the relationship between son and mother. In later contributions, too, Abraham maintained that unconscious hate directed at the mother, who is experienced as 'bad' but longed for as 'good', was a central factor in the aetiology of depression, a view he had to defend vis-à-vis Freud. The author contends that in the Segantini paper Abraham was describing an inner world similar to that evinced by the work of Melanie Klein and significantly different from Freud's. It is characterised by hate, revenge, death wishes and guilt feelings on the one hand and tranquillity and inner peace on the other.

Induction of cytochrome P450 (CYP)1A1, CYP1A2, and CYP3A4 but not of CYP2C9, CYP2C19, multidrug resistance (MDR-1) and multidrug resistance associated protein (MRP-1) by prototypical inducers in human hepatocytes.

Human hepatocytes cultured serum-free for up to 6 weeks were used to study expression and induction of enzymes and membrane transport proteins involved in drug metabolism. Phase I drug metabolizing enzymes cytochrome P450 (CYP)1A1, CYP1A2, CYP2C9, CYP2C19, CYP2E1, and CYP3A4 were detected by Western blot analyses and, when appropriate, by enzymatic assays for ethoxyresorufin-O-deethylase(EROD)-activity and testosterone-6beta-hydroxylase(T6H)-activity. Expression of the membrane transporter multi-drug resistance protein (P-glycoprotein, MDR-1), multidrug resistance-associated protein (MRP-1), and lung-resistance protein (LRP) was maintained during the culture as detected by RT-PCR and Western blot analyses. Model inducers like rifampicin, phenobarbital, or 3-methylcholanthrene and beta-naphtoflavone were able to induce CYP1A or CYP3A4 as well as EROD or T6H activities for up to 30 days. CYP2C9, CYP2C19 and CYP2E1 expression was maintained but not inducible for 48 days. Also, rifampicin and phenobarbital were unable to increase MDR-1 and MRP-1 protein levels significantly.

Freud's early clinical theory (1894-1896): outline and context.

The author points out that all Freud's publications and lectures from the period 1894-1896 had the aim of establishing an aetiological theory of the neuroses and psychoses. Freud found that the clinical pictures covered by the theory had a sexual aetiology and were distinguishable from each other by specific mechanisms. Numerous references are presented to show that what the author calls Freud's early clinical theory had its roots in contemporary neuropathology and psychiatry, and the prevailing views in these disciplines are discussed. He was able to build on the work of predecessors such as Möbius in regard to the causal role of psychic factors. Whereas Freud was of his time in attempting to redefine the category of 'neurasthenia' and adducing the familiar concept of 'sexual noxae', his originality lay in the elevation of these factors, hitherto seen as external, to the status of 'true' causes. In the author's view, the rejection met with by Freud's early clinical theory was due to its pre-experiential 'vision' of the sexual aetiology of the neuroses rather than to its content. She notes that Freud differed from his contemporaries on the concept of and systematic part played by sexuality, as well as on the central role of psychic mechanisms (i.e. of defence).

Interferon alpha (IFN alpha 2a) therapy for herpes virus-associated inflammatory bowel disease (ulcerative colitis and Crohn's disease).

BACKGROUND/AIMS: The etiology and pathogenesis of ulcerative colitis and Crohn's disease remain unclear, so that exact causal therapy is not yet possible. In our UC and CD patients, viral infections, particularly of the upper respiratory tract, aggravated the underlying disease. This had led us to use in-situ hybridization to investigate intestinal mucosa for viral agents such as HSV I + II- and Epstein-Barr virus DNA. We found these DNA in the cell nuclei in the surface and glandular epithelia of the affected mucosa of the small intestine and the colon. These findings indicated that viruses may exacerbate these inflammatory bowel diseases. METHODOLOGY: Over a period of 1-4.7 years, we treated 16 patients aged 25-65 with Crohn's disease (12 patients) or ulcerative colitis (four patients). In 14 patients, inflammatory bowel disease had been diagnosed years before (mean, 15.3 years). When we started therapy, 75% of the patients with Crohn's disease had extra-intestinal manifestations; and the CDAI after Best averaged considerably above 150. All patients had been taking either prednisone or prednisolone and/or 5-ASA or SASP and/or azathioprine or metronidazole for many years. Using PCR, mucosal specimens of the small intestine and/or the colon were tested for EBV-, HSV I + II, HHV6- and CMV DNA. In 12 of the 16 patients. EBV- and/or HHV6 DNA were found in the affected mucosa. Since interferon alpha administration has proven effective in chronic hepatitis-B therapy, we decided to administer interferon alpha 2a (13,46,47,55). After stopping the above-mentioned basic therapies, we commenced treatment with 6 million units of interferon alpha 2a subcutaneously 3 times per week for at least six months. Four of the patients showed no signs of improvement, and their therapy was stopped after three months. For the others, therapy was continued until patients were clinically symptom-free and viral DNA could no longer be traced in their mucosal biopsies. RESULTS: With interferon therapy, 12 of the 16 patients showed slow but continual improvement. Particularly impressive was the remission of the extra-intestinal manifestations, which did not recur in any patient during interferon therapy. Four patients did not show any improvement, and the clinical symptom of diarrhea continued. Two patients with ulcerative colitis suffered relapses three and four years later, after severe bouts of para-influenza of the upper respiratory tract. In these two patients, EBV- and HHV6 DNA was found in the inflamed mucosa of the colon. Renewed therapy with interferon alpha 2a successfully cleared up the inflammation. The patient group needed an average of eight weeks to become clinically symptom-free, and an average of six months to achieve complete virus elimination in the pathologically altered mucosa. CONCLUSIONS: For herpesvirus-associated ulcerative colitis and Crohn's disease, interferon alpha 2a treatment should be started as early as possible to prevent disease becoming chronic. Whether this kind of antiviral treatment will be as effective in the long term, and whether malignant transformation (herpes viruses are potential tumor inducers) will be delayed or prevented, are questions that can be answered only by future long-term studies.

Ubiquinone biosynthesis. Cloning of the genes coding for chorismate pyruvate-lyase and 4-hydroxybenzoate octaprenyl transferase from Escherichia coli.

Chorismate pyruvate-lyase activity was detected in extracts of Escherichia coli. 4-Hydroxybenzoate was identified as the product of the enzymatic reaction by chemical derivatization and GC-MS analysis. The ubiC gene, coding for the chorismate pyruvate-lyase, was cloned and sequenced. The molecular weight of the gene product was calculated as 18,776 Da and confirmed by expression of the protein in E. coli minicells. The ubiA gene, coding for the 4-hydroxybenzoate octaprenyl transferase, was identified by sequence homology and complementation of a ubiA- strain. It is located directly downstream of ubiC in a typical operon structure.

Naftidrofuryl in the treatment of mild senile dementia. A double-blind study.

After a wash-out period of four weeks 51 patients with mild to moderate senile dementia were treated with either 600 mg naftidrofuryl (n = 23) daily per os or placebo (n = 28) over an eight-week period. When classified according to Hachinski's score, 24 patients were found to be suffering from senile dementia of Alzheimer's type (SDAT), whereas 27 patients presented with vascular dementia (MID). During wash-out and the treatment period the somatic and social symptoms of the disease were assessed by the AGP score. Cerebral performance was evaluated by a battery of tests measuring memory, concentration, psychomotor coordination and degree of depression. Electrical activity of the brain was estimated by a power-spectral analysis of EEG. In the total study group, the naftidrofuryl group showed a significantly better improvement in the results of the psychometric test battery, which was the primary variable during treatment. A parallel development was to be found in the AGP score and electrical brain function. When results of subgroups were analyzed according to the etiopathogenetic background of patients with SDAT, it was possible to show that naftidrofuryl affected psychopathometry and EEG-parameters while patients with MID responded to naftidrofuryl with changes in AGP score and EEG variables. These findings indicate the importance of etiopathologic features in performing studies with nootropic drugs in obtaining information on possible different actions in patients with different kinds of senile dementia.

[Status of drug knowledge in the population]. / Zum Stand des Arzneimittelwissens der Bevölkerung.

In the 'Self-Medication' NFP-8 Study (National Research Programme No.8: 'Efficiency and Effectiveness in the Swiss Health Service') an attempt has been made to assess the population's basic knowledge about the proper way of dealing with drugs. The study shows that nearly a third of the adult population has insufficient knowledge. Women and better educated people have above average knowledge whereas old people and, paradoxically, those belonging to specific risk groups (e.g. diabetics, hypertensive persons, regular consumers of alcoholic drinks etc.) tend to underestimate the potential dangers of self medication. The study further suggests that a greater knowledge of drugs promotes a more active attitude to information. On the other hand a comparison with the results of other surveys leads to the conclusion that the existing basic knowledge about the risks of self-medication is often not translated into the appropriate attitude. This is why it is considered all the more important to develop strategies specific to consumer groups which are geared to motivating individual drug consumers to adopt the proper attitude to the problem.

UDP-glucose:digitoxin 16'-O-glucosyltransferase from suspension-cultured Digitalis lanata cells.

Suspension cultures from several cell lines of Digitalis lanata, as well as cultures from 6 other plant species were checked for their ability to form purpurea-glycoside A from digitoxin. An in-vitro assay for the UDP-glucose:digitoxin 16'-O-glucosyltransferase (DGT, EC 2.4.1.-) has been established based on an HPLC method. The enzyme is located in the soluble fraction. Its pH optimum is at 7.4. No enzyme activity was found in either purified vacuole preparations or lysed vacuoles. Ascorbate (10 mM) increased the transferase activity about 4-fold. Of the sugar nucleotides tested, only UDP-glucose served as a glucosyl donor. Digitoxin, digoxin, α -acetyldigitoxin, and α-acetyldigoxin are substrates for the glucosyltransferase. The role of the DGT during the biotransformation of cardenolides in Digitalis lanata cell suspension cultures is discussed.

[Loss events in childhood as predisposing factors for neurotic and psychotic depression (author's transl)]. / Verlustereignisse in der Kindheit als prädisponierende Faktoren für neurotische und psychotische Depressionen.

In a semistructured interview 90 endogenous depressives, 38 neurotic depressive patients, and 41 controls, 47-67 years of age, were questioned to ascertain the loss events during childhood. 1. The endogenous depressives, the neurotic depressive patients, and the control group had experienced an equal amount of deaths and separations in their childhood. 2. The depressive patients who first became ill after their 41st year of life were as frequently separated from their parents during childhood as the control group. Patients who had first become ill before their 41st year of life had experienced a separation from their parents more frequently than the control group. 3. Within the depressive patient group the following applies: Patients with illnesses before the age of 40 had lost their father earlier than those who became ill after 40; likewise, patients who were ill two and more times had more frequently experienced the loss of a father than those who were depressively ill only once.