COVID-19 pandemic and maternal mental health: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of the COVID-19 pandemic on anxiety and depression of women during pregnancy and perinatal period. METHODS: We systematically searched online databases to identify any report on maternal depression during pregnancy or postpartum using the Edinburgh Postnatal Depression Survey (EPDS) and maternal anxiety using the State-Trait Anxiety Inventory (STAI) until 5th July 2020. The random-effects model was used to pool the effect sizes and standardized mean differences (SMDs) and the corresponding 95% confidence intervals (CIs). RESULTS: Eight studies reported depressive and anxiety states of 7750 women, either pregnant or postpartum were included. The overall pooled EPDS score was higher among women during pandemic (SMD= 0.40, 95% CI: -0.05 - 0.86, p = .083) compared to previous non-pandemic times, without reaching a statistically significant difference. However, the overall pooled STAI score was significantly higher during pandemic (SMD= 0.82, 95% CI: 0.49 - 1.16, p < .001). No significant publication bias existed in selected studies (p > .05). CONCLUSION: The present meta-analysis provides evidence that the COVID-19 pandemic significantly increases the risk of anxiety among women during pregnancy and perinatal period. Support measures should be considered for women during pregnancy or perinatal period to guarantee mental health for this susceptible population.

Cardiometabolic and Thrombotic Risk Profile in Women Undergoing Oocyte Donation for Assisted Reproduction.

Background: The last two decades have seen a growing number of pregnancies in women who needed the donation of oocytes. With oocyte donation pregnancies, studies on obstetric outcomes among these women revealed an increased incidence of pre-eclampsia and pregnancy-induced hypertension. Furthermore, several studies have found a higher incidence of low birth weight, preterm birth, and delivery by cesarean section in oocyte donation rather than in women subjected to assisted reproduction techniques (ART) with autologous oocytes. Numerous studies have also shown a deep connection between cardiovascular and thrombotic risk factors and adverse pregnancy outcomes. In this setting, to strictly assess the preconceptional risk for women who undergo egg donation to achieve pregnancy, the aim of our study is to draw a detailed assessment of the vascular risk profile of patients with gamete donation ART indications through the evaluation of comorbidities and cardiometabolic and thrombophilic markers Materials and Methods: Patients undergoing ART with oocyte or sperm donation or double donation of gametes underwent a careful clinical assessment through a detailed personal and family anamnesis and they were evaluated for cardiometabolic and thrombophilic profile. Clinical and demographic characteristics, comorbidities, and biohumoral parameters were collected. The study was approved by the Regional Ethical Committee(Em 2018-017 CINECA 10189). Results: We evaluated 525 women. Around 73.1% were >40 years and 35% of them were older than 45 years. There was a high prevalence of dyslipidemias (58.1%), smoking habit (24.6%), a body mass index >25 in 28.6% of patients, a high abdominal circumference in 58.1% of cases, a prevalence of acquired thrombophilia in about 7% and hereditary of 19.2%. Around 39.2% of patients had total cholesterol >200 mg/dL, 19.5% had high-density lipoprotein <48 mg/dL and 43.6% had low-density lipoprotein >115 mg/dL, and 6.9% had triglyceride values >150 mg/dL. Conclusions: A careful assessment of the preconceptional status of patients undergoing ART programs with oocyte donation can be highly recommended.

Growth hormone cotreatment for poor responders undergoing in vitro fertilization cycles: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of growth hormone (GH) supplementation in improving the in vitro fertilization (IVF) outcomes of poor responders. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Poor ovarian responders undergoing conventional IVF or intracytoplasmic sperm injection (ICSI). INTERVENTION(S): Randomized controlled trials (RCTs) of poor ovarian responders undergoing a single IVF/ICSI cycle with GH supplementation versus conventional controlled ovarian stimulation. This review was registered in the PROSPERO database before starting data extraction (CRD42020151681). MAIN OUTCOME MEASURE(S): Primary outcome was live birth rate. Clinical pregnancy rate, miscarriage rate, ongoing pregnancy rate, number of oocytes, number of mature (metaphase II [MII]) oocytes and the number of embryos available to transfer were considered as secondary outcomes. RESULT(S): Twelve RCTs were included; 586 women were assigned to the intervention group and 553 to the control group. The analysis revealed that patients receiving GH supplementation did not show an increased live birth rate, miscarriage rate, or ongoing pregnancy rate. However, GH supplementation in poor responders increased clinical pregnancy rate, number of oocytes retrieved (mean difference 1.62), number of MII oocytes (mean difference 2.06), and number of embryos available to transfer (mean difference 0.76). Sensitivity and subgroup analyses did not provide statistical changes to pooled results. CONCLUSION(S): The present meta-analysis provides evidence that GH supplementation may improve some reproductive outcomes in poor responders, but not live birth rates.

Severe recurrent endometriomas in a young woman with congenital von Willebrand disease.

The pathophysiology of severe endometriosis in young women remains unknown. Menorrhagia, or heavy and prolonged menstrual bleeding, is the most common symptom experienced by women with von Willebrand disease (vWD) and represents a possible risk factor for developing endometriosis. A 17-year-old woman affected by vWD presented with severe dysmenorrhea and heavy menstrual bleeding. After being diagnosed with multiple ovarian endometriomas, the patient underwent repeated surgeries due to suspicious appearance of recurrent pelvic masses. vWD may be a risk factor for developing severe endometriosis, and patients with endometriosis should be screened for vWD and other bleeding disorders. Ovarian endometriomas in such patients might present a more severe progression and unique ultrasound findings, mimicking malignancies.

Ongoing pregnancies in patients with unexplained recurrent pregnancy loss: adverse obstetric outcomes.

To investigate the incidence of adverse pregnancy outcomes in couples with an unexplained Recurrent Pregnancy Loss (RPL) history, a retrospective cohort study was conducted between 2014 and 2015. The study group (A) included couples with an unexplained RPL, and the control group (B) was composed of couples who attended the Low-Risk Antenatal Unit during the same period. On the other hand, 53 couples were included in the study group (A) and on the other hand, 65 in the control group (B). Women with previous unexplained recurrent pregnancies loss had a significantly increased risk of gestational diabetes with 12 cases (22.6%) in the study group and 3 cases (4.6%) in the control (OR: 6.048; 95% CI: 1.607-22.762; p = 0.007). A slight increase in the risk of preterm delivery and hepatic cholestasis was observed in the study group (6 cases, 11.3%, in study group and 1 case, 1.5% in the controls (OR: 8.170; 95% CI: 0.951-70.158; p = 0.0555). Women with a history of RPL delivered more frequently by caesarean section (OR: 3.252; 95% CI: 1.460-7.241; p = 0.0039). Women with a history of RPL were at an increased risk for adverse pregnancy outcomes, mainly gestational diabetes. Therefore, a closer surveillance during the antenatal period is recommended in this group of patients.

Adnexal masses: what is the role of ultrasonographic imaging?

PURPOSE: Adnexal masses represent a common finding among both premenopausal and postmenopausal women. This article will concentrate on the importance of an accurate preoperative diagnosis of adnexal masses that may be encountered in the course of an assessment of the female pelvis. The ultrasonographic modalities including two-dimensional, Doppler, three-dimensional and real-time four-dimensional approach, the accuracy of the technique, and the role of second-level exam will be discussed. METHODS: In this review, we searched for the most relevant articles on the topic with a special focus on the importance of an accurate preoperative diagnosis of adnexal masses, the different ultrasonographic modalities, and the role of second-level exam. RESULTS: The primary goal of diagnostic evaluation is to exclude malignancy. Furthermore, differentiation among pelvic masses with non-malignant features is relevant as well since suitable counseling and treatment depend on the suspected histology. Ultrasound represents the first-line modality for assessing adnexal masses and showed a very accurate examination. Ultrasound, performed by experienced operators, is effective in the morphologic evaluation of the adnexal masses and is useful in discriminating between benign and malignant lesions. Second-level exams may include assessment by an experienced ultrasound examiner, magnetic resonance imaging, and computed tomography. CONCLUSION: Ultrasound represents the first-line modality for assessing adnexal masses. Predicting the nature of an adnexal mass is essential regarding counseling, clinical management and surgical planning in such patients. Pattern recognition can accurately diagnose the majority of the benign masses and malignancies.

[Susceptibility rate to tigecycline and antibiotic-resistance among Klebsiella pneumoniae strains isolated in Intensive Care Unit]. / Suscettibilità alla tigeciclina e antibiotico-resistenza in ceppi di Klebsiella pneumoniae isolati in Unità di Terapia Intensiva.

Antibiotic resistance in Klebsiella pneumoniae strains is an increasing problem in a lot of hospitals. It is a public health emergency because it relates with high mortality rate among patients in Intensive Care Unit (ICU). From 1/1/2009 to 31/08/2010, in ICU of SS Annunziata Hospital of Taranto, 140 isolated Klebsiella pneumoniae strains were detected. The strain identification and antimicrobial susceptibility testing were performed using a Vitek2 automated system. These isolate showed a low level of susceptibility to levofloxacin (3.4%), ciprofloxacin (6.2%), ceftazidime (2.8%) and piperacillin/tazobactam (8%). We reported also that the 10% and 13.9% of them were susceptible to meropenem and imipenem. An anti-Klebsiella pneumoniae activity in vitro to tigecycline was present in 64.6% of isolates while almost all strains (56/58) tested to colistin were susceptible. In order to our data of worryng high multiclass drug resistance including tygecicline, it needs to apply appropriate measures of surveillance and antibiotic prescription to avoid rapid spread of these mutiresistant strains in other areas.

Varicella zoster virus encephalitis during treatment with anti-tumor necrosis factor-alpha agent in a psoriatic arthritis patient.

The introduction of targeted immunotherapies has greatly improved the therapeutic options of several inflammatory diseases such as psoriatic arthritis. However treatment-related opportunistic infections and viral reactivations may still occur. We describe a case of varicella zoster virus (VZV) encephalitis due to the reactivation of latent VZV infection during a long therapy with the anti-tumor necrosis factor-alpha (TNF-alpha) drug Adalimumab. The low incidence of VZV encephalitis in patients treated with biological agents does not justify VZV serological screening in these subjects, but careful monitoring of the patients is recommended to recognize early signs and symptoms of herpes zoster to start prompt antiviral therapy to prevent associated complications.

[Encephalitis associated to novel influenza A virus infection (H1N1) in two young adults]. / Encefalite associata al virus influenza A (H1N1) in due giovani adulte.

At today, neurologic desorders associated with novel influenza A (H1N1) virus were reported only in children but not in adult. We report two cases of encephalitis associated to H1N1 virus infection occurred in females of age 28 and 37 years. In both cases disease was less severe without neurologic sequelae. In one case PCR analysis of CSF sample showed a positivity for HSV1. Novel influenza A (H1N1) viral RNA by real time PCR was detected in nasopharyngeal specimens.

[Epidemiologic and clinical parameters in hospitalized patients with novel Influenza A (H1N1) in Taranto province, Italy]. / Caratteristiche epidemiologiche e cliniche dei pazienti ospedalizzati con Influenza A (H1N1) nella provincia di Taranto, Italia.

The global spread of novel influenza A (H1N1) led the World Health Organization to declare a pandemic on June 11, 2009. Our study aimed to describe the epidemiologic and clinical parameters of hospitalized patients during the pandemic. Fifty-one persons with suspected influenza A H1N1 were hospitalized. Thirty-two of them (14 male and 18 female) were positive for novel influenza A (H1N1) viral RNA by real time PCR in nasopharyngeal specimens. Of those who tested positive, 46.8% (15 patients) were aged between 25-49 years and only 9.3% (3) were over 65 years old. Nineteen of the 32 presented a co-morbidity. The mean duration of hospitalization was 6.5 days (range 3-19). An influenza complication was presented by 68.7% of patients (all of them older than 65 years), which in most cases was pulmonary disease (18 bronchopneumonia, 2 interstitial pneumonia). Four patients required mechanical ventilation in Intensive Therapy Care. One patient died of a concomitant myopericarditis. Of the patients with influenza complications, 60% presented co-morbidity conditions. Neurologic complication (encephalitis) occurred in two young women; prognosis was good and without neurologic sequelae. In conclusion, our data do not show a correlation between gender and risk of hospitalization or influenza complication. The presence of co-morbidity does not increase the risk of pulmonary complication, which is more frequent among young adults.

[No floroquinolone resistance in non typhoidal salmonellas from hospitalized persons in an endemic area of Apulia, Italy]. / Nessuna resistenza ai fluorochinolonici in salmonelle non tifoidee isolate da persone ospedalizzate in un'area endemica della Puglia.

Non typhi-salmonella is the most common cause of hospitalization or death associated with acute diarrhea. It is usually a self limiting disease and antibiotic therapy is not required, but in immunocompromised people it is essential. Increasing antimicrobial resistance in salmonella, in future, would limit the therapeutic options. During 2002, 198 persons were hospitalized for acute gastroenteritis. The 55% of cases were female, the age ranged between 4 and 94 years and the 25% of them were > 60 years old. The 58.5% of hospitalizations occurred between June and October. Non-typhi salmonella was isolated in the stool of 49 persons, with a rate of hospitalization of 24.7% respect to other causes of gastroenteritis. The incidence of resistance that was defined as resistance to one or more drugs was 14.3%. Only one non-typhi salmonella showed a multiple resistance (> four drugs). Among all antibiotics tested, only the fluorquinolones showed a susceptibility in vitro in all strains. Non typhoidal Salmonellosis is a public healt problem in the world and it will be important to restrict the use of antibiotics in medicine and veterinary to reduce the spread of multiresistant strains.

[Myocardial infarction in the course of antiretroviral therapy with protease inhibitor]. / Infarto miocardico in corso di terapia antiretrovirale con inibitore della proteasi.

The use of protease inhibitors (PIs) in the antiretroviral therapy (ART) of HIV-1 infection has reduced the rate of morbidity and mortality; but, unfortunately, this therapy has several side effects and a long term toxicity. Unexpected lipid abnormalities and cardiovascular complications are observed. We report a case of myocardial infarction in a young man HIV-1 positive patient without a history of metabolic disorders and cardiovascular pathologies undergoing PI treatment. The new ART without PI was not suppressive, while hypertriglyceridemia value improved by omega 3 fatty acids use. Our opinion is to continue ART with PI and to correct lipid abnormalities with the use of antidislipidemic drugs instead to change a demonstrated suppressive ART.