Tweeting environmental pollution: Analyzing twitter language to uncover its correlation with county-level obesity rates in the United States.

BACKGROUND: Environmental pollution has been linked to obesogenic tendencies. Using environmental-related posts from Twitter (now known as X) from U.S. counties, we aim to uncover the association between Twitter linguistic data and U.S. county-level obesity rates. METHODS: Analyzing nearly 300 thousand tweets from January 2020 to December 2020 across 207 U.S. counties, using an innovative Differential Language Analysis technique and drawing county-level obesity data from the 2020 Food Environment Atlas to identify distinct linguistic features in Twitter relating to environmental-related posts correlated with socioeconomic status (SES) index indicators, obesity rates, and obesity rates controlled for SES index indicators. We also employed predictive modeling to estimate Twitter language's predictive capacity for obesity rates. RESULTS: Results revealed a negative correlation between environmental-related tweets and obesity rates, both before and after adjusting for SES. Contrarily, non-environmental-related tweets showed a positive association with higher county-level obesity rates, indicating that individuals living in counties with lower obesity rates tend to tweet environmental-related language more frequently than those living in counties with higher obesity rates. The findings suggest that linguistic patterns and expressions employed in discussing environmental-related themes on Twitter can offer unique insights into the prevailing cross-sectional patterns of obesity rates. CONCLUSIONS: Although Twitter users are a subset of the general population, incorporating environmental-related tweets and county-level obesity rates and using a novel language analysis technique make this study unique. Our results indicated that Twitter users engaging in more active dialog about environmental concerns might exhibit healthier lifestyle practices, contributing to reduced obesity rates.

Longitudinal effects of prenatal substance use and environmental stressors on executive functioning in low-income African American adolescents: A latent growth modeling analysis.

Adverse prenatal substance use and environmental stressors have been linked to prefrontal cortex (PFC) impairments, the brain region that regulates executive functioning. Executive functions (e.g., inhibitory control, working memory, and cognitive flexibility) are crucial for sophisticated cognitive activities throughout child and adolescent development. There is little research on how prenatal substance use and environmental stressors longitudinally program executive functioning in children over time. We investigated the associations between prenatal/environmental stressors (i.e., maternal prenatal substance use, maternal-fetal bonding, and neighborhood disorganization) and executive function performance among low-income African American youth from age 6 until age 18. Analyses were based on four waves of data collected between 1994 and 2014 in the Memphis New Mothers Study, a longitudinal randomized controlled trial that was an intervention during pregnancy and the first two years of the child's life in low-SES women and their first-born children. Mothers and their children were followed longitudinally through 18 years post-childbirth. Prenatal substance use (e.g., prenatal smoke, alcohol, and drug use) and environmental stressor (e.g., food environment, maternal-fetal bonding and neighborhood disorganizations) evaluations were gathered from mothers and children prenatally and postnatally before the age of 4.5 years. Executive function was assessed using the Child Behavior Checklist for impulsivity and inattention, while the coding subscale of the Wechsler Intelligence Scale for Children-Third Edition, the reading recognition subtest of the Peabody Individual Achievement Test, and the digit span subtest of the Wechsler Adult Intelligence Scale were employed to assess working memory at three time periods (6, 12, and 18 years). Covariate-adjusted latent growth models estimated the associations between prenatal substance use and environmental stressors and changes in executive functioning over three time points. Prenatal smoking and alcohol use were associated with changes in impulsivity scores over 12 years. Prenatal alcohol use predicted higher inattention at baseline and a slower rate of change from ages 6 to 18. Neighborhood disorganization at ages 6 and 18 predicted higher inattention and lower working memory in youth at age 18, respectively. Our findings underscore the long-term impact of prenatal substance use exposures and neighborhood environments on cognitive development and highlight the importance of early interventions to mitigate these effects.

Pharmacoethics and pregnancy: Overcoming the therapeutic orphan stigma.

There is paucity of evidence to support clinical decision making and counselling related to medication use in pregnancy. Despite multiple efforts from legislative bodies and advocacy groups, the inclusion of pregnant women in clinical drug trials assessing efficacy and safety remains scarce. Pregnancy can be complicated by multiple comorbidities that require pharmacological intervention; these interventions primarily target the pregnant woman but also sometimes have secondary effects for the foetus. The US Food and Drug Administration has issued multiple guidance documents on incorporating pregnant women in clinical trials to aid pharmaceutical companies in designing a protocol to ensure safety and adherence to ethical standards. Advances in paediatric pharmacology studies provide lessons for researchers on the best practice of designing clinical trials with inclusion of patients from special populations. In this review, we present the status of pregnant women in clinical trials, highlighting the ethical stigma and possible future directives.

Prenatal Lead Exposure Is Associated with Reduced Abundance of Beneficial Gut Microbial Cliques in Late Childhood: An Investigation Using Microbial Co-Occurrence Analysis (MiCA).

Many analytical methods used in gut microbiome research focus on either single bacterial taxa or the whole microbiome, ignoring multibacteria relationships (microbial cliques). We present a novel analytical approach to identify microbial cliques within the gut microbiome of children at 9-11 years associated with prenatal lead (Pb) exposure. Data came from a subset of participants (n = 123) in the Programming Research in Obesity, Growth, Environment and Social Stressors cohort. Pb concentrations were measured in maternal whole blood from the second and third trimesters of pregnancy. Stool samples collected at 9-11 years old underwent metagenomic sequencing to assess the gut microbiome. Using a novel analytical approach, Microbial Co-occurrence Analysis (MiCA), we paired a machine learning algorithm with randomization-based inference to first identify microbial cliques that were predictive of prenatal Pb exposure and then estimate the association between prenatal Pb exposure and microbial clique abundance. With second-trimester Pb exposure, we identified a two-taxa microbial clique that included Bifidobacterium adolescentis and Ruminococcus callidus and a three-taxa clique that also included Prevotella clara. Increasing second-trimester Pb exposure was associated with significantly increased odds of having the two-taxa microbial clique below the median relative abundance (odds ratio (OR) = 1.03, 95% confidence interval (CI) [1.01-1.05]). Using a novel combination of machine learning and causal inference, MiCA identified a significant association between second-trimester Pb exposure and the reduced abundance of a probiotic microbial clique within the gut microbiome in late childhood.

The effect of different types of anemia on HbA1c levels in non-diabetics.

BACKGROUND: Diabetes mellitus is one of the most common diseases worldwide with significant morbidity and mortality. HbA1c remains one of the most important methods for diagnosis and monitoring of the disease. Since HbA1c is a reflection of the glucose attached to red blood cells, factors affecting hemoglobin and red blood cells' half-life can influence HbA1c measurements. OBJECTIVE: This study aims to evaluate the effect of different types of anemia including iron deficiency anemia, sickle cell anemia, ß -thalassemia trait, and megaloblastic anemia on HbA1c levels in a tertiary hospital over the past 6 years (2016-2022). METHOD: This is a retrospective chart review study of 324 patients including those with one of the four types of anemia mentioned above and a control group. The control group were healthy adults with normal HbA1c and hemoglobin, who were not known to have diabetes or anemia. Patients with diabetes or prediabetes based on self-reporting or elevated fasting, random blood sugar, or 2 hours post-prandial blood glucose were excluded. RESULTS: The mean HbA1c levels were significantly higher in sickle cell anemia at 5.83% (95% CI = 5.39-6.28) and in iron deficiency anemia at 5.75% (95% CI = 5.68-5.82) when compared to the control group at 5.32% (95% CI = 5.22-5.41). However, the mean HbA1c levels in megaloblastic anemia were 5.38% (95% CI = 5.26-5.5) and 5.45% (95% CI = 5.21-5.69) in beta thalassemia trait, which were not significantly different when compared to the control group. HbA1c significantly decreased from 5.75 to 5.44% after treatment in the iron-deficient group with a p-value of < 0.001. Moreover, lower hemoglobin and higher red cell distribution width correlated with higher HbA1c levels in patients with sickle cell anemia. CONCLUSION: This study found a significant increase in HbA1c levels in iron deficiency anemia and sickle cell disease in patients not known to have diabetes. However, there was no significant effect in those patients with ß-thalassemia trait and megaloblastic anemia. Treatment of iron deficiency anemia significantly decreased the HbA1c level, bringing it back to normal.

Prenatal manganese biomarkers and operant test battery performance in Mexican children: Effect modification by child sex.

BACKGROUND: Manganese (Mn) is essential to healthy neurodevelopment, but both Mn deficiency and over-exposure have been linked to prefrontal cortex (PFC) impairments, the brain region that regulates cognitive and neurobehavioral processes responsible for spatial memory, learning, motivation, and time perception. These processes facilitated by attention, inhibitory control, working memory, and cognitive flexibility are often sexually dimorphic and complex, driven by multiple interconnected neurologic and cognitive domains. OBJECTIVE: We investigated the role of child sex as an effect modifier of the association between prenatal Mn exposure and performance in an operant testing battery (OTB) that assessed multiple cognitive and behavioral functional domains. METHODS: Children (N = 575) aged 6-8 years completed five OTB tasks. Blood and urinary Mn measurements were collected from mothers in the 2nd and 3rd trimesters. Multiple regression models estimated the association between Mn biomarkers at each trimester with OTB performance while adjusting for socio-demographic covariates. Covariate-adjusted weighted quantile sum (WQS) regression models were used to estimate the association of a Mn multi-media biomarker (MMB) mixture with OTB performance. Interaction terms were used to estimate modification effect by child sex. RESULTS: Higher blood Mn exposure was associated with better response rates (more motivation) on the progressive ratio task and higher overall accuracy on the delayed matching-to-sample task. In the WQS models, the MMB mixture was associated with better response rates (more motivation) on the progressive ratio task. Additionally, for the linear and WQS models, we observed a modification effect by child sex in the progressive ratio and delayed matching-to-sample tasks. Higher prenatal Mn biomarker levels were associated with improved task performance for girls and reduced performance in boys. CONCLUSION: Higher prenatal blood Mn concentrations and the MMB mixture predicted improved performance on two of five operant tasks. Higher prenatal Mn concentrations regulated executive functions in children in a sexually dimorphic manner. Higher prenatal Mn exposure is associated with improved performance on spatial memory and motivation tasks in girls, suggesting that Mn's nutritional role is sexually dimorphic, and should be considered when making dietary and/or environmental intervention recommendations.

Linguistic Methodologies to Surveil the Leading Causes of Mortality: Scoping Review of Twitter for Public Health Data.

BACKGROUND: Twitter has become a dominant source of public health data and a widely used method to investigate and understand public health-related issues internationally. By leveraging big data methodologies to mine Twitter for health-related data at the individual and community levels, scientists can use the data as a rapid and less expensive source for both epidemiological surveillance and studies on human behavior. However, limited reviews have focused on novel applications of language analyses that examine human health and behavior and the surveillance of several emerging diseases, chronic conditions, and risky behaviors. OBJECTIVE: The primary focus of this scoping review was to provide a comprehensive overview of relevant studies that have used Twitter as a data source in public health research to analyze users' tweets to identify and understand physical and mental health conditions and remotely monitor the leading causes of mortality related to emerging disease epidemics, chronic diseases, and risk behaviors. METHODS: A literature search strategy following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extended guidelines for scoping reviews was used to search specific keywords on Twitter and public health on 5 databases: Web of Science, PubMed, CINAHL, PsycINFO, and Google Scholar. We reviewed the literature comprising peer-reviewed empirical research articles that included original research published in English-language journals between 2008 and 2021. Key information on Twitter data being leveraged for analyzing user language to study physical and mental health and public health surveillance was extracted. RESULTS: A total of 38 articles that focused primarily on Twitter as a data source met the inclusion criteria for review. In total, two themes emerged from the literature: (1) language analysis to identify health threats and physical and mental health understandings about people and societies and (2) public health surveillance related to leading causes of mortality, primarily representing 3 categories (ie, respiratory infections, cardiovascular disease, and COVID-19). The findings suggest that Twitter language data can be mined to detect mental health conditions, disease surveillance, and death rates; identify heart-related content; show how health-related information is shared and discussed; and provide access to users' opinions and feelings. CONCLUSIONS: Twitter analysis shows promise in the field of public health communication and surveillance. It may be essential to use Twitter to supplement more conventional public health surveillance approaches. Twitter can potentially fortify researchers' ability to collect data in a timely way and improve the early identification of potential health threats. Twitter can also help identify subtle signals in language for understanding physical and mental health conditions.

Investigating Racial Disparities in Cancer Crowdfunding: A Comprehensive Study of Medical GoFundMe Campaigns.

BACKGROUND: In recent years, there has been growing concern about prejudice in crowdfunding; however, empirical research remains limited, particularly in the context of medical crowdfunding. This study addresses the pressing issue of racial disparities in medical crowdfunding, with a specific focus on cancer crowdfunding on the GoFundMe platform. OBJECTIVE: This study aims to investigate racial disparities in cancer crowdfunding using average donation amount, number of donations, and success of the fundraising campaign as outcomes. METHODS: Drawing from a substantial data set of 104,809 campaigns in the United States, we used DeepFace facial recognition technology to determine racial identities and used regression models to examine racial factors in crowdfunding performance. We also examined the moderating effect of the proportion of White residents on crowdfunding bias and used 2-tailed t tests to measure the influence of racial anonymity on crowdfunding success. Owing to the large sample size, we set the cutoff for significance at P<.001. RESULTS: In the regression and supplementary analyses, the racial identity of the fundraiser significantly predicted average donations (P<.001), indicating that implicit bias may play a role in donor behavior. Gender (P=.04) and campaign description length (P=.62) did not significantly predict the average donation amounts. The race of the fundraiser was not significantly associated with the number of donations (P=.42). The success rate of cancer crowdfunding campaigns, although generally low (11.77%), showed a significant association with the race of the fundraiser (P<.001). After controlling for the covariates of the fundraiser gender, fundraiser age, local White proportion, length of campaign description, and fundraising goal, the average donation amount to White individuals was 17.68% higher than for Black individuals. Moreover, campaigns that did not disclose racial information demonstrated a marginally higher average donation amount (3.92%) than those identified as persons of color. Furthermore, the racial composition of the fundraiser's county of residence was found to exert influence (P<.001); counties with a higher proportion of White residents exhibited reduced racial disparities in crowdfunding outcomes. CONCLUSIONS: This study contributes to a deeper understanding of racial disparities in cancer crowdfunding. It highlights the impact of racial identity, geographic context, and the potential for implicit bias in donor behavior. As web-based platforms evolve, addressing racial inequality and promoting fairness in health care financing remain critical goals. Insights from this research suggest strategies such as maintaining racial anonymity and ensuring that campaigns provide strong evidence of deservingness. Moreover, broader societal changes are necessary to eliminate the financial distress that drives individuals to seek crowdfunding support.

Impact of the number of retrieved oocytes on IVF outcomes: oocyte maturation, fertilization, embryo quality and implantation rate.

The process of oocyte retrieval represents a key phase during the cycles of in vitro fertilization (IVF). It involves controlled ovarian stimulation to retrieve the highest number of oocytes possible. According to many previous studies, the higher the number of oocytes the higher the chances of obtaining embryos for multiple transfers. In this study, in total, 1987 patients were retrospectively reviewed to investigate the correlations between the number of retrieved oocytes and the subsequent IVF outcomes. Patients were divided into three groups according to the number of retrieved oocytes (Group 1: ≤5 oocytes; Group 2: 6-15 oocytes; Group 3: ≥15 oocytes). The results showed a significant negative correlation between oocyte number and maturation rate as well as fertilization rate. However, a significant positive correlation was found between oocyte number and the blastulation rate. The implantation rate after fresh embryo transfers was higher in group 2 (6-15 oocytes) compared with group 1 (≤5 oocytes). According to our findings, we conclude that oocyte numbers between 6 and 15 oocytes can result in the highest chances of positive IVF outcomes in terms of embryo quality and fresh embryo transfers with lower risks of ovarian hyperstimulation.

Risk-Based Screening Tools to Optimise HIV Testing Services: a Systematic Review.

PURPOSE OF REVIEW: Effective ways to diagnose the remaining people living with HIV who do not know their status are a global priority. We reviewed the use of risk-based tools, a set of criteria to identify individuals who would not otherwise be tested (screen in) or excluded people from testing (screen out). RECENT FINDINGS: Recent studies suggest that there may be value in risk-based tools to improve testing efficiency (i.e. identifying those who need to be tested). However, there has not been any systematic reviews to synthesize these studies. We identified 18,238 citations, and 71 were included. The risk-based tools identified were most commonly from high-income (51%) and low HIV (<5%) prevalence countries (73%). The majority were for "screening in" (70%), with the highest performance tools related to identifying MSM with acute HIV. Screening in tools may be helpful in settings where it is not feasible or recommended to offer testing routinely. Caution is needed for screening out tools, where there is a trade-off between reducing costs of testing with missing cases of people living with HIV.

Stress impact of liposomes loaded with ciprofloxacin on the expression level of MepA and NorB efflux pumps of methicillin-resistant Staphylococcus aureus.

One mechanism of ciprofloxacin resistance is attributed to chromosomal DNA-encoded efflux pumps such as the MepA and NorB proteins. The goal of this research is to find a way to bypass Staphylococcus aureus' efflux pumps. Because of its high membrane permeability and low association with NorB and MepA efflux proteins, a liposome-encapsulating antibiotic is one of the promising, cost-effective drug carriers and coating mechanisms for overcoming active transport of methicillin-resistant S. aureus (MRSA) multidrug-resistant efflux protein . The calculated "Log Perm RRCK" membrane permeability values of 1,2-distearoyl-sn-glycerol-3-phosphocholine (DSPC) ciprofloxacin liposome-encapsulated (CFL) showed a lower negative value of - 4,652 cm/s and greater membrane permeability than ciprofloxacin free (CPF). The results of RT-qPCR showed that cationic liposomes containing ciprofloxacin in liposome-encapsulated form (CFL) improved CPF antibacterial activity and affinity for negatively charged bacterial cell surface membrane in comparison to free drug and liposome, as it overcame several resistance mechanisms and reduced the expression of efflux pumps. Ciprofloxacin liposome-encapsulated (CFL) is therefore more effective than ciprofloxacin alone. Liposomes can be combined with a variety of drugs that interact with bacterial cell efflux pumps to maintain high sustained levels of antibiotics in bacterial cells.

Sequential evolution of virulence and resistance during clonal spread of community-acquired methicillin-resistant Staphylococcus aureus.

The past two decades have witnessed an alarming expansion of staphylococcal disease caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). The factors underlying the epidemic expansion of CA-MRSA lineages such as USA300, the predominant CA-MRSA clone in the United States, are largely unknown. Previously described virulence and antimicrobial resistance genes that promote the dissemination of CA-MRSA are carried by mobile genetic elements, including phages and plasmids. Here, we used high-resolution genomics and experimental infections to characterize the evolution of a USA300 variant plaguing a patient population at increased risk of infection to understand the mechanisms underlying the emergence of genetic elements that facilitate clonal spread of the pathogen. Genetic analyses provided conclusive evidence that fitness (manifest as emergence of a dominant clone) changed coincidently with the stepwise emergence of (i) a unique prophage and mutation of the regulator of the pyrimidine nucleotide biosynthetic operon that promoted abscess formation and colonization, respectively, thereby priming the clone for success; and (ii) a unique plasmid that conferred resistance to two topical microbiocides, mupirocin and chlorhexidine, frequently used for decolonization and infection prevention. The resistance plasmid evolved through successive incorporation of DNA elements from non-S. aureus spp. into an indigenous cryptic plasmid, suggesting a mechanism for interspecies genetic exchange that promotes antimicrobial resistance. Collectively, the data suggest that clonal spread in a vulnerable population resulted from extensive clinical intervention and intense selection pressure toward a pathogen lifestyle that involved the evolution of consequential mutations and mobile genetic elements.

Antioxidant activities and lipid peroxidation status in human follicular fluid: age-dependent change.

Maternal age is a significant factor influencing in vitro fertilization (IVF) outcomes. Oxidative stress (OS) is one of the major causes of age-related cellular and molecular damage. The purpose of this work was to investigate the correlation between maternal age with intrafollicular antioxidants and OS markers in follicular fluid (FF), and also to determine the OS status in patients of advanced age. This study was a prospective study including 201 women undergoing IVF whose age was between 24 and 45 years old. FF samples were obtained from mature follicles at the time of oocyte retrieval. After treatment of FF, lipid peroxidation levels (MDA) and enzyme activities such as superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR) and glutathione (GSH) level were evaluated using spectrophotometry. The results indicated that the age cutoff point for increasing the MDA level was fixed at 37 years, allowing the study to be differentiated into two age groups. Group I included patients whose age was less than 37 years, and group II included patients whose age was greater than or equal 37 years. Statistical analysis revealed that MDA and GSH levels and GR activity were significantly higher in group II compared with group I. The SOD and CAT activities were significantly less in group II compared with group I. We concluded that from 37 years old a reproductive ageing was accompanied by a change in the antioxidant pattern in FF that impaired reactive oxygen species scavenging efficiency.

Insights into fear: A phenomenological study of Black mothers.

AIM: The aim of the study was to explore the lived experience of stress as described by Black childbearing women. DESIGN: A phenomenological approach was used. METHODS: Seven mothers who met inclusion criteria participated in both individual and group interviews between August 2018 and August 2019. Each session was audio recorded and professionally transcribed. Consistent with van Manen's phenomenological approach, three rounds of reflective transcript analysis were conducted over several months. RESULTS: Several stress themes were identified from the data. However, the most pervasive theme was the fear of having a son and keeping him safe. In this paper, the themes of Living in Fear and Living with Fear are detailed. CONCLUSION: Previous research has found that Black populations in America fear for their safety. This study identified a pervasive and profound fear for their children, specifically sons who are at a higher risk of being killed in normal daily activities. Mothers also expressed fears about their responsibility to keep them safe by providing the right tools. IMPACT: Although scientists have long studied poor pregnancy outcomes for Black American women, the disparity persists. This study sought to identify stressors acknowledged by Black mothers themselves. For the first time, Black mothers stated that their primary stress is fear for their children's lives. The role this fear has in adverse pregnancy outcomes, if any, is yet to be determined.

Phytochemical Profiling of Lavandula coronopifolia Poir. Aerial Parts Extract and Its Larvicidal, Antibacterial, and Antibiofilm Activity Against Pseudomonas aeruginosa.

Infections associated with the emergence of multidrug resistance and mosquito-borne diseases have resulted in serious crises associated with high mortality and left behind a huge socioeconomic burden. The chemical investigation of Lavandulacoronopifolia aerial parts extract using HPLC-MS/MS led to the tentative identification of 46 compounds belonging to phenolic acids, flavonoids and their glycosides, and biflavonoids. The extract displayed larvicidal activity against Culex pipiens larvae (LC50 = 29.08 µg/mL at 72 h). It significantly inhibited cytochrome P-450 monooxygenase (CYP450), acetylcholinesterase (AChE), and carboxylesterase (CarE) enzymes with the comparable pattern to the control group, which could explain the mode of larvae toxification. The extract also inhibited the biofilm formation of Pseudomonas aeruginosa by 17-38% at different Minimum Inhibitory Concentrations (MICs) (0.5-0.125 mg/mL) while the activity was doubled when combined with ciprofloxacin (ratio = 1:1 v:v). In conclusion, the wild plant, L.coronopifolia, can be considered a promising natural source against resistant bacteria and infectious carriers.

Blood type association with bleeding outcomes at delivery in a large multi-center study.

Postpartum hemorrhage is a leading cause of maternal death globally. Recent studies have associated Type-O group to increased risk of bleeding. We aimed to determine if women with Type-O blood are at higher risk of PPH. This is a retrospective cohort analysis of a multi-center database included women admitted to labor and delivery from January 2015 to June 2018. All deliveries resulting in live birth were included. Association between Type-O and non Type-O were examined using chi-square test and fishers exact test. Prevalence of postpartum hemorrhage, estimated blood loss, drop in hematocrit and red blood cell transfusion were compared. The matched sample included 40,964 Type-O and the same number of no Type-O. The overall prevalence of postpartum hemorrhage was 6.4%, and there was no difference in the prevalence of PPH among Type-O compared to non Type-O (6.38% vs. 6.37% respectively; p = 0.96). There was no difference in hematocrit drop and estimated blood loss between Type-O and non Type-O in all deliveries. However, in cesarean delivery there was a significant difference in blood loss among the two groups. Finally, Type-O had 1.09-fold increased risk for transfusion compared to non Type O (95% CI 0.9-1.34). There is an association between Type-O group and risk of bleeding in women undergoing cesarean delivery. More prospective studies, taking into account coagulation profile, platelet count and tissue factors, are needed to draw a conclusion on whether ABO system can be considered a heritable risk of postpartum hemorrhage.

Anatomical and physiological alterations of pregnancy.

The extensive metabolic demands of pregnancy require specific physiological and anatomical changes. These changes affect almost all organ systems, including the cardiovascular, respiratory, renal, gastrointestinal, and hematologic system. The placenta adds another layer of complexity. These changes make it challenging for clinicians to understand presenting signs and symptoms, or to interpret laboratory and radiological tests. Furthermore, these physiological alterations can affect the pharmacokinetics and pharmacodynamics of drugs. Drug safety in lactation is only supported by limited evidence. In addition, the teratogenic effects of medications are often extrapolated from animals, which further adds uncertainties. Unfortunately, pregnant women are only rarely included in clinical drug trials, while doses, regimens, and side effects are often extrapolated from studies conducted in non-pregnant populations. In this comprehensive review, we present the changes occurring in each system with its effects on the pharmacokinetic variables. Understanding these physiological changes throughout normal pregnancy helps clinicians to optimize the health of pregnant women and their fetuses. Furthermore, the information on pregnancy-related physiology is also critical to guide study design in this vulnerable 'orphan' population, and provides a framework to explore pregnancy-related pathophysiology such as pre-eclampsia.

Reactive oxygen species in reproduction: harmful, essential or both?

The process of embryonic development is crucial and radically influences preimplantation embryo competence. It involves oocyte maturation, fertilization, cell division and blastulation and is characterized by different key phases that have major influences on embryo quality. Each stage of the process of preimplantation embryonic development is led by important signalling pathways that include very many regulatory molecules, such as primary and secondary messengers. Many studies, both in vivo and in vitro, have shown the importance of the contribution of reactive oxygen species (ROS) as important second messengers in embryo development. ROS may originate from embryo metabolism and/or oocyte/embryo surroundings, and their effect on embryonic development is highly variable, depending on the needs of the embryo at each stage of development and on their environment (in vivo or under in vitro culture conditions). Other studies have also shown the deleterious effects of ROS in embryo development, when cellular tissue production overwhelms antioxidant production, leading to oxidative stress. This stress is known to be the cause of many cellular alterations, such as protein, lipid, and DNA damage. Considering that the same ROS level can have a deleterious effect on the fertilizing oocyte or embryo at certain stages, and a positive effect at another stage of the development process, further studies need to be carried out to determine the rate of ROS that benefits the embryo and from what rate it starts to be harmful, this measured at each key phase of embryonic development.

Cortical hyperostosis, rare adverse effect of prostaglandin.

We describe here an infant girl with ductal dependent complex cyanotic heart disease, who required prostaglandin infusion for a total of five months prior to Blalock-Taussig shunt procedure. Her alkaline phosphatase activity was raised after seven weeks being on prostaglandin and only dropped to the normal range seven days after discontinuing prostaglandin infusion. During our review at five months old, her limbs were grossly swollen and radiographic examination showed dense periosteal reaction in the long bones. Based on the clinical findings and investigations, she was diagnosed to have cortical hyperostosis, which is an uncommon side effect of prostaglandin. She underwent right Blalock-Taussig Shunt procedure successfully with no major complications. Unfortunately, she succumbed to infection two months after surgery.

A barrier to care: Distance traveled affects adherence to treatment and follow-up plans for patients with infantile hemangioma.

A chart review was performed of all patients diagnosed with infantile hemangioma in the pediatric dermatology clinic to determine whether distance traveled by the patient affected adherence to follow-up and treatment plans. An increase in distance was associated with an increase in likelihood of nonadherence to treatment or follow-up plans. Compared to patients who lived within 10 miles of a pediatric dermatologist, families who lived farther away were less likely to adhere to treatment plans. Families who traveled over 20 miles to clinic were 7.38 times more likely to be nonadherent to the treatment plan than those who traveled 0-10 miles.