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Duarte G, Linhares IM, Kreitchmann R, Tristão ADR, Traina E, Canti I, Takimura M, Andrade JQ. Vulvovaginitis in pregnant women. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-FPS03. [PMID: 38765512 PMCID: PMC11075393 DOI: 10.61622/rbgo/2024fps03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
• The balanced vaginal microbiome is the main factor defending the vaginal environment against infections. Lactobacilli play a key role in this regard, maintaining the vaginal pH within the normal range (3.8 to 4.5). •Hormonal and immune adaptations resulting from pregnancy influence changes in the vaginal microbiome during pregnancy. •An altered vaginal microbiome predisposes to human immunodeficiency virus (HIV) infection. •Bacterial vaginosis is the main clinical expression of an imbalanced vaginal microbiome. •Vulvovaginal candidiasis depends more on the host's conditions than on the etiological agent. •Trichomonas vaginalis is a protozoan transmitted during sexual intercourse. •The use of probiotics is not approved for use in pregnant women.
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Affiliation(s)
- Geraldo Duarte
- Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo Ribeirão PretoSP Brazil Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Iara Moreno Linhares
- Faculdade de Medicina Universidade de São Paulo São PauloSP Brazil Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Regis Kreitchmann
- Universidade Federal de Ciências da Saúde de Porto Alegre Porto AlegreRS Brazil Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Andréa da Rocha Tristão
- Faculdade de Medicina de Botucatu Universidade Estadual Paulista BotucatuSP Brazil Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Evelyn Traina
- Escola Paulista de Medicina Universidade Federal de São Paulo São PauloSP Brazil Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ivete Canti
- Universidade Federal do Rio Grande do Sul Porto AlegreRS Brazil Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marcos Takimura
- Universidade Positivo CuritibaPR Brazil Universidade Positivo, Curitiba, PR, Brazil
| | - Joelma Queiroz Andrade
- Faculdade de Medicina Universidade de São Paulo São PauloSP Brazil Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Axler E, Lipner SR. Antifungal Selection for the Treatment of Onychomycosis: Patient Considerations and Outcomes. Infect Drug Resist 2024; 17:819-843. [PMID: 38463386 PMCID: PMC10922011 DOI: 10.2147/idr.s431526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/24/2024] [Indexed: 03/12/2024] Open
Abstract
Onychomycosis, a common fungal nail infection, affects >20% of adults over age 60 and >50% of people over age 70. Onychomycosis may cause pain, psychosocial problems, and secondary infections, therefore meriting treatment. This review describes the range of treatment modalities, including FDA-approved systemic drugs and topical therapies. Additionally, new and emerging oral and topical therapies are discussed. We emphasize the importance of tailoring onychomycosis therapy to individual patient characteristics, comorbidities, preferences, extent of nail involvement, and fungal species, such that physicians may optimize treatment outcomes, patient satisfaction, and safety.
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Affiliation(s)
- Eden Axler
- Weill Cornell Medicine, Department of Dermatology, New York, NY, 10021, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, 10021, USA
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Papadopoulos EA, Howley MM, Fisher SC, Van Zutphen AR, Werler MM, Romitti PA, Browne ML. Antifungal medication use during early pregnancy and the risk of congenital heart defects in the National Birth Defects Prevention Study, 1997-2011. Birth Defects Res 2024; 116:e2308. [PMID: 38343154 DOI: 10.1002/bdr2.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Fungal infections are common among pregnant people. Recent studies suggest positive associations between oral antifungals used to treat fungal infections and congenital heart defects (CHDs). METHODS We estimated associations between first trimester antifungal use and 20 major, specific CHDs using data from the National Birth Defects Prevention Study (NBDPS), a multi-site, case-control study that included pregnancies with estimated delivery dates from October 1997 through December 2011. Infants with CHDs ("cases") were ascertained from 10 birth defect surveillance programs. Live born infants without major birth defects ("controls") were randomly selected from birth records or hospital discharge lists. First trimester antifungal use was self-reported via maternal interview. We estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) using logistic regression with Firth's penalized likelihood. RESULTS First trimester antifungal use was reported by 148/11,653 (1.3%) case and 123/11,427 (1.1%) control participants. We estimated AORs for 12 CHDs; six had AORs >1.5 (tetralogy of Fallot, double outlet right ventricle with transposition of the great arteries [DORV-TGA], atrioventricular septal defect, hypoplastic left heart syndrome, pulmonary atresia, muscular ventricular septal defect), and one (pulmonary valve stenosis) had an AOR <0.7. All CIs included the null, except for DORV-TGA. CONCLUSIONS First trimester antifungal use was rare. We observed some positive associations for several specific CHDs in our analysis, although the CIs largely included the null. Results do not support a large increase in risk, but smaller increases in risk for certain CHD cannot be ruled out.
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Affiliation(s)
- Eleni A Papadopoulos
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Meredith M Howley
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Sarah C Fisher
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Alissa R Van Zutphen
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Martha M Werler
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Marilyn L Browne
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
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Papadopoulos EA, Howley MM, Fisher SC, Van Zutphen AR, Werler MM, Romitti PA, Browne ML. Antifungal medication use during pregnancy and the risk of selected major birth defects in the National Birth Defects Prevention Study, 1997-2011. Pharmacoepidemiol Drug Saf 2024; 33:e5741. [PMID: 38112229 DOI: 10.1002/pds.5741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Recent studies suggest increased birth defect risk associated with maternal use of specific oral antifungals. We estimated associations between first-trimester antifungal use and selected non-cardiac birth defects using National Birth Defects Prevention Study (NBDPS) data. METHODS Participants with a pregnancy affected by a study-eligible birth defect ("cases") were ascertained from 10 birth defect surveillance programs; participants who delivered livebirths without a major birth defect ("controls") were randomly selected from birth records or hospital discharge lists. First-trimester antifungal use was self-reported via maternal interview. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for birth defects with ≥5 exposed cases using logistic regression. We estimated crude ORs and exact 95% CIs for birth defects with 3-4 exposed cases. Additionally, we conducted a probabilistic bias analysis of exposure misclassification. RESULTS Our analysis included 19 624 cases and 11 427 controls; 257 (1.3%) cases and 123 (1.1%) controls reported first-trimester antifungal use. Of those who reported antifungals, 62.6% of cases and 64.2% of controls reported topical antifungals; 10.1% of cases and 4.9% of controls reported oral antifungals. We observed the strongest associations for encephalocele and Dandy-Walker malformation and modestly elevated estimates for several other defects. Bias-adjusted estimates were similar to the main analysis. CONCLUSION First-trimester antifungal use was positively associated with several birth defects in our analysis, although CIs were imprecise. Further study is warranted to investigate associations between antifungal use and birth defects, including potential bias due to confounding by indication.
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Affiliation(s)
- Eleni A Papadopoulos
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Meredith M Howley
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Sarah C Fisher
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Alissa R Van Zutphen
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Martha M Werler
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Marilyn L Browne
- Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
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Mhlongo JT, Waddad AY, Albericio F, de la Torre BG. Antimicrobial Peptide Synergies for Fighting Infectious Diseases. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2300472. [PMID: 37407512 PMCID: PMC10502873 DOI: 10.1002/advs.202300472] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/28/2023] [Indexed: 07/07/2023]
Abstract
Antimicrobial peptides (AMPs) are essential elements of thehost defense system. Characterized by heterogenous structures and broad-spectrumaction, they are promising candidates for combating multidrug resistance. Thecombined use of AMPs with other antimicrobial agents provides a new arsenal ofdrugs with synergistic action, thereby overcoming the drawback of monotherapiesduring infections. AMPs kill microbes via pore formation, thus inhibitingintracellular functions. This mechanism of action by AMPs is an advantage overantibiotics as it hinders the development of drug resistance. The synergisticeffect of AMPs will allow the repurposing of conventional antimicrobials andenhance their clinical outcomes, reduce toxicity, and, most significantly,prevent the development of resistance. In this review, various synergies ofAMPs with antimicrobials and miscellaneous agents are discussed. The effect ofstructural diversity and chemical modification on AMP properties is firstaddressed and then different combinations that can lead to synergistic action,whether this combination is between AMPs and antimicrobials, or AMPs andmiscellaneous compounds, are attended. This review can serve as guidance whenredesigning and repurposing the use of AMPs in combination with other antimicrobialagents for enhanced clinical outcomes.
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Affiliation(s)
- Jessica T. Mhlongo
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)School of Laboratory Medicine and Medical SciencesCollege of Health SciencesUniversity of KwaZulu‐NatalDurban4041South Africa
- Peptide Science LaboratorySchool of Chemistry and PhysicsUniversity of KwaZulu‐NatalWestvilleDurban4000South Africa
| | - Ayman Y. Waddad
- Peptide Science LaboratorySchool of Chemistry and PhysicsUniversity of KwaZulu‐NatalWestvilleDurban4000South Africa
| | - Fernando Albericio
- Peptide Science LaboratorySchool of Chemistry and PhysicsUniversity of KwaZulu‐NatalWestvilleDurban4000South Africa
- CIBER‐BBNNetworking Centre on BioengineeringBiomaterials and Nanomedicineand Department of Organic ChemistryUniversity of BarcelonaBarcelona08028Spain
| | - Beatriz G. de la Torre
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)School of Laboratory Medicine and Medical SciencesCollege of Health SciencesUniversity of KwaZulu‐NatalDurban4041South Africa
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Genital Tract Infections in Women, Pregnancy and Neonates. Obstet Gynecol Clin North Am 2022; 49:751-769. [DOI: 10.1016/j.ogc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bradfield Strydom M, Walpola RL, McMillan S, Khan S, Ware RS, Tiralongo E. Lived experience of medical management in recurrent vulvovaginal candidiasis: a qualitative study of an uncertain journey. BMC Womens Health 2022; 22:384. [PMID: 36123738 PMCID: PMC9487134 DOI: 10.1186/s12905-022-01973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Recurrent vulvovaginal candidiasis (RVVC) is experienced by up to 10% of pre-menopausal women globally, yet there is limited research exploring the perspective of women living with this challenging condition.
Methods
Semi-structured interviews with Australian women experiencing RVVC were conducted between April–July 2021. Interviews were transcribed verbatim, and qualitative interpretative phenomenological analysis (IPA) was conducted.
Results
Ten RVVC patients were interviewed. IPA revealed an uncertain journey living with RVVC for all participants ranging from initial symptoms and difficulties in obtaining a diagnosis, the trial and error of symptom management, to the overall debilitating impact of living with a personal and intimate health condition. Four key themes were identified: Theme 1 outlined challenges and delays in diagnosis and clinically appropriate management. Theme 2 found that health care professional (HCP) knowledge limitations impacted RVVC management. Theme 3 illustrated the consequences of a lack of HCP support leading to self-referral and self-education. Theme 4 details the significant emotional and psycho-social repercussions of RVVC.
Conclusions
This debilitating, life-long disease has a prolonged effect on women both physically and psychologically. Living with RVVC seems an uncertain journey that, to a large degree, women feel they must navigate alone. While resilience and self-empowerment were noted, better support through evidence-based treatment options, educated and evidence-informed HCPs and a sympathetic social support network is needed to decrease the disease burden. Future clinical management guidelines and patient support need to consider the findings of this study.
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Foessleitner P, Farr A, Deinsberger J. Risk of fetal malformation, spontaneous abortion, and adverse pregnancy outcomes after gestational terbinafine exposure: a systematic review. J DERMATOL TREAT 2022; 33:3073-3079. [PMID: 35930463 DOI: 10.1080/09546634.2022.2110837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Fungal skin and nail infections are common health issues affecting an estimated 10%-20% of the world's population. The antifungal agent terbinafine shows broad-spectrum activity against a wide range of fungal species and is commonly prescribed as a first-line treatment for dermatomycoses and onychomycoses. However, owing to insufficient data regarding embryotoxicity and adverse pregnancy outcomes, treatment with terbinafine is currently not recommended in pregnancy and breastfeeding. This systematic review aimed to evaluate the effects of gestational terbinafine exposure on congenital malformations, spontaneous abortions, and adverse pregnancy outcomes. PubMed/MEDLINE, EMBASE, and clinicaltrials.org were searched to retrieve relevant reports up to March 2022. Two investigators independently screened the articles, extracted the data, and performed a quality assessment using the Newcastle-Ottawa Scale. Two cohort and two case-control studies were eligible for inclusion. Overall, the study showed the absence of an increased risk of congenital malformations, spontaneous abortion, preterm birth, small for gestational age, low birth weight, or stillbirth, following systemic or topical terbinafine exposure during pregnancy. In conclusion, the use of systemic and topical terbinafine during pregnancy can be regarded as safe for mothers and unborn children. The current recommendation concerning gestational terbinafine administration should be reconsidered.
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Affiliation(s)
- Philipp Foessleitner
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Nie X, Liu X, Wang C, Wu Z, Sun Z, Su J, Yan R, Peng Y, Yang Y, Wang C, Cai S, Liu Y, Yu H, Wu Q, Peng X, Yin C. Assessment of evidence on reported non-genetic risk factors of congenital heart defects: the updated umbrella review. BMC Pregnancy Childbirth 2022; 22:371. [PMID: 35488214 PMCID: PMC9055777 DOI: 10.1186/s12884-022-04600-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Congenital heart defect (CHD) is the leading cause of birth defects globally, which results in a great disease burden. It is still imperative to detect the risk factors of CHD. This umbrella review aimed to comprehensively summarize the evidence and grade the evidence of the associations between non-genetic risk factors and CHD. METHODS Databases including Medline, Embase, Web of Science, Cochrane Library, and four Chinese databases were searched from inception to 18 Jan 2022. The reference lists of systematic reviews (SR) and meta-analyses (MA) were screened, which aimed to explore the non-genetic risk factors of CHD. Subsequently, titles and abstracts of identified records and full texts of selected SR/MA were screened by two independent reviewers based on predefined eligibility criteria. A priori developed extraction form was used to abstract relative data following the PRISMA 2020 and MOOSE guidelines. The risk of bias was assessed with the AMSTAR2 instrument. Data were synthesized using fixed-effects and random-effects meta-analyses, respectively. Finally, the evidence on the association of non-genetic risk factors and CHD was graded using Ioannidis's five-class evidence grade. RESULTS A total of 56 SRs, encompassing 369 MAs, were identified. The risk factors included relative factors on air pollution, reproductive-related factors, parental age and BMI, parental life habits, working and dwelling environment, maternal drug exposure, and maternal disease. Based on AMSTAR2 criteria, only 16% (9/56) of SRs were classified as "Moderate". One hundred and two traceable positive association MAs involving 949 component individual studies were included in further analysis and grading of evidence. Family genetic history, number of abortions, maternal obesity, especially moderate or severe obesity, decoration materials, harmful chemicals, noise during pregnancy, folic acid supplementation, SSRIs, SNRIs, any antidepressants in the first trimester, maternal DM (including both PGDM and GDM), and gestational hypertension were convincing and highly suggestive factors for CHD. After sensitivity analyses based on cohort studies, some grades of evidence changed. CONCLUSION The present umbrella review will provide evidence-based information for women of childbearing age before or during pregnancy to prevent CHD. In addition, sensitivity analysis based on cohort studies showed the changed evidence levels. Therefore, future SR/MA should concern the sensitivity analysis based on prospective birth cohort studies and case-control studies.
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Affiliation(s)
- Xiaolu Nie
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xiaohang Liu
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Chen Wang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Zehao Wu
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Zimo Sun
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Jian Su
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Ruohua Yan
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yaguang Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yuxuan Yang
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Chengrong Wang
- Department of Scientific research, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Siyu Cai
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yali Liu
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Huanling Yu
- Department of Nutrition and Food Hygiene, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China.
| | - Chenghong Yin
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, China.
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Patel MA, Aliporewala VM, Patel DA. Common Antifungal Drugs in Pregnancy: Risks and Precautions. J Obstet Gynaecol India 2021; 71:577-582. [PMID: 34898894 PMCID: PMC8617216 DOI: 10.1007/s13224-021-01586-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023] Open
Abstract
Fungal skin infections are on the rise in India, and pregnant women are not immune to them. They are one of the commonest causes of secondary pruritus in pregnancy and can worsen the quality of life. Cutaneous dermatophytic infections have seen a recent emergence as a public health problem in India with increasing incidence as well as failure to appropriately respond to treatment. Vaginal candidiasis may cause obstetric and perinatal complications such as chorioamnionitis, premature rupture of membranes, preterm labor and neonatal candidiasis. Antifungal drugs are commonly prescribed in pregnancy. The common oral antifungals used are fluconazole, ketoconazole, itraconazole, terbinafine and griseofulvin; whereas the common topical antifungals are azoles, ciclopirox oleamine, terbinafine, amongst others. There have been reports of congenital abnormalities in the fetus and spontaneous abortions attributed to oral antifungals. Prescribing antifungal drugs in pregnancy needs careful consideration. In this article, we discuss the safety profile and recommendations regarding the use of these drugs during gestation. We have performed a literature search of recent large-scale cohort, case-control, and meta-analysis studies and presented them in this review. Antifungals such as echinocandins, amphotericin B, flucytosine, etc. which are indicated for systemic mycoses are beyond the scope of this article. Finally, we have given authors' perspective regarding the justifiable use of these antifungals in pregnant women.
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Affiliation(s)
- Madhuri A. Patel
- N. Wadia Hospital, Parel, Mumbai, India
- Police Hospital, Mumbai, India
- Sion, Mumbai, India
| | | | - Disha A. Patel
- Department of Community Medicine at TNMC, BYL Nair Charitable Hospital, Mumbai, India
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Gould AP, Winders HR, Stover KR, Bookstaver PB, Griffin B, Bland CM, Eiland LS, Murray M. Less common bacterial, fungal and viral infections: review of management in the pregnant patient. Drugs Context 2021; 10:dic-2021-4-3. [PMID: 34603460 PMCID: PMC8462995 DOI: 10.7573/dic.2021-4-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022] Open
Abstract
This review is a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections. It offers guidance to clinicians based on the most recently published evidence-based research and expert recommendations. A search of MEDLINE (inception to March 2021) and the CDC website was performed. Liposomal amphotericin B is the preferred therapy for cryptococcosis, histoplasmosis, oesophageal candidiasis, and coccidioidomycosis, especially during the first trimester due to teratogenic concerns with azole antifungals. For oral candidiasis, clotrimazole troches or miconazole mucoadhesive buccal tablets are recommended. A β-lactam antimicrobial is preferred over doxycycline for various manifestations of Lyme disease and the drug of choice for Pneumocystis pneumonia is trimethoprim/sulfamethoxazole. Acyclovir is the preferred antiviral for varicella zoster virus. Fluoroquinolones, macrolides, and aminoglycosides should be avoided if possible and there are alternate agents available for an effective treatment regimen. There is a scarcity of clinical data in pregnant patients with less common bacterial, fungal and viral infections. This population lacks definitive recommendations in many clinical practice guidelines. The key to optimizing therapy is a comprehensive review of the available evidence and a careful balance of risks and benefits before final treatment decisions.
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Affiliation(s)
| | - Hana R Winders
- University of South Carolina College of Pharmacy, Columbia, SC, USA.,Prisma Health Midlands, Columbia, SC, USA
| | - Kayla R Stover
- University of Mississippi School of Pharmacy, Jackson, MS, USA
| | | | - Brooke Griffin
- Midwestern University College of Pharmacy, Downers Grove, IL, USA
| | | | - Lea S Eiland
- Auburn University Harrison School of Pharmacy, Meridian, MS, USA
| | - Milena Murray
- Midwestern University College of Pharmacy, Downers Grove, IL, USA.,Northwestern Memorial Hospital, Chicago, IL, USA
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Favero V, Bacci C, Volpato A, Bandiera M, Favero L, Zanette G. Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures. Dent J (Basel) 2021; 9:dj9040046. [PMID: 33921608 PMCID: PMC8072957 DOI: 10.3390/dj9040046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.
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Affiliation(s)
- Vittorio Favero
- Unit of Maxillofacial Surgery and Dentistry, University of Verona, 37129 Verona, Italy;
| | - Christian Bacci
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Andrea Volpato
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
- Correspondence: or
| | - Michela Bandiera
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Lorenzo Favero
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
| | - Gastone Zanette
- Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy; (C.B.); (M.B.); (L.F.); (G.Z.)
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13
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Budani MC, Fensore S, Di Marzio M, Tiboni GM. Maternal use of fluconazole and congenital malformations in the progeny: A meta-analysis of the literature. Reprod Toxicol 2021; 100:42-51. [DOI: 10.1016/j.reprotox.2020.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
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14
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Vaginal Yeast Infection. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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García Roa M, Arias Gómez A, García Franco R, Ramírez Neria P. Endogenous endophthalmitis during pregnancy: Case report. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:512-515. [PMID: 32553803 DOI: 10.1016/j.oftal.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
Endogenous endophthalmitis is a disease that potentially threatens vision. It is produced by the haematogenous spread of microorganisms from a septic focus. It is a rare condition that is related to debilitating diseases, immunosuppression states, and invasive procedures. Endogenous endophthalmitis during pregnancy is even rarer, and has become a challenge due to the safety and side effects of the local and systemic treatments. The case is presented of a pregnant woman with a history of complicated appendicitis, septic shock, and thrombocytopenia that presented endogenous endophthalmitis due to Candida albicans in the immediate post-operative period. This required the use of intravitreal and systemic antimycotics and vitrectomy. She made a significant anatomical and functional recovery, and without any maternal or foetal side effects.
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Affiliation(s)
- M García Roa
- Servicio de Retina y Vítreo, Instituto de la Retina del Bajío, Santiago de Querétaro, México
| | - A Arias Gómez
- Servicio de Retina y Vítreo, Instituto de la Retina del Bajío, Santiago de Querétaro, México.
| | - R García Franco
- Servicio de Retina y Vítreo, Instituto de la Retina del Bajío, Santiago de Querétaro, México
| | - P Ramírez Neria
- Servicio de Retina y Vítreo, Instituto de la Retina del Bajío, Santiago de Querétaro, México
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16
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Lokugamage AU, Eftime VAI, Porter D, Ahillan T, Ke SX. Birth preparation acupuncture for normalising birth: An analysis of NHS service routine data and proof of concept. J OBSTET GYNAECOL 2020; 40:1096-1101. [PMID: 31971456 DOI: 10.1080/01443615.2019.1694878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A number of studies show that acupuncture may help with labour and delivery. An NHS maternity acupuncture service providing birth preparation acupuncture has assessed its routine hospital maternity annual data from 2014 to 2016 to see what effect it had on labour and delivery outcomes. The data from this service was analysed and women who had birth preparation acupuncture were compared with those who did not receive it. Maternal age, parity and socio-economic status were considered confounders and were adjusted for in the analysis. Women who received acupuncture had more normal births (less surgical births) [OR 0.76 (0.64, 0.91)], required less intrapartum analgesia [OR 0.74 (0.63, 0.86)], fewer components of an induction of labour [OR 0.74 (0.61, 0.91)] and a reduced length of a hospital stay [OR 0.91 (0.87, 0.95)]. The patients highly valued the availability of acupuncture within the maternity service as it enhanced their patient journey.Impact statementWhat is already known on this subject? Numerous studies provide evidence for the effects of acupuncture in normalising pregnancy and birth. These effects include musculoskeletal preparation of the pelvis, cervical ripening, enhancing endogenous oxytocin release, and analgesic properties.What do the results of this study add? Our analysis shows that women who received birth preparation acupuncture had fewer surgical births, required less intrapartum analgesia, less components of induction of labour and had a reduced length of hospital stay, supporting the use of maternity acupuncture in normalising birth outcomes.What are the implications of these findings for clinical practice and/or further research? The findings show that acupuncture, by potentially normalising birth, may lead to reductions in costs of service. Further, additional research is required to see whether acupuncture is cost effective and could have an adjunctive role as a complementary therapy for improving birth outcomes and a woman's experience of childbirth.
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Affiliation(s)
- A U Lokugamage
- Whittington Health NHS Trust, London, UK.,University College Medical School, London, UK
| | - V A I Eftime
- Whittington Health NHS Trust, London, UK.,Asante Academy of Chinese Medicine, London, UK
| | - D Porter
- University College Medical School, London, UK
| | - T Ahillan
- University College Medical School, London, UK
| | - S X Ke
- Asante Academy of Chinese Medicine, London, UK
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