Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning:A case report

BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Postpartum depression and partner support during the period of lactation:Correlation research and its influencing factors

BACKGROUND Postpartum depression(PPD)not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development.Partners who are in close contact with parturient women play a key role in communication and emotional support.This study explores the PPD support relationship with partners and its influencing factors,which is believed to establish psychological well-being and improve maternal partner support.AIM To explore the correlation between PPD and partner support during breastfeeding and its influencing factors.METHODS Convenience sampling was used to select lactating women(200 women)who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022.A cross-sectional survey was conducted on the basic information(general information questionnaire),depression level[edinburgh postnatal depression scale(EPDS)],and partner support score[dyadic coping inventory(DCI)]of the selected subjects.Pearson’s correlation analysis was used to analyze the correlation between PPD and DCI in lactating women.Factors affecting PPD levels during lactation were analyzed using multiple linear regression.RESULTS The total average score of EPDS in 200 lactating women was(9.52±1.53),and the total average score of DCI was(115.78±14.90).Dividing the EPDS,the dimension scores were:emotional loss(1.91±0.52),anxiety(3.84±1.05),and depression(3.76±0.96).Each dimension of the DCI was subdivided into:Pressure communication(26.79±6.71),mutual support(39.76±9.63),negative support(24.97±6.68),agent support(6.87±1.92),and joint support(17.39±4.19).Pearson’s correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support,stress communication,mutual support,and cosupport(P<0.05).The total mean score of the EPDS and its dimensions were positively correlated with negative support(P<0.05).Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony,newborn health,stress communication,mutual support,negative support,cosupport,and the total score of partner support(P<0.05).CONCLUSION PPD during breastfeeding was associated with marital harmony,newborn health,stress communication,mutual support,negative support,joint support,and the total DCI score.

Paying Attention to Special Populations:1 Case of COVID-19 Asymptomatic Infection with Positive Nucleic Acid and Negative Antibodies in Puerpera

As a newly emerged disease,COVID-19's in-depth understanding is still being explored.And also as the epidemic changes,various new situations will be encountered.Atypical patients have brought difficulties to our prevention and control of this disease.Among them,asymptomatic patients are a special category,and puerperae are a special population.What happens when a puerpera is infected with asymptomatic COVID-19?This study describes 1 case of COVID-19 asymptomatic infection with positive nucleic acid and negative antibodies in puerpera.The aim is to remind clinicians to take special cases seriously,such as puerperae and pregnant women,AIDS,and other immunocompromised patients.It may not be enough to rely solely on antibody detection,but more than two repeated nucleic acid tests are necessary,so that no suspicious patient can be easily let off.

Sirolimus combined with oseltamivir and corticosteroid treatment for a puerpera with severe pneumonia caused by 2009 pandemic H1N1:A case report

Severe pneumonia in patients infected with the 2009 pandemic H1N1(pH1N1)virus was partially attributed to excessive immune response.Anti-virus treatment for these patients was insufficient.Here we reported the therapy effect of sirolimus,an immunosuppressor,combined with oseltamivir and corticosteroid for a puerpera with severe pneumonia caused by pH1N1 virus.This patient has infected with the pH1N1 virus in late pregnancy,and antiviral therapy was not implemented timely.She developed severe pneumonia and ARDS rapidly and need receive a cesarean section on the 39th week after pregnancy.After giving birth to a healthy baby,she received a combination of oseltamivir,sirolimus and corticosteroid,and improved in the following days.Moreover,the cytokines in serum and viral loads in BALF decreased significantly.She recovered without infectious symptoms and was discharged.Sirolimus combined with oseltamivir and corticosteroid is likely responsible for lowering the viral loads,reducing the patient's cytokine level,and further improving her clinical outcomes.It provides evidence that adjuvant treatment was beneficial to patients with severe pneumonia induced by the pH1N1 virus.