Maternal mental disorders in pregnancy and the puerperium and risks to infant health

Prenatal and postnatal period presents the highest prevalence of mental disorders in women's lives and depression is the most frequent one,affecting approximately one in every five mothers.The aggravating factor here is that during this period psychiatric symptoms affect not only women's health and well-being but may also interfere in the infant's intra and extra-uterine development.Although the causes of the relationship between maternal mental disorders and possible risks to a child's health and development remain unknown,it is suspected that these risks may be related to the use of psychotropic drugs during pregnancy,to substance abuse and the mother's lifestyle.Moreover,after delivery,maternal mental disorders may also impair the ties of affection(bonding) with the newborn and the ma-ternal capacity of caring in the post-partum period thus increasing the risk for infant infection and malnutrition,impaired child growth that is expressed in low weight and height for age,and even behavioral problems and vulnerability to presenting mental disorders in adulthood.Generally speaking,research on this theme can be divided into the type of mental disorder analyzed: studies that research minor mental disorders during pregnancy such as depression and anxiety find an association between these maternal disorders and obstetric complications such as prematurity and low birth weight,whereas studies that evaluate severe maternal mental disorders such as schizophrenia and bipolar disorder have found not only an association with general obstetric complications as well as with congenital malformations and perinatal mortality.Therefore,the success of infant growth care programs also depends on the mother's mental well being.Such findings have led to the need for new public policies in the field of maternal-infant care geared toward the population of mothers.However,more research is necessary so as to confirm the association between all factors with greater scientific rigor.

Fibrosis assessment using Fibro Meter combined to first generation tests in hepatitis C

AIM To evaluate the performance of FibroMeter^(Virus3G) combined to the first generation tests aspartate aminotransferase-to-platelet ratio index(APRI) or Forns index to assess significant fibrosis in chronic hepatitis C(CHC).METHODS First generation tests APRI or Forns were initially applied in a derivation population from Rio de Janeiro in Brazil considering cut-offs previously reported in the literature to evaluate significant fibrosis.FibroMeter^(Virus3G) was sequentially applied to unclassified cases from APRI or Forns.Accuracy of non-invasive combination of tests,APRI plus FibroMeter^(Virus3G) and Forns plus FibroMeter^(Virus3G) was evaluated in the Brazilian derivation population.APRI plus FibroMeter^(Virus3G) combination was validated in a population of CHC patients from Angers in France.All patients were submitted to liver biopsy staged according to METAVIR score by experienced hepatopathologists.Significant fibrosis was considered as METAVIR F≥2.The fibrosis stage classification was used as the reference for accuracy evaluation of non-invasive combination of tests.Blood samples for the calculation of serum tests were collected on the same day of biopsy procedure or within a maximum 3 mo interval and stored at-70 ℃.RESULTS Seven hundred and sixty CHC patients were included(222 in the derivation population and 538 in the validation group).In the derivation population,the FibroMeter^(Virus3G) AUROC was similar to APRI AUROC(0.855 vs 0.815,P=0.06) but higher than Forns AUROC(0.769,P<0.001).The best FibroMeter^(Virus3G) cut-off to discriminate significant fibrosis was 0.61(80% diagnostic accuracy;75% in the validation population,P=0.134).The sequential combination of APRI or Forns with FibroMeter^(Virus3G) in derivation population presented similar performance compared to FibroMeter^(Virus3G) used alone(79% vs 78% vs 80%,respectively,P=0.791).Unclassified cases of significant fibrosis after applying APRI and Forns corresponded to 49% and 54%,respectively,of the total sample.However,the combination of APRI or Forns with FibroMeter^(Virus3G) allowed 73% and 77%,respectively,of these unclassified cases to be correctly evaluated.Moreover,this combination resulted in a reduction of FibroMeter^(Virus3G) requirement in approximately 50% of the entire sample.The stepwise combination of APRI and FibroMeter^(Virus3G) applied to the validation population correctly identified 74% of patients with severe fibrosis(F≥3).CONCLUSION The stepwise combination of APRI or Forns with FibroMeter^(Virus3G) may represent an accurate lower cost alternative when evaluating significant fibrosis,with no need for liver biopsy.

Increasing pancreatic cancer is not paralleled by pancreaticoduodenectomy volumes in Brazil:A time trend analysis

Background: Currently, surgical resection represents the only curative treatment for pancreatic cancer(PC), however, the majority of tumors are no longer resectable by the time of diagnosis. The aim of this study was to describe time trends and distribution of pancreaticoduodenectomies(PDs) performed for treating PC in Brazil in recent years. Methods: Data were retrospectively obtained from Brazilian Health Public System(namely DATASUS) regarding hospitalizations for PC and PD in Brazil from January 2008 to December 2015. PC and PD rates and their mortalities were estimated from DATASUS hospitalizations and analyzed for age, gender and demographic characteristics. Results: A total of 2364 PDs were retrieved. Albeit PC incidence more than doubled, the number of PDs increased only 37%. Most PDs were performed in men(52.2%) and patients between 50 and 69 years old(59.5%). Patients not surgically treated and those 70 years or older had the highest in-hospital mortality rates. The most developed regions(Southeast and South) as well as large metropolitan integrated municipalities registered 76.2% and 54.8% of the procedures, respectively. LMIM PD mortality fluctuated, ranging from 13.6% in 2008 to 11.8% in 2015. Conclusions: This study suggests a trend towards regionalization and volume-outcome relationships for PD due to PC, as large metropolitan integrated municipalities registered most of the PDs and more stable mortality rates. The substantial differences between PD and PC increasing rates reveals a limiting step on the health system resoluteness. Reduction in the number of hospital beds and late access to hospitalization, despite improvement in diagnostic methods, could at least in part explain these findings.