Teratogenic Risk Research Articles

Awareness of Most Commonly Used Drugs in Dentistry Inducing Teratogenic Effects among Dental Practitioners

Aim: The aim of the study was to assess the awareness of most commonly used drugs in dentistry inducing teratogenic effects, among dental practitioners. Birth defects may be caused by many factors such as physical conditions, teratogens, environmental exposures, genetic defects, etc., Although prescription drug use is common during pregnancy, the human teratogenic risks are undetermined for more than 90% drug treatments approved in the USA during the past decades. A particular birth defect may have its origins through multiple mechanisms and possible exposures including medications. A specific chemical process may result in different outcomes depending upon factors such as embryonic age at which a drug is administered, duration and dose of exposure and genetic susceptibility. Estimating the risk of fetal malformations attribute to the use of medications is difficult and perception of risk by health professionals will impact their counseling and treatment of patients. Pregnancy is a unique physiologic condition and importantly specific drugs like folic acid use may have several benefits for pregnant mother. The patient should maintain a good gynecologist patient-Dentist communication. For example a woman with two spontaneous abortions would be expected to be skeptical of any drug therapy in her next pregnancy and by communicating this to physicians and respective clinician. She may influence the physician and dentist perception. The clinician should be aware of all the newer drugs and its teratogenic effects. For health professionals this includes awareness of specific drug information and sources that provide realistic descriptions of risk beyond product monographs. A greater focus on this aspect may act to balance Risk perceptions. Physicians and dentists need to weigh risks and benefits of drug prescribing to pregnant patients based on the available knowledge.

Affective disorders: A question of continuing treatment during pregnancy (Review).

Fetal development, especially in the first trimester, has proven to be heavily influenced by external factors, such as chemical intake of medication. Chronic psychiatric treatment might interfere with the anatomical and physiological wellbeing of the fetus, because psychotropic medication proceeds past the placenta, into the amniotic fluid, and can enter breast milk. Hence some of the medications prescribed for mood disorders should be reconsidered during pregnancy, without sub-optimally treating when it is needed. A literature review is presented which systematically collects modern data and synthesizes previous interdisciplinary research findings on the safety of psychiatric treatment for affective disorders during pregnancy (term-based) and lactation. Antidepressants and mood stabilizers, fundamental strategies in treating affective disorders, have been classified by the FDA as C respectively D drugs pertaining to their risk, with some exception. Most guidelines recommend pharmacologically treating moderate-severe depression, preferably with SSRIs. Evidence advocates that drugs should be used during pregnancy only if clearly needed and the benefit outweighs the risk to the fetus. However, guidelines the American College of Obstetricians and Gynecologists state that antidepressants are a preferred first course of treatment and does not take into account the severity of the depression. Among mood-stabilizers, lithium is considered to be the safest option for pregnant women. Anticonvulsants have a higher risk of teratogenicity compared with lithium, with lamotrigine being the safest one. All mood stabilizers should be recommended in the lowest effective doses. There is controversy regarding the safety of second-generation antipsychotics during pregnancy and further research is required. Several case reports and meta-reviews have been published in order to emphasize the safety of electroconvulsive therapy (ECT) during pregnancy, but practitioners still stigmatize this procedure. Evaluating the overall risk-benefit ratio should be assessed by the medical care provider, taking into consideration current findings.

Diluted concentrations of methamphetamine in surface water induce behavior disorder, transgenerational toxicity, and ecosystem-level consequences of fish

Methamphetamine (METH) has been recognized as an emerging organic contaminant as it was widely detected in the aquatic environment via wastewater effluent discharge. However, the ecological hazard posed by METH at environmentally relevant concentrations was remained unclear. In this study, adult medaka fish were exposed to METH at environmental levels (0.05, 0.2, 0.5, 5 μg L−1) and high level (25 and 100 μg L−1) for 90 days to investigate its effect on ecologically behavioral functions, histopathology, bioconcentration, and transgenerational toxicity. The significant increase of locomotion activity, total distance, and max velocity of adult medaka were observed at low METH levels (0.2–0.5 μg L−1), while it markedly decreased at high levels (25–100 μg L−1). This effect may increase the predation risk of the fish. The significant alteration on the relative expressions of the genes (cacna1c, oxtr, erk1, and c-fos), as well as the contents of the proteins (oxytocin (OXT) and protein kinase A (PKA)) involved in Voltage Dependent Calcium Channel (VDCC) and Mitogen-Activated Protein Kinase (MAPK) signaling channel induced by METH could partly elucidate the underlying mechanisms of the changes of the behavioral traits. METH could induce obvious minimal gliosis, neuronal loss, and necrotic in brain tissues. Additionally, the significant increase of hepatic-somatic index (HSI) of male medaka at 0.2–5 μg L−1 groups, and the decrease of female medaka at 100 μg L−1 group indicated male fish was more susceptible to METH. Nephric-somatic index (NSI) of medaka markedly declined induced by METH at 0.05–100 μg L−1. The bioconcentration factor (BCF) (0.4–5.8) in medaka fish revealed the bioconcentration potential of METH in fish. This study for the first time demonstrated METH could induced the development defects of larvae in F1 generation at environmentally relevant concentrations, thereby resulting in a significant decrease in the capacity of fish to produce offspring. Meanwhile, the RQ values (>1) of METH in river in China, USA, and Australia showed a high teratogenic risk level, suggesting the ecosystem-levels consequence posed by METH should be concerned.

Sodium valproate prescription to women of childbearing age in a New Zealand inpatient psychiatric unit.

Sodium valproate's teratogenicity has prompted increasing restriction in its use. It is still widely prescribed to women of childbearing age in New Zealand. To examine this problem, we audited the prescribing pattern of sodium valproate in a psychiatric inpatient unit in New Zealand. We reviewed the clinical records of women admitted over a 2-year period (2016-2018). Results were analysed and compared with local and international guidelines. Five hundred and thirty-four women of child-bearing age were admitted over the sampling period, 96 of whom (18%) were prescribed valproate on discharge. Half of these patients had diagnoses other than bipolar affective disorder, valproate's only approved psychiatric indication in New Zealand. Pregnancy testing and contraception status were documented in a minority (29 and 10 cases, respectively). Teratogenic risk discussion was documented in only 11 cases. Prescription of valproate to women of childbearing age in our sample currently falls well short of best practice. Urgent action at both clinician and organisational levels is required to address this risk.

Vismodegib (ERIVEDGE) pregnancy prevention programme: assessment of risk awareness

Introduction Vismodegib (Erivedge; Roche), a Hedgehog pathway inhibitor (HPI), is indicated for the treatment of symptomatic metastatic basal cell carcinoma (BCC) and locally advanced BCC inappropriate for surgery or radiotherapy. Due to the known risk of HPI teratogenicity, the Erivedge Pregnancy Prevention Program (PPP) was introduced at approval (2013) as part of the EU Risk Management Plan. Methods Structured, quantitative Web-based surveys were conducted in 2015 (Wave 1), 2016 (Wave 2), and 2017/2018 (Wave 3) among prescribing oncologists and dermato-oncologists in Austria, France, Germany, Hungary, and the United Kingdom to assess the effectiveness of the Erivedge PPP. Results Overall, 95%, 87%, and 91% of respondents in Waves 3 (N = 181), 2 (N = 214), and 1 (N = 207), respectively, were vismodegib prescribers. The surveys consistently showed a high awareness about the risk of teratogenicity associated with vismodegib (98%, Wave 3; 95%, Wave 2) and that a high proportion of prescribing physicians took appropriate precautions to minimize this risk (95%, Wave 3; 92%, Wave 2; 88%, Wave 1). Physicians were also highly aware of the Erivedge PPP (70%, Wave 3; 67%, Wave 2; 71%, Wave 1). Conclusion Survey data suggest that the risk of teratogenicity with vismodegib has been effectively communicated to the prescribing community.

A Call for Gender Identity Data Collection in iPLEDGE and Increasing the Number of Isotretinoin Prescribers Among Transgender Health Providers.

Acne is a common adverse event among trans-masculine people using testosterone as masculinizing hormone therapy. Isotretinoin is the most effective medication for severe recalcitrant acne and, as such, trans-masculine people with severe acne would likely benefit from treatment with this therapy. Incorporation of gender identity-based questions in iPLEDGE registration documentation will increase information about gender-diverse patients taking isotretinoin in the United States and allow better understanding of teratogenicity risks among these patients. An increase in the number of transgender health providers registered as isotretinoin prescribers in iPLEDGE would increase access to this effective medicine and may improve outcomes in these patients.

Pharmacists and Contraception in the Inpatient Setting.

The choice of contraceptive method should be based on patient specific factors, patient preference, and method-specific properties. In this article, we review opportunities for an inpatient clinical pharmacist to assist in the selection and counseling of contraceptives in hospitalized patients. An inpatient pharmacist has the opportunity to discuss various contraceptive methods with the patient, ensuring an appropriate method is used after discharge, which is especially important after the occurrence of a contraception-related adverse effect or contraindication to certain contraceptive methods. Barriers, such as formulary restrictions, can limit inpatient initiation of contraceptive therapy while hospitalized, but pharmacists can provide education on appropriate alternatives. Inpatient clinical pharmacists can also make recommendations for contraceptive methods in special populations. It is crucial to select an appropriate therapy in patients with an underlying medical condition, such as those with active or history of breast cancer, psychiatric disorder, or thrombophilia, as inappropriate therapy can cause an increased risk of harm. Pharmacists can assist in contraceptive counseling, evaluating for drug-drug and drug-disease interactions, and recommending the most appropriate therapy in special populations. An inpatient pharmacist has the opportunity to interact with the medical team and assist in navigation of teratogenic medication use and Risk Evaluation and Mitigation Strategies.

Medication prescribing pattern and potential teratogenicity risk among pregnant women at Hidar 11 General Hospital, south Wollo, northeast Ethiopia

Drugs given to pregnant mothers for therapeutic purposes may cause serious structural and functional adverse effects in the developing child. However, the fact that drugs are needed to mitigate complications during pregnancy cannot be totally avoided. Hence, the current study is aimed to evaluate the pattern of medication prescribing practice during pregnancy at Hidar 11 General Hospital, Ethiopia. Institution based cross sectional study was conducted on 310 pregnant women whose medical charts were selected using systematic random sampling from antenatal care (ANC) attendants at Hidar 11 General Hospital. Data was collected through medical chart review by using data abstraction tool and analyzed by statistical package for social sciences (SPSS) Version 24 software. Among the study participants, 263 (84.8%) had a prescription at least for one drug during their pregnancy. Majority of the drugs prescribed for the pregnant women were vitamins and minerals (60.6%), antibacterial agents (30.6%) and central nervous system drugs (28.4%). A high proportion of drugs were prescribed from US Food and Drug Administration (US FDA) category C (57.7%) followed by category B (50.6%) and category A (22.9%). Only 6.8% of the prescribed drugs were with positive evidence of risk (US FDA category D) during all trimesters and no drugs were prescribed from proven fetal risk category (US FDA X category). Even though, drugs from category X were not prescribed, a significant number of pregnant women consumed drugs with potential fetal risk that should be addressed by informing the prescribers to stick to the treatment guidelines and seek safer options.

Pregnancy prevention programs for medications used in dermatology

Certain drugs used in dermatology carry a high risk of teratogenicity after maternal as well as paternal exposure. The birth of an offspring with impairments or disabilities is an emotionally distressing situation for parents, often resulting in lifelong liability for the family as well as the society. An obligation to prevent such pregnancies exposed to teratogenic agents has resulted in the development of pregnancy prevention programs. United States Food and Drug Administration in cooperation with drug manufacturers has developed a Risk Evaluation and Mitigation Strategies for a biologic or a drug to ensure that its benefit outweighs the risk. These complex but comprehensive programs were established to ensure that fetal exposure to teratogenic agents does not occur by controlling their prescription and usage. This article will review the organization, application and ethical issues raised by the mandatory standardized drug distribution programs for drugs used in dermatology, namely, thalidomide, isotretinoin, and acitretin.

Crystal structure of the SALL4-pomalidomide-cereblon-DDB1 complex.

Thalidomide-dependent degradation of the embryonic transcription factor SALL4 by the CRL4CRBN E3 ubiquitin ligase is a plausible major driver of thalidomide teratogenicity. The structure of the second zinc finger of SALL4 in complex with pomalidomide, cereblon and DDB1 reveals the molecular details of recruitment. Sequence differences and a shifted binding position relative to Ikaros offer a path to the rational design of cereblon-binding drugs with reduced teratogenic risk.

What has been the impact of new drug treatments on epilepsy?

Nearly two dozen antiseizure medications (ASMs) with different mechanisms of action have been introduced over the past three decades with the aim of providing better efficacy or safety profile than the previous drugs. Several new ASMs with improvement on a classic drug family or have novel mechanisms of action have been recently approved for epilepsy. The present review explored recent studies or guidelines on new agents and discussed the potential impact of these novel treatments on epilepsy management and future directions of research. Long-term cohort studies showed that, collectively, the second-generation did not improve the overall prognosis of epilepsy. Individual monotherapy studies showed similar efficacy of second-generation (levetiracetam and zonisamide) and third-generation (eslicarbazepine acetate and lacosamide) ASMs compared to controlled-release carbamazepine for the treatment of focal epilepsy. However, there appears to be no evidence to support any second-generation or third-generation ASMs to be as efficacious as valproate monotherapy for generalized and unclassified epilepsies. Cannabidiol adjunctive treatments were found to be efficacious for Dravet syndrome and Lennox-Gastaut syndrome. Although most newer generation ASMs are less prone to drug-drug interactions, stiripentol and cannabidiol can elevate the plasma concentration of N-desmethylclobazam, the active metabolite of clobazam. Generally speaking, the second-generation ASMs have lower teratogenic risk than the older drugs but there is scant study on neurodevelopmental effect of third-generation ASMs. Although the newer generation ASMs may not have improved the overall seizure control they have advantages in terms of drug-drug interactions and teratogenicity, and thus offer valuable individualized options in the treatment of epilepsy.

Renal artery stenosis presenting as preeclampsia

BackgroundRenal artery stenosis is a notorious cause of secondary hypertension which classically presents as chronic refractory hypertension, recurrent flash pulmonary edema or renal insufficiency after initiation of an angiotensin converting enzyme inhibitor. Rarely, there have been reported cases of pregnant patients presenting with new onset or superimposed preeclampsia secondary to renovascular hypertension. In this subset of patients, renovascular hypertension carries significantly higher risks including obstetric, fetal and medical emergencies and death. Prompt treatment is required. However, the teratogenic risks of radiological investigations and antihypertensive medications limit diagnostic and management options thus posing quite a dilemma.Case presentationA 38-year-old female, at 33 weeks of gestation, was hospitalized for preeclampsia with severe features. A viable neonate had been expeditiously delivered yet the patient’s post-partum blood pressures remained severely elevated despite multi-class anti-hypertensive therapy. Renal artery dopplers revealed greater than 60% stenosis of the proximal left renal artery and at least 60% stenosis of the right renal artery. Renal angiography showed 50% stenosis of the left proximal renal artery for which balloon angioplasty and stenting was performed. The right renal artery demonstrated less than 50% stenosis with an insignificant hemodynamic gradient, thus was not stented. Following revascularization, the patient’s blood pressure improved within 48 h, on dual oral antihypertensive therapy.ConclusionsPreeclampsia that is refractory to multi-drug antihypertensive therapy should raise suspicion for renal artery stenosis. Suspected patients can be screened safely with Doppler ultrasonography which can be then followed by angiography. Even if renal artery stenosis does not seem severe, early renal revascularization may be considered in patients with severe preeclampsia who do not respond to antihypertensive management.

Hyperthyroidism and Its Implications for Diagnosis and Management of Complications During Pregnancy

Thyroid dysfunction alters the physiological events of pregnancy that may have serious outcomes if left untreated. Hyperthyroidism (a thyroid disease) is related to complications during pregnancy. A challenging task for the physician is to correctly diagnose and properly manage hyperthyroidism in pregnant women. Hyperthyroidism is an autoimmune disease caused by excessive production of thyroxin hormone. The objective of this paper is to review the research in detection and management of Graves’ disease (thyrotoxicosis) during and after pregnancy. This paper discusses thyroid receptor antibodies, etiology of Grave’s disease (thyrotoxicosis), pregnancy related complications, infants’ thyrotoxicosis management, as well as post-partum management, guidelines and counseling offered to pregnant women. Literature search was conducted using the keyword ‘hyperthyroidism’ in conjunction with pregnancy, anti-thyroid drugs and birth defects in Pubmed, Google Scholar and Medline. Maintaining thyroid gland may reduce the complications of pregnancy. At the beginning of pregnancy, low doses of anti-thyroid drugs are usually recommended to women by endocrinologists. However, the use of these drugs is completely stopped after 4 – 8 weeks of gestation. Propylthiouracil is the preferred anti-thyroid drug used in the first trimester in case of preconception to decrease the risk of teratogenicity. Carbimazole may be used in the first three months. Early diagnosis and maintaining normal hormone concentration by reducing the level of thyroid receptor antibodies as well as anti-thyroid drugs is essential in order to prevent maternal and fetal complications. Counseling and guidelines provided by endocrinologists constitute the key to a healthy and successful pregnancy.

Pregnancy outcomes in heart transplant recipients

The population of female heart transplant recipients of reproductive age is growing, and counseling regarding reproductive decisions is important. We describe maternal and fetal outcomes of pregnancy in the Transplant Pregnancy Registry International. Data regarding pregnancies between 1987 and 2016 were collected via questionnaires, phone interviews, and medical records review. Demographics, comorbidities, changes in immunosuppressive regimens, rejection episodes during pregnancy, data on maternal retransplants, and deaths were recorded. A total of 91 patients reported 157 pregnancies. Mean maternal age at conception was 27 ± 5.6 years. The most common indications for transplant were congenital heart disease (22%) and viral myocarditis (18%). Average transplant to conception interval was 7 ± 6.1 years. Immunosuppression was calcineurin inhibitor-based in almost all patients, with 20% of recipients taking mycophenolic acid (MPA) while pregnant. Complications during pregnancy included pre-eclampsia (23%) and infections (14%). Rejection was reported during 9% of pregnancies and within 3 months postpartum in 7%. Livebirths occurred in 69%, with no neonatal deaths. Miscarriages occurred in 26% of pregnancies, 49% of which had MPA exposure. Mean follow-up post pregnancy was 8.9 ± 6.5 years. At last follow-up, 30 recipients had died, an average of 9.4 ± 6.2 years after pregnancy. The most common causes included allograft vasculopathy and rejection. This is the largest reported series of pregnancies in heart transplant recipients and demonstrates that two thirds of pregnancies reported are successful. MPA exposure is associated with increased risk of teratogenicity and miscarriage. Pre-pregnancy counseling should include discussions of risk of MPA exposure, rejection, graft dysfunction, and maternal survival.

P364 New insights into the molecular mechanisms of thalidomide in paediatric inflammatory bowel disease patients

Abstract Background Thalidomide is an effective drug in children with inflammatory bowel disease (IBD) refractory to standard treatments, however, its use is often limited by its safety profile, in particular for the risk of teratogenicity and peripheral neuropathy. Multiple hypotheses exist to explain the molecular mechanism of thalidomide action but no data have been published on IBD patients. To identify determinants of thalidomide action in paediatric IBD, high-throughput microRNA (miRNA) and messenger RNAs (mRNA) profiles during treatment were analysed. Methods IBD patients responsive to thalidomide were enrolled. miRNA and mRNA profiles from peripheral blood obtained before and after 12 weeks of treatment were determined using next-generation sequencing. Differentially expressed genes were identified by fold change from the general linear model. In order to detect the potentially altered pathways, the hypergeometric test based on gene ontology annotations was used. The identification of putative mRNA targets of thalidomide sensitive miRNAs was performed by Targetscan database. Results Ten IBD paediatric patients (mean age 13.1 years, 6 males) were enrolled. Sequencing analysis identified 10 miRNAs (3 downregulated) and 252 mRNAs (76 downregulated) deregulated after treatment. Five upregulated miRNAs could putatively recognise the 3′UTR of several Hox genes, a group of transcription factors that play important roles in the development of structures such as limbs, lungs and nervous system. The hypergeometric test highlighted the altered pathways involved in inflammatory response, regulation of immune system, prostaglandin receptor activity and G protein-coupled receptor signalling. Among the 10 miRNAs deregulated by thalidomide, six could putatively regulate the differentially expressed mRNAs resulting from the analyses. Conclusion Thalidomide induces specific gene expression alterations, which could help to elucidate its molecular mechanism in paediatric IBD patients. miRNA results may suggest new molecular targets involved in the teratogenic effects of this drug. Moreover, mRNA profiles indicate a strong involvement of adenylate cyclase-modulating G protein-coupled receptor signalling in the thalidomide mechanism of action.

Knowledge regarding teratogens among women of childbearing age at a large tertiary care center in Saudi Arabia.

Aim:To investigate the knowledge of Saudi women regarding the teratogenic effects of environmental agents such as fever, some chronic conditions and medications and its association with certain socio-demographic factors.Materials and Methods:A survey based cross-sectional study was conducted on 315 Saudi women of childbearing age visiting OB/GYN clinics at a large tertiary care centre in Riyadh, Saudi Arabia. Knowledge of subjects on teratogenic risk of common entities was measured and nonparametric Mann–Whitney and Kruskal–Wallis tests were used to associate knowledge score with various predictors.Results:The response rate was 75%. Most of the participants were between 28 and 37 years. Knowledge on teratogenic risk was generally poor with specifically higher knowledge regarding insulin intake and isotretinoin. Older age, higher education, being employed, and having a high monthly income were significantly associated with a higher knowledge score (P < 0.05).Conclusion:Women's knowledge regarding teratogenic risks is crucial in ensuring a safe pregnancy and a healthy fetus. Our study revealed inadequate knowledge of teratogens among the participants which implies an urgent need to increase awareness of mothers regarding the harmful effects of common teratogens.

Teratogenic effects (resorptions and reduction in weight and crown rump length) of valproate on fetal mice

Background and Aims: Teratology is the study of abnormal development in fetus. Teratology first came into existence in 1930 when a number of experiments were conducted. There are various causes of congenital anomalies such as genetic factors, environmental factors such as radiation, changes in temperature, hypoxia, chemical substances, drugs, and maternal infections. At present, valproic acid is the most widely used antiepileptic drug. Valproic acid is salt of dipropyl acetic acid. Most of the studies on the valproate were done at higher doses starting from 400 mg/kg. Hence, the present study was done to assess teratogenic effects at lower dose of valproate i.e., 200 mg/kg. Only few studies are conducted on fetal mice at Valproate dose of 200 mg/kg. The aim of the present study is to report the teratogenic effects of valproate at dose of 200 mg/kg on single gestational day (8th) and multiple gestational days (7th, 8th, and 9th) in fetal mice. Materials and Methods: Forty pregnant mice were taken in the present study, and these are distributed in three groups. Group A which was control group received normal saline. In Group B, Valproate was administered on single gestational day (8th). In Group C, Valproate was administered on multiple gestational days (7th, 8th, and 9th). Dose of valproate given in each group was 200 mg/kg intraperitoneally. On the 18th gestational day, fetuses were collected after uterotomy. The fetuses of all three groups were weighed by digital laboratory weighing scale. Crown rump length (CRL) of fetuses of all groups was documented by means of graph paper. Mean, standard deviation, and P value were calculated. Statistical analysis was done by the ANOVA one-way test. Results: Valproate administered groups showed resorptions. CRL and fetal weight reduction were found in treated groups. These findings were more found in Group C in comparison to Group B. Conclusion: Valproate is teratogenic drug at 200 mg/kg dose, so valproate should be prescribed at lowest efficacious dosage to minimize the teratogenic risk.

Evaluation of the pregnant women's approaches regarding drug utilization.

OBJECTIVE:Drug utilization habits of the pregnant are a critical aspect of rational use of the medicine (RUM). This study aimed to analyze the RUM related attitudes and the behaviors of women during their pregnancies.METHODS:The data were collected between May 2016–October 2016 by conducting surveys to 71 pregnant women admitted to the private and governmental hospitals in five districts of Northern Cyprus. The sociodemographic characteristics of the pregnant as well as their attitudes and behaviors concerning drug use were evaluated.RESULTS:The mean age and the gestational week of the patients was 29.7±4.3 years and 25.7±11.2 weeks, respectively. Planned pregnancies constituted 71.8% of all. The percentage of patients with an unplanned pregnancies who were using drugs at the time of the survey (25.0%) was lower than that in those with planned pregnancies (49.0%, p<0.05). Almost two-thirds (66.2%) of the women were exposed to a drug during pregnancy, mostly for “vitamin/mineral prophylaxis” (38.3%) and agents controlling nausea/vomiting (19.1%). Two out of eleven women (18.2%) were using folic acid when they learned about their pregnancy. One of the drugs used for the chronic disorder in the third trimester was acetylsalicylic acid (11.1%), a category D drug in this setting. Most of the patients stated that they frequently read the instructions (60.9%), “often” paying attention to side effects (56.5%). Considering some of the habits related to drug use, 8.7% and 10.9% of pregnant women declared that they sometimes “did not follow the instructions” and “dosage/duration of the drug usage”, respectively. Seven patients (15.2%) declared that they did not consider side effects on the medication guide while more than half (56.5%) did it “often”. Near one in five (19.6%) of the pregnant women stated that they hesitated about the drug usage due to teratogenicity risks.CONCLUSION:Our study highlights the drug utilization attitudes and behaviors of pregnant women during pregnancy in Northern Cyprus, indicating several shortcomings, including insufficient prenatal folic acid use, occasional use of risky drugs, and unsatisfactory medication guide handling. Available findings underline the necessity of education not only for patients but also for healthcare providers to disseminate RUM in pregnancy.

Electroconvulsive therapy: old acquaintance for the youngster or new opportunity for the elder? Review of the literature and applications in the geriatric population

Electroconvulsive therapy (ECT) is among the most controversial and mythicized therapies in the psychiatric and medical clinical context. Historically, this practice was used in some contexts as a torture or a coercive method and the lay public as well as the collective imaginary has always considered and represented this treatment as inhuman. Prejudices and limited knowledge of this therapeutic tool have contributed to consider this procedure as a violent act and an assault to human dignity, progressively reducing its employment in time. Despite these prejudices, in the international literature several studies have demonstrated a considerable evidence in support of the use of ECT for some psychiatric diseases, considering it among the safest and most effective treatments. Especially in case of life-risk diseases, such as major depression, ECT proved to be necessary in dealing with pharmaco-resistance and bringing to remission psychotic depression with high risk of suicide. Furthermore, to date ECT results to be the treatment of choice in depressed patients that cannot be treated with pharmacotherapy, e.g. in pregnant women, in which the use of antidepressant drugs exposes the fetus to a teratogenic risk, or in elder patients, in which multiple-drug treatments and interactions have to be carefully considered. The purpose of this paper is to provide a review of the literature regarding ECT and concise guidelines for this treatment and its clinical outcomes, with special reference to geriatric population.

Correlating ecotoxicological early-warning systems to biotic indices to assess riverine teratogenic contamination

We constructed a new ecotoxicological tool to test for the presence of teratogens in rivers by exploiting the regenerative capabilities of Hydra vulgaris because using living organisms is considered good practice in environmental monitoring for detecting detrimental pressures. Outputs on the Hydra assay were integrated with two biotic indices based on benthic invertebrates and macrophytes to evaluate whether the assay acts as a tool for detecting generalised freshwater conditions or as a biological test model revealing only the effects of dissolved teratogens. Several hypostomae of H. vulgaris were reared in waters collected in diverse southern central Latium rivers, where physiochemical descriptors were surveyed for environmental characterisation. The regeneration rate and amount of aberrations were evaluated to obtain a teratogenic risk index (TRI) score and then compared with the control. TRI calculations showed 4 sites (18.18%) in Class I (no risk), 15 sites (68.18%) in Class II (low risk), 2 sites (9.09%) in Class III (moderate risk) and 1 site (4.55%) in Class IV (high risk). No Class V sites (very high risk) were found. No significant correlations emerged among physicochemical parameters (except for PO43–), environmental descriptors, Simpson diversity indices and biotic indices and the TRI. These results promote an integrated approach to improving links between biological and ecological responses to anthropogenic impacts.