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Biomedical subjects

Gideon Koren

Publications and source records attributed to Gideon Koren.

At least 163 records · Page 9Linked to original sources
PubMed2004

Risks of untreated depression during pregnancy.

QUESTION: One of my patients who was taking an antidepressant for major depression is now pregnant and does not wish to take it any more. I believe she needs to continue her medication. She, however, is adamant about stopping it because she believes it would put her baby at risk. Is there evidence that not treating depression during pregnancy puts babies at risk? ANSWER: A growing body of literature investigating the effects of not treating depression on mother and developing fetus suggests that untreated depression is associated with adverse fetal outcomes and a higher risk of maternal morbidity, including suicide ideation and attempts, and postpartum depression.

Adult↗
PubMed2004

New antidepressants in pregnancy.

QUESTION: I have read that fluoxetine is the drug of choice for treating depression during pregnancy. One of my patients, who did not respond to the "old" selective serotonin reuptake inhibitors, is doing well on venlafaxine and is now 6 weeks pregnant. What advice should I give her? ANSWER: Fluoxetine is recommended because to date it has the most evidence of its safety. It is important that women be treated appropriately for depression during pregnancy, and some research on the newer antidepressants, such as venlafaxine, will be useful to you and your patient in making an informed decision regarding treatment.

Abnormalities, Drug-Induced↗
PubMed2004

Hypothyroidism during pregnancy.

QUESTION: I have a 27-year-old patient diagnosed with hypothyroidism in the 8th week of pregnancy. She received conflicting opinions regarding risk for her baby and wants to get more information. I also found conflicting information in the literature. How should I advise her? ANSWER: Pregnant patients with untreated hypothyroidism are at increased risk of obstetric complications. Adequate treatment with thyroid hormones greatly reduces the frequency of these complications. Observational studies suggest that children whose mothers had hypothyroxinemia in early pregnancy have lower IQs than matched controls. Another study has shown that even if levothyroxine therapy is started after the first trimester, there is an excellent chance children will have normal neuropsychologic development.

Adult↗
PubMed2004

Multivitamin supplements for pregnant women. New insights.

QUESTION: One of my patients is planning pregnancy and has started taking multivitamin supplements. She is experiencing gastric discomfort. What are the alternatives? ANSWER: Gastric discomfort is usually related to iron intake; pregnant women could use supplements with less iron. Pregnant women need 0.4 to 1.0 mg of folic acid daily. If they have a family history of neural tube defects (NTDs), insulin-dependent diabetes mellitus, or epilepsy, or are currently taking valproic acid, carbamazepine, or antifolates (eg, sulfonamides), they are at intermediate-to-high risk of having babies with NTDs and need 4.0 to 5.0 mg of folic acid daily.

Abdominal Pain↗
PubMed2004

Antiretroviral treatment of maternal HIV infection.

QUESTION: One of my pregnant patients tested positive for human immunodeficiency virus. Will HIV therapy put her pregnancy outcome at risk? ANSWER: The biggest risk is vertical transmission of HIV to her baby. She should be treated with combination therapy; triple therapy is required to reduce vertical transmission. Zidovudine is not teratogenic in humans, but information on other antiretroviral drugs is incomplete.

Anti-HIV Agents↗
PubMed2004

Breakthrough in treating gestational diabetes mellitus.

QUESTION: I practise in a remote community in Manitoba. Quite a few of my patients experience gestational diabetes. Their compliance with the insulin regimen is abysmal. Can I give them an oral medication? ANSWER: Recent studies have indicated that glyburide does not cross the human placenta and that its effectiveness and safety profiles are similar to those of insulin.

Adult↗
PubMed2004

Appendicitis during pregnancy.

QUESTION: A 26-year-old patient in our clinic, who was 18 weeks pregnant at the time, experienced acute abdominal pain and was diagnosed with appendicitis. The inflamed appendix was successfully removed. Is her pregnancy at risk? ANSWER: Appendicitis is not rare during pregnancy and is associated with increased reproductive risk. Women who have undergone appendectomy during pregnancy are at higher risk of fetal loss, especially in early pregnancy and with appendiceal perforation, and of premature contractions and labour. Despite the difficulty of diagnosing appendicitis during pregnancy, appendectomy should not be delayed.

Adult↗
PubMed2004

Using corticosteroids during pregnancy. Are topical, inhaled, or systemic agents associated with risk?

QUESTION: I am concerned about use of corticosteroids during pregnancy. Some of my women patients of reproductive age are using topical, inhaled, or oral preparations, and I am not sure what to advise. ANSWER: Both topical and systemic corticosteroids are used for a variety of autoimmune and inflammatory conditions. Results of first-trimester studies were inconclusive and underpowered. Recent meta-analyses suggest a small but significant association between use of systemic corticosteroids during the first trimester and oral clefts. This is consistent with results of animal studies. No similar evidence exists for topical or inhaled corticosteroids, probably because of much lower systemic exposure.

Administration, Inhalation↗
PubMed2004

Is a fetus a non-consenting patient?

QUESTION: In the 1960s, Dr Cameron, a Montreal, Que, psychiatrist, experimented with drug-induced sleep and electroconvulsive therapy for psychiatric patients, believing that this method "wipes them clean of harmful memories." In 1992 the government of Canada settled lawsuits by former patients of Dr Cameron, awarding them large payments. The government rejected a similar claim by Lloyd Schrier, whose mother had been treated by Dr Cameron while she was carrying Lloyd, arguing that Lloyd was not Cameron's patient. Or was he? ANSWER: The fetus was exposed to the medications taken by his mother, (eg, barbiturates) and thus qualifies as an unconsenting patient.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2004

Celiac disease during pregnancy.

QUESTION: One of my patients was diagnosed with celiac disease and maintains a strict gluten-free diet. Is her fetus at risk of neural tube defects because she does not get folic acid from bread and other flour-based foods? ANSWER: A woman with celiac disease must supplement her diet with multivitamins, including folic acid. Most prenatal vitamins contain 0.8 to 0.9 mg of folic acid, double the amount recommended by Health Canada for prevention of neural tube defects. Without supplementation (eg, undiagnosed pregnancy), women with celiac disease might not take in enough folate to maintain protective levels.

Celiac Disease↗
PubMed2004

Is it all right to drink a little during pregnancy?

QUESTION: When I told a female patient who just transferred from another city to abstain from alcohol during pregnancy, she was surprised. She mentioned that, in the past, several doctors had told her it was all right to drink moderately. I am confused. Have I missed something? ANSWER: No, you have not. Women should be advised to abstain from alcohol during pregnancy. There are insufficient data to suggest a safe threshold for fetal alcohol exposure.

Adult↗
PubMed2003

DEET-based insect repellents: safety implications for children and pregnant and lactating women.

Reducing the risk of mosquito bites is currently the only way to reduce the risk of West Nile virus infection. Methods for avoiding mosquito bites include limiting the time spent outdoors at dawn and dusk, wearing protective clothing and using an insect repellent. Repellents containing DEET (N,N-diethyl-m-toluamide, also known as N,N-diethyl-3-methylbenzamide) are the most effective and most widely used. However, concerns have been raised over the risk of adverse toxic effects, especially in young children and pregnant and lactating women. In this article, we review the available evidence on the effectiveness and safety of DEET-based products. The evidence does not support increased risk in young children.

Animals↗
PubMed2003

Tissue-specific expression of two human Ca(v)1.2 isoforms under the control of distinct 5' flanking regulatory elements.

Transcriptional regulation may be important for L-type Ca(2+) channel alpha(1C) subunit (Ca(v)1.2) gene expression. In this study, we found two human Ca(v)1.2 isoforms, one strongly and selectively expressed in heart and the other with apparently ubiquitous expression. The promoter for the cardiac isoform has an 'initiator' sequence, and is active in neonatal cardiomyocytes but not in cardiac fibroblasts, H9C2 cells, human aorta-vascular smooth muscle and HEK293 cells. The promoter for the ubiquitously expressed isoform is of the 'housekeeping' type and is active in all cell types examined. These data indicate specific expression patterns of two human Ca(v)1.2 isoforms under the control of distinct 5' flanking regulatory sequences.

Animals↗
PubMed2003

Cyclosporine excretion into breast milk.

Although many female patients of childbearing age who are receiving cyclosporine have successful pregnancies, these women may be advised not to breast-feed. During recent years, cases of uneventful pregnancies and subsequent successful breast-feeding have been reported in the literature. The infant's blood cyclosporine concentration was usually very low. Based on these findings and the lack of detectable adverse effects, some investigators have suggested that women on cyclosporine may breast-feed, challenging the conventional view that cyclosporine is contraindicated during breast-feeding. Here, we report our experience with cyclosporine use during breast-feeding in five mother-infant pairs. We show a wide range of infant exposures to the drug in milk, noting that one of the infants had therapeutic blood concentrations of cyclosporine despite relatively low concentrations of the drug in milk.

Cyclosporine↗
PubMed2003

Iron poisoning in young children: association with the birth of a sibling.

BACKGROUND: Iron is a leading cause of death due to poisoning in young children. Because perinatal iron therapy is common, the presence of these tablets, which have a candylike appearence, in the home may pose a hazard to a mother's other young children. We explored the association between iron poisoning in young children and the birth of a sibling. METHODS: We conducted a population-based case-control study linking health care databases in Ontario. Health care records for the mothers of children less than 3 years of age admitted to hospital with iron poisoning between Apr. 1, 1991, and Mar. 31, 2000, were compared with those for the mothers of age- and sex-matched control children without iron poisoning. RESULTS: We studied records for 40 children admitted to hospital for iron poisoning. Seventeen cases (42%) occurred within a year (before or after) a sibling's birth. Children whose mothers had given birth to a sibling were almost twice as likely as children whose mothers had not given birth to a sibling to be admitted for iron poisoning within 6 months of birth (adjusted odds ratio [OR] 1.9, 95% confidence interval [CI] 0.9 to 3.9). The postpartum year was associated with a consistently elevated risk, including an almost 4-fold increase in the risk of iron poisoning during the first postpartum month (adjusted OR 3.6, 95% CI 0.8 to 16.5). INTERPRETATION: Pregnancy is a major risk factor for iron poisoning in young children, and the period immediately after delivery is associated with the greatest risk. Almost half of all hospital admissions for iron poisoning in young children could be prevented by keeping iron supplements safely out of reach in the year before and after the birth of a sibling.

Accidents, Home↗
PubMed2003

Seroprevalence of Toxoplasma gondii infection among veterinary staff in Ontario, Canada (2002): implications for teratogenic risk.

BACKGROUND: Toxoplasma gondii infection is embryotoxic in humans. It is mainly transmitted through raw/undercooked meat and ingestion of oocysts in cat feces. There remains controversy about the actual risk of cats transmitting the disease to humans. Our primary objective was to determine the seroprevalence of T. gondii antibody among veterinary staff, to ascertain whether they have an increased risk through occupational exposure. Our secondary objective was to examine their practices regarding cats, toxoplasma infection, and pregnancy. METHODS: Veterinary staff attending the 2002 Annual Ontario Veterinary Medical Association Conference were invited to discuss their toxoplasma seroprevalence. Interested attendees completed a questionnaire and a physician drew blood samples to determine T. gondii titres using the ELISA IgG test. RESULTS: We collected 161 completed questionnaires, and 141 blood samples. There were 20 (14.2%, CI 95%:8.4-19.9%) reactive titres among the veterinarian staff (80% females aged 30-45). All were regularly exposed to cats, washed their hands when in contact and few wore gloves routinely. CONCLUSIONS: These findings of low positive rates may be used to reassure veterinary staff that their exposure to cats does not appear to increase their risk of contracting toxoplasma infection and that pregnant women are not at an increased risk by owning a cat.

Animals↗