Written by Thu Tran, MD,FACOG
January 17, 2016
CDC Warning of Zika Virus Infection to Pregnant Women Traveling to Latin America or Caribbean Countries
Last Friday, the Centers of Disease Control and Prevention (CDC) warned pregnant women to postpone trips to 13 Latin American or Caribbean countries such as the United States Virgin Islands, and Puerto Rico, where Zika virus, transmitted by mosquito bites,has caused brain damage to thousands of babies. The 14 areas mentioned were Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras Martinique, Mexico, Panama, Paraguay, Suriname, Venzuela, and Puerto Rico.
Zika virus is related to Yellow fever, Dengue and West Nile Virus. There’s currently no treatment for Zika infection. People infected with the virus tend to have mild symptoms such as rash, fever, red eyes. Pregnant women in the first trimester (at the end of 13 weeks of pregnancy) have a higher risk of having children with brain damage and microcephaly (small heads). More than 3,500 cases of brain damage, with 3,194 cases of microcephaly, have been reported in Brazil, where normally only 150 such cases are reported yearly. Dengue, chikungunya or other related flaviviruses have not been known to cause microcephaly.
Other links to Zika virus infection:
Common Analgesics and Heart Failure Risk
A meta-analysis by Mayo Clinic, using data from seven studies with 7,543,805 study subjects, showed a higher incidence of heart failure in users of non-steroidal anti-inflammatory drugs (NSAIDs). The study was published in Clinical Cardiology.
The results showed a signigicantly higher risk of heart failure in users of these commonly used medications. The researchers explained that this statistically significant risk of heart failure could be a result of elevated blood pressure and fluid retention in the users.
As many of us use NSAIDs such as Ibuprofen or Naproxen for a variety of reasons such as aches, pains, inflammation or fever, we should be aware of such risk, especially if we have underlying cardiac problems.
Oral Antifungal and Spontaneous Abortion Risk
Fluconazole (Diflucan) is a commonly used antifungal medication in non-pregnant women. It’s an effective medication even with a single dose treatment. However, a study published in the Journal of American Medical Association (JAMA) linked the use of Fluconazole to a much higher risk of spontaneous miscarriage. The study involved 1.4 million pregnancies in Denmark.
The researchers compared the effect of miscarriage in women of the same gestational age who took oral Fluconazole versus nonusers and users of topical antifungal cream. Those who took oral Fluconazole had a significantly higher risk of miscarriage compared to other groups.
As the authors noted that 10% of pregnant patients have vaginal candidiasis, topical antifungal cream is the treatment of choice for these women, until further studies are conducted and establish the safety of oral antifungal medication use during pregnancy.
Paroxetine (Paxil) and Link to Infant Heart Disease
Depression is a troublesome medical condition in pregnancy, as safe use of antidepressants is not well established. A recent meta-analysis study published in the British Journal of Clinical Pharmacology showed that paroxetine (Paxil) use in the first trimester (from the beginning of pregnancy to the end of the 13th week) is associated with a 23% increased risk of major congenital cardiac malformations.
The study authors from University of Montreal in Quebec used data from 23 studies from many countries including the US and Canada, U.K., Australia and many European countries, and concluded that clinicians should be careful using Paroxetine in pregnant patients, and women with major depression should plan their pregnancies carefully when using Paroxetine. They should be counseled thoroughly about the risks and benefits of using these medications during pregnancy. Dr. Anick Berard, one of the study authors, also advised patients to use alternative treatments such as counseling or exercise during this period to reduce the symptoms of depression. She noted that most patients with depression during pregnancy have mild to moderate symptoms of depression.
Severe Acne and Prolonged Ineffective Use of Antibiotics
I often see patients with severe acne who were treated with antibiotics for more than six months, although their symptoms of acne did not greatly improve. Overusage of antibiotics has been shown to cause serious side effects stemming from antibiotic resistance problems. The CDC reported approximately 23,000 deaths yearly result from inappropriate use of antibitotics.
A study by Seth Orlow, MD,PhD, and colleagues from NYU Langone Medical Center, published in the Journal of the American Academy of Dermatology, showed too many patients were prescribed antibiotics for lengthy periods before being offered isotretinoin (Accutane) treatment. Many of these patients took antibiotics for more than 11 months without improvement of their acne. The study authors believe the potential severe side effects and federal restrictions on isotretinoin use have caused many physicians to prolong antibiotic treatment for their patients.
The authors believe physicians should be counseling their patients carefully and promptly about the use of Isotretinoin in case antibiotics are ineffective for the patients. They believe clinicians should recognize within weeks, not months, that antibiotics are ineffective in certain patients and make the switch to Isotretinoin earlier, to avoid prolonged use of antibiotics.
The United States Preventive Services Task Force (USPSTF) Guidelines for Breast Cancer
The USPSTF confirmed its recommendation that mammograms are most beneficial in women between 50 and 74 year old. It stated that women of average risks should make an individual choice whether to screen between 40 to 49, or to screen every other year between 50 to 74 years of age.
The American College of Obstetricians and Gynecology (ACOG) stands by its recommendation of screening mammogram every year from 40 on. ACOG plans to meet with the USPSTF and other organizations later this month to discuss further about these recommendations.