No abstract

Due to the increasing rate of couples suffering from infertility, recently, the use of assisted reproductive technology (ART) has increased by 5%–10% per year. Some ART pregnancies are at risk of obstetric and neonatal complications, but it is unknown whether the procedures used or the etiology of infertility influences this risk. Multiple ART pregnancies are responsible for the increased rate of prematurity and its associated complications. Also, it has been demonstrated that ART pregnancies have a higher risk of congenital anomalies. The rate of ART-associated ocular abnormalities is incompletely known due to a small number of studies conducted regarding this pathology. In this paper, we presented a review of literature on ocular anomalies associated with ART in order to raise awareness of the need to implement ophthalmological screening in children from pregnancies obtained by ART. Abbreviations: ART = assisted reproductive techniques, IVF = in vitro fertilization, ICSI = intracytoplasmic sperm injection, LBW = low birth weight, ROP = retinopathy of prematurity

Objective: To evaluate the efficacy of naltrexone in patients with dual diagnosis-alcohol dependence and personality disorder. Methods: A group of 24 patients, mean age 38.7, admitted in our department for alcohol dependence, were also diagnosed with axis II pathology. The diagnosis of personality disorder was based upon Structured Clinical Interview for DSM IV Disorder (SCID-II) and clinical psychiatric evaluation. Patients received naltrexone 50 mg/day, after the initial detoxification period. Patients were monitored using Inventory of Drug Taking Situations-alcohol focused version (IDTS), Global Assessment of Functioning (GAF) and Clinical Global Impressions (CGI-S/I). These measurements were applied every week during the first month and every 4 weeks for another 5 months. Results: At week 24, patients had an overall improved IDTS score (-45.2 points to baseline, p< 0.05), with greater improvements observed in areas like "physical discomfort" (p=.0463) and testing personal control (p=.0374). Cluster B personality disorders were associated with a better response in IDTS score and with a lower rate of relapses (p< 0.01) and missed treatment doses (p< 0.01). GAF values increased in the treatment group with 24.5 points, compared to baseline, with a non-significant trend in favor of cluster B and C personality disorders. CGI-I decreased from a mean value of 4.5 to 1.5 at week 20 and remained at the same value until the endpoint, without significant differences between clusters. Conclusions: Naltrexone decreased significantly alcohol consumption in situations of "physical discomfort" and testing of personal control in patients with associated personality disorders.

Objective: To evaluate the comparative medium-term efficacy of dual antidepressants in patients with dysthymic disorder and major depressive disorder who also met criteria for alcohol dependence. Methods: A group of 16 patients, mean age 43.2, diagnosed with dysthymic disorder and major depressive disorder, according to DSM IV TR criteria, were screened positive for alcohol dependence during the initial interview. Antidepressants used were dual agents-venlafaxine mean daily dose 225 mg (n=7), milnacipran 100 mg (n=5) and duloxetine 75.6 mg (n=4). Other drugs were used in the treatment of alcohol related pathology, like naltrexone 50 mg/day and anxiolytics. Patients were monitored every 4 weeks for 6 months using Hamilton Depression Rating Scale (HAMD)-17 items, Clinical Global Impressions-Severity/Improvement (CGI-S/I), Global Assessment of Functioning (GAF), Inventory of Drug Taking Situations-alcohol focused version (IDTS). Results: Depressive symptoms responded well to all three antidepressants, with a slow trend in favor of venlafaxine (HAMD score-15.6 vs.-13.3 duloxetine and-12.2 milnacipran), but without statistical significance (p=0.122). CGI-I showed also a significant improvement at endpoint (3.2 mean decrease, p< 0.01) for all three antidepressants. GAF increased accordingly, to a mean value of 82.3 at week 24, compared to baseline. The severity of alcohol dependence fluctuated, but mean values of IDTS at endpoint improved with 56.5% for venlafaxine, 52.2% for milnacipran and 50.1% for duloxetine. A number of 4 patients relapsed into alcohol abuse during the trial. Conclusion: Serotonergic and dopaminergic reuptake inhibitors are useful in the treatment of double depression associated with alcohol dependence.

Objective: To assess the quality of life in patients diagnosed with colon malignant tumors and secondary depressive disorders, during medium-term trazodone treatment. Methods: A group of 19 patients, mean age 51.2, diagnosed with malignant colon tumor, were referred for depressive symptoms that negatively influenced their functionality and adherence to oncologic therapy. All these patients were diagnosed with major depressive episode and received trazodone 237.5 mg mean daily dose for 24 week. Patients were evaluated at baseline and every 4 weeks using Hamilton Depression Rating Scale-17 items (HAMD), Global Assessment of Functioning (GAF), Clinical Global Impressions-Severity/Improvement (CGI-S/I) and Quality of Life Inventory (QOLI). A self-rated visual analogic scale (VAS) was used as an instrument for the patient's side effects related discomfort and improvement in the quality of life. Results: Patients responded well to trazodone therapy, as the final HAMD (-15.2, p< 0.01) and GAF (+22.3, p< 0.01) scores reflected. Reduction of insomnia correlated highly with improvement in life quality (.52), followed by decreased anxiety (.43). Also, GAF and CGI-I scores improved, from mean baseline values of 46.9 and 4.8, to 72.2 and 2.1 respectively. The quality of life scales regarding health, family relations and social relations from the QOLI registered significant improvement compared to baseline (+12.3%, +10.2% and +11.5% respectively, p< 0.01). On VAS the self-appreciation of the life quality improvement increased significantly, with 6.2 points. Conclusion: Treatment of depressive episodes associated with colonic cancer increases patients' life quality and trazodone is an efficient agent for this indication.