Haemorrhoidal disease in pregnancy: results from a self-assessment questionnaire administered by means of a social network.

BACKGROUND: The anal symptoms occurring during pregnancy and post-partum, mainly related to Haemorrhoidal Disease (HD), have been reported with in a wide range of incidence in the literature. Although in many cases the course of the disease is mild and self-limiting, sometimes it is severe enough to affect quality of life. METHODS: Our study has been conducted through a questionnaire administered via social media with the aim of obtaining epidemiologic data on the incidence of the symptoms of HD in an unselected population of pregnant women. In addition, we looked for the presence of those factors notoriously predisposing or associated to HD (constipation, straining on the toilet, low dietary fibres and fluid intake). RESULTS: Out of 133 patients 51% reported symptoms of HD during pregnancy, mainly in the second and third trimester. Constipation, straining on the toilet, low dietary fibres and fluid intake were not significantly related to incidence of HD. Only a previous history of HD was correlated to onset of symptoms of HD in pregnancy and reached a statistical significance (odds ratio = 5.2, p < 0.001). CONCLUSION: Although with the limitations posed by the nature of our retrospective study via a self-assessment interview, our results suggest that the occurrence of HD in pregnancy seems not sustained by the classical risk factors observed in the general population. At the moment, specific therapeutic measures are lacking and treatment relies on empiric suggestions concerning diet, fluid intake, bowel care, local ointment. Further studies are needed in order to identify a targeted etiologic treatment.

Sex ratio at birth: causes of variation and narrative review of literature.

INTRODUCTION: The human sex ratio at birth (SRB) is the parameter which reflects the relationship between males and females at birth. It is not 50:50, but approximately 0.515 in favor of males. There are many factors that can influence SRB and its variations are not easily demonstrable. EVIDENCE ACQUISITION: Our aim was to investigate the environmental and human agents capable of causing variations in the SRB by providing a narrative review of the scientific literature. EVIDENCE SYNTHESIS: Studies demonstrated that male and female embryos/fetuses' response to stress in different way and the male ones show less resistance. This phenomenon seems to persist for approximately six months after a stressful event, suggesting a purpose of reproductive regulation and protection of the perpetuation of the species. Although the relationship of dependence with parenting decisions, thanks to prenatal diagnosis and assisted fertility techniques is easily understood, it is more complex to correlate its variations with environmental pressures that act through secondary mechanisms. The Covid-19 pandemic, natural catastrophes, terroristic attacks, economic crises are some of the difficulties encountered in recent times. CONCLUSIONS: The impact of all the factors reported is not explained only with a possible a priori determination of sex at conception, but also with secondary effects in the pregnancy outcomes. Thus, the determination of sex appears to be a complex and multifactorial mechanism, besides a matter of genetics. The pandemic and climate changes are the present important opportunities of research for possibly reaching more certain answers.