Association Between Inflammatory Biomarkers and Mental Health Symptoms in Middle Eastern Refugees in the US.

INTRODUCTION: Refugees are at increased risk for trauma-related mental health disorders, including anxiety, depression, and post-traumatic stress disorder (PTSD). The underlying biological mechanisms linking trauma to mental disorders need additional study, and the possible pathophysiological role of the immune system is attracting increasing interest. In this study, we investigated whether two well-known pro-inflammatory cytokines (interleukin (IL-8) and IL-6) are associated with mental health symptoms in Middle Eastern refugees displaced to the United States. METHODS: Refugees (n=64, mean age=37.6 years) ages ranged from 21 to 74 years (mean=37.62, SD=11.84) were interviewed one month after arrival in Michigan, United States, using a validated survey in Arabic. Questions covered pre-displacement trauma, current anxiety, depression, and PTSD symptoms. Blood, collected immediately following the interview, was analyzed for the levels of interleukins. Multivariate linear regression was used to determine the association between mental health symptoms and IL-6 and IL-8. RESULTS: In multivariate modeling, older age (ß=0.37; p<0.01) and anxiety (ß=0.31; p<0.05) were positively associated with IL-8. Age (ß=0.28; p<0.05) and pre-displacement trauma (ß=0.40; p<0.05) were positively associated with IL-6. Depression (ß=-0.38) was negatively associated with IL-6. CONCLUSION/RELEVANCE: This study of inflammatory biomarkers suggests the possibility of differential associations between mental health symptoms (anxiety and depression) and pro-inflammatory markers (IL-6 and IL-8). To enhance our ability to prevent and more effectively treat trauma-exposed refugees, we need to better understand the neuroinflammatory mechanisms contributing to mental disorders.

Congenital Central Hypoventilation Syndrome: What to Expect During Pregnancy.

Congenital central hypoventilation syndrome (CCHS) is a rare autosomal dominant disease that affects the autonomic regulation of breathing. Patients present with respiratory symptoms such as sleep apnea and dependency on mechanical ventilation during sleep or nonrespiratory symptoms such as orthostatic hypotension and sinus bradycardia. CCHS in the neonates are linked but not limited to Hirschsprung disease, neural crest cell tumors, and esophageal dysmotility. Literature about CCHS management in pregnancy is scarce. Several studies have shown that pregnant CCHS patients are at risk of adverse pregnancy outcomes such as preterm delivery, low birth weight, and maternal complications including increased dependency on the mechanical ventilation and sometimes cardiopulmonary arrest. A multidisciplinary approach has been shown to be associated with better pregnancy outcomes. In this case report, we present a case of a patient with CCHS who had her prenatal care at our high-risk pregnancy unit and delivered a healthy baby. We encourage having a thorough discussion with such high-risk patients throughout their prenatal care or even preconception about their pregnancy expectations and outcomes in order to provide them and their babies with the care needed in the postpartum period.