Risk factors associated with postpartum depressive symptoms: A multinational study.

OBJECTIVE: To evaluate the association between maternal age, parity, gestational number (singleton vs twin), newborn gender and self-reported postpartum depressive symptoms (PDS) in a large multinational sample using survey data from a digital telephone application. METHODS: Women using the Flo app answered a survey (available in 10 languages) from January 2018 to April 2020. A survey question asking about emotional state was used to determine the presence of PDS. Chi-squared statistics were used to compare groups. A weighted mean prevalence was calculated based upon the socioeconomic status and reproductive population of each country in 2020. RESULTS: Over a million women from 138 countries participated. Of all respondents, 9.4% endorsed PDS. The weighted mean prevalence of PDS was 11%. We found that PDS decreased with advancing age. First-time mothers reported higher rates of PDS. Twin births were associated with a higher symptom burden than singleton births and mothers of twins in the oldest age group reported the greatest burden. We did not find a clinically significant difference in rates of PDS between mothers of singleton girls and boys. CONCLUSIONS: To our knowledge, this study is the first to examine risk factors for postpartum symptoms using the same survey across a large international population. These results can further research and clinical aims to identify and treat maternal depression more effectively. LIMITATIONS: Data was aggregated, thereby limiting analysis of individual associations. The survey was self-report and not diagnostic for postpartum depression. Generalizability of risks of postpartum depression should be approached with caution.

Screening for Echinococcus granulosus in dogs: Comparison between arecoline purgation, coproELISA and coproPCR with necropsy in pre-patent infections.

Echinococcus granulosus is an important zoonotic infection of dogs. The purpose of the present study assessed the performance of two laboratory diagnostic methods with arecoline purgation and necropsy in infected dogs. In total 65 dogs were successfully experimentally infected with protoscoleces of E. granulosus from ovine infection. At 14-34 days post-infection groups of dogs were purged with arecoline hydrobromide and then necropsied. Faecal samples were tested at weekly intervals by coproantigen ELISA and coproPCR. The necropsy infection rate with E. granulosus was 89.2 per cent. Only 43 per cent of dogs were successfully purged after one arecoline dose; this percentage increased to 76.9% for two doses of arecoline purgation. E. granulosus coproantigen was detected by coproELISA in 82.8% of faeces. The positive and negative predictive values for coproantigen ELISA were 96 and 44.4% respectively. E. granulosus DNA was detected in pre-patent faecal samples by coproPCR in 25.9% of dogs. These results indicate that coproELISA is more sensitive than arecoline purgation for the detection of pre-patent E. granulosus infection in dogs. CoproPCR detected E. granulosus DNA in dog faeces by 21 days post-infection before egg production.

Taeniasis/cysticercosis in a Tibetan population in Sichuan Province, China.

The results of a preliminary survey of taeniasis/cysticercosis in Yajiang County, Ganze Tibetan Prefecture in southwest Sichuan Province, China, indicated a very high prevalence of taeniasis (22.5%), with Taenia saginata as the dominant species. There was also a significant occurrence of late-onset epilepsy (8.5% prevalence and 16.4% seropositive for Taenia solium antibodies) attributable in large part to probable neurocysticercosis caused by T. solium. The poor sanitation and hygiene in this Tibetan community likely contributed to a high risk of human cysticercosis despite a low level of T. solium taeniasis (actually no T. solium carriers were detected amongst the 21 proven Taenia carriers). In addition, three taeniasis cases were confirmed by DNA genotyping as Taenia asiatica, which is the first report of this tapeworm in Tibetans, the first report for Sichuan Province and only the third report for mainland China.

Failed medical termination of pregnancy associated with implantation in a non-communicating uterine horn.

A failed medical termination of pregnancy at 16 weeks' gestation proved to be due to a uterine malformation. Delay in diagnosis resulted in uterine rupture and the need for an emergency laparotomy. Recommendations are made for earlier diagnosis.

Echinococcus granulosus infection in domestic dogs in urban and rural areas of the Coquimbo region, north-central Chile.

Hydatidosis is a zoonotic disease caused by the cystic stage of the cestode parasite Echinoccocus granulosus, in which the definitive hosts are mainly domestic dogs. This parasite is regarded mainly as a rural disease, where man is exposed through contact with eggs excreted by definitive hosts; however, some studies have shown that domestic dogs can get infected within urban areas. This study was conducted to assess differences in prevalence of E. granulosus in urban and rural sites in Coquimbo region of Chile. From 2005 to 2006 a cross-sectional household questionnaire survey was conducted in Coquimbo and Ovalle cities, in three towns and in rural sites along two transects from these cities to the Fray Jorge NP in the Coquimbo region. Faecal samples were collected from dogs during the questionnaire survey and tested for Echinococcus coproantigens. Positive dogs were found in urban areas. Analysis of risk factors indicated that dogs inhabiting the borders of urban areas were at greater risk of being coproantigen positive than those in the centre of these areas. These results are likely to be related to the custom of slaughtering livestock at home in urban areas during local celebrations, which could favour the importation of E. granulosus to urban areas by acquiring livestock contaminated with cysts from rural sites. This study shows that surveillance and control measures in livestock and domestic dogs need to be introduced in urban areas as well as rural areas of the Coquimbo region to reduce the public health risk of hydatid disease.

Dot immunogold filtration assay (DIGFA) with multiple native antigens for rapid serodiagnosis of human cystic and alveolar echinococcosis.

A new 3-min rapid dot immunogold filtration assay (DIGFA) for serodiagnosis of human cystic and alveolar echinococcosis was developed using four native antigen preparations: crude and partially purified hydatid cyst fluid extracts from Echinococcus granulosus (EgCF and AgB), E. granulosus protoscolex extract (EgP) and Echinococcus multilocularis metacestode antigen (Em2). The overall sensitivity of DIGFA in a hospital diagnostic setting was 80.7% for human cystic echinococcosis (CE) (n=857) and 92.9% for human alveolar echinococcosis (AE) (n=42). Highest specificity was 93.4% with AgB extract for CE, and 90.3% with Em2 antigen for AE when CE versus AE cross-reactivity was excluded. Anti-AgB antibodies were present in 35.5% of AE cases and anti-Em2 in 7.4% of CE cases. In endemic communities in northwest China screened for echinococcosis, the sensitivity of DIGFA ranged from 71.8% to 90.7% in comparison to abdominal ultrasound; specificity for CE using AgB was 94.6% and for AE using Em2 was 97.1%. This simple eye-read rapid test can be used for both clinical diagnostic support, as well as in conjunction with ultrasound for mass screening in endemic CE and AE areas.

Mechanisms of corneal tissue cross-linking in response to treatment with topical riboflavin and long-wavelength ultraviolet radiation (UVA).

PURPOSE: Treatment of de-epithelialized human corneas with riboflavin (RF) + long-wavelength ultraviolet light (UVA; RFUVA) increases corneal stroma tensile strength significantly. RFUVA treatment retards the progression of keratoconus, perhaps by cross-linking of collagen molecules, but exact molecular mechanisms remain unknown. Research described here tested possible chemical mechanisms of cross-linking. METHODS: Corneas of rabbits and spiny dogfish sharks were de-epithelialized mechanically, subjected to various chemical pretreatments, exposed to RFUVA, and then subjected to destructive tensile stress measurements. Tensile strength was quantified with a digital force gauge to measure degree of tissue cross-linking. RESULTS: For both rabbit and shark corneas, RFUVA treatment causes significant cross-linking by mechanism(s) that can be blocked by the presence of sodium azide. Conversely, such cross-linking is greatly enhanced in the presence of deuterium oxide (D(2)O), even when RF is present at only one tenth the currently used clinical concentrations. Blocking carbonyl groups preexisting in the stroma with 2,4-dinitrophenylhydrazide or hydroxylamine blocks essentially all corneal cross-linking. In contrast, blocking free amine groups preexisting in the stroma with acetic anhydride or ethyl acetimidate does not affect RFUVA corneal cross-linking. When both carbonyl groups are blocked and singlet oxygen is quenched, no RFUVA cross-linking occurs, indicating the absence of other cross-linking mechanisms. CONCLUSIONS: RFUVA catalyzes cross-linking reactions that require production of singlet oxygen ((1)O(2)), whose half-life is extended by D(2)O. Carbonyl-based cross-linking reactions dominate in the corneal stroma, but other possible reaction schemes are proposed. The use of D(2)O as solution media for RF would enable concentration decreases or significant strength enhancement in treated corneas.

Towards a better understanding of involuntary detrusor activity.

UNLABELLED: There is a wide spectrum of topics covered in this section. The ever-present problem of nocturia is further explored by authors from Sweden, with interesting conclusions. In addition, several papers describe various issues relating to the surgical correction of stress urinary incontinence. Finally, authors from Switzerland describe their use of sacral magnetic stimulation in non-inflammatory chronic pelvic pain syndrome. OBJECTIVES: To compare the measured variables of involuntary detrusor activity (IDA) during ambulatory cystometry (AC) in women with and with no overactive bladder symptoms, and to evaluate the correlation between these variables and symptom severity. PATIENTS AND METHODS: In all, 61 symptomatic and 39 asymptomatic women completed the Bristol Female Lower Urinary Tract Symptoms Questionnaire (BFLUTS-Q) and underwent AC. Measured variables of IDA (amplitude, duration, bladder volume and symptoms) were compared in the two cohorts. RESULTS: IDA was detected in 47 of 61 symptomatic women (77%) and in 17 of 36 (47%) controls (P < or = 0.01). The maximum IDA (defined as the highest amplitude contraction in any fill-void cycle) occurred at significantly lower volumes (328 vs 450 mL, P < or = 0.05), was of higher amplitude (26 vs 12 cm H(2)O, P = 0.14) and longer duration (83 vs 14 s, P < or = 0.05) in symptomatic women than in controls. There was coincident incontinence in 22 (36%) symptomatic women and no controls (P < or = 0.01). Discriminatory levels for clinically relevant IDA were established, and when applied retrospectively, classified 35 of 61 symptomatic women (55%) and one control (3%) as having such IDA. The correlation between symptom severity (measured by the BFLUTS-Q) and urodynamics was higher when these criteria were applied (r = 0.52 vs 0.38, P < or = 0.01). CONCLUSION: There are quantifiable differences between IDA found during AC in symptomatic and asymptomatic women. The measured variables of IDA may be useful to determine its clinical relevance, which may be indicated by contractions associated with leakage or contractions of >30 s occurring at bladder volumes of <300 mL.