Suicidal ideation in the perinatal period: findings from the Thailand-Myanmar border.

BACKGROUND: Suicide is a leading cause of maternal death globally. Migrant and refugee populations may experience higher risk of suicide. We report data on suicidal ideation from migrant and refugee women living on the Thailand-Myanmar border. METHODS: Women were recruited in their first trimester of pregnancy. Depression status was assessed by diagnostic interview in the first, second and third trimesters and at 1 month post-partum. We calculated prevalence of suicidal ideation and used logistic regression to identify associated socio-demographic factors. RESULTS: During the perinatal period, 5.3% (30/568) women experienced suicidal ideation. Refugee women were more likely to experience suicidal ideation than migrant women (8.0 versus 3.1%; P = 0.01). Most women with suicidal ideation did not have severe depression. Previous trauma (OR 2.32; 95% CI: 1.70-3.15) and unplanned pregnancy (OR 2.74; 95% CI: 1.10-6.86) were significantly associated with suicidal ideation after controlling for all other variables. CONCLUSIONS: Suicidal ideation represents an important symptom among migrant and refugee women on the Thailand-Myanmar border. Screening only those with severe depression may be insufficient to identify women at risk of suicide. Community-level interventions addressing social and gender inequalities and prioritization of family planning programmes are needed alongside targeted suicide prevention initiatives to help lower the rates of people dying by suicide.

Migration and perinatal mental health in women from low- and middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Migrant women are at risk of perinatal mental disorders due to stressors experienced before, during and after migration. OBJECTIVES: This systematic review and meta-analysis summarises the prevalence, associated factors and interventions for perinatal mental disorders in migrant women from low- and middle-income countries (LMIC). SEARCH STRATEGY: We systematically searched nine electronic databases and the grey literature using a predefined search strategy. SELECTION CRITERIA: Studies were included if they assessed pregnant or postpartum migrants from LMIC, used a structured tool and a case-control, cross-sectional, cohort or intervention study design. DATA COLLECTION AND ANALYSIS: Data was double-extracted. We calculated pooled prevalence of depression and weighted mean anxiety and depression scores. We calculated crude odds ratios from risk factor studies and summarised intervention studies descriptively. MAIN RESULTS: Forty studies were identified from 10 123 references. Pooled prevalence was 31% [95% condidence interval (CI) 23%-40%] for any depressive disorder and 17% (95% CI 12-23%) for major depressive disorder. Previous depression and lower social support were associated with perinatal depression. There were insufficient data to assess the burden of anxiety, post-traumatic stress disorder or psychosis in this population. CONCLUSIONS: One in three migrant women from LMIC experiences symptoms of perinatal depression. Social support is an important protective factor. Evidence on LMIC women relocating to other LMIC is lacking. Given the adverse consequences of perinatal mental illness on women and their children, further research in low-resource settings is a priority. TWEETABLE ABSTRACT: One in three migrant women from low- and middle-income countries has symptoms of perinatal depression.

Differential effect of intrauterine growth restriction on childhood neurodevelopment: a systematic review.

BACKGROUND: Neurodevelopmental disorders are increasingly believed to originate from intrauterine growth restriction (IUGR). Current reviews exploring the neurodevelopmental effects of IUGR, however, are mostly based on birthweight, an inadequate proxy. OBJECTIVE: We aimed to examine the association between IUGR documented in utero, and neurodevelopmental outcomes during childhood. SEARCH STRATEGY: Medline, CINAHL, PsycInfo and Scopus were searched for relevant studies published after 1970. SELECTION CRITERIA: The analysis included studies that identified IUGR in utero, with follow-up assessments between 1 month and 12 years of age. DATA COLLECTION AND ANALYSIS: Data was extracted for cognitive, behavioural, language, motor, hearing, vision or sleep outcomes. Studies were summarised separately for children born at <35 and ≥35 weeks gestation. MAIN RESULTS: Of 28 876 titles identified, 38 were suitable for inclusion. IUGR children born ≥35 weeks gestation scored on average 0.5 SD lower than non-IUGR children across all neurodevelopmental assessments. IUGR children born <35 weeks of gestation scored approximately 0.7 SD lower than non-IUGR children across all neurodevelopmental assessments. IUGR children with evidence of fetal circulatory redistribution (preferential perfusion of the brain) had more severe neurodevelopmental impairments than those born IUGR alone. CONCLUSIONS: IUGR increases the risk of neurodevelopmental impairment during childhood differentially across domains. IUGR children born preterm or with evidence of fetal circulatory redistribution are more severely affected. TWEETABLE ABSTRACT: IUGR is associated with an overall risk for neurodevelopmental delay in a range of neurodevelopmental domains.

Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity.

AIMS: Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. METHODS: We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS). RESULTS: Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR) = 1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR = 1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR) = 1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR = 0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR = 1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR = 0.85; 95% CI: 0.78-0.91). CONCLUSIONS: Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

Comparison of tea and sesame seed oils as two natural antioxidants in a fish oil model system by radical scavenging activity.

Tea and sesame seed oils, two natural antioxidants at 5% and 10% levels, were added to carp (Cyprinus caprio) and common kilka (Clupeonella cultiventris caspia) oils, and the peroxide value and thiobarbituric acid were evaluated after 13 days at 60 degrees C (oven test). The results showed that the antioxidant effects of tea and sesame seed oils in the two aforementioned fish oils were statistically similar. In addition, the radical scavenging activity (RSA) of tea and sesame seed oils (extracted with two solvents:n-hexane and benzene) and their methanolic extract (methanol-soluble phase), ethanolic extract (ethanol-soluble phase) and lipid fraction (non-soluble in methanol or ethanol) were evaluated by the 2,2-diphenyl-1-picrylhydrazyl radical method. The results revealed that the RSA of sesame seed oil was higher than that of tea seed oil (IC(50) = 52 mg and 45 mg, respectively). In addition, among ethanolic and methanolic extracts, the RSA of the ethanolic extract of sesame seed oil (IC(50) = 65 ml and 68 ml in n-hexane and benzene solvents, respectively) and of the ethanolic extract of tea seed oil in benzene solvent (IC(50) = 73 ml) were the highest. Also, the RSA in the lipid fraction, non-soluble phase of sesame seed oil was the highest (IC(50) = 74 mg and 81 mg in n-hexane and benzene solvents, respectively). Furthermore, after 6 days at 60 degrees C the RSA values of tea and sesame seed oils were the same.

Psychological and psychosocial interventions for refugee children resettled in high-income countries.

Large numbers of refugee children are arriving in high-income countries. The evidence to date suggests that they have mental health needs that are higher than for the general population and that these are exacerbated by the numbers of traumatic events they have experienced and the post-migration stressors they continue to be exposed to. The importance of a thorough and thoughtful assessment is discussed. Treatments of note are described for post-traumatic stress disorder, family functioning, general mental health problems and school environments. Future opportunities to operationalise outcome measures, develop multimodal interventions and utilise implementation science methodology are considered.

Improvement of Corrosion and Tribocorrosion Behavior of Pure Titanium by Subzero Anodic Spark Oxidation.

The present investigation reports corrosion and tribocorrosion behavior of anodic spark oxidation (ASO) coatings formed at 20 and -10 °C. Despite the numerous open pores on the layers formed at 20 °C , the plasma discharged channels were blocked on the surfaces of the subzero ASO coatings. According to polarization curves, the samples treated at -10 °C showed a significant increase in the corrosion resistance ( jcorr of 0.75 nA cm-2). Electrochemical impedance spectroscopy experiments illustrated lower capacitance and higher resistance of both inner and porous layers formed at low temperature. Subzero ASO coatings also demonstrated the lowest overall open circuit potential drop in tribocorrosion studies.

The effect of dexamethasone on postoperative vomiting and oral intake after adenotonsillectomy.

OBJECTIVE: Vomiting is one of the most important postoperative complications of adenotonsillectomy. This study was designed to determine the effectiveness of preoperative intravenous dexamethasone on postoperative emesis. METHODS: In a double-blind, placebo-controlled clinical trial, 100 patients aged 5-15 years, ASA classes I and II were randomly selected to receive either 0.5 mg/kg IV dexamethasone (n=50), as study group or an equivalent volume of saline preoperatively, as control group. The anesthetic regimen and surgical procedures were standardized for all patients. The incidence of early and late vomiting, the time to first oral intake and duration of intravenous hydration were compared in both groups. RESULTS: Data analysis showed that the overall incidence of early and late vomiting was significantly lesser in dexamehasone group than the control one. The time to first oral intake and duration of IV therapy were also significantly shorter in dexamethasone group. CONCLUSION: A single dose of dexamethasone significantly decreased the incidence of postoperative vomiting in early and late recovery phase and shortened the time to first oral intake and the duration of IV therapy.

Epidural Dexamethasone for Postoperative Analgesia in Patients Undergoing Unilateral Inguinal Herniorrhaphy: A Comparative Study.

Background. This study was designed to evaluate the effect of adding dexamethasone to epidural bupivacaine on postoperative analgesia in unilateral inguinal herniorrhaphy. Methods. Forty-four patients were enrolled in this double-blind, clinical trial study. Patients were randomly allocated into dexamethasone or control group. In the dexamethasone group, patients received 18 ml of bupivacaine 0.5% and 2 ml (8 mg) of dexamethasone; in the control group, patients received 18 ml of bupivacaine 0.5% and 2 ml of normal saline. The onset of sensory block and its duration and incidence of nausea and vomiting were recorded. Results. The onset of epidural anesthesia was significantly more rapid in the dexamethasone group than in the control group (P < 0.001). Duration of analgesia was markedly prolonged in the dexamethasone group than in the control group (P < 0.001). Five patients (22.7%) in the control group had nausea in the first hour after the procedure (P = 0.048). None of the patients in the dexamethasone group had nausea. None of our patients had vomiting in the two groups. Conclusions. This study showed that adding dexamethasone to bupivacaine significantly prolongs the duration of postoperative analgesia. This trial is registered with Iranian Registry of Clinical Trials (IRCT) number IRCT2012062910137N1.

Evaluation of gamma radiation-induced cytotoxicity of breast cancer cells: Is there a time-dependent dose with high efficiency?

CONTEXT: Radiotherapy is one of the important treatment modalities in the management of breast cancer. AIMS: The aim of this study is to study the efficient treatment of breast cancer as related to the dose delivery. MATERIALS AND METHODS: The human breast cancer cell lines (MCF-7) cells were cultured and exposed by 1, 2, 4, 6, 8, 10, and 20 Gy of γ-rays. Radiation-induced cell death was detected and evaluated, using three assay methods: Cell viability, clonogenic cell survival assay and induction of apoptosis. The cell viability was determined using trypan blue staining, 24 and 72 h post-irradiation. The survival fraction (SF) was determined by colony counting, 14 days after exposure and the apoptotic cell death was determined using the TUNEL assay. STATISTICAL ANALYSIS USED: One- or two-way analysis of variance was deemed as appropriate, followed by relevant post t-test to determine P values. RESULTS: The difference of MCF-7 cell death through increasing post-radiation time from 24 to 72 h following the dose of 1, 6 and 10 Gy was found to be 2%, 9.6% and 7.14%, respectively. D0of MCF-7 was 220 cGy and the SF in the cells irradiated by 1 Gy and 10 Gy doses were 0.8 and 0.0001, respectively. The estimated variances were 2%, 11.1% and 8.4%, between 24 h and 72 h post-radiation apoptosis death for 1, 6, and 10 Gy, respectively. CONCLUSIONS: The dose and time dependence inducing apoptotic death was significant (P = 0.001). The delayed mortality and apoptosis was observed in MCF-7 cell, but the variance of total cell death and apoptosis in 24 and 72 h post-radiation with 6 Gy was obviously more than that with other doses.

Long-term follow-up of the use of the Jones' intestinal tube in adhesive small bowel obstruction.

INTRODUCTION: Intestinal intubation with a Jones' tube has been suggested to reduce the incidence of recurrent adhesive obstruction. This paper describes our experience of this technique. PATIENTS AND METHODS: A retrospective case-note review was performed on 68 patients admitted to a teaching hospital who were identified as having had the Jones' intestinal tube placed over an 11-year period from 1980 to 1991, with a follow-up to 2003. The indication for placement and outcome following placement of the tube were documented with particular reference to recurrence of adhesive small bowel obstruction. RESULTS: Data on 63 patients were available. Of these, 7 had the Jones' tube placed prophylactically after pouch surgery and were thus excluded from the main study. Of the remaining 56 patients, all had the Jones' tube placed for recurrent adhesive small bowel obstruction with a median follow-up of 92 months, representing 353 patient-years. In 51 patients, the Jones' tube was placed during emergency surgery, while five others had it placed electively. A total of 1.7 cases of adhesive small bowel obstruction per 100 years of patient follow-up were identified following use of the Jones' tube compared to 12.9 cases per 100 patient-years prior to the use of the Jones' tube. CONCLUSIONS: Intestinal intubation with a Jones' tube is a safe and effective method of preventing recurrent adhesive obstruction.

Retrobulbar versus topical anesthesia for phacoemulsification.

To evaluate and compare intraoperative pain, perioperative complications and hemodynamic changes during phacoemulsification under topical and retrobulbar anesthesia. A total of 564 patients were randomly allocated into topical and retrobulbar groups. All patients received 2 mcg kg(-1) fentanyl 5 min before the start of their procedures. Patients in the topical group were treated with tetracaine 0.5% eye drops and given preservative free lidocaine 2% intracamerally during surgery. Patients in the retrobulbar group received a 4 mL lidocaine 2% into the retrobulbar space. The number of complications, hemodynamic changes, phaco time and pain severity on the base of a 10-point visual analog scale of pain were recorded immediately after surgery. Differences between the 2 study groups in age, sex, postoperative visual acuity and phaco time were not statistically significant. Blood oxygen saturation, heart rate, systolic and diastolic blood pressure had no difference before and after surgery in the two groups (p > 0.05). Chemosis, periorbital hematoma and subconjunctival hemorrhage occurred only in the retrobulbar anesthesia group. Incidence of vitreous loss, corneal edema and zonular tear was not statistically significant in the two groups. Two hundred thirty five patients (83%) in the retrobulbar and 238 (84%) in the topical group reported minimal discomfort (0-2). The Mean +/- SD pain score in the topical group was 1.13 +/- 1.36 and in the retrobulbar group 1.14 +/- 1.47 (p = 0.92). Patients undergoing cataract surgery with topical anesthesia and those undergoing cataract surgery with retrobulbar block did not vary in terms of subjective pain score and other parameters measuring intraoperative pain, efficacy of anesthesia and feasibility of surgery. This suggests that cataract surgery can be performed with topical anesthesia without compromising the safety of the procedure.

Overnight intensive recovery: elective open aortic surgery without a routine ICU bed.

OBJECTIVES: Most patients are managed on the intensive care unit (ICU) after elective open aortic surgery. We preoperatively identify patients suitable for extubation in theatre with overnight management in theatre recovery before discharge back to the ward (overnight intensive recovery (OIR)). The safety of this was investigated. DESIGN: Retrospective case note analysis of all patients who underwent EOAS from 1998 to 2002, recording in-hospital morbidity and mortality. Physiological and operative severity score for the enUmeration of mortality and morbidity (POSSUM) data were collected prospectively. METHODS: Patients were divided into those selected for OIR and those booked for elective ICU admission. Observed morbidity and mortality data were compared with predicted outcomes generated by Portsmouth-POSSUM and POSSUM equations. RESULTS: Hundred and fifty-two out of 178 patients used OIR; 155 patients had abdominal aortic aneurysm (AAA) repair. The elective ICU group had significantly higher anaesthetic risk scores (ASA grade), larger AAA, greater intraoperative blood loss and longer operations. In the OIR group, ten patients (7%) needed ICU admission within 48h postoperatively. Complications occurred in 85/152, with two deaths. There was no excess morbidity or mortality in the OIR group (predicted 95% CI 83-105 and 5-17, respectively). CONCLUSION: Most patients having elective open aortic surgery can be managed safely using OIR.