Is There a Role for the Family and Close Community to Help Reduce the Risk of Postpartum Depression in New Mothers? A Cross-Sectional Study of Turkish Women

OBJECTIVES: Postpartum depression is an important and under-diagnosed problem. The aims of this study were (1) to compare the prevalence of depressive symptomology in Turkish mothers who were 1-3 months postpartum with the prevalence of depressive symptomology in mothers who had not been pregnant for at least 1 year, (2) to identify risk factors associated with depression in both groups, and (3) to examine the effect of postpartum depression on breastfeeding by the mothers. DESIGN: Cross-sectional study SETTING: Well-baby clinic PARTICIPANTS: 326 women enrolled in January 2001; 163 were 1-3 months postpartum, and 163 had not been pregnant in the previous year. RESULTS: The prevalence of depressive symptomology in the postpartum and non-postpartum groups was 17% (28/163) and 24.5% (40/163), respectively; this was not statistically significant (P = 0.102). When we compared mean Beck Depression Inventory (BDI) scores, the difference between the two groups was statistically significant (10.75 +/- 8.06 and 12.63 +/- 8.81, respectively, P = 0.045). Premenstrual tension and a history of depression were risk factors for depressive symptomology in both groups. Three or more births and a history of induced abortion were risk factors for depressive symptomology in the non-postpartum group. In the postpartum group, the effect of depression on breast-feeding was not statistically significant (P = 0.7). The generalisability of the study results to the community is limited. CONCLUSION: In this study, the prevalence of depressive symptomology in the postpartum and non-postpartum groups did not show a significant difference, but the prevalence of depressive symptomology was high in both groups. Postpartum depression did not have a negative effect on breast-feeding. Lower BDI scores in the postpartum period may be the result of the protective factors of motherhood which is a respected status for women in populations where the preservations of traditions and customs are valued.     

A case of rheumatic fever with multiple recurrences of carditis

Rheumatic fever is still one of the major public health problems in developing countries. Recurrences have been reported during continuous regular prophylaxis. Here, we describe a 13-year-old girl who had four apparent recurrences of carditis while on a regimen of intramuscular benzathine penicillin G (BPG) every three weeks. The interesting and special features of this case were the presence of frequent recurrences of carditis with no evidence of arthritis despite regular BPG injections every three weeks, the requirement of long-term corticosteroid therapy due to these recurrences, and the shortness of time periods between attacks after withdrawal of steroid therapy. In this case, the administration of supraphysiologic doses of glucocorticoids caused iatrogenic Cushing syndrome with decreased bone mineral density and bilateral avascular tibial necrosis mimicking the symptoms of arthritis. Thus, this is a rare case. In similar cases with recurrences of either arthritis or carditis, instead of long-term corticosteroid therapy, we suggest a regimen of BPG prophylaxis every two weeks rather than every three weeks or monthly BPG injections because of the superiority of the every two weeks schedule in the adequate control of rheumatic fever recurrences, as shown in some previous studies.     

A comparative dosimetric analysis of virtual stereotactic body radiotherapy to high-dose-rate monotherapy for intermediate-risk prostate cancer

PurposeStereotactic body radiotherapy (SBRT) is being used with increasing frequency as definitive treatment of early stage prostate cancer. Much of the justification for its adoption was derived from earlier clinical results using high-dose-rate (HDR) brachytherapy. We determine whether HDR's dosimetry can be achieved by virtual SBRT.Methods and MaterialsPatients with intermediate-risk prostate cancer on a prospective trial evaluating the efficacy of HDR monotherapy treated to dose of 9.5 Gy × 4 fractions were used for this study. A total of 5 patients were used in this analysis. Virtual SBRT plans were developed to reproduce the planning target volume (PTV) HDR dose distributions. Both normal tissue– and PTV-prioritized plans were generated.ResultsFrom the normal tissue–prioritized plan, HDR and virtual SBRT achieved similar PTV V₁₀₀ (93.8% vs. 93.1%, p = 0.20) and V₁₅₀ (40.3% vs. 42.9%, p = 0.69) coverage. However, the PTV V₂₀₀ was not attainable with SBRT (15.2% vs. 0.0%, p < 0.001). The rectal D_max was significantly lower with HDR (94.2% vs. 99.42%, p = 0.05). The rectal D_{2 cc} was also lower (60.8% vs. 71.1%, p = 0.07). Difference in D_{1 cc} urethral dose was not significantly different (87.7% vs. 75.2%, p = 0.33). Comparing the PTV-prioritized plans, the rectal D_max (94.2% vs. 111.1%, p = 0.05) and mean dose (27.1% vs. 33.3%, p = 0.03) were significantly higher using SBRT, and the rectal D_{2 cc} was higher using SBRT (60.8% vs. 81.8%, p = 0.07).ConclusionsHDR achieves significantly higher intraprostatic doses while achieving a lower maximum rectal dose compared with our virtual SBRT treatment planning. Future studies should compare clinical outcomes and toxicity between these modalities.     

Is meconium stained amniotic fluid related to occult myocardial injury in term low risk pregnancies?

Aim

The present study aimed to compare Troponin T (Tp T) levels of infants born with meconium stained amniotic fluid (MSAF) to those with clear amniotic fluid.

Study design

Case–control study

Subjects

Thirty-five women who had delivery complicated by MSAF between 37 and 41 weeks of gestation were defined as the study group and women with healthy uncomplicated pregnancies with clear amniotic fluid who were matched for age, parity, and gestational age were defined as the control group.

Outcome measures

Cord blood Tp T level, gas analysis and neonatal outcomes were compared between groups.

Results

Tp T levels of the study and control groups were 0.026 ± 0.013 ng/ml and 0.031 ± 0.016 ng/ml, respectively. The difference was not statistically significant (p = 0.132). On the other hand, the study group had a statistically lower HCO₃ level (21.80 vs 23.60 mmol/l ) and higher rate of base deficit (4.85 vs 3.25 mmol/l) than the control group.

Conclusion

The presence of meconium during labor is not related to occult myocardial injury in low-risk term pregnancies.     

Severe peripheral pulmonary artery stenosis is not a contraindication to liver transplantation in Alagille syndrome

We described a case of Alagille syndrome with severe peripheral pulmonary artery stenosis and very high right ventricular pressure that underwent successful living-related liver transplantation without any peri-operative and mid-term postoperative complication because of this cardiac malformation. The aim of this report is to point out that the severe pulmonary artery stenosis may be a risk factor but not a contraindication to liver transplantation in patients with Alagille syndrome.     

Determinants of Postoperative Outcomes of Female Genital Fistula Repair Surgery

OBJECTIVE:: To determine predictors of fistula repair outcomes 3 months postsurgery. METHODS:: We conducted a multicountry prospective cohort study between 2007 and 2010. Outcomes, measured 3 months postsurgery, included fistula closure and residual incontinence in women with a closed fistula. Potential predictors included patient and fistula characteristics and context of repair. Multivariable generalized estimating equation models were used to generate adjusted risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS:: Women who returned for follow-up 3-month postsurgery were included in predictors of closure analyses (n=1,274). Small bladder size (adjusted RR 1.57, 95% CI 1.39-1.79), prior repair (adjusted RR 1.40, 95% CI 1.11-1.76), severe vaginal scarring (adjusted RR 1.56, 95% CI 1.20-2.04), partial urethral involvement (adjusted RR 1.36, 95% CI 1.11-1.66), and complete urethral destruction or circumferential defect (adjusted RR 1.72, 95% CI 1.33-2.23) predicted failed fistula closure. Women with a closed fistula at 3-month follow-up were included in predictors of residual incontinence analyses (n=1,041). Prior repair (adjusted RR 1.37, 95% CI 1.13-1.65), severe vaginal scarring (adjusted RR 1.35, 95% CI 1.10-1.67), partial urethral involvement (adjusted RR 1.78, 95% CI 1.27-2.48), and complete urethral destruction or circumferential defect (adjusted RR 2.06, 95% CI 1.51-2.81) were significantly associated with residual incontinence. CONCLUSION:: The prognosis for genital fistula closure is related to preoperative bladder size, previous repair, vaginal scarring, and urethral involvement. LEVEL OF EVIDENCE:: II.