Comparing the effectiveness of home visiting paraprofessionals and mental health professionals delivering a postpartum depression preventive intervention: a cluster-randomized non-inferiority clinical trial

To determine whether pregnant women receiving the Mothers and Babies group–based intervention exhibited greater depressive symptom reductions and fewer new cases of major depression than women receiving usual community-based services, and to examine whether groups run by paraprofessional home visitors and mental health professionals yielded similar depressive symptom reductions and prevention of major depression. Using a cluster-randomized design, 37 home visiting programs were randomized to usual home visiting, Mothers and Babies delivered via home visiting paraprofessionals, or Mothers and Babies delivered via mental health professionals. Baseline assessments were conducted prenatally with follow-up extending to 24 weeks postpartum. Eligibility criteria were ≥ 16 years old, ≤ 33 gestation upon referral, and Spanish/English speaking. Depressive symptoms at 24 weeks postpartum was the primary outcome. Eight hundred seventy-four women were enrolled. Neither intervention arm was superior to usual care in decreasing depressive symptoms across the sample (p = 0.401 home visiting paraprofessional vs. control; p = 0.430 mental health professional vs. control). Post hoc analyses suggest a positive intervention effect for women exhibiting mild depressive symptoms at baseline. We have evidence of non-inferiority, as the model-estimated mean difference in depressive symptoms between intervention arms (0.01 points, 95% CI: −0.79, 0.78) did not surpass our pre-specified margin of non-inferiority of two points. Although we did not find statistically significant differences between intervention and control arms, non-inferiority analyses found paraprofessional home visitors generated similar reductions in depressive symptoms as mental health professionals. Additionally, Mothers and Babies appears to reduce depressive symptoms among women with mild depressive symptoms when delivered by mental health professionals. This trial is registered on ClinicalTrials.gov (initial post: December 1, 2016; identifier: NCT02979444).

     

Cervical internal carotid artery pseudoaneurysm following stab injury

Carotid artery pseudoaneurysm is a rare complication of injury to the head and neck, which has been traditionally managed by an open surgical repair to avoid the occurrence of devastating cerebral strokes. Their treatment presents a challenge because of the risk of serious neurological events. This report presents a case of a stab penetrating injury to the left upper neck (Monson`s zone-III), which resulted in ipsilateral seventh and twelfth cranial nerve palsy and contra lateral hemiparesis, and false aneurysm of the internal carotid artery. After excision of the aneurysm, the internal carotid artery was ligated. The postoperative course was uneventful, and the patient remains free of symptoms.     

Seroprevalence of hepatitis E among Iranian renal transplant recipients

Background

Renal transplant recipients are known to be susceptible to viral infections, with more severe clinical presentations compared to healthy persons. Hepatitis E is generally a self-limited disease, which is caused by hepatitis E virus. Recently, hepatitis E has become more important in organ transplant recipients, because of new findings regarding the potential for chronic infections in this patient group.

Objectives

This study aimed to evaluate the seroprevalence of anti-HEV IgG among kidney transplant recipients in Urmia, in the north-western region of Iran.

Patients and Methods

91 patients were selected randomly from amongst patients who had undergone kidney transplantation in Urmia, Iran. Each patient was tested for the presence of anti-HEV IgG antibody using an enzyme-linked immunosorbent assay (ELISA, Dia.Pro; Diagnostic Bioprobes, Italy).

Results

28 subjects (30.8%) were seropositive for anti-HEV IgG. Seropositive patients were generally older than seronegative patients (P = 0.009). There was no correlation between HEV infection and the level of education (P = 0.206), the history of blood transfusion (P = 0.164), or history of pre-transplantation hemodialysis (P = 0.228). There was no significant difference in the serum alanine aminotransferase (ALT) levels of the anti-HEV seropositive and seronegative patients. Multinomial logistic regression analysis indicated no significant relationship between HEV infection and increase in ALT levels, even after controlling for treatment with azathioprine (P = 0.79, OR = 1.12; 95% CI: 0.45–2.76).

Conclusion

The anti-HEV IgG antibody has a high prevalence in Iranian kidney transplant recipients, and it is significantly higher in comparison with previous studies in the general population or in hemodialysis patients.     

Marjoram increases basal gastric acid and pepsin secretions in rat

Considering the high consumption rate of marjoram in the Iranian population, this study was designed to investigate the effects of marjoram extract on gastric acid and pepsin secretion. In this study, Wistar rats (n=12) were divided into two equal case and control groups. Under general anaesthesia with 50 mg/kg i.p. sodium thiopental, laparatomy was done and a cannula inserted in the duodenum. In the case animals marjoram (12.5 mg/kg) was injected into the stomach through the mentioned cannula. The gastric contents were collected by the wash-out technique. Acid and pepsin secretions were then measured by titration and the Anson method, respectively. In the marjoram group, basal acid and pepsin secretions were significantly increased compared with the control group (acid: 20+/-3.36 vs 4.1+/-0.36 micromol/15 min; pepsin: 9.04+/-0.01 vs 5.62+/-0.12 microg/15 min; p<0.001). In the control group, pentagastrin stimulation increased acid secretion in comparison with the basal level (10.14+/-1.34 vs 4.1+/-0.36 micromol/15 min, p<0.001), while in the marjoram group, there was a significant decline (16.46+/-3.23 vs 20+/-3.36 micromol/15 min, p<0.001). In the marjoram group pentagastrin increased pepsin secretion in comparison with the basal state (12+/-0.11 vs 9.04+/-0.1 microg/15 min, p<0.001). It seems that marjoram contains some components that activate chief and parietal cells and increase basal acid and pepsin secretion.     

Intraocular pressure trend following myopic photorefractive keratectomy

International Ophthalmology - To evaluate the intraocular pressure (IOP) trend and risk factors for IOP rise after myopic photorefractive keratectomy (PRK). One eye of each patient undergone PRK...     

The effect of open Bristow-Latarjet procedure for anterior shoulder instability: a 10-year study

Operative procedures are the usual treatment for patients with anterior traumatic shoulder instabilities. Soft tissue procedures, Bankart repair, cannot be performed in some patients. They need Bristow-Latarjet one. We decided to determine midterm results of this procedure in almost all types of anterior shoulder instability, even shoulders with Bankart lesion in non-athletic cases. Thirty patients after Bristow-Latarjet procedure from 1997 to 2007 were followed 2–8 years. Clinical outcomes, consisted of muscle strength, range of motion (mean 8.66 degrees decreased in external rotation with arm in neutral position and 18.33 with arm in 90 degrees of abduction), recurrent instability (no relapse), and Rowe score (mean 77.66) showed good to excellent results. We had no screw-related or neurovascular complications. Thirty percent of cases had signs of mild arthropathy. Although Bankart procedure is the preferred method in patients with isolated Bankart lesion, but we can perform Bristow-Latarjet for all types of anterior traumatic shoulder instability in non-athletics cases with acceptable results.     

Lead exposure changes gastric acid secretion in rat: role of nitric oxide (NO)

Sub chronic exposure to lead in rats slows gastric emptying, but little is known about the effects of lead on gastric secretion. This study was designed to investigate the effects of lead on gastric acid secretion and its possible mechanisms in rats. Lead acetate was dissolved in drinking water in a concentration of 1%. Sodium acetate-containing water with a molar concentration similar to lead was also prepared. We had nine groups of animals (n=8); four of them were exposed to lead for 1, 2, 3, and 4 weeks (Pb1, Pb2, Pb3 and Pb4 groups, respectively). Sodium acetate solution was given to another four groups for 1, 2, 3, and 4 weeks (Na1, Na2, Na3 and Na4 groups, respectively). Gastric secretion was collected by washout technique and its acid output was measured in the basal (Basal Acid Output, BAO), vogotomy (Vagotomized Acid Output, VAO), and vagally stimulated (Vagally Stimulated Acid Output, VSAO) states using titrator instrument. Nitric oxide (NO) metabolite of gastric tissue was determined by Griess micro assay method to evaluate the possible mechanism of lead effect on gastric secretion. VSAO was significantly less in Pb1 and Pb2 groups than Na1 and Na2 ones respectively (1.75 ± 0.17, 2.10 ± 0.30 vs. 5.79 ± 0.20, 6.18 ± 0.27 μmol/15min) (P=0.001, P=0.001). BAO was significantly more in Pb3 and Pb4 groups than Na3 and Na4 ones respectively (2.77 ± 0.37, 2.80 ± 0.31 vs. 1.73 ± 0.16, 1.79 ± 0.34 μmol/15min) (P=0.01, P=0.02), but it was the same after vagotomy. VSAO was more in Pb3 and Pb4 groups than their Na counterparts (P=0.001, P=0.0001). NO metabolite of gastric tissue was more in all Pb groups in comparison to their Na counterparts (P=0.0001). In this study, it seems that lead exposure, via NO mechanism, has different effects on acid secretion. Nitric oxide in small and large amounts decrease and increase gastric acid secretion, respectively.