Exposure to domestic violence and the risk of developing depression within 6 months postpartum in Bangladesh

Purpose

Domestic violence (DV) by husbands or in-laws is a recognized problem in many countries and is associated with a wide range of adverse mental health outcomes. However, detailed knowledge on the relationship between DV experience and postpartum depression (PPD) is essential to design appropriate interventions. Therefore, this study assesses the relationship between maternal experience of DV perpetrated by husbands or in-laws and PPD in Bangladesh.

Methods

A cross-sectional survey was conducted from October to December 2019 among 497 mothers within the first 6 months postpartum who attended a health center in Rajshahi City Corporation, Bangladesh. Multivariable logistic regressions were performed to identify the associations after controlling for potential confounders.

Results

The prevalence of PPD in this sample was 34% within the first 6 months after birth; 58.6% of mothers reported having experienced any form of DV in their lifetime. Maternal experience of any form of DV (Adjusted Odds Ratio [AOR] = 1.87; 95% confidence interval [CI] = 1.19–2.93) was associated with PPD, as were experiences of any physical DV (AOR = 2.25; 95% CI = 1.40–3.59), emotional DV (AOR = 2.07; 95% CI = 1.34–3.19), and controlling behavior (AOR = 1.69; 95% CI = 1.08–2.66). Additionally, the likelihood of PPD significantly increased among women who experienced more forms of DV.

Conclusion

DV perpetrated by husband and/or in-laws is highly prevalent and significantly associated with PPD in Bangladesh. Strategies in developing interventions for improving maternal mental health should consider DV perpetrated by either husband or in-laws.

     

Alopecia areata in children: a clinical profile

Alopecia areata (AA) is prevalent among children in Kuwait. In this prospective survey we studied 215 children with AA to determine their clinical and epidemiologic features. Ninety-seven percent of the children were of Arab ancestry. Girls outnumbered boys by a 2.5:1 ratio. The peak age of onset was seen between 2 and 6 years of age with a mean age of onset at 5.7 +/- 2.8 years. A majority of the patients (80.5%) had mild disease and extensive disease (more than 50% hair loss) was seen in 13% of the children. A positive family history of AA was obtained in 51.6% of cases and nail changes were seen in 26.5% of the children. The age of onset, a positive family history of AA, and associated atopic disorders were observed to have no influence on the extent and severity of the disease. The results were compared with those reported elsewhere for this age group.     

Thyroid function,autoantibodies, and HLA tissue typing in children with alopecia areata

A total of 80 Kuwaiti children with alopecia areata (AA), without clinical evidence of thyroid disease, were screened for the presence of thyroid abnormalities, and 50 unrelated children with AA were tissue typed for human leukocyte antigen (HLA) class I and class II antigens. Thyroid abnormalities were detected in 14 children (17.5%). Among these, 11 children (14%) had thyroid autoantibodies. These observations highlight the significance of screening for thyroid abnormalities in children with chronic, recurrent, and/or extensive disease. The Kuwaiti children with AA were observed to have a significant association with HLA B21 (OR 18.850, 95% CI 4.404-80.677), B40 (OR 6.767, 95% CI 1.818-25.181), and HLA B12 (OR 4.833, 95% CI 1.198-19.505) antigens. These findings differed from those reported elsewhere.     

Evaluating surface bound rTFPI through an in vitro model of vessel wall injury

Introduction

Injury to the surrounding vessel wall is one of the major reasons for failure of implantable medical devices. The surgical procedure itself or the altered flow conditions after implantation can cause damage to the vessel wall. This damage exposes tissue factor (TF), the initiator of the extrinsic pathway of coagulation. One approach to combat thrombosis is to use an anticoagulant on the surface of the device. The primary aim of this study is to develop a simplified physiologically relevant in vitro model of vessel wall injury to study the mechanisms by which immobilized recombinant tissue factor pathway inhibitor (rTFPI) effectively inhibits TF initiated thrombosis.

Materials and methods

A two well chamber slide was used for the study. Fibroblasts were cultured on the upstream portion of the slide. Fibroblast cells stimulated with TNF-α acted as a source of surface TF. The downstream portion of the slide was coated with rTFPI. A mixture of FX, FVIIa and calcium was perfused over the slides to generate FXa. Effluent collected at the outlet was used to analyze the inhibition of this surface generated FXa by the rTFPI present downstream.

Results and conclusions

Different shear rates and rTFPI densities were used to study this effect. In most cases rTFPI inhibited FXa generated upstream as a function of the wall shear rate and rTFPI dosage (surface density). This study shows the effectiveness of the surface bound inhibitor when FXa is generated from an upstream injury site and the bulk of FXa is near the wall.     

A computational analysis of an in vitro vessel wall injury model

Implantation of vascular grafts or stents causes significant injury to the vessel wall. Activated coagulation factors, such as FXa are generated at the injury site. The size of the injury and the flow conditions influence the transport of these activated factors. A simulation model has been developed to evaluate surface bound coagulation inhibitors on medical devices. Tissue factor pathway inhibitor (TFPI) isa potent inhibitor of FXa in vivo. This physiologically relevant in vitro model studies the mechanism by which immobilized rTFPI effectively inhibits TF initiated thrombosis.Computational fluid dynamics was used to develop the model and validated by experiments performed in a parallel plate flow chamber. The lower plate was divided into two zones. The first zone represents fibroblasts that catalyze FXto FXa by TF-FVIIa. The second represents passively absorbed surface bound rTFPI. The efficacy of rTFPI in inhibiting FXa from the injury site was studied under both venous and moderate arterial shear rates. This model extends a previous model to include a more physiologic model of vessel wall injury in which FXa generation by TF:VIIa occurs at the wall upstream of the TFPI coated surface. The previous model estimated a uniform inlet FXa concentration of 20 nM (20% conversion of the approximate physiologic concentration of 100 nM) to the parallel plate chamber.     

Levels of cadmium,copper and iron in deciduous teeth of children living in Bahrain

Shed deciduous teeth were collected from children (n = 61) living in the island of the State of Bahrain. The teeth were analyzed for the toxic cadmium metal and for the biologically essential metals iron and copper. The mean concentrations of cadmium, iron and copper were 53.8 ng/g, 20.22 mug/g and 2.78 mug/g respectively. The data obtained showed no clear relation between the trace metal concentrations and the children's age, sex, social status or nationality. Teeth from the upper jaw were found to have higher metal concentrations than those obtained from the lower jaw.     

The impact of disease activity, pain, disability and treatments on fatigue in established rheumatoid arthritis

We investigate a range of clinical factors and anti-rheumatic treatments, for their degree of association with rheumatoid arthritis (RA) fatigue in 557 patients. A range of clinical measures concerning disability, pain and disease activity together with drug history were recorded as part of routine clinical visits. Fatigue was measured using the Functional Assessment of Chronic Illness Therapy (FACIT-F) questionnaire. Spearman's correlation (p < 0.05) evaluated FACIT-F against the other clinical measures. Mean FACIT-F was compared between the treatment groups. Multivariate linear regression analysis investigated association between the clinical measures and FACIT-F in more detail. Correlation (p < 0.05) with FACIT-F was the strongest for Health Assessment Questionnaire (HAQ) (r = −0.68), patient global (r = −0.64) and pain (r = −0.62) visual analogue scores. In multivariate models, DAS28, HAQ and pain explained variability in fatigue the best (R ² = 0.54). Further analyses, looking at the sub components of DAS28, show that fatigue is mainly associated with tender joint counts and pain rather than swollen joint counts or erythrocyte sedimentation rate. RA fatigue levels were not significantly different between patients on no treatment, disease modifying anti-rheumatic drugs or biologics. Fatigue in established RA is not specifically influenced by the type of treatment used but is associated with tender joint counts, pain and disability. This finding is in contrast to recent trials in early RA that suggest biologics are better than traditional disease modifying anti-rheumatic drugs for fatigue. This difference in result may be because the origins of fatigue are not the same in early compared with established RA.