Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: a cross-sectional study

INTRODUCTION

This study aimed to investigate the prevalence, severity, and factors associated with antenatal depression among women receiving antenatal care at Mubende Regional Referral Hospital (MRRH) in Uganda. Antenatal depression is a critical concern for maternal and child well-being, as it is associated with adverse outcomes such as preterm birth, abortion, low birth weight, and impaired maternal-infant bonding. Despite several international guidelines recommending routine screening for antenatal depression, local Ugandan guidelines often overlook this essential aspect of maternal care.

METHODS

A cross-sectional study involving 353 pregnant women utilized the Patient Health Questionnaire 9 (PHQ-9) to assess antenatal depression. Participants were categorized as having antenatal depression if their total PHQ-9 score was ≥ 5 and met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for either major or minor depression. Psychosocial demographic and obstetric characteristics were recorded. Logistic regression analysis identified factors linked to antenatal depression.

RESULTS

The burden of antenatal depression was notably high, affecting 37.68% of the participants. Among those with antenatal depression, the majority exhibited mild symptoms 94 (70.68%). The significant factors associated with antenatal depression, revealed by multivariate analysis, included younger age (≤ 20 years), older age (≥ 35 years), history of domestic violence, alcohol use, gestational age, history of abortion, history of preeclampsia, and unplanned pregnancies.

CONCLUSION

This study revealed a significantly high prevalence of antenatal depression, emphasizing its public health importance. Most cases were classified as mild, emphasizing the importance of timely interventions to prevent escalation. The identified risk factors included age, history of domestic violence, alcohol use, first-trimester pregnancy, abortion history, previous preeclampsia, and unplanned pregnancy.

Myocardial function in COVID-19 patients after hospital discharge: a descriptive study comparing the first and second 'wave' patients

In hospitalized COVID-19 patients, myocardial injury and echocardiographic abnormalities have been described. The present study investigates cardiac function in COVID-19 patients 6 weeks post-discharge and evaluates its relation to New York Heart Association (NYHA) class. Furthermore cardiac function post-discharge between the first and second wave COVID-19 patients was compared. We evaluated 146 patients at the outpatient clinic of the Leiden University Medical Centre. NYHA class of II or higher was reported by 53% of patients. Transthoracic echocardiography was used to assess cardiac function. Overall, in 27% of patients reduced left ventricular (LV) ejection fraction was observed and in 29% of patients LV global longitudinal strain was impaired (> - 16%). However no differences were observed in these parameters reflecting LV function between the first and second wave patients. Right ventricular (RV) dysfunction as assessed by tricuspid annular systolic planar excursion (< 17 mm) was present in 14% of patients, this was also not different between the first and second wave patients (15% vs. 12%; p = 0.63); similar results were found for RV fraction area change and RV strain. Reduced LV and RV function were not associated with NYHA class. In COVID-19 patients at 6 weeks post-discharge, mild abnormalities in cardiac function were found. However these were not related to NYHA class and there was no difference in cardiac function between the first and second wave patients. Long term symptoms post-COVID might therefore not be explained by mildly abnormal cardiac function.

SARS-CoV-2 Seroprevalence in Aden, Yemen: A population-based study

Background

In Yemen, initial surveillance of coronavirus disease 2019 (COVID-19) focused primarily on patients with symptoms or severe disease. The full spectrum of the disease remains unclear. To the best of the authors’ knowledge, this is the first seroprevalence study performed in Yemen.

Methods

This cross-sectional investigation included 2001 participants from all age groups from four districts in Aden, southern Yemen. A multi-stage sampling method was used. Data were collected using a well-structured questionnaire, and blood samples were taken. Healgen COVID-19 IgG/IgM Rapid Diagnostic Test (RDT) Cassettes were used in all participants. All positive RDTs and 14% of negative RDTs underwent enzyme-linked immunosorbent assay (ELISA) testing (WANTAI SARS-CoV-2 Ab ELISA Kit) for confirmation.

Results

In total, 549 of 2001 participants were RDT positive and confirmed by ELISA, giving a prevalence of COVID-19 of 27.4%. The prevalence of immunoglobulin G was 25%. The prevalence of asymptomatic COVID-19 in the entire study group was 7.9%. The highest prevalence was observed in Al-Mansurah district (33.4%). Regarding sociodemographic factors, the prevalence of COVID-19 was significantly higher among females, housewives and subjects with a history of contact with a COVID-19 patient: 32%, 31% and 39%, respectively.

Conclusion

This study found high prevalence of COVID-19 in the study population. Household transmission was common.

Accuracy of electroanatomical mapping guided cardiac radiotherapy for ventricular arrhytmias: pitfalls and solutions

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was partially supported by the grant AZV NU20-02-00244 from the Ministry of Health of the Czech Republic

OnBehalf

WECAM

Background

One of the main limitations of Radiofrequency catheter ablation (RFCA) is the difficulty in targeting specific VT substrate locations when they are deep intramural, covered by epicardial fat or in the proximity of a coronary artery. Stereotactic body radiotherapy (SBRT) has emerged as an alternative treatment for VT after RFCA failure. However, the accuracy of substrate volume delineation, the gross target volume (GTV), based on electroanatomical mapping (EAM) and interobserver agreement are still unknown.

Aim

To analyze and optimize the interobserver agreement for GTV delineation on cardiac CT (CCT) based on EAM data acquired to guide radiotherapy for ventricular arrhythmias.

Method

Available EAM data was exported and merged with the segmented CCT using manual registration by two observers. A GTV was created by the observers for predefined left ventricular (LV) areas based on preselected endocardial EAM points, indicating the 2D-surface area of interest. The interobserver (non)overlapping GTV volumes were analyzed. The influence of (interobserver) registration accuracy and availability of EAM data on the final GTV and 2D-surface location within each LV area was evaluated.

Results

The median distance between the CCT and EAM after registration was 2.7 mm, 95%th percentile 6.2 mm for observer #1 and 3.0 mm, 95%th percentile 7.6 mm for observer #2 (p = 0.9). Created GTVs were significantly different (8 vs 19 ml) with lowest GTV overlap (35%) for lateral wall target areas. Similar, the highest shift between 2D-surfaces was observed for the lateral LV (6.4mm (3.0-9.9)). The same trend is seen in the (non) overlapping volume for lateral area (P = 0.004). The optimal surface registration accuracy (2.6 mm) and interobserver agreement (Δ interobserver EAM surface registration accuracy 1.32 mm) on final GTVs could be achieved if at least three cardiac chambers were mapped, including high-density LV EAM.

Conclusion

Detailed EAM of at least three chambers allows for accurate co-registration of EAM data with CCT and high interobserver agreement on GTVs to guide radiotherapy of ventricular arrythmias. However, the substrate location should be taken in consideration when creating a treatment volume margin. Gross target volume (GTV) and InterobserGTV volume Observer #1 (cc)GTV volume Observer #2 (cc)Surface shift (mm)Basal anterior, (IQR)7.6 (6.2-11.5)9.3 (5.3-10)3.8 (2.2-4.5)Lateral, (IQR)8.0 (6.9-12.7)19.1 (15.7-21.4)6.2 (5.3-6.4)Septal, (IQR)10.1 (6.2-12.8)13.9 (7.7-14.6)6.4 (3.0-9.9)Abstract Figure. Graphical abstract

Short-term outpatient follow-up of COVID-19 patients: A multidisciplinary approach

BACKGROUND

Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients.In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped.

METHODS

We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status.

FINDINGS

Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P<0.001; 15.4%; P<0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients.

INTERPRETATION

Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.