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Background: Infant birthweight is an important public health indicator that is a proxy of maternal and baby's health. Earthquakes can cause acute distress, but can also contribute to chronic stress through long-term disruptions to social, economic and domestic circumstances. The aims of this study were to examine the direct effect of earthquake experiences on the birthweight of infants of women who experienced the 2015 Nepal Earthquakes during pregnancy and whether mental health mediated this relationship., Methods: This is a prospective, population-based cohort study. Pregnant women in Bhaktapur District, Nepal who had experienced the 2015 earthquakes after conception were recruited. Baseline data were collected in structured individual interviews. Follow up was a short telephone interview two weeks after the baby's birth. Infant birthweight recorded on the hospital-issued birth certificate. The direct effect of earthquake experiences on birthweight and the indirect effect via antenatal common mental disorders (CMDs) were tested using Sobel tests simultaneously., Results: In total 497/498 women contributed baseline data and 469 (94.4%) women also provided the birth weight of their infants. In total 6% of infants had low birth weight (< 2.5 kg). The earthquake experiences did not have a significant direct effect on birthweight (p = 0.116). However, the effect of earthquake experiences had a significant indirect effect on infant birthweight via CMDs. When 15 covariates were controlled, women who had moderate to severe earthquake experiences had an increase of 1.58 scores of antenatal CMD symptoms that resulted in their babies being 20.50 g lighter than those who had low earthquake experiences (p = 0.026)., Conclusions: The findings from this study indicate that the relationship is mediated by the mental health of women during pregnancy. Data demonstrate that the mental health of women who are pregnant should be prioritised in post-disaster management not only because of the burden experienced by women but also because of the risk for the growth and development of their babies.

Background: Antenatal common mental disorders (CMDs) including anxiety, depressive, adjustment, and somatoform disorders are prevalent worldwide. There is emerging evidence that experiencing a natural disaster might increase the risk of antenatal CMDs. This study aimed to synthesise the evidence about the prevalence and determinants of clinically-significant symptoms of antenatal CMDs among women who had recently experienced an earthquake., Methods: This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search included both electronic and manual components. Five major databases were searched. A data extraction table was used to summarise study characteristics and findings. Two authors examined the quality of studies independently using a quality assessment tool. A narrative synthesis of the findings reported., Results: In total seven articles met inclusion criteria. Quality scores ranged from six to seven out of ten. All the studies were cross-sectional surveys and were conducted in high and middle-income countries. Sample sizes varied among studies. The prevalence of clinically-significant symptoms of antenatal CMD ranged from 4.6% (95% CI, 3.2; 6.5) experiencing 'psychological stress' in Japan to 40.8% (95% CI, 35.5; 46.4) 'depression' in China. While all studies were conducted in an earthquake context, only four examined some aspect of earthquake experiences as a risk factor for antenatal CMDs. In multivariable analyses, higher marital conflict, poor social support, multiparity, stresses of pregnancy and the personality characteristic of a negative coping style were identified as risks and a positive coping style as protective against antenatal CMDs., Conclusions: This systematic review found that women who have recently experienced an earthquake are at heightened risk of antenatal mental health problems. It indicates that in addition to the establishment of services for safe birth which is recognised in post-disaster management strategies, pregnancy mental health should be a priority. The review also revealed that there is no evidence available from the world's low-income nations where natural disasters might have more profound impacts because local infrastructure is more fragile and where it is already established that women experience a higher burden of antenatal CMDs., Trial Registration: PROSPERO- CRD42017056501 .

Background: Antenatal mental health problems are of concern globally not only because of the burden and limits to participation experienced by women but also because of risks for foetal neurocognitive development and adverse birth outcomes. The aim was to describe the indicative prevalence of and risk and protective factors for clinically-significant symptoms of antenatal common mental disorders (CMDs) among women who experienced the 2015 Nepal earthquakes during pregnancy., Methods: A population-based cross-sectional study in Bhaktapur, one of 14 districts highly affected by the 2015 Nepal earthquakes. The primary outcome, clinically significant symptoms of CMDs, was ascertained using the Nepali validation of the Edinburgh Postnatal Depression Scale (EPDS-N). In order to investigate potential trauma reactions, a subset of EPDS items as indicators of trauma symptoms was constructed. Standardised instruments and study-specific questions were used to measure potential risk and protective factors. Data were collected in individual structured interviews by trained health researchers. Hierarchical multiple linear regression models were used to establish risk and protective factors for clinically significant symptoms of CMDs and indicators of post-earthquake trauma reaction., Results: Overall, 497/498 eligible pregnant women provided complete data. We found that 21.9% (95% CI, 18.4; 25.8) of participants had EPDS-N scores > 12 and another 17.1% (95% CI 13.9; 20.7) scored 10-12 indicating a high prevalence of clinically significant CMD symptoms. In total, 20 factors were included in the final hierarchical multiple linear regression model and together explained 33.3% of the variance in EPDS total scores; seven factors, including earthquake experiences and lifetime experience of intimate partner violence, increased risk and five including having income-generating work and a kind, and encouraging partner were protective. The association between earthquake experiences and the indicators of trauma symptoms was not significant in the hierarchical multiple linear regression analysis., Limitations: The EPDS has not yet been formally validated in Nepal for use during pregnancy. Data were collected 6 months post-earthquake, so we were not able to capture the experiences of women who had spontaneous or induced abortions or premature births in the immediate aftermath of the earthquake., Conclusions: In addition to the restoration of antenatal and obstetric services, the mental health of women who are pregnant requires specific consideration and interventions after natural disasters. This should take into account the additional adverse impact of violence perpetrated by an intimate partner., (Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.)

Background/aims: HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus coinfection. Limited data are available on those with hepatocellular carcinoma (HCC)., Methods: A retrospective analysis from 1992 to 2005 in 6 centers identified 63 HIV-infected HCC patients. Controls were 226 consecutive HIV-negative HCC patients from four sites., Results: HIV-positive patients were younger than controls (52 vs. 64 years, p<0.001), more commonly had chronic hepatitis B or C (97% vs. 73%, p<0.001), were more frequently symptomatic (51% vs. 38%, p=0.048), had a higher median alfa-fetoprotein level (227 vs. 51 ng/ml, p=0.005), but a similar mean Child-Turcotte-Pugh score (7.0 vs. 7.5, p=0.05) and HCC staging score (Barcelona-Clínic-Liver-Cancer stages C+D in 50% vs. 58%, p=0.24). HCC developed faster in HIV/HCV-coinfected than in HCV-monoinfected patients (mean, 26 vs. 34 years after HCV infection, p=0.002). HIV-positive patients received proven therapy more often (48% vs. 31%, p=0.017), but median survival was similar (6.9 vs. 7.5 months, p=0.44). Independent factors predicting survival were symptomatic presentation (hazard ratio [HR], 0.437; p<0.001), any proven therapy (HR, 2.19; p<0.001), diagnosis after 01-Jan-2002 (HR, 1.52; p=0.010), Barcelona-Clínic-Liver-Cancer stages C+D (HR, 0.491; p<0.001), AST/ALT >or= 2.00 (HR, 0.597; p=0.001), AFP >or= 400 ng/mL (HR, 0.55, p=0.003), and platelets >or= 100,000/mm3 (HR, 0.651; p=0.012), but not HIV-serostatus (p=0.19). In HIV-infected patients without HCC therapy (n=33), median survival was longer with undetectable HIV RNA (<400 copies/mL) than with HIV viremia (6.5 vs. 2.6 months, p=0.013)., Conclusions: HIV-positive HCC patients are younger and more frequently symptomatic and infected with HCV or HBV than HIV-negative patients. Tumor staging and survival are similar. In untreated patients, undetectable HIV RNA independently predicts better survival.

In the present study, we report our experience of using three-dimensional reconstruction of transesophageal two-dimensional echocardiographic images in the assessment of aortic dissection (22 patients), aortic rupture (1 patient), aortic aneurysm without dissection (2 patients), and aortic tumor (1 patient).

Acute renal failure developed in a 25-year-old man following status asthmaticus. He was found to have myoglobinuria. Vigorous contraction of the respiratory muscles and hypoxia were considered to be responsible for the development of myoglobinuria. Associated dehydration, in the presence of myoglobinuria, also contributed to the development of acute renal failure.