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Home > Association Between Immediate Postnatal Anaemia and Risk of Developing Postpartum Depression at the Aga Khan University Hospital: A Cohort Study

Association Between Immediate Postnatal Anaemia and Risk of Developing Postpartum Depression at the Aga Khan University Hospital: A Cohort Study

Thesis Info

Author

Kimani, John Ndungu

Department

Obstetrics and Gynaecology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2016

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728037873

Similar


Introduction: Postpartum depression has significant burden on obstetric psychopathology. While risk factors for the same have been extensively studied, most of this studies have focused on the role of psychosocial factors. Data on the role of physiological variables such as anaemia and role of obstetric complications in postpartum depression is now emerging. There are still gaps in literature regarding the same in developing countries and in Africa. Primary Objective: To determine the association between low postnatal hemoglobin andpostpartum depression Secondary Objective: To determine the association between obstetric complication specifically postpartum hemorrhage, operative delivery and NICU/NHDU admission and postpartum depression. Materials and methods: Study design: prospective cohort study Procedure: Using a cutoff of 11 grams/deciliter, 90 anemic and 90 non anemic women without a prior history of depression were recruited on the second postnatal day. The Edinburgh Postpartum Depression scale was administered at the six week postnatal visit and a score of 13 was used to determine those at risk of postpartum depression. Results: Using logistic regression analysis, we did not find a statistically significant association between postnatal anemia and postpartum depression. (Adjusted odds ratio 1.25, CI 0.51-3.05, p 0.6290). There was also no significant association between mode of delivery (OR 1.10 CI 0.46-2.60 p=0.8337) nor postpartum hemorrhage (OR 1.45 CI 0.60-3.54 p=0.4092) and postpartum depression. Admission to the neonatal unit (Adjusted OR 6.14 CI 1.09-34.42 p=0.039) and not taking antenatal iron supplements (Adjusted OR 2.83 CI 1.15-6.93 p=0.023) were significantly associated with postpartum depression. Conclusion: Postnatal anemia, postpartum hemorrhage and mode of delivery are not associated with postpartum depression. NICU/NHDU admission and not taking antenatal iron are associated with postpartum depression though this was not hypothesized a priori and may therefore be a chance finding. Recommendations: We recommend a prospective cohort study looking at the association of postnatal anemia, iron stores and postpartum depression. We also recommend a study looking at the association between adverse perinatal outcome (NICU/NHDU admission), operative delivery and postpartum depression.
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آوارگی

آوارگی
تمہیں فرصت ہو تو۔۔۔ذرا دیکھو۔۔۔!
لہریں تڑپتی رہتی ہیں
بادبانوں سے گلے ملتے ہوئے، ہوائیں چلتی رہتی ہیں
جواز صلیب کی ارغوانی خانقاہوں کا۔۔۔!
میں کیسے گمشدہ لفظوں کی امید بن کر طواف کرتا ہوں
کہیں تاثیر قیس بن کر۔۔۔!
کہیں عزیز حسن بن کر۔۔۔!
رات کے پچھلے پہر آہوانِ راز کی طرح
دلفریب خوشبو میں قلندرانہ رقص کرتا رہتا ہوں۔۔۔!
سعد ستاروں کی وصل زاد آواز کی طرح!
دشت و بیابان میں۔۔۔فرشتوں کی حویلی میں!
منتظر سبز بانہوں میں!
سرخ نصاب کا یقیں بن کر رہتا ہوں
پورب کی لالی سے۔۔۔پچھم کی لالی تک۔۔۔!
فقیروں میں اپنی جاگیر تقسیم کرتے ہوئے!

بھید کے ہراساں نقشے میں!
میں اپنے لہو سے رنگ بھرتے ہوئے!
زخمی ناقہ ٔلذت کا پھٹا محمل رفو کرتا ہوں
گلابوں میں سوسن و نسترن سجاتے ہوئے!
زعفرانی کھیتوں میں!
گمنام جزیروں سے چمپا اور چنبیلی بلاتے ہوئے!
پھول چنتی دھڑکنوں میں چراغ بن کے جلتا رہتا ہوں
نرم استعاروں میں آوارگی کی تشریح کرتا رہتا ہوں

اسلام كے فوجداری نظام كا ضابطہ قسامت

e Qasama Doctrine of Islamic Criminal Law The mashroom-growth like blind murder cases, have, now a days confused and perplexed the law-enforcing agencies the reason is that such murder-cases are taken in hand and tried to be dealt with the common criminal procedures The criminal in such a case leaving no clue thereto succeed in detracting the police. As a result the FIR is lodged against an anonymous 'accused' afterwards and the case is filed because of the non-availability of required proof. Contrary to the above Islam introduces the procedure cf Qasama _ which literally means administring an oath which in juristic terminology applied to a way and process where some persons are held responsible in a blind murder for an oath in words, that; By Allah! Neither they have committed the murder nor they noticed the culprit. In case of refusal they are adjudicated for Qisasand for the payent of Diyat in vice versa. Historically Qasama procedure is traced back to pre-lslamic tribal-law which were then, afterwards modified and re-enforced by the Prophet (SAW) and his Khulafa. With the exception of some minor juristic controversies regarding the structure and framework of Qasama procedure multitude of muslim jurists hold it a valid way for the adjudication of a blind-murder. It is with all regrets that-lslamic Ideological council ( HC) despite its introduction .

Oral Health Conditions, Head and Neck Cancer Risks in Patients Visiting Cancer Hospitals in Peshawar

HNC comprises tumors in the oral cavity, pharynx and larynx. Pakistan falls into a high risk of HNC geographical zone. Oral cancer is one of the most prevalent malignancy worldwide, it is the second most prevalent cancer in Pakistan after lung carcinoma in men and breast carcinoma in women. Epidemiological studies have reported that various factors render increased risk for HNC which include smoking, alcohol consumption, intake of betel quid, chewing of tobacco, naswar, ingestion of fruit and vegetables in very low quantity, hereditary factors and family history, exposure to carcinogens, poor oral hygiene and Epstein–Barr virus. This study was aimed to investigate the association of HNC with demographic variables, oral health indicators and 7 SNPs of 5 interleukin gene in a case-control study design. This study was conducted in two phases. In phase I, epidemiological study was carried out and in phase II SNPs study was carried out. There were 276 cases which were pathologically confirmed patients with HNC, and among those 231 were selected for SNPs analysis, prospectively recruited from the IRNUM, Peshawar, Pakistan, from Nov. 2015 to Aug. 2016. The controls (n=275) were ethnically and linguistically matched subjects without any oral pathology. The clinical and pathological detail and data regarding demographic variables, risk factors, and oral health indicators were obtained and blood was also collected for SNPs analysis. Descriptive statistics and logistic regression modeling were employed to analyze the data. There were 276 cases and 275 controls. Majority of participants (cases and controls) belonged to Pashto ethnicity (90%), poor socioeconomic background (85%), rural origin (68%), and were illiterate (54%). There were statistically no differences among the cases and xi controls with respect to demographic attributes. In the present study patients were mostly presented with cancer of oral cavity (61%) or larynx (13%). Results shows that a high proportion of patients had poor oral hygiene (88%). The other oral health indicators were: no toothbrushing (65%), no use of dental floss (45%) and mouthwash (98%), periodontal diseases (65%), certain missing teeth (79%), and use of denture (13%). Smoking was more prevalent among the patients compared to the controls (25% vs. 12%; OR=2.53; 95%CI:1.60-4.00; p<0.0001). Similarly, a significantly higher number of patients used naswar (41% vs. 18%; OR=3.15; 95%CI:2.13-4.66; p<0.0001). A stepwise logistic regression was used to assess combined effect of independent variables which revealed that poor oral hygiene (OR=9.45, 95%CI: 5.95-15.01), material used of toothbrush (OR=5.01, 95%CI:2.20-11.37), no use of mouthwash (OR=4.76, 95%CI:1.46-15.48), and periodontal diseases (OR=5.04, 95%CI:3.18-8.01), were the significant predictors of oral cancer. It is pertinent to mention that demographic variables appeared not significant in multivariable analyses. It was further assessed that in absence of smoking and naswar use, the aforementioned four variables and no toothbrush use were significant risk factors for oral cancer. In the present study 231 cases (newly registered patients) and 219 controls were recruited for SNPs analysis in the selected genes. A significantly high number of cases had poor oral hygiene compared to controls (90.5% vs 23.7%) (p<0.01). Majority of cases never brush the teeth compared to controls (89.6% vs 49.3%). Furthermore, the frequency of missing teeth and the use of naswar were significantly high among cases compared to control (p<0.001). However, very less proportion of xii subjects were found to be smokers (p=0.58). Only 1.7% of cases contrasting to 0.9% controls used to chew paan (p=0.69). Similarly, 1.3% of used to drink alcohol compared to 0.5% of controls (p=0.62). The polymorphisms data showed that out of seven SNPs, oneSNP (IL10 rs1800896 T/C) was found to significantly associated with oral cancer. This study suggests that oral health indicators and polymorphism in IL10 rs1800896 T/C in combination with smoking confer an increased risk of oral cancer in Pakistani patients.