Prevalence of Adverse Childhood Experiences (ACEs) among young adults of Kashmir.

OBJECTIVE: Studies on the prevalence of adverse childhood experiences (ACEs) in Kashmir, India, are yet to be conducted. This study aims to estimate the prevalence of ACEs among young adults across all the ten districts of Kashmir Valley. METHODS: A cross-sectional research strategy was used to assess the prevalence of ACEs by employing a multi-stage sampling method. Data were collected from 800 students studying in different colleges and universities in Kashmir with the help of the "Adverse Childhood Experiences" (ACEs) scale. RESULTS: Findings disclosed that less than a quarter of the respondents reported high exposure to ACEs (15.4 %), more than one-tenth of the participants reported extremely high exposure to ACEs (13.4 %), over a quarter of the sample reported moderate exposure to ACEs (26.3 %), one-third of the youth reported low exposure to ACEs (33.0 %) and over one-tenth of the respondents reported no exposure to ACEs (11.8 %). The prevalence of ACEs was found to be 88.2 % (females: 82.7 % and males: 90.8 %) in Kashmir. The ACEs with the highest level of prevalence were "often or very often sworn at, insulted, or put down" (49.8 %), followed by "often or very often acted in a way that made them afraid that they would be physically hurt" (47.6 %), "often or very often pushed, grabbed, shoved, or slapped" (41.6 %), "often or very often hit so hard that they had marks or were injured" (28.3 %) and "touched or sexually fondled" (25.3 %). Thirteen out of 21 adverse events during childhood were significantly associated with gender. CONCLUSION: The findings suggest the need to advocate early targeted interventions, reduce ACEs and their impact, and design efficient measures to improve the health and well-being of young adults in Kashmir.

Depression Among Medical Students of Karachi A Cross Sectional Study.

This article was migrated. The article was marked as recommended. INTRODUCTION: Depression is a mood disorder characterized by loss of interest in daily activity, feeling of hopelessness and helplessness, decreased appetite, anger and irritability. The risk factors which leads to depression include academic demands, daily habits, sleeping hours, sedentary lifestyle, inability to cope, helplessness, increased psychological pressure, mental tension and increased work load etc. The objective of current study is to find out the prevalence of depression among students of different medical colleges of Karachi and its association with life style, habits and coping mechanisms. METHODS: A descriptive cross-sectional study was conducted in 6 months i.e. April 2018 to September 2018, using a self-designed, self-explanatory questionnaire which also included Public Health Questionnaire (PHQ-9) for identification of depression. The coefficient of reliability including Cronbach alpha was 0.839 for the questionnaire. The data was analyzed by using mean with standard deviation and frequency with percentages while association was calculated by using Chi-square test. RESULTS: The mean age of participants was 21.43 ±1.803. About 2/3 of the participants were female with marital status of 3/4th of participants being single. 92% of the medical students were found to be depressed while 26% of them have suicidal thoughts. Symptoms of depression were compared with depression score, which showed strong positive correlation. Depression scores were also compared with lifestyle habits of participants, including sleeping hours, exercise, recent trauma and multiple coping mechanisms, presented significant association with depression scores (p-value ≤ 0.01). CONCLUSIONS: It is concluded that depression is highly prevalent amongst medical student populations while the lifestyle habits, sleeping hours, physical activities, recent trauma and coping mechanism showed significant positive association with depression.

Restrictive allograft syndrome (RAS): a novel form of chronic lung allograft dysfunction.

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) with small-airway pathology and obstructive pulmonary physiology may not be the only form of chronic lung allograft dysfunction (CLAD) after lung transplantation. Characteristics of a form of CLAD consisting of restrictive functional changes involving peripheral lung pathology were investigated. METHODS: Patients who received bilateral lung transplantation from 1996 to 2009 were retrospectively analyzed. Baseline pulmonary function was taken as the time of peak forced expiratory volume in 1 second (FEV(1)). CLAD was defined as irreversible decline in FEV(1) < 80% baseline. The most accurate threshold to predict irreversible decline in total lung capacity and thus restrictive functional change was at 90% baseline. Restrictive allograft syndrome (RAS) was defined as CLAD meeting this threshold. BOS was defined as CLAD without RAS. To estimate the effect on survival, Cox proportional hazards models and Kaplan-Meier analyses were used. RESULTS: Among 468 patients, CLAD developed in 156; of those, 47 (30%) showed the RAS phenotype. Compared with the 109 BOS patients, RAS patients showed significant computed tomography findings of interstitial lung disease (p < 0.0001). Prevalence of RAS was approximately 25% to 35% of all CLAD over time. Patient survival of RAS was significantly worse than BOS after CLAD onset (median survival, 541 vs 1,421 days; p = 0.0003). The RAS phenotype was the most significant risk factor of death among other variables after CLAD onset (hazard ratio, 1.60; confidential interval, 1.23-2.07). CONCLUSIONS: RAS is a novel form of CLAD that exhibits characteristics of peripheral lung fibrosis and significantly affects survival of lung transplant patients.

Transfusion-related acute lung injury (TRALI) in graft by blood donor antibodies against host leukocytes.

It is unknown the extent to which transfusion-related acute lung injury (TRALI) contributes to primary graft dysfunction (PGD), the leading cause of death after lung transplantation. In this case of suspected transfusion-associated acute bilateral graft injury in a 61-year-old idiopathic pulmonary fibrosis patient, recipient sera from before and after transplantation/transfusion, as well as the sera of 22 of the 24 implicated blood donors, were individually screened by Luminex bead assay for the presence of human leukocyte antigen (HLA) antibodies, with recipient and lung donor HLA typing to explore for cognate relationships. A red-cell-unit donor-source anti-Cw6 antibody, cognate with the HLA type of the recipient, was identified. This is the second reported case of TRALI in the setting of lung transplantation, and the first to show an associated interaction between donor antibodies (in a low-plasma volume product) with recipient leukocytes (rather than graft antigens); therefore, it should be considered in the differential diagnosis of PGD.