Birth and early parenting during the COVID-19 pandemic: A cross-sectional study in the Austrian and German population.

BACKGROUND: During the COVID-19 pandemic, new mothers and their babies represent a particularly vulnerable group. This study investigates the effects of the pandemic on the pregnancy and childbirth experience, as well as on postnatal stress and depression levels. METHODS: An online survey was completed by 1964 Austrian and German mothers who gave birth during the COVID-19 pandemic. The survey included the Pregnancy Distress Questionnaire (PDQ), the Childbirth Experience Questionnaire (CEQ), the Edinburgh Postnatal Depression Score (EPDS), the Perceived Stress Score (PSS), and additional pregnancy- and pandemic-related questions. We conducted multilinear regression models in order to investigate which factors predict childbirth experience, stress and depression scores. FINDINGS: There was a high prevalence of depression symptoms (42%), though the mean EPDS score was 8·71 (SD = 5·70), below the cut-off for depression of 10. The prevalence of high stress scores was 9%, and the mean PSS score was 17·7 (SD = 6·64), which indicates moderate perceived stress. The pandemic reduced the time spent with grandparents, as well as the help received by the mother from relatives and friends. Not receiving help was associated with higher stress and depression scores. In the multilinear regression models, the most important predictor for a negative childbirth experience was a high-risk pregnancy, while the strongest predictors for high stress and depression levels were low social support and negatively perceived pandemic repercussions on financial, social or health aspects of family life. INTERPRETATION: The results suggest that the pandemic had an impact on maternal mental health. While the perceived consequences due to the pandemic negatively affected the postnatal depression and stress levels, perceived social support acted as a protective factor.

Healthier rhythm, healthier brain? Integrity of circadian melatonin and temperature rhythms relates to the clinical state of brain-injured patients.

BACKGROUND: Healthy circadian rhythmicity has been suggested to relate to a better state of brain-injured patients and to support the emergence of consciousness in patient groups characterized by a relative instability thereof such as patients with disorders of consciousness (DOC). METHODS: Going beyond earlier studies, a systems-level perspective was adopted and, using multilevel modelling, the joint predictive value of three indices of circadian rhythm integrity derived from skin temperature variations, melatoninsulfate secretion, and physical activity (wrist actigraphy) patterns was evaluated for the behaviourally assessed state [Coma Recovery Scale - Revised (CRS-R) score] of DOC patients [13 unresponsive wakefulness syndrome; seven minimally conscious (exit) state]. Additionally, it was assessed in a subset of 16 patients whether patients' behavioural repertoire (CRS-R score) varied (i) with time of day or (ii) offset from the body temperature maximum (BTmax ), i.e. when cognitive performance is expected to peak. RESULTS: The results reveal that better integrity of circadian melatoninsulfate and temperature rhythms relate to a richer behavioural repertoire. Moreover, higher CRS-R scores are, by trend, related to assessments taking place at a later daytime or deviating less from the pre-specified time of occurrence of BTmax . CONCLUSIONS: In conclusion, the results suggest that therapeutic approaches aimed at improving circadian rhythms in brain-injured patients are promising and should be implemented in hospitals or nursing homes. Beyond this, it might be helpful to schedule diagnostic procedures and therapies around the (pre-assessed) BTmax (≈4 pm in healthy individuals) as this is when patients should be most responsive.

General versus locoregional anesthesia in carotid surgery: a prospective randomised trial.

BACKGROUND: To evaluate the influence of anesthetic technique on perioperative neurological and cardiopulmonary complication rates in patients undergoing carotid endarterectomy. PATIENTS AND METHODS: 186 patients with symptomatic internal carotid artery (ICA) stenosis > 70% or asymptomatic ICA stenosis > 80% were prospectively randomized for either locoregional (LA) or general anesthesia (GA). RESULTS: Neurological complication rates were similar in both groups (GA 2% vs. LA 2%). Cardiopulmonary complication rates were not significantly different (GA 4% vs LA 1%). There were no stroke-related deaths, but one patient from the GA group died from severe postoperative pneumonia. Thus, a significant difference in combined stroke/cardiopulmonary related death between the two groups (GA 1% vs LA 0%) could not be found. However, perioperative cardiopulmonary monitoring showed that significantly more patients operated under general anesthesia had hypertensive events, with systolic blood pressure values greater than 180 mmHg on postoperative day one. There were no differences in the number of postoperatively hypotensive episodes (systolic blood pressure values < 100 mmHg) between the two groups. CONCLUSIONS: Significant differences in the perioperative neurological and cardiopulmonary complication rates between general and locoregional anesthesia in patients undergoing carotid endarterectomy could not be observed.

[Brachial plexus. Long lasting neurological deficit following interscalene blockade of the brachial plexus]. / Plexus brachialis. Langanhaltendes neurologisches Defizit nach interskalenärer Blockade des Plexus brachialis (Winnie).

An interscalene block of the brachial plexus was combined with general anaesthesia for repair of a complex chronic lesion of the shoulder. The localisation of the plexus with electro-stimulation and the injection of Bupivacain 0.5% were accomplished easily and without painful sensations. 48 hours later the block was still partially present. Paraesthesia and a sensory and motor innervation deficit affected mainly the dorsal fascicle, but also areas innervated by the median and lateral fascicles. The deficit did not completely disappear for 18 month. The cause could have been due to direct traumatisation during blockade or operation, toxic action of the injected substance (Bupivacain 0.5%, 30 ml), distension of the plexus, a cervical syndrome or an aseptic plexitis, although a definite determination is not possible. However, the pattern of the lesion and the lack of pain during localisation of the plexus and injection favour traumatisation during the acromioplasty.

[Spatial orientation and postural regulation in patients with idiopathic scoliosis]. / Untersuchung zur Raumwahrnehmung und Haltungsregulation bei Patienten mit idiopathischer Skoliose.

QUESTION: Etiology of idiopathic scoliosis is unknown. In literature a primarily neurogenic disturbance of postural regulation is discussed with subsequent changes of the spine. In the present paper, individual functions of postural regulation in patients with idiopathic scoliosis were examined by neurophysiologic investigations and compared to a normal population. METHOD: The body sway of 28 patients was investigated in upright position under various testing conditions by means of a force measuring platform, allowing examination of the efferent part of postural regulation as well as the sensory systems involved. Registration of the eye movements (ENG) made it possible to investigate the function of the vestibulo-cerebellar system. Furthermore the optokinetic capability of scoliotic patients was tested by determination of the subjective visual vertical (SVV). RESULTS: It turned out that none of the neurophysiologic test procedures showed clearly pathological findings in scoliotic patients as compared to a normal population. CONCLUSION: It has not to be considered as probable that idiopathic scoliosis is caused by a disturbance of postural regulation.

Prognosis of facial palsy in Borrelia burgdorferi meningopolyradiculoneuritis.

Out of 72 patients treated for Borrelia burgdorferi meningopolyradiculoneuritis facial palsies occurred in 22 (12 unilateral, 10 bilateral). Eleven of the 32 pareses were initially complete. By the follow-up examination patients had recovered well with slight sequelae in 22% without cosmetically disfiguring pareses or synkinesias. Electrophysiological studies revealed axonal damage of the nerve as the underlying mechanism.

Standardization of electrode positioning and composition of meals for long-term intragastric pH metry in man.

In these prospective studies the influence of two different intragastric positions of electrodes and of four different compositions of standardized meals on 24-hour ambulatory pH recording were compared intraindividually in healthy male subjects. Simultaneous pH monitoring in 12 subjects demonstrated a more pronounced postprandial pH elevation in the fundus body compared to the antral area. The intraindividual comparison of an identical diet given on two different days to 10 subjects revealed nearly identical pH profiles. Variations of carbohydrate, protein and fat content of isocaloric meals given in a randomized order did not significantly alter 24-hour intragastric pH profiles. It is concluded from these data that positioning of the pH electrode in the fundus body area is superior to an antral position. 24-hour ambulatory intragastric pH monitoring in man is well reproducible. A strict standardization of the composition of meals is mandatory only for scientific investigations.

Simultaneous comparison of 24-hour intragastric pH recording using glass and antimony electrodes in man.

Based upon the results of in vitro studies, antimony electrodes are generally considered to have inferior electrochemical properties when compared with glass electrodes. Since a direct comparison in man is lacking, a 24-hour ambulatory intragastric pH recording was performed in 10 healthy male subjects simultaneously using glass and antimony electrodes. In the first set of experiments (when both electrodes were calibrated in buffers of pH 7 and 1 at 37 degrees C: beaker calibration) significantly lower pH recordings during fasting periods were registered with the antimony electrode. This difference could be corrected by a modified calibration, using the external skin reference electrode of the antimony electrode (finger calibration). In the second series of experiments (performed after finger calibration) comparable recordings of 24-hour intragastric pH could be obtained with antimony and glass electrodes in the same subjects. The reason for statistically insignificant differences of pH recordings with both electrodes in the early hours of the morning remains uncertain. The drift of glass and antimony electrodes did not differ. It is concluded from these data that, after adequate calibration, inferior electrochemical properties of antimony electrodes do not influence intragastric pH recordings in man.

Diminishing efficacy of octreotide (SMS 201-995) on gastric functions of healthy subjects during one-week administration.

In this study, the pharmacokinetics, efficacy, and tolerability of 25 and 100 micrograms of octreotide given t.i.d. for 7 days subcutaneously were investigated in 12 healthy male subjects. Serum concentrations of the drug were well reproducible within 1 wk. Octreotide significantly raised 24-h median intragastric pH on day 1, but no longer on day 6. Peptone-stimulated gastric acid and volume secretion were markedly less suppressed by octreotide on day 7 compared with day 2. Peptone-stimulated gastrin release was abolished on days 2 and 7, as was peptone-stimulated insulin release. Blood glucose was altered in a biphasic pattern on days 2 and 7. All effects of octreotide were without clear-cut dose-response relationship. A mean half-life of 115 min was calculated. Dose-unrelated side effects (e.g., abdominal cramps, diarrhea, and fatty stools) were registered. In conclusion, octreotide is a powerful inhibitor of gastric acid and volume secretion during acute treatment. Its loss of efficacy during a 1-wk administration may be due to the adaptation of somatostatin receptors and hormonal counterregulation.