Maternal History of Child Maltreatment and Household Chaos: Examining the Mediating Role of Maternal and Child Psychopathology

Caregiver history of childhood maltreatment can have pervasive effects on familial and household dynamics. Maternal history of child maltreatment (MCM) is linked to maternal depressive symptoms and offspring behavioural problems. Further, maternal and child mental health are associated with chaotic home environments. In this study, we examined the potential mediating roles of maternal depressive symptoms and child behavioural problems in the association between MCM and household chaos. A sample of 133 mother-child dyads participated in home visits during which mothers completed questionnaires measuring their history of child maltreatment, depressive symptoms, household chaos and child behaviour problems. Mothers also conducted videotaped home tours related to household chaos. Structural equation modelling results indicated that MCM was indirectly associated with higher household chaos via elevated maternal depressive symptoms and child externalizing, but not internalizing behaviour problems. Interventions aimed at mitigating the effects of MCM on maternal and child psychopathology may positively influence household dynamics.

Galectin-3 as a Predictor of Post Cardiac Surgery Atrial Fibrillation: A Scoping Review

PURPOSE

Galectin-3 is associated with myocardial fibrosis, a known risk factor for developing re-entrant circuits associated with atrial fibrillation (AF). Previous studies have demonstrated increased galectin levels in AF patients. Whether preoperative galectin-3 levels can predict the incidence of postoperative atrial fibrillation (POAF) remains unknown.

METHODS

This scoping review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic searches were conducted in Medline, EMBASE, Cochrane, and Google Scholar databases using a predetermined strategy. Methodological variables, demographics and operative data were extracted. Data extraction was performed manually by three reviewers.

RESULTS

The search yielded 620 citations, of which 74 underwent full text review, and 3 citations with 3 independent samples (n=1812) met full inclusion/exclusion criteria and were included. Of the three studies that reported on the association between preoperative galectin-3 levels and POAF, two studies compared median galectin levels in patients who developed POAF and those who did not. While Alexandre et al. reported a significant difference (p=0.002), Bening et al did not find a significant difference between POAF and non-POAF groups (p=0.3). A third study reporting on the association between galectin-3 and atrial fibrillation comparing 3rd and 1st tercile galectin-3 levels found a significant association between preoperative galectin levels and POAF on univariate analysis (OR 1.54; 95% CI 1.14-2.09).

CONCLUSIONS

Galectin-3 is an emerging biomarker that has been associated with the development of AF. However, there is currently not enough evidence to establish its prognostic role in post-cardiac surgery atrial fibrillation.

Postoperative management of pediatric patients undergoing minimally invasive repair of pectus excavatum: Where are we now?

PURPOSE

Minimally invasive repair of pectus excavatum (MIRPE) often leads to a painful and challenging recovery period. This study aims to describe the postoperative management of pediatric patients undergoing MIRPE and compare postoperative outcomes between patients using different routes of postoperative analgesia.

METHODS

Retrospective chart review of pediatric patients who underwent MIRPE from July 2003 to September 2019 at a single pediatric tertiary care center. Data on pain management and course of hospital stay were ascertained. Descriptive statistics, Mann-Whitney U and Pearson Chi-Square tests were used to analyze data. A p-value <0.05 was considered significant.

RESULTS

Of the 115 patients identified, 58 (50.4%) managed pain postoperatively using thoracic epidural and 57 (49.6%) used intravenous patient-controlled analgesia (IVPCA). The transition from the predominant use of epidural to IVPCA for MIRPE occurred between 2012 and 2013. Higher pain scores were reported by the IVPCA group at 6 h (p<0.001) and 12 h (p<0.001) postoperative. Patients using IVPCA had lower postoperative opioid consumption (p<0.001) and switched to oral opioids sooner than the epidural group (p<0.001). Fewer patients in the IVPCA group required urinary catheterization (p<0.001). Patients using IVPCA had a shorter hospital stay (4 days [IQR 4-5]) compared to the epidural group (5.5 [IQR 5-6]; p<0.001). Readmission was comparable at 3.48% in the total sample.

CONCLUSION

Patients using intravenous patient-controlled analgesia reported higher pain scores however, this route of analgesia was associated with shorter hospital stay. Prospective studies designed to address moderator variables are required to confirm findings and develop standardized recovery protocols.