THE WIDER EFFECTS OF PATERNAL POST NATAL DEPRESSION: AN OVERVIEW

Paternal Post Natal Depression (PPND), although becoming more prevalent, is still poorly recognised. Unfortunately, its effects and negative outcomes have not been as widely researched as that of maternal postnatal depression. PPND can affect the fathers parenting style and lead to a negative effect on their child’s behaviour and social development. Furthermore, depressed fathers may feel unsupported and this can lead to problems with the marital relationship and be associated with concurrent maternal postnatal depression. Moreover, support services and interventional therapy come at a cost to the health service and therefore treating PPND can impact the economy. Identifying the effects PPND has is important as implementing reliable screening measures and better education may prevent negative outcomes

THE WIDER EFFECTS OF PATERNAL POST NATAL DEPRESSION: AN OVERVIEW

Paternal Post Natal Depression (PPND), although becoming more prevalent, is still poorly recognised. Unfortunately, its effects and negative outcomes have not been as widely researched as that of maternal postnatal depression. PPND can affect the fathers parenting style and lead to a negative effect on their child’s behaviour and social development. Furthermore, depressed fathers may feel unsupported and this can lead to problems with the marital relationship and be associated with concurrent maternal postnatal depression. Moreover, support services and interventional therapy come at a cost to the health service and therefore treating PPND can impact the economy. Identifying the effects PPND has is important as implementing reliable screening measures and better education may prevent negative outcomes

THE EFFECTS OF EATING DISORDERS IN PREGNANCY ON MOTHER AND BABY: A REVIEW

The psychological and physiological interaction between anorexia and the pregnant state has a large intrapartum and postpartum impact on mother and baby. Current research has attempted to discern the short and long term effects of eating disorders (EDs) on pregnancy as well as mother and baby-related sequelae; however little is understood about which management strategies are likely to prove most successful in mitigating these risks. The incidence and effect of low pre-pregnancy body mass index (BMI) on obstetric outcomes, and possible health complications in the future child, has attracted widespread attention. Especially concerning is the fact that it has long been known that the incidence of EDs in women of childbearing age is not only the highest out of all age categories but also is on an increasing trajectory. This paper aims to highlight the recent evidence underpinning the management of pregnant women with EDs in the light of the discussed short and long term effects of the disorders on mother and baby. We shall focus on those women who have a previous diagnosis of an ED prior to being pregnant. Particular attention will be paid to those studies considering anorexia nervosa. We argue for the use of early intervention strategies for the management of pregnant women with eating disorders, and for the use of a multidisciplinary approach in the treatment of these patients with complex problems

THE EFFECTS OF EATING DISORDERS IN PREGNANCY ON MOTHER AND BABY: A REVIEW

The psychological and physiological interaction between anorexia and the pregnant state has a large intrapartum and postpartum impact on mother and baby. Current research has attempted to discern the short and long term effects of eating disorders (EDs) on pregnancy as well as mother and baby-related sequelae; however little is understood about which management strategies are likely to prove most successful in mitigating these risks. The incidence and effect of low pre-pregnancy body mass index (BMI) on obstetric outcomes, and possible health complications in the future child, has attracted widespread attention. Especially concerning is the fact that it has long been known that the incidence of EDs in women of childbearing age is not only the highest out of all age categories but also is on an increasing trajectory. This paper aims to highlight the recent evidence underpinning the management of pregnant women with EDs in the light of the discussed short and long term effects of the disorders on mother and baby. We shall focus on those women who have a previous diagnosis of an ED prior to being pregnant. Particular attention will be paid to those studies considering anorexia nervosa. We argue for the use of early intervention strategies for the management of pregnant women with eating disorders, and for the use of a multidisciplinary approach in the treatment of these patients with complex problems

Effective headache management in the aneurysmal subarachnoid patient: a literature review

Subarachnoid haemorrhage (SAH) is described throughout the literature as a devastating neurological disorder associated with significant mortality and morbidity rates, arising not just from the haemorrhage itself, but also as a result of the catastrophic multisystem sequelae that can accompany the condition. Rupture of an intracranial aneurysm accounts for up to 85% of instances of SAH, occurring in approximately 6–7 per 100,000 in most populations and costing an estimated £510 million annually in the United Kingdom alone (Rivero-Arias et al, 2010). Treatment of Aneurysmal Subarachnoid Haemorrhage (aSAH) includes prevention of re-bleeding, evacuation of space occupying haematomas, management of hydrocephalus and prevention of secondary cerebral insult. Headache has been highlighted as the predominant, most characteristic and often the only symptom of aSAH, its severity having a variety of physiological and psychological effects on the patient. This paper summarises the findings of a literature review conducted as part of a research study to examine existing practices in the assessment and management of headache in patients with aSAH in an Irish Neurosciences Centre. The review demonstrates that despite a wealth of published literature on the diagnosis and management of aSAH, evaluation and management of its main symptom, headache, remains suboptimal and under-researched. The lack of available literature demonstrates that such enquiry is both timely and necessary

Deep-Learning for Epicardial Adipose Tissue Assessment with Computed Tomography: Implications for Cardiovascular Risk Prediction

Background: Epicardial adipose tissue (EAT) volume is a marker of visceral obesity that can be measured in coronary computed tomography angiograms (CCTA). The clinical value of integrating this measurement in routine CCTA interpretation has not been documented./ Objectives: This study sought to develop a deep-learning network for automated quantification of EAT volume from CCTA, test it in patients who are technically challenging, and validate its prognostic value in routine clinical care./ Methods: The deep-learning network was trained and validated to autosegment EAT volume in 3,720 CCTA scans from the ORFAN (Oxford Risk Factors and Noninvasive Imaging Study) cohort. The model was tested in patients with challenging anatomy and scan artifacts and applied to a longitudinal cohort of 253 patients post-cardiac surgery and 1,558 patients from the SCOT-HEART (Scottish Computed Tomography of the Heart) Trial, to investigate its prognostic value./ Results: External validation of the deep-learning network yielded a concordance correlation coefficient of 0.970 for machine vs human. EAT volume was associated with coronary artery disease (odds ratio [OR] per SD increase in EAT volume: 1.13 [95% CI: 1.04-1.30]; P = 0.01), and atrial fibrillation (OR: 1.25 [95% CI:1.08-1.40]; P = 0.03), after correction for risk factors (including body mass index). EAT volume predicted all-cause mortality (HR per SD: 1.28 [95% CI: 1.10-1.37]; P = 0.02), myocardial infarction (HR: 1.26 [95% CI:1.09-1.38]; P = 0.001), and stroke (HR: 1.20 [95% CI: 1.09-1.38]; P = 0.02) independently of risk factors in SCOT-HEART (5-year follow-up). It also predicted in-hospital (HR: 2.67 [95% CI: 1.26-3.73]; P ≤ 0.01) and long-term post–cardiac surgery atrial fibrillation (7-year follow-up; HR: 2.14 [95% CI: 1.19-2.97]; P ≤ 0.01). Conclusions: Automated assessment of EAT volume is possible in CCTA, including in patients who are technically challenging; it forms a powerful marker of metabolically unhealthy visceral obesity, which could be used for cardiovascular risk stratification

Comprehensive Phenotypic Characterization of Late Gadolinium Enhancement Predicts Sudden Cardiac Death in Coronary Artery Disease

Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) offers the potential to noninvasively characterize the phenotypic substrate for sudden cardiac death (SCD). The authors assessed the utility of infarct characterization by CMR, including scar microstructure analysis, to predict SCD in patients with coronary artery disease (CAD). Patients with stable CAD were prospectively recruited into a CMR registry. LGE quantification of core infarction and the peri-infarct zone (PIZ) was performed alongside computational image analysis to extract morphologic and texture scar microstructure features. The primary outcome was SCD or aborted SCD. Of 437 patients (mean age: 64 years; mean left ventricular ejection fraction [LVEF]: 47%) followed for a median of 6.3 years, 49 patients (11.2%) experienced the primary outcome. On multivariable analysis, PIZ mass and core infarct mass were independently associated with the primary outcome (per gram: HR: 1.07 [95% CI: 1.02-1.12]; P = 0.002 and HR: 1.03 [95% CI: 1.01-1.05]; P = 0.01, respectively), and the addition of both parameters improved discrimination of the model (Harrell's C-statistic: 0.64-0.79). PIZ mass, however, did not provide incremental prognostic value over core infarct mass based on Harrell's C-statistic or risk reclassification analysis. Severely reduced LVEF did not predict the primary endpoint after adjustment for scar mass. On scar microstructure analysis, the number of LGE islands in addition to scar transmurality, radiality, interface area, and entropy were all associated with the primary outcome after adjustment for severely reduced LVEF and New York Heart Association functional class of >1. No scar microstructure feature remained associated with the primary endpoint when PIZ mass and core infarct mass were added to the regression models. Comprehensive LGE characterization independently predicted SCD risk beyond conventional predictors used in implantable cardioverter-defibrillator (ICD) insertion guidelines. These results signify the potential for a more personalized approach to determining ICD candidacy in CAD. [Abstract copyright: Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

A Role for TLR4 in Clostridium difficile Infection and the Recognition of Surface Layer Proteins

Clostridium difficile is the etiological agent of antibiotic-associated diarrhoea (AAD) and pseudomembranous colitis in humans. The role of the surface layer proteins (SLPs) in this disease has not yet been fully explored. The aim of this study was to investigate a role for SLPs in the recognition of C. difficile and the subsequent activation of the immune system. Bone marrow derived dendritic cells (DCs) exposed to SLPs were assessed for production of inflammatory cytokines, expression of cell surface markers and their ability to generate T helper (Th) cell responses. DCs isolated from C3H/HeN and C3H/HeJ mice were used in order to examine whether SLPs are recognised by TLR4. The role of TLR4 in infection was examined in TLR4-deficient mice. SLPs induced maturation of DCs characterised by production of IL-12, TNFα and IL-10 and expression of MHC class II, CD40, CD80 and CD86. Furthermore, SLP-activated DCs generated Th cells producing IFNγ and IL-17. SLPs were unable to activate DCs isolated from TLR4-mutant C3H/HeJ mice and failed to induce a subsequent Th cell response. TLR4−/− and Myd88−/−, but not TRIF−/− mice were more susceptible than wild-type mice to C. difficile infection. Furthermore, SLPs activated NFκB, but not IRF3, downstream of TLR4. Our results indicate that SLPs isolated from C. difficile can activate innate and adaptive immunity and that these effects are mediated by TLR4, with TLR4 having a functional role in experimental C. difficile infection. This suggests an important role for SLPs in the recognition of C. difficile by the immune system

The Relationship Between Problematic Appearance Comparisons on Social Media, Self-Compassion and Body Dissatisfaction

Body dissatisfaction is a prevalent and problematic issue among young adults and adolescents and can be heightened with social media use. However, little is known about precisely how social media influences the appearance comparison and body ideal internalisation mechanisms that underpin body dissatisfaction, or how to successfully counter these problematic mechanisms to reduce body dissatisfaction. This thesis sought to investigate how these mediating mechanisms operate on social media and use these findings to inform the design of a social media-focused intervention to counter body dissatisfaction. Firstly, qualitative focus groups explored the body ideal internalisation and appearance comparison processes engaged with by with young adults and adolescents on social media. Findings were used to develop a psychometric tool the \u27Appearance Comparisons on Social Media Scale\u27 (ACSMS), which was validated using exploratory and confirmatory factor analysis in a large sample of young adults using cross-sectional and prospective designs. Results indicated that social media?s unique content and affordances increased problematic appearance comparisons with upward, contrastive targets, widened perceived discrepancies between one?s own body and that of body ideals and resulted in self-critical evaluations and body dissatisfaction, especially in adolescents and women. Compassion-focused approaches which target self-criticism are promising for addressing body dissatisfaction; however, they have not been extensively investigated in adolescents or in social media context where they may be of most benefit. A novel five-week intervention, grounded in Gilbert?s (2010) Compassionate Mind Training (CMT) and adapted to address body image concerns in the social media context, was developed and administered to adolescent boys and girls (14-17 years) in Irish secondary schools. A mixed methods quasi-experimental design was used to evaluate the Digital SMART intervention versus a wait list control. Although no significant differences in outcome measures were observed at post-intervention in intention to treat analyses, improvements in body satisfaction were observed at three-month follow up. The programme was feasible and mostly acceptable and was qualitatively reported by some girls to improve body image and outcomes of social media use. Although this indicates the potential utility of self-compassion in improving adolescent body image, further research is warranted. Study implications, limitations and recommendations for future research are discussed

Investigating the utility of Computed Tomography Coronary Angiography in Spontaneous Coronary Artery Dissection.

Background Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes, particularly among young women and individuals with few conventional atherosclerotic risk factors. Invasive coronary angiography (ICA) is the gold standard for the diagnosis of SCAD, although there are risks associated with ICA. Computed tomography coronary angiography (CTCA) is an emerging alternative modality to diagnose SCAD. The accuracy of CTCA for diagnosing SCAD remains unclear. Objective To investigate the accuracy of CTCA in acute SCAD diagnosis, and to apply novel CT technology including peri-coronary fat attenuation index (FAI)-score for the diagnosis of acute SCAD, and indices of coronary tortuosity in patients previously diagnosed with SCAD. Methods CTCA studies were obtained with patients consented to participate in the UK SCAD registry. The diagnostic accuracy of CTCA was assessed in 25 acute SCAD, and 25 normal scans by five independent readers. Standard FAI-score in the proximal vessel was obtained in an extended cohort. Finally, indices of coronary tortuosity were calculated in patients previously diagnosed with SCAD. Results CTCA showed poor sensitivity, and negative predictive value for the diagnosis of acute SCAD compared to normal scans. Secondly, using previously reported methods of tortuosity assessment, and a novel semi-automated technique we confirm previous reports that coronary tortuosity is more prevalent in SCAD compered to normal, and that tortuosity is throughout the coronary tree. Finally, standard FAI-score in the proximal vessel suggests that in large vessels the FAI-score is higher compared to SCAD. However, it has limited utility in the diagnosis of SCAD. Conclusion The role of standard CTCA analysis in acute SCAD seems limited. However, enhanced CTCA, using a refined FAI-score and other features, holds promise for a future non-invasive imaging strategy.</p