Effects of bipolar disorder on maternal and fetal health during pregnancy: a systematic review.

BACKGROUND: Bipolar disorder (BD) is a mental disorder characterized by mood shifts from severe depression to mania. Pregnant women with BD may experience manic or depressive episodes, so they are usually concerned about the effects of BD on their pregnancy. The aim of this systematic review is to determine the effects of BD on maternal health and fetal health, weight, and development. It also addresses how BD affects the probability of incidence of pregnancy complications in women with bipolar compared with healthy controls. METHODS: Seven electronic databases (Ovid MEDLINE, Embase, MIDRIS, APA PsychINFO, Scopus, Web of Science, and ScienceOpen) were searched, and 1728 eligible studies were identified. After deduplication, screening, and manual search processes, we included only 15 studies. Descriptive analysis, and calculation of the probability of incidence for each pregnancy outcome were used to analyze the results. RESULTS: The findings of the included studies suggest that BD during pregnancy may affect both fetal growth and maternal health by increasing the risk of giving birth to an infant with some birth defects such as microcephaly, CNS problems, small for gestational age, and other congenital anomalies, in addition to causing some obstetric complications such as gestational hypertension, preterm labor, need for assisted delivery, hospital readmission, and others. CONCLUSION: Bipolar disorder during pregnancy negatively affects mothers and their fetuses and increases the probability of incidence of obstetrics complications.

Effects of different physiotherapy modalities on insomnia and depression in perimenopausal, menopausal, and post-menopausal women: a systematic review.

BACKGROUND: Menopause is the time that marks passing 12 months after the last menstruation cycle in women between ages 40-50. Menopausal women often experience depression and insomnia that significantly impact their overall well-being and quality of life. This systematic review aims to determine the effects of different therapeutic physiotherapy modalities on insomnia and depression in perimenopausal, menopausal, and post-menopausal women. METHODOLOGY: After identifying our inclusion/exclusion criteria, we conducted a database search in Ovid Embase, MIDRIS, PubMed, Cochrane, and ScienceOpen, where 4007 papers were identified. By using EndNote software, we excluded duplicates, unrelated, and non-full text papers. Adding more studies from manual search, we finally included 31 papers including 7 physiotherapy modalities: exercise, reflexology, footbath, walking, therapeutic and aromatherapy massage, craniofacial message, and yoga. RESULTS: Reflexology, yoga, walking and aromatherapy massage showed an overall significant impact on decreasing insomnia and depression in menopausal women. Most of exercise and stretching interventions also showed improvement in sleep quality but inconsistent findings regarding depression. However, insufficient evidence was found regarding the effect of craniofacial massage, footbath, and acupressure on improving sleep quality and depression in menopausal women. CONCLUSION: Using non-pharmaceutical interventions such as therapeutic and manual physiotherapy have an overall positive impact on reducing insomnia and depression in menopausal women.

Post-haemorrhagic hydrocephalus is associated with poorer surgical and neurodevelopmental sequelae than other causes of infant hydrocephalus.

PURPOSE: This retrospective cohort study aimed to investigate the surgical and neurodevelopmental outcomes (NDO) of infant hydrocephalus. We also sought to determine whether these outcomes are disproportionately poorer in post-haemorrhagic hydrocephalus (PHH) compared to other causes of infant hydrocephalus. METHODS: A review of all infants with hydrocephalus who had ventriculoperitoneal (VP) shunts inserted at Great Ormond Street Hospital (GOSH) from 2008 to 2018 was performed. Demographic, surgical, neurodevelopmental, and other clinical data extracted from electronic patient notes were analysed by aetiology. Shunt survival, NDO, cerebral palsy (CP), epilepsy, speech delay, education, behavioural disorders, endocrine dysfunction, and mortality were evaluated. RESULTS: A total of 323 infants with median gestational age of 37.0 (23.29-42.14) weeks and birthweight of 2640 g (525-4684 g) were evaluated. PHH was the most common aetiology (31.9%) and was associated with significantly higher 5-year shunt revision rates, revisions beyond a year, and median number of revisions than congenital or "other" hydrocephalus (all p < 0.02). Cox regression demonstrated poorest shunt survival in PHH, related to gestational age at birth and corrected age at shunt insertion. PHH also had the highest rate of severe disabilities, increasing with age to 65.0% at 10 years, as well as the highest CP rate; only genetic hydrocephalus had significantly higher endocrine dysfunction (p = 0.01) and mortality rates (p = 0.04). CONCLUSIONS: Infants with PHH have poorer surgical and NDO compared to all other aetiologies, except genetic hydrocephalus. Research into measures of reducing neurodisability following PHH is urgently required. Long-term follow-up is essential to optimise support and outcomes.

Aortic root enlargement: When and how.

Aortic valve replacement is the definitive management for severe aortic stenosis. Intraoperatively, an aortic root enlargement (ARE) may be used to facilitate the implementation of a suitably sized prosthetic valve. This is to prevent patient prosthesis mismatch (PPM), a condition that causes a left ventricular outflow obstruction. There are four main techniques that are used to perform ARE, namely, Nicks, Manouguian, Nunez (modified Manouguian), and Kanno-Rastan procedures. They each involve incisions through different anatomical structures and allow a variety of valve sizes to be implanted. Studies prove that ARE effectively reduces the incidence of PPM. In addition, they show that there is no definitive link between ARE and perioperative mortality or other complications. There is a scarcity of literature exploring the comparative outcomes of each surgical technique. Therefore, further research is warranted for these procedures to be compared adequately. This review aims to summarise the available literature surrounding ARE with respect to three main questions. (1) What are the indications for ARE, (2) what surgical techniques exist to facilitate ARE, and (3) are there significant differences in patient outcomes when these surgical techniques are employed?

EUS-guided hepaticogastrostomy combined with fine-gauge antegrade stenting: a pilot study.

BACKGROUND AND STUDY AIM: To minimize bile leakage and avoid possible death because of stent migration in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), we have recently combined EUS-HGS with EUS-guided antegrade stenting (EUS-AS) of the biliary obstruction using a novel uncovered metallic stent with a fine-gauge delivery system. In this pilot study, we evaluated the feasibility and adverse events associated with this combination therapy using the novel stent. PATIENTS AND METHODS: We performed EUS-guided antegrade stenting and hepaticogastrostomy in 12 consecutive patients. RESULTS: The novel EUS-AS stent was placed across the ampulla of Vater in 8 patients and above the ampulla in 4. Technical and functional success rates were 100 %. In addition, the insertion of the first stent was achieved in all patients without dilation of the fistula between stomach and intrahepatic bile duct. Although 1 patient experienced mild pancreatitis, adverse events such as bile peritonitis or stent dysfunction did not occur during follow-up (mean 122 days, range 62 - 210 days). CONCLUSION: This method appears to safely and effectively avoid adverse events associated with EUS-HGS.

Can endoscopic ultrasound-guided fine needle aspiration offer clinical benefit for thick-walled gallbladders?

BACKGROUND: No previous studies have compared cytology obtained under endoscopic transpapillary gallbladder drainage (ETGD) and EUS-guided fine needle aspiration (EUS-FNA) for thick-walled gallbladders. AIM: The present study investigated the diagnostic yield of bile cytology under ETGD and EUS-FNA for gallbladder tumors. METHODS: A total of 69 patients were diagnosed as having gallbladder wall thickening. Among these patients, 28 patients were diagnosed by clinical follow-up, solely by imaging such as computed tomography or by histological examination of surgical specimens. The remaining 41 patients underwent ETGD and/or EUS-FNA. In these 41 patients, the clinical data collected included gender, age, diameter of gallbladder wall, site of gallbladder wall thickening, final diagnosis, adverse events, and diagnostic yield of ETGD and EUS-FNA. RESULTS: Cyto-histological diagnosis with EUS-FNA was higher than that with ETGD, with a sensitivity of 100 versus 71%, specificity of 100 versus 94%, and accuracy of 100 versus 88%, respectively, in the two groups. In addition, the sampling adequacy of EUS-FNA was 100%. Adverse events were seen in five patients in the ETGD group (mild pancreatitis), although no adverse events were seen in the EUS-FNA group (P = 0.08). CONCLUSION: Our results suggest that EUS-FNA can be safely performed for the diagnosis of gallbladder lesions. Further, this procedure may be the diagnostic method of choice over cytology of bile juice obtained via ETGD to obtain histological evidence of gallbladder cancer.

Understanding the Awareness, Knowledge and Perceptions of Interventional Radiology Amongst Undergraduates in the UK.

INTRODUCTION: The role of interventional radiology (IR) in health care is rapidly expanding in the United Kingdom (UK). However, the presence of IR in the current undergraduate curriculum is lacking. PURPOSE: This study investigates the awareness, knowledge and perceptions of IR in undergraduates through the clinical years of medical school to suggest future interventions. METHODS: A total of 360 questionnaires, designed to test undergraduates' knowledge of, and exposure to, IR were distributed over a 14-day period in a UK medical institution. RESULTS: Of the 312 respondents (86.7%), the majority had never formally shadowed a radiologist (65.4%) or encountered teaching from an interventional radiologist (54.5%). Most students (88.5%) felt their knowledge of IR was lower than other specialties. Students' knowledge of IR procedures did not statistically increase through the clinical years. Students were most cognisant of vascular procedures and least aware of IR's role in oncology. Only 10.9% would consider a career in IR, with 39.7% citing the lack of knowledge and 18.6% citing patient contact as the top reasons for this. CONCLUSION: Current students have poor exposure to IR through the undergraduate curriculum. Consequently, there is no increase in knowledge of IR clinical practice through the clinical years. Multi-level interventions, incorporating universities and radiological societies are required to increase undergraduate awareness and promote IR as a career. LEVEL OF EVIDENCE: Level 3, Local non-random sample.

A Duodenal Ulcer Caused by Pancreatic Ductal Hypertension with Chronic Pancreatitis.

We herein describe the case of a 67-year-old woman with a duodenal ulcer thought to be caused by elevated pancreatic ductal pressure. The patient complained of continuous upper abdominal pain. Her medical history included idiopathic chronic pancreatitis. Endoscopy revealed a huge duodenal ulcer located on the inferior duodenal angle, which had not been seen on endoscopic retrograde pancreatography two months previously. A combination study using endoscopy and contrast imaging confirmed the relationship between the duodenal ulcer and the pancreatic branch duct. To our knowledge, this is the first case of duodenal ulcer thought to be caused by elevated pancreatic ductal pressure.

Liver abscess caused by CTX-M-55-type extended-spectrum ß-lactamase (ESBL)-producing Salmonella enteritidis.

Liver abscesses secondary to Salmonella species are rarely described in the general population. We herein describe a case of a liver abscess caused by CTX-M-55-type extended-spectrum ß-lactamase (ESBL)-producing Salmonella enteritidis, which has not been reported in the literature. A 54-year-old male was admitted due to a high fever and was clinically diagnosed with a liver abscess. Culture of the fluid from the liver abscess revealed CTX-M-55-type ESBL-producing S. enteritidis. Although the patient underwent percutaneous transhepatic abscess drainage and antibiotic therapy, he died one month later. It should be noted that liver abscesses are potentially fatal depending on the causative pathogen.