Pregnancy Outcomes in Women with Sickle Cell Disease in Ireland: A Retrospective Review

Background: Sickle cell disease (SCD) is one of the most common single gene disorders worldwide and is characterised by significant morbidity and early mortality.[1] Pregnancy in SCD is associated with an increased risk of maternal and foetal complications.[2,3] The 2011 RCOG and the 2021 BSH guidelines[5,6] on the management of pregnancy in SCD have provided the basis for best practice care in the UK over the past decade and is the guidance which we follow in Ireland. To date, there is no published data on outcomes for pregnant women with SCD in Ireland. The number of Irish patients with SCD has risen over the past 20 years. Without a national database, the exact prevalence is not known but currently there are at least 600 adults and children with SCD in Ireland, whose population is just over 5 million.[4] Aims: Our study assesses outcomes of pregnant patients with SCD from 2015 to 2022. Our aims were to: * Assess adherence to current guidelines * Assess pregnancy outcomes and maternal complications * Assess transfusion rates amongst our patient cohort. Method(s): This is a retrospective cohort study. We do not have a directly matched cohort, but have compared our findings to published data on Irish pregnancy outcomes from the Irish Maternity Indicator System National Report and have correlated our findings with studies of women with SCD who were managed in UK centres.[8,9,10] Results: We reviewed outcomes of 29 pregnancies in 19 women over a 7-year period. The median age was 29 (range 20-41) and the predominant maternal sickle genotype was HbSS (65.5%). Before conception, 55.2% of cases had pre-existing complications of SCD, including acute chest syndrome (ACS), pulmonary hypertension (PHTN) and prior stroke. In accordance with current guidelines, 100% of women (n=29) were prescribed folic acid, penicillin, and aspirin prophylaxis. 51.7% (n=15) of women had documented maternal complications during pregnancy, including ACS (34%), vaso-occlusive crisis (34%), gestational diabetes (10%), VTE (3%) and UTI (3%). Two women (7%) developed Covid-19 pneumonitis despite vaccination. There was one case of maternal bacteraemia (3%). 65.5% of cases (n=19) required blood transfusion during pregnancy. One woman was already on a blood transfusion programme for disease modification prior to pregnancy. In 6 cases (20.6%), a transfusion programme was commenced during pregnancy due to prior pregnancy complications or intrauterine growth restriction. During pregnancy, 27.6% (n=8) of women required emergency red cell exchange for ACS. Prior studies have suggested that between 30% and 70% of pregnant women with SCD require at least one blood transfusion during pregnancy.[8,9,10] By comparison, only 2.6% of the Irish general obstetric population required transfusion during pregnancy.[7] 20.6% (n=6) of births were preterm at <37 weeks' gestation. There was one live preterm birth (3%) at <34 weeks and one intrauterine death (3%) at 23 weeks' gestation. Similar to UK data[9], 31% of women required critical care stay (n=9) during pregnancy, in comparison with 1.44% nationwide in 2020.[7] Conclusion(s): It is well established that pregnancy in SCD is high risk, and despite adherence to current guidelines, we have shown very high rates of critical care admission, significant transfusion requirement and hospital admissions. Our findings are comparable to published UK outcomes and they further support the need for a comprehensive specialist care setting for this patient cohort.

Cerebral Vasculopathy-Associated Ischemic Stroke in the Setting of Bacterial Meningitis

INTRODUCTION: Bacterial Meningitis is known to have high morbidity and mortality rates. A less recognized complication from this disease includes acute ischemic stroke, which conveys a worse prognosis. DESCRIPTION: A 37-year-old previously healthy woman presented to the hospital with progressive encephalopathy associated with ataxia and dysarthria. Her immediate past travel history revealed a trip to Europe where she endured a COVID19 infection three weeks before her admission. Nevertheless, she recovered without any complications. However, she developed fatigue and headaches, prompting a diagnosis of post-COVID19 syndrome by her primary care physician. Over the course of several days, her ability to carry out her normal daily activities and perform work-related duties deteriorated as she developed severe fatigue accompanied by a painless diffuse skin rash. She presented to the ED once she started having symptoms of dysarthria, abasia, and truncal ataxia. An emergently obtained CSF sample was consistent with bacterial meningitis. Standard empiric antibiotics and steroids were administered. The patient's condition acutely decompensated soon after antibiotics administration. A follow-up head CT showed global cerebral edema and hydrocephalus, triggering an EVD placement for ICP monitoring. An MRI brain showed multiple bilateral acute ischemic strokes in the brainstem and basal ganglia. A head CT angiography showed diffuse narrowing of the cerebral arteries. The patient ultimately completed a course of antibiotics (Neisseria PCR was positive). We used TCD-guided blood pressure augmentation to prevent the progression of cerebral ischemia. The patient was discharged on long-term steroid therapy for presumed post-infectious vasculopathy. A follow-up MRI brain did not reveal a progression of cerebral ischemia. DISCUSSION: Bacterial Meningitis is a severe disease with significant complications. One such complication is ischemic stroke. However, the exact pathophysiology is unknown. Understanding the risks of developing cerebral ischemia and the related pathophysiology could help improve patient outcomes with better treatment modalities. The interplay between COVID19 infection and conventional infectious pathogens is an ongoing area of interest.

DELIRIUM IN OLDER ADULTS

Delirium, a neurobehavioral syndrome, is characterized by fluctuating attention and rapid changes in cognition occurring over a short period of time. This chapter reviews the disorder, which is common in hospitalized older adults (age 65+) and is closely linked with the most prevalent diseases and complications in this population. Delirium is often the first clinical manifestation of critical illness in this age group. We provide the definition of delirium and its prevalence and discuss conceptual issues, including the major theories of its pathogenesis, the evolution of delirium over time, and risk factors. We then describe the assessment of delirium, including medical/psychological approaches and controversies. Finally, we propose means of prevention and management of delirium. A special note is also included addressing delirium in the context of the COVID-19 pandemic. © 2022 selection and editorial matter, Shane S. Bush and Brian P. Yochim individual chapters, the contributors.

Existential Implications of Internet Gaming Disorder (IGD)

Internet gaming disorder (IGD), a condition warranting further study in the Diagnostic and Statistical Manual 5, has received considerable research attention in recent years (American Psychiatric Association, 2013). Characterized by problematic and repetitive use of Internetbased games, research suggests a complex etiology and that frequent usage, in and of itself, is not necessarily always problematic. Common motivations for intense usage, such as feelings of isolation, distress, and boredom may, in part, reflect an individual’s best attempts to navigate contact with the ‘ultimate’ anxieties identified by Yalom (1980). This article reviews the research pertaining to IGD, conceptualizes the disorder from an existentialhumanistic therapy (E-H) perspective, and concludes with an explanation of how E-H can offer a unique treatment perspective from which to work with clients struggling with problematic online gaming concerns within the context of the COVID-19 pandemic and beyond. © 2021 American Psychological Association

Psychology for sustainability: 5th edition

Psychology for Sustainability applies psychological science to so-called environmental problems that manifest when human behavior disrupts and degrades natural systems. Drawing on environmental psychology, ecopsychology, conservation psychology, and related disciplines, the authors provide an extensive review of relevant theory and research in a lively and easy-to-read style. This edition represents a substantial revision and expansion spurred by a burgeoning body of research and by global ecological, political, and social developments. Particular attention is paid to environmental justice and collective action for systems change. More than one-third of the content is entirely new, and there are more than nine hundred new references. This edition also features a new full-color design and over two hundred full-color fgures, tables, and photos. Timely topics include climate change, biodiversity loss, environmental racism, Indigenous perspectives, social media, and COVID-19 and other pandemics. Content retained from the previous edition has been updated throughout. The twelve chapters are organized into four parts: 1.What on Earth Are We Doing includes a prologue on psychology as a sustainability science, followed by three chapters that provide an overview of the ecological crisis and its historical origins and offer a vision for a sustainable future. 2.Psychology for a Sustainable Future encompasses fve chapters on research methods, theory, and fndings pertinent to understanding and shifting unsustainable behavior. 3.What’s Good for the Planet Is Good for Us includes two chapters that address the reciprocal relationship between planetary health and human health. 4.Being the Change We Want to See introduces two new chapters to inspire readers to take what they have learned and apply it as changemakers in the world. The frst is about collective action for systemic change. The second presents a positive psychology perspective on how to tackle the ecological crisis in a way that promotes wellbeing and resilience and is personally meaningful and fulflling. Carefully tailored to the length of a standard college semester, Psychology for Sustainability is essential reading for courses on sustainability across disciplines. It will be invaluable to people outside academia as well, including policymakers, legislators, and those working on building sustainable communities. The text is also supplemented by online resources for instructors.