Sligo General Hospital

Heart failure (HF) remains a global health challenge, necessitating improved risk stratification tools. This systematic review evaluates the combined role of epicardial fat thickness (EFT) and B-type natriuretic peptide (BNP)/N-terminal pro B-type natriuretic peptide (NT-proBNP) in HF risk stratification, examining their pathophysiological interplay and clinical utility across diverse populations, including a wide age range, various comorbidities (e.g., obesity, diabetes, and systemic sclerosis), and geographic regions. EFT, a measurable marker of epicardial adipose tissue (EAT) located between the myocardium and visceral pericardium, was evaluated alongside BNP/NT-proBNP, established biomarkers of cardiac stress. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, 12 case-control studies were included after screening 192 records from PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library. Studies assessed EFT and BNP/NT-proBNP in HF or at-risk populations. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS). EFT consistently correlated with elevated BNP/NT-proBNP, though patterns differed by HF phenotype. In HF with reduced ejection fraction (HFrEF), NT-proBNP associated more strongly with muscle loss than adiposity, while in HF with preserved ejection fraction (HFpEF), EFT was linked to metabolic comorbidities and inflammatory markers. Paradoxically, lower EFT predicted worse outcomes in nonischemic cardiomyopathy (NICMP), potentially reflecting disease-related fat depletion or cachexia; this finding underscores the need for phenotype-specific interpretation of EFT in risk stratification. Mechanistically, EAT contributed to myocardial remodeling via adipokine secretion and inflammatory signaling. Four studies had a low risk of bias (NOS ≥ 8), while one showed a high risk. The combined assessment of EFT and BNP/NT-proBNP offers complementary prognostic insights, EFT capturing subclinical inflammation and adiposity-related remodeling, while BNP/NT-proBNP reflects myocyte stress, potentially guiding personalized treatment decisions, including closer monitoring of HFpEF patients with elevated EFT and early nutritional or anti-inflammatory interventions in those with muscle loss and elevated NT-proBNP. Inclusion criteria encompassed adult populations with HF or related conditions, with exclusion of reviews, case reports, and non-English articles, supporting the methodological rigor of this synthesis. Standardized EFT measurement and targeted EAT-modulating therapies warrant further investigation.

Femoral hernias are at a high risk of strangulation due to their narrow necks. They are an exceptionally rare occurrence in males. In many cases, differentiation between a femoral and inguinal hernia is difficult. We present the case of a bilateral strangulated femoral hernia in a 70-year-old male. To our knowledge, there has been only one previously published report of such a case in males. Our patient presented with generalized abdominal pain and bilateral irreducible groin swellings, originally thought to be bilateral strangulated inguinal hernia. Upon initial inguinal incision, a diagnosis of a strangulated femoral hernia was made. A modified lower midline laparotomy incision was made to gain access to and diagnose both femoral hernias and allow for bowel resection and abdominal washout. Our case highlights the importance of modifying the surgical approach when encountering with a different diagnosis intraoperatively.

Ireland has low provision rates of general and forensic beds compared with other western countries. In recent years there have been difficulties and delays in accessing forensic beds for prisoners with severe mental illness.

We aimed to determine clinical outcomes for male prisoners assessed as requiring psychiatric admission over an extended period, with time frames for admission and other outcomes. We aimed to determine whether admissions to forensic and non-forensic locations were risk-appropriate.

Participants included all male prisoners placed on psychiatric admission waiting lists in Ireland over five years 2015-2019. We described demographic, clinical and offending variables. We measured clinical outcomes including forensic admission, other admission and recovery with voluntary treatment in prison. We also measured times to clinical outcomes. Security requirements and clinical urgency were assessed using the DUNDRUM Toolkit scales 1 and 2.

541 male prisoners were placed on admission waiting lists and spent an aggregate of over 114 years on admission waiting lists during 2015-2019. Almost one quarter improved with voluntary treatment allowing removal from waiting lists, while over 75% did not. Admission was achieved for a majority of cases, albeit after lengthy delays for some. The most frequent outcome was diversion from remand to non-forensic inpatient settings. Non-forensic admissions arranged by the Prison Inreach and Court Liaison Service (PICLS) at Ireland's main remand prison at Cloverhill contributed 54% (179/332) of all admissions achieved and 76% (179/235) of all non-forensic admissions from prison waiting list. Median delay to admission was 59 days for forensic admissions and 69 days for admissions to non-forensic hospitals from sentenced settings, compared with 16.5 days for admissions to non-forensic hospitals from remand.

Long delays for forensic admission during a five-year period of limited access to such beds were partly mitigated by transfers to non-forensic hospitals, mainly diversion of minor offenders from remand settings.