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Recent Submissions

  • Where does Pelvic and Acetabular Fracture Treatment fit into the Newly Proposed Major Trauma Model in Ireland?

    Fenelon, C; Murphy, E.P; O’Daly, B.J; Leonard, M (Irish Medical Journal, 2019-04)
    Major trauma continues to be the biggest cause of death in people aged between 5 and 45 years of age. Suboptimal trauma management results in greater ongoing costs to patients, hospitals and society. Trauma networks in the United States, Australia and more recently the United Kingdom have proven successful in significantly reducing morbidity and mortality. In the UK, analysis by the Trauma Audit Research Network (TARN) has shown that a major trauma patient has a 19% increase in the odds of survival following major trauma since its introduction in 2012. No integrated trauma network yet exists in Ireland but a recent report “A Trauma System for Ireland” published in January of 2018 outlined plans of how such a trauma network would be introduced. The report called for the introduction of two regional trauma networks, a central and south network, with one major trauma centre for each. However, the report made no mention of where the treatment of pelvic and acetabular fractures fell within it.
  • Primary External Ventricular Drains in the Management of Open Myelomeningocele Repairs in the Neonatal Setting in Ireland

    Finnegan, R; Kehoe, J; McMahon, O; Donoghue, V; Crimmins, D; Caird, J; Murphy, J (Irish Medical Journal, 2019-05)
    The aim of this study is to outline the role of primary external ventricular drains (EVD) in the management of open myelomeningoceles in the neonatal setting in Ireland.
  • Physiotherapist-Led Triage at a Rheumatology-Based Musculoskeletal Assessment Clinic: an 18-Month Service Evaluation of Activity and Outcomes

    Caffrey, Aoife; Smart, Keith M.; Fitzgerald, Oliver (American College of Rheumatology, 2019)
    Physiotherapist-led musculoskeletal triage clinics are an effective and efficient means of managing patients presenting with musculoskeletal disorders in primary and secondary care. Data regarding the activity and outcomes of physiotherapist-led triage in hospital-based outpatient rheumatology clinics are scarce. Thus, the aim of this study was to undertake a service evaluation of activity and outcomes of a physiotherapist-led rheumatologybased Musculoskeletal Assessment Clinic (MAC). The primary objective was to quantify the proportion of patients independently managed by the clinical specialist physiotherapists (CSPs).
  • Listeria Meningitis in an Immunocompetent Child: Case Report and Literature Review

    McCarthy, K.N; Leahy, T.R; Murray, D.M (Irish Medical Journal, 2019-05)
    Listeria monocytogenes is a facultatively anaerobic Gram-positive bacillus that is an unusual cause of illness among immunocompetent individuals1. Infection with listeria is most commonly encountered in pregnancy, the neonatal period, and in immunocompromised patients2. Risk factors include food-borne exposures, particularly to soft cheeses and delicatessen meats, and life stock exposure3. Meningitis is the most frequently encountered clinical syndrome. L. monocytogenes accounts for 20% of cases of meningitis in neonates and in those >60 years and is the most common cause of meningitis among immunocompromised individuals1. Listeriosis is a rare disease in Ireland with a crude incidence rate of 0.41 per 100,000 which is lower than the EU average of 0.48 per 100,000 4.
  • Estimated Weight of Paediatric Patients versus Measured Weight – A Prospective Comparison

    Lineen, C; O’Donnell, S; Birrane, K; O’Riordan, A; Twomey, J; Murphy, A.M; O’Gorman, C (Irish Medical Journal, 2019-04)
    Weight measurement is fundamental in the management of paediatric patients. Many methods have been described for estimating a patient’s weight. The aim of this study was to assess the accuracy of the APLS 2017 estimated weight guidelines.
  • Surgical Parathyroidectomy Services

    Burke, E; Waris, A; O’Donoghue, G (Irish Medical Journal, 2019-04)
    Retrospectively audit our experience with surgical parathyroidectomy over a 5 year period from the beginning of 2013 to June 2018.
  • Targeted Anti-D, The First Irish Perspective

    McCormick, C.A; Mulvany, L; De Tavernier, M.C (Irish Medical Journal, 2019-04)
    The use of anti-D to prevent haemolytic disease of the new-born can be regarded as one of the greatest success stories of modern medicine. Rhesus antibodies cause significant harm to rhesus positive foetuses in utero including anaemia, jaundice, hydrops fetalis and stillbirth. Deaths due to haemolytic disease of the new born have fallen dramatically. In the UK 1 in 2180 babies in 1953 died due to Rhesus haemolytic disease. 37 years later, in 1990, this figure had dropped to 1 in 62,500 1. Recent initiatives including the routine administration of anti-D at 28-32 weeks gestation have further reduced the incidence of sensitisation2.
  • Oxygen Therapy in Ireland: A Nationwide Review of Delivery, Monitoring and Cost Implications

    O’Donnell, C; Davis, P (Irish Medical Journal, 2019-05)
    Our aim was to establish which hospitals in Ireland are running oxygen clinics and to compare oxygen prescription in hospitals to a guideline standard. Long term oxygen therapy is known to be of benefit to a specific cohort of patients but is not without risk.
  • Audit of PPI Prescribing Practices: A Risk to Patient Safety?

    O’Connell, L; O’Connell, R.M; Ahmed, O; Mealy, K (Irish Medical Journal, 2019-04)
    Proton pump inhibitors (PPIs) are frequently prescribed to surgical patients (50-60%) to prevent gastrointestinal bleeding. However, most surgical patients are at low risk of significant bleeds. The aim of this audit was to identify inappropriate PPI prescribing, if any, in a cohort of surgical inpatients.
  • Can Early Changes in Vital signs Predict Duration of Antibiotic Therapy in Suspected Neonatal Sepsis?

    McGovern, M; Morrissey, P; Ryan, E (Irish Medical Journal, 2019-04)
    Suspected sepsis remains a leading causes of Neonatal Intensive Care Unit admission, with infants often receiving 48-72 hours of empirical antibiotic therapy. Early in treatment it is difficult to predict infants who will require prolonged antibiotic therapy. Our aim was to assess if vital sign measurements in the initial period of treatment can predict those neonates requiring prolonged antibiotic therapy in term and late-preterm infants.
  • An Under-Recognised Cause of Iatrogenic, Severe Metabolic Acidosis

    Spring, A; Owens, R; Fratita, M; O’Dwyer, M (Irish Medical Journal, 2019-04)
    Pyroglutamic acidosis is an uncommonly diagnosed but important cause of a high anion gap metabolic acidosis. Our case report concerns an elderly male admitted to the Intensive Care Unit (ICU) following the acute onset of coma which developed during treatment of a prosthetic joint infection. A diagnosis of pyroglutamic acidosis was ultimately made and later confirmed with laboratory testing. Blood gas analysis revealed a profound high anion gap metabolic acidosis.
  • Bereavement Counselling for Healthcare Workers in the Aftermath of Child Death

    O’Sullivan, D; Stone, G; Mahomed, H; O’Reilly, P; Stewart, P; Noonan, H; Murphy, A.M (Irish Medical Journal, 2019-05)
    To assess the views and experiences of bereavement counselling services among healthcare staff dealing with paediatric ward death at UHL.
  • Bilateral Plantar Fibromatosis

    Newman, C; McQuaid, S.E (Irish Medical Journal, 2019-04)
    Plantar fibromastosis is a hyperproliferative disorder of the plantar fascia which predominantly affects males over the age of fifty. Its etiology is incompletely understood; however up to 42% of affected patients also have a diagnosis of Diabetes Mellitus.
  • Congenital Atrial Haemangioma

    Daly, A; Franklin, O; Nölke, L (Irish Medical Journal, 2019-04)
    Cardiac hemangioma is a rare form of primary cardiac tumor. Only small a number of cardiac hemangioma cases have been reported in the literature and therefore appreciation of the best management strategies for primary cardiac tumors in neonates is somewhat lacking. We present the rare case of a neonate who presented with symptoms arising from a congenital atrial haemangioma on day three of life. This report serves to remind the paediatric medical community of the rare diagnosis of primary cardiac tumours, diagnostic clues and therapeutic interventions used to address this unusual diagnosis.
  • The Human Mesenteric Lymph Node Microbiome Differentiates Between Crohn's Disease and Ulcerative Colitis.

    Kiernan, Miranda G; Coffey, J Calvin; McDermott, Kieran; Cotter, Paul D; Cabrera-Rubio, Raul; Kiely, Patrick A; Dunne, Colum P (Journal of Crohn's and Colitis, 2019-01-01)
    Mesenteric lymph nodes are sites in which translocated bacteria incite and progress immunological responses. For this reason, understanding the microbiome of mesenteric lymph nodes in inflammatory bowel disease is important. The bacterial profile of Crohn’s disease mesenteric lymph nodes has been analysed using culture-independent methods in only one previous study. This study aimed to investigate the mesenteric lymph node microbiota from both Crohn’s disease and ulcerative colitis patients.
  • Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study.

    O'Donnell, Martin; Mente, Andrew; Rangarajan, Sumathy; McQueen, Matthew J; O'Leary, Neil; Yin, Lu; Liu, Xiaoyun; Swaminathan, Sumathi; Khatib, Rasha; Rosengren, Annika; Ferguson, John; Smyth, Andrew; Lopez-Jaramillo, Patricio; Diaz, Rafael; Avezum, Alvaro; Lanas, Fernando; Ismail, Noorhassim; Yusoff, Khalid; Dans, Antonio; Iqbal, Romaina; Szuba, Andrzej; Mohammadifard, Noushin; Oguz, Atyekin; Yusufali, Afzal Hussein; Alhabib, Khalid F; Kruger, Iolanthe M; Yusuf, Rita; Chifamba, Jephat; Yeates, Karen; Dagenais, Gilles; Wielgosz, Andreas; Lear, Scott A; Teo, Koon; Yusuf, Salim (BMJ, 2019-03-13)
    To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults.
  • Activation of a TLR9 mediated innate immune response in preeclampsia.

    Williamson, Rachel D; McCarthy, Fergus P; Kenny, Louise C; McCarthy, Cathal M (Scientific Reports, 2019-04-11)
    Preeclampsia is a multisystemic disorder leading to the development of a placental ischemic microenvironment with a resultant increase in oxidative stress. There is evidence that mitochondrial dysfunction and the innate immune system both play a role in the pathophysiology of this disease. Mitochondrial DAMPs such as mtDNA bind specifc pattern recognition receptors such as Toll-like receptor 9 (TLR9) on the endosomal surface of immune cells, in particular neutrophils, subsequently activating them and triggering an innate response. We hypothesised that the exaggerated innate immune response seen in preeclampsia is provoked by dysfunctional mitochondria. Here we provide evidence that TLR9 activity is signifcantly increased at time of disease in women with preeclampsia. Furthermore, we show activation of neutrophil markers, Calprotectin, Myeloperoxidase (MPO), and IL-8 are signifcantly increased at time of disease compared to uncomplicated pregnancies. This research supports a potential role of TLR9 activation of an innate immune response evident in preeclampsia which may possibly be initially triggered by dysfunctional mitochondria.
  • Mycoplasma Pneumonia: Late Treatment Leading to Acute Respiratory Distress Syndrome and Renal Failure.

    Cummiskey, A Graham; Reardon, Michael (European Journal of Case Reports in Internal Medicine, 2019-01-01)
    Mycoplasma pneumonia is one of the most common types of pneumonia, although it is often not diagnosed due to mild clinical course.
  • Transcriptome level analysis in Rett syndrome using human samples from different tissues.

    Shovlin, Stephen; Tropea, Daniela (Orphanet Journal of Rare Diseases, 2018-07-11)
    The mechanisms of neuro-genetic disorders have been mostly investigated in the brain, however, for some pathologies, transcriptomic analysis in multiple tissues represent an opportunity and a challenge to understand the consequences of the genetic mutation. This is the case for Rett Syndrome (RTT): a neurodevelopmental disorder predominantly affecting females that is characterised by a loss of purposeful movements and language accompanied by gait abnormalities and hand stereotypies. Although the genetic aetiology is largely associated to Methyl CpG binding protein 2 (MECP2) mutations, linking the pathophysiology of RTT and its clinical symptoms to direct molecular mechanisms has been difficult. One approach used to study the consequences of MECP2 dysfunction in patients, is to perform transcriptomic analysis in tissues derived from RTT patients or Induced Pluripotent Stem cells. The growing affordability and efficiency of this approach has led to a far greater understanding of the complexities of RTT syndrome but is also raised questions about previously held convictions such as the regulatory role of MECP2, the effects of different molecular mechanisms in different tissues and role of X Chromosome Inactivation in RTT. In this review we consider the results of a number of different transcriptomic analyses in different patients-derived preparations to unveil specific trends in differential gene expression across the studies. Although the analyses present limitations- such as the limited sample size- overlaps exist across these studies, and they report dysregulations in three main categories: dendritic connectivity and synapse maturation, mitochondrial dysfunction, and glial cell activity. These observations have a direct application to the disorder and give insights on the altered mechanisms in RTT, with implications on potential diagnostic criteria and treatments.
  • An Unusual Case of a Facial Guard Causing Penetrating Soft Tissue Injury in the Game of Hurling

    Farrell, T; McDonald, C.; Sheehan, E. (Irish Medical Journal, 2019-02)
    Hurling is a fast-paced impact sport that is known to be associated with trauma to the head, face and hands1. Helmets with facial guards have been introduced by the Gaelic athletic association (GAA) in 2010 as a means of preventing head and maxillofacial injuries. Although the national safety authority of Ireland (NSAI) identify certain standards for hurling helmets, modifications are known to be quite common2. A recent study by O’Connor (2018) showed that 31% of players surveyed from a total of 304 had modified their helmet in some fashion either by changing the faceguard completely or removal of single bars. The main reasons given for modification were; restricted vision, comfort and perceived poor quality of the helmet/faceguard. Anecdotally, players may modify one’s helmet to help improve peripheral vision and thus situational awareness. In the literature, there exists only one case of penetrating injury from a facial guard of a hurling helmet3. The trend of modifying helmets seems to be increasing the incidence of these serious injuries. We believe that there is a general lack of awareness among players and officials as to the dangers of modifying protective equipment. We present the case of a penetrating hand injury as a direct result of a modified facial guard where a single bar was removed.

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