• H1N1 influenza in an Irish population: patterns of chest radiograph abnormality in patients testing positive.

      O'Sullivan, K; Halpenny, D; McNeill, G; Torreggiani, W; Department of Radiology, AMNCH, Tallaght, Dublin 24 (2012-02-29)
      The winter of 2010/2011 saw a second peak in the number of H1N1 cases detected in Ireland. The purpose of this study was to investigate the radiological characteristics of patients diagnosed during this period. A retrospective analysis of these cases was performed. Chest radiographs were classified as normal or abnormal. A total of 37 patients were included. Of these, 22 (59%) of chest radiographs were abnormal and 15 (41%) were normal. In the 7 paediatric patients, 4 (57%) had a perihilar distribution of disease, 2 (28%) had peripherally based disease with 1 (14%) having a mixed distribution. A series of radiographs was available for 9 patients, 6 of these showed a radiographic deterioration from the initial study. The majority of chest radiographs of patients with confirmed H1N1 infection will be abnormal. In children, disease is more likely to be perihilar in distribution. Chest radiography is an important initial investigation in patients with H1N1 infection and is useful to track progression of disease in the subset of patients requiring hospitalization for severe disease.
    • Haematological abnormalities in Adults with Down’s Syndrome

      McClean, S; McHale, C; Enright, H (Irish Journal Medical Science, 2009)
    • Haematological emergencies managing hypercalcaemia in adults and children with haematological disorders.

      Sargent, Jeremy T S; Smith, Owen P; Trinity College, and Department of Haematology & Oncology, Our Lady's Children's , Hospital, Crumlin, Dublin, Ireland. (2012-02-01)
      Hypercalcaemia is a common metabolic complication of malignant disease often requiring emergency intervention. Although it is more frequently associated with solid tumours, malignancy-associated hypercalcaemia (MAH) is seen in a significant number of patients with blood diseases. Its association with myeloma and adult T-cell leukaemia/lymphoma is well recognized but the incidence of hypercalcaemia in other haematological neoplasms, affecting adults and children, is less clearly defined. Haematologists need to be familiar with the clinical manifestations of, the differential diagnosis to be considered and the most effective management strategies that are currently available for MAH. The key components of management of MAH include aggressive rehydration, specific therapy to inhibit bone resorption and, crucially, treatment of the underlying malignancy. Bisphosphonates have revolutionized the management of MAH over the last 20 years, however the elucidation of molecular pathways implicated in MAH is facilitating the development of more targeted approaches to treatment.
    • Hairball--a case of mistaken identity.

      Kelly, M E; Ferede, A; Corbally, M; Our Lady's Children's Hospital, Crumlin, Dublin 12. kellym11@tcd.ie (2012-02-01)
      We report a classical presentation of trichobezoar in an 8 year old girl who was referred for consultation querying a probable abdominal neoplasm in the left upper quadrant. A large mobile mass was palpable in the left upper quadrant extending toward the umbilicus. Of note, she also had symptoms of recurrent abdominal pain, nausea, vomiting and halitosis. Although a rare occurrence, trichobezoar must be considered as a differential diagnosis in a patient who had a history of pica, presenting with an abdominal mass.
    • Hand dominance in orthopaedic surgeons.

      Lui, Darren F; Baker, Joseph F; Nfila, Gala; Perera, Anthony; Stephens, Michael; Department of Trauma and Orthopaedics, Cappagh, National Orthopaedic Hospital, Finglas, Dublin, Ireland. darrenflui@gmail.com (Acta orthopaedica Belgica, 2012-08)
      Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.
    • Hand weakness in Charcot-Marie-Tooth disease 1X.

      Arthur-Farraj, P J; Murphy, S M; Laura, M; Lunn, M P; Manji, H; Blake, J; Ramdharry, G; Fox, Z; Reilly, M M; MRC Centre for Neuromuscular Diseases, Department of Molecular Neuroscience, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. p.arthurfarraj@gmail.com (Neuromuscular disorders : NMD, 2012-07)
      There have been suggestions from previous studies that patients with Charcot-Marie-Tooth disease (CMT) have weaker dominant hand muscles. Since all studies to date have included a heterogeneous group of CMT patients we decided to analyse hand strength in 43 patients with CMT1X. We recorded handedness and the MRC scores for the first dorsal interosseous and abductor pollicis brevis muscles, median and ulnar nerve compound motor action potentials and conduction velocities in dominant and non-dominant hands. Twenty-two CMT1X patients (51%) had a weaker dominant hand; none had a stronger dominant hand. Mean MRC scores were significantly higher for first dorsal interosseous and abductor pollicis brevis in non-dominant hands compared to dominant hands. Median nerve compound motor action potentials were significantly reduced in dominant compared to non-dominant hands. We conclude that the dominant hand is weaker than the non-dominant hand in patients with CMT1X.
    • Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models.

      Leblanc, Fabien; Senagore, Anthony J; Ellis, Clyde N; Champagne, Bradley J; Augestad, Knut M; Neary, Paul C; Delaney, Conor P; Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5047, USA. (Journal of surgical education, 2010)
      The aim of this study was to compare a simulator with the human cadaver model for hand-assisted laparoscopic colorectal skills acquisition training.
    • Hand-assisted versus straight laparoscopic sigmoid colectomy on a training simulator: what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator.

      Leblanc, Fabien; Delaney, Conor P; Ellis, Clyde N; Neary, Paul C; Champagne, Bradley J; Senagore, Anthony J; Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA. (World journal of surgery, 2010-12)
      We hypothesized that simulator-generated metrics and intraoperative errors may be able to differentiate the technical differences between hand-assisted laparoscopic (HAL) and straight laparoscopic (SL) approaches.
    • The hardness test is key to diagnosis of factitious calcium carbonate stones.

      McGing, Peadar G; Mulready, Keith J; McGoldrick, Desmond; Department of Clinical Chemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland. (2013-09-25)
    • Harlequin Ichthyosis – A Case Report

      Ugezu, C H; Mazumdar, A; Dunn, E; Das, A (Irish Medical Journal, 2017-07)
      Harlequin Ichthyosis is a very rare genetic disorder affecting mainly the skin with severe morbidity and mortality. It affects both sexes with incidence of about 1 in 300,000 live births. Autosomal recessive inheritance has been inferred with mutation in ABCA 12 gene identified. Hence, genetic counseling and mutation screening of this gene should be considered in at-risk patients. Death usually occurred in the first 3 months of life due to sepsis, feeding problems and respiratory distress. With improved neonatal care and early introduction of retinoids, its survival rate has increased.
    • Has the ThinPrep method of cervical screening maintained its improvement over conventional smears in terms of specimen adequacy?

      Treacy, A; Reynolds, J; Kay, E W; Leader, M; Grace, A; Department of Pathology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. anntreacy@mac.com (2009-04)
      Liquid-based cytology (LBC) has replaced conventional smear assessment in many centers over recent years. In our laboratory this transfer took place in 1999. At that time we performed a split sample study comparing the conventional method of cervical smear evaluation with the ThinPrep system. This split sample study identified a dramatic improvement in specimen adequacy with LBC. While 11% of conventional preparations were reported as unsatisfactory and almost 9% were reported as suboptimal, evaluation of the same cases using LBC saw this combined figure reduced to 2.3%. AIM: To evaluate whether this dramatic fall in unsatisfactory smears has been maintained with the use of LBC. The database for all smears reported for 2005 (100% LBC) was interrogated. The number of unsatisfactory reports was calculated. The reason for an unsatisfactory report was recorded for each case. The overall unsatisfactory rate was compared with that reported in the 1999 split sample study. A total of 41,312 smear tests were reported in 2005. 1,342 (3.25%) were reported as unsatisfactory. Our findings support the ongoing value of LBC in a routine cervical screening laboratory in terms of continuing to maintain a low rate of unsatisfactory smears.
    • HDACi: cellular effects, opportunities for restorative dentistry.

      Duncan, H F; Smith, A J; Fleming, G J P; Cooper, P R; Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland. (2011-12)
      Acetylation of histone and non-histone proteins alters gene expression and induces a host of cellular effects. The acetylation process is homeostatically balanced by two groups of cellular enzymes, histone acetyltransferases (HATs) and histone deacetylases (HDACs). HAT activity relaxes the structure of the human chromatin, rendering it transcriptionally active, thereby increasing gene expression. In contrast, HDAC activity leads to gene silencing. The enzymatic balance can be 'tipped' by histone deacetylase inhibitors (HDACi), leading to an accumulation of acetylated proteins, which subsequently modify cellular processes including stem cell differentiation, cell cycle, apoptosis, gene expression, and angiogenesis. There is a variety of natural and synthetic HDACi available, and their pleiotropic effects have contributed to diverse clinical applications, not only in cancer but also in non-cancer areas, such as chronic inflammatory disease, bone engineering, and neurodegenerative disease. Indeed, it appears that HDACi-modulated effects may differ between 'normal' and transformed cells, particularly with regard to reactive oxygen species accumulation, apoptosis, proliferation, and cell cycle arrest. The potential beneficial effects of HDACi for health, resulting from their ability to regulate global gene expression by epigenetic modification of DNA-associated proteins, also offer potential for application within restorative dentistry, where they may promote dental tissue regeneration following pulpal damage.
    • HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk.

      Cooney, M T; Dudina, A; De Bacquer, D; Wilhelmsen, L; Sans, S; Menotti, A; De Backer, G; Jousilahti, P; Keil, U; Thomsen, T; et al. (Atherosclerosis, 2009-10)
      We aimed to clarify some previous inconsistencies regarding the role of high density lipoprotein cholesterol (HDL-C) as a CVD protective factor.
    • Head and neck cancer of unknown primary site

      McArdle, Orla; McDermott, Ronan (2013-11-21)
    • Heading for a fall? Management of head injury in infants

      Williamson, M; Keenan, P; McKay, M; Kuan, S (Irish Medical Journal, 2010-09)
    • Headshop heartache: acute mephedrone 'meow' myocarditis.

      Nicholson, Patrick J; Quinn, Martin J; Dodd, Jonathan D; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
    • The healing of bony defects by cell-free collagen-based scaffolds compared to stem cell-seeded tissue engineered constructs.

      Lyons, Frank G; Al-Munajjed, Amir A; Kieran, Stephen M; Toner, Mary E; Murphy, Ciara M; Duffy, Garry P; O'Brien, Fergal J; Department of Anatomy, Royal College of Surgeons in Ireland, Dublin 2, Ireland. (2010-12)
      One of the key challenges in tissue engineering is to understand the host response to scaffolds and engineered constructs. We present a study in which two collagen-based scaffolds developed for bone repair: a collagen-glycosaminoglycan (CG) and biomimetic collagen-calcium phosphate (CCP) scaffold, are evaluated in rat cranial defects, both cell-free and when cultured with MSCs prior to implantation. The results demonstrate that both cell-free scaffolds showed excellent healing relative to the empty defect controls and somewhat surprisingly, to the tissue engineered (MSC-seeded) constructs. Immunological analysis of the healing response showed higher M1 macrophage activity in the cell-seeded scaffolds. However, when the M2 macrophage response was analysed, both groups (MSC-seeded and non-seeded scaffolds) showed significant activity of these cells which are associated with an immunomodulatory and tissue remodelling response. Interestingly, the location of this response was confined to the construct periphery, where a capsule had formed, in the MSC-seeded groups as opposed to areas of new bone formation in the non-seeded groups. This suggests that matrix deposited by MSCs during in vitro culture may adversely affect healing by acting as a barrier to macrophage-led remodelling when implanted in vivo. This study thus improves our understanding of host response in bone tissue engineering.
    • A health and safety survey of Irish funeral industry workers.

      Kelly, N; Reid, A; Occupational Health Unit, The Adelaide and Meath Hospital, incorporating the, National Children's Hospital, Dublin 24, Ireland. nualakelly@physicians.ie (2012-02-01)
      BACKGROUND: Those handling deceased individuals, including the funeral industry, face a variety of health and safety hazards including occupationally acquired infectious disease. AIMS: To identify the knowledge, attitudes and beliefs of Irish funeral industry workers towards occupational hazards and infectious disease in 2009. METHODS: The sample analysed consisted of all listed member premises of the Irish Association of Funeral Directors as at 1 July 2009. A postal survey was sent to each premises in July 2009, with two rounds of follow-up reviews sent to non-responders. Four main areas were covered--occupational hazards, embalming, industry expertise and demographics. The quantitative and qualitative results were analysed to assess knowledge, attitudes and beliefs. Data collection was completed on 31 December 2009. RESULTS: Two hundred and thirty listed member premises were contacted. Twenty-two were unsuitable for the survey. One hundred and thirty-eight valid replies were received from 130 premises, representing a premises response rate of 63% (130/208). Seventy-three premises (56%) identified themselves as embalmers. Embalmers had variable vaccine uptake and variable knowledge, attitude and beliefs towards embalming those with blood-borne viruses. Fifteen per cent of respondents reported a work-related injury, back injury being the most common. Splash and sharps injuries were reported as a work-related injury, and infections believed to be work related were also reported. CONCLUSIONS: This study demonstrates widespread occupational health concerns among this professional group. It confirms the need for occupational health advice and services. There is also a strong desire for regulation of this profession in Ireland.
    • The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

      Varley, J; Delanty, N; Normand, C; Fitzsimons, M; Epilepsy Research Department, Beaumont Hospital, Dublin, Ireland. trimvarleys@gmail.com (2011-02)
      Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.
    • The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

      Varley, J; Delanty, N; Normand, C; Fitzsimons, M; Epilepsy Research Department, Beaumont Hospital, Dublin, Ireland., trimvarleys@gmail.com (2012-02-01)
      Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.