• James Connolly Memorial Hospital annual report 1993

      James Connolly Memorial Hospital (Eastern Health Board (EHB), 1993)
      1993 was a very busy year for James Connolly Memorial Hospital with activity in all hospital services continuing at a high level. The bed occupancy in the medical area was over 94% with the occupancy in the surgical area in excess of 96%. Emergency admissions accounted for over 75% of all admissions. The average length of stay for medical patients is over eight days. This high average is partly attributable to a number of patients who were inappropriately kept in acute medical beds while appropriate long term care was being sought for them. The average length of stay for surgical patients is less than six days.
    • James Connolly Memorial Hospital annual report 1994

      James Connolly Memorial Hospital (Eastern Health Board (EHB), 1994)
      Hospital Activity 1994 was again a very busy year for the hospital with service activity increasing in many areas. Demands for in-patient services were particularly high throughout the year which resulted in our bed occupancy reaching 100%. This occupancy was achieved through the use of additional beds in the wards. This practice places great strain and demands on patients and staff alike. Staff are to be complimented for their dedication and commitment while working under extremely difficult conditions. The Hospital Management recognises that the primary function of the hospital is the provision of an Accident & Emergency Service and in meeting this commitment the hospital found it necessary on an on-going basis to cancel elective/planned admissions.
    • JNK mitogen-activated protein kinase limits calcium-dependent chloride secretion across colonic epithelial cells.

      Donnellan, Fergal; Keating, Niamh; Geoghegan, Paul; Murray, Frank E; Harvey, Brian J P; Keely, Stephen J; Dept. of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Ctr., Smurfit Bldg., Beaumont Hospital, Dublin 9, Ireland. (2010-01)
      Neuroimmune agonists induce epithelial Cl(-) secretion through elevations in intracellular Ca2+ or cAMP. Previously, we demonstrated that epidermal growth factor receptor (EGFR) transactivation and subsequent ERK MAPK activation limits secretory responses to Ca2+-dependent, but not cAMP-dependent, agonists. Although JNK MAPKs are also expressed in epithelial cells, their role in regulating transport function is unknown. Here, we investigated the potential role for JNK in regulating Cl(-) secretion in T(84) colonic epithelial cells. Western blot analysis revealed that a prototypical Ca2+-dependent secretagogue, carbachol (CCh; 100 microM), induced phosphorylation of both the 46-kDa and 54-kDa isoforms of JNK. This effect was mimicked by thapsigargin (TG), which specifically elevates intracellular Ca2+, but not by forskolin (FSK; 10 microM), which elevates cAMP. CCh-induced JNK phosphorylation was attenuated by the EGFR inhibitor, tyrphostin-AG1478 (1 microM). Pretreatment of voltage-clamped T(84) cells with SP600125 (2 microM), a specific JNK inhibitor, potentiated secretory responses to both CCh and TG but not to FSK. The effects of SP600125 on CCh-induced secretion were not additive with those of the ERK inhibitor, PD98059. Finally, in apically permeabilized T(84) cell monolayers, SP600125 potentiated CCh-induced K+ conductances but not Na+/K+ATPase activity. These data demonstrate a novel role for JNK MAPK in regulating Ca2+ but not cAMP-dependent epithelial Cl(-) secretion. JNK activation is mediated by EGFR transactivation and exerts its antisecretory effects through inhibition of basolateral K+ channels. These data further our understanding of mechanisms regulating epithelial secretion and underscore the potential for exploitation of MAPK-dependent signaling in treatment of intestinal transport disorders.
    • Junior doctors and undergraduate teaching: the influence of gender on the provision of medical education.

      Prichard, David; Collins, Niamh; Boohan, Mairead; Wall, Catherine; Department of Nephrology, Adelaide and Meath Hospital, Incorporating the National, Children's Hospital, Dublin, Ireland. (2012-02-01)
      BACKGROUND: International experience has demonstrated that the medical profession is becoming less dominated by men. This "feminization of medicine" has been a topic of much debate in the medical literature. As the gender ratio in the profession changes, it is likely that a greater proportion of undergraduate education will be provided by women. Whether this shift away from the male-dominated provision of medical education will have an effect on undergraduate education is unknown. PURPOSE: The aim of this research was to clarify whether there are differences between the attitudes and practices of male and female junior doctors regarding the practice of undergraduate teaching. METHOD: A survey methodology among a cohort of nonconsultant hospital doctors in a major Irish teaching hospital was utilized. The overall response rate was 93%. The cohort held a positive attitude toward teaching undergraduates, and the majority were actively engaged in this activity. Doctors of both genders expressed a willingness to undertake teacher training. RESULTS: There were no significant differences between the genders regarding the self-reported quantity of teaching provided to undergraduates. Male doctors perceived themselves as more confident educators when compared to female doctors, but this is likely to reflect cohort demographics in which a greater proportion of male doctors were more senior. CONCLUSIONS: This study demonstrates that male and female doctors have similar attitudes toward, and practices in, voluntary undergraduate teaching. As a result, any gender shift in medicine is unlikely to result in a significant change in junior doctors' attitudes toward undergraduate medical education.
    • Just as the twig is bent, the tree's inclined: lessons from the future of surgical education.

      Winter, Desmond C; Institute for Clinical Outcomes Research and Education (iCORE) and Department of , Surgery, St Vincent's University Hospital, Dublin, Ireland. winterd@indigo.ie (2012-02-01)
    • Juvenile folliculotropic and ichthyosiform mycosis fungoides.

      Ryan, C; Whittaker, S; D'Arcy, C; O'Regan, G M; Rogers, S; Department of Dermatology, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. caitrionaryan80@hotmail.com (2012-02-01)
      Ichthyosiform mycosis fungoides (MF) is a recently recognized clinical variant of MF, which appears as dry scaling patches and plaques, or as a generalized eruption. Acquired ichthyosis is well recognized as a paraneoplastic cutaneous presentation of malignancy, especially in lymphoproliferative disorders. In contrast, the ichthyosiform eruption in ichthyotic MF is attributable to infiltration of the skin by tumour cells. We report the case of a 15-year-old boy who presented with a 5-year history of enlarging pruritic plaques on the forehead and back, patchy alopecia and generalized ichthyosis. Histology of the forehead and back showed a dense, lymphocytic, folliculocentric and perivascular infiltrate of predominantly CD4-positive T cells consistent with folliculotropic MF. Histological examination of biopsies from ichthyotic skin found similar features. Our patient had a histological diagnosis at the age of 15 years, making him the youngest reported patient with either folliculotropic MF or ichthyotic MF.
    • Juxta-articular myxoma: an unusual benign mesenchymal lesion, readily mistaken for malignancy

      Beggan, C; Davies, K; Kinsella, J; Leader, M (Irish Medical Journal, 2014-07)
      Myxomas are benign tumours of mesenchymal origin. We describe the 1st reported case of paraspinal juxta-articular myxoma. Juxta-articular myxomas show increased cellularity and distinction from cellular myxoma is required. The differential also includes malignant myxofibrosarcoma. For patient prognosis and management it is essential to separate these entities. Complete surgical excision is the mainstay of treatment as local recurrences may occur.
    • KAT6A Syndrome: genotype-phenotype correlation in 76 patients with pathogenic KAT6A variants.

      Kennedy, Joanna; Goudie, David; Blair, Edward; Chandler, Kate; Joss, Shelagh; McKay, Victoria; Green, Andrew; Armstrong, Ruth; Lees, Melissa; Kamien, Benjamin; et al. (2018-09-24)
      Purpose: Pathogenic variants in KAT6A have recently been identified as a cause of syndromic developmental delay. Within 2 years, the number of patients identified with pathogenic KAT6A variants has rapidly expanded and the full extent and variability of the clinical phenotype has not been reported. Methods: We obtained data for patients with KAT6A pathogenic variants through three sources: treating clinicians, an online family survey distributed through social media, and a literature review. Results: We identified 52 unreported cases, bringing the total number of published cases to 76. Our results expand the genotypic spectrum of pathogenic variants to include missense and splicing mutations. We functionally validated a pathogenic splice-site variant and identified a likely hotspot location for de novo missense variants. The majority of clinical features in KAT6A syndrome have highly variable penetrance. For core features such as intellectual disability, speech delay, microcephaly, cardiac anomalies, and gastrointestinal complications, genotype- phenotype correlations show that late-truncating pathogenic variants (exons 16-17) are significantly more prevalent. We highlight novel associations, including an increased risk of gastrointestinal obstruction. Conclusion: Our data expand the genotypic and phenotypic spectrum for individuals with genetic pathogenic variants in KAT6A and we outline appropriate clinical management.
    • Kawasaki Disease – A Review of Treatment and Outcomes in an Irish Paediatric Cohort 2010-14.

      Flinn, AM; Gavin, PJ; McMahon, CJ; Oslizlok, P; Butler, KM (Irish Medical Journal, 2018-02)
      Diagnosis of Kawasaki Disease (KD) can be challenging due to lack of a diagnostic test, and some children present with ‘incomplete’ KD when not all diagnostic criteria are met. Treatment with intravenous immunoglobulin (IVIG) and aspirin reduces the risk of coronary artery complications. There is sub-group of patients who are resistant to IVIG/aspirin therapy and are at increased risk of complications. Recent evidence suggests that additional treatment of this high-risk group with corticosteroids is beneficial in reducing this risk. We examine the treatment and coronary artery outcomes, by retrospective review of medical records, of a cohort of 32 paediatric patients with KD admitted to a single Irish tertiary centre from January 2010-December 2014. Twenty-eight percent of patients (9/32) had an incomplete diagnosis of KD; these patients received IVIG later compared to those with a complete KD diagnosis. 15/32 (47%) had abnormal echocardiogram findings in the acute phase, 8/32 (25%) had echocardiogram abnormalities at 6-week follow-up, and 4/32 (12.5%) had persisting abnormalities. This study highlights the potential for adverse outcome in KD, the difficulty in diagnosis in ‘incomplete’ cases, and the need to identify children at higher risk for adverse outcome where adjunctive therapies would be most beneficial.
    • Key Performance Indicators in Paediatric Anaesthesia

      Doody, K; Barry, D; Holmes, C (Irish Medical Journal, 2019-07)
      Currently no national guidelines on performance measurement exist for paediatric anaesthesia in Ireland1. The purpose of this study was to ascertain if we are achieving Key Performance Indicators (KPIs) in areas of post-operative nausea and vomiting (PONV) and post-operative pain when compared to international standards.
    • Kicking society's tobacco habit: does the butt stop here?

      Winter, Desmond C; Institute for Clinical Outcomes Research and Education, St Vincent's University Hospital, Elm Park, Dublin 00004, Ireland. des.winter@gmail.com (2012-04)
    • Kikuchi-Fujimoto disease--an unusual mimicker?

      Scully, Diarmaid F; Walsh, Ceara; Eskander, Hala F; Kane, David; Department of Rheumatology, Adelaide and Meath incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. discully@tcd.ie. (2013)
      We describe the case of a 27-year-old Chinese female diagnosed with Kikuchi-Fujimoto disease in Ireland. It principally occurs in Asian populations, but is being increasingly reported in non-Asian populations. This rare, benign disease may potentially be misdiagnosed as lymphoma, and has an association with the subsequent development of systemic lupus erythematosus. Clinicians and pathologists need to be aware of the clinical and histological features of this rare disorder to avoid misdiagnosis.
    • Kindling-induced potentiation of excitatory and inhibitory inputs to hippocampal dentate granule cells. II. Effects of the NMDA antagonist MK-801.

      Robinson, G B; Department of Psychology, University of New Brunswick, Fredericton, Canada. (1991-10-18)
      The effect of the non-competitive N-methyl-D-aspartate antagonist MK-801 on the early development of kindling-induced potentiation was examined in the rabbit hippocampal dentate gyrus. MK-801 (0.5 mg/kg) was administered 2 h before each daily kindling stimulation was applied to the perforant path. This treatment continued for the first 10 days of kindling. MK-801 depressed the growth of the afterdischarge duration and suppressed development of behavioral seizures. MK-801 did not block kindling-induced potentiation of either the perforant path-dentate granule cell population spike or excitatory postsynaptic potential. Random impulse train stimulation and non-linear systems analytic techniques were used to examine kindling-induced potentiation of presumed GABAergic recurrent inhibitory circuits. Both the magnitude and duration of kindling-induced response inhibition, to the second of each pair of impulses within the train, were reduced in rabbits pretreated with MK-801. These results suggest that MK-801 differentially affects kindling-induced potentiation of excitatory and inhibitory circuits within the rabbit hippocampal dentate gyrus.
    • Kinetics of host immune responses and cytomegalovirus resistance in a liver transplant patient.

      Schaffer, Kirsten; Moran, Julie; Duffy, Margaret; McCormick, Aiden P; Hall, William W; Hassan, Jaythoon; Department of Microbiology, St. Vincent's University Hospital, Elm Park, Dublin, , Ireland. kirsten.e.schaffer@ucd.ie (2012-02-01)
      Among solid organ transplant (SOT) recipients, donor-seropositive/recipient-seronegative (D+/R-) cytomegalovirus (CMV) status is associated with the highest risk of ganciclovir-resistant CMV disease, which has been reported for patients receiving oral ganciclovir but not valganciclovir prophylaxis. We report a case of CMV breakthrough infection in a D+/R- liver transplant patient while he was receiving oral valganciclovir. Forty samples collected over 6 months were analyzed for the CMV viral load, lymphocyte counts, cytokine levels, and lymphocyte differentiation status. Genotypic resistance testing of the viral UL97 gene was performed when the patient failed to respond. CMV viremia occurred on day 50 post-transplant, and 5 samples taken between days 50 and 85 showed the wild-type UL97 genotype. The appearance of deletion 594-595 was observed from day 114 post-transplant. Viral loads declined when foscarnet was commenced and remained below 10,000 copies/mL when the lymphocyte count was greater than 1000/microL (P = 0.02). T cell responses revealed significant expansion of CD8+ terminal effector memory cells. CD4+ cells were largely populations of naive and central memory cells. Circulating interleukin 10 (IL-10) levels correlated with the viral load (P < 0.0001). Seroconversion occurred on day 230. The CMV viral load in combination with lymphocyte counts and IL-10 may be a predictive marker for the risk of development of resistant CMV disease in D+/R- SOT patients.
    • Knobloch syndrome: novel intra-oral findings.

      O'Connell, Anne C; Toner, Mary; Murphy, Sinead; Division of Public and Child Dental Health, Dublin Dental School and Hospital, Lincon Place, Dublin, Ireland. anne.oconnell@dental.tcd.ie (2009-05)
    • Knowledge and behaviour of parents in relation to the oral and dental health of children aged 4-6 years.

      ElKarmi, R; Shore, E; O'Connell, A; Division of Public and Child Dental Health-Dublin Dental University Hospital-Trinity College-Dublin, Lincoln Place, Dublin2, Ireland, rawankarmi@yahoo.com. (European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry, 2014-11-04)
      To evaluate baseline knowledge and behaviour of parents with regard to the oral and dental health of their young children.
    • Knowledge, attitudes and practices in the provision of nutritional care.

      Fletcher, Antoinette; Carey, Eileen; St Vincent's University Hospital Dublin. (2012-02-01)
      The nutritional care of patients is one of the primary responsibilities of all registered nurses (Persenius et al, 2008). A poor nutritional status can lead to malnutrition, which can have serious consequences for an individual's quality of life (Field and Smith, 2008). This paper commences with an introduction to the concept of nutrition, provides an overview of nutritional guidelines and nutritional screening tools which identify those at risk of malnutrition. It reviews the literature on nurses' knowledge, attitudes and practices in the provision of nutritional care and debates challenges and opportunities encountered to help nurses ensure adequate patient nutrition.
    • Knowledge, Skills and Experience Managing Tracheostomy Emergencies: A Survey of Critical Care Medicine trainees

      Nizam, AA; Ng, SC; Kelleher, M; Hayes, N; Carton, E (Irish Medical Journal, 2016-10)
      Since the development of percutaneous tracheostomy, the number of tracheostomy patients on hospital wards has increased. Problems associated with adequate tracheostomy care on the wards are well documented, particularly the management of tracheostomy-related emergencies. A survey was conducted among non-consultant hospital doctors (NCHDs) starting their Critical Care Medicine training rotation in a university affiliated teaching hospital to determine their basic knowledge and skills in dealing with tracheostomy emergencies. Trainees who had received specific tracheostomy training or who had previous experience of dealing with tracheostomy emergencies were more confident in dealing with such emergencies compared to trainees without such training or experience. Only a minority of trainees were aware of local hospital guidelines regarding tracheostomy care. Our results highlight the importance of increased awareness of tracheostomy emergencies and the importance of specific training for Anaesthesia and Critical Care Medicine trainees.
    • Kufs disease, the major adult form of neuronal ceroid lipofuscinosis, caused by mutations in CLN6.

      Arsov, Todor; Smith, Katherine R; Damiano, John; Franceschetti, Silvana; Canafoglia, Laura; Bromhead, Catherine J; Andermann, Eva; Vears, Danya F; Cossette, Patrick; Rajagopalan, Sulekha; et al. (2011-05-13)
      The molecular basis of Kufs disease is unknown, whereas a series of genes accounting for most of the childhood-onset forms of neuronal ceroid lipofuscinosis (NCL) have been identified. Diagnosis of Kufs disease is difficult because the characteristic lipopigment is largely confined to neurons and can require a brain biopsy or autopsy for final diagnosis. We mapped four families with Kufs disease for whom there was good evidence of autosomal-recessive inheritance and found two peaks on chromosome 15. Three of the families were affected by Kufs type A disease and presented with progressive myoclonus epilepsy, and one was affected by type B (presenting with dementia and motor system dysfunction). Sequencing of a candidate gene in one peak shared by all four families identified no mutations, but sequencing of CLN6, found in the second peak and shared by only the three families affected by Kufs type A disease, revealed pathogenic mutations in all three families. We subsequently sequenced CLN6 in eight other families, three of which were affected by recessive Kufs type A disease. Mutations in both CLN6 alleles were found in the three type A cases and in one family affected by unclassified Kufs disease. Mutations in CLN6 are the major cause of recessive Kufs type A disease. The phenotypic differences between variant late-infantile NCL, previously found to be caused by CLN6, and Kufs type A disease are striking; there is a much later age at onset and lack of visual involvement in the latter. Sequencing of CLN6 will provide a simple diagnostic strategy in this disorder, in which definitive identification usually requires invasive biopsy.