• OAS1: a multiple sclerosis susceptibility gene that influences disease severity.

      O'Brien, M; Lonergan, R; Costelloe, L; O'Rourke, K; Fletcher, J M; Kinsella, K; Sweeney, C; Antonelli, G; Mills, K H; O'Farrelly, C; et al. (2012-02-01)
      BACKGROUND: Type 1 interferons upregulate oligoadenylate synthetase 1 (OAS1). A single nucleotide polymorphism (SNP) in exon 7 of OAS1 results in differential RNAseL enzyme activity, the A allele coding for a truncated form with low activity and the G conferring high activity. We hypothesized that OAS1 genotypes would influence both susceptibility to multiple sclerosis (MS) and disease activity with the AA genotype being overrepresented and the GG genotype underrepresented in relapsing-remitting MS (RRMS) with increased disease activity. METHODS: We examined OAS1 genotype distribution in 401 patients with MS, 394 healthy controls, and 178 patients with RRMS receiving interferon-beta (IFNbeta) assessed as 1) having no or minimal disease activity on IFNbeta, 2) having disease activity despite IFNbeta, and 3) 65 patients with RRMS with highly active disease. RESULTS: The OAS1 genotype distribution differed between patients with MS and controls (p = 0.000003), with lower frequency of GG homozygotes in patients with MS (6%) compared with controls (17%). In relation to disease severity, 34 (32%) patients with no or minimal disease activity on IFNbeta had the AA and 8 (8%) the GG genotype; of patients with disease activity despite IFNbeta, 27 (51%) were AA, while only 1 (2%) was GG (p = 0.03). Median time to first relapse on IFNbeta was 24 months in patients with RRMS with AA genotype and 33 months with AG or GG genotype (p = 0.04). The GG genotype was absent in 65 patients with highly active RRMS (p = 0.03). CONCLUSIONS: A functional OAS1 SNP, AA genotype, confers susceptibility to MS and the GG genotype may protect against increased disease activity.
    • Obesity and disability in the symptomatic Irish knee osteoarthritis population.

      Ambrose, N L; Keogan, F; O'Callaghan, J P; O'Connell, P G; Beaumont Hospital, Dublin, Ireland. nicolaambrose@yahoo.ie (2010-06)
      Osteoarthritis (OA) of the knee is a common disorder with significant social and financial implications. Obesity is the strongest modifiable risk factor of knee OA. There is little data on obesity in Irish knee OA populations and its relationship to other measures of disease severity.
    • Obesity in an ageing society: implications for health, physical function and health service utilisation

      Leahy, Siobhan; Nolan, Anne; O'Connell, Jean; Kenny, Rose Anne; The Irish Longitudinal Study on Ageing, Trinity College Dublin (TILDA, 2014-07)
      Obesity is a chronic disease defined by the World Health Organisation (WHO) as a condition of abnormal or excessive fat accumulation, to the extent that health may be impaired (1). This excess fat mass is thought to lead to a chronic, low grade inflammation which is associated with an increased risk of ill-health such as metabolic and cardiovascular disease, musculoskeletal problems, decreased physical function, and some cancers (2). Obesity prevalence has risen dramatically worldwide over the past 3-4 decades and is now considered a global epidemic (1, 3). Several societal factors have contributed to the rapid spread of obesity such as increasingly sedentary lifestyles and the widespread availability of energy dense foods in combination with a so-called ‘obesogenic environment’. However, the impact of obesity on health is complex, and differs, for example, according to age, sex and the trajectory of changes in body weight over time (
    • Obesity in Ireland in 2008: what radiological equipment is available to image the obese patient?

      Campbell, N; Buckley, O; McGlone, B; O'Shea, D; Torreggiani, W C; Weight Management Service and Department of Radiology, St Columcille's Hospital, Loughlinstown, Co Dublin. naomicampbell28@hotmail.com (Irish medical journal, 2009-04)
      Obesity is a global epidemic, responsible for 2000 premature deaths in Ireland each year. The extent of this epidemic was quantified by the National Taskforce on Obesity (IOTF), whose report, published in 2005, found that 39% of adults in Ireland were overweight and 18% obese with obesity in adults predicted to increase by 1% per year. In light of the clear evidence that we, as a nation, are quite literally expanding, how well equipped are Irish hospitals and, in particular, radiology departments, to deal with patients of increasing size and weight? The purpose of this study was to quantify the weight limits and girth restrictions of the radiology equipment, in particular CT, MRI and fluoroscopy, in hospitals, both public and private, in Ireland in an attempt to answer this question.
    • Objective assessment of surgical performance and its impact on a national selection programme of candidates for higher surgical training in plastic surgery.

      Carroll, Sean M; Kennedy, A M; Traynor, Oscar; Gallagher, Anthony G; St Vincent's University Hospital, Dublin 4, Ireland. smdc@indigo.ie (2012-02-01)
      OBJECTIVE: The objective of this study was to develop and validate a transparent, fair and objective assessment programme for the selection of surgical trainees into higher surgical training (HST) in plastic surgery in the Republic of Ireland. METHODS: Thirty-four individuals applied for HST in plastic surgery at the Royal College of Surgeons in Ireland (RCSI) in the academic years 2005-2006 and 2006-2007. Eighteen were short-listed for interview and further assessment. All applicants were required to report on their undergraduate educational performance and their postgraduate professional development. Short-listed applicants completed validated objective assessment simulations of surgical skills, an interview and assessment of their suitability for a career in surgery. RESULTS: When applicants' short-listing scores were combined with their interview scores and assessment of their suitability for a career in surgery, individuals who were selected for HST in plastic surgery performed significantly better than those who were not (P<0.002). However, when the assessment of technical skills scores were added the significance level of this difference increased further (P<0.0001) as did the statistical power of the difference to 99.9%, thus increasing the robustness of the selection package. CONCLUSION: The results from this study suggest that the assessment protocol we used to select individuals for HST in plastic surgery reliably and statistically significantly discriminated between the performances of candidates.
    • Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis.

      Semkovska, Maria; McLoughlin, Declan M; Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, St. Patrick's University Hospital, Ireland. (2010-09-15)
      Electroconvulsive therapy (ECT) is the most acutely effective treatment for depression, but is limited by cognitive side effects. However, research on their persistence, severity, and pattern is inconsistent. We aimed to quantify ECT-associated cognitive changes, specify their pattern, and determine progression.
    • Obstetric Anal Sphincter Injuries: A Survey of Clinical Practice and Education among Obstetricians and Gynaecologists in Ireland

      Abdelrahman, M; Geary, M; Eogan, M (Irish Medical Journal, 2019-01)
      This paper summarises results of a survey of obstetricians in Ireland regarding their technique, management, and education on episiotomy and Obstetric Anal Sphincter Injury (OASIS). An anonymous survey was emailed to all obstetricians and gynaecologists in Ireland, including trainees between January and September 2017. The response rate was 45% (155/343) with 111 out of 144 (77%) reported clinical experience as part of their training and 92 (64%) attended an OASIS workshop or classroom teaching. The majority prescribe antibiotics and laxatives post-op, request physiotherapy review and follow-up patients in outpatient settings. We identified that most specialists and trainees practice within guidelines, but some recognise a need for further teaching and exposure to these types of injuries. These results will direct future curriculum and optimise ongoing training for trainees, unify service provision and contribute to patient safety.
    • Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers.

      Hehir, Mark P; O'Connor, Hugh D; Higgins, Shane; Robson, Michael S; McAuliffe, Fionnuala M; Boylan, Peter C; Malone, Fergal D; Mahony, Rhona; Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles St. Dublin 2 , Ireland (2013-10)
      Obstetric anal sphincter injury (OASIS) represents a major cause of maternal morbidity and is a risk factor for the development of fecal incontinence. We set out to analyze the incidence of OASIS and its association with mode of delivery in two large obstetric hospitals across an 8-year study period.
    • Obstetric outcome with low molecular weight heparin therapy during pregnancy.

      Donnelly, J; Byrne, J; Murphy, K; McAuliffe, F; Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles St, Dublin 2. jenniferdonnelly@mac.com (Irish Medical Journal (IMJ), 2012-01)
      This was a prospective study of women attending a combined haematology/obstetric antenatal clinic in the National Maternity Hospital (2002-2008). Obstetric outcome in mothers treated with low molecular weight heparin (LMWH) was compared to the general obstetric population of 2006. There were 133 pregnancies in 105 women. 85 (63.9%) received prophylactic LMWH and 38 (28.6%) received therapeutic LMWH in pregnancy. 10 (7.5%) received postpartum prophylaxis only. The perinatal mortality rate was 7.6/1000 births. 14 (11.3%) women delivered preterm which is significantly higher than the hospital population rate (5.7%, p<0.05). Despite significantly higher labour induction rates (50% vs 29.2% p<0.01), there was no difference in CS rates compared to the general hospital population (15.4% vs 18.9%, NS). If carefully managed, these high-risk women can achieve similar vaginal delivery rates as the general obstetric population.
    • Obstructive sleep apnea and inflammation.

      McNicholas, Walter T; Sleep Research Laboratory, St. Vincent's University Hospital, Dublin, Ireland., walter.mcnicholas@ucd.ie (2012-02-01)
      The pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome (OSAS) is not fully understood but is likely multifactorial in origin. Inflammatory processes play an important role in the pathogenesis of atherosclerosis, and circulating levels of several markers of inflammation have been associated with future cardiovascular risk. These include cell adhesion molecules such as intercellular adhesion molecule-1 and selectins, cytokines such as tumour necrosis factor alpha and interleukin 6, chemokines such as interleukin 8, and C-reactive protein. There is also increasing evidence that inflammatory processes play an important role in the cardiovascular pathophysiology of OSAS and many of the inflammatory markers associated with cardiovascular risk have been reported as elevated in patients with OSAS. Furthermore, animal and cell culture studies have demonstrated preferential activation of inflammatory pathways by intermittent hypoxia, which is an integral feature of OSAS. The precise role of inflammation in the development of cardiovascular disease in OSAS requires further study, particularly the relationship with oxidative stress, metabolic dysfunction, and obesity.
    • Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

      Lee, Ruth; McNicholas, Walter T; Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland. (2011-03)
      Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome.
    • Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

      Lee, Ruth; McNicholas, Walter T; Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin,, Ireland. (2012-02-01)
      PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome. RECENT FINDINGS: The severity of obstructive ventilatory impairment and hyperinflation, especially the inspiratory capacity to total lung capacity (TLC) ratio, correlates with the severity of sleep-related breathing disturbances. Early treatment with continuous positive airway pressure (CPAP) improves survival, reduces hospitalization and pulmonary hypertension, and also reduces hypoxemia. Evidence of systemic inflammation and oxidative stress in COPD and sleep apnea provides insight into potential interactions between both disorders that may predispose to cardiovascular disease. Long-term outcome studies of overlap patients currently underway should provide further evidence of the clinical significance of the overlap syndrome. SUMMARY: Studies of overlap syndrome patients at a clinical, physiological and molecular level should provide insight into disease mechanisms and consequences of COPD and sleep apnea, in addition to identifying potential relationships with cardiovascular disease.
    • Obturation of the root canal system

      Duncan, HF; Kanagasingam, S (Oxford, Wiley-Blackwell, 2011)
    • Obturation of the root canal system.

      Duncan, H.F; Kanagasingam, S.; Dublin Dental University Hospital (Wiley-Blackwell, 2011-07)
    • OC15.01: Prenatal determination of placental cord insertion site in monochorionic and dichorionic twin gestations: a predictor of growth discordance?

      Breathnach, F.; McAuliffe, F.; Geary, M.; Daly, S.; Higgins, J.; Dornan, J. J.; Morrison, J. J.; Burke, G.; Higgins, S.; Carroll, S.; et al. (2010-10)
    • OC15.03: Intratwin weight discordance and the prediction of successful vaginal twin birth: the ESPRiT study

      Breathnach, F.; McAuliffe, F.; Geary, M.; Daly, S.; Higgins, J.; Dornan, J.; Morrison, J. J.; Burke, G.; Higgins, S.; Carroll, S.; et al. (2011-11-18)
    • Occlusive ascending aorta and arch atheroma treated with deep hypothermic circulatory arrest and thromboendarterectomy.

      O' Sullivan, Katie E; Early, Sarah A; Lawler, Leo; Hurley, John; Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland. (2013-12)
      We describe an uncommon presentation of severely advanced aortic atherosclerosis in a 48-year old man with a history of hypertension and heavy smoking. Initial presentation with upper limb ischaemia led to the diagnosis of an aortic arch atheroma occluding 90% of the aortic lumen, managed with deep hypothermic circulatory arrest and aortic thromboendarterectomy. To our knowledge, this is the first reported case of atherosclerotic plaque resulting in aortic occlusion and requiring emergent operative intervention.
    • Occupation and risk of upper aerodigestive tract cancer: the ARCAGE study.

      Richiardi, Lorenzo; Corbin, Marine; Marron, Manuela; Ahrens, Wolfgang; Pohlabeln, Hermann; Lagiou, Pagona; Minaki, Ploumitsa; Agudo, Antonio; Castellsague, Xavier; Slamova, Alena; et al. (2012-05-15)
      We investigated the association between occupational history and upper aerodigestive tract (UADT) cancer risk in the ARCAGE European case-control study. The study included 1,851 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1,949 controls. We estimated odds ratios (OR) and 95% confidence intervals (CI) for ever employment in 283 occupations and 172 industries, adjusting for smoking and alcohol. Men (1,457 cases) and women (394 cases) were analyzed separately and we incorporated a semi-Bayes adjustment approach for multiple comparisons. Among men, we found increased risks for occupational categories previously reported to be associated with at least one type of UADT cancer, including painters (OR = 1.74, 95% CI: 1.01-3.00), bricklayers (1.58, 1.05-2.37), workers employed in the erection of roofs and frames (2.62, 1.08-6.36), reinforced concreters (3.46, 1.11-10.8), dockers (2.91, 1.05-8.05) and workers employed in the construction of roads (3.03, 1.23-7.46), general construction of buildings (1.44, 1.12-1.85) and cargo handling (2.60, 1.17-5.75). With the exception of the first three categories, risks both increased when restricting to long duration of employment and remained elevated after semi-Bayes adjustment. Increased risks were also found for loggers (3.56, 1.20-10.5) and cattle and dairy farming (3.60, 1.15-11.2). Among women, there was no clear evidence of increased risks of UADT cancer in association with occupations or industrial activities. This study provides evidence of an association between some occupational categories and UADT cancer risk among men. The most consistent findings, also supported by previous studies, were obtained for specific workers employed in the construction industry.
    • The occurrence of paraesthesia of the maxillary division of the trigeminal nerve after dental local anaesthetic use: a case report

      Moorthy, Advan; Stassen, Leo FA (Journal of the Irish Dental Association, 2015-02)
      Local anaesthetics are usually safe, effective and indispensable drugs used routinely in dentistry. Local anaesthetics allow dentistry to be practised in a painfree environment. However, their use may involve complications. Paraesthesia can be defined as persistent anaesthesia (anaesthesia well beyond the expected duration) or as an altered sensation (tingling or itching).1-3 It is the result of damage to a nerve and the occurrence of paraesthesia following the use of local anaesthesia in dentistry represents a rare but important side effect, which is often under-reported4-8 and is important in medico-legal practice. To date, there have been very few recorded incidences or published cases of maxillary nerve paraesthesia following the use of dental local anaesthetic for a routine extraction
    • Ocular health among radiologists in the age of PACS: is it time for our profession to open its eyes to this issue in light of existing European legislation?

      Halpenny, D; O'Driscoll, D; Torreggiani, W C; Adelaide and Meath Hospitals, Tallaght, Dublin, Ireland. darraghhalpenny@hotmail.com (2012-12)
      The regular use of visual display units (VDUs) at work has been shown to cause the development of a constellation of symptoms ranging from dry eyes to temporary myopia. European workers who use VDUs are now protected under detailed legislation enacted by the European Union (Directive 90/270/EEC). The use of picture archiving and communications systems, which are almost ubiquitous in European countries, means that, as a profession, radiologists fall under the remit of this legislation. This paper aims to assess the impact that full implementation of this law would have on a radiologist's practice and to more broadly examine the issue of eye care as an occupational health issue in radiology. The authors conclude that eye care in the setting of regular VDU use among radiologists is an important quality control and occupational health issue. There is a clear legal basis requiring employers to provide regular eye examinations and reporting breaks. In the absence of leadership from employers on this issue individual radiologists have a responsibility to ensure that their work practices reflect the legal situation and minimise the effect of eye strain on their performance.