• The dual influences of age and obstetric history on fecal continence in parous women.

      Eogan, Maeve; O'Brien, Conor; Daly, Leslie; Behan, Michael; O'Connell, P Ronan; O'Herlihy, Colm; Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland. (2011-02)
      To assess whether women who underwent forceps delivery were more likely than those who delivered either normally (spontaneous vaginal delivery [SVD]) or by cesarean to experience deterioration in fecal continence as they aged.
    • Dual kidney transplantation with organs from extended criteria cadaveric donors.

      D'Arcy, Frank T; O'Connor, Kevin M; Shields, William; Zimmerman, Jose A; Mohan, Ponnusamy; Eng, Molly; Little, Dilly M; Power, Richard; Dorman, Anthony; Hickey, David P; et al. (2009-10)
      The critical shortage of kidneys available for transplantation has led to alternate strategies to expand the pool. Transplantation of the 2 kidneys into a single recipient using organs suboptimal for single kidney transplantation was suggested. We assessed results in 24 grafts allocated for dual kidney transplantation vs those in a control group of 44 designated for single kidney transplantation. Each group underwent pretransplant biopsy and recipients were age matched.
    • Dual origin of the left vertebral artery: extracranial MRA and CTA findings.

      Tobin, W Oliver; Killeen, Ronan; Kinsella, Justin A; McCabe, Dominick J H; Department of Neurology, The Adelaide and Meath Hospital, Trinity College Dublin,, Ireland. (2012-02-01)
      A 48-year-old man presented with a posterior circulation stroke secondary to left lateral medullary infarction. Contrast-enhanced magnetic resonance angiography (CEMRA) revealed 40-45% intracranial left vertebral artery stenosis, likely atherosclerotic in nature. CEMRA and subsequent computed tomography angiography also identified a duplicate origin of the left vertebral artery. The importance of recognition of this rare anatomical variant, its potential contribution to stroke aetiology, and the advantage of non-invasive vascular imaging prior to catheter angiography is emphasised.
    • Duel energy CT imaging of tophaceous gout

      Fitzgerald, L; Donnellan, J; Buckley, O; Kane, D; Department of Radiology, AMNCH, Tallaght (Irish Medical Journal, 2013-09)
      Gout is characterized by an inflammatory response that is initiated by the precipitation of monosodium urate within and surrounding the joints as well as the soft tissue. This is the most common form of inflammatory arthritis and has been showing increasing incidence over recent years in association with increased incidence of the metabolic syndrome 1 . Arthritis Ireland believe the same increase is taking place in Ireland with up to 5% of the Irish population suffering from gout. Many associate alcohol consumption with gout but fructose in non alcoholic soft drinks and beers may also have a contributory role. Male patients who consume over 2 soft drinks daily are thought to have a 1.85 relative risk for developing gout.
    • DUNDRUM Restriction-Intrusion of Liberty Ladders (DRILL) Audit Toolkit

      Kennedy, Harry G; Timmons, David; Gill, Pauline; McKenna, Paul; Braham, Paul; Mullaney, Ronan (Academic Department of Psychiatry, University of Dublin, Trinity College, 2011-09)
      This series of rating 'ladders' is intended to allow a quantitative and qualitative analysis of the use of restrictive and intrusive interventions as part of the therapeutic management of violence and aggression in psychiatric hospital settings. This is an evolving handbook. The ladders are currently organised to facilitate a behavioural analysis. Context, antecedents, behaviour, interventions, consequences are conceptualised as a series of events organised in temporal sequence so that causes, interactions and effects can be considered. The complexity of analysis possible is limited by the statistical power of the numbers of cases and events available. The use of the DUNDRUM-1 triage security scale may enable some benchmarking of patient groups according to their average need for therapeutic security for comparative purposes, when combined with measures of risk such as the DASA and HCR-20, while the quantitative relational security in a given unit provides an essential further aspect of context.
    • The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study.

      Flynn, Grainne; O'Neill, Conor; McInerney, Clare; Kennedy, Harry G; National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. (2011)
      The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity.
    • DUNDRUM-2: Prospective validation of a structured professional judgment instrument assessing priority for admission from the waiting list for a Forensic Mental Health Hospital.

      Flynn, Grainne; O'Neill, Conor; Kennedy, Harry G (2011-07-03)
      Abstract Background The criteria for deciding who should be admitted first from a waiting list to a forensic secure hospital are not necessarily the same as those for assessing need. Criteria were drafted qualitatively and tested in a prospective 'real life' observational study over a 6-month period. Methods A researcher rated all those presented at the weekly referrals meeting using the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale. The key outcome measure was whether or not the individual was admitted. Results Inter-rater reliability and internal consistency for the DUNDRUM-2 were acceptable. The DUNDRUM-1 triage security score and the DUNDRUM-2 triage urgency score correlated r = 0.663. At the time of admission, after a mean of 23.9 (SD35.9) days on the waiting list, those admitted had higher scores on the DUNDRUM-2 triage urgency scale than those not admitted, with no significant difference between locations (remand or sentenced prisoners, less secure hospitals) at the time of admission. Those admitted also had higher DUNDRUM-1 triage security scores. At baseline the receiver operating characteristic area under the curve for a combined score was the best predictor of admission while at the time of admission the DUNDRUM-2 triage urgency score had the largest AUC (0.912, 95% CI 0.838 to 0.986). Conclusions The triage urgency items and scale add predictive power to the decision to admit. This is particularly true in maintaining equitability between those referred from different locations.
    • Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.

      Manning, Brian J; O'Neill, Sean M; Haider, Syed N; Colgan, Mary P; Madhavan, Prakash; Moore, Dermot J; Department of Vascular and Endovascular Surgery, St James Hospital, Dublin,, Ireland. brianjmanning@gmail.com (2012-02-01)
      OBJECTIVES: Cumulative radiation dose, cost, and increased demand for computed tomography aortography (CTA) suggest that duplex ultrasonography (DU) may be an alternative to CTA-based surveillance. We compared CTA with DU during endovascular aneurysm repair (EVAR) follow-up. METHODS: Patients undergoing EVAR had clinical and radiological follow-up data entered in a prospectively maintained database. For the purpose of this study, the gold standard test for endoleak detection was CTA, and an endoleak detected on DU alone was assumed to be a false positive result. DU interpretation was performed independently of CTA and vice versa. RESULTS: One hundred thirty-two patients underwent EVAR, of whom 117 attended for follow-up ranging from six months to nine years (mean, 32 months). Adequate aneurysm sac visualisation on DU was not possible in 1.7% of patients, predominantly due to obesity. Twenty-eight endoleaks were detected in 28 patients during follow-up. Of these, 24 were initially identified on DU (four false negative DU examinations), and eight had at least one negative CTA with a positive DU prior to diagnosis. Twenty-three endoleaks were type II in nature and three of these patients had increased sac size. There was one type I and four type III endoleaks. Two of these (both type III) had an increased sac size. Of 12 patients with increased aneurysm size of 5 mm or more at follow-up, five had an endoleak visible on DU, yet negative CTA and a further five had endoleak visualisation on both DU and CTA. Of six endoleaks which underwent re-intervention, all were initially picked up on DU. One of these endoleaks was never demonstrated on CTA and a further two had at least one negative CTA prior to endoleak confirmation. Positive predictive value for DU was 45% and negative predictive value 94%. Specificity of DU for endoleak detection was 67% when compared with CTA, because of the large number of false positive DU results. Sensitivity for DU was 86%, with all clinically significant endoleaks demonstrated on CTA also detected on DU. CONCLUSION: Despite its low positive predictive value, we found DU to be a sensitive test for the detection of clinically significant endoleaks. Given concerns about cumulative radiation exposure and cost, and the surprisingly low sensitivity of CTA for endoleak detection in this series, selective CTA based on DU surveillance may be a more appropriate long-term strategy.
    • Duplications of the neuropeptide receptor gene VIPR2 confer significant risk for schizophrenia.

      Vacic, Vladimir; McCarthy, Shane; Malhotra, Dheeraj; Murray, Fiona; Chou, Hsun-Hua; Peoples, Aine; Makarov, Vladimir; Yoon, Seungtai; Bhandari, Abhishek; Corominas, Roser; et al. (2011-03-24)
      Rare copy number variants (CNVs) have a prominent role in the aetiology of schizophrenia and other neuropsychiatric disorders. Substantial risk for schizophrenia is conferred by large (>500-kilobase) CNVs at several loci, including microdeletions at 1q21.1 (ref. 2), 3q29 (ref. 3), 15q13.3 (ref. 2) and 22q11.2 (ref. 4) and microduplication at 16p11.2 (ref. 5). However, these CNVs collectively account for a small fraction (2-4%) of cases, and the relevant genes and neurobiological mechanisms are not well understood. Here we performed a large two-stage genome-wide scan of rare CNVs and report the significant association of copy number gains at chromosome 7q36.3 with schizophrenia. Microduplications with variable breakpoints occurred within a 362-kilobase region and were detected in 29 of 8,290 (0.35%) patients versus 2 of 7,431 (0.03%) controls in the combined sample. All duplications overlapped or were located within 89 kilobases upstream of the vasoactive intestinal peptide receptor gene VIPR2. VIPR2 transcription and cyclic-AMP signalling were significantly increased in cultured lymphocytes from patients with microduplications of 7q36.3. These findings implicate altered vasoactive intestinal peptide signalling in the pathogenesis of schizophrenia and indicate the VPAC2 receptor as a potential target for the development of new antipsychotic drugs.
    • Duration of short-course androgen suppression therapy and the risk of death as a result of prostate cancer.

      D'Amico, Anthony V; Chen, Ming-Hui; Crook, Juanita; Armstrong, John G; Malone, Shawn; Steigler, Allison; Dunne, Mary; Kantoff, Philip W; Denham, James W; Brigham and Women's Hospital, Boston, MA 02115, USA. adamico@partners.org (2011-12-10)
      We evaluated whether the duration of androgen suppression therapy (AST) had an impact on the risk of prostate cancer-specific mortality (PCSM) in men with unfavorable-risk prostate cancer (PC) within established Gleason score (GS) categories.
    • DVT presentations to an emergency department: a study of guideline based care and decision making

      Lillis, D; Lloyd, C; O’Kelly, P; Kelada, S; Kelly, S; Gilligan, P (Irish Medical Journal, 2016-02)
      Pre-test probability scoring and blood tests for deep venous thrombosis (DVT) assessment are sensitive, but not specific leading to increased demands on radiology services. Three hundred and eighty-five patients presenting to an Emergency Department (ED), with suspected DVT, were studied to explore our actual work-up of patients with possible DVT relating to risk stratification, further investigation and follow up. Of the 205 patients with an initially negative scan, 36 (17.6%) were brought for review to the ED Consultant clinic. Thirty-four (16.6%) patients underwent repeat compression ultrasound with 5 (2.4%) demonstrating a DVT on the second scan. Repeat compression ultrasound scans were performed on 34 (16.6%) patients with an initially negative scan, with essentially the same diagnostic yield as other larger studies where 100% of such patients had repeat scanning. Where there is ongoing concern, repeat above-knee compression ultrasound within one week will pick up a small number of deep venous thromboses.
    • Dynamic electrocardiographic changes in patients with arrhythmogenic right ventricular cardiomyopathy.

      Quarta, Giovanni; Ward, Deirdre; Tomé Esteban, María T; Pantazis, Antonios; Elliott, Perry M; Volpe, Massimo; Autore, Camillo; McKenna, William J; The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London W1G 8PH, UK. william.mckenna@uclh.org (Heart (British Cardiac Society), 2010-04)
      Electrocardiographic (ECG) abnormalities of depolarisation and repolarisation contribute to the diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC). The development of diagnostic ECG features were investigated in a genotyped cohort with ARVC to provide more sensitive markers of early disease.
    • Dynamic four-dimensional 320 section CT and carpal bone injury - a description of a novel technique to diagnose scapholunate instability.

      Halpenny, D; Courtney, K; Torreggiani, W C; Adelaide and Meath Hospitals, Tallaght, Dublin, Ireland. (Clinical radiology, 2012-02)
    • Dyslipidaemia--hepatic and intestinal cross-talk.

      Tomkin, Gerald H; Trinity College Dublin and Diabetes Institute of Ireland, Beacon Hospital, Sandyford, Clontra, Quinns Road, Shankill Co, Dublin, Ireland. gerald.tomkin@tcd.ie, tomking@tcd.ie (2010-06)
      Cholesterol metabolism is tightly regulated with the majority of de novo cholesterol synthesis occurring in the liver and intestine. 3 Hydroxy-3-methylglutaryl coenzyme A reductase, a major enzyme involved in cholesterol synthesis, is raised in both liver and intestine in diabetic animals. Niemann PickC1-like1 protein regulates cholesterol absorption in the intestine and facilitates cholesterol transport through the liver. There is evidence to suggest that the effect of inhibition of Niemann PickC1-like1 lowers cholesterol through its effect not only in the intestine but also in the liver. ATP binding cassette proteins G5/G8 regulate cholesterol re-excretion in the intestine and in the liver, cholesterol excretion into the bile. Diabetes is associated with reduced ATP binding cassette protein G5/G8 expression in both the liver and intestine in animal models. Microsomal triglyceride transfer protein is central to the formation of the chylomicron in the intestine and VLDL in the liver. Microsomal triglyceride transfer protein mRNA is increased in diabetes in both the intestine and liver. Cross-talk between the intestine and liver is poorly documented in humans due to the difficulty in obtaining liver biopsies but animal studies are fairly consistent in showing relationships that explain in part mechanisms involved in cholesterol homeostasis.
    • Dyslipidemia therapy update: the importance of full lipid profile assessment.

      Menown, I B A; Murtagh, G; Maher, V; Cooney, M T; Graham, I M; Tomkin, G; Craigavon Cardiac Centre, Craigavon BT63 5QQ, Northern Ireland, UK. ian.menown@southerntrust.hscni.net (Advances in therapy, 2009-07)
      Lipid guidelines typically focus on total cholesterol +/- low-density lipoprotein cholesterol levels with less emphasis on high-density lipoprotein cholesterol (HDL-C) or triglyceride assessment, thus potentially underestimating cardiovascular (CV) risk and the need for lifestyle or treatment optimization. In this article, we highlight how reliance on isolated total cholesterol assessment may miss prognostically relevant lipid abnormalities; we describe from the European Systematic COronary Risk Evaluation (SCORE) data set how incorporation of HDL-C may improve estimation of CV risk; and, finally, we critically evaluate the evidence base surrounding triglycerides and CV risk.
    • Dysphagia in Bipolar Affective Disorder

      Sowman, R; Regan, J; Walsh, I (2009)
    • Dysphagia in Schizophrenia

      Regan, J; Sowman, R; Walsh, I (2009)
    • Dysphagia in the Elderly Following Anterior Cervical Surgery: A Multidisciplinary Approach

      Osuafor, C N.; Greene, B; El-Kininy, N; Donegan, C (Irish Medical Journal, 2017-11)
      Dysphagia is a risk factor for adverse health outcomes like aspiration, recurrent chest infections and malnutrition. Here, we describe a case of an 82-year-old lady who presented with a two-month history of dysphagia after an anterior odontoid screw fixation for a type II odontoid process fracture. This case highlights the importance of a multidisciplinary approach to patient care.
    • Dysregulation of TIM-3-galectin-9 pathway in the cystic fibrosis airways.

      Vega-Carrascal, Isabel; Reeves, Emer P; Niki, Toshiro; Arikawa, Tomohiro; McNally, Paul; O'Neill, Shane J; Hirashima, Mitsuomi; McElvaney, Noel G; Respiratory Research Division, Department of Medicine, Education and Research, Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9,, Ireland. (2012-02-01)
      The T-cell Ig and mucin domain-containing molecules (TIMs) have emerged as promising therapeutic targets to correct abnormal immune function in several autoimmune and chronic inflammatory conditions. It has been reported that proinflammatory cytokine dysregulation and neutrophil-dominated inflammation are the main causes of morbidity in cystic fibrosis (CF). However, the role of TIM receptors in CF has not been investigated. In this study, we demonstrated that TIM-3 is constitutively overexpressed in the human CF airway, suggesting a link between CF transmembrane conductance regulator (CFTR) function and TIM-3 expression. Blockade of CFTR function with the CFTR inhibitor-172 induced an upregulation of TIM-3 and its ligand galectin-9 in normal bronchial epithelial cells. We also established that TIM-3 serves as a functional receptor in bronchial epithelial cells, and physiologically relevant concentrations of galectin-9 induced TIM-3 phosphorylation, resulting in increased IL-8 production. In addition, we have demonstrated that both TIM-3 and galectin-9 undergo rapid proteolytic degradation in the CF lung, primarily because of neutrophil elastase and proteinase-3 activity. Our results suggest a novel intrinsic defect that may contribute to the neutrophil-dominated immune response in the CF airways.
    • Dysregulation of TIM-3-galectin-9 pathway in the cystic fibrosis airways.

      Vega-Carrascal, Isabel; Reeves, Emer P; Niki, Toshiro; Arikawa, Tomohiro; McNally, Paul; O'Neill, Shane J; Hirashima, Mitsuomi; McElvaney, Noel G; Respiratory Research Division, Department of Medicine, Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland. (2011-03-01)
      The T-cell Ig and mucin domain-containing molecules (TIMs) have emerged as promising therapeutic targets to correct abnormal immune function in several autoimmune and chronic inflammatory conditions. It has been reported that proinflammatory cytokine dysregulation and neutrophil-dominated inflammation are the main causes of morbidity in cystic fibrosis (CF). However, the role of TIM receptors in CF has not been investigated. In this study, we demonstrated that TIM-3 is constitutively overexpressed in the human CF airway, suggesting a link between CF transmembrane conductance regulator (CFTR) function and TIM-3 expression. Blockade of CFTR function with the CFTR inhibitor-172 induced an upregulation of TIM-3 and its ligand galectin-9 in normal bronchial epithelial cells. We also established that TIM-3 serves as a functional receptor in bronchial epithelial cells, and physiologically relevant concentrations of galectin-9 induced TIM-3 phosphorylation, resulting in increased IL-8 production. In addition, we have demonstrated that both TIM-3 and galectin-9 undergo rapid proteolytic degradation in the CF lung, primarily because of neutrophil elastase and proteinase-3 activity. Our results suggest a novel intrinsic defect that may contribute to the neutrophil-dominated immune response in the CF airways.