• Left-dominant arrhythmogenic cardiomyopathy: an under-recognized clinical entity.

      Sen-Chowdhry, Srijita; Syrris, Petros; Prasad, Sanjay K; Hughes, Siân E; Merrifield, Robert; Ward, Deirdre; Pennell, Dudley J; McKenna, William J; Inherited Cardiovascular Disease Group, The Heart Hospital, London, United Kingdom. srijita@aol.com (Journal of the American College of Cardiology, 2008-12-16)
      We sought to investigate the clinical-genetic profile of left-dominant arrhythmogenic cardiomyopathy (LDAC).
    • Lemierre's syndrome.

      O'Dwyer, D N; Ryan, S; O'Keefe, T; Lyons, J; Lavelle, L; McKone, E; St Vincent's University Hospital, Elm Park, Dublin 4, Ireland., daviodwyer@gmail.com (2012-02-01)
      Lemierre's syndrome is a rare disease that results in an oropharyngeal infection, which precipitates an internal jugular vein thrombosis and metastatic infection. Fusobacterium necrophorum is an anaerobic Gram-negative bacillus and has been identified as the causative agent. We describe the case of a young girl whose presentation and diagnosis were confounded by a history of valvular heart disease. Infection of heart valves can produce many of the signs and symptoms associated with Lemierre's syndrome. We describe the diagnosis, investigation and optimal management of this rare disorder.
    • Lemierres syndrome: the forgotten disease

      Morariu, I; Curran, A; Killeen, RP (Irish Medical Journal, 2014-09)
      Lemierres syndrome is a rare and potentially fatal entity affecting otherwise healthy and young adults. The infection originates in the throat and spreads via a septic trombophlebitis of the internal jugular vein, with development of distant septic emboli. This clinical picture is characteristic but many clinicians are unaware of the condition and diagnosis is often delayed with potentially fatal consequences.
    • Lemur tyrosine kinase-2 signalling regulates kinesin-1 light chain-2 phosphorylation and binding of Smad2 cargo.

      Manser, C; Guillot, F; Vagnoni, A; Davies, J; Lau, K-F; McLoughlin, D M; De Vos, K J; Miller, C C J; Department of Neuroscience P037, MRC Centre for Neurodegeneration Research, Institute of Psychiatry, King's College London, London, UK. (2012-05-31)
      A recent genome-wide association study identified the gene encoding lemur tyrosine kinase-2 (LMTK2) as a susceptibility gene for prostate cancer. The identified genetic alteration is within intron 9, but the mechanisms by which LMTK2 may impact upon prostate cancer are not clear because the functions of LMTK2 are poorly understood. Here, we show that LMTK2 regulates a known pathway that controls phosphorylation of kinesin-1 light chain-2 (KLC2) by glycogen synthase kinase-3β (GSK3β). KLC2 phosphorylation by GSK3β induces the release of cargo from KLC2. LMTK2 signals via protein phosphatase-1C (PP1C) to increase inhibitory phosphorylation of GSK3β on serine-9 that reduces KLC2 phosphorylation and promotes binding of the known KLC2 cargo Smad2. Smad2 signals to the nucleus in response to transforming growth factor-β (TGFβ) receptor stimulation and transport of Smad2 by kinesin-1 is required for this signalling. We show that small interfering RNA loss of LMTK2 not only reduces binding of Smad2 to KLC2, but also inhibits TGFβ-induced Smad2 signalling. Thus, LMTK2 may regulate the activity of kinesin-1 motor function and Smad2 signalling.
    • Length of latency with preterm premature rupture of membranes before 32 weeks' gestation.

      Peaceman, Alan M; Lai, Yinglei; Rouse, Dwight J; Spong, Catherine Y; Mercer, Brian M; Varner, Michael W; Thorp, John M; Ramin, Susan M; Malone, Fergal D; O'Sullivan, Mary J; et al. (2015-01)
      The objective of the article is to describe latency for patients with preterm premature membrane rupture (PPROM) between 24(0/7) and 31(6/7) weeks' gestation.
    • Length of stay following elective surgery can we improve efficiency?

      Solon, JG; Coffey, JC; McNamara, DA (Irish Medical Journal, 2013-06)
      Increasing emergency admissions place significant demands on limited hospital resources. We assessed national practices and resources for initiatives to reduce length of stay (LOS) and thereby improve efficiency of resource utilisation. Consultant members of the Irish Association of Coloproctology received a questionnaire seeking information about available initiatives aimed at reducing LOS. 20 out of 32 (62.5%) consultants responded to the questionnaire. Pre-assessment clinics for day surgery were available to 18(90%). Only 13 (65%) had access to pre-assessment clinics for patients requiring longer admissions. 11 (55%) could admit major cases on the day of surgery. Only 9 (45%) surgeons could guarantee immediate re-admission of patients discharged from hospital if needed. There was a divergence of opinion regarding the acceptable average LOS and percentage suitable for day surgery for a variety of common surgical procedures. This study highlights a number of key areas in which certain well-established initiatives could improve efficiency.
    • Length of stay of general psychiatric inpatients in the United States: systematic review.

      Tulloch, Alex D; Fearon, Paul; David, Anthony S; Department of Psychiatry, Institute of Psychiatry, Kings College London, De Crespigny Park, London, SE5 8AF, UK, alexander.d.tulloch@kcl.ac.uk. (2011-05)
      Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.
    • Leptin in diabetic pregnancy

      Higgins, M; Russell, N; Brazil, D; McAuliffe, F (Irish Journal of Medical Science, 2011-02)
      Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2011
    • A less invasive approach to screening for early onset neonatal GBS.

      Glackin, S; Miletin, I; Deasy, A M (Irish Medical Journal, 2015-03)
      Recent recommendations for the management of an asymptomatic term infant with one septic risk factor for Group B Streptococcal (GBS) invasive disease have advised a clinical approach. Following a previous audit in our unit which showed that high numbers of asymptomatic infants were receiving antibiotics, a new protocol was introduced which emphasised the importance of clinical examination. This study assessed the safety and efficacy of this new protocol through chart review of 1855 eligible infants. We found a statistically significant decrease (P < 0.0001) from 444 (19%) to 121 (6.5%) in the total number of term infants who underwent septic evaluations and received antibiotics. 241 asymptomatic infants with one septic risk factor were managed conservatively. No eligible infants had GBS invasive disease during the three month study period. The new protocol is a safe and effective tool for evaluating infants at risk of GBS invasive disease.
    • Letter: single liver stiffness measurement predicts liver-related mortality in chronic hepatitis C.

      McCormick, P A; Elrayah, E; Hughes, B; Schmidt, D; Moloney, J (Alimentary pharmacology & therapeutics, 2014-06)
      Letter
    • Leucocyte esterase in the rapid diagnosis of paediatric septic arthritis.

      Kelly, E G; Cashman, J P; Dept. of Trauma and Orthopaedic Surgery, Children's University Hospital, Temple St., Dublin, Ireland. endagkelly@gmail.com (2013-02)
      Septic arthritis may affect any age group but is more common in the paediatric population. Infection is generally bacterial in nature. Prompt diagnosis is crucial, as delayed treatment is associated with lifelong joint dysfunction. A clinical history and application of Kocher's criteria may indicate that there is a septic arthritis. However, definitive diagnosis is made on culture of septic synovial fluid. The culture process can take over 24h for the initial culture to yield bacterial colonies. Leucocyte esterase is released by leucocytes at the site of an infection. We hypothesise that leucocyte esterase can be utilized in the rapid diagnosis of septic arthritis and shorten the time to decisive treatment whilst simultaneously decreasing unnecessary treatment of non-septic joints.
    • Leukaemic alveolar rhabdomyosarcoma.

      Curry, Sarah; Bacon, Christopher L; Robinson, Ian; Capra, Michael; Smith, Owen P; Department of Oncology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland. (2012-02-01)
    • Leukocytosis in women with polycystic ovary syndrome (PCOS) is incompletely explained by obesity and insulin resistance.

      Phelan, N; O'Connor, A; Kyaw Tun, T; Correia, N; Boran, G; Roche, Hm; Gibney, J; Departments of Endocrinology and Diabetes, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. (Clinical endocrinology, 2012-06-20)
      OBJECTIVES: Low-grade chronic inflammation predicts cardiovascular outcomes and is observed in women with polycystic ovary syndrome (PCOS). Whether this is entirely a cause or consequence of insulin resistance (IR) is unknown. METHODS: Seventy pairs of women with and without PCOS, matched for age, BMI and IR (HOMA, QUICKI and Avignon index), were generated from a larger cohort of 103 women with and 104 BMI-matched women without PCOS. Women with PCOS were studied in the follicular phase of the menstrual cycle. White cell count (WCC), high-sensitivity CRP (hsCRP) and a series of 12 cytokines and growth factors were measured. These inflammatory markers were also compared between women with PCOS and 10 normal women studied in the follicular, peri-ovulatory and luteal stages. RESULTS: When all subjects were compared, WCC (6.75 x 10(9) vs 5.60 x 10(9) g/l, p<0.005), hsCRP (4.04 vs 2.90 mg/l, p<0.05), and IL-6 (1.11 vs 0.72 pg/ml, p<0.05) were greater in women with PCOS. Pair-matching for IR eliminated between-group differences in hsCRP and cytokines but did not alter the difference in WCC (6.60 x 10(9) vs 5.60 x 10(9) g/l, p<0.005). WCC was greater in PCOS compared to normal women at all stages of the menstrual cycle. CONCLUSIONS: Low-grade inflammation occurs in PCOS. Increased hsCRP and cytokines are associated with IR but increased WCC is observed even when IR is accounted for. The explanation for this and its clinical significance is unknown. © 2012 Blackwell Publishing Ltd.
    • Levels of oxidative damage and lipid peroxidation in thyroid neoplasia.

      Young, Orla; Crotty, Tom; O'Connell, Rohana; O'Sullivan, Jacintha; Curran, Aongus J; Department of Otolaryngology, Head & Neck Surgery, UCD School of Medicine &, Medical Science, St Vincent's University Hospital, Elm Park, Dublin. (2012-02-01)
      BACKGROUND: This study assessed the presence of oxidative damage and lipid peroxidation in thyroid neoplasia. METHODS: Using tissue microarrays and immunohistochemistry, we assessed levels of DNA damage (8-oxo-dG) and lipid peroxidation (4-HNE) in 71 follicular thyroid adenoma (FTA), 45 papillary thyroid carcinoma (PTC), and 17 follicular thyroid carcinoma (FTC) and matched normal thyroid tissue. RESULTS: Cytoplasmic 8-oxo-dG and 4-HNE expression was significantly higher in FTA, FTC, and PTC tissue compared to matched normal tissue (all p values < .001). Similarly, elevated nuclear levels of 8-oxo-dG were seen in all in FTA, FTC, and PTC tissue compared to matched normal (p values < .07, < .001, < .001, respectively). In contrast, a higher level of 4-HNE expression was detected in normal thyroid tissue compared with matched tumor tissue (p < .001 for all groups). Comparing all 3 groups, 4-HNE levels were higher than 8-oxo-dG levels (p < .001 for all groups) except that cytoplasmic levels of 8-oxo-dG were higher than 4-HNE in all (p < .001). These results were independent of proliferation status. CONCLUSION: High levels of DNA damage and lipid peroxidation in benign and malignant thyroid neoplasia indicates this damage is an early event that may influence disease progression.
    • Liaison neurologists facilitate accurate neurological diagnosis and management, resulting in substantial savings in the cost of inpatient care.

      Costelloe, L; O'Rourke, D; Monaghan, T S; McCarthy, A J; McCormack, R; Kinsella, J A; Smith, A; Murphy, R P; McCabe, D J H; Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating, the National Children's Hospital, Trinity College Dublin, Tallaght, Dublin 24,, Ireland. (2012-02-01)
      BACKGROUND: Despite understaffing of neurology services in Ireland, the demand for liaison neurologist input into the care of hospital inpatients is increasing. This aspect of the workload of the neurologist is often under recognised. AIMS/METHODS: We prospectively recorded data on referral and service delivery patterns to a liaison neurology service, the neurological conditions encountered, and the impact of neurology input on patient care. RESULTS: Over a 13-month period, 669 consults were audited. Of these, 79% of patients were seen within 48 h and 86% of patients were assessed by a consultant neurologist before discharge. Management was changed in 69% cases, and discharge from hospital expedited in 50%. If adequate resources for neurological assessment had been available, 28% could have been seen as outpatients, with projected savings of 857 bed days. CONCLUSIONS: Investment in neurology services would facilitate early accurate diagnosis, efficient patient and bed management, with substantial savings.
    • Licking as an out-of-hospital burns treatment-An isolated cultural phenomenon?

      Seoighe, Deirdre M; Baker, Joseph F; Conroy, Frank; Department of Plastic Surgery, Our Ladys Hospital for Sick Children, Crumlin,, Dublin 12, Ireland. Deirdre.seoighe@gmail.com (2012-02-01)
      Wound management in burns is a potentially complex issue. Salivary constituents have been shown experimentally to be of benefit in the treatment of thermal injuries. In our clinical experience we have encountered patients who have saliva directly applied to the burn wound prior to presenting to the national burns service. The practice is known as "Licking". We report two cases to illustrate the presentations we have encountered. We believe that these illustrate an isolated phenomenon unique to the Republic of Ireland.
    • Life After the Event: A Review of Basic Life Support Training for Parents Following Apparent Life-Threatening Events and Their Experience and Practices Following Discharge

      Macken WL; Clarke N; Nadeem M; Coghlan D (Irish Medical Journal, 2017-05)
      Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17/25 (68%) were trained and 13/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2/13 (15%) of children. Non-medical grade monitors were in use by 10/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge
    • Life course social mobility and risk of upper aerodigestive tract cancer in men.

      Schmeisser, N; Conway, D I; McKinney, P A; McMahon, A D; Pohlabeln, H; Marron, M; Benhamou, S; Bouchardy, C; Macfarlane, G J; Macfarlane, T V; et al. (2010-03)
      The aim of this study was to explore associations between social mobility and tumours of the upper aero-digestive tract (UADT), focussing on life-course transitions in social prestige (SP) based on occupational history. 1,796 cases diagnosed between 1993 and 2005 in ten European countries were compared with 1585 controls. SP was classified by the Standard International Occupational Prestige Scale (SIOPS) based on job histories. SIOPS was categorised in high (H), medium (M) and low (L). Time weighted average achieved and transitions between SP with nine trajectories: H --> H, H --> M, H --> L, M --> H, M --> M, M --> L, L --> H, L --> M and L --> L were analysed. Odds ratios (ORs) and 95%-confidence intervals [95%-CIs] were estimated with logistic regression models including age, consumption of fruits/vegetables, study centre, smoking and alcohol consumption. The adjusted OR for the lowest versus the highest of three categories (time weighted average of SP) was 1.28 [1.04-1.56]. The distance of SP widened between cases and controls during working life. The downward trajectory H --> L gave an OR of 1.71 [0.75-3.87] as compared to H --> H. Subjects with M --> M and L --> L trajectories ORs were also elevated relative to subjects with H --> H trajectories. The association between SP and UADT is not fully explained by confounding factors. Downward social trajectory during the life course may be an independent risk factor for UADT cancers.
    • Life saving positioning in patients with air embolism

      M Kooblall, M; SJ Lane, SJ; Moloney, E (Irish Medical Journal, 2015-12)
      Air embolism is an uncommon, but potentially catastrophic, event that occurs as a consequence of the entry of air into the vasculature. 1 The following illustrates such a case; an 82 year old lady, COPD with an FEV1 of 0.6 L (40%) was admitted following an exacerbation of her COPD. Her CXR showed a right sided density and her CT thorax confirmed a 4 x 3 cm mass in the right upper lobe. She was booked for a CT core biopsy. Patient was initially scanned in the prone position but was turned into the left lateral decubitus position as it was felt that this was a better access into the mass. Under aseptic technique and CT fluoroscopic guidance, core biopsy was obtained using an 18 gauge core biopsy needle. 3-4 samples were sent to pathology.
    • Life threatening sepsis while on high dose steroids requiring extra-corporeal membrane oxegenation

      Orr, C; McCarthy, C; Gunaratnam, C; Kearns, G (Irish Medical Journal (IMJ), 2013-07)
      We present a case of life-threatening streptococcal sepsis in a young man with a history of Behˆ§etâ s disease within two weeks of commencing high dose corticosteroid therapy for an exacerbation of Behˆ§etâ s disease.