• Vitamin D nutrient intake for all life stages

      McKenna, M; McCarthy, R; Kilbane, M (Irish Medical Journal, 2011-05-25)
    • Vitamin D nutrient intake for all life stages.

      McKenna, M; McCarthy, R; Kilbane, M; Molloy, E (Irish medical journal, 2011-04)
      Vitamin D, unlike other nutrients, is a conditionally required nutrient being obtained from two sources – predominantly by skin production upon exposure to natural ultraviolet (UV) solar radiation, and to a lesser extent by oral intake. Being a fat soluble vitamin it has a long half-life of about two weeks and is stored in fat tissues.1 For nearly six months of the year from October to March in Ireland, skin production is absent and the population is dependent on oral intake from natural foodstuffs, (which are consumed in small quantities only), fortified foodstuffs (most notably some milk products for the past 25 years) and vitamin D supplements, either in multivitamin tablets or in combination with calcium tablets.
    • Vitamin D nutritional status in preterm infants and response to supplementation.

      McCarthy, Roberta A; McKenna, Malachi J; Oyefeso, Oyinkansola; Uduma, Ogenna; Murray, Barbara F; Brady, Jennifer J; Kilbane, Mark T; Murphy, John F; Twomey, Anne; O' Donnell, Colm P; et al. (2013-07-14)
      Little is known about vitamin D status in preterm infants and their response to supplementation. To investigate this, we assessed serum 25-hydroxyvitamin D (25OHD) levels using RIA in a consecutive sample of stable preterm very low birth weight (VLBW) infants (born ≤ 32 weeks gestation or birth weight ≤ 1·5 kg), and we explored associated factors. Serum 25OHD level was first assessed once infants were tolerating feeds (n 274). If this first 25OHD level was below 50 nmol/l (20 ng/ml), which is the level associated with covering requirements in terms of skeletal health in the majority, then we recommended prolonged augmented vitamin D intake ( ≥ 10 μg (400 IU) daily) from a combination of fortified feeds and vitamin supplements and follow-up re-assessment at approximately 6 weeks corrected age (n 148). The first assessment, conducted at a median for chronological age of 18 (interquartile range (IQR) 11-28) d, found that 78 % had serum 25OHD levels below 50 nmol/l. Multivariable analysis demonstrated that the determinants of serum 25OHD levels were duration of vitamin D supplementation and gestational age at birth (r 2 0·215; P< 0·001). At follow-up, after a median of 104 (IQR 78-127) d, 87 % achieved levels ≥ 50 nmol/l and 8 % had levels >125 nmol/l, a level associated with potential risk of harm. We conclude that low 25OHD levels are an issue for preterm VLBW infants, warranting early nutritional intervention. In infants with serum 25OHD levels < 50 nmol/l, a vitamin D intake of ≥ 10 μg (400 IU) daily achieves target levels in the majority; however, further work is needed to determine the exact dose to safely meet target levels without overcorrection.
    • Vitamin D receptor agonists inhibit pro-inflammatory cytokine production from the respiratory epithelium in cystic fibrosis.

      McNally, P; Coughlan, C; Bergsson, G; Doyle, M; Taggart, C; Adorini, L; Uskokovic, M R; El-Nazir, B; Murphy, P; Greally, P; et al. (2011-07-22)
      BACKGROUND: 1,25-Dihydroxycholecalciferol (1,25(OH)(2)D(3)) has been shown to mitigate epithelial inflammatory responses after antigen exposure. Patients with cystic fibrosis (CF) are at particular risk for vitamin D deficiency. This may contribute to the exaggerated inflammatory response to pulmonary infection in CF. METHODS: CF respiratory epithelial cell lines were exposed to Pseudomonas aeruginosa lipopolysaccharide (LPS) and Pseudomonas conditioned medium (PCM) in the presence or absence of 1,25(OH)(2)D(3) or a range of vitamin D receptor (VDR) agonists. Levels of IL-6 and IL-8 were measured in cell supernatants, and cellular total and phosphorylated IκBα were determined. Levels of human cathelicidin antimicrobial peptide (hCAP18) mRNA and protein were measured in cells after treatment with 1,25(OH)(2)D(3). RESULTS: Pretreatment with 1,25(OH)(2)D(3) was associated with significant reductions in IL-6 and IL-8 protein secretion after antigen exposure, a finding reproduced with a range of low calcaemic VDR agonists. 1,25(OH)(2)D(3) treatment led to a decrease in IκBα phosphorylation and increased total cellular IκBα. Treatment with 1,25(OH)(2)D(3) was associated with an increase in hCAP18/LL-37 mRNA and protein levels. CONCLUSIONS: Both 1,25(OH)(2)D(3) and other VDR agonists significantly reduce the pro-inflammatory response to antigen challenge in CF airway epithelial cells. VDR agonists have significant therapeutic potential in CF.
    • Vitamin D Status in Irish Children and Adolescents: Value of Fortification and Supplementation.

      Carroll, Aoife; Onwuneme, Chike; McKenna, Malachi J; Mayne, Philip D; Molloy, Eleanor J; Murphy, Nuala P; Children's University Hospital, Dublin, Ireland University College Dublin, Dublin, Ireland aoifecar@gmail.com. (Clinical pediatrics, 2014-07-07)
      Background. Vitamin D has important skeletal and extraskeletal roles but those living at northerly latitudes are at risk of suboptimal levels because of reduced sunlight exposure. Aim. To describe the vitamin D status of Irish children and identify factors predictive of vitamin D status. Methods. A prospective cross sectional study was undertaken over a 12 month period. Two hundred and fifty two healthy children attending for minor medical or surgical procedures were recruited. All had 25-hydroxyvitamin D (25OHD), parathyroid hormone and bone profiles measured. Results. The mean (standard deviation) for 25OHD was 51(25) nmol/L (20.4 (10) ng/mL). Forty-five percent had levels >50 nmol/L (20 ng/mL). The following variables were significantly associated with 25OHD levels >50 nmol/L (20 ng/mL): sample drawn in April-September, use of vitamin D supplements, consumption of formula milk, and non-African ethnicity. Conclusion. More than half of the children in this study had 25OHD levels less than 50 nmol/L (20 ng/mL). Vitamin D status was significantly improved by augmented oral vitamin D intake.
    • Vitamin D: new roles and therapeutic potential in inflammatory bowel disease.

      Raftery, Tara; O'Morain, Colm A; O'Sullivan, Maria; Department of Clinical Medicine, Trinity College Dublin Centre for Health Sciences, Adelaide & Meath Hospital, Dublin 24, Ireland. (2012-11)
      Inflammatory bowel disease (IBD) encompasses 2 independent but related entities: ulcerative colitis (UC) and Crohn's disease. Crohn's disease is characterised by transmural patchy inflammation which can involve any portion of the gastrointestinal tract. UC is characterised by superficial inflammation that begins in the rectum and extends proximally along the colon. In Europe, approximately 2.2 million people have a diagnosis of IBD. The aetiology of IBD is unknown, however, immune, environmental and genetic factors are thought to be involved. Individuals with IBD are at risk of developing osteoporosis. In line with this, there are clear guidelines that recommend vitamin D supplementation for IBD patients to prevent bone disease, especially when undergoing steroid treatment. Despite an established role for vitamin D in IBD, deficiency is common. More novel effects of vitamin D beyond bone are emerging. It is now well established that vitamin D is an important regulator of the immune system which may have implications for the development, severity and management of immune related disorders such as IBD. The efficacy of vitamin D as an immune modulator in IBD remains to be proven. This review aims to evaluate the evidence implicating vitamin D deficiency in IBD pathogenesis, to examine vitamin D's anti-inflammatory mechanisms and to explore its therapeutic potential, optimal serum levels and dietary intakes which may support immune function in this disease.
    • Voriconazole in the treatment of allergic bronchopulmonary aspergillosis in cystic fibrosis.

      Glackin, L; Leen, G; Elnazir, B; Greally, P; Department of Respiratory Medicine, National Children's Hospital, Tallaght, Dublin 24. Peter.Greally@amnch.ie (2009-01)
      Allergic bronchopulmonary aspergillosis (ABPA) can cause a significant clinical deterioration in patients with cystic fibrosis. There is very little research in the current literature with regard to alternatives for treatment, apart from long courses of steroids. We conducted a retrospective review of all our patients with ABPA treated with the antifungal voriconazole and found there was a significant drop in IgE levels post treatment as well as a decrease in steroid dosing. The improvement in FEV was not statistically significant; however there was a very wide variation in pre-treatment levels.
    • Warfarin use in hemodialysis patients: what is the risk?

      Phelan, P J; O'Kelly, P; Holian, J; Walshe, J J; Delany, C; Slaby, J; Winders, S; O'Toole, D; Magee, C; Conlon, P J; et al. (2012-02-01)
      BACKGROUND: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. METHODS: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. RESULTS: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). CONCLUSIONS: This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. SUMMARY: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.
    • Warfarin use in hemodialysis patients: what is the risk?

      Phelan, P J; O'Kelly, P; Holian, J; Walshe, J J; Delany, C; Slaby, J; Winders, S; O'Toole, D; Magee, C; Conlon, P J; et al. (2011-03)
      Background: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. Methods: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. Results: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). Conclusions: This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. Summary: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.
    • Warming preterm infants in the delivery room: polyethylene bags, exothermic mattresses or both?

      McCarthy, Lisa K; O'Donnell, Colm P F; The National Maternity Hospital, Dublin 2, Ireland. lisamac79@yahoo.com (2011-12)
      To compare the admission temperature of infants treated with polyethylene bags alone to infants treated with exothermic mattresses in addition to bags in the delivery room.
    • Wasted - the years waiting for an alcohol policy

      Murphy, JFA (Irish Medical Journal, 2012-12)
      Throughout his lecture Bedford portrayed the close and complex relationship between Irish society and alcohol. Alcohol is part of our image both nationally and internationally. Some of the most abiding images of US presidential visits to Ireland are of drinking pints in Irish pubs. There is Arthur’s day and jump into Ireland. Alcohol is intertwined with our great sporting occasions and achievements. The famous Ireland vs England rugby match at Croke Park was set against the backdrop of intensive Guinness advertising. All Ireland final day has a strong association with the drinks industry.
    • The way forward for the refractory asthmatic

      Kooblall, M; Moloney, E; Lane, SJ (Irish Medical Journal, 2015-07)
      Ireland has the fourth highest prevalence of asthma in the world. 7.1% of 18+ population and 18.9% of 13-15 year olds have asthma. 38.5% of 13-15 year olds reported wheezing. More than 1 person a week dies from asthma and 29% of asthma patients miss school or work. 1 Despite very safe and effective treatment 5-10% of patients with bronchial asthma do not respond well to their treatment. This group of patients are labelled as refractory asthmatics. Besides compliance, presence of psychogenic and trigger factors and comorbid illness, steroid insensitiveness or resistance may play a significant role in the poorly controlled/responding asthmatics. Type I Steroid resistance is due to lack of binding affinity of steroids to glucocorticoid receptors and may respond to higher doses of steroids while type II steroid resistance is because of reduced number of cells with glucocorticoid receptors, which is very rare and do not respond to even higher doses of systemic steroids and these cases require alternative/novel therapies. 2
    • A Web-Based Electronic Neurology Referral System: A Solution for anOverburdened Healthcare System

      Williams, L; O’Riordan, S; McGuigan, C; Hutchinson, M; Tubridy, N (Irish Medical Journal (IMJ), 2012-10)
    • Weight gain as a manageable side effect in psychiatric populations

      Cahill, Dr Michele; Noone, Dr Patricia; Eli Lilly & Co. (2003)
    • Weight management services for adults highlighting the role of primary care

      Hassan, SJ; O’Shea, D (Irish Medical Journal, 2012-12)
    • Westermark's sign of pulmonary embolism--well known but frequently overlooked.

      Tsvetanova, Z; Logan, H (Irish Medical Journal, 2015-01)
      Pulmonary embolism (PE) is frequently a difficult diagnosis because of non-specific symptoms that can lead to misdiagnosis 1 . We report a patient with PE successfully diagnosed and treated, whose CXR showed Westermark’s sign of pulmonary embolism. Westermark’s sign is distal oligaemia in the affected area of the lung due to a reduction in size of vessels distal to a PE 2 . It has a low sensitivity (14%) and high specificity (92%) for the diagnosis of pulmonary embolism 3 . Its high specificity for PE makes it a sign well worth being aware of and in this case described its early recognition may led to early treatment and to prevention of cardiovascular insult.
    • What are the spondyloarthropathies?

      FitzGerald, Oliver; Maksymowych, Walter P; Dept of Rheumatology, St. Vincents University Hospital, Elm Park, Dublin, 4, Ireland. oliver.fitzgerald@ucd.ie (2010-10)
    • What do gastroenterology trainees want: recognition, remuneration or recreation?

      Harewood, G C; Pardi, D S; Hansel, S L; Corr, A E; Aslanian, H; Maple, J; Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland, harewood.gavin@gmail.com. (2010-07-27)
      BACKGROUND: Occupational psychologists have identified three factors important in motivating physicians: financial reward, academic recognition, time off. AIM: To assess motivators among gastroenterology (GI) trainees. METHODS: A questionnaire was distributed to GI trainees to assess their motivators: (1) work fewer hours for less lucrative rate, (2) reduction in salary/increase in hours for academic protected time, and (3) work longer hours for higher total salary, but less lucrative hourly rate. RESULTS: Overall, 61 trainees responded; 52% of trainees would work shorter hours for less lucrative rate; 60% would accept a disproportionate reduction in salary/increase in hours for academic protected time; 54% would work longer hours for more money but less lucrative rate. Most trainees (93%) accepted at least one scenario. CONCLUSIONS: Most GI trainees are willing to modify their job description to align with their personal values. Tailoring job descriptions according to these values can yield economic benefits to GI Divisions.
    • What do gastroenterology trainees want: recognition, remuneration or recreation?

      Harewood, G C; Pardi, D S; Hansel, S L; Corr, A E; Aslanian, H; Maple, J; Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin,, Ireland. harewood.gavin@gmail.com (2012-02-01)
      BACKGROUND: Occupational psychologists have identified three factors important in motivating physicians: financial reward, academic recognition, time off. AIM: To assess motivators among gastroenterology (GI) trainees. METHODS: A questionnaire was distributed to GI trainees to assess their motivators: (1) work fewer hours for less lucrative rate, (2) reduction in salary/increase in hours for academic protected time, and (3) work longer hours for higher total salary, but less lucrative hourly rate. RESULTS: Overall, 61 trainees responded; 52% of trainees would work shorter hours for less lucrative rate; 60% would accept a disproportionate reduction in salary/increase in hours for academic protected time; 54% would work longer hours for more money but less lucrative rate. Most trainees (93%) accepted at least one scenario. CONCLUSIONS: Most GI trainees are willing to modify their job description to align with their personal values. Tailoring job descriptions according to these values can yield economic benefits to GI Divisions.
    • What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service.

      Jabbar, F; Casey, P; Schelten, S L; Kelly, B D; Department of Adult Psychiatry, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin 7, Ireland. (2011-03)
      This study aimed to measure patient satisfaction with the care they were receiving; examine patients' knowledge of the psychiatric services in general; and identify variables associated with satisfaction.