• B-Type natriuretic peptide in the cardiology department

      Shea, P; Daly, R; Kasim, S; Tormey, WP (Irish Medical Journal, 2012-12)
    • Be Wary of the Thorny QALY

      Sugrue, A; Havelin, A (Irish Medical Journal (IMJ), 2012-10)
    • The benefit of a pre-pregnancy care program in women with Type 1 and Type 2 diabetes: continued improvement

      Mustafa, E; Khalil, S; Kirwan, B; Carmody, L; Gallacher, T; Mitchell, Y; Todd, M; Hoashi, S; Durkan, M; Dunne, F; et al. (Royal Academy of Medicine in Ireland, 2011)
    • Best practice in youth health promotion in Ireland

      Nic Gabhainn, S.; Corrigan, H.; Centre for Health Promotion Studies, Department of Health Promotion, National University of Ireland, Galway (2003)
    • Bouncy castle burns.

      Healy, Claragh; Riordan, Colin; Kelly, Jack L; Department of Plastic and Reconstructive Surgery, University College Hospital Galway, Galway, Ireland. claraghhealy@eircom.net (2006-11)
    • Brachial neuritis (Parsonnage-Turner syndrome) - a case study.

      De Burca, Neasa; University Hospital Galway, Ireland. neasa.deburca@ul.ie (2009-10)
    • Buttressing staples with cholecyst-derived extracellular matrix (CEM) reinforces staple lines in an ex vivo peristaltic inflation model.

      Burugapalli, Krishna; Chan, Jeffrey C Y; Kelly, John L; Pandit, Abhay; National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland. (Springer, 2008-11)
      Staple line leakage and bleeding are the most common problems associated with the use of surgical staplers for gastrointestinal resection and anastomotic procedures. These complications can be reduced by reinforcing the staple lines with buttressing materials. The current study reports the potential use of cholecyst-derived extracellular matrix (CEM) in non-crosslinked (NCEM) and crosslinked (XCEM) forms, and compares their mechanical performance with clinically available buttress materials [small intestinal submucosa (SIS) and bovine pericardium (BP)] in an ex vivo small intestine model.
    • Can Early Changes in Vital signs Predict Duration of Antibiotic Therapy in Suspected Neonatal Sepsis?

      McGovern, M; Morrissey, P; Ryan, E (Irish Medical Journal, 2019-04)
      Suspected sepsis remains a leading causes of Neonatal Intensive Care Unit admission, with infants often receiving 48-72 hours of empirical antibiotic therapy. Early in treatment it is difficult to predict infants who will require prolonged antibiotic therapy. Our aim was to assess if vital sign measurements in the initial period of treatment can predict those neonates requiring prolonged antibiotic therapy in term and late-preterm infants.
    • Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.

      Dover, Mary; Tawfick, Wael; Sultan, Sherif (Vascular and endovascular surgery, 2013-09-17)
      Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI's discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to identify patients requiring cardiac intervention prior to vascular procedures.
    • Cardiovascular disease: primary prevention, disease modulation and regenerative therapy.

      Sultan, Sherif; Hynes, Niamh; Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Ireland. sherif.sultan@hse.ie (Vascular, 2012-10)
      Cardiovascular primary prevention and regeneration programs are the contemporary frontiers in functional metabolic vascular medicine. This novel science perspective harnesses our inherent ability to modulate the interface between specialized gene receptors and bioavailable nutrients in what is labeled as the nutrient-gene interaction. By mimicking a natural process through the conveyance of highly absorbable receptor specific nutrients, it is feasible to accelerate cell repair and optimize mitochondrial function, thereby achieving cardiovascular cure. We performed a comprehensive review of PubMed, EMBASE and Cochrane Review databases for articles relating to cardiovascular regenerative medicine, nutrigenomics and primary prevention, with the aim of harmonizing their roles within contemporary clinical practice. We searched in particular for large-scale randomized controlled trials on contemporary cardiovascular pharmacotherapies and their specific adverse effects on metabolic pathways which feature prominently in cardiovascular regenerative programs, such as nitric oxide and glucose metabolism. Scientific research on 'cardiovascular-free' centenarians delineated that low sugar and low insulin are consistent findings. As we age, our insulin level increases. Those who can decelerate the rapidity of this process are prompting their cardiovascular rejuvenation. It is beginning to dawn on some clinicians that contemporary treatments are not only failing to impact on our most prevalent diseases, but they may be causing more damage than good. Primary prevention programs are crucial elements for a better outcome. Cardiovascular primary prevention and regeneration programs have enhanced clinical efficacy and quality of life and complement our conventional endovascular practice.
    • A Case of Paget-Schroetter Syndrome in a Young Male After Lifting Weights

      Umana, E.; Elsherif, M.; Binchy, J. (Irish Medical Journal, 2019-02)
      Paget-Schroetter Syndrome (PSS) or effort thrombosis of the axillary-subclavian venous axis is a rare disease affecting healthy young adults which requires a high index of suspicion to diagnose. Management often requires not only anticoagulation but also thrombolysis with first rib resection to prevent recurrence and complications. We present a case of a 31-year-old male who presented to our emergency department with pain and swelling of his left upper limb. He was diagnosed with PSS and underwent; anticoagulation, catheter directed thrombolysis and planned for first rib resection.
    • Changing practices in the surgical management of hyperparathyroidism - A 10-year review.

      Department of Surgery, Galway University Hospital, Galway, Ireland. (2012-01-31)
      AIM: Parathyroid surgery has undergone a paradigm shift over the last decade, with a move from traditional bilateral neck exploration to minimally invasive parathyroidectomy (MIP), and increasing reliance on pre- and intra-operative localization of overactive glands. We aimed to assess changing surgical practices and their impact on the management of parathyroid disease in a tertiary referral centre in the West of Ireland. METHODS: A retrospective cohort analysis of those patients undergoing a surgical intervention for parathyroid disease in the period between 1999 and 2009 in our centre was carried out. Data was analysed using PASW (v18) software. RESULTS: 248 procedures were performed, increasing from an annual rate of 6 in 1999 to 45 in 2009. 129 procedures were completed by minimally invasive means, following the introduction of MIP in 2003. Single-gland disease accounted for 87% of cases (n = 216) with carcinomas in 2 patients (0.8%). Pre-operative localization had disappointing diagnostic value, with high false negative rates for both ultrasound (37.3%) and Sestamibi Scanning (35.81%). Intra-operative adjuncts were more helpful, with intra-operative Parathyroid hormone monitoring facilitating curative resection of adenomas in 94.03% at 10 min. Median length of post-operative stay has significantly decreased from 6 days in 1999 to 1 night only in 2009 (p < 0.01, ANOVA). Those patients undergoing MIP had shorter stay than the open group (1.71 days -v-4.73, p = 0.003,t-test). CONCLUSION: The practice in our centre has shifted to a less invasive approach. Increased utilisation of intra-operative adjuncts has facilitated this change, and resulted in favourable changes in length of stay, extent of dissection, and number of patients treated.
    • Childhood obesity: the extent of the problem among 6-year-old Irish national school children.

      Evans, D S; Glacken, M; Goggin, D; Health Service Executive West, Department of Public Health, Merlin Park Hospital, Galway, Ireland. david.evans@hse.ie (2011-05)
      Childhood obesity is rapidly increasing worldwide. In Ireland, the number of overweight children has trebled over the last decade. The study aimed to provide an assessment of the prevalence of obesity of 6-year-old children in one region of Ireland.
    • Children with Down Syndrome: Are we hearing their needs

      O'Duffy, F; McAskill, D; Keogh, IJ (Irish Medical Journal, 2013-02)
    • Children’s research and ethical review executive summary

      Felzmann, Heike; Sixsmith, Jane; Department of Health and Children (DOHC); National University of Ireland, Galway (NUIG); Health Promotion Research Centre (HPRC); Centre of Bioethical Research and Analysis (COBRA); O’Higgins, Siobhan; Ni Chonnactaigh, Sorcha; Nic Gabhainn, Saoirse (The Stationery Office, Dublin, 2009-06)
    • Clinical efficacy and cost per quality-adjusted life years of pararenal endovascular aortic aneurysm repair compared with open surgical repair.

      Sultan, Sherif; Hynes, Niamh; Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland. sherif.sultan@hse.ie (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2011-04)
      To gauge the efficacy of applying commercially-available endografts to pararenal endovascular abdominal aortic aneurysm (AAA) repair compared with open surgical repair (OSR).
    • Clinical problem-solving. Looking at the whole picture.

      Donagh, Carol; Bruzzi, John; MacNeill, Briain; DaCosta, Mark; Berman, Jeffrey S; O'Regan, Anthony W; Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland. (2012-01-31)
    • Clofarabine in the treatment of poor risk acute myeloid leukaemia.

      Krawczyk, Janusz; Ansar, Naeem; Swords, Ronan; Murphy, Tracy; MacDonagh, Barry; Meenaghan, Teresa; Hayden, Patrick; Hayad, Amjad; Murray, Margaret; O'Dwyer, Michael; et al. (2010-09)
      Clofarabine is a second generation nucleoside analogue. It inhibits DNA repair and activates the mitochondrial apoptotic pathway leading to cell death. In vitro clofarabine has demonstrated synergy with daunorubicin and Ara-C and in phase II clinical trials has shown promising activity in poor risk Acute myeloid leukaemia (AML) patients. In our institution over a 24 month period 22 AML patients (11 M, 11 F) with poor risk features, deemed unsuitable for standard therapy, were treated with clofarabine, alone (eight patients) or in combination (14 patients) for up to three cycles of treatment. The median age was 67.5 years (24-76) with 16 patients > 60 years. At the time of treatment 18 patients had active AML. Four patients intolerant of standard induction received clofarabine as consolidation. The overall response rate (ORR) for the 18 patients with active AML was 61%, nine patients (50%) achieving a complete response (CR). Induction and consolidation were well tolerated with no unexpected toxicities. Predictably, all patients developed grade 4 neutropenia but the median duration was only 20 days (17-120). Induction mortality was acceptable at 17%. In conclusion, clofarabine (alone or in combination) is active in poor risk AML with an acceptable safety profile and should be considered a potential option in poor risk AML patients.
    • A comparison of direct and indirect laryngoscopes and the ILMA in novice users: a manikin study.

      Maharaj, C H; McDonnell, J G; Harte, B H; Laffey, J G; Department of Anaesthesia, Galway University Hospitals, Galway, Ireland. (2007-11)
      Direct laryngoscopic tracheal intubation using the Macintosh laryngoscope is taught to many healthcare professionals as it is a potentially life-saving procedure. However, it is a difficult skill to acquire and maintain. Several alternative intubation devices exist that may provide a better view of the glottis and require less skill to use. We conducted a prospective, randomised trial of four different laryngoscopes and the ILMA in 30 medical students who had no prior airway management experience. The devices were tested in both normal and cervical immobilisation laryngoscopy scenarios. Following brief didactic instruction, each participant took turns performing laryngoscopy and intubation using each device under direct supervision. Each student was allowed up to three intubation attempts with each device, in each scenario. The Airtraq, McCoy, and the ILMA each demonstrated advantages over the Macintosh laryngoscope. In both the easy and difficult airway scenarios, the Airtraq, McCoy, and the ILMA reduced the number of intubation attempts, and reduced the number of optimisation manoeuvres required. The Airtraq and ILMA reduced the severity of dental trauma in both scenarios. The performance of the other devices studied was more variable. Overall, participants found that only the Airtraq was less difficult to use and they were more confident using it compared to the Macinosh laryngoscope.
    • Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization.

      Malik, M A; Maharaj, C H; Harte, B H; Laffey, J G; Department of Anaesthesia, Clinical Sciences Institute, Galway University Hospitals, Galway, Ireland. (2008-11)
      The purpose of this study was to evaluate the effectiveness of the Pentax AWS, Glidescope, and the Truview EVO2, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.