• Kernicterus with abnormal high-signal changes bilaterally in the globus pallidus: A case report.

      Culleton, S; Kok, HK; Barras, C; Looby, S; Brennan, P; Asadi,H (Irish Medical Journal, 2018-04)
      Kernicterus is a relatively rare consequence of hyperbilirubinemia. There is an important role for MRI imaging for this entity in the appropriate clinical context as there are distinct signal changes in the globus pallidus. A case report and image findings are presented
    • Kicking off a Retropharyngeal Abscess

      Rana, A; Heffernen, L; Binchy, J (Irish Medical Journal, 2019-03)
      Retropharyngeal abscesses (RPA) are deep neck space infections that can pose an immediate life-threatening emergency, such as airway obstruction. [1] The potential space can become infected by bacteria spreading from a contiguous area [2] or direct inoculation from penetrating trauma. [3] Infection is often polymicrobial (most commonly group A beta-hemolytic streptococci). [4
    • Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope.

      Maharaj, C H; Costello, J F; Higgins, B D; Harte, B H; Laffey, J G; Department of Anaesthesia, University College Hospital Galway, Ireland. (2006-07)
      Direct laryngoscopic tracheal intubation is taught to many healthcare professionals as it is a potentially lifesaving procedure. However, it is a difficult skill to acquire and maintain, and, of concern, the consequences of poorly performed intubation attempts are potentially serious. The Airtraq Laryngoscope is a novel intubation device which may possess advantages over conventional direct laryngoscopes for use by novice personnel. We conducted a prospective trial with 40 medical students who had no prior airway management experience. Following brief didactic instruction, each participant took turns in performing laryngoscopy and intubation using the Macintosh and Airtraq devices under direct supervision. Each student was allowed up to three attempts to intubate in three laryngoscopy scenarios using a Laerdal Intubation Trainer and one scenario in a Laerdal SimMan Manikin. They then performed tracheal intubation of the normal airway a second time to characterise the learning curve for each device. The Airtraq provided superior intubating conditions, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. In both easy and simulated difficult laryngoscopy scenarios, the Airtraq decreased the duration of intubation attempts, reduced the number of optimisation manoeuvres required, and reduced the potential for dental trauma. The Airtraq device showed a rapid learning curve and the students found it significantly easier to use. The Airtraq appears to be a superior device for novice personnel to acquire the skills of tracheal intubation.
    • Lentiviral vector mediated modification of mesenchymal stem cells & enhanced survival in an in vitro model of ischaemia.

      McGinley, Lisa; McMahon, Jill; Strappe, Padraig; Barry, Frank; Murphy, Mary; O'Toole, Daniel; O'Brien, Timothy; Regenerative Medicine Institute and Department of Medicine, National University, of Ireland, Galway and Galway University Hospital, University Road, Galway,, Ireland. timothy.obrien@nuigalway.ie. (2012-01-31)
      INTRODUCTION: A combination of gene and cell therapies has the potential to significantly enhance the therapeutic value of mesenchymal stem cells (MSCs). The development of efficient gene delivery methods is essential if MSCs are to be of benefit using such an approach. Achieving high levels of transgene expression for the required period of time, without adversely affecting cell viability and differentiation capacity, is crucial. In the present study, we investigate lentiviral vector-mediated genetic modification of rat bone-marrow derived MSCs and examine any functional effect of such genetic modification in an in vitro model of ischaemia. METHODS: Transduction efficiency and transgene persistence of second and third generation rHIV-1 based lentiviral vectors were tested using reporter gene constructs. Use of the rHIV-pWPT-EF1-alpha-GFP-W vector was optimised in terms of dose, toxicity, cell species, and storage. The in vivo condition of ischaemia was modelled in vitro by separation into its associated constituent parts i.e. hypoxia, serum and glucose deprivation, in which the effect of therapeutic gene over-expression on MSC survival was investigated. RESULTS: The second generation lentiviral vector rHIV-pWPT-EF1-alpha-GFP-W, was the most efficient and provided the most durable transgene expression of the vectors tested. Transduction with this vector did not adversely affect MSC morphology, viability or differentiation potential, and transgene expression levels were unaffected by cryopreservation of transduced cells. Over-expression of HSP70 resulted in enhanced MSC survival and increased resistance to apoptosis in conditions of hypoxia and ischaemia. MSC differentiation capacity was significantly reduced after oxygen deprivation, but was preserved with HSP70 over-expression. CONCLUSIONS: Collectively, these data validate the use of lentiviral vectors for efficient in vitro gene delivery to MSCs and suggest that lentiviral vector transduction can facilitate sustained therapeutic gene expression, providing an efficient tool for ex vivo MSC modification. Furthermore, lentiviral mediated over-expression of therapeutic genes in MSCs may provide protection in an ischaemic environment and enable MSCs to function in a regenerative manner, in part through maintaining the ability to differentiate. This finding may have considerable significance in improving the efficacy of MSC-based therapies.
    • Living with relapsed myeloma: Symptoms and self-care strategies.

      Cormican, Orlaith; Dowling, Maura (2018-04-01)
      Aims and Objectives To explore which symptoms relapsed myeloma patients experience and what self‐care strategies are used. Methods This was a qualitative study utilising focus group interviews (n = 4) with relapsed myeloma patients (n = 15) and carers (n = 9). The focus groups were analysed and guided by thematic analysis. Results Three major themes with subthemes were identified following analysis of the interview data: “difficult symptoms; “self‐care” and “feeling vulnerable.” These findings indicate the challenges relapsed myeloma patients experience with ongoing symptoms and highlight the importance of continuity of care. Conclusions Symptom management for myeloma patients remains complex due to the array of treatments given. These patients require holistic care and thorough regular assessments to help them cope with the adverse effects on their physical and psychological health. For patients with a long‐term diagnosis of myeloma, self‐management workshops and regular education sessions may be of benefit.
    • Locally advanced rectal cancer: a cooperative surgical approach to a complex surgical procedure.

      Owens, P; Lynch, N; Curtin, M; Devitt, A (Irish Medical Journal, 2015-01)
      Single stage en bloc abdominoperineal resection and sacrectomy, with a myocutaneous flap closure is a relatively uncommon procedure. Our case study of a 77 year old man with a locally invasive rectal adenocarcinoma highlights the complex intraoperative management of such a patient.
    • Low back pain post partum - A case report.

      De Búrca, Neasa; Physiotherapy Department, University Hospital Galway, Galway, Ireland. (2012-02-23)
      Sacral stress fracture is an unusual source of low back pain and can be easily confused with a number of other clinical conditions seen in physiotherapy clinics. The purpose of this case report is to describe the case of a patient presenting with low back pain post partum illustrating pertinent aspects of differential diagnosis and issues of management. A 31 year old female presented complaining of low back pain since the birth of her second child 11 months earlier. Subjective and objective examination led the Therapist to consider a diagnosis of sacral stress fracture. This diagnosis was confirmed by MRI. Three months after presenting to physiotherapy the patient was pain free and had returned to all aspects of her daily life without any difficulties. Clinicians must be aware of the less common pathologies in any hypotheses development. A careful history and physical examination and broad hypotheses generation will ensure that patients are accurately diagnosed and receive appropriate and effective treatments.
    • Management of diabetes in pregnancy

      Dunne, F; Noctor, E; Galway University Hospital (2011)
    • Management of Diabetic Ketoacidosis in the insulin analogue era

      Matiullah, S; Ryan, J; Tuohy, S (Irish Journal of Medical Science, 2010)
    • Management of Paediatric Buckle (Torus) Wrist Fractures in Irish Emergency Departments: A National Survey

      Abdelhady, A; Ahmed, A; Umana, E; O’Donnell, J; University Hospital Galway (Irish Medical Journal, 2018-07)
      Buckle fractures are the most common wrist fractures reported in the paediatric age group. National Institute for Clinical Excellence (NICE) recommends using a non-rigid immobilisation with no follow up for these patients and appropriate discharge advice. A telephone survey was conducted to assess the variation in practice in Irish hospitals regarding the mpediatrianagement of buckle fractures. Twenty eight centres that manage paediatric patients with trauma were contacted. This survey demonstrates that over 70% (>20) of centres in Ireland are managing buckle fractures using the traditional approach of backslab cast and follow-up in fracture clinic. Despite relevant research and NICE guideline recommendations, there is a slow adoption of current evidence among Irish hospitals which points to a need for a national consensus on management of buckle fractures.
    • Maternal obesity in pregnancy

      Dunne, F; Dennedy, MC; Galway University Hospital (Springer, 2012)
    • Maxillofacial osseous reconstruction using the angular branch of the thoracodorsal vessels.

      Dolderer, Jürgen H; Kelly, Jack L; McCombe, David; Burt, Jamie; Pfau, Matthias; Morrison, Wayne A; Department of Plastic, Hand and Reconstructive Surgery, BG-Trauma-Center, Eberhard-Karls-University Tuebingen, Tuebingen, Germany. drdolderer@hotmail.com (Thieme Publications, 2010-09)
      Mandibular and maxillary resections can produce complex three-dimensional defects requiring skeletal, soft tissue, and epithelial reconstruction. The subscapular vascular axis offers a source of skin, bone, and muscle on a single pedicle for microvascular flap transfer. We reviewed four cases where the subscapular vascular pedicle was used as a source of tissue for complex facial reconstructions in maxillofacial defects. Reconstruction of these complex defects was performed with a latissimus dorsi muscle or myocutaneous flap in combination with the lateral border of the scapula, harvested on the angular branch of the thoracodorsal vessels. There were three cases of maxillectomy and one case of partial mandibulectomy for malignant tumors. In each case, the angular branch of the thoracodorsal artery supplied 6 to 8 cm of the lateral border of the scapula and a latissimus dorsi myocutaneous flap was used for soft tissue reconstruction. Follow-up ranged from 9 months to 3 years and in all cases there was successful bony union. Shoulder movement was normal. This series encourages the further use of subscapular axis flaps as flexible sources of combined myocutaneous and osseous flaps on a single vascular pedicle in cases of complex maxillofacial reconstruction.
    • Meconium Ileus in Two Irish Newborns: The Presenting Feature of Cystic Fibrosis

      Smith, A.; Ryan, E; O’Keeffe, D; O’Donovan, D. (Irish Medical Journal, 2019-03)
      Cystic Fibrosis (CF) is the most common genetically inherited disease in Ireland1. Approximately 1/ 2,300 infants per year are born with CF in Ireland2. Newborn bloodspot screening (NBS) screening for CF was introduced to Ireland in 20113. NBS screening for CF is associated with improved lung function, nutritional status and increased survival into early adulthood4. Therefore early recognition and management of this chronic condition is vital to ensuring optimal patient management.
    • Medical record weight (MRW): a new reliable predictor of hospital stay, morbidity and mortality in the hip fracture population?

      Calpin, P; Taheny, K; Baker, JF; Green, J; McCabe, JP (Irish Medical Journal, 2016-11)
      We sought to compare the weight of patient’s medical records (MRW) to that of standardised surgical risk scoring systems in predicting postoperative hospital stay, morbidity, and mortality in patients with hip fracture. Patients admitted for surgical treatment of a newly diagnosed hip fracture over a 3-month period were enrolled. Patients with documented morbidity or mortality had significantly heavier medical records. The MRW was equivalent to the age-adjusted Charlson co-morbidity index and better than the American Society of Anaesthesiologists physical status score (ASA), the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM,) and Portsmouth-POSSUM score (P-POSSUM) in correlation with length of hospital admission, p = .003, 95% CI [.15 to .65]. Using logistic regression analysis MRW was as good as, if not better, than the other scoring systems at predicting postoperative morbidity and 90-day mortality. Medical record weight is as good as, or better than, validated surgical risk scoring methods. Larger, multicentre studies are required to validate its use as a surgical risk prediction tool, and it may in future be supplanted by a digital measure of electronic record size. Given its ease of use and low cost, it could easily be used in trauma units globally.
    • Medical speciality choice: does personality matter?

      Lydon, S; O'Connor, P; McVeigh, T; Offiah, C; Byrne, D (Irish Medical Journal, 2015-03)
      There has been increasing interest in the personalities of doctors. This study examined whether personality differed based upon gender, level of training or medical speciality among 200 physicians and 134 medical students. Post-internship doctors scored significantly higher on conscientiousness (p = .001) than those pursuing basic medical training. Among those pursuing basic medical training, females scored significantly higher than males on agreeableness (p < .001) and conscientiousness (p = .001). Among post-internship respondents, females scored significantly higher on agreeableness (p = .004). There were no personality differences between post-internship doctors working in different specialities. However, among those pursuing basic medical training, those interested in person-focused medical specialities scored significantly higher on extraversion (p < .001), conscientiousness (p = .001), and lower on neuroticism (p = .01) than those who had no strong preference. These results suggest that there is no unique personality profile associated with medical practice, or medical speciality. Instead, it appears that medical school may shape personality.
    • Methylphenidate-induced erections in a prepubertal child.

      Kelly, B D; Lundon, D J; McGuinness, D; Brady, C M; Department of Urology, Galway University Hospital, Ireland. drbriankelly@hotmail.com (2013-02)
      Methylphenidate is a medication used routinely in the management of attention deficit hyperactivity disorder. We report a case of a prepubertal child who developed unwanted erections after commencing a response-adjusted dosing regimen of sustained release methylphenidate. Despite priapism being a rare adverse reaction associated with methylphenidate, physicians and parents need to be aware as it can have significant long-term complications.
    • Microsurgical replantation of an ear with no venous repair.

      Hussey, A J; Kelly, J I; Department of Plastic, Reconstructive and Hand Surgery, University College Hospital, Galway, Ireland. (Informa Healthcare, 2010-02)
      Replantation of an avulsed ear was completely successful with only arterial repair (to the superficial temporal artery) and the use of medicinal leeches.
    • A mixed methods study exploring the factors and behaviours that impact on glycaemic control following a structured education programme: the Irish DAFNE Study

      Casey, D; Meehan, B; O'Hara, MC; Byrne, M; Dineen, SF; Murphy, K; 1School of Nursing and Midwifery, NUI Galway, Galway, Ireland, Qualitative Data Analysis Projects, QDA Training, Pembroke Lane, Dublin 4, Ireland, Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Psychology, NUI Galway, Galway, Ireland (2016-04)
      INTRODUCTION Diabetes is now the commonest non-communicable illness in the world and is associated with significant morbidity and mortality; over 371 million people worldwide have diabetes (IDF 2012a). It is associated with microvascular and macrovasular complications. As there is no diabetes registry in Ireland, it is difficult to establish the true prevalence rates. However, the International Diabetes Federation estimates that there are 191,380 people with diabetes in Ireland (with a prevalence of 6.1% in the population), approximately 7-9% of whom have type 1 diabetes (T1D) (IDF 2012b). Some of the longer-term complications of diabetes can be avoided by maintaining good glycaemic control. Glycosylated haemoglobin (HbA1c) is used to identify the average plasma glucose concentration over a period of approximately 3 months. Best practice would recommend testing HbA1c every 3 months if the person is trying to improve their glycaemic control or every 6 months if glycaemic control is already achieved and they want to maintain it. HbA1c goals usually determine how tight people with type 1 diabetes have to run their blood sugar, which is usually individualised to the person’s treatment needs. Current guidelines recommend a target HbA1c of between 53 mmol/ mol (7%) and 59 mmol/ mol (7.5%) (ADA 2013). Landmark trials such as the Diabetes Complications and Control Trial demonstrated that poorer glycaemic control (higher HbA1c) was associated with an increased risk of some of the complications of diabetes such as retinopathy, however, tighter control (lower HbA1c) was associated with an increase in the frequency of severe hypoglycaemia (Kilpatrick et al 2008). Hypoglycaemia can be very debilitating to those who experience it and can negatively impact on people’s quality of life (Lawton et al 2013). The challenge in day-to-day management of T1D is to find a balance between an acceptable low level of HbA1c without frequent hypoglycaemia.
    • Moderate and extreme maternal obesity.

      Abdelmaboud, M O; Ryan, H; Hession, M; Avalos, G; Morrison, J J; Department of Obstetrics Gynaecology, University Hospital, Newcastle Road, Galway. (Irish Medical Journal (IMJ), 2012-05)
      The aim of this study was to investigate the prevalence of moderate and extreme obesity among an Irish obstetric population over a 10-year period, and to evaluate the obstetric features of such pregnancies. Of 31,869 women delivered during the years 2000-2009, there were 306 women in the study group, including 173 in the moderate or Class 2 obese category (BMI 35-39.9) and 133 in the extreme or Class 3 obese category (BMI > or = 40).The prevalence of obese women with BMI > or = 35 was 9.6 per 1000 (0.96%), with an upward trend observed from 2.1 per 1000 in the year 2000, to 11.8 per 1000 in the year 2009 (P = 0.001). There was an increase in emergency caesarean section (EMCS) risk for primigravida versus multigravid women, within both obese categories (P < 0.001). However, there was no significant difference in EMCS rates observed between Class 2 and Class 3 obese women, when matched for parity. The prevalence of moderate and extreme obesity reported in this population is high, and appears to be increasing. The increased rates of abdominal delivery, and the levels of associated morbidity observed, have serious implications for such women embarking on pregnancy.