• Unusual complications associated with maxillary herpes zoster

      Falzon, K; Galea, M; Guerin, M (Irish Medical Journal, 2011-02)
    • Unusual genome complexity in Lactobacillus salivarius JCM1046

      Raftis, Emma J; Forde, Brian M; Claesson, Marcus J; O’Toole, Paul W (2014-09-08)
      Abstract Background Lactobacillus salivarius strains are increasingly being exploited for their probiotic properties in humans and animals. Dissemination of antibiotic resistance genes among species with food or probiotic-association is undesirable and is often mediated by plasmids or integrative and conjugative elements. L. salivarius strains typically have multireplicon genomes including circular megaplasmids that encode strain-specific traits for intestinal survival and probiotic activity. Linear plasmids are less common in lactobacilli and show a very limited distribution in L. salivarius. Here we present experimental evidence that supports an unusually complex multireplicon genome structure in the porcine isolate L. salivarius JCM1046. Results JCM1046 harbours a 1.83 Mb chromosome, and four plasmids which constitute 20% of the genome. In addition to the known 219 kb repA-type megaplasmid pMP1046A, we identified and experimentally validated the topology of three additional replicons, the circular pMP1046B (129 kb), a linear plasmid pLMP1046 (101 kb) and pCTN1046 (33 kb) harbouring a conjugative transposon. pMP1046B harbours both plasmid-associated replication genes and paralogues of chromosomally encoded housekeeping and information-processing related genes, thus qualifying it as a putative chromid. pLMP1046 shares limited sequence homology or gene synteny with other L. salivarius plasmids, and its putative replication-associated protein is homologous to the RepA/E proteins found in the large circular megaplasmids of L. salivarius. Plasmid pCTN1046 harbours a single copy of an integrated conjugative transposon (Tn6224) which appears to be functionally intact and includes the tetracycline resistance gene tetM. Conclusion Experimental validation of sequence assemblies and plasmid topology resolved the complex genome architecture of L. salivarius JCM1046. A high-coverage draft genome sequence would not have elucidated the genome complexity in this strain. Given the expanding use of L. salivarius as a probiotic, it is important to determine the genotypic and phenotypic organization of L. salivarius strains. The identification of Tn6224-like elements in this species has implications for strain selection for probiotic applications.
    • An unusual presentation of a glomus tumour

      Nugent, N; Henry, M; O'Shaughnessy, M (Irish Medical Journal, 2011-02)
    • An unusual presentation of non pathological delayed splenic rupture: a case report

      Khan, Suhail A; Muhammad, Izz; Laabei, Fadal; Rothwell, Jane (2009-06-16)
      Abstract The diagnosis of Delayed Splenic Rupture poses a major challenge to even the most astute clinician, as it can mimic other medical emergencies. We present a case of an unusual presentation of delayed splenic rupture in a 23-year-old Caucasian man, who presented to the emergency department with a 2 day history of left upper quadrant pain. He initially denied any history of trauma. There were no signs of generalized peritonisim on examination but his haemoglobin level was low (8.9 gm/dl) for which there was no obvious cause identified. He was resuscitated and a computed tomography of the abdomen was performed. This revealed complete rupture of the splenic capsule with haemorrhagic fluid in the abdomen. With the computed tomography abdomen findings and further questioning of the patient, the only potential precipitating event that he could remember was a minor kick to the left upper quadrant more than 2 weeks ago while playing football. An urgent splenectomy was performed and histology confirmed complete rupture of the splenic capsule with a large adherent haematoma to the capsule. This case illustrates the difficulty in diagnosing delayed splenic rupture especially when accurate history is not available. A high index of suspicion is essential as delay in diagnosis can be fatal. Early diagnosis in suspected cases can be achieved by performing computed tomography of the abdomen.
    • An unusual talon Cusp

      McNamara, CM (1997)
    • Update on medications – management of asthma in adults and children

      Morrow, Ruth (Nursing in General Practice, 2014-11)
    • Update on respiratory drugs

      Morrow, Ruth (Nursing in General Practice, 2014-01)
    • An update on the economics of dementia care in Ireland.

      Trépel, D (Irish Medical Journal (IMJ), 2012-02)
    • The Uptake of Human Papillomavirus Vaccine In Irish Schools: The Impact Of Disadvantage

      Migone, C; Barrett, T; Cotter, S; Clarke, A; Corcoran, B (Irish Medical Journal, 2017-07)
    • Uptake of newly introduced universal BCG vaccination in newborns.

      Braima, O; Rigney, A; Ryan, C A; Murphy, C; Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork. (2010-06)
      Universal neonatal BCG vaccination was discontinued in Cork in 1972. Following an outbreak of TB in 2 creches in the HSE South, a universal BCG vaccination program was re-introduced in October 2008. The aim of this study was to determine the vaccination process (in-hospital and community) and the in-hospital uptake of the vaccine. Following informed parental consent, babies of birth weight > 2.5 Kg were eligible for in-hospital vaccination if they were not: febrile, jaundiced on phototherapy, on antibiotics and if not born to HIV- positive mothers. Parents of babies not vaccinated in-hospital were asked to book an appointment in either of the 2 Cork community clinics. The immunisation nurse collected data on BCG vaccination, prospectively. This study examined vaccination uptakes in-hospital and community over a 6 month period (October 2008 to March 2009). There were 4018 deliveries during the study period. In-hospital consent was declined in only 16 babies (<1%) while the in-hospital vaccination uptake was 80% of total liv births. Although 635 newborns were admitted to the NICU, only 46 (8%) were vaccinated while in the NICU. At least 48% of planned community vaccination has been achieved to date. In conclusion, in-hospital consent was almost universal and vaccination uptake was satisfactory. NICU exclusion criteria accounted for a significant proportion of non-vaccination in-hospital. These criteria need to be readdressed considering that all premature babies are given other routine newborn vaccines at 2 months of age, regardless of weight.
    • Urachal endometrioma: a case report.

      Browne, Katherine M; Connolly, Stephen S; Daly, Niamh; Crotty, Tom; Flynn, Robert J; Department of Urology, Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. (2009)
      INTRODUCTION: We discuss a rare presentation of an unusual case of endometrioma. CASE PRESENTATION: A 40-year-old Caucasian woman presented with subacute abdominal pain and a suprapubic mass. A final diagnosis was made after the mass was resected and histopathology confirmed an endometrioma originating from an urachal remnant. Select imaging studies and histopathology are presented in this case report. CONCLUSION: While endometriomata are well known to arise from abdominal scars, the condition described in this case report is a rare example of an endometrioma arising from the urachus. A review of the pathological complications of the urachus is also included.
    • Urban overdose hotspots: a 12-month prospective study in Dublin ambulance services

      Klimas, Jan; O'Reilly, Martin; Egan, Mairead; Tobin, Helen; Bury, Gerard (The American Journal of Emergency Medicine, 2014-07)
    • Urethral stricture secondary to self-instrumentation due to delusional parasitosis: a case report

      Ismail, Muhammad F; Cassidy, Eugene M (2015-09-15)
      Abstract Introduction Delusional parasitosis is a rare psychiatric disorder which often presents with dermatological problems. Delusional parasitosis, which involves urethral self-instrumentation and foreign body insertion, is exceptionally rare. This is the first case report to date that provides a detailed presentation of the urological manifestation of delusional parasitosis with complications associated with repeated self-instrumentation and foreign body insertion, resulting in stricture formation and requiring perineal urethrostomy. Case presentation A 45-year-old Irish man was electively admitted for perineal urethrostomy with chronic symptoms of dysuria, haematuria, urethral discharge, and intermittent urinary retention. He reported a 4-year history of intermittent pain, pin-prick biting sensations, and burrowing sensations, and held the belief that his urethra was infested with ticks. He also reported a 2-year history of daily self-instrumentation, mainly injecting an antiseptic using a syringe in an attempt to eliminate the ticks. He was found to have urethral strictures secondary to repeated self-instrumentation. A foreign body was found in his urethra and was removed via cystoscopy. On psychiatric assessment, he displayed a fixed delusion of tick infestation and threatened to surgically remove the tick himself if no intervention was performed. The surgery was postponed due his mental state and he was started on risperidone; he was later transferred to an acute in-patient psychiatric unit. Following a 3-week admission, he reported improvement in his thoughts and distress. Conclusions Delusional parasitosis is a rare psychiatric disorder. Self-inflicted urethral foreign bodies in males are rare and have high comorbidity with psychiatric disorders; hence, these patients have a low threshold for referral for psychiatric assessment. The mainstay treatment for delusional parasitosis is second-generation antipsychotic drugs.
    • The use of a chaperone in obstetrical and gynaecological practice.

      Afaneh, I; Sharma, V; McVey, R; Murphy, C; Geary, M; The Rotunda Hospital, Parnell Square, Dublin 1. iyadafaneh@physicians.ie (2010-05)
      The aim of this study was to assess the use of a chaperone in obstetrical and gynaecological practice in Ireland and to explore patients' opinions. Two questionnaires were designed; one for patients and the other one was sent to 145 gynaecologists in Ireland. One hundred and fifty two women took part in this survey of whom 74 were gynaecological and 78 were obstetric patients. Ninety five (65%) patients felt no need for a chaperone during a vaginal examination (VE) by a male doctor. On the other hand 34 (23%) participating women would request a chaperone if being examined by a female doctor. Among clinicians 116 (80%) responded by returning the questionnaire. Overall 60 (52%) always used a chaperone in public practice, in contrast to 24 (27%) in private practice. The study demonstrated that most patients do not wish to have a chaperone during a VE but a small proportion would still request one regardless of the examiner's gender. Patients should be offered the choice of having a chaperone and their opinion should be respected and documented.
    • Use of a highly-sensitive cardiac troponin I assay in a screening population for hypertrophic cardiomyopathy: a case-referent study

      McGorrian, Catherine M; Lyster, Sarah; Roy, Andrew; Tarrant, Heloise; Codd, Mary; Doran, Peter; Fitzgibbon, Maria; Galvin, Joseph; Mahon, Niall G (2013-09-11)
      Abstract Background Hypertrophic cardiomyopathy (HCM) is a genetic condition, and relatives of affected persons may be at risk. Cardiac troponin biomarkers have previously been shown to be elevated in HCM. This study examines the new highly-sensitive cardiac troponin I (hsTnI) assay in a HCM screening population. Methods Nested case–control study of consecutive HCM sufferers and their relatives recruited from May 2010 to September 2011. After informed consent, participants provided venous blood samples and clinical and echocardiographic features were recorded. Associations between the natural log (ln) of the contemporary troponin I (cTnI) and hsTnI assays and markers of cardiac hypertrophy were examined. Multiple regression models were fitted to examine the predictive ability of hsTnI for borderline or definite HCM. Results Of 107 patients, 24 had borderline and 19 had definite changes of HCM. Both TnI assays showed significant, positive correlations with measures of cardiac muscle mass. After age and sex adjustment, the area under the receiver operator characteristic (AUROC) curve for the outcome of HCM was 0.78, 95% CI [0.65, 0.90], for ln(hsTnI), and 0.66, 95% CI [0.51, 0.82], for ln(cTnI) (p=0.11). Including the hsTnI assay in a multiple-adjusted “screening” model for HCM resulted in a non-significant improvement in both the AUROC and integrated discrimination index. Conclusions Both cTnI and hsTnI show a graded, positive association with measures of cardiac muscle mass in persons at risk of HCM. Further studies will be required to evaluate the utility of these assays in ECG- and symptom-based identification of HCM in at-risk families.
    • Use of analgesics in intentional drug overdose presentations to hospital before and after the withdrawal of distalgesic from the Irish market

      Corcoran, Paul; Reulbach, Udo; Keeley, Helen S; Perry, Ivan J; Hawton, Keith; Arensman, Ella (2010-03-18)
      Abstract Background Distalgesic, the prescription-only analgesic compound of paracetamol (325 mg) and dextropropoxyphene (32.5 mg) known as co-proxamol in the UK, was withdrawn from the Irish market as of January 2006. This study aimed to evaluate the impact of the withdrawal of distalgesic in terms of intentional drug overdose (IDO) presentations to hospital emergency departments (EDs) nationally. Methods A total of 42,849 IDO presentations to 37 of the 40 hospitals EDs operating in Ireland in 2003-2008 were recorded according to standardised procedures. Data on sales of paracetamol-containing drugs to retail pharmacies for the period 1998-2008 were obtained from IMS Health. Results The withdrawal of distalgesic from the Irish market resulted in an immediate reduction in sales to retail pharmacies from 40 million tablets in 2005 to 500,000 tablets in 2006 while there was a 48% increase in sales of other prescription compound analgesics. The rate of IDO presentations to hospital involving distalgesic in 2006-2008 was 84% lower than in the three years before it was withdrawn (10.0 per 100,000). There was a 44% increase in the rate of IDO presentations involving other prescription compound analgesics but the magnitude of this rate increase was five times smaller than the magnitude of the decrease in distalgesic-related IDO presentations. There was a decreasing trend in the rate of presentations involving any paracetamol-containing drug that began in the years before the distalgesic withdrawal. Conclusions The withdrawal of distalgesic has had positive benefits in terms of IDO presentations to hospital in Ireland and provides evidence supporting the restriction of availability of means as a prevention strategy for suicidal behaviour.
    • Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.

      Heneghan, Helen M; McCabe, John P; Department of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. helenheneghan@hotmail.com (2009)
      BACKGROUND: Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications associated with iliac crest harvest when performed in the setting of Anterior Cervical Decompression (ACD). Also, to perform a comparative analysis of patient satisfaction and quality of life scores after ACD surgeries, when performed with and without iliac graft harvest. METHODS: All patients who underwent consecutive ACD procedures, with and without the use of autologous iliac crest graft, over a 48 month period were included (n = 53). Patients were assessed clinically at a minimum of 12 months postoperatively and administered 2 validated quality of life questionnaires: the SF-36 and Cervical Spine Outcomes Questionnaires (Response rate 96%). Primary composite endpoints included incidence of bone graft donor site morbidity, pain scores, operative duration, and quality of life scores. RESULTS: Patients who underwent iliac graft harvest experienced significant peri-operative donor site specific morbidity, including a high incidence of pain at the iliac crest (90%), iliac wound infection (7%), a jejunal perforation, and longer operative duration (285 minutes vs. 238 minutes, p = 0.026). Longer term follow-up demonstrated protracted postoperative pain at the harvest site and significantly lower mental health scores on both quality of life instruments, for those patients who underwent autologous graft harvest CONCLUSION: ACD with iliac crest graft harvest is associated with significant iliac crest donor site morbidity and lower quality of life at greater than 12 months post operatively. This is now avoidable by using alternatives to autologous bone without compromising clinical or technical outcome.
    • The use of complementary and alternative medicine by patients with diabetes mellitus in Bahrain: a cross-sectional study.

      Khalaf, Abeer J; Whitford, David L; Department of Family & Community Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, PO Box 15503, Busaiteen, Kingdom of Bahrain. dwhitford@rcsi-mub.com (2010)
      CAM use is widespread, especially among patients with diabetes. The Gulf States have a high prevalence of diabetes, alongside a long tradition of CAM use. The aim of this study is to establish the prevalence of CAM use among patients with diabetes mellitus in Bahrain and to examine the characteristics of the CAM users.
    • The use of complementary and alternative medicine in an Irish cohort of people with an iatrogenic hepatitis C infection: Results from a health and lifestyle survey

      Coughlan, Barbara M.; Thornton, Lelia M.; Murphy, Niamh; Tait, Michele A.; Flanagan, Paula C.; Kenny-Walsh, Elizabeth E.; O’Lorcain, Piaras P.; UCD School Of Nursing, Midwifery and Health Systems, University College Dublin (Complementary Therapies in Medicine, 2014-06)