• Study protocol: assessing SleeP IN infants with early-onset atopic Dermatitis by Longitudinal Evaluation (The SPINDLE study).

      O'Connor, Cathal; Irvine, Alan; Murray, Deirdre; Murphy , Michelle; Hourihane, Jonathan; Boylan, Geraldine (2022-06-18)
      Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin condition in childhood. Most (50-60%) children with AD report sleep disturbance, which is secondary to itch, dry skin, inflammation, and abnormal circadian rhythm. Sleep is essential for brain development, learning, and growth. Sleep disruption in early life is associated with cognitive and psychological dysfunction in later life. The aim of this study is to describe in detail the sleep architecture of infants with early-onset atopic dermatitis (AD), compared to controls, by using EEG polysomnography, sleep actigraphy, and parental reporting. Methods: This observational study will recruit six- to eight-month old infants with moderate to severe AD and age-matched control infants who do not have AD. At six-eight months diurnal sleep electroencephalography and polysomnography will be performed in our research center. Nocturnal sleep actigraphy will be performed at home for five consecutive nights at six-eight months and 12 months. Between six and 12 months, monthly questionnaires will capture data on quantitative sleep and parental sleep. Skin barrier and immune profiles will be captured at six-eight and 12 months. AD will be assessed using standardized severity assessment tools and treated according to protocol. A neurodevelopmental assessment will be performed at 18 months to assess cognition and behaviour. An estimated sample size of 50 participants in each group is required to power the primary outcome of disturbed macrostructure of sleep and secondary outcomes of disturbed microstructure of sleep, and disturbed parental sleep, assuming an attrition rate of 60%. Potential confounding factors which will be controlled for in the data analysis will include parental educational level, parental depression, feeding practice, and number of siblings. Discussion: This study will provide a rich analysis of sleep in infants with AD in the first year of life using detailed electroencephalography, novel actigraphy techniques, and longitudinal parent-reported data. It may provide guidance on the optimal treatment of AD to prevent or reduce sleep disruption. Trial registration: clinicaltrials.gov NCT05031754 , retrospectively registered on September 2nd, 2021.
    • KBG syndrome mimicking genetic generalized epilepsy.

      Murphy, M J; McSweeney, N; Cavalleri, G L; Greally, M T; Benson, K A; Costello, D J; CUH (2022-04-20)
      KBG syndrome is a rare autosomal dominant disorder characterised by short stature, craniofacial dysmorphism and other developmental skeletal and dental anomalies such as macrodontia [1]. The acronym KBG was chosen to represent the initial of the surnames of the three original families described and epileptic seizures are a common feature [1,2,3]. In addition shyness, anxiety, autistic spectrum disorders and hearing loss have all been reported and most affected patients exhibit developmental delay and intellectual disability [1,4,5]. Although considered polygenic in nature, Genetic Generalized Epilepsy (GGE) typically occurs sporadically [6]. Early descriptions reported high concordance rates among monozygotic twins [7,8]. Descriptive reports highlighted consistent clinical and electroencephalographic (EEG) similarities in twin pairs. Because the clinical and EEG phenotypes are often striking and collectively pathognomonic, GGE is less frequently misdiagnosed compared to other subtypes of epilepsy. Nonetheless, GGE can be erroneously misdiagnosed in Glut-1 deficiency, CHD-2 mutations and focal epilepsy with a midline dipole [9,10]. We report a pair of monozygotic twins who were initially diagnosed with GGE on clinical and EEG grounds. Whole exome trio testing was undertaken in their teenage years when their epilepsy proved drug-resistant and atypical clinical features became more prominent. Mutations in the ANKRD11 gene confirmed a diagnosis of KBG syndrome. We report that mutations in the ANKRD11 gene may produce a clinical syndrome that closely simulates sporadic GGE.
    • Porokeratotic adnexal ostial nevus: A paradigm of cutaneous mosaicism.

      Kiely, Lisa; Ni Mhaolcatha, Sarah; Fitzgibbon, Jim; Murphy, Lesley-Ann; O'Connor, Cathal (2022-04-12)
      Porokeratotic adnexal ostial nevus (PAON) is a term encompassing porokeratotic eccrine ostial and dermal duct naevus (PEODDN) and porokeratotic eccrine and hair follicle naevus (PEHFN). We present the case of a 7‐year‐old girl who presented with hyperkeratotic verrucous papules in a blaschkolinear distribution on the sole of her left foot.
    • Hospital physicians' and older patients' agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting.

      Huibers, C J A; Sallevelt, B T G M; Heij, J M J Op; O'Mahony, D; Rodondi, N; Dalleur, O; van Marum, R J; Egberts, A C G; Wilting, I; Knol, W (2022-03-15)
      139 patients were included, mean (SD) age 78.3 (5.1) years, 47% male and median (IQR) number of medications at admission 11 (9-14). In total, 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors (both 74%). Factors associated with higher agreement in multivariate analysis were: female gender (+ 17.1% [3.7; 30.4]), ≥ 1 falls in the past year (+ 15.0% [1.5; 28.5]) and renal impairment i.e. eGFR 30-50 ml/min/1.73 m2; (+ 18.0% [2.0; 34.0]). The main reason for disagreement (40%) was patients' reluctance to discontinue or initiate medication.
    • Association between Psychiatric Disorders and Glomerular Disease.

      Desmond, Hailey E; Lindner, Clare; Troost, Jonathan P; Held, Zack; Callaway, Andrea; Oh, Gia J; Lafayette, Richard; Elliott, Matthew; Adler, Sharon G; Kamil, Elaine S; et al. (2021-07-08)
      Data were available for 950 participants, with a median of 58 months of follow-up. 110 (12%) participants were diagnosed with psychiatric disorder during the follow-up. The estimated rate of psychiatric diagnosis after kidney disease was 14.7 cases per 1,000 person-years and was highest among those of adolescent age at the time of kidney disease diagnosis. Adjusted analyses found adolescent age (vs. adult, hazard ratio [HR] = 3.11, 95% confidence interval [CI] 1.87-5.17) and Asian race (vs. white, HR = 0.34, 95% CI 0.16-0.71) were associated with psychiatric diagnosis. A higher UPCR per 1 log unit (HR 1.13, 95% CI 1.01-1.27) and a higher total number of oral medications were associated with psychiatric disorder (p < 0.001). Psychiatric diagnosis was also associated with progression to ESKD (HR = 2.45, 95% CI 1.53-3.92) in adjusted models.
    • Disease Behaviour During the Peri-Diagnostic Period in Patients with Suspected Interstitial Lung Disease: The STARLINER Study.

      Wijsenbeek, Marlies S; Bendstrup, Elisabeth; Valenzuela, Claudia; Henry, Michael T; Moor, Catharina C; Jouneau, Stéphane; Fois, Alessandro G; Moran-Mendoza, Onofre; Anees, Syed; Mirt, Mirela; et al. (2021-06-11)
      Introduction: Disease behaviour may guide diagnosis and treatment decisions in patients with interstitial lung disease (ILD). STARLINER aimed to characterise disease behaviour in patients with suspected ILD during the peri-diagnostic period using real-time home-based assessments. Methods: STARLINER (NCT03261037) was an international, multicentre study. Patients ≥ 50 years old with suspected ILD were followed throughout the peri-diagnostic period, consisting of a pre-diagnostic period (from enrolment to diagnosis) and a post-diagnostic period (from diagnosis to treatment initiation). Study length was variable (≤ 18 months). The primary endpoint was time-adjusted semi-annual forced vital capacity (FVC) change measured during the peri-diagnostic period using daily home spirometry in patients with idiopathic pulmonary fibrosis (IPF). Secondary outcomes included changes in FVC (home spirometry) in patients with non-IPF ILD, changes in FVC (site spirometry), changes in physical functional capacity measured by daily home accelerometry and site 6-min walk distance (6MWD), and changes in patient-reported outcomes (PROs) in IPF or non-IPF ILD. Results: Of the 178 patients enrolled in the study, 68 patients were diagnosed with IPF, 62 patients were diagnosed with non-IPF ILD, 9 patients received a non-ILD diagnosis and 39 patients did not receive a diagnosis. Technical and analytical issues led to problems in applying the prespecified linear regression model to analyse the home FVC data. Time-adjusted median (quartile [Q]1, Q3) semi-annual FVC change during the peri-diagnostic period measured using home and site spirometry, respectively, was - 147.7 (- 723.8, 376.2) ml and - 149.0 (- 314.6, 163.9) ml for IPF and 19.1 (- 194.9, 519.0) ml and - 23.4 (- 117.9, 133.5) ml in non-IPF ILD. A greater decline in steps per day was observed for IPF versus non-IPF ILD, whereas an increase in 6MWD was observed for patients with IPF versus a decline in 6MWD for patients with non-IPF ILD. No clear patterns of disease behaviour were observed for IPF versus non-IPF ILD for PROs. Conclusions: Despite home spirometry being feasible for most patients and centres, technical and analytical challenges in the home-based assessments prevented firm conclusions regarding disease behaviour. This highlights that further optimisation of the technology and analysis methods is required before widespread implementation.
    • Anaplastic thyroid cancer: outcomes of trimodal therapy.

      Houlihan, Orla A; Moore, Richard; Jamaluddin, Muhammad F; Sharifah, Adrinda; Redmond, Henry Paul; O'Reilly, Seamus; Feeley, Linda; Sheahan, Patrick; Rock, Kathy (2021-06-09)
      Backround: The purpose of this study is to assess the impact of trimodal therapy [surgery, chemotherapy and external beam radiotherapy (EBRT)] in patients with anaplastic thyroid cancer (ATC) treated with curative intent. Materials and methods: Retrospective review of patients with ATC treated at a tertiary referral centre between January 2009 and June 2020. Data were collected regarding demographics, histology, staging, treatment and outcomes. Results: Seven patients (4 female) were identified. Median age was 58 years (range 52-83 years). All patients received EBRT with concurrent doxorubicin. Six patients received surgery followed by chemoradiotherapy (CRT), and one underwent neoadjuvant CRT followed by surgery. Median radiological tumour size was 50mm (range 40-90 mm). Six patients had gross extrathyroidal extension and three had N1b disease. Prescribed radiotherapy schedules were 46.4 Gy in 29 bidaily fractions (n = 2, treated 2010), 60 Gy in 30 daily fractions (n = 2), 66 Gy in 30 fractions (n = 2) and 70 Gy in 35 fractions (n = 1; patient received neoadjuvant CRT). CRT was discontinued early for two patients due to toxicities. At median follow up of 5.8 months, 42.9% (3/7) patients were alive and disease-free. Only one patient developed a local failure. Three patients died from distant metastases without locoregional recurrence. Conclusions: Despite poor prognosis of ATC, selected patients with operable tumours may achieve high locoregional control rates with trimodal therapy, with possibility of long-term survival in select cases.
    • Seroprevalence study of SARS-CoV-2 antibodies in healthcare workers following the first wave of the COVID-19 pandemic in a tertiary-level hospital in the south of Ireland.

      Faller, Eamonn; Wyse, Adrianne; Barry, Rachel; Conlon, Kevin; Everard, Cormac; Finnegan, Paula; Foran, Claire; Herlihy, Emer; Kerr, Gerry; Lapthorne, Susan; et al. (2021-06-08)
      Objective: This study investigated seroprevalence of SARS-CoV-2-specific IgG antibodies, using the Abbott antinucleocapsid IgG chemiluminescent microparticle immunoassay (CMIA) assay, in five prespecified healthcare worker (HCW) subgroups following the first wave of the COVID-19 pandemic. Setting: An 800-bed tertiary-level teaching hospital in the south of Ireland. Participants: Serum was collected for anti-SARS-CoV-2 nucleocapsid IgG using the Abbott ARCHITECT SARS-CoV-2 IgG CMIA qualitative assay, as per the manufacturer's specifications.The groups were as follows: (1) HCWs who had real-time PCR (RT-PCR) confirmed COVID-19 infection (>1-month postpositive RT-PCR); (2) HCWs identified as close contacts of persons with COVID-19 infection and who subsequently developed symptoms (virus not detected by RT-PCR on oropharyngeal/nasopharyngeal swab); (3) HCWs identified as close contacts of COVID-19 cases and who remained asymptomatic (not screened by RT-PCR); (4) HCWs not included in the aforementioned groups working in areas determined as high-risk clinical areas; and (5) HCWs not included in the aforementioned groups working in areas determined as low-risk clinical areas. Results: Six of 404 (1.49%) HCWs not previously diagnosed with SARS-CoV-2 infection (groups 2-5) were seropositive for SARS-CoV-2 at the time of recruitment into the study.Out of the 99 participants in group 1, 72 had detectable IgG to SARS-CoV-2 on laboratory testing (73%). Antibody positivity correlated with shorter length of time between RT-PCR positivity and antibody testing.Quantification cycle value on RT-PCR was not found to be correlated with antibody positivity. Conclusions: Seroprevalence of SARS-CoV-2 antibodies in HCWs who had not previously tested RT-PCR positive for COVID-19 was low compared with similar studies.
    • Factors associated with SARS-CoV-2 infection in patients attending an acute hospital ambulatory assessment unit.

      Ronan, Geoffrey; Kumar, Lakshman; Davey, Mary; O Leary, Catriona; McAleer, Sarah; Lynch, Jenny; Lavery, Ros; Campion, John; Ryan, Joseph; O'Donoghue, P J; et al. (2021-04-06)
      To describe the factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in mild-to-moderate patients attending for assessment. This observational study was conducted in a Model 4 tertiary referral center in Ireland. All patients referred for SARS-CoV-2 assessment over a 4-week period were included. Patient demographics, presenting symptoms, comorbidities, medications, and outcomes (including length of stay, discharge, and mortality) were collected. Two hundred and seventy-nine patients were assessed. These patients were predominantly female (62%) with a median age of 50 years (SD 16.9). Nineteen (6.8%) patients had SARS-CoV-2 detected. Dysgeusia was associated with a 16-fold increased prediction of SARS-CoV-2 positivity (p = .001; OR, 16.8; 95% CI, 3.82-73.84). Thirteen patients with SARS-COV-2 detected (68.4%) were admitted, in contrast with 38.1% (99/260) of patients with SARS-CoV-2 non-detectable or not tested (p = .001). Female patients were more likely to be hospitalized (p = .01) as were current and ex-smokers (p = .05). We describe olfactory disturbance and fever as the main presenting features in SARS-CoV-2 infection. These patients are more likely to be hospitalized with increased length of stay; however, they make up a minority of the patients assessed. "Non-detectable" patients remain likely to require prolonged hospitalization. Knowledge of predictors of hospitalization in a "non-detectable" cohort will aid future planning and discussion of patient assessment in a SARS-CoV-2 era.
    • Fulvestrant-Big Mac Index: Defining Inequality in Oncology.

      O'Reilly, David; Abu Al-Saud, Yassmeen; O'Reilly, Seamus; Ronayne, Cian (2021-04)
    • Skin deep: Cutaneous manifestation of PIP implant rupture.

      Casey, Máire-Caitlín; Kelly, Edward Jason (2021-03-19)
      PIP (Poly Implant Prothèse, France) implants were readily employed for breast reconstruction until withdrawn from the market in 2010. These implants have an early and increased risk of rupture compared to non-PIP implants. This report outlines a significant cutaneous manifestation of PIP-implant rupture not previously described in the literature. This patient developed significant cutaneous xanthomatous inflammation with sinus tract formation that has yet to resolve despite explantation. Further investigation is warranted to elucidate the aetiology of this clinical sign and the optimal management of the cutaneous manifestation.
    • Staff-Care by Chaplains during COVID-19.

      Tata, Beba; Nuzum, Daniel; Murphy, Karen; Karimi, Leila; Cadge, Wendy (2021-03-17)
      The aim of this study was to understand how chaplains delivered spiritual care to staff during the Covid-19 pandemic. The researchers analyzed data collected from an International Survey of Chaplain Activity and Experience during Covid-19 (N = 1657). The findings revealed positive changes that emerged and new practices evolved around the use of technology as useful tools for maintaining contact with staff.
    • Inside the skin of a patient with diabetes: fostering cognitive empathy through insulin pump simulation.

      Ryan, Paul MacDaragh (2021-02-26)
      In order to best treat a patient, the carer must be able to clearly see their point of view. In the case of the complexities of insulin pump therapy, physicians may not fully understand the common challenges that drive patients to non-adherence. The author undertook a three-day simulation using wearable technology to explore this experience. This form of simulation represents a simple yet effective means by which to foster cognitive empathy in undergraduate and postgraduate medical education settings alike.
    • Have Legislative Interventions Impacted the Incidence of Needlestick Injuries?

      O'Sullivan, G; Gallagher, J (2020-12-16)
      Introduction The aim of this study was to examine the impact the EU Directive for the Prevention of Sharps injuries had on the incidence of needlestick injuries (NSI) in Ireland. Methods A five-year retrospective study prior to, and after the introduction of these regulations, was conducted. Secondary data from the Occupational Health Department's annual NSI reports were used. The population studied were healthcare workers who reported a NSI from 2013 to 2017. Results The incidence of NSI varied from 157 in 2017 to 207 in 2014. 'Miscellaneous needles' was the category which caused the most NSI (23%). 'Disposable needles with syringes' accounted for 20% of all NSI before the legislation; this figure was reduced to 12-15% after the regulations were introduced. Conclusion The EU regulations did not reduce the incidence of NSI. A lower incidence of NSI was reported from 'disposable needles with syringes' after the implementation of the regulations.
    • Irritant contact dermatitis in healthcare workers as a result of the COVID-19 pandemic: a cross-sectional study.

      Kiely, L F; Moloney, E; O'Sullivan, G; Eustace, J A; Gallagher, J; Bourke, J F (2020-09-05)
      COVID-19 healthcare workers (HCWs) require frequent handwashing and use of personal protective equipment (PPE) to prevent infection. However, evidence is emerging that these practices are causing adverse effects on their skin integrity. A single-centre, cross-sectional study of HCWs from an Irish hospital was undertaken to evaluate the degree of COVID-19-related irritant contact dermatitis (ICD) between April and May 2020. Of 270 participants surveyed, 223 (82.6%) reported symptoms of ICD. The hands were the most commonly affected site (76.47%) and the most frequently reported symptom was dry skin (75.37%). Nearly all (268; 99.26%) HCWs had increased hand-washing frequency, but 122 (45.35%) did not use emollients. In the ICD group, 24.7% cited a history of dermatitis compared with 4.3% of unaffected staff (P < 0.001). The ICD group recorded PPE usage for an average of 3.15 h compared with the non-ICD group at 1.97 h (P = 0.21). Promoting awareness of COVID-19-related ICD is vital to highlight prevention and treatment for frontline staff.
    • Pilot Randomized Controlled Trial of a Standard Versus a Modified Low-Phosphorus Diet in Hemodialysis Patients.

      Byrne, Fiona N; Gillman, Barbara A; Kiely, Mairead; Palmer, Brendan; Shiely, Frances; Kearney, Patricia M; Earlie, Joyce; Bowles, Maria B; Keohane, Fiona M; Connolly, Pauline P; et al. (Elsevier, 2020-08-18)
      There was no significant difference in the change in serum phosphate between the standard and modified diets. Although total dietary phosphorus intake was similar, phytate-bound phosphorus, found in pulses, nuts, and whole grains, was significantly higher in the modified diet (P < 0.001). Dietary fiber intake was also significantly higher (P < 0.003), as was the percentage of patients reporting an increase in bowel movements while following the modified diet (P = 0.008). There was no significant difference in the change in serum potassium or in reported protein intake between the 2 diets. Both diets were similarly well tolerated.
    • Severe maternal morbidity in Ireland annual report 2018

      Leitao, S.; Manning, E.; Corcoran, P.; Campillo, I.; Cutliffe, A.; Greene, R.A.; National Perinatal Epidemiology Centre (National Perinatal Epidemiology Centre, 2020-08)
      The seventh report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 401 cases of SMM occurring in all 19 Irish maternity units in 2018.
    • Two cases of deliberate implant mismatch in knee arthroplasty.

      Marie-Hardy, Laura; O'Loughlin, Padhraig; Bonnin, Michel; Ait Si Selmi, Tarik (2020-06-17)
      Cases: Knee arthroplasty is increasingly common with good clinical results. However, there is a cohort of patients whose native knee anatomy may not marry well with standard implants. The current authors describe two cases (one unicompartmental knee arthroplasty (UKA), one total knee arthroplasty (TKA)), during which deliberately implanting an implant designed for the contra-lateral distal femur (TKA) or contralateral femoral condyle (UKA) respectively, led to a better fit than correct-sided implants. Conclusion: The authors share their experience to raise awareness of a potential solution to such an intra-operative challenge and suggest that implant customisation may ultimately address challenges with grossly abnormal native anatomy.
    • Cardiovascular Clinical Trials in a Pandemic: Immediate Implications of Coronavirus Disease 2019.

      Spitzer, Ernest; Ren, Ben; Brugts, Jasper J; Daemen, Joost; McFadden, Eugene; Tijssen, Jan Gp; Van Mieghem, Nicolas M (2020-05-01)
      The coronavirus disease 2019 (COVID-19) pandemic started in Wuhan, Hubei Province, China, in December 2019, and by 24 April 2020, it had affected >2.73 million people in 185 countries and caused >192,000 deaths. Despite diverse societal measures to reduce transmission of the severe acute respiratory syndrome coronavirus 2, such as implementing social distancing, quarantine, curfews and total lockdowns, its control remains challenging. Healthcare practitioners are at the frontline of defence against the virus, with increasing institutional and governmental supports. Nevertheless, new or ongoing clinical trials, not related to the disease itself, remain important for the development of new therapies, and require interactions among patients, clinicians and research personnel, which is challenging, given isolation measures. In this article, the authors summarise the acute effects and consequences of the COVID-19 pandemic on current cardiovascular trials.
    • Uropathogenic Biofilm-Forming Capabilities are not Predictable from Clinical Details or from Colonial Morphology.

      Whelan, Shane; O'Grady, Mary Claire; Corcoran, Dan; Finn, Karen; Lucey, Brigid (2020-04-30)
      Antibiotic resistance is increasing to an extent where efficacy is not guaranteed when treating infection. Biofilm formation has been shown to complicate treatment, whereby the formation of biofilm is associated with higher minimum inhibitory concentration values of antibiotic. The objective of the current paper was to determine whether biofilm formation is variable among uropathogenic Escherichia coli isolates and whether formation is associated with recurrent urinary tract infection (UTI), and whether it can be predicted by phenotypic appearance on culture medium A total of 62 E. coli isolates that were reported as the causative agent of UTI were studied (33 from patients denoted as having recurrent UTI and 29 from patients not specified as having recurrent UTI). The biofilm forming capability was determined using a standard microtitre plate method, using E. coli ATCC 25922 as the positive control. The majority of isolates (93.6%) were found to be biofilm formers, whereby 81% were denoted as strong or very strong producers of biofilm when compared to the positive control. Through the use of a Wilcox test, the difference in biofilm forming propensity between the two patient populations was found to not be statistically significant (p = 0.5). Furthermore, it was noted that colony morphology was not a reliable predictor of biofilm-forming propensity. The findings of this study indicate that biofilm formation is very common among uropathogens, and they suggest that the biofilm-forming capability might be considered when treating UTI. Clinical details indicating a recurrent infection were not predictors of biofilm formation.