Connolly Hospital
http://hdl.handle.net/10147/128168
2024-03-28T17:15:29ZSigmoid Perforation Secondary to Accidental Ingestion of a Chicken Bone
http://hdl.handle.net/10147/635826
Sigmoid Perforation Secondary to Accidental Ingestion of a Chicken Bone
Boland, Patrick A.
Presentation We describe an unusual presentation of sigmoid colon perforation secondary to an ingested chicken bone. Diagnosis The patient presented with a 4 day history of abdominal pain and distension. On examination there were signs of peritonism. Inflammatory markers were raised. Computed tomography revealed a linear density projecting through the wall of the colon. Treatment The patient underwent emergency laparotomy and a Hartmann’s procedure. A chicken bone was found to be the causative foreign object. Conclusion Foreign body ingestion is an uncommon cause of sigmoid perforation which may mimic more common surgical presentations such as diverticulitis.
2020-01-01T00:00:00ZUrosepsis and the urologist!
http://hdl.handle.net/10147/631719
Urosepsis and the urologist!
Ryan, James; O'Neill, Eoghan; McLornan, Liza
Introduction: Sepsis is a life-threatening organ dysfunction that is caused by a dysregulated host response to the infection. Urosepsis contributes up to 25% of all sepsis cases. An important part of the management of urosepsis is to rule out possible surgical causes such as urolithiasis, obstructive uropathy, or abscess formation along the urogenital tract.
Objective: The aim of this study is to look at whether urological conditions and recent urological surgery contribute significantly to all patients admitted with urosepsis.
Methods: A total of 2679 urine cultures and 654 blood cultures performed in Connolly Hospital Emergency Department were reviewed between 2016 and 2018. Patients were included if they had a matching urine culture and blood culture performed within 24 hours of admission. A retrospective chart review was performed for all patients included in the study.
Results: Our study included 85 patients admitted with urosepsis between 2016 and 2018. The average age was 70.3 years (21-100 years), in which 61% (n = 52) of patients were female, 18% (n = 16) had a long-term indwelling catheter, 11.8% (n = 10) were admitted as urosepsis with a urological condition. The most common urological condition predisposing patients to urosepsis in this study was bladder outlet obstruction secondary to benign prostatic hyperplasia. A total of 4.7% (n = 4) of patients died during their admission. The complications as a result of urosepsis included a prostatic abscess, a psoas abscess, an ileus, an infected cyst, and 1 case of emphysematous pyelonephritis.
Conclusion: In this study, the majority of patients admitted with urosepsis did not have an underlying urological condition or recent urological instrumentation. Clinicians should be aware of potential complications as a result of a urosepsis.
2021-03-29T00:00:00ZTesticular swelling leading to a diagnosis of adrenocortical carcinoma - co-incidence or causation?
http://hdl.handle.net/10147/631340
Testicular swelling leading to a diagnosis of adrenocortical carcinoma - co-incidence or causation?
Batool, Maria; Fennell, David; Slattery, David; Leen, Eamon; Cormican, Liam; Sreenan, Seamus; H McDermott, John
Summary: Adrenocortical carcinoma (ACC) is a rare malignancy with an incidence of 0.7-2.0 cases/million/year. A majority of patients present with steroid hormone excess or abdominal mass effects, and in 15% of patients ACC is discovered incidentally. We present a case of 30-year-old otherwise asymptomatic Caucasian male who presented with a testicular swelling. Subsequent imaging and investigations revealed disseminated sarcoidosis and an 11 cm adrenal lesion. An adrenalectomy was performed. Histological examination of the resected specimen confirmed an ACC and also demonstrated a thin rim of adrenal tissue containing non-caseating granulomas, consistent with adrenal sarcoid.
Learning points: This case highlights an unusual presentation of two uncommon diseases. This case also highlights how separate and potentially unrelated disease processes may occur concomitantly and the importance, therefore, of keeping an open mind when dealing with unusual diagnostic findings. We also hypothesize a potential link between the ACC and sarcoidosis in our patient.
2021-06-01T00:00:00ZMay Measurement Month 2019: an analysis of blood pressure screening results from the United Kingdom and Republic of Ireland.
http://hdl.handle.net/10147/631107
May Measurement Month 2019: an analysis of blood pressure screening results from the United Kingdom and Republic of Ireland.
McDonnell, Barry J; Rees, Emma; Cockcroft, John R; Beaney, Thomas; Clayton, Bethan; Le Kieu, Phuong; Brady, Adrian J B; Padmanabhan, Sandosh; McCallum, Linsay; Dolan, Eamon; O'Brien, Eoin; Tomaszewski, Maciej; Schutte, Aletta E; Poulter, Neil R; Cappuccio, Francesco P
In the UK, heart and circulatory diseases account for 29% of all deaths (14% through coronary heart disease and 8% through stroke). In 2015, the prevalence of hypertension was 20% in the UK and 23% in the Republic of Ireland. In 2019, 14% of people registered with a UK general practice had hypertension and yet it was the attributable risk factor for around half of all deaths from coronary heart disease or stroke. We participated in May Measurement Month 2019 to increase awareness of blood pressure (BP) measurement, and to identify the proportion of undiagnosed hypertension and degree of uncontrolled hypertension in the community. The 2019 campaign set up screening sites within the community at places of worship, supermarkets, GP surgeries, workplaces, charity events, community pharmacies, gyms, and various other public places. We screened 10194 participants (mean age 51 ± 18 years, 60% women) and found that 1013 (9.9%) were on antihypertensive treatment, while 3408 (33.4%) had hypertension. Of the 3408 participants with hypertension, only 33.5% were aware of their condition despite 98.8% having previous BP measurements. In those on antihypertensive medication, only 38.2% had controlled BP (<140 and <90 mmHg). Our UK and Republic of Ireland data demonstrate concerning levels of undiagnosed hypertension and sub-optimal BP control in many individuals with a diagnosis. This evidence supports a critical need for better systematic community and primary care screening initiatives.
2021-05-20T00:00:00ZLow uptake of continuous subcutaneous insulin infusion therapy in people with type 1 diabetes in Ireland: a retrospective cross-sectional study.
http://hdl.handle.net/10147/630787
Low uptake of continuous subcutaneous insulin infusion therapy in people with type 1 diabetes in Ireland: a retrospective cross-sectional study.
Gajewska, Katarzyna Anna; Bennett, Kathleen; Biesma, Regien; Sreenan, Seamus
Background: The uptake of continuous subcutaneous insulin infusion (CSII) therapy in those with type 1 diabetes varies internationally and is mainly determined by the national healthcare reimbursement systems. The aim of this study is to estimate national and regional uptake of CSII therapy in children, adolescents and adults with type 1 diabetes in Ireland.
Methods: A retrospective cross-sectional study was conducted utilizing the national pharmacy claims database in 2016. Individuals using CSII were identified by dispensing of infusion sets. The uptake of CSII was calculated as the percentage of people with type 1 diabetes claiming CSII sets in 2016, both in children and adolescent (age < 18 years) and adult populations (≥ 18 years). Descriptive statistics including percentages with 95% confidence intervals (CIs) are presented, stratified by age-groups and geographical regions, and chi-square tests used for comparisons.
Results: Of 20,081 people with type 1 diabetes, 2111 (10.5, 95% CI: 10.1-10.9%) were using CSII in 2016. Uptake was five-fold higher in children and adolescents at 34.7% (95% CI: 32.9-36.5%) than in adults at 6.8% (95% CI: 6.4-7.2%). Significant geographical heterogeneity in CSII uptake was found, from 12.6 to 53.7% in children and adolescents (p < 0.001), and 2 to 9.6% in adults (p < 0.001).
Conclusions: Uptake of CSII in people with type 1 diabetes is low in Ireland, particularly in those ≥18 years. Identification of barriers to uptake, particularly in this group, is required.
2020-06-23T00:00:00ZOptimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR).
http://hdl.handle.net/10147/629753
Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR).
Butler, Tom; Kerley, Conor P; Altieri, Nunzia; Alvarez, Joe; Green, Jane; Hinchliffe, Julie; Stanford, Dell; Paterson, Katherine
Nutrition has a central role in both primary and secondary prevention of cardiovascular disease yet only relatively recently has food been regarded as a treatment, rather than as an adjunct to established medical and pharmacotherapy. As a field of research, nutrition science is constantly evolving making it difficult for patients and practitioners to ascertain best practice. This is compounded further by the inherent difficulties in performing double-blind randomised controlled trials. This paper covers dietary patterns that are associated with improved cardiovascular outcomes, including the Mediterranean Diet but also low-carbohydrate diets and the potential issues encountered with their implementation. We suggest there must be a refocus away from macronutrients and consideration of whole foods when advising individuals. This approach is fundamental to practice, as clinical guidelines have focused on macronutrients without necessarily considering their source, and ultimately people consume foods containing multiple nutrients. The inclusion of food-based recommendations aids the practitioner to help the patient make genuine and meaningful changes in their diet. We advocate that the cardioprotective diet constructed around the traditional Mediterranean eating pattern (based around vegetables and fruits, nuts, legumes, and unrefined cereals, with modest amounts of fish and shellfish, and fermented dairy products) is still important. However, there are other approaches that can be tried, including low-carbohydrate diets. We encourage practitioners to adopt a flexible dietary approach, being mindful of patient preferences and other comorbidities that may necessitate deviations away from established advice, and advocate for more dietitians in this field to guide the multi-professional team.
2020-02-25T00:00:00ZAcute diabetic neuropathy following improved glycaemic control: a case series and review.
http://hdl.handle.net/10147/629422
Acute diabetic neuropathy following improved glycaemic control: a case series and review.
Siddique, N; Durcan, R; Smyth, S; Tun, T Kyaw; Sreenan, S; McDermott, J H
Summary: We present three cases of acute diabetic neuropathy and highlight a potentially underappreciated link between tightening of glycaemic control and acute neuropathies in patients with diabetes. Case 1: A 56-year-old male with poorly controlled type 2 diabetes (T2DM) was commenced on basal-bolus insulin. He presented 6 weeks later with a diffuse painful sensory neuropathy and postural hypotension. He was diagnosed with treatment-induced neuropathy (TIN, insulin neuritis) and obtained symptomatic relief from pregabalin. Case 2: A 67-year-old male with T2DM and chronic hyperglycaemia presented with left lower limb pain, weakness and weight loss shortly after achieving target glycaemia with oral anti-hyperglycaemics. Neurological examination and neuro-electrophysiological studies suggested diabetic lumbosacral radiculo-plexus neuropathy (DLPRN, diabetic amyotrophy). Pain and weakness resolved over time. Case 3: A 58-year-old male was admitted with blurred vision diplopia and complete ptosis of the right eye, with intact pupillary reflexes, shortly after intensification of glucose-lowering treatment with an SGLT2 inhibitor as adjunct to metformin. He was diagnosed with a pupil-sparing third nerve palsy secondary to diabetic mononeuritis which improved over time. While all three acute neuropathies have been previously well described, all are rare and require a high index of clinical suspicion as they are essentially a diagnosis of exclusion. Interestingly, all three of our cases are linked by the development of acute neuropathy following a significant improvement in glycaemic control. This phenomenon is well described in TIN, but not previously highlighted in other acute neuropathies.
Learning points: A link between acute tightening of glycaemic control and acute neuropathies has not been well described in literature. Clinicians caring for patients with diabetes who develop otherwise unexplained neurologic symptoms following a tightening of glycaemic control should consider the possibility of an acute diabetic neuropathy. Early recognition of these neuropathies can obviate the need for detailed and expensive investigations and allow for early institution of appropriate pain-relieving medications.
2020-02-26T00:00:00ZDistribution of lymph node metastases in esophageal carcinoma [TIGER study]: study protocol of a multinational observational study.
http://hdl.handle.net/10147/627233
Distribution of lymph node metastases in esophageal carcinoma [TIGER study]: study protocol of a multinational observational study.
Hagens, Eliza R C; van Berge Henegouwen, Mark I; van Sandick, Johanna W; Cuesta, Miguel A; van der Peet, Donald L; Heisterkamp, Joos; Nieuwenhuijzen, Grard A P; Rosman, Camiel; Scheepers, Joris J G; Sosef, Meindert N; van Hillegersberg, Richard; Lagarde, Sjoerd M; Nilsson, Magnus; Räsänen, Jari; Nafteux, Philippe; Pattyn, Piet; Hölscher, Arnulf H; Schröder, Wolfgang; Schneider, Paul M; Mariette, Christophe; Castoro, Carlo; Bonavina, Luigi; Rosati, Riccardo; de Manzoni, Giovanni; Mattioli, Sandro; Garcia, Josep Roig; Pera, Manuel; Griffin, Michael; Wilkerson, Paul; Chaudry, M Asif; Sgromo, Bruno; Tucker, Olga; Cheong, Edward; Moorthy, Krishna; Walsh, Thomas N; Reynolds, John; Tachimori, Yuji; Inoue, Haruhiro; Matsubara, Hisahiro; Kosugi, Shin-Ichi; Chen, Haiquan; Law, Simon Y K; Pramesh, C S; Puntambekar, Shailesh P; Murthy, Sudish; Linden, Philip; Hofstetter, Wayne L; Kuppusamy, Madhan K; Shen, K Robert; Darling, Gail E; Sabino, Flávio D; Grimminger, Peter P; Meijer, Sybren L; Bergman, Jacques J G H M; Hulshof, Maarten C C M; van Laarhoven, Hanneke W M; Mearadji, Banafsche; Bennink, Roel J; Annema, Jouke T; Dijkgraaf, Marcel G W; Gisbertz, Suzanne S
Background: An important parameter for survival in patients with esophageal carcinoma is lymph node status. The distribution of lymph node metastases depends on tumor characteristics such as tumor location, histology, invasion depth, and on neoadjuvant treatment. The exact distribution is unknown. Neoadjuvant treatment and surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy has not been reached. The aim of this study is to determine the distribution of lymph node metastases in patients with resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed. This can be the foundation for a uniform worldwide staging system and establishment of the optimal surgical strategy for esophageal cancer patients.
Methods: The TIGER study is an international observational cohort study with 50 participating centers. Patients with a resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed in participating centers will be included. All lymph node stations will be excised and separately individually analyzed by pathological examination. The aim is to include 5000 patients. The primary endpoint is the distribution of lymph node metastases in esophageal and esophago-gastric junction carcinoma specimens following transthoracic esophagectomy with at least 2-field lymphadenectomy in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and (disease free) survival.
Discussion: The TIGER study will provide a roadmap of the location of lymph node metastases in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and survival. Patient-tailored treatment can be developed based on these results, such as the optimal radiation field and extent of lymphadenectomy based on the primary tumor characteristics.
2019-07-04T00:00:00ZMycoplasma Pneumonia: Late Treatment Leading to Acute Respiratory Distress Syndrome and Renal Failure.
http://hdl.handle.net/10147/624166
Mycoplasma Pneumonia: Late Treatment Leading to Acute Respiratory Distress Syndrome and Renal Failure.
Cummiskey, A Graham; Reardon, Michael
Mycoplasma pneumonia is one of the most common types of pneumonia, although it is often not diagnosed due to mild clinical
course.
2019-01-01T00:00:00Z"Say BOO to the FLU!" Introduction of the Seasonal Influenza Peer Vaccination Programme in the Emergency Department and AMAU.
http://hdl.handle.net/10147/623888
"Say BOO to the FLU!" Introduction of the Seasonal Influenza Peer Vaccination Programme in the Emergency Department and AMAU.
Donaghy, Lisa; Martin, Patrick
The Seasonal Influenza Peer Vaccination Programme was developed by the Republic of Ireland Health Service Executive (HSE)1 with the aim of increasing the number of health care workers receiving annual flu vaccinations. Supporting these efforts, various studies illustrated that increasing health care staff vaccination rates decreased patient illness and death,2 while other research
reported a 40% reduction of influenza-related deaths in hospitals with higher rates of health care workers' influenza vaccinations.3 Flu vaccination recommendations from The WorldHealthOrganization (WHO) include a target uptake of
75% in health care staff and people age 65 and older.3 In accordance with HSE national guidelines that health care
organizations achieve and/or surpass the minimum threshold goal of 40% of employees receiving the flu vaccine,4 and recognizing that Peer-to-Peer Influenza Vaccination Programmes are an essential aspect of the overall infection prevention and control arrangements in our health care setting, Connolly Hospital In Dublin, Ireland, initiated the Peer Vaccination Programme in the Emergency Department and Acute Medical Assessment Unit (AMAU) during the 2016–2017 flu season. The challenges
facing successful ED and AMAU programme implementation included the large volume of interdisciplinary staff serving theED
area, a vast cohort of undifferentiated complex patients at risk for increased complications if exposed to influenza, and an elevated risk of exposure to the influenza virus for all members of the health care team. Similar to programs in other countries, the Peer-to-Peer Vaccination Programme vaccinates health care workers against the influenza viruses identified as those most likely to circulate in the upcoming season.5 Although recognizing that frontline staff have a duty of care to protect their patients and colleagues, receiving the flu vaccine is not a mandatory requirement for health care worker employment in Ireland.
2018-07-01T00:00:00Z