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  • Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium.

    Bryant, Josephine M; Grogono, Dorothy M; Rodriguez-Rincon, Daniela; Everall, Isobel; Brown, Karen P; Moreno, Pablo; Verma, Deepshikha; Hill, Emily; Drijkoningen, Judith; Gilligan, Peter; Esther, Charles R; Noone, Peadar G; Giddings, Olivia; Bell, Scott C; Thomson, Rachel; Wainwright, Claire E; Coulter, Chris; Pandey, Sushil; Wood, Michelle E; Stockwell, Rebecca E; Ramsay, Kay A; Sherrard, Laura J; Kidd, Timothy J; Jabbour, Nassib; Johnson, Graham R; Knibbs, Luke D; Morawska, Lidia; Sly, Peter D; Jones, Andrew; Bilton, Diana; Laurenson, Ian; Ruddy, Michael; Bourke, Stephen; Bowler, Ian Cjw; Chapman, Stephen J; Clayton, Andrew; Cullen, Mairi; Daniels, Thomas; Dempsey, Owen; Denton, Miles; Desai, Maya; Drew, Richard J; Edenborough, Frank; Evans, Jason; Folb, Jonathan; Humphrey, Helen; Isalska, Barbara; Jensen-Fangel, Søren; Jönsson, Bodil; Jones, Andrew M; Katzenstein, Terese L; Lillebaek, Troels; MacGregor, Gordon; Mayell, Sarah; Millar, Michael; Modha, Deborah; Nash, Edward F; O'Brien, Christopher; O'Brien, Deirdre; Ohri, Chandra; Pao, Caroline S; Peckham, Daniel; Perrin, Felicity; Perry, Audrey; Pressler, Tania; Prtak, Laura; Qvist, Tavs; Robb, Ali; Rodgers, Helen; Schaffer, Kirsten; Shafi, Nadia; van Ingen, Jakko; Walshaw, Martin; Watson, Danie; West, Noreen; Whitehouse, Joanna; Haworth, Charles S; Harris, Simon R; Ordway, Diane; Parkhill, Julian; Floto, R Andres (2016-11-11)
    Lung infections with Mycobacterium abscessus, a species of multidrug resistant nontuberculous mycobacteria, are emerging as an important global threat to individuals with cystic fibrosis (CF) where they accelerate inflammatory lung damage leading to increased morbidity and mortality. Previously, M. abscessus was thought to be independently acquired by susceptible individuals from the environment. However, using whole genome analysis of a global collection of clinical isolates, we show that the majority of M. abscessus infections are acquired through transmission, potentially via fomites and aerosols, of recently emerged dominant circulating clones that have spread globally. We demonstrate that these clones are associated with worse clinical outcomes, show increased virulence in cell-based and mouse infection models, and thus represent an urgent international infection challenge.
  • Maternal sepsis is an evolving challenge

    Turner, Michael J.; UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland. (Wiley, 2019-04-26)
    Despite major advances in the last century, particularly in high resource settings, maternal sepsis remains a common and potentially preventable cause of direct maternal death globally. A barrier to further progress has been the lack of consensus on the definition of maternal sepsis. Publications from two recent multidisciplinary consensus conferences, one on sepsis in the non-pregnant adult and the other on sepsis in the pregnant woman, concluded that the criteria for diagnosing sepsis should be clinically-based, applicable at the bedside, and should not be laboratory-based. Informed by reviews of the evidence, in 2017 WHO published a new definition of maternal sepsis based on the presence of suspected or confirmed infection. It also announced a Global Maternal and Neonatal Sepsis Initiative to identify the diagnostic criteria for the early identificati on, epidemiology, and disease classification of maternal sepsis. Standardizing the criteria for maternal sepsis optimizes clinical audit and research. It may facilitate the evaluation of the role of different clinical parameters and biomarkers in the diagnosis, earlier recognition and management of maternal infection and sepsis. Further work is required to develop an international consensus on the criteria for diagnosing maternal sepsis and any associated organ dysfunction.
  • Awareness and Preventative Behaviours Regarding Toxoplasma, Listeria and Cytomegalovirus Among Pregnant Women

    Basit, I; Crowley, D; Geary, M; Kirkham, C; Mc Dermott, R; Cafferkey, M; Sayers, G (Irish Medical Journal, 2019-06)
    Serious fetal infections can be transmitted transplacentally or perinatally. Vaccination is a key prevention method as shown by the dramatic reduction of congenital rubella. Reducing the risk of toxoplasmosis, listeriosis and CMV in pregnancy requires knowledge of their epidemiology and appropriate prevention strategies in the absence of vaccines. Primary infection with Toxoplasma gondii occurs following ingestion of active or inactive cysts. Sources of cysts include undercooked or raw meat (e.g. uncooked or dried meats), contaminated unwashed cooking surfaces and utensils, contaminated cat litter, soil and water supplies, unwashed soil-grown fruits and vegetables, unpasteurised milk, and less frequently, transplanted organs and blood products. Primary toxoplasmosis in pregnancy can lead to chorioretinitis, deafness, microcephaly, developmental delay, late onset of ocular defects, and stillbirth.
  • The Prevalence of Pseudomonas Aeruginosa Infection Over a Ten-Year Period in Children with Cystic Fibrosis

    Al Shidhani, K; O’Reilly, R; Javadpour, S; O’Sullivan, N; McNally, P; Cox, D.W (Irish Medical Journal, 2019-06)
    A retrospective observational study was performed at Our Lady’s Children’s Hospital, Crumlin (OLCHC), Dublin, the largest paediatric tertiary CF referral centre in Ireland. Patient’s case notes, microbiology laboratory results and data from the Cystic Fibrosis Registry of Ireland (CFRI) database were used as sources for the data collection. We compared the prevalence of PA infection in 2014 with 2004. PA infection was defined as one positive culture on an airway sample (either a sputum, throat swab or broncho-alveolar lavage sample). The modified Leed’s criteria was used to classify PA infection into never infected, free of infection (negative PA culture for > 12 months), intermittent infection ( positive PA culture for < 6 months) and chronic infection ( positive PA culture for > 6 months).
  • Challenges of Cancer Screening

    Kelly, D; OConnor, M (Irish Medical Journal, 2019-06)
    The goal of cancer screening is to detect presymptomatic disease and commence treatment sooner, thereby reducing the incidence of advanced disease and the associated morbidity and mortality1. Challenges exist around designing, managing and evaluating national screening strategies. Programs require clear governance, reporting structures, accountability and regular appraisal of staff. The Scally report highlighted the vital role Public health expertise should play in delivering and integrating these services along with managing the flow of patient information between the National Cancer Control Programme and the National Cancer Registry2. All screening programmes must have a robust Quality Assurance (QA) process and be able to conduct audit effectively1.
  • A Dedicated Perineal Clinic – An Audit in Support

    Corry, E; O’Connor, E; Eogan, M; Fitzpatrick, M; O’Sullivan, S; Imcha, M (Irish Medical Journal, 2019-04)
    To assess the quality of care in both the initial management of obstetric anal sphincter injury (OASI) and subsequent follow up postnatally in a tertiary maternity hospital without direct access to a perineal clinic.
  • Where does Pelvic and Acetabular Fracture Treatment fit into the Newly Proposed Major Trauma Model in Ireland?

    Fenelon, C; Murphy, E.P; O’Daly, B.J; Leonard, M (Irish Medical Journal, 2019-04)
    Major trauma continues to be the biggest cause of death in people aged between 5 and 45 years of age. Suboptimal trauma management results in greater ongoing costs to patients, hospitals and society. Trauma networks in the United States, Australia and more recently the United Kingdom have proven successful in significantly reducing morbidity and mortality. In the UK, analysis by the Trauma Audit Research Network (TARN) has shown that a major trauma patient has a 19% increase in the odds of survival following major trauma since its introduction in 2012. No integrated trauma network yet exists in Ireland but a recent report “A Trauma System for Ireland” published in January of 2018 outlined plans of how such a trauma network would be introduced. The report called for the introduction of two regional trauma networks, a central and south network, with one major trauma centre for each. However, the report made no mention of where the treatment of pelvic and acetabular fractures fell within it.
  • Primary External Ventricular Drains in the Management of Open Myelomeningocele Repairs in the Neonatal Setting in Ireland

    Finnegan, R; Kehoe, J; McMahon, O; Donoghue, V; Crimmins, D; Caird, J; Murphy, J (Irish Medical Journal, 2019-05)
    The aim of this study is to outline the role of primary external ventricular drains (EVD) in the management of open myelomeningoceles in the neonatal setting in Ireland.
  • Physiotherapist-Led Triage at a Rheumatology-Based Musculoskeletal Assessment Clinic: an 18-Month Service Evaluation of Activity and Outcomes

    Caffrey, Aoife; Smart, Keith M.; Fitzgerald, Oliver (American College of Rheumatology, 2019)
    Physiotherapist-led musculoskeletal triage clinics are an effective and efficient means of managing patients presenting with musculoskeletal disorders in primary and secondary care. Data regarding the activity and outcomes of physiotherapist-led triage in hospital-based outpatient rheumatology clinics are scarce. Thus, the aim of this study was to undertake a service evaluation of activity and outcomes of a physiotherapist-led rheumatologybased Musculoskeletal Assessment Clinic (MAC). The primary objective was to quantify the proportion of patients independently managed by the clinical specialist physiotherapists (CSPs).
  • Listeria Meningitis in an Immunocompetent Child: Case Report and Literature Review

    McCarthy, K.N; Leahy, T.R; Murray, D.M (Irish Medical Journal, 2019-05)
    Listeria monocytogenes is a facultatively anaerobic Gram-positive bacillus that is an unusual cause of illness among immunocompetent individuals1. Infection with listeria is most commonly encountered in pregnancy, the neonatal period, and in immunocompromised patients2. Risk factors include food-borne exposures, particularly to soft cheeses and delicatessen meats, and life stock exposure3. Meningitis is the most frequently encountered clinical syndrome. L. monocytogenes accounts for 20% of cases of meningitis in neonates and in those >60 years and is the most common cause of meningitis among immunocompromised individuals1. Listeriosis is a rare disease in Ireland with a crude incidence rate of 0.41 per 100,000 which is lower than the EU average of 0.48 per 100,000 4.
  • Estimated Weight of Paediatric Patients versus Measured Weight – A Prospective Comparison

    Lineen, C; O’Donnell, S; Birrane, K; O’Riordan, A; Twomey, J; Murphy, A.M; O’Gorman, C (Irish Medical Journal, 2019-04)
    Weight measurement is fundamental in the management of paediatric patients. Many methods have been described for estimating a patient’s weight. The aim of this study was to assess the accuracy of the APLS 2017 estimated weight guidelines.
  • Surgical Parathyroidectomy Services

    Burke, E; Waris, A; O’Donoghue, G (Irish Medical Journal, 2019-04)
    Retrospectively audit our experience with surgical parathyroidectomy over a 5 year period from the beginning of 2013 to June 2018.
  • Targeted Anti-D, The First Irish Perspective

    McCormick, C.A; Mulvany, L; De Tavernier, M.C (Irish Medical Journal, 2019-04)
    The use of anti-D to prevent haemolytic disease of the new-born can be regarded as one of the greatest success stories of modern medicine. Rhesus antibodies cause significant harm to rhesus positive foetuses in utero including anaemia, jaundice, hydrops fetalis and stillbirth. Deaths due to haemolytic disease of the new born have fallen dramatically. In the UK 1 in 2180 babies in 1953 died due to Rhesus haemolytic disease. 37 years later, in 1990, this figure had dropped to 1 in 62,500 1. Recent initiatives including the routine administration of anti-D at 28-32 weeks gestation have further reduced the incidence of sensitisation2.
  • Oxygen Therapy in Ireland: A Nationwide Review of Delivery, Monitoring and Cost Implications

    O’Donnell, C; Davis, P (Irish Medical Journal, 2019-05)
    Our aim was to establish which hospitals in Ireland are running oxygen clinics and to compare oxygen prescription in hospitals to a guideline standard. Long term oxygen therapy is known to be of benefit to a specific cohort of patients but is not without risk.
  • Audit of PPI Prescribing Practices: A Risk to Patient Safety?

    O’Connell, L; O’Connell, R.M; Ahmed, O; Mealy, K (Irish Medical Journal, 2019-04)
    Proton pump inhibitors (PPIs) are frequently prescribed to surgical patients (50-60%) to prevent gastrointestinal bleeding. However, most surgical patients are at low risk of significant bleeds. The aim of this audit was to identify inappropriate PPI prescribing, if any, in a cohort of surgical inpatients.
  • 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.
  • An Under-Recognised Cause of Iatrogenic, Severe Metabolic Acidosis

    Spring, A; Owens, R; Fratita, M; O’Dwyer, M (Irish Medical Journal, 2019-04)
    Pyroglutamic acidosis is an uncommonly diagnosed but important cause of a high anion gap metabolic acidosis. Our case report concerns an elderly male admitted to the Intensive Care Unit (ICU) following the acute onset of coma which developed during treatment of a prosthetic joint infection. A diagnosis of pyroglutamic acidosis was ultimately made and later confirmed with laboratory testing. Blood gas analysis revealed a profound high anion gap metabolic acidosis.
  • Bereavement Counselling for Healthcare Workers in the Aftermath of Child Death

    O’Sullivan, D; Stone, G; Mahomed, H; O’Reilly, P; Stewart, P; Noonan, H; Murphy, A.M (Irish Medical Journal, 2019-05)
    To assess the views and experiences of bereavement counselling services among healthcare staff dealing with paediatric ward death at UHL.
  • Bilateral Plantar Fibromatosis

    Newman, C; McQuaid, S.E (Irish Medical Journal, 2019-04)
    Plantar fibromastosis is a hyperproliferative disorder of the plantar fascia which predominantly affects males over the age of fifty. Its etiology is incompletely understood; however up to 42% of affected patients also have a diagnosis of Diabetes Mellitus.
  • Congenital Atrial Haemangioma

    Daly, A; Franklin, O; Nölke, L (Irish Medical Journal, 2019-04)
    Cardiac hemangioma is a rare form of primary cardiac tumor. Only small a number of cardiac hemangioma cases have been reported in the literature and therefore appreciation of the best management strategies for primary cardiac tumors in neonates is somewhat lacking. We present the rare case of a neonate who presented with symptoms arising from a congenital atrial haemangioma on day three of life. This report serves to remind the paediatric medical community of the rare diagnosis of primary cardiac tumours, diagnostic clues and therapeutic interventions used to address this unusual diagnosis.

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