Recent Submissions

  • 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).
  • 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).
  • 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.
  • 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.
  • 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.
  • Mycoplasma Pneumonia: Late Treatment Leading to Acute Respiratory Distress Syndrome and Renal Failure.

    Cummiskey, A Graham; Reardon, Michael (European Journal of Case Reports in Internal Medicine, 2019-01-01)
    Mycoplasma pneumonia is one of the most common types of pneumonia, although it is often not diagnosed due to mild clinical course.
  • Transcriptome level analysis in Rett syndrome using human samples from different tissues.

    Shovlin, Stephen; Tropea, Daniela (Orphanet Journal of Rare Diseases, 2018-07-11)
    The mechanisms of neuro-genetic disorders have been mostly investigated in the brain, however, for some pathologies, transcriptomic analysis in multiple tissues represent an opportunity and a challenge to understand the consequences of the genetic mutation. This is the case for Rett Syndrome (RTT): a neurodevelopmental disorder predominantly affecting females that is characterised by a loss of purposeful movements and language accompanied by gait abnormalities and hand stereotypies. Although the genetic aetiology is largely associated to Methyl CpG binding protein 2 (MECP2) mutations, linking the pathophysiology of RTT and its clinical symptoms to direct molecular mechanisms has been difficult. One approach used to study the consequences of MECP2 dysfunction in patients, is to perform transcriptomic analysis in tissues derived from RTT patients or Induced Pluripotent Stem cells. The growing affordability and efficiency of this approach has led to a far greater understanding of the complexities of RTT syndrome but is also raised questions about previously held convictions such as the regulatory role of MECP2, the effects of different molecular mechanisms in different tissues and role of X Chromosome Inactivation in RTT. In this review we consider the results of a number of different transcriptomic analyses in different patients-derived preparations to unveil specific trends in differential gene expression across the studies. Although the analyses present limitations- such as the limited sample size- overlaps exist across these studies, and they report dysregulations in three main categories: dendritic connectivity and synapse maturation, mitochondrial dysfunction, and glial cell activity. These observations have a direct application to the disorder and give insights on the altered mechanisms in RTT, with implications on potential diagnostic criteria and treatments.
  • An Unusual Case of a Facial Guard Causing Penetrating Soft Tissue Injury in the Game of Hurling

    Farrell, T; McDonald, C.; Sheehan, E. (Irish Medical Journal, 2019-02)
    Hurling is a fast-paced impact sport that is known to be associated with trauma to the head, face and hands1. Helmets with facial guards have been introduced by the Gaelic athletic association (GAA) in 2010 as a means of preventing head and maxillofacial injuries. Although the national safety authority of Ireland (NSAI) identify certain standards for hurling helmets, modifications are known to be quite common2. A recent study by O’Connor (2018) showed that 31% of players surveyed from a total of 304 had modified their helmet in some fashion either by changing the faceguard completely or removal of single bars. The main reasons given for modification were; restricted vision, comfort and perceived poor quality of the helmet/faceguard. Anecdotally, players may modify one’s helmet to help improve peripheral vision and thus situational awareness. In the literature, there exists only one case of penetrating injury from a facial guard of a hurling helmet3. The trend of modifying helmets seems to be increasing the incidence of these serious injuries. We believe that there is a general lack of awareness among players and officials as to the dangers of modifying protective equipment. We present the case of a penetrating hand injury as a direct result of a modified facial guard where a single bar was removed.
  • Continuous Glucose Monitoring in the Management of Neonatal Hypoglycaemia

    McGlacken-Byrne, S.M; O’Neill, R.; Jenkinson, A.; Murphy, J.F.A. (Irish Medical Journal, 2019-03)
    A quality improvement project was carried out in a Level 3 Neonatal Intensive Care Unit (NICU) which aimed to successfully implement the use of continuous glucose monitoring systems (CGMS) in hypoglycaemic infants. Piloting of the device revealed several potential practical barriers to its reliably successful implementation. Five Plan-Do-Study-Act (PDSA) cycles followed, tackling these problems and other issues inductively identified throughout the project. Parents and multi-professional stakeholders were involved and consulted throughout. Change was measured on a runchart using qualitative and quantitative feedback. Problem rate per patient was reduced to zero by the end of a one-month study period. This study used basic quality improvement methodologies to implement a change intervention in a structured manner and elucidated aspects of its use that need to be adapted for its successful incorporation into real-life clinical practice.
  • Analysis of inflammatory cytokine and TLR expression levels in Type 2 Diabetes with complications.

    Gupta, Saket; Maratha, Ashwini; Siednienko, Jakub; Natarajan, Anandan; Gajanayake, Thusitha; Hoashi, Shu; Miggin, Sinéad (Scientific Reports, 2017-08-09)
    The pathogenesis and complications of type 2 diabetes (T2DM) are closely linked with defective glucose metabolism, obesity, cardiovascular disease and an inability to mount an effective immune response to certain pathogenic organisms. Perturbations in key innate immune receptors known as Toll-like receptors (TLRs) and inflammatory mediators such as IL-6, TNFα and IL-1β have been linked with T2DM. Herein, we sought to establish whether patients with T2DM and underlying complications exhibit perturbations in cytokine and TLR expression. Serum cytokine and mRNA levels of cytokines/TLRs in monocytes (M) and neutrophils (N) were measured in a cohort of 112 diabetic patients: good glycaemic control without complications (GC), good glycaemic control with complications (GCC), poor glycaemic control without complications (PC) and poor glycaemic control with complications (PCC) and compared them with 34 non-diabetic volunteers (NGT). Serum cytokine levels were normal in all study participants. In the GC group, cytokine and TLR gene expression were enhanced compared to NGT. In contrast, suppressed cytokine and TLR gene expression were evident in PC, GCC & PCC groups when compared to the GC. In conclusion, whereas serum pro-inflammatory cytokine levels are unaltered in T2DM patients, differences in inflammatory gene profiles exist among the T2DM patient groups.
  • Is birth weight the major confounding factor in the study of gestational weight gain?: an observational cohort study.

    O'Higgins, Amy C; Doolan, Anne; McCartan, Thomas; Mullaney, Laura; O'Connor, Clare; Turner, Michael J (BMC Pregnancy & Childbirth, 2018-06-07)
    Much interest has been focussed on both maternal obesity and gestational weight gain (GWG), particularly on their role in influencing birth weight (BW). Several large reviews have reported that excessive GWG is associated with an increase in BW Women were enrolled at their convenience before 18 weeks gestation. Height and weight were measured accurately at the first antenatal visit and BMI calculated. Maternal weight was measured again after 37 weeks gestation. The weight of the baby was measured at birth. Relationships were tested using linear regression analysis, chi-squared tests and t-tests as appropriate. Of the 522 women studied, the mean BMI was 25.3 kg/m The positive correlation between GWG in pregnancy and BW can be accounted for by the contribution of fetal weight to GWG antenatally without a contribution from increased maternal adiposity. There was a wide range of BW irrespective of the degree of GWG and obese women had a lower GWG than non-obese women. These findings help explain why Randomized Controlled Trials (RCTs) designed to reduce GWG have failed to decrease BW and suggest there is no causative link between excessive GWG and increased BW.
  • Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial.

    Adnan, Nita; Conlan-Trant, Rebecca; McCormick, Ciara; Boland, Fiona; Murphy, Deirdre J (BMJ, 2018-09-04)
    To determine whether intravenous oxytocin is more effective than intramuscular oxytocin at preventing postpartum haemorrhage at vaginal delivery. Double blind placebo controlled randomised trial. University affiliated maternity unit in the Republic of Ireland. 1075 women aged 18 years or older, at term with a singleton pregnancy who were aiming for a vaginal delivery with an actively managed third stage of labour.
  • Infliximab Induced Cardiac Tamponade

    O’Morain, N; Kumar, L; O’Carroll-Lolait, C; Alakkari, A; Ryan, B (Irish Medical Journal, 2019-03)
    Biologic therapies are increasingly used in the treatment of Inflammatory Bowel Disease. Reactions to infusion therapy are not uncommon but are mostly benign and self-limiting. Rarely, life-threatening complications can occur.

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