Recent Submissions

  • The Human Mesenteric Lymph Node Microbiome Differentiates Between Crohn's Disease and Ulcerative Colitis.

    Kiernan, Miranda G; Coffey, J Calvin; McDermott, Kieran; Cotter, Paul D; Cabrera-Rubio, Raul; Kiely, Patrick A; Dunne, Colum P (Journal of Crohn's and Colitis, 2019-01-01)
    Mesenteric lymph nodes are sites in which translocated bacteria incite and progress immunological responses. For this reason, understanding the microbiome of mesenteric lymph nodes in inflammatory bowel disease is important. The bacterial profile of Crohn’s disease mesenteric lymph nodes has been analysed using culture-independent methods in only one previous study. This study aimed to investigate the mesenteric lymph node microbiota from both Crohn’s disease and ulcerative colitis patients.
  • Activation of a TLR9 mediated innate immune response in preeclampsia.

    Williamson, Rachel D; McCarthy, Fergus P; Kenny, Louise C; McCarthy, Cathal M (Scientific Reports, 2019-04-11)
    Preeclampsia is a multisystemic disorder leading to the development of a placental ischemic microenvironment with a resultant increase in oxidative stress. There is evidence that mitochondrial dysfunction and the innate immune system both play a role in the pathophysiology of this disease. Mitochondrial DAMPs such as mtDNA bind specifc pattern recognition receptors such as Toll-like receptor 9 (TLR9) on the endosomal surface of immune cells, in particular neutrophils, subsequently activating them and triggering an innate response. We hypothesised that the exaggerated innate immune response seen in preeclampsia is provoked by dysfunctional mitochondria. Here we provide evidence that TLR9 activity is signifcantly increased at time of disease in women with preeclampsia. Furthermore, we show activation of neutrophil markers, Calprotectin, Myeloperoxidase (MPO), and IL-8 are signifcantly increased at time of disease compared to uncomplicated pregnancies. This research supports a potential role of TLR9 activation of an innate immune response evident in preeclampsia which may possibly be initially triggered by dysfunctional mitochondria.
  • Ustekinumab-induced subacute cutaneous lupus.

    Tierney, Emma; Kirthi, Shivashini; Ramsay, Bart; Ahmad, Kashif (JAAD Case Reports, 2019-03-01)
    Drug-induced lupus erythematosus (DILE) is a lupus-like syndrome temporally related to continuous drug exposure. DILE can be divided into systemic lupus erythematosus (SLE), subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus.1 Hydrochlorothiazide was the first drug associated with SCLE in 1985,2 but at least 100 other agents have since been reported to induce/exacerbate SCLE, with terbinafine, tumor necrosis factor (TNF)-α inhibitors, antiepileptics, and proton pump inhibitors, the most frequently associated medications. We present a case of ustekinumab-induced SCLE in a patient being treated for psoriasis.
  • High Rates of Diabetic Ketoacidosis in Patients with New and Known Type 1 Diabetes over a Six-Year Period

    Finn, B.P.; Trayer, J.; Cronin, C.; O’Connell, S.M (Irish Medical Journal, 2019-03)
    Ireland is a high incidence country for type 1 diabetes (T1DM) with 28.8 newly diagnosed cases/100,000/year1. Patients with new onset T1DM frequently (15-70%) present with diabetic ketoacidosis (DKA)2,3,4,5. Lansdown et al found that 25% of children with new onset T1DM under 19 years of age presented in DKA in Wales between 1991 and 20096. The rates of DKA in known T1DM on an international stage remains significant- Austria and Germany (5%), Wales and England (6.4%) and the United States (7.1%)7. The aim of our study was to analyse all admissions with diabetic ketoacidosis to the regional paediatric diabetes centre at Cork University Hospital, over the past six years. Our objectives include assessing the proportion of patients with new and known T1DM, treatment modalities (e.g. pump/multiple daily injections), patient demographics, severity, length of stay and outcomes.
  • Impact of oral rehabilitation on the quality of life of partially dentate elders in a randomised controlled clinical trial: 2 year follow-up.

    McKenna, Gerald; Allen, Patrick Finbarr; Hayes, Martina; DaMata, Cristiane; Moore, Ciaran; Cronin, Michael (Plos One, 2018-01-01)
    This randomised clinical trial aimed to compare the impact of two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and functionally orientated treatment based on the shortened dental arch (SDA) concept, on Oral Health-related Quality of Life (OHrQOL). 89 patients completed a randomised clinical trial. Patients were recruited in two centres: Cork University Dental Hospital (CUDH) and a Geriatric Day Hospital (SFDH). 44 patients were randomly allocated to the RPD group and 45 to the SDA group where adhesive bridgework was used to provide 10 pairs of occluding contacts. The impact of treatment on OHrQOL was used as the primary outcome measure. Each patient completed the Oral Health Impact Profile (OHIP-14) at baseline, 1, 6, 12 and 24 months after treatment. Both treatment groups reported improvements in OHIP-14 scores at 24 months (p<0.05). For the SDA group OHIP-14 scores improved by 8.0 scale points at 12 months (p<0.001) and 5.9 scale points at 24 months (p<0.05). For the RPD group OHIP-14 scores improved by 5.7 scale points at 12 months (p<0.05) and 4.2 scale points at 24 months (p<0.05). Analysis using ANCOVA showed that there were significant between group differences recorded in both treatment centres. 24 months after intervention the SDA group recorded better OHIP-14 scores by an average of 2.9 points in CUDH (p<0.0001) and by an average of 7.9 points in SFDH (p<0.0001) compared to the RPD group. Patients in the SDA group maintained their improvements in OHrQOL scores throughout the 24 month study period. For the RPD group the initial improvement in OHrQOL score began to diminish after 6 months, particularly for those treated in SFDH. Thus, the benefits of functionally orientated treatment increased over time, particularly for the older, more systemically unwell cohort in SFDH.
  • Counselling in Primary Care – A General Practitioner’s Perspective

    Rafferty, M.; Bradley, C.; 1. Mercy University Hospital 2. Department of General Practice, University College Cork (Irish Medical Journal, 2019-02)
    Counselling in Primary care (CIPC) is a new service introduced by the HSE in 2013, providing short-term counselling for medical-card holders, suffering from mild to moderate mental health problems.
  • Erectile Dysfunction and Ischaemic Heart Disease.

    Ibrahim, Abdalla; Ali, Mohamed; Kiernan, Thomas J; Stack, Austin G (European Cardiology Review, 2018-12-01)
    Erectile dysfunction (ED) is a common disorder that affects the quality of life of many patients. It is prevalent in more than half of males aged over 60 years. Increasing evidence suggests that ED is predominantly a vascular disorder. Endothelial dysfunction seems to be the common pathological process causing ED. Many common risk factors for atherosclerosis such as diabetes, hypertension, smoking, obesity and hyperlipidaemia are prevalent in patients with ED and so management of these common cardiovascular risk factors can potentially prevent ED. Phosphodiesterase type 5 inhibitors provide short-term change of haemodynamic factors to help initiate and maintain penile erection. They have been shown to be an effective and safe treatment strategy for ED in patients with heart disease, including those with ischaemic heart disease and hypertension.
  • Diagnostic Yield of Routine EEG in Adults with Active Epilepsy

    McGinty, R.N.; Costello, D.J.; Kinirons, P; McNamara, B (Irish Medical Journal, 2019-01)
    Routine electroencephalogram (rEEG) is an important investigation in suspected seizures but can be normal in people with epilepsy. The diagnostic yield of rEEG varies considerably according to the patient group studied. We aimed to estimate the diagnostic yield of rEEG in a real-world cohort of adults with active epilepsy—a population not previously reported. This single centre study evaluated neurophysiology findings for adults with prolonged inpatient video EEG (vEEG)-confirmed active epilepsy, who had at least one prior rEEG. Sixty-eight patients had a total of 171 rEEGs, of which 93 (54.4%) were normal, 42 (24.6%) found non-specific abnormalities and 36 (21.1%) captured interictal epileptiform abnormalities (IIEAs). Serial rEEGs revealed a 22.1% yield of IIEAs on the first test, with the cumulative yield peaking at 33.8% on the fourth rEEG. This study adds to existing evidence regarding the limited diagnostic usefulness of serial rEEG in patients with active epilepsy.
  • Pulmonary aspiration in preschool children with cystic fibrosis.

    Clarke, D; Gorman, I; Ringholz, F; McDermott, M; Cox, D W; Greally, P; Linnane, B; Mc Nally, P (Respiratory Research, 2018-12-17)
    Pulmonary aspiration of gastric refluxate (PAGR) has been demonstrated in association with pulmonary inflammation in school aged children with Cystic Fibrosis (CF). We sought to determine if similar findings were present in preschool children. Pepsin was measured in Broncho-alveolar lavage (BAL) fluid collected from clinically stable preschool children with CF and controls. Elevated pepsin levels were found in a subgroup of children with CF, but this was not found to be associated with pulmonary infection, pulmonary inflammation or respiratory or gastrointestinal symptoms.
  • Prevalence and correlates of central venous catheter use among haemodialysis patients in the Irish health system - a national study.

    Hussein, Wael F; Mohammed, Husham; Browne, Leonard; Plant, Liam; Stack, Austin G (BMC Nephrology, 2018-04-02)
    Central venous catheters (CVC) are associated with substantial morbidity and mortality among patients undergoing haemodialysis (HD), yet they are frequently used as the primary vascular access for many patients on HD. The goal of this study was to determine the prevalence and variation in CVC use across centres in the Irish health system. Data from the National Kidney Disease Clinical Patient Management System (KDCPMS) was used to determine CVC use and patterns across centres. Data on demographic characteristics, primary cause of end-stage kidney disease (ESKD), comorbid conditions, laboratory values and centre affiliation were extracted for adult HD patients (n = 1, 196) who were on dialysis for at least three months up to end of December 2016. Correlates of CVC use were explored using multivariable logistic regression. Overall prevalence of CVC use was 54% and varied significantly across clinical sites from 43% to 73%, P < 0.001. In multivariate analysis, the likelihood of CVC use was lower with increasing dialysis vintage, OR 0.40 (0.26-0.60) for 4 years vs 1 year vintage, rising serum albumin, OR 0.73 (0.59-0.90) per 5 g/L), and with cystic disease as a cause of ESKD, OR 0.38 (95% CI 0.21-0.6). In contrast, catheter use was greater for women than men, OR 1.77 (1.34-2.34) and for 2 out of 10 regional dialysis centres, OR 1.98 (1.02-3.84) and OR 2.86 (1.67-4.90) respectively compared to referent group). Catheters are the predominant type of vascular access in patients undergoing HD in the Irish health system. Substantial centre variation exists which is not explained by patient-level characteristics.
  • Patients' perception of privacy and confidentiality in the emergency department of a busy obstetric unit.

    Hartigan, Lucia; Cussen, Leanne; Meaney, Sarah; O'Donoghue, Keelin (BMC Health Services Research, 2018-12-18)
    Privacy and confidentiality are central components of patient care and are of particular importance in obstetrics and gynaecology, where clinical situations of a sensitive nature regularly occur. The layout of the emergency department (ED) in maternity units is often not conducive to maintaining privacy. Our study aimed to discover if changing the environment could improve patients' experiences in the ED. We surveyed patients and asked specific questions about their perception of privacy in the ED. We then repeated the survey following renovations to the ED which involved replacing curtained patient areas with walled cubicles. There were 75 pre-renovation surveys and 82 post-renovation surveys completed. Before the renovations took place, only 21% (n = 16) found their privacy to be adequate during their visit to the ED. However this rose to 89% (n = 73) post-renovation. Our study showed that patients' perception of privacy and confidentiality significantly improved following refurbishment of the ED.
  • A budget impact analysis of a clinical medication review of patients in an Irish university teaching hospital

    Kearney, Alan; Walsh, Elaine. K; Kirby, Ann; Halleran, Ciaran; Byrne, Derina; Haugh, Jennifer; Sahm, Laura. J (Global & Regional Health Technology, 2018-09)
    To measure the net benefit of a pharmacist-led medication review in acute public hospitals. To identify and measure the resources used when completing a pharmacist-led medication review, an observational study was conducted in an acute urban university teaching hospital. Health Information and Quality Authority guidelines were used to value resources used in a pharmacist-led medication review. Model inputs included demographic data, probability of adverse drug events associated with the pharmacist interventions, estimates of future discharges and cost data. The cost of a pharmacist-led medication review and savings generated from avoidance of adverse drug events were estimated and projected over a 5-year period, using hospital discharge rates taken from the hospital inpatient enquiry system and the census of population. Using the per-patient cost of a medication review, the annual cost of delivering a bi-weekly medication review is projected to vary between €6 m and €6.4 m over a 5-year period from 2017 to 2021. The per-patient net benefit of a bi-weekly medication review is €45.88. Therefore, the projected annual net benefit of a bi-weekly medication review is between €29.5 m and €31.2 m over the 5-year period of 2017 to 2021. Introducing a pharmacist-led medication review for each inpatient saves in the short and longer term. The results are consistent with previous findings. Substantial savings were estimated, regardless of variation in model parameters tested in sensitivity analysis.
  • Neonatal Therapeutic Hypothermia in Ireland Annual Report 2016-2017

    Meaney, S; McGinley, J; Horkan, S; Corcoran, P; Greene, RA; Murphy, J; National Perinatal Epidemiology Centre Department of Obstetrics and Gynaecology University College Cork (National Perinatal Epidemiology Centre, 2018)
  • Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes.

    Coughlan, J J; Kiernan, Thomas; Mylotte, Darren; Arnous, Samer (International Cardiology Review, 2018-09-01)
    Transcatheter aortic valve implantation (TAVI) is the treatment of choice in patients with symptomatic severe aortic stenosis who are either inoperable or at high risk for conventional surgical aortic valve replacement. Recent data have also shown favourable outcomes in patients deemed to be at intermediate operative risk, which expands the application of this novel technology. Despite its success, TAVI has been associated with rare life-threatening complications. Of these, aortic annular rupture is considered to be the most devastating. Advances in pre-procedural screening and patient selection have reduced the incidence of annular rupture. When this complication occurs, early recognition and prompt management are essential. This article is intended to provide a comprehensive review of the predictors, management and clinical outcomes of aortic annular rupture.
  • Temporal trends in hyperuricaemia in the Irish health system from 2006-2014: A cohort study.

    Kumar A U, Arun; Browne, Leonard D; Li, Xia; Adeeb, Fahd; Perez-Ruiz, Fernando; Fraser, Alexander D; Stack, Austin G; University Hospital Limerick (PLOS ONE, 2018-01-01)
    Elevated serum uric acid (sUA) concentrations are common in the general population and are associated with chronic metabolic conditions and adverse clinical outcomes. We evaluated secular trends in the burden of hyperuricaemia from 2006-2014 within the Irish health system. Data from the National Kidney Disease Surveillance Programme was used to determine the prevalence of elevated sUA in adults, age > 18 years, within the Irish health system. Hyperuricaemia was defined as sUA > 416.4 μmol/L in men and > 339.06 μmol/L in women, and prevalence was calculated as the proportion of patients per year with mean sUA levels above sex-specific thresholds. Temporal trends in prevalence were compared from 2006 to 2014 while general estimating equations (GEE) explored variation across calendar years expressed as odds ratios (OR) and 95% Confidence intervals (CI). From 2006 to 2014, prevalence of hyperuricaemia increased from 19.7% to 25.0% in men and from 20.5% to 24.1% in women, P<0.001. The corresponding sUA concentrations increased significantly from 314.6 (93.9) in 2006 to 325.6 (96.2) in 2014, P<0.001. Age-specific prevalence increased in all groups from 2006 to 2014, and the magnitude of increase was similar for each age category. Adjusting for baseline demographic characteristics and illness indicators, the likelihood of hyperuricemia was greatest for patients in 2014; OR 1.45 (1.26-1.65) for men and OR 1.47 (1.29-1.67) in women vs 2006 (referent). Factors associated with hyperuricaemia included: worsening kidney function, elevated white cell count, raised serum phosphate and calcium levels, elevated total protein and higher haemoglobin concentrations, all P<0.001. The burden of hyperuricaemia is substantial in the Irish health system and has increased in frequency over the past decade. Advancing age, poorer kidney function, measures of nutrition and inflammation, and regional variation all contribute to increasing prevalence, but these do not fully explain emerging trends.
  • Infants who required Therapeutic Hypothermia in Ireland, 2016-2017: lay summary

    National Perinatal Epidemiology Centre (Cork University Maternity Hospital, 2018)
    The National Clinical Programme Paediatrics and Neonatology (NCPPN) has identified a gap in the knowledge available nationally to clinicians and managers regarding TH. In 2017, a collaboration was agreed between the NCPPN and the National Perinatal Epidemiology Centre to examine the care of all infants who underwent TH in the years, 2016 and 2017. The primary aim of this report is to present an overview and national statistics on TH in Ireland for the years 2016 and 2017.
  • Placental FKBP51 mediates a link between second trimester maternal anxiety and birthweight in female infants.

    Togher, Katie L; O'Keeffe, Gerard W; Khashan, Ali S; Clarke, Gerard; Kenny, Louise C; Cork University Maternity Hospital and University College Cork (Scientific Reports, 2018-10-11)
    Prenatal distress is associated with adverse outcomes in affected offspring. Alterations in placental glucocorticoid signalling and subsequent foetal overexposure to glucocorticoids have been implicated as an underlying mechanism. Infant sex is emerging as an important factor in disease susceptibility. This study aimed to examine the effects of maternal distress across pregnancy on birth outcomes and placental glucocorticoid genes in a sex-dependent manner. Participants completed psychological distress questionnaires throughout pregnancy. Placental HSD11B2, NR3C1 and FKBP51 were analysed by real time PCR and cortisol was measured in new-born hair. Second trimester stress was negatively correlated with birthweight in males and positively correlated with placental NR3C1 mRNA in females. Second trimester anxiety was negatively correlated with birthweight and placental FKBP51 mRNA in females. In mediation analysis, placental FKBP51 mRNA expression was found to mediate the link between prenatal anxiety and birthweight. New-born cortisol was negatively correlated with second trimester anxiety and positively correlated with female placental FKBP51 mRNA levels. Again, FKBP51 mRNA was found to mediate the link between anxiety and new-born cortisol. These results highlight a role for FKBP51 in the placental response to prenatal distress in females. The precise role that placental FKBP51 has in foetal and infant development has not been extensively studied and warrants further investigations.
  • Merkel Cell Carcinoma: A Case Series

    Zafar, S.A; O.M Ahmed, O.M; Boland, M.R; Aucharaz, N; Lal, A (Irish Medical Journal, 2018-10)
    Merkel cell carcinoma (MCC) is a rare cutaneous tumour that is clinically aggressive with a high local, regional, and distant metastatic potential.
  • IgG4 Related Disease, A Case of Large Vessel Vasculitis

    O’Sullivan, A; Ghazi Al Qatari, S; Murphy, G; Cork University Hospital (Irish Medical Journal, 2018-10)
    This report describes a case of large vessel vasculitis highlighting diagnostic and therapeutic challenges. It describes the use of the B cell depleting agent Rituximab in this setting. This is the case of a 50 year old lady with bipolar disorder presenting with lower limb pain.
  • Coming of Age in Ireland: the Twilight Zone!

    Power, B.D; Stewart, P; Stone, G; O’Reilly, P; Costigan, C; O’Gorman, C; Murphy, A.M; University Hospital Limerick (Irish Medical Journal, 2018-10)
    To describe the healthcare needs of adolescent patients inhabiting the ‘seventh age of childhood’ in our region with a view towards future workforce and infrastructure planning.

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