Recent Submissions

  • Urethral cancer managed with phallus preserving surgery: a case report.

    Walsh, Emily; Kelly, Niall; Daly, Padraig; Shah, Nigam; Cullen, Ivor (2021-02-19)
    Background: Primary urethral carcinoma (PUC) is rare and accounts for < 1% of all genito-urinary cancers. There is a male predominance of 3:1 and a peak incidence in the 7th and 8th decades. The aetiology of this cancer is similar to penile cancer, and the human papilloma virus (HPV) is thought to be an essential factor in tumorigenesis. Urethral cancer should be diagnosed and staged with a combination of tumour biopsy, MRI, and CT with treatment involving a multimodal approach. Contemporary management emphasises phallus-preserving surgery where feasible. Case presentation: Here, we describe a case of distal urethral carcinoma, which presented as a metastatic groin mass and identifying the primary lesion proved challenging. Diagnostic flexible cystoscopy identified a tiny lesion in the navicular fossa, which was biopsied and confirmed to be a squamous cell carcinoma. The patient then underwent phallus preserving surgery, including distal urethrectomy with bilateral inguinal lymph node dissections. The final stage was pT1N1M0, and adjuvant chemotherapy was started. The distal urethrectomy involved the surgical creation of a hypospadic meatus in the midshaft of the penis. Normal voiding and sexual function were preserved. Conclusions: Urethral cancer is a rare malignancy and clinicians should bear in mind that early diagnosis of this disease can be very difficult depending on the anatomical location of the tumour. Treatment currently favours penis-preserving surgery.
  • 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.
  • 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.
  • Axillary artery and brachial plexus injury secondary to blunt trauma.

    Foley, James; Elamien, Ahmed; McCann, Brendan (2021-03-13)
    Rupture of the axillary artery in the absence of a fracture of dislocation is a rare traumatic event. An associated injury to the brachial plexus may accompany an axillary artery injury but has rarely been reported in the literature. We present the case of an elderly female, who fell onto an outstretched arm and sustained an axillary artery rupture, combined with a brachial plexus injury. The patient in this case did well post-operatively. The challenge in these cases is early recognition and diagnosis of a vascular injury. A significant mechanism of injury needs to alert the clinician to the possibility of such injuries and if suspected, early investigation and surgical exploration should be initiated to prevent limb ischemia. Subsequently, if the neurological symptoms do not improve, consideration must be given to the possibility of a nerve injury and early recognition and management to prevent long-term functional deficits.
  • Long-Term Surveillance and Laparoscopic Management of Zinner Syndrome.

    Kelly, Niall P; Fuentes-Bonachera, Adrian; Shields, William P; Cullen, Ivor M; Daly, Padraig J (2021-03-09)
    Zinner syndrome was first described in 1914 and represents the triad of unilateral renal agenesis and ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Seminal vesicle cysts are often asymptomatic but can also present with pain, haematospermia, or other lower urinary tract symptoms. Treatment strategies include observation and surgical excision. We present the laparoscopic management of an enlarged seminal vesicle cyst, consistent with Zinner syndrome, 14 years after the initial diagnosis. A 58-year-old male patient was diagnosed with a left-sided seminal vesicle cyst while undergoing assessment for renal transplant due to progressively worsening renal function in his solitary right kidney. The otherwise asymptomatic cyst enlarged from the time of initial diagnosis in 2004 (11.3 cm × 9.7 cm × 13.1 cm) to nearly double the size in 2018 (12.8 cm × 11.9 cm × 14.2 cm). This cyst size ultimately precluded renal transplant, and the patient was referred for excision. Laparoscopic excision of the cyst was performed, histopathology confirmed seminal vesicle cyst tissue, and there has been no recurrence of the cyst to date. The patient remains active on the renal transplant waitlist. Zinner syndrome is a rare syndrome, with the seminal vesicle cysts being managed by observation or surgical excision. We report the longest documented observation of a seminal vesicle cyst, culminating in a safe and successful laparoscopic excision.
  • Severe maternal morbidity in Ireland annual report 2017

    Leitao, S.; Manning, E.; Corcoran, P.; Greene, R.A.; National Perinatal Epidemiology Centre (National Perinatal Epidemiology Centre, 2019-08)
    The sixth report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 391 cases of SMM occurring in all 19 Irish maternity units in 2017.
  • Bare necessities? The utility of full skin examination in the COVID-19 era.

    O'Connor, C; Gallagher, C; O'Connell, M; Bourke, J; Murphy, M; Bennett, M (2021-03-18)
    Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.
  • 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.
  • 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.
  • 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.
  • Fulvestrant-Big Mac Index: Defining Inequality in Oncology.

    O'Reilly, David; Abu Al-Saud, Yassmeen; O'Reilly, Seamus; Ronayne, Cian (2021-04)
  • Neonatal Therapeutic Hypothermia in Ireland: Annual Report: 2018 Aggregate Report 2016–2018

    Meaney, S.; McGinley, J.; Corcoran, P.; McKenna, P.; Filan, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2020-02)
    This is the Neonatal Therapeutic Hypothermia in Ireland report for 2018. It is a collaborative initiative undertaken by the National Clinical Programme for Paediatrics and Neonatology (NCPPN), the National Perinatal Epidemiology Centre (NPEC) and the National Women and Infants Health Programme (NWIHP). The Therapeutic Hypothermia steering committee has overseen the governance of the project. This report serves as a valuable resource to Medical, Midwifery and Nursing staff who are striving to make quality changes in the services we deliver to mothers and their babies. The recently formed National Neonatal Encephalopathy Action Group reflects this. The group comprises representatives from the Department of Health, the States Claims Agency, and the Health Service Executive, the NWIHP, the NPEC, Clinical Leads and patient advocates. The group acknowledges the long-lasting consequences caused by Neonatal Encephalopathy. The group aims to reduce avoidable instances of Neonatal Encephalopathy through the identification of known causes and risk factors and plans to drive initiatives to eliminate or mitigate them. The aspiration is a reduction in cases requiring therapeutic hypothermia intervention in our national maternity units/ hospitals. This working group has been endorsed by the Minister for Health Mr Simon Harris.
  • Neonatal Therapeutic Hypothermia in Ireland Annual Report | 2016-2017

    Meaney, S.; McGinley, J.; Horkan, S.; Corcoran, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2018-11)
    This report contains maternal and infant data pertaining to Neonatal Therapeutic Hypothermia (TH) in Ireland for the period of 2016/2017. Anonymised data was collected on maternal characteristics, history of antenatal care and delivery. Data were collected on infant characteristics, resuscitation, assessment, hospital transfers, their 72-hour clinical course, rewarming, feeding and outcomes.
  • Severe maternal morbidity in Ireland annual report 2019

    Leitao, S.; Manning, E.; Corcoran, P.; San Lazaro Campillo, I.; Greene, R.A. (National Perinatal Epidemiology Centre, 2021-04)
    The eighth report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 375 cases of SMM occurring in all 19 Irish maternity units in 2019. The SMM rate is a composite rate of a group of clearly defined severe maternal morbidities. Over two thirds of the women who experienced SMM in 2019 were diagnosed with one morbidity (n=253, 67.5%); 25% (n=95) were diagnosed with two morbidities; 6% (n=24) with three SMMs; 0.5% (n=2) with four morbidities; and 0.3% (n=1) with five morbidities. The SMM rate has shown a steady increase since the reference year of 2011. From 2011 to 2019, the SMM rate has increased by 68% from 3.85 to 6.47 per 1,000 maternities. The incidence has changed from one case of SMM for every 260 maternities in 2011 to one case in 155 maternities in 2019.
  • Neonatal Therapeutic Hypothermia in Ireland: Annual Report: 2019 Aggregate Report 2016-2019

    Meaney, S.; McGinley, J.; Corcoran, P.; McKenna, P.; Filan, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2021-04)
    This is the Neonatal Therapeutic Hypothermia report for 2019. The working partnership between the National Perinatal Epidemiology Centre, the National Women and Infant Health Programme and the National Clinical Programme for Paediatrics and Neonatology continues to be productive. This year marks the third published report. The Therapeutic Hypothermia (TH) steering committee continues to oversee the governance of this project and its members remain committed to the building of a national register for TH cases in Republic of Ireland. The electronic register was launched in early March 2020 and this system was utilised for the 2019 TH data collection. The data was collected and verified by the National TH Co-ordinator who visited the maternity units. The findings are accurate and applicable to clinical practice. This year, for the first time, data was collected on the Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III) assessment of the infants. This developmental assessment is undertaken when the infant is aged two years. This assessment provides information on the longerterm outcome of the infant cohort.
  • The environmental impact of personal protective equipment in a pre and post COVID era in the ENT clinic.

    Farrell, Eric; Smyth, David (2021-05-27)
    Purpose: The use of single use plastic items and plastic wrapping has increased over the last number of decades. Outside of the medical field there has been a conscious drive to reduce single use plastic and reuse items to reduce the amount of waste we produce. We undertook this investigation to quantify our plastic waste production and generate ideas to reduce this volume. Methodology: Data was collected from a University Hospital ENT outpatient department via real-time recording methods using standard data collection forms. We measured plastic unit usage pre and post COVID restrictions and compared this to our number of patient encounters. Projections of plastic usage were determined via a hypothetical resumption of patient services model. Results: In total there were 440 patients included. In period one the mean units of plastic used per day was 65.1 (median 67; range 27-84). In the second period, the mean number of plastic units was 23.4 (median 22; range 1-7). Blue nitrile gloves and masks were the most commonly used single use items. The hypothetical projection model predicted a 147.6% increase in single use items following the introduction of COVID precautions. Conclusion: We have a duty of care not only to our patients but future generations of patients and the environment which we share. Single use items and excessive plastic wrapping have benefits in terms of convenience and sterility, but these conveniences can be easily extended to reusable types to limit our volume of waste, reduce our waste management costs and protect our environment.
  • Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture.

    Khojaly, Ramy; Mac Niocaill, Ruairí; Shahab, Muhammad; Nagle, Matthew; Taylor, Colm; Rowan, Fiachra E; Cleary, May (2021-05-27)
    Background: Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods: A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion: Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures.
  • Zn-Containing Membranes for Guided Bone Regeneration in Dentistry.

    Toledano, Manuel; Vallecillo-Rivas, Marta; Osorio, María T; Muñoz-Soto, Esther; Toledano-Osorio, Manuel; Vallecillo, Cristina; Toledano, Raquel; Lynch, Christopher D; Serrera-Figallo, María-Angeles; Osorio, Raquel (2021-05-29)
    Barrier membranes are employed in guided bone regeneration (GBR) to facilitate bone in-growth. A bioactive and biomimetic Zn-doped membrane with the ability to participate in bone healing and regeneration is necessary. The aim of the present study is to state the effect of doping the membranes for GBR with zinc compounds in the improvement of bone regeneration. A literature search was conducted using electronic databases, such as PubMed, MEDLINE, DIMDI, Embase, Scopus and Web of Science. A narrative exploratory review was undertaken, focusing on the antibacterial effects, physicochemical and biological properties of Zn-loaded membranes. Bioactivity, bone formation and cytotoxicity were analyzed. Microstructure and mechanical properties of these membranes were also determined. Zn-doped membranes have inhibited in vivo and in vitro bacterial colonization. Zn-alloy and Zn-doped membranes attained good biocompatibility and were found to be non-toxic to cells. The Zn-doped matrices showed feasible mechanical properties, such as flexibility, strength, complex modulus and tan delta. Zn incorporation in polymeric membranes provided the highest regenerative efficiency for bone healing in experimental animals, potentiating osteogenesis, angiogenesis, biological activity and a balanced remodeling. Zn-loaded membranes doped with SiO2 nanoparticles have performed as bioactive modulators provoking an M2 macrophage increase and are a potential biomaterial for promoting bone repair. Zn-doped membranes have promoted pro-healing phenotypes.
  • 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.
  • Correction to: Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture.

    Khojaly, Ramy; Niocaill, Ruairí Mac; Shahab, Muhammad; Nagle, Matthew; Taylor, Colm; Rowan, Fiachra E; Cleary, May (2021-06-21)

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