• ACP Journal Club. An intensive lifestyle intervention increased remission from type 2 diabetes in overweight adults.

      Kyithar, Ma P; Dinneen, Sean F; Galway Roscommon University Hospitals Group, Galway, Ireland. (2013-05-21)
    • The Airtraq as a rescue airway device following failed direct laryngoscopy: a case series.

      Maharaj, C H; Costello, J F; McDonnell, J G; Harte, B H; Laffey, J G; Department of Anaesthesia, Clinical Sciences Institute, National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland. (2007-06)
      We report the successful use of the Airtraq as a rescue device following failed direct laryngoscopy, in patients deemed at increased risk for difficult tracheal intubation. In a series of seven patients, repeated attempts at direct laryngoscopy with the Macintosh blade, and the use of manoeuvres to aid intubation, such as the gum elastic bougie placement, were unsuccessful. In contrast, with the Airtraq device, each patient's trachea was successfully intubated on the first attempt. This report underlines the utility of the Airtraq device in these patients.
    • Alcohol-attributable mortality in Ireland.

      Martin, Jennifer; Barry, Joe; Goggin, Deirdre; Morgan, Karen; Ward, Mark; O'Suilleabhain, Tadhg; Department of Public Health, Merlin Park, Galway, Ireland. Jennifer.martin@hse.ie (2010)
      The study aim was to calculate Irish alcohol-attributable fractions (AAFs) and to apply these measurements to existing data in order to quantify the impact of alcohol on mortality.
    • The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial.

      McDonnell, John G; O'Donnell, Brian; Curley, Gerard; Heffernan, Anne; Power, Camillus; Laffey, John G; Department of Anaesthesia and Intensive Care Medicine, University College Hospital, Galway, Ireland. (2007-01)
      The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial.
    • The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial.

      McDonnell, John G; Curley, Gerard; Carney, John; Benton, Aoife; Costello, Joseph; Maharaj, Chrisen H; Laffey, John G; Department of Anaesthesia, Clinical Sciences Institute, Centre for Pain Research, National University of Ireland, Galway, Ireland. (2008-01)
      The transversus abdominis plane (TAP) block is an effective method of providing postoperative analgesia in patients undergoing midline abdominal wall incisions. We evaluated its analgesic efficacy over the first 48 postoperative hours after cesarean delivery performed through a Pfannensteil incision, in a randomized controlled, double-blind, clinical trial.
    • Association between anxiety and depression symptoms with resistant hypertension and central hemodynamics: A pilot study.

      Mermerelis, A; Kyvelou, S-M; Vellinga, A; Papageorgiou, C; Stefanadis, C; Douzenis, A (Elsevier, 2016)
      The hypothesis that symptoms of anxiety and depression contribute to the development of hypertension has been controversial. Rutledge and Hogan found that the risk of developing hypertension is approximately 8% higher among people with psychological distress compared to those with minimal distress. People suffering from either severe depression or anxiety were two to three times more likely to develop hypertension. The aim of the present pilot study was to compare the prevalence of anxiety and depression in patients with resistant HTN (rHTN) who underwent renal denervation (RDN) versus medical management alone. An additional aim was to assess possible associations with central hemodynamics using the cardio-ankle vascular index (CAVI). The study included 34 patients who lacked a comorbid mental health disorder, had rHTN and were a mean age of 58.3 ± 11.2 years. Twenty-four hour ambulatory blood pressure monitoring (24 hABPM) was conducted in all patients, and they were divided into the following groups: group I (n = 20) underwent RDN and group II (n = 14) was treated with medical management alone. The mean office SBP and DBP measurements for group I were 163 mmHg and 92 mmHg, respectively; for group II, they were 159 mmHg and 91 mmHg, respectively. There was no significant difference in the duration of hypertension (10.1 vs 9.4 years, p = NS) or in the familial burden. Finally, there was no difference in the number of antihypertensive medications in the two groups (5.1 vs 5.5, p = NS). The evaluation of anxiety disorder was performed with the Hospital Anxiety Depression Scale (HADS)3,4. The Beck Depression Inventory (BDΙ) was used to evaluate depression5. Both scales consist of a simple, yet reliable, self-assessment screening questionnaire. For the HADS scale, a score of ≥11 is thought to indicate a significant case of psychological morbidity. The BDI is a 21-item self-report depression inventory that measures depressive symptoms. For each item, the score ranges from 1 to 4. The total score is obtained by summing the scores on each of the 21 questions. CAVI was measured with a Vasera VS-1500 (Fukuda Denshi, Tokyo, Japan) vascular screening device. Descriptive and univariate comparisons were made using SPSS (version 20.0). Due to the low number of subjects in each group, only non-parametric tests were used (Spearman for correlations, Mann-Whitney U-test for comparison of groups and Chi square for categorized comparisons). A p-value of 0.05 was set as the cut-off for significance. The HADS and BDI scores were highly correlated in the entire group [correlation coefficient (CC) = 0.787, p = 0.0001] as well as separately in each of the two groups [group I (CC) = 0.825, p = 0.0001 and group II (CC) = 0.779, p = 0.0001, respectively]. When comparing HADS and BDI scores between the two groups, no significant difference was identified. Comparing CAVI results, CAVIR, but not CAVIL, was significantly higher in group I (p = 0.02). In group II, there seems to be a negative correlation between the CAVIR, CAVIL and HADS scores [CAVIR-HADS CC = -0.597, p = 0.024; CAVIL-HADS CC = -0.668, p = 0.009] This small pilot study showed that there is a significant correlation between the two scores in the total population; however, patients treated with RDN are not different from those with medical management alone. A negative association was also noted between the anxiety scoring scale and CAVIR and CAVIL in patients treated with medical management alone. A previous study documented a lack of difference in the prevalence of panic, anxiety and depression between patients with rHTN and non-resistant controls. In agreement with our study, the prevalence of anxiety and depression was high in the two groups of patients with rHTN; however, the RDN made no difference in the total impact of the two modalities, which is in contrast with previous results. To the best of our knowledge, this report describes the first attempt to associate the arterial stiffness using the CAVI with anxiety and depression in this population. In a previous study, there was an association between an increased arterial stiffness, autonomic disbalance and depression in a young hypertensive population. The present study is a small pilot study that highlights the higher prevalence of depression and anxiety in patients with resistant hypertension, as well as a negative association with central hemodynamics. However, because the sample is small, acquisition of a larger sample size with the continuation of this study might reveal stronger correlations in the future.
    • Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria.

      O'Sullivan, E P; Avalos, G; O'Reilly, M; Dennedy, M C; Gaffney, G; Dunne, F; Department of Diabetes, Galway University Hospital, Galway, Ireland. (2012-01-31)
      AIMS/HYPOTHESIS: New diagnostic criteria for gestational diabetes mellitus (GDM) have recently been published. We wished to evaluate what impact these new criteria would have on GDM prevalence and outcomes in a predominantly European population. METHODS: The Atlantic Diabetes In Pregnancy (DIP) programme performed screening for GDM in 5,500 women with an oral glucose tolerance test at 24-28 weeks. GDM was defined according to the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and compared with previous WHO criteria; maternal and neonatal adverse outcomes were prospectively recorded. RESULTS: Of the participants, 12.4% and 9.4% were diagnosed with GDM using IADPSG and WHO criteria, respectively. IADPSG GDM pregnancies were associated with a statistically significant increased incidence of adverse maternal outcomes (gestational hypertension, polyhydramnios and Caesarean section) and neonatal outcomes (prematurity, large for gestational age, neonatal unit admission, neonatal hypoglycaemia and respiratory distress). The odds ratio for the development of these adverse outcomes remained significant after adjustment for maternal age, body mass index and non-European ethnicity. Those women who were classified as having normal glucose tolerance by WHO criteria but as having GDM by IADPSG criteria also had significant adverse pregnancy outcomes. CONCLUSIONS/INTERPRETATION: GDM prevalence is higher when using newer IADPSG, compared with WHO, criteria, and these women and their offspring experience significant adverse pregnancy outcomes. Higher rates of GDM pose a challenge to healthcare systems, but improved screening provides an opportunity to attempt to reduce the associated morbidity for mother and child.
    • ATLANTIC DIP: pregnancy outcome for women with pregestational diabetes along the Irish Atlantic seaboard.

      Dunne, Fidelma P; Avalos, Gloria; Durkan, Meave; Mitchell, Yvonne; Gallacher, Therese; Keenan, Marita; Hogan, Marie; Carmody, Louise A; Gaffney, Geraldine; Department of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland. fidelma.dunne@nuigalway.ie (2009-07)
      Prospective evaluation of pregnancy outcomes in pregestational diabetes along the Atlantic seaboard 2006-2007.
    • ATLANTIC DIP: simplifying the follow-up of women with previous gestational diabetes.

      Noctor, E; Crowe, C; Carmody, L A; Avalos, G M; Kirwan, B; Infanti, J J; O'Dea, A; Gillespie, P; Newell, J; McGuire, B; et al. (European journal of endocrinology / European Federation of Endocrine Societies, 2013-11)
      Previous gestational diabetes (GDM) is associated with a significant lifetime risk of type 2 diabetes. In this study, we assessed the performance of HbA1c and fasting plasma glucose (FPG) measurements against that of 75 g oral glucose tolerance testing (OGTT) for the follow-up screening of women with previous GDM.
    • ATLANTIC DIP: the impact of obesity on pregnancy outcome in glucose-tolerant women.

      Owens, Lisa A; O'Sullivan, Eoin P; Kirwan, Breeda; Avalos, Gloria; Gaffney, Geraldine; Dunne, Fidelma; Department of Medicine, National University of Ireland, Galway, Ireland. (2010-03)
      OBJECTIVE A prospective study of the impact of obesity on pregnancy outcome in glucose-tolerant women. RESEARCH DESIGN AND METHODS The Irish Atlantic Diabetes in Pregnancy network advocates universal screening for gestational diabetes. Women with normoglycemia and a recorded booking BMI were included. Maternal and infant outcomes correlated with booking BMI are reported. RESULTS A total of 2,329 women fulfilled the criteria. Caesarean deliveries increased in overweight (OW) (odds ratio 1.57 [95% CI 1.24-1.98]) and obese (OB) (2.65 [2.03-3.46]) women. Hypertensive disorders increased in OW (2.30 [1.55-3.40]) and OB (3.29 [2.14-5.05]) women. Reported miscarriages increased in OB (1.4 [1.11-1.77]) women. Mean birth weight was 3.46 kg in normal BMI (NBMI), 3.54 kg in OW, and 3.62 kg in OB (P < 0.01) mothers. Macrosomia occurred in 15.5, 21.4, and 27.8% of babies of NBMI, OW, and OB mothers, respectively (P < 0.01). Shoulder dystocia occur in 4% (>4 kg) compared with 0.2% (<4 kg) babies (P < 0.01). Congenital malformation risk increased for OB (2.47 [1.09-5.60]) women. CONCLUSIONS OW and OB glucose-tolerant women have greater adverse pregnancy outcomes.
    • Bouncy castle burns.

      Healy, Claragh; Riordan, Colin; Kelly, Jack L; Department of Plastic and Reconstructive Surgery, University College Hospital Galway, Galway, Ireland. claraghhealy@eircom.net (2006-11)
    • Brachial neuritis (Parsonnage-Turner syndrome) - a case study.

      De Burca, Neasa; University Hospital Galway, Ireland. neasa.deburca@ul.ie (2009-10)
    • Clinical efficacy and cost per quality-adjusted life years of pararenal endovascular aortic aneurysm repair compared with open surgical repair.

      Sultan, Sherif; Hynes, Niamh; Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland. sherif.sultan@hse.ie (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2011-04)
      To gauge the efficacy of applying commercially-available endografts to pararenal endovascular abdominal aortic aneurysm (AAA) repair compared with open surgical repair (OSR).
    • Clinical problem-solving. Looking at the whole picture.

      Donagh, Carol; Bruzzi, John; MacNeill, Briain; DaCosta, Mark; Berman, Jeffrey S; O'Regan, Anthony W; Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland. (2012-01-31)
    • Clofarabine in the treatment of poor risk acute myeloid leukaemia.

      Krawczyk, Janusz; Ansar, Naeem; Swords, Ronan; Murphy, Tracy; MacDonagh, Barry; Meenaghan, Teresa; Hayden, Patrick; Hayad, Amjad; Murray, Margaret; O'Dwyer, Michael; et al. (2010-09)
      Clofarabine is a second generation nucleoside analogue. It inhibits DNA repair and activates the mitochondrial apoptotic pathway leading to cell death. In vitro clofarabine has demonstrated synergy with daunorubicin and Ara-C and in phase II clinical trials has shown promising activity in poor risk Acute myeloid leukaemia (AML) patients. In our institution over a 24 month period 22 AML patients (11 M, 11 F) with poor risk features, deemed unsuitable for standard therapy, were treated with clofarabine, alone (eight patients) or in combination (14 patients) for up to three cycles of treatment. The median age was 67.5 years (24-76) with 16 patients > 60 years. At the time of treatment 18 patients had active AML. Four patients intolerant of standard induction received clofarabine as consolidation. The overall response rate (ORR) for the 18 patients with active AML was 61%, nine patients (50%) achieving a complete response (CR). Induction and consolidation were well tolerated with no unexpected toxicities. Predictably, all patients developed grade 4 neutropenia but the median duration was only 20 days (17-120). Induction mortality was acceptable at 17%. In conclusion, clofarabine (alone or in combination) is active in poor risk AML with an acceptable safety profile and should be considered a potential option in poor risk AML patients.
    • Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization.

      Malik, M A; Maharaj, C H; Harte, B H; Laffey, J G; Department of Anaesthesia, Clinical Sciences Institute, Galway University Hospitals, Galway, Ireland. (2008-11)
      The purpose of this study was to evaluate the effectiveness of the Pentax AWS, Glidescope, and the Truview EVO2, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.
    • A comparison of tracheal intubation using the Airtraq or the Macintosh laryngoscope in routine airway management: A randomised, controlled clinical trial.

      Maharaj, C H; O'Croinin, D; Curley, G; Harte, B H; Laffey, J G; Department of Anaesthesia, University College Hospital, Galway, Ireland. (2006-11)
      The Airtraq laryngoscope is a novel single use tracheal intubation device. We compared the Airtraq with the Macintosh laryngoscope in patients deemed at low risk for difficult intubation in a randomised, controlled clinical trial. Sixty consenting patients presenting for surgery requiring tracheal intubation were randomly allocated to undergo intubation using a Macintosh (n = 30) or Airtraq (n = 30) laryngoscope. All patients were intubated by one of four anaesthetists experienced in the use of both laryngoscopes. No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, was successfully intubated on the first attempt. There was no difference between groups in the duration of intubation attempts. In comparison to the Macintosh laryngoscope, the Airtraq resulted in modest improvements in the intubation difficulty score, and in ease of use. Tracheal intubation with the Airtraq resulted in less alterations in heart rate. These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in low risk patients.
    • The cost of universal screening for gestational diabetes mellitus in Ireland.

      Gillespie, P; O'Neill, C; Avalos, G; O'Reilly, M; Dunne, F; School of Business and Economics, National University of Ireland, Galway, Ireland. paddy.gillespie@nuigalway.ie (2011-08)
      To estimate the costs associated with universal screening for gestational diabetes mellitus in Ireland.
    • Cranio-facial manifestations of Beckwith-Wiedemann syndrome.

      McCann, J; McNamara, T; Hewson, A; University College Hospital, Galway, Ireland. (1993)
    • Demographics, nature and treatment of orthopaedic trauma injuries occurring in an agricultural context in the West of Ireland.

      Byrne, F J; Waters, P S; Waters, S M; Hynes, S; Ní Thuairisg, C P; O'Sullivan, M; Department of Orthopaedics and Trauma Surgery, Merlin Park Hospital, Galway, Ireland. fergbyrne@gmail.com (2011-03)
      Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway.