• Proliferative myositis of the latissimus dorsi presenting in a 20-year-old male athlete

      Mc Hugh, N; Tevlin, R; Beggan, C; Ryan, DJ; Larkin, J; Moloney, F; Bennett, MW; Kelly, J (Irish Medical Journal, 2017-08)
      We describe the case of a 20-year-old rower presenting with an uncommon condition of Proliferative Myositis (PM) affecting the Latissimus Dorsi (LD). PM is a rare, benign tumour infrequently developing in the upper back. Its rapid growth and firm consistency may mistake it for sarcoma at presentation. Therefore, careful multidisciplinary work-up is crucial, and should involve appropriate radiological and histopathological investigations. Here, we propose the aetiology of LD PM to be persistent myotrauma induced by repetitive rowing motions. Symptoms and rate of progression ultimately determine the management which includes surveillance and/or conservative resection. There have been no documented cases of recurrence or malignant transformation.
    • Stevens - Johnson Syndrome Induced by Combination of Lamotrigine and Valproic Acid in a 9-Year-Old Boy

      Maduemem, K; Vatca, A; O’Neill, T; Buckley, D (Irish Medical Journal, 2017-06)
      We describe the case history of a 9-year-old boy who developed Stevens-Johnson syndrome (SJS) following concomitant use of valproic acid and lamotrigine. He presented with rash and fever several weeks after introduction of lamotrigine, having been on valproic acid for seizure disorder. SJS happens to be one of the rare adverse reactions of antiepilepsy drugs (AED). Management is mainly supportive with care escalation when necessary because of the significant morbidity.
    • Association between psychological distress and cancer type in patients referred to a psycho-oncology service

      Lavelle, C; Ismail, MF; Doherty, K; Bowler, A; Mohamad, MM; Cassidy, EM (Irish Medical Journal, 2017-06)
      Psychological distress is common in patients with cancer and psychological well-being is increasingly seen as an important component of cancer care. The aim of this study was to examine the relationship between cancer type and subjective distress. The following data were collected from a database of consecutive psycho-oncology referrals to the Liaison Psychiatry service in Cork University Hospital from 2006 to 2015: demographics, cancer diagnosis, Distress Thermometer (DT) score. 2102 out of 2384 referrals were assessed. Of those assessed, the most common cancer diagnoses were breast (23%, n=486) followed by haematological (21%, n=445). There were significant difference in DT score between the different cancer types, (χ2(13)=33.685, p=0.001, Kruskal–Wallis test). When adjusted for age, gender and whether or not the cancer was recently diagnosed, there was no significant association between cancer type and psychological distress. In conclusion, cancer type is not associated with level of distress in cancer.
    • A Multicentre Study of Thromboprophylaxis in Pregnancy

      Crowley, MP; Noone, C; Higgins, JR; O Shea, S (Irish Medical Journal, 2017-05)
      Venous thromboembolism (VTE) is a leading cause of maternal mortality. The risk increases with increasing maternal age, mode of delivery and medical co-morbidities. Thromboprophylaxis with low molecular weight heparin (LMWH) has been shown to be both safe and efficacious. The aim of this study was to prospectively investigate the incidence of maternal risk factors in pregnant women admitted to hospital, to calculate their VTE risk status and to investigate if they were receiving appropriate thromboprophylaxis. All patients admitted to the participating hospitals on the day of investigation were assessed for risk of VTE on the basis of hospital chart review. Five Hundred and forty women were recruited from 16 hospitals. Almost 32% (31.7%) were receiving thromboprophylaxis with LMWH. Just under 80% of patients were on the correct thromboprophylaxis strategy as defined by the RCOG guideline but 49% were under-dosed. The odds of receiving appropriate thromboprophylaxis were significantly increased if the woman was >35 years 0or with parity>3.
    • Hospital Acquired Thrombosis (HAT) Prevention in an Acute Hospital; A Single Centre Cross-Sectional Study

      Khan, MI; O’Leary, C; O’Brien, A; Lester, L; Silvari, V; Duggan, C; O’Shea, S (Irish Medical Journal, 2017-04)
      Evidence based guidelines are effective in reducing incidence of venous thromboembolism (VTE) which is associated with morbidly, mortality and economic burden. This study aimed to identify the proportion of inpatients who had a VTE risk assessment (RA) performed and who received thromboprophylaxis (TP), in Cork University Hospital. There was no structured RA tool at the time; information was obtained from medical and drug charts to ascertain if a RA was performed. Patients were then RA by researchers and stratified as per NICE guidelines and the proportion who received TP was calculated. One thousand and nineteen inpatients were screened. Risk was documented in 24% of cases. TP was prescribed in 43.2% of inpatients. Following application of a RA tool >80% were at high risk of VTE with low risk of bleeding with TP prescription in 46.3% of inpatients. A national collaborative effort should be encouraged to develop a standardized approach for safe RA of inpatients and prescription of TP for prevention of HAT
    • Incidence of Hospital Acquired Thrombosis (HAT) in a Tertiary Care Hospital.

      Khan, MI; O’Leary, C; Silvari, V; O’Brien, A; Duggan, C; O’Shea, S (Irish Medical Journal, 2017-04)
      Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality in hospitalized patients. In spite of guidelines, VTE prophylaxis continues to be underutilised, and hospital acquired thrombosis (HAT) continues to be a problem. This study was conducted to estimate the incidence of HAT in a tertiary referral centre and to examine whether VTE risk assessment and thromboprophylaxis (TP) were implemented. Patients 18 years and above, with a radiologically-confirmed acute VTE during the study period of 15 weeks were included. Acute VTE was diagnosed in 100 patients and HAT was diagnosed in 48. There were 12,024 admissions over the study period, therefore the incidence of HAT was 0.4%. TP was prescribed in only 35% of patients, and 65% did not receive any or appropriate TP. Hospitals without active implementation of a formal risk assessment tool and TP policy are likely to continue to have increased incidence of HAT.
    • Venous Thromboembolism – Risk Assessment Tool and Thromboprophylaxis Policy: A National Survey

      Khan, MI; O’Leary, C; Silvari, V; O’Brien, A; O’Connor, M; Duggan, C; O’Shea, S (Irish Medical Journal, 2017-01)
      Venous Thromboembolic (VTE) events in hospitalised patients are associated with significant mortality and morbidity and a major economic burden on the health service. It is well established in the literature that active implementation of a mandatory risk assessment tool and thromboprophylaxis policy reduces the incidence of hospital associated thrombosis (HAT). This study examines the utilization of a VTE risk assessment tool and thromboprophylaxis (TP) policy in Irish hospitals that manage acute admissions. A national survey was distributed to forty acute hospitals throughout Ireland. The response rate was 78% (31/40). The results showed that only 26% (n=8/31) of acute hospitals in Ireland have a local implemented TP policy. Six (75%) of these eight had a risk assessment tool in conjunction with the TP policy. All respondents who did not report to have a TP policy and risk assessment tool agreed that they should implement VTE prevention policy at their hospital. Based on the data from this survey and evidence from the effectiveness of the VTE prevention programme introduced in the United Kingdom, there is a need for a national risk assessment and thromboprophylaxis policy in Ireland. This change in practice would have the potential to prevent or reduce the morbidity and mortality associated with hospital acquired thrombosis
    • Infant formula feeding practices in a prospective population based study

      Smith, Hazel Ann; Hourihane, Jonathan O’B; Kenny, Louise C; Kiely, Mairead; Leahy-Warren, Patricia; Murray, Deirdre M. (BMC Pediatrics, 2016-12-08)
      : It is recommended that formula-fed infants are given standard whey-based infant formula throughout the first year of life, unless otherwise advised by healthcare professionals. To our knowledge it has not yet been explored if parents are using a whey-based infant formula throughout the first 12 months of life. Reasons for parental choice of formula are also unknown. Therefore, the objective of this paper was to describe parental administration of whey-based and non whey-based infant formula in the first year of life.
    • Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy.

      Kharoshankaya, Liudmila; Stevenson, Nathan J; Livingstone, Vicki; Murray, Deirdre M; Murphy, Brendan P; Ahearne, Caroline E; Boylan, Geraldine B (Developmental Medicine & Child Neurology, 2016-12)
      To examine the relationship between electrographic seizures and long-term outcome in neonates with hypoxic-ischemic encephalopathy (HIE).
    • When do we think it is Safe to Drive after Hand Surgery? – Current Practice and Legal Perspective

      Murphy, SF; Martin-Smith, JD; Martin-Smith, W; O’Broin, E; Clover, APJ (Irish Medical Journal, 2016-11)
      Patients recovering from hand surgery frequently ask when it is safe to drive and it is unclear where the responsibility lies; the surgeon, the patient or the insurance company. An eight-question survey looking at various aspects of clinical practice was circulated to consultant and trainee plastic and orthopaedic surgeons in Ireland and the UK. Of the 89 surgeons who replied, (53%) felt the decision when to drive was the patient’s compared with the insurance company (40%) and the surgeon (7%). 80% advised patients to contact their insurance company. 87% were unaware of current regulations or guidelines. National guidelines were vague and left the decision with the treating doctor. Similarly, major insurers advise patients to contact their doctor for advice. From a legal standpoint, the patient has a duty of care to other road users to be in full control of his vehicle prior to driving, regardless of any advice received.
    • Hepatitis E Virus (HEV) Infection in Ireland

      Hickey, C; Spillane, D; Benson, J; Levis, J; Fanning, LJ; Cryan, B; Prentice, Michael B (Irish Medical Journal, 2016-09)
      Hepatitis E virus (HEV) is a single stranded RNA virus causing infection worldwide. In developing countries HEV genotypes 1 and 2 spread faeco-orally via water. Recently, infections with HEV have been detected in Europe and North America in patients with no travel history. These are food-borne HEV genotypes 3 and 4, a pig-associated zoonosis. Most infections are asymptomatic but morbidity and chronic infection may occur with prior liver disease or immunosuppression. International seroprevalence rates vary and with improved diagnostics have increased. To determine the current prevalence in this region we studied anonymised serum samples submitted in 2015 for routine testing. We detected anti-HEV IgG in 16/198 (8%) individuals, highest rate in 40-59 year olds (43.8%). This is higher than reported for the same region in 1995 (0.4%) using a previous generation assay. This study provides evidence of HEV circulation in Ireland and reinforces the need for ongoing surveillance.
    • Near field communications technology and the potential to reduce medication errors through multidisciplinary application

      O’Connell, Emer; Pegler, Joe; Lehane, Elaine; Livingstone, Vicki; McCarthy, Nora; Sahm, Laura J.; Tabirca, Sabin; O’Driscoll, Aoife; Corrigan, Mark (2016-07)
      Patient safety requires optimal management of medications. Electronic systems are encouraged to reduce medication errors. Near field communications (NFC) is an emerging technology that may be used to develop novel medication management systems.
    • Perinatal mortality in Ireland: annual report 2014

      Corcoran, P.; Manning, E.; O’Farrell, I.B.; McKernan, J.; Meaney, S.; Drummond, L.; de Foubert, P.; Greene, R.A.; National Perinatal Epidemiology Centre (National Perinatal Epidemiology Centre. University College Cork, 2016-06)
    • Severe maternal mobidity in Ireland: annual report 2014

      Manning, E.; Corcoran, P.; O'Farrell, I.B.; de Foubert, P.; Drummond, L.; McKernan, J.; Meaney, S.; Greene, R.A.; National Perinatal Epidemiology Centre. University College Cork (National Perinatal Epidemiology Centre., 2016-06)
    • Attitudes toward Palliative Care and End of Life Issues: A Prospective Survey in Patients with Metastatic Cancer

      Docherty, C; Lester, L; O’Reilly, S (Irish Medical Journal, 2016-05)
      Palliative care (PC) positively impacts patient outcomes, decreases hospital admissions and improves quality of life. Despite evidence, PC resources are reported as under-utilised. Few studies have explored patient attitudes towards PC. This study evaluated patient attitudes towards PC. It was a prospective study conducted in oncology outpatient clinics. A 26-item questionnaire was distributed to those with metastatic cancer (N = 44). Sixty percent believed PC can make people ‘feel better’, 63.4% believed PC is offered when nothing more can be done. Most were unsure or disagreed that opioids are addictive. Eighty percent reported symptom control is more important than prolonging life. Sixty-one percent strongly agreed or agreed that ‘losing hope makes people die sooner’. Although PC was deemed beneficial, a significant relationship exists between familiarity with PC and thinking it’s offered when ‘nothing more can be done’. Lack of knowledge about opioids, preference for symptom control over life prolonging measures and the importance of hope were also emphasised.
    • Cow’s milk protein allergy in infants

      Daly, Deirdre (Nursing in General Practice, 2016-05)
      Cow’s Milk Protein Allergy (CMPA) is the most common food allergy in early childhood in the developed world next to egg allergy. The prevalence is estimated at three to seven per cent, with a resolution rate of 80 to 90 per cent at six years. Accurate diagnosis rests on a good clear allergy focused history.
    • Technical knockout: when is traumatic brain injury “just” a concussion?

      O’Halloran, P J; Johnson, A (Irish Medical Journal, 2016-05)
      While cricket is an unlikely source of concussion, the fierce contagion of media coverage surrounding Rugby and Gaelic Football has led to difficulties in deciphering real from perceived risk. The surge in public interest has forced this young science to mature quickly. The principles of managing head injury have not changed, but there is now a greater awareness that concussion is a traumatic brain injury (TBI). Concussion is a poorly understood, historical term, used to describe a low velocity injury causing brain “shaking.” This results in a nebulous cluster of non-specific symptoms. The most recent attempt to redefine the term was in 2012 (Zurich). The key features of concussion involve the transmission of an impulsive force to the head, the rapid onset of transient, spontaneously resolving neurological impairment, and clinical symptoms that may or may not involve loss of consciousness1
    • Computed tomography dose optimisation in cystic fibrosis: A review.

      Ferris, Helena; Twomey, Maria; Moloney, Fiachra; O'Neill, Siobhan B; Murphy, Kevin; O'Connor, Owen J; Maher, Michael (Baishideng Publishing Group Inc., 2016-04-28)
      Cystic fibrosis (CF) is the most common autosomal recessive disease of the Caucasian population worldwide, with respiratory disease remaining the most relevant source of morbidity and mortality. Computed tomography (CT) is frequently used for monitoring disease complications and progression. Over the last fifteen years there has been a six-fold increase in the use of CT, which has lead to a growing concern in relation to cumulative radiation exposure. The challenge to the medical profession is to identify dose reduction strategies that meet acceptable image quality, but fulfil the requirements of a diagnostic quality CT. Dose-optimisation, particularly in CT, is essential as it reduces the chances of patients receiving cumulative radiation doses in excess of 100 mSv, a dose deemed significant by the United Nations Scientific Committee on the Effects of Atomic Radiation. This review article explores the current trends in imaging in CF with particular emphasis on new developments in dose optimisation.
    • Foot Drop: Looking Beyond Common Peroneal Nerve Palsy – A Neurophysiology Centre Experience

      Yap, SM; McNamara, B (Irish Medical Journal, 2016-04)
      Foot drop is a complex symptom with a considerable range in aetiology, severity and prognosis. We aim to characterise the aetiologies of foot drop and assess the diagnostic contribution of neurophysiologic testing (NCS/EMG). Retrospective review of consecutive referrals of foot drop to the Neurophysiology Department in Cork University Hospital was performed over a two year period (January 2012 to December 2013). Of a total of 59 referrals, common peroneal nerve (CPN) palsy comprised only slightly more than half of cases; 3(5%) have central origin; 3(5%) have motor neuron disease. Six (10%) have diabetes; 7(12%) have cancer; 5(8%) were bilateral. NCS/EMG altered initial working diagnosis in 14 out of 52 (27%) cases whereby initial diagnosis was provided. However one-third of all cases revealed additional coexistent pathology in an anatomic location remote to that of the primary diagnosis. Foot drop with central and proximal localisations are important and under recognised. NCS/EMG is valuable and also reveals additional pathology which warrants investigation
    • Recognition and management of Shaken Baby Syndrome

      Nicholson, Alf (Irish Medical Journal, 2016-04)
      Abusive head trauma (previously referred to as Shaken Baby Syndrome) consists of a triad of findings which included subdural haemorrhage, retinal haemorrhages and encephalopathy after receiving a shake injury or blunt trauma to the head. Debate rages regarding the exact mechanism. Previously published reports on abusive head trauma (AHT) highlight the young age of the victims (median 4 months of age), the significant preponderance of male infants (3:1 in most series), the high rate of probable male perpetrators (just over 50%), and relatively high rates of mortality and morbidity