• Ability of fracture risk assessment tool and national osteoporosis guideline group guidance to stratify people appropriately before fracture.

      Brewer, Linda; Mellon, Lisa; Duggan, Joseph; Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Dublin, Ireland. (2013-09)
    • Accrual to Cancer Clinical Trials

      Kelly, C; Smith, M; Flynn, S; Reyes, A; Higgins, M; McCaffrey, J; Kelly, C (Irish Medical Journal, 2016-07)
      Accrual to cancer clinical trials (CCT) is imperative to safeguard continued improvement in cancer outcomes. A retrospective chart review was performed of patients (n=140) starting a new anti-cancer agent in a north Dublin cancer centre. This review was performed over a four-month period, beginning in November 2015. Only 29% (n=41) had a CCT option. The overall accrual rate to CCT was 5% (n=7), which is comparable to internationally reported figures. The main reasons for failure to recruit to CCT included the lack of a CCT option for cancer type (n=30, 23%), stage (n=25, 19%), and line of treatment (n=23, 17%). Over the last decade, the rate of accrual to CCTs has in fact doubled and the number of trials open to recruitment has tripled. Ongoing governmental and philanthropic support is necessary to continue this trend to further expand CCT patient options with a target accrual rate of 10%.
    • Acquired Anterior Laryngeal Web in a Shotgun Injury

      Lennon, P; Lang, E; O Dwyer, T (Irish Medical Journal, 2015-06)
      We report the first case of an anterior laryngeal web post gunshot wound in the modern literature. A 27 year-old man suffered a close range shotgun injury to his neck. He presented with stridor and a large open neck wound. Emergency tracheostomy was required. A postoperative fibreoptic laryngoscopy revealed anterior glottic web formation. This case report highlights the difficulties in managing acquired anterior laryngeal webs and reviews the only other case in the in the literature from 1915.
    • Acute exacerbations and pulmonary hypertension in advanced idiopathic pulmonary fibrosis.

      Judge, Eoin P; Fabre, Aurelie; Adamali, Huzaifa I; Egan, Jim J; Dept of Respiratory Medicine, and Irish National Lung Transplant Unit, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. eoinjudge@yahoo.com (2012-07)
      The aim of this study was to evaluate the risk factors for and outcomes of acute exacerbations in patients with advanced idiopathic pulmonary fibrosis (IPF), and to examine the relationship between disease severity and neovascularisation in explanted IPF lung tissue. 55 IPF patients assessed for lung transplantation were divided into acute (n=27) and non-acute exacerbation (n=28) groups. Haemodynamic data was collected at baseline, at the time of acute exacerbation and at lung transplantation. Histological analysis and CD31 immunostaining to quantify microvessel density (MVD) was performed on the explanted lung tissue of 13 transplanted patients. Acute exacerbations were associated with increased mortality (p=0.0015). Pulmonary hypertension (PH) at baseline and acute exacerbations were associated with poor survival (p<0.01). PH at baseline was associated with a significant risk of acute exacerbations (HR 2.217, p=0.041). Neovascularisation (MVD) was significantly increased in areas of cellular fibrosis and significantly decreased in areas of honeycombing. There was a significant inverse correlation between mean pulmonary artery pressure and MVD in areas of honeycombing. Acute exacerbations were associated with significantly increased mortality in patients with advanced IPF. PH was associated with the subsequent development of an acute exacerbation and with poor survival. Neovascularisation was significantly decreased in areas of honeycombing, and was significantly inversely correlated with mean pulmonary arterial pressure in areas of honeycombing.
    • Acute Nontraumatic Spinal Intradural Hematoma in a Patient on Warfarin.

      Bruce-Brand, Robert A; Colleran, Gabrielle C; Broderick, James M; Lui, Darren F; Smith, Eimear M; Kavanagh, Eoin C; Poynton, Ashley R; Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland. (2013-08-26)
      Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences.
    • The addition of sodium thiosulphate to hyperthermic intraperitoneal chemotherapy with cisplatin in ovarian cancer.

      Glennon, Kate; Mulligan, Karen; Carpenter, Kirsten; Mooney, Ruth; Mulsow, Jurgen; McCormack, Orla; Boyd, William; Walsh, Tom; McVey, Ruaidhri; Thompson, Claire; et al. (2021-05-26)
      Cisplatin based hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong recurrence free and overall survival of women with ovarian cancer who have responded to neoadjuvant chemotherapy. The aim of this study was to assess the impact of cytoreductive surgery with or without the addition of HIPEC on renal function. Method: This is a retrospective case-controlled study at a tertiary teaching hospital in Dublin, Ireland. All patients who had interval cytoreductive surgery (CRS) and HIPEC from October 2017 to October 2020 were included. A cohort of patients who had interval CRS without HIPEC were included as a control. Sodium thiosulphate (ST) was added to the HIPEC protocol in 2019. In order to assess the impact of ST as a renal protectant, renal function and post-operative outcomes were compared between the groups. Results: Sixty patients who had interval CRS were included, thirty of whom received cisplatin-based HIPEC. Seven received cisplatin 50 mg/m2 without the addition of ST. Twenty three patients received cisplatin 100 mg/m2 and ST. There were no statistically differences in age, body mass index BMI, American society of anaesthesia score, estimated blood loss or peritoneal cancer index between the cohorts (p > 0.05). The only episode of acute kidney injury (AKI) was within the HIPEC cohort, after cisplatin 50 mg/m2 (without ST) and this was sustained at three months. In contrast, no patients within the CRS cohort or cisplatin 100 mg/m2 that received the addition of ST, sustained a renal injury and all had a creatinine within the normal range at three days post operatively. Conclusion: The renal toxicity associated with cisplatin HIPEC and major abdominal surgery can be minimised with careful preoperative optimisation, intra operative fluid management and attention to renal function. The addition of sodium thiosulphate is a safe and effective method to minimise toxicity and should be added to any cisplatin HIPEC protocol.
    • Alexia without Agraphia

      E Mulroy, E; Murphy, S; Lynch, T (Irish Medical Journal, 2011-04)
    • Anatomy and bronchoscopy of the porcine lung. A model for translational respiratory medicine.

      Judge, Eoin P; Hughes, J M Lynne; Egan, Jim J; Maguire, Michael; Molloy, Emer L; O'Dea, Shirley; 1 Irish National Lung and Heart Transplant Program, Mater Misericordiae University Hospital, Dublin, Ireland. (2014-09)
      The porcine model has contributed significantly to biomedical research over many decades. The similar size and anatomy of pig and human organs make this model particularly beneficial for translational research in areas such as medical device development, therapeutics and xenotransplantation. In recent years, a major limitation with the porcine model was overcome with the successful generation of gene-targeted pigs and the publication of the pig genome. As a result, the role of this model is likely to become even more important. For the respiratory medicine field, the similarities between pig and human lungs give the porcine model particular potential for advancing translational medicine. An increasing number of lung conditions are being studied and modeled in the pig. Genetically modified porcine models of cystic fibrosis have been generated that, unlike mouse models, develop lung disease similar to human cystic fibrosis. However, the scientific literature relating specifically to porcine lung anatomy and airway histology is limited and is largely restricted to veterinary literature and textbooks. Furthermore, methods for in vivo lung procedures in the pig are rarely described. The aims of this review are to collate the disparate literature on porcine lung anatomy, histology, and microbiology; to provide a comparison with the human lung; and to describe appropriate bronchoscopy procedures for the pig lungs to aid clinical researchers working in the area of translational respiratory medicine using the porcine model.
    • Anticipate study protocol: Baseline profile and care outcomes of patients attending Mater Misericordiae University Hospital with COVID-19 infection.

      Avramovic, Gordana; McHugh, Tina; Connolly, Stephen P; Cullen, Walter; Lambert, John S (2021-01-18)
      Background: While the COVID-19 pandemic is currently impacting on health and social care in Ireland, this impact is most marked in metropolitan Dublin. This is especially the case for the Mater Misericordiae University Hospital (MMUH) in Dublin's North Inner, which is situated in an area where local socially deprived communities are at high risk of infection and of experiencing adverse outcomes. Aims: To determine baseline characteristics and longer-term care outcomes of COVID-19 patients presenting to / attending the Infectious Diseases Department at MMUH, including the virtual clinic. Methods: Retrospective study: we will retrospectively examine clinical records and extract anonymised data on patient demographics, baseline morbidity and outcomes. Prospective study: we will prospectively examine healthcare outcomes among patients who consent to follow up at two time points (three months, and six months to 12 months after discharge/onset of disease). Two patient groups will be assessed for morbid complications: those hospitalised with COVID infection and those followed-up remotely with confirmed COVID infection. Deliverables: The project will involve collaboration with Ireland's Health Service Executive (HSE) Clinical Programmes and Ireland East Hospital Group to inform health service policies that will attenuate the adverse impacts of the COVID pandemic on population health. This research protocol will evaluate morbid complications of COVID depending on the severity of the disease.
    • Application of the critical incident technique in refining a realist initial programme theory.

      Cunningham, U; De Brún, A; McAuliffe, E (2020-05-26)
      Background: As realist methodology is still evolving, there is a paucity of guidance on how to conduct theory driven interviews. Realist researchers can therefore struggle to collect interview data that can make a meaningful contribution to refining their initial programme theory. Collecting data to inform realist Inital Programme Theories (IPTs) in healthcare contexts is further compounded due to the healthcare workers' busy work schedules. In this case study of team interventions in acute hospital contexts, we explore the benefits of using the Critical Incident Technique (CIT) in order to build and refine an initial programme theory. We contend that use of the CIT helps to draw on more specific experiences of "Key Informants" and therefore elicits richer and more relevant data for realist enquiry. Methods: The five steps of the CIT were mapped against realist methods guidance and adapted into an interview framework. Specifications to identify an incident as "critical" were agreed. Probes were embedded in the interview framework to confirm, refine and/or refute previous theories. Seventeen participants were interviewed and recordings were transcribed and imported for analysis into NVivo software. Using RAMESES guidelines, Context-Mechanism-Outcomes configurations were extrapolated from a total of 31 incidents. Results: We found that the CIT facilitated construction of an interview format that allowed participants to reflect on specific experiences of interest. We demonstrate how the CIT strengthened initial programme theory development as it facilitated the reporting of the specifics of team interventions and the contexts and mechanisms characteristic of those experiences. As new data emerged, it was possible to evolve previous theories synthesised from the literature as well as to explore new theories. Conclusions: Utilising a CIT framework paid dividends in terms of the relevance and usefulness of the data for refining the initial programme theory. Adapting the CIT questioning technique helped to focus the participants on the specifics relating to an incident allowing the interviewers to concentrate on probes to explore theories during the interview process. The CIT interview format therefore achieved its purpose and can be adapted for use within realist methodology.
    • Aspergilloma

      Murphy, D; Murray, J; Gaine, S (Irish Medical Journal, 2013-09)
      A 71 year-old man presented for pre-operative assessment prior to a radical neck dissection for squamous cell carcinoma of the tongue. He was an ex-smoker, with known pulmonary fibrosis and bronchiectasis of undetermined aetiology. He denied any respiratory symptoms with no shortness of breath, cough or wheeze. Respiratory examination was notable only for bibasal crackles. Blood work was normal. His mantoux skin test was negative. Imaging evaluation was initially with a chest radiograph, followed by a CT scan of the chest. Both of these examinations are shown in figures 1 and 2 respectively.
    • Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: the North Dublin Population Stroke Study.

      Ní Chróinín, Danielle; Callaly, Elizabeth L; Duggan, Joseph; Merwick, Áine; Hannon, Niamh; Sheehan, Órla; Marnane, Michael; Horgan, Gillian; Williams, Emma B; Harris, Dawn; et al. (2011-04)
      Statins improve infarct volume and neurological outcome in animal stroke models. We investigated the relationship between statin therapy and ischemic stroke outcome in the North Dublin Population Stroke Study.
    • Atypical stress-avulsion fracture of the Lisfranc joint complex.

      O'Neill, Barry J; Sweeney, Laura A; Moroney, Paul J; Mulhall, Kevin J; Department of Trauma and Orthopaedics, Mater Misericordiae University Hospital, Ireland. (2014-04)
      Antiphospholipid syndrome and systemic erythematosus have been associated with metatarsal stress fractures. Stress fractures of the Lisfranc joint complex are uncommon injuries but have been reported to occur most frequently in ballet dancers. We present a case of an avulsion fracture of the Lisfranc joint complex that occurred spontaneously. We have reviewed the association between systemic conditions and metatarsal fractures and proposed a series of hypothetical pathological events that may have contributed to this unusual injury.
    • Bacteraemia in the ED: Are We Meeting Targets?

      Borhan, N; Borhan, F; Ni Cheallaigh, C; Dinesh, B; O’Reilly, K; Moughty, A (Irish Medical Journal, 2018-03)
      When sepsis is identified early in the Emergency Department (ED) and its severe form is treated aggressively with the protocolised care bundle of early goal directed therapy (EGDT), improvements in mortality are significant1,2. Surviving sepsis guidelines recommend the administration of effective intravenous antimicrobials within the first hour of recognition of septic shock and severe sepsis without septic shock3. The Mater University Hospital has antimicrobial guidelines to guide empiric prescribing in adult sepsis available on the hospital intranet and on a smartphone app.
    • Barriers to and facilitators of HIV serostatus disclosure to sexual partners among postpartum women living with HIV in South Africa.

      Adeniyi, Oladele Vincent; Nwogwugwu, Charlotte; Ajayi, Anthony Idowu; Lambert, John (2021-05-13)
      Background: Disclosure of HIV serostatus to a sexual partner can facilitate partner's support and testing and better treatment outcomes. Studies examining changes in disclosure rates of serostatus from delivery and postpartum periods are scarce. Our study fills this gap by using a follow-up survey of postpartum women with HIV to examine if disclosure prevalence has improved compared to the proportion recorded at childbirth. We further assessed the reasons for non-disclosure and correlates of serostatus disclosure to sexual partners. Methods: We conducted a cross-sectional analytical study (exit interview) with a final sample of 485 postpartum women with HIV drawn from the East London Prospective Cohort study database between January and May 2018. Disclosure of HIV status to partner was based on self-reporting. We fitted adjusted and unadjusted logistic regression models and also conducted descriptive statistical analyses. Sampling weights were used to correct for sampling errors. Results: Overall, 81.8% of women in the study cohort had disclosed their status to their partners, representing a 7.4 percentage point increase since child delivery. After adjusting for important covariates, women were more likely to disclose their status if they were married [adjusted odds ratio (AOR): 3.10; 95% confidence interval (CI):1.39-6.91] but were less likely to disclose if they used alcohol [AOR: 0.61; 95% CI:0.37-0.99] or had reported adherence to ART [AOR: 0.59; 95% CI:0.36-0.96]. Fear of rejection, stigma or being judged, new or casual relationships, and having a violent partner were the main reasons for not disclosing HIV status to sexual partners. Conclusion: We found a relatively higher rate of HIV status disclosure in the cohort compared to the rate recorded at childbirth, suggesting an improvement over time. Also, complicated relationship dynamics and fear of social exclusion still constitute barriers to HIV status disclosure to sexual partners despite patients' counselling.
    • Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort.

      Fernández Hidalgo, Núria; Gharamti, Amal A; Aznar, María Luisa; Almirante, Benito; Yasmin, Mohamad; Fortes, Claudio Querido; Plesiat, Patrick; Doco-Lecompte, Thanh; Rizk, Hussein; Wray, Dannah; et al. (2020-04-10)
      Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009).
    • Bi-allelic JAM2 Variants Lead to Early-Onset Recessive Primary Familial Brain Calcification.

      Schottlaender, Lucia V; Abeti, Rosella; Jaunmuktane, Zane; Macmillan, Carol; Chelban, Viorica; O'Callaghan, Benjamin; McKinley, John; Maroofian, Reza; Efthymiou, Stephanie; Athanasiou-Fragkouli, Alkyoni; et al. (2020-03-05)
      Primary familial brain calcification (PFBC) is a rare neurodegenerative disorder characterized by a combination of neurological, psychiatric, and cognitive decline associated with calcium deposition on brain imaging. To date, mutations in five genes have been linked to PFBC. However, more than 50% of individuals affected by PFBC have no molecular diagnosis. We report four unrelated families presenting with initial learning difficulties and seizures and later psychiatric symptoms, cerebellar ataxia, extrapyramidal signs, and extensive calcifications on brain imaging. Through a combination of homozygosity mapping and exome sequencing, we mapped this phenotype to chromosome 21q21.3 and identified bi-allelic variants in JAM2. JAM2 encodes for the junctional-adhesion-molecule-2, a key tight-junction protein in blood-brain-barrier permeability. We show that JAM2 variants lead to reduction of JAM2 mRNA expression and absence of JAM2 protein in patient's fibroblasts, consistent with a loss-of-function mechanism. We show that the human phenotype is replicated in the jam2 complete knockout mouse (jam2 KO). Furthermore, neuropathology of jam2 KO mouse showed prominent vacuolation in the cerebral cortex, thalamus, and cerebellum and particularly widespread vacuolation in the midbrain with reactive astrogliosis and neuronal density reduction. The regions of the human brain affected on neuroimaging are similar to the affected brain areas in the myorg PFBC null mouse. Along with JAM3 and OCLN, JAM2 is the third tight-junction gene in which bi-allelic variants are associated with brain calcification, suggesting that defective cell-to-cell adhesion and dysfunction of the movement of solutes through the paracellular spaces in the neurovascular unit is a key mechanism in CNS calcification.
    • 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.
    • A Borderline Ovarian Tumour in a Patient with Classic Bladder Exstrophy; a Case Report.

      Beauchamp, K; Ryan, G; Gibney, B; Walsh, T; Brennan, D (Irish Medical Journal, 2018-02)
      A 37-year-old Romanian lady presented with a large pelvic mass, urosepsis and deteriorating renal function. She had undergone separation from her conjoined twin. Imaging revealed grossly abnormal anatomy and a suspicious pelvic mass. Examination was consistent with classic bladder exstrophy. Postoperative histology showed borderline ovarian tumour (BTO)
    • Breast cancer genomics: challenges in interpretation and application.

      Kelly, Cathy M; Symmans, W Fraser; Andreopoulou, Eleni; Bianchini, Giampaolo; Mater Misericordiae University Hospital, Dublin, Ireland; (2013)