Research by staff affiliated to Tallaght University Hospital (formerly Adelaide Meath Hospital, Tallaght)

Recent Submissions

  • Periorbital and Orbital Cellulitis (Adults and Paediatrics) [v2.0]

    Yong, Ken Au; Harris, Karen (Irish Association for Emergency Medicine, 2022-04)
  • Acute Carbon Monoxide Poisoning [V1.0]

    Moore, Tom; Irish Association for Emergency Medicine (IAEM) (Irish Association for Emergency Medicine, 2023-06)
  • Management of Patients with Severe Pre-eclampsia and Eclampsia [v1.0]

    Ngaditono, Andrew; Smyth, Suzanne; O'Neill, Aoife; McCabe, Aileen (Tallaght University Hospital, 2023-11)
  • Emergency Department Management of Suspected or Confirmed SARS-CoV-2 (COVID- 19) [v1.0]

    McCabe, Aileen; Hassan, Termizi; Harris, Karen; Irish Assoication for Emergency Medicine (Tallaght University Hospital, 2020-03)
  • Guideline for the Assessment and Management of Patients with Suspected or Confirmed Eating Disorders in the Emergency Department [v1.0]

    McCabe, Aileen; Raji, Omotayo; Boyle, Pauline; Feehan, Sinead; Deery, Sarah; McGarvey, Aine; Naddy, Breda; McKay, Paula; Clifford, Michelle; Irish Assoication for Emergency Medicine (Tallaght University Hospital, 2023-10)
  • Management of Thermal, Chemical and Electrical Burns in the Emergency Department [V1.0]

    Davis, Jamie; Pierce, Denise; Doolan, Aoife; Shelley, Odhran; O'Donoghue, Patricia; McCabe, Aileen; Irish Assoication for Emergency Medicine (Tallaght University Hospital, 2023-08)
  • Acute Thoracic Aortic Dissection Emergency Medicine Guideline [v1.0]

    McCabe, Aileen; Gray, James; Moore, David; Irish Assoication for Emergency Medicine (Tallaght University Hospital, 2019-02)
  • Management of Patients with Acute Epididymo- orchitis in the Emergency Department [v1.0]

    Cooper, Paul; Flynn, Robert; Prior, Anna-Rose; McCabe, Aileen; Irish Assoication for Emergency Medicine (Tallaght University Hospital, 2021-04)
  • Hip Fracture and the Weekend Effect in an Irish Trauma Hospital.

    Downey, C; Flannery, S; Izydorczyk, A; Quinlan, J F (2019-06-17)
    Aims We examined the relationship between the 1-year mortality (OYM) rate and (i) those admitted at the weekend, (ii) those who underwent surgery at the weekend and (iii) those admitted during the NCHD changeover months (January & July) for the management of hip fracture in Tallaght University Hospital (TUH). Methods Admissions to TUH (2013 - 2016) with hip fracture (> 60 years old) were retrospectively examined. Data from the Irish Deaths and Events Registry was analysed to identify death events at 1 year. Logistic regression analysis was performed with respect to OYM with the three variables above. Results 646 hip fracture patients were admitted (2013 – 2016). 178 (27.5%) were weekend admissions, 183 (28.4%) underwent weekend surgery and 93 patients (14.4%) were admitted during NCHD changeover months. There was no significant relationship between OYM and (i) weekend admission, (ii) weekend surgery or (iii) changeover admission in TUH. Conclusion This study offers the first examination of the weekend effect on fragility hip fractures and mortality in Irish patients and reports no significant weekend effect regarding 1-year mortality in this hip fracture cohort.
  • Gender specific considerations in septorhinoplasty, a retrospective observational study and review of the literature.

    Gillanders, S L; Walsh, M; Anderson, S; Abdulrahman, S (2022-05-18)
    Introduction: In our service experience, we found we had a high proportion of male patients undergoing septorhinoplasty. This encouraged us to research gender specific differences in anatomy, surgical techniques, expectations and outcomes. Methods: We performed a retrospective chart review of patients who have had rhinoplasty surgery under a single otolaryngology consultant with a special interest in rhinoplasty. Patient information and results of the 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey for Functional and Cosmetic Rhinoplasty pre and post-surgery were collected. Results: There was no statistically significant difference in the mean pre-operative symptom (29.31 vs 32.29 p = 0.559), change in symptom (23.25 vs 24.14 p = 0.827) or satisfaction scores (8.69 vs 7.29 p = 0.089) between male and female patients. A discussion on gender specific anatomical features and deformities is presented. Conclusion: All patients reported improved symptoms and high levels of satisfaction. Careful patient counselling and patient-specific surgical planning help to achieve optimal outcomes.
  • Outcome reporting bias in nephrology randomized clinical trials: Examining outcomes represented by graphical illustrations.

    Ward, Frank; Shiely, Frances (2022-05-25)
    Background Outcome reporting bias (ORB) is widely reported in the medical literature, but the contribution from published graphical illustrations is unknown. The aim of this study was to investigate the occurrence of ORB in contemporary nephrology clinical trials relating to the choice of outcomes reported through graphical illustrations. Methods An observational study was conducted using nephrology clinical trials searched from five high-impact medical journals from 2015 to 2020. Eligible trials reported a phase 2, 3 or 4 trial, contained at least one published outcome graphical illustration and were registered on a clinical trial registry. The primary outcome was the occurrence of ORB based on the choice of graphical illustrations in published trial manuscripts, deemed to be present if a graphical illustration displayed a secondary or unregistered outcome ahead of a trial's primary outcome, or if any unregistered trial outcome was presented as a graphical illustration. Results In 75 eligible clinical trials, the primary outcome for ORB was present in 60% of the trials (n = 45). Occurrence of the primary outcome did not differ significantly based on trial sample size, funding model, trial phase, individual medical journal or publication year. An unregistered trial outcome was graphically illustrated in 93% (n = 42) of those clinical trials with ORB present. Conclusion Outcome reporting bias based on the choice of graphical illustration is common, driven primarily by graphical illustration of unregistered trial outcomes. More appropriate choice of outcomes for graphical illustrations by authors, coupled with both increased enforcement of CONSORT guidelines by medical journals and specific guidelines for graphical illustrations choice, are desirable to address these findings.
  • IAEM Clinical Guideline: Management of patients with tension pneumothorax in the emergency department [v1.0]

    McCabe, Aileen; Gray, James; Moloney, Edward; Lane, Stephen; Irish Association for Emergency Medicine (IAEM) (Tallaght University Hospital, 2019-01)
    Undiagnosed tension pneumothorax is a readily treatable cause of cardiac arrest. Tension pneumothorax is a clinical diagnosis and should not require a chest X-ray to diagnose. This is a respiratory emergency and mandates prompt decompression. Air is drawn into the pleural space with each inspiration and there is no escape of air during expiration. Pressure builds up in the intrapleural space such that the mediastinum is pushed over into the contralateral hemithorax along with compression of the great veins. The patient will progress to obstructive shock and further deteriorate to a cardiorespiratory arrest (PEA arrest typically) if not emergently treated by needle thoracocentesis.
  • Maxillary Odontogenic Keratocyst.

    Walsh, Michael; Hussein, Mansoor A; Carter, Marguerite; Abdulrahman, Shawkat (2022-04-11)
    Case report: The Odontogenic Keratocyst (OKC) is one of the most aggressive odontogenic cysts. OKCs of the maxilla are particularly rare with less than 1% of cases reported in the literature. A 29-year-old female patient presented with pain and loose upper molars. Imaging confirmed an ectopic tooth at the osteomeatal complex and a maxillary OKC. These were endoscopically surgically removed and two teeth were encountered at the maxillary antrum. Histopathology confirmed the diagnosis of OKC of the maxilla. Surveillance with CT imaging and clinical assessment at 6 months shows no evidence of recurrence.
  • Outcomes in Antiplatelet-Associated Intracerebral Hemorrhage in the TICH-2 Randomized Controlled Trial.

    Law, Zhe Kang; Desborough, Michael; Roberts, Ian; Al-Shahi Salman, Rustam; England, Timothy J; Werring, David J; Robinson, Thompson; Krishnan, Kailash; Dineen, Robert; Laska, Ann Charlotte; et al. (2021-02-15)
    Abstract Background Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain. Methods and Results This is an exploratory analysis of the TICH‐2 (Tranexamic Acid in Intracerebral Hemorrhage‐2) double‐blind, randomized, placebo‐controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre‐ICH antiplatelet therapy, and 24‐hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre‐ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no‐antiplatelet group. Pre‐ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01–1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32–1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25–2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62–0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41–0.91) with no significant interaction between pre‐ICH antiplatelet therapy and tranexamic acid (P interaction=0.248). Conclusions Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional outcome. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use.
  • Contemporary Management of Isolated Ostial Side Branch Disease: An Evidence-based Approach to Medina 001 Bifurcations.

    Suleiman, Suleiman; Coughlan, J J; Touma, George; Szirt, Richard (2021-04-05)
    The optimal management of bifurcation lesions has received significant interest in recent years and remains a matter of debate among the interventional cardiology community. Bifurcation lesions are encountered in approximately 21% of percutaneous coronary intervention procedures and are associated with an increased risk of major adverse cardiac events. The Medina classification has been developed in an attempt to standardise the terminology when describing bifurcation lesions. The focus of this article is on the management of the Medina 0,0,1 lesion ('Medina 001'), an uncommon lesion encountered in <5% of all bifurcations. Technical considerations, management options and interventional techniques relating to the Medina 001 lesion are discussed. In addition, current published data supporting the various proposed interventional treatment strategies are examined in an attempt to delineate an evidence-based approach to this uncommon lesion.
  • Association of plasma mitochondrial DNA with COPD severity and progression in the SPIROMICS cohort.

    Zhang, William Z; Hoffman, Katherine L; Schiffer, Kristen T; Oromendia, Clara; Rice, Michelle C; Barjaktarevic, Igor; Peters, Stephen P; Putcha, Nirupama; Bowler, Russell P; Wells, J Michael; et al. (2021-04-26)
    Background: There is a lack of mechanism-driven, clinically relevant biomarkers in chronic obstructive pulmonary disease (COPD). Mitochondrial dysfunction, a proposed disease mechanism in COPD, is associated with the release of mitochondrial DNA (mtDNA), but plasma cell-free mtDNA has not been previously examined prospectively for associations with clinical COPD measures. Methods: P-mtDNA, defined as copy number of mitochondrially-encoded NADH dehydrogenase-1 (MT-ND1) gene, was measured by real-time quantitative PCR in 700 plasma samples from participants enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort. Associations between p-mtDNA and clinical disease parameters were examined, adjusting for age, sex, smoking status, and for informative loss to follow-up. Results: P-mtDNA levels were higher in participants with mild or moderate COPD, compared to smokers without airflow obstruction, and to participants with severe COPD. Baseline increased p-mtDNA levels were associated with better CAT scores in female smokers without airflow obstruction and female participants with mild or moderate COPD on 1-year follow-up, but worse 6MWD in females with severe COPD. Higher p-mtDNA levels were associated with better 6MWD in male participants with severe COPD. These associations were no longer significant after adjusting for informative loss to follow-up. Conclusion: In this study, p-mtDNA levels associated with baseline COPD status but not future changes in clinical COPD measures after accounting for informative loss to follow-up. To better characterize mitochondrial dysfunction as a potential COPD endotype, these results should be confirmed and validated in future studies.
  • Nutritional immunity: the impact of metals on lung immune cells and the airway microbiome during chronic respiratory disease.

    Healy, Claire; Munoz-Wolf, Natalia; Strydom, Janné; Faherty, Lynne; Williams, Niamh C; Kenny, Sarah; Donnelly, Seamas C; Cloonan, Suzanne M (2021-04-29)
    Nutritional immunity is the sequestration of bioavailable trace metals such as iron, zinc and copper by the host to limit pathogenicity by invading microorganisms. As one of the most conserved activities of the innate immune system, limiting the availability of free trace metals by cells of the immune system serves not only to conceal these vital nutrients from invading bacteria but also operates to tightly regulate host immune cell responses and function. In the setting of chronic lung disease, the regulation of trace metals by the host is often disrupted, leading to the altered availability of these nutrients to commensal and invading opportunistic pathogenic microbes. Similarly, alterations in the uptake, secretion, turnover and redox activity of these vitally important metals has significant repercussions for immune cell function including the response to and resolution of infection. This review will discuss the intricate role of nutritional immunity in host immune cells of the lung and how changes in this fundamental process as a result of chronic lung disease may alter the airway microbiome, disease progression and the response to infection.
  • Colon capsule endoscopy is a viable alternative to colonoscopy for the investigation of intermediate- and low-risk patients with gastrointestinal symptoms: results of a pilot study.

    Ismail, Mohd Syafiq; Semenov, Serhiy; Sihag, Sandeep; Manoharan, Thilagaraj; Douglas, Atiyekeogbebe Rita; Reill, Phyllis; Kelly, Michael; Boran, Gerard; O'connor, Anthony; Breslin, Niall; et al. (2021-05-27)
    Background and study aims  Colon capsule endoscopy (CCE) is a recommended viable alternative to colonoscopy for colonic visualisation in a variety of clinical settings with proven efficacy in polyp detection, surveillance, screening and Inflammatory Bowel Disease (IBD) assessment. CCE efficacy in an unselected average risk symptomatic cohort has yet to be established. The aim of this study was to determine the feasibility of CCE imaging assessment in average risk symptomatic patients as an alternative to colonoscopy with and without additional biomarker assessment. Patients and methods  This was a prospective, single-center comparison study of colonoscopy, CCE and biomarker assessment. Results  Of 77 invited subjects, 66 underwent both a CCE and colonoscopy. A fecal immunochemical test (FIT) and fecal calprotectin (FC) were available in 56 and 59 subjects. In all 64 % (n = 42) had any positive finding with 16 (24 %) found to have significant disease (high-risk adenomas, IBD) on colonoscopy. The CCE completion rate was 76 %, five (8 %) had an inadequate preparation, the CCE polyp detection rate was high at 35 %. The sensitivity, specificity, positive and negative predictive values of CCE for significant disease were 81 %, 98 %, 93 % and 94 % respectively. In addition, three (5 %) significant small bowel diagnoses were made on CCE. FC and FIT were frequently elevated in patients with both colitis (5/7, 71 %) and high-risk adenomas (4/7 57 %). While both had a low positive predictive value for clinically significant disease, FIT 32 % and FC 26 %. Conclusions  CCE is a safe and effective alternative to colonoscopy in symptomatic average risk patients with or without the addition of biomarker screening.
  • Altered inflammasome activation in neonatal encephalopathy persists in childhood.

    Kelly, L A; O'Dea, M I; Zareen, Z; Melo, A M; McKenna, E; Strickland, T; McEneaney, V; Donoghue, V; Boylan, G; Sweetman, D; et al. (2021-05-02)
    Neonatal encephalopathy (NE) is characterized by altered neurological function in term infants and inflammation plays an important pathophysiological role. Inflammatory cytokines interleukin (IL)-1β, IL-1ra and IL-18 are activated by the nucleotide-binding and oligomerization domain (NOD)-, leucine-rich repeat domain (LRR)- and NOD-like receptor protein 3 (NLRP3) inflammasome; furthermore, we aimed to examine the role of the inflammasome multiprotein complex involved in proinflammatory responses from the newborn period to childhood in NE. Cytokine concentrations were measured by multiplex enzyme-linked immunosorbent assay (ELISA) in neonates and children with NE in the absence or presence of lipopolysaccharide (LPS) endotoxin. We then investigated expression of the NLRP3 inflammasome genes, NLRP3, IL-1β and ASC by polymerase chain reaction (PCR). Serum samples from 40 NE patients at days 1 and 3 of the first week of life and in 37 patients at age 4-7 years were analysed. An increase in serum IL-1ra and IL-18 in neonates with NE on days 1 and 3 was observed compared to neonatal controls. IL-1ra in NE was decreased to normal levels at school age, whereas serum IL-18 in NE was even higher at school age compared to school age controls and NE in the first week of life. Percentage of LPS response was higher in newborns compared to school-age NE. NLRP3 and IL-1β gene expression were up-regulated in the presence of LPS in NE neonates and NLRP3 gene expression remained up-regulated at school age in NE patients compared to controls. Increased inflammasome activation in the first day of life in NE persists in childhood, and may increase the window for therapeutic intervention.
  • Can saline injection protect phrenic nerve? - A randomised controlled study.

    Srinivasan, Karthikeyan Kallidaikurchi; Ryan, John; Snyman, Lindi; O'Brien, Ciara; Shortt, Conor (2021-06-22)
    Significantly less patients in the saline group developed diaphragmatic paresis when compared to conventional group (44% vs. 94%, Chi-squared = 10.01, P = 0.002). There was no difference in post-operative pain, subjective sensation of dyspnoea or patient satisfaction between the groups.

View more