• Early diagnosis of bilateral sub-deltoid bursitis using clinic-based ultrasonography in a patient receiving infliximab therapy for ulcerative pouchitis.

      Veerappan, S G; Moinuddin, G; Kennedy, M; O'Morain, C A; Kane, D; Department of Gastroenterology, Adelaide & Meath Hospital, Tallaght, Dublin 24, Republic of Ireland. sveerappan@rcsi.ie (2010-12)
      Infliximab, a monoclonal chimeric antibody to tumour necrosis factor (TNF)α, is a novel therapy used in the management of chronic refractory pouchitis that is unresponsive to conventional medical therapy.
    • Early life adversity is associated with brain changes in subjects at family risk for depression.

      Carballedo, Angela; Lisiecka, Danutia; Fagan, Andrew; Saleh, Karim; Ferguson, Yolande; Connolly, Gerard; Meaney, James; Frodl, Thomas; Department of Psychiatry, Institute of Neuroscience, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), St. James's Hospital and Centre of Advanced Medical Imaging (CAMI), University Dublin, Trinity College, Ireland. (2012-12)
      The interplay of genetic and early environmental factors is recognized as an important factor in the aetiology of major depressive disorder (MDD). The aim of the present study was to examine whether reduced volume of hippocampus and frontal brain regions involved in emotional regulation are already present in unaffected healthy individuals at genetic risk of suffering MDD and to investigate whether early life adversity is a relevant factor interacting with these reduced brain structures.
    • Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis

      Little, M. A.; Nightingale, P.; Verburgh, C. A.; Hauser, T.; De Groot, K.; Savage, C.; Jayne, D.; Harper, L. (Annals of the Rheumatic Diseases, 2010-06)
    • Early rise in C-reactive protein is a marker for infective complications in laparoscopic colorectal surgery.

      Nason, Gregory J; Barry, Brian D; Obinwa, Obinna; McMacken, Eamon; Rajaretnam, Nigel S; Neary, Paul C (2014-02)
      Infective complications are the most significant cause of morbidity associated with elective colorectal surgery. It can sometimes be difficult to differentiate complications from the normal postoperative course. C-reactive protein (CRP) is an acute phase reactant which has been reported to be predictive of postoperative infective complications.
    • Effect of childhood maltreatment on brain structure in adult patients with major depressive disorder and healthy participants.

      Chaney, Aisling; Carballedo, Angela; Amico, Francesco; Fagan, Andrew; Skokauskas, Norbert; Meaney, James; Frodl, Thomas; Department of Psychiatry, Institute of Neuroscience, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Dublin 24, University Dublin, Trinity College, Dublin, Dublin, Ireland. (2013-07-30)
      Background: Childhood maltreatment has been found to play a crucial role in the development of psychiatric disorders. However, whether childhood maltreatment is associated with structural brain changes described for major depressive disorder (MDD) is still a matter of debate. The aim of this study was to investigate whether patients with MDD and a history of childhood maltreatment display more structural changes than patients without childhood maltreatment or healthy controls. Methods: Patients with MDD and healthy controls with and without childhood maltreatment experience were investigated using high-resolution magnetic resonance imaging (MRI), and data were analyzed using voxel-based morphometry. Results: We studied 37 patients with MDD and 46 controls. Grey matter volume was significantly decreased in the hippocampus and significantly increased in the dorsomedial prefrontal cortex (DMPFC) and the orbitofrontal cortex (OFC) in participants who had experienced childhood maltreatment compared with those who had not. Patients displayed smaller left OFC and left DMPFC volumes than controls. No significant difference in hippocampal volume was evident between patients with MDD and healthy controls. In regression analyses, despite effects from depression, age and sex on the DMPFC, OFC and hippocampus, childhood maltreatment was found to independently affect these regions. Limitations: The retrospective assessment of childhood maltreatment; the natural problem that patients experienced more childhood maltreatment than controls; and the restrictions, owing to sample size, to investigating higher order interactions among factors are discussed as limitations. Conclusion: These results suggest that early childhood maltreatment is associated with brain structural changes irrespective of sex, age and a history of depression. Thus, the study highlights the importance of childhood maltreatment when investigating brain structures.
    • Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke.

      Appleton, Jason P; Woodhouse, Lisa J; Bereczki, Daniel; Berge, Eivind; Christensen, Hanne K; Collins, Rónán; Gommans, John; Ntaios, George; Ozturk, Serefnur; Szatmari, Szabolcs; et al.
      Background and Purpose- Increased blood pressure (BP), heart rate, and their derivatives (variability, pulse pressure, rate-pressure product) are associated with poor clinical outcome in acute stroke. We assessed the effects of glyceryl trinitrate (GTN) on hemodynamic parameters and these on outcome in participants in the ENOS trial (Efficacy of Nitric Oxide in Stroke). Methods- Four thousand and eleven patients with acute stroke and raised BP were randomized within 48 hours of onset to transdermal GTN or no GTN for 7 days. Peripheral hemodynamics were measured at baseline (3 measures) and daily (2 measures) during treatment. Between-visit BP variability over days 1 to 7 (as SD) was assessed in quintiles. Functional outcome was assessed as modified Rankin Scale and cognition as telephone mini-mental state examination at day 90. Analyses were adjusted for baseline prognostic variables. Data are mean difference or odds ratios with 95% CI. Results- Increased baseline BP (diastolic, variability), heart rate, and rate-pressure product were each associated with unfavorable functional outcome at day 90. Increased between-visit systolic BP variability was associated with an unfavourable shift in modified Rankin Scale (highest quintile adjusted odds ratio, 1.65; 95% CI, 1.37-1.99), worse cognitive scores (telephone mini-mental state examination: highest quintile adjusted mean difference, -2.03; 95% CI, -2.84 to -1.22), and increased odds of death at day 90 (highest quintile adjusted odds ratio, 1.57; 95% CI, 1.12-2.19). GTN lowered BP and rate-pressure product and increased heart rate at day 1 and reduced between-visit systolic BP variability. Conclusions- Increased between-visit BP variability was associated with poor functional and cognitive outcomes and increased death 90 days after acute stroke. In addition to lowering BP and rate-pressure product, GTN reduced between-visit systolic BP variability. Agents that lower BP variability in acute stroke require further study.
    • The effect of growth hormone (GH) replacement on muscle strength in patients with GH-deficiency: a meta-analysis.

      Widdowson, W Matthew; Gibney, James; Department of Endocrinology and Diabetes, Adelaide and Meath Hospital, Tallaght, , Dublin, Ireland. (2012-02-01)
      CONTEXT/OBJECTIVES: GH replacement increases muscle mass and reduces body fat in growth hormone deficiency (GHD) adults. A recent meta-analysis has demonstrated that this improvement in body composition is associated with improved exercise performance. The current meta-analysis was carried out to determine whether high-quality evidence exists to support a beneficial effect of GH replacement on strength. DESIGN/METHODS: An extensive Medline search/literature review identified eight studies with utilizable, robust data, involving 231 patients in nine cohorts. Previously unpublished data were sought from authors and obtained in two cases. All studies included were randomized, double-blind, placebo-controlled, of parallel or cross-over design and of an average 6.7 months duration. Information was retrieved in uniform format, with data pertaining to patient numbers, study-design, GH-dose, mean age, IGF-I levels and muscle strength measurements (isometric or isokinetic quadriceps strength) recorded. Data were analysed using a fixed-effects model, utilizing continuous data measured on different scales. A summary effect measure (d(s)) was derived for individual strength variables, whereas an overall summary effect was derived from the sum of all studies incorporating different variables; 95% CIs were calculated from the weighted variances of individual study effects. RESULTS: Analysis revealed no significant improvement, neither when all studies were combined (d(s) = +0.01 +/- 0.26) nor when measured individually (isometric quadriceps strength, d(s) = +0.02 +/- 0.32 and isokinetic quadriceps strength, d(s) = 0.00 +/- 0.45). CONCLUSIONS: Evidence from short-term controlled studies fails to support a benefit on muscle strength of GH replacement in GHD patients, which is likely to occur over a longer time-course, as seen in open-label studies.
    • Effect of sedentary behaviour and vigorous physical activity on segment-specific carotid wall thickness and its progression in a healthy population.

      Kozàkovà, Michaela; Palombo, Carlo; Morizzo, Carmela; Nolan, John J; Konrad, Thomas; Balkau, Beverley; Department of Internal Medicine, University of Pisa, Via Roma, 67, Pisa 56122, Italy. m.kozakova@in.med.unipi.it (European heart journal, 2010-06)
      This study investigated whether sedentary behaviour and different activity levels have an independent association with carotid intima-media thickness (IMT) and with the 3-year IMT progression in different carotid segments.
    • Effects of 18 months of L-T4 replacement in women with subclinical hypothyroidism.

      Adrees, M; Gibney, J; El-Saeity, N; Boran, G; Department of Clinical Chemistry, Adelaide and Meath Hospital incorporating the, National Children's Hospital, Dublin 24, Ireland. (2012-02-01)
      CONTEXT: Some of the cardiovascular and renal abnormalities seen in overt hypothyroidism have also been reported in subclinical hypothyroidism (SCH). Short-term L-T4 replacement in SCH improves cardiovascular risk markers and reduces carotid intima-media thickness (CIMT), a surrogate marker of atherosclerosis. The haemodynamic and renal effects of L-T4 replacement in SCH are poorly understood. OBJECTIVES: To compare cardiovascular risk factors and renal variables in women with SCH and normal women. To study the effects of L-T4 replacement in SCH subjects on these variables and on structural and functional changes in common carotid and brachial arteries. DESIGN: Fifty-six women with SCH before and after L-T4 replacement for 18 months and 56 normal women of similar age distribution were studied. Blood Pressure (BP), plasma lipids and homocysteine were measured and renal function evaluated [estimation of glomerular filtration rate (eGFR) using standard equations and measurement of serum Cystatin-C] in women with SCH before and after 18 months of l-T4, and in healthy women. CIMT and endothelial function (using brachial artery ultrasound) were studied before and after L-T4 in a subgroup of women with SCH. RESULTS: Systolic and diastolic BP, total cholesterol, triglyceride, LDL-cholesterol, lipoprotein(a) and homocysteine were greater in SCH (P < 0.05), and following L-T4 replacement decreased (P < 0.05) to levels that no longer differed from normal subjects. Estimated GFR was reduced and serum Cystatin-C increased (P < 0.05) in SCH. These variables also normalized following L-T4. Following L-T4 replacement the carotid artery baseline diameter increased by 7.1% and CIMT decreased by a mean value of 13%, while brachial artery diameter increased basally by 12.5% and following endothelium-dependent vasodilatation by 17.5% (P < 0.05). However, the increment following reactive hyperaemia did not differ before or following L-T4 replacement. CONCLUSION: Normalization of cardiovascular risk factors following L-T4 replacement in SCH potentially explains reduced CIMT. Increased carotid and brachial artery diameters and normalized eGFR indicates a haemodynamic effect of L-T4 replacement, the importance of which requires further investigation.
    • The effects of phototherapy on the numbers of circulating natural killer cells and T lymphocytes in psoriasis.

      Tobin, A M; Maguire, B; Enright, H; Kirby, B; Department of Dermatology, ASdelaide and Meath Hospital, Dublin, Ireland. (Photodermatology, photoimmunology & photomedicine, 2009-04)
      The innate immune system is believed to be important in the pathogenesis of psoriasis and natural killer (NK) have been found in increased numbers in psoriatic plaques. Alterations in the numbers of NK cells in peripheral blood have been reported. We investigated the effect of phototherapy on levels of peripheral NK cells and lymphocytes in patients with psoriasis. In nine patients whom we followed before, during and after narrowband ultraviolet B (UVB) treatment there were no differences in the numbers of circulating lymphocytes, lymphocyte subsets or cells expressing NK markers and controls. Treatment with narrowband UVB did, however, significantly lower circulating CD4 counts which gradually recovered posttreatment.
    • Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis.

      Atchia, Ismaël; Kane, David; Reed, Mike R; Isaacs, John D; Birrell, Fraser; Northumbria Healthcare NHS Foundation Trust, Ashington, Northumberland, UK. ish@doctors.org.uk (Annals of the rheumatic diseases, 2011-01)
      Intra-articular injection is effective for osteoarthritis, but the best single injection strategy is not known, nor are there established predictors of response. The objectives of this study were to assess and predict response to a single ultrasound-guided injection in moderate to severe hip osteoarthritis.
    • The Efficacy of Bronchial Thermoplasty for Severe Persistent Asthma– the First National Experience

      Watchorn, DC; Egan, JJ; Lane, SJ (Irish Medical Journal, 2016-05)
      There is an unmet need for new therapies in severe persistent asthma. Bronchial thermoplasty is a bronchoscopic procedure which employs radiofrequency energy to reduce airway smooth muscle and has been demonstrated to improve symptomatic control in severe persistent asthma in other populations. Seven patients have completed bronchial thermoplasty at a tertiary referral centre in Ireland. Asthma Control Test scores and data on hospitalisations, exacerbations, maintenance corticosteroid requirements, rescue bronchodilator use and peak expiratory flow rate (PEFR) were compared one year before and one year post treatment. Significant improvements were demonstrated in mean Asthma Control Test scores, from 8.9 to 14.7 (p = 0.036). Trends towards improvement were seen in mean hospitalisations (respective values for total in 12 month period 5.0, 0.9; p = 0.059) and PEFR (181.4 l/min, 280 l/min respectively; p = 0.059). These data support the use of bronchial thermoplasty in severe persistent asthma in the Irish population.
    • The Efficacy of COPD Outreach in Reducing Length of Stay and Improving Quality of Life

      Sahadevan, A; Baily, C; Cullen, L; Kooblall, M; Watchorn, DC; Lane, SJ; Moloney, E (Irish Medical Journal, 2015-06)
      COPD exacerbations results in prolonged hospitalisation, re-admissions, reduces health-related quality of life (HRQoL) and increases mortality. The study aimed to assess the efficacy of a COPD Outreach service in reducing average length of stay (ALOS), reducing re-admissions within 90 days of admission, improving HRQoL and reducing mortality among COPD patients with acute exacerbations (AECOPD). AECOPD data for a 2 year period commencing September 2011 was analysed. The COPD Assessment test (CAT) quantified HRQoL at enrolment and 6 weeks post Outreach. COPD Outreach had an ALOS of 2.47 days compared to ALOS 8.59 days and 8.5 days for all AECOPD before and during an operational COPD Outreach. Re-admission rates among patients enrolled in COPD Outreach were 36.3%. CAT improved from mean 19.3 to 13.5. Mortality was 4.9% among Outreach patients and 2.5% for overall AECOPD in 2012-2013. COPD Outreach reduced ALOS and improved HRQoL for selected patients with AECOPD. It did not reduce re-admissions or mortality.
    • Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy.

      Bahari, Syah; El-Dahab, Mohamed; Cleary, May; Sparkes, Joseph; Department of Trauma and Reconstructive Surgery, Adelaide and Meath Hospital, incorporating the National Children Hospital, Tallaght, Dublin 24, Republic of, Ireland. syahbahari@gmail.com (2012-02-01)
      The study is a prospective blinded randomised controlled trial to compare the efficacy of triamcinolone acetonide, bupivacaine or in combination in managing pain after lumbar discectomy. Patients undergoing primary single-level lumbar discectomy were randomised. Triamcinolone acetonide, bupivacaine or in combination was instilled at the nerve root as decompression. Preoperative, day 1 and 6 weeks pain score, 24-h postoperative opiate requirements and duration of inpatient stay were recorded. Data was analysed using Mann-Whitney test for statistical significance. 100 patients were recruited. A significant difference was noted in day one postoperative mean pain score, mean 24-h opiate requirement and mean inpatient stay in the triamcinolone acetonide and bupivacaine group. At 8 weeks postoperatively, no significant differences were seen in the pain score in all groups. Significant postoperative pain reduction and opiate requirements in the first 24 h, and significantly shortened duration of inpatient stay were achieved in the triamcinolone acetonide and bupivacaine group compared with other groups.
    • Efficiency of computerized discharge letters

      Keane, B; O’Neill, D; Coughlan, T; Collins, R (Irish Medical Journal, 2014-07)
    • Electroejaculatory stimulation and its implications for male infertility in spinal cord injury: a short history through four decades of sperm retrieval (1975-2010).

      O'Kelly, Fardod; Manecksha, Rustom P; Cullen, Ivor M; McDermott, Ted E; Flynn, Robert; Grainger, Ronald; Department of Urology, Adelaide and Meath Hospitals, National Children's Hospital, Dublin, Ireland. fokelly@rcsi.ie (2011-06)
    • Electroejaculatory stimulation for male infertility secondary to spinal cord injury: the Irish experience in National Rehabilitation Hospital.

      McGuire, Ciara; Manecksha, Rustom P; Sheils, Pauline; McDermott, Thomas E D; Grainger, Ronald; Flynn, Robert; Department of Urology, Adelaide and Meath Hospital, Tallaght, Ireland. (2012-02-01)
      OBJECTIVES: To examine the success rate of electroejaculatory stimulation in patients with acquired spinal injuries in a single Irish institution. The use of electroejaculatory stimulation is of benefit in patients with spinal cord injury who wish to have children. METHODS: A retrospective review of the Hospital In-Patient Enquiry scheme database and the patients' medical notes was performed. Any patient who had undergone electroejaculatory stimulation in the past 14 years was included. The quality of semen obtained and the pregnancy rate were assessed in relation to several variables, including patient age and level of spinal injury. RESULTS: From 1994 to 2008, 31 patients (29 patients with acquired spinal injury and 2 patients with a congenital spinal abnormality) had undergone electroejaculatory stimulation as a method of providing semen for assisted conception. Of the 31 patients, 6 had requested cryopreservation of their semen for future use and were therefore excluded from the pregnancy rate analysis. Of the 25 patients who had used the semen, 9 (36%) were successful in achieving pregnancy that resulted in living offspring. The semen analysis results were available for 15 patients. Three patients (one each with contaminated semen, poor semen quality, and an abandoned procedure) required testicular biopsy to extract viable sperm and subsequently achieved pregnancy. Lower spinal lesions (below T10) were associated with lower rates of pregnancy after electroejaculatory stimulation. One patient developed autonomic dysreflexia during the procedure, which was therefore abandoned. CONCLUSIONS: Electroejaculatory stimulation is an effective method of obtaining semen for reproductive purposes and is an option for fertility preservation in patients with spinal cord injury-related anejaculation.
    • Elevated active secretory sphingomyelinase in antineutrophil cytoplasmic antibody-associated primary systemic vasculitis.

      Kiprianos, Allan P; Morgan, Matthew D; Little, Mark A; Harper, Lorraine; Bacon, Paul A; Young, Stephen P (2012-06)
    • Elevated resting heart rate is an independent risk factor for cardiovascular disease in healthy men and women.

      Cooney, Marie Therese; Vartiainen, Erkki; Laatikainen, Tiina; Juolevi, Anne; Dudina, Alexandra; Graham, Ian M; Department of Cardiology, Adelaide Meath Hospital, Tallaght, Dublin 24, Ireland. (American heart journal, 2010-04)
      Elevated resting heart rate (RHR) is known to be associated with reduced survival but inconsistencies remain, including lack of significance in most studies of healthy women, lack of independence from systolic blood pressure (SBP) in some, and the suggestion that RHR is merely functioning as a marker of physical inactivity or other comorbidities. We aimed to clarify these inconsistencies.