• 'I'm just short for my weight, doctor': body weight and risk.

      Graham, Ian; Dudina, Alexandra; Cooney, Marie-Therese (European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, 2011-10)
    • Identification of distinct phenotypes of locally advanced pancreatic adenocarcinoma.

      Teo, Minyuen; Crotty, Grace F; O'Súilleabháin, Criostóir; Ridgway, Paul F; Conlon, Kevin C; Power, Derek G; McDermott, Ray S; Department of Medical Oncology, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland. neuy924@gmail.com (2013-03)
      A significant number of pancreatic ductal adenocarcinoma present as locally advanced disease. Optimal treatment remains controversial. We sought to analyze the clinical course of locally advanced pancreatic adenocarcinoma (LAPC) in order to identify potential distinct clinical phenotypes.
    • Identification of NR4A2 as a transcriptional activator of IL-8 expression in human inflammatory arthritis.

      Aherne, Carol M; McMorrow, Jason; Kane, David; FitzGerald, Oliver; Mix, Kimberlee S; Murphy, Evelyn P; College of Life Sciences, UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland. (2009-10)
      Expression of the orphan nuclear receptor NR4A2 is controlled by pro-inflammatory mediators, suggesting that NR4A2 may contribute to pathological processes in the inflammatory lesion. This study identifies the chemoattractant protein, interleukin 8 (IL-8/CXCL8), as a molecular target of NR4A2 in human inflammatory arthritis and examines the mechanism through which NR4A2 modulates IL-8 expression. In TNF-alpha-activated human synoviocyte cells, enhanced expression of IL-8 mRNA and protein correspond to temporal changes in NR4A2 transcription and nuclear distribution. Ectopic expression of NR4A2 leads to robust changes in endogenous IL-8 mRNA levels and co-treatment with TNF-alpha results in significant (p<0.001) secretion of IL-8 protein. Transcriptional effects of NR4A2 on the human IL-8 promoter are enhanced in the presence of TNF-alpha, suggesting molecular crosstalk between TNF-alpha signalling and NR4A2. A dominant negative IkappaB kinase antagonizes the combined effects of NR4A2 and TNF-alpha on IL-8 promoter activity. Co-expression of NR4A2 and the p65 subunit of NF-kappaB enhances IL-8 transcription and functional studies indicate that transactivation occurs independently of NR4A2 binding to DNA or heterodimerization with additional nuclear receptors. The IL-8 minimal promoter region is sufficient to support NR4A2 and NF-kappaB/p65 co-operative activity and NR4A2 can interact with NF-kappaB/p65 on a 39bp sequence within this region. In patients treated with methotrexate for active inflammatory arthritis, a reduction in NR4A2 synovial tissue levels correlate significantly (n=10, r=0.73, p=0.002) with changes in IL-8 expression. Collectively, these data delineate an important role for NR4A2 in modulating IL-8 expression and reveal novel transcriptional responses to TNF-alpha in human inflammatory joint disease.
    • Identification of the optimal donor quality scoring system and measure of early renal function in kidney transplantation.

      Moore, Jason; Ramakrishna, Satish; Tan, Kay; Cockwell, Paul; Eardley, Kevin; Little, Mark A; Rylance, Paul; Shivakumar, Kunigal; Suresh, Vijayan; Tomlinson, Kerry; et al. (Transplantation, 2009-02-27)
      The early identification of kidney allografts at risk of later dysfunction has implications for clinical practice. Donor quality scoring systems (preoperative) and measures of early allograft function (first week postoperative) have previously shown practical utility. This study aimed to determine the optimal parameter(s) (preoperative and postoperative) with greatest predictive power for the development of subsequent allograft dysfunction.
    • Image of dermoid cyst in infant.

      Nadeem, Montasser; Quinn, Nuala; Greally, Peter; Paediatric Respiratory Department, The Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland. drnadeem.gad@gmail.com (2011-08)
    • Image of the month. Pericardial varices secondary to superior vena cava obstruction.

      O'Brien, Julie; Enright, Helen; Hamilton, Samuel; Department of Radiology, Adelaide and Meath Incorporating National Children's Hospital, Tallaght, Dublin, Ireland. juliemobrien@gmail.com (Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2010-01)
    • The imaging appearances of calyceal diverticula complicated by uroliathasis.

      Stunell, H; McNeill, G; Browne, R F J; Grainger, R; Torreggiani, W C; Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24,, Ireland. (2012-02-01)
      The presence of diverticula arising from the calyceal system is a relatively uncommon urological problem, occurring with an incidence of 2.1-4.5 per 1000 intravenous urogram (IVU) examinations. While the incidence of calyceal diverticula is low, the frequency of stone formation within them is high. We describe the aetiology and clinical presentation and describe the role of imaging with ultrasound, intravenous and retrograde pyelography and CT in diagnosis and planning treatment. We also describe the potential of fluid-sensitive magnetic resonance imaging techniques as a radiation-free alternative to the use of more conventional modalities, such as intravenous urography and retrograde pyelography, in delineating the anatomy of calyceal diverticula before surgical and radiological intervention especially in young patients and pregnant women.
    • Imaging spectrum of sudden athlete cardiac death.

      Arrigan, M T; Killeen, R P; Dodd, J D; Torreggiani, W C; Department of Radiology, Adelaide and Meath Hospital incorporating the National, Children's Hospital, Dublin, Ireland. martinarrigan@gmail.com (2012-02-01)
      Sudden athlete death (SAD) is a widely publicized and increasingly reported phenomenon. For many, the athlete population epitomize human physical endeavour and achievement and their unexpected death comes with a significant emotional impact on the public. Sudden deaths within this group are often without prior warning. Preceding symptoms of exertional syncope and chest pain do, however, occur and warrant investigation. Similarly, a positive family history of sudden death in a young person or a known family history of a condition associated with SAD necessitates further tests. Screening programmes aimed at detecting those at risk individuals also exist with the aim of reducing fatalities. In this paper we review the topic of SAD and discuss the epidemiology, aetiology, and clinical presentations. We then proceed to discuss each underlying cause, in turn discussing the pathophysiology of each condition. This is followed by a discussion of useful imaging methods with an emphasis on cardiac magnetic resonance and cardiac computed tomography and how these address the various issues raised by the pathophysiology of each entity. We conclude by proposing imaging algorithms for the investigation of patients considered at risk for these conditions and discuss the various issues raised in screening.
    • Immediate effects of thermal-tactile stimulation on timing of swallow in idiopathic Parkinson's disease.

      Regan, Julie; Walshe, Margaret; Tobin, W Oliver; SLT Department, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland., julie.regan@amnch.ie (2012-02-01)
      Oropharyngeal dysphagia frequently presents in people with idiopathic Parkinson's disease (IPD). Clinical sequelae of dysphagia in this group include weight loss and aspiration pneumonia, the latter of which is the leading cause of hospital admissions and death in IPD. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. The effects of TTS on swallowing have not yet been investigated in IPD. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people with IPD and known oropharyngeal dysphagia. Thirteen participants with IPD and known dysphagia attended for videofluoroscopy during which standardised volumes of liquid barium and barium paste were administered preceding and immediately subsequent to TTS. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. TTS significantly reduced median pharyngeal transit time on fluids (0.20 s, 95% CI = 0.12-0.28, p = 0.004) and on paste (0.3 s, 95% CI = 0.08-0.66, p = 0.01). Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00-1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08-1.46, p = 0.033). Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12-0.34, p = 0.002). TTS did not significantly alter median oral transit time on either fluid or paste consistency. TTS significantly reduced temporal measures of the pharyngeal phase of swallowing in the IPD population. Significant results may be attributed to the role of sensory stimulation in improving motor function in IPD, with emphasis on the impaired glossopharyngeal and vagus nerves in this population. It is still unclear whether these findings will translate into a clinically beneficial effect.
    • Immune profile and Epstein-Barr virus infection in acute interstitial nephritis: an immunohistochemical study in 78 patients.

      Mansur, Abdurrezagh; Little, Mark A; Oh, Weng Chin; Jacques, Steven; Nightingale, Peter; Howie, Alexander J; Savage, Caroline O S; Renal Immunobiology, University of Birmingham, College of Medical and Dental Sciences, London, UK. (Nephron. Clinical practice, 2011)
      Acute interstitial nephritis (AIN) is a common cause of acute kidney injury and is characterised by a dense interstitial cellular infiltrate, which has not been well defined. Previous studies have demonstrated a correlation between Epstein-Barr virus (EBV) infection and AIN. The purpose of our study was to define the nature of the interstitial immune infiltrate and to investigate the possibility of renal infection with EBV.
    • Immunochemical faecal occult blood tests have superior stability and analytical performance characteristics over guaiac-based tests in a controlled in vitro study.

      Lee, Chun Seng; O'Gorman, Paudy; Walsh, Paul; Qasim, Asghar; McNamara, Deirdre; O'Morain, Colm A; Boran, Gerard P; Department of Clinical Medicine, Trinity Centre for Health Sciences (at Tallaght), Trinity College Dublin, Dublin, Ireland. leecs@tcd.ie (Journal of clinical pathology, 2011-06)
      The aims of this study were (1) to determine the measurement accuracy of a widely used guaiac faecal occult blood test (gFOBT) compared with an immunochemical faecal occult blood test (iFOBT) during in vitro studies, including their analytical stability over time at ambient temperature and at 4°C; and (2) to compare analytical imprecision and other characteristics between two commercially available iFOBT methods.
    • Immunohistochemical staining for the differentiation of subungual keratoacanthoma from subungual squamous cell carcinoma.

      Connolly, M; Narayan, S; Oxley, J; de Berker, D A R; Department of Dermatology, Bristol Royal Infirmary, Bristol, UK. connollymo@btopenworld.com (Clinical and experimental dermatology, 2008-08)
      Subungual keratotic tumours are rare. The clinical and histological distinctions between subungual keratoacanthomas (SUKAs) and subungual squamous cell carcinomas (SCCs) are important, but often difficult. Adequate methods of differentiation between the two are required, both for the purpose of management and for assessment of prognosis.
    • Impact of a new electronic handover system in surgery.

      Ryan, S; O'Riordan, J M; Tierney, S; Conlon, K C; Ridgway, P F; Department of Surgery, University of Dublin, Trinity College, Adelaide & Meath Hospital Incorporating National Children's Hospital, Tallaght, Dublin 24, Ireland. (International journal of surgery, 2011)
      Accurate handover of clinical information is imperative to ensure continuity of patient care, patient safety and reduction in clinical errors. Verbal and paper-based handovers are common practice in many institutions but the potential for clinical errors and inefficiency is significant. We have recently introduced an electronic templated signout to improve clarity of transfer of patient details post-surgical take. The aim of this study was to prospectively audit the introduction of this new electronic handover in our hospital with particular emphasis regarding efficacy and efficiency. The primary surrogate chosen to assess efficacy and efficiency was length of stay for those patients admitted through the emergency department. To do this we compared two separate, two-week periods before and after the introduction of this new electronic signout format. Users were not informed of the study. Information recorded on the signout included details of the emergency admissions, consults received on call and any issues with regard to inpatients. ASA grade, time to first intervention and admission diagnosis were also recorded. Our results show that introduction of this electronic signout significantly reduced median length of stay from five to four days (P=0.047). No significant difference in ASA grades, time to first intervention or overall admission diagnosis was obtained between the two time periods. In conclusion, this is the first study to show that the introduction of electronic signout post-call was associated with a significant reduction in patient length of stay and provided better continuity of care than the previously used paper-based handover.
    • Impact of family history on relations between insulin resistance, LDL cholesterol and carotid IMT in healthy adults.

      Anderwald, Christian; Stadler, Marietta; Golay, Alain; Krebs, Michael; Petrie, John; Luger, Anton; Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. christian-heinz.anderwald@meduniwien.ac.at (Heart (British Cardiac Society), 2010-08)
      Insulin resistance (IR) is implicated as an independent risk factor for vascular disease. The aim of this study was to assess the impact of family history (FH) of type 2 diabetes (T2DM) and/or cardiovascular disease (CVD) on the associations between IR, low-density-lipoprotein cholesterol (LDL-C) and subclinical atherosclerosis (common and internal carotid artery intima media thickness (IMT)) in healthy European adults.
    • The impact of hemoglobin levels on patient and graft survival in renal transplant recipients.

      Moore, Jason; He, Xiang; Cockwell, Paul; Little, Mark A; Johnston, Atholl; Borrows, Richard; Department of Nephrology and Renal Transplantation, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, United Kingdom. (Transplantation, 2008-08-27)
      It remains unclear whether low hemoglobin levels are associated with increased mortality or graft loss after renal transplantation. This study assessed the relationship of hemoglobin levels with patient and graft survival in 3859 patients with functioning renal transplants more than 6-months posttransplantation.
    • Impact of outpatient clinic ultrasound imaging in the diagnosis and treatment for shoulder impingement: a randomized prospective study.

      Saeed, Aamir; Khan, Mumtaz; Morrissey, Siobhan; Kane, David; Fraser, Alexander Duncan; Department of Rheumatology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland, modelian@gmail.com. (2013-11-05)
      The use of musculoskeletal ultrasonography (MSUS) in guiding subdeltoid injection has been shown to improve outcome up to 6 weeks in a few small studies. A recent meta-analysis identified the need for further studies with longer-term outcome and larger sample size. This randomized prospective study assessed whether clinic-based MSUS can significantly improve diagnostic accuracy in shoulder pain and whether MSUS-guided shoulder injection results in improved long-term outcomes. One hundred consecutive patients with 125 painful shoulders were recruited. Patients were randomized to receive either sonographic assessment with consequent palpation-guided injection (Group 1, n = 66) or sonographic assessment with a MSUS-guided injection of 40 mg of methylprednisolone acetate (Group 2, n = 59). A blinded rheumatologist (ADF) performed clinical assessments at baseline, 6 and 12 weeks including shoulder function tests (SFTs) (Hawkins-Kennedy test, supraspinatus tendon tenderness), physician global assessment (PGA) and patient visual analogue scores (VAS) for pain (0-10). Eighty patients with 90 symptomatic shoulders completed 12-week follow-up. Twenty patients, 11 (20 shoulders) from the palpation-guided group and 9 (15 shoulders) from the MSUS-guided group, were excluded at 6 weeks either due to requirement for repeat injection or due to surgical referral. Mean age for patients was 57.7 years, and 65 % patients were female; mean shoulder pain duration was 18 weeks (range 14-22 weeks). SFTs, patient VAS and PGA scores for pain improved significantly from baseline in both groups with significantly greater improvements in the MSUS-guided group (44 shoulders) compared to the palpation-guided group (46 shoulders) in all parameters at 6 (p < 0.01) and 12 weeks (p < 0.05). The use of MSUS in guiding subdeltoid injection has been shown to improve outcome up to 6 weeks in a few small studies. A recent meta-analysis identified the need for further studies with longer-term outcome and larger sample size.
    • Impact of the introduction of guidelines on vitamin B₁₂ testing.

      McHugh, Johnny; Afghan, Rabia; O'Brien, Edel; Kennedy, Patricia; Leahy, Maeve; O'Keeffe, Denis (2012-02)
    • Imported childhood malaria: the Dublin experience, 1999-2006.

      Leahy, T R; Malikiwi, A; Cafferkey, M; Butler, K M; Department of Paediatrics, Adelaide and Meath Hospitals, incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. tronanleahy@hotmail.com (2009-09)
      Imported childhood malaria has never been studied in Ireland. We aimed to document the incidence and species of malaria in children presenting to paediatric hospitals in Dublin and to examine management and outcome measures.
    • Improving the working relationship between doctors and pharmacists: is inter-professional education the answer?

      Gallagher, Ruth M; Gallagher, Helen C; Trinity College Dublin/Health Services Executive Specialist Training Programme, Department of Public Health & Primary Care, Trinity College Centre for Health Sciences, Adelaide & Meath Hospital, Tallaght, Ireland. (2012-05)
      Despite their common history, there are many cultural, attitudinal and practical differences between the professions of medicine and pharmacy that ultimately influence patient care and health outcomes. While poor communication between doctors and pharmacists is a major cause of medical errors, it is clear that effective, deliberate doctor-pharmacist collaboration within certain clinical settings significantly improves patient care. This may be particularly true for those patients with chronic illnesses and/or requiring regular medication reviews. Moreover, in hospitals, clinical and antibiotic pharmacists are successfully influencing prescribing and infection control policy. Under the new Irish Pharmacy Act (2007), pharmacists are legally obliged to provide pharmaceutical care to their patients, thus fulfilling a more patient-centred role than their traditional 'dispensing' one. However, meeting this obligation relies on the existence of good doctor-pharmacist working relationships, such that inter-disciplinary teamwork in monitoring patients becomes the norm in all healthcare settings. As discussed here, efforts to improve these relationships must focus on the strategic introduction of agreed changes in working practices between the two professions and on educational aspects of pharmaceutical care. For example, standardized education of doctors/medical students such that they learn to prescribe in an optimal manner and ongoing inter-professional education of doctors and pharmacists in therapeutics, are likely to be of paramount importance. Here, insights into the types of factors that help or hinder the improvement of these working relationships and the importance of education and agreed working practices in defining the separate but inter-dependent professions of pharmacy and medicine are reviewed and discussed.
    • Inappropriate colonoscopic surveillance of hyperplastic polyps.

      Keane, R A; O'Connor, A; Ryan, B; Breslin, N; O'Connor, H J; Qasim, A; O'Morain, C; AMNCH, Tallaght, Dublin 24. rukeane@tcd.ie (2011-11-15)
      Colonoscopic surveillance of hyperplastic polyps alone is controversial and may be inappropriate. The colonoscopy surveillance register at a university teaching hospital was audited to determine the extent of such hyperplastic polyp surveillance. The surveillance endoscopy records were reviewed, those patients with hyperplastic polyps were identified, their clinical records were examined and contact was made with each patient. Of the 483 patients undergoing surveillance for colonic polyps 113 (23%) had hyperplastic polyps alone on last colonoscopy. 104 patients remained after exclusion of those under appropriate surveillance. 87 of the 104 patients (84%) were successfully contacted. 37 patients (8%) were under appropriate colonoscopic surveillance for a significant family history of colorectal carcinoma. 50 (10%) patients with hyperplastic polyps alone and no other clinical indication for colonoscopic surveillance were booked for follow up colonoscopy. This represents not only a budgetary but more importantly a clinical opportunity cost the removal of which could liberate valuable colonoscopy time for more appropriate indications.