• The nasal bridle: A useful approach to prevent the dislodgement of feeding tubes e-SPEN,

      Power, S; Smyth, N; Duggan, SN; Roddy, M; Feehan, S (Journal of Clinical Nutrition and Metabolism, 2010)
    • The National Paediatric Diabetes Register and its impact on healthcare

      Roche, EF (Irish Medical Journal, 2014-07)
      In the field of management it has long been recognised that effective management of any given outcome requires knowledge and control of inputs to the system. This is also true in healthcare particularly in Type 1 diabetes (T1D), a common and severe chronic disease in childhood which is a huge health, social and economic burden 1,2 . In T1D the outcome, in terms of prevention of diabetes related complications, has been clearly shown to be related to resource dependent disease management 3 and more recently the Hvidore Study group demonstrated better glycaemic control in those patients with more clinical contact
    • National Survey Of The Aetiological Assessment Service Of Permanent Childhood Hearing Loss In Ireland

      Balfe, J; Van Der Spek, N; Waldron, D (Irish Medical Journal, 2018-09)
      Best practice indicates that all children who are identified with permanent childhood hearing loss (PCHL) should have access to prompt paediatric assessment to determine the need for aetiological investigations[i]. Early paediatric assessment allows the identification and management of potentially treatable causes e.g. congenital CMV (cCMV) infection and provides an opportunity to prevent or reduce disability. It also allows the identification of associated co-morbidities including potentially fatal cardiac arrhythmias. The role of the paediatrician also includes liaison with agencies including tertiary specialist services, education, disability services and other community based organisations
    • Neural correlates of treatment outcome in major depression.

      Lisiecka, Danuta; Meisenzahl, Eva; Scheuerecker, Johanna; Schoepf, Veronica; Whitty, Peter; Chaney, Aisling; Moeller, Hans-Juergen; Wiesmann, Martin; Frodl, Thomas; Department of Psychiatry, School of Medicine & Trinity College Institute of, Neuroscience, Integrated Neuroimaging, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital (AMiNCH), & St James's Hospital,, Trinity College, Dublin, Ireland. (2012-02-01)
      There is a need to identify clinically useful biomarkers in major depressive disorder (MDD). In this context the functional connectivity of the orbitofrontal cortex (OFC) to other areas of the affect regulation circuit is of interest. The aim of this study was to identify neural changes during antidepressant treatment and correlates associated with the treatment outcome. In an exploratory analysis it was investigated whether functional connectivity measures moderated a response to mirtazapine and venlafaxine. Twenty-three drug-free patients with MDD were recruited from the Department of Psychiatry and Psychotherapy of the Ludwig-Maximilians University in Munich. The patients were subjected to a 4-wk randomized clinical trial with two common antidepressants, venlafaxine or mirtazapine. Functional connectivity of the OFC, derived from functional magnetic resonance imaging with an emotional face-matching task, was measured before and after the trial. Higher OFC connectivity with the left motor areas and the OFC regions prior to the trial characterized responders (p<0.05, false discovery rate). The treatment non-responders were characterized by higher OFC-cerebellum connectivity. The strength of response was positively correlated with functional coupling between left OFC and the caudate nuclei and thalami. Differences in longitudinal changes were detected between venlafaxine and mirtazapine treatment in the motor areas, cerebellum, cingulate gyrus and angular gyrus. These results indicate that OFC functional connectivity might be useful as a marker for therapy response to mirtazapine and venlafaxine and to reconstruct the differences in their mechanism of action.
    • Neuroendocrine tumors of the pancreas.

      Davies, Karen; Conlon, Kevin C; Department of Surgery, Trinity College Dublin, The Adelaide and Meath Hospital, incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. (2012-02-01)
      Pancreatic endocrine tumors are rare neoplasms accounting for less than 5% of pancreatic malignancies. They are broadly classified into either functioning tumors (insulinomas, gastrinomas, glucagonomas, VIPomas, and somatostatinomas) or nonfunctioning tumors. The diagnosis of these tumors is difficult and requires a careful history and examination combined with laboratory tests and radiologic imaging. Signs and symptoms are usually related to hormone hypersecretion in the case of functioning tumors and to tumor size or metastases with nonfunctioning tumors. Surgical resection remains the treatment of choice even in the face of metastatic disease. Further development of novel diagnostic and treatment modalities offers potential to greatly improve quality of life and prolong disease-free survival for patients with pancreatic endocrine tumors.
    • Neuroendocrine tumors of the pancreas.

      Davies, Karen; Conlon, Kevin C; Department of Surgery, Trinity College Dublin, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. (Current gastroenterology reports, 2009-04)
      Pancreatic endocrine tumors are rare neoplasms accounting for less than 5% of pancreatic malignancies. They are broadly classified into either functioning tumors (insulinomas, gastrinomas, glucagonomas, VIPomas, and somatostatinomas) or nonfunctioning tumors. The diagnosis of these tumors is difficult and requires a careful history and examination combined with laboratory tests and radiologic imaging. Signs and symptoms are usually related to hormone hypersecretion in the case of functioning tumors and to tumor size or metastases with nonfunctioning tumors. Surgical resection remains the treatment of choice even in the face of metastatic disease. Further development of novel diagnostic and treatment modalities offers potential to greatly improve quality of life and prolong disease-free survival for patients with pancreatic endocrine tumors.
    • Neurological signs and involuntary movements in schizophrenia: intrinsic to and informative on systems pathobiology.

      Whitty, Peter F; Owoeye, Olabisi; Waddington, John L; Department of Psychiatry, The Adelaide and Meath Hospital, Tallaght, Dublin,, Ireland. (2012-02-01)
      While it has long been considered whether the pathobiology of schizophrenia extends beyond its defining symptoms to involve diverse domains of abnormality, in the manner of a systemic disease, studies of neuromotor dysfunction have been confounded by treatment with antipsychotic drugs. This challenge has been illuminated by a new generation of studies on first-episode schizophrenia before initiation of antipsychotic treatment and by opportunities in developing countries to study chronically ill patients who have remained antipsychotic naive due to limitations in provision of psychiatric care. Building from studies in antipsychotic-naive patients, this article reviews 2 domains of neuromotor dysfunction in schizophrenia: neurological signs and involuntary movements. The presence and characteristics of neurological signs in untreated vis-a-vis treated psychosis indicate a vulnerability marker for schizophrenia and implicate disruption to neuronal circuits linking the basal ganglia, cerebral cortex, and cerebellum. The presence and characteristics of involuntary movements in untreated vis-a-vis treated psychosis indicate an intrinsic feature of the disease process and implicate dysfunction in cortical-basal ganglia-cortical circuitry. These neuromotor disorders of schizophrenia join other markers of subtle but pervasive cerebral and extracerebral, systemic dysfunction, and complement current concepts of schizophrenia as a disorder of developmentally determined cortical-basal ganglia-thalamo-cortical/cerebellar network disconnectivity.
    • Neuropsychiatric complications associated with interferon - alpha -2b treatment of malignant melanoma.

      Enudi, W; Udolu, O J; Adelaide and Meath Hospital, Tallaght, Ireland. waltenudi@yahoo.com (2012-02-01)
      Several adverse effects have been associated with interferon alpha 2b treatment and neuropsychiatric effects have also been commonly reported. Psychosis and mood disorders have been described in the literature. This case report is of a 30 year old man with malignant melanoma stage 3a who was receiving adjuvant alpha 2b interferon and developed a manic episode two weeks post switching after one month of treatment on a high dose to a low dose. There was no previous psychiatric illness and no known family history of mental illness. This is in keeping with previous reports that mania has been observed in patients undergoing interferon treatment especially after significant dose-reduction or treatment breaks. Mania induced by interferon responds well to antimanic drugs .Since interferon alpha 2b is now commonly used in the treatment of malignant melanoma and other conditions, the need to be aware of its neuropsychiatric complications is essential.
    • Neurosarcoidosis-related intracranial haemorrhage: three new cases and a systematic review of the literature.

      O'Dwyer, J P; Al-Moyeed, B A; Farrell, M A; Pidgeon, C N; Collins, D R; Fahy, A; Gibney, J; Swan, N; Dempsey, O J; Kidd, D P; et al. (2012-06-09)
      BACKGROUND AND PURPOSE: Intracranial haemorrhage in neurosarcoidosis (NS-ICH) is rare, poorly understood and the diagnosis of NS may not be immediately apparent. METHODS: The clinical features of three new NS-ICH cases are described including new neuropathological findings and collated with cases from a systematic literature review. RESULTS: Cases: (i) A 41-year-old man with headaches, hypoandrogenism and encephalopathy developed a cerebellar haemorrhage. He had neuropathological confirmation of NS with biopsy-proven angiocentric granulomata and venous disruption. He responded to immunosuppressive therapy. (ii) A 41-year-old man with no history of hypertension was found unconscious. A subsequently fatal pontine haemorrhage was diagnosed. Liver biopsy revealed sarcoid granulomas. (iii) A 36-year-old man with raised intracranial pressure headaches presented with a seizure and a frontal haemorrhage. Hilar lymph node biopsy confirmed sarcoidosis, and he was treated successfully. Systematic Review: Twelve other published cases were identified and collated with our cases. Average age was 36 years and M:F = 2.3:1; 46% presented with neurological symptoms and 31% had CNS-isolated disease. Immediate symptoms of ICH were acute/worsening headache or seizures (60%). ICH was supratentorial (62%), infratentorial (31%) or subarachnoid (7%). 40% had definite NS, 53% probable NS and 7% possible NS (Zajicek criteria). Antigranulomatous/immunosuppressive therapy regimens varied and 31% died. CONCLUSIONS: This series expands our knowledge of the pathology of NS-ICH, which may be of arterial or venous origin. One-third have isolated NS. Clinicians should consider NS in young-onset ICH because early aggressive antigranulomatous therapy may improve outcome.
    • A new evaluation of the upper esophageal sphincter using the functional lumen imaging probe: a preliminary report.

      Regan, J; Walshe, M; Rommel, N; McMahon, B P; Schools of Clinical Medicine Clinical Speech and Language Studies, Trinity College Dublin Speech and Language Therapy Department Medical Physics and Clinical Engineering, Adelaide and Meath Hospital, Dublin, Ireland Department of Neurosciences, ExpORL, University of Leuven Neurogastroenterology and Motility Clinic, University Hospital Leuven, Leuven, Belgium. (Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E, 2012-03-06)
      Objective and reliable evaluation of upper esophageal sphincter (UES) opening during swallowing based on videofluoroscopy and pharyngeal manometry challenges dysphagia clinicians. The functional lumen imaging probe (FLIP) is a portable tool based on impedance planimetry originally designed to measure esophogastric junction compliance. It is hypothesized that FLIP can evaluate UES distensibility, and can provide UES diameter and pressure measurements at rest, during swallowing, and during voluntary maneuvers. Eleven healthy adult subjects consented to FLIP evaluation. The probe was inserted transorally, and the balloon was positioned across the UES. Two 20-mL ramp distensions were completed. Changes in UES diameter and intraballoon pressure were measured during dry and 5-mL liquid swallows, and during voluntary swallow postures and maneuvers employed in clinical practice. The protocol was completed by 10 of 11 healthy subjects. Mean intraballoon pressure increased throughout 5-mL (5.8 mmHg; -4.5-18.6 mmHg), 10-mL (8.7 mmHg; 2.3-28.5 mmHg), 15-mL (17.3 mmHg; 9.5-34.8 mmHg), and 20-mL (31.2 mmHg; 16-46.3 mmHg) balloon volumes. Mean resting UES diameter (4.9 mm) increased during dry swallows (9.2 mm) and 5-mL liquid swallows (7.7 mm). Mean UES diameter increased during 5-mL liquid swallows with head turn to right (8.1 mm) and left (8.3 mm), chin tuck (8.4 mm), effortful swallow (8.5 mm), Mendelsohn maneuver (8.1 mm), and supraglottic swallow (7.8 mm). FLIP was safely inserted and distended in the UES, and provided useful quantitative data regarding UES distensibility and UES diameter changes during swallowing maneuvers. Further research is being conducted to explore the role of FLIP in UES evaluation.
    • New Inf2 mutations in a large cohort with sporadic and hereditary FSGS and further evidence for variable

      Gbadegesin, Rasheed; Lavin, Peter J; Hall, Gentzon; Bartkowiak, B; Homstad, A; Jiang, R; Byrd, Wu G; Lynn, Kelvin; Wolfish, Norman; Ottati, Caroline; et al. (Kidney International, 2012)
    • A New Locus for Familial FSGS on Chromosome 2P

      Gbadegesin, R.; Lavin, P.; Janssens, L.; Bartkowiak, B.; Homstad, A.; Wu, G.; Bowling, B.; Eckel, J.; Potocky, C.; Abbott, D.; et al. (Journal of the American Society of Nephrology, 2010-08)
    • New measures of upper esophageal sphincter distensibility and opening patterns during swallowing in healthy subjects using EndoFLIP®

      Regan, J; Walshe, M; Rommel, N; Tack, J; McMahon, B P; School of Clinical Medicine, Trinity College Dublin, Dublin, Ireland Speech & Language Therapy Department, Adelaide and Meath Hospital, Dublin, Ireland Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin, Ireland Department of Neurosciences, ExpORL, University of Leuven, Leuven, Belgium Neurogastroenterology & Motility Clinic, University Hospital Leuven, Leuven, Belgium Medical Physics & Clinical Engineering, Adelaide and Meath Hospital, Dublin, Ireland. (2013-01)
      Background  This paper aims to measure upper esophageal sphincter (UES) distensibility and extent and duration of UES opening during swallowing in healthy subjects using EndoFLIP(®) . Methods  Fourteen healthy subjects (20-50 years) were recruited. An EndoFLIP(®) probe was passed trans-orally and the probe balloon was positioned across the UES. Two 20-mL ramp distensions were completed and UES cross-sectional area (CSA) and intra-balloon pressure (IBP) were evaluated. At 12-mL balloon volume, subjects completed dry, 5- and 10-mL liquid swallows and extent (mm) and duration (s) of UES opening and minimum IBP (mmHg) were analyzed across swallows. Key Results  Thirteen subjects completed the study protocol. A significant change in UES CSA (P < .001) and IBP (P < .000) was observed during 20-mL distension. UES CSA increased up to 10-mL distension (P < .001), from which point IBP raised significantly (P = 0.004). There were significant changes in UES diameter (mm) (P < .000) and minimum IBP (mmHg) (P < .000) during swallowing events. Resting UES diameter (4.9 mm; IQR 0.02) and minimum IBP (18.8 mmHg; IQR 2.64) changed significantly during dry (9.6 mm; IQR 1.3: P < .001) (3.6 mmHg; IQR 4.1: P = 0.002); 5 mL (8.61 mm; IQR 2.7: P < .001) (4.8 mmHg; IQR 5.7: P < .001) and 10-mL swallows (8.3 mm; IQR 1.6: P < 0.001) (3 mmHg; 4.6: P < .001). Median duration of UES opening was 0.5 s across dry and liquid swallows (P = 0.91). Color contour plots of EndoFLIP(®) data capture novel information regarding pharyngo-esophageal events during swallowing. Conclusions & Inferences  Authors obtained three different types of quantitative data (CSA, IBP, and timing) regarding UES distensibility and UES opening patterns during swallowing in healthy adults using only one device (EndoFLIP(®) ). This new measure of swallowing offers fresh information regarding UES dynamics which may ultimately improve patient care.
    • Night blindness in a teenager with cystic fibrosis.

      Roddy, Marie Frances; Greally, Peter; Clancy, Geraldine; Leen, Gerardine; Feehan, Sinead; Elnazir, Basil; Adelaide and Meath Hospital, Dublin, Ireland. marie.roddy@amnch.ie (Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2011-12)
      This article describes the case of a 16-year-old boy with cystic fibrosis who presented with difficulty seeing in the dark. He had a history of bowel surgery at birth, and he developed cystic fibrosis liver disease and osteopenia during his teenage years. He always had good lung function. When his serum vitamin A level was checked, it was undetectable in sample. He was diagnosed with night blindness and commenced on high-dose vitamin A. His symptoms resolved within 3 days. However, it took over 1 year for his vitamin A level to return to normal. This case emphasizes the importance of monitoring vitamin levels in cystic fibrosis to detect deficiency and prevent long-term consequences, and it highlights the challenges encountered during the course of night blindness treatment.
    • Non-attendance at counselling therapy in cocaine-using methadone-maintained patients: lessons learnt from an abandoned randomised controlled trial.

      Darker, C; Sweeney, B; El Hassan, H; Kelly, A; O' Connor, S; Smyth, B; Barry, J; Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. Catherine.Darker@tcd.ie (2012-12)
      Recently, the authors commenced a randomised controlled trial to study the effectiveness of cognitive behavioural coping skills (CBCS) to reduce cocaine usage in methadone-maintained patients' in a clinical setting by assessing attendance at treatment sessions and outcomes in terms of cocaine use. However, recruitment into the study stopped when it became apparent that attendance at counselling sessions was poor.
    • Non-steroidal anti-inflammatory drug prescriptions in hospital inpatients: are we assessing the risks?

      Kitchen, J; Kane, D; Department of Rheumatology, Adelaide and Meath Hospital incorporating the, National Children's Hospital, Tallaght, Dublin 24, Ireland. kitchen.jo@gmail.com (2012-02-01)
      AIM: To determine non-steroidal anti-inflammatory drug (NSAID) prescribing practices in a tertiary referral hospital. METHODS: A single time-point audit of drug kardexes and clinical notes of n = 388 patients on 2 July 2008 was carried out assessing demographics, gastrointestinal and coronary heart disease risk factors, renal function and co-prescribed medications. RESULTS: Fifty-seven of 388 (14.7%) hospital patients were on NSAIDs. Forty-nine were prescribed NSAID after admission. Nineteen (32.2%) were on regular NSAID (11/19 on PPI) and 38 patients were on PRN NSAID (12/38 on PPI). Seventeen of 49 patients were on other medications associated with gastrointestinal bleeding (10/17 were on PPI). Nineteen patients (33.3%) were >60 years. Eight patients had three or four risk factors for gastrointestinal bleeding; six were on PPI. Thirteen patients had two risks; 7 were on PPI. Six of 19 patients with one risk factor were on PPI. 40.3% had stage 2/3 chronic kidney disease. 35.1% had ischaemic heart disease. CONCLUSIONS: NSAIDs and PPIs are often prescribed inappropriately.
    • 'Not another UTI ... '.

      Redmond, Patrick; O'Shea, Brendan; Crowe, Morgan; TCD/HSE General Practice Training Scheme, Trinity College Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland. predmond@rcsi.ie (Age and ageing, 2012-07)
      Malaria includes a global disease burden with approximately 300-500 million cases worldwide annually. Varied symptomatology creates a diagnostic challenge. This is a case report of a stroke rehabilitation facility resident who developed Plasmodium ovale infection, several months post-exposure. Physicians should maintain a broad list of differential diagnoses, thinking beyond the range of common diagnoses.
    • A novel mutation in the nerve-specific 5'UTR of the GJB1 gene causes X-linked Charcot-Marie-Tooth disease.

      Murphy, Sinéad M; Polke, James; Manji, Hadi; Blake, Julian; Reiniger, Lilla; Sweeney, Mary; Houlden, Henry; Brandner, Sebastian; Reilly, Mary M; MRC Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK. sinead.murphy@uclh.nhs.uk (Journal of the peripheral nervous system : JPNS, 2011-03)
      X-linked Charcot-Marie-Tooth disease (CMT1X) is the second most common cause of CMT, and is usually caused by mutations in the gap junction protein beta 1 (GJB1) gene which codes for connexin 32 (CX32). CX32 has three tissue-specific promoters, P1 which is specific for liver and pancreas, P1a specific for liver, oocytes and embryonic stem cells, and P2 which is nerve-specific. Over 300 mutations have been described in GJB1, spread throughout the coding region. We describe two families with X-linked inheritance and a phenotype consistent with CMT1X who did not have mutations in the GJB1 coding region. The non-coding region of GJB1 was sequenced and an upstream exon-splicing variant found at approximately - 373G>A which segregated with the disease in both families and was not present in controls. This substitution is located at the last base of the nerve-specific 5'UTR and thus may disrupt splicing of the nerve-specific transcript. Online consensus splice-site programs predict a reduced score for the mutant sequence vs. the normal sequence. It is likely that other mutations within the GJB1 non-coding regions account for the CMT1X families who do not have coding region mutations.
    • A novel surrogate index for hepatic insulin resistance.

      Vangipurapu, J; Stančáková, A; Kuulasmaa, T; Paananen, J; Kuusisto, J; Ferrannini, E; Laakso, M; Department of Medicine, University of Eastern Finland, Kuopio University Hospital, 70210, Kuopio, Finland. (Diabetologia, 2011-03)
      In epidemiological and genetic studies surrogate indices are needed to investigate insulin resistance in different insulin-sensitive tissues. Our objective was to develop a surrogate index for hepatic insulin resistance.
    • Nursing service report 2006

      Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH) (2007)