• Ageism And Clinical Research

      Briggs, R; Robinson, S; O’Neill, D (Irish Medical Journal (IMJ), 2012-10)
    • Alcohol, drug misuse and suicide attempts: unrecognised causes of out of hospital cardiac arrests admitted to intensive care units.

      McLaughlin, A M; Hardt, J; McKay, A P; Fitzpatrick, G J; Donnelly, M B; Department of Intensive Care, Adelaide & Meath Hospital incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland. annemmclaughlin@gmail.com (Irish journal of medical science, 2009-03)
      To assess the contribution of alcohol, drug abuse and suicide attempts to out of hospital cardiac arrests (OHCA) who are admitted to our intensive care unit (ICU).
    • Alzheimer disease: functional abnormalities in the dorsal visual pathway.

      Bokde, Arun L W; Lopez-Bayo, Patricia; Born, Christine; Ewers, Michael; Meindl, Thomas; Teipel, Stefen J; Faltraco, Frank; Reiser, Maximilian F; Moller, Hans-Juergen; Hampel, Harald; et al. (2012-02-01)
      PURPOSE: To evaluate whether patients with Alzheimer disease (AD) have altered activation compared with age-matched healthy control (HC) subjects during a task that typically recruits the dorsal visual pathway. MATERIALS AND METHODS: The study was performed in accordance with the Declaration of Helsinki, with institutional ethics committee approval, and all subjects provided written informed consent. Two tasks were performed to investigate neural function: face matching and location matching. Twelve patients with mild AD and 14 age-matched HC subjects were included. Brain activation was measured by using functional magnetic resonance imaging. Group statistical analyses were based on a mixed-effects model corrected for multiple comparisons. RESULTS: Task performance was not statistically different between the two groups, and within groups there were no differences in task performance. In the HC group, the visual perception tasks selectively activated the visual pathways. Conversely in the AD group, there was no selective activation during performance of these same tasks. Along the dorsal visual pathway, the AD group recruited additional regions, primarily in the parietal and frontal lobes, for the location-matching task. There were no differences in activation between groups during the face-matching task. CONCLUSION: The increased activation in the AD group may represent a compensatory mechanism for decreased processing effectiveness in early visual areas of patients with AD. The findings support the idea that the dorsal visual pathway is more susceptible to putative AD-related neuropathologic changes than is the ventral visual pathway.
    • Ampullary Carcinoma

      Gillis, A; Cleary, S; Ridgway, PF (UOT Press, 2012)
    • Amyloid neuropathies

      Murphy, Sinead M; Reilly, Mary M (Advances in Clinical Neuroscience and Rehabilitation, 2011-04)
    • Anaesthetic considerations of adults with Morquio's syndrome - a case report

      McLaughlin, Anne; Farooq, Muhammad; Donnelly, Maria B; Foley, Kieran (BMC Anesthesiology, 2011-10)
    • Analysis of routine EEG usage in a general adult ICU.

      McHugh, J C; Downey, T; Murphy, R P; Connolly, S; Department of Neurology, AMNCH, Tallaght, Dublin 24, Ireland. drjohnmchugh@ireland.com (Irish journal of medical science, 2009-09)
      Non-convulsive seizures and status epilepticus are common in brain-injured patients in intensive care units. Continuous electroencephalography (cEEG) monitoring is the most sensitive means of their detection. In centres where cEEG is unavailable, routine EEG is often utilized for diagnosis although its sensitivity is lower.
    • An analysis of the duplicate testing strategy of an Irish immunochemical FOBT colorectal cancer screening programme.

      Kelley, Leanne; Swan, Niall; Hughes, David J; Department of Gastroenterology, Adelaide & Meath Hospital, Dublin, 24, Ireland. (2013-06-10)
      AIM: This study examined the relevance of using a two sample quantitative immunochemical faecal occult blood test (iFOBT or FIT) at a high cut off stringency by the first population-based colorectal cancer (CRC) pilot screening programme in Ireland. METHOD: Approximately ten thousand individuals between the ages of 50-74 years were invited to perform two consecutive FITs. These were analysed in tandem using the OC-Sensor and participants with at least one positive result with a haemoglobin cut off for positivity at 100 ng/ml were offered colonoscopy. RESULTS: A total of 5023 (52%) (2177 (43%) male; 2846 (57%) female) individuals with a median age of 64 years participated. At least one positive FIT test was detected from 514 (10%) individuals. From the 419 (82%) patients who proceeded to colonoscopy 17 (4%) had CRC and 132(33%) had an advanced adenoma. The detection rate for these screen relevant lesions was 3% (95% CIs = 2.5% - 3.5%) and the FIT positive + colonoscopy detection rate was 36% (95% CI = 31% - 40%). The numbers needed to colonoscope to find an advanced lesion was 2.8. The two test system detected four (23.5%) additional patients with CRC and 37 (28%) with an advanced adenoma compared with a single test. CONCLUSION: The CRC miss rate estimated for a single test (23.5%) was unacceptably high when the goal was to maximize the discovery of advanced lesions in the initial screening round. We conclude that the two test protocol at a high cut off threshold is suitable to optimize FIT screening in Ireland. This article is protected by copyright. All rights reserved.
    • Analysis of the last decade of weekend out-of-hours CT imaging: How have things changed?

      Culleton, S; Torreggiani, W; Department of Radiology (Irish Medical Journal (IMJ), 2014-03)
      CT has become an invaluable diagnostic tool. The clinical applications and technological capacity of CT has continued to increase. There is an increasing demand for radiology services including during weekend on-call hours. The objective of this study was to assess the trend in weekend CT imaging requests over a ten-year period form 2001-2010. Electronic data was retrieved from the hospital Radiology Inpatient System. In total 8530 CT scans were performed during weekend on-call hours. Over the decade weekend imaging grew from 466 to 1448 (210.7%) CT examinations. CT brain imaging accounted for 3944 of the total 8530(46%) and this was a 126% increase. A ten-fold, eight-fold and three-fold increase occurred in adult CT thorax, CT pelvis and CT abdominal imaging respectively. These results demonstrate rising demand on radiology services and need to plan for continued future growth. Radiology and emergency departments need to prepare and develop pathways to deal with this projected growth.
    • An analytic observational study on complaints management in the general practice out of hours care setting: who complains, why, and what can we do about it?

      Barragry, Ruth A; Varadkar, Leo E; Hanlon, David K; Bailey, Ken F; O'Dowd, Tom C; O'Shea, Brendan J (BioMed Central, 2016)
      General Practice Co-Operatives provide most out of hours care in communities in Ireland. Limited data exists on patient complaints. This study reports on complaints at Kildare and West Wicklow Doctors on Call ('K Doc'), a GP Co-Operative in Ireland, examining the impact of a formal risk reduction strategy implemented (2010-2013). The aim of the study was to determine if it was possible to reduce the rate of written complaints per 1000 consultations through a formal approach encompassing evaluation of complaints, improved communication in relation to complaints, and more direct use of insights gained from complaints analysis in continuing professional development at the Co-Operative.
    • Animal models of antineutrophil cytoplasm antibody-associated vasculitis.

      Salama, Alan D; Little, Mark A; UCL Centre for Nephrology Royal Free Hospital, London, UK. a.salama@ucl.ac.uk (2012-01)
      To provide an update on the experimental models that have been developed recapitulating clinical antineutrophil cytoplasm antibody (ANCA) associated vasculitis. The application of the models in the study of pathogenesis, and the therapeutic implications of this, are covered in the article by van Timmeren and Heeringa in this issue.
    • Another Case of Lemierre's Syndrome

      O’Dwyer, E; Doody, O (Irish Medical Journal, 2015-05)
      We read with interest the excellent article by Dr Morariu and colleagues that appeared in the IMJ 1 . Their case of Lemierre's Syndrome clearly illustrated the complication of septic thrombophlebitis of the internal jugular vein
    • Answer to Case of the Month #145 Lemierre's Syndrome.

      Doody, Orla; Buckley, Orla; Ward, Emily; Wormald, Robert; Torreggiani, William C; Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin,, Ireland. (2012-02-01)
    • Answer to case of the month #149 alveolar soft-part sarcoma.

      Ward, Emily; Doody, Orla; d'Adhemar, Charles; Swan, Niall; Torreggiani, William C; Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin,, Ireland. (2012-02-01)
    • Anti Ma2-associated myeloradiculopathy: expanding the phenotype of anti-Ma2 associated paraneoplastic syndromes.

      Murphy, Sinéad M; Khan, Usman; Alifrangis, Constantine; Hazell, Steven; Hrouda, David; Blake, Julian; Ball, Joanna; Gabriel, Carolyn; Markarian, Pierre; Rees, Jeremy; et al. (Journal of neurology, neurosurgery, and psychiatry, 2012-02)
    • Anti-neutrophil cytoplasmic antibodies stimulate release of neutrophil microparticles.

      Hong, Ying; Eleftheriou, Despina; Hussain, Abdullah A K; Price-Kuehne, Fiona E; Savage, Caroline O; Jayne, David; Little, Mark A; Salama, Alan D; Klein, Nigel J; Brogan, Paul A; et al. (2012-01)
      The mechanisms by which anti-neutrophil cytoplasmic antibodies (ANCAs) may contribute to the pathogenesis of ANCA-associated vasculitis are not well understood. In this study, both polyclonal ANCAs isolated from patients and chimeric proteinase 3-ANCA induced the release of neutrophil microparticles from primed neutrophils. These microparticles expressed a variety of markers, including the ANCA autoantigens proteinase 3 and myeloperoxidase. They bound endothelial cells via a CD18-mediated mechanism and induced an increase in endothelial intercellular adhesion molecule-1 expression, production of endothelial reactive oxygen species, and release of endothelial IL-6 and IL-8. Removal of the neutrophil microparticles by filtration or inhibition of reactive oxygen species production with antioxidants abolished microparticle-mediated endothelial activation. In addition, these microparticles promoted the generation of thrombin. In vivo, we detected more neutrophil microparticles in the plasma of children with ANCA-associated vasculitis compared with that in healthy controls or those with inactive vasculitis. Taken together, these results support a role for neutrophil microparticles in the pathogenesis of ANCA-associated vasculitis, potentially providing a target for future therapeutics.
    • Anti-proteinase 3 anti-neutrophil cytoplasm autoantibodies recapitulate systemic vasculitis in mice with a humanized immune system.

      Little, Mark A; Al-Ani, Bahjat; Ren, Shuyu; Al-Nuaimi, Hamad; Leite, Maurilo; Alpers, Charles E; Savage, Caroline O; Duffield, Jeremy S; Centre for Nephrology, Royal Free Hospital, University College London, London, United Kingdom. mark.little@ucl.ac.uk (2012)
      Evidence is lacking for direct pathogenicity of human anti-proteinase-3 (PR3) antibodies in development of systemic vasculitis and granulomatosis with polyangiitis (GPA, Wegener's granulomatosis). Progress in study of these antibodies in rodents has been hampered by lack of PR3 expression on murine neutrophils, and by different Fc-receptor affinities for IgG across species. Therefore, we tested whether human anti-PR3 antibodies can induce acute vasculitis in mice with a human immune system. Chimeric mice were generated by injecting human haematopoietic stem cells into irradiated NOD-scid-IL2Rγ⁻/⁻ mice. Matched chimera mice were treated with human IgG from patients with: anti-PR3 positive renal and lung vasculitis; patients with non-vasculitic renal disease; or healthy controls. Six-days later, 39% of anti-PR3 treated mice had haematuria, compared with none of controls. There was punctate bleeding on the surface of lungs of anti-PR3 treated animals, with histological evidence of vasculitis and haemorrhage. Anti-PR3 treated mice had mild pauci-immune proliferative glomerulonephritis, with infiltration of human and mouse leukocytes. In 3 mice (17%) more severe glomerular injury was present. There were no glomerular changes in controls. Human IgG from patients with anti-PR3 autoantibodies is therefore pathogenic. This model of anti-PR3 antibody-mediated vasculitis may be useful in dissecting mechanisms of microvascular injury.
    • An antipodean infection.

      Cafferkey, A; Collins, J; Kane, D; Gibney, J; Fennell, J P (Irish medical journal, 2012-04)
    • An Approach to Optimise Therapeutic Vancomycin Dosage in a Haemodialysis Population

      Gunning, H; Taylor, G; Smyth, H; Mellotte, G; Fennell, J; Murphy, P; Lavin, P; Wall, C (Irish Medical Journal, 2016-10)
      Haemodialysis patients are at risk of gram-positive bacteraemia and commonly require intravenous vancomycin. Intravenously administered vancomycin is primarily excreted by the kidney and exhibits complex pharmacokinetics in haemodialysis patients; achieving therapeutic levels can be challenging. An audit in our unit showed current practises of vancomycin administration resulted in a high proportion of sub-therapeutic levels. A new protocol was developed with fixed weight-based loading and subsequent dosing guided by pre-dialysis levels, target levels were 10-20mg/L. Its effectiveness was prospectively evaluated between 24th September 2012, and 8th February 2013. During this period 25 patients commenced vancomycin, 15 were included. In total, 112 vancomycin levels were taken, 94 (84%) were therapeutic, this was a significant improvement compared to previous practise (odds ratio 5.4, CI 3.1-9.4, p < 0.0001). In conclusion, our study shows this protocol can consistently and reliably achieve therapeutic vancomycin levels